RED-S: The Evolution of the Female Athlete Triad

For years, the Female Athlete Triad was the go-to framework for understanding the impact of energy deficiency on female athletes. It focused on three key components: low energy availability (with or without an eating disorder), menstrual dysfunction, and decreased bone mineral density. While this model was useful, it became clear that it didn't fully capture the complexities of energy deficiency in all athletes—especially male athletes. Enter Relative Energy Deficiency in Sport (RED-S), a broader and more inclusive term introduced by the International Olympic Committee (IOC) in 2014. RED-S expands on the Female Athlete Triad by recognizing that low energy availability affects both men and women and has widespread consequences beyond bone health and menstruation.

In 2014, the International Olympic Committee (IOC) presented a new, more inclusive term to the previously known Female Athlete Triad.

What is RED-S?

While RED-S and the Female Athlete Triad share similarities, RED-S provides a more comprehensive framework for understanding the impact of energy deficiency in athletes of all genders. Recognizing and addressing RED-S early can help athletes maintain long-term health and peak performance in their sport.

RED-S occurs when an athlete’s energy intake is insufficient to meet the demands of training and daily life. This creates a cascade of negative effects on various physiological systems, including:

• Hormonal Imbalances: Disruptions in estrogen, testosterone, and other key hormones.

• Metabolic Slowdown: A decreased resting metabolic rate, making it harder to maintain weight and muscle mass.

• Impaired Bone Health: Increased risk of stress fractures and osteoporosis.

• Reduced Immune Function: More frequent illness and longer recovery times.

• Cardiovascular Issues: Decreased heart rate variability and potential long-term heart health concerns.

• Mental Health Struggles: Increased risk of depression, anxiety, and disordered eating patterns.

• Decreased Performance: Reduced endurance, strength, coordination, and overall training capacity.

  
  

Recognizing the Signs of RED-S

Athletes, coaches, and healthcare providers should be aware of warning signs such as:

• Persistent fatigue

• Frequent injuries, especially stress fractures

• Menstrual irregularities (or low testosterone in men)

• Difficulty recovering from workouts

• Poor concentration and mood swings

Prevention & Treatment

The key to preventing RED-S is ensuring adequate energy intake relative to training demands. Some strategies include:

• Fueling properly before, during, and after exercise

• Prioritizing rest and recovery

• Monitoring energy availability and adjusting training load accordingly

• Seeking professional guidance from dietitians, physical therapists, and sports medicine experts.

If you or your student athlete are experiencing symptoms of RED-S or have concerns about energy availability, don't hesitate to reach out to a qualified performance physical therapist. Here at Chardon Performance Therapy we specialize in performance training and physical therapy. Your performance, well-being, and longevity in sport depend on it!