{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:17:36Z","timestamp":1788347856634,"version":"build-2803163510"},"reference-count":119,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The beneficial effect of regular physical activity across all bodily functions is well known. The use of oral contraceptives (OCs) is highly prevalent among premenopausal women due to their contraceptive efficacy and favorable safety profile. However, the impact of combined oral contraceptives (COCs) in exercise conditions remains controversial and inconclusive. We aim to explore the effects of COCs on cardiorespiratory and immune function in premenopausal women engaged in exercise when compared with non-COC users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Extensive searches of relevant databases, including MEDLINE, CINAHL, Cochrane CENTRAL, and other health sources, were conducted on the EBSCOhost interface from January 2024 to May 2026. All studies that included healthy, physically active premenopausal women and female athletes (15\u201340 years old) on COC and non-COC users were appraised using the relevant JBI appraisal tools. Data analysis was performed using Review Manager (RevMan) version 5.3. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      The review and meta-analysis included 29 studies comprising 726 participants (recreationally active and trained female athletes) involved in exercise, of whom 390 (53.7%) used COC, and 336 (46.3%) were non-COC users. Overall, 19 studies with a comparator group were included in our meta-analysis. The overall pooled estimates suggest that the use of COC had little to no difference on certain makers of cardiorespiratory and immune function such as\u00a0heart rate [MD\u00a0=\u00a00.02, 95% CI (\u22121.85, 1.9),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.98], respiratory parameters [SMD = \u22120.07, 95% CI (\u22120.18, 0.04),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.28], and IL-6 levels [MD = -0.88, 95% CI (2.75,\u00a00.98),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.35)] when compared with the non-COC group. Similarly, there is little to no difference in the body composition (BMI) [MD = -0.21, 95% CI (-0.59, 0.18),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.3)] and metabolic changes [SMD = -0.15, 95% CI (-0.43, 0.12),\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.36)] among COC users compared with the non-COC group. Nonetheless, the certainty of evidence across all measured outcomes in the included studies is low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The current evidence does not demonstrate a consistent detrimental effect of COC use on cardiorespiratory or immune outcomes among physically active premenopausal women; however, confidence in these findings remains limited due to the low certainty of the available evidence. The low certainty of the evidence across the included studies is attributable to small sample sizes, high risk of bias, varied methodological approaches, and a lack of data from specific geographical locations, among other factors. Thus, caution should be exercised when extrapolating these findings for consultation or decision-making regarding COC use in and out of clinical settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42021265257<\/jats:ext-link>\n                      , identifier CRD42021265257.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2026.1728032","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:48:12Z","timestamp":1784695692000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of oral contraceptive use on cardiorespiratory and immune function in premenopausal women involved in exercise: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Oyesanmi A.","family":"Fabunmi","sequence":"first","affiliation":[{"name":"Section Sports Medicine, Faculty of Health Sciences, University of Pretoria","place":["Pretoria, South Africa"]},{"name":"Health-awareness, Exercise and Cardio-immunologic Research Unit (HECIRU), Department of Physiology, College of Medicine, Ekiti State University","place":["Ado-Ekiti, Ekiti State, Nigeria"]},{"name":"Sport Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria","place":["Pretoria, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gugulethu P.","family":"Luthuli","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, University of KwaZulu-Natal","place":["Durban, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phiwayinkosi V.","family":"Dludla","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, University of KwaZulu-Natal","place":["Durban, South Africa"]},{"name":"Department of Biochemistry and Microbiology, University of Zululand","place":["KwaDlangezwa, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bongani B.","family":"Nkambule","sequence":"additional","affiliation":[{"name":"School of Medicine, College of Health Sciences, University of KwaZulu-Natal","place":["Durban, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1080\/02640414.2021.1885782","article-title":"Iron status in athletic females, a shift in perspective on an old paradigm","volume":"39","author":"Badenhorst","year":"2021","journal-title":"J. Sports Sci."