EXERCISE FOR GIRLS WOMEN Historical Attitudes

EXERCISE FOR GIRLS & WOMEN

Historical Attitudes Towards Women 1875: Hutchingson: Women have a sum total of nervous force equivalent to man Women have more organs Nervous force is weakened in each organ Resistance to disease is weakened Women are more sensitive and more liable to derangement

1875 Dr. King, Obstetrics & Gynecology Women menstruate because of a failure to conceive Menstruate occurs because the organ was not used for it’s intended purpose When an organ is not used = atrophy & disease Therefore, once reaching puberty a woman should be encouraged to marry and immediately impregnated Continuously impregnated as not to menstruate

Beigel, Physician: 10 -14 days of Bed Rest for Each Menstrual Cycle

International Olympic Committee: Circa 1900 Women should not engage in any activity which they cannot wear a long dress

Wearing Corsets Without Heart Rate (/min) Heart Rate Response to Running 540 Yard Run Seargent

Fashion allowed more exercise

1928 Modern Olympics 11 women First 800 m Race 5 collapsed during the Run 5 collapsed at the Finish Winner collapsed in the Dressing Room

EXERCISE & GYNECOLOGY

Ballet Sport Olympic High School College AGE OF MENARCHE

MATURATION AND SPORT Does sport delay maturation? Is maturation unsuccessful for sport?

Sport Ballet High School College Olympic AGE OF MENARCHE

LATER AGE OF MENARCHE FEWER COMPAINTS IN MENOPAUSE Jazman, Frontiers of Hormone Research 2: 22, 1973.

…. AS A YOUNG WOMAN…

OS OR S ER RD SO DI OS TE OP G N TI EA IS FEMALE ATHLETE TRIAD AMENORRHEA

HS Specific Sports College Percent of Athletes INCIDENCE OF ANOREXIA & BULIMA

Percent of Population (%) AMENORRHEA Athletes General

Active Regular Cycling Active Amenorrhic Incidence of Bone Fractures (%) OSTEOPOROSIS Control Marcus eat al, Ann Int Med 102: 158 -163, 1985

ACSM RECOMMENDATIONS 1. Serious Syndrome 2. Unrealistic pressures to lose weight in athletics. 3. Sports Medicine Professionals need more education 4. Screening programs should be developed. 5. Develop prevention strategies 6. Educate parents to have reasonable goals for children. 7. Educate the girls 8. More research.

EXERCISE IN PREGNANCY

PREGNANCY EXERCISE SKELETAL METABOLISM RESPIRATORY CARDIOVASCULAR ENDOCRINE THERMOREGULATION

EXERCISE IN PREGNANCY 1. Safe for mother? 2. Safe for fetus 3. Affect on pregnancy outcome?

Weight (kg) WEIGHT GAIN DURING PREGANACY Weeks of Gestation (wks)

SKELETAL SYSTEM Forward displacement of the center of gravity Increased anterior flexion of cervical spine Lumbar Lordosis Forward rotation of Pelvis & Femur

SKELETAL SYSTEM PREGNANCY 1. Lumbar Lordosis 2. Cervical Spine 3. Pelvis & Femur 4. Center of Gravity 5. Increased joint mobility EXERCISE 1. Lumbrosacral Pain 2. Compression Syndromes 1. Carpal Tunnel 2. Ulnar Nerve 3. Posterior Tibial 4. Perennial 5. Overextension Injury

METABOLISM

PREGNANCY METABOLISM 1. Increased Resting Metabolism EXERCISE 1. Increased metabolism at submaximal work 1. 80, 000 cal 2. 300 cal/day 2. Glucose = primary fuel 2. Hypoglycemia

RESPIRATORY SYSTEM 1. Chest cavity increases transverse diameter 2. Raised diaphragm

PULMONARY FUNCTIONS Volume (ml) Insp Res Tidal Vol. Exp Res RV

RESPIRATORY SYSTEM PREGNANCY EXERCISE 1. Pulmonary Functions 1. Increased tidal volume 2. Decreased Residual Vol 2. Metabolism & Pulmonary Functions 3. 40% increase in Resting Minute Ventilation (VE)

Heart Rate (/min) RESTING HEART RATE Gestation (wks) Wilson et al. , Am J Med 68: 97, 1980.

Percent Increase (%) CARDIOVASCULAR SYSTEM Cardiac Output Blood Volume Gestation (wks)

CARDIOVASCULAR SYSTEM PREGNANCY 1. Cardiac Output 1. Heart Rate 2. Stroke Volume EXERCISE 1. Decreased Physical Work Capacity 2. Increased Submaximal work 1. Heart Rate 2. Stroke Volume 3. Cardiac Output

Heart Rate (/min) CARDIOVASCULAR SYSTEM Workrate (kpm/min)

Stroke Volume (cc) CARDIOVASCULAR SYSTEM Workrate (kpm/min)

Cardiac Output (L/min) CARDIOVASCULAR SYSTEM Workrate (kpm/min)

C(a-v)O 2 (ml/L) CARDIOVASCULAR SYSTEM Workrate (kpm/min)

