Gut microbiome and inflammation among athletes in wheelchair in a crossover randomized pilot trial of probiotic and prebiotic interventions.

Disorders related to gut health are a significant cause of morbidity among athletes in wheelchair. This pilot feasibility trial aims to investigate whether probiotics compared to prebiotics can improve inflammatory status and gut microbiome composition in elite athletes in wheelchair. We conducted a 12-week, randomized, cross-over controlled trial involving 14 elite Swiss athletes in wheelchair. Participants were given a multispecies-multistrain probiotic or prebiotic (oat bran) daily for 4 weeks (Clinical trials.gov NCT04659408 09/12/2020). This was followed by a 4-week washout and then crossed over. Thirty inflammatory markers were assessed using bead-based multiplex immunoassays (LegendPlex) from serum samples. The gut microbiome was characterized via 16S rRNA sequencing of stool DNA samples. Statistical analyses were conducted using linear mixed-effect models (LMM). At baseline, most athletes (10/14) exhibited low levels of inflammation which associated with higher gut microbiome alpha diversity indices compared to those with high inflammation levels. The use of probiotic had higher decrease in 25 (83%) inflammatory markers measured compared to prebiotic use. Probiotic has the potential in lowering inflammation status and improving the gut microbiome diversity. The future trial should focus on having sufficient sample sizes, population with higher inflammation status, longer intervention exposure and use of differential abundance analysis.

Characteristics of the gut microbiome of Swiss elite athletes with a spinal cord injury: An exploratory study.

OBJECTIVES: To illustrate and explore associations between the gut microbiome and spinal cord injury (SCI) characteristics, physical training, dietary intake, body composition, and blood biomarkers of elite Swiss athletes. DESIGN AND SETTING: Baseline data analysis of athletes with SCI who participated in a pilot trial (NCT04659408) in the Swiss Paraplegic Center, Nottwil, Switzerland. PARTICIPANTS: Elite athletes, five males, and six females, with SCI who competed internationally. OUTCOME MEASURES: We conducted a differential abundance analysis and measured the alpha and beta diversity of the gut microbiome. RESULTS: The athletes' median age was 34.5 years. Six had traumatic SCI and five had a spina bifida. The athletes competed in para-cycling (5), wheelchair athletics (3), and wheelchair tennis (3). A higher duration of training per week was positively associated with Akkermansia and Akkermansiaceae but negatively associated with Prevotellaceae. Muribaculaceae was negatively associated with the average number of trainings per week. Waist circumference is negatively associated with Butyricimonas. Significant differences in the alpha diversity were found with sex, gastrointestinal quality of life index (GIQLI) scores, total caloric intake, total fat intake, total carbohydrate intake, and high-sensitivity C-reactive protein (hs-CRP). Beta diversity differences were found with impairment of the sympathetic nervous system of the gut at the genus level and HbA1c at the family level. CONCLUSIONS: This study provides insight into the gut microbiome of athletes with SCI. Our results were similar to those found in athletes without SCI. Further replication is needed to confirm the relationships of organisms observed in the gut of athletes with SCI.

Reliability of a Submaximal Field Test in Wheelchair Rugby.

The aim was to investigate the test-retest reliability of performance and physiological variables of a submaximal wheelchair rugby field test. Eight trained wheelchair rugby athletes with a spinal cord injury (age: median 40, interquartile range 6.9 y; body mass: median 77.7, interquartile range 23.9 kg) performed a submaximal field test two times with a duration of 41 min, split up into four sets of eight min. Each set included eight laps with one eight-meter sprint (SP8) and one four-meter sprint (SP4). The absolute and relative reliability and the performance decrease (fatigue) across the sets were investigated. The examined variables were sprinting time, heart rate, and RPE. The measured parameters showed moderate (peak heart rate ICC3,1=0.663, peak rate of perceived exertion ICC3,1=0.718), good (SP4 ICC3,1=0.874), and excellent (mean heart rate ICC3,1=0.905, SP8 ICC3,1=0.985) test-retest reliability. Fatigue was observed for SP8 in test 2 between set 2/3 and set 2/4. For test 1 a significant decrease of performance for SP4 was found between set 2/3, set 2/4 and between set 3/4. In conclusion the submaximal field test showed moderate to excellent reliability for all measured parameters. The observed fatigue seems to be not clinically relevant. The test can be recommended to assess the effects of training or interventions.

