ReviewSports medicine (Auckland, N.Z.)2021
Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities.
Review in Sports medicine (Auckland, N.Z.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
54 citing papers in PubMed, 1 synthesis or guideline pooled it, 151 citations in OpenAlex.
- Perspectives on Concurrent Strength and Endurance Training in Healthy Adult Females: A Systematic Review.Sports medicine (Auckland, N.Z.) · 2024Pooled it
- Glycaemic Impact of Low- and High-Glycaemic Index Carbohydrate Diets in Ultra-Endurance Athletes: Insights From Continuous Glucose Monitoring.European journal of sport science · 2025Trial
- Competitive level is associated with dietary practices but not sports nutrition knowledge in collegiate athletes: associations with body composition profiles.BMC sports science, medicine & rehabilitation · 2026Article
- Awareness of Relative Energy Deficiency in Sport Among Russian Coaches Working with Athletes of Various Levels in Athletics and Short-Track Speed Skating.Sports (Basel, Switzerland) · 2026Article
- Study protocol of the eating and nutritional habits in athletes and controls longitudinal examination - ENHANCE Study.Discover mental health · 2026Article
- Relative Energy Deficiency in Sport (REDs) and Body Composition.Sports (Basel, Switzerland) · 2026Review
- Physical and Mental Recovery for Female Footballers: Considerations and Approaches for Better Practice.Sports medicine (Auckland, N.Z.) · 2026Review
- Monitoring Menstrual Health in Footballers: Considerations for Tracking Menstrual and Hormonal Contraceptive Cycles in the Field to Support Performance.Sports medicine (Auckland, N.Z.) · 2026Review
- Exercise addiction risk in recreational athletes: a cross-sectional study of psychological distress and food choice motivations in Jordan.Discover mental health · 2026Article
- Coupling mechanisms between energy compensation and metabolic adaptation during high-intensity training in athletes: a longitudinal study based on multi-omics and individualized energy modeling.Scientific reports · 2026Article
- In-Field Validity and Inter-Unit Variability of Metabolic Carts During Simulated Exercise.Scandinavian journal of medicine & science in sports · 2026Article
- Eating attitudes and behaviors characteristics in high-level Kenyan female and male distance runners.Frontiers in sports and active living · 2026Article
- Health of Collegiate Athletes - An Investigation into Symptoms Associated with Low Energy Availability.International journal of exercise science · 2026Article
- Protecting women's health in sport: the role of low energy availability in the Female Athlete Triad and RED-S.Frontiers in sports and active living · 2026Review
- Nutritional considerations for athletes with diabetes: optimizing performance and glycemic control.Frontiers in nutrition · 2026Review
- Considerations of Fertility in Elite Sportswomen: A Narrative Review.BJOG : an international journal of obstetrics and gynaecology · 2026Review
- Pharmacological vs. Non-Pharmacological Treatment in the Management of Relative Energy Deficiency in Sport (REDs): A Systematic Review and Meta-Analysis.Sports (Basel, Switzerland) · 2025Review
- Assessing the risk of low energy availability, bone mineral density and psychological strain in endurance athletes.Journal of the International Society of Sports Nutrition · 2025Article
- The impact of low energy availability risk on pre-competition physiological function in Chinese female combat athletes.Journal of the International Society of Sports Nutrition · 2025Article
- Evaluating the muscularity-oriented eating test: Factor structure and psychometric properties among university athletes and across sexes.Eating behaviors · 2025Article
Corrections and comments
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Authors and funding
7 authors at 6 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.