Review of the scientific rationale, development and validation of the International Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool : V.2 (IOC REDs CAT2)-by a subgroup of the IOC consensus on REDs

Journal article


Stellingwerff, Trent, Mountjoy, Margo, McCluskey, Walter Tp, Ackerman, Kathryn E., Verhagen, Evert and Heikura, Ida. (2023). Review of the scientific rationale, development and validation of the International Olympic Committee Relative Energy Deficiency in Sport Clinical Assessment Tool : V.2 (IOC REDs CAT2)-by a subgroup of the IOC consensus on REDs. British Journal of Sports Medicine. 57(17), pp. 1109-1118. https://doi.org/10.1136/bjsports-2023-106914
AuthorsStellingwerff, Trent, Mountjoy, Margo, McCluskey, Walter Tp, Ackerman, Kathryn E., Verhagen, Evert and Heikura, Ida
Abstract

Relative Energy Deficiency in Sport (REDs) has various different risk factors, numerous signs and symptoms and is heavily influenced by one’s environment. Accordingly, there is no singular validated diagnostic test. This 2023 International Olympic Committee’s REDs Clinical Assessment Tool—V.2 (IOC REDs CAT2) implements a three-step process of: (1) initial screening; (2) severity/risk stratification based on any identified REDs signs/symptoms (primary and secondary indicators) and (3) a physician-led final diagnosis and treatment plan developed with the athlete, coach and their entire health and performance team. The CAT2 also introduces a more clinically nuanced four-level traffic-light (green, yellow, orange and red) severity/risk stratification with associated sport participation guidelines. Various REDs primary and secondary indicators have been identified and ‘weighted’ in terms of scientific support, clinical severity/risk and methodological validity and usability, allowing for objective scoring of athletes based on the presence or absence of each indicator. Early draft versions of the CAT2 were developed with associated athlete-testing, feedback and refinement, followed by REDs expert validation via voting statements (ie, online questionnaire to assess agreement on each indicator). Physician and practitioner validity and usability assessments were also implemented. The aim of the IOC REDs CAT2 is to assist qualified clinical professionals in the early and accurate diagnosis of REDs, with an appropriate clinical severity and risk assessment, in order to protect athlete health and prevent prolonged and irreversible outcomes of REDs.

Year2023
JournalBritish Journal of Sports Medicine
Journal citation57 (17), pp. 1109-1118
PublisherBMJ Publishing Group
ISSN0306-3674
Digital Object Identifier (DOI)https://doi.org/10.1136/bjsports-2023-106914
PubMed ID37752002
Scopus EID2-s2.0-85172677096
Open accessOpen access
Page range1109-1118
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online26 Sep 2023
Publication process dates
Accepted14 Aug 2023
Deposited16 Apr 2025
Additional information

Bronze open access.

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ

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