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Assessing Body Composition in Paralympians: Accuracy of Different Measurement Methods Compared with Dual-Energy X-Ray
Raffaella Spada1, Valentina Cavedon2, Lucrezia Macori1
1Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197 Rome, Italy.
Journal of Functional Morphology and Kinesiology
|January 21, 2026
Summary
Current body composition methods like Bioelectrical Impedance Analysis (BIA), Air Displacement Plethysmography (ADP), and skinfold equations are inaccurate for Paralympic athletes. Further research is needed to develop reliable assessment techniques for this diverse group.
Area of Science:
- Sports Science
- Human Physiology
- Biomedical Engineering
Background:
- Paralympic athletes present unique challenges for body composition analysis due to their heterogeneity.
- Accurate body composition assessment is crucial for training, health, and performance optimization in elite athletes.
Purpose of the Study:
- To evaluate the accuracy of Bioelectrical Impedance Analysis (BIA), Air Displacement Plethysmography (ADP), and skinfold equations for estimating relative fat mass (%FM) in Paralympians.
- To compare these methods against Dual-Energy X-Ray Absorptiometry (DXA) as the reference standard.
Main Methods:
- Sixty-six male and sixty-seven female Paralympians participated.
- Body composition was assessed using BIA, ADP, skinfold equations, and DXA on the same day.
- Statistical analyses included paired t-tests, concordance correlation coefficients, regression, and Bland-Altman analysis.
Main Results:
- BIA, ADP, and skinfold equations showed poor agreement with DXA.
- These methods significantly underestimated %FM in both male and female Paralympians, with biases from -1.8% to -10.7%.
- Skidfold sums, particularly the nine-skinfold model, demonstrated stronger correlations with %FM_DXA (adjusted R² ≈ 0.8).
Conclusions:
- Existing body composition assessment methods (skinfold equations, BIA, ADP) lack transferability and accuracy for Paralympic athletes.
- New methods or adaptations are required to accurately assess body composition in this population.
- Future research should consider specific impairments and health conditions when investigating body composition assessment techniques for Paralympians.
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