Clinical application of interactive monitoring of indicators of health in professional dancers
Authors: Keay Nicola , Lanfear Martin , Francis Gavin 
Published: September 2021

AbstractObjectivesThe 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.MethodsDancers 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.ResultsTwenty 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.ConclusionsMultimodal 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.Summary boxesWhat are the new findings?Monitoring professional dancers with a variety of interactive methods: dance specific questionnaire; online tracking of menstrual cycle for female dancers; wellbeing and training load; blood testing and personal online meetings - facilitates comprehensive, personalised support for dancer health.Overall, the dancer participants were healthy both physically and mentally. This was demonstrated by the positive scores derived from the dancer health questionnaire. The healthy status of the majority of the dancers was confirmed with online health tracking and objective blood test results.All results were discussed individually with dancers remotely and where any issues were found from questionnaires, online health tracking or blood tests, timely appropriate tailored recommendations were made.Although not the original design, the timing of the study during the COVID-19 pandemic provided insights into the impact of this unprecedented time on dancers. The study showed that easy virtual access to clinical medical support was helpful.Dancers and healthcare staff highly rated this initiative of multimodal, personalised monitoring and access to rapid virtual clinical discussion.How might this study impact on clinical practice in the future?Proactive, interactive monitoring of dancer health and wellbeing facilitates personalised, preventative support. It is far better to be proactive in preventing future illness or injury than to deal with issues after they have happened.Personalised medical input is important for optimising health and performance and prevention, not just for outcomes injury or illness.The dancer health questionnaire could be used for all new dancers entering a dance school or company, to identify any areas where individual dancers might benefit more specific input. For example, to identify any early warning signs of low energy availability in both male and female dancers. In all cases, the objective would be to offer prompt targeted support. The health questionnaire could then be completed annually to act as a monitoring system.Comprehensive online monitoring of wellbeing, training load and menstrual cycle for female dancers, is a valuable clinical tool for dancers. Combined with access to individual virtual discussion, this provision is highly rated by dancers and healthcare staff.Regular blood testing for dancers provides objective measures of health. This allows early identification of any deficiencies or dysfunction and facilitates prompt advice on appropriate practical measures. This testing can also act as an objective monitoring tool for individual dancers which could be combined with artificial intelligence techniques further personalisation.Open access for all dancers to discuss clinical issues with virtual discussions to facilitate ease of access at short notice and on return to performing and touring, which is highly valued by dancers.Provision of educational information about relative energy deficiency in sport (RED-S) such as British Association Sport and Exercise Medicine website www.health4performance.co.uk can help the dance community be aware of low energy availability