Validity of a Wheelchair Rugby Field Test to Simulate Physiological and Thermoregulatory Match Outcomes.

The purpose of the study was to verify the criterion-validity (concurrent) of an existing and reliable, submaximal wheelchair Rugby (WCR) field test by examining the correlations of selected measures of physical performance between the field test and real games. Therefore, ten WCR athletes were observed during two WCR real games and during completing the field test two times. Total distance, mean and peak velocity, playing time, number of sprints, sprints per minute, mean and maximal heart rate, body core temperature (Tc), sweat rate, body weight loss, rate of perceived exertion and thermal sensation were measured. Values were correlated with the data observed by completing the field test two times separated by seven days. The results showed significant correlations between games and field tests for sweat rate (r = 0.740, p < 0.001), body weight loss (r = 0.732, p < 0.001) and the increase of Tc (r = 0.611, p = 0.009). All other correlations were not significant. For perceptual responses Bland−Altman analysis showed data within the limits of agreement. Descriptive statistics showed similarity for mean velocity and total distance between tests and games. In conclusion the study provides the first indications that the submaximal field test seems comparable with the game outcomes in terms of increase in Tc, covered distance, mean velocity and perceptual responses. Nevertheless, more research and additional validation are required.

Sports nutrition knowledge in athletes with a spinal cord injury and coaches of para sports.

Sports nutrition for athletes with a spinal cord injury (SCI) is complex, making it challenging for athletes to stay informed. The aim of this study was to assess sports nutrition knowledge in athletes with an SCI and coaches of para sports. The secondary aim was to report sources of sports nutrition information. Eighty athletes and 26 coaches across various adapted sports were recruited. The Nutrition for Sport Knowledge Questionnaire was used to assess nutrition knowledge for both groups. Athletes achieved their highest score among the alcohol (65 ± 19%) category and the lowest in sports nutrition (43 ± 17%). Coaches demonstrated the most knowledge in the alcohol (73 ± 17%) category and lowest knowledge in the supplementation (45 ± 19%) category. Both groups relied on the internet, dietitians, and coaches for sports nutrition information. Future studies should explore the effects of nutrition education on nutrition knowledge and dietary intakes among these populations.

Fluid Balance and Thermoregulatory Responses during Wheelchair Basketball Games in Hot vs. Temperate Conditions.

The impaired vaso- and sudomotor functions limit sweat capacity in individuals with a spinal cord injury (SCI) and might increase the risk for heat-related illness and decreased performance, especially in hot conditions (HOT). This study investigated the differences in fluid balance and thermal responses between wheelchair basketball (WCB) games in HOT and temperate conditions (TMP). Eleven male WCB athletes (39.8 y, 82.8 kg) with SCI (lesion level C5-L4) participated, five in HOT (31 °C) and eight in TMP games (21 °C). Fluid balance, sweat rate, body core temperature, distance, velocity and thermal sensation were assessed. The relative change in body mass was higher in the HOT group (median: -0.35%, interquartile-range: 0.15%, p = 0.02) compared to TMP (+0.11%, 0.35%) group. The sweat rate was significantly higher in the HOT group (0.93 L/h, 0.58 L/h, p = 0.02) compared to the TMP groups (0.48 L/h, 0.19 L/h). Body core temperature increased significantly higher in the TMP group (1.05 °C, 0.15 °C, p = 0.01) compared to the HOT group (0.8 °C, 0.4 °C). The mean velocity (HOT: 1.12 m/s, 0.11 m/s, TMP: 1.07 m/s, 0.08 m/s, p = 0.54) did not differ between the games. The WCB game in HOT leads to significantly higher sweat rate and loss in body mass compared to TMP. Even relative body mass loss was less than 2%. Athletes thus have to be supported with enough fluid, especially during games in HOT.

