Prevalence of Normal Weight Obesity Amongst Young Adults in the Southeastern United States

Authors: 1Helena Pavlovic, 2Tristen Dolesh, 3Christian Barnes, 4Angila Berni, 5Nicholas Castro, 6Michel Heijnen, 7Alexander McDaniel, 8Sarah Noland, 9Lindsey Schroeder, 10Tamlyn Shields, 11Jessica Van Meter, and 12Wayland Tseh*

1Northern Kentucky University, Highland Heights, Kentucky, USA

AUTHORS INSTITUATIONAL AFFILIATION:

School of Health and Applied Human Sciences, University of North Carolina Wilmington, Wilmington, North Carolina, United States of America

Corresponding Author:

*CORRESPONDING AUTHOR:  

Wayland Tseh, Ph.D. 

University of North Carolina Wilmington 

School of Health and Applied Human Sciences 

601 South College Road 

Wilmington, North Carolina, 28403-5956 

Phone Number: 910.962.2484 

E-Mail: tsehw@uncw.edu 

ABSTRACT

‘Normal weight obesity (NWO) is characterized by a normal or low body mass index (BMI) alongside a high percentage of body fat, which increases the risk for hypokinetic diseases. This study aims to investigate the prevalence of NWO among a sample of young, non-sedentary adults. Two hundred and fifty-four apparently healthy volunteers (Age = 22.2 ± 7.2 yrs; Height = 171.5 ± 9.6 cm; Body Mass = 69.9 ± 13.4 kg) provided informed consent prior to participation. Body mass index was calculated by dividing body mass (kg) by height squared (m2). Body fat percentage was measured using the BODPOD® G/S, which utilizes air displacement plethysmography to accurately estimate body composition. Class I Obesity and Low/Normal BMI categorizations were defined by the American College of Sports Medicine. Data revealed that 12.2% of the overall sample exhibited NWO, with a higher prevalence among males (17.2%) compared to females (9.8%). The study also seeks to evaluate whether individuals with NWO face greater health risks than those with similar BMI but lower body fat percentages. From a practical perspective, identifying individuals with NWO is an opportunity for clinicians to proactively educate their clients regarding the health risks associated with hypokinetic disease(s).

KEYWORDS: Body Mass Index, BODPOD, Percent Body Fat, Normal Weight Obesity

INTRODUCTION

Within the United States, the prevalence of obesity has dramatically increased over the past 50 years given the ubiquitous obesogenic environment (31). In 2019, Ward and colleagues yielded compelling predictive insights indicating a trajectory wherein, by the year 2030, nearly 50% of adults will be afflicted by obesity (48.9%) with heightened prevalence exceeding 50% in 29 states, demonstrating a pervasive nationwide trend (50). Moreover, no state is anticipated to exhibit a prevalence below 35% (50). Projections also indicate that a substantial proportion of the adult population is anticipated to experience severe obesity, with an estimated 24.2% affected by 2030 (50). Against this backdrop, the predictive analyses conducted by Ward and associates (50) underscored the widespread and escalating severity of the obesity epidemic across the United States. These findings are indicative of an impending public health challenge, necessitating strategic interventions and policy considerations to mitigate the escalating burden of obesity and its associated health implications. When delineating the magnitude of obesity, clinicians and practitioners must employ precise instrumentation capable of quantifying a client’s body composition in terms of percentage body fat. Numerous methodologies exist for this purpose, encompassing hydrostatic weighing, bioelectrical impedance analysis, air displacement plethysmography, skinfold assessment, and dual-energy x-ray absorptiometry scan.

Drawing from antecedent research studies, dual-energy X-ray absorptiometry (DXA) is acknowledged as the clinical gold standard for appraising body composition (9, 10, 12, 21, 25, 26, 42, 47). However, a notable drawback of DXA lies in its emission of low-level radiation (6, 9, 32, 45, 47), thereby subjecting clients to unnecessary radiation exposure (1, 33). An alternative method is utilizing the BOD POD® Gold Standard (GS), which employs air displacement plethysmography to estimate body composition. Previous literature has heralded the BOD POD® GS as the applied, pragmatic gold standard for assessing body composition due to its validity (2, 7, 38), as well as its within- and between-day reliability (48). Additionally, owing to the BOD POD® GS’s facile and non-invasive procedures, most individuals can attain accurate measures of body composition values, specifically pertaining to percent body fat, enabling the discernment of pounds of fat-free mass and fat mass.

According to the American College of Sports Medicine (ACSM), males with a percent body fat ≥ 25% and females ≥ 32% (4) are predisposed to an elevated risk of developing a myriad of hypokinetic diseases, notably cardiovascular disease(s), metabolic syndrome, and cardiometabolic dysfunction (14, 27, 35, 37, 39, 40, 43, 44, 46, 51, 56). Another evaluative approach involves the calculation of Body Mass Index (BMI), derived from dividing body weight in kilograms by square of height in meters (4). Given the ease and efficiency of calculating BMI, the obesity-related classification in which it provides at the individual level is potentially flawed (3, 8, 22, 24, 41, 53, 56).

Presently, within the United States, a dearth of research exists on the prevalence of normal weight obesity (NWO) amongst apparently healthy young adults (11,52). Normal weight obesity is characterized by individuals exhibiting a low BMI (<18.5 kg∙m-2) or normal BMI (18.5 – 24.9 kg∙m-2) yet manifesting obesity-related percentage body fat values (male = ≥20%; female = ≥30%) (5, 14, 20, 36, 37, 40, 43, 44, 57). Individuals with low/normal BMI and high percentage body fat values face an augmented risk of hypokinetic diseases, as their seemingly normal exterior masks a deleteriously high amount of body fat beneath the surface layer. Previous research endeavors have revealed the prevalence of NWO amongst a population of South Americans (14, 34, 40, 44), Central Europeans (15), and Asians (28-30, 37, 54, 55, 57, 58). Given that most aforesaid research studies on NWO have been conducted internationally, it is of paramount interest to ascertain the prevalence of NWO domestically. Consequently, the primary objective of this research study is to investigate the prevalence of normal-weight obesity among a sample of ostensibly healthy males and females.

METHODS

Participants

All participants were required to report to the Body Composition Laboratory to complete a singular session. Before the participants arrived, volunteers were instructed to abstain from consuming caffeinated sustenance or beverages that may acutely influence body mass. Moreover, researchers advised participants to refrain from vigorous physical activity/exercise the night before and prior to their appointed session. Upon arrival, volunteers read and signed an informed consent form approved by the University’s Institutional Review Board for human subject use (IRB#: H23-0499). As displayed in Table 1, a cohort comprising 254 male and female volunteers were recruited to participate in this study.

Table 1. Descriptive characteristics (Mean ± SD) of all male and female participants (N = 254). 

Variables Overall (N = 254) Male (n = 101) Female (n = 153) 
Age (yrs) 22.2 ± 7.2 22.5 ± 7.7 22.0 ± 6.8 
Height (cm) 171.5 ± 9.6 179.5 ± 7.2 166.2 ± 7.0 
Body Mass (kg) 69.9 ± 13.4 79.9 ± 11.6 63.2 ± 10.0 

Below highlights the details of the singular Session required for each participant.

Body Mass Index (BMI)

Before each assessment, participants were asked to remove any unattached item(s) from their body, such as shoes, socks, rings, bracelets, and/or glasses. Height was measured to the nearest 0.5 cm as participants stood barefoot, with both legs together, with their back to a Seca 217 Mobile Stadiometer (Model Number 2171821009, USA). Body mass was measured on a Tanita Multi-Frequency Total Body Composition Analyzer with Column (Model DC-430U, Tanita Corporation, Japan) to the nearest 0.1 kg. Body mass index was calculated using body mass expressed in kilograms (kg) divided by height expressed in meters squared (m2). Body mass index categorizations, set forth via ACSM (4), for low BMI was (<18.5 kg∙m-2) and normal BMI was (18.5 – 24.9 kg∙m-2).

BOD POD® Gold Standard (GS)

BOD POD® Gold Standard (GS) (COSMED USA Inc., USA) was calibrated daily according to the manufacturer’s instructions with a 50.238 Liter cylindrical volume provided by COSMED USA Inc. Specific details illustrating the technicalities of the calibration mechanism are published elsewhere (16, 18). Because different clothing schemes have been shown to underestimate percentage body fat (%BF) results from the BOD POD® (19, 49), female participants were instructed to wear one- or two-piece bathing suit or sports bra and compression shorts, while male participants were instructed to wear form-fitted compression shorts. All participants wore a swim-like cap provided by COSMED USA Inc. After race, height, and age were inputted by a technician into the BOD POD® GS kiosk, participants were asked to step on an electronic scale to determine body mass to the nearest .045 kg. Once the BOD POD® GS system recorded body mass, participants were instructed to sit comfortably and breathe normally within the BOD POD® GS for two trials lasting 40 seconds per trial. A third trial was conducted if Trials 1 and 2 had high variability. Once both (or three) trials were conducted, body composition values, specifically, body mass, percent body fat, fat-free mass, and fat mass, were immediately displayed on the kiosk viewer and recorded by a technician. Once height, body mass, and body composition assessments were completed, participants dressed back into their original clothing and exited the Body Composition Lab.

Statistical Analyses

Descriptive statistics (mean ± SD) were derived to describe the sample population. A Chi-Square Goodness of Fit Test was used to determine the prevalence of low/normal BMI values with obesity-related percent body fat. For all analyses, statistical significance was established at p < 0.05.

RESULTS

At the conclusion of the study, 254 volunteers were recruited, and zero dropped out, therefore, all 254 participants’ results were included in the statistical analyses. Table 2 displays the descriptive measures of the study participants.

Table 2. Body Mass Index, Class I Obesity, and Percent Normal Weight Obesity Amongst Males and Females. 

 Total Male Female 
Participants 254 101 153 
Low BMI (≤ 18.4 kg∙m-2
Normal BMI (18.5 – 24.9 kg∙m-2181 58 123 
Class I Obesity (F ≥ 32%; M ≥ 25%) 22 10 12 
Masked Obesity 12.2% 17.2% 9.8% 
High BMI (≥ 25.0 kg∙m-271 43 28 

The chi-squared statistic was 1.886 (df = 1, p = 0.17) indicating no statistical difference in NWO between males (17.2%) and females (9.8%).

