## Modelling Strava Fitness and Freshness

Since my blog about Strava Fitness and Freshness has been very popular, I thought it would be interesting to demonstrate a simple model that can help you use these metrics to improve your cycling performance.

As a quick reminder, Strava’s Fitness measure is an exponentially weighted average of your daily Training Load, over the last six weeks or so. Assuming you are using a power meter, it is important to use a correctly calibrated estimate of your Functional Threshold Power (FTP) to obtain an accurate value for the Training Load of each ride. This ensures that a maximal-effort one hour ride gives a value of 100. The exponential weighting means that the benefit of a training ride decays over time, so a hard ride last week has less impact on today’s Fitness than a hard ride yesterday. In fact, if you do nothing, Fitness decays rate is about 2.5% per day.

Although Fitness is a time-weighted average, a simple rule of thumb is that your Fitness Score equates to your average daily Training Load over the last month or so. For example, a Fitness level of 50 is consistent with an average daily Training Load (including rest days) of 50. It may be easier to think of this in terms of a total Training Load of 350 per week, which might include a longer ride of 150, a medium ride of 100 and a couple of shorter rides with a Training Load of 50.

## How to get fitter

The way to get fitter is to increase your Training Load. This can be achieved by riding at a higher intensity, increasing the duration of rides or including extra rides. But this needs to be done in a structured way in order be effective. Periodisation is an approach that has been tried and tested over the years. A four-week cycle would typically include three weekly blocks of higher training load, followed by an easier week of recovery. Strava’s Fitness score provides a measure of your progress.

### Modelling Fitness and Fatigue

An exponentially weighted moving average is very easy to model, because it evolves like a Markov Process, having the following property, relating to yesterday’s value and today’s Training Load.
$F_{t} = \lambda * F_{t-1}+\left ( 1-\lambda \right )*TrainingLoad_{t}$
where
$F_{t}$ is Fitness or Fatigue on day t and
$\lambda = exp(-1/42) \approx 0.976$ for Fitness or
$\lambda = exp(-1/7) \approx 0.867$ for Fatigue

This is why your Fitness falls by about 2.5% and your Fatigue eases by about 13.5% after a rest day. The formula makes it straightforward to predict the impact of a training plan stretching out into the future. It is also possible to determine what Training Load is required to achieve a target level of Fitness improvement of a specific time period.

The change in Fitness over the next seven days is called a weekly “ramp”. Aiming for a weekly ramp of 5 would be very ambitious. It turns out that you would need to increase your daily Training Load by 33. That is a substantial extra Training Load of 231 over the next week, particularly because Training Load automatically takes account of a rider’s FTP.

Interestingly, this increase in Training Load is the same, regardless of your starting Fitness. However, stepping up an average Training Load from 30 to 63 per day would require a doubling of work done over the next week, whereas for someone starting at 60, moving up to 93 per day would require a 54% increase in effort for the week.

In both cases, a cyclist would typically require two additional hard training rides, resulting in an accumulation of fatigue, which is picked up by Strava’s Fatigue score. This is a much shorter term moving average of your recent Training Load, over the last week or so. If we assume that you start with a Fatigue score equal to your Fitness score, an increase of 33 in daily Training Load would cause your Fatigue to rise by 21 over the week. If you managed to sustain this over the week, your Form (Fitness minus Fatigue) would fall from zero to -16. Here’s a summary of all the numbers mentioned so far.

Whilst it might be possible to do this for a week, the regime would be very hard to sustain over a three-week block, particularly because you would be going into the second week with significant accumulated fatigue. Training sessions and race performance tend to be compromised when Form drops below -20. Furthermore, if you have increased your Fitness by 5 over a week, you will need to increase Training Load by another 231 for the following week to continue the same upward trajectory, then increase again for the third week. So we conclude that a weekly ramp of 5 is not sustainable over three weeks. Something of the order of 2 or 3 may be more reasonable.

### A steady increase in Fitness

Consider a rider with a Fitness level of 30, who would have a weekly Training Load of around 210 (7 times 30). This might be five weekly commutes and a longer ride on the weekend. A periodised monthly plan could include a ramp of 2, steadily increasing Training Load for three weeks followed by a recovery week of -1, as follows.

This gives a net increase in Fitness of 5 over the month. Fatigue has also risen by 5, but since the rider is fitter, Form ends the month at zero, ready to start the next block of training.

