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EDITED BY
Fabien Ohl,
Université de Lausanne, Switzerland
REVIEWED BY
Roberta Antonini Philippe,
Université de Lausanne, Switzerland
*CORRESPONDENCE
Jill Colangelo
jill.colangelo@unibe.ch
RECEIVED 01 August 2023
ACCEPTED 10 October 2023
PUBLISHED 16 November 2023
CITATION
Colangelo J, Smith A, Buadze A and Liebrenz M
(2023) “There just isn’t any other option—so we
just have to put up with it”: mental health in
women’s cycling and the necessity of structural
change.
Front. Sports Act. Living 5:1270957.
doi: 10.3389/fspor.2023.1270957
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“There just isn’t any other
option—so we just have to put up
with it”: mental health in women’s
cycling and the necessity of
structural change
Jill Colangelo1*, Alexander Smith1, Anna Buadze2
and Michael Liebrenz1
1
Department of Forensic Psychiatry, University of Bern, Bern, Switzerland,
2
Department of Psychiatry,
Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
Historically, bicycle riding connoted freedom, independence, and enhanced
mental and physical wellbeing for women. Persevering through criticism and
moral panic, female cyclists have been competitive since the late 19th century—
many earning substantial prize money and prestige. Unfortunately, this progress
was not linear in its trajectory and contemporary professional women’s cycling
continues to be pervaded by structural and cultural challenges, which can have
deleterious effects on athlete mental health. Notably, socioeconomic pressures
endure, like unstable employment terms, limited team support, and role
conflicts. Furthermore, sexual harassment, body shaming, and manipulation may
characterize women’s experiences with their coaches and teams. Sizable
investment gaps between men’s and women’s teams and competitions often
underpin these scenarios of disadvantage. Alongside hindering the development
of women’s cycling, these adverse circumstances may induce psychosocial risk
factors. Within this context, by highlighting sport-specific and sex-specific
considerations, the emerging subdiscipline of sports psychiatry can be valuable
for protecting and promoting athlete welfare in women’s cycling. Raising
awareness about extant symptoms, vulnerabilities, contributing behaviours, and
systemic issues, can bolster efforts to develop better conditions and care
equivalence. To that end, this perspective article draws upon anecdotal and
scholarly evidence to provide an overview of psychiatric concerns in women’s
professional cycling. This informs recommended strategies to improve mental
health and advance equality within the sport, which should involve actions from
several stakeholders, such as athletes, teams, and governing bodies.
KEYWORDS
mental health, women’s cycling, sports psychiatry, risk factors, elite athlete, equality
1. Introduction
1.1. Historical overview of women’s competitive cycling
With modernized bicycle designs in the late 1800s, women started riding in greater
numbers (1). Gender-based independence was expanding in this epoch, yet female cyclists
faced societal judgement, sexism, and pseudoscientific theories (2). Specifically, cycling
could remove women from the home and might induce “adverse”physical effects, such as
muscle growth or a so-called “strained face”(1). Since bicycling was normatively framed
TYPE Perspective
PUBLISHED 16 November 2023
|
DOI 10.3389/fspor.2023.1270957
Frontiers in Sports and Active Living 01 frontiersin.org
as a masculine pursuit during this time, questions of sexuality and
even morality arose (3). Some of this conjecture was conditioned by
changes in women’s fashion, including billowing skirts, which
could impede riding (1). Interestingly, this led women to register
for a significant proportion of cycling-specific clothing patents
(4,5). Again, however, clothing innovations were considered
both masculine and provocative, and the women who wore them
were frequently derided (5).
In the same epoch, women were encouraged to compete in
cycling races as an exposition of “speed and skill”; nonetheless,
this has been viewed more as a financial ploy exploiting societal
curiosity towards women competing in minimal attire, rather
than a framework for proto sporting equality (2). Cycling races
were considered to be entertainment and therefore, women’s
ability to attract large crowds to the velodrome conferred value
(2). Nevertheless, societal motivations aside, female riders were
committed, dedicated, and persistent (6). This was exemplified
by early professionals like Tillie Andersen (1875–1965), who
worked full-time while simultaneously breaking records and
earning sponsorships (6).
