Introdução: A Deficiência Energética Relativa no Esporte (REDs) descreve a condição em que a ingestão energética é insuficiente para sustentar as demandas fisiológicas impostas pelo exercício físico. Mais recentemente, esse conceito foi expandido para o ambiente operacional, dando origem ao RED-M (Relative Energy Deficiency in Military). No contexto militar, fatores como treinamento intenso e prolongado, privação de sono, estresse térmico, logística alimentar limitada e práticas de controle de peso aumentam a vulnerabilidade ao desenvolvimento de baixa disponibilidade energética. Esse desequilíbrio pode comprometer múltiplos sistemas fisiológicos, gerando impacto negativo na saúde, no desempenho físico e cognitivo e, consequentemente, na prontidão operacional. Objetivo: Este artigo teve como objetivo discutir a relevância, os mecanismos e as implicações do RED-M, com foco nas Forças Armadas. Tendo sido abordados os fatores de risco específicos do ambiente militar, os efeitos da insuficiência energética sobre sistema ósseo, endócrino, metabólico e psicológico, e os prejuízos associados ao desempenho físico e cognitivo. Além disso, foram destacadas estratégias fundamentais para triagem, monitoramento e manejo do RED-M, enfatizando o papel contínuo e estratégico do profissional de Educação Física na identificação precoce de sinais e na adequação das cargas de treinamento. Conclusão: O RED-M é uma condição emergente no ambiente militar, com potencial para comprometer saúde, desempenho e prontidão operacional. Seu reconhecimento precoce e a aplicação de protocolos de triagem e manejo baseados em evidências são essenciais para reduzir riscos e otimizar o desempenho.

The participation of women in sports such as powerlifting and weightlifting has grown over the years, and there is no consensus on the role of exercises in pelvic floor disorders (PFDs). We aimed to identify and summarize the current evidence on the impact of powerlifting and weightlifting on PFDs. A systematic literature search was conducted on databases with no language restriction, from inception to 20 January 2024. We included observational studies or randomized controlled trials investigating female athletes in powerlifting or weightlifting providing information regarding the impact of these sports on pelvic floor structures. Studies on CrossFit trainers, nonfemale athletes, age <18, and congress abstracts were excluded. Two researchers independently performed the data extraction and quality assessment. The risk of bias was assessed using the Risk Of Bias In Non-randomized Studies—of Interventions. The main outcomes were the prevalence of PFDs in women practicing powerlifting or weightlifting, the factors associated with PFDs, and exercise related to urinary loss. Of the 221 articles found, 5 studies with 1,809 participants were included in the qualitative synthesis. The prevalence of urinary incontinence (UI) in powerlifters ranged from 41.0

Female participation in sports has increased in recent decades and a similar increase in the Female Athlete Triad can be observed. This syndrome is characterized by three components: low available energy, menstrual cycle disorders and low bone mineral density. The aim of this study was to identify the components of the Triad, profile macro and micronutrient intake and identify the frequency of low available energy. This was a descriptive observational study with quantitative analysis. The sample consisted of ten athletes, five handball and five futsal, with an average age of 23 (+/- 1.9) years. An anamnesis was taken, a three-day food record, a photographic record of food, anthropometry and body composition, an estimate of energy expenditure at rest and during exercise and the magnitude of the Triad risk. One athlete was diagnosed with bulimia, and another reported a previous stress fracture and irregular menstruation. The average consumption of macronutrients was 3.0g/kg/day of carbohydrates, 1.2g/kg/day of protein and 32% of the total caloric value of lipids. All had low apparent adequacy of magnesium and calcium intake, and the average intake of iron, vitamin A, C and B12 was below the Recommended Dietary Allowance (RDA) and Adequate Intake (AI). All had low available energy (<= 30 kcal/kg GLM/day). Nine athletes were at low risk and one was at moderate risk, so it can be concluded that low available energy and inadequate micronutrient intake was high in university athletes, corroborating the occurrence of the Female Athlete Triad.

