Lifespan Health, 2018.

1. Adolescent Athletes
Katie Egger
A Comprehensive Approach to the
Maintenance of the Physical and Mental
Health of Adolescent Athletes

2. Adolescent Athletes - Overview
Adolescence begins between 11 and 13 years of age
and can continue until 24 years of age. During adolescence,
children experience a transition from childhood to adulthood
in the following areas. (Edelman, Kudzma, & Mandle, 2013)
 Physicality
 Psychosocial Experience
 Emotions
 Cognition
 Morals

3. Overview cont.
Adolescents experience physical changes including
increased physical strength and endurance. Adolescence is
also the period in which the majority of children become
more committed to their sports and when some choose to
commit fully to one. Keeping this in mind, it is vitally
important to equip adolescent athletes with the knowledge
they need to make healthy choices.
▪ This presentation will give an overview of the following:
– cognitive changes during adolescence
– nutritional needs of adolescent athletes
– sports injury prevention in adolescent athletes

4. Maturation of Cognitive Function
There are many factors that
influence brain maturation in
adolescents. Factors that are of
specific importance to adolescent
athletes are sex hormones,
nutritional status, sleep,
environment, and drug abuse.
(Arain et al., 2013) Athletes are
prone to inadequacy in one or
more of these factors due to busy
schedules with sports and school
and the pressure they feel from
society to succeed and fit in.
Figure 1. Brain maturation. (Arain et al., 2013)

5. The Adolescent Brain During Puberty
A 2007 study found that adolescents
process information differently than
adults. Functional magnetic resonance
imaging revealed that as adolescents age,
information processing becomes more
predominant in the pre-frontal cortex.
This physiological change accompanies
the changes in self-perception and
behavior that characterize the adolescent
period of life. (Yurgelan-Todd, 2007) In
order for cognitive maturation to occur, it
is important that adolescents are meeting
the requirements for maturation of the
brain. Cognitive disorders and
inadequacies may result and lead to
problematic behavioral patterns later in
life.
Figure 2.
(a) Functional MRI
scans of the pre-
frontal cortex and
amygdala.
(b) Scatterplots
depicting the
relationship between
age and pre-frontal
cortex (PFC) activity
and amygdala
activity. As age
increases, PFC
activity increases
significantly and the
amygdala did not
show significant
activity increase.
(Yurgelan-Todd, 2007)

6. Mental Health related to Cognitive Growth
During adolescence, individuals begin to develop a sense of self that derives
from their increasing ability to think abstractly about themselves.This sense of self
can be impacted by physiological changes,` such as hormones, as well as
environmental shifts, such as the outward signs of puberty, school transition, and
gender effects. (Schaffhuser,Allemand, & Schwarz, 2016)Adolescence is a difficult
time to navigate due to the amount that is out of one’s control. Sleep patterns, for
example, are impacted by sex hormones.The hormones induce a small shift into the
circadian cycle to where adolescents prefer to go to sleep later and wake up later.
(Peper & Dahl, 2013)
Because of the amount that adolescents can not control and the stress that
can result, it is important that adolescents are intentional in being healthy in the
aspects they can control, such as nutrition. By being aware of the changes and how to
ameliorate them, adolescents and their care takers can be proactive in preventing
depressive disorders.This is vitally important because suicide is the third leading
cause of death in adolescents between the ages of 10 and 24. (Edelman, Kudzma, &
Mandle, 2013)

7. Adolescent Nutrition
Adolescents need a greater
amount of caloric intake because they
are in a period of rapid growth, but not
every calorie is equal. Different types of
foods activate different biochemical
pathways for digestion.Therefore,
what one eats is a large factor in
maintaining a healthy body weight.
(Manninen, 2004) Body weight is not
the only aspect that can be affected by
the kinds of foods one eats.There is
evidence that suggests that reduced
carbohydrate diets have a normalizing
effect on pubertal hormones. (Casazza,
Granger,Wallace, & Gower, 2011)
(Nguyen, 2015)

8. Helping them Make the Right Choices
The Healthy Eating Plate (HEP) was created by nutrition
experts at Harvard’s School of Public Health.The HEP offers
suggestions on what kinds of foods to focus on in each food
group and includes limitations on foods that are associated
with health issues that emerge later in life.The HEP
provides nutritional advice that was not subjugated to
political or commercial pressures and derives it’s advice
from the most current nutritional research.The HEP would
be an excellent guide for adolescents in general. It would be
wise for school mealtime programs to adopt an approach
such that the HEP plate takes in limiting harmful foods to
ensure that students can make healthier choices when
eating at school.While adolescents may eat healthy at
home, sugary drinks and refined grains in meals at school
can undermine a child’s health.Copyright © 2011, Harvard University. For more information about The Healthy Eating Plate,
please see The Nutrition Source, Department of Nutrition, Harvard School of Public Health,
www.thenutritionsource.org, and Harvard Health Publications, www.health.harvard.edu. (2011)

