The female The female athleteathleteThe female The female athleteathleteCorso di Laurea in Scienze Motorie Corso di Laurea in Scienze Motorie Prof G.Galanti A.A. 2003/2004Prof G.Galanti A.A. 2003/2004
Until 1970 women were barred from officialUntil 1970 women were barred from official
partecipation in the marathon. partecipation in the marathon.
This restriction resulted from a This restriction resulted from a
misconception that women were physiologically misconception that women were physiologically
unsuited for endurance activity. unsuited for endurance activity.
Yet,at the 1984 Los Angeles Olympic Games ,Yet,at the 1984 Los Angeles Olympic Games ,
Joan Benoit won the gold medal in the Joan Benoit won the gold medal in the
first-ever Olympic marathon for women first-ever Olympic marathon for women
with a time of 02:24:52.with a time of 02:24:52.
Her time would have won 11 of the previous 20 Her time would have won 11 of the previous 20
men’s Olympic marathons!men’s Olympic marathons!
Sex-specific differencesSex-specific differencesBody compositionBody composition
Until puberty, boys and girls do not differUntil puberty, boys and girls do not differ
significantly in:significantly in:
•• heigth heigth •• weigth weigth•• girth girth •• bone with bone with•• fat-mass fat-mass •• fat-free mass fat-free mass
Sex-specific differences in body composition Sex-specific differences in body composition appeares at puberty and are due to theappeares at puberty and are due to the hormonal influences.hormonal influences.
Sex differences in FFM Sex differences in FFM changes with agechanges with age
Hormonal influences on body Hormonal influences on body compositioncomposition
TestosteroneTestosterone (men)(men) • • bone formationbone formation• • muscle massmuscle mass
EstrogensEstrogens (women)(women) • • growth rate of bonegrowth rate of bone• • broadening the pelvisbroadening the pelvis• • breast developmentbreast development• • fat deposition (thighs andfat deposition (thighs and hips)hips)
0
10
20
30
40
50
60
70
weigth FFM FM
malefemale
Kg
Sex diffences in body composition Sex diffences in body composition at the end of puberty at the end of puberty (mean values)(mean values)
Sex diffences in body Sex diffences in body composition with agingcomposition with aging
Relative body fat values for average, Relative body fat values for average, untrained women and menuntrained women and men
Relative body fat (%)Relative body fat (%)Women MenWomen Men 20-24 13-1620-24 13-16 22-25 15-2022-25 15-20 24-30 18-2624-30 18-26 27-33 23-2927-33 23-29 30-36 26-3330-36 26-33 30-36 29-3330-36 29-33
Age groupAge group yearsyears 15-1915-19 20-2920-29 30-3930-39 40-4940-49 50-5950-59 60-6960-69
Sex differences in Sex differences in physiological responsesphysiological responses
to acute exercise to acute exercise
NeuromuscolarNeuromuscolar CardiovascularCardiovascular RespiratoryRespiratory MetabolicMetabolic
Sex differences Sex differences in physiological responses in physiological responses
to acute exerciseto acute exercise
NeuromuscolarNeuromuscolarCardiovascularCardiovascularRespiratoryRespiratoryMetabolicMetabolic
Differences in strengthDifferences in strength
In terms of absolute strength, women have been regarded as theIn terms of absolute strength, women have been regarded as the““weaker sex”, but when lower-body strength is expressed relativeweaker sex”, but when lower-body strength is expressed relativeto FFM, differences between women and men disappeares!to FFM, differences between women and men disappeares!
