The Active Female: Health Issues throughout the Lifespan

Preface
About the Editors
Role and Scope Statement
Audience
Acknowledgments
Contents
Contributors
Part I: Unique Gender and Sex Related Physical, Psychological and Physiological Characteristics of Females
1: Considerations of Sex Differences in Musculoskeletal Anatomy Between Males and Females
1.1 Introduction
1.2 Research Findings
1.2.1 Sex Differences in the Anatomy of Selected Musculoskeletal Components
1.2.1.1 Sex Differences in Skeletal Geometry
1.2.1.2 Sex Differences in Musculoskeletal Tissues
1.2.2 Selected Regional Considerations in Female Functional Pathoanatomy
1.2.2.1 Upper Extremity
Shoulder
Elbow
Wrist and Hand
1.2.2.2 Lower Extremity
Hip Joint
Knee Complex
Ankle and Foot
1.2.2.3 Spine
Cervical
Thoracic
Lumbar
Sacroiliac Joint and Pelvis
1.3 Contemporary Understanding of the Issues
1.4 Future Directions
1.5 Conclusion
Review Questions
References
2: Body Image Throughout the Lifespan
2.1 Introduction
2.2 Research Findings
2.2.1 Risk Factors for the Development of Body Dissatisfaction
2.2.1.1 Theoretical Perspectives
2.2.2 Body Image Concerns Across Age Groups
2.2.2.1 Preadolescent and Adolescent Females
2.2.2.2 Young Adult Women
2.2.2.3 Older Women
2.2.3 Body Image Assessment
2.2.3.1 Body Image Assessment Scales and Questionnaires
2.3 Contemporary Understanding of the Issues
2.3.1 Theoretical Foundations
2.3.2 Body Image Intervention Strategies
2.3.2.1 Socioecological Framework
2.3.2.2 Dissonance-Based Prevention
2.3.2.3 Physical Activity
2.3.2.4 Female Athletes
2.3.2.5 Health and Wellness Coaching
2.3.2.6 Health Communication Strategies
Mobile Apps
Diverse Ad Campaigns
Social Media Campaigns
2.4 Future Directions
2.4.1 Emotional Intelligence and Mindfulness
2.4.2 Developmental Stages and Life Transitions
2.4.3 Spectrum of Body Image and Eating Concerns
2.4.4 Mental Health Literacy and eHealth Literacy
2.4.5 Assessment
2.5 Concluding Remarks
Appendices
Appendix 1: Body Image Quality of Life Inventory
Appendix 2: Body Image Concern Inventory
Appendix 3: Physical Appearance State and Trait Anxiety Scale: Trait
Chapter Review Questions
References
3: The Psychology of Female Sport Performance from a Gender Perspective
3.1 Introduction
3.2 Research Findings and Contemporary Understanding of the Issues
3.2.1 Confidence
3.2.2 Competitive Anxiety
3.2.3 Gender Differences in the Motivation for Sport Participation and Competitiveness
3.2.4 Group Dynamics, the Cohesion–Performance Relationship and Conflict
3.2.5 Stressors and Coping
3.2.6 Self-Compassion
3.2.7 Weight Pressures, Body Dissatisfaction, and Associated Eating Disorders
3.2.8 Coaching and Coach Behaviors
3.2.9 Microaggressions Towards Female Athletes
3.3 Future Directions and Concluding Remarks
Chapter Review Questions
References
4: Reproductive Changes from Puberty to Menopause and the Effects of the Menstrual Cycle on Bone Formation and Bone Loss
4.1 Introduction
4.2 Research Findings and Contemporary Understanding of the Issues
4.2.1 Puberty
4.2.2 Menstrual Cycle
4.2.3 Disruption of the Menstrual Cycle
4.2.4 Cessation of the Menstrual Cycle
4.2.5 Bone Composition and Physiology
4.2.6 Effects of Female Sex Hormones on Bone
4.2.7 Peak Bone Mass
4.2.8 Results of an Abnormal Menstrual Cycle on Peak Bone Mass
4.2.9 Menopause and Bone Mineral Density
4.3 Future Directions and Concluding Remarks
Chapter Review Questions
References
5: A Modern Understanding of the Models of Energy Deficits in Athletes
5.1 Introduction into Energy Availability
5.1.1 The Female Athlete Triad (FAT)
5.1.2 Relative Energy Deficiency in Sport (RED-S)
5.2 Research Findings and Contemporary Understanding of Health Consequences of Low-Energy Availability
5.2.1 Eating Disorders
5.2.2 Menstrual Dysfunction
5.2.3 Bone Health
5.2.4 Energy Availability, Bone Health, and Menstrual Dysfunction Interaction
5.2.5 Performance Consequences of Low-Energy Availability
5.3 Future Directions and Concluding Remarks
5.3.1 Importance of Early Intervention and Prevention
5.3.2 Conclusion
Chapter Review Questions
References
6: The Physiology of Anorexia Nervosa and Bulimia Nervosa
6.1 Introduction
6.1.1 Diagnostic Criteria for Anorexia Nervosa
6.1.2 Diagnostic Criteria for Bulimia Nervosa
6.1.3 Eating Disorder Crossover and Identification
6.2 Research Findings
6.2.1 Adverse Health Effects of Anorexia Nervosa
6.2.1.1 Gastrointestinal Abnormalities
6.2.1.2 Fluid and Electrolyte Abnormalities
6.2.1.3 Integumentary Abnormalities
6.2.1.4 Hematologic Abnormalities
6.2.1.5 Skeletal Problems
6.2.1.6 Central Nervous System Abnormalities
6.2.1.7 Effects on Pregnancy
6.2.2 Comorbidities and Mortality Rates for Anorexia Nervosa
6.2.2.1 Cardiovascular Abnormalities
6.2.2.2 Endocrine Abnormalities
6.2.2.3 Mortality Rates
6.2.3 Adverse Health Effects of Bulimia Nervosa
6.2.3.1 Gastrointestinal Abnormalities
6.2.3.2 Gynecological Problems and Hormones
6.2.3.3 Cardiovascular Abnormalities
6.2.3.4 Immunologic Abnormalities
6.2.4 Comorbidities and Mortality Rates for Bulimia Nervosa
6.3 Contemporary Understanding of the Issues
6.3.1 Genetic Variables and Eating Disorders
6.3.2 Neurotransmitters and Neuropeptides
6.3.2.1 Serotonin and Tryptophan
6.3.2.2 Neural Signaling Response to Food Consumption
6.3.2.3 Receptor Subtypes for Serotonin
6.3.2.4 Dopamine
6.3.2.5 Catechol-O-methyltransferase
6.3.3 Peptides and Proteins
6.3.3.1 Leptin
6.3.3.2 Ghrelin
6.3.3.3 Cholecystokinin
6.3.3.4 Brain-Derived Neurotrophic Factor
6.4 Future Directions
6.4.1 Anorexia Nervosa
6.4.2 Bulimia Nervosa
6.4.3 Secondary Prevention and Education
6.5 Concluding Remarks
Chapter Review Questions
References
7: Exercise Metabolism and Menstrual Cycle
7.1 Introduction
7.2 Research Findings and Contemporary Understanding of the Issues in Substrate Metabolism
7.2.1 Methodological Limitations and Recommendations
7.2.2 Substrate Metabolism at Rest
7.2.2.1 Estrogen Receptors and Estrogen Action
7.2.2.2 Effects of Estrogen and Progesterone on Carbohydrate and Fat Metabolism
7.2.2.3 Effects of Sex Hormone-Binding Globulin in Estrogen Action
7.2.3 Substrate Metabolism During Exercise
7.2.3.1 Substrate Metabolism During Aerobic Exercise (AE)
7.2.3.2 Substrate Metabolism During Resistance Training (RT)
7.3 Future Directions
7.4 Concluding Remarks
Chapter Review Questions
References
Part II: Inequities in Women’s Health Care and Alternative Management Strategies for Women’s Health
8: Racism, Health Disparities, Health Inequities, and Black Women’s Health and Healthy Activity
8.1 Introduction
8.2 Internal Racism and an Absence of Female Consciousness Frameworks
8.2.1 Internal Racism
8.2.2 An Absence of Female Consciousness
8.3 Racism, Racial Discrimination, Health, and Health Care
8.4 Bridging the Gaps Study: Health Disparities and Inequities in the African–American Community
8.4.1 Procedures
8.5 Research Findings
8.6 A Quantitative Study of the Impact of Sexism and Racism of Black Women
8.6.1 Method
8.7 Future Directions and Concluding Remarks
8.7.1 Health Inequities and Disparities in Black Communities
8.7.2 Black Women’s Experiences of Racial Discrimination
Chapter Review Questions
References
9: The Pandemic Within Systemic Injustice: Intersectional Cultural Dimensions of Women’s Aging, Health, and Case Stories of COVID-19
9.1 COVID-19
9.2 Cultural Competency
9.3 The Disproportionate Impact of COVID-19
9.3.1 Structural Racism, Structural Sexism, and Intersectionality
9.4 The Essential Intersection of Social Networks and Active Lifestyles as Women Age
9.5 The Importance of Social Networks for the LGBTQI Community
9.6 Case Stories of COVID-19
9.6.1 Knock, Knock, It Is Déjà Vu: Marbley
9.6.2 Friends Indeed: Starkey
9.6.3 Unsung Shero: Murphy
9.6.4 A Chill Is in the Air: Abdullah
9.7 Reflection
9.8 Conclusion
9.9 Recommendations
Chapter Review Questions
References
10: Evidence-Based Disordered Eating Prevention Programs for Active Females Including Mindfulness
10.1 Introduction
10.2 Research Findings
10.2.1 The Transtheoretical Model in Health Behavior Change
10.2.2 General Treatment Principles
10.2.3 Exercise as Medicine in the Treatment of Eating Disorders Program
10.2.4 Dissonance-Based Eating Disorder Prevention Program
10.2.5 Riding the [Third] Wave of Mindfulness
10.2.5.1 Mindfulness-Based Eating Awareness Training (MB-EAT)
10.2.5.2 Mindfulness Disordered Eating Prevention Programs
10.2.5.3 Mindful Eating
10.2.6 Pharmacological Treatment of Eating Disorders
10.2.7 Eating Disorder Organizations and Resources
10.3 Contemporary Understanding of the Issues
10.4 Future Directions
10.5 Concluding Remarks
Chapter Review Questions
References
11: Alternative Treatment Modalities for the Active Female with Musculoskeletal Pain
11.1 Introduction
11.2 Research Findings and Contemporary Understanding of the Issues
11.2.1 Cold Therapy
11.2.2 Heat Therapy
11.2.3 Heat vs. Cold
11.2.4 Exercise
11.2.5 Yoga
11.2.6 Exergames
11.2.7 Pain Neuroscience Education
11.2.8 Supplements
11.2.9 Chiropractic Therapy
11.2.10 Acupuncture/Trigger Point Dry Needling
11.2.11 Dynamic Compression
11.2.12 Transcutaneous Electrical Nerve Stimulation (TENS)
11.2.13 Kinesio Taping
11.2.14 Cupping
11.2.15 Homeopathy
11.3 Future Directions and Concluding Remarks
Chapter Review Questions
References
Part III: Screening, Prevention, and Management of Health-Related Issues/Injuries in Active Females
12: Screening for Eating Disorders, Dysfunctional Exercise, and Menstrual Dysfunction in Female Athletes
12.1 Introduction
12.2 Definitions
12.2.1 Eating Disorders
12.2.2 Dysfunctional Exercise
12.2.3 Menstrual Dysfunction
12.3 Research Findings in Disordered Eating/Eating Disorders, Dysfunctional Exercise, and Menstrual Dysfunction
12.3.1 Prevalence
12.3.1.1 Prevalence of Disordered Eating/Eating Disorders in Active Females
12.3.1.2 Prevalence of Dysfunctional Exercise in Active Females
12.3.1.3 Prevalence of Menstrual Dysfunctional in Female Athletes
12.3.2 Current Research in Disorder Eating/Eating Disorders, Dysfunctional Exercise, and Menstrual Dysfunction: Screening Tools
12.3.2.1 Current Research in Disorder Eating/Eating Disorders
Screening for Disordered Eating/Eating Disorders and Pre-Participation Examinations
Reasons to Screen for Disordered Eating or Eating Disorders and Screening Practices
Functionality of Screening Tools for Disordered Eating or Eating Disorders
Screening Settings for Disordered Eating or Eating Disorders
Barriers to Recognition of Disordered Eating/Eating Disorders
Screening Tools for Disordered Eating/Eating Disorders
General Screening Tools for Disordered Eating/Eating Disorders and Diagnostic Screening Tools for Eating Disorders (Table 12.5)
Self-Report Questionnaire Screening Tools, Athlete Specific for Disordered Eating/Eating Disorders
Non-Gender-Specific Eating Disorder Tools (Table 12.8)
12.3.2.2 Current Research in Dysfunctional Exercise Etiology
Physiological Hypothesis
Psychological Hypothesis
Psychobiological Hypothesis
Dysfunctional Exercise in the Active Female
Dysfunctional Exercise Components
Qualitative Component
Quantitative Component
Thresholds for Dysfunctional Exercise: What We Know
Screening Tools for Dysfunctional Exercise
Classification of the Screening Tools for the Assessment of Dysfunctional Exercise
Qualitative Screening Tools for Dysfunctional Exercise
Quantitative Screening Tools
12.3.2.3 Current Research in Menstrual Dysfunction Types of Menstrual Dysfunction
Functional Hypothalamic Amenorrhea
Who Should Be Screened for Menstrual Dysfunction?
When to Screen for Menstrual Dysfunction
Screening Questions for Menstrual Dysfunction
Evaluation of Menstrual Dysfunction Beyond Screening
Management of Functional Hypothalamic Amenorrhea
12.4 Contemporary Understanding of the Issues
12.5 Future Directions
12.6 Concluding Remarks
Appendix 1: Screening Tools
Appendix 1.1: Eating Disorders/Disordered Eating
1.1.1 General Screening Tools
EAT-26
SCOFF Questionnaire
Eating Disorders Exam-Questionnaire (EDE-Q)
Eating Disorder Inventory-3 (EDI-3)
Eating Disorder Screen for Primary Care (ESP)
Bulimia Test-Revised (BULIT-R)
National Eating Disorders Association (NEDA) Screening Program
1.1.2 Eating Disorders Diagnostic Tools
Eating Disorders Exam (EDE)
Interview for Diagnosis of Eating Disorders (IDED)-IV
1.1.3 Athlete Specific Screening Tools
Female Athlete Screening Tool (FAST)
Health, Weight, Dieting, and Menstrual History Questionnaire (HWDMHQ)
Physiologic Screening Test
Female Athlete Triad Screening Questionnaire
Athletic Milieu Direct Questionnaire (AMDQ)
Athlete
Low Energy Availability in Females Questionnaire (LEAF-Q)
Brief Eating Disorder in Athletes Questionnaire (BEDA-Q)
1.1.4 Non-Gender Specific Screening Tools
College Health-Related Informational Survey (CHRIS)
De Palma
Survey of Eating Disorders Among Athletes (SEDA)
Pre-participation Physical Evaluation, Fifth Edition
International Olympic Committee Periodic Health Evaluation of Elite Athletes
Appendix 1.2: Dysfunctional Exercise Questionnaires
Obligatory Exercise Questionnaire (OEQ)
Exercise Addiction Inventory (EAI)
Compulsive Exercise Test (CET)
Exercise Dependence Questionnaire (EDQ)
Commitment to Exercise Scale (CES)
Exercise Belief Questionnaire (EBQ)
Bodybuilding Dependence Scale (BDS)
Exercise Dependence Scale (EDS) and Exercise Dependence Scale Revised (EDS-R)
Exercise Identity Scale (EIS)
The Exercise Salience Scale (ESS)
Exercise and Eating Disorder Questionnaire (EED-Q)
The Exercise Dependence and Elite Athletes Scales (EDAS)
Athletes Relationship with Training Scale (ART)
Chapter Review Questions
Eating Disorder/Disordered Eating Questions
Dysfunctional Exercise Questions
Menstrual Dysfunction Questions
References
13: The Importance of Posture and Muscular Balance in the Body for Managing Skeletal Muscle Injuries in Active Females
13.1 Introduction to the Active Female and Posture
13.2 Research Findings and Contemporary Understanding of the Issues
13.2.1 Components of Posture
13.2.1.1 The Musculoskeletal System
13.2.1.2 The Neuromuscular Junction
13.2.1.3 The Nervous System’s Role
13.2.2 The Effects of Postural Change
13.2.2.1 Gender and Age
13.2.2.2 Muscular Imbalances
13.2.2.3 Pain and Injury
13.2.3 Preventative Measures
13.2.3.1 Assessment of Posture
Flexicurve Ruler
Bubble Inclinometer
13.2.4 Exercise and Physical Activity
13.2.4.1 Other Therapeutic Modalities
13.3 Future Directions and Concluding Remarks
Chapter Review Questions
References
14: Prevention and Management of Common Musculoskeletal Injuries in Skeletally Immature Female Athletes
14.1 Introduction
14.2 Research Findings and Contemporary Understanding of the Issues
14.2.1 The Important Changes from Prepubescence to Postpubescence in Females As Far As Anatomy and Physiology of the Musculoskeletal System Are Concerned