DISCUSSION

As stated previously, there is a dearth of data determining the prevalence of NWO domestically, more specifically, within the southeast region of the United States. Therefore, the primary objective of this research study was to investigate the frequency of NWO amongst a sample of apparently healthy individuals. Participants completed a singular data collection session whereby height, body mass, and percentage body fat were quantified via BOD POD® GS. Within this current study, low and normal BMI classifications were <18.5 kg∙m-2 and 18.5 – 24.9 kg∙m-2, respectively. Class I obesity for females and males were ≥ 32% and ≥ 25%, respectively. Given said thresholds, data revealed that 12.2% of the overall sample exhibited NWO, with a higher prevalence amongst males (17.2%) compared to females (9.8%). These findings are relatively comparable within other research investigating the prevalence of NWO amongst a sample of young adults (5, 35, 44, 57).

In 2017, Ramsaran and Maharaj investigated the prevalence of NWO within a cohort of 236 young adults (mean age = 21.3 ± 2.5 years). The quantification of %BF was accomplished using the Tanita Ironman body composition analyzer. Subsequent data analyses unveiled a heightened prevalence of NWO among the male participants (14.4%), surpassing their female counterparts (5.5%). The outcomes of the current study align with the findings reported by Ramsaran and Maharaj (44), wherein NWO manifested in 17.2% of males and 9.8% of females. A nuanced distinction between the two investigations lies in the designated thresholds for %BF. Ramsaran and Maharaj (44) set the elevated %BF thresholds at ≥ 23.1% for males and ≥ 33.3% for females. In contrast, the current study employed thresholds of ≥ 25.0% for males and ≥ 32.0% for females. Notwithstanding the marginal elevation (+1.9%) in the %BF threshold within the current study, males exhibited a greater prevalence (+2.8%) compared to Ramsaran and Maharaj’s (44) dataset. Conversely, the current study adopted a lower %BF threshold (–1.3%) for females and uncovered a higher prevalence of NWO (+4.4%). These subtle yet discernible variations in %BF thresholds may elucidate the divergent prevalence rates of NWO observed between the two scholarly investigations.

Akin to Ramsaran and Maharaj (44) and the present investigation, Anderson and colleagues (5) examined the incidence of NWO within a more modest cohort of 94 young adults (mean age = 19.6 ± 1.5 years). The quantification of %BF was assessed via DXA. The %BF thresholds were predicated on National Health and Nutrition Examination Survey standards, establishing obesity values of ≥ 30.0% for males and ≥ 35.0% for females. Findings elucidated an NWO prevalence in males (26.7%) and females (7.8%). Noteworthy is the marked elevation in male NWO rates (+9.5%) and marginal reduction (–2.0%) in female NWO rates compared to the current study. While discrepancies may be attributed to variances in sample size (254 in the present study vs. 94 in Anderson et al.), divergent methodologies for %BF assessment (utilizing BOD POD® GS presently as opposed to DXA in Anderson et al.), and distinct %BF thresholds (ACSM criteria in the current study versus NHANES in Anderson et al.), the overarching findings remain concordant. Specifically, data from all three research investigations underscore the consistent pattern wherein males manifest elevated NWO prevalence rates relative to their female counterparts.

In contradistinction to the two previous research investigations and the current study, Zhang et al. (57) explored the NWO prevalence amongst 383 young adults (mean age = 20.4 ± 1.6 years). Assessment of %BF was executed through bioelectrical impedance analyses (BIA) employing the InBody 720 device. Obesity classification was contingent upon threshold values of ≥20.0% for males and ≥30.0% for females, as established by Zhang and associates (57). Analyses unveiled an NWO prevalence of 13.2% in males and 27.5% in females, a prominent deviation from the present study’s findings. The contrasting NWO prevalence patterns observed between the two studies are notably discernible. Specifically, Zhang and colleagues (57) reported a higher prevalence in females than males, whereas the current investigation revealed the converse. This discordance is seemingly attributable to variances in the %BF thresholds implemented for obesity classification. Zhang et al. (57) utilized a considerably lower threshold for males at 20.0%, as opposed to the 25.0% threshold applied in the current study. Similarly, for females, Zhang et al. (57) employed a lower %BF threshold at 30.0%, whereas the present study utilized a more conservative threshold of 32.0%. Moreover, a salient methodological distinction lies in the apparatus employed for %BF quantification. The current study utilized the BOD POD® GS, acknowledged as the applied gold standard for assessing body composition, while Zhang et al. (57) employed the InBody 720 BIA. These methodological nuances likely contribute to the divergent findings between the present research and Zhang et al. (57), underscoring the importance of rigorously evaluating both threshold criteria and assessment modalities when interpreting and comparing NWO prevalence data.

In a recent investigation, Maitiniyazi et al. (35) endeavored to ascertain the prevalence of NWO within a cohort of 279 young adults (mean age = 21.7 ± 2.1 years). Percentage body fat was assessed utilizing the InBody 770 BIA method. Obesity classification thresholds were established at 20.0% for males and 30.0% for females. Parallel to the observed NWO patterns delineated by Zhang and colleagues (57), Maitiniyazi et al. also discerned a higher prevalence of NWO in females (40.1%) as opposed to males (25.5%). Notably, while these NWO trends align with the patterns identified by Zhang et al. (57), they markedly deviate from the outcomes of the current investigation. Such discordant findings may find elucidation in the nuanced disparities in the thresholds employed to categorize obesity and the instrumentation deployed for %BF quantification. Specifically, the divergence in %BF thresholds used for obesity classification emerges as a significant factor. Maitiniyazi et al. (35) employed thresholds different from those of Zhang et al. (57) and the current study, thereby contributing to the observed inconsistencies. Additionally, the equipment utilized to quantify %BF introduces another layer of methodological variation. While Zhang et al. (57) implemented InBody 720 BIA and the current study utilized BOD POD® GS, Maitiniyazi et al. deployed the InBody 770 BIA method. These divergent methodological approaches underscore the imperative of meticulous consideration when interpreting and comparing NWO prevalence data, highlighting the multifaceted nature of the interplay between obesity thresholds and assessment methodologies in elucidating NWO prevalence.

CONCLUSIONS

This comprehensive investigation contributes significantly to our understanding of NWO prevalence within a young adult population, particularly within the Southeast region of the United States. The study employed the BOD POD® GS for precise measurement of height, body mass, and percentage body fat, revealing a higher, but not statistically different, prevalence in NWO between males and females. These results align with similar studies collectively emphasizing the consistent pattern of elevated NWO prevalence in males relative to females. The study’s alignment with said research investigations further underscores the robustness of the findings, notwithstanding variations in sample size, methodology, and threshold criteria. Conversely, discrepancies with other research investigations highlight the sensitivity of NWO prevalence to %BF thresholds and assessment modalities. Despite the divergence in outcomes, these studies collectively reinforce the need for careful consideration of methodological nuances in interpreting and comparing NWO prevalence data.

APPLICATION IN SPORTS

From a practical perspective, the findings emphasize the importance of incorporating regional and demographic variations when assessing NWO prevalence. Furthermore, the study underscores the relevance of employing standardized methodologies in ensuring consistency and comparability across investigations. Future endeavors in this domain should continue to explore regional variations, refine %BF threshold criteria, and employ advanced methodologies for accurate NWO characterization. This knowledge is pivotal for tailoring preventive measures and interventions; more precisely, accurately identifying NWO individuals is an opportunity for clinicians to proactively educate their clients regarding the health risks associated with hypokinetic disease(s), particularly cardiovascular disease(s), metabolic syndrome, and cardiometabolic dysfunction.

ACKNOWLEDGMENTS

The author would like to personally thank the following research assistants that contributed to the success of this research investigation: Tristen, Brennan, Marisa, Maddie, Samantha, Caylin, and Ethan.

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2024-10-24T15:50:50-05:00October 25th, 2024|Research, Sports Health & Fitness, Sports Nutrition|Comments Off on Prevalence of Normal Weight Obesity Amongst Young Adults in the Southeastern United States

Low Energy Availability (LEA) in Male Athletes: A Review of the Literature

Authors:Brandon L. Lee1

1The Department of Exercise, Health, and Sport Sciences, Pennsylvania Western University

Corresponding Author:

Brandon L. Lee, MS, RD, CCRP
10263 4th Armored Division Dr.
Fort Drum, NY 13603
leebl18@outlook.com
315-772-0689

Brandon L. Lee, MS, RD, CCRP is a Holistic Health and Fitness (H2F) Dietitian for the U.S. Army Forces Command and a Doctor of Health Science (DHSc) student at Pennsylvania Western University. Brandon’s research interests include energy systems and metabolism, energy availability, andragogical methods for adult learning, and reflective practice to enhance learning in formal education..

ABSTRACT

Purpose: Low energy availability (LEA) is a physiological state when there is inadequate energy to meet the demands placed on the body, often through physical activity, exercise, or sports. LEA can impact any athlete engaged in a sport with low energy intake or excessive energy expenditure. LEA is a precursor to the onset of The Male Athlete Triad (MAT) and Relative Energy Deficiency in Sport (RED-S). There is no defined low energy availability threshold specific to male athletes engaged in high-energy expenditure sports leading to MAT and RED-S. This literature review evaluates the literature on the relationship between LEA and signs or symptoms of MAT and RED-S to establish a low energy availability threshold specific to male athletes engaged in high-energy expenditure sports.

Methods: The Pennsylvania Western University library electronic database was used for the literature search. Search terms included “male athletes”, “low energy availability”, “male athlete triad”, “relative energy deficiency in sport”, and “energy deficiency”. Research studies included cross-sectional, experimental, systematic reviews, meta-analyses, case studies, and some narrative and literature reviews. Studies must have been peer-reviewed and published within five years of the literature search (12/2018- 12/2023).

Results: A review of the literature shows that it is difficult to determine a LEA threshold due to present research gaps and inconsistent findings related to health and performance consequences. Based on the results of experimental studies, practitioners can expect an LEA threshold of 20-25kcal per kilogram (kg) of fat-free mass (FFM) per day in male athletes engaged in high energy-expenditure sports.

Conclusions: Athletes engaged in sports that lead to inadequate energy intake or high energy expenditure are at risk for LEA, MAT, and RED-S. Experimental research on the LEA threshold in athletes engaged in physiologically demanding sports is the greatest research gap. Based on present findings, male athletes may have an LEA threshold of <30kcal/kg of FFM/day.

