what is the purpose of a presentation critique

How to Give Effective Presentation Feedback

A conversation with sam j. lubner, md, facp.

Giving an effective scientific presentation, like all public speaking, is an acquired skill that takes practice to perfect. When delivered successfully, an oral presentation can be an invaluable opportunity to showcase your latest research results among your colleagues and peers. It can also promote attendee engagement and help audience members retain the information being presented, enhancing the educational benefit of your talk, according to Sam J. ­Lubner, MD, FACP , Associate Professor of Medicine and Program Director, Hematology-Oncology Fellowship, at the University of Wisconsin Carbone Cancer Center, and a member of ASCO’s Education Council.

Sam J. ­Lubner, MD, FACP

In 2019, the Education Council launched a pilot program to provide a group of selected speakers at the ASCO Annual Meeting with feedback on their presentations. Although some of the reviewers, which included members of the Education Council and Education Scholars Program, as well as ASCO’s program directors, conveyed information to the presenters that was goal-referenced, tangible, transparent, actionable, specific, and personalized—the hallmarks of effective feedback—others provided comments that were too vague to improve the speaker’s performance, said Dr. Lubner. For example, they offered comments such as “Great session” or “Your slides were too complicated,” without being specific about what made the session “great” or the slides “too complicated.”

“Giving a presentation at a scientific meeting is different from what we were trained to do. We’re trained to take care of patients, and while we do have some training in presentation, it usually centers around how to deliver clinical information,” said Dr. Lubner. “What we are trying to do with the Education Council’s presentation feedback project is to apply evidence-based methods for giving effective feedback to make presentations at ASCO’s Annual Meeting, international meetings, symposia, and conferences more clinically relevant and educationally beneficial.”

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The ASCO Post talked with Dr. Lubner about how to give effective feedback and how to become a more effective presenter.

Defining Effective Feedback

Feedback is often confused with giving advice, praise, and evaluation, but none of these descriptions are exactly accurate. What constitutes effective feedback?

When I was looking over the literature on feedback to prepare myself on how to give effective feedback to the medical students and residents I oversee, I was amazed to find the information is largely outdated. For example, recommendations in the 1980s and 1990s called for employing the “sandwich” feedback method, which involves saying something positive, then saying what needs to be improved, and then making another positive remark. But that method is time-intensive, and it feels disingenuous to me.

What constitutes helpful feedback to me is information that is goal-referenced, actionable, specific, and has immediate impact. It should be constructive, descriptive, and nonjudgmental. After I give feedback to a student or resident, my next comments often start with a self-reflective question, “How did that go?” and that opens the door to further discussion. The mnemonic I use to provide better feedback and achieve learning goals is SMART: specific, measurable, achievable, realistic, and timely, as described here:

• Specific: Avoid using ambiguous language, for example, “Your presentation was great.” Be specific about what made the presentation “great,” such as, “Starting your presentation off with a provocative question grabbed my attention.”
• Measurable: Suggest quantifiable objectives to meet so there is no uncertainty about what the goals are. For example, “Next time, try a summary slide with one or two take-home points for the audience.”
• Achievable: The goal of the presentation should be attainable. For example, “Trim your slides to no more than six lines per slide and no more than six words per line; otherwise, you are just reading your slides.”
• Realistic: The feedback you give should relate to the goal the presenter is trying to achieve. For example, “Relating the research results back to an initial case presentation will solidify the take-home point that for cancer x, treatment y is the best choice.”
• Timely: Feedback given directly after completion of the presentation is more effective than feedback provided at a later date.

The ultimate goal of effective feedback is to help the presenter become more adept at relaying his or her research in an engaging and concise way, to maintain the audience’s attention and ensure that they retain the information presented.

“Giving a presentation at a scientific meeting is different from what we were trained to do.” — Sam J. Lubner, MD, FACP Tweet this quote

Honing Your Communication Skills

What are some specific tips on how to give effective feedback?

There are five tips that immediately come to mind: (1) focus on description rather than judgment; (2) focus on observation rather than inference; (3) focus on observable behaviors; (4) share both positive and constructive specific points of feedback with the presenter; and (5) focus on the most important points to improve future ­presentations.

Becoming a Proficient Presenter

How can ASCO faculty become more proficient at delivering their research at the Annual Meeting and at ASCO’s thematic meetings?

ASCO has published faculty guidelines and best practices to help speakers immediately involve an audience in their presentation and hold their attention throughout the talk. They include the following recommendations:

• Be engaging. Include content that will grab the audience’s attention early. For example, interesting facts, images, or a short video to hold the audience’s focus.
• Be cohesive and concise. When preparing slides, make sure the presentation has a clear and logical flow to it, from the introduction to its conclusion. Establish key points and clearly define their importance and impact in a concise, digestible manner.
• Include take-home points. Speakers should briefly summarize key findings from their research and ensure that their conclusion is fully supported by the data in their presentation. If possible, they should provide recommendations or actions to help solidify their message. Thinking about and answering this question—if the audience remembers one thing from my presentation, what do I want it to be?—will help speakers focus their presentation.
• When it comes to slide design, remember, less is more. It’s imperative to keep slides simple to make an impact on the audience.

Another method to keep the audience engaged and enhance the educational benefit of the talk is to use the Think-Pair ( ± Share) strategy, by which the speaker asks attendees to think through questions using two to three steps. They include:

• Think independently about the question that has been posed, forming ideas.
• Pair to discuss thoughts, allowing learners to articulate their ideas and to consider those of others.
• Share (as a pair) the ideas with the larger group.

The value of this exercise is that it helps participants retain the information presented, encourages individual participation, and refines ideas and knowledge through collaboration.

RECOMMENDATIONS FOR SLIDE DESIGN

• Have a single point per line.
• Use < 6 words per line.
• Use < 6 lines per slide.
• Use < 30 characters per slide.
• Use simple words.
• When using tables, maintain a maximum of 6 rows and 6 columns.
• Avoid busy graphics or tables. If you find yourself apologizing to the audience because your slide is too busy, it’s a bad slide and should not be included in the presentation.
• Use cues, not full thoughts, to make your point.
• Keep to one slide per minute as a guide to the length of the presentation.
• Include summary/take-home points per concept. We are all physicians who care about our patients and believe in adhering to good science. Highlight the information you want the audience to take away from your presentation and how that information applies to excellent patient care.

Speakers should also avoid using shorthand communication or dehumanizing language when describing research results. For example, do not refer to patients as a disease: “The study included 250 EGFR mutants.” Say instead, “The study included 250 patients with EGFR -mutant tumors.” And do not use language that appears to blame patients when their cancer progresses after treatment, such as, “Six patients failed to respond to [study drug].” Instead say, “Six patients had tumors that did not respond to [study drug].”

We all have respect for our patients, families, and colleagues, but sometimes our language doesn’t reflect that level of respect, and we need to be more careful and precise in the language we use when talking with our patients and our colleagues.

ASCO has developed a document titled “The Language of Respect” to provide guidance on appropriate respectful language to use when talking with patients, family members, or other health-care providers and when giving presentations at the Annual Meeting and other ASCO symposia. Presenters should keep these critical points in mind and put them into practice when delivering research data at these meetings. ■

DISCLOSURE: Dr. Lubner has been employed by Farcast Biosciences and has held a leadership role at Farcast Biosciences.

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Techniques for using critique language for more powerful and effective presentations

Ryan Orcutt

Pairing your talk with a well-designed visual accompaniment, like a PowerPoint presentation, can mean the difference between a piece of communication that moves an audience and succeeds at delivering a message — and one that fails and is forgotten. Good visuals are so important for presentations because research has shown that visual information is easier for humans to process, remember, and recall.

If you feel like you could use some extra help ensuring that your deck is designed to make a powerful impression on audiences, we recommend you develop critique language skills. Learning how to use critique language to evaluate slides will allow you to improve your own slides, or help you communicate to a colleague how they could improve theirs.

Here are some tips for determining whether slides are designed well or ineffectively, how to articulate their strengths and weaknesses, and what active steps you can take to improve the visual design of any presentation using critique language.

Learn and evaluate the 5 essential slide design elements

There are 5 essential design elements of every slide that are critical to the visual impact a presentation makes. Learn what these elements are as a presenter, then refer to each when you evaluate the visual quality of a presentation. Make sure you carefully consider each element when you look at a slide, then determine whether it is executed to effectively communicate your message, or whether it may obscure your meaning or get overlooked.

Contrast between design elements (in color, size, etc.) helps focus attention, create drama, and set hierarchy. When you look at a presentation slide, consider the contrast in the design and ask yourself: Is the prioritization clear, or is it indistinct?

Whitespace drives focus and is like the oxygen of a slide: it must exist so that all other elements can function the way they are supposed to. When you consider the whitespace on a slide, ask yourself: Is the space open, or cluttered? If a slide feels too cluttered, decide how it can be pared-down for more effective messaging.

Good hierarchy treats things visually according to their importance. Consider the most and least important elements on a slide when evaluating. Ask yourself: is a parent/child relationship apparent or absent in the ideas on the slide? If you can’t tell the most important takeaway, make changes so that what’s essential is highlighted.

Consistency and cohesiveness are vital for delivering one comprehensible presentation big idea. Unity is achieved through consistent look and feel, image treatment, and placement of elements. As you go through each of your presentation slides, decide: does the presentation look structured or unstructured? Make changes to ensure every slide looks like it’s coming from the same place and presenter.

Flow is what directs the eye along certain, pre-determined paths of a slide to areas of focus. Consider: Is there a clear path for the eye to follow on this slide or is that path unclear? Make sure people look at the thing you need them to, so you make your point.

Does this slide pass the Glance Test™?

After you evaluate every slide for its critical design elements, use the Glance Test to ensure that it is comprehensible and digestible for everyone sitting in your audience.

The Glance Test is a powerful method used to ensure that slides can be easily understood and taken in by people who are sitting far away from the presentation screen and who only have a brief moment to look at the slide (while they are simultaneously listening to you talk).

Here’s how to use the Glance Test:

• Look at a slide for 3 seconds, then look away from the slide.
• Determine whether you can remember and communicate the information or message that was included in the slide.
• If, after three seconds, you are wondering what the slide was about, or can’t quite convey the message you saw, the slide has too much information for your audience to process.
• If the slide doesn’t pass the glance test, return to it to pare it down or redesign it.

Don’t just identify problems, propose solutions

If you are critiquing a colleague’s slides, or you are attempting to improve your own, you want to start by identifying which slides don’t properly execute the 5 essential slide design elements, or which don’t pass the Glance Test.

However, it is not enough to simply point out the problems with the slides and say why they don’t work. Instead, it helps to take it one step further and explain where the slides might be failing, and in what ways they could be improved. Could this slide be improved by adding more contrast into the background? Could unity be achieved by having all of the photos in black and white? Could we achieve more whitespace by breaking this content up over 3 slides? It’s easy to identify problems, it’s more valuable to help solve them.

By approaching a deck with an improvement mentality, and understanding what makes a slide work — or fail — you can easily understand which elements should be tweaked, and how they can be changed to better fit effective slide design criteria.

Proposing solutions during a critique for a colleague can also help boost a presenter’s confidence and make them clearer on their big idea.

Allow for a defense of the design

If you are critiquing the design of another person and they strongly disagree about a slide you believe doesn’t work, allow them to defend the design. See if their defense aligns with the essential principles of effective slide design.

If a slide fails the glance test for you, ask them to expand on how they believe their slide makes a lasting, effective impact in under 3 seconds. It’s possible your mind will be changed after hearing them defend their design choices.

If blue isn’t working for you as a background color, ask them if they think it’s achieving enough contrast for the text. They may explain that brand standards say blue must be used for backgrounds but the color of the type could be changed.

It’s most likely that the process will be a good lesson on the important principles of slide design for both the critique giver and the recipient.

By utilizing critique language to make yours and others’ presentations better, you can ensure that you’re effectively reaching everyone in your audience in a way that resonates.

Illustrated by Melissa Chen.

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Speech Analysis #1: How to Study and Critique a Speech

The Speech Analysis Series is a series of articles examining different aspects of presentation analysis. You will learn how to study a speech and how to deliver an effective speech evaluation. Later articles will examine Toastmasters evaluation contests and speech evaluation forms and resources.

• How to Study and Critique a Speech
• The Art of Delivering Evaluations
• Modified Sandwich Technique for Evaluations
• Evaluation Forms, Tools, and Resources
• Toastmasters Evaluation Contests

The first in the series, this article outlines questions to ask yourself when assessing a presentation . Ask these questions whether you attend the presentation, or whether you view a video or read the speech text. These questions also apply when you conduct a self evaluation of your own speeches .

The Most Important Thing to Analyze: The Speech Objectives

Knowing the speaker’s objective is critical to analyzing the speech, and should certainly influence how you study it.

• What is the speaker’s goal? Is it to educate , to motivate , to persuade , or to entertain ?
• What is the primary message being delivered?
• Why is this person delivering this speech ? Are they the right person?
• Was the objective achieved ?

The Audience and Context for the Speech

A speaker will need to use different techniques to connect with an audience of 1500 than they would with an audience of 15. Similarly, different techniques will be applied when communicating with teenagers as opposed to communicating with corporate leaders.

• Where and when is the speech being delivered?
• What are the key demographic features of the audience ? Technical? Students? Elderly? Athletes? Business leaders?
• How large is the audience?
• In addition to the live audience, is there an external target audience ? (e.g. on the Internet or mass media)

Speech Content and Structure

The content of the speech should be selected and organized to achieve the primary speech objective. Focus is important — extraneous information can weaken an otherwise effective argument.

Before the Speech

• Were there other speakers before this one ? Were their messages similar, opposed, or unrelated?
• How was the speaker introduced ? Was it appropriate?
• Did the introduction establish why the audience should listen to this speaker with this topic at this time ?
• What body language was demonstrated by the speaker as they approached the speaking area? Body language at this moment will often indicate their level of confidence .

The Speech Opening

Due to the primacy effect , words, body language, and visuals in the speech opening are all critical to speaking success.

• Was a hook used effectively to draw the audience into the speech? Or did the speaker open with a dry “ It’s great to be here today. “
• Did the speech open with a story ? A joke ? A startling statistic ? A controversial statement ? A powerful visual ?
• Did the speech opening clearly establish the intent of the presentation?
• Was the opening memorable ?

The Speech Body

• Was the presentation focused ? i.e. Did all arguments, stories, anecdotes relate back to the primary objective?
• Were examples or statistics provided to support the arguments ?
• Were metaphors and symbolism use to improve understanding?
• Was the speech organized logically ? Was it easy to follow?
• Did the speaker transition smoothly from one part of the presentation to the next?

The Speech Conclusion

Like the opening, the words, body language, and visuals in the speech conclusion are all critical to speaking success. This is due to the recency effect .

• Was the conclusion concise ?
• Was the conclusion memorable ?
• If appropriate, was there a call-to-action ?

Delivery Skills and Techniques

Delivery skills are like a gigantic toolbox — the best speakers know precisely when to use every tool and for what purpose.

Enthusiasm and Connection to the Audience

• Was the speaker enthusiastic ? How can you tell?
• Was there audience interaction ? Was it effective?
• Was the message you – and we-focused , or was it I- and me-focused ?
• Was humor used?
• Was it safe and appropriate given the audience?
• Were appropriate pauses used before and after the punch lines, phrases, or words?
• Was it relevant to the speech ?

Visual Aids

• Were they designed effectively?
• Did they complement speech arguments ?
• Was the use of visual aids timed well with the speaker’s words?
• Did they add energy to the presentation or remove it?
• Were they simple and easy to understand ?
• Were they easy to see ? e.g. large enough
• Would an additional visual aid help to convey the message?

Use of Stage Area

• Did the speaker make appropriate use of the speaking area?

Physical – Gestures and Eye Contact

• Did the speaker’s posture display confidence and poise?
• Were gestures natural, timely, and complementary ?
• Were gestures   easy to see ?
• Does the speaker have any distracting mannerisms ?
• Was eye contact effective in connecting the speaker to the whole audience?

Vocal Variety

• Was the speaker easy to hear ?
• Were loud and soft variations used appropriately?
• Was the speaking pace  varied? Was it slow enough overall to be understandable?
• Were pauses used to aid understanding, heighten excitement, or provide drama?
• Was the language appropriate for the audience?
• Did the speaker articulate clearly?
• Were sentences short and easy to understand?
• Was technical jargon or unnecessarily complex language used?
• What rhetorical devices were used? e.g. repetition, alliteration, the rule of three , etc.

Intangibles

Sometimes, a technically sound speech can still miss the mark. Likewise, technical deficiencies can sometimes be overcome to produce a must-see presentation. The intangibles are impossible to list, but here are a few questions to consider:

• How did the speech make you feel ?
• Were you convinced ?
• Would you want to listen to this speaker again?
• Were there any original ideas or techniques?

Next in the Speech Analysis Series

The next article in this series – The Art of Delivering Evaluations – examines how best to utilize speech evaluation skills as a teaching tool.

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• Speech Analysis #4: Evaluation Forms, Tools, and Resources
• Speech Analysis #3: Modified Sandwich Technique for Evaluations
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40 comments.

I absolutely loved this article. It gave me a major idea of what to write on my speech critique. Great information, organized, and detailed!

Great post. I have to say, it was when I started to do exactly what you say that my skills took off.

If anyone wants to go farther, just teach a class on public speaking. You do not need a degree to teach continuing ed. It will help you, as some of my students who went on to teach to improve even more. This is because not only are you observing your students for these points. You are actually teaching them how to attain some of these skills.

oh my god….thank you!! i had no idea where to even start my speech analysis!

