Contents Chapter One : Equality or Inequality Equity or Inequity Gender Differences Anatomical Variations Metabolic Variations Strength Variations

Programming

1 3 4 9 10 13 13 14 17 18 19 21 23 24 27 28 29 30 33 35 39 41 42 43 45 47
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Chapter Two :

Chapter Three : Menstruation : Performance and Disorders The Ovarian and Menstrual Cycles The Effects of Exercise The Effects of Menstruation Chapter Four : The Female Athlete Triad The Female Athlete Triad Chapter Five : Exercise and Pregnancy General Information Effects of Exercise on....The Foetus Effects of Exercise on....The Mother Exercise and Pregnancy Guidelines and Modifications Post Natal Coaching Considerations Aspects of Coaching Points to Consider When Coaching the Female Athlete

Chapter Six :

Glossary of Terms References

Considering Gender

Rob Orr

Chapter 1

The immergence of the female athlete has, and in many ways still is, an uphill battle. Social issues and the expected stereotypical female image in many ways responsible for the barriers and resistance. However before discussing gender equality and its possible lack, the term must first be clearly defined. Gender Equity Gender Equity is an atmosphere and a reality where fair distribution of overall athletic opportunity and resources are proportionate to enrolment, are available to men and women and where no student-athlete, coach or athletic administrator is discriminated against in any way in the athletic program on the basis of gender. That is to say, an athletic program is a gender equitable when the mens sports program would be pleased to accept for its own overall participation, opportunities and resources currently allocated to the womens program and visa versa.

At a young age society begins to effect the young man and lady. Girls are seen as daddys little girl or mummys helper, with time outside restricted and playing inside with dolls preferable to running around outside with toy guns (Weinberg & Gould, 1995). Even the games played follow the stereotypical role of the male and female, the young lady playing the nurturing mother or parent, the young man with the gun playing the male hero. These roles are still enforced in many ways by our daily entertainment, be they movies, television or even books. Primary school yards portray this social ideology every day with most girls sitting in small groups reading or talking and most boys tearing around on playground equipment or playing some form of game. Even at this prime young age, before the hormonal effects of puberty separate physical attributes, females tend to be left behind in the important skill development brought on by the numerous repetitions of movement patterns portrayed in school lunch time games. This is highlighted by Weinberg and Gould (1995) who state that By the first grade, girls assess their general athletic ability more negatively than boys do and attach less importance to the sport domain. They see themselves as less able in sport than in academic areas and see sports as less important than other areas.

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Conformity or Achievement This segregation increases through puberty as the hormonal and social effects take hold. For many young teenage women their major concern becomes where they fit and their social standing as opposed to what they can achieve. Being in the in crowd is more highly valued than coming first in a race. Kerr (1985, as cited by DeBoer 1998) calls this mentality the issues of conformity versus achievement. For the female, particularly the teenager, conformity is the image of femininity. Anything which causes a women to contradict societys image of femininity is a threat to their social conformity. This is commonly shown on most television soap series involving the young female teenager, they fear the dreaded PT or PE class with the hardnose female coach, their main premise becomes one of attracting boys, shopping and gossip. Female or Athlete, one or the other According to Allison (1991 as cited by Weinberg & Gould, 1995) the Victorian femininity traits include submissiveness, passivity, grace and beauty whilst competitive sport is seen as aggressiveness, toughness and achievement. This conception of female social standing means that any female who participates in active sports tends to be ostracised, with the sport they are playing and their level of success being two main factors as to how far they are outcast. For example, a female teenage athlete chosen to represent her state at rhythmic gymnastics would not receive as much negative rebuke as a similar athlete chosen to represent the state in Shot Putt. This is again enforced by the Feminist Majority Foundation (1995) who state that Female athletes in traditionally masculine sports challenge the social dictates about proper behaviour in females : therefore the reasoning goes, there must be something wrong with them. In 1986 at the athletic championships held in Bucharest, the International Amateur Athletic Federation (IAAF) ordered all female contestants to undergo a nude parade in front of a female gynaecologist to ensure they were not pseudo-hermaphrodites (Costa & Guthrie, 1994). This together with common verbal reminders given by male coaches to male teams like You hit like a girl, Youre playing like a bunch of girls or Wheres your skirt ?, tend to reinforce the ideology that if you are good at your sport you cannot be a girl and if you are bad then you are on the same level as a female. Homophobia Homophobia, a fear of being labelled homosexual, caused by the discussed socially expected role of the female, effectively provides a major hurdle in the development of female athletes. The Feminist Majority Foundation explain that together with 51 % of female coaches and 49 % of female athletes, half of the female administrators surveyed claimed that their involvement in sports had lead to the conception that they were lesbians (Feminist Majority Foundation,1995).
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Media Coverage In line with Homophobia, there are several cause and effect factors that continue to plague the female in sport. Firstly there is little coverage of the female athlete in comparison to the male athlete. According to the Feminist Majority Foundation (1995) in 1993 fewer than 5 % of sports news in four major US newspapers were devoted to female athletes only. Weinberg & Gould (1995) found more diverse results when comparing four major Canadian newspapers, the exclusive female athlete articles ranging from 2 % to 14 %. Compare this to the 25% to 56% male coverage and the inequality becomes apparent. Just recently in Australia, all media attention was on the Australian mens basketball team, the Boomers and their attempt to win a medal at the 1998 world championships. Even their seventh - eighth place play off was widely televised. In contrast, the Australian womens basketball team, the opals, won a bronze medal, but few knew. It was reported by Jenny McAsey in the Weekend Australian newspaper that whilst ten Australian journalists went to Athens to cover the mens basketball championships, only two were sent to cover the womens (McAsey, 1998). Even with the increased effort to cover female sporting activities, those chosen are more feminine in nature. NBC obviously programmed its Olympic coverage to appeal to a predominantly female audience, but it centred on pretty sports like gymnastics, swimming and diving at the expense of the gritty sports like softball, soccer and basketball. (San Francisco Examiner 1996).

By covering those that the produces and audience perceive as feminine they again reinforce the attitude that the harder sports are not feminine. As Costa and Gutherie (1995) state The under representation and misrepresentation of female athletes thus harms womens chances for equal opportunities in sports.

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Considering Gender

Funding & Salaries This lower media coverage leads to less sponsorship which inturn means less sponsor funding. Less sponsor funding inevitably means lower salaries for those who would coach, and lower scholarships for athletes who would participate in, a low coverage activity. In 1991, Although the numbers of men and women on campus were roughly equal, the NCAA found that men received 70% of scholarship money, 77% of operating budgets, and 83% of recruiting money. (Feminist Majority Foundation 1995)

Title IX On June 23, 1972, the American president, Richard Nixon signed Title IX as part of a larger bill. The relevance of Title IX to the sporting athlete is shown below : No person in the U.S. shall, on basis of sex be excluded from participating in, or denied the benefits of, or be subject to discrimination under any educational program or activity receiving federal aid. (Grant 1995) The outstanding performance of the female athletes in the Atlanta Olympics has been in large part attributed to the expansion of womens sports mandated by this bill (Time Magazine, 1997). Prior to the launch of the bill, and its required compliance by 1978, it is claimed that only one in 27 high school girls (San Francisco Examiner 1996), approximately 300,00 girls or 7.5 % (Feminist Majority Foundation 1995), participated in sports. This figure in 1992 rose to one in three girls (San Francisco Examiner 1996) 1.9 million girls or 36% of girls (Feminist Majority Foundation 1995). As shown in the figure below this figure is still growing.

