Intensity Gradients: A Novel Method for Interpreting External Loads in Football.

PURPOSE: Global navigation satellite system device-derived metrics are commonly represented by discrete zones with intensity often measured by standardizing volume to per-minute of activity duration. This approach is sensitive to imprecision in duration measurement and can lead to highly variable outcomes-transforming data from zones to a gradient may overcome this problem. The purpose of this study was to critically evaluate this approach for measuring team-sport activity demands. METHODS: Data were collected from 129 first-team and 73 academy matches from a Scottish Premiership football club. Gradients were calculated for velocity, acceleration, and deceleration zones, along with per-minute values for several commonly used metrics. Means and 95% CIs were calculated for playing level, as well as first-team positional groups. Within-subject coefficients of variation were also calculated for match level, position, and individual groups. RESULTS: The gradient approach showed consistency with per-minute metrics when measuring playing level and position groups. With coefficients of variation of 10.8% to 26.9%, the gradients demonstrated lower variability than most per-minute variables, which ranged from 10.7% to 84.5%. CONCLUSIONS: Gradients are a potentially useful way of describing intensity in team sports and compare favorably to existing intensity variables in their ability to distinguish between match types and position groups, providing evidence that gradient variables can be used to monitor match and training intensity in team sports.

Monitoring Within-Individual Dose-Response Relationships in Professional Soccer Players: The Importance of Fitness Level.

PURPOSE: To (1) examine within-individual player dose-response associations between selected training-load measures and changes in aerobic fitness level via submaximal exercise heart rate (HRex%) and (2) measure the relationships between these dose-response associations with basal HRex% (to study the influence of fitness level on dose-response relationship). METHODS: During an in-season phase, selected training-load measures including total minutes, total distance, mechanical work (the sum number of accelerations and decelerations > 3 m2), high metabolic load distance, and Edwards' training impulse were collected via Global Positioning System and heart-rate sensors for analyzing accumulated load. A submaximal warm-up test was used repeatedly before and after 9 phases to elicit HRex% and track fitness changes at an individual level. RESULTS: Negative to positive extensive ranges of within-individual associations were found among players for different metrics (r = -.84 to .89). The relationship between pooled HRex% (basal fitness) and dose-response correlations showed inverse very large (r = -.71) and large (r = -.65) values for accumulated weekly minutes and distance. However, moderate values were found for all other measures (r = -.35 to -.42). CONCLUSIONS: Individual players show extensive different ranges of dose-response associations with training measures. The dose-response association is influenced by players' fitness level, and players with lower fitness levels show stronger inverse relationships with accumulated minutes and total distance.

Nitric Oxide in the Field: Prevalence and Use of Nitrates by Dietitians and Nutritionists in Spanish Elite Soccer.

Soccer players make frequent use of dietary supplements to improve performance. One of the most widely used strategies to optimize performance is to increase the bioavailability of nitric oxide through nitrates, as it could delay fatigue during physical exertion, among other benefits. This may be positive for performance in soccer, although there is almost no research in professional soccer. The aim of the study was to evaluate the use of nitrates and behaviours related to their consumption in Spanish elite soccer clubs. Dietitian-nutritionist representatives from 45 teams from the most important Spanish soccer leagues completed an online survey to determine if, when, how and why nitrates are prescribed to soccer players. Of the total sample, 55.6% indicated providing nitrates, always before matches, but only 36% in training. There was a wide variation and lack of consistency in the timing, dosage and form of administration of nitrates. The use of mouthwashes or the protocol of chronic nitrate intake was not taken into account in most cases. The present study indicates a lack of interpretation between scientific knowledge and its application in practice, highlighting the need for future research to better understand how to optimize the use of nitrates in professional soccer.

Greater male variability in daily energy expenditure develops through puberty.

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.

The effect of two sessions of combined jump and sprint training per week on fitness parameters in soccer players. A randomized controlled trial.

