Strenuous exercise is synonymous with disturbing gastrointestinal integrity and function, subsequently prompting systemic immune responses and exercise-associated gastrointestinal symptoms, a condition established as “exercise-induced gastrointestinal syndrome.” When exercise stress and aligned exacerbation factors (i.e., extrinsic and intrinsic) are of substantial magnitude, these exercise-associated gastrointestinal perturbations can cause performance decrements and health implications of clinical significance. This potentially explains the exponential growth in exploratory, mechanistic, and interventional research in exercise gastroenterology to understand, accurately measure and interpret, and prevent or attenuate the performance debilitating and health consequences of exercise-induced gastrointestinal syndrome. Considering the recent advancement in exercise gastroenterology research, it has been highlighted that published literature in the area is consistently affected by substantial experimental limitations that may affect the accuracy of translating study outcomes into practical application/s and/or design of future research. This perspective methodological review attempts to highlight these concerns and provides guidance to improve the validity, reliability, and robustness of the next generation of exercise gastroenterology research. These methodological concerns include participant screening and description, exertional and exertional heat stress load, dietary control, hydration status, food and fluid provisions, circadian variation, biological sex differences, comprehensive assessment of established markers of exercise-induced gastrointestinal syndrome, validity of gastrointestinal symptoms assessment tool, and data reporting and presentation. Standardized experimental procedures are needed for the accurate interpretation of research findings, avoiding misinterpreted (e.g., pathological relevance of response magnitude) and overstated conclusions (e.g., clinical and practical relevance of intervention research outcomes), which will support more accurate translation into safe practice guidelines.
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Assessment of Exercise-Associated Gastrointestinal Perturbations in Research and Practical Settings: Methodological Concerns and Recommendations for Best Practice
Ricardo J.S. Costa, Pascale Young, Samantha K. Gill, Rhiannon M.J. Snipe, Stephanie Gaskell, Isabella Russo, and Louise M. Burke
Energy Availability Over One Athletic Season: An Observational Study Among Athletes From Different Sports
Filipe Jesus, Mónica Sousa, Catarina L. Nunes, Ruben Francisco, Paulo Rocha, Cláudia S. Minderico, Luís B. Sardinha, and Analiza M. Silva
During the athletic season, changes in body composition occur due to fluctuations in energy expenditure and energy intake. Literature regarding changes of energy availability (EA) is still scarce. The aim was to estimate EA of athletes from nonweight and weight-sensitive sports during the athletic season (i.e., preparatory and competitive phase). Eighty-eight athletes (19.1 ± 4.2 years, 21.8 ± 2.0 kg/m2, 27% females, self-reported eumenorrheic) from five sports (basketball [n = 29]; handball [n = 7]; volleyball [n = 9]; swimming [n = 18]; and triathlon [n = 25]) were included in this observational study. Energy intake and exercise energy expenditure were measured through doubly labeled water (over 7 days and considering neutral energy balance) and metabolic equivalents of tasks, respectively. Fat-free mass (FFM) was assessed through a four-compartment model. EA was calculated as EA = (energy intake − exercise energy expenditure)/FFM. Linear mixed models, adjusted for sex, were performed to assess EA for the impact of time by sport interaction. Among all sports, EA increased over the season: basketball, estimated mean (SE): 7.2 (1.5) kcal/kg FFM, p < .001; handball, 14.8 (2.9) kcal/kg FFM, p < .001; volleyball, 7.9 (2.8) kcal/kg FFM, p = .006; swimming, 8.7 (2.0) kcal/kg FFM, p < .001; and triathlon, 9.6 (2.0) kcal/kg FFM, p < .001. Eleven athletes (12.5%) had clinical low EA at the preparatory phase and none during the competitive phase. During both assessments, triathletes’ EA was below optimal, being lower than basketballers (p < .001), volleyballers (p < .05), and swimmers (p < .001). Although EA increased in all sports, triathlon’s EA was below optimal during both assessments. Risk of low EA might be seasonal and resolved throughout the season, with higher risk during the preparatory phase. However, in weight-sensitive sports, namely triathlon, low EA is still present.
