Education improves bra knowledge and fit, and level of breast support in adolescent female athletes: a cluster-randomised trial

Breaking barriers: Exploring female-specific health challenges affecting performance in an elite multisport training environment

OBJECTIVES

Female-specific issues, such as breast injuries, pelvic floor dysfunctions, saddle sores, and menstrual symptoms, can significantly impact female athletes. This study examined the prevalence, perceived impact on performance, and role of the support staff in addressing and managing these issues in elite athletes based at a multisport training centre.

DESIGN

Anonymous online questionnaire.

METHODS

A total of 180 female athletes from various sport disciplines at the Dutch Olympic Training Centre were invited to participate in the study. An anonymous, 39-item questionnaire was developed and hosted on Qualtrics collecting data on respondents' characteristics, breast injuries, pelvic floor dysfunctions, saddle sores, menstrual symptoms, contraceptive use, and communication about these issues.

RESULTS

A total of 105 valid responses were analysed. The findings revealed that athletes regularly experience breast injuries (15.2 %), urinary incontinence (29.5 %), other pelvic floor problems (21.0 %), saddle sores (65.7 %), and menstrual cycle-related symptoms, with negative performance effects. Communication with support staff remained limited, with only 23.8 % of athletes discussing any of these issues, often due to concerns about understanding, shame, or a lack of opportunity for easy communication.

CONCLUSIONS

The findings underscore the crucial role of creating a supportive environment, promoting early intervention, and utilising multisport centres to comprehensively address these concerns, emphasising the need for open communication, education, and support to enhance female athletes' performance and well-being.

Hidden support for the lionesses: a breast/bra intervention

Despite health and performance benefits of appropriate breast support in sport, elite women athletes' knowledge of breasts/bras is poor leading to poor bra choices, breast pain and performance decrements. This multiphase intervention assessed breast/bra issues and preferences, individually prescribed sports bras and evaluated outcomes for the England Senior Women footballers. Breast/bra workshops were delivered to England players; all 36 completed pre-intervention surveys and breast/bra assessments, before being prescribed bras six weeks before European and World Championships (2022, 2023). 24 players completed post-intervention surveys. Pre-intervention outcomes identified poor knowledge, poor bra fit, many bra issues, and cultural sensitivities. Breast pain was prevalent (61%), with 25% reporting clinically significant breast pain. Post-intervention, players reported significant improvements with prescribed sports bras. 91% reported improvements in knowledge and benefiting from the intervention. This successful intervention provided an evidence-base for ongoing breast health initiatives with England Teams, plus roll-out to all levels of women's football.

Understanding experience, knowledge and perceived challenges related to bra fit for sports participation: a scoping review

The breasts are reported as the fourth largest barrier to participation in physical activity (PA). This scoping review provides a comprehensive understanding of experiences, knowledge and challenges relating to bra fit and sports participation. The search strategy was adopted by the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines and multiple databases were searched. All research was in English and within the last 20 years. Exclusion criteria excluded reviews, male participants and the inability to locate or access full-text articles. The JBI critical appraisal tool assessed methodological quality. Twenty-three studies were included. Key themes from the studies are breast motion during PA, sports bra design, perceived barriers to participation in PA and education/knowledge of breast support and bra fit. Increasing breast support reduces breast movement during PA yet breast motion and bra fit are still the most common breast concerns for females. This is likely influenced by poor breast knowledge, leading to poor breast support choices. Future research should explore to what extent breast motion, knowledge and bra fit influences sport participation, and this research should include a more diverse range of adult ages, cup sizes, ethnicities and PA levels to provide a wider understanding.

Impact of autologous breast reconstruction on bra fit

PURPOSE

To inform bra design by analyzing 3D surface images of breast cancer patients who underwent autologous breast reconstruction.

