Women Amp Training

Women and Training -1-
Exercise and training in women.

Part I. Influence of gender on exercise and training responses
by
Roy J. Shephard
from
Faculty of Physical Education & Health
and
Dept. of Public Health Sciences,
Faculty of Medicine, University of Toronto.
Correspondence to: Professor Roy J. Shephard,
PO Box 521, 41390 Dryden Rd., Brackendale, BC V0N 1H0.
Phone: 604-898-5527 Fax: 604-898-5724 E-mail: royjshep@mountain-inter.net

Abstract/Resumé
Exercise and training responses in women are briefly reviewed. Part I of the paper considers the
influence of gender on such responses. The average woman has a smaller inherent aerobic power and
less muscular strength than a man. Such gender differences reflect not only socio-cultural influences, but
also differences in physical size, body composition and hormonal milieu. Nevertheless, physical abilities
show a wide range of normality in both sexes, and the best-trained women can out-perform sedentary
men. The handicap of the average woman is offset in part by a lighter body mass, and a tendency to
metabolize fat rather than carbohydrate during exercise. The pattern of training response is generally
similar in women and men, although a lack of anabolic hormones may limit increase of muscle bulk in
the female. A low initial level of fitness, may enhance the scope for training in some women, but it also
limits the intensity of conditioning that is tolerated. Nevertheless, women seem less vulnerable than men
to both exercise-induced sudden death and overtraining. Part II of the review considers the influence of
the menstrual cycle upon exercise and training responses, and exercise responses during pregnancy.
Physical activity programmes for young women should always take account of possible pregnancy.
Potential dangers to the foetus include an excessive rise of core body temperature, a decrease of maternal
blood sugar, and foetal hypoxia. Nevertheless, regular moderate exercise generally has a favourable
impact upon pregnancy outcomes.
La réponse des femmes à l’exercise et le conditionnement physique est passée brièvement en revue. La
première partie de cette critique examine l’influence de sexe sur ces réponses. La puissance aerobie et la
force musculaire d’une femme typique semblent plus faible que les valeurs comparable d’un homme, non
seulement à cause des influences socio-culturelles, mais aussi par conséquent de quelques différences de
grandeur, composition corporelle, et milieu humorale. Néanmoins, l’écart de normalité est important
pour chaque sexe, et les femmes bien conditionnées peuvent atteindre un niveau de performance
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dépassant cela d’un homme sédentaire. Le désavantage feminin est normalement atténué par un poids
corporel léger et une tendance de remplacer le métabolisme de hydrate de carbone par les lipids pendant
l’activité physique de longue durée. La réponse à l’entrainement physique semble comparable entres les
hommes et les femmes, sauf qu’une manque des anabolisants peut limiter la synthèse de protéine chez la
femme. Un niveau bas de conditionnement physique peut augmenter la possibilité d’entrainement de
quelques femmes, tout en reduisant l’intensité d’effort tolérée. Cependant, les femmes généralement
semblent moins suceptibles aux catastrophes cardiaques et quelques autres problêmes de surentrainement.
La deuxième partie de cette revue examine l’influence des règles et d’une grossesse sur les réponses à
l’activité physique et l’entrainement. La programmation d’entrainement doivent toujours considérer la
possibilité d’une grossesse parmi les femmes jeunes. Les dangers prinicipales comprisent une élévation
excessive de la température corporelle, une hypoglycémie maternelle, et une hypoxie foetale.
Cependant, la pratique d’une activité physique modérée normalement peut influencer l’aboutissement
d’une grossesse d’un façon bénéfique.
Key Words/Mots-Clés
Sex differences Différences sexuales
Socio-cultural issues Facteurs socio-culturelles
Biological differences Différences biologiques
Physical activity L’activité physique
Conditioning Conditionnement physique
Menstruation Menstruation
Pregnancy Grossesse
Employment standards Mesures d’employabilité