The Influence of Exercise, Lifestyle Behavior Components, and Physical Fitness on Maternal Weight Gain, Postpartum Weight Retention, and Excessive Gestational Weight Gain
Pedro Acosta-Manzano, Francisco M. Acosta, Irene Coll-Risco, Lidia Romero-Gallardo, Marta Flor-Alemany, Luis J. Martínez-González, María Jesús Alvarez-Cubero, Víctor Segura-Jiménez, and Virginia A. Aparicio
This study examines (a) the influence of exercise, lifestyle behavior components (sedentary time, physical activity, and sleep and dietary patterns), and physical fitness on maternal weight gain, postpartum weight retention, and excessive gestational weight gain and (b) whether exercise protects against the adverse effects of impaired metabolism and nonoptimal body composition related to excessive gestational weight gain. Subjects were assigned to either a supervised concurrent (aerobic + resistance) exercise program followed 3 days/week (n = 47) or a control group (n = 54). Sedentary time, physical activity, sleep and dietary patterns (assessed by accelerometry and questionnaires), muscle strength (handgrip test), and cardiorespiratory fitness (Bruce test) were determined at gestational Weeks 16 and 33 (early-middle and late pregnancy, respectively), and at 6 weeks postpartum. Weight gain and weight retention were calculated using recorded weights at prepregnancy, early-middle, and late pregnancy, and at 6 weeks postpartum. Birth complications, maternal postpartum body composition, cardiometabolic, and inflammatory markers in maternal and umbilical cord arterial and venous blood, and in colostrum, and mature milk were also recorded. The exercise intervention reduced late weight gain (B = −2.7, SE = 0.83, p = .003) and weight retention (B = −2.85, SE = 1.3, p = .03), independent of any lifestyle behavior component or physical fitness, but did not prevent excessive weight gain. Increasing cardiorespiratory fitness, muscle strength, and sleep duration were associated with a smaller mean weight gain and lower excessive weight gain values (p < .05). Among the participants who experienced excessive weight gain, those who were exercisers had a lower body mass index and systemic tumor necrosis factor-alpha concentration, lower umbilical cord venous tumor necrosis factor-alpha and arterial interferon gamma levels, higher cord arterial interleukin-10 levels, and improved placental function compared with controls (p < .05). In summary, exercise may help optimize gestational weight gain and weight retention, and may attenuate the impaired phenotype related to excessive weight gain. Increasing cardiorespiratory fitness, muscle strength, and sleep duration might help to prevent excessive weight gain during pregnancy.
Evening Caffeine Did Not Improve 100-m Swimming Time Trials Performed 60 Min Post-Ingestion or the Next Morning After Sleep
Josh W. Newbury, Bryan Saunders, and Lewis A. Gough
The potential ergogenic benefits of caffeine (CAF) are well known within the athletic community, often leading to its use in adolescent swimming cohorts to enhance their performance. However, it has previously been reported that CAF has sleep-disturbing effects, which could be detrimental to performance over consecutive days in multiday competitions. Moreover, the effects that evening CAF ingestion has on sleep, side effects, and next-day performances are yet to be researched in trained adolescents. In a double-blind, randomized, crossover design, eight national-level swimmers (age: 18 ± 1 years, height: 1.76 ± 0.06 cm, body mass [BM]: 69.4 ± 6.4 kg) ingested a capsule containing 3 mg/kg BM CAF or a placebo 60 min before an evening 100-m swimming time trial. The next morning, sleep was analyzed (Core Consensus Sleep Diary) and 100-m time trials were repeated. Side effects were analyzed via visual analog scales throughout the study. No differences were found for swimming performance (p = .911) in the evening (CAF: 59.5 ± 7.8 s, placebo: 59.9 ± 7.9 s, g = 0.06) or morning (CAF: 59.7 ± 7.7 s, placebo: 60.2 ± 7.9 s, g = 0.07). In addition, no group differences were found for any subjective side effects (e.g., anxiety: p = .468, tachycardia: p = .859, alertness: p = .959) or sleep parameters (e.g., sleep latency: p = .395, total sleep time: p = .574). These results question the use of a standardized 3 mg/kg BM CAF ingestion strategy for 100-m swimming time trials in trained adolescents, although objective measures may be needed to confirm that CAF does not affect sleep within this cohort.
