1
|
Srinivasa Gopalan S, Mann C, Rhodes RE. Impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational physical activity of cyclically menstruating individuals: A systematic review. Prev Med 2024; 184:107980. [PMID: 38704099 DOI: 10.1016/j.ypmed.2024.107980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/13/2024] [Accepted: 04/30/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The menstrual cycle often presents barriers to participation in daily life activities, including physical activity (PA), which is a cornerstone of health and well-being. The purpose of this systematic review was to explore and summarize the impact of symptoms, experiences, and perceptions of the menstrual cycle on recreational PA (RPA), including sports, exercise and active recreation, in the general population. METHODS Six databases were searched for studies that investigated the impact of the menstrual cycle on PA among individuals who were cyclically menstruating, healthy, and not involved in professional sports training. RESULTS The search yielded 3025 studies that were screened for relevance and eligibility, resulting in 25 eligible studies, which were found to be of moderate-to-high quality following a quality and risk-of-bias assessment. Thematic synthesis of qualitative and quantitative data from the selected studies, constituting 16,557 adults and 3715 adolescents, identified the impact of menstrual symptoms on the physical and psychological capability to participate in RPA, social opportunity barriers to RPA (e.g., social pressure due to the sociocultural taboo against menstruation), as well reflective (knowledge) and automatic (habit) motivation on RPA behaviours. CONCLUSION The variability in menstrual symptoms and corresponding experiences suggested the need for an individualized approach to RPA promotion. Furthermore, this review highlighted the need to address the sociocultural taboo against menstruation, as well as improve the provision of knowledge and resources related to the menstrual cycle and RPA, in order to promote and facilitate RPA for cyclically menstruating individuals throughout the menstrual cycle.
Collapse
Affiliation(s)
- Sharan Srinivasa Gopalan
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada.
| | - Caitlin Mann
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
2
|
Yamashita N, Kume M, Satake T, Inoue K, Yoshida T. Subjective perceived risk factors of exertional heat exhaustion-related symptoms in female collegiate athletes in Japan. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:1303-1314. [PMID: 38598168 DOI: 10.1007/s00484-024-02667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
Associations of exertional heat exhaustion (EHE)-related symptoms with lifestyle habits and health factors specific to female athletes, ranked by relative risks from high to low, remain elusive. Addressing this issue would benefit athletes and coaches, ensuring safer practices during summer sports activities. To address this issue, we distributed paper-based questionnaires to seven universities in Japan, and 983 respondents completed our survey. The questionnaires covered various personal characteristics, lifestyle habits, perceived health factors, perceived athletic activity, and EHE-related symptoms. In this retrospective case-control study, we analyzed the relationships of EHE-related symptoms (objective variables) with lifestyle habits, health factors, and athletic activity conditions (explanatory variables) using the partial proportional odds model. The questionnaire responses revealed that perceived dehydration, sickness, loss of appetite, perceived accumulated fatigue, perceived mental stress, lack of ambient wind, and insufficient rest breaks were positively associated with EHE-related symptoms, with relative risks ranging from high to low. Using an air conditioner during sleep and having a sleep duration of ≥ 6 h were associated with a reduced risk of EHE-related symptoms. The study results suggest that female athletes should be allowed to postpone exercise or reduce its intensity and volume based on their perceptions of dehydration, sickness, loss of appetite, accumulated fatigue, and mental stress in summer to prevent heat-related illnesses.
Collapse
Affiliation(s)
- Naoyuki Yamashita
- Faculty of Arts and Sciences, Kyoto Institute of Technology, Kyoto, Japan.
