An Example Analysis for a Gender-inclusive Approach in Sport and Exercise Science Research using Fitbit Outcomes from the All of Us Research Program Dataset.

Prevalence studies with wearable devices are used to understand disparities in health-related physical activity behaviors and whether interventions are efficacious. However, studies have been limited to a binary definition of sex. This example analysis aimed to demonstrate how researchers can investigate differences in data beyond the sex-gender binary. Using a cross-sectional analysis of the All of Us Research Program dataset, participants' self-identified gender was categorized into Cisgender Female (n = 10,401), Additional Options (n = 27), Non-binary (n = 84), Transgender (n = 17), and Cisgender Male (n = 4,470). Fitbit data on active calories, steps, sedentary minutes, and very active minutes were analyzed following a valid statistical decision framework found in the companion editorial to this paper. Data were checked for normality using the Shapiro-Wilk test, and because data were not normally distributed, homogeneity was evaluated using the Brown-Forsyth test. The omnibus test for significant group differences was determined using the Kruskal-Wallis test, with significance accepted at p < 0.05. Effect sizes (ES) for omnibus test results were calculated using Epsilon squared. Results provide evidence for differences in physical activity metrics among gender groups (p < 0.001; active calories ES = 0.069, steps ES = 0.005, and very active minutes ES = 0.026). Cisgender males had higher active calories, steps, and very active minutes than cisgender females (40% more) and non-binary individuals (45% more). No differences were observed among other gender groups studied. These findings highlight that activity patterns vary beyond traditional binary classifications, emphasizing the need for gender-inclusive research in sport and exercise science. Specifically, the disparities observed underscore the importance of nuanced interpretations and tailored recommendations for diverse populations, addressing systemic gaps in supporting gender-diverse individuals in health and exercise behaviors.