This study aimed to investigate the effect of a combined jump and sprint training program, two sessions a week for 6 weeks, on sprinting, change of directions (COD) and jumping performance in semi-professional soccer players. Twenty soccer players were enrolled in this randomized controlled trial (age 20 ± 2 years, body mass 74.3 ± 5.9 kg). Players were randomized into two groups such as training group (TG, n = 10 players) or control group (CG, n = 10 players). Physical tests were performed before and after 6 weeks of training such as sprint 10 m, sprint 30 m, 505-COD test and standing long jump (LJ). The two groups performed the same training except for the combined jump and sprint training performed twice a week by TG. After 6 weeks of training, between-group analysis reported statistical difference in favor of the TG in sprint 10 m (p = 0.015, η2 = 0.295, large), sprint 30 m (p < 0.001, η2 = 0.599, large), in 505-COD (p = 0.026, η2 = 0.154, large), and LJ (p = 0.025, η2 = 0.027, small). These data indicate that combined sprint and jump training, when performed twice a week, for the duration of 6 weeks, in addition to the regular team training, can improve specific physical performance in male soccer players. This study has shown that a volume increment of 10% after 3 weeks of training can be a suitable training dose progression and that a combination of 64-70 jumps and 675-738 m of sprinting training per session can yield benefits in sprint, COD and jump performance.

Rationale and Practical Recommendations for Testing Protocols in Female Soccer: A Narrative Review.

ABSTRACT: Beato, M, Datson, N, Anderson, L, Brownlee, T, Coates, A, and Hulton, A. Rationale and practical recommendations for testing protocols in female soccer: A narrative review. J Strength Cond Res 37(9): 1912-1922, 2023-The aim of this narrative review is to evaluate the presented literature on tests (aerobic, speed, changes of direction [COD], strength, power, jump, and anthropometry) of the varied components of female soccer and to draw attention to the most suitable protocols to allow practitioners to accurately track players' fitness status. The 2 most common field tests used to assess aerobic fitness are the Yo-Yo intermittent test (level 1 and level 2) and the 30-15 intermittent fitness test because of an ability to measure multiple players at once with a soccer-specific intermittent profile. The sprinting performance can be assessed on distances of <30 m; however, longer distances (e.g., 40 m) allow for achieving peak speed (flying sprint test), which can be assessed using global navigation satellite system. Changes-of-direction capacity has been found to be an important component of players testing and training programs, although there is no "gold standard" to assess COD or repeated sprint ability performance in female players. Lower-limb power can be assessed using jump tests that can use force platforms, jump mats, and optoelectronic devices, while maintaining a good reliability. Several in-direct tests are currently available for assessing anthropometry parameters, such as skinfold thickness, hydrodensitometry, and ultrasound. However, dual-energy x-ray absorptiometry is the most valid and reliable method for assessing body composition in team sport athletes, with the addition of bone health that is a key measure in female athletes. In conclusion, the evidence reported in this review will be able to aid practitioners, coaches, and researchers to decide which tests meet the requirements of their environment.

Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure.

Obesity is caused by a prolonged positive energy balance1,2. Whether reduced energy expenditure stemming from reduced activity levels contributes is debated3,4. Here we show that in both sexes, total energy expenditure (TEE) adjusted for body composition and age declined since the late 1980s, while adjusted activity energy expenditure increased over time. We use the International Atomic Energy Agency Doubly Labelled Water database on energy expenditure of adults in the United States and Europe (n = 4,799) to explore patterns in total (TEE: n = 4,799), basal (BEE: n = 1,432) and physical activity energy expenditure (n = 1,432) over time. In males, adjusted BEE decreased significantly, but in females this did not reach significance. A larger dataset of basal metabolic rate (equivalent to BEE) measurements of 9,912 adults across 163 studies spanning 100 years replicates the decline in BEE in both sexes. We conclude that increasing obesity in the United States/Europe has probably not been fuelled by reduced physical activity leading to lowered TEE. We identify here a decline in adjusted BEE as a previously unrecognized factor.

Lessons from the COVID-19 pandemic: Insights into effective training strategies for physical development in football.

