Risk Factors For Eating Disorders Research Articles

Do female dieters have an "eating disorder" self-schema?

BackgroundThe processing of schema-related information is important in the maintenance of specific eating disorder (ED)-related belief systems and psychopathology. To date, most research on differences in the processing of ED schematic information has used interview or self-report questionnaire measures. Dieting is a known risk factor for EDs and dieters have been included in some studies. However, they have not been compared with non-dieters on a novel, objective measure of ED related schema processing.MethodsThe current study recruited healthy female volunteers from the community and divided them into dieting (n = 25) and non-dieting (n = 24) groups using rigorous criteria. ED self-schemas with content unrelated to eating, weight and shape were measured using a self-schema processing task.ResultsDieters endorsed significantly more ED relevant words compared to non-dieters, whereas non-dieters rejected significantly more ED relevant words compared to dieters. Reaction times to endorsements and rejections were non-significant when the two groups were compared. In a surprise recall task, dieters recalled significantly more ED relevant words.ConclusionThe results of this study support the presence of ED self-schemas with negative content unrelated to eating, weight and shape in otherwise healthy dieters. Implications for future research and the early identification of individuals vulnerable to EDs are discussed.

Effectiveness of a school-based mindfulness program for transdiagnostic prevention in young adolescents

Anxiety, depression and eating disorders show peak emergence during adolescence and share common risk factors. School-based prevention programs provide a unique opportunity to access a broad spectrum of the population during a key developmental window, but to date, no program targets all three conditions concurrently. Mindfulness has shown promising early results across each of these psychopathologies in a small number of controlled trials in schools, and therefore this study investigated its use in a randomised controlled design targeting anxiety, depression and eating disorder risk factors together for the first time. Students (M age 13.63; SD = .43) from a broad band of socioeconomic demographics received the eight lesson, once weekly.b (“Dot be”) mindfulness in schools curriculum (N = 132) or normal lessons (N = 176). Anxiety, depression, weight/shape concerns and wellbeing were the primary outcome factors. Although acceptability measures were high, no significant improvements were found on any outcome at post-intervention or 3-month follow-up. Adjusted mean differences between groups at post-intervention were .03 (95% CI: −.06 to −.11) for depression, .01 (−.07 to −.09) for anxiety, .02 (−.05 to −.08) for weight/shape concerns, and .06 (−.08 to −.21) for wellbeing. Anxiety was higher in the mindfulness than the control group at follow-up for males, and those of both genders with low baseline levels of weight/shape concerns or depression. Factors that may be important to address for effective dissemination of mindfulness-based interventions in schools are discussed. Further research is required to identify active ingredients and optimal dose in mindfulness-based interventions in school settings.

Characterization of eating behavior disorders in school-aged children and adolescents: a population-based study.

Cross-sectional study to assess the characteristics of the risk behaviors for eating disorders (EDs) in school children between 10 and 14 years of age in the city of Recife, Pernambuco, Brazil. 1405 school-aged children were assessed, using the Eating Behaviours and Body Image Test (EBBIT) to screen for EDs. The normality of the continuing variables was tested using the Kolmogorov-Smirnov test with Lilliefors correction. They were described as medians and interquartile intervals (25 and 75th percentiles). The criteria that represented a condition of anorexia and/or bulimia nervosa were considered as strong indicators of risk for EDs in school-aged children who indicated the following behaviors with scores superior to the 75th percentile on the scales: "compulsive eating" 3.0% (CI95% 2.2-4.0); "dissatisfaction with body image/restrictive eating" 1.3% (CI95% 0.8-2.0); children scoring superior to the 30th percentile, "compulsive eating" + "dissatisfaction with body image/restrictive eating", 0.6% (CI95% 0.3-1.2); and superior to the 50th percentile; "compensatory behavior for hyperphagia" 6.7% (CI95% 5.4-8.1). In addition, greater vulnerability of the female gender was perceived, as well as an increase in the preliminary risk factors of EDs, such as advanced age, dissatisfaction with the body image linked to restrictive behaviors and the compulsive establishment of an eating pattern. This study shows the dimension of the problem in this ecological context and the urgent need for intervention programs, developed among different sectors, from the perspective of the adolescents' empowerment to prevent and minimize the vulnerability factors of the eating disorders.