| | - Masashi Kume
- Department of Food and Nutrition, Kyoto Bunkyo Junior College, Uji, Japan
| | - Toshiyuki Satake
- Faculty of Health Science, Kyoto Koka Women's University, Kyoto, Japan
| | - Keiko Inoue
- Graduate School of Science and Technology, Kyoto Institute of Technology, Kyoto, Japan
| | - Tetsuya Yoshida
- Faculty of Arts and Sciences, Kyoto Institute of Technology, Kyoto, Japan
| |
Collapse
|
3
|
Johnson KA, Shields RK. Influence of the Menstrual Cycle and Training on the Performance of a Perturbed Single-Leg Squatting Task in Female Collegiate Athletes. Orthop J Sports Med 2024; 12:23259671241251720. [PMID: 38831876 PMCID: PMC11146038 DOI: 10.1177/23259671241251720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/16/2023] [Indexed: 06/05/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) injuries often occur when an athlete experiences an unexpected disruption, or perturbation, during sports. ACL injury rates may also be influenced by the menstrual cycle. Purpose To determine whether training adaptations to knee control and muscle activity during a perturbed single-leg squatting (SLS) task depend on menstrual cycle phase in female athletes. Study Design Controlled laboratory study. Methods A total of 21 healthy female collegiate athletes (current or former [<3 years]) who competed in 9 different sports performed an SLS task in which they attempted to match their knee position (user signal) to a target signal. The protocol consisted of a 9-condition pretest, 5 sets of 3 training trials, and a 9-condition posttest. One perturbation was delivered in each condition by altering the resistance of the device. Sagittal knee control (absolute error between the target signal and user signal) was assessed using a potentiometer. Muscle activity during perturbed squat cycles was normalized to maximal activation and to corresponding muscle activity during unperturbed squat cycles (%unperturbed) within the same test condition. Athletes performed the protocol during a distinct menstrual cycle phase (early follicular [EF], late follicular [LF], midluteal [ML]). Two-way mixed analysis of variance was used to determine the effects of the menstrual cycle and training on knee control and muscle activity during task performance. Venous blood was collected for hormonal analysis, and a series of health questionnaires and anthropometric measures were also assessed to determine differences among the menstrual cycle groups. Results After training, athletes demonstrated better knee control during the perturbed squat cycles (lower absolute error, P < .001) and greater soleus feedback responses to the perturbation (%unperturbed, P = .035). Better knee control was demonstrated in the ML phase versus the EF phase during unperturbed and perturbed squat cycles (P < .039 for both). Quadriceps activation was greater in the ML phase compared with the EF and LF phases, both immediately before and after the perturbation (P < .001 for all). Conclusion Athletes learned to improve knee control during the perturbed performance regardless of menstrual cycle phase. The best knee control and greatest quadriceps activation during the perturbed squatting task was found in the ML phase. Clinical Relevance These findings may correspond to a lower incidence of ACL injury in the luteal phase and alterations in exercise performance across the menstrual cycle.
Collapse
Affiliation(s)
- Kristin A. Johnson
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Richard K. Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
4
|
Oester C, Norris D, Scott D, Pedlar C, Bruinvels G, Lovell R. Inconsistencies in the perceived impact of the menstrual cycle on sport performance and in the prevalence of menstrual cycle symptoms: A scoping review of the literature. J Sci Med Sport 2024; 27:373-384. [PMID: 38508888 DOI: 10.1016/j.jsams.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/16/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVES This scoping review aimed to summarize the findings of studies regarding the perceived impact of the menstrual cycle on athletic performance, as well as the prevalence of negative menstrual cycle symptoms. DESIGN Scoping review. METHODS Three databases were searched and the Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) was used as guidance. RESULTS A total of 39 studies were included in the final analysis. Between 2.8 and 100 % of athletes reported their performance being negatively impacted by their menstrual cycle, and the main reason was the occurrence of menstrual cycle symptoms. Additionally, a large variability in the prevalence of menstrual cycle symptoms was reported in the different studies mainly due to methodological differences and recall biases. CONCLUSIONS Similarly, as to what has been reported in reviews summarizing performance outcomes during different menstrual cycle phases, this review highlights the high degree of variability between how athletes perceive to be impacted by their menstrual/hormonal contraceptive cycle. REGISTRATION The protocol of this scoping review was registered at the Open Science Framework on 14 September 2023 (osf.io/efu9x).
