Objectives: To develop a sustainable and accessible educational programme on biopsychosocial female-specific topics, for young female athletes in organised sport, their parents and coaches for future testing and evaluation in a full-scale intervention study.

Methods: A digital educational programme, along with its methodology, was developed in four steps: First, content validity of female-specific topics was identified through (a) literature reviews by an interdisciplinary research team and (b) an online survey of 1323 female athletes (aged 16–24 years) assessing perceived knowledge and knowledge needs regarding biopsychosocial topics. Second, film scripts based on identified topics were written, internally reviewed and evaluated by a pilot group of six 13–16-year-old female athletes. Third, online surveys assessing main and secondary outcomes were developed and tested in the pilot group. Finally, digital format and production were developed collaboratively with a film scholar and film technicians.

Results: The intervention development yielded 12 videos of 5–7 min, featuring sports science researchers and female elite athletes sharing their perspectives on biopsychosocial topics specific to women. The protocol development produced a quasi-experimental, modified staircase cluster trial design, including bi-weekly assessment of main (ie, well-being and sporting experiences) and secondary outcomes (eg, perceived support) at baseline, pre-, post-intervention and post-post follow-up.

Conclusion: This study outlines the development of a digital educational intervention for young female athletes, their parents and coaches, emphasising that interdisciplinary collaboration and user engagement are key to identifying intervention components and relevant outcomes.

Aim This cross-sectional two-step study aimed to investigate the prevalence of eatingdisorder (ED) symptoms and associated mental health difficulties among elite athletesand an age-and sex matched comparison group.

Methods National team athletes were recruited through national sport federations,while participants in the comparison group were recruited via social media. A totalof 408 participants (athletes n = 256; comparison group n = 152) (72.1% female),completed an anonymous online survey comprising validated psychometricmeasures of ED symptoms, exercise addiction, depression and psychological flexibility.Participants who screened positive for ED symptoms and providing contact detailswere invited to undergo a clinical assessment using the ED Examination Interview (EDE17.0D).

Results Overall, 25.0% (n = 102) reported ED symptoms, with a higher prevalence inthe comparison group than among athletes (37.5% vs. 17.6%, p < 0.001). Interviewswere completed by 78.0% (n = 18) of athletes and 47.0% (n = 16) of comparison groupparticipants who screened positive for ED symptoms, confirming an ED diagnosis inall but one athlete. Furthermore, 18.6% (n = 76) reported clinically relevant symptomsof depression, and 22.8% (n = 93) of exercise addiction. Associations were observedbetween ED symptoms and symptoms of exercise addiction, depression, andpsychological inflexibility in the total sample, among athletes and in the comparisongroup.

Conclusion ED symptoms were common among athletes and the comparison groupand were associated with depressive symptoms, problematic exercise behaviour, andpsychological inflexibility. To safeguard athlete health and optimise performance,national sports organisations should implement systematic preventive strategies,promote early identification, establish clear referral pathways, and ensure access tocoordinated multidisciplinary care.

Introduction: This cross-sectional study aimed to determine the prevalence ofRelative Energy Deficiency in Sport (REDs) among Swedish national-teamathletes across multiple sports and to examine selected endocrine andmetabolic markers in relation to within-day energy balance (WDEB) metrics.

Methods: REDs severity was retrospectively classified in 43 athletes (60.5%females) using the IOC REDs Clinical Assessment Tool 2 framework.Assessments included DXA-derived body composition, resting metabolic rate(RMR) by ventilated-hood indirect calorimetry, blood markers, validatedquestionnaires, clinical eating disorder interview. 4-day dietary intake, energyavailability (EA), EB, and WDEB metrics were assessed in a subsample (n = 33;19 females, 14 males).

Results: Twenty athletes (46.5%) were classified as controls (no/low risk; 45.0%female), whereas 23 (53.5%) were classified with REDs (73.9% female). MostREDs cases were mild, however 61% exhibited ≥2 additional potential REDsindicators, a pattern also observed in 50% of controls. Athletes classified withREDs had higher cortisol and cortisol-to-insulin ratio, lower RMR ratio, lowerenergy intake and 24 h EA, and greater exposure to negative WDEB patterns.In unadjusted analyses, insulin was associated with both 24 h EB and EA.Exploratory analyses in females identified associations between cortisol-toinsulinratio and negative WDEB metrics, and between Exercise AddictionInventory score and 24 h EB; however, these associations were no longersignificant after Benjamini-Hochberg false discovery rate correction.

