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Relative Energy Deficiency in Sport Flashcards

1
Q

American College of Sports Medicine defined Triad as

A

clinical entity that refers to the relationship between three interrelated components: energy availability, menstrual function and bone health

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2
Q

what was added to the triad definition?

A

understanding of the pathophysiology - over a period of time the athlete moves along on a continuous spectrum ranging from healthy with optimal EA, regular menses and healthy bones to amenorrhoea, low EA and osteoporosis

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3
Q

aetiological factor underpinning the triad

A

energy deficiency relative to the balance between dietary energy intake and energy expenditure to support homeostasis, health and the ADL, growth, and sporting activities

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4
Q

a syndrome resulting form relative energy deficiency

A

affects many aspects of physiological function including metabolic rate, menstrual function, bone health, immunity, protein synthesis, CV and psych health - even in men

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5
Q

what did the IOC coined as a new term for the female athlete triad?

A

relative energy deficiency in sport

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6
Q

calculation for energy availability

A

EI - energy cost of exercise relative to FFM - 45kcal/kg FFM/day - energy balance
requires expertise and is generally imprecise

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7
Q

what underpins a large proportion of cases of low EA?

A

disordered eating

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8
Q

what are other reasons for low EAs (without psychological overlay)

A

mismanaged programme to quickly reduce body mass/fat or inability to track EI with an extreme exercise commitment

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9
Q

Low EA in men

A

same at risk sports as female athletes - weight sensitive sports in which leanness and/or weight are important due to their role in performance, appearance or requirement to meet a competition weight category

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10
Q

disordered eating

A

continuum starting with appropriate eating and exercise behaviours (occasional use of more extreme weight loss methods such as short term restrictive <30kcal/kg FFM) and ends with clinical eating disorders, abnormal eating behaviours, distorted body image, weight fluctuations, medical complications and variable athletic performance

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11
Q

secondary amenorrhoea

A

absence of three consecutive cycle post menarche

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12
Q

oligomenorrhea

A

cycle length greater than 45 days

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13
Q

Aetiological factors in menstrual disorders in athletes - 5

A

abnormal levels of hormones, LH pulsatility, inadequate body fat stores, low EA and exercise stress

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14
Q

marked reduction in EA and LH pulsatility

A

may disrupt it by affecting the hypothalamic hormone gonadotropin releasing hormone output which subsequently alters the menstrual cycle

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15
Q

Low EA alters

A

levels of metabolic hormones and substrates - insulin, cortisol, GH, insulin like growth factor I, 3,3,5 - triiodothyroxine, grehlin, leptin, peptide tyrosine-tyrosine, glucose, FA, and ketones

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16
Q

REDS have serious implications for

A

many body systems - short and long term compromise of optimal health and performance

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17
Q

long term low EA - 3

A

nutrient deficiencies (including anaemia), chronic fatigue and increased risk of infections and illnesses, - harming health and performance

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18
Q

physiological and medical complications of REDS - 7

A

CV, GI, endocrine, reproductive, musculoskeletal, renal and CNS

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19
Q

Psychological aspects of REDS

A

Psychological stress and/or depression

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20
Q

at what kcal/kg FFM is MPS reduced?

A

30

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21
Q

Total energy expenditure = 4

A

Resting metabolic rate + thermos effect of food + non-exercise activity thermogenesis + energy expenditure from exercise

22
Q

Resting metabolic rate represents _% of total energy

A

38-47%

23
Q

Resting metabolic rate in elite athletes vs sedentary ind

A

60-80%

24
Q

Two equations to estimate energy requirement

A

Harris Benedict

  • Men = 66.5 + (13.7 X weight in kg) + (5 x height in cm) - (6.8 X age) = BMR
  • women = 655 + (9.6 X kg) + (1.8 X cm) - (4.7 x age) = BMR

Cunningham
- men and women = (370+ 21.6 X lean mass in kg) = BMR

25
Q

Estimated energy needs

A

BMR x activity level

Sedentary = 1.1, low = 1.3, mod = 1.5, active =1.7, very active = 1.8, extremely active = 1.9-2.1

26
Q

REDS and bone

A

peak bone mass - 19 in women and 20.5 in men - oestrogen increases uptake of calcium into blood and deposition into bone while progesterone facilitates actions of oestrogen through multiple complex mechanisms - silent imbalance (subclinical ovulatory disturbances) with low EA will produce negative changes in your bone.

27
Q

Testosterone and bone

A

anabolic effect in both men and women as it increases bone formation and calcium absorption
low levels = low bone marrow density in males

28
Q

endogenous oestrogens and androgens and bone

A

independent effects on bone development in both sexes

29
Q

stress hormones and bone

A

increase in it such as catecholamines and cortisol combined with low EA is bad

30
Q

functional impairments associated with low EA

A

greater prevalence of viral illnesses, injuries, and reduced responsiveness to training and subsequent performance

31
Q

Health consequence of REDS went from the triad to a wide range of outcomes - 10

A 
immunological 
menstrual function 
bone health 
endocrine 
metabolic
hematological 
growth and development 
psychological 
CV 
GI
32
Q

psychological aspect and REDS

A

precede REDS or be the result

33
Q

Low EA in male athletes - 3

A

cyclists had severely reduced EA of 8kcal/kg FFM

  • cycling, gravitational (high jump, pole vault, ski jump, and weight class sports
  • endocrine function and direct and indirect impacts on bones
34
Q

energy availability

A

amt of dietary energy available to the body to perform all other functions after the cost of exercise is subtracted

35
Q

65kg athlete, 15% body fat, 85% FFM, EI = 2500kcal, EEE = 600kcal, EA?

A

34.4kcal/kg FFM

36
Q

relative energy deficiency

A

energy balance exists, but there is insufficient energy for health, function, and ADL after accounting for EEE

37
Q

_ kcal/kg FFM for energy balance and optimal health?

A

45

38
Q

_ kcal/kg FFM associated with impairments in body function

A

30

39
Q

female athlete triad

A

syndrome of low EA with or w/o DE, functional hypothalamic amenorrhoea, and osteoporosis

40
Q

3 predecesors of Female athlete triad

A

reduced EA with or without DE, subclinical menstrual disorders and low BMD

41
Q

opposite end of female athlete triad

A

Optimal EA
eumenorrhea
optimal bone health

42
Q

11 performance concerns with REDS

A

decreased endurance, training response, coordination, concentration, glycogen stores and muslce strength.
increased injury risk, infection/illnesses
impaired judgement
irritability
depression

43
Q

Red light in REDS diagnosis

A

denied participation in sport, treatment contract

44
Q

Yellow light in REDS diagnosis

A

train with a medical plan and compete when cleared

45
Q

green light in REDS diagnosis

A

full training

46
Q

REDS controversy - 9

A 
insufficiently supported by scientific research to warrant adoption 
lacks scientific integrity 
misinterpretations of the scientific lit 
errors in treatment recommendations 
ambiguous return to play model 
sex diff protects men 
poorly referenced 
ill conceived and poorly defended 
inadequate and inaccurate
47
Q

should we be able to pull an athlete out

A

pushing someone too far as a therapist/physician, not all athletes know the chronic effects of FAT

48
Q

Males with reduced testosterones due to inadequate nutrition- 2

A

hypogonadotropic hypogonadism, and/or impaired bone density

49
Q

Increase in male REDS

A

increased ED and DE

severely reduced EA of 8 kcal/kg FFM

50
Q

What kind of nutrition should be emphaseized?

A

adequate for optimal performance

51
Q

what should be deemphasized

A

weight as a performance parameter

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