Figure 1. A graphical representation of high school athletic participation from Grant (1995).

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Knowledge and Education Besides legislation, the major contribution to effective dissolvent of the presented barriers is education. Education designed to negate the social prejudice against the female athlete. Areas that require focus and education include; increasing media coverage, sponsorship, funding for female activities and events and, at a basic level, coaching practices. These will be discussed further on in this module.

Even with an increasing awareness of equity, there are still many perceived and hidden factors that effect the female athlete from a social point of view. These need to be considered, along with the physiological gender differences discussed next chapter, if you are to develop an understanding of the issues effecting the gender of your athlete.

Equality or Inequality ?

Considering Gender

Rob Orr

Chapter 2

Although male and females have the same basic anatomical systems they have several gender specific differences. These differences are said to be the result of the cells of the body that are responsible for reproduction as opposed to those dedicated to the individuals survival (Wells,1991). Height and Weight Up until adolescents there is little difference between the male and female anatomical structures (deVries & Housh, 1994; Wilmore & Costill, 1994; Fox, Bowers & Foss,1993; Wells,1991). At around 11 years of age girls spurt ahead of boys in both height and weight but this is reversed at around age 13 when the boys experience puberty.(deVries & Housh, 1994; Wells,1991). Once puberty begins hormones have a distinct effect and gender specific differences begin to immerge (deVries & Housh, 1994; Wilmore & Costill, 1994; Fox, Bowers & Foss,1993; Wells,1991). With the onset of menarche, usually around 12 years to 14 years old, linear growth begins to slow as oestrogen hastens the fusing of the epiphyseal ( growth ) plates (Wells,1991). Therefore girls who begin menarche at a younger age usually are shorter than those who mature at a later age (Wells,1991). In regards to adults, the average female is 10% or 10 to 13 cm shorter and 15 to 22 kg lighter than their male counter part (Ebben & Jensen, 1998; Wilson, 1995; Wilmore & Costill, 1994; Fox, Bowers & Foss, 1993; McArdle, Katch & Katch, 1991; Wells,1991). Pelvis Width and Levers With the height advantage the average male has longer limbs than the average female, this does not however mean that they are biomechanically disadvantaged and relationships between the upper and lower portions of a limb need to be considered, (Usually determined by indexes like the crural and brachial index.). Other biomechanical factors, like pelvis size, shape and width need also be considered. Due to the sex specific role of the female in relation to gestation and child birth, females tend to have a wider relative pelvis. This increase in pelvic width combined with shorter femurs increases their Quadriceps Angle or Q - Angle (Lee et al., 1996; Wells, 1991; Cavanagh, 1990; Tortora & Anagnostakos, 1987). This needs to be taken into account when prescribing certain limb positions for leg exercises, eg. narrow squats, lunges and plyometrics, and when examining exercise technique. For example, females performing running based activities require a greater pelvic displacement or shift to keep their centre of gravity over the foot during its stance (weight bearing) phase. However this mechanical deficiency has been shown to have little effect on running speed (Fox, Bowers & Foss,1993)

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With the relatively broader hips, women usually have narrow shoulders (deVries & Housh, 1994; Wells,1991) whilst their male counter parts tend to have a larger frame, broader shoulders and relatively narrower hips, thus providing a lever advantage (Ebben & Jensen,1998; Wells,1991). Due to the relatively narrower shoulders and wider hips, many women portray a marked valgus angle or carrying angle at the elbow to clear their hips. This effect also increases their biomechanical disadvantage, which means that throwing mechanisms may be different for the female athlete (Australian Coaching Council,1990) However, Wells (1991) remind us that this is not always the case and some males may have narrow shoulders whilst some females may have the broad shoulders. Male
> 90* Turned Inward Small Heart Shaped Long and Narrow Heavy and Thick Large Pubic Arch Ischial Tuberosity Pelvic Inlet Sacrum General Structure Joint Surfaces

Female
< 90 * Turned Outward Large and more Oval Broad and Flat Light and Thin Small

The centre of gravity, which represents the balance point across three dimensions (Transverse plane, Sagittal plane and Frontal plane), is generally considered lower in females. This lower centre of gravity is beneficial in sports that require a stable base and balance, like gymnastics and detrimental in sports that require the acquisition of height, like high jump. However although the differences is quoted at being between 1% to 6% lower (Seiler,1995), one must remember that the difference is dominantly due to the size of the individual more than their sex, women being shorter on general tend to have a generally lower centre of gravity. Wells (1994) states that for the same standing height and somatotype, the difference in center of gravity would probably be less than 1 inch. With this in mind centre of gravity and its sporting implications should be judged by height and somatotype rather than gender. Flexibility Both the female athlete and the female in general display a greater general flexibility than males (Australian Coaching Council, 1990; Dorkamph, 1987). This can be seen in the normative data scoring for males and females in the sit and reach flexibility test (Dorkamph, 1987). Higher flexibility has its requirements in several sports, thus providing a female advantage, the most notable being rhythmic and artistic gymnastics (Australian Coaching Council,1990).
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The male androgen Testosterone, of which males have considerably more, (Chu et.al,1996; Wilson,1995; Holloway,1994; Wilmore & Costill,1994; McArdle, Katch & Katch,1991)is responsible for protein synthesis (building muscle) and bone formation. It is due to a greater exposure of this hormone that males are taller and heavier. As females have a significantly lower amount of this tissue building Testosterone it is more difficult for them to put on muscle mass. This would indicate that the fears many woman have of becoming big and bulky (Cadogan,1996) are unjustified. Hypertrophy (gains in muscle size) will occur but not to the extent many woman fear, as Wilson (1995c, p.5) states ...women will not develop, massive bulging muscles through resistance training nor will they develop the same level of strength as men. Oestrogen, the female reproductive hormone, is primarily responsible for the storage of fat (Marieb, 1998; Wilmore & Costill, 1994) particularly in the hips and thighs (Wilmore & Costill,1994). This predisposes women to have a higher fat mass (3 to 6 kg higher (Ebben & Jensen, 1998; Wilmore & Costill, 1994; Fox, Bowers & Foss,1993). The effects of this higher fat mass on a smaller frame is shown when the average total percent body fat is expressed, these being 13% to 16 % for males and 22 % to 26 % for females. (Costa & Guthrie, 1994; McArdle, Katch & Katch, 1991; Wells, 1991). With this in mind, as Wilmore and Costill (1994, p.445) state Many women are constantly fighting fat deposition on the thighs and hips, but they are usually fighting a loosing battle., however they also state that. women can reduce fat stores well below what is considered normal for their age. As such female athletes have a lower difference in percentage fat when compared to a male athlete, being between 2 % to 6 %, (as opposed to the average sedentary female difference of around 10 % when compared to the average sedentary man) (Wells,1991). Women do still have more fat mass in general however which means that, not only is fat loss hormonally harder, but they are also disadvantaged in sports that require a rapid acceleration of the body (eg. jumping ) as they have a lower lean body mass (LBM).(deVries & Housh, 1994). This is shown by deVreis and Housh (1994) in their book, Physiology of Exercise 5th Edition - Table 31.1 pg 603, which lists the ratios of performance in 1991 (determined by world records) comparing females to males. The ratios of note were those for the Long Jump and the High Jump, which were 84 % and 86 % of male performance respectively (deVries & Housh, 1994). This increased fat mass in women need not always be a disadvantage. Fat provides buoyancy and protection from the cold which may be an advantage in swimming sports. As such females, although having a lower LBM, have a counter balance (by means of a higher fat mass.) which reduces the effect of gender differences in swimming performance (deVries & Housh, 1994; Fox, Bowers & Foss,1993). This is again shown in the table mentioned above with the female ratio of performance for the 800 m freestyle being 95% that of a males (deVries & Housh, 1994).

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Due to their smaller stature, women have a lower blood volume and smaller hearts (therefore smaller left ventricles). However Q or cardiac output for the same absolute power output is generally the same in both sexes (Wilmore & Costill,1994). With heart rate and stroke volume being the predominant determinants of Q, the virtual equality would mean that an increased heart rate in females is needed to compensate their smaller stroke volumes (Wilmore & Costill,1994). Being smaller of frame also predisposes the female to have a lower tidal and ventilatory volume. Combine this with a lower haemoglobin (Hb) content (10 to 15% less per 100ml of blood (Costa & Guthrie, 1994; deVries & Housh, 1994; Fox, Bowers & Foss,1993; McArdle, Katch & Katch,1991; Wells,1991) and the active muscles receive less oxygen, this in turn effects the metabolic systems (Wilmore & Costill,1994).

VO2MAX. Although post puberty the average female VO2 max is 15 % to 30 % lower than that of a males (Wilmore & Costill,1994; McArdle, Katch & Katch,1991), elite female athletes show only an 8 % to 12 % lower value than those of elite male athletes (Wilmore & Costill,1994). Many references mention studies which compared females to their male counterparts, the most intriguing had the men wear padded clothing around their waists in an attempt to simulate the extra fat free mass (FFM) carried by women. The results showed lower mean gender differences and that womens greater sex - specific essential body fat stores are major determinants of gender differences in metabolic responses to running.(Wilmore & Costill,1994). Although absolute VO2max values are shown to be lower, VO2 gains in men and woman are said to be the same. (Wells,1991). Lactate Thresholds . Women tend to reach their lactate threshold sooner than men at the same absolute workload (Wilmore & Costill,1994; Wells,1991). This may be because women have a lower oxidative capacity (due to >Hb) and would therefore rely more heavily on the anaerobic systems. When expressed in terms of percentage VO2max, however, lactate thresholds do not differ between the sexes (Wilmore & Costill,1994; Wells,1991).

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As already stated males have a greater average weight than their female counter parts. This heavier mass gives them a distinct advantage in the development of absolute strength and leads to Holloways (1994) statement that woman have approximately two thirds the absolute strength and power than that of a man (Holloway, 1994). These differences vary between the upper and lower body as shown below. With this basic weight variation it can be seen why males have an approximate 33 % greater absolute strength (Wilson,1995; Holloway; 1994; Wilmore & Costill,1994; McArdle, Katch & Katch,1991). Ebben et al. (1998) 40 - 60 % 25 - 30 % Wilson (1995) 60 % 30 % Wilmore & Costill (1994) 43 - 63 % 25 - 30 %

Upper Body Lower Body

The above authorities also agree that when expressed as relative strength the gap between the genders decreases rather rapidly and, in the comparisons of the lower body, may actually disappear (Ebben & Jensen,1998; Wilson,1995; Holloway, 1994; Costa & Guthrie, 1994; Wilmore & Costill,1994; McArdle, Katch & Katch,1991). Costa & Guthrie (1994), boldly claim that In fact, relative strength measures have shown the lower body strength of females to be slightly greater than that of males.

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Holloway (1994) makes an important statement when discussing the differences in weight training regimes for men and women. This (the) similarity at cellular level is what strongly supports the use of the same training procedure for men and women.(Holloway, 1994). This statement is agreed with by Wathen, Schmidt, Chu & Satterwhite, (1996). It can now be seen why prescribing higher repetition ranges for woman because they are woman is unjustified. For prescription purposes, the training variables (repetitions, sets, rest, etc) should be governed by goal and training history as opposed to gender (Ebben & Jensen,1998; Chu et al., 1996; Costa & Guthrie, 1994; Holloway, 1994).

Several gender differences in hormones, metabolic responses and the cardio respiratory system have been identified. These in essence show that for the same absolute workload females generally have to work harder. How much harder they have to work depends on the type of activity they are performing. NOTE : We are discussing the comparative differences for both the average male / female sedentary person and average male / female athlete. The individuality in the subject will play a large part in determining specific comparisons and as such a female athlete with a higher fitness level can out perform a male of a lower level. Although overall performance outputs by females are lower when compared to males the adaptation to training has been shown to be similar regardless of gender. Therefore in regards to programming Fox et al. (1993) acknowledges that ....ample evidence exists to demonstrate that men and women respond to training programmes in a similar fashion. Therefore the same general approach to physiological conditioning can be used in planning programmes for men and women. (Fox, Bowers & Foss,1993). It is the opinion of the American College of Sports Medicine that females should not be denied the opportunity to compete in long distance running. There exists no conclusive or medical evidence that long - distance running is contra - indicated for the healthy, trained female athlete. The American College of Sports Medicine recommends that females be allowed to compete at the national and inter - national level in the same distances in which their counterparts compete.(deVries & Housh, 1994).

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Gender Differences

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The focus of this section will be to look at the effects of menstruation on physical performance and visa versa. However before these effects can be discussed a basic understanding of this cycle needs to be developed.

The ovarian cycle relates to the series of events associated with the development and maturation of a female ovum or reproductive egg. The menstrual or uterine (Marieb, 1998; Wilmore & Costill ,1994) cycle is the cyclic discharge of blood, secretions, tissue and mucus from a mature uterus in the absence of pregnancy. It is the hormonal effects of oestrogen and proestrogen, produced during the ovarian cycle, that influence the menstrual cycle (Spence, 1990). Both of these cycles typically last for 28 Days.

