Are sport and exercise studies excluding women?

Think:Health cultivates and articulates the best in health research and news.

 

The following episode, which aired on Sunday 12 June 2016, features:

• criticism of the lack of studies on females in the sport and exercise field (01:10); 
• sports data and the role information plays in creating winning teams (8:39); and
• how frontotemporal dementia affects people's ability to empathise (17:35).

Academic guests:

• Georgie Bruinvels - PhD student at the University College of London
• Michael Rennie - Strength and Conditioning Coach with the Sydney Swans and PhD candidate in the UTS Faculty of Health
• Matthew Jeffriess - Strength and Conditioning Coach and Rehabilitation Coordinator for NRL referees (Sydney) and PhD candidate in the UTS Faculty of Health
• Dr Muireann Irish - Cognitive Neuroscientist at Neuroscience Research Australia

Host/s:

• Ellen Leabeater, 2ser
• Ninah Kopel, 2ser

Listen to 2ser online
 

START OF TRANSCRIPT

Ellen Leabeater: Hi, Welcome to the show, Ellen Leabeater with you. Today, we find out how data is transforming sport as we know it.

Matthew Jeffriess: We’re in an age, especially in sport science at the moment where it’s sort of the data tsunami.  We can collect numbers and metrics on every single thing. The good thing about sport is that it has that unpredictability and that passion, and I don’t think we should ever go away from that.

Ellen Leabeater: And, how a certain type of dementia affects empathy.

But first on the show, does a woman perform better in sporting competitions if she has her period? Well the answer is, nobody knows, because nobody has ever tested it. An editorial published this week in the British journal of sports medicine has criticised the lack of studies on females in the sport and exercise field.  The authors say that women have been left out of studies because of the hormonal variations in their menstrual cycle, and it’s not just sport and exercise studies either. It’s across the whole health spectrum.  Georgie Bruinvels is a PhD student from the University College of London and one of the authors of the study.

Georgie Bruinvels: So, I think the key thing is that there’s variations in hormones through the menstrual cycle, so oestrogen and progesterone have, like, a cyclical pattern that varies through the 28 to 35 day cycle of your average female and the problem is that we simply don’t understand with each phase what exactly is going on because research just hasn’t been done. And the key reason for that is because effectively you need females to come in every single day and track their response to many different things. Now that adds costs and time and we’re always wanting to forge forward with research and this would be taking, like, a massive backwards step. So, either, females are not included or they’re only tested in their early follicular phase when their hormone levels are really low and most similar to those of a man, or they’re given the oral contraceptives so effectively everything is just the same. But, women have to compete at all phases of their menstrual cycle and live through all phases of their menstrual cycle, so effectively we’re missing massive snapshots of time.

Ellen Leabeater: Is there research on women’s menstrual cycles? Just on the menstrual cycle full stop?

Georgie Bruinvels: Very limited. I mean, away from the exercise field, like, yes there is… I mean we know how the hormones cycle for example, but we don’t know the repercussions of that.  I was at a conference last week and they were talking about females and the heart – how female hearts are different to male hearts.  But, there’s sort of a general accepted…. Like I put my hand up and I said, “But hang on, what about certain changes with their menstrual cycle” and they said, “Yeah, well, we don’t think there will be a change, but we don’t really know.” And then, there was a very well-known female research who jumped up and said “Hang on a minute, we don’t know that.” So…

Ellen Leabeater: Does that surprise you? You know, that we’re on our way to curing cancer but we still don’t know how women’s menstrual cycles work?

Georgie Bruinvels: Exactly, like, I mean, it is a fundamental thing of life.  In my article earlier I alluded to this fact that 80% of withdrawn from the market are due to unacceptable side effects on women. Now, Alyson McGregor who is a co-author on the paper is really trying to forge forward in female research, which is brilliant and I think in the clinical world they’re doing a better job and, I mean, it’s likely, it’s inevitable that they’d be ahead of the sport science or sports medicine field. But still, they’re struggling. It’s really hard to make up for that historical lack of studies and as I said, you always want to push forward and not add in extra costs.  And doing research on females I guess, is going to do that.

Ellen Leabeater: So discrimination aside, I guess because a woman’s menstrual cycle is a variable you can’t control and when you’re doing research you obviously want to control all the variables.  Do you think we will see an increase in women’s research or is it just too hard?

