Underfueled and overloaded: association between low energy availability symptoms and current self-reported injury status in climbers.

OBJECTIVE: The objective of this study was to investigate whether low energy availability (LEA) symptom burden is associated with current self-reported climbing-related injury status. METHODS: A cross-sectional, web-based survey was conducted to assess current self-reported climbing-related injury status, LEA symptoms, eating pathology, and psychological distress using validated and previously published instruments. Multivariable logistic regression models were applied to estimate odds ratios (ORs) for reporting a current injury, adjusting for age, sex, level of performance, training frequency, and climbing frequency. Sensitivity and interaction analyses were performed to evaluate psychosocial and climbing-context moderators. RESULTS: A total of 417 climbers participated (mean age 33.1 ± 9.9 years; 56.2% female). Higher-ability climbers showed greater odds of reporting a current climbing-related injury than lower-ability climbers (OR 2.10, 95% CI 1.33-3.30). LEA symptom burden was independently associated with current self-reported injury status (OR 1.38, 95% CI 1.08-1.76). The association remained significant after adjusting for anxiety and climbing discipline but was attenuated after adjusting for eating pathology and depressive symptoms. Eating pathology, depression, and anxiety were not independently associated with injury. Exploratory interaction analyses suggested that the association between LEA symptom burden and current self-reported injury status may be stronger among climbers scoring higher on eating pathology and higher climbing ability; however, these interactions were not statistically significant and should therefore be interpreted cautiously. Gastrointestinal symptoms were the LEA domain most consistently associated with self-reported current injury status. CONCLUSION: Greater LEA symptom burden was independently associated with current self-reported climbing-related injury status after adjusting for demographic characteristics and climbing exposure. Gastrointestinal symptoms demonstrated the most consistent association with current self-reported injury status. Higher climbing ability and LEA symptom burden were also associated with greater odds of reporting a current injury. However, there is a need for prospective longitudinal studies to clarify the temporal and potentially causal relationships among energy availability, psychological health, training load, and injury outcomes.