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The Female Triathlete

  • Margo MountjoyEmail author
  • Alex Thomas
  • Jasmine Levesque
Chapter

Abstract

Participation in triathlon from the recreational to the elite level can provide significant health benefits for female athletes. Regular training in the three triathlon components of swimming, cycling and running can result in the reduction of the risk of developing non-communicable diseases such as hypertension, diabetes mellitus and cardiovascular disease. Other health benefits of triathlon participation include an improvement in bone mineral density, muscular strength, cardiovascular fitness, mental health and well-being. There are however, potential health risks of sport participation in triathlon that are unique to the female athlete. This chapter provides an overview of the following health issues for female triathletes: training, injury prevention, relative energy deficiency in sport (RED-S), nutrition, gynecological issues, pelvic floor dysfunction, mental health, non-accidental violence and doping.

The objectives of this chapter are (1) to increase knowledge of relevant topics related to healthy female athlete participation in triathlon, (2) to encourage the adoption of healthy female triathlete sport practices by athletes, coaches and other members of the athlete entourage, and (3) to promote safe participation for female athletes in triathlon. Through the implementation of the prevention and treatment practices outlined in this chapter, female athletes can enjoy the many health benefits of triathlon.

Keywords

Triathlon Female athlete Injury prevention Illness prevention RED-S Mental health 

