Menstrual dysfunction is more prevalent in young Finnish athletes than it is among non-athletes of a similar age, but athletes experience less body weight dissatisfaction than non-athletes do. These findings are from a recent study at the Faculty of Sport and Health Sciences at the University of Jyväskylä, Finland. The study was conducted among members of sports clubs who exercised at least four times a week (athletes) and non-members (non-athletes).
The current study used data from the Finnish Health Promoting Sports Club (FHPSC) study, in which a cohort of athletes and non-athletes in adolescence (14-16 years) and subsequently in young adulthood (18-20 years) were investigated.
The findings of the study showed that in adolescence, 18% of both athletes and non-athletes reported menstrual dysfunction. However, 8% of the athletes reported primary amenorrhea (absence of menses by the age of 15) in contrast to the non-athletes group, where the prevalence of primary amenorrhea was 0%. In young adulthood, the prevalence of menstrual dysfunction in athletes was 39%, while 6% of the non-athletes reported menstrual dysfunction. In this study, menstrual dysfunction was defined as follows: primary amenorrhea, prolonged menstrual cycle (>35 days) or absence of menses for at least three consecutive months (secondary amenorrhea).
“We did not investigate the reasons for menstrual dysfunction, but we know from previous studies that one of the most common reasons for menstrual dysfunction is low energy availability (i.e., inadequate energy intake relative to exercise energy expenditure),” explains Suvi Ravi, the corresponding author and a PhD student at the Faculty of Sport and Health Sciences.
“The human body is wise, and in this kind of situation it allocates energy to the functions essential for survival and reduces energy allocation for the systems that are not so essential for life, such as reproductive function.”
The present study also assessed body weight dissatisfaction among the participants. The results showed that athletes were more satisfied with their weight and had less desire to lose weight than non-athletes did. Despite this, in both age groups about 20% of the athletes and about 40% of the non-athletes reported body weight dissatisfaction.
“This is concerning since we know that body weight dissatisfaction can result in disordered eating,” Ravi says.
“Attention should be paid to young people’s body weight dissatisfaction as well as menstrual dysfunction in order to prevent future health problems, such as disordered eating and impaired bone mineral density, which can result from low energy availability and menstrual dysfunction.”
Two decades of research among female athletes over the age of 13 years shows that a lack of nutrition knowledge about what they need to eat to stay healthy and compete may contribute to poor performance, low energy and nutrient intake, and potential health risks, according to a Rutgers Robert Wood Johnson Medical School study.
Mary Downes Gastrich, associate professor at the school, who recently published a review study in the Journal of Women’s Health, talks about why female athletes often do not meet their nutritional requirements and energy needs, ranging from a lack of education and poor time management skills to chronic dieting and disordered eating behaviors.
What were the main reasons found for nutritional deficiencies and low energy?
In our comprehensive literature review, prior studies have found a lack of general knowledge of nutrition among athletes, coaches and other sports team specialists. Other factors included poor time management and food availability, disordered eating behaviors such as chronic dieting or a drive for lower body weight. Some female athletes may purposefully restrict their calorie intake for performance or aesthetic reasons, while others may unintentionally have low energy expenditure due to increased training or lack of education on how to properly fuel themselves for their sports’ demands.
In addition, specific sports, such as gymnastics, distance running, diving, figure skating and classical ballet emphasize a low body weight; thus, making these athletes at greater risk for inadequate calorie consumption, poor body image, disordered eating or a serious mental health disorder diagnosis of an eating disorder such as anorexia nervosa or bulimia nervosa.
What nutritional deficiencies did the studies show?
Current studies suggest that female athletes’ diets are often not optimal for the types and amounts of carbohydrates, fats and total energy intake. However, we found that most female athletes — other than those who participate in sports promoting leanness, such as dancing, swimming and gymnastics — may be consuming adequate protein needs.
When the energy and nutrients from the foods consumed does not match the level of energy expenditure in the sport and nutrient needs for proper body function and growth, it can affect female athletes’ bone health and reproductive system. Deficiencies in vitamin D, zinc, calcium, magnesium and B vitamins can occur from exercise-related stress and inadequate dietary intakes. Recent reports suggest that up to 42% of female athletes have insufficient vitamin D levels and up to 90% fall short of the adequate intake for calcium. These two deficiencies can increase the risk of bone stress fractures and also place these athletes at risk for osteoporosis later in life.
Diminished bone mineral density can increase the risk of fracture from repetitive stress on the bones during training and competition. The age that sport training begins is an important factor influencing bone mineral density. A study of teen and young adult female elite gymnasts found that the earlier the age of strenuous exercise, the more negative the effect on bone acquisition later on in life.
Female athletes with insufficient diets, who regularly miss menstruation or have a low body mass index should supplement their diet with the recommended 1500?milligrams of calcium a day as well as other dietary supplements, including vitamin D for bone health and optimal calcium absorption. However, for safety reasons, all athletes should consult their physician and/or a registered dietitian nutritionist before taking any dietary supplements.
