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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Women's Health".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 64763

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Special Issue Editors

Dr. Ana Belén Peinado

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Guest Editor

LFE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, Martín Fierro 7, 28040 Madrid, Spain
Interests: exercise; female athletes; women; iron metabolism; sex hormones; inflammation; muscle damage; body composition; cardiovascular fitness

Dr. Erica Wehrwein

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Guest Editor

Department of Physiology, Michigan State University, East Lansing, MI 48824, USA
Interests: autonomic physiology; baroreflex; mind-body therapy; yoga breathing; sympathetic nervous system; hypertension

Dr. Xanne Janse de Jonge

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Guest Editor

The University of Newxcastle, Callaghan NSW 2308, Australia
Interests: exercise; performance; female athletes; sex hormones; menstrual cycle; strength training; women

Special Issue Information

Dear Colleagues,

Scientific knowledge regarding female training responses and adaptations is minimum compared to the body of research concerning males. One of the reasons is the fact that including women in studies could be a methodological difficulty due to the complexity of controlling hormone fluctuations associated with the menstrual cycle.

It is important to highlight that female participation in sports over the last years has increased, which demonstrates the need for research in the area of the physiological effects and consequences of exercise in women. Further, hormonal changes should be considered when exercise response is evaluated in females besed on the increasing number of women engaging in sports and training programs.

Not only to understand the unique physiology of women and how the sex hormones might influence the physiological response to exercise and sport performance, but to study women across the age span as they experience menarche to menopause, also including postmenopausal women. Therefore, we should attempt to provide a global perspective of women’s different reproductive profiles over their lifespan and their influence over physical fitness.

Dr. Ana Belén Peinado
Dr. Erica Wehrwein
Dr. Xanne Janse de Jonge
Guest Editors

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Keywords

Sex hormones
Menopause
Menstrual cycle
Exercise
Performance
Female training

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Published Papers (11 papers)

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Research

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14 pages, 1367 KiB

Open AccessArticle

The Relationship between Anxiety and Depression Levels and General Health Status before and 12 Months after SUI Treatment in Postmenopausal Women from the Lower Silesian Population

by Maciej Zalewski, Gabriela Kołodyńska, Felicja Fink-Lwow, Anna Mucha and Waldemar Andrzejewski

Int. J. Environ. Res. Public Health 2022, 19(9), 5156; https://doi.org/10.3390/ijerph19095156 - 24 Apr 2022

Cited by 2 | Viewed by 2021

Abstract

Menopause is often the cut-off point from which most cases of stress urinary incontinence (SUI) in women begin. This dysfunction affects not only the physical experience of the patient, but is also related to the psychological aspects, leading to a reduced quality of life. Despite the large number of patients with SUI and the frequent use of surgical treatment for this condition, there are few scientific reports evaluating the effectiveness of the procedure in terms of reducing depressive symptoms or improving overall health. The aim of this study was to evaluate the relationship between anxiety and depression and general health status before and 12 months after surgical treatment for SUI in postmenopausal women. Seventy-five patients qualified for the study, but due to the long study duration, both sets of questionnaires were eventually obtained from 60 postmenopausal patients. All patients that qualified for the study had a trans obturator tape (TOT) procedure. All patients enrolled in the project were given the Hospital Anxiety and Depression Scale (hAdS) and King’s Health Questionnaire (KHQ). After 12 months of surgery with midurethral slings, symptoms of depression were present in only a small number of subjects, 11.7%, and anxiety was present in 13.3% of the entire group. The study confirms that patients with a general poor health condition may suffer from depression or anxiety, and therefore may also need psychological treatment. Patients with SUI should therefore receive therapeutic care from a multidisciplinary team, in which therapeutic activities are divided between doctors, nurses, physiotherapists and psychologists. As a result of the treatment, after 12 months, we confirmed a significant improvement in patients with depression and anxiety disorders. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

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8 pages, 317 KiB

Open AccessArticle

Hemostatic Responses to Multiple Bouts of Firefighting Activity: Female vs. Male Differences in a High Demand, High Performance Occupation

by Denise L. Smith, Gavin P. Horn, Steven J. Petruzzello, Gregory G. Freund, Samuel I. Bloom and Bo Fernhall

Int. J. Environ. Res. Public Health 2022, 19(4), 2124; https://doi.org/10.3390/ijerph19042124 - 14 Feb 2022

