Women in Performing Arts

Hormones, Health and Performance Across the Female Lifespan


Overview

This workshop introduces performing artists, teachers, coaches and companies to the hormonal and

physiological changes women experience across their careers — from adolescence through the reproductive

years, pregnancy, and into perimenopause and menopause — and how these changes intersect with training,

rehearsal and performance. It draws on physiotherapy, sports medicine and performing-arts-specific research

to give participants practical, body-literate tools rather than generic wellness advice.


Rationale

Performing artists — dancers, circus artists, actors and musicians — train and perform on a schedule that

rarely allows for the periodisation or off-season recovery built into competitive sport. Hormonal fluctuation

across the menstrual cycle, reproductive health conditions such as RED-S and PMOS, pregnancy, and the

menopause transition all affect strength, flexibility, injury risk, mood, cognition and stamina — yet this

knowledge is rarely part of standard training education. Despite growing awareness in elite sport, performing

arts institutions still largely lack structured education on this topic, leaving artists, teachers and companies to

navigate these changes without shared language or support.


Target Audience

• Circus, dance and other performing arts students and pre-professionals

• Professional performers and freelance artists

• Artistic and pedagogical staff: coaches, teachers, rehearsal/artistic directors

• Company management, health and wellbeing staff


Learning Objectives

By the end of the workshop, participants will be able to:

• Describe the phases of the menstrual cycle and documented effects of hormones on strength, flexibility,

injury risk, metabolism, body composition and temperature regulation

• Recognise signs of Relative Energy Deficiency in Sport (RED-S), hypothalamic amenorrhea and

Polyendocrine Metabolic Ovarian Syndrome (PMOS/PCOS), and know appropriate referral pathways

• Identify how pregnancy and the postnatal period affect training capacity, and adapt technique and

workload accordingly

• Understand perimenopause and menopause symptoms (vasomotor, musculoskeletal, cognitive,

psychological) and their specific impact on performance health

• Compare the demands of performing arts against those of competitive sport, and apply that distinction

to training and career planning


Format & Duration

Suggested format: Half-day workshop (3 hours)

Delivery: Lecture-style presentation with slides, interspersed with facilitated discussion, case examples

Also available as: A single 90-minute introductory talk, or a modular series delivered across several

sessions


Content Outline

Module 1 — The Menstrual Cycle and Performance (45 min)

• Hormonal phases: follicular, ovulatory, luteal — oestrogen, progesterone, LH, FSH

• How hormones interplay with other internal and external factors and affects: strength, flexibility, injury

probability, metabolism, body composition, temperature regulation

• Practical implications for scheduling training load, rehearsal intensity and technique focus


Module 2 — When the Cycle Signals a Problem (45 min)

• Relative Energy Deficiency in Sport (RED-S) and Health for Performance principles

• Functional hypothalamic amenorrhea: causes, health consequences (bone, cardiovascular, mental

health) and root-cause treatment

• Polyendocrine Metabolic Ovarian Syndrome (PMOS/PCOS): prevalence, diagnostic criteria

(Rotterdam), and why performing artists are an under-recognised risk group

• The Personal Energy Availability Questionnaire (PEAQ) as a self-screening tool


Module 3 — Pregnancy and the Return to Performance (30 min)

• Trimester-by-trimester physical and physiological changes relevant to training

• Adapting technique, apparatus work and choreography across pregnancy

• Postnatal return-to-performance: realistic timelines and common pitfalls


Module 4 — Perimenopause and Menopause (45 min)

• Defining perimenopause, menopause, premature and early menopause

• Vasomotor, musculoskeletal, cognitive and psychological symptoms — and their specific

manifestations for performers

• Menopausal hormone therapy (MHT/HRT): current consensus on safety and effectiveness

• The physical–psychological feedback loop: identity, confidence and stigma in performance careers


Module 5 — Performing Arts Is a Sport but has Different Rules (20–30 min)

• Performance cycle vs. competition cycle; consistency vs. peak performance

• Training load without an off-season; audience perception vs. athlete recognition

• Discussion: what performing arts can borrow from sports medicine, and where it needs its own model



Selected Sources

• Hoeger, K. M., Dokras, A., & Piltonen, T. (2021). Update on PCOS: consequences, challenges, and

guiding treatment. The Journal of Clinical Endocrinology & Metabolism, 106(3), e1071–e1083.

