The Exercising Female: Science and Its Application 0815391986, 9780815391982

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The Exercising Female

The Exercising Female: Science and Its Application is the first book to provide students, researchers, and professionals with an evidence-­based reference on the exceptional scientific issues associated with female participation in sport and exercise. Based on the latest research, and treating women as a unique population, the book seeks to critically evaluate current debates, present the science underpinning female sport and exercise performance, and inform applied practice for the exercising female. Featuring contributions from leading scientists from around the world, and adopting a multidisciplinary approach – from exercise physiology, endocrinology, and biochemistry to psychology, biomechanics, and sociology – the book includes chapters on topics such as: • • • •

Exercise and the menstrual cycle, contraception, pregnancy, motherhood, and menopause. Body image, exercise dependency, the psychology of sports performance, and homophobia in female sport. The Female Athlete Triad, bone health, musculoskeletal injury, and breast biomechanics. Nutritional requirements for the exercising female, immune function and exercise, and cardiovascular health.

Filling a considerable gap in book literature around the science of female sport and exercise, this is crucial reading for any student studying female sport and exercise science, researchers of female sport, and any coach, sport scientist, strength and conditioning coach, sport psychologist, physician, or physiotherapist working with female athletes. Jacky Forsyth is an associate professor at Staffordshire University, UK. She is a prominent researcher and speaker in the area of women’s exercise and health. Her research is centred on the interactive effect of ovarian hormones, exercise, and bone. One of her research priorities is to promote, raise awareness, and to advance understanding of the key influences, which impact the exercising female. She is vice chair of the Women in Sport and Exercise Academic Network (WISEAN), the aim of which is ‘To grow, strengthen, and promote research on women in sport and exercise, with the ultimate goal of optimising women’s athletic success and their participation’. Jacky publishes regularly in peer-­reviewed journals in her field. Claire-­Marie Roberts is a senior lecturer in Sport and Exercise Psychology at the University of the West of England, Bristol, UK, and a practising Sport Psychology consultant. Her experiences of working with athletes reflect her research interests. These include female-­ specific issues relating to career transitions in sport such as pregnancy and motherhood and the psychology of female sport performance. Claire-­Marie is the chair of the WISEAN, a non-­ executive board director of UK Anti-­Doping, and a member of the Women in Sport Research Action Group.

Routledge Research in Sport and Exercise Science

The Routledge Research in Sport and Exercise Science series is a showcase for cutting-­edge research from across the sport and exercise sciences, including physiology, psychology, biomechanics, motor control, physical activity, and health, and every core sub-­discipline. Featuring the work of established and emerging scientists and practitioners from around the world, and covering the theoretical, investigative, and applied dimensions of sport and exercise, this series is an important channel for new and groundbreaking research in the human movement sciences. Available in this series: The Athlete Apperception Technique Manual and Materials for Sport and Clinical Psychologists Petah M. Gibbs, Mark B. Andersen and Daryl B. Marchant Complex Sport Analytics Felix Lebed The Science of Figure Skating Edited by Jason D. Vescovi and Jaci L. VanHeest The Science of Judo Edited by Mike Callan Modelling and Simulation in Sport and Exercise Edited by Arnold Baca and Jürgen Perl The Exercising Female Science and Its Application Edited by Jacky Forsyth and Claire-­Marie Roberts For more information about this series, please visit: www.routledge.com/ sport/series/RRSES

The Exercising Female Science and Its Application

Edited by Jacky Forsyth and Claire-­Marie Roberts

First published 2019 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2019 selection and editorial matter, Jacky Forsyth and Claire-­Marie Roberts; individual chapters, the contributors The right of Jacky Forsyth and Claire-­Marie Roberts to be identified as the authors of the editorial matter, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-­in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-­in-Publication Data A catalog record has been requested for this book ISBN: 978-0-8153-9198-2 (hbk) ISBN: 978-1-351-20027-1 (ebk) Typeset in Garamond by Wearset Ltd, Boldon, Tyne and Wear

Contents



List of figures List of tables List of contributors Acknowledgements List of abbreviations

