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Female Athlete Health in Training and Sports Performance

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Sport and Health".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 64980

Special Issue Editors


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Guest Editor
The Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology (AUT), Auckland 1010, New Zealand; Faculty of Health, University of Waikato, Hamilton 3216, New Zealand
Interests: exercise physiology; nutrition science; stressors (heat, hydration, hypoxia); sex differences; fluid balance; thermoregulation; epigenetics; neuro-endocrine interactions; non-pharmaceutical interventions

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Guest Editor
Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA
Interests: cardiovascular; physiology; environmental; heat; exercise; autonomic

Special Issue Information

Dear Colleagues,

Over the last three decades, there has been a rise in the number of women participating in exercise, from physical activity to elite sport, attributable to the increasing development of, and investment in, women’s professional sport. It is well documented that performance-based research in women has not kept pace with the exponential rise in participation, and that the generalization from male data cannot be directly applied to women, given the anatomical, physiological, endocrinological, and genetic differences between the sexes. To further the development of women in sport, sex-specific research which considers the effects of women’s genetics and physiology (including hormone status) on performance is needed. This Special Issue aims to examine sex differences in performance, including preparation and recovery modalities. Broadly, this Special Issue is seeking original submissions that: (1) Use sound scientific design to distinguish differences between phases of the menstrual cycle and/or natural vs. hormonal contraception cycles on performance; (2) Investigates sex differences (from molecular through to whole-body scales) in athletic performance; and (3) Best practices for designing, implementing, and/or evaluating sex-specific training modalities. Special interest will be given to innovative submissions that expand and build upon optimizing performance and recovery between sexes. Other manuscript types of interest include relevant position papers, brief reports, and commentaries.

Dr. Stacy T. Sims
Prof. Dr. Christopher T. Minson
Guest Editors

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Keywords

  • sex differences
  • menstrual cycle phase
  • hormonal contraception
  • female athlete health
  • performance
  • recovery
  • training methods
  • health inequalities

Published Papers (12 papers)