0
0,5
1
1,5
2
2,5
leg press benchpress
Arm curl
strengthstrengt/weigthstrength/FFM
Str
en
gth
ra
tio
(m
en
/wo
men
)S
tre
ng
th r
ati
o (
me
n/w
om
en)
For the same amount of muscle, For the same amount of muscle, there are no differencesthere are no differences
in strength between sexes,in strength between sexes, though women possess smallerthough women possess smaller
muscle fiber cross-sectional areas and muscle fiber cross-sectional areas and less muscle mass than menless muscle mass than men
Differences in strengthDifferences in strength
Sex differences in Sex differences in physiological responsesphysiological responses
to acute exercise to acute exercise
NeuromuscolarNeuromuscolarCardiovascularCardiovascularRespiratoryRespiratoryMetabolicMetabolic
Cardiovascular responseto acute exercise
• women have higher submaximal HR than men
• maximum HR is the same in both sexes
• Cardiac Output (CO) for the same absolute rate of work is the same in both sexes• increase of CO in women is primarly due to an increase in HR, more than in stroke volume
Women’ lower stroke volume is related toWomen’ lower stroke volume is related to
smaller heart size related to their smaller body smaller heart size related to their smaller body
surface area (lower testosterone levels)surface area (lower testosterone levels)
Smaller blood volume, also related to smaller Smaller blood volume, also related to smaller
body sizebody size
Cardiovascular responseto acute exercise
Sex differences in Sex differences in physiological responsesphysiological responses
to acute exercise to acute exercise
NeuromuscolarNeuromuscolar CardiovascularCardiovascular RespiratoryRespiratory MetabolicMetabolic
Changes in aerobic capacity Changes in aerobic capacity
(VO2 max)(VO2 max)
Changes in aerobic capacity Changes in aerobic capacity
(VO2 max)(VO2 max)
VO2 max = CO x A-V diffVO2 max = CO x A-V diffVO2 max = CO x A-V diffVO2 max = CO x A-V diff
VO2max in normal women
The average woman’s VO2max is only 70% The average woman’s VO2max is only 70% to 75% that of the average man. to 75% that of the average man.
The main causes of this differences are:The main causes of this differences are:
•• women’s greater fat masswomen’s greater fat mass
•• lower hemoglobin levelslower hemoglobin levels
•• lower maximal cardiac outputlower maximal cardiac output
VO2 max in male and female VO2 max in male and female athletesathletes
The highest The highest VO2maxVO2max reported in literature reported in literature for a for a female athlete is 77ml/Kg/min,female athlete is 77ml/Kg/min, that of a that of a
Russian cross-country skier.Russian cross-country skier.
The highest value for a The highest value for a male athletemale athlete was was reported in Norwegian cross-country skier, reported in Norwegian cross-country skier,
who achieved a value of who achieved a value of 94 ml/Kg/min94 ml/Kg/min
Women Women respond respond
to physical to physical training training
in the same in the same manner manner
as men doas men do
Women’s adaptations to chronic exercise
Effect of training on body Effect of training on body composition in womencomposition in women
• • Fat-free mass (generally much less than man)Fat-free mass (generally much less than man)
• • Fat massFat mass
• • Relative fatRelative fat
• • Total body massTotal body mass
This changes are morerelated to total energy
expenditure than tosex differences.
Effect of resistence training on Effect of resistence training on women’s muscular strengthwomen’s muscular strength
Women can experience a relevant increase in strengthWomen can experience a relevant increase in strength
(20% to 40%) as a result of resistence training, (20% to 40%) as a result of resistence training,
and the magnitude of these changes is similar and the magnitude of these changes is similar
to that seen in men.to that seen in men.
These gains are due primarly to neural factors,These gains are due primarly to neural factors,
in fact women’s increase in muscle massin fact women’s increase in muscle mass
is generally small because of their is generally small because of their
low testosterone levels. low testosterone levels.
Cardiovascular effects of Cardiovascular effects of endurance trainingendurance training
Cardiovascular adaptations to endurance training are Cardiovascular adaptations to endurance training are
not sex specific. So, trained women have:not sex specific. So, trained women have:
•• lower rest and submaximal HRlower rest and submaximal HR
•• higher cardiac size (physiological hypertrophy)higher cardiac size (physiological hypertrophy)
•• higher stroke volume higher stroke volume
• • higher maximal cardiac outputhigher maximal cardiac output
•• largest blood volume largest blood volume
•• higher muscular capillary densityhigher muscular capillary density
………… …………than sedentary than sedentary
ones.ones.
