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Hunter SK, Senefeld JW. Sex differences in human performance. J Physiol 2024. [PMID: 39106346 DOI: 10.1113/jp284198] [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: 10/30/2023] [Accepted: 07/08/2024] [Indexed: 08/09/2024] Open
Abstract
Sex as a biological variable is an underappreciated aspect of biomedical research, with its importance emerging in more recent years. This review assesses the current understanding of sex differences in human physical performance. Males outperform females in many physical capacities because they are faster, stronger and more powerful, particularly after male puberty. This review highlights key sex differences in physiological and anatomical systems (generally conferred via sex steroids and puberty) that contribute to these sex differences in human physical performance. Specifically, we address the effects of the primary sex steroids that affect human physical development, discuss insight gained from an observational study of 'real-world data' and elite athletes, and highlight the key physiological mechanisms that contribute to sex differences in several aspects of physical performance. Physiological mechanisms discussed include those for the varying magnitude of the sex differences in performance involving: (1) absolute muscular strength and power; (2) fatigability of limb muscles as a measure of relative performance; and (3) maximal aerobic power and endurance. The profound sex-based differences in human performance involving strength, power, speed and endurance, and that are largely attributable to the direct and indirect effects of sex-steroid hormones, sex chromosomes and epigenetics, provide a scientific rationale and framework for policy decisions on sex-based categories in sports during puberty and adulthood. Finally, we highlight the sex bias and problem in human performance research of insufficient studies and information on females across many areas of biology and physiology, creating knowledge gaps and opportunities for high-impact studies.
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Affiliation(s)
- Sandra K Hunter
- Movement Science Program, School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathon W Senefeld
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, Illinois, USA
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García-Durán J, González-Jurado JA, Sánchez-Oliver AJ. Sports Supplement Consumption in 316 Federated Female Road Cyclists. Nutrients 2024; 16:2563. [PMID: 39125442 PMCID: PMC11314008 DOI: 10.3390/nu16152563] [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: 07/12/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Although the extensive use of sports supplements (SSs) is prevalent among cyclists, this area has been poorly explored; in fact, no studies have been conducted on this topic regarding women cyclists to date. This descriptive, cross-sectional study, which included 316 federated female road cyclists, aimed to analyze SS consumption patterns in relation to scientific evidence and various categories. SSs were categorized according to the groups and subgroups established by the Australian Sport Institute (AIS, 2023) based on the level of evidence supporting their use. The analysis found that 85.1% of the female road cyclists surveyed used SSs, with an average consumption of 7 ± 6 supplements per individual. Pharmacies (60.8%), dietitian-nutritionists (58.9%), and health status (60.1%) were the primary purchase location, source of information, and reason for use, respectively. The most frequently consumed supplements were sports bars (77.5%), sports gels (61.4%), and caffeine (49.1%). Significantly, 80% of the ten most commonly used supplements were from the group with the highest evidence level, as classified by the AIS, with an average intake of 5 ± 3 supplements per cyclist. In summary, the use of SSs is prevalent among female road cyclists, with reliable sources for both purchasing and obtaining advice on supplements.
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Affiliation(s)
- Jesús García-Durán
- Faculty of Sports Science, Pablo de Olavide University, 41013 Seville, Spain
| | - José Antonio González-Jurado
- Faculty of Sports Science, Pablo de Olavide University, 41013 Seville, Spain
- Research Center on Physical and Sports Performance, Pablo de Olavide University, 41013 Seville, Spain
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3
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Desai I, Wewege MA, Jones MD, Clifford BK, Pandit A, Kaakoush NO, Simar D, Hagstrom AD. The Effect of Creatine Supplementation on Resistance Training-Based Changes to Body Composition: A Systematic Review and Meta-analysis. J Strength Cond Res 2024:00124278-990000000-00483. [PMID: 39074168 DOI: 10.1519/jsc.0000000000004862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
ABSTRACT Desai, I, Wewege, MA, Jones, MD, Clifford, BK, Pandit, A, Kaakoush, NO, Simar, D, and Hagstrom, AD. The effect of creatine supplementation on resistance training-based changes to body composition: A systematic review and meta-analysis. J Strength Cond Res XX(X): 000-000, 2024-The purpose of this review was to determine the added effect of creatine supplementation on changes in body composition with resistance training in adults younger than 50 years. The review protocol was preregistered on the Open Science Framework (osf.io/x48a6/). Our primary outcome was lean body mass (LBM); secondary outcomes were body fat percentage (%) and body fat mass (kg). We performed a random-effects meta-analysis in R using the metafor package. Subgroup analyses were conducted to examine the effects of training status and use of a carbohydrate drink with creatine. We conducted a meta-regression to examine the moderating effect of total training volume. Statistical significance was set at p < 0.05. One thousand six hundred ninety-four records were screened, and 67 full-text articles were assessed for eligibility. Twelve studies were included in the meta-analysis. Fifty-two percentages of the studies had low risk, 41% some concerns, and 7% high risk of bias. Compared with resistance training (RT) alone, creatine supplementation increased LBM by 1.14 kg (95% CI 0.69 to 1.59), and reduced body fat percentage by -0.88% (95% CI -1.66 to -0.11) and body fat mass by -0.73 kg (95% CI -1.34 to -0.11). There were no differences between training status or carbohydrate subgroups. Training volume was not associated with effect size in all outcomes; 7 g or 0.3 g/kg of body mass of creatine per day is likely to increase LBM by 1 kg and reduce fat mass by 0.7 kg more than RT alone. Concurrent carbohydrate ingestion did not enhance the hypertrophy benefits of creatine.