Excellent article. Will refer members of my club to it.

Dear Eugenia You refer to “members of your club” and I wanted to know an online public speaking club. Does this exist. Regards Berty

Your article is very informative. Hope you post more tips on writing a speech and how to analyse it!! 😎

Thanks for providing this information. I am writing an essay critiquing my own speech in third person. A tough task, but these pointers made it easier. Thank you.

i loved this information very much.now i am preparing for my examination and i think this article will help me to get good mark. thanks

Great summary/overview on basic things to evaluate while listening to a speech. Will be very much helpful when i have to do evaluations for speech class!

Thank you sooooo much for this article!! This is helping me soooo much for my speech analysis!

Thank you so so much! You are awesome and very helpful plus amazing too!

Great job once again! I liked the clarity with which these concepts were explained. Self explanatory and useful for both novice and advanced speakers. Keep it up!

Such a great article, thank you! It truly helped

I have to look at this for a class project and really learned some new tips from this.

This helped immensely; thank you so much!

thank you, you helped me a lot

Best article I found for speech critique and analysis. Definitely a place to come back for speech resource.

Thank you Andrew, great articles and valuable information. I recently joined a Toastmaster’s group and this will really help. Once I figure out how to “tweet” I will be “tweeting” this site to Kwantlen University Students and Alumni.

I absolutely loved this article it gave me a major idea of what to write on my speech critique great information, organized, and detailed!

Fantastic article. For someone that is new to Taostmasters this gives me at least an idea of how I should approach giving an evaluation…frigthening me more than giving a speech!! Thanks!

hi Andrew, this is a great article for someone who is a beginner to evaluate a speech. thanks a lot. -Venkat

very informative article will certainly help me to develop my speech technique.

Thus really helpful…we always read text resurfacely I gained alot from this article. now I know where to start when I want to present information through speech to the public

thank you this helped me vey much.

thanks a lot this just help me with my paper. you explain it better than my teacher

I am a toastmaster who loves to compete. I believe these articles will help me help other to deliver their speeches and both of us can grow.

Hi Andrew Dlugan, i am really happy to come across your site as new trainee in the public speaking and writing profession. i am programmer but i have passion for writing especially poems.Do you have any advice or resources to help me survive in the world of speaking and writing.

Thank You, Best Regards, Lawal Abdulateef Olawle

I came here looking for a speech review but reading this article helped me a lot in my opening speech. I hope many people who are having trouble in analysing there speech they should really open this website. Thank you

This is a helpful source to me. Thanks a lot

Great article. I am preparing to critique a public speaking competition this weekend and I found this article quite helpful Thanks a lot

Hi Andrew, May I use your article in our club newsletter? It is particularly timely as we approach the contest season in Toastmasters. I will source it to your web site and also include a link under the Articles about speaking of our club website.

John Sleigh Rockhampton, Queensland, Australia

Amazing breakdown of how to not only analysis a speech but to also push yourself that inch further to get more scope for marks. I really recommend this webpage. Thank you

Thank you for this amazing information, your 6 minutes guide is great and I am learning so much with it.

Really GREAT JOB! thanks so much! Best! Rasha

I really love this and would want more of this

This information was very informative and knowledgeable.Thank you.

Your articles are very thorough. I really enjoyed reading the first one.

Can you give me some examples of relevant puns used in speeches?

One more treasure trove on the internet. Thanks for sharing DLugan.

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How to Study and Critique a Speech -A quick How to for #College Students: https://t.co/z9z7ODho2n by @6minutes — @cdbond Oct 28th, 2015

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7 Blog Links

Evaluation Contest Resources | World Champion Evaluator — Mar 3rd, 2010

Evaluation Contest Resources | World Champion Evaluator « Brinker Toastmasters — Mar 3rd, 2010

ToastMASTERY » Evaluation Contest Resources | World Champion Evaluator — Mar 3rd, 2010

The 25 Essential Presentation Skills for Public Speaking | David Edgerton Jr — May 6th, 2010

State of the Union 2012 « E-126 — Jan 31st, 2012

Speech Evaluations | Plantation Toastmasters — May 27th, 2012

Fall 2012 Club Contest | — Aug 6th, 2012

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Giving Effective Presentations: 50 Things to Consider (with evaluation rubric)

Effective presentations require that you put a good deal of thought into how your audience will react to every component of your presentation. While an engaging personality or an intriguing subject matter will help, you can make any topic work well if you follow several key guidelines, divided into nine areas: Audience Adaptation ; Opening ; Organization ; Content & Ethos ; Storytelling ; Visual Display ; Delivery ; Team Interplay ; and Conclusion .

Review this evaluation checklist to make sure you’ve covered all the important areas for giving an effective presentation. Descriptions of each of the 50 components are listed below.

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Audience Adaptation

Adapting to your audience is, above all else, the most important thing you must consider. Make sure you think about what they care about (not what you find interesting), what they’ll expect to hear, what they don’t already understand (and what they do), and so forth. If you don’t know your audience before going into a presentation, research them. Ask questions. The more you know about them, the better you can prepare for them.

Use appropriate tone:  Just like you speak differently with your friends than you likely do with your mother, you’ll want to change the way you speak to one audience over another. Ask yourself: What level of formality is appropriate? Should I attempt humor? (In most cases, unless you  know  you’re funny, you may want to avoid attempting to be in order to steer clear of awkwardness if a joke doesn’t go well.) Will my audience be relaxed, tense, or bored? How can I adapt to that?

Use appropriate jargon & acronyms:  Every audience will have a certain level of understanding of your subject matter prior to seeing you present. It’s critically important that you understand what specific terms they know and don’t know so that you don’t use words or acronyms that are confusing to them. If you use industry-specific jargon or acronyms, make sure your audience knows them in advance. If they don’t, define the terms for them.

Make topic relevant to audience:  Make sure that your audience will care about your topic. Sometimes you’ll present information to your boss because he asked you to. In this case, the topic will probably automatically be relevant. But in other cases, your audience may be there because they have to be for work, or they may be there to learn more information but may not fully understand what they’re about to learn. Make sure, regardless of what the situation is, that you tailor the message to the audience’s situation and make them care about the topic.

Knowledge of subject matter appropriate for audience:  Present depth of knowledge at the level your audience can understand. If you’re a chemistry professor speaking about nutrition to pharmaceutical researchers, your depth of explanation will be quite different than if you’re speaking to college freshmen about nutrition. Two things are important here: if your audience knows a lot about your topic going in, don’t patronize or bore them by telling them things they already know. If they don’t know much about the topic, be clear and detailed to make sure they’re on the same page as you and start from a common ground they can relate to.

Your opening is key to engaging your audience right from the beginning. If you bore them up front, you may have lost them for good.

Start with Strong attention-grabber:  Attention grabbers can come in may forms. Some of the most common include telling stories; sharing fascinating quotes; giving alarming or surprising statistics; asking your audience a question; telling a joke (but only if it’s both relevant  and  funny); creating an imaginary scenario (“imagine you’re stuck on an island…”); surprising your audience; or giving a demonstration or object lesson. Regardless of what you choose, make it relevant, make it pithy, and make it work for your audience. Do the attention-grabber well, and you’ll be on pace to keep you audience engaged the entire time.

Make Your Topic Clear:  There should be no question in your audience’s mind, even just a couple minutes into it, where you are headed with the presentation. State your topic, address the issues, and make it relevant.

Make Your Topic Interesting:  Interest comes with relevancy and what we call “exigency.” Make your audience care by letting them know how your topic affects them. Give the facts, stories, anecdotes, issues, etc. that will intrigue and interest them.

Forecast a clear direction for presentation:  At the end of your opening, tell the audience what to expect. What are you going to cover? Create a clear road map so that they know what to expect and so that they know where you’re at in the middle of the presentation.

Organization is key to keeping your audience fully engaged for the entire presentation. As soon as you veer off track somewhere, you begin to lose the attention of your audience.

Follow the Road Map:  In your introduction, you gave your audience the road map. Now be sure that you follow it in the order that you said you would. Stick to the plan from start to finish.

Include Frequent Transitions & Signposts:  Transitions are statements that connect a previous section or idea of your presentation to the next section or idea. Use words and phrases that link the two so that there is a clear connection between ideas and so that audiences can sense a progression. A “signpost” is a kind of transition. It’s a word or phrase that reminds the audience where you are in the presentation. You might connect a dot, remind the audience where you are, or let them know what’s coming next.

Progress towards Finish:  Just like in any good movie, there needs to be a sort of plot building at all times. You’ll want to always be building towards a finish, with each piece of your presentation moving you towards some kind of conclusion. Remember that all good communications should have a beginning, middle, and end. Be sure that each component of the middle progresses towards a clear and meaningful end.

Provide Summary(ies) of Main Points:  If your presentation goes beyond 10 or 15 minutes, it may be helpful to occasionally remind your audience what’s been said. Help your audience understand, at every step along the way, what is happening and what the information or data means.

Connect Loose Dots:  If you begin a story or anecdote, be sure to tell the ending at some point. If you provide interesting data, make sure you let the audience know what it means. If you’re leading towards a recommendation, be sure that the recommendation is based on research or evidence you just suggested. Don’t leave your audience hanging in any capacity.

Content & Ethos

Ethos refers to your credibility. In order for an audience to fully appreciate and follow your arguments and positions, you must show that you are knowledgeable of the subject matter and that the information you are presenting is founded on something that your audience can agree is good supporting evidence.

Use Only Persuasive Argumentation:  Avoid presenting an argument with gaps or holes. You may wish to study the  logical fallacies for more insight on where arguments can go wrong. When you make a statement, make sure you qualify it and provide appropriate support.

Conduct Sound Research:  As you know and understand your audience, you should know what they will consider valuable and worthwhile research for your type of presentation. Generally speaking, you want to build your argument based on a variety of sources. You might provide case studies, survey data, secondary research (information from books, journals, etc.), observations, testimonials, expert endorsement, or something else. Regardless, you must convince your audience that you’ve done your due diligence.

Include Only Relevant Material:  While this may seem obvious, don’t present material that isn’t directly relevant to your key points. Don’t get distracted and stick to your organizational plan. Make sure all content has a purpose and that it leads towards that strong conclusion.

Provide Convincing Analyses and Conclusions:  Show your audience how much you know about the subject matter by giving them clear, logical analyses of your data and draw conclusions that come directly from your data. Avoid drawing conclusions that come from personal opinion, but rather focus on what your research and data suggest.

Pertinent Data and Evidence:  Be sure that all of you data and evidence is directly related to your overall message. Don’t pull in facts simply because you find them interesting. Again, all content needs to build or progress towards something. Don’t get sidetracked with tangentially related data.

Storytelling

All good presentations–no matter for business, school, clubs, or church–are better when stories are told. Human beings have a natural inclination for stories. People want to know how stories end. Make stories work for your presentation by describing people (characters), situations (settings), problems, climaxes, and resolutions. All presentations should have at least one story, but you may incorporate many more.

Read: How to Organize a Paper: The Narrative Format

Tell Stories with Purpose:  Don’t tell stories just to tell stories, but make connections between what you are telling your audience with a real example.

Tell Realistic Stories:  You don’t want your audience to think you made the story up or that it’s exaggerated. Provide enough appropriate detail so that your audience can believe what you’re telling them is not only true, but its possible, likely, or directly relevant to them.

Tell Stories with   Cl early Described Characters:  Make sure your audience knows who the people are and why they matter to the story.

Be Sure to Have a Conflict:  Stories don’t need to be complicated or extraordinary to be good. But they should have a conflict (which leads to the purpose for telling the story.) There must always be some issue that needs to be resolved.

Don’t Forget the Resolution:  When you start a story of any kind, make sure that you let your audience know how it turned out.

Tell Only Relevant Stories:  Avoid getting sidetracked or on a tangent. All stories should have a clear purpose and should lead the audience towards your conclusions and arguments.

Perhaps the single greatest complaint in the history of presentations is that PowerPoint slides have too much text. Use your slide deck platform to create visually stunning, supportive visuals. Visuals should always complement (not distract or supersede) a presentation’s message. But images are almost always better than text when on the screen.

Be Simple:  Make slide designs simple. As Leonardo da Vinci famously said: simplicity is the ultimate sophistication. White background with black text is a great choice. Avoid fancy or distracting backgrounds or other visual noise. Keep the design simple, giving focus to the key elements.

Be Clear:  Be sure that your images or graphics have a clear purpose. If you’re showing data in chart or graph, explain the graph. Don’t talk about something else while hoping your audience will read all the numbers and draw conclusions. Point them to what they should learn from the graph.

Use Minimal (if any) Text:  People don’t remember text very well and they don’t remember what they hear very well…unless there’s a picture attached to what they hear. Use pictures to supplement and enhance what you are saying. Avoid as much text as is possible. Oftentimes, it’s better on a slide to not use any text at all–just give the audience a picture that supports what you are saying.

Only Use Relevant of Images:  While this may seem obvious, may novice presenters like to include clipart or other non-essential images simply to “pretty up” the presentation. Inserting images just to insert images is not only distracting, it’s tacky. Make all images worthwhile to your audience. If there is absolutely nothing interesting to show your audience when talking about something (that would be rare), use a blank slide. But don’t put in louse images.

Create Effective Charts, Graphs, and Animations:  Make sure the graphs are readable for everyone in the audience. Use large text and clearly understandable colors, sizes, and so forth. Always be sure to talk about visualized data on the screen. Don’t expect your audience to have the patience (especially while you are speaking about something else) to read or interpret the data on their own.

Make Visuals Readable:  Whatever your visual is, be sure it’s big enough for your audience to interpret it without trouble. No small data points, no pixelated graphics or photos, no tiny lines on graphs.

Color Scheme:  Keep colors simple and minimal. Use black text in most cases on a white background. Make sure contrast is always high. Be careful of yellows and oranges as they are often hard to read and they don’t project well on a screen.

Choose Good Typefaces:  The font you choose matters. It gives the entire document a personality. Make sure all fonts are readable (no script or crazy decorative fonts) and big. Avoid default fonts like Calibri or Times New Roman and definitely avoid cliche fonts like Comic Sans and Papyrus.

Delivery is about the way you look as an individual to an audience. It’s about you being articulate, clear, confident, approachable, and everything else. If you content is awesome but your delivery is bad, the presentation won’t have the effect you want.

Make Eye Contact:  Look at people in the eyes. Look all around the room–don’t get stuck looking at the same person or group of people more than everyone else in the room.

Smile and Show Enthusiasm:  Practice so that you’re less nervous and present with a smile and/or enthusiasm about what you’re talking about. No monotone voices, no bored expressions.

Move Naturally:  Avoid unnatural nervous ticks, like swaying, shifting hips, playing with hair, pacing, playing with clothing, etc. Most people have some weird habit when presenting in front of people. Learn what yours is and stop doing it.

Project a Loud, Articulate Voice:  Make sure everyone in the audience can hear you. No quiet talking or trailing off. Avoid filler words like “um” or “like” or “uh.”

Change Vocal Intonation:  Move your voice higher and lower. Act as if you would talking to a friend. Be excited, engaged, and change the sound of your voice so that it does become monotonous.

Have Good Posture:  Show confidence and professionalism by stranding straight, facing the audience. Don’t look at the computer screen, don’t lean on a table, don’t slouch, don’t put your hands in your pocket.

Exhibit Confidence:  Easier said than done, right? Just be sure to talk slowly (so you don’t seem nervous), smile, take deep breaths, and be passionate. When you look nervous, your credibility drops.

Speak Slowly:  Many nervous or excited speakers get going to fast. Speak at a slow pace so that your audience can process what you are saying, especially when you’re talking about complex subjects or you’re explaining research or data.

Dress Appropriately:  Know what your audience will be wearing and dress at a level just up from them. Know if the situation requires formality or not. Avoid distracting or revealing clothing. Women, you must be especially careful with this as revealing or low-cut clothing can be more distracting on an audience than typical business clothing for men.

Show Poise:  Things don’t always go well. You might forget something or your PowerPoint may not work or you may trip on a cord. Just relax and show poise. If you’re calm, your audience will be calm with you. If you freak out, your audience will get really uncomfortable and your credibility will be shot.

Team Interplay

If you’re presenting with a team of people, there are a few extra delivery considerations.

Introduce All Presenters:  Make sure the audience knows everyone participating in the presentation. Describe their role to the audience so that there’s no confusion.   Interact and Engage with Each Other:  While presenting, talk about each other and let the audience know throughout that you worked together. Don’t hesitate to use each other’s names and say things like “Thanks, Mike, for the details on….” and “As Tiffany just mentioned…” Avoid just dividing up the time of the presentation by presenters (don’t just say, “you take the first five minutes, I’ll do the next five, and you conclude.”) Rather, go back and forth between the content of the presentation.

Have Clear Roles & Responsibilities:  Make sure you each have a valuable part to play in the presentation. If it’s awkward or your have too many people, consider removing people without clear roles from the presentation. When you’re not speaking, be sure to be out of the way of other speakers.

Utilize Each Other’s Strengths:  Know what each person is good at or most knowledgeable in and let them present that. Sometimes, if a person on a team isn’t great at presenting, but they’re good at designing or organizing, they may play a different role in the team presentation.

Always have a conclusion. There’s an old mantra in public speaking: Tell them what you’re going to tell them (introduction forecast). Then tell them (middle). Then tell them what you just told them (conclusion summary). Summarize Presentation:  Remind your audience of the key points and conclusions drawn. Wrap up any loose ends and make your point clear.

