11/11/2022

1.- Women and exercise

Although women and men display similar physiological adaptations to exercise
training, there are some gender-specific physiological factors that must be
taken into account when examining the effects of exercise on women.
1.1.- Differences between Female and Male Physiology
• Women typically have lower body weight (~14 kg) and height (~13 cm) than
men
• Women typically have lower fat-free mass (less muscle mass), and higher
body fat than men
• The lower muscle mass is due to a decrease in the diameter of muscle
fibers, given that the number of fibers in each muscle is similar in both
sexes
• Women tend to have higher proportion of Type I fiber than men (men
have higher proportion of Type IIa fibers)
• Women have lower absolute force (strength) and power than men.
• This difference is especially relevant in the upper body strength 
most of women’s muscle mass is below the waist.

• At prolonged submaximal effort, the rate of lipolysis is higher in women than

in men (men show greater glycogen utilization)
• As compared with men, women have lower stroke volume, lower maximal
cardiac output , and lower hemoglobin concentration (testosterone increases
EPO production). Therefore 
• Women have a VO2max 5 – 15% lower than men
• Despite these physiological differences, men and women undergo similar
improvements after endurance and/or resistance training

1.2.- Effect of sexual cycle on performance

• Physical performance is not affected by the menstrual cycle
• Neither muscular strength nor muscular endurance has been found to
change throughout the menstrual cycle, and there is no correlation
between muscle function and circulating concentrations of
progesterone and estrogen
• Many female athletes experience Dysmenorrhea (painful menstruation)
that may limit training due to discomfort

2
 11/11/2022

1.3.- The female athlete triad

• Although the menstrual cycle does not affect exercise performance, the
opposite is true: large volumes of endurance training, especially when a
restricted energy intake is also present, can impair the menstrual cycle,
giving rise to the onset of amenorrhea (lost of menstrual cycles)
• The onset of amenorrhea is caused by an insufficient availability of
energy due to either an inadequate food intake (dieting, eating
disorders) or an excessive energy expenditure due to heavy
training. Relationship Between Miles Run per Week
• Many female athletes, engaged and the Incidence of Amenorrhea in Women
in sports that emphasize
thinness are dieting.
• These athletes are also at risk
of developing eating disorders
such as bulimia or anorexia
• Both dieting or eating
disorders can lead to a
deficient intake of calcium
and vitamin D that may affect
bone mineralization

Miles run per week

• An insufficient energy availability is associated with a deficient secretion of

FSH and LH, which leads to amenorrhea and deficit of estrogen production
by the ovaries
• Impaired estrogen production leads to a decreased bone mineral density
and, if severe enough, to osteoporosis. This condition can be aggravated
by an insufficient intake of calcium or vitamin D
• The decreased bone mineral density leads to an increased risk of bone
stress fractures
• The interrelationship between insufficient energy availability,
amenorrhea, and decreased bone density has been termed  The
Female Athlete Triad
• 4% of all female athletes meet criteria for triad
• 26% possess at least two components
• The primary treatment for the condition involves increasing energy intake
and/or reducing training volume so that energy availability becomes
sufficient to permit normal menstrual function and female sex steroid
synthesis

4
 11/11/2022

The Female
Athlete’s Psychological/Competitive Stress
Triad
Insufficient Energy Availability
(Excessive Training Volume and/or
Dieting – Eating Disorders)

Bone Mineral Loss Amenorrhea

1.4.- Exercise and Pregnancy

• Major adaptations during pregnancy
• Blood volume increases 40–50%
• Oxygen uptake and heart rate are higher at rest and during exercise
• Cardiac output is higher at rest and during exercise

The American College of Obstetricians and Gynecologists guidelines

(visit “papers of interest” in the web page of the course):
• Pregnant women can obtain health benefits from mild to moderate exercise
performed at least three days per week.
• Women should avoid supine exercise and motionless standing after the first
trimester because this compromises venous return, which in turn
compromises cardiac output.
• Women should stop exercising when fatigued, should not exercise to
exhaustion, and should modify their routines based on maternal symptoms.
Weight-bearing exercises under some circumstances may be continued, but
non-weight bearing activities such as cycling or swimming are encouraged
to reduce the risk of injury.
• Care should be taken not to participate in sports or exercises in which falling
or abdominal trauma may occur.

