Darren Delaney

Since the introduction of relative energy deficiency in sport (REDs) in 2014, research has primarily focused on athletes’ experiences of REDs symptomatology and consequences, limiting understanding beyond athletes’ perspective. This study assessed the relationship between athletes’ expectations of coaching and support staff in relation to REDs, and staff members’ perceptions of athletes’ REDs experiences. Two interrelated questionnaires were implemented in a mixed-methods cross-sectional study: the Athlete- and Coach-Centric Questionnaires. 101 respondents participated, comprising 56 athletes and 45 coaching and support staff. Awareness of REDs was reported by 31 (55%) athletes and 33 (73%) coaching and support staff. Among athletes, 31 (55%) expected coaches to be aware of REDs symptoms, while 35 (62%) expected awareness of REDs consequences. Only 8 (18%) staff members reported the presence of a REDs assessment, and 10 (22%) a REDs treatment responsibility in their sporting organisation. Qualitative analysis highlighted the importance of the coach-athlete relationship in delivering individualised REDs care. Athletes reported negative coaching practices, and expected to receive limited support, while coaching and support staff highlighted that REDs symptoms were often unreported by athletes. Staff also felt that REDs was under-supported by national governing bodies (NGBs), limiting their potential to positively influence REDs experiences. Further exploration of REDs-specific education for coaching and support staff, athletes, and NGBs is warranted.

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.