ObjectivesTo evaluate the efficacy of a sport-specific energy availability (EA) questionnaire, combined with clinical interview, for identifying male athletes at risk of developing bone health, endocrine and performance consequences of relative energy deficiency in sports (RED-S).MethodsFifty competitive male road cyclists, recruited through links of participants in a pilot study, were assessed by a newly developed sport-specific questionnaire and clinical interview (SEAQ-I) and received dual energy X-ray absorptiometry (DXA) bone mineral density (BMD) and body composition scans and blood tests for endocrine markers.ResultsLow EA as assessed using the SEAQ-I, was observed in 28% of cyclists. Low lumbar spine BMD (Z-score<−1.0) was found in 44% of cyclists. EA was the most significant determinant of lumbar spine BMD Z-score (p<0.001). Among low EA cyclists, lack of previous load-bearing sport was associated with the lowest BMD (p=0.013). Low EA was associated with reduced total percentage fat (p<0.019). The 10 cyclists with chronic low EA had lower levels of testosterone compared with those having adequate EA (p=0.024). Mean vitamin D concentration was below the level recommended for athletes (90  nmol/L). Training loads were positively associated with power-to-weight ratios, assessed as 60  min functional threshold power (FTP) per kg (p<0.001). Percentage body fat was not significantly linked to cycling performance.ConclusionsThis study demonstrates that a SEAQ-I is effective for identifying male road cyclists with acute intermittent and chronic sustained low EA. Cyclists with low EA, particularly in the long-term, displayed adverse quantifiable measures of bone, endocrinology and performance consequences of RED-S.

The practice of rapid weight loss (RWL) in mixed martial arts (MMA) is an increasing concern but data remain scarce. The aim of this study was to investigate the prevalence, magnitude, methods, and influencers of RWL in professional and amateur MMA athletes. MMA athletes (N = 314; 287 men and 27 women) across nine weight categories (strawweight to heavyweight), completed a validated questionnaire adapted for this sport. Sex-specific data were analyzed, and subgroup comparisons were made between athletes competing at professional and amateur levels. Most athletes purposefully reduced body weight for competition (men: 97.2%; women: 100%). The magnitude of RWL in 1 week prior to weigh-in was significantly greater for professional athletes compared with those competing at amateur level (men: 5.9% vs. 4.2%; women: 5.0% vs. 2.1% of body weight; p < .05). In the 24 hr preceding weigh-in, the magnitude of RWL was greater at professional than amateur level in men (3.7% vs. 2.5% of body weight; p < .05). Most athletes “always” or “sometimes” used water loading (72.9%), restricting fluid intake (71.3%), and sweat suits (55.4%) for RWL. Coaches were cited as the primary source of influence on RWL practices (men: 29.3%; women: 48.1%). There is a high reported prevalence of RWL in MMA, at professional and amateur levels. Our findings, constituting the largest inquiry to date, call for urgent action from MMA organizations to safeguard the health and well-being of athletes competing in this sport.

ObjectivesTo investigate indicators and correlates of low energy availability (LEA) in male and female dancers.MethodsA Dance-Specific Energy Availability Questionnaire (DEAQ) was developed and administered online internationally to dancers training at preprofessional, professional or advanced amateur level. The DEAQ drew on current validated, published questionnaires for LEA, linked to the clinical outcomes of relative energy deficiency in sport (RED-S). Questions addressed recognised physiological indicators and consequences of LEA in the context of dance, together with potential correlates. LEA was quantified using a scoring system to include these characteristics.Results247 responses to the DEAQ were analysed (225 female and 22 male), mean age 20.7 years (SD 7.9) with 85% practising ballet. Psychological, physiological and physical characteristics consistent with LEA were reported by 57% of the female dancers and 29% of male dancers, indicating a risk of RED-S. The unique nature of dance training, in terms of demands and environment, was found to be potentially influential in development of this situation. Less than one-third (29%) of dancers were aware of RED-S.ConclusionThis study found dancers to be a specific group of high-level artistic performers displaying indicators of LEA and consequently at risk of developing the adverse clinical health and performance consequences of RED-S. Awareness of RED-S was low. The DEAQ has the potential to raise awareness and be a practical, objective screening tool to identify dancers in LEA, at risk of developing RED-S.

ObjectiveTo clinically evaluate education to improve eating behaviour and skeletal loading exercise in male cyclists at risk of poor bone health and impaired performance due to relative energy deficiency in sports.MethodsEarly race season, 50 competitive male road cyclists were matched, in pairs, based on Z-scores for lumbar spine bone mineral density (BMD). One member of each pair was randomly allocated to receive educational interventions. After the season, 45 cyclists returned for dual-energy X-ray absorptiometry scans and blood tests. Least significant change was applied to identify clinically meaningful BMD changes. Cyclists completed a follow-up sport-specific questionnaire and clinical interview to ascertain adherence to the interventions.ResultsThe questionnaire and clinical interview categorised behaviour changes as positive, negative or unchanged. Positive changes in nutrition and skeletal loading were associated with a statistically significant increase of 2.0% in lumbar spine BMD; 7 of 11 cyclists’ increases were clinically meaningful. Negative changes in both behaviours were associated with a significant decrease of 2.7% in lumbar BMD; all nine cyclists’ BMD decreases were clinically meaningful. Regarding performance, taking account of functional threshold power, changes in nutritional behaviour accounted for gains or losses of 95 British Cycling racing points. Cyclists reported psychological barriers to change in behaviours, specifically fear of negatively impacting performance.ConclusionsEducational nutritional and skeletal loading interventions can improve bone health, well-being and race performance in male cyclists over a 6-month race season. Psychological support may be required to help some athletes change behaviour.

Objectives-To measure the long term effects of dance training and the contribution of the timing and duration of any menstrual disruption on bone mineral density (BMD). Design Reduced BMD in such exercising amenorrhoeic women can result in an immediate risk of fracture.' This leads to the hypothesis that, if the reduction in BMD is irreversible, then there may exist an increased risk of early osteoporosis in later life. However, until now no studies have been possible to assess fully the long term effects on BMD, as athletic amenorrhoea is a relatively new phenomenon associated with recent increased training levels in women. Studies have therefore concentrated on young women still in training, with a short follow up period: 15 months6 and 24 months.7 Although BMD has been measured in a small group of 14 older retired dancers,8 menstrual and dance training history were not recorded, so the long term effect of amenorrhoea or any other relevant factors on BMD later in a dancer's career has not yet been assessed.The aim of the present study was to quantify the long term effects of dance training and the contribution of the timing and duration of any menstrual disruption on BMD in order to identify whether any aspects of such training may influence the risk of developing osteoporosis. This was achieved by measuring BMD in a group of professionally trained female ballet dancers and relating the measurements to menstrual and training history. Methods A group of 57 women who had followed professional dance careers were studied. All