Clinical application of interactive monitoring of indicators of health in professional dancers (Preprint)

2021 ◽  
Author(s):  
Nicola Keay ◽  
Martin Lanfear ◽  
Gavin Francis
Keyword(s):  
At Risk ◽  
Early Identification ◽  
Hormonal Contraception ◽  
Well Being ◽  
Relative Energy ◽  
Low Risk ◽  
Energy Availability ◽  
Health Questionnaire ◽  
Blood Testing ◽  
Energy Deficiency

BACKGROUND Dancers can be at risk of developing intentional and/or unintentional relative energy deficiency in sport (RED-S). Early identification of those at risk is important in prevention. OBJECTIVE The purpose of this study was to assess the effectiveness of interactive monitoring of professional dancer health with a variety of subjective and objective monitoring methods and delivering swift personalised clinical advice. METHODS Dancers from a ballet company completed a published, online dance-specific health questionnaire. Over the study period, dancers recorded wellbeing and training metrics, with menstrual cycle tracking and capillary blood testing for the recognised indicators of low energy availability. At regular, virtual clinical discussions with each dancer, findings were discussed and personalised advice given. RESULTS Twenty dancers participated in the study (mean age 26.2 years, SD 3.7), comprising 14 females (mean age 25.5 years, SD 3.7) and 6 males (mean age 27.7 years, SD 2.4). Ten of the female and all the male dancers recorded positive scores on the dance health questionnaire, suggesting a low risk of relative energy deficiency in sport (RED-S). Two female dancers were taking hormonal contraception. Apart from one, all female dancers not on hormonal contraception reported current eumenorrhoeic status. Blood testing confirmed the low risk of insufficient energy availability across the group, apart from female dancers with negative questionnaire scores. The initiative of monitoring menstrual cycles and on demand virtual clinical support was well received by dancers, healthcare and artistic staff. CONCLUSIONS Multimodal monitoring facilitated delivery of prompt personalised clinical medical feedback specific for dance. This interactive strategy permitted the early identification and swift management of emergent clinical issues. Dancers highly rated the new monitoring modalities and opportunity to discuss health and well-being, in confidence, with a doctor conversant in dance.

scholarly journals Clinical application of interactive monitoring of indicators of health in professional dancers

2021 ◽  
Author(s):  
Nicola Keay ◽  
Martin Lanfear ◽  
Gavin Francis
Keyword(s):  
Hormonal Contraception ◽  
Well Being ◽  
Relative Energy ◽  
Low Risk ◽  
Energy Availability ◽  
Health Questionnaire ◽  
Monitoring Methods ◽  
Blood Testing ◽  
Energy Deficiency ◽  
Professional Dancer

Abstract Objectives The purpose of this study was to assess the effectiveness of interactive monitoring of professional dancer health with a variety of subjective and objective monitoring methods and delivering swift personalised clinical advice. Methods Dancers from a ballet company completed a published, online dance-specific health questionnaire. Over the study period, dancers recorded wellbeing and training metrics, with menstrual cycle tracking and capillary blood testing for the recognised indicators of low energy availability. At regular, virtual clinical discussions with each dancer, findings were discussed and personalised advice given. Results Twenty dancers participated in the study (mean age 26.2 years, SD 3.7), comprising 14 females (mean age 25.5 years, SD 3.7) and 6 males (mean age 27.7 years, SD 2.4). Ten of the female and all the male dancers recorded positive scores on the dance health questionnaire, suggesting a low risk of relative energy deficiency in sport (RED-S). Two female dancers were taking hormonal contraception. Apart from one, all female dancers not on hormonal contraception reported current eumenorrhoeic status. Blood testing confirmed the low risk of insufficient energy availability across the group, apart from female dancers with negative questionnaire scores. The initiative of monitoring menstrual cycles and on demand virtual clinical support was well received by dancers, healthcare and artistic staff. Conclusions Multimodal monitoring facilitated delivery of prompt personalised clinical medical feedback specific for dance. This interactive strategy permitted the early identification and swift management of emergent clinical issues. Dancers highly rated the new monitoring modalities and opportunity to discuss health and well-being, in confidence, with a doctor conversant in dance.

