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Ms-represented: strategies to increase female representation in sports cardiology research
  1. Amy Mitchell1,
  2. Kristel Janssens1,2,
  3. Erin J Howden3,
  4. André La Gerche4,5,
  5. Jessica J Orchard6
  1. 1 Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  2. 2 Exercise and Nutrition Research program, The Mary MacKillop Institute for Health Research, Australian Catholic University, Fitzroy, Victoria, Australia
  3. 3 Human Integrated Physiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  4. 4 Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  5. 5 St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
  6. 6 Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Jessica J Orchard, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia; jessica.orchard{at}

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Female athletes are unduly under-represented in sports cardiology research, resulting in an inferior knowledge base to inform clinical management.1 Accurate and timely diagnosis of pathology in female athletes using electrocardiography or cardiac imaging is currently limited by our poor understanding of the ranges of normality in the female athlete’s heart.2

This editorial seeks to identify factors contributing to inequitable sex representation in sports cardiology research and proposes strategies to promote greater female athlete engagement (box 1).

Box 1

The six principles for sex parity in sports cardiology research

1. Commit to multilevel sex parity*†‡

  • In research samples, on editorial boards, among reviewers and in the research team.

2. Rethink archaic exclusions*

  • Minimise exclusion criteria that affect females (ie, menstrual status, hormonal contraceptives).

3. Increase resources* ‡

  • Designate funding for female-specific enquiries.

  • Make allowances for the additional costs incurred by the complex methodologies required to study females.

4. Think like a female (or consult one)*

  • Consider sex and gender differences in values and mindset to recruit females.

  • Minimise barriers for participation (ie, offer childcare support and compensation, expand study visit hours and implement remote follow-up).

5. Prioritise sample diversity over sample size†

  • Recognise the value of underpowered female cohorts.

  • Encourage data disaggregation by sex.

6. Counter complacency† ‡

  • Mandate EDI statements in grants and publications.

  • Guide reviewers to assess EDI principles in grants and scientific investigations.

*Researcher responsibility.

Journal responsibility.

Funding body responsibility.

EDI, equity, diversity and inclusion.

Potential research barriers and proposed solutions

Complexities of female physiology

Barrier: the effects of female sex hormones and their fluctuation represent a potential confounder in research. Considerations …

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  • Twitter @KJanssensAU, @alagerche, @jessicajorchard

  • AM and KJ contributed equally.

  • Contributors AM and KJ contributed equally. All authors contributed ideas and experience to the generation of this editorial. JJO was responsible for initiation and executive oversight.

  • Funding JJO is funded by a National Health and Medical Research Council Investigator Grant (No. 2016730). KJ is supported through an Australian Government Research Training Program Scholarship. EJH is supported by Australian National Heart Foundation Future Leader Fellowships (ID 102536).

  • Competing interests ALG and JJO are members of the BJSM editorial board.

  • Provenance and peer review Not commissioned; externally peer reviewed.