{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T23:24:46Z","timestamp":1772061886862,"version":"3.50.1"},"reference-count":55,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FCT","award":["UIDB\/05913\/2020"],"award-info":[{"award-number":["UIDB\/05913\/2020"]}]},{"name":"FCT","award":["UIDB\/00617\/2020"],"award-info":[{"award-number":["UIDB\/00617\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: Sport plays an important role in the health promotion of people with cerebral palsy (CP). However, risk factors may impair sport performance and health in non-ambulatory athletes. Therefore, the aim of the present study was to explore body composition and bone health in a group of world-class Boccia players with CP. Methods: Five BC2-class players with CP, aged 15\u201342 years old, were assessed using Dual-Energy X-Ray Absorptiometry (DXA) for body composition and bone mineral density (BMD) and content (BMC). The fat mass index (kg\/m2) was used to define obesity, and the BMD Z-score used to analyze bone health. A preliminary indicator of sarcopenia was considered using the appendicular lean mass index. Results: Players 1 and 3 exhibited similar body compositions (obesity class 1 and BMD Z-score are below the expected range for age). Player 5 exhibited multiple health-related risk factors. The results regarding youth players (Player 2 and Player 4) should be analyzed with caution. Conclusions: Overall, due to Boccia\u2019s specific characteristics, players may benefit from close monitoring by multidisciplinary teams and supplementary strategies (e.g., strength training, individualized diet plans) to promote quality of life and performance. However, further research is needed to confirm the data, since these preliminary findings do not allow for broader generalizations.<\/jats:p>","DOI":"10.3390\/healthcare13141658","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T07:38:27Z","timestamp":1752133107000},"page":"1658","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploratory Assessment of Health-Related Parameters in World-Class Boccia Players Using DXA"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9397-8109","authenticated-orcid":false,"given":"B\u00e1rbara","family":"Vasconcelos","sequence":"first","affiliation":[{"name":"Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4099-002 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2099-9643","authenticated-orcid":false,"given":"Jos\u00e9 Irineu","family":"Gorla","sequence":"additional","affiliation":[{"name":"Department of Adapted Physical Activity Studies, Faculty of Physical Education, State University of Campinas, Bar\u00e3o Geraldo 13083-859, Brazil"},{"name":"ACELERAR Development Center, Rol\u00e2ndia 86605-000, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7027-526X","authenticated-orcid":false,"given":"Karina Santos Guedes de","family":"S\u00e1","sequence":"additional","affiliation":[{"name":"Department of Adapted Physical Activity Studies, Faculty of Physical Education, State University of Campinas, Bar\u00e3o Geraldo 13083-859, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2125-0805","authenticated-orcid":false,"given":"Rui","family":"Corredeira","sequence":"additional","affiliation":[{"name":"Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, 4099-002 Porto, Portugal"},{"name":"Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9974-408X","authenticated-orcid":false,"given":"T\u00e2nia","family":"Bastos","sequence":"additional","affiliation":[{"name":"Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4099-002 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"ref_1","first-page":"2130","article-title":"Cerebral Palsy: An Overview","volume":"101","author":"Vitrikas","year":"2020","journal-title":"Am. Fam. Physician"},{"key":"ref_2","first-page":"8","article-title":"A report: The definition and classification of cerebral palsy April 2006","volume":"49","author":"Rosenbaum","year":"2006","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2622310","DOI":"10.1155\/2022\/2622310","article-title":"A Review on recent advances of cerebral palsy","volume":"2022","author":"Paul","year":"2022","journal-title":"Oxidative Med. Cell. Longev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/GRF.0b013e3181870ba7","article-title":"Diagnosis, treatment, and prevention of cerebral palsy","volume":"51","year":"2008","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1080\/09638280801976233","article-title":"Influence of adapted sport on quality of life: Perceptions of athletes with cerebral palsy","volume":"31","author":"Groff","year":"2009","journal-title":"Disabil. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"205","DOI":"10.6018\/cpd.492031","article-title":"Boccia in Paralympic Games: The evolution from 1984 to 2016 and future perspectives","volume":"22","author":"Ferreira","year":"2022","journal-title":"Cuad. Psicol. Del Deporte"},{"key":"ref_7","unstructured":"World Boccia (2025, January 02). About Boccia. Available online: https:\/\/www.worldboccia.com\/about-boccia\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1589\/jpts.32.574","article-title":"Throwing distance and competitive performance of Boccia players","volume":"32","author":"Kataoka","year":"2020","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_9","unstructured":"Boccia England (2024, December 10). Big Boccia Survey 2024 Results. Available online: https:\/\/www.bocciaengland.org.uk\/news\/big-boccia-survey-2024-results."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.amepre.2004.02.002","article-title":"Physical activity participation among persons with disabilities: Barriers and facilitators","volume":"26","author":"Rimmer","year":"2004","journal-title":"Am. J. Prev. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Shin, H.I., and Jung, S.H. (2021). Body fat distribution and associated risk of cardiovascular disease in adults with cerebral palsy. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.733294"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1016\/j.apmr.2010.04.008","article-title":"Interlimb muscle and fat comparisons in persons with lower-limb amputation","volume":"91","author":"Sherk","year":"2010","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/j.jocd.2008.04.006","article-title":"Body composition in paraplegic men","volume":"11","author":"Dionyssiotis","year":"2008","journal-title":"J. Clin. Densitom."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1152\/japplphysiol.00729.2002","article-title":"Factors influencing body composition in persons with spinal cord injury: A cross-sectional study","volume":"95","author":"Spungen","year":"2003","journal-title":"J. Appl. Physiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1123\/jsr.2015-0036","article-title":"Assessment of body composition and sport performance of Brazilian Paralympic swim team athletes","volume":"25","author":"Medeiros","year":"2016","journal-title":"J. Sports Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1123\/ijspp.2014-0186","article-title":"Relationships between propulsion and anthropometry in Paralympic swimmers","volume":"10","author":"Dingley","year":"2015","journal-title":"Int. J. Sports Physiol. Perform."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e09023","DOI":"10.1016\/j.heliyon.2022.e09023","article-title":"Anthropometry, body composition, and athletic performance in specific field tests in Paralympic athletes with different disabilities","volume":"8","author":"Cherif","year":"2022","journal-title":"Heliyon"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.1016\/j.apmr.2015.06.007","article-title":"Greater adipose tissue distribution and diminished spinal musculoskeletal density in adults with cerebral palsy","volume":"96","author":"Peterson","year":"2015","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.pediatrneurol.2023.09.002","article-title":"Does botulinum toxin injection exacerbate sarcopenia and bone mass in individuals with cerebral palsy?","volume":"149","author":"Su","year":"2023","journal-title":"Pediatr. Neurol."},{"key":"ref_21","first-page":"1296","article-title":"Sarcopenia among adults with cerebral palsy in South Korea","volume":"11","author":"Jeon","year":"2019","journal-title":"Phys. Med. Rehabil. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/j.1469-8749.2003.tb00853.x","article-title":"Prevalence of reduced bone mass in children and adults with spastic quadriplegia","volume":"45","author":"King","year":"2003","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Won, J.H., and Jung, S.H. (2021). Bone mineral density in adults with cerebral palsy. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.733322"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1007\/s00198-015-3393-6","article-title":"Osteoporosis in adults with cerebral palsy: Feasibility of DXA screening and risk factors for low bone density","volume":"27","author":"Marciniak","year":"2016","journal-title":"Osteoporos. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.bone.2014.10.003","article-title":"Adults with spastic cerebral palsy have lower bone mass than those with dyskinetic cerebral palsy","volume":"71","author":"Kim","year":"2015","journal-title":"Bone"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.apmr.2015.03.012","article-title":"Bone density in premenopausal women and men under 50 years of age with cerebral palsy","volume":"96","author":"Fowler","year":"2015","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1002\/jbmr.3694","article-title":"Adults with cerebral palsy have higher prevalence of fracture compared with adults without cerebral palsy independent of osteoporosis and cardiometabolic diseases","volume":"34","author":"Whitney","year":"2019","journal-title":"J. Bone Miner. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e11296","DOI":"10.7717\/peerj.11296","article-title":"Body composition and bone mineral density in athletes with a physical impairment","volume":"9","author":"Cavedon","year":"2021","journal-title":"PeerJ"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Kelly, T.L., Wilson, K.E., and Heymsfield, S.B. (2009). Dual energy X-Ray absorptiometry body composition reference values from NHANES. PLoS ONE, 4.","DOI":"10.1371\/journal.pone.0007038"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jocd.2006.05.002","article-title":"Official positions of the International Society for Clinical Densitometry and Executive Summary of the 2005 Position Development Conference","volume":"9","author":"Binkley","year":"2006","journal-title":"J. Clin. Densitom."},{"key":"ref_31","unstructured":"Hastie, T., Witten, D., James, G., and Tibshirani, R. (2021). An Introduction to Statistical Learning with Applications in R, Springer. [2nd ed.]."},{"key":"ref_32","unstructured":"R Core Team (2024). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.47197\/retos.v48.95110","article-title":"Current status of sport performance in Boccia: Systematic review of the literature","volume":"48","author":"Ferreira","year":"2023","journal-title":"Retos"},{"key":"ref_34","unstructured":"Vanlandewijck, Y.C., and Thomposon, W.R. (2011). Nutrition, body composition and pharmacology. Handbook of Sports Medicine and Science: The Paralympic Athlete, Wiley-Blackwell."