},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/s23063251","article-title":"Heart rate variability based estimation of maximal oxygen uptake in athletes using supervised regression models","volume":"23","author":"Balakarthikeyan","year":"2023","journal-title":"Sensors"},{"key":"B3","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/j.cca.2010.02.069","article-title":"Effect of exercise training on chronic inflammation","volume":"411","author":"Beavers","year":"2010","journal-title":"Clin. Chim. Acta"},{"key":"B4","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1007\/s10286-023-00951-z","article-title":"Heart rate variability between hormone phases of the menstrual and oral contraceptive pill cycles of young women","volume":"33","author":"Blake","year":"2023","journal-title":"Clin. Auton. Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1080\/02640414.2012.762984","article-title":"The relationship between cardiac autonomic function and maximal oxygen uptake response to high-intensity intermittent-exercise training","volume":"31","author":"Boutcher","year":"2013","journal-title":"J. Sports Sci."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.1152\/japplphysiol.00818.2020","article-title":"Evaluating the effects of oral contraceptive use on biomarkers and body composition during a competitive season in collegiate female soccer players","volume":"130","author":"Bozzini","year":"2021","journal-title":"J. Appl. Physiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1136\/bjsm.30.1.36","article-title":"Effect of low dose oral contraceptives on exercise performance","volume":"30","author":"Bryner","year":"1996","journal-title":"Br. J. Sports Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1007\/s10654-020-00705-5","article-title":"Oral contraceptive use by formulation and endometrial cancer risk among women born in 1947\u20131964: The Nurses\u2019 Health Study II, a prospective cohort study","volume":"36","author":"Burchardt","year":"2021","journal-title":"Eur. J. Epidemiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1161\/hypertensionaha.112.202598","article-title":"Ovarian cycle and sympathoexcitation in premenopausal women","volume":"61","author":"Carter","year":"2013","journal-title":"Hypertension"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1698","DOI":"10.1152\/japplphysiol.00622.2002","article-title":"Effects of oral contraceptives on peak exercise capacity","volume":"93","author":"Casazza","year":"2002","journal-title":"J. Appl. Physiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1007\/s40279-016-0534-9","article-title":"Combined oral contraceptives increase high-sensitivity C-reactive protein but not haptoglobin in female athletes","volume":"47","author":"Cauci","year":"2017","journal-title":"Sport Med."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/molecules26041070","article-title":"Oxidative stress is increased in combined oral contraceptives users and is positively associated with high-sensitivity c-reactive protein","volume":"26","author":"Cauci","year":"2021","journal-title":"Molecules"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2019.01550","article-title":"Inflammatory effects of high and moderate intensity exercise\u2014a systematic review","volume":"10","author":"Cerqueira","year":"2020","journal-title":"Front. Physiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1038\/icb.2015.97","article-title":"Inflammation during skeletal muscle regeneration and tissue remodeling: Application to exercise-induced muscle damage management","volume":"94","author":"Chazaud","year":"2016","journal-title":"Immunol. Cell Biol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1161\/01.atv.0000036611.77940.f8","article-title":"Associations between cardiorespiratory fitness and C-reactive protein in men","volume":"22","author":"Church","year":"2002","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fspor.2021.634866","article-title":"Hormonal contraceptive use in football codes in Australia","volume":"3","author":"Clarke","year":"2021","journal-title":"Front. Sport Act. Living"},{"key":"B18","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1111\/j.1475-097x.2006.00674.x","article-title":"Test-retest reliability for two indices of ventilatory efficiency measured during cardiopulmonary exercise testing in healthy men and women","volume":"26","author":"Davis","year":"2006","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"B19","unstructured":"2.7.2. Cardio-respiratory function \u2013 fundamentals of health and physical activity\n          \n          \n            \n              Delaney\n              K. Z.\n            \n            \n              Barker\n              L."