To simplify the calculations, I assumed the same Training Load every day in each week. This is unrealistic in practice, because all athletes need a rest day and training needs to mix up the duration and intensity of individual rides. The fine tuning of weekly rides is a subject for another blog.

### A tougher training block

A rider engaging in a higher level of training, with a Fitness score of 60, may be able to manage weekly ramps of 3, before the recovery week. The following Training Plan would raise Fitness to 67, with sufficient recovery to bring Form back to positive at the end of the month.

### A general plan

The interesting thing about this analysis is that the outcomes of the plans are independent of a rider’s starting Fitness. This is a consequence of the Markov property. So if we describe the ambitious plan as [3,3,3,-2], a rider will see a Fitness improvement of 7, from whatever initial value prevailed: starting at 30, Fitness would go to 37, while the rider starting at 60 would rise to 67.

Similarly, if Form begins at zero, i.e. the starting values of Fitness and Fatigue are equal, then the [3,3,3,-2] plan will always result in a in a net change of 6 in Fatigue over the four weeks.

In the same way, (assuming initial Form of zero) the moderate plan of [2,2,2,-1] would give any rider a net increase of Fitness and Fatigue of 5.

## Strava – Tour de Richmond Park Clockwise

Following my recent update on the Tour de Richmond Park leaderboard, a friend asked about the ideal weather conditions for a reverse lap, clockwise around the park. This is a less popular direction, because it involves turning right at each mini-roundabout, including Cancellara corner, where the great Swiss rouleur crashed in the 2012 London Olympics, costing him a chance of a medal.

An earlier analysis suggested that apart from choosing a warm day and avoiding traffic, the optimal wind direction for a conventional anticlockwise lap was a moderate easterly, offering a tailwind up Sawyers Hill. It does not immediately follow that a westerly wind would be best for a clockwise lap, because trees, buildings and the profile of the course affect the extent to which the wind helps or hinders a rider.

Currently there are over 280,000 clockwise laps recorded by nearly 35,000 riders, compared with more than a million anticlockwise laps by almost 55,000 riders. As before, I downloaded the top 1,000 entries from the leaderboard and then looked up the wind conditions when each time was set on a clockwise lap.

In the previous analysis, I took account of the prevailing wind direction in London. If wind had no impact, we would expect the distribution of wind directions for leaderboard entries to match the average distribution of winds over the year. I defined the wind direction advantage to be the difference between these two distributions and checked if it was statistically significant. These are the results for the clockwise lap.

The wind direction advantage was significant (at p=1.3%). Two directions stand out. A westerly provides a tailwind on the more exposed section of the park between Richmond Gate and Roehampton, which seems to be a help, even though it is largely downhill. A wind blowing from the NNW would be beneficial between Roehampton and Robin Hood Gate, but apparently does not provide much hindrance on the drag from Kingston Gate up to Richmond, perhaps because this section of the park is more sheltered. The prevailing southwesterly wind was generally unfavourable to riders setting PBs on a clockwise lap.

The excellent mywindsock web site provides very good analysis for avid wind dopers. This confirms that the wind was blowing predominantly from the west for the top ten riders on the leaderboard, including the KOM, though the wind strength was generally light.

The interesting thing about this exercise is that it demonstrates a convergence between our online and our offline lives, as increasing volumes of data are uploaded from mobile sensors. A detailed analysis of each section of the million laps riders have recorded for Richmond Park could reveal many subtleties about how the wind flows across the terrain, depending on strength and direction. This could be extended across the country or globally, potentially identifying local areas where funnelling effects might make a wind turbine economically viable.

### References

Jupyter notebook for calculations

## Strava: Richmond Park leaderboard update

If you have ever had the feeling that it is becoming harder to rise up the Strava leaderboards and that KOMs are ever more elusive, you are right. I took a snapshot of the top 1000 entries for the Tour de Richmond Park segment in April 2019 and compared it with the leaderboard from February 2017 that I used for an earlier series of blogs.

The current rankings are led by a team of Onyx RT riders, who rode as a group at 6:02am on 25 July 2018, beating Rob Sharland’s solo effort by 6 seconds, with a time of 13:51. Some consider that targeting a KOM by riding as a team time trial is a kind of cheating. Having said that, many riders have achieved their best laps around Richmond Park while riding in the popular Saturday morning and Wednesday evening chain gang rides. In fact, if the Onyx guys had checked my blogs on the optimal wind direction and weather conditions, and chosen a warm evening with a moderate Easterly wind, they would have probably gone faster.