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Affiliation(s)
- Imtiaz Desai
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Michael A Wewege
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; and
| | - Matthew D Jones
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Center for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; and
| | - Briana K Clifford
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Anurag Pandit
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Nadeem O Kaakoush
- School of Biomedical Sciences, University of New South Wales, Sydney, Australia
| | - David Simar
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Amanda D Hagstrom
- School of Health Sciences, University of New South Wales, Sydney, Australia
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Larrosa M, Gil-Izquierdo A, González-Rodríguez LG, Alférez MJM, San Juan AF, Sánchez-Gómez Á, Calvo-Ayuso N, Ramos-Álvarez JJ, Fernández-Lázaro D, Lopez-Grueso R, López-León I, Moreno-Lara J, Domínguez-Balmaseda D, Illescas-Quiroga R, Cuenca E, López T, Montoya JJ, Rodrigues-de-Souza DP, Carrillo-Alvarez E, Casado A, Rodriguez-Doñate B, Porta-Oliva M, Santiago C, Iturriaga T, De Lucas B, Solaesa ÁG, Montero-López MDP, Benítez De Gracia E, Veiga-Herreros P, Muñoz-López A, Orantes-Gonzalez E, Barbero-Alvarez JC, Cabeza-Ruiz R, Carnero-Diaz Á, Sospedra I, Fernández-Galván LM, Martínez-Sanz JM, Martín-Almena FJ, Pérez M, Guerra-Hernández EJ, López-Samanes Á, Sánchez-Oliver AJ, Domínguez R. Nutritional Strategies for Optimizing Health, Sports Performance, and Recovery for Female Athletes and Other Physically Active Women: A Systematic Review. Nutr Rev 2024:nuae082. [PMID: 38994896 DOI: 10.1093/nutrit/nuae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
CONTEXT Despite the progress toward gender equality in events like the Olympic Games and other institutionalized competitions, and the rising number of women engaging in physical exercise programs, scientific studies focused on establishing specific nutritional recommendations for female athletes and other physically active women are scarce. OBJECTIVE This systematic review aimed to compile the scientific evidence available for addressing the question "What dietary strategies, including dietary and supplementation approaches, can improve sports performance, recovery, and health status in female athletes and other physically active women?" DATA SOURCES The Pubmed, Web of Science, and Scopus databases were searched. DATA EXTRACTION The review process involved a comprehensive search strategy using keywords connected by Boolean connectors. Data extracted from the selected studies included information on the number of participants and their characteristics related to sport practice, age, and menstrual function. DATA ANALYSIS A total of 71 studies were included in this review: 17 focused on the analysis of dietary manipulation, and 54 focused on the effects of dietary supplementation. The total sample size was 1654 participants (32.5% categorized as competitive athletes, 30.7% as highly/moderately trained, and 37.2% as physically active/recreational athletes). The risk of bias was considered moderate, mainly for reasons such as a lack of access to the study protocol, insufficient description of how the hormonal phase during the menstrual cycle was controlled for, inadequate dietary control during the intervention, or a lack of blinding of the researchers. CONCLUSION Diets with high carbohydrate (CHO) content enhance performance in activities that induce muscle glycogen depletion. In addition, pre-exercise meals with a high glycemic index or rich in CHOs increase CHO metabolism. Ingestion of 5-6 protein meals interspersed throughout the day, with each intake exceeding 25 g of protein favors anabolism of muscle proteins. Dietary supplements taken to enhance performance, such as caffeine, nitric oxide precursors, β-alanine, and certain sport foods supplements (such as CHOs, proteins, or their combination, and micronutrients in cases of nutritional deficiencies), may positively influence sports performance and/or the health status of female athletes and other physically active women. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD480674.
