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Convit L, Kelly MK, Jardine WT, Périard JD, Carr AJ, Warmington S, Bowe SJ, Snipe RMJ. Influence of acute heat mitigation strategies on core temperature, heart rate and aerobic performance in females: A systematic literature review. J Sports Sci 2024; 42:1491-1511. [PMID: 39262133 DOI: 10.1080/02640414.2024.2396225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 08/17/2024] [Indexed: 09/13/2024]
Abstract
This review examined the effect of acute heat mitigation strategies on physiological strain and exercise performance in females exercising in the heat. Three databases were searched for original research with an acute heat mitigation (intervention) and control strategy in active females and reporting core temperature, heart rate and/or aerobic exercise performance/capacity with ≥ 24°C wet bulb globe temperature. Hedges' g effect sizes were calculated to evaluate outcomes. Thirteen studies (n = 118) were included. Most studies that applied an acute heat mitigation strategy to females did not reduce thermal (9/10) or cardiovascular (6/6) strain or improve exercise performance/capacity (8/10). The most effective strategies for attenuating thermal strain were pre-cooling with ice-slurry (effect size = -2.2 [95% CI, -3.2, -1.1]) and ice-vests (-1.9 [-2.7, -1.1]), and pre- and per-cooling with an ice-vest (-1.8 [-2.9, -0.7]). Only pre-cooling with an ice-vest improved running performance (-1.8 [-2.9, -0.7]; ~0.43 min) whilst sodium hyperhydration improved cycling capacity at 70% V O2peak (0.8 [0.0, 1.6]; ~20.1 min). There is currently limited research on acute heat mitigation strategies in females, so the evidence for the efficacy is scarce. Some studies show beneficial effects with ice-slurry, ice-vests and sodium hyperhydration, which can guide future research to support female exercise performance in the heat.
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Affiliation(s)
- Lilia Convit
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Monica K Kelly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - William T Jardine
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Julien D Périard
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Bruce, Australia
| | - Amelia J Carr
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Stuart Warmington
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Steven J Bowe
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Rhiannon M J Snipe
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Moran RN, Guin JR, Roehmer C, Murray NG. Hormonal Contraceptive Influence on Baseline Vestibular/Ocular Symptomatology and Provocation for Concussion. Orthop J Sports Med 2024; 12:23259671241259735. [PMID: 39157027 PMCID: PMC11329980 DOI: 10.1177/23259671241259735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/01/2024] [Indexed: 08/20/2024] Open
Abstract
Background Hormonal contraceptives (HCs) and the menstrual cycle have been suggested to affect symptom severity and postconcussion recovery. Additionally, hormones have been a suggested rationale for sex differences between female and male athletes on concussion assessment. Researchers have yet to explore the effects of HC use on baseline symptomatology, including symptom reporting and provocation. Purpose To examine the influence of HC use on a baseline symptom reporting and vestibular/ocular provocation battery. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 61 college-aged individuals (21 HC-using women, 21 non-HC-using women, 19 men) were administered a baseline symptom battery consisting of the Post-Concussion Symptom Scale (PCSS), Headache Impact Test-6 (HIT-6), Pediatric Vestibular Symptom Questionnaire (PVSQ), and Vestibular/Ocular Motor Screening (VOMS). The main outcome measures consisted of PCSS symptom reporting (total symptoms, symptom severity score, and symptom factors), HIT-6 and PVSQ total scores, and VOMS item (ie, saccades, convergence, or vestibular/ocular reflex) symptom provocation scores. Results Significant differences were reported on HIT-6, with the highest headache reporting in the HC group (P = .026). On the PVSQ, the HC group also reported greater dizziness and unsteadiness symptoms than the non-HC group (P = .023). Similar findings existed on the PCSS, with the HC group reporting greater total symptoms (P < .001), symptom severity (P < .001), and vestibular-somatic (P = .024), cognitive-sensory (P = .004), sleep-arousal (P = .001), and affective (P < .001) factors compared with the non-HC group. Smooth pursuit (ie, following finger smoothly with eyes) was the only VOMS items with differences between groups (P = .003), with the HC group having greater provocation compared with non-HC users (P = .020). Conclusion HC use was associated with overall symptomatology and worse self-reported symptoms on vestibular-related inventories and concussion symptom scales and factors when compared with non-HC users and male controls. Additionally, HC users reported higher VOMS provocation scores on the smooth pursuit item than non-HC users and male controls.
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Affiliation(s)
- Ryan N. Moran
- Department of Health Science, Athletic Training Research Laboratory, The University of Alabama, Tuscaloosa, Alabama, USA
| | - J. Russell Guin
- Family, Internal, and Rural Medicine, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Christian Roehmer
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Madigan SM. Sex and gender in sports nutrition research: bridging the gap. Proc Nutr Soc 2024:1-7. [PMID: 38948944 DOI: 10.1017/s002966512400466x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
The Olympic Games have grown to be the largest, gender-equal sporting event in the world, and the International Olympic Committee is committed to gender equality in sports encouraging and supporting the promotion of women in sports at all levels and in all structures with a view to implementing the principle of equality of men and women (IOC, 2023). Women competed for the first time at the 1900 Olympic Games in Paris, and the number of women competing has grown exponentially over the last 100 years, so an estimated 5494 female athletes (48 %) competed in the Summer Olympic Games 2021 in Tokyo. Supporting women (alongside men) in achieving optimum performance is crucial, and understanding that there are sex and gender gaps in sports nutrition research is important. One reason for this gap is the historical bias in sports and exercise science research towards male participants. This has led to a poor understanding of the unique physiological and nutritional needs of female athletes. In summary, a balanced approach is crucial to address the nutritional needs of both male and female athletes. Researchers should continue exploring this important area to optimise performance and health for all athletes. The aim of this review is to summarise current sports nutrition literature and highlight research that seeks to understand and address where the gaps are with respect to several key areas in sports nutrition recommendations that can impact advice and practice with both males and females.
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Affiliation(s)
- Sharon M Madigan
- Sport Ireland Institute, Dublin, D15 D462, Ireland
- Sport and Human Performance Research Centre, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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Oester C, Norris D, Scott D, Pedlar C, Bruinvels G, Lovell R. Inconsistencies in the perceived impact of the menstrual cycle on sport performance and in the prevalence of menstrual cycle symptoms: A scoping review of the literature. J Sci Med Sport 2024; 27:373-384. [PMID: 38508888 DOI: 10.1016/j.jsams.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES This scoping review aimed to summarize the findings of studies regarding the perceived impact of the menstrual cycle on athletic performance, as well as the prevalence of negative menstrual cycle symptoms. DESIGN Scoping review. METHODS Three databases were searched and the Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) was used as guidance. RESULTS A total of 39 studies were included in the final analysis. Between 2.8 and 100 % of athletes reported their performance being negatively impacted by their menstrual cycle, and the main reason was the occurrence of menstrual cycle symptoms. Additionally, a large variability in the prevalence of menstrual cycle symptoms was reported in the different studies mainly due to methodological differences and recall biases. CONCLUSIONS Similarly, as to what has been reported in reviews summarizing performance outcomes during different menstrual cycle phases, this review highlights the high degree of variability between how athletes perceive to be impacted by their menstrual/hormonal contraceptive cycle. REGISTRATION The protocol of this scoping review was registered at the Open Science Framework on 14 September 2023 (osf.io/efu9x).
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Affiliation(s)
- Chelsea Oester
- Western Sydney University, School of Health Sciences, Australia.
| | - Dean Norris
- Western Sydney University, School of Health Sciences, Australia. https://twitter.com/DNorrisSC
| | - Dawn Scott
- Washington Spirit, USA. https://twitter.com/DawnScott06
| | - Charles Pedlar
- St Mary's University, Faculty of Sport, Health and Applied Science, United Kingdom; National University of Ireland, Orreco Business Innovation Unit, Ireland; University College of London, Institute of Sport, Exercise and Health, United Kingdom. https://twitter.com/PedlarCR
| | - Georgie Bruinvels
- St Mary's University, Faculty of Sport, Health and Applied Science, United Kingdom; National University of Ireland, Orreco Business Innovation Unit, Ireland; University College of London, Institute of Sport, Exercise and Health, United Kingdom. https://twitter.com/GBruinvels
| | - Ric Lovell
- Western Sydney University, School of Health Sciences, Australia; University of Wollongong, Faculty of Science, Medicine and Health, Australia. https://twitter.com/Ric_Lovell
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Howe OR. Ethical Risks of Systematic Menstrual Tracking in Sport. JOURNAL OF BIOETHICAL INQUIRY 2024:10.1007/s11673-023-10333-9. [PMID: 38762835 DOI: 10.1007/s11673-023-10333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 05/20/2024]
Abstract
In this article it will be concluded that systematic menstrual tracking in women's sport has the potential to cause harm to athletes. Since the ruling of Dobbs v. Jackson Women's Health Organization (2022) in the United States, concerns regarding menstrual health tracking have arisen. Research suggests that the menstrual tracking of female athletes presents potential risks to "women's autonomy, privacy, and safety in sport" (Casto 2022, 1725). At present, the repercussions of systematic menstrual tracking are particularly under-scrutinized, and this paper seeks to combine novel research in the sport sciences with present ethical debates in the philosophy of sports. Utilizing Beauvoir's feminist philosophy (2011), this paper argues that systematic menstrual tracking may contribute to the wider system of women's oppression by exploiting female athletes, as well as enabling the internalization of submissive behaviour in cultures where athletes are expected to comply unquestioningly. Five policy recommendations are made concerning autonomy, informed consent, education, safeguarding and data access. The overall findings of this paper propose that a more in-depth understanding of the links between data, privacy, and the menstrual cycle are required by sports organizations and governing bodies if athletes are to be protected in a future where systematic menstrual tracking is inevitable.
