Effects of the Six Pillars of Lifestyle Medicine on the Performance of High School Athletes: A Systematic Review.

Abstract

Introduction: High school athletes face unique challenges, including balancing academic and athletic demands, addressing mental health concerns, maintaining adequate nutrition and sleep, and mitigating risks such as substance use and maladaptive behaviors. Female athletes frequently encounter additional issues, including amenorrhea and irregular menses. Lifestyle Medicine, encompassing nutrition, sleep, stress management, physical activity, avoidance of risky substances, and social connection, offers a promising framework for addressing these challenges through targeted, evidence-based interventions.

Methods: A review of peer-reviewed studies from the last 15 years was conducted using databases like PubMed, Scopus, and Embase. Studies focused on athletes aged 14-18 were included, with 1423 studies screened and 31 meeting inclusion criteria. Studies on nonathlete populations and adults were excluded.

Results: Of the 31 included studies, 6 addressed nutrition, 3 physical activity, 5 sleep, 5 stress management, 7 avoidance of risky substances, and 5 social connection. Notably, 52.1% of female athletes were found to be at risk for low energy availability (LEA), and over 79% of athletes reported sleeping fewer than 8 h per night, below the recommended range of 8-10 h for adolescents. Stress management emerged as a critical gap, with 91% of athletes reporting sport-related stress, yet only 27% received professional support. High-contact sports were associated with increased risks of substance misuse, including lifetime opioid use rates as high as 46% in some cohorts.

Conclusion: This review underscores the urgent need for targeted interventions such as nutrition education programs, sleep hygiene initiatives, and mindfulness-based stress management tailored to high school athletes. Addressing these gaps within the framework of Lifestyle Medicine can enhance both performance and long-term well-being. Future research should evaluate the effectiveness of these interventions and explore their clinical and developmental implications.