Introduction
Current knowledge of the physiological and biochemical responses to exercise and training is
based largely on responses of young adult males. Given the ever-increasing involvement of
women in both sport and active occupational roles, there is an urgent need to evaluate the extent
of gender differences in exercise and training responses. In particular, clear recommendations
are needed to guide training at various stages of pregnancy. The first part of the present review
notes key issues to be considered when comparing exercise and training responses between
women and men. It also summarizes the nature of the more important and better established
gender differences in exercise and training responses, pointing out some practical implications
for exercise testing, athletic performance, the setting of employment standards, the prescription
of a physical training regimen, and motivation to continued physical activity. The second part of
the review considers the influence of the menstrual cycle and pregnancy on exercise and training
responses.
Issues in comparing exercise and training responses in men and women.
The existence and magnitude of inherent physiological and biochemical differences between
males and females are extremely controversial and emotionally charged issues, with important
practical implications, particularly when setting employment standards in traditional male
occupations.
Social and cultural influences. Some investigators have argued that much if not all of the
commonly described gender differences in body composition, physiological characteristics,
athletic and occupational performance reflect parallel gender differences in opportunities to
practice and encouragement to pursue physical activity and sport from an early age ( Fasting and
Tangen , 1980; Ferris, 1980; Harris, 1980; Graydon, 1987). Those espousing this viewpoint draw
attention to the shrinking gap between male and female records in many types of athletic
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competition (Wells, 1985). They further suggest that the currently popular range of athletic
events favours male dominance, and they argue that the time may not be too distant when
women will outperform men in a number of types of competition. For example, a tendency to
metabolize fat rather than carbohydrates gives women a significant advantage in the latter stages
of both ultra-long distance races and sustained military operations (Speechly et al., 1996;
Tarnopolsky, 1999). In one comparison, the running speed over a 90 km distance was 171
m/min in women and 155 m/min in men (Speechly et al., 1996). Certainly, it is important to
recognize that in many types of sporting activities the best trained females out-perform all but
the best trained males, and their performance greatly exceeds that of sedentary or moderately-
trained males. Equally, in physically demanding occupations, a very well-trained woman may
have a functional capacity that matches or exceeds that of her male peers.
Fundamental gender differences in physical characteristics. Realists point to fundamental
gender differences in body form and dimensions, with their almost body inevitable impact upon
physical performance.
The typical female carries a substantially greater burden of fat than her male counterpart.
This offers a significant disadvantage when performing most types of physical activity except
long distance swimming (a situation where the additional body fat increases buoyancy and
protects the individual against an excessive rate of cooling). Part of the greater fat content of the
female could reflect lesser opportunities for physical activity, and indeed a fair part of the
usually anticipated gender difference in fat storage disappears in response to prolonged
involvement in endurance running (Wilmore et al. , 1977). Nevertheless, there are residual
differences in the amount and distribution of stored fat even between top female and male
international-class athletes. Moreover, perhaps as a safeguard against the metabolic demands of
a potential pregnancy, reserves of body fat seem more resistant to the metabolic demands of
exercise in women than in men (Murray et al. , 1986; Hardman et al. , 1992; Cortright, 1999;
Westerterp, 1999), so that it is more difficult to correct obesity in women than in men.
Size is another important gender-linked difference. Women are, on average, some 0.1 m
shorter than men, and this difference has a substantial impact upon a variety of physical abilities.
For example, an individual’s peak muscle force is approximately proportional to the third power
of her or his stature, so that a woman who is 0.1 metres shorter than her male counterpart
inevitably tends to a 20% disadvantage in peak strength. In many practical industrial tasks such
as the lifting of heavy objects, the female handicap of inherently weaker musculature is
compounded by a low centre of gravity of the body and less leverage than in a typical man.
Problems of interpreting mean data. Occupational standards of functional capacity have
commonly been based on the respective mean values for men and women. However, a focus on
average gender differences in body dimensions and resulting physical abilities ignores the large
within-sex differences in these same characteristics. Thus, in practice the weakest males at any
given age are not as strong as the strongest women, and well-trained female athletes often
resemble sedentary or even athletic males more closely than their female peers.
If indeed it is important to exclude individuals with inadequate physical or physiological
characteristics from a certain type of employment on grounds of poor job performance or safety,
considerations of equity demand that such exclusions be based on an objective testing of the
individual rather than on physiologic norms which reflect often out-dated group averages. Some
progress has been made in the development of performance-related field tests that can assess
aptitude for various physically-demanding occupations, but unfortunately many of the currently
available procedures still lack the reliability and validity needed to make an appropriate
classification of individual workers (Shephard, 1990).
Methods of data standardization. Lack of agreement on appropriate methods of standardizing
data in order to allow for size effects is a problem when discussing gender differences in
exercise response.
Men are generally some 0.1 m taller and 15-20 kg heavier than women. However, there
is little consensus whether data such as maximal oxygen intake and peak muscle forces should be
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expressed in absolute terms, per unit of height2, per height3, per kg of body mass, or per kg of
lean mass (Drinkwater, 1984). In many industrial tasks, much of the total work must be
performed external to the individual. The demand is based on absolute rather than relative
criteria. Classification of functional capacity must then be based on absolute strength and
absolute aerobic power. The choice of such units inevitably places shorter subjects at a
disadvantage, and indeed some exponents of employment equity have criticized absolute
performance criteria on this basis. However, in many athletic events, the main physical task is to
displace body mass, and in these circumstances, data are best related to total body mass. Such
relative values still place women at a disadvantage relative to men, since a higher proportion of
the total body mass is fat rather than active muscle in female subjects. One author has
questioned whether even the expression of aerobic power per kg of lean mass would allow
adequate gender matching, because of the influence of other intervening gender-related
differences such as haemoglobin level (Drinkwater , 1984). In the case of muscular performance,
many measurements examine torque (the product of muscle force and the length of the lever
arm) rather than force per se, so that limb length also becomes as important a determinant of
score as the local muscle bulk.
Despite the difficulties in initial matching of sexes for fitness, such matching is an
important preliminary step when comparing exercise responses and assessing the relative
effectiveness of training programmes in men and women. For example, it is well known that a
person's level of fitness influences the rate of sweat production at any given core temperature,
and thus the tolerance of exercise in a hot environment. Thus, if we wish to examine whether
exercising women sweat more than their male peers, the two subject groups must be matched for
their initial level of fitness, and exercised at a comparable fraction of their respective maximal
oxygen intakes. Likewise, a person’s initial physical fitness is the prime determinant of response
to an aerobic training regimen (Shephard, 1968) . Some authors have chosen to equate the
training status of their subjects on the basis of maximal oxygen intake per kg of body mass.
However, both in sedentary adults and in well-trained international athletes, the average aerobic
power is some 20% less in women than in men (Shephard, 2000a). Thus, those who adopt this
tactic tend to compare the responses of fit women with those of unfit men.
Another possible option is to examine the “best” athletes of each sex, but this comparison
is again somewhat biased, since current female competitors are generally drawn from a smaller
pool of interested individuals than are their male peers. At the other extreme, we can compare
individuals of both sexes who are currently sedentary, but again it remains arguable that women
are at a disadvantage because socio-cultural factors have restricted their leisure physical activity
from an early age, making them more sedentary than sedentary men. Other options are to
compare individuals who are undertaking an equivalent weekly volume of training (Costill et al.,
1979; Sparling, 1980), or to match subjects using a combination of physical activity history and
measurements of aerobic power (Cureton, 1981). In terms of aerobic power, the best approach at
present seems to match subjects per kg of lean mass (Drinkwater , 1984; Tarnopolsky, 1999). But
plainly we will not have a definitive answer to questions regarding the extent of biological
differences in physical abilities between women and men until lifetime opportunities for physical
activity have been equalized for the general population of both sexes.
Gender-related morphological differences and their consequences
Cardiac and skeletal musculature. With the specific exception of the sex organs, girls and
boys show only minor differences in physical characteristics through to the age of puberty. The
hormonal differentiation of puberty causes a substantial increase of body fat in females, whereas
in males the dominant change is an increase in muscle bulk.
At maturity, androgen secretion induces the development of a substantially larger muscle
mass and greater cardiac dimensions in the male than in the female, even after allowance for
gender differences in average stature. Early investigators suggested that there were no consistent
sex differences in the relative proportions of slow and fast twitch muscle fibres ( Costill et al.,
1976; Prince et al., 1977), but more recent reports have indicated that- particularly in the vastus
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lateralis muscle- women have fewer type II fibres and a smaller type II/type I fibre area ratio
than men (Sale et al., 1987; Simoneau and Bouchard, 1989; Miller et al., 1993). The female
musculature is thus appropriate to prolonged rather than very intense physical activity. The
gender differences in muscle fibre type have other important implications for muscle function, as
discussed below.
Body fat content. Some of the accumulation of fat in the female is culturally imposed, and
indeed the percentage of body fat found in a “typical” woman has diminished as society has
sanctioned the adoption of a more active lifestyle. Nevertheless, because of phylogenetic
considerations related to the energy needs of pregnancy and lactation, the minimum quantity of
essential fat associated with good health is substantially larger in a woman than in a man
(probably 10-12% rather than 3% of body mass) (Katch et al. , 1980; Murray et al. , 1986; Wilmore
et al., 1992; Tarnopolsky, 1999).
Skeletal structures. The mature female has a smaller thorax, a larger abdomen, a broader and
shallower pelvis, shorter legs, and a lower relative centre of gravity than the male. The bones
are also smaller and lighter in structure (Komi, 1980), making them more vulnerable to fracture
(Jones et al., 1993; Ross and Woodward, 1994; Kelly and Bradway, 1997). The smaller
proportion of bone tissue reduces the average density of the lean body compartment (a key
figure in the simple, two-compartment hydrostatic determination of body fat).
The morphometric differences seen between the average male and the average female
have a number of biomechanical consequences. The broader hips and a marginally lower centre
of gravity tend to give greater stability to the female, facilitating activities that require balance
(especially gymnastic performance); on the other hand, they reduce a woman’s ability to lift
objects and handicap performance in athletic events such as high-jumping. Women's shoulders
tend to be narrower than those of men, with a greater slope, and the upper arms hang less
vertically. However, the concept of an increased carrying angle at the elbows, and resulting
problems in throwing has been challenged as a poorly documented fallacy ( Beals, 1976). Any
gender differences in throwing ability are attributable rather to a combination of less practice of
the requisite skills, a shorter lever arm and lesser arm strength in the typical female. A greater
angulation of the lower limbs, with an inward slope of the thighs toward the knees affects gait
patterns and the mechanical efficiency of movement, possibly increasing the woman's likelihood
of developing problems of patella tracking during running (Hunter-Griffin, 1988). The shorter
limb length of a woman also tends to limit stride frequency and thus peak running speeds
(Hoffman, 1972). Gender differences of joint angles and leverage affect scores in isometric tests
of muscle strength (Sale, 1999).
Estimating desirable body mass. Because current society places an excessive emphasis upon
the physical appearance of females, many women present for training with a suboptimal body
mass, and some participants in events that are judged partly on physical appearance (such as
gymnastics and figure skating) actively seek a suboptimal body mass. It is thus useful to
estimate the minimal desirable body mass of a female competitor. Katch and Katch ( Katch and
Katch , 1988) have suggested that this can be calculated as Mass (kg) = 1.11 (Height, m) x
(D/33.5)2, where D is the sum (in cm) of twelve diameters (biacromial, chest, bi-iliac,
bitrochanteric, R + L knees, R + L ankles, R + L elbows, and R + L wrists).
Gender-related differences in physiological responses to exercise
The commonly encountered gender differences in physiological responses to exercise stem
partly from culturally imposed differences in habitual physical activity and underlying
morphological differences, as discussed above. Nevertheless, there are also some inherent
physiological differences in the exercise responses of the two sexes, particularly during adult
life.
Maximal aerobic power. Prior to puberty, gender-related differences in maximal oxygen
intake are small (Shephard, 1981), and seem attributable almost entirely to socio-cultural factors.
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The gender discrepancy in aerobic power widens at puberty. Given that absolute values for
cardiac volume, blood volume and peak oxygen transport are all power functions of body size
(Von Döbeln, 1966; Shephard et al. , 1980), the greater height of the average man could account for
at least 30% of his ultimate advantage in aerobic power. A second important factor is a gender
difference in blood haemoglobin concentration (typically 13.8 g/dL in a woman, but 15.6 g/dL
in a man). The lower haemoglobin levels of the female apparently arise from a combination of
menstruation-related iron losses (Scott and Pritchard , 1967), lower blood levels of androgenic
steroids and in some cases deliberate dietary restriction. For every litre of blood that is pumped
by the heart, a typical man can carry to the working tissues a 13% greater quantity of oxygen
than a female subject. Finally, because the skeletal muscles of a woman are smaller than those
of a man, they tend to contract at a larger fraction of their maximal voluntary force; thus, at any
given absolute work rate the vascular impedance limiting cardiac ejection is greater in the female
than in the male (Kay and Shephard , 1969), with a corresponding limitation of peak cardiac output.
The absolute aerobic power as measured on a treadmill or cycle ergometer is commonly
at least 30-40% smaller in a woman than in a man of similar age, although differences decrease
after the female menopause. Gender differences in peak oxygen transport during aerobic arm
exercise are of at least a similar order (Shephard et al., 1988); indeed, because the gender
difference in muscle strength is greater for the arms than for the legs, men tend to have a larger
advantage of peak oxygen intake when exercise involves primarily the upper limbs.
During many types of athletic activity, the substantial physiological disadvantage of the
average woman is offset by a lighter body mass. She thus performs a smaller total amount of
mechanical work than a man when competing in any event that involves a displacement of body
mass. If maximal oxygen intake values are expressed per kg of body mass, the gender
discrepancy narrows to less than 20% in young adults. Nevertheless, claims that the residual
discrepancy reflects no more than socially conditioned differences in habitual physical activity
seem unwarranted. If statistics are examined for highly trained young endurance athletes, the
highest reported values are 94 ml.kg-1.min-1 for a male competitor, but only 77 ml.kg-1.min-1 for
the best female athlete, a discrepancy of some 18 percent (Drinkwater , 1984) .
Peak oxygen transport is closely related to muscle mass, and gender differences in
aerobic power are smallest if data are expressed per kg of lean tissue mass (Cureton, 1981;
Drinkwater , 1984). Such a calculation eliminates the penalty associated with the larger fraction of
essential body fat in a woman. If data for aerobic power are expressed per kg of lean tissue, the
gap between young men and women may be as small as 5% (Cureton, 1981). However, the
practical significance of oxygen transport per kg of lean mass is unclear, whether the observer is
evaluating athletic or industrial performance. The performance of external work and weight-
supported tasks demands a certain level of absolute aerobic power, and tasks where body weight
must be displaced require a specific oxygen transport per kg of total body mass. Thus,
depending on the type of activity to be performed, the aerobic power of male and female
subjects is best compared either in absolute units or per kg of total body mass.
By the normal age of retirement, the difference in hormonal milieu between the sexes has
greatly narrowed, and perhaps for this reason there is little difference of relative aerobic power
between typical representatives of the two sexes at this stage of life (Shephard, 1994).
A further issue influencing the relative performance of men and women is the
mechanical efficiency of movement. There have been suggestions that the economy of running
and cycling is 4-7% poorer in women than in men (Dengel et al., 1989; Daniels and Daniels,
1992; Miura et al., 1997). However, in this area, the socio-cultural argument remains strong.
Mechanical efficiency can be improved by practice, and it remains unclear how far any current
gender discrepancy reflects differences in technical skill rather than biomechanical constraints
imposed by differences in limb length and leverage.
Anaerobic power and capacity. The anaerobic power of a subject determines the ability to
undertake short sprints and jumping movements. It reflects mainly the magnitude of local stores
of phosphagen in the active muscles, and the potential to mobilize these reserves of energy
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quickly. Because women are less muscular than men (they have only about 70% of the fibre
area for both fast and slow twitch muscle fibres), a substantial disadvantage of anaerobic power
might be envisaged in women, even if the phosphagen stores per unit volume of muscle were
independent of gender.
Tests of absolute muscle power such as the work performed during a brief bout of all-out
cycle ergometry (the Wingate test) and peak lactate readings both suggest that the average
woman attains only 68-73% of male values for anaerobic power and anaerobic capacity ( Karlsson
and Jacobs, 1980). However, because the gender difference in body mass is of a similar
magnitude, much if not all of the apparent female disadvantage disappears in anaerobic tasks that
are performed against body mass (for example, jumping, or the Margaria staircase sprint) ( Wells,
1985; Haymes, 1988).
The intensity of endurance effort where a significant accumulation of lactate begins (the
ventilatory threshold) apparently corresponds to a similar fraction of maximal oxygen intake in
women as in men (Berg and Keul, 1980). The peak blood lactate concentrations reached during
all-out effort reflect the ratio of muscle mass to plasma volume. Partly for this reason, women
usually reach peak lactate values that are some 20% lower than in men (Karlsson et al. , 1980);
nevertheless, the discrepancy is much smaller in well-trained athletes, suggesting that socio-
cultural differences may also be involved(Berg et al. , 1980). The repayment of “oxygen deficit”
following a period of vigorous exercise is also smaller in women than in men ( Shephard et al.,
1989), although this difference disappears if values are expressed per kg of body mass.
Muscle strength and endurance. The absolute muscle strength of a woman is typically only
60% of values seen in men (Nordgren, 1972; Wilmore, 1974; Komi, 1980; Wells, 1985; Heyward
et al., 1986). The main source of this gender difference seems the smaller size of the individual
muscle fibres in women, although females may also develop a smaller peak force per unit cross-
section of muscle, perhaps because a given cross-section contains greater proportions of

