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

Click name to view affiliation

Joelle Leonie Flueck Institute for Sports Medicine, Swiss Paraplegic Center, Nottwil, Switzerland

Search for other papers by Joelle Leonie Flueck in
Current site
Google Scholar
PubMed
Close
*
and
Karsten Koehler Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany

Search for other papers by Karsten Koehler in
Current site
Google Scholar
PubMed
Close
Restricted access

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.

Flueck (joelle.flueck@ssns.ch) is corresponding author.

  • Collapse
  • Expand
  • 1.

    Price M. Energy expenditure and metabolism during exercise in persons with a spinal cord injury. Sports Med. 2010;40(8):681696. PubMed ID: 20632738 doi:10.2165/11531960-000000000-00000

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Cunningham JJ. A reanalysis of the factors influencing basal metabolic rate in normal adults. Am J Clin Nutr. 1980;33(11):23722374. PubMed ID: 7435418 doi:10.1093/ajcn/33.11.2372

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Conger SA, Bassett DR. A compendium of energy costs of physical activities for individuals who use manual wheelchairs. Adapt Phys Activ Q. 2011;28(4):310325. PubMed ID: 21914904 doi:10.1123/apaq.28.4.310

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Egger T, Flueck JL. Energy availability in male and female elite wheelchair athletes over seven consecutive training days. Nutrients. 2020;12(11):3262. doi:10.3390/nu12113262

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Brook EM, Tenforde AS, Broad EM, et al. Low energy availability, menstrual dysfunction, and impaired bone health: a survey of elite Para athletes. Scand J Med Sci Sports. 2019;29(5):678685. PubMed ID: 30644600 doi:10.1111/sms.13385

    • Search Google Scholar
    • Export Citation
  • 6.

    Mountjoy M, Sundgot-Borgen J, Burke L, et al. International Olympic Committee (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Int J Sport Nutr Exerc Metab. 2018;28(4):316331. PubMed ID: 29771168 doi:10.1123/ijsnem.2018-0136

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Blauwet CA, Brook EM, Tenforde AS, et al. Low energy availability, menstrual dysfunction, and low bone mineral density in individuals with a disability: implications for the Para athlete population. Sports Med. 2017;47(9):16971708. PubMed ID: 28213754 doi:10.1007/s40279-017-0696-0

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Mirmosayyeb O, Badihian S, Manouchehri N, et al. The interplay of multiple sclerosis and menstrual cycle: which one affects the other one? Mult Scler Relat Disord. 2018;21:4650. PubMed ID: 29455074 doi:10.1016/j.msard.2018.01.020

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Strock NCA, Koltun KJ, Southmayd EA, Williams NI, De Souza MJ. Indices of resting metabolic rate accurately reflect energy deficiency in exercising women. Int J Sport Nutr Exerc Metab. 2020;30(1):1424. PubMed ID: 31887723 doi:10.1123/ijsnem.2019-0199

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Koehler K, Williams NI, Mallinson RJ, Southmayd EA, Allaway HC, De Souza MJ. Low resting metabolic rate in exercise-associated amenorrhea is not due to a reduced proportion of highly active metabolic tissue compartments. Am J Physiol Endocrinol Metab. 2016;311(2):E480E487. PubMed ID: 27382033 doi:10.1152/ajpendo.00110.2016

    • Search Google Scholar
    • Export Citation
  • 11.

    Pelly FE, Broad EM, Stuart N, Holmes MA. Resting energy expenditure in male athletes with a spinal cord injury. J Spinal Cord Med. 2018;41(2):208215. PubMed ID: 28472894 doi:10.1080/10790268.2017.1317060

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Bosy-Westphal A, Braun W, Schautz B, Müller MJ. Issues in characterizing resting energy expenditure in obesity and after weight loss. Front Physiol. 2013;4:47. PubMed ID: 23532370 doi:10.3389/fphys.2013.00047

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Stellingwerff T, Morton JP, Burke LM. A framework for periodized nutrition for athletics. Int J Sport Nutr Exerc Metab. 2019;29(2):141151. PubMed ID: 30632439 doi:10.1123/ijsnem.2018-0305

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Mallinson RJ, Williams NI, Olmsted MP, Scheid JL, Riddle ES, De Souza MJ. A case report of recovery of menstrual function following a nutritional intervention in two exercising women with amenorrhea of varying duration. J Int Soc Sports Nutr. 2013;10(1):34. PubMed ID: 23914797 doi:10.1186/1550-2783-10-34

    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 2864 841 47
Full Text Views 204 157 1
PDF Downloads 102 34 1