Ever since the ancient Greeks came up with the idea of wandering wombs causing women’s “hysteria” and health problems, knowledge of female anatomy has lagged behind that of male anatomy.
As Guardian Australia’s Gabrielle Jackson wrote in Pain and Prejudice, almost everything we know about human health comes from the study of men and male animals – even male cell lines.
“In medicine, man is the default human being,” she wrote. “Any deviation is atypical, abnormal, deficient.”
Now, new research has found that the gender research gaps are playing out in exercise science, where research is done on men, by men, risking the injury, misdiagnosis and mistreatment of women.
Cisgender women, in general, have different hormones, different body fat distribution, a different (average) size and different risk factors for various diseases to men. They also have periods, pregnancies and menopause.
This year the journal Sports Medicine published an article arguing that there were enough differences between men and women who run ultramarathons, including fatigue and injury susceptibility, that sex-specific guidelines could be useful – although further research is required.
Research from the University of Melbourne found sport psychology research studies, which can influence coaching methods, injury management and performance psychology, are predominantly based on men.
An editorial in the British Medical Journal in June highlighted a range of studies showing the gender gap in sports research and the need to acknowledge and address it.
Another study, this one from April, found that when women led studies they were more likely to have equal numbers of men and women as participants.
And a study published in the journal Sports Medicine last week audited official exercise guidelines and found that they were overwhelmingly based on studies written by men, about men.
Mandy Hagstrom, the study’s author and senior lecturer at the University of New South Wales, wrote in the Conversation that governing bodies in the Australia, the United States and the United Kingdom put out “consensus statements” on training which ultimately informs personal trainers and coaches.
“The findings in these statements trickle down into what you and I see happen in the gym every week,” she wrote. Hagstrom also points out that research has not served sex and gender diverse people well, either, and notes that neither sex nor gender are binary.
Her audit found more than nine in 10 first (or lead) authors were men, while women made up just 13% of authors. Less than third of study participants were women. That means we do not know if women should be doing things differently, she writes.
“Research suggests differences in skeletal muscle structure, the way muscle fibres work, and in the time taken to recover following intense exercise … work from our team has also shown men gain more absolute muscle size and strength following participation in resistance training but that relative gains tend to be similar or greater in women.”
“And recent research has shown strength differences appear to still be present, even when muscle size is matched between sexes.”
‘There are things we’re definitely missing’
Kiara Roscio, an exercise physiologist, set up a specialised women’s health practice, Seed Exercise Physiology, to help women through stages and issues including pregnancy, menopause and pelvic floor strength.
The Flinders university associate lecturer in exercise science and clinical exercise physiology says she had to scrape through medical databases to gather the best information she could.
“All of our treatment, particularly in the medical field, is based on the male model, a typical white male, and we know that a lot of the time this means women are misdiagnosed,” she says.
Women need to know about the importance of weight-bearing exercises for bone density, which declines with menopause, she says, and of pelvic floor exercises before and after pregnancy – and any other time.
The other thing she sees is fear around exercising while pregnant.
“They’re unsure about if and how much they should be exercising,” Roscio says, adding that it is almost always recommended unless there’s a specific risk.
So what are women supposed to do, when the foundations sound so shaky? Keep exercising, Prof Sophia Nimphius says.
Nimphius, Edith Cowan University’s pro vice-chancellor (sport) and human performance professor, has worked with some of Australia’s top sporting bodies. She says the disparity between the research done on men versus women permeates all areas of medicine and science and can have real consequences.
As an extreme example, she points to higher rates of injury and death for women in car crashes because crash test dummies are based on the average male.
“The lack of data on women and then the implementation of findings have caused real distress, injury and [the] potential death of women because the decisions and designs we’ve made were exclusively based on the data of men and that put women at risk,” she says.
The focus on exercise has been heightened as more women are playing elite sports and exercising at high intensity, she says.
“But are we really doing it all wrong? Probably not,” she says. “There are things we’re definitely missing but that doesn’t mean it’s all wrong.
“Physiological processes may differ, but our ability to get stronger, improve fitness or improve bone health, occur because we respond very similarly to mechanical stimulus.”
And she is wary of people saying that the solution is simply more data from women. More data doesn’t necessarily mean better research, she says, not if we fail to design better research and acknowledge or consider influential impacts from other factors instead of risking attributing all differences to sex and gender.
A woman’s age, exercise history, access to recovery and training, background, socioeconomic status, available time, and even their beliefs about exercise and what they can achieve all play a part.
“If we had great individual information and we contextualised the nuance I’m sure it would improve our understanding of exercise for women,” she says.
“But for most of us, just doing something is our greatest challenge.”