Cited by 2 | Viewed by 2417

Abstract

While the fire service has long been a male-dominated occupation, women’s participation in this strenuous, high risk, high performance activity has increased in recent years. Firefighting induces significant cardiovascular strain, including hemostatic disruption; however, the effect of sex on hemostatic responses has not been investigated despite evidence that there are sex-related differences in hemostatic variables at rest and following exercise. Thus, we investigated hemostatic responses in age- and BMI-matched male and female firefighters who performed 3–4 evolutions of firefighting drills over a 3 h period. Venous blood samples were collected before and after the firefighting training drills and hemostatic variables were assessed. Firefighting significantly increased platelet count and factor VIII, tissue plasminogen activator (t-PA) antigen, and t-PA activity, and decreased activated partial thromboplastin time and plasminogen activator inhibitor (PAI-1) activity. Females had lower values for epinephrine-induced platelet closure time, antithrombin III, PAI-1 activity, and PAI-1 antigen. There were no interactions between sex and time for any variables assessed. In conclusion, multiple bouts of firefighting activity resulted in a procoagulatory state. Although there were sex differences for several hemostatic variables, male and female firefighters did not differ in their hemostatic response to multiple bouts of firefighting. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

13 pages, 653 KiB

Open AccessArticle

Interaction Effect between Physical Activity and the BDNF Val66Met Polymorphism on Depression in Women from the PISMA-ep Study

by Juan Antonio Zarza-Rebollo, Esther Molina, Elena López-Isac, Ana M. Pérez-Gutiérrez, Blanca Gutiérrez, Jorge A. Cervilla and Margarita Rivera

Int. J. Environ. Res. Public Health 2022, 19(4), 2068; https://doi.org/10.3390/ijerph19042068 - 12 Feb 2022

Cited by 12 | Viewed by 2857

Abstract

The relationship between depression and the Val66Met polymorphism at the brain-derived neurotrophic factor gene (BDNF), has been largely studied. It has also been related to physical activity, although the results remain inconclusive. The aim of this study is to investigate the relationship between this polymorphism, depression and physical activity in a thoroughly characterised sample of community-based individuals from the PISMA-ep study. A total of 3123 participants from the PISMA-ep study were genotyped for the BDNF Val66Met polymorphism, of which 209 had depression. Our results are in line with previous studies reporting a protective effect of physical activity on depression, specifically in light intensity. Interestingly, we report a gene-environment interaction effect in which Met allele carriers of the BDNF Val66Met polymorphism who reported more hours of physical activity showed a decreased prevalence of depression. This effect was observed in the total sample (OR = 0.95, 95%CI = 0.90–0.99, p = 0.027) and was strengthened in women (OR = 0.93, 95%CI = 0.87–0.98, p = 0.019). These results highlight the potential role of physical activity as a promising therapeutic strategy for preventing and adjuvant treatment of depression and suggest molecular and genetic particularities of depression between sexes. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

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17 pages, 1032 KiB

Open AccessArticle

“Do Elite Sport First, Get Your Period Back Later.” Are Barriers to Communication Hindering Female Athletes?

by Martina Höök, Max Bergström, Stig Arve Sæther and Kerry McGawley

Int. J. Environ. Res. Public Health 2021, 18(22), 12075; https://doi.org/10.3390/ijerph182212075 - 17 Nov 2021

Cited by 26 | Viewed by 7047

Abstract

Competitive female athletes perceive their hormonal cycles to affect their training, competition performance and overall well-being. Despite this, athletes rarely discuss hormonal-cycle-related issues with others. The aim of this study was to gain an in-depth understanding of the perceptions and experiences of endurance athletes and their coaches in relation to barriers to athlete–coach communication about female hormonal cycles. Thirteen Swedish national-/international-level female cross-country skiers (age 25.8 ± 3.6 y) and eight of their coaches (two women and six men; age 47.8 ± 7.5 y) completed an online survey relating to their educational background, prior knowledge about female hormonal cycles and a coach–athlete relationship questionnaire (CART-Q). They then participated in an online education session about female hormonal cycles and athletic performance before participating in semi-structured focus-group interviews. Thematic analyses revealed three main barriers to communication: knowledge, interpersonal, and structural. In addition, the results suggested that a good coach–athlete relationship may facilitate open communication about female hormonal cycles, while low levels of knowledge may hinder communication. To overcome the perceived barriers to communication, a model is proposed to improve knowledge, develop interpersonal relationships and strengthen structural systems through educational exchanges and forums for open discussion. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

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12 pages, 362 KiB

Open AccessArticle

The Effect of the Menstrual Cycle and Oral Contraceptive Cycle on Muscle Performance and Perceptual Measures

by Belinda M. Thompson, Kaitlyn B. Drover, Rhiannon J. Stellmaker, Dean V. Sculley and Xanne A. K. Janse de Jonge

