Assessing the presence and motivations of orthorexia nervosa among athletes and adults with eating disorders: a cross-sectional study.

PURPOSE: Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. METHODS: Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). RESULTS: ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [- 2.24, - 0.34], p = 0.008; r = 0.26, 95% CI [- 2.11, - 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001). CONCLUSION: Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior. LEVEL OF EVIDENCE: III: Evidence obtained from cohort studies.

Positional and temporal differences in peak match running demands of elite football.

Temporal changes in the total running demands of professional football competition have been well documented, with absolute running demands decreasing in the second half. However, it is unclear whether the peak match running demands demonstrate a similar decline. A total of 508 GPS files were collected from 44 players, across 68 matches of the Australian A-League. GPS files were split into the 1st and 2nd half, with the peak running demands of each half quantified across 10 moving average durations (1-10 min) for three measures of running performance (total distance, high-speed distance [> 19.8 km · h-1] and average acceleration). Players were categorised based on positional groups: attacking midfielder (AM), central defender (CD), defensive midfielder (DM), striker (STR), wide defender (WD) and winger (WNG). Linear mixed models and effect sizes were used to identify differences between positional groups and halves. Peak running demands were lower in the second half for STR across all three reported metrics (ES = 0.60-0.84), with peak average acceleration lower in the second half for DM, WD and WNG (ES = 0.60-0.70). Irrespective of match half, AM covered greater peak total distances than CD, STR, WD and WIN (ES = 0.60-2.08). Peak high-speed distances were greater across both halves for WIN than CD, DM and STR (ES = 0.78-1.61). Finally, STR had lower peak average acceleration than all positional groups across both halves (ES = 0.60-1.12). These results may help evaluate implemented strategies that attempt to mitigate reductions in second half running performance and inform position specific training practices.

Temporal distribution of peak running demands relative to match minutes in elite football.

The peak match running demands of football (soccer) have been quantified across time durations of 1-10 min, however, little is known as to when the peak match running demands occur within match play. Data were collected from 44 elite footballers, across 68 fixtures (Files = 413, mean ± SD; 11 ± 8 observations per player, range; 1-33), with peak match running demands quantified for each playing half at ten incremental rolling average durations (1 min rolling averages, 2 min rolling averages, etc.). Data were assessed if players completed the full match. Three measures of running performance were assessed total distance (TD), high-speed distance (> 19.8 km · h-1) (HSD) and average acceleration (AveAcc)], with the in-game commencement time of the peak running demands recorded. Descriptive statistics and normality were calculated for each rolling average duration, with the self-containment of shorter rolling average epochs within longer epochs also assessed (e.g. Do the 1 min peak running demands occur within the 10 min peak running demands). Peak TD and AveAcc demands occurred early in each half (median time = 7-17 min and 6-16 min, respectively). Conversely, peak HSD covered was uniformly distributed (Skewness = 0-0.5, Kurtosis = 1.7-2.0). There were low-moderate levels of self-containment for each peak match running period (10-51%), dependent upon metric. Peak match running demands for TD and AveAcc occurred at similar stages of a match where TD and acceleration volumes are typically greatest, whereas peak HSD demands appeared more unpredictable. These timings may help inform training prescriptions in preparation of athletes for competition.

Between-match variation of peak match running intensities in elite football.

Peak match running intensities have recently been introduced to quantify the peak running demands of football competition, across incremental time intervals, to inform training practices. However, their between-match variation is yet to be comprehensively reported, limiting the ability to determine meaningful changes in peak match running intensities. The current study aimed to quantify the between-match variability in peak match running intensities across discrete moving average durations (1-10 min). GPS data were collected from 44 elite football players across 68 matches (mean ± SD; 13 ± 10 observations per player). For inclusion players must have completed 70mins of a match across a minimum of two matches. Performance metrics included total and high-speed (> 19.8 km · h-1) running distances and average acceleration (m · s-2), expressed relative to time. For each metric, the coefficient of variation and smallest worthwhile difference were calculated. The peak match running intensity data was similar to previously reported data from various football competitions. The between-match CV of relative total distance ranged between 6.8-7.3%, with the CV for average acceleration and relative high-speed running being 5.4-5.8% and 20.6-29.8%, respectively. The greater variability observed for relative high-speed running is likely reflective of the varying constraints and contextual factors that differ between matches. The reported between-match variability helps to provide context when interpreting match performance and prescribing training drills using peak match running intensity data.