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Affiliation(s)
- Mar Larrosa
- Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Angel Gil-Izquierdo
- Research Group on Food and Nutrition (ALINUT), University of Alicante, 03690 Alicante, Spain
- Quality, Safety, and Bioactivity of Plant Foods Group, Department of Food Science and Technology, CEBAS-CSIC, University of Murcia, 30100 Murcia, Spain
| | - Liliana Guadalupe González-Rodríguez
- Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, 28040 Madrid, Spain
- VALORNUT Research Group, Complutense University of Madrid, 28040 Madrid, Spain
| | - María José Muñoz Alférez
- Department of Physiology (Faculty of Pharmacy, Cartuja University Campus), Institute of Nutrition and Food Technology "José Mataix", University of Granada, 18071 Granada, Spain
| | - Alejandro F San Juan
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Natalia Calvo-Ayuso
- Departamento de Enfermería y Fisioterapia, Campus de Ponferrada, Universidad de León, 24401 Ponferrada, Spain
| | - Juan José Ramos-Álvarez
- School of Sport Medicine, Department of Radiology, Rehabilitation and Physiotherapy, Complutense University Madrid, 28040 Madrid, Spain
| | - Diego Fernández-Lázaro
- Department of Cellular Biology, Genetics, Histology and Pharmacology, Faculty of Health Sciences, University of Valladolid, 42004 Soria, Spain
- Neurobiology Research Group, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
| | - Raúl Lopez-Grueso
- Facultad de Ciencias de la Salud, Universidad Isabel I, 09003 Burgos, Spain
| | - Inmaculada López-León
- Departamento de Motricidad Humana y Rendimiento Deportivo, University of Seville, 41013 Seville, Spain
| | - Javier Moreno-Lara
- Departamento de Motricidad Humana y Rendimiento Deportivo, University of Seville, 41013 Seville, Spain
| | - Diego Domínguez-Balmaseda
- Facultad de Ciencias de la Actividad Física, Deporte y Fisioterapia, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Román Illescas-Quiroga
- Departamento de Enfermería y Fisioterapia, University of Alcala, 28805 Alcalá de Henares, Spain
| | - Eduardo Cuenca
- Academia de Guardias y Suboficiales de la Guardia Civil, 23440 Baeza, Spain
| | - Teba López
- Academia de Guardias y Suboficiales de la Guardia Civil, 23440 Baeza, Spain
| | - Juan José Montoya
- School of Sport Medicine, Department of Radiology, Rehabilitation and Physiotherapy, Complutense University Madrid, 28040 Madrid, Spain
| | - Daiana Priscila Rodrigues-de-Souza
- Departamento de Enfermería, Farmacología y Fisioterapia, 14004 Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain
| | - Elena Carrillo-Alvarez
- Global Research on Wellbeing (GRoW) Research Group, Blanquerna School of Health Sciences, University Ramon Llull, 08025 Barcelona, Spain
| | - Arturo Casado
- Centro de Investigación en Ciencias del Deporte, Universidad Rey Juan Carlos, 28943 Fuenlabrada, Spain
| | | | - Mireia Porta-Oliva
- Faculty of Food Technology, Autonomous University of Barcelona (UAB), Bellaterra, Spain
- FC Barcelona Medical Department, FC Barcelona, 08028 Barcelona, Spain
- Catalan School of Kinanthropometry, INEFC, 0838 Barcelona, Spain
| | - Catalina Santiago
- Facultad de Ciencias de la Actividad Física, Deporte y Fisioterapia, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Támara Iturriaga
- Facultad de Ciencias de la Actividad Física, Deporte y Fisioterapia, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Beatriz De Lucas
- Facultad de Ciencias de la Actividad Física, Deporte y Fisioterapia, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | | | | | - Elvira Benítez De Gracia
- Facultad de Ciencias de la Salud, Universidad Alfonso X El Sabio, 28691 Villanueva de la Cañada, Spain
| | - Pablo Veiga-Herreros
- Facultad de Ciencias de la Salud, Universidad Alfonso X El Sabio, 28691 Villanueva de la Cañada, Spain
| | - Alejandro Muñoz-López
- Departamento de Motricidad Humana y Rendimiento Deportivo, University of Seville, 41013 Seville, Spain
| | - Eva Orantes-Gonzalez
- Department of Sports and Computer Science, Faculty of Sports, University of Pablo de Olavide, 41013 Seville, Spain
| | | | - Ruth Cabeza-Ruiz
- Departamento de Motricidad Humana y Rendimiento Deportivo, University of Seville, 41013 Seville, Spain
| | - Ángel Carnero-Diaz
- Departamento de Educación Física y Deportiva, University of Seville, 41013 Seville, Spain
| | - Isabel Sospedra
- Nursing Department, Faculty of Health Sciences, University of Alicante, 03690 San Vicente del Raspeig, Spain
| | | | - José Miguel Martínez-Sanz
- Nursing Department, Faculty of Health Sciences, University of Alicante, 03690 San Vicente del Raspeig, Spain
| | | | - Margarita Pérez
- Department of Health and Human Performance, Faculty of Physical Activity and Sports Sciences (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Eduardo J Guerra-Hernández
- Departamento de Nutrición y Bromatología, Facultad de Farmacia, Universidad de Granada, 18011 Granada, Spain
| | - Álvaro López-Samanes
- Faculty of Human and Social Sciences, Universidad Pontificia Comillas, 28049 Madrid, Spain
| | - Antonio Jesús Sánchez-Oliver
- Departamento de Motricidad Humana y Rendimiento Deportivo, University of Seville, 41013 Seville, Spain
- Studies Research Group in Neuromuscular Responses (GEPREN), University of Lavras, 37203-202 Lavras, Brazil
| | - Raúl Domínguez
- Departamento de Motricidad Humana y Rendimiento Deportivo, University of Seville, 41013 Seville, Spain
- Studies Research Group in Neuromuscular Responses (GEPREN), University of Lavras, 37203-202 Lavras, Brazil
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Kuikman MA, McKay AKA, Minahan C, Harris R, Elliott-Sale KJ, Stellingwerff T, Smith ES, McCormick R, Tee N, Skinner J, Ackerman KE, Burke LM. Effect of Menstrual Cycle Phase and Hormonal Contraceptives on Resting Metabolic Rate and Body Composition. Int J Sport Nutr Exerc Metab 2024; 34:207-217. [PMID: 38653456 DOI: 10.1123/ijsnem.2023-0193] [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: 09/10/2023] [Revised: 01/17/2024] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
The cyclical changes in sex hormones across the menstrual cycle (MC) are associated with various biological changes that may alter resting metabolic rate (RMR) and body composition estimates. Hormonal contraceptive (HC) use must also be considered given their impact on endogenous sex hormone concentrations and synchronous exogenous profiles. The purpose of this study was to determine if RMR and dual-energy X-ray absorptiometry body composition estimates change across the MC and differ compared with HC users. This was accomplished during a 5-week training camp involving naturally cycling athletes (n = 11) and HC users (n = 7 subdermal progestin implant, n = 4 combined monophasic oral contraceptive pill, n = 1 injection) from the National Rugby League Indigenous Women's Academy. MC phase was retrospectively confirmed via serum estradiol and progesterone concentrations and a positive ovulation test. HC users had serum estradiol and progesterone concentrations assessed at the time point of testing. Results were analyzed using general linear mixed model. There was no effect of MC phase on absolute RMR (p = .877), relative RMR (p = .957), or dual-energy X-ray absorptiometry body composition estimates (p > .05). There was no effect of HC use on absolute RMR (p = .069), relative RMR (p = .679), or fat mass estimates (p = .766), but HC users had a greater fat-free mass and lean body mass than naturally cycling athletes (p = .028). Our findings suggest that RMR and dual-energy X-ray absorptiometry body composition estimates do not significantly differ due to changes in sex hormones in a group of athletes, and measurements can be compared between MC phases or with HC usage without variations in sex hormones causing additional noise.
