Final - Female Athlete Train and Exercise During Pregnancy Flashcards
female athlete triad
disordered eating
amenorrhea
osteoporosis
updated female athlete triad definition
relationships among energy availability, menstrual function and BMD that may have clinical manifestations including eating disorders, functional hypothalamic amenorrhea, or osteoporosis
relative energy deficiencies in sport (RED-S)
encompasses the syndrome in males as well as females
- comprehensive model depicting low energy status in physically active women or men
risk factors for developing female athlete triad
- more likely in athletes participating in sports emphasizing low body weight or subjective judging of appearance
- more likely in athletes with social isolation and local of support system due to extreme focus on training
- competition at very high or elite level
- family history of disordered eating
- perceived lack of control of environment
- coaches, parental, school, society pressure
bulemia
- episodes of binge eating followed by extreme guilt and some kind of purging
- desire to be thin but usually or normal or above normal weight
anorexia nervosa
- psychiatric syndrome of severe weight loss by self starvation that is due to extreme desire to be thin and a distorted body image
risks associated with disordered eating
- Decreased bone mineral density (premature osteoporosis)
- Menstrual abnormalities leading to amenorrhea and infertility
- Electrolyte disturbances
- Decreased immune function
- Diminished ability to heal wounds
- GI dysfunction
amenorrhea
The absence of at least 3 to 6
consecutive menstrual cycles in
women who have already begun
menstruating
hypothalamic amenorrhea
diagnosis of exclusion
*cessation of menstruation due to dysfunction of hypothalamic signals
to the pituitary gland,resultingin anovulation
functional amenorrhea
- Exercise or acute
* Weight loss
Psychogenic amenorrhea
- Associated with psychological trauma or stress;
* May be accompanied by caloric deficiency
Anorexia nervosa amenorrhea
•Starvation
•Body wasting
•Severe
hypothalamic and other endocrine abnormalities
amenorrhea in athletes
- Some athletes do not show frank amenorrhea, but do have other menstrual dysfunction
- irregular menses (oligomenorrhea)
- luteal phase defects (LPD)
- LPD: patient ovulates, but ovarian function is insufficient to support implantation.
Amenorrhea and Energy Deficit
•Recent research favors “energy deficit” or a “hypometabolic state” as a causal factor in luteal phase defects and exercise-induced amenorrhea
does exercise in itself affect reproductive function?
nope
Exercise Induced Amenorrhea
Working Hypothesis
Suppression of reproductive function is a neuroendocrine adaptation to caloric deficit
energy deficit affects ovulatory function
- normal metabolic state –> ovulatory menstrual cycles
- intermittent/ transient energy deficit –> luteal phase deficient menstrual cycles
- long term energy deficit –> amenorrheic cycles
what does energy deficit suppress?
GnRH pulsatility –> disruption of LH secretion pulsatility –> ovulatory irregularities
maybe look over these two ovulation graphs on pg 20 and 21 if you want to
Amenorrhea And Energy Drain
•The lower limit of energy availability compatible with healthy LH pulsatilityvaries among women.
•The threshold appears to be 20 -30 kcal/kg FFM/day
(FFM = fat-free mass)
how much energy availability is enough to maintain normal LH pulsitility
30 kcal/kg/day
osteoporosis
- Refers to premature bone loss or inadequate bone formation in this group
- Resulting in:
- Low bone mass for age
- Microarchitectural deterioration
- Increased skeletal fragility
- Increased risk of fracture
BMD loss rates
- Normally cycling adult woman = 0.3-0.5% /year
- Amenorrheic athletes: 2-6% /year—up to 25%
- Postmenopausal: 3% per year for 10 years,
- Then BMD loss returns to 0.3% per year rate.
Low BMD With Exercise-related Amenorrhea
Vs Postmenopausal Women
•It appears that the premature osteoporosis in
exercise-related amenorrhea is better related to the
chronic energy deficit than to the hypoestrogenism
associated with amenorrhea
•Exercise amenorrhea (energy deficit): slowed bone
accretion (formation)
•Postmenopausal (low estrogen): accelerated bone
reabsorption
chronic energy deficit results in
- Low thyroid hormone (T3)
- Low insulin growth factor (IGF-I)
- Low leptin
•The pattern indicates a state of energy conservation
•All are involved in bone accretion (trophic to bone)
Is premature osteoporosis in this group
completely reversible with treatment
not supes sure
maybe in the short term but doesn’t seem to completely replace lost BMD
osteoporosis results
These late-maturing/amenorrheic women may not reach peak bone mass and will enter menopause (25-30 yrs later) with lower bone mineral density than their peers
there’s a little graph on interactions with the triad on slide 31 if you care
i dont
treatment of female athlete triad
restore energy- days or weeks
recover menstrual status- months
recovery BMD- years
maternal adaptations to pregnancy
- elevated HR, SV, CO
- steady MAP then increase toward the end
- decreased TPR
Does Uteroplacental Blood Flow Decrease During
Exercise?
- Sympathetic nerve activity increases to viscera (e.g.intestines, kidneys) during exercise and reduces or limits absolute blood flow
- More is known about uterine blood flow in animals than in humans, due to technical limitations with ultrasound
Does Uterine Blood Flow Decrease During
Exercise In Women?
•Probably –> May be intensity-dependent
•Key point –> This exercise-induced reduction in blood flow
is well tolerated in healthy pregnancies!!!