References

  1. 1.
    Etter F, Knechtle B, Bukowski A, Rüst CA, Rosemann T, Lepers R. Age and gender interactions in short distance triathlon performance. J Sports Sci. 2013;31(9):996–1006.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    International Triathlon Union. Women’s committee case study. https://www.triathlon.org/news/article/womens_committee_case_study_1_driving_female_participation_in_triathlon. Accessed 15 July 2018.
  3. 3.
    International Triathlon Union. #Women. https://www.triathlon.org/search#q=women. Accessed 15 July 2018.
  4. 4.
    Laurenson NM, Fulcher KY, Korkia P. Physiological characteristics of elite and club level female triathletes during running. Int J Sports Med. 1993;14(8):455–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Millet GP, Candau RB, Barbier B, Busso T, Rouillon JD, Chatard JC. Modelling the transfers of training effects on performance in elite triathletes. Int J Sports Med. 2002;23(1):55–63.CrossRefPubMedGoogle Scholar
  6. 6.
    Dolan SH, Houston M, Martin SB. Survey results of the training, nutrition, and mental preparation of triathletes: practical implications of findings. J Sports Sci. 2011;29(10):1019–28.CrossRefPubMedGoogle Scholar
  7. 7.
    Vleck V, Millet GP, Alves FB. The impact of triathlon training and racing on athletes’ general health. Sports Med. 2014;44(12):1659–92.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    O’Toole ML. Training for ultraendurance triathlons. Med Sci Sports Exerc. 1989;21(5 Suppl):S209–13.PubMedGoogle Scholar
  9. 9.
    Hecht SS, Arendt E. Training the female athlete. In: Handbook of sports medicine and science. Wiley-Blackwell, West Sussex, UK; 2014 p. 1–8. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118862254.ch1. Accessed 15 July 2018.
  10. 10.
    Sanborn CF, Jankowski CM. Physiologic considerations for women in sport. Clin J Sports Med. 1994;13(2):315–27.Google Scholar
  11. 11.
    Wilmore JH. The application of science to sport: physiological profiles of male and female athletes. Can J Appl Sport Sci. 1979;4(2):103–15.PubMedGoogle Scholar
  12. 12.
    Soligard T, Steffen K, Palmer D, et al. Sports injuries and illnesses in the Rio de Janeiro 2016 Olympic Summer Games. Br J Sports Med. 2017;51(17):1265–71.CrossRefPubMedGoogle Scholar
  13. 13.
    Walker M, Vleck V, Ussher M, Sanjay S. Casualty incidence at the World Triathlon Championships: are age, gender and event type associated with increased risk? Br J Sports Med. 2014;48(7):670.CrossRefGoogle Scholar
  14. 14.
    Collins K, Wagner M, Peterson K, Storey M. Overuse injuries in triathletes: a study of the 1986 Seafair Triathlon. Am J Sports Med. 1989;17(5):675–80.CrossRefPubMedGoogle Scholar
  15. 15.
    Mountjoy M, Sundgot-Borgen J, Burke L, et al. IOC Consensus Statement. Beyond the triad – relative energy deficiency in sport (RED-S). Br J Sports Med. 2014;48:491–7.CrossRefGoogle Scholar
  16. 16.
    Constantini NW. Medical concerns of the dancer. Book of Abstracts, XXVII FIMS World Congress of Sports Medicine, 5–9 June 2002, Budapest, Hungary. p. 151.Google Scholar
  17. 17.
    Hoch AZ, Stavrakos JE, Schimke JE. Prevalence of female athlete triad characteristics in a club triathlon team. Arch Phys Med Rehab. 2007;88(5):681–2.CrossRefGoogle Scholar
  18. 18.
    Kimber NE, Ross JJ, Mason SL, Speedy DB. Energy balance during an ironman triathlon in male and female triathletes. Int J Sport Nutr Exerc Metab. 2002;12(1):47–62.CrossRefPubMedGoogle Scholar
  19. 19.
    Knechtle B, Wirth A, Baumann B, Knechtle P, Rosemann T. Personal best time, percent body fat, and training are differently associated with race time for male and female ironman triathletes. Res Q Exerc Sport. 2010;81(1):62–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Leake CN, Carter JE. Comparison of body composition and somatotype of trained female triathletes. J Sports Sci. 1991;9(2):125–35.CrossRefPubMedGoogle Scholar
  21. 21.
    Melin A, Tornberg ÅB, Skouby S, et al. The LEAF questionnaire: a screening tool for the identification of female athletes at risk for the female athlete triad. Br J Sports Med. 2014;48(7):540–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Mountjoy M, Sundgot-Borgen J, Burke L, et al. Relative energy deficiency in sport clinical assessment tool (RED-S CAT). Br J Sports Med. 2015;49(7):421–4.CrossRefPubMedGoogle Scholar
  23. 23.
    Mountjoy M, Sundgot-Borgen J, Burke L, et al. International Olympic Committee (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687–97.CrossRefGoogle Scholar
  24. 24.
    Getzin AR, Milner C, Harkins M. Fueling the triathlete: evidence-based practical advice for athletes of all levels. Curr Sports Med Rep. 2017;16(4):240–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Jeukendrup AE. Nutrition for endurance sports: Marathon, triathlon, and road cycling. J Sport Sci. 2011;29(Suppl 1):S91–9.CrossRefGoogle Scholar
  26. 26.
    Bentley DJ, Cox GR, Green D, Laursen PB. Maximising performance in triathlon: applied physiological and nutritional aspects of elite and non-elite competitions. J Sci Med Sport. 2008;11(4):407–16.CrossRefPubMedGoogle Scholar
  27. 27.
    Jeukendrup AE. Carbohydrate intake during exercise and performance. Nutrition. 2004;20(7–8):669–77.CrossRefPubMedGoogle Scholar
  28. 28.
    Sawka MN, Noakes TD. Does dehydration impair exercise performance? Med Sci Sports Exerc. 2007;39(8):1209–17.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Almond CSD, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, et al. Hyponatremia among runners in the Boston Marathon. New Engl J Med. 2005;352(15):1550–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Rocker L, Hinz K, Holland K, Gunga H, Vogelgesang J, Kiesewetter H. Influence of endurance exercise (triathlon) on circulating transferrin receptors and other indicators of iron status in female athletes. Clin Lab. 2002;48(5–6):307–12.PubMedGoogle Scholar
  31. 31.
    Burke LM. Nutritional guidelines for female athletes. In: Handbook of sports medicine and science [Internet]. West Sussex, UK: Wiley-Blackwell; 2014 [cited 2018 Jun 18]. p. 30–41. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781118862254.ch4. Accessed 15 July 2018.
  32. 32.
    Health Canada. Dietary reference intakes tables. 2005. https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables.html. Accessed 15 July 2018.
  33. 33.
