American College of Sports Medicine defined Triad as
clinical entity that refers to the relationship between three interrelated components: energy availability, menstrual function and bone health
what was added to the triad definition?
understanding of the pathophysiology - over a period of time the athlete moves along on a continuous spectrum ranging from healthy with optimal EA, regular menses and healthy bones to amenorrhoea, low EA and osteoporosis
aetiological factor underpinning the triad
energy deficiency relative to the balance between dietary energy intake and energy expenditure to support homeostasis, health and the ADL, growth, and sporting activities
a syndrome resulting form relative energy deficiency
affects many aspects of physiological function including metabolic rate, menstrual function, bone health, immunity, protein synthesis, CV and psych health - even in men
what did the IOC coined as a new term for the female athlete triad?
relative energy deficiency in sport
calculation for energy availability
EI - energy cost of exercise relative to FFM - 45kcal/kg FFM/day - energy balance
requires expertise and is generally imprecise
what underpins a large proportion of cases of low EA?
disordered eating
what are other reasons for low EAs (without psychological overlay)
mismanaged programme to quickly reduce body mass/fat or inability to track EI with an extreme exercise commitment
Low EA in men
same at risk sports as female athletes - weight sensitive sports in which leanness and/or weight are important due to their role in performance, appearance or requirement to meet a competition weight category
disordered eating
continuum starting with appropriate eating and exercise behaviours (occasional use of more extreme weight loss methods such as short term restrictive <30kcal/kg FFM) and ends with clinical eating disorders, abnormal eating behaviours, distorted body image, weight fluctuations, medical complications and variable athletic performance
secondary amenorrhoea
absence of three consecutive cycle post menarche
oligomenorrhea
cycle length greater than 45 days
Aetiological factors in menstrual disorders in athletes - 5
abnormal levels of hormones, LH pulsatility, inadequate body fat stores, low EA and exercise stress
marked reduction in EA and LH pulsatility
may disrupt it by affecting the hypothalamic hormone gonadotropin releasing hormone output which subsequently alters the menstrual cycle
Low EA alters
levels of metabolic hormones and substrates - insulin, cortisol, GH, insulin like growth factor I, 3,3,5 - triiodothyroxine, grehlin, leptin, peptide tyrosine-tyrosine, glucose, FA, and ketones
REDS have serious implications for
many body systems - short and long term compromise of optimal health and performance
long term low EA - 3
nutrient deficiencies (including anaemia), chronic fatigue and increased risk of infections and illnesses, - harming health and performance
physiological and medical complications of REDS - 7
CV, GI, endocrine, reproductive, musculoskeletal, renal and CNS
Psychological aspects of REDS
Psychological stress and/or depression
at what kcal/kg FFM is MPS reduced?
30
Total energy expenditure = 4
Resting metabolic rate + thermos effect of food + non-exercise activity thermogenesis + energy expenditure from exercise
Resting metabolic rate represents _% of total energy
38-47%
Resting metabolic rate in elite athletes vs sedentary ind
60-80%
Two equations to estimate energy requirement
Harris Benedict
- Men = 66.5 + (13.7 X weight in kg) + (5 x height in cm) - (6.8 X age) = BMR
- women = 655 + (9.6 X kg) + (1.8 X cm) - (4.7 x age) = BMR
Cunningham
- men and women = (370+ 21.6 X lean mass in kg) = BMR
Estimated energy needs
BMR x activity level
Sedentary = 1.1, low = 1.3, mod = 1.5, active =1.7, very active = 1.8, extremely active = 1.9-2.1
REDS and bone
peak bone mass - 19 in women and 20.5 in men - oestrogen increases uptake of calcium into blood and deposition into bone while progesterone facilitates actions of oestrogen through multiple complex mechanisms - silent imbalance (subclinical ovulatory disturbances) with low EA will produce negative changes in your bone.
Testosterone and bone
anabolic effect in both men and women as it increases bone formation and calcium absorption
low levels = low bone marrow density in males
endogenous oestrogens and androgens and bone
independent effects on bone development in both sexes
stress hormones and bone
increase in it such as catecholamines and cortisol combined with low EA is bad
functional impairments associated with low EA
greater prevalence of viral illnesses, injuries, and reduced responsiveness to training and subsequent performance
Health consequence of REDS went from the triad to a wide range of outcomes - 10
immunological menstrual function bone health endocrine metabolic hematological growth and development psychological CV GI
psychological aspect and REDS
precede REDS or be the result
Low EA in male athletes - 3
cyclists had severely reduced EA of 8kcal/kg FFM
- cycling, gravitational (high jump, pole vault, ski jump, and weight class sports
- endocrine function and direct and indirect impacts on bones
energy availability
amt of dietary energy available to the body to perform all other functions after the cost of exercise is subtracted
65kg athlete, 15% body fat, 85% FFM, EI = 2500kcal, EEE = 600kcal, EA?
34.4kcal/kg FFM
relative energy deficiency
energy balance exists, but there is insufficient energy for health, function, and ADL after accounting for EEE
_ kcal/kg FFM for energy balance and optimal health?
45
_ kcal/kg FFM associated with impairments in body function
30
female athlete triad
syndrome of low EA with or w/o DE, functional hypothalamic amenorrhoea, and osteoporosis
3 predecesors of Female athlete triad
reduced EA with or without DE, subclinical menstrual disorders and low BMD
opposite end of female athlete triad
Optimal EA
eumenorrhea
optimal bone health
11 performance concerns with REDS
decreased endurance, training response, coordination, concentration, glycogen stores and muslce strength.
increased injury risk, infection/illnesses
impaired judgement
irritability
depression
Red light in REDS diagnosis
denied participation in sport, treatment contract
Yellow light in REDS diagnosis
train with a medical plan and compete when cleared
green light in REDS diagnosis
full training
REDS controversy - 9
insufficiently supported by scientific research to warrant adoption lacks scientific integrity misinterpretations of the scientific lit errors in treatment recommendations ambiguous return to play model sex diff protects men poorly referenced ill conceived and poorly defended inadequate and inaccurate
should we be able to pull an athlete out
pushing someone too far as a therapist/physician, not all athletes know the chronic effects of FAT
Males with reduced testosterones due to inadequate nutrition- 2
hypogonadotropic hypogonadism, and/or impaired bone density
Increase in male REDS
increased ED and DE
severely reduced EA of 8 kcal/kg FFM
What kind of nutrition should be emphaseized?
adequate for optimal performance
what should be deemphasized
weight as a performance parameter