Sports Research: Where are the Women?

Samantha Fisher 00:03
I think that this is a topic that is not super apparent to the public until you highlight the extent of the issue of how underrepresented women are in sport and exercise research. And one just wouldn’t realize until you bring this up. And every time somebody asks me about my research, and I explained this to them, how the findings of male studies are generalized to females, when there’s so many sex differences that aren’t accounted for, I get the same response every time. It’s “No way, that’s crazy! I didn’t realize that.”

Jennifer Jamieson 00:36
I actually just had to reject a 2019 study in a reputable journal that was on cyclist because they did not report the sex of the cyclists. So I just couldn’t believe that got through the peer review system. It got through the editor and nobody thought, oh, are these male cyclists? It’s mixed. It’s really important to include that detail.

Annika Leslie 01:04
Men’s and women’s bodies are so different, having a lack of access to the information that has been collected specifically for us can put us at that risk, and the fact that it’s us having to make that data for ourselves for the first time. I think it does put us at a disadvantage not having that information readily available for us.

Rhys Waters 01:27
Welcome to Beyond Research, a podcast brought to you by Research Nova Scotia.
This is the sound of team Canadas women’s rugby team, right now they’re in full training mode, ready for the rugby world cup in New Zealand. As they run drills and practice ready for the main event, on the sidelines they’re watched closely by a team of experts whose job it is to maximize their performance in every game.
In a time when athletes are trying everything at their disposal to gain the slightest competitive edge, sports research has never played a more significant role. When we look at the world of sports nutrition research, female athletes trying to get that competitive edge may come to find that they are at a disadvantage compared to their male counterparts. This is because the current body of sports nutrition literature is largely skewed to focus on male athletes.
In this episode we explore this gap in women’s sports nutrition research and how current and emerging researchers are working to address this disparity. When we look at an issue like this, it helps to consider how it can be addressed at the research level, but also in practice for actual team dieticians who are working with athletes on a day-to-day basis.
With this in mind, we will discuss this sex data gap with a student researcher and a professor from Saint Francis Xavier University who are investigating this topic, a team dietician from Saint Mary’s University, and a member of Team Canada’s under 20 women’s soccer team.
To begin, let’s hear from a student researcher, Samantha Fisher, about her work happening at St. Francis Xavier University.

Samantha Fisher 03:27
I’m currently entering my fourth year of human nutrition with honours degree here at STFX in Nova Scotia. I’m very passionate about food, health, wellness, all that stuff. so, the Human Nutrition Program here at STFX really spoke to me and it was just a perfect fit for me. I’m also really passionate about inequalities in sport with women, especially being a woman in sport. So when my prof mentioned about doing sport nutrition research, I just knew that I was interested right off the get go. And then she mentioned the topic about the sex data gap in sport nutrition literature and I just knew that that was a perfect fit for me.

Rhys Waters 04:07
After working on another project with her current supervisor, Jennifer Jamieson, they applied for and were awarded funding to pursue this exploration of the sex data gap in sports nutrition literature.

Samantha Fisher 04:17
So, the title of our project is looking into the sex data gap in sport nutrition research. In the past, women’s participation in sport was a lot lower than it is today. And there was a lot less of a demand and interest in female specific sport and exercise data. And because of this, most of the high-quality data that we have comes from studies with male participants. And then this data is then generalized to female athletes. And this should not be the case should not be done because men and women are just so different. There’s anatomical differences, physiological, hormonal differences, all these things that make men and women so different. It’s been noted that there’s differences in energy metabolism, injury risk, thermal regulation, muscular strength, all these things. So, research that optimizes training for males, is not likely to optimize training for females. And you have to take into consideration too, for women, there’s the influence of the menstrual cycle, hormonal contraceptive use, pregnancy. So, all these things that’s going to impact women’s physiological functioning. So just to apply things that work for men and to say they’re going to work for women, that’s just not true. It’s not right.

Samantha Fisher 05:33
The problem is that women continue to be underrepresented in sport and exercise research today, and that there is a lack of evidence-based guidelines for females in relation to sport and exercise. So, this really limits the understanding of women’s needs for training and performance. So, for our project, what we’re really looking for is to shed light on the sex data gap within the literature, so that people like researchers, publishers, funding agencies, all these important people are aware of this issue so that they can work together to close the sex data gap.

