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Exercise dependence, eating disorder symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes
  1. Monica Klungland Torstveit1,
  2. Ida Lysdahl Fahrenholtz1,
  3. Mia Beck Lichtenstein2,
  4. Thomas Birkedal Stenqvist1,
  5. Anna Katarina Melin3
  1. 1 Faculty of Health and Sport Science, Institute of Public Health, Sport & Nutrition, University of Agder, Kristiansand, Norway
  2. 2 Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
  3. 3 Department of Sports Science, Linnaeus University, Kalmar, Sweden
  1. Correspondence to Dr Monica Klungland Torstveit; monica.k.torstveit{at}


Objectives To explore associations betweenexercise dependence, eating disorder (ED) symptoms and biomarkers of Relative Energy Deficiency in Sports (RED-S) among male endurance athletes.

Methods Fifty-three healthy well-trained male cyclists, triathletes and long-distance runners recruited from regional competitive sports clubs were included in this cross-sectional study. The protocol comprised the Exercise Dependence Scale (EXDS), the ED Examination Questionnaire (EDE-Q), measurements of body composition, resting metabolic rate, energy intake and expenditure and blood analysis of hormones and glucose.

Results Participants with higher EXDS score displayed a more negative energy balance compared with subjects with lower EXDS score (p<0.01). EXDS total score was positively correlated with EDE-Q global score (r=0.41, p<0.05) and the subscale score for restraint eating (r=0.34, p<0.05) and weight concern (r=0.35, p<0.05). EXDS total score and the subscales lack of control and tolerance were positively correlated with cortisol (r=0.38, p<0.01, r=0.39, p<0.01 and r=0.29, p<0.05, respectively). The EXDS subscales withdrawal and tolerance were negatively correlated with fasting blood glucose (r=−0.31 and r=−0.32, p<0.05, respectively), while intention effect was negatively correlated with testosterone:cortisol ratio (r=−0.29, p<0.05) and positively correlated with cortisol:insulin ratio (r=0.33, p<0.05).

Conclusion In this sample of healthy male athletes, we found associations between higher EXDS scores, ED symptoms and biomarkers of RED-S, such as a more pronounced negative energy balance and higher cortisol levels.

  • relative energy deficiency
  • compulsive exercise
  • exercise addiction
  • disordered eating
  • low energy availability

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  • Contributors MKT, AKM and TBS planned and initiated the main study. AKM, MBL and ILF performed the statistical analyses, and TBS was responsible for the methodological part. MKT and ILF drafted the manuscript. All authors critically revised the manuscript.

  • Funding The costs were covered by the University of Agder.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Permission to undertake the study was granted by the University Faculty Ethics Committee and the Norwegian Data Protection Official for Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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