Exploring the presentation of REDs in ultra endurance sport: a review
Study Details
This new review of 16 studies (over 4,700 athletes) across ultra-endurance disciplines including…
🏃♂️ Ultramarathon
🥇 Triathlon
🚴♂️ Cycling
🏊 Open-water swimming
…to establish presence and effects of REDs in ultra-endurance sport 🔍
Here are the key findings ⬇️
Key Findings
🔥 Ultra-endurance athletes face extreme physical and psychological stress, heightening risk for REDs, Low Energy Availability (LEA), and Disordered Eating (DE)
📊 Up to 65% may be at risk, often through underfueling
🧩 The REDs model may overlook key mental health factors, highlighting the need for integrated care
📈 Between 43–65% showed LEA risk, and up to 88% displayed DE behaviours
🧍♀️ 61% of women and 29% of men were at moderate risk; 5.6% at high risk
🧬 Biomarkers showed reduced metabolism, low thyroid hormones, high cortisol, and bone injuries
⚖️ Many athletes remained in negative energy balance (~ -450 kcal/day) even before competition
😔 Athletes described perfectionism, guilt, and pressure to perform, often tied to identity and body image
🪞 Beliefs like “leaner is faster” led to caloric restriction and exercise dependence, despite awareness of harm
💀 Common consequences included stress fractures, amenorrhea, fatigue, and low testosterone
🩹 Recovery was often nonlinear, with lingering fears of weight gain and identity conflict
⚖️ The REDs framework focuses too heavily on physiology ➡️ psychological drivers like control, anxiety, and low self-worth are central
🧠 Many athletes are misdiagnosed or treated physically without addressing mental health
🧍♂️ Males and gender-diverse athletes remain under-researched despite clear vulnerability
Future Directions ⬇️
🔬 Investigate personality traits linked to underfueling
⚧️ Expand research to men and non-binary athletes
🧑⚕️ Adopt ED-informed interventions for REDs
🧾 Develop accessible screening tools for recreational athletes
Conclusion
Ultra-endurance athletes are highly vulnerable to both physical and psychological REDs 🚨
Effective management requires a holistic, multidisciplinary approach integrating nutrition and mental health for prevention, recovery, and long-term wellbeing ✅
Reference
https://pubmed.ncbi.nlm.nih.gov/41013848/
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