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Boston Marathon athlete performance outcomes and intra-event medical encounter risk associated with low energy availability indicators
Whitney, Kristin E. DeJong Lempke, Alexandra F. Stellingwerff, Trent Burke, Louise M. Holtzman, Bryan Baggish, Aaron L. D'Hemecourt, Pierre A. Dyer, Sophia Troyanos, Chris Adelzadeh, Kaya
Whitney, Kristin E.
DeJong Lempke, Alexandra F.
Stellingwerff, Trent
Burke, Louise M.
Holtzman, Bryan
Baggish, Aaron L.
D'Hemecourt, Pierre A.
Dyer, Sophia
Troyanos, Chris
Adelzadeh, Kaya
Author
Abstract
Objective
To determine the association between survey-based self-reported problematic low energy availability indicators (LEA-I) and race performance and intra-event medical encounters during the Boston Marathon.
Methods
1030 runners who were registered for the 2022 Boston Marathon completed an electronic survey (1–4 weeks pre-race) assessing LEA-I, training and medical history. De-identified survey data were linked to event wearable timing chips and medical encounter records. LEA-I was defined as: an elevated Eating Disorder Examination Questionnaire score, elevated Low Energy Availability (LEA) in Females Questionnaire score, LEA in Males Questionnaire with a focus on gonadal dysfunction score and/or self-report of diagnosed eating disorder/disordered eating.
Results
The prevalence of LEA-I was 232/546 (42.5%) in females and 85/484 (17.6%) in males. Athletes without LEA-I (non-LEA-I) achieved significantly better race times versus those with LEA-I (accounting for demographic and anthropomorphic data, training history and marathon experience), along with better division finishing place (DFP) mean outcomes (women’s DFP: 948.9±57.6 versus 1377.4±82.9, p<0.001; men’s DFP: 794.6±41.0 versus 1262.4±103.3, p<0.001). Compared with non-LEA-I athletes, LEA-I athletes had 1.99-fold (95% CI: 1.15 to 3.43) increased relative risk (RR) of an intra-event medical encounter of any severity level, and a 2.86-fold increased RR (95% CI:1.31 to 6.24) of a major medical encounter.
Conclusion
This is the largest study to link LEA-I to intra-event athletic performance and medical encounters. LEA-I were associated with worse race performance and increased risk of intra-event medical encounters, supporting the negative performance and medical risks associated with problematic LEA-I in marathon athletes.
Keywords
Date
2025
Type
Journal article
Journal
British Journal of Sports Medicine
Book
Volume
59
Issue
4
Page Range
222-230
Article Number
ACU Department
Centre for Exercise and Nutrition
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY-NC 4.0
File Access
Open
Notes
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC (http://creativecommons.org/licenses/by-nc/4.0/). No commercial re-use. See rights and permissions. Published by BMJ Group.