Abstract
round/Objectives:Masters athletes are adults aged≥40 who compete in sport, exhibiting superior physical function and healthier aging than their sedentary peers. How- ever, even highly trained masters athletes experience age-related performance declines. Women masters athletes represent a growing yet understudied population who may face unique physiological challenges. This scoping review synthesizes literature from 1984 to 2024, examining the impact of age and menopause on determinants of endurance perfor- mance in women masters athletes.Methods:Following JBI scoping review methodology, six databases were searched (Medline, Embase, Central, CINAHL, SPORTdiscus, Sco- pus). Studies were evaluated for population characteristics, methodological approaches, and physiological determinants of performance (i.e., aerobic capacity, lactate kinetics, and exercise economy).Results:Twenty-nine studies were included. Most (n= 28) as- sessed aerobic capacity, reporting declines between 0.36 and 0.84 mL·kg −1 · min −1 · year −1 (0.5–2.4%·year −1 ). These reductions were primarily associated with decreased cardiac out- put followed by changes in body composition. Training volume emerged as a predictor of aerobic capacity, but the effects of menopause were unclear. Findings on lactate kinetics and exercise economy were mixed but preliminary research indicated that lactate threshold rela- tive to VO2max generally increased, peak lactate remained stable and energy cost increased with age. Fitness and health
cardiac out- put followed by changes in body composition. Training volume emerged as a predictor of aerobic capacity, but the effects of menopause were unclear. Findings on lactate kinetics and exercise economy were mixed but preliminary research indicated that lactate threshold rela- tive to VO2max generally increased, peak lactate remained stable and energy cost increased with age. Fitness and health characteristics among women athletes differed from sedentary populations, emphasizing the need for athlete-specific data to support training and health decisions.Conclusions:Aging is associated with decreased aerobic capacity and variable changes in lactate kinetics and exercise economy. While training volume may attenuate performance decrements, the impact of menopause remains uncertain, underscoring the need for longitudinal research to better support this growing segment of the population. Keywords:age-related decline; women; masters athlete; menopause; endurance sport; sport performance; aerobic capacity; lactate; economy 1. Introduction Participation in sport among women and girls is at an all-time high [1], including among those above the age of 40—namely, masters athletes [2,3]. Engaging in sport provides significant physical and mental health benefits, supporting overall wellbeing and quality of life [4–6]. As a result, masters athletes generally maintain better function than their age-matched sedentary peers and are often seen as models of healthy aging [7–9]. Healthcare2026,14, 1080 https://doi.org/10.3390/healthcare14081080
Healthcare2026,14, 1080 2 of 25 This growing participation has been accompanied by increased sport science research on masters athletes, especially in endurance sports such as triathlon, swimming, cycling, and running [3,10–13]. The popularity of these events provides a large data pool for studies examining the unique physiological and performance characteristics of masters athletes [3]. Yet, despite continued engagement in endurance sport, aging is associated with decreased performance, even in the most capable athletes [8,14]. Several studies have quantified age-related declines in running [11,12,15], swim- ming [11], and triathlon [9,16]. World records and cross-sectional comparisons show modest decreases starting around age 35 with accelerated declines beginning around ages 60–70 [11,14,16,17]. These changes are observed in both men and women and have been linked to a variety of physiological and training factors [11,14]. Endurance performance is commonly quantified through three central determinants: aerobic capacity (i.e., maximal, VO2max, or peak oxygen consumption, VO2peak), lactate kinetics, and exercise economy (i.e., oxygen cost or energy cost at submaximal exercise intensity) [18]. Although age-related declines in endurance performance are commonly attributed to decreased aerobic capacity [11], the reality is more complex and a holistic approach is needed to fully understand the underlying mechanisms. While many studies have explored age-related declines in endurance performance, comparatively few reviews [3,19] or meta-analyses [20] have summarized these effects in women masters athletes. Meanwhile, existing summaries are often limited by small sample sizes, cross-sectional designs, non-athlete populations or a narrow focus on a single determinant of endurance performance [21]. The inadequate research on age-related decline in women athletes reflects the broader issue of “invisible sportswomen” in sport science [2,22]. Moreover, many studies including women rely on data from mixed cohorts [2,15], preventing careful analyses of women- specific experiences. Namely, the impact of menopause on endurance performance remains unclear [2] despite its serious and well-documented short- (e.g., hot flashes, mood changes, etc.) and long-term health effects (e.g., bone density loss, cardiovascular risk, cognitive changes, urogenital symptoms, etc.) [23,24]. Given that nearly all women experience menopause and many face related health complications, this knowledge gap poses signif- icant health and performance concerns. Therefore,