## Survival of the fittest

The Darwinian nature of Strava leaderboards ensures that the slowest times are continually culled. Over the two year gap, the average time of the top 1000 riders improved by 35 seconds, which equates to an increase in speed of about 1.6% per annum. In 2017, a time of 17:40 was good enough to reach the top 1000. You now need to complete the rolling 10.8km course in less than 17:07, averaging over 37.8kph, to achieve the same ranking. The rider currently ranked 1000th would have been 503rd on the 2017 leaderboard, making the turnover about 50%.

Strava inflation produces a right shift in the speeds at which riders complete the segment. Rider speeds exhibit “long tailed” distributions, with just a few riders producing phenomenal performances: although many people can hold an average of 38kph, it remains very hard to complete this segment at over 42kph.

### More faster riders

A total of 409 names dropped off the bottom of the 2017 leaderboard, to be replaced by new faster riders. Some of these quicker times were set by cyclists who had improved enough to rise up the leaderboard into the top 1000, while others were new riders who had joined Strava or not previously done a lap of Richmond Park.

### Riders riding faster

Of the 591 riders who appeared on both leaderboards, 229 improved their times by an average of 53 seconds. These included about 90 riders who would have dropped out of the top 1000, had they not registered faster times.

### Getting faster without doing anything

One curious anomaly arose from the analysis: 32 efforts appearing on the 2019 leaderboard were recorded on dates that should have shown up on the 2017 leaderboard. Nine of these appeared to be old rides uploaded to Strava at a later date, but that left 23 efforts showing faster times in 2019 than 2017 for exactly the same segments completed by the same cyclists on the same rides.

For example, Gavin Ryan’s ride on 25 August 2016 appeared 8th on the 2017 leaderboard with a time of 14:23, but now he appears as 16th on the 2019 leaderboard with a time of 14:20! It seems that Strava has performed some kind of recalculation of historic times, resulting a new “effort_id” being assigned to the same completed segment. If you want to see a list of other riders whose times were recalculated, click here and scroll down to the section entitled “Curious anomaly”.

## Summer is the time to go faster

Strava leaderboards were never designed to rank pure solo TT efforts. Although it is possible to filter by sex, age, weight and date, it remains hard to distinguish between team versus solo efforts, road versus TT bikes and weather conditions. The nature of records is that they are there to be broken, so the top times will always get faster. The evidence from this analysis suggests that there are more faster cyclists around today than two years ago.

As the weather warms up, perhaps you can pick a quiet time to move up the leaderboard on your favourite segment, while showing courtesy to other road users and respecting the legal speed limit.

## Relative Energy Deficit in Sport (RED-S)

Unfortunately an increasing proportion of the population of western society has fallen into the habit consuming far more calories than required, resulting an a huge increase in obesity, with all the associated negative health consequences. At the opposite end of the spectrum, a smaller but important group experiences problems stemming from insufficient energy intake. This group includes certain competitive athletes, especially those involved in sports or dance, where a low body weight confers a performance advantage. A new infographic draws attention to this problem and highlights the fact that the individuals have control over the factors that can put them on the path to optimal health and performance.

## RED-S

The human body requires a certain amount of energy to perform normal metabolic functions, including, maintaining homeostasis, cardiac and brain activity. The daily requirement is around 2,000 kcal for women and 2,500 kcal for men. Additional energy intake is required to balance the energy requirements any physical activities performed.

Athletes and dancers need to eat more than sedentary people, but they can fall into an energy deficit in two ways.

• Reducing energy intake, while maintaining the same training load. This is typically an intentional decision, in order to lose weight, in the belief that this might improve performance. It can also arise unintentionally, perhaps due to failing to calculate energy demands of the training programme.
• Increasing training load, while maintaining the same energy intake. This can often occur unintentionally, as a result of a more intensive training session or a shift into a higher training phase. Some athletes or dancers perform extra training sessions while deliberately failing to eat more, in the hope, once again, that this might improve performance.

