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Cited by 43Eating Disorders and BehaviorsSports Performance and TrainingLower Extremity Biomechanics and Pathologies

Methodology for studying Relative Energy Deficiency in Sport (REDs): a narrative review by a subgroup of the International Olympic Committee (IOC) consensus on REDs

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Ackerman, Kathryn E, Rogers, Margot Anne, Heikura, Ida A, Burke, Louise M, Stellingwerff, Trent, Hackney, Anthony C, Verhagen, Evert, Schley, Stacey +3 more·2023·British Journal of Sports Medicine
DOI 10.1136/bjsports-2023-107359
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Abstract

In the past decade, the study of relationships among nutrition, exercise and the effects on health and athletic performance, has substantially increased. The 2014 introduction of Relative Energy Deficiency in Sport (REDs) prompted sports scientists and clinicians to investigate these relationships in more populations and with more outcomes than had been previously pursued in mostly white, adolescent or young adult, female athletes. Much of the existing physiology and concepts, however, are either based on or extrapolated from limited studies, and the comparison of studies is hindered by the lack of standardised protocols. In this review, we have evaluated and outlined current best practice methodologies to study REDs in an attempt to guide future research. This includes an agreement on the definition of key terms, a summary of study designs with appropriate applications, descriptions of best practices for blood collection and assessment and a description of methods used to assess specific REDs sequelae, stratified as either Preferred , Used and Recommended or Potential . Researchers can use the compiled information herein when planning studies to more consistently select the proper tools to investigate their domain of interest. Thus, the goal of this review is to standardise REDs research methods to strengthen future studies and improve REDs prevention, diagnosis and care.

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Crossref · 10.1136/bjsports-2023-107359

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  • The wide range in prevalence is due to the lack of a singular definitive diagnosis, mistaken use of LEA and REDs as interchangeable terms, lack of standardisation and accuracy of research methodologies, variation in physiological demands among study populations, and participant study volunteering biases.

    “due to the lack of a singular definitive diagnosis, mistaken use of LEA and REDs as interchangeable terms, lack of standardisation and accuracy of research methodologies (eg, inaccurate EA measurements), variation in physiological demands among the study populations and participant study volunteering biases.”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [21]

    The Review and Data collection methods sections describe inconsistent REDs assessment methods, measurement limitations, and the need for standardisation. The Introduction also cautions that findings from narrow athlete samples may not apply to all athletes. Our copy does not establish that these factors explain a wide range of prevalence estimates, or identify participant volunteering bias or interchangeable use of LEA and REDs as causes. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Our scientific understanding of the time-course of LEA leading to validated signs/symptoms is still emerging, largely due to difficulties in accurately assessing and controlling for EA in prospective research.

    “Our scientific understanding of the time-course of LEA leading to validated physiological and psychological signs/symptoms are still emerging, largely due to difficulties in accurately assessing and controlling for EA in prospective research.21”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [21]

  • Most of the research since the seminal REDs research has involved cross-sectional study designs investigating the prevalence of various LEA indicators.

    “Although the seminal REDs research implemented randomised clinical trials with strict laboratory-controlled EA interventions in habitually sedentary females, 45 125 127 160 165 most of the research since has involved cross-sectional study designs investigating the prevalence of various LEA indicators (indirectly via questionnaires or directly via indicators).8 11 21 49 78 166 167”

    From 2023 international olympic committee's (IOC) consensus statement on relative energy deficiency in sport (REDs) (2023) · cites this paper as [21]

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Authors
Ackerman, K. E., Rogers, M. A., Heikura, I. A., Burke, L. M., Stellingwerff, T., Hackney, A. C., Verhagen, E., Schley, S., Saville, G. H., Mountjoy, M., & Holtzman, B.
Affiliations
  • Boston Children's Hospital (US)
  • University of Canberra (AU)
  • University of Victoria (CA)
  • Australian Catholic University (AU)
  • University of North Carolina at Chapel Hill (US)
  • Health & Safety in Sports (NL)
  • International Olympic Committee (CH)
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2023-09
Volume
57
Issue
17
Pages
1136-1152
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2023-107359
OpenAlex
W4387036452
Cited by
43
References
34
Citations by year
2026: 16 · 2025: 12 · 2024: 13 · 2023: 2
FWCI
2.17
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Sports Medicine (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Keywords
relative energy deficiency in sport, red, research design, blood collection, nutrition and physical activity
MeSH terms
Relative Energy Deficiency in Sport, Humans, Practice Guidelines as Topic, Consensus, Athletic Performance

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