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Acute Effect of Heavy Weightlifting on the Pelvic Floor Muscles in Strength-Trained Women: An Experimental Crossover Study. Med. Sci. Sports Exerc., Vol. 56, No. 1, pp. 37-43, 2024. Introduction/Purpose: Heavy lifting may produce strain on the pelvic floor muscles (PFM) due to high increases in intra-abdominal pressure, but knowledge of the impact of weightlifting on the PFM is lacking. Therefore, this study aimed to investigate acute effects of heavy weightlifting on the PFM in strength-trained women and whether general strength in whole-body exercises correlated to PFM strength. Methods: Forty-seven nulliparous women between 18 and 35 yr who regularly performed weightlifting and were able to lift their own body weight ( 1.2 in back squat and 1.5 in deadlift were included in this experimental crossover study. They participated in baseline evaluations (questionnaire/measurements of background characteristics and pelvic floor disorders, one-repetition maximum (1RM) tests in back squat and deadlift) and one test day where they were randomized to start with 60 min of weightlifting (four sets of four repetitions at 75%–85% of 1RM in back squat and deadlift) or seated rest of 60 min. Vaginal pressure measurements of PFM resting pressure, strength, and endurance and surface electromyography measurements of PFM resting activity were performed before/after weightlifting and rest. Results: No statistically significant differences were found when comparing the change in PFM resting pressure, strength, endurance, and resting activity after heavy weightlifting and rest. There were no statistically significant correlations between PFM strength and maximum (1RM) or relative strength (1RM/bodyweight) in either back squat or deadlift. Conclusions: Our results imply that heavy weightlifting is well tolerated by the PFM in short term among young, nulliparous, and strength-trained women. Strength in whole-body exercises was not correlated to PFM strength. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the menstrual cycle (MC) characteristics, explore the impact on performance, and identify barriers to and facilitators of MC‐related communication among high‐performance female adolescent athletes in Singapore. Ninety athletes (15.4 ± 1.8 years) from multiple sports completed an online questionnaire. Eighty‐four athletes were postmenarcheal (menarcheal age 11.9 ± 1.3 years), including two who were using an oral contraceptive pill (OCP). Secondary amenorrhea, current or history of, was self‐reported in 16% of athletes. Sixty‐two percent and 67% of non‐OCP athletes perceived that the MC affected their ability to train and compete, respectively. Athletes preferred speaking to a parent (85%) and a female figure (67%) about MC‐related concerns. Through thematic analysis, three barriers to communication were constructed: (1) pervasive menstrual stigma, (2) constraints of the training environment, and (3) the low value placed on MC‐related conversations. Two facilitators of communication were constructed: (1) respect athletes' individual experiences as menstruating girls and (2) foster a safe space for MC‐related conversations. Findings demonstrated that menstrual irregularities are common in adolescent athletes and screening for MC disorders, particularly primary amenorrhea should be undertaken in this population, with clear support pathways for management including symptom mitigation. To support athletes in raising MC‐related concerns when needed, structured communication pathways that consider individual preferences and involve a (female) point of contact should be established within the training environment. Improving menstrual health literacy among adolescent athletes before any misinformation or negative perceptions are firmly established may contribute to longevity in their athletic careers. [ABSTRACT FROM AUTHOR]

Much study focuses on the effects of unavoidable injuries in sparring (i.e. contact injuries). However, the majority of martial arts injuries occur during training, rather than competition. Many common martial arts injuries, from ligament tears to ankle sprains, could be prevented with appropriate prehabilitation. With an emphasis on tradition, recreational martial arts clubs have not yet widely adopted modern prehabilitation exercises, which are particularly crucial given the higher rates of preventable injuries in the female athlete and national efforts to increase participation of women in sport. We reviewed the literature to identify injury prevalence and mechanism in martial arts striking sports (MASS). Given the lack of data on female martial artists, we also reviewed common injuries in female athletes engaging in high impact sport. We then identified sport-specific evidence-based interventions using a combination of literature review and Physiotec exercise video library and filtered this through the constraints of recreational martial arts environments to develop a cohesive, useable prehabilitation programme for MASS. We propose a programme of 12 exercises for injury prevention in martial arts striking sports (MASS-12). We emphasise the importance of biomechanical retraining to ameliorate the heightened risk in the female athlete while targeting common injuries across all sexes in martial arts. Hip-knee-ankle alignment is key to injury prevention in MASS, while improved injury surveillance across recreational MASS is needed for future intervention. [ABSTRACT FROM AUTHOR]

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Purpose: The female athlete triad is a condition of low energy availability, menstrual dysfunction, and low bone mineral density familiar to dancers and weight-class athletes. This study investigated the prevalence of the female athlete triad components and risk factors. The elements and risk factors were discussed in light of the sources of nutritional information and factors that affected the daily dietary intake of female athletes and dancers. Materials and Methods: Fifty-four (54) female athletes and dancers (18.96 ± 3.49 years old) answered a survey questionnaire about years of formal dance or sports training, sources of nutritional information, factors that affected their daily food choices, menstrual history, and injury history. Energy availability was estimated using the Low Energy Availability in Females Questionnaire (LEAF-Q; MELIN et al., 2014). Results and Conclusion: Twenty-one participants (38.90 %) had a risk of low energy availability, while 28 participants (51.90 %) had menstrual dysfunction. Twenty participants (37%) had a history of musculoskeletal injuries. The mean body mass index was 20.46 ± 4.08, and the mean percent body fat was 18.19 ± 5.73%. The primary sources of nutritional information were coaches, peers, and magazines. Personal preference, convenience, and parents were the main factors that affected daily food choices. The prevalence of the Female Athlete Triad components and risk factors was relatively high. The presence of the components and risk-factors should alarm coaches, trainers, and parents for further tests and proper intervention measures. [ABSTRACT FROM AUTHOR]

Background: Approximately 1 in 4 athletes returning to sports will sustain a second anterior cruciate ligament (ACL) injury. Psychological factors related to kinesiophobia, confidence, and psychological readiness are associated with second ACL injury; however, the evidence is conflicting. Hypothesis: Athletes who sustain a second ACL injury (ie, graft rupture or contralateral ACL rupture) within 2 years of ACL reconstruction (ACLR) would have greater kinesiophobia, less confidence, and lower psychological readiness prior to return to sport (RTS) compared with athletes who do not sustain a second ACL injury. Study Design: Secondary analysis of a prospective randomized trial. Level of Evidence: Level 3. Methods: A total of 39 female Level I/II athletes completed the following measures after postoperative rehabilitation and a 10-session RTS and second ACL injury prevention program: ACL Return to Sport after Injury (ACL-RSI) scale, the 11-item Tampa Scale of Kinesiophobia (TSK-11), and question 3 on the Knee injury and Osteoarthritis Outcome Score (KOOS) quality of life (QoL) subscale. Athletes were dichotomized based on whether they sustained a second ACL injury within 2 years of ACLR or not. Independent t tests determined group differences in TSK-11, KOOS-QoL, ACL-RSI, and the 3 individual components of the ACL-RSI (ie, emotions, confidence, risk appraisal). Results: Nine athletes sustained a second ACL injury (4 graft ruptures and 5 contralateral ACL ruptures). The group that sustained a second ACL injury had higher scores on the ACL-RSI (P = 0.03), higher on the risk appraisal questions of the ACL-RSI (P < 0.01), and met RTS criteria sooner than athletes who did not (P = 0.04). All second ACL injuries occurred in athletes who underwent primary ACLR with hamstring tendon autografts. Conclusion: Athletes who sustained a second ACL within 2 years of ACLR had a more positive psychological outlook, higher scores on the specific questions related to the risk appraisal construct of the ACL-RSI, and met RTS criteria sooner than athletes who did not sustain a second ACL injury. Clinical Relevance: Counseling athletes about delaying RTS to reduce the risk of second ACL injury may be especially important in athletes who display high psychological readiness and meet RTS criteria sooner. [ABSTRACT FROM AUTHOR]

