Female Recreational Exercisers at Risk for Low Energy Availability
Abstract
Low energy availability (LEA) describes the disruption in normal physiological function existent when insufficient energy intake is combined with exercise. To conserve energy a range of endocrine adaptations occur, impairing health and athletic performance. The prevalence of LEA has not been fully established especially among recreational exercisers. Determining recreational exercisers at risk of LEA may help to maximize prevention, early diagnosis and treatment. The design of this study was a cross-sectional online survey. One-hundred and nine female recreational exercisers, with a mean age of 23.8 (SD 6.9) years were recruited via gyms and fitness centers throughout NZ. Participants completed an online questionnaire including questions from the LEAF-Q (Low Energy Availability in Females Questionnaire). A total of 45.0% (CI, 35.4%, 54.8%) of participants were classified as “at risk“ of LEA. For every extra hour of exercise per week the odds of being at risk of LEA were 1.13 times greater (CI 1.02, 1.25, p = .016). All participants reporting previous stress fracture injuries (n = 4) were classified as at risk for LEA. Significantly more subjects participating in an individual sport were classified as at risk for LEA (69.6%, CI 24.3%, 54.8%) compared with team sports (34.8%, CI 18.7%, 40.5%) (p = .006). The high prevalence of female recreational exercisers at risk of LEA is of concern, emphasizing the importance of increasing awareness of the issue, and promoting prevention and early detection strategies, so treatment can be implemented before health is severely compromised.
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Caloric restriction is prevalent among recreationally active to elite female athletes.
“which has been shown to be prevalent among recreationally active to elite female athletes [113,124,233–236]”
From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [233]
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“Two research groups have shown that screening active females for symptoms of LEA effectively identified those at increased risk who would benefit from diet and exercise interventions [39, 118].”
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“Furthermore, significantly more participants involved in individual sports are classified at risk of LEA compared with team sports [41].”
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“Because of the challenges associated with directly measuring EA, the validated Low Energy Availability in Females Questionnaire (LEAF-Q) has been used to assess the risk of LEA in athletes, with the prevalence reported to range between 33 and 46% [19,20].”
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“%) and recreational active women (45%; Folscher et al., 2015; Slater et al., 2016).”
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“Recent studies have shown that 45% of female recreational exercises were found to be at risk of LEA [6], while another study found a high LEA prevalence in both male and female elite young athletes (males, 56%; females, 51%) [7].”
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“Slater 2016 [130] Low Energy Availability Amongst New Zealand Athletes (LEANZA) questionnaire Identify those at risk of LEA Indirect Adult female athletes”
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“While energy intake and energy expenditure are necessary to determine EA, accurate measurement can be confounded by numerous variables, including underreported energy intake and technological limitations in assessing energy expenditure.”
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“%) in recreationally active females in New Zealand using the same questionnaire (LEAF-Q) (Slater et al., 2016).”
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Lane, A. R., Hackney, A. C., Smith-Ryan, A., Kucera, K., Registar-Mihalik, J., & Ondrak, K. (2019) · Medicina · doi:10.3390/medicina55100665 · Cited by 45 · see citing works
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“Furthermore, with interviewees reflecting on their physiological data, the project highlights the athletes varying levels of engagement with their biological bodies relating particularly to changes in hormones, body composition, and bone health resulting from LEA and RED-S.”
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Black, K., Slater, J., Brown, R. C., & Cooke, R. (2018) · Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000002540 · Cited by 41 · see citing works
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“…that recreational runners are less likely to attend a formal running club where this kind of information may be available; therefore, it may be pertinent to suggest that educational materials and interventions are also targeted at gyms, fitness centres and healthcare settings (Slater et al., 2016).”
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“Thus, this study and others [65, 68, 96] do not provide causal evidence for a link between energy deficiency/low EA and GI or immune function, but rather imply that participants are in an energy-deficient state despite limited or no physiological evidence of energy deficiency.”
ResultHas Menstruation Disappeared? Functional Hypothalamic Amenorrhea—What Is This Story about?