},{"key":"B20","doi-asserted-by":"publisher","first-page":"3669","DOI":"10.4049\/jimmunol.1103180","article-title":"IL-10 triggers changes in macrophage phenotype that promote muscle growth and regeneration","volume":"189","author":"Deng","year":"2012","journal-title":"J. Immunol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1016\/b978-141603197-0.10069-2","article-title":"Testing for maximal aerobic power","author":"Deuster","year":"2008","journal-title":"Sport Med. Resour. Man."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.1152\/ajpregu.00700.2005","article-title":"Menstrual cycle phase and sex influence muscle glycogen utilization and glucose turnover during moderate-intensity endurance exercise","volume":"291","author":"Devries","year":"2006","journal-title":"Am. J. Physiol. - Regul. Integr. Comp. Physiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1001\/jamapsychiatry.2019.2838","article-title":"Association of use of oral contraceptives with depressive symptoms among adolescents and young women","volume":"77","author":"De Wit","year":"2020","journal-title":"JAMA Psychiatry"},{"key":"B24","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1136\/jech.52.6.377","article-title":"The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions","volume":"52","author":"Downs","year":"1998","journal-title":"J. Epidemiol. Community Health"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2019.07.011","article-title":"Cardiorespiratory responses during high-intensity interval training prescribed by rating of perceived exertion in patients after myocardial infarction enrolled in early outpatient cardiac rehabilitation","volume":"8","author":"Dun","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1152\/japplphysiol.00921.2020","article-title":"Interleukin-6 is higher in naturally menstruating women compared with oral contraceptive pill users during the low-hormone phase","volume":"131","author":"Eagan","year":"2021","journal-title":"J. Appl. Physiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1007\/s40279-020-01317-5","article-title":"The effects of oral contraceptives on exercise performance in women: A systematic review and meta-analysis","volume":"50","author":"Elliott-Sale","year":"2020","journal-title":"Sport Med."},{"key":"B28","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s40279-021-01435-8","article-title":"Methodological considerations for studies in sport and exercise science with women as participants: A working guide for standards of practice for research on women","volume":"51","author":"Elliott-Sale","year":"2021","journal-title":"Sport Med."},{"key":"B29","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1016\/j.contraception.2012.11.023","article-title":"Examining the role of oral contraceptive users as an experimental and\/or control group in athletic performance studies","volume":"88","author":"Elliott-Sale","year":"2013","journal-title":"Contraception"},{"key":"B30","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1055\/a-2205-1849","article-title":"Effects of a transoceanic rowing challenge on cardiorespiratory function and muscle fitness","volume":"45","author":"Ellis","year":"2024","journal-title":"Int. J. Sports Med."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0298429","article-title":"Effect of combined oral contraceptive on cardiorespiratory function and immune activation in premenopausal women involved in exercise: A systematic review protocol","volume":"19","author":"Fabunmi","year":"2024","journal-title":"PloS One"},{"key":"B32","doi-asserted-by":"crossref","first-page":"77","DOI":"10.70252\/AKBM3973","article-title":"Oxygen consumption and substrate utilization during and after resistance exercises performed with different muscle mass","volume":"9","author":"Farinatti","year":"2016","journal-title":"Int. J. Exerc Sci."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20043148","article-title":"Effect of menstrual cycle phase on fuel oxidation post HIT in women reproductive age: A pilot study","volume":"20","author":"Frientes","year":"2023","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B34","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1007\/s00421-006-0355-x","article-title":"Central circulatory and peripheral O2 extraction changes as interactive facilitators of pulmonary O2 uptake during a repeated high-intensity exercise protocol in humans","volume":"99","author":"Fukuba","year":"2007","journal-title":"Eur. J. Appl. Physiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.4324\/9780203166635-12","article-title":"Decreased submaximal oxygen uptake during short duration oral contraceptive use: A randomized cross-over trial in premenopausal women","volume":"43","author":"Giacomoni","year":"2000","journal-title":"Ergonomics"},{"key":"B36","doi-asserted-by":"publisher","first-page":"693","DOI":"10.69645\/kjiw4106","article-title":"Immune function in sport and exercise","volume":"103","author":"Gleeson","year":"2007","journal-title":"J. Appl. Physiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1038\/nri3041","article-title":"The