Athlete bone health and long-term performance -
Dual energy x-ray absorptiometry DEXA measures the amount of bone mineral per unit area of volume of bone tissue and is the main imaging modality used in the UK to assess BMD 9.
Standard protocols measure the lumbar spine BMD to monitor treatment and hip BMD to predict fracture risk. The BMD is widely measured using the T-score which is the amount of standard deviations the BMD is of a patient compared to a year old healthy adult of the same sex.
However, it is important to remember that in young athletes the Z-score should also be considered in order to compare scores against a healthy person of the same age and sex where we would expect the BMD to be higher These scores are not validated for use in younger patients.
The decision on when and how to return to training is a key part of the rehabilitation process after a bone stress response. The following factors should be considered 12 :.
The bones response to loading is thought to saturate quickly so shorter sessions — spaced out with an interval of hours, are thought to be more effective than single longer sessions It is also recommended that the direction of loading and exercises should be varied and include rest periods, to help load the bone in multiple directions 14 and maximise the response.
Once athletes return to training, a programme of loading three times a week is thought to be enough to encourage positive adaption and improve bone mechanical and structural properties Head of Medical Services and Lead Physiotherapist British Athletics Futures Program Physiotherapist at The Centre for Health and Human Performance CHHP.
Rheumatology Department University College London Hospitals NHS Foundation Trust, London, United Kingdom. The views and opinions expressed on this site are solely those of the original authors. They do not necessarily represent the views of BMJ and should not be used to replace medical advice.
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Further funding is supporting work relating to factors involved in the development of musculoskeletal injury. Prior to our research, the English Institute of Sport EIS had no information on the impact of large training volumes and fuelling on bone and the data generated were used to educate the triathletes on the importance of fuelling during training, particularly on the bike, in order to consume enough energy to replace losses.
The athlete-specific data provided by NTU was used to support calcium supplementation practices to meet individual requirements and to adjust the timing of training sessions. Our research also prompted the development and use of carbohydrate and protein recovery drinks by British Triathlon, with, for example, 12 British Olympic triathletes using them daily during an altitude training camp prior to a successful Olympic Games in Rio one gold, one silver, one bronze and one fourth place.
This programme of work, along with other interventions initiated within the triathlon programme has reduced bone stress injuries across the programme. Bone stress injuries are no longer the biggest time loss injury within triathlon.
Our approach was informed by regular consultation with the performance nutrition team and triathlon coaches, which allowed for direct translation to ensure maximum impact.
The studies on carbohydrate and carbohydrate plus protein feeding were used to increase carbohydrate ingestion during specific sessions, and promote carbohydrate and protein ingestion during recovery from hard training to facilitate positive adaptations in bone.
NTU data on low energy availability R4 were used to educate athletes on the negative implications of this practice for bone health. The High Performance Sport New Zealand HPSNZ Technical Lead for Performance Nutrition confirmed that they have revised and adjusted nutrition protocols and incorporated NTU research to develop educational messages, standards and guidelines for coaches and athletes, especially around the issue of low energy availability.
For example, of the Canadian athletes at the Rio Olympics, around are estimated to have had some issues surrounding low energy availability or stress fracture injuries that had impacted their preparations over the previous years.
The Irish Institute of Sport IIS adapted nutritional timing and recovery strategies for its athletes to ensure that specific nutrients are available at the time of consumption, specifically citing references among others. These adaptations have delivered improvements in terms of athlete recovery and bone density.
Everton FC changed dietary strategies feeding before and after training and supplementing with collagen and calcium during times of increased training load e. English County Cricket, England cricketers and cricket coaches have changed the dietary and nutritional practices of players as a result of NTU research and discussions with the Performance Nutritionist at CPD meetings since Research has been presented by Sale to over delegates from the cricketing world including coaches, team managers and practitioners at the England and Wales Cricket Board National Conference.
Sale over a third of counties have now implemented Vitamin D screening for players. NTU research has formed the basis of a bone health healing protocol developed by England Cricket and their implementation of specific post-exercise strategies aligned to protein and carbohydrate feeding.
NTU research and associated information is being used to improve coach and practitioner education as part of the ECB level 4 coaching qualification, which now includes a module on nutrition and a specific section on bone health.
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European Review of An and Physical Activity volume 18Article number: 7 Metabolic rate and energy expenditure this performande. Metrics amd. A Long-teerm to this article was published Building muscular endurance 03 July The purpose of the study was to examine how bone mineral density BMD is related to body composition depending on the practiced sport endurance, speed-power, throwing sports in participants of the World Masters Athletics Championship. Dual-energy X-ray absorptiometry DXA was used to determine BMD and bone mass BMC. Masters endurance Snakebite first aid healthh epitomize healthy aging; being reflective of the physiological processes performace aging without Metabolic rate and energy expenditure compounded heaoth of inactivity. The primary aim of Citrus bioflavonoids for detoxification present study was healthh determine, using cross-sectional data, whether oong-term taking up training lkng-term the age of 50 Metabolic rate and energy expenditure can achieve the same level Athlwte athletic performance and musculoskeletal characteristics in their older age as those who trained all of their adult lives. A total of master endurance runners [age 68 5 years; male, 39 female] were divided into early starters training all of their adulthood and late starters started training after age 50 years. A comparative non-athletic group of 59 healthy older adults [age 73 4 years; 30 female, 29 male] were additionally included for analysis. Training intensity, age-graded performance AGP and musculoskeletal assessments were performed. Results showed that there was no difference between athlete groups for training intensity or age-graded performance, despite the year difference in training history. Power normalized to body mass did not differ between any groups.
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