Georgie Bruinvels: No, I definitely think we can do.  I mean, I was having a long discussion with my supervisor about this last night and I’m definitely… As soon as I finish my PhD, that is going to be my key area. And hopefully this editorial will start encouraging people to start bridging this gap.  I think we’ve got to appreciate that we’re going to have to take some steps back in researching females in a way.  We can’t just keep finding out new things about the general exercising population.  We need to go and look specifically at females.  Now it sounds like I’m discriminating, but, you know, we have gain this… Like for example, does their metabolism vary through the menstrual cycle? Like could that be a reason for these performance detriments, which are noted by many females? And that’s like a massive, massive part. I mean, it’s the Olympics coming up and I’d love to find out the number of females on the day of competition that actually feel like their menstrual cycle is holding them back. 

Ellen Leabeater: Is there research looking at that?

Georgie Bruinvels: I really don’t think so.  Not that I’ve found.  I mean, in my first study, I looked at the number of females who said that their menstrual cycle affected their performance and it was 51%.  That ‘s a hell of a lot, and that includes elite athletes as well. So, effectively on the start line of every race, two in every five is saying that their menstrual cycle is preventing them from performing at their best.  And it could be that the others are taking the wrong contraceptive, so just to control it.  It’s a fundamental issue which I just don’t think… it’s this taboo subject and no one wants to talk about it, but actually, it needs to be addressed.

Ellen Leabeater: And, in saying that, do we know what affect the oral contraceptive has on performance compared to women who aren’t on the oral contraceptive?

Georgie Bruinvels: Exactly, no. And that’s my supervisor biggest bugbear.  He’s saying, “well, we don’t know!” It could be… I mean it’s assumed that it’s fine and there have obviously been trials done on it but we don’t know how it affects your performance, because the cyclical variation in hormones may actually be good. It may be good for bone health and I wouldn’t be surprised if it is. I mean [menstruation] happens for a reason, but when you’re taking your contraceptive you take that away.

Ellen Leabeater: You mentioned that we’re not sure, for example, how the menstrual cycle affects metabolism. Is there anything else in the sport and exercise field that’s really missing the menstrual cycle?

Georgie Bruinvels: So much, like immune status, oxidative stress levels, injury risk - so injury risk is said to vary through the menstrual cycle – strength during the menstrual cycle… So this is all hypothesized. This is the problem.  I’ve got this image of how the hormones vary but we don’t actually know if any of this is real because it’s all “one study says this, one study says that”, because there’s just not enough out there. Like, there’s blood pressure even… there’s a whole host of things, which are said to be variable potentially.

Ellen Leabeater: Georgie Bruinvels, PhD student from the University College of London, speaking there about the need for more women to be included in research studies.

Female: Think:Health on 2SER 107.3.

Ellen Leabeater: Well, from no research to too much research. Sports scientist have been using data to track the training and skills development of players for many years now and advances in technology means even more data can be collected to improve performance.  But with so much data, it isn’t always easy to numbers into action.  Ninah Kopel went along to a sports science panel discussion at the University of Technology Sydney to determine how all of this information is being used and to ask the question, has sports science gone too far.

Ninah Kopel: When you think about sports, say the NRL or AFL, you think about the players on the field who’ve trained long and hard to be there.  They’ve physically and mentally pushed themselves to their limits.  But how often do we stop to think about the science behind the sport.  Michael Rennie is a strength and conditioning coach with the Sydney Swans. He’s also a PhD candidate at UTS, researching the demands of running in AFL.  To do so, he’s looking at millions of cells of information, but at the end of the day, he says data anlaysis in sport comes down to one main thing.

Michael Rennie: You’re really trying to figure out the reasons why you win and why you lose.  I think the hardest part is trying to change the way you do things in order for people to implement the changes on the field. And sport is such a dynamic environment. Things are always changing: the competition, the weather, the recovery that you’ve had, the mood that you’ve had, you’re home life can affect it. So, I think trying to get people to put in the changes that you find out in your research – that’s the hardest part and I think that’s the art of coaching. It’s the biggest challenge in sports science I think.

Ninah Kopel: And how do you navigate that psychological tension in people’s minds when, you know, you want to emphasize or look at the physical ability… but how do you then first take a step back and acknowledge that psychological health is important as well?

