59 results on '"Michelle T. Barrack"'
Search Results
2. The Path Towards Progress: A Critical Review to Advance the Science of the Female and Male Athlete Triad and Relative Energy Deficiency in Sport
- Author
-
Mary Jane De Souza, Madhusmita Misra, Elizabeth Joy, Michelle T. Barrack, Mark R. Hutchinson, Emily A Ricker, Kristen J. Koltun, Nancy I. Williams, Nicole C.A. Strock, and Aurelia Nattiv
- Subjects
Female athlete triad ,Gerontology ,medicine.medical_specialty ,biology ,Sports medicine ,Athletes ,media_common.quotation_subject ,Energy (esotericism) ,Physical Therapy, Sports Therapy and Rehabilitation ,medicine.disease ,biology.organism_classification ,Affect (psychology) ,Triad (sociology) ,medicine ,Orthopedics and Sports Medicine ,Quality (business) ,Psychology ,Relative energy ,media_common - Abstract
Energy status plays a key role in the health of athletes and exercising individuals. Energy deficiency/low energy availability (EA), referring to a state in which insufficient energy intake and/or excessive exercise energy expenditure has resulted in compensatory metabolic adaptations to conserve fuel, can affect numerous physiological systems in women and men. The Female Athlete Triad, Male Athlete Triad, and Relative Energy Deficiency in Sport (RED-S) models conceptualize the effects of energy deficiency in athletes, and each model has strengths and limitations. For instance, the Female Athlete Triad model depicts relationships between low EA, reproductive, and bone health, underpinning decades of experimental evidence, but may be perceived as limited in scope, while the more recent RED-S model proposes a wider range of potential health effects of low EA, though many model components require more robust scientific justification. This critical review summarizes current evidence regarding the effects of energy deficiency on athlete health by addressing the quality of the underlying science, the strengths and limitations of each model, and highlighting areas where future research is needed to advance the field. With the health and wellness of athletes and exercising individuals as the overarching priority, we conclude with specific steps that will help focus future research on the Female and Male Athlete Triad and RED-S, and encourage all researchers, clinicians, and practitioners to collaborate to support the common goal of promoting the highest quality science and evidence-based medicine in pursuit of the advancement of athletes’ health, well-being, and performance.
- Published
- 2021
3. Prevalence and factors associated with bone stress injury in middle school runners
- Author
-
Bryan C. Heiderscheit, Brian J. Krabak, Margo Lewis, Kathryn E. Ackerman, William O. Roberts, Mitchell J. Rauh, Emily Kraus, Michelle T. Barrack, Adam S. Tenforde, Alexander C. Wu, Stephanie DeLuca, and Karen L. Troy
- Subjects
Male ,Female athlete triad ,medicine.medical_specialty ,Adolescent ,media_common.quotation_subject ,Osteoporosis ,Population ,Physical Therapy, Sports Therapy and Rehabilitation ,Running ,Bone Density ,Internal medicine ,Prevalence ,medicine ,Humans ,Girl ,Family history ,Child ,education ,Retrospective Studies ,media_common ,Femoral neck ,education.field_of_study ,Schools ,business.industry ,Rehabilitation ,Odds ratio ,medicine.disease ,Confidence interval ,Cross-Sectional Studies ,medicine.anatomical_structure ,Neurology ,Female ,Neurology (clinical) ,business ,human activities - Abstract
BACKGROUND Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. OBJECTIVE To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. DESIGN Retrospective cross-sectional study. SETTING Online survey distributed to middle school runners. METHODS Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. MAIN OUTCOME MEASUREMENTS Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. PARTICIPANTS 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. RESULTS One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p = .004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming
- Published
- 2021
4. Running‐related injuries in middle school cross‐country runners: Prevalence and characteristics of common injuries
- Author
-
William O. Roberts, Michelle T. Barrack, Mitchell J. Rauh, Margo Lewis, Brian J. Krabak, Stephanie DeLuca, Alexander C. Wu, Kathryn E. Ackerman, Bryan C. Heiderscheit, and Adam S. Tenforde
- Subjects
Male ,medicine.medical_specialty ,Shin splints ,Adolescent ,Outcome measurements ,Iliotibial Band Syndrome ,Population ,Physical Therapy, Sports Therapy and Rehabilitation ,Patellofemoral pain ,Injury prevention ,Prevalence ,Humans ,Injury risk ,Medicine ,education ,Retrospective Studies ,education.field_of_study ,Schools ,Cross country ,business.industry ,Rehabilitation ,medicine.disease ,Cross-Sectional Studies ,Neurology ,Athletic Injuries ,Physical therapy ,Female ,Neurology (clinical) ,business ,Ankle sprain ,human activities - Abstract
Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention.To determine the prevalence of running-related injuries and describe factors related to a history of injury.Retrospective cross-sectional study.Survey distributed online to middle school runners.Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation.Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age.Youth runners (total: 2113, average age, 13.2 years; boys: n = 1255, girls: n = 858).Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p .001).Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.
- Published
- 2021
5. The Male Athlete Triad—A Consensus Statement From the Female and Male Athlete Triad Coalition Part II: Diagnosis, Treatment, and Return-To-Play
- Author
-
Andrea Kussman, Elizabeth Joy, Michelle T. Barrack, Emily Kraus, Michael Fredericson, Kristen J. Koltun, Mary Jane De Souza, Madhusmita Misra, Nancy I. Williams, and Aurelia Nattiv
- Subjects
Male ,medicine.medical_specialty ,Consensus ,Adolescent ,Sports medicine ,Osteoporosis ,Physical Therapy, Sports Therapy and Rehabilitation ,Young Adult ,03 medical and health sciences ,Triad (sociology) ,0302 clinical medicine ,Bone Density ,Hypogonadotropic hypogonadism ,Humans ,Relative Energy Deficiency in Sport ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Disordered eating ,biology ,business.industry ,Athletes ,030229 sport sciences ,medicine.disease ,biology.organism_classification ,Return to Sport ,Clinical research ,Physical therapy ,business ,Risk assessment - Abstract
The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic-pituitary-gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.
- Published
- 2021
6. Sport Specialization and Low Bone Mineral Density in Female High School Distance Runners
- Author
-
Jeanne F. Nichols, Michelle T. Barrack, Adam S. Tenforde, Michael D. Rosenthal, and Mitchell J. Rauh
- Subjects
Adolescent ,Physical Therapy, Sports Therapy and Rehabilitation ,Context (language use) ,Standard score ,Logistic regression ,Body Mass Index ,Running ,03 medical and health sciences ,Absorptiometry, Photon ,0302 clinical medicine ,Bone Density ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Original Research ,Bone mineral ,030222 orthopedics ,Schools ,biology ,Athletes ,business.industry ,Body Weight ,030229 sport sciences ,General Medicine ,Odds ratio ,biology.organism_classification ,Confidence interval ,Menstruation ,Bone Diseases, Metabolic ,Cross-Sectional Studies ,Female ,business ,human activities ,Body mass index ,Demography - Abstract
Context Sport specialization may contribute to sport injury and menstrual dysfunction in female high school distance runners. Despite the recent growth in sport specialization, including among high school–aged runners, the association of sport specialization with bone mineral density (BMD) remains poorly described. Objective To evaluate whether sport specialization was associated with BMD in female high school distance runners. Design Cross-sectional study. Setting Six high schools. Patients or Other Participants Sixty-four female runners (age = 15.6 ± 1.4 years) who competed in cross-country or track distance events and were not currently on birth control medication. Main Outcome Measure(s) Each runner completed a survey on menstrual history and sport participation. Height and weight were measured, and dual-energy x-ray absorptiometry was used to measure whole-body, spine, and hip BMD. Each runner was assigned a sport specialization status: low (participation in ≥1 nonrunning sport and distance-running sport(s) for ≤8 mo/y); moderate (participation in both distance-running sport(s) ≥9 mo/y and ≥1 nonrunning sport(s) or limited to distance-running sport(s) for ≤8 mo/y); or high (participation only in distance-running sport(s) for ≥9 mo/y). Multivariable logistic regression was performed to determine the adjusted odds ratio and 95% confidence interval for sport specialization to BMD values, adjusting for body mass index and gynecological age. Results Overall, 21.9%, 37.5%, and 40.6% of participants were high, moderate, or low sport specializers, respectively. Low BMD (spine or whole-body BMD z score < −1.0 [standardized by age and sex normative values]) was present in 23 (35.9%) runners. Compared with low sport specializers, high sport specializers were 5 times more likely (adjusted odds ratio = 5.42, 95% confidence interval = 1.3, 23.3; P = .02) to have low BMD. Conclusions A high level of sport specialization in high school female distance runners may be associated with a heightened risk for low BMD. Further investigation of this association is warranted due to the health concerns about low BMD in adolescent female runners.
- Published
- 2020
7. Prioritized Dietary Supplement Information Needs of 307 NCAA Division I Student Athletes
- Author
-
Virginia Gray, Kelly Smallwood, Michelle T. Barrack, Alaina B. Coffey, Michelle Loy, and Sarah Osterman
- Subjects
Adult ,Male ,Gerontology ,Adolescent ,Sports Nutritional Sciences ,030309 nutrition & dietetics ,Dietary supplement ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,Information needs ,Sports nutrition ,Diet Surveys ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Nutrition information ,0303 health sciences ,Nutrition and Dietetics ,business.industry ,Athletes ,Dietary Supplements ,Female ,Student athletes ,business - Abstract
Objective To evaluate dietary supplement information needs among collegiate athletes. Methods Three hundred seven (n = 154 male; n = 153 female) student athletes participating in a National Collegiate Athletic Association Division I team completed a dietary supplement survey. Qualitative coding addressed open-ended responses, and chi-square test of independence explored differences among athlete subgroups. Results Five themes representing athletes’ information needs included quality/composition (53.5%; n = 77), general information (31.9%; n = 46), nutrition information (30.6%; n = 44), performance (18.8%; n = 27), and body composition (13.2%; n = 19). Athletes with “no” or “minimal” (n = 63), vs “moderate” or “strong” (n = 195), perceived knowledge of supplement safety were more likely to list a question about supplement quality or composition (34.9% [n = 22/63] vs 21.5% [n= 42/195]; P = .03; chi-square = 4.6). Conclusions and Implications Further research is needed to corroborate findings to inform educational efforts and promote safe and effective use of dietary supplements by student athletes.