Case Study: Improving Energy Status in a Wheelchair Athlete With Suppressed Resting Energy Expenditure.

PURPOSE: Wheelchair athletes experience a reduction in fat-free mass due to the underlying condition and/or muscle disuse. This leads to a lower resting energy expenditure (REE), as well as a lower energy expenditure during exercise or daily activities. Traditional markers of low energy availability (LEA), including amenorrhea and low bone mineral density, are often inconclusive in wheelchair athletes. This case study provides data from a professional female wheelchair badminton player with multiple sclerosis who presented with a reduced measured-to-predicted REE ratio (REEratio), a common indicator of LEA in able-bodied athletes. Furthermore, a nutrition and exercise intervention was conducted to restore REE. METHODS: REE and body composition were measured using indirect calorimetry and dual-energy X-ray absorptiometry, respectively. The predicted REE of the REEratio was calculated using 2 separate approaches. An REEratio <0.9 was considered an indicator for LEA. A nutrition and exercise intervention was implemented to normalize REE and induce weight loss through increased meal frequency, a 200- to 400-kcal/d increase in energy intake, and added endurance exercise. RESULTS: The athlete (33 y, 78 kg, 154 cm) initiallly showed an REEratio of 0.65 to 0.70, which increased to 1.00 to 1.09 after 1 year. The athlete lost 11.8 kg, almost exclusively (11 kg) in the form of fat mass. The athlete reported reduced fatigue and higher perceived fitness. CONCLUSION: The nutrition and exercise intervention successfully restored energy status, induced sustainable weight loss, and reduced fatigue in a wheelchair athlete with multiple sclerosis with presumed LEA. Methods to assess LEA in this population require further validation.

Physical activity and cardiometabolic risk factors in individuals with spinal cord injury: a systematic review and meta-analysis.

Physical inactivity in individuals with spinal cord injury (SCI) has been suggested to be an important determinant of increased cardiometabolic disease (CMD) risk. However, it remains unclear whether physically active SCI individuals as compared to inactive or less active individuals have truly better cardiometabolic risk profile. We aimed to systematically review and quantify the association between engagement in regular physical activity and/or exercise interventions and CMD risk factors in individuals with SCI. Four medical databases were searched and studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the certainty of evidence. Of 5816 unique citations, 11 randomized clinical trials, 3 non-randomized trial and 32 cross-sectional studies comprising more than 5500 SCI individuals were included in the systematic review. In meta-analysis of RCTs and based on evidence of moderate certainty, physical activity in comparison to control intervention was associated with: (i) better glucose homeostasis profile [WMD of glucose, insulin and Assessment of Insulin Resistance (HOMA-IR) were - 3.26 mg/dl (95% CI - 5.12 to - 1.39), - 3.19 µU/ml (95% CI - 3.96 to - 2.43)] and - 0.47 (95% CI - 0.60 to - 0.35), respectively], and (ii) improved cardiorespiratory fitness [WMD of relative and absolute oxygen uptake relative (VO2) were 4.53 ml/kg/min (95% CI 3.11, 5.96) and 0.26 L/min (95% CI 0.21, 0.32) respectively]. No differences were observed in blood pressure, heart rate and lipids (based on evidence of low/moderate certainty). In meta-analysis of cross-sectional studies and based on the evidence of very low to low certainty, glucose [WMD - 3.25 mg/dl (95% CI - 5.36, - 1.14)], insulin [- 2.12 µU/ml (95% CI - 4.21 to - 0.03)] and total cholesterol [WMD - 6.72 mg/dl (95% CI - 13.09, - 0.34)] were lower and HDL [WMD 3.86 mg/dl (95% CI 0.66, 7.05)] and catalase [0.07 UgHb-1 (95% CI 0.03, 0.11)] were higher in physically active SCI individuals in comparison to reference groups. Based on limited number of cross-sectional studies, better parameters of systolic and diastolic cardiac function and lower carotid intima media thickness were found in physically active groups. Methodologically sound clinical trials and prospective observational studies are required to further elaborate the impact of different physical activity prescriptions alone or in combination with other life-style interventions on CMD risk factors in SCI individuals.

