2016 Winners of the BASEM Travelling Fellowship – Dr Kate Hutchings & Dr Anita Biswas
Our BASEM travelling fellowship this year took us to the University of Guelph, Toronto to visit Professor Margo Mountjoy and her clinical team.
The purpose of our visit was to increase our understanding and knowledge of Relative Energy Deficiency in Sport (RED-S) and the impact this has on athlete’s health and sports performance.
We arrived to a cold, but crisp Toronto in January and our schedule at the High Performance Centre at Guelph University was superbly organised to spend time with all members of the multidisciplinary team, including sessions with coaches and athletes to understand the practical implications of managing athletes with RED-S.
We attended the weekly “rounds”, which included an overview of the multi systems effect of RED-S and the performance consequences. Margo Mountjoy discussed the fundamental mismatch of energy availability and energy expenditure and described how low energy availability, as a metabolic stressor, can lead to a range of adverse effects on both physiological and psychological function in both genders. The challenges and practicalities of returning an athlete to play were outlined, with the use of a clinical assessment tool with objective markers. It was fascinating to hear a personal insight into RED-S from a middle distance runner and we learnt first-hand how athletes respond to the initial diagnosis and the difficulties in adapting training volumes. We were also fortunate to spend time with both track and field and triathlon coaches at training venues and it was interesting to discuss their monitoring and how they recognise the performance effects of RED-S in the field of play.
Over the course of the week, we spent time with each member of the team to discuss their individual roles and management strategies. In our meeting with the nutritional team we learnt about recent studies evaluating diagnostic primary and secondary criteria, including blood biomarkers of Leptin and IGf-1 to track energy availability. With the Sports Psychiatrist, we discussed how psychological symptoms can be both a cause and result of low energy availability and how this can manifest as a spectrum of symptoms. We had very informative discussions on psychological and pharmacological management and potential performance side effects of medication. It was interesting to discuss case studies ranging from anxiety related/ adjustments disorders that can arise with chronic injuries, to disordered eating patterns and clinical eating disorders that can require hospital admission. The physiological assessment of RED-S was outlined with the Exercise Physiology team with discussions on anthropometric serial monitoring, DEXA analysis and correlating data with serial blood screening in order to track trends in an athlete’s energy status and performance.
Throughout our time at the High Performance Centre, one of the key learning points was the importance of the recognition of sub clinical symptoms of RED-S and early intervention strategies to prevent the long term health and performance effects. It was also evident that the corner stone of optimal management was the open communication channels and in depth understanding of the issues amongst, not just the clinical team, but athletes and coaches alike. Athlete education was paramount in every case and this enabled a positive rehabilitation process and return to sport.
Our visit to Toronto ended with a spectacular view at Niagara Falls and a compulsory drop or two of the local Ice wine…
It was an invaluable experience with many gems to bring back home – thank you to BASEM for your support and to the team at Guelph University for their generous hospitality and knowledge sharing.