Professional soccer players typically perform regular training sessions and match play for most of the yearly macrocycle with limited time focused on solely developing physical development. The COVID-19 outbreak in 2020 caused mass disruption to professional soccer but provided an opportunity for an alternative approach to training in attempt to develop professional soccer players physical fitness levels. In a non-randomised and non-controlled study, we aimed to assess the effectiveness of a 13-week remote based physical training programme on physical fitness levels in elite professional soccer players. Twenty professional soccer players undertook body composition assessments, a countermovement jump (CMJ) test, eccentric hamstring strength test and a submaximal 30-15 intermittent fitness test (IFT) pre- and post-remote based training programme. Body mass (79.3 ± 6.7 vs. 80.0 ± 7.3 kg), skinfold thickness (54.1 ± 14.8 vs. 56.7 ± 15.2 mm), maximum CMJ height (38.4 ± 3.4 vs. 40.9 ± 4.1 cm), eccentric hamstring strength (1035 ± 158 vs. 1009 ± 140 n) and percentage max heart rate reached in submaximal 30-15 IFT (81.3 ± 5.2 vs. 82.3 ± 7.3%) were maintained (all P > 0.05) from pre- to post training programme, respectively. Although team-based soccer specific training load was removed, and the training programmes prescribed had an increased physical focus, fitness levels were maintained. This suggests that alternative modes of training can potentially be used in instances where team-based soccer specific training load isn't required or is unavailable, without negatively impacting physical development.

Variation in human water turnover associated with environmental and lifestyle factors.

Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (2H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.

Variability in energy expenditure is much greater in males than females.

In mammals, trait variation is often reported to be greater among males than females. However, to date, mainly only morphological traits have been studied. Energy expenditure represents the metabolic costs of multiple physical, physiological, and behavioral traits. Energy expenditure could exhibit particularly high greater male variation through a cumulative effect if those traits mostly exhibit greater male variation, or a lack of greater male variation if many of them do not. Sex differences in energy expenditure variation have been little explored. We analyzed a large database on energy expenditure in adult humans (1494 males and 3108 females) to investigate whether humans have evolved sex differences in the degree of interindividual variation in energy expenditure. We found that, even when statistically comparing males and females of the same age, height, and body composition, there is much more variation in total, activity, and basal energy expenditure among males. However, with aging, variation in total energy expenditure decreases, and because this happens more rapidly in males, the magnitude of greater male variation, though still large, is attenuated in older age groups. Considerably greater male variation in both total and activity energy expenditure could be explained by greater male variation in levels of daily activity. The considerably greater male variation in basal energy expenditure is remarkable and may be explained, at least in part, by greater male variation in the size of energy-demanding organs. If energy expenditure is a trait that is of indirect interest to females when choosing a sexual partner, this would suggest that energy expenditure is under sexual selection. However, we present a novel energetics model demonstrating that it is also possible that females have been under stabilizing selection pressure for an intermediate basal energy expenditure to maximize energy available for reproduction.

Physical loading in professional soccer players: Implications for contemporary guidelines to encompass carbohydrate periodization.

Despite more than four decades of research examining the physical demands of match-play, quantification of the customary training loads of adult male professional soccer players is comparatively recent. The training loads experienced by players during weekly micro-cycles are influenced by phase of season, player position, frequency of games, player starting status, player-specific training goals and club coaching philosophy. From a macronutrient perspective, the periodization of physical loading within (i.e., match versus training days) and between contrasting micro-cycles (e.g., 1, 2 or 3 games per week schedules) has implications for daily carbohydrate (CHO) requirements. Indeed, aside from the well-recognised role of muscle glycogen as the predominant energy source during match-play, it is now recognised that the glycogen granule may exert regulatory roles in activating or attenuating the molecular machinery that modulate skeletal muscle adaptations to training. With this in mind, the concept of CHO periodization is gaining in popularity, whereby CHO intake is adjusted day-by-day and meal-by-meal according to the fuelling demands and specific goals of the upcoming session. On this basis, the present paper provides a contemporary overview and theoretical framework for which to periodize CHO availability for the professional soccer player according to the "fuel for the work" paradigm.

Injury risk is greater in physically mature versus biologically younger male soccer players from academies in different countries.