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Affiliation(s)
- Megan A Kuikman
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Clare Minahan
- Griffith Sports Science, Griffith University, Gold Coast, QLD, Australia
- Female Performance and Health Initiative, Australian Institute of Sport, Canberra, ACT, Australia
| | - Rachel Harris
- Female Performance and Health Initiative, Australian Institute of Sport, Canberra, ACT, Australia
- Perth Orthopaedic and Sports Medicine Research Institute, West Perth, WA, Australia
| | - Kirsty J Elliott-Sale
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom
| | - Trent Stellingwerff
- Canadian Sport Institute-Pacific, Pacific Institute for Sport Excellence, Victoria, BC, Canada
- Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ella S Smith
- 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
| | - Nicolin Tee
- 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, USA
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
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Lima AB, Quinaud RT, Karasiak FC, Galvão LG, Gonçalves CE, Carvalho HM. Longitudinal Meta-Analysis of Peak Height Velocity in Young Female Athletes. Cureus 2024; 16:e59482. [PMID: 38826930 PMCID: PMC11142863 DOI: 10.7759/cureus.59482] [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] [Accepted: 04/26/2024] [Indexed: 06/04/2024] Open
Abstract
Growth patterns and biological milestones in youth sports are key to interpreting the development of young athletes. However, there is no analysis of longitudinal meta-analysis describing the growth of young female athletes. This longitudinal meta-analysis estimated growth curves and age at peak height velocity (PHV) in young female athletes based on anthropometric data from longitudinal studies found in the literature. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, studies with repeated measurements in young female athletes were identified from searches of four databases (MEDLINE, Web of Science, SCOPUS, and SPORTDiscus) without date restrictions through August 2023. We adapted our bias assessment criteria using the Cochrane risk of bias tool for randomized controlled trials as a reference. Bayesian multilevel modeling was used to perform a longitudinal meta-analysis to extract stature growth curves and age at PHV. Fourteen studies met our eligibility criteria. Twenty-one independent samples could be included in the analysis. Conditional on the data and models, the predicted mean age at PHV for female athletes was 11.18 years (90% CI: 8.62; 12.94). When studies were aggregated by sport in the models, the models could not capture sport-specific growth curves for stature and estimate a corresponding age at PHV. We provide the first longitudinal meta-analytic summary of pubertal growth and derive age at PHV in young female athletes. The meta-analysis predicted that age at PHV occurs at similar ages to those in the general pediatric population. The data pool was limited in sports and geographic distribution, emphasizing the need to promote longitudinal research in females across different youth sports contexts.
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Affiliation(s)
- Ahlan B Lima
- School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, BRA
| | - Ricardo T Quinaud
- Department of Physical Education, University of the Extreme South of Santa Catarina, Criciúma, BRA
| | - Fábio C Karasiak
- School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, BRA
| | - Luciano G Galvão
- School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, BRA
| | - Carlos E Gonçalves
- Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, PRT
| | - Humberto M Carvalho
- School of Sports, Federal University of Santa Catarina, Florianópolis, Santa Catarina, BRA
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7
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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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8
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Andjelkovic M, Paal P, Kriemler S, Mateikaite-Pipiriene K, Rosier A, Beidleman BA, Derstine M, Pichler Hefti J, Hillebrandt D, Horakova L, Jean D, Keyes LE. Nutrition in Women at High Altitude: A Scoping Review-UIAA Medical Commission Recommendations. High Alt Med Biol 2024; 25:9-15. [PMID: 37971430 DOI: 10.1089/ham.2023.0047] [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: 11/19/2023] Open
Abstract
Andjelkovic, Marija, Peter Paal, Susi Kriemler, Kaste Mateikaite-Pipiriene, Alison Rosier, Beth Beidleman, Mia Derstine, Jacqueline Pichler Hefti, David Hillebrandt, Lenka Horakova, Dominique Jean, and Linda E. Keyes. Nutrition in women at high altitude: a scoping review-UIAA Medical Commission recommendations. High Alt Med Biol. 25:9-15, 2024. Background: Nutritional concerns such as food composition, energy intake, and nutrient absorption are essential for performance at high altitude and may differ between men and women. We performed a scoping review to summarize what is currently known on nutrition for women during short-term, high-altitude, physically active sojourns. Methods: The UIAA Medical Commission convened an international team to review women's health issues at high altitude and to publish updated recommendations. Pertinent literature from PubMed and Cochrane was identified by keyword search combinations (including nutrition, metabolism, energy composition, micronutrients) with additional publications found by hand search. Results: We found 7,165 articles, of which 13 original articles assessed nutritional aspects in physically active women on short-term high-altitude sojourns, with other articles found by hand search. We summarize the main findings. Conclusions: Data on women's nutrition at altitude are very limited. Reduction in energy intake plus increased energy expenditure at high altitude can lead to unbalanced nutrition, negatively influencing high-altitude adaptation and physical performance. Therefore, adequate dietary and fluid intake is essential to maintaining energy balance and hydration at high altitude in women as in men. Iron supplementation should be considered for women with iron depletion before travel.
