High Prevalence and Magnitude of Rapid Weight Loss in Mixed Martial Arts Athletes

International society of sports nutrition position stand: nutrition and weight cut strategies for mixed martial arts and other combat sports

Following an extensive literature review, the International Society of Sports Nutrition (ISSN) has developed an official position on nutritional and weight cut strategies for combat sports. The type of combat sport, length of the fight camp, and time between weigh-in and competition are factors influencing nutritional and weight cut strategies. The following 16 points constitute the Position Statement of the Society; the Research Committee has approved them. 1. Combat sports have differing weight categories, official weigh-in times, and competition frequencies, influencing the nutritional and weight cut strategies for training and competition. 2. As the duration of a combat match increases, >4 min, contribution of the aerobic system can rise to >70%, yet anaerobic alactic pathways and anaerobic glycolytic pathways support high-output bursts. 3. During the off camp/general preparation phase, athletes should maintain a weight ranging 12% to 15% above the weight division requirement. 4. Supplements including creatine, beta-alanine, beta-hydroxy-beta-methylbutyrate, and caffeine have been shown to enhance performance and/or recovery during preparation phases, competition, and post-competition. 5. During fight camp, strategic decreases in calorie intake are necessary for an efficient longitudinal weight descent. Individual caloric needs can be determined using indirect calorimetry or validated equations such as Mifflin St. Jeor or Cunningham. 6. Protein should be prioritized during longitudinal weight descents to preserve lean body mass, and the timely delivery of carbohydrates supports training demands. Macronutrients should not drop below the following: carbohydrates 3.0-4.0 g/kg, protein 1.2-2.0 g/kg, and fat 0.5 to 1.0 g/kg/day. 7. Suitable losses in body mass range from 6.7% at 72 h, 5.7% at 48 h, and 4.4% at 24 h, prior to weigh-in. 8. Sodium restriction and water loading are effective for inducing polyuria and acute water loss. 9. During fight week, water-bound glycogen stores can be depleted through exercise and carbohydrate restriction, facilitating a 1% to 2% loss in body mass, with equivalent losses from a low-fiber intake of <10 g/day for 4 days. 10. During fight week, acute water loss strategies, including sauna, hot water immersion, and mummy wraps, can be used effectively with appropriate supervision (optimally ~2-4% of body mass within 24 h of weigh-in). 11. Post-weigh-in, rapid weight gain strategies are utilized to recover lost body fluid/mass before competition with the intent of gaining a competitive advantage. 12. Oral rehydration solutions (1 to 1.5 liters/h) combined with a sodium range of 50-90 mmol/dL should take precedence immediately post-weigh-in. 13. Fast-acting carbohydrates at a tolerable rate of ≤ 60 g/h should follow oral rehydration solutions. Post weigh-in intake of fiber should be limited to avoid gastrointestinal distress. 14. Post-weigh-in carbohydrate intake at 8-12 g/kg may be appropriate for combat athletes that undertook significant glycogen depletion strategies during fight week. About 4-7 g/kg may be suitable for modest carbohydrate restriction. 15. Post weigh-in, rehydration/refueling protocols should aim to regain ≥10% of body mass to mitigate declines in performance and the negative effects of rapid weight loss. 16. The long-term effects of frequent weight cuts on health and performance are unknown, necessitating further research.

Is there a relationship between rapid weight changes and self-reported injury in combat sports athletes? A 14-month study of 24 combat sports events

OBJECTIVES

To explore the potential association between rapid weight changes and self-reported injury status (presence or absence of injury) 7 days following competitive events among male and female combat sports competitors.

DESIGN

A 14-month study of 24 events.

METHODS

A weight management questionnaire was completed 1-day post-competition, and an injury questionnaire was completed 7 days post-competition. These online questionnaires provided data on body mass and injury status. Mixed effects logistic regression models were used to analyse the odds ratios of rapid weight change variables and their impact on athletes' self-reporting as injured or non-injured.

RESULTS

There were 172 responses (155 athletes) to both questionnaires (37 females (24 %) and 118 males (76 %)); 88 athletes (51 %) reported no injury, and 84 (49 %) reported injury. Rapid weight loss 7 days (RWL -7 days) and 24 h (RWL -24 h) before weigh-ins was 4.9 % ± 3.4 % and 2.6 % ± 2.1 % for females, and 6.1 % ± 3.2 % and 3.0 % ± 1.9 % for males. Mixed effects logistic regression models returned the highest odds ratio for male RWL -24 h (odds ratio: 1.20, 95 % confidence interval: 1.00-1.43, p = 0.044). This indicates that for a 1 % increase in male RWL -24 h before official weigh-ins, the likelihood of reporting an injury increases by a factor of 1.2.

CONCLUSIONS

Male RWL -24 h before weigh-ins is associated with reporting an injury at 7 days post-competition. Therefore, athletes and coaches should carefully consider and aim to limit pre-competition rapid weight loss to minimise the likelihood of injury.

Body Mass Management Practices of Olympic Weightlifting Athletes

This study explored the body mass (BM) management practices among competitive male and female Olympic weightlifting athletes, hypothesizing that athletes compete in lighter weight categories than their habitual training weight (i.e., making weight). Utilizing a validated, anonymous survey, data were collected from 149 Olympic weightlifting athletes (>18 years; female = 94). The survey comprised five sections: demographics, training/competition history, weight history, source of influence, and BM management practices. The prevalence, magnitude, and methods employed for BM management were analyzed with subgroup analysis using one-way analysis of variance. Post hoc testing including Spearman's rho and chi-square analysis was completed when a significant effect was found. Three quarters (76%) of athletes acknowledged using chronic weight loss and/or acute weight loss strategies to make weight. Usual BM loss (2%-3%) in the week before competition was within recommended guidelines. Gradual dieting, fluid restriction, and low food weight, high-calorie options were the most commonly used BM management strategies. Female athletes were more likely to use gradual dieting (p = .043; r = .104) and were less likely to increase their exercise (p = .046; r = -.105) and utilize fasting (p = .038; r = .05) compared with their male counterparts. Women further identified dietitians/nutritionists (p = .006; r = .022) as a highly influential source of information. This research offers new insights into the BM management practices of Olympic weightlifting athletes, identifying that the majority of athletes compete at a BM lighter than their habitual training weight, achieved using a range of chronic weight loss and acute weight loss strategies.