OBJECTIVES: To investigate if maturity status was associated with injury risk in male academy soccer players. DESIGN: Prospective cohort surveillance study. SETTING: Professional soccer academies. PARTICIPANTS: 501 players (aged 9-23 years) from eight academies in England, Spain, Uruguay and Brazil. MAIN OUTCOME MEASURES: Players were grouped by maturity offset as pre-peak height velocity (PHV), circa-PHV, post-PHV or adult. Injury prevalence proportion (IPP) and days missed were recorded for one season per player, with training/match exposure recorded in a sub-sample (n = 166). RESULTS: IPP for all injuries combined increased with advancing maturity, with circa-PHV (p = 0.032), post-PHV (p < 0.001) and adult (p < 0.001) higher than pre-PHV. IPP was higher in post-PHV and adult than pre-PHV for non-contact (p = 0.001 and p = 0.012), soft-tissue (both p < 0.001), non-contact soft-tissue (p < 0.001 and p = 0.005), muscle (both p < 0.001), thigh (both p < 0.001), ankle (p = 0.035 and p = 0.007) and hamstring injuries (p = 0.041 and p = 0.017). Ligament/tendon IPP was greater in adult versus pre-PHV (p = 0.002). IPP for growth-related injuries was lower in post-PHV than pre-PHV (p = 0.039). Injury incidence rates (n = 166) exhibited similar patterns to IPP in the full cohort. CONCLUSIONS: Injury patterns were similar between post-PHV and adult academy players but, crucially, relatively more of these groups suffered injuries compared to pre- and circa-PHV (except growth-related injuries).

Playing Position and the Injury Incidence Rate in Male Academy Soccer Players.

CONTEXT: Whether playing position influences injury in male academy soccer players (ASPs) is unclear. OBJECTIVE: To determine if playing position was associated with injury in ASPs. DESIGN: Descriptive epidemiology study. SETTING: English, Spanish, Uruguayan, and Brazilian soccer academies. PATIENTS OR OTHER PARTICIPANTS: A total of 369 ASPs from the under-14 to under-23 age groups, classified as post-peak height velocity using maturity offset, and grouped as goalkeepers, lateral defenders, central defenders, lateral midfielders, central midfielders, or forwards. MAIN OUTCOME MEASURE(S): Injuries were recorded prospectively over 1 season. Injury prevalence proportion (IPP), days missed, and injury incidence rate (IIR, injuries/1000 training or match hours, n = 116) were analyzed according to playing position. RESULTS: No association with playing position was observed for any injury type or location regarding IPP (P ≥ .089) or days missed (P ≥ .235). The IIR was higher in central defenders than in lateral defenders for general (9.30 versus 4.18 injuries/1000 h, P = .009), soft tissue (5.14 versus 1.95 injuries/1000 h, P = .026), and ligament or tendon injuries (2.69 versus 0.56 injuries/1000 h, P = .040). The central versus lateral or forward positions were not associated with IPP (P ≥ .051) or days missed (P ≥ .083), but general IIR was greater in the central position than the lateral or forward positions (8.67 versus 6.12 injuries/1000 h, P = .047). CONCLUSIONS: Academy soccer players' playing positions were not associated with IPP or days missed, but the higher general, soft tissue, and ligament or tendon IIRs in central defenders suggest that this position warrants specific attention regarding injury-prevention strategies. These novel findings highlight the importance of considering training or match exposure when investigating the influence of playing position on injury in ASPs.

Total energy expenditure is repeatable in adults but not associated with short-term changes in body composition.

Low total energy expenditure (TEE, MJ/d) has been a hypothesized risk factor for weight gain, but repeatability of TEE, a critical variable in longitudinal studies of energy balance, is understudied. We examine repeated doubly labeled water (DLW) measurements of TEE in 348 adults and 47 children from the IAEA DLW Database (mean ± SD time interval: 1.9 ± 2.9 y) to assess repeatability of TEE, and to examine if TEE adjusted for age, sex, fat-free mass, and fat mass is associated with changes in weight or body composition. Here, we report that repeatability of TEE is high for adults, but not children. Bivariate Bayesian mixed models show no among or within-individual correlation between body composition (fat mass or percentage) and unadjusted TEE in adults. For adults aged 20-60 y (N = 267; time interval: 7.4 ± 12.2 weeks), increases in adjusted TEE are associated with weight gain but not with changes in body composition; results are similar for subjects with intervals >4 weeks (N = 53; 29.1 ± 12.8 weeks). This suggests low TEE is not a risk factor for, and high TEE is not protective against, weight or body fat gain over the time intervals tested.