Ryterská, K., Kordek, A., & Załęska, P. (2021) · Nutrients · doi:10.3390/nu13082827 · Cited by 42 · see citing works
Low Energy Availability and Relative Energy Deficiency in Sport: What Coaches Should Know
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“35 However, recalling injury status in the previous year (injured/uninjured) is considered accurate 35 and self-reported menstrual dysfunction is a valid predictor for clinical menstrual dysfunction among athletes.”
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“It was used with different groups of athletes such as elite runners [31], elite and recreational female aesthetic sports athletes [32], elite rock climbers [33], female recreational exercisers recruited via gyms and fitness centres [34], football players [35], paralympic athletes [36], American football players [37],…”
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“at greater risk of menstrual dysfunction [43,44], when experiencing the heightened stress of COVID-19, may be particularly vulnerable to cycle length changes and/or adverse changes in symptomology.”
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Protein Requirements of Pre-Menopausal Female Athletes: Systematic Literature Review
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“(27) reported that significantly fewer participants in team sports were at risk of LEA (34.”
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“This is consistent with findings from Danielle and Slater et al., where it was observed that an additional hour of training per week increased the risk of LEA by 1.06 to 1.13 times [31,37].”
InfluentialBaranauskas, M. N., Freemas, J. A., Carter, S. J., Blodgett, J. M., Pedlar, C., & Bruinvels, G. (2023) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2023.07.001 · Cited by 9 · see citing works
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CULTURAL ADAPTATION AND VALIDATION OF THE LOW ENERGY AVAILABILITY IN FEMALES QUESTIONNAIRE (LEAF-Q)
de Maria, U. P., & Juzwiak, C. R. (2021) · Revista Brasileira de Medicina do Esporte · doi:10.1590/1517-869220212702223889 · Cited by 10 · see citing works
“There is an adapted version of the LEAF-Q for New Zealand physical activity practitioners 20 .”
Gimunová, M., Bozděch, M., Bernacikovà, M., Fernandes, R. A., Kumstát, M., & Paludo, A. C. (2024) · PeerJ · doi:10.7717/peerj.17533 · Cited by 7 · see citing works
“This phenomenon seems partially supported by the fact that recreational athletes have less access to the nutritional and sport medicine specialists ( Slater et al., 2016 ) and highlights the need for public health programs raising the awareness of LEA and its health consequences among this speci fi…”
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“Low energy availability (<30 kcal·kgLBM) is common 62 in female athletes and recreationally active individuals and is associated with menstrual dysfunction and impaired 63 bone health (Nattiv et al. 2007; De Souza et al. 2014; Slater et al. 2016) and it has been suggested that many other 64”
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“In previous studies, LEA was found in 30% of female Australian football players 30 and 45% of female leisure exercisers 31 .”
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“In a sample of 109 adult recreationally active women, almost half were reported to be at risk of LEA, and this included women involved in both individual and team sport activities (68).”
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Kuikman, M., & Burke, L. (2023) · Nutrition Today · doi:10.1097/nt.0000000000000603 · Cited by 10 · see citing works
Changes in the concentration of bone turnover markers in men after maximum intensity exercise
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“There is a risk that among athletes practicing endurance sports, there may be an insufficient supply of energy, which may have adverse effects on the bones ( Loucks, Kiens & Wright, 2011 ; Slater et al., 2016 ; Papageorgiou et al., 2018 ).”
BackgroundImpact of Perfectionism on the Risk of the Female Athlete Triad in Collegiate Athletes
Brooks, S., Peach, H. D., Howden, R., Lowrie, J., & Marino, J. S. (2024) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000005006 · Cited by 3 · see citing works
“This can be compared with other studies that use the LEAF-Q that show 56.3% prevalence in female collegiate soccer players (25) and 45.0% prevalence in female recreational athletes (35).”
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“Reported LEAF-Q results are similar to other reports assessing LEA risk, which found increased risk in * 40% of physically active females of varying athletic abilities in Ireland, 30 45% of RA females in New Zealand, 31 and 44% of ultramarathoners.”
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“The prevalence of LEA in female athletes has been reported as between 33% and 46% (Folscher et al., 2015; Slater et al., 2016) and as high as 65% in young female football players.”
