An Exploratory Survey of Education Needs and Preferences Regarding Relative Energy Deficiency in Sport for Female Triathletes and Their Coaches

Female triathletes are at high risk of developing Relative Energy Deficiency in Sport (REDs) due to high training loads and complex dietary requirements. The harmful health consequences of REDs likely contribute to the high prevalence of bone stress injury in female triathletes. Consequently, the understanding of REDs needs to improve across the sport. However, what information coaches and athletes require to improve decision making and decrease REDs prevalence, and how the information is delivered to them is unclear. This cross-sectional survey study aimed to characterize knowledge, viewpoints, experiences, and education preferences of female triathletes and coaches. A total of 713 female triathletes and 30 coaches were surveyed. Although 64% of female triathletes and 85% of coaches were aware of the term “REDs,” gaps in the knowledge of the REDs model were evident. The understanding of REDs was largely limited to energy imbalance and acute under fueling. A high proportion of athletes (74%) agreed or strongly agreed that female triathletes can expect to stop menstruating during high training loads. Confidence in seeking help and managing symptoms related to REDs was low in athletes (39%). Most athletes (95%) and two thirds of coaches (71%) were unaware of available resources to identify, prevent, and/or manage REDs. Digital platforms including podcasts, websites, and videos were the top mediums participants preferred to be used to receive education on REDs. Future development of resources and educational initiatives to improve the capacity of coaches and athletes to prevent and identify REDs should use engaging digital technology to communicate evidence-based content.