Strength Training and Conditioning for Women: The Female Athletic Triad

           Regardless of gender, benefits of exercise to improve fitness and sports performance are well known and documented. Response to exercise is mostly the same for both genders with minor differences.

          Body size and composition is one of the major differences between men and women. During pre-puberty years, there is no significant difference in height, weight, and body size. During puberty, estrogen secretion increases in women, this increases fat deposition and breast development. In men, an increase in testosterone secretion increases bone formation and protein synthesis (1,3). This is when significant differences in body size and composition become more evident. As far as body composition goes, women possess higher body fat than men. To summarize the differences in body size and composition, women on the average are (6):

• 13 cm / 5 in shorter,
• 14 kg to 18 kg / 30lbs to 40 lbs. lighter,
• 18 kg to 22 kg lighter in fat-free mass,
• 3 kg to 6 kg heavier in fat mass, and
• 6% to 10% higher in relative body fat

        The increase in protein synthesis during puberty for the males accounts for the greater muscle mass compared to women. Testosterone levels in males are 15 to 20 times times higher compared to females. (1)

          In terms of absolute strength, females tend to have two-thirds the strength of men (60 to 63.5%). Upper body strength levels tend to be around 55% of that of males, while lower body strength tend to be around 72%. However, when relative strength is considered, the differences in strength tend to lessen. Relative strength is defined as the absolute strength divided by the body weight or fat free mass. (3)

          As far as training response is concerned, there is also little difference between the two genders. In both strength and endurance exercise response, both respond similarly. Major cardiovascular and respiratory adaptations to exercise are not gender specific. On the average, women experience the same relative increase VO2max as compared to men, about 15% to 20% . Women can experience also the same increases in strength as men with an average increase of about 20% to 40%. Therefore, there is little reason to advocate different training or conditioning programs based on gender. (1, 3, 4, 6)

           However, for strength training and conditioning for sports for women there are a few considerations. One of the things to watch out for in female athletes is the warning signs of the female athletic triad.

          The female athletic triad starts with eating disorders. This followed by secondary amenorrhea, and finally bone disorders.

         When it comes to losing weight, most people resort to diets. Diets do work, but in conjunction with exercise. In sports where weight plays a major role, this can become a problem. The athlete may develop eating disorders. Eating disorders refers to a spectrum of behaviors, core attitudes, coping strategies, and conditions that share an emotionally based, inordinate, and often pathological preoccupation with body weight and shape (4).

           Eating disorders must meet a specific criteria set by the American Psychiatric Association 6. The two most common eating disorders are Anorexia Nervosa and Bulimia Nervosa (1, 4, 6). Eating disorders among women became prominent in the 1980s, with men constituting about 10% of those cases. Anorexia has been recognized as a clinical syndrome since the 19th century. Bulimia, on the other hand was first described in 1976. (6)

            Anorexia nervosa is characterized by the following: (1, 4, 6)

• Refusal to maintain more than the minimal normal weight based on age and height.
• Distorted body image
• Intense fear of fatness or gaining weight
• Amenorrhea

             There are two types of anorexia nervosa: (1)

• Restricting type: Does not regularly engage in binge eating or purging behavior.
• Binge eating purging type: Regularly engages in binge eating purging behavior.

 

Distorted body image is on of the signs of Aneroxia Nervosa

 

 

              Bulimia nervosa, on the other hand, is characterized by: (6)

• Recurrent episodes of binge eating
• A feeling of a lack of control during these binges
• Purging behavior, which includes the use of self-induced vomiting, laxatives and diuretic use.

 

Purging Behavior is one of the signs of Bulimia

 

              Below is a short list of warning signs for anorexia and bulimia nervosa. A more comprehensive list can be found in Mcardle, Katch and Katch’s Exercise Physiology text book: (6)

 

 

               Anorexia Nervosa Warning Signs:

• Dramatic loss in weight
• A preoccupation with food, calories, and weight
• Wearing baggy or layered clothing
• Relentless excessive exercise
• Mood swings
• Avoiding food-related social activities

                

             Bulimia Nervosa Warning Signs:

• A noticeable weight loss or gain
• Excessive concern about food
• Bathroom visits after meals
• Depressed mood
• Strict dieting followed by eating binges
• Increased criticisms of one’s body.

              The NSCA also includes a list of warning signs for both disorders: (2)

• Complaining frequently of constipation or stomach aches
• Mood swings
• Social withdrawal
• Relentless, excessive exercise
• Excessive concern about weight
• Strict dieting
• Increased criticism of one’s body
• Strong denial that a problem exists even when confronted with hard evidence.

