The Health of Competitive Fitness Athletes

Study Overview
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Brief Summary
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Fitness athletes emphasize the value of staying lean, muscular and defined, and motivates and inspires followers through social media. We want to study the effect of such lifestyle on selected aspects of psychological and physical health in female fitness athletes, and compare the outcomes to a healthy, physically active female population.

Detailed Description
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Little is known about the mental and physical health effect from following the modern, idealized fitness lifestyle. The lifestyle is characterized by selective and restrictive eating behavior, strength training and use of supplements. The athletes emphasize the value of staying lean, muscular and defined, and motivates and inspires followers through social media. This study will recruit and observe a group of competitive female fitness athletes over their typical 3 month dieting period when preparing for contest. Before their contest diet is initiated, the athletes will be screened on selected aspects of psychological and physical health. The screening is repeated two weeks prior to their first seasonal contest, and then finally one month post-contest season. During the diet period of 3 months, the athletes answers brief questionnaires by email on eating- and training behavior and on mood, while also reporting dietary intake by telephone interview. Recreational physically females, not planning to do any fitness contest, will be recruited to serve as a parallel control group. They will perform the same physical and psychological screening, and answer the same questionnaires throughout the fitness contest diet period.

Official Title
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The Health of Competitive Fitness Athletes, a Cohort Study of Female Fitness Athletes and Physical Active Control's During and After Three Months of Fitness Contest Dieting

Conditions
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Resting Metabolic Rate, Bone Mineral Density, Low, Susceptibility to, Body Image, Perfectionism, Depression, Eating Disorder, Exercise-Related Amenorrhea, Exercise Addiction, Binge Eating, Dietary Amenorrhea, Dietary Deficiency

Intervention / Treatment
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* Other: Psychological health
* Other: Physiological health


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Fitness athletes: planning to compete in fitness sport during spring or fall 2017 Controls: being regular physically active (exercise >2 times/week during last year) with a BMI between 17,5-30 Exclusion Criteria: Controls: having competed in fitness sports previously or planning to do in the future, or working as a personal trainer. Not able to meet at the Norwegian School of Sport Sciences for baseline and follow up screenings. Being pregnant or nursing Metabolic related diseases

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Female Fitness Athletes<br>Psychological health and physiological health of fitness athletes | Other: Psychological health<br>* Observing and measuring baseline, and changes in, psychological health through a fitness contest preparation period<br>Other: Physiological health<br>* Observing and measuring baseline, and changes in, physiological health through a fitness contest preparation period<br>|
| Female, physically active Controls<br>Psychological health and physiological health of female controls | Other: Psychological health<br>* Observing and measuring baseline, and changes in, psychological health through a fitness contest preparation period<br>Other: Physiological health<br>* Observing and measuring baseline, and changes in, physiological health through a fitness contest preparation period<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body composition | Baseline values, change from pre-test to mid-test, and finally change from mid- to post-test, for lean body mass and fat mass, measured with Dual Xray absorptiometry (DXA) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Resting Metabolic Rate | Baseline values, change from pre-test to mid-test, and finally change from mid- to posttest, for resting metabolic rate, measured with indirect calorimetry | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Bone Mineral Density | Baseline values, change from pre-test to mid-test, and finally change from mid- to post-test, for bone mineral density measured with Dual Xray absorptiometry (DXA) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Perfectionism | Comparing scores on perfectionism between case and controls, and individual changes in scores through study period, with Child Adolescent Perfectionism Scale (CAPS 22 items) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Depression | Baseline values, change from pre-test to mid-test, and finally change from mid- to post-test, for scores on depressive mood, measured with Becks Depression Inventory (BDI) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Eating disorders | Baseline values, change from pre-test to mid-test, and finally change from mid- to post-test, for scores on Eating disorder examination questionnaire (EDE-q) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Eating behavior; binge eating | Baseline values, change from pre-test to mid-test, and finally change from mid- to post-test, for scores on Binge Eating Scale (BES) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Eating behavior; restrictive eating and sensation of hunger | Baseline values, change from pre-test to mid-test, and finally change from mid- to post-test, for scores on Three Factor Eating Questionnaire (TFEQ-21) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Menstrual Status, self-reported | Baseline status, change from pre-test to mid-test, and finally change from mid- to post-test, for self-reported menstruation health (Low Energy Availability in Females questionnaire, LEAF) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Dietary intake, weighed diet registration | Change in dietary intake. Baseline status, change from pre-test to mid-test, and finally change from pre- to post-test, evaluated with weighed dietary registration and analysed with national analytical software (Kostholdsplanleggeren.no) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Exercise dependency | Baseline status, change from pre-test to mid-test, and finally change from pre- to post-test, evaluated with Exercise Dependency Scale (EDS) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Reason for Exercise | Baseline status, change from pre-test to mid-test, and finally change from pre- to post-test, evaluated with Reason for Exercise Inventory (REI) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Depression | Changes in reported state of depression during the dieting period of fitness athletes, measured with BDI | Each 2nd week during the 3 month contest dieting period (between pre-test and mid-test) | 
| Dietary intake, 24-hour recall interview | Changes in energy and nutrient intake during the dieting period of fitness athletes, measured with dietary 24-hour recall interview and analysed with national analytical software (Kostholdsplanleggeren.no) | Each 2nd week during the 3 month contest dieting period (between pre-test and mid-test) | 
| Menstrual cycle, self reported | Self reported menstrual bleeding's during the dieting period of fitness athletes (LEAF) | Each 2nd week during the 3 month contest dieting period (between pre-test and mid-test) | 
| Eating disordered behavior | Changes in eating behavior during the dieting period of fitness athletes, measured with the behavioral aspects of EDE-q | Each 2nd week during the 3 month contest dieting period (between pre-test and mid-test) | 
| Eating behavior; binge eating behavior | Changes in eating behavior during the dieting period of fitness athletes, measured with BES | Each 2nd week during the 3 month contest dieting period (between pre-test and mid-test) | 
| Eating behavior; restrictive eating and sensation of hunger | Changes in eating behavior during the dieting period of fitness athletes, measured with TFEQ-21 | Each 2nd week during the 3 month contest dieting period (between pre-test and mid-test) | 
| Training volume, self reported | Reporting number of training sessions pr week and type of exercise (endurance related exercise or strength training) | Each 2nd week during the 3 month contest dieting period (between pre-test and mid-test) | 
| Training history, self reported | Reporting experience with training, giving details on specific sport activity and typical intensity | Retrospective | 
| Dietary Supplements | Reporting usage of dietary supplements during the dieting period | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest), and each 2nd week during the 3 month contest dieting period (between pre-test and mid-test) | 
| Eating disorders, history | Reporting previous eating disorder and whether treatment were recieved or not | Retrospective | 
| Drive for Muscularity | Baseline status, change from pre-test to mid-test, and finally change from pre- to post-test, evaluated with Drive for Muscularity (DM) (McCreary & Sasse 2000) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Drive for Leanness | Baseline status, change from pre-test to mid-test, and finally change from pre- to post-test, evaluated with Drive for Leanness (DL) (Smolak & Murnen 2008) | Pre-test (3 months before contest), mid-test (2 weeks before contest) and post-test (one month post-contest) | 
| Body Weight, history | Reporting lowest and highest bodyweight after 18 yr's of age (excluding periods of pregnancy) | Retrospective | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Body composition, Bone mineral density, Binge Eating, Eating Disorder, Exercise Dependency, Depression, Perfectionism, Body building, Drive for Muscularity, Drive for leanness