  1 Introduction to The Exercising Female: Science and Its Application

viii ix x xii xiii

1

J A C K Y F O R S Y T H A N D C L A I R E - M A R I E R oberts

  2 The adolescent exercising female

7

L indsay W oodford

  3 The menstrual cycle and the exercising female: implications for health and performance

19

N ancy I . W illiams and K aitlyn M . R uffing

  4 Hormonal-based contraception and the exercising female

30

K irsty J . E lliott - ­S ale and K irsty M arie  H icks

  5 Energy and the nutritional needs of the exercising female

44

J oan M . E ckerson

  6 The Female Athlete Triad M ary J ane D e S ou z a , K R isten J . K oltun , E mily A . S outhmayd , and N icole C . A urigemma

66

vi   Contents

  7 Bone health and the exercising female

85

J acky F orsyth and K aren  H ind

  8 Body image and the exercising female

100

S arah G rogan

  9 Exercise addiction in the exercising female: an interdisciplinary examination

112

H eather A . H ausenblas and D erek T . Y .   M ann

10 Immune function and the exercising female

125

J udith A llgro v e and G len D a v ison

11 Musculoskeletal injury and the exercising female

142

M imi Zumwalt

12 Breast health and the exercising female

160

J enny B urbage , M ichelle N orris , B rogan H orler , and T im B lackmore

13 The psychology of female sport performance

175

C laire - ­M arie R oberts , L eah F erguson , and A mber M osewich

14 The changing nature of lesbian athletes coming out in competitive organised team sports

187

R achael B ullingham

15 Pregnancy and the exercising female

198

R obin P ickering

16 Postnatal depression and the exercising female

211

A manda J . D aley and R uth V . P ritchett

17 Motherhood in the exercising female

224

C laire - ­M arie R oberts and G ö ran K entt ä

18 Athletic career termination in females C laire - ­M arie R oberts

236

Contents   vii

19 Cardiovascular health and the exercising female

245

K aren B irch and G emma  L yall

20 Menopause and the exercising female

259

H elen J ones , M adeleine F rance , and D a v id A .   L ow



Index

276

Figures

  6.1 The Female Athlete Triad   6.2 Reproductive hormone profiles across the spectrum of menstrual cycle types 11.1 Risky limb landing attitude 11.2 Hip/knee angular difference 11.3 Alignment/forces across the knee joint 11.4 Risky versus safe landing positions 11.5 Anterior cruciate ligament tear 12.1 Representative figure of eight breast trajectory for a 34D female over five gait running cycles 19.1 The effects of oestrogen loss, for example after menopause, upon parameters of cardiovascular health 20.1 Practical recommendations for exercise training to increase cardiorespiratory fitness in postmenopausal women

67 73 145 146 147 151 153 165 246 261

Tables

  5.1 Calculations to estimate energy requirements for females   5.2 Guidelines for carbohydrate, protein, and fat intake for exercising females   9.1 Exercise addiction criteria 10.1 Illness incidence proportion (per cent) among athletes at major competitive events 12.1 Regnault’s system for the grading of breast ptosis 16.1 Subgroup meta-analysis by population, intervention type, and exercise context 20.1 Summary of cardiorespiratory fitness changes from exercise training studies performed in postmenopausal women 20.2 The exercise training- mediated changes in hot flush frequency and severity measured using subjective rating scales 20.3 Participant characteristics and menopausal systems prior to (pre) and following (post) 16 weeks of moderate-­intensity supervised exercise

47 49 114 137 162 214 260 267 270

Contributors

Dr Judith Allgrove, Kingston University, UK. Miss Nicole C. Aurigemma, Pennsylvania State University, USA. Professor Karen Birch, University of Leeds, UK. Dr Tim Blackmore, University of Portsmouth, UK. Dr Rachael Bullingham, University of Worcester, UK. Dr Jenny Burbage, University of Portsmouth, UK. Professor Amanda J. Daley, Loughborough University, UK. Dr Glen Davison, University of Kent, UK. Professor Mary Jane De Souza, Pennsylvania State University, USA. Professor Joan M. Eckerson, Creighton University, USA. Dr Kirsty J. Elliott-­Sale, Nottingham Trent University, UK. Dr Leah Ferguson, University of Saskatchewan, Canada. Dr Jacky Forsyth, Staffordshire University, UK. Miss Madeleine France, Liverpool John Moores University, UK. Professor Sarah Grogan, Manchester Metropolitan University, UK. Professor Heather A. Hausenblas, Jacksonville University, USA. Dr Kirsty Marie Hicks, Northumbria University, UK. Dr Karen Hind, Leeds Beckett University, UK. Miss Brogan Horler, University of Portsmouth, UK. Professor Helen Jones, Liverpool John Moores University, UK. Dr Göran Kenttä, The Swedish School of Sport and Health Sciences GIH, Sweden.