14.2.2 The Pertinent Differences and Similarities Between Young Females and Males in Terms of Anatomy, Physiology, and Biomechanics of the Musculoskeletal System
14.2.3 The Occurrence of Various Common Musculoskeletal Injuries More Unique to Young Female Athletes Especially During the Adolescent Growth Spurt
14.2.4 Several Measures for Prevention of Athletic Injuries from Occurring in Preadolescent and Adolescent Females
14.2.5 Different Methods of Orthopedic Treatment for Musculoskeletal Injuries Incurred by Young Female Athletes, Including Specific Recommendations for a Regular Conditioning Program Once Healing Is Complete in Order to Enhance Their Physical Fitness
14.3 Future Directions and Concluding Remarks
Chapter Review Questions with Scenario
Scenario
Questions
Plausible Answers
References
15: Prevention and Management of Common Musculoskeletal Injuries in the Adult Female Athlete
15.1 Introduction
15.2 Research Findings and Contemporary Understanding of the Issues
15.2.1 The Fundamental Differences in Anatomy, Physiology, and Body Composition Between Adolescent and Adult Females in Terms of the Musculoskeletal System
15.2.2 The Relative Similarities and Pertinent Differences Between Adult Males and Females Concerning the Anatomy, Body Composition, and Biomechanics of the Musculoskeletal System
15.2.3 Various More Common Types of Orthopedic Injuries Sustained by Adult Females Involved in Certain Athletic Activities
15.2.4 Several Measures for Prevention of Musculoskeletal Injuries Incurred by Adult Female Athletes
15.2.5 Different Modes of Treatment for Orthopedic Injuries Sustained by Adult Females Participating in Certain Sporting Activities
15.3 Future Directions and Concluding Remarks
Chapter Review Questions with Scenario
Scenario
Review Questions
Plausible Answers
References
16: Prevention and Management of Common Musculoskeletal Injuries in the Aging Female Athlete
16.1 Introduction
16.2 Research Findings and Contemporary Understanding of the Issues
16.2.1 The Hormonal, Physiological, Anatomical/Musculoskeletal Changes in Female Athletes as they Transition from Young Adulthood into the Middle Age and Beyond
16.2.2 The Differences and Similarities Between Older Males Versus Females in Terms of Their Body Composition, Musculoskeletal Components, and Athletic Performance
16.2.3 Various Musculoskeletal Injuries and Orthopedic Conditions More Common to Aging and Fairly Unique in Older Female Athletes
16.2.4 Several Measures of Prevention to Keep Musculoskeletal Injuries in Older Active Females from Occurring
16.2.5 Different Methods of Treatment for Orthopedic Conditions Incurred in Aging Female Athletes, Including Exercise Prescription as Recommended by Various Nationally Recognized Organizations
16.3 Future Directions and Concluding Remarks
Chapter Review Questions with Scenario
Scenario
Review Questions
Plausible Answers
References
17: Prevention and Management of Osteoporosis Through Exercise
17.1 Introduction and Background
17.1.1 Diagnosis and Measurement of Osteoporosis
17.1.2 Bone Histology and Pathophysiology of Osteoporosis
17.1.3 Changes in Bone Mass Through the Active Female’s Lifespan
17.1.4 Risk Factors in the Development of Osteoporosis
17.2 Research Findings
17.2.1 Prevention and Management of Osteoporosis Through Exercise: Overview
17.2.2 Exercise-Related Mechanisms Leading to Bone Accrual
17.2.3 Exercise Interventions for Preventing and Managing Osteoporosis: Jumping or Hopping
17.2.4 Exercise Interventions for Preventing and Managing Osteoporosis: Resistance Training
17.2.5 Exercise Interventions for Preventing and Treating Osteoporosis: Avoiding Low-Impact Exercise
17.2.6 Exercise Interventions for Preventing Osteoporosis: Whole-Body Vibration
17.2.7 Exercise Interventions for Preventing and Treating Osteoporosis: Site Specificity
17.2.8 Exercise Interventions Specifically for Treating Osteoporosis
17.2.9 Exercise Through the Lifespan
17.2.10 Subsidiary Benefits of Bone-Loading Exercise
17.3 Contemporary Understanding of the Issues
17.3.1 Estrogen as a Confounding Factor for Bone Strength
17.3.2 The Confounding Effects of Nutrition on Bone Health
17.4 Future Directions
17.5 Concluding Remarks
Chapter Review Questions
References
Part IV: Nutrition, Energy Balance, and Energy Availability in Active Females
18: Estimating Energy Requirements
18.1 Introduction
18.2 Research Findings and Nutritional Terminology
18.2.1 Terms Used when Discussing Total Daily Energy Expenditure (TDEE)
18.2.1.1 Calorie (Capital C or Uppercase C), Calories (Lowercase c), and Kilocalorie
18.2.1.2 Basal Metabolic Rate (BMR)
18.2.1.3 Basal Energy Expenditure (BEE)
18.2.1.4 Resting Metabolic Rate (RMR)
18.2.1.5 Resting Energy Expenditure (REE)
18.2.1.6 Thermic Effect of Food
18.2.1.7 Energy Balance
18.2.1.8 Energy Efficiency from Digestion to Exercise