anti-inflammatory effects of exercise: Mechanisms and implications for the prevention and treatment of disease","volume":"11","author":"Gleeson","year":"2011","journal-title":"Nat. Rev. Immunol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1630","DOI":"10.2337\/db06-1733","article-title":"Interleukin-6 directly increases glucose metabolism in resting human skeletal muscle","volume":"56","author":"Glund","year":"2007","journal-title":"Diabetes"},{"key":"B39","doi-asserted-by":"publisher","first-page":"500","DOI":"10.36660\/ijcs.20200399","article-title":"Effects of physical exercise on lipid and inflammatory profile of women using combined oral contraceptive: A cross-over study","volume":"35","author":"Gomes","year":"2022","journal-title":"Int. J. Cardiovasc. Sci."},{"key":"B40","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1111\/cpf.12469","article-title":"The effects of menstrual cycle phase on the incidence of plateau at V\u02d9O2max and associated cardiorespiratory dynamics","volume":"38","author":"Gordon","year":"2018","journal-title":"Clin. Physiol. Funct. Imaging"},{"key":"B41","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1016\/j.jacc.2007.03.042","article-title":"Exercise oscillatory ventilation may predict sudden cardiac death in heart failure patients","volume":"50","author":"Guazzi","year":"2007","journal-title":"J. Am. Coll. Cardiol."},{"key":"B42","first-page":"143","article-title":"Chapter 6: Choosing effect measures and computing estimates of effect | Cochrane Training","volume-title":"Cochrane Handb. Syst. Rev. Interv","author":"Higgins","year":"2019"},{"key":"B43","doi-asserted-by":"publisher","first-page":"R1465","DOI":"10.1152\/ajpregu.00778.2006","article-title":"Physiologically high concentrations of 17\u03b2-estradiol enhance NF-\u03baB activity in human T cells","volume":"292","author":"Hirano","year":"2007","journal-title":"Am. J. Physiol. Integr. Comp. Physiol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"E752","DOI":"10.1152\/ajpendo.00238.2001","article-title":"No effect of menstrual cycle phase on glucose kinetics and fuel oxidation during moderate-intensity exercise","volume":"282","author":"Horton","year":"2002","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1016\/j.jsams.2019.04.002","article-title":"Changes in inflammation markers after a 10-week high-intensity combined strength and endurance training block in women: The effect of hormonal contraceptive use","volume":"22","author":"Ihalainen","year":"2019","journal-title":"J. Sci. Med. Sport"},{"key":"B46","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s00421-014-3075-7","article-title":"Maximal fat oxidation, but not aerobic capacity, is affected by oral contraceptive use in young healthy women","volume":"115","author":"Isacco","year":"2015","journal-title":"Eur. J. Appl. Physiol."},{"key":"B47","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1113\/EP091800","article-title":"Exercise-induced changes in left ventricular strain are affected by interleukin-6 activity: An exploratory analysis of a randomised-controlled trial in humans with abdominal obesity","volume":"109","author":"J\u00f8nck","year":"2024","journal-title":"Exp. Physiol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1891","DOI":"10.1519\/jsc.0b013e3182736935","article-title":"Effect of long-term oral contraceptive use on determinants of endurance performance","volume":"27","author":"Joyce","year":"2013","journal-title":"J. Strength Cond Res."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1016\/j.mayocp.2016.10.003","article-title":"Reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing data from the fitness registry and the importance of exercise national database","volume":"90","author":"Kaminsky","year":"2015","journal-title":"Mayo Clin. Proc."},{"key":"B50","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.bbrc.2004.05.188","article-title":"AMPK activity is diminished in tissues of IL-6 knockout mice: The effect of exercise","volume":"320","author":"Kelly","year":"2004","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00497","article-title":"Inflammation and oral contraceptive use in female athletes before the Rio Olympic Games","volume":"11","author":"Larsen","year":"2020","journal-title":"Front. Physiol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/s0167-5273(02)00014-1","article-title":"Effect of exercise training on skeletal muscle fibre characteristics in men with chronic heart failure. Correlation between skeletal muscle alterations, cytokines and exercise capacity","volume":"83","author":"Larsen","year":"2002","journal-title":"Int. J. Cardiol."},{"key":"B53","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1136\/bjsm.37.4.315","article-title":"Decreased maximal aerobic capacity with use of a triphasic oral contraceptive in highly active women: A randomised controlled trial","volume":"37","author":"Lebrun","year":"2003","journal-title":"Br. J. Sports Med."