Factors that may impact long-term health
| Topic | Statement | SORT rating |
| Cardiovascular | Youth athletes may experience exercise-induced cardiac adaptations similar to that seen in adults; more data are needed about the long-term health implications of these findings. | B |
| Cardiovascular | Rates of sudden cardiac arrest/sudden cardiac death are low in adolescent runners. | B |
| Screening | The PPE may identify prior injuries in youth runners, but research is needed to assess its effectiveness as a screening tool and ability to affect future outcomes. | C |
| Screening | Screening for low EA is important for both male and female youth runners. While additional prospective studies are needed to evaluate their use, screening tools such as the Triad RTPC and/or RED-S CAT are recommended to identify risk factors and address factors including low EA and menstrual dysfunction that may contribute to impaired BMD and risk for injury. | C |
| Screening | Youth runners should undergo preparticipation cardiovascular evaluation using the focused history and physical exam based on the AHA-14 question survey or the PPE fifth edition monograph. The use of additional testing (eg, ECG) should be based on available cardiology expertise and resources or local, national, or sport federation requirements. | C |
| Nutrition | Youth runners of both sexes require adequate EA to promote optimal sports performance and support growth. As specific EA requirements for individual runners vary and that specific thresholds for adequate EA to support health and performance in this population are unknown, prospective studies are needed to determine appropriate and safe requirements for EA in youth runners. (SORT C) | C |
| Nutrition | In youth runners, meeting recommended intake levels of micronutrients, including calcium and vitamin D, paired with adequate EA, may promote optimal bone health and reduce risk of bone stress injury. | C |
AHA, American Heart Association; BMD, bone mineral density; RED-S CAT, Relative Energy Deficiency in Sports Clinical Assessment Tool; EA, energy availability; PPE, preparticipation physical evaluation; Triad RTPC, female athlete triad return to play criteria; SORT, strength of recommendation taxonomy.