The Assessment of Female Athlete Resilience

Wu Tsai Center of Excellence for Female Athlete Health and Performance Alliance

at Harvard Medical School*

 

Tiffany Stewart, Ph.D. (PI), Pennington Biomedical

Carolyn Becker, Ph. D. (Co-PI), Trinity University

Miriam Rowan, PsyD (Co-PI), Boston Children’s Hospital

Kate Ackerman, MD, Women’s Health, Sports & Performance Institute

Nicole Wesley, MPA, Pennington Biomedical

Kelsey Varzeas, Ph.D., Pennington Biomedical

Vivienne Hazzard, Ph.D., Michigan State University

Emily Matheson, Ph.D., Consultant

 

Psychological resilience is a critical determinant of athlete health and performance, yet it remains underexplored in female athletes. This project takes an innovative longitudinal approach to define resilience more precisely and identify modifiable risk and protective factors that shape it. This study examines key constructs—including emotion regulation, intolerance of uncertainty, sleep, low energy availability, injury history, body image, training practices, and social support—across time, while also accounting for differences by age and sexual/gender minority status. In addition, the team tested the predictive validity of resilience for depression, anxiety, eating disorder symptoms, substance use, and psychosocial stress. An ancillary study incorporated WHOOP fitness trackers to provide objective sleep and recovery data, advancing integration of physiological and psychological markers of resilience. By moving beyond cross-sectional research, this project represents a critical first step toward identifying actionable factors that can inform resilience-building interventions. Findings have already yielded multiple publications and provide a strong foundation for future grants. Ultimately, this work aims to guide the development of scalable, evidence-based training programs to strengthen resilience in female athletes.

 

 * We acknowledge support of this work by the Wu Tsai Human Performance Alliance at Harvard University and the Joe and Clara Tsai Foundation.

Physical & Mental Resilience in Female Athletes

Wu Tsai Center of Excellence for Female Athlete Health and Performance Alliance

at Stanford University*

 

Tiffany Stewart, Ph.D. (PI), Pennington Biomedical

Guillaume Spielmann, Ph.D. (Co-I), Department of Kinesiology, Louisiana State University

Neil Johannsen, Ph.D. (Co-I), Department of Kinesiology, Louisiana State University

Carolyn Becker, Ph. D. (Co-I), Trinity University

Nicole Wesley, MPA, Pennington Biomedical

Rachel Matthews, Ph.D., Department of Kinesiology, Louisiana State University

Youyoung Kim, Ph.D., Department of Kinesiology, Louisiana State University

 

Female athletes face unique and chronic stressors—including academic pressures and competitive demands—that place them at heightened risk for impaired immune function, elevated hormonal stress responses, and declines in mental health, performance, and resilience. Despite these risks, optimization strategies and resilience-focused approaches remain under-investigated in this population. This innovative project advanced the science of athlete resilience by examining the mental, physical, hormonal, and immune factors that underlie adaptation to stress in female athletes. The study assessed resilience across three timepoints: baseline (V0), moderate allostatic stress load driven by training (V1), and high allostatic stress load during combined academic and competitive demands (V2), separated by pre-season (T1) and in-season (T2) training periods. Through this design, the project evaluated how repeated exposure to academic and competitive stressors impacts biomarkers of immune competency and stress, including salivary immune markers, heart rate variability (HRV), and stress hormones. It also assessed physiological responses to exercise—heart rate, ventilatory thresholds, and blood lactate—across stress periods, while linking these physiological measures to mental health and psychological resilience. By integrating psychological, physiological, and biological markers, this work provides one of the first multidimensional profiles of resilience in female athletes. The findings not only clarify mechanisms by which chronic stress undermines resilience but also inform the design of future controlled trials and resilience-based interventions. Ultimately, this research paves the way for evidence-based strategies to optimize athlete schedules, training, and support systems that protect both health and performance.

 

* We acknowledge support of this work by the Wu Tsai Human Performance Alliance at Stanford University and the Joe and Clara Tsai Foundation.

Aim High: Readiness & Meeting the Standards in Military Pre-Recruits

Center for Military Performance & Resilience Program Project

Department of Defense (DOD)

Tiffany Stewart, Ph.D., Principal Investigator

MAJ Michael Switzer

Nicole Wesley, MPA

Felicia Chaisson, Ph.D.

Kelsey Varzeas, Ph.D.

Heather Brady, MA

Catherine Thomas, RDN

 

Roughly 77% of young Americans would not qualify for military service without a waiver due to lack of fitness required to join (passing required body composition standards and/or pass physical fitness tests) being on certain medications or having mental and physical health difficulties. A large part of the recruiting pool is unable to join due to these readiness issues. This project aims to develop and pilot test a scalable, integrated physical and mental optimization training program with interactive, evidence-based programming to ready young cadets to join the military in a high school aged population.