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Affiliation(s)
- Olivia R Howe
- Faculty of Physical Education and Sport, Charles University, José Martího 269/31, 162 52, Prague 6, Veleslavín, Czech Republic.
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Flood TR, Clausen E, Kuikman MA, Smith E, McKay AKA, Burke LM, Elliott-Sale KJ. Auditing the representation of hormonal contraceptives in studies assessing exercise performance in women. J Sports Sci 2024; 42:825-839. [PMID: 38896557 DOI: 10.1080/02640414.2024.2368762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
Hormonal contraceptive (HC) users have a different ovarian hormonal profile compared to eumenorrheic women. Due to the prevalence of HC use amongst sportswomen, there has been increased research efforts to understand their impact on exercise performance. The aim was to audit this research. Studies identified were assessed for HC type, athlete calibre, performance outcome, study design, and quality of methodological control regarding ovarian hormonal profiles. Sixty-eight different HCs were reported across 61 studies. Monophasic combined oral contraceptive (OCP) pills represented 60% of HCs, followed by other pills [34%, phasic-combined, progestogen-only, and un-specified], phasic and long acting reversible contraceptives [5%, vaginal ring, patch, implant, injection, intrauterine system] and unspecified HCs (1%). Eleven percent of participants using HCs were classified as highly trained or elite/international with no participants being classed as world class. Whilst the number of studies involving HCs has increased two-fold over the past decade, the number of studies ranked as gold standard has not increased (HC; 2003-57%, 2011-55%, 2022-43%. OCP; 2003-14%, 2011-17%, 2022-12%). Future research assessing HCs and exercise performance should adopt high-quality research designs and include a broader range of HCs in highly trained to world-class populations to increase the reach and impact of research in this area.
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Affiliation(s)
- Tessa R Flood
- Department of Sport and Exercise Science, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Emma Clausen
- Department of Sport and Exercise Science, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Megan A Kuikman
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Ella Smith
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kirsty J Elliott-Sale
- Department of Sport and Exercise Science, Manchester Metropolitan University Institute of Sport, Manchester, UK
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7
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McKay AKA, Minahan C, Harris R, McCormick R, Skinner J, Ackerman KE, Burke LM. Female Athlete Research Camp: A Unique Model for Conducting Research in High-Performance Female Athletes. Med Sci Sports Exerc 2024; 56:706-716. [PMID: 38109054 DOI: 10.1249/mss.0000000000003354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
PURPOSE The purpose of this study is to describe the implementation of a novel research protocol for conducting research with highly trained female athletes, including characterizing menstrual cycle (MC) function, hormonal profiles and symptoms of the participating athletes. METHODS Twenty-four Australian First Nation female Rugby League athletes completed this study, which involved 11 wk of cycle tracking, followed by attendance at a 5-wk training camp. Throughout the study, athletes completed a daily survey, reporting their MC function and any associated symptoms. During the training camp, athletes reported to the laboratory on three occasions and provided a venous blood sample, which was analyzed for reproductive hormones. For naturally cycling athletes (athleteNC, n = 11), this included phase 1, 2, and 4 of the menstrual cycle, whereas athletes using hormonal contraception (athleteHC; n = 13) were tested at three equally spaced time points in which consistent exogenous hormone provision occurred. RESULTS In the athleteNC cohort, just one athlete reached criteria for classification as eumenorrheic, with five athletes showing evidence of MC dysfunction. The prevalence of symptoms on any given day was similar between athleteNC (33.7%) and athleteHC (22.9%; P = 0.376); however, more symptoms were reported in athleteNC, suggesting that they were more likely to report multiple symptoms. Regardless of MC function, there was a significant, positive association between bleeding and symptoms ( P < 0.001), where athletes were more likely to report one or more symptoms on bleeding (50.1%) compared with nonbleeding days (22.0%). CONCLUSIONS We describe an innovative strategy to investigate the effect of MC function and MC phase in a high-performance sport environment, including approaches to address the challenges of undertaking research with female athletes with MC variability and those using exogenous hormonal therapies.
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Affiliation(s)
- Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, AUSTRALIA
| | | | | | - Rachel McCormick
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, AUSTRALIA
| | | | - Kathryn E Ackerman
- Female Athlete Program, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, AUSTRALIA
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8
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Thompson SL, Brade CJ, Henley-Martin SR, Naylor LH, Spence AL. Vascular adaptation to exercise: a systematic review and audit of female representation. Am J Physiol Heart Circ Physiol 2024; 326:H971-H985. [PMID: 38391316 DOI: 10.1152/ajpheart.00788.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/24/2024]
Abstract
Biological sex is a salient factor in exercise-induced vascular adaptation. Although a male bias is apparent in the literature, the methodological quality of available studies in females is not yet known. This systematic review with narrative synthesis aimed to assess available evidence of exercise interventions on endothelial function, measured using flow-mediated dilation, in otherwise healthy individuals and athletes. A standardized audit framework was applied to quantify the representation of female participants. Using a tiered grading system, studies that met best-practice recommendations for conducting physiological research in females were identified. A total of 210 studies in 5,997 participants were included, with 18% classified as athletes. The primary exercise mode and duration were aerobic (49%) and acute (61%), respectively. Despite 53% of studies (n = 111) including at least one female, female participants accounted for only 39% of the total study population but 49% of the athlete population. Majority (49%) of studies in females were conducted in premenopausal participants. No studies in naturally menstruating, hormonal contraceptive-users or in participants experiencing menstrual irregularities met all best-practice recommendations. Very few studies (∼5%) achieved best-practice methodological guidelines for studying females and those that did were limited to menopause and pregnant cohorts. In addition to the underrepresentation of female participants in exercise-induced vascular adaptation research, there remains insufficient high-quality evidence with acceptable methodological control of ovarian hormones. To improve the overall methodological quality of evidence, adequate detail regarding menstrual status should be prioritized when including females in vascular and exercise research contexts.
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Affiliation(s)
- Sarah L Thompson
- Exercise Science, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Carly J Brade
- Exercise Science, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Sarah R Henley-Martin
- Exercise Science, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Louise H Naylor
- Cardiovascular Research Group, School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - Angela L Spence
- Exercise Science, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
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Klug P, Adams J, Lents G, Long R, Herda A, Vopat B, Vopat L. Auditing the Representation of Female Athletes in Sports Medicine Research: Fifth-Metatarsal Fractures. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241318. [PMID: 38584819 PMCID: PMC10996359 DOI: 10.1177/24730114241241318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Background Female representation within athletics has increased as a result of Title IX, rising popularity, demand for equal compensation, and greater participation in multiple sports. Despite this, gender disparities in sports medicine research are apparent. This project serves to review the literature available on fifth-metatarsal fractures and assess the representation of female athletes in current literature. Methods We used a standardized protocol to audit the representation of female athletes in sports science and sports medicine research for fifth-metatarsal fractures. Primary factors included population, athletic caliber, menstrual status, research theme, sample of males and females, journal impact factor, and Altmetric score. Results Thirty articles met the inclusion criteria. A total of 472 fifth-metatarsal fractures were identified, with 373 of 472 fractures (79%) occurring in males and 99 of 472 (21%) in females. The majority of studies (18/30, 60%) were mixed cohort, followed by 10 male only (33.33%), 1 female only (3.33%), and 1 male vs female (3.33%). Out of 831 total patients in the 18 mixed-cohort studies, 605 of 831 patients (72.8%) were male and 226 of 831 patients (27%) were female. All 18 mixed-sex cohorts investigated health outcomes. Male-only studies evaluated health outcomes and performance metrics. No studies investigated female performance. The one female-only study investigated health outcomes and was the only study to account for menstrual status. There was a single metatarsal fracture in this study population. Conclusion Females are underrepresented in research regarding sports science and sports medicine research for fifth-metatarsal fractures. Research focused on female-only fifth-metatarsal fracture studies exploring the potential impact of female sex-specific factors such as menstrual status in study design are needed.