• Rosenfield, R. L., & Ehrmann, D. A. (2016). The pathogenesis of polycystic ovary syndrome (PCOS):

the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Reviews, 37(5),

467–520.

• Hybská et al. (2021). Menstruation cycle — phases and main hormones.

• Dr Nicky Keay — Health for Performance educational resource on RED-S (health-for-

performance.co.uk) and Personal Energy Availability Questionnaire (mypeaq.streamlit.app)

• Dr June Tan Sheren — PAMA webinar (2026), Hormones in Peri- and Menopause; Impact of

Menopause on Performance Health

• Ménard, J. F., & Hallé, M. (2014). Circus also needs performance psychology: Facts and realities of

consulting at Cirque du Soleil. In Becoming a Sport, Exercise, and Performance Psychology

Professional (pp. 127–134). Psychology Press.

• BBC News — "Bumps, Boobs and Bouncing Back: An athlete's path through pregnancy"

The Aerialist's Shoulder

Biomechanics, Strength and Injury Prevention for Vertical Apparatus


Overview

This workshop gives aerialists, circus teachers and coaches a working understanding of shoulder

biomechanics - why grip and shoulder stability fail, diffrent grips, how to build capacity through progressive

overload, and how to recognise and manage the injuries that actually occur in this population. It combines

applied anatomy, current sports-science principles (load management, tissue healing), and circus-specific

injury data, translated into practical training and prehab strategies.

The material is adapted from a conference presentation developed for the Rope Meeting Stockholm 2026,

and is scalable from a single lecture to a full-day format including a movement/practical component. For

that, gym setup and training space with aerial points are necessary.


Rationale

Aerial apparatuses place high, sustained torque and grip demand on a joint — the glenohumeral joint — that

is built for mobility, not inherent stability. Aerial injuries are overwhelmingly overuse-related rather than

acute, and are concentrated in the shoulder and upper body. Despite this, training in circus schools and

companies is often inconsistent: absent periodisation, insufficient strength/cross-training, neglecting lower

body strength and explosivity and unclear progressions are recurring patterns behind the injuries practitioners

see. This workshop closes that gap by connecting the anatomy and the evidence directly to training decisions

aerialists and their coaches make every week, explaining transfer of force throughout the body and why grip

relies much more on the overal body capacity rather than upper extremity strength.


Target Audience

• Aerialists (both vertical and horizontal apparatus) — students through professional level

• Circus teachers, coaches and rehearsal/company staff

• Physiotherapists, athletic trainers and movement professionals working with circus artists


Learning Objectives

By the end of the workshop, participants will be able to:

• Explain the anatomy and biomechanics of the aerialist's shoulder, including scapular stability, force

couples, generating and transfer of force trhroughout the body, kinetic chains and why grip is a whole-

body (not just arm) issue

• Apply progressive overload and load-management principles (acute:chronic workload, tissue-specific

recovery windows) to aerial training design

• Identify effective prehab and off-apparatus strength work for the shoulder, hip and trunk, and

understand why training a cluster of skills beats isolated drilling

• Recognise the injury patterns most common in aerialists (overuse, upper body, rotator cuff/labrum)

using published circus injury-surveillance data

• Understand the tissue-healing timeline and apply appropriate loading (not just rest or ice) at each phase

of recovery


Format & Duration

Suggested format: Half-day workshop (3 hours), or full-day (6 hours) including hands-on/practical strength

and prehab session. For that, gym setup and training space with aerial points are necessary.

Delivery: Lecture with slides, anatomical/biomechanical illustration, applied case discussion, and a guided

reflection exercise on personal injury history

Also available as: A single 90-minute talk focused on either (a) shoulder biomechanics and grip, or (b) load

management and injury prevention


Content Outline

Module 1 — Vertical Apparatus and the Aerial Shoulder (40 min)

• Vertical vs horizontal grip demands

• Long levers, high torque, and elastic recoil energy in aerial dynamics

• The athletic shoulder: anatomical and neuromuscular components of GH joint stability

• The scapula as the link between upper extremity and trunk; force couples and shoulder blade

positioning


Module 2 — Building Capacity: Progressive Overload & Load Management (45 min)

• Load > capacity → performance; applied load >>> capacity → injury

• Rethinking overuse injury as a training-load prescription error (Gabbett)

• Acute:chronic workload ratio and week-to-week load changes

• Strength training as the number-one injury prevention factor; working in clusters of transferable skills

rather than isolated tricks


Module 3 — Prehab and Off-Apparatus Training (40 min)

• Focus prehab areas: shoulder ER/ABD/protraction/upward rotation, hip extension and flexion, straight-

arm inversion, long-arm beats

• Training legs and trunk for aerial performance — force is generated from the trunk and lower body, not

the shoulders alone

• Vision, vestibular and proprioceptive input: why complete, accurate sensory signals matter for safe,

efficient movement


Module 4 — What the Injury Data Actually Shows (35 min)

• Injury surveillance from Montreal's National Circus School (ENC) and CNAC: incidence, anatomical

location, and discipline-specific risk

• Aerial injuries are mostly overuse, upper-body (shoulders, ribs, elbows, fingers), not acute-onset

• Common training mistakes behind these patterns: inadequate warm-up, lack of periodisation,

insufficient variety and cross-training

• Professional vs. hobby aerialist: why structure and intentionality — not hours trained — determine risk


Module 5 — Tissue Healing and Smart Return to Training (30 min)

• The three-to-four phase healing timeline: bleeding, inflammation, proliferation, remodeling/maturation

• Why we need inflammation to heal, and the risks of over-icing or over-medicating early injury

• PEACE & LOVE framework for soft-tissue injury management

• Early, appropriate loading (not rest) as the key to a full return to aerial training

(Full-day format adds a supervised practical: applying prehab drills and grip/shoulder-stability exercises on

and off the apparatus, plus a guided group reflection on past injuries — what happened, whether it was

avoidable, and how.)


Selected Sources

• Stuckey, M. I. et al. (2022). Clinical Burden of Injuries in Students at a Professional Circus College: A

7.5-Year Longitudinal Study. Circus discipline & anatomic-location injury data (Montreal National

Circus School).

• Greenspan, S., & Stuckey, M. I. (2023). Untangling risk factors including discipline-specific exposure

for injuries in preprofessional and professional circus artists in the USA. BMJ Open Sport & Exercise

Medicine, 9(2).

• Stuckey, M. I., & Krielaars, D. Don't go chasing waterfalls: Multiple factor prediction of injuries in a

performance context. JSAMS Plus.

• Hakim, H., Puel, F., & Bertucci, W. (2019). Investigation des blessures chez les étudiant-artistes du

cirque. 12e Congrès SFMES-SFTS.

• Gabbett, T. J., & Oetter, E. (2024); Gabbett, T. (2016). Training-load and injury-risk framework.

• International Olympic Committee consensus statement on load in sport and risk of injury (2016),

BJSM.

• Joyce, D., & Lewindon, D. (2016). Sports Injury Prevention and Rehabilitation. Routledge.

• Glasser, Frey, Frias et al. (2022); Blaise Dubois & Jean-Francois Esculier — tissue healing and injury

repair timelines (BJSM).

• SHIFT Movement Science and Gymnastics Education Conference (2024).

• Ben Ashworth, MPT, Circus Doc webinar (2025), Athletic Shoulder.

• PJ Perry & Alex Allan — RopeLab course (2024).

• Emily Scherb, PT, DPT — Circus Medicine Education Course (2021).

Clinical Insights on Tissue Capacity for Aerialists

Progressive Tissue Overload Beyond the Apparatus: Strategies for Building Tissue Tolerance


Overview

This workshop takes aerialists and their coaches beneath the skill itself, into the tissue-level physiology that

determines whether training builds resilience or breaks it down. It covers work and tissue capacity, why

aerial disciplines place unusually specific demands on the body, and how to apply current load-management

science to real training decisions — off the apparatus as much as on it.

The content is adapted from a clinical presentation developed for aerial and circus training contexts, and is

scalable from a single lecture to a full-day format including practical capacity testing.