Rhys Waters 06:04
Samantha is beginning by figuring out just how big and how widespread the issue is. She’s starting with a narrower field within sports nutrition research: gastrointestinal symptoms during exercise.

Samantha Fisher 06:18
We’re starting with a literature search to identify all the relevant papers to our area of interest. And then once we have all these papers identified, we’re going to analyze each study individually to determine the under representation of female athletes in these studies.

Rhys Waters 06:33
Through this careful detective work, she’ll build a solid understanding of exactly where the gaps are. It’s something that can then be applied more broadly.

Samantha Fisher 06:42
This procedure can be done on other topics such as carbohydrate requirements, micronutrients, fluid intake, so all these different topics can be explored. And this just shows how far this project can expand to highlight the sex data gap in different areas of sport nutrition research.

Rhys Waters 06:59
When we look at areas of sports nutrition literature that may be particularly lacking in women focused studies, Samantha has some early assumptions on areas of particular concern.

Samantha Fisher 07:10
The sex data auditing framework that we’re following to highlight the sex data gap in the literature, it actually analyzes data by intervention topic, such as performance enhancing supplements, rather than by the sport itself. So, for example, a recent audit of sport nutrition supplements that include caffeine, creatine nitrate, beta alanine, they found a large bias towards male only studies with females only accounting for 23% of total percent participants in research studies. So, in general, I would expect this bias in most areas of sport nutrition research, but likely even more so in nutrition for strength and power-based training, such as protein requirements. But we need to audit the literature to confirm this. And we’re only in the introduction stage of this research so far, so this again goes to show how far this research can expand from this.

Rhys Waters 08:05
As this evaluation of the sports nutrition gap identifies problem areas, the question is how this disparity grew so large over time. Samantha mentioned how previously lower levels of female participation in sport contributed to the sex data gap, but she also has some other ideas on where this hesitancy to conduct female-focused sports nutrition research may have come about.

Samantha Fisher 08:29
I know that studying women on in their hormonal stages in their menstrual cycle, it is hard to control for, and it the research will take longer, it is more expensive to fund all these different things. So, it’s easy to say, “Okay, we’re just not going to do it on women, we’re just going to stick with the males and make it simpler”. But

Samantha Fisher 08:48
It doesn’t mean that women should not be studied and receive the same guidelines as men, just because they may be more difficult to study in some, it’s still very important to study these women and to understand their needs and their guidelines.

Annika Leslie 09:06
Men’s and women’s bodies are so different that you can’t apply studies and data that you’ve taken from a man just move it over to the women’s side.

Rhys Waters 09:14
When we spoke with Annika Leslie, of Team Canada’s under 20 women’s soccer team and West Virginia University’s varsity team, she thought that this gap in women’s sports nutrition research was putting female athletes at a disadvantage.

Annika Leslie 09:30
I think having a lack of access to the information that has been collected specifically for us can put us at that risk, and the fact that it’s us having to make that data for ourselves for the first time. I think it does put us at a disadvantage not having that information readily available for us.

Rhys Waters 09:46
For one thing, the technology available now means that a huge amount of data can be collected. Between national team and NCAA duties, being monitored is standard.

Annika Leslie 09:58
We do a lot of data collection, whether it be at the neuroscience institution, we wear rings that track our recovery, our activity, our sleep. So, they have all sorts of data on that side. And then we wear GPS and heart rate monitors during our training to kind of manage our loading, as we do have quite a high volume and intensity of training. So, I think, where I train now, there’s a lot of data collection being taken directly from us. And they use that more so to guide our training, rather than research that’s been done on males. Whereas in the past, I think we’ve been we’ve been given information that has been researched on men. So, I think I’ve seen little bit of a change, as I reach higher levels of my sport.

Rhys Waters 10:39
Annika is keen to participate in studies and provide data for future generations of female athletes so that they can have as much knowledge of their needs as possible.

Annika Leslie 10:49
Even if it’s just tracking stuff that I do already. if it can help in the future to help athletes like myself like down the road, I think it’s really special to be a part of and I’m personally really interested in. I know there is interest in other athletes as well, just because it’s such a big part of the game.