Menstrual or Flow Phase : Days 1 - 5 During this phase the uterine lining (endometrium) is shed and menstrual flow occurs. The menstrual flow or menses consists of blood, disintegrated endometrial tissue, mucus and secretions of the uterine glands. Proliferative Phase : Days 6 - 14 During this phase the uterine lining rebuilds itself, helped by the increased oestrogen produced by the maturing ovarian follicle. Blood and nutrient supply to the uterus also increase as the uterus prepares for pregnancy. This phase ends when a mature follicle ruptures to release its ova (ovulation). This occurs most frequently fourteen days after the onset of menstruation. Together, the menstrual and proliferative phase correspond to the follicular phase of the ovarian cycle. Secretory Phase : Days 15 - 28 This phase corresponds to the luteal phase of the ovarian cycle. During this phase proestrogen and oestrogen increase sharply. Near the end of this phase the luteum begins to degenerate and proestrogen levels fall. Without hormonal support the endometrium cells begin to die and the functional layers begin to self digest. This sets up the return to the menstrual phase.

Menarche or the first menstrual period occurs at around twelve to fourteen years of age,(Gwyther, 1997; deVries & Housh 1994; Costa & Gutherie, 1994; Wilmore & Costill ,1994; Fox, Bowers & Foss, 1993 Wells, 1991), however it takes further hormonal development until these cycles become regular. In regards to this Marieb (1998) states that Usually, it is not until the third year post menarche that the cycles become regular and all are ovulatory.
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Amenorrhoea There are two basic categories of amenorrhoea. Primary amenorrhoea is the delay of menarche, (the onset of menstruation.) (ACSM, 1997; Costa & Gutherie, 1994; Wilmore & Costill,1994; Wells, 1991). Whereas secondary amenorrhoea is the absence of menstruation for females who have had previous menstrual cycles. ACSM, 1997; Costa & Gutherie, 1994; Wilmore & Costill,1994; Wells, 1991). Oligomenorrhoea These are irregular or inconsistent menstrual cycles of 39 to 90 days (Faulks, 1997; Costa & Gutherie, 1994; Wilmore & Costill ,1994; Wells, 1991 ). Dysmenorrhoea Dysmenorrhoea refers to painful menstruation (Marieb, 1998; Wells, 1991; Australian Coaching Council, 1990)

Recent studies have shown that young athletic females may be more likely to experience a delay in the onset of menarche (Costa & Gutherie, 1994; deVries & Housh, 1994; Wilmore & Costill ,1994; Fox, Bowers & Foss, 1993; Wells, 1991), thus developing primary amenorrhoea. They have also concluded that certain sports and their intensity levels play a large part in this delay. Sports like gymnasts, (Wilmore & Costill ,1994;Wells, 1991.) ballet (Costa & Gutherie, 1994) and distance runners (Powers & Howley ,1994; Wilmore & Costill ,1994; Fox, Bowers & Foss, 1993) have been found to have the greatest percentage of athletes who experience a delay in menarche. Studies have found that the age of menarche tended to be younger than average in young Swedish swimmers (deVries & Housh, 1994; Fox, Bowers & Foss, 1993). This may be indicative of two things, one is nationality (Fox, Bowers & Foss, 1993), and the other is the requirement in certain sports to reduce body fat (deVries & Housh, 1994). A hypothesis by Fricsh (1983 as cited by Wilmore & Costill 1994), has a 5 month delay of menarche for every year of training pre-menarch. This implies that training is the cause of primary amenorrhea (Wilmore & Costill ,1994). However Loucks (1990, as cited by deVries & Housh 1994,p.611) explains that At present, it is correct to say that the average age of menarche is later in athletes than non - athletes, but there is no experimental evidence that athletic training delays menarche in anyone. This is agreed with by Wilmore & Costill, (1994) who state that At this time, evidence is insufficient to support the theory that training delays menarche. In light of this delay in menarche, Wells (1991) states that No evidence to date has shown that young athletes with a later age of menarche fail to obtain normal menstrual function and fertility.
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Dysmenorrhoea It is a common belief that sporting activity and exercise may have a positive effect on dysmenorrhoea (Fox, Bowers & Foss, 1993; Wells, 1991; ACC, 1990). However, it has also been shown that swimmers who train during menstruation are more likely to suffer dysmenorrhoea (Fox, Bowers & Foss, 1993; Wells, 1991). Amenorrhoea Exercise -induced or athletic amenorrhoea has been closely associated in sports that require either low body weight and fat, like gymnastics and ballet dancing, have a long duration of activity, like distance running, or have a high appearance component like swimming and diving. Statistics show this clearly. Only 2 % to 5 % of sedentary women suffer from amenorrhoea (Eicher et al. 1997; Faulks, 1997; Wilmore & Costill, 1994; Fox, Bowers & Foss, 1993; Wells, 1991) whilst up to 12 % of swimmers (Faulks, 1997; Costa & Gutherie, 1994; Wells, 1991) and 44 % of ballet dancers and runners are said to suffer from this condition (Faulks, 1997; Costa & Gutherie, 1994; Wells, 1991). The most probable cause of amenorrhoea is low body fat stores which can be induced by a poor diet and / or a sudden increase in, or continual, high intensity training (Faulks, 1997; Costa & Gutherie, 1994; Fox, Bowers & Foss, 1993). Athletes with a previous history of menstrual dysfunction, prior to the commencement of high intensity activity, are also more likely to suffer from amenorrhoea (Costa & Gutherie, 1994). With these factors in mind the Australian Couching Council recommends a decrease in the volume and intensity and an increase in weight for those coaching amenorrheic athletes (ACC, 1990). Gwyther (1997) explains that A major misconception is that SA is a natural birth control. Evidence states that amenorrheic women can still get pregnant. Several other authorities agree with this statement (ACSM, 1997; Wilmore & Costill, 1994; ACC, 1990). Although authorities agree more long term study is needed most agree that once training stops, the menstrual cycle and child bearing functions return to normal (Gwyther, 1997; deVries & Housh, 1994; Fox, Bowers & Foss, 1993). Although secondary amenorrhoea does not effect performance (Faulks, 1997), the American College of Sports Medicine, in their position stand on the female athlete triad in 1997, state that Amenorrhoea is neither a desirable nor a normal result of physical training. (ACSM, 1997,p.**). One of the known risks of amenorrhoea is its involvement in the female-athlete triad, which is explained in the next chapter.

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Athletes need to be educated about menstrual disorders, including signs and effects. (Faulks, 1997; Costa & Gutherie, 1994). It is recommended that female athletes plot their cycles, allowing them to keep a track of fluctuations and identify potential problems sooner (Faulks, 1997). Athletes suffering from menstrual disorders need to see their physician as soon as possible. (Faulks, 1997; Costa & Gutherie, 1994). Develop awareness of the sports that are more likely to encounter amenorrhoea and establish the risk to their athletes (Faulks, 1997). Utilise effective periodisation and planning to avoid sudden increases in workload (Faulks, 1997). Ensure that the athlete is maintaining a diet with sufficient caloric intake and nutritional value (Eicher et al. 1997; Shield & Young, 1995). The Australian Coaching Council (1990) and Shields et al (1995) recommend a decrease in the volume and intensity of the athletes training programme if amenorrhic. The ACSM recommends that, due to the effects of the female athlete triad (discussed next chapter), the athletes should consume an additional 1500mg of calcium per day.

