Morphology-Related Health Risks in Elite TriathlonTriathlon

Liz Broad, PhD,Liz Broad, PhD,

Manager of Clinical Services, Sports Nutrition,

Australian Institute of Sport

OVERVIEWOVERVIEW

• What do we mean by morphology?y p gy

• What is the morphology of an elite triathlete?

• Has this changed over time, and is it different g ,between Olympic distance and Ironman?

• What is optimal for performance?

• What risks might be associated with achieving an optimal morphology?

• What do we have to look out for?

MorphologyMorphology

• Physical characteristics of a human beingy g

• Includes:– Body fatness

– Limb lengths

– Muscle mass

B b dth– Bone breadths

• Much of this is genetically pre-determined• Much of this is genetically pre-determined

What do we commonly measure inWhat do we commonly measure in practice?

• Surface anthropometry:– Skinfold thicknesses, sum of 7 or 8 skinfolds (ISAK

)methodology). Track changes over time.

– Stretch stature

– Body mass– Body mass

– Girths (e.g. arm flexed, waist, gluteal, mid thigh, calf)

– Limb lengths, bone bredths

• DXA scan: – % body fat

– lean body mass (total and segmental)

– must use standardised procedures for body composition

Has morphology changed in the past 12Has morphology changed in the past 12 years?

Differences in body fat levels across the whole field is less now at elite level than in 2000.

Is morphology different in OlympicIs morphology different in Olympic Distance v’s Long Course?

Many people believe that Ironman athletes have a greater muscle mass than Olympic distance (i.e. heavier for the same height, equally lean)

Has there been much change over time?Has there been much change over time?

ITU world champs winner, 2000-2010

Ironman world champs winner, 2000-20102010 2000-2010

Height (cm)

Weight (kg)

BMI (kg/m2)

Height(cm)

Weight (kg)

BMI (kg/m2)

165 60.5 22.2 165 50.0* 18.4

152 58.2 25.2

180 57 7 17 8180 57.7 17.8

160 49.1* 19.2

160 51.7 20.2 180 60.0 18.5

167 57.3 20.5 170 60.0* 20.7

167 55.0 19.7

170 57.3* 19.8 160 51.8 20.2

NB Reported figures, ? Accuracy (especially highlighted ones).* = multiple winnerp

Pre 2000 (pre draft-legal racing in elite i OD)senior OD)

• 1991 – closer to swimmers than to runners (body composition ( y pand somatotype)

• Low levels of adiposity (body fat) correlated with total time and performance in most disciplines

• Proportionally longer segmental lengths contributed to swim outcomeoutcome

• Relatively tall – similar to specialist cyclists, smaller than specialist swimmers but taller than specialist endurance runnersp p

• Smaller hip and thigh girths associated with better performance

• Elite triathletes tend to weigh less than sub-elite / recreational triathletes

Ackland et al. 1997, Leake & Carter 1991, Landers et al. 2000, Sleivert & Rowlands 1996

Alterations in morphology of junior triathletes 1997 2011triathletes, 1997-2011

MALE 1997 MALE 2011 FEMALE 1997 FEMALE 2011

HEIGHT (cm) 175.7 178.4 164.9 167.3

WEIGHT (kg) 67.0 65.8 56.7 52.8

SKINFOLD (sum of 8)

51.5 51.1 73.1 75.8

FLEXED ARM GIRTH ( )

31.0 29.8 27.7 26.4GIRTH (cm)

ENDOMORPHY 2.4 2.1 3.5 3.3

MESOMORPHY 4.7 3.7 3.5 3.0

ECTOMORPHY 3.1 3.8 2.9 4.1

Longer limbs, smaller bone breadths and girths

Landers et al. 2012

What other factors interact withWhat other factors interact with morphology to influence performance?

• The impact of morphology on performance can• The impact of morphology on performance can be dependent on:– Race terrain (hilly v’s flat cycle and / or run)( y y )

– Environmental conditions (hot v’s cold – and swim may be influenced differently to run)

W t it– Wetsuits

What is an optimal morphology for f ?performance?

• Swim performance – long limbs

– some body fat is believed to be useful to improve buoyancy and reduce hydrodynamic dragreduce hydrodynamic drag

• Cycling performance – partly depends on terrainpartly depends on terrain

– Surface area (related to both height and weight) influences performance on a relatively flat course, with lower height and weight (Jobson et al 2007) and a larger lower to upper bodyweight (Jobson et al. 2007) and a larger lower to upper body circumference ratio (Miller & Manfredi 1987) being advantageous

• Run performanceRun performance – lower body fat improves run performance (Brandon & Boileu 1987)

– may also be advantage with lower muscle mass

What is an optimal morphology for TRIATHLON performance?