Rationale

Two aerialists can look equally skilled and still carry very different injury risk: one may move well but lack

the raw tissue capacity to handle the load; another may be strong and technically sound yet still break down

due to under-recovered, degenerating tissue. Injury prevention research consistently points to training load

itself — not bad luck or fragility — as the primary driver of overuse injury. This workshop translates that

evidence, plus tissue-specific recovery science into decisions coaches and artists can actually use in day-to-

day training.


Target Audience

• Aerialists and circus artists at student through professional level

• Circus, dance and physical-preparation coaches

• Physiotherapists and movement professionals working with aerial/circus artists


Learning Objectives

By the end of the workshop, participants will be able to:

• Distinguish work capacity, tissue capacity and load, and explain how a mismatch between them causes

injury even in technically strong artists

• Apply progressive overload and load-management principles (ACWR, avoiding large week-to-week

load spikes) to aerial training design

• Understand that different tissues (muscle, tendon, bone, cartilage) recover on different timelines, and

periodise training accordingly

• Use simple, discipline-specific assessment concepts (e.g. the ASH test for force transfer) to gauge

readiness for high-demand skills

• Build an actionable, whole-body strength and conditioning plan that treats strength training as part of

flexibility and injury prevention, not separate from it


Format & Duration

Suggested format: Half-day workshop (3 hours), or full-day (6 hours) including hands-on testing and

strength-programming exercises, how to build a specific program in the gym, practical applications on aerial

apparatus

Delivery: Lecture with slides, applied case discussion, and a practical demonstration of assessment tools

Also available as: A single 90-minute talk focused on load management and tissue-specific recovery


Content Outline

Module 1 — Work Capacity, Tissue Capacity and Aerial Specificity (35 min)

• Defining work capacity vs. tissue capacity vs. load, and why aerial disciplines (long levers, high

torque, elastic recoil, grip demand) are unusually specific

• Three failure patterns: moving well with weak tissue; strong and moving well but tissue degeneration;

force-transfer mismatch between upper and lower body

• "A tissue is at full capacity when it can perform the required functional movements, at the required

volume and frequency, without symptoms or injury" (Cook & Docking, 2015)


Module 2 — Load Management and Progressive Overload (40 min)

• Load management as a major, modifiable risk factor for injury; the case for well-developed physical

qualities as protective

• Load > capacity → performance; applied load >>> capacity → injury

• Rethinking overuse injury as a training-load prescription error (Gabbett); large week-to-week load

spikes on low chronic load as the core mechanism

• Acute:chronic workload ratio (ACWR) as a practical monitoring tool


Module 3 — Tissue-Specific Recovery and Periodisation (35 min)

• Recovery timelines differ by tissue: rapid eccentric/high-intensity tendon loading needs up to 72h;

isometric work recovers in hours

• Systematic loading supports tissue architecture maintenance, neurophysiological performance, and

adaptive metabolic/hormonal stress — each with a distinct purpose

• Practical periodisation: stressing one system per session while allowing others to recover, rather than

repeating the same load on the same tissue daily


Module 4 — Injury Insights and Regional Interdependence (30 min)

• Why tendon/tissue pathology doesn't always predict load tolerance, and why young vs. adult tissue

adapts differently

• Regional interdependence: an initial injury (e.g. hamstring) can reduce capacity elsewhere (e.g. groin),

and 75% of re-injuries occur in a different body part

• Normalising capacity across the full kinetic chain after injury, not just the injured tissue


Module 5 — Assessing Capacity: The ASH Test and Discipline-Specific Demands (35 min)

• The ASH test (Ashworth): assessing force transfer from trunk to upper limb and capability to load in

long-lever positions

• Benchmarks across levels (recreational to world-class) and how to interpret them

• Discipline-specific force demands: straps generate tension forces many times bodyweight (up to ~7.9x

in giants), rigid apparatus produces short impulse responses — training implications for grip and

whole-body strength


Module 6 — Actionable Plan: Strength as Flexibility, Not Separate From It (25 min)

• Build whole-body resilience; avoid large week-to-week load increases; progressive overload accounts

for life stress, not just mechanical loading

• Train rate of force development, isometric holds and plyometrics, not maximal strength alone — both

sport-specific and locally specific

• "Strength training is flexibility training": coordination and efficiency matter as much as raw strength;

injuries are never local, so return-to-sport must address the whole system



Selected Sources

• Cook, J. L., & Docking, S. I. (2015). "Rehabilitation will increase the 'capacity' of your... insert

musculoskeletal tissue here...": Defining 'tissue capacity': a core concept for clinicians. British Journal

of Sports Medicine, 49(23), 1484–1485.

