4.4. Strengths and Limitations
EEE
This is the first study evaluating EA during different training phases of wheelchair athletes. One limitation of our study is that not all athletes competed in the same sport type, resulting in unmatched time points in terms of the athletic season. However, this bias was minimized as most athletes competed in summer sports. Therefore, most athletes were in the pre-competition phase at the first two time points and in the competition phase at the last two time points. Nutrition knowledge was not assessed in this study. It may be that some of our athletes, such as endurance athletes, are more aware of the importance of fueling, especially carbohydrate intake [DXA measurements have been identified as the most accurate tool to assess whole-body fat, regional fat mass, and FFM in adults and athletes with SCI [Data collection using diaries is subject to under- or over-reporting, which may have influenced our results. The collection of physical activity data based on self-reported training diaries may lead to over- or underestimation of EEE and thus EA [It remains unknown whether the cut-off values for LEA in able-bodied athletes can be applied to wheelchair athletes [The data analyzed in this study were collected as part of a clinical trial. The athletes were asked not to change their diet or exercise patterns. The intervention evaluated in the clinical trial, the intake of probiotic and prebiotic supplementation, was also not expected to influence diet and exercise patterns. Nevertheless, participation in a clinical trial may have affected the behavior of the athletes. We speculate that this only had a minimal impact on the findings reported in this study.