6
 11/11/2022

• Because pregnancy requires an extra 300 kcal of energy per day, an

exercising woman should pay particular attention to diet to ensure that she is
receiving adequate calories.
• Heat dissipation is of particular concern, so an exercising woman should
wear correct clothing, be sure that her fluid intake is sufficient, and select
optimal environmental conditions.

Main benefits of exercising during pregnancy

• Decreased Risk of developing Gestational Diabetes Mellitus (GDM)
• During pregnancy, most women experience insulin resistance, which
can compromise the regulation of blood glucose levels.
• Up to 7% of pregnant women develop GDM, which can lead to health
concerns for the mother (infection, excess weight gain, and postpartum
hemorrhaging) and the child (jaundice, excess weight at birth, and low
blood sugar).
• Several studies have shown that moderate exercise before and/or
during pregnancy significantly reduces the risk of GDM.

• Decreased risk of Preeclampsia

• Preeclampsia is a hypertensive disorder that has been associated with
liver and kidney failure, thrombosis, and cerebral hemorrhaging in
pregnant women.
• About 7% of pregnant women are at risk of developing preeclampsia,
and the disease accounts for 15% of all maternal deaths
• Regular exercise activity during pregnancy decreases the risk of
preeclampsia by about 50%

Moderate or even vigorous exercise during pregnancy neither increases the risk
of premature births nor has negative effect on fetal morbidity and mortality
https://www.thisisinsider.com/exercising-running-while-pregnant-2017-5

8
 11/11/2022

2.- Children and Exercise

2.1.- Exercise and Growth
• Prepubertal and pubertal athletes display the same rates of growth in height
and weight as nonathletes.
• However, natural growth rates can be attenuated in some sports in
which athletes —particularly females— are encouraged to restrict caloric
intake to maintain an abnormally low body weight and body fat content.
• Experts have concluded that adequate caloric intake must be sustained
in prepubertal and pubertal athletes to ensure proper growth and sexual
development
2.2.- Training and the cardiopulmonary system
• Heart rate both at rest and during aerobic exercise is higher in children than
in adults
• At rest and for any given exercise intensity, blood pressure is lower in
children than in adults
• After endurance training, children have lower improvements in VO2 max
(~10%) than adults (20% – 25%)

2.3.- Resistance Training

• Children can effectively gain strength as a result of resistance training, although
muscle hypertrophy is less than in adults
• Resistance training among children enhances bone density
• Concerns about safety  when using proper technique, resistance training is safe in
healthy children and adolescents (see “papers of interest” in the course’s web page)

10
 11/11/2022

3.- The Aged and Exercise

3.1.- Physiological Effect of Aging
3.1.a.- Cardiovascular System
• Maximal Cardiac Output declines with age 
• Decreased Heart Rate
• Decreased Maximal Stroke Volume due to reduced Left Ventricular
Contractility
• a-v O2 difference declines with age, due to reduced capacity of muscles to
extract oxygen from blood

Both circumstances explain the decrease in VO2max that runs parallel to age at
a rate of 8% to 10% per decade from its peak value, at approximately 25 years
of age

Ageing is associated with increased blood pressure both at rest and during
exercise  At 65 years of age about 65% of individuals are hypertensive

11

3.1.b.- Skeletal Muscle

• Muscle mass and strength are well conserved until reaching 50 years of age
(only 10% loss).
• However, beyond 50 years of age, muscle atrophy occurs at a rate of 10%
per decade, and the process accelerates after 65 years of age. This loss in
muscle mass and strength is caused by
• Atrophy of muscle fibers, with type II being most affected
• Decrease in the number of fibers comprising the muscle due to
apoptosis of type I and Type II muscle fibers
• The age-related loss in muscle mass and function is termed sarcopenia. It
is found in about a quarter of adults older than age 65, and the prevalence
increases with age.
• It is associated with the inability to perform activities of daily living such
as getting up from a chair, climbing stairs, bathing, or dressing
independently,