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Research

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7 pages, 323 KiB  
Article
High Prevalence of Iron Deficiency Exhibited in Internationally Competitive, Non-Professional Female Endurance Athletes—A Case Study
by Stacy T. Sims, Kelsi Mackay, Alana Leabeater, Anthea Clarke, Katherine Schofield and Matthew Driller
Int. J. Environ. Res. Public Health 2022, 19(24), 16606; https://doi.org/10.3390/ijerph192416606 - 10 Dec 2022
Cited by 6 | Viewed by 2008
Abstract
Background: While iron deficiency is commonly discussed in populations of professional female athletes, less is known about highly trained, sub-elite female athletes (e.g., those winning international age-group competitions) who generally have less access to medical and allied health support. Methods: Thirteen non-professional highly [...] Read more.
Background: While iron deficiency is commonly discussed in populations of professional female athletes, less is known about highly trained, sub-elite female athletes (e.g., those winning international age-group competitions) who generally have less access to medical and allied health support. Methods: Thirteen non-professional highly trained female endurance athletes provided training diaries and completed a blood test, where iron markers of haemoglobin (Hb), haematocrit (Hct), C-reactive protein (Crp), serum iron, serum ferritin, and transferrin were assessed. Resting metabolic rate (RMR) and body composition using dual-energy X-ray absorptiometry (DXA) were also obtained. Participants were classified as iron deficient (ID) if serum ferritin was <30 ug/L serum ferritin. Results: Six of the 13 females were classified as ID. Serum iron, ferritin, Hb, Hct, and ferrin were greater in the ID group (p < 0.05). Crp resulted in large to very large correlations with serum iron (r = −0.72), serum ferritin (r = −0.66), and transferrin (r = 0.70). Conclusions: In this population of highly trained female athletes, 46% were diagnosed with sub-optimal iron levels, which could have lasting health effects and impair athletic performance. The need for more education and support in non-professional athletes regarding iron deficiency is strongly advised. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
10 pages, 702 KiB  
Article
Sex Differences in Racing History of Recreational 10 km to Ultra Runners (Part B)—Results from the NURMI Study (Step 2)
by Mohamad Motevalli, Derrick Tanous, Gerold Wirnitzer, Claus Leitzmann, Thomas Rosemann, Beat Knechtle and Katharina Wirnitzer
Int. J. Environ. Res. Public Health 2022, 19(20), 13291; https://doi.org/10.3390/ijerph192013291 - 14 Oct 2022
Cited by 6 | Viewed by 1635
Abstract
Sex differences in anatomy and physiology are the primary underlying factor for distinctions in running performance. Overall participation in recreational running events has been dominated by males, although increasing female participation has been reported in recent years. The NURMI study participants filled in [...] Read more.
Sex differences in anatomy and physiology are the primary underlying factor for distinctions in running performance. Overall participation in recreational running events has been dominated by males, although increasing female participation has been reported in recent years. The NURMI study participants filled in a survey following the cross-sectional study design with questions on sociodemographic data, running and racing motivations, training behaviors, and racing history and experience. Data analysis included 141 female and 104 male participants aged 39 (IQR 17) with a healthy median BMI (21.7 kg/m²; IQR 3.5). Statistical analyses revealed sex differences with the males performing faster at half-marathon (p < 0.001) and marathon (p < 0.001) events but no difference at ultra-marathons (p = 0.760). Mediation analyses revealed no significant sex differences in the performance of half-marathon and marathon when considering training behaviors (p > 0.05), racing history (p > 0.05), or racing experience (p > 0.05). Differences in recreational performance may be more closely related to social constraints and expectations of females rather than the physiological advantages of the male athlete. Health professionals who guide and support recreational runners as well as the runners themselves and their coaches may benefit from this study’s results in order to improve the best time performance through a deeper understanding of the areas that mediate sex differences. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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14 pages, 1146 KiB  
Article
Sex Differences in Training Behaviors of 10 km to Ultra-Endurance Runners (Part A)—Results from the NURMI Study (Step 2)
by Derrick Tanous, Mohamad Motevalli, Gerold Wirnitzer, Claus Leitzmann, Thomas Rosemann, Beat Knechtle and Katharina Wirnitzer
Int. J. Environ. Res. Public Health 2022, 19(20), 13238; https://doi.org/10.3390/ijerph192013238 - 14 Oct 2022
Cited by 8 | Viewed by 1880
Abstract
Training for running events is fundamental for successful participation in various running events such as 10 km, half-marathon, marathon, or ultra-marathon distances. Training behaviors are likely based on runner motivations and social constraints, particularly for females. Participants completed a questionnaire following a cross-sectional [...] Read more.
Training for running events is fundamental for successful participation in various running events such as 10 km, half-marathon, marathon, or ultra-marathon distances. Training behaviors are likely based on runner motivations and social constraints, particularly for females. Participants completed a questionnaire following a cross-sectional approach, including questions on sociodemographics, general training behaviors, and periodization training strategies. The final sample included 245 participants (141 females, 104 males), mostly from Germany (72%), Austria (18%), and Switzerland (5%), with a median age of 39 years (IQR 17) and a BMI of 21.7 kg/m² (IQR 3.5). Males more often trained alone and independently, whereas females were most likely to follow an external resource (p = 0.037). Non-parametric ANOVA revealed significant training differences between sexes in daily training mileages and durations at each phase and stage (p < 0.05) as well as in weekly training mileages and durations for general basic training and race-specific training (p < 0.05). Critical sex differences in training behaviors may arise from physiological differences and social expectations, which may be related to the distances they prefer to race at as well as their motivations for running and racing. This study provides a wide overview of training behaviors for endurance runners or professionals guiding healthy running performance. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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10 pages, 1169 KiB  