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At present the effects of menstruation are still unclear. Of athletes surveyed, some claim a decrease in performance, some an increase and others no change (deVries & Housh, 1994; Wilmore & Costill, 1994; Fox, Bowers & Foss, 1993; Wells, 1991). Studies on the metabolic effects of exercise during menses, at sub maximal and maximal levels, have shown no change in performance (deVries & Housh, 1994; Fox, Bowers & Foss, 1993). The studies of Jurkowski and coworkers (1981, as cited by deVries & Housh 1994,p.612) found no change in VO2max during the follicular and luteal phase of the ovarian cycle. They did however find that time to exhaustion was longer in the luteal phase and that blood lactate was lower. With this in mind they suggested that the best performances in higher intensity events lasting up to three minutes is during the luteal phase (deVries & Housh, 1994). However Wilmore and Costill (1995) states that Several studies have suggested that athletic performance is best during the immediate post - flow period up to the fifteenth day of the cycle.

At present there is no indication that exercise during menstruation is harmful and as such menstruation should not be seen as a way out of activity. Unless the female is suffering from dysmenorrhoea, in which case she should see her medical practitioner, she is capable of performing physical activity (Wells, 1991). The coach must however be aware of the psychological effect of menstruation on the athlete and, if a positive approach to menses is to be developed, the coach should ensure that the female athlete is allowed to attend to personal hygiene during a session, if she feels the need. The coach must ensure that the athlete is in no way embarrassed, or this will have a negative effect on the athletes attitude towards training during menstruation. There is a common misconception that menstruating females need to be prevented from swimming, they do NOT (Fox, Bowers & Foss, 1993; Wells, 1991). For those who fear a decrease in pool hygiene, studies have shown that menstrual fluids have NO effect on the normal pool bacteria levels (Fox, Bowers & Foss, 1993; Wells, 1991). As Wells (1991) states, Menstrual and Vaginal fluids are cleaner than nose, mouth, skin or anal secretions. There is also no evidence to suggest enhanced vaginal bacterial infections (Fox, Bowers & Foss, 1993; Wells, 1991). With all this in mind however, most authorities agree that with these points in mind the overall decision of participation still belongs to the athlete.
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The term female athlete triad was first coined in a special American College of Sports Medicine (ACSM) conference in 1992 (ACSM, 1997; Eicher, et. al, 1997). Its development was produced by concern over three areas involving female athletes, these being eating disorders, amenorrhoea and Oesteoporosis (ACSM, 1997; Eicher, et. al, 1997; Sadler, et. al, 1995).

As previously discussed amenorrhoea is a dysfunction of the menstrual cycle which leads to an absence of the menstrual cycle (Eicher, et. al, 1997; Faulks, 1997; Fox, et. al, 1993). With the cessation of menstruation, hormone balances are disrupted and the oestrogens protection of bone is decreased thus leading to bone loss and porosity (Costa & Cutheris, 1994; McArdle, et.al, 1991). This increases the danger stress fractures, particularly in sports involving high continuous impact (Faulks, 1997; Rielly, et.al, 1990).

It has been stated that ...the development of amenorrhoea and subsequent osteoporosis occur secondary to the disordered eating. (Eicher, et. al, 1997). Many references agree with this hypothesis (Sadler, et. al, 1995; Wilmore & Costill, 1994). Eating Disorders can in large part be blamed on the society acceptance of what should be a female athletes body image. The causes of this disorder are numerous due to individuality however, as Sadler, et. al, (1995) states, Exercise will not cause an eating disorder but may exacerbate the problem. Anorexia nervosa and bulimia nervosa are two acknowledged eating disorders. Anorexia nervosa is predominantly found in thin athletes who may be suffering from amenorrhoea and have a fear becoming fat. This leads them to therefore restrict dietary intake (Wilmore & Costill, 1994; Fox, et. al, 1993). Bulimia Nervosa is characterised by binge eating followed by purging (self induced vomiting) (Wilmore & Costill, 1994; Fox, et. al, 1993). It is important that eating disorders be identified as soon as possible to ensure early treatment and the prevention of the female athlete triad. Education on what eating disorders are, body image awareness and correct diet patterns can help alleviate the problem. A point to remember is that members suffering from an eating disorder may suffer from self denial and embarrassment. The instructor must be careful of how the subject is broached.
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Considering Gender

Osteoporosis is an increase in the porosity of bone through a decrease in bone mineral content (deVries & Housh, 1994; Fox, et. al, 1993; McArdle, et.al, 1991) and is responsible for 1.2 million fractures annually (deVries & Housh 1994, p.242). Although more common in post menopausal women, athletes suffering from eating disorders and amenorrhoea are highly susceptible to osteoporosis.

By suffering from an eating disorder, the athlete does not get enough calcium and, together with the decrease in bone protection caused by amenorrhoea, is highly susceptible to osteoporosis and hence the female triad is formed.

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The Female Athlete Triad

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Pregnancy Duration :

280 Days or 40 weeks (Safely ranging from 38 to 42 weeks)

ACOG Afterbirth Amniotic Fluid Amniotic Sac Cervix Contraction Diastasis Recti E.D.C. Foetus Gestation

American College of Obstetricians and Gynaecologists. The Placenta. The liquid the baby floats in. The waters. The membrane that holds the baby and the amniotic fluid. The neck of the uterus. The tightening of the womb muscle. A separation of the rectus abdominas along the linea alba. Expected date of confinement. The name given to a baby after about 12 weeks. From gestare which means to carry

Gestational Diabetes A condition defined as glucose intolerance with onset or first recognition during pregnancy. Quickening RACOG 1st Trimester 2nd Trimester 3rd Trimester The babys first felt movements. Royal Australian College of Obstetricians and Gynaecologists. Weeks 1 to 12. The most critical period of development where the foetus is at greatest risk. Weeks 13 to 27. Weeks 28 to 40.

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There are several areas of concern regarding the effects of exercise on the foetus. Whilst some of these effects are acute in nature, eg. foetal temperature, heart rate and oxygenation, others are chronic, eg. gestation and birth weight.

ACOG and RACOG guidelines state that a maternal core temperature should not raise above 380C (Araujo, 1997; Champion, 1997a; ONeill, 1996; RACOG, 1994). With core temperature rising before perspiration occurs and, as the foetus is usually hotter than the mother, pregnant women should not regard the lack of sweat as an indication of core temperature. Spa baths, hydrotherapy pools or pools of a high temperature (above 300C) should also be regarded with caution. Ridge and Budd (1990), who conducted a study with non pregnant women, found that when placed in a 400 spa bath and instructed to exit when they felt hot, not one left the spa before their core temperature had reached 390C (Champion, 1997a; ONeill, 1996). With this in mind, 280C to 300C is generally regarded as an acceptable water temperature to prevent core hyperthermia of maternal members (ONeill, 1996; RACOG, 1994).