12
 11/11/2022

3.1.c.- Skeletal System

• Aging is associated with a loss of bone mineral density and, accordingly,
bone strength.
• This age-related decline in bone mineral density is most pronounced among
women, although it also is apparent to a lesser extent among men, and can
lead to 
• Osteoporosis, a degenerative disease characterized by bone mass loss
resulting in bone fragility. It affects 10% of U.S. citizens aged 50 years or
more.
• The age-related decline of bone mineral density has been shown to run
parallel with the loss of muscle mass and strength. This relationship has led
to the saying among gerontologists and exercise physiologists that, “strong
muscles equal strong bones.”
• Thus, they recommend weight-bearing exercise, as well as resistance
training, for the effective strengthening of not only muscles but also the
bones to which they are attached

13

3.2.- Adaptations to Exercise Training

3.2.a.- Cardiovascular System
• When engaged to endurance training programs elderly people experience
improvements in VO2max
• In both aged men and women, endurance training results in a lower heart
rate and mean arterial pressure, both at rest and during submaximal-
intensity exercise
• As in younger people, an endurance training program lasting several months
can significantly improve body composition, reducing body fat and body
mass, with minimal changes in fat-free mass

3.2.b.- Muscular System

• With appropriate resistance training programs elderly people are capable of
significantly improving their strength and undergoing muscle hypertrophy.
• Similar to endurance training, resistance exercise also significantly improves
body composition.
• Endurance training elicits reductions in fat mass with minimal effects on
lean body mass, whereas resistance training both increases lean body
mass and decreases fat mass.

14
 11/11/2022

3.2.c.- Skeletal System

• Both Endurance and Resistance training significantly enhances bone
mineral density by 1% - 3%
• The effect of endurance training only observed in weight-bearing
exercises
• The effect of resistance training is more general
3.3.- Exercise Prescription
• Most evidence suggests that older people should follow the same exercise
prescription guidelines as recommended for young adults.
• This is true for endurance training intended to improve cardiovascular
fitness, as well as resistance training designed to enhance
musculoskeletal fitness.
• Only those who have pre-existing medical conditions should limit or
even preclude exercise training.
• A unique aspect of exercise prescription for the aged is the inclusion of
exercises that are designed specifically to improve balance and
coordination.
• This is done in response to and increased likelihood of bone fractures
and other morbidities that result from falls.
• Hip fractures are of particular concern among the aged because
mortality rate within 1 year of the injury is about 20% (one in each five
individuals with hip fractures).
15

Physical Exercise and Disease

1º.- Asthma
• Asthma is a contraction of the smooth muscle of the bronchioles.

• This bronchoconstriction typically is triggered by exposure to environmental

allergens, which cause an inflammatory response when mast cells located
on the airway surface release histamine, prostaglandins, and leukotrienes.

• Asthma can affect people of all ages, but it is most commonly identified
among children and adolescents because they are more regularly exposed
to environments where allergens can be found.

• Both the American College of Sports Medicine and the American Thoracic
Society recommend that asthmatic patients participate in regular and
vigorous activity, assuming, of course, that they are controlling their
condition with medications.

16
 11/11/2022

Exercise-Induced Asthma (EIA)

• Since physical activity requires a marked increase in pulmonary ventilation,

this can trigger the onset of asthma’s symptoms. Indeed, up to 90% of
asthma patients experience what is termed “exercise induced asthma,” or
EIA
• However, EIA is not exclusive of asthma patients. Up to 13% of EIA cases
appear in otherwise healthy individuals
• EIA is especially related to endurance exercise, such as running, cycling,
and swimming. However, any mode of exercise performed at an intensity ≥
80% of VO2max is capable of evoking EIA in susceptible individuals.

