The call to prioritize research in female athletes continues to grow louder, with researchers and innovators keenly rising to the challenge. A recent increase in female-specific research publications1 and the continued growth of the “fem-tech” industry are signs of positive change. However, the evidence that this is improving practice and delivery of support to athletes is less clear.
In 2021, we published an editorial describing what we perceived as an application gap in elite sport: where scientific research and technological innovation struggle to impact the delivery of health and performance support to athletes in the way they intend.2 While academics and innovators may offer the latest supposed impactful research or game changing technology, they often lack the contextual understanding of elite sport environments. In contrast, coaches and sport science and medicine practitioners working with world class and elite level athletes3 understand their needs and the complexity of their environments but may be averse to the change of a previously successful formula, or they may perceive new as threatening. Our collective experiences of elite sport and academia have shaped these reflections, but the question remains “How much does the application gap matter?” After all, if nothing changes, researchers will continue to generate new knowledge, tech innovation will continue, and practitioners will still provide support to elite athletes, who will always be capable of producing world class performances. We, as authors, think it does matter, particularly for elite female athletes. The sex gap in sports science, medicine, innovation, and resources remains a challenge but also presents us an opportunity to do things differently. The potential impact of a collaborative approach to female athlete health and performance is so much greater than if we continue to work independently. Perhaps the question is no longer whether an application gap exists, but rather how can we close it?
Practitioner Insights
We presented this viewpoint at the 2023 Female Athlete Conference in Boston, the United States; at which we offered our thoughts and sought the experiences and opinions of the ∼150 academics, researchers, and applied science and medicine practitioners in attendance to our session. Therein we explored the challenges faced, the obstacles experienced, and discussed how all sides may work together to collectively bridge the application gap. A real-time survey during our presentation identified areas the audience perceived to be the biggest barriers to impactful research and innovation in elite sport (Figure 1). In brief, resources, both time and money, were common themes, along with translation, engagement, and the practical challenges of research in elite female sport. It is widely recognized it is challenging to obtain funding for projects involving such a select cohort, but recognition of the potential translational benefits to the general, exercising population might encourage better resourcing of elite female athlete research. While funding agencies, sports groups, and other power brokers are just starting to recognize the need for advancement of female-specific science, it is time to properly resource this area of research. Here we briefly discuss the most pertinent barriers and suggest possible solutions (Table 1).
The responses to a real-time survey question during the 2023 Female Athlete Conference in Boston, MA, United States, when asked about their largest barrier to impactful research and its application in elite female athlete health and performance. Attendees identified themselves as either (1) academic/researcher, (2) sport practitioner, or (3) researching practitioner and provided 266 responses.
Citation: International Journal of Sports Physiology and Performance 2024; 10.1123/ijspp.2023-0390
Recommendations for Approaches and Strategies to Help Increase the Applicability and Value of Research and Innovation in the Elite Female Athlete Community
| Approaches to help bridge the gap | |
|---|---|
| Codesign | • Sport practitioners and researchers work together to understand the performance/health question. • Researchers immerse themselves in the sport environment to understand context and establish relationships. • Researchers provide the scientific rigor required for meaningful data collection. • Use athlete and coach experiences to help inform the research process. • For guidance on implementation strategies, see https://thecenterforimplementation.com/ |
| Applicable evidence, before generalizability | • Case studies might provide more precise insight—a starting place for impactful larger studies. |
| Multicenter research studies | • Elite athletes are rare, so this approach can maximize participant numbers. • Pooling data from multiple centers will increase the strength of data. • Nonduplication of effort might create resource efficiencies and reduce costs. • See Elliott-Sale et al4 for an example of an international multisite approach to female athlete research. |
| Coach engagement | • Walk in the coach’s shoes, appreciate their knowledge/expertise, and understand their priorities. • Engage coaches early in the research and innovation journey. Bring them with you. • Use research and innovation to inform and supportively challenge coaches, rather than telling or directing them what to do. |
The Challenges of Elite Female Athlete Research
The translation of sports science and medicine research to applied practice is challenging. There can be a mismatch between the interests of academics and researchers and those working directly in sport. Elite training and performance take place in environments that cannot be entirely controlled by researchers, and the complex demands placed upon the athletes such as scheduling of training and coaching meetings, alongside individualized and variable fueling, warm-up, and recovery strategies, may not lend themselves to traditional research designs.
In the search for evidence with adequate statistical power, academics may opt for more easily accessible subelite cohorts, which often does not provide the level of evidence for practitioners and coaches to confidently change their practices in elite sport. This results in generalized, nonspecific data, practitioners, and coaches who are skeptical of the research and innovation process, and researchers frustrated with the lack of engagement from the elite sport world. While these challenges exist in male sport, our collective experiences suggest that the relative paucity of female-specific research amplifies this issue in the current female athlete landscape. As the demand for improved female-specific knowledge grows, and the pressure to reduce sex data gaps increases, it is vital to develop more impactful research approaches and avoid an “anything is better than nothing” attitude to the elite female athlete research landscape.