Applications in Sport: Healthy nutritional practices are essential to sports performance. Interdisciplinary sports performance teams must collaborate with nutrition professionals to develop effective LEA prevention, screening, and intervention protocols.

Keywords: energy intake, energy deficiency, energy expenditure of exercise, male athlete triad, relative energy deficiency in sport, sports nutrition

Low Energy Availability (LEA) in Male Athletes: A Review of the Literature

Energy availability (EA) is the energy dedicated to body system functions. In sports nutrition, energy availability is defined as the amount of energy remaining to support an athlete’s bodily functions after energy expenditure of exercise (EEE) is deducted from energy intake (EI) (2). Health and athletic performance issues arise when athletes have inadequate energy intake or excessive energy expenditure, depleting their EA. The designated term for this is low energy availability (LEA). LEA is defined as a physiological state when there is inadequate energy to meet the demands placed on the body, often through physical activity, exercise, or sports (23). Causes of LEA include obsessive causes (disordered eating or eating disorders), intentional causes (attempts to modify body mass or composition), and inadvertent causes (byproduct of high EEE) (1).
LEA can impact any athlete engaged in a sport with low energy intake or excessive energy expenditure. LEA is most common in sports of high intensity, duration, volume, or frequency and in sports that emphasize low body weight/fat, aesthetics, or thinness, including distance cycling and running, triathlons, tactical (i.e., military), swimming, gymnastics, wrestling, bodybuilding, martial arts, boxing, soccer, tennis, rowing, horse racing, and volleyball. LEA is a precursor to the onset of both The Male Athlete Triad (MAT) and Relative Energy Deficiency in Sport (RED-S), two conditions that result in weakened physiological functions, with the former focused on reproductive and bone health decline (22). The problem is the prevalence of LEA among male athletes participating in high-energy expenditure sports, leading to potential health and performance issues. Additionally, there is no defined low energy availability threshold specific to male athletes engaged in high-energy expenditure sports leading to MAT and RED-S (3, 4, 5, 9, 11, 14, 17, 22, 26).
This literature review aims to evaluate the literature on the relationship between LEA and signs or symptoms of MAT and RED-S to establish a defined low energy availability threshold specific to male athletes engaged in high-energy expenditure sports. This literature review will report on LEA’s impact on health, body composition, athletic performance; establish LEA thresholds, and address research gaps.

RELATIVE ENERGY DEFICIENCY IN SPORT (RED-S)
LEA is a common precursor to many health and athletic performance issues. In 2014, the International Olympic Committee (IOC) developed a consensus statement titled “Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport (RED-S)” and established RED-S as a new condition that refers to diminished physiological processes due to relative energy deficiency. The most current IOC RED-S models show that RED-S can impact the following systems: immunological, menstrual/reproductive function and bone health (related to athlete triad), endocrine, metabolic, hematological, growth and development, psychological, cardiovascular, and gastrointestinal. Moreover, another IOC RED-S model shows the potential performance effects of RED-S, including decreased endurance performance, increased injury risk, decreased training response, impaired judgment, decreased coordination, decreased concentration, irritability, depression, decreased glycogen stores, and decreased muscle strength (19). Much of the research on the impact of LEA and the cascade of events that lead to RED-S has primarily been conducted on female athletes, and the findings are extrapolated to their male counterparts; however, this is changing.

MALE ATHLETE TRIAD
The Male Athlete Triad (MAT) was first introduced in the 64th Annual Meeting of the American College of Sports Medicine (ACSM) in 2017 (6). MAT has comprised three essential components: LEA (sometimes referred to as energy deficiency), impaired bone health, and suppression of the hypothalamic-pituitary-gonadal (HPG) axis (22).
Prevention and treatment methods of MAT hinge on the EA or energetic status of the athlete at risk. Nattiv et al. (2021) explain that energy deficiency or LEA is confirmed when one of the following metabolic adaptations is presented: reduced RMR compared to body size or fat-free mass (FFM), unintentional weight loss resulting in a new low set point, underweight body mass index (BMI), and reduced metabolic hormones such as triiodothyronine (T3), leptin, and several more. Hypogonadotropic hypogonadism can manifest as oligospermia (deficiency of sperm in the semen) or decreased libido (reduced sexual drive). Lastly, poor bone health can manifest as osteopenia, osteoporosis, or bone stress injury (22).
The energetic status of the athlete can vary greatly depending on frequency, intensity, duration, type of sport, volume, and progression. Nattiv et al. (2021) have surmised that male athletes engaged in leanness sports typically have low energy intake compared to recommended amounts from the Institute of Medicine Daily Recommended Intakes or Food and Agriculture Organization of the United Nations/World Health Organization. Unfortunately, male leanness sports or weight-class athletes potentially consume up to 1000kcal/day less than required to support their exercise demands (22). Athletes consistently at risk for MAT include runners and cyclists, primarily if they compete in long-distance competitions.

Cardiovascular Health
Cardiovascular health (CVH) is essential to every athlete engaged in any sport. A healthy cardiovascular system effectively moves blood from one location to another to transport oxygen-containing blood cells for muscular activity. Langan-Evans et al. (2021) studied the impact of incorporating daily fluctuations in LEA on cardiorespiratory capacity via treadmill test in one combat athlete preparing to make weight for competition. The athlete experienced microcycle EA fluctuations ranging from 7 to 31 kcal per kilogram (kg) of FFM/day (mean EA of 20kcal/kg of FFM/day) for seven days and did not experience any significant changes in resting heart rate, cardio output, or overall CVH (14). Theoretically, LEA would have significant structural, conduction, repolarization, and peripheral vascular effects on CVH (17). However, a scant amount of research establishes any correlation between CVH and LEA, and primary research studies conducted within the past five years have yet to establish causation between the two.
On the other hand, Fagerberg (2018) has found that EA <25kcal/kg FFM over six months in bodybuilders preparing for a competition can impact CVH by reducing heart rate. According to Fagerberg (2018), low body fat percentages in bodybuilders worsen CVH risk (4). This heart rate reduction, paired with low body fat, is likely a physiological adaptation to conserve energy and sustain life. There needs to be more consistency in the literature regarding the impact of LEA on CVH.

Physiological Health
LEA and RED-S are both physiological and psychological health risks. Sports that emphasize leanness (e.g., cycling) or have weight divisions (e.g., combat sports) often place additional mental stress on athletes to perform well and possess a specific physique. For example, Schofield et al. (2021) found that male cyclists are at risk for LEA and RED-S due to rigid weight management practices, desire for leanness, disordered eating and eating disorders, and body dissatisfaction (26).
Elevating psychological health is commonly conducted via a questionnaire or interview. Langbein et al. (2021) explored the subjective experience of RED-S in endurance athletes through semi-structured, open-ended interviews. The first male participant commented on hitting “rock bottom” and the body’s sensitivity to energy intake changes. In addition, the other male athlete appeared to have a transactional relationship with food and exercise, void of any joy or performance goals. Both male athletes reported negative psychological consequences regarding RED-S; these consequences included increased rates of irritability because they were obsessed with food and exercise and feelings of helplessness and despair (15).
Perelman et al. (2022) also examined the male athlete’s psychological state by evaluating and intervening on body dissatisfaction, drive for muscularity, body-ideal internalization, and muscle dysmorphia. Male athlete participants (n=79) were from various sports, including baseball, golf, soccer, swimming, track and field, volleyball, and wrestling. The results showed that group sessions focused on reframing ideal body perception, the consequences of RED-S, encouraging positive self-talk, and reviewing strategies to modify energy balance healthfully can significantly reduce body dissatisfaction, body-ideal internalization, and drive for muscularity (p < .05) (24). The results demonstrate the value of understanding, supporting, and guiding an athlete’s psychological state toward personal health and satisfaction.

Reproductive Health
Functional hypogonadotropic hypogonadism is one of the three primary pillars of the MAT. LEA can induce disruptions to the hypothalamic-pituitary-gonadal (HPG) axis, resulting in functional hypogonadotropic hypogonadism. Signs of hypogonadotropic hypogonadism include (1) reductions of testosterone (T) and luteinizing hormone (LH), (2) decreased T and responsiveness of gonadotropins to gonadotropin-releasing hormone (GnRH) stimulation after training, (3) alterations in spermatogenesis, and (4) self-reported data on decreased libido and sexual desire (22). Most current research studies examine free and total T as an indicator of HPG axis suppression. Lundy et al. (2022) categorize low total T (<16nmol/L) and low free T (<333 pmol/L) as primary indicators for LEA (16).
A significant contribution to this area comes from the work by Jurov et al. (2021) who conducted a non-randomized experimental study with a crossover design to investigate the reproductive health impacts of progressively reducing EA by 50% for 14 days in well-trained and elite endurance male athletes. The results demonstrated a positive correlation between T levels and measured EA; as EA declined, so did T (9).
The empirical evidence on the causal relationship between LEA and T has been growing over recent years, with studies such as one conducted by Dr. Iva Jurov and colleagues. In three progressive steps, their quasi-experimental study reduced EA (via increasing EEE and controlling EI) in well-trained and elite male endurance athletes. Participants had statistically significant T changes starting at the 50% EA reduction phase with a mean EA of 17.3 ± 5.0kcal/kg of FFM/day for 14 days (p < 0.037). Furthermore, T levels continued to significantly decline at 75% EA reduction phase with a mean EA of 8.83 ± 3.33 for ten days (p < 0.095) (10). Conversely, in another quasi-experimental study by Jurov et al. (2022b), endurance male athletes had their EA reduced by 25% by increasing EEE and controlling EI for 14 days. The mean EA was 22.4 ± 6.3kcal/kg of FFM/day. The results show no significant changes to T levels, potentially indicating that a greater EA reduction was required to induce change (11).
Stenqvist et al. (2020) conducted four weeks of intensified endurance training designed to increase aerobic performance and determine the impact of T and T: cortisol ratio on well-trained male athletes. After the four weeks of intensified endurance training, the results showed that total T significantly increased by 8.1% (p=0.011) while free T (+4.1%, p=0.326), total T: cortisol ratio (+1.6%, p=0.789), and free T: cortisol ratio (-3.2%, p=0.556) did not have significant changes when compared to baseline (27). It is complex to determine the EA threshold defined by HPG axis suppression. Research on LEA and suppression of the HPG axis (i.e., T reduction) have demonstrated varied results based on athlete EA study design features (e.g., high EEE intensity or low EI duration); however, endurance athletes remain at the highest risk (18, 22, 26).