9. Athletes require more energy intake than non-active adolescents because of their
growth paired with frequent and extended physical exercise. In order to keep up
with the energy requirements for exercise, on top of the requirements for growth,
the following actions are recommended. (Bingham, Borkan, & Quatromoni, 2015)
▪ Fill your plate with fresh food. There is no better fuel source than real food; not packaged
foods or supplements.
▪ Eat to compete. Eat three meals and snack strategically in order to be fueled for practice and
games.
▪ Reload for rapid recovery. Refuel within 30 minutes of exercise with a combination of fluid,
electrolytes, carbohydrates, and protein.
▪ Hydrate. Water is best for sports hydration.
▪ Color your plate. Different colors = different nutrients.
▪ Plan ahead. Think ahead and pack snacks (healthy ones) to eat before and after practices or
games.
▪ Change it up. Don’t forget the micronutrients! Iron, Calcium ,Vitamin D, and other vitamins,
minerals, and antioxidants.
▪ Ask for help. If there are issues, ask for help.

10. Nutritional Supplementation for Athletes
Caffeine
Caffeine binds
and blocks
adenosine
receptors which inhibits
the perception of pain
and exertion.The
suggested quantity to
enhance performance is
2-6 mg/kg of body weight
and is recommended for
endurance type activities
rather than anaerobic,
short term exercises.
(Goldstein et al. ,2010)
Creatine
One of the
best studied
supplements,
creatine has been shown to
improve performance as much
as 10-20% in power and strength
athletes. It has also been shown
that creatine can improve
recovery, injury prevention,
thermoregulation, and protect
against concussion. A maximum
of 30 g/day for 5 years has been
proven safe across a variety of
age groups. (Kreider et al., 2017)
It is common for adolescent athletes to use supplements that companies claim will
enhance performance despite there being little data to back this up.The following
details the few supplements that may have beneficial effects.
Protein
Protein
supplementation,
most commonly
done via protein powders, has
been shown to promote
muscle protein synthesis after
exercise. Proteins are oxidized
and broken down at a faster
rate during exercise.The
suggested daily range for
supplementation is 1.6 – 2
g/kg/day for strength and
power exercises. (Campbell et
al., 2007)
(Caffeine
structure,
2016)
(Creatine
structure,
2008)
(Rose, Bradley,
Valasatava,
Duarte, Prlić, &
Rose, 2016; Rose
& Hildebrand,
2015)

11. Eating Disorders in Athletes
sports. Eating disorders can have serious consequences on
bones, menstrual cycles, and the cardiovascular system, and if
not addressed, can cause chronic health issues. (Patel,
Greydanus, Pratt, & Phillips, 2003)
In order to combat eating disorders, it is best to take a
multidisciplinary approach. Coaches, trainers, and parents
should be involved to promote appropriate weight
management. Preventative programs that teach athletes about
appropriate weight management techniques should also be
implemented. In a study done in 2004, it was found that among
high school coaches, there are deficits in knowledge regarding
weight management and specific nutritional strategies for
exertion and recovery periods. (Lemyre &Trudel, 2004) A
standardized program to educate coaches regarding specific
strategies on nutrition and weight management would further
help prevent eating disorders in athletes. The figure shows the percentage of coaches reporting that they use
a resource for nutrition-related questions. (Couture et al.,, 2015)
Eating disorders most frequently seen in adolescent athletes are anorexia nervosa, bulimia nervosa, and atypical eating
disorders such as specific diets. Male athlete eating disorders are relatively uncommon as 95% of those with an eating
disorders are female athletes. Eating disorders are more common in weight class sports, aesthetic sports, and endurance

12. There are numerous benefits to participating in organized sports
including supporting social and cognitive maturation, enhancing
physical growth, countering stress and anxiety, and improving self-
image and sociality. (Armstrong et al., 1998)
Organized sports consequently involve risk for the adolescent
participants if not done properly. Excessive training, inadequate or
abnormal nutrition, over-use and catastrophic injuries, and increased
anxiety and stress are side-effects of organized sports that athletes are
at risk for. (Armstrong et al., 1998)
Many of these risks can be prevented by knowledgeable adults in the
lives of adolescents; specifically sport governing bodies, coaches,
parents, and healthcare practitioners. (Armstrong et al., 1998)The
following outlines a few of the risk factors and ways to combat them.
(Sports, 2015)

