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Matheson, Gordon O; Klügl, Martin; Engebretsen, Lars; Bendiksen, Fredrik; Blair, Steven N; Börjesson, Mats; Budgett, Richard; Derman, Wayne; Erdener, Uğur; Ioannidis, John P A; Khan, Karim M; Martinez, Rodrigo; Van Mechelen, Willem; Mountjoy, Margo; Sallis, Robert E; Schwellnus, Martin; Shultz, Rebecca; Soligard, Torbjørn; Steffen, Kathrin; Sundberg, Carl Johan; Weiler, Richard; Ljungqvist, Arne
Sundgot-Borgen, Jorunn; Meyer, Nanna L; Lohman, Timothy G; Ackland, Timothy R; Maughan, Ronald J; Stewart, Arthur D; Müller, Wolfram
doi: 10.1136/bjsports-2013-092966pmid: 24115480
A focus on low body weight and body fat content, combined with regulations in some weight-sensitive sports, are considered risk factors for extreme dieting, eating disorders (EDs) and related health consequences among athletes. At present there are, from a health perspective, no generally accepted optimum values for body weight or percentage of fat mass in different sports and there is no ‘gold standard’ method for body composition assessment in athletes. On the basis of health considerations as well as performance, medical support teams should know how to approach elite athletes who seek to achieve an unrealistic body composition and how to prevent restrictive eating practices from developing into an ED. In addition, these teams must know when to raise the alarm and how to advice athletes who are affected by extreme dieting or clinical EDs. However, there is no consensus on when athletes struggling with extreme dieting or EDs should be referred for specialist medical treatment or removed from competition. Based on the present review, we conclude that there is a need for (1) sport-specific and gender-specific preventive programmes, (2) criteria for raising alarm and ‘does not start’ (DNS) for athletes with EDs and (3) modifications to the regulations in some sports. Further, the key areas for research identified include the development of standard methods for body composition assessment in elite athletes; screening measures for EDs among athletes; development and testing of prevention programmes; investigating the short and long-term effects of extreme dieting; and EDs on health and performance.
Mountjoy, Margo; Junge, Astrid
doi: 10.1136/bjsports-2013-092999pmid: 24055779
Objective To determine the priorities and activities of International Sport Federations (IFs) with respect to the promotion of health in their sport and for the general population. Methods All 35 IFs participating in Olympic Games in 2014 or in 2016 were asked to rate the importance of 10 indicated topics, and to report their programmes, guidelines or research activities on 16 health-related topics using an online questionnaire (response rate 97%). Results On average, the ‘fight against doping’ had the highest priority followed by ‘health of their elite athlete’ and ‘image as a safe sport’. The topics with the lowest importance ratings were ‘health of their recreational athlete’, ‘increasing the number of recreational athletes’ and ‘health of the general population’. All except one IF reported to have health-related programmes/guidelines/research activities; most IFs had 7 or 8 of the listed activities. Eight IFs (23.5%) stated to have activities for ‘prevention of chronic diseases in the general population’ but only FIFA and FINA reported related projects. Conclusions IFs aimed to protect the health of their elite athletes through a variety of activities, however the health and number of their recreational athletes was of low importance for them. Thus, IFs are missing an important opportunity to increase the popularity of their sport, and to contribute to the health of the general population by encouraging physical activity through their sport. FIFA’s ‘Football for Health’ and FINA’s ‘Swim for All’ projects could serve as role models.