In addition, insufficient iron consumption may lead to iron deficiency anemia, which is more common in females participating in intense training, like distance running, due to the potential for additional loss of iron through urine, the rupture of red blood cells and gastrointestinal bleeding.
What is “disordered eating” and what role does it play?
To optimize their performance, some female athletes often strive to maintain or reach a low body weight, which may be achieved by unhealthy dieting. Such “disordered eating” can include various unhealthy eating behaviors, including chronic dieting, excessive calorie counting, food-related anxiety and use of laxatives, which could potentially result in a more serious clinical diagnosis of an eating disorder.
Prior work has shown a higher prevalence of eating disorders among female athletes competing in leanness sports, such as dancing, swimming and gymnastics, compared with female athletes competing in non-leanness sports, such as basketball, tennis or volleyball.
What can be done to improve nutrition in female athletes?
Our review from prior studies suggests that the nutrition status of female athletes needs to be more closely monitored due to greater risks of disordered eating, low energy availability and its effects on performance, as well as lack of accurate sports nutrition knowledge.
Interdisciplinary teams — including physicians, registered dietitian nutritionists, psychologists, parents and coaches — would be beneficial in screening, counseling and helping female athletes improve their overall diet, performance and health. These teams should be regularly trained on the negative health effects of inadequate calorie intake on both performance and long-term health. Early detection of low energy availability is essential in preventing further health issues, and diagnosed stress injuries should be considered a red flag, signaling further evaluation.
LAWRENCE — For most people, exercise is healthy for both body and mind. Hours spent jogging, bike riding or lifting weights can elevate mood, boost heart health, build muscle and spur weight loss.
Yet the last of these supposed workout benefits — weight loss — is problematic for people living with an eating disorder such as anorexia nervosa or bulimia nervosa. Both eating disorders are marked by distorted negative perceptions of one’s body and often a compulsive desire to lose weight.
“Excessive exercise is a behavior people with eating disorders can engage in without anybody really noticing that they’re doing something that could be harmful,” said Danielle Chapa, a doctoral student at the Center for the Advancement of Research on Eating Behaviors in the University of Kansas Department of Psychology. “With excessive-exercise behavior, people may be exercising with extreme intensity, for two or more hours, or when they have a fever or when they’re injured. Exercise can be a compulsive behavior — something they have to do. It’s problematic because it could make recovery from an eating disorder a much longer process. There’s also a lot of medical complications that go along with excessive exercise — for instance, increased susceptibility to injury.”
Now, with an $84,940 award from the National Institute of Mental Health, Chapa will investigate the causes and effects of excessive exercise on study participants who are experiencing eating disorders. The investigation, called the FuEL Study (Function of Unhealthy Exercise in Everyday Life), represents Chapa’s doctoral thesis. She hopes it also will expand the tools available to clinicians to help diagnose and treat eating disorders when lives hang in the balance — 20,000 people die each year from eating disorders due to medical complications or suicide.
“Eating disorders have the highest mortality rate out of all other mental health conditions,” Chapa said. “That mortality number comes from death by suicide but also deaths from medical complications associated with eating disorders. It’s really important that we understand excessive-exercise behavior in people with eating disorders, because it can significantly prolong their recovery — and it’s usually missed. Excessive exercise is not always treated in interventions for eating disorders, because it may go unnoticed.”
Chapa now is recruiting 80 participants at firstname.lastname@example.org. She hopes to better understand the emotional function of excessive exercise in those living with eating disorders, as well as “moment-to-moment predictors” of unhealthy exercise. People in the study will be prompted via smartphone to track their emotional state for seven days.
“We’re interested in seeing how affect changes in relation to exercise — so we’re looking at the hours before somebody exercises,” she said. “How is their affect changing? And then in the hours after exercise, how is their affect changing?”
For a week, each participant in Chapa’s study will receive random surveys via a mobile-phone app every few hours.
“We want to see what their mood is at each of those surveys,” she said. “With enough surveys throughout the day, we can see how affect changes.”
To track exercise, the same participants will wear a research-grade activity monitor for the duration of their participation, allowing Chapa to detect relationships between participants’ emotional states and the timing and intensity of their exercise.
“The Actigraph will collect things like number of steps that a person takes, how long a person is physically active and the level of intensity of their physical activity — if it’s moderate or vigorous,” she said. “We’ll also use that data to identify when exercise occurred in the day, because you get an exact time of exercise. We can then combine the Actigraph data with information we get from the surveys.”
At the end of each day, participants will log information about overall health and injuries.
Chapa, who works with people experiencing eating disorders in a clinical setting as part of her KU doctoral work, said she hoped her study would produce data that someday could underpin effective interventions for excessive exercise as a follow up to her project.
“In this study, we aim to understand what triggers excessive exercise and if there are individual differences,” she said. “If we can predict when someone is going to engage in excessive exercise, then we could send them a quick text message through an app that suggests maybe they use another coping skill rather than exercising excessively. If we know what triggers excessive exercise, we can build these personalized interventions that provide additional support to persons with eating disorders throughout the day.”