Knowledge, Attitude, and Skill of High School Coaches with Regard to the Female Athlete Triad

Published:October 06, 2016DOI:


      Study Objective

      The purpose of this study was to investigate knowledge high school coaches have about the female athlete triad and to determine if gender differences in knowledge, attitudes, and behaviors exist.


      Cross-sectional survey.


      Twenty-six high schools in and around the vicinity of Cleveland, Ohio.


      Two-hundred currently employed high school coaches.


      Participants completed a 30-question survey used to assess knowledge, attitudes, and behaviors coaches had about the female athlete triad.

      Main Outcome Measures

      Descriptive statistics (means, SD, frequency) and gender differences in response to triad knowledge, attitude, and behavior questions.


      One hundred twenty-three high school coaches completed the survey. Survey respondents were between 25 and 35 years of age, coached for 6-10 years, and coached female athletes 75%-100% of the time. Twenty-four percent reported “having heard of the triad” and 14% (17 of 123) were able to correctly name all of its components. There were no significant differences between gender and the coach's ability to correctly name the 3 triad components (t = 1.47, P = .14). There was no correlation between coach gender (r = 0.13, P = .07), age (r = 0.07, P = .42), number of years of coaching (r = 0.014, P = .88), and coach's knowledge of the triad components, respectively.


      Female athletes might be at risk for developing the female athlete triad and high school coaches can be instrumental in identifying athletes who are at risk. This study showed that gaps in knowledge about the triad exist and that educating coaches about the condition could serve as an important means of prevention for the condition.

      Key Words

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        • DeSouza M.J.
        • Nattiv A.
        • Joy E.
        • et al.
        2014 Female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad: 1st international conference held in San Francisco, CA, 2012, and 2nd international conference held in Indianapolis, IN, 2013.
        Clin J Sports Med. 2014; 24: 96-119
        • Loucks A.B.
        • Verdun M.
        • Heath E.M.
        Low energy availability, not stress exercise alters LH pulsatility in exercising women.
        J Appl Physiol. 1998; 84: 37-46
        • Loucks A.B.
        • Manore M.M.
        • Sanborn C.F.
        • et al.
        The female athlete triad: position stand.
        Med Sci Sports Exerc. 2007; 39: 1867-1882
      1. Goodman CC, Fuller KS: The female genital/reproductive system. In: Pathology: Implications for the Physical Therapist, 4th ed. Philadelphia, Elsevier, 2015, pp 1020–1034.