• Gabbett, T. J., & Oetter, E. (2024). From Tissue to System: What Constitutes an Appropriate Response

to Loading? Sports Medicine, 1–19.

• Gabbett, T. J., & Whiteley, R. (2017). Two training-load paradoxes. International Journal of Sports

Physiology and Performance, 12(s2), S2-50.

• Gabbett, T. J. (2016). The training–injury prevention paradox. British Journal of Sports Medicine,

50(5), 273–280.

• Soligard, T. et al. (2016). How much is too much? IOC consensus statement on load in sport and risk

of injury. British Journal of Sports Medicine, 50(17), 1030–1041.

• Ashworth, B., & Cohen, D. D. (2019). Force awakens: a new hope for athletic shoulder strength testing

(ASH test). British Journal of Sports Medicine, 53(9), 524–524.

• Cossin, M., Ross, A., & Gosselin, F. P. (2017). Making single-point aerial circus disciplines safer.

Proceedings of the Institution of Mechanical Engineers, Part P, 231(4), 362–373.

• Cossin, M., Bergeron-Parenteau, A., & Ross, A. (2022). Maximal dynamic forces exerted by acrobats

on nine circus apparatuses. Circus: Arts, Life, and Sciences, 1(1).

• Nielsen, R. O. et al. (2018). Training load and structure-specific load: applications for sport injury

causality and data analyses. British Journal of Sports Medicine, 52(16), 1016–1017.

• SHIFT Movement Science and Gymnastics Education Conference (2024).

The Biomechanics of the Handstand

Balance, Strength and Training Structure for Handbalancers


Overview

This workshop breaks down why the handstand is much harder to control than standing, what current

research shows about the strategies skilled handbalancers use to balance, and how to structure training

sessions that build the strength, proximal stability and technical repetition needed to progress safely. It

moves from the biomechanics and sensory systems integration behind balance, through the most common

technique faults and their root causes, to a practical framework for structuring a training session.

The material is adapted from the SKH Handstand Course 2026, and is scalable from a single lecture to a

half-day format including supervised handstand practice.


Rationale

Handstand is mechanically much harder than standing: a smaller base of support, a higher centre of mass,

and wrist joints that are far less capable of the fine, continuous corrections the ankles make when standing

upright. Add in the demand to integrate visual, vestibular and proprioceptive input under inversion, and it's

easy to see why so much handstand teaching focuses on cueing ("grip the floor", "squeeze everything")

rather than the underlying mechanics. This workshop gives artists and coaches the biomechanical and

training-science grounding to diagnose why a handstand fails — and to structure practice that actually builds

the specific strength and control it requires.


Target Audience

• Handbalancers and circus artists working on inversions — students through professional level

• Circus, dance and acrobatics teachers and coaches

• Physiotherapists and movement professionals working with handbalancers and aerialists

Learning Objectives

By the end of the workshop, participants will be able to:

• Explain why balancing in an inverted position is mechanically harder than standing, and how the

visual, vestibular and proprioceptive systems contribute to control

• Identify the most common handstand technique faults (shoulder flexion deficits, forward focal point,

ineffective finger use, posterior chain inflexibility) and their underlying causes

• Summarise what current research shows about control strategies, strength, and hand placement in

handstand balance

• Apply correct finger and hand mechanics — including force direction and weight distribution — to

improve balance efficiency

• Structure a single handstand training session (warm-up, focus areas, strength work, play) and build

proximal stability, pulling strength and flexibility appropriate to handbalancing


Format & Duration

Suggested format: Half-day workshop (4 hours), including supervised handstand practice and

strength/prehab session

Delivery: Lecture with slides, biomechanical illustration, applied technique analysis, and guided practical

handstand work

Also available as: A single 90-minute talk focused on either (a) the biomechanics of balance, or (b) training

structure and programming for handbalancers


Content Outline

Module 1 — Why Handstand Is Harder Than Standing (30 min)