The risk for the female athlete triad in Brazilian athletes
de Maria, U. P., & Juzwiak, C. R. (2020) · Human Movement · doi:10.5114/hm.2021.100013 · Cited by 2 · see citing works
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SINDROM RELATIVNEGA ENERGIJSKEGA PRIMANJKLJAJA PRI OTROCIH IN MLADOSTNIKIH
Salobir, N., Jazbinšek, S., Dovč, K., & Kotnik, P. (2023) · Slovenska pediatrija revija pediatrov Slovenije in specialistov šolske ter visokošolske medicine Slovenije · doi:10.38031/slovpediatr-2023-1-01 · Cited by 1 · see citing works
Sources of Nutrition Information in Recreational Ultra-marathon Runners: A Mixed Methods Analysis
Mahoney, S. E., Wójcicki, T. R., & Carnes, A. J. (2020) · Human performance in extreme environments · doi:10.7771/2327-2937.1131 · Cited by 2 · see citing works
“, 2018) and is not solely found in elite athletes, but is a concern for recreational athletes as well (Slater et al., 2016).”
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Prevalence of physically active females at risk for the female athlete triad in Spain
Ramos, A., Bellver, M., Esquius, L., Pastor, I. M., Montes, A. B., & Andrés, A. (2025) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2025.2590641 · Cited by 1 · see citing works
“In line with this observation, we also found a higher weekly training load to be associated with an increased risk of the Triad, aligning with previous studies [16,19,21].”
InfluentialRisk of Red-S Syndrome among Individuals Who Regularly Engage in Physical Activity
Martyniuk, A. W., Galczak-Kondraciuk, A., Ciołek, K., & Górniak, K. (2026) · Polish Journal of Sport and Tourism · doi:10.2478/pjst-2026-0004 · Cited by 1 · see citing works
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Surfboard riders are at risk of low energy availability – A pilot study
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“…in females is markedly greater than previous studies featuring larger female samples of elite AFL players (Condo et al., 2019), elite soccer players (Luszczki et al. 2021), elite and recreational runners (Dervish et al., 2022; Sharps et al., 2022) and exercisers (Slater et al., 2016) of 30 – 53%.”
InfluentialEnergy Availability and Health
Volpe, S. L. (2023) · ACSMʼs Health & Fitness Journal · doi:10.1249/fit.0000000000000872 · Cited by 1 · see citing works
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Salobir, N., Jazbinšek, S., Dovč, K., & Kotnik, P. (2023) · Slovenska pediatrija revija pediatrov Slovenije in specialistov šolske ter visokošolske medicine Slovenije · doi:10.38031/slovpediatr-2023-1-01en
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“As a consequence of the substantial energy demands associated with intense and sustained exercise, sportspeople are deemed at higher risk of LEA and REDs than are those with lower levels of exercise engagement (Logue et al., 2018).”
InfluentialKubica, C., Zimmermann, S., & Nigg, C. R. (2026) · BMC Women s Health · doi:10.1186/s12905-026-04503-1
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- Authors
- Slater, J., McLay-Cooke, R., Brown, R., & Black, K.
- Corresponding author
- Black, Katherine
- Venue
- International Journal of Sport Nutrition and Exercise Metabolism
- Publisher
- Human Kinetics
- Published
- 2016-10
- Volume
- 26
- Issue
- 5
- Pages
- 421-427
- ISSN
- 1526-484X (ISSN-L)
- 1543-2742
- OpenAlex
- W2419217859
- Cited by
- 62
- References
- 0
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 5 · 2023: 13 · 2022: 5 · 2021: 8 · 2020: 6 · 2019: 7 · 2018: 5 · 2017: 4
- FWCI
- 7.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Sport Nutrition and Exercise Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pennington Biomedical Research Foundation
- University of Otago
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- low energy availability, exercise stress, energy intake, LEAF-Q, stress fractures, individual sports, team sports, exercise volume, endocrine adaptation, early detection and prevention
- MeSH terms
- Adolescent, Adult, Energy Intake, Cross-Sectional Studies, Female, Humans, New Zealand, Surveys and Questionnaires, Risk Factors, Exercise, Fractures, Stress, Malnutrition, Athletic Performance, Young Adult, Athletes, Sports Nutritional Physiological Phenomena
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