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 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.
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.
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
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