Article
Offered Support and Knowledge about the Menstrual Cycle in the Athletic Community: A Cross-Sectional Study of 1086 Female Athletes
by Philip von Rosen, Linda Ekenros, Guro Strøm Solli, Øyvind Sandbakk, Hans-Christer Holmberg, Angelica Lindén Hirschberg and Cecilia Fridén
Int. J. Environ. Res. Public Health 2022, 19(19), 11932; https://doi.org/10.3390/ijerph191911932 - 21 Sep 2022
Cited by 13 | Viewed by 3948
Abstract
Many female athletes perceive that symptoms related to the menstrual cycle such as dysmenorrhea, premenstrual symptoms, amenorrhea or side-effects of hormonal contraceptives negatively impact their training, performance, and general well-being. Knowledge and communication about female athletes’ health is therefore important in the sport [...] Read more.
Many female athletes perceive that symptoms related to the menstrual cycle such as dysmenorrhea, premenstrual symptoms, amenorrhea or side-effects of hormonal contraceptives negatively impact their training, performance, and general well-being. Knowledge and communication about female athletes’ health is therefore important in the sport community. The aims of this study were to explore the level of knowledge and communication about menstrual cycle issues and use of hormonal contraceptives in the athletic community and to describe the kinds of medical support offered to female athletes. A total of 1086 Swedish and Norwegian athletes from 57 different sports responded to a web-based questionnaire. Of these, 58% (n = 627) practiced team sports and 42% (n = 459) individual sports. Twenty-six percent (n = 278) of the athletes perceived their knowledge about female athlete health to be poor/very poor and the knowledge was most often acquired from medical staff. Fifty-three percent (n = 572) of the athletes perceived the knowledge acquired of their coaches as poor/very poor, even though a significantly (p < 0.001) higher proportion of athletes with a female coach (30%, n = 31) rated their coach’s knowledge as very good/good, compared to athletes with a male coach (5%, n = 31). Only 11% (n = 116) of the athletes discussed female health issues with their coach. The majority (81%, n = 842) of the athletes partly to strongly agreed that female athlete health is considered a taboo topic in the athletic community. Forty-seven percent (n = 510) of the athletes had access to a physiotherapist, while only three percent (n = 29) had access to a gynecologist. Low perceived knowledge, lack of communication and support demonstrate the need for a multi-professional medical team and enhanced educational efforts focused on female athlete health in the athletic community. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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12 pages, 1360 KiB  
Article
Influence of Female Sex Hormones on Ultra-Running Performance and Post-Race Recovery: Role of Testosterone
by Eladio Collado-Boira, Pablo Baliño, Ana Boldo-Roda, Ignacio Martínez-Navarro, Bárbara Hernando, Paula Recacha-Ponce, Carlos Hernando and María Muriach
Int. J. Environ. Res. Public Health 2021, 18(19), 10403; https://doi.org/10.3390/ijerph181910403 - 2 Oct 2021
Cited by 7 | Viewed by 3490
Abstract
In recent years, increasing numbers of women have participated in extremely long races. In adult males, there is a clear association between physiological levels of endogenous sex hormones and physical performance. However, the influence of plasmatic sex hormones and the effects of different [...] Read more.
In recent years, increasing numbers of women have participated in extremely long races. In adult males, there is a clear association between physiological levels of endogenous sex hormones and physical performance. However, the influence of plasmatic sex hormones and the effects of different types of hormonal contraception (HC) on the modulation of physical performance in adult females remain to be fully clarified. Eighteen female ultra-endurance athletes were recruited to participate in the study. Different variables were studied, including hematological parameters, body mass index, and body composition. Strength measurements were obtained using the squat-jump and hand-grip test. A repeated-measures analysis demonstrated significant differences in hematological values of CK and LDH pre-race as compared to immediately post-race and after 24/48 h. Furthermore, statistical differences were found in squat-jump and hand-grip test results after the ultramarathon. Testosterone, estradiol, and the testosterone/estrogen ratio were significantly correlated with muscle fatigue and were found to be indirect markers of muscle damage. A multivariate analysis demonstrated the protective role of testosterone against muscle damage and severe fatigue. Fluctuations in endogenous testosterone levels were correlated with greater fatigability and muscle damage after the competition. Adjusting the menstrual cycle with HC would not provide any further benefit to the athlete’s competitive capacity. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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13 pages, 669 KiB  
Article
Comparison of the Morphological Characteristics of South African Sub-Elite Female Football Players According to Playing Position
by Anita Strauss, Martinique Sparks and Cindy Pienaar
Int. J. Environ. Res. Public Health 2021, 18(7), 3603; https://doi.org/10.3390/ijerph18073603 - 31 Mar 2021