Self-esteem, body shame and eating disorder risk in obese and normal weight adolescents: A mediation model

ObjectiveTo investigate dysfunctional eating behaviors and psychological variables typically associated to eating disturbances such as low self-esteem, perfectionism, shame, perceived parental care and protectiveness in obese and normal weight adolescents and to examine how the main powerful eating disorder risk factors interact with each other which explains eating psychopathology vulnerability. Method111 high school students (68 males; age range 13–19years) classified as obese and 111 age-, sex- and social status-homogeneous normal weight controls were included in the current study. All participants were asked to fill out self-report measures of parental behavior as perceived by the offspring, eating disturbance attitudes and behaviors, self-esteem, perfectionism and shame. ResultsSignificant differences between the two groups in relation to dysfunctional eating behaviors emerged. Body shame had the strongest relationship to eating problems vulnerability and acted as a mediator in the relationship between low self-esteem and eating disorder risk among both obese and non-obese youngsters. ConclusionsThese findings further our understanding of a potential underlying mechanism for eating pathology development in youngsters in general and in obese adolescents in particular, which is of great importance in terms of prevention and treatment.

Особенности внутрисемейных отношений девочек-подростков с риском нарушений пищевого поведения

The family risk factors of eating disorders (ED) of adolescent girls were studied. 376 girls aged 13 to 17 years from Ryazan city schools filled in Eating Attitude Test (EAT-26), CRPBI (E. Schaefer, Russian adaptation), Risk Factors of ED (T.A. Meshkova, research questionnaire). Comparison of the groups with upper and lower quartiles of EAT-26 scores demonstrates, that the families of the girls being at risk of ED are characterized by the authoritarian mother, who disregards of daughter's problems, and by the neutral position of the father.Parents more often were concerned about daughters’ figure, have a preoccupation with dieting. The girls of risk group have a fear of condemnation from family members, blaming for missteps. They have lack of praise for achievements, frequent bans and physical punishment, sense of dependency on family. It is possible, that daughter's eating disturbances reflect the some kind of protest and present a defensive reaction to the current family situation.

Psychosocial mediators of the relationship between religious orientation and eating disorder risk factors in young Jewish women.

Psychosocial mediators of the relationship between religious orientation and eating disorder risk factors in young Jewish women.

Reducing eating disorder symptoms and risk factors using the internet: A meta-analytic review.

The purpose of this meta-analytic review was, first, to evaluate the efficacy of Internet-based programs in decreasing eating disorder (ED) symptoms, and, second, to identify moderator variables these effects. Twenty studies were identified and between-group effect sizes were calculated for ED symptoms and risk factors. Compared with control conditions, Internet-based programs successfully decreased body dissatisfaction (d = 0.28, 95% CI [0.15-0.41], p < .001), internalization of the thin ideal (d = 0.36, 95% CI [0.07-0.65], p < .05), shape and weight concern (d = 0.42, 95% CI [0.13-0.71], p < .05), dietary restriction (d = 0.36, 95% CI [0.23-0.49], p < .001), drive for thinness (d = 0.47, 95% CI [0.33-0.60], p < .001), bulimic symptoms (d = 0.31, 95% CI [0.20-0.41], p < .001), purging frequency (d = 0.30, 95% CI [0.02-0.57], p < .05), and negative affect (d = 0.32, 95% CI [0.12-0.52], p < .001). Moderator analyses revealed no impact of data analytic strategy on intervention effects. Similarly, participant risk status was not a moderator for most outcomes. Internet-based programs are successful in decreasing ED symptoms and risk factors with small to moderate between-group effect sizes.

Shape and weight concern as a moderator of program outcomes from the Prevention Across the Spectrum RCT

Results Moderation was indicated by significant interaction effects for group (Media Smart; Life Smart; HELPP; Control) X moderator (high shape and weight concern; low shape and weight concern) X time (post-program; 6-month followup; 12-month follow-up), with baseline entered as a covariate. Such effects were found for shape concern, weight concern, eating concern, regular eating, body dissatisfaction, and physical activity. Post-hoc testing found Media Smart participants with high baseline shape and weight concern experienced a reduction in risk at 12-month follow-up for 4 of the 6 variables. Discussion This study shows it is possible for a school-based program to reduce eating disorder risk factors in participants with high baseline risk of an eating disorder.

