Evidence map›Paper›PMID 39532316›Full record

ArticleBritish journal of sports medicine2025

Boston Marathon athlete performance outcomes and intra-event medical encounter risk associated with low energy availability indicators.

Kristin E Whitney, Alexandra F DeJong Lempke, Trent Stellingwerff, Louise M Burke, Bryan Holtzman, Aaron L Baggish, Pierre A D'Hemecourt, Sophia Dyer, Chris Troyanos, Kaya Adelzadeh and 6 more

Abstract read
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In one paragraph

Article in British journal of sports medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. TheFrontiers in physiology · 2026
    Pooled it
  3. Pooled it
  4. Stress Fracture in Athletes: A Practical Approach.Journal of clinical medicine · 2026
    Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Kristin E WhitneyHarvard Medical School, Boston, Massachusetts, USA kristin.whitney@childrens.harvard.edu.ORCID http://orcid.org/0000-0002-1612-3852
Alexandra F DeJong LempkePhysical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.ORCID http://orcid.org/0000-0002-5702-9184
Trent StellingwerffCanadian Sport Institute Pacific, Victoria, Victoria, Canada.ORCID http://orcid.org/0000-0002-4704-8250
Louise M BurkeMary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.ORCID http://orcid.org/0000-0001-8866-5637
Bryan HoltzmanHarvard Medical School, Boston, Massachusetts, USA.
Aaron L BaggishDepartment of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Pierre A D'HemecourtHarvard Medical School, Boston, Massachusetts, USA.
Sophia DyerBoston University School of Medicine, Boston, Massachusetts, USA.
Chris TroyanosInternational Institute of Race Medicine, Plymouth, Massachusetts, USA.
Kaya AdelzadehHarvard Medical School, Boston, Massachusetts, USA.
Grace H SavilleHarvard Medical School, Boston, Massachusetts, USA.
Ida A HeikuraCanadian Sport Institute Pacific, Victoria, Victoria, Canada.ORCID http://orcid.org/0000-0002-1088-428X
Nicole FarnsworthHarvard Medical School, Boston, Massachusetts, USA.
Laura ReeceHarvard Medical School, Boston, Massachusetts, USA.
Anthony C HackneyExercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA.ORCID http://orcid.org/0000-0002-7437-6225
Kathryn E AckermanHarvard Medical School, Boston, Massachusetts, USA.ORCID http://orcid.org/0000-0003-2626-7785

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo 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.

methods1030 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.

resultsThe 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.

conclusionThis 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.

Indexed as

Athletic PerformanceMarathon RunningRunningAdultBostonFeeding and Eating DisordersFemaleHumansMaleMiddle AgedSelf ReportSurveys and QuestionnairesEnergy intakePhysical EnduranceRelative Energy Deficiency in SportRunning

Identifiers

PMID39532316
PMCPMC11874277

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.