Cited by 2 | Viewed by 2602
Abstract
Limited information is available on the morphological characteristics of adult female footballers, therefore the aim of this article was to examine if there are position-specific differences in the morphological characteristics of sub-elite female football players and to establish normative standards for this level [...] Read more.
Limited information is available on the morphological characteristics of adult female footballers, therefore the aim of this article was to examine if there are position-specific differences in the morphological characteristics of sub-elite female football players and to establish normative standards for this level of female football players. The morphological features of 101 sub-elite female football players (age: 21.8 ± 2.7 years) were assessed. Twenty anthropometric sites were measured for body composition and somatotype. The average value of body fat percentage was 20.8 ± 5.7%. The somatotype of the overall group was 4.0–2.4–2.1. Significant (p ≤ 0.05) differences were found between goalkeepers and outfield players in morphological characteristics. Goalkeepers were taller (166.2 ± 8.4 cm), heavier (66.5 ± 5.1 kg), possessed the highest body fat percentage (17.2 ± 6.2%) and showed higher values for all skinfold (sum of 6 skinfolds = 125.6 ± 45.9 cm), breadth, girth and length measurements. However, there were very few practically worthwhile differences between the outfield positions. Positional groups did not differ (p ≤ 0.05) in somatotype characteristics either. The study suggests that at sub-elite level there are mainly differences between goalkeepers and outfield players, but outfield players are homogeneous when comparing morphological characteristics. These results may serve as normative values for future comparisons regarding the morphological characteristics of female football players. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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10 pages, 321 KiB  
Article
Effects of Short-Term Plyometric Training on Agility, Jump and Repeated Sprint Performance in Female Soccer Players
by Marcin Maciejczyk, Renata Błyszczuk, Aleksander Drwal, Beata Nowak and Marek Strzała
Int. J. Environ. Res. Public Health 2021, 18(5), 2274; https://doi.org/10.3390/ijerph18052274 - 25 Feb 2021
Cited by 18 | Viewed by 4759
Abstract
The aim of the study was to determine the effects of short-term (4 weeks, twice a week: 8 sessions) plyometric training on agility, jump, and repeated sprint performance in female soccer players. The study comprised 17 females performing this sports discipline. The players [...] Read more.
The aim of the study was to determine the effects of short-term (4 weeks, twice a week: 8 sessions) plyometric training on agility, jump, and repeated sprint performance in female soccer players. The study comprised 17 females performing this sports discipline. The players were randomly divided into two groups: with plyometric training (PLY) and the control (CON). All players followed the same training program, but the PLY group also performed plyometric exercises. Tests used to evaluate physical performance were carried out immediately before and after PLY. After implementing the short PLY training, significant improvement in jump performance (squat jump: p = 0.04, ES = 0.48, countermovement jump: p = 0.009, ES = 0.42) and agility (p = 0.003, ES = 0.7) was noted in the PLY group. In the CON group, no significant (p > 0.05) changes in physical performance were observed. In contrast, PLY did not improve repeated sprint performance (p > 0.05) among female soccer players. In our research, it was shown that PLY can also be effective when performed for only 4 weeks instead of the 6–12 weeks typically applied. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
10 pages, 486 KiB  
Article
Effectiveness of Plyometric and Eccentric Exercise for Jumping and Stability in Female Soccer Players—A Single-Blind, Randomized Controlled Pilot Study
by Guillermo Porrati-Paladino and Rubén Cuesta-Barriuso
Int. J. Environ. Res. Public Health 2021, 18(1), 294; https://doi.org/10.3390/ijerph18010294 - 3 Jan 2021
Cited by 10 | Viewed by 6192
Abstract
Hamstring muscle injury is common in female soccer players. Changes affecting eccentric strength, flexibility, and the quadriceps–hamstring contraction cycle are risk factors associated with this type of injury. Methods: Seventeen soccer players were randomized to two groups: experimental (plyometric and eccentric exercises [...] Read more.
Hamstring muscle injury is common in female soccer players. Changes affecting eccentric strength, flexibility, and the quadriceps–hamstring contraction cycle are risk factors associated with this type of injury. Methods: Seventeen soccer players were randomized to two groups: experimental (plyometric and eccentric exercises without external loads) and control (eccentric exercises without external loads). Eighteen sessions were scheduled over 6 weeks. The exercise program included three plyometric exercises (single-leg squat and lunge, 180 jump, and broad jump stick landing) and three eccentric exercises (Nordic hamstring exercise, diver, and glider). Dependent variables were jumping height (My Jump 2.0 App) and anterior, posteromedial, and posterolateral lower limb stability (Y-Balance test). Results: Following intervention, improvements were found in anterior and posteromedial stability (p = 0.04) in the experimental group. Posterolateral stability improved in athletes included in the control group (p = 0.02). There were differences in the repeated measures analysis for all variables, with no changes in group interaction (p > 0.05). Conclusions: Eccentric exercises, either combined with plyometric exercises or alone, can improve lower limb stability. No changes in jump height were noted in either group. There were no differences between the two groups in the variables studied. Future studies should analyze the effect of external loads on jumping stability and height in the performance of plyometric exercises. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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Review