- Published
- 2020
8. An Investigation of Habitual Dietary Supplement Use Among 557 NCAA Division I Athletes
- Author
-
Terri Lisagor, Jennifer Nguyen, Aaron Rafferty, Mark Muster, and Michelle T. Barrack
- Subjects
Male ,0301 basic medicine ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Universities ,biology ,Athletes ,business.industry ,Dietary supplement ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,Vitamins ,biology.organism_classification ,Article ,03 medical and health sciences ,Cross-Sectional Studies ,0302 clinical medicine ,Environmental health ,Dietary Supplements ,Humans ,Medicine ,Female ,business - Abstract
Supplements may expose athletes to dangerous ingredients, banned substances, toxins or contaminants; however, few investigations assess use among collegiate athletes in the U.S. OBJECTIVE: This cross-sectional study evaluated habitual dietary supplement intake, defined use ≥2 days/week over the past year, in NCAA Division I athletes. METHODS: Male and female members of a NCAA Division I team, at two universities in southern California completed a 13-item survey. Among 705 eligible participants, 596 submitted surveys (84.5% response rate), 557 surveys included complete data. Chi-square (χ(2)) analyses evaluated differences among athletes based on sex, weight status, year in college, and sport-type. Independent t-test or ANOVA evaluated mean differences for continuous variables. RESULTS: A total of 45.2% athletes (n= 252) reported taking supplements (≥2 days/week over the past year). Vitamin/minerals (25.5%, n= 142), protein/amino acids (24.6%, n= 137) were used most frequently. Male, vs. female athletes, took more supplements overall (1.2 ± 0.1 vs. 0.8 ± 0.1, p = 0.004) and indicated higher use of protein/amino acid products (34.2% vs. 13.5%, p
- Published
- 2020
9. Associations Between Sport Specialization, Running-Related Injury, and Menstrual Dysfunction Among High School Distance Runners
- Author
-
Jeanne F. Nichols, Michelle T. Barrack, Mitchell J. Rauh, Adam S. Tenforde, and Michael D. Rosenthal
- Subjects
03 medical and health sciences ,0302 clinical medicine ,business.industry ,Specialization (functional) ,Medicine ,030229 sport sciences ,030212 general & internal medicine ,General Medicine ,business ,Clinical psychology - Published
- 2018
10. Disordered Eating, Development of Menstrual Irregularity, and Reduced Bone Mass Change After a 3-Year Follow-Up In Female Adolescent Endurance Runners
- Author
-
Michelle T. Barrack, Jeanne F. Nichols, Marta D. Van Loan, and Mitchell J. Rauh
- Subjects
medicine.medical_specialty ,Time Factors ,Adolescent ,Medicine (miscellaneous) ,Female adolescent ,Menstrual irregularity ,Running ,Feeding and Eating Disorders ,03 medical and health sciences ,0302 clinical medicine ,Absorptiometry, Photon ,Bone Density ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Disordered eating ,Prospective cohort study ,Bone mineral ,030222 orthopedics ,Nutrition and Dietetics ,Hip ,Lumbar Vertebrae ,business.industry ,Body Weight ,Female Athlete Triad Syndrome ,030229 sport sciences ,General Medicine ,Sports Nutritional Physiological Phenomena ,Physical therapy ,Body Composition ,Physical Endurance ,Amenorrhea ,Female ,medicine.symptom ,business ,Body mass index ,Bone mass ,Follow-Up Studies - Abstract
This prospective study evaluated the 3-year change in menstrual function and bone mass among 40 female adolescent endurance runners (age 15.9 ± 1.0 years) according to baseline disordered eating status. Three years after initial data collection, runners underwent follow-up measures including the Eating Disorder Examination Questionnaire and a survey evaluating menstrual function, running training, injury history, and prior sports participation. Dual-energy X-ray absorptiometry was used to measure bone mineral density and body composition. Runners with a weight concern, shape concern, or global score ≥4.0 or reporting >1 pathologic behavior in the past 28 days were classified with disordered eating. Compared with runners with normal Eating Disorder Examination Questionnaire scores at baseline, runners with disordered eating at baseline reported fewer menstrual cycles/year (6.4 ± 4.5 vs. 10.5 ± 2.8, p = .005), more years of amenorrhea (1.6 ± 1.4 vs. 0.3 ± 0.5, p = .03), and a higher proportion of menstrual irregularity (75.0% vs. 31.3%, p = .02) and failed to increase lumbar spine or total hip bone mineral density at the 3-year follow-up. In a multivariate model including body mass index and menstrual cycles in the past year at baseline, baseline shape concern score (B = −0.57, p value = .001) was inversely related to the annual number of menstrual cycles between assessments. Weight concern score (B = −0.40, p value = .005) was inversely associated with lumbar spine bone mineral density Z-score change between assessments according to a multivariate model adjusting for age and body mass index. These finding support associations between disordered eating at baseline and future menstrual irregularities or reduced accrual of lumbar spine bone mass in female adolescent endurance runners.
- Published
- 2021
11. Dietary Supplement Use According to Sex and Triad Risk Factors in Collegiate Endurance Runners
- Author
-
Andrea Kussman, Emily Kraus, Brian Kim, Francis Dizon, Michael Fredericson, Aurelia Nattiv, Adam S. Tenforde, Michelle T. Barrack, and Sonal Singh
- Subjects
Male ,medicine.medical_specialty ,Cross-sectional study ,Dietary supplement ,Nutritional Status ,Physical Therapy, Sports Therapy and Rehabilitation ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Orthopedics and Sports Medicine ,Disordered eating ,Bone mineral ,business.industry ,030229 sport sciences ,General Medicine ,Vitamins ,Frequent use ,Cross-Sectional Studies ,Dietary Supplements ,Amenorrhea ,Female ,medicine.symptom ,business ,Multivitamin ,human activities - Abstract
Barrack, MT, Fredericson, M, Dizon, F, Tenforde, AS, Kim, BY, Kraus, E, Kussman, A, Singh, S, and Nattiv, A. Dietary supplement use according to sex and Triad risk factors in collegiate endurance runners. J Strength Cond Res 35(2): 404-410, 2021-This cross-sectional study evaluated the prevalence in the use of dietary supplements among elite collegiate runners among 2 NCAA Division I cross-country teams. At the start of each season from 2015 to 2017, male and female endurance runners were recruited to complete baseline study measures; the final sample included 135 (male n = 65, female n = 70) runners. Runners completed a health survey, web-based nutrition survey, and Triad risk assessment. The prevalence of dietary supplement use and Triad risk factors, including disordered eating, low bone mass, amenorrhea (in women), low body mass index, and stress fracture history, was assessed. A total of 78.5% (n = 106) runners reported taking 1 or more supplements on ≥4 days per week over the past month, 48% (n = 65) reported use of ≥3 supplements. Products used with highest frequency included multivitamin/minerals 46.7% (n = 63), iron 46.7% (n = 63), vitamin D 34.1% (n = 46), and calcium 33.3% (n = 45). More women, compared with men, used iron (61.4 vs. 30.8%, p < 0.001) and calcium (41.4 vs. 24.6%, p = 0.04); men exhibited higher use of amino acids and beta-alanine (6.2 vs. 0%, p = 0.04). Runners with bone stress injury (BSI) history, vs. no previous BSI, reported more frequent use of ≥3 supplements (61.5 vs. 32.8%, p = 0.001), vitamin D (49.2 vs. 19.4%, p < 0.001), and calcium (47.7 vs. 19.4%, p = 0.001). Low bone mineral density was also associated with higher use of vitamin D and calcium. Most runners reported regular use of 1 or more supplements, with patterns of use varying based on sex, history of BSI, and bone mass.
- Published
- 2020
12. Prevalence and Predictors of Higher-Risk Supplement Use Among Collegiate Athletes
- Author
-
Mark Muster, Michelle T. Barrack, and John Sassone
- Subjects
Male ,medicine.medical_specialty ,Universities ,Cross-sectional study ,Physical Therapy, Sports Therapy and Rehabilitation ,030204 cardiovascular system & hematology ,Body Mass Index ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Weight loss ,Internal medicine ,Caffeine ,Supplement use ,medicine ,Prevalence ,Humans ,Orthopedics and Sports Medicine ,Young adult ,Motivation ,biology ,business.industry ,Athletes ,030229 sport sciences ,General Medicine ,Odds ratio ,biology.organism_classification ,Confidence interval ,Cross-Sectional Studies ,Dietary Supplements ,Physical therapy ,Female ,Anti-Obesity Agents ,Plant Preparations ,medicine.symptom ,business ,Body mass index - Abstract
Sassone, J, Muster, M, and Barrack, MT. Prevalence and predictors of higher-risk supplement use among National Collegiate Athletic Association Division I athletes. J Strength Cond Res 33(2): 443-450, 2019-This study aimed to identify the prevalence and predictors associated with the use of higher-risk dietary supplements, defined as supplements containing herbal ingredients, caffeine, or those classified for weight loss, muscle-building, or as a preworkout supplement, among 557 National Collegiate Athletic Association Division I male and female collegiate athletes. Although 252 (45.2%) athletes reported the use of a dietary supplement on ≥2 days per week over the past year, 46 (8.3%) athletes met criteria for higher-risk supplement use. Twenty (3.6%) athletes reported the use of herbal, 1 (0.2%) caffeinated, 5 (0.9%) weight loss, 28 (5.0%) preworkout, and 1 (0.2%) muscle-building supplements. Body mass index status (BMI ≥30 kg·m), sport-type (sports using the phosphocreatine energy system), and college year (≥4th year) were associated with the use of preworkout, muscle-building, or herbal supplements. A multiple regression analysis identified predictors of higher-risk supplement use including the number of dietary supplements used in the past year (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.7-2.7, p < 0.001), the reported motivation of taking dietary supplements to gain muscle and lose body fat (OR = 3.5, 95% CI = 1.1-11.7, p = 0.04), and the motivation to increase athletic endurance (OR = 3.5, 95% CI = 4.0, 95% CI = 1.6-9.9, p < 0.005). These factors may be considered as a part of a screening process to evaluate athletes with an increased risk of higher-risk supplement use and potential consequences to health or eligibility status.
- Published
- 2018
13. Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury
- Author
-
Michelle T. Barrack, Sonal Singh, Adam S. Tenforde, Andrea Kussman, Brian Kim, Michael Fredericson, Emily Kraus, Kristin L. Sainani, Aurelia Nattiv, and Megan Deakins-Roche
- Subjects
Female athlete triad ,Male ,medicine.medical_specialty ,Adolescent ,Fractures, Stress ,Baseline risk ,Physical Therapy, Sports Therapy and Rehabilitation ,Rate ratio ,Risk Assessment ,Running ,03 medical and health sciences ,symbols.namesake ,Young Adult ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Poisson regression ,Prospective Studies ,Retrospective Studies ,Bone mineral ,business.industry ,Female Athlete Triad Syndrome ,030229 sport sciences ,General Medicine ,medicine.disease ,Increased risk ,Athletic Injuries ,symbols ,business ,Risk assessment ,human activities ,Cumulative risk assessment - Abstract
ObjectivesBone stress injuries (BSI) are common in runners of both sexes. The purpose of this study was to determine if a modified Female Athlete Triad Cumulative Risk Assessment tool would predict BSI in male distance runners.Methods156 male runners at two collegiate programmes were studied using mixed retrospective and prospective design for a total of 7 years. Point values were assigned using risk assessment categories including low energy availability, low body mass index (BMI), low bone mineral density (BMD) and prior BSI. The outcome was subsequent development of BSI. Statistical models used a mixed effects Poisson regression model with pResults42/156 runners (27%) sustained 61 BSIs over an average 1.9 years of follow-up. In the baseline risk factor model, each 1 point increase in prior BSI score was associated with a 57% increased risk for prospective BSI (p=0.0042) and each 1 point increase in cumulative risk score was associated with a 37% increase in prospective BSI risk (p=0.0079). In the longitudinal model, each 1 point increase in cumulative risk score was associated with a 27% increase in prospective BSI risk (p=0.05). BMI (rate ratio (RR)=1.91, p=0.11) and BMD (RR=1.58, p=0.19) risk scores were not associated with BSI.ConclusionA modified cumulative risk assessment tool may help identify male runners at elevated risk for BSI. Identifying risk factors may guide treatment and prevention strategies.
