ArticlePDF Available

“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

Authors:

Abstract

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.
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 isnt any other optionso we
just have to put up with it: mental health in
womens cycling and the necessity of structural
change.
Front. Sports Act. Living 5:1270957.
doi: 10.3389/fspor.2023.1270957
COPYRIGHT
© 2023 Colangelo, Smith, Buadze and Liebrenz.
This is an open-access article distributed under
the terms of the Creative Commons Attribution
License (CC BY). The use, distribution or
reproduction in other forums is permitted,
provided the original author(s) and the
copyright owner(s) are credited and that the
original publication in this journal is cited, in
accordance with accepted academic practice.
No use, distribution or reproduction is
permitted which does not comply with these
terms.
There just isnt any other
optionso we just have to put up
with it: mental health in womens
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 womens 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
conicts. Furthermore, sexual harassment, body shaming, and manipulation may
characterize womens experiences with their coaches and teams. Sizable
investment gaps between mens and womens teams and competitions often
underpin these scenarios of disadvantage. Alongside hindering the development
of womens cycling, these adverse circumstances may induce psychosocial risk
factors. Within this context, by highlighting sport-specic and sex-specic
considerations, the emerging subdiscipline of sports psychiatry can be valuable
for protecting and promoting athlete welfare in womens 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 womens
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, womens cycling, sports psychiatry, risk factors, elite athlete, equality
1. Introduction
1.1. Historical overview of womens 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 pseudoscientic theories (2). Specically, cycling
could remove women from the home and might induce adversephysical 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 womens fashion, including billowing skirts, which
could impede riding (1). Interestingly, this led women to register
for a signicant proportion of cycling-specic 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 nancial 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, womens
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 exemplied
by early professionals like Tillie Andersen (18751965), who
worked full-time while simultaneously breaking records and
earning sponsorships (6).
Despite this initial popularity, womens 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 womens 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. Womens competitive cycling:
contemporary perspectives
Today, womens 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: Womens World Tour, UCI
ProSeries, Class 1 and Class 2 (7). As of 2022, there were two
hundred and thirty-nine riders over fteen 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, womens 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 condence in
the sporting ability of professional female cyclists (17), predicated
on gender-based dynamics. For instance, Lucas has identied
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-specic vulnerabilities may be evident
across womens 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 scientic literature and by other stakeholders
in the sport. One professional cyclist articulated this sense of
inertia: There just isnt any other optionso 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 authorsopinion, the burgeoning popularity of womens
cycling presents an opportunity to facilitate real change. To that
end, this perspective paper explores the current mental health
landscape within womens cycling, underscoring the necessity of
enhanced resources and robust actions to support athlete welfare
and advance gender equity.
2. Risk factors in womens professional
cycling
2.1. Socioeconomic determinants
Despite recent progress, substantial economic challenges
remain across womens professional cycling, which can present
psychosocial burdens for athletes. For instance, the average
budget for a mens team may range between 20 and 35 million
USD depending on category and classication, whereas womens
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
exemplied 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 doesnt matter(22).
WT mens teams have a mandated minimum wage which is
signicantly 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,
Colangelo et al. 10.3389/fspor.2023.1270957
Frontiers in Sports and Active Living 02 frontiersin.org
which may compromise health outcomes (15,21). For example,
mens support staff typically include physical therapy
professionals and chef-nutritionists, who assist with recovery
(25). Consequently, discussions about the inequities between
mens and womens team budgets often illustrate a vicious chain
of events; in womens 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 womens sports or choices not to cover them at
all; instead, recent viewership gures underline the awed 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 difcult 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 doesntseem
like its 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 mens and womens disciplines
(28). In womens 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 teammates experiences of fat-shaming, which
was so terrible that this poor girl was falling apart by the end of
her rst training camp(20). Another revealed how a teammate
received a penis-shaped trophyfrom a coach because she was
the rst 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). Signicantly, 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 womens sport, abusive incidents are well-documented,
which again raises concern for athlete welfare (36). In cycling-
specic 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 womens 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 prisoneron the promise of racing
in the World Tour(20).
Again, a culture of secrecy can predominate within womens
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 condentiality (20).
This may compromise the mental health of athletes, as again has
been identied within the sport: It was so damaging that it really
started to affect my condence. I began to think that maybe I
shouldnt even try to be a cyclist [] and this was when I was
already riding for an elite professional womensteam(20).
2.4. Organizational structures and rules
Many athletes characterized the structural and organizational
aspects of professional cycling as exclusionary and problematic.
Colangelo et al. 10.3389/fspor.2023.1270957
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
mens races (14,15). For example, the 2023 Mens 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
womens 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 mens course, despite women being physiologically
well-suited and even having certain advantages, as shown in
endurance sport (4446). 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
womens 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 womens cycling specically,
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 ndings, 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 cyclists autobiography
also highlighted psychosocial pressures and revealed potential
indicators of disorder symptomatology (54,55).
Concerningly, unaddressed mental health issues have disrupted
athletescareers. Per the CyclistsAlliance survey of n= 124
professional female riders, 22% of respondents identied mental
health as a reason to consider retiring from the sport (18).
Despite not being classied within the International Classication
of Diseases as a mental disorder, exercise addiction can also be
prominent in womens 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 exemplied
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 womens 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 insufcient evidence-base around
psychiatric symptoms and pharmacological therapeutic
interventions amongst female athletes has been identied, as have
the difculties associated with attempting to extrapolate
information garnered from male-centric samples (64).