Collapse
Affiliation(s)
- Chelsea Oester
- Western Sydney University, School of Health Sciences, Australia.
| | - Dean Norris
- Western Sydney University, School of Health Sciences, Australia. https://twitter.com/DNorrisSC
| | - Dawn Scott
- Washington Spirit, USA. https://twitter.com/DawnScott06
| | - Charles Pedlar
- St Mary's University, Faculty of Sport, Health and Applied Science, United Kingdom; National University of Ireland, Orreco Business Innovation Unit, Ireland; University College of London, Institute of Sport, Exercise and Health, United Kingdom. https://twitter.com/PedlarCR
| | - Georgie Bruinvels
- St Mary's University, Faculty of Sport, Health and Applied Science, United Kingdom; National University of Ireland, Orreco Business Innovation Unit, Ireland; University College of London, Institute of Sport, Exercise and Health, United Kingdom. https://twitter.com/GBruinvels
| | - Ric Lovell
- Western Sydney University, School of Health Sciences, Australia; University of Wollongong, Faculty of Science, Medicine and Health, Australia. https://twitter.com/Ric_Lovell
| |
Collapse
|
5
|
Flood TR, Clausen E, Kuikman MA, Smith E, McKay AKA, Burke LM, Elliott-Sale KJ. Auditing the representation of hormonal contraceptives in studies assessing exercise performance in women. J Sports Sci 2024; 42:825-839. [PMID: 38896557 DOI: 10.1080/02640414.2024.2368762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 06/09/2024] [Indexed: 06/21/2024]
Abstract
Hormonal contraceptive (HC) users have a different ovarian hormonal profile compared to eumenorrheic women. Due to the prevalence of HC use amongst sportswomen, there has been increased research efforts to understand their impact on exercise performance. The aim was to audit this research. Studies identified were assessed for HC type, athlete calibre, performance outcome, study design, and quality of methodological control regarding ovarian hormonal profiles. Sixty-eight different HCs were reported across 61 studies. Monophasic combined oral contraceptive (OCP) pills represented 60% of HCs, followed by other pills [34%, phasic-combined, progestogen-only, and un-specified], phasic and long acting reversible contraceptives [5%, vaginal ring, patch, implant, injection, intrauterine system] and unspecified HCs (1%). Eleven percent of participants using HCs were classified as highly trained or elite/international with no participants being classed as world class. Whilst the number of studies involving HCs has increased two-fold over the past decade, the number of studies ranked as gold standard has not increased (HC; 2003-57%, 2011-55%, 2022-43%. OCP; 2003-14%, 2011-17%, 2022-12%). Future research assessing HCs and exercise performance should adopt high-quality research designs and include a broader range of HCs in highly trained to world-class populations to increase the reach and impact of research in this area.
Collapse
Affiliation(s)
- Tessa R Flood
- Department of Sport and Exercise Science, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Emma Clausen
- Department of Sport and Exercise Science, Manchester Metropolitan University Institute of Sport, Manchester, UK
| | - Megan A Kuikman
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Ella Smith
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kirsty J Elliott-Sale
- Department of Sport and Exercise Science, Manchester Metropolitan University Institute of Sport, Manchester, UK
| |
Collapse
|
6
|
Di Gioia G, Crispino SP, Maestrini V, Monosilio S, Squeo MR, Lemme E, Nenna A, Luvero D, Angioli R, Pelliccia A. Cardiovascular Effects of Chronic Hormone Therapy: Study on Olympic Female Athletes. Am J Cardiol 2024; 212:6-12. [PMID: 37984634 DOI: 10.1016/j.amjcard.2023.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/01/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
Female physiology is regulated after puberty by the menstrual cycle, whose hormonal fluctuations create a multitude of effects on several systems, including the cardiovascular one. The use of hormone therapy (HT) is quite common in female athletes, and data on cardiovascular effects in this population are lacking. We sought to investigate the effects of HT in highly trained athletes to assess any difference associated with HT on cardiac remodeling, exercise capacity, and clinical correlates. We studied 380 female elite athletes (mean age 25.5 ± 4.8) competing in endurance and mixed sports; 67 athletes (18%) were in chronic HT therapy. All athletes underwent baseline electrocardiography, exercise electrocardiography stress test, transthoracic echocardiogram, and complete blood tests, including lipid profile and inflammation indexes. The echocardiographic study showed a characteristic left ventricular (LV) remodeling, defined by lower LV mass index (86.2 vs 92.5 g/m2, p <0.006), end-diastolic LV diameter (28.3 vs 29.4 mm/m2, p <0.004), and end-diastolic LV volume (61.82 vs 67.09 ml/m2, p <0.010) compared with controls, without changes in systolic function and diastolic relaxation/filling indexes. A lower burden of ventricular arrhythmias on exercise was observed in HT athletes (1.5% vs 8.6% in those without therapy, p = 0.040). Linear regression analysis showed that HT had an independent effect on LV end-diastolic diameter indexed (p = 0.014), LV end-diastolic volume indexed (p = 0.030), and LV mass indexed (p = 0.020). In conclusion, chronic treatment with HT in female athletes is associated with less cardiac remodeling, including a lower LV cavity, volume, and mass, with preserved systolic and diastolic function, and decreased burden of exercise-induced ventricular arrhythmias. HT, therefore, appears to be responsible for a more economic but equally efficient cardiac adaptation to intensive athletic conditioning.
