The experience of breast pain (mastalgia) in female runners of the 2012 London Marathon and its effect on exercise behaviour

Sports Bra Restriction on Respiratory Mechanics during Exercise

PURPOSE

We set out to understand how underband tightness or pressure of a sports bra relates to respiratory function and the mechanical work of breathing ( during exercise. Our secondary purpose was to quantify the effects of underband pressure on O 2 during submaximal running.

METHODS

Nine highly trained female runners with normal pulmonary function completed maximal and submaximal running in three levels of underband restriction: loose, self-selected, and tight.

RESULTS

During maximal exercise, we observed a significantly greater during the tight condition (350 ± 78 J·min -1 ) compared with the loose condition (301 ± 78 J·min -1 ; P < 0.05), and a 5% increase in minute ventilation ( ) during the tight condition compared with the loose condition ( P < 0.05). The pattern of breathing also differed between the two conditions; the greater maximal during the tight condition was achieved by a higher breathing frequency (57 ± 6 vs. 52 ± 7 breaths·min -1 ; P < 0.05), despite tidal volume being significantly lower in the tight condition compared with the loose condition (1.97 ± 0.20 vs. 2.05 ± 0.23 L; P < 0.05). During steady-state submaximal running, O 2 increased 1.3 ± 1.1% (range: -0.3 to 3.2%, P < 0.05) in the tight condition compared with the loose condition.

CONCLUSIONS

Respiratory function may become compromised by the pressure exerted by the underband of a sports bra when women self-select their bra size. In the current study, loosening the underband pressure resulted in a decreased work of breathing, changed the ventilatory breathing pattern to deeper, less frequent breaths, and decreased submaximal oxygen uptake (improved running economy). Our findings suggest sports bra underbands can impair breathing mechanics during exercise and influence whole-body metabolic rate.

Breasts as a perceived barrier to physical activity in Mexican women: A cross-sectional study

BACKGROUND

Scarce evidence exists on barriers to physical activity in Mexican women. Despite evidence from other countries, no research has investigated the influence of the breast on PA in this population.

OBJECTIVE

To determine the association between the breast and physical activity in Mexican women.

DESIGN

Cross-sectional observational study.

METHODS

Volunteers were 279 Mexican women from Veracruz, Durango, and Baja California states, who completed a paper survey of their demographics, brassiere characteristics, breast pain, and frequency and amounts of weekly physical activity.

RESULTS

The first barrier to physical activity was time constraints, followed by breast-related issues. Breast pain was reported by 47.1% of women, and the breast as a barrier to physical activity participation was reported by 30.6%. Responses, such as "I am embarrassed by excessive breast movement" and "My breasts are too big" were the most frequently reported breast-related barriers to physical activity. Breast pain was associated with the menstrual cycle and exercise. Breast health knowledge and pain intensity were unrelated to moderate- and vigorous-intensity physical activity. The 36.4% and 6.7% of women did not meet weekly moderate- and vigorous-intensity physical activity guidelines, respectively. Weekly moderate- and vigorous-intensity physical activity was similar between women reporting breast pain and those who did not.

CONCLUSIONS

Because the breast was the second most significant barrier to physical activity, it is imperative to increase breast health knowledge in Mexican women to reduce impediments to physical activity.

A multi-phase intervention study of sports bra prescription for elite UK female athletes preparing for the Tokyo Olympics and Paralympics

Athletes report poor breast/bra knowledge, breast pain, sports bras causing lacerations and chafing, negatively affecting sports performance. No bra interventions to address these issues are reported. Working with 142 UK female athletes preparing for Tokyo Olympics/Paralympics (27 sports), this multi-phase intervention assessed breast/bra knowledge, preferences, issues via surveys and breast/bra assessments. Data were used to develop two sports bras. A total of 112 athletes were prescribed one of the new bras through individual assessments. After four weeks, wear athletes completed evaluations. Pre-intervention breast/bra knowledge was low (83% ≤average), multiple breast/bra issues were reported and most athletes wore ill-fitting, loose bras, offering limited support. Post-intervention, 63% reported improved knowledge and 97% reported their prescribed bra as better than their original bra. Eighty-seven per cent reported benefitting from this intervention, with 17% reporting improved performance. This intervention effectively assessed sports bra needs, developed and implemented solutions, which improved knowledge and potentially performance for some UK athletes.