Bone Health
The last pillar of the MAT is osteoporosis with or without bone stress injury (BSI). Impaired bone health is most common in athletes in sports that have low-impact loading patterns, such as cycling, swimming, or distance running. Bone mineral density (BMD) is the primary measurement method to evaluate overall bone health and risk for osteoporosis. Dual-energy x-ray absorptiometry (DXA) is the gold standard for assessing bone density, but quantitative computed tomography (QCT) is also emerging as an equally acceptable alternative. In outpatient or rehabilitation settings, frequency of DXA scans is recommended no sooner than every ten months to allow for detectable changes in bone mineral density (17).
Risk factors for low BMD include LEA, low body weight (<85% of ideal body weight), hypogonadism, running mileage >30/week, and a history of stress fractures (22). In addition to BMD, other indicators of bone health include bone mineral content (BMC), markers of bone formation including β-carboxyl-terminal cross-linked telopeptide of type I collagen (β-CTX), bone alkaline phosphatase, and osteocalcin, and markers of bone resorption including amino-terminal propeptide of type-1 procollagen (P1NP), tartrate-resistant acid phosphatase, and carboxy-terminal collagen cross-links (4, 17). Studies will occasionally implement biomarkers such as Vitamin D and calcium to evaluate dietary intake and risk of BSI or osteoporosis.
What is the prevalence of low BMD in athletes? Tam et al. (2018) evaluated the bone health and body composition of elite male Kenyan runners (n=15) compared to healthy individuals. The results showed that 40% of Kenyan runners have Z-scores indicating low bone mineral density in their lumbar spine for their respective age (z-score <−2.0). This study did not measure energy availability with bone mineral density (29). However, based on previous research, low bone mineral density may have LEA origins.
Heikura et al. (2018) studied the BMD of middle- and long-distance runners and race walkers and found that athletes had an LEA (21kcal/kg of FFM/day) (7). Athletes with a moderate EA generally had better z-scores than the LEA athletes; however, the differences were not statistically significant. Similarly, Õnnik et al. (2022) found that high-level Kenyan male distance runners had an average EI of 1581kcal, and male controls had an average EI of 1454kcal per day. The male athletes did not show a statistically significant difference in BMD (p = 0.293) compared to the male control group, with only one runner (out of 20) at risk for osteoporosis (lumbar spine z-score <1.0) (23).
Cyclists are at the highest risk for poor bone health due to chronic LEA, reduced osteogenic simulation, and low levels of impact or resistance (26). Keay et al. (2018) assessed the efficacy of a sport-specific EA questionnaire and clinical interview (SEAQ-I) in British professional cyclists at risk of developing RED-S. Based on the results of the SEAQ-I, 28% (n=14) were identified with LEA, and 44% of the cyclists had low lumbar spine BMD (z-score <-1.0) (p< 0.001). Also, cyclists with a history of lack of load-bearing sports or activities had the lowest BMD (p= 0.013) (13). This study demonstrates a clear association between LEA and reduced lumbar spine BMD in professional cyclists.
In a randomized controlled trial, Keay et al. (2019) investigated the efficacy of an educational intervention with British competitive cyclists to improve energy availability and bone health. The researchers induced LEA by 25% (mean EA of 22.4 ± 6.3kcal/kg of FFM/day) for 14 days. Athletes who implemented nutritional strategies (provided by nutrition professionals) to improve EA and strength training strategies to improve skeletal loading saw lumbar spine BMD improvements. Mean vitamin D levels significantly improved from pre-season (90.6 ± 23.8 nmol/L) to post-season (103.6nmol/L; p=0.0001). Calcium, correct calcium, and alkaline phosphatase had no statistically significant changes between pre-season and post-season (12). Keay et al. have established the prevalence of LEA and poor bone health in cyclists and demonstrated nutrition education efficacy for BMD improvements. Noteworthy findings such as these help to raise awareness in the cycling community and can inform preventative or rehabilitative strategies.

BODY COMPOSITION
Body composition is the distinction between fat mass and fat-free mass. Fat-free mass includes water, tissue, organs, bones, and muscle (e.g., skeletal muscle). Body composition control and maintenance are essential for an athlete’s health, performance, and mindset. Research measurements of body composition include weight, body mass index, body fat percentage, lean mass, and water content. According to Lundy et al. (2022), a body mass index <18.5 kg/m2 is a primary indicator of LEA; this suggests body composition changes in response to LEA (16).
What is the impact of LEA on body composition? Stenqvist et al. (2020) implemented a four-week intensified endurance training designed to increase aerobic performance and elevate body composition’s impact on well-trained cyclists. The results did not show statistically significant changes in energy intake, body weight, fat mass, or fat-free mass. Body weight loss was potentially averted due to reduced resting metabolic rate as a protective mechanism (27). Whereas Stenqvist et al. (2020) focused on increasing EEE, Jurov et al. (2021) attempted to induce LEA via EI manipulation. Jurov et al. (2021) progressively reduced EA by 50% for 14 days in well-trained and elite endurance male athletes; the results showed no significant changes in body mass and fat-free mass (9).
Regarding resistance training and LEA, Murphy and Koehler (2022) conducted a meta-analysis to quantify the discrepancy in lean mass accretion between interventions providing resistance training in an energy deficit and those without an energy deficit. The literature findings demonstrated lean mass gains impairment in athletes resistance training in an energy deficit compared to those training without an energy deficit (significantly, p = 0.02). The results also surmised that an energy deficit of as much as 500kcal/day could impede lean mass gains (21).
Roth et al. (2023) evaluated the impact of a relatively high- versus moderate volume resistance training program on alterations in lean mass during caloric restriction in male weightlifters. The results showed that whole-body lean mass significantly declined in both groups (high and moderate volume groups) following six weeks of energy restriction. The high-volume group had an EA of 31.7 ± 2.8kcal/kg of FFM/day, and the moderate-volume group had an EA of 29.3 ± 4.2kcal/kg of FFM/day (25). Both studies demonstrate that muscle hypertrophy is unattainable in the presence of LEA.
Furthermore, Murphy and Koehler (2020) found that three days of caloric restriction at an EA of 15kcal/kg of FFM/day in recreational weightlifters resulted in significant reductions in weight (p<0.01), fat mass (p<0.01), and lean mass (p<0.001). Also, the total mass loss was significant (p<0.01) when compared to a control group (EA of 40kcal/kg of FFM/day) (20). The results of studies focused on resistance training and caloric restriction hold applicability for athletes in sports that rely on lean mass gains while manipulating EI, such as bodybuilding (4).

CARDIORESPIRATORY ENDURANCE
Cardiorespiratory endurance (CRE) is the ability of the lungs, heart, and blood vessels to deliver sufficient oxygen to cells to meet the physiological demands of exercise and physical activity (8). Evaluating maximal oxygen uptake or VO2max is a standard CRE measure. A VO2 max of 67.9 ± 7.4 mL/kg/min is categorized as a high fitness level (28).
What is the impact of induced LEA on CRE performance outcomes? Jurov et al. (2021) investigated the endurance performance impact of progressively reducing energy availability by 50% for 14 days in well-trained and elite endurance male athletes. The researchers increased EEE to achieve a mean energy availability of 17.3 ± 5 kcal/kg of FFM/day. The results showed lowered EA reduced endurance performance, as indicated by respiratory compensation point (RC) and VO2max. Jurov et al. (2022b) reduced EA by 25% (by increasing EEE and controlling EI) in trained endurance male athletes and monitored for aerobic performance changes. The results showed that inducing LEA by 25% (mean EA of 22.4 ± 6.3kcal/kg of FFM/day) for 14 days reduced hemoglobin levels, indirectly impacting VO2max and aerobic performance (11). Beyond research conducted by Dr. Iva Jurov and colleagues, there is insufficient experimental research on LEA and CRE.

MUSCULAR STRENGTH AND ENDURANCE
In recent years, few experimental studies have evaluated the impact of LEA on muscular strength, endurance, and athletic performance. Research on athletic performance and LEA has shown that endurance athletes with an EA of 17.3 ± 5 kcal/kg of FFM/day show no reductions in agility t-tests, power output, or countermovement jump results, indicating no association with EA (9). Also, Jurov et al. (2022b) found that a mean EA of 22.4 +/- 6.3kcal/kg of FFM/day in endurance male athletes for 14 days results in significant changes to explosive power (countermovement jump) but not agility t-tests (11).
Furthermore, Jurov et al. (2022a) also reduced EA (via increasing exercise energy expenditure and controlling energy intake) in male endurance athletes to evaluate performance and muscular power impact. The results showed significant reductions in explosive power (measured via vertical jump height test) at a mean EA of 22.4, 17.3, and 8.82 kcal/kg of FFM/day. Based on these findings, athletes reach the LEA threshold after a long time in an energy-deficient state, such as ten to 14 days (10).
However, Stenqvist et al. (2020) aimed to measure peak power in male cyclists after four weeks of intensified endurance training. The results showed that the cyclists significantly improved their peak power output (4.8%, p < 0.001) and functional threshold power (6.5%, p < 0.001) measured via stationary bike. Possibly, the EEE of the intervention was insufficient to induce LEA but instead induced the Specific Adaptation to Imposed Demands (SAID) principle in the athletes (27).
Regarding weightlifters, Murphy and Koehler (2022) studied whether energy deficiency impairs strength gains in response to resistance training. This research study was a meta-analysis of randomized controlled trials. The study findings showed that strength gains were comparable between resistance training groups in either an energy deficit or a balance state. These results demonstrated that low energy availability for prolonged periods (i.e., RED-S) did not impede strength output (21). There are a few studies that report bodybuilders with strength declines with estimations of EA <20 kcal/kg of FFM/day (4). The theory remains that inadequate energy intake will inevitably reduce muscular strength and output.