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Affiliation(s)
- Peter Klug
- Kansas University Medical Center, Kansas City, KS, USA
| | - Jacob Adams
- Kansas University Medical Center, Kansas City, KS, USA
| | - Gordon Lents
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Rachel Long
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Ashley Herda
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS, USA
| | - Bryan Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Lisa Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
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Braman M, Root C, Harmon I, Long R, Vopat L, Vopat B, Herda A. Auditing the Representation of Female Athletes in Sports Medicine Research: Achilles Repair. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241255360. [PMID: 38827564 PMCID: PMC11143824 DOI: 10.1177/24730114241255360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
Background Establishing evidence-based recommendations specific to female athletes has been overlooked in sports medicine. Achilles tendon rupture is one of the most common musculoskeletal injuries, occurring in 15 to 55 per 100 000 people annually. Differences in injury rates could be due to hormonal effects, as estrogen receptors have been identified in tendons along with decreased tendon strain based on oral contraceptive use. The primary purpose of this study was to audit the representation of female athletes in the literature regarding Achilles repair. Methods An electronic search was performed using PubMed to identify articles related to Achilles repair using the protocol by Smith et al. Studies were assessed by population, size, athletic caliber, study impact, research theme, and menstrual status. Results Female representation across all studies was 1783 of 10 673 subjects (16.7%). Composition of included studies was predominantly mixed-sex cohorts with 131 of 169 (77.5%) included studies. Within mixed-sex cohort studies, the total representation of female athletes was 1654 of 8792 participants (18.9%). Thirty-two studies were male only, constituting 1540 participants, whereas 3 studies were female only composed of 86 athletes. Importantly, the disparity between male and female representation worsened as the athletic caliber of the study population increased, with 5.0% female representation in studies with professional athletes. No study collected data related to menstrual status and its potential relationship to Achilles rupture or postoperative outcomes. Conclusion Mixed-sex cohort studies underrepresented female athletes, and male-only cohort studies were more common than female-only studies. These findings indicate a need for increased representation of female athletes as well as acknowledgment of menstrual status in research related to Achilles repair. Future studies should focus on representation of female athletes and data collection related to sex-specific hormones, hormonal contraceptive use, and menstrual status to improve treatment of Achilles tendon ruptures for female athletes. Level of Evidence Level IV, case series.
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Affiliation(s)
- Michael Braman
- The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Cooper Root
- The University of Kansas School of Medicine, Kansas City, KS, USA
| | - Ian Harmon
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Rachel Long
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Lisa Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Bryan Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Ashley Herda
- Department of Health, Sport & Exercise Science, School of Education and Human Sciences, University of Kansas, Overland Park, KS, USA
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Kelly MK, Smith ES, Brown HA, Jardine WT, Convit L, Bowe SJ, Condo D, Guy JH, Burke LM, Périard JD, Snipe RMJ, Snow RJ, Carr AJ. Auditing the Representation of Females Versus Males in Heat Adaptation Research. Int J Sport Nutr Exerc Metab 2024; 34:111-121. [PMID: 38211577 DOI: 10.1123/ijsnem.2023-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/08/2023] [Accepted: 11/08/2023] [Indexed: 01/13/2024]
Abstract
The aim of this audit was to quantify female representation in research on heat adaptation. Using a standardized audit tool, the PubMed database was searched for heat adaptation literature from inception to February 2023. Studies were included if they investigated heat adaptation among female and male adults (≥18-50 years) who were free from noncommunicable diseases, with heat adaptation the primary or secondary outcome of interest. The number and sex of participants, athletic caliber, menstrual status, research theme, journal impact factor, Altmetric score, Field-Weighted Citation Impact, and type of heat exposure were extracted. A total of 477 studies were identified in this audit, including 7,707 participants with ∼13% of these being female. Most studies investigated male-only cohorts (∼74%, n = 5,672 males), with ∼5% (n = 360 females) including female-only cohorts. Of the 126 studies that included females, only 10% provided some evidence of appropriate methodological control to account for ovarian hormone status, with no study meeting best-practice recommendations. Of the included female participants, 40% were able to be classified to an athletic caliber, with 67% of these being allocated to Tier 2 (i.e., trained/developmental) or below. Exercise heat acclimation was the dominant method of heat exposure (437 interventions), with 21 studies investigating sex differences in exercise heat acclimation interventions. We recommend that future research on heat adaptation in female participants use methodological approaches that consider the potential impact of sexual dimorphism on study outcomes to provide evidence-based guidelines for female athletes preparing for exercise or competition in hot conditions.
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Affiliation(s)
- Monica K Kelly
- Centre for Sport Research, Deakin University, Burwood, VIC, Australia
| | - Ella S Smith
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Harry A Brown
- Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce, ACT, Australia
| | - William T Jardine
- Centre for Sport Research, Deakin University, Burwood, VIC, Australia
| | - Lilia Convit
- Centre for Sport Research, Deakin University, Burwood, VIC, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Burwood, VIC, Australia
- Faculty and School of Health, Victoria University of Wellington, Kelburn, Wellington, New Zealand
| | - Dominique Condo
- Centre for Sport Research, Deakin University, Burwood, VIC, Australia
| | - Joshua H Guy
- School of Health, Medical and Applied Sciences, Central Queensland University, Cairns, QLD, Australia
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Julien D Périard
- Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce, ACT, Australia
| | | | - Rodney J Snow
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
| | - Amelia J Carr
- Centre for Sport Research, Deakin University, Burwood, VIC, Australia
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Willmott AGB, Diment AG, Chung HC, James CA, Maxwell NS, Roberts JD, Gibson OR. Cross-adaptation from heat stress to hypoxia: A systematic review and exploratory meta-analysis. J Therm Biol 2024; 120:103793. [PMID: 38471285 DOI: 10.1016/j.jtherbio.2024.103793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Abstract
Cross-adaptation (CA) refers to the successful induction of physiological adaptation under one environmental stressor (e.g., heat), to enable subsequent benefit in another (e.g., hypoxia). This systematic review and exploratory meta-analysis investigated the effect of heat acclimation (HA) on physiological, perceptual and physical performance outcome measures during rest, and submaximal and maximal intensity exercise in hypoxia. Database searches in Scopus and MEDLINE were performed. Studies were included when they met the Population, Intervention, Comparison, and Outcome criteria, were of English-language, peer-reviewed, full-text original articles, using human participants. Risk of bias and study quality were assessed using the COnsensus based Standards for the selection of health status Measurement INstruments checklist. Nine studies were included, totalling 79 participants (100 % recreationally trained males). The most common method of HA included fixed-intensity exercise comprising 9 ± 3 sessions, 89 ± 24-min in duration and occurred within 39 ± 2 °C and 32 ± 13 % relative humidity. CA induced a moderate, beneficial effect on physiological measures at rest (oxygen saturation: g = 0.60) and during submaximal exercise (heart rate: g = -0.65, core temperature: g = -0.68 and skin temperature: g = -0.72). A small effect was found for ventilation (g = 0.24) and performance measures (peak power: g = 0.32 and time trial time: g = -0.43) during maximal intensity exercise. No effect was observed for perceptual outcome measures. CA may be appropriate for individuals, such as occupational or military workers, whose access to altitude exposure prior to undertaking submaximal activity in hypoxic conditions is restricted. Methodological variances exist within the current literature, and females and well-trained individuals have yet to be investigated. Future research should focus on these cohorts and explore the mechanistic underpinnings of CA.
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Affiliation(s)
- Ashley G B Willmott
- The Cambridge Centre for Sport and Exercise Sciences (CCSES), Anglia Ruskin University, East Road, Cambridge, United Kingdom; Environmental Extremes Laboratory, University of Brighton, Eastbourne, East Sussex, United Kingdom; Para-Monte Altitude Awareness Charity, Eastbourne, East Sussex, United Kingdom.
| | - Alicia G Diment
- The Cambridge Centre for Sport and Exercise Sciences (CCSES), Anglia Ruskin University, East Road, Cambridge, United Kingdom; Pulmonary Function Laboratory, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, United Kingdom.
| | - Henry C Chung
- School of Sport, Rehabilitation and Exercise Sciences (SRES), University of Essex, Colchester, Essex, United Kingdom.
| | - Carl A James
- Hong Kong Sports Institute, Sha Tin, Hong Kong, China; Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China.
| | - Neil S Maxwell
- Environmental Extremes Laboratory, University of Brighton, Eastbourne, East Sussex, United Kingdom; Para-Monte Altitude Awareness Charity, Eastbourne, East Sussex, United Kingdom.
| | - Justin D Roberts
- The Cambridge Centre for Sport and Exercise Sciences (CCSES), Anglia Ruskin University, East Road, Cambridge, United Kingdom.
| | - Oliver R Gibson
- Centre for Physical Activity in Health and Disease (CPAHD), Division of Sport, Health and Exercise Sciences, Brunel University London, Uxbridge, United Kingdom.