PHYSICAL WORK CAPACITY Lowest PWC in First Trimester Highest PWC in Second Trimester Decreases as Body Weight Increases in Third Trimester

Concentration (iu/1000 ml urine) ENDOCRINE SYSTEM HCG Gestation (days)

ENDOCRINE SYSTEM PREGNANCY 1. Hormone Changes EXERCISE 1. Physical Work Capacity 2. Joint Injury 3. Gestational Diabetes

THERMOREGULATION PREGNANCY 1. Increased Sweat Gland Activity 2. Shunt blood to Periphery 3. Fetus >1 o. C EXERCISE 1. Dehydration 2. Heat Related Injury 3. Spinal Cord Growth Retardation (1 st trimester)

EXERCISE IN PREGNANCY 1. Safe for mother? 2. Safe for fetus 3. Affect on pregnancy outcome?

FOR THE MOTHER? Exercise Training during Pregnancy 1. Physical Work Capacity 1. Increases during pregnancy 2. Not above Pre-Pregnant Values 2. Lower Exercise Heart Rates* 1. At same workrate 3. Increased Heart Volume* * Not all studies agree

FOR THE MOTHER? 1. Skinfold thickness 2. Maternal Weight Gain 3. Resting Heart Rate 4. Maximal Heart Rate 5. Exercising Heart Rates* 6. Cardiac Output at Submax 7. Stroke Volume at Submax 8. Resting & Orthostatic Blood Pressures 9. VO 2 at submax 10. Resting Metabolism 11. VEmax 12. VEsubmax

FOR THE FETUS?

FETAL HEART RATES Deceleration >15 /min Normal response to mild or transient hypoxia Moderate 100 -120/min Initial response to Bradycardia Profound hypoxia <100/min Bradycardia Tachycardia Normal response to prolonged hypoxia >160/min Compensatory adaptation during hypoxic recovery

FETAL HEART RATES 1. During Exercise 1. Slight Increase 2. Slight Decrease 3. No change 2. Recovery from Exercise 1. Slight Increase 2. Slight Decrease 3. No change

FETAL HEART RATES 6/40 Exercise Studies Bradycardia Irregularity Tachycardia Cord tightly wrapped around neck (3 x) Loop of umbilical cord prolapsed by head Flattened umbilical cord (4”) Fetal distress at birth Hon & Wohlgemuth, Am J Obstet Gynecol 81: 361 -371, 1961.

Human • 26 normal • 29 Pre-Ec Supine Ex Radioactive Na+ Clearance Times (min) UTERINE BLOOD FLOW Morris, et al. , Lancet 8 Sept 1956; pg 481 -484

6 Pregnant Percent Change from Rest (%) UTERINE BLOOD FLOW 2 Non-Pregnant Flow of Uterine Artery Orr, et al. , Am J Obstet Gynecol 114: 213 -217, 1972

3 mph 10% Exhaustion n=10 Cath Percent of Uterine Blood Flow (%) UTERINE BLOOD FLOW Curet, et al. , J Appl Physiol 40: 725 -728, 1976

PO 2 (mm. Hg) UTERINE BLOOD FLOW Emmanouilides et al. Am J Obstet Gynecol 122: 130 -137, 1972

PCO 2 (mm. Hg) UTERINE BLOOD FLOW Emmanouilides et al. Am J Obstet Gynecol 122: 130 -137, 1972

p. H UTERINE BLOOD FLOW Emmanouilides et al. Am J Obstet Gynecol 122: 130 -137, 1972

Glucose (mg/dl) FETAL GLUCOSE Time (min) Soultanakis, et al. , Seminars in Perinatology. 20(4): 315 -27, 1996

Core Temperature (Co) FETAL TEMPERATURES Time (min) Soultanakis, et al. , Seminars in Perinatology. 20(4): 315 -27, 1996

PREGNANCY OUTCOME 1. Stages of Labor 2. Complications of Labor & Delivery 3. Health of Infant

PREGNANCY OUTCOME STAGES OF LABOR 1. Progressive Cervical Dilation 8 to 24 hrs 2. Head moves into birth canal to birth 1 – 30 min (same as head) 3. Passing of the Placenta

PREGNANCY OUTCOME STAGES OF LABOR 1. Duration of Labor 1. Primi- or Multi-parous 2. Mode of Delivery 3. Work of Labor & Delivery

Complications of Labor & Delivery 1. Pre-Mature 2. Caesarean Section 3. Rupture 4. Perineotomy 5. Episiotomy 6. Forceps Delivery

PREGNANCY OUTCOME Health of Infant 1. Apgar Scores 2. Neonatal Complications 3. Infant Birth Weight 4. Infant Head Circumference

10 ct fe r APGAR SCORES 0 1 2 Heart Rate Absent <100 >100 Respiratory Effort Absent Weak Strong Cry Muscle Tone Limp Some Fl Flex Extremities Reflex (feet) Irritability Absent Some Motion Cry Color Blue Body Pink Completely Limbs blue Pink Pe

Neonatal Complications 1. Asphyxiated Infants 2. Neonatal Morbidity

PREGNANCY OUTCOME Lamasze 276 Exercise Minutes 281 Control Rodway et al. J Obstet Gynec Brt Comm 54: 77 -85, 1947.