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Affiliation(s)
- Marija Andjelkovic
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Institute of Pharmacy, Singidunum University, Belgrade, Serbia
| | - Peter Paal
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St. John of God Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Susi Kriemler
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Kaste Mateikaite-Pipiriene
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Diaverum Dialysis Clinic, Elektrėnai, Lithuania
| | - Alison Rosier
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Beth A Beidleman
- U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Natick, Massachusetts, USA
| | - Mia Derstine
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jacqueline Pichler Hefti
- Swiss Sportclinic, Bern, Switzerland
- Department of Internal Medicine, Hospital Biel/Bienne, Biel, Switzerland
| | - David Hillebrandt
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- General Medical Practitioner, Holsworthy, Devon
| | - Lenka Horakova
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology, Perioperative and Intensive Care, Masaryk Hospital, Usti nad Labem, Czech Republic
| | - Dominique Jean
- Medical Commission of the International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Paediatrics, Infectious Diseases and Altitude Medicine, Grenoble, France
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
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9
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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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10
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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: 11] [Impact Index Per Article: 11.0] [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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11
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Wickham KA, Spriet LL. Food for thought: Physiological considerations for nutritional ergogenic efficacy. Scand J Med Sci Sports 2024; 34:e14307. [PMID: 36648389 DOI: 10.1111/sms.14307] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023]
Abstract
Top-class athletes have optimized their athletic performance largely through adequate training, nutrition, recovery, and sleep. A key component of sports nutrition is the utilization of nutritional ergogenic aids, which may provide a small but significant increase in athletic performance. Over the last decade, there has been an exponential increase in the consumption of nutritional ergogenic aids, where over 80% of young athletes report using at least one nutritional ergogenic aid for training and/or competition. Accordingly, due to their extensive use, there is a growing need for strong scientific investigations validating or invalidating the efficacy of novel nutritional ergogenic aids. Notably, an overview of the physiological considerations that play key roles in determining ergogenic efficacy is currently lacking. Therefore, in this brief review, we discuss important physiological considerations that contribute to ergogenic efficacy for nutritional ergogenic aids that are orally ingested including (1) the impact of first pass metabolism, (2) rises in systemic concentrations, and (3) interactions with the target tissue. In addition, we explore mouth rinsing as an alternate route of ergogenic efficacy that bypasses the physiological hurdles of first pass metabolism via direct stimulation of the central nervous system. Moreover, we provide real-world examples and discuss several practical factors that can alter the efficacy of nutritional ergogenic aids including human variability, dosing protocols, training status, sex differences, and the placebo effect. Taking these physiological considerations into account will strengthen the quality and impact of the literature regarding the efficacy of potential ergogenic aids for top-class athletes.
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Affiliation(s)
- Kate A Wickham
- Environmental Ergonomics Lab, Department of Kinesiology, Brock University, St. Catharines, Ontario, Canada
| | - Lawrence L Spriet
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
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12
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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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13
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D'Souza AC, Wageh M, Williams JS, Colenso-Semple LM, McCarthy DG, McKay AKA, Elliott-Sale KJ, Burke LM, Parise G, MacDonald MJ, Tarnopolsky MA, Phillips SM. Menstrual cycle hormones and oral contraceptives: a multimethod systems physiology-based review of their impact on key aspects of female physiology. J Appl Physiol (1985) 2023; 135:1284-1299. [PMID: 37823207 PMCID: PMC10979803 DOI: 10.1152/japplphysiol.00346.2023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/18/2023] [Accepted: 10/10/2023] [Indexed: 10/13/2023] Open
Abstract
Hormonal changes around ovulation divide the menstrual cycle (MC) into the follicular and luteal phases. In addition, oral contraceptives (OCs) have active (higher hormone) and placebo phases. Although there are some MC-based effects on various physiological outcomes, we found these differences relatively subtle and difficult to attribute to specific hormones, as estrogen and progesterone fluctuate rather than operating in a complete on/off pattern as observed in cellular or preclinical models often used to substantiate human data. A broad review reveals that the differences between the follicular and luteal phases and between OC active and placebo phases are not associated with marked differences in exercise performance and appear unlikely to influence muscular hypertrophy in response to resistance exercise training. A systematic review and meta-analysis of substrate oxidation between MC phases revealed no difference between phases in the relative carbohydrate and fat oxidation at rest and during acute aerobic exercise. Vascular differences between MC phases are also relatively small or nonexistent. Although OCs can vary in composition and androgenicity, we acknowledge that much more work remains to be done in this area; however, based on what little evidence is currently available, we do not find compelling support for the notion that OC use significantly influences exercise performance, substrate oxidation, or hypertrophy. It is important to note that the study of females requires better methodological control in many areas. Previous studies lacking such rigor have contributed to premature or incorrect conclusions regarding the effects of the MC and systemic hormones on outcomes. While we acknowledge that the evidence in certain research areas is limited, the consensus view is that the impact of the MC and OC use on various aspects of physiology is small or nonexistent.