With an enlarging uterus blood flow to the foetus can be effected, especially when exercising in the supine position, as there is compression of the vena cava. Compression of the main blood returning vein reduces cardiac output and can result in decreased blood flow to the foetus as well as the mothers head, causing dizziness or light headedness. Recumbent cycling and near maximal cycling in the upright position have also been associated with a decrease in foetal blood flow (Champion, 1997a; ONeill, 1996).

A change in foetal heart rate represents a change in the foetal environment (overheating or hypoxia). Foetal brachycardia has been observed in maternal subjects who trained at high near maximal intensities, interestingly the instances of brachycardia where found to dominate in the first 3 minutes post exercise (Champion, 1997a; AGOC, 1994).

Exercise, particularly of a high frequency (five times or more) or intensity in the last trimester, has been shown to lead to a lower foetal birth weight (Champion, 1997a ONeill, 1996; RACOG, 1994). Although this decrease in weight is only small (around 300g to 350g)(Champion, 1997a; ONeill, 1996), it may be of clinical significance in those babies with an already low development weight. With 3000g considered as a healthy birth outcome, (Champion, 1997a; ONeill, 1996) every 100g below this range has been shown to increase the incidence of infant health problems (Champion, 1998; Champion, 1997a).
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There are several changes that effect the natal womens biomechanics. The most substantial is caused by an enlarging uterus which creates an anterior displacement. This exaggerates normal lumbar lordosis and alters the centre of gravity to a position inferior and posterior to the lumbar spine (Marieb, 1998; Araujo, 1997; Colliton ,1996). The increase in size and weight (up to several kilograms (Champion, 1997a; Wells, 1991)) of the breasts also effects body load and can contribute to shoulder and upper back pain. This structural change to the body and its effect on the centre of gravity can be expected to effect coordination, agility, balance and stability (Araujo, 1997; Champion, 1997a; Aartal, 1996). Due to the increase in breast weight it is important for female athletes to wear a strong supportive bra. Weight Gain Due to the development of the foetus, weight gain is to be expected. The general opinion is that weight gain in the range of 10 kg to 15 kg is healthy (Marieb, 1998; Champion, 1997a; Kleiner, 1996; Charlish, 1995; RACOG, 1994). Carpal Tunnel Syndrome Fluid accumulation in the wrist and forearm can increase pressure on the median nerve and, although occurring in only a small percentage of pregnant women, carpal tunnel syndrome is not uncommon (Champion, 1997a; Aartal, 1996). Separation of the Rectus Abdominous Diastasis recti, or abdominal separation, occurs in approximately 30% of pregnant women. Although not known to be painful, it is recommended that abdominal exercises cease. It is important to resume abdominal exercises post partum however in order to return strength to the weakened abdominal wall as lack of reconditioning can lead to long term back pain.

The physical space taken up by the enlarging uterus causes a displacement of the diaphragm by up to 4 cm. This encroachment can create dyspnea and general discomfort (Araujo, 1997; Aartal, 1996). The body does however compensate to ensure that sufficient air can be inspired by increasing thoracic capacity, and although respiratory rate does not increase, there is an increase in tidal volume (Wells, 1991).
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As blood is the primary means of supplying the foetus with oxygen and nutrients, the mothers circulatory blood flow must increase. To this end cardiac output (Q), the result of stroke volume and heart rate, increases. This increased cardiac output is derived from an increase in both stroke volume, which may increase by much as 30 % (Wells, 1991), and resting heart rate (RHR), which may be raised by up to seven beats per minute (bpm) in the first trimester and 15 bpm in the remaining trimesters (Araujo, 1997; Wells, 1991). It is not uncommon for resting heart rates to increase by as much as 30 bpm (Champion, 1997a). The increase in RHR effects the heart rate reserve (RHR) or cardiac reserve. With maximal heart rate remaining the same and RHR increasing, the difference between the two is decreased (Aartal, 1996) meaning that the exercise intensity required to reach target heart rate is reached more easily (Champion, 1998). There are three important points for the instructor to remember : 1. Although cardiac output increases, usually by 30% to 50%, when in the supine position, it can decrease below non-pregnant levels (Araujo, 1997; Wells, 1991). 2. An adjunct to this increase in cardiac output is the increased risk of venous pooling, especially during exercise (Champion, 1997a). 3. Those that utilise resting heart rate as a measure of fitness should be informed that the rise in resting heart rates is a natural process and does not reflect a drop in fitness levels. The increase in cardiac output, combined with an increase in blood volume (by 35% to 45%), may result in an increased endurance performance during the first trimester, before increases in uterine size and maternal body weight impede athletic performance (Araujo, 1997). However, although resting VO2 has been shown to increase during pregnancy by up to 20% (Fox et al., 1993; Wells, 1991), following the results of a case study, state that VO2max falls dramatically in the first trimester, recovering slightly through the remainder of the gestational period (Fox et al., 1993). A factor which may have lead to these result was a decrease in the training mileage of the test subjects during the first term. NOTE : With the increase in blood volume there is also an increase in venous capacitance, therefore blood pressure does not increase markedly.

From the time of conception the body increases its release of several hormones including progesterone, oestrogen, elastin and relaxin. Relaxin, the hormone which has the responsibility for causing connective tissue to relax, loosens the pelvic joints (symphysis pubis and sacroiliac) in preparation for the birthing process (Marieb, 1998; Champion, 1997a; Colliton,1996). The effect is not localised however, and all the joints in the body are effected. This implies that natal women are more susceptible to joint injuries and connective tissue damage (Colliton , 1996; Shields & Young, 1995).

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Another effect of this sudden hormonal increase is morning sickness (Champion, 1997a; Charlish, 1995; Wells, 1991). This may effect those who are used to training in the morning and it is recommended that they change their training times. The increased hormones also have an effect on the nervous system. During the first trimester it is common for a pregnant woman to feel sleepy and fatigued. These feelings may be induced by the high level of the hormone progesterone (Wells, 1991). Combine this lethargy with morning sickness and it can be seen why for many training is reduced or ceased in the first trimester (This may explain the case study results of a lower VO2max). The second trimester is associated with a general feeling of well being and euphoria, whilst during the third trimester feelings of fatigue and depression are common (Wells, 1991).