},{"key":"ref_35","first-page":"228","article-title":"Gender differences in boccia underhand throw biomechanics","volume":"18","author":"Hendarto","year":"2023","journal-title":"Revista Iberoamericana Ps\u00edcologia Ejercicio Deporte"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"381","DOI":"10.47197\/retos.v54.102554","article-title":"The effects of Boccia training load on emotional intelligence and quality of life in individuals with cerebral palsy","volume":"54","author":"Rezavandzayeri","year":"2024","journal-title":"Retos"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1589\/jpts.36.245","article-title":"Training effect of repeated rolling motions on boccia players with severe cerebral palsy: Comparison with the effect of conventional upper-limb training using a crossover test","volume":"36","author":"Yahagi","year":"2024","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1111\/sms.14281","article-title":"\u201cIt gives me a wake up call\u201d-It is time to implement athlete health monitoring within the Para sport context","volume":"33","author":"Fagher","year":"2022","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1111\/dmcn.14028","article-title":"Cardiovascular disease and related risk factors in adults with cerebral palsy: A systematic review","volume":"61","author":"McPhee","year":"2018","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/j.1469-8749.1999.tb00660.x","article-title":"Causes of excess mortality in cerebral palsy","volume":"41","author":"Strauss","year":"1999","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.apmr.2015.09.007","article-title":"Impact of wheelchair rugby on body composition of subjects with tetraplegia: A pilot study","volume":"97","author":"Gorla","year":"2016","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/dmcn.13053","article-title":"Exercise and physical activity recommendations for people with cerebral palsy","volume":"58","author":"Verschuren","year":"2016","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e000111","DOI":"10.1136\/bmjsem-2016-000111","article-title":"High-intensity interval training to improve fitness in children with cerebral palsy","volume":"2","author":"Lauglo","year":"2016","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"ref_44","unstructured":"Olympics (2025, January 13). Paralympic Schedule&Results: Boccia. Available online: https:\/\/olympics.com\/en\/paris-2024\/paralympic-games\/schedule\/boccia?day=29-august."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Broad, E. (2019). Assessing body composition of athletes. Sports Nutrition for Paralympic Athletes, Taylor & Francis Group. [2nd ed.].","DOI":"10.1201\/9780429491955"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1249\/MSS.0000000000003379","article-title":"Energy Requirements of Paralympic Athletes: Insights from the Doubly Labeled Water Approach","volume":"56","author":"Weijer","year":"2024","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_47","unstructured":"Boccia Canada (2024, December 21). Long-Term Athlete Development Model. Available online: https:\/\/bocciacanada.ca\/wp-content\/uploads\/2021\/08\/Long-Term-Athlete-Development-Model-en.pdf."},{"key":"ref_48","first-page":"543","article-title":"American College of Sports Medicine Joint Position Statement. Nutrition and Athletic Performance","volume":"48","author":"Thomas","year":"2016","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1002\/jcsm.12922","article-title":"Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults","volume":"13","author":"Nunes","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Wu, S.H., Chen, K.L., Hsu, C., Chen, H.C., Chen, J.Y., Yu, S.Y., and Shiu, Y.J. (2022). Creatine supplementation for muscle growth: A scoping review of randomized clinical trials from 2012 to 2021. Nutrients, 14.","DOI":"10.3390\/nu14061255"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Koivisto-Mork, A.E., Steffen, K., Finnes, T.E., Pretorius, M., and Berge, H.M. (2023). High prevalence of low bone mineral density but normal trabecular bone score in Norwegian elite Para athletes. Front. Sports Act. Living, 5.","DOI":"10.3389\/fspor.2023.1246828"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00774-007-0789-1","article-title":"Effect of sports activity on bone mineral density in wheelchair athletes","volume":"26","author":"Miyahara","year":"2008","journal-title":"J. Bone Miner. Metab."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"101767","DOI":"10.1016\/j.bonr.2024.101767","article-title":"Do Paralympic athletes suffer from brittle bones? Prevalence and risk factors of low bone mineral density in Paralympic athletes","volume":"21","author":"Weijer","year":"2024","journal-title":"Bone Rep."},{"key":"ref_54","unstructured":"Broad, E. (2004). Cerebral Palsy and Acquired Brain Injuries. Sports Nutrition for Paralympic Athletes, Taylor & Francis Group."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Broad, E. (2019). Use of supplements in athletes with an impairment. Sports Nutrition for Paralympic Athletes, Taylor & Francis Group. [2nd ed.].","DOI":"10.1201\/9780429491955"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/13\/14\/1658\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:07:30Z","timestamp":1760033250000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/13\/14\/1658"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":55,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["healthcare13141658"],"URL":"https:\/\/doi.org\/10.3390\/healthcare13141658","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]}}}