- Published
- 2018
14. Body Mass-Related Predictors of the Female Athlete Triad Among Adolescent Athletes
- Author
-
Jeanne F. Nichols, Mitchell J. Rauh, Katie J. Thralls, Mark Kern, and Michelle T. Barrack
- Subjects
Gerontology ,Female athlete triad ,medicine.medical_specialty ,Percentile ,Adolescent ,Bone density ,Medicine (miscellaneous) ,Body fat percentage ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,Risk Factors ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Menstruation Disturbances ,Nutrition and Dietetics ,biology ,Athletes ,business.industry ,Body Weight ,Female Athlete Triad Syndrome ,Feeding Behavior ,030229 sport sciences ,General Medicine ,Anthropometry ,biology.organism_classification ,medicine.disease ,Cross-Sectional Studies ,Body Composition ,Female ,Underweight ,medicine.symptom ,business ,Body mass index - Abstract
Early detection of the female athlete triad is essential for the long-term health of adolescent female athletes. The purpose of this study was to assess relationships between common anthropometric markers (ideal body weight [IBW] via the Hamwi formula, youth-percentile body mass index [BMI], adult BMI categories, and body fat percentage [BF%]) and triad components, (low energy availability [EA], measured by dietary restraint [DR], menstrual dysfunction [MD], low bone mineral density [BMD]). In the sample (n = 320) of adolescent female athletes (age 15.9± 1.2 y), Spearman’s rho correlations and multiple logistic regression analyses evaluated associations between anthropometric clinical cutoffs and triad components. All underweight categories for the anthropometric measures predicted greater likelihood of MD and low BMD. Athletes with an IBW ≤85% were nearly 4 times more likely to report MD (OR = 3.7, 95% CI [1.8, 7.9]) and had low BMD (OR = 4.1, 95% CI [1.2, 14.2]). Those in
- Published
- 2016
15. Dietary Intake Patterns And Risk Of Energy Deficiency In Ncaa Endurance Athletes
- Author
-
Megan Roche, Kristen Gravani, Chris Hernandez, Lauren Papanos, Michelle T. Barrack, Erik Grohmann, Catherine Brotman, Andrea Kussman, Dylan Edwin Agans, Michael Fredericson, Aurelia Nattiv, Emily Kraus, and Beth Miller
- Subjects
biology ,Athletes ,business.industry ,Environmental health ,Dietary intake ,Medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,biology.organism_classification ,business ,Energy deficiency - Published
- 2020
16. DESCRIPTIVE STUDY OF INJURIES IN MIDDLE SCHOOL CROSS COUNTRY RUNNERS
- Author
-
Adam S. Tenforde, Alexander C. Wu, Kate G. Ackerman, and Michelle T. Barrack
- Subjects
Gerontology ,Cross country ,Increased risk ,biology ,Athletes ,business.industry ,Medicine ,Orthopedics and Sports Medicine ,Descriptive research ,biology.organism_classification ,business ,Article ,High school athletes - Abstract
Background: High school athletes participating in cross-country sports are at increased risk of overuse injuries. Little is known in younger athletes including those participating in running during middle school regarding prevalence of injuries or related risk factors. The objective of this study was to assess the frequency of sports-related injuries in middle school cross-country runners. Methods: This was a retrospective online survey study of middle school cross-country runners. Middle school cross-country coaches from middle school teams in the Boston area sent letters of invitation via email to the parents of their athletes to participate in an optional, anonymous online survey administered in REDCap. Participants received a $5 gift card for their time. The online survey included demographic information, weight, height, training variables, daily dietary patterns, and injury history. We conducted univariate and bivariate analyses while stratifying for sex. Results: A total of 101 subjects completed the survey, 47% (n=48) were female. Mean age was 12.5 years [SD 0.94], and 24% (n=24) were in sixth grade, 39% (n=39) in seventh grade, and 38 % (n=38) in 8th grade. The mean BMI for girls was 17.9 kg/m2 and for boys 18.24 kg/m2. The self-reported race/ethnicity was white in 72% (n=72), Asian in 22% (n=22), Latino in 5% (n=5), and black in 1% (n=1). Mean weekly mileage during the cross-country season was 15.2 miles [SD 7.6]. Of female subjects, 17% (n=8) reported that they were diagnosed with a bone stress injury (BSI) due to running, compared to 2% (n=1) of male subjects, p=0.009. The injured bones in females included the tibia (n=1), fibula (n=1), navicular (n=1) and metatarsal bones (n=6). The injured bone in the male was a sacral fracture. Compared to those without injury, runners with BSIs did not have observed differences in calcium or vitamin D intake; no differences were observed related to ball sport or other forms of strengthening exercises. A total of 63 non-fracture injuries occurred from running, with females (18%) more likely to have sprained ankles than males (6%, p=0.47). Conclusions/Significance: Running-related injuries are relatively common in middle school cross-country runners. In middle school, female runners are more likely to sustain running related BSIs than male runners. Efforts to prevent overuse stress injuries in middle school runners should be considered. Table. Demographic and injury history of middle school runners N=101 All (n=101) Girls (n=48) Boys (n=53) P value Age (years) 12.45 [0.94] 12.41 [0.81] 12.49 [1.05] 0.66 Grade6th 7th 8th 24% (24)39% (39)38% (38) 22% (11)41% (20)37% (18) 25% (13)37% (19)39% (20) 0.73 Weight (kg) 44.3 [8.08] 42.0 [7.022] 46.4 [8.19] 0.006 Height (cm) 155 [18.4] 150.9 [23.3] 160 [11.81] 0.021 BMI (kg/m2) 18.09 [2.99] 17.94 [3.30] 18.24 [2.69] 0.62 Race/ethnicityWhiteLatinoBlackAsian/Pacific IslanderOther 72% (72)5% (5)1% (1)22% (22)1% (1) 71% (34)8% (4)2% (1)19% (9)0%(0) 77% (41)3% (1)0% (0)25% (13)2% (1) 0.34 Absences from training last year due to injuryNoneOnce or twice3-4 times5 or moreDidn’t run last year 52% (53)35% (36)8% (8)2% (2)3% (3) 47% (23)39% (19)8% (4)2% (1)4% (2) 57% (30)32% (17)8% (4)2% (1)2% (1) 0.88 Diagnosed with a bone stress injury by a doctor 11% (11) 19% (9) 4% (2) 0.016 Diagnosed with a bone stress injury by a doctor due to running 9% (9) 17% (8) 2% (1) 0.0092 Injured boneTibiaFibulaMetatarsalSacrum 1*2*6 (1 female had both tibia/fibula fracture) 0001 InjuriesTotal injuriesAchilles tendonitisShin splintsRunner’s kneeIT band syndromeSprained ankleHamstring strainOsgood-Schlatter DiseaseSever diseaseOther tendon/bone/joint injuryPlantar fasciitis (63)8% (8)5% (7)13% (14)1% (1)12% (12)4% (4)4% (4)8% (8)5% (5) 3% (3) (39)8% (4)6% (3)20% (10)0% (0)18% (9)6% (3)6% (3)4% (2)6% (3) 4% (2) (25)8% (4)4% (2)8% (4)3% (1)6% (3)2% (1)2%(1)11% (6)4% (2) 2% (1) 0.910.580.0590.300.0470.270.270.170.58 0.51 *Some subjects had more than one injury.
- Published
- 2020
17. Association Between Sport Specialization and Low BMD Among Female High School Distance Runners
- Author
-
Adam S. Tenforde, Michael D. Rosenthal, Jeanne F. Nichols, Mitchell J. Rauh, and Michelle T. Barrack
- Subjects
business.industry ,Specialization (functional) ,Medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,business ,Association (psychology) ,Demography - Published
- 2019
18. Evidence of a cumulative effect for risk factors predicting low bone mass among male adolescent athletes
- Author
-
Adam S. Tenforde, Aurelia Nattiv, Michael Fredericson, and Michelle T. Barrack
- Subjects
musculoskeletal diseases ,Female athlete triad ,Male ,medicine.medical_specialty ,Bone density ,Adolescent ,Fractures, Stress ,Adolescent athletes ,Population ,Nutritional Status ,030209 endocrinology & metabolism ,Physical Therapy, Sports Therapy and Rehabilitation ,Logistic regression ,Body Mass Index ,Running ,03 medical and health sciences ,0302 clinical medicine ,Absorptiometry, Photon ,Bone Density ,Risk Factors ,Medicine ,Humans ,Orthopedics and Sports Medicine ,education ,Cumulative effect ,Bone mineral ,education.field_of_study ,business.industry ,Body Weight ,030229 sport sciences ,General Medicine ,medicine.disease ,Cross-Sectional Studies ,Athletes ,Physical therapy ,Body Composition ,business ,Body mass index ,Demography - Abstract
Background Limited research has evaluated risk factors for low bone mineral density (BMD) in male adolescent athletes. Aims/objectives To evaluate predictors of low BMD (defined as BMD Z-score Methods Male adolescent athletes completed a survey characterising sports participation, nutrition, stress fracture history, dual energy X-ray absorptiometry (DXA)-measured BMD and body composition. Independent t-tests and analysis of covariance (ANCOVA) evaluated group differences; logistic regression evaluated low BMD risk factors. Results Runners (n=51) exhibited a lower body weight (p=0.02), body mass index (BMI) (kg/m2) (p=0.02), per cent expected weight (p=0.02) and spine BMD Z-score (p=0.002) compared with non-runners (n=18). Single risk factors of low BMD included 30 in the past year (OR=6.4, 95% CI 1.5 to 27.1). The strongest two-variable and three-variable risk factors included weekly mileage >30+ stress fracture history (OR=17.3, 95% CI 1.6 to 185.6) and weekly mileage >30+ 30, stress fracture history and Conclusions Male adolescent runners exhibited lower body weight, BMI and spine BMD Z-score values. The risk of low BMD displayed a graded relationship with increasing risk factors, highlighting the importance of using methods to optimise bone mass in this population.
