Table 3. The Relative Energy Deficiency in Sport Return-to-Play Model (modified from Skårderud et al, 2012)140 High risk red light Moderate risk yellow light } No competition } Supervised training allowed when medically cleared for adapted training } Use of written contract (see supplementary appendix 1) W - Use of reputable sources of information. - Promotion of awareness that good performance does not always mean the athlete is healthy. - Encouragement and support of appropriate, timely and effective treatment. Healthcare professional recommendations HealthCare professionals can decrease the health implications of RED-S through the following interventions: - Identification of a multidisciplinary athlete health support team including sports physician, nutritionist, psychologist, physiotherapist and physiologist. - Education of the medical team in the detection and treatment of the RED-S. - Implementation of the RED-S Risk Assessment Model in the PHE and the RED-S RTP Model. Sport organisation recommendations Sport organisations such as International Federations, National Olympic Committees and National Sport Federations can prevent RED-S through the implementation of: - Preventative educational programmes; - Rule modifications/changes to address weight-sensitive issues in sport; - Policies for coaches on the healthy practice of managing athlete eating behaviour, weight and body composition. Research recommendations Research institutions should focus on research and evaluation of: - The aetiology and treatment of athletes with RED-S including males, ethnic and disabled populations; - Design and validation of tools to accurately measure EA in the clinical setting; - The validation of screening tools and treatment programmes such as the RED-S Risk Assessment Model and RED-S RTP Model. hat is already known on this topic? - The International Olympic Committee (IOC) has published a Consensus Statement and Position Stand (2005) on the Female Athlete Triad outlining the pathophysiology and prevalence of this syndrome. - Low energy availability is the aetiological process underpinning the development of the Female Athlete Triad. - Prevalence measures of the Triad indicate that female athletes are particularly vulnerable to this syndrome in sports where leanness and/or weight are important due to their role in performance, appearance or requirement to meet a competition weight category. How might this IOC consensus statement impact on clinical practice in the near future? - Scientific evidence and clinical experience around the effects of low energy availability shows that several body systems in addition to the reproductive and musculoskeletal systems are affected, and that men are at risk as well as women. - Based on the evidence, a broader term, which includes what has so far been called the ‘Female Athlete Triad’, is introduced: Relative Energy Deficiency in Sport (RED-S). - Owing to the potential serious health consequences of this syndrome, there is a need in the clinical realm to establish a ‘Sport Risk Assessment’ model to protect the health and well-being of athletes with this syndrome. - ‘Return-to-Play’ guidelines will assist the athlete health support team in the safe return of the affected athlete to sport participation. - Recommendations for sport organisations, athlete entourage and research institutions will result in future awareness, understanding and further evidence-based knowledge of the RED-S. References 1 Olympic Charter. International Olympic Committee. Lausanne, Switzerland, 2011. http://www.olympic.org/Documents/olympic_charter_en.pdf (retrieved 23 Nov 2013). 2 Olympic Movement Medical Code. In force as from 1 Oct 2009. http:// www.olympic. org/PgeFiles/61597/Olympic_Movement_Medical_Code_ eng.pd (retrieved 23 Nov 2013). } May compete once medically cleared under supervision } May train as long as is following the treatment plan Low risk: green light } Full sport participation nummer 4 | september 2014 | Sport & Geneeskunde 23 Pagina 22
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