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Low energy availability in females: A sleeping giant
Abstracts / Journal of Science and Medicine in Sport 20S (2017) e67–e105
182 Stay healthy: Project outline, methodology and approach Michael Drew 1,2 , Nicole Vlahovich 1,4 , David Hughes 1,2 , Renee Appaneal 1 , Kirsten Peterson 1 , Louise Burke 1,5 , Bronwen Lundy 1,5 , Mary Toomey 6,7 , David Watts 6 , Gregory Lovell 1 , Stephan Praet 1 , Shona Halson 1 , Candice Colbey 8 , Silvia Manzanero 1 , Marijke Welvaert 1,3 , Nic West 8 , David B. Pyne 1,3 , Gordon Waddington 1,3 1
Australian Institute of Sport, Australia Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia 3 University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia 4 Bond University, Australia 5 Mary MacKillop Institute for Health Research, Australian Catholic University, Australia 6 Queensland Academy of Sport, Australia 7 Department of Physiotherapy, Griffith University, Australia 8 Menzies Health Institute Queensland, Griffith University, Australia 2
Introduction: Illness has the potential to ruin Olympic campaigns. There have been many studies examining mechanisms of illness in athletes with emerging evidence indicating an increased risk of illness in some athlete cohorts. Despite this body of research few systematic risk factors have been clearly identified across multiple domains of health or in Olympic athlete cohorts of multiple sports. This paper will discuss the background surveillance data which led to creation of the Stay Healthy study, the study design, methodologies and analytical approaches. Method: Risk factors were identified from the literature and integrated with expert clinical knowledge. These factors were evaluated at two time points in the final year of Olympic preparations within a cross-sectional study design. Phase 1 (P1) was deployed in the summer period of December 2015–January 2016 and Phase 2 (P2) involved the period in the autumn (late April–June 2016) prior to the Olympics Games in August 2016. Fifteen National Sporting Organisations participated in the project with 317 athletes involved in at least one component of the study (59% of potential athletes). Nine questionnaires were included: the Depression, Anxiety and Stress Questionnaire (DASS-21), Perceived Stress Scale (PSS), Dispositional Resilience Scale (DRS), Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy in Females Questionnaire (LEAF-Q), a modified Personal and Household Hygiene questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and custom-made questionnaires on probiotic usage and travel. Illness in P1 was defined as sports incapacity due to any medical illness in the previous month. In P2, a symptom checklist was utilized and categorized into Upper Respiratory Tract Symptoms (URTS), bodily aches, gastrointestinal (GIT), head, eye, fatigue or chest symptoms with sports incapacity also reported. Odds ratios and population attributable risks were calculated for all variables using an a priori list of research questions. Results: The point prevalence of illness was 20% in P1 and 70% in P2. In P2 the most prevalent illness was associated with Upper Respiratory Tract Illness symptoms (n = 64, 47% of participants). The point prevalence of injury was 36% in Phase 2. The key results will be discussed in the subsequent abstracts.