- Published
- 2016
19. Poster 155 Higher Cumulative Risk Assessment Scores Are Associated with Delayed Return to Play in Division I Collegiate Distance Runners
- Author
-
Michael Fredericson, Andrea Kussman, Adam S. Tenforde, Megan Deakins-Roche, Emily Kraus, Brian Kim, Aurelia Nattiv, John Morkos, Michelle T. Barrack, and Sonal Singh
- Subjects
030222 orthopedics ,medicine.medical_specialty ,business.industry ,Rehabilitation ,Physical Therapy, Sports Therapy and Rehabilitation ,030229 sport sciences ,Division (mathematics) ,Return to play ,03 medical and health sciences ,0302 clinical medicine ,Neurology ,Physical therapy ,medicine ,Neurology (clinical) ,business ,Cumulative risk assessment - Published
- 2016
20. Risk Biotypes and the Female Athlete Triad
- Author
-
Michelle T. Barrack, Maria de Lourdes Eguiguren, and Kathryn E. Ackerman
- Subjects
Female athlete triad ,Gerontology ,medicine.medical_specialty ,biology ,business.industry ,Athletes ,Rowing ,Specific risk ,Sequela ,medicine.disease ,biology.organism_classification ,Triad (sociology) ,Endocrinology ,Internal medicine ,medicine ,Amenorrhea ,medicine.symptom ,business ,human activities ,Dieting - Abstract
The number of women participating in sports has increased dramatically in the past few decades. This rise in sports participation promotes numerous mental and physical benefits to the female athlete. However, clinical experience and research reports provide evidence of a health sequela, the “Female Athlete Triad,” developing as a result of inadequate dietary intake relative to exercise expenditure among a subset of athletes. The Female Athlete Triad (Triad) is an interrelated disorder of low energy availability, menstrual dysfunction, and reduced bone mineral density, and has been studied in various populations of athletic girls and women. In addition, current evidence suggests that athletes with Triad can experience other detrimental effects, including musculoskeletal, cardiovascular, gastrointestinal, renal, and neuropsychiatric symptoms. Female athletes participating in sports emphasizing leanness are at increased risk of developing the Triad. Factors that may account for this increased risk include an increased pressure to meet specific weight or body shape requirements of sport, the perceived benefit of a low body weight or thin frame in optimizing performance, and an increased susceptibility to sociocultural demands. These factors can lead to harmful dieting and subsequent energy deficit with likely health repercussions. Alternatively, some leanness sport athletes, such as those in endurance sports, may also develop an energy deficit inadvertently as a result of a high training volume and lack of awareness of their energy and nutritional needs. The specific risk biotypes considered in this chapter include endurance sports (e.g., runners, triathletes, cyclists, and swimmers), aesthetic sports (e.g., figure skating and gymnastics), weight-class sports (e.g., lightweight rowing and wrestling), and others. The involvement of a multidisciplinary team including sport medicine physicians, athletic trainers, dietitians, sports psychologists, among others, is required for the treatment of the Triad. The management comprises non-pharmacological and pharmacological approaches in some cases. However, the most effective way to avoid long-term consequences is early detection and prevention of this condition, especially in higher risk populations.
- Published
- 2016
21. Restoration of Menses With Nonpharmacologic Therapy in College Athletes With Menstrual Disturbances: A 5-Year Retrospective Study
- Author
-
Michelle T. Barrack, Min-Yuen Cynthia Cheung, Julie C. Arends, and Aurelia Nattiv
- Subjects
Female athlete triad ,medicine.medical_specialty ,Universities ,media_common.quotation_subject ,Hypothalamus ,Medicine (miscellaneous) ,Weight Gain ,Body Mass Index ,Menstruation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Exercise physiology ,Amenorrhea ,Exercise ,Menstrual cycle ,Retrospective Studies ,media_common ,Nutrition and Dietetics ,biology ,business.industry ,Athletes ,Retrospective cohort study ,General Medicine ,medicine.disease ,biology.organism_classification ,Diet ,Oligomenorrhea ,Physical therapy ,Female ,medicine.symptom ,Energy Metabolism ,business ,Weight gain ,Body mass index - Abstract
Background:Functional hypothalamic amenorrhea is common among female athletes and may be difficult to treat. Restoration of menses (ROM) is crucial to prevent deleterious effects to skeletal and reproductive health.Objectives:To determine the natural history of menstrual disturbances in female college athletes managed with nonpharmacologic therapies including increased dietary intake and/or decreased exercise expenditure and to identify factors associated with ROM.Study Design:A 5-yr retrospective study of college athletes at a major Division I university.Methods:373 female athletes’ charts were reviewed. For athletes with menstrual disturbances, morphometric variables were noted. Months to ROM were recorded for each athlete.Results:Fifty-one female athletes (19.7%) had menstrual disturbances (14.7% oligomenorrheic, 5.0% amenorrheic). In all, 17.6% of oligo-/amenorrheic athletes experienced ROM with nonpharmacologic therapy. Mean time to ROM among all athletes with menstrual disturbances was 15.6 ± 2.6 mo. Total absolute (5.3 ± 1.1 kg vs. 1.3 ± 1.1 kg, p < .05) and percentage (9.3% ± 1.9% vs. 2.3% ± 1.9%, p < .05) weight gain and increase in body-mass index (BMI; 1.9 ± 0.4 kg/m2 vs. 0.5 ± 0.4 kg/m2, p < .05) emerged as the primary differentiating characteristics between athletes with ROM and those without ROM. Percent weight gain was identified as a significant positive predictor of ROM, OR (95% CI) = 1.25 (1.01, 1.56), p < .05.Conclusions:Nonpharmacologic intervention in college athletes with menstrual disturbances can restore regular menstrual cycles, although ROM may take more than 1 yr. Weight gain or an increase in BMI may be important predictors of ROM.
- Published
- 2012
22. A Displaced Femoral Neck Stress Fracture in an Amenorrheic Adolescent Female Runner
- Author
-
Marci Goolsby, Aurelia Nattiv, and Michelle T. Barrack
- Subjects
Female athlete triad ,medicine.medical_specialty ,menstrual dysfunction ,Physical Therapy, Sports Therapy and Rehabilitation ,Signs and symptoms ,Low energy ,female athlete triad ,Medicine ,Orthopedics and Sports Medicine ,Femoral neck ,Hip fracture ,Cross country ,Stress fractures ,business.industry ,medicine.disease ,low energy availability ,Surgery ,Orthopaedic Surgery ,medicine.anatomical_structure ,hip fracture ,Physical therapy ,cross-country ,business ,bone mineral density - Abstract
This case demonstrates the potential serious consequences of the female athlete triad and its effects on bone. Displaced femoral neck stress fractures cause significant morbidity, and this case highlights the preventable nature of this injury. The treatment was focused on improving low energy availability, and, although challenging, improvements were made. This injury could have been prevented if the signs and symptoms of her injury had been addressed and there had been better knowledge of her risk factors. This case highlights the need for further education in the sports and health communities.
- Published
- 2012
23. Proper nutrition can prevent negative health outcomes in young female athletes
- Author
-
Michelle T. Barrack and M. D. van Loan
- Subjects
low bone mass ,Gerontology ,medicine.medical_specialty ,menstrual dysfunction ,Bone density ,Low bone mass ,Osteoporosis ,energy availability ,Health outcomes ,Anorexia nervosa ,lcsh:Agriculture ,Menstruation ,Internal medicine ,Food and Nutrition ,Medicine ,lcsh:Agriculture (General) ,Disordered eating ,adolescent nutrition ,Sports Medicine Residency Program ,biology ,Athletes ,business.industry ,lcsh:S ,General Engineering ,biology.organism_classification ,medicine.disease ,lcsh:S1-972 ,Endocrinology ,business - Abstract
Since the onset of Title IX, opportunities have dramatically increased for female athletes, largely to their benefit. However, some negative health outcomes such as disordered eating, chronic menstrual disturbances and low bone mass have been associated with high-level competition among some female athletes, particularly in sports such as gymnastics and cross-country running, where a slender physique or lean body build is important. Adolescent female athletes, in a rapid growth and development phase, may be at greatest risk. We sought to identify athletes at risk, understand the origin of possible negative outcomes and recommend behavioral modifications that promote participation in competitive sports while supporting lifetime health. This review discusses the development and impact of disordered eating and menstrual dysfunction on bone mass in young, competitive, female athletes and provides nutrition recommendations for their energy, carbohydrate, protein, vitamin and mineral intake.
- Published
- 2011
24. Body Mass, Training, Menses, and Bone in Adolescent Runners
- Author
-
Michelle T. Barrack, Mitchell J. Rauh, Marta D. Van Loan, and Jeanne F. Nichols
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Adolescent ,Osteoporosis ,Physiology ,Physical Therapy, Sports Therapy and Rehabilitation ,Body Mass Index ,Contraceptives, Oral, Hormonal ,Running ,Absorptiometry, Photon ,Bone Density ,Body Fat Distribution ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Menstrual Cycle ,Menstruation Disturbances ,Bone mineral ,business.industry ,Body Weight ,Age Factors ,medicine.disease ,Body Height ,Athletes ,Linear Models ,Physical therapy ,Early adolescents ,Bone mineral content ,Female ,Amenorrhea ,Lumbar spine ,medicine.symptom ,business ,Body mass index ,Follow-Up Studies ,Bone mass - Abstract
Endurance runners with low bone mass during adolescence may risk attaining a low peak bone mineral density (BMD) in adulthood. Alternatively, they may mature late and undergo delayed bone mineral accumulation. Purpose: The purpose of this study was to evaluate 40 adolescent runners (aged 15.9 ± 0.2 yr) at two time points, approximately 3 yr apart, to assess bone mass status and identify variables associated with bone mass change. Methods: Follow-up measures included a questionnaire to assess menstrual status, training, and sports participation history, height and weight, and a dual-energy x-ray absorptiometry scan to assess total body, total hip, and lumbar spine BMD, bone mineral content (BMC), BMD z-score, and body composition. We used -1 and -2 BMD z-score cutoffs to categorize runners with low bone mass. Results: Eighty-seven percent of girls with low BMD at baseline had low BMD at the follow-up. Girls with low compared with normal baseline BMD had lower follow-up adjusted total body (2220.4 ± 65.8 vs 2793.1 ± 68.2 g, P < 0.001), total hip (27.0 ± 1 vs 33.9 ± 1.0 g, P < 0.05), and lumbar spine (47.8 ± 2.0 vs 66.3 ± 2.2 g, P < 0.001) BMC values. Variables related to 3-yr training volume, menstrual function, age, developmental stage, and change in body mass explained 29%-54% of the variability in BMC change. Conclusions: The majority of adolescent runners with low BMD at baseline had low BMD after a 3-yr follow-up. Our observations suggest that "catch-up" accrual may be difficult and, thus, emphasize the importance of gaining adequate bone mineral during the early adolescent years.