13. | Conquering Inadequate or Abnormal Nutrition
Adolescent athlete nutrition, as
detailed earlier, needs to be
sufficient in order to support
their level of activity and growth.
Inadequate nutrition could look
like an eating disorder, reliance
on supplementation or meal
replacements, or poor food
choices.A lack of nutrients could
cause weakness and energy
deprivation, leading to injury.
Activities that can combat
poor nutrition as it relates to
sports injuries are:
– Educational sessions
– Group goal setting regarding
improving nutrition
– Keeping a food diary
– Creating a team “recipe” book
of easy and nutritious snacks
and meals(Stickyman 001, 2008)

14. | Sports Injury: Overuse and Muscle Imbalances
It is becoming increasingly common for young athletes to specialize
early in one sport given that increased athletic ability later in
adolescence is commonly but incorrectly attributed to early
specialization. Early sport specialization is associated with higher burn
out rates and injuries. (Buckley et al., 2017) An estimated 4.5 million
sport and recreation related injuries occur in child and adolescent age
groups with as many as 75% of the injuries in high school athletes being
lower extremity injuries. (McGuine et al., 2017)The frequency of injuries
associated with sport specialization are commonly attributed to overuse
and muscle imabalances. (Buckley et al., 2017; Micheli, 2011)The
following section details activities to lower the risk of injury due to
overuse and muscle imbalances.

15. Routine Rehabilitation to Prevent Overuse
Taking the proper time to warm up, stretch, and cool down after
exercises allows athletes to not only improve performance, but to
prevent injuries as well. In order to reduce overuse injuries, following
these recommendations will allow adolescent athletes to rest and
relieve their muscles. (Micheli, 2011)
1. Limbering up. 5 minutes. Break a sweat to warm up before stretching.
2. Stretching. 5-10 minutes. Don’t overstretch. Do hold the tension for 30 – 60 seconds in
each position.
3. Warming up. 10 minutes. Mimic primary exercise activity at a lower intensity.
4. Primary exercise.
5. Cool down and stretch. 5 and 5 minutes.Think gradual and gentle movements.
This helps the body prepare to heal and minimize flexibility loss.

16. Muscle Imbalance Interventions
Muscle imbalances can cause injuries
by putting excessive amounts of
stress on muscles that normally
would not be as engaged in the
exercise.They can be caused by sport
specialization, especially early sport
specialization, due to the repetitive
nature of the physical activity
required by only one sport. (Micheli,
2011 ) In order to prevent muscle
imbalances and strengthen the entire
body, cross training would be an
excellent intervention. Practicing
yoga tailored for athletes would be
beneficial as well as explained in the
video. (ThePostGame, 2013)(ThePostGame, 2013)

17. | Creating a Psychosocially Nurturing Environment
Injury prevention also requires establishing a caring
environment where athletes feel motivated and in control of
themselves. A caring environment promotes motivation,
caring behavior, greater enjoyment overall, and lower cortisol
levels. (Chamberlin, Fry, & Iwasaki, 2016) Practicing
mindfulness as individuals and as a team would create an
open-minded and caring environment, conducive to improved
performance and resilience.Various ways to create
mindfulness exist, yet all have three common goals.
(Petterson & Olson, 2017)
▪ Increase mental flexibility to reduce stress
▪ Support nonjudgmental perspectives
▪ Increase positive emotional states
(ConscioUS, 2017)
Mindfullness

18. Team-based Activities to Enhance Development
▪ Activities for cognitive growth
– Having players analyze their own film and learn to think introspectively about their performance would
enhance their sense of self and independence as a developing adult, as well as increase analytical and self
reflection skills.
▪ Activities for social development
– Team-building activities and outside of sport involvement, such as volunteering, would raise social
awareness of people and environments outside of the athlete's sport and would provide the athlete with
greater empathy and the skills to communicate with a larger array of people.
▪ Activities for emotional maturation
– A peer mentoring system would provide the younger athletes with someone to lean on and learn from
while the the older athletes would take greater responsibility for their actions and develop altruism for
when their mentee is in need.This would strengthen team bonds and provide greater emotional
connection between teammates.

