Chapter Exercise and Women’s Health Dixie L. Thompson C H A P T E R

Health Conditions Faced Primarily by Women Pregnancy Osteoporosis Not specific to females, but significantly more prevalent in the female population Female athlete triad

During Pregnancy, Exercise May… …help with psychological well-being …alleviate excessive fatigue …give rise to shorter and easier delivery …offset excessive gestational weight gain …lower risk of developing gestational diabetes mellitus

Physician Guidance in Pregnancy Needed when cardiovascular, pulmonary, or metabolic diseases are present Needed in cases of severe maternal obesity Needed in cases of maternal underweight status See text for full list of American College of Obstetrics and Gynecology absolute and relative contraindications

Exercise and Pregnancy: Four Potential Problems 1. Heat dissipation Excessive heat may cause developmental defects, especially to 1st-trimester fetus Increased maternal blood volume should provide adequate mechanism for heat dissipation Increased maternal skin blood flow aids in body temperature regulation Temperature at which sweating begins decreases as pregnancy progresses (continued)

Exercise and Pregnancy: Four Potential Problems (continued) 2. Oxygen delivery Increased maternal blood volume and decreased systemic vascular resistance allow for increased cardiac output O 2 supply is kept constant under reasonable exercise intensities Fetal HR is modestly affected with exercise, if at all

Exercise and Pregnancy: Four Potential Problems (continued) 3. Nutrition supply Pregnancy carries with it an additional energy requirement of 300 kcals per day Energy balance in the exercising mother is key 4. Premature delivery No link between length of pregnancy and exercise status in normal pregnancies Avoid contact sports (e.g., waterskiing) that might lead to fetal injury

Exercise Testing During Pregnancy Avoid maximal exercise testing unless medically needed Terminate submaximal testing at <75% HRR If specific info is required for exercise RX General fitness testing in pregnant women is rarely indicated during pregnancy; delay until several weeks after delivery

Exercise Prescription During Pregnancy Moderate to vigorous activity is safe for previously active women 150 minutes per week of moderate-intensity exercise Encourage regular exercise rather than periodic Gauge intensity with RPE (12-14) Use HR ranges based on age (table 17.1) Base mode of exercise on comfort and convenience

Cautionary Measures During Exercise Avoid exercise in supine position after 1st trimester Avoid heat injury Limit exposure to falling and impact injury Adjust activity for center of gravity changes as pregnancy progresses Increased joint laxity Avoid extreme air pressure changes

Warning Signs With Exercise Vaginal bleeding Dyspnea before exertion Headache Chest pain Muscle weakness Calf pain and swelling Preterm labor Decreased fetal movement Amniotic fluid leakage

Osteoporosis Affects 10 million women over the age of 50 Another 34 million have osteopenia Most common sites of osteoporotic fractures: hip, vertebra, wrist Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry Bone mineral per unit area; accounts for 70% of bone strength

Treatment and Prevention of Osteoporosis Pharmaceutical treatment Selective estrogen receptor modulators (Tamoxifen, Evista) Hormone replacement therapy Bisphosphonates (Actonel, Boniva, Fosomax) Exercise for prevention Maximize BMD in childhood and adolescence Adequate calcium, vitamin D, weight-bearing aerobic activity, and resistance training

Risk Factors for Osteoporosis Female Older age Half of women over age 50 will have a fracture Estrogen deficiency Responsible for decline in bone mass 3% to 5% each year Caucasian or Asian descent Peak BMD is higher in those of African descent (continued)

Risk Factors for Osteoporosis (continued) Low weight or BMI Diet low in calcium Estimated that only 25% of boys and 10% of girls achieve recommended levels Alcohol abuse Inactivity Muscle weakness

Risk Factors for Osteoporosis (continued) Family history of osteoporosis Smoking History of fracture

Exercise Prescription for Bone Health Children, adolescents, and nonosteoporotic adults Focus on weight-bearing aerobic activity or jumping activities Include moderate resistance training Follow guidelines on intensity, duration, and frequency found in previous chapters

Exercise Guidelines: Osteoporotic Adults Weight-bearing aerobic 3 to 5 days per week Resistance training 2 or 3 days per week 60% to 80% 1RM Duration of 30 to 60 minutes Aerobic and RT combined

Testing and Rx: Considerations for Osteoporotic Adults Weigh benefits against risks Physician should be present during maximal exercise testing Stationary cycling may be a better alternative to treadmill testing in many instances Avoid activities that involve significant spinal flexion (risk of compression fractures) Consider tests and exercises for balance and functional muscular strength

Female Athlete Triad: Interrelated Components Low energy Low energy intake or inadequate nutritional density may lead to amenorrhea Bone health Estrogen deficiency caused by amenorrhea Leads to osteopenia Menstrual status In those with amenorrhea, BMD is comparable to that in postmenopausal women