Characteristics of Official Wheelchair Basketball Games in Hot and Temperate Conditions.

This study compared performance parameters of two wheelchair basketball games under hot (30.3 °C, 52% relative humidity) and temperate (21.6 °C, 30% relative humidity) environmental conditions and described the characteristics of wheelchair basketball. Eight wheelchair basketball players from two teams were monitored during two games using an indoor position tracking system. Total distance, mean- and peak-speed, playing-time, number of sprints, sprints per minute, heart rate and rate of perceived exertion were recorded. Additionally, athletes with a lesion level above and below T6 were compared. No measured parameter differed between the games. Across quarters (Q) mean velocity (m/s) (Q1: 1.01; Q2: 1.10; Q3: 1.18; Q4: 1.06; p < 0.001) and sprints per minute (Q1: 16; Q2: 14; Q3: 23; Q4: 14; p = 0.033) differed significantly, independent of the conditions. Descriptive statistics did not reveal differences between the groups with a lesion level below or above T6. In the present study, hot environmental conditions seemed not to have an impact on activity parameters of wheelchair basketball players. It was speculated that the game intensity and therefore metabolic heat production was too low; consequently, the athletes had a sufficient heat loss to prevent a decrease in performance during the play in hot conditions.

Vitamin D supplementation in chronic spinal cord injury (VitD-SCI): study protocol for a randomised controlled trial.

INTRODUCTION: Vitamin D insufficiency, a vitamin D status or serum 25(OH)D concentration of ≤75 nmol/L, is highly prevalent in individuals with a spinal cord injury (SCI). Vitamin D is important for the functioning of the musculoskeletal, immune and respiratory systems, which are relevant determinants of secondary health conditions in SCI. An insufficiency should be treated with vitamin D supplementation. However, there is a lack of evidence regarding the optimal dosage and duration of vitamin D supplementation for individualised and long-term management of the vitamin D status in the context of SCI. This paper presents the protocol for the vitamin D supplementation in chronic spinal cord injury (VitD-SCI) trial that aims to investigate the effect of a 12-month intake of vitamin D supplementation on vitamin D status as well as on several secondary parameters among individuals with a chronic SCI. METHODS AND ANALYSES: The VitD-SCI trial is a randomised, placebo-controlled, double-blinded, parallel-group, superiority trial, conducted at the Swiss Paraplegic Centre. A total of 45 participants living with an SCI for at least 3 years (chronic SCI) and a vitamin D insufficiency at the first study visit, will be randomly assigned to one of three intervention groups. Participants receive either a monthly dosage of 24 000 IU or 48 000 IU vitamin D or a placebo for 12 months. Measurements taking place every 3 months include the assessment of vitamin D status (primary outcome) as well as bone mineral density, handgrip strength, fatigue, mood, pain and pressure injuries (secondary outcomes). Safety and tolerance of vitamin D supplementation will also be evaluated. ETHICS AND DISSEMINATION: The Swiss Ethics Committee for Northwest/Central Switzerland (EKNZ, 2020-01493) and the Swiss Agency for Therapeutic Products (Swissmedic, 2020DR3150) approved this study. Findings will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBERS: NCT04652544 and SNCTP000004032.

Nutritional Considerations for Para-Cycling Athletes: A Narrative Review.

