Ch. 13- Female
What are common medications that can be prescribed for conditions within the triad?
estrogen: for women with menstrual dysfunction and at risk for osteoporosis; can improve bone mineral retention antidepressants: for women who have a diagnosed eating disorder
What effect does human placental lactogen have on the body during pregnancy?
functions like growth hormone to alter metabolic properties to deliver more energy to the growing baby
What is Pica and what are the complications associated with?
having an appetite for nonnutritive substances (ex. paper, chalk, or sand) complications: GI stress and blockages
When should you stop exercise and seek medical attention in pregnant and postpartum women?
-vaginal bleeding -shortness of breath before exercise -dizziness -headache -chest pain - muscle weakness -calf pain or swelling -preterm labor -decreased fetal movements -amniotic fluid leakage
What are the 5 prevention strategies for the female athlete triad?
1. keep a written record of menstrual cycle 2. keep track of daily caloric consumption 3. eat every 3 to 4 hours, 3 meals a day with at least 2 snacks 4. consider snacks as a mini-meal with constituents that are nutritious and healthy 5. keep a written record of daily exercise (mode, type, time and intensity)
what is amenorrhea?
3 or more missed cycles (90 days)
What are the recovery statistics for anorexia nervosa, bulimia nervosa, and binge-eating?
AN: after 5 years of treatment, 70% BN: after 5 years of treatment, 50% Binge-eating: recovery occurs in 20-60%
What are the KEGEL exercise recommendations for pregnant and postpartum women?
M: contract pelvic floor muscles F: daily I: can be done in sitting or standing position; squeeze the pelvic floor moving posterior to anterior (10 reps) M: hold for 3 s then release
What is loss of bone mass related to?
deficiencies in consumption of calcium and vitamin D
What is osteoporosis characterized by?
bones are more porous and thus fragile due to negative changes in estrogen and loss of calcium -bone is undergoing constant renewal called modeling that consists of resorption (breakdown or removal: osteoclasts) and formation (growth: osteoblasts)
What effect does relaxin have on the body during pregnancy?
may contribute to low back pain and affect other joints due to relaxing of the surrounding ligaments -may lead to inflammation and pain
What medications are given to women during pregnancy and postpartum?
over the counter medicines to alleviate side effects: -headaches -constipation -hemorrhoids -diarrhea -nausea -bloating -heartburn prenatal vitamin/ mineral -folic acid -calcium -iron
What is recommended exercise for females with the female athlete triad?
shift from training and competition to treatment -need BMI to increase to 18.5 or greater
What are the AEROBIC exercise recommendations for pregnant and postpartum women?
M: lower level skill (walking, cycling or swimming) F: 3-5 days/wk not to exceed 5 I: RPE between 13-14 V: at least 150 min/wk
What are the RESISTANCE exercise recommendations for pregnant and postpartum women?
M: machines or free weights in seated position F: 2-3 sessions not to exceed 5 I: 60-80% of 10 RM (12-15 reps) after 28 weeks of pregnancy do 12-15 reps at lighter resistance V: varies
What are the FLEXIBILITY exercise recommendations for pregnant and postpartum women?
M: stretches that do not cause increased abdominal size F: daily I: maintain each stretch below discomfort threshold to reduce injury due to joint elasticity V: hold stretch for 10-30 s
What are resistance training recommendations for clients that are menopausal or postmenopausal?
M: weight bearing F: 1 or 2 sets of 15-20 reps I: 40-60% 1RM for beginners and progress slowly to 80-85% of 1RM -power training is beneficial -spine specific exercises recommended
What is rumination disorder?
Repeated regurgitation, chewing, and re-swallowing of food, not caused by: -contraction of abdominal muscles -no retching -no nausea -no heartburn -no odor -no abdominal pain
What is the female athlete triad?
The interrelationship between energy availability, menstrual function, and bone mineral density. exhibited clinically by: eating disorders, amenorrhea, and osteoporosis
What can low energy availability do to the reproductive system in girls?
-[usually after age 11 or 12] can disrupt proper functioning resulting in irregular or less frequent menstrual cycles (oligomenorrhea)
What are the feeding and eating disorders defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)?
-anorexia nervosa -bulimia nervosa -pica -rumination disorders -avoidant/restrictive food intake -"other specified feeding or eating disorders" (OSFED)
What are the benefits of exercise during postpartum?
-assist in weight loss and improve fitness levels and psychological well-being (without altering milk production) -fat breakdown also increases to deliver more free fatty acids to growing baby
What are the benefits of exercise during pregnancy?
-assist with weight management -reduce incidence of gestational diabetes -improve psychological health
What are some exercise considerations the exercise professional should remember?
-avoid hot environments -supine positions should be avoided after first trimester -avoid activity that risks abdominal trauma -postpartum exercise should resume gradually -pelvic floor exercises can assist the restoration of musculoskeletal function and alleviate urinary and anal incontinence, pelvic organ prolapse, sexual dysfunction and chronic pain
What is bulimia nervosa characterized by?
-binge eating followed by purging, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors
What are some signs of anorexia nervosa?
-brittle hair and nails -dry and yellowish skin -constipation -muscle wasting and weakness -low blood pressure -sluggish-ness -reduced body temperature -making one feel cold
What medical treatments are included when treading feeding or eating disorders?
-changes in diet -psychological treatments -prescription medications
What is avoidant/ restrictive food intake disorder (aka slective eating disorder)?
-characterized by prevention of consuming certain types of food -can be caused by significant weight loss, nutrition deficiency, use of a feeding tube or dietary supplements, or a significant psychosocial interference
What are training recommendations for menopausal and postmenopausal women?