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Affiliation(s)
- Alysha C D'Souza
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Mai Wageh
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Devin G McCarthy
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - 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
| | - Gianni Parise
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Mark A Tarnopolsky
- Department of Pediatrics, McMaster University Medical Center, Hamilton, Ontario, Canada
| | - Stuart M Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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14
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Burt LA, Wyatt PM, Morrison A, Boyd SK. Bone Quality in Competitive Athletes: A Systematic Review. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2023; 23:456-470. [PMID: 38037364 PMCID: PMC10696374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 12/02/2023]
Abstract
The study objective was to assess bone quality measured by high resolution peripheral quantitative computed tomography (HR-pQCT) in competitive athletes. Medline, EMBASE and Sport Discus were searched through May 2022. Prior to submission, a follow-up database search was performed (January 2023). Studies of competitive athletes using HR-pQCT to assess bone quality were included. Athletes were aged between 14 and 45 years. Data extraction included study design and location (country), skeletal imaging modality and site, bone variables and any additional musculoskeletal-related outcome. Information identifying sports and athletes were also extracted. This review included 14 manuscripts and a total of 928 individuals (male: n=75; female: n=853). Athletes comprised 78% (n=722) of the included individuals and 93% of athletes were female. Assessment scores indicate the studies were good to fair quality. The athletes included in this review can be categorized into three groups: 1) healthy athletes, 2) athletes with compromised menstrual function (e.g., amenorrhoea), and 3) athletes with compromised bone health (e.g., bone stress injuries). When assessing bone quality using HR-pQCT, healthy competitive athletes had denser, stronger and larger bones with better microarchitecture, compared with controls. However, the same cannot be said for athletes with amenorrhoea or bone stress injuries.
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Affiliation(s)
- Lauren A. Burt
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Paige M. Wyatt
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Canadian Sports Institute, Calgary, Canada
| | - Alida Morrison
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven K. Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
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15
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Elliott-Sale KJ, Ackerman KE, Lebrun CM, Minahan C, Sale C, Stellingwerff T, Swinton PA, Hackney AC. Feminae: an international multisite innovative project for female athletes. BMJ Open Sport Exerc Med 2023; 9:e001675. [PMID: 37808006 PMCID: PMC10551965 DOI: 10.1136/bmjsem-2023-001675] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Sufficient high-quality studies in sport science using women as participants are lacking, meaning that our knowledge and understanding of female athletes in relation to their ovarian hormone profiles is limited. Consortia can be used to pool talent, expertise and data, thus accelerating our learning on a given topic and reducing research waste through collaboration. To this end, we have assembled an international multisite team, described here, to investigate the effects of the menstrual cycle and contraceptive pill phase on aspects of exercise physiology and sports performance in female athletes. We intend to produce an adequately powered, high-quality dataset, which can be used to inform the practices of female athletes. Our approach will also employ research transparency-through the inclusion of a process evaluation-and reproducibility-through a standardised study protocol.
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Affiliation(s)
- Kirsty J Elliott-Sale
- Department of Sport and
Exercise Sciences, Manchester
Metropolitan University Institute of Sport, Manchester, UK
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete
Program, Division of Sports Medicine, Boston Children's
Hospital, Boston, MA, USA
- Neuroendocrine
Unit, Massachusetts General Hospital and Harvard Medical
School, Boston, MA, USA
| | - Constance M Lebrun
- Department of Family
Medicine, University of Alberta
Faculty of Medicine & Dentistry, Edmonton, Alberta,
Canada
| | - Clare Minahan
- Griffith Sports Science,
Griffith Health, Griffith
University, Gold Coast,
Queensland, Australia
| | - Craig Sale
- Department of Sport and
Exercise Sciences, Manchester
Metropolitan University Institute of Sport, Manchester, UK
| | | | - Paul A Swinton
- School of Health
Sciences, Robert Gordon
University, Aberdeen,
UK
| | - Anthony C Hackney
- Department of Exercise
& Sport Science – Department of Nutrition, The University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
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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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Tan R, Baranauskas MN, Karl ST, Ortiz de Zevallos J, Shei RJ, Paris HL, Wiggins CC, Bailey SJ. Effects of dietary nitrate supplementation on peak power output: Influence of supplementation strategy and population. Nitric Oxide 2023; 138-139:105-119. [PMID: 37438201 DOI: 10.1016/j.niox.2023.06.004] [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: 07/14/2023]
Abstract
Increasing evidence indicates that dietary nitrate supplementation has the potential to increase muscular power output during skeletal muscle contractions. However, there is still a paucity of data characterizing the impact of different nitrate dosing regimens on nitric oxide bioavailability and its potential ergogenic effects across various population groups. This review discusses the potential influence of different dietary nitrate supplementation strategies on nitric oxide bioavailability and muscular peak power output in healthy adults, athletes, older adults and some clinical populations. Effect sizes were calculated for peak power output and absolute and/or relative nitrate doses were considered where applicable. There was no relationship between the effect sizes of peak power output change following nitrate supplementation and when nitrate dosage when considered in absolute or relative terms. Areas for further research are also recommended including a focus on nitrate dosing regimens that optimize nitric oxide bioavailability for enhancing peak power at times of increased muscular work in a variety of healthy and disease populations.