},{"key":"B54","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1113\/jphysiol.2007.147629","article-title":"V\u0307O2: What do we know, and what do we still need to know","volume":"586","author":"Levine","year":"2008","journal-title":"J. Physiol."},{"key":"B55","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.bbrc.2017.07.063","article-title":"Comparing the androgenic and estrogenic properties of progestins used in contraception and hormone therapy","volume":"491","author":"Louw-du Toit","year":"2017","journal-title":"Biochem. Biophys. Res. Commun."},{"key":"B56","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1007\/s004210000380","article-title":"Low dosage monophasic oral contraceptive use and intermittent exercise performance and metabolism in humans","volume":"84","author":"Lynch","year":"2001","journal-title":"Eur. J. Appl. Physiol."},{"key":"B57","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s004210050462","article-title":"Effects of menstrual cycle phase and oral contraceptive use on intermittent exercise","volume":"78","author":"Lynch","year":"1998","journal-title":"Eur. J. Appl. Physiol. Occup. Physiol."},{"key":"B58","doi-asserted-by":"publisher","first-page":"926","DOI":"10.1123\/ijspp.2017-0330","article-title":"Period prevalence and perceived side effects of hormonal contraceptive use and the menstrual cycle in elite athletes","volume":"13","author":"Martin","year":"2018","journal-title":"Int. J. Sports Physiol. Perform."},{"key":"B59","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1111\/sms.13590","article-title":"Menstrual and oral contraceptive cycle phases do not affect submaximal and maximal exercise responses","volume":"30","author":"Mattu","year":"2020","journal-title":"Scand. J. Med. Sci. Sport"},{"key":"B60","doi-asserted-by":"publisher","first-page":"276","DOI":"10.11613\/bm.2012.031","article-title":"Interrater reliability: The kappa statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Med."},{"key":"B61","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1513\/annalsats.201612-997fr","article-title":"Cardiopulmonary exercise testing: Basics of methodology and measurements","volume":"14","author":"Mezzani","year":"2017","journal-title":"Ann. Am. Thorac. Soc"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1016\/j.cyto.2022.155872","article-title":"High-intensity intermittent exercise induces a potential anti-inflammatory response in healthy women across the menstrual cycle","volume":"154","author":"Minuzzi","year":"2022","journal-title":"Cytokine"},{"key":"B63","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1016\/j.imbio.2016.07.006","article-title":"Hyperglycemia induces mixed M1\/M2 cytokine profile in primary human monocyte-derived macrophages","volume":"222","author":"Moganti","year":"2017","journal-title":"Immunobiology"},{"key":"B64","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1002\/dta.2873","article-title":"Fluctuations in hematological athlete biological passport biomarkers in relation to the menstrual cycle","volume":"12","author":"Mullen","year":"2020","journal-title":"Drug Test. Anal."},{"key":"B65","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1111\/jog.14613","article-title":"Effect of administration of monophasic oral contraceptive on the body composition and aerobic and anaerobic capacities of female athletes","volume":"47","author":"Nakamura","year":"2021","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"B66","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1057\/9781137292155_8","article-title":"IL\u20106 signaling in acute exercise and chronic training: Potential consequences for health and athletic performance","volume":"33","author":"Nash","year":"2022","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1111\/apha.14013","article-title":"The effects of menstrual cycle phases on immune function and inflammation at rest and after acute exercise: A systematic review and meta-analysis","volume":"238","author":"Notbohm","year":"2023","journal-title":"Acta Physiol."},{"key":"B68","article-title":"Comparison of the cytokine responses to acute strength exercise between oral contraceptive users and naturally cycling women","volume-title":"Eur J Appl Physiol","author":"Notbohm","year":"2023"},{"key":"B69","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/0002-9378(87)90059-7","article-title":"The effect of low-dose oral contraceptives on cardiorespiratory function, coagulation, and lipids in exercising young women: A preliminary report","volume":"156","author":"Notelovitz","year":"1987","journal-title":"Am. J. Obstet. Gynecol"},{"key":"B70","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.thromres.2018.03.005","article-title":"Systematic review and meta-analysis of the association of combined oral contraceptives on the risk of venous thromboembolism: The role of the progestogen type and estrogen dose","volume":"165","author":"Oedingen","year":"2018","journal-title":"Thromb. Res."