Learnings from 2023 The Female Athlete Conference – Part 1

Every two years, the team at the Female Athlete Program at Boston Children’s Hospital hosts The Female Athlete Conference to “promote understanding of female athletes’ unique and understudied physiology and lived experience, as well as clinical best practices and interdisciplinary calls-to-action.” Conference attendees are from a variety of backgrounds including sports medicine physicians, researchers, exercise physiologists, physical therapists, sports psychologists, sports dieticians and nutritionists, coaches and athletes which creates an invigorating, multidisciplinary learning opportunity. Last week, the conference was held live here in Boston and the virtual recordings will be released later this week so if you are interested in purchasing the virtual offering, you can do so here.

Below is a summary of my learnings from the sessions I attended, and I look forward to reviewing the remaining sessions when they are released later this week.

  • The sessions I attended demonstrated significant progress (vs. the 2019 live conference) in the research and understanding of the female athlete across her life stages
  • A clear theme across several sessions & in Sherry Levin’s inspiring keynote address that we are “stronger together” and need to partner as a multidisciplinary team to continue to innovate and improve health & performance outcomes for female athletes
  • There was a foundational acknowledgement of the importance of ensuring the athlete is eating enough for their health & performance and understanding the why behind under-fueling which can differ by sport and individual.
  • A new IOC Consensus Statement on Relative Energy Deficiency in Sport (REDs) will be released later this year. Key updates include:
    • Low energy availability (LEA) is the underlying driver of REDsDifferentiation of problematic vs. adaptable LEA. Problematic LEA is when there is significant disruption resulting from higher exposure (duration & amount). Adaptable is considered benign, reversible, and was acknowledged that short periods of LEA may improve performance. It is important to note that short periods of LEA is only recommended in elite athlete populations under multidisciplinary supervision. There is a new clinical assessment tool coming out later this fall that assesses REDs severity and risk for use in clinical diagnosis & treatment. The model uses a multifactorial evidence-based set of indicators including suppressed T3, prior bone stress injuries, primary amenorrhea, low bone mineral density, eating disorder risk assessment, etc. Secondary indicators in the tool include increased LDL, depression, oligomenorrhea, low blood pressure, etc. and identifies a set of emerging indicators such urinary incontinence, bradycardia, low IGF1, etc. that need more research.
    • The importance of early identification of LEA & REDs so impacts can be mitigated but it was acknowledged it is difficult to diagnose REDs without first ruling out other potential causes of the symptoms e.g. rule out pelvic floor insufficiency when a client presents with urinary incontinence.
  • Several sessions highlighted the importance of acknowledging and normalizing the menstrual cycle and reinforced that that individuals can have different responses to training across their cycle. We cannot conclude that all female athletes should be cycle synching their training (and nutrition!) as individual variations in hormones and responses makes group level conclusions challenging but we can, and should evaluate this at the individual level through tracking of cycles, along with training and recovery metrics.
  • A discussion on pregnancy in sport highlighted opportunities to improve the support system and education of pregnant/post-partum athletes including fueling/nutrition and mental health.
  • Female athletes have a higher incidence of GI distress, and the causes can be multifactorial e.g. fiber, supplements/electrolytes, dehydration, low energy availability/disordered eating, medications, meal timing, stress levels, celiac, IBS, recent travel, etc.

Some of the sessions I missed that I’m most looking forward to reviewing later this week are:

  • Evaluation of the Relationships Between Body Composition, Nutrition and Menopause Symptoms Across the Menopause Transition
  • Behind the Scenes of the Development of the IOC REDs Clinical Assessment Tool and Evaluating the Effect of Energy Availability on Performance and Medical Outcomes at the Boston Marathon
  • How to Pick Contraception Options for Family Planning and other Medical Issues – What’s a Gal to Do?
  • Managing Iron Deficiency and Cardiac Issues in Female Athletes

Stay tuned for part 2 of my learnings from The Female Athlete conference!