Relative Energy Deficiency in Sport (REDs) is a syndrome first coined by the International Olympic Committee in 2014. In this blog, we will explore what it is, who it can affect, the warning signs, and the role a CSSM Physiotherapist may play in management.

 

 

What is REDs?

 

REDs occurs when athletes and active people experience negative health and performance consequences due to under-fueling or low energy availability (LEA). LEA, and subsequently REDs, occurs due to an imbalance between energy intake and expenditure and exists when under-fueling is sustained for extended periods of time.

 

In the simplest terms:

Energy (dietary) intake < energy expenditure = LEA.

Sustained LEA = REDs.

  

If left untreated, REDs can lead to long-term irreversible damage and can negatively affect almost every system in the body.

 

 

Who does this affect?

While REDs can and does affect active people of any gender and ability level, it has an increased prevalence amongst:

 

  • Endurance athletes – some high-level endurance training (often >30hrs of training per week), can result in extreme energy expenditure that exceeds the body’s ability to regulate energy absorption.
  • Sports that tie athletic success to leanness (eg road cycling, gymnastics, long distance running) and/or require regular weigh-ins to meet a weight category (eg rowing, combat sports).
  • Adolescences – on top of their daily needs and exercise, adolescents require increased energy intake (ie. food) for growth.
  • Females – whilst under-fueling affects all genders, the AIS reported a third of female athletes may be under-fueling. Prolonged under-fuelling causes REDs.

 

So what can cause under-fueling?

Although often associated with disordered eating, under-fueling can be caused unintentionally or through poor weight management efforts.

 

Examples of this can include:

  • Altered training/competition load
  • New training squad/location
  • Not understanding individual energy needs for specific sports/training loads

 

What warning signs should I look out for?

  • Changes to mood / increased irritability / reduced motivation
  • Persistent fatigue
  • Recurrent injury or illness
  • Loss of menstruation
  • Plateaued or reduced performance

Spreading awareness of REDs is a vital tool not only for health practitioners, but by recognising the warning signs, athletes, coaches, and parents can keep ahead of potential REDs symptoms.

 

Consequences of REDs may include changes to:

  • Musculoskeletal function
  • Growth and development
  • Bone health
  • Immunity
  • Reproductive function

 

These changes can lead to:

  • Decreased muscle strength and power
  • Decreased cognitive performance/skill
  • Reduced endurance performance
  • Decreased motivation
  • Increased injury risk

 

How is it treated?

Early identification of individuals at risk of REDs is essential as some long-term sequelae may be irreversible. As REDs is multifactorial, management requires a multi-disciplinary team of health professionals. Treatment is very individualised and aims to address symptoms and the cause of under-fuelling. It aims to support individuals to participate in sports at a safe and appropriate level, whilst replenishing fuel sources that promote their long-term health, wellbeing, and sports performance.

 

What is a Physio’s role in REDs management?

Physio’s play a significant role amongst the multidisciplinary team in the prevention and management of REDs.

This can include:

  • Initial screening: early identification and appropriate referral to sports medicine physician and multidisciplinary team
  • Rehabilitation: managing injuries, particularly bone stress injuries, and optimal strength and resistance training
  • Ongoing education regarding appropriate and safe training load

 

Seeking professional help is paramount to the health and wellbeing of individuals at risk of REDs. If you, or someone you know is at risk of REDs please get in contact with one of our Physio’s today.

 

About the author:

As a recreational runner and Pilates lover, Katie enjoys utilising exercise therapy and Clinical Pilates to get individual’s back on track. In addition, Katie has a particular interest in pre/post-natal rehabilitation and working with active people and athletes to get them back to their desired sport.

 

Resources:

Australian Sports Commission, Australian Government 2024,

<https://www.ais.gov.au/nutrition/additional-resources#causes_of_low_energy_availability>.

Mountjoy M, Ackerman K, Bailey D, Burke L, Constantini N, Hackney A, Heikura I, Melin A, Pensgaard A, Stellingwerff T, Sundgot-Borgen J, Torstveit M, Jacobsen A, Verhagen E, Budgett R, Engebretsen L, Erdener U, 2023, ‘International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)”

British Journal of Sports Medicine 2023, no 57:1073-1098, <https://bjsm.bmj.com/content/57/17/1073>.