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Affiliation(s)
- Rachel Tan
- Department of Sports Medicine, Pepperdine University, Malibu, CA, 90263, USA.
| | - Marissa N Baranauskas
- Department of Human Physiology & Nutrition, University of Colorado, Colorado Springs, CO, 80918, USA
| | - Sean T Karl
- Department of Sports Medicine, Pepperdine University, Malibu, CA, 90263, USA
| | | | - Ren-Jay Shei
- Indiana University Alumni Association, Indiana University, Bloomington, IN, 47408, USA
| | - Hunter L Paris
- Department of Sports Medicine, Pepperdine University, Malibu, CA, 90263, USA
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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18
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Tan R, Baranauskas MN, Karl ST, Ortiz de Zevallos J, Shei RJ, Paris HL, Wiggins CC, Bailey SJ. Effects of dietary nitrate supplementation on muscular power output: Influence of supplementation strategy and population. Nitric Oxide 2023:S1089-8603(23)00047-2. [PMID: 37244391 DOI: 10.1016/j.niox.2023.05.003] [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: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
Increasing evidence indicates that dietary nitrate supplementation has the potential to increase muscular power output during skeletal muscle contractions. However, there is still a paucity of data characterizing the impact of different nitrate dosing regimens on nitric oxide bioavailability its potential ergogenic effects across various population groups. This narrative review discusses the potential influence of different dietary nitrate supplementation strategies on nitric oxide bioavailability and muscular power output in healthy adults, athletes, older adults and some clinical populations. Areas for further research are also recommended including a focus individualized nitrate dosing regimens to optimize nitric oxide bioavailability and to promote muscular power enhancements in different populations.
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Affiliation(s)
- Rachel Tan
- Department of Sports Medicine, Pepperdine University, Malibu, CA, 90263, USA.
| | - Marissa N Baranauskas
- Department of Human Physiology & Nutrition, University of Colorado, Colorado Springs, CO, 80918, USA
| | - Sean T Karl
- Department of Sports Medicine, Pepperdine University, Malibu, CA, 90263, USA
| | | | - Ren-Jay Shei
- Indiana University Alumni Association, Indiana University, Bloomington, IN, 47408, USA
| | - Hunter L Paris
- Department of Sports Medicine, Pepperdine University, Malibu, CA, 90263, USA
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephen J Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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19
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Kuikman MA, Smith ES, McKay AKA, Ackerman KE, Harris R, Elliott-Sale KJ, Stellingwerff T, Burke LM. Fueling the Female Athlete: Auditing Her Representation in Studies of Acute Carbohydrate Intake for Exercise. Med Sci Sports Exerc 2023; 55:569-580. [PMID: 36251373 PMCID: PMC9924969 DOI: 10.1249/mss.0000000000003056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE The aim of this audit was to assess the representation of female athletes within the literature that has led to current guidelines for carbohydrate (CHO) intake in the acute periods surrounding exercise and the quality of this research. METHODS We conducted a standardized audit of research assessing CHO loading protocols, CHO mouth rinse, and CHO intake before, during, and after exercise. RESULTS A total of 937 studies were identified in this audit. There were a total of 11,202 participants across these studies, with only ~11% being women. Most studies involved male-only cohorts (~79%), with a mere 38 studies (~4%) involving female-only cohorts and 14 studies (~2%) including a methodological design for comparison of sex-based responses. The frequent use of incorrect terminology surrounding menstrual status and the failure of most studies (~69%) to provide sufficient information on the menstrual status of participants suggests incomplete understanding and concern for female-specific considerations among researchers. Of the 197 studies that included women, only 13 (~7%) provided evidence of acceptable methodological control of ovarian hormones, and no study met all best-practice recommendations. Of these 13 studies, only half also provided sufficient information regarding the athletic caliber of participants. The topics that received such scrutiny were CHO loading protocols and CHO intake during exercise. CONCLUSIONS The literature that underpins the current guidelines for CHO intake in the acute periods around exercise is lacking in high-quality research that can contribute knowledge specific to the female athlete and sex-based differences. New research that considers ovarian hormones and sex-based differences is needed to ensure that the recommendations for acute CHO fueling provided to female athletes are evidence based.
