Improving the health and performance of distance runners
Submitting InstitutionSt Mary's University, Twickenham
Unit of AssessmentSport and Exercise Sciences, Leisure and Tourism
Summary Impact TypeHealth
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Summary of the impact
The research outlined below concerning medico-physiological issues in
distance runners has
directly informed medical policy, investigations and therapy strategies
applied to elite distance
runners, and raised the profile of issues relating to the Female Athlete
Triad for coaches such as
those within British Athletics and England Athletics.
The research findings have been disseminated via several avenues, such as
the education of Sport
and Exercise Medicine (SEM) doctors (through content for lectures
delivered on SEM programmes
at bachelors and masters level), and via CPD workshops for coaches and SEM
with the capacity to directly affect medical practice.
The elite athlete endeavours to optimise performance through effective
training and competition
preparation; however, negative consequences for health and well-being can
ensue. The work of
Pedlar and co-authors has furthered understanding of aspects of elite
endurance athlete health
(female athlete triad1; iron-deficiency non-anaemia2),
as well as other elite athlete issues such as
hypoxic training3 and performance at altitude, performance
determinants, sleep4,5, and recovery6.
Pedlar combines research with practice at St Mary's University College
(SMUC), resulting in
research outputs with high ecological validity, and direct application.
Two themes are highlighted:
i) The Female Athlete Triad (the Triad), characterised by low
bone-mineral density, loss of the
menstrual cycle, and disordered eating. The long-term prognosis is poorly
associated with an increased risk of stress fracture, failure to achieve
peak bone strength, and poor
performance. Summer and winter sports athletes as well as in recreational
exercisers are at risk.
The American College of Sports Medicine, the International Olympic
Commission and others have published position stands on the Triad.
ii) Iron deficiency in distance runners may be caused by a number
of mechanisms including
inflammation / hepcidin interaction, footstrike haemolysis, reduced
visceral blood flow during
exercise, and gastro-intestinal bleeding. Iron is involved in
mitochondrial energy production and
the production and maintenance of haemoglobin; thus, a healthy iron
balance is crucial for
performance. Iron injections have been effective in some, but not in all,
studies. Longitudinal data,
particularly in elite athletes, are rare and much needed in order to
further understand the clinical
significance of iron deficiency.
The Pollock et al. (2010) paper 1 details the prevalence of
aspects of the female athlete triad in 44
elite British female distance runners. Low bone mineral density was
present in 34.2% of athletes,
with 33% displaying osteoporosis of the radius. Pedlar commenced pilot
data collection for the
project in 2002, concerned that the health of distance runners could be
compromised by their
training and recovery practices. Female distance runners based at SMUC
were encouraged to visit
Middlesex University for an annual Duel-energy X-ray Absorptiometry (DXA)
scan, funded by the
English Institute of Sport. Interest grew and a number of collaborations
developed with sports
medicine practitioners including Dr Roger Wolman and Dr Noel Pollock,
prompting the systematic
data collection for the purpose of a research study commencing in 2003.
preliminary data at a British Olympic Association professional development
session for doctors in
2007, organised by Dr Roger Wolman and after sufficient longitudinal data
was collected, the paper
was published in 2010 by clinician Dr Noel Pollock.
The Pedlar et al. (2013) case study2 relating to iron
deficiency contains unique data derived from
the combined sports science and medical support of a world-class
professional female athlete over
4 years, demonstrating that continued aerobic development occurred despite
deficiency. A PhD student supervised by Pedlar is currently studying the
efficacy of iron repletion
in iron deficient, non-anaemic elite distance runners and has completed a
collaborative study with
the Mr Toby Richards at University College London (vascular surgeon).
References to the research
The research relating to the Details of the impact section below:
1. Pollock N, Grogan C, Perry M, Pedlar C, Cooke K, Morrissey D,
Dimitriou L. Bone-mineral
density and other features of the female athlete triad in elite endurance
runners: a longitudinal and
cross-sectional observational study. Int J Sport Nutr Exerc Metab.
2. Pedlar CR, Whyte GP, Burden R, Moore B, Horgan G, Pollock N. A
Case Study of an Iron
Deficient Female Olympic 1500m Runner. Int J Sports Physiol Perform.