A multi-stage intervention assessing, advising and customising sports bras for elite female British athletes

Appropriate breast support is recommended in sport; however, what constitutes appropriate support is complex, individual and often sports specific, particularly in elite sport given the wear duration. This intervention educated, assessed and advised elite British female athletes on breasts and bras; those with unresolved issues engaged in bespoke bra interventions. Following educational workshops (n = 80), breast/bra surveys (n = 60), individual bra assessments (n = 37); a rower, shooter, and hockey player participated in the bespoke bra intervention. Eighty-three per cent of athletes rated their breast/bra knowledge as ≤average. Fifty-one per cent experienced breast pain, affecting performance for 29%; seven used medication and one surgery to relieve symptoms. In individual bra assessments most wore ill-fitting, unsupportive bras and wanted bra advice. Bespoke bra interventions eliminated breast pain: for the rower, improved breast position and spine rotation; for the shooter, repositioned tissue and improved performance; and for the hockey player, accommodated smart devices. Whilst bespoke bra development is challenging, most elite athlete breast/bra issues are resolved via education, advice and fitting.

Immersive virtual reality to relieve exercise-induced pain caused by aerobic cycling

Chronic pain affects 20% of the global population and is incredibly complex to treat. The burden of chronic pain is physical, emotional and financial, and prevalence rates continue to rise. Current treatments are ineffective long-term against pain and common comorbidities, including anxiety and depression, mood and sleep disorders, and social isolation. While a large body of evidence supports regular physical exercise as an effective long-term treatment for chronic pain and its comorbidities, exercise-induced pain and kinesiophobia are significant barriers to participation and adherence. Immersive virtual reality is a powerful short-term pain reliever, that, when combined with exercise, can help overcome these barriers. This perspective argues for the use of combined exercise and virtual reality treatment techniques to mitigate chronic pain.

Breast biomechanics, exercise induced breast pain (mastalgia), breast support condition and its impact on riding position in female equestrians

Breast biomechanics, exercise-induced breast pain (EIBP) and performance effects in female athletes are established. Wearing sports bras during exercise reduces breast movement and EIBP. Despite the prevalence of female equestrians, little investigation of breast movement during horse riding exists, yet excessive breast movement, embarrassment and EIBP are reported. Breast movement relative to the torso is linked to EIBP, associated with magnitude and direction of forces generated. Equestrians may experience novel breast and upper-body movement patterns in response to large vertical excursions of the horse. This study aimed to establish relative vertical breast displacement (RVBD), EIBP and positional changes in three support conditions: ‘no support’, ‘low support’ and ‘high support’. Thirty-eight female equestrians rode a Racewood™ Equine Simulator in each breast support condition in medium walk, medium trot (sitting) and medium canter. Trials were filmed and analysed using Quintic® Biomechanics V29. Significant reductions in RVBD (P<0.001) and EIBP (P<0.001) were identified with increased breast support in all gaits. In medium trot (sitting) a significant reduction in range of movement (ROM) of shoulder-elbow-wrist (P<0.001) was seen from low to high support. ROM of torso-vertical angles were reduced from no support to low support (P<0.001) and further by high support (P<0.001). This reduction in ROM was significantly greater in large breasted riders (cup size DD-FF) (n=21) (P<0.001) compared to small breasted (cup size AA-D) (n=17). These results suggest that appropriate breast support positively impacts EIBP and riding position in female riders possibly enhancing performance. As RVBD and reported EIBP were not wholly comparative with results in female runners, further research is warranted to establish breast movement in equestrianism in three dimensions.

Can Physical Characteristics and Sports Bra Use Predict Exercise-Induced Breast Pain in Elite Female Athletes?

OBJECTIVE

To evaluate whether a simple 4-factor model using self-reported data could be used to predict exercise-induced breast pain in elite female athletes.

DESIGN

Survey study.

SETTING

Online or hard-copy surveys completed at sporting competitions and training facilities around Australia.

PARTICIPANTS

Four hundred ninety female athletes competing nationally or internationally across 49 sports.

