Injury recovery

LEA – Low Energy Availability

Written by: Caitlin Sargent

What is Low Energy Availability?

Research is coming to understand more and more about Low Energy Availability (LEA) and its wide-ranging implications on almost all systems of the body. Physiotherapists are well placed to help pick up on these signs to assist in early intervention. As with most conditions, prevention is better than a cure and the earlier treatment starts the better. So what is LEA?

Energy availability is very self-descriptive! It is measured using the equation below

Energy intake (ie food) – energy expenditure (exercise + energy needed for daily life) = energy availability

How can it present?

If there is inadequate energy intake for the activity being undertaken, then energy availability will be low which can have a number of consequences. These can include:

  • Poor immune function
  • Gastrointestinal dysfunction (including increased gut sensitivity)
  • Poor bone health/reduce bone mass
  • Endocrine/thyroid dysfunction
  • Menstrual dysfunction
  • Impacts on growth and development (in younger athletes)
  • Cardiovascular anomalies

As a physiotherapist, we may see:

  • Increased injury rate
  • Poor sleep and recovery, extreme fatigue
  • Decreased co-ordination
  • Irritability, depression or decreased concentration
  • Decreased muscle strength and endurance performance
  • Decreased training response

The science

While this is an evolving area of research, some recent studies suggest that up to 45% of recreational athletes and up to 80% or elite athletes either have or are at risk of LEA. In a sporting context, it is also referred to as relative energy deficiency in sport (RED-S).

It is relevant to note, that while disordered eating can play a role, many people are not purposely restricting their food intake. The combination of heavy training causing appetite suppression and underestimating the caloric demands of life + training is a factor in the high incidence of LEA.

Treatment for LEA/RED-S is usually led by a dietician (+/- psychologist if needed) and consists of fuelling strategies and modified activity until baseline health functions return. Physiotherapists can help play an important role in identifying LEA and managing graduated return to exercise/training.


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