Awareness and indicators of low energy availability in male and female dancers
Authors: Keay Nicola , Overseas AusDancers , Francis Gavin 
Published: June 2020

Objectives

To investigate awareness and indicators of low energy availability (LEA) in male and female dancers

Methods

A dance-specific energy availability questionnaire (DEAQ) was developed and administered online internationally to dancers in full time training. 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 psychological drivers and aetiological factors specific to dance training. LEA was quantified using a scoring system to include these characteristics.

Results

247 responses to the DEAQ were analysed (225 female and 22 male), mean age 20.7 years (SD 7.9) with transition to full time training at 15.0 years (SD 7.9) and 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 a third (29%) of dancers were aware of RED-S.

Conclusion

This study found dancers to be a specific group of high-level exercisers 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.

Summary boxes

What are the new findings?

Dancers reported many recognised indicators of low energy availability (LEA) and consequently are at risk of developing the adverse health and performance outcomes of relative energy deficiency in sport (RED-S).

Few dancers in this study demonstrated an awareness of RED-S.

The unique nature of dance training, in terms of demands and environment, was found to be influential in the development of LEA in dancers

The DEAQ is the first questionnaire specific to dancers. Applying a scoring system to the responses from the DEAQ can provide an objective assessment of LEA

How might this study impact on clinical practice in the future?

As LEA and subsequent risk of RED-S is not matched by awareness, providing educational resources for dancers is important. A British Association of Sport and Exercise Medicine website has been developed by the research team for both athletes and dancers www.health4performance.co.uk

The DEAQ has the potential to be a practical, objective, screening tool to identify male and female dancers worldwide in LEA. By identifying these dancers, support could be targeted to modify dancer behaviours to reduce the risk of dancers developing the adverse health and performance sequelae of RED-S

Early identification of dancers at risk of developing RED-S is of particular importance when situations arise out of dancers’ control, such as lock down in pandemics COVID-19 or time off dancing due to illness/injury. Targeted support may be required as a dancer’s tendencies towards exercise dependence and disordered eating patterns may increase as a way to seek control and combat uncertainty.