Have a Clear and Obvious End:  There’s nothing more awkward for you or your audience than them not knowing when to clap. Be sure you lead towards an end with a clear finishing statement. Avoid just stopping and saying things like, “K, that’s it. Any questions?”

Finish Strong:  Leave the audience with something to think about. Maybe tell a final story or give a powerful statistic or quote. Regardless, don’t just end without thinking through a really strong, pithy statement to leave your audience with.

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How to Give a Killer Presentation

Lessons from TED by Chris Anderson

Summary .   

For more than 30 years, the TED conference series has presented enlightening talks that people enjoy watching. In this article, Anderson, TED’s curator, shares five keys to great presentations:

• Frame your story (figure out where to start and where to end).
• Plan your delivery (decide whether to memorize your speech word for word or develop bullet points and then rehearse it—over and over).
• Work on stage presence (but remember that your story matters more than how you stand or whether you’re visibly nervous).
• Plan the multimedia (whatever you do, don’t read from PowerPoint slides).
• Put it together (play to your strengths and be authentic).

According to Anderson, presentations rise or fall on the quality of the idea, the narrative, and the passion of the speaker. It’s about substance—not style. In fact, it’s fairly easy to “coach out” the problems in a talk, but there’s no way to “coach in” the basic story—the presenter has to have the raw material. So if your thinking is not there yet, he advises, decline that invitation to speak. Instead, keep working until you have an idea that’s worth sharing.

A little more than a year ago, on a trip to Nairobi, Kenya, some colleagues and I met a 12-year-old Masai boy named Richard Turere, who told us a fascinating story. His family raises livestock on the edge of a vast national park, and one of the biggest challenges is protecting the animals from lions—especially at night. Richard had noticed that placing lamps in a field didn’t deter lion attacks, but when he walked the field with a torch, the lions stayed away. From a young age, he’d been interested in electronics, teaching himself by, for example, taking apart his parents’ radio. He used that experience to devise a system of lights that would turn on and off in sequence—using solar panels, a car battery, and a motorcycle indicator box—and thereby create a sense of movement that he hoped would scare off the lions. He installed the lights, and the lions stopped attacking. Soon villages elsewhere in Kenya began installing Richard’s “lion lights.”

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Critical Analysis and Evaluation

Many assignments ask you to   critique   and   evaluate   a source. Sources might include journal articles, books, websites, government documents, portfolios, podcasts, or presentations.

When you   critique,   you offer both negative and positive analysis of the content, writing, and structure of a source.

When   you   evaluate , you assess how successful a source is at presenting information, measured against a standard or certain criteria.

Elements of a critical analysis:

opinion + evidence from the article + justification

Your   opinion   is your thoughtful reaction to the piece.

Evidence from the article  offers some proof to back up your opinion.

The   justification   is an explanation of how you arrived at your opinion or why you think it’s true.

How do you critique and evaluate?

When critiquing and evaluating someone else’s writing/research, your purpose is to reach an   informed opinion   about a source. In order to do that, try these three steps:

• How do you feel?
• What surprised you?
• What left you confused?
• What pleased or annoyed you?
• What was interesting?
• What is the purpose of this text?
• Who is the intended audience?
• What kind of bias is there?
• What was missing?
• See our resource on analysis and synthesis ( Move From Research to Writing: How to Think ) for other examples of questions to ask.
• sophisticated
• interesting
• undocumented
• disorganized
• superficial
• unconventional
• inappropriate interpretation of evidence
• unsound or discredited methodology
• traditional
• unsubstantiated
• unsupported
• well-researched
• easy to understand
• Opinion : This article’s assessment of the power balance in cities is   confusing.
• Evidence:   It first says that the power to shape policy is evenly distributed among citizens, local government, and business (Rajal, 232).
• Justification :  but then it goes on to focus almost exclusively on business. Next, in a much shorter section, it combines the idea of citizens and local government into a single point of evidence. This leaves the reader with the impression that the citizens have no voice at all. It is   not helpful   in trying to determine the role of the common voter in shaping public policy.  

Sample criteria for critical analysis

Sometimes the assignment will specify what criteria to use when critiquing and evaluating a source. If not, consider the following prompts to approach your analysis. Choose the questions that are most suitable for your source.

• What do you think about the quality of the research? Is it significant?
• Did the author answer the question they set out to? Did the author prove their thesis?
• Did you find contradictions to other things you know?
• What new insight or connections did the author make?
• How does this piece fit within the context of your course, or the larger body of research in the field?
• The structure of an article or book is often dictated by standards of the discipline or a theoretical model. Did the piece meet those standards?
• Did the piece meet the needs of the intended audience?
• Was the material presented in an organized and logical fashion?
• Is the argument cohesive and convincing? Is the reasoning sound? Is there enough evidence?
• Is it easy to read? Is it clear and easy to understand, even if the concepts are sophisticated?

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Evaluation Form Templates

12 Free Presentation Evaluation Forms (What to Include)

A presentation evaluation form is a document used by an evaluator to analyze and review a particular presentation.

The form allows you to give structured feedback to the presenter about their presentation. Additionally, it can be used whenever you want to rate an individual’s presentation skills. Assessments are an important means for individuals to improve themselves, and you must therefore provide the presenter with accurate feedback regarding their presentation. This will enable them to make the necessary adjustments and enhance their presentation skills.

Furthermore, the feedback form allows you to judge whether the presenter comprehensively covered all the important topics and answered questions appropriately. An elaborate presentation should be able to give clear insights into the chosen topics. For example, if the presentation is about the advantages and values of using the company’s products and services, everyone present during the presentation should be able to clearly understand the products and their market valuation.

The form used to evaluate presentations, its purpose, the evaluation criteria, and some helpful assessment advice will all be covered in this article.

Download Free Form Templates

A presentation evaluation form should be comprehensive as it is meant to provide the presenter with honest reviews of their performance. To ensure you have a form that is thorough, you should use a template to prepare it. That will make it easier for you to create a proper form.

Also, it will ensure that you have all the required sections and details. You can access and download these templates for free from below:

Purpose of Presentation Evaluation Form

An evaluation form allows you to give a critical review and evaluation of a presentation. Different aspects of the presentation are judged as part of the evaluation; this includes the presenter’s effectiveness and efficiency in imparting information, body language, enthusiasm, volume, modulation, ease of flow, clarity of speaking, and the presenter’s overall preparedness.

Therefore, after you have reviewed the presentation, you should share your comments with the presenter. They can use it to understand what they need to do to improve their overall performance. Furthermore, your feedback form should be easy to understand and should convince the presenter to take action towards improving their confidence and appearance.

Also, you may give suggestions to help the presenter improve their emotional control during presentations; this is an effective way of convincing and persuading the audience.

A well-drafted review will allow you to give your opinion without sabotaging the presenter’s confidence. Therefore, feedback has to be constructed positively but must also provide clear instructions about those areas that need improvement.

3 Different Kinds of Presentation Evaluations

An effective way of helping individuals give powerful and informative presentations is by informing them on how their presentations will be evaluated.

Here are three techniques you can use to evaluate a presentation:

Self-evaluation

One of the most effective ways of improving someone’s presentation skills is by allowing them to judge their own performance. This can be achieved by making them rate their presentations. Occasionally, there are those who will be able to give accurate and insightful reviews on what they did well and where they need to improve. Also, there are some who will find it difficult to evaluate themselves.

Asking a presenter questions about their performance will enable you as an evaluator to assist them in self-evaluation. You can ask them how they think they performed, what they think they have accomplished, what they gained before, during, and after the performance, and what they think they could have done differently during the process of presenting.

Peer evaluation

Assessment by peers encourages the presenters to provide feedback on each other’s performances. For instance, if you are a teacher, you can ask your students to give their opinions about their classmates’ performances. Peer evaluation is an effective way of helping the students to differentiate between a perfect and an average presentation.

Also, this will allow them to be more attentive as they observe and learn how to present their projects effectively. You can distribute forms to each student to give their feedback. Then, you can request that they give the forms to the presenter at the end of the presentation.

Professional evaluation

Professional evaluations of presentations are usually conducted by someone like a teacher. Therefore, as an evaluator, you are required to verbally give your comments  instead of recording them on some evaluation forms. In most cases, you are required to discuss the presentation immediately when it ends; this allows the presenter to get immediate feedback.

To professionally evaluate a presentation, you can ask for its copy prior to the presentation. This will allow you enough time to review the contents and be prepared to give provide a comprehensive assessment. As a result, you will be able to help the presenter get better at their future presentations.

Evaluation Criteria for Presentation

A presentation is judged on six criteria. The individual or group presenting their work must have the required skills to present their content effectively.

Below are the six abilities that you must assess as part of the evaluation:

Ability to analyze the audience

You need to assess if the presenter understands their audience based on the following:

• Whether their content was tailored and relevant or just generic
• If the pitching was done correctly
• If they used proper language
• If they used terminology that the audience understood
• If they engaged their audience
• If their audience seemed focused or distracted.

If the presenter understands the audience, they will most likely have a great presentation. As an evaluator, you must determine if the presenter researched their audience and was able to handle any challenges they encountered during their presentation.

Ability to develop a structured presentation

You need to determine if the presenter has a structured presentation that makes the content persuasive. The message alone cannot be impactful if it lacks a logical flow and structure of ideas. You should judge if the presentation was clear, easy to follow, and had a narrative or story-like flow with a clear beginning and conclusion. 

Also, you need to check if the transitions used between sections were smooth, if the presenter used relevant visual aids such as PowerPoint slides or handouts, and finally, if it had a clear call to action section at the end. 

A proper and clear structure is important if the presenter wants their message to impact the audience. It should have a clear start, flow smoothly, build momentum, and have a powerful ending without losing the audience’s attention at any point.

Ability to engage the audience

The presenter must also have the ability to engage the audience. If the presenter properly analyzes the audience, they will most likely be able to connect with them. This is a significant factor that distinguishes a great presentation from a poor one. Ascertain if the presenter had content that the audience would find interesting. 

Also, you need to check if the presenter’s method of delivery was effective. The presenter should be able to build a rapport with the members of the audience, use proper gestures and body language, and speak clearly and confidently with proper intonation in a conversational tone.

Ability to prepare effective slides

The ability to prepare slides that effectively convey the intended message is an important aspect of a successful presentation. Slides are visual aids meant for the speaker to elaborate on their information and enable their audience to understand the message thoroughly. You need to determine if these slides are easy to read, have detailed information, and have a proper layout and format for easier understanding.

The slides should have a good balance between text, graphics, and images. The slides can be considered effective if they contain text in bullet points as well as impactful graphics that reinforce the presenter’s message.

Ability to be confident and other strengths

It is also important to evaluate if the speaker does not lack confidence when presenting. The presenter should exude confidence, be natural, and be in control while presenting. You need to assess if they were at ease while speaking to their audience, whether they appeared confrontational, whether they seemed anxious or distracted, and whether they were awkward or shy. 

Ability to summarize and achieve intended outcomes

The conclusion should also have a clear and achievable call to action and be inspirational. Therefore, you need to ascertain the presenter’s ability to summarize and conclude their presentation in a manner that ensures they have achieved their intended outcomes. You must assess whether their closing statement was well-rounded and  included all the main points.  A proper closing should leave the audience with a sense of having achieved something.

Best Tips for You

There are tips that you should keep in mind when evaluating a presentation if you wish to have impactful feedback that will benefit the presenter.

Below are the three main tips that you should consider:

Emphasize the process

You need to focus on the process of preparation rather than the product itself. That means that you should evaluate and comment on the process taken, such as gathering information, analyzing the audience, etc. This is more impactful, and it will help the person identify the areas that need improvement so they can make it better next time.

Be specific

Your feedback should include specific directions to help the presenter  improve themselves, rather than just giving opinions.

For example:

Instead of writing, “You were not audible or confident enough during your presentation,” you should write,  “At some point during the presentation, you were not audible and did not seem confident. This made it hard to hear or understand you. Pay close attention to your pace and audibility the next time. If you are feeling underconfident, use gestures and take your time to pause instead of using filler words such as “um,” “ah,” and “like.” 

End on a positive note

Always conclude your assessment on a positive note. The assessment is meant to motivate a person to develop their presentation abilities. Therefore, it is important that besides  highlighting the flaws, also include positive feedback to encourage the presenter 

Your job as an evaluator is to assist the presenter in improving their skills. An effective way of doing this is by giving them constructive feedback. Your assessment should not only highlight the shortcomings but also be thoughtful and positive. When you use an evaluation form, you can make precise notes about the areas where a presenter needs to improve and the ones where they did well. The oral presentation can be challenging and time-consuming. However, with a form, you can comprehensively explain what is expected of a presenter during and after their presentation. Notably, it is important to focus on its different aspects, which include the style of presenting and the contents. As an evaluator, you are responsible for objectively assessing the skills and content of the presenter. Therefore, your feedback should be detailed and effective. Ensure that you have an evaluation criteria that will make it easy for you to provide your comments regarding all relevant aspects. You can use templates to create forms that meet all your evaluation requirements effortlessly.

Keep reading

9 free course evaluation forms (word | pdf | excel), employee evaluation form (how to conduct + templates), 6 free teacher evaluation form templates, free training evaluation forms and questionnaires, 15 free performance evaluation forms (word | pdf), 23+ free questionnaire templates & survey forms.

6 Ways You Can Evaluate Your Own Presentation

Hrideep barot.

• Body Language & Delivery , Presentation , Public Speaking

Naturally, giving a presentation is a skill that falls on the professional side of the spectrum. It involves a lot of formality along with practice to get good at it. 

But how do you decide what exactly it is that you need to work on? Read on to find out about six ways to evaluate your presentation skills.

Evaluating your presentation requires the ability to analyze your performance based on some very specific criteria related to delivery and content. More importantly, you must do it in an objective sense, without letting your self-bias come in the way.

Importance and benefits of evaluating your presentations yourself

Public speaking requires skills that are developed over time. Whether you’re a pro at it or a beginner, there is always room to grow because people have a varying set of abilities. 

Presentations are all about influence. You aim to create a dynamic with your audience so they buy into whatever it is that you’re trying to convey. 

And if you keep innovating your techniques and find your strength (which all comes with self-evaluating), you’ll essentially be enhancing your power to influence. 

In addition to that, it makes you a better presenter. The lack of being told what to do by someone else gives you a sense of self-confidence and patience. 

Additionally, you being a good presenter would mean more successful meetings, which in turn means you’d profit your business.

Basically, the better your presentation, the more likely are your chances to successfully fulfill your agenda. So grab a paper and a pen and embark upon your journey of getting better!

What criteria do I need to follow for evaluation?

Let’s address the skills we need for pulling off a good presentation.

Quality of content

• Engagement with audience
• Visual aids
• Focusing on strengths. 

Based on these categories, you need to form criteria to test yourself. Think of it like setting a frame of reference for yourself, placing yourself on a scale ranging between good and bad would help you track your progress. 

Following are the pointers you need to keep in mind while evaluating your presentation skills-

The two most things to keep in mind about structure is that you need to have a very intriguing start to your presentation, something that hooks the audience. (an anecdote, perhaps)

Secondly, make sure your ending is clear and in alignment with the purpose of the presentation. And include a call to action. For example, if your presentation is about mental health awareness, make sure one of your end slides has a comprehensive contact list of psychologists/therapists. 

Apart from that, the transitions between your pointers have to be smooth. Try adding segues (which is basically building context for your next point) In the previous example, a personal anecdote involving someone with depression can be a good segue to talk about the importance of mental health. 

If you’re new to structuring content or making presentations, here’s an article of ours that might help- The Ultimate Guide to Structuring a Speech

Delivery is everything. From gestures to hand movements, your body language must emphasize CONVEYING something. 

When you say something especially important, there must be some emphasis on part of your delivery. Like slowing your speech, or knocking the table, or repetition of the point, etc. 

There should be some sort of continuity to your narrative, the ‘flow’ must come naturally. This can be done using the smooth transition technique mentioned above. 

Adding a story-like quality to your speech might help. (having proper segregation between the beginning, middle, and end)

You cannot be providing generic content. Always remember, in presentations, quality surpasses quantity. 

Rambling about your topic on and on would not only bore your audience but also hinder the aforementioned flow and transitions that are so important. 

You need to make sure you’re adding something of value that is unique to you, and not general. You may refer to our article that might help further with this- Should a Presentation Have an Agenda?

Engagement with the audience

Your content must always be altered according to your audience. Knowing your audience is a very crucial step. You cannot say the same things in front of an MNC board meeting members as you would in front of a bunch of college students.

Knowing your audience helps you decide your content, flow, transition, practically everything. 

Also, engagement with the audience means the interaction that takes place between you and them. You need to appear approachable for them to talk to you. 

But at the same time, you need to prepare yourself in advance to be able to answer the questions that might come your way. A little prediction here and there can save you a lot of anxiety. 

Visual Aids

Visual aids during a presentation include everything from the design and arrangement of content in your presentation to your appearance. (But mostly the former)

Now when it comes to visual aids in a PPT, there is no better advice than the 5 by 5 rule.

The Powerpoint 5×5 slide rule states that-

a. Each of your slides should have no more than 5 lines.

b. Each of those lines should have no more than 5 words.

It ensures keeping your content crisp and to the point. A tip to apply this rule would be to not focus on including the main content in the ppt. Instead, write only pointers and elaborate on them yourself.

This way, you prevent your audience from getting too caught up in reading the slides hence getting distracted from you. 

How exactly do I evaluate my presentation?

Here are the six-pointers that will guide you through it step-by-step.

Identify patterns

Keeping in mind the above-mentioned pointers, start looking for what you’re doing wrong.

