Relative Energy Deficiency in Sport and Dance

June 24, 2024 updated by: Matthew Wyon, University of Wolverhampton

Prevalence of Relative Energy Deficiency in Sport and Dance

The International Olympic Committee recently published its consensus statement on relative energy deficiency syndrome (REDs) in sport which was followed by a similar version for dance by clinicians and researchers in dance. REDs is a complex multisystem syndrome with low energy availability as its foundation. Dancers and gymnasts, particularly in ballet, have long been reported to have body weight issues with an increase prevalence of eating disorders which has been associated with early onset osteoporosis. Combat sports have a similar issue, with athletes needing to "make weight" to compete in their ideal weight category that has lead to similar eating disorder and associated issues to dance. Currently there are no data on REDs prevalence in dance, gymnastics or combat sports and therefore understanding the underlying prevalence of REDs in both these populations will provide important information for both clinicians and coaches to help develop a safe and healthy environment for their dancers and athletes to compete/perform and to be able to retire from sport/dance without an increased risk of osteoporosis. In a few sports and dance genres, some participants might be more prone to a negative health effect referred to as relative energy deficiency syndrome (REDs). This is an energy deficiency relative to the balance between dietary energy intake and energy availability required to support homeostasis, health and activities of daily living, growth and sporting activities that can result in multiple systems being affected including decreases in bone health, energy metabolism, reproductive function, musculoskeletal health, immunity, glycogen synthesis and cardiovascular and haematological health. The purpose of this study is to examine the prevalence of REDs in specific sports (combat sports and gymnastics) and dance genres (ballet and musical theatre). Voluntary participants will be tested three times a year over a 5-year period. This will include an annual dual-energy x-ray absorptiometry and blood tests plus resting energy expenditure and questionnaires three times a year.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Participants will be asked to be available three times for testing over a 12-month period, for a period of 3-years. Their initial test visit will be at a university exercise science laboratory whilst the other testing sessions will occur at their place of work/training.

Each year the initial testing session will include a bone health scan (DXA), a blood sample (2x 5ml samples), a body composition analysis (bioimpedance), resting metabolic rate test and a series of questionnaires. Subsequent test session will include the same tests except the DXA scan unless there is a medical reason to carry out a further scan (two or more bone stress injuries).

The DXA scan, where participants will need to lie still for approximately 20 minutes will monitor body composition, bone mineral density and bone mineral content for the whole body and at the forearm (radius), lower spine (Lumbar 4 and 5) and upper leg (femur). The scan will also look at the ratio between outer (cortical) and inner (trabecular) bone content.

The blood samples will measure a series of markers that have been associated with low energy availability for male and female participants and amenorrhea for female participants.

Anthropometric measurements will consist of body composition analysis will consist of a body composition, stature and body mass. The participant will have their height measured and then stand on bioimpedance scales and hold onto two handles. This will allow changes in body composition changes to be monitored throughout the year without exposing the participant to further radiation from the DXA.

To monitor resting metabolic rate participants will lie down on a bed in a quiet room. They will be fitted with a mask over the mouth and nose that is connected to a breathe-by-breathe gas analyser. They will lie as still as possible for 20-minutes for the test to conclude.

The validated questionnaires (Low Energy Availability Male Questionnaire, Low Energy Availability Female Questionnaire, Health questionnaire) will focus on sleep quality, general health, attitudes towards food and eating, perceptions of energy availability, and mood.

Basic injury incidence data will be provided by the participant's medical team through out the monitoring period. Injury data will consist of location, type and severity of each injury.

Participants' injury incidence and aetiology will be monitored by their club's/company's medical teams and summarised data provided to the research team via a signed medical release agreement. REDs prevalence will be analysed by the research team in conjunction with the participants' medical teams and for those diagnosed with the syndrome the relevant management plan will be put into place for their safe return to activity.

Study Type

Observational

Enrollment (Estimated)

200

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United Kingdom
    • West Midlands
      • Walsall, West Midlands, United Kingdom, WS1 3BD
        • University of Wolverhampton
        • Contact:
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

Dancers: ballet, contemporary dance and musical theatre Combat sports: judo, karate, taekwondo Gymnastics: artistic

Description

Inclusion Criteria:

  • Full-time training at either a NGB centre, dance company, vocational dance school or academy
  • Engaged in full-time training at start of project