18.2.1.9 Energy Availability
18.2.1.10 Estimated Energy Requirement
18.2.1.11 Metabolic Equivalent
18.2.1.12 Compendium of Physical Activities
18.2.2 Energy Requirements Versus Nutrient Requirements
18.2.3 Energy Requirements
18.2.4 The Components of Energy Expenditure
18.2.4.1 Factors Affecting Resting Energy Expenditure
18.2.4.2 Factors Affecting the Thermic Effect of Food
18.2.4.3 Factors Affecting the Energy Expended in Physical Activity and Exercise
18.3 Contemporary Understanding of the Issues
18.3.1 Methods of Measuring Energy Expenditure
18.3.2 Estimated Energy Expenditure Prediction Equations
18.4 Future Directions
18.4.1 Resting Metabolic Rate and Adaptive Thermogenesis
18.4.1.1 Adaptive Thermogenesis
18.4.2 NEAT Definition
18.4.3 Estimating TEE Using the Compendium of PA
18.4.3.1 Estimating TEE: A Case Study
18.4.4 Estimating NEAT
18.4.4.1 NEAT Estimation
18.5 Concluding Remarks
Appendix 1 2011 Compendium of Physical Activities [12] (Reprinted with permission from Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Jr., Tudor-Locke C, et al. The Compendium of Physical Activities tracking guide:
Appendix 2 2005 Compendium of Physical Activities for Children and Adolescents by Age Group and Sex [14] (Adapted with permission from Harrell JS, McMurray RG, Baggett CD, Pennell ML, Pearce PF, Bangdiwala SI. Energy costs of physical activitie
Appendix 3 2018 Compendium of Physical Activities for Children and Adolescents by Age Group and Sex [13] (Adapted with permission from Butte NF, Watson KB, Ridley K, Zakeri IF, McMurray RG, Pfeiffer KA, et al. A Youth Compendi
Chapter Review Questions
References
19: Nutritional Guidelines for Active Children
19.1 Introduction
19.2 Research Findings
19.2.1 Dietary Guidelines for Americans (DGA)
19.2.2 Macronutrients
19.2.3 Micronutrients and Water
19.2.4 Nutritional Responsibility
19.3 Contemporary Understanding of the Issue
19.4 Future Directions
19.5 Concluding Remarks
Appendix 1
Appendix 2
Chapter Review Questions
References
20: Nutritional Guidelines Including Hydration Recommendations and Energy Needs for the Female Athlete: Preventing Low Energy Availability and Functional Amenorrhea Through Nutritional Therapy
20.1 Introduction
20.2 Research Findings
20.3 Contemporary Understanding of the Issues
20.3.1 Energy Availability and Functional Amenorrhea
20.3.2 Hormonal Regulation of Food Intake
20.3.3 Estimating Energy and Nutritional Intake
20.4 Future Directions
20.4.1 Nutritional Guidelines for the Female Athlete
20.4.1.1 Priority Is Meeting Energy Needs
20.4.1.2 Macro and Micronutrients for Athletes
20.4.2 The Importance of Hydration Before, During, and After Exercise
20.5 Concluding Remarks
Appendix 1
Appendix 2 Nutrition questionnaire with 3-day recall (Adapted from Dynamics of nutrition support: assessment, evaluation, and implementation. Krey SH, Murray RL, Appleton-Century-Crofts, 1986 [84])
Appendix 3 Food Frequency Questionnaire (Adapted from Dynamics of nutrition support: assessment, evaluation, and implementation. Krey SH, Murray RL, Appleton-Century-Crofts, 1986 [84])
Chapter Review Questions
References
21: Nutritional Guidelines and Energy Needs During Pregnancy and Lactation for Active Women
21.1 Introduction
21.1.1 Nutritional Guidelines During Pregnancy and Lactation
21.2 Research Findings and Contemporary Understanding of the Issues
21.2.1 Energy Requirements and Important Nutrients for Optimal Pregnancy/Lactation and Infant Outcomes
21.2.1.1 Energy Requirements
21.2.1.2 Macronutrients
Carbohydrate
Protein
Fat
21.2.1.3 Micronutrients
Folic Acid (Folate)
Iron
Iodine
Vitamin D
21.3 Concerns During Pregnancy and Lactation
21.3.1 Weight Gain During Pregnancy
21.3.2 Vegetarianism and Pregnancy: A New Issue
21.4 Future Directions
21.5 Concluding Remarks
Appendix 1
Chapter Review Questions
References
22: Nutritional Guidelines, Energy Balance, and Weight Control: Issues for the Aging Active Female
22.1 Introduction
22.2 Research Findings
22.2.1 Energy Balance and Weight Control
22.3 Contemporary Understanding of the Issues
22.3.1 Dietary Guidelines for the Mature Woman
22.3.2 Important Nutrients, Vitamins, and Minerals for Physically Active Women
22.4 Future Directions
22.4.1 Vitamin B12 and Folate
22.4.2 Vitamin A
22.4.3 Thiamin
22.4.4 Vitamin C
22.4.5 Vitamin E
22.4.6 Calcium
22.4.7 Iron
22.5 Concluding Remarks
Appendix 1 Dietary Reference Intakes (DRIs) Reports
Appendix 2 USDA Food Patterns—Food Groups and Subgroups
Appendix 3 Healthy U.S.-Style Eating Pattern: Recommended Amounts of Food from Each Food Group at 12 Calorie Levels
Appendix 4 Age Recommendations for Activity
Key Activity Guidelines for Adults [43]
Examples of Physical Activities for Older Adults [43]
Health Benefits Associated with Regular Physical Activity [43]
Appendix 5 Ideas for Activity
Some Websites for Being Active
Appendix 6 Estimated Calorie Needs Per Day by Age and Activity Level [31]