INDEPENDENT VARIABLES

A binomial logistic regression analysis was used to evaluate the strength of a predictive model that included 2 continuous independent variables (age and body mass index) and 2 binary independent variables (breast size and sports bra use). Odds ratios were also calculated to determine the likelihood of an athlete reporting exercise-induced breast pain in association with each of the 4 variables.

MAIN OUTCOME MEASURES

Exercise-induced breast pain was the binary dependent variable.

RESULTS

The model incorporating athlete age, breast size, body mass index, and sports bra use was found to be statistically significant, but weak, in its ability to predict exercise-induced breast pain in elite female athletes (correctly identified 66% of athletes). For every 1-year increase in age, a significant 2.6% increase in the likelihood of experiencing exercise-induced breast pain was observed. Athletes with medium-to-hypertrophic sized breasts were 5.5 times more likely to experience exercise-induced breast pain than athletes with small breasts.

CONCLUSIONS

Although the current model was not sensitive enough for use by clinicians and coaches, age and breast size were both identified as critical variables in the prediction of exercise-induced breast pain. Future research is encouraged to investigate whether incorporating additional variables such body fat percentage, bra fit, and other relevant factors can add strength to the model.

The incidence of breast health issues and the efficacy of a sports bra fit and issue service in British Army recruits

Increasing retention of female recruits throughout Basic Training (BT) is a key priority for the British Army. The aims of this study were two-fold; (i) quantify breast health issues and sports bra usage within female British Army recruits, and (ii) assess the influence of professionally fitted sports bras on breast health and bra fit issues across 13 weeks of BT. A survey was completed by 246 female recruits that identified the incidence of breast health issues during BT. Subsequently, 33 female recruits were provided with professionally fitted sports bras during Week-1 of BT. Recruits completed a survey in Week-1 (Pre) and Week-13 (Post). There was a high incidence of bra issues during BT, which did not reduce following the implementation of professionally fitted sports bras. The authors recommend further research into the specific functional requirements of breast support relative to the demands of BT and the needs of the female recruit. Practitioner Summary: The British Army have a duty of care to ensure female recruits are equipped sufficiently for the demands of training. Despite the implementation of a sports bra fitting and issue service bra fit issues remained high. Further research into the specific functional requirements of breast support during training is recommended. Abbreviations: BT: Basic Training; ATR(W): Army Training Regiment Winchester; ATC(P): Army Training Centre Pirbright; BMI: Body Mass Index; NRS: Numeric Rating Scale; FET: Fisher's Exact Test.

Pain During a Marathon Run: Prevalence and Correlates in a Cross-Sectional Study of 1,251 Recreational Runners in 251 Marathons

This cross-sectional study aimed to obtain fundamental knowledge about pain during a marathon run. During the first seven months of 2007, announcements on websites of interest to marathon runners were used to recruit participants. A total of 1,251 runners (550 female runners) completed a 41-question online survey about the location and intensity of their primary pain during their last marathon and potentially related variables [perception of effort during the marathon, number of prior marathons run, typical pain intensity during training runs, percentage of training days with run-induced pain, highest intensity pain ever experienced]. Pain location was selected from a list of 27 specified body sites covering the entire body. Kilometer at which pain first occurred indexed pain threshold. Pain intensity at the primary location of pain was measured with a standardized, well-validated 0–10 pain intensity scale. Pearson correlations and multiple regression quantified the associations between average pain intensity and other variables. Sex-related differences in pain were tested using independent t-tests. Effort ratings (6–20) were added as a covariate in an ANCOVA to test if perceived effort accounted for possible sex-related differences in pain. Based on the available research, it was hypothesized that: (i) most runners would report moderate intensity pain, (ii) pain would be associated with both exercise intensity during the marathon and pain during training, and (iii) after adjusting for expected sex-related differences in perceived effort, females would experience pain earlier and rate the pain intensity as higher. All but two runners (99.8%) reported pain during a marathon, and most frequently in the anterior/medial thigh (17.1%), hamstring (10%), and calf (9.3%) locations. Pain threshold occurred at 25.3 ± 9.8 km (15.7 ± 6.1 miles) and the overall pain intensity of the run was 5.26 ± 2.45. No sex-related pain differences were found. Overall pain intensity during a marathon was significantly associated with: pain intensity during training runs (r = 0.39), percentage of training days with run-induced pain (r = 0.23), highest intensity pain ever experienced (r = 0.23), number of prior marathons (r = −0.18), and intensity of effort (r = 0.11) (all P < 0.001). Most runners experience moderate to very strong intensity pain during a marathon; the pain was independent of biological sex, and the pain is weakly associated with marathon race experience, pain during training, race effort, and the highest intensity of pain ever experienced.

