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Tsukahara Y, Nose-Ogura S, Kinoshita S, Nakamura H, Koshimizu T, Gleason CN, Mason RA, Harada M, Hiraike O, Osuga Y. Differences in screening and treating relative energy deficiency in sport between the United States of America and Japan. J Sports Med Phys Fitness 2024; 64:175-182. [PMID: 38015478 DOI: 10.23736/s0022-4707.23.15302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND The diagnosis and treatment of relative energy deficiency in sport (RED-S) are challenging owing to variations in symptoms and the absence of specific guidelines. This study aimed to investigate differences in the diagnosis and follow-up of RED-S, its consequences, and related factors among sports medicine physicians with different backgrounds in Japan and the USA and examine the differences between the two countries. METHODS An anonymous survey regarding the diagnosis and treatment processes of RED-S was distributed to sports medicine physicians via email. Respondents included 58 sports medicine physicians from the USA and 241 from Japan. RESULTS The findings showed that 77.6% of the US physicians screened athletes for RED-S, whereas 17.5% of their Japanese counterparts did so. Moreover, 98.3% and 36.7% of the US and Japanese physicians, respectively, answered that they screened athletes for eating disorders upon suspicion of low energy availability. Logistic regression analysis revealed that the number of US sports medicine physicians who screened athletes for the female athlete triad (Triad) and RED-S (odds ratio [OR] = 12.78, P<0.001) and adhered to specific criteria for athlete suspension and return-to-play (OR=33.67, P<0.01) was higher than that of their Japanese counterparts. CONCLUSIONS The prevalence of RED-S-related screening and treatment differed between US and Japanese sports medicine physicians. Educating sports medicine physicians about the diagnosis and treatment of athletes with possible signs of RED-S is important in treating female athletes and further investigations are required to identify why the physicians screened/not screened the athletes.
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Affiliation(s)
- Yuka Tsukahara
- Department of Sports Medicine, Tokyo Women's College of Physical Education, Tokyo, Japan
| | - Sayaka Nose-Ogura
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Sakiko Kinoshita
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Hiroe Nakamura
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Takako Koshimizu
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Courtney N Gleason
- School of Medicine, Division of Sports Medicine, Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Rudolph A Mason
- School of Medicine, Division of Sports Medicine, Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, University of Tokyo Hospital, Tokyo, Japan
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2
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Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin A, Pensgaard AM, Stellingwerff T, Sundgot-Borgen JK, Torstveit MK, Jacobsen AU, Verhagen E, Budgett R, Engebretsen L, Erdener U. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med 2023; 57:1073-1097. [PMID: 37752011 DOI: 10.1136/bjsports-2023-106994] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023]
Abstract
Relative Energy Deficiency in Sport (REDs) was first introduced in 2014 by the International Olympic Committee's expert writing panel, identifying a syndrome of deleterious health and performance outcomes experienced by female and male athletes exposed to low energy availability (LEA; inadequate energy intake in relation to exercise energy expenditure). Since the 2018 REDs consensus, there have been >170 original research publications advancing the field of REDs science, including emerging data demonstrating the growing role of low carbohydrate availability, further evidence of the interplay between mental health and REDs and more data elucidating the impact of LEA in males. Our knowledge of REDs signs and symptoms has resulted in updated Health and Performance Conceptual Models and the development of a novel Physiological Model. This Physiological Model is designed to demonstrate the complexity of either problematic or adaptable LEA exposure, coupled with individual moderating factors, leading to changes in health and performance outcomes. Guidelines for safe and effective body composition assessment to help prevent REDs are also outlined. A new REDs Clinical Assessment Tool-Version 2 is introduced to facilitate the detection and clinical diagnosis of REDs based on accumulated severity and risk stratification, with associated training and competition recommendations. Prevention and treatment principles of REDs are presented to encourage best practices for sports organisations and clinicians. Finally, methodological best practices for REDs research are outlined to stimulate future high-quality research to address important knowledge gaps.