Due to the increased metabolic demand created by moving an increased body weight and the developing foetus, it is recommended that caloric intake be increased by around 300 calories per day (Marieb, 1998; Champion, 1997a; Kleiner, 1996; ACOG, 1994; AGOC, 1985). It is also recommended that protein intake is increased by 10g to 15g per day (Kleiner, 1996; Charlish, 1995). Champion (1997a) however advises that up to an additional 100g of protein per day may be required. Folic Acid Also known as Folacin and Folate, Folic Acid is a critical nutrient during pregnancy and as such several large campaigns have launched awareness of Folic Acid during pregnancy. A low intake of Folic Acid during the first three months of pregnancy has been associated with brain and spinal cord defects in the growing fetus (Marieb, 1998; Kleiner, 1996; Charlish, 1995). Alcohol Alcohol has been linked to several adverse foetal effects, including higher rates of miscarriage, low birth weights and a condition known as foetal alcohol syndrome (Kleiner, 1996). Consumption of alcohol should be limited or kept to a severely restricted consumption. Caffeine The effects of caffeine on the foetus is still in question and evidence is mixed. However several studies have shown evidence of birth defects. Again conservative caution is recommended and caffeine intake should be limited and if possible avoided altogether. Foods to Avoid Soft Cheeses - Soft cheeses (eg. Brie and Camembert ) can be contaminated with a bacteria called Listeria. Raw Foods - Foods that contain raw eggs like egg nog, soft serve ice cream, Caesar salad dressing and raw dough should be avoided. Raw fish , poultry and meats should also be avoided.
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Exercise will assist in developing a sense of well being, help to maintain aerobic fitness and aid in preventing excessive weight gain. Although most studies show that exercise may have no influence on labour performance, a study by Clapp (1990 as cited by Champion, 1997a ) who had a group exercise throughout their pregnancy, has shown positive improvements. Sports women have also shown to have less ruptures that active women or house wives (Wells, 1991). Fox et al (1993) state that In general, female athletes tend to have fewer pregnancy - and childbirth - related complications than do non-athletic women.(Fox et al., 1993). Wells (1991) and deVreis et al. (1994) mention the studies by Erdelyi in 1962 that led to the following statistics in regards to athletic women : 87% delivered their babies faster with a shorter duration of labour, 50% fewer caesarean sections, and fewer forceps deliveries (Wells, 1991). However, Wells (1993) also discusses a study by Lokey in 1988 that showed no differences between exercising and non - exercising groups in gestation period, caesarean delivery or length of delivery. (Wells, 1991; de Vries, & Housh, 1994). As previously discussed there is an exaggerated normal lumbar lordosis through a shift in the center of gravity. Add to this the effects of the hormone relaxin on the joints and the decrease in abdominal muscle tonus, caused by the enlarging uterus and stretching abdominal muscles, and it can be seen why 50% of pregnant women will experience lower -back pain (Araujo, 1997; Colliton ,1996). In regards to this Colliton (1996) states that Patients should be aware that exercise and posture correction will minimise but not completely prevent lumbar or sacroiliac pain during pregnancy. Exercise can also help those women who develop gestational diabetes, a condition found in 3 % to 6 % of pregnant Americans (Australian centres reporting 5.5% to 8.8%) (Hoffman,et.al., 1998; Aartal, 1996).

There are however certain pregnant members who should be advised not to undertake any form of exercise during pregnancy. To identify these members ACOG has developed a list of contra indications. The list is divided into two categories, Absolute Contraindications, for those who have conditions for which exercises is not recommended, and Relative Contraindications, those who have conditions which must be reviewed by an obstetrician, (who will make the final decision as to whether exercise should be performed) prior to the commencement of exercise.

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Absolute Contraindications.
History of three or more spontaneous miscarriages. Ruptured membranes. Premature labour. Diagnosed multiple pregnancies (eg,. Twins). Intrauterine growth retardation. Incompetent cervix. Bleeding or a diagnosed placenta previa. Diagnosed cardiac disease. Pregnancy - induced hypertension. Primary pulmonary hypertension.

Relative Contraindications.
Hypertension. Anaemia. Thyroid disease. Diabetes. Extremely over / under weight. Breech position in third trimester. History of bleeding during pregnancy.

Any sport or activity that may result in a fall or impact should be avoided, including some of the following : Surfing, Rock climbing, Contact sports, Sports with contact potential Eg. Netball and Soccer, Water-skiing, Horseback riding, Gymnastics, and Activities that have a low oxygen state, Eg. Mountain climbing and scuba diving. These activities increase the risk of abdominal trauma and musculoskeletal injury. With this in mind a pregnant member should cease these activities as soon as they are aware that they are pregnant. Even before they are showing a forceful blow or twist to the abdomen may carry serious consequences (Champion, 1997a).

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Prior to the commencement of exercise ALL pregnant members must be screened and require a doctors permission in writing. This is NOT the time for untrained members to commence with exercise. Those members with no previous training are advised NOT to commence with exercise during their pregnancy.

If a pregnant women experiences any of the following she should cease exercising immediately and consult her obstetrician : Feels very hot, faint, dizzy, dyspnea, disorientation, lower abdominal pain or cramping, back or pubic pain, difficulty walking or vaginal bleeding (Champion, 1997a; Aartal, 1996).

It is recommended that natal women do not exercise more than four times a week after the 28th week (Champion, 1997a; RACOG, 1994). Champion (1998) mentions research that has indicated an association between frequent exercise after week 28 and lower foetal birth weights. It is generally considered that their is no need to restrict exercise in the first three to four months (Wells, 1991) unless contra indications are present. In an ACOG (1994) technical bulletin it is stated that, Regular exercise (at least three times per week) is preferable to intermittent activity.

Although the original ACOG statement in 1985 recommended that heart rates were to be set at 25 % to 35 % lower than usual, not exceeding 140 bpm (Champion, 1997a; ACOG, 1985), this figure is considered over conservative by some for a trained female athlete. In 1994 the ACOG technical bulletin recommended that They should be encouraged to modify the intensity of their exercise according to maternal symptoms.(AGOC, 1994). Even with several authorities now regarded 150 bpm to 155 bpm (Champion, 1998) as a more appropriate guideline, the RACOG (1994) still recommend that Maternal heart rate should not exceed 140 beats per minute. (Shields & Young, 1995; RACOG, 1994).

Although many people utilise the Borgs perceived rate of exertion, Champion (1997a) states that it should not be utilised alone as it tends to underestimate exercise intensities.

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The exact duration of exercise is still under question. ACOG advises that exercises does not exceed 15 minutes (Wells, 1991; ACOG, 1985) whilst RACOG (1994) recommends a duration of 15 to 20 minutes. Champion (1998) however recommends no more than 25 minutes in the training heart range.

