Relative Energy Deficiency in sport (RED-S) in lightweight rowing: investigating athlete and physiotherapists’ perspectives

1.1 Objective
There is a high prevalence of Relative Energy Deficiency in Sport (RED-S) in weight- dependent athletes, potentially resulting in long-term health implications if not managed and treated correctly by healthcare professionals. The aim of this research is to i) investigate the physical and psychosocial impact of RED-S, from the personal perspective of lightweight rowers in the UK and ii) investigate the knowledge and management of RED-S in lightweight rowers and physiotherapists working in lightweight rowing.
1.2 Methods
Twelve lightweight rowers and twelve physiotherapists were recruited for the semi- structured interviews. Eligibility criteria for lightweight rowers were: aged ≥18 years, had competed in lightweight rowing for ≥1 year, and experienced ≥1 symptom of RED-S (recurrent injuries including stress fractures, menstrual dysfunction, low energy during training, prioritising leanness, excessive fatigue, muscle loss, an inability to recover from sessions, a diagnosis of RED-S or Female Athlete Triad. To be eligible, physiotherapists had to be currently or previously registered to work in the UK and have worked with lightweight rowers for >1 year. All participants undertook audio-recorded semi-structured telephone interviews. Data was analysed using an inductive thematic approach, and coding was iterative and data-driven, facilitated by NVivo software.
1.3 Results
To address the first aim, twelve current and former lightweight rowers (67% female, 33% male, aged 19-32 years), who competed in lightweight rowing at an international level to elite level were interviewed. Participants restricted calories and increased energy expenditure to elicit weight-loss in order to pass weighing-in and compete as a lightweight rower. This resulted in psychosocial implications (reduced social interaction, difficulty maintaining relationships, poor emotional regulation, low mood, poor concentration, disordered eating, guilt and anxiety around food and a negative body image) many of which persisted after ceasing participation in lightweight rowing. Participants described a range of physical implications, including disrupted sleep, decreased performance and recovery, bowel disruption, menstrual dysfunction, fatigue, musculoskeletal pain, injury and weakened immune systems.
To address the second aim, data from 12 lightweight rowers and 12 physiotherapists (50% male, and 50% female, aged 22-64 years, with 1-20 years of experience working in lightweight rowing) were utilised in this study. Five key themes were identified: insufficient knowledge of RED-S, inadequate RED-S education, inappropriate management of RED-S, referring responsibility to other health professionals, and prioritising performance over health. Participants provided suggestions for improving knowledge and management of RED-S in lightweight rowers, including formal physiotherapy education and training, and targeted education for athletes and coaches.
1.4 Conclusion
This study describes short and long term physical and psychosocial impacts of RED-S, from the personal perspective of lightweight rowers. This highlights the importance of screening, education and effective management strategies from healthcare professionals to reduce the negative health implications of RED-S in lightweight rowers. There was a significant lack of awareness of RED-S amongst physiotherapists and lightweight rowers. Most physiotherapists were not confident discussing or managing RED-S in athletes, and lightweight rowers were dissatisfied with the management they received. Improving RED- S education for physiotherapists may have significant and positive health implications for lightweight rowers in the UK.

Keywords: Relative Energy Deficiency in Sport (RED-S)
athlete health
Knowledge
Lightweight rowing
Psychosocial implications
Physiotherapists
athlete welfare
education
Advisor: Filbay, S
Arden, N