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Affiliation(s)
- Margo Mountjoy
- Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
- Games Group, International Olympic Committee, Lausanne, Switzerland
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Naama Constantini
- Sports Medicine Center, Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Anthony C Hackney
- Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ida Aliisa Heikura
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anna Melin
- Department of Sport Science - Swedish Olympic Committee Research Fellow, Linnaeus University, Kalmar, Sweden
| | - Anne Marte Pensgaard
- Department of Sport and Social Sciences, Norwegian School of Sports Sciences, Oslo, Norway
| | - Trent Stellingwerff
- Canada Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | | | | | | | - Evert Verhagen
- Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
- World Archery, Lausanne, Switzerland
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3
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Warrick AE, Hassid B, Coleman B, Cansino C, Faustin M. Multidisciplinary physician survey assessing knowledge of the female athlete triad and relative energy deficiency in sport. J Eat Disord 2023; 11:70. [PMID: 37161433 PMCID: PMC10169360 DOI: 10.1186/s40337-023-00800-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Short and long-term health consequences surrounding Low Energy Availability can be mitigated by recognizing the risk factors and making early diagnosis of the Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S). While awareness of the Triad among physicians and allied health professionals has been studied, there are very few studies that assess physician awareness of both the Triad and RED-S. METHODS Our study assesses Low Energy Availability, the Triad, and RED-S knowledge with an electronic survey, educational handout, and follow up survey among physicians across multiple specialties at a single academic institution. RESULTS Among 161 respondents, respective Triad and RED-S awareness among surveyed specialties was highest in Orthopedic surgeons (100%, 100%), followed by Physical Medicine & Rehabilitation (70%, 53%), Family Medicine (67%, 48%), Internal Medicine (54%, 36%), Obstetrics and Gynecology (46%, 32%), Pediatrics (45%, 29%), Endocrinology (33%, 33%), and Other (33%, 33%). Comparing the initial survey results to the follow-up survey results, there was an increase from 37 to 72% of physicians who correctly identified that the presence of low BMI or recent weight loss is not a required component of the Triad or RED-S. Both the initial and follow-up survey revealed a continued misperception surrounding the use of hormonal contraception to resume menstrual cycles, with 33% of physicians on initial survey and 44% of physicians on follow-up survey incorrectly answering that question. CONCLUSIONS Multidisciplinary physicians have various levels of knowledge surrounding the Triad and RED-S, and there is a need for improved physician awareness, diagnosis, and treatment of the Triad and RED-S. Misperceptions exist surrounding the role of hormonal contraception in female athletes with the Triad and RED-S to regain and regulate menses.
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Affiliation(s)
- Alexandra E Warrick
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Brandon Hassid
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Brandon Coleman
- Department of Physical Medicine and Rehabilitation, University of California Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA, 95817, USA
| | - Catherine Cansino
- Department of Obstetrics and Gynecology, University of California Davis School of Medicine, 2521 Stockton Blvd, 4th floor, Sacramento, CA, 95817, USA
| | - Marcia Faustin
- Department of Family & Community Medicine, University of California Davis School of Medicine, 4860 Y street Suite 3850, Sacramento, CA, 95816, USA.
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4
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Fahrenholtz IL, Melin AK, Wasserfurth P, Stenling A, Logue D, Garthe I, Koehler K, Gräfnings M, Lichtenstein MB, Madigan S, Torstveit MK. Risk of Low Energy Availability, Disordered Eating, Exercise Addiction, and Food Intolerances in Female Endurance Athletes. Front Sports Act Living 2022; 4:869594. [PMID: 35592590 PMCID: PMC9110838 DOI: 10.3389/fspor.2022.869594] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Relative energy deficiency in sport (RED-S) is a complex syndrome describing health and performance consequences of low energy availability (LEA) and is common among female endurance athletes. Various underlying causes of LEA have been reported, including disordered eating behavior (DE), but studies investigating the association with exercise addiction and food intolerances are lacking. Therefore, the aim of this cross-sectional study was to investigate the association between DE, exercise addiction and food intolerances in athletes at risk of LEA compared to those with low risk. Female endurance athletes, 18–35 years, training ≥5 times/week were recruited in Norway, Sweden, Ireland, and Germany. Participants completed an online-survey comprising the LEA in Females Questionnaire (LEAF-Q), Exercise Addiction Inventory (EAI), Eating Disorder Examination Questionnaire (EDE-Q), and questions regarding food intolerances. Of the 202 participants who met the inclusion criteria and completed the online survey, 65% were at risk of LEA, 23% were at risk of exercise addiction, and 21% had DE. Athletes at risk of LEA had higher EDE-Q and EAI scores compared to athletes with low risk. EAI score remained higher in athletes with risk of LEA after excluding athletes with DE. Athletes at risk of LEA did not report more food intolerances (17 vs. 10%, P = 0.198), but were more frequently reported by athletes with DE (28 vs. 11%, P = 0.004). In conclusion, these athletes had a high risk of LEA, exercise addiction, and DE. Exercise addiction should be considered as an additional risk factor in the prevention, early detection, and targeted treatment of RED-S among female endurance athletes.