Contributors   xi Ms Kristen J. Koltun, Pennsylvania State University, USA. Dr David A. Low, Liverpool John Moores University, UK. Miss Gemma Lyall, University of Leeds, UK. Dr Derek T. Y. Mann, Jacksonville University, USA. Dr Amber Mosewich, University of Alberta, Canada. Ms. Michelle Norris, University of Portsmouth, UK. Dr Robin Pickering, Whitworth University, USA. Dr Ruth V. Pritchett, University of Birmingham, UK. Dr Claire-­Marie Roberts, University of the West England, UK. Miss Kaitlyn M. Ruffing, Pennsylvania State University, USA. Miss Emily A. Southmayd, Pennsylvania State University, USA. Professor Nancy I. Williams, Pennsylvania State University, USA. Mrs Lindsay Woodford, University of the West England, UK. Professor Mimi Zumwalt, Texas Tech University, USA.

Acknowledgements

Jacky Forsyth and Claire-­Marie Roberts We would both like to extend our heartfelt thanks to all the authors of each chapter, who contributed to the writing of this book. These authors put so much time and effort into ensuring that the content within each chapter was thoroughly researched and relevant, and we are both extremely grateful. Special thanks also go to Megan Smith, Rebecca Connor, and William Bailey at Routledge and Anastasia Said for their support and assistance in producing this book.

Mimi Zumwalt I would like to dedicate Chapter 11 to significant females in my life: my mother Francoise and daughter Demi, both of whom I appreciate/love with all my heart! I also want to thank Mark Wellborn and Charles Henderson for their expert IT/AV assistance.

Abbreviations

3D ACL ACSM BCAA BM BMD BMI BMR CBT CHO COLIA1 CRP CVD DCs DMPA DSM-­5 DT DXA EA EAA EEX EI eNOS EPOC ERα ERβ ET-­1 FFA FFM FHA FSH GABA HDL-­C

Three-­dimensional Anterior cruciate ligament American College of Sports Medicine Branched chain amino acids Body mass Bone mineral density Body mass index Basal metabolic rate Cognitive behavioural therapy Carbohydrate Collagen type I alpha 1 C-­reactive protein Cardiovascular disease Dendritic cells Depot Medroxyprogesterone Acetate Diagnostic and Statistical Manual, 5th edition Drive for thinness Dual energy X-­ray absorptiometry Energy availability Essential amino acids Energy expenditure from structured exercise Energy intake Endothelial nitric oxide synthase Excess post-­exercise oxygen consumption Oestrogen receptor-­alpha Oestrogen receptor-­beta Endothelin-­1 Free-­fatty acids Fat-­free mass Functional hypothalamic amenorrhoea Follicle-­stimulating hormone Gamma-­aminobutyric acid High-­density lipoprotein cholesterol

xiv   Abbreviations HPA HRT IDA IGF-­1 IL IL-­1ra IMTG LBM LDL-­C LGBT MPS MRI NICE NK NKCA NO OC OPG OT PEP PND pQCT PRO RANK RANKL RBCs RCT REE RMR ROS SBP SD sIgA SOD SOP SPP TDEE TEA TEF TG TNFα Triad TT3 URS URTI

