Effects of Low Energy Availability on Bone Health in Endurance Athletes and High-Impact Exercise as A Potential Counterm
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REVIEW ARTICLE
Effects of Low Energy Availability on Bone Health in Endurance Athletes and High‑Impact Exercise as A Potential Countermeasure: A Narrative Review Mark J. Hutson1 · Emma O’Donnell1 · Katherine Brooke‑Wavell1 · Craig Sale2 · Richard C. Blagrove1
© The Author(s) 2020
Abstract Endurance athletes expend large amounts of energy in prolonged high-intensity exercise and, due to the weight-sensitive nature of most endurance sports, often practice periods of dietary restriction. The Female Athlete Triad and Relative Energy Deficiency in Sport models consider endurance athletes at high-risk for suffering from low energy availability and associated health complications, including an increased chance of bone stress injury. Several studies have examined the effects of low energy availability on various parameters of bone structure and markers of bone (re)modelling; however, there are differences in findings and research methods and critical summaries are lacking. It is difficult for athletes to reduce energy expenditure or increase energy intake (to restore energy availability) in an environment where performance is a priority. Development of an alternative tool to help protect bone health would be beneficial. High-impact exercise can be highly osteogenic and energy efficient; however, at present, it is rarely utilized to promote bone health in endurance athletes. Therefore, with a view to reducing the prevalence of bone stress injury, the objectives of this review are to evaluate the effects of low energy availability on bone health in endurance athletes and explore whether a high-impact exercise intervention may help to prevent those effects from occurring.
Key Points Many endurance athletes suffer low energy availability because of the time and energy demand of training and the need to achieve (or maintain) a target body weight on a regular basis. * Mark J. Hutson [email protected] Emma O’Donnell [email protected] Katherine Brooke‑Wavell k.s.f.brooke‑[email protected] Craig Sale [email protected] Richard C. Blagrove [email protected] 1
School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham NG11 8NS, UK
2
Female weight-bearing endurance athletes with symptoms of low energy availability exhibit lower bone mineral density, total and cross-sectional area, estimated strength and thinner cortices, each of which may contribute to the development of bone stress injury. The effects of low energy availability in male athletes are not yet well described. High-impact exercise may offer a time and energy efficient solution to counter the effects of low energy availability on bone in situations where restoration of energy availability is difficult.
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1 Introduction Endurance exercise is energetically demanding, and it is recommended that athletes
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