              A third eating disorder has also been recently recognized, anorexia athletica. This term actually describes a continuum of eating behavior of athletes who do not meet the criteria of a full eating disorder, but exhibit at least one unhealthy method of weigh management. This may include fasting, self-induced vomiting, diet pills, laxatives, and diuretics. As per Mcardle et al, the prevalence of disordered eating behavior among athletes ranges from 15% to 60%, depending upon the sport. (4)

             Anorexia athletica, or eating disorders among athletes, is usually observed during the competitive season. It usually ends after the season ends. This does not really reflect a true pathologic eating disorder, but a desire to achieve optimum performance. However, some athletes, the season may never end and may develop into a true eating disorder. (4)

            There are certain sports, which are more prone to eating disorders, and thus the triad, than others are. Endurance, weight classification, and appearance sports (bodybuilding, ballet, diving, figure skating, gymnastics, cheerleading) athletes are prone to eating disorders. About 25% to 60% of the athletes, less than 5% of the general population, exhibit some form eating disorder. (4, 6)

             When the warning signs for eating disorders are recognized, it would best for the athletic trainer, strength and conditioning coach, or whoever is in charge, to report the problem immediately to the team doctor or psychologist. As mentioned earlier, eating disorders are a psychological problem and must be dealt with by qualified personnel.

             Menstrual dysfunction is the second warning sign in the female athletic triad. Menarche is the term used to describe the first occurrence of menstruation. If the female has regular normal menstrual function, the term used is eumenorrhea. The term used to describe an irregular menstrual cycle is oligomenorrhea. Dysmenorrhea is painful menstruation. Amenorrhea is used to describe the absence of menstruation. Primary amenorrhea refers to the absence of menarche in women 16 years or older. These women never began menstruating. Athletes with previous normal menstrual function have sometimes reported the absence of menstruation for 180 days or more. This is referred to as secondary amenorrhea.

            Secondary amenorrhea can occur in about 4% to 5% of the female population. In athletic groups, the figure is about 40%. When secondary amenorrhea occurs in athletic groups, it is sometimes referred to as athletic amenorrhea. There are currently two existing hypothesis on the menstrual irregularity when it comes to athletes. Exercise stress and the energy availability. (4)

           The exercise stress theory states that the hypothalamic-pituitary-adrenal axis may be disrupted thus modifying the output of the gonadotropic-releasing hormone 4. Current evidence shows that the alternative theory, energy availability, is more likely the cause. As per Wilmore et al, studies have shown that inadequate caloric intake, when the intake of calories does not match the caloric expenditure, is the primary cause of secondary amenorrhea (6).

                A well balanced diet reverses and prevents athletic amenorrhea. This can be done even without reducing the intensity or volume (4). A qualified licensed nutritionist should be able to create such a dietary plan with consultations with the athlete.

              Secondary amenorrhea is also related to third sign of the triad, bone disorders. Specifically, osteoporosis. As we age, bone density decreases with aging. This normal occurrence is termed as osteopenia. Osteoporosis, on the other hand, is a more sever loss of bone mass. The microarchitecture of the bone deteriorates and leading to fragile porous bones. The injury rate due to bone fracture increases. These changes start to occur after the age of 30. Typically, in post-menopausal women, the injury rate due to fractures increases by about five times. Men also experience osteoporosis, but to a lesser degree. Bone mineral loss is slower in males. (6)

              Wilmore et al lists three major contributing factors to osteoporosis common to post-menopausal women: (6)

• Estrogen deficiency
• Inadequate calcium intake
• Inadequate physical activity

             While we know that physical activity is beneficial to bone health, especially for young middle aged women. Amenorrhic runners tend to have lower bone mass than eumenorrhic untrained runners in an unpublished study. However, in the same study, the same amenorrhic runners still had higher bone mineral content than untrained amenorrhic women. In addition, eumenorrhic runners still had a higher bone mass than untrained eumenorrhic women. (6)

               Bone density remains closely related to menstrual regularity and the total number of menstrual cycles. Women who are amenorrhic tend to also have low serum estrogen. Estrogen has a protective effect on bone. The premature cessation of menstruation removes the protective effect of estrogen on bone. Persistent amenorrhea tends to negate the effect of exercise on bone mass. As per Mcardle et al, a 5% decrease in bone mass may lead to a 40% increase risk of fractures. (4)

                Inadequate calcium intake can be best addresses by a sound balanced diet. Increasing calcium intake to about 1,200 mg to 1,500 mg daily has been proposed for decreasing the risk of osteoporosis (6).