The Impact of Rapid Weight Regain on Fight Outcomes in Bellator Mixed Martial Arts Athletes

OBJECTIVES

This study aimed to evaluate the effect of rapid weight regain on the fight outcomes in professional mixed martial arts (MMA) athletes competing in Bellator.

MATERIALS AND METHODS

Twenty fighters (16 male and four female fighters) were included in the analysis. Official weigh-in and fight-night weights were recorded, and percentage weight regain was calculated. Fighters were divided into groups based on their percentage weight regain (<10% vs. ≥10%). Descriptive statistics were calculated, and independent t-tests and logistic regression were employed.

RESULTS

The results indicated that while fighters significantly regained weight between weigh-ins and fight-night, this weight gain did not significantly (p ≥ 0.05) predict fight outcomes.

CONCLUSION

These findings suggest that weight regain may not provide a competitive advantage in Bellator MMA athletes.

Rapid Weight Changes and Competitive Outcomes in Muay Thai and Mixed Martial Arts: A 14-Month Study of 24 Combat Sports Events

This study investigates the rapid weight loss (RWL) and rapid weight gain (RWG) of contest winners and losers from Muay Thai (MT) and mixed martial arts (MMA) events. The relationship between rapid weight change variables of males and females, and competitive success is also examined. Data from a weight management questionnaire was collected one day post-competition from 185 participants across 24 fight events, resulting in 263 responses (MMA: n = 78, MT: n = 185). Official and secondary weigh-in data were provided by the Combat Sports Commission. The results show that in MT, contest winners compared to losers had significantly greater RWL-7 days (5.9 ± 2.6% vs. 4.6 ± 2.7%, p = 0.01), RWG (6.2 ± 2.9% vs. 4.7 ± 2.8%, p = 0.003), and RWG/RWL ratio (108% [86-132%] vs. 86% [60-119%], p = 0.038), while no significant differences were observed for MMA. Mixed logistic regression models that controlled for age showed that a 1% increase in female RWL-24 h ([OR = 1.57, R2 = 0.105, p = 0.001]) was associated with a 1.6 times higher likelihood of winning compared to female athletes without this increase. We emphasise that associations do not imply causation, and it is possible that other factors which align with rapid weight change practices may impact the observed relationship. Nonetheless, MT contest winners show greater RWL, RWG, and RWG/RWL ratio than losers, and female rapid weight changes appear to be associated with competitive success in this cohort.

The Practice of Weight Loss in Combat Sports Athletes: A Systematic Review

The aim of this systematic review is to comprehensively assess the weight loss (WL) practices in different combat sports (CS). The review protocol was preregistered with PROSPERO [CRD42023487196]. Three databases were searched (Web of Science, EBSCOhost, and PubMed) until 8 December 2023. Eligible studies had to meet five criteria: they must have been (a) written in English, (b) published in a peer-reviewed journal, (c) used a survey design to investigate the WL practices of CS athletes, and (d) reported the WL methods used by athletes using a five-point scale. Twenty-six studies (3994 participants from 14 CS) were included. This review found that (1) WL is highly prevalent in CS athletes; (2) many CS athletes started losing weight for competition as teenagers two to three times a year; (3) CS athletes usually lose <5% body weight in 7-14 days before competition; (4) increasing exercise and gradually dieting are the most commonly used WL methods; and (5) the influence of scientific practitioners on athletes is negligible. The habitual practices of CS athletes may be relatively harmless, but in some special cases, CS athletes also perform extreme WL practices. Scientific practitioners have little influence on their WL practices, which may form a vicious cycle of non-qualified influence.

Physiological Perturbations in Combat Sports: Weight Cycling and Metabolic Function-A Narrative Review

Combat sports athletes seeking a competitive edge often engage in weight management practices to become larger than their opponents, which ultimately includes periods of gradual weight loss, rapid weight loss, and weight regain. This pattern of weight loss and regain is known as weight cycling and often includes periods of low energy availability, making combat sports athletes susceptible to metabolic dysfunction. This narrative review represents an effort to explore the metabolic perturbations associated with weight cycling and outline the short-, medium-, and long-term effects on metabolic flexibility, function, and health. The short-term effects of rapid weight loss, such as a reduced metabolic rate and alterations to insulin and leptin levels, may prelude the more pronounced metabolic disturbances that occur during weight regain, such as insulin resistance. Although definitive support is not currently available, this cycle of weight loss and regain and associated metabolic changes may contribute to metabolic syndrome or other metabolic dysfunctions over time.

Rapid Weight Loss Practices Within Olympic Weightlifters

ABSTRACT

Gee, TI, Campbell, P, Bargh, MJ, and Martin, D. Rapid weight loss practices within Olympic weightlifters. J Strength Cond Res 37(10): 2046-2051, 2023-Rapid weight loss (RWL) practices are common among athletes to "make weight" for a chosen bodyweight class. This study's purpose was to investigate RWL prevalence, magnitude, and methods within Olympic weightlifters from Great Britain. Subjects (n = 39, male = 22, female = 17) were recruited from International Weightlifting Federation lifting populations (mandatory two-hour competition weigh-in). Subjects were categorized into competitive groups based on Sinclair coefficient total (high, mid, low) and also gender (male, female). The validated Rapid Weight Loss Questionnaire was used to establish RWL magnitude and practices. Of respondents, 33 of 39 (84.6%) had purposely acutely reduced body mass to compete, a higher proportion present within females (94.1%) than males (77.3%). The cohort's mean habitual precompetition acute body mass loss was 3.8 ± 1.7% and the "rapid weight loss score" (RWLS) was 23.6 ± 9.5. Across competitive groups there were no significant differences in habitual or highest precompetition body mass loss, postcompetition body mass gain or RWLS (p > 0.05). However, females attributed a significantly greater "highest" relative precompetition body mass loss compared with males (7.4 vs 4.9%, p = 0.045). For RWL methods used, frequencies of "always" and "sometimes" were reported highest for "restricting fluid ingestion" (81.8%), "gradual dieting" (81.8%), and "water loading" (54.5%). The prevalence of RWL is high among competitive Olympic weightlifters, and especially within the sampled female athletes. Magnitude of RWL was similar across different standards of athlete; however, female lifters demonstrated a higher maximum precompetition RWL.

