Olga Roldan-Reoyo

Purpose: The potential impact of hormonal contraceptives (HCs) on player health and performance in women’s rugby union (rugby) is not well understood, despite rugby’s growing popularity worldwide. This study investigated the prevalence of HC use and reported associations with training and performance in a global sample of women rugby players. Method: A globally distributed online survey, seeking to explore experiences in women’s rugby, was completed by 1596 current or former adult women 7s or 15s rugby players (mean age 27 [6] y; 7 [5] y playing experience) from 62 countries. The survey included a section of questions about reported HC use, including the type, reason for use, symptoms, and experiences relating to rugby training and performance. Results: A total of 606 (38%) participants from 33 of the 62 (53%) countries reported using HCs, with the combined oral contraceptive pill reported as the most frequently used (44%). Almost half of participants using HCs (43%) tracked HC-related symptoms. Over 10% reported altered rugby performance due to HC-related symptoms, 22% required medication to manage symptoms, and 11% used HCs to control or stop their menstrual periods for rugby training and performance. Conclusions: The current study highlights the prevalence of HC use in women’s rugby, identifying practices that may negatively affect performance, health, and well-being. Thus, there is an urgent need to better understand the motivations for such practices and knowledge of potential side effects among women rugby players across all levels and countries.

Rugby Union (rugby) is a full-contact team sport characterised by frequent collision events. Over one third (2.7 million) of global rugby participants are women and girls. Yet, most rugby research, laws, and regulations are derived from the men’s game with limited transferability to the women’s game. This includes research focused on injury and concussion management. Greater insights are urgently required to enable appropriate adaptations and support for all rugby participants. Therefore, this paper presents the protocol for a project that sought to gather insights into the understanding, experiences, and attitudes of players and coaches in women’s rugby regarding key issues of concussion, injury, and training for injury prevention, as well as the implications of the menstrual cycle for training and performance. From August 2020 to November 2020, online, open, cross-sectional surveys for players and coaches were distributed globally through rugby governing bodies and women’s rugby social media platforms using snowball sampling. Survey responses were recorded anonymously via a GDPR-compliant online survey platform, JISC (jisc.ac.uk, Bristol, England). Participant eligibility included being ≥18 years and either actively playing or coaching women’s rugby 15s and/or sevens, or having done so in the past decade, at any level, in any country. To enhance the number and accuracy of responses, the survey was professionally translated into eight additional languages. A total of 1596 participants from 62 countries (27 ± 6 years; 7.5 ± 5.1 years of playing experience) and 296 participants from 37 countries (mean age = 36.64, SD = 9.09, mean experience = 6.53 years, SD = 3.31) completed the players’ and coaches’ surveys, respectively. Understanding women’s participation in and experiences of rugby is important to enable lifelong engagement and enjoyment of the sport and health during and following participation.

Objectives To systematically review studies evaluating one or more components of physical fitness (PF) in pregnant women, to answer two research questions: (1) What tests have been employed to assess PF in pregnant women? and (2) What is the validity and reliability of these tests and their relationship with maternal and neonatal health? Design A systematic review. Data sources PubMed and Web of Science. Eligibility criteria Original English or Spanish full-text articles in a group of healthy pregnant women which at least one component of PF was assessed (field based or laboratory tests). Results A total of 149 articles containing a sum of 191 fitness tests were included. Among the 191 fitness tests, 99 (ie, 52%) assessed cardiorespiratory fitness through 75 different protocols, 28 (15%) assessed muscular fitness through 16 different protocols, 14 (7%) assessed flexibility through 13 different protocols, 45 (24%) assessed balance through 40 different protocols, 2 assessed speed with the same protocol and 3 were multidimensional tests using one protocol. A total of 19 articles with 23 tests (13%) assessed either validity (n=4), reliability (n=6) or the relationship of PF with maternal and neonatal health (n=16). Conclusion Physical fitness has been assessed through a wide variety of protocols, mostly lacking validity and reliability data, and no consensus exists on the most suitable fitness tests to be performed during pregnancy. PROSPERO registration number CRD42018117554.