                 Mcardle et al suggests a four phase plan in reducing athletic amenorrhea: (4)

• Reduce training levels by 10% to 20%
• Gradually increase total energy intake
• Increase the body weight by about 2% to 3%
• Maintain calcium intake by about 1,500 mg daily.

               If you are training women, one should be mindful for the signs of the triad. Especially for those who are highly competitive, trying to lose weight drastically, and obsessed with food and calories. Early recognition of the signs is good way to prevent the situation from getting out of hand.

Bibliography:

 

1.  Baechle, Thomas R. and Roger W. Earle “Essentials of Strength Training and Conditioning 3rd edition” 2008

 

2.  Baechle, Thomas R. and Roger W. Earle “Essentials of Personal Training” 2004

3.  Fleck, Steven J. and William J. Kraemer “Designing Resistance Training Programs 3rd edition” 2004

4.  Mcardle William D. Frank I. Katch, And Victor L. Katch “Exercise Physiology: Energy, Nutrition, and Human 

     Performance 7th edition” 2010

5.  Wilmore, Jack M. and David L. Costill “Training for Sport and Activity: The Physiological Basis of the 

     Conditioning Process” 1988

6.  Wilmore, Jack M., David L. Costill and W. Larry Kenney “Physiology of Sport and Exercise 4th edition” 2008

Basic Resistance Workout Principles and Programming Part II

           In this article, let us discuss the intensity prescribed in weight training.  The term intensity in the article is used to denote the amount of weight lifter per exercise. It is sometimes interchanged with load.

The intensity prescribed for the workout is dependent on the goal of the individual. The individual goals, regardless what they are, fall into muscular endurance, muscular strength, or muscular hypertrophy.  All can play a role in fitness and sports performance enhancement.

            What intensity to use will depend also upon the training experience of the individual. Beginners are usually advised to do a lower intensity. This is to allow them time to learn the movement pattern of the particular exercise. Strength is partly dependent on the body’s ability to recruit muscle fibers needed in an exercise movement pattern. When learning a new movement, it takes time for the body to “learn” how and which muscle fibers to recruit ^{1, 4}.

            For intermediate and advanced lifters, the use of percentage of the 1 repetition maximum (RM) can be useful. What percentage to use will depend again on the goal and, if the workout program is properly designed, what phase the lifter is in.

            The 1 RM testing protocol can be found elsewhere on the internet. This site prefers the National Strength and Conditioning Association (NSCA) 1RM protocol: http://www.sport-fitness-advisor.com/strengthtests.html. If acquiring the 1 RM is not possible through a direct test, there are other alternatives in acquiring the 1 RM value. Such as the RM testing suggested by the NSCA. This site provides the multiple RM protocol and how to extrapolate the 1RM: http://www.unm.edu/~lkravitz/Article%20folder/musassess.html.

            The NSCA has suggested frequency, intensity, volume, and rest periods based on the training status of various clients ¹. Let’s start first with training frequency:

Guidelines for Resistance Training Frequency¹

Resistance training status	Recommended number of sessions per week
Beginner	2-3
Intermediate	3-4
Advanced	4+

                                         Fig. 1: NSCA suggested training frequency for general fitness

          The table is pretty clear-cut on this. Beginners need less training days as it is assumed that the recovery period is longer. This is because they body is still adjusting to the overload placed upon it. Intermediate and advanced lifters may workout more frequently as their recovery period is much faster.

            The NSCA, for general fitness, recommends three ranges of training intensities for various goals: For muscular endurance, the recommended load is ≤ 67% of 1RM. For muscular hypertrophy, the recommended load is 65% - 85%, and for muscular strength it is > than 85%. Table below:

Assigning Loads and Repetitions Based on Training Goal¹

Training Goal	Load (%1RM)	Goal Repetitions
Muscular Endurance	≤ 67	≥ 12
Hypertrophy	67-85	6-12
Muscular Strength	≥85	≤6

                             Fig 2: NSCA suggested Load and Repetitions for general fitness

             Volume can refer to the total amount of weight lifted, or the number repetitions (reps) multiplied by the number of  sets (a group of repetitions). The above table recommends the following number of repetitions based upon the assigned intensity. The table below suggests the volume, number of sets, based on the goal repetitions. As the load gets lighter, the number of repetitions goes up, and vice versa. Take note that these are suggested for general fitness

Assigning Volume Based on the Training Goal¹

Training Goal	Goal Repetitions	Sets
Muscular Endurance	≥12	2-3
Hypertrophy	6-12	3-6
Muscular Strength	≤6	2-6

                                   Fig 3: NSCA suggested number of sets based on goal repetitions

        For athletes the assignment of intensity is a little bit different from for general fitness as there a component of power involved after strength. Frequency and volume also differ slightly. If the athlete is a beginner, the above-mentioned tables may be sufficient for a period of time. Intermediate to advanced athletes, frequency of training, assignment of intensity/load, and volume differ from that of general fitness. Program design for athletes can be discussed at a later date.