Despite scarce scientic 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?(7072).
4. Recommendations
Based on current anecdotal and scientic evidence then, we
believe that there is a need to bolster regulatory programmes,
improve awareness, and enhance care provisions in womens
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
womens 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 womens cycling increases, we
believe this should be a signicant 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 womens 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 nd 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 womens 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 nancial security and self-worth
(9,21).
As a basic requirement, women who pursue competitive
cycling professionally should be afforded sufcient 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 nancial 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 scientic research is needed in all
aspects of womens 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 womens 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 fullling vocation for many, and it is
therefore logical that women may pursue a career in the sport.
Yet, due to the structural difculties and detrimental patterns
in current professional contexts at the time of writing, we believe
that it is unclear if these benets are universally attainable.
Instead, specic 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 full either overly positive or negative agendas.
Rather than a culture of silence, womens 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 nancial support was received for
the research, authorship, and/or publication of this article.
Conict of interest
The authors declare that the research was conducted in the
absence of any commercial or nancial relationships that could
be construed as a potential conict of interest.
Colangelo et al. 10.3389/fspor.2023.1270957
Frontiers in Sports and Active Living 05 frontiersin.org
Publishers note
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their afliated
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.
References
1. Jarry J. Ofce for science and society. The moral and medical panic over bicycles
(2020). Available at: https://www.mcgill.ca/oss/article/history-did-you-know/moral-
and-medical-panic-over-bicycles (Accessed May 22, 2023).
2. Horton D, Rosen P, Cox P. Cycling and society. Oxfordshire, England: Routledge
(2016). 222.
3. Smethurst P. The bicycletowards a global history. New York: Springer (2015). 208.
4. Gray SH, Peteu MC. Invention, the angel of the nineteenth century: patents for
womens cycling attire in the 1890s. Dress. (2005) 32(1):2742. doi: 10.1179/
036121105805253080
5. Jungnickel K. One needs to be very brave to stand all that: cycling, rational dress
and the struggle for citizenship in late nineteenth century britain. Geoforum. (2015)
64:36271. doi: 10.1016/j.geoforum.2015.04.008
6. Gilles R. Women on the move: The forgotten era of womens bicycle racing.
Lincoln: University of Nebraska Press (2018). 316.
7. UCI Women WorldTour teams. Available at: https://www.procyclingstats.com/
teams/women (Accessed July 18, 2023).
8. Frattini K. Womens WorldTour the denitive guide for 2023 (2023). Available
at: https://www.cyclingnews.com/features/womens-worldtour-the-denitive-guide/
(Accessed July 19, 2023).
9. Erp TV. The development of womens professional cycling. J Sci Cycl. (2019) 8
(3):12. doi: 10.28985/1920.jsc.01
10. Ofcial website of the ParisRoubaix Femmes. Available at: https://www.paris-
roubaix-femmes.fr/en (Accessed July 18, 2023).
11. Scholten D. Johan Cruyff Institute - the Netherlands. Womens cycling is
growing fast and new challenges are arising”–Anna van der Breggen, interview
part 2 (2022). Available at: https://cruyfnstitute.nl/en/coaching/womens-cycling-is-
growing-fast-and-new-challenges-are-arising-anna-van-der-breggen-interview-part-2/
(Accessed July 18, 2023).
12. We love cycling magazine. Womens road cycling in 2023: look at how far weve
come by Kasia Niewiadoma (2023). Available at: https://www.welovecycling.com/
wide/2023/03/24/womens-road-cycling-in-2023-look-at-how-far-weve-come-by-
kasia-niewiadoma/ (Accessed July 18, 2023).
13. Frattini K. UCI conrms minimum salary for division 1womens teams in
2020 (2018). Available at: https://www.cyclingnews.com/news/uci-conrms-
minimum-salary-for-division-1-womens-teams-in-2020/ (Accessed July 13, 2023).
14. Best I. Vital statistics: facts that show the differences in womens and mens pro
cycling (2018). Available at: https://www.cyclingnews.com/features/vital-statistics-
facts-that-show-the-differences-in-womens-and-mens-pro-cycling/ (Accessed July
13, 2023).
15. Ryder SE. A hobby or a job?: A multi-sited examination of gender and labour
relations in professional womens road cycling. Melbourne: Institute of Health and
Sport, Victoria University (2021). Available at: https://vuir.vu.edu.au/42975/1/
RYDER_Suzanne-thesis.pdf
16. Maxwell S, Harris J. The outer line: the dark legacy of sexism and abuse in
womens cycling. Velo (2018). Available at: https://velo.outsideonline.com/news/the-
outer-line-the-legacy-of-sexism-and-abuse-in-womens-cycling/ (Accessed July 14, 2023).
17. Lucas S. Womens cycle racing: enduring meanings. J Sport Hist. (2012) 39
(2):22742. doi: 10.5406/jsporthistory.39.2.227
18. TCA annual rider survey results are revealed for 2022 (2022). Available at:
https://cyclistsalliance.org/2022/09/the-cyclists-alliance-annual-rider-survey-results-
are-revealed/ (Accessed May 17, 2023).
