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Female Athlete Triad (TRIAD), Relative Energy Deficiency of the Sport (RED-S), and Burnout Syndrome of the Athlete (BSA): Concepts, Similarities, and Differences from Overtraining Syndrome (OTS)

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Overtraining Syndrome in Athletes

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Abstract

While overtraining syndrome (OTS) has been majorly studied in males, women have been extensively evaluated for the presence of the female athlete triad (TRIAD), which has been further proposed to be termed as relative energy deficiency of the sport (RED-S).

TRIAD consists of three interrelated conditions: menstrual dysfunction, decreased mineral bone density, and low energy availability (LEA). LEA also independently plays a key role in the development functional hypothalamic amenorrhea (FHA) that typically occurs in TRIAD.

RED-S is a proposal of a new understanding of the TRIAD that encompasses the TRIAD and expands its concepts to male athletes and to a wider range of dysfunctions, not originally comprised in TRIAD. Since studies were predominantly conducted with females, some authors claim that the existing data still does not allow to extend the understanding of TRIAD to male athletes

Conversely, burnout syndrome, characterized by an atypical presentation of features of depression, anxiety, and loss of self-identification, has been proposed to be also present in athletes, with some adaptations of its characteristics, including a possible loss of performance and unwillingness to believe and continue in the athletes’ career, and which has been termed as burnout syndrome of the athlete (BSA).

In common, OTS/PDR, TRIAD/RED-S, and BSA derive from some sorts of deprivation, including resting, eating, and/or sleeping, due to either self-inability to allow a better balance, resulted from an “excessive motivation” with implicates in lower or avoidance of self-perception of fatigue and other signs, or due to a toxic sports environment. For all these conditions, insufficient caloric intake of exact cutoff of <30 kcal/kg FFM/day (fat-free mass) have been identified as a major risk factor.

OTS/PDS, RED-S/TRIAD, and BSA related to the athlete share sufficient similar characteristics to allow propose that these are different clusters of a multidimensional spectrum of a same broader condition. However, this hypothesis cannot be confirmed until comparative between populations with similar baseline characteristics tested for the same parameters are conducted.

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  1. Federal University of São Paulo, São Paulo, São Paulo, Brazil

    Flavio Cadegiani

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Cadegiani, F. (2020). Female Athlete Triad (TRIAD), Relative Energy Deficiency of the Sport (RED-S), and Burnout Syndrome of the Athlete (BSA): Concepts, Similarities, and Differences from Overtraining Syndrome (OTS). In: Overtraining Syndrome in Athletes. Springer, Cham. https://doi.org/10.1007/978-3-030-52628-3_9

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  • DOI: https://doi.org/10.1007/978-3-030-52628-3_9

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