- Published
- 2011
25. Optimising bone health in the young male athlete
- Author
-
Kathryn E. Ackerman, Michael Fredericson, Adam S. Tenforde, Aurelia Nattiv, and Michelle T. Barrack
- Subjects
Male ,Female athlete triad ,Peak bone mass ,medicine.medical_specialty ,Adolescent ,Bone density ,Physical Therapy, Sports Therapy and Rehabilitation ,Health Promotion ,Bone and Bones ,03 medical and health sciences ,0302 clinical medicine ,Bone Density ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Child ,Young male ,Bone mineral ,030222 orthopedics ,biology ,Athletes ,business.industry ,030229 sport sciences ,General Medicine ,Anthropometry ,biology.organism_classification ,medicine.disease ,Health promotion ,Physical therapy ,business - Abstract
Sports participation provides many health benefits to young athletes of both sexes. However, a subset of male athletes may suffer from unrecognised low bone density and impaired skeletal health, predisposing them to an increased risk of fracture. The effects of delayed diagnosis and inappropriate treatment of low bone density among male athletes may have severe consequences in future longevity in sport as well as long-term bone health. It has been well described that low energy availability alters the neuroendocrine axis, resulting in menstrual dysfunction, low bone mineral density (BMD) and increased risk for bone stress injury (BSI) in female athletes.1 ,2 However, male athletes may also experience an analogous process that parallels the female athlete triad (Triad).3 As childhood and adolescence represent a critical time for accruing peak bone mass, identifying modifiable risk factors for impaired skeletal health is important to ensure the long-term health in athletes of both sexes. Similar to female athletes,4 there appear to be cumulative risk factors for low BMD (Z-scores
- Published
- 2016
26. Eating Disorder Risk Evaluation for Males in Substance Abuse Recovery
- Author
-
Long Wang, Michelle T. Barrack, Virginia Gray, S. Petersen, D. Wiss, and V. Goh
- Subjects
Disorder risk ,Substance abuse ,medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Medicine ,General Medicine ,business ,medicine.disease ,Psychiatry ,Food Science - Published
- 2018
27. Physiologic and behavioral indicators of energy deficiency in female adolescent runners with elevated bone turnover
- Author
-
Michelle T. Barrack, Marta D. Van Loan, Jeanne F. Nichols, and Mitchell J. Rauh
- Subjects
medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Medicine (miscellaneous) ,Parathyroid hormone ,Diet Surveys ,Collagen Type I ,Body Mass Index ,Running ,Bone remodeling ,Insulin-like growth factor ,Bone Density ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,Vitamin D ,Amenorrhea ,Bone mineral ,Nutrition and Dietetics ,Estradiol ,Chemistry ,Leptin ,Body Weight ,Alkaline Phosphatase ,Vitamin D Deficiency ,Diet Records ,Diet ,Menstruation ,Calcium, Dietary ,Endocrinology ,Athletes ,Female ,Bone Remodeling ,medicine.symptom ,Energy Intake ,Peptides ,Body mass index ,Biomarkers - Abstract
Background: Female adolescent runners have an elevated prevalence of low bone mass for age—an outcome that may be partially due to inadequate energy intake. Objective: The objective was to evaluate diet, menstrual history, serum hormone concentrations, and bone mass in female adolescent runners with normal or abnormal bone turnover. Design: Thirty-nine cross-country runners (age: 15.7 6 0.2 y) participated in the study, which included a 7-d dietary assessment with the use of a food record and daily 24-h dietary recalls; serum measures of insulin-like growth factor I, estradiol, leptin, parathyroid hormone, progesterone, triiodothyronine, 25-hydroxycholecalciferol, bone-specific alkaline phosphatase (BAP), and cross-linked Ctelopeptides of type I collagen (CTX); an evaluation of height, weight, bone mass, and body composition with the use of dualenergy X-ray absorptiometry; and a questionnaire to assess menses and sports participation. Age- and sex-specific BAP and CTX concentrations of at least the 97th percentile and no greater than the third percentile, respectively, were considered abnormal. Results: All abnormal BAP and CTX concentrations fell within the elevated (! 97%) range. Runners with an elevated bone turnover (EBT) (n = 13) had a lower body mass, fewer menstrual cycles in the past year, lower estradiol and 25-hydroxycholecalciferol concentrations, and a higher prevalence of body mass index ,10% for age, vitamin D insufficiency, amenorrhea, and low bone mass. Girls with EBT consumed less than the recommended amounts of energy and had a higher prevalence of consuming ,1300 mg Ca than did those with normal bone turnover. Conclusions: Runners with EBT had a profile consistent with energy deficiency. Nutritional support to increase energy, calcium intake, and 25-hydroxycholecalciferol concentrations may improve bone mineral accrual in young runners with EBT. This trial was registered at clinicaltrials.gov as NCT01059968. Am J Clin Nutr 2010;92:652‐9.
- Published
- 2010
28. Bone mineral density in female high school athletes: Interactions of menstrual function and type of mechanical loading
- Author
-
Mitchell J. Rauh, Michelle T. Barrack, Jeanne F. Nichols, and Hava-Shoshana Barkai
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Histology ,Adolescent ,Physiology ,Endocrinology, Diabetes and Metabolism ,medicine.disease_cause ,Weight-bearing ,Weight-Bearing ,Absorptiometry, Photon ,Bone Density ,medicine ,Humans ,Femur ,Menstruation Disturbances ,Rachis ,Bone mineral ,Trochanter ,biology ,business.industry ,Athletes ,biology.organism_classification ,Biomechanical Phenomena ,Menstruation ,El Niño ,Physical therapy ,Female ,Amenorrhea ,medicine.symptom ,business ,Sports - Abstract
During adolescence, skeletal integrity of girls is largely dependent on menstrual function and impact exercise, yet currently there is limited research regarding the interaction between menstrual status and type of mechanical loading associated with various high school sports. Our purpose was to examine associations of menstrual status, type of mechanical loading, and bone mineral density (BMD) in female high school athletes participating in high/odd impact or repetitive/non-impact sport. Participants were 161 female high school athletes (15.7+/-1.3 years; 165.3+/-6.9 cm; 59.4+/-8.7 kg) representing high/odd impact (n=93, including soccer, softball, volleyball, tennis, lacrosse, and track sprinters and jumpers), or repetitive/non-impact sports (n=68, including swimmers, cross-country and track distance runners who participated in events>or=800 m). Areal BMD was measured by DXA at the spine (L1-L4), proximal femur, and total body. Menstrual status was determined by self-report. Athletes with primary, secondary or oligomenorrhea were combined into a single group (oligo/amenorrheic) and compared to eumenorrheic athletes. Analysis of covariance (ANCOVA) with Bonferroni post hoc comparisons adjusted for age, BMI, and gynecological age were used to compare BMD of athletes in combined mechanical loading and menstrual status groups. We found significantly greater total hip (p=0.04) and trochanter (p=0.02) BMD (g cm(-2)) among eumenorrheic high/odd impact compared to eumenorrheic repetitive/non-impact athletes, and greater spine (p=0.01) and trochanter (p=0.04) BMD among high/odd impact eumenorrheic athletes compared to repetitive/non-impact oligo/amenorrheic athletes. Chi-squared analysis of BMD Z-scores adjusted for gynecological age showed a significantly greater percentage of repetitive/non-impact athletes (33.9%) compared to high/odd impact athletes (11.8%) with low spine BMD for their age (BMD Z-score
- Published
- 2007
29. Parallels with the Female Athlete Triad in Male Athletes
- Author
-
Adam S. Tenforde, Michelle T. Barrack, Michael Fredericson, and Aurelia Nattiv
- Subjects
Female athlete triad ,Male ,Pathology ,medicine.medical_specialty ,Bone density ,Sports medicine ,030209 endocrinology & metabolism ,Physical Therapy, Sports Therapy and Rehabilitation ,Anorexia nervosa ,Bone and Bones ,Feeding and Eating Disorders ,03 medical and health sciences ,0302 clinical medicine ,Hypogonadotropic hypogonadism ,Bone Density ,medicine ,Humans ,Orthopedics and Sports Medicine ,Testosterone ,Disordered eating ,Bone mineral ,biology ,Athletes ,business.industry ,Hypogonadism ,Female Athlete Triad Syndrome ,030229 sport sciences ,medicine.disease ,biology.organism_classification ,Female ,Bone Diseases ,business ,Energy Metabolism ,Clinical psychology ,Sports - Abstract
Participation in sports offers many health benefits to athletes of both sexes. However, subsets of both female and male athletes are at increased risk of impaired bone health and bone stress injuries. The Female Athlete Triad (Triad) is defined as the interrelationship of low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density. The Triad may result in health consequences, including bone stress injuries. Our review presents evidence that an analogous process may occur in male athletes. Our review of the available literature indicates that a subset of male athletes may experience adverse health issues that parallel those associated with the Triad, including low energy availability (with or without disordered eating), hypogonadotropic hypogonadism, and low bone mineral density. Consequently, male athletes may be predisposed to developing bone stress injuries, and these injuries can be the first presenting feature of associated Triad conditions. We discuss the evidence for impaired nutrition, hormonal dysfunction, and low bone mineral density in a subset of male athletes, and how these health issues may parallel those of the Triad. With further research into the mechanisms and outcomes of these health concerns in active and athletic men, evidence-based guidelines can be developed that result in best practice.