19. Adolescent Athletes’ Comprehensive Health Promotion
Adolescents require increased nutrients and caloric intake and
also require environments which allow them to explore their sense of
self. Adolescent athletes experience these same requirements, but the
consequences for failing to fulfill them are much more grave. In order
to ensure proper cognitive, emotional, social, and physical growth,
athletes need to be consistent in maintaining their health through
proper nutrition and physical interventions to prevent injury. Parents,
coaches, and healthcare providers must be aware of athletes’ habits
and involved in helping them shape health aware habits. By creating a
goal oriented approach to improving healthy behaviors, adolescents
will be more enthusiastic and driven to create healthy habits for
themselves.

20. Future Endeavors
I will be attending medical school this fall with an
intention to specialize in Family Medicine or Pediatrics.The
information in this presentation will be particularly effective
in either specialty because I will be able to address sports
injuries in a multifaceted manner, employing a
comprehensive approach to improve the health of the
athlete I am seeing.With the prevalence of athletic
involvement in adolescents, especially in their high school
years, there will be plenty of opportunities to use this
information.

21. References
Arain, M., Haque, M., Johal, L., Mathur, P., Nel,W., Rais, A., Sandhu, R., & Sharma, S. (2013). Maturation of the adolescent brain. Neuropsychiatric Disease
andTreatment, 9, 449–461. http://dx.doi.org/10.2147/NDT.S39776
Armstrong, M.N., Bar-Or,O., Boreham, C., Chan, K., Eston, R., Hills, A.P., Maffuli, H., Malina, R.M., Nair, N.V.K., Nevill,A., Rowland,T., Sharp, C., Stanish,
W.D.,Tanner, S. Sports and Children:Consensus Statement on Organized Sports for Children: FIMS/WHO Ad Hoc Committee on Sports and
Children. Bulletin of theWorld Health Organization, 76(5), 445–447.
Buckley, P.S., Bishop, M., Kane, P., Ciccotti, M.C., Selverian, S., Exume, D., Emper,W., Freedman, K.B., Hammoud, S., Cohen, S.B., and Ciccotti, M.G.
(2017). Early Single-Sport Specialization. The Orthopaedic Journal of Sports Medicine, 5(7), 1-7. DOI: 10.1177/2325967117703944
Bingham, M.E., Borkan, M.E., & Quatromoni, P.A. (2015). Sports NutritionAdvice for AdolescentAthletes:ATime to Focus on Food. American Journal of
Lifestyle Medicine, 9(6), 398-402. DOI: 10.1177/15598276155
Caffeine structure by,Vaccinationist, 2016, https://commons.wikimedia.org/wiki/File:Caffeine_structure.svg. Public domain.
Campbell, B., Kreider, R.B., Ziegenfuss,T., La Bounty, P., Roberts, M., Burke, D., Landis, J., Lopez, H., &Antonio, J. (2007). International Society of Sports
Nutrition position stand: protein and exercise. Journal of the International Society of Sports Nutrition, 4(8), 1-7. doi:10.1186/1550-2783-4-8
Casazza, K., Granger,W.M.,Wallace, S., & Gower, B.A. (2011). Can Reduction in DietaryCarbohydrate Play a Role in Normalizing the Endocrine-Metabolic
State Perturbed During the PubertalTransition?The PRIMO Pilot Study. ICAN: Infant, Child, & Adolescent Nutrition, 3(1), 31-37. DOI:
10.1177/1941406410393282
Chamberlin, J.M., Fry, M.D., & Iwasaki, S. (2017). High School Athletes’ Perceptions of the MotivationalClimate in their Off-Season Training Programs.
The Journal of Strength and Conditioning Research, 31(3), 736–742.
Creatine structure by, Edgar181, 2008, https://commons.wikimedia.org/wiki/File:Creatine_neutral.png. Public domain.
ConscioUS. (2017, July 1). Kobe Bryant & PhilJackson | Meditation [Video file]. Retrieved from https://www.youtube.com/watch?v=E78y66GEPvs.
Couture, S., Lamarche, B., Morissette, E., Provencher,V.,Valois, P., Goulet,C., & Drapeau,V. (2015). Evaluation of Sports Nutrition Knowledge and
Recommendations Among High School Coaches. International Journal of Sport Nutrition and Exercise Metabolism, 25(4), 326 -334.
http://dx.doi.org/10.1123/ijsnem.2014-0195
Edelman, C.L., Kudzma, E.C., & Mandle, C.L. (2013). Health promotion throughout the lifespan. (8th ed.). St. Louis, MO: Elsevier Mosby.
Goldstein, E.R., Ziegenfuss,T., Kalman, D., Kreider, R., Campbell, B.,Wilborn,C.,Taylor, L.,Willoughby, D., Stout, J., Graves, B.S.,Wildman, R., Ivy, J.L.,
Spano, M., Smith,A.E., Antonio, J. (2010). International society of sports nutrition position stand: caffeine and performance. Journal of the
International Society of Sports Nutrition, 7(5), 1-15.