Chapter Review Questions
References
23: Ergogenic Aids and the Female Athlete
23.1 Introduction
23.2 Research Findings
23.2.1 What Supplements Are Female Athletes Taking?
23.2.2 Protein Needs in Female Athletes
23.2.3 Protein Supplements Sources
23.2.3.1 Animal Protein Sources (Milk, Bovine Colostrum, Beef, and Insect)
Milk Protein Supplements (Whey and Casein)
Whey Protein Supplements
Casein Protein Supplements
Bovine Colostrum Supplements
Beef and Insect Protein Supplements
23.2.3.2 Plant-Based Protein Supplements
Soy Protein Supplements
Rice and Pea Protein Supplements
23.2.4 Nutritional Profile of Different Animals and Plant-Based Protein Supplements
23.2.5 Acute Dose-Response Effects of Ingesting Different Types of Protein Supplements
23.2.6 Long-Term Effects of Protein Supplementation
23.2.7 The Use of Amino Acids as Nutritional Supplements
23.2.8 Branched Chain Amino Acids (BCAAs)
23.2.9 β-Hydroxy ß-methylbutyrate (HMB)
23.2.10 L-Glutamine
23.2.11 L–Arginine and L-Citrulline
23.2.12 β-Alanine
23.2.13 Integrating Supplementation and Diet
23.2.14 Creatine
23.3 Common Ingredients in Energy Drinks and Pre-workouts
23.3.1 Carnitine
23.3.2 Caffeine
23.3.2.1 Dosage
23.3.2.2 Adverse Effects
23.3.2.3 High-Intensity Exercise
23.3.2.4 Strength
23.3.2.5 Endurance
23.3.3 Ginseng
23.3.4 Energy Drinks
23.3.4.1 The Effects of Energy Drinks on Sprint Performance and High-Intensity Exercise
23.3.4.2 The Effects of Energy Drinks on Endurance Performance
23.3.4.3 Conclusion: Are Energy Drinks Ergogenic?
23.3.5 Pre-workouts
23.4 Echinacea as an Ergogenic Aid
23.4.1 Echinacea and Erythropoietin
23.5 Multivitamins
23.6 Iron
23.6.1 Does Correcting Iron Insufficiency or Deficiency Improve Performance?
23.7 Contemporary Understanding of the Issues
23.8 Future Directions
23.9 Concluding Remarks
Chapter Review Questions
References
Part V: Exercise Guidelines and Precautions for Active Females Throughout the Lifespan
24: Screening for Safe Exercise Participation and Exercise Guidelines for Health-Related Fitness
24.1 Introduction
24.2 Current Research Findings and Objectives
24.3 Physical Activity Recommendations for Health-Related Fitness from Leading Health Organizations
24.3.1 Review of Current Standards
24.4 Safe and Effective Exercise for Health-Related Benefits
24.4.1 The Pre-exercise Screening Process
24.4.2 The Difference Between Moderate Physical Activity, Vigorous Physical Activity, Exercise and Physical Activity, Health-Related Physical Fitness, and Sports-Related Fitness
24.4.3 The American College of Sports Medicine’s Exercise Recommendations for Cardiorespiratory Fitness
24.4.3.1 Adults
24.4.3.2 Children and Adolescents
24.4.4 The American College of Sports Medicine’s Exercise Recommendations for Muscular Fitness
24.4.5 The American College of Sports Medicine’s Exercise Recommendations for Healthy Body Composition
24.4.6 The American College of Sports Medicine’s Exercise Recommendations for Flexibility
24.5 Concluding Remarks
Appendix 1 2021 PAR-Q+
Appendix 2 Determining Exercise Intensity Using the Heart Rate Reserve Method (HRR) [13]
Sample Exercise Resistance Program for Postmenopausal Women: 4, 6, 8, and 12-Week Programs
Sample Resistance Exercises for Women
Appendix 3 Determining Moderate and Vigorous Exercise Intensity Using the Borg Rating of Perceived Exertion (RPE) Scale [13, 22]
Chapter Review Questions
References
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25: Cardiovascular Exercise Guidelines for Optimal Performance of Active Females Throughout the Lifespan Including Children, Adolescents, and the Aging Female
25.1 Introduction
25.2 Research Findings
25.2.1 General Cardiovascular Exercise Guidelines for Children and Adolescents
25.2.1.1 Children’s and Adolescents’ Unique Characteristics
25.2.1.2 How to Approach Exercise with Children and Adolescents
25.2.2 General Cardiovascular Exercise Guidelines for Healthy Adults
25.2.2.1 Adult Women’s Unique Characteristics
25.2.3 General Cardiovascular Exercise Guidelines for Older Adults
25.2.3.1 Postmenopausal Women’s Unique Characteristics
25.2.4 Training Principles and Methods
25.2.4.1 Principles of Training
Principle of Individuality
Principle of Specificity
Principle of Overload
Principle of Progression
Principle of Diminishing Returns
Principle of Reversibility
Principle of Recovery
25.2.4.2 Examples of Training Load and Specificity for Optimal Performance
25.2.4.3 Training Program Designs
Continuous Training vs. HIIT
Periodization
Cardiovascular Exercise Alone vs. Combined Cardiovascular and Resistance Training
25.3 Contemporary Understanding of the Issues
25.4 Future Directions
25.5 Concluding Remarks
Chapter Review Questions
References
26: Resistance Training Guidelines for Active Females Throughout the Lifespan, from Childhood to Elderly