of menopause on endurance performance remains unclear [2] despite its serious and well-documented short- (e.g., hot flashes, mood changes, etc.) and long-term health effects (e.g., bone density loss, cardiovascular risk, cognitive changes, urogenital symptoms, etc.) [23,24]. Given that nearly all women experience menopause and many face related health complications, this knowledge gap poses signif- icant health and performance concerns. Therefore, the primary purpose of this scoping review was to explore what is known about the impact of age on the determinants of endurance performance in women masters athletes. The secondary purpose was to explore what is known about the role of menopause in mediating these age-related changes. 2. Materials and Methods The Population/Concept/Context (PCC) framework [25] guided the inclusion and exclusion criteria (Table). Articles were included if participants were women or female (aged 40 to 65) who were endurance athletes (runners, cyclists, swimmers and/or triathletes) classified as Tier 2 or above as per the Participant Classification Framework [26]. This classification requires athletes to train≥3 per week, compete locally or above, and train with intent to compete [26]. These sports were selected based on preliminary searches indicating sufficient literature within these disciplines. Studies including other endurance sports (e.g., rowing) did not meet the remaining inclusion criteria. In addition, studies had to include at least one key determinant of endurance performance (i.e., aerobic capacity, lactate kinetics, exercise economy) with changes reported over time, either as a longitudinal or as a cross-sectional study comparing younger to older athletes. Articles with men athletes or sedentary women were included if the data could be stratified to allow analysis of eligible women masters athletes. Cross-sectional studies comparing younger to older athletes were considered if at least one age group fell within the 40 to 65 age criteria. https://doi.org/10.3390/healthcare14081080
Healthcare2026,14, 1080 3 of 25 This age range was chosen to align with common definitions of masters athletes in sport science research [3], while focusing our search on the years surrounding menopause, thus supporting our secondary objective. Table 1.Inclusion and exclusion criteria by PCC category, sub-category, and criteria. PCC Category Sub-Category Criteria Population Women * Women or female participants, aged 40 to 65. Athletes Endurance athletes (runners, cyclists, swimmers, triathletes). Competitive level Classified as Tier 2 or above [26]. Other Men athletes or sedentary women included if stratified for women or female athletes aged 40–65. Concept Determinant of endurance performance At least one key determinant of endurance performance (aerobic capacity, lactate kinetics, exercise economy) with change over time (longitudinal). Comparison of younger and older athletes (cross-sectional) included if at least one group aged 40–65. Menopause Studies including relevant discussions on menopause. Context Design, Setting, Publication Type No limits on study setting. Peer-reviewed literature only. Reviews, qualitative studies or opinion papers were excluded. Language, Year No limits on publication date or language. * Many included articles were published before clear distinctions between sex and gender were emphasized in sport science research, resulting in the use of gendered terms (e.g., women) where sex-specific language (e.g., female) may have been more appropriate [27]. While this review focuses on biological processes, the included studies rarely justified their use of “women” versus “female.” While we acknowledge that sex and gender are distinct and non-binary concepts, “women” is recognized as an inclusive term [22], including biological females as well as individuals who identify as women. As such, we use “women” throughout this review to align with and enable a cohesive discussion of the original sources. Given the relative lack of sport science research on women masters athletes, a scoping review was chosen to broadly map and characterize the state of the literature [25,28]. This style of review was chosen to identify key concepts and knowledge gaps, and inform future, more focused investigations. The JBI (formerly Joanna Briggs Institute) methodology for scoping reviews [25] was followed and we reported the process according to the Preferred Reporting Items
athletes, a scoping review was chosen to broadly map and characterize the state of the literature [25,28]. This style of review was chosen to identify key concepts and knowledge gaps, and inform future, more focused investigations. The JBI (formerly Joanna Briggs Institute) methodology for scoping reviews [25] was followed and we reported the process according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) (Appendix) [ 29]. The three-step approach included a preliminary search of Google Scholar, Medline, and the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis. Although several reviews examined age-, sex- and gender-related changes in endurance or strength outcomes, no reviews specifically focused on women masters athletes [20,30–32] or addressed menopause as a subtopic in this field. Nevertheless, an adequate number of seed articles [16,33–36] were identified to support the feasibility of conducting a scoping review. Next, text words from the titles and abstracts as well as subject headings from seed articles informed the development of a comprehensive Medline search strategy (Appendix). The search included four concepts: women, age, masters athletes, and endurance performance. Each concept included keywords and subject headings. The Medline search was translated to other databases where keywords were the same across all databases, and subject headings were responsive to the controlled vocabulary of each database. The preliminary protocol was conducted in accordance with an a priori protocol [25] and registered on 18 December 2024, with the Open Science Framework Registries OSF (https://osf.io/dfjcv/overview; accessed 15 December 2025). 