Video Intervention of Relative Energy Deficiency in Sport

The objective was to assess the effectiveness of a brief online educational video in improving knowledge, attitudes, and perceived confidence toward the Triad and REDs among Spanish healthcare professionals.

Design: Randomized controlled educational trial. A total of 200 Spanish healthcare professionals (physicians, nurses, and physiotherapists) were randomized 1:1 into an intervention group (VG) and a control group (CG). The VG received access to an 18-minute YouTube-based educational video titled "Triad of the Female Athlete and RED-S". The CG did not have access to the video until the study was completed. Both completed a validated 16-question questionnaire before and after the intervention.

The Primary Outcome Measure was the change in knowledge score about the Female/Male Athlete Triad and REDs. Secondary outcomes included questions from the definition group (questions 1 and 3), low energy availability group (questions 2, 4, 5, 10, 14, 15 and 16), the menstrual health group (questions 6,9,11 and 13) and the bone health group (questions 7,8 and 12)

Descriptive analyses were conducted to determine means, standard deviations, frequencies, and percentages. A two-way repeated-measures ANOVA was performed after verifying the statistical assumptions required for this methodology. Outliers were examined using the first and third quartiles and the interquartile range. Participants with a total score ≤4 were excluded from the analysis to preserve the reliability and validity of the data and to ensure that statistical analyses reflected only responses with adequate informational content consistent with the study conditions. Data normality was assessed through Q-Q plots and the Shapiro-Wilk test. The effects of the group factor (VG vs. CG), the time factor (pre- vs. post-test), and their interaction were analysed, considering a 95% confidence interval (p ≤ 0.05).

Knowledge Questions

• What do you consider to be the three components of the Female Athlete Triad?
• Low energy availability in a person occurs when the energy to maintain the functions required by the human body to preserve health and optimal performance is insufficient.
• What is the main factor that would cause REDs?
• Low energy availability could be associated with a decrease in carbohydrate intake.
• There may be low energy availability without changes in weight or body mass index.
• Menarche in adolescents after the age of 15 is normal if they engage in intense physical activity.
• At what age does peak bone mineral density occur in women?
• Osteopenia in adolescent girls or young adult women can be reversed if, in adulthood, they reduce the intensity or volume of their physical activity.
• In a physically active woman, secondary amenorrhea can be considered normal if she engages in intense sport.
• Menstrual disorders in physically active women are a risk factor for having low bone mineral density.
• Low energy availability can cause secondary amenorrhea in physically active women.
• In physically active women, menstrual cycle alterations or amenorrhea are indicators of intense training.
• In physically active women, stress fractures may occur at a higher rate in women with prolonged amenorrhea than in eumenorrheic women.
• Low energy availability can affect an athlete's recovery.
• Low energy availability can increase performance (strength, speed, power).
• After performing intense exercise, the basis of caloric intake should be...

Inclusion criteria

• Registered in a health professional association in Spain (medicine, nursing, or physiotherapy).
• Voluntary participation and completion of the baseline questionnaire.
• Consent to provide an email address for communication and randomization

Exclusion criteria

• Not to be registered in a health professional association in Spain (medicine, nursing, or physiotherapy).
• Incomplete questionnaire responses.
• Total score ≤4 in the pre-test, to preserve data reliability and validity.