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Related Experiment Video

Updated: May 28, 2026

Determining the Contribution of the Energy Systems During Exercise

Determining the Contribution of the Energy Systems During Exercise

Published on: March 20, 2012

Relative energy deficiency in sport (REDs).

Brittney Hulsey¹, Clay W Walker, Sylvia Dory

¹In the PA program at A.T. Still University in Mesa, AZ, Brittney Hulsey is an associate professor and the program director, Clay W. Walker is an assistant professor and the director of didactic education, Sylvia Dory is a clinical coordinator, and Delani Dietrich is a student. In addition, B. Hulsey practices family medicine at Village Medical in Phoenix, AZ, and C.W. Walker is an assistant professor of family medicine at Mayo Clinic in Phoenix, AZ. C.W. Walker discloses service as an external clinical expert on the GlaxoSmithKline UTI Consultancy Panel; service as a medical consultant and advisor for Cosmas Health's Pyrls; and service as a mentor for PAs and NPs in clinical practice through Medgeeks. The authors have disclosed no other potential conflicts of interest, financial or otherwise.

JAAPA : Official Journal of the American Academy of Physician Assistants

|May 26, 2026

Summary

Relative energy deficiency in sport (REDs) is a serious health issue impacting athletes. Early recognition and management by clinicians are crucial to prevent long-term health problems.

Keywords:

REDs athletes functional hypothalamic amenorrhea low energy availability relative energy deficiency in sport return to sport

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Area of Science:

Sports Medicine
Endocrinology
Nutritional Science

Background:

Relative energy deficiency in sport (REDs) is a prevalent syndrome affecting athletes across genders.
It stems from chronic low energy availability, leading to multisystem impairments.

Purpose of the Study:

To review the epidemiology, pathophysiology, and complications of REDs.
To provide a practical diagnostic and management guide for clinicians, particularly in primary care.

Main Methods:

Literature review of REDs epidemiology and pathophysiology.
Outline of diagnostic approaches including history, labs, and the IOC RED-S CAT v2.
Summary of management strategies focusing on energy availability, nutrition, training, and supportive care.

Main Results:

REDs can cause low bone mineral density, stress fractures, infertility, and cardiovascular issues.
Functional hypothalamic amenorrhea is a key consideration in females.
The IOC RED-S CAT v2 aids in risk stratification.

Conclusions:

Effective management requires restoring energy availability through nutrition and training adjustments.
Multidisciplinary care, including psychological support and targeted therapies, is essential.
Primary care physicians play a vital role in early REDs detection and management to prevent chronic morbidity.