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13
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Nuzzo JL. Sex differences in skeletal muscle fiber types: A meta-analysis. Clin Anat 2024; 37:81-91. [PMID: 37424380 DOI: 10.1002/ca.24091] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/11/2023]
Abstract
Biopsies have been acquired from living men and women to determine proportions of Type I (slow-twitch) and II (fast-twitch) skeletal muscle fibers since the 1970s. Sex differences have been assumed but the literature has not been submitted to meta-analysis. Here, the aim was to generate effect sizes of sex differences in muscle fiber cross-sectional areas, distribution percentages, and area percentages. Data from 2875 men and 2452 women, who participated in 110 studies, were analyzed. Myofibrillar adenosine triphosphatase histochemistry was used in 71.8% of studies to classify fibers as Type I, II, IIA, and/or IIX; immunohistochemistry, immunofluorescence, or sodium dodecyl sulfate-polyacrylamide gel electrophoresis were used in 35.4% of studies to similarly classify myosin heavy chain (MHC) isoform content. Most studies involved biopsies from vastus lateralis (79.1%) in healthy individuals (92.7%) between 18 and 59 years old (80.9%). Men exhibited greater cross-sectional areas for all fiber types (g = 0.40-1.68); greater distribution percentages for Type II, MHC II, IIA, IIX fibers (g = 0.26-0.34); greater area percentages for Type II, IIA, MHC IIA, IIX fibers (g = 0.39-0.93); greater Type II/I and Type IIA/I fiber area ratios (g = 0.63, 0.94). Women exhibited greater Type I and MHC I distribution percentages (g = -0.13, -0.44); greater Type I and MHC I area percentages (g = -0.53, -0.69); greater Type I/II fiber area ratios (g = -1.24). These data, which represent the largest repository of comparative muscle fiber type data from living men and women, can inform discussions about biological sex and its impact on pathologies and sports performance (e.g., explaining sex differences in muscle strength and muscle endurance).
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Affiliation(s)
- James L Nuzzo
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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14
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Carr AJ, McKay AKA, Burke LM, Smith ES, Urwin CS, Convit L, Jardine WT, Kelly MK, Saunders B. Use of Buffers in Specific Contexts: Highly Trained Female Athletes, Extreme Environments and Combined Buffering Agents-A Narrative Review. Sports Med 2023; 53:25-48. [PMID: 37878211 PMCID: PMC10721675 DOI: 10.1007/s40279-023-01872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 10/26/2023]
Abstract
This narrative review evaluated the evidence for buffering agents (sodium bicarbonate, sodium citrate and beta-alanine), with specific consideration of three discrete scenarios: female athletes, extreme environments and combined buffering agents. Studies were screened according to exclusion and inclusion criteria and were analysed on three levels: (1) moderating variables (supplement dose and timing, and exercise test duration and intensity), (2) design factors (e.g., use of crossover or matched group study design, familiarisation trials) and (3) athlete-specific factors (recruitment of highly trained participants, buffering capacity and reported performance improvements). Only 19% of the included studies for the three buffering agents reported a performance benefit, and only 10% recruited highly trained athletes. This low transferability of research findings to athletes' real-world practices may be due to factors including the small number of sodium citrate studies in females (n = 2), no studies controlling for the menstrual cycle (MC) or menstrual status using methods described in recently established frameworks, and the limited number of beta-alanine studies using performance tests replicating real-world performance efforts (n = 3). We recommend further research into buffering agents in highly trained female athletes that control or account for the MC, studies that replicate the demands of athletes' heat and altitude camps, and investigations of highly trained athletes' use of combined buffering agents. In a practical context, we recommend developing evidence-based buffering protocols for individual athletes which feature co-supplementation with other evidence-based products, reduce the likelihood of side-effects, and optimise key moderating factors: supplement dose and timing, and exercise duration and intensity.
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Affiliation(s)
- Amelia J Carr
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Ella S Smith
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Charles S Urwin
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Lilia Convit
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - William T Jardine
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Monica K Kelly
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Bryan Saunders
- Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculdade de Medicina FMUSP, School of Physical Education and Sport, Universidade de São Paulo, University of São Paulo, São Paulo, Brazil
- Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
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15
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Fensham NC, Govus AD, Peeling P, Burke LM, McKay AKA. Factors Influencing the Hepcidin Response to Exercise: An Individual Participant Data Meta-analysis. Sports Med 2023; 53:1931-1949. [PMID: 37347443 DOI: 10.1007/s40279-023-01874-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Hepcidin, the master iron regulatory hormone, has been shown to peak 3-6 h postexercise, and is likely a major contributor to the prevalence of iron deficiency in athletes. Although multiple studies have investigated the hepcidin response to exercise, small sample sizes preclude the generalizability of current research findings. OBJECTIVE The aim of this individual participant data meta-analysis was to identify key factors influencing the hepcidin-exercise response. METHODS Following a systematic review of the literature, a one-stage meta-analysis with mixed-effects linear regression, using a stepwise approach to select the best-fit model, was employed. RESULTS We show that exercise is associated with a 1.5-2.5-fold increase in hepcidin concentrations, with pre-exercise hepcidin concentration accounting for ~ 44% of the variance in 3 h postexercise hepcidin concentration. Although collectively accounting for only a further ~ 3% of the variance, absolute 3 h postexercise hepcidin concentrations appear higher in males with lower cardiorespiratory fitness and higher pre-exercise ferritin levels. On the other hand, a greater magnitude of change between the pre- and 3 h postexercise hepcidin concentration was largely attributable to exercise duration (~ 44% variance) with a much smaller contribution from VO2max, pre-exercise ferritin, sex, and postexercise interleukin-6 (~ 6% combined). Although females tended to have a lower absolute 3 h postexercise hepcidin concentration [1.4 nmol·L-1, (95% CI [- 2.6, - 0.3]), p = 0.02] and 30% less change (95% CI [-54.4, - 5.1]), p = 0.02) than males, with different explanatory variables being significant between sexes, sample size discrepancies and individual study design biases preclude definitive conclusions. CONCLUSION Our analysis reveals the complex interplay of characteristics of both athlete and exercise session in the hepcidin response to exercise and highlights the need for further investigation into unaccounted-for mediating factors.
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Affiliation(s)
- Nikita C Fensham
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
| | - Andrew D Govus
- Discipline of Sport and Exercise Science, La Trobe University, Melbourne, VIC, Australia
| | - Peter Peeling
- University of Western Australia, Crawley, WA, Australia
- Western Australia Institute of Sport, Mt Claremont, WA, Australia
| | - Louise M Burke
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Alannah K A McKay
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
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16
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James JJ, Klevenow EA, Atkinson MA, Vosters EE, Bueckers EP, Quinn ME, Kindy SL, Mason AP, Nelson SK, Rainwater KAH, Taylor PV, Zippel EP, Hunter SK. Underrepresentation of women in exercise science and physiology research is associated with authorship gender. J Appl Physiol (1985) 2023; 135:932-942. [PMID: 37650136 DOI: 10.1152/japplphysiol.00377.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023] Open
Abstract
Historically, low representation of women participants in exercise science and physiology studies has led to a lack of understanding in the response of women to exercise and therapeutic interventions. We hypothesized that 1) the number of women authors, participants, and editorial board members increased over 30 years (1991-2021) and 2) larger representation of women as editors and authors is associated with more women participants. Gender (man/woman) of editorial board members (n = 394), authors (n = 5,735), and participants (n = 2,984,883) of 972 original research articles with human participants published in 1991 and 2021 was analyzed from three journals: Journal of Applied Physiology, Medicine and Science in Sports and Exercise, and British Journal of Sports Medicine. Between 1991 to 2021, the average percent women per article as participants (21.9 ± 31.7% vs. 36.3 ± 30.3%, respectively, P < 0.001), authors (16.4 ± 22.4% vs. 30.9 ± 24.0%, P < 0.001), and editorial board members (13.3 ± 5.4% vs. 41.5 ± 7.3%, P = 0.006) increased. In 2021, the gender proportion of participants in large datasets was similar (50.2 ± 20.2% women). However, studies with smaller datasets (i.e., <∼3,000 participants) included less women (35.6 ± 30.6%). Women participants (%) were less when the last author was a man rather than a woman in 1991 (19.9 ± 29.5% vs. 34.3 ± 42.2%) and 2021 (31.6 ± 27.7% vs. 51.7 ± 33.4%). In 2021, there was a positive correlation between author and participant gender (% women) (r = 0.42, P < 0.001). Our data suggest that the low representation of women in exercise science and physiology research could be resolved with equitable numbers of women authors and editors and by encouraging men authors to study both women and men participants.NEW & NOTEWORTHY Analysis of human applied physiology studies revealed that the representation of women authors, participants, and editorial board members increased over 30 years but remained lower than men in 2021. Larger representation of women editors and authors was associated with more women participants. Women authors assessed similar numbers of women and men participants, whereas men authors included less women. Equitable representation of women participants may be achieved by closing the gender gap in authorship and editorial board membership.
