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Supporting female performance in sport and fitness
Supporting female performance in sport and fitness

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2 What is the problem?

RED-S occurs for several reasons as you shall see, but central to its development is an intentional or unintentional restriction of sufficient energy to effectively fuel training, recovery and health. For some athletes this stems from a belief that restricting the diet and losing weight will improve performance, while for others it is about conforming to socially constructed body image of attractiveness. The third cause is when energy intake restriction happens because of a clinical eating disorder.

But what is the cost of RED-S on the body? In Activity 1 Anna Boniface, an international marathon runner, shares her experiences.

Activity 1 Stress fractures and osteoporosis

Timing: Allow about 10 minutes

Listen to the audio clip where Anna Boniface tells her story of how long-term under eating and over training impacted on her body and performance in marathon running.

Then answer the following question:

  • What impact did Anna’s overtraining and undereating have on her skeleton?
Download this audio clip.Audio player: boc_sfps_1_session7_activity1.mp3
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Anna says that she had not had a period for about 8 years and identifies the lowering of the hormone oestrogen as damaging to her bone health. As a result she experienced a stress fracture to her ankle due to reduced bone density (‘thinning’ of the bones). It was also found that she had osteoporosis in her spine which could have led to thinning or fractured vertebrae.

Anna outlines the link between bone health and disruptions to the menstrual cycle. The loss of a regular menstrual cycle (amenorrhea) leads to lower bone mass, less bone strength, and higher rates of fractures among athletes (Elliott-Sale et al., 2018).

What is the relationship between low energy availability and the menstrual cycle? You will explore this in the next section.