Competition Anxiety in Combat Sports and the Importance of Mental Toughness

Combat sports require participants to engage in potentially dangerous forms of contact-based competition. Pressure to succeed, coupled with the risk of severe injury can induce significant levels of anxiety, which if uncontrolled, can negatively impact performance and possibly promote unsporting conduct. The present study examined competitive anxiety levels of combat sports athletes and determined whether self-reported scores were associated with mental toughness and Sportspersonship attitudes. A cross-sectional survey design was used whereby participants (N = 194) completed a battery of questionnaires measuring competitive combat sport experiences, demographic details, Sportspersonship traits (compliance towards rules, respect for opponents, and game perspective), and competition anxiety (somatic, cognitive, and self-confidence; reported retrospectively). Results suggest that mentally tough athletes experience lower levels of cognitive and somatic anxiety, and higher self-confidence, prior to competitions. Findings also found that athletes endorsing more altruistic and respectful attitudes in sport (Sportspersonship) reported higher levels of competition anxiety. The findings demonstrate that mental toughness is allied to positive attributes and could potentially be operationalized to improve both the retention and performance of combat sports athletes. Thus, the authors advocate the use of mental toughness coaching interventions within combat sports.

Rapid weight loss can increase the risk of acute kidney injury in wrestlers

Objective

Restrictive diets, forced starvation or voluntary weight loss are attracting more and more attention from scientists. Overall trends show that about 80% of combat sports athletes use specific methods of reducing body mass. Rapid weight loss could be a risk factor for kidney-related adverse outcomes. This study aimed to examine the impact of high-intensity specific training combined with rapid weight loss in the first and without rapid weight loss in the second phases on body composition and biochemical markers of kidney function.

Methods

The study was conducted on 12 male wrestlers. Kidney function markers were measured, including blood urea nitrogen, serum creatinine, uric acid and serum Cystatin-C. Alterations in analysed markers were noted in both phases of the research.

Results

According to the data, a significant increase was noted in blood urea nitrogen (p=0.002), uric acid (p=0.000) and serum creatinine (p=0.006) during the first phase in comparison with the second phase. The levels of serum Cystatin-C were slightly elevated after both phases compared with the initial measurement.

Conclusion

It is evident that high-intensity specific training combined with rapid weight loss significantly affects the increase in kidney function markers compared with identical training without rapid weight loss. The findings in this study suggest that rapid body mass reduction is associated with an increased risk of acute kidney injury in wrestlers.

Exercise-induced hypohydration impairs 3 km treadmill-running performance in temperate conditions

Research assessing exercise-induced hypohydration on running performance in a temperate environment is scarce. Given the weight-bearing nature of running, the negative effects of hypohydration might be offset by the weight-loss associated with a negative fluid balance. Therefore, this study investigated the effect of exercise-induced hypohydration on running performance in temperate conditions. Seventeen intermittent games players (age 22 ± 1 y; VO2peak 52.5 ± 4.1 mL∙kg-1∙min-1) completed preliminary and familiarisation trials, and two experimental trials consisting of 12 blocks of 6 min of running (65% VO2peak; preload) with 1 min passive rest in-between, followed by a 3 km time trial (TT). During the preload, subjects consumed minimal fluid (60 mL) to induce hypohydration (HYP) or water to replace 95% sweat losses (1622 ± 343 mL; EUH). Body mass loss (EUH -0.5 ± 0.3%; HYP -2.2 ± 0.4%; P < 0.001), and other changes indicative of hypohydration, including increased serum osmolality, heart rate, thirst sensation, and decreased plasma volume (P ≤ 0.022), were apparent in HYP by the end of the preload. TT performance was ~6% slower in HYP (EUH 900 ± 87 s; HYP 955 ± 110 s; P < 0.001). Exercise-induced hypohydration of ~2% body mass impaired 3 km running TT performance in a temperate environment.

Post-exercise rehydration: Comparing the efficacy of three commercial oral rehydration solutions

Introduction

This study compared the efficacy of three commercial oral rehydration solutions (ORS) for restoring fluid and electrolyte balance, after exercise-induced dehydration.

Method

Healthy, active participants (N = 20; ♀ = 3; age ∼27 y, V˙O₂peak ∼52 ml/kg/min) completed three randomised, counterbalanced trials whereby intermittent exercise in the heat (∼36°C, ∼50% humidity) induced ∼2.5% dehydration. Subsequently, participants rehydrated (125% fluid loss in four equal aliquots at 0, 1, 2, 3 h) with a glucose-based (G-ORS), sugar-free (Z-ORS) or amino acid-based sugar-free (AA-ORS) ORS of varying electrolyte composition. Urine output was measured hourly and capillary blood samples collected pre-exercise, 0, 2 and 5 h post-exercise. Sodium, potassium, and chloride concentrations in urine, sweat, and blood were determined.

