TABLE 1.

Summary of the global and specific issues facing athletes and research staff when undertaking female athlete research, as well as our approach to addressing these issues within the specific design of this project, and a general summary of the outcome.

Issue	Background Comments	Strategy Employed in FARC1	Outcome of FARC1 Strategy
Global Issues
Reluctance of females to participate in research projects	Underpinning reasons unknown but could include: • Lack of awareness of research projects. • Busy lifestyle/lack of time within family, work/study and sporting commitments. • Unwillingness to change training and nutrition practices to suit study intervention. • Unwillingness to undertake invasive procedures. • Perceived lack of personal gain/value from participation in study.	Collaboration with the AIS FPHI used to assist with • Publicizing research opportunity within networks. • Identifying specific barriers to involvement with camp-based project. • Identifying specific training and nutrition needs of potential participants, including research interests. • Identifying characteristics of team to establish a “value proposition” (summary of benefits) for participation in activity.	• NRL identified priority to undertake project with their Women’s Indigenous Academy. • NRL and research team designed camp to balance research quality vs quantity, participant “cost vs benefit”, and logistics. • NRL managed registration of interest (n = 83), study enrolment camp (n = 43) and final participant selection (n = 25). • Study completed by 24 participants.
Fewer resources available for women’s sport, whereas female-focused project are likely to require greater expense and expertise	• Lower resourcing of women’s sport reduces capacity of individual programs to have expertise or funding to undertake projects. • Additional expenses for special items in female research (e.g. hormonal testing). • Project methodology likely to be more complicated to accommodate menstrual status/phase and (historically) is done with sub-optimal approaches.	• Collaboration established between key organizations focused on female athletes to pool financial and expertise resources to support overall camp structure and major project. • Involvement/contributions invited from other interested groups if practical, to add extra value to camp and to support projects from “lesser funded” sources.	• Primary collaboration established between AIS FPHI, ACU MMIHR and WTHPA FAH to fund and provide oversight over research camp structure and major projects. • Partnership established with NRL, to commit to project and support involvement of players, coaches and SSSM staff. • Additional research projects funded by 3 universities integrated into camp activities.
Differences in key metrics of interest in study may be altered by menstrual status or phase	• Differences in key reproductive hormones between (e.g. different menstrual status), and within participants (e.g. HC use or changes within a natural MC) may affect physiology, psychology and performance parameters, obscuring effect of study intervention. • There are insufficient well-controlled studies in females, particularly female athletes to be certain of such effects. • Sequential recruitment of participants with longitudinal monitoring of menstrual phase requires a lengthy study design.	• Methodology of FARC1 specifically chosen in recognition of potential for generic and individual changes in various health and performance according to menstrual status/phase. • Camp duration (5 wk period) chosen to allow monitoring of a complete cycle in each female participant with cycles <~42 d. • Cycling tracking completed for 11 wk before camp to attempt to predict menstrual status and phase of individual participants before camp. • Researchers and NRL team identified key health and performance metrics of interest.	• Camp deliberately involved recruitment based on athletic caliber from specific NRL pool, leading to mixture of menstrual status among athletes.
Insufficient female athletes of standardized or known caliber/training status	• Current literature has relied on subjective and variable descriptions of athlete caliber/status. • Lack of standardized descriptions of athlete caliber limits comparisons or studies or confident translation of existing research.	• Collaboration with an NRL supported recruitment of team sport athletes of known and similar caliber/training status. • Use of new standardized athlete tiering system (7) to describe athlete caliber/training status.	• Athletes identified as Tier 3 Rugby League Players with First Nations (Aboriginal and Torres Strait Island) heritage.
Specific
Camp value proposition to encourage involvement with study	• Many studies focus on the research questions and methodology without consideration of benefits to participants.	• Recognition that long-term residential camp offers opportunity for lengthy interaction with participants but that activities should be carefully curated activities to focus on participant benefits. • Primary benefit promoted via positioning of camp as an opportunity to train as a professional rugby player: daily training with expert coaching and resources, visits from “talent scouts”, auxiliary education activities on themes of key interest. • Focus on health and performance research themes of interest to NRL, and able to be integrated into camp without interrupting key activities.	• Camp recruitment and retention of participants successful (24/25 completed camp activities). • Exit surveys identified value of camp, with 100% of athletes stating that they would participate in another research embedded training camp. • 5 players selected for National teams. • 3 players selected for professional contracts in 2023. • Health education sessions delivered on bra fitting, pelvic floor health, nutrition, sleep.