Int. J. Environ. Res. Public Health 2021, 18(20), 10565; https://doi.org/10.3390/ijerph182010565 - 9 Oct 2021

Cited by 15 | Viewed by 4387

Abstract

Most reproductive-aged women are exposed to fluctuating female steroid hormones due to the menstrual cycle or oral contraceptive use. This study investigated the potential effect of the menstrual cycle and combined monophasic oral contraceptive cycle on various aspects of muscle performance. Thirty active females (12 with a natural menstrual cycle, 10 taking a high-androgenicity oral contraceptive and 8 taking a low-androgenicity oral contraceptive), aged 18 to 30 years, were tested three times throughout one menstrual or oral contraceptive cycle. Counter-movement jumps, bilateral hop jumps, handgrip strength, isometric knee extensor strength and isokinetic knee flexion and extension were assessed. Perceptual ratings of fatigue, muscle soreness, pain and mood were recorded. Most variables showed no significant changes over the menstrual or oral contraceptive cycle. However, for the menstrual cycle group, isokinetic knee flexion at 240° s⁻¹, and time of flight in bilateral hopping and counter movement jumps showed better results during the mid-luteal phase compared with the late follicular phase. For the high-androgenicity oral contraceptive group, isokinetic knee flexion at 240° s⁻¹ was significantly higher in the late hormone phase compared with the early hormone phase. For the low-androgenicity oral contraceptive group, time of flight for the counter-movement jumps was lower in the late hormone phase compared with the early hormone phase. The findings indicate that faster and explosive aspects of muscle performance may be influenced by endogenous and exogenous female hormones. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

13 pages, 1433 KiB

Open AccessArticle

Arterial Stiffness and Hemodynamics in Young Women: The Effects of Oral Contraceptive Intake and Physical Habits

by Carina Enea, Pernelle Laffetas, Aurélien Pichon and Nathalie Delpech

Int. J. Environ. Res. Public Health 2021, 18(7), 3393; https://doi.org/10.3390/ijerph18073393 - 25 Mar 2021

Cited by 5 | Viewed by 2889

Abstract

Oral contraceptive (OC) intake seems to be associated with increased central hemodynamics and arterial stiffness. Conversely, physical activity (PA) is known to induce benefits on vascular structure and function, suggesting that the negative effects of the OC pill could be counterbalanced by regular PA. The aim of this cross-sectional study was to determine (1) whether OC intake in young women is associated with higher values of hemodynamic parameters and arterial stiffness and (2) whether these negative effects could be counterbalanced by regular physical activity. Forty-nine young healthy women (21.9 years ± 2.1) were recruited and divided into 4 groups, depending on their hormonal status (OC users: OC+ or non-OC users: OC−) and their physical habits (active/inactive). Assessments of central hemodynamics (central blood pressure, Aix75) and pulse wave velocity (PWV) were performed using applanation tonometry. cBP was higher in OC+ vs. OC−, while PWV was similar between these two groups. No interaction between physical activity and hormonal status was observed for any of these variables. Nevertheless, PWV was lower in young active women compared with age-matched inactive women, suggesting that the positive effect of regular physical exercise on the cardiovascular system is already visible in the first years of women’s adulthood, whatever the hormonal status. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

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12 pages, 1989 KiB

Open AccessArticle

Menstrual Cycle Phases Influence on Cardiorespiratory Response to Exercise in Endurance-Trained Females

by Beatriz Rael, Víctor M. Alfaro-Magallanes, Nuria Romero-Parra, Eliane A. Castro, Rocío Cupeiro, Xanne A. K. Janse de Jonge, Erica A. Wehrwein, Ana B. Peinado and IronFEMME Study Group

Int. J. Environ. Res. Public Health 2021, 18(3), 860; https://doi.org/10.3390/ijerph18030860 - 20 Jan 2021