METHODS

We computed bra design measurements on 3D surface images of patients who underwent unilateral and bilateral autologous breast reconstruction. Breast measurements and right-left symmetry between preoperative baseline and postoperative time points were compared using either paired Student t-test or Wilcoxon signed-rank test, depending on the data's distribution. Regression analysis determined associations between measurements and patient characteristics such as age. Postoperative measurements and symmetry differences were also compared between autologous and implant-based breast reconstruction.

RESULTS

Among participants who underwent bilateral autologous breast reconstruction, the reconstructed breasts were smaller and positioned higher on the chest wall than their native breasts. For patients who underwent unilateral reconstruction, similar postoperative changes were observed in the contralateral breast due to symmetry procedures. Overall, for participants whose baseline breast measurements showed substantial asymmetry, unilateral reconstruction decreased right-left asymmetry whereas bilateral reconstruction amplified right-left asymmetry. Preoperative baseline breast measurements, age, and BMI were statistically significantly associated with most postoperative breast measurements for participants who underwent bilateral autologous reconstruction. Compared to implant-based reconstruction, autologous reconstruction resulted in fewer changes in breast shape and symmetry that are pertinent to bra fit.

CONCLUSION

Preoperative baseline breast measurements, age, and BMI can impact bra designs for breast cancer survivors who undergo autologous reconstruction due to size, shape, and symmetry changes. Bra needs of people who undergo autologous reconstruction differ from those who undergo implant-based reconstruction.

A multi-phase intervention study of sports bra prescription for elite UK female athletes preparing for the Tokyo Olympics and Paralympics

Athletes report poor breast/bra knowledge, breast pain, sports bras causing lacerations and chafing, negatively affecting sports performance. No bra interventions to address these issues are reported. Working with 142 UK female athletes preparing for Tokyo Olympics/Paralympics (27 sports), this multi-phase intervention assessed breast/bra knowledge, preferences, issues via surveys and breast/bra assessments. Data were used to develop two sports bras. A total of 112 athletes were prescribed one of the new bras through individual assessments. After four weeks, wear athletes completed evaluations. Pre-intervention breast/bra knowledge was low (83% ≤average), multiple breast/bra issues were reported and most athletes wore ill-fitting, loose bras, offering limited support. Post-intervention, 63% reported improved knowledge and 97% reported their prescribed bra as better than their original bra. Eighty-seven per cent reported benefitting from this intervention, with 17% reporting improved performance. This intervention effectively assessed sports bra needs, developed and implemented solutions, which improved knowledge and potentially performance for some UK athletes.

A multi-stage intervention assessing, advising and customising sports bras for elite female British athletes

Appropriate breast support is recommended in sport; however, what constitutes appropriate support is complex, individual and often sports specific, particularly in elite sport given the wear duration. This intervention educated, assessed and advised elite British female athletes on breasts and bras; those with unresolved issues engaged in bespoke bra interventions. Following educational workshops (n = 80), breast/bra surveys (n = 60), individual bra assessments (n = 37); a rower, shooter, and hockey player participated in the bespoke bra intervention. Eighty-three per cent of athletes rated their breast/bra knowledge as ≤average. Fifty-one per cent experienced breast pain, affecting performance for 29%; seven used medication and one surgery to relieve symptoms. In individual bra assessments most wore ill-fitting, unsupportive bras and wanted bra advice. Bespoke bra interventions eliminated breast pain: for the rower, improved breast position and spine rotation; for the shooter, repositioned tissue and improved performance; and for the hockey player, accommodated smart devices. Whilst bespoke bra development is challenging, most elite athlete breast/bra issues are resolved via education, advice and fitting.

