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Using published guidelines, 29% of female collegiate athletes in this study were classified into moderate- or high-risk categories using the Female Athlete Triad Cumulative Risk Assessment Score. Moderate- and high-risk athletes were more likely to subsequently sustain a BSI; most BSIs were sustained by cross-country runners.

Peak bone mass is attained during the second and third decades of life. Sports participation during the years that peak bone mass is being acquired may lead to adaptive changes that improve bone architecture through increased density and enhanced geometric properties. A review of the literature evaluating sports participation in young athletes, ages 10-30 years, revealed that sports that involve high-impact loading (eg, gymnastics, hurdling, judo, karate, volleyball, and other jumping sports) or odd-impact loading (eg, soccer, basketball, racquet games, step-aerobics, and speed skating) are associated with higher bone mineral composition, bone mineral density (BMD), and enhanced bone geometry in anatomic regions specific to the loading patterns of each sport. Repetitive low-impact sports (such as distance running) are associated with favorable changes in bone geometry. Nonimpact sports such as swimming, water polo, and cycling are not associated with improvements in bone mineral composition or BMD, and swimming may negatively influence hip geometry. Participating in sports during early puberty may enhance bone mass. Continued participation in sports appears to maintain the full benefits of increased peak bone mass, although former athletes who do not maintain participation in sports may retain some benefits of increased BMD. Long-term elite male cycling was reported to negatively influence bone health, and female adolescent distance running was associated with suppressed bone mineral accrual; confounding factors associated with participation in endurance sports may have contributed to those findings. In summary, young men and women who participate in sports that involve high-impact or odd-impact loading exhibit the greatest associated gains in bone health. Participation in nonimpact sports, such as swimming and cycling, is not associated with an improvement in bone health.

Prior fracture represents the most robust predictor of stress fractures in both sexes. Low body mass index, late menarche, and prior participation in gymnastics and dance are identifiable risk factors for stress fractures in girls. Participation in basketball appears protective in boys and may represent a modifiable risk factor for stress fractures. These findings may help guide future translational research and clinical care in the management and prevention of stress fractures in young runners.

The term Relative Energy Deficiency in Sport was introduced by the International Olympic Committee in 2014. It refers to the potential health and performance consequences of inadequate energy for sport, emphasizing that there are consequences of low energy availability (EA; typically defined as <30 kcal·kg fat-free mass·day) beyond the important and well-established female athlete triad, and that low EA affects populations other than women. As the prevalence and consequences of Relative Energy Deficiency in Sport become more apparent, it is important to understand the current knowledge of the hormonal changes that occur with decreased EA. This paper highlights endocrine changes that have been observed in female and male athletes with low EA. Where studies are not available in athletes, results of studies in low EA states, such as anorexia nervosa, are included. Dietary intake/appetite-regulating hormones, insulin and other glucose-regulating hormones, growth hormone and insulin-like growth factor 1, thyroid hormones, cortisol, and gonadal hormones are all discussed. The effects of low EA on body composition, metabolic rate, and bone in female and male athletes are presented, and we identify future directions to address knowledge gaps specific to athletes.

These findings demonstrate that low EA measured using self-report questionnaires is strongly associated with many health and performance consequences proposed by the RED-S models.

Governments have restricted public life during the COVID-19 pandemic, inter alia closing sports facilities and gyms. As regular exercise is essential for health, this study examined the effect of pandemic-related confinements on physical activity (PA) levels. A multinational survey was performed in 14 countries. Times spent in moderate-to-vigorous physical activity (MVPA) as well as in vigorous physical activity only (VPA) were assessed using the Nordic Physical Activity Questionnaire (short form). Data were obtained for leisure and occupational PA pre- and during restrictions. Compliance with PA guidelines was calculated based on the recommendations of the World Health Organization (WHO). In total, n = 13,503 respondents (39 ± 15 years, 59% females) were surveyed. Compared to pre-restrictions, overall self-reported PA declined by 41% (MVPA) and 42.2% (VPA). Reductions were higher for occupational vs. leisure time, young and old vs. middle-aged persons, previously more active vs. less active individuals, but similar between men and women. Compared to pre-pandemic, compliance with WHO guidelines decreased from 80.9% (95% CI: 80.3–81.7) to 62.5% (95% CI: 61.6–63.3). Results suggest PA levels have substantially decreased globally during the COVID-19 pandemic. Key stakeholders should consider strategies to mitigate loss in PA in order to preserve health during the pandemic.