19. Dixon MA, Graham JA, Hartzell AC, Forrest K. Enhancing womens
participation and advancement in competitive cycling. J Appl Sport Manag. (2017)
9(4):1021. doi: 10.18666/JASM-2017-V9-I4-8135
20. The status of womens pro cycling part 2: a cultural legacy of sexism and abuse
| The outer line. Available at: https://theouterline.com/status-of-womens-cycling-2-
sexism-and-abuse/ (Accessed May 18, 2023).
21. Ronald I. Nearly half of women pros still cant make ends meet with income
from racing (2022). Available at: https://www.cyclingnews.com/news/nearly-half-of-
women-pros-still-cant-make-ends-meet-with-income-from-racing/ (Accessed July
13, 2023).
22. Pidd H. Mara Abbott ghting anorexia and nancial chasm as she chases third
Giro. The Guardian (2016). Available at: https://www.theguardian.com/sport/2016/
jul/01/mara-abbott-womens-cycling-still-faces-an-uphill-struggle-giro-rosa (Accessed
July 18, 2023).
23. Top paid professional cyclists - cycling digest - cycling information bulletin
(2023). Available at: https://cyclingdigest.net/top-paid-professional-cyclists/, https://
cyclingdigest.net/top-paid-professional-cyclists/ (Accessed August 1, 2023).
24. Frattini K. Lefevere claims womens cycling is articially pushedby minimum
salaries (2023). Available at: https://www.cyclingnews.com/news/lefevere-claims-
womens-cycling-is-articially-pushed-by-minimum-salaries/ (Accessed August 1,
2023).
25. Bien L. How does a Tour de France team work? (2018). Available at: https://
www.sbnation.com/cycling/2018/7/17/17570042/tour-de-france-team-tactics-staff-support
(Accessed July 18, 2023).
26. Global cycling network. Global cycling network - home | GCN. Available at:
https://dotcom-globalcyclingnetwork-1du1kq55l.qa.globalcyclingnetwork.com/ (Accessed
August 1, 2023).
27. Ryder S, McLachlan F, McDonald B. Riding in a mans world: gendered struggles
in professional womens road cycling. In: Bowes A, Culvin A, editors. The
professionalisation of womens sport. Bingley, UK: Emerald Publishing Limited
(2021). p. 17591. (Emerald studies in sport and gender).
28. Roberts CJ, Hurst HT, Hardwicke J. Eating disorders and disordered eating in
competitive cycling: a scoping review. Behav Sci. (2022) 12(12):490. doi: 10.3390/
bs12120490
29. Cunningham S, Craig D. Being really realon YouTube: authenticity,
community and brand culture in social media entertainment. Media Int Aust.
(2017) 164(1):7181. doi: 10.1177/1329878X17709098
30. Goddard B. Cyclist, 25, announces retirement after ve-year anorexia battle
ruined career (2022). Available at: https://www.mirror.co.uk/sport/other-sports/
cycling/cyclist-battled-anorexia-for-years-28581619 (Accessed July 13, 2023).
31. Ballinger A. UCI steps up anti-doping enforcement in womens peloton (2020).
Available at: https://www.cyclingweekly.com/news/racing/uci-steps-up-anti-doping-
enforcement-in-womens-peloton-447474 (Accessed July 13, 2023).
32. Havnes IA, Jørstad ML, Innerdal I, Bjørnebekk A. Anabolic-androgenic steroid
use among women a qualitative study on experiences of masculinizing, gonadal and
sexual effects. Int J Drug Policy. (2021) 95:102876. doi: 10.1016/j.drugpo.2020.102876
33. OShea S. Vuelta Femenina: controversy brewing over pee stop that saw Demi
Vollering lose red jersey (2023). Available at: https://news.yahoo.com/vuelta-femenina-
controversy-brewing-over-100203009.html (Accessed July 14, 2023).
34. CyclingUpToDate.com. If riders cannot do a pee stop anymore, then cycling is
going to be difcult- Anna van der Breggen critical of Movistars Vuelta Femenina
tactics (2023). Available at: https://cyclinguptodate.com/cycling/if-riders-cannot-do-a-
pee-stop-anymore-then-cycling-is-going-to-be-difcult-anna-van-der-breggen-
critical-of-movistars-vuelta-femenina-tactics (Accessed July 14, 2023).
35. Caruso BA, Clasen T, Yount KM, Cooper HLF, Hadley C, Haardörfer R.
Assessing womens negative sanitation experiences and concerns: the development
of a novel sanitation insecurity measure. Int J Environ Res Public Health. (2017) 14
(7):755. doi: 10.3390/ijerph14070755
36. Sundgot-Borgen J, Fasting K, Brackenridge C, Torstveit MK, Berglund B. Sexual
harassment and eating disorders in female elite athletes a controlled study. Scand
J Med Sci Sports. (2003) 13(5):3305. doi: 10.1034/j.1600-0838.2003.00295.x
37. Zehntner C, McGannon KR, McMahon J. Control, consent and complicity in
the coaching of elite womens cycling in Australia: a media analysis. Sport Educ Soc.
(2019) 24(5):52032. doi: 10.1080/13573322.2017.1417257
38. Hardwicke J. Women on wheels: orthodox masculinity and the marginalisation of
women in competitive cycling. In: Hardwicke J, editors. Masculinities and the culture of
competitive cycling. Cham: Springer International Publishing (2023). p. 15972.
(Palgrave Studies in Masculinity, Sport and Exercise).
