RED-S – Low Energy Availability in Sport: The Outdoor Athlete Podcast

On the second episode of The Outdoor Athlete, we’re in conversation with Dr Nicky Keay, who is an expert in sports and dance Endocrinology. Nicky works closely with the British Association of Sport and Exercise Medicine and in conjunction with BASEM and a number of colleagues, has been working to increase awareness of RED-S amongst athletes, dancers and active people. This episode addresses some of the potential performance and health issues that may be encountered in an athlete who either inadvertently or intentionally enters a low energy availability state. We discuss RED-S generally and Nicky gives some guidance to medical professionals on how to approach a person with these potential issues along with a host of other information for athletes and coaches Read More

Resources that we refer to in this episode include: an excellent resource for athletes, dancers, parents, coaches, governing organisations and anyone working with athletes of all levels. more about Nicky.

Keay, N., Francis, G. & Hind, K. (2018) Low energy availability assessed by a sport-specific questionnaire and clinical interview indicative of bone health, endocrine profile and cycling performance in competitive male cyclists BMJ Open Sport & Exercise Medicine;4:e000424. doi: 10.1136/bmjsem-2018-000424. Full text:

Mountjoy, M., Sundgot-Borgen, J.K., Burke, L.M., et al (2018)IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update Br J Sports Med 2018;52:687-697.

Mountjoy, M. Sundgot-Borgen, Burke, L., et al.(2014)The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S) Br J Sports Med; 48:491-497. Full Text:

Insights from Dr Nigel Callender

Sport climbing is included in the 2020 Tokyo summer games in its three competitive disciplines; bouldering, lead climbing and speed climbing. Each sub-discipline has a slightly different athlete profile and physiological demands, but all are obviously under the heading of gravity dependent sports. Current participation figures put yearly indoor climbing participation at around the one million mark in the UK and it is said to be one of the fastest growing sports worldwide. The sport is being recognised as a great way to improve overall health and fitness, with recent papers citing it as a useful rehab activity for many physical and mental health conditions and also as a health promotion tool.

Although climbing has been a formal competitive sport in some sense since the late 80’s, it still lacks much in the way of formal training and medical guidelines. Being a gravity dependent sport, strength to weight ratio is important, however my colleagues and I are seeing a high incidence of restrictive eating patterns at all levels of the sport and a lack of awareness around the performance impairments and health risks associated with a significant or prolonged negative energy balance in some athletes.

The Outdoor Athlete Podcast is a bit of a winter project that came about to establish a gold-standard resource, driven by credible experts in their relevant fields, as an attempt to provide high-quality and evidence-based information amongst the confusing advice that is now the internet. It’s free and always will be and it was inspired by the BJSM Podcasts though broadly aiming at ‘Outdoor Athletes’ e.g. Climbers, Fell/Trail runners, Mountain bikers and anyone happy to listen.

For more information on climbing in the UK, including competition climbing see

About Dr Nigel Callender:  I am a sports scientist turned medical doctor (anaesthetics/crit care trainee) though I am about to jump ship to train in sport and exercise medicine. I’m a very active researcher, largely into the exercise physiology aspects of climbing and am an ex-competitor, having represented Ireland at international level and been British bouldering champion before shoulder injuries ended that. I own a climbing wall in Ireland and a small performance consultancy clinic in Sheffield. Luckily my research work allows me to work with climbers of all levels including elite-level competitors.

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