},{"key":"B71","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1055\/s-0043-101377","article-title":"Effect of resistance exercise on arterial stiffness during the follicular and luteal phases of the menstrual cycle","volume":"38","author":"Okamoto","year":"2017","journal-title":"Int. J. Sports Med."},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B73","doi-asserted-by":"publisher","first-page":"1805","DOI":"10.1007\/s00404-019-05340-4","article-title":"A multicenter, double-blind, randomized trial on the bleeding profile of a drospirenone-only pill 4 mg over nine cycles in comparison with desogestrel 0.075 mg","volume":"300","author":"Palacios","year":"2019","journal-title":"Arch. Gynecol Obstet."},{"key":"B74","doi-asserted-by":"crossref","first-page":"e195","DOI":"10.1111\/j.1600-0838.2009.00947.x","article-title":"A COX-2 inhibitor reduces muscle soreness, but does not influence recovery and adaptation after eccentric exercise","volume":"20","author":"Paulsen","year":"2010","journal-title":"Scand. J. Med. Sci. Sport."},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2022.928308","article-title":"Association between the empirical dietary inflammatory index and cardiorespiratory fitness in Tehranian adults in 2017\u20132018","volume":"9","author":"Payandeh","year":"2022","journal-title":"Front. Nutr."},{"key":"B76","doi-asserted-by":"publisher","first-page":"E155","DOI":"10.1152\/ajpendo.00257.2004","article-title":"Acute IL-6 treatment increases fatty acid turnover in elderly humans in vivo and in tissue culture in vitro","volume":"288","author":"Petersen","year":"2005","journal-title":"Am. J. Physiol. Endocrinol. Metab."},{"key":"B77","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1152\/japplphysiol.00164.2004","article-title":"The anti-inflammatory effect of exercise","volume":"98","author":"Petersen","year":"2005","journal-title":"J. Appl. Physiol."},{"key":"B78","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00659","article-title":"Measurement and interpretation of exercise ventilatory efficiency","volume":"11","author":"Phillips","year":"2020","journal-title":"Front. Physiol."},{"key":"B79","doi-asserted-by":"publisher","first-page":"3046","DOI":"10.1093\/humrep\/des225","article-title":"Oral, transdermal and vaginal combined contraceptives induce an increase in markers of chronic inflammation and impair insulin sensitivity in young healthy normal-weight women: A randomized study","volume":"27","author":"Piltonen","year":"2012","journal-title":"Hum. Reprod."},{"key":"B80","doi-asserted-by":"publisher","DOI":"10.3390\/sports11030054","article-title":"Long-term resistance\u2013endurance combined training reduces pro-inflammatory cytokines in young adult females with obesity","volume":"11","author":"Pranoto","year":"2023","journal-title":"Sports"},{"key":"B81","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1249\/mss.0b013e31816a0df6","article-title":"Effect of oral contraceptives on weight and body composition in young female runners","volume":"40","author":"Procter-Gray","year":"2008","journal-title":"Med. Sci. Sports Exerc"},{"key":"B82","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/ijerph18030860","article-title":"Menstrual cycle phases influence on cardiorespiratory response to exercise in endurance-trained females","volume":"18","author":"Rael","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B83","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4137\/ccrpm.s449","article-title":"The respiratory exchange ratio is associated with fitness indicators both in trained and untrained men: A possible application for people with reduced exercise tolerance","volume":"2","author":"Ramos-Jim\u00e9nez","year":"2008","journal-title":"Clin. Med. Circ. Respirat Pulm. Med."},{"key":"B84","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.contraception.2009.11.005","article-title":"Effect of low-dose combined oral contraceptive on aerobic capacity and anaerobic threshold level in active and sedentary young women","volume":"81","author":"Rebelo","year":"2010","journal-title":"Contraception"},{"key":"B85","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1055\/s-2007-965334","article-title":"Oral contraceptive phase has no effect on endurance test","volume":"29","author":"Rechichi","year":"2008","journal-title":"Int. J. Sports Med."},{"key":"B86","doi-asserted-by":"publisher","first-page":"3830","DOI":"10.1210\/jc.2004-2401","article-title":"Effect of a synthetic progestin on the exercise status of sedentary young women","volume":"90","author":"Redman","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"B87","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1055\/s-0028-1105932","article-title":"Footwear and running cardio-respiratory responses","volume":"30","author":"Rubin","year":"2009","journal-title":"Int. J. Sports Med."