The comparison of the effect of flaxseed oil and vitamin E on mastalgia and nodularity of breast fibrocystic: a randomized double-blind clinical trial

Background

Fibrocystic changes are a common benign condition in women aged 20–50. The medical intervention aims to stop fibrocystic disease progress and relieve the breast’s pain and tenderness. In the long-term, reversing the fibrocystic changes is also desirable.

Methods

In this randomized double-blind clinical trial, the effect of flaxseed oil on the severity of pain and breast nodularity was investigated against vitamin E. This study was conducted on 100 women with mastalgia. The intervention group received Flaxseed oil pearls and the control group received vitamin E pearl 200 IU twice a day for 2 months. The duration and severity of breast pain were evaluated by Cardiff chart and VAS (Visual Analogue Scale). The nodularity was assessed by Lucknow-Cardiff scale at baseline, then the first and second months of intervention.

Results

At baseline, there was no statistically significant difference between the two groups in characteristics. The breast pain improved in both groups during the first and second months of intervention (P-value within group< 0.001). However, the mean breast pain was not significantly different between the two groups at the end of the first and second month (P1= 0.54, P2= 0.73). Furthermore, the breast pain during four phases of the menstrual cycle showed no difference between vitamin E and flaxseed oil groups (menstruation phase= 0.76, follicular phase= 0.48, the first week of luteal phase= 0.86, the second week of luteal phase=0.30). The breast nodularity also decreased during the first and second months of intervention, yet no significant difference between the two groups was found (p= 0.9).

Conclusions

This study showed that flaxseed oil and vitamin E both could be effective in breast pain-relieving and decreasing nodularity with minimal side effects in contrast with the baseline. But there are no significant differences between these two agents. Larger scale prospective studies are needed to evaluate these effects in the long-term.

Trial registration

IRCT201612243014N18, Registration date: 2017-10-15.

Biomechanics of Breast Support for Active Women

More systematic breast biomechanics research and better translation of the research outcomes are necessary to provide information upon which to design better sports bras and to develop effective evidence-based strategies to alleviate exercise-induced breast pain for women who want to participate in physical activity in comfort.

Sports bra but not sports footwear decreases breast movement during walking and running

Running is a modality that has a large number of adepts, including women. Therefore, it is important to understand how sportswear can help women, with special attention to the breast movement. The aim of this study was to analyse the effect of different combinations of breast support and footwear on the breast movement during walking and running. Twenty women performed treadmill walking (5 km/h) and running (7 and 10 km/h) combining different footwear (barefoot, minimalist, and traditional) and breast support conditions (bare breast, everyday bra, and sports bra). Three-dimensional data from breast and trunk markers were tracked for 10 stride cycles. Relative breast displacement was calculated and derived for velocity. An interaction effect was observed between support, footwear, and speed conditions. The bare breast conditions presented differences from the other conditions in the majority of the kinematic variables, presenting higher breast displacement and velocity values. On the other hand, the sports bra conditions presented the lowest values for the kinematics variables. In the vertical component of breast displacement during running (10 km/h) we verified that the sports bra presented reductions of 56% and 43% in relation to the bare breast and everyday bra conditions, respectively. Despite this, no differences were found between footwear within each breast support condition. A sports bra is efficient to decrease breast movement. In addition, neither of the tested footwear was able to decrease these movements.