Müller, Wolfram; Horn, Martin; Fürhapter-Rieger, Alfred; Kainz, Philipp; Kröpfl, Julia M; Maughan, Ronald J; Ahammer, Helmut
doi: 10.1136/bjsports-2013-092232pmid: 24055780
Background Extremely low weight and rapid changes in weight and body composition have become major concerns in many sports, but sufficiently accurate field methods for body composition assessment in athletes are missing. This study aimed to explore the use of ultrasound methods for assessment of body fat content in athletes. Methods 19 female athletes (stature: 1.67(±0.06) m, weight: 59.6(±7.6) kg; age: 19.5(±3.3) years) were investigated by three observers using a novel ultrasound method for thickness measurement of uncompressed subcutaneous adipose tissue and of embedded structures. Two observers also measured skinfold thickness at eight International Society for the Advancement of Kinanthrometry (ISAK) sites; mean skinfold values were compared to mean subcutaneous adipose tissue thicknesses measured by ultrasound. Interobserver reliability of imaging and evaluation obtained by this ultrasound technique: intraclass correlation coefficient ICC=0.968 (95% CI 0.957 to 0.977); evaluation of given images: ICC=0.997 (0.993 to 0.999). Results Skinfold compared to ultrasound thickness showed that compressibility of subcutaneous adipose tissue depends largely on the site and the person: regression slopes ranged from 0.61 (biceps) to 1.59 (thigh) and CIs were large. Limits of agreement ranged from 2.6 to 8.6 mm. Regression lines did not intercept the skinfold axis at zero because of the skin thickness being included in the skinfold. The four ISAK trunk sites caused ultrasound imaging problems in 13 of 152 sites (8 ISAK sites, 19 athletes). Conclusions The ultrasound method allows measurement of uncompressed subcutaneous adipose tissue thickness with an accuracy of 0.1–0.5 mm, depending on the probe frequency. Compressibility of the skinfold depends on the anatomical site, and skin thickness varies by a factor of two. This inevitably limits the skinfold methods for body fat estimation. Ultrasound accuracy for subcutaneous adipose tissue measurement is limited by the plasticity of fat and furrowed tissue borders. Comparative US measurements show that skinfold measurements do not allow accurate assessment of subcutaneous adipose tissue thickness.
Müller, Wolfram; Horn, Martin; Fürhapter-Rieger, Alfred; Kainz, Philipp; Kröpfl, Julia M; Ackland, Timothy R; Lohman, Timothy G; Maughan, Ronald J; Meyer, Nanna L; Sundgot-Borgen, Jorunn; Stewart, Arthur D; Ahammer, Helmut
Meyer, Nanna L; Sundgot-Borgen, Jorunn; Lohman, Timothy G; Ackland, Timothy R; Stewart, Arthur D; Maughan, Ronald J; Smith, Suzanne; Müller, Wolfram
doi: 10.1136/bjsports-2013-092561pmid: 24065075
Needleman, I; Ashley, P; Petrie, A; Fortune, F; Turner, W; Jones, J; Niggli, J; Engebretsen, L; Budgett, R; Donos, N; Clough, T; Porter, S
doi: 10.1136/bjsports-2013-092891pmid: 24068332
Background Oral health is important both for well-being and successful elite sporting performance. Reports from Olympic Games have found significant treatment needs; however, few studies have examined oral health directly. The aim of this study was to evaluate oral health, the determinants of oral health and the effect of oral health on well-being, training and performance of athletes participating in the London 2012 Games. Methods Cross-sectional study at the dental clinic within the Polyclinic in the athletes’ village. Following informed consent, a standardised history, clinical examination and brief questionnaire were conducted. Results 302 athletes from 25 sports were recruited with data available for 278. The majority of athletes were from Africa, the Americas and Europe. Overall, the results demonstrated high levels of poor oral health including dental caries (55% athletes), dental erosion (45% athletes) and periodontal disease (gingivitis 76% athletes, periodontitis 15% athletes). More than 40% of athletes were ‘bothered’ by their oral health with 28% reporting an impact on quality of life and 18% on training and performance. Nearly half of the participants had not undergone a dental examination or hygiene care in the previous year. Conclusions The oral health of athletes attending the dental clinic of the London 2012 Games was poor with a resulting substantial negative impact on well-being, training and performance. As oral health is an important element of overall health and well-being, health promotion and disease prevention interventions are urgently required to optimise athletic performance.
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Morbidity and mortality from preventable, non-communicable chronic disease (NCD) threatens the health of our populations and our economies. The accumulation of vast amounts of scientific knowledge has done little to change this. New and innovative thinking is essential to foster new creative approaches that leverage and integrate evidence through the support of big data, technology and design thinking. The purpose of this paper is to summarise the results of a consensus meeting on NCD prevention sponsored by the IOC in April 2013. Within the context of advocacy for multifaceted systems change, the IOC's focus is to create solutions that gain traction within healthcare systems. The group of participants attending the meeting achieved consensus on a strategy for the prevention and management of chronic disease that includes the following: (1) Focus on behavioural change as the core component of all clinical programmes for the prevention and management of chronic disease. (2) Establish actual centres to design, implement, study and improve preventive programmes for chronic disease. (3) Use human-centred design in the creation of prevention programmes with an inclination to action, rapid prototyping and multiple iterations. (4) Extend the knowledge and skills of Sports and Exercise Medicine (SEM) professionals to build new programmes for the prevention and treatment of chronic disease focused on physical activity, diet and lifestyle. (5) Mobilise resources and leverage networks to scale and distribute programmes of prevention. True innovation lies in the ability to align thinking around these core strategies to ensure successful implementation of NCD prevention and management programmes within healthcare. The IOC and SEM community are in an ideal position to lead this disruptive change. The outcome of the consensus meeting was the creation of the IOC Non-Communicable Diseases ad hoc Working Group charged with the responsibility of moving this agenda forward.