e79
Discussion: This study highlights the inter-related nature of the determinants of health in athletes. The subsequent abstracts will discuss the outcomes of this project in detail. Prevention programs must consider multiple aspects of health and their interaction. This symposium will discuss the outcomes of the project and how they relate to each other such that the mitigation strategies can be implemented in the clinic and field. http://dx.doi.org/10.1016/j.jsams.2017.01.031 183 Low energy availability in females: A sleeping giant Bronwen Lundy 1,5 , Louise M. Burke 1,5 , Nicole Vlahovich 1,4 , Marijke Welvaert 1,3 , David Hughes 1,2 , Gordon Waddington 1,3 , Michael K. Drewa 2 1
Australian Institute of Sport, Australia Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia 3 University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia 4 Bond University, Australia 5 Mary MacKillop Institute for Health Research, Australian Catholic University, Australia 2
Introduction: The amount of energy remaining to support body functions after the kilojoule cost of exercise is subtracted from dietary energy intake is termed “energy availability”. Low energy availability can occur when an athlete restricts their energy intake and/or increases the volume or intensity of training, with the consequence that there is no longer sufficient energy to fulfil the functions needed to stay healthy. While the previous focus on low energy availability targeted menstrual function and bone health, there is now evidence that the consequences are wider ranging. Methods: Two case–control studies were undertaken in a similar cohort of female athletes (December and April–May). A validated questionnaire, Low Energy Availability in Females (LEAF-Q), was administered at both collection points. The published cut-off value of ≥8 was utilized as an indication of low energy availability. In phase 2, illnesses were sub-grouped to Upper Respiratory Tract Symptoms (URTS), bodily aches, gastrointestinal, head, eye, fatigue or chest symptoms. Two-by-two tables reporting odds ratios and attributable fractions in the exposed (AFE) were produced. Results: The prevalence of a high LEAF-Q score (≥8) was 49 and 53%. A high LEAF-Q score was associated with increased reports of illness across both time periods (Phase1: Any illness OR 7.4, 95%CI 0.8–352, AFE 0.87; Phase 2: URTS OR 3.8, 95%CI 1.3–11.6, AFE 0.74; Bodily Aches OR 5.8, 95%CI 1.6–23.5, AFE 0.83; Gastrointestinal symptoms OR 3.8, 95%CI 1.3–11.6, AFE 0.74; Head symptoms OR 4.4, 95%CI 1.4–14.3, AFE 0.77). Discussion: This study shows a repeated high prevalence of low energy availability among elite female athletes as measured by the LEAF-Q. Furthermore, the consistent association with reportable symptoms of illness warrants further studies to investigate this observed risk and high attributable risks. Addressing low energy availability may potentially prevent up to 74%–87% of cases in this population. Clinically, one in two elite female athletes is likely to score higher than the cut-off value. Female athletes who present with illness should be screened for low energy availability; assistance to better match nutrition and training may improve resilience against illness as well as other aspects of health and performance. http://dx.doi.org/10.1016/j.jsams.2017.01.032
182 Stay healthy: Project outline, methodology and approach Michael Drew 1,2 , Nicole Vlahovich 1,4 , David Hughes 1,2 , Renee Appaneal 1 , Kirsten Peterson 1 , Louise Burke 1,5 , Bronwen Lundy 1,5 , Mary Toomey 6,7 , David Watts 6 , Gregory Lovell 1 , Stephan Praet 1 , Shona Halson 1 , Candice Colbey 8 , Silvia Manzanero 1 , Marijke Welvaert 1,3 , Nic West 8 , David B. Pyne 1,3 , Gordon Waddington 1,3 1
Australian Institute of Sport, Australia Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia 3 University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia 4 Bond University, Australia 5 Mary MacKillop Institute for Health Research, Australian Catholic University, Australia 6 Queensland Academy of Sport, Australia 7 Department of Physiotherapy, Griffith University, Australia 8 Menzies Health Institute Queensland, Griffith University, Australia 2
Introduction: Illness has the potential to ruin Olympic campaigns. There have been many studies examining mechanisms of illness in athletes with emerging evidence indicating an increased risk of illness in some athlete cohorts. Despite this body of research few systematic risk factors have been clearly identified across multiple domains of health or in Olympic athlete cohorts of multiple sports. This paper will discuss the background surveillance data which led to creation of the Stay Healthy study, the study design, methodologies and analytical approaches. Method: Risk factors were identified from the literature and integrated with expert clinical knowledge. These factors were evaluated at two time points in the final year of Olympic preparations within a cross-sectional study design. Phase 1 (P1) was deployed in the summer period of December 2015–January 2016 and Phase 2 (P2) involved the period in the autumn (late April–June 2016) prior to the Olympics Games in August 2016. Fifteen National Sporting Organisations participated in the project with 317 athletes involved in at least one component of the study (59% of potential athletes). Nine questionnaires were included: the Depression, Anxiety and Stress Questionnaire (DASS-21), Perceived Stress Scale (PSS), Dispositional Resilience Scale (DRS), Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy in Females Questionnaire (LEAF-Q), a modified Personal and Household Hygiene questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and custom-made questionnaires on probiotic usage and travel. Illness in P1 was defined as sports incapacity due to any medical illness in the previous month. In P2, a symptom checklist was utilized and categorized into Upper Respiratory Tract Symptoms (URTS), bodily aches, gastrointestinal (GIT), head, eye, fatigue or chest symptoms with sports incapacity also reported. Odds ratios and population attributable risks were calculated for all variables using an a priori list of research questions. Results: The point prevalence of illness was 20% in P1 and 70% in P2. In P2 the most prevalent illness was associated with Upper Respiratory Tract Illness symptoms (n = 64, 47% of participants). The point prevalence of injury was 36% in Phase 2. The key results will be discussed in the subsequent abstracts.