Body Scan Processing, Generative Design, and Multiobjective Evaluation of Sports Bras

Sports bras are critical to the comfort and performance of female athletes, yet mechanical models of sports bras are generally not used to guide their design. Typically, assessing any sports bra’s performance requires time-consuming and expensive biomechanical testing, which limits the number of designs considered. To more broadly advance knowledge on how different design properties of sports bras affect their performance, this paper presents a new design framework to explore and evaluate the sports bra design space. The framework incorporates methods for body scan analysis, fast simulation, design generation, and performance evaluation. Using these methods together enables the rapid exploration of hundreds, or thousands, of designs—each one having been evaluated on key metrics related to sports bra performance, namely, range of motion and average pressure. With this framework, designers can potentially discover a diverse set of new, high-performing sports bra concepts, as well as gain insights into how design decisions affect performance.

Do static and dynamic activities induce potentially damaging breast skin strain?

Background/Aim

This study aimed to quantify breast skin strain and strain rate and the effect of support garments at reducing strain and to determine characteristics that correlate with strain during static and dynamic activity.

Methods

39 women (UK size 32C to 36G) had electromagnetic sensors applied to their breast skin. Sensor coordinates were recorded while standing, walking, running, in no, low and high breast support conditions, plus bare-breasted in the estimated neutral position to calculate strain. Relative breast coordinates and 35 inter-sensor distances identified peak breast skin strain (%) and strain rate (%·s^-1), which were then correlated with nipple kinematics, breast pain and participant characteristics.

Results

Mean peak breast skin strain was generally <60% during standing, walking and running; however, some individuals exhibited 93% strain in bare-breasted running. Compared with low support, high support did not further reduce strain during standing and walking. Peak breast skin strain/strain rate location was longitudinal, in lateral and medial breast regions and displayed strong correlations with breast volume, body mass index and bust circumference.

Conclusion

Static and dynamic activity did not result in excessive breast skin strain, suggesting low risk of skin damage. However, during running, some individuals experienced excessive skin strains (up to 93%) and strain rates (up to 1258%·s^-1). Breast skin strain/strain rate location suggests lift is required in the lateral and medial bra cup to reduce strain, particularly in larger breast volumes due to increased skin strain risk.

Effects of sports bra and footwear on vertebral posture during walking and running

Little attention has been given to factors which affects women running, such as proper footwear and breast support and their effects on spine. The objective of study was to analyse the influence of different breast support and footwear on vertebral posture during walking and running. Seventeen women (x¯ = 23.51; SD = 3.70 years) performed a treadmill walking (5 km/h) and running (7 and 10 km/h) with different footwear (barefoot, minimalist and traditional) and breast support (bare breast, everyday bra and sports bra) conditions. Spine movements were analyzed using three cameras in grayscale video mode, positioned behind the participant to register reflective markers fixed in the vertebrae. From the 3D coordinates of the trunk markers we computed, for the whole gait cycle (C) and for the average gait posture (neutral curve-NC) the maximal (M) thoracic (T) kyphosis and lateral flexion, and the maximal lumbar (L) lordosis and lateral flexion. Frontal plane: bare breast presented higher lumbar NC than the everyday bra and sports bra, higher MLC than the sports bra and lower MTC than the everyday bra and sports bra. Barefoot presented higher MTC than minimalist. Sagittal plane: bare breast presented lower MTC than the sports bra. Barefoot presented higher lumbar NC than the minimalist and traditional footwear and higher MLC than the minimalist and traditional ones. The sports bra increased curvatures in the thoracic spine that were rectified during bare breast conditions. In addition, both footwears were able to maintain the natural curvatures of the spine in the lumbar.

ACR Appropriateness Criteria® Breast Pain

Breast pain is a common complaint. However, in the absence any accompanying suspicious clinical finding (eg, lump or nipple discharge), the association with malignancy is very low (0%-3.0%). When malignancy-related, breast pain tends to be focal (less than one quadrant) and persistent. Pain that is clinically insignificant (nonfocal [greater than one quadrant], diffuse, or cyclical) requires no imaging beyond what is recommended for screening. In cases of pain that is clinically significant (focal and noncyclical), imaging with mammography, digital breast tomosynthesis (DBT), and ultrasound are appropriate, depending on the patient's age. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

