Research Supports Flag Football for Girls in Colorado

Historically, girls in high school are more likely to drop out of sports earlier than teenage boys. Despite advancements in gender equality for sports participation, many inequalities remain for high school girls, including fewer opportunities for team sports, underrepresentation and lack of research around mental and physical health and their associated benefits. That’s why researchers at Children’s Hospital Colorado teamed up with the Denver Broncos Foundation to investigate the benefits of flag football for female athletes and gather the evidence required for sanctioning the sport in the state of Colorado.

Risk of injury versus mental health in flag football

Madison Brna, former clinical researcher at Children’s Colorado, was instrumental in setting up the study along with the rest of the research team at the Sports Medicine Center. She gathered extensive data around a variety of health-related outcomes during the flag football season. The intention of this work was to provide data to inform the Colorado High School Activity Association's (CHSAA) decision of whether to support the sanctioning of girl’s flag football.

”Developing this study and implementing the protocol was a tremendous undertaking, but when you think about it, the overall impact of what came out of the study truly pales in comparison to everything that went into it,” Brna says. “This was something I had to keep in mind throughout the process. Gathering and contributing integral data to a fairly significant decision-making process that ultimately came to and will continue to benefit hundreds of high school athletes in Colorado and support a sport that is only going to grow is a testament to the greater purpose clinical research serves.”

Specifically, in their 4-month study, the research team worked to gather data from a pre-season assessment and weekly in-season questionnaires among female flag football players. Brna then led efforts to evaluate the sport’s physical impacts (injuries) and trends of tracked in-season mental health factors like sleep, stress and energy levels. While injuries were difficult to predict based on any single factor, athletes’ fingers were found to be the most often impacted.

Additionally, flag football players reported significantly more physical activity than non-athletes during the season, emphasizing the impact this new sport can have on helping adolescent females meet physical activity recommendations. Brna and team also found that flag football athletes had much higher energy levels during the week than non-athletes, even when accounting for differences in physical activity. This led them to propose that flag football provided benefits to mental health, in addition to the physical and mental health benefits of athletic activity alone. Overall, the data demonstrated that flag football provided not only benefits of physical activity but may also support athlete mental health, and its risk of injury is comparable to other team-based girls high school sports.

“But getting to work with a foundation that is one of the pioneers nationally in supporting and expanding a sport I would have loved to have had the opportunity to play was an incredible experience,” Brna shares. “Our cooperation, as a group of people passionate about using research and resources to push forward policy that supports the expansion of opportunities for girls in sport in high school resulting in numerous benefits (that I personally experienced), demonstrates the immense value and power in working together with community partners to enact meaningful change.”

Menstrual dysfunction and mental health in flag football

Physical therapist Rachel Meyers, PT, DPT, further explored the physical and mental impacts of female athlete participation in flag football. Sports participation offers a key opportunity for a multitude of health benefits, such as promoting female adolescents’ confidence, self-esteem, resilience, academic performance and increased social interactions. However, certain aspects of female athlete health, such as menstrual function, may get overlooked despite it being a potential indicator of overall health.

Dr. Meyers worked with the research team to conduct pre-season assessments followed by evaluating sleep, mood, stress and physical activity levels each week during the season. At the start of the season, 25% of female athletes reported menstrual dysfunction, which is defined as irregular periods (having nine or less in 12 months), having the first period at age 15 or older, or going three or more consecutive months without a period. While this didn’t affect energy or mood, those with menstrual dysfunction experienced higher stress levels and worse sleep quality ratings during the season.

“Many healthcare providers do not feel comfortable asking about menstrual health,” Dr. Meyers says. “And yet it is essential that all healthcare providers who treat female athletes have this conversation with their patients. Menstrual health can affect all aspects of life: physical, psychological and emotional domains. Thus, it is imperative to identify screening practices for menstrual dysfunction pre-season to help improve quality of life and overall health for all female athletes and to reduce the prevalence of menstrual dysfunction in this population.”

This led Dr. Meyers to investigate the mental-physical health connection and consider how menstrual dysfunction could be addressed in female athletes through screenings or treatments.

The research is far from over to ensure continued opportunities in sports for female adolescent athletes and to evaluate their holistic health outcomes, and studies continue to explore girls flag football and its effects on mental and physical health.

“We see the athletes as a whole person and don’t just treat the physical," Dr. Meyers says. “All domains are interconnected, and this research gives me and other healthcare providers insight on which domains are affected and which aspects we should pay more attention to, specifically in flag football athletes with menstrual dysfunction, to provide more optimal care.”

In collaboration with the Denver Broncos Foundation, Children’s Colorado’s research ensured in the 2024-25 school year that girls flag football was the 18^th sport for girls sanctioned by CHSAA.