scholarly journals Risk of Low Energy Availability in National and International Level Paralympic Athletes: An Exploratory Investigation

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 979
Author(s):  
Kelly Pritchett ◽  
Alicia DiFolco ◽  
Savannah Glasgow ◽  
Robert Pritchett ◽  
Katy Williams ◽  
...  
Keyword(s):  
At Risk ◽  
National Level ◽  
Relative Energy ◽  
Low Energy ◽  
Assessment Tools ◽  
Energy Availability ◽  
Mineral Density ◽  
Menstrual Dysfunction ◽  
Energy Deficiency ◽  
Low Energy Availability

(1) Background: The purpose of this study was to examine the symptoms of low energy availability (LEA) and risk of relative energy deficiency in sport (RED-S) symptoms in para-athletes using a multi-parameter approach. (2) Methods: National level para-athletes (n = 9 males, n = 9 females) completed 7-day food and activity logs to quantify energy availability (EA), the LEA in Females Questionnaire (LEAF-Q), dual energy X-ray absorptiometry (DXA) scans to assess bone mineral density (BMD), and hormonal blood spot testing. (3) Results: Based on EA calculations, no athlete was at risk for LEA (females < 30 kcal·kg−1 FFM·day−1; and males < 25 kcal·kg−1 FFM·day−1; thresholds for able-bodied (AB) subjects). Overall, 78% of females were “at risk” for LEA using the LEAF-Q, and 67% reported birth control use, with three of these participants reporting menstrual dysfunction. BMD was clinically low in the hip (<−2 z-score) for 56% of female and 25% of male athletes (4) Conclusions: Based on calculated EA, the risk for RED-S appears to be low, but hormonal outcomes suggest that RED-S risk is high in this para-athlete population. This considerable discrepancy in various EA and RED-S assessment tools suggests the need for further investigation to determine the true prevalence of RED-S in para-athlete populations.

scholarly journals Female football specific energy availability questionnaire and menstrual cycle hormone monitoring

2021 ◽  
Author(s):  
Nicola Keay ◽  
Eddie Craghill ◽  
Gavin Francis
Keyword(s):  
Menstrual Cycle ◽  
Female Athletes ◽  
Previous History ◽  
Relative Energy ◽  
Training Load ◽  
Low Risk ◽  
Energy Availability ◽  
Clinical Tool ◽  
Variable Flow ◽  
Energy Deficiency

Abstract Objectives The purpose of this study was to assess the energy availability status of professional female football players with an online Female Football Energy Availability Questionnaire (FFEAQ), combined with the clinical tool to model menstrual cycle hormones using artificial intelligence (AI) techniques. Methods The Female Football Energy Availability (FFEAQ) was developed based on published questionnaires, with a weighted scoring system to assess risk of Relative Energy Deficiency in Sport (RED-S). For menstrual cycle hormones AI techniques modelled hormone variation over a cycle, using the results from capillary blood samples taken at two time points. Results 21 female footballers of professional club level participated in this study, with mean age 22 years [range 16 to 30]. 20 athletes recorded positive scores on the FFEAQ, suggesting a low risk of Relative Energy Deficiency in Sport (RED-S). No players had experienced primary amenorrhoea. 5 athletes reported previous history of secondary amenorrhoea. Amongst the 15 players not taking hormonal contraception, 2 reported current oligomenorrhoea. The application of AI techniques to model menstrual cycle hormones found that in 1 of the 3 players, subclinical hormone disruption was occurring with this player reporting variable flow of menstruation. Although the other 2 players showed expected menstrual hormone variation, 1 player reported variable flow according to training load, suggestive of subclinical anovulation. At the time of testing training load was low due to pandemic lock down. Conclusions The professional female football athletes in this study were found to be at low risk of RED-S from the FFEAQ. Modelling menstrual cycle hormones using AI techniques indicated that this has the potential to be an effective clinical tool in identifying subtle hormone dysfunction such as subclinical anovulatory cycles in female athletes.