An investigation of bra concerns and barriers to participation in horse riding

Horse riding is a female-dominated sport where participation levels are declining. The influence of the breast on participation levels and current satisfaction with bras for this activity is unknown. This study aimed to investigate bra concerns and breast-related barriers to participation in horse riding. A 6-part, 32 question online survey was completed by 1,324 females who participated in horse riding. Descriptive and chi-squared analyses were utilised; inductive content analysis was completed to analyse qualitative responses. At least one breast-related barrier was reported by 25% of all participants. Larger-breasted riders were less satisfied (P<0.001) with their bras. 70% of riders stated that improvements needed to be made in bras to help reduce breast health issues, with support, style and fit the most common reasons cited. This study highlights the importance of addressing breast-related barriers and provides rationale for the development of equestrian-specific breast support garments and educational initiatives.

Clinical management of idiopathic mastalgia: a systematic review

ABSTRACT INTRODUCTIONIdiopathic mastalgia (benign breast pain of unknown origin) is often poorly managed because of its subjective nature and unclear aetiology. Mastalgia is a reason for up to 50% of breast outpatient referrals. Existing systematic reviews discuss dated treatment options that provide limited symptomatic relief. METHODSA systematic review was conducted for aetiology and treatment of idiopathic mastalgia in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Databases such as PubMed, MEDLINE, Cochrane Database and the Clinical Trial Registry were searched (February 2016). RESULTSReassurance plus bra-fitting advice provides relief for most women. If symptoms persist, addition of topical non-steroidal anti-inflammatory drugs (NSAIDs) provides relief in 70–92% of women. There is some benefit in reducing dietary coffee and fat intake. Medical treatments have serious side-effects (often androgenic or menopausal) and should be considered only in cases resistant to simpler measures. Dopamine agonists are useful, but less effective than endocrine treatments such as Danazol or Tamoxifen. Of the Selective Oestrogen Receptor Modulator drugs, Ormeloxifene appears most effective, but is not licenced in the United Kingdom. Relaxation therapy, acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness. DISCUSSIONFirst-line management of breast pain should be explanation, reassurance and a bra-fitting advice. Subsequent drug therapy should be balanced against its side-effects; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects. Newer agents (Ormeloxifene) currently being used for mastalgia in India could be considered in the developed world.

Development and psychometric evaluation of the breast size satisfaction scale

Purpose The purpose of this paper is to develop and evaluate psychometrically an instrument named the Breast Size Satisfaction Scale (BSSS) to assess breast size satisfaction. Design/methodology/approach The present scale was developed using a set of 16 computer-generated 3D images of breasts to overcome some of the limitations of existing instruments. The images were presented to participants and they were asked to select the figure that most accurately depicted their actual breast size and the figure that most closely represented their ideal breast size. Breast size satisfaction was computed by subtracting the absolute value of the difference between ideal and actual perceived size from 16, such that higher values indicate greater breast size satisfaction. Findings Study 1 ( n=65 female undergraduate students) showed good test-retest reliability and study 2 ( n=1,000 Iranian women, aged 18 years and above) provided support for convergent validity using a nomological network approach. Originality/value The BSSS demonstrated good psychometric properties and thus can be used in future studies to assess breast size satisfaction among women.

Breast cancer education for schoolgirls: an exploratory study

Adolescent girls are an important target group for breast cancer education and promoting breast awareness. However, research has not established schoolgirls' perceived importance of breast cancer education or explored factors that may impact engagement. This study aimed to identify schoolgirls' concerns about breast cancer, desire to know more and perceived importance of breast cancer education, and explored associations with demographic factors. Of 2089 schoolgirls (11-18 years) surveyed, 1958 completed all relevant breast cancer questions and demographic factors (ethnicity, school type, breast size, physical activity level and age). χ-Tests assessed associations between demographics, desire to know more and perceived importance of breast cancer. Overall, 44% of schoolgirls reported concerns about breast cancer, 72% wanted to know more and 77% rated the topic as extremely important. Breast size was not associated with wanting to know more about breast cancer. Schoolgirls who wanted to know more about breast cancer were White, from single-sex schools with boys at sixth form, more physically active and older. However, among other ethnic groups, school types and physical activity levels, the proportion of girls who wanted to know more about breast cancer was still high (≥61%). This study provides evidence of the need for breast cancer education for schoolgirls across all school types, irrespective of breast size or physical activity levels. The results highlight the need to be inclusive and engage schoolgirls from all ethnic groups and to promote breast awareness at a young age to ensure effective breast cancer education.