26.1 Introduction
26.2 Research Findings and Contemporary Understanding of the Issues
26.2.1 Skeletal Muscle as an Essential Organ for Health
26.2.2 The Importance of Muscle Growth and Its Relationship with Bone Health
26.3 Determining Strength Expression During Resistance Exercise Training
26.3.1 Physiological and Neurological Variables
26.3.1.1 Training Intensity and Volume (Sets and Repetitions)
26.3.1.2 Rest Between Sets
26.3.1.3 Frequency of Training
26.3.1.4 Duration of Session and the Available Time per Session
26.3.2 Biomechanical Variables
26.3.2.1 Exercises Selection and Order of Execution
26.3.2.2 Training Device
26.4 Resistance Training for Children and Adolescents
26.4.1 How to Approach Strength Training with Children and Adolescents
26.4.1.1 Type of Exercise and Order of Execution for Children
26.4.1.2 Workout Configuration (Intensity and Volume) for Children
26.4.1.3 Rest Intervals Between Sets for Children
26.4.1.4 Repetitions and Movement Velocity for Strength Training for Children
26.4.1.5 Frequency of Strength Training for Children
26.4.1.6 Specific Program Design Considerations and Progression Strategies for Children and Adolescents
26.4.2 Resistance Training as a Preventive Factor from Injuries and Healthy Posture Later in Life
26.5 Resistance Training for Adults and the Elderly Population, with Emphasis for Females
26.5.1 Resistance Training Guidelines for Adults
26.5.2 General Guidelines for Adults
26.5.2.1 Training Volume
26.5.2.2 Types of Exercise/Exercise Selection
26.5.2.3 Frequency
26.5.2.4 Special Considerations for Women
Effects of Hormones on Muscular Fitness
Periodization Strategies and Their Integration with Resistance Training in Women
Resistance Training and Hormonal Status in Adult Women
26.5.3 Specific Recommendations for the Elderly
26.5.3.1 Designing and Supervising Resistance Training in Older Adults: Key Points
26.6 Future Directions
26.7 Concluding Remarks
Chapter Review Questions
References
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27: Exercise Guidelines During Pregnancy
27.1 Introduction
27.2 Research Findings
27.2.1 Physiology of Pregnancy
27.2.1.1 Cardiovascular Function
27.2.1.2 Pulmonary Function
27.2.1.3 Endocrine System
27.2.1.4 Metabolism, Energy Expenditure, and Weight Control
27.2.1.5 Musculoskeletal System
27.3 Contemporary Understanding of the Issues
27.3.1 Benefits of Exercise in Pregnant Women
27.3.1.1 Cardiorespiratory Health
27.3.1.2 Decreased Lumbar Pain
27.3.1.3 Weight Control
27.3.1.4 Prevention of Gestational Diabetes
27.3.1.5 Hypertension and Preeclampsia
27.3.1.6 Psychological Benefits
27.3.1.7 Benefits for the Fetus
Improved Labor and Birth Outcomes
More Active Children
27.3.2 Risks of Exercise in Pregnant Women
27.3.3 Risks of Exercise During Pregnancy for the Fetus
27.3.3.1 Acute Hypoxia
27.3.3.2 Acute Hyperthermia
27.3.3.3 Low Glucose Availability
27.3.3.4 Spontaneous Abortion in the First Trimester
27.3.3.5 Risk of Preterm Delivery
27.3.3.6 Reduced Birth Weight
27.3.4 Recommendations for Exercise During Pregnancy
27.3.4.1 General Recommendations for Programming Exercise
27.3.4.2 Post-delivery
27.4 Future Directions
27.5 Concluding Remarks
Chapter Review Questions
References
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28: Exercise and Immunity: Beliefs and Facts
28.1 Introduction
28.2 Exercise and Risk of Infection: Challenging the J-Shaped Curve
28.2.1 Extrenous Exercise and Risk of Infection
28.2.2 Moderate Exercise and Risk of Infection
28.3 Effect of Exercise on the Immune System
28.3.1 Overview of the Immune System
28.3.2 Exercise Influence on Immune Cell Count
28.3.2.1 Factors Responsible for Exercise-Induced Leukocytosis
28.3.2.2 Enhanced Immunosurveillance After Acute Exercise
28.3.3 Effect of Exercise on the Immune Function
28.3.3.1 Innate Immune Responses to Exercise
28.3.3.2 Adaptive Immune Responses to Exercise
28.3.3.3 Cytokine Induction
28.3.4 Possible Factors Underlying Immune Suppression Through Intensive Exercise
28.3.4.1 Immune Cell Frequency and Function
28.3.4.2 Reactivation of Latent Virus
28.4 Clinical Implications of Regular Moderate Intensity Exercise
28.5 Contemporary Understanding of the Issues
28.5.1 Methodological Limitations
28.5.2 Role of Nutrition in Exercise-Induced Immune Changes
28.5.3 Sex Differences in Immune Response and Exercise
28.5.4 Recommendation to Exercise During and After a URTI
28.5.5 Exercise, Immune Function and Microbiome
28.5.6 Exercise and Immunometabolism
28.5.7 Exercise and Immunosenescence
28.6 Future Directions
28.7 Concluding Remarks
Chapter Review Questions
References
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29: Exercise Recommendations for Females Affected by Cancer Throughout the Lifespan
29.1 Introduction
29.2 Research Findings and Contemporary Understanding of the Issues in Women