22. Healthy Eating Plate [Graphic]. (2011). Retrieved from https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/.
Kreider, R.B., Kalman, D.S,Antonio, J., Ziegenfuss,T.M.,Wildman, R., Collins, R., Candow, D.G., Kleiner, S.M., Almada,A.L., & Lopez, H.L. (2017).
International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. Journal
of the International Society of Sports Nutrition,14(18), 1-18. DOI 10.1186/s12970-017-0173-z
Lemyre, F., &Trudel, P. (2004). Le parcours d’apprentissage au rôle d’entraîneur bénévole. Avante, 10(3), 40–55. Retreived from
http://web.b.ebscohost.com.ezproxy.lib.ou.edu/ehost/detail/detail?vid=2&sid=efbc4381-8139-45af-ad3f-
7912170ecca4%40sessionmgr120&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=ibh&AN=19678759.
Manninen, A.H. (2004). Is a Calorie Really a Calorie? MetabolicAdvantage of Low-Carbohydrate Diets. Journal of the International Society of Sports
Nutrition, 1(2), 21-26. https://doi.org/10.1186/1550-2783-1-2-21
McGuine,T.A., Post, E.G., Hetzel, S.J., Brooks, M.A.,Trigsted,S., & Bell, D.R. (2017). A Prospective Study on the Effect of Sport Specialization on Lower
Extremity Injury Rates in High School Athletes. The American Journal of Sports Medicine, 45(12), 2706-2712. DOI: 10.1177/0363546517710213
Micheli, L.J. (2011). Encyclopedia of Sports Medicine: Preventing Sports Injuries. (Vol. 1).Thousand Oaks, CA: SAGE Publications, Inc.
Nguyen, D. (2015, March 8). Diet and Nutrition in Adolescents:Taking a StepTowards Better Health andWellness [Video file]. Retrieved
from https://www.youtube.com/watch?v=8A_mnANB45o.
Patel, D.R., Greydanus, D.E., Pratt, H.D., Phillips, E.L. (2003). Eating Disorders in AdolescentAthletes. Journal of Adolescent Research, 18(3), 280-296 DOI:
10.1177/0743558403251870
Petterson, H., & Olson, B.L. (2017). Effects of Mindfulness-Based Interventions in High School and College Athletes for Reducing Stress and Injury, and
Improving Quality of Life. Journal of Sport Rehabilitation, 26(6), 578 -587. http://dx.doi.org/10.1123/jsr.2016-0047
Peper, J.S., & Dahl, R.E. (2013).TheTeenage Brain: Surging Hormones—Brain-Behavior Interactions During Puberty.Current Directions in Psychological
Science, 22(2), 134-139. DOI: 10.1177/0963721412473755
Rose, A.S., Bradley,A.R.,Valasatava,Y., Duarte, J.M., Prlić,A., & Rose, P.W. (2016).Web-based molecular graphics for large complexes. ACM Proceedings
of the 21st International Conference onWeb3DTechnology (Web3D '16), 185-186. doi:10.1145/2945292.2945324
Rose, A.S. & Hildebrand, P.W. (2015). NGLViewer: a web application for molecular visualization. Nucleic Acids Research, 1(43(WI)), W576-W579.
doi:10.1093/nar/gkv402
Schaffhuser, K.,Allemand, M., & Schwarz, B. (2016).The Development of Self-Representations During theTransition to EarlyAdolescence:The Role of
Gender, Puberty, and SchoolTransition. Journal of Early Adolescence, 37(6), 774-804. DOI: 10.1177/0272431615624841
Sports [Graphic]. (2015). Retrieved from https://pixabay.com/en/balls-sports-balls-game-balls-312192/. Public domain.
Stickyman 001 [Graphic]. (2008). Retrieved from https://openclipart.org/detail/13216/stickyman-001.
ThePostGame. (2013, December 16). Kareem Abdul-Jabbar HelpsYogaGo MainstreamWith Athletes [Video file]. Retrieved from
https://www.youtube.com/watch?v=CMqg1eG0vCw.
Yurgelun-Todd, D. (2007). Emotional and cognitive changes during adolescence. Current Opinion in Neurobiology, 17(2), 251-257.
https://doi.org/10.1016/j.conb.2007.03.009