Results

Net fluid balance peaked at 4 h and was greater in AA-ORS (141 ± 155 ml) and G-ORS (101 ± 195 ml) than Z-ORS (-47 ± 208 ml; P ≤ 0.010). Only AA-ORS achieved positive sodium and chloride balance post-exercise, which were greater for AA-ORS than G-ORS and Z-ORS (P ≤ 0.006), as well as for G-ORS than Z-ORS (P ≤ 0.007) from 1 to 5 h.

Conclusion

when provided in a volume equivalent to 125% of exercise-induced fluid loss, AA-ORS produced comparable/superior fluid balance and superior sodium/chloride balance responses to popular glucose-based and sugar-free ORS.

Rapid weight gain predicts fight success in mixed martial arts - evidence from 1,400 weigh-ins

We aimed to analyze whether rapid weight gain (RWG) between the official weigh-in and the time of the fight was associated with fight success in MMA. A total of 700 professional MMA fights involving 1,400 weigh-ins from 21 MMA promotions regulated by the California State Athletic Commission were analyzed. Multilevel logistic regression accounting for individual (i.e. athlete) and cluster levels (i.e. fights) was used to analyze the association of all measures with a theoretical relationship with the dependent variable and without interdependency with one another (i.e. %RWG, sex, body mass division, competition level) with the fight outcome (i.e. win or loss). The odds ratios (OR) with 95% confidence intervals (95%CI) were calculated. The highest mean %RWG was found for the flyweight, bantamweight, featherweight, and lightweight divisions. The %RWG significantly predicted the fight outcome (ß = 0.044; OR = 1.045; 95%CI = 1.014-1.078; p = 0.005) so that for each 1% of additional RWG, the chance of winning increased by 4.5%. With the largest sample to date and in a "real-world" scenario, the present results suggest that the magnitude of RWG is linked to the chance of winning in MMA combats. It is suggested that regulatory commissions, confederations, and event organisers should consider regulating RWG, considering that, despite its detrimental impact on the athletes' health and performance, the potential advantage might stimulate athletes to invest in rapid weight loss, followed by gain after the official weigh-in to increase their chance of winning.

Weight Loss and Competition Weight in Ultimate Fighting Championship (UFC) Athletes

Previous research has demonstrated that professional mixed martial arts (MMA) athletes employ a variety of weight manipulation strategies to compete at given weight classes. Although there is much literature demonstrating weight manipulation methods, minimal research exists analyzing how much weight MMA athletes lose prior to the official weigh-in. Moreover, there is minimal research examining how much weight professional MMA athletes gain between the official weigh-in and competition. Therefore, the purpose of the current study was to analyze weight loss/regain in professional MMA athletes. Data collected from 616 professional MMA athletes (31.1 ± 4.0 yrs.; 177.1 ± 4.7 cm) competing for the Ultimate Fighting Championship (UFC) between 2020 and 2022 were used for the study. The athlete's weight was obtained 72 h, 48 h, and 24 h prior to the official weigh-in, at the official weigh-in, and prior to competition. Random effects analysis was utilized to compare weight at a variety of time points between different weight classes. All statistics were analyzed, and significance was set at p ≤ 0.05. There is a significant (p ≤ 0.05) difference between weight classes and time points in professional MMA. MMA athletes decrease body weight significantly prior to the official weigh-in. MMA athletes increase body weight significantly between official weigh-in and competition. Based on these data, it appears that MMA athletes average a weight loss of nearly 7% within 72 h prior to the official weigh-in. The data also suggest that athletes gain nearly 10% of total weight between the official weigh-in and competition.

A Survey of Combat Athletes' Rapid Weight Loss Practices and Evaluation of the Relationship With Concussion Symptom Recall

OBJECTIVE

There is a high incidence of concussion and frequent utilization of rapid weight loss (RWL) methods among combat sport athletes, yet the apparent similarity in symptoms experienced as a result of a concussion or RWL has not been investigated. This study surveyed combat sports athletes to investigate the differences in symptom onset and recovery between combat sports and evaluated the relationships between concussion and RWL symptoms.

DESIGN

Cross-sectional study.

SETTING

Data were collected through an online survey.

PARTICIPANTS

One hundred thirty-two (115 male athletes and 17 female athletes) combat sport athletes.

INTERVENTIONS

Modified Sport Concussion Assessment Tool (SCAT) symptom checklist and weight-cutting questionnaire.

MAIN OUTCOME MEASURES

Survey items included combat sport discipline, weight loss, medical history, weight-cutting questionnaire, and concussion and weight-cutting symptom checklists.

RESULTS

Strong associations ( rs = 0.6-0.7, P < 0.05) were observed between concussion and RWL symptoms. The most frequently reported symptom resolution times were 24 to 48 hours for a weight cut (WC; 59%) and 3 to 5 days for a concussion (43%), with 60% to 70% of athletes reporting a deterioration and lengthening of concussion symptoms when undergoing a WC. Most of the athletes (65%) also reported at least one WC in their career to " not go according to plan ," resulting in a lack of energy (83%) and strength/power (70%).

CONCLUSIONS

Rapid weight loss and concussion symptoms are strongly associated, with most of the athletes reporting a deterioration of concussion symptoms during a WC. The results indicate that concussion symptoms should be monitored alongside hydration status to avoid any compound effects of prior RWL on the interpretation of concussion assessments and to avoid potential misdiagnoses among combat athletes.

Effect of rapid weight loss incorporating hot salt water immersion on changes in body mass, blood markers, and indices of performance in male mixed martial arts athletes

Purpose

To investigate the effects of rapid weight loss (RWL), incorporating comparison of hot water immersion (HWI) in fresh or salt water, on changes in body mass, blood markers, and indices of performance in mixed martial arts athletes.

Methods

In a crossover design comparing fresh water (FWB) to salt water (SWB; 5.0%wt/vol Epsom salt) bathing, 13 males performed 20 min of HWI (~ 40.3 °C) followed by 40 min wrapped in a heated blanket, twice in sequence (2 h total). Before bathing, ~ 26 to ~ 28 h of fluid and dietary restriction was undertaken, and ~ 24 to ~ 26 h of a high carbohydrate diet and rehydration was undertaken as recovery.