Four Pillars of Defense: A Whole Health Approach to Military & First Responders

Center for Military Performance & Resilience Program Project

Department of Defense (DOD)

Tiffany Stewart, Ph.D., Principal Investigator

MAJ Michael Switzer

Nicole Wesley, MPA

Felicia Chaisson, Ph.D.

Kelsey Varzeas, Ph.D.

Heather Brady, MA

Catherine Thomas, RDN

 

Interdisciplinary approaches to optimizing human and operational performance directly impact Soldier and unit readiness, improving Soldier health and resilience. Current efforts to deliver these approaches have limited functional integration and lack consistency in formal training and delivery, impacting skill development and application. This project aims to build on prior work funded by the DOD, develop and pilot test a scalable, integrated physical and mental optimization training app that would be embedded into relevant systems and expanded to other high-performance populations, e.g. other branches of the military, first responders.

Institute for the Health & Performance of Champions

Provost Big Idea Grant

Guillaume Spielmann, Ph.D. (PI), Department of Kinesiology, Louisiana State University

Neil Johannsen, Ph.D. (Co-I), Department of Kinesiology, Louisiana State University

Tiffany Stewart (Co-I), Ph.D., Pennington Biomedical

Shelly Mullenix, ATC, LCSW (Co-I), Athletics, Louisiana State University

Hollis O’Neal, MD (Co-I), Our Lady of the Lake

Robert Zura, MD (Co-I), LSU Health Sciences Center

 

This multi-campus grant is dedicated to promoting student athlete health, well-being, and overall performance in the very competitive world of collegiate athletics. This grant provides the seed funding for the creation of the Institute of the Health and Performance of Champions; a natural progression of existing partnerships between researchers included in this proposal and LSU Athletics. This project will: 1) formally recognize this multi-campus collaboration targeting high performance populations, e.g athletes, tactical athletes, first responders, and 2) collect initial cross-sectional data on the impact of training cessation on the health and well-being of former LSU athletes.

Institute for the Health & Performance of Champions

Longitudinal Athlete Health & Wellbeing

Collaboration in Action Grant

Neil Johannsen, Ph.D. (PI), Department of Kinesiology, Louisiana State University

Guillaume Spielmann, Ph.D. (Co-I), Department of Kinesiology, Louisiana State University

Tiffany Stewart, Ph.D. (Co-I), Pennington Biomedical

Shelly Mullenix, ATC, LCSW (Co-I), Athletics, Louisiana State University

Samuel Stroope, Ph.D. (Co-I), Department of Sociology, Louisiana State University

Hollis O’Neal, MD (Co-I), Our Lady of the Lake

Robert Zura, MD (Co-I), LSU Health Sciences Center

 

While regular moderate-intensity exercise is associated with well-documented health benefits, prolonged exposure to elite-level athletic competition can heighten risks of injury, cardiovascular dysfunction, and psychological strain. Yet despite increasing concern, the long-term health effects of sport cessation among retired collegiate athletes remain poorly understood. Former athletes, particularly in weight-focused sports such as football, commonly experience substantial post-retirement body composition changes that elevate risk for cardiometabolic disease. However, whether similar risks extend across other sports, or impact outcomes such as immune function and psychological well-being, is largely unknown. This project represents an innovative effort to examine the long-term health trajectories of former LSU athletes, spanning 1 to 25 years post-retirement, across all sports. The study integrates cardiovascular, immune, and psychological assessments with evaluations of social determinants of health (SDOH), a critical but understudied dimension of athlete well-being. Data collection will include cardiometabolic testing (Quest Fitnescity), immune and laboratory measures (Quest Diagnostics), and psychological/SDOH surveys (Qualtrics), with recruitment conducted through direct outreach to former athletes. The significance of this work lies in its potential to establish one of the first comprehensive, longitudinal platforms for understanding athletes’ health trajectories—from sport initiation through retirement to morbidity and mortality. Such research is only possible through cross-disciplinary collaboration, bridging expertise in physiology, immunology, psychology, and social sciences. By identifying long-term health risks and protective factors, this study will generate essential pilot data to guide interventions, improve quality of life, and support smoother transitions out of competitive sport.

