Energy, Exercise and Overtraining

The infographic below describes some of the symptoms associated with low energy. See if you recognise any of them.

infographic Energy, Exercise and Overtraining

Most people know that having energy for exercise is important

But what happens if we lack energy when exercising, or consistently train in an energy deficient state? This phenomena is called “Relative Energy Deficiency Syndrome” or “RED-S”.

This article discusses the negative health affects associated with RED-S and what we can do to prevent getting this

What is Relative Energy Deficiency Syndrome (RED-S)?

RED-S is a medical condition that occurs when there is physiological, metabolic or mental health disruption from due to poor energy balance. The resultant affect is that the exerciser becomes “energy deficient”.

In its most simplest form, energy deficiency occurs when “energy availability” (energy going in and available for the body to use) does not meet “energy expenditure” (energy being spent by exercise and routine body functions), across a sustained period of time. This eventually leads to an imbalance in the body.

scales Energy, Exercise and Overtraining

Is RED-S the same as over-training?

Overtraining and energy deficiency can be linked and share very similar signs and symptoms. However, it is possible to over-exercise and still have a positive energy balance. Conversely, it is also possible to under-exercise, but for the body to still be in an energy deficient state.

How does RED-S present?

Musculoskeletal injury is the commonest way RED-S presents. Typical overuse injuries, such as shin splints in runners, can be a subtle sign that the patient is chronically energy deficient. Bone stress and fractures are more severe and indicate that training in an energy deficient state has occurred over a long time.

However, there are many other ways in which RED-S can present. Disruption to menstrual function, poor mental heath, altered bowel habits and increased susceptibility illness and infections are other common ways.

“Poor mental health is often associated with energy deficiency”

female training Energy, Exercise and Overtraining

Who is at risk of RED-S?

Although RED-S can occur in anyone, certain cohorts of people are at higher risk. These high risk groups include;

  • Athletes (professional and amateur)
  • People starting a new exercise regime they are not familiar with
  • Women between the ages of 15-40
  • Elderly people
  • Those recovering from injury, illness or after an operation
  • Patients with mental health conditions such as disordered eating, body dysmorphia
  • Patient with medical conditions that affect absorption of food and nutrients e.g. coeliac disease

Although well recognised in the athletic population, there are still large numbers of everyday exercises, weekend warriors and amateur athletes where this diagnosis is either being missed, or not even considered.

Why is RED-S difficult to detect?

Part of the difficultly in recognising RED-S can be explained by following factors;

  • It can present in people with normal weight. Being energy deficient does not always mean you will have a low Body Mass Index (BMI). People with a high BMI (>30) may also be at risk of over training or under fuelling (for example weight lifters). However, a low BMI of less than 20 is certainly a risk factor.
  • It can present with a large variety of symptoms. This may include musculoskeletal injury, body physiological disruption, illness and poor mental health.
  • Time scales of presentations. It may take weeks and even months for signs and symptoms of RED-S to present. This is because the body’s physiological system are able to adapt to some degree, before they begin to fail.
  • Health care professionals do not really consider it or known enough about it. This may be due to;
    • Lack of time in consultation to discuss energy and training.
    • Lack of knowledge around RED-S or feeling it is ‘out of scope’.
    • Limited access to diagnostic and investigatory tools, such as scans or blood tests
    • Logistical challenges making it difficult for health care professionals to connect and link care pathways, e.g. mental health and bone health.

What to do if you suspect energy deficiency?

If you feel yourself, or someone you know may be suffering from symptoms of energy deficiency, please get in touch with us.

The best way to manage low energy is to firstly understand where the imbalance lies and why it is occurring. Any imbalance could be due to a variety of risk factors. A thorough medical work up and assessment is always required.

Our medical team are experts in recognising and treating energy deficiency. Please let us know if you need support.

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