Coaches are important figures of influence with potential to create environments that influence athlete health and performance outcomes. Ideally, coaches provide supportive environments that lead to performance optimisation and long-term health. Coaches who employ language and behaviours that overemphasise body composition and/or provide misinformed nutrition advice may predispose athletes to low energy availability (LEA) and the associated health consequences. Having a clear understanding of current knowledge, attitudes and beliefs of coaches with regard to LEA is required to guide future coach education/support initiatives to optimise athlete health and performance. Thus, the aim of this investigation was to systematically review published literature regarding coach knowledge, attitudes/beliefs and behaviours of LEA.
Data from 20 eligible studies was extracted into predetermined categories according to coach ‘knowledge‘; ‘attitudes/ beliefs’; and ‘behaviours’ regarding LEA/Relative Energy Deficiency in Sport/Female Athlete Triad and/or eating disorders and/or disordered eating. Any single study could provide outcomes to inform one or multiple of these categories. The majority of results were drawn from studies conducted prior to LEA being defined as a concern for athlete health, which limited our understanding of the contemporary knowledge, attitudes/eliefs and behaviours of coaches on this important issue. That said, indications of gaps in coach knowledge and the employment of inappropriate attitudes/beliefs and behaviours regarding issues associated with LEA were evident. An opportunity exists for key stakeholders to develop comprehensive coach education frameworks, which equip coaches with the adequate capability, opportunity and motivation to support athlete health and avoid the consequences of LEA.
MountjoyMSundgot-BorgenJBurkeL, et al.The IOC consensus statement: beyond the female athlete triad-relative energy deficiency in sport (RED-S). Bri J Sports Med2014; 48: 491–497.
2.
NattivALoucksABManoreMM,et al.American College of sports medicine position stand. The female athlete triad. Med Sci Sports Exerc2007; 39: 1867–1882.
3.
SlaterJBrownRMcLay-CookeR,et al.Low energy availability in exercising women: historical perspectives and future directions. Sports Med2017; 47: 207–220.
4.
TenfordeASCarlsonJLChangA, et al.Association of the female athlete triad risk assessment stratification to the development of bone stress injuries in collegiate athletes. Am J Sports Med2017; 45: 302–310.
5.
KuikmanMAMountjoyMStellingwerffT,et al.Embracing change: the evolving science of relative energy deficiency in sport. Int J Sport Nutr Exerc Metab2021; 1: 1–2.
6.
MountjoyMSundgot-BorgenJBurkeL, et al.International Olympic committee (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Int J Sport Nutr Exerc Metab2018; 28: 316–331.
7.
WasserfurthPPalmowskiJHahnA,et al.Reasons for and consequences of low energy availability in female and male athletes: social environment, adaptations, and prevention. Sports Med2020; 6: 1–14.
8.
LangbeinRKMartinDAllen-CollinsonJ,et al.I’d got self-destruction down to a fine art": a qualitative exploration of relative energy deficiency in sport (RED-S) in endurance athletes. J Sports Sci2021; 39: 1555–1564.
9.
LogueDMadiganSMelinA, et al.Low energy availability in athletes 2020: an updated narrative review of prevalence, risk, within-day energy balance, knowledge, and impact on sports performance. Nutrients2020; 12: 835.
10.
BurkeLLundyBFahrenholtzIL,et al.Pitfalls of conducting and interpreting estimates of energy availability in free-living athletes. Int J Sport Nutr Exerc Metab2018; 28: 350–363.
11.
WellsKJeacockeNAppanealR, et al.The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. Br J Sports Med2020; 54: 1247–1258.
12.
SandgrenSSHaycraftEPearceR,et al.Support for athletes with eating psychopathology symptoms: exploring the views of athletes, coaches and sport practitioners. J Appl Sport Psychol2022; 26: 1–23.
13.
SchofieldKLThorpeHSimsST“This is the next frontier of performance”: power and knowledge in coaches “proactive” approaches to sportswomen’s health. Sports Coach Rev2022; 7: 1–22.
14.
StirlingAKerrG. Perceived vulnerabilities of female athletes to the development of disordered eating behaviours. Eur J Sport Sci2012; 12: 262–273.
15.
TenfordeASBeauchesneARBorg-SteinJ, et al.Awareness and comfort treating the female athlete triad and relative energy deficiency in sport among healthcare providers. J Nurse Pract2020; 71: 76–80.
16.