        • Loucks A.B.
        • Thuma J.R.
        Lutenizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women.
        J Clin Endocrinol Metab. 2003; 88: 297-311
        • Warren M.P.
        • Perlroth N.E.
        The effects of intense exercise on the female reproductive system.
        J Endocrinol. 2001; 170: 3-11
        • Schneider J.E.
        • Wade G.N.
        Inhibition of reproduction of service of energy balance.
        in: Wallen K. Schneider J.E. Reproduction in Context: Social and Environmental Influences on Reproductive Physiology and Behavior. The MIT Press, Cambridge, MA2000: 35-82
        • DeSouza M.J.
        • Van Heest J.
        • Demers L.M.
        • et al.
        Luteal phase deficiency in recreational runners: evidence for a hypometabolic state.
        J Clin Endocrinol Metab. 2003; 88: 337-346
        • Loucks A.B.
        • Heath E.M.
        Dietary restriction reduces luteinizing hormone (LH) pulse frequency during waking hours and increases LH pulse amplitude during sleep in young menstruating women.
        J Clin Endocrinol Metab. 1994; 78: 910-915
        • Loucks A.B.
        Energy availability, not body fatness, regulates reproductive function in women.
        Exerc Sports Sci Rev. 2003; 31: 144
        • Williams N.I.
        • Helmreich D.L.
        • Parfitt D.B.
        • et al.
        Evidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training.
        J Clin Endocrinol Metab. 2001; 86: 5184-5193
        • Loucks A.B.
        • Hovarth S.M.
        • Freedson P.S.
        Menstrual status and validation of body fat prediction in athletes.
        Hum Biol. 1984; 56: 383-392
        • DeSouza M.J.
        • West S.L.
        • Jamal S.A.
        • et al.
        The presence of both an energy deficiency and estrogen deficiency exacerbate alterations of bone metabolism in exercising women.
        Bone. 2008; 43: 140-148
        • Mallinson R.J.
        • Williams N.J.
        • Hill B.R.
        • et al.
        Body composition and reproductive function exert unique influences and indices of bone health in exercising women.
        Bone. 2013; 56: 91-100
        • Nattiv A.
        • Kennedy G.
        • Barrack M.T.
        • et al.
        Correlation of MRI grading of bone stress injuries with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes.
        Am J Sports Med. 2013; 41: 1930-1941
        • Duckham R.L.
        • Peirce N.
        • Meyer C.
        • et al.
        Risk factors for stress fracture in female endurance athletes: a cross-sectional study.
        BMJ Open. 2012; 2: e001920
        • Kelsey J.L.
        • Bachrach L.K.
        • Procter-Gray E.
        • et al.
        Risk factors for stress fracture among young female cross-country runners.
        Med Sci Sports Exerc. 2007; 39: 1457-1463
        • Vanheest J.L.
        • Rodgers C.D.
        • Mahoney C.E.
        • et al.
        Ovarian suppression impairs sports performance in junior elite female swimmers.
        Med Sci Sports Exerc. 2014; 46: 156-166
        • O’Donnell E.
        • Harvey P.J.
        • Goodman J.M.
        • et al.
        Long-term estrogen deficiency lowers regional blood flow, resting systolic blood pressure, and heart rate in exercising premenopausal women.
        Am J Physiol Endocrinol Metab. 2007; 292: E1401-E1409
        • Rickenlund A.
        • Eriksson M.J.
        • Schenck-Gustafsson K.
        • et al.
        Amenorrhea in female athletes is associated with endothelial dysfunction and unfavorable lipid profile.
        J Clin Endocrinol Metab. 2005; 90: 1354-1359
        • Barrack M.T.
        • Ackerman K.E.
        • Gibbs J.C.
        Update on the female athlete triad.
        Curr Rev Musculoskelet Med. 2013; 6: 195-204
        • Keen A.D.
        • Drinkwater B.I.
        Irreversible bone loss in former amenorrheic athletes.
        Osteoporosis Int. 1997; 7: 311-315
        • Pantano K.J.
        Current knowledge, perceptions and interventions used by college coaches in the U.S., regarding the prevention and treatment of the female athlete triad.
        N Am J Sports Phys Ther. 2006; 1: 195-207
        • Sherman R.T.
        • DeHass D.
        • Thompson R.A.
        • et al.
        NCAA coaches survey: the role of the coach in identifying and managing athletes with disordered eating.
        Eat Disord. 2005; 13: 447-466
        • Mukherjee S.
        • Chand V.
        • Wong X.
        • et al.
        Perceptions, awareness and knowledge of the female athlete triad among coaches – are we meeting the expectations for athlete safety?.
        Int J Sports Sci Coach. 2016; 11: 545-551
        • Kroshus E.
        • Sherman R.T.
        • Thompson R.A.
        • et al.
        Gender differences in high school coaches’ knowledge, attitudes, and communication about the female athlete triad.
        Eat Disord. 2014; 22: 193-208
        • Brown K.N.
        • Wengreen H.J.
        • Beals K.A.
        Knowledge of the female athlete triad, and prevalence of triad risk factors among female high school athletes and their coaches.
        J Pediatr Adolesc Gynecol. 2014; 27: 278-282
        • Portney L.G.
        • Watkins M.P.
        Foundations of Clinical Research: Applications to Practice.
        3rd ed. Pearson/Prentice Hall, Upper Saddle River, NJ2009
        • Drinkwater B.
        • Bruemner B.
        • Chestnut C.H.
        Menstrual history as a determinant of current bone density in young athletes.
        JAMA. 1990; 263: 545-548
        • Rumble J.S.
        • LeBrun C.M.
        Pre-participation physical examination: selected issues for the female athlete.
        Clin J Sport Med. 2004; 14: 153-160
        • De La Torre D.M.
        • Snell B.J.
        Use of a pre-participation physical exam in screening for the female athlete triad among high school athletes.
        J Sch Nurs. 2005; 21: 340-345