intramuscular fat (Maughan et al., 1984; Kanehisa et al., 1994; Kanehisa et al., 1996) and
connective tissue (Miller et al., 1993) than in a man.
Gender-related differences in strength become much smaller if values are expressed per
kg of total body mass, and they are further reduced if data are expressed per unit of lean body
mass. For some types of athletic performance, strength per unit of total body mass may be
relevant, but from the standpoint of occupation, absolute strength is usually the critical variable
(Sale, 1999).
Gender differences in strength are smaller for the legs than for the arms (Sale, 1999).
Female values come closest to the male level in the case of the hip flexors and extensors, and the
discrepancies are larger for the muscles of the chest, shoulders, arms, and forearms ( Wilmore,
1974). Peak values for leg extension and quadriceps force become almost independent of
gender when expressed per kg of body mass (Komi, 1980). Although women are able to increase
their muscle strength by training (below), they show little of the increase in muscle bulk
characteristic of male subjects who have engaged in a similar training regimen ( Brown and
Wilmore , 1974; Oyster, 1979).
Perhaps the most striking gender difference in muscle characteristics is in the time
required to develop peak force. Largely because of a lower absolute strength, a woman takes
longer than a man to reach a given absolute muscle force (Häkkinen, 1993; Behm and Sale,
1994). Opinions still differ on the rates of development of relative force in men and women,
although a slower rate might be anticipated in females because they generally have a smaller
proportion of type II (fast-twitch) muscle fibres. In one study, women took almost twice as long
as men to reach 70% of their peak force (Komi, 1980), but other investigators have reported a
similar or even a more rapid development of relative force in women (Morris et al., 1983; Bell
and Jacobs, 1986; Häkkinen, 1993).
For reasons that are not yet completely understood, the gender difference in muscle
strength is smaller for eccentric and larger for concentric contractions (Seger and Thorstensson,
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1994). Women seem to store elastic energy in the stretched muscles more readily than men
(Aura and Komi, 1986).
Absolute muscular endurance is greater in men than in women, but women can match or
exceed men in their ability to sustain contractions at a given proportion of their maximal force
(Maughan et al., 1986; West et al., 1995).
Coordination and motor performance. It is generally accepted that women have greater
flexibility (FitnessCanada. , 1983) and better fine motor skills than men, although once again the
possible contribution of cultural factors has been raised. For example, the female advantage in
fine motor skills may result from differences in play patterns which are imposed from early
childhood (Greendorfer and Brundage , 1987). Other factors potentially contributing to better
coordination in the female are a lower centre of gravity and a shorter average limb length.
Reaction times of the female are generally similar to those of male peers, but because of
shorter limb lengths and less powerful muscles, movement times are substantially slower in
women than in men (Wright and Shephard , 1978; Yandell and Spirduso, 1981). Since task
performance depends on a combination of reaction time and movement time, women tend to
respond more slowly to such tasks as the braking of a motor vehicle.
Metabolic function. Women have a lower resting metabolic rate than men, reflecting sex
differences in overall body size and composition (Westerterp, 1999). Women also seem better
able to match their total energy expenditures to food intake, preserving body composition in the
face of an energy deficit.
On the other hand, women seem unable to boost intramuscular stores of glycogen as men
do (Tarnopolsky et al., 1995; Ruby, 1999; Tarnopolsky, 1999), although this may be partly
because they fail to optimize their patterns of carbohydrate intake (Tanaka et al., 1995). One
recent study noted that if men and women were each given appropriate carbohydrate or
carbohydrate-protein supplements following glycogen depletion, the rate of glycogen resynthesis
was similar in the two sexes (Tarnopolsky et al., 1997).

