Many micronutrients play key roles in energy metabolism, and during strenuous physical activity the rate of energy turnover in skeletal muscle may be increased up to 20-100 times the resting rate. Although an adequate vitamin and mineral status is essential for normal health, marginal deficiency states may only be apparent when the metabolic rate is high. Prolonged strenuous exercise performed on a regular basis may also result in increased losses from the body or in an increased rate of turnover, resulting in the need for an increased dietary intake. An increased food intake to meet energy requirements will increase dietary micronutrient intake, but individuals who are very active may need to pay particular attention to their intake of iron and calcium.
Iron deficiency anemia affects some athletes engaged in intensive training and competition, but it seems that the prevalence is the same in athletic and sedentary populations, suggesting that exercise per se does not increase the risk. The implications of even mild anemia for exercise performance are, however, significant. A fall in the circulating hemoglobin concentration is associated with a reduction in oxygen-carrying capacity and a decreased exercise performance. Low serum ferritin levels are not associated with impaired performance, however, and iron supplementation in the absence of frank anemia does not influence indices of fitness.
Osteoporosis is now widely recognized as a problem for both men and, more especially, women, and an increased bone mineral content is one of the benefits of participation in an exercise program. Regular exercise results in increased mineralization of those bones subjected to stress and an increased peak bone mass may delay the onset of osteoporotic fractures; exercise may also delay the rate of bone loss. Estrogen plays an important role in the maintenance of bone mass in women, and prolonged strenuous activity may result in low estrogen levels, causing bone loss. Many very active women also have a low body fat content and may also have low energy (and calcium) intakes in spite of their high activity levels. All of these factors are a threat to bone health. The loss of bone in these women may result in an increased predisposition to stress fractures and other skeletal injury and must also raise concerns about bone health in later life. It should be emphasized, however, that this condition appears to affect only relatively few athletes, and that physical activity is generally beneficial for the skeleton.
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