Comparative Morphological Evaluation of Young Women's Breast-Bra Reshaping by Different Bra Cups

Female breasts are regarded as a factor reflecting women's morphological beauty. An appropriate bra can fulfill aesthetic needs, thus boosting self-esteem. This study proposed a method to analyze young women's breast-bra morphological variations between two identical bras with different bra cup thicknesses. The 3D surface scan data of 129 female students who were braless and wore a thin bra (13 mm) and a thick bra (23 mm) were analyzed. Integral sections of the breasts and bra were cut at a fixed thickness of 10 mm, and slice maps were derived. Morphological parameters were extracted in braless and the two bra conditions. The variations in breast-bra shape caused by different thicknesses of bra cups were evaluated by quantifying breast ptosis, gathering, and breast slice area. The results showed that the thin bra lifted the breasts by 2.16 cm, whereas the thick bra decreased breast separation, gathering the breasts and moving them 2.15 cm laterally towards the center of the chest wall. Moreover, prediction models constructed using the critical morphological parameters were used to characterize breast-bra shape after wearing the provided bras. The findings lay the groundwork for quantifying the breast-bra shape variation caused by different bra cup thicknesses, allowing young females to choose optimally fitting bras to achieve their desired breast aesthetics.

Verification of Xiphoid Point as a New Measuring Point for Chest Shape Measurement

The measurement point of chest shape based on non-rigorous ergonomics is the key problem affecting the accuracy of measurement results. Xiphoid point, as a representative human skeleton point, can provide a theoretical basis for the development of new chest shape measurement methods and technology. In order to verify the stability of xiphoid point, 30 subjects were selected to measure the chest shape based on upper limb movement in the transverse plane of human body. The displacement of mastoid and xiphoid points in the sagittal plane, coronal plane, and axial plane was compared, and the factors influencing the displacement of mastoid and xiphoid points were analyzed. The results showed that the displacement of the mammary point was the largest in the coronal plane during the upper limb movement. The displacement of xiphoid point is far less than that of mastoid point. The displacement of the breast point is closely related to the chest circumference when the upper limb is in the horizontal adduction. There was a positive correlation between the displacement of xiphoid point and the amplitude of upper limb movement. Compared with mammary point, xiphoid point is a fixed and stable measurement point of chest shape.

The impact of breast support garments on fit, support and posture of larger breasted women

Due to current measurement, sizing and fitting approaches, poor bra fit is prevalent amongst larger breasted women. The impact of improving bra fit hasn't yet been explored. This pre-clinical study aimed to explore immediate and short-term biomechanical responses to changing breast support garment. Asymptomatic participants (n=24) performed a static standing task, drop jumps and seated typing whilst kinematic data from the breasts and spine were recorded. Three breast support conditions were assessed: Usual, professionally fitted bra in the immediate term (PFB), and the same professionally fitted bra after four weeks wear (PFB₂₈). Bra fit assessments were included for both bras. All participants failed the bra fit assessment when wearing the Usual bra and 67% (n=16) failed when wearing the PFB. Less bra fit issues were present in the PFB, resulting in immediate biomechanical changes relating to breast support and spinal posture, yet nothing in the short term (PFB₂₈). This research sets the foundations for future work to investigate whether the implementation of better fitting breast support garments can influence musculoskeletal pain amongst larger breasted women, whilst attributing potential improvement of symptoms, objective measures of breast support and spinal posture.

Sports Bra Preferences by Age and Impact of Breast Size on Physical Activity among American Females

For many females, sports bras are an essential piece of equipment for participation in sports and physical activity. Breast pain or discomfort from lack of support may be a contributing factor to the noted gender disparity in physical activity of females compared to males. Our objective was to evaluate sports bra usage and characterize sports bra preferences of an active female cohort. This multicenter cross-sectional survey study was conducted at five geographically distinct academic centers. Our measure was administered during outpatient sports medicine clinic visits to females aged 11–64 years old. Chi-square tests were used to compare characteristics across subgroups. Our analysis consisted of 438 respondents, with a mean age of 22 ± 12.2 years. More than a quarter (27.4%) reported lack of breast support prevented them from being active or exercising. Age (p = 0.03), breast size (p < 0.0001), and household income (p = 0.01) were significantly associated with greater frequency of physical activity being limited by lack of breast support. Lack of breast support may be an important barrier for young females of specific populations to meeting physical activity recommendations. Further research is needed to improve the understanding of this important piece of sporting equipment for women.

