A better understanding of the practical and methodological challenges inherent in accurately tracking female hormonal status would enhance the clarity of research findings in exercise metabolism. The purpose of this study was to conduct an objective assessment of the quality of existing literature in this area and to provide a general overview of the practical conditions and issues encountered in studies investigating substrate metabolism during exercise in women, both in those using (HC+) or not using (HC−) hormonal contraceptives. Forty-four articles were identified through systematic reviews, meta-analyses, and searches on PubMed/MEDLINE. A quality assessment framework was developed and applied using a double-blind scoring approach. The loss/exclusion of data between baseline and final analyses per study was quantified, and the main challenges were highlighted. A higher mean global score was observed in studies conducted among HC+ women (81%) than those among HC− women (46%). Although the dropout rates were rarely mentioned in HC+ women articles, the mean rate of participant/data loss in HC− groups was 22.1%. The rate of HC− participant loss was positively correlated with the global score (r = .504, p = .02). High-quality research may be easier to achieve in studies involving HC+ women compared with those involving HC− women. Studies on HC− women seem to face more practical challenges, such as tracking the menstrual cycle and targeting specific (sub)phases of the menstrual cycle, along with technical and feasibility limitations. Thus, although the framework for designing such studies exists, the quality assessment of the available literature emphasizes its challenge in terms of research implementation.
Female Exercise Metabolism: Quality Assessment of Existing Knowledge Base and Key Challenges in Study Design
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Observatoire National de l’Activité Physique et de la Sédentarité (ONAPS), Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France
International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France
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Miles-Chan https://orcid.org/0000-0003-0313-7048
Hackney https://orcid.org/0000-0002-6607-1472
Duclos https://orcid.org/0000-0002-7158-386X
Isacco https://orcid.org/0000-0002-1152-3902
Bagot (sarah.bagot@uca.fr) is corresponding author, https://orcid.org/0000-0001-7152-4600
A concerted effort is needed to enhance the quality of studies investigating the impact of ovarian hormonal status on exercise metabolism, particularly concerning the effects of the menstrual cycle.
High-quality research appears to be more readily achievable in studies involving participants using hormonal contraceptives compared with those involving naturally menstruating participants.
Studies involving naturally menstruating women seem to encounter more practical challenges, such as tracking the menstrual cycle and targeting its specific (sub)phases, along with technical and feasibility limitations (e.g., blood sampling, inter- and intraindividual variability).
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Several experts have emphasized the importance of advancing female-specific scientific studies, including women who use hormonal contraceptives (HC+) and those who do not (HC−), highlighting the need not only to increase the number of such studies but also to improve their methodological quality. To improve the clarity of research findings in exercise metabolism, a better understanding of the practical and methodological challenges involved in accurately tracking female hormonal status is crucial. This study aims to objectively evaluate the quality of existing literature on the topic and provide an overview of the key challenges encountered when studying substrate metabolism during exercise in women.
Forty-four relevant articles were identified from sources like PubMed/MEDLINE, systematic reviews, and meta-analyses. A quality assessment framework was developed and applied using a double-blind scoring approach to ensure objectivity. The study measured the loss or exclusion of data between the baseline and final analyses, revealing key challenges in conducting high-quality research in this area.
The findings show that studies involving HC+ women generally score higher in terms of quality, with an average global score of 81%. In contrast, studies focusing on HC− women scored significantly lower, with a mean score of 46%. One key difference observed was that dropout rates in HC+ studies were rarely mentioned, whereas in HC− studies, the mean participant or data loss rate was 22.1%. Interestingly, the data showed a positive correlation between participant loss in HC− groups and the global quality score (r = .504, p = .02). This suggests that, despite the higher data loss in HC− studies, efforts to maintain research quality were still in place.
The challenges faced by researchers when studying HC− women seem more pronounced, particularly when it comes to tracking the menstrual cycle and accurately targeting its specific phases or subphases. This introduces complexities in both the planning and execution of the studies, including difficulties in blood sampling, managing inter- and intraindividual variability, and general technical feasibility. Although there are frameworks for conducting such studies, the findings highlight that implementing them at a high-quality level is not straightforward. A notable limitation across many HC− studies was the failure to report key quality criteria, which undermines the reliability of the conclusions that can be drawn from the available data. For instance, terms like “eumenorrhea” are frequently used without a clear or objective definition, which further complicates efforts to standardize research and draw meaningful comparisons between studies. Future research should avoid vague terminology and adopt more rigorous standards to ensure that the data collected are reliable and comparable across studies.
In contrast, research involving HC+ women appears to encounter fewer practical obstacles, possibly because hormonal contraceptives regulate hormonal fluctuations, making it easier to control study variables. However, even though high-quality research is more easily achievable in HC+ studies, there has been less research conducted in this group compared with HC− women. This points to the need for more studies focusing on women using various types of hormonal contraceptives, not just combined oral contraceptives. By expanding the research scope to include different hormonal contraceptives, researchers could gain a better understanding of how these medications influence exercise metabolism.
Overall, this study highlights the need for a concerted effort to improve the quality of research in this field, particularly when investigating the impact of ovarian hormones and the menstrual cycle on exercise metabolism. Although the frameworks for improving study designs exist, researchers face significant challenges when trying to implement high-quality protocols in practice.
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