39. de Haan D, Norman L. Mind the gap: the presence of capital and power in the
female athletemale -coach relationship within elite rowing. Sports Coach Rev. (2020)
9(1):95118. doi: 10.1080/21640629.2019.1567160
40. Tomlinson A, Yorganci I. Male coach/female athlete relations: gender and power
relations in competitive sport. J Sport Soc Issues. (1997) 21(2):13455. doi: 10.1177/
019372397021002003
41. Broughton C. Sexualisation, misogyny and social media - how online platforms
are failing female cyclists (2023). Available at: https://www.cyclingnews.com/features/
Colangelo et al. 10.3389/fspor.2023.1270957
Frontiers in Sports and Active Living 06 frontiersin.org
sexualisation-misogyny-and-social-media-how-online-platforms-are-failing-female-
cyclists/ (Accessed August 1, 2023).
42. Nicholas R. Womens Tour De France: all you need to know about le tour De
France Femmes (2022). Available at: https://biketips.com/womens-tour-de-france-
femmes/ (Accessed August 1, 2023).
43. McLaughlin L. Not the Tour de France: womens race directors safety remarks
spark anger. The Guardian (2023). Available at: https://www.theguardian.com/sport/
2023/jun/12/womens-cycling-tour-feminin-international-des-pyrenees (Accessed
August 1, 2023).
44. Williams S. Are womenbetter ultra-endurance athletes than men? BBC news(2019).
Available at: https://www.bbc.com/news/world-49284389 (Accessed July 14, 2023).
45. Lanning AC, Power GA, Christie AD, Dalton BH. Inuence of sex on
performance fatigability of the plantar exors following repeated maximal dynamic
shortening contractions. Appl Physiol Nutr Metab. (2017) 42(10):111821. doi: 10.
1139/apnm-2017-0013
46. Tiller NB, Elliott-Sale KJ, Knechtle B, Wilson PB, Roberts JD, Millet GY. Do sex
differences in physiology confer a female advantage in ultra-endurance sport? Sports
Med. (2021) 51(5):895915. doi: 10.1007/s40279-020-01417-2
47. Duhaney. UCI reverses course, bans transgender women from racing in womens
category (2023). Available at: https://www.bicycling.com/news/a44546265/uci-bans-
transgender-women/ (Accessed July 17, 2023).
48. MacMichael S. Amy Pieters shows signs of awarenessfour months after crash
that left her in a coma (2022). Available at: https://road.cc/content/news/amy-pieters-
signs-awareness-4-months-after-crash-292335 (Accessed July 17, 2023).
49. SafeSport. Preventing and addressing abuse | U.S. center for safesport. Available
at: https://uscenterforsafesport.org/ (Accessed July 19, 2023).
50. Pascoe M, Pankowiak A, Woessner M, Brockett CL, Hanlon C, Spaaij R, et al.
Gender-specic psychosocial stressors inuencing mental health among women
elite and semielite athletes: a narrative review. Br J Sports Med. (2022) 56
(23):13817. doi: 10.1136/bjsports-2022-105540
51. Koppenburg C, Saxer F, Vach W, Lüchtenberg D, Goesele A. Eating disorder
risks and awareness among female elite cyclists: an anonymous survey. BMC Sports
Sci Med Rehabil. (2022) 14(1):172. doi: 10.1186/s13102-022-00563-6
52. Haakonssen EC, Martin DT, Jenkins DG, Burke LM. Race weight: perceptions of
elite female road cyclists. Int J Sports Physiol Perform. (2015) 10(3):3117. doi: 10.
1123/ijspp.2014-0070
53. Lichtenstein MB, Johansen KK, Runge E, Hansen MB, Holmberg TT, Tarp K.
Behind the athletic body: a clinical interview study of identication of eating
disorder symptoms and diagnoses in elite athletes. BMJ Open Sport Exerc Med.
(2022) 8(2):e001265. doi: 10.1136/bmjsem-2021-001265
54. Kuettel A, Pedersen AK, Larsen CH. To Flourish or Languish, that is the
question: exploring the mental health proles of Danish elite athletes. Psychol Sport
Exerc. (2021) 52:101837. doi: 10.1016/j.psychsport.2020.101837
55. Newman HJH, Howells KL, Fletcher D. The dark side of top level sport: an
autobiographic study of depressive experiences in elite sport performers. Front
Psychol. (2016) 7:112. doi: 10.3389/fpsyg.2016.00868
56. ICD-11. ICD-11. Available at: https://icd.who.int/en (Accessed July 18, 2023).
57. Baker F, Grifths MD, Calado F. Can cycling be addictive? A qualitative
interview study among amateur female cyclists. Int J Ment Health Addict. (2023) 21
(3):174669. doi: 10.1007/s11469-021-00624-w
58. Fahrenholtz IL, Melin AK, Wasserfurth P, Stenling A, Logue D, Garthe I, et al.
Risk of low energy availability, disordered eating, exercise addiction, and food
intolerances in female endurance athletes. Front Sports Act Living. (2022) 4:111.
doi: 10.3389/fspor.2022.869594
59. Adams J, Kirkby R. Exercise dependence and overtraining: the physiological and
psychological consequences of excessive exercise. Sports Sci Med Rehabil. (2001) 10
(3):199222. doi: 10.1080/10578310210395
60. Kotler DH, Cushman DM, Rice S, Gilbert C, Bhatnagar S, Robidoux CG, et al.
Fear, anxiety, and return to sport after cycling crashes. Phys Med Rehabil Clin N Am.