Metabolic adaptationMetabolic adaptation
Women can improve their VO2max by 10% to 40% with endurance training (same % seen in men)
As in men, the magnitude of of change depends on:
• initial level of fitness
• intensity and duration of training session
• frequency of training
Medical problemsMedical problems in female athletein female athleteMedical problemsMedical problems in female athletein female athlete
Female athlete triadeFemale athlete triade
In 1992 the Task Force on Women’s Issues of the In 1992 the Task Force on Women’s Issues of the
American College of Sports Medicine describedAmerican College of Sports Medicine described
the “female athlete triade” as a syndrome of 3 medical,the “female athlete triade” as a syndrome of 3 medical,
often interrelated, entities that can occur inoften interrelated, entities that can occur in
female athlete :female athlete :
•Menstrual dysfunctions until Menstrual dysfunctions until amenorrheaamenorrhea•Eating disordersEating disorders•OsteoporosisOsteoporosis
Menstrual dysfunction
EumenorrheaEumenorrhea : normal menstrual function : normal menstrual function
OligomenorrheaOligomenorrhea : abnormally infrequent or : abnormally infrequent or scant menstruationscant menstruation
AmenorrheaAmenorrhea : absence of menstruation : absence of menstruation
Primary amenorrheaPrimary amenorrhea: absence of menarche in : absence of menarche in women 18 years of agewomen 18 years of age
Secondary amenorrheaSecondary amenorrhea : lack of menstruation in : lack of menstruation in women who previously had been eumenorrheicwomen who previously had been eumenorrheic
The Pituitary gland The Pituitary gland II
GHGHGrowth hormoneGrowth hormone
TSHTSH Thyroid-stimulating hormoneThyroid-stimulating hormone
ProlactinProlactin
ACTHACTHAdrenocorticotropinAdrenocorticotropin
FSH FSH Follicle-stimulating hormoneFollicle-stimulating hormone
LHLHLuteinizing hormoneLuteinizing hormone
Anterior lobeAnterior lobe
The Pituitary gland The Pituitary gland VIVI Anterior lobe Hypothalamic Controlling FactorsAnterior lobe Hypothalamic Controlling Factors
FSHFSH : stimulated by : stimulated by GnRH GnRH (gonadotropin-realising (gonadotropin-realising
hormone)hormone)
LH LH : stimulated by : stimulated by GnRHGnRH
PROLACTINPROLACTIN : stimulated by : stimulated by PRHPRH (prolactin-realising (prolactin-realising
hormone)hormone)
Inibited by Inibited by PIHPIH (prolactin-inibiting hormone) (prolactin-inibiting hormone)
The Pituitary gland The Pituitary gland IVIVAnterior lobeAnterior lobe
TARGET TARGET ORGANORGAN
Thyroid glandThyroid gland
Adrenal cortexAdrenal cortex
BreastsBreasts
MAJORMAJOR FUNCTIONSFUNCTIONS Controls the amount of T3 and T4 Controls the amount of T3 and T4
produced and released by the produced and released by the thyroid gland thyroid gland
Controls the secretion of Controls the secretion of
hormones from the adrenal hormones from the adrenal cortex cortex
Stimulates breasts developement Stimulates breasts developement and milk secretionand milk secretion
HORMONEHORMONE
TSHTSH
ACTHACTH
PROLACTINPROLACTIN
The Pituitary gland VAnterior lobe
TARGET TARGET ORGANORGAN
Ovaries, TestesOvaries, Testes
Ovaries, TestesOvaries, Testes
MAJORMAJOR FUNCTIONSFUNCTIONS Initiates growth of follicles inthe Initiates growth of follicles inthe
ovaries and promotes secretion of ovaries and promotes secretion of estrogen from the ovaries. estrogen from the ovaries. Promotes developement of sperm Promotes developement of sperm in testes.in testes.
Promotes secretion of estrogen Promotes secretion of estrogen and progesterone and causes the and progesterone and causes the follicle to rupture, releasing the follicle to rupture, releasing the ovum. Causes testes to secrete ovum. Causes testes to secrete testosteronetestosterone
HORMONEHORMONE
FSHFSH
LHLH
Secondary amenorrhea in athletes
The prevalence of secondary amenorrhea The prevalence of secondary amenorrhea
among athletes is not well documented, but is among athletes is not well documented, but is
estimated to be 5% to 40% (2-3% in general estimated to be 5% to 40% (2-3% in general
population), depending on the sport and the population), depending on the sport and the
level of competition. Prevalence appears to be level of competition. Prevalence appears to be
greater in those who train many hours each day greater in those who train many hours each day
and in those who train at very high intensities. and in those who train at very high intensities.
