East Africian Distance Runners: Female Athlete Triad and Relative Energy Deficiency in Sport (RED-S) Conditions

Research Team Members: Martin Mooses, Anthony C. Hackney, Diresibachew H Wondimu, Robert Ojiambo and Amy R. Lane


International research team (R to L): Amy Lane, Marin Mooses, Silva Suvi, Robert Ojiambo, Diresibachew Wondimu, and Anthony Hackney

Why did you do this study?

The Female Athlete Triad (TRIAD) and more recently, Relative Energy Deficiency in Sport (RED-S) health conditions in men (male hypogonadism) have been linked a state called “low energy availability” (LEA). LEA occurs when an individual’s energy intake (food) minus their exercise energy expenditure is below a level that will ensure adequate energy for exercise as well as all physiological processes within the body (<30 kcal/kg body weight/day).


Maximal oxygen uptake test of elite athlete

LEA results in hormonal, metabolic and bone disorders which compromise overall health, but are specially related to reproductive system dysfunctions. These disorders also can have detrimental effects on exercise performance, injury rate, as well as impact aspects of the athletes’ health later in life (e.g., increased risk of osteoporosis).

Athletes who participate in endurance sports are at increased risk for LEA due to the extremely high volumes of exercise training they perform. The research conducted in this area so far has been done predominantly in Caucasian (US and European) populations. Very little is known, however, about prevalence in East African endurance athletes, who are some of the best runners in the world based upon the numerous world records and Olympic medals.

Earlier research by our group suggests that the low body mass and BMI of these African runners have benefitted their performance; i.e., through a more advantageous running economy, but those same anthropometric factors (body mass, BMI) could also put them at risk for the TRIAD or RED-S conditions. Therefore, the focus of our study is to identify the prevalence and risk factors for the TRIAD and RED-S in East African elite distance runners (both females and males). The intent is to collect data in field settings where the athletes live and train.

What did you do and what did you find in this study?


Field tests for blood lactate responses (lactate threshold test)

The study has been operating for the last 9 months. This past fall and winter, members of our international team from Ethiopia, Kenya, Estonia as well as UNC-CH have been on-site in Kenya working collecting data on male and female athletes at a running training camp at Eldoret, Kenya (2200 meters elevation, southwestern Kenya). UNC-CH EXSS professor Anthony Hackney and his doctoral student Amy Lane have been on sight collecting body composition, training, blood samples, nutritional and psychological data from the research subjects (pictures 1,2,3). The logistics of how to collect some of this data in rural areas of Kenya have been challenging at times.

The work is moving towards a commencement of the final data collection in fall 2017. Participants will include 30 female and 30 male elite East African endurance runners, with 30 female and 30 male adult non-athletes matched for age and ethnicity as controls. This study is funded on a 2 year grant through the International Athletics Foundation (project # 417) and is  truly collaborative international project. The main member of the research team are shown in picture 4.

How do these findings impact the public?


UNC doctoral student interviewing one of the research subjects relative to there training and dietary history

The findings from this study will help build knowledge about the impact that LEA has on elite East African endurance athletes. Through the identification of prevalence rates, this work can contribute to development of future interventions to minimize the prevalence, prevent occurrence and improve recovery from TRIAD and/or RED-S. Additionally, bringing this research to Kenya may increase education about energy availability to a broader audience.