Resting energy expenditure in professional dancers as an objective measure of low energy expenditure
Wyon, Matthew Allen, Nick Brown-Appenzeller, Derrick Cloak, Ross Devonport, Tracey Gregory, Kim Penner, Joanne Hassan-Smith, Zaki Webster, Rachel Wolman, Roger
Wyon, Matthew
Allen, Nick
Brown-Appenzeller, Derrick
Cloak, Ross
Devonport, Tracey
Gregory, Kim
Penner, Joanne
Hassan-Smith, Zaki
Webster, Rachel
Wolman, Roger
Abstract
Objective: To investigate the prevalence of low resting energy expenditure (REE) in ballet dancers and to examine its association with low energy availability (LEA) questionnaires and physiological parameters, including menstrual function and body composition.
Methods: Participants were screened two times during a dance season. Measurements included direct REE (REEm) via gas analysis, body composition, bone health, menstrual status and LEA questionnaires. REEm was compared against eight predictive equations (REEp). Metabolic suppression was defined as an REEm/REEp ratio <0.90.
Results: 47 professional classical ballet dancers (female: n=27, age 24±5.21 years, body mass index (BMI) 18.8±1.67; male: n=20, age 25±4.27 years, BMI 23.1±1.59) volunteered. A high prevalence of suppressed REE was identified, affecting 37.5% of females and 46% of males. No single predictive equation was superior; using multiple equations improved the identification of at-risk dancers. In females, low REE was strongly associated with menstrual irregularity and a significantly later menarche. In males, low REE was linked to lower body fat%. Crucially, low REE was not reliably predicted by low body mass or BMI. Instead, the ratio of kcal/FFM kg/day was a more sensitive discriminator between low and normal REE groups in both sexes. Dancers with low REE also demonstrated less favourable bone health profiles.
Conclusion: Metabolic suppression indicative of LEA is widespread in elite dancers and is not discernible by body mass alone. Clinical screening should incorporate direct metabolic measurement, assessment of menstrual status and evaluation of body composition to effectively identify dancers at risk of the long-term health consequences of relative energy deficiency in dance.
MIDER Authors
Date
2026-04-02
Type
Article
Subject
Dancing, Bone density, Menstruation, Sports, Dancing
Collections
Citation
Wyon M, Allen N, Brown-Appenzeller D, Cloak R, Devonport T, Gregory K, Penner J, Hassan-Smith Z, Webster R, Wolman R. Resting energy expenditure in professional dancers as an objective measure of low energy expenditure. BMJ Open Sport Exerc Med. 2026 Apr 2;12(2):e003216. doi: 10.1136/bmjsem-2026-003216.
Journal / Source Title
BMJ Open Sport & Exercise Medicine
DOI
10.1136/bmjsem-2026-003216
PMID
41948421
Publisher
BMJ Publishing Group
Publisher’s URL
https://bmjopensem.bmj.com/