The effects of exercise on mastalgia

OBJECTIVE

Mastalgia is often ignored by physicians although it is the most common breast-related complaint among women. The effectiveness of exercise therapy for mastalgia is unclear. The aim of this study is to investigate the effects of exercise on mastalgia.

METHODS

A randomized controlled trial was conducted with twenty women with complaints of mastalgia fulfilling the inclusion and exclusion criteria. Patients were randomly assigned to the control group and to the exercise group. Sports brassiere, refraining from caffeine- and methylxanthine-containing foods, and simple analgesics were recommended for two groups. In the exercise group, an exercise program was conducted three times a week for 6 weeks. Participants in both groups were evaluated for breast pain and using the Short-Form Health Survey (SF-36) questionnaire before and six weeks after study. Serum cytokine levels were also collected and analyzed.

RESULTS

No significant differences were detected with respect to age, body mass index, menopausal status, psychiatric condition, and existence of unexplained pain syndromes between the groups. Total breast pain scores were similar in both groups. The sensory component of breast pain questionnaire and visual analogue scale values significantly improved via exercise in only exercise group (p = 0.012 and p = 0.016). There was no significant difference between groups in serum levels of cytokines. SF-36 subscale scores for general health and social functioning significantly improved in the control group and scores for role physical, bodily pain, and social functioning improved in exercise group.

CONCLUSIONS

Based on our preliminary findings, exercise treatment is beneficial for patients with mastalgia and it can be suggested by clinicians.

Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study

OBJECTIVES

To investigate the relationship between the occurrence of stress fracture and premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese adolescent athletes.

DESIGN

Cross-sectional study.

SETTING

Osaka, Japan.

PARTICIPANTS

A school-based survey on menstruation and school life was conducted using a sample of 1818 Japanese female students who belonged to two public high schools in Japan. Among them, we recruited 394 athletes who had regular menstrual cycles (25-38 days) and completed a questionnaire about their premenstrual symptoms and their competitive career.

MAIN OUTCOME MEASURE

Premenstrual symptoms and the occurrence of stress fracture.

RESULTS

The prevalences of moderate-to-severe PMS and PMDD were 8.9% and 1.3%, respectively, which were the same as in collegiate athletes in a previous study. Premenstrual symptoms disturbed 'Work efficiency or productivity, home responsibilities', 'Relationships with coworkers or family' and 'Athletic performance in training or competition' more severely than menstrual pain (p=0.031, p=0.004 and p<0.001, respectively). 66 athletes (16.8%) reported having experienced a stress fracture. The severity of 'Overeating or food cravings', 'Physical symptoms' and 'Performance in training or competition' in athletes with previous stress fractures were much higher than in those without a history of stress fractures (p=0.015, p=0.008 and p=0.006, respectively). In terms of premenstrual symptoms, 'Physical symptoms' was associated with an increased risk of stress fractures in athletes (OR 1.66, 95% CI 1.06 to 2.62).

CONCLUSIONS

The results from this study indicated that premenstrual symptoms may affect athletic performance and has the risk of stress fractures in adolescent athletes.

Do women with smaller breasts perform better in long-distance running?

Literature has established that a range of physiological, biomechanical, and training variables influence marathon performance. The influence of anthropometric characteristics has also received attention. However, despite major marathons exceeding 40,000 participants and approximately a third of these runners being female, no data exist on the influence of the breast on running performance. This cross-sectional study aimed to explore the impact of breast mass on marathon finish time. One hundred and sixty-eight of 321 female marathon runners contacted completed an on-line survey focusing on marathon performance during the 2012 London marathon. Participants were categorised as smaller (<500 g, 54%) or larger breasted (>500 g, 46%). Regression analysis identified that 24% of marathon performance variance could be explained by body mass index (BMI), but breast mass improved the model to explain 28% of performance variation. The model determined that for women with 32/34 or 36/38 underband each increase in cup size equates to a performance decrement of 4.6 min or 8.6 min, equivalent to 34.4 min difference between a woman with 36A compared to 36DD breast size. Larger breasted runners had greater BMIs, completed less marathons and had slower marathon finish times (316 ± 48 min) compared to smaller breasted runners (281 ± 51 min). Twenty-five per cent less larger breasted women finished in the fastest quartile. These results suggest that differences in breast mass are an important factor for female athletes and should be considered in future research in this area.

