The Athletes' Relationships with Training scale (ART): A self-report measure of unhealthy training behaviors associated with eating disorders.

OBJECTIVE: Several studies indicate that eating-disorder (ED) psychopathology is elevated in athletes compared to non-athletes. The assessment of excessive exercise among athletes is a challenge because, compared to non-athletes, athletes are required to train at higher intensities and for longer periods of time. However, individuals participating in competitive sports are still susceptible to unhealthy physical-activity patterns. Most ED assessments were developed and normed in non-athlete samples and, therefore, do not capture the nuances of athletes' training experiences. The purpose of the current study was to develop and validate a clinically useful, self-report measure of unhealthy training behaviors and beliefs in athletes, the Athletes' Relationships with Training Scale (ART). METHOD: The initial item pool was administered to N = 267 women collegiate athletes who were participating in an ED prevention program study and N = 65 women athletes who were in ED treatment. RESULTS: Factor analyses indicated the ART had a four-factor structure. Factorial and construct validity of the ART were demonstrated. ART scores significantly predicted health care utilization and differed between athletes with an ED versus athletes without an ED. For athletes in ED treatment, ART scores significantly decreased from treatment admission to discharge. DISCUSSION: The ART showed evidence of strong psychometric properties and clinical utility. The ART could be helpful for clinicians and athletic trainers to help gauge whether athletes are engaging in unhealthy training practices that may warrant clinical attention and for tracking clinical outcomes in athletes with EDs who are receiving treatment.

Gender differences in high school coaches' knowledge, attitudes, and communication about the female athlete triad.

The objective of this study was to assess high school coaches' knowledge, attitudes, communication, and management decisions with respect to the Female Athlete Triad and to determine whether results are patterned by coach gender. Data were obtained through an online survey of high school coaches (n = 227). Significant differences were found between male and female coaches in certain attitudes and communication behaviors related to eating and menstrual irregularity. School or district level policies may help reduce these differences and may help mitigate the health consequences for athletes related to possible differential prevention and detection of the comorbidities of the Female Athlete Triad.

Coaches' knowledge and management of eating disorders: a randomized controlled trial.

PURPOSE: It has been suggested that programs regarding early identification and prevention of eating disorders (ED) among athletes are unlikely to succeed without their coaches' endorsement and participation. Therefore, we developed a 1-yr intervention aiming to prevent the development of ED among adolescent elite athletes by targeting athletes and their coaches. The separate part of the intervention targeting the coaches was designed to provide knowledge and strategies regarding healthy nutrition, eating behavior, and ED (symptoms, identification, management, and prevention). In this trial, we examined the effect of the educational program on the coaches' knowledge and management index in three content areas (nutrition, weight regulation, and ED). We also examined their subjective evaluation of their ED knowledge. METHODS: All Norwegian Elite Sport High Schools were included (intervention group (n = 9) and control group (n = 7)). Seventy-six coaches employed at and coaching first year student athletes at the different schools were followed for three school years (2008-2011). At pretest and posttest (9 months after intervention), they completed a questionnaire regarding nutrition, weight regulation, and ED. RESULTS: Intervention coaches had higher knowledge index scores than control coaches for weight regulation (6.2 ± 1.7 vs. 4.8 ± 1.3, P < 0.001), ED (including recognition and management) (19.3 ± 4.4 vs. 16.5 ± 5.0, P = 0.004), and total knowledge (weight regulation, ED, and nutrition) (35.0 ± 7.2 vs. 31.6 ± 8.0, P = 0.021) at posttest. Moreover, the coaches likelihood of describing knowledge of ED as "somewhat good" or better was seven times higher for intervention than control coaches at posttest (OR = 7.1, 95% CI, 2.2-23.2, P = 0.001). CONCLUSION: Intervention coaches had higher index scores on total knowledge, weight regulation, and ED (including recognition and management) than control coaches. The intervention also was successful in producing effects on the coaches' subjective evaluation of their ED knowledge.

Moderators of the association between exercise identity and obligatory exercise among participants of an athletic event.

Previous research has connected exercise identity with obligatory exercise, yet to date no empirical studies have identified moderator variables of this association. The current study included participants of an athletic event (full marathon, n=582; half marathon, n=1,106; shorter distance, n=733) who completed questionnaires about exercise behaviors, obligatory exercise, and internalization of both the thin-ideal and athletic-ideal body shapes. General linear model analyses were conducted to examine the exercise identity-obligatory exercise relationship; moderator variables included gender, internalization of the thin-ideal body shape, and internalization of the athletic-ideal body shape. After controlling for the effects of body mass index, age, and distance group, the three-way interaction of exercise identity, gender, and internalization of the athletic-ideal body shape predicted obligatory exercise. Findings suggest that women who report high identification with exercise and high value on having an athletic physique may be vulnerable to obligatory exercise.

Practical use of the International Olympic Committee Medical Commission Position Stand on the Female Athlete Triad: a case example.

UNLABELLED: The female athlete triad consists of the interrelated problems of disordered eating, amenorrhea, and osteoporosis, and it is believed to affect female athletes in all sports and at all levels of competition. OBJECTIVE: The current article highlights the Position Stand on the Female Athlete Triad of the International Olympic Committee's Medical Commission (IOCMC). METHOD: The literature related to disordered eating, energy availability, amenorrhea, and bone loss in athletes is briefly reviewed. A hypothetical case is presented to illustrate some of the common issues and problems encountered when working with athletes affected by the triad, such as the effect of weight on performance in "thin" sports, coach involvement, sport participation by symptomatic athletes, and treatment resistance/motivation. RESULTS: Strategies recommended by the position stand for managing those issues and problems are presented regarding the referral, evaluation, and treatment phases of the management process. CONCLUSION: Implications of the position stand are discussed in terms of the IOCMC's endorsement of the athlete's health being primary to her performance.

NCAA coaches survey: the role of the coach in identifying and managing athletes with disordered eating.

The primary objective of the present study was to survey collegiate coaches with respect to how female athletes with disordered eating or eating disorders are identified, how coaches are involved, and the identification criteria used. An additional objective was to determine how symptomatic athletes are managed regarding treatment and sport participation. Participants were 2,894 coaches representing 23 sports. Findings indicated that athletic trainers, teammates, and coaches are frequently involved in identification. Eating disorder symptoms were most often used to identify symptomatic athletes, and athletes from high-risk sports were more often identified. Coaches rated symptoms as being serious, both in terms of how they affect the athlete's health and her athletic performance, with amenorrhea being a notable exception. Implications of the study were discussed in terms of education and training of coaches and athletic trainers.

The female athlete triad.

The Female Athlete Triad is a syndrome of the interrelated components of disordered eating, amenorrhea, and osteoporosis. Sometimes inadvertently, but more often by willful dietary restriction, many female athletes do not ingest sufficient calories to adequately fuel their physical or sport activities, which can disrupt menstrual functioning, thereby increasing their risk of bone loss. Although its prevalence is unknown, the Female Athlete Triad is believed to affect many athletes at all ages and all sport competition levels. Even though the Triad affects athletes in all sports, girls and women in sports that emphasize a thin or small body size or shape appear to be most at risk. This article focuses on the risks of the Female Athlete Triad for middle- and high-school-age female athletes as well as the unique issues related to the identification, management, and treatment of the various components of the Triad in this special adolescent subpopulation.