Navigating REDs Recovery while Staying in the Game
Contents
Athlete Support: Managing Training and Competing with a REDs Diagnosis
Your athlete has been diagnosed with REDs. What can you as a coach do to support them through their training and competition as they navigate recovery?
Recovery from REDs requires an increase in Energy Intake (EI), a reduction in Exercise Energy Expenditure (EEE), or both. However, not all instances of REDs require an athlete to completely stop competing or training. A thoughtful, individualized approach is essential.
Balancing Performance and Well-being
Training and competition provide stability. Removing an athlete entirely from their sport can add psychological stress, potentially worsening their situation. Health must take priority. The challenge is to support recovery while maintaining some level of engagement where appropriate.
Some athletes will require complete rest. In these cases, connecting them with mental health resources and support networks is crucial to ensure they feel valued beyond their sport.
Guidance on Training and Competition Adjustments
Using the IOC Diagnostic criteria as a framework, here’s how to modify training and competition based on an athlete’s current health status:
Yellow Category: Full training and competition are allowed as long as the athlete actively works with coaches and support staff to improve their health and nutrition status.
Orange Category: Adjustments may be necessary, such as reducing training volume or intensity and limiting competition participation to allow for adequate recovery.
Red Category: In most cases, athletes in this category should be removed from all training and competition to prioritize medical and nutritional recovery.
Addressing Both Physical and Psychological Health
While REDs is often viewed primarily as a physiological condition, research suggests a reciprocal relationship between psychological health and Low Energy Availability (LEA) (Mountjoy et al., 2014; 2018). Psychological challenges can precede or result from REDs, meaning that both aspects must be addressed for full recovery.
To restore optimal physiological function (e.g., resumption of menses, improved bone health, hormonal balance), athletes must achieve adequate energy availability by increasing EI and/or reducing EEE (Mountjoy et al., 2021).
Supporting Athletes Beyond Training Adjustments
Above all, experiencing REDs can feel isolating. Coaches play a vital role in ensuring that athletes do not feel alienated during their healing process. Support may include:
Encouraging open and judgment-free communication
Connecting athletes with mental health professionals if needed
Providing alternative team roles (e.g., mentorship, strategy discussions) for those unable to train fully
Reinforcing their value beyond athletic performance
Ways to Keep Athletes Involved During REDs Recovery
Give the Athlete a Choice: Ask how they’d like to stay involved, if at all, and offer different levels of engagement to avoid pressure.
Create Alternative Team Roles: Offer non-physical roles like mentorship, strategy discussions, video analysis, or assisting with logistics to keep them engaged.
Keep Social Connection Without Pressure: Invite them to team events, include them in meetings if they’re comfortable, and check in one-on-one to offer support.
Normalize Their Situation & Reinforce Their Value: Remind them that setbacks are part of sport and that their worth extends beyond performance.
Provide Flexible, Low-Stress Physical Engagement (if appropriate): If medically advised, encourage light activities like warm-ups, technical drills, or alternative recovery exercises.
Offer an Exit Option and Respect Their Boundaries: Some athletes may need space, so avoid guilt-driven language and let them know they’re welcome whenever they’re ready.
Above all else, experiencing REDs can have both physical and psychological impacts, both of which the athlete will need support with. Finding ways to support the athlete to ensure they don’t feel alienated during their healing is critical.