A participação feminina em esportes aumentou nas últimas décadas e o mesmo ocorreu com a ocorrência da Tríade da Mulher Atleta. Esta síndrome é caracterizada pela presença de um ou mais dos seguintes componentes: baixa energia disponível, distúrbios no ciclo menstrual e baixa densidade mineral óssea. Nesse sentido objetivou-se identificar os componentes da Tríade, traçar o perfil do consumo de macro e micronutrientes e identificar a frequência de baixa energia disponível em atletas universitárias. Trata-se de um estudo observacional descritivo com dez atletas universitárias, sendo cinco do handebol e cinco do futsal. Foi realizada anamnese, registro alimentar de três dias, registro fotográfico dos alimentos, antropometria e composição corporal, estimativa do gasto de energia em repouso e no exercício e magnitude do risco da Tríade. A média de idade das participantes foi 23 (±1,9) anos, e todas apresentaram baixa energia disponível (≤30 kcal/kg MLG/dia). Somente uma atleta apresentou os três componentes da tríade, sendo que as demais apresentaram risco baixo. A média do consumo de macronutrientes foi 3,0g/kg/dia de carboidrato, 1,2g/kg/dia de proteína e 32% do valor calórico total de lipídios. Todas apresentaram baixa adequação aparente para ingestão magnésio e cálcio, e a média de ingestão de ferro, vitamina A, C e B12 apresentaram abaixo da Recommended Dietary Allowance (RDA) e Adequate Intake (AI). desta forma, conclui-se que em atletas universitárias a baixa energia disponível e a inadequação do consumo de micronutrientes foi elevada corroborando para ocorrência da Tríade da Mulher Atleta.

RESUMO Introdução: A participação feminina no esporte teve um marco importante em 1972, quando uma emenda constitucional foi implementada para garantir a igualdade de oportunidades para homens e mulheres. Desde então, o percentual de participantes em esportes competitivos tem crescido. Nesse contexto tornou-se necessário compreender sobre ciclo menstrual, uso de anticoncepcionais e suas respostas individuais. Objetivo: Investigar características do ciclo menstrual, sintomas físicos e de humor, queixas relacionadas ao sangramento vaginal e métodos contraceptivos usados por atletas olímpicas brasileiras. Avaliar se percebem influência do sangramento vaginal no desempenho esportivo, como elas o controlam e o que pode ser mudado para melhorar seus cuidados e desempenho esportivo. Além disso, propõe-se atendimento específico por ginecologista especializada em medicina esportiva. Métodos: Estudo observacional, descritivo, realizado de julho a agosto de 2016 que incluiu 118 atletas olímpicas brasileiras, na menacme. As atletas responderam a um questionário online autoaplicável e adaptado intitulado “Pre-Participation Gynaecological Examination”. Resultados: As participantes praticavam 28 esportes diferentes, com média de idade = 27 ± 4,7 anos. Para 66%, foi a primeira participação em um evento olímpico. A maioria usava anticoncepcional (54%), principalmente oral (61%). A maioria (76%) acredita que o sangramento vaginal influencia o desempenho esportivo e 63% preferiam competir após o mesmo. 58% das atletas competiriam no momento preferido de seu ciclo. Sintomas de ansiedade, distensão abdominal, aumento do apetite, depressão e dismenorreia foram indicados por 52%. Entre esses, 49% deterioraram o desempenho esportivo. Conclusão: Em sua primeira participação olímpica, as atletas brasileiras utilizaram anticoncepcionais hormonais, principalmente orais, para controlar e adaptar o sangramento vaginal ao calendário de competição, pois a maioria referiu que os sintomas físicos e de humor prejudicaram o desempenho esportivo. A presença de uma Ginecologista Esportiva como parte da Equipe Médica Olímpica destacou os problemas das atletas femininas e as ajudou a melhorar o desempenho esportivo. Nível de Evidência IV; Estudo Observacional.

ABSTRACT Introduction: Female participation in sports has reached a milestone in 1972 when a constitutional amendment was implemented to ensure equal opportunities for men and women. Since then, the percentage of participants in competitive sports has grown. In this context became necessary to understand menstrual cycle, contraceptive use, and its individual responses. Objective: To investigate menstrual cycle characteristics, physical and mood symptoms related to vaginal bleeding, and contraceptives used by Brazilian Olympic athletes. Also, to assess if these athletes relate that vaginal bleeding influences sportive performance, how they manage it and what can be changed to improve their health care and sportive performance. Additionally, we propose specialized female care by a gynaecologist specialized in sports medicine. Methods: Descriptive observational study was conducted from July to August 2016 and included 118 Brazilian Olympic female athletes, in menacme. The athletes completed a self-administered online questionnaire, adapted from Pre-Participation Gynaecological Examination of female athletes. Results: Participants practiced 28 different sports, mean age 27 ± 4.7 years. For 66% it was their first participation in an Olympic Game. Most used contraceptives (54%), mainly oral (61%). Most (76%) believed that vaginal bleeding influenced sports performance, and 63% preferred to compete after bleeding cessation. Fifty-eight percent would compete at preferred time of their cycle. Anxiety symptoms, bloating, increased appetite, depression, and dysmenorrhea were indicated by 52%. Among these, 49% reported that these symptoms deteriorated their sportive performance. Conclusion: Most in their first Olympic participation, Brazilian athletes used hormone contraceptives, mainly oral ones to manage and adapt their vaginal bleeding to the competition calendar because most of them referred those physical and mood symptoms deteriorated their sportive performance. The presence of a Sportive Gynaecologist as part of the Olympic Medical Staff highlighted the female athletes issues and helped them to improve sportive performance. Level of Evidence IV; Cross-sectional observational study