Despite this initial popularity, women’s professional racing
largely diminished until the late 1950s, in part due to the rise of
other sports and the availability of automobiles (6). Aside from
limited attempts to reestablish women’s racing in 1937 and 1958,
it was not recognised in the Olympics until 1984, the same year
that the female Tour de France was originally instituted (6).
Notably, this event has continually experienced disruption and
inconsistencies in its scheduling and format.
1.2. Women’s competitive cycling:
contemporary perspectives
Today, women’s cycling is overseen by the Union Cycliste
Internationale (UCI) and is organized into professional World
Teams (WT) and Continental Teams (CT). Races are categorized
across four divisions, namely: Women’s World Tour, UCI
ProSeries, Class 1 and Class 2 (7). As of 2022, there were two
hundred and thirty-nine riders over fifteen WT and sixty CT
encompassing seven hundred and nine riders (7,8). For 2023,
thirty races were scheduled, comprising both single-day events and
stage races (8). There has been an 80% increase in professional
riders from 2012 to 2020 (9), and with the introduction of the
Paris-Roubaix Femmes in 2021, women’s racing is receiving more
acclaim (10), as demonstrated by expanding spectator support and
more challenging course designs (11,12).
However, although the notion of a female riding a bike no
longer deemed controversial in nearly all societies, the professional
sport continues to endure inherent challenges. Many of these have
socioeconomic origins, culminating in lower wages and limited
resources (13,14). Other concerns stem from harmful behaviours
and unbalanced power dynamics, leading to abusive and coercive
experiences (15,16). While governing bodies seek to strengthen
the discipline, there may still be a broader lack of confidence in
the sporting ability of professional female cyclists (17), predicated
on gender-based dynamics. For instance, Lucas has identified
three persistent attitudes: female cyclists lack speed, strength, and
stamina; they are not well-suited to long-distance racing; and
there is still great sensitivity around public urination (17).
Against this background, substantial socioenvironmental
challenges and sport-specific vulnerabilities may be evident
across women’s cycling, demanding greater scrutiny and tailored
responses. Although anecdotal evidence reveals prevailing
concerns, the mental health of female riders has been largely
neglected in current scientific literature and by other stakeholders
in the sport. One professional cyclist articulated this sense of
inertia: “There just isn’t any other option—so we just have to put
up with it”(16). As an emerging subdiscipline, sports
psychiatrists have a responsibility to investigate these detrimental
paradigms and inform recommendations to safeguard riders. In
the authors’opinion, the burgeoning popularity of women’s
cycling presents an opportunity to facilitate real change. To that
end, this perspective paper explores the current mental health
landscape within women’s cycling, underscoring the necessity of
enhanced resources and robust actions to support athlete welfare
and advance gender equity.
2. Risk factors in women’s professional
cycling
2.1. Socioeconomic determinants
Despite recent progress, substantial economic challenges
remain across women’s professional cycling, which can present
psychosocial burdens for athletes. For instance, the average
budget for a men’s team may range between ∼20 and 35 million
USD depending on category and classification, whereas women’s
teams may operate within a substantially smaller budget bracket
of ∼150,000 USD (14,18). These disparities can detrimentally
affect salaries, access to health resources, and personal self-
esteem, amongst other aspects (19).
We acknowledge that laudable developments have occurred in
this area, like the introduction of a minimum wage in 2020
(∼35,000 USD annually) (13). Nevertheless, this only applies to
WT riders, meaning that 52% of female cyclists must pursue a
secondary form of employment and 20% of CT riders receive no
remuneration (18). Additionally, many participants, even those
earning below the minimum salary, are responsible for expenses,
like travel costs or repairs following a crash (20,21).