},{"key":"B88","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12961-019-0435-0","article-title":"Supporting implementation of Cochrane methods in complex communication reviews: Resources developed and lessons learned for editorial practice and policy","volume":"17","author":"Ryan","year":"2019","journal-title":"Heal. Res. Policy Syst"},{"key":"B89","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1152\/japplphysiol.01395.2005","article-title":"Point: In health and in a normoxic environment, V\u0307O2max is limited primarily by cardiac output and locomotor muscle blood flow","volume":"100","author":"Saltin","year":"2006","journal-title":"J. Appl. Physiol."},{"key":"B90","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1590\/S1413-35552008000300006","article-title":"Influence of oral contraceptive use on lipid levels and cardiorespiratory responses among healthy sedentary women","volume":"12","author":"Santos","year":"2008","journal-title":"Rev. Bras. Fisioter"},{"key":"B91","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1249\/mss.0000000000001171","article-title":"Oral contraceptive use dampens physiological adaptations to sprint interval training","volume":"49","author":"Schaumberg","year":"2017","journal-title":"Med. Sci. Sports Exerc"},{"key":"B92","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2020.00629","article-title":"Oral contraceptive use influences on-kinetic adaptations to sprint interval training in recreationally-active women","volume":"11","author":"Schaumberg","year":"2020","journal-title":"Front. Physiol."},{"key":"B93","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-11-22","article-title":"Dealing with substantial heterogeneity in Cochrane reviews. Cross-sectional study","volume":"11","author":"Schroll","year":"2011","journal-title":"BMC Med. Res. Methodol."},{"key":"B94","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e17049","article-title":"The influence of the menstrual cycle and hormonal contraceptives on cardiorespiratory fitness in physically active women: A systematic review and meta-analysis","volume":"9","author":"Schumpf","year":"2023","journal-title":"Heliyon"},{"key":"B95","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2466-12-23","article-title":"Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension","volume":"12","author":"Schwaiblmair","year":"2012","journal-title":"BMC Pulm. Med."},{"key":"B96","article-title":"C-reactive protein: clinical relevance and interpretation","volume-title":"Statpearls","author":"Singh","year":"2025"},{"key":"B97","doi-asserted-by":"publisher","DOI":"10.4061\/2011\/532620","article-title":"Effect of exercise training on interleukin-6, tumour necrosis factor alpha and functional capacity in heart failure","volume":"1","author":"Smart","year":"2011","journal-title":"Cardiol. Res. Pract."},{"key":"B98","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1159\/000509132","article-title":"Combined all-extremity high-intensity interval training regulates immunometabolic responses through toll-like receptor 4 adaptors and A20 downregulation in obese young females","volume":"13","author":"Soltani","year":"2020","journal-title":"Obes. Facts"},{"key":"B99","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1139\/h09-107","article-title":"Moderate and heavy oxygen uptake kinetics in postmenopausal women","volume":"34","author":"Stathokostas","year":"2009","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"B100","doi-asserted-by":"publisher","first-page":"2683","DOI":"10.1096\/fj.06-7477com","article-title":"Nitric oxide production is a proximal signaling event controlling exercise\u2010induced mRNA expression in human skeletal muscle","volume":"21","author":"Steensberg","year":"2007","journal-title":"FASEB J."},{"key":"B101","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1016\/j.fertnstert.2020.08.1396","article-title":"Lifestyle modifications alone or combined with hormonal contraceptives improve sexual dysfunction in women with polycystic ovary syndrome","volume":"115","author":"Steinberg Weiss","year":"2021","journal-title":"Fertil. Steril"},{"key":"B102","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1124\/mol.104.004465","article-title":"Estrogen receptor activation of phosphoinositide-3 kinase, Akt, and nitric oxide signaling in cerebral blood vessels: Rapid and long-term effects","volume":"67","author":"Stirone","year":"2005","journal-title":"Mol. Pharmacol."},{"key":"B103","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2021.761760","article-title":"Influence of menstrual cycle or hormonal contraceptive phase on physiological variables monitored during treadmill testing","volume":"12","author":"Taipale-Mikkonen","year":"2021","journal-title":"Front. Physiol."},{"key":"B104","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s40279-019-01219-1","article-title":"The effect of the menstrual cycle and oral contraceptives on acute responses and chronic adaptations to resistance training: A systematic review of the literature","volume":"50","author":"Thompson","year":"2020","journal-title":"Sport Med."