Michael Rennie: I think before we’re coach sciences or before we’re coaches, we sort of work on these personal relationships more than anything, and that… I think in any good working environment, everyone has good relationships and the managers and the leaders, they drive the interpersonal stuff.  Most of the information that we get, as far as our player development and our recovery and stuff goes, is from talking to the players.  We ask a lot of questions about their health, about their wellness, about their recovery, about which muscles are sore, so, the value of the information comes directly from them and that information is incredibly more valid and incredibly more reliable when you’re trusting. It’s similar when you go to the doctor I guess, the quality of the healthcare they provide you is really dependent on the information that you give them.

Ninah Kopel: And what’s the end result? What is the ideal player that you’re trying to establish?

Michael Rennie: The thing that you’re trying to achieve as far as team performance goes is team cohesiveness, and that comes from first of all choosing the right players in your team that have the right physical qualities, the technical qualities that you want, and then also really smart players that can implement the tactics that the coach wants to employ.  And the tactics are always going to change depending on the opposition.  The weather has a big impact in AFL… but first and foremost you have to try and develop a group that works well as a team.

Ninah Kopel: And does that also come back to the creativity where you have to look at different players and at different abilities and skills and then find a way of applying that in an innovative way.

Michael Rennie: Yeah definitely.  You know, we’ve got 22 players in an AFL team – 18 players on the field at one time so trying to get to execute the same tactics at the same time is very very difficult. So first and foremost, I think you need to have a good coach that can teach the players about the tactics – how they think the game should be played. And then it’s up to the players on game day to execute it.

Ninah Kopel: For coaches and players, it’s easy to understand how this type of data about performance and health could play into their training plans.  But there’s another way data is changing the game.  Matt Jeffriess is a strength and conditioning coach and rehabilitation coordinator for the NRL referees.  And he’s also a UTS PhD candidate, looking at referee performance and decisions. But with video footage playing more of a role in referee decisions and data becoming more and more accessible, I wanted to know if the next step would be replacing referees with robots.

Matthew Jeffriess: I definitely hope not.  If sporting decisions were just black and white, the whole entertainment concept would go and that’s sort of why we’ve pushed to give it more context.  If it were so black and white, the whole spectacle would just go out the window. The referees themselves will evaluate their own performance and they’re scored metrically based on their decision-making, but I think the whole idea of the A.I referee is a little bit scary.

Ninah Kopel: What is that entertainment value? What is the enjoyment that comes from having a referee on the field interacting with players and having that experience.

Matthew Jeffriess: When you get to this level, basically the sport is just entertainment.  We know that the money comes from media deals, it’s from online views, it’s from subscriptions, so I don’t think many of the referees are deluded in thinking that they’re the centre of attention for the game.  We know that it’s an entertainment value. In saying that, we’re not out there to sort of get the most on-the-edge-of-your-seat endings.  I remember reading an interview from one of the referees saying, “I don’t care about the outcome of the game”. He’s just out there to referee as best as he can.

Ninah Kopel: Could you argue then that sports science could go to far or has gone to far? Are we at risk of losing the fun?

Matthew Jeffriess: Absolutely, absolutely.  We’re in an age, especially in sports science at the moment, where it’s sort of the data tsunami. We can collect numbers and metrics on every single thing. The good thing about sport is that it has that unpredictability and that passion, and I don’t think we should ever go away from that. So, yes, I think we can push it too far.

Ninah Kopel: Something that struck me today that I’ve never thought of is the fact that refs are sports people. They are incredibly fit, they go through training. Do you think that people realise that?

Matthew Jeffriess: Not at all. Often when I tell people that I’m involved with the high-performance part of referees, like you said, they don’t even know that they train. They don’t know how hard and how physically they train, so, up to three to four physical sessions a week. They then have their own coaching and evaluations and mental skills training that they do as well.  I think at the junior levels, people think that referees just turn up with a whistle, which is OK, but again, even at that level, they’re doing some training throughout the week.  So you’ve got to realise that these guys are training, they are performing a difficult task out there. They’re going to make mistakes, so there has to be a level of sympathy out there for them. There’s got to be a bit of empathy for what they do and the pressure that they’re under. There aren’t many other jobs in the world where your decisions are scrutinised so heavily to the point that you get home from a day’s work and there’s up to a hundred people on social media saying all sorts of things that they want to do to you because your team lost by two to three points.

Ninah Kopel: Them and politicians! Do people still want to be referees despite all of that?