Body, Brain, and Belonging: A Biopsychosocial Framework for Sustainable Engagement in Youth Sports

Collaboration in Action Grant (CAPS) 2026 

Tiffany Stewart, Ph.D. (PI), Pennington Biomedical

Shelly Mullenix, ATC, LCSW (Co-I), Athletics, Louisiana State University

Neil Johannsen, Ph.D. (Co-I), Department of Kinesiology, Louisiana State University

Hollis O’Neal, MD (Co-I), Our Lady of the Lake

Guillaume Spielmann, Ph.D. (Co-I), Department of Kinesiology, Louisiana State University

Samuel Stroope, Ph.D. (Co-I), Department of Sociology, Louisiana State University

Ryan Hylteen, Ph.D. (Co-I), Department of Kinesiology, Louisiana State University

 

While regular participation in youth sport is widely associated with improved physical health, psychological well-being, and social development, increasing dropout rates during adolescence threaten the ability of sport to produce long-term health benefits. Despite billions of dollars spent annually on youth athletics, rates of obesity, chronic disease, and mental health concerns among children continue to rise, suggesting that current approaches to sport participation fail to sustain lifelong engagement in physical activity. Research indicates that adolescents frequently discontinue sports due to a complex interaction of biological, psychological, and social factors, including injury, stress, lack of motivation, limited access to facilities, and insufficient social support. However, the mechanisms that determine whether adolescents remain engaged in sport—or withdraw—remain poorly understood, particularly within diverse community settings. This project represents an innovative effort to examine the biopsychosocial determinants of sport retention among adolescents ages 12–18 in South Louisiana, with the goal of identifying modifiable factors that promote resilience, motivation, and continued participation. The study integrates biological assessments, psychological measures , and social determinants of health, along with qualitative interviews to capture lived experiences. Participants will be recruited through schools, athletic organizations, and community partners, and data will be analyzed using multilevel and thematic approaches to identify key predictors of sport continuation versus dropout. The significance of this work lies in its potential to establish a comprehensive, systems-level understanding of how biological, psychological, and social influences interact to shape adolescent health trajectories. By combining expertise across physiology, psychology, sociology, and community health, this project will generate critical pilot data to guide future interventions, inform community programming, and support policies that reduce barriers to participation. Ultimately, this research aims to transform youth sport from a short-term activity into a sustainable pathway for lifelong physical activity, resilience, and chronic disease prevention.

Institute for the Health & Performance of Champions

Salivary Biomarkers of mTBI in Football Players

Collaboration in Action Grant (CAPS) 2026

Guillaume Spielmann, Ph.D. (PI), Department of Kinesiology, Louisiana State University

Neil Johannsen, Ph.D. (Co-I), Department of Kinesiology, Louisiana State University

Tiffany Stewart, Ph.D. (Co-I), Pennington Biomedical

Shelly Mullenix, ATC, LCSW (Co-I), Athletics, Louisiana State University

Kevin Callerame, MD (Co-I), Our Lady of the Lake

Micah Klumpp, MD (Co-I), Our Lady of the Lake

Micki Collins, (Co-I), Athletics, Louisiana State University

Dalis Boyette (Co-I), Athletics, Louisiana State University

Keneth Civello MD (Co-I), Our Lady of the Lake

Hollis O’Neal, MD (Co-I), Our Lady of the Lake

 

Among contact sport athletes, American football players appear to be at the greatest risk of developing mTBI and severe concussions due to the repetition and high intensity of in-practice and in-game accelerations/decelerations to the head. Although the term concussion is often interchangeable with a “mild” form of TBI, historically, less attention has been placed on the deleterious effects of sub-concussive repeated head impacts on brain structure and function. This is of clinical relevance in sports where the repeated impacts are low to moderate force and typically would not prompt a diagnosis of mTBI. Moreover, identifying sensitive biomarkers of brain damage is crucial in contact sport athletes with a history of sport-related concussions where experiencing recurrent concussions within sports is more likely than those with no concussion history. This is especially true among collegiate athletes who exhibit an intensified desire for continued on-field participation and are more likely to ignore or underreport symptoms of mTBI compared to their professional counterparts, thus return to play before full recovery. Emerging evidence suggests that salivary biomarkers of mTBI could offer a less invasive alternative to their bloodborne counterparts, enabling a more frequent sampling strategy and the generation of individual-specific salivary profile to track mTBI risks over time. However, whether salivary biomarkers of mTBI concentrations 1) exhibit weekly variations regardless of concussion and 2) correlate with validated measures of mTBI in collegiate football remains unknown. Thus, there is a critical unmet need to validate novel non-invasive salivary biomarkers of mTBI in football players to enhance early detection and continued monitoring of concussions in this population. This will pave the way to the creation of easy-to-deploy point of care sensors for the near-real time evaluation of brain health in at-risk populations such as athletes or warfighters.

