Knowledge of the Female Athlete Triad and Relative Energy Deficiency in Sport Among Female Cross-Country Athletes and Support Staff

Abstract

CONTEXT: Female endurance athletes exhibit an increased risk of Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). Triad and RED-S are conditions that explore the health and performance consequences of low energy availability (LEA). Few studies to date have assessed the knowledge that athletes, coaches, and athletic trainers (ATs) have regarding Triad/RED-S. Proper education has been shown to be effective in increasing knowledge of sports medicine concerns for athletes. Yet, there are no known continuing education programs for Triad/RED-S at collegiate institutions. OBJECTIVE: The primary purpose of this study was to assess the knowledge, confidence, and impact of identifying, screening, treating, and preventing Triad/RED-S. DESIGN: Cross-sectional study. SETTING: An evidence-based online survey was developed and administered via QualtricsTM. PARTICIPANTS: Female collegiate cross-country athletes (n = 275; 20 ± 1 yrs.), collegiate cross-country coaches (n = 55, 34 ± 9 yrs.), and ATs working with cross-country teams (n = 30, 36 ± 11 yrs.). MAIN OUTCOME MEASURE: Knowledge, confidence, and impact scores were assessed between groups using ANOVA. Independent t-tests were used to determine differences in impact scores between people who had or had not received education. RESULTS: Female cross-country athletes' total knowledge, confidence, and impact scores (mean scores of 25.00 ± 5.27, 95.42 ± 28.83, 18.81 ± 7.05 respectively) were significantly different from scores of coaches (mean scores of 26.92 ± 5.02, 111.35 ± 24.14 and 22.41 ± 6.33) and ATs (mean scores of 28.66 ± 4.02, 117.67 ± 22.53, and 23.93 ± 5.69) (p < 0.05). CONCLUSIONS: Knowledge, confidence, and impact scores of Triad/RED-S were lowest in female cross-country athletes and highest in ATs. These findings support the call for education, which should be regarded as the primary tool to increase knowledge to improve the prevention and treatment of Triad/RED-S.

Effects of a 16-Week Digital Intervention on Sports Nutrition Knowledge and Behavior in Female Endurance Athletes with Risk of Relative Energy Deficiency in Sport (REDs)

“…Study week 0 (baseline) was followed by the intervention (Part 3), during the athletes' off-season or a 16-week control period (study week [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. The duration from Part 1 to Part 2 was approximately four weeks.…”

“…There are many reasons for LEA ranging from disordered eating and eating disorders to unintentional under fueling [5]. One of the most prevalent underlying causes of LEA-and RED-S-related symptoms has been reported to be unintentional [6,7], due to the suppression of appetite after high-and moderate-intensity training [8,9] and/or a lack of knowledge of optimal sports nutrition, and the consequences of LEA over time [10][11][12][13][14]. In addition, there seems to be a normalization of some of the most frequent RED-S conditions, preventing female athletes from seeking help, for e.g., menstrual dysfunction [15].…”

“…Though several factors influence food choices in athletes [22,23], nutrition knowledge is one of the few determinants of dietary behavior that are modifiable and, therefore has the potential to impact athletic health and performance [23]. More specifically, sports nutrition knowledge has been positively associated with energy availability and carbohydrate intake in female endurance athletes [24], and educational initiatives have been proposed as a promising strategy to prevent and improve symptoms of RED-S [10,25].…”

Beyond the medals: a cross-sectional study exploring retired elite female athletes’ health

“…The presentation of RED-S may be unrecognised by athletes and coaches. 48 For example, one athlete described struggling with ‘low iron/ferritin, stress fractures, overtraining, and low body fat levels, which I feel all impaired my performance and tolerance of the training load’, although RED-S was not specifically reported by any athlete. Lack of awareness and support surrounding reproductive and endocrine health was a recurring theme from our participants and should be prioritised via educational initiatives, periodic health evaluations, and counselling.…”

Relative energy deficiency in sport: Health implications in female athletes

“…Despite the fact that the female athlete triad was defined nearly three decades ago, several surveys have indicated a knowledge deficit among physicians, physical therapists, and athletic trainers, with less than half of these healthcare professionals correctly identifying components of the female athlete triad. [16][17][18][19] RED-S, being relatively new to the scene as having been defined in 2014, is less understood among healthcare professionals. In a 2020 survey of healthcare professionals in attendance at a sports medicine conference, 76% includ-ing nurse practitioners, physicians, physician assistants, and physical therapists were aware of the triad, but only 29% were aware of RED-S. 20 Only 13% of survey participants indicated feeling confident in treating individuals with RED-S. 20 These results are discouraging when considering the critical role of healthcare professionals in promoting health and preventing disease.…”