Co-designed and multicenter research is underutilized approaches in sport science but could be innovative solutions to help deal with the situation.4 Merging the worlds of academic research and elite sport will harness the respective skillsets of all involved and provide more insightful outcomes. Researchers who immerse themselves in the competitive sport environment will improve their contextual understanding, and elite sport will be supported with the scientific rigor required to produce useful data. Examples of this type of approach are emerging, including the authors’ own experiences of collaboration between the UK Sports Institute, Manchester Metropolitan University in the United Kingdom and British Rowing, where a coalition of expertise is resulting in athletes, coaches, and practitioners utilizing more meaningful information and researchers iterating their questions based on contextual understanding and elite athlete experiences—a more valuable outcome for all. For a review of strategies and the impacts of such research partnership approaches, see Hoekstra et al.5
Academic Rigor
The steady increase in the number of sport science studies focusing on the influence of female-specific physiology is an indication of positive change, which needs to continue. Yet, as the number of studies increases it is important that the quality of the research follows suit. This presents a notable challenge for researchers, one that was previously discussed by Noordhof et al1 who described a quantity/quality paradox; the demand for increased methodological quality might ultimately prevent sport and exercise science researchers from undertaking studies. Excellent methodological papers have outlined much needed recommendations to help quality assure the rigor of research protocols thereby providing a framework for improving the quality of data (eg, Elliott-Sale et al6). Yet, in elite sport environments, it is not always possible or practical to adhere to the gold standard methodology, due to the constraints of the training and performance environments of elite athletes described previously. For the academic, this presents a conundrum. They are evaluated on their scholarly productivity (eg, published research papers), yet rigor in the application of scientific methods is required by scientific journals for papers to be considered for publication.
What Is Evidence?
Do we need to rethink research designs, to consider how to ensure impact for the athlete? Should we in the sport science and sport medicine community place greater value on case studies, which offer the precision insight vital in elite sport, where it is the individual that matters?7 Case studies are regarded as low quality in traditional hierarchies of research evidence, in part due to the lack of generalizability. While it is clear there is a need for large-scale studies and randomized controlled trials in broader areas of public health, we would argue that generalizability is not what is required in elite sport. The complex nature of elite environments, the small numbers of elite athletes, and the large interindividual and intraindividual variation in physiological and psychological characteristics between sports often means interventions are not always linear processes, and outcomes can be unpredictable. Along this line, there is a growing rationale for greater inclusion of case study research in public health as it helps to evidence context and transferability8 and we believe the same is true in elite sport research. The International Journal of Sport Physiology and Performance was one of the first publications to highlight the importance of case study research, and while the limitations of this method are clear (see Murad et al9 for a review on hierarchies of evidence), if science and medicine practitioners were to receive more information they could practically relate with, and use to make a difference; then, elite athletes, coaches, and their environments might become more accessible to researchers.
Engaging Coaches
Coaches not engaging enthusiastically with sport science and innovation are often cited by practitioners and researchers as a barrier to advancing female athlete support. Human nature being what it is, there are coaches-trainers who are resistant to any change, especially if they have had a margin of success in the past, regardless of where the advice for that change is coming from. Published, statistically significant information based on cohorts who are subelite in nonspecific assessment outcomes provides little to no insight to them to change their ways. As a result, from the outside looking into their world, it appears they are resistant to change by not acting on science. We need to give them better reasons to act. Coaches want to see their athletes improve, and many are open to learning from scientific advancements in exercise science; however, they want applicable evidence from academics before being willing to change methods and approaches. As such, it is important for practitioners and researchers to understand that coach buy-in is critical to the process, they should be involved, alongside the athletes, from the beginning of the journey. That way, coaches and athletes are more likely to engage and utilize learning, rather than feeling like science and innovation are being forced onto them. In our experience, there is no single best way to engage coaches, as no 2 coaches or sporting environments will be the same. Coaches will have varying degrees of familiarity with the research process or statistical analysis, which may influence their preconceptions of the value science and research offers. To increase engagement of coaches, as is the case when fostering most human relationships, developing trust is vital. How a researcher or practitioner goes about doing that is likely to be context and person specific.
Practical Applications and Conclusions
This commentary has highlighted several solutions to many of the obstacles faced in female athlete science and medicine (Table 1). To offer female athletes the quality of scientific research required to improve their health and performance, collaboration is vital, (1) within the research process between researchers, sport practitioners, athletes, and coaches and (2) between sports, national organizations, and funding bodies. Providing female athletes with meaningful and valuable information requires a collective effort and responsibility from sport organizations and academic institutions, which in turn may help mitigate resource barriers. We owe it to female athletes to combine the skills of researchers with the applied and contextual expertise of science and medicine practitioners. If practitioners articulate their questions better, and academics improve their ability to explore these questions in more complex and uncontrolled environments, knowledge development will be more cost-efficient and better serve the population toward whom it is aimed. If all parties work more collaboratively, we will see improvements in the science supporting female athlete performance. Let us work together to bridge the application gap.
References
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