Potential Training Modifications and Return to Play Guidelines

In some cases, a temporary reduction in training load may be required to assist in recovering energy availability and support recovery in some athletes with REDs (particularly when an individual is resistant to increasing overall energy intake through their diet). In this case, the athletic performance coach and wider coaching team will agree on a plan with the wider sports medicine team, targeting performance sustainability rather than short-term gains in sight. In some cases, a return to play ‘checklist’ may be put in place before the athlete is available for competition, such as:

• Restoration of a regular menstrual cycle in females
• Restoration of energy availability
• Adequate bone health and metabolic markers
• Psychological readiness
• Supervised and gradual increase in training load.

The above return to play protocol is not a universal approach and therefore will be subject to your performance environment and individual athlete case. It should be noted that all treatment and management plans should be communicated clearly and discussed with the athlete in question to ensure complete transparency across the plan. 

As REDs is a chronic condition, it is important to have appropriate follow-up and monitoring during the recovery process, aiming for a follow-up at least every three months to review progress. Athletes should also become self-aware of their ‘relapse risks’ such as high stress situations e.g. competition, injury, exams, personal life stressors, etc in order to flag early with their support staff to prevent relapse during these windows.