Para-cycling is a sport including athletes with different disabilities competing on the track and on the roads using bicycles, tandems, tricycles, and handbikes. Scientific literature in this special population is scarce, especially in the field of sports nutrition. This review summarizes the physiological aspects and demands of para-cycling. This information together with the existing literature on nutritional interventions in this population, helps to discuss the nutritional considerations. To date, only a limited amount of recommendations are available for this population. In most para-cycling athletes, a reduction in active muscle mass and consequently a reduction in resting energy expenditure occurs, except for visually impaired athletes. Furthermore, carbohydrate and protein intake and hydration, supplementation, heat, and weight loss need to be tailored to the disability-specific adaptations such as the reduced active muscle mass, neurogenic bladder, and bowel, a reduced metabolic cost during exercise, and a higher risk of micronutrient deficiency.

Systematic Review of the Effects of Oat Intake on Gastrointestinal Health.

BACKGROUND: Oats are a food source with multiple health benefits that could support beneficial bacterial groups and provide important bioactive compounds for the gut. OBJECTIVES: This review explores the association between oat intake, gastrointestinal (GI) symptoms, and microbial community changes in individuals with celiac disease (CeD), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD) and without GI disease. METHODS: Four databases and Google Scholar were systematically searched from inception until April 29, 2021. Clinical trials, observational studies, and in vitro studies with human gut-derived samples were included. RESULTS: There were 84 articles [23 randomized controlled trials (RCTs), 21 nonrandomized trials, 8 observational studies, and 32 in vitro studies] included. Oat intake increased total bacterial count, Lactobacilli spp., and Bifidobacterium spp. in healthy individuals and those with CeD. There was an increased concentration of short-chain fatty acids and improved gut permeability with oat intake but with no significant quality-of-life difference. In some individuals with CeD, consumption of certain oat types was associated with worsening of GI symptoms. We found no studies reporting on IBS and only 3 for IBD. The quality of RCTs showed some concerns mostly in domains of randomization (73.9%), whereas the quality of evidence of non-RCTs, observational studies, and in vitro studies was satisfactory. CONCLUSIONS: Oat intake was associated with the increase of beneficial bacterial groups in individuals without GI disease and those with CeD. Most studies showed no changes in GI symptoms with oat consumption. In vitro studies in CeD provide insight to oat-sensitive individuals and their GI mucosa, but the clinical studies remain limited, precluding our ability to draw firm conclusions. The prevalence of oat sensitivity in individuals with CeD should be further explored as this could improve clinical management and facilitate inclusion of oat in the diet for this population.

Exercise Capacity, Functioning and Quality of Life 12 Weeks after Traumatic Thoracic Spinal Cord Injury.

BACKGROUND: A spinal cord injury (SCI) leads to patho-physiological changes that can affect physical and psychological performance. The aim of this observational study was to evaluate the relationship between exercise capacity, functioning and quality of life in patients 12 weeks after traumatic paraplegia participating in early rehabilitation. MATERIAL AND METHODS: 13 patients participated in this study and performed cardio-pulmonary exercise testing (CPET) on an arm-crank ergometer to determine peak exercise capacity (VO2peak). Data from the spinal cord independence measure (SCIM) were used to assess different areas of functioning. The 12-item short form survey (SF12) questionnaire was applied to measure quality of life. Spearman correlations were used to relate VO2peak with SCIM data and results from the SF12 questionnaire. RESULTS: VO2peak ranged between 12.6 and 28.1 ml/kg/min. A significant relationship was found between VO2peak and the physical component of the SF12 questionnaire, whereas no correlations were found with either SCIM sub or total score, or with the mental component or the total score of the SF12 questionnaire. CONCLUSIONS: 1. Patients with traumatic paraplegia showed fair to average exercise capacity after 12 weeks of early rehabilitation. 2. A significant relationship between VO2peak and subjectively rated physical fitness exists at this time point. 3. The implementation of an individual fitness program tailored to the patients' needs based on CPET results is highly recommended in order to improve functioning and quality of life.