While most of the population would benefit from a period of moderate energy deficit. High level athletes and dancers tend to be very lean, to the extent that losing further weight compromises health and performance. The reason is that the endocrine system is forced to react to an energy deficit by scaling back or shutting down key metabolic systems. For example, levels of the sex hormones testosterone and oestrogen can fall, leading to, among other things, reductions in bone density. Unlike men, women have a warning sign, in the form of an interruption or cessation of menstruation. Both men and women with RED-S are likely to suffer from a failure to achieve their peak athletic performance.

## Achieving peak performance

Fortunately athletes have control over the levers that lead to peak performance. These are nutrition, training load and, of course, recovery. Consistently fuelling for the energy required, whilst ensuring that the body has adequate time to recover, allows the endocrine system to trigger the genes that lead to the beneficial outcomes of exercise, such as improved cardiovascular efficiency, effective muscular development, optimal body composition, healthy bones and a fully functional immune system. These are the changes required to reach the highest levels of performance.

## Don’t ride your bike like an astronaut

Astronauts return from the International Space Station with weak bones, due to the lack of gravitational forces. It is surprising to learn that competitive cyclists can experience similar losses in bone density over the period of a race season.

The problem is called Relative Energy Deficiency is Sport (RED-S). This occurs when lean athletes reach a tipping point where the benefits of losing weight become overwhelmed by negative impacts on health. When deprived of sufficient energy intake to match training load, certain metabolic systems become impaired or shut down.

Colleagues from Durham University and I recently published a study investigating what cyclists at risk of RED-S can do to improve their health and performance. It is freely available and written in an accessible way, without the requirement for specialist expertise.

## Race performance

Race performance was measured by the number of British Cycling points accumulated over the season. This was correlated with power (FTP and FTP/kg) and training load. However, changes in energy availability proved to be an important factor. After adjusting for FTP, cyclists who improved their fuelling (green triangles) gained, on average, 95 points more than those who made no change. In contrast, those who restricted their nutrition (red crosses) accumulated 95 fewer points and reported fatigue, illness and injury.

The nutritional advice included recommendations on adequate fuelling before, during and after rides. Also see my previous article on fuelling for the work required.

## Bone health

Competitive road cyclists can fall into an energy deficit due to the long hours of training they complete. Although an initial loss of excess body weight can lead to performance improvements, athletes need to maintain a healthy body mass. The lumbar spine is particularly sensitive to deficiencies of energy availability.

In cyclists, the lower back also fails to benefit from the gravitational stresses of weight-bearing sports. This is why, in addition to nutritional advice, study participants were recommended some basic skeletal loading exercises (yes, that is me in the pictures).

The cyclists fell into three general groups: those who made positive changes to nutrition and skeletal loading, those who made negative changes and the remainder. The resulting changes in bone mineral density over a six month period were striking, with highly statistically significant differences observed between the groups.

Those making positive changes (green triangles) saw significant gains in bone mineral density, while those making negative changes (red crosses) saw equally significant negative losses in bone density. Any individual observation outside the band of the least significant change (LSC) is indicative of a material change in bone health.

## Conclusions

The study provided strong evidence of the benefits of positive changes and the costs of negative changes in nutrition and skeletal loading exercises. It was noted that certain cyclists found it hard to overcome psychological barriers preventing them from deviating from their current routines. It is hoped that such strong statistical results will help these vulnerable athletes make beneficial behavioural changes

## References

Clinical evaluation of education relating to nutrition and skeletal loading in competitive male road cyclists at risk of relative energy deficiency in sports (RED-S): 6-month randomised controlled trial, Nicola Keay, Gavin Francis, Ian Entwistle, Karen Hind. BMJ Open Sport and Exercise Medicine Journal, Volume 5, Issue 1. http://dx.doi.org/10.1136/bmjsem-2019-000523

## Fuel for the work required: periodisation of carbohydrate intake

Last week I attended an event announcing the forthcoming launch of a new fitness app called Pillar. It offers combined training and nutrition advice to help athletes achieve their goals. Pillar is backed by a strong scientific team including Professor James Morton, Team Sky Head of Performance Nutrition, and Professor Graeme Close, England Rugby Head of Performance Nutrition.

James Morton gave a fascinating presentation about the periodisation of carbohydrate (CHO) fuelling, including a detailed description of the nutrition strategy he created to support Chris Froome’s famous 80km attack on stage 19 of the 2018 Giro d’Italia. His recent paper explains the underlying science. These are some of the key points.