Relative age effects (RAEs) are commonly associated with advantages for older athletes. However, a variety of benefits attributed to 'advantage reversals' have been observed among relatively younger professional athletes. Considering psychosocial development as a proposed mechanism, the purpose of this study was twofold: (1) To explore an association between developmental assets (i.e., facilitators of positive youth development [PYD]) and RAEs; (2) To assess whether overall developmental asset levels are protective against sport dropout. The Developmental Assets Profile© was distributed to members of a one-year cohort of post-adolescent, female soccer players from Ontario, Canada. The presence of differences between groups of relatively older (H1; n = 64) and younger (H2; n = 57) participants and developmental asset scales were assessed using discriminant analysis. A binary logistic regression was conducted to assess whether overall developmental asset levels are protective against sport dropout, with consideration of relevant factors. Findings suggest that relatively younger, female players score higher in two internal categories: commitment to learning and positive values. The overall developmental asset scores were not found to be protective against dropout. This study provides preliminary, albeit cautious, support that 'advantage reversals' may be in part associated with enhanced PYD resulting from developmental sport experiences. [ABSTRACT FROM AUTHOR]

Over the past ten years there has been a dramatic rise in female sport participation and accompanying female professional national leagues across multiple sports, yet research has not followed suit. Although there are known variations between female and male physiology, training protocols in female sport are predominantly underpinned by research undertaken in male athletes. The hormonal variability experienced by women across the menstrual cycle, as well as the menstrual cycle variability between women, may contribute to the complexity of conducting rigorous physiological studies, leading to a paucity of robust sports-specific research that can be confidently applied to female athletes. Moreover, barriers exist in female sport that potentially limit the ability to conduct research, including the lack of full-time programs and limited resources. Recently, there has been increased interest in the potential effects of fluctuations in the female sex hormones, progesterone and oestrogen, on sport performance across different phases of the menstrual cycle. However, current research evaluating the menstrual cycle and physical performance (such as strength, speed, aerobic fitness, and athletes' perception of their performance) have shown inconsistent results. Additionally, methodological design across studies has shown little consistency, making it difficult to draw firm conclusions, which potentially prevents female athletes optimising their physical and sporting performance. It further impacts coaches and sports science researchers in their ability to provide appropriate training recommendations and educational opportunities. It is important to progress in female athlete research with an understanding of how the unique physiology of female athletes may influence their ability to physically perform in their respective sport, which requires representation in sports science research. This paper will provide an overview on current evidence and limitations within menstrual cycle research and provide considerations and directions for future research in this space within team sports. [ABSTRACT FROM AUTHOR]

BackgroundProblematic low energy availability (EA) is the underlying culprit of relative energy deficiency in sport (REDs), and its consequences have been suggested to be exacerbated when accompanied by low carbohydrate (CHO) intakes.ObjectivesThis study compared dietary intake, nutrition status and occurrence of REDs symptoms in groups of female athletes, displaying different patterns of EA and CHO intake.MethodsFemale athletes (n = 41, median age 20.4 years) from various sports weighed and recorded their food intake and training for 7 consecutive days via a photo-assisted mobile application. Participants were divided into four groups based on patterns of EA and CHO intakes: sufficient to optimal EA and sufficient to optimal CHO intake (SEA + SCHO), SEA and low CHO intake (SEA + LCHO), low energy availability and SCHO (LEA + SCHO), and LEA and LCHO (LEA + LCHO). SEA patterns were characterised by EA ≥30 and LEA by EA

The roles of 17β estradiol (E2) and progesterone (P4), the primary female sex hormones, are pivotal in regulating various aspects of metabolism. E2 influences food intake, energy expenditure, adipose tissue distribution, and insulin sensitivity across multiple tissues. Meanwhile, P4 impacts energy expenditure, electrolyte balance, amino acid oxidation, muscle protein synthesis, and glucose metabolism. The interactions between these hormones affect macronutrient utilization, both at rest and during exercise. Acknowledging the need to incorporate sex hormone perturbations in research, this paper explores the current landscape of study design and menstrual cycle tracking for female-specific sport research. It emphasizes the importance of standardization in terminology, hormone phases, reference values, and affordable hormone detection methods to advance our understanding of how the menstrual cycle influences female athletes.

Yuka Tsukahara,1 Satoshi Kodama,2 Saaya Kikuchi,1 Carly Day3,4 1Department of Sports Medicine, Tokyo Women’s College of Physical Education, Kuitachi, Tokyo, Japan; 2Department of Neurology, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan; 3Department of Health and Kinesiology, Purdue University, West Lafayette, IN, USA; 4Franciscan Physician Network, West Lafayette, IN, USACorrespondence: Yuka Tsukahara, Department of Sports Medicine, Tokyo Women’s College of Physical Education, 4-30-1 Fujimidai Kunitachi, Tokyo, 1868668, Japan, Tel +8180-3688-6128, Fax +81471-60-6112, Email yuka.voila@gmail.comPurpose: The Athlete Sleep Behavior Questionnaire (ASBQ) is an 18-item self-reported questionnaire that can be used to screen for sleep disorders in athletes and assess environmental, behavioral, and sports-related factors along with sleep disorders. This study aimed to analyze the reliability and validity of the ASBQ translated into Japanese (ASBQ-J).Patients and Methods: 111 female collegiate athletes completed both the initial test and retest. Independent variables were what kind of sports they perform, level as an athlete, grade (freshman, sophomore, junior, senior), and age. The reliability of the survey was assessed using Cronbach’s alpha and intraclass correlation, and Pearson’s correlation coefficient was calculated to determine the correlation between the total ASBQ scores and three components which were routine/environmental, behavioral, and sports factors.Results: A total of 37.8% of athletes had ASBQ scores equal or less than 36 indicating good sleep. However, 19.8% of athletes scored more than 42, indicating poor sleep. Cronbach alpha was 0.62 and 0.65 for test and retest, respectively. Intraclass correlation was 0.78 (P < 0.01), indicating sufficient internal consistency and test–retest validity. Mean ASBQ scores were 38.5 ± 5.0 and 37.0 ± 6.5 for test and retest, respectively, and it was not significantly different between the two groups (P = 0.37). The correlation coefficients between the ASBQ-J and component scores were all statistically significant (all P < 0.01).Conclusion: ASBQ-J is a reliable questionnaire for assessing sleep disorders in athletes whose primary language is Japanese.Keywords: collegiate athlete, female athlete, performance level, survey

Purpose of reviewThe exponential growth of women participating in competitive sports throughout the years was made possible through several initiatives by the International Olympic Committee and the passage and implementation of Title IX as a federal law in the United States. However, this positive trend towards gender equity in sports has not transpired for women in medicine, especially in fields that care for elite athletes. This current review will discuss specific areas that can be tailored to help female athletes prevent injuries and optimize their athletic performance. We will also highlight how increased female team physician representation in sports may help optimize care for female athletes.Recent findingsFemale athletes are considered high risk for certain conditions such as ACL tears, patellofemoral pain syndrome, bone stress injuries, sport-related concussions, and sexual violence in sport. Addressing factors specific to female athletes has been found to be valuable in preventing injuries. Strength and conditioning can optimize athletic performance but remains underutilized among female athletes. Although diversity in healthcare workforce has been found to be beneficial for multiple reasons, women remain underrepresented in sports medicine. Increasing female team physician representation may positively impact care for female athletes. Team physicians must understand the physiologic, biomechanical, and anatomic factors that are unique to female athletes in order to tailor injury prevention programs and optimize their athletic performance. Advocating for gender equity in sports medicine to advance representation of women in the field will increase workforce diversity and promote excellence in sports medicine care.

