Participation in physical activity provides girls and female adolescents with many benefits, including (1) improved cardiovascular fitness, bone health, and musculoskeletal health, (2) decreased risk of obesity, (3) decreased likelihood of dropping out of school, (4) decreased likelihood of becoming pregnant, and (5) improved self-esteem and mental health.3–5

Even though more girls and female adolescents are participating in physical activity, their physical activity levels have declined. In addition, physical activity levels decrease during adolescence in both males and females. However, this decrease is greater in female adolescents, particularly those who are nonwhite.2 Therefore, it is particularly important to promote physical activity in girls and female adolescents and to address their perceived barriers to participation (e.g., time constraints, access to facilities and programs, skill level).

Although the benefits of participating in physical activity greatly outweigh the risks, there are some health issues and concerns that physically active girls and female adolescents, as well as parents, physical education teachers, coaches, and health professionals, should be aware of. A major concern is the relationship between unhealthy eating behaviors, amenorrhea (absence of menstruation), and osteoporosis, known as the Female Athlete Triad.6

Physically active girls and female adolescents whose caloric intake is not sufficient to provide the energy needed to participate in physical activity are at risk for weight loss and energy drain. Energy drain can lead to menstrual irregularities, most often amenorrhea, and negative consequences for bone health (i.e., premature bone loss, decreased bone density, increased risk of stress fractures).7

Some girls and female adolescents are not aware that they must increase their caloric intake as they increase their physical activity levels. Often there is a perception that weight is directly related to physical activity performance; therefore, girls and female adolescents often believe that their performance will improve if they lose weight. Pressure to excel from parents, physical education teachers, coaches, teammates, and girls and female adolescents themselves can lead to unhealthy eating behaviors. Restricted food intake, bingeing, purging, and a negative body image can occur among children and adolescents of both sexes regardless of the physical activities they participate in, but those at greatest risk are girls and female adolescents who participate in activities that focus on appearance, size, body shape, or weight class (e.g., ballet, gymnastics, figure skating, running, crew). (See the Eating Disorders chapter.)

Girls and female adolescents should be encouraged to focus on their body composition and performance, not their weight. They can obtain peak performance by balancing their intake of healthy foods with their physical activity levels.

It is important to identify and treat girls and female adolescents experiencing the consequences of the Female Athlete Triad early because bone loss is only partially reversible despite estrogen replacement, calcium supplementation, and resumption of menstrual periods. Girls and female adolescents who develop symptoms such as excessive weight loss, irregular menstrual periods, or frequent injuries (including stress fractures) should be evaluated by a health care team.

Other health issues and concerns for physically active girls and female adolescents include