The genetic association with injury risk in male academy soccer players depends on maturity status.

It is currently unknown if injury risk is associated with genetic variation in academy soccer players (ASP). We investigated whether nine candidate single nucleotide polymorphisms were associated (individually and in combination) with injury in ASP at different stages of maturation. Saliva samples and one season's injury records were collected from 402 Caucasian male ASP from England, Spain, Uruguay, and Brazil, whose maturity status was defined as pre- or post-peak height velocity (PHV). Pre-PHV COL5A1 rs12722 CC homozygotes had relatively higher prevalence of any musculoskeletal soft tissue (22.4% vs. 3.0%, p = 0.018) and ligament (18.8% vs. 11.8%, p = 0.029) injury than T-allele carriers, while VEGFA rs2010963 CC homozygotes had greater risk of ligament/tendon injury than G-allele carriers. Post-PHV IL6 rs1800795 CC homozygotes had a relatively higher prevalence of any (67.6% vs. 40.6%, p = 0.003) and muscle (38.2% vs. 19.2%, p = 0.013) injuries than G-allele carriers. Relatively more post-PHV EMILIN1 rs2289360 CC homozygotes suffered any injury than CT and TT genotypes (56.4% vs. 40.3% and 32.8%, p = 0.007), while the "protective" EMILIN1 TT genotype was more frequent in post- than pre-PHV ASP (22.3 vs. 10.0%, p = 0.008). Regardless of maturity status, T-alleles of ACTN3 rs1815739 and EMILIN1 rs2289360 were associated with greater absence following ankle injury, while the MMP3 rs679620 T-allele and MYLK rs28497577 GT genotype were associated with greater absence following knee injury. The combination of injury-associated genotypes was greater in injured vs. non-injured ASP. This study is the first to demonstrate that a genetic association exists with injury prevalence in ASP, which differs according to maturity status.

Physical activity and fat-free mass during growth and in later life.

BACKGROUND: Physical activity may be a way to increase and maintain fat-free mass (FFM) in later life, similar to the prevention of fractures by increasing peak bone mass. OBJECTIVES: A study is presented of the association between FFM and physical activity in relation to age. METHODS: In a cross-sectional study, FFM was analyzed in relation to physical activity in a large participant group as compiled in the International Atomic Energy Agency Doubly Labeled Water database. The database included 2000 participants, age 3-96 y, with measurements of total energy expenditure (TEE) and resting energy expenditure (REE) to allow calculation of physical activity level (PAL = TEE/REE), and calculation of FFM from isotope dilution. RESULTS: PAL was a main determinant of body composition at all ages. Models with age, fat mass (FM), and PAL explained 76% and 85% of the variation in FFM in females and males < 18 y old, and 32% and 47% of the variation in FFM in females and males ≥ 18 y old, respectively. In participants < 18 y old, mean FM-adjusted FFM was 1.7 kg (95% CI: 0.1, 3.2 kg) and 3.4 kg (95% CI: 1.0, 5.6 kg) higher in a very active participant with PAL = 2.0 than in a sedentary participant with PAL = 1.5, for females and males, respectively. At age 18 y, height and FM-adjusted FFM was 3.6 kg (95% CI: 2.8, 4.4 kg) and 4.4 kg (95% CI: 3.2, 5.7 kg) higher, and at age 80 y 0.7 kg (95% CI: -0.2, 1.7 kg) and 1.0 kg (95% CI: -0.1, 2.1 kg) higher, in a participant with PAL = 2.0 than in a participant with PAL = 1.5, for females and males, respectively. CONCLUSIONS: If these associations are causal, they suggest physical activity is a major determinant of body composition as reflected in peak FFM, and that a physically active lifestyle can only partly protect against loss of FFM in aging adults.

Energy compensation and adiposity in humans.

