Women and Sports Performance
Research studies in sports science and sports medicine have historically focused more on male athletes than female athletes and this underrepresentation of women in research studies raises concerns about the generalisability of findings to female athletes.
This lack of comprehensive understanding hinders the development of targeted interventions and recommendations for female athletes.
The resources on this page are designed to provide an introduction to the topic of women and sports performance with a particular focus on the scientific evidence base.
Critical Questions to Consider
What are the priority issues in women's sport/ (e.g. Lebel et al, 2021)
What problems are encountered when a large of amount of elite sports performance research is based on studies with men? (e.g. Emmonds et al, 2019; Cowley et al, 2021; Sims & Heather, 2018; Parsons et al, 2021)
What are some of the methodological considerations for studies in sport and exercise science with women as participants (e.g. Elliot-Sale et al, 2021; Burden et al, 2021; Thompson & Han, 2019; Hirschberg, 2022)
What inconsistencies of participant reporting may be present in the evidence-base? (e.g. Elliot-Sale et al, 2021)
Women have been shown to be at increased risk of ACL tears, patellofemoral pain syndrome, bone stress injuries, and sport-related concussions. What is the evidence related to this? (e.g. de Borja et al, 2022, Wang et al, 2022, Parsons et al, 2021)
What are the effects of menstrual cycle phase on exercise performance in women (e.g. McNulty et al, 2020; Sims & Heather, 2018; Colenso-Semple et al, 2023; Hackney et al, 2021)
Does use of combined estrogen-progestin oral contraceptives affect exercise performance? (e.g. de Borja et al, 2022)
What are the implications and advice for female athletes who become pregnant? ( e.g. L’Heveder et al, 2022; Wang, L. et al, 2023; Jackson et al, 2022; Kimber et al, 2021; Davenport et al, 2022)
What are the trends in S&C for female athletes? (Santos et al, 2022)
What are the nutritional considerations for female athletes in weight-category sports (e.g. Langan-Evans et al, 2021)
Recommended Reading
Bruinvels, G., Hackney, A. C., & Pedlar, C. R. (2022). Menstrual cycle: the importance of both the phases and the transitions between phases on training and performance. Sports Medicine, 52(7), 1457-1460. https://doi.org/10.1007/s40279-022-01691-2
Burden, R., Shill, A. L., & Bishop, N. (2021). Elite female athlete research: stop searching for the ‘magic P’. Experimental Physiology, 106(10), pp. 2029-2030. https://doi.org/10.1113/EP089884
de Borja, C., Chang, C. J., Watkins, R., & Senter, C. (2022). Optimizing health and athletic performance for women. Current reviews in musculoskeletal medicine, 15(1), 10-20. https://doi.org/10.1007/s12178-021-09735-2
Cano, A., Ventura, L., Martinez, G., Cugusi, L., Caria, M., Deriu, F., & Manca, A. (2022). Analysis of sex-based differences in energy substrate utilization during moderate-intensity aerobic exercise. European journal of applied physiology, 1-42. https://doi.org/10.1007/s00421-021-04802-5
Carmichael, M. A., Thomson, R. L., Moran, L. J., & Wycherley, T. P. (2021). The impact of menstrual cycle phase on athletes’ performance: a narrative review. International journal of environmental research and public health, 18(4), 1667. https://doi.org/10.3390/ijerph18041667
Colenso-Semple, L. M., D'Souza, A. C., Elliott-Sale, K. J., & Phillips, S. M. (2023). Current evidence shows no influence of women's menstrual cycle phase on acute strength performance or adaptations to resistance exercise training. Frontiers in Sports and Active Living, 5, 1054542. https://doi.org/10.3389/fspor.2023.1054542
