Health Challenges in Sport and Exercise Medicine

Question 1

Uk Medical officers guidelines?

Answer 1

muscle strengthening activities 2 days a week

150 minutes of moderate intensity activity or 75 mins vigorous activity

Minimise sedentary time and break up periods of inactivity

For older Adults balance and flexibility activities at least 2 times a week

Question 2

How is physical activity protective?

Answer 2

Increases muscle, which increases anti-inflammatory myokines, reduces systemic inflammation

It also decreases visceral (within organ) fat which reduces systemic inflammation

Question 3

What is RED-S?

Answer 3

The syndrome of RED-S refers to impaired physiological functioning caused by relative energy deficiency, and includes but is not limited to impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis, and cardiovascular health.

The cause of the Relative Energy Deficiency in Sport is the scenario termed ‘low energy availability’, where an individual’s dietary energy intake is insufficient to support the energy expenditure required for health, function and daily living, once the costs of exercise and sporting activities are taken into account.

Disordered eating (under-eating when energy is needed) is when your energy input is not tracking your energy output: It’s important to know that, in the context of RED-S,disordered eating includes both intentional and non-intentional under-consumption of calories at the time of need. This can occur both as a function of poor eating habits and as a function of too intense exercise.

This term (RED-S) has somewhat superseded the more gendered notion of the female athlete triad: this involves the continuum of three factors – disordered eating, amenorrhea (the absence of the menstrual cycle) and osteoporosis (reduced bone density and quality).

Red-S occurs when the athlete’s body does not have enough energy to sustain it and begins to shut down.
She [Nicky Keay] says: “The body partitions the energy you get from your diet. You need an amount to cover training, then the remaining energy is what you need for day-to-day life.
“If you’re not getting enough spare energy you go into survival mode. Oestrogen levels drop in women and testosterone for men which is key for bone health.
“It’s like when your phone’s battery drops to a low level, it switches off lots of non-essential apps, this is what the body is doing

Ironically thelongterm consequences of low energy availability produce adverse effects on body composition: increased fat/lean and reduction in BMD. In other words, the precise opposite effects of what an energy restricted athlete is trying to achieve. In terms of bone health, the lumbar spine is most sensitive to nutrition/endocrine factors (apart from rowers where mechanical loading can attenuate BMD loss at this site in RED-S). Suboptimal BMD is associated with an increased risk of bone injury and therefore impaired performance.

Question 4

Self reflection questions for athletes regarding RED?

Answer 4

1. As a female athlete am I aware of the health benefits of a regular menstrual cycle and the need to seek medical advice if I have not had a period by the age of 16?
2. How do I reflect on my training schedule in terms of frequency, intensity and duration of work to make sure I am avoiding the effects of over-training?
3. In what ways does my training diary record other indicators which may suggest RED-S may be a factor in terms of weight, lack of ability to recover between sessions, poor concentration and depression?
4. Am I prepared to commit to long development and progression in the sport? Am I aware that pursuing short-term success can put my long-term development at risk?

Question 5

QUESTIONS FOR COACHES, PARENTS AND SUPPORT GROUP

Answer 5

1. In accepting that I want the female athlete to be open and honest about menstrual health, how comfortable am I in talking about this appropriately?
2. In what ways does my communication with the female athlete reinforce the positive health benefits of a menstrual cycle?
3. As a coach, how do I ensure variation in schedules to avoid the effects of overtraining. For example, drill/circuits/cross training sessions?
4. What mechanisms are available to me to spot signs of RED-S in terms of illness, injury, excessive fatigue and poor psychological health of the athlete?
5. As a coach how am I remaining faithful to the principle of ‘athlete-centredness’ by building towards long-term goals rather than short-term success?
   »Emily Dudgeon, who ran for Scotland in the 800m at the 2014 Commonwealth Games, is leading the BMC’s mentoring scheme. Matt Long is editor of BMC News magazine. For more, email:mentor@britishmilersclub.com

Question 6

How does RED effect hormone system?

Answer 6

(Leptin inhibits hunger and so levels drop)

Bone health is affected early on
Your body releases more stress hormones
You feel more hungry
Your fertility drops
You lose both muscle and fat mass
Sex drive and periods are lost
You lose bone density & increase fat mass

Question 7

Male/female risks?

Answer 7

In males:
Testosterone levels drop and sex drive can decrease
Low testosterone means the bones weaken, prone to fracture
In females:
Oestrogen levels drop and periods cease
Low estrogen means the bones become more porous, and less dense, prone to fracture

Question 8

Physical warning signs of RED?

Answer 8

Dehydration
Muscle cramps, weakness, or fatigue
Dental and gum problems
Hypothermia (cold intolerance)
Amenorrhoea
Gastrointestinal problems
Cardiac abnormalities: low/abnormal HR and/or BP when changing positions)
Stress fractures (and other overuse injuries)
Significant weight loss

Question 9

Psychological warnings of RED?

Answer 9

Anxiety or depression
Unfocused, difficulty concentrating
Preoccupation with weight and eating
Avoidance of eating and eating situations
”Feeling fat” despite being thin
Exercising beyond what’s expected/required
Excessive use of the restroom
Use of laxatives, diet pills, etc.”