doi: 10.1136/bjsports-2013-092233pmid: 23956337
Background Very low body mass, extreme mass changes, and extremely low per cent body fat are becoming increasingly common in many sports, but sufficiently reliable and accurate field methods for body composition assessment in athletes are missing. Methods Nineteen female athletes were investigated (mean (SD) age: 19.5 (±3.3) years; body mass: 59.6 (±7.6) kg; height: 1.674 (±0.056) m; BMI: 21.3 (±2.3) kg/m2). Three observers applied diagnostic B-mode-ultrasound (US) combined with the evaluation software for subcutaneous adipose tissue measurements at eight ISAK sites (International Society for the Advancement of Kinanthrometry). Regression and reliability analyses are presented. Results US measurements and evaluation of subcutaneous adipose tissue (SAT) thicknesses (including fibrous structures: Dincluded; n=378) resulted in an SE of estimate SEE=0.60 mm, R2=0.98 (p<0.001), limit of agreement LOA=1.18, ICC=0.968 (0.957–0.977). Similar values were found for Dexcluded: SEE=0.68 mm, R2=0.97 (p<0.001). Dincluded at individual ISAK sites: at biceps, R2=0.87 and intraclass-correlation coefficient ICC=0.811 were lowest and SEE=0.79 mm was highest. Values at all other sites ranged from R2: 0.94–0.99, SEE: 0.42–0.65 mm, and ICC: 0.917–0.985. Interobserver coefficients ranged from 0.92 to 0.99, except for biceps (0.74, 0.83 and 0.87). Evaluations of 20 randomly selected US images by three observers (Dincluded) resulted in: SEE=0.15 mm, R2=0.998(p<0.001), ICC=0.997 (0.993, 0999). Conclusions Subject to optimal choice of sites and certain standardisations, US can offer a highly reliable field method for measurement of uncompressed thickness of the SAT. High accuracy and high reliability of measurement, as obtained with this US approach, are essential for protection of the athlete’s health and also for optimising performance.
Background Successful performers in weight-sensitive sports are characterised by low body mass (BM) and fat content. This often requires chronic energy restriction and acute weight loss practices. Aim To evaluate current use of body composition (BC) assessment methods and identify problems and solutions with current BC approaches. Methods A 40-item survey was developed, including demographic and content questions related to BC assessment. The survey was electronically distributed among international sporting organisations. Frequencies and χ2 analyses were computed. Results 216 responses were received, from 33 countries, representing various institutions, sports and competitive levels. Of the sample, 86% of respondents currently assess BC, most frequently using skinfolds (International Society for the Advancement of Kinanthropometry (ISAK): 50%; non-ISAK, conventional: 40%; both: 28%), dual energy X-ray absorptiometry (38%), bioelectrical impedance (29%), air displacement plethysmography (17%) and hydrostatic weighing (10%). Of those using skinfolds, more at the international level used ISAK, whereas conventional approaches were more reported at regional/national level (p=0.006). The sport dietitian/nutritionist (57%) and physiologist/sports scientist (54%) were most frequently the professionals assessing BC, followed by MDs and athletic trainers, with some reporting coaches (5%). 36% of 116 respondents assessed hydration status and more (64%) did so at international than regional/national level (36%, p=0.028). Of 125 participants answering the question of whether they thought that BC assessment raised problems, 69% said ‘yes’, with most providing ideas for solutions. Conclusions Results show high use of BC assessment but also a lack of standardisation and widespread perception of problems related to BM and BC in sport. Future work should emphasise standardisation with appropriate training opportunities and more research on BC and performance.