IOC Medical Commission to reveal new insights into the Female Athlete Triad

17 Jan 2014
IOC News

A group of high-level experts recently reviewed the science of the syndrome of the Female Athlete Triad - a phenomenon which affects the athlete’s health and performance - and has recommended practical clinical models for the health care management of affected athletes.

Under the leadership of the IOC Medical Commission and its Chairman, Arne Ljungqvist, the group set up a brand-new “Sport Risk Assessment and Return to Play model” – which categorises the syndrome into three groups, from low to moderate to high risk, and translates this classification into practical recommendations ranging from “No Start” to “Full Participation” for competing athletes. Another unique feature of the Consensus Statement is a review of the scientific literature on this syndrome as it pertains to male athletes, athletes of non-Caucasian ethnicity and athletes with a disability.

Beyond the Female Athlete Triad: Relative Energy Deficiency in Sport
After a thorough review of the latest scientific evidence, the experts decided to introduce a broader term for a larger, more comprehensive overall syndrome, which includes what has so far been called "Female Athlete Triad" syndrome. The new term “Relative Energy Deficiency in Sport” (RED-S) points to the complexity involved and the fact that male athletes are also affected.

Decoding RED-S
The scientific evidence shows that the cause of RED-S is an energy deficiency relative to the balance between the dietary energy intake and the energy expenditure required to support health and the activities of daily living, growth and sporting activities. It is also evident that the clinical phenomenon is no longer only a “triad”, or constellation of the three entities of energy availability, menstrual function and bone health, but rather a syndrome that affects many aspects of physiological function, including metabolic rate, menstrual function, bone health, immunity, protein synthesis and cardiovascular and psychological health.

Athletes’ health a top priority

IOC Medical Commission Chairman Arne Ljungqvist said: “RED-S concerns quite a number of athletes across different sports, and I am glad we took the decision to gather top experts in this field to update and deepen our previous reviews of the research on this syndrome. We translated the new findings into useful tools to help affected athletes and their entourage and, even more importantly, to prevent RED-S when possible.”

Claudia Bokel, Chair of the IOC Athletes’ Commission said: “This consensus statement demonstrates once again that the protection of the athletes’ health is of major concern for the IOC and its Medical Commission. Such findings are not only of huge direct benefit for all concerned athletes, but also help to break taboos and raise awareness about topics that are not necessarily openly addressed on the field of play.”

A new assessment tool to help athletes and their entourage
A key feature of the Consensus Statement is the presentation of a “Sport Risk Assessment and Return to Play model” that outlines classification criteria for the designation of the athlete with RED-S into one of three categories:  “High Risk - Red Light”, “Moderate Risk – Yellow Light” or “Low Risk – Green Light”.  Sports participation based on the athlete classification is recommended, ranging from “No Start” in the Red Light category to Full Participation for athletes classified in the Green Light category.  Recommendations for the prevention and management of RED-S are provided for members of the athletes’ entourage, including health care professionals, and sports organisations.

In addition, the Consensus Statement provides an update on the latest scientific evidence for the screening for and diagnosis of the syndrome. Treatment strategies for energy deficiency, menstrual dysfunction, bone health, eating disorders and other psychological sequelae are also included. Research gaps are identified and recommendations for future research directions are proposed.

Where to find the Consensus Statement
The RED-S Consensus Statement will be published in the IOC Injury and Illness Prevention issue of the British Journal of Sports Medicine in April 2014,and subsequently on the IOC website.

RED-S a topic at upcoming IOC World Conference
The new findings, recommendations and tools presented in the Consensus Statement will also be presented at the IOC World Conference on Prevention of Injury & Illness in Sport, set to take place in Monte Carlo, Monaco, from 10 to 12 April 2014.

Learn more about this key event for world-renowned sports and medical experts here.

Find the detailed list of the expert group members here. 

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