Date of Award
Spring 4-17-2026
Document Type
Dissertation
Degree Name
Doctor of Kinesiology (PhD)
Department
Kinesiology
Abstract
Ultra-endurance (UE) participation among female athletes has increased substantially, yet research examining health awareness and physiological risk in this population remains limited. Excessive training combined with inadequate energy intake places ultra-endurance female athletes at elevated risk for the Female Athlete Triad (FAT) and Relative Energy Deficiency in Sport (RED-S), both driven primarily by chronic low energy availability (LEA) and associated with menstrual dysfunction, impaired bone health, metabolic disturbances, and reduced performance.
This mixed-methods, cross-sectional study examined awareness of overall health, fueling behaviors, menstrual health, and recognition of FAT and RED-S among ultra-endurance female athletes over 25 years of age. Participants (N = 35) were recreational to amateur athletes competing in endurance events exceeding six hours across running, cycling, triathlon, and open-water swimming. Data were collected via self-administered questionnaires assessing training volume, caloric intake, supplement use, menstrual history, injury history, recovery practices, and health awareness. A modified Low Energy Availability in Females Questionnaire (LEAF-Q) was used to assess LEA risk.
Results demonstrated substantial variability in training load and caloric intake, with a proportion of athletes reporting intake potentially insufficient for training demands. Menstrual irregularities and injury history were common, yet most participants demonstrated limited awareness of FAT and RED-S and did not associate symptoms with low energy availability. Although supplement use was prevalent, it did not consistently offset inadequate total energy intake.
These findings reveal a significant disconnect between physiological risk and health awareness among ultra-endurance female athletes and underscore the need for targeted education, routine screening, and interdisciplinary support to promote long-term health and sustainable performance.