Em 2014, o Comitê Olímpico Internacional (COI) publicou uma declaração de consenso intitulada “Além da Tríade da Mulher Atleta: Deficiência Relativa de Energia para o Esporte (Relative Energy Deficiency in Sport ou RED-S)“.
A Síndrome de Deficiência de Energia Relativa no Esporte refere-se ao “funcionamento fisiológico prejudicado causado por deficiência energética relativa e inclui, mas não se limita a, comprometimentos da taxa metabólica, função menstrual, saúde óssea, imunidade, síntese protéica e saúde cardiovascular”. O fator etiológico dessa síndrome é a baixa disponibilidade de energia.
Originalmente chamada de “Tríade da Mulher Atleta” e mais recentemente atualizada para incluir componentes psicológicos e físicos adicionais, a Deficiência de Energia Relativa no Esporte (RED-S) é uma condição que pode afetar atletas de qualquer idade e sexo. RED-S ocorre quando um desequilíbrio na ingestão e produção de energia tem efeitos prejudiciais na saúde óssea, função menstrual (em mulheres), taxa metabólica, função imunológica, saúde cardiovascular e saúde psicológica.
A RED-S pode se sobrepor a um transtorno alimentar ou servir como um fator de risco para o início do transtorno alimentar, mas não necessariamente. Mesmo quando a RED-S não se sobrepõe a uma apresentação típica do transtorno alimentar, a deficiência de energia pode causar sérios problemas de saúde física e psicológica. Uma preocupação naqueles com RED-S é a osteoporose. O baixo crescimento ósseo como resultado da deficiência de energia em jovens pode levar a fraturas por estresse. Além disso, os indivíduos com evidências de RED-S aumentaram o risco de lesão, diminuíram a resistência e reduziram a força muscular, juntamente com a diminuição da coordenação, julgamento prejudicado, irritabilidade e depressão. Embora os atletas possam acreditar que aumentarão o desempenho esportivo reduzindo a ingestão calórica e aumentando o cronograma de treinamento, ocorre o oposto. O desempenho esportivo fica abaixo da disponibilidade de energia.
Para atletas em todos os níveis de participação esportiva, avaliar as necessidades de ingestão e ajustar a ingestão para atender às necessidades de treinamento é vital. Para alcançar o equilíbrio energético, o aumento de um cronograma de treinamento, juntamente com o crescimento e desenvolvimento normais, requer um aumento no consumo de energia.
A Baixa Disponibilidade de Energia (BDE), que sustenta o conceito de RED-S, é um descompasso entre a ingestão alimentar do atleta (dieta) e a energia gasta no exercício, deixando energia inadequada para suportar as funções exigidas pelo corpo para manter a saúde e o desempenho ideais. Operacionalmente, a disponibilidade de energia (DE) é definida como: onde o Gasto Energético do Exercício (GEE) é calculado como a energia adicional gasta acima da vida diária durante o exercício, e o resultado geral é expresso em relação à massa livre de gordura, refletindo os tecidos mais metabolicamente ativos do corpo.
Os efeitos da Baixa Disponibilidade de Energia (BDE) no sistema endócrino foram descritos predominantemente em atletas do sexo feminino e apenas recentemente em atletas do sexo masculino. Os achados em algumas atletas femininas nos estados de Baixa Disponibilidade de Energia incluem interrupção do eixo hipotalâmico-hipofisário-gonadal, alterações na função tireoidiana, alterações nos hormônios reguladores do apetite (por exemplo, diminuição da leptina e ocitocina, aumento da grelina , peptídeo YY e adiponectina), diminuição da insulina e do fator de crescimento semelhante à insulina 1 (IGF-1), aumento da resistência ao hormônio do crescimento (GH) e elevação do cortisol. Muitas dessas alterações hormonais provavelmente ocorrem para economizar energia. funções corporais mais importantes ou usar as reservas de energia do corpo para processos vitais.
Mudanças específicas nos homens não são completamente compreendidas; entretanto, a redução da pulsatilidade e da amplitude do hormônio luteinizante (LH) tem sido descrita em uma série de corredores de maratonas masculinas, uma população de alto risco para a Baixa Disponibilidade de Energia. Outros estudos, principalmente em populações masculinas de endurance, mostraram reduções na testosterona e achados inconsistentes em diferenças nos parâmetros basais de LH.