Introduction: Excessive menstrual bleeding is menstrual loss that interferes with the woman's quality of life, regardless of the absolute amount. Drug treatment is preferred to avoid surgical risks and preserve fertility. Anti-inflammatory, antifibrinolytic, oral contraceptive and progestogen are prescribed. These therapies result in 40 to 50% reduction in menstrual loss. The intrauterine levonorgestrel system (SIU-LNG) is the most effective long-term clinical treatment. On the other hand, hysterectomy is the most widely performed gynecological surgical procedure in the world and, although it offers complete control of symptoms, it is the most invasive, morbidly, irreversible and costly method of treatment. Objective: To compare the results and costs of clinical treatment with SIU-LNG and hysterectomy in women with large uteri and excessive menstrual bleeding. Method: It is a retrospective cohort study with 62 patients who performed two treatments: SIU-LNG insertion or videolaparoscopic hysterectomy (HVLP) and followed for four years. Results: The groups were homogeneous regarding age, parity, body mass index, schooling and uterine volume. SIU-LNG failed in 32.3% of patients, while the efficacy of hysterectomy was 100%. Complications occurred 22.6% after UIS insertion and 19.4% in the surgical group, the most serious. The cost of clinical treatment, including its complications, was nearly five times lower than the cost of surgical treatment with its complications. Conclusion: Compared to hysterectomy, treatment with SIU-LNG had lower efficacy, but simpler complications and lower costs.

ABSTRACT Objective To evaluate the effectiveness of the levonorgestrel intrauterine system in the treatment of patients with heavy menstrual bleeding and an enlarged uterus and to compare satisfaction and its complications with hysterectomy. Methods This was a comparative cross-sectional observational study of women with heavy menstrual bleeding and an enlarged uterus. Sixty-two women were treated and followed up for four years. Insertion of the levonorgestrel intrauterine system was performed in Group 1, and laparoscopic hysterectomy was performed in Group 2. Results In Group 1 (n=31), 21 patients (67.7%) showed improvement in the bleeding pattern, and 11 patients (35.5%) had amenorrhea. Five patients (16.1%) remained with heavy bleeding and were considered to have experienced treatment failure. There were seven expulsions (22.6%); in five patients, bleeding remained heavy, but in two patients the bleeding returned to that of normal menstruation. No relationship was found between treatment failure and greater hysterometries (p=0.40) or greater uterine volumes (p=0.50), whereas expulsion was greater in uteri with smaller hysterometries (p=0.04). There were 13 (21%) complications, seven (53.8%) in the group that underwent insertion of the levonorgestrel intrauterine system (all were device expulsions), and six (46.2%) in the surgical group, which were the most severe ones (p=0.76). Regarding satisfaction, 12 patients (38.7%) were dissatisfied with the levonorgestrel intrauterine system and one (3.23%) was dissatisfied with the surgical treatment (p=0.00). Conclusion Treatment with the levonorgestrel intrauterine system in patients with heavy menstrual bleeding and an enlarged uterus was effective, and when compared with laparoscopic hysterectomy, it had a lower rate of satisfaction and the same rate of complications, although less severe.

AbstractObjective:To investigate the prevalence of sexual dysfunctions in physically active versus sedentary female university students.Methods:Cross-sectional case-control survey study, involving 202 female university students aged 18–40 years (180 who performed regular physical activity and 22 sedentary students, in the same age group). Sexual function was evaluated by the Female Sexual Function Index.Results:Sexual dysfunction was more prevalent in sedentary (45.5%) than physically active participants (38.9%; p = 0.646). In relation to the domains valued by Female Sexual Function Index, only “excitation” presented a statistically significant difference (p = 0.031).Conclusion:Prevalence of sexual dysfunction was similar in active and sedentary female university students.