LOW ENERGY AVAILABILITY THRESHOLD
To date, optimal EA levels and the threshold for LEA in male athletes are under investigation. However, many research studies are cross-sectional, only demonstrating a correlation between athletes and energy availability (e.g., LEA commonly found in endurance athletes). The scant number of current experimental studies often fail to induce LEA and thereby fail to establish clear LEA thresholds.
To prevent LEA and subsequent conditions such as RED-S and MAT, athletes need to maintain their energy availability. Primarily, athletes need to ensure adequate EI and carefully manage their EEE. Current EA “zones” for female athletes are also applied to male athletes until experimental research can demonstrate a need for separate guidelines. EA >45kcal/kg of FFM/day supports body mass gain and maintains healthy physiological functions; 45kcal/kg of FFM/day is optimal for weight maintenance and healthy physiological functions; 30-45kcal/kg of FFM/day is considered suboptimal and at-risk for reduced physiological functions; and ≤30kcal/kg of FFM/day is considered low energy availability (1, 3, 4, 9, 10, 14, 17, 26).
Research by Jurov and colleagues has demonstrated mixed results regarding performance outcomes, body composition, and bone health (9, 10, 11). Mean energy availability in those studies ranged between 17-22 kcal/kg of FFM/day (9, 11). Based on their research findings, Jurov and colleagues have proposed a range of 9-25kcal/kg of FFM/day (mean value of 17kcal/kg of FFM/day) for an LEA threshold (10).
Regarding performance and body composition outcomes, Murphy and Koehler (2020) conducted a randomized, single-blind, repeated-measures crossover trial that showed three days of caloric restriction at an EA of 15kcal/kg of FFM/day induced considerable anabolic resistance to a heavy resistance training bout (20).
In a case study by Langan-Evans et al. (2021), an EA of 20kcal/kg per FFM/day led to weight loss and fat loss without signs of MAT and RED-S. However, an EA of <10kcal/kg of FFM/day did result in signs and symptoms of MAT and RED-S, including disruptions to the hypothalamic-pituitary-gonadal axis, resting metabolic rate (measured), and resting metabolic rate (ratio) (14). Additionally, some LEA thresholds may need to be sport-specific. For instance, Fagerberg et al. (2018) suggest an LEA threshold of 20-25kcal/kg of FFM/day for male bodybuilders with a lower body fat percentage (4). Research to establish EA zones and an LEA threshold for male athletes continues, and guidelines primarily still consider ≤30kcal/kg of FFM/day appropriate for male athletes. However, some researchers have also contested that male athletes can go lower before exhibiting signs and symptoms of MAT and RED-S.

RESEARCH GAPS
There are sizable research gaps regarding LEA and RED-S. First, this literature was unable to address the impact of LEA on endocrine, metabolic, hematological, and gastrointestinal health due to insufficient research published in the past five years. Mountjoy et al. (2018) identified the following research gaps: (1) lack of practical tools to measure and detect LEA and RED-S, (2) lack of validated prevention interventions for RED-S, (3) RED-s in male athlete research, (4) health and performance consequences of RED-S research, and (5) lack of evidence-based guidelines for treatment and return-to-play for athletes with RED-S. Research gaps focused on male athletes with MAT are even more prominent (19).

Moreover, Fredericson et al. (2021) listed several research gaps that need scientific attention, including screening protocols to detect MAT in adolescent and young males, identification of MAT energetic and metabolic impact factors, prevalence of DEED in male athletes with MAT, evaluating the efficacy and effectiveness of clearance and return-to-play protocols, risk assessment for BSI and poor bone health, prevalence of MAT in military recruits, health interventions on the prevention and treatment of MAT, and lastly, cutoff values (or threshold) for LEA (5). Addressing these research gaps would enable sports and health practitioners to effectively prevent and treat LEA, RED-S, and MAT, ensuring athlete health and sports performance.

SUMMARY
LEA is defined as a physiological state when there is inadequate energy to meet the demands placed on the body, often through physical activity, exercise, or sports (23). LEA can impact any athlete engaged in a sport with low energy intake or excessive energy expenditure. LEA is a precursor to the onset of both The Male Athlete Triad (MAT) and Relative Energy Deficiency in Sport (RED-S), two conditions that result in weakened physiological functions, with the former focused on reproductive and bone health decline (22).

Recent literature has shown mixed results on LEA’s impact on immunological health, metabolic markers, bone health, body composition, cardiorespiratory endurance, and muscular strength and endurance. There has been little evidence to connect LEA and endocrine, metabolic, hematological, and gastrointestinal health. However, a notable causal relationship exists between LEA and psychological health and reproductive health. Currently, there is still no defined low energy availability threshold specific to male athletes, however, EA zones from 15-25kcal/kg of FFM/day may be appropriate based on current literature (4, 20, 10, 18, 22, 26).

APPLICATION TO SPORT
Healthy nutritional practices are essential to sports performance. Interdisciplinary sports performance teams must collaborate with nutrition professionals such as Registered Dietitians accredited by the Commission on Dietetic Registration to develop effective LEA prevention, screening, and intervention protocols. Preventative measures must prioritize energy availability, modify sporting culture to encourage energy intake, and mitigate barriers to calorie- and nutrient-dense foods in male athletes. Screening protocols must include EA evaluations based on dietary intake, exercise energy expenditure, and fat-free mass measured via DXA or bioelectrical impedance analysis. Male athletes with an EA ≤20-25kcal/kg of FFM/day must receive nutritional guidance to reduce health and performance impairments. Intervention protocols must be enacted when LEA is confirmed and should primarily focus on increasing energy intake, decreasing energy expenditure, and addressing other associated aspects such as psychological health. Athletes, coaches, and practitioners must raise LEA awareness, dispel energy consumption stigmas, and foster an environment where food and nutrition fuel peak performance.

ACKNOWLEDGEMENTS
This work was supported by the Pennsylvania Western University Department of Exercise, Health, and Sport Sciences. The author would like to thank Dr. Marc Federico and Dr. Brian Oddi for their guidance and feedback on the manuscript

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2024-10-21T09:45:40-05:00October 23rd, 2024|Book Reveiws, Research, Sports Nutrition|Comments Off on Low Energy Availability (LEA) in Male Athletes: A Review of the Literature

Can there be two speeds in a clean peloton? Performance strategies in modern road cycling

Authors: Karsten Øvretveit1

1K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing,

Corresponding Author:

K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology,
Trondheim, Norway, PB 8905, N-7491 Trondheim, Norway
karsten.ovretveit@ntnu.no

Karsten Øvretveit, MSc3, is a physiologist and PhD candidate at the Norwegian University of Science and Technology (NTNU). His research areas include genetic disease risk, physical performance, motivational dynamics, and human nutrition.

Can there be two speeds in a clean peloton? Performance strategies in modern road cycling

ABSTRACT

In the history of professional cycling, riders have always sought competitive advantages. Throughout 20th century, many relied on performance-enhancing drugs (PEDs) which gave rise to a phenomenon called “two-speed cycling”. Throughout its modern era, professional cycling has seen anti-doping efforts repeatedly intensify on the heels of several large doping scandals. Over the past decade, the sport appears to have transitioned away from large-scale systematic doping and towards novel, legal performance-enhancing strategies, facilitated by a close relationship with scientific, technological, and engineering communities. The tools and technologies available to assess the demands of the sport, the capabilities of the riders, and the role of environmental factors such as wind resistance, altitude, and heat are more refined and comprehensive than ever. Teams and riders are now able to leverage these to improve training, recovery, equipment, race tactics and more, often from a very early age. This review explores several key developments in road cycling and their implications for the modern professional peloton.


Key Words: professional cycling; performance-enhancing drugs; marginal gains; performance analysis

INTRODUCTION

The main pack of riders navigating the road in a cycling race, known as the peloton, comprises a wide range of physiological, anthropometrical, technical, and strategical attributes. The role of each rider in a given race is typically based on strengths, weaknesses, and objectives, and can be modified by injuries, fitness level, personal goals, and unexpected in-race developments. The concept of “cycling at two speeds”, cyclisme à deux vitesses, has historically been used to distinguish between chemically enhanced riders and those who ride clean (134). However, despite increasingly stringent doping controls in professional cycling along with a clear shift in doping culture, the concept of two-speed cycling remains.
Given the well-documented benefits of performance-enhancing drugs (PEDs), there is an expectation that the intensification of anti-doping measures in professional cycling leads to more homogeneous performance levels in the peloton by reducing the number of artificially enhanced riders. Although this may be a reasonable assumption, it discounts the many substantial advances made in training, nutrition, technology, and strategy, as well as the growing talent pool of potential professionals and the early age at which they begin to seriously structure their training, racing, and recovery. These factors can differ greatly between teams and individual riders and thus help maintain the two-speed phenomenon. This review provides a brief history of the PED culture and use in professional cycling, followed by an examination of some of the key developments in the sport that has helped preserve the two-speed phenomenon in a peloton riding within an increasingly strict anti-doping framework.

The performance-enhanced past of the peloton

Drugs have been used to enhance athletic performance for millennia, stretching back to at least the ancient Olympic Games (16). Cycling as a profession emerged among working-class men who likened endurance sports to physically demanding jobs where the use of drugs to aid performance was considered the right thing to do (58). Indeed, doping has been pervasive in professional cycling for over 150 years, throughout most of which it was either legal or not subject to testing (34). For decades, riders doped to simply be able to do the job – faire le métier (33). Then, athlete health became a concern and a major driving force to regulate, if not outright ban the use of certain substances. Drug testing in the Tour de France (TdF), the most prestigious event on the race calendar, began in 1966. Despite this, amphetamines, cortisone, and steroids remained widespread in the professional peloton. It was also around this time that rumors about the use of blood transfusions in athletes began (60). The year after Raymond Poulidor underwent the first drug test in the TdF, Tom Simpson collapsed on the ascent of Mount Ventoux and later passed away due to an unfortunate combination of alcohol, amphetamines, intense heat, and extreme physical exertion. Although this event brought more attention to the use of stimulants and other drugs in cycling and in sports in general (69), doping would persist for decades to follow. Based on interviews with riders on a professional cycling team at the turn of the millennium, psychiatrist Jean-Christophe Seznec (115) asserted that professional cyclists are not only prone to develop an addiction to PEDs, but also recreational drugs, noting the importance of explicitly acknowledging this risk in order to mitigate it.