Purpose: To determine the impact of the quality and quantity of sleep during an international flight on subsequent objective sleep characteristics, training and match-day load, self-reported well-being, and perceptions of jet lag of elite female cricketers during an International Cricket Council Women's T20 World Cup. Methods: In-flight and tournament objective sleep characteristics of 11 elite female cricketers were assessed using activity monitors. Seated in business class, players traveled west from Melbourne, Australia, to Chennai, India. The outbound flight departed Melbourne at 3:30 AM with a stopover in Dubai for 2 hours. The arrival time in Chennai was 8:10 PM local time (1:40 AM in Melbourne). The total travel time was 19 hours 35 minutes. Perceptual ratings of jet lag, well-being, and training and competition load were collected. To determine the impact of in-flight sleep on tournament measures, a median split was used to create subsamples based on (1) in-flight sleep quantity and (2) in-flight sleep quality (2 groups: higher vs lower). Spearman correlation coefficients were calculated to assess the bivariate associations between sleep measures, self-reported well-being, perceptual measures of jet lag, and internal training and match-day load. Results: Mean duration and efficiency of in-flight sleep bouts were 4.72 hours and 87.45%, respectively. Aggregated in-flight sleep duration was 14.64 + 3.56 hours. Players with higher in-flight sleep efficiency reported higher ratings for fatigue (ie, lower perceived fatigue) during the tournament period. Tournament sleep duration was longer, and bed and wake times were earlier compared with habitual. Compared with other nights during the tournament, sleep duration was shorter following matches. Conclusions: Maximizing in-flight sleep quality and quantity appears to have implications for recovery and sleep exhibited during competition. Sleep duration was longer than habitual except for the night of a match, which suggests that T20 matches may disrupt sleep duration. [ABSTRACT FROM AUTHOR]

Women’s wrestling is actively practiced in many countries. While severe spinal injuries pose a threat to an athlete’s career and health, research on severe spinal injuries in female wrestlers remains limited. The aim of this study was to investigate the characteristics of severe spinal injuries and post-injury management in Korean female wrestlers. We enrolled 54 female wrestlers participating in the national team selection competition. Interviews were conducted to examine the characteristics of spinal injuries that resulted in a time loss of more than three weeks from training throughout their athletic careers and their post-injury management practices. Approximately 46% of participants experienced severe spinal injuries, and 52% faced re-injuries during their wrestling careers. These injuries predominantly occurred during technical training due to overuse during tackling and standing attacks. The most frequent injuries were lumbosacral disc injuries (72%) and cervical disc injuries (20%), with 36% requiring surgery. Nearly half of the injured athletes received specialized rehabilitation, yet roughly 76% resumed training without medical clearance. Athletes injured during their student years were notably less likely to receive specialized rehabilitation compared with those injured during their professional careers (p = 0.011). On average, athletes returned to play within 2.7 to 3.0 months. Spinal injury characteristics and post-injury management were not significantly different between the light- and heavyweight classes. While Korean female wrestlers are at a high risk of experiencing severe spinal injuries and re-injuries during their careers, appropriate post-injury management is often lacking, highlighting the need for proactive intervention by healthcare professionals to prevent recurrent spinal injuries in female wrestlers and to ensure safe return to training.

Rugby union (RU) is a field-based team sport with a large number of high-intensity actions such as sprinting, change of direction, tackling, scrummaging, rucking, and mauling. Competitive success in female RU has previously been related to anthropometric and physical characteristics, and with the recent introduction of professionalism in female rugby, characterizing such physical attributes may provide insight into selection and training processes. Purpose: To identify anthropometric and physical characteristics of competitive female RU players and differences between playing positions. Methods: Twenty-two players were recruited from the top tier of female RU in the United Kingdom during the 2018–2019 Premiership season. Players were split into forwards and backs and underwent body composition testing via dual-X-ray absorptiometry and physical characteristic tests (10- and 20-m speed, 1-repetition-maximum bench press and squat, countermovement jump, drop jump, isometric midthigh pull, and 1200-m shuttle). Results: Moderate to large significant differences between playing positions in both anthropometric and physical characteristics were found (P <.01). Forwards displayed greater body mass (P =.03), fat mass (P =.01), and absolute upper-body strength (P =.03), whereas backs demonstrated superior countermovement jump height (P =.01), drop jump height (P =.01), greater reactive strength (P =.03), and speed (P =.03). Conclusion: These findings provide practitioners with a greater understanding of anthropometric and physical characteristics of professional female RU players. [ABSTRACT FROM AUTHOR]

Purpose: Women's professional cycling has grown in popularity, and this increase is also apparent in Brazil, which has increased its female cycling calendar in recent years. The aim of this observational study was to (1) determine training and competition loads of a top-level Brazilian female cycling team, (2) evaluate nutrition and clinical health, and (3) measure whether exercise capacity changed throughout the season. Methods: Training and competition data were collected over the season using global positioning system monitors, while laboratory-based physiological and performance measures (incremental cycling test, 30-s Wingate, 4-km time trial) and clinical and nutritional analyses were performed at time points throughout the season. Results: Total distance covered over the year was 11,124 (2895) km (7382–14,698 km). Endurance capacity was reduced over the season (P =.005) but not anaerobic power (all P >.05). Nutrition and stress markers remained largely unchanged throughout the season, although there were some individual fluctuations in some measures, and testosterone concentration was low for some. Median estimated energy availability ranged between 32.3 and 56.8 kcal·kgLBM−1·d−1 during training and 26.4 and 53.8 kcal·kgLBM−1·d−1 during competition. Percentage of training spent in optimal estimated energy availability was generally low, with 3 athletes spending <35% within the optimal intake. Conclusions: Substantial training and competition loads of the monitored professional Brazilian female cyclists may have reduced exercise capacity toward the end of the season, indicative of a grueling yearlong schedule. Several athletes may have had suboptimal energy availability during the season, potentially affecting testosterone concentration. These data demonstrate the difficulties in maintaining optimal nutrition, health, and performance throughout a season in professional female cycling and highlight the need for quality sport-science support for this type of top-level athlete. [ABSTRACT FROM AUTHOR]

Introduction: Canoe slalom is a physically very demanding discipline, in which body constitution, body composition, and relative strength are significant factors in high performance. Although anthropometric and strength parameters are relatively well-studied in male athletes, there is a lack of evidence for any conclusions in women. Therefore, the objective of this study was to determine the morphology and upper-limb strength parameters of female canoe slalom paddlers and identify whether morphological differences exist between performance groups.Methods: Altogether, 63 female competitors of the 2023 ICF Canoe Slalom World Cup (n = 29) and 2023 ICF Canoe Slalom World Ranking Competition (n = 34) in Prague (Czech Republic) were examined with a battery of anthropometric tests, segmental bioimpedance analysis, and handgrip strength test. The athletes were divided into groups according to age and performance: elite athletes belonging to the world top 10 according to the ICF World Ranking (WORLD, n = 7), international-level athletes competing during the World Cup (ELITE, n = 22), international-level junior athletes competing in the World Ranking Race (JUNIOR, n = 17), and other lower performance-level athletes competing in the World Ranking Race (REST, n = 17).Results: Female slalom paddlers are, in general, of average body height (∼165 cm), lower body mass (∼60 kg), BMI (∼22 kg/m2), and body fat (∼20%) and without exceptional anthropometric dimensions and proportions. However, differences were detected when performance was factored in. Female paddlers belonging to the world TOP 10 have the largest circumferences of arms and forearms, and their somatotype is more mesomorphic, with a lower proportion of total body fat and a higher proportion of muscle mass. In addition, the WORLD group differs significantly in upper-limb strength.Discussion: The results shows the significance of muscular strength and power for canoe slalom athletes and the importance of well-developed musculature in operating the boat in the unstable environment. Being a successful female canoe slalom athlete requires a well-developed musculature, maximizing strength capabilities while maintaining a low body weight through limited hypertrophy of the lower limbs and a low level of body fat.