Inability to boost glycogen stores might be a handicap when performing prolonged
endurance activity, but in practice any disadvantage of the women is offset by a greater tendency
to metabolize lipids (Tarnopolsky et al., 1997). Thus, women tend to show a lower respiratory
gas exchange ratio at any given relative intensity of submaximal exercise (Jansson, 1986;
Tarnopolsky et al., 1990; Tarnopolsky et al., 1995), although there have been suggestions that
these differences disappear if the intensity of exercise is high (Froberg and Pedersen, 1984), or
the subjects are well-trained (Costill et al., 1979; Friedmann and Kindermann, 1989). The
reliance of women upon lipids leads to a sparing of available carbohydrate stores as a bout of
physical activity continues (Nygaard, 1986; Tarnopolsky et al., 1990). During two hours of
exercise at 40% of aerobic power, the respective fractions of total energy derived from fat were
51% in women and 44% in men (Horton et al., 1998). Experimental studies in male rats have
shown that the administration of oestradiol increases muscle lipoprotein lipase (LPL) activity,
while reducing LPL activity in adipose tissue; thus, plasma triacylglycerol-derived fatty acids
are distributed towards working muscle (Ellis et al., 1994), with a sparing of glycogen and an
increase in endurance performance (Kendrick and Ellis, 1991; Rooney et al., 1993). Likewise, if
oestradiol is administered to amenorrhoeic females, there is a decrease of gluconeogenesis
during moderate intensity exercise (Ruby et al., 1997). Women catabolize less protein than men
when they are exercising, but nevertheless they may be at a greater risk of developing a negative
nitrogen balance because of a poor total energy intake (Phillips, 1999).
Women appear to be more susceptible than men to the lipid mobilizing action of
caffeine. This drug acts by antagonizing adenosine receptors. It is as yet unclear whether
women have more adenosine receptors on their adipocytes, or whether these receptors are more
critical in inhibiting the process of lipolysis in women (Graham and McLean, 1999).
Hormonal differences. The most obvious gender difference is in the secretion of sex
hormones. As already noted, oestrogens have a substantial influence on patterns of metabolic
activity, both at rest and during exercise. They are thought to encourage subcutaneous fat
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deposition (Tarnopolsky and Cortright, 1999), and to modify appetite either by a direct action on
the satiety centres in the brain or by modifying levels of circulating fat. Oestrogens also
stimulate insulin production, increasing liver glycogen stores, decreasing hepatic
gluconeogenesis, improving glucose tolerance (Costrini and Kalkhoff, 1971; Matute and
Kalkhoff, 1973), and augmenting catecholamine-stimulated lipolysis in fat cells (Hansen et al.,
1964).
In contrast, progesterone stimulates fat accumulation, also by modifying the action of
adipocyte lipases (Kim and Kalkhoff, 1975).
There is also some evidence of gender differences in cortisol secretion in response to
heavy exercise. One investigation found that following a marathon run, cortisol levels were
increased in male but not in female runners (Keizer et al., 1989).
Androgens have a marked anabolic action, and are important to the increase of muscle
bulk during training. They increase the synthesis and decrease the breakdown of protein; muscle
cells, in particular, carry a substantial number of androgen receptors (Kanaley et al., 1992).
Androgens also decrease adiposity (Hervey and Hutchinson, 1973), stimulating the production of
growth hormone, and thus insulin-dependent growth factor-1 (Blizzard et al., 1989). Male
testosterone secretion depends on an adequate energy intake, and as with oestrogens and
progesterone in women, secretion can drop if heavy training induces a negative energy balance
(Prior, 1992). However, given an adequate diet, both endurance (Keizer et al., 1989) and
resistance (Häkkinen et al., 1988) training augment basal testosterone levels.
During exercise, catecholamine levels tend to rise to higher levels in men than in women,
perhaps in part because men have a greater muscle efferent activity (Sanchez et al., 1980), and in
part because the typical male at present pursues many sports in a more competitive spirit. It is
also possible that oestrogens exert a suppressant action on catecholamine production (Ettinger,
1999). Since catecholamine secretion is one factor that can precipitate sudden death during
exercise, this has implications for the safety of sport, physical activity and heavy industrial work;
women seem much less vulnerable to exercise-induced sudden death than are men (Romo,
1972). Plasma glycerol levels during exercise remain similar in men and women, suggesting
that women may be more sensitive to the lipolytic action of catecholamines (Horton et al.,
1998).
Gender differences in thyroid hormone secretion may contribute to differences in muscle
fibre type distribution between the two sexes (Larsson and Yu, 1997). Females also have higher
plasma leptin concentrations than males, even when data are matched for body fat content;
moreover, leptin levels fall with endurance training in women, but not in men (Hickey et al.,
1997).
Finally, the mononuclear cell secretion of the inflammation-promoting cytokine
interleukin-1 is greater in women than in men (Lynch et al., 1994). These observations need to
be interpreted in the light of the trend for less oxidative stress and exercise-induced muscle
damage in women (below).
Immunological factors Excessive physical effort can lead to a temporary suppression of
immune function, with a corresponding increase in the risk of upper respiratory infections. To
the extent that women perform any given task at a larger fraction of aerobic power or peak
isometric strength than men, they may be more vulnerable to adverse immune responses. On the
other hand, there have been suggestions that one factor contributing to the exercise-induced
suppression of immune function is a depletion of carbohydrate reserves, with subsequent
metabolism of the branch-chained amino acids which are important to leucocyte function. Thus,
a lesser tendency to carbohydrate and protein metabolism may protect the female immune
system during periods of very prolonged activity.
Empirical data on this important issue are as yet very limited. Some find no gender-
related differences in immune responses to exercise (Barriga et al., 1993), but others point to
discrepancies between the sexes (DeLanne et al., 1960; Röcker et al., 1978; Schouten et al.,
1988; Ferry et al., 1994). Further information is urgently awaited.