When professional cycling entered the 90s, the banned yet at that time undetectable erythropoiesis-stimulating agent (ESA) recombinant human erythropoietin (rHuEPO) arrived in the peloton (101), and performances hit a new level. Increasing circulating erythropoietin (EPO) by illegal means has been perceived by some riders and coaches to give an estimated performance boost, without the term “performance” being strictly defined, of 3% to 20% (31, 100, 134, 138). Interestingly, despite its popularity in the peloton, the research literature on the effects of ESAs such as rHuEPO on endurance performance is equivocal. Its effects on hematological values like hemoglobin concentration ([Hb]) and clinical measurements of power and maximal oxygen uptake (V̇O2max) are well-established, but the real-world benefits are not always clear (116, 123).

There are several aspects of professional cycling that are difficult to account for in experimental studies on exogenous EPO, such as the extremely high fitness level of a peaked professional cyclist and the physiological impact of training and racing on parameters such as Hb. A recent randomized controlled trial found no apparent benefit of EPO on relevant performance markers has sometimes been cited to shed doubt on the true effects of the drug (47). However, this study was done in cyclists with an average V̇O2max of 55.6 mL/kg/min, which is substantially lower than their professional counterparts (124). By his own account, former professional Michael Rasmussen saw his hematocrit (Hct) drop from 41% to 36% following the 2002 Giro d’Italia (98), illustrating how blood composition can be severely perturbed by training and racing. Similar values have been observed in other professionals following participation in Grand Tours (17, 89). Using Rasmussen as an example, using rHuEPO to bring this up to 49%, just below the old 50% limit, would represent a relative Hct increase of 36% and result in improved ability to maintain a much higher intensity in training and racing, and consequently greater exercise-induced adaptations.

Throughout the 90s, Grand Tour riders with supraphysiological Hct would traverse France, Italy, and Spain at impressive speeds until it all seemingly came to an end in 1998. Three days before the start of the 85th edition of the TdF, a Festina team car carrying various PEDs was stopped by customs agents at the French-Belgian border. This event marked the start of what later became known as the Festina affair, a major catalyst in cycling’s transition to a cleaner sport. The wake of this scandal saw an increasing number of calls to action against doping, including by the driver of the Festina car (132), with claims of the sport dying unless drastic action is taken. Subsequent large-scale doping cases such as Operación Puerto and the contents of the USADA’s Reasoned Decision Report (10) served as reminders that PEDs were still present in the peloton and strengthened the resolve of those fighting for a cleaner sport.
Although riders are often blamed for the pervasive drug use in cycling, most entered a sport with a lack of top-down anti-doping efforts, leaving them with the difficult choice of either conforming to the culture or competing on unequal terms. One of the most crucial steps towards a cleaner sport is a change in culture among teams and riders. Much, if not most, of the credit should go to the riders themselves, many of which have actively pushed against the use of PEDs for years (46, 50, 59, 85, 130). Today, most doping cases in cycling are among semi-professional riders, whereas the number of riders testing positive at the highest level is approaching zero (88).

Although absence of evidence is not evidence of absence, fewer doping cases at the highest level of cycling suggests that overt, systematic drug use is a thing of the past. Given professional cycling’s checkered history, it would be naïve to think that doping has been eliminated entirely, but the sport does appear to have evolved beyond doping being perceived as all but necessary to gain entry into the professional peloton. Generational shifts not only among riders, but also among governing bodies and team leadership have contributed to an overall firmer stance against doping, removing potentially significant contributors to anti-doping violations (6). There is also indications that the post-Armstrong generation, especially those who started their careers young, are less likely to use PEDs (5), although the evidence is equivocal (64). Additionally, anti-doping technology continues to improve, with recent advances such as gene expression analysis being able to extend the detection window of blood manipulations (28, 133).

Conceptual approaches to legal performance development

It could be argued that the extraordinary performances regularly being on display by the current generation of riders suggest that the dismantling of systematic doping practices has led to progression rather than regression of the sport of cycling. The transition away from prevalent PED use has forced teams and riders to seek out other areas of improvement, some with barely measurable effects, to keep up. Although seeking improvements in many areas is not a new phenomenon in professional cycling, it has received increasing attention over the past decade with the success of Team Sky, now INEOS Grenadiers, and team director, Dave Brailsford, who called this concept “marginal gains”. Brailsford and his team set out to win the TdF within five years with a clean British rider (29). To achieve this, he brought with him the approach he used as a performance director for British Cycling, which had led to considerable success in track cycling. Team Sky was established on the back of British dominance in the Laoshan velodrome during the 2008 Beijing Olympics, where they took home seven gold medals. As he transitioned from the track to the road, Brailsford brought the idea that compiling enough marginal gains could provide a greater performance advantage than PEDs (87).

Although the marginal gain concept came to prominence with Team Sky during one of professional cycling’s most recent avowed shift from banned to legal performance-enhancing strategies, it has been practiced by cyclists since at least the mid-1900s. Italian Fausto Coppi, who rode to multiple victories in the TdF and Giro d’Italia, as well as in one-day classics throughout the 40s and early 50s, was an early adopter of novel diet and training approaches. After World War II, the sport of cycling was anything but advanced and Coppi set out to change that. He worked with Bianchi to develop bikes and other equipment; he adapted his diet to better fuel his riding – not only its contents, but also the timing and amount; and he explored strategies for how to best race as a team (37). Some of these developments would later influence other greats, such as Eddie Merckx, who, among other things, was obsessed with proper bike fit (38). Current director of the French national team, Cyrille Guimard, has also long been known for his application of cutting-edge technology and training methods. One of his former riders, Laurent Fignon, described him as being “right up-to-date. He had files for everything. He was interested in all the lates training methods. Where his protégés were concerned, he would look at the very last detail and even the slightest defect would be corrected. He knew how to ensure everyone had the very best equipment that was on the market: made-to-measure bikes, the newest gadgets.” (32, p. 56).

 The notion that modern riders can surpass past performances solely through legal performance strategies rests on the assumption that these strategies, particularly when combined, are highly effective. Furthermore, a larger pool of athletes and an earlier onset of structured athletic development might amplify these effects. The following section explores the degree of improvement that can be made in the areas of training, nutrition, and technology.

There is not a single anthropometric or physiological characteristic that is completely uniform across high-level cyclists (65, 111). Those with elite potential tend to have stand-out absolute measurements of aerobic fitness and power, but these are attributes that can also be found in cyclists of lower caliber. Elite riders also possess very high power-to-weigh ratios, typically expressed as watts per kilogram (W/kg). An emerging concept that may also distinguish riders of different caliber is durability, i.e., the point and degree of physiological decline during extended exercise (66, 79, 80). Laboratory measurements of key performance determinants such as power-to-weigh ratio, V̇O2max, cycling economy, critical power, and peak power output provide a detailed physiological profile of each individual rider but cannot accurately predict real-life performance.

Training Strategies

Aided by technology, experience, and insights from a growing body of research, training is more refined, structured, and supervised than before, with most, if not all, training sessions serving a specific purpose. Each rider typically follows an individualized training plan that is carried out under comprehensive monitoring of variables such as heart rate, power output, climate, and terrain. These data, along with laboratory measurements, race outcomes, and even psychological variables, are used to adjust volume, frequency, intensity, and/or modality throughout the season. This allows each rider to absorb as much recoverable training volume as possible to optimize physiological adaptations and peak repeatedly for competition while avoiding overtraining. Whereas virtually every single pedal stroke of the modern rider is quantified and analyzed to guide training, racing, and recovery, riders of the past relied more on “feel”, often opting for subjective rather than objective measurements of output. During the 1987 TdF, Laurent Fignon declared his legs to be “functioning again, more or less”, but did not see the value in monitoring his heart rate, explaining that “I lost my temper with those blasted pulse monitors: I handed mine back so that it wouldn’t tell me anything anymore” (32, p. 182).

Although W/kg is often favored as an indicator of riding capacity and a way to quantify cycling performances, a large V̇O2max has long been considered a basic requirement of entry into the professional peloton. Values reported for GC contenders are generally comparable between generations, with the lowest value found in the most dominant TdF rider of all time, albeit with an asterisk (table 1). There are a few caveats to these numbers, such as the validity of the actual measurement, most of which are not described in the research literature but rather in media. Moreover, oxygen uptake does not increase in proportion to body mass and scaling V̇O2max to whole body mass is thus not appropriate when comparing athletes of different body sizes (71). Although some of these values may be exacerbated by PED use, both the baseline level and plasticity of V̇O2max are under considerable genetic influence (15, 86, 135), and WorldTour levels can be reached without doping in those with sufficient genetic predisposition and appropriate stimulus.

Interestingly, there seems to be a physiological trade-off between efficiency and power, where adaptations towards the latter may attenuate the former (72, 113). This phenomenon was observed in Norwegian cyclist, Oskar Svendsen, who once had the highest V̇O2max ever recorded. Svendsen showed promise early by becoming junior time trial champion with less than three years of training and placing high in Tour de l’Avenir. However, despite an incredible V̇O2max of 96.7 ml/kg/min at 18 years of age, Svendsen never became a WorldTour rider. Although his early retirement at age 20 left his potential at the elite level largely unexplored, the reduction in cycling economy he experienced with increased training load could have been resolved as he matured as a rider, as cyclists appear to become more efficient over the span of their careers with little change in V̇O2max (112). If he remained active, Svendsen may eventually have been able to exploit his incredible baseline to reach the proverbial second speed in the modern peloton without chemical assistance. These insights into Svendsen’s physiological profile not only reveal some of the physiological complexities involved in high-level endurance performance, but also serve as an example of the scientific resources available to modern teams and riders that allows for a level of detail in the assessment and follow-up of athletes never seen before at that level of the sport.

Among the many training-related advances in the modern era is a more systematic approach to altitude training. Altitude-mediated erythropoiesis has long been recognized as an exposure that can produce adaptations that improves performance at sea level, as well as acclimatize athletes to sustain performance in hypobaric conditions. There are several ways to approach altitude training and care should be taken to avoid carrying the detrimental effects of prolonged hypoxic exposure, such as reduced cardiac output (Q̇) due to hypovolemia (117), into competition. Today, professional cycling teams rely on both experience as well as past and emerging research to use altitude as an important preparatory measure in various parts of the season. As the individual responses to hypoxic conditions can vary greatly (93), a large hematological response following real or simulated altitude exposure is an important attribute in modern riders. If done properly, altitude training can induce comparable hematological changes to rHuEPO use (table 2), making it a crucial performance-enhancing strategy in the modern peloton. Increasing [Hb] not only improves V̇O2max by improving the oxygen-carrying capacity of blood (43), it also enables sustained work at a higher fraction of maximal capacity (40) and faster V̇O2 kinetics (18), which can be hugely influential in a peloton with limited interindividual difference in V̇O2max.