The aim of this cross-sectional study was to examine relationships of external load variables between beach and indoor volleyball amongst individual positions on the team. The movements of eight beach and fourteen indoor female volleyball players were recorded during elite playoff matches; in total, 2,336 three-dimensional trajectories were analyzed. Time-outs and intervals between rallies or sets were excluded from active play time. In both beach and indoor volleyball, 80% of rallies lasted up to 10 s, and players covered 4.5 to 10 m of court during 60% of rally play. Differences in dependent variables of external load were found between independent variables of sports and player positions (p < 0.05). The distance covered in beach volleyball rallies and Player Load™ parameters was significantly higher by up to 23%. The unstable court surface with sand in beach volleyball elevated explosive Player Load™ (accelerations in all three orthogonal planes of motion higher than 3.5 m/s3) in beach volleyball players compared to those of players on stable flooring in indoor. While beach volleyball blocker and defender positions showed no significant difference in parameters between each other, they differed in all parameters when compared to player positions in indoor volleyball. Indoor blocker and libero reached higher loads than setter, outside and opposite positions in various parameters. Factors that influence external load include the larger relative court areas covered by each player in beach volleyball, complexity of players’ roles, and game strategy. This data adds to the knowledge of elite match demands in female volleyball. Specified agility-drill distances and times are essential for training optimization and must be supported by scientific observation. Researchers, coaches, and conditioning specialists should find this helpful for achieving a higher degree of training regulation.

Objective: Anterior cruciate ligament (ACL) tears are exceedingly common among the athletic population and are seen with higher incidence in females. Observational studies have noted peak ACL tear rates in the luteal phase of the menstrual cycle, a time in which the hormone relaxin peaks in serum concentration. Methods: A systematic review of the literature was performed. Inclusion criteria specified all prospective and retrospective studies which included the role of relaxin in the pathogenesis of ACL tears. Results: Six studies met inclusion criteria yielding 189 subjects from clinical studies and 51 in vitro samples. Included studies found that ACL samples exhibit selective relaxin binding. When pre-treated with estrogen prior to relaxin exposure, female ACL tissue samples exhibit increased expression of collagen degrading receptors. Conclusion: Relaxin displays binding specificity to the female ACL and increased serum concentrations are correlated with increased ACL tear rates in female athletes. Further research is needed in this area. Level of Evidence: V. [ABSTRACT FROM AUTHOR]

The roles of 17β estradiol (E2) and progesterone (P4), the primary female sex hormones, are pivotal in regulating various aspects of metabolism. E2 influences food intake, energy expenditure, adipose tissue distribution, and insulin sensitivity across multiple tissues. Meanwhile, P4 impacts energy expenditure, electrolyte balance, amino acid oxidation, muscle protein synthesis, and glucose metabolism. The interactions between these hormones affect macronutrient utilization, both at rest and during exercise. Acknowledging the need to incorporate sex hormone perturbations in research, this paper explores the current landscape of study design and menstrual cycle tracking for female-specific sport research. It emphasizes the importance of standardization in terminology, hormone phases, reference values, and affordable hormone detection methods to advance our understanding of how the menstrual cycle influences female athletes. [ABSTRACT FROM AUTHOR]

To develop and assess the test-retest reliability of a survey exploring Australian high-performance female athlete's perspectives toward the periodic health evaluation and their perceived health needs. A structured three-phase method for survey development was used to develop the periodic health evaluation for female athletes (PHE FA) survey. Initially, a literature review and gap analysis was performed to identify themes and questions (Phase 1). Survey questions were developed covering demographic information (n = 9); sports-related medical screening (n = 19) and health needs and information (n = 7) (Phase 2). Test-retest reliability of the survey was then assessed (Phase 3). The survey was administered to a purposeful sample of seven high-performance level female athletes who completed the survey, on two separate occasions, 3 weeks apart via Checkbox© survey software (Checkbox Technology Inc., San Francisco, CA). Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). The mean age of the athletes was 29 years (SD 4 years, range 24–34 years). All were able-bodied athletes and 71% participated in team sports. Eighty-six percent of athletes have competed in world championships and 71% were Olympians. The average ICC of all items was 0.998 (95% CI 0.997–0.998, p = 0.000) demonstrating excellent consistency of measures between the two time points. All the athletes preferred a Sport and Exercise Medicine Physician to conduct their PHE and 86% preferred a female doctor. The key topics of interest were pelvic floor health including incontinence (100%); fertility (86%); pregnancy (71%); and mental and emotional wellbeing (71%). Face-to-face education was the preferred option to receive health information. The PHE FA survey was co-created with an athlete and other key stakeholders. Excellent consistency of measures between the two time points was indicated by the high test-retest reliability of the PHE FA survey. Data collected using the PHE FA survey can contribute to informed evidence-based policies, and processes to support the health and wellbeing of female athletes. [ABSTRACT FROM AUTHOR]

The purpose of this review was to identify what impacts RED-S has on the menstrual cycle, and if these changes caused any negative affects to performance in female athletes. PubMed and Google Scholar were searched using the following search criterion 1) Must mention RED-S or 2) Must mention Low Energy Availability in Athletes 3) Must involve or make mention to female subjects 4) Must make links to menstrual cycle changes and performance outcomes. Based on the 14 reviewed papers, it is certain that RED-S can have a profound impact on the athlete's health and wellbeing. If a female athlete is diagnosed with RED-S this can cause hormonal disturbances that affect the athlete's menstrual cycle and, in some cases, have a negative impact on their performance due to injury and time spent away from training and competing. It's recommended that athletes, coaches and support staff have some understanding of what RED-S is and how it can impact the athlete's health and performance. Some significant signs and symptoms to be aware of are, the absences of menses by age 16 or the athlete has missed three cycles (not due to pregnancy), repeated stress fractures, shin splints or persistent hip pain, and /or the athlete has a low body mass percentage. A formal diagnosis and classification of the severity (high, moderate or low risk), by a clinician is a vital step in the process of rehabilitation. Once diagnosed the athlete and support staff can begin the process of adjusting energy intake, energy expenditure, or both. [ABSTRACT FROM AUTHOR]

The rise of women's sports has attracted a growing number of fans, and Instagram has emerged as the most popular platform for sports enthusiasts. To better understand the reasons why fans engage with female athletes on Instagram, this study employed empirical survey data collected from 246 international sports consumers at EXPO 2021. The study used structural equation modeling to test its hypotheses and found that factors such as fandom, entertainment, social media popularity, and physical attraction were strong predictors of engagement with female athletes, whereas information played a negligible role. By understanding the factors that drive fans to engage with female athletes on Instagram, social media agencies can tailor their marketing strategies to maximize engagement and conversion rates. Female athletes themselves can also use this knowledge to better promote themselves on social media and connect with fans in a more effective and meaningful way. [ABSTRACT FROM AUTHOR]

Pregnancy and lactation hormones have been shown to mediate anatomical changes to the musculoskeletal system that generates animal movement. In this study, we characterize changes in the medial gastrocnemius muscle, its tendon and aponeuroses that are likely to have an effect on whole animal movement and energy expenditure, using the rat model system, Rattus norvegicus. We quantified muscle architecture (mass, cross‐sectional area, and pennation angle), muscle fiber type and diameter, and Young's modulus of stiffness for the medial gastrocnemius aponeuroses as well as its contribution to Achilles tendon in three groups of three‐month‐old female rats: virgin, primiparous pregnant, and primiparous lactating animals. We found that muscle mass drops by 23% during lactation but does not change during pregnancy. We also found that during pregnancy muscle fibers switch from Type I to IIa and during lactation from Type IIb to Type I. The stiffness of connective tissues that has a demonstrated role in locomotion, the aponeurosis and tendon, also changed. Pregnant animals had a significantly less stiff aponeurosis. However, tendon stiffness was most affected during lactation, with a significant drop in stiffness and interindividual variation. We propose that the energetic demands of locomotion may have driven the evolution of these anatomical changes in muscle‐tendon units during pregnancy and lactation to ensure more energy can be allocated to fetal development and lactation. [ABSTRACT FROM AUTHOR]