2.1. Search Strategy The following databases were searched in September 2024: Medline All (Ovid), Em- base (Ovid), Central (Wiley), CINAHL Plus with Full Text (Ebsco), SPORTdiscus with Full Text (Ebsco), and Scopus (Elsevier). Additionally, the reference lists of all included sources were screened to identify further studies. There were no restrictions on publication date or language. Our search was supported by a librarian (K.A.H.) and retrieved database records were uploaded into Covidence [37]. The full search strategy for each database can be found under Appendix. https://doi.org/10.3390/healthcare14081080
sources were screened to identify further studies. There were no restrictions on publication date or language. Our search was supported by a librarian (K.A.H.) and retrieved database records were uploaded into Covidence [37]. The full search strategy for each database can be found under Appendix. https://doi.org/10.3390/healthcare14081080
Healthcare2026,14, 1080 4 of 25 2.2. Study Selection Following the search, all identified citations were collated and uploaded into Cov- idence (Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at.) [ 37]. After duplicates were removed, all reviewers (D.V., M.N., P.K.D.-B.) independently conducted a pilot test of 50 randomly selected records (titles and abstracts) against the inclusion criteria. Interrater agreement was above the suggested 75%. After the pilot test, D.V. and M.N. screened all retrieved titles and abstracts to assess their eligibility. Full texts of potentially relevant citations were then reviewed by D.V. and M.N. to determine final inclusion. Disagreements at any stage were resolved through discussion with P.K.D.-B. and reasons for exclusion at the full- text stage were documented. Following consultation with P.K.D.-B., one study involving “endurance-trained” women was included given the high fitness and training frequencies (i.e.,≥3 sessions per week [26]; Table) and the article’s inclusion of menopause-related metrics, despite not explicitly including women masters athletes [38]. 2.3. Data Extraction During the pilot screening phase, the data extraction form was tested with identified seed studies (Appendix). It was modified and refined as necessary throughout the data extraction process. Extracted data included specific details about the participants, concept, context, study methods, and key findings relevant to the review questions. Through the data extraction process, additional columns were added to increase detail about exercise protocols and performance metrics beyond the three primary performance determinants. Articles screened prior to the addition of new data extraction criteria were revisited to capture the relevant information. Data extraction was conducted by D.V. except for one Japanese-language article [39] which was reviewed by M.N., who is fluent in Japanese. Data extraction was verified by P.K.D.-B. After extraction, D.V. and P.K.D.-B. discussed prevalent themes and established a logical flow for presenting findings. We were unable to classify participants as per the STRAW+10 framework (Stages of Reproductive Aging Workshop) outlined in our protocol [24] because few studies provided details on their method of identifying menopause status. 3. Results The initial search identified 8675 records, of which 3771 duplicates were removed, leaving 4904 for title/abstract screening.
and established a logical flow for presenting findings. We were unable to classify participants as per the STRAW+10 framework (Stages of Reproductive Aging Workshop) outlined in our protocol [24] because few studies provided details on their method of identifying menopause status. 3. Results The initial search identified 8675 records, of which 3771 duplicates were removed, leaving 4904 for title/abstract screening. Of these, 4853 were excluded, with 51 advancing to full-text review. Only 29 studies met inclusion criteria for analysis. The most common exclusion reason was lack of stratified data (Figure). The earliest article was published in 1984 and the most recent in 2022 (Table articles were published in North America (n= 21), 19 of which were published in the United States. Study designs were either cross-sectional (n= 25) or longitudinal (n= 4). Most studies included athletes between the ages of 40 and 70, but one study included athletes as young as 13 [40] and one as old as 90 [41]. Twelve studies discussed menopause [34,38,39,42–50], although the extent to which it was discussed varied greatly. Menopause was typically defined as≥12 months of amenorrhea [38,42,44,46] but some required participants to be≥24-month from last menses [45]. One study classified menopause status using the comprehensive Notelovitz framework [ Aerobic capacity was included in every article except one (n= 28) [52]. Seven articles presented measures of lactate [34,35,52–56] and three mentioned exercise econ- omy [49,57,58]. Other articles reported metrics such as VO2at estimated anaerobic thresh- old [59], glucose response to endurance exercise [54], and lipid profiles of endurance-trained women [39,44]. https://doi.org/10.3390/healthcare14081080