Rhys Waters 11:06
When discussing how the sex data gap grew so wide in the first place, Annika was perplexed by how variables such as hormonal stages in women’s menstrual cycles could lead to less women being represented in the studies.

Annika Leslie 11:17
There are challenges with any type of research. And having that as an excuse as to why there hasn’t been research is a cop out. You’re always going to have problems with whatever research you do. And as a researcher, you find ways around it. having research on this, represents half the population. I think it’s really important to find ways to work around that even if it might not be straightforward.

Rhys Waters 11:39
Speaking of working around these barriers to achieve equal female participation, Samantha Fisher points to some progress in the form of new methodology on how to effectively control for women’s cycles in research studies.

Samantha Fisher 11:52
But there is things coming out in the literature for how to structure the research to control for women’s cycles to make it easier for researchers to do this process. So, things are coming out as we advance, and they’re trying to make it easier for women to be studied.
Rhys Waters 12:08
Although Samantha is only in the beginning of her research career, she has a clear idea about fully addressing women’s needs in sports nutrition literature.

Samantha Fisher 12:17
I would love to see that women can easily retrieve guidelines and recommendations and evidence-based research that’s tailored towards themselves and their needs, and where women’s hormonal changes and contraceptive methods are accounted for, and where women are not excluded from participating in research studies without valid reasons. And I would love to see that the sports community is more inviting and inclusive for women to participate and for women to have the same opportunities for success in their sports as men.

Rhys Waters 12:50
Jennifer Jamieson is an associate professor of Human Nutrition at St Francis Xavier University and is Samantha’s supervisor. Jennifer noted how more consideration needs to be given to how researchers gather study participants, as even if a study is meant to be open to all sexes, recruitment methods may dictate what groups you attract and others that are excluded.

Jennifer Jamieson 13:10
So, One thing I have noticed is that there’s often studies that are open to both men and women. And it’s often event face. So they go to a triathlon and recruit from that, for example. But only one women will participate. So, it’s like 20 men and one woman. In that case, they do become an outlier. So, in some of the audits that have already gone on, they have noticed this what they call a self selection bias. So, when you do open it up to both men and women, you get more men. I don’t think we fully know why that is. It could be something social, like, the female athletes have less time outside of training, so they’re not able to participate. They have more commitments at home, or, is there some other barrier that’s keeping them from participating? I don’t think we know that yet.

Rhys Waters 14:03
Jennifer points to some areas of improvement regarding representation of women is sports nutrition literature in recent years, but she also notes that there are many areas in which no clear progress can be found.

Jennifer Jamieson 14:13
We got into this topic in the last couple years during the pandemic, and I have seen an increase in publications. And this summer, there’s actually the first training camp for the Australian Institute of Sport. They’re doing a whole elite training camp on the effects of the menstrual cycle on elite female athletes. So, I do feel like it’s growing. But the paper that got us started on this was the 2021 paper. And they were doing a follow up to look at this, the bias in the sex data for sport nutrition. And in 2014, it was 61% male participants. And in 2021, it was 66% male participants. So, in terms of including women in the research, it’s still we’re still not making much progress. But I think the audits that we’re doing, and other groups have already put out a few and the one we’re working on, can maybe be that first step to advocate and raise awareness and so that people know that this is a problem. I actually just had to reject a 2019 study in a reputable journal that was on cyclist because they did not report the sex of the cyclists. So I just couldn’t believe that got through the peer review system. It got through the editor and nobody thought, oh, are these are these male cyclists? It’s mixed. It’s really important to include that detail.

Rhys Waters 15:52
When it comes to performance optimization, Jennifer believes female athletes are at a particular disadvantage.

Jennifer Jamieson 15:59
I would say the biggest gap in the literature is actually in the performance sector. So, when you do sport nutrition research to really understand how to optimize that performance, almost none of those studies are done on women. I think it’s like 3% of the participants are women and that’s really important for elite performance and competitions.

Rhys Waters 16:20
When we look at other neglected communities of female athletes in the world of sports nutrition literature, those who play team sports and strength and power athletes come to mind for Jennifer.

Jennifer Jamieson 16:31
The bulk of the sport nutrition research tends to be endurance based. And there’s less available on strength and power athletes, and there’s even less on team sports. So that’s just kind of a general trend that we see. For women, I would think female power strength athletes would probably be the smallest amount of information.

Rhys Waters 16:58
Looking forward to where she sees the world of sports nutrition heading, Jennifer wants there to be an emphasis on female participation in all aspects of sports nutrition research in the coming years.

Jennifer Jamieson 17:09
Long term, I think what we really want is to see the research done by women and the research done for women to be equally valued. And that means also equally funded. There are problems from getting the funds to do the work, recruiting the women to participate in the studies, and then publishing it properly so that you’re separating, okay, this is what we found for men, this is what we found for women. And these are important sex based differences. So I think we want to see every researcher looking at sex based differences from the beginning, as they design their study, to analyzing the data to reporting that data. It’s going to increase the quality of the research, the rigor of the work, it’s going to reduce biases, that are hindering why we’re seeing this difference between men and women. And it’s going to, help reduce harm in terms of health outcomes, but also improve the exercise and training outcomes of athletes.

Rhys Waters 18:14
Jennifer’s former student is Mikaela Henderson, a registered dietitian specializing in sports nutrition in Halifax, Nova Scotia. Mikaela works with various teams at Saint Mary’s University including Football, Men’s Basketball, cross-Country/Track & Field, Women’s Rugby, Women’s Volleyball, and Women’s Soccer. She also has a private practice at Coastal Sports & Wellness.

Mikaela Henderson 18:36
I think if we can shift our research a bit more, we can really bring a big spotlight on women’s sports, bring more awareness, and more spectatorship I don’t know if you heard Gatorade is now not going to renew their NHL sponsorship, and they’re actually going to shift that money more towards women’s and youth sport sponsorships. So, I think if we start to see more of that and more funding going in to female athletes, and women’s sports, then hopefully that will also help and provide a positive impact.

Rhys Waters 19:06
Mikaela has seen the gap first hand – the one that Jennifer and Samantha are working to understand and address, and the one that Annika has to deal with every day.

Mikaela Henderson 19:14
I have noticed a gap in the literature for sure. I think between male and female athletes, as well, as we maybe also don’t recognize the difference in literature and kind of elite athletes and recreational level athletes. So that also can play into it. So you might find some articles looking at female athletes, but they might be more on the recreational level. So, then that still might not even apply. So, I’ve definitely encountered that gap over and over again.

Rhys Waters 19:42
As the dietician for a range of Saint Mary’s University Men’s and Women’s teams, Mikaela has the unique perspective of seeing this gap in women’s sports nutrition literature first-hand in her work with these athletes.

Mikaela Henderson 19:53
I can’t speak for everyone, but I would say that at times, definitely you don’t necessarily have a choice. You kind of just have to look and appraise the literature and find okay, well what is the best available evidence and go from there. But I think it is really important when doing so you want to make sure that you’re keeping in mind, the athlete themselves, because even between female athletes, there’s a whole host of differences, individual to individual. So, I think as long as you’re keeping that at the forefront critically evaluating the literature, then you have at least a pretty good basis to go on.

Rhys Waters 20:27
Mikaela has similar views to Samantha on how we reached this current state of sports nutrition literature and the lack of female-focused studies.

Mikaela Henderson 20:36
It is one thing to do a study on female athletes, and just not note anything, but just have a group of females. And it’s another thing to then note what their hormone levels are at the time of the study, what phase of their menstrual cycle that they’re going through? Are they on a hormonal contraceptive that can, then add another layer into it? And so, it does seem like historically the reason why they’ve been excluded is that it adds that extra layer of complexity. Is that a good reason? Probably not.

Rhys Waters 21:03
Another key component of the implementation of these improvements in sports nutrition research is the actual interaction and collaboration between athletes, coaches, and trainers. Although there is much work to be done to normalize discussing how things like menstrual cycles impact female athletes, Mikaela sees potential to create a lasting dialogue in the sports community.

Mikaela Henderson 21:25
In every community, we seem to be so hesitant to talk about the female menstrual cycle, just in general, and especially in the athletic communities, and I think, a lot of coaches are doing a great job. We just might not have the awareness that, we need to watch out for relative energy deficiency in sport and, an absence of a period, they might not be aware of, because their player might not be sharing that information, because, because they don’t know that if that’s an issue or something like that. So, I think, yeah, a lot more awareness and kind of comfort needs to be brought both to coaches and to the players. But we need to get away from that and be able to have those conversations because it can be very, very detrimental to female athletes to be going through that severe low energy availability.

