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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
  1. Nicola Keay1,
  2. Gavin Francis2,
  3. Karen Hind3
  1. 1 Department of Sport and Exercise Sciences, Durham University, Durham, UK
  2. 2 Science4performance, London, UK
  3. 3 Department of Sport and Exercise Sciences, Durham University, Durham, UK
  1. Correspondence to Dr Nicola Keay; nickykeayfrancis{at}


Objectives To evaluate the efficacy of a sport-specific energy availability (EA) questionnaire, combined with clinical interview, for identifying male athletes at risk of developing bone health, endocrine and performance consequences of relative energy deficiency in sports (RED-S).

Methods Fifty competitive male road cyclists, recruited through links of participants in a pilot study, were assessed by a newly developed sport-specific questionnaire and clinical interview (SEAQ-I) and received dual energy X-ray absorptiometry (DXA) bone mineral density (BMD) and body composition scans and blood tests for endocrine markers.

Results Low EA as assessed using the SEAQ-I, was observed in 28% of cyclists. Low lumbar spine BMD (Z-score<−1.0) was found in 44% of cyclists. EA was the most significant determinant of lumbar spine BMD Z-score (p<0.001). Among low EA cyclists, lack of previous load-bearing sport was associated with the lowest BMD (p=0.013). Low EA was associated with reduced total percentage fat (p<0.019). The 10 cyclists with chronic low EA had lower levels of testosterone compared with those having adequate EA (p=0.024). Mean vitamin D concentration was below the level recommended for athletes (90  nmol/L). Training loads were positively associated with power-to-weight ratios, assessed as 60  min functional threshold power (FTP) per kg (p<0.001). Percentage body fat was not significantly linked to cycling performance.

Conclusions This study demonstrates that a SEAQ-I is effective for identifying male road cyclists with acute intermittent and chronic sustained low EA. Cyclists with low EA, particularly in the long-term, displayed adverse quantifiable measures of bone, endocrinology and performance consequences of RED-S.

  • energy availability
  • male athletes
  • bone health
  • relative energy deficiency in sport

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  • Collaborators Ian Entwistle and Brian Oldroyd, Leeds Beckett University, Leeds, UK.

  • Contributors NK: conceptualisation of project, development of study design, research funding application, involvement of cyclists, their coaches and sports performance dieticians, conducting clinical sport specific interviews, drafting and revision of manuscript. GF: cycle specific advanced statistical analysis and revision of manuscript. KH: development of study design, research funding application, scanning of cyclists, drafting and revision of manuscript, IE and BO scanning of cyclists.

  • Funding Thank you to the British Association of Sport and Exercise Medicine (BASEM) for funding this study with a research bursary. Thanks also to SunVitD3 for funding the analysis of endocrine and metabolic markers.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Leeds Beckett University Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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