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Nancy I. Williams, Clara V. Etter and Jay L. Lieberman

An understanding of the health consequences of abnormal menstrual function is an important consideration for all exercising women. Menstrual disturbances in exercising women are quite common and range in severity from mild to severe and are often associated with bone loss, low energy availability, stress fractures, eating disorders, and poor performance. The key factor that causes menstrual disturbances is low energy availability created by an imbalance of energy intake and energy expenditure that leads to an energy deficit and compensatory metabolic adaptations to maintain energy balance. Practical guidelines for preventing and treating amenorrhea in exercising women include evidence-based dietary practices designed to achieve optimal energy availability. Other factors such as gynecological age, genetics, and one’s susceptibility to psychological stress can modify an individual’s susceptibility to menstrual disturbances caused by low energy availability. Future research should explore the magnitude of these effects in an effort to move toward more individualized prevention and treatment approaches.

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Laurie Stickler, Trisha Armstrong, Alyssa Polso and Melissa Smith

Context:

Low energy availability has been identified through research as the cornerstone of the female athlete triad, yet reasons for nutritional choices among female collegiate athletes are poorly understood.

Objective:

To explore the perspectives of female collegiate cross country runners on eating behaviors and attitudes toward health.

Design:

Phenomenologic qualitative study with individual, semistructured interviews.

Methods:

Ten collegiate female cross country runners, ages 18–22, participated in the study. All interviews were audiotaped then transcribed. Three researchers independently coded data and developed themes and subthemes before meeting and negotiating findings.

Results:

The following four themes were identified: health behaviors, nutritional knowledge, internal and external factors, and health attitudes.

Conclusions:

This study contributes to understanding “the why” behind health behaviors of female collegiate cross country runners. This developmental understanding may assist in interpreting the behavioral causes of low energy availability; thus, both management and prevention of the triad may be aided by this information.

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Steven J. Howard, Caylee J. Cook, Rihlat Said-Mohamed, Shane A. Norris and Catherine E. Draper

Background:

An area of growth in physical activity research has involved investigating effects of physical activity on children’s executive functions. Many of these efforts seek to increase the energy expenditure of young children as a healthy and low-cost way to affect physical, health, and cognitive outcomes.

Methods:

We review theory and research from neuroscience and evolutionary biology, which suggest that interventions seeking to increase the energy expenditure of young children must also consider the energetic trade-offs that occur to accommodate changing metabolic costs of brain development.

Results:

According to Life History Theory, and supported by recent evidence, the high relative energy-cost of early brain development requires that other energy-demanding functions of development (ie, physical growth, activity) be curtailed. This is important for interventions seeking to dramatically increase the energy expenditure of young children who have little excess energy available, with potentially negative cognitive consequences. Less energy-demanding physical activities, in contrast, may yield psychosocial and cognitive benefits while not overburdening an underweight child’s already scarce energy supply.

Conclusions:

While further research is required to establish the extent to which increases in energy-demanding physical activities may compromise or displace energy available for brain development, we argue that action cannot await these findings.

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contraceptive pill or pharmaceutical agents for treating low bone density in female athletes. Rather, increasing energy availability and weight gain are more effective strategies, with bone strength improvements reported over one to six years. There is scant evidence on the long-term bone health in female

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Taylor K. Wise

athletic trainers), be educated on energy availability, healthy eating, nutrition, and the risks of dieting so that they are better able to detect unhealthy eating behaviors and explore treatment options ( Mountjoy et al., 2014 ). Another risk specific to athletes is that DE can be maintained by approval

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Jenny H. Conviser, Amanda Schlitzer Tierney and Riley Nickols

(DEBs) influence energy availability and increase the risk of a health syndrome known as “Relative Energy Deficiency in Sport” or “RED-S” ( Mountjoy et al., 2017 ). RED-S occurs when energy expenditure exceeds energy intake, creating an energy deficiency and a resulting compromise in health systems

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Laura K. Fewell, Riley Nickols, Amanda Schlitzer Tierney and Cheri A. Levinson

suggest that increased nutritional intake, reduction in excessive exercise, or a combination of both remedied low energy availability and facilitated strength improvements. In the full sample, VO 2 max and vertical jump did not significantly differ from admission to discharge. VO 2 max was measured via