BrunetPAmbresinAEGojanovicB. What do you know of RED-S? A field study on adolescent coaches’ knowledge. Rev Med Suisse2019; 15: 1334–1338.
17.
MukherjeeSChandVWongXX, et al.Perceptions, awareness and knowledge of the female athlete triad amongst coaches - Are we meeting the expectations for athlete safety?Int J Sport Sci Coach2016; 11: 545–551.
18.
CharltonBTForsythSClarkeDC. Low energy availability and relative energy deficiency in sport: what coaches should know. Int J Sports Sci Coach2022; 17: 445–460.
19.
HamerJDesbrowBIrwinC. Are coaches of female athletes informed of relative energy deficiency in sport? A scoping review. Women Sport Phys Act J2021; 29: 1–9.
20.
MelinATorstveitMKBurkeL,et al.Disordered eating and eating disorders in aquatic sports. Int J Sport Nutr Exerc Metab2014; 24: 450–459.
21.
BrownKNWengreenHJBealsKA. Knowledge of the female athlete triad, and prevalence of triad risk factors among female high school athletes and their coaches. J Pediatr Adolesc Gynecol2014; 27: 278–282.
22.
AckermanKStellingwerffTElliott-SaleK, et al.#REDS (relative energy deficiency in sport): time for a revolution in sports culture and systems to improve athlete health and performance. Bri J Sports Med2020; 54: 369–370.
23.
CarsonTLTournatTSonnevilleK,et al.Cultural and environmental associations with body image, diet and well-being in NCAA DI female distance runners: a qualitative analysis. Br J Sports Med2020; 55: 433–437.
24.
Gymnastics Australia. Gymnastics Australia Body Positive Guidelines. South Melbourne, Victoria, Australia2019.
25.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev2021; 10: 1–11.
26.
PantanoKJ. Current knowledge, perceptions, and interventions used by collegiate coaches in the US regarding the prevention and treatment of the female athlete triad. N Am J Sports Phys Ther2006; 1: 195–207.
27.
TroyKHochAStavrakosJ. Awareness and comfort in treating the female athlete triad: are we failing our athletes?Wis Med J2006; 105: 21.
28.
LassiterJWWattCA. Student coaches’ knowledge, attitudes, skills, and behaviors regarding the female athlete triad. The Physical Educator2007; 64: 142.
29.
KroshusEShermanRTThompsonRA,et al.Gender differences in high school coaches’ knowledge, attitudes, and communication about the female athlete triad. Eat Disorders2014; 22: 193–208.
30.
FrideresJEMottingerSGPalaoJM. Collegiate coaches’ knowledge of the female athlete triad in relation to their characteristics. Cent Eur J Sport Sci Med2016a; 16: 55–66.
31.
FrideresJEMottingerSGPalaoJM. Collegiate coaches’ knowledge of the female athlete triad in relation to sport type. J Sports Med Phys Fitness2016b; 56: 287–294.
32.
PantanoKJ. Knowledge, attitude, and skill of high school coaches with regard to the female athlete triad. J Pediatr Adolesc Gynecol2017; 30: 540–545.
33.
LodgeMTAckermanKEGarayJ. Knowledge of triad and RED-S in female cross-country athletes and support staff. J Athl Train2021; 57: 385–392.
GoveroCBushmanBA. Collegiate cross country coaches’ knowledge of eating disorders. Women Sport Phys Act J2003; 12: 53–65.
36.
ShermanRTThompsonRADeHassD,et al.NCAA coaches survey: the role of the coach in identifying and managing athletes with disordered eating. Eat Disorders2005; 13: 447–466.
37.
KerrGBermanEDe SouzaM. Disordered eating in women’s gymnastics: perspectives of athletes, coaches, parents, and judges. J Appl Sport Psychol2006; 18: 28–43.
38.
Torres-McGeheeTMLeaver-DunnDGreenJM,et al.Knowledge of eating disorders among collegiate administrators, coaches, and auxiliary dancers. Percept Mot Skills2011; 112: 951–958.
39.
NowickaPEliKNgJ,et al.Moving from knowledge to action: a qualitative study of elite coaches’ capacity for early intervention in cases of eating disorders. In J Sports Sci Coach2013; 8: 343–355.
40.
PlateauCRArcelusJMcDermottHJ,et al.Responses of track and field coaches to athletes with eating problems. Scand J Med Sci Sports2015; 25: 240–250.
41.
MartinsenMShermanRTThompsonRA,et al.Coaches’ knowledge and management of eating disorders: a randomized controlled trial. Med Sci Sports Exercise2015; 47: 1070–1078.
