Background: The American College of Sports Medicine defines the female athlete triad (FAT) as interrelated components of energy availability, menstrual function, and bone mineral density. High school athletes have likely not experienced a lengthy duration of exposure to disordered eating, amenorrhea, and low bone density compared to older athletes because of their young age; the purpose for screening and creating awareness is to educate before negative consequences reach full effect later in life and running career. Purpose: The purpose of this study is to screen high school distance runners for awareness and baseline knowledge of the components of FAT. Methods: Four surveys submitted to high school female athletes assessing FAT knowledge, a questionnaire assessing triad risk factors, calcium intake, and demographic information. Results: Significant findings include faster 5k times with a body mass index (BMI) under 18.5 mg/kg², increased calcium intake correlated with positive awareness to the FAT, and a higher FAT knowledge score correlating with triad awareness. Conclusion: The results from this study did not show a relationship between BMI and menstrual history, 5k time and menstrual history, and BMI and calcium intake. All of the athletes' responses indicated having one or more components of the triad. Education of the components of the triad is needed in high schools, and screening should be incorporated into preparticipation health physicals so as to ensure athletes minimize their risks for stress fractures and impaired bone health.

The Female Athlete Triad, consisting of the interrelated conditions of low energy availability, leading to menstrual disturbances and low bone mineral density, is commonly diagnosed amongst excessively exercising women. The American College of Sports Medicine emphasizes that the underlying factor of the Triad is a discrepancy between dietary energy intake and the energy requirements needed to support high levels of physical activity in addition to other homeostatic and physiological bodily processes. Although low energy availability is largely recognized as a causative factor for amenorrhea and low bone density, no studies to date have examined specific macro- and micro-nutrient intake relating to bone mineral density in the female athlete population. The hypothesis to be tested was that a difference in the intake of specific nutrients between athletes with menstrual disturbances (amenorrheic) and regularly menstruating (eumenorrheic) athletes contributes to low bone mineral density in female athletes exhibiting symptoms of the Triad. Methods: 4-day food records were collected from 118 females, ages 14-23 years, who exhibited weight within the normal range. 68 participants were amenorrheic athletes (AA), 24 participants were eumenorrheic athletes (EUM), and 26 participants were non-exercising females within the same age group (non-athletes: NA). Serum levels of vitamin D, phosphorus, calcium, and estradiol were also collected. Results: In contrast to previous studies, there was no difference in energy availability between the AA, EUM, and NA groups. The groups did differ in their intake of several macro-and micro-nutrients, and many of these nutrients correlated significantly with lumbar spine BMD. In a multivariate model that included vegetable and total proteins, soluble, insoluble and total dietary fiber, pectins, phytic acid, natural folate, calcium intake, vitamin D intake, serum vitamin D levels, and % calories from saturated fatty acids (SFA), only dietary fiber remained negatively associated and % calories from SFA positively associated with lumbar spine BMD. Conclusions: Dietary fiber has a significant inverse association and % calories from SFA a positive association with lumbar spine BMD, even after controlling for other nutrient intake and serum levels and intake of Vitamin D and calcium. Therefore, fiber and saturated fat may exert effects unrelated to vitamin D status and overall energy availability to impact bone density. Nutrition guidelines for female athlete triad patients need to be reassessed.

High school coaches play a huge role in establishing a healthy environment for their athletes and often students. The coach-°©‐athlete relationship has proven to be a strong and useful bond in prevention of adverse behaviors of athletes or in prevention of health problems such as concussions. The female athlete triad (triad) is a common health problem among female athletes. Many high school coaches are unaware of the triad or the serious health and performance consequences for their athletes. The triad is a syndrome marked by 3 interrelated adverse effects: decreased energy availability, menstrual dysfunction, and decreased bone mineral density. The Purpose of this study was to develop an online educational resource aimed at educating coaches about the triad. After the online education materials were created and reviewed by small panel groups, the materials were launched online and available to the public with the aim to target high school coaches. We collected online surveys from 90 participants including coaches and parents of high school female athletes and found a lack of knowledge, attitudes, and confidence in preventing the triad. By educating coaches and providing the tools for prevention, we hypothesize that coaches can play a large role in the prevention of the triad among high school athletes and help to keep our student athletes healthy and performing well in school and sports.

Adolescence is a time of increased control over food choices and dietary practices. Participating in high school sports or attending college presents unique nutritional concerns and health risks. Some female high school athletes have low energy availability (consuming inadequate calories to compensate for exercise energy expenditure), which can result in menstrual dysfunction, bone loss, and injury, also known as the female athlete triad (Triad). College students who consume diets low in fruits and vegetables and high in fast food are at increased risk for weight gain, chronic disease, and some cancers. Nutrition education interventions that were tailored to the participants' unique nutritional concerns yielded positive results such as increased Triad knowledge among female high school athletes and increased self-efficacy and readiness to change dietary behaviors among college students. Peer-led education was preferred by college students, but not by high school students.