To determine the level of energy balance and energy availability (EA) in female basketball players during the preparation period. Fifteen basketball players (age: 19.53 ± 1.3 years; height: 173.6 ± 8.95 cm; weight: 67.55 ± 14.34 kg; training experience: 9.6 ± 2.7 years) and 15 age and body mass index-matched controls (age: 19.53 ± 1.1 years; height: 169.4 ± 5.06 cm; weight: 63.10 ± 6.14 kg) participated in the study. Resting metabolic rate (RMR) and body composition were measured by the indirect calorimetric method and dual-energy x-ray absorptiometry, respectively. A 3-day food diary was used to determine macronutrients and energy intake while a 3-day physical activity log was used to determine energy expenditure. Independent Samples t-test was used for data analysis. The daily energy intake and expenditure of female basketball players were 2136.5 ± 594.9 kcal·day−1 and 2953.8 ± 614.5 kcal·day−1, respectively, indicating 817 ± 779 kcal·day−1 of negative energy balance. One hundred percent and 66.6% of the athletes failed to meet the carbohydrate and protein intake recommendations, respectively. EA of female basketball players was 33.04 ± 15.69 kcal·fat free mass−1·day−1 and the percentages of athletes who had negative energy balance, low EA, and reduced EA were 80%, 40%, and 46.7%, respectively. However, despite the low and decreased EA, the measured RMR to predicted RMR ratio (RMRratio) was 1.31 ± 0.17 and the body fat percentage (BF%) was 31.00 ± 5.21%. This study shows that female basketball players have a negative energy balance during the preparation period which can be partly explained by insufficient carbohydrate intake. Although most of the athletes experienced low or reduced EA during the preparation period, the physiologically normal RMRratio and relatively high BF% indicate that this is a transient situation. In this regard, strategies to prevent the development of low EA and negative energy balance during the preparation period will contribute to positive training adaptations throughout the competition period. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pelvic floor dysfunction (PFD) affects many women and participation in elite sport and high-impact exercise has been reported as a potential risk. However, few studies have investigated the effects of exercising at recreational levels on PFD. Our aim was to investigate levels of PFD in women exercising at, or above, UK guidelines for health and compare them with levels in non-exercisers. Method: Data on levels of PFD and potential risk factors (age, hormonal status, body mass index, constipation, parity, forceps delivery, and recreational exercise) were collected using a cross-sectional survey distributed via social media. The International Consultation Incontinence Questionnaire (ICIQ) Urinary Incontinence Short Form was used to estimate prevalence of urinary incontinence (UI). Selected questions from the ICIQ vaginal symptom and bowel symptom questionnaires were used to estimate prevalence of anal incontinence (AI) and pelvic organ prolapse (POP). Logistic regression analysis was used to compare exercisers and non-exercisers after adjusting for potential confounders. Results: We recruited 1,598 adult women (1,141 exercisers and 457 non-exercisers). The majority were parous. High prevalence of UI (70%), AI (52%) and POP (18%) was reported. No significant association was found between recreational exercise and PFD despite adjustment for confounders, or further investigation regarding exercise involving impact, although some increased reporting of AI was seen in those exercising for over 10 hours per week. Conclusion: High levels of all PFD were reported but no significant association was found between recreational exercise and symptoms. However, data suggest that women modify their exercise regimes as required. Few symptomatic women sought professional help. [ABSTRACT FROM AUTHOR]

An increased professionalization within women's 15-a-side rugby union (R15s) has prompted greater sports science support and a need to better understand demands of the sport. Online database (PubMed, MEDLINE, and SPORTDiscus) searches were performed according to the PRISMA Scoping Review protocol. Studies were eligible if match-play demands or anthropometric characteristics of women's R15s players were investigated. After calibration exercises, the lead and senior authors independently quality assessed each study. A total of 1,068 studies were identified; 15 of which met the study criteria. The mean total match-play distance covered was 5,378 ± 626 m (forwards: 5,188 ± 667 m and backs: 5,604 ± 609 m), with first half values exceeding second half (2,922 ± 87 m vs. 2,876 ± 115 m). The mean relative distance (RD) (72.0 m·min-1) was greater than their male counterparts (64.2 m·min-1-68.2m·min-1). Backs were exposed to more severe collisions compared with forwards (661 vs. 564). Work:rest ratios ranged between 1.0:0.7-1.0:0.9. Regarding anthropometric characteristics, the mean lean and fat mass was reported as 51.9 ± 5.2 kg and 18.664.6 kg, respectively. The mean body fat percentage was 24.765.4%. The mean bone mineral density and bone mineral content was 1.27 ± 0.04 g·cm-2 and 3.07 ± 0.2 kg, respectively. This scoping review summarizes the current evidence base and key findings relating to the match-play demands and anthropometric characteristics that can be used in practice to inform player welfare and sport science support to women's R15s players at a national and international standard. Numerous gaps in our understanding of how best to develop and optimize performance, physical demands, and anthropometric characteristics of women's R15s players remain. [ABSTRACT FROM AUTHOR]

Background: Arthrofibrosis can limit function and return to sport after anterior cruciate ligament (ACL) reconstruction. Previously reported risk factors for developing arthrofibrosis after ACL reconstruction include female sex, age <18 years, time from injury to surgery <28 days, concomitant meniscal repair, prolonged immobilization, and genetic factors. There is a lack of evidence regarding whether race plays a significant role. Hypothesis: The risk of undergoing manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA) after primary ACL reconstruction with bone–patellar tendon–bone (BTB) autograft in female basketball players is higher in African American players than in White players. Study Design: Case-control study; Level of evidence, 3. Methods: Using a computerized relational database, the authors identified competitive female basketball players who underwent primary ACL reconstruction with BTB autograft by the senior author over a 13-year period. Data previously entered from examinations and surgical findings were reviewed retrospectively. Univariate statistics and multivariable logistic regression were used to assess the relationship between undergoing subsequent MUA and/or LOA and study predictors. Results: A total of 186 knees (114 African American knees and 72 White knees) met inclusion criteria. The overall rate of MUA and/or LOA was 8.6%. Thirteen African American knees (11.4%) and 3 White knees (4.2%) underwent MUA and/or LOA for treatment of arthrofibrosis. No study predictor was found to have a statistically significant relationship with the rate of MUA and/or LOA on univariate analysis. However, when controlling for body mass index and previously described risk factors (age <18 years, time from injury to surgery ≤28 days, and concomitant meniscal repair) in the logistic regression model, the authors found that MUA and/or LOA was more likely in African American (odds ratio, 4.01 [95% CI, 1.01-15.92]; P =.049) than in White female players and in patients who underwent ACL reconstruction within 28 days of injury (odds ratio, 4.01 [95% CI, 1.18-13.57]; P =.026) compared with those with surgery delayed beyond 28 days. Conclusion: In female basketball players, the present study found a statistically significantly increased risk for undergoing MUA and/or LOA after primary ACL reconstruction with BTB autograft in African American females compared with White females and in patients who underwent ACL reconstruction within 28 days of injury. [ABSTRACT FROM AUTHOR]

This scoping review aims to provide a comprehensive overview of biological mechanisms underlying the menstrual cycle's impact on various performance-determining anatomical and physiological parameters. It is intended to identify the various proposed vital concepts and theories that may explain performance changes following hormonal fluctuations. The review was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol. A framework of six groups was built such as skeletal muscle physiology, muscle damage, tendons and ligaments, neuromuscular control, cardiovascular system, and exercise metabolism to cluster studies thematically and to specify the concept of "performance." Original research studies published between 1970 and 2021 that were conducted with a naturally menstruating population were considered. Changes in performance regarding the menstrual cycle phase were crucial for inclusion. Topic-specific reviews and systematic reviews were included if they addressed the impact of female steroid hormones on any structure or part of the human body. The review indicates that the impact of estrogen and progesterone is primarily responsible for observed changes in athletic performance during the menstrual cycle. Estrogen seems capable of fostering protein synthesis, diminishing collagen metabolism, preventing muscle damage due to its antioxidant effects, and restraining inhibitory, while promoting excitatory, control by interacting with neurotransmitters. Progesterone is assumed to increase thermoregulation and enhance ventilatory drive by interacting with hypothalamic pathways and may further amplify inhibitory control by interacting with neurotransmitters. The female steroid hormones and the endocrinologic system collaborate in complex interrelationships with biological systems to maintain homeostasis. However, proposed mechanisms are often derived from animal studies and studies conducted in vitro and still remain to be proven true in the human regularly menstruating population. In the future, it is crucial to rely on studies that followed the methodology for cycle monitoring recommendations thoroughly. Otherwise, it is not possible to determine whether hormonal fluctuations cause observed changes in performance or not. [ABSTRACT FROM AUTHOR]

