title: Delayed but normally progressed puberty is more pronounced in artistic compared with rhythmic elite gymnasts due to the intensity of training.
abstract: BACKGROUND
  Elite gymnasts are subjected to intense training, which may alter pubertal development.
  
  
  OBJECTIVE
  The objective of the investigation was to study the impact of gymnastics on pubertal development in rhythmic (RGs) and artistic gymnasts (AGs).
  
  
  METHODS
  Evaluation of somatometric parameters, pubertal stage, and intensity of training in the competition field were studied.
  
  
  METHODS
  The study was conducted at European and world championships of years 1997-2004.
  
  
  METHODS
  Subjects included 433 elite RGs and 427 AGs, aged 11-23 yr.
  
  
  METHODS
  There were no interventions.
  
  
  METHODS
  Mean chronological and bone ages of each pubertal stage and their relation to the intensity of training were measured.
  
  
  RESULTS
  AGs and RGs showed a delay in skeletal maturation (Delta age-bone age, 2.13 and 1.28, respectively; P < 0.001). AGs were subjected to higher levels of physical training. Thelarche occurred at 12.9 yr for RGs and 13.2 yr for AGs (P = 0.003) and pubarche at 12.5 and 12.9 yr, respectively (P = 0.002). Puberty was delayed but normally progressed. AGs entered each pubertal stage later than RGs. The delay was influenced by the amount of energy output. Menarcheal age was 14.6 yr for RGs and 14.9 yr for AGs. Menarche was influenced in AGs by bone age (b = 0.333; t = 2.521; P = 0.020), pubarche (b = 0.322; t = 2.401; P = 0.026), and body fat (b = -0.458; t = -3.412; P = 0.003) and in RGs by bone age (b = 0.378; t = 3.689; P < 0.001) and pubarche (b = 0.525; t = 6.017; P < 0.001).
  
  
  CONCLUSIONS
  In RGs and AGs, pubertal development was shifted to a later age, maintaining a normal rate of progression, which followed the bone age. AGs, who were exposed to a greater and more sustained energy output than RGs, presented a more pronounced delay in both skeletal maturation and pubertal development.
authors.affiliation: Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Rio-26500, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Theodoropoulou
authors.forename: Kostas B
authors.initials: KB
authors.lastname: Markou
authors.forename: George A
authors.initials: GA
authors.lastname: Vagenakis
authors.forename: Dan
authors.initials: D
authors.lastname: Benardot
authors.forename: Michel
authors.initials: M
authors.lastname: Leglise
authors.forename: George
authors.initials: G
authors.lastname: Kourounis
authors.forename: Apostolos G
authors.initials: AG
authors.lastname: Vagenakis
authors.forename: Neoklis A
authors.initials: NA
authors.lastname: Georgopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006173:Gymnastics; D006801:Humans; D008572:Menarche; D010806:Physical Education and Training; D011628:Puberty, Delayed; D012044:Regression Analysis; D012741:Sexual Maturation