- Published
- 2015
30. Effect of Exercise-Induced Hyperthermia on Serum Iron Concentration
- Author
-
Patricia Bradley, Kristina A Majer Cottonaro, Michelle T. Barrack, Michael J. Buono, and Fabienne Bouton-Sander
- Subjects
Adult ,Male ,Hyperthermia ,medicine.medical_specialty ,Fever ,Iron ,Endocrinology, Diabetes and Metabolism ,Strenuous exercise ,Clinical Biochemistry ,Biochemistry ,Inorganic Chemistry ,Internal medicine ,Post exercise ,medicine ,Humans ,Exercise physiology ,Exercise ,Core (anatomy) ,medicine.diagnostic_test ,Prolonged exercise ,Chemistry ,Biochemistry (medical) ,Repeated measures design ,General Medicine ,medicine.disease ,Endocrinology ,Immunology ,Serum iron ,Female ,Body Temperature Regulation - Abstract
Serum iron levels have been shown to decline both with fever and with strenuous exercise, leading to the supposition that the decrease might be the result of a rise in core body temperature. To evaluate this hypothesis, the serum iron response to an exercise-induced 1.5 degrees C rise in core body temperature was measured. To increase core temperature, five females and two males exercised in an environmental chamber heated to 41 degrees C with a relative humidity of 40%. Blood samples were taken before exercise and immediately after body temperature increased approximately 1.5 degrees C. Blood was also collected 1 h, 6 h, and 24 h postexercise. Results showed that the core body temperature significantly increased (p
- Published
- 2005
31. A Qualitative and Quantitative Evaluation of Dietary Supplement Topics Prioritized by Collegiate Athletes
- Author
-
Michelle T. Barrack, S. Osterman, and Virginia Gray
- Subjects
0301 basic medicine ,medicine.medical_specialty ,030109 nutrition & dietetics ,Nutrition and Dietetics ,biology ,Athletes ,business.industry ,Dietary supplement ,Alternative medicine ,General Medicine ,biology.organism_classification ,03 medical and health sciences ,medicine ,Physical therapy ,business ,Food Science - Published
- 2017
32. Nutrition Goals Prioritized By Elite Endurance Runners Undergoing A Nutrition Education Intervention
- Author
-
Tenforde S. Adam, Andrea Kussman, Michelle T. Barrack, Sonal Singh, Emily Kraus, Yasi Ansari, Brian W. Kim, Kristen Gravani, Beth Miller, Aurelia Nattiv, and Michael Fredericson
- Subjects
medicine.medical_specialty ,business.industry ,Intervention (counseling) ,Nutrition Education ,Elite ,Physical therapy ,Medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,business - Published
- 2017
33. Preliminary Results from a Prospective Study Using the Female Athlete Triad Cumulative Risk Assessment
- Author
-
Michelle T. Barrack, Sonal Singh, Andrea Kussman, Emily Kraus, Brian W. Kim, Megan Deakins-Roche, Aurelia Nattiv, Michael Fredericson, Nikita Mistra, and Adam S. Tenforde
- Subjects
Female athlete triad ,medicine.medical_specialty ,business.industry ,Physical therapy ,medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Prospective cohort study ,medicine.disease ,business ,Cumulative risk assessment - Published
- 2017
34. Misunderstanding the female athlete triad: refuting the IOC consensus statement on Relative Energy Deficiency in Sport (RED-S)
- Author
-
Aurelia Nattiv, Barbara L. Drinkwater, Karsten Koehler, Margot Putukian, Emma O'Donnell, Paula J. Harvey, Marci Goolsby, Jenna C. Gibbs, Gordon O. Matheson, Mary Jane De Souza, Jaci L. VanHeest, Julia M K Alleyne, Mitchell J. Rauh, Mimi Johnson, Madhusmita Misra, Nancy I. Williams, Lauren Costello, Amanda K Weiss Kelly, Marion P. Olmsted, Anne Z. Hoch, L Tyler Wadsworth, Michelle T. Barrack, Michael Fredericson, Suzanne Hecht, Jacalyn J. Robert McComb, George A. Brooks, Charlotte F. Sanborn, Rebecca J. Mallinson, Carol L. Otis, Rosemary Agostini, Anne B. Loucks, Elizabeth Joy, Jeanne F Nichols, and Lisa R. Callahan
- Subjects
Female athlete triad ,Warrant ,Male ,Pathology ,medicine.medical_specialty ,Consensus ,Umbrella term ,Physical Therapy, Sports Therapy and Rehabilitation ,Scientific literature ,Sports Medicine ,Medical and Health Sciences ,Terminology ,Education ,Triad (sociology) ,Engineering ,Terminology as Topic ,medicine ,Humans ,Orthopedics and Sports Medicine ,Female Athlete Triad Syndrome ,biology ,Athletes ,business.industry ,General Medicine ,medicine.disease ,biology.organism_classification ,Female ,business ,Energy Metabolism ,Sport Sciences ,Clinical psychology - Abstract
An IOC consensus group has recently introduced a new umbrella term, that is, ‘Relative Energy Deficiency in Sport’ (RED-S) to describe the physiological and pathophysiological effects of energy deficiency in male and female athletes.1 The authors assert that “new terminology is required to more accurately describe the clinical syndrome originally known as the Female Athlete Triad” that is a “more comprehensive, broader term for the overall syndrome, which includes what has so far been called the ‘Female Athlete Triad’.”1 This new terminology (RED-S) is insufficiently supported by scientific research to warrant adoption at this time. The Female Athlete Triad has more than 30 years of published evidence to support its existence in the scientific literature with strong evidence for its clinical sequelae and should remain a focus of scientific inquiry and translation.2–6 Moreover, several major concerns and errors with the IOC consensus statement should give researchers and practitioners great pause before adopting the IOC's new terminology, its theoretical construct and its proposed recommendations for screening and return to play. As stated by the IOC authors, the science of energy deficiency in the male athlete and in other groups is still in its ‘infancy’.1 In contrast, research on the Triad has been published since the early 1990s4 and, in fact, even earlier. Reports of menstrual and other problems in athletes were becoming prevalent in the literature as early as the 1960s, but particularly in the 1970s and 1980s.7–10 The first symposium related to the topic at the American College of Sports Medicine (ACSM) Annual Meeting was organised by Barbara Drinkwater in 1981 and was entitled ‘Menstrual Irregularities in Female Athletes’. The term ‘Female Athlete Triad’ was introduced at a workshop in 1992.4 The first position stand from the ACSM was published in 1997,2 and …
- Published
- 2014
35. 2014 female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad
- Author
-
Michelle T. Barrack, Louise M. Burke, Mary Jane De Souza, Madhusmita Misra, Anne B. Loucks, Margo Mountjoy, Nancy I. Williams, Marci Goolsby, Aurelia Nattiv, Jorunn Sundgot Borgen, Jenna C. Gibbs, Elizabeth Joy, Jeanne F Nichols, Rebecca J. Mallinson, Barbara L. Drinkwater, Gordon O. Matheson, Marion P. Olmsted, and Connie Lebrun
- Subjects
Female athlete triad ,medicine.medical_specialty ,Bone Density ,Intervention (counseling) ,Surveys and Questionnaires ,Health care ,medicine ,Humans ,Orthopedics and Sports Medicine ,Disordered eating ,Female Athlete Triad Syndrome ,biology ,business.industry ,Athletes ,Public Health, Environmental and Occupational Health ,General Medicine ,biology.organism_classification ,medicine.disease ,Eating disorders ,Treatment Outcome ,Family medicine ,Physical therapy ,Amenorrhea ,Female ,medicine.symptom ,business ,Sports - Abstract
The female athlete triad is a medical condition often observed in physically active girls and women and involves three components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with one or more of the three triad components, and early intervention is essential to prevent its progression to serious end points that include clinical eating disorders, amenorrhea, and osteoporosis. This consensus statement presents a set of recommendations developed following the first (San Francisco, CA) and second (Indianapolis, IN) International Symposia on the Female Athlete Triad. This consensus statement was intended to provide clinical guidelines for physicians, athletic trainers, and other health care providers for the screening, diagnosis, and treatment of the female athlete triad and to provide clear recommendations for return to play. The expert panel has proposed a risk stratification point system that takes into account magnitude of risk to assist the physician in decision making regarding sport participation, clearance, and return to play. Guidelines are offered for clearance categories, management by a multidisciplinary team, and implementation of treatment contracts.
- Published
- 2014
36. Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women
- Author
-
Michelle T. Barrack, Jeanne F. Nichols, Mitchell J. Rauh, Jenna C. Gibbs, Nancy I. Williams, Aurelia Nattiv, and Mary Jane De Souza
- Subjects
Female athlete triad ,medicine.medical_specialty ,Adolescent ,Fractures, Stress ,Poison control ,Physical Therapy, Sports Therapy and Rehabilitation ,California ,Young Adult ,Absorptiometry, Photon ,Bone Density ,Risk Factors ,Surveys and Questionnaires ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Femoral neck ,Female Athlete Triad Syndrome ,Ontario ,Stress fractures ,Anthropometry ,business.industry ,Incidence ,Pennsylvania ,medicine.disease ,Diet ,medicine.anatomical_structure ,Physical therapy ,Amenorrhea ,Female ,medicine.symptom ,business ,Energy Intake ,Cohort study ,Sports - Abstract
Background:Identifying the risk factors associated with a bone stress injury (BSI), including stress reactions and stress fractures, may aid in targeting those at increased risk and in formulating prevention guidelines for exercising girls and women.Purpose:To evaluate the effect of single or combined risk factors as defined by the female athlete triad—a syndrome involving 3 interrelated spectrums consisting of energy availability, menstrual function, and bone mass—with the incidence of BSIs in a multicenter prospective sample of 4 cohorts of physically active girls and women.Study Design:Cohort study; Level of evidence, 3.Methods:At baseline, participants’ (N = 259; mean age, 18.1 ± 0.3 years) anthropometric characteristics, eating attitudes and behaviors, menstrual function, sports participation or exercise activity, and pathological weight control behaviors were assessed. Dual-energy x-ray absorptiometry (DXA) measured the bone mass of the whole body, total hip, femoral neck, lumbar spine, and body composition. Participants were followed prospectively for the occurrence of injuries; those injuries confirmed by a physician were recorded.Results:Twenty-eight participants (10.8%) incurred a BSI. Forty-six percent of those who had ≥12 h/wk of purposeful exercise, a bone mineral density (BMD) Z score 2, oligo- or amenorrhea, elevated dietary restraint, and/or participation in a leanness sport exercise/activity at baseline, incurred a BSI during the prospective study period. Single factors significantly ( P < .05) associated with the development of a BSI included ≥12 h/wk of purposeful exercise (14.7%), BMI 2(15.3%), and low bone mass (BMD Z score Conclusion:In the sample, which included female adolescents and young adults participating in competitive or recreational exercise activities, the risk of BSIs increased from approximately 15% to 20% for significant single risk factors to 30% to 50% for significant combined female athlete triad–related risk factor variables. These data support the notion that the cumulative risk for BSIs increases as the number of Triad-related risk factors accumulates.