Collapse
Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, Italy.
| | - Simone Pasquale Crispino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Italy
| | - Viviana Maestrini
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, Italy; Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, Italy
| | - Sara Monosilio
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, Italy; Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, Italy
| | - Maria Rosaria Squeo
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, Italy
| | - Erika Lemme
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, Italy
| | - Antonio Nenna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Italy
| | - Daniela Luvero
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
| | - Roberto Angioli
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
| | - Antonio Pelliccia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, Italy
| |
Collapse
|
7
|
Ekenros L, von Rosen P, Norrbom J, Holmberg HC, Sundberg CJ, Fridén C, Hirschberg AL. Impact of Menstrual cycle-based Periodized training on Aerobic performance, a Clinical Trial study protocol-the IMPACT study. Trials 2024; 25:93. [PMID: 38287424 PMCID: PMC10823667 DOI: 10.1186/s13063-024-07921-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/09/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The menstrual cycle and its impact on training and performance are of growing interest. However, evidence is lacking whether periodized exercise based on the menstrual cycle is beneficial. The primary purpose of this proposed randomized, controlled trial, the IMPACT study, is to evaluate the effect of exercise periodization during different phases of the menstrual cycle, i.e., comparing follicular phase-based and luteal phase-based training with regular training during the menstrual cycle on physical performance in well-trained women. METHODS Healthy, well-trained, eumenorrheic women between 18 and 35 years (n = 120) will be recruited and first assessed for physical performance during a run-in menstrual cycle at different cycle phases and then randomized to three different interventions: follicular phase-based training, luteal phase-based training, or regular training during three menstrual cycles. The training intervention will consist of high-intensity spinning classes followed by strength training. The menstrual cycle phases will be determined by serum hormone analysis throughout the intervention period. Assessment of aerobic performance (primary outcome) and muscle strength, body composition, and blood markers will be performed at baseline and at the end of the intervention. DISCUSSION With a robust methodology, this study has the potential to provide evidence of the differential effects of exercise periodization during different phases of the menstrual cycle in female athletes. TRIAL REGISTRATION ClinicalTrials.gov NCT05697263 . Registered on 25 January 2023.
Collapse
Affiliation(s)
- Linda Ekenros
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83, Huddinge, Sweden.
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83, Huddinge, Sweden
| | - Jessica Norrbom
- Department of Physiology and Pharmacology, Molecular Exercise Physiology, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Hans-Christer Holmberg
- Department of Physiology and Pharmacology, Molecular Exercise Physiology, Karolinska Institutet, Stockholm, 171 77, Sweden
- Department of Health Sciences, Lulea University of Technology, 971 87, Lulea, Sweden
| | - Carl Johan Sundberg
- Department of Physiology and Pharmacology, Molecular Exercise Physiology, Karolinska Institutet, Stockholm, 171 77, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Healthcare and Welfare, Malardalens University, 721 23, Vasteras, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 171 76, Stockholm, Sweden
| |
Collapse
|
8
|
Hayward E, Akam L, Hunter D, Mastana S. Role of the Menstrual Cycle on Performance and Injury Risk: A Survey of Female Professional Rugby Players in the United Kingdom. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:150. [PMID: 38397641 PMCID: PMC10888092 DOI: 10.3390/ijerph21020150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Female athletic performance and injury risk is impacted by variations in the menstrual cycle (MC), but the understanding of the impacts and mechanisms influenced by the menstrual cycle on exercise performance are not fully delineated. AIMS AND OBJECTIVES Evaluate associations between the menstrual cycle, perceived performance, and injury risk of elite female rugby players using an online survey. METHODS An anonymous online questionnaire was completed by 150 elite female rugby players from two English rugby leagues, the Betfred Women's Super League (BWSL) and the Allianz Premier 15s (AP15s). The collected data were analysed thematically. RESULTS The Chi-square test was used to assess associations between age groups and contraception usage, weight change, and training and playing performance; none of the associations were statistically significant (all p values > 0.05). Thematic analysis of 11,660 words of data revealed four themes: (a) MC impact on training and competition, (b) education and period management plans, (c) openness of conversations and comfort taking time off, and (d) injury risk. The impacted performance areas were physical (83.7%), psychological (85.7%), and nutritional (80.3%); players experienced decreased appetite, nausea, fatigue, strength declines, heighted emotions, and worsened focus. In total, 87.8% of athletes perceived the MC to negatively impact performance, 85.7% of players desired to be educated further to prevent injuries, improve nutrition, and training adaptions, 51.7% of participants perceived risk of injury to be higher during MC, and 86.4% of participants did not feel comfortable taking time off due to the MC, worrying that selection would be affected and about opinions from others. CONCLUSION A clear negative impact on perceived performance and injury risk was reported by survey participants. The interaction of physical, psychological, and nutritional factors, and a lack of awareness and education emphasise the need for further comprehensive studies and interventions, with measures such as MC monitoring and profiling, education, and training adaptions to develop openness, knowledge, and understanding.
Collapse
Affiliation(s)
| | | | | | - Sarabjit Mastana
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (E.H.); (L.A.); (D.H.)
| |
Collapse
|
9
|
Nabeyama T, Suzuki Y, Saito H, Yamamoto K, Sakane M, Sasaki Y, Shindo H, Takita M, Kami M. Prevalence of iron-deficient but non-anemic university athletes in Japan: an observational cohort study. J Int Soc Sports Nutr 2023; 20:2284948. [PMID: 38018828 PMCID: PMC11018321 DOI: 10.1080/15502783.2023.2284948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Iron deficiency (ID) and iron deficiency anemia (IDA) are long-standing health problems in athletes, affecting both performance and health. ID prevalence in young athletes remains high and a matter of concern. ID and IDA can lead to fatigue, reduced endurance, and decreased oxygen transport, potentially compromising athletic performance. We hypothesized that ID would still be a major health concern in university athletes across sports clubs in Japan. PURPOSE The study aimed to investigate the prevalence of ID and IDA in athletes participating in Kendo, badminton, baseball, and handball at the University of Tsukuba (Tsukuba, Ibaraki Prefecture, Japan). The study also examined the correlation between hypoferritinemia and other variables, such as previous use of iron supplements, body mass index (BMI), energy intake, and years of athletics. METHODS Between January and December 2019, 126 university athletes, consisting of 79 males and 47 females, underwent physical measurements and blood tests. The blood test included complete blood count, levels of serum ferritin, serum iron, and total iron-binding capacity. The anemia was defined in accordance with the WHO criteria. Daily energy and iron intake were estimated with the food frequency questionnaire in Japanese (FFQg). Thirty-four female athletes responded to a survey about their menstruation and low-dose estrogen-progestin (LEP) usage. RESULTS While none of the athletes had anemia, 22 (47%) female athletes exhibited serum ferritin levels of 30 ng/mL or less, defining them as hypoferritinemia. The multivariate logistic regression model revealed that a shorter duration of the athletic experience (adjusted odd ratio [95% confidence interval]: 0.62 [0.43-0.90]), lower energy intake (0.994 [0.989-0.999]), and higher dietary iron intake (4.40 [1.12-17.26]) were associated with hypoferritinemia. Seventeen (50%) female athletes reported a decline in subjective performance during menstruation, albeit two took LEP regularly. CONCLUSIONS This study reveals that ID is a prevalent health concern among young female athletes across sports clubs. It underscores the need for their education on the importance of assessing ID status. Limitation includes the nature of single-site and observational study, the absence of hepcidin measurement, and an unspecified amount of exercise. Comprehensive investigations are needed to elucidate the causes and optimal treatments for ID in young athletes.