scholarly journals Low Energy Availability in Athletes 2020: An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 835 ◽  
Author(s):  
Danielle M. Logue ◽  
Sharon M. Madigan ◽  
Anna Melin ◽  
Eamonn Delahunt ◽  
Mirjam Heinen ◽  
...  
Keyword(s):  
At Risk ◽  
Relative Energy ◽  
Narrative Review ◽  
Low Energy ◽  
Screening Tools ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Exercise Energy Expenditure ◽  
And Gender ◽  
Low Energy Availability

Low energy availability (EA) underpins the female and male athlete triad and relative energy deficiency in sport (RED-S). The condition arises when insufficient calories are consumed to support exercise energy expenditure, resulting in compromised physiological processes, such as menstrual irregularities in active females. The health concerns associated with longstanding low EA include menstrual/libido, gastrointestinal and cardiovascular dysfunction and compromised bone health, all of which can contribute to impaired sporting performance. This narrative review provides an update of our previous review on the prevalence and risk of low EA, within-day energy deficiency, and the potential impact of low EA on performance. The methods to assess EA remain a challenge and contribute to the methodological difficulties in identifying “true” low EA. Screening female athletic groups using a validated screening tool such as the Low Energy Availability in Females Questionnaire (LEAF-Q) has shown promise in identifying endurance athletes at risk of low EA. Knowledge of RED-S and its potential implications for performance is low among coaches and athletes alike. Development of sport and gender-specific screening tools to identify adolescent and senior athletes in different sports at risk of RED-S is warranted. Education initiatives are required to raise awareness among coaches and athletes of the importance of appropriate dietary strategies to ensure that sufficient calories are consumed to support training.

scholarly journals Indicators and correlates of low energy availability in male and female dancers

2020 ◽  
Vol 6 (1) ◽  
pp. e000906
Author(s):  
Nicola Keay ◽  
AusDancers Overseas ◽  
Gavin Francis
Keyword(s):  
At Risk ◽  
Relative Energy ◽  
Low Energy ◽  
Energy Availability ◽  
Male And Female ◽  
Energy Deficiency ◽  
Physiological Indicators ◽  
Dance Training ◽  
High Level ◽  
Low Energy Availability

ObjectivesTo investigate indicators and correlates of low energy availability (LEA) in male and female dancers.MethodsA Dance-Specific Energy Availability Questionnaire (DEAQ) was developed and administered online internationally to dancers training at preprofessional, professional or advanced amateur level. The DEAQ drew on current validated, published questionnaires for LEA, linked to the clinical outcomes of relative energy deficiency in sport (RED-S). Questions addressed recognised physiological indicators and consequences of LEA in the context of dance, together with potential correlates. LEA was quantified using a scoring system to include these characteristics.Results247 responses to the DEAQ were analysed (225 female and 22 male), mean age 20.7 years (SD 7.9) with 85% practising ballet. Psychological, physiological and physical characteristics consistent with LEA were reported by 57% of the female dancers and 29% of male dancers, indicating a risk of RED-S. The unique nature of dance training, in terms of demands and environment, was found to be potentially influential in development of this situation. Less than one-third (29%) of dancers were aware of RED-S.ConclusionThis study found dancers to be a specific group of high-level artistic performers displaying indicators of LEA and consequently at risk of developing the adverse clinical health and performance consequences of RED-S. Awareness of RED-S was low. The DEAQ has the potential to raise awareness and be a practical, objective screening tool to identify dancers in LEA, at risk of developing RED-S.

scholarly journals The LEAF questionnaire is a good screening tool for the identification of the Female Athlete Triad/Relative Energy Deficiency in Sport among young football players

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12118
Author(s):  
Edyta Łuszczki ◽  
Pawel Jagielski ◽  
Anna Bartosiewicz ◽  
Maciej Kuchciak ◽  
Katarzyna Dereń ◽  
...  
Keyword(s):  
At Risk ◽  
Body Composition ◽  
Energy Intake ◽  
Female Athlete ◽  
Relative Energy ◽  
Screening Tools ◽  
Football Players ◽  
Female Athlete Triad ◽  
Energy Deficiency ◽  
Not At Risk