Not as simple as it seems: Front foot contact kinetics, muscle function and ball release speed in cricket pace bowlers.

This study investigated the relationship between front foot contact (FFC) ground reaction forces (GRF) during the delivery stride, lower-limb strength, eccentric dexterity and power, and ball release speed (BRS) among pace bowlers. Thirteen high-level male pace bowlers performed double and single leg drop landings; isometric mid-thigh pull; countermovement jump; and pace bowling (two-over bowling spell measuring BRS and FFC GRF). The relationship between assessed variables and BRS was determined via frequentist and Bayesian multiple linear regression. The model including peak braking force was the most probable given the data (Bayes Factor=1.713) but provided only weak evidence in comparison to the null model. The results of frequentist and Bayesian modelling were comparable with peak braking force explaining 23.3% of the variance in BRS (F(1, 11)=4.64, P=0.054). Results indicate pace bowlers with greater peak braking GRF during FFC generally elicit higher BRS. However, the weak relationship between peak braking force and BRS, and the lack of a linear relationship between BRS and other variables, highlights the complexities and inter-individual variability inherent to pace bowling at a high-level. A more individual-focused analysis revealed varied strategies within pace bowlers to deliver the outcome (e.g., BRS) and should be considered in future study designs.

Skeletal Muscle Microvascular Adaptations Following Regular Cold Water Immersion.

This study investigated the effect of endurance training and regular post-exercise cold water immersion on changes in microvascular function. Nine males performed 3 sessions∙wk-1 of endurance training for 4 weeks. Following each session, participants immersed one leg in a cold water bath (10°C; COLD) for 15 min while the contra-lateral leg served as control (CON). Before and after training, microvascular function of the gastrocnemius was assessed using near-infrared spectroscopy, where 5 min of popliteal artery occlusion was applied and monitored for 3 min upon cuff release. Changes in Hbdiff (oxyhemoglobin - deoxyhemoglobin) amplitude (O-AMP), area under curve (O-AUC) and estimated muscle oxygen consumption (mVO2) were determined during occlusion, while the reperfusion rate (R-RATE), reperfusion amplitude (R-AMP) and hyperemic response (HYP) were determined following cuff release. Training increased O-AMP (p=0.010), O-AUC (p=0.011), mVO2 (p=0.013), R-AMP (p=0.004) and HYP (p=0.057). Significant time (p=0.024) and condition (p=0.026) effects were observed for R-RATE, where the increase in COLD was greater compared with CON (p=0.026). In conclusion, R-RATE following training was significantly higher in COLD compared with CON, providing some evidence for enhanced microvascular adaptations following regular cold water immersion.

Characterizing the plasma metabolome during 14 days of live-high, train-low simulated altitude: A metabolomic approach.

NEW FINDINGS: What is the central question of this study? Does 14 days of live-high, train-low simulated altitude alter an individual's metabolomic/metabolic profile? What is the main finding and its importance? This study demonstrated that ∼200 h of moderate simulated altitude exposure resulted in greater variance in measured metabolites between subject than within subject, which indicates individual variability during the adaptive phase to altitude exposure. In addition, metabolomics results indicate that altitude alters multiple metabolic pathways, and the time course of these pathways is different over 14 days of altitude exposure. These findings support previous literature and provide new information on the acute adaptation response to altitude. ABSTRACT: The purpose of this study was to determine the influence of 14 days of normobaric hypoxic simulated altitude exposure at 3000 m on the human plasma metabolomic profile. For 14 days, 10 well-trained endurance runners (six men and four women; 29 ± 7 years of age) lived at 3000 m simulated altitude, accumulating 196.4 ± 25.6 h of hypoxic exposure, and trained at ∼600 m. Resting plasma samples were collected at baseline and on days 3 and 14 of altitude exposure and stored at -80°C. Plasma samples were analysed using liquid chromatography-high-resolution mass spectrometry to construct a metabolite profile of altitude exposure. Mass spectrometry of plasma identified 36 metabolites, of which eight were statistically significant (false discovery rate probability 0.1) from baseline to either day 3 or day 14. Specifically, changes in plasma metabolites relating to amino acid metabolism (tyrosine and proline), glycolysis (adenosine) and purine metabolism (adenosine) were observed during altitude exposure. Principal component canonical variate analysis showed significant discrimination between group means (P < 0.05), with canonical variate 1 describing a non-linear recovery trajectory from baseline to day 3 and then back to baseline by day 14. Conversely, canonical variate 2 described a weaker non-recovery trajectory and increase from baseline to day 3, with a further increase from day 3 to 14. The present study demonstrates that metabolomics can be a useful tool to monitor metabolic changes associated with altitude exposure. Furthermore, it is apparent that altitude exposure alters multiple metabolic pathways, and the time course of these changes is different over 14 days of altitude exposure.

