Background Despite an increasing rate of women participating in professional sports, emergency services, and military settings where they are exposed to exertional heat stress, our understanding of female thermoregulation and the detrimental effects of heat on women’s performance, especially regarding the menstrual cycle, is limited. This review aimed to quantify the representation of women in exercise thermoregulation research between 2010 and 2019 and the frequency that these articles reported details pertaining to female participants’ menstrual cycle to determine the volume of novel research that is directly relevant to this growing population. Methods Original exercise thermoregulatory studies published in three major sports medicine databases (PubMed, MEDLINE, and SPORTDiscus) between 2010 and 2019 were surveyed. Articles were screened to determine the number of female and male participants in the study and whether studies involving women reported menstrual orientation or phase. Research involving healthy adult participants and an exercise protocol with a thermoregulatory outcome measure were included in the review. Results A total of 1407 articles were included in the review, involving 28,030 participants. The annual representation of women ranged from a mean of 11.6% [95% credible interval (CI); 9.2, 14.3] to 17.8% [95% CI; 15.2, 20.6] across the 10 years, indicating studies predominantly included men. Nonetheless, there was a small statistical increase in the overall proportion of women, with a mean overall proportion change of 0.7% [95% CI; 0.2, 1.2] per year. The increase appeared to be driven by a reduction in the number of studies including only men, rather than studies including more women alongside men, or increased women-only studies. Less than one third of articles involving women reported the menstrual orientation of participants and less than one quarter reported both menstrual orientation and phase. Summary/Conclusion This study shows that women were proportionally underrepresented in exercise thermoregulation research during the past decade and the majority of studies did not report menstrual cycle details of female participants. Researchers should consider including women in future work where their inclusion could contribute meaningful data that enhance the evidence-based and ultimately improves our comprehension of women’s thermal physiology.

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According to an expansive body of research and best practice statements, whole-body cold water immersion is the gold standard treatment for exertional heat stroke. However, as this founding evidence was predominantly drawn from males, the current guidelines for treatment are being applied to women without validation. Given the recognised differences in thermal responses experienced by men and women, all-encompassing exertional heat stroke treatment advice may not effectively protect both sexes. In fact, recent evidence suggests that hyperthermic women cool faster than hyperthermic men during cold water immersion. This raises the question of whether overcooling is risked if the present guidelines are followed. The current mini-review examined the literature on women’s response to cold water immersion as a treatment for exertional heat stroke and aimed to clarify whether the current guidelines have appropriately considered research investigating women. The potential implications of applying these guidelines to women were also discussed.

Aim: Prediction intervals are a useful measure of uncertainty for meta-analyses that capture the likely effect size of a new (similar) study based on the included studies. This study aimed to: (i) estimate the proportion of meta-analysis studies that report a prediction interval in sports medicine, using medicine as a comparator; and (ii) estimate the proportion of studies with a discrepancy between the reported confidence interval and a calculated prediction interval.Methods: We identified all meta-analysis published between 2012 and 2022 in 10 highly ranked sports medicine and eight medical journals. From these articles, 750 were randomly selected from each discipline. Articles that used a random effect meta-analysis model were included. We randomly selected one meta-analysis from each article to extract data from, which included the number of estimates, the pooled effect, and the confidence and prediction interval.Results: Of the 1500 articles screened, 866 (514 from sports medicine) used a random effect model. The probability of a prediction interval being reported in sports medicine was 1.7% (95% CI = 0.9%, 3.3%). In medicine the probability was 3.9% (95% CI = 2.4%, 6.6%). There were 57% lower odds of a prediction interval being reported in sports medicine (odds ratio = 0.432, 95% CI = 0.178, 0.995). However, the 95% CI was compatible with the difference being practically none. Three of the nine sports medicine studies that reported a prediction interval considered it in their conclusions. A prediction interval was able to be calculated for 220 sports medicine studies. For 60% of these studies, there was a discrepancy in study findings between the reported confidence interval and the calculated prediction interval. Prediction intervals were 3.4 times wider than confidence intervals.Conclusion: Very few meta-analyses report prediction intervals and hence are prone to missing the impact of between-study heterogeneity on the overall conclusions. The widespread misinterpretation of random effect meta-analyses could mean that potentially harmful treatments, or those lacking a sufficient evidence base, are being used in practice. Authors, reviewers, and editors should be aware of the importance of prediction intervals. Journals should consider mandating the inclusion of prediction intervals. Changing the default settings of meta-analysis software to include a prediction interval and changes to the PRISMA reporting guidelines could help improve reporting rates.