Effect of sports bra type and gait speed on breast discomfort, bra discomfort and perceived breast movement in Chinese women

This study investigated the effect of sports bra type (encapsulation versus compression) and gait speed on perceptions of breast discomfort, bra discomfort and breast movement reported by Chinese women. Visual analogue scales were used to evaluate breast discomfort, bra component discomfort and perceived breast movement of 21 Chinese participants when they wore an encapsulation or a compression sports bra, while static and while exercising at three different gait speeds. Participants perceived less breast discomfort and breast movement when wearing a compression bra compared to an encapsulation bra at a high gait speed, suggesting that compression bras are likely to provide the most effective support for Chinese women. However, significantly higher bra discomfort was perceived in the compression bra compared to the encapsulation bra when static and at the lower gait speed, implying that ways to modify the design of sports bras, particularly the straps, should be investigated to provide adequate and comfortable breast support.

PRACTITIONER SUMMARY

The compression sports bra provided more comfortable support than the encapsulation sports bra for these Chinese women when running on a treadmill. However, these women perceived higher bra discomfort when wearing the compression bra when stationary. Further research is needed to modify the design of sports bras, particularly the straps, to provide adequate and comfortable breast support.

Is Breast Pain Greater in Active Females Compared to the General Population in the UK?

Cyclic and noncyclic breast pain effect up to 60% of women, decreasing the quality of life. In addition, exercise-induced breast pain (thought to be caused by tension on breast skin and fascia during breast motion) is reported in up to 72% of exercising females. These forms of breast pain may be experienced concurrently; therefore, it is hypothesized that this compound effect may cause higher breast pain prevalence and severity in active populations. This study investigated the prevalence and severity of breast pain in an active cohort, compared to a random cohort. A random sample of 234 UK females completed a self-administered survey reporting physical activity history, prevalence, severity and frequency of breast pain, breast support habits, bra satisfaction, occurrence of bra-related issues, and demographics. This sample was age-matched to a sample of active females (n = 234) from a cross-sectional survey of 1,285 female marathon runners who completed a similar survey. Breast pain prevalence was significantly lower in the active cohort (32.1%) compared to the random cohort (43.6%), however, the severity and frequency of breast pain was similar in both cohorts. Females in the active cohort undertook significantly more physical activity, were lighter, had greater nulliparous rates, greater adherence to sports bra use, but less adherence to professional bra fitting. With lower breast pain rates in the active cohort the hypothesis of a compound effect of multiple forms of breast pain causing an increase in prevalence and severity is rejected. The lower prevalence may be related to increased physical activity, reduced body mass, and increased sports bra use. Sports bra use is already recommended in the literature for symptomatic women, however, this is the first study to report that increased physical activity and weight loss may be an appropriate life style choice to reduce the prevalence of breast pain.

[Breast pain: Recommendations]

OBJECTIVES

To evaluate the diagnostic value of clinical examination and additional tests in the exploration of breast pain, to evaluate the strategy of their care and to provide recommendations.

METHODS

A literature search in English and French carried out by consulting the databases PubMed, Cochrane Library and international recommendations.

RESULTS

Clinical examination and interrogation, with the use of visual analog scale used to differentiate non-cyclical breast pain from mastodynia (LE2). A calendar can be used to characterize the cyclical breast pain (LE3). Using a questionnaire can help to characterize the pain (LE3). In the absence of palpable abnormality, it is not recommended to modify systematic or individual screening modalities (LE2). MRI is not recommended in case of normal mammography and sonography. Explorations biopsy is guided by imaging. The therapeutic management includes reassurance after a normal clinical evaluation and/or normal radiological findings (LE2), and precise fitting of a brassière. In case of failure of this first approach, NSAIDs gel can be proposed (LE1-2).