Iron considerations for the athlete: a narrative review.

Iron plays a significant role in the body, and is specifically important to athletes, since it is a dominant feature in processes such as oxygen transport and energy metabolism. Despite its importance, athlete populations, especially females and endurance athletes, are commonly diagnosed with iron deficiency, suggesting an association between sport performance and iron regulation. Although iron deficiency is most common in female athletes (~ 15-35% athlete cohorts deficient), approximately 5-11% of male athlete cohorts also present with this issue. Furthermore, interest has grown in the mechanisms that influence iron absorption in athletes over the last decade, with the link between iron regulation and exercise becoming a research focus. Specifically, exercise-induced increases in the master iron regulatory hormone, hepcidin, has been highlighted as a contributing factor towards altered iron metabolism in athletes. To date, a plethora of research has been conducted, including investigation into the impact that sex hormones, diet (e.g. macronutrient manipulation), training and environmental stress (e.g. hypoxia due to altitude training) have on an athlete's iron status, with numerous recommendations proposed for consideration. This review summarises the current state of research with respect to the aforementioned factors, drawing conclusions and recommendations for future work.

Nutritional Intake in Elite Cross-Country Skiers During Two Days of Training and Competition.

This study investigated the energy, macronutrient, and fluid intakes, as well as hydration status (urine specific gravity), in elite cross-country skiers during a typical day of training (Day 1) and a sprint skiing competition the following day (Day 2). A total of 31 (18 males and 13 females) national team skiers recorded their food and fluid intakes and urine specific gravity was measured on Days 1 and 2. In addition, the females completed the Low Energy Availability in Females Questionnaire to assess their risk of long-term energy deficiency. Energy intake for males was 65 ± 9 kcal/kg on Day 1 versus 58 ± 9 kcal/kg on Day 2 (p = .002) and for females was 57 ± 10 on Day 1 versus 55 ± 5 kcal/kg on Day 2 (p = .445). Carbohydrate intake recommendations of 10-12 g·kg-1·day-1 were not met by 89% of males and 92% of females. All males and females had a protein intake above the recommended 1.2-2.0 g/kg on both days and a postexercise protein intake above the recommended 0.3 g/kg. Of the females, 31% were classified as being at risk of long-term energy deficiency. In the morning of Day 1, 50% of males and 46% of females were dehydrated; on Day 2, this was the case for 56% of males and 38% of females. In conclusion, these data suggest that elite cross-country skiers ingested more protein and less carbohydrate than recommended and one third of the females were considered at risk of long-term energy deficiency. Furthermore, many of the athletes were dehydrated prior to training and competition.

Practitioner Perceptions of Evidence-Based Practice in Elite Sport in the United States of America.

Fullagar, HHK, Harper, LD, Govus, A, McCunn, R, Eisenmann, J, and McCall, A. Practitioner perceptions of evidence-based practice in elite sport in the United States of America. J Strength Cond Res 33(11): 2897-2904, 2019-Practitioners' perceptions regarding the use and effectiveness of research evidence in sport is not well understood. The purpose of the present study was to examine practitioners' perceptions around the use, implementation, and barriers to evidence-based practice (EBP) in sport science in the United States of America (USA). A survey (28 items) was completed by 67 full-time staff who were a physical performance team member employed by universities or professional sporting organizations in the USA. Questions included the use of research, contribution of research areas, barriers to accessing and implementing EBP, and methods of feedback to the coach and players. All respondents (100%) stated they used research evidence in their performance/training program, ranking research as contributing most (largest contribution = 1 to smallest contribution = 4) to individualized preparation or recovery recommendations (1.98 ± 1.02). The top 3 preferred sources of information were "peer-reviewed research" (100% of respondents), "conferences/seminars" (76%), and "practitioners within your sport" (63%). Commonly reported perceived barriers between accessing and implementing research were "lack of staff" (accessing = 33%, implementing = 46%) "time" (accessing = 38%, implementing = 48%) and nonapplicable research (accessing = 33%, implementing = 37%), whereas "poor player compliance" was a clear barrier to implementing EBP (56%). Practitioners most preferred, and actual, method of feedback for coaching staff (87% for both) and players (94 and 95%, respectively) was "informal conversations/speaking." Improved access to educational and financial resources, increased integration of staff in coach settings and understanding of player/coach contexts may help to alleviate barriers to EBP.