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Affiliation(s)
- Jessica J James
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States
| | - Emilie A Klevenow
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States
| | - Mira A Atkinson
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States
| | - Emma E Vosters
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States
| | - Elizabeth P Bueckers
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States
| | - Meagan E Quinn
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States
| | - Samantha L Kindy
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States
| | - Azara P Mason
- University School of Milwaukee, River Hills, Wisconsin, United States
| | | | | | | | | | - Sandra K Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, United States
- Athletic and Human Performance Research Center, Marquette University, Milwaukee, Wisconsin, United States
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17
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Dupuit M, Meignié A, Chassard T, Blanquet L, LeHeran J, Delaunay T, Bernardeau E, Toussaint JF, Duclos M, Antero J. On-Field Methodological Approach to Monitor the Menstrual Cycle and Hormonal Phases in Elite Female Athletes. Int J Sports Physiol Perform 2023; 18:1169-1178. [PMID: 37666497 DOI: 10.1123/ijspp.2022-0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Currently, there are no guidelines for implementing the monitoring of menstrual status, including the natural menstrual cycle (NC) or oral contraception (OC), in a sport setting. We aimed to provide a feasible, on-field methodological approach for monitoring NC and OC in female athletes. METHODS We developed a smartphone app with daily questionnaires to monitor both NC and OC phases in 19 elite female soccer players (23.7 [4.4] y) over 7 months. Adherence and compliance were evaluated. The NC and OC phases were based on calendar data to establish an individual menstrual profile for each athlete. RESULTS The initial questionnaire revealed that the vast majority of female players (80%) were interested in monitoring their menstrual status. The online monitoring yielded high athlete adherence (87.0% [14.2%]) with a slight decrease over the winter break and at the end of the championship, which necessitated adaptations to promote compliance. Monitoring identified the specific menstrual pattern of each athlete and highlighted large interindividual variability. CONCLUSION This study assesses, for the first time, the interest of female players in monitoring their menstrual status. It provides a new methodological approach, as well as guidelines for optimizing on-field monitoring. It also anticipates some obstacles sport staff may encounter when trying to implement such follow-up. It is essential to better understand the menstrual profile of athletes and determine its potential impacts on well-being and performance.
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Affiliation(s)
- Marine Dupuit
- Laboratory of Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne (UCA), Clermont-Ferrand, France
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Alice Meignié
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Tom Chassard
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Ludivine Blanquet
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | | | | | | | - Jean-François Toussaint
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
- CIMS, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Martine Duclos
- Sport Medicine and Functional Explorations, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
- Unité de Nutrition Humaine (UNH), Université Clermont Auvergne (UCA), INRA, Clermont-Ferrand, France
| | - Juliana Antero
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
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18
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BURKE LOUISEM, WHITFIELD JAMIE, ROSS MEGANLR, TEE NICOLIN, SHARMA AVISHP, KING ANDYJ, HEIKURA IDAA, MORABITO AIMEE, MCKAY ALANNAHKA. Short Severe Energy Restriction with Refueling Reduces Body Mass without Altering Training-Associated Performance Improvement. Med Sci Sports Exerc 2023; 55:1487-1498. [PMID: 36940222 PMCID: PMC10348613 DOI: 10.1249/mss.0000000000003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
PURPOSE We investigated short-term (9 d) exposure to low energy availability (LEA) in elite endurance athletes during a block of intensified training on self-reported well-being, body composition, and performance. METHODS Twenty-three highly trained race walkers undertook an ~3-wk research-embedded training camp during which they undertook baseline testing and 6 d of high energy/carbohydrate (HCHO) availability (40 kcal·kg FFM -1 ·d -1 ) before being allocated to 9 d continuation of this diet ( n = 10 M, 2 F) or a significant decrease in energy availability to 15 kcal·kg FFM -1 ·d -1 (LEA: n = 10 M, 1 F). A real-world 10,000-m race walking event was undertaken before (baseline) and after (adaptation) these phases, with races being preceded by standardized carbohydrate fueling (8 g·kg body mass [BM] -1 for 24 h and 2 g·kg BM -1 prerace meal). RESULTS Dual-energy x-ray absorptiometry-assessed body composition showed BM loss (2.0 kg, P < 0.001), primarily due to a 1.6-kg fat mass reduction ( P < 0.001) in LEA, with smaller losses (BM = 0.9 kg, P = 0.008; fat mass = 0.9 kg, P < 0.001) in HCHO. The 76-item Recovery-Stress Questionnaire for Athletes, undertaken at the end of each dietary phase, showed significant diet-trial effects for overall stress ( P = 0.021), overall recovery ( P = 0.024), sport-specific stress ( P = 0.003), and sport-specific recovery ( P = 0.012). However, improvements in race performance were similar: 4.5% ± 4.1% and 3.5% ± 1.8% for HCHO and LEA, respectively ( P < 0.001). The relationship between changes in performance and prerace BM was not significant ( r = -0.08 [-0.49 to 0.35], P = 0.717). CONCLUSIONS A series of strategically timed but brief phases of substantially restricted energy availability might achieve ideal race weight as part of a long-term periodization of physique by high-performance athletes, but the relationship between BM, training quality, and performance in weight-dependent endurance sports is complicated.
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Affiliation(s)
- LOUISE M. BURKE
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - JAMIE WHITFIELD
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - MEGAN L. R. ROSS
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - NICOLIN TEE
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | | | - ANDY J. KING
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - IDA A. HEIKURA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
- Canadian Sport Institute–Pacific, Victoria, British Columbia, CANADA
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, CANADA
| | - AIMEE MORABITO
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
| | - ALANNAH K. A. MCKAY
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, AUSTRALIA
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19
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Kelly MK, Bowe SJ, Jardine WT, Condo D, Guy JH, Snow RJ, Carr AJ. Heat Adaptation for Females: A Systematic Review and Meta-Analysis of Physiological Adaptations and Exercise Performance in the Heat. Sports Med 2023; 53:1395-1421. [PMID: 37222863 PMCID: PMC10289939 DOI: 10.1007/s40279-023-01831-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Heat adaptation regimes are used to prepare athletes for exercise in hot conditions to limit a decrement in exercise performance. However, the heat adaptation literature mostly focuses on males, and consequently, current heat adaptation guidelines may not be optimal for females when accounting for the biological and phenotypical differences between sexes. OBJECTIVES We aimed to examine: (1) the effects of heat adaptation on physiological adaptations in females; (2) the impact of heat adaptation on performance test outcomes in the heat; and (3) the impact of various moderators, including duration (minutes and/or days), total heat dose (°C.min), exercise intensity (kcal.min-1), total energy expended (kcal), frequency of heat exposures and training status on the physiological adaptations in the heat. METHODS SPORTDiscus, MEDLINE Complete and Embase databases were searched to December 2022. Random-effects meta-analyses for resting and exercise core temperature, skin temperature, heart rate, sweat rate, plasma volume and performance tests in the heat were completed using Stata Statistical Software: Release 17. Sub-group meta-analyses were performed to explore the effect of duration, total heat dose, exercise intensity, total energy expended, frequency of heat exposure and training status on resting and exercise core temperature, skin temperature, heart rate and sweat rate. An explorative meta-regression was conducted to determine the effects of physiological adaptations on performance test outcomes in the heat following heat adaptation. RESULTS Thirty studies were included in the systematic review; 22 studies were meta-analysed. After heat adaptation, a reduction in resting core temperature (effect size [ES] = - 0.45; 95% confidence interval [CI] - 0.69, - 0.22; p < 0.001), exercise core temperature (ES = - 0.81; 95% CI - 1.01, - 0.60; p < 0.001), skin temperature (ES = - 0.64; 95% CI - 0.79, - 0.48; p < 0.001), heart rate (ES = - 0.60; 95% CI - 0.74, - 0.45; p < 0.001) and an increase in sweat rate (ES = 0.53; 95% CI 0.21, 0.85; p = 0.001) were identified in females. There was no change in plasma volume (ES = - 0.03; 95% CI - 0.31, 0.25; p = 0.835), whilst performance test outcomes were improved following heat adaptation (ES = 1.00; 95% CI 0.56, 1.45; p < 0.001). Across all moderators, physiological adaptations were more consistently observed following durations of 451-900 min and/or 8-14 days, exercise intensity ≥ 3.5 kcal.min-1, total energy expended ≥ 3038 kcal, consecutive (daily) frequency and total heat dose ≥ 23,000 °C.min. The magnitude of change in performance test outcomes in the heat was associated with a reduction in heart rate following heat adaptation (standardised mean difference = - 10 beats.min-1; 95% CI - 19, - 1; p = 0.031). CONCLUSIONS Heat adaptation regimes induce physiological adaptations beneficial to thermoregulation and performance test outcomes in the heat in females. Sport coaches and applied sport practitioners can utilise the framework developed in this review to design and implement heat adaptation strategies for females.