• OD – swim sufficiently fast to be in front pack, cycleOD swim sufficiently fast to be in front pack, cycle efficiently, run fast (men <30 min 10km, women <34 10km) but paced effectively– Influence of body fat in swim can be counteracted by

wetsuits

• Non drafting races each component is important• Non-drafting races – each component is important but greater likelihood that a fast run will overcome a slower swimslower swim

• Therefore, lean / lower body mass is advantageous, particularly in heat and hilly races, BUT not if it p y ycompromises swim performance

• Currently body composition is more like runners

Example of one female athlete over a seasonseason

85Skinfolds (mm)

5455

Mass (kg)

55

65

75

495051525354

25

35

45

4546474849

21BMI (kg/m2)

17

18

19

20The ‘ideal’ body fat / muscle mass level will be individual and may need to be achieved

16and may need to be achieved progressively

Can an athlete get too light / lean?Can an athlete get too light / lean?

• Yes!

• In training, more prone to struggle with swim pool temperature

• Can impact heavily on swim component (strength, change body position, hypothermia)

• Reduced strength on bike

• Increased fatigue in run following a hard bike

• Intolerance to colder temperatures

What about age / level of competition?What about age / level of competition?

• Junior athletes are still developing and do so at p gdifferent ages – expect differences in body composition and changes over time naturally

• Transition from junior to U23, focus on learning how to train effectively, race, self-maintenance, fuel appropriately as first prioritiesappropriately as first priorities– females may need more leniency on body fat

– males often lean but lower muscled – expect that musclemales often lean but lower muscled expect that muscle mass will increase over time with strength

• Age group athletes – still important but must be balanced with their physiological capabilities and overall lifestyle

Are there risks associated with achieving ti l h l ?optimal morphology?

• Process inappropriate:pp p– Disordered eating behaviours / eating disorder

– Low energy availability

• Too rapid a loss of body mass / fat:– Reduced muscle mass / strength

P t ti l t ‘ b d’– Potential to ‘rebound’

• Restrictive diet / insufficient carb diet:Inability to train effectively and recover– Inability to train effectively and recover

– Compromised immune system

– Increased risk of injury and illnessj y

– Increased risk of micronutrient deficiencies

Female Athlete TriadFemale Athlete Triad

ACSM Position Stand – The Female Athlete Triad. 2007.

London 2012 Olympics: triathlete Hollie Avil reveals why she has decided to bring an end to her

Elite Females and Eating Disorder Discussionposted by Jodie Swallowdecided to bring an end to her

promising career(The Telegraph, November 2012)

p yIf there were any story I could tell talented athletic girls - it is one of forfeited years in the sport I love. I have missed championships and

That quickly changed when one of the coaches – not mine – said: “You’ll need to start thinking about your weight if you want to run quick, Hollie.” That comment planted a seed in my head that didn’t need to be

have missed championships and been plagued by injury, I have little doubt this is a consequence of the eating disorder I developed in the early yearsplanted a seed in my head that didn t need to be

planted.early years.I Follow The Swallow (Blog) – November 19, 2012

"I haven't revealed it before," she says, taking a small breath before t lki b t h t ti di d "Th i till ti d Italking about her past eating disorders. "There is still a stigma and so I swing between wanting to talk about it and being ashamed because to me it's still tantamount to weakness. But every week I receive letters from women and young girls. They don't know I've suffered from eating disorders but they explain how they're suffering from these same afflictions. I've got a message in my inbox now from an American girl saying: 'I don't know where to turn, can you help me?' She's a triathlete."Chrissie WellingtonChrissie Wellington

How Many Triathletes Have (Had) Eating y ( ) gDisorders?

Blaydon & Lindner 2002 (n=203 included elite and• Blaydon & Lindner 2002 (n=203, included elite and age-group from 1998 World Championships):– Female professionals had higher exercise-dependence andFemale professionals had higher exercise dependence and

lower eating disorder scores than amateur

– 50% of females were rated as having an eating disorder d t 27% f lcompared to 27% of males

• ACSM position stand: The Female Athlete Triad (2007)(2007)– Disordered eating, eating disorders and amenorrhea occur

more frequently in sports that emphasise leanness

• DeBate et al. 2002 – triathletes susceptible to a higher prevalence of disordered eating

Eating Disorders

• Anorexia nervosa

B li i• Bulimia nervosa

• Binge eating disorder

• Disordered eating behaviour / eating disorder not otherwise specified

• DSM-IV diagnostic criteria (American Psychiatric Association 1994)Association, 1994)

• Characterised by SEVERE disturbances in eating behaviour and body imagebehaviour and body image

• Many subclinical eating disorders that don’t fit in to these DSM-IV diagnostic criteriathese DSM IV diagnostic criteria

Warning Signs for Disordered EatingWarning Signs for Disordered Eating

• Rapid weight loss • Increasing variability in training performance• Large variations in weight

(fluctuations of >1kg)

• Weight gain

training performance (fatigue, inability to back up training, inability to increase

• Weight gain

• Relentless, excessive exercise (inappropriate training – e.g

intensity sufficiently)

• Distorted association between body mass and( app op a e a g e g

when injured)