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21 pages, 1751 KiB  
Review
Training, Wellbeing and Recovery Load Monitoring in Female Youth Athletes
by Dani A. Temm, Regan J. Standing and Russ Best
Int. J. Environ. Res. Public Health 2022, 19(18), 11463; https://doi.org/10.3390/ijerph191811463 - 12 Sep 2022
Cited by 4 | Viewed by 4657
Abstract
Participation in youth sports is ever-increasing, along with training and competition demands placed upon youth athletes. Young athletes may experience high training loads due to playing several sports, as well as participating in school physical education. Therefore, monitoring youth athlete load is an [...] Read more.
Participation in youth sports is ever-increasing, along with training and competition demands placed upon youth athletes. Young athletes may experience high training loads due to playing several sports, as well as participating in school physical education. Therefore, monitoring youth athlete load is an emerging area of research that may help limit non-functional overreaching, injury, or illness and assist with long-term athlete development. This narrative review highlights that multiple measures have been explored to monitor both internal and external load. However, the validity, reliability and practicality of these measures are often not fully understood in female youth populations. The most commonly used external monitoring methods are GPS tracking and TRIMP whereas common internal monitoring tools are questionnaires, perceived exertion rating and heart rate measures. The reporting of injuries and menstrual cycles is also crucial for providing completeness when monitoring an athlete. It has been suggested that the combination of training load, recovery and wellbeing monitoring variables is the optimal way to monitor an athlete’s fatigue levels. Whichever monitoring method is applied, in a youth population it is important that the protocol can be individualised, is inexpensive and can be easily implemented and reported so that the monitoring is sustainable. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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12 pages, 490 KiB  
Review
Transwoman Elite Athletes: Their Extra Percentage Relative to Female Physiology
by Alison K. Heather
Int. J. Environ. Res. Public Health 2022, 19(15), 9103; https://doi.org/10.3390/ijerph19159103 - 26 Jul 2022
Cited by 4 | Viewed by 11659
Abstract
There is increasing debate as to whether transwoman athletes should be included in the elite female competition. Most elite sports are divided into male and female divisions because of the greater athletic performance displayed by males. Without the sex division, females would have [...] Read more.
There is increasing debate as to whether transwoman athletes should be included in the elite female competition. Most elite sports are divided into male and female divisions because of the greater athletic performance displayed by males. Without the sex division, females would have little chance of winning because males are faster, stronger, and have greater endurance capacity. Male physiology underpins their better athletic performance including increased muscle mass and strength, stronger bones, different skeletal structure, better adapted cardiorespiratory systems, and early developmental effects on brain networks that wires males to be inherently more competitive and aggressive. Testosterone secreted before birth, postnatally, and then after puberty is the major factor that drives these physiological sex differences, and as adults, testosterone levels are ten to fifteen times higher in males than females. The non-overlapping ranges of testosterone between the sexes has led sports regulators, such as the International Olympic Committee, to use 10 nmol/L testosterone as a sole physiological parameter to divide the male and female sporting divisions. Using testosterone levels as a basis for separating female and male elite athletes is arguably flawed. Male physiology cannot be reformatted by estrogen therapy in transwoman athletes because testosterone has driven permanent effects through early life exposure. This descriptive critical review discusses the inherent male physiological advantages that lead to superior athletic performance and then addresses how estrogen therapy fails to create a female-like physiology in the male. Ultimately, the former male physiology of transwoman athletes provides them with a physiological advantage over the cis-female athlete. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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Other