• Smaller base of support, higher centre of mass, and weaker wrist joints compared to the ankles

• The inverted pendulum model and the "wrist strategy" for maintaining balance

• Visual, vestibular and proprioceptive integration: why complete, accurate sensory input is required to

move safely and efficiently


Module 2 — Common Technique Faults and Their Root Causes (40 min)

• Correct vs. incorrect handstand variants: shoulder flexion, thoracic position, and "hollowing" of the

chest

• Compensation patterns: insufficient scapular stability, neck extension, load on the anterior chain

• Limited wrist flexibility, excessive forward focal point, ineffective hand/finger use, and inefficient

balance point — and how each reduces margin for error

• Posterior chain inflexibility and insufficient strength as root limiters, not just "balance problems"


Module 3 — What the Research Shows (35 min)

• Control strategies: ankle/knee/hip vs. wrist/elbow/shoulder/hip strategies, and why the wrist strategy

dominates in handstand

• Muscle activity and postural control differences between young and adult gymnasts, and why strength

correlates with better balance

• Hand placement research: joined vs. open fingers, and what it means for teaching progression

• "Grip the floor" as an inaccurate cue: correct force direction (diagonally into the floor through the

fingertip pads) and weight distribution (~75% palms, ~25% fingers)


Module 4 — Building the Physical Base for Handbalancing (45 min)

• The ASH test: assessing pushing/pulling force transfer and long-lever capability, with reference

benchmarks

• Pulling strength and control (hanging work) vs. pushing mechanics, and how aerial and handstand

demands differ despite similar movements

• Proximal stability, isometric body strength and hollow-shape work: anti-extension/anti-flexion strength

as the foundation

• Flexibility training as strength training: why "strength training is flexibility training" for handbalancers


Module 5 — Structuring a Handstand Training Session (30 min)

• Session structure: general warm-up/mobility, handstand-specific warm-up/mobility, focus areas,

maintenance/refinement work, strength work, and play

• Progressive overload principles applied to handstand training; avoiding large week-to-week load spikes

• Cross-training for handbalancers: building general aerobic/anaerobic capacity to support discipline-

specific work

• Regressions, prehab and proprioceptive awareness: how the nervous system's input–interpretation–

output cycle shapes learning the position


Module 6 — Applying It: Technical Practice and Play (20 min)

• Handstand technical training: basics, repetition, shapes, transitions, endurance, and finding the line of

least effort

• Playing with inverted positions: control in transitions, using objects, building stamina — and making

room to simply enjoy the position



Selected Sources

• Gatti, C. J. (2022). A Primer on the Handstand: Basic Technique and Common Issues. CRITAC, École

nationale de cirque, Montréal.

• McDonald, M., Baker, J. S., Gu, Y., & Ugbolue, U. C. (2025). Biomechanical analyses of the

handstand: a systematic review. Frontiers in Sports and Active Living.

• Kochanowicz, A., Niespodziński, B., Marina, M., Mieszkowski, J., Biskup, L., & Kochanowicz, K.

(2018). Relationship between postural control and muscle activity during a handstand in young and

adult gymnasts. Human Movement Science, 58, 195–204.

• Omorczyk, J., Bujas, P., Puszczałowska-Lizis, E., & Biskup, L. (2018). Balance in handstand and

postural stability in standing position in athletes practicing gymnastics. Acta of Bioengineering and

Biomechanics, 20(2).

• Milosis, D. C., & Siatras, T. A. The effectiveness of different handstand placement techniques in

handstand balance control and gender differences. Science of Gymnastics Journal, 15(3), 375–394.

• Chris Gatti — The Academic Acrobat (finger-body connection and force direction in handstand).

• Ashworth, B., & Cohen, D. D. (2019). Force awakens: a new hope for athletic shoulder strength testing

(ASH test). British Journal of Sports Medicine, 53(9), 524–524.




Nutrition for Performing Artists

Energy Balance, Macronutrients and Practical Fuelling Strategies for Circus, Dance and Aerial Artists


Overview

This workshop introduces performing artists, teachers and coaches to the basic principles of sports nutrition and shows how to apply them to the specific demands of circus, dance and aerial training. It moves from energy balance and macronutrient function through to practical fuelling strategies around classes and rehearsals, and closes with an honest look at the risks of underfuelling in aesthetic performance disciplines. The material is built to demystify nutrition rather than add another layer of rules: the goal is a body-literate, low-anxiety relationship with food that supports training, recovery and performance.


