Key Factors Impacting Performance Health During Growth and Maturation in Adolescent Competitive Aesthetic and...

Aesthetic and acrobatic sports place high physical demands on youth athletes during critical periods of growth and maturation. These sports often involve intense training loads from an early age, which can influence physical development, injury risk, long-term health outcomes and performance.

The objectives were (1) to conduct a systematic review addressing key factors impacting performance health during growth and maturation in aesthetic and acrobatic high-performance youth athletes and (2) to investigate current methods for evaluating growth and maturation in this athletic population.

The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed.

The protocol was registered on the PROSPERO International prospective register (CRD42021261883). The electronic databases PubMed, Web of Science, SPORTDiscus and PsycINFO were searched for relevant studies up to 27 September 2025. Inclusion criteria were any sub-elite and elite athletes in aesthetic and acrobatic sports 18 years or under, a quantitative measurement of maturation and/or growth status/process in reference to the athlete's health outcome. Two independent authors screened search results, performed data extraction and assessed risk of bias using the quality assessment tool developed by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the Research Triangle Institute (RTI) international.

The results were reported on the basis of identifying 5 common themes amongst 65 studies and involving a total of 7782 participants; bone health; injury, illness and pain as outcomes; and anthropometric, biomechanical and training and performance as associated factors. Nutrition was also identified as a common interacting factor across themes. Growth and maturation measures and methods varied across studies. The review found that gymnastics training positively impacts bone health in prepubertal athletes, particularly in weight-bearing sites, although the risk of bone health injury increases around puberty possibly owing to later menarche, lower bone age and nutritional deficiencies. Dance studies show mixed results on bone health outcomes. Anthropometric and biomechanical factors including shorter stature, hypermobility and scoliosis and flexibility-strength imbalances may influence injury risk in association with being prepubescent. Later menarche, inadequate energy intake and discipline-specific bone development may contribute to tendon injuries, bone stress and overuse injuries in post-pubertal aesthetic and acrobatic athletes. Regular pre-pubertal gymnastics supports superior balance development. Training intensity can influence psychological stress and illness, particularly pre menarche, and male athletes respond differently to training than females during growth and maturation. Energy availability, along with psychological and behavioural factors may further affect injury, illness and performance outcomes.

The factors contributing to performance health in aesthetic and acrobatic athletes during growth and maturation are inter-related and include anthropometric, biomechanical, training and nutrition. Earlier identification and appropriate timely prevention strategies are essential for performance health in aesthetic and acrobatic athletes.