Knowledge on Signs and Symptoms of Relative Energy Deficiency in Sports among Healthcare Professionals and Physically Active Individuals ^†

Abstract

To reduce the risk of Relative Energy Deficiency in Sports (RED-S), athletes and their support teams first require sufficient knowledge about the signs and symptoms of RED-S in athletic performance, recovery and overall health. Thus, our study aimed to assess knowledge of the signs and symptoms of RED-S among healthcare professionals and physically active individuals. We also assessed the level of comfort that healthcare professionals experienced when providing health and nutrition advice to athletes. A convenience sample of 97 healthcare professionals and 77 physically active individuals were recruited via personal communication and social media. An 18-item validated questionnaire was used to assess knowledge. Health professionals rated their level of comfort when providing advice to athletes on 100 mm visual analogue scales (VAS). A higher proportion of participants (41%) had heard of Triad, compared to those who had heard of Low Energy Availability (20%) (LEA) and RED-S (15%). On the knowledge questionnaire, out of the highest possible score of 18, healthcare professionals scored a mean ± SD of 14 ± 3, which was significantly higher than the average score of 11 ± 3 achieved by the physically active individuals. Participants with some nutrition education scored significantly higher than those with no nutrition education (mean difference = 2.5; p < 0.001). The healthcare professionals reported being more comfortable providing advice on menstruation, compared to providing advice on disordered eating/eating disorders, and weight management (median on a 100 mm VAS scale: 80 mm, 58 mm and 61 mm, respectively). All participants agreed that an athletes' health is an important consideration, and rated weight and leanness as less important. Overall, our study demonstrated that participants, particularly healthcare professionals, have some understanding of the signs and symptoms of RED-S. Healthcare professionals have adequate comfort in addressing some elements of RED-S with athletes. However, continuing education is necessary to ensure that these groups are well equipped for the identification, treatment and prevention of RED-S.