-combine aerobic endurance, resistance training and mineral supplementation -> can improve blood lipids, muscular strength and bone mass maintenance -progression should be less than 5% per week
What effects can exercise have on females with the female athlete triad?
-could exacerbate the effects of the female athlete triad even by small amounts of caloric expenditure
What effect does estrogen have on the body during pregnancy?
-has an anabolic effect to promote breast tissue development and blood vessel enlargement -regulates levels of progesterone
What are the common side effects of hormone replacement therapy?
-headaches -nausea -fluid retention -weight gain -breast tenderness -risk of breast cancer -risk of heart disease -risk of stroke -blood clots
What are early detections of the female athlete triad?
-history of menstrual irregularities -history of stress fractures -history of depression -history of dieting -personality factors (perfectionism and obsessiveness) -pressure to lose weight -early start of sport-specific training -overtraining -recurrent and nonhealing injuries
What happens during menopause?
-hormone levels change dramatically (decreases in estrogen) -loss of bone mineral and can lead to osteoporosis -loss of ovarian follicular function cessation of child-bearing
When is postpartum and what are some characteristics?
-immediately following birth through about six weeks after delivery -menstrual cycle might not return to normal during breast feeding -musculoskeletal changes in pelvic floor muscles and pubic symphysis continue
What are the common signs and symptoms for the female athlete triad?
-irregular or absent menstrual cycles -constant feelings of tiredness and fatigue -sleeping disorders -stress fractures and recurrent injuries -self-restricted food consumption -constant efforts to be thinner -eating less food in an effort to improve performance and appearance -cold hands and feet
What does disrupted menstrual cycles result in?
-less estrogen being produced leading to a larger risk of stress fractures -less estrogen also triggers bone loss
What is osteopenia?
-loss of bone mass -occurs more in postmenopausal women due to loss of estrogen -BMD score between -1 and -2.5
What is anorexia nervosa characterized by?
-low body weight -obsessing over body shape and size -fear of gaining weight -restrictive eating behaviors
What is postmenopause and what are some symptoms?
-no menses for a 12 month period symptoms: -night sweats -back and muscle pains -loss of lean muscle -weight gain -increase in visceral abdominal fat -bloating -indigestion -constipation -heart palpitations
What is perimenopause and what are the symptoms?
-period between childbearing years and menopause (lasts 5-8 years) Symptoms: -rapid heart rate -vasomotor inability to regulate body temp -mood changes -depression -irritability -anxiety -sleep disturbances -cognitive issues such as lack of focus or concentration
What is osteoporosis?
-progressive bone disease that is characterized by a decrease in bone mass or BMD -having a BMD 2.5 or more standard deviations below mean peak bone mass of average 30 y.o.
How does exercise effect women that are pregnant or postpartum?
-promotes muscle strength and endurance -increases energy -improves body posture -improves sleep -improves mood -decreases back aches -decreases bloating -decreases swelling and constipation -improves ability to manage labor
What does medical treatment for anorexia nervosa include?
-restoring woman to healthy body weight -treating psychological issues -reducing or eliminating the behaviors or thoughts of relapse
What are the risk factors for osteoporosis?
-small boned -caucasian or asian -over age of 55 -family history of osteoporosis or hip fractures -physical inactivity -diet low in calcium and vitamin D -smoking -high consumption of alcohol
What are the risk factors for developing the female athlete triad?
-sport requires weight monitoring -social isolation -exercising more than necessary -pressure to feel the need to win -punishment for weight gain -controlling or overbearing parents or coaches
For females with the female athlete triad what factors will help bone mass and muscle strength?
-vitamin D -calcium -resistance training but low- impact
What behaviors are associated with anorexia nervosa?
-weighing oneself constantly -using laxatives -forcing oneself to vomit -exercising excessively -eating small amounts of food
What medications are used for menopause-related osteoporosis?
1. antiresorptive: prevent bone loss and lower risk of breaking bones 2. anabolic medications: increase rate of bone formation and thus bone strength
What does "other specified feeding or eating disorders" include (OSFED)?
1. atypical anorexia nervosa 2. atypical bulimia nervosa 3. binge-eating disorder (both with low frequency or limited duration) 4. purging disorder 5. night eating syndrome
What are the 5 criteria for binge eating disorders?
1. eating a large amount of food in a discrete period of time 2. eating episodes that include three or more of the following: eating faster than normal, eating until uncomfortably satiated; eating large amounts of food when not hungry; eating alone due to embarrassment amount of food consumed; feeling disgusted with oneself, depressed or guilty after eating 3. feeling emotional, distressed or anxious after binging 4. episodes that occur at least once a week for 3 months 5. not associated with repeated use of compensatory behavior and does not exclusively occur during the course of bulimia nervosa or anorexia nervosa
Out of the three components of the female athlete triad, in what order are they recovered?
1. energy availability can improve in a matter of days or weeks w/ return to normal menstrual status 2. recovery of BMD may take up to several years 3. returning to the last body weight where normal menses was last observed should be a benchmark for normal energy status
How is prevention of the female athlete triad best accomplished?
1. healthy attitude toward exercise and food 2. team approach (coaches, exercise professionals, medical personnel, and psychologists) 3. refer to licensed professional with consultation with the coach
What are medications that are used for menopausal symptoms?
1. hormone replacement therapy: -reduces severity of hot flashes -lessens irritability and sleep disorders -increase skin collage levels -assist in decreasing osteoporosis by slowing bone loss and promoting bone density 2. low doses of antidepressants 3. paroxetine and conjugated estrogens (bazedoxifene formula): treat hot flashes