Rationale

Performing artists move more, and often more intensely, than the general population, yet nutrition education is rarely part of standard circus or dance training. This gap leaves artists to piece together information from social media, well-meaning but inconsistent advice from peers, or restrictive “ideal body” narratives common in aesthetic disciplines. At the same time, nutrition can be overstated and turned into another source of control and anxiety around food. This workshop grounds participants in the fundamentals — energy balance, macronutrient roles, timing and consistency — so that nutrition becomes a practical tool for training and recovery rather than a source of stress, and so participants can recognise early warning signs of underfuelling and RED-S in themselves, their peers or their students.


Target Audience

• Circus, dance and other performing arts students and pre-professionals

• Professional performers and freelance artists

• Artistic and pedagogical staff: coaches, teachers, rehearsal/artistic directors

• Company management, health and wellbeing staff


Learning Objectives

By the end of the workshop, participants will be able to:

• Explain the concept of energy balance and identify the components of daily energy expenditure (BMR, TEF, TEA/NEAT)

• Describe the roles of carbohydrates, protein and fat, and apply general intake guidelines for training, recovery and competition/performance preparation

• Plan fuelling and snacking strategies around classes, rehearsals and performances, including timing of carbohydrate and protein intake and its relationship to blood sugar and hormonal recovery

• Recognise the signs and risks of chronic underfuelling and Relative Energy Deficiency in Sport (RED-S) in aesthetic performance disciplines

• Distinguish evidence-based nutrition guidance from restrictive or anxiety-driven food rules, and apply a consistent, flexible approach to daily eating


Format & Duration

Suggested format: Half-day workshop (3 hours)

Delivery: Lecture-style presentation with slides, worked examples from a personal case study (meal-plan data and body-composition testing), and facilitated discussion

Also available as: A single 90-minute introductory talk, or a modular series split across energy/macronutrients and practical fuelling/underfuelling


Content Outline

Module 1 — Energy Balance and Daily Energy Expenditure (35 min)

• Energy balance as the foundation of nutrition: matching intake to expenditure and current training demands

• Components of total daily energy expenditure: basal metabolic rate (BMR), thermic effect of food (TEF), thermic effect of activity (TEA) and NEAT

• METs and estimating energy expenditure for different training activities

• A practical FITT self-test (frequency, intensity, timing, training type) for estimating personal energy needs


Module 2 — Macronutrients: Function, Sources and Requirements (45 min)

• Carbohydrates as the body's preferred fuel: storage as glycogen, minimum daily requirements and recommended intake for dancers/aerialists

• Protein: essential amino acids, protein turnover and synthesis, quality and digestibility of animal vs. plant sources, and daily requirements for training and recovery

• Fat: energy storage, hormonal function, essential fatty acids (omega-3/omega-6) and recommended intake ranges

• Applying macronutrient targets without turning them into rigid rules


Module 3 — Fuelling Around Training (40 min)

• Before, during and after training: what and when to eat to support performance and recovery

• Blood sugar, insulin sensitivity and exercise: why consistent snacking through the day supports hormonal balance

• The role of the evening meal in supporting overnight recovery: protein, tryptophan, melatonin and growth hormone release

• Planning ahead: matching tonight's intake to tomorrow's training load, and strategies for days with limited breaks


Module 4 — Underfuelling, RED-S and Disordered Eating Risk (40 min)

• Why aesthetic performance disciplines carry elevated risk of intentional and unintentional underfuelling

• Relative Energy Deficiency in Sport (RED-S): mechanisms, performance consequences and injury risk

• Prevalence of disordered eating and eating disorders in circus and aesthetic-sport populations, and why “good athlete” traits can overlap with disordered patterns

• Practical, non-alarmist ways to talk about food, body and performance with students and peers


Module 5 — Case Study and Take-Away Principles (20–30 min)

• Walkthrough of a real multi-day meal-plan and energy-expenditure comparison (training day vs. sedentary day)

• What body-composition and metabolic testing (DEXA, bioimpedance, VO2max) can and cannot tell an artist about their nutrition

