The Effects of Low Energy Availability and High-Impact Exercise on Bone and Body Composition

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Virginia Tech


Low energy availability (LEA) has been identified as the underlying etiology of the Female Athlete Triad and Relative Energy Deficiency in Sport (REDs) syndrome. The term energy availability (EA) describes the amount of dietary energy intake (EI) that is remaining to support physiological function after accounting for the energy cost of exercise. Exposure to LEA stimulates metabolic adaptations that may disrupt certain biological systems, such as endocrine function, and impair sports performance. Controlled laboratory research has shown suppression of bone formation biomarkers with accelerated rates of bone resorption after only three to five days of LEA in active females. Correcting LEA by increasing EI or decreasing exercise energy expenditure (EEE) may not be feasible for all athletes and additional approaches for protecting bone health during LEA require further investigation. Recent evidence suggests that brief bouts of high-impact exercise attenuate the increased rate of bone resorption in females with diet-induced LEA. However, it is unknown whether similar exercises have a protective effect on bone health when LEA is induced through a combination of dietary restriction and exercise. A gap also remains in the understanding of how EA fluctuates throughout the athletic season and what potential effect that has on body composition and performance outcomes. To address these gaps, we conducted two studies to investigate the interactions of EA, bone health, and body composition. The first investigation employed a randomized crossover design in which female runners underwent two, five-day experimental conditions of LEA consisting of dietary restriction and daily running (EA = 15 kcal·kg FFM-1·day-1). During one of the experimental conditions, participants also completed a bout of 50 jumping exercises daily. Serum markers of bone resorption (C-terminal cross-linking telopeptide of type 1 collagen [CTX-I]), bone formation (N-terminal propeptide of type 1 procollagen [PINP]), and hormonal profiles were compared between baseline and post-intervention using linear mixed effects modeling. We hypothesized that daily high-impact exercise would have a positive effect on bone by attenuating the rise in bone resorption. In contrast to our hypothesis, bone resorption marker CTX-I increased following both LEA conditions (+12%, P=0.004) with no difference in the response between the jumping and non-jumping conditions. Bone formation was not suppressed following either LEA condition. Concentrations of free triiodothyronine (T3), insulin-like growth factor-1, leptin, and insulin decreased in response to five days of LEA independent of condition (P<0.05); however, when taking into account condition, the decrease in free T3 was only statistically significant following the LEA condition without jumping (-27%, P=0.022, Cohen's d=0.87). Our findings suggest that high-impact jumping exercises are not an effective countermeasure to protect bone health during short-term LEA in female runners who continue to run routinely. In a second study, we conducted a longitudinal, observational study in collegiate male soccer players to investigate seasonal changes in EA and body composition. Measurements of EA, body composition, and sports performance were assessed at the start and end of the non-championship Spring athletic season. We hypothesized that EA would be positively associated with changes in body composition at the end of the three-month season. Despite most athletes reporting desires to gain total and/or lean body mass, no changes in EA or body composition were detected at the end of the season compared to the start. Furthermore, sports performance and bone density improved across the season regardless of individual changes in EA. These results indicate EA of collegiate male soccer players during the Spring season is sufficient to maintain current body composition and improve sports performance, but insufficient to support total and/or lean body mass gains.



energy availability, bone biomarkers, DXA, performance nutrition, athlete