(2022) 33(1):10722. doi: 10.1016/j.pmr.2021.08.008
61. Biegon A. Considering biological sex in traumatic brain injury. Front Neurol.
(2021) 12:112. doi: 10.3389/fneur.2021.576366
62. Smith A, Colangelo J, Buadze A, Liebrenz M. A review of mental health issues in
high-performance and elite-level cycling. Int J Sports Med. (2023). doi: 10.1055/a-
2145-6355
63. Kremžar JovanovićB, Smrdu M, Holnthaner R, Kajtna T. Elite sport and
sustainable psychological well-being. Sustainability. (2022) 14(5):2705. doi: 10.3390/
su14052705
64. Reardon CL, Factor RM. Sport psychiatry. Sports Med. (2010) 40(11):96180.
doi: 10.2165/11536580-000000000-00000
65. Sidhu MPS, Deol NS. Analytical study of psychological, cultural & gender factors
contributing to stress among cyclists in competitive situations. Int J Physiol Nutr Phys
Educ. (2018) 3(1):16838.
66. Röthlin P, Wyler M, Müller B, Zenger N, Kellenberger K, Wehrlin JP, et al. Body
and mind? Exploring physiological and psychological factors to explain endurance
performance in cycling. Eur J Sport Sci. (2023) 23(1):1018. doi: 10.1080/17461391.
2021.2018049
67. Dillane T. Olivia Podmore death: Olympian allegedly pressured to lie during
inquiry (2023). Available at: https://www.nzherald.co.nz/nz/olivia-podmores-death-
cyclist-allegedly-pressured-to-lie-during-cycling-nzs-heron-inquiry/
DMJEDTLUZ5P4FWKR5I7LCH5CXU/ (Accessed July 17, 2023).
68. Woodyatt A. These young female athletes died by suicide. They all had head
injuries in common. CNN (2023). Available at: https://www.cnn.com/2023/02/05/
sport/head-injury-suicide-female-athletes-intl-spt-cmd/index.html (Accessed July 17,
2023).
69. Benson D. Pernille Mathiesen retires due to mental health struggles and an
eating disorder. Velo (2022). Available at: https://velo.outsideonline.com/road/
pernille-mathiesen-retires-due-to-mental-health-struggles-and-an-eating-disorder/
(Accessed July 17, 2023).
70. Weaver M. How the harsh realities of pro cycling left me with an eating
disorder. Velo (2020). Available at: https://velo.outsideonline.com/road/road-racing/
harsh-realities-of-womens-cycling-part-three-eating-disorders/ (Accessed July 17, 2023).
71. Frattini K. Soet opens up about struggle with anorexia in farewell message to
pro cycling (2022). Available at: https://www.cyclingnews.com/news/soet-opens-up-
about-struggle-with-anorexia-in-farewell-message-to-pro-cycling/ (Accessed July 17,
2023).
72. Abbot M. Mara Abbott: leaving professional sports is hard(2017). Available at:
https://www.espn.com/espnw/voices/article/20695210/cyclist-mara-abbott-leaving-
sport-dealing-eating-disorder (Accessed July 17, 2023).
73. Arthurs-Brennan M. Does elite cycling have a problem with mental health?
(2019) Available at: https://www.cyclingweekly.com/tness/training/elite-cycling-
problem-mental-health-410224 (Accessed July 18, 2023).
74. Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental
health in elite athletes: international Olympic committee consensus statement. Br
J Sports Med. (2019) 53(11):66799. doi: 10.1136/bjsports-2019-100715
75. Purcell R, Pilkington V, Carberry S, Reid D, Gwyther K, Hall K, et al. An
evidence-informed framework to promote mental wellbeing in elite sport. Front
Psychol. (2022) 13:112. doi: 10.3389/fpsyg.2022.780359
76. Hurford M. Womens pro cycling makes international strides, but theres more
to be done (2022). Available at: https://www.bicycling.com/racing/a41246508/
womens-cycling-alliance-survey-results/ (Accessed July 17, 2023).
77. The status of womens cycling part 1: a discussion with Iris Slappendel | the
outer line. Available at: https://theouterline.com/status-of-womens-cycling-1-iris-
slappendel/ (Accessed July 17, 2023).
78. UCI. UCI: Womens cycling. Available at: https://www.uci.org/women-cycling/
4mlSVS9JjVsfxchbscypD1 (Accessed July 17, 2023).
79. Jones A. There are two womens cycling unions; only one is supported by
the UCI. Velo (2021). Available at: https://velo.outsideonline.com/news/there-are-
two-womens-cycling-unions-only-one-is-supported-by-the-uci/ (Accessed August 1,
2023).
80. UCI: mental health. Available at: https://www.uci.org/mental-health/
3U57vF98R1zjolF0WNDWIT (Accessed July 19, 2023).
81. Deardorff-McClain N. NGNM - no gods no Masters
®
cycling. Womens cycling
in the 1980s: weve come a long way, baby! Available at: https://nogodsnomasters.life/
blogs/stories/womens-cycling-in-the-80s (Accessed July 19, 2023).
