Do coaches’ and athletes’ perceptions of relative energy deficiency in sport align? A narrative review

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Abstract
Relative energy deficiency in sport (REDs) is a syndrome that negatively impacts the health and performance of athletes, due to low energy availability (LEA), resulting in metabolic, cardiovascular, and endocrine function impairments, and an increased risk of injury. An increased emphasis on the coach-athlete relationship may facilitate the knowledge transfer of LEA's negative effects, mitigating the potential of an athlete developing REDs. Yet building on the International Olympic Committee's 2023 REDs statement of articles published between 2018–2022, to also include articles from 2023–2024, it is noted 38,424 participants were recruited to 246 REDs-related studies, with coaching staff only represented ∼3% of the total cohort. This review aims to assess coaches’ and athletes’ perceptions of their respective, as well as each other's roles and experiences in the presence of LEA and REDs. A summary of athlete and coach first-person experiences of REDs-related issues is provided. However first-person REDs experiences are often that of the athlete, while the coach will more often ‘ experience ’ REDs from a second-person perspective, thereby highlighting the need for the development and provision of REDs education targeted to coaching staff which maybe sports-specific, taking into account topics such as appropriate language to use and how/when to discuss an athlete's body, health and/or performance. A better understanding of how athletes experience REDs-related issues may facilitate individual coaching staffs’ evaluation of their role in preventing and/or addressing a potential REDs diagnosis.

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