• Mood swings or depressed

between body mass and body fat changes (e.g. greater body mass change

mood

• Avoidance of eating publicly

B th i it ft l

than body fat

• Increased self-criticism of b d h / l k• Bathroom visits after meals

• Preoccupation with food, calories and weight

body shape / looks

• Wearing baggy or layered clothingcalories and weight clothing

Treatment of Eating DisordersTreatment of Eating Disorders

• Referral to an appropriate multi-disciplinary teampp p p y– Physician

– Psychologist / psychiatrist

– Dietitian experienced in managing eating disorders

– Coach, trainer, exercise scientist and family should all be involvedinvolved

• Recovery can take months, or more typically years– Early identification is crucial y

• Can recur

Energy AvailabilityEnergy Availability

Energy availability (EA) = Energy intake – Energy gy y ( ) gy gycost of training / competition

• Energy availability is the amount of energy remaining to look after physiological needs (cellular

i h l i hmaintenance, thermoregulation, growth, reproduction, immunity and locomotion)

• Low EA <30 kcal/kg FFM (<125 kJ/kg FFM)

Ad t EA 45 k l/k FFM (190 kJ/k FFM)• Adequate EA ~ 45 kcal/kg FFM (190 kJ/kg FFM)

Loucks & Thuma 2003, Ihle & Loucks 2004

Consequences of Low Energy AvailabilityConsequences of Low Energy Availability

• Reduced metabolic rate

• Reduced endocrine function (leading to amenorrhea)

• Lowered testosterone (in males)

• Loss of bone density (increased risk of stress fractures)

• Compromised immunity

• Reduced micronutrient status

• Fatigue – Increased risk of injury

When is Low EA Likely to Occur?When is Low EA Likely to Occur?

• Energy restriction or additional exercise in order to gylose body fat / weight

• Inadvertent failure to increase energy intake sufficiently during increased training loads

• Eating disorders / disordered eating behaviour

• Low EA can be chronic / constant, or may be intermittent

Warning Signs of Low Energy AvailabilityWarning Signs of Low Energy Availability

• Limited weight loss despite the athlete assuring you that they’re ‘trying hard’

V i bl t i i bilit• Variable training capability

• Low mood state

• Amenorrhoea (in females)

• Low libido (in males)

• Unusual fatigue

• Frequent illness / injury

• Remember this can happen in males too!

Assessment of Low Energy AvailabilityAssessment of Low Energy Availability

• Resting energy expenditureg gy p– Usually suppressed

• 7 day weighed food diary in conjunction with assessment of energy expenditure– Sensewear™

T i i l– Training logs

• Menstrual function

Blood tests iron stat s th roid f nction estrogen• Blood tests – iron status, thyroid function, estrogen, Vitamin D status

• Bone density assessment• Bone density assessment

• Fat free mass measurement

Treatment of Low EATreatment of Low EA

• Increased energy intake (e.g. 350 kcal or 1500 gy ( gkJ/day) and / or reduction in exercise energy expenditure

• Appropriate treatment of underlying eating disorder / disordered eating behaviour (if present)

O i i l i i k d Vi i D• Optimise calcium intake and Vitamin D status

• May require changes in macronutrient content (protein satiating high carboh drate / high fibre(protein = satiating, high carbohydrate / high fibre diet can = appetite suppression)

• Training capabilities will return before resumption of• Training capabilities will return before resumption of normal menstrual function or improvements in bone densityy

BUTBUT......

• Athletes with normal bone density can still get boney y g yinjuries

• Amenorrhoea may still occur without low energy availability (not unusual for females to be amenorrhoeic during the most competitive part of the season but their menstrual function will return in theseason – but their menstrual function will return in the off season)

And of courseAnd of course....

• There remain some athletes who don’t lose weight gbecause they really don’t understand – Inability to follow instructions appropriately

– Poor nutrition knowledge

– Low or intermittent compliance

Poor insight into own eating behaviours / serving sizes– Poor insight into own eating behaviours / serving sizes

– “I’m an athlete, it’s a licence to eat”

– Fear of running out of fuelg

– Reduce energy intake at the wrong times (early in day, recovery periods) then get excessively hungry at other timestimes

What morphology might we see in theWhat morphology might we see in the future?

• Leanness will always be a crucial factor for performancep

• Tendency towards lower muscle mass in OD

= more ectomorphic (linear) physiquep ( ) p y q

Key Messages for CoachesKey Messages for Coaches

• Body composition IS important, but has to be y p pmanaged effectively

• Get your athletes to see a sports nutrition expert!

• Athletes don’t need to be in race shape during the early / heaviest periods of training, nor do they

d t b i th hneed to be in the same race shape every year (especially in transition from junior to U23)

Some athletes may benefit from GAINING body• Some athletes may benefit from GAINING body fat in order to sustain heavy training loads

• Set realistic targets and prioritise effective training• Set realistic targets and prioritise effective training

• Watch for signs of low energy availability