Results

During the entire RWL process, participants lost ~ 5.3% body mass. Body mass lost during the 2 h hot bath protocol was 2.17 ± 0.81 kg (~ 2.7% body mass) and 2.24 ± 0.64 kg (~ 2.8% body mass) for FWB and SWB, respectively (P = 0.647 between trials). Blood urea nitrogen, creatinine, sodium, chloride, hemoglobin, and hematocrit were increased (all P < 0.05), and plasma volume was decreased (~ 14%; P < 0.01), but did not differ between FWB and SWB, and were similar to baseline values after recovery. No indices of performance (e.g., countermovement jump, isometric strength, and functional threshold power) were impacted when RWL was followed by the recovery process.

Conclusion

Under the conditions of this hot bath protocol, fluid loss was not augmented by the addition of ~ 5.0%wt/vol of Epsom salt during HWI, and RWL of ~ 5.3% body mass followed by > 24 h of recovery did not impact indices of performance.

Exploratory Systematic Review of Mixed Martial Arts: An Overview of Performance of Importance Factors with over 20,000 Athletes

This review aimed to analyze the findings in the literature related to Mixed Martial Arts (MMA) through an exploratory systematic review and to present the state of the art from a multifactorial perspective. The review was conducted in accordance with the PRISMA statement, with a search performed in the Scopus, PubMed, and Web of Science databases. Participants were competitive athletes (amateurs or professionals) of regional, national, or international levels. Of the 2763 registries identified, 112 studies met the eligibility criteria. The pooled sample size and age were 20,784 participants, with a mean age of 27.7 ± 6 years for male and 28.9 ± 3 years for female, with the vast majority of athletes being male (94.9%). MMA athletes were 17.2% amateurs, 73.8% professionals, and 9% were not reported. The scientific literature related to MMA reported injuries (n = 28), weight loss (n = 21), technical and tactical analysis (n = 23), physical fitness (n = 8), physiological responses and training characteristics (n = 13), psychobiological parameters (n = 12), and interventions applied to MMA athletes (n = 7). Therefore, this exploratory systematic review presents practitioners and researchers with seven broad summaries of each facet of performance of importance in this population of athletes.

Empowered, Yet Vulnerable: Motives for Sport Participation, Health Correlates, and Experience of Sexual Harassment in Female Combat-Sport Athletes

Background: To explore motives for combat sport participation, weight regulation practices, symptoms of low energy availability (LEA), disordered eating (DE) or eating disorders (ED), and any experiences with sexual harassment (SH) among female combat-sport athletes. Methods: In total, 29 athletes were recruited by social media and in clubs. Participants responded to a questionnaire on health behavior and mental health and completed diet registration and a DXA-scan. Results: Most athletes started combat sports to feel empowered and experienced an inclusive milieu, but the frequency of health issues was high. A total of 21−67% had symptoms of ED, suffered from injuries, had low site-specific BMD, and/or symptoms of LEA. Athletes had insufficient intake of energy and nutrients, and <50% received any dietary information or guidance from their clubs. Most athletes complied with favorable weight-loss strategies; still, >20% used unfavorable methods and rapid weight-loss periods. A total of 70% of the athletes had experienced SH, of which 41% experienced SH within the combat-sport context. Conclusion: Combat sport offers an inclusive milieu, which may increase women’s health and confidence; still, our results indicates a need for actions to safeguard female combat-sport athletes’ mental and physical health, implying a cultural change within the community of combat sport and a need for increased health and nutrition literacy.

The Association between Rapid Weight Loss and Body Composition in Elite Combat Sports Athletes

Rapid Weight Loss (RWL) is a rapid reduction in weight over a short period of time seeking to attain the norm required for a competition in a particular weight category. RWL has a negative health impact on athletes including the significant muscle damage induced by RWL. This study aimed to identify the association between RWL and body composition among competitive combat athletes (n = 43) in Lithuania. Our focus was laid on the disclosure of their RWL practice by using a previously standardized RWL Questionnaire. The body composition of the athletes was measured by means of the standing-posture 8-12-electrode multi-frequency bioelectrical impedance analysis (BIA) and the electrical signals of 5, 50, 250, 550 and 1000 kHz. This non-experimental cross-sectional study resulted in preliminary findings on the prevalence and profile of RWL among combat athletes in Lithuania. 88% of the athletes surveyed in our study had lost weight in order to compete, with the average weight loss of 4.6 ± 2% of the habitual body mass. The athletes started to resort to weight cycling as early as 9 years old, with a mean age of 12.8 ± 2.1 years. The combination of practiced weight loss techniques such as skipping meals (adjusted Odd Ratio (AOR) 6.3; 95% CI: 1.3−31.8), restricting fluids (AOR 5.5; 95% CI: 1.0−31.8), increased exercise (AOR 3.6; 95% CI: 1.0−12.5), training with rubber/plastic suits (AOR 3.2; 95% CI: 0.9−11.3) predicted the risk of RWL aggressiveness. RWL magnitude potentially played an important role in maintaining the loss of muscle mass in athletes during the preparatory training phase (β −0.01 kg, p < 0.001). Therefore, an adequate regulatory programme should be integrated into the training plans of high-performance combat sports athletes to keep not only the athletes but also their coaches responsible for a proper weight control.

Evaluation of the early weigh-in policy for mixed martial arts events adopted by North American athletic commissions

OBJECTIVE

To characterize the epidemiology of overweight athletes before and after the introduction of the Early Weigh-In Policy (EWIP).

METHODS

A retrospective cohort study examined the weigh-in results for professional mixed martial arts (MMA) events over a 2-year period around the introduction of the new EWIP between 2014 and 2018. Descriptive statistics were used to characterize the study populations. Risk ratios were used to identify differences in the study populations before and after the introduction of the EWIP.

