The document discusses the evolution of the Female Athlete Triad concept into what is now known as RED-S Syndrome. RED-S Syndrome refers to Relative Energy Deficiency in Sport and recognizes that low energy availability can negatively impact both male and female athletes. The key components of RED-S are low energy availability, menstrual dysfunction, and bone health problems. Left untreated, RED-S can have psychological, metabolic, immune, and growth/repair consequences. While traditionally considered a women's issue, low energy availability is now known to potentially cause hormonal dysfunction and health problems for male athletes as well. Further research is still needed to better identify at-risk athletes and develop prevention and treatment protocols for RED-S.

1. RED-S Syndrome in Men & Women
PRESENTED BY: HANNA PANCH

2. Evolution of RED-S Syndrome
Female Athlete Triad
• Female Athlete Triad
• Defined as female athletes who
have had the following three
components:
1. Eating disorders
2. Menstrual Abnormalities
3. Low bone mineral density

3. Evolution of RED-S Syndrome
Female Athlete Triad Changes
• Most important change occurred in 2007
by the American College of Sports
Medicine (ACSM):
• Term was redefined to having components
of energy availability (EA), menstrual
function, and bone health
• Marked EA as the main cause for the
Female Athlete Triad
EA = (Dietary Intake (EI) – Energy Cost of
Exercise) / Fat- Free Mass (FFM)
Healthy Adults: value of 45/kcal/kg FFM/day =
energy balance

4. Energy Availability
• Decrease seen in weight
sensitive sports
• This can be caused by
1. Specific performance
roles
2. Body appearance
3. Competing weight class
requirement

5. Evolution of RED-S Syndrome
Female Athlete Triad to RED-S
• The International Olympic Committee
(IOC) created the term RED-S
• Energy Deficiency is a problem for both males
and females
• Expansion on the components that were
originally in the ‘triad’
• Affects the physically active population, not just
athletes

6. Consequences associated with RED-S
• Low estrogen
• Risk of stress fractures
• Nutrient Deficiencies
• Decreased Endurance
• Decreased Coordination
• Decrease in Metabolic Metabolism
• Decrease in production of growth hormone
• Decrease in Muscle Strength
• Fertility issues (long-term)

7. Consequences of RED-S Syndrome
• Psychological Component- Double
Arrow:
• Energy deficiency can cause
psychological issues
• psychological issues can cause
energy deficiency

8. RED-S Syndrome in Males
• Low EA in males:
• Can cause hormonal dysfunction
• Disruption in GnRH and LH pulsatality which
decreases testosterone
• Reproductive Dysfunction in endurance athletes
• Lack of education in health care professionals in
identifying males with RED-S
• Hard to identify male athletes at risk for RED-S

9. RED-S Syndrome in Males
Low EA in Elite Male Athletes
• Commonness in Disorderly
Eating in Males:
• Cycling: 50%
• Weight Class events: 18%
• Gravitational sports: 24%
• Disorderly eating related to
low bone mass

10. Previous Research on Olympic Athletes
Exercise Time and Load
• Study done in a University Hospital on 223 participants (125 Males; 98 females) who were
all past participants of the Olympic games of 2002 and 2004
• This study looked at the weight control strategies used by the Olympic athletes who
strived for leanness in order to gain a performance advantage
• Results: Represented in Table 3
• Exercise Time:
• Athletes who participated in leanness-stressed disciplines was higher than non-
leanness stressed disciplines
• Negative correlation for entire population between training time and BMI (r =
-0.23; P < 0.01)
• Training load >10 was described more from athletes in leanness-stressed disciplines
(Hagmar. Hirschberg, Berglund,
Berglund, (2008)

11. Previous Research on Olympic Athletes
Illness & Injuries
• Results: Represented in Table 3
• Illness:
• Athletes in leanness-stressed disciplines exhibited higher
reported illnesses than athletes in non-leanness stressed
disciplines
• Only statistical significance in males who practiced
leanness-stressed disciplines
• Injury:
• Athletes in leanness-stressed disciplines exhibited higher
reported injuries than athletes in non-leanness stressed
disciplines
• Statistical difference in males only who practiced
leanness-stressed disciplines. (higher amount of reports
of injury 3 months prior to Games)

12. IOC’s RED-S Risk Assessment Model for Sport Participation

13. IOC’S RED-S Sport Decision- Based Return-to-Play Model

14. IOC’s RED-S Return-to-Play Model

15. Future Research Needs for
RED-S
• Finding effective methods to identify athletes at risk for RED-S.
• Creating scientifically validated prevention interventions for RED-S.
• Continued research on how RED-S affects male athletes, different ethnicities, and
Paralympic athletes
• Research on RED-S in how it varies between different sports.
• Guidelines for the treatment for RED-S in athletes and ‘return to play.’

16. Questions?