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Affiliation(s)
- Ida Lysdahl Fahrenholtz
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- *Correspondence: Ida Lysdahl Fahrenholtz
| | | | - Paulina Wasserfurth
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Andreas Stenling
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Danielle Logue
- Sport Ireland Institute, National Sports Campus, Dublin, Ireland
| | - Ina Garthe
- The Norwegian Olympic and Paralympic Committee and Confederation of Sport, Oslo, Norway
| | - Karsten Koehler
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Maria Gräfnings
- Department of Medical Science, Dalarna University, Falun, Sweden
| | - Mia Beck Lichtenstein
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sharon Madigan
- Sport Ireland Institute, National Sports Campus, Dublin, Ireland
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5
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Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nat Rev Dis Primers 2022; 8:26. [PMID: 35484131 DOI: 10.1038/s41572-022-00352-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 01/11/2023]
Abstract
Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Boston Children's Hospital, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Belinda R Beck
- School of Health Sciences & Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Gold Coast, Queensland, Australia.,The Bone Clinic, Brisbane, Queensland, Australia
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Harvard Medical School and Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David B Burr
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA.,Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.
| | - Stuart J Warden
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indiana University, Indianapolis, IN, USA. .,Department of Physical Therapy, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA. .,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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6
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Westerman R, Kuhnt AK. Metabolic risk factors and fertility disorders: A narrative review of the female perspective. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:66-74. [PMID: 34765754 PMCID: PMC8569630 DOI: 10.1016/j.rbms.2021.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 05/12/2023]
Abstract
Metabolic risk factors such as obesity are considered major obstacles to female fertility. Chronic infertility imposes psychological and social burdens on women because infertility violates societal gender roles. Although the prevalence of obesity among women is expected to increase in the future, the relevance of metabolic status for fertility is still underestimated. However, the assessment of metabolic risk factors is highly relevant for understanding fertility disorders and improving infertility treatment. This narrative review discusses the associations of metabolic risk factors (e.g. obesity, female athlete triad, oxidative stress) with significant infertility. An electronic search was conducted for studies published between 2006 and 2020 in Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, PubMed, Scopus, Google Scholar and related databases. In total, this search identified 19,309 results for polycystic ovary syndrome, 28,969 results for endometriosis, and only 1611 results for idiopathic and/or unknown infertility. For the present narrative review, 50 relevant studies were included: 19 studies were on obesity, 24 studies investigated the female athlete triad, and seven studies addressed other risk factors, including reactive oxygen species. This narrative review confirms the direct impact of obesity on female infertility, while the effect of other risk factors needs to be confirmed by large-scale population studies.
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Affiliation(s)
- Ronny Westerman
- Federal Institute of Population Research, Wiesbaden, Germany
| | - Anne-Kristin Kuhnt
- Department of Sociology and Demography, University of Rostock, Rostock, Germany
- Corresponding author.