Understanding the impacts of activity on energy balance is crucial. Increasing levels of activity may bring diminishing returns in energy expenditure because of compensatory responses in non-activity energy expenditures.1-3 This suggestion has profound implications for both the evolution of metabolism and human health. It implies that a long-term increase in activity does not directly translate into an increase in total energy expenditure (TEE) because other components of TEE may decrease in response-energy compensation. We used the largest dataset compiled on adult TEE and basal energy expenditure (BEE) (n = 1,754) of people living normal lives to find that energy compensation by a typical human averages 28% due to reduced BEE; this suggests that only 72% of the extra calories we burn from additional activity translates into extra calories burned that day. Moreover, the degree of energy compensation varied considerably between people of different body compositions. This association between compensation and adiposity could be due to among-individual differences in compensation: people who compensate more may be more likely to accumulate body fat. Alternatively, the process might occur within individuals: as we get fatter, our body might compensate more strongly for the calories burned during activity, making losing fat progressively more difficult. Determining the causality of the relationship between energy compensation and adiposity will be key to improving public health strategies regarding obesity.

Daily energy expenditure through the human life course.

Total daily energy expenditure ("total expenditure") reflects daily energy needs and is a critical variable in human health and physiology, but its trajectory over the life course is poorly studied. We analyzed a large, diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 years. Total expenditure increased with fat-free mass in a power-law manner, with four distinct life stages. Fat-free mass-adjusted expenditure accelerates rapidly in neonates to ~50% above adult values at ~1 year; declines slowly to adult levels by ~20 years; remains stable in adulthood (20 to 60 years), even during pregnancy; then declines in older adults. These changes shed light on human development and aging and should help shape nutrition and health strategies across the life span.

A standard calculation methodology for human doubly labeled water studies.

The doubly labeled water (DLW) method measures total energy expenditure (TEE) in free-living subjects. Several equations are used to convert isotopic data into TEE. Using the International Atomic Energy Agency (IAEA) DLW database (5,756 measurements of adults and children), we show considerable variability is introduced by different equations. The estimated rCO2 is sensitive to the dilution space ratio (DSR) of the two isotopes. Based on performance in validation studies, we propose a new equation based on a new estimate of the mean DSR. The DSR is lower at low body masses (<10 kg). Using data for 1,021 babies and infants, we show that the DSR varies non-linearly with body mass between 0 and 10 kg. Using this relationship to predict DSR from weight provides an equation for rCO2 over this size range that agrees well with indirect calorimetry (average difference 0.64%; SD = 12.2%). We propose adoption of these equations in future studies.

The prevalence of disordered eating in elite male and female soccer players.

PURPOSE: To examine the prevalence of disordered eating (DE) in elite male and female soccer players and the influence of perfectionism. METHODS: Using a cross-sectional design, elite male (n = 137) and female (n = 70) soccer players and non-athlete controls (n = 179) completed the clinical perfectionism questionnaire (CPQ-12) and the eating attitudes test (EAT-26) to assess perfectionism and DE risk, respectively. RESULTS: Male soccer players had higher EAT-26 scores than controls (10.4 ± 9.9 vs. 6.8 ± 6.7; P = 0.001), but there were no differences in the prevalence of clinical levels of DE (EAT-26 score ≥ 20) (15 vs. 5%, respectively; X2 = 0.079) The proportion of females with DE risk was higher in controls [EAT-26: 13.9 ± 11.6 (25% of population)] than female players [EAT-26: 10.0 ± 9.0% (11% of population)] (X2 = 0.001). With linear regression, perfectionism explained 20% of the variation in DE risk in males (P = 0.001); in females, athletic status (player vs. control) and perfectionism were significant predictors of DE risk, explaining 21% of the variation (P = 0.001). Male reserve team players had higher EAT-26 (+ 3.5) and perfectionism (+ 2.7) scores than first-team players (P < 0.05). There were no differences in the prevalence of DE risk between the male and female soccer players (X2 = 0.595). CONCLUSIONS: The prevalence of DE risk was not different in elite male and female soccer players; in fact, the prevalence was greatest in non-athlete female controls. Perfectionism is a significant predictor of DE risk in males and females. LEVEL OF EVIDENCE: III, case-control study.