Colangelo et al. 10.3389/fspor.2023.1270957
Frontiers in Sports and Active Living 07 frontiersin.org
... Two women's WorldTour stage races have been established recently (the Tour de Frances Femmes in 2022 and Challenge by La Vuelta in 2020), thereby negating the possibility of conducting longitudinal analysis. As there are gender disparities in the exhibition of EDs and related research [2], and adverse weight-management behaviours have been identified in women's cycling [9,57,61], it would be important to chart historical BMI trends in the Giro d'Italia Femminile; this has been running consecutively from 1988, although the 2021 edition lost UCI WorldTour status. Correspondingly, detailed investigations involving female cyclists with both low BMI and low body fat content could offer valuable data about weight-related concerns in women's cycling, as these factors could have sizeable health consequences for these riders [9,57,61]. ...
... As there are gender disparities in the exhibition of EDs and related research [2], and adverse weight-management behaviours have been identified in women's cycling [9,57,61], it would be important to chart historical BMI trends in the Giro d'Italia Femminile; this has been running consecutively from 1988, although the 2021 edition lost UCI WorldTour status. Correspondingly, detailed investigations involving female cyclists with both low BMI and low body fat content could offer valuable data about weight-related concerns in women's cycling, as these factors could have sizeable health consequences for these riders [9,57,61]. ...
Article
Full-text available
Weight-related issues can be prevalent in elite-level sports, especially in men’s road cycling, where riders may exhibit harmful behaviours, with potentially adverse outcomes for mental and physical health. This study investigated Body Mass Index (BMI) values amongst the top five finishers in the three Grand Tours and the five Monuments races between 1994 and 2023 to assess longitudinal patterns. Publicly available height and weight figures were sourced from ProCyclingStats and BMI scores were calculated for n = 154 and n = 255 individual athletes for the Grand Tours and Monuments, respectively. Two analyses were conducted with correlations and ANOVAs: the first included the BMIs of all top-five finishes and the second focussed on the BMIs of new top-five entrants. The results from both analyses revealed consistent mean BMI decreases over the years and larger effect sizes were apparent in the Grand Tours compared to the Monuments. Although lower BMIs are associated with certain performance advantages, these declining trajectories suggest a need for enhanced awareness in the cycling community and possible regulatory measures and educational programmes to promote the sustainable wellbeing of riders. This may be particularly pertinent given the wider evidence of unhealthy weight-related attitudes and behaviours throughout the sport.
... Nonetheless, motorsport science literature only includes negligible samples of female drivers, primarily in amateur circuits with a mix of open and closed-cockpit vehicles (100). It is important to contextualize this lack of gender-specific information with the positive and concerted efforts to encourage female F1 participation and the psychosocial challenges that other elite female athletes have faced when entering traditionally male-dominated sports (101,102). As of 2023, women are being proactively recruited and trained in the F1 Academy program, though drivers have already discussed their experiences with mental health challenges, some of which are pre-existing, but others may have arisen due to racing pressures (103,104). ...
Article
Full-text available
Formula One (F1) racing has recently grown in popularity, extending well beyond its traditional European roots. However, there has been a paucity of scholarly research dedicated to the health of drivers and even less discussion of the prevalence of psychiatric symptoms, risk factors, and types of psychopathology in F1. This is notable given advancements in sports psychiatry and evidence of psychiatric disorders emerging across other sports. Accordingly, this perspective paper details the physiological conditions in F1 and the socioenvironmental pressures that a driver may encounter during their career, including heat stress, weight restrictions, harassment, and other factors. These extreme physiological and psychological stressors, both in racing and non-racing environments, alongside sport-specific psychosocial pressures, may cause HPA axis dysregulation and other issues in drivers, heightening vulnerabilities for mental health concerns. Additionally, F1 is still affected by stigmatizing attitudes and regressive sociocultural norms, which could inhibit progress toward promoting sustainable wellbeing. Consequently , drivers may be at risk for mental disorder and a decrease in overall health and wellbeing. Against this background, we thereby recommend mental health programs and regulatory actions that could better address these challenges and promote mental wellbeing across F1.
Article
Objectives Women experience more saddle-related pain during cycling compared to men. However, there is a lack of research focused on the optimal saddle for this population. Therefore, the aim of this study was to analyze the most used type of saddle (i.e., women's saddles, men's saddles or unisex) and the effect of saddle type on perceived comfort in elite women road cyclists. Methods Sixty national level road cyclists completed a questionnaire about their training characteristics, saddle use background and saddle comfort. The measures of the participants saddles were also obtained. Results Women's saddles were chosen by the majority of participants, being more comfortable (4.2 vs. 3.8 on a 1–5 comfort scale, respectively) than men's saddles. What is more, among cyclists who had tried both saddles, 55% felt better with the women's saddle, while only 16% preferred the men's saddle. However, more experienced cyclists (i.e., higher weekly and annual training load and years of experience) used men's saddles. Also, 50% of the participants still presented pain, regardless of the type of saddle used. The type of saddle also affected the cyclist's position on the saddle (i.e., at the rear of the saddle with men's saddles) and the location of pain (i.e., higher on the ischial tuberosities with men's saddles). Conclusion In conclusion, women's saddles are more comfortable for women road cyclists. Saddle type may also have some effect on bike-fit, as woman sit further back when using a men's saddle (i.e., increasing the effective saddle height).