Background It has been noticed that Female Athlete Triad (Fat) and Relative Energy Deficiency (Red-S) in Sport are characterized by the symptoms of impaired endocrine-metabolic function and bone health in female athletes. In addition, it may be evaluated with a qualitative tool, such as Low Energy Availability in Females questionnaire (LEAF-Q) and quantitative measurements: bone mineral density (BMD), resting energy expenditure (REE), body composition, 24-hour dietary recall. Methods The aim of this study was to assess the prevalence of Triad and Red-S using the LEAF-Q in youth female football players. Additionally, the difference in the BMD, body composition, REE and energy intake (EI) were assessed between the Triad/Red-S risk and not at-risk groups. Results Almost two thirds (64.7%) of participants are classified as being at-risk for the triad according to their LEAF-Q scores. There were no statistically significant differences (p > 0.05) between most of the values among children from the analyzed groups. There was a statistically significant difference (p < 0.001) between the EI values among girls from the two analyzed groups: at-risk (1,773.18 kcal ±  232.57) and not at-risk (2,054.00 kcal ±  191.39). Girls who did not meet the energy intake recommendations were 10.00 as likely to be in the Triad/Red-S risk group. Conclusion Early identification of Fat/Red-S symptoms by screening tools such as the LEAF questionnaire is important in protecting young athletes from long-term damage due to the progression of the risk factors associated with the Fat/Red-S.

Low energy availability surrogates correlate with health and performance consequences of Relative Energy Deficiency in Sport

2018 ◽  
Vol 53 (10) ◽  
pp. 628-633 ◽  
Author(s):  
Kathryn E Ackerman ◽  
Bryan Holtzman ◽  
Katherine M Cooper ◽  
Erin F Flynn ◽  
Georgie Bruinvels ◽  
...  
Keyword(s):  
Female Athletes ◽  
Relative Energy ◽  
Low Energy ◽  
Clinical Population ◽  
Energy Availability ◽  
Energy Deficiency ◽  
Increased Risk ◽  
Performance Consequences ◽  
And Performance ◽  
Low Energy Availability

Low energy availability (EA) is suspected to be the underlying cause of both the Female Athlete Triad and the more recently defined syndrome, Relative Energy Deficiency in Sport (RED-S). The International Olympic Committee (IOC) defined RED-S as a syndrome of health and performance impairments resulting from an energy deficit. While the importance of adequate EA is generally accepted, few studies have attempted to understand whether low EA is associated with the health and performance consequences posited by the IOC.ObjectiveThe purpose of this cross-sectional study was to examine the association of low EA with RED-S health and performance consequences in a large clinical population of female athletes.MethodsOne thousand female athletes (15–30 years) completed an online questionnaire and were classified as having low or adequate EA. The associations between low EA and the health and performance factors listed in the RED-S models were evaluated using chi-squared test and the odds ratios were evaluated using binomial logistic regression (p<0.05).ResultsAthletes with low EA were more likely to be classified as having increased risk of menstrual dysfunction, poor bone health, metabolic issues, haematological detriments, psychological disorders, cardiovascular impairment and gastrointestinal dysfunction than those with adequate EA. Performance variables associated with low EA included decreased training response, impaired judgement, decreased coordination, decreased concentration, irritability, depression and decreased endurance performance.ConclusionThese findings demonstrate that low EA measured using self-report questionnaires is strongly associated with many health and performance consequences proposed by the RED-S models.

Pitfalls of Conducting and Interpreting Estimates of Energy Availability in Free-Living Athletes

2018 ◽  
Vol 28 (4) ◽  
pp. 350-363 ◽  
Author(s):  
Louise M. Burke ◽  
Bronwen Lundy ◽  
Ida L. Fahrenholtz ◽  
Anna K. Melin
Keyword(s):  
Energy Intake ◽  
Good Health ◽  
Relative Energy ◽  
Fat Free Mass ◽  
Energy Availability ◽  
Response Patterns ◽  
Male Athletes ◽  
Energy Deficiency ◽  
Definition Of ◽  
Residual Errors

