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Delayed but Normally Progressed Puberty Is More Pronounced in Artistic Compared with Rhythmic Elite Gymnasts Due to the Intensity of Training

Department of Medicine, Division of Endocrinology (A.T., K.B.M., G.A.V., A.G.V.), University of Patras Medical School, University Hospital, Patras 26500, Greece; College of Health and Human Sciences (D.B.), Georgia State University, Atlanta, Georgia 30303-3083; International Federation of Gymnastics Medical Committee (M.L., K.B.M.), Lausanne 2740, Switzerland; and Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology (N.A.G., G.K.), University of Patras Medical School, University Hospital, 26500 Patras, Greece

Address all correspondence and requests for reprints to: Apostolos G. Vagenakis, Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, University Hospital, Rio-26500, Greece. E-mail: vag.inmd{at}med.upatras.gr.

Context: 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).

Design: Evaluation of somatometric parameters, pubertal stage, and intensity of training in the competition field were studied.

Setting: The study was conducted at European and world championships of years 1997–2004.

Subjects: Subjects included 433 elite RGs and 427 AGs, aged 11–23 yr.

Intervention: There were no interventions.

Main Outcome Measures: 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 ( 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).

Conclusion: 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.

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