Effectiveness of an eating disorder preventative intervention in primary care medical settings

ObjectiveTo conduct a pilot effectiveness trial of a brief dissonance-based eating disorder preventative program, the Body Project, when implemented at primary care medical clinics. MethodSixty-six female adolescents between the ages of 13 and 17 who reported at least some body image dissatisfaction were recruited at two primary care clinics and randomized to Body Project groups or an educational video control condition; eating disorder risk factors and symptoms were measured at pretest, posttest, and 3-month follow-up. ResultsBody Project versus educational video control participants showed significantly greater reductions in thin-ideal internalization, pressure to be thin, dieting, and eating disorder symptoms at posttest, which were medium to large effect sizes. Body Project participants also showed greater decreases in body dissatisfaction and negative affect at posttest, though these moderate sized effects were not significant. Effects persisted through 3-month follow-up. ConclusionAverage pre–post effect sizes (d = 0.58) compare favorably to those observed in past Body Project efficacy (average d = 0.59) and effectiveness trials (average ds of 0.43 and 0.69), suggesting that primary care clinics may represent a novel venue for offering and extending the reach of this eating disorder prevention program.

Attachment to God moderates the relation between sociocultural pressure and eating disorder symptoms as mediated by emotional eating

Research suggests that secure attachment to God protects against eating disorder risk factors, but studies have not examined how attachment to God might moderate the effects of sociocultural pressure on eating disorder symptoms. Moreover, models testing moderation in combination with mediation by eating in response to negative emotions have not been tested. Questionnaires collected from 102 women (19–57 years) recruited from Amazon's Mechanical Turk were analysed. Participants had diverse religious affiliations and beliefs. Insecure-anxious attachment to God moderated the effect of sociocultural pressure on eating disorder symptoms; women with higher anxious attachment were more susceptible to the effects of sociocultural pressures. Eating in response to negative emotions mediated the relation between sociocultural pressure and eating disorder symptoms, and moderated mediation analyses revealed that participants with average or above-average levels of anxious God attachment had an increase in emotional eating and consequent eating disorder symptoms as a result of sociocultural pressure.

A randomized controlled trial of a peer co-led dissonance-based eating disorder prevention program for gay men

ObjectiveGay males have increased risk for eating disorders compared to heterosexual males, establishing a need to develop and empirically evaluate programs to reduce risk for this population. The present study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention (The PRIDE Body Project©) in reducing eating disorder risk factors among gay males in a university-based setting. MethodEighty-seven gay males were randomized to either a 2-session DB intervention (n = 47) or a waitlist control condition (n = 40). Participants completed eating disorder risk factor assessments pre-intervention, post-intervention, and at 4-week follow-up, and those receiving the intervention completed post-treatment acceptability measures. ResultsAcceptability ratings were highly favorable. Regarding efficacy, the DB condition was associated with significantly greater decreases in body dissatisfaction, drive for muscularity, self-objectification, partner-objectification, body-ideal internalization, dietary restraint, and bulimic symptoms compared to waitlist control from pre- to post-intervention. Improvements in the DB group were maintained at 4-week follow-up, with the exception of body-ideal internalization. Body-ideal internalization mediated treatment effects on bulimic symptoms. ConclusionResults support the acceptability and efficacy of The PRIDE Body Project© and provide support for theoretical models of eating pathology in gay men.

Reducing eating disorder risk factors: A pilot effectiveness trial of a train-the-trainer approach to dissemination and implementation.

Impediments limit dissemination and implementation of evidence-based interventions (EBIs), including lack of sufficient training. One strategy to increase implementation of EBIs is the train-the-trainer (TTT) model. The Body Project is a peer-led body image program that reduces eating disorder (ED) risk factors. This study examined the effectiveness of a TTT model at reducing risk factors in Body Project participants. Specifically, this study examined whether a master trainer could train a novice trainer to train undergraduate peer leaders to administer the Body Project such that individuals who received the Body Project (i.e., participants) would evidence comparable outcomes to previous trials. We hypothesized that participants would evidence reductions in ED risk factors, with effect sizes similar to previous trials. Utilizing a TTT model, a master trainer trained a novice trainer to train undergraduate peer leaders to administer the Body Project to undergraduate women. Undergraduate women aged 18 years or older who received the Body Project intervention participated in the trial and completed measures at baseline, post-treatment, and five-month follow-up. Primary outcomes included body dissatisfaction, thin ideal internalization, negative affect, and ED pathology. Participants demonstrated significant reductions in thin ideal internalization, ED pathology and body dissatisfaction at post-treatment and 5-month follow-up. At 5 months, using three different strategies for managing missing data, effect sizes were larger or comparable to earlier trials for 3 out of 4 variables. Results support a TTT model for Body Project implementation and the importance of utilizing sensitivity analyses for longitudinal datasets with missing data.