• Always go into competition fully fuelled with carbohydrate
• Well-fuelled athletes perform for longer at higher intensities than those with depleted reserves
• Basic biochemistry: fat burning is too slow and supplies of the phosphocreatine are too small to sustain intensities over 85% of VO2max
• Theory is backed up by experiment
• There are pros and cons to training with low levels of carbohydrate
• Positive effects: Improved fat burning, changes in cell signalling, gene expression and enzyme/protein activity, potential to save precious glycogen stores for crucial attacks later in a race
• Negative effects: Inconsistent evidence of improved performance, ability to complete training session may be compromised, reduced immunity, risks to bone health, loss of top end for those on high fat/low carb (ketogenic) diet
• Different ways to train with low carbohydrate
• doing two sessions in one day with minimal refuelling
• low carb evening meal and breakfast: sleep low, train low the next morning
• fasted rides
• high fat/low carb diet

Is there a structured method of training that provides the benefits without the negatives?

• The authors propose a glycogen threshold hypothesis
• Positive effects seem to be dependent on commencing with muscle glycogen levels within a specific range
• Levels have to be low enough to promote positive effects
• But when too low, protein synthesis may be impaired and the ability to complete sessions is compromised
• This leads to the idea of periodising carbohydrate consumption, meal by meal, around planned training sessions
• “Fuelling for the work required”
• low carbs before and during lighter training sessions
• high carbs in preparation for and during rides with greater intensities
• always refuel after training
• The diagram above provides an example for an elite endurance cyclist
• The red, amber, green colour coding indicates low, medium or high carbohydrate consumption
• On day 1, the athlete aims to “train high” for a hard session
• A lighter evening meal on day 1 prepares to “sleep low, train low” ahead of a lower intensity session on day 2
• Carbohydrate intake rises after exercise on day 2 in anticipation of a high intensity session on day 3
• Fuelling is moderated on the evening of day 3 as day 4 is assigned as a recovery day
• Carbohydrate rises later on day 4 to prepare for the next block of training
• The Pillar app aims to provide these leading edge scientific principles to amateur cyclists and other athletes

In order to put this into action, you need to know how much carbohydrate you are consuming. My assumption has been that my diet is reasonably healthy, but I have never actually measured it. So I have been experimenting with free app MyFitnessPal that can be downloaded onto your phone. This provides a simple and convenient way to track the nutritional composition of your diet, including a barcode scanner that recognises most foods. You can link it to other apps such as Training Peaks to take account of energy expended. However, neither of these tools plans nutrition ahead of training sessions. Pillar aims to fill this gap. It will be interesting to see whether this turns out to be successful.

## References

Fuel for the Work Required: A Theoretical Framework for Carbohydrate Periodization and the Glycogen Threshold Hypothesis, SG Impey, MA Hearris, KM Hammond, JD Bartlett, J Louis, G Close, JP Morton, Sports Med (2018) 48:1031–1048, https://doi.org/10.1007/s40279-018-0867-7

Fuel for the work required: a practical approach to amalgamating train-low paradigms for endurance athletes, Impey SG, Hammond KM, Shepherd SO, Sharples AP, Stewart C, Limb M, Smith K, Philp A, Jeromson S, Hamilton DL, Close GL, Morton JP, Physiol Rep. 2016 May;4(10). pii: e12803. doi: 10.14814/phy2.12803

Low carbohydrate, high fat diet impairs exercise economy and negates the performance benefit from intensified training in elite race walkers, Burke LM, Ross ML, Garvican-Lewis LA, Welvaert M, Heikura IA, Forbes SG, Mirtschin JG, Cato LE, Strobel N, Sharma AP, Hawley JA.  J Physiol. 2017;595:2785–807

Low energy availability assessed by a sport-specific questionnaire and clinical interview indicative of bone health, endocrine profile and cycling performance in competitive male cyclists, BMJ Open Sport & Exercise Medicine,https://doi.org/10.1136/bmjsem-2018-000424

## Fuelling for Cycling Performance

Some commentators were skeptical of Team Sky’s explanation for Chris Froome’s 80km tour-winning attack on stage 19 of the Giro. His success was put down to the detailed planning of nutrition throughout the ride, with staff positioned at strategic refuelling points along the entire route.  If you consider how skeletal the riders look after two and a half weeks of relentless competition, along with the limits on what can be physically absorbed between stages, the nutrition story makes a lot of sense. Did Yates, Pinot and Aru dramatically fall by the wayside simply because they ran out of energy?

