ECSS Paris 2023: OP-PN17
INTRODUCTION: Relative energy deficiency in sport (RED-S), resulting from chronic low energy availability, is associated with negative health outcomes (e.g. menstrual and immune dysfunction, compromised bone health, etc) and reduced performance. More common in female athletes, most research has focused on individual and endurance sports. We explored the association of female athlete health knowledge and the prevalence of RED-S in Canadian university team sport athletes. METHODS: University team sport female athletes (N=97; 19.8±1.7 years; BC, Canada) completed an online survey during pre-season (Aug-Sept 2025) assessing confidence (0=not at all to 100=completely confident) and knowledge responding to female athlete health questions and RED-S risk (LEAF-Q screening tool). LEAF-Q focuses on symptoms linked to low energy availability affecting physiological function across three domains (injuries, gastrointestinal function, and menstrual function). Scores were summed across all sections (0-25) with ≥8 vs. <8 identifying athletes at risk vs. not at risk for RED-S. Data is mean±SD. RESULTS: On average, athletes were not confident (32.7±24.6/100; range=0-90) answering the health questions with an average knowledge score of 42.3% [14.4±6.3/34 (range=1-31)]. Most athletes had heard of RED-S prior to study participation (72.2%; first-year: 86.7%>returning: 65.2%, p=0.030) and 55.8% identified low energy availability as the primary cause of RED-S. 67% of female athletes (80% first-year vs. 62.1% returning) were at risk for RED-S (LEAF-Q scores: means: overall=9.3±3.8, not at risk=5.2±1.5 vs. at risk=11.3±2.8; overall range=2-18). There was no significant difference in LEAF-Q scores between hormonal (36%) vs. non-hormonal (64%) contraceptive users (10.1±4.2 vs. 8.9±3.5, p=0.163) or between first-year and returning athletes (10.0±2.6 vs. 9.0±4.2, p=0.194). There were no significant differences in confidence (28.0%±23.0% vs. 34.2%±24.8%, p=0.250) or knowledge (13.4±6.2 vs. 15.0±6.4, p=0.256) scores between first-year and returning athletes. While there was a positive correlation between confidence and knowledge (r=0.55, p<0.001), there was no significant correlation between confidence or knowledge and LEAF-Q scores (all p>0.05). CONCLUSION: A significant proportion of intermittent or skill-based team sport athletes may be at risk for RED-S requiring further clinical evaluation. Additional education is warranted given the low confidence and knowledge scores related to female athlete health reported by these athletes. Multi-domain standardized screening procedures should be considered to facilitate detection of RED-S particularly a) for hormonal contraceptive users given LEAF-Q may underestimate risk and b) given the lack of association between knowledge and LEAF-Q scores. Pre-season provides an opportunity for early intervention and education prior to the added demands of academics and the competitive season for university athletes.
Read CV Alyssa FenutaECSS Paris 2023: OP-PN17
INTRODUCTION: In 2023, the International Olympic Committee (IOC) introduced the Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool Version 2 (CAT2), including a refined four-level traffic light severity/risk stratification, classifying athletes based on presence of various primary and secondary indicators. To ensure equitable and universally applicable REDs diagnostics, CAT2 must be validated in multiple countries, each with their own healthcare frameworks and guideline approaches. OBJECTIVE: The aim of this retrospective cohort study was to evaluate the utility and applicability of the IOC REDs CAT2 in Aotearoa, New Zealand private healthcare setting by prospectively applying the tool amongst females with confirmed clinical diagnoses of REDs. METHODS: Available relevant medical data from 49 (26.6±6.45 years) female patients, who had previously received a clinical diagnosis of REDs from an experienced medical specialist, were applied to the CAT2 to obtain a severity/risk classification (green, yellow, orange or red) based on medical information present in their files. Differences in CAT2 indicators outcomes (categorical and continuous) and availability of data were examined between severity/risk classifications, using Fishers Exact test, one-way analysis of variance and logistical regressions. RESULTS: Twelve percent of patients previously clinically diagnosed with REDs were classified as green according to CAT2 criteria, while the remaining classifications were 45% yellow, 27% orange and 16% red severity. More participants in yellow, orange and/or red classifications had primary/prolonged secondary amenorrhea, secondary amenorrhea, low bone mineral density (BMD) and any menstrual dysfunction (p<0.05) compared to those assigned as a green. Patients classified as red also demonstrated higher prevalence of reported historical clinical eating disorders, high-risk bone stress injury (BSI)/ ≥2 low-risk BSI, ≥1 low-risk BSI and any menstrual dysfunction (p<0.05), compared to orange and/or yellow. Interestingly, patients with more CAT2 indicator information available in their clinical notes had greater odds of being classified as red vs yellow risk (OR 4.339, p=0.0039, 95% CI (1.475-21.31)). CONCLUSION: IOC REDs CAT2 demonstrates utility in a New Zealand female population with a prior clinical diagnosis in determining REDs severity/risk classification based on the number and severity of most CAT2 indicators. However, CAT2 severity/risk classifications often depend on clinical information available, meaning athletes could be at risk of being under-classified when CAT2 is applied in a real-world, clinical setting.