Aerobics Step It is recommended that during the first trimester the step height is lowered, preferably to platform height only. Moves or high choreography classes, propulsive movements and the use of hand weights should be avoided due to joint laxity and the decreases in balance and coordination. Step classes are considered contra indicated in the second and third trimester (Champion 1997) and should be avoided. Pump Pump classes should follow the guidelines found under resistance training and it is recommended that the Pregnancy and Pump. Position statement be adhered to by all pump instructors. A point of note made by Champion (1997a:b) in the above mentioned position stand is that PUMP is not the most appropriate workout for the pregnant exerciser. High / Low Any form of propulsion / elevation should be avoided as should classes with a high choreographic content. It is recommended that pregnant participants perform the unelevated or low classes only with careful monitoring of their temperature, hydration and most importantly heart rate. New Body Hand weights in a new body styled class should not exceed 0.5 kg. Heavier weights, through isometric contractions of the forearms, increase heart rate and blood pressure. No weight is the preferred option and should be recommended, especially for those who portray signs of carpal tunnel syndrome ie. feelings of numbness or pins and needles in their palms, wrists or more classically thumb, index and / or middle fingers. Resistance Training 1. Due to the weakening and laxity of the pelvis and the decrease in balance and coordination, exercises like squats and lunges are contra indicated. 2. Exercises with a higher balance requirement, like a standing overhead press, should be substituted for one of a higher stability, eg. machine or seated. 3. Exercises that place pressure on the wrist like Bench Pressing or those that utilise dumbbells may be difficult to perform if the natal women is suffering from pregnancy induced carpal tunnel syndrome. Positions like the four point bridging position and push up position may also aggravate the wrist.

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4. Certain exercises that create movement or compression of the breasts may cause discomfort due to breast enlargement and tenderness. 5. Due to the effect on foetal blood flow exercise should not be performed in the supine position for more than two to three minutes and avoided altogether after the first trimester (Chivers,1998; ACOC,1994). However low intensity work in the supine position (for under three minutes) may be performed up until the 35th week unless contra indications are present. 6. The valsalva manoeuvre (forceful breath holding) should be avoided. With these considerations in mind, the main emphasis should be to utilise a lower intensity, avoiding isometric and heavy lifting exercises, with a repetition range that remains above ten. Champion (1997a) states that There is no problem working to the point of failure as long as it is not achieved with low reps and heavy weights. Champion, (1997a) The use of machines is also recommended due to the altering body position which causes a change in proprioception and centre of gravity, in turn effecting balance and coordination. Abdominal Training Abdominal activities can continue unless contra indications are present. Two additional contra indications have already been discussed, these are lying in the supine position and diastis recti or abdominal separation. It is also recommended that whilst performing abdominal activities the natal exerciser wraps both arms around her stomach, similar to a hug, to provide abdominal wall support. Pelvic Floor Exercises The muscles of the pelvic floor or pelvic diaphragm, these being the Levator Ani (Iliococcygeus and Pubococcygeus) and the Coccygeus, provide a sling to support the bladder, the uterus and the intestines. They also form sphincters around the anorectual junction and vagina. During a vaginal delivery, these muscles have to stretch and open in order to allow the birthing process. These muscles should be trained and strengthened during and after pregnancy so that they can resume their support role as soon as possible. If the functional strength of these muscles is not redeveloped, incontinence, vaginal flatus or a vaginal prolapse may result (Champion, 1997a ; Gerber,1995). There are two effective means of training these muscles, a sustained isometric contraction or a short sharp contraction. To train these muscles the member needs to visualise a lifting of the pelvic organs. A training dose of ten to fifteen contractions, performed several times a day, during and post partum is recommended (Champion, 1997a).

Although the pelvic floor muscles contract to stop urination, it is not advisable to train the muscles by forcefully stopping urinary flow as this may cause urinary tract infections. (Champion, 1997a)

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Training in Water Water, by being up to 1000 times more dense than air (Town & Kearney, 1994), has several positive effects on the body and is therefore regarded by many as the most appropriate form of exercise for the pregnant member. Firstly, the buoyancy effect of water decreases load across the joints as, when immersed up to the neck in water, a female supports only 8 % of her body weight (Harrison & Bulstrode, n.d.). This support also decreases the potential problems caused by loss of balance and coordination and prevents venous pooling and the effects of swelling during pregnancy (Champion, 1997a). Water is also an effective heat conductor and can disperse heat up to 25 % faster than air (Champion, 1997a), reducing the risk of over heating and hyperthermia. Exercise in water has also shown to produce lower heart rates when compared to the same intensity on land (Champion, 1997a). Furthermore, when in a prone swimming position, like freestyle or breaststroke, foetal blood flow is optimal and it can be seen why swimming and water based activity is so highly regarded for the natal woman. Remember hydrotherapy and spa pools are too hot for the pregnant exerciser. The pool temperature should be between 28oC and 30oC (ONeill, 1996). In conclusion, Wells (1991) gives sound advice to maternal women in regards to exercise, Basically, a woman (whether pregnant or not) should listen to her body. Everyone is different, and what happens to one might not happen to another.

Many athletes compete during pregnancy, some even winning Olympic medals. It is generally considered that competition is acceptable during the first trimester to fifteen weeks (Araujo, 1997; Wells, 1991). Wells (1991) states that Usually pregnancy has no effect on athletic performance up to the first 2 to 3 months. It is often the desire to train, through hormonal induced fatigue and morning sickness, that may provide the most resistance. Although there are claims that some women have completed marathons in their eighth month of pregnancy, after the fourth or so month when gravity displacement and an enlarging foetus begin to effect balance, agility and quality of movement, it is advised that competition cease.

Exercise has not been shown to effect the amount of milk volume produced (Champion, 1997a). The only ill effect comes from possible lactic acid accumulation in breast milk. This may last for up to 90 minutes post high intensity exercise and gives the milk a slightly bitter taste. It is recommended that if the baby does not feed well in the 90 minute period following exercise (other factors excluded), the mother either changes her feeding times (waiting for at least 90 minutes post exercise), expresses milk prior to exercise to be given immediately after exercise or simply reduces her intensity.
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It is normally recommended that, although some women may feel able to commence exercise within a week of giving birth, they await their six week check up before resuming exercise. Women who have had a caesarean section in particular must wait at least six weeks to allow organ and soft tissue recovery. It must be remembered that due to the effects of the hormone relaxin, which may last for up to three months (Champion, 1997a) and the loss in abdominal muscle tone, caution and exercise selection is of importance. RACOG and ACOG recommend that past partum members follow the same exercise guidelines as for pregnancy (AGOC, 1994; RACOG, 1994) with the following exception : Swimming should be avoided until bleeding has ceased. This may take up to four weeks postpartum (RACOG, 1994). From several case studies it has been found that pregnancy itself is not detrimental to post natal performance (after suitable recovery / retraining time) (Wells, 1991). Again, several women have won Olympic medals after having given birth to one or more children. In fact de Vreis and Housh (1994) mentions a study conducted by Noack (1954) on fifteen German athletes who bore children during their careers. Of these athletes eight agreed that they were tougher and had more strength and endurance. (de Vries, & Housh, 1994).

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Exercise and Pregnancy

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Chapter 6

It has already been established that, due to a variety of factors, the male and female athlete view and review performances, both individually and as a group, differently. Self confidence is largely greater in the male athlete, particularly when the sport is viewed as being masculine in nature (Weinberg and Gould, 1995). With this in mind, success in these tough sports could compromise the feminine standing of the female athlete in both societys and their own eyes. This social value also has side effects for the male. The more masculine the sport is deemed to be, the more competitive the male athlete becomes as by loosing, they are seen to become less of