Cowley, E. S., Olenick, A. A., McNulty, K. L., & Ross, E. Z. (2021). “Invisible sportswomen”: the sex data gap in sport and exercise science research. Women in Sport and Physical Activity Journal, 29(2), 146-151. https://doi.org/10.1123/wspaj.2021-0028
Davenport, M. H., Nesdoly, A., Ray, L., Thornton, J. S., Khurana, R., & McHugh, T. L. F. (2022). Pushing for change: a qualitative study of the experiences of elite athletes during pregnancy. British Journal of Sports Medicine, 56(8), 452-457. https://doi.org/10.1136/bjsports-2021-104755
Donnelly, G. M., & Moore, I. S. (2023). Sports Medicine and the Pelvic Floor. Current Sports Medicine Reports, 22(3), 82-90. https://doi.org/10.1249/jsr.0000000000001045
Emmonds, S., Heyward, O., & Jones, B. (2019). The challenge of applying and undertaking research in female sport. Sports medicine-open, 5, 1-4. https://doi.org/10.1186/s40798-019-0224-x
Elliott-Sale, K. J., Minahan, C. L., de Jonge, X. A. J., Ackerman, K. E., Sipilä, S., Constantini, N. W., ... & Hackney, A. C. (2021). Methodological considerations for studies in sport and exercise science with women as participants: a working guide for standards of practice for research on women. Sports Medicine, 51(5), 843-861. https://doi.org/10.1007/s40279-021-01435-8
Hackney, A. C. (2021). Menstrual cycle hormonal changes and energy substrate metabolism in exercising women: a perspective. International Journal of Environmental Research and Public Health, 18(19), 10024. https://doi.org/10.3390/ijerph181910024
Hirschberg, A. L. (2022). Challenging aspects of research on the influence of the menstrual cycle and oral contraceptives on physical performance. Sports Medicine, 52(7), 1453-1456. https://doi.org/10.1007/s40279-021-01616-5
Hutchins, K. P., Borg, D. N., Bach, A. J., Bon, J. J., Minett, G. M., & Stewart, I. B. (2021). Female (under) representation in exercise thermoregulation research. Sports Medicine-Open, 7(1), 1-9. https://doi.org/10.1186/s40798-021-00334-6
Langan-Evans, C., Reale, R., Sullivan, J., & Martin, D. (2022). Nutritional considerations for female athletes in weight category sports. European journal of sport science, 22(5), 720-732. https://doi.org/10.1080/17461391.2021.1936655
Lebel, K., Mumcu, C., Pegoraro, A., LaVoi, N. M., Lough, N., & Antunovic, D. (2021). Re-thinking women's sport research: looking in the mirror and reflecting forward. Frontiers in Sports and Active Living, 3, 746441. https://doi.org/10.3389/fspor.2021.746441
L’Heveder, A., Chan, M., Mitra, A., Kasaven, L., Saso, S., Prior, T., ... & Jones, B. P. (2022). Sports obstetrics: implications of pregnancy in elite sportswomen, a narrative review. Journal of Clinical Medicine, 11(17), 4977. https://doi.org/10.3390/jcm11174977
Jackson, T., Bostock, E. L., Hassan, A., Greeves, J. P., Sale, C., & Elliott-Sale, K. J. (2022). The legacy of pregnancy: elite athletes and women in arduous occupations. Exercise and Sport Sciences Reviews, 50(1), 14-24. https://doi.org/10.1249/JES.0000000000000274
Kimber, M. L., Meyer, S., McHugh, T. L., Thornton, J., Khurana, R., Sivak, A., & Davenport, M. H. (2021). Health Outcomes after Pregnancy in Elite Athletes: A Systematic Review and Meta-analysis. Medicine and Science in Sports and Exercise, 53(8), 1739-1747. https://doi.org/10.1249/MSS.0000000000002617
McNulty, K. L., Elliott-Sale, K. J., Dolan, E., Swinton, P. A., Ansdell, P., Goodall, S., ... & Hicks, K. M. (2020). The effects of menstrual cycle phase on exercise performance in eumenorrheic women: a systematic review and meta-analysis. Sports Medicine, 50, 1813-1827. https://doi.org/10.1007/s40279-020-01319-3
Nimphius, S. (2019). Exercise and sport science failing by design in understanding female athletes. International Journal of Sports Physiology and Performance, 14(9), 1157-1158. https://doi.org/10.1123/ijspp.2019-0703