The 30-15 Intermittent Fitness Test: Can It Predict Outcomes in Field Tests of Anaerobic Performance?

This study determined whether a composite assessment of intermittent fitness could be used to quantify performance in several anaerobic tasks. Fifty-two male recreational athletes (age: 24.3 ± 4.4 years; body mass: 85.1 ± 12.2 kg; height: 180.5 ± 7.0 cm) were recruited from various team sports. Participants completed a battery of field tests to assess sprinting speed (40-m sprint), acceleration ability (10-m sprint), change of direction speed (505 test), anaerobic capacity (300-m shuttle), lower-body power (vertical jump), and repeated-sprint ability and the 30-15 Intermittent Fitness Test to determine the velocity of intermittent fitness (VIFT). Relationships between anaerobic tests and VIFT were quantified via Pearson product-moment correlations, and a 2-predictor model multiple linear regression estimated the predictive relationships between the exercise tests and the VIFT. Multiple linear regression showed that VIFT significantly predicted 56, 51, 44, 36, 12, and 1% of the variance in the 300-m shuttle, repeated sprint, 505- and 40-m sprint, vertical jump, and 10-m sprint tests, respectively. The 2-predictor model determined the 300-m shuttle, and repeated-sprint performance accounted for 67% of the variance in VIFT. These findings highlight that various anaerobic characteristics contribute to the intermittent fitness qualities that are quantified through VIFT. More specifically, these data indicate that VIFT is useful for tracking performance in tasks largely determined by anaerobic capacity, but may not be a good predictor of brief all-out sprinting and jumping efforts.

Regular postexercise cooling enhances mitochondrial biogenesis through AMPK and p38 MAPK in human skeletal muscle.

This study investigated the effect of regular postexercise cold water immersion (CWI) on muscle aerobic adaptations to endurance training. Eight males performed 3 sessions/wk of endurance training for 4 wk. Following each session, subjects immersed one leg in a cold water bath (10°C; COLD) for 15 min, while the contralateral leg served as a control (CON). Muscle biopsies were obtained from vastus lateralis of both CON and COLD legs prior to training and 48 h following the last training session. Samples were analyzed for signaling kinases: p38 MAPK and AMPK, peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α), enzyme activities indicative of mitochondrial biogenesis, and protein subunits representative of respiratory chain complexes I-V. Following training, subjects' peak oxygen uptake and running velocity were improved by 5.9% and 6.2%, respectively (P < 0.05). Repeated CWI resulted in higher total AMPK, phosphorylated AMPK, phosphorylated acetyl-CoA carboxylase, ß-3-hydroxyacyl-CoA-dehydrogenase and the protein subunits representative of complex I and III (P < 0.05). Moreover, large effect sizes (Cohen's d > 0.8) were noted with changes in protein content of p38 (d = 1.02, P = 0.064), PGC-1α (d = 0.99, P = 0.079), and peroxisome proliferator-activated receptor α (d = 0.93, P = 0.10) in COLD compared with CON. No differences between conditions were observed in the representative protein subunits of respiratory complexes II, IV, and V and in the activities of several mitochondrial enzymes (P > 0.05). These findings indicate that regular CWI enhances p38, AMPK, and possibly mitochondrial biogenesis.

Acute hypoxic exercise does not alter post-exercise iron metabolism in moderately trained endurance athletes.