Breast Biomechanics: What Do We Really Know?

Although half the world's population will develop breasts, there is limited research documenting breast structure or motion. Understanding breast structure and motion, however, is imperative for numerous applications, such as breast reconstruction, breast modeling to better diagnose and treat breast pathologies, and designing effective sports bras. To be impactful, future breast biomechanics research needs to fill gaps in our knowledge, particularly related to breast composition and density, and to improve methods to accurately measure the complexities of three-dimensional breast motion. These methods should then be used to investigate breast biomechanics while individuals, who represent the full spectrum of women in the population, participate in a broad range of activities of daily living and recreation.

Breast Education Improves Adolescent Girls' Breast Knowledge, Attitudes to Breasts and Engagement With Positive Breast Habits

Many females experience breast-related issues that are considered to negatively impact health and well-being. These include breast cancer, issues related to incorrect bra fit, and issues related to breast movement including an increased incidence of breast pain, breast sag, and embarrassment, which can be a barrier to physical activity participation. Knowledge and awareness of these breast issues among females is low. Furthermore, these breast concerns are more prevalent in adolescent girls compared to adult females, with 87% of girls reporting ≥ one breast concern. This study evaluated the short- and longer-term impact of a 50 min breast education intervention on adolescent girls' (11 to 14 years) breast knowledge, attitudes to breasts and engagement with positive breast habits. A mixed methods, controlled, longitudinal, cohort design was employed, using two control schools (n: 412; receiving no intervention) and two intervention schools (n: 375; receiving the intervention) from privileged and less privileged areas. Adolescent girls in four schools completed a validated breast survey pre- and immediately post-intervention as well as 3 and 6 months post-intervention. Additionally, in one intervention school, six focus groups were conducted immediately and 4 months after the intervention. The intervention was equally effective in the two intervention schools. Following the intervention, participants in the intervention schools significantly improved their breast knowledge, their attitudes to breasts and their engagement with positive breast habits, compared to participants in the control schools, p < 0.01 (with large effect sizes). These improvements were sustained 6 months post-intervention. Participants described the session as "informative," it made them "feel less embarrassed" about their breasts; they also reported wanting to do more exercise and to change their bra purchasing and bra wearing habits. These novel, positive findings provide insight into the benefits of teaching adolescent girls about breasts from a young age and can be used to inform effective breast education in schools. It is recommended that education on multiple breast topics should be introduced in schools, preferably being first introduced in primary schools, with a modular structure and progressive information.

Biomechanics of Breast Support for Active Women

More systematic breast biomechanics research and better translation of the research outcomes are necessary to provide information upon which to design better sports bras and to develop effective evidence-based strategies to alleviate exercise-induced breast pain for women who want to participate in physical activity in comfort.

Breast and torso characteristics of female contact football players: implications for the design of sports bras and breast protection

This study aimed to provide normative data characterising the breast size, breast position and torso size of female contact football players. 117 AFL, Rugby League, Rugby Union and Rugby 7s players attended a single testing session where a three-dimensional scan was taken of their naked breasts and torso. Dimensions relevant to the design of sports bras and breast protective equipment were then calculated from the scans. Several breast and torso characteristics of female contact football athletes differed to measurements reported for females in the general population and amongst the contact football codes. Designers and manufacturers of sports bras or breast protective equipment should consider the specific breast and torso dimensions of female contact football players to maximise the fit, comfort and efficacy of these garments. Practitioner summary: Using three-dimensional scanning, this study characterised the breast and torso size and shape of 117 female contact football players. These normative data should be used to improve the fit and comfort of sports bras and breast protective equipment for female contact football players.