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Ballet dancers are a unique population of athletes in that, unlike other sports, their success strictly depends on both physical capabilities and aesthetic factors. While the physical demands of the performing sport are strenuous, ballet dancers are often required to exhibit a thin physique, frequently resulting in weights 10-12% below the ideal. These low weights are commonly achieved by low energy intakes which increase dancers' susceptibility to the development of various health conditions. Research investigating the health of dancers, however, is limited and hampered by methodological limitations. To address these issues, we tested the hypothesis that dancers would report a low habitual energy intake and, therefore, be subject to conditions comprising the Female Athlete Triad, including low energy availability, suboptimal bone density and menstrual irregularities. In addition, we hypothesized that elite female dancers would have lower than expected resting metabolic rate (RMR) based upon their fat-free mass, and thus greater energetic efficiency as a result of chronic energy deficiency. As hypothesized, dancers reported a significantly lower energy intake and exhibited a lower RMR as compared to lean, pair-matched controls. Because treatment of these metabolic abnormalities is challenging, prevention of adverse health outcomes among adolescent pre-professional dancers is key in promoting overall health and optimal performance. Through our subsequent 'formative work', we determined that the current availability of nutrition education offered to both professional and pre-professional dancers is minimal and of questionable quality. Thus, we developed, implemented, and evaluated a DVD-based educational program, entitled "Nutrition for Optimal Performance", aimed at improving health knowledge and behaviors of pre-professional adolescent ballet dancers. Our findings indicate that participants increased their knowledge of basic nutrition principles and self-efficacy for adopting healthier dietary habits, as compared to pre-program and control group scores, and that knowledge gains were sustained at a six-week follow-up assessment. Collectively, these studies provide the field of dance medicine with novel findings related to the characteristics and health conditions of professional ballet dancers, and the effectiveness of a low-resource, disseminable nutrition education program which promotes the health and optimal performance of pre-professional adolescent ballet dancers. / Ph. D.

Prior research has found the female athlete triad in both female athletes and female non-athletes. This study consisted of 192 female participants attending Utah State University with 103 collegiate athletes and 89 non-athletes. The instruments used included the EAT-26, menstrual cycle history questionnaire, osteoporosis questionnaire, and time spent in exercise questionnaire. Results from the present study found a statistically significant difference between athletes and non-athletes being at risk for the triad with female athletes having a higher percentage (4.8%, 3.4%). No statistical significant correlation was found between the risk of the triad and excessive amounts of time spent in exercise in athletes (r=.113, p=.256) and non-athletes (r=-.041, p=.706). When athletes were divided into lean and non-lean athletes statistical significance was found with non-lean (17.4%) sport athletes (χ²(1,N=103)=83.971, p<.01) having a higher overall percentage of being at risk of the triad compared to the athletes involved in lean (5%) sports.

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Background: The number of women participating in sports has increased dramatically, though research in sports are often performed on men. Physical exercise is known to increase physical performance and improve well-being. Although exercise has beneficial health effects for most of the women, it is known that strenuous exercise may also have negative health consequences. Common are menstrual dysfunctions and the medical effects of a long-standing amenorrhea are serious. Moreover, strenuous exercise without adequate recovery may lead to overreaching (OR) /overtraining syndrome (OTS). An improved muscle strength are of great importance in many sports, hence an increased understanding on how to generate optimal strength training programs in women without negative side effects are essential. The aims of this thesis were to investigate the effects on strength and power of high frequency periodised leg resistance training to evaluate a training regime and moreover to investigate if the training was well accepted and without potential exercise-related negative consequences. Moreover, to provide normative data on oxytocin and cortisol to elucidate if these hormones could be one diagnostic marker in combination with others to monitor and diagnose female athletes that may be at risk to develop OR/OTS. Methods: Fifty-nine women, participated in the four month intervention study. Two groups performed high frequency leg resistance training for two weeks of each menstrual/oral contraceptive (OC) cycle. The remaining part of the cycle they performed the leg training once a week. Group 1, trained with high frequency (5 times·w-1) during the first two weeks of each cycle, and group 2, during the last two weeks of each cycle. A control group performed regular (3 times·w-1) leg resistance training. Another 33 women participated in the observational study. The OC users and non-users, were followed over a nine-month period with monthly blood sampling of oxytocin and cortisol, and the Profile of Mood State (POMS) as a subjective measure of OR/OTS. Results: The women who performed high frequency leg resistance training, 5 times·w-1, during the first two weeks of each cycle showed significant increase in jump height, peak torque values in hamstrings, increased lean body mass of the legs, and their experiences of the training were positive. These results were not found when the periodised training was performed during the last two weeks of each cycle. In the control group an increase in jump height, and peak torque (left hamstring) was observed. There were no evident differences in the training effects between women with or without OC use. Moreover, no exercise-related negative consequences were detected in any of the three groups. The women in the observational study showed seasonal variations in oxytocin and cortisol, with different pattern in OC users to non-users. No convincing relationships to POMS were found.  Conclusions: The high frequency periodised leg resistance training during the first two weeks of the cycle is more beneficial to optimize resistance training, than the last two weeks. The high frequency periodised leg resistance training was not associated with exercise-related negative consequences and was well accepted when performed during the first two weeks of each cycle. Due to seasonality and impact of OC use, oxytocin and cortisol are not suggested to be optimal, diagnostic markers alone/in combination with others, to detect OR/OTS in physically active women.