Background: Previous research suggests that estrogen plays a role in increased ligamentous laxity observed within the female population. Whereas many studies have sought to evaluate the impact of exogenous estrogen on anterior cruciate ligament injuries, research has not yet explored its impact on the medial patellofemoral ligament. Furthermore, less is known about the role of exogenous progesterone on ligamentous structures. Purpose: To determine whether women prescribed systemic estrogen (ethinyl estradiol) or progesterone (norgestimate or etonogestrel) hormonal contraceptives had an increased risk of undergoing reconstruction surgery for patellar instability compared with women without a prescription for systemic hormonal contraceptives. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The TriNetX Research Network database was queried using International Classification of Disease and Common Procedural Terminology codes for women aged 15 to 26 years who underwent reconstruction procedures for patellar instability between 2012 and 2022. Women were grouped according to whether they had a coded prescription for a systemic hormonal contraceptive containing either ethinyl estradiol or etonogestrel; controls were matched by age, sex, race, and ethnicity. The relative risk (RR) of undergoing reconstruction for patellar instability was determined for each contraceptive. Results: After 1-to-1 propensity score matching, 0.054% (525/980,878) of women prescribed a systemic contraceptive containing ethinyl estradiol underwent reconstruction procedures for patellar instability compared with 0.043% (417/980,878) of controls (RR, 1.3; 95% CI, 1.1-1.4; P =.0004). Likewise, 0.058% (67/116,260) of women prescribed a form of systemic contraceptive containing only etonogestrel underwent reconstruction procedures for patellar instability compared with 0.026% (30/116,260) of controls (RR, 2.2; 95% CI, 1.5-3.4; P =.0002). Conclusion: Female patients prescribed systemic contraceptives containing estrogen or progesterone had an increased rate of reconstruction procedures for patellar instability. [ABSTRACT FROM AUTHOR]

Context: The indirect markers of muscle damage have been previously studied in females. However, inconclusive results have been found, possibly explained by the heterogeneity regarding monitoring and verification of menstrual-cycle phase. Purpose: To determine whether the fluctuations in sex hormones during the menstrual cycle influence muscle damage. Methods: A total of 19 well-trained eumenorrheic women (age 28.6 [5.9] y; height 163.4 [6.1] cm; weight 59.6 [5.8] kg body mass) performed an eccentric-based resistance protocol consisting of 10 × 10 back squats at 60% of their 1-repetition maximum on the early follicular phase (EFP), late follicular phase, and midluteal phase of the menstrual cycle. Range of motion, muscle soreness, countermovement jump, and limb circumferences were evaluated prior to 24 and 48 hours postexercise. Perceived exertion was evaluated after each set. Results: Differences in sex hormones indicated that tests were adequately performed in the different menstrual-cycle phases. Prior to exercise, muscle soreness was higher in the EFP (4.7 [7.7]) than in the late follicular phase (1.1 [3.2]; P =.045). No other variables showed significant differences between phases. Time-point differences (baseline, 24, and 48 h) were observed in knee range of motion (P =.02), muscle soreness, countermovement jump, and between sets for perceived exertion (P <.001). Conclusion: Although the protocol elicited muscle damage, hormonal fluctuations over the menstrual cycle did not seem to affect indirect markers of muscle damage, except for perceived muscle soreness. Muscle soreness was perceived to be more severe before exercise performed in EFP, when estrogen concentrations are relatively low. This may impair women's predisposition to perform strenuous exercise during EFP. [ABSTRACT FROM AUTHOR]

Introduction: Primary dysmenorrhea (PD), painful menstruation in the absence of pelvic pathology, is a common gynecological condition that affects between 45 and 95% of menstruating women.1 Among the parameters as- sociated with PD, body composition, core stability, flexibility, balance and psychological problems are prominent.2,3 The high incidence of PD in female athletes4 has led to the need for more comprehensive investigation of these parameters that may affect PD in these athletes. Objectives: To compare body composition, core stability, flexibility, balance and psychological state in female ath- letes with and without PD. Study design: A case-control study. Methods: Nineteen athletes with PD (PD group, age=20 (19-23) years) and 17 athletes without PD (control group, age=21 (18-24) years) were included. Body composition with Tanita BC601 device, core stability with McGill-trunk endurance tests and Sahrmann test, flexibility with sit-and-reach test, balance with Y-balance test and psychological state with Athletic Psychological Skills Inventory were evaluated on days off menstruation. Results: The branches of athletes in the PD group were volleyball (n=17), rugby (n=1) and swimming (n=1). The branches of athletes in the control group were volleyball (n=11), basketball (n=4) and swimming (n=2). Daily training time of PD and control groups were 60 (30-120) min and 60 (30-120) min, respectively. The pain intensity of PD group was 7.3(4.4- 10) cm. Waist-hip ratio (p=0.06) in PD group were higher than control group. Trunk flexor (p=0.029), extensor (p=0.015), right (p=0.001) and left lateral flexor endurance (p=0.018), Sahrmann (p<0.001) and sit-and-reach scores (p=0.004) were lower in PD group than control group. There were no differences in other parameters between groups (p>0.05). Conclusions: While waist-hip ratio was higher in athletes with PD than athletes without PD; core stability and flexibility were lower. These parameters related to sports performance should be considered in management of female athletes with PD. [ABSTRACT FROM AUTHOR]

Purpose: To investigate changes in self-reported physical fitness, performance, and side effects across the menstrual cycle (MC) phases among competitive endurance athletes and to describe their knowledge and communication with coaches about the MC. Methods: The responses of 140 participants (older than 18 y) competing in biathlon or cross-country skiing at the (inter)national level were analyzed. Data were collected via an online questionnaire addressing participants' competitive level, training volume, MC history, physical fitness, and performance during the MC, MC-related side effects, and knowledge and communication with coaches about the MC and its effects on training and performance. Results: About 50% and 71% of participants reported improved and reduced fitness, respectively, during specific MC phases, while 42% and 49% reported improved and reduced performance, respectively. Most athletes reported their worst fitness (47%) and performance (30%) and the highest number of side effects during bleeding (P <.01; compared with all other phases). The phase following bleeding was considered the best phase for perceived fitness (24%, P <.01) and performance (18%, P <.01). Only 8% of participants reported having sufficient knowledge about the MC in relation to training, and 27% of participants communicated about it with their coach. Conclusions: A high proportion of athletes perceived distinct changes in fitness, performance, and side effects across the MC phases, with their worst perceived fitness and performance during the bleeding phase. Because most athletes indicate a lack of knowledge about the MC's effect on training and performance and few communicate with coaches on the topic, the authors recommend that more time be devoted to educating athletes and coaches. [ABSTRACT FROM AUTHOR]