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Responses to environmental stress. The tolerance of extremes of heat and cold has
importance in the context of both sport and certain types of industrial work. A number of
investigators have compared male and female responses to extremes of environmental
temperature. Suggestions that women have a higher thermal set-point (Shapiro et al., 1980)
have been clouded by differences of initial fitness between male and female subjects, which in
themselves influence heat tolerance. If indeed women have a higher skin temperature, as would
be the case with a higher set-point, this might protect them against heat gain from the
surrounding environment under very hot conditions.
Because they have a greater thickness of subcutaneous fat, women have some advantage
over men in activities that involve severe cold exposure, such as distance swimming ( Pugh et al. ,
1960; Wyndham et al. , 1964) or exercise under cold and wet conditions. However, the female
advantage is less than might at first appear, since women also have a larger surface area/body
mass ratio (Kollias et al. , 1974), and a lower peak rate of heat production (Graham, 1983).
Moreover, the body derives some of its insulation in a cold environment from poorly perfused
muscle rather than from superficial fat, and in this respect the male has an advantage over the
female (Sloan and Keatinge , 1973). Women apparently seem less able than men to generate heat
through non-shivering thermogenic mechanisms such as the catecholamine-stimulated
breakdown of depot fat (Shephard, 1993); possibly, this helps to conserve fat reserves for the
needs of reproduction and lactation, as discussed above. Women thus begin to shiver at a higher
core temperature than men (Cunningham et al. , 1978), and this can have an adverse effect on their
performance of skilled motor tasks in a cold environment.
Many of the gender-related differences which have been noted in the cold operate in the
opposite sense during exposure to hot and humid conditions. The greater surface area/body mass
ratio gives the woman an advantage over a man in a hot environment (except as noted below,
under conditions where heat is being gained from the environment). Nevertheless, the rise of
core temperature may still be greater in a woman than in a man during what is generally the
critical occupational criterion, the ability to perform a given absolute quantity of work, since the
extent of body heating depends on the relative intensity of exercise (expressed as a percentage of
maximal aerobic power).
There is a substantial interaction between an individual’s level of aerobic fitness and his
or her tolerance of a hot environment. Unfortunately, most of the available studies have had
difficulties in matching men and women for aerobic fitness, and until effective matching has
been achieved, it seems premature to discuss gender-related differences in the rate of sweat
production or other indices of heat tolerance. Some recent studies suggest that at any given
fraction of an individual's aerobic power, the severity of heat stress is rather similar for men and
for women (Avellini et al., 1980; Wells, 1980).
In desert conditions, where the environment is hotter than skin temperature, the woman is
at a disadvantage; she gains more heat than a man for a given exposure because she has a
larger relative body surface area. If male subjects exercise at a higher absolute rate than females
under hot and dry conditions, they tend to produce more sweat than the women ( Horstman and
Christensen , 1982). However, sweating is more efficient in the female, because a larger
proportion of the secreted sweat is evaporated (Avellini et al., 1980). Moreover, training and/or
acclimation increase sweat production in women as in men, and indeed if the two sexes are
matched in terms of aerobic power, the advantage of men in hot, dry conditions does not seem to
persist once heat acclimation has been completed (Frye and Kamon, 1981).
Training responses.
There is as yet only limited information on the adaptive responses of women to a training
programme. In most cases, the magnitude of the immediate response seems to be independent of
gender (Wells, 1991; Plowman and Smith, 1997), but the time course and limits of trainability of
women remain unclear. Gender-related difference in training response could arise because of
biological factors, differences in initial level of fitness and patterns of training, and differences
in attitudes towards training.

-21-
Biological factors. Specific issues affecting the training of women include dimensional
constraints, the ability to induce muscle hypertrophy despite low levels of androgens, the greater
stability of depot fat in females, and possible gender-differences in the risks of overtraining.
Cardiac dimensions and blood volumes tend to vary as the third power of body size, thus
limiting the ability of women to match the aerobic power of men despite vigorous training. This
constraint is compounded by a low haemoglobin concentration (due to the combined effects of
menstrual blood loss and low levels of anabolic steroids).
Despite androgen levels that are much lower than in men, studies of elite athletes suggest
that the female cardiovascular system responds to endurance training in the same qualitative
fashion as a male subject. A well-designed conditioning programme yields substantial increases
in aerobic power, oxygen pulse, peak ventilatory volume and submaximal work performance
(Drinkwater, 1984). The typical gain in aerobic power (7 to 37%) covers a similar range to the
response seen in men, varying with the individual’s initial level of fitness (Knowlton et al.,
1978). Indeed, when men and women train together, the percentage change in aerobic power is
identical for the two sexes (Eddy et al., 1977), although because they usually begin from a
lower initial level, the absolute gain tends to be smaller in the women. There are also increases
of left ventricular cavity size and left ventricular mass in women as in men (Pollak et al., 1987;
Douglas et al., 1988; Douglas and O'Toole, 1992; Pellicia et al., 1996). Suggestions that women
increase their stroke volume without augmenting their maximal arterio-venous oxygen
difference are incorrect, and have been traced to the adoption of lower relative intensities of
training in the studies concerned (Cunningham et al., 1979). As in men, women show a close
correlation between development of their aerobic power and an increase in the number of
capillaries per muscle fibre (Saltin et al., 1977). Aerobic training also increases the mechanical
efficiency of running much as it does in male subjects (Pate et al., 1987). However, one study
found larger decreases of body mass and smaller increments of maximal respiratory volume in
women than in men (Burke, 1977).

Aerobic training should apparently be prescribed at a similar relative intensity in women
as in men. In both sexes, the usual choice for the training of the average individual is at or
below the lactate threshold, which lies in the range 72-88% of aerobic power for cycling and 80-
85% of aerobic power in running (Kohrt et al., 1989; O'Toole et al., 1989).
Despite gender differences in initial skeletal muscle strength, some reports have
suggested that women and men respond to resistance training by similar gains in strength and
muscle cross-sectional area (Wilmore, 1974; Weltman et al., 1978; Cureton et al., 1988; Tesch,
1992). Others have inferred from cross-sectional comparisons that men can induce hypertrophy
more easily than women, with the male subjects placing a particular emphasis on the
development of type II, fast twitch fibres; in women, in contrast, the two fibre types show a
similar degree of hypertrophy (Alway et al., 1989; Bell and Jacobs, 1990). High intensity
training also increases the extent of intracellular lipid deposits more in men than in women
(Howald et al., 1985).
There have been fewer studies of metabolic adaptations to training in women than in
men; however, increases of in vitro catecholamine-stimulated adipose cell lipolysis (Mauriege et
al., 1997) and lactate concentration at any given intensity of effort (Friedmann et al., 1989)
suggest that glycogen-sparing adaptations occur in women much as in men. However, in at least
one study, the women showed a decrease in RER, whereas the men did not; this could imply that
adaptations are greater in the women than in men (Friedlander et al., 1998), although in this
particular investigation the women also showed a much larger gain in aerobic power than the
men. Another possible gender difference in training response is in the pattern of sympathetic
nervous system adaptation; whereas highly trained men show a greater capacity for epinephrine
secretion than their untrained peers at a given work rate (Kjaer and Galbo, 1988), the women
studied by Friedlander and associates showed no difference in epinephrine levels and
significantly reduced norepinephrine levels following a period of training (Friedlander et al.,
1998).
-23-
Heavy training decreases gonadotropin-releasing hormone pulsatility in women (Rogol et
al., 1992). Resistance training also lowers serum cortisol in men but not in women (Staron et
al., 1994). The resulting increase in the testosterone/cortisol ratio may favour anabolism in the
male (Häkkinen et al., 1988). Little is known about the relative rates of training-induced protein
synthesis in women and in men; because of the action of androgens, faster synthesis might be
anticipated in men, but on the other hand females seem better able to protect themselves against
the muscle wasting associated with aging (Nuutila et al., 1995) and trauma (Yang and Birkhahn,
1993).
Training patterns. The average woman tends to have a lower initial level of fitness than her
male counterpart, increasing scope for a training response, but also influencing the intensity of
training that can be tolerated in the early stages of conditioning. More athletic women often
follow similar training patterns to men, and there is usually little difference of “tapering”
patterns between male and female competitors (O'Toole, 2000). Training volumes (distance x
pace) tend to be smaller in women than in men (Sparling et al., 1987). Despite this difference,
and usually the attainment of a lower peak aerobic power by the women, endurance performance
often shows little gender difference. This may be in part because there is a training ceiling,
beyond which additional conditioning is of little benefit (Speechly et al., 1996; O'Toole, 2000).
In one recent study, women had better perceptions of their primary school physical
education programme than did the men (Trudeau et al., 1999), and those women who had
received a daily physical education programme as a child were more likely than their male peers
to exceed the activity level of their peers (Trudeau et al., 1998); however, a positive effect of
daily physical education on adult abstinence from cigarettes was seen only in men (Trudeau et
al., 1999). Evaluation of responses to an employee fitness programme also showed a reduction
of cigarette addiction in the men but not in the women (Shephard et al., 1982). The reasons
governing participation in conditioning programmes commonly differ between men and women
(Sidney et al., 1983; Godin and Shephard, 1990). Men are often attracted by competition, fast
movement and even physical danger, whereas women are more inclined to view a training
programme as a source of social contact, a means of improving physical appearance, and in
older individuals of improving health (Sidney et al., 1983).
Safety of heavy exercise and training. The risk of cardiovascular emergencies increases with
intensity of effort, being exacerbated by excitement and aging. However, as discussed above,
the risk of sudden, exercise-induced death seems much lower in women than in men (Romo,
1972). Possible reasons for this include a lesser tendency to atherosclerosis in women, a lesser
tendency to continue exercising in the face of extreme fatigue, a lesser secretion of
catecholamines, and possible specific antagonistic effects of oestrogens on catecholamines (see
above).
In both men and women, the risk of musculo-skeletal injury is much greater than the risk
of a cardiovascular emergency. Musculo-skeletal problems arise simply from the volume of
training. Despite weaker muscles and bones, difficulties seem less prevalent in women than in
men, perhaps in part because they are less liable to undertake an excessive volume of training,
and in part because oestrogens possess anti-oxidant and membrane stabilizing properties (Tiidus,
1995; Clarkson and Sayer, 1999). In consequence, both skeletal and cardiac muscle are less
susceptible to injury in women than in men (Subbiah et al., 1993; Tiidus, 1995; Clarkson et al.,
1999; Tiidus, 1999). Because of a weaker bone structure, the risk of stress fractures is also
greater in women than in men (Kelly et al., 1997).
(Part II of this review describes the influence of the menstrual cycle and of pregnancy on the
responses to exercise and training. It also lists references. It will appear in the next issue of the
Canadian Journal of Applied Physiology)

