Reduced neuromuscular performance in amenorrheic elite endurance athletes

Åsa B Tornberg; Anna Melin; Fiona Manderson Koivula; Anders Johansson; Sven O Skouby; Jens Faber; Anders Mikael Sjödin

doi:10.1249/MSS.0000000000001383

Reduced neuromuscular performance in amenorrheic elite endurance athletes

Åsa B Tornberg, Anna Melin, Fiona Manderson Koivula, Anders Johansson, Sven O Skouby, Jens Faber, Anders Mikael Sjödin

26 Citations (Scopus)

Abstract

Introduction Secondary functional hypothalamic amenorrhea (SFHA) is common among female athletes, especially in weight-sensitive sports. The aim of this study was to investigate the link between SFHA and neuromuscular performance in elite endurance athletes. Methods Sixteen eumenorrheic (EUM) and 14 SFHA athletes from national teams and competitive clubs participated. Methods included gynecological examination, body composition (dual-energy x-ray absorptiometry), resting metabolic rate and work efficiency, exercise capacity, knee muscular strength (KMS) and knee muscular endurance (KME), reaction time (RT), blood sampling performed on the third to fifth days of the menstrual cycle, and 7-d assessment of energy availability. Results SFHA athletes had lower estrogen (0.12 ± 0.03 vs 0.17 ± 0.09 nmol·L^-1, P < 0.05), triiodothyronine (T₃) (1.4 ± 0.2 vs 1.7 ± 0.3 nmol·L^-1, P < 0.01), and blood glucose (3.8 ± 0.3 vs 4.4 ± 0.3 mmol·L^-1, P < 0.001) but higher cortisol levels (564 ± 111 vs 400 ± 140 nmol·L^-1, P < 0.05) compared with EUM athletes. SFHA had a lower body weight (55.0 ± 5.8 vs 60.6 ± 7.1 kg, P < 0.05), but no difference in exercise capacity between groups was found (56.4 ± 5.8 vs 54.0 ± 6.3 mL O₂·min^-1·kg^-1). RT was 7% longer, and KMS and KME were 11% and 20% lower compared with EUM athletes. RT was negatively associated with glucose (r = -0.40, P < 0.05), T₃ (r = -0.37, P < 0.05), and estrogen (r = -0.43, P < 0.05), but positively associated with cortisol (r = 0.38, P < 0.05). KMS and KME correlated with fat-free mass in the tested leg (FFM_leg; r = 0.52, P < 0.001; r = 0.58, P < 0.001) but were negatively associated with cortisol (r = -0.42, P < 0.05; r = -0.59, P < 0.001). FFM_leg explained the differences in KMS, while reproductive function and FFM_leg independently explained the variability in KME. Conclusions We found lower neuromuscular performance among SFHA compared with EUM athletes linked to a lower FFM_leg, glucose, estrogen, T₃, and elevated cortisol levels.

Original language	English
Journal	Medicine and Science in Sports and Exercise
Volume	49
Issue number	12
Pages (from-to)	2478-2485
Number of pages	8
ISSN	0195-9131
DOIs	https://doi.org/10.1249/MSS.0000000000001383
Publication status	Published - 1 Dec 2017

Keywords

Faculty of Science
Amenorrhea
Energy availability
Fat free mass
Blood glucose
Cortisol
T3

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10.1249/MSS.0000000000001383

Cite this

@article{25b83cf4e0d84f73b2883e2592014981,

title = "Reduced neuromuscular performance in amenorrheic elite endurance athletes",

