Last spring, Swim England hosted its annual Sport Science and Medicine conference with the special topic of the female athlete. In hopes of gaining deeper understanding the female athlete, conference presentations paid special attention to the concept of Relative Energy Deficiency in Sport (RED-S).  A brief overview of what was presented at the conference is highlighted below.

RED-S, as the name suggests, is caused by relative energy deficiency, which is when the caloric intake is too low to match the level of calories needed for swimmers in to reach optimal health and performance. RED-S has broad and far reaching impact on the body and mind with it impacting the cardiovascular system, gastrointestinal system, the menstrual function, the immune system, the metabolic rate, the growth and development of an athlete, menstrual function, bone health, protein synthesis, as well as psychological functioning.

Consequence of RED-S that coaches and support staff may see in the pool includes (but is not limited to) a variety of physical issues such as decreased muscle strength, decreased endurance, increased risk of injury, and is less responsive to training. There is also an increased risk of depression, impairment of judgement, and increased irritability. From a psychological perspective, it is important to understand a swimmer’s psychology can be a cause of RED-S, but RED-S can also cause a negative impact on a swimmer’s psychology.  RED-S and psychology have a bidirectional relationship. For example, disordered eating or an eating disorder can mean a swimmer has a large calorie deficiency resulting in RED-S. Or a swimmer can experience psychological distress and depression due to RED-S.

When it comes to treatment of RED-S, increasing energy intake and a reduction of exercise should be considered in conjunction. However, if an athlete refuses to follow a treatment plan that involves increased energy intake and a reduction of exercise then it is likely that a psychological factor is present, with that athlete suffering from disordered eating or an eating disorder. It is important for coaches and support staff to not wait to see dramatic weight loss before talking to a swimmer about their concerns and seeking professional help for that athlete.

Early detection of RED-S is crucial to limit its impact on health and performance. Educating coaches and staff on the signs and symptoms and including screening for RED-S in annual health checks is key. Additionally, nutrition conversations should focus on how good nutrition can enhance performance and not weight loss. Comments on body shape should be avoided, and a general understanding that a “normal weight” and even good performance does not always mean a healthy individual.  Creating an open and communicative coach-athlete relationship and team culture can allow for athletes who may be suffering from psychological issues related to RED-S to open up before physical symptoms manifest. Keeping a multidisciplinary team up to date on the RED-S research and collaborating openly with athletes is paramount to minimising the negative impact RED-S will have.

To book your place at this year’s conference held in March in Nottingham you can visit: