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‘Invisible Sportswomen’ - The Gender Data Gap in sport and
exercise science research.
Journal:
Women in Sport and Physical Activity Journal
Manuscript ID
WSPAJ.2021-0028.R2
Manuscript Type:
Article
Keywords:
exercise, gender, health, physical activity, sociocultural perspectives
Human Kinetics, 1607 N Market St, Champaign, IL 61825
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Keywords. Gender bias, Data gap, Gender, Sexism, Gender stereotypes, Sport science
Highlights.
●Females are significantly underrepresented in sport and exercise science research.
●The gender data gap is evident across multiple journals and over numerous years
(2014 to 2019).
●The majority of publications that include females only typically state this in their title,
this contrasts with publications that include only male which typically do not state this
in their title.
●The majority of publications conducted in males only are not studying sex-specific
health topics and therefore could involve female participants also.
Abstract
This study aimed to conduct an updated exploration of the ratio of male and female
participants in sport and exercise science research. Publications involving humans were
examined from The European Journal of Sports Science, Medicine & Science in Sport &
Exercise, The Journal of Sport Science & Medicine, The Journal of Physiology, The American
Journal of Sports Medicine, and The British Journal of Sports Medicine 2014 to 2020. The
total number of participants, the number of male and female participants, the title, and the
topic, were recorded for each publication. Data were expressed in frequencies and
percentages. Chi-square analyses were used to assess the differences in frequencies in each
of the journals. 5,261 publications and 12,511,386 participants were included in the analyses.
63% of publications included both males and females, 31% included males only, and 6%
included females only (p < 0.0001). When analysing participants included in all journals, a
total of 8,253,236 (66%) were male and 4,254,445 (34%) were female (p < 0.0001). Females
remain significantly underrepresented within sport and exercise science research. Therefore,
at present most conclusions made from sport and exercise science research might only be
applicable to one sex. As such, researchers and practitioners should be aware of the ongoing
sex data gap within the current literature, and future research should address this.
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1Introduction
2Over the last seven decades, there has been a steep rise in the number of women
3participating in sport and exercise. For example, at the elite level, the number of
4women participating in the Olympic Games has increased from 10.5% of competitors
5in Helsinki in 1952 to a predicted high of 48.8% of competitors in Tokyo in 2021 (Elliott-
6Sale et al., 2021). This rise in participation can be largely attributed to changing
7societal and cultural views and the increasing development of, and investment in,
8women's sport (Forsyth & Roberts, 2018). Indeed, acts such as Title IX have had a
9significant effect on high school girls' participation in sport, with an increase of over
10 900% in girls' sport participation since the act was first passed in 1972 (Vadhera,
11 2018). Likewise, the 'This Girl Can' campaign run by Sport England has encouraged
12 3.5 million more women to be active by challenging preconceptions about exercise
13 that had become barriers to them choosing to participate (Sport England, 2015).
14 Similarly, global campaigns, such as Nike's 'Dream Crazier' and Adidas' 'She Breaks
15 Barriers' promote the visibility of women in sport and serve to inspire future
16 generations of female athletes. These organisations, charters, and laws have pushed
17 towards the advancement of gender equality in sport and exercise. Today, with more
18 women participating in sport and exercise, there is an increased requirement for
19 researchers to contribute to the advancement of understanding women’s physiology
20 and performance and develop and disseminate effective strategies that optimise the
21 health and performance of sportswomen.
22 Despite the decreasing sex gap in sport and exercise participation, there remains a
23 sex data gap within sport and exercise science research. Specifically, Costello (2014)
24 concluded that females were "significantly underrepresented" within the top three sport
25 and exercise science journals. Much of the current sport and exercise science
26 guidelines have been derived from studies with males as participants, with this data
27 generalised to females (Sims & Heather, 2018). Further, it is common for publication
28 titles to include "human", but for the study to include only men participants, which
29 predicates that the results can be applied to women (e.g., Balshaw et al., 2021;
30 Hammond et al., 2016; Porter et al., 2015; Tiller et al., 2017). However, it is naïve to
31 assume that all research on men can be directly applied to women given the known
32 anatomical, physiological and endocrinological differences between the sexes.
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33 Indeed, sex differences are evident when examining how males and females respond
34 and adapt to exercise (Ansdell et al., 2020). There are noted differences between
35 sexes for injury risk (Lin et al., 2018), in particular concussion management (Solomito
36 et al., 2018). Other differences include biomechanics (Carson & Ford, 2011), energy
37 metabolism (Maggi & Torre, 2018), thermoregulation (Wickham et al., 2021), exercise
38 capacity (Hunter, 2016), muscular strength and hypertrophy (Brandon et al., 2020),
39 sleeping patterns (Mong & Cusmano, 2016), and cognition (Gaillaird et al., 2020).
40 Other factors, such as the influence of the menstrual cycle, hormonal contraceptive
41 use, pregnancy, and menopause, influence how females specifically respond and
42 adapt to exercise and therefore interventions may require investigation exclusively on
43 female participants. As such, it is evident that females will benefit from an increase in
44 their participation within research that applies to both sexes and an increase in
45 research investigating female specific factors that may influence health and
46 performance.
47 In an attempt to readdress the balance in sport and exercise science, there have been
48 numerous research papers recently published to highlight sex disparity (Bruinvels et
49 al., 2017; Costello et al., 2014; Emmonds et al., 2019; Hagstrom, Yuwono, Warton &
50 Ford, 2020; Martinez-Rosales et al., 2021), and to clarify methods to assist
51 researchers in including women as participants (Elliott-Sale, Ross, Burden & Hicks,
52 2021; Janse de Jonge et al, 2019; Sims & Heather, 2018). The recent demand for,
53 interest in, and methodological support for, high quality women-specific sport and
54 exercise science data may all play important roles in closing the sex-data gap,
55 identified by Costello and colleagues in 2014. Accordingly, to determine if the sex data
56 gap still exists within sport and exercise science, the ratio of male and females
57 participants was investigated for all peer-reviewed publications during a seven year
58 period from six sport and exercise journals. This study further aimed to specifically
59 explore the accuracy of publication titles and the sex-specific nature of the research
60 topics being investigated.
61
62 Methods
63 Search strategy
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64 Medicine & Science in Sport & Exercise, The American Journal of Sports Medicine,
65 and The British Journal of Sports Medicine were included in this study as they were
66 used in the original review conducted by Costello and colleagues in 2014. A further
67 three journals (The European Journal of Sports Science [impact factor 2.781], The
68 Journal of Sport Science & Medicine [impact factor 1.806], and The Journal of
69 Physiology [impact factor 4.547]), were also identified and included based on their
70 relevance in the field of sport and exercise science and on their impact factor ratings,
71 recorded from the journal websites in January 2021. All papers published in these six
72 journals between January 1st, 2014, to December 31st, 2020, were screened for
73 inclusion by the first author.
74
75 Gendered language
76 It is important to acknowledge that it is not only people who identify as women for
77 whom it is necessary to research the female body in order to optimise their health and
78 wellbeing. Although this study refers to the terms "woman" and "female" as individuals
79 born with XX chromosomes, a female reproductive system, and who identify with the
80 sex they were assigned with at birth, authors do not know if researchers of the included
81 studies used biological sex and gender.
82
83 Data extraction
84 The abstracts of all papers published between the years 2014 to 2020 within the six
85 included journals were screened individually. Terms used to capture sex information
86 were 'female', OR 'male', OR 'women', OR 'men', OR 'girls', OR 'boys'. Only original
87 and epistemological publications were included. Studies including animal models, in-
88 vitro research, cadavers, narrative and systematic reviews, meta-analyses, letters to
89 the Editor, and methodological advances were excluded. If the information on
90 participant sex was not included within the abstract, the full text was reviewed. Only
91 publications that included sample size and the number of participants based on sex
92 were included. Any publications that did not explicitly state this information (either
93 within the title, abstract, main text, tables, or figures) were excluded. The total number
94 of participants and the total number of males and females were recorded for each of
95 the included publications. Publication title and content were also screened, and
96 information was recorded if: (i) the title identified what sex was included in the study
97 to determine sex disparity between publication titles; and (ii) the publication focused
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98 on a sex-specific topic (e.g., prostate cancer, menstrual cycle, pregnancy) to
99 determine if there was a disparity between the number of male-only and female-only
100 publications that focused on sex-specific topics.
101
102 Statistical analysis
103 Chi-square (2) analysis (Excel 2021, version 16) was used to compare the sex counts
104 across each of the journals and total counts across all six journals. Independent t-tests
105 were used to compare the proportion of publications with identification of sex within
106 the title and compare the proportion of male only or female only publications that focus
107 on a sex-specific issue.
108
109 Results
110 Sex disparity in sport and exercise publications
111 A total of 5,261 publications were reviewed from six sport and exercise science journals
112 between the years 2014 to 2020 (Figure 1). Of these publications, 3,302 (63%) studies
113 included data from both sexes. There was a difference between the number of
114 publications that included males only (1,631; 31%) and females only (328; 6%), with a
115 considerable number of single-sex studies with a male bias, 2 [1, N = 1,959] = 866.671,
116 p<0.0001 (Figure 2A).
117
118 Sex disparity in sport and exercise research participants
119 Of the 12,511,386 participants included in the overall analysis there was a difference
120 between the number of male (8,253,236; 66%) and female (4,254,445; 34%)
121 participants 2 [1, N = 8,678,681] = 7,060,325, p<0.0001 (Figure 2B).
122
123 Sex disparity in sport and exercise publication titles
124 Significantly more publications that included exclusively female participants stated the
125 sex of the studied population within the publication title, 2 [1, N = 430] = 296.270,
126 p<0.0001 (Figure 2C). Indeed, of the 1,631 publications that only included male
127 participants, 223 had a title illustrating that males were included in the study (14%). In
128 contrast, of the 328 publications that included only female participants, 207 had a title
129 that identified females were included in the study (63%).
130
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131 Disparity in sex-specific health research
132 There was a difference between the proportion of male only publications that focus on
133 male-specific factors and the proportion of female only publications which focus on
134 female-specific factors 2 [1, N = 74] = 242.716, p<0.0001 (Figure 2D). Specifically, of
135 the 1,631 publications that included males only, 10 (0.6%) studies aimed to assess
136 male-specific factors (e.g., prostate cancer). In contrast, of the 328 publications that
137 included females only, 64 (20%) studies had the purpose of investigating female
138 specific factors (e.g., the menstrual cycle, hormonal contraceptive use, pregnancy,
139 and breast cancer).
140
141 Discussion
142 The purpose of the present study was to provide an updated review on the sex data
143 gap in sport and exercise science research from six journals between the years 2014
144 to 2020. The results provide evidence that female participants continue to be
145 underrepresented within sport and exercise science research. Specifically, results
146 from this study showed a male bias in both the total number of participants and the
147 number of single-sex studies. Additionally, sex disparity was demonstrated within
148 publication titles and sex-specific research.
149 The current study is only the second to assess sex differences in participants across
150 sport and exercise science journals to the authors' knowledge. In agreement with the
151 results reported by Costello (2014), the results from the present study demonstrate
152 that female participants remain underrepresented within sport and exercise science
153 research. Specifically, of the 5,261 publications and 12,511,386 participants included
154 in this paper, from six sport and exercise science journals between 2014 and 2020,
155 females accounted for 34% of total participants, and only 6% of total publications were
156 conducted exclusively on females. Seven years earlier, Costello (2014) demonstrated
157 that within their analysis of 1,382 articles and 6,076,580 participants from three leading
158 sport and exercise science journals, between 2011 and 2013, females accounted for
159 39% of total participants, with the average percentage of female participation per
160 article being between 35 to 37%. Only 4 to 13% of the articles exclusively included
161 females. Therefore, it appears that both the total number of female participants and
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162 studies exclusively conducted on females within sport and exercise science research
163 have remained relatively consistent over the last decade.
164 The continued discrimination in the sport and exercise science literature is of concern
165 considering what we know about the physiological differences in response to exercise
166 between sexes. Traditionally, it was thought that the physiological responses to
167 exercise did not differ between men and women, with men being viewed as adequate
168 proxies for women (Bruinvels et al., 2016). Today, however, it is becoming accepted
169 that sex is an important biological variable and one of the many mediating influences
170 on the physiological responses to exercise (Ansdell et al., 2020). Indeed, in 2016, the
171 National Institutes of Health (NIH) required that studies must account for sex as a
172 biological variable, and sex should be factored into research designs, analyses, and
173 reporting in animal and human studies. Despite this, the results from the present study
174 demonstrate that there remains a broad imbalance in the total number of participants
175 in sport and exercise science research, with a male bias. Additionally, the findings in
176 the present study show that only 0.6% of male-only studies were investigating male-
177 specific factors (i.e., n = 9 prostate cancer, n = 1 semen quality). This finding suggests
178 that most of the research conducted exclusively on males are topics or questions that
179 potentially have equal application to females. As such, there is a clear gap in the
180 current knowledge base regarding female physiology in sport and exercise. Therefore,
181 it seems imperative that future studies strive to include more female participants to
182 explore potential sex differences, and the mechanisms contributing to these
183 differences, or confirm no sex difference at all. Additionally, even if researchers do not
184 explicitly investigate sex differences, it is essential to have this data available for future
185 researchers to compare results. Further, researchers are urged to include self-report
186 measures which focus on participant biological sex and/or gender and/or gender
187 identity. Ultimately researchers should strive for a study design that supports sex
188 disaggregation of the data to support the development of sport and exercise science
189 guidelines, which improve performance and health outcomes for both sexes.
190 Despite this imbalance in the number of participants in sport and exercise science
191 research, there is growing evidence that women experience performance, training,
192 injury, and recovery differently than males and would benefit from sex-specific
193 research and guidelines. However, findings from the present study show that only 6%
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194 of total publications were conducted exclusively on females. Thus, there remains a
195 considerable number of single-sex studies with a male bias within the literature. As a
196 result, sport and exercise science practitioners and sport coaching education currently
197 use curricula informed by male-centric research, and female specific-factors are rarely
198 discussed in education or training. It is inequitable when women athletes and those
199 working with them do not know when and how to take different approaches towards
200 health and performance related to sex. Without data, women are at risk of being
201 underserved when they have little evidence to inform their understanding of their active
202 body or the best training programme, nutrition, or health behaviours to support it.
203 Therefore, there is an urgent need for more women to be included in research and for
204 more women-only research which looks at the effects of sex-specific factors, such as
205 the menstrual cycle, hormonal contraceptive use, pregnancy, and menopause on sport
206 and exercise outcomes.
207 Sex disparity was also found within sport and exercise publication titles. Results from
208 our investigation indicate that most studies being conducted solely on males are not
209 acknowledging this in their title as only 14% have a title highlighting that research was
210 conducted exclusively in males. In comparison, 63% of publications specific to females
211 acknowledge this in the title. This finding is an important consideration given that much
212 of the research in sport and exercise science has the potential to be directly applied
213 to practice, to improve health and/or performance. To ensure that this translation is
214 effective, practitioners need to be able to easily discern if the outcomes of these
215 studies are applicable to both sexes. Therefore, moving away from only including this
216 information within a methods section and instead ensuring that authors clearly state
217 sex within the title of the paper is recommended for future research to assist in
218 translating this research into practice.
219 A range of factors are likely responsible for the sex bias in the current sport and
220 exercise science literature. Although a detailed investigation into these barriers is
221 beyond the scope of this paper, several issues have been suggested to contribute.
222 Women are more physiologically variable than men because of fluctuating
223 reproductive hormonal profiles across the menstrual cycle and across the lifespan
224 from puberty to menopause. This potential for added variability and the methodological
225 challenges affecting study design are often cited as the basis for the exclusion of
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226 women participants in studies. Difficulties in controlling or matching hormonal status
227 increase the cost of experiments, complicates, and lengthens the study's schedule,
228 and often predicates that invasive blood markers of hormonal profiles are necessary.
229 However, in recent years multiple methodological papers have been published to
230 assist researchers in including women in sport and exercise science research, as well
231 as improve the overall methodological quality of the studies conducted (Elliott-Sale et
232 al., 2021; Janse de Jonge et al., 2019; Schaumberg et al., 2017; Sims & Heather,
233 2018). So whilst including more women in sport and exercise science research likely
234 requires more resources, grant giving organisations can play a pivotal role in closing
235 the sex data gap in this field by prioritising women-focused research calls, considering
236 the implementation of quotas, and accounting for the potential increased duration and
237 cost of women centred studies. Journal publication guidelines should also encourage
238 authors to report results by sex and gender, and review article titles that include
239 participant sex to ensure they are not misleading to readers.
240 It is also important to consider contextual barriers to women’s inclusion in sport and
241 exercise science research. For instance, despite the rise in women participating in
242 sport and exercise, participation rates are still less than men’s, and a greater number
243 of men are taking part in sport at both the recreational (Eime 2016) and elite (Pfister,
244 2011) level, potentially skewing the participant pool towards them. Funding issues
245 might also play a role, with men’s sporting bodies typically having access to larger
246 budgets than women’s organisations (NCAA, 2017). Moreover, there is a greater
247 percentage of men working in sport and exercise science than women (Tannenbaum
248 & Bekker, 2019; Van Miegroet 2019). A recent study found that women account for
249 less than 17% of senior authors and only 12% of Editor in Chief positions are held by
250 women (Martinez-Rosales et al., 2021), a figure reflective of this current review as only
251 one of the six sport and exercise science journals included is a woman. It is plausible
252 that these individuals hold their own set of implicit biases (Tannenbaum & Bekker,
253 2019) considering women investigators were found to be more likely to study women
254 than men investigators (Nielson et al., 2017), and abstract reviewers were less likely
255 to recommend the publication of research conducted in women in comparison to men
256 (Murrar et al., 2021). Combined, this underrepresentation of women (and other
257 minority groups) in senior academic and ‘gate-keeper’ positions may lead to a
258 continued dominance of white male-focused research (Woolston, 2020). Closing
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259 gender gaps in academic institutions, from pay to equal representation at early career,
260 leadership, and board levels, might help, in part, address the sex data gap.
261
262 Strength and limitations
263 It is important to recognise that the present study is not without its limitations. Although
264 a large number of participants were included in the analyses (>12 million), only six
265 sport and exercise science journals were included. Indeed three journals were
266 selected based on the previous review by Costello (2014), and the further three
267 journals included were based on impact factor and authors perceived popularity. While
268 these journals cover many sport and exercise science disciplines, it is important to
269 highlight that the perceived popularity of included journals may be a source of potential
270 bias, as well as noting that certain subjects, such as psychology, are
271 underrepresented. Further, As such, it is possible that exploring publications from
272 other journals might provide different results. Therefore, we advocate for a wider
273 examination of other sport and exercise science journals in future research.
274 Furthermore, research that did not state the sex of its participants anywhere in the
275 paper were excluded, which might have affected our results. Finally, future studies
276 exploring the sex data gap should seek to establish how determinants such as the
277 menstrual cycle and hormonal contraceptive use are factored into study design and
278 controlled for. This information will provide further information on the quality and
279 quantity of women specific sport and exercise science research.
280
281 Conclusion
282 To the authors' knowledge, the current study is only the second to assess sex
283 differences in participants within six sport and exercise science journals. These data
284 provide continued evidence that women remain underrepresented within sport and
285 exercise science research. Indeed, women account for only 34% of the absolute
286 number of participants included in this analysis, and only 6% of total publications were
287 conducted exclusively on women. This review also identified a bias in relation to
288 publication title and sex-specific factors within sport and exercise science research.
289 Based on these findings, it is imperative that future studies in sport and exercise
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290 science include women to better understand women’s physiology and its impact on
291 sport and exercise outcomes. It is time to redress the current knowledge gap and
292 achieve equivalence of understanding of both sexes. Where possible, the use of best
293 practice methods should be encouraged to ensure that women are receiving the same
294 quality and quantity of research moving forward. Ultimately, this will optimise the
295 support we give to women, allowing them to fulfil their full health and performance
296 potential.
297 Declaration of interest statement
298 No potential competing interest was reported by the authors
299 Data access statement
300 All data created during this research is available via 10.5255/UKDA-SN-854926.
301
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405 Solomito, M. J., Reuman, H. & Wang, D. H. (2018) Sex differences in concussion: a
406 review of brain anatomy, function, and biomechanical response to impact, Brain
407 Injury. 33(2). https://doi.org/10.1080/02699052.2018.1542507
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409 Sport England (2015). This Girl Can, https://www.sportengland.org/campaigns-and-
410 our-work/this-girl-can, [accessed 18th March 2021]
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412 Sims, S.T. & Heather, A.K. (2018). Myths and Methodologies: Reducing scientific
413 design ambiguity in studies comparing sexes and/or menstrual cycle phases,
414 Experiential Physiology. 103(10), 1309-1317. https://doi.org/10.1113/EP087261
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416 Tannenbaum, C. & Bekker, S. (2019). Sex, gender and sports, The British Medical
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419 Tiller, N., Campbell, I. & Romer, L. (2017). Influence of upper-body exercise on the
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421 Exercise. 49(7), 1461-1472. https://doi.org/10.1249/MSS.0000000000001251
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426 Van Miegroet H., Glass C., Callister R. & Sullivan K. (2019). Unclogging the pipeline"
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430 Wickham, K. A., Wallace, P. J. & Cheung, S. S. (2020) Sex differences in the
431 physiological adaptations to heat acclimation: a state-of-the-art review, European
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435 Woolston C. (2020) White men still dominate in UK academic science, Nature.
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459 Appendices:
460
461 Figure 1. Flow diagram of the number of publications identified between the years
462 2014 to 2020 among the six included sport and exercise science journals.
463
464
465 Figure 2. (A) the number of male-only and female-only publications per year from 2014
466 to 2020 in six of the included sport and exercise science journals; (B) the absolute
467 number of male and female participants across all publications per year from 2014 to
468 2020 in six of the included sport and exercise science journals; (C) the proportion of
469 publications including a sex-identifier in the title in male-only and female-only
470 publications; and (D) the proportion of publications investigating sex-specific topics
471 within male-only and female-only publications.
472
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