e79
Discussion: This study highlights the inter-related nature of the determinants of health in athletes. The subsequent abstracts will discuss the outcomes of this project in detail. Prevention programs must consider multiple aspects of health and their interaction. This symposium will discuss the outcomes of the project and how they relate to each other such that the mitigation strategies can be implemented in the clinic and field. http://dx.doi.org/10.1016/j.jsams.2017.01.031 183 Low energy availability in females: A sleeping giant Bronwen Lundy 1,5 , Louise M. Burke 1,5 , Nicole Vlahovich 1,4 , Marijke Welvaert 1,3 , David Hughes 1,2 , Gordon Waddington 1,3 , Michael K. Drewa 2 1
Australian Institute of Sport, Australia Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia 3 University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia 4 Bond University, Australia 5 Mary MacKillop Institute for Health Research, Australian Catholic University, Australia 2
Introduction: The amount of energy remaining to support body functions after the kilojoule cost of exercise is subtracted from dietary energy intake is termed “energy availability”. Low energy availability can occur when an athlete restricts their energy intake and/or increases the volume or intensity of training, with the consequence that there is no longer sufficient energy to fulfil the functions needed to stay healthy. While the previous focus on low energy availability targeted menstrual function and bone health, there is now evidence that the consequences are wider ranging. Methods: Two case–control studies were undertaken in a similar cohort of female athletes (December and April–May). A validated questionnaire, Low Energy Availability in Females (LEAF-Q), was administered at both collection points. The published cut-off value of ≥8 was utilized as an indication of low energy availability. In phase 2, illnesses were sub-grouped to Upper Respiratory Tract Symptoms (URTS), bodily aches, gastrointestinal, head, eye, fatigue or chest symptoms. Two-by-two tables reporting odds ratios and attributable fractions in the exposed (AFE) were produced. Results: The prevalence of a high LEAF-Q score (≥8) was 49 and 53%. A high LEAF-Q score was associated with increased reports of illness across both time periods (Phase1: Any illness OR 7.4, 95%CI 0.8–352, AFE 0.87; Phase 2: URTS OR 3.8, 95%CI 1.3–11.6, AFE 0.74; Bodily Aches OR 5.8, 95%CI 1.6–23.5, AFE 0.83; Gastrointestinal symptoms OR 3.8, 95%CI 1.3–11.6, AFE 0.74; Head symptoms OR 4.4, 95%CI 1.4–14.3, AFE 0.77). Discussion: This study shows a repeated high prevalence of low energy availability among elite female athletes as measured by the LEAF-Q. Furthermore, the consistent association with reportable symptoms of illness warrants further studies to investigate this observed risk and high attributable risks. Addressing low energy availability may potentially prevent up to 74%–87% of cases in this population. Clinically, one in two elite female athletes is likely to score higher than the cut-off value. Female athletes who present with illness should be screened for low energy availability; assistance to better match nutrition and training may improve resilience against illness as well as other aspects of health and performance. http://dx.doi.org/10.1016/j.jsams.2017.01.032