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• Intense training in elite female athletes: evidence of reduced growth and delayed maturation?
  Shona Bass
  Published on: 12 October 2022

• Published on: 12 October 2022

  Intense training in elite female athletes: evidence of reduced growth and delayed maturation?

  • Shona Bass, senior lecturer
  • Other Contributors:
    • R Daly, and D Caine

  Dear Editor

  In their recent article 'Intensive training in elite young female athletes,' Baxter-Jones and Maffulli reviewed 18 manuscripts and concluded 'training does not appear to affect growth and maturation .'[1] We have two concerns about this conclusion. First, we agree that analyses of cross -sectional and cohort data in this population are confounded by sampling bias; gymnasts who are successful at an elite leve...

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  Dear Editor

  In their recent article 'Intensive training in elite young female athletes,' Baxter-Jones and Maffulli reviewed 18 manuscripts and concluded 'training does not appear to affect growth and maturation .'[1] We have two concerns about this conclusion. First, we agree that analyses of cross -sectional and cohort data in this population are confounded by sampling bias; gymnasts who are successful at an elite level are likely to be self- selected by their small stature and delayed maturation. Frequently, however, data from cross-sectional and cohort studies are averaged. This 'group' approach provides little information about individual growth patterns. Thus, in Baxter-Jones and Maffuli's review, and the literature at large, an important basic question has been overlooked; that is, is there any evidence that growth and/or maturation are adversely affected in some athletes and if so, what is the frequency of this condition?

  Second, in contrast to their findings, our analysis of over 35 clinical reports, cross-sectional and historical and prospective cohort studies indicates that elite level gymnasts may be at risk for adverse effects on growth [2]. We reported that the increased magnitude of the delay in skeletal maturation with training in adolescent female gymnasts, coupled with the occurrence of catch-up growth during periods of reduced training or retirement, provides evidence that growth and maturation may be affected in some instances [2,3]. Furthermore, in contrast to the interpretation Baxter-Jones and Maffulli made of our data, we did report an association between reduced growth and years of gymnastic training, and that the deficits were greater at the axial than appendicular skeleton [3].

  We are in agreement with Baxter-Jones and Maffulli that a cause- effect relationship between gymnastics training and inadequate growth of females has not been demonstrated; there have been no randomized controlled trials. However, this does not mean there is 'no evidence for inadequate growth among female gymnasts.' If clinicians are coerced by group means and ignore variability about the mean, then gymnasts who are at increased risk of reduced growth may be overlooked. We recommend that the growth of all young elite female gymnasts should be monitored regularly. Any gymnast who falls behind in growth i.e. across two major percentiles of the growth chart, should undergo a complete evaluation for underlying pathology, even when height is not below the fifth percentile. This may be normal short stature, but the clinical criterion warrants assessment.

  References

  (1) Baxter-Jones ADG, Maffulli N, Intensive training in elite young female athletes Br J Sports Med. 2002;36:13-15
  (2) Caine D, Lewis R, O'Connor P, Howe W, Bass S. Does gymnastics training inhibit growth of females? Clin J Sport Med 2001;11:260-70.
  (3) Bass S, Bradney M, Pearce G, et al. Short stature and delayed puberty in gymnasts: Influence of selection bias on leg length and the duration of training on trunk length. J Pediatrics 2000;136(2):149-55.

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  Conflict of Interest:
  None declared.

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