ABSTRACT Introduction: Female participation in sports had reached a milestone in 1972 when a constitutional amendment was implemented to ensure equal opportunities for men and women. Since then, the percentage of participants in competitive sports has grown. In 1992, an association was made between three disorders related to female athletes called the “Female Athlete Triad”. After that, much has been studied about this and other particularities of female athletes. Objective: To identify the professionals who follow-up Brazilian female Olympic athletes and the association between a multidisciplinary approach and athletes’ knowledge about gynecological issues related to the practice of sport, i.e., female athlete triad, urinary incontinence, and weight control concerns. Methods: This observational study was conducted in Rio de Janeiro, Brazil, in 2016, during the Olympic Games. It included 120 female members of the Brazilian teams. A self-applied questionnaire, validated and adapted from the pre-participation gynecological evaluation of female athletes, was used to evaluate their multidisciplinary follow-ups, weight control concerns, and knowledge about the Female Athlete Triad and urinary incontinence. Results: The athletes practiced 28 different sports. For 66%, it was their first participation in Olympic Games; 56% were unaware of the female athlete triad, 77% indicated weight concerns, and 52% were on a diet. The use of diuretics or laxatives or vomiting was reported by 11%; 67.5% were aware that sports are a risk factor for urinary incontinence, and 40% had already experienced urine loss. Decreased sportive performance was mentioned by 31%. Several athletes presented multidisciplinary follow-ups psychological (83%), nutritional (96%), and gynecological (83%). Conclusion: Brazilian Olympic athletes sought multidisciplinary follow-ups during the Olympic cycle; however, participants’ knowledge of sports-related issues remains limited. An orientation program regarding the above conditions is needed for female athletes and the professionals working with them to improve health and performance. Evidence Level IV; Cross-sectional observational study.

INTRODUCTION AND HYPOTHESIS:Female athletes can develop symptoms of urinary incontinence (UI) as well as risk behaviors for eating disorders owing to the type of training and sports modality. Such symptoms are intensified by the demands for results and an idealized body composition. Our aim is to investigate the possible association between urinary incontinence and risk behaviors for eating disorders in female athletes.METHODS:A case-control study was conducted with 270 female athletes who answered the International Consultation on Incontinence Questionnaire (ICIQ-SF) and the Eating Attitudes Test (EAT-26). Different sports modalities and their respective impact levels were considered in the study. Female athletes were divided into two groups, i.e., athletes with UI (case group) and those without UI (control group). Multiple logistic regression was used to calculate associated factors.RESULTS:From all variables included in the study, only abnormal eating behavior was found to be associated with UI according to the multiple logistic regression test. Participants with UI were 2.15-fold more likely to have risk behaviors for eating disorders.CONCLUSIONS:Female athletes with UI were more likely to have risk behaviors for eating disorders. Multidisciplinary teams that provide care for these athletes should be attentive to symptoms that may not appear to be associated at first glance but may reflect a condition that needs to be treated.

Dia rosa da atividade física: avaliação dos fatores limitantes a prática de atividade física em pacientes tratadas por câncer de mamaPhysical activity pink day: assessment of limiting factors to physical activity in

Maintenance optimization of railway infrastructure includes several kinds of aspects, such as safety, economic, operational, organization and regulatory issues. Among them the regulatory issues, that are fixed, increase the maintenance costs significantly. This is especially true in so-called capillary networks (local regional railway networks), where only the freight transport exists. Hence, the question is how to minimize maintenance costs with respect to regulatory issues? To solve this problem, we propose a clustering approach. The idea is to cluster tracks, considering elements of railway infrastructure as attributes. Once railway tracks are clustered in groups with similar attributes, then the maintenance can be organized more efficiently. In this paper, Variable Neighborhood Search metaheuristic is developed to solve minimum sum of squares clustering problem. Based on the results of clustering and available real and simulated data we report 22% savings in maintenance schedule for clusters.

