Female athlete health domains: a supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport

Abstract

The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data.In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes.Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments.This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.

Keywords: athletes; female; health.

Figure 1

A flow diagram providing an overview of the six-step process undertaken in writing this extension, including the authorship contributions in each step.

Figure 2

Theoretical pathways and female-specific examples for each of the potential relationships between health domains and health problems, that is, causal, mediation, confounding and effect modification.

Figure 3

Examples of hypothetical prospectively collected female athlete health domains, and injury and illness data. Adapted from Bahr et al. X indicates when an athlete is no longer part of the observational study due to unrelated health problems. Sexual abuse is more commonly encountered by female athletes than male athletes, and hence this has been used as an example. D-BP, breast feeding, parenting and caregiving health domain; D-MG, menstrual and other gynaecological health, health domain; D-PR, pregnancy health domain; D-PF, pelvic floor health domain; D-SE, sport environment health domain; REDs, relative energy deficiency syndrome.