Collapse
Affiliation(s)
- Takahiro Nabeyama
- University of Tsukuba, Faculty of Health and Sport Sciences, Tsukuba, Ibaraki, Japan
| | - Yosuke Suzuki
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | - Hiroaki Saito
- Department of Internal medicine, Soma Central Hospital, Soma, Fukushima, Japan
| | - Kana Yamamoto
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| | | | - Yoichiro Sasaki
- University of Tsukuba, Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki, Japan
| | - Haruka Shindo
- University of Tsukuba, Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki, Japan
| | - Morihito Takita
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
- Navitas Clinic, Department of Internal Medicine, Tachikawa, Tokyo, Japan
| | - Masahiro Kami
- Medical Governance Research Institute, Minato-ku, Tokyo, Japan
| |
Collapse
|
10
|
Ekenros L, Fridén C, von Rosen P. Previous Injury and Lower Well-being Increase Injury Risk in Female Adolescent Athletes. Int J Sports Med 2023; 44:919-924. [PMID: 37490928 DOI: 10.1055/a-2108-6463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Several risk factors for injury have been suggested in female elite athletes. However, there is a lack of prospective studies in young female athletes where multiple risk factors have been studied. The aim of this study was to identify risk factors for injury in female adolescent elite athletes. Substantial injuries were monitored in 222 athletes using the validated Oslo Sports Trauma Research Centre Questionnaire over 20 weeks. Over 20 potential risk factors were explored. Based on a binomial generalized linear mixed model, two significant (p<0.05) risk factors for injury were identified; previous injury within the last 12 months (OR 2.55) and well-being (OR 0.97). An athlete with a previous injury had twice as high a risk of injury (13% vs. 6%) compared to an athlete with no previous injury. Higher perceived well-being was associated with a decreased risk of injury. Based on a prospective design with a large sample of female adolescent elite athletes, investigating over 20 potential risk factors for injury, our results suggest that a previous injury and well-being are risk factors for injury.
Collapse
Affiliation(s)
- Linda Ekenros
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Cecilia Fridén
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Philip von Rosen
- Department of Neurobiology, Care Sciences, and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
11
|
Hirschberg AL. Author's Reply to Prado: Comment on "Challenging Aspects of Research on the Influence of the Menstrual Cycle and Oral Contraceptives on Physical Performance". Sports Med 2023; 53:931-932. [PMID: 38163842 DOI: 10.1007/s40279-022-01787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, SE, Sweden.
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 171 76, Stockholm, SE, Sweden.
| |
Collapse
|
12
|
Impact of Premenstrual Syndrome Symptoms on Sport Routines in Nonelite Athlete Participants of Summer Olympic Sports. Int J Sports Physiol Perform 2023; 18:142-147. [PMID: 36577421 DOI: 10.1123/ijspp.2022-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE Most women during their lifetime experience a combination of premenstrual syndrome (PMS) symptoms (eg, menstrual cramps) before and often to the end of menstruation. However, the impact of these symptoms on sport routines (eg, performance, training absence) during phases around menstruation is still unclear. Therefore, we investigated the impact of PMS symptoms on sport routines among nonelite athletes over 3 phases related to menstruation. METHODS An online questionnaire was developed to recruit nonelite female athletes who participate in summer Olympic sports. Participants were allocated into 2 groups: those who experienced mild to moderate PMS symptoms (no-PMS) and those with severe PMS symptoms (p-PMS). Two hundred thirty-four responses from eumenorrheic women (p-PMS = 78%) were considered valid. An unpaired Student t test was conducted to compare demographic characteristics between groups and chi-square test to evaluate the impact of PMS status on sport routines between groups. RESULTS A significant (P < .05) proportion of women in the p-PMS group changed their training schedule because of menstrual (55%) and premenstrual (61%) symptoms compared with the no-PMS group. Overall, all participants indicated that training (P = .01) and competitive (P < .01) performance are impacted during menstruation, followed by a greater impact (P < .05) in the p-PMS group before menstruation. CONCLUSION The presence of PMS symptoms reduces training and competitive performance, primarily during and before menstruation, respectively. Severity of PMS symptoms was significantly associated with alterations in training schedule but not with competitive schedule.