Matthew Jeffriess: Yeah, you sort of would wonder why you would want to be a referee. But what we’re doing now is we’re sort of restructuring the referee system so that there’s a national structure and we sort of have junior tiers and junior academies and we do still see people coming through and you must wonder why at the top level because of the scrutiny they get, but there is still that love for the game at the junior levels and the people just want to be involved in the game. So, again fostering that at the junior levels to increase retention rates is where we’ve got to go in a lot of more effort has got to come from the game to foster that, to get those referees coming through the ranks.  And the support system that’s around it too – so if they are abused by a parent from the sideline, they should know that there are systems in place that we can help them with there, so we promote their work rather than steering them away from the game.

Ninah Kopel: So from a data collection perspective and from a training perspective, where are we heading if there is that risk of going too scientific, too data heavy?

Matthew Jeffriess: Again, there’s a lot of gut-feel in it.  So we can provide reports and numbers to the coaches and the referee boss.  In the end, he makes the decision on who goes where. And it’s the same with the referees. We can give them data on anything and the interesting thing about the referees is that they’re that intelligent that they want to learn, they want to learn the statistics behind it.  But in saying that, they also know that the statistics that we give them really isn’t going to go out there with them when they cross that white line.  I’m not going to be able to go out there and help them make better decisions on the field, and no two games are ever going to be the same. So it’s about giving them the tools during the week that they can use and then for them doing what they do best, which is being the best referees in the world.

Ellen Leabeater: Ninah Kopel speaking there with Matthew Jeffriess, PhD candidate in the Faculty of Health at UTS.

You’re listening to Think:Health on 2SER 107.3, on demand on 2SER.com or on your favourite podcast app.

Ellen Leabeater: Dementia is often associated with memory loss, but did you know it can also be associated with a loss of empathy? For those under the age of 65, the most common form of dementia is what’s known as frontotemporal dementia.  This type of dementia causes damage to the frontal and or temporal lobes of the brain which control behaviour and personality.  As a result, people with this type of dementia may act differently.  They may start shoplifting or inappropriately commenting on someone’s appearance.  And it’s all because of a lack of empathy.  New research has attempted to explain why empathy loss is associated with this type of dementia.  Dr Muireann Irish, cognitive neuroscientist at Neuroscience Research Australia has more.

Muireann Irish: Yeah, so, empathy is one of those really interesting constructs that we all take for granted in our daily lives, and yet it provides the foundation for all of our social interactions. And so research points to the fact that there are different types of empathy. So there’s a cognitive type which we can understand as the “thinking” type of empathy – so we understand and appreciate the experiences, sort of the emotional experiences of others.  But there’s also what’s known as the affective type of empathy –and this is the emotional type of empathy. And this allows us to really share the emotional experience of other people.  So on one hand we can understand what other people are going through via the cognitive type, but the affective type lets us really empathise and share the emotional experience of other people.

Ellen Leabeater: And how is this affected with people who have dementia?

Muireann Irish: So there are a certain group of dementia syndromes, so a subtype of dementia called frontotemporal dementia, and what we see in subtypes of this form of dementia is really a loss of what we call social cognition. So these patients will present with changes in personality and changes in the way that they interact with others. So they lose the capacity to interact on the social and emotional plane.  They’re not able to empathise, they’re not able to take the perspective of other people.  They’re not even able to consider how their actions and their words might affect other people.  So we see really that there’s this social domain which is highly compromised, and it can make it extremely difficult for care-givers to relate to these individuals and to try and care for them and adapt to their changing needs.

Ellen Leabeater: Frontotemporal dementia – that’s something I’ve never heard of.  I kind of thought there was just one kind of blanket term for dementia.

Muireann Irish: Yeah, so this is a common misperception about dementia. So really, when we’re talking about dementia, it’s an umbrella term that refers to many different forms of neuro-degenerative diseases. And so frontotemporal dementia is just a subtype of dementia, and it’s one of the younger onset dementias and by younger-onset we mean that it strikes individuals typically under the age of 65 years old, so it occurs much earlier in life and you can imagine that that causes a lot of challenges that aren’t necessarily present in the later onset dementias.

Ellen Leabeater: Do we know what causes this particular type of dementia?

Muireann Irish: So, because there are a number of different subtypes again within this rubric of frontotemporal dementia, there have been some links with certain mutations, genetic mutations and there are certain different risk factors, but as with most of the dementia conundrum, it’s still unclear how these different genetic factors and also these environmental factors interact to cause the emergence of dementia but certainly there are a lot of groups worldwide, and they’re chipping away at trying to understand the genetic risks and also how these symptoms then come to manifest.