42.
Di CagnoAFiorilliGIulianoE, et al.Disordered eating behaviors in rhythmic gymnasts: a survey to investigate the coaches’ point of view on the management. J Phys Educ Sport2018; 18: 1748–1755.
43.
ReaganBPPierceD. Beyond scope of practice: inferring high school tennis coaches’ behavior from their nutrition and eating disorder knowledge. J Phys Fitness, Med Treat Sports2018; 1: 555571.
44.
CôtéJ. The development of coaching knowledge. Int J Sports Sci Coach2006; 1: 217–222.
45.
MallettC. Quality coaching, learning and coach development. J Jpn Sport Edu Studies2011; 30: 51–62.
46.
González-VílloraSSerrano-OlivaresJGonzález-MartíI,et al.What does ‘Playing Well’ mean to elite sports coaches? Implicit thinking of elite Spanish soccer coaches. J New Approaches Educ Res2012; 1: 27–32.
47.
CushionCJArmourKMJonesRL. Coach education and continuing professional development: experience and learning to coach. Quest2003; 55: 215–230.
48.
MallettCTrudelPLyleJ,et al.Formal vs. informal coach education. Int J Sports Sci Coach2009; 4: 325–364.
49.
PotracPBrewerCJonesR,et al.Toward an holistic understanding of the coaching process. Quest2000; 52: 186–199.
50.
GilbertWCôtéJMallettC. Developmental paths and activities of successful sport coaches. Int J Sports Sci Coach2006; 1: 69–76.
51.
MárquezSMolineroO. Energy availability, menstrual dysfunction and bone health in sports; an overview of the female athlete triad. Nutr Hosp2013; 28: 1010–1017.
52.
ClarkeAGovusADonaldsonA. What male coaches want to know about the menstrual cycle in women’s team sports: performance, health, and communication. Int J Sports Sci Coach2021; 16: 544–553.
53.
De SouzaMJNattivAJoyE, et al.Female athlete triad coalition consensus statement on treatment and return to play of the female athlete triad. Br J Sports Med2014; 48: 289. –.
54.
BrownNKnightCJ. Understanding female coaches’ and practitioners’ experience and support provision in relation to the menstrual cycle. Int J Sports Sci Coach2021; 17: 235–243.
55.
BrownNKnightCJForrestLJ. Elite female athletes’ experiences and perceptions of the menstrual cycle on training and sport performance. Scand J Med Sci Sports2021; 31: 52–69.
56.
FindlayRJMacraeEHWhyteIY,et al.How the menstrual cycle and menstruation affect sporting performance: experiences and perceptions of elite female rugby players. Br J Sports Med2020; 54: 1108–1113.
57.
McNultyKLElliott-SaleKJDolanE, et al.The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta-analysis. Sports Med2020; 50: 1813–1827.
58.
O’ConnorHOldsTMaughanRJ. Physique and performance for track and field events. J Sports Sci2007; 25: 49–60.
59.
KasperAMLangan-EvansCHudsonJF, et al.Come back skinfolds, all is forgiven. Nutrients2021; 13: 1075.
60.
DunneAWarringtonGMcGoldrickA, et al.Estimation of body fat percentage in jockeys: implications for a weight category sport. Int J Exerc Sci2020; 13: 511.
61.
PetrieTAGreenleafCReelJJ,et al.An examination of psychosocial correlates of eating disorders among female collegiate athletes. Res Q Exerc Sport2009; 80: 621–632.
62.
MuscatACLongBC. Critical comments about body shape and weight: disordered eating of female athletes and sport participants. J Appl Sport Psychol2008; 20: 1–24.
63.
KongPHarrisLM. The sporting body: body image and eating disorder symptomatology among female athletes from leanness focused and nonleanness focused sports. J Psychol2015; 149: 141–160.
64.
BecknerBNRecordRA. Navigating the thin-ideal in an athletic world: influence of coach communication on female athletes’ body image and health choices. Health Commun2016; 31: 364–373.
65.
LangbeinRKMartinDAllen-CollinsonJ,et al.“It’s hard to find balance when you’re broken”: exploring female endurance athletes’ psychological experience of recovery from relative energy deficiency in sport (RED-S). Perform Enhanc Health2021; 10: 100214.
66.
SchnellAMayerJDiehlK,et al.Giving everything for athletic success! - sports-specific risk acceptance of elite adolescent athletes. Psychol Sport Exerc2014; 15: 165–172.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