Collapse
|
13
|
Roles of Estrogen, Estrogen Receptors, and Estrogen-Related Receptors in Skeletal Muscle: Regulation of Mitochondrial Function. Int J Mol Sci 2023; 24:ijms24031853. [PMID: 36768177 PMCID: PMC9916347 DOI: 10.3390/ijms24031853] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Estrogen is an essential sex steroid hormone that functions primarily in female reproductive system, as well as in a variety of tissues and organs with pleiotropic effects, such as in cardiovascular, nervous, immune, and musculoskeletal systems. Women with low estrogen, as exemplified by those in postmenopause, are therefore prone to suffer from various disorders, i.e., cardiovascular disease, dementia, metabolic syndrome, osteoporosis, sarcopenia, frailty, and so on. Estrogen regulates the expression of its target genes by binding to its cognate receptors, estrogen receptors (ERs) α and β. Notably, the estrogen-related receptors (ERRs) α, β, and γ are originally identified as orphan receptors that share substantial structural homology and common transcriptional targets with ERs. Accumulating evidence suggests that ERs and ERRs play crucial roles in skeletal muscles, such as muscle mass maintenance, muscle exercise physiology, and muscle regeneration. In this article, we review potential regulatory roles of ERs and ERRs in muscle physiology, particularly with regard to mitochondrial function and metabolism.
Collapse
|
14
|
Bergström M, Rosvold M, Sæther SA. "I hardly have a problem […] I have my period quite rarely too": Female football players' and their coaches' perceptions of barriers to communication on menstrual cycle. Front Sports Act Living 2023; 5:1127207. [PMID: 37033882 PMCID: PMC10076858 DOI: 10.3389/fspor.2023.1127207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Symptoms related to the menstrual cycle (MC) affect the performance level and health of female athletes in various ways. Previous research has reported MC symptoms such as pain, mood disturbance, reduced coordination and competition distraction as well as diminished performance levels and an increased injury risk among female elite athletes. Despite this, the coach-athlete communication related to the female hormonal cycle is limited. The aim of the present study was to explore the perceptions of MC communication in a group of junior elite football players and their male coaches in a case study of one youth football team in a specific club in Norway. Methods The study used a qualitative approach with semi-structured interviews. In total, 8 female junior elite players (aged 16-20) from a Norwegian football team and 2 of their male coaches participated in the study. Results The data analysis revealed two main communication barriers: 1. interpersonal barriers (e.g., false assumptions about the coach/athletes and social discomfort) and 2. knowledge barriers (e.g., unaware/perceptions of insufficient knowledge levels). Discussion As the players seemed to be unaware of their insufficient MC knowledge (e.g., failed to see a connection between the MC and their health and performance level), the coaches perceived their knowledge as insufficient and coped mainly by outsourcing MC communication to female staff and apps. Hence, the MC communication was hindered by both the athletes and the coaches (e.g., mutual avoidance). In line with previous research, this study supports that there is a need for developing effective strategies to overcome the interpersonal barriers and knowledge gaps.
Collapse
|
15
|
Colenso-Semple LM, D'Souza AC, Elliott-Sale KJ, Phillips SM. Current evidence shows no influence of women's menstrual cycle phase on acute strength performance or adaptations to resistance exercise training. Front Sports Act Living 2023; 5:1054542. [PMID: 37033884 PMCID: PMC10076834 DOI: 10.3389/fspor.2023.1054542] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction The bias towards excluding women from exercise science research is often due to the assumption that cyclical fluctuations in reproductive hormones influence resistance exercise performance and exercise-induced adaptations. Methods Hence, the purpose of this umbrella review was to examine and critically evaluate the evidence from meta-analyses and systematic reviews on the influence of menstrual cycle phase on acute performance and chronic adaptations to resistance exercise training (RET). Results We observed highly variable findings among the published reviews on the ostensible effects of female sex hormones on relevant RET-induced outcomes, including strength, exercise performance, and hypertrophy. Discussion We highlight the importance of comprehensive menstrual cycle verification methods, as we noted a pattern of poor and inconsistent methodological practices in the literature. In our opinion, it is premature to conclude that short-term fluctuations in reproductive hormones appreciably influence acute exercise performance or longer-term strength or hypertrophic adaptations to RET.
Collapse
Affiliation(s)
| | - Alysha C. D'Souza
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | | | - Stuart M. Phillips
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
- Correspondence: Stuart M. Phillips
| |
Collapse
|