A more recent strategy to legally induce hematological adaptations is heat acclimation. Prolonged exposure to heat is associated with both increased plasma volume, which can improve stroke volume and consequently Q̇ and V̇O2max, as well as an expansion of total hemoglobin mass (Hbmass) (91). In fact, light exercise in a heated environment five times per week has been shown to increase Hbmass by 3% – 11% in endurance athletes (90, 103, 107). Due to the logistical challenges and cost related to with altitude camp designs such as live high-train low, heat acclimation training may offer a more accessible strategy for riders and teams with less resources, or an additional stimulus to regular stays at altitude.
The mechanistic similarities between synthetic and natural causes of erythropoiesis makes it physiologically possible to harness the benefits of EPO without doping. Voet (132) recounts that pre-scandal Festina riders did not even bring EPO to altitude camps because it was going to be “useless”. Describing his first stay at altitude, formerly enhanced rider, Thomas Dekker, wrote that “[t]he altitude works its magic: the thin air jolts my body into producing extra red blood cells and the Swiss Tour is the first race in ages where I can stay with the pace on the climbs” (25, p. 135), expressing relief that he could hang with the peloton without PEDs. Michele Ferrari, Lance Armstrong’s coach during the height of his career, argues that the effects of EPO on hemoglobin concentration can be achieved through proper altitude training alone (31).

Every rider in the professional peloton possesses rare abilities as cyclists. Given that the sport selects for individuals with above average baseline values of [Hb] and Hct, it may not take much stimulus to maintain a high level. However, compared to simply administering rHuEPO, strategies such as altitude training and heat acclimation are more complex undertakings, partly because of potential drawbacks with that must be accounted for, such as transiently reduced Q̇ and altered dietary requirements. The financial cost associated with prolonged exposure to altitude and/or heat for a professional team is also a considerable barrier, as the finances of teams can differ greatly. In some cases, PED use might simply just be more practical than legal strategies, and not necessarily more powerful.

Improving oxygen delivery and utilization have been main training targets for cyclists throughout most of its history, while resistance training (RT) has been largely neglected. As the impact of both power output and oxygen consumption on cycling performance is intrinsically related to rider weight, maintaining a low body mass has been, and still is, imperative. However, RT with an emphasis on neural adaptations can substantially improve force-generating capacity and reduce the oxygen cost of exercise in athletes without adding unnecessary bulk (51-53, 140). It also helps maintain bone mineral density, which elite cyclists are prone to lose (48, 110). A recent study found that RT with traditional movements and individualized load improved bone mineral density and endurance performance in professional cyclists (126). Moreover, it appeared to improve strength, power, and body composition to a greater degree than short sprint training, a more traditional power training modality for cyclists, supporting the role of structured RT as a part of a professional cyclists overall training program. Indeed, evidence for the benefit of RT on cycling performance has been mounting over the past years (table 3) (62, 102, 104-106, 108, 109, 120, 131, 141). This has contributed to changing the way RT is perceived and applied in the.

An elite physiology is easier to perturb than improve. At the highest level of cycling, large adaptations to training are unlikely to occur in the short term. The full, natural potential of a rider can only be reached via the cumulative effects of proper training and recovery, both of which are highly dependent on proper fueling.
Nutrition, body composition, and supplementation

In Jørgen Leth’s classic documentary, “A Sunday in Hell”, Roger De Vlaeminck can be seen consuming a plate of meat with his team before setting out to defend his multiple Paris–Roubaix victories from the previous years in the 1976 edition, with the narrator explaining that “a rare steak is a good breakfast for what lies ahead” (67). This is in stark contrast to the low-residue diet often consumed by riders in the modern peloton (39). A low-residue diet is characterized by a very low fiber content, which can reduce rider weight and consequently improve race performance (36). This diet is usually combined with a very high carbohydrate intake throughout a race to ensure constant glucose availability, and the reduced satiety that can be associated with low-residue diets may even help a rider maintain energy intake during a race. The exact amount differs between riders, with numbers around 100 g of carbohydrate per hour being a rough estimate that may be exceeded considerably on hard days. The recognition of the added performance benefit of increased carbohydrate intake has given rise to the concept of gut training for athletes (56, 78). Racing hard for hours on end for multiple consecutive days with limited glucose availability is guaranteed to hamper performance compared to a well-fueled athlete; as red blood cells do not convert to adenosine triphosphate; blood doping cannot replace bioenergetic fuel.

There are some examples of riders that leveraged nutrition to increase their performance throughout history, such as Fausto Coppi (37), but in the modern era, all riders pay attention and have access to both nutritionists and chefs, both of which are roles that have become integral parts of professional teams. Riders also have access to more knowledge and tools, such as food apps powered by machine learning (121). The days of training hard during the day following by alcohol consumption in the evening and racing on the weekends are gone, but were reportedly common until fairly recently (25, 54). The culmination of evidence- and experience-based diets in professional cycling has led to better fueling strategies and lower body mass in the peloton and perhaps especially among the best riders.

Although described as “thin as rakes” (132, p. 63), the riders of the 90s were heavy by today’s standard. Laurent Fignon (32) explains that the importance of power-to-weight ratio did not become known among the riders before the mid-80s and that he, until that point, paid little attention to diet. Looking at the top 10 finishers of the TdF for the past four decades, starting with the latest edition, suggest that it is becoming more and more of a requirement for the overall GC placing (table 4). Notably, between 1992 and 2022, the average BMI of the top 10 decreased by 8.1%. This trend seems to generally hold across all Grand Tours for the past decades (118).

Supplements such as creatine and beta-alanine have been shown to improve endurance performance, including in cycling (7, 12, 21, 49, 127, 128). Creatine was introduced to the peloton in the mid-90s but was very expensive at the time. Riders who had access to it could consume up to 30 g the day before a long time trial or a mountain stage in hopes of a performance boost (132). Creatine and beta-alanine are now both affordable and widely used, alongside other supplements such as caffeine, electrolytes, nitrates, various vitamins, and minerals, as well as macronutrient supplements such as protein and carbohydrate.

In recent years, a lot of attention has been devoted to exogenous ketones. It is a contentious supplement that has been embraced some of the strongest teams while being recommended against by the Union Cycliste Internationale (UCI) and the Movement for Credible Cycling (MPCC). Ketones, or ketone bodies, are acetyl-CoA-derived metabolites that are produced by the liver under conditions with reduced glucose availability, such as low-carbohydrate diets, fasting, and during or after hard exercise. Ketone bodies such as β-hydroxybutyrate can spare glycogen by inhibiting glycolysis and acting as an alternative fuel in oxidative phosphorylation, which in turn can improve endurance (19). As with the research on other legal and illegal enhancement strategies, the degree to which exogenous ketones translates to improved exercise performance remains to be fully elucidated (24, 92, 94, 96, 125, 139). Although there may be potential drawbacks with isolated ketone supplementation (82), in conjunction with sodium bicarbonate, which is a weak base that has been used for some time in endurance sports (45), ketone supplementation has been shown to improve power output towards the end of a race simulation by 5% (95), although this effect may be unreliable and warrants further study (97).

Much of the hype surrounding some of the proposed effect of ketones as an energy substrate appears unwarranted, but emerging evidence suggest that it may have intriguing properties as a signaling molecule. A few years ago, it was shown that infusion of ketone bodies increased circulating EPO levels in healthy adults (63). The impact of ketones on EPO is supported by the observation that adherence to a ketogenic diet can increase [Hb] and Hct by ~3%, with the caveat this effect is within the biological variation of these markers (83). Recently, Evans et al. (30) found that ingestion of ketone monoester after cycling exercise increased serum EPO concentration, providing further evidence that it may be the signaling effects rather than nutritional value of ketone supplements confers the greatest performance benefit for professional cyclists.

Technology and equipment
Science tends to be reductionistic by necessity, whereas a cycling race is much more open-ended. There is, however, a certain cycling event that is performed in highly controlled conditions and relies heavily on technological advances that can serves as a good example of marginal gains in modern road cycling: the hour record. In 1972, Eddy Merckx, perhaps the greatest cyclist of all time, rode a distance of 49.431 km to set a new hour record for the first time since the 1950s. Twelve years later, Francesco Moser breached 50 km with an effort totaling 51.151 km, aided by disc wheels and a skin suit. The following years would see various innovative approaches by riders such as Graeme Obree and Chris Boardman, until the UCI decided to revise the rules in 1994 and again in 2014 (table 5). To set his records, Boardman worked closely with Brailsford’s predecessor in British Cycling, Peter Keen, and then later with Brailsford himself after his retirement, on what would be the beginning of British riders’ marginal gains on the track and later in the peloton (14).

From Voigt’s first attempt to Ganna’s latest, the modern hour record has been improved by over 11%. Although Ganna is a multiple World Time Trial champion and likely one of the most suitable riders to attempt the record, the last person to hold the record before him was Daniel Bigham, the only rider on the list that was never a WorldTour rider. Although an accomplished cyclist in his own right, Bigham’s record is a prime example of how far and fast you can get by maximizing the margins, with his record being set at an average power output approximately 100 watts less than Wiggins. Bigham himself puts his performance down to 50% physiology and 50% equipment (137). One of the main aspects Bigham exploited was aerodynamics; his coefficient of aerodynamic drag (CdA) was ~0.15, which is considerably below what is commonly seen in cyclists, including professionals (41).

Aerodynamics is not only relevant when riding fast around a velodrome for an hour, but also one of the most important things to consider when trying to ride fast on a bike in general. At a riding speed of about 54 km/h, close to the average on a flat TdF stage, approximately 90% of the total resistance is aerodynamic resistance (13, 44). Most of the resistance is caused by the rider himself, with common estimates ranging from 60-82% (74), and the rest by other factors such as equipment (22, 73, 77). The importance of minimizing CdA underlies much of the development of modern bike frames, wheels, handlebars, helmets, clothing, and more. In recent years, there has been less emphasis from manufacturers on getting their bikes down to the UCI weight limit of 6.8 kg in favor of more aerodynamic optimizations. This approach is supported by findings showing that simply opting for aerodynamic rather than light wheels will reduce climbing time on 3% – 6% grade hills (57). Steeper hills favor lighter wheels and WorldTour riders often make specific selections of wheelset, gear ratio, and even frameset based on race or stage profile. Some teams take it a step further, such as Jumbo-Visma, who use a portable aero sensor to measure exact wind conditions on race day and make equipment selections accordingly (81).