-25-
Exercise and training in women.
Part II. Influence of menstrual cycle and of pregnancy
on exercise responses
by
Roy J. Shephard
from
Faculty of Physical Education & Health
and
Dept. of Public Health Sciences,
Faculty of Medicine, University of Toronto.
Correspondence to: Professor Roy J. Shephard,
PO Box 521, 41390 Dryden Rd., Brackendale, BC V0N 1H0.
Phone: 604-898-5527 Fax: 604-898-5724 E-mail: royjshep@mountain-inter.net

This part of the review considers the impact of the menstrual cycle and of pregnancy
upon exercise performance, together with the implications of continued, regular exercise for the
developing fetus. Specific issues that are covered changes in physical performance over the
menstrual cycle, the impact of training on the menstrual cycle, a need for awareness of potential
pregnancy, alterations in fitness, performance, circulatory, respiratory and metabolic function
during pregnancy, potential hazards to the fetus from hyperthermia and hypoxia, a recommended
physical activity programme for the pregnant woman, and the impact of continued exercise upon
pregnancy outcomes.
Physical performance and menstruation
The luteal phase of the menstrual cycle is associated with a substantial increase in resting
body temperature (about 0.5oC). This inevitably reduces the safe margin for heat accumulation
when working in a hot environment. However, it seems to have remarkably little impact upon
physiological responses to submaximal exercise, even when such activity is performed in the
heat (Horvath and Drinkwater , 1982). The extent of any impact of menstrual cycle phase upon
athletic performance is still vigorously debated (Nicklas et al., 1989; Dibrezzo et al., 1991;
Lebrun et al., 1995).
The ovarian hormones have a major effect upon substrate utilization. The influence of
oestradiol was discussed in Part I of this review. High blood levels of progesterone that develop
during the luteal phase of the menstrual cycle lower circulating levels of free fatty acids,
influencing the RER and decreasing the ability to sustain blood glucose (Bonen et al., 1983;
Lavoie, 1986; Hackney et al., 1994).
There is an associated increase in the ventilatory response to a given intensity of exercise
during the luteal phase, with implications for such measures as the “talk-test” of training
intensity; however, the increase in ventilation does not appear to influence the overall maximal
oxygen intake (Schoene et al., 1981). It remains possible that a larger fraction of the oxygen
-27-
intake is consumed by the chest muscles during the luteal phase, leaving less oxygen available
for the muscles that are performing external work.
Water retention during the pre-menstrual phase of the cycle may lead to a small increase
of body mass; in theory, this would cause a small increase in the oxygen cost of activities that
involve a displacement of body mass. Intra-ocular pressure may also rise during the pre-
menstrual phase, and this could be sufficient to impair activities requiring a high level of visual
acuity (Dalton and Williams , 1976). Possible treatments such as fluid restriction and the
administration of diuretics or small doses of progesterone during the latter part of the menstrual
cycle need to be adopted cautiously, with competent medical advice and a full awareness of
potential risks. Simple reaction times are unaffected by premenstrual changes, but one report
has noted a small decrease in hand steadiness (Zimmerman and Parlee , 1973).
A number of athletes manipulate the timing of menstruation to avoid its coincidence with
major competition, but many others maintain a full schedule of training and competition through
all phases of the menstrual cycle. A heavy menstrual flow may sometimes impose practical
problems of personal hygiene for a day or so, but there is now a strong consensus that physical
performance shows remarkably little change over the course of a normal menstrual cycle. The
performance of events requiring strength may even show a small improvement during the
premenstrual phase, although at this stage there may be a minor deterioration in the performance
of activities requiring intense concentration or cooperation with other players. It is plainly
impossible to conduct double-blind observations on physical performance over the menstrual
cycle, and it is thus unclear how far any reported changes are a psychological response to
socially conditioned expectations rather than a consequence of underlying physiological and
biochemical phenomena.
Impact of training on menstrual function

A number of reports have suggested that moderate exercise is helpful in relieving
dysmenorrhoea, possibly by altering the balance of prostaglandins (Anderson, 1979) or improving
overall mood state.
Participation in gymnastics, figure skating and prolonged endurance events is frequently
associated with delayed menarche. The affected individual is often dissatisfied with her current
body image. In such instances, the intake of food energy is inadequate relative to metabolic
needs, and the percentage of body fat is very low (Frisch et al. , 1980; Rippon et al., 1988).
However, many coaches deliberately select late maturers in activities that are judged by physical
appearance and favour the petite competitor (Malina et al. , 1978), and this is a further factor
contributing to a late average age of menarche among participants. In a few unfortunate
instances, "doping" procedures may even have been used to delay normal maturation in top
Olympic contestants.
The onset of irregular menstruation and the development of a temporary amenorrhoea are
common concomitants of heavy training, particularly when such training is associated with the
psychological stress of intense competition, and development of a negative energy or nitrogen
balance. It has been argued (Prior, 1992) that parallel events such as a suppression of sperm
production can be seen in male endurance competitors, and that the entire phenomenon is a
normal reproductive response to a relative shortage of food supply. Normal menstruation is
resumed when training is moderated or the intake of food is increased. A weakening of bone
structure is one possible negative consequence of exercise-induced menstrual disturbances.
Women who have never had regular menstrual cycles show, on average, an acute 17% deficit of
bone density relative to their normally menstruating peers. It has yet to be determined how
readily a normal bone density can be restored once such individuals halt intensive training
(Drinkwater et al. , 1990), and normal menstruation returns. Musculo-skeletal injuries are certainly
more common in athletes with disturbed menstruation, although it is hard to separate out the
-29-
mechanical effects of exposure to intense and prolonged training from the consequences of a
lesser secretion of oestrogens in the affected individuals.
If the menstrual cycle of a woman who is training becomes irregular, the physician
should first rule out causes other than exercise (including pregnancy!). If an exercise-induced
energy deficit is responsible, a normal menstrual cycle can usually be restored by a combination
of counselling, a 10% reduction of training volume, and an increase of food intake sufficient to
induce a modest (2 kg) increase of body mass. If anovulation or amenorrhoea persist for longer
than 3-6 months, medroxyprogesterone can be administered 14 days monthly, and calcium
intake should also be increased to the level recommended for menopausal women (1500
mg/day).
Awareness of potential pregnancy
Young women who are training on a regular basis may not recognize that they are
pregnant for several weeks, and as noted above, pregnancy can be confused with a training-
induced amenorrhoea. In view of the susceptibility of the foetus to injury in the early stages of
pregnancy, it is important that all training programmes for fertile women be compatible with a
safe pregnancy. Most authorities now agree that it is beneficial to continue moderate physical
activity throughout pregnancy, although in the later stages of gestation it is plainly advisable to
avoid contact sports and activities where there is a risk of falling and thus provoking an abortion.
Fitness, performance and pregnancy
As body mass increases during pregnancy, there is a progressive decrease of performance
capacity in all types of weight-bearing exercise, because more energy is required to move an
increased body mass (Artal et al., 1989) . Since the increase of weight is due to fat, placenta
and foetal tissue, the aerobic power per kg of body mass decreases progressively as pregnancy
advances. Changes in absolute aerobic power (expressed in l.min -1) are more variable (Clapp and
Capeless, 1990; Lotgering et al., 1991; Wolfe and Mottola, 1993). Much depends on
pregnancy-related changes in the individual’s patterns of habitual physical activity. Sedentary