Perfecionismo, perturbações emocionais e suas relações com o comportamento alimentar perturbado: Um estudo com adolescentes Portugueses

O perfecionismo tem sido associado ao desenvolvimento de sintomatologia de perturbação alimentar, apesar de ser ainda necessário o seu escrutínio em adolescentes dos dois sexos. Pretendeu-se investigar o contributo e as relações entre o perfecionismo e a sintomatologia emocional no desenvolvimento de comportamento alimentar perturbado em ambos os sexos numa amostra de 531 adolescentes. Utilizaram-se o Eating Attitudes Test 26, Cuestionario Educativo-Clínico: Ansiedad y Depresión e a subescala de perfecionismo do Eating Disorder Inventory 2. Com recurso a regressões múltiplas hierárquicas identificou-se que a idade, dieta, perfecionismo auto-orientado e depressão contribuem para explicar significativamente 42% da variância da sintomatologia de perturbação alimentar nas raparigas. Nos rapazes o perfecionismo global e a sintomatologia de perturbação emocional contribuíram para explicar 10% da variância da sintomatologia relativa a esta perturbação. São discutidas as implicações dos fatores de risco estudados para o desenvolvimento das perturbações alimentares na adolescência e sua forma de avaliação.

Effectiveness of a peer-delivered dissonance-based program in reducing eating disorder risk factors in high school girls.

This pilot study investigated the feasibility, acceptability, and effectiveness of a peer-led dissonance-based eating disorders (ED) prevention/risk factor reduction program with high school girls. Ninth grade girls (n = 50) received the peer-led program within the school curriculum. A quasi-experimental design was used to assess changes in ED risk factors preintervention and postintervention compared with waitlist control. Participants were followed through 3-month follow-up. Peer-leader adherence to an intervention manual tailored for this age group was high. The intervention was rated as highly acceptable, with a large proportion of participants reporting that they enjoyed the program and learned and applied new information. Intervention participants exhibited significantly greater pre-post reductions in a majority of risk-factor outcomes compared to waitlist controls. When groups were combined to assess program effects over time there were significant pre-post reductions in a majority of outcomes that were sustained through 3-month follow-up. This pilot study provides tentative support for the effectiveness of using peer leaders to implement an empirically supported ED risk factor reduction program in a high school setting. Additional research is needed to replicate results in larger, better-controlled trials with longer follow-up.

Mo1294 Body Dissatisfaction and Disordered Eating in GI Patients: A Comparison of Functional Bowel Disorders, Inflammatory Bowel Disorders, and Esophageal Disorders