Other research examples cited in Underpinning research section
3. BA Holliss, J Fulford, A Vanhatalo, CR Pedlar, AM Jones.
Influence of intermittent hypoxic
training on muscle energetics and exercise tolerance. J Appl Physiol.,
4. Pedlar CR, Whyte G, Emegbo S, Stanley N, Hindmarch I and
Godfrey R. Acute sleep responses
in a normobaric hypoxic tent. Med Sci Sports Exerc., 2005
5. Leeder J, Glaister M, Pizzoferro K, Dawson J and Pedlar C.
Sleep duration and quality in elite
athletes measured using wristwatch actigraphy. J Sports Sci., 2012
6. Hill J, Howatson G, van Someren K, Leeder J, Pedlar C.
Compression garments and recovery
from exercise-induced muscle damage: A meta-analysis. Br J Sports
All references listed here are published in established peer reviewed
journals and are available on
request from the institution.
Details of the impact
The published findings from the Pollock et al. (2010) paper1,
described in section 2, have
highlighted the prevalence of the Triad in female athletes and triggered a
new approach to the
medical care of British female distance runners, prioritising prompt
identification and treatment of
the Triad. Dr Noel Pollock — a British Athletics Doctor (and first author
of the paper) commented:
`This study has informed British Athletics medical policy, investigations,
and therapy strategy and,
amongst other things, raised the profile of the issue for coaches'. Dr
Pollock has provided a British
Athletics medical policy document citing this work.
This work has received global attention, featuring in a number of text
books and websites, and
summarised by other agencies. The work is cited in a professional
development article in the South
African Journal of Family Practice (Schwellnus et al. 2011) and summarised
on the Female Athlete
Triad Coalition (an international consortium affiliated to the American
College of Sports Medicine)
— `To this end, it is notably imperative that female endurance
athletes complete a DXA amongst their pre-participation screening.
Furthermore, future research
should investigate this association between high training volume,
potential menstrual dysfunction,
and reductions in lumbar BMD in larger populations of female endurance
athletes. Based on these
findings, it is indirectly suggested that a negative energy balance is a
contributing factor to bone
loss in these athletes.' Together, these references highlight the
strong likelihood that this work has
influenced practice internationally.
At SMUC, a post-doctoral research fellow with expertise in the promotion
of bone health has been
recruited in order to further this research and to seek further research
funding to expand research
into optimising the bone health of elite athletes.
The iron deficiency case study2 was reviewed in detail in the
popular press in a Runner's World
blog, and has had over 5000 views (currently 100 / week): http://www.runnersworld.com/nutrition-runners/iron-levels-olympic-miler.
The Runners World Website attracts 3.8 million views per week.
Furthermore, Gill Horgan (a co-author), presented the case study to the
Sports Dietitians UK group,
of which she is a member, potentially influencing practice amongst Sports
St Mary's is uniquely placed in British distance running circles to
influence, via its research, current
and developing athletes, owing to the quality and quantity of distance
runners training locally. St
Mary's has hosted a number of high profile distance runners in the London
Athletics and British Athletics supported Endurance Performance and
Coaching Centre (EPACC).
The EPACC has grown from 2 elite runners in 2003 (including Mo Farah) to
some 140 athletes in
2013, and is host to several training camps, workshops, conferences and
seminars for the distance
running community; for example, the annual London Marathon Young Athlete
Camp, the Annual
England Athletics seminar series and the British Milers Club Endurance
Conference 2013. This
profile provides considerable scope for research impact through local and
national distance running
Beyond St Mary's, both themes feature in education programmes delivered
to Sport and Exercise
Medicine doctors at Queen Mary University of London and University College
guest lectures by Dr Pedlar and co-authors, annually since 2010.
Furthermore, Dr Pedlar is a
guest lecturer on the British Association of Sport and Exercise Medicine
Course using both of the above research examples as a means of educating
the trainee sports
doctor delegates. Dr Pedlar has recently spoken to practitioners about his
research at the BASEM
Annual Conference 2012, Marathon Medicine 2012, The Beachy Head Marathon
The European Athletics Endurance Conference 2013, and the Running 2012
Sources to corroborate the impact
References from GB level high performance athletics coaches
Sport and Exercise Medicine Doctors from the British Olympic Association,
English Institute of
Sport, British Athletics, and the London Marathon Medical Committee.