BJSM Table 2. The Relative Energy Deficiency in Sport Decision-based Return-to-Play Model (modified from Creighton et al)143 Steps Step 1 Evaluation of health status Risk modifiers Medical factors Criteria Patient demographics Symptoms Medical history Signs Laboratory tests Psychological health Potential seriousness Step 2 Evaluation of participation risk Step 3 Decision modification Decision modifiers Sport risk modifiers Type of sport Position played Competitive level Timing and season Pressure from athlete External pressure Conflict of interest Fear of litigation DXA, dual-energy X-ray absorptiometry. Red-S-specific criteria Age, sex (see Yellow light column of table 1) Recurrent dieting, menstrual health, bone health Weight loss/fluctuations, weakness Hormones, electrolytes, ECG and DXA Depression, anxiety, disordered eating/eating disorder Abnormal hormonal and metabolic function Stress fracture Weight sensitive, leanness sport Individual vs team sport Elite vs Re-creational In/out of season, travel, environmental factors Desire to compete Coach, team owner, athlete family and sponsors If restricted from competition this model are based on those used at the Norwegian Olympic Training Center,140 and also recommended by the IOC Body Composition, Health and PerformanceWorking group.8 It is recommended that athletes in the ‘High Risk—Red Light’ risk category should not be cleared to participate in sport. Owing to the severity of their clinical presentation, sport participation may pose serious jeopardy to their health and may also distract the athlete from devoting the attention needed for treatment and recovery.138 These athletes should receive treatment using a written treatment contract (see online supplementary appendix 1). Athletes in the ‘Moderate Risk—Yellow Light’ risk category should be cleared for sport participation only with supervised participation and a medical treatment plan. Re-evaluation of the athlete’s risk assessment should occur at regular intervals of 1–3 months depending on the clinical scenario to assess compliance and to detect changes in clinical status. Return-to-play Decision-making regarding return-to-play (RTP) following time away from sport for recovery from injury and/or illness is based on the assessment of the athlete’s health and the requirements of his/her sport.143,144 Creightons’s RTP Model and the guidelines from the Norwegian group140 dition of RED-S specific criteria. 22 Sport & Geneeskunde | september 2014 | nummer 4 Recommendations to address RED-S The following recommendations are formulated based on a review of the scientific evidence and the collective expertise of the IOC Consensus group relating to the RED-S. Athlete entourage recommendations The athlete’s entourage can prevent RED-S through implementation of the following strategies: - Educational programmes on RED-S, healthy eating, nutrition, EA, the risks of dieting and how these affect health and performance. - Reduction of emphasis on weight, emphasising nutrition and health as a means to enhance performance. Table 3 adapts to the athlete with RED-S through the ad- Development of realistic and health-promoting goals related to weight and body composition. - Avoidance of critical comments about an athlete’s body shape/weight. The RED-S Risk Assessment Model is adapted to aid clinicians’ decision-making for determining an athlete’s readiness to return to sport. Following clinical reassessment utilising the three-step evaluation outlined in table 2, athletes can be reclassified into the ‘High Risk—Red Light’, ‘Moderate Risk—Yellow Light’ or ‘Low Risk—Green Light’ categories. The RED-S return-to-play model (table 3) outlines the sport activity recommended for each risk category. Pagina 21
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Sport & Geneeskunde nummer 4 | november 2014 Lees publicatie 43Home