Ellen Leabeater: When someone is diagnosed with dementia, do we know what type of dementia that they’re going to get?

Muireann Irish: So this is one of the real clinical challenges that we face at the moment, that certain dementia presentation will follow a rather sort of typical root, and we’ll be able to sort of diagnose… a classic sort of memory profile is often indicative of someone who might have Alzheimer’s disease. Other times, the diagnosis is not so clear, and so within the clinic, it’s up to us to use an array of different, what we call, “cognitive tests” looking at different ways of thinking, attention, language, memory to try and work out, does this individual have the classic features of this type of dementia.  And often what we’ll resort to is also using neuro-imaging and this allows us then to look at the level of the brain and it’s structure and the volume of different structures to see where the pathology is targeting and what regions have started to shrink. And often there are characteristic profiles of brain shrinkage, what we call “atrophy” – this can also be a clue as to what type of dementia the individual has.

Ellen Leabeater: Your recent research has looked at how this frontotemporal dementia affects empathy, is that right?

Muireann Irish: Yes, so we’re interested to look to see what are the neural substrates – so what are the brain regions - that seem particularly vulnerable in this patient group or this population. And so what we did is was we looked within frontotemporal dementia and we also used the group of Alzheimer’s patients as what we call a disease control, because often we don’t see the same social cognitive deficits in Alzheimer’s disease.  And we had caregivers rate the individuals across an array of different forms of empathy: so, how the individual relates to others, whether they’re able to share in the emotional experience of others and understand the different perspectives and feelings that other people have. And we were able to then look at the cognitive aspect of empathy and the affective aspect of empathy and we found some very interesting differences. So we found that both of our dementia groups – so the Alzheimer’s and the frontotemporal dementia patients – showed compromised cognitive empathy.  So, they seemed to both have difficulty in just appreciating the emotional perspectives of others.  But, we found that affective empathy – so being able to share in the emotional experience of others – was only compromised in the frontotemporal dementia group.  And when we controlled for just overall disease severity, we found that this in turn explained those deficits in the Alzheimer’s patient group, so it was more a cognitive problem in just understanding rather than an emotional perceptual problem perse. But, in the frontotemporal dementia group, the deficits remain. So really what we’re finding is there’s this gross inability to actually take the perspective of others and to share in the emotional experience of others in this frontotemporal dementia group.  And then we used our neuro-imaging to look at the level of the brain, we found that atrophy and brain shrinkage in a key region of the social brain is the driving force behind these changes.

Ellen Leabeater: Going back to what happens when these people are first diagnosed with dementia, is this sort of research going to be able to help carers understand the behaviour that that person is going to start exhibiting?

Muireann Irish: I think that’s a really important point. We certainly need to start educating our care-givers more about the types of changes that are potentially lying on the horizon for them.  So, we found in a separate study actually looking at empathy in other different subtypes of dementia that one of the key drivers of care-giver burden and care-giver distress was the emergence of some of these behavioural and social changes that they hadn’t actually anticipated. So I think some knowledge in this domain is actually key and then the care-givers can start to anticipate and then respond, you know, pre-emptively rather than reacting to embarrassing or awkward circumstances. So education, I think, is key.

Ellen Leabeater: Because, it can’t be easy seeing someone that you love start exhibiting behaviours that were otherwise completely out of their normal personality…

Muireann Irish: Absolutely. And to make that issue even worse is the fact that our patients show a lack of insight into their actions, that they’re unaware of what they’re actually doing, they’re unaware and actually unable to appreciate how these actions can impact on other people.  And another factor to consider is that this is younger onset dementia, so oftentimes these individuals will still have relatively young families, they’re in the workforce, they’re physically able and fit, and so, it can be very challenging to, you know, try and deal with these changes at a time in your life when you weren’t really anticipating having to deal with dementia, so, it’s fraught with many different challenges and difficulties, and it can be a very distressing time for the family.

Ellen Leabeater: Dr Muireann Irish, cognitive neuroscientist at Neuroscience Research Australia ending that story.

Don’t forget, if you’d like to find out more about anything you’ve heard today, you can visit us at 2ser.com/thinkhealth.  You can also tweet us @2ser.  Please remember that journalists are not doctors. If we’ve made you ask questions, go and see your GP.  This show is produced with the support of the University of Technology Sydney, Faculty of Health.  I’m Ellen Leabeater, see you next week for more. 

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