Volume 32 (2022): Issue 4 (Jul 2022)
Comment on: “Association of Vitamin D Supplementation in Cardiorespiratory Fitness and Muscle Strength in Adult Twins: A Randomized Controlled Trial”
Nicholas B. Tiller
Retraction: Medeiros et al. (2022)
James A. Betts
Fat-Free Mass Using Bioelectrical Impedance Analysis as an Alternative to Dual-Energy X-Ray Absorptiometry in Calculating Energy Availability in Female Adolescent Athletes
Ivy Evangelista Ramos, Gabriela Morgado Coelho, Haydée Serrão Lanzillotti, Elisabetta Marini, and Josely Correa Koury
Energy availability (EA) is calculated by subtracting exercise energy expenditure from energy intake, adjusted for fat-free mass (FFM) obtained using accurate methods, such as dual-energy X-ray absorptiometry (DXA). Unlike DXA, the bioelectrical impedance analysis (BIA) is low in cost, simple and easy to carry out. This study aimed to test the concordance between the calculation of EA using FFM values from four BIA predictive equations and FFM obtained using DXA in female adolescent athletes (n = 94), recruited via social media. Paired Student’s t test, Wilcoxon test, Lin’s concordance correlation coefficient, root mean square error, limits of agreement, and mean absolute percentage error were used to evaluate agreement between the FFM values obtained by the four SF-BIA predictive equations and DXA. Regression linear analysis was used to determine the relation between FFM values obtained using DXA and the BIA predictive equations. Standardized residuals of the FFM and EA were calculated considering DXA values as reference. The most appropriate model for the FFM (limits of agreement = 4.0/−2.6 kg, root mean square error = 1.9 kg, mean absolute percentage error = 4.34%, Lin’s concordance correlation coefficient = .926) and EA (limits of agreement = 2.51/4.4 kcal·kg FFM−1·day−1, root mean square error = 1.8 kcal·kg FFM−1·day−1, mean absolute percentage error 4.24%, Lin’s concordance correlation coefficient = .992) was the equation with sexual maturity as a variable, while the equation with the greatest age variability was the one with the lowest agreement. FFM-BIA predictive equations can be used to calculate EA of female adolescent athletes. However, the equation should be chosen considering sex, age, and maturation status. In the case of athletes, researchers should use equations developed for this group.
Restrictive Eating and Prior Low-Energy Fractures Are Associated With History of Multiple Bone Stress Injuries
Sarah Gehman, Kathryn E. Ackerman, Signe Caksa, Sara E. Rudolph, Julie M. Hughes, Margaret Garrahan, Adam S. Tenforde, Mary L. Bouxsein, and Kristin L. Popp
Bone stress injuries (BSIs) are common among athletes and have high rates of recurrence. However, risk factors for multiple or recurrent BSIs remain understudied. Thus, we aimed to explore whether energy availability, menstrual function, measures of bone health, and a modified Female Athlete Triad Cumulative Risk Assessment (CRA) tool are associated with a history of multiple BSIs. We enrolled 51 female runners (ages 18–36 years) with history of ≤1 BSI (controls; n = 31) or ≥3 BSIs (multiBSI; n = 20) in this cross-sectional study. We measured lumbar spine, total hip, and femoral neck areal bone mineral density by dual-energy X-ray absorptiometry, bone material strength index using impact microindentation, and volumetric bone mineral density, microarchitecture, and estimated strength by high-resolution peripheral quantitative computed tomography. Participants completed questionnaires regarding medical history, low-energy fracture history, and disordered eating attitudes. Compared with controls, multiBSI had greater incidence of prior low-energy fractures (55% vs. 16%, p = .005) and higher modified Triad CRA scores (2.90 ± 2.05 vs. 1.84 ± 1.59, p = .04). Those with multiBSI had higher Eating Disorder Examination Questionnaire (0.92 ± 1.03 vs. 0.46 ± 0.49, p = .04) scores and a greater percentage difference between lowest and highest body mass at their current height (15.5% ± 6.5% vs. 11.5% ± 4.9% p = .02). These preliminary findings indicate that women with a history of multiple BSIs suffered more prior low-energy fractures and have greater historical and current estimates of energy deficit compared with controls. Our results provide strong rationale for future studies to examine whether subclinical indicators of energy deficit contribute to risk for multiple BSIs in female runners.