Read CV Keyle BrownECSS Paris 2023: OP-PN17
Background: Low energy availability (LEA), an imbalance between energy intake and exercise energy expenditure, is common in female athletes and may arise intentionally or unintentionally. Emerging evidence indicates that LEA impairs muscle hypertrophy, strength, and protein synthesis in response to physical training in healthy adult athlete populations, yet effects remain unknown in younger, post-injury populations. Purpose: To assess strength and hop-test outcomes in the at 6-months after anterior cruciate ligament reconstruction (ACLR) among adolescent female athletes with LEA indicators (LEA-I) compared to those without (non-LEA-I). We hypothesized that those with LEA-I would have inferior neuromuscular outcomes. Methods: In this retrospective case-control study, we included females age 15-21 years, with bilateral lower extremity isometric strength measurements and hop-testing at 6-months post-ACLR following standard rehabilitation. Athletes with multi-ligamentous or meniscal injuries, prior lower extremity surgeries, hormonal medication exposure, and/or polycystic ovarian syndrome were excluded. LEA-I were defined as menstrual dysfunction (i.e. primary and/or secondary amenorrhea, oligomenorrhea) and/or diagnosed eating disorder. Descriptive statistics were used to compare patient characteristics, and analyses of variance were used to compare group and limb neuromuscular outcomes (alpha=0.050). Results: 224 participants met inclusion criteria, with 56 (24%) having LEA-I (age: 16.4± 1.3 years), who were matched by age and graft type to 56 non-LEA-I participants (16.7± 1.4 years). There was no difference in BMI (LEA-I: 22.5 ± 3.1 kg/m2, non-LEA-I: 22.6 ± 3.5 kg/m2 ; p=0.859), nor primary sport (p=0.402, X2=5.12), between groups. At 6-months post-ACLR, quadriceps strength was inferior among those with LEA-I compared to those without, on the operative limb (LEA-I: 4.05 ± 1.14 Nm/kg, non-LEA-I: 4.75 ± 0.81 Nm/kg; p<0.001) and contralateral limb (LEA-I: 4.26 ± 1.14 Nm/kg, non-LEA-I: 4.79 ± 0.70 Nm/kg ; p=0.004). Hamstrings strength was inferior among those with LEA-I compared to those without, on the operative (LEA-I: 2.18 ± 0.49 Nm/kg, non-LEA-I: 2.45 ± 0.68 Nm/kg ; p=0.019) and contralateral limb (LEA-I: 2.83 ± 0.63 Nm/kg, non-LEA-I: 3.31 ± 0.63 Nm/kg ; p<0.001). Operative limb timed hop test results were inferior among those with LEA-I (2.54 ± 0.54 sec) compared to non-LEA-I (2.34 ± 0.38 sec), p=0.028, while all other operative and contralateral limb hop testing (i.e. single hop, triple hop, crossover hop) was equivocal between groups. Conclusions: Adolescent female athletes 6-months post-ACLR with LEA-I demonstrated inferior bilateral quadriceps and hamstrings strength, and inferior timed hop test results compared to age- and graft-matched non-LEA-I counterparts. LEA-I are prevalent among adolescent female athletes presenting for ACLR, and LEA may have substantial negative impact on rehabilitation and return to sport preparedness.
Read CV Kristin WhitneyECSS Paris 2023: OP-PN17