What is it?
RED-S is a condition in which an individual doesn’t consume enough energy through food to support the amount of exercise and/or daily living activities they are participating in. This prolonged exposure to low energy availability can lead to detrimental impacts on both physiological and psychological functioning.
Understanding RED-S: The Basics of Who It Impacts and Why We Need to Take Action
RED-S can affect athletes of all genders, ages, and performance levels, though it is especially prevalent in endurance, aesthetic, and weight-sensitive sports. RED-S impacts numerous bodily functions including menstrual health, bone density, immunity, cardiovascular health, and psychological well-being, ultimately impairing both short and long term athletic performance as well as having long term impacts on overall health and well-being.
It often stems from unintentional under fuelling or pressure to maintain a certain body weight or physique. Addressing RED-S is crucial not only for protecting the athlete’s health but also for supporting sustainable performance and career longevity. Early education, awareness, and a supportive sport environment are essential to prevention and recovery.
Physiological Symptoms of RED-S Include:
The physiological symptoms of RED-S can affect multiple body systems due to the body not having enough energy to support normal function. Key physiological symptoms include:
- Menstrual Dysfunction (in females)
Irregular or absent periods (amenorrhea), infertility risks - Decreased Bone Health
Low bone mineral density (osteopenia or osteoporosis), increased injury risk - Metabolic Impairment
Low energy levels and chronic fatigue - Immune Dysfunction
Increased frequency of illness and infections, with slow recovery - Cardiovascular Effects
Low heart rate (bradycardia), low blood pressure, and risk of arrhythmias in severe cases - Gastrointestinal Issues
Constipation, bloating, and abdominal discomfort - Endocrine and Hormonal Disruptions
Low estrogen and testosterone levels, and thyroid dysfunction (e.g., low T3) - Impaired Growth and Development (in youth athletes)
Stunted growth and delayed puberty - Decreased Muscle Strength and Performance
Loss of lean muscle mass, reduced endurance, and coordination
Early identification and intervention are critical to reverse these symptoms and prevent long term damage.
Psychological Symptoms of RED-S Include:
The psychological symptoms of RED-S are often significant and can both contribute to and result from the condition. These include:
- Low Mood and Depression
Persistent sadness or emotional numbness, feelings of hopelessness or worthlessness - Increased Anxiety
Performance-related anxiety as well as generalised anxiety - Irritability and Mood Swings
Difficulty managing emotions, feelings of frustration/anger over minor issues - Obsessive Behaviours
Obsessive focus on training, diet, body weight, or perfectionism - Disordered Eating Patterns
Restrictive eating, bingeing or purging behaviours, or fear of gaining weight - Poor Concentration and Focus
Difficulty staying focused in training, school, or daily activities; mental fatigue or “brain fog” - Low Self-Esteem
Negative body image - Social Withdrawal
Avoidance of social situations involving food or rest, and isolation from others
These psychological symptoms can further impair performance, well-being, and recovery, making early recognition and support from coaches, health professionals, and teammates crucial.
How Does This Impact My Performance in Sport?
Relative Energy Deficiency in Sport (RED-S) can significantly impact your performance by depriving your body of the energy it needs to train, recover, and compete at its best. Without enough fuel, your endurance, strength, speed, coordination, and concentration all decline, making it harder to meet training goals and perform well in competition.
You may feel constantly fatigued, struggle to recover between sessions, and become more prone to injuries like stress fractures and muscle strains. Hormonal imbalances can further disrupt muscle function, mood, and sleep, all of which are essential for peak athletic performance. Ultimately, RED-S not only limits your progress but can also shorten your athletic career if left unaddressed.
How Can Pro Health Exercise Physiology Help?
At Pro Health Exercise Physiology, we play a crucial role in the assessment, management, and recovery from Relative Energy Deficiency in Sport (RED-S). Our experienced exercise physiologists specialise in helping athletes safely restore the balance between training demands, energy intake, and recovery needs.
Through tailored exercise assessments, an exercise physiologist can identify areas of compromised performance, such as reduced aerobic capacity, muscle strength, or metabolic function. They can then design individualized training programs that reduce physical stress while promoting gradual rebuilding of fitness, bone density, and overall health.
Importantly, exercise physiologists work closely with dietitians, doctors, and mental health professionals to ensure a holistic, multidisciplinary approach that addresses both the physical and psychological aspects of RED-S. Their guidance supports athletes in returning to sport safely and sustainably, while reducing the risk of long-term health consequences.
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