Is there something that you repetitively keep doing wrong? Maybe the topics you choose aren’t relevant, maybe you use too much text in slides, maybe you don’t captivate your audience by raising vocals, maybe you don’t move enough. 

There are always patterns. You need to develop attention to detail. 

Focus on the audience

Your audience engagement can make or break the deal. While you’re presenting, make sure you make eye contact with as many people as you can. And keep an eye out for people’s reactions. It helps you get real-time feedback. 

Now there’s a chance this might not work and you get distracted or disheartened. In which case, drop this tactic. Nothing is worth blowing your confidence down during the presentation. 

Take feedback

Part of the reward for good audience engagement is honest feedback. If people like your content but find your delivery a little off, if you engage well with them, they will be a little more open to bringing it to your attention.

Maybe to make it a little more certain, announce at the end that you’re open to constructive criticism. It also adds to the impression you make. People find people who are willing to admit their flaws, admirable. 

Make sure you maintain a record of your progress, right from making those criteria scales to your speeches through successive presentations. You could do it on paper or a device, whatever is more comfortable. 

Make notes about what you need to work on right after presentations, and tick them off when you do in the next ones. It brings along a sense of accomplishment. 

In reference to keeping track of practicing, you may check out our 13 Tips For Rehearsing A Presentation

Objective set of eyes

Ask a friend or a colleague to give you honest advice. Truth is, no matter what, your clients would always be skeptical of telling you what’s wrong. And there’s only so much you would criticize about yourself.

Asking someone you trust can help you get a fresh perspective on your progress since we get a little over in our heads sometimes. 

Use your strengths and weaknesses

After having acquainted yourself with this whole system of evaluation, it is no doubt you’d be very aware of your strong and weak points. It is a good thing. 

Honestly, there could always be some little things here and there that we cannot wrap our heads around, and that’s okay. Because we also have our strengths to cover up for them.

For example, you could be a little off with a smooth transition between subpoints, but if you drop a super-strong call to action, in the end, it gets compensated. 

And the best part is, only you can use them to your benefit since you’re the only one who knows about them!

Additionally, watching content related to your topic can be of massive help too. For example, if your speech is on mental health , then maybe watching a TEDTalk by a mental health professional can add on to the authenticity of your content.

To go that extra mile, you could also record yourself while giving the speech in front of a camera and review the recording to see where exactly you went wrong. Sometimes, watching your presentation from the audience’s perspective gives you a peak into what they see, and consequently, allows you to have a bigger impact on them.

Here’s a checklist to keep in mind while self-evaluating:

Print the checklist out for easy accessibility, mark yes or no after every presentation to keep track of your progress.

Practical Tools to use for self-evaluation

Feedback forms.

Feedback from your audience is important, as stated before. However, you can’t store all of the verbal feedback in your brain, let alone use it for self-evaluation later. Moreover, sometimes the audience might be vague with how they respond and that is unhelpful.

What you can do, instead, is devise a feedback form enlisting specific questions, the answers to which would be relevant for your purpose. This not only lifts the burden of remembering all you heard after presenting, but also eliminates unnecessary jargon from the audience.

Self-reflection

Self-reflection is the most important part of this process. Now, this does not only involve you going to the feedback forms but also reviewing specific areas that you need extra work on. You can make a categorized list or a scale of easily ‘fixable issues’ to issues that need relatively more practice and work.

If there is an issue that you don’t seem to be able to work around, another form of self-reflection you can do is record yourself. As mentioned before, use the camera and present as you would in the conference room. Looking at a tape of yourself after presenting(as opposed to while presenting in front of the mirror), can help you detect what’s wrong in a better way. Plus, it helps you check body language.

Presentation rubrics are one of the handiest tools you can use for evaluation. It is a specific set of criteria that sets qualitative standards for the things/skills you need to have in your presentation to qualify as a good one.

For example, For a college research paper, the categories of criteria would be creativity, research element, use of sources and references, innovative aspects, etc. These categories would then be assessed on a scale of good to excellent or 1 to 5 and be marked accordingly.

It provides a quantified version of assessment which helps tremendously to analyze where specifically, and how much do you need to work on.

Apart from this, if you’re a techno-savvy person who is not inclined to write with a journal to keep track or implicate any of the other tools, worry not! We happen to have just the thing to help you! In today’s technology and smart phone driven world where most things are online, we can do self-evaluation up there too!

Here is a detailed and comprehensive article about 34 Best Smartphone Apps for Presenters and Professional Speakers that will guide you through that process.

Well, with all these tools and techniques, you’re all set to begin your self-evaluation! Remember, different techniques work for different people. It’s all a matter of trial and error. Some patience and practice can take you a long way to become the presenter you aspire to be.

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• Writing well

How to write a critique

• Starting well
• How to write an annotated bibliography
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• Finishing well

Before you start writing, it is important to have a thorough understanding of the work that will be critiqued.

• Study the work under discussion.
• Make notes on key parts of the work.
• Develop an understanding of the main argument or purpose being expressed in the work.
• Consider how the work relates to a broader issue or context.

Example template

There are a variety of ways to structure a critique. You should always check your unit materials or Canvas site for guidance from your lecturer. The following template, which showcases the main features of a critique, is provided as one example.

Introduction

Typically, the introduction is short (less than 10% of the word length) and you should:

• name the work being reviewed as well as the date it was created and the name of the author/creator
• describe the main argument or purpose of the work
• explain the context in which the work was created - this could include the social or political context, the place of the work in a creative or academic tradition, or the relationship between the work and the creator’s life experience
• have a concluding sentence that signposts what your evaluation of the work will be - for instance, it may indicate whether it is a positive, negative, or mixed evaluation.

Briefly summarise the main points and objectively describe how the creator portrays these by using techniques, styles, media, characters or symbols. This summary should not be the focus of the critique and is usually shorter than the critical evaluation.

Critical evaluation

This section should give a systematic and detailed assessment of the different elements of the work, evaluating how well the creator was able to achieve the purpose through these. For example: you would assess the plot structure, characterisation and setting of a novel; an assessment of a painting would look at composition, brush strokes, colour and light; a critique of a research project would look at subject selection, design of the experiment, analysis of data and conclusions.

A critical evaluation does not simply highlight negative impressions. It should deconstruct the work and identify both strengths and weaknesses. It should examine the work and evaluate its success, in light of its purpose.

Examples of key critical questions that could help your assessment include:

• Who is the creator? Is the work presented objectively or subjectively?
• What are the aims of the work? Were the aims achieved?
• What techniques, styles, media were used in the work? Are they effective in portraying the purpose?
• What assumptions underlie the work? Do they affect its validity?
• What types of evidence or persuasion are used? Has evidence been interpreted fairly?
• How is the work structured? Does it favour a particular interpretation or point of view? Is it effective?
• Does the work enhance understanding of key ideas or theories? Does the work engage (or fail to engage) with key concepts or other works in its discipline?

This evaluation is written in formal academic style and logically presented. Group and order your ideas into paragraphs. Start with the broad impressions first and then move into the details of the technical elements. For shorter critiques, you may discuss the strengths of the works, and then the weaknesses. In longer critiques, you may wish to discuss the positive and negative of each key critical question in individual paragraphs.

To support the evaluation, provide evidence from the work itself, such as a quote or example, and you should also cite evidence from related sources. Explain how this evidence supports your evaluation of the work.

This is usually a very brief paragraph, which includes:

• a statement indicating the overall evaluation of the work
• a summary of the key reasons, identified during the critical evaluation, why this evaluation was formed
• in some circumstances, recommendations for improvement on the work may be appropriate.

Reference list

Include all resources cited in your critique. Check with your lecturer/tutor for which referencing style to use.

• Mentioned the name of the work, the date of its creation and the name of the creator?
• Accurately summarised the work being critiqued?
• Mainly focused on the critical evaluation of the work?
• Systematically outlined an evaluation of each element of the work to achieve the overall purpose?
• Used evidence, from the work itself as well as other sources, to back and illustrate my assessment of elements of the work?
• Formed an overall evaluation of the work, based on critical reading?
• Used a well structured introduction, body and conclusion?
• Used correct grammar, spelling and punctuation; clear presentation; and appropriate referencing style?

Further information

• University of New South Wales: Writing a Critical Review
• University of Toronto: The Book Review or Article Critique

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04-12-2019 HOW TO BE A SUCCESS AT EVERYTHING

3 helpful ways to give feedback on a presentation

When you discuss these 3 things, you help someone else take their presentation to the next level.

[Photo: Miguel Henriques /Unsplash]

BY  Anett Grant 3 minute read

How many times has your coworker, your boss, or your friend asked you, “How was my presentation?”

Chances are, if you thought the presentation was boring, you said, “great job” with a flat tone. If you thought it was actually great, you said, “great job!” with an enthusiastic tone. After all, giving someone feedback about their presentation is a delicate act. You don’t want to provide feedback that upsets them, but you know that flattery isn’t going to turn them into a better speaker. So how can you give feedback that makes a difference without risking hurt feelings?

Here are three ways you can give your teammate feedback about their presentation that inspires improvement, whether it’s from okay to good, or from very good to excellent.

1) Discuss what was memorable

Begin your feedback by telling your presenter what you found memorable about his or her presentation. This takes your feedback to big-picture level, which is much more effective than providing granular comments. Your presenter probably has no memories of  their behavior at any particular moment, so feedback on details won’t get them very far. For example, in our Ted Talk Tips, we direct you to look at a particular moment in the talker’s presentation. Unless the talker was a highly trained orator or had meticulously rehearsed their presentation, they would have no conscious memory of exactly how they moved. They wouldn’t know what foot they were standing on, or the precise moment that they made that gesture.

Rather than giving feedback about particular moments or habits, you should describe what was most memorable to you. This way, you’re providing feedback at a level that helps the presenter understand their dominant message. If you tell them that what you remember the most was their passion, their conviction, or their idea, you’re helping your speaker focus on the big takeaway. You’ll inspire creative behavior, not obsessional adjustment.

2) Discuss the key message

If you tell your speaker, “I thought your key message was X,” you’re opening up the door to the most critical part of the presentation–what the message was, and not what the data, graphs, or charts were. In business today, presentations are not just PowerPoint parades . It doesn’t matter if you’re presenting to high-level executives or a group of interns, your talk needs to have meaning. It has to show how you think and how you synergize data into meaningful messages that have relevance and impact on the business.

By giving your presenter feedback about their key message, you are helping your presenter position their ideas at the right level, for the right audience. You’re not telling them what to do in a robotic way–you’re challenging them to align their thinking to their situation. You want to help them increase their impact, not wordsmith their speaking notes.

3) Share when you started to tune out?

No matter how much good intention you have, you’ll inevitably tune out, occasionally at best, frequently at worst. Of course, you could blame yourself or feel ashamed, but that’s a dead end. A more productive route would be to think about why you tuned out at that particular moment. Were there too many details? Was i too monotone? Too irrelevant?

When you pinpoint and share the moment that you disengaged, you identify a problem you had. You’re inviting your speaker to think about solutions to the problem–you’re not telling them what to do. Even better, you’re focusing your teammate’s attention on connecting with their audience versus getting through the material.

So, next time your colleague asks you, “What did you think about my presentation?” don’t just bite your tongue and say “great!” When you discuss the things set out in this article, you’re help your coworker become a better speaker. Who knows, you might even learn a thing or two about how to improve your own presentation.

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Anett Grant is the CEO of Executive Speaking, Inc. and the author of multiple e-books on speaking. Read her latest e-book here   More

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What's the purpose of a presentation? You might well think that there's a simple answer. But, of course there isn't. That's because the purpose of your presentation depends on you, the presenter. That's right. What is it that you want to achieve with your audience? And, of course, that's the starting point for some serious work.

What's The Purpose Of A Presentation?

Because your job is to achieve results with your audience. That's results set against your own objectives.

So, what do you want to achieve? To help, you can phrase another question, along the lines of…" what do you want your audience to understand after your presentation ?

You want your audience to…

• Understand something,
• Know something,
• Believe something, or
• Do something

You plan to achieve a result with your audience, all because of your presentation. And that result is a change in their understanding . Or a change in their knowledge or beliefs . Or, perhaps your audience will choose to do something, all because of your presentation.

So, that's the purpose of a presentation. It's your purpose…your objective for your own presentation. So, it's not important whether it's a PowerPoint or a Keynote presentation. Your purpose is what really matters.

What's Your Purpose?

And, if you don't have a rationale for your presentation?

Then you need one. Because without purpose your presentation won't work. Your purpose for your presentation drives everything:

• Your points
• Your examples
• And, your evidence with which you illustrate your points

And, as your presentation is the best way to forge a communication with your audience, then now is the time to get cracking with a purpose for your presentation.

All the best public speakers have an answer to the question, " why give a speech ?" And so should all of us.

You can always discover more presentation tips with our regular series of podcast and video tips. And, when you are ready for more intensive learning, then you can always join us on a presentation course or ask us to organise a coaching session. Please don't hesitate to get in touch when the time is right.

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Dilemma – The Purpose Paradox (Album Review)

Review of the DILEMMA album ‘The Purpose Paradox’

by Steve Joyce

I’ve been a Dilemma fan since enjoying their vibrant live set supporting Flying Colors in 2019. I was captivated by the presence of maestro drummer Collin Leijenaar in particular. I quickly purchased their 2018 album “Random Acts of Liberation” and it’s been in regular rotation ever since. How exciting, then, that Dilemma now unleash their third opus, “The Purpose Paradox” – a 63-minute musical odyssey and, cementing their prog rock credentials, it’s a concept album with a fantastic story.

Leijenaar, of course, will need no introduction to Neal Morse fans; he was the powerhouse behind Morse’s pre-NMB ‘Euro’ band. His percussive dexterity is immortalised on Morse’s awesome “Sola Scriptura & Beyond” live DVD and the magnificent “So Many Roads” triple live album.

For “The Purpose Paradox”, the Dilemma line-up is completed by Paul Crezee (guitars), Kristoffer Gildenlöw (bass), Robin Z (keyboards) and new vocalist Jermain van der Bogt, aka Wudstik. There are cameos from Dream Theater alumnus Derek Sherinian and Snarky Puppy’s Mark Lettieri.

Produced by Leijenaar and with mixing and mastering by legendary music wizard Rich Mouser, the album is sonically awesome: the delicate moments are rendered beautifully and the faster, louder passages – of which there are gratifyingly plenty – pulsate from the speakers with dynamic intensity.

The concept features a man named Neon and his quest for fulfilment, with support from an unconventional guide named Electra. Neon battles the corporate machine known as The Hand and seeks to discover the ‘outer light’. Escapist hokum for some listeners, possibly, but like many prog fans I’m a sucker for a good concept and I found the story to be engaging, adding hugely to my enjoyment of the music.

Instantly capturing the attention with a flamboyant keyboard riff, album opener ‘Sanctuary’ showcases the many different sides of Dilemma. It has everything you need from a prog song: catchy melodies, stomping rock choruses, a quiet interlude and a prog-metal workout evoking the rowdiest moments of Neal Morse, Dream Theater, Porcupine Tree and Frost*. It’s like distilling the best of modern progressive rock music into an eight minute overture.

New vocalist Wudstick is immediately awe-inspiring, belting out choruses with hair-raising power, and he’s equally effective on the quieter, more reflective moments. He’s clearly a singer of wide range and skill, rivalling the best of his contemporaries on the modern prog scene. He’s massively augmented Dilemma’s already powerful sound.

Second track ‘I Am Neon’ continues in similar style with another rocking intro in 7. Some would argue that this is an overdone prog trope, and they’re liberally used on this album, but this band is especially good at them so why not?! The vocals are gorgeous on this song, even if the lyrics are a little hard to connect with (…“celestial voices”…) – but it’s the epic outro that is the searing memory of this song. Marvellous stuff!

‘Electra’ introduces Neon’s enigmatic companion. Featuring Gildenlöw’s brooding, menacing bass, the song has tasteful keyboard/guitar solos, a singable chorus and an action-packed coda that is one of the grooviest prog moments since the overture to Spock’s Beard’s Snow. The drumming here is extraordinary.

A word, then, about Leijenaar’s playing on this album. His ability to rock out in odd time signatures rivals a certain blue-bearded contemporary for groove, chutzpah and “balls & chunk”. The spectacular tom fills and intricate kick/snare interplay are electrifying. The drum parts perfectly complement the music. Leijenaar is at least the equal of any of his more celebrated peers and his playing on ‘The Purpose Paradox” should be award-winning. Judges of prog rock awards take note!

Although a major triumph for Leijenaar, all band members contribute stellar performances that strike an ideal balance between musicality and virtuosity. I must call out keyboardist Robin Z as a highly impressive player who almost steals the show from Leijenaar. The keyboards throughout the album are outstanding and a huge pleasure to listen to.

Returning to the album, next song ‘Thunder’ also has many aspects to delight prog fans: a melancholic piano-led intro and verse, a radio-friendly chorus (that would sound at home on an Asia album), a gorgeous keyboard solo and a tasteful guitar solo by Crezee, one of several on the album. It’s one of the strongest songs here, and a good choice of single.

‘Allies’ rocks out in a 5/5/5/6 groove and boasts a soaraway chorus which musically suits the “out of the stratosphere” lyric. The much heralded keyboard solo by Sherinian, lauded by Dilemma’s publicity as the “King of Keyboards” is…okay, but didn’t ‘wow’ me; it feels a bit throwaway and in my humble opinion doesn’t match the quality of Robin Z’s keyboard parts throughout the album. The band’s rhythm section is on fire, however, and despite a slightly jarring key change in the final chorus, the song rocks hard and has a joyously naughty outro.