PURPOSE: This study measured the influence of acute hypoxic exercise on Interleukin-6 (IL-6), hepcidin, and iron biomarkers in athletes. METHODS: In a repeated measures design, 13 moderately trained endurance athletes performed 5 × 4 min intervals at 90 % of their peak oxygen consumption velocity (vVO2peak) in both normoxic [NORM, fraction of inspired oxygen (F IO2) = 0.2093, 15.3 ± 1.7 km h(-1)] and simulated hypoxic (HYP, F IO2 = 0.1450, 13.2 ± 1.5 km h(-1)) conditions. Venous blood samples were obtained pre-, post-, and 3 h post-exercise, and analysed for serum hepcidin, IL-6, ferritin, iron, soluble transferrin receptor (sTfR), and transferrin saturation. RESULTS: Peak heart rate was significantly lower in HYP compared with NORM (p = 0.01); however, the rating of perceived exertion was similar between trials (p = 0.24). Ferritin (p = 0.02), transferrin (p = 0.03), and IL-6 (p = 0.01) significantly increased immediately post-exercise in both conditions, but returned to baseline 3 h later. Hepcidin levels significantly increased in both conditions 3 h post-exercise (p = 0.05), with no significant differences between trials. A significant treatment effect was observed between trials for sTfR (p = 0.01), but not iron and transferrin saturation. CONCLUSION: Acute exercise in hypoxia did not influence post-exercise IL-6 production, hepcidin activity or iron metabolism compared with exercise at the same relative intensity in normoxia. Hence, acute exercise performed at the same relative intensity in hypoxia poses no further risk to an athlete's iron status, as compared with exercise in normoxia.

Peak match acceleration demands differentiate between elite youth and professional football players.

Youth footballers need to be developed to meet the technical, tactical, and physical demands of professional level competition, ensuring that the transition between competition levels is successful. To quantify the physical demands, peak match intensities have been measured across football competition tiers, with team formations and tactical approaches shown to influence these physical demands. To date, no research has directly compared the physical demands of elite youth and professional footballers from a single club utilising common formations and tactical approaches. The current study quantified the total match and peak match running demands of youth and professional footballers from a single Australian A-League club. GPS data were collected across a single season from both a professional (n = 19; total observations = 199; mean ± SD; 26.7 ± 4.0 years) and elite youth (n = 21; total observations = 59; 17.9 ± 1.3 years) team. Total match demands and peak match running demands (1-10 min) were quantified for measures of total distance, high-speed distance [>19.8 km·h-1] and average acceleration. Linear mixed models and effect sizes identified differences between competition levels. No differences existed between competition levels for any total match physical performance metric. Peak total and high-speed distances demands were similar between competitions for all moving average durations. Interestingly, peak average acceleration demands were lower (SMD = 0.63-0.69) in the youth players across all moving average durations. The data suggest that the development of acceleration and repeat effort capacities is crucial in youth players for them to transition into professional competition.

Factors Influencing the Hepcidin Response to Exercise: An Individual Participant Data Meta-analysis.

BACKGROUND: Hepcidin, the master iron regulatory hormone, has been shown to peak 3-6 h postexercise, and is likely a major contributor to the prevalence of iron deficiency in athletes. Although multiple studies have investigated the hepcidin response to exercise, small sample sizes preclude the generalizability of current research findings. OBJECTIVE: The aim of this individual participant data meta-analysis was to identify key factors influencing the hepcidin-exercise response. METHODS: Following a systematic review of the literature, a one-stage meta-analysis with mixed-effects linear regression, using a stepwise approach to select the best-fit model, was employed. RESULTS: We show that exercise is associated with a 1.5-2.5-fold increase in hepcidin concentrations, with pre-exercise hepcidin concentration accounting for ~ 44% of the variance in 3 h postexercise hepcidin concentration. Although collectively accounting for only a further ~ 3% of the variance, absolute 3 h postexercise hepcidin concentrations appear higher in males with lower cardiorespiratory fitness and higher pre-exercise ferritin levels. On the other hand, a greater magnitude of change between the pre- and 3 h postexercise hepcidin concentration was largely attributable to exercise duration (~ 44% variance) with a much smaller contribution from VO2max, pre-exercise ferritin, sex, and postexercise interleukin-6 (~ 6% combined). Although females tended to have a lower absolute 3 h postexercise hepcidin concentration [1.4 nmol·L-1, (95% CI [- 2.6, - 0.3]), p = 0.02] and 30% less change (95% CI [-54.4, - 5.1]), p = 0.02) than males, with different explanatory variables being significant between sexes, sample size discrepancies and individual study design biases preclude definitive conclusions. CONCLUSION: Our analysis reveals the complex interplay of characteristics of both athlete and exercise session in the hepcidin response to exercise and highlights the need for further investigation into unaccounted-for mediating factors.

