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Stephen S. Cheung

potentially vital spice in the overall appeal of sports for the general public. But despite the competitions happening in the heat of summer every year, the Australian Open’s extreme heat policy is brief to the point of being meaningless, with any and all decisions left completely to the referee’s discretion

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Brandy S. Cowell, Christine A. Rosenbloom, Robert Skinner and Stephanie H. Summers

Iron deficiency is the most prevalent nutritional deficiency in the United States. This condition has been reported to affect 60% of female athletes. The Centers for Disease Control and Prevention emphasize screening for anemia in women of childbearing age. The purpose of this study was to determine the number of National Collegiate Athletic Association (NCAA) Division I-A schools that implement screening for iron deficiency in female athletes as well as the screening policies for those who do. A link to an online survey was sent to 94 NCAA Division I-A schools to determine current practices concerning screening and treating female athletes for iron deficiency. There was a 58% response rate. Frequencies for each response were computed. Forty-three percent of responding institutions report screening female athletes for iron deficiency. This study suggests that screening for iron deficiency in female athletes at NCAA Division I-A schools is not a routine procedure and, for those who do screen, variability exists in the criteria for diagnosis, as well as in treatment protocols. Standard protocols for assessment and treatment of iron deficiency in female athletes need to be developed and implemented.

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Nessan Costello, Jim McKenna, Louise Sutton, Kevin Deighton and Ben Jones

perform a behavior. Surrounding the COM-B are nine intervention functions (education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement) and seven policy categories (communication/marketing, guidelines; fiscal measures, regulation

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Martin C. Waller, Deborah A. Kerr, Martyn J. Binnie, Emily Eaton, Clare Wood, Terreen Stenvers, Daniel F. Gucciardi, Carmel Goodman and Kagan J. Ducker

supplement programs. Therefore, gaining an understanding of the level of knowledge that athletes possess regarding supplements and the policies that guide their use is important in guiding education programs to combat or reinforce current supplement behaviors. Recent reports have suggested that 15–30% of

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Andrew C. Cornett and Joel M. Stager

It has been hypothesized that large differences in maximal performance can arise between various geopolitical regions solely on the basis of differing numbers of participants in the target activity. While there is evidence in support of this hypothesis for a measure of intellectual performance, the same relationship has not been examined for a measure of physical performance.


To determine whether the number of participants is a predictor of the best athletic performance in a region.


The 2005–2010 USA Swimming Age Group Detail reports were used to determine the number of competitive swimmers participating in each age group for the 59 local swimming communities in the United States. The USA Swimming performance database provided 50-yd-freestyle times in each community for boys and girls for each age (6–19 y). Simple linear regression was used to examine the relationship between the outcome variable (fastest time) and the predictor variable (log of the number of swimmers) for each combination of age, sex, and calendar year.


The log of the number of swimmers in a region was a significant predictor of the best performance in that region for all 168 combinations of age, sex, and calendar year (P < .05) and explained, on average, 41%, and as much as 62%, of the variance in the fastest time.


These findings have important implications for the development of regional sport strategic policy. Increasing the number of participants in the target activity appears a viable strategy for improving regional performance.

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David B. Pyne, Joshua H. Guy and Andrew M. Edwards

Heat and immune stress can affect athletes in a wide range of sports and environmental conditions. The classical thermoregulatory model of heat stress has been well characterized, as has a wide range of practical strategies largely centered on cooling and heat-acclimation training. In the last decade evidence has emerged of an inflammatory pathway that can also contribute to heat stress. Studies are now addressing the complex and dynamic interplay between hyperthermia, the coagulation cascade, and a systemic inflammatory response occurring after transient damage to the gastrointestinal tract. Damage to the intestinal mucosal membrane increases permeability, resulting in leakage of endotoxins into the circulation. Practical strategies that target both thermoregulatory and inflammatory causes of heat stress include precooling; short-term heat-acclimation training; nutritional countermeasures including hydration, energy replacement, and probiotic supplementation; pacing strategies during events; and postevent cooling measures. Cooperation between international, national, and local sporting organizations is required to ensure that heat-management policies and strategies are implemented effectively to promote athletes’ well-being and performance.

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Louise M. Burke, Linda M. Castell, Douglas J. Casa, Graeme L. Close, Ricardo J. S. Costa, Ben Desbrow, Shona L. Halson, Dana M. Lis, Anna K. Melin, Peter Peeling, Philo U. Saunders, Gary J. Slater, Jennifer Sygo, Oliver C. Witard, Stéphane Bermon and Trent Stellingwerff

The International Association of Athletics Federations recognizes the importance of nutritional practices in optimizing an Athlete’s well-being and performance. Although Athletics encompasses a diverse range of track-and-field events with different performance determinants, there are common goals around nutritional support for adaptation to training, optimal performance for key events, and reducing the risk of injury and illness. Periodized guidelines can be provided for the appropriate type, amount, and timing of intake of food and fluids to promote optimal health and performance across different scenarios of training and competition. Some Athletes are at risk of relative energy deficiency in sport arising from a mismatch between energy intake and exercise energy expenditure. Competition nutrition strategies may involve pre-event, within-event, and between-event eating to address requirements for carbohydrate and fluid replacement. Although a “food first” policy should underpin an Athlete’s nutrition plan, there may be occasions for the judicious use of medical supplements to address nutrient deficiencies or sports foods that help the athlete to meet nutritional goals when it is impractical to eat food. Evidence-based supplements include caffeine, bicarbonate, beta-alanine, nitrate, and creatine; however, their value is specific to the characteristics of the event. Special considerations are needed for travel, challenging environments (e.g., heat and altitude); special populations (e.g., females, young and masters athletes); and restricted dietary choice (e.g., vegetarian). Ideally, each Athlete should develop a personalized, periodized, and practical nutrition plan via collaboration with their coach and accredited sports nutrition experts, to optimize their performance.