For this listener, things take a dip ever so slightly with the next couple of shorter songs, ‘Not Enough Now’ and ‘Glow’ – there’s some hummable keyboard parts and a nice guitar solo, but these songs don’t quite scale the heights of the others, in my view.

Happily, the album is firmly put back on course with penultimate song ‘Cities’ – it has my favourite vocal performance of the album (the “I don’t want to see tomorrow” refrain is truly impactful) and there’s a brilliant guitar solo. It’s my favourite track on the album and one of the best tracks I’ve heard by anyone all year.

Which brings us to the 15-minute album closer, ‘Outer Light’. There’s everything to like here: prog metal grooves that have you headbanging in seven (if you can…) and some deliciously funky bass by Gildenlöw. There’s a thrilling ‘Octavarium’-style instru-mental extravaganza which is tantalisingly shorter than I think it could have been. The playing here is absolutely phenomenal; Mark Lettieri’s guitar solo is truly dazzling. Finishing the album in cinematic style is the one-two knockout punch of a dramatic vocal by Wudstick, straining every sinew with a heart-stirring “…in the end…” lyric, followed by a reprise of the song’s exciting chorus, bringing the album to a shattering denouement.

With ‘The Purpose Paradox,’ Dilemma has delivered an entertaining album that is definitely one for prog rock fans to get their musical rocks off! Perhaps losing one or two of the shorter tracks would have delivered a tighter album musically, but the concept’s narrative flow is important and overall it’s a cohesive, satisfying journey. There’s an abundance of breathtaking music and the performances by all band members, Collin Leijenaar and Robin Z especially, deserve recognition in all the major award categories. This will no doubt be one of the better albums to come out this year. ‘The Purpose Paradox’ is certainly a must-listen for Neal Morse, Mike Portnoy and Dream Theater fans and one for all lovers of modern progressive rock to revel in and enjoy.

Released on September 20th, 2024

Pre-order the album here: https://shop.dilemma.band/

Tracklist: 1 SANCTUARY 7:58 2 I AM NEON 6:10 3 ELECTRA 5:59 4 THUNDER 6:12 5 ALLIES 6:08 6 NOT ENOUGH NOW 4:26 7 GLOW 5:18 8 CITIES 5:06 9 OUTER LIGHT 15:40

The band: Wudstik – vocals Paul Crezee – guitars Kristoffer Gildenlöw – bass Collin Leijenaar – drums Robin Z – keyboards

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Dilemma share new single and video “Sanctuary” from forthcoming 3rd album ‘The Purpose Paradox’

Dilemma share new single and video “Thunder” from forthcoming 3rd album ‘The Purpose Paradox’

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Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?

• Review Article
• Open access
• Published: 17 September 2024

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• Asker E. Jeukendrup 1 , 2 ,
• Jose L. Areta 3 ,
• Lara Van Genechten 2 ,
• Carl Langan-Evans 3 ,
• Charles R. Pedlar 4 ,
• Gil Rodas 5 ,
• Craig Sale 6 &
• Neil P. Walsh   ORCID: orcid.org/0000-0002-3681-6015 3  

Relative energy deficiency in sport (REDs) is a widely adopted model, originally proposed by an International Olympic Committee (IOC) expert panel in 2014 and recently updated in an IOC 2023 consensus statement. The model describes how low energy availability (LEA) causes a wide range of deleterious health and performance outcomes in athletes. With increasing frequency, sports practitioners are diagnosing athletes with “REDs,” or “REDs syndrome,” based largely upon symptom presentation. The purpose of this review is not to “debunk” REDs but to challenge dogmas and encourage rigorous scientific processes. We critically discuss the REDs concept and existing empirical evidence available to support the model. The consensus (IOC 2023) is that energy availability, which is at the core of REDs syndrome, is impossible to measure accurately enough in the field, and therefore, the only way to diagnose an athlete with REDs appears to be by studying symptom presentation and risk factors. However, the symptoms are rather generic, and the causes likely multifactorial. Here we discuss that (1) it is very difficult to isolate the effects of LEA from other potential causes of the same symptoms (in the laboratory but even more so in the field); (2) the model is grounded in the idea that one factor causes symptoms rather than a combination of factors adding up to the etiology. For example, the model does not allow for high allostatic load (psychophysiological “wear and tear”) to explain the symptoms; (3) the REDs diagnosis is by definition biased because one is trying to prove that the correct diagnosis is REDs, by excluding other potential causes (referred to as differential diagnosis, although a differential diagnosis is supposed to find the cause, not demonstrate that it is a pre-determined cause); (4) observational/cross-sectional studies have typically been short duration (< 7 days) and do not address the long term “problematic LEA,” as described in the IOC 2023 consensus statement; and (5) the evidence is not as convincing as it is sometimes believed to be (i.e., many practitioners believe REDs is well established). Very few studies can demonstrate causality between LEA and symptoms, most studies demonstrate associations and there is a worrying number of (narrative) reviews on the topic, relative to original research. Here we suggest that the athlete is best served by an unbiased approach that places health at the center, leaving open all possible explanations for the presented symptoms. Practitioners could use a checklist that addresses eight categories of potential causes and involve the relevant experts if and when needed. The Athlete Health and Readiness Checklist (AHaRC) we introduce here simply consists of tools that have already been developed by various expert/consensus statements to monitor and troubleshoot aspects of athlete health and performance issues. Isolating the purported effects of LEA from the myriad of other potential causes of REDs symptoms is experimentally challenging. This renders the REDs model somewhat immune to falsification and we may never definitively answer the question, “does REDs syndrome exist?” From a practical point of view, it is not necessary to isolate LEA as a cause because all potential areas of health and performance improvement should be identified and tackled.

Avoid common mistakes on your manuscript.

1 Introduction

Relative energy deficiency in sport (REDs) is a model that built upon the female athlete triad work first presented in 1993 [ 1 ] with a female athlete triad consensus paper published in 1997 [ 2 ]. REDs was first introduced in 2014 [ 3 ] and describes how inadequate energy intake, for the demands of training [i.e., low energy availability (LEA)] by athletes, “causes” a wide range of symptoms far beyond the health symptoms discussed in the female athlete triad, including effects on performance [ 4 ]. This wide range of symptoms include amongst others menstrual irregularities, poor bone health, compromised immune function, reductions in performance, fatigue and poor mental health.

The number of publications on the topic of REDs has risen significantly since the concept was first introduced [ 3 ]. Although REDs was originally described as a model [ 3 ], in sports practice, athletes are now being diagnosed with “REDs” or “REDs syndrome” [ 4 , 5 ] and it may appear that REDs is well-established. We even see dedicated REDs clinics (examples [ 6 , 7 , 8 ]). REDs has become a much-discussed topic on social media and in mainstream media news outlets (examples: [ 9 , 10 , 11 ]). However, as the REDs concept is nascent, the mediatic growth is incommensurate with the scientific evidence, and the number of clinical trials showing a causal effect of LEA is limited.

The first consensus statement by the IOC on this topic [ 3 ] encouraged readers to never stop questioning. Herein, we have taken up this challenge and have undertaken an examination of the REDs model. Much of the support provided for the model is from studies that have used simple questionnaires, or poor measurements of energy availability, whereas the current consensus [ 4 ] clearly indicates the difficulties measuring energy availability as well as limitations using questionnaires without measurements of bone mineral density (BMD) and a series of other biomarkers (as evidenced by the new REDs CAT-2 tool). Many researchers and practitioners are working on the basis that REDs is a well-established phenomenon and that LEA and REDs are highly prevalent in athletes [ 12 , 13 , 14 , 15 , 16 ] with studies even reporting 100% of athletes with LEA [ 17 , 18 ] and up to 80% being at risk or suffering from REDs [ 12 , 16 ]. We believe this is possibly misleading and may prevent the researcher and practitioner communities from unveiling the multifactorial causes of common symptoms observed in athletes.

The main goal of this article is to provide a critical review of the concept of REDs to help advance the science, have an objective view on the strength of the available evidence behind the concept (focused on the most researched aspects of REDs), and ask the pragmatic question, “what is the best way to support the health and performance of athletes?” Herein we suggest that the REDs model is too “calorie centric” and propose a more holistic and comprehensive approach in which LEA is one of many potential causes of the symptoms described by the model (Fig.  1 ).

Comparison of the current REDs model that centers around LEA as the only cause of symptoms (Left: with permission [ 4 ]) and the more holistic approach we are presenting in this paper

Instead of LEA being the single cause of REDs symptoms we propose that there are many causes (in eight categories). These causes can act independently or in combination and LEA can be one of these many causes (or moderators). We are not proposing a new model, rather we are stating that models developed in the 1950s and 1990s (the general adaptation syndrome and the allostatic load model) are more comprehensive and are more suitable to explain the REDs symptoms in athletes (Sect.  3 ). This is not the first time the REDs model has been evaluated and critiqued. For example, in one critical paper [ 19 ] the authors question several assumptions and methods and ask for more research. Several years later attempts have been made to address some but not all of these questions. In the meantime, the REDs model has also evolved attempting to address some of the concerns, but this has also raised new questions. For example, the latest consensus paper stresses that diagnosis of REDs cannot be performed directly and would need to be made through measurements of symptoms and exclusion of other causes. The model has evolved into including even more symptoms and even more potentially affected body systems without providing robust evidence to support such claims. Most importantly, in this process of diagnosing by exclusion, the assumption, and a bias, is that symptoms are directly caused by LEA, unless there is another cause. We will introduce an Athlete Health and Readiness Checklist (AHaRC), which has a number of tools from other expert/consensus statements, that together will provide a more holistic and less biased approach to athlete health.

1.1 Historical Perspective

In 1993 the female athlete triad was proposed by authors researching eating disorders, menstrual function and bone mineral density (BMD) in athletes [ 1 ]. A common co-existence of the clinical manifestations, amenorrhea and osteoporosis, was reported in individuals with eating disorders. In 1997 a triad consensus statement was published referring to LEA as a hypothetical factor causing amenorrhea and osteoporosis in the presence or absence of an eating disorder [ 2 ]. At this point in time there was little experimental work to support the claims, but seminal research by Loucks and colleagues, aiming to separate the effects of energy availability (EA) and exercise in a series of well-designed studies, established causal links between LEA and alterations of the endocrine milieu and markers of bone metabolism and BMD [ 20 , 21 , 22 , 23 ]. A 2007 female athlete triad consensus statement made a major modification replacing “eating disorders” with “low energy availability” [ 24 ]. In 2014, a new model, the RED-S (now REDs ), was proposed to build upon and expand the female athlete triad model [ 3 ].

This REDs model suggested that LEA could have several health effects in addition to amenorrhea and osteoporosis including, but not limited to, effects on immune function, gastrointestinal function, and cardiovascular function [ 3 ]. It was also stated that male athletes were at a lower risk for developing eating disorders [ 25 , 26 ], but there were links between LEA and BMD in males [ 27 ]. In contrast to the female athlete triad, where the diagnoses were eating disorders, amenorrhea, or osteoporosis, REDs was now also presented as a diagnosis, a syndrome with many potential symptoms. It was acknowledged that the screening and diagnosis of REDs was challenging [ 3 ]. This statement was refined 4 years later in a new consensus statement by the IOC [ 28 ]. Some of the changes included a more comprehensive discussion of the effects in male athletes, a discussion of the complications of assessing LEA, and it was stated that one of ultimate goals was to stimulate awareness of the effects of LEA [ 28 ].

The definition of REDs has evolved over time, but in the latest IOC consensus statement it is defined as a syndrome of impaired physiological and/or psychological functioning experienced by female and male athletes that is caused by exposure to problematic (prolonged and/or severe) LEA [ 4 ]. The detrimental outcomes include, but are not limited to, decreases in metabolic function, reproductive function, musculoskeletal health, immunity, glycogen synthesis, and cardiovascular and hematological health, which can all individually and synergistically lead to impaired well-being, increased injury risk, and decreased sports performance [ 4 ].

The most recent REDs IOC consensus statement attempted to address some of the shortcomings of the previous statements, and reporting on advancements in the field [ 4 ]. Some of the main changes included: an expanded range of symptoms, recognition that not all LEA has negative health or performance outcomes, and a wide array of differential diagnoses. Some LEA was classed as “adaptable,” with REDs specifically being the outcome of “problematic” LEA [ 4 ]. The consensus does not, however, cite any primary evidence or objective parameters to provide clarity on how adaptable and problematic LEA could be separated, other than waiting for symptoms to develop. This is a limitation because most studies used to support the REDs model have studied adaptable LEA and not problematic LEA. The new consensus recognizes that other factors may play a role in the etiology of REDs and can even be independent of EA, but these are referred to as “moderating factors” [ 4 ]. Importantly, a supporting paper provides an extensive list of moderating factors that need to be considered, including many different etiologies (differential diagnoses) that could generate the signs or symptoms of REDs [ 29 ]. The list of factors to be considered and excluded, is likely far from complete and is not practical for practitioners or clinicians. Perhaps this was beyond the scope of the consensus, but it is central to the task of helping athletes to maintain health and performance.

Finally, it is worth highlighting a major logical fallacy in the fundamental tenet of the REDs model. As it is stated: “REDs (by definition) is a collection of symptoms that are caused only by problematic LEA” [ 4 ]. It is only possible to diagnose problematic LEA through the measurements of symptoms. But then the same statement acknowledges “there are other causes of these symptoms” [ 4 ]. Therefore, it appears that a calorie-centric (energy-centric) model may be a paradigm that predisposes the observer to bias, inflicting at least partial blinding of several other common etiological factors that may be exerting responses attributed only to LEA; a more holistic approach is warranted.

1.2 The Definition and Calculation of Energy Availability

Previous visualizations of the REDs model placed REDs as the hub of a wheel with a large number of spokes [ 3 ], representing categories of symptoms, although this seems to have been in error, since REDs refers to the symptoms and not the cause, which has always been said to be LEA. This has been corrected in the most recent consensus [ 4 ] in which LEA is displayed as the only cause of a wide range of symptoms and the overall syndrome is referred to as REDs. The current definition of EA refers to the dietary energy available to sustain normal physiological function after exercise energy expenditure is subtracted, and in its latest form the algebraic definition is represented as [ 30 ]:

It is generally considered that an EA of ~ 45 kcal . kg FFM −1 .day −1 is healthy, but an EA below 30 kcal . kg FFM −1. day −1 is problematic for health. These levels have been largely based upon two instrumental studies that titrated EA levels in habitually sedentary women who performed exercise to 10, 20, 30, and 45 kcal . kg FFM −1. day −1 for 5 days; showing that with EA at or below 30 kcal . kg FFM −1. day −1 alterations in hormonal and metabolic markers occurred [ 21 , 22 , 31 ]. These changes were consistent with alteration of the hypothalamic pituitary gonadal (HPG) axis hormones that are mechanistically linked to the cause of amenorrhea [ 21 , 22 , 31 ] and changes in markers of bone resorption and formation, with a reduction in bone formation indicated in each LEA condition and an increase in bone resorption indicated at more severe LEA [ 32 ].

Although this mathematical equation of establishing EA seems very straightforward, the reality is that the calculation lacks accuracy [ 33 ] for several reasons:

Interpretation of what net energy expenditure entails is not uniformly agreed or applied i.e., there is no consensus on what is classified as “exercise” and what is “non-exercise activity thermogenesis.”

Assessment of energy intake is usually done using food diaries which are known to result in underreporting with errors of up to 60% (19% on average [ 34 ]).

The accuracy of estimations of energy expended during exercise will vary greatly by sport, and will be dependent upon factors such as the device used (often accelerometers, or heart rate monitors), whether or not activity is self-reported, mechanical efficiency, and so on [ 35 ].

Measurements of FFM are typically achieved through generic equations. These equations vary significantly, may be established in different populations, and will only provide an approximation of an individual’s FFM. Errors upwards of 2–3% [ 36 ] are likely with gold standard methods (and standardization of measurement procedures), but at an individual level and with techniques often used in sports practice (such as bioelectrical impedance and skinfolds) these errors can be significantly larger due to accumulation of measurement error and day to day variation.

It is now generally agreed that, in practical settings, it is questionable whether estimations of LEA can be obtained that are reliable enough to base sound conclusions upon [ 4 , 33 ]. In addition, such measurements only provide a snapshot and would not necessarily be representative of the preceding weeks, months or years. Finally, a fixed cut off value for EA of 30 kcal . kg FFM −1  day −1 does not consider the possible inter-individual variation in responses to EA [ 37 ]. Especially in real-life settings when the direct assessment of LEA cannot be relied upon for the diagnosis of REDs [ 4 , 33 ]. The use of cut-off values was abandoned in the last IOC consensus paper [ 4 , 33 ]. This does not solve the issue: how would we ever know if someone is in LEA if the measurements are not accurate and we do not have cut-offs?

It is also noteworthy that even though field-based EA assessment is fraught with error, a significant number of observational studies adopt field-based EA assessment [ 38 , 39 , 40 , 41 , 42 , 43 ]. Many of these studies interpret outcomes of these EA assessments as accurate, with little or no consideration for the error of measurement. In many cases this has resulted in classification of athletes being in LEA (“clinical” or “subclinical”). It is more than likely that this has resulted in an over-estimation of the prevalence and severity of LEA. In a recent study in female football players the average EA was 34 ± 12 kcal . kg FFM −1. day −1 with six players (34%) reported to meet the criteria for LEA (below the threshold of 30 kcal . kg FFM −1. day −1 ). When corrected for potential underreporting (based on [ 44 ]), however, the average EA was 44 kcal . kg FFM −1. day −1 with only one player (5%) meeting the criteria for LEA) [ 45 ]. Other studies have been more careful and more critical in their interpretation of the data [ 46 , 47 ] but still use the same methods or the cutoffs that have been abandoned and a single short duration assessment period.