A contemporary understanding of iron metabolism in active premenopausal females.

Iron metabolism research in the past decade has identified menstrual blood loss as a key contributor to the prevalence of iron deficiency in premenopausal females. The reproductive hormones estrogen and progesterone influence iron regulation and contribute to variations in iron parameters throughout the menstrual cycle. Despite the high prevalence of iron deficiency in premenopausal females, scant research has investigated female-specific causes and treatments for iron deficiency. In this review, we provide a comprehensive discussion of factors that influence iron status in active premenopausal females, with a focus on the menstrual cycle. We also outline several practical guidelines for monitoring, diagnosing, and treating iron deficiency in premenopausal females. Finally, we highlight several areas for further research to enhance the understanding of iron metabolism in this at-risk population.

An Analysis of Warm-Up Strategies at a Cross-Country Skiing National Championship.

PURPOSE: To provide a descriptive analysis of the warm-up (WU) strategies employed by cross-country skiers prior to distance and sprint competitions at a national championship and to compare the skiers' planned and executed WUs prior to the respective competitions. METHODS: Twenty-one national- and international-level skiers (11 women and 10 men) submitted WU plans prior to the distance and sprint competitions, and after the competitions, reported any deviations from the plans. Skiers used personal monitors to record heart rate (HR) during WU, races, and cooldown. Quantitative statistical analyses were conducted on WU durations, durations in HR-derived intensity zones, and WU loads. Qualitative analyses were conducted on skiers' WU plans and their reasons for deviating from the plans. RESULTS: Skiers' planned WUs were similar in content and planned time in HR-derived intensity zones for both the distance and sprint competitions. However, 45% of the women and 20% of the men reported that their WU was not carried out as planned, with reasons detailed as being due to incorrect intensities and running out of time. WU activities including skiing across variable terrain, muscle-potentiating exercises, and heat-maintenance strategies were missing from the skiers' planned routines. CONCLUSIONS: Skiers favored a long, traditional WU approach for both the sprint and distance events, performing less high-intensity and more moderate-intensity exercise during their WUs than planned. In addition, elements likely relevant to successful performance in cross-country skiing were missing from WU plans.

Hormonal Contraceptive Use in Football Codes in Australia.

The recent launch of the new National elite women's football competitions in Australia has seen a 20-50% increase in grassroots female participation. With the growing participation across grassroots to elite competitions, understanding the health of female athletes should be prioritized. In elite level athletes, hormonal contraceptive (HC) use is common (~50%), however, little is known about the prevalence and reasons for use and disuse of HC in elite female football athletes. As such, the impact of HC use is often not considered when monitoring the health of female footballers. This study involved a subset of data collected as part of a larger questionnaire investigating menstrual cycle function, hormonal contraception use, and the interaction with training load volume and perceived performance in elite female football code athletes. A total of 177 participants completed the questionnaire across three football codes within Australia (rugby league, rugby union/sevens, Australian football). One third (n = 58) of athletes were currently using HC, predominately in the form of an oral contraceptive pill (OC, n = 47). Reasons for use included: to avoid pregnancy (71%); to control/regulate cycle (38%); and to reduce menstrual pain (36%). However, most athletes using an OC (89%) could not identify the type of pill used (e.g., mono-, bi-, or triphasic). The main reason for disuse was due to the negative side effects (n = 23), such as mood swings, weight gain, and depression/anxiety. Comparing HC users and non-users, there were no statistical differences in the number of reported menstrual symptoms, use of medication to relieve menstrual pain, or frequency for needing to adapt training due to their menstrual cycle (p > 0.05). Since most athletes were unaware of the type of OC they used, female football athletes require further education about the different types of HC, and specifically OC, available to them. Similarities in the symptoms experienced, pain management, and training adaptation requirements between groups suggests that HC use may not have the intended outcome for certain athletes. As such, greater awareness of athlete's personal experiences with the menstrual cycle, how HC may influence their experience, and acknowledgment of non-pharmacological methods to help manage menstrual cycle related symptoms are warranted.