Oosthuyse, T., Strauss, J. A., & Hackney, A. C. (2023). Understanding the female athlete: molecular mechanisms underpinning menstrual phase differences in exercise metabolism. European Journal of Applied Physiology, 123(3), 423-450. https://doi.org/10.1007/s00421-022-05090-3
Parsons, J. L., Coen, S. E., & Bekker, S. (2021). Anterior cruciate ligament injury: towards a gendered environmental approach. British journal of sports medicine. 55:984-990 https://doi.org/10.1136/bjsports-2020-103173
Pettersen, S. D., Adolfsen, F., & Martinussen, M. (2022). Psychological factors and performance in women’s football: A systematic review. Scandinavian Journal of Medicine & Science in Sports, 32, 161-175. https://doi.org/10.1111/sms.14043
Santos, A. C., Turner, T. J., & Bycura, D. K. (2022). Current and future trends in strength and conditioning for female athletes. International Journal of Environmental Research and Public Health, 19(5), 2687. https://doi.org/10.3390/ijerph19052687
Sims, S. T., & Heather, A. K. (2018). Myths and Methodologies: Reducing scientific design ambiguity in studies comparing sexes and/or menstrual cycle phases. Experimental physiology, 103(10), 1309-1317. https://doi.org/10.1113/EP086797
Skelly, L. E., Bailleul, C., & Gillen, J. B. (2021). Physiological responses to low-volume interval training in women. Sports Medicine-Open, 7(1), 99. https://doi.org/10.1186/s40798-021-00390-y
Smith, E. S., McKay, A. K., Kuikman, M., Ackerman, K. E., Harris, R., Elliott-Sale, K. J., ... & Burke, L. M. (2022). Auditing the representation of female versus male athletes in sports science and sports medicine research: Evidence-based performance supplements. Nutrients, 14(5), 953. https://doi.org/10.3390/nu14050953
Thompson, B., & Han, A. (2019). Methodological recommendations for menstrual cycle research in sports and exercise. Medicine and science in sports and exercise, 51(12), 2610-2617. https://doi.org/10.1249/mss.0000000000002073
Tiller, N. B., Elliott-Sale, K. J., Knechtle, B., Wilson, P. B., Roberts, J. D., & Millet, G. Y. (2021). Do sex differences in physiology confer a female advantage in ultra-endurance sport?. Sports Medicine, 51(5), 895-915. https://doi.org/10.1007/s40279-020-01417-2
Vogel, K., Larsen, B., McLellan, C., & Bird, S. P. (2023). Female Athletes and the Menstrual Cycle in Team Sports: Current State of Play and Considerations for Future Research. Sports, 12(1), 4. https://doi.org/10.3390/sports12010004
Walton, C. C., Gwyther, K., Gao, C. X., Purcell, R., & Rice, S. M. (2022). Evidence of gender imbalance across samples in sport and exercise psychology. International Review of Sport and Exercise Psychology, 1-19. https://doi.org/10.1080/1750984X.2022.2150981
Wang, A., Mehta, R., Impellizzeri, F., Massey, A., Harrison, M., Glendinning, R., & McCall, A. (2022). Can we evidence-base injury prevention and management in women's football? A scoping review. Research in Sports Medicine, 1-16. https://doi.org/10.1080/15438627.2022.2038161
Wang, L., & Wu, Y. (2023). Current Understanding and Future Challenges in Physical Activity during Pregnancy. Journal of Clinical Medicine, 12(12), 3986. https://doi.org/10.3390/jcm12123986
Wieloch, N., Klostermann, A., Kimmich, N., Spörri, J., & Scherr, J. (2022). Sport and exercise recommendations for pregnant athletes: a systematic scoping review. BMJ Open Sport & Exercise Medicine, 8(4), e001395. https://doi.org/10.1136/bmjsem-2022-001395
Supplementary Reading
The Guardian (10 Feb, 2024) ‘It felt like somebody had hit a hammer through my knee’: the crisis of ACL injuries in women’s football https://www.theguardian.com/lifeandstyle/2024/feb/10/it-felt-like-somebody-had-hit-a-hammer-through-my-knee-the-crisis-of-acl-injuries-in-womens-football
Further Resources on this website
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Professor Kirsty Sale - @ElliotSale