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19 pages, 2292 KiB  
Systematic Review
Sex Differences in VO2max and the Impact on Endurance-Exercise Performance
by Kelsey J. Santisteban, Andrew T. Lovering, John R. Halliwill and Christopher T. Minson
Int. J. Environ. Res. Public Health 2022, 19(9), 4946; https://doi.org/10.3390/ijerph19094946 - 19 Apr 2022
Cited by 34 | Viewed by 12990
Abstract
It was not until 1984 that women were permitted to compete in the Olympic marathon. Today, more women than men participate in road racing in all distances except the marathon where participation is near equal. From the period of 1985 to 2004, the [...] Read more.
It was not until 1984 that women were permitted to compete in the Olympic marathon. Today, more women than men participate in road racing in all distances except the marathon where participation is near equal. From the period of 1985 to 2004, the women’s marathon record improved at a rate three times greater than men’s. This has led many to question whether women are capable of surpassing men despite the fact that there remains a 10–12% performance gap in all distance events. The progressive developments in sports performance research and training, beginning with A.V. Hill’s establishment of the concept of VO2max, have allowed endurance athletes to continue performance feats previously thought to be impossible. However, even today women are significantly underrepresented in sports performance research. By focusing more research on the female physiology and sex differences between men and women, we can better define how women differ from men in adapting to training and potentially use this information to improve endurance-exercise performance in women. The male advantage in endurance-exercise performance has commonly been attributed to their higher VO2max, even when expressed as mL/kg/min. It is widely known that oxygen delivery is the primary limiting factor in elite athletes when it comes to improving VO2max, but little research has explored the sex differences in oxygen delivery. Thus, the purpose of this review is to highlight what is known about the sex differences in the physiological factors contributing to VO2max, more specifically oxygen delivery, and the impacts on performance. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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8 pages, 591 KiB  
Commentary
Menstrual Cycle Hormonal Changes and Energy Substrate Metabolism in Exercising Women: A Perspective
by Anthony C. Hackney
Int. J. Environ. Res. Public Health 2021, 18(19), 10024; https://doi.org/10.3390/ijerph181910024 - 24 Sep 2021
Cited by 13 | Viewed by 6695
Abstract
This article discusses the research supporting that the hormonal changes across the menstrual cycle phases affect a woman’s physiology during exercise, specifically addressing aspects of energy substrate metabolism and macro-nutrient utilization and oxidation. The overarching aim is to provide a perspective on what [...] Read more.
This article discusses the research supporting that the hormonal changes across the menstrual cycle phases affect a woman’s physiology during exercise, specifically addressing aspects of energy substrate metabolism and macro-nutrient utilization and oxidation. The overarching aim is to provide a perspective on what are the limitations of earlier research studies that have concluded such hormonal changes do not affect energy metabolism. Furthermore, suggestions are made concerning research approaches in future studies to increase the likelihood of providing evidence-based data in support of the perspective that menstrual cycle hormonal changes do affect energy metabolism in exercising women. Full article
(This article belongs to the Special Issue Female Athlete Health in Training and Sports Performance)
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