Conclusion: More than half of the elite athletes in this cohort, were classifiedwith REDs, with a higher prevalence among females. REDs classification wasassociated with lower EA, greater exposure to negative WDEB patterns, andadditional endocrine and metabolic alterations consistent with energydeficiency. Notably, a similar pattern was also observed in 50% of controls,supporting a continuum rather than discrete risk categories. Although WDEBand dietary metrics may provide useful contextual information they should beinterpreted cautiously and integrated with comprehensive multi-markerclinical REDs evaluation.

The Milano Cortina 2026 Olympic Winter Games are projected to be the most gender-balanced Winter Games to date, with women comprising an estimated 47% of athletes. However, this numerical balance has outpaced the scientific evidence base informing the training and health support of elite female winter sport athletes. This expert-led narrative review synthesizes the biological foundations of sex-based performance differences, evaluates corresponding training and health considerations specific to female winter sport athletes. Biological divergence emerging at puberty, particularly in hemoglobin mass, cardiac dimensions, skeletal muscle mass, and body composition, underpins persistent sex differences in absolute performance. When normalized to body mass or lean mass, many physiological differences are attenuated, with hemoglobin concentration and body fat percentage remaining as primary determinants of the performance gap. Despite these differences, contemporary evidence indicates that when training is prescribed relative to individual capacity, women exhibit comparable physiological adaptations to men after puberty. Thus, the principles of effective training are largely shared across sexes, emphasizing the need for sport-specific and individualized training prescriptions. Health is a critical enabler of performance. Female athletes face elevated risks of iron deficiency, relative energy deficiency in sport (REDs), and menstrual dysfunction, conditions that can compromise adaptation, increase injury risk, and threaten career longevity. Addressing these challenges requires integrated, sex-specific monitoring and prevention strategies. By translating biological insights into individualized training and health practices, this review provides evidence-based support to enhance the performance and health of elite female winter Olympians at Milano Cortina 2026 and beyond.

Introduction: Oxidating fat as an energy substrate requires more oxygen than utilizing carbohydrates and can be acutely increased by hyperoxia. Therefore, substrate utilization may affect endurance performance and gas consumption in divers, but previous research is limited. This study aimed to evaluate changes in maximal fat oxidation (MFO) in navy divers during training.

Methods: Seven explosive ordnance disposal (EOD) divers (age 20.0 +/- 1.4, BMI 23.5 +/- 1.6), five combat divers (age 23.6 +/- 3.0, BMI 26.2 +/- 1.2), and seven amphibious rangers (controls) (age 23.0 +/- 2.9, BMI 26.2 +/- 1.7) were recruited. MFO was measured with indirect calorimetry using an incremental test before and after diver training of 15 weeks (EOD divers) or 16 weeks spaced over nine months (combat divers and controls). EOD divers performed a treadmill protocol in normoxia and hyperoxia, and combat divers and controls performed a bicycle ergometer protocol in normoxia.

Results: Combat divers increased their MFO with 0.14 g/minute ([95 % CI] 0.04 to 0.23) while no difference was observed in EOD divers (-0.05 g/minute;-0.19 to 0.08) or controls (0.00 g/minute;-0.14 to 0.14).

Discussion: Combat diver training can increase fat oxidation, potentially affecting oxygen consumption and carbon dioxide production. A combination of training stressors, including hyperoxia, training load, and negative energy balance, may cause these changes.