Cited by 29 | Viewed by 11139

Abstract

The aim of this study was to analyse the impact of sex hormone fluctuations throughout the menstrual cycle on cardiorespiratory response to high-intensity interval exercise in athletes. Twenty-one eumenorrheic endurance-trained females performed an interval running protocol in three menstrual cycle phases: early-follicular phase (EFP), late-follicular phase (LFP) and mid-luteal phase (MLP). It consisted of 8 × 3-min bouts at 85% of their maximal aerobic speed with 90-s recovery at 30% of their maximal aerobic speed. To verify menstrual cycle phase, we applied a three-step method: calendar-based counting, urinary luteinizing hormone measurement and serum hormone analysis. Mixed-linear model for repeated measures showed menstrual cycle impact on ventilatory (EFP: 78.61 ± 11.09; LFP: 76.45 ± 11.37; MLP: 78.59 ± 13.43) and heart rate (EFP: 167.29 ± 11.44; LFP: 169.89 ± 10.62; MLP: 169.89 ± 11.35) response to high-intensity interval exercise (F_2.59 = 4.300; p = 0.018 and F_2.61 = 4.648; p = 0.013, respectively). Oxygen consumption, carbon dioxide production, respiratory exchange ratio, breathing frequency, energy expenditure, relative perceived exertion and perceived readiness were unaltered by menstrual cycle phase. Most of the cardiorespiratory variables measured appear to be impassive by menstrual cycle phases throughout a high-intensity interval exercise in endurance-trained athletes. It seems that sex hormone fluctuations throughout the menstrual cycle are not high enough to disrupt tissues’ adjustments caused by the high-intensity exercise. Nevertheless, HR based training programs should consider menstrual cycle phase. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

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12 pages, 759 KiB

Open AccessArticle

The Relationship between Health Status and Social Activity of Perimenopausal and Postmenopausal Women (Health Status and Social Relationships in Menopause)

by Beata Naworska, Anna Brzęk and Monika Bąk-Sosnowska

Int. J. Environ. Res. Public Health 2020, 17(22), 8388; https://doi.org/10.3390/ijerph17228388 - 12 Nov 2020

Cited by 10 | Viewed by 3354

Abstract

The quantity and quality of interpersonal relations (including participation in University of the Third Age—U3A) play an important role for women during menopausal changes. Women who have a social network are found to be more positive about menopause, and are less likely to be depressed. This case-control study aimed to analyze the relationship between participating in formal social groups and health status related to physical activity and climacteric and depressive symptoms. The study was conducted among 621 peri- and postmenopausal women aged 50–64 years. The women were classified into two groups: U3A and controls. The participants were selected using a multistage sampling method. The IPAQ (The International Physical Activity Questionnaire), Kupperman Index (KI), and Beck Depression Inventory were used for data collection. Significant differences between the groups were confirmed in the area of professional work (p < 0.001), free time (p < 0.001), and sitting (p < 0.05). The average KI score in the U3A group was higher (t-Student = 2.12, p < 0.05). Depressive symptoms were found in 43.49% of U3A women vs. 51.15% in controls (p < 0.01). We conclude that participation in formal social groups is associated with higher level of physical activity and reduced severity of both climacteric and depressive symptoms. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

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Review

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21 pages, 1171 KiB

Open AccessReview

Impact of Nutrition-Based Interventions on Athletic Performance during Menstrual Cycle Phases: A Review

by Macy M. Helm, Graham R. McGinnis and Arpita Basu

Int. J. Environ. Res. Public Health 2021, 18(12), 6294; https://doi.org/10.3390/ijerph18126294 - 10 Jun 2021

Cited by 9 | Viewed by 14571

Abstract

Despite the steady increase in female participation in sport over the last two decades, comprehensive research on interventions attenuating the influence of female menstrual physiology on performance remains scarce. Studies involving eumenorrheic women often only test in one menstrual phase to limit sex hormone variance, which may restrict the application of these findings to the rest of the menstrual cycle. The impacts of nutrition-based interventions on athletic performance throughout the menstrual cycle have not been fully elucidated. We addressed this gap by conducting a focused critical review of clinical studies that reported athletic outcomes as well as menstrual status for healthy eumenorrheic female participants. In total, 1443 articles were identified, and 23 articles were included. These articles were published between 2011 and 2021, and were retrieved from Google Scholar, Medline, and PubMed. Our literature search revealed that hydration-, micronutrient-, and phytochemical-based interventions can improve athletic performance (measured by aerobic capacity, anaerobic power, and strength performance) or attenuate exercise-induced damage (measured by dehydration biomarkers, muscle soreness, and bone resorption biomarkers). Most performance trials, however, only assessed these interventions in one menstrual phase, limiting the application throughout the entire menstrual cycle. Improvements in athletic performance through nutrition-based interventions may be contingent upon female sex hormone variation in eumenorrheic women. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

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6 pages, 292 KiB

Open AccessBrief Report

Influence of Menstrual Cycle Estradiol-β-17 Fluctuations on Energy Substrate Utilization-Oxidation during Aerobic, Endurance Exercise

by Hannah N. Willett, Kristen J. Koltun and Anthony C. Hackney

Int. J. Environ. Res. Public Health 2021, 18(13), 7209; https://doi.org/10.3390/ijerph18137209 - 5 Jul 2021

