CHAPTER 98 • THE FEMALE ATHLETE 579- In a study of estrogen administration in young women
with anorexia nervosa, overall there was no significant
difference in bone mass after 1.5 years between the
treatment and control groups, although it appeared that
the estrogen did help a subgroup of patients who had
body weights <70% of ideal body weight; however, a
more marked improvement in BMD was obtained with
recovery from the eating disorder and gaining weight
to ≥85% of ideal body weight and having spontaneous
return of normal menstrual function with administra-
tion of estrogen (Klibanski et al, 1995).
URINARY INCONTINENCE
- Urinary incontinence is defined by the International
Continence Society as the “involuntary loss of urine,
which is objectively demonstrable and is a social and
hygienic problem.” (Elia, 1999) - Stress urinary incontinence(SUI) is the most common
type of urinary incontinence, with a prevalence of
10–70% in women between ages 15 and 65. (Bo and
Borgen, 2001; Nygaard, 1997; Nygaard, Glowacki, and
Saltzman, 1996; Nygaard et al, 1990) - SUI is the involuntary loss of urine related to increased
intra-abdominal pressure with such activities as sneez-
ing, coughing, running, jumping, or heavy lifting. - Risk factors for SUI include anything that increases
intra-abdominal pressure and anything that could
weaken the pelvic floor muscles, such as pregnancy
and delivery, or decreased estrogen. - Athletes involved in high-impact activities such as
gymnastics (dismount/tumbling) or basketball or vol-
leyball are at risk for SUI during competition or prac-
tice (Elia, 1999; Resnick, 1997). - Management of SUI is directed at correcting the
underlying pelvic relaxation. Treatment for mild SUI
usually includes pelvic floor strengthening exercises.
For women with evidence of vaginal and urethral atro-
phy secondary to estrogen deficiency, topical or sys-
temic estrogen can be prescribed. For women with
severe pelvic relaxation and prolapse, a temporizing
measure such as a pessary may be used, but definitive
therapy will probably require an invasive treatment
such as injection therapy or a surgical repair.
EXERCISE IN PREGNANCY
•Physiologic changes of pregnancy include an increase
in blood volume and cardiac output that can have an
effect on the maternal response to exercise as early as
the first trimester, as these changes happen before
uterine and fetal growth (Clapp, 2000).
- Blood volume increases by almost 50% at term.
- The increase in plasma volume occurs before the
increase in red cell mass, leading to a dilutional anemia
in the second trimester that is partially corrected at term. - Resting heart rate increases 10 to 15 bpm during preg-
nancy, and stroke volume and cardiac output also
increase (Christian et al, 2002). - Blood pressure usually falls slightly; reaching a nadir
in the second trimester, then slowly rises to prepreg-
nancy levels by term.
•Tidal volume, minute ventilation, and oxygen con-
sumption all increase in pregnancy. - The usual increases in pulse, cardiac output, blood
pressure, and temperature with exercise are slightly
blunted in pregnancy. - Progesterone and relaxin increase pelvic and joint
laxity in pregnancy. - There is no evidence that exercise has a detrimental
effect on pregnancy or labor, or fetal well-being
(Clapp, 2000).
•Exercise during and after pregnancy has been shown
to have a positive psychologic effect (Christian et al,
2002). - The babies of regularly exercising women appear to
tolerate labor well, and have been shown to have a sim-
ilar head circumference and length, but lower body fat
than babies born to nonexercising mothers (Clapp et al,
2002). - Positive effects of exercise during pregnancy that have
been reported include—a tendency to deliver 1 week
earlier than nonexercising women, a decreased rate of
interventions during labor, including pitocin use and
cesarean section, decreased pain perception, and
being more than twice as likely to progress from 4 cm
to completely dilated in under 4 h, and an average
second stage of 36 min versus 60 min in controls
(Clapp, 2000; Christian et al, 2002).
•Exertion at altitudes up to 6000 ft appears to be safe,
but engaging in physical activities at higher altitudes
carries various risks, and women who travel to
higher altitudes should be aware of the signs and
symptoms of altitude sickness, for which they should
cease activity and descend to a lower altitude (Clapp,
2000). - Scuba diving should be avoided throughout preg-
nancy as the fetus is at increased risk of decom-
pression sickness secondary to the inability of the
fetal pulmonary circulation to filter bubble formation.
(American College of Obstetricians and Gynecologists,
2002) - Absolute contraindications to aerobic exercise during
pregnancy:
a. Hemodynamically significant heart disease
b. Restrictive lung disease
c. Incompetent cervix/cerclage
- The increase in plasma volume occurs before the