Article
Full-text available
This article reports on the findings from a scoping review on eating disorders and disor�dered eating in competitive cycling. The review was informed by a scoping review methodological framework as well as the Preferred Reporting Items for Systematic Reviews and Meta-analysis ex�tension for scoping reviews (PRISMA-ScR) reporting guidelines. PubMed, SPORTDiscus and Web of Science were used to identify relevant literature for review. Fourteen studies met the eligibility criteria and were included in the full review. A narrative synthesis was used to summarise the main findings and themes across the included literature. Findings from the review are presented under the following themes: cycling as an ‘at-risk’ discipline; power to weight ratio; energy requirements and risk of low energy availability; the social environment of cycling; nutrition support provision; rela�tionship between eating disorders/disordered eating and exercise addiction; and recommendations made in identified literature. Overall, the literature suggests competitive cycling is a sport with a high prevalence of disordered eating and/or eating disorders and a sport with unique risk factors that contribute to this. Crucially, more research is needed in this area. The article concludes with the gaps in the literature highlighted, implications for future research, and applications to policy and practice suggested.
Article
Full-text available
Elite and semielite athletes commonly experience mental health concerns and disorders. Compared with men athletes, women athletes are at greater risk of a range of psychological stressors that contribute to health concerns and mental health disorders, which can impact their career satisfaction and longevity. In order to address and improve the mental health of women athletes, it is necessary to simultaneously tackle the gender specific psychosocial stressors that contribute to mental health outcomes. This narrative review examines the gender-specific stressors that affect mental health and well-being in women athletes, some of which are modifiable. Psychosocial stressors identified include exposure to violence, be it psychological, physical or sexual in nature, which can result in a myriad of acute and long-lasting symptoms; and inequities as reflected in pay disparities, under-representation in the media, fewer opportunities in leadership positions and implications associated with family planning and motherhood. Strategies to promote mental health in women athletes should be considered, and where possible, should proactively address gender-specific stressors likely to influence mental health in order to maximise positive outcomes in women athletes.
Article
Full-text available
Background Eating disorders (EDs) are an increasingly recognized concern in professional sports. Previous studies suggests that both female gender and endurance sports put athletes at risk. Female elite cyclists are hence of specific interest. The present study aimed at evaluating the distribution of the individual risk of ED in this group. Further the association between individual risk and both the awareness for the topic ED and the deviation from “normal” weight was depicted. Methods Female cyclists registered with the Union Cycliste Internationale were contacted via email or facebook and asked to complete a survey comprising age, weight, the Eating-Attitude-Test (EAT-26), and questions regarding ED awareness. The observed distribution of the EAT-26 score was compared to results from previous studies in normal subjects and athletes. The distribution of the ED awareness was described and ED awareness was correlated with the EAT-26 score. Both the deviation from ideal weight and the body mass index (BMI) were correlated with the EAT-26 score. Results Of the 409 registered athletes 386 could be contacted, 122 completed the questionnaire. Age ranged from 20-44yrs, BMI from 17.0 to 24.6 kg/m². In the EAT-26, 39 cyclists (32.0%) scored above 20 points indicating a potential benefit from clinical evaluation, 34 cyclists (27.9%) scored 10–19 points suggesting disordered eating. Sixteen athletes (13.2%) had been treated for an ED. About 70% of athletes had been pressured to lose weight. The mean EAT-26 score was above the average observed in normal female populations. It was also above the average observed in many female athlete populations, but lower than in other leanness focussed sports. More than 80%of athletes perceived elite cyclists at risk for developing ED. Increased ED awareness and deviation from the ideal weight were associated with higher EAT-26 scores, but not the body mass index. Conclusion Female cyclists are at risk of developing ED and they are aware of this risk. To improve their health and well-being, increased efforts to support elite cyclists and their teams in preventive activities and early detection are crucial.
Article
Full-text available
Eating disorders are more prevalent in athletes than in the general population and may have severe consequences for sports performance and health. Identifying symptoms can be difficult in athletes because restrictive eating and slim body images are often idealised in a sports setting. The Eating Disorders Examination Questionnaire (EDE-Q) and the SCOFF (Sick, Control, One stone, Fat and Food) questionnaire (SCOFF) are widely used generic instruments to identify symptoms of eating disorders. This study aimed to investigate the instruments’ validity and explore eating disorder symptoms in a sample of athletes. A sample of 28 athletes (25 females) competing at a national level was interviewed based on the diagnostic criteria for eating disorders. We interviewed 18 athletes with a high score on EDE-Q and 10 with a low score. All interviews were transcribed and analysed from a general inductive approach. We identified 20 athletes with an eating disorder diagnosis, while 8 had no diagnosis. EDE-Q found 90% of the cases, while SCOFF found 94%. EDE-Q found no false-positive cases, while SCOFF found one. The qualitative results showed that most athletes reported eating concerns, restrictive eating, eating control (counting calories), weight concerns, body dissatisfaction (feeling fat and non-athletic), excessive exercise and health problems (eg, pain, fatigue). In conclusion, EDE-Q and SCOFF seem valid instruments to screen athletes’ samples but may fail to find 6%–10% cases with eating disorders. Despite athletic bodies and normal body mass index, many athletes report severe eating problems and dissatisfaction with weight and body appearance. Implementation of regular screening may identify these symptoms at an early stage.