RESULTS

After the introduction of the EWIP, the number of overweight athletes increased from 5.7% to 8.4% and the average overweight mass increased from 1.3 kg (2.9 lbs) to 1.8 kg (3.9 lbs) [difference, 0.5 kg (1.0 lb), p = 4.35 × 10^(-5)]. The proportion of athletes is not distributed similarly across the different overweight mass categories when comparing the pre- and post-EWIP time frames (p = 0.006). More athletes in the pre-EWIP period were overweight by smaller amount, while in the post-EWIP period athletes were overweight by larger amount. Of the athletes who were overweight before the regulation change, 28.7% were over the weight limit by greater than 1.8 kg (4 lbs), compared to 39.5% after the new EWIP introduction. On average, the ratio of overweight athletes per events by commission was 1.2 before the introduction of the EWIP and 2.1 after.

CONCLUSION

These results appear to indicate that the EWIP has not altered weight-cutting culture in MMA in a positive manner. This study casts doubt on the benefits of an EWIP and raised the possibility of utilizing the longitudinal weight monitoring approach to mitigate rapid weight-cycling behavior. However, before additional changes are made by any athletic commission, further research is needed to examine the efficacy of the abovementioned longitudinal weight monitoring approach or any other strategy.

Mental Well-Being or Ill-Being through Coaching in Adult Grassroots Sport: A Systematic Mapping Review

There is convincing evidence on the effects of sport and exercise on mental health and well-being. Less evidence is provided about how to achieve these benefits in the context of grassroots sport coaching. We systematically reviewed the scientific literature of three databases to narratively synthesize the current knowledge about which coaching-related factors influence well-being or ill-being, and how to promote mental health in adult athletes through sport coaches. The review includes 52 studies with different methodological and theoretical approaches and mental health outcomes. The wide range of themes were mapped and synthesized within two clusters, i.e., coaching behavior, antecedents, and context; and coach–athlete relationship and social support. The results highlight the importance of the promotion of empowering environments, autonomy-supportive coaching behavior, and coach–athlete relationship quality that relate to the satisfaction of basic psychological needs. The review also calls for a critical perspective, in the sense that the coaching context and working environment may not be empowering and supportive to the well-being of coaches and consequently to the athletes, and that coaches who want to provide autonomy-supportive environments may face various obstacles. Finally, the review synthesizes recommendations for the training of coaches, as one piece of a holistic mental health promotion.

Nutritional Considerations for Female Athletes in Weight Category Sports

Weight making can be described as the process of reducing body mass in events where aesthetics, propulsion or the requirement to meet a specific weight category limit, are considered to be of competitive importance. Cross sectional research specifically focussed on weight category sports, has highlighted behaviours and practices that are similar in athletes of both sexes. Regardless of this and despite parallel participation in weight category sporting events, females are drastically underrepresented in studies examining body mass loss interventions across both chronic and acute timeframes. However, it has been well characterised that these types of body mass loss strategies can be causative of low energy availability, leading to consequences of female athlete triad and relative energy deficiency in sports. Furthermore, female-specific body composition and physiological systems modulated by the anterior pituitary and ovarian hormones within the menstrual cycle or use of hormonal contraception, can lead to potential outcomes which need to be considered carefully, particularly when employing acute weight loss strategies that are often utilised by weight making athletes. Therefore, the aim of this article serves to review the aforementioned issues, whilst offering practical recommendations via initial assessment, chronic/acute interventions and refeeding/recovery plans to help support the implementation of body mass loss strategies in the context of weight making specifically with female athletes.

ACSM Expert Consensus Statement on Weight Loss in Weight-Category Sports

ABSTRACT

Weight-category sports are defined by the requirement of a weigh-in before competition to provide performance equity and reduced injury risks by eliminating size discrepancies. Athletes in these sports try to gain a theoretical advantage by competing in weight divisions that are lower than their day-to-day body mass (BM), using a combination of chronic strategies (body-fat losses) and acute manipulations over a period of hours to days before weigh-in ("making weight"). Strategies to support safer practices include minimal competition weight classification based on preseason body composition, reductions in the period between weigh-in and competition, and prohibition of unhealthy weight loss techniques. At an individual level, expert guidance by a sports nutrition professional can help an athlete to establish a pragmatic and long-term approach to BM management, recognizing the nuances of their sport, to achieve favorable outcomes for both health and performance.

Rapid Weight Loss Habits before a Competition in Sambo Athletes

BACKGROUND

Like other combat sports, sambo has competition rules that divide athletes into categories based on gender, age and weight. Athletes in combat sports often resort to rapid weight loss (RWL) methods to be more competitive in lower weight categories and gain an advantage against lighter, smaller and weaker competitors. The aim of this study was to examine the methodology implemented by two different sambo age categories, junior and senior athletes, in order to attain RWL.

METHODS

The sample consisted of 103 male sambo elite athletes (seniors/juniors: age 28.5 ± 4.3/18.9 ± 0.8; height (m): 1.7 ± 0.1/1.8 ± 0.1; weight (kg): 76.3 ± 17.8/74.4 ± 16.3; BMI (kg/m²): 25.0 ± 3.8/23.7 ± 3.9) who completed a survey on RWL.

RESULTS

Athletes reported losing a mean of 5 kg starting approximately 12 days before a competition. The most common methodology reported by senior and junior sambo athletes was gradually increasing dieting, followed by sauna and plastic suit training. Less common methods adopted were laxatives, diuretics, the use of diet pills and vomiting. There were significant group differences for sauna and diet pill ingestion. Coaches and parents are influential people in the lives of athletes concerning the weight loss strategy to be adopted.

CONCLUSIONS

This study's results unequivocally confirm the prevalent practice of RWL in both senior and junior sambo athletes. Although athletes prevalently chose "less harmful" methods, there is a need to inform parents and coaches of the risks and benefits of RWL.

