Overtraining syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S) are two conditions that can significantly affect the performance and general health of athletes.
A discussion of this paper:
What is overtraining syndrome (OTS)?
OTS happens when athletes engage in excessive training, without giving their bodies enough time to recover and adapt to the stress. OTS can have a severe impact on athletic performance, as the signs of physical and mental exhaustion can last for weeks or even months.
What is RED-S?
RED-s arises when there is insufficient energy intake (calories)to support daily exercise energy expenditure. This can cause a wide range of health problems, including hormonal dysregulation, bone issues, and impaired immune function, among others. Both conditions are a significant concern for athletes, and identification, monitoring, and early intervention are crucial in mitigating the risks.
What are the symptoms?
The symptoms of OTS are varied and can be difficult to detect, as many of them overlap with symptoms of regular training fatigue. However, when athletes experience a protracted decrease in performance, elevated resting heart rate, poor appetite, mood swings or depression, sleep disruption, and increased frequency of infections, it may be a sign that they are suffering from OTS.
On the other hand, RED-S is characterized by a calorie deficit, which can manifest in a variety of ways. Women are at particular risk, as a lack of adequate energy and nutrient intake can lead to menstrual irregularities, decreased bone density, and other health problems. Athletes suffering from RED-S may also report frequent injuries, fatigue, impaired cognitive function, and a weakened immune system.
Who can be affected?
Overtraining syndrome (OTS) and relative energy deficiency in sport (RED-S) does not discriminate. They can affect individuals participating in sports at any level, from casual enthusiasts to elite professionals, if the athlete surpasses their body’s recovery capacity or fails to consume adequate nutrition to meet the demands of their sport.
What are the diagnosis criteria?
The diagnosis of OTS and RED-S is primarily based on medical history, clinical examination, and laboratory tests. For OTS, a thorough assessment of the athlete’s overall training load, including intensity, duration, and frequency, is necessary to identify any overreaching or overtraining symptoms. Furthermore, blood tests, such as creatine kinase levels, cortisol, and catecholamines, can assist in assessing hormonal imbalance or other biological stressors.
For RED-S diagnosis, a comprehensive assessment of the athlete’s energy and nutrient intake, including macro- and micronutrient deficiencies, hydration status, and menstrual health, is crucial. Laboratory tests, such as hormonal profiles and bone density scans, can provide further insight into the severity of the condition.
What is the treatment or prevention of OTS or RED-S?
Treatment and prevention for OTS and RED-S are centered on minimizing training stress and ensuring adequate energy and nutrient intake. For OTS, rest and recovery periods, modification of exercise regimes, and addressing any underlying medical or nutritional issues are recommended. For RED-S, increased caloric intake, adoption of healthy eating behaviours, and addressing any underlying psychological or social issues can help to improve overall health and restore normal bodily function.
Prevention strategies for both conditions involve monitoring training loads, practicing good nutrition, and establishing healthy lifestyle habits. In conclusion, OTS and RED-S are conditions that have serious implications for athletes’ performance, health, and overall well-being. Both conditions emphasize the importance of balancing training intensity, recovery, and proper nutrition to maintain overall well-being and optimal athletic performance. As high-performance sport continues to evolve, a comprehensive understanding of how to manage and prevent OTS and RED-S is essential.
Key recommendations from the daveynutrition team:
- Accurate diagnosis, monitoring, and intervention are vital in preventing further complications.
- Effective management and prevention strategies involve collaboration between athletes, coaches, sports physicians, and nutritionists.
- Tailored and personalized nutrition support is essential to address the unique needs and challenges faced by each athlete based on their specific diagnosis.
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Stellingwerff, T., Heikura, I. A., Meeusen, R., Bermon, S., Seiler, S., Mountjoy, M. L., & Burke, L. M. (2021). Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities. Sports medicine (Auckland, N.Z.), 51(11), 2251–2280. https://doi.org/10.1007/s40279-021-01491-0