women may choose to become more active, or may increase their level of physical fitness simply
because they are carrying a greater total body mass (Webb et al., 1994). In contrast, very well-
conditioned women may decide to reduce their training schedules.
During pregnancy, the metabolic reserve available for exercise is diminished by (i) an
increase in resting heart rate, (ii) a blunting of the sympathetic system response to physical
activity (Bonen et al., 1992), with a decrease of maximal heart rate (Clapp, 1985), and (iii) an
increase in the rate of resting metabolism as pregnancy advances. The ventilatory threshold
remains unchanged (Wolfe et al., 1994; Lotgering et al., 1995), but several factors interact to
reduce the peak respiratory gas exchange ratio and peak lactate concentrations: a reduced ability
to metabolize carbohydrate, blunted liver glycogenolysis with a decrease in carbohydrate
availability, dilution of lactate in the expanded plasma volume, and foetal metabolism of lactate
(Clapp et al. , 1987; McMurray et al., 1988; Lotgering et al., 1991; Wolfe et al. , 1994) .
Circulatory changes during pregnancy
The circulatory changes associated with pregnancy include an increase of stroke volume
and cardiac output, both at rest and in submaximal exercise (Guzman and Caplan, 1970; Sady et
al., 1990; Pivarnik et al., 1991). The increase of blood volume may improve physical ability
during the first few months of pregnancy, although this advantage is later offset by a significant
increase of body mass. There is a dilatation of all four cardiac chambers, an increase in aortic
diameter, an enlargement of the venous capacity vessels, a dilatation of arteriolar resistance
vessels (Duvekot et al., 1993), a 40-50% increase of blood volume (Lund and Donovan, 1967)
and a 10-15 beat/min increase of heart rate during submaximal exercise (Clapp, 1985). This last
change can compromise heart-rate based predictions of aerobic fitness and training intensity. In
the late stages of pregnancy, the foetus may shift to a position where maternal venous return is
compromised, particularly if physical activity is performed while lying supine.
The endocrine effects of pregnancy often mask the enhancement of resting
parasympathetic activity that is induced by light training (Wolfe, 2000). However, reductions
-31-
of heart rate during submaximal exercise can still be demonstrated in response to more vigorous
training. The pregnancy-induced increase of blood volume and left ventricular mass may also be
enough to mask similar responses to moderate training.
Changes in respiratory function during pregnancy
Elevation of the diaphragm by the developing foetus reduces the residual lung volume,
expiratory reserve and total lung volume (Ratigan, 1983). These changes, together with the
effects of increased circulating progesterone, increase respiratory sensitivity (Wolfe et al.,
1998) . The resting respiratory minute volume is increased, from perhaps 6 l.min -1 to 9 l.min-1
(Moore et al., 1987), and the dyspnoea threshold is commonly reduced (Field et al., 1991).
Hyperventilation also augments arterial oxygen pressure at the expense of an excessive
elimination of carbon dioxide. The latter is compensated by an increased excretion of
bicarbonate (Hytten, 1968; Blechner, 1993). In the late stages of pregnancy, the increase of
body size and mass, plus a restriction of abdominal breathing make vigorous exercise quite
difficult.
Metabolic changes during pregnancy
The foetus is dependent on glucose as its energy source, and it is thus important to ensure
that a heavy and sustained bout of maternal exercise does not induce hypoglycemia. There is
some evidence that (perhaps as a means of protecting the foetus from hypoglycemia) pregnancy
reduces the ability of the mother to metabolize carbohydrate (Clapp et al. , 1987). If so, this could
limit the ability of the mother to perform anaerobic activities during pregnancy. The pancreatic
secretion of insulin is augmented during pregnancy, and adiposity tends to increase during the
first trimester (Hollingsworth, 1985). Circulating placental hormones increase peripheral insulin
sensitivity, and this probably explains any increase in fat metabolism and sparing of
carbohydrate (Hollingsworth, 1985).
Moderate conditioning does not reverse the pregnancy-induced increase in body fat
stores (Greer and Wolfe, 1994). However, the usual metabolic effects of training (an increased
fat utilization, with a reduced output of carbon dioxide and a decrease in respiratory quotient)
have been noted to persist in healthy pregnant women (Ohtake and Wolfe, 1998). The reduction
of carbon dioxide output tends to offset the respiratory hypersensitivity and low dyspnoea
threshold discussed above (Ohtake et al., 1998).
Thermal hazards to the foetus
Moderate physical activity has no adverse effect upon the foetus (Wolfe et al. , 1994).
However, there is some increase in the risk of teratogenic effects if exercise is pushed to a level
inducing significant hyperthermia (>38.9°C) during the first trimester of pregnancy. Pregnancy
also reduces the thermal reserve, since the resting core body temperature is usually 0.5°C higher
than before pregnancy. The adverse consequences of an increased mass/surface area ratio, foetal
heat production and impaired circulation are countered by increased peripheral vasodilatation
and a reduction in the sweating threshold (Clapp, 1991). The thermal hazard of abnormal foetal
development has been shown directly in exercising animals, and a parallel risk has been inferred
in humans on the basis of adverse responses to the fevers induced by infectious diseases
(McKenzie , 1992).
Foetal hypoxia
Late in pregnancy, over-vigorous exercise may reduce placental perfusion, causing foetal
bradycardia. This is presumably a sign of temporary hypoxia, and the magnitude of the response
depends on the intensity of exercise that is performed (Lotgering et al., 1983) . Its impact upon
foetal development has yet to be decided (Carpenter et al. , 1988). Exercise-induced
haemoconcentration may compensate at least partially for any decrease of placental blood flow
during heavy physical activity (Lotgering et al. , 1984). Exercise also causes a compensatory
redistribution of blood flow from the uterine myometrium to the cotyledons, together with an
increase in foetal arterio-venous oxygen extraction (Wolfe et al. , 1994).
The exercise-induced slowing of foetal heart rate and respiratory rate conserve the
oxygen supply which is available to the foetus. The extent of hypoxic changes during vigorous
-33-
exercise is affected by gestational and maternal age and the muscle mass involved (Lotgering et
al., 1983) . The usual foetal reaction to maternal exercise is an increase in the baseline foetal
heart rate (Watson et al., 1991; Clapp et al., 1993), with a reduction in foetal heart rate reactivity
and breathing movements (Manders et al., 1997). Typically, a slowing of the foetal heart rate is
seen only with moderate to vigorous exercise, the incidence in light exercise being 10-15%.
Any bradycardia that does develop is transient, and is seen most clearly immediately following
the bout of activity (Carpenter et al. , 1988; Webb et al., 1994).
Recommended physical activity programme for pregnant women
During the early stages of pregnancy, light to moderate activity can be pursued safely,
provided a watch is kept for hyperthermia and hypoglycaemia. It may be necessary to change
the pattern of conditioning exercise in order to reduce the risk of falls (for example, cycle
ergometry becomes preferable to cycling on the street) and discomfort may be decreased if
uphill treadmill walking replaces running. Pregnancy is not an indication for embarking upon
intensive conditioning, and in general the quantity of exercise performed should not be increased
over previous levels during the first fourteen and the final twelve weeks of pregnancy.
Depending on the intensity of effort and resulting circulatory and thermal challenges, ordinary
pregnant women tolerate exercise sessions of up to 30 minutes duration, 4 times per week
(Brenner et al., 1991; Webb et al., 1994; Wolfe et al. , 1994; Ohtake et al., 1998), and tolerance is
probably greater in fitter individuals.
Swimming is a particularly suitable activity for the pregnant woman, given the support of
body mass and the easier control of core temperatures. As pregnancy advances, an increased
laxity of the mother’s ligaments may increase the risk of musculo-skeletal injuries (Berry et al. ,
1989). About a half of pregnant women elect to reduce their training schedules beyond the 28th
week of gestation. At this stage, it is often helpful to introduce weight-supported activities such
as swimming, aquabics and running in water (Leaf, 1989).