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Affiliation(s)
- Megan A Kuikman
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, AUSTRALIA
| | - Ella S 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
| | - Kathryn E Ackerman
- Female Athlete Program, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Kirsty J Elliott-Sale
- Department of Sport and Exercise Sciences, Institute of Sport, Manchester Metropolitan University, Manchester, UNITED KINGDOM
| | | | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, AUSTRALIA
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20
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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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21
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Moore SR, Gordon AN, Cabre HE, Hackney AC, Smith-Ryan AE. A Randomized Controlled Trial of Changes in Fluid Distribution across Menstrual Phases with Creatine Supplementation. Nutrients 2023; 15:nu15020429. [PMID: 36678300 PMCID: PMC9865497 DOI: 10.3390/nu15020429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
This study examined the effects of creatine (Cr) loading on body mass (BM) and fluid markers of total body water (TBW), extra-cellular fluid (ECF), and intra-cellular fluid (ICF) across the menstrual cycle (MC). Thirty moderately active females, either naturally-menstruating (NM) or using hormonal contraceptives (HC), were randomized to Cr (Cr; 4 × 5 g/day of creatine monohydrate for 5 days; n = 15) or a non-caloric placebo (PL; n = 15) using a double-blind, placebo-controlled design, with a menstrual phase crossover. BM, TBW, ECF, and ICF were measured at pre- and post-supplementation in randomized order of follicular phase (FP; NM: MC days 0−8, HC: inactive pill days) or luteal phase (LP; NM: ≤15 days from next projected cycle start date, HC: active pill days) using bioelectrical impedance spectroscopy. Acute hydration status and salivary estrogen were used as covariates. Change in BM was not different between groups across MC ([PL-Cr] Δ 0.40 ± 0.50 kg; p = 0.427) or between MC phase across groups ([FP-LP] Δ 0.31 ± 0.48 kg; p = 0.528). TBW (p = 0.802), ECF (p = 0.373), and ICF (p = 0.795) were not different between supplement groups at pre-supplementation/FP time points. There were no significant differences between the NM and HC subjects at any time point, for any outcome (p > 0.05). Following LP supplementation, significant changes were observed in TBW (Cr: Δ 0.83 ± 0.38 L, PL: Δ −0.62 ± 0.38 L; p = 0.021), ECF (Cr: Δ 0.46 ± 0.15 L, PL: Δ −0.19 ± 0.15 L; p = 0.013), and ICF (Cr: Δ 0.74 ± 0.23 L, PL: Δ −0.02 ± 0.23 L; p = 0.041). These data demonstrate an increase in all fluid compartments in the LP following Cr loading, without observed alterations in body weight for females.
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Affiliation(s)
- Sam R. Moore
- Applied Physiology Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Human Movement Science Curriculum, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amanda N. Gordon
- Applied Physiology Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Hannah E. Cabre
- Applied Physiology Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Human Movement Science Curriculum, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Anthony C. Hackney
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Abbie E. Smith-Ryan
- Applied Physiology Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Human Movement Science Curriculum, Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Correspondence: ; Tel.: +1-919-962-2574
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22
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Colenso-Semple LM, D'Souza AC, Elliott-Sale KJ, Phillips SM. Current evidence shows no influence of women's menstrual cycle phase on acute strength performance or adaptations to resistance exercise training. Front Sports Act Living 2023; 5:1054542. [PMID: 37033884 PMCID: PMC10076834 DOI: 10.3389/fspor.2023.1054542] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction The bias towards excluding women from exercise science research is often due to the assumption that cyclical fluctuations in reproductive hormones influence resistance exercise performance and exercise-induced adaptations. Methods Hence, the purpose of this umbrella review was to examine and critically evaluate the evidence from meta-analyses and systematic reviews on the influence of menstrual cycle phase on acute performance and chronic adaptations to resistance exercise training (RET). Results We observed highly variable findings among the published reviews on the ostensible effects of female sex hormones on relevant RET-induced outcomes, including strength, exercise performance, and hypertrophy. Discussion We highlight the importance of comprehensive menstrual cycle verification methods, as we noted a pattern of poor and inconsistent methodological practices in the literature. In our opinion, it is premature to conclude that short-term fluctuations in reproductive hormones appreciably influence acute exercise performance or longer-term strength or hypertrophic adaptations to RET.
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Affiliation(s)
| | - Alysha C. D'Souza
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | | | - Stuart M. Phillips
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
- Correspondence: Stuart M. Phillips
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23
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Hutchins KP, Minett GM, Stewart IB. Treating exertional heat stroke: Limited understanding of the female response to cold water immersion. Front Physiol 2022; 13:1055810. [PMID: 36505067 PMCID: PMC9732943 DOI: 10.3389/fphys.2022.1055810] [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: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 11/26/2022] Open
Abstract
According to an expansive body of research and best practice statements, whole-body cold water immersion is the gold standard treatment for exertional heat stroke. However, as this founding evidence was predominantly drawn from males, the current guidelines for treatment are being applied to women without validation. Given the recognised differences in thermal responses experienced by men and women, all-encompassing exertional heat stroke treatment advice may not effectively protect both sexes. In fact, recent evidence suggests that hyperthermic women cool faster than hyperthermic men during cold water immersion. This raises the question of whether overcooling is risked if the present guidelines are followed. The current mini-review examined the literature on women's response to cold water immersion as a treatment for exertional heat stroke and aimed to clarify whether the current guidelines have appropriately considered research investigating women. The potential implications of applying these guidelines to women were also discussed.
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24
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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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