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Affiliation(s)
- Monica K Kelly
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Steven J Bowe
- Deakin Biostatistics Unit, Faculty of Health, Deakin University, Burwood, VIC, Australia
- Faculty and School of Health, Victoria University of Wellington, Kelburn, Wellington, New Zealand
| | - William T Jardine
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Dominique Condo
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Joshua H Guy
- School of Health, Medical and Applied Sciences, Central Queensland University, Cairns, QLD, Australia
| | - Rodney J Snow
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
| | - Amelia J Carr
- Centre for Sport Research, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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20
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Ishida A, Draper G, White JB, Travis SK. Does Prematch Neuromuscular Performance Affect Running Performance in Collegiate Elite Female Soccer? J Strength Cond Res 2023; 37:854-858. [PMID: 36731019 DOI: 10.1519/jsc.0000000000004344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Ishida, A, Draper, G, White, JB, and Travis, SK. Does prematch neuromuscular performance affect running performance in collegiate elite female soccer? J Strength Cond Res 37(4): 854-858, 2023-The purpose of this study was to investigate whether prematch neuromuscular performance affected match physical performance by player position in Division I collegiate female soccer. Fourteen players participated (20.7 ± 1.3 years; 165.1 ± 6.0 cm; 63.3 ± 7.0 kg) in this study. Players were selected based on being free from injuries, playing for a duration of ≥72 minutes, and match intervals were ≥2 days. Data included 73 observations ( n = 5 defenders, n = 7 midfielders, and n = 2 forward) from 14 official matches. Prematch neuromuscular performance was assessed using countermovement jump (CMJ) with polyvinyl chloride pipe on dual force plates. Countermovement jump variables included jump height (JH) and relative peak power (RPP). Match physical performance included average speed, high-speed running (HSR), and number of high accelerations and decelerations. Linear mixed model was compiled with fixed effects of loaded with fixed effect of JH, RPP, and position and random effects per individual player. In CMJ and player position model, RPP was a significant predictor for average HSR ( p = 0.003) while fixed effects of JH and position were not significant ( p = 0.15-0.86). The fixed and random effects explained 34.8 and 42.1% of variances in average HSR. In CMJ-only model, RPP significantly predicted the variances in average HSR ( p = 0.001). The fixed effects and random effects of the model explained 22.7 and 51.8% of the variance in average HSR. However, position-only was not a significant predictor for average HSR in the position-only model ( p = 0.26 and 0.33). Prematch CMJ RPP may be the greatest predictor of average HSR in collegiate female soccer.
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Affiliation(s)
| | - Garrison Draper
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
- Philadelphia Union, Philadelphia, Pennsylvania
| | - Jason B White
- School of Applied Health Science and Wellness, Ohio University, Athens, Ohio; and
| | - S Kyle Travis
- Muscle Biology Laboratory, College of Public Health & Health Professions, Department of Physical Therapy, University of Florida, Gainesville, Florida
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21
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The sex gap in sports and exercise medicine research: who does research on females? Scientometrics 2023. [DOI: 10.1007/s11192-023-04641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AbstractFemales are underrepresented in sports and exercise medicine research, both as authors and as research participants. The aim of this study was therefore to explore who does sports and exercise medicine research on females. All original research articles with female-only samples published in six major sports and exercise medicine journals over a 7-year period (2014–2020; n = 334) were examined. Out of the 2027 authors of the articles in question, 1149 were categorized as male (56.7%) and 850 were categorized as female (41.9%; 28 [1.4%] could not be categorized). A slight majority of the articles had a female as first author (51.5%), while the majority of the last authors were male (62.3%). Binomial tests of proportions revealed that females were overrepresented in all author roles in this sample compared to the field at large, while chi-square tests of proportions indicated minimal variations in female authorship across the studied period. These findings indicate that females are relatively more likely to do research on females than males are, and that the rate of female authorship remained relatively constant over time.
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Thorpe H, Bekker S, Fullagar S, Mkumbuzi N, Nimphius S, Pape M, Sims ST, Travers A. Advancing feminist innovation in sport studies: A transdisciplinary dialogue on gender, health and wellbeing. Front Sports Act Living 2023; 4:1060851. [PMID: 36685066 PMCID: PMC9845704 DOI: 10.3389/fspor.2022.1060851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/01/2022] [Indexed: 01/06/2023] Open
Abstract
Athlete health and wellbeing requires a holistic, multidimensional approach to understanding, supporting, and treating individual athletes. Building more supportive, inclusive, and equitable environments for the health and wellbeing of women and gender expansive people further requires gender-responsive approaches that promote broader cultural change. Feminist sport and exercise medicine practitioners, sports scientists, and social science researchers are increasingly coming together in their efforts to do this work. However, working across disciplines inevitably includes an array of ontological, epistemological, and political challenges. In this paper, we offer a curated 'dialogue' with a group of feminist scholars engaged in research and practice across disciplines, bringing them together to discuss some of the most pressing gendered issues in sport today (i.e., ACL injury, concussion, menstruation in sport, mental health, gender categories). In so doing, we amplify the voices of those working (empirically and clinically) at the disciplinary intersections of gender, sport and health, and learn about some of the current and future possibilities for transdisciplinary innovations and strategies for building (responsiveness to) cultural change.
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Affiliation(s)
- Holly Thorpe
- School of Health, University of Waikato, Hamilton, New Zealand
| | - Sheree Bekker
- Department for Health, University of Bath, Bath, United Kingdom
| | - Simone Fullagar
- Department of Tourism, Sport and Hotel Management, Griffith University, Nathan, AU-QLD, Australia
| | | | - Sophia Nimphius
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, AU-WA, Australia
| | - Madeleine Pape
- Institute of Sports Science, Université de Lausanne, Lausanne, Switzerland
| | - Stacy T. Sims
- AUT Sports Performance Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - A. Travers
- Department of Sociology and Anthropology, Simon Fraser University, Burnaby, BC, Canada
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23
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McCormack TJ, Vopat ML, Rooker J, Tarakemeh A, Baker J, Templeton KJ, Mulcahey MK, Mullen SM, Schroeppel JP, Vopat BG. Sex-Based Differences in Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement: A Systematic Review. Orthop J Sports Med 2022; 10:23259671221137857. [PMID: 36452337 PMCID: PMC9703514 DOI: 10.1177/23259671221137857] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 08/30/2022] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND While sex-based differences in outcomes after hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) are often recorded, no studies have been dedicated to analyzing the literature as a whole. PURPOSE To investigate whether sex is a predictor of outcomes in studies evaluating hip arthroscopic surgery for FAIS. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, Embase, Cochrane, Ovid, and PubMed Central databases for English-language studies that evaluated sex-specific outcomes in human populations. The search terms used were as follows: ("Hip Arthroscopy") AND ("Femoroacetabular Impingement" OR "FAI") AND ("Sex" OR "Gender" OR "Male" OR "Female"). Studies with evidence levels 2 through 4 were included. The studies were then screened, followed by data extraction. Modified Harris Hip Score (mHHS) outcomes and return-to-sport (RTS) rates were recorded. These were analyzed using random-effects meta-analysis. Heterogeneity was calculated using the I 2 statistic. RESULTS Of 256 full-text articles screened, 48 articles were included in this analysis; of these, 14 studies (29%) concluded that female sex was a negative predictor of postoperative outcomes, while 6 studies (13%) found female sex to be positive predictor. The remaining 28 studies (58%) found no sex-based differences in postoperative outcomes. Of 7 studies (416 male and 519 female) included in the mHHS analysis, 2 studies concluded that male patients had significantly higher postoperative mHHS scores. Of 6 studies (502 male and 396 female) included in the RTS analysis, 1 study concluded that male patients had a significantly higher RTS rate. CONCLUSION Almost one-third of the included studies determined that female sex was a negative predictor of postoperative outcomes, 13% found female sex to be a positive predictor, and 58% found no sex-based differences. Our study illustrates an insufficiency of high-level evidence supporting sex-specific differences in outcomes after hip arthroscopic surgery, but findings indicated that the postoperative mHHS score and RTS rate may be influenced by sex.