The Female Athlete Body Project (FAB)

National Institutes of Health

NIH 1 RO1 MH094448-01

Tiffany Stewart, Ph.D. (PI), Pennington Biomedical

Carolyn Becker, Ph.D. (Co-PI), Trinity University

Nicole Wesley, MPA, Pennington Biomedical

Lisa Kilpela, Ph.D., Trinity University

Kelly MacKenzie, Ph.D., American University

Athena Argyropoulos, American University

Shelly Mullenix, ATC, LCSW, Louisiana State University

Jamie Meeks, RD, CSSD, Louisiana State University

 

Eating disorders (EDs) represent a pressing public health concern due to their high treatment costs, significant morbidity, and elevated mortality rates. Preventive approaches are therefore of critical importance. The Healthy Weight (HW) program, which emphasizes small, sustainable lifestyle modifications, has shown promise in reducing risk factors and preventing the onset of EDs in at-risk populations. Female athletes represent a particularly vulnerable group. Disordered eating behaviors are not only prevalent in this population but also especially hazardous, as they contribute to the Female Athlete Triad—a condition defined by low energy availability/disordered eating, menstrual dysfunction, and reduced bone mineral density/osteoporosis—which in turn increases risk for injury and long-term health consequences. This project advanced the science of prevention by conducting a cluster randomized controlled trial to test the effectiveness of the HW intervention among 500 collegiate female athletes across three diverse sites: Louisiana State University (Baton Rouge, LA), Trinity University (San Antonio, TX), and American University (Washington, D.C.). By focusing on an underserved and high-risk population, this study contributes novel evidence regarding scalable, evidence-based prevention programming. Its findings have the potential to shift the paradigm of athlete care by embedding early intervention strategies directly within collegiate athletic systems, ultimately reducing the burden of eating disorders and enhancing athlete health, performance, and resilience.

Sport Carried Onward for Resilience & Enrichment (S.C.O.R.E.)

Tiffany Stewart, Ph.D., Principal Investigator

Nicole Wesley, MPA

Felicia Chaisson, Ph.D.

Kelsey Varzeas, Ph.D.

Heather Brady, MA

Catherine Thomas, RDN

 

Nearly 8 million students participate in high school athletics in the United States each year. Of these, just over 480,000 advance to compete as NCAA athletes, and only a select few transition to professional careers. For the vast majority, athletic participation ends by early adulthood. Yet, student athletes dedicate countless hours to training and competition, shaping not only their skills but also their sense of identity. Sport becomes central to who they are—defining their social circles, daily routines, and long-term goals. Collegiate athletics place students in high-performance environments marked by intense expectations and unique rewards. While this environment can cultivate discipline, resilience, and achievement, it also generates significant pressures to perform and conform to sport-specific norms. As a result, athletes are not immune to mental and behavioral health struggles. While many collegiate athletes are offered mental health services, these are often narrowly focused on sports performance. Stigma and athletic culture can further discourage athletes from seeking support for broader mental health or well-being needs. This gap underscores the urgent need for programs that extend beyond performance-based mental health services to address the full spectrum of athlete well-being. The S.C.O.R.E. (Sport Carried Onward for Resilience & Enrichment) program was developed as a novel strategy to fill this void. S.C.O.R.E. is designed not only to enhance athletes’ resilience and performance during their playing years but also to provide a structured intervention that supports their adjustment and long-term health as they transition out of elite athletics. By targeting both the immediate and post-sport phases of an athlete’s life, this program represents an innovative, holistic approach to athlete care. Its impact lies in fostering sustainable health behaviors, reducing stigma around mental health, and equipping athletes with the skills needed to thrive beyond the field of play—ultimately reshaping how we understand and support athlete well-being across the lifespan.

 

*Pilot funded by the Pennington Family Foundation

Project Play

Nicole Wesley, MPA, Principal Investigator

Tiffany Stewwart, Ph.D.

Felicia Chaisson, Ph.D.

Kelsey Varzeas, Ph.D.

Heather Brady, MA

Catherine Thomas, RDN

The lab was honored recently by being named a “Project Play Champion” by the Aspen Institute. This national recognition honors organizations making meaningful progress toward building a youth-centered sports ecosystem that reflects the vision of Sport for All, Play for Life. Through this funding, the lab is developing a handbook of best practices for Coaches to foster mental resilience in young athletes. Designed to enhance coaches’ confidence in training and communicating effectively with their players on mental health and performance optimization, the handbook will feature educational content and practice scenarios that help coaches and staff translate knowledge into actionable behaviors to impact health and performance at every level, from youth to elite.