MB ChB students publish systematic review on Relative Energy Deficiency in Sport (REDs)

Tell us about yourselves, and your journey at WMS

Rosie: I’m currently a final year medical student. Since starting medical school, I have developed an interest in sports medicine, having been an elite swimmer, and since taking on Ironmans for fun! I’m currently on the USEMs (Undergraduate Sport and Exercise Medicine Society) committee and Warwick Sports Medicine committee. I’m also interested in charity work, having been a previous OddBalls ambassador, raising awareness for testicular cancer throughout the University and wider community.

Louisa: I am also a final year Warwick medical student. I completed my undergraduate degree in Biomedicine, which deepened my fascination with the sciences and gave me a strong foundation for pursuing medicine. I’ve always been very interested in sports, particularly trampolining, which has been a big part of my life. After finishing my biomedicine degree, I spent a year working in teaching sports, specifically as a qualified trampolining coach. It was an incredibly rewarding experience, as it allowed me to combine my love for sports with my interest in helping others grow and develop. That experience taught me valuable skills in communication, patience and teamwork, which I’ve carried forward into my medical training. Now in medical school, I’m building on my academic foundation and personal growth to pursue a career where I can make a meaningful impact.

What attracted you to the MB ChB course and studying medicine?

Rosie: I really liked the idea that medicine at Warwick is for graduates only and has a small catchment area for placements. There are also great research opportunities encouraged at the university. Last May, Louisa and I were grateful to win the prize for Best Symposium Poster Prize at the 2024 RCGP (Midland) Education, Research and Innovation conference for our research in REDs.

As you are both final year students what are your plans after graduation?

Rosie: After graduation, I’m hoping to move to Sheffield to complete F1 and F2, with the aim of pursuing sports medicine as a career.

Louisa: I plan to complete my foundation training and gain more experience in a range of specialties. I am interested in women's health, but I plan to stay open to other avenues of medicine. I'm eager to explore diverse opportunities in medicine, ensuring I can make a meaningful impact in patient care, education, and research.

You were recently joint first authors on an important piece of research about REDs – can you tell us more about this and why you chose this subject?

Rosie: My interest in REDs first started when I was invited to discuss the topic of overtraining in 2021 on a REDs podcast. Having had friends who have experienced REDs, and who had been misdiagnosed, I felt this was an important area of research to explore. We both learnt more about REDs during our SSC1 module, which was run by our supervisors for this publication, Dr Hollie White and Prof Lucy Hammond.

Louisa: I actually first heard about REDs from Rosie! I thought it was such an important topic to delve further into. I’m passionate about women’s health as it is so underrepresented in research, which links to REDs, as menstrual dysfunction is a common symptom in females with REDs. Despite its widespread impact on athletes, REDs remains an unknown diagnosis for many, highlighting a gap in awareness and knowledge. By researching REDs, I hope to shed light on this vital issue, contribute to better diagnostic tools, management, and ensure all athletes receive the support and care they need for their overall wellbeing.

What surprised you most during your research into REDs?

Rosie: I think there is a common misconception that REDs only affects females, as REDs was previously termed the Female Athlete Triad. However, there is increasing evidence which implicates REDs in female and male athletes from any sporting discipline and at any performance level. Thus, the International Olympic Committee (IOC) altered the name in 2014. With only 22% of healthcare professionals (and only 10.1% of general practitioners) having heard of REDs, it is evident that much more needs to be done within this field of medicine.

Louisa: Echoing what Rosie has mentioned, the lack of research on the topic was shocking to me. Although often misconceived as a condition affecting only women, REDs is also prevalent in men. However, this is underrepresented in research, with only one study exclusively focusing on male athletes. The lack of awareness about REDs is widespread among both doctors and athletes. Through our research, we aim to increase understanding of the condition, promote awareness, and contribute to the development of effective treatments to support those affected.

What are your conclusions after conducting your research?

Rosie and Louisa: REDs presents an array of negative implications for both athlete health and performance. Nevertheless, this systematic review indicates that there are interventions available to aid in recovery. Increasing energy intake is essential and can be more effective when used in conjunction with education and hormonal treatment. Despite this, future research is needed that utilises standardised definitions and methodology to enable better analysis into the efficacy of interventions for REDs, in order to inform better clinical practice. A major challenge faced in this search was the lack of primary research into the efficacy of treatment for REDs, with only 11 studies fitting the inclusion criteria. More high-quality primary research is vital to fully understand the efficacy of interventions.
 

Lastly, is there any further information that you would like to signpost people to if they are interested in knowing more about REDs?

Rosie and Louisa: Project RED-S have some great resources and digital toolkits. Renee McGregor and Dr Nicky Keay have some great resources and are incredibly knowledgeable about REDs.