Hypothalamic-­pituitary-adrenal Hormone replacement therapy Iron-­deficiency anaemia Insulin-­like growth factor-­1 Interleukin Interleukin receptor antagonist Intramuscular triglycerides Lean body mass Low-­density lipoprotein cholesterol Lesbian, gay, bisexual, and transsexual Muscle protein synthesis Magnetic resonance imaging National Institute for Health and Care Excellence Natural killer Natural killer cell cytotoxic activity Nitric oxide Oral contraceptive Osteoprotegerin Overtraining syndrome Prevent Injury and Enhance Performance Postnatal depression Peripheral quantitative computed tomography Protein Receptor Activator of Nuclear factor Kappa-­B Receptor Activator of Nuclear factor Kappa-­B Ligand Red blood cells Randomised controlled trial Resting energy expenditure Resting metabolic rate Reactive oxygen species Systolic blood pressure Standard deviation Secretory immunoglobulin Superoxide dismutase Self-­oriented perfectionism Socially-­prescribed perfectionism Total daily energy expenditure Thermic effect of activity Thermic effect of food Triglycerides Tumour necrosis factor alpha Female Athlete Triad Total triiodothyronine Upper respiratory symptoms Upper respiratory tract infections

Abbreviations   xv UVB . VO2max WHI WHO

Ultraviolet B Maximal oxygen consumption Women’s Health Initiative World Health Organization

1 Introduction to The Exercising Female: Science and Its Application Jacky Forsyth and Claire-­Marie Roberts

Trends in sport and exercise for females At the recreational level, there is a general decline in rates of participation in sport and exercise through the female lifespan; sociocultural reasons can be used to explain this trend. However, recent efforts to engage women in sport and exercise worldwide have had a positive impact, and general participation trends are on the increase. Additionally, we are seeing a greater percentage of female athletes comprising national teams at multisport, major events such as the Olympic Games. The possible reasons for this increase include a change of mindset, where women are now rightly viewed as a unique population, with their own motivations and barriers to participation. Despite this growth in women’s participation in sport and exercise, research on the exercising female, and how a woman’s body responds to exercise still falls short of that carried out on men. For instance, there is limited research on how variations in ovarian hormones can affect sports performance (Bruinvels et al., 2017), and females, as participants in research, are significantly under-­represented in sport and exercise medicine (Costello, Bieuzen, & Bleakley, 2014). Training programmes, exercise regimes, dietary guidelines, psychological interventions, and injury prevention and rehabilitation programmes are therefore, largely based on research that has been carried out on men. It is important to keep studying and researching about females who exercise, since the research that has emerged in the last few decades, as explored in this book, has identified that women should be considered in isolation, and not grouped with men, when conducting research, and when providing recommendations for training. Sex discrimination, gender inequality, gender bias, and gender stereotyping in sport and exercise continue to exist, since, historically, sport has been a male-­dominated, and male-­controlled institution (Brown & Stone, 2016; Plaza, Boiché, Brunel, & Ruchaud, 2017; Shin, 2017). This sexual inequality is evidenced in the media portrayal of females in sport, where, as well as there being a lack of coverage on women’s sport, a sports woman’s physical attributes are often prioritised over their performance attributes (Musto, Cooky, & Messner, 2017; Walker & Bopp, 2010). Female professional athletes earn less

2   Jacky Forsyth and Claire-Marie Roberts than their male counterparts (Women’s Sports Foundation, 2015), with no women featuring in the top 100 of Forbes’ list of the world’s highest-­paid athletes for 2018 (Badenhausen, 2018). Males also outnumber females in sport- and exercise-­related employment, especially in graduate-­level jobs, senior roles, and in leadership positions (Hartmann-­Tews & Pfister, 2005). For instance, there are far fewer female head athletic trainers (Mazerolle, Burton, & Raymond, 2015), sports physicians (Stern, Gateley, & Barrett, 2013), sport coaches/head coaches (Acosta & Carpenter, 2014; Norman, 2012; Walker & Bopp, 2010), and governance executives of organised sport (Burton, 2015; Koca & Öztürk, 2015; Pfister & Radtke, 2009) than there are male. From 87 subject-­specific statues (ignoring anonymous and unknown figures) in the UK, there are only two that depict women, that of Mary Peters (athletics) and Dorothy Round (tennis) (Stride, Thomas, & Wilson, 2012). Of the 387 in situ, subject-­specific football (soccer) statues around the world, only one (