- Published
- 2014
37. Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: A 5-year prospective study in collegiate track and field athletes
- Author
-
Gannon Kennedy, Leanne L. Seeger, Julie C. Arends, Aurelia Nattiv, Marci Goolsby, Ashraf Abdelkerim, and Michelle T. Barrack
- Subjects
Male ,Time Factors ,Fractures, Stress ,MRI grading ,Risk Factors ,female athlete triad ,Orthopedics and Sports Medicine ,Prospective Studies ,Grading (education) ,Prospective cohort study ,Female Athlete Triad Syndrome ,Trauma Severity Indices ,medicine.diagnostic_test ,biology ,bone stress injury ,Prognosis ,Magnetic Resonance Imaging ,Female ,Cohort study ,stress fracture ,Female athlete triad ,medicine.medical_specialty ,Biomedical Engineering ,Physical Therapy, Sports Therapy and Rehabilitation ,Physical examination ,Stress ,Article ,Bone and Bones ,Decision Support Techniques ,Young Adult ,Sex Factors ,medicine ,Humans ,Analysis of Variance ,business.industry ,Athletes ,Mechanical Engineering ,Track and Field ,Human Movement and Sports Sciences ,Recovery of Function ,Anthropometry ,medicine.disease ,biology.organism_classification ,Orthopedics ,Linear Models ,Physical therapy ,business ,Fractures ,Follow-Up Studies - Abstract
Background:Bone stress injuries are common in track and field athletes. Knowledge of risk factors and correlation of these to magnetic resonance imaging (MRI) grading could be helpful in determining recovery time.Purpose:To examine the relationships between MRI grading of bone stress injuries with clinical risk factors and time to return to sport in collegiate track and field athletes.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:A total of 211 male and female collegiate track and field and cross-country athletes were followed prospectively through their competitive seasons. All athletes had preparticipation history, physical examination, and anthropometric measurements obtained annually. An additional questionnaire was completed regarding nutritional behaviors, menstrual patterns, and prior injuries, as well as a 3-day diet record. Dual-energy X-ray absorptiometry was performed at baseline and each year of participation in the study. Athletes with clinical evidence of bone stress injuries had plain radiographs. If radiograph findings were negative, MRI was performed. Bone stress injuries were evaluated by 2 independent radiologists utilizing an MRI grading system. The MRI grading and risk factors were evaluated to identify predictors of time to return to sport.Results:Thirty-four of the athletes (12 men, 22 women) sustained 61 bone stress injuries during the 5-year study period. The mean prospective assessment for participants was 2.7 years. In the multiple regression model, MRI grade and total-body bone mineral density (BMD) emerged as significant and independent predictors of time to return to sport. Specifically, the higher the MRI grade ( P = .004) and lower the BMD ( P = .030), the longer the recovery time. Location of the bone injury at predominantly trabecular sites of the femoral neck, pubic bone, and sacrum was also associated with a prolonged time to return to sport. Female athletes with oligomenorrhea and amenorrhea had bone stress injuries of higher MRI grades compared with eumenorrheic athletes ( P = .009).Conclusion:Higher MRI grade, lower BMD, and skeletal sites of predominant trabecular bone structures were associated with a delayed recovery of bone stress injuries in track and field athletes. Knowledge of these risk factors, as well as nutritional and menstrual factors, can be clinically useful in determining injury severity and time to return to sport.
- Published
- 2013
38. Low bone density risk is higher in exercising women with multiple triad risk factors
- Author
-
Mitchell J. Rauh, Aurelia Nattiv, Jeanne F. Nichols, Mary Jane De Souza, Nancy I. Williams, Michelle T. Barrack, and Jenna C. Gibbs
- Subjects
Female athlete triad ,medicine.medical_specialty ,Bone density ,Adolescent ,Cross-sectional study ,Osteoporosis ,Physical Therapy, Sports Therapy and Rehabilitation ,Body Mass Index ,Young Adult ,Bone Density ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Amenorrhea ,Exercise ,Caloric Restriction ,Retrospective Studies ,Bone mineral ,Menarche ,business.industry ,Age Factors ,medicine.disease ,Oligomenorrhea ,Cross-Sectional Studies ,Physical therapy ,Female ,business ,Energy Intake ,Body mass index ,Cohort study ,Sports - Abstract
The cumulative effect of the female athlete triad (Triad) risk factors on the likelihood of low bone mineral density (BMD) in exercising women is unclear.This study aimed to determine the risk of low BMD in exercising women with multiple Triad risk factors.We retrospectively examined cross-sectional data from 437 exercising women (mean ± SD age of 18.0 ± 3.5 yr, weighed 57.5 ± 7.1 kg with 24.5% ± 6.1% body fat) obtained at baseline from 4 prospective cohort studies examining Triad risk factors. Questionnaires were completed to obtain information on demographic characteristics, self-reported eating attitudes/behaviors, menstrual function, sport/activity participation, and medication use. Height and body weight were measured. BMD was measured using dual energy x-ray absorptiometry. Low BMD was defined as z-scores of-1 and ≤-2. Chi-square tests were performed to determine the percentage of women with low BMD who met the criteria for individual (current oligo/amenorrhea, late menarche, low body mass index (BMI), elevated dietary restraint, lean sport/activity participation) or multiple (2, 3, 4, or 5) Triad risk factors.Late menarche and low BMI were associated with the highest percentage of low BMD (z-score-1), 55% and 54%, respectively, and low BMD (z-score ≤-2), 14% and 16%, respectively. The percentage of participants with low BMD (z-score-1 and ≤-2) increased from 10% to 62% and from 2% to 18%, respectively, as women met the criteria for an increasing number of Triad risk factors.A cumulative number of Triad risk factors were associated with an increased risk of low BMD, suggesting a dose-response association between the number of Triad risk factors and BMD in exercising women. Further research should be conducted to develop a user-friendly algorithm integrating these indicators of risk for low BMD in exercising women (particularly factors associated with low BMI/body weight, menstrual dysfunction, lean sport/activity participation, and elevated dietary restraint).
- Published
- 2013
39. Use Of Dietary Supplements, Energy and Protein Bars, Gels and Drinks Among Elite Collegiate Endurance Runners
- Author
-
Jennifer Ratanapratum, Michelle T. Barrack, Sonal Singh, Adam S. Tenforde, Emily Kraus, Brian Kim, Aurelia Nattiv, and Michael Fredericson
- Subjects
medicine.medical_specialty ,business.industry ,Elite ,Physical therapy ,medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,business - Published
- 2016
40. Assessing the Prevalence of Dietary Supplement Use Among Collegiate Athletes
- Author
-
Terri Lisagor, Aaron Rafferty, Mark Muster, Michelle T. Barrack, Martin Caniza, and Jennifer Ratanapratum
- Subjects
Gerontology ,medicine.medical_specialty ,biology ,business.industry ,Athletes ,Dietary supplement ,Alternative medicine ,medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,business ,biology.organism_classification - Published
- 2016
41. Utility of the actiheart accelerometer for estimating exercise energy expenditure in female adolescent runners
- Author
-
Michelle T. Barrack, Jeanne F. Nichols, Sonia Garcia Merino, Hilary Aralis, Mitchell J. Rauh, and Lindsay Stalker-Fader
- Subjects
medicine.medical_specialty ,Adolescent ,Physical Exertion ,Medicine (miscellaneous) ,Accelerometer ,Fisiología humana ,Sensitivity and Specificity ,Running ,symbols.namesake ,Oxygen Consumption ,Heart Rate ,Atleta ,Covariate ,Heart rate ,Statistics ,medicine ,Humans ,Orthopedics and Sports Medicine ,Exercise physiology ,Exercise ,Mathematics ,Analysis of Variance ,Nutrition and Dietetics ,Medicina deportiva ,Reproducibility of Results ,Regression analysis ,Calorimetry, Indirect ,General Medicine ,Bonferroni correction ,Standard error ,Energy expenditure ,symbols ,Physical therapy ,Exercise Test ,Kinetocardiography ,Female ,Energy Metabolism - Abstract
There is a growing need to accurately assess exercise energy expenditure (EEE) in athletic populations that may be at risk for health disorders because of an imbalance between energy intake and energy expenditure. The Actiheart combines heart rate and uniaxial accelerometry to estimate energy expenditure above rest. The authors’ purpose was to determine the utility of the Actiheart for predicting EEE in female adolescent runners (N = 39, age 15.7 ± 1.1 yr). EEE was measured by indirect calorimetry and predicted by the Actiheart during three 8-min stages of treadmill running at individualized velocities corresponding to each runner’s training, including recovery, tempo, and 5-km-race pace. Repeated-measures ANOVA with Bonferroni post hoc comparisons across the 3 running stages indicated that the Actiheart was sensitive to changes in intensity (p < .01), but accelerometer output tended to plateau at race pace. Pairwise comparisons of the mean difference between Actiheart- and criterion-measured EEE yielded values of 0.0436, 0.0539, and 0.0753 kcal · kg−1 · min−1 during recovery, tempo, and race pace, respectively (p < .0001). Bland–Altman plots indicated that the Actiheart consistently underestimated EEE except in 1 runner’s recovery bout. A linear mixed-model regression analysis with height as a covariate provided an improved EEE prediction model, with the overall standard error of the estimate for the 3 speeds reduced to 0.0101 kcal · kg−1 · min−1. Using the manufacturer’s equation that combines heart rate and uniaxial motion, the Actiheart may have limited use in accurately assessing EEE, and therefore energy availability, in young, female competitive runners.
- Published
- 2010
42. Cross-sectional evidence of suppressed bone mineral accrual among female adolescent runners
- Author
-
Michelle T. Barrack, Jeanne F. Nichols, and Mitchell J. Rauh
- Subjects
medicine.medical_specialty ,Adolescent ,Cross-sectional study ,Endocrinology, Diabetes and Metabolism ,Female adolescent ,Lower body ,Bone Density ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Bone mineral ,Lumbar Vertebrae ,biology ,business.industry ,Athletes ,Organ Size ,biology.organism_classification ,Menstruation ,Cross-Sectional Studies ,Physical therapy ,Bone mineral content ,Lumbar spine ,Female ,business ,human activities ,Body mass index ,Demography - Abstract
We aimed to evaluate patterns of bone mineral accrual among a cross-sectional sample of female adolescent runners and girls participating in a nonendurance running sport. One-hundred and eighty-three interscholastic competitive female athletes (age 16.0 +/- 0.1 years), 93 endurance runners and 90 nonrunners, completed a menstrual and sports history questionnaire, had their height and weight measured, and underwent a dual-energy X-ray absorptiometry scan for the measurements of body composition and bone mass. For the majority of analyses, the girls were separated into four groups according to their age (13 to 14 years, 15 years, 16 years, and 17 to 18 years). Runners' height, weight, body mass index (BMI), percent body fat, lean tissue mass, number of menstrual cycles in the past year, and months of participation in a non-lean-build/variable-impact-loading sport were significantly lower than mean values for nonrunners. Although bone mass rose at all sites in the nonrunners between the ages of 13 to 14 years and 17 to 18 years, no such increase was noted in the runners. Runners compared with nonrunners exhibited significantly lower body weight and height-adjusted total body and lumbar spine bone mineral content (BMC) values and lower bone mineral density (BMD) Z-score values among the older (16 years and/or 17 to 18 years) but not younger (13 to 14 years and/or 15 years) age groups. These findings suggest that the runners, in contrast to the nonrunners, exhibited a suppressed bone mineral accrual pattern, which supports the notion that female adolescent endurance runners may be at risk for inadequate bone mass gains and thus a low peak BMD.