Secondary amenorrhea in athletes
The causes of secondary amenorrhea in The causes of secondary amenorrhea in
athletes are unknown, however the two principal athletes are unknown, however the two principal
causes seem to be:causes seem to be:
•• inadeguate nutritioninadeguate nutrition
•• hormonal changeshormonal changes related to exercise stress related to exercise stress
might disrupt GnRH secretion which is needed might disrupt GnRH secretion which is needed
to ‘direct’ the normal menstrual cycleto ‘direct’ the normal menstrual cycle
Eating disorders in female Eating disorders in female athletesathletes
Eating disorders must be considered among the Eating disorders must be considered among the
most serious problems facing female athletes most serious problems facing female athletes
today, considering the severe physiological today, considering the severe physiological
conseguences of this disorder (until death) and conseguences of this disorder (until death) and
the extraordinary costs of specific treatment. the extraordinary costs of specific treatment.
Eating disorders in female Eating disorders in female athletesathletes
Athletic trainers and coaches, who are the Athletic trainers and coaches, who are the
people closest to the elite athletes , should be people closest to the elite athletes , should be
able to suspect eating disorders and recognize able to suspect eating disorders and recognize
the seriousness of the problem, in order to refer the seriousness of the problem, in order to refer
the athlete to a person specifically trained in the athlete to a person specifically trained in
dealing with this kind of problems.dealing with this kind of problems.
Eating disordersEating disorders
The two most commonly The two most commonly diagnosed eating disorders diagnosed eating disorders are:are: anorexia nervosaanorexia nervosa and and bulimia nervosabulimia nervosa
Eating disordersEating disordersAnorexia nervosaAnorexia nervosa
anorexia nervosaanorexia nervosa is characterized by:is characterized by:
• • refusal to maintain more than the minimal refusal to maintain more than the minimal
normal weight based on an age and heigthnormal weight based on an age and heigth
• • distorted body imagedistorted body image
• • intense fear of fatness or gaining weigthintense fear of fatness or gaining weigth
• • amenorrheaamenorrhea
Prevalence: about 1% in females from ages 12 to 21
Eating disordersEating disordersBulimia nervosaBulimia nervosa
bulimia nervosabulimia nervosa is characterized by:is characterized by:
• • reccurent episodes of binge eatingreccurent episodes of binge eating
• • a feeling of lack of control during these binges a feeling of lack of control during these binges
• • purging behaviour, which can include self purging behaviour, which can include self
induced vomiting, laxative use and diuretic useinduced vomiting, laxative use and diuretic use
Prevalence: about 1% in females from ages 12 to 21
Eating disordersEating disordersAnorexia athleticaAnorexia athletica
Anorexia athleticaAnorexia athletica is characterized by: is characterized by:
• • an intense fear of gaining weigth or becaming an intense fear of gaining weigth or becaming
fat even though one is under-weigthfat even though one is under-weigth
• • A weigth loss of at least 5%, resulted from a A weigth loss of at least 5%, resulted from a
reduction of total energy intake with extensive reduction of total energy intake with extensive
exerciseexercise
• • reported use of self-induced vomiting or use of reported use of self-induced vomiting or use of
laxative or diuretics laxative or diuretics
Anorexia athletica: Anorexia athletica: problem dimensionproblem dimension
Prevalence of anorexia athletica is not wellPrevalence of anorexia athletica is not well
understood, however some reserchers have understood, however some reserchers have
estimated the prevalence to be as estimated the prevalence to be as 50%50% for elite for elite
athletes in higher risks sports.athletes in higher risks sports.
Eating disordersEating disordersAnorexia athleticaAnorexia athletica
As in the general population , female athletes As in the general population , female athletes
are exposed at a higher risk than male athletes.are exposed at a higher risk than male athletes.