Carbohydrate Considerations for Athletes with a Spinal Cord Injury.

The Paralympic movement is growing in popularity, resulting in increased numbers of athletes with a spinal cord injury (SCI) competing in various sport disciplines. Athletes with an SCI require specialized recommendations to promote health and to maximize performance, as evidenced by their metabolic and physiological adaptations. Nutrition is a key factor for optimal performance; however, scientifically supported nutritional recommendations are limited. This review summarizes the current knowledge regarding the importance of carbohydrates (CHO) for health and performance in athletes with an SCI. Factors possibly affecting CHO needs, such as muscle atrophy, reduced energy expenditure, and secondary complications are analyzed comprehensively. Furthermore, a model calculation for CHO requirements during an endurance event is provided. Along with assessing the effectiveness of CHO supplementation in the athletic population with SCI, the evaluation of their CHO intake from the available research supplies background to current practices. Finally, future directions are identified. In conclusion, the direct transfer of CHO guidelines from able-bodied (AB) athletes to athletes with an SCI does not seem to be reasonable. Based on the critical role of CHOs in exercise performance, establishing recommendations for athletes with an SCI should be the overall objective for prospective research.

The Thermoregulatory and Thermal Responses of Individuals With a Spinal Cord Injury During Exercise, Acclimation and by Using Cooling Strategies-A Systematic Review.

Background: In individuals with a spinal cord injury thermoregulatory mechanisms are fully or partially interrupted. This could lead to exercise-induced hyperthermia in temperate conditions which can be even more distinct in hot conditions. Hyperthermia has been suggested to impair physiological mechanisms in athletes, which could negatively influence physical performance and subjective well-being or cause mild to severe health issues. Objective: The aim was to evaluate the literature on the thermoregulatory and thermal responses of individuals with a spinal cord injury during exercise in temperate and hot conditions taking the effects of cooling techniques and heat acclimation into account. Data sources: Two electronic databases, PubMed and Web of Science were searched. Studies were eligible if they observed the influence of exercise on various thermoregulatory parameters (e.g., core and skin temperature, sweat rate, thermal sensation) in individuals with a spinal cord injury. Results: In total 32 articles were included of which 26 were of strong, 3 of moderate and 3 of weak quality. Individuals with a high lesion level, especially those with a tetraplegia, reached a higher core and skin temperature with a lower sweat rate. The use of cooling techniques before and during exercise can positively affect the burden of the impaired thermoregulatory system in all individuals with a spinal cord injury. Conclusion: Due to the absence of normal thermoregulatory abilities, individuals with a high-level spinal cord injury need special attention when they are exercising in temperate and hot conditions to prevent them from potential heat related issues. The use of cooling techniques can reduce this risk.

Protein Considerations for Athletes With a Spinal Cord Injury.

Athlete participation in the Paralympic games is steadily increasing; prompting research focused on the unique needs of this population. While the Paralympic Games includes a diversity of athletes, athletes with a spinal cord injury (PARA-SCI) represent a subgroup that requires specialized recommendations. Nutritional guidelines designed to optimize performance, in the context of the neurological impairments, are required. This narrative review summarizes the current literature regarding the importance of dietary protein for optimal health and performance. Factors with the potential to affect protein needs in PARA-SCI including loss of active muscle mass, reduced energy expenditure, and secondary complications are examined in detail. Furthermore, we analyze protein intakes in PARA-SCI from the available research to provide context around current practices and trends. In conclusion, we make the case that protein recommendations for able-bodied athletes may not be directly transferable to PARA-SCI. Consequently, PARA-SCI need their own guidelines to maximize performance and ensure long-term health.

Key Nutritional Considerations for Youth Winter Sports Athletes to Optimize Growth, Maturation and Sporting Development.