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Affiliation(s)
| | | | - Jacob Rooker
- Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Medical Center, University of Kansas, Kansas City, Kansas, USA
| | - Jordan Baker
- Medical Center, University of Kansas, Kansas City, Kansas, USA
| | | | - Mary K. Mulcahey
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Scott M. Mullen
- Medical Center, University of Kansas, Kansas City, Kansas, USA
| | | | - Bryan G. Vopat
- Medical Center, University of Kansas, Kansas City, Kansas, USA
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24
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Shannon OM, Allen JD, Bescos R, Burke L, Clifford T, Easton C, Gonzalez JT, Jones AM, Jonvik KL, Larsen FJ, Peeling P, Piknova B, Siervo M, Vanhatalo A, McGawley K, Porcelli S. Dietary Inorganic Nitrate as an Ergogenic Aid: An Expert Consensus Derived via the Modified Delphi Technique. Sports Med 2022; 52:2537-2558. [PMID: 35604567 PMCID: PMC9474378 DOI: 10.1007/s40279-022-01701-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Dietary inorganic nitrate is a popular nutritional supplement, which increases nitric oxide bioavailability and may improve exercise performance. Despite over a decade of research into the effects of dietary nitrate supplementation during exercise there is currently no expert consensus on how, when and for whom this compound could be recommended as an ergogenic aid. Moreover, there is no consensus on the safe administration of dietary nitrate as an ergogenic aid. This study aimed to address these research gaps. METHODS The modified Delphi technique was used to establish the views of 12 expert panel members on the use of dietary nitrate as an ergogenic aid. Over three iterative rounds (two via questionnaire and one via videoconferencing), the expert panel members voted on 222 statements relating to dietary nitrate as an ergogenic aid. Consensus was reached when > 80% of the panel provided the same answer (i.e. yes or no). Statements for which > 80% of the panel cast a vote of insufficient evidence were categorised as such and removed from further voting. These statements were subsequently used to identify directions for future research. RESULTS The 12 panel members contributed to voting in all three rounds. A total of 39 statements (17.6%) reached consensus across the three rounds (20 yes, 19 no). In round one, 21 statements reached consensus (11 yes, 10 no). In round two, seven further statements reached consensus (4 yes, 3 no). In round three, an additional 11 statements reached consensus (5 yes, 6 no). The panel agreed that there was insufficient evidence for 134 (60.4%) of the statements, and were unable to agree on the outcome of the remaining statements. CONCLUSIONS This study provides information on the current expert consensus on dietary nitrate, which may be of value to athletes, coaches, practitioners and researchers. The effects of dietary nitrate appear to be diminished in individuals with a higher aerobic fitness (peak oxygen consumption [V̇O2peak] > 60 ml/kg/min), and therefore, aerobic fitness should be taken into account when considering use of dietary nitrate as an ergogenic aid. It is recommended that athletes looking to benefit from dietary nitrate supplementation should consume 8-16 mmol nitrate acutely or 4-16 mmol/day nitrate chronically (with the final dose ingested 2-4 h pre-exercise) to maximise ergogenic effects, taking into consideration that, from a safety perspective, athletes may be best advised to increase their intake of nitrate via vegetables and vegetable juices. Acute nitrate supplementation up to ~ 16 mmol is believed to be safe, although the safety of chronic nitrate supplementation requires further investigation. The expert panel agreed that there was insufficient evidence for most of the appraised statements, highlighting the need for future research in this area.
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Affiliation(s)
- Oliver M Shannon
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Jason D Allen
- Department of Kinesiology, School of Education and Human Development and Division of Cardiovascular Medicine, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Raul Bescos
- School of Health Professions, Faculty of Health, Plymouth Institute of Health and Care Research (PIHR), University of Plymouth, Plymouth, UK
| | - Louise Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Chris Easton
- Institute for Clinical Exercise and Health Sciences, University of the West of Scotland, Blantyre, UK
| | - Javier T Gonzalez
- Department for Health, University of Bath, Bath, UK
- Centre for Nutrition and Exercise Metabolism, University of Bath, Bath, UK
| | - Andrew M Jones
- Sport and Health Sciences, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Kristin L Jonvik
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Filip J Larsen
- Department of Physiology, Nutrition and Biomechanics, Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Peter Peeling
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, WA, Australia
| | | | - Mario Siervo
- School of Life Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Anni Vanhatalo
- Sport and Health Sciences, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, UK
| | - Kerry McGawley
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Simone Porcelli
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
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25
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Assessment of Exercise-Associated Gastrointestinal Perturbations in Research and Practical Settings: Methodological Concerns and Recommendations for Best Practice. Int J Sport Nutr Exerc Metab 2022; 32:387-418. [PMID: 35963615 DOI: 10.1123/ijsnem.2022-0048] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/26/2022] [Accepted: 07/07/2022] [Indexed: 12/14/2022]
Abstract
Strenuous exercise is synonymous with disturbing gastrointestinal integrity and function, subsequently prompting systemic immune responses and exercise-associated gastrointestinal symptoms, a condition established as "exercise-induced gastrointestinal syndrome." When exercise stress and aligned exacerbation factors (i.e., extrinsic and intrinsic) are of substantial magnitude, these exercise-associated gastrointestinal perturbations can cause performance decrements and health implications of clinical significance. This potentially explains the exponential growth in exploratory, mechanistic, and interventional research in exercise gastroenterology to understand, accurately measure and interpret, and prevent or attenuate the performance debilitating and health consequences of exercise-induced gastrointestinal syndrome. Considering the recent advancement in exercise gastroenterology research, it has been highlighted that published literature in the area is consistently affected by substantial experimental limitations that may affect the accuracy of translating study outcomes into practical application/s and/or design of future research. This perspective methodological review attempts to highlight these concerns and provides guidance to improve the validity, reliability, and robustness of the next generation of exercise gastroenterology research. These methodological concerns include participant screening and description, exertional and exertional heat stress load, dietary control, hydration status, food and fluid provisions, circadian variation, biological sex differences, comprehensive assessment of established markers of exercise-induced gastrointestinal syndrome, validity of gastrointestinal symptoms assessment tool, and data reporting and presentation. Standardized experimental procedures are needed for the accurate interpretation of research findings, avoiding misinterpreted (e.g., pathological relevance of response magnitude) and overstated conclusions (e.g., clinical and practical relevance of intervention research outcomes), which will support more accurate translation into safe practice guidelines.
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26
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Smith ES, McKay AKA, Kuikman M, Ackerman KE, Harris R, Elliott-Sale KJ, Stellingwerff T, Burke LM. Managing Female Athlete Health: Auditing the Representation of Female versus Male Participants among Research in Supplements to Manage Diagnosed Micronutrient Issues. Nutrients 2022; 14:3372. [PMID: 36014878 PMCID: PMC9412577 DOI: 10.3390/nu14163372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022] Open
Abstract
Micronutrient deficiencies and sub-optimal intakes among female athletes are a concern and are commonly prevented or treated with medical supplements. However, it is unclear how well women have been considered in the research underpinning current supplementation practices. We conducted an audit of the literature supporting the use of calcium, iron, and vitamin D. Of the 299 studies, including 25,171 participants, the majority (71%) of participants were women. Studies with exclusively female cohorts (37%) were also more prevalent than those examining males in isolation (31%). However, study designs considering divergent responses between sexes were sparse, accounting for 7% of the literature. Moreover, despite the abundance of female participants, the quality and quantity of the literature specific to female athletes was poor. Just 32% of studies including women defined menstrual status, while none implemented best-practice methodologies regarding ovarian hormonal control. Additionally, only 10% of studies included highly trained female athletes. Investigations of calcium supplementation were particularly lacking, with just two studies conducted in highly trained women. New research should focus on high-quality investigations specific to female athletes, alongside evaluating sex-based differences in the response to calcium, iron, and vitamin D, thus ensuring the specific needs of women have been considered in current protocols involving medical supplements.
