Risks for eating disorder in ultra-endurance athletes and the role of training volume: a cross-sectional study

Characterized by prolonged physical activity, ultra-endurance sports (UES) have attracted increasing popularity. Though moderate exercise can confer mental health benefits, the effects of extreme training volumes remain unclear. Instead, emerging research suggests a link between high training loads and increased psychiatric vulnerabilities, including for eating disorders (ED). Consequently, this study aimed to investigate trends in ED risk in a sample of ultra-endurance athletes (UEA) and the relationship to training volumes.

A cross-sectional survey was administered among UEA using the Eating Attitudes Test-26 (EAT-26), alongside gathering demographic data and information on training hours. Athletes were categorized into three training volume groups: <10 h, 10-20 h, and >20 h per week. Statistical tests, including ANOVA, Mann-Whitney U-tests, and Receiver Operating Characteristic analysis, were used to examine correlations between training volume and ED risk while adjusting for age and gender.

Of the n = 531 participants, 11% (n = 58) scored above the clinical threshold on the EAT-26, indicating a need for further evaluation. Equally, 20.3% (n = 107) exhibited at least one conspicuous behavioral symptom of disordered eating. Training volume was a significant predictor of ED risk (F = 31.494, p < 0.001), with athletes training more per week exhibiting higher EAT-26 scores and greater engagement in disordered eating behaviors. Specifically, ROC analysis identified 14 h per week as the threshold for heightened ED susceptibility, with a sensitivity of 53.4% and specificity of 76.1%.

There was a significant association between high training volumes and increased ED risk among this UEA sample, suggesting a need for greater awareness of psychiatric vulnerabilities in endurance athletes. Given the growing popularity of UES, better education on the risks associated with high training volumes may be necessary to promote healthier training practices, underpinned by further research into its physiological and psychological consequences.