Compensatory Mechanisms To Protect Fetus
From Hypoxia During Exercise
•Redistribution of flow from the wall of the uterus to the placenta
•Hemoconcentration (greater O2/ml blood)
•Increase in uterine oxygen extraction
•(a-vO2 difference rises)
•Fetal adaptations:
-Maintain or slight increase in umbilical flow
-Decreased fetal activity
Glucose Availability and Exercise
- Fetal growth highly dependent on maternal glucose.
- Glucose delivery (blood flow x [glucose])
- can affect birth weight
Late pregnancy in particular is associated with increased risk of
maternal hypoglycemia during/after strenuous exercise
- reduced liver glycogen stores in the face of acute catecholamine-induced glycogenolysis
- increased maternal skeletal muscle glucose utilization associated with exercise
- increased demand by the fetus
how can women who exercise late in pregnancy avoid hypoglycemia?
by ingesting carbohydrates during or after exercise
in a healthy pregnancy, does moderate exercise result in growth restriction?
nope
Thermoregulation, Exercise and Pregnancy
•In the first trimester, exposure to high heat stress such as fever
increases risk for teratogenesis—no hot tub use, please!
– However, there is no evidence that heat stress from exercise increases the risk for teratogenesis.
Adaptations Enhancing Thermoregulation During Maternal Exercise
- Downward shift in the sweating threshold allows evaporative heat loss at lower body core temperatures
- Increased skin blood flow in pregnancy enhances heat transfer
- Increase in VE augments heat loss from respiratory tract
Does Regular Physical Activity During Pregnancy Harm The Mother
Moderate exercise in previously sedentary women improves maternal physical fitness and enhances maternal metabolic and cardiopulmonary capacities!!!!
physical activity during pregnancy May help prevent or ameliorate problems associated with chronic inactivity:
- Impaired glucose metabolism
- Excessive weight gain
- Poor posture
- Low back pain
- Improve self-image
So far, it appears that regular, moderate aerobic exercise does not:
- Increase the risk of premature labor
- Cause fetal growth retardation
- Or alter fetal development
does properly performed resistance exercise harm the fetus?
nope
In Trained Women Who Continued To Exercise Strenuously During Pregnancy…
- Total volume of exercise decreased as pregnancy continued
- Maternal weight was less, and the gain in weight was less
- Babies lighter due to decreased adiposity
- May have less labor pain, shorter labor
- Babies had normal growth and development
In Women Who Began A Moderate Exercise Program During Pregnancy
•Starting a moderate exercise program had no adverse effects on
pregnancy outcomes
•No significant effect on labor length, maternal & baby weight or %fat
•New research suggests that light to moderate exercise 25-40 min/bout improves glucose tolerance in patients at risk for gestational diabetes
Clinical Recommendations on Physical Activity in Pregnancy
•American College of Obstetrics and Gynecology (2015).
•Women with uncomplicated pregnancies should be encouraged to
engage in aerobic and strength-conditioning exercises before, during
and after pregnancy
•2019 Canadian Guideline for Physical Activity throughout
Pregnancy:
•All women without contraindication should be physically active thru
pregnancy
•Subgroups included 1) previously inactive, 2) gestational diabetes
mellitus, and 3) overweight or obese
General Recommendations Exercise In Pregnancy
•Avoid exercise in the supine position after the 4th month (~16 wk)
– compression of vena cava decreases venous return
– Consider non-weight bearing exercise as pregnancy continues
– avoid activities with risk of abdominal trauma or falling
•Maintain adequate diet
•Don’t abruptly increase intensity before wk14 or after wk28
should you use standard heart rate training ranges to prescribe exercise intensity in pregnant women?
no
Exercise in Pregnancy -SEP Recommendations
All women without contraindications
- Encouraged to participate in aerobic and strength-conditioning
exercises during pregnancy - Reasonable goals in should be to maintain good fitness without trying to achieve peak fitness or train for an athletic competition
- Should choose activities minimizing loss of balance and fetal trauma
- Should be advised that there is no adverse pregnancy or neonatal
outcome for exercising women - Initiation of pelvic floor exercises immediately postpartum may reduce risk of future urinary incontinence.
does moderate exercise during lactation affect milk production or composition
no
Exercise Prescription in Pregnancy (ACSM guidelines)
•Frequency: ≥ 3-5 d/wk •Time: ~30 min/session to total ≥150 min/wk moderate activity OR 75 min/wk vigorous •Intensity: moderate • 3-5.9 METs • RPE 12-13 • Talk test •Intensity: Vigorous •For women who exercised vigorously prior to pregnancy or who progress during pregnancy • RPE 14-17 • ≥6 METs • Type: dynamic, rhythmic • physical activities using large muscle groups
Resistance Training In Pregnancy prescription
•Intensity: 2-3/wk; submax; e.g.
•8-10, 12-15 RM weight that
elicits moderate fatigue
what should be avoided for resistance training in pregnancy?
•Isometric exercises and Valsalva
maneuver
•Supine position after week 16
(beginning of 2nd trimester)
Warning Signs to Discontinue Exercise While
Pregnancy!!!
•Vaginal bleeding, Regular painful contractions,
Amniotic fluid leak
•Dyspnea before exertion, Dizziness, Headache
•Chest pain, Muscle weakness affecting balance,
Calf pain or swelling
Absolute contraindications to exercise during
pregnancy (continue ADLs)
•Pregnancy-induced
hypertension/preeclampsia
•Pre-term rupture of membranes
•Preterm labor during the prior or current
pregnancy or both
•Incompetent cervix
•Persistent 2nd or 3rd trimester bleeding
•Intrauterine growth retardation
•Higher order pregnancy (e.g.triplet)
•Uncontrolled Type 1 DM, hypertension, thyroid disease
•Other serious CV, respiratory or systemic disorder
