Date of Award

Spring 2021

Degree Type



Exercise Science

Director of Thesis

Dr. Toni M. Torres-McGehee

First Reader

Allison B. Smith

Second Reader

Allison B. Smith


Content: As the pressure on collegiate and elite female athletes to perform at their highest possible capabilities has grown, so to have the consequences associated with their high energy expending lifestyles. The Female Athlete Triad (Triad) is a syndrome defined as having one or more of the following conditions: LEA with or without disordered eating, menstrual dysfunction, and/or low BMD. Due to potential long-term, irreversible health consequences of the Triad, the Female Athlete Triad Coalition developed a risk assessment tool known as the Triad CRA to identify at-risk athletes and subsequent return-to-play status. Objective: To determine the risk classification and return-to-play status for each female collegiate student-athlete according to the Triad CRA, and to examine the efficacy of the Triad CRA. Design: This was a retrospective study designed to investigate the efficacy of the Triad CRA. The data analyzed was part of a larger study. Setting: Research laboratory. Participants: This study re-evaluated previously collected data from local female collegiate student-athletes (n = 125). The student-athletes included were from the disciplines of equestrian (n=29), volleyball (n=13), softball (n=17), beach volleyball (n=18), soccer (n=20), and ballet (n=28). Interventions: Independent variables included sport type. Main Outcome Measures: Dependent variables included Triad CRA classifications (low, moderate, high) and corresponding return-to-play status (full clearance, provisional clearance, restricted from training). Results: Overall, significant differences were found between sport type and CRA scores (P = .035) and LEA with or without an ED risk (P ≤ 0.01). For LEA with or without ED risk, 2.4% (n=3/125) of student-athletes were classified as low risk, 34.4% (n=43/125) were moderate risk, and 63.2% (n=79/125) were high risk. Significant differences were also found between return-to-play status and sport type (P = .045). Full clearance was given to 24.0% (n=30/125) of athletes, provisional/ limited clearance was given to 74.4% (n=93/125) and restricted from training and competing was given to 1.6% (n=2/125). Conclusion: Since it was predicted that the majority of the study’s female student- athletes would be placed in the moderate risk category, the hypothesis was supported because 74.4% of student-athletes were assigned moderate risk (provisional clearance). Another important finding was that 34.4% of all athletes had moderate risk and 63.2% of athletes had high risk for LEA with or without ED risk. Since LEA with or without ED risk has been shown to have potential long-term, irreversible health consequences, an athlete could be considered high risk and suffer future medical consequences without having a clinical ED diagnosis and, therefore, it should not be used as criteria in the Triad CRA. Lastly, any athlete classified as moderate or high risk warrants greater surveillance and further investigation into their health status before healthcare providers can confidently allow them a safe, full clearance on training and competing.

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