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7
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Stellingwerff T, Heikura IA, Meeusen R, Bermon S, Seiler S, Mountjoy ML, Burke LM. Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities. Sports Med 2021; 51:2251-2280. [PMID: 34181189 DOI: 10.1007/s40279-021-01491-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
The symptom similarities between training-overload (with or without an Overtraining Syndrome (OTS) diagnosis) and Relative Energy Deficiency in Sport (RED-S) are significant, with both initiating from a hypothalamic-pituitary origin, that can be influenced by low carbohydrate (CHO) and energy availability (EA). In this narrative review we wish to showcase that many of the negative outcomes of training-overload (with, or without an OTS diagnosis) may be primarily due to misdiagnosed under-fueling, or RED-S, via low EA and/or low CHO availability. Accordingly, we undertook an analysis of training-overload/OTS type studies that have also collected and analyzed for energy intake (EI), CHO, exercise energy expenditure (EEE) and/or EA. Eighteen of the 21 studies (86%) that met our criteria showed indications of an EA decrease or difference between two cohorts within a given study (n = 14 studies) or CHO availability decrease (n = 4 studies) during the training-overload/OTS period, resulting in both training-overload/OTS and RED-S symptom outcomes compared to control conditions. Furthermore, we demonstrate significantly similar symptom overlaps across much of the OTS (n = 57 studies) and RED-S/Female Athlete Triad (n = 88 studies) literature. It is important to note that the prevention of under-recovery is multi-factorial, but many aspects are based around EA and CHO availability. Herein we have demonstrated that OTS and RED-S have many shared pathways, symptoms, and diagnostic complexities. Substantial attention is required to increase the knowledge and awareness of RED-S, and to enhance the diagnostic accuracy of both OTS and RED-S, to allow clinicians to more accurately exclude LEA/RED-S from OTS diagnoses.
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Affiliation(s)
- Trent Stellingwerff
- Pacific Institute for Sport Excellence, Canadian Sport Institute-Pacific, 4371 Interurban Road, Victoria, BC, V9E 2C5, Canada.
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.
| | - Ida A Heikura
- Pacific Institute for Sport Excellence, Canadian Sport Institute-Pacific, 4371 Interurban Road, Victoria, BC, V9E 2C5, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stéphane Bermon
- Université Côte d'Azur, LAMHESS Nice, Nice, France
- World Athletics, Health and Science Department, Monte Carlo, Monaco
| | - Stephen Seiler
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Margo L Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- IOC Medical Commission Games Group, Lausanne, Switzerland
| | - Louise M Burke
- Australian Institute of Sport, Bruce, ACT, Australia
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
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9
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Relative Energy Deficiency in Sport: an Orthopaedic Perspective. J Am Acad Orthop Surg 2021; 29:e14-e21. [PMID: 33273407 DOI: 10.5435/jaaos-d-20-00460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023] Open
Abstract
Relative energy deficiency in sport (RED-S) is a constellation of clinical findings related to low energy availability. Manifestations are variable but may include endocrine and reproductive dysfunction, impaired bone and muscle health, psychological complaints, and performance issues, among many others. Unlike the previously common terminology, the female athlete triad, RED-S encompasses a broader range of signs and symptoms and includes descriptions for the male athlete. Since first being described in 2014 by the International Olympic Committee, an abundance of research has sought to define, prevent, and treat the underlying condition of RED-S. Although medicine, and society in general, has tried to expose the hazardous training and lifestyle behaviors that can underpin RED-S, further research and education is required on the part of the clinician and athlete to reshape the culture and prevent the deleterious consequences of low energy availability.
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10
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Comparison of Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (RED-S): a Review of Low Energy Availability, Multidisciplinary Awareness, Screening Tools and Education. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00296-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Richard N, Palmer C, Adams HP. Female Athlete Triad. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2018.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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International Olympic Committee (IOC) Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 Update. Int J Sport Nutr Exerc Metab 2018; 28:316-331. [PMID: 29771168 DOI: 10.1123/ijsnem.2018-0136] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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13
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Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, Lebrun C, Lundy B, Melin AK, Meyer NL, Sherman RT, Tenforde AS, Klungland Torstveit M, Budgett R. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med 2018; 52:687-697. [DOI: 10.1136/bjsports-2018-099193] [Citation(s) in RCA: 345] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 01/20/2023]
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