The best performing cyclists have excellent balancing skills. This includes the ability to match energy intake with energy demand. The pros benefit from teams of support staff monitoring every aspect of their nutrition and performance. However, many serious club-level cyclists pick up fads and snippets of information from social media or the cycling press that lead them to try out all kinds ideas, in an unscientific manner, in the hope of achieving an improvement in performance. Some of these activities have potentially harmful effects on the body.

Competitive riders can become obsessed with losing weight and sticking to extremely tough training schedules, leading to both short-term and long-term energy deficits that are detrimental to both health and performance. One of the physiological consequences can be a reduction in bone density, which is particularly significant for cyclists, who do not benefit from gravitational stress on bones, due to the non-weight-bearing nature of the sport. In a recent paper, colleagues at Durham University and I describe an approach for identifying male cyclists at risk of Relative Energy Deficit in Sport (RED-S).

You need a certain amount of energy simply to maintain normal life processes, but an athlete can force the body into a deficit in two ways: by intentionally or unintentionally restricting energy intake below the level required to meet demand or by increasing training load without a corresponding increase in fuelling.

Our bodies have a range of  ways to deal with an energy deficit. For the average, slightly overweight casual cyclist, burning some fat is not a bad thing. However, most competitive cyclists are already very lean, making the physiological consequences of an energy deficit more serious. Changes arise in the endocrine system that controls the body’s hormones. Certain processes can shut down, such as female menstruation, and males can experience a reduction in testosterone. Sex steroids are important for maintaining healthy bones. In our study of 50 male competitive cyclists, the average bone density in the lumbar spine, measured by DXA scan, was significantly below normal. Some relatively young cyclists had the bones of a 70 year old man!

The key variable associated with poor bone health was low energy availability, i.e. male cyclists exhibiting  RED-S. These riders were identified using a questionnaire followed by an interview with a Sports Endocrinologist. The purpose of the interview was to go through the responses in more detail, as most people have a tendency to put a positive spin on their answers. There were two important warning signs.

• Long-term energy deficit: a prolonged significant weight reduction to achieve “race weight”
• Short-term energy deficit: one or more fasted rides per week

Among riders with low energy availability, bone density was not so bad for those who had previously engaged in a weight-bearing sport, such as running. For cyclists with adequate energy availability, those with vey low levels of vitamin D had weaker bones. Across the 50 cyclists, most had vitamin D levels below the level of 90 nmol/L recommended for athletes, including some who were taking vitamin D supplements, but clearly not enough. Studies have shown that the advantages of athletes taking vitamin D supplements include better bone health, improved immunity and stronger muscles, so why wouldn’t you?

In terms of performance, British Cycling race category was positively related with a rider’s power to weight ratio, evaluated by 60 minute FTP per kg (FTP60/kg). Out of all the measured variables, including questionnaire responses, blood tests, bone density and body composition, the strongest association with FTP60/kg was the number of weekly training hours. There was no significant relationship between percentage body fat and FTP60/kg. So if you want to improve performance, rather than starving yourself in the hope of losing body fat, you are better off getting on your bike and training with adequate fuelling.

Cyclists using power meters have the advantage of knowing exactly how many calories they have used on every ride. In addition to taking on fuel during the ride, especially when racing, the greatest benefits accrue from having a recovery drink and some food immediately after completing rides of more than one hour.

For those wishing to know more about RED-S, the British Association of Sports and Exercise Medicine has provided a web resource.

A related blog will explore the machine learning and statistical techniques used to analyse the data for this study.

### References

Low energy availability assessed by a sport-specific questionnaire and clinical interview indicative of bone health, endocrine profile and cycling performance in competitive male cyclists, BMJ Open Sport & Exercise Medicine,https://doi.org/10.1136/bmjsem-2018-000424

Relative Energy Deficiency in Sport, British Association of Sports and Exercise Medicine

Synergistic interactions of steroid hormones, British Journal of Sports Medicine

Cyclists: Make No Bones About It, British Journal of Sports Medicine

Male Cyclists: bones, body composition, nutrition, performance, British Journal of Sports Medicine