Healthcare2026,14, 1080 5 of 25 Records screened (n = 4904) Reports sought for retrieval (n = 51) Studies from databases/registers (n = 8675) MEDLINE (n = 2677) Embase (n = 2673) Scopus (n = 1594) CENTRAL (n = 883) CINAHL (n = 430) SPORTDiscus (n = 418) References removed (n = 3771) Duplicates identified manually (n = 6) Duplicates identified by Covidence (n = 3765) Marked as ineligible by automation tools (n = 0) Other reasons (n = 0) Records excluded (n = 4853) Reports not retrieved (n = 0) Reports assessed for eligibility (n = 51) Reports excluded (n = 22) Review article (n = 1) Wrong population (age) (n = 1) Wrong population (sex) (n = 2) Does not observe change over time (n = 2) Poster presentation or abstract only (n = 5) Wrong population (non-endurance athletes) (n = 4) Does not stratify data (e.g., by age, sex, training status, etc.) (n = 7) Studies included in review (n = 29) Identification Screening Included Identification of studies via databases and registers Figure 1.PRISMA 2020 flow diagram for new systematic reviews [29] (Appendix). Age-related decline in aerobic capacity was presented in several ways, including regres- sion equations, absolute changes (mL·kg −1 · min −1 · year −1 ), or percent changes (%·year −1 ) (Table). Lactate parameters were most frequently presented as peak lactate [34,35,52,54,55], lactate threshold [35,55,56] or lactate threshold as a percentage of VO2max [35,55–57]. Ex- ercise economy was typically presented as oxygen cost [49,57,58] or energy cost [58] of submaximal exercise. Aerobic capacity was assessed predominantly using treadmill [34,35,38,39,42–48,54– 58,60–65] and cycle ergometer-based indirect calorimetry [41,50,53,60,61]. Twenty-three studies determined aerobic capacity by measuring VO2max. Most of these studies (n= 20) included standardized criteria to confirm attainment of a true physiological maximum, such as a plateau in VO2despite increasing work rate, respiratory exchange ratio (between 1.05 and 1.15, heart rate within 10% of age-predicted maximum, and a rating of perceived https://doi.org/10.3390/healthcare14081080
attainment of a true physiological maximum, such as a plateau in VO2despite increasing work rate, respiratory exchange ratio (between 1.05 and 1.15, heart rate within 10% of age-predicted maximum, and a rating of perceived https://doi.org/10.3390/healthcare14081080
Healthcare2026,14, 1080 6 of 25 exertion near maximal effort [34,35,39,40,43–45,47–50,54–57,61–65]. Studies lacking stan- dardized criteria for aerobic capacity reported VO2peak (n= 5), representing the highest oxygen consumption reached during an exercise bout [38,41,42,58,60]. While VO2max and VO2peak are distinct concepts [66], they are referred to collectively as aerobic capacity throughout this review. Table 2.Study characteristics by location, year, design, determinant of endurance performance, and menopause status. Study Characteristics Category Number ( n= 29) Location (Continent) North America 21 Europe 4 Oceania 1 Asia 3 Publication Year 1980–1984 2 1985–1989 1 1990–1994 4 1995–1999 8 2000–2004 6 2005–2009 3 2010–2014 1 2015–2019 2 2020–2024 2 Study Design Cross-sectional 25 Longitudinal 4 Endurance Determinant * Aerobic Capacity 28 Lactate Kinetics 7 Exercise Economy 3 Menopause Discussed 12 Not discussed 17 Note: Lactate kinetics include various blood lactate metrics such as peak lactate, lactate threshold or % of VO2max. * Some studies included multiple endurance determinants (Table). Testing protocols were similar across studies. For example, several treadmill-based protocols used a modified Balke test that began at 2.5 miles per hour with incremental increases in grade by 2% and speed by 0.5 miles per hour every two minutes until voli- tional exhaustion [34,35,43,57]. Lactate concentrations were assessed either by intravenous sampling or portable devices [34,52–54]. Lactate-related metrics varied across studies, with some authors reporting peak exercising concentrations and others assessing lactate threshold as a percentage of VO2max, among other metrics. Few studies collected lactate data outside of treadmill-based assessments [52]. Exercise economy, referring to the oxygen or energy cost required to perform submaxi- mal exercise, was mentioned in three studies [49,57,58], with in-depth analysis limited to just one study [58]. Body composition was measured using hydrostatic weighing [34,43,45,47,48,54,55,65], skinfold calipers [42,46,48,62,64] and dual-energy X-ray absorptiometry [38,43,48,56,62,63]. Body composition assessments were used to quantify bone mineral density, fat mass, and fat-free mass, and to facilitate discussions on the relationship between body composition and aerobic capacity [43,47,54,55]. Table 3.Studies by author, determinant of endurance performance, primary study objective, and conclusion. Author (Year) n Age Range Determinant Primary Objective Conclusion AC LK EE Rainville (1984) [46] 20
Description
The review explores how aging and menopause affect endurance performance in women athletes.