},{"key":"B105","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182010565","article-title":"The effect of the menstrual cycle and oral contraceptive cycle on muscle performance and perceptual measures","volume":"18","author":"Thompson","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B106","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1113\/jphysiol.2006.118265","article-title":"Macrophages promote muscle membrane repair and muscle fibre growth and regeneration during modified muscle loading in mice in vivo","volume":"578","author":"Tidball","year":"2007","journal-title":"J. Physiol."},{"key":"B107","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1152\/japplphysiol.00171.2005","article-title":"Influence of gender, menstrual phase, and oral contraceptive use on immunological changes in response to prolonged cycling","volume":"99","author":"Timmons","year":"2005","journal-title":"J. Appl. Physiol."},{"key":"B108","doi-asserted-by":"crossref","DOI":"10.46658\/JBIMES-24-03","article-title":"Systematic\u00a0reviews of effectiveness","volume-title":"JBI Manual for Evidence Synthesis","author":"Tufanaru","year":"2024"},{"key":"B109","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.physbeh.2016.06.023","article-title":"Exercise-induced B cell mobilisation: Preliminary evidence for an influx of immature cells into the bloodstream","volume":"164","author":"Turner","year":"2016","journal-title":"Physiol. Behav."},{"key":"B110","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1519\/jsc.0000000000003958","article-title":"Oral contraceptives do not affect physiological responses to strength exercise","volume":"35","author":"Umlauff","year":"2021","journal-title":"J.\u00a0Strength Cond Res."},{"key":"B111","volume-title":"Contraceptive Use by Method 2019: Data Booklet. Contracept Use by Method 2019","year":"2019"},{"key":"B112","doi-asserted-by":"crossref","first-page":"764","DOI":"10.2466\/05.06.PMS.113.6.764-772","article-title":"Phase of oral contraceptive cycle and endurance capacity of rowers","volume":"113","author":"Vaiksaar","year":"2011","journal-title":"Percept. Mot Skills"},{"key":"B113","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1519\/jsc.0b013e3181df7fd2","article-title":"No effect of menstrual cycle phase and oral contraceptive use on endurance performance in rowers","volume":"25","author":"Vaiksaar","year":"2011","journal-title":"J. Strength Cond Res."},{"key":"B114","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.contraception.2005.06.006","article-title":"Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: The vaginal ring, the transdermal patch and an oral contraceptive","volume":"72","author":"Van Den Heuvel","year":"2005","journal-title":"Contraception"},{"key":"B115","doi-asserted-by":"publisher","first-page":"1465","DOI":"10.1002\/14651858.cd003553","article-title":"Triphasic versus monophasic oral contraceptives for contraception","volume":"2011","author":"Van Vliet","year":"2011","journal-title":"Cochrane Database Syst. Rev."},{"key":"B116","doi-asserted-by":"publisher","first-page":"3757","DOI":"10.1113\/jp270551","article-title":"CrossTalk proposal: Diffusion limitation of O2 from microvessels into muscle does contribute to the limitation of V\u02d9O2 max","volume":"593","author":"Wagner","year":"2015","journal-title":"J. Physiol."},{"key":"B117","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.4049\/jimmunol.2000247","article-title":"Differential effects of myeloid cell PPAR\u03b4 and IL-10 in regulating macrophage recruitment, phenotype, and regeneration following acute muscle injury","volume":"205","author":"Welc","year":"2020","journal-title":"J. Immunol."},{"key":"B118","doi-asserted-by":"crossref","first-page":"207","DOI":"10.17219\/acem\/66354","article-title":"The effect of high intensity physical exercise and hypoxia on glycemia, angiogenic biomarkers and cardiorespiratory function in patients with type 1 diabetes","volume":"27","author":"Zebrowska","year":"2018","journal-title":"Adv. Clin. Exp. Med."},{"key":"B119","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1074\/jbc.m112.419788","article-title":"Interleukin-6\/signal transducer and activator of transcription 3 (STAT3) pathway is essential for macrophage infiltration and myoblast proliferation during muscle regeneration","volume":"288","author":"Zhang","year":"2013","journal-title":"J. Biol. Chem."}],"updated-by":[{"DOI":"10.3389\/fphys.2026.1951039","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000}}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1728032\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:58:02Z","timestamp":1788346682000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2026.1728032\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":119,"alternative-id":["10.3389\/fphys.2026.1728032"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2026.1728032","relation":{},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]},"article-number":"1728032"}}