Background: It is clinically important for GEs to identify patients with or at risk for eating disorders. Food restriction is common in patients with GI conditions and it is often difficult to determine when such restriction rises to the level of eating disorder pathology. Body dissatisfaction is both a diagnostic criterion and an important risk factor for most eating disorders but is rarely considered in GI practices. We examined image and eating behavior in 3 GI patient populations: functional bowel disorders (FBD), inflammatory bowel diseases (IBD), and esophageal disorders (ESO). We hypothesized that dissatisfaction would differentiate GI patient groups and predict disordered eating. Methods: GI patients presenting to an academic medical center GI practice completed demographic information, the dissatisfaction scale of the Eating Disorder Inventory-3 and the Eating Attitudes Test. The dissatisfaction scale assesses discontent with the size and shape of different areas of the through statements such as I think that my thighs are too large. The EAT-26 consists of three subscales: dieting (e.g., food restriction), bulimia/food preoccupation (e.g., purging behaviors and/or having excessive thoughts about food intake), and oral control (e.g., pressure to eat from others and/or specific habits such as eating slowly). Sample items include I am preoccupied with the thought of fat on my body and I like my stomach to be empty. One-way Anova and t-tests were performed to identify differences between groups. Regression analyses were used to determine the role of dissatisfaction on eating behavior. Results: 31 patients completed the survey, mean age 44.23(16.26), n=31, 81% Female, mean BMI 24.97(5.92). ANOVA compared the effect of GI group (FBD, IBD, ESO) on dissatisfaction and disordered eating [Table 1]. There was a main effect for GI group on dissatisfaction (F(2, 27) = 4.94, p = .02) and a trend towards disordered eating (F(2, 27) = 2.57, p = .096) by group. Body dissatisfaction was significantly higher in IBD than ESO. FBD did not significantly differ from either group. Disordered eating was significantly higher in FBD than ESO. IBD group did not differ. Body dissatisfaction significantly predicted dieting (b = .41; p = .04) and bulimia/food preoccupation ((b = .47; p = .01) but not oral control (b = .23; p = .22) on EAT-26. Conclusions: Body dissatisfaction and disordered eating appear to vary by GI patient group. IBD patients tend to be the most at-risk for dissatisfaction, which may potentially be due to visible signs of illness or medication side effects. FBD group was more likely to endorse disordered eating. Body dissatisfaction predicted dieting as well as bulimia/food preoccupation and may serve as a useful tool to identify GI patients at risk for disordered eating. The Effect of GI Patient Group on Body Dissatisfaction and Disordered Eating

The Role of Personality and Pubertal Development in Eating Disorders: a European Discordant Sister-pair Study.

Background Puberty has been found to be a major risk period for the onset of eating disorders (EDs). The experience of puberty can, however, be very different depending on the adolescent’s personality. It is currently unknown how the interplay between personality and experiences of pubertal development are related to subsequent EDs. Objective To investigate the timing of puberty and attitudes towards puberty in ED patients when compared to their healthy sisters, and to assess the relationship between pubertal risk factors, ED symptoms and personality. Method The sample consisted of 354 discordant sister-pairs. Pubertal risk factors were assessed through the Oxford Risk Factor Interview (ORFI) and the EATATE-1. ED symptoms and personality traits were also assessed. Result ED patients displayed a later age of menarche, and reported feeling less prepared and more distressed towards pubertal changes than their healthy sisters (see Table 1). While only a few pubertal risk factors were related to ED symptoms, significantly higher Harm Avoidance and Childhood Obsessive-Compulsive traits (both p Conclusion Later age of menarche and negative attitudes towards puberty act as important risk factors for EDs. The assessment of personality provides important insights into which girls struggle with pubertal development and could therefore be at increased risk for later EDs. Download : Download full-size image

Preventing eating disorders with an interactive gender-adapted intervention program in schools: study protocol of a randomized controlled trial.

BackgroundThere are a high number of adolescents who are at risk of developing an eating disorder. There is, therefore, a strong need to implement prevention programs aimed at reducing the incidence of eating disorders at this critical age. Among other factors, successful prevention programs have been shown to be interactive, carried out by professionals, focused on educational as well as psychosocial elements and have taken risk factors as well as resources into account. The objective of this study protocol is to present the design of a new prevention program for eating disorders in schools.Methods/DesignThe gender-adapted prevention program extends over six school hours. It contains interactive and educational elements about eating disorders and their treatment. Participants pass through different exercises and reflect on the influences of the media, self-esteem, body perception and individual resources. A cluster-randomized controlled trial is chosen to evaluate the program. Based on an estimated effect size of d = 0.3 a total of 1848 participants are enrolled in the study. Eating disorder risk, internalization of Western beauty ideals, body dissatisfaction, self-concept as well as anxiety and symptoms of depression are measured before and immediately after the intervention as well as at a six-month follow-up. In addition, the intervention group evaluates the different components of the program.DiscussionThe study intends to test the practicability and efficacy of an interactive, gender-adapted ED prevention program in schools. Moreover, it will provide valuable information about the occurrence of eating disorder risk factors in school-aged children.Trial registrationISRCTN97989348; Registered 19 December 2012.

Do executive functioning deficits underpin binge eating disorder? A comparison of overweight women with and without binge eating pathology.