Based on a comprehensive review and critical analysis of the literature regarding the nutritional concerns of female athletes, conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society: 1. Female athletes have unique and unpredictable hormone profiles, which influence their physiology and nutritional needs across their lifespan. To understand how perturbations in these hormones affect the individual, we recommend that female athletes of reproductive age should track their hormonal status (natural, hormone driven) against training and recovery to determine their individual patterns and needs and peri and post-menopausal athletes should track against training and recovery metrics to determine the individuals’ unique patterns. 2. The primary nutritional consideration for all athletes, and in particular, female athletes, should be achieving adequate energy intake to meet their energy requirements and to achieve an optimal energy availability (EA); with a focus on the timing of meals in relation to exercise to improve training adaptations, performance, and athlete health. 3. Significant sex differences and sex hormone influences on carbohydrate and lipid metabolism are apparent, therefore we recommend first ensuring athletes meet their carbohydrate needs across all phases of the menstrual cycle. Secondly, tailoring carbohydrate intake to hormonal status with an emphasis on greater carbohydrate intake and availability during the active pill weeks of oral contraceptive users and during the luteal phase of the menstrual cycle where there is a greater effect of sex hormone suppression on gluconogenesis output during exercise. 4. Based upon the limited research available, we recommend that pre-menopausal, eumenorrheic, and oral contraceptives using female athletes should aim to consume a source of high-quality protein as close to beginning and/or after completion of exercise as possible to reduce exercise-induced amino acid oxidative losses and initiate muscle protein remodeling and repair at a dose of 0.32–0.38 g·kg−1. For eumenorrheic women, ingestion during the luteal phase should aim for the upper end of the range due to the catabolic actions of progesterone and greater need for amino acids. 5. Close to the beginning and/or after completion of exercise, peri- and post-menopausal athletes should aim for a bolus of high EAA-containing (~10 g) intact protein sources or supplements to overcome anabolic resistance. 6. Daily protein intake should fall within the mid- to upper ranges of current sport nutrition guidelines (1.4–2.2 g·kg−1·day−1) for women at all stages of menstrual function (pre-, peri-, post-menopausal, and contraceptive users) with protein doses evenly distributed, every 3-4 h, across the day. Eumenorrheic athletes in the luteal phase and peri/post-menopausal athletes, regardless of sport, should aim for the upper end of the range. 7. Female sex hormones affect fluid dynamics and electrolyte handling. A greater predisposition to hyponatremia occurs in times of elevated progesterone, and in menopausal women, who are slower to excrete water. Additionally, females have less absolute and relative fluid available to lose via sweating than males, making the physiological consequences of fluid loss more severe, particularly in the luteal phase. 8. Evidence for sex-specific supplementation is lacking due to the paucity of female-specific research and any differential effects in females. Caffeine, iron, and creatine have the most evidence for use in females. Both iron and creatine are highly efficacious for female athletes. Creatine supplementation of 3 to 5 g per day is recommended for the mechanistic support of creatine supplementation with regard to muscle protein kinetics, growth factors, satellite cells, myogenic transcription factors, glycogen and calcium regulation, oxidative stress, and inflammation. Post-menopausal females benefit from bone health, mental health, and skeletal muscle size and function when consuming higher doses of creatine (0.3 g·kg−1·d−1). 9. To foster and promote high-quality research investigations involving female athletes, researchers are first encouraged to stop excluding females unless the primary endpoints are directly influenced by sex-specific mechanisms. In all investigative scenarios, researchers across the globe are encouraged to inquire and report upon more detailed information surrounding the athlete’s hormonal status, including menstrual status (days since menses, length of period, duration of cycle, etc.) and/or hormonal contraceptive details and/or menopausal status.

Growth and maturation are central concerns in the organization of training and competitions in youth sports. This study examined maturity-associated variation in body size and adiposity among adolescent girls participating in competitive age group youth soccer. The sample included 441 players 10.08-16.73 years of age. Stature and body mass were measured and body composition was predicted. The Fels method was used to estimate skeletal age. Skeletally maturity status (late, average or early maturing) was based on the difference between chronological and skeletal age for each player. Mean stature approximated the 50th percentiles of the general population in all competitive age groups, while mean weight fluctuated between 50th and 75th percentiles. Age- and maturity-specific means for estimated fat mass ranged between 18.0% and 28.2%. The number of players classified as skeletally mature increased with competitive age groups (under-13: 0%; under-15: 8%; under-17: 49%). In general, early maturing girls tended to be heavier than their age group peers and especially when compared to late maturing players. [ABSTRACT FROM AUTHOR]

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Low energy availability (LEA) describes a state where the energy intake is insufficient to cover the energy costs of both exercise energy expenditure and basal physiological body functions. LEA has been associated with various physiological consequences, such as reproductive dysfunction. However, the effect of LEA on skeletal muscle protein synthesis in females performing exercise training is still poorly understood. We conducted a randomized controlled trial to investigate the impact of LEA on daily integrated myofibrillar and sarcoplasmic muscle protein synthesis in trained females. Thirty eumenorrheic females were matched based on training history and randomized to undergo 10 days of LEA (25 kcal · kg fat‐free mass (FFM)−1 · day−1) or optimal energy availability (OEA, 50 kcal · kg FFM−1 · day−1). Before the intervention, both groups underwent a 5‐day 'run‐in' period with OEA. All foods were provided throughout the experimental period with a protein content of 2.2 g kg lean mass−1 · day−1. A standardized, supervised combined resistance and cardiovascular exercise training programme was performed over the experimental period. Daily integrated muscle protein synthesis was measured by deuterium oxide (D2O) consumption along with changes in body composition, resting metabolic rate, blood biomarkers and 24 h nitrogen balance. We found that LEA reduced daily integrated myofibrillar and sarcoplasmic muscle protein synthesis compared with OEA. Concomitant reductions were observed in lean mass, urinary nitrogen balance, free androgen index, thyroid hormone concentrations and resting metabolic rate following LEA. These results highlight that LEA may negatively affect skeletal muscle adaptations in females performing exercise training. Key points: Low energy availability (LEA) with potential health and performance impairments is widespread among female athletes.We investigated the impact of 10 days of LEA on daily integrated myofibrillar and sarcoplasmic muscle protein synthesis in young, trained females.We show that LEA impairs myofibrillar and sarcoplasmic muscle protein synthesis in trained females performing exercise training.These findings suggest that LEA may have negative consequences for skeletal muscle adaptations and highlight the importance of ensuring adequate energy availability in female athletes. [ABSTRACT FROM AUTHOR]

To understand the energy balance of international female rugby sevens (R7s) players in applied environments, this study estimated the energy intakes (EI) and total daily estimated energy expenditures (TDEE) during a five-day training camp (TRAIN) and phase of competition preparation (COMP) of equal duration. Tri-axial accelerometer devices were worn throughout both scenarios to estimate TDEE, whereas EI was estimated via self-reported food diaries. Energy deficits of −47% (TDEETRAIN: 14.6 ± 1.6 MJ·day−1, EITRAIN: 7.7 ± 0.9 MJ·day−1, p ≤ 0.001, d = 5.1) and −50% (TDEECOMP: 15.5 ± 1.6 MJ·day−1, EICOMP: 7.7 ± 1.0 MJ·day−1, p ≤ 0.001, d = 5.7) were observed throughout TRAIN (n = 11; age: 25 ± 4 years, height: 170 ± 6 cm, weight: 71 ± 7 kg) and COMP (n = 8; age: 25 ± 3 years, height: 172 ± 5 cm, weight: 72 ± 6 kg), respectively. Carbohydrate intakes were below the lower range of sports nutrition recommendations in both TRAIN (−62%; 2.3 ± 0.3 g·kg−1 BM, p ≤ 0.001) and COMP (−60%; 2.4 ± 0.5 g·kg−1 BM, p ≤ 0.001). For protein (TRAIN: 1.7 ± 0.4 g·kg−1 BM, COMP: 1.5 ± 0.1 g·kg−1 BM), intakes met the lower range of recommendations. Fat intake exceeded recommendations of the percentage of total EI (COMP: 39 ± 5%). Accordingly, the dietary strategies of international female R7s players may warrant optimization, as carbohydrate and fat intakes were less than optimal when compared to current performance-based sports nutrition guidelines. [ABSTRACT FROM AUTHOR]