Effect of Weight Class on Regional Brain Volume, Cognition, and Other Neuropsychiatric Outcomes among Professional Fighters

Traumatic brain injury (TBI) is a common source of functional impairment among athletes, military personnel, and the general population. Professional fighters in both boxing and mixed martial arts (MMA) are at particular risk for repetitive TBI and may provide valuable insight into both the pathophysiology of TBI and its consequences. Currently, effects of fighter weight class on brain volumetrics (regional and total) and functional outcomes are unknown. Fifty-three boxers and 103 MMA fighters participating in the Professional Fighters Brain Health Study (PRBHS) underwent volumetric magnetic resonance imaging (MRI) and neuropsychological testing. Fighters were divided into lightweight (≤139.9 lb), middleweight (140.0–178.5 lb), and heavyweight (>178.5 lb). Compared with lightweight fighters, heavyweights displayed greater yearly reductions in regional brain volume (boxers: bilateral thalami; MMA: left thalamus, right putamen) and functional performance (boxers: processing speed, simple and choice reaction; MMA: Trails A and B tests). Lightweights suffered greater reductions in regional brain volume on a per-fight basis (boxers: left thalamus; MMA: right putamen). Heavyweight fighters bore greater yearly burden of regional brain volume and functional decrements, possibly related to differing fight dynamics and force of strikes in this division. Lightweights demonstrated greater volumetric decrements on a per-fight basis. Although more research is needed, greater per-fight decrements in lightweights may be related to practices of weight-cutting, which may increase vulnerability to neurodegeneration post-TBI. Observed decrements associated with weight class may result in progressive impairments in fighter performance, suggesting interventions mitigating the burden of TBI in professional fighters may both improve brain health and increase professional longevity.

Rapid Weight Gain Following Weight Cutting in Male and Female Professional Mixed Martial Artists

Rapid weight loss or "weight cutting" is a common but potentially harmful practice used in mixed martial arts competition. Following the official weigh-in, competitors refeed and rehydrate themselves in a process known as rapid weight gain (RWG) to realize a potential competitive advantage. While data from surveys and small series have indicated the majority of mixed martial arts athletes engage in rapid weight loss, there is a lack of officially collected data from sanctioning organizations describing its prevalence. The present investigation represents a summary of the data collected between December 2015 and January 2018 by the California State Athletic Commission. In total, 512 professional mixed martial artists (455 males and 57 females) were included. Of these, 503 (98%) athletes gained body mass between weigh-in and their bouts. Total RWG between weigh-in and competition was 5.5 ± 2.5 kg, corresponding to an 8.1% ± 3.6% body mass increase. Total RWG was 5.6 ± 2.5 kg (8.1% ± 3.6%) for males and 4.5 ± 2.3 kg (8.0% ± 3.8%) for females. More than one quarter of men and one third of women gained >10% body mass between weigh-in and competition. Athletes from leading international promotions gained more absolute, but not relative, body mass than those from regional promotions. Our findings indicate RWG is nearly ubiquitous in professional , with a similar prevalence in male and female athletes. Trends based on promotion suggest a larger magnitude of RWG in presumably more experienced and/or successful mixed martial artists from leading international promotions.

Acute Effects of Supervised Making Weight on Health Markers, Hormones and Body Composition in Muay Thai Fighters

Making weight is a practice often used in combat sports. This consists of a rapid weight loss (RWL) and a subsequent rapid weight gain (RWG) in the days preceding competition. However, this practice is often carried out based on anecdotal information provided by ex-athletes or non-professionals, which has led to several adverse events. This study aimed to assess the acute effects of a supervised nutritional period of RWL/RWG on health markers, hormone concentrations, and body composition. We performed a single-arm repeated-measures (baseline, after RWL and after RWG) clinical trial with twenty-one (8F:16M) Italian Muay Thai fighters. Body mass was significantly lower after the RWL (-4.1%) while there was a significantly higher glucose availability after RWL and RWG. Blood urea nitrogen, lipid profile, and creatinine were within the normal range after RWL/RWG. Testosterone decrease significantly after RWL and RWG in the men group. Male fighters had a significant reduction in thyroid-stimulating hormone concentration after the RWL and RWG intervention, but no change was found in women at pre-competition. Bioelectrical parameters were almost fully restored after RWG. An evidence-based and individualized nutrition methodology reduces the adverse events after an RWL and RWG practice, although the impact on the hormonal profile is inevitable.

Worth the Weight? Post Weigh-In Rapid Weight Gain is Not Related to Winning or Losing in Professional Mixed Martial Arts

Body mass (BM) manipulation via rapid weight loss (RWL) and rapid weight gain (RWG) is a common practice among mixed martial art (MMA) athletes to ensure qualification for the division in which the athlete wishes to compete. Professional MMA competitors in California are required to weigh in twice: 24 hr prior to competition and immediately prior to the bout after they have typically engaged in RWG. In analyzing data from five MMA events sanctioned by the Californian State Athletic Commission, the authors used Bayesian analyses to compare bout winners (n = 62) and losers (n = 62) in terms of in-competition BM (in kilograms) and the amount of BM regained between the two weigh-ins (in kilograms). These data do not support the hypothesis that differences in in-competition BM (Bayes factor [BF10] = 0.667, d = 0.23) or the amount of BM regained between the two weigh-ins (BF10 = 0.821, d = 0.23) determine winning or losing. In addition, there was no statistical difference between bouts ending via strikes, submission, or decision for either in-competition BM (BF10 = 0.686, ω2 < 0.01) or the amount of BM regained between the two weigh-ins (BF10 = 0.732, ω2 = 0.054). In conclusion, the authors report for the first time that the magnitude of RWG does not predict winning or losing in a professional cohort of MMA athletes. In addition, they also report that MMA athletes typically compete at a BM that is at least 1-2 divisions higher than the division in which they officially weighed-in. These analyses may provide impetus for governing bodies and coaches to enact changes at both professional and amateur levels to reduce negative health consequences associated with extreme RWL and RWG.