Objective To compare the prevalence of urinary incontinence (UI) before and during the COVID-19 quarantine in CrossFit women and their relationship with training level. Methods A cross-sectional study was performed among 197 women practicing CrossFit. The inclusion criteria were nulliparous women, between 18 and 45 years old, who had trained, before quarantine, in accredited gyms. The exclusion criteria were not following the COVID-19 prevention protocols and having UI on other occasions than just sport. An online questionnaire was emailed containing questions about frequency, duration, and intensity of training and data related to the COVID-19 pandemic. The participants were invited to answer whether they were infected with COVID-19 and what treatment/recommendation they have followed. Whether UI stopped among participants, they were asked about the possible reasons why this happened. The training intensity was categorized as “the same,” “decreased” or “increased.” Results The mean age of the participants was 32 years old and most (98.5%) could practice CrossFit during the pandemic. There was a decrease in training intensity in 64% of the respondents. Exercises with their own body weight, such as air squat (98.2%), were the most performed. Urinary incontinence was reported by 32% of the participants before the COVID-19 pandemic, and by only 14% of them during the pandemic (odds ratio [OR]=0.32 [0.19-0.53]; p<0.01; univariate analysis). Practitioners reported that the reason possibly related to UI improvement was the reduction of training intensity and not performing doubleunder exercise. Conclusion The reduction in the intensity of CrossFit training during the COVID-19 quarantine decreased the prevalence of UI among female athletes.

Objectives CrossFit comprises a set of high-intensity, high-impact exercises that includes movements that may increase intra-abdominal pressure and cause involuntary loss of urine. There is scant literature about the prevalence of urinary incontinence (UI) in female crossfitters, as well as its associated factors. Methods A population-based Internet survey stored in a website created with information on the benefits and risks of CrossFit for women’s health (https://crosscontinencebr.wixsite.com/crosscontinencebr) invited female crossfitters. In total, 551 women answered an online questionnaire, and the demographic variables (age, marital status, and parity), anthropometric data (weight, height, and body mass index), and the presence of UI during exercises were also investigated. The prevalence of UI and its associated factors were calculated using a logistic regression model. The significance level was set at 5%. Results The overall prevalence of UI during CrossFit exercises was 29.95%, and most women with UI reported loss of urine during at least one exercise (16.70%). Women with UI were older (33.77 ± 8.03 years) than those without UI (30.63 ± 6.93 years; P < 0.001). Double under (20.15%) and single under (7.99%) were the exercises that were most frequently associated with UI and also the only variables that remained in the final model that caused UI. The duration of CrossFit practice, number of days per week practicing CrossFit, daily time practice, previous vaginal delivery, and mean birth weight were not statistically associated with UI. Conclusions One-third of female crossfitters presented with UI during exercise. Double under was the exercise that was the most associated with UI.

Introduction and hypothesis: Urinary incontinence (UI) during exercise (athletic incontinence) affects about 30% of CrossFit practitioners. Due to the COVID-19 pandemic, CrossFit academies were closed, impacting on several dimensions of the health of these athletes. We aimed to evaluate the effect of quarantine due to COVID19 pandemic on the training volume and UI during exercises for female crossfitters. Methods: A cross-sectional study was performed among 197 female CrossFit practitioners. An online questionnaire was emailed containing questions about frequency, duration and intensity of training and data related to the COVID-19 pandemic. Whether UI stopped among participants, they were asked about the possible reasons why this happened. A 5% significance level was stablished.Results: Mean age of the participants was 32 years old, with an average frequency of training of 50 minutes per day, four times/ week. Most participants lived in an apartment (65.5%) and with another person (40.1%). Main CrossFit training location during quarantine was inside home (55%). There was a decrease in training intensity in 64% of the respondents. Exercises with their own body weight, such as air squat (98.2%) followed by push up (92.2%) were the most performed. UI was reported by 32% of participants before the COVID-19 pandemic, and only 14% of them during the pandemic (OR = 0.32[0.19-0.53],p <0.01; univariate analysis). Practitioners reported that the reason possibly related to UI improvement was the reduction of training intensity and not performing double under exercise. Conclusion: Quarantine by COVID-19 reduced in 18% of UI during exercises by CrossFit practitioners.

Maíta Poli de Araujo (  dramaita@gmail.com ) Department of Sport Medicine, Escola Paulista de Medicina/ Universidade Federal de São Paulo, São Paulo (SP), Brazil https://orcid.org/0000-0003-4717-0106 Laisa Chimello School of Medicine Universidade Anhembi Morumbi https://orcid.org/0000-0002-0871-4476 Barbara Pelincer Brigido School of Medicine Universidade Anhembi Morumbi https://orcid.org/0000-0001-5005-6262 Benno Ejnisman Department of Sport Medicine, Escola Paulista de Medicina/ Universidade Federal de São Paulo, São Paulo (SP), Brazil https://orcid.org/0000-0002-3301-1457 Alberto de Castro Pochini Department of Sport Medicine, Escola Paulista de Medicina/ Universidade Federal de São Paulo, São Paulo (SP), Brazil https://orcid.org/0000-0003-3229-2063