PMID- 34181189
OWN - NLM
STAT- MEDLINE
DCOM- 20211025
LR  - 20211025
IS  - 1179-2035 (Electronic)
IS  - 0112-1642 (Linking)
VI  - 51
IP  - 11
DP  - 2021 Nov
TI  - Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): 
      Shared Pathways, Symptoms and Complexities.
PG  - 2251-2280
LID - 10.1007/s40279-021-01491-0 [doi]
AB  - The symptom similarities between training-overload (with or without an 
      Overtraining Syndrome (OTS) diagnosis) and Relative Energy Deficiency in Sport 
      (RED-S) are significant, with both initiating from a hypothalamic-pituitary 
      origin, that can be influenced by low carbohydrate (CHO) and energy availability 
      (EA). In this narrative review we wish to showcase that many of the negative 
      outcomes of training-overload (with, or without an OTS diagnosis) may be 
      primarily due to misdiagnosed under-fueling, or RED-S, via low EA and/or low CHO 
      availability. Accordingly, we undertook an analysis of training-overload/OTS type 
      studies that have also collected and analyzed for energy intake (EI), CHO, 
      exercise energy expenditure (EEE) and/or EA. Eighteen of the 21 studies (86%) 
      that met our criteria showed indications of an EA decrease or difference between 
      two cohorts within a given study (n = 14 studies) or CHO availability decrease (n 
      = 4 studies) during the training-overload/OTS period, resulting in both 
      training-overload/OTS and RED-S symptom outcomes compared to control conditions. 
      Furthermore, we demonstrate significantly similar symptom overlaps across much of 
      the OTS (n = 57 studies) and RED-S/Female Athlete Triad (n = 88 studies) 
      literature. It is important to note that the prevention of under-recovery is 
      multi-factorial, but many aspects are based around EA and CHO availability. 
      Herein we have demonstrated that OTS and RED-S have many shared pathways, 
      symptoms, and diagnostic complexities. Substantial attention is required to 
      increase the knowledge and awareness of RED-S, and to enhance the diagnostic 
      accuracy of both OTS and RED-S, to allow clinicians to more accurately exclude 
      LEA/RED-S from OTS diagnoses.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
FAU - Stellingwerff, Trent
AU  - Stellingwerff T
AUID- ORCID: 0000-0002-4704-8250
AD  - Pacific Institute for Sport Excellence, Canadian Sport Institute-Pacific, 4371 
      Interurban Road, Victoria, BC, V9E 2C5, Canada. tstellingwerff@csipacific.ca.
AD  - Exercise Science, Physical and Health Education, University of Victoria, 
      Victoria, BC, Canada. tstellingwerff@csipacific.ca.
FAU - Heikura, Ida A
AU  - Heikura IA
AUID- ORCID: 0000-0002-1088-428X
AD  - Pacific Institute for Sport Excellence, Canadian Sport Institute-Pacific, 4371 
      Interurban Road, Victoria, BC, V9E 2C5, Canada.
AD  - Exercise Science, Physical and Health Education, University of Victoria, 
      Victoria, BC, Canada.
FAU - Meeusen, Romain
AU  - Meeusen R
AUID- ORCID: 0000-0001-7553-9957
AD  - Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit 
      Brussel, Brussels, Belgium.
FAU - Bermon, Stephane
AU  - Bermon S
AUID- ORCID: 0000-0002-9529-2901
AD  - Universite Cote d'Azur, LAMHESS Nice, Nice, France.
AD  - World Athletics, Health and Science Department, Monte Carlo, Monaco.
FAU - Seiler, Stephen
AU  - Seiler S
AUID- ORCID: 0000-0001-8024-5232
AD  - Department of Sport Science and Physical Education, University of Agder, 
      Kristiansand, Norway.
FAU - Mountjoy, Margo L
AU  - Mountjoy ML
AUID- ORCID: 0000-0001-8604-2014
AD  - Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
AD  - IOC Medical Commission Games Group, Lausanne, Switzerland.
FAU - Burke, Louise M
AU  - Burke LM
AUID- ORCID: 0000-0001-8866-5637
AD  - Australian Institute of Sport, Bruce, ACT, Australia.
AD  - Mary Mackillop Institute for Health Research, Australian Catholic University, 
      Melbourne, VIC, Australia.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210628
PL  - New Zealand
TA  - Sports Med
JT  - Sports medicine (Auckland, N.Z.)
JID - 8412297
SB  - IM
MH  - Athletes
MH  - Energy Intake
MH  - Energy Metabolism
MH  - Female
MH  - *Female Athlete Triad Syndrome
MH  - Humans
MH  - *Relative Energy Deficiency in Sport
EDAT- 2021/06/29 06:00
MHDA- 2021/10/26 06:00
CRDT- 2021/06/28 12:32
PHST- 2021/05/26 00:00 [accepted]
PHST- 2021/06/29 06:00 [pubmed]
PHST- 2021/10/26 06:00 [medline]
PHST- 2021/06/28 12:32 [entrez]
AID - 10.1007/s40279-021-01491-0 [pii]
AID - 10.1007/s40279-021-01491-0 [doi]
PST - ppublish
SO  - Sports Med. 2021 Nov;51(11):2251-2280. doi: 10.1007/s40279-021-01491-0. Epub 2021 
      Jun 28.