Infant Birth Weight (gms) BIRTH WEIGHT Naeye & Peters, Pediatrics 69: 724 -727, 1982.

ATHLETIC TRAINING 729 athletes General population

Percent of Sample (%) ATHLETIC TRAINING Disturbances with Pregnancy Competing during Pregnancy Good Pregnancy Outcome Improved Performance after n=64 n=59 n=27

EXERCISE IN PREGNANCY Not Unsafe for Mother or Fetus • In moderation No Athletic Competition or Sport

1. Physical conditioning during pregnancy results in no detrimental effect on pregnancy outcome. 2. Physical conditioning during pregnancy does not appear to result in the same physiological changes as physical conditioning in the non -pregnant state. 3. Continued athletic training during pregnancy may result in obstetric complications. 4. Athletic training, if discontinued during pregnancy results in no detrimental effects on pregnancy. 5. Pregnancy may improve athletic performance following pregnancy. 1. Continued occupational activity during the last weeks of pregnancy can result in lower infant birth weight which in some cases, is related to poorer infant health.

ABSOLUTE CONTRAINDICATIONS FOR EXERICSE IN PREGNANCY Heart Disease Restrictive lung disease Pregnancy induced hypertension Incompetent Cervix Multiple Gestation Hx: Placenta Previa Hx: Breech Presentation Hx: Ruptured Membranes Hx: Premature Labor

RELATIVE CONTRAINDICATIONS FOR EXERICSE IN PREGNANCY Anemia Maternal cardiac arrhythmia Chronic bronchitis Extreme Morbid Obesity Extreme Underweight (BMI <12) Orthopedic limitations Heavy Smoker Poorly controlled • • Thyroid Disease Type 1 diabetes Hypertension/pre eclampsia Seizure disorder

EXRX: Pregnancy MODE CV; non-wt bearing as weight increases Discontinue Athletic Training Flexibility for Muscle Soreness Muscle Endurance is OK FREQUENCY 3 -4/wk (resistance 2/wk) DURATION 20 -30 min up to 60 min INTENSITY Moderate 50 -85% (< Ventilatory threshold) Not guided by Heart Rates

EXRX: Pregnancy PRECAUTIONS 1. Thermoregulation 2. Injury 3. Supine Exercise (>4 months) 4. As pregnancy progresses 1. Move to non-weight bearing 2. Decrease intensity increase frequency

EXRX: Pregnancy DISCONTINUE: 1. Pain or Bleeding 2. 3. 4. 5. 6. 7. Dizziness or Faintness Pubic Pain Palpitations Back Pain Shortness of Breath Difficulty Walking

EXERCISE IN POST-PARTUM

Beginning In 1974 Infants Refused to Nurse following Maternal Exercise 7%

Lactic Acid (m. M/L) Concentrations of Lactic Acid in Blood and Milk following Maximal Exercise Wallace & Rabin, Int J Sports Med 12: 328 -331, 1991

Lactic Acid (m. M/L) Concentrations of Lactic Acid in Milk following a Normal Workout & Maximal Exercise Wallace et al, J Women’s Health 3: 91 -96, 1994

PERCEPTION OF TASTE SOUR MILK? Accept Reject Lactic Acid Concentration

THE RELATIOSHIP BETWEEN TASTE AND LACTIC ACID CONENTRATIONS IN MOTHER’S MILK Detect Recognize

EXERCISE GUIDELINES FOR LACTATION Only for Women who have Problems 1. Nurse before Exercise 2. Collect Milk before Exercise 3. Discard first 30 -60 min post exercise milk production 4. Exercise below Ventilatory Threshold

IN MENOPAUSE Increased Risk of Disease • Heart Disease • Hypertension • Hyperlipidemia • Breast Cancer Symptoms of Menopause • • Hot Flash Insomnia Fatigue Nervousness/Depression

STUDIES ON MENOPAUSAL SYMPTOMS PENN STATE Subjects • 11 Pre • 7 Peri • 11 Post Exercise • Walk/Jog • Swim • Dance • Aerobic Games • 4/wk for 6 wks • Moderate SAN DIEGO STATE IU Subjects • 9 Post • 4 Control Subjects • 10 Post • 10 Control Exercise • Walk/Jog • 3/wk for 12 wks • Moderate

Changes with Training (%) CHANGES IN POSTMENOPAUSAL SYMPTOMS WITH TRAIING

IN OLD AGE

IMMERSION EXERCISE 12 pregnant women • 15, 25, 35 weeks • 8 -10 wks postpartum 20 min of immersion 30 o. C 20 min of exercise @ 60% VO 2 max (bike) 20 min supine recovery Mc. Murray, R. G. , et al. American Journal of Obstetrics & Gynecology. 158(3 Pt 1): 481 -6, 1988

IMMERSION EXERCISE HRwater Qpostpartum PVRwater