• Take-away principles: energy balance first, consistency and timing of meals, small snacks are usually enough, and movement matters more than nutrition alon



Selected Resources

  • Åkesdotter, C., Kenttä, G., Eloranta, S., & Franck, J. (2020). The prevalence of mental health problems in elite athletes. Journal of science and medicine in sport, 23(4), 329-335.
  • Dallas, G. C., Dallas, C. G., Simatos, E. J., & Simatos, J. E. (2017). Nutritional recommendations and guidelines for women in gymnastics: Current aspects and critical interventions. Science of Gymnastics Journal, 9(1).
  • Dave, S. C., & Fisher, M. (2022). Relative energy deficiency in sport (RED–S). Current Problems in Pediatric and Adolescent Health Care, 52(8), 101242.
  • Decker, A., Aubertin, P., & Kriellaars, D. (2021). Body composition adaptations throughout an elite circus student-artist training season. Journal of Dance Medicine & Science, 25(1), 46-54.
  • DEUTZ, R. C., BENARDOT, D., MARTIN, D. E., & CODY, M. M. (2000). Relationship between energy deficits and body composition in elite female gymnasts and runners. Medicine & Science in Sports & Exercise, 32(3), 659-668.
  • Ganong, W.F. (1997) Review of Medical Physiology. 16th Edition, LANGE Medical Publication, Prentice- Hall International Inc.
  • Greenspan, S., Munro, D., Nicholas, J., Stubbe, J., Stuckey, M. I., & Van Rijn, R. M. (2022). Circus-specific extension of the International Olympic Committee 2020 consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport. BMJ Open Sport & Exercise Medicine, 8(3), e001394.
  • Challis, J., Stevens A., & IADMS. (2019) Nutrition resource paper: Resource for dancers and teachers. [2024-08-09].
  • Martinsen, M., & Sundgot-Borgen, J. (2013). Higher prevalence of eating disorders among adolescent elite athletes than controls. Medicine & Science in Sports & Exercise, 45(6), 1188-1197.
  • Mifflin, M. D., St Jeor, S. T., Hill, L. A., Scott, B. J., Daugherty, S. A., & Koh, Y. O. (1990). A new predictive equation for resting energy expenditure in healthy individuals. The American journal of clinical nutrition, 51(2), 241-247.
  • Mountjoy, M., Sundgot-Borgen, J. K., Burke, L. M., Ackerman, K. E., Blauwet, C., Constantini, N., ... & Meyer, N. L. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update., 2018, 52. DOI: https://doi. org/10.1136/bjsports-2018-099193, 687-697.
  • Shrier I, Meeuwisse WH, Matheson GO, et al. Injury patterns and injury rates in the Circus arts: an analysis of 5 years of data from Cirque Du SOLEIL. Am J Sports Med 2009;37:1143–9.
  • Sousa, M., Carvalho, P., Moreira, P., & Teixeira, V. H. (2013). Nutrition and nutritional issues for dancers. Medical problems of performing artists, 28(3), 119-123.
  • van Rens, F. E., Metse, A. P., & Heritage, B. (2022). Exploring the mental health of circus artists: Circus factors, psychological resilience, and demographics predict disordered eating and exercise addictions. Psychology of Sport and Exercise, 59, 102107.
  • Walby, Kevin and Shawn Stuart. 2021. “‘You Have to Accept the Pain’: Body Callusing and Body Capital in Circus Aerialism.” Qualitative Sociology Review 17(4):6-23. Retrieved Month, Year (http://www.qualitativesociologyreview.org/ENG/archive_eng. php). DOI: https://doi.org/10.18778/1733-8077.17.4.01
  • Wolfenden HE, Angioi M. Musculoskeletal injury profile of Circus artists: a systematic review of the literature. Med Probl Perform Art 2017;32:51–9.
  • presentation by Dr. Alexia de Macar, Circus Doc Smart Speaker Series 2023
  • presentation by Dr. Nicky Keay- IADMS Annual Conference 2023 (International Association for Dance Medicine and Science)
  • presentations from the GIH Nutrition for Dance Educators Course, 2024
  • presentation by Dr. Stephanie Potreck, IADMS Resources, PAMA (Performing Arts Medicine Association)