Educational Intervention Improves Female Athlete Triad Awareness in Female Collegiate Swimmers

Abstract

Introduction: The Female Athlete Triad (Triad) is characterized by high energy expenditure and low caloric intake, leading to dysregulation of menstruation and bone metabolism. Triad-associated relative energy deficiency in sport (REDs) adversely affects performance and mental health. Risk factors are underrecognized in swimmers, who are less likely to present with bone stress injuries because of swimming’s non-weightbearing nature. Our objective was to quantify knowledge about the Triad and REDs among collegiate swimmers and demonstrate the value of educational intervention. Methods: Members of two Division III women’s varsity swim teams completed a Qualtrics survey, consisting of 35 Triad and REDs questions, and 13 demographics questions. Participants then attended an in-person, 20-minute educational session focused on Triad risk factors and prevention, after which they completed a post-session survey. The post-session survey contained 13 additional questions using a Likert scale, where 1=Strongly Agree and 5=Strongly Disagree. Pre- and post-session data were analyzed using Microsoft Excel. Results: Thirty-one swimmers were included. Pre-session, 9.7% of respondents named one or more Triad components, compared to 96.8% after (p<0.0001). 9.7% could define the REDs acronym pre-session, compared to 87.1% after (p<0.0001). Participants better understood the Triad post-session (mean Likert score=1.23) and found the session helpful (mean=1.23), but in a hypothetical scenario, felt relatively uncomfortable contacting medical staff about Triad symptoms (mean=1.87, p=0.0002). Of the 35.5% who believed they may be experiencing Triad components, 72.7% indicated the session motivated them to seek help. Conclusions: Female collegiate swimmers’ low baseline Triad and REDs knowledge improved significantly after an educational intervention. Survey responses highlighted the importance of heightened Triad awareness, but also its continued stigmatization. The session encouraged swimmers with self-identified Triad symptoms to seek help, underscoring the importance of continued education efforts, especially in sports where the Triad is underrecognized.