â€œMy body might have broken down but my brain was the real minefieldâ€ : a psychological exploration of low energy availability in sport and exercise
Creators: name: Langbein, Rachel
Publisher: name: University of Lincoln
Year: 2024
Subjects: C600 - Sport &amp; exercise science

description: In recent years, the detrimental consequences associated with inadequate fuelling and excessive exercise among athletic populations have been emphasised. Low energy availability (LEA) refers to a physiological state in which energy intake (EI) is insufficient to meet the daily energy demands of the body, once exercise energy expenditure (EEE) has been considered, while Relative Energy Deficiency in Sport (RED-S) describes a syndrome of impaired health and physical performance underpinned by LEA. Despite propositions that psychological factors may precede, or result from LEA, and symptoms of RED-S, there remains a paucity of evidence to explain this. Therefore, the aim of this PhD was to explore the psychological experience of LEA in sport and exercise.Study 1 explored qualitatively the subjective experience of RED-S in endurance athletes. By interviewing twelve participants reporting previous or current experiences of RED-S, it aimed to elucidate contexts and mechanisms perceived to influence its onset and outcomes, as well as subjective meanings of â€œrecoveryâ€ from its consequences. Regardless of whether LEA was initiated intentionally, its short?term implications (e.g., weight loss, performance improvements) promoted a psychopathological cycle of disordered eating (DE) and compulsive exercise, resulting in numerous symptoms represented within the RED-S models. Furthermore, athletes reported considerable psychological conflict in their attempts to overcome physiological consequences of RED-S.Study 2 adopted an integrated qualitative multiple-case study design to further explore psychological conflict experienced during RED-S recovery among eight female endurance athletes identifying as â€œin recoveryâ€ or â€œrecoveredâ€ from RED-S. Together, a topical life-history interview, online diary task, photovoice activity, and stimulated-recall interview captured the psychological experience of RED-S recovery, including sources of psychological conflict and responses to these in the pursuit of optimal energy availability (EA). The findings provided insights into eating psychopathology, additional mental health concerns, and fears that pursuing recovery may hinder competitive sports participation. Several adaptive and maladaptive coping strategies were reported in the management of psychological conflict, which ultimately dictated recovery progress. Study 3 employed a sequential explanatory mixed methods design to examine psychological factors contributing to perceived LEA in the presence and absence of eating psychopathology. Initially, a cross-sectional questionnaire assessing eating psychopathology, compulsive exercise, psychological stress, and subjective EA appraisals was completed by sport and exercise participants (N=177). Subsequently, 13 endurance-trained individuals categorised as â€˜at-riskâ€™ of intentional or inadvertent LEA participated in semi-structured interviews exploring their prior appraisals of EA and any changes since completing the questionnaire. Past experience of physiological symptoms associated with LEA facilitated ongoing efforts to achieve adequate EA for many, while a history of eating psychopathology, sociocultural sporting norms, and fears of losing control over eating and exercise practices perpetuated a cycle of LEA for others. Together, the three empirical studies in the thesis contribute new insights into psychological factors underlying a phenomenon that has, to date, been predominantly explored from a physiological perspective. Furthermore, findings emphasise the need for holistic prevention and early intervention approaches, which incorporate nutritional and psychological support, to ameliorate the occurrence of behaviours that can initiate LEA and produce adverse long-term health outcomes.