            Bompa and Cornacchia offer a slightly different alternative to the NSCA when it comes to the intensity/load and repetitions. The tables are listed below:

Intensity Values²

% of 1 RM	Load
> 105%	Super maximum
90 - 100	Maximum
80 -90	Heavy
50 - 80	Medium
30 - 50	Low

                     Fig 4: Intensity Load and Percentage values suggested by Bompa and Cornacchia

Repetitions based on Training phases²

Maximum Strength	1 – 7 reps
Hypertrophy	6 – 12 reps
Muscular Endurance	30 – 150 reps

                     Fig 5: Suggested repetitions based on training phase by Bompa and Cornacchia

Very few people in general fitness would try above heavy or even over 30+ repetitions. However, this does provide a guideline for the trainer to follow. The loads and reps suggested by Bompa and Cornacchia are for bodybuilders or for those into serious strength straining ². Nevertheless, even before getting into heavy lifting, athletes still have to start at the beginning and still lift for general fitness.

            In creating and administering a workout, it would be better to err on the side of caution than to be aggressive. Even intermediate and advanced lifters coming from an off-season need to start at a low intensity for the first few weeks.

            Starting at ≤ 67% of 1RM is a good suggestion for intermediate to advanced lifters. For beginners, Bompa’s suggestion of low intensity of 30 – 50% 1RM is good. This would allow the lifter to concentrate on form. Another good suggestion is to do only one set on the first day of training. This would minimize the DOMS (delayed onset of muscular soreness). Add the second set either on the second training day, or on the following week, depending upon the age and/or recovery of the lifter. And the third set on the third day, or week,  and so on if need be. This allows the lifter to ease into the program without too much discomfort. Making it less unpleasant for the person.

            When adding load to the exercises, or progression,  the NSCA suggests that adding  1% to  2% of previous load for upper body assistance exercises, and about 2.5% for upper body core exercises for beginners. For lower body exercises, about 5% for lower body core and 2.5% to 5% for lower body assistance.¹

            For intermediate to advanced lifters, load increases for the upper body core are suggested to be 2.5% to 5%+ . And 2.5% to 5% for upper body assistance. For lower body exercises, 5% to 10%+ for core, and 5% to 10% for assistance. ¹

            Core exercises are defined as multijoint exercises. Or exercises that involve more than one joint ¹. It can also described as primary exercise ³. Assistance exercises are those that use one joint, or single joint ^{1, 3}.

            When to progress depends upon the individual. The NSCA suggests that one follow the 2 for 2 rule. The rule is that when the lifter can lift two more reps than the goal repetitions for two consecutive sessions, it is time to increase the load following the above-mentioned guidelines ^{1, 3}.

            Other types old time strongman progression methods are single and double progression. In a single progression system, you only increase one variable. For example, the load lifted is at 3 sets x 8 reps x 110 lbs. Next week, you try for 3 x 8 x 120, and the following week, 3 x 8 x 130. In this case, you’re only progressing the weight. You can also try progressing the number of sets or reps.

            In the double progression system, you advance two variables. Let’s say you’re doing 3 sets x 6-8 reps x 150 lbs. You start lifting 150 lbs. at 6 reps for three sets. You try to progress to 8 reps. This is the first variable. Once you hit 8 reps, you increase the second variable, the load. You increase to 160 lbs. then you start over again at 6 reps. You can also try increasing the number of sets and drop back down to 6 reps. A good explanation of both systems can be found here: http://strength-basics.blogspot.hk/2011/07/training-terminology-single-vs-double.html.  

            Using the % 1RM gives the individual, and the trainer something more concrete in terms of quantifying the load/intensity for a given goal. It also quantifies the progression of the individual in intensity/load, repetitions, and sets.

Bibliography:

1.       Baechle, Thomas R. and Roger W. Earle “Essentials of Personal Training 1^st edition” 2004

2.       Bompa, Tudor and Lorenzo Cornacchia “Serious Strength Training 1^st edition” 1998

3.       Fleck, Steven J. and William J. Kaemer  “Designing Resistance Training Programs 3^rd edition” 2004

4.   Mcardle, William D., Frank I. Katch, and Victor L. Katch “Exercise Physiology: Energy, Nutrition, and Human Performance 4^th edition” 1996