1.3 Why Diagnosing REDs by Symptom Presentation Alone is Flawed

As it is not possible to use the mathematical model and calculate LEA accurately in practice, and because even with such a calculation it is not feasible to distinguish adaptable from problematic LEA, it has been proposed that the only approach that will work is to measure the outcome (symptoms) [ 33 , 48 ]. Several questionnaire-based tools have been developed to estimate the risk of LEA, including the LEAF-Q [ 49 ], LEAM-Q [ 50 ], and RED-S-CAT [ 51 ] (succeeded by REDs-CAT2 [ 52 ]). A recent review counted eight questionnaires that claimed to be validated plus three more questionnaires, all with the aim to predict LEA [ 53 ]. There is clearly no uniform way of assessing symptoms and these tools have no inherent consideration for the fact that the symptoms could be caused by other factors that are either related to, or completely independent of LEA. The tools are usually validated in one specific population but are sometimes applied across a wide range of athlete populations.

There is a flaw in the reasoning that measuring common symptoms can provide information about the cause, unless all other important factors are considered. An analogy would be that if we have studies showing that excess energy intake in the form of sugar can result in weight gain, and there are studies showing that weight gain can result in obesity over time, and obesity is associated with various negative health outcomes, then, if we measure these health outcomes in an individual, can we conclude that the person ate excessive amounts of sugar? Of course, this conclusion would be flawed because there are many other factors that need to be considered in the development of obesity and related health consequences. Some of these factors could be nutrition related (for example, fat or alcohol intake), but also social factors, psychological factors and many environmental factors like infrastructure would need to be considered. We would not call all these factors “moderators” of the effect of excessive sugar intake. They are just other causes that also need to be considered.

1.4 REDs is a Model, and a Model is a Simplified Representation of Reality

Models are useful for making a particular part or feature of the world easier to understand, define, quantify, visualize or simulate. A model is an idealized (simplified) representation of aspects of the world around us, simplifying physical, biological or sociological phenomena.

The model does this by referencing existing and usually commonly accepted knowledge. Although models are indispensable for biomedical research they need to be tested, and in this process, it is usually discovered that the model is inadequate or even incorrect and needs to be adjusted or replaced by a different model. REDs is a model [ 3 ] and like any other model it needs to be scrutinized and improved. The group that was responsible for the consensus statements will continue to do this, but others should also scrutinize the ideas, the assumptions and theories. In mainstream media, however, the idea is presented as a fact and the large number of narrative reviews and consensus statements suggest that it is well-established. We propose that the model could be adapted or a new model could be developed with less bias towards insufficient calorie intake as the only cause. The approach should be more open-minded with the goal of finding the cause, rather than trying to prove that LEA is the cause. There are other equally likely, or sometimes more likely, causes of the symptomology that need to be considered.

In the following sections, we discuss the underlying evidence for the REDs model highlighting that it has not been as thoroughly tested as is often claimed and therefore remains a model that may have to be adjusted or maybe even abandoned or replaced.

2 How Strong is the Evidence?

In the last few years there has been a significant increase in the number of publications in this area. A search on PubMed using the terms “energy availability” AND “exercise” OR “athlete” (20 Sept 2023) provided 440 papers. Approximately 40% were narrative reviews, commentaries and editorials and 60% were empirical research studies, of which roughly 90% were observational and less than 10% RCTs (i.e., able to show a causal relationship between LEA and study outcomes). Much of the empirical research quoted consists of older studies that were used as support for the female athlete triad model, indicating that the area has advanced little since this original work. It is also important to note that most of the empirical research studies (70%) were short term (less than 7 days in duration), and only 29% of the studies investigated athletes, and even fewer elite athletes. Importantly, there was no evidence of experimental studies to support the majority of the proposed health and performance consequences of REDs. Of course, absence of evidence does not mean evidence of absence, but it confirms that REDs is a model that still needs to be thoroughly tested.

Since REDs is being diagnosed in sports practice, regular publications are appearing from major organizations like the IOC [ 3 , 4 , 48 ], and REDs clinics are being opened [ 6 , 7 , 8 ], the assumption is that the underlying evidence is strong. In this section we will make the point that this is not the case, and that especially concerning REDs, the ideas are so new, and the research required so complex, that many aspects of the model are only supported by associations, and findings are not consistent. In the evidence pyramid, clinical research trials provide the most control and can demonstrate causality. Studies that report correlations or associations cannot demonstrate causality. As we will see in the section below, very few studies have demonstrated causality between LEA and REDs symptoms. Most of the evidence describes associations that provide a much lower level of evidence, because the symptoms are not very specific, there are many different potential causes that would need to be considered in addition to LEA.

As discussed above, the error of assessment of EA can be very high, yet many cross-sectional studies are still based upon poorly measured outcomes that are likely inaccurate (and often an under-estimation of the real value). Much of the evidence purported to support the REDs model is therefore mostly obtained from indirect evidence, derived from studies that did not involve athletes, and often obtained with different research questions and objectives in mind. Arguably the strongest support for the model should come from the areas that have been researched the most, i.e., the parts of the female athlete triad: effects of LEA on reproductive function, energy metabolism, bone health and immune function. We will therefore focus on these areas in the following sections of this review to demonstrate that there are still many unanswered questions even in these relatively well studied areas.

2.1 Reproductive Function

Here we critically discuss the available evidence regarding the relationship between LEA and reproductive function, including menstrual function, sex hormone dysregulation and sperm quality. While LEA can be a potent modulator of the HPG axis in men and women [ 30 ], other possible etiological factors should also be considered when an athlete displays signs and symptoms of reproductive dysfunction. Other causative factors may act independently of LEA or interact synergistically with LEA; consequently, focusing on EA alone may lead to other important causative factors being missed, hampering effective treatment. For example, psychological stress, depression, anxiety [ 54 , 55 ], and poor sleep [ 34 ] often occur simultaneously with LEA [ 56 ] and have known influence on the hypothalamic–pituitary–adrenal (HPA) axis and may therefore modulate the HPG axis and reproductive function [ 57 ]. Accordingly, menstrual disturbances in women elicited by a diet and exercise programme were associated with metabolic stress but also with significant increases in perceived stress [ 58 ]. Elegant work, albeit in female cynomolgus monkeys and yet to be replicated in humans, showed much greater impairment in reproductive function (assessed as abnormal menstrual cycle length) after a combination of psychosocial stress plus diet and exercise stress compared with either stressor alone [ 59 ].

Animal models have historically provided strong support for a relationship between LEA and reproductive function. In female animals there is clear evidence of menstrual cycle suppression as a result of pharmacological inhibition of substrate utilization [ 60 ], increased thermoregulatory demand [ 61 ] and increased foraging effort [ 62 ] in rodents, and a high exercise volume without a compensatory increase in calorie intake in monkeys [ 63 ]. In male animals the evidence of alterations in reproductive function is less clear, but there are examples showing reduced sperm quality and disrupted testicular metabolism in rodents [ 64 ] and suppression of luteinizing hormone and testosterone pulse frequency in male rhesus monkeys [ 65 ]. However, there is also evidence of favorable effects of long-term calorie restriction improving testicular function in male rhesus monkeys [ 66 ].

In human females, the causal effect of LEA on sex hormone concentrations has been determined via systematic laboratory-based research emerging through the 1990 and 2000s [ 30 , 67 ] ultimately putting LEA at the core of the female athlete triad model [ 2 , 19 ]. Several lines of enquiry provide evidence of disruption to reproductive function due to LEA. Short term studies in exercising females provide direct evidence of disruption of the hypothalamic pituitary ovarian (HPO) axis hormones luteinizing hormone (pulsatility) and follicle stimulating hormone, but not oestrogen with LEA [ 30 , 67 ]. In addition, to these mechanistic studies, a large body of observational human studies in female athletes [ 4 , 28 ] associate disruption to reproductive function with LEA. Therefore, there is support for the idea that, in females exposed to LEA, the cyclicity of primary female sex hormones is blunted resulting in menstrual disturbances. Depending upon the severity and duration of LEA, amenorrhea may develop [ 59 , 68 ], though the relationship between reduced energy availability and menstrual dysfunction in practice is less clear [ 37 ].

In human males , although direct supporting evidence is scarce, negative impact on male reproductive function may be evidenced through decreased testosterone, libido, sexual dysfunction and spermatogenesis and sperm abnormalities [ 19 ]. Testosterone is considered a key hormone in the development of reproductive dysfunction and secondary hypogonadism (clinical or subclinical), which are considered primary indicators of REDs [ 4 , 69 ]. Although severe energy deficit in healthy individuals has been associated with reduced circulating testosterone [ 70 ] and sperm quality [ 71 ], it is not clear if exercise stress on its own may down-regulate circulating testosterone [ 69 , 72 ] and what is the independent effect of LEA. In three LEA-specific experimental studies of 3–6 days duration in males, where exercise volume was not a confounding factor, LEA did not affect circulating testosterone [ 73 , 74 , 75 ].

For an athlete managing various training, competition and life stressors, LEA is likely to co-exist in the presence of a variety of other stressors. These other stressors may even be responsible for the disruptions in the HPA and HPG axis in the absence of/independent of LEA. Military studies lend themselves well to research in multi-stressor environments that could be applied to athlete settings. For example, women reporting high levels of psychological stress during intense military training, exhibited perturbations of the HPA axis [ 76 ], marked HPG axis suppression and prevalence of menstrual disorders without clear signs of LEA [ 77 ]. The authors are not aware of similar studies in female athletes highlighting factors other than LEA in the etiology of reproductive dysfunction.

In males it has been known for decades that psychological stress can reduce testosterone and spermatogenesis via central mechanisms [ 78 ]. Multi-stressor environments that include energy deficit reduce testosterone, that returns to normal levels when the stressors are removed [ 79 , 80 , 81 ]. Several studies of the longitudinal effects of training and competition and associated variables (sleep, the positivity of coaching, winning versus losing, competition environment) describe a modulatory effect on the hypothalamic pituitary adrenal (HPA) and HPG axis in male athletes (for example [ 82 , 83 ]) that should be considered in future research and in applied practice.

In summary, variations in reproductive function are to be expected in athletes with numerous factors having an influence on the HPA and HPG axis in females and males. There is a need for well-controlled studies to determine to what extent, different stressors may contribute to reproductive health disturbances in athletes, and the point at which these may reach clinical concern. This research would help to establish preventative strategies and comprehensive clinical treatment. Further work is needed to establish the specific causal relationship between LEA and reproductive function in athletes.

2.2 Energy Metabolism

Although LEA is often associated with “impaired energy metabolism,” it is not always clear what this represents. Within both the 2014 REDs consensus and 2018 update, the term “metabolic” is not specifically defined, but is stated as “impaired physiological functioning caused by relative energy deficiency and includes impairments of metabolic rate” [ 3 , 28 ]. The 2023 REDs consensus update extends this to further include “exposure to problematic LEA, with detrimental outcomes including decreases in energy metabolism” [ 4 ]. From those studies used to evidence the evolution of the REDs models, it appears that “metabolic rate” and “energy metabolism” are describing perturbations that may occur at either the whole body and/or tissue levels. These can be assessed through measurements of resting metabolic rate (RMR meas ) and other indirect markers, including the endocrine hormones of the hypothalamic-pituitary-thyroid axis (e.g., triiodothyronine; T 3 ; see Table 2 of the 2023 consensus) [ 84 ].

There are important points to consider regarding these measures, as they are often used to indicate a “pathology” in relation with REDs. As an example, metabolic changes at the whole-body level, can occur independent of those at the tissue level via a phenomenon known as adaptive thermogenesis, defined as a reduction in RMR meas , beyond what could be predicted from changes in fat and FFM [ 85 ]. As this could demonstrate a compensatory response to LEA, it is a common practice in both research and applied settings to examine RMR meas against an equation-based prediction of RMR (RMR pred ), to establish a ratio (RMR ratio ). If this ratio is below an arbitrary threshold (i.e., < 0.90) this is considered as a proxy surrogate of energy deficiency [ 86 ]. Given the complexity of RMR meas standardization procedures and the numerous RMR pred equations used across male and female populations, the combinations of these two factors may warrant lower or higher cut-offs for RMR ratio [ 87 ]. Furthermore, for measurement of indirect markers such as T 3 , clinically relevant reference ranges from across globally diverse population are difficult to agree, nor have these been well established in athletes [ 88 ]. A deviation from the average might be expected in an athlete population and does not necessarily indicate pathology, therefore, do we have clear cut off values for what is considered normal? Do we know when we are dealing with an adaptation versus development of pathology?

Besides these considerations, it is important to note that the evidence quoted to support the notion that the manipulation of energy intake and/or exercise energy expenditure may affect energy metabolism is not derived from athletes. Studies in this area are mainly conducted in lean healthy, overweight/obese, sedentary or active males and females, but not specifically athletes [ 30 , 84 , 87 ]. Furthermore, within the three consensus statements [ 3 , 4 , 28 ], many of the studies included to evidence any negative perturbations on markers of energy metabolism include those that have not directly examined LEA per se [ 89 , 90 , 91 , 92 , 93 ] or were conducted in cohorts of exercising females with a focus on outcomes predominantly related to the female athlete triad and not specifically REDs [ 59 , 94 , 95 , 96 , 97 , 98 ]. The evidence therefore is indirect.

In addition, the majority of studies are cross sectional or longitudinal making it impossible to establish causality of LEA. There are also many conflicting outcomes. Some studies have highlighted an apparent relationship between LEA and negative perturbations to markers of energy metabolism (i.e., reduced RMR meas , RMR ratio and/or T 3 ) [ 99 , 100 , 101 , 102 ], with others showing no effect, but with individuals not being in LEA (above the threshold for LEA) [ 103 , 104 , 105 ]. Other studies show no negative outcomes despite LEA [ 17 , 43 , 46 , 106 , 107 , 108 ].

Experimental studies have highlighted a potential causal link between the effect of LEA on energy metabolism in recreationally trained eumenorrheic females [ 109 ], yet this was not shown in well trained male endurance athletes [ 73 ]. The time course of these studies was short (3–10 days) and any highlighted significant differences were small (65 kcal∙day −1 in RMR meas ) and not below clinically relevant reference ranges (> 1.0 nmol∙L −1 T 3 ). If we use these markers to indicate pathology, what evidence is there to confirm that this indicates pathology and not adaptation. In other words, what would be classified as adaptable versus problematic LEA in this instance?

In summary, energy balance and likely also energy availability are dynamic processes and maintenance of body mass is the result of a highly complex and dynamic energy balance system, in which perturbations to individual components can cause coordinated and inter-related compensatory responses elsewhere. The strength of these compensatory responses is individually subtle, and early identification of this variability may help recognize individuals that respond well or poorly to an intervention. Changes in RMR meas may deviate from RMR pred owing to a range of methodological reasons, and/or because RMR meas is not static. We have little or no evidence to support that a deviation in an arbitrary cutoff (i.e., RMR ratio ) or changes in indirect markers (i.e., T 3 ) indicates a pathology. This in combination with the fact that even the existence of adaptive thermogenesis is still heavily debated [ 110 ], means that these measures are not a solid evidence-based indicator of pathology that can be used in the diagnosis of a syndrome. Further experimental research is necessary for thorough characterization of the relationship between of LEA and measures of energy metabolism, specifically in athletic populations. We would also encourage future research that investigates whether the changes that are observed are “normal physiological responses,” “adaptations,” or “pathology.”

2.3 Bone Health

The bone health of athletes was the subject of interest and research even before the female athlete triad was proposed in 1993 [ 1 ]. In the male and female athlete triad and REDs models, LEA is linked to adverse bone health. Herein we will make the point that, whilst there is evidence of an effect of LEA on bone outcomes, this evidence might not be as strong as one might imagine, especially given the difficulties in:

measuring energy availability;

determining the bone health of athletes;

isolating the effects of LEA from other factors (i.e., exercise factors, nutrient availability, sleep, illness, psychological stress);

determining the extent to which short-term periods of LEA and adaptations to bone relate to longer-term problems for bone health.

Much of the evidence base in this area comes from clinical populations, particularly those with anorexia nervosa (AN), but also from those with other eating disorders (albeit to a lesser extent), where altered bone metabolism, low BMD and increased fracture risk have been reported (see [ 111 , 112 , 113 ] for relevant systematic reviews and meta-analyses). It is difficult, however, to extrapolate findings from non-athletic individuals with eating disorders to athletes experiencing LEA, even when the athlete is also suffering from an eating disorder. Differences in diet composition and nutrient intake are likely to exist (which could influence bone outcomes). A further difference is that the LEA state experienced by the athlete is underpinned by significant energy expenditure through exercise, which is different (type, intensity, duration, volume) to some, although certainly not all, individuals with an eating disorder [ 114 ]. Exercise could alter the effects of LEA on bone, although not necessarily consistently in the same direction depending upon the type of exercise performed (e.g., [ 115 , 116 , 117 ].

The case that LEA directly influences bone is mostly based upon studies that examine changes in bone markers in short term studies. These studies investigated bone markers either acutely or over short periods of LEA lasting between 3 and 5 days and showed that changes in bone marker concentrations can occur within this timeframe [ 32 , 115 , 118 ]. LEA tends to reduce circulating concentrations of bone formation markers (for a review see [ 119 , 120 ]) and increased bone resorption marker concentrations might also occur with more severe reductions in energy availability [ 32 ].