Despite a wealth of sport nutrition guidelines for adult athletes, there are currently no nutrition guidelines for youth winter sports athletes. Whilst it may be pragmatic to apply nutrition guidelines for adult athletes to youth winter sports athletes, it is inappropriate. Due to a paucity of research on youth athletes, it is impossible to provide evidence-based guidelines for this population, so careful extrapolation from the theoretical and practical considerations that apply to other athletic groups is necessary. Youth winter sport athletes undergo rapid biological growth and maturation which influences their nutritional requirements. A varied and balanced diet that ensures sufficient energy availability for optimal growth and maturation as well as sporting performance is the cornerstone of youth athlete nutrition and should also allow for youth athletes to meet their micronutrient requirements. In some cases, micronutrient status (e.g., vitamin D and iron) should be monitored and optimized if appropriate by a medical professional. Dietary supplement use is prevalent amongst youth athletes, however is often unnecessary. Education of youth athletes, their parents and coaches on best nutritional practices as well as the risks associated with dietary supplements is vital for their long-term athletic development. Further research in youth winter sports athletes across different stages of growth and maturation competing in a variety of sports is urgently required in order to inform nutritional guidelines for this population.

Energy Availability in Male and Female Elite Wheelchair Athletes over Seven Consecutive Training Days.

BACKGROUND: Low energy availability (LEA) is a major problem as athletes often restrict their energy intake. It has been shown that LEA occurs often in female and endurance athletes and in athletes from weight-sensitive or aesthetic sports. The purpose of this study was to investigate energy availability (EA) in elite wheelchair athletes. METHODS: Fourteen elite wheelchair athletes (8 males; 6 females) participated. Data were collected using a weighed seven-day food and training diary to estimate energy intake and exercise energy expenditure. Resting energy expenditure and body composition were measured, whereas energy balance (EB) was calculated. RESULTS: Measured over 7 days, EA was significantly different (36.1 ± 6.7 kcal kg-1 FFM day-1) in male compared to female (25.1 ± 7.1 kcal kg-1 FFM day-1) athletes (p < 0.001). From all analyzed days, LEA occurred in 73% of the days in female athletes and in 30% of the days in male athletes. EB was positive in male athletes (+169.1 ± 304.5 kcal) and negative (-288.9 ± 304.8 kcal) in female athletes. CONCLUSIONS: A higher prevalence of LEA was found in female compared to male athletes. A higher energy intake would be recommended to meet energy needs and to maximize training adaptation.

Body Composition in Swiss Elite Wheelchair Athletes.

The aim of this study was to retrospectively interpret body composition in various wheelchair athletes. In total, 69 athletes (mean ± standard deviation; age 33 ± 11 years; body mass 65.1 ± 14.8 kg; height 169.9 ± 14.9 cm and time since injury 19 ± 11 years) from different national teams in wheelchair sports underwent a dual X-ray absorptiometry (DXA) measurement during the yearly medical check-up. The data showed a significant difference between total fat and total fat-free mass between male (fat mass: 15.1 ± 7.6 kg; fat-free mass: 51.8 ± 9.3 kg) and female (fat mass: 19.4 ± 7.8 kg; fat-free mass: 36.8 ± 7.6 kg) athletes (p = 0.032, p < 0.001). In contrast, no significant difference (p = 0.16, p = 0.07) in fat and fat-free mass between paraplegic, tetraplegic and non-SCI athletes was found. Comparing different sports, the lowest fat mass was found in paracycling athletes whereas curling game players showed the highest total fat mass. Basketball game players showed the highest fat-free mass (fat-free mass: 54.8 ± 10.1 kg). In tetraplegic athletes, difference in fat-free mass between left and right arms correlated with the upper extremity motor score. For the interpretation of the data it seems to be crucial, that many different parameters (i.e., gender, motor level of the injury) are taken into consideration in wheelchair athletes.