Effects of age and body mass index on breast characteristics: a cluster analysis

Limited research has quantified variation in the characteristics of the breasts among women and determined how these breast characteristics are influenced by age and body mass. The aim of this study was to classify the breasts of women in the community into different categories based on comprehensive and objective measurements of the characteristics of their breasts and torsos, and to determine the effect of age and body mass index on the prevalence of these breast categories. Four breast characteristic clusters were identified (X-Large, Very-ptotic & Splayed; Large, Ptotic & Splayed; Medium & Mildly-ptotic; and Small & Non-ptotic), with age and BMI shown to significantly affect the breast characteristic clusters. These results highlight the difference in breast characteristics exhibited among women and how these clusters are affected by age and BMI. The breast characteristic clusters identified in this study could be used as a basis for future bra designs and sizing systems in order to improve bra fit for women. Practitioner summary: This original research provides evidence for bra designers and manufacturers on the diverse breast characteristics exhibited by women within the population and the significant effect that both body mass index and age have on the breast characteristic clusters. Future bra designs should consider the variation in breast characteristics among women.

ABBREVIATIONS

BMI: Body Mass Index; UBCC: Under-bust chest circumference.

Perceived exercise barriers explain exercise participation in Australian women treated for breast cancer better than perceived exercise benefits

OBJECTIVES

This study aimed to determine the effect of perceived exercise benefits and barriers on exercise levels among women who have been treated for breast cancer and have not participated in a formal exercise intervention.

DESIGN

This was an anonymous, national, online cross-sectional survey study.

METHODS

Four hundred thirty-two women treated for breast cancer completed an online survey covering their treatment and demographic background, current exercise levels, and perceived exercise benefits and barriers. Each perceived benefit and barrier was considered in a binary logistic regression against reported exercise levels to ascertain significant relationships and associative values (odds ratio [OR]).

RESULTS

Agreement with 16 out of 19 exercise barriers was significantly related to being more likely to report insufficient exercise levels, whereas agreement with 6 out of 15 exercise benefits was significantly related to being less likely to report insufficient levels of exercise. Feeling too weak, lacking self-discipline, and not making exercise a priority were the barriers with the largest association to insufficient exercise levels (OR=10.97, 95% confidence interval [CI]=3.90, 30.86; OR=8.12, 95% CI=4.73, 13.93; and OR=7.43, 95% CI=3.72, 14.83, respectively). Conversely, exercise enjoyment, improved feelings of well-being, and decreased feelings of stress and tension were the top 3 benefits associated with being less likely to have insufficient exercise levels (OR=0.21, 95% CI=0.11, 0.39; OR=0.21, 95% CI=0.07, 0.63; and OR=0.31, 95% CI=0.15, 0.63, respectively).

LIMITATIONS

Self-reported data measures were used to collect exercise data.

CONCLUSIONS

Targeting exercise barriers specific to women treated for breast cancer may improve exercise participation levels in this cohort. Awareness of the impact of exercise barriers identified in the present study will enable physical therapists to better plan exercise interventions that support all women treated for breast cancer.

Evaluation of professional bra fitting criteria for bra selection and fitting in the UK

A correctly fitting bra is essential for good health; this study investigates the use of professional bra fitting criteria to establish best-fit in an underwire bra commonly sold in the UK. A comparison was made between women's bra size as measured by the traditional bra fitting method with their recommended bra size based on professional bra fitting criteria. Forty-five female participants were recruited; their mode self-reported bra size was 34DD. Participants were measured in their own bra using the traditional bra-fitting method to establish their 'traditional size'. A 'best-fit' bra size was recorded for participants based on professional bra fitting criteria. Significant differences were found between traditional and best-fit cup and band sizes (p < 0.001); the traditional method of bra fitting overestimated band size and underestimated cup size. As band size increased the traditional method also became more inaccurate (p < 0.001). It is recommended that women are educated in assessing their own bra fit using professional bra fitting criteria and less emphasis placed on determining absolute bra size. Practitioner Summary: This is the first study to investigate using professional bra fitting criteria to establish best-fit in an underwired bra commonly sold in the UK. The traditional method of bra fitting was found to be inadequate, especially for larger-breasted women; the use of professional bra fitting criteria should be encouraged.