abstract = "Introduction Secondary functional hypothalamic amenorrhea (SFHA) is common among female athletes, especially in weight-sensitive sports. The aim of this study was to investigate the link between SFHA and neuromuscular performance in elite endurance athletes. Methods Sixteen eumenorrheic (EUM) and 14 SFHA athletes from national teams and competitive clubs participated. Methods included gynecological examination, body composition (dual-energy x-ray absorptiometry), resting metabolic rate and work efficiency, exercise capacity, knee muscular strength (KMS) and knee muscular endurance (KME), reaction time (RT), blood sampling performed on the third to fifth days of the menstrual cycle, and 7-d assessment of energy availability. Results SFHA athletes had lower estrogen (0.12 ± 0.03 vs 0.17 ± 0.09 nmol·L-1, P < 0.05), triiodothyronine (T3) (1.4 ± 0.2 vs 1.7 ± 0.3 nmol·L-1, P < 0.01), and blood glucose (3.8 ± 0.3 vs 4.4 ± 0.3 mmol·L-1, P < 0.001) but higher cortisol levels (564 ± 111 vs 400 ± 140 nmol·L-1, P < 0.05) compared with EUM athletes. SFHA had a lower body weight (55.0 ± 5.8 vs 60.6 ± 7.1 kg, P < 0.05), but no difference in exercise capacity between groups was found (56.4 ± 5.8 vs 54.0 ± 6.3 mL O2·min-1·kg-1). RT was 7% longer, and KMS and KME were 11% and 20% lower compared with EUM athletes. RT was negatively associated with glucose (r = -0.40, P < 0.05), T3 (r = -0.37, P < 0.05), and estrogen (r = -0.43, P < 0.05), but positively associated with cortisol (r = 0.38, P < 0.05). KMS and KME correlated with fat-free mass in the tested leg (FFMleg; r = 0.52, P < 0.001; r = 0.58, P < 0.001) but were negatively associated with cortisol (r = -0.42, P < 0.05; r = -0.59, P < 0.001). FFMleg explained the differences in KMS, while reproductive function and FFMleg independently explained the variability in KME. Conclusions We found lower neuromuscular performance among SFHA compared with EUM athletes linked to a lower FFMleg, glucose, estrogen, T3, and elevated cortisol levels.",

keywords = "Faculty of Science, Amenorrhea, Energy availability, Fat free mass, Blood glucose, Cortisol, T3",

author = "Tornberg, {{\AA}sa B} and Anna Melin and {Manderson Koivula}, Fiona and Anders Johansson and Skouby, {Sven O} and Jens Faber and Sj{\"o}din, {Anders Mikael}",

note = "CURIS 2017 NEXS 317",

year = "2017",

month = dec,

day = "1",

doi = "10.1249/MSS.0000000000001383",

language = "English",

volume = "49",

pages = "2478--2485",

journal = "Medicine and Science in Sports and Exercise",

issn = "0195-9131",

publisher = "Lippincott Williams & Wilkins",

number = "12",

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TY - JOUR

T1 - Reduced neuromuscular performance in amenorrheic elite endurance athletes

AU - Tornberg, Åsa B

AU - Melin, Anna

AU - Manderson Koivula, Fiona

AU - Johansson, Anders

AU - Skouby, Sven O

AU - Faber, Jens

AU - Sjödin, Anders Mikael

N1 - CURIS 2017 NEXS 317

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Introduction Secondary functional hypothalamic amenorrhea (SFHA) is common among female athletes, especially in weight-sensitive sports. The aim of this study was to investigate the link between SFHA and neuromuscular performance in elite endurance athletes. Methods Sixteen eumenorrheic (EUM) and 14 SFHA athletes from national teams and competitive clubs participated. Methods included gynecological examination, body composition (dual-energy x-ray absorptiometry), resting metabolic rate and work efficiency, exercise capacity, knee muscular strength (KMS) and knee muscular endurance (KME), reaction time (RT), blood sampling performed on the third to fifth days of the menstrual cycle, and 7-d assessment of energy availability. Results SFHA athletes had lower estrogen (0.12 ± 0.03 vs 0.17 ± 0.09 nmol·L-1, P < 0.05), triiodothyronine (T3) (1.4 ± 0.2 vs 1.7 ± 0.3 nmol·L-1, P < 0.01), and blood glucose (3.8 ± 0.3 vs 4.4 ± 0.3 mmol·L-1, P < 0.001) but higher cortisol levels (564 ± 111 vs 400 ± 140 nmol·L-1, P < 0.05) compared with EUM athletes. SFHA had a lower body weight (55.0 ± 5.8 vs 60.6 ± 7.1 kg, P < 0.05), but no difference in exercise capacity between groups was found (56.4 ± 5.8 vs 54.0 ± 6.3 mL O2·min-1·kg-1). RT was 7% longer, and KMS and KME were 11% and 20% lower compared with EUM athletes. RT was negatively associated with glucose (r = -0.40, P < 0.05), T3 (r = -0.37, P < 0.05), and estrogen (r = -0.43, P < 0.05), but positively associated with cortisol (r = 0.38, P < 0.05). KMS and KME correlated with fat-free mass in the tested leg (FFMleg; r = 0.52, P < 0.001; r = 0.58, P < 0.001) but were negatively associated with cortisol (r = -0.42, P < 0.05; r = -0.59, P < 0.001). FFMleg explained the differences in KMS, while reproductive function and FFMleg independently explained the variability in KME. Conclusions We found lower neuromuscular performance among SFHA compared with EUM athletes linked to a lower FFMleg, glucose, estrogen, T3, and elevated cortisol levels.