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Mindy Millard-Stafford, Ann E. Swanson and Matthew T. Wittbrodt

Men outperform women in sports requiring muscular strength and/or endurance, but the relative influence of “nurture” versus “nature” remains difficult to quantify. Performance gaps between elite men and women are well documented using world records in second, centimeter, or kilogram sports. However, this approach is biased by global disparity in reward structures and opportunities for women. Despite policies enhancing female participation (Title IX legislation), US women only closed performance gaps by 2% and 5% in Olympic Trial swimming and running, respectively, from 1972 to 1980 (with no change thereafter through 2016). Performance gaps of 13% in elite middistance running and 8% in swimming (∼4-min duration) remain, the 5% differential between sports indicative of load carriage disadvantages of higher female body fatness in running. Conversely, sprint swimming exhibits a greater sex difference than sprint running, suggesting anthropometric/power advantages unique to swim-block starts. The ∼40-y plateau in the performance gap suggests a persistent dominance of biological influences (eg, longer limb levers, greater muscle mass, greater aerobic capacity, and lower fat mass) on performance. Current evidence suggests that women will not swim or run as fast as men in Olympic events, which speaks against eliminating sex segregation in these individual sports. Whether hormone reassignment sufficiently levels the playing field in Olympic sports for transgender females (born and socialized male) remains an issue to be tackled by sport-governing bodies.

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Oliver R. Barley, Dale W. Chapman and Chris R. Abbiss

Context: Combat sports are typically divided into weight classes, and body-mass manipulation to reach a weight class is commonplace. Previous research suggests that weight loss practices in mixed martial arts (MMA) may be more extreme than in other combat sports. Purpose : To investigate the magnitude of weight loss and the prevalence of weight loss strategies in different combat sports. Methods: Competitors (N = 637) from Brazilian jiu-jitsu, boxing, judo, MMA, Muay Thai/kickboxing, taekwondo, and wrestling completed an online questionnaire seeking information regarding their weight loss practices. Results: Body-mass manipulation was commonly undertaken by all combat-sport athletes, with a particularly high incidence of gradual dieting, increased exercise, and fluid restriction. Skipping meals was higher in taekwondo and wrestling (84%) compared with the other combat sports (∼58%), whereas training in heated rooms and forced oral fluid loss (spitting) was higher in wrestling (83% and 47%, respectively) compared with other combat sports (∼45% and ∼19%, respectively). MMA athletes reported the highest usage of sauna (76%) and water loading (67%) while also reporting the second-highest use of training in rubber/plastic suits (63%). Conclusions: Body-mass manipulation was present in all combat sports, with the prevalence and magnitude of acute weight loss greater in MMA. The incidence of and practices reported will help support staff be fully aware of the variety of methods these athletes and coaches may use to achieve weight loss. Additionally, the results could aid regulatory bodies in the further development of policies on weight cutting.

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Emily C. Borden, William J. Kraemer, Bryant J. Walrod, Emily M. Post, Lydia K. Caldwell, Matthew K. Beeler, William H. DuPont, John Paul Anders, Emily R. Martini, Jeff S. Volek and Carl M. Maresh

Purpose: To evaluate the changes in the state of hydration in elite National Collegiate Athletic Association (NCAA) Division I college wrestlers during and after a season. Methods: Ohio State University wrestling team members (N = 6; mean [SD] age = 19.6 [1.1] y; height = 171.6 [2.9] cm; body mass = 69.5 [8.1] kg) gave informed consent to participate in the investigation with measurements (ie, body mass, urine-specific gravity [USG; 2 methods], Visual Analog Scale thirst scale, plasma osmolality) obtained during and after the season. Results: Measurements for USG, regardless of methods, were not significantly different between visits, but plasma osmolality was significantly (P = .001) higher at the beginning of the season—295.5 (4.9) mOsm·kg−1 compared with 279.6 (6.1) mOsm·kg−1 after the season. No changes in thirst ratings were observed, and the 2 measures of USG were highly correlated (r > .9, P = .000) at each time point, but USG and plasma osmolality were not related. Conclusions: A paradox in the clinical interpretation of euhydration in the beginning of the season was observed with the USG, indicating that the wrestlers were properly hydrated, while the plasma osmolality showed they were not. Thus, the tracking of hydration status during the season is a concern when using only NCAA policies and procedures. The wrestlers did return to normal euhydration levels after the season on both biomarkers, which is remarkable, as previous studies have indicated that this may not happen because of the reregulation of the osmol-regulatory center in the brain.