The high risk sports can be grouped into 3 The high risk sports can be grouped into 3
categories:categories:
• • ‘‘Appearence sports’Appearence sports’: figure skating, gymnastic, : figure skating, gymnastic,
body building, balletbody building, ballet
• • Endurance sportsEndurance sports: distance running, swimming: distance running, swimming
• • Weight-classification sportsWeight-classification sports: horse racing, : horse racing,
boxing, wrestlingboxing, wrestling
Warning signs for eating Warning signs for eating disorders in female athletesdisorders in female athletes
Warning signs for anorexia nervosa:Warning signs for anorexia nervosa:1.1. Dramatic loss in weigthDramatic loss in weigth2.2. A preoccupation with food, calories and A preoccupation with food, calories and
weigthweigth3.3. Wearing baggy or layered clothingWearing baggy or layered clothing4.4. Relentless, excessive exerciseRelentless, excessive exercise5.5. Mood swingsMood swings6.6. Avoiding food-related social activitiesAvoiding food-related social activities
Adapted from National Collegiate Athletic Association
Warning signs for eating Warning signs for eating disorders in female athletesdisorders in female athletes
Warning signs for bulimia nervosa:Warning signs for bulimia nervosa:
1.1. A noticeble weigth loss or gainA noticeble weigth loss or gain
2.2. Excessive concern about weigthExcessive concern about weigth
3.3. Bathroom visits after mealsBathroom visits after meals
4.4. Depressed moodsDepressed moods
5.5. Strict dieting followed by eating bingesStrict dieting followed by eating binges
6.6. Increased criticism of one’s bodyIncreased criticism of one’s body
Adapted from National Collegiate Athletic Association
OsteoporosisOsteoporosisOsteoporosisOsteoporosis
18201820 :Lobstein :Lobstein described a “deteriorated described a “deteriorated human bone” and defined this pathology human bone” and defined this pathology as “osteoporosis” (‘osteon’ + ‘porous’)as “osteoporosis” (‘osteon’ + ‘porous’)
19411941: Albrigth: Albrigth described osteoporosis as described osteoporosis as “ a decreased production of osteoid by the “ a decreased production of osteoid by the osteoblasts”osteoblasts”
OsteoporosisOsteoporosis First DescriptionsFirst Descriptions
Osteoporosis Osteoporosis Recent DefinitionsRecent Definitions
‘‘An age-related disorder characterized by a reduced An age-related disorder characterized by a reduced bone mass and an increase in susceptibility to bone mass and an increase in susceptibility to
fracture, in the absence of other recognisable causesfracture, in the absence of other recognisable causesof bone loss.of bone loss.
(Consensus Development Conference 1987)(Consensus Development Conference 1987)
‘‘An disorder characterized by increased skeletalAn disorder characterized by increased skeletalfragility due to decreased bone mass and to fragility due to decreased bone mass and to
microarchitectural deterioration of bone tissue. microarchitectural deterioration of bone tissue. (Consensus Development Conference 1996)(Consensus Development Conference 1996)
OsteoporosisOsteoporosis
The principal complications of osteoporosis are the fractures in
particular sites:
• proximal femur
• Vertebral body
• Distal radius (Colle’s fracture)
Peak bone massPeak bone massPeak bone massPeak bone mass
Troughout childhood, bone mass Troughout childhood, bone mass increases linearly with skeletal growth.increases linearly with skeletal growth.
A rapid incresease in density occurs A rapid incresease in density occurs during puberty, as much as 40%.during puberty, as much as 40%.