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Affiliation(s)
- Ella S. Smith
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Alannah K. A. McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Megan Kuikman
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Kathryn E. Ackerman
- Wu Tsai Female Athlete Program, Boston Children’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Rachel Harris
- Female Athlete Performance and Health Initiative, Australian Institute of Sport, Canberra, ACT 2617, Australia
- Perth Orthopaedic and Sports Medicine Research Institute, West Perth, WA 6005, Australia
| | | | - Trent Stellingwerff
- Canadian Sport Institute-Pacific, Institute for Sport Excellence, 4371 Interurban Road, Victoria, BC V9E 2C5, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC V8P 5C2, Canada
| | - Louise M. Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
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Tarnowski CA, Rollo I, Carter JM, Lizarraga-Dallo MA, Oliva MP, Clifford T, James LJ, Randell RK. Fluid Balance and Carbohydrate Intake of Elite Female Soccer Players during Training and Competition. Nutrients 2022; 14:nu14153188. [PMID: 35956363 PMCID: PMC9370343 DOI: 10.3390/nu14153188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 02/06/2023] Open
Abstract
This study examined sweat rate, sweat sodium concentration [Na+], and ad-libitum carbohydrate and fluid intakes in elite female soccer players during training (n = 19) and a match (n = 8); eight completed both for comparisons. Body mass (kg) was obtained before and after exercise to calculate sweat rate. The sweat [Na+] was determined from absorbent patches on the thigh or back. Sweat rate, percentage body mass change, and sweat [Na+] for 19 players during training were 0.47 ± 0.19 L·h−1, +0.19 ± 0.65%, and 28 ± 10 mmol·L−1, respectively. Sweat rate was higher during a match (0.98 ± 0.34 L·h−1) versus training (0.49 ± 0.26 L·h−1, p = 0.007). Body mass losses were greater post-match (−1.12 ± 0.86%) than training (+0.29 ± 0.34%, p = 0.003). Sweat [Na+] was similar for training (29 ± 9 mmol·L−1) and a match (35 ± 9 mmol·L−1) (p = 0.215). There were no differences in match versus training carbohydrate intakes (2.0 ± 2.3 g·h−1, 0.9 ± 1.5 g·h−1, respectively, p = 0.219) or fluid intakes (0.71 ± 0.30 L·h−1, 0.53 ± 0.21 L·h−1, respectively, p = 0.114). In conclusion, female soccer players’ sweat rates were higher during a match than during training, and carbohydrate intakes were below recommendations for matches and training.
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Affiliation(s)
- Caroline A. Tarnowski
- Gatorade Sports Science Institute, PepsiCo Life Sciences, Global R&D, Leicestershire LE4 1ET, UK; (I.R.); (J.M.C.); (R.K.R.)
- Correspondence:
| | - Ian Rollo
- Gatorade Sports Science Institute, PepsiCo Life Sciences, Global R&D, Leicestershire LE4 1ET, UK; (I.R.); (J.M.C.); (R.K.R.)
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK; (T.C.); (L.J.J.)
| | - James M. Carter
- Gatorade Sports Science Institute, PepsiCo Life Sciences, Global R&D, Leicestershire LE4 1ET, UK; (I.R.); (J.M.C.); (R.K.R.)
| | | | - Mireia Porta Oliva
- FC Barcelona Medical Department, FC Barcelona, 08014 Barcelona, Spain; (M.A.L.-D.); (M.P.O.)
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK; (T.C.); (L.J.J.)
| | - Lewis J. James
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK; (T.C.); (L.J.J.)
| | - Rebecca K. Randell
- Gatorade Sports Science Institute, PepsiCo Life Sciences, Global R&D, Leicestershire LE4 1ET, UK; (I.R.); (J.M.C.); (R.K.R.)
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK; (T.C.); (L.J.J.)
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Badenhorst CE, Forsyth AK, Govus AD. A contemporary understanding of iron metabolism in active premenopausal females. Front Sports Act Living 2022; 4:903937. [PMID: 35966107 PMCID: PMC9366739 DOI: 10.3389/fspor.2022.903937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Iron metabolism research in the past decade has identified menstrual blood loss as a key contributor to the prevalence of iron deficiency in premenopausal females. The reproductive hormones estrogen and progesterone influence iron regulation and contribute to variations in iron parameters throughout the menstrual cycle. Despite the high prevalence of iron deficiency in premenopausal females, scant research has investigated female-specific causes and treatments for iron deficiency. In this review, we provide a comprehensive discussion of factors that influence iron status in active premenopausal females, with a focus on the menstrual cycle. We also outline several practical guidelines for monitoring, diagnosing, and treating iron deficiency in premenopausal females. Finally, we highlight several areas for further research to enhance the understanding of iron metabolism in this at-risk population.
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Affiliation(s)
- Claire E. Badenhorst
- School of Sport, Exercise, and Nutrition, College of Health, Massey University, Auckland, New Zealand
- *Correspondence: Claire E. Badenhorst
| | - Adrienne K. Forsyth
- School of Behavioural and Health Science, Australian Catholic University, Fitzroy, VIC, Australia
| | - Andrew D. Govus
- Discipline of Sport and Exercise, Department of Sport, Exercise, and Nutrition Science, La Trobe University, Melbourne, VIC, Australia
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29
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Keyes LE, Schlein SM, Brown AB, Polukoff NE, Byrne A, Pollock NW. Gender Distribution Associated With the Journal Wilderness & Environmental Medicine. Wilderness Environ Med 2022; 33:267-274. [PMID: 35753901 DOI: 10.1016/j.wem.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Publication and peer review are fundamental to career advancement in science and academic medicine. Studies demonstrate that women are underrepresented in science publishing. We evaluated the gender distribution of contributors to Wilderness & Environmental Medicine (WEM) from 2010 through 2019. METHODS We extracted author data from ScienceDirect, reviewer data from the WEM Editorial Manager database, and editorial board data from journal records. Gender (female and male) was classified using automated probability-based assessment with Genderize.io software. RESULTS A total of 2297 unique authors were published over the 10-y span, generating 3613 authorships, of which gender was classified for 96% (n=3480). Women represented 26% (n=572) of all authors, which breaks down to 22% of all, 19% of first, 28% of second, and 18% of last authorships. Women represented 20% of peer reviewers (508/2517), 20% of reviewers-in-training (19/72), and 16% of editorial board members (7/45). The proportion of female authors, first authors, and reviewers increased over time. Women received fewer invitations per reviewer than men (mean 2.1 [95% CI 2.0-2.3] vs 2.4 [95% CI 2.3-2.5]; P=0.004), accepted reviews at similar rates (mean 73 vs 71%; P=0.214), and returned reviews 1.4 d later (mean 10.4 [CI 9.5-11.3] vs 9.0 d [95% CI 8.5-9.6]; P=0.005). CONCLUSIONS While female representation increased over the study period, women comprise a minority of WEM authors, peer reviewers, and editorial board members. Gender equity could be improved by identifying and eliminating barriers to participation, addressing any potential bias in review processes, implementing strategies to increase female-authored submissions, and increasing mentorship and training.
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Affiliation(s)
- Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, CO.
| | - Sarah M Schlein
- Larner College of Medicine, University of Vermont, Burlington, VT
| | - Alainna B Brown
- School of Medicine, University of Washington, Seattle, WA; Department of Human Centered Design & Engineering, University of Washington, Seattle
| | | | | | - Neal W Pollock
- Department of Kinesiology, Université Laval, Quebec, Canada
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Auditing the Representation of Female Versus Male Athletes in Sports Science and Sports Medicine Research: Evidence-Based Performance Supplements. Nutrients 2022; 14:nu14050953. [PMID: 35267928 PMCID: PMC8912470 DOI: 10.3390/nu14050953] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Although sports nutrition guidelines promote evidence-based practice, it is unclear whether women have been adequately included in the underpinning research. In view of the high usage rates of performance supplements by female athletes, we conducted a standardised audit of the literature supporting evidence-based products: β-alanine, caffeine, creatine, glycerol, nitrate/beetroot juice and sodium bicarbonate. Within 1826 studies totalling 34,889 participants, just 23% of participants were women, although 34% of studies included at least one woman. Across different supplements, 0–8% of studies investigated women exclusively, while fewer (0–2%) were specifically designed to compare sex-based responses. The annual publication of female-specific studies was ~8 times fewer than those investigating exclusively male cohorts. Interestingly, 15% of the female participants were classified as international/world-class athletes, compared with 7% of men. Most studies investigated performance outcomes but displayed poorer representation of women (16% of participants), whereas health-focussed studies had the greatest proportion of female participants (35%). Only 14% of studies including women attempted to define menstrual status, with only three studies (~0.5%) implementing best practice methodologies to assess menstrual status. New research should target the efficacy of performance supplements in female athletes, and future sports nutrition recommendations should specifically consider how well female athletes have contributed to the evidence-base.
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