Although short term studies tend to support an effect of LEA on bone, it is difficult to determine how important this might be for longer-term bone health (i.e., over months or years). It remains unclear whether the acute and/or short-term responsiveness of bone markers is consistent following the repeated application of the same stimulus over time. Most importantly, it is not clear whether changes in these markers can predict longer-term alterations to bone mass, microarchitecture or bone stress injury risk. Until these elements are confirmed, it is difficult to determine whether the changes that have been shown in bone marker concentrations are positive or negative for longer-term bone health and whether they are clinically relevant for the athlete. In the context of the definitions provided in the latest REDs consensus statement [ 4 ], these acute and/or short-term studies would seem to be more reflective of adaptable responses to LEA rather than of problematic responses to LEA.

As such, and somewhat understandably given the difficulties in conducting long-term studies in this area, the available evidence for an effect (or not) of LEA on bone outcomes in athletes largely comes from cross-sectional studies. Here, conclusions are drawn on the basis of various bone outcomes in athletes who are reported to be in LEA when compared with those who are not (for a selection of examples see [ 43 , 101 , 121 , 122 , 123 , 124 , 125 , 126 , 127 ]). These studies tend to show reduced BMD at some (but not all) sites and some (but not all) studies report increased bone stress injury risk with reports of LEA and/or associated indicators. Whilst cross-sectional studies can be useful in the generation of hypotheses and in informing further study designs, the major issue is that they cannot establish a cause-and-effect relationship or provide information on how outcomes and behaviors might change over time; they essentially just provide a snapshot of one point in time. A further issue is that, whilst these studies tend to use relatively strong measures of bone related outcomes (e.g., dual energy X-ray absorptiometry derived measurements of BMD, high-resolution peripheral quantitative computed tomography derived measurements of bone micro architecture and strength, bone stress injury records), they rely upon relatively weak indicators of LEA (e.g., diet and training records, Triad or REDs symptoms, LEA questionnaires).

A further important consideration when evaluating the effects of LEA on bone is the fact that it is often hard to separate the effects of energy availability from the effects of nutrient availability. In terms of athlete bone health, this is perhaps most apparent with regards to carbohydrate and calcium availability, but likely also relates to other nutrients of importance for bone (for a broad overview of these see [ 128 ]).

It is extremely difficult to identify a magnitude and duration of LEA that might predispose an athlete to bone problems. Determining the direct impact of LEA on athlete bone health that is intermittently applied or not continuously applied over the longer-term, is even harder. The current evidence for an effect of LEA on bone health is not based on optimal study methods or designs, which, for example, makes it difficult to separate the independent effects of LEA from numerous other factors. There is a need for further research that recruits larger numbers of athletes and utilizes gold standard methods to significantly improve our understanding. It is noted, however, that this would be a major undertaking and the feasibility of such studies is questionable.

2.4 Immune Function

Evidence is currently lacking to support the notion that LEA of the magnitude often reported in athletes causes ‘immunological dysfunction’ [ 129 , 130 ]. A handful of cross-sectional, survey studies show that leanness and LEA are associated with the recall of illness symptoms in athletes [ 16 , 56 , 131 ]. Besides the acknowledged challenges assessing energy availability in free-living athletes, and the lack of a clear definition for LEA [ 33 ], these studies suffer many of the limitations common to field investigations of athlete immune health, including:

absent or inadequate comparator control group;

confounding owing to recruitment bias and low responder rates;

unstandardized recall of illness symptoms over the last 1–3 months, rather than recommended daily symptom monitoring using validated questionnaires ( e.g. , Jackson or Wisconsin) [ 132 ];

investigating (LEA as a risk factor for) only a small number of self-reported respiratory symptom episodes occurring outside of the common cold season (e.g., 16 respiratory symptom episodes among 81 athletes in the Australian summer [ 131 ]);

lacking pathology tests to confirm symptoms were of infectious etiology (e.g., rather than seasonal allergy) [ 133 ] and

lacking in-vivo immune measures that provide clinically relevant information about “immunological function” (e.g., vaccination responses) [ 132 , 134 ].

Reporting only time lost from training due to illness symptoms in the last month does not constitute a rigorous and comprehensive immunological assessment sufficient to determine “immunological dysfunction,” a term used in one recent paper examining REDs symptoms in elite and pre-elite athletes [ 16 ]. Similarly, reporting only circulating leukocyte counts after laboratory exercise does not provide an adequate assessment of the “immune response” to exercise with LEA [ 75 ]; researchers are directed to the methodological recommendations of the Exercise Immunology Society [ 132 , 134 ].

Prominent risk factors for infection in elite athletes and military personnel are similar to the general population and include wintertime (i.e., common cold and flu season) [ 135 , 136 ] and foreign travel [ 136 ], when exposure to pathogens increases, alongside factors that influence neuro-endocrine-immune interactions including stress, anxiety and depression [ 131 ], high training load [ 137 ] and poor sleep [ 138 , 139 ]. Psychological stress, poor sleep, and heavy exertion influence immune function via the shared effector limbs of the sympathetic-adrenal axis and pituitary-adrenal axis and the resulting immunoregulatory hormones, such as cortisol (Fig.  2 ) [ 140 ]. It stands to reason that the emotional experience evoked by different situations (i.e., overloaded versus coping, aversive versus pleasant) influences immunity and illness incidence in elite athletes during heavy training and major competition. Indeed, subjective stress and anxiety have been shown to modify the immune response to exercise [ 141 ]. Given the shared pathways for the body’s response to various psychological and physical challenges [ 142 ], it is not at all surprising that studies reporting greater recall of illness symptoms in female athletes with LEA (LEAF-Q score ≥ 8) show considerable interdependence of various illness risk factors [ 56 , 131 ]. For example, anxiety, stress, depression and overall recovery state explained 74% of the variance in illness symptom episodes in one study [ 56 ] and the odds ratio (OR) for illness was stronger for depression (OR = 8.4) than LEA (OR = 7.4) in another [ 131 ].

The general adaptation syndrome (GAS) ( A ), allostatic load model ( B ), and the pathway ( C ) that connects various stressors with symptoms and pathology. Effective coping to any stressful situation depends on the person’s cognitive appraisal of the stressful event (perceived stress), and the subsequent type of behavioral coping strategy used [ 167 ]. The GAS model ( A ) described how a stress response causes function (represented by the blue line) to decrease initially (phase 1). Adaptation occurs and this helps to resist the continued stress (phase 2). After a while this cannot be sustained anymore and exhaustion occurs (phase 3). The GAS model also explained the role of common neuroendocrine pathways for various challenges (sympathetic nervous systems and HPA axis) ( C ). The GAS model was further developed into the allostatic model ( B ) [ 169 , 171 ]. Allostasis is a response to challenges whereby the setpoint will change. The most well studied allostatic responses to a range of challenges involve the sympathetic nervous systems and HPA axis ( C ). Activation of these systems, independent of the source of stress, releases catecholamines from nerve endings and adrenal medulla and leads to corticotropin secretion from the pituitary gland. Corticotropin, in turn, will stimulate the release of cortisol from the adrenal cortex and this will exert its effect through binding to glucocorticoid receptors in various target tissues, which can be up or downregulated. This is a fast and effective response. If this response is not immediately turned off, over time this increases the “allostatic load.” Allostatic load or eventually overload will affect many body systems causing wear and tear [ 169 , 171 ].

Four situations are associated with allostatic load (panels B1–4; the red line represents problematic responses and the green line normal responses). The first and most obvious is frequently repeated stress (B1). A second situation would be inadequate adaptation to repeated stressors of the same type (B2). This can also result in prolonged exposure to stress hormones. The third would be a situation where there is an inability to shut off the stress response after termination of the stress (B3). An example of this is exercise training that induces allostatic load in the form of elevated sympathetic and HPA-axis activity, which may result in weight loss, amenorrhea, and even AN [ 182 ]. In the fourth type of allostatic load, there could be an inadequate response by one system and this could trigger a compensatory increase in another (B4). For example, if cortisol secretion fails to increase in response to stress, secretion of inflammatory cytokines (which are counter-regulated by cortisol) increases [ 183 ]. A range of challenges that an athlete faces (training load, competition stress, poor nutrition, poor sleep) can increase allostatic load, which can trigger a range of symptoms and clinical conditions

Nutrient availability influences immunity because macro- and micronutrients are involved in a multitude of immune processes; macronutrients are involved in immune cell metabolism and protein synthesis (e.g., production of immunoglobulins, cytokines, and acute-phase proteins) and micronutrients in antioxidant defenses (for review see [ 129 ]). So long as the diet is made up of a diverse variety of foods, ensuring no nutrient deficiency, dietary energy restriction typically elicits a healthy phenotype reducing the incidence of diabetes, cancer and cardiovascular disease and extending the lifespan [ 143 , 144 , 145 ]. Studies on LEA in recreational and military populations show only subtle and short-lived changes in immune markers, and no changes in the immune-modulating hormone cortisol, after short-term severe energy restriction (48 h, ~ 90% restriction) [ 146 , 147 ] and long-term moderate energy restriction during training (8 weeks, ~ 25% restriction) [ 148 ]. Although severe dietary carbohydrate restriction (< 10% dietary intake as carbohydrate) is associated with an exaggerated cortisol response to exercise [ 75 , 149 , 150 ], LEA appears to have a limited effect on circulating cortisol in athletes [ 151 ]. This finding is in keeping with a meta-analysis showing that circulating cortisol increases in states of complete fasting but not typically during less severe energy restriction [ 152 ].

Protein deficiency is widely considered responsible for the clinical features of immune suppression in severely advanced Kwashiokor and starvation [ 153 ], supported by protein-energy malnutrition research in animals [ 154 ] and the observation that immunity is typically well-preserved in patients with AN is likely because protein intake is adequate (carbohydrate and fat are typically reduced) [ 129 , 155 ]. In female endurance athletes with an LEA determination [body mass index (BMI) 18.9 kg/m 2 ] protein intake appears to be more than adequate to support immunity, typically exceeding government (0.8–0.9 g/kg/day) and endurance athlete specific recommendations (1.2–1.7 g/kg/day) [ 46 , 156 ]. Paradoxically, AN is considered to afford protection against infection, that is until the condition becomes extremely severe (BMI < 15 kg/m 2 ) when cross-sectional studies report evidence of decreased cellular immunity [ 157 , 158 , 159 ]. Moreover, hospitalized patients with AN suffer infections readily during rapid refeeding protocols [ 160 , 161 ]. As food restriction and exercise are considered anxiolytic in AN, with as many as 83% of patients reporting a history of anxiety disorders [ 162 ], eliminating these anxiolytic behaviors in hospitalized patients with AN undergoing rapid refeeding likely accounts for the clinical levels of psychological stress, depression and anxiety, and decreased immunity [ 163 ]; indeed, psychological stress is widely accepted to increase susceptibility to infection [ 164 ].

In summary, direct evidence supporting the notion that LEA in female athletes causes “immunological dysfunction” is currently lacking. Athlete immune health should be considered in a broad conceptual framework that encompasses mental health (e.g., anxiety, stress and depression), sleep, recovery status, and nutrition [ 56 , 142 ].

2.5 Conclusion on the Strength of Evidence for the REDs Model

REDs was proposed in 2014 as a model to explain the effects of LEA; over the years it has expanded from being the cause of ten problem areas [ 3 , 28 ] to now 14 categories of symptoms [ 4 ]. Of the many symptoms in the REDs model (Fig.  1 ), those discussed above are amongst the most researched. It is clear though, that even in these more researched areas, there are still many unanswered questions, in particular about the causal links between LEA and these symptoms or clinical manifestations. The evidence for the remaining symptoms (the symptoms not discussed here) is even less convincing, which is to be expected, given the fact that the model is nascent and performing longitudinal studies is time consuming, complex, and likely expensive. Perhaps this is also why in the latest consensus statement there is mention of theoretical, empirical and clinical evidence to support the model. We should focus on the clinical evidence, but this evidence is limited and, in some areas, not available. Nevertheless, diagnostic tools, based upon symptoms are being developed and used. A recent review listed as many as eleven different diagnostic tools to identify LEA or risk of REDs [ 53 ]. In the next section we will discuss alternative explanations for these symptoms as well as reasons why it is unlikely that a single factor can fully and independently explain the symptoms described as REDs.

3 Alternative Explanations for REDs Symptoms in Athletes

As acknowledged in the recent REDs consensus statement, there are alternative explanations for the symptoms described by the REDs model [ 4 ]. The statement also mentions differential diagnoses for the first time and these are discussed in more detail in a supporting paper [ 52 ]. There are other causes of the same symptoms that need to be excluded before we can draw conclusions about the relative importance of LEA. It is highly likely that in almost all situations the causes are multifactorial, especially because the pathways for neuroendocrine responses to challenges an athlete faces (exercise load, competition, sleep disruption, travel, etc.) are shared via the HPA axis. This was first recognized in 1936 in a letter by Selye to the editor of Nature [ 165 ] and in 1950 when Selye [ 166 ] published a paper on the general adaptation syndrome (GAS) model (Fig.  2 A). According to Lazarus and Folkman’s [ 167 ] model of stress and coping, effective coping to any stressful situation, depends upon the person's cognitive appraisal of the stressful event, and the subsequent type of behavioral coping strategy used. Sterling and Eyer built on the idea of the GAS model and introduced the paradigm “allostasis” in 1988 [ 168 ]. This was further developed by McEwen in subsequent years [ 169 , 170 , 171 , 172 ]. The allostatic model described how one, or many different stressors combined, can result in an increase in allostatic load. Over time this causes “wear and tear” on one or many systems in the body, emerging as a disease state if left unchecked. The parallels between the disease states in the allostasis literature and the multitude of REDs symptoms are apparent [ 169 , 170 , 171 , 172 ].

In sport science, everyone is familiar with the term homeostasis (originally described by Claude Bernard as “milieu interieur”) [ 173 ]. No one argues with the idea that maintaining homeostasis is critical to optimizing good health. Body temperature, serum glucose concentration, serum sodium concentration and blood pH are a few examples of variables that are controlled within a very narrow physiological range and if this control fails for some reason, there will be severe health (even fatal) consequences.

Allostasis is another type of process that is critical to survival [ 168 ]; but perhaps not so well known to most sport scientists and certainly largely ignored in the sport science literature. Allostasis means “achieving stability through change”. Allostasis is a response to a change from outside (or inside) the body, but a fundamental difference with homeostasis is that allostasis is not trying to restore parameters to their “setpoint,” instead, the setpoint will change. The most well studied allostatic responses involve the HPA axis (Fig.  2 C). If there are many frequent challenges, if the stress response is not immediately turned off, if responsivity of the stress is affected or if alternative pathways are activated (Fig.  2 B), this increases the “allostatic load” over time. Over weeks, months, or years, exposure to increased secretion of stress hormones, such as cortisol (from whatever source of stress), can result in allostatic load [ 174 ] and its pathophysiologic consequences (Fig.  2 ). The damage and pathology of various body systems is often described as “wear and tear” [ 169 , 171 ]. For example, past or current depressive illness is associated with lower BMD in women likely because the allostatic load of chronic, moderately elevated serum cortisol concentrations inhibits bone formation [ 175 ].

Because the mechanisms operate through the autonomic nervous system and the HPA axis that control most systems in the body, it is not surprising that most body systems are affected. An increase in allostatic load can affect the immune system, the gut, fatigue, and performance, reproductive function, bone health, sleep, neurocognitive performance, energy metabolism, glucose and fat metabolism, incontinence and more [ 169 , 171 ] (see Fig.  3 ).

Common symptoms and clinical conditions in athletes that are similar to REDs may be caused by many factors independent of—or in combination with—LEA. Eight categories of factors that can contribute to these symptoms are shown (in no order preference). In many situations several factors, potentially from several categories, may play a role in the development of REDs symptoms in athletes. Many different types of challenges can independently or in combination increase allostatic load and over time this can cause wear and tear on the body and ultimately result in symptoms and pathology. The common pathways are the HPA axis and central nervous system (CNS). The brain plays a central role and psychiatric disorders, trauma, and abuse, as well as major life events, play an important role by modifying neuro-endocrine reactivity to stress. Life/environmental factors that can cause stress related to relationships, competition or self-image, to name just a few. There are also many important behavioral factors, most notably for athletes, including their training, their nutrition and sleep. Lingering infections can also affect allostatic load, but could also have direct effects on a number of symptoms. This is the case for several other factors as well; for example, iron deficiencies or other nutritional deficiencies can have direct effects, causing REDs symptoms

3.1 Applying the Allostatic Load Model to Athletes

In the 1990s, work on the overtraining syndrome (OTS) was published, the majority as reviews [ 176 , 177 , 178 , 179 ]. Excessive training was linked to a wide range of symptoms [ 179 ], similar to the symptoms of REDs [ 3 , 48 ]. Many of them are generic symptoms [ 180 ]. In other fields of research, such as “stress” and “sleep,” many similar links with similar clinical outcomes and symptoms are reported [ 8 , 169 , 170 , 171 , 172 , 181 ]. The overlap between REDs, overtraining, stress, and sleep has not gone unnoticed and Stellingwerff et al. [ 180 ] concluded that many of the previous training studies did not control for energy intake and perhaps the reported symptoms were the result of LEA and not overtraining [ 180 ]. This conclusion, however, would seem biased towards LEA being the cause of all symptoms and that all factors are just moderators of this effect. It could also be interpreted as, in these multi-stressor situations, the accumulated stress (i.e., allostatic load) causes pathology over time because of the wear and tear it produces. LEA could be one of these stressors. Perhaps in studies that mention LEA and REDs, the effects of very high training volumes, poor sleep, or other stressors were underestimated?