Etiology of EIA
• As exercise begins and ventilation increases, the airways network
undergoes a process of cooling and dehydration. The greater the ventilation
rate, the more severe the dehydration and cooling of the airway surface.
• When the mast cells located in the walls of the airways dry, they release
leukotrienes and histamine, triggering an inflammatory response and
bronchoconstriction.
• Because cold air also tends to be dry, outdoor winter sport athletes are
especially vulnerable to EIA.

17

Prevention of EIA
Pharmacologic Measures
• Inhaling β2 agonists 15 minutes before the onset of exercise has been proven to be
useful.
• Other therapeutic possibilities: glucocorticoids or leukotrinene inhibitors
• Competitive athletes should consult with their physicians what asthma medications
are considered safe in order to avoid disqualifications (doping)

Nonpharmacological measures
• Because exercise itself acts as a bronchodilator, it is important that those affected by
EIA warm-up properly before training. This warm-up should include short bursts of
high-intensity exercise to stimulate the release of catecholamines, which elicit
bronchodilation.
• At the cessation of exercise, it is advisable to gradually cool down.
• Managing the environment in which the athlete practices and competes may also
contribute to the effective prevention of EIA.
• For those who have reactions to pollen or other naturally occurring allergens in
the air, simply avoiding freshly cut grass or fields may be helpful.
• For cold-weather athletes, a face mask can be useful to warm and humidify the
inhaled air before it enters the air passages.
• With appropriate treatment, virtually all the athletes who displays EIA symptoms can
participate in vigorous physical activity and sports

18
 11/11/2022

2.- Diabetes
• Diabetes is a disease characterized by the inability to maintain blood
glucose levels within their normal limits (70 – 99 mg/dl). Two types:
• Type 1. Most frequent in children. There is a failure of the pancreas to
produce and secrete insulin into the bloodstream. It account for 10% of
the cases, and is treated with insulin.
• Type 2. Most frequent in adults. It is caused by a decreased insulin
sensibility of target tissues such as liver, adipose tissue, and skeletal
muscle. It accounts for 90% of the cases, and is usually controlled with
oral antidiabetic drugs. This disease is linked to excessive fat
accumulation, especially in the abdomen
• The incidence of diabetes increases according to age.
• Perhaps more alarming is the more than doubling in the prevalence of
diabetes since 1980, even when changes in aging demographics are
accounted for.
• Among adults from Canary Islands, 12% of men and 10% of women are
diabetic (CDC study). This prevalence is higher than in the rest of Spain

http://www.mscbs.gob.es/biblioPublic/publicaciones/recursos_propios/re
sp/revista_cdrom/vol83/vol83_4/RS834C_567.pdf
• Moreover, the mortality rate attributed to diabetes among Canarians
is three times higher than in the rest of Spain.
19

Diagnosis  To have either

• Fasting blood glucose level higher than or equal to 126 mg/dl
• A casual blood glucose level higher than or equal to 200 mg/dl
• Blood glucose level higher than or equal to 200 mg/dl 2 hours after the taking of 75
grams of glucose dissolved in water (Oral Glucose Tolerance Test  OGTT)
• To have glycated hemoglobin (Hb A1C) higher than or equal to 6.5%

Prediabetes  People without diabetes but with signs of altered glucose metabolism 
high risk of developing diabetes. Diagnosis:
• Fasting plasma glucose levels between 100 – 125 mg/dl
• Plasma glucose levels between 140 – 199 during a OGTT
• To have glycated hemoglobin levels between 5.7% – 6.4%

20
 11/11/2022

Exercise and Type 1 Diabetes

• Increased use of glucose by working muscles during exercise may lead to
hypoglycemia, which leads to confusion, loss of coordination, and even coma
• Because of the risk of hypoglycemia, many people with type 1 diabetes avoid sports
and working out.
• Despite reservations that exercise may lower blood glucose, exercise has
traditionally been, and continues to be, a vital component of the therapeutic strategy
prescribed for diabetic patients.
• The diabetic athlete requires adaptations to maintain normoglycemic conditions
during training: In endurance events, insulin dosages should be reduced and
carbohydrates should be eaten before workouts. It is also important to monitor blood
glucose following exercise