Background Exercise can be beneficial to cardiovascular system function, but its influence during pregnancy is less well understood. Heterogeneity in research studies has led to a lack of consensus on whether physical exercise during pregnancy can elicit cardiovascular adaptations during a period in which the cardiovascular system is already being challenged. Furthermore, little research has been conducted regarding the influence of physical exercise on foetal heart rate (FHR). This paper presents the protocol for a randomised controlled trial which will evaluate the influence of supervised antenatal physical exercise on cardiovascular adaptations during and after pregnancy, as well as the FHR response to acute and chronic maternal exercise. Methods The PE-CAMP Study (Physical Exercise and Cardiovascular Adaptation Monitoring in Pregnancy) is a randomised controlled trial (RCT) in which pregnant women will be randomised into an intervention group (INT), which attended supervised physical exercise programme up to three days per week, or a comparison group (COMP) which followed standard health care. All participants were assessed at three time-points i) 18-22 weeks pregnant, time-point 1; ii) 33-37 weeks pregnant, time-point 2; and iii) 12-16 weeks postnatal, time-point 3. A standardised experimental protocol was used for data collection, including body composition assessment, upper-body flexibility and strength assessment, physical activity assessment via questionnaires and acceletometry, and haemodynamic and cardiovascular evaluation before, during and after an acute 10-minute exercise bout. Foetal heart rate will be assessed at the time-point 2 before, during and after acute exercise. Discussion Although it is necessary and informative to continue investigating the effects of exercise on maternal cardiac and haemodynamic responses using specific laboratory-based tests, it is also critical to evaluate these influences during activities that are more achievable and realistic for pregnant women. The PE-CAMP study will provide data on the cardiac and haemodynamic responses to a typical acute bout of exercise, which could help inform future decisions and policies on maternal exercise prescription made by maternity healthcare providers and exercise professionals. Clinical Trials Registration Number NCT03748888

Background Physical fitness (PF) is a powerful marker of health throughout the lifespan. In pregnant women, higher PF is associated with better maternal and fetal health, better delivery outcomes and earlier postpartum recovery. The assessment of PF during pregnancy requires special considerations to preserve fetal and maternal health; thus, providing a compilation of the most frequently used fitness tests, and assessing their validity, reliability, and association with maternal and neonatal health-related outcomes is of scientific and clinical interest. Objectives To systematically review studies evaluating one or more components of PF in pregnant women, to answer two research questions: 1) What fitness tests have been previously employed in pregnant women? and 2) What is the validity and reliability of these tests and their relationship with health-related outcomes? Data Sources PubMed and Web of Science. Methods Two independent reviewers systematically examined the articles in each database. The information from the included articles was summarized by a single researcher. Results A total of 149 articles containing a sum of 191 fitness tests were included. Among the 191 fitness tests, 99 (i.e.,52%) assessed cardiorespiratory fitness through 75 different protocols, 28 (15%) assessed muscular fitness through 16 different protocols, 14 (7%) assessed flexibility through 13 different protocols, 45 (24%) assessed balance through 40 different protocols, 2 assessed speed with the same protocol and 3 were multidimensional tests using one protocol. A total of 19 articles with 23 tests (13%) assessed either validity (n=4), reliability (n=6), or the relationship of PF with maternal and neonatal health-related outcomes (n=16). Conclusion PF during pregnancy has been assessed through a wide variety of protocols, mostly lacking validity and reliability data. PROSPERO Registration Number: CRD42018117554 Key points Physical Fitness during pregnancy has been assessed through a wide variety of tests (n=191) and different protocols (n=149). We found that cardiorespiratory fitness has been assessed with 75 different protocols (many of them made ad hoc), muscular fitness with 16 different protocols, flexibility with 13 different protocols, and balance with 40 different protocols. Most of the protocols lacked validity and reliability data, which limits the confidence on the association of fitness with maternal and neonatal health-related outcomes, which is still scarce. We advocate for an expert consensus to be developed in the following years to achieve the goal of appropriate and effective PF assessment during pregnancy. Running Heading Assessing physical fitness during pregnancy: validity, reliability and relationship with maternal and neonatal health-related outcomes.