AB - Introduction Secondary functional hypothalamic amenorrhea (SFHA) is common among female athletes, especially in weight-sensitive sports. The aim of this study was to investigate the link between SFHA and neuromuscular performance in elite endurance athletes. Methods Sixteen eumenorrheic (EUM) and 14 SFHA athletes from national teams and competitive clubs participated. Methods included gynecological examination, body composition (dual-energy x-ray absorptiometry), resting metabolic rate and work efficiency, exercise capacity, knee muscular strength (KMS) and knee muscular endurance (KME), reaction time (RT), blood sampling performed on the third to fifth days of the menstrual cycle, and 7-d assessment of energy availability. Results SFHA athletes had lower estrogen (0.12 ± 0.03 vs 0.17 ± 0.09 nmol·L-1, P < 0.05), triiodothyronine (T3) (1.4 ± 0.2 vs 1.7 ± 0.3 nmol·L-1, P < 0.01), and blood glucose (3.8 ± 0.3 vs 4.4 ± 0.3 mmol·L-1, P < 0.001) but higher cortisol levels (564 ± 111 vs 400 ± 140 nmol·L-1, P < 0.05) compared with EUM athletes. SFHA had a lower body weight (55.0 ± 5.8 vs 60.6 ± 7.1 kg, P < 0.05), but no difference in exercise capacity between groups was found (56.4 ± 5.8 vs 54.0 ± 6.3 mL O2·min-1·kg-1). RT was 7% longer, and KMS and KME were 11% and 20% lower compared with EUM athletes. RT was negatively associated with glucose (r = -0.40, P < 0.05), T3 (r = -0.37, P < 0.05), and estrogen (r = -0.43, P < 0.05), but positively associated with cortisol (r = 0.38, P < 0.05). KMS and KME correlated with fat-free mass in the tested leg (FFMleg; r = 0.52, P < 0.001; r = 0.58, P < 0.001) but were negatively associated with cortisol (r = -0.42, P < 0.05; r = -0.59, P < 0.001). FFMleg explained the differences in KMS, while reproductive function and FFMleg independently explained the variability in KME. Conclusions We found lower neuromuscular performance among SFHA compared with EUM athletes linked to a lower FFMleg, glucose, estrogen, T3, and elevated cortisol levels.

KW - Faculty of Science

KW - Amenorrhea

KW - Energy availability

KW - Fat free mass

KW - Blood glucose

KW - Cortisol

KW - T3

U2 - 10.1249/MSS.0000000000001383

DO - 10.1249/MSS.0000000000001383

M3 - Journal article

C2 - 28723842

AN - SCOPUS:85025160119

SN - 0195-9131

VL - 49

SP - 2478

EP - 2485

JO - Medicine and Science in Sports and Exercise

JF - Medicine and Science in Sports and Exercise

IS - 12

ER -

Reduced neuromuscular performance in amenorrheic elite endurance athletes

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Keywords

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