Article
Full-text available
Relative energy deficiency in sport (RED-S) is a complex syndrome describing health and performance consequences of low energy availability (LEA) and is common among female endurance athletes. Various underlying causes of LEA have been reported, including disordered eating behavior (DE), but studies investigating the association with exercise addiction and food intolerances are lacking. Therefore, the aim of this cross-sectional study was to investigate the association between DE, exercise addiction and food intolerances in athletes at risk of LEA compared to those with low risk. Female endurance athletes, 18-35 years, training ≥5 times/week were recruited in Norway, Sweden, Ireland, and Germany. Participants completed an online-survey comprising the LEA in Females Questionnaire (LEAF-Q), Exercise Addiction Inventory (EAI), Eating Disorder Examination Questionnaire (EDE-Q), and questions regarding food intolerances. Of the 202 participants who met the inclusion criteria and completed the online survey, 65% were at risk of LEA, 23% were at risk of exercise addiction, and 21% had DE. Athletes at risk of LEA had higher EDE-Q and EAI scores compared to athletes with low risk. EAI score remained higher in athletes with risk of LEA after excluding athletes with DE. Athletes at risk of LEA did not report more food intolerances (17 vs. 10%, P = 0.198), but were more frequently reported by athletes with DE (28 vs. 11%, P = 0.004). In conclusion, these athletes had a high risk of LEA, exercise addiction, and DE. Exercise addiction should be considered as an additional risk factor in the prevention, early detection, and targeted treatment of REDS among female endurance athletes.
Article
Full-text available
There is conflicting evidence that sport plays a protective role in the development of psychopathological disorders and contributes to the sustainability of mental health. The aim of the present study was to determine the prevalence of mental disorders among elite Slovenian athletes. We were interested in the prevalence of depression, anxiety, suicide risk, substance abuse, and eating disorders among athletes of both sexes and among athletes of individual and team sports aged 18 years or older. A total of 97 elite athletes participated in the study. We used PAI and EDI-3 questionnaires, and the study also included a control group of 90 non-athletes, matched in gender and age to the target group of elite athletes. Testing was conducted in 2020 and 2021. The comparison between elite athletes and the normative group showed a similar expression of depressive and anxious symptomatology. The athletes have a more pronounced drive for thinness and are more expansive, self-confident, and confident of their abilities compared to the control group. A total of 14% of the athletes show self-confidence to the point of self-grandiosity. Male athletes are more likely to use alcohol and other psychoactive substances and are also more impulsive and risk-taking, while female athletes are at higher risk of developing eating disorders. The study suggests that the prevalence of mental disorders in elite athletes is as high as in the general population. There is an urgent need to sustainably ensure the psychological well-being of athletes.
Article
Full-text available
Elite athletes, coaches and high-performance staff are exposed to a range of stressors that have been shown to increase their susceptibility to experiencing mental ill-health. Despite this, athletes may be less inclined than the general population to seek support for their mental health due to stigma, perceptions of limited psychological safety within sport to disclose mental health difficulties (e.g., selection concerns) and/or fears of help-seeking signifying weakness in the context of high performance sport. Guidance on the best ways to promote mental health within sporting environments is increasing, though current frameworks and position statements require greater focus on a whole of system approach, in which the needs of athlete, coaches and high-performance staff are considered within the context of the broader ecological system in which they operate and perform. This paper synthesizes existing research, reviewed for translatability by mental health professionals working in elite sport, to provide an evidence-informed framework with real world utility to promote mentally healthy environments for all stakeholders in elite sporting organizations, from athletes through to administrators. Recommendations are provided to positively impact the mental wellbeing of athletes and support staff, which may in turn influence athletic performance. This framework is intended to provide sporting organizations with evidence-informed or best practice principles on which they can develop or progress their policies to support mental health promotion and prevent the onset of mental health difficulties. It is intended that the framework can be adapted or tailored by elite sporting organizations based upon their unique cultural, contextual and resourcing circumstances.
Article
Despite the public health benefits of cycling in the general population, mental health issues may be evident in high-performance and elite-level competitive domains. With prominent riders disclosing their experiences with psychiatric symptoms, distinctive socioenvironmental factors could exacerbate psychopathological vulnerabilities. This suggests a need for greater mental health awareness amongst stakeholders, supplemented by actions from international and national federations and regulators. To synthesise relevant observations about psychiatric concerns in high-performance and elite-level cycling, we conducted a keyword search of articles in APA PsycINFO, PubMed, and Scopus based on specified exclusion criteria. Thirteen papers were identified that examined mental health issues in high-performance and/or elite-level cycling per classifications from the World Health Organization’s International Classification of Diseases 11th Revision. A large proportion of articles illustrated eating disorder symptomatology, but others discussed attention deficit/hyperactivity disorder, anxiety disorder, depression, sleep wake disorders, and substance use disorder. Existing literature underlines important considerations for all stakeholders within the cycling community around mental health initiatives and care provisions, which are currently lacking across the sport. Such programmes could incorporate consensus statements, psychiatric screening, psychoeducation, stigma-reducing policies, and athlete advocacy. These can help mitigate socioenvironmental risk factors and prioritise athlete wellbeing over performance-centred motivations.
Chapter
This chapter examines women’s experiences in competitive cycling, and how orthodox masculinities may influence this. The chapter reminds readers of the influences of gender relations on the development of sport, and on the sport of road cycling specifically. The chapter discusses how the culture of competitive road cycling, in which orthodox masculinity is idolised, may lead to women being marginalised in the sport.