Deficits in executive function (EF)-including inhibitory control, cognitive flexibility, decision-making, and working memory-may be risk or maintenance factors for binge eating disorder (BED). However, there is mixed evidence regarding EF deficits in individuals with BED. Significant methodological weaknesses (e.g., use of a single EF measure, omission of relevant covariates) in the current literature represent one reason for lack of consensus. This study compared EF in a sample of overweight women with (n = 31) and without (n = 43) full or subthreshold BED, with the aim of conducting a multifaceted investigation of the neurocognitive profile of BED. A neuropsychological battery of EF was administered to all participants. After controlling for IQ and age, individuals with binge eating displayed significantly poorer performance on tasks of problem-solving and inhibitory control, and displayed higher prioritization of immediate versus delayed rewards, but the two groups did not appear to differ on set-shifting, working memory, and risk taking. Differences in inhibitory control were no longer statistically significant when depressive symptomology was added as a covariate and correction for multiple comparisons was applied. Exploratory analyses indicated that full and sub-threshold BED groups did not differ in EF. Results partially support the hypothesis of relative EF deficits in individuals with BED, suggesting that binge eating may be maintained by cognitive factors distinct from those of obesity. Future research should aim to replicate with a larger sample, control for a wider range of psychiatric comorbidities, and examine whether EF deficits predict treatment outcome.

Understanding the feasibility of integrating the eating disorders and obesity fields: the beyond obesity and disordered eating in youth (BODY) Study.

Attention has been devoted to exploring ways to integrate the eating disorders (ED) and obesity (OB) prevention fields. Although research has revealed considerable overlap between the risk factors for ED and those for OB, collaboration between the two fields remains strained. Existing position papers focus mainly on discussions about the lack of collaboration and whether or not the two fields should merge their prevention efforts. However, no empirical study has yet addressed these questions. The beyond obesity and disordered eating in youth (BODY) Study is a qualitative study that sheds light on the relationship between the ED and OB fields. Using part of the BODY Study data and findings, this paper aims to further explore the costs and benefits of ED and OB collaboration/integration. Four models, or scenarios, proposed by Neumark-Sztainer to describe the interaction between the ED and OB prevention fields are used as a framework to guide the BODY Study findings' discussion. Based on grounded theory methodology, the BODY Study used in-depth interviews and focus groups as data collection methods. A total of 61 participants took part in the study: 35 researchers/practitioners who work in either ED or OB; and 26 youths (aged 16-26 who attended six focus groups and 12 in-depth interviews). Selected BODY Study themes, relevant to better understanding the four scenarios proposed by Neumark-Sztainer, presented in this paper are: (a) Two camps: understanding the relationship between the ED and OB fields; (b) Consequences for professionals and youths of the existence of two camps; (c) Root causes of the perceived tension: ideology and philosophy, power and knowledge, and gender. Findings from this study mirror existing theoretical papers that look at the relationship between the two fields-including Neumark-Sztainer's scenarios. At the same time, this empirical work further discusses the costs of a possible integration that, even if desirable, does not take into account the root causes of the tension between the two fields (e.g., power imbalance, gender neutrality).

Risk Factors for Eating Disorders among Male Adolescent Athletes.

ObjectiveEating disorders (ED) are an important and increasing problem in adolescents. The objective of this study was to examine the risk factors and the prevalence of risk for ED among male adolescent elite athletes and nonathletic controls. Differences between male athletes competing in aerobic, anaerobic and aerobic-anaerobic sports were examined as well.MethodsThis was a cross-sectional epidemiological study. A cross-sectional questionnaire survey and anthropometric measurements were conducted on 351 adolescents (athletes n = 228; controls n = 123). All participants were aged 15–17 at the time of measuring. Risk for ED was determined using a SCOFF questionnaire.ResultsThe overall prevalence of the risk for ED in male adolescents was 24.8%, with no significant differences among athletes and controls or different subgroups of athletes (p>0.05), although the highest prevalence (37.2%) was registered in aerobic subgroup of athletes. Higher number of attempts to lose weight was associated with increased risk of ED in each group (athletes and controls). Other predictors referred to lack of breakfast and body composition in aerobic subgroup of athletes and number of meals and training frequency in anaerobic subgroup. The most common reasons for dieting were improvement of sport results (19.6–44.2%) and better self-esteem (41.5%) in athletes and controls respectively.ConclusionsParticipation in the competitive sport itself is not associated with the increased risk for ED. It seems that risk factors for ED for adolescent athletes competing in aerobic and anaerobic sports represent a subject that deserves consideration and further investigation in the future.