21

Exercise and Type 2 Diabetes

• Unlike type 1 diabetes, in which exercise can only play a role in managing
the condition, type 2 diabetes can not only be treated but also prevented
with exercise
• Exercise augments the sensitivity of target tissues to insulin, thereby
improving the uptake of blood glucose and thus ameliorating the needs for
insulin
• Other benefits accrued from exercise training are related to the
cardiovascular risk factors commonly associated with type 2 diabetes.
• Regular sessions of aerobic exercise help reduce hypertension, poor
blood lipid profiles (i.e., high cholesterol and triglycerides), and poor
body composition typically identified among those with type 2 diabetes.
• Indeed, the risk of death from cardiovascular disease and its
complications is up to four times higher in those with diabetes than in the
general population.
• It has been estimated that including regular physical activity as part
of a healthier lifestyle might decrease this risk by more than 50%

22
 11/11/2022

Before engaging in an exercise training regimen, patients

with type 2 diabetes should undergo a thorough medical
screening and consultation with a physician

Exercise and Hypertension

• About one-third of adults are hypertensive.
• The prevalence of hypertension increases with age. After 65 years of age
about 66% of individuals are hypertensive
• Hypertension is defined as resting blood pressure ≥ 140/90 for systolic
and/or diastolic blood pressure
• There are methods of effectively managing hypertension, including the use
of antihypertensive medications and lifestyle modifications. One of those
lifestyle changes is exercise training
• The most effective mode of exercise in treating hypertension is aerobic-type
endurance exercise such as walking, jogging, cycling, and swimming. Most
research demonstrates that when such activity is performed at a moderate
intensity (<70% of VO2max) for 30–60 minutes per session over a period of
several weeks, resting systolic and diastolic blood pressure decreases by 7
and 6 mm Hg, respectively, among hypertensive patients.

23

• Endurance training attenuates the rise in blood pressure during moderate-

intensity, aerobic exercise
• Aerobic exercise causes a significant postexercise decrease in blood
pressure among hypertensive patients. This has been termed “postexercise
hypotension,” and lasts for up to 22 hours following moderate-intensity
endurance exercise.
• Resistance training also induces declines in resting systolic and diastolic
pressures but to a lesser extent (only 3 mm Hg) than aerobic exercise
• Heavy weight lifting can have a marked pressor effect and should be
avoided
• Hypertensive patients would avoid the Valsalva Maneuver 
https://fundaciondelcorazon.com/corazon‐facil/blog‐impulso‐vital/2413‐
entrenamiento‐de‐fuerza‐en‐hipertensos‐i.html
• Hypertensive patients should avoid isommetric exercises
• If hypertension is poorly controlled, heavy physical exercise as well as
maximal exercise testing should be discouraged or postponed until
appropriate drug treatment has been instituted and blood pressure lowered .
• When exercising, it appears prudent to maintain systolic blood pressures at
≤220 mmHg and/or diastolic blood pressures ≤105 mmHg

24
 11/11/2022

Aerobic Endurance Training is the method of choice for patients with

hypertension

25

Exercise and Coronary Artery Disease (CAD)

• Physical Inactivity is a risk factor for CAD.
• According to the American Heart Association, these risk factors include
• Family history of premature cardiovascular disease
• Age
• Sex
• Ethnicity
• Tobacco smoke
• Hypertension
• Abnormal blood lipids and lipoproteins
• Physical inactivity Modificable factors
• Obesity and overweight
• Diabetes and insulin resistance
• Stress

• Exercise, especially endurance aerobic training is associated with a reduced risk of

developing cardiovascular disease. This is due to
• Exercise causes a significant reduction in resting blood pressure
• Exercise causes decrement in both LDL-C (10%) and Triglycerides
• Exercise tends to increase serum levels of HDL-C
• Exercise helps to reduce body weight
• Exercise improves the diabetic state
• Exercise helps to reduce stress

26