Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (REDs) describe potential health and performance consequences of low energy availability.


We surveyed female cross-country athletes to assess differences in educational impact scores (knowledge score * confidence score factor, EIS) of Triad and REDs. Associations between EIS and participant characteristics [e.g., mileage (current and peak), years of running experience, age, bone stress injury history, division level participation, academic area of study, Triad or REDs diagnoses, and Triad or REDs education] were explored.

Materials & Methods:

An evidence-based online survey was developed and administered via Qualtrics™ to female collegiate cross-country athletes (n = 275; age = 20 ± 1 yrs).


There was a weak correlation between peak career mileage and EIS (r = 0.195; p = 0.010). EIS significantly differed in athletes with a related academic area of study vs. those without (21.91 ± 5.16, 16.11 ± 5.54, respectively). EIS significantly differed in athletes with Triad and REDs diagnoses (21.69 ± 5.85 and 22.58 ± 6.82, respectively) vs. those without (16.80 ± 6.54 and 17.20 ± 6.34, respectively). EIS was higher in those who had received Triad education vs. those who had not (21.03 ± 6.86, 18.12 ± 6.82, respectively). A significant interaction between peak career mileage and Triad diagnosis was found (p = 0.005).


Significant education-based and diagnoses differences suggests that Triad diagnoses correlate with peak career mileage. These findings support education to improve not only treatment, but prevention, of Triad and REDs.

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