Relative Energy Deficiency in Sport and Dance

NCT06480682 | Not Yet Recruiting

• 1 other identifier: REDsWyon24
• Study Type: observational
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Relative Energy Deficiency in Sport; Bone Stress Reaction

Keywords

Judo; Ballet; Gymnastics; Male; Female; Dance; weight category sport

Outcome Measures

Primary Outcomes (1)

• Relative energy deficiency (REDs)

  Prevalence of REDs in cohorts by diagnosis by elimination by medical team.

  Throughout study; an average of 3 times a year

Secondary Outcomes (4)

• Bone stress injuries

  Number of participants with bone stress injuries. Throughout study an average of 3 times a year

• Primary Amenorrhea (females)

  Number of participants with primary and secondary amenorrhea. Throughout study an average of 3 times a year

• Resting Metabolic rate

  Throughout study; an average of 3 times a year

• Monitoring of all blood markers for below normal values (red flags)

  Throughout study; an average of 3 times a year

Study Arms (3)

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; Diagnostic Test: Blood screen; Other: Questionnaires; Other: Anthropometric measurements; Procedure: Resting Metabolic rate

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; Diagnostic Test: Blood screen; Other: Questionnaires; Other: Anthropometric measurements; Procedure: Resting Metabolic rate; Other: 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; Diagnostic Test: Blood screen; Other: Questionnaires; Other: Anthropometric measurements; Procedure: Resting Metabolic rate; Other: Energy expenditure

Interventions

Dual x-ray scan RADIATION

Annual whole body scan monitoring bone mineral density for whole body, radius, L1-4 and femur and body composition

Combat Sports; Dance; Gymnastics

Blood screen DIAGNOSTIC_TEST

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

Combat Sports; Dance; Gymnastics

Questionnaires OTHER

Informed consent; Low energy availability questionnaires for males and females; General health including menstrual status (females)

Also known as: Low Energy Availability Male Questionnaire, Low Energy Availability Female Questionnaire; Consent; Health

Combat Sports; Dance; Gymnastics

Anthropometric measurements OTHER

Three times a year participant's measurements will be taken: stature, body mass and body composition (bio-impedence)

Combat Sports; Dance; Gymnastics

Resting Metabolic rate PROCEDURE

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; Dance; Gymnastics

Energy expenditure OTHER

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

Combat Sports; Gymnastics

Eligibility Criteria

• Age: 16 Years - 45 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)
• Sampling Method: Non-Probability Sample

Study Population

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

You may qualify if:

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

You may not qualify if:

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

Sponsors & Collaborators

• University of Wolverhampton: lead

Study Sites (1)

University of Wolverhampton

Walsall, West Midlands, WS1 3BD, United Kingdom

Location

Related Publications (6)

• Koltun KJ, Strock NCA, Southmayd EA, Oneglia AP, Williams NI, De Souza MJ. Comparison of Female Athlete Triad Coalition and RED-S risk assessment tools. J Sports Sci. 2019 Nov;37(21):2433-2442. doi: 10.1080/02640414.2019.1640551. Epub 2019 Jul 11.

  PMID: 31296115 BACKGROUND

• Sim A, Burns SF. Review: questionnaires as measures for low energy availability (LEA) and relative energy deficiency in sport (RED-S) in athletes. J Eat Disord. 2021 Mar 31;9(1):41. doi: 10.1186/s40337-021-00396-7.

  PMID: 33789771 BACKGROUND

• Allen N, Kelly S, Lanfear M, Reynolds A, Clarke R, Mountjoy ML, Wyon M, Wolman R. Relative energy deficiency in dance (RED-D): a consensus method approach to REDs in dance. BMJ Open Sport Exerc Med. 2024 Mar 7;10(1):e001858. doi: 10.1136/bmjsem-2023-001858. eCollection 2024.

  PMID: 38463191 RESULT

• Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, Heikura IA, Melin A, Pensgaard AM, Stellingwerff T, Sundgot-Borgen JK, Torstveit MK, Jacobsen AU, Verhagen E, Budgett R, Engebretsen L, Erdener U. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023 Sep;57(17):1073-1097. doi: 10.1136/bjsports-2023-106994.

  PMID: 37752011 RESULT

• Civil R, Lamb A, Loosmore D, Ross L, Livingstone K, Strachan F, Dick JR, Stevenson EJ, Brown MA, Witard OC. Assessment of Dietary Intake, Energy Status, and Factors Associated With RED-S in Vocational Female Ballet Students. Front Nutr. 2019 Jan 9;5:136. doi: 10.3389/fnut.2018.00136. eCollection 2018.

  PMID: 30687712 RESULT

• Staal S, Sjodin A, Fahrenholtz I, Bonnesen K, Melin AK. Low RMRratio as a Surrogate Marker for Energy Deficiency, the Choice of Predictive Equation Vital for Correctly Identifying Male and Female Ballet Dancers at Risk. Int J Sport Nutr Exerc Metab. 2018 Jul 1;28(4):412-418. doi: 10.1123/ijsnem.2017-0327. Epub 2018 Jun 22.

  PMID: 29405782 RESULT

MeSH Terms

Conditions

Relative Energy Deficiency in Sport; Fractures, Stress

Interventions

Absorptiometry, Photon; Surveys and Questionnaires; Consent Forms; Health; Basal Metabolism; Energy Metabolism

Condition Hierarchy (Ancestors)

Feeding and Eating Disorders; Mental Disorders; Fractures, Bone; Wounds and Injuries

Intervention Hierarchy (Ancestors)

Radiography; Diagnostic Imaging; Diagnostic Techniques and Procedures; Diagnosis; Densitometry; Photometry; Chemistry Techniques, Analytical; Investigative Techniques; Data Collection; Epidemiologic Methods; Health Care Evaluation Mechanisms; Quality of Health Care; Health Care Quality, Access, and Evaluation; Public Health; Environment and Public Health; Informed Consent; Jurisprudence; Social Control, Formal; Health Care Economics and Organizations; Records; Organization and Administration; Health Services Administration; Population Characteristics; Metabolism

Study Officials

• Roger Wolman, PhD

  Honorary Professor

  STUDY CHAIR

Central Study Contacts

Matthew A Wyon, PhD

CONTACT

01902323144; m.wyon@wlv.ac.uk

Ross Cloak, PhD

CONTACT

01902321285; r.cloak@wlv.ac.uk

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor in Exercise Physiology

Study Record Dates

• First Submitted: June 10, 2024
• First Posted: June 28, 2024
• Study Start: September 10, 2024
• Primary Completion (Estimated): July 30, 2029
• Study Completion (Estimated): July 30, 2029
• Last Updated: June 28, 2024

Record last verified: 2024-06

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL
• Time Frame: Protocol and statistical analysis plan will be available pre data collection Data will be available at point of publication
• Access Criteria: All data will be made available in line with Open Science protocols

Locations

GB (1)