Very few studies have applied the allostatic model to exercise but in the general stress literature there are many studies that provide support for the various aspects of this model [ 171 , 184 , 185 , 186 , 187 , 188 ]. Figure  3 conceptualizes how we apply the allostasis model to athletes. The figure demonstrates that multiple causes (on the left side of the figure), likely in combination, can affect many body systems and cause a range of symptoms. It also visualizes the many factors that can act independently or in combination to cause such symptoms with common pathways being the HPA-axis and CNS. In real life it will be virtually impossible to untangle the effects of LEA from a wide range of other causes with similar outcomes (symptoms).

Athletes are exposed to specific challenges (stressors related to their sport) as well as common stressors that anyone would experience. Examples are captured in Fig.  3 under the name environmental stress. Examples of specific challenges for an athlete would include: exercise (training) most days of the week, sometimes several times a day; manipulation of their body mass or composition through under-fueling or avoiding carbohydrate. Athletes may feel pressures from social media to look a certain way and this may cause body dissatisfaction and anxiety [ 45 ]. Athletes will often feel pressure to perform, have to manage relationships with their coach, fellow athletes and sponsors. Athletes may also train at altitude or in extremely hot conditions.

Many athletes are perfectionists, achievers, highly competitive and have high expectations. Studies have shown that an athlete’s personality characteristics (e.g., tendency for perfectionism, high trait anxiety) influence their response to cumulative life stressors, predicting long-term negative health outcomes [ 189 ]. Chronic stress is associated with exaggerated neuroendocrine responses to acute psychological stressors (Fig.  3 ) [ 190 ] and recent life stress influences the immune response to exercise [ 141 ]. Another important consideration is early life adversity (ELA), which is more common in elite athletes than the general population and even considered a precursor for success in super-elite athletes [ 191 , 192 ]. Individuals with ELA experience exaggerated emotional and neuroendocrine-immune reactivity to daily life challenges and are more susceptible to the long-term wear and tear associated with high allostatic load [ 193 , 194 ]. The signature left by ELA increases vulnerability to immune dysregulation, inflammation, and long-term health consequences in adulthood; including, depression [ 195 ], generalized anxiety disorder [ 196 ], eating disorders [ 197 ], and poor sleep [ 198 ].

Athletes who are characterized by a combination of high athletic identity, perfectionistic concerns and negative life stress and poor coach-athlete relationship, were shown to be significantly more often affected by overuse injuries (74% of the time) [ 199 ]. It was noted that psychological factors may contribute to the risk of overuse injuries through complex interactions rather than through their independent influences [ 200 ]. In addition to specific stressors, athletes are also exposed to common life stressors that everyone else is exposed to, like relationship issues, financial or family issues, a lingering infection, an injury, tooth problems or having an unbalanced diet with nutrient deficiencies.

Individuals cope with various challenges in different ways (partly as a result of resilience) and it is the perceived stress in particular that appears to be a deciding factor in determining the allostatic load and potential consequences [ 201 ]. To some degree how someone deals with these stressors may be genetic, but experience and personal development can also help to modify the perceived stress [ 169 , 170 ]. All stressors will activate the autonomic nervous system and/or the HPA axis and can influence metabolic, immune and cardiovascular responses. Each of these factors individually may not be very significant or impactful, but together these stressors can have synergistic effects that will add up over time (weeks, months or years) to increase allostatic load [ 171 , 172 , 202 ]. It is impossible, and from a practical point of view a futile exercise, to isolate a single stressor, as it is the accumulated stressors that determine the allostatic load. Please note that energy intake is listed under nutrition and energy expenditure under exercise as possible stressors; together these makeup energy availability. Exercise can cause a range of physiological responses (increases in stress hormones, cytokines, inflammation, activation of the HPA axis, increased core temperature, and so on), which may contribute positively or negatively to allostatic load. Exercise is not just a form of energy expenditure. Indeed, allostasis also comes with an energetic cost [ 203 ].

3.2 AHaRC (Athlete Health and Readiness Checklist)

The listed symptoms of REDs are generic and can have many different causes. The symptoms described as “REDs symptoms” could also be described as symptoms that are common in sport and even outside of sport, not all of them and possibly few are caused by LEA. The new IOC consensus statement recognizes the fact that there could be other causes of the symptoms too, stating: “each of these outcomes can occur in the absence of LEA, therefore the differential diagnosis should be considered in the assessment and diagnosis of REDs severity and/or risk” [ 4 ]. Therein, an extensive list of such differential diagnoses is provided alongside a long list of common generic/common symptoms that athletes may display. The list, however, is perhaps too large for practical purposes and does not even cover all possible diagnoses, the tools for these differential diagnoses are not always clear (for example, how do you diagnose overtraining syndrome?) and the suggested approach [ 4 ] does not acknowledge allostatic overload. And most importantly the starting point of the proposed approach [ 4 ] is biased: “it is LEA, unless it is not.”

Herein we would like to broaden the viewpoint to better support athlete health. We identified eight categories of factors that could alone or in combination with each other cause a host of clinical manifestations and symptoms that overlap greatly with those described as REDs symptoms. In the search for the most important cause(s) and appropriate treatment, it is important to consider all eight of these categories; although we recognize that some aspects will be more practical and easier to check than others and are, therefore, more likely to be checked regularly. Categories are not independent and many links between them exist. In most cases it may not be possible to identify a single cause but a checklist will help to identify all areas that could help towards treating the causes of the symptoms or prevent additional clinical issues (Fig.  4 ).

Training/exercise: training-related stress (e.g., training load, training intensity, monotony etc.) [ 204 , 205 , 206 ].

Life/environmental: non-training related stress (e.g., family stress, competition stress, stressors related to performance goals and expectations, relationship with a coach, sponsors, travel, time zones, climates, media, social media, body image, societal pressure, etc.) [ 207 ]. These stressors can add up and accumulate over time and increase allostatic load.

Mental health: this includes psychiatric conditions such as depression and anxiety disorders [ 208 ]. This also includes recent or current life stress, major life events and early life adversity. Mental health has been recognized as a cause and consequence of LEA [ 209 ].

Disordered eating and eating disorders: although there is obvious overlap with mental health issues above (e.g., anorexia nervosa is a psychiatric condition) we list it here separately also because disordered eating which may not be diagnosed as a clinical disorder, may still have long lasting consequences and usually precedes an eating disorder [ 208 , 210 ]. Disordered eating may result in nutrition deficits which are listed separately under point 5.

Nutrition: low energy intake is one of these possible deficits, but carbohydrate availability and adequate protein intake are important as well; micronutrient deficiencies (e.g., iron, zinc, magnesium, calcium, B vitamins, and vitamin D) could also play a role [ 211 ].

Sleep: poor sleep and clinical sleep disorders may cause a wide range of symptoms. Long-term consequences of sleep disruption in otherwise healthy individuals include (but not limited to) hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, reproductive function, depression, and anxiety and immune dysfunction [ 212 , 213 ].

Infectious etiology: ongoing fatigue and recurrent illness symptoms may have an infectious etiology (e.g., related to herpes viruses, Epstein Barr, long covid etc. [ 214 , 215 , 216 ].

Undiagnosed clinical conditions: including, for example, thyroid problems, diabetes, cardiac problems, and malignant disease [ 214 , 215 , 217 ].

Athlete Health and Readiness Checklist (AHaRC) providing a multidimensional decision tree to maintain athletes’ health and performance. The AHaRC will act as a guide for practitioners working with athletes, to implement regular checks, identifying possible tools and the most relevant professionals to consult. There are eight categories (no order of preference), all important to check. Some need frequent checks (daily or weekly) others more periodically (suggested frequency: D = daily, W = weekly, M = monthly, AH = ad hoc, OI = on indication). The list here is not exhaustive but should be a good starting point for those responsible for athlete health. For each component in the checklist, the recommended tools and possible actions are supported by expert/consensus recommendations. Profile of mood states (POMS); recovery stress questionnaire for athletes (RESTQ-S), and daily analyses of life demands of athletes (DALDA). (1) Training/exercise [ 204 , 205 , 206 ], (2) life/environmental [ 207 ], (3) mental health [ 208 ], (4) disordered eating/eating disorders [ 208 , 210 ], (5) nutrition [ 211 ], (6) sleep [ 213 ], (7) infection/illness [ 216 ], and (8) undiagnosed clinical condition [ 214 , 217 ]

3.3 Does REDs Differ from Disordered Eating?

It is often stated that the symptoms listed under REDs can occur with or without a clinically diagnosed eating disorder. But can it also occur without disordered eating? Papers regularly refer to accidental, unintentional, or inadvertent LEA [ 4 , 24 ]. In such cases athletes are not aware that they are not consuming enough energy for their activity levels. However, what are the chances that this “accidental” energy deficit is chronic and not just in periods where they may train harder, are too busy etc.? We have not been able to find any evidence that connects problematic LEA with accidental undereating. This would imply that hunger feelings must not be adequately regulated.

In any case, eating disorders (ED) [ 218 ] or disordered eating (DE) [ 219 ] are a highly prevalent problem in this population at risk for LEA, making it difficult to untangle the physiological effects of LEA from the psycho-physiological effects of DE/ED in cross-sectional studies. For example, a cross-sectional study evaluating risk of eating disorders in conjunction with field-assessed energy availability in 121 collegiate athletes reported that 81% ( n  = 98) had “LEA” (a prevalence likely inflated by the methodological issues highlighted earlier), and 76% ( n  = 92) displayed LEA with an eating disorder risk [ 220 ]. Another study evaluating long-term markers of LEA and DE/ED in 464 adolescent (13–18 years) female athletes, reported that only 6.5% ( n  = 30) showed markers of chronic LEA (low BMD), and 24 of these (5.2% of total) did not meet the criteria for ED/DE [ 221 ]. Importantly, of the 426 individuals assessed 40% reported with desire to lose weight (7%), disordered eating (31%), or an eating disorder (2%) [ 221 ]. In summary, current evidence is limited to support the idea that inadvertent under-fuelling is rife, or that problematic (and thus chronic) LEA can occur in the absence of disordered eating.

3.4 Practical Aspects

We have identified several reasons why it would be premature to use REDs as a diagnosis or even as a model. Many parts remain relatively untested, there is no way to distinguish adaptable and problematic LEA apart from waiting for the symptoms to develop. The model in general is too calorie-centric and the name and definition of the model only acknowledge one cause. Models are by definition a simplification of reality. But when is a model oversimplified and less useful, and when is it simple, not entirely correct, but useful? In line with a famous quote from British statistician George Box: “all models are wrong, some are useful,” one could argue, that even if the REDs model is an oversimplification, it could still be useful. Perhaps the greatest value of the REDs model is that it is extremely simple, and it may help athletes understand that obsession with body mass and composition and continued LEA may be unhealthy. The REDs model may, therefore, seem a useful education tool. However, it remains an oversimplification and athletes should be educated equally on the other aspects of health and performance (e.g., related to sleep, recovery, mental health). The question is therefore: Is it a useful education tool that will help athletes to be less obsessed with body mass and eat more according to recommendations? We are not aware of evidence that would support this notion, but this is certainly a research question that needs attention, i.e., Does REDs education using the model help to prevent symptoms of REDs?

The counterargument would be that the model is less helpful, it will over-diagnose individuals and it will distract from the complexities of the multifactorial etiology (Fig.  3 ). The 2019 IOC consensus on Athlete’s mental health states that reframing an eating disorder and calling it something else (e.g., REDs) may reduce stigma [ 208 ]. A major risk is that a diagnosis of REDs might prevent appropriate treatment for some individuals. If athletes are diagnosed with REDs, often by minimally qualified individuals, they may therefore not accept the treatment that is required (e.g., seeing a clinical psychiatrist in the case of an athlete with an eating disorder).

Tackling LEA could help in many cases but assuming that symptoms are always caused by an inadequate energy intake for the amount of exercise, may close the door to, or at least distract from exploring other reasons why these same symptoms may develop. In the analogy we used previously where overfeeding sugar in combination with a positive energy balance will result in weight gain, tackling just sugar intake may or may not have a positive outcome. An approach that explores all potential causes and gives them equal thought, without a bias towards sugar, would likely result in more effective treatment. Besides this, in athletes who are supported well by qualified practitioners, they will already receive the advice to fuel appropriately.

If LEA is the single cause of REDs symptoms, treatment should be easy (increase energy intake, decrease energy expenditure). In reality, however, there are many underlying dietary and psychological factors that determine eating behavior, and these are in most cases the main etiology, not just “calories” as the definition of LEA dictates.

4 Overall Conclusion

REDs is a relatively new model and many aspects of the model have not been thoroughly tested. The title of this critical analysis is “Does Relative Energy Deficiency in Sport (REDs) Syndrome exist?” We may never get to the answer to the question does REDs exist. The main limitation of the REDs model is in the name and definition. The REDs model, as it is often presented, places energy availability at the center and it is becoming more and more obvious that this is an oversimplification of causation of a very complex and multifaceted symptomatology. One may argue that a differential diagnosis should be performed to confirm that calories are the cause. But by doing this, a bias is already present. We would welcome a discussion about a change from REDs to a broader more holistic athlete health approach and we encourage the scientific community to not hold on to terminology at all cost, but be open minded and adapt to make the model more accurate and more useful.

The research in this area is complex and everyone who has performed studies in this area should be commended for attempting to untangle some of these complexities. We encourage research in this area, to gain a better understanding of the etiology of the symptoms that athletes present.

Future studies will need to demonstrate causal links between LEA and all symptoms of REDs, they must be large scale, carefully controlled studies, longitudinal in nature (month and years, not days or weeks) with all important variables like nutrition intake and training load, energy expenditure, but also all other potential stressors in an athlete’s life, illnesses, infections etc. carefully monitored. These studies would need to be performed in free living athletes where numerous aspects of their lives need to be controlled whilst maintaining ecological validity. To study causality EA would need to be manipulated. However, studying “problematic” LEA may not only be time consuming, complex, and costly, but also unethical. We will encourage funding bodies to support such work, but at the same time we hope that time and effort will be spent on developing pragmatic approaches that will help practitioners in the field to consider all aspects of mental and physical health of an athlete, as well as performance.

Regardless, there is an urgent question from the field, where athletes suffer from various symptoms (similar to those presented by the REDs model). The causes of these symptoms are unknown, but could also be nutrition related. We propose a more holistic approach and a checklist (AHaRC) that assesses eight areas. In each of these eight areas we make use of tools that have been proposed in previous consensus statements or expert opinion pieces. The factors in these eight areas could all result in symptoms that could be mistaken for symptoms of LEA (REDs symptoms). As mentioned before, the new consensus statement is in agreement with this but we argue that REDs tools are primarily trying to prove that it is LEA instead of trying to find potential causes of the symptoms. It is, therefore, important to check all potential causes and have individuals with relevant expertise and qualifications to assess or triage the various components. As part of this larger assessment, nutrition and exercise/training patterns should be considered as a contributing cause, and as part of nutrition and exercise effects, energy or LEA should be considered. We are not dismissing the importance of energy availability at all; however, rather than having a calorie-centric approach where “LEA is the cause,” we are advocates of a more holistic, less biased approach that considers LEA as one of many possible causes, recognizing that it is also possible that accumulation of effects of various potential causes can result in negative side effects. From a practical point of view there is little or no need to identify LEA as a single cause. It is much more important to identify the origin of the presented symptoms.

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Jeukendrup, A.E., Areta, J.L., Van Genechten, L. et al. Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?. Sports Med (2024). https://doi.org/10.1007/s40279-024-02108-y

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• Excellent written and verbal communication skills; interpersonal and collaborative skills; and the ability to communicate IT security and IT Security risk-related concepts to technical and nontechnical audiences.

The pay range for this position at commencement of employment is expected to be between $151,200 and $226,800 per year; however, while salary ranges are effective from 1/1/24 through 12/31/24, fluctuations in the job market may necessitate adjustments to pay ranges during this period. Further, final pay determinations will depend on various factors, including, but not limited to geographical location, experience level, knowledge, skills and abilities. The total compensation package for this position may also include other elements, including a sign-on bonus, restricted stock units, and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered. Details of participation in these benefit plans will be provided if an employee receives an offer of employment. If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Why Novartis: Our purpose is to reimagine medicine to improve and extend people’s lives and our vision is to become the most valued and trusted medicines company in the world. How can we achieve this? With our people. It is our associates that drive us each day to reach our ambitions. Be a part of this mission and join us! Learn more here: https://www.novartis.com/about/strategy/people-and-culture You’ll Receive : You can find everything you need to know about our benefits and rewards in the Novartis Life Handbook. https://www.novartis.com/careers/benefits-rewards Commitment to Diversity & Inclusion: Novartis is committed to building an outstanding, inclusive work environment and diverse teams representative of the patients and communities we serve. Join our Novartis Network : If this role is not suitable to your experience or career goals but you wish to stay connected to hear more about Novartis and our career opportunities, join the Novartis Network here: https://talentnetwork.novartis.com/network

Why Novartis: Helping people with disease and their families takes more than innovative science. It takes a community of smart, passionate people like you. Collaborating, supporting and inspiring each other. Combining to achieve breakthroughs that change patients’ lives. Ready to create a brighter future together? https://www.novartis.com/about/strategy/people-and-culture

Join our Novartis Network: Not the right Novartis role for you? Sign up to our talent community to stay connected and learn about suitable career opportunities as soon as they come up: https://talentnetwork.novartis.com/network

Benefits and Rewards: Read our handbook to learn about all the ways we’ll help you thrive personally and professionally: https://www.novartis.com/careers/benefits-rewards