# Sex Differences in the Impact of Body Composition and Bone Mineral Content on Cardiopulmonary Performance in Elite Youth Water Polo Athletes

## TL;DR

This study explores how body composition and bone density affect aerobic performance in youth water polo athletes, finding sex-specific differences in these relationships.

## Contribution

The study reveals sex-specific correlations between body composition, bone mineral density, and cardiopulmonary performance in elite youth athletes.

## Key findings

- Body fat mass negatively correlates with exercise time and relative maximal oxygen uptake.
- Lean body mass and bone mineral content positively correlate with maximal oxygen uptake and ventilation.
- Bone density correlations with cardiopulmonary performance are stronger in males.

## Abstract

Body composition, bone mineral density, and cardiopulmonary exercise testing (CPET) are commonly used to assess aerobic fitness in athletes, but their interrelationships remain unclear. This study compared these parameters by sex and examined their associations in elite athletes. Our study included 145 youth water polo players (age: 15.7 ± 1.6 years; male: 75). Body composition was measured by DEXA, and treadmill CPET was performed using a sport-specific protocol. We analysed the correlations between the following factors by multivariate linear regression: lean body mass (LBM, LBMindex); body fat mass (BFM); percent body fat (PBF); bone mineral content (BMC); lumbar, femoral, and radial bone mineral density (LBMD, FNBMD, FTBMD, RBMD); exercise time; absolute and relative maximal oxygen uptake (VO2absmax, VO2relmax); maximal ventilation (VEmax). Exercise time was found to be negatively correlated with BFM, while VO2relmax was found to be negatively correlated with BFM and PBF. VO2absmax was found to be positively correlated with BFM, LBM, BMC, FNBMD, and RBMD. VEmax was found to be positively correlated with LBM and LBMindex. In males, VO2absmax and VEmax were found to be positively correlated with LBMD and FTBMD. Correlations between bone density and CPET proved to be stronger in males. Our results indicate that body composition and bone density parameters influence CPET parameters, and their complex evaluation can support personalized diagnostics and athletes’ health.