The safety of any proposed activity programme is best assessed by use of the physical
activity readiness questionnaire for pregnancy (PAR MedX for pregnancy) developed jointly by
the Ontario Fitness Safety Standards Committee and the Canadian Society for Exercise
Physiology. Important contraindications to vigorous exercise include premature labour and/or
ruptured membranes, placental injury or dysfunction, an incompetent cervix, pregnancy induced
hypertension, pre-eclampsia or toxaemia, and intra-uterine growth retardation
(AmericanCollegeofObstetriciansandGynecologists, 1994;
CanadianSocietyforExercisePhysiology, 1996). Caution should be shown if there is a history of
spontaneous abortion or premature labour, and twin pregnancy also requires a more limited
schedule of physical activity. If maternal energy stores are initially low, care must be taken to
maintain energy balance (AmericanCollegeofObstetriciansandGynecologists, 1994;
CanadianSocietyforExercisePhysiology, 1996). Reasons to review activity patterns with a
physician include persistent uterine contractions, bleeding or loss of fluid from the vagina,
failure of normal foetal weight gain and signs suggestive of pre-eclampsia (swelling of the
extremities, headaches, dizziness, or disturbances of vision).
Because of the circulatory changes discussed above, the heart rate corresponding to the
target intensity of effort is reduced by 15-20 beats/min during pregnancy. It is thus helpful to
use ratings of perceived exertion in gauging an appropriate intensity of effort (Ohtake et al.,
1988; Pivarnik et al., 1991).
Effects of continued regular exercise on pregnancy outcomes
The effects of regular moderate exercise on the outcome of a pregnancy are in general
neutral or positive. It may speed the course of labour (Wong and McKenzie , 1987), and the long-
term condition of the mother is improved (Hall and Kaufmann, 1987).
The energy supply of the fetus is in general well protected against the added metabolic
demands of maternal exercise, although repeated bouts of very vigorous physical activity can
lead to some reduction of birth weight (Clapp and Dickstein , 1984). Prospective trials indicate no
-35-
significant effect of moderate conditioning on pregnancy outcomes (Wolfe, 2000). Small-scale
trials suggest favourable outcomes in women who continue to run or jog throughout pregnancy
(Zaharieva, 1972; Hutchinson et al., 1981; Lutter et al., 1984; Cohen et al., 1989). If more
strenuous exercise is pursued during pregnancy, birthweight may be increased (Hatch et al.,
1993), in part because of augmented placental growth (Clapp and Rizk, 1992). In contrast, very
strenuous exercise may reduce birthweight (Clapp et al. , 1984; Pivarnik, 1998); this seems due at
least in part to a reduction in foetal adiposity (Clapp et al., 1990).
The energy demands of regular exercise do not appear to impede lactation. Indeed,
cross-sectional comparisons suggest that relative to their sedentary peers, women who choose to
exercise regularly secrete larger volumes of milk with a higher energy content ( Lovelady et al. ,
1990). This benefit may reflect enhanced levels of serum prolactin, or a relief of post-partum
depression in the exercisers (Schelkun, 1991). Following delivery, body mass decreases by 5-7
kg, blood volume quickly returns to pre-pregnancy values (South-Paul et al., 1992), and with the
decrease in circulating levels of progesterone, respiratory sensitivity normalizes. Anaemia may
sometimes persist, and systemic vascular resistance, end-diastolic volume and stroke volume
remain elevated for up to 12 weeks (Capeless and Clapp, 1991).
Recumbent abdominal and pelvic floor exercises can be initiated soon after delivery,
along with deep breathing, static muscular contractions and light walking (FitnessOntario, 1983),
but intensive abdominal exercises should be deferred until abdominal muscle separation is
corrected. Individual tolerance provides the best guide to the progression of exercise. The
competitive performance of international athletes is sometimes enhanced following full recovery
from pregnancy. It has been suggested that the heavy circulatory demands of gestation offer the
equivalent of 9 months of rigorous conditioning (Klaus and Noack , 1971)!
Conclusions
More information is needed on gender differences in exercise and training responses, using well-
matched samples of men and women. Although some differences can be explained in terms of socio-
cultural factors, there are also inherent biological factors (for instance, differences in physical size, body
composition and hormonal milieu) that give the average woman a smaller aerobic power and less
muscular strength than a man, even after rigorous training. Account must be taken of such differences in
setting occupational standards. Nevertheless, both sexes show a wide range of functional capacities, so
that the fittest women can out-perform many men both in sport and in physically demanding work. The
pattern of training response is generally similar in women and men; a lack of anabolic hormones may
limit the female response, but women also seem less vulnerable than men to both exercise-induced
sudden death and overtraining. Conditioning programmes for young women should take account of
possible pregnancy, with foetal hazards of an excessive rise in core body temperature, a decrease of
maternal blood sugar, and foetal hypoxia. However, regular moderate exercise appears to have a
favourable impact upon pregnancy outcomes.
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Women and Training -1-

Exercise and training in women.

Faculty of Physical Education & Health

Dept. of Public Health Sciences,

Faculty of Medicine, University of Toronto.

Correspondence to: Professor Roy J. Shephard,

PO Box 521, 41390 Dryden Rd., Brackendale, BC V0N 1H0.

Phone: 604-898-5527 Fax: 604-898-5724 E-mail: royjshep@mountain-inter.net

impact upon pregnancy outcomes.

femme. Un niveau bas de conditionnement physique peut augmenter la possibilité d’entrainement de

l’activité physique et l’entrainement. La programmation d’entrainement doivent toujours considérer la

excessive de la température corporelle, une hypoglycémie maternelle, et une hypoxie foetale.

d’une grossesse d’un façon bénéfique.

Sex differences Différences sexuales

Socio-cultural issues Facteurs socio-culturelles

Biological differences Différences biologiques

Physical activity L’activité physique

Conditioning Conditionnement physique

Employment standards Mesures d’employabilité

of gender differences in exercise and training responses. In particular, clear recommendations

Issues in comparing exercise and training responses in men and women.

practical implications, particularly when setting employment standards in traditional male

commonly described gender differences in body composition, physiological characteristics,

athletic and occupational performance reflect parallel gender differences in opportunities to

Fundamental gender differences in physical characteristics. Realists point to fundamental

usually anticipated gender difference in fat storage disappears in response to prolonged

international-class athletes. Moreover, perhaps as a safeguard against the metabolic demands of

Problems of interpreting mean data. Occupational standards of functional capacity have

If indeed it is important to exclude individuals with inadequate physical or physiological

classification of individual workers (Shephard, 1990).

Methods of data standardization. Lack of agreement on appropriate methods of standardizing

adequate gender matching, because of the influence of other intervening gender-related

score as the local muscle bulk.

Gender-related morphological differences and their consequences

in males the dominant change is an increase in muscle bulk.

At maturity, androgen secretion induces the development of a substantially larger muscle

sanctioned the adoption of a more active lifestyle. Nevertheless, because of phylogenetic

et al., 1992; Tarnopolsky, 1999).

figure in the simple, two-compartment hydrostatic determination of body fat).

of muscle strength (Sale, 1999).

bitrochanteric, R + L knees, R + L ankles, R + L elbows, and R + L wrists).

Gender-related differences in physiological responses to exercise

The commonly encountered gender differences in physiological responses to exercise stem

Maximal aerobic power. Prior to puberty, gender-related differences in maximal oxygen

The absolute aerobic power as measured on a treadmill or cycle ergometer is commonly

the best female athlete, a discrepancy of some 18 percent (Drinkwater , 1984) .

imposed by differences in limb length and leverage.

1985; Haymes, 1988).

ventilatory threshold) apparently corresponds to a similar fraction of maximal oxygen intake in

section of muscle, perhaps because a given cross-section contains greater proportions of

connective tissue (Miller et al., 1993) than in a man.

Wilmore , 1974; Oyster, 1979).

and Jacobs, 1986; Häkkinen, 1993).

(Aura and Komi, 1986).

(Maughan et al., 1986; West et al., 1995).

respond more slowly to such tasks as the braking of a motor vehicle.

face of an energy deficit.

carbohydrate-protein supplements following glycogen depletion, the rate of glycogen resynthesis

was similar in the two sexes (Tarnopolsky et al., 1997).

Inability to boost glycogen stores might be a handicap when performing prolonged

oestradiol is administered to amenorrhoeic females, there is a decrease of gluconeogenesis

nitrogen balance because of a poor total energy intake (Phillips, 1999).

hormones. As already noted, oestrogens have a substantial influence on patterns of metabolic