The human body requires energy for numerous functions including, growth, thermogenesis, reproduction, cellular maintenance, and movement. In sports nutrition, energy availability (EA) is defined as the energy available to support these basic physiological functions and good health once the energy cost of exercise is deducted from energy intake (EI), relative to an athlete’s fat-free mass (FFM). Low EA provides a unifying theory to link numerous disorders seen in both female and male athletes, described by the syndrome Relative Energy Deficiency in Sport, and related to restricted energy intake, excessive exercise or a combination of both. These outcomes are incurred in different dose–response patterns relative to the reduction in EA below a “healthy” level of ∼45 kcal·kg FFM−1·day−1. Although EA estimates are being used to guide and monitor athletic practices, as well as support a diagnosis of Relative Energy Deficiency in Sport, problems associated with the measurement and interpretation of EA in the field should be explored. These include the lack of a universal protocol for the calculation of EA, the resources needed to achieve estimates of each of the components of the equation, and the residual errors in these estimates. The lack of a clear definition of the value for EA that is considered “low” reflects problems around its measurement, as well as differences between individuals and individual components of “normal”/“healthy” function. Finally, further investigation of nutrition and exercise behavior including within- and between-day energy spread and dietary characteristics is warranted since it may directly contribute to low EA or its secondary problems.

2 The prevalence of musculoskeletal injuries, menstrual irregularity and disordered eating in junior elite athletics in the UK

2021 ◽  
Vol 55 (16) ◽  
pp. 940.2-941
Author(s):  
J Wilkinson ◽  
L Mayhew
Keyword(s):  
Disordered Eating ◽  
Sports Medicine ◽  
Injury Risk ◽  
Relative Energy ◽  
Track And Field ◽  
Energy Availability ◽  
Female Athlete Triad ◽  
Menstrual Dysfunction ◽  
Energy Deficiency ◽  
The Uk

The prevalence of injury in adolescent elite track and field competitors is high,1 however only one study has been conducted with UK athletes.2 Relative Energy Deficiency in Sport (RED-S), encapsulating the Female Athlete Triad, is a syndrome whereby decreased energy availability affects health and performance, potentially leading to an increased injury risk; particularly to bone (3). Calculating decreased energy availability is difficult, however identifying contributing factors, such as disordered eating and menstrual dysfunction, is more viable.3AimThis study was conducted to identify the prevalence of musculoskeletal injury, disordered eating and menstrual dysfunction in elite junior UK track and field athletes.MethodData was collected from track and field athletes ranked within the top 10 of the UK U17 rankings in 2017 or 2018, with 138 athletes participating. Participants completed a self-reported musculoskeletal injury, disordered eating and menstrual dysfunction questionnaire relating to a 12-month time period.ResultsThis study found a 12-month retrospective injury prevalence of 43.5%. 13% of participants presented with disordered eating, whilst 37.7% of female participants presented with menstrual dysfunction. There was a statistically significant difference in injury prevalence according to gender, with more male athletes sustaining an injury compared with female athletes. No differences in injury prevalence were noted according to event group, menstrual dysfunction or disordered eating. The anatomical location displaying the highest prevalence of injury was the ankle and foot (22.5%). The anatomical structure displaying the highest 12-month injury prevalence was muscle (43.6%), followed by bone (30.9%). Additionally, 21.7% of respondents reported having previously sustained a stress fracture prior to taking part in this study.ConclusionThere is a high prevalence of injuries in junior UK track and field athletes, with most injuries affecting the lower limb. Although there was no difference noted in injury risk for athletes with menstrual dysfunction or disordered eating, the prevalence of bone injuries was alarmingly high. This study indicates the requirement for future research investigating RED-S within this population.ReferenceZemper, E. Track andField Injuries. In: Caine DJ, Maffulli N. (eds). Epidemiology of Pediatric Sports Injuries. Individual Sports. Med Sport Science: Volume 48. Basel, Karger; 2005. p. 138–151D’Souza D. Track and field athletics injuries - a one-year survey. British Journal of Sports Medicine 1994; 28 (3): 197–202.Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). British Journal of Sports Medicine 2014; 48: 491–497.

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