Cited by 12 | Viewed by 3774

Abstract

This study examined the effect of estradiol-β-17 across the menstrual cycle (MC) during aerobic exercise on energy substrate utilization and oxidation. Thirty-two eumenorrheic (age = 22.4 ± 3.8 y (mean ± SD)), physically active women participated in two steady-state running sessions at 65% of VO_2max, one during the early follicular and one during the luteal phase of the MC. Blood samples were collected at rest before each exercise session and analyzed for Estradiol-β-17 to confirm the MC phase. Carbohydrate (CHO) utilization and oxidation values were significantly lower (p < 0.05) in the luteal (utilization: 51.6 ± 16.7%; oxidation: 1.22 ± 0.56 g/min; effect size (ES) = 0.45, 0.27) than follicular phase (utilization: 58.2 ± 15.1%; oxidation: 1.38 ± 0.60 g/min) exercise sessions. Conversely, fat utilization and oxidation values were significantly (p < 0.05) higher in the luteal (utilization: 48.4 ± 16.7%; oxidation: 0.49 ± 0.19 g/min; ES = 0.45,0.28) than follicular phase (utilization: 41.8 ± 15.1%; oxidation: 0.41 ± 0.14 g/min). Estradiol-β-17 concentrations were significantly (p < 0.01) greater during the luteal (518.5 ± 285.4 pmol/L; ES = 0.75) than follicular phase (243.8 ± 143.2 pmol/L). Results suggest a greater use of fat and reduced amount of CHO usage during the luteal versus follicular phase, directly related to the change in resting estradiol-β-17. Future research should investigate the role these changes may play in female athletic performance. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

22 pages, 2268 KiB

Open AccessStudy Protocol

Methodological Approach of the Iron and Muscular Damage: Female Metabolism and Menstrual Cycle during Exercise Project (IronFEMME Study)

by Ana B. Peinado, Victor M. Alfaro-Magallanes, Nuria Romero-Parra, Laura Barba-Moreno, Beatriz Rael, Cristina Maestre-Cascales, Miguel A. Rojo-Tirado, Eliane A. Castro, Pedro J. Benito, Carmen P. Ortega-Santos, Elena Santiago, Javier Butragueño, Antonio García-de-Alcaraz, Jesús J. Rojo, Francisco J. Calderón, Alberto García-Bataller and Rocío Cupeiro

Int. J. Environ. Res. Public Health 2021, 18(2), 735; https://doi.org/10.3390/ijerph18020735 - 16 Jan 2021

Cited by 14 | Viewed by 7989

Abstract

Background: The increase in exercise levels in the last few years among professional and recreational female athletes has led to an increased scientific interest about sports health and performance in the female athlete population. The purpose of the IronFEMME Study described in this protocol article is to determine the influence of different hormonal profiles on iron metabolism in response to endurance exercise, and the main markers of muscle damage in response to resistance exercise; both in eumenorrheic, oral contraceptive (OC) users and postmenopausal well-trained women. Methods: This project is an observational controlled randomized counterbalanced study. One hundered and four (104) active and healthy women were selected to participate in the IronFEMME Study, 57 of which were eumenorrheic, 31 OC users and 16 postmenopausal. The project consisted of two sections carried out at the same time: iron metabolism (study I) and muscle damage (study II). For the study I, the exercise protocol consisted of an interval running test (eight bouts of 3 min at 85% of the maximal aerobic speed), whereas the study II protocol was an eccentric-based resistance exercise protocol (10 sets of 10 repetitions of plate-loaded barbell parallel back squats at 60% of their one repetition maximum (1RM) with 2 min of recovery between sets). In both studies, eumenorrheic participants were evaluated at three specific moments of the menstrual cycle: early-follicular phase, late-follicular phase and mid-luteal phase; OC users performed the trial at two moments: withdrawal phase and active pill phase. Lastly, postmenopausal women were only tested once, since their hormonal status does not fluctuate. The three-step method was used to verify the menstrual cycle phase: calendar counting, blood test confirmation, and urine-based ovulation kits. Blood samples were obtained to measure sex hormones, iron metabolism parameters, and muscle damage related markers. Discussion: IronFEMME Study has been designed to increase the knowledge regarding the influence of sex hormones on some aspects of the exercise-related female physiology. Iron metabolism and exercise-induced muscle damage will be studied considering the different reproductive status present throughout well-trained females’ lifespan. Full article

(This article belongs to the Special Issue Interdisciplinary Aspects of Women’s Physiology and Physical Fitness)

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