Elsevier

The Journal of Pediatrics

Volume 136, Issue 2, February 2000, Pages 149-155
The Journal of Pediatrics

Short stature and delayed puberty in gymnasts: Influence of selection bias on leg length and the duration of training on trunk length,☆☆,

https://doi.org/10.1016/S0022-3476(00)70094-1Get rights and content

Abstract

Background: Delays in bone age, the onset of puberty, and skeletal growth in gymnasts could be, in part, the reason for an interest in gymnastics, rather than being the result of vigorous exercise. We hypothesized that short stature and delayed bone age are present at the start of gymnastics, and training delays growth, producing short stature, even after retirement. Methods: Sitting height and leg length were measured in 83 active female gymnasts, 42 retired gymnasts, and 154 healthy control subjects. Results were expressed as age-specific SD scores (mean ± SEM). Results: In the cross-sectional data, active gymnasts had delayed bone age (1.3 ± 0.1 years), reduced height –1.32 ± 0.08 SD, sitting height –1.24 ± 0.09 SD, and leg length, –1.25 ± 0.08 SD (all P < .001). However, in those training for less than 2 years, the deficit was confined to leg length (–0.8 ± 0.2 SD). During 2 years of follow-up of 21 gymnasts, only the deficit in sitting height worsened (by 0.4 ± 0.1 SD). In 13 gymnasts followed up in the immediate 12 months after retirement, sitting height accelerated, resulting in a lessening of the deficit in sitting height by 0.46 ± 0.14 SD (P < .01). Adult gymnasts who had been retired for 8 years had no deficit in sitting height, leg length, or menstrual dysfunction. Conclusions: Short stature in active gymnasts is partly due to selection of individuals with reduced leg length. Reduced sitting height is likely to be acquired but is reversible with cessation of gymnastics. A history of gymnastic training does not appear to result in reduced stature or menstrual dysfunction in adulthood. (J Pediatr 2000;136:149-55)

Section snippets

Active and Retired Gymnasts

We studied 83 active prepubertal and peripubertal female gymnasts (bone age, 5.0-12.8 years; chronological age, 5.6-15.6 years), 110 healthy girls (bone age, 6.5-17.0 years; chronological age, 6.9-16.6 years), 42 retired gymnasts, and 44 age-matched control subjects (chronological age, 20.0-35.5 years). Twenty-one of the 83 gymnasts and the 110 control subjects were assessed every 6 months for 2 years. Thirteen of the 83 active gymnasts retired during the study and were followed up for 12.5 ±

Skeletal Maturation, Stature, and Dietary Intake in Active Gymnasts

In the cross-sectional analyses, skeletal maturation in the 83 active gymnasts was delayed by 1.3 ± 0.1 years (P < .001); there was no difference between bone age and chronological age in the control subjects. The delay in skeletal maturation in the gymnasts worsened with increasing years of training (r = –0.47, P < .0001). There were deficits in standing height (–1.32 ± 0.08 SD), sitting height (–1.24 ± 0.09 SD), and leg length (–1.25 ± 0.08 SD) (all P < .001). As shown in Fig 1, there was no

DISCUSSION

In our study the active gymnasts had short stature and a shift to the right and blunting of the growth velocity curve for total height; 2 mechanisms may have contributed to their deficits in stature. First, reduced leg length may be due to selection bias because the deficit in leg length was present at baseline in the cross-sectional data and did not worsen with increasing duration of gymnastic training. Leg length increased at the same rate as it did in control subjects during 2 years of

Acknowledgements

We thank the gymnasts and coaches from Victorian Institute of Sport, the students and staff from Ivanhoe Girls Grammar School, dietitian Kylie Andrews, and research nurse Jan Edmonds for making this work possible.

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Supported by the Dairy Research and Development Corporation of Australia.

☆☆

Reprint requests: Ego Seeman, MD, Endocrine Department, Austin and Repatriation Medical Center, Heidelberg, Melbourne, 3084, Australia.

0022-3476/2000/$12.00 + 0  9/21/103354

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