Female athletes encounter biological challenges, such as puberty and hormonal health, embedded within psychosocial coaching environments. Despite their relevance, these topics remain insufficiently integrated into coach education programmes. This study surveyed 779 coaches in Norway and Sweden to examine perceived knowledge versus the importance of female-specific topics through a biopsychosocial perspective. Results revealed a consistent discrepancy: coaches rated these topics as highly important but reported limited knowledge. Latent profile analysis identified three distinct profiles: “High-Performance but Resource-Limited”, “Aware but Underprepared”, and “Confident but Unaware,” with no significant differences based on coach sex or education. Across profiles, coaches reported limited resource access and a strong need for education regarding how these factors impact communication, training, and well-being. These findings indicate persistent gaps in coach preparedness, highlighting the need for context-sensitive education. Integrating biologically grounded content within a biopsychosocial perspective may strengthen coaching practice and thus enhance female athletes´ long-term development.

Both the countermovement jump (CMJ) and the isometric mid-thigh pull(IMTP) are frequently used performance tests to monitor neuromuscular fatigueand recovery after exhaustive physical activities. However, to date, neitherthe reliability nor the validity of the CMJ and IMTP performed after thecardiopulmonary exercise testing (CPET) has been studied. Thus, this studyprimarily aimed to investigate the intrasession relative and absolute reliability ofthe CMJ and IMTP when performed after the CPET. Second, the study aimedto examine the discriminative validity of the CMJ and IMTP performed after theCPET by differentiating between elite male and female athletes. Twenty-eightfemale (26.8 ± 6.6 years) and seventeen male (23.8 ± 3.5 years) elite Swedishathletes voluntarily participated in the study. Protocols included anthropometricmeasurements, a cycle ergometer-based CPET (i.e., VO_2peak test), followed bythree maximal test-retest CMJ and IMTP trials. Jump height, peak power, andrelative peak power during CMJ and peak force and relative peak force duringIMTP testing were analysed. Results showed high relative reliability of the CMJand IMTP in the total sample (ICC: 0.97 and 0.98) and separately in male (ICC:0.88 and 0.98) and female (ICC: 0.98 and 0.93) athletes. The good absolutereliability of the CMJ and IMTP was evidenced by low within-subjects testretestvariability (CVWS%) and typical measurement error percentage, rangingbetween 5.7% and 6.5% and 6.3% and 8.9%, respectively. Both the CMJ and IMTPshowed good test sensitivity, with the smallest worthwhile change exceedingthe typical error. The CMJ’s jump height, relative peak power, and IMTP’s peakforce showed a large discriminatory capacity to differentiate between maleand female athletes (Cohen’s d = 3.92, 1.80 and 5.14, respectively). However,when the peak force was standardised relative to body mass and lean mass,the differences between sexes diminished. In conclusion, given that the CMJand IMTP tests demonstrated high reliability and sensitivity following CPET, they could be confidently used as practical tools for monitoring neuromuscular fatigue and recovery, even after exhaustive cardiopulmonary exertion activities. Additionally, the demonstrated discriminative validity in differentiating betweenmale and female athletes further supports their role in sex-specific performanceprofiling.

The International Consensus Conference "Optimising Performance of the Elite Athlete," held in November 2024, brought together 29 scientists, some coaches, and athletes to establish evidence-based consensus statements aimed at enhancing elite athletic performance and health. The conference addressed critical themes including training strategies, nutrition, female athlete considerations, injury management, and emerging technologies. Key conclusions emphasize individualized, sport-specific approaches to training and nutrition, integrating concurrent training modalities to improve endurance, resilience, and efficiency. Nutrition strategies highlight the importance of tailored energy and macronutrient periodization, recognition of low energy availability risks, and cautious use of dietary supplements. Special attention was directed to female athletes, advocating for improved monitoring of menstrual cycles and hormonal status, while acknowledging current knowledge gaps in hormonal influences on performance and injury risk. Injury prevention remains a challenge, with tendon overuse and Achilles tendon ruptures significantly impacting athlete careers; rehabilitation should rely on criteria-based progression and multidisciplinary input. Emerging technologies, including wearable sensors and multi-omics analyses, hold promise for personalized training and nutrition but require further validation in elite contexts. Despite robust consensus, the panel identified substantial research gaps, particularly regarding female athletes, longitudinal training effects, and efficacy of novel interventions. This consensus provides a practical, scientifically grounded framework to optimize elite athlete performance and health, while underscoring the need for continued research to address outstanding questions and promote inclusive evidence-based practices.