Bone density continues to increase for Bone density continues to increase for several years until maximum bone mass is several years until maximum bone mass is
achieved achieved (peak bone mass)(peak bone mass)
Peak bone massPeak bone massPeak bone massPeak bone mass
Genetic Genetic InfluencesInfluences (75%)(75%)
Genetic Genetic InfluencesInfluences (75%)(75%)
MechanicalMechanical factorsfactors MechanicalMechanical factorsfactors
HormonalHormonal factorsfactors HormonalHormonal factorsfactors
NutritionalNutritional factorsfactors NutritionalNutritional factorsfactors
Peak Bone MassPeak Bone Mass
Bone remodellingBone remodellingannual rate of 25% in trabecular bone, annual rate of 25% in trabecular bone,
2-3% in compact, cortical bone2-3% in compact, cortical bone
Bone remodellingBone remodellingannual rate of 25% in trabecular bone, annual rate of 25% in trabecular bone,
2-3% in compact, cortical bone2-3% in compact, cortical bone
Age-related bone lossAge-related bone lossAge-related bone lossAge-related bone loss
Following attainment of peak bone mass, a Following attainment of peak bone mass, a gradual loss of bone occurs with ageing, in both gradual loss of bone occurs with ageing, in both sexes.sexes.
In women, bone loss before menopausa is small In women, bone loss before menopausa is small (<1% per annum), accelerating in the 5 years (<1% per annum), accelerating in the 5 years postmenopausal period to 1-2% per annum.postmenopausal period to 1-2% per annum.
OsteoporosisOsteoporosisMain causesMain causes
OsteoporosisOsteoporosisMain causesMain causes
•• Estrogen deficiencyEstrogen deficiency•• inadeguate calcium intakeinadeguate calcium intake•• inadeguate physical activityinadeguate physical activity
Osteoporosis Osteoporosis EpidemiologyEpidemiology
Osteoporosis Osteoporosis EpidemiologyEpidemiology
OSTEOPOROSIS OSTEOPOROSIS interests two main groups of people:interests two main groups of people: •• women beyond menopausawomen beyond menopausa lack of estrogenslack of estrogens• • elderly women and men elderly women and men carence of vit D carence of vit D PTH PTH reducted physical activityreducted physical activity reducted calcium dietary apportreducted calcium dietary apport
Female young athletes at Female young athletes at risk of osteoporosisrisk of osteoporosis
Female young athletes at Female young athletes at risk of osteoporosisrisk of osteoporosis
Premature osteoporosis is not frequent in female Premature osteoporosis is not frequent in female athletes. It generally results as a conseguence athletes. It generally results as a conseguence of the secondary amenorrhea (lack of estrogens’ of the secondary amenorrhea (lack of estrogens’ influence on bone tissue) and the eating disorders influence on bone tissue) and the eating disorders (inadeguate calcium intake). (inadeguate calcium intake). So, the best way to prevent osteoporosis in female So, the best way to prevent osteoporosis in female athletes is to prevent , or correct at their onset,athletes is to prevent , or correct at their onset,the menstrual and the eating disorders . the menstrual and the eating disorders .
Eating disordersEating disorders
Inadeguate calcium Inadeguate calcium intakeintake
AmenorrheaAmenorrhea
Lack of estrogens Lack of estrogens Influence on bone tissueInfluence on bone tissue
OsteoporosisOsteoporosis
Female athlete triadeFemale athlete triade
Correlation between Correlation between bone density,mentrual function bone density,mentrual function
and physical activity and physical activity
Correlation between Correlation between bone density,mentrual function bone density,mentrual function
and physical activity and physical activity
0
20
40
60
80
100
120
140
160
180
Am Untrained Am runners Eu Untrained Eu runners
Bon
e M
iner
al C
onte
nt (
mg/
BS
A)
Bon
e M
iner
al C
onte
nt (
mg/
BS
A)
Am= Amenorrheic Eu= EumenorreichAm= Amenorrheic Eu= Eumenorreich
In developing people exercise and a In developing people exercise and a
calcium rich diet allow the calcium rich diet allow the
achievement of an higher value of achievement of an higher value of
bone mass peak, that is a fondamental bone mass peak, that is a fondamental
step in the prevention of osteoporosisstep in the prevention of osteoporosis
OsteoporosisOsteoporosispreventionprevention
Evidence certainly suggests that :Evidence certainly suggests that :
•• Increased physical activity Increased physical activity
•• adeguate calcium intake adeguate calcium intake
•• adeguate caloric intake adeguate caloric intake
is a sensible approach to preserve the is a sensible approach to preserve the
integrity of bone, at any ageintegrity of bone, at any age
OsteoporosisOsteoporosispreventionprevention