Relative Energy Deficiency in Sport (RED-S) in Adolescents – A Practical Review

Abstract

There are many immediate and longer-term physical, psychological and metabolic benefits of being active during adolescence. These benefits exist when exercise and physical activity are undertaken in a state of energy balance. When exercise occurs in an environment of low energy availability, this is currently termed relative energy deficiency in sport and there are potential significant negative effects on mental well-being, bone, endocrine and metabolic health. Therefore, relative energy deficiency in sport may present to many different specialists or allied health professionals depending upon the symptoms or reasons for seeking help, which include injury, such as bone stress or soft tissue problems, irregular or absent menstruation, stress, anxiety or low mood, or sporting underperformance as examples. The promotion of physical activity in adolescence is a critical part of public health strategy. In parallel with this positive public health message, there needs to be an increase in the awareness of, and education about, relative energy deficiency in sport for those working with and looking after adolescents.This review provides an up to date, practical evidenced based guide on the recognition, investigation and management of relative energy deficiency in sport in the adolescent, both male and female.

RED-S: A Review of the Screening, Diagnosis, Treatment, and Recovery

“…Despite many studies investigating the prevalence of LEA, RED-S, and its symptoms (45), the literature on treatment options is surprisingly scarce. Consensus statements address the treatment options for athletes with LEA (65,78), and review papers provide an overview and recommendations of treatment strategies (12,28,39,71,82). However, there are only a handful of trials (13,29,34,40,77) and case studies (3,18,37,51) which have directly investigated improving EA in those with LEA (Table 1).…”

“…Reducing EEE is not always necessary, and an adequate EA can be achieved by an increase in EI alone (13,77). However, discussions with athletes, coaches, parents, and support teams may be useful to understand the athlete's overall physical demands for training, competing, other activities such as walking, other sports/teams, and work/educational commitments which may significantly contribute to their daily EEE and to canvas their views on a potential reduction (28,72). The inclusion of rest days into a well-structured training program should be considered, and an emphasis should be placed on the importance of recovery, not just for health but also for training adaptations and performance (28).…”

“…When increasing EI, it is important to adopt a "food first" approach, as opposed to one based on supplements (8,28).…”

Low Energy Availability and Eating Disorders Risk: A Comparison between Elite Female Adolescent Athletes and Ballet Dancers

“…Low energy availability (LEA) occurs when either the energy intake is too low or the energy output through training is too high, leading to an insufficient amount of energy left to maintain normal physiological functions such as bone health, cardiovascular health, immune function, and menstrual function in female athletes [1][2][3][4][5][6]. Both athletes and ballet dancers are driven by strong internal and external pressure to achieve optimal performance [6].…”

Controlling Behavior, Sex Bias and Coaching Success in Japanese Track and Field

“…Excessively controlling the athlete could also have an effect not only during but also after the athletic career, physiologically and psychologically [ 4 ] For example, if the coaches restrict the athletes’ food intake, it could lead to relative energy deficiency in sports (RED-S) and studies have shown that athletes who have suffered from RED-S could be at increased risk of cardiovascular diseases due to altered cholesterol metabolism [ 8 , 9 ]. Moreover, athletes with RED-S, especially during adolescence, are prone to low bone mineral density and decreased peak bone mass which is a predictor for bone fractures [ 10 , 11 , 12 ]. In addition, studies have shown that, possibly due to excessive pressure from coaches, athletes could experience depressive symptoms [ 13 , 14 , 15 , 16 , 17 ].…”