Since the inception of professional cycling there have been numerous technological advances and there is still a steady flow of innovations reaching the peloton. Some of these become widely adopted, such as aero-optimized gear; some are providing new alternatives without replacing old ones, such as tubeless tires (riders still use a variety of tubed, tubeless, and tubular tires); and others are replacing without immediately improving a function, such as disc brakes. Technology has also enabled more extensive monitoring of athletes, both on and more recently off the bike. For instance, several teams are now measuring body temperature and hydration status, and by analyzing the individual sodium composition sweat, can select the appropriate supplementary amount of sodium for each rider. During very hot days, riders are often seen wearing cooling gear to keep body temperature down. This can not only keep the riders comfortable, but may also benefit their performance in the race by lowering thermal strain (75).

Although professional cycling continues to benefit from science, technology, and engineering, the UCI have rules and regulations in place that ensures that cycling does not, for better or worse, stray too far away from its origins. Although these are subject to change based on new developments, they sometimes can become more restrictive, such as the recent ban on handlebars narrower than 350mm. Riders with the ability and resources to combine effective performance strategies from training, nutrition, recovery, and technology – perhaps especially strategies with small effects that are more likely to be ignored by others – may find themselves able to ride at a different speed than the rest of the peloton.

Merging the margins

Imagine a gifted and durable athlete with an exceptional ability to consume oxygen across all intensity domains, maintain a low body mass, effectively utilize lactate, absorb and recover from a high training load without injury or illness, handle training and race nutrition, thermoregulate in various climates, and respond well to altitude and heat exposure finding his or her way into cycling early in life. Suppose this young cyclist learns to maintain an aerodynamic position on the bike, pedal with an efficient cadence, move seamlessly through the peloton, avoid accidents, calmly handle the pressure of competition, and execute winning moves. Professional cycling selects for individuals with supraphysiological potential from environments that have allowed this potential to be expressed. Then, it awards those who have made it to the starting line and are able make as many performance determinants as possible come together on race day.

Increased professionalism at the highest level of the sport trickles down to the amateur and junior ranks, exposing up-and-coming cyclists to favorable conditions at an earlier age, leading to greater improvements in physiology, psychology, and race craft. Some riders may show incredible promise in some aspects of racing and struggle with others. Oskar Svendsen, V̇O2max world record holder, undoubtedly had one of the greatest physiological potentials ever seen in a rider. However, he admittedly also had technical and tactical challenges: “Cycling is a monotonous sport, yet so complex and driven by tactics that you won’t win races unless you deliver on all those qualities. I came into the sport with good physical qualities, but I struggled most with the tactics and patterns. I did learn a lot in my senior years on Team Joker though, even if I still had a long way to go. Descending down hills was also something I struggled a lot with, and it sapped much of my energy in races.” (99) Svendsen’s career serves as an example of how cycling is not only a physiological sport, but also technical, tactical, and psychological. Recently retired rider, Richie Porte, described former TdF GC winners Chris Froome and Tadej Pogačar as “psychological beasts” and noted that cycling has become increasingly scientific, which does not suit all riders (35). Modern riders are more methodical, data driven, and regimented than before. This reduces the human element of the sport, to the dismay of those claiming that this will increase predictability. Some researchers in the field have also warned against measuring just for the sake of measuring, and advise that rider data should serve a specific purpose (55).

The widely established routine of constant fueling during training and racing not only acutely increase work capacity but also improves subsequent recovery by preventing the rider from becoming completely depleted. This is in stark contrast to the days when reaching for your bottle during a hard training ride, even if it only contained water, was considered a weakness. Paul Köchli, former coach of riders such as Bernard Hinault and Greg Lemond, once said that the art of cycling is to do the right thing at the right moment (27). This is true not only in the context of a race, but indeed for the professional cyclist’s career as a whole. The effects of proper training, nutrition, and recovery accumulate not only throughout a season, but a whole career, benefitting those who consistently do the right things from early on.

Conclusion and future perspectives

In some ways, modern approaches to improving cycling performance represent a first principles approach to cycling and a fundamental challenge of conventions, within the rules and regulations of UCI. It seems to have restored some of the faith in the sport that was once lost with various doping scandals. Given the measurable impacts of legal performance-enhancing strategies, many of which were previously unknown or overlooked, it could be argued that combining these effects can bring a clean rider’s performance close to, or even surpass, that of an enhanced cyclist, assuming a gifted baseline and sufficient degree of adaptability.

Suggesting that it is possible to win at the highest level in cycling without the use of PEDs is not the same as claiming that the sport is completely clean. As others have pointed out, periods that have previously been perceived as clean have later been shown to be anything but (26). This paper covers some of the key legal advances in road cycling that has contributed to elite performances in the modern peloton, while at the same time acknowledging that illegal strategies may still be present.

Much of what was once considered “marginal gains” have now become common in all professional cycling teams. This represents a shift from a culture of doping to a culture of exhaustive continuous improvement, a lot of which is kept under wraps and some that may even be considered a grey area. Effective anti-doping measures contribute to a more level playing field, but not entirely level. The teams with the most resources often get the most talented riders, allowing them to combine the greatest potential with the best strategies. And even still, there are some who favor optimizing riders and their equipment for weight rather than aerodynamics, ignoring the latter to the extent that it becomes a considerable detriment. In an era of professional cycling where individual performances are influenced by a multitude of human and nonhuman factors, which in combination can have profound effects, the existence of two-speed cycling in a clean peloton is not only logical – it should be expected.

Acknowledgments

This work was supported by the Norwegian University of Science and Technology (NTNU). The author would like to thank Dr. Endre T. Nesse and Dr. Fabio G. Laginestra for their comments and feedback on the manuscript.

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2024-02-22T11:24:51-06:00February 23rd, 2024|Research, Sport Education, Sport Training, Sports Coaching, Sports Health & Fitness, Sports Medicine, Sports Nutrition|Comments Off on Can there be two speeds in a clean peloton? Performance strategies in modern road cycling

Daily Self-Monitoring of Physical Leisure Activities and Health Practices, Self-Concept, and Quality-of-Life

Submitted by Jennifer Kwak1 MA*, Michael Amrhein2*, Harald Barkhoff2*, and Elaine M. Heiby1*

1* Department of Psychology, University of Hawai’i at Mānoa

2* Department of Kinesiology and Exercise Sciences, University of Hawai’i at Hilo

ABSTRACT

Purpose: Being physically active during leisure time is a positive contributor to overall physical and mental health, while sedentariness is a risk factor for several diseases. Minority students are at-risk of physical inactivity during leisure time and more research is needed to better understand how this affects health outcomes and its dynamical nature.

Methods: Computer Assisted Mobile Interview (CAMI) cell phone technology was used to prospectively collect daily self-monitoring of physical leisure activity and the outcomes of six health practices (eating habits, feeling hassled, mood, alcohol and cigarette consumption, and use of sun protection) and mental health indicators of self-concept and quality-of-life, over four months with 28 multi-ethnic college students in Hawaiʻi, U.S.

Results: Correlational and multiple regression analyses yielded significant positive relationships among daily physical leisure activity, self-concept, and feeling less hassled. Daily sedentary leisure activity was significantly associated with poorer health practices. Very-Physically-Active participants reported significantly more positive self-concept than Not-Very-Physically-Active participants. Self-concept and quality-of-life were significantly related to more positive daily health practices.

Conclusions: These results provide preliminary evidence for the positive and dynamical effects of active physical leisure activity on health practices and mental health indicators, and demonstrate cell phones as an effective tool for daily self-monitoring.

Applications in Sport: Health professionals, coaches, and educators may better understand the temporal health effects of physical leisure activities in student minorities. The use of cell phone technology, particularly text-messaging, can be an effective tool to self-monitor daily activities to improve health and fitness during leisure time.

Key words: physical leisure activities, health practices, self-monitoring, self-concept, quality-of-life

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2015-05-11T09:00:09-05:00May 11th, 2015|Contemporary Sports Issues, Sports Nutrition|Comments Off on Daily Self-Monitoring of Physical Leisure Activities and Health Practices, Self-Concept, and Quality-of-Life

Effect of National-Level Field Hockey on Physical Fitness and Body Composition Parameters In Turkish Females

Submitted by Yılmaz Ucan1, Ph.D*

1* Abant Izzet Baysal University, School of Physical Education and Sports

Yılmaz Ucan, PhD, is an assistant professor in the Department of Coaching Science at the Abant Izzet Baysal University, Turkey. 

ABSTRACT

To be successful in field sports such as soccer, rugby, football and hockey, players need to be enhancing some bio-motor abilities like endurance, strength, speed and flexibility. The purpose of this study was to investigate the effects of national-level field hockey on physical fitness and body-composition parameters in Turkish females. Twenty-four female subjects (12 non-sporting healthy controls aged 19 to 22, 12 elite, national level field hockey players aged 18 to 21) participated in this study. Body composition, 30-meter sprint, leg power, handgrip strength, posture balance were measured. At the end of measurements, there was a significant differences in body-fat percentage (p < 0.014), fat mass (p < 0.044), speed (p < 0.000), leg power (p < 0.006), grip strength (p < 0.022), but no significant differences in fat-free mass (p > 0.442) and fall index (p > 0.258) were observed between hockey players and non-sporting controls. Results suggest that regular participation to hockey training programs improves body composition, speed, and lower- and upper-extremity strength, with no effect on fat-free mass and posture balance in young females. Additional studies may identify effects of field hockey training on physical fitness and body composition in males and different age groups.

Key words: Field hockey, fat mass, speed, strength, posture balance

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2015-07-24T14:15:32-05:00May 8th, 2015|Contemporary Sports Issues, Sports Nutrition, Sports Studies and Sports Psychology, Women and Sports|Comments Off on Effect of National-Level Field Hockey on Physical Fitness and Body Composition Parameters In Turkish Females
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