“My body might have broken down but my brain was the real minefield”: a psychological exploration of low energy availability in sport and exercise

Langbein, Rachel Kate (2021) “My body might have broken down but my brain was the real minefield”: a psychological exploration of low energy availability in sport and exercise. PhD thesis, University of Lincoln.

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“My body might have broken down but my brain was the real minefield”: a psychological exploration of low energy availability in sport and exercise
PhD Thesis
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Item Type:Thesis (PhD)
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Abstract

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 “recovery” 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 “in recovery” or “recovered” 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 ‘at-risk’ 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.

Keywords:low energy availability, energy availability, competitive sports
Subjects:C Biological Sciences > C600 Sports Science
Divisions:College of Social Science > School of Sport and Exercise Science
ID Code:48456
Deposited On:04 Mar 2022 16:42

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