- Published
- 2010
43. Relationships Among Injury and Disordered Eating, Menstrual Dysfunction, and Low Bone Mineral Density in High School Athletes: A Prospective Study
- Author
-
Michelle T. Barrack, Jeanne F. Nichols, and Mitchell J. Rauh
- Subjects
Female athlete triad ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Bone density ,Sports medicine ,Adolescent ,Poison control ,Physical Therapy, Sports Therapy and Rehabilitation ,Context (language use) ,Risk Assessment ,Severity of Illness Index ,California ,Feeding and Eating Disorders ,Injury Severity Score ,Risk-Taking ,Bone Density ,Risk Factors ,Surveys and Questionnaires ,Injury prevention ,medicine ,Odds Ratio ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Disordered eating ,Menstruation Disturbances ,Original Research ,Female Athlete Triad Syndrome ,Schools ,business.industry ,Incidence ,General Medicine ,medicine.disease ,Health Surveys ,Logistic Models ,Athletic Injuries ,Physical therapy ,Female ,business ,Sports - Abstract
Context:Prior authors have reported associations among increased risk of injury and factors of the female athlete triad, as defined before the 2007 American College of Sports Medicine position stand, in collegiate and adult club sport populations. Little is known about this relationship in an adolescent competitive sports population.Objective:To examine the relationship among disordered eating, menstrual dysfunction, and low bone mineral density (BMD) and musculoskeletal injury among girls in high school sports.Design:Prospective cohort study.Setting:The sample consisted of 163 female athletes competing in 8 interscholastic sports in southern California during the 2003–2004 school year. Each participant was followed throughout her respective sport season for occurrence of musculoskeletal injuries.Main Outcome Measure(s):Data collected included daily injury reports, the Eating Disorder Examination Questionnaire that assessed disordered eating attitudes and behaviors, a dual-energy x-ray absorptiometry scan that measured BMD and lean tissue mass, anthropometric measurements, and a questionnaire on menstrual history and demographic characteristics.Results:Sixty-one athletes (37.4%) incurred 90 musculoskeletal injuries. In our BMD z score model of ≤−1 SD, a history of oligomenorrhea/amenorrhea during the past year and low BMD (z score ≤−1 SD) were associated with the occurrence of musculoskeletal injury during the interscholastic sport season. In our BMD z score model of ≤−2 SDs, disordered eating (Eating Disorder Examination Questionnaire score ≥4.0), a history of oligomenorrhea/amenorrhea during the past year, and a low BMD (z score ≤−2 SDs) were associated with musculoskeletal injury occurrence.Conclusions:These findings indicate that disordered eating, oligomenorrhea/amenorrhea, and low BMD were associated with musculoskeletal injuries in these female high school athletes. Programs designed to identify and prevent disordered eating and menstrual dysfunction and to increase bone mass in athletes may help to reduce musculoskeletal injuries.
- Published
- 2010
44. Prevalence of and traits associated with low BMD among female adolescent runners
- Author
-
Jeanne F. Nichols, Mitchell J. Rauh, and Michelle T. Barrack
- Subjects
musculoskeletal diseases ,Female athlete triad ,medicine.medical_specialty ,Future studies ,Bone density ,Adolescent ,Population ,Physical Therapy, Sports Therapy and Rehabilitation ,Female adolescent ,Running ,Eating ,Absorptiometry, Photon ,Bone Density ,Internal medicine ,medicine ,Prevalence ,Humans ,Orthopedics and Sports Medicine ,education ,Bone mineral ,education.field_of_study ,business.industry ,medicine.disease ,Menstruation ,Endocrinology ,Increased risk ,Adolescent Behavior ,Female ,business ,Body mass index ,Attitude to Health ,Demography - Abstract
Purpose: Identify the prevalence of and traits that may increase the risk of low bone mineral density (BMD) among 93 female adolescent competitive endurance runners. Methods: Participants were 93 high school runners, ages 13-18 yr, from southern California. Eating attitudes and behaviors were assessed using the Eating Disorder Examination Questionnaire (EDE-Q). Menstrual and sports participation history were evaluated using an interviewer-assisted, self-report questionnaire. Bone mineral density (BMD) of the spine (L1-L4), total hip, and total body were measured by dual-energy x-ray absorptiometry. The -2 and -1 BMD age-matched, gender-specific z-score cutoffs were used to categorize girls as having low bone mass for age. Results: Among the female runners, 11.8% and 28% met the -2 and -1 BMD z-score cutoffs, respectively, whereas 25.8% reported menstrual irregularity (MI). Total hip BMD, lumbar spine BMD, and lumbar spine BMD z-score were significantly lower in runners with MI after adjusting for body mass index (BMI) and lean tissue mass. Runners that participated in five or more compared with three seasons of endurance running exhibited a significantly lower total body and lumbar spine BMD z-score after adjusting for BMI, lean tissue mass, and number of menstrual cycles in the past year. Multiple regression analysis indicated that MI, participation in five or more seasons of endurance running, BMI, and lean tissue mass were independent predictors of low BMD. Conclusion: Female adolescent endurance runners may represent a population with an increased risk of low bone mass. Future studies are necessary to further understand the factors contributing to low bone mass in young runners and to identify behavioral strategies that will promote optimal bone mineral accumulation during the adolescent years.
- Published
- 2008
45. Dietary restraint and low bone mass in female adolescent endurance runners
- Author
-
Michelle T. Barrack, Mitchell J. Rauh, Hava-Shoshana Barkai, and Jeanne F. Nichols
- Subjects
medicine.medical_specialty ,Bone density ,Adolescent ,Diet, Reducing ,Adolescent Nutritional Physiological Phenomena ,Psychology, Adolescent ,Medicine (miscellaneous) ,Standard score ,Risk Assessment ,Body Mass Index ,Running ,Feeding and Eating Disorders ,Absorptiometry, Photon ,Bone Density ,Surveys and Questionnaires ,Prevalence ,Medicine ,Humans ,Medical history ,Disordered eating ,Menstruation Disturbances ,Bone mineral ,Nutrition and Dietetics ,biology ,Athletes ,business.industry ,Confounding ,biology.organism_classification ,Physical therapy ,Physical Endurance ,Female ,business ,Body mass index - Abstract
Background: Because disordered eating (DE) has been related to menstrual irregularity (MI) and low bone mineral density (BMD) in some studies of female athletes but not in others, it seems beneficial to assess the DE attitudes and behaviors most associated with these conditions. Objective: We aimed to determine the relation between Eating Disorder Examination Questionnaire (EDE-Q) subscale scores, pathologic behaviors, MI, and low BMD in adolescent female runners. Design:Participantswere93femalecompetitivecross-countryrunners 13–18 y old. The EDE-Q, composed of subscales for weight concern, shape concern, eating concern, and dietary restraint, was used to assess DE. Menstrual history was determined by using a questionnaire derived from a medical history form administered before participation in high school athletics. The International Society for Clinical Densitometry and the World Health Organization criterion of2or1 SD, respectively, was used to categorize runners as having low BMD. Results: Runners with elevated restraint had a significantly (P 0.001)greaterincidenceoflowBMDthandidrunnerswithelevated weight and shape concern. After adjustment for possible confounding variables (including menstrual history), lumbar spine BMD, bone mineral content, and BMD z score values were lowest in runners with elevated restraint. In addition, total-body BMD and totalbody BMD z scores were significantly (P 0.05) lower in runners with elevated restraint than in those with elevated weight or shape concern.ElevatedEDE-Qscoresforweightorshapeconcern,pathologic behaviors, or any combination of the 3 without concurrent dietary restraint were not significantly associated with low bone mass. Conclusion: These findings suggest that, in adolescent female runners, dietary restraint may be the DE behavior most associated with negative bone health effects. Am J Clin Nutr 2008;87:36–43.
- Published
- 2008
46. Disordered eating and menstrual irregularity in high school athletes in lean-build and nonlean-build sports
- Author
-
Michelle T. Barrack, Jeanne F. Nichols, Mitchell J. Rauh, Hava-Shoshana Barkai, and Yael Pernick
- Subjects
Female athlete triad ,medicine.medical_specialty ,Sports medicine ,Adolescent ,Universities ,Medicine (miscellaneous) ,Menstrual irregularity ,Feeding and Eating Disorders ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,Orthopedics and Sports Medicine ,Disordered eating ,Students ,Amenorrhea ,Menstrual Cycle ,Nutrition and Dietetics ,biology ,business.industry ,Athletes ,Body Weight ,General Medicine ,Eating disorder examination questionnaire ,biology.organism_classification ,medicine.disease ,Oligomenorrhea ,Physical therapy ,Body Composition ,Female ,medicine.symptom ,business ,High school athletes ,Sports - Abstract
The authors’ purpose was to determine the prevalence and compare associations of disordered eating (DE) and menstrual irregularity (MI) among high school athletes. The Eating Disorder Examination Questionnaire (EDE-Q) and a menstrual-history questionnaire were administered to 423 athletes (15.7 ± 1.2 y, 61.2 ± 10.2 kg) categorized as lean build (LB; n = 146) or nonlean build (NLB; n = 277). Among all athletes, 20.0% met the criteria for DE and 20.1% for MI. Although the prevalence of MI was higher in LB (26.7%) than NLB (16.6%) athletes (P = 0.01), no differences were found for DE. For both sport types, oligo/amenorrheic athletes consistently reported higher EDE-Q scores than eumenorrheic athletes (P < 0.05). Athletes with DE were over 2 times as likely (OR = 2.3, 95%CI: 1.3, 4.2) to report oligo/amenorrhea than athletes without DE. These data establish an association between DE and MI among high school athletes and indicate that LB athletes have more MI but not DE than NLB athletes.
- Published
- 2007
47. Parent Perceptions of Healthy Snack Guidelines Implemented in a Southern California Youth Soccer Organization
- Author
-
S. Singh-Carlson, Michelle T. Barrack, Virginia Gray, and A. Sauceda
- Subjects
Gerontology ,Nutrition and Dietetics ,business.industry ,Medicine ,General Medicine ,Parental perception ,business ,Food Science - Published
- 2015
48. Distribution of Bone Stress Injuries in Elite Male and Female Collegiate Runners
- Author
-
Michelle T. Barrack, Sonal Singh, Brian Kim, Michael Fredericson, Andrea Kussman, Emily Kraus, Adam S. Tenforde, and Aurelia Nattiv
- Subjects
Stress (mechanics) ,business.industry ,Elite ,Medicine ,Distribution (economics) ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,business ,Demography - Published
- 2015
49. Evidence of Energy Deficiency and Low Carbohydrate Intake Among Male and Female Elite Collegiate Endurance Runners
- Author
-
Elisabeth Daniels, Brian Kim, Maren Stein, Emily Kraus, Nattiv Aurelia, Michelle T. Barrack, Adam S. Tenforde, and Michael Fredericson
- Subjects
medicine.medical_specialty ,business.industry ,Elite ,Physical therapy ,medicine ,Physiology ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Low carbohydrate ,business ,Energy deficiency - Published
- 2015
50. Anthropometric Predictors of the Female Athlete Triad among Adolescent Athletes
- Author
-
Jeanne F. Nichols, Michelle T. Barrack, Katie J. Thralls, Mark Kern, and Mitchell J. Rauh
- Subjects
Female athlete triad ,medicine.medical_specialty ,business.industry ,Adolescent athletes ,medicine ,Physical therapy ,Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine ,Anthropometry ,medicine.disease ,business - Published
- 2015
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.