Low Energy Availability Leads to Poorer Performance and More Injuries

Written by: Jorunn Sundgot-Borgen, Monica Klungland Torstveit, Therese Fostervold Mathisen, Anne Marte Pensgaard

New Guidelines for the Syndrome Relative Energy Deficiency in Sport (REDs)

High-Risk Sports

Athletes in weight-sensitive sports are considered to be at increased risk of developing REDs. These include: Sports where low body weight offers a performance advantage, such as ski jumping or wrestling (where strength-to-weight ratio is key), endurance sports, like long-distance running, cross-country skiing, or cycling, which require high energy expenditure, and aesthetic sports, like gymnastics, dance, or rhythmic gymnastics, where appearance and execution are judged. The prevalence of symptoms ranges from 23–80% in female athletes and 15–70% in male athletes, depending on the specific sport and methodology used in the studies (1). Young athletes, who require extra energy for growth and development, need special attention. (1, 3).

Prevention, Diagnosis, and Treatment

Specific guidelines for prevention have been developed, including: Primary prevention strategies, such as increasing awareness of REDs and reducing the emphasis on measuring body composition (3), Secondary prevention, like early identification of symptoms to prevent more serious consequences. Tertiary prevention, which involves the treatment of energy deficiency (4). It is crucial that sports medicine professionals rule out other diagnoses during clinical evaluation of athletes showing signs of REDs. To support clinicians working with athletes, the IOC REDs Clinical Assessment Tool (IOC REDs CAT2) has been developed. This tool provides a practical clinical approach for diagnosing REDs (5). The cornerstone of REDs treatment is to reverse low energy availability, either by increasing energy intake through dietary measures or by reducing energy expenditure through training modifications.