Female athletes follow a strict diet and perform rigorous exercise to boost their performance, which induces health issues called the female athlete triad (FAT), defined as the combination of disordered eating, amenorrhoea and low bone mineral density. It is known to have a significant effect on bones. However, its effects on the small intestine, which is responsible for nutrient uptake into the body, remain unclear. In this study, we created an animal model of FAT to examine its effects on digestive and absorptive molecules in the small intestine. Thirty 5-week-old female Sprague-Dawley (sd) rats with an initial body weight of about 147 g were divided into control (Con, n = 7), exercise (Ex, n = 7), food restriction (FR, n = 8) and exercise plus food restriction (FAT, n = 8) groups. The rats were subjected to 4 weeks of wheel running (Ex, FAT) and 50–40 % food restriction (FR, FAT) to examine the effects on bone and typical digestive enzymes and transporters in the jejunum. Two-way ANOVA and the Kruskal–Wallis test were used for statistical analysis of normal and non-normal data, respectively. Four weeks of exercise and food restriction decreased bone weight (vs. other group P < 0·01) and bone breaking power (vs. other group P < 0·01). Villus height decreased in the jejunum (vs. other group P < 0·01), but the expression of typical macronutrients digestive enzyme and absorptive molecules remained unchanged. In contrast, sucrase-isomaltase gene (v. Ex P = 0·02) and protein expression were increased (vs. other group P < 0·05). The study findings show that FAT affects sucrase-isomaltase without histone methylation changes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine longitudinal changes in fitness and body composition throughout athletes' 4-year collegiate soccer careers. Performance testing occurred before preseason during freshman, sophomore, junior, and senior year in 17 female Division I soccer players. Body composition was assessed through air-displacement plethysmography to determine percent body fat (%BF), fat-free mass (FFM), and body mass (BM). Maximal countermovement vertical jump height was assessed through contact mat using arm swing (CMJAS) and hands-on-hips (CMJHOH) methods to calculate power (CMJwatts/HOHwatts). Aerobic capacity (V̇o2max) and ventilatory threshold (VT) were assessed by indirect calorimetry during a maximal graded exercise test on a treadmill. Linear mixed models were used to assess changes across academic years (p < 0.05). No changes occurred in %BF, BM, V̇o2max, VT, CMJAS, or CMJwatts. A time main effect was seen for FFM (p = 0.01) with increases from freshman to senior (p = 0.02). Time main effects were observed for CMJHOH (p < 0.001) and CMJHOHwatts (p < 0.001) with increases from freshman to junior (CMJHOH,p = 0.001; CMJHOHwatts, p = 0.02) and senior (CMJHOH, p < 0.001; CMJHOHwatts, p = 0.003) as well as sophomore to senior (CMJHOH, p < 0.001; CMJHOHwatts, p = 0.02). Countermovement vertical jump with hands on hips also increased from sophomore to junior (p = 0.005). The lower FFM and power capabilities as freshmen compared with upperclassman indicate a potential limited readiness. Coaches and training staff should account for these developmental differences when entering the preseason. Adequate conditioning programs before starting a collegiate program may help build a fitness foundation and prepare freshmen athletes to compete at the same level as their upperclassmen counterparts. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the clinical presentation (using PCSS), mechanism of injury, and recovery time of concussions sustained by gymnasts. A retrospective chart review was performed at Boston Children's Hospital: Sports Medicine Clinic. Patients were identified with the words 'gymnastics' and 'concussion.' Male and female gymnasts were included if they sustained a concussion during gymnastics training or competition and were between the ages of 6–22 years old. Sex, age, injury site, diagnosis, mechanism of injury, and time to presentation are described. Patients were compared during different types of gymnastics events for overall symptom burden, and individual symptom severities. A total of 201 charts were assessed over a 6-year period and 62 patients met inclusion criteria. Floor exercise was the most common event at the time of injury. Loss of consciousness occurred in 20% of injuries. There was no significant association between the type of event and PCSS upon initial clinical visit (p = 0.82). A total of 13 gymnasts returned to the clinic for a subsequent injury after their concussion (Table 3). Gymnasts are at risk for sport-related concussions. Most gymnasts reporting to a tertiary care center with the diagnosis of concussion sustain their injuries during floor exercise. [ABSTRACT FROM AUTHOR]

Menstrual health represents a state of complete physical, mental, and social well-being in relation to a woman's menstrual cycle. From a health literacy perspective, knowledge acquisition and expertise are dependent upon the degree to which an individual can find, access, understand, critically analyse, and apply health information. Therefore, menstrual health literacy can be used to describe the state of knowledge acquisition and application specific to menstrual health-related issues. Menstrual health literacy is low among female athletes, their coaches, and practitioners, and few evidence-informed education or implementation strategies exist to improve menstrual health literacy in sport. Moreover, athletes seldom discuss their menstrual cycles or hormonal contraceptive use with their coaches, despite experiencing menstrual symptoms and/or disturbances and perceiving their menstrual cycles/hormonal contraceptive use to affect performance. Barriers to communication about menstrual cycle- and hormonal contraceptive-related topics include a perceived lack of knowledge among athletes, coaches, and practitioners, concerns about how conversations on these issues will affect interpersonal relationships, and a lack of formal and informal discussion forums. Whilst evidence relating to the effects of the menstrual cycle phase and hormonal contraceptive use on training and performance is currently limited, with existing studies often lacking methodological rigour, impactful steps can still be made to support female athletes. This cornerstone review highlights the current state of menstrual health literacy among athletes, coaches, and practitioners, and provides recommendations for improving menstrual health literacy in sport. [ABSTRACT FROM AUTHOR]

Psychological hardiness encompasses three components: commitment, control, and challenge, and illustrates how individuals respond to stressors. Analyzing athletes' responses to wins and losses, depending on their psychological hardiness level, may provide insight of the impact of game outcome on student-athlete wellness. The purpose of this study was to examine postgame subjective wellness scores based on level of psychological hardiness following wins and losses in collegiate female lacrosse athletes. Players (n = 17) took the Dispositional Resilience Scale Scale-15 (DRS-15) at the start of the academic year and were grouped based on hardiness level: above average (AH) and below average (BA). Participants took a daily wellness survey rating their overall wellness, energy level, muscle soreness, stress level, and sleep quality. RM-ANOVA indicated no difference in post-game wellness scores between hardiness groups (Lambda(5,11) = 1.073, p = .426, ES = .328), by game outcome (Lambda(5,11) = 2.361, p = .109, ES = .518), or an interaction between hardiness and outcome of game (Lambda(5,11) = 1.421, p = .291, ES = .392). No hardiness group differences were found for overall wellness or sub-scores. These results show subjective wellness scores decrease collectively after a loss versus a win but refute prior studies as hardy players did not experience significantly less stress than their less hardy counterparts. Future studies should be conducted to assess wellness after differing game outcomes over many seasons to assist coaching staff on the subjective, psychological impacts of game. [ABSTRACT FROM AUTHOR]

The impact of maternity (Mat) on subsequent athletic performance is not well known. This study aims to investigate the impact of maternity among elite marathoners on their overall performance progression. For each runner listed in the top 150 female marathoners, who had experienced a mid-career maternity, performance development was reconstituted throughout the career. Maternity data and career break time span (Ttotal) were collected from publicly available informations. Performances were modelled according to the known age-performance relationship and the impact of maternity was added into the model. Linear mixed effect model was used to study the influence of maternity on the overall career. Among this sample, 37 runners had at least 1 child during her career. Among them, 14 had 2 children. Eleven runners (29.72%) made their personal best performance before Mat, which occurred at an average age of 28.40 ± 4.00 years. Twenty-six runners (70.28%) establish their best performances after Mat, at an average age of 32.20 ± 4.28. The age-performance relationship model explains 92% of the performance variability during the career's progression. When age is considered, maternity does not have significant impact on performance development. World's most competitive marathoners can still perform at their best level after pregnancy. The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance during career development. Highlights Mid-career maternity does not have a significant impact on overall progression in high level runners, who return to official races. The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance. Age is the variable that explains most of performance progression, independently of mid-career maternity occurrence(s). [ABSTRACT FROM AUTHOR]

The purpose of this study is to describe negative experiences related to human rights among female college student athletes in South Korea. For this purpose, qualitative research methods were used in this study. A total of 10 female college athletes participated in in-depth interviews, and the interview was conducted from March 1 to September 1, 2021. The main research results are as follows. First of all, most female college athletes who participated in the interview revealed that they had experienced physical or psychological harassment and abuse since elementary school. Second, female college student athletes experienced pressure with respect to their freedom and self-determination. It was found that life as an athlete is controlled by way of limiting the athletes’ right to self-determination including restriction on appearance, being excluded from various college activities and restrictions on socializing due to curfews. Third, participants demonstrated that the perpetrators were senior athletes and coach. Therefore, the study indicated that it is a fact of life at college level that female college athletes have experienced physical and verbal violence in sport. As such, human rights education and policies are needed to promote the human rights of female college students. [ABSTRACT FROM AUTHOR]