Consequently, even top-performing athletes still experience
economic insecurity, with resulting mental health effects, as
exemplified by a two-time Giro Rosa champion working part-
time to supplement her income: “it becomes depressing (our
italics) […] you can only keep putting your whole heart into
something for so long when you feel it doesn’t matter”(22).
WT men’s teams have a mandated minimum wage which is
significantly higher than WT women (14,18,23). Even still,
efforts to equalize pay have been criticized and there is a lack of
awareness about sex-based discrepancies [e.g., (24)]. This wage
gap correlates with a resource gap, leaving many female athletes
without access to the same services as their male counterparts,
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Frontiers in Sports and Active Living 02 frontiersin.org
which may compromise health outcomes (15,21). For example,
men’s support staff typically include physical therapy
professionals and chef-nutritionists, who assist with recovery
(25). Consequently, discussions about the inequities between
men’s and women’s team budgets often illustrate a vicious chain
of events; in women’s cycling a lack of media coverage leads to a
lack of societal interest, in turn leading to a lack of investment.
Yet, this neglects the role of the media in perpetuating negative
stereotypes about women’s sports or choices not to cover them at
all; instead, recent viewership figures underline the flawed basis
for these decisions and, encouragingly, certain media are
beginning to actively champion the sport (21,26,27).
Separately, female riders have noted a culture of secrecy around
wages and some teams may actively discourage athletes from
discussing salaries, concomitantly undermining organizational
trust and intra-team relationships (15). Several women have
claimed that contracts were misrepresented or changed without
review and some found it difficult to receive any remuneration
(14,20). Other riders have described the harmful psychological
impact of what they depict as “economic manipulation”, with one
conceding: “you quickly reach the point where it just doesn’tseem
like it’s worth it. And there is basically nowhere else to go”(20).
2.2. Performance, physiology and
sociocultural pressures
Performance, physiological, and sociocultural pressures may
engender adverse health concerns amongst some female athletes.
As a sport, cycling has historically favored lighter competitors
with higher power-to-weight ratios, meaning that unsafe dieting,
harmful behaviours, and body shaming can be commonly
observed phenomena across both men’s and women’s disciplines
(28). In women’s cycling, alarming patterns have emerged,
including athletes being forcibly restricted from eating or mocked
for their body size by coaches and subsequently developing
career-ending eating disorders (ED) (20,29,30). One female
cyclist outlined a teammate’s experiences of “fat-shaming”, which
“was so terrible that this poor girl was falling apart by the end of
her first training camp”(20). Another revealed how a teammate
received a penis-shaped “trophy”from a coach because she was
the first rider that he had made cry that season (20).
Additionally, performance-enhancing drugs (PEDs) are
becoming an increasingly prominent concern, prompting
rigorous testing measures from the UCI (31). Again, external
dynamics can contribute to individual behaviours, with some
athletes suggesting that support staff encouraged them to change
their attitude towards doping (20). Discussing an interaction, one
rider stated: “He told me everyone does cortisone, like, that made
it okay for me to use it, too?”(20). Significantly, athletes may
experience long-term harms from PED use and substantial
penalties or suspensions can be enforced when doping
infractions are detected (31,32).
As another controversial issue, attending to basic needs such as
urination during competition presents further concerns (15). In
certain contexts, sociocultural stigma towards women urinating
in public persists, meaning that race facilities must be adapted at
additional cost (17). Unlike male riders, the need to cease riding
to urinate has been considered a weakness of female cyclists,
rather than a biological reality (15). This has been appropriated
to justify the reluctance of race organizers to increase stage
lengths, as well as being used as evidence to support a lack of
competitive drive (17). Yet, the consequences of restricted
urination are stark; female cyclists have developed urinary tract
infections due to the inability or inconvenience of urinating
during competitions, which can require antibiotics and may even
lead to severe kidney disease (17). Additionally, riders have been
penalised for taking “nature breaks”, inhibiting broader
inclinations to urinate (33,34). Inadequate sanitation facilities
are likely to render some women at-risk for intra-race anxiety
and other psychological issues since they are unable to manage
this basic need (35).