Rhys Waters 22:13
Like Samantha, Mikaela has also noted this lack of research on female athletes relating to supplements.

Mikaela Henderson 22:21
There’s definitely a gap in the supplement efficacy point of view, not just creatine, but really all of our supplements, I’ve found, it is harder to find data that is done on female athletes. So that is a huge issue, I believe, because supplements, depending on the product can be quite helpful once we’re at this high level. And then also, I would say, a lot of the research that’s on female athletes is a lot more about kind of health outcomes versus performance outcomes. So not as much your actual time to exhaustion it’s a lot more on this sort of like health outcomes.

Rhys Waters 22:50
Earlier we heard Mikaela mention how simply making the research specific to women is not always enough to go off for an accurate representation of the needs of all women. She believes this just emphasizes how nuanced sports nutrition research is depending on an athlete’s sex and level of performance.

Mikaela Henderson 23:08
I think that might also be a whole other issue of its own because, we do have to remember how far we can generalize this data. So, if we’re doing research on an elite female soccer team, that might not be what that kind of regular recreational soccer player is going to need. And I think we do see that quite often because the media picks a lot of those more, maybe exciting studies. And then we have all these recreational athletes trying all these supplements when that’s really not what they should be focusing on and, they’re not going to maybe see that benefit.

Rhys Waters 23:40
With some clear opportunities to improve the state of women’s sports nutrition in the future, there’s one constant that will be needed to help us get there — investment.

Mikaela Henderson 23:50
I think obviously it really all boils down to the funding… And not only available to do all the research that needs to be done, whether that’s happening locally or across the globe we all have to work together on that. But even just funding to allow female sports to have the same access to health care providers. At the professional level even there’s not dieticians, or physios or massage therapists and AT’s that are available to all female teams. So, I think just kind of funding overall and shifting the focus that people enjoy women’s sports, people enjoy participating them watching them. It’s, great quality, athleticism, and sport, and just kind of shifting the focus there, I think overall, will help both the research side of things, and then being able to kind of implement that and allowing access to care for those athletes.

Rhys Waters 24:49
As we heard from our guests on this episode, findings from a study on one gender can not be blindly applied to the other, and even within the same gender, applicable information can differ widely based on performance level, body type, and countless other factors. Considering this, closing this sex data gap will not happen over night. It will require a myriad of researchers, funding, and participants.
So, what will be the tipping point for female athletes to no longer be looked at as anomalies in sports research when they make up more than 50% of the population? For all the current and future female athletes around the world we must continue to make strides to address these gaps in research so that one day all athletes — regardless of sex — can accurately understand their own physiology and work with it to maximize not only their performance, but also recovery, injury prevention and overall enjoyment of sport.

END QUOTES

Samantha Fisher 22:43
It’s just shown me how this field and research has such a long way to go to help women be equally represented in the sport and exercise literature, and how much opportunity there is for researchers to address this issue, and to make a huge change for women in sport. This issue is just so easy to overlook. And I think that what we’re doing by highlighting this gap in the literature, through this research, it can bring this to attention so, it can be addressed, hopefully in the future.

Mikaela Henderson 26:12
I think really to solve this whole issue, we have to have an all-hands-on deck approach. not only having student researchers and current researchers and future researchers looking at this issue, but then even having the collaboration between practitioners and researchers. There are a lot of people that do both, but that’s not always the case.

Annika Leslie 26:36
Even if it’s just tracking stuff that I do already if it can help in the future to help athletes like myself down the road, I think it’s really special to be a part of and I’m personally really interested in. I know there is interest in other athletes as well, just because it’s such a big part of the game.

Rhys Waters 26:54

Thank you for listening to Beyond Research brought to you by Research Nova Scotia.
We would like to expend a special thank you to our guests Mikaela Henderson, Jennifer Jamieson, Samantha Fisher, Annika Leslie.
To learn more about the research heard on this podcast visit researchns.ca/beyondresearch.
I’m your host, Rhys Waters, and we’ll see you next time.