Estabelece-se que a Baixa Disponibilidade de Energia (BDE) contribui para a saúde óssea prejudicada em atletas, particularmente mulheres. Estudos transversais de atletas do sexo feminino fisicamente ativas com oligomenorreia / amenorreia ou Baixa Disponibilidade de Energia (BDE) medida demonstraram diminuição da densidade de massa óssea, alteração da micro-arquitetura óssea e marcadores de turnover ósseo, diminuição da estimativa da força óssea e aumento do risco de lesões ósseas em comparação com atletas eumanorréicos e aqueles que são disponibilidade energética normal. Populações específicas de esportes femininos e masculinos têm maior risco de densidade mineral óssea menor, incluindo jóqueis, corredores, nadadores e ciclistas. Locais anatômicos com menor carga óssea e / ou maior conteúdo trabecular versus osso cortical (coluna lombar e rádio versus quadril total) apresentam maior risco de baixa densidade mineral óssea e microarquitetura prejudicada em populações suscetível a Baixa Disponibilidade Energética.
O baixo índice de massa corporal (IMC) é um marcador substituto imperfeito para a Baixa Disponibilidade energética. No entanto, o IMC ≤17,5 kg / m2, <85% do peso corporal esperado para adolescentes ou ≥10% de perda de peso em 1 mês são indicadores propostos da baixa disponibilidade energética, e, de fato, tanto o IMC quanto o peso corporal esperados estão associados a maior risco de baixa densidade mineral óssea em ambos os sexos. A Baixa Disponibilidade de Energia (BDE) pode ser acompanhada por Distúrbios alimentares, disfunção menstrual e baixa densidade mineral óssea, e a combinação de fatores coloca os atletas em maior risco de lesão por estresse ósseo.
Aqui estão algumas coisas para lembrar ao avaliar se seu corpo está recebendo a ingestão adequada (comida) em relação à produção (exercício):
1- A perda da menstruação não é uma parte normal do treinamento; é uma bandeira vermelha. Enquanto algumas mulheres acham que períodos irregulares ou faltosos são uma parte normal do treinamento para o esporte, a interrupção da menstruação é um sinal de deficiência de energia. Períodos irregulares indicam que é provável que uma pessoa experimente outros elementos de RED-S, incluindo perda de densidade óssea. Perda de menstruação pode acontecer mesmo quando as meninas e as mulheres não estão com um peso baixo.
2- O aumento da ingestão é necessário se um programa de treinamento aumentar. A fim de atender às necessidades de treinamento, é necessário fazer refeições e lanches regulares. Pode ser necessário adicionar lanches extras durante o dia, quando a programação de treinamento aumenta. Consulte um nutricionista para ajudá-lo a avaliar suas necessidades energéticas.
3-Muito exercício pode ser problemático. Altos níveis de exercício podem levar a alto risco de lesão. Os corpos funcionam bem quando estão ativos e o exercício tem muitos benefícios; no entanto, os corpos também precisam de muito descanso. Para indivíduos com um transtorno alimentar ativo, o exercício vigoroso é desencorajado, mas o excesso de treinamento pode ser problemático mesmo para aqueles que não têm um transtorno alimentar.
4- O “corpo ideal” retratado nos esportes pode ser um padrão inatingível. Alguns esportes podem ter diferenças específicas em como um tipo de corpo “ideal” pode ser retratado. Por exemplo, o corpo “ideal” retratado para um ginasta é diferente do de um tenista. Embora muitas vezes haja uma presunção de que alcançar um tipo de corpo específico resultará em melhor desempenho, esse não é o caso. Diferentes indivíduos têm diferentes tipos de corpo como resultado de seus genes, mesmo se aderirem aos programas de treinamento similares. Além disso, ter um corpo que não adere aos padrões “típicos” de um esporte não impede a participação, o prazer, a melhoria e o sucesso nesse esporte. Para muitos indivíduos, as tentativas de buscar um ideal corporal específico diminuirão seu desempenho esportivo à medida que experimentam deficiência de energia.
A conclusão é que a participação esportiva deve ser benéfica, não prejudicial ao seu corpo. Estimar corretamente e abordar as necessidades de energia é a melhor maneira de equipar seu corpo para os rigores do treinamento.
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