Logistical support to allow participation in a residential camp	• 5 wk camp requires major lifestyle commitment which may be difficult for participants with children or work commitments. • Lengthy camp is also culturally challenging for participants living in rural/indigenous communities: homesickness expected.	• Daily allowance and travel costs of participants supported by NRL to facilitate attendance. • Negotiation with individual players to allow occasional “leave pass” to visit families or undertake culturally significant activities.	• 42% of participants who signed informed consent were unable to commit to study due to lifestyle and financial challenges. • 24/25 participants who commenced camp were able to complete all activities successfully with some negotiating family and work commitments during camp.
Selection of participants based on menstrual status	• Menstrual status/phase may affect a variety of factors underpinning health and performance. • Research on female athletes is needed to either investigate such effects or control for such effects in research designs. • Best practice protocols are available to standardize or characterize menstrual status or phase (9). • Research camp designs in which a group of female athletes undertake an activity simultaneously are likely to present a mixture of menstrual phase and status unless participants are recruited in a reductive manner.	• Although a mixture of menstrual phase and status was likely, the theme of engaging with an authentic team sport was given priority. • Athletes were invited to participate in camp based on sports suitability, leading to study of effects of menstrual status and phase in representative cohort of athletes. • Protocol was designed to investigate effect of menstrual phase within naturally menstruating female athletes, and in comparison to effects of hormonal contraception.	• Final cohort of female athletes included 11 naturally cycling and 13 HC (see Fig. 1). • Eumenorrhea was only evident in 1/11 naturally cycling athletes. • Menstrual dysfunction noted in 5 of 12 naturally cycling athletes.
Selection of characteristics to be investigated in study	• Most health and performance issues for female athletes related to menstrual status or phase are poorly studied. All are considered of value to investigate. • Specific health and performance issues of Aboriginal and Torres Strait Island populations are even less well studied, but some issues related to socioeconomic disadvantage are expected.	• Discussions held with NRL to identify: • Health and performance themes of interest and direct relevance. • Protocols that could be isolated into short and discrete phase-based testing blocks to reduce time commitment of each athlete and interference with afternoon training sessions. • Expertise within own research team and additional collaborators organized to maximize the robustness of research design and data collection.	Multiple data sets were collected within research camp. Specific themes of interest included: • Daily/bi-daily metrics (sleep, iron metabolism, muscle damage). • Phase-based interests (resting metabolic rate, body composition, physical and cognitive performance, proprioception and joint stiffness).
Cultural considerations of participant group	• Strong cultural traditions of Australian Aboriginal and Torres Strait Island people include recognition of country, family and elders. • Indigenous Australians make up ~3.8% of population (8) and many Australians are unfamiliar with this cultural heritage. • At the time of the study, Australia was considering a referendum to alter its Constitution to recognize its First Peoples. This created a period of sensitivity and an opportunity for raising cultural awareness.	• Cultural sensitivities addressed in ethics application to ACU. • Cultural awareness training conducted for research group by the NRL before camp. • Relevant activities included within Camp, with invitations extended to research group. • Elders consulted on camp activities and data collection involving sensitive themes to incorporate appropriate strategies into protocols. • Elders were present at group activities and available for individual support around sensitive themes.	• NRL, participants and researchers shared major activities (e.g. Welcome to Country, reception at Governor General’s residence to recognize camp importance), creating awareness and respect. • Exit interview of participants reported a mean score of 94/100 for perception of cultural safety during the camp.
Maximization of compliance to long-term study requirements	• Lengthy studies challenge subject commitment and risk noncompliance or dropout. • Research themes or data collection methods may involve issues to which there are sex, cultural or personal sensitivities (e.g. measurement of body composition, discussion of reproductive issues).	• NRL collaboration ensured that research issues were of interest and relevance to the team/participants. • Study design developed with awareness of issues that might create challenges around individual sensitivity or compliance (e.g. dietary standardization was implemented only for 24 h before data collection rather than whole camp due to lack of insight into usual/traditional dietary practices of participants). • Enrolment camp used to educate participants about study requirements and allow “design tweaks”. • Residential camp allowed rapport and relationships to develop between research team, NRL team and participants, contributing to mutual respect. • Involvement of head coach of Indigenous Women’s Academy as intermediary for all groups and advocated for special needs of each party.	• Robust data collected from 24/25 participants who completed study • Subjective view of researchers: good compliance to protocols was achieved. • Exit interviews from participants: study was a manageable commitment, and 100% of athletes would participate in another study.

AIS FPHI, Australian Institute of Sport Female Performance and Health Initiative; MMIHR, Mary MacKillop Institute for Health Research; ACU, Australian Catholic University; NRL, National Rugby League; WTHPA FAH, Wu Tsai Human Performance Alliance Female Athlete Hub, Boston Children’s Hospital.