Relative energy deficiency in sport and the role of ultrarunning coaches according to two female ultrarunners

Relative Energy Deficiency in Sport (RED-S) is a complex syndrome that occurs as a result of prolonged Low Energy Availability (LEA) leading to health and performance impairments. However, whilst the coach plays an important role when working with athletes with RED-S, no research exists specifically exploring their role. Therefore, this study investigates the role of the coach from the athletes' perspective within an ultrarunning context. Ultrarunners are at risk of LEA due to large training volumes and record high incidences of psychological and physiological conditions linked to RED-S, such as disordered eating and bone stress injuries. Two female ultrarunners who had experience with RED-S each participated in three semi-structured interviews. The findings highlight the multifaceted role of the coach which changes depending on the stage of the athletes' RED-S Journey. Of primary importance was that the coach should be educated on RED-S in order to provide value throughout. Secondly, for effective recovery, the coach should embrace working with a multidisciplinary support team of experts. Thirdly, the coach should actively work on establishing strong relationships with the athlete and their support network. This will propagate trust and honest conversations, a key requirement for recovery from, and ongoing training post, RED-S.