The Underrepresentation of Females in Studies Assessing the Impact of High-Dose Exercise on Cardiovascular Outcomes: a Scoping Review

Roshan Patel, Caitlin L. Kemp, Muneebah Hafejee, Nicholas Peckham, Vageesh Jain, Gerry P. McCann, Susil Pallikadavath*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


High-dose exercise-induced cardiac outcomes may vary between sexes. However, many studies investigating the cardiovascular effects of high-dose exercise have excluded or under-recruited females. This scoping review aimed to describe the recruitment of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and describe how this has changed over time. This scoping review followed the protocol outlined by Arksey and O’Malley and is reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. The OVID and EMBASE databases were searched for studies that assessed the effects of high-dose exercise on cardiovascular outcomes. Both professional and nonprofessional groups were included. The review found 2973 studies, and 250 met the inclusion criteria including cumulatively 17,548,843 subjects. Over half the studies (n = 127) excluded females entirely, and only 8 (3.2%) studies recruited all-female participants. The overall mean percentage of females recruited was 18.2%. The mean percentage was 14.5% in studies conducted before 2011 and 21.8% in studies conducted after 2011. Females are an underrepresented group in studies assessing the cardiovascular outcomes related to high-dose exercise. As cardiovascular outcomes vary between sexes, translating findings from a largely male-based evidence may not be appropriate. Future investigators should aim to establish and overcome barriers to female recruitment.

Original languageEnglish
Article number30
Number of pages10
JournalSports Medicine - Open
Issue number1
Publication statusPublished - 29 Apr 2021
Externally publishedYes

Bibliographical note

Funding Information:
The authors would like to acknowledge Mr Keith Nockels (Academic librarian, University of Leicester, Leicester, UK) for his assistance in developing the search strategy.

Publisher Copyright:
© 2021, The Author(s).


  • Athletes
  • Cardiovascular outcomes
  • Exercise
  • Female participants


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