Exclusion Criteria

  • Not engaged in full-time training
  • Injury preventing engagement in training

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Dance
Age: 16-45yrs old Sex: Female and male Activity: Dance (ballet, contemporary, musical theatre); Level: Full-time training at either a dance company, vocational dance school Status: Engaged in full-time training at start of project without activity limiting injury
Radiation: Dual x-ray scan
Annual whole body scan monitoring bone mineral density for whole body, radius, L1-4 and femur and body composition
Diagnostic test: Blood screen
Three times a year blood samples will be taken to measure: full blood count, ferritin, B12, folate, erythrocyte sedimentation rate (ESR), renal function, liver function, thyroid stimulating hormone (TSH), Free thyroxine (T4), luteinizing hormone (LH), oestradiol, testosterone, follicle-stimulating hormone (FSH), coeliac screen, vitamin D (25(OH)D), Leptin and Ghrelin
Other: Questionnaires
Informed consent; Low energy availability questionnaires for males and females; General health including menstrual status (females)
Other Names:
  • Low Energy Availability Male Questionnaire, Low Energy Availability Female Questionnaire; Consent; Health
Other: Anthropometric measurements
Three times a year participant's measurements will be taken: stature, body mass and body composition (bio-impedence)
Procedure: Resting Metabolic rate
Resting metabolic rate will be measured by resting gas analysis. Each participant will lie down for a period of 15 minutes, in the final 5 minutes their expired gases are analysed using a breath-by-breath gas analyser (Cortex).
Combat Sports
Age: 16-45yrs old Sex: Female and male Activity: Combat sports (judo, karaté, taekwondo); Level: Full-time training at either a NGB centre Status: Engaged in full-time training at start of project without activity limiting injury
Radiation: Dual x-ray scan
Annual whole body scan monitoring bone mineral density for whole body, radius, L1-4 and femur and body composition
Diagnostic test: Blood screen
Three times a year blood samples will be taken to measure: full blood count, ferritin, B12, folate, erythrocyte sedimentation rate (ESR), renal function, liver function, thyroid stimulating hormone (TSH), Free thyroxine (T4), luteinizing hormone (LH), oestradiol, testosterone, follicle-stimulating hormone (FSH), coeliac screen, vitamin D (25(OH)D), Leptin and Ghrelin
Other: Questionnaires
Informed consent; Low energy availability questionnaires for males and females; General health including menstrual status (females)
Other Names:
  • Low Energy Availability Male Questionnaire, Low Energy Availability Female Questionnaire; Consent; Health
Other: Anthropometric measurements
Three times a year participant's measurements will be taken: stature, body mass and body composition (bio-impedence)
Procedure: Resting Metabolic rate
Resting metabolic rate will be measured by resting gas analysis. Each participant will lie down for a period of 15 minutes, in the final 5 minutes their expired gases are analysed using a breath-by-breath gas analyser (Cortex).
Other: Energy expenditure
Energy expenditure was estimated using accelerometery (Genieactive) and activity logs in the participants' normal environment, assessed during 3 weekdays of scheduled dance training and 2 weekend days without scheduled dance training. Focus is on daily energy expenditure
Gymnastics
Age: 16-45yrs old Sex: Female and male Activity: Gymnastics (artistic) Level: Full-time training at either a NGB centre or academy Status: Engaged in full-time training at start of project without activity limiting injury
Radiation: Dual x-ray scan
Annual whole body scan monitoring bone mineral density for whole body, radius, L1-4 and femur and body composition
Diagnostic test: Blood screen
Three times a year blood samples will be taken to measure: full blood count, ferritin, B12, folate, erythrocyte sedimentation rate (ESR), renal function, liver function, thyroid stimulating hormone (TSH), Free thyroxine (T4), luteinizing hormone (LH), oestradiol, testosterone, follicle-stimulating hormone (FSH), coeliac screen, vitamin D (25(OH)D), Leptin and Ghrelin
Other: Questionnaires
Informed consent; Low energy availability questionnaires for males and females; General health including menstrual status (females)
Other Names:
  • Low Energy Availability Male Questionnaire, Low Energy Availability Female Questionnaire; Consent; Health
Other: Anthropometric measurements
Three times a year participant's measurements will be taken: stature, body mass and body composition (bio-impedence)
Procedure: Resting Metabolic rate
Resting metabolic rate will be measured by resting gas analysis. Each participant will lie down for a period of 15 minutes, in the final 5 minutes their expired gases are analysed using a breath-by-breath gas analyser (Cortex).
Other: Energy expenditure
Energy expenditure was estimated using accelerometery (Genieactive) and activity logs in the participants' normal environment, assessed during 3 weekdays of scheduled dance training and 2 weekend days without scheduled dance training. Focus is on daily energy expenditure

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Relative energy deficiency (REDs)
Time Frame: Throughout study; an average of 3 times a year
Prevalence of REDs in cohorts by diagnosis by elimination by medical team.
Throughout study; an average of 3 times a year

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Bone stress injuries
Time Frame: Number of participants with bone stress injuries. Throughout study an average of 3 times a year
Reported bone stress injuries by the inhouse medical teams
Number of participants with bone stress injuries. Throughout study an average of 3 times a year
Primary Amenorrhea (females)
Time Frame: Number of participants with primary and secondary amenorrhea. Throughout study an average of 3 times a year
Loss of menses for at least 6 months
Number of participants with primary and secondary amenorrhea. Throughout study an average of 3 times a year
Resting Metabolic rate
Time Frame: Throughout study; an average of 3 times a year
Actual resting metabolic rate/estimated metabolic rate below 0.9
Throughout study; an average of 3 times a year
Monitoring of all blood markers for below normal values (red flags)
Time Frame: Throughout study; an average of 3 times a year
Blood markers: full blood count, ferritin, B12, folate, erythrocyte sedimentation rate (ESR), renal function, liver function, thyroid stimulating hormone (TSH), Free thyroxine (T4), luteinizing hormone (LH), oestradiol, testosterone, follicle-stimulating hormone (FSH), coeliac screen, vitamin D (25(OH)D), Leptin and Ghrelin
Throughout study; an average of 3 times a year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Wolverhampton

Investigators

  • Study Chair: Roger Wolman, PhD, Honorary Professor

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

September 10, 2024

Primary Completion (Estimated)

July 30, 2029

Study Completion (Estimated)

July 30, 2029

Study Registration Dates

First Submitted

June 10, 2024

First Submitted That Met QC Criteria

June 24, 2024

First Posted (Actual)

June 28, 2024

Study Record Updates

Last Update Posted (Actual)

June 28, 2024

Last Update Submitted That Met QC Criteria

June 24, 2024

Last Verified

June 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REDsWyon24

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

All anonymised data will be shared via figshare

IPD Sharing Time Frame

Protocol and statistical analysis plan will be available pre data collection Data will be available at point of publication

IPD Sharing Access Criteria

All data will be made available in line with Open Science protocols

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL

Study Data/Documents

  1. Individual Participant Data Set
    Information identifier: RED-D
    Information comments: All anonymised data will be published on figshare
  2. Study Protocol
    Information identifier: RED-D
    Information comments: Study protocol will be published on figshare

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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