    Coates A, Mountjoy M, Burr J. Incidence of iron deficiency and iron deficient anemia in elite runners and triathletes. Clin J Sport Med. 2017;27(5):493–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Potgieter S, Wright HH, Smith C. Caffeine improves triathlon performance: a field study in males and females. Int J Sport Nutr Exerc Metab. 2018;28(3):228–37.CrossRefPubMedGoogle Scholar
  35. 35.
    Maughan R, Burke L, Dvorak J, et al. International Olympic Committee consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439–55.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Karlsson MK, Rosengren BE. Training and bone - from health to injury. Scan J Med Sci Sport. 2012;22:15–23.CrossRefGoogle Scholar
  37. 37.
    Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP. The female athlete triad. Med Sci Sports Exerc. 2007;39(10):1867–82.CrossRefGoogle Scholar
  38. 38.
    Writing Group for the ISCD Position Development Conference. Diagnosis of osteoporosis in men, premenopausal women, and children. J Clin Densitom. 2004;7(1):17–26.CrossRefGoogle Scholar
  39. 39.
    Scofield KL, Hecht S. Bone health in endurance athletes: runners, cyclists, and swimmers. Curr Sports Med Rep. 2012;11:328–34.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    McClanahan BS, Ward KD, Vukadinovich C, Klesges RC, Chitwood L, Kinzey SJ, et al. Bone mineral density in triathletes over a competitive season. J Sports Sci. 2002;20(6):463–9.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Duncan CS, Blimkie CJR, Cowell CT, Burke ST, Briody JN, Howman-Giles R. Bone mineral density in adolescent female athletes: relationship to exercise type and muscle strength. Med Sci Sports Exerc. 2002;34(2):286–94.CrossRefPubMedGoogle Scholar
  42. 42.
    Rutherford OM. Spine and total body bone mineral density in amenorrheic endurance athletes. J Appl Physiol. 1993;74(6):2904–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Vescovi JD, VanHeest JL. Case study: impact of inter- and intra-day energy parameters on bone health, menstrual function, and hormones in an elite junior female triathlete. Int J Sport Nutr Exerc Metab. 2016;26(4):363–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Yi J, Tenfelde S, Tell D, Brincat C, Fitzgerald C. Triathlete risk of pelvic floor disorders, pelvic girdle pain, and female athlete triad. Female Pelvic Med Reconstr Surg. 2016;22(5):373–6.CrossRefPubMedGoogle Scholar
  45. 45.
    Bruinvels G, Burden R, Brown N, Richards T, Pedlar C. The prevalence and impact of heavy menstrual bleeding (menorrhagia) in elite and non-elite athletes. PLoS One. 2016;11(2):e0149881.  https://doi.org/10.1371/journal.pone.0149881.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Sambanis M, Kofotolis N, Kalogeropoulou E, Noussios G, Sambanis P, Kalogeropoulos J. A study of the effects on the ovarian cycle of athletic training in different sports. J Sports Med Phys Fitness. 2003;43(3):398–403.PubMedGoogle Scholar
  47. 47.
    Ducher G, Turner AI, Kukuljan S, Pantano KJ, Carlson JL, Williams NI, et al. Obstacles in the optimization of bone health outcomes in the female athlete triad. Sport Med. 2011;41(7):587–607.CrossRefGoogle Scholar
  48. 48.
    Nieves JW, Ruffing JA, Zion M, Tendy S, Yavorek T, Lindsay R, et al. Eating disorders, menstrual dysfunction, weight change and DMPA use predict bone density change in college-aged women. Bone. 2016;84:113–9.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Constantini NW, Dubnov G, Lebrun CM. The menstrual cycle and sport performance. Clin Sports Med. 2005;24(2):51–82.CrossRefGoogle Scholar
  50. 50.
    Rechichi C, Dawson B, Goodman C. Oral contraceptive phase has no effect on endurance test. Int J Sports. 2008;29(4):277–81.CrossRefGoogle Scholar
  51. 51.
    Trofaier ML, Schneidinger C, Marschalek J, Hanzal E, Umek W. Pelvic floor symptoms in female cyclists and possible remedies: a narrative review. Int Urogynecol J. 2016;27(4):513–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Mkhombe W, Jeffery S. Pelvic floor dysfunction in female triathletes. BJOG. 2017;124(Suppl 1):195.Google Scholar
  53. 53.
    Reardon C, Factor R. Sport psychiatry. A systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Med. 2010;40(11):961–80.CrossRefPubMedGoogle Scholar
  54. 54.
    Lopez-Fernandez I, Merino-Marban R, Fernandez-Rodriguez E. Examining the relationship between sex and motivation in triathletes. Percept Motor Skills. 2014;119(1):42–9.CrossRefPubMedGoogle Scholar
  55. 55.
    DeBate RD, Wethington H, Sargent R. Sub-clinical eating disorder characteristics among male and female triathletes. Eat Weight Disord. 2002;7(3):210–20.CrossRefGoogle Scholar
  56. 56.
    DiGioacchino DeBate R, Wethington H, Sargent R. Body size dissatisfaction among male and female triathletes. Eat Weight Disord. 2002;7(4):316–23.CrossRefPubMedGoogle Scholar
  57. 57.
    Virnig AG, McLeod CR. Attitudes toward eating and exercise: a comparison of runners and triathletes. J Sport Behav. 1996;19:82–90.Google Scholar
  58. 58.
    Mountjoy M, Brackenridge C, Arrington M, Blauwet C, Carska-Sheppard A, Fasting K, Kirby S, Leahy T, Marks S, Martin K, Starr K, Tiivas A, Budgett R. The IOC Consensus Statement: harassment and abuse in sport. Br J Sports Med. 2016;50(17):1019–29.CrossRefPubMedGoogle Scholar
  59. 59.
    Mountjoy M. “Only by speaking out can we create lasting change”: what can we learn from the Dr. Larry Nassar tragedy? Br J Sports Med. 2018;53:57.  https://doi.org/10.1136/bjsports-2018-099403.CrossRefPubMedGoogle Scholar
  60. 60.
    World Anti-Doping Association. WADA prohibited list. https://www.wada-ama.org/en/what-we-do/the-prohibited-list. Accessed 15 July 2018.
  61. 61.
    Dietz P, Dalaker R, Letzel S, et al. Analgesics use in competitive triathletes: its relationship to doping and on predicting its usage. J Sports Sci. 2016;34(20):1965–9.CrossRefPubMedGoogle Scholar
  62. 62.
    World Anti-Doping Association. WADA therapeutic use exemptions. https://www.wada-ama.org/en/what-we-do/science-medical/therapeutic-use-exemptions. Accessed 15 July 2018.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Margo Mountjoy
    • 1
    • 2
    • 3
    Email author
  • Alex Thomas
    • 4
  • Jasmine Levesque
    • 4
  1. 1.International Olympic Committee–Games GroupLausanneSwitzerland
  2. 2.FINA Sport MedicineLausanneSwitzerland
  3. 3.Department of Family MedicineMcMaster UniversityHamiltonCanada
  4. 4.Michael G. DeGroote School of MedicineMcMaster UniversityHamiltonCanada

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