Comparison of hot water immersion at self-adjusted maximum tolerable temperature, with or without the addition of salt, for rapid weight loss in mixed martial arts athletes

Hot water immersion is used by athletes in weight category sports to produce rapid weight loss (RWL) by means of passive fluid loss, and often is performed with the addition of Epsom salts (magnesium sulphate). This study investigated the magnitude of body mass losses during hot water immersion with or without the addition of salt, with the temperature commencing at 37.8°C and being self-adjusted by participants to their maximum tolerable temperature. In a crossover design, eight male MMA athletes (29.4 ± 5.3 y; 1.83 ± 0.05 m; 85.0 ± 4.9 kg) performed a 20 min whole-body immersion followed by a 40 min wrap in a warm room, twice in sequence per visit. During one visit, only fresh water was used (FWB), and in the other visit, magnesium sulphate (1.6% wt/vol) was added to the bath (SWB). Prior to each visit, 24 h of carbohydrate, fibre and fluid restriction was undertaken. Water temperatures at the end of the first and second baths were ~39.0°C and ~39.5°C, respectively. Body mass losses induced by the hot bath protocols were 1.71 ± 0.70 kg and 1.66 ± 0.78 kg for FWB and SWB, respectively (P = 0.867 between trials, d = 0.07), and equivalent to ~2.0% body mass. Body mass lost during the entire RWL protocol was 4.5 ± 0.7%. Under the conditions employed, the magnitude of body mass lost in SWB was similar to FWB. Augmenting passive fluid loss during hot water immersion with the addition of salt may require a higher salt concentration than that presently utilised.

Comparison of hot water immersion at 37.8°C with or without salt for rapid weight loss in mixed martial arts athletes

Hot water immersion, known as a hot bath, is used by MMA athletes to produce rapid weight loss (RWL) by means of passive fluid loss. This study investigated the magnitude of body mass losses using a standardized hot bath protocol with or without the addition of salt. In a crossover design, eleven male MMA athletes (28.5 ± 4.6 y; 1.83 ± 0.07 m; 82.5 ± 9.1 kg) performed a 20-min immersion at 37.8°C followed by a 40-min wrap in a warm room. This bath and wrap was performed twice per visit. During one visit, only fresh water was used (FWB), and in the other visit, magnesium sulphate (1.6% wt/vol) was added to the bath (SWB). Prior to each visit, 24 h of carbohydrate, fibre, and fluid restriction was undertaken as part of the RWL protocol. Body mass losses induced by the hot bath protocols were 1.63 ± 0.75 kg and 1.60 ± 0.80 kg for FWB and SWB, respectively, and equivalent to ~2.1% body mass. Under the conditions employed, the magnitude of body mass loss in SWB was similar to FWB. However, further research should explore bathing in a temperature that is consistent with that habitually used by fighters, and/or higher concentrations of salt.

Medical care in unlicensed combat sports: A need for standardised regulatory frameworks

OBJECTIVES

To explore the provision of medical care at 'unlicensed', full-contact amateur and lower-level professional combat sports competitions in England.

DESIGN

Qualitative, mixed methods.

METHODS

Observations totalling 200h of fieldwork shadowing medical professionals at 27 individual combat sports events, alongside formal, semi-structured interviews with 25 medical professionals, 7 referees and 9 promoters/event staff.

RESULTS

Practices and standards vary widely. Event organisers and promoters often have very little understanding of how different types of medical practitioners operate. They rarely, if ever, check that the staff they are hiring are qualified, sometimes resulting in unqualified staff being used to provide medical cover at events. Venues are often poorly equipped to accommodate basic medical procedures. Patient confidentiality is very often compromised. Medical professionals often have limited autonomy within the combat sports milieu and may find themselves marginalised, with their judgements overruled by non-medical staff during competitive events. Some practitioners are cognisant of the dangers such working environments pose to their professional reputations and livelihoods, but remain working within combat sports regardless.

CONCLUSIONS

Despite pockets of good practice, the lack of standardised rules for medical care provision creates substantial risks to athletes, to practitioners and the standing of the profession. The development and implementation of standardised, enforceable regulatory frameworks for full-contact combat sports in England is urgently needed.

Prevalence, Magnitude and Methods of Rapid Weight Loss Reported by Male Mixed Martial Arts Athletes in Ireland

Rapid weight loss (RWL) is frequently practiced in weight category sports, including Mixed Martial Arts (MMA). The aim of the present study was to describe self-reported methods of RWL in a sample of competitive MMA athletes comprising of both amateur and professional fighters. The previously-validated Rapid Weight Loss Questionnaire, with the addition of questions on water loading and hot salt baths, was completed anonymously online by athletes (n = 30; all male, n = 15/15 professional/amateur) from MMA clubs around Dublin, Ireland. All but one (97%) of the athletes surveyed lost weight in order to compete, with the average weight loss being 7.9% ± 3.1% of habitual body mass. The RWL score (mean ± SD) for this sample was 37.9 ± 9.6, and a tendency for higher [6.0 (95%CI; −1.1, 13.1) (p = 0.093; d = 0.64)] RWL scores for professional (40.8 ± 8.9) compared to amateur (34.8 ± 9.6) athletes was observed. Frequencies of “always” or “sometimes” were reported as 90% for water loading, 76% for hot salt baths and 55% for 24 h of fasting. Fellow fighters (41%) and coaches/mentors (38%) were “very influential” on RWL practices of these athletes, with doctors (67%), dietitians (41%), and physical trainers (37%) said to be “not influential”. RWL is highly prevalent in MMA across both amateur and professional athletes, and RWL scores are higher than other combat sports. Water loading and hot salt baths are amongst the most commonly used methods of RWL despite little research on these methods for body mass reduction or effects on performance in weight category sports.