Document Type


Date of Degree Completion

Spring 2019

Degree Name

Master of Science (MS)



Committee Chair

Kelly Pritchett

Second Committee Member

Robert Pritchett

Third Committee Member

Elizabeth Broad


The prevalence of low-energy availability (LEA) in able-bodied female athletes has been extensively examined; however, research has yet to examine LEA in Paralympic athletes. Therefore, the purpose of this study was to examine the risk of LEA and related symptoms including menstrual health, hormonal profiles, and bone mineral density (BMD) in female para-athletes. Female national para-athletes (n = 9) completed 7-day food and activity logs, Low Energy Availability in Females Questionnaire (LEAF-Q) and Eating Disorder Examination Questionnaire (EDE-Q), Dual energy X-Ray Absorptiometry (DXA) scans, and hormonal profile blood spot testing. LEAF-Q results suggested that 78% of athletes were considered “at-risk” for LEA, while energy availability calculations based on energy intake (EI) and exercise energy expenditure (EEE) suggested that none of the participants had LEA ( < 30 Menstrual dysfunction was reported in four participants who were also taking hormonal contraceptives. Hormonal blood spot tests suggested that progesterone was low in 67% of the participants (2.1 + 0.3 nmol/L), with no trends between those considered “at-risk” and “not at-risk” for LEA using LEAF-Q. Triiodothyronine (T3) and estradiol levels were within normal range for all participants. Insulin-growth factor (IGF-1) was elevated ( > 13.1-39.2 nmol/L) in 22% of athletes. Five participants (56%) had clinically low BMD in the hip regional score ( < -2 z-score), one of which reported a bone-related injury within the past year. Based on the LEAF-Q and DXA scans risk of LEA appears to be high;, however, according to the EDE-Q and EA calculation risk of LEA appears to be low. This considerable discrepancy in the assessment tools suggests the need for further investigation using a larger sample size and a wide range of assessment tools to determine which are most effective for assessing energy availability in female para-athletes.