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Cited by 171Sports Performance and TrainingCardiovascular and exercise physiologyExercise and Physiological Responses

The DOI matches its Crossref record; 274 of the 277 references it cites were found in a registry or an index.

Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities

Stellingwerff, Trent, Heikura, Ida A., Meeusen, Romain, Bermon, Stéphane, Seiler, Stephen, Mountjoy, Margo L., Burke, Louise M.·2021·Sports Medicine
DOI 10.1007/s40279-021-01491-0
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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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Crossref · 10.1007/s40279-021-01491-0

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Metadata

Authors
Stellingwerff, T., Heikura, I. A., Meeusen, R., Bermon, S., Seiler, S., Mountjoy, M. L., & Burke, L. M.
Affiliations
  • University of Victoria (CA)
  • Vrije Universiteit Brussel (BE)
  • Université Côte d'Azur (FR)
  • University of Agder (NO)
  • International Olympic Committee (CH)
  • Australian Catholic University (AU)
Corresponding author
Stellingwerff, Trent
ORCID
Venue
Sports Medicine
Publisher
Springer Science and Business Media LLC
Published
2021-06-28
Volume
51
Issue
11
Pages
2251-2280
ISSN
  • 0112-1642 (ISSN-L)
  • 1179-2035
DOI
10.1007/s40279-021-01491-0
OpenAlex
W3173850147
Cited by
171
References
277
Citations by year
2026: 28 · 2025: 36 · 2024: 51 · 2023: 33 · 2022: 22 · 2021: 1
FWCI
5.70
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
  • Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology (medical) › Exercise and Physiological Responses
Keywords
overtraining syndrome, relative energy deficiency in sport, training overload, energy availability, carbohydrate availability, energy intake, exercise energy expenditure, hypothalamic-pituitary axis, female athlete triad, misdiagnosis, diagnostic accuracy
MeSH terms
Relative Energy Deficiency in Sport, Energy Intake, Energy Metabolism, Female, Humans, Female Athlete Triad Syndrome, Athletes

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