29.2.1 Cancer in Females
29.2.1.1 Most Common Types of Cancer in Women
29.2.1.2 Benefits of Physical Activity on Common Cancer Symptoms in Women
29.3 Pathophysiology of Cancer and Symptoms Produced
29.3.1 Cancer-Related Fatigue
29.3.2 Physical Function
29.3.3 Lymphedema
29.3.4 Anxiety, Depression, and Quality of Life
29.3.5 Peripheral Neuropathy
29.3.6 Body Composition
29.3.7 Other Symptoms
29.4 Physical Activity Recommendations
29.4.1 Current Standings on Physical Activity for Women with Cancer
29.4.2 Considerations to Exercise
29.5 Research Findings and Contemporary Understanding of the Issues in Children and Adolescents
29.5.1 Prevalence of Cancer in Children and Adolescents
29.6 Physical Activity Recommendations for Children with Cancer
29.6.1 Exercise and Childhood Cancer Evolution
29.6.2 Benefits of Physical Activity in Pediatric Cancer
29.6.2.1 Physical Activity Guidelines
29.6.3 Considerations to Exercise
29.7 Future Directions
29.8 Concluding Remarks
Chapter Review Questions
References
Part VI: The Obese Active Female
30: Not So Normal Unhealthy Lean
30.1 Introduction
30.1.1 Metabolically Unhealthy Normal Weight (MUNW)
30.1.2 Normal Weight with Central Obesity (NWCO)
30.1.3 Normal Weight Obesity (NWO)
30.1.4 Overlap Between Different Unhealthy Lean Phenotypes
30.2 Research Findings
30.2.1 Prevalence of Unhealthy Normal Weight Phenotypes
30.2.1.1 Prevalence of Metabolically Unhealthy Normal Weight (MUNW)
30.2.1.2 Prevalence of Normal Weight Central Obesity (NWCO)
30.2.1.3 Prevalence of Normal Weight Obesity (NWO)
30.2.2 Pathophysiology of Unhealthy Normal Weight Phenotypes
30.2.2.1 The Role of Adipose Tissue
30.2.2.2 Increased Inflammation and Oxidative Stress
30.2.2.3 The Role of Skeletal Muscle
30.2.2.4 Changes in Bones
30.2.3 Factors Associated with Unhealthy Lean
30.2.3.1 Early Life Factors
30.2.3.2 Age and Sex
30.2.3.3 Ethnicity
30.2.3.4 Genetics
30.2.3.5 Physical Activity and Physical Fitness
30.2.3.6 Dietary Factors
30.2.3.7 Alcohol Consumption and Smoking
30.2.3.8 Other Sociodemographic Factors
30.3 Contemporary Understanding of the Issue
30.3.1 Health Risks Associated with Unhealthy Lean
30.3.1.1 Increased Cardiovascular Disease Risk
30.3.1.2 Increased Risk for Hyperlipidemia and Hypertension
30.3.1.3 Increased Risk for Diabetes
30.3.1.4 Increased Risk for Mild Cognitive Impairment
30.3.1.5 Increased Risk for Cancer
30.3.1.6 Increased Mortality Risk
30.3.2 Interventions to Improve the Health of Unhealthy Lean
30.3.2.1 Normal Weight Status May Be a Barrier to Healthy Behavior
30.3.2.2 Dietary Interventions
30.3.2.3 Exercise Interventions
30.3.2.4 Combined Lifestyle Interventions
30.4 Future Directions
30.4.1 Consensus on Definitions is Needed
30.4.2 Screening for Unhealthy Lean
30.4.3 Future Research on Interventions for Unhealthy Lean
30.5 Conclusions
Chapter Review Questions
References
31: Maternal Obesity and Its Epigenetic Effects
31.1 Introduction
31.2 Overview of Epigenetic Reprogramming Mechanisms
31.2.1 DNA Methylation
31.2.2 Histone Modifications
31.2.3 Histone Acetylation
31.2.4 Histone Methylation
31.2.5 MicroRNAs (miRNAs) in Epigenetic Regulation
31.2.6 Interrelationships Between Epigenetic Modifications
31.2.6.1 Link Between DNA Methylation and Histone Modifications
31.2.6.2 Cross Talk between miRNA, DNA Methylation, and Histone Modifications
31.3 Maternal Obesity and Its Epigenetic Effects in Humans
31.3.1 Maternal Obesity and Its Effects on the Offspring
31.3.2 Maternal Dietary Factors and Epigenetic Changes of the Offspring
31.3.3 Maternal Physical Activity and Epigenetic Changes
31.3.4 Lifestyle Interventions to Reduce Gestational Weight Gain in Overweight and Obese Women
31.4 Animal Models of Maternal Obesity
31.4.1 Dietary Regulation in Animal Models
31.4.1.1 Dietary Effects on DNA Methylation
31.4.1.2 Histone Modification by Dietary Modulation
31.4.1.3 Diet-Mediated Alterations of miRNAs
31.4.2 Physical Activity in Animal Models
31.5 Conclusion and Future Studies
Chapter Review Questions
References
32: Exercise and Nutritional Guidelines for Weight Loss and Weight Maintenance in the Obese Female
32.1 Introduction
32.2 Nutrition Guidelines for Weight Management
32.2.1 Background
32.2.2 Understanding Macronutrients (CHO, Protein, and Fats)
32.2.3 Pre-testing and Meeting with Health Specialists
32.2.4 Diets
32.2.5 Summary of Diets
32.2.6 Weight Loss Programs
32.3 Weight Loss Procedures
32.4 Exercise Guidelines for Weight Management
32.4.1 Background
32.4.2 Pre-testing and Meeting with Health Specialists
32.4.3 Health-Related Components of Physical Fitness
32.4.4 Research and Contemporary Findings
32.5 Future Directions and Concluding Remarks
Chapter Review Questions
References
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Index