2.3. Harmful behaviors, sexual harassment
and abuse
Across women’s sport, abusive incidents are well-documented,
which again raises concern for athlete welfare (36). In cycling-
specific settings, commentators have argued this behavior may be
used to coerce and manipulate riders into conforming to male-
centric training and performance frameworks (37,38). In this
regard, sexist assumptions support the ideology that women are
weaker than men and that hostility and aggression can enhance
strength and performance (24,38). Power imbalances within the
athlete-coach dynamic may contribute to this, particularly since
most coaches in women’s cycling are men (37,39,40). Wider
representations may further encourage humiliation and
abasement, as shown by negative media depictions that heighten
sexist attitudes towards the sport (41). Moreover, past reports
illustrate how cyclists have been dehumanized, verbally and
emotionally abused, pitted against teammates, humiliated, and
sexually harassed (15,20,37,38). One rider described these
situations: “I was nearly held prisoner—on the promise of racing
in the World Tour”(20).
Again, a culture of secrecy can predominate within women’s
cycling teams and beyond, meaning athletes seldom come
forward to disclose their experiences, fearing retribution and the
reporting protocols (20). Notably, the UCI reporting system is an
anonymous email address and the subsequent investigation
process has been criticized for lacking full confidentiality (20).
This may compromise the mental health of athletes, as again has
been identified within the sport: “It was so damaging that it really
started to affect my confidence. I began to think that maybe I
shouldn’t even try to be a cyclist […] and this was when I was
already riding for an elite professional women’steam”(20).
2.4. Organizational structures and rules
Many athletes characterized the structural and organizational
aspects of professional cycling as exclusionary and problematic.
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Frontiers in Sports and Active Living 03 frontiersin.org
Dixon and colleagues found that the practice of mixing competitive
categories was a participation barrier, with women not being
afforded the same opportunities as men (9,19). Female UCI
races are generally shorter and sometimes restructured to have
less challenging terrain and/or less climbing, decreasing the
prestige of the competition (and prize money) in comparison to
men’s races (14,15). For example, the 2023 Men’s Tour de
France encompassed 21 stages over 3,500 km, as compared to the
2023 Tour des Femmes with 8 stages over 1,029 km (42).
Some race directors continue to have safety concerns about
women’s abilities, sometimes cancelling or changing races (43).
These discrepancies can result in lower self-esteem and possible
internalized feelings of being weaker (15). Again, a prominent
reason for shorter races assumes that riders are unable to
complete the men’s course, despite women being physiologically
well-suited and even having certain advantages, as shown in
endurance sport (44–46). Other controversial issues are evident,
including debates about trans athletes competing (47), and
questions around physical and mental health management in the
wake of tragic accidents (48,49).
3. Evidence of psychopathology in
women’s cycling
General literature indicates that elite athletes experience mental
health concerns with at least the same prevalence rates as the
general population, such as for disorders like anxiety, depression,
and ED. Across the subpopulation of elite athletes, females may
be particularly at-risk for gender-based psychosocial issues, that
can lead to the onset of psychopathological disorders or
exacerbate extant issues (50). In women’s cycling specifically,
only a limited number of studies have noted researched
psychiatric conditions. However, akin to general elite athlete
groups, those that are available have underlined the presence of
anxiety, depression, and ED symptoms. For example, in an
anonymous survey of n= 122 female riders, 13% received
treatment for ED and 32% were at-risk for ED (51). Moreover,
in this work, 70% of participants reported being pressured to
lose weight (51). A sample of n= 32 female cyclists provided
similar findings, revealing patterns of extreme weight
management and weight-related pressures (52), as did qualitative
interviews with female riders described by Lichtenstein et al.
(53). Work by Kuettel and colleagues suggests that signs of
anxiety and depression may be evident in female riders and a
narrative analysis of a female professional cyclist’s autobiography
also highlighted psychosocial pressures and revealed potential
indicators of disorder symptomatology (54,55).
Concerningly, unaddressed mental health issues have disrupted
athletes’careers. Per the Cyclists’Alliance survey of n= 124
professional female riders, 22% of respondents identified mental
health as a reason to consider retiring from the sport (18).
Despite not being classified within the International Classification
of Diseases as a mental disorder, exercise addiction can also be
prominent in women’s cycling (56,57). Exercise addiction may
further compromise athlete wellbeing, as it may lead to injury,
low energy availability, hypothalamic amenorrhea, or
Overtraining Syndrome and associated wide-ranging physical and
mental disturbances (58,59). Equally, depression and anxiety
have been found to be correlated with bicycle crashes, and
women riders in particular are prone to experience greater
psychological challenges following a crash (60). In addition,
traumatic brain injury (TBI) has links with depression and
preliminary data suggests that there may be gender-based
differences in symptomatology post-injury (60,61).
Though research has examined psychiatric disorders in elite
cycling (62), there is a distinct lack of tailored investigations into
female athletes and gender-based concerns. This is exemplified
by the fact that, of those few studies in this area, the majority
use mixed samples [e.g., (63)]. However, with the disparate
experiences between female and male riders, it may not be
appropriate to derive meaning for both genders equally, as has
been outlined in other sporting contexts (64). Further, certain
projects that do include both genders may overlook the
socioenvironmental realities of women’s cycling. One inquiry
into the psychological aspects of stress reported that women
experience more stress in racing situations versus men,
suggesting gender roles expectations as an explanation (65).
Another study aiming to understand psychological performance
factors in cyclists highlighted how being male was correlated
with better endurance performance, based on a group of n=7
women (66). Generally, an insufficient evidence-base around
psychiatric symptoms and pharmacological therapeutic
interventions amongst female athletes has been identified, as have
the difficulties associated with attempting to extrapolate
information garnered from male-centric samples (64).
Despite scarce scientific data, there is considerable anecdotal
reporting of mental health issues among female cyclists,
underlining the need for more academic attention. For example,
a group of twelve riders spoke about critical life events on the
condition of anonymity for fear of retaliation (20). A former
Olympic cyclist, reportedly pressured into silence about an
improper team member-coach relationship, died by suicide (67).
Furthermore, an Olympic track cyclist also died by suicide,
possibly related to TBI (68). Another competitor announced her
retirement after enduring experiences with ED (69). Elsewhere,
three riders disclosed their experiences of ED, questioning the
sporting environment that enables unhealthy behaviors: “Who
would put themselves through that?”I wondered. “How could
that possibly be OK?”(70–72).
4. Recommendations
Based on current anecdotal and scientific evidence then, we
believe that there is a need to bolster regulatory programmes,
improve awareness, and enhance care provisions in women’s
cycling. Currently, it is alarming to note that many vulnerable
riders may be unwilling or unable to access psychiatric support
(73). Elsewhere in sports psychiatry and beyond, researchers have
advocated for focus groups, consensus statements, and
psychoeducation schemes (74,75). These may be useful for
Colangelo et al. 10.3389/fspor.2023.1270957
Frontiers in Sports and Active Living 04 frontiersin.org
women’s cycling, but alone are not enough; despite incremental
progress, historic gender-based disparities still persist across the
sport (76,77). As described, it is also possible that governance
structures, reporting protocols, and help-seeking pathways may
be inadequate, despite pledges to better support female riders
(20,77,78). It is likely that there have been previous calls to
improve these conditions, which have failed to yield positive
results; notably, attempts at establishing an impartial union in
service of women cyclists have not been without controversy
(79). Within this context, proactive interventions are essential to
transform the sport into a safer space and to strengthen its
reputation, utilising learnings and evidence from other programs
[e.g., (49)]. As the popularity of women’s cycling increases, we
believe this should be a significant driving force for change.
For optimal success, initiatives must be implemented at-scale
and quickly enough to generate positive outcomes. With many
risk factors and the adverse conditions of women’s cycling, it
may be important to distinguish between cycling as a healthy
leisure activity and professional riding, which could incur
negative physical and mental health outcomes. Some women may
enter the sport due to their love of riding and camaraderie or as
a pursuit of health but find these qualities lacking in professional
contexts. Resultantly, we urge prospective athletes to develop a
comprehensive understanding of the potential dynamics of
competition and a dedicated self-care plan. Thus,
psychoeducational measures in women’s cycling may better
prepare riders for the realities of participation, which should be
disseminated holistically through teams and governing
federations. Additionally, recent advancements have been made
toward economic equity, but further measures should be enacted
to continue progress in this area, owing to the potential
psychosocial effects of lower financial security and self-worth
(9,21).
As a basic requirement, women who pursue competitive
cycling professionally should be afforded sufficient psychiatric
support. Though recommendations around screening, referral,
and care have been generally provided by the UCI (80), it
remains unclear if this is offered universally, independently, and
anonymously, ensuring dignity and respect and protecting
against retributive consequences. Despite financial constraints,
teams should be mandated to provide these services as an entry
criteria for competition, upholding the duty of care towards their
riders. Likewise, coaches should undergo thorough evaluation
prior to employment in efforts to distinguish their suitability for
the role and to mitigate against potentially injurious or abusive
practices. Here, governance bodies and teams should be held
accountable for delivery, while providing systems for safe,
anonymous reporting with the support of athlete unions, and
robust disciplinary actions for any harmful behaviours that may
occur.
Finally, it is clear that more scientific research is needed in all
aspects of women’s professional cycling. That being said, in lieu of
this, anecdotal evidence from athletes is highly valuable. Though
much can be learned from former professionals sharing
information (81), we hope that more current athlete-advocates
are able to discuss their experiences to improve the welfare of
fellow competitors and contemporary conditions within the
sport. To that end, regulators, athlete unions, sponsors, and the
media can encourage the sharing of these dialogues with the aim
of boosting mental health literacy across women’s cycling.
5. Conclusion
Historically, cycling has held a mercurial place in the lives of
women. Though bike riding has contributed to gender-based
advancement and has improved mental and physical health, it
has also engendered moral panic and denigration. Still, cycling
represents an exciting and fulfilling vocation for many, and it is
therefore logical that women may pursue a career in the sport.
Yet, due to the structural difficulties and detrimental patterns
in current professional contexts at the time of writing, we believe
that it is unclear if these benefits are universally attainable.
Instead, specific interventions and systemic change are needed to
mitigate against gender-based issues and concurrent health
disparities. This should involve various stakeholders, such as
governing bodies, scientists, teams, and coaches. We also believe
that the media have a responsibility to accurately report on these
issues and not fulfil either overly positive or negative agendas.
Rather than a culture of silence, women’s cycling must
emphasise a culture of zero tolerance, enforcing measures to
safeguard athlete mental health and promote equitable conditions.
Data availability statement
The original contributions presented in the study are included
in the article/Supplementary Material, further inquiries can be
directed to the corresponding author.
Author contributions
JC: Conceptualization, Investigation, Writing –original draft,
Writing –review and editing. AS: Conceptualization,
Investigation, Writing –original draft, Writing –review and
editing. AB: Conceptualization, Writing –review and editing.
ML: Conceptualization, Supervision, Writing –review and editing.
Funding
The author(s) declare that no financial support was received for
the research, authorship, and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
Colangelo et al. 10.3389/fspor.2023.1270957
Frontiers in Sports and Active Living 05 frontiersin.org
Publisher’s note
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
claim that may be made by its manufacturer, is not guaranteed
or endorsed by the publisher.
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