Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete.

Problem: If athletes develop low energy availability (LEA), it can lead to a Relative Energy Deficiency in Sport (RED-S) syndrome which has severe health consequences if not treated. Methodology: A narrative review of the most recent and pertinent literature on the topic, with special emphasis on women. Results: In assessing the current literature, we have synthesized: i) the scientific implications of LEA and RED-S, ii) the clinical manifestations of the conditions currently available for detection, as well as iii) the practical implications for healthcare and support for female athletes and teams in planning intervention or prevention strategies (maintaining EA >45 kcal/kg FFM/day). Discussion: The 'Female Athlete Triad" emerged in the 1990s as researchers understood more of the etiological adaptation of female athlete health to sports training. In the last 10 years, the scientific community has recognized that the 'Triad' approach was too narrow in focus, and the broader concept of RED-S emerged. Both the Triad and RED-S are consequences of a frequently prevalent LEA in athletes (<30 kcal/kg FFM/day). Developing LEA and RED-S compromises training adaptation, performance capacity, and health in athletes. For these reasons, it is critical that an athlete's support team recognize the behaviors that may indicate RED-S evolution. In this way, we can assist female athletes in reaching their full potential in sports while protecting their health.

Lessons learned from a pilot randomized clinical trial of home-based exercise prescription before allogeneic hematopoietic cell transplantation.

Allogeneic hematopoietic cell transplantation (alloHCT) is a life-saving technology that can cure otherwise incurable diseases, but imposes significant physiologic stress upon recipients. This stress leads to short-term toxicity and mid- to long-term physical function impairment in some recipients. Exercise interventions have demonstrated preliminary efficacy in preserving physical function in HCT recipients, but the role of these interventions prior to HCT (prehabilitative) is less known. We tested a 5- to 12-week, prehabilitative higher intensity home-based aerobic exercise intervention in a randomized study of alloHCT candidates. Of 113 patients screened, 34 were randomized to control or intervention groups, 16 underwent pre- and post-intervention peak oxygen consumption (VO2peak) testing, and 12 underwent pre- and post-intervention 6-min walk distance (6MWD) testing. No significant differences in VO2peak or 6MWD were seen pre- to post-intervention between intervention and control groups, but final numbers of evaluable participants in each group were too small to draw inferences regarding the efficacy of the intervention. We conclude that the design of our prehabilitative intervention was not feasible in this pilot randomized study, and make recommendations regarding the design of future exercise intervention studies in alloHCT.

Influence of segmental body composition and adiposity hormones on resting metabolic rate and substrate utilization in overweight and obese adults.

PURPOSE: Low resting metabolic rate (RMR) and high carbohydrate reliance at rest are associated with weight gain, but are highly variable in obese individuals. This study determined the relationship of total and segmental body composition and adiposity hormones with RMR and respiratory exchange ratio (RER) in overweight and obese adults. METHODS: In 49 men (n = 23) and premenopausal women (n = 26) [mean ± SD; age = 35.0 ± 8.9 years; body mass index (BMI) = 33.6 ± 5.2 kg·m-2; percent body fat (%fat) = 40.0 ± 8.0%], RMR and RER were evaluated using indirect calorimetry. Total and segmental body composition [fat mass (FM), percent fat (%fat), lean mass (LM), visceral adipose tissue (VAT)] were estimated using dual-energy X-ray absorptiometry. Fasted blood and saliva samples were analyzed for insulin, leptin, estradiol, and cortisol. RESULTS: In men (M) and women (W), RMR significantly correlated (p < 0.05) with FM (M: R = 0.535; W: R = 0.784) and LM (M: R = 0.645; W: R = 0.867). Of the segmental measures, trunk LM (M: R = 0.593; W: R = 0.879; p < 0.05) and leg LM (M: R = 0.664; W: R = 0.821; p < 0.05) had the strongest correlations with RMR. In men, but not women, RER significantly correlated with FM (R = 0.449; p = 0.032), trunk FM (R = 0.501; p = 0.015), and VAT (R = 0.456; p = 0.029). In men, RMR positively correlated with cortisol (R = 0.430, p = 0.040) and estradiol (R = 0.649, p = 0.001) and RER positively correlated with insulin (R = 0.525, p = 0.010). In women, RMR positively correlated with insulin (R = 0.570, p = 0.006), but RER was not significantly correlated with hormones (p > 0.05). CONCLUSIONS: Segmental evaluation of body composition, specifically in the lower extremities and abdomen, may be an effective and efficient way to evaluate metabolic status. Sex-specific evaluations are also imperative.

Body Composition, Muscle Quality and Scoliosis in Female Collegiate Gymnasts: A Pilot Study.

Research has demonstrated an elevated prevalence of body weight concerns and scoliosis among female gymnasts. The purpose of the current pilot study was to evaluate the utility of ultrasonography and dual-energy X-ray absorptiometry (DXA) as practical imaging modalities to measure body composition and spinal curvature variables that may correlate with performance in female collegiate gymnasts (n=15). DXA was used to evaluate body composition and lateral spinal curvature, utilizing a modified Ferguson method. Echo intensity (EI) and cross-sectional area (CSA) of the vastus lateralis were determined from a panoramic cross-sectional ultrasound image. For returning athletes (n=9), performance scores from the previous season were averaged to quantify performance. The average performance score was correlated with lean mass of the arms (R=0.714; P=0.03) and right leg (R=0.680; P=0.04). Performance was not correlated with total mass, fat mass or body fat percentage (P>0.10). Scoliosis was identified in 3 of 15 scans (20%). Echo intensity and CSA of the vastus lateralis were inversely correlated with each other (R=-0.637, P=0.01), but not with other measures of body composition or performance. Results suggest that limb LBM may be a determinant of gymnastics performance, and DXA may provide important health and performance-related information for female collegiate gymnasts.

Personalized home-based interval exercise training may improve cardiorespiratory fitness in cancer patients preparing to undergo hematopoietic cell transplantation.

Impaired cardiorespiratory fitness is associated with inferior survival in patients preparing to undergo hematopoietic cell transplantation (HCT). Exercise training based on short, higher intensity intervals has the potential to efficiently improve cardiorespiratory fitness. We studied home-based interval exercise training (IET) in 40 patients before autologous (N=20) or allogeneic (N=20) HCT. Each session consisted of five, 3 min intervals of walking, jogging or cycling at 65-95% maximal heart rate (MHR) with 3 min of low-intensity exercise (<65% MHR) between intervals. Participants were asked to perform sessions at least three times weekly. The duration of the intervention was at least 6 weeks, depending on each patient's scheduled transplantation date. Cardiorespiratory fitness was assessed from a peak oxygen consumption test (VO2peak) and a 6 min walk (6MWD) before and after the intervention period. For the autologous HCT cohort, improvements in VO2peak (P=0.12) and 6MWD (P=0.19) were not statistically significant. For the allogeneic cohort, the median VO2peak improvement was 3.7 ml/kg min (P=0.005) and the median 6MWD improvement was 34 m (P=0.006). Home-based IET can be performed before HCT and has the potential to improve cardiorespiratory fitness.

Characterization of the work-time relationship during cross-country ski ergometry.

The purpose of this study was to examine the validity and reliability of estimated parameters of the work-time relationship during cross-country ski ergometry using the traditional multi-trial critical power (CP) test and a 3 min 'all-out' test (3MT). Fourteen recreationally active male participants (mean ± SD; age: 22.14 ± 2.85 yrs; height: 177.09 ± 6.57 cm; weight: 85.68 ± 13.56 kg) completed three testing visits. All testing was conducted using an upper-body ergometer (SkiErg, Concept2, Inc., Morrisville, VT). A graded exercise test was used to determined maximal oxygen uptake (VO2peak). Two separate 3MT sessions were used to determine oxygen uptake (VO23MT), end-test power (EP), work above end-test power (WEP) and end stroke rate (ESR). Additionally, three time trials completed in a single day at simulated distances of 300 m, 650 m and 1000 m were used to estimate CP, W' and critical stroke rate (CSR). VO2peak (3.65 ± 0.50 l · min(-1)) and VO23MT (3.59 ± 0.4 l · min(-1)) were not significantly different (p = 0.162). Intraclass correlation coefficients for EP, WEP and ESR were 0.809, 0.611 and 0.783, respectively. EP (148 ± 33 W) and CP (157 ± 49 W), were not significantly different between the testing methodologies (p = 0.290) and were highly correlated (r = 0.780). WEP (8.4 ± 3.0 kJ) and W' (8.3 ± 3.0 kJ) were similar (p = 0.947) but not related (r = 0.119), while ESR (45 ± 7 spm) and CSR (47 ± 7 spm) values were not significantly different (p = 0.238) and moderately correlated (r = 0.498). The 3MT using ski ergometry was shown to produce concurrently valid results with the traditional multi-trial CP test for CP and CSR, but not W', and elicited similar maximal oxygen uptake values when compared to a graded exercise test.

Tracking fat-free mass changes in elderly men and women using single-frequency bioimpedance and dual-energy X-ray absorptiometry: a four-compartment model comparison.

BACKGROUND/OBJECTIVES: To compare single estimations of fat-free mass (FFM) and to track FFM using single-frequency bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA) compared with a four-compartment (4C) model in healthy elderly Americans. SUBJECTS/METHODS: Thirty-four men and thirty-eight women (Caucasian, ≥ 65 years) were included in the study. Subjects participated in either the control group or the exercise group. All testing and training took place during the 21-week investigation. Body composition assessments using nine BIA equations, DXA and a 4C model were performed during weeks 1, 12 and 24 of the study. RESULTS: Single estimations for DXA and BIA produced high r values (0.79-0.95) and low standard error of estimate values (1.62-3.3 kg), producing subjective ratings of 'ideal' for men and 'excellent' for women. Both DXA and two BIA equations revealed the same significance when comparing groups and times with the 4C model. Individual accuracy for tracking changes was similar among BIA equations and DXA compared with the 4C model, with a total agreement of 25% for BIA and 27% for DXA compared with the 4C model. CONCLUSIONS: The current data in combination with the reliability errors for both BIA and DXA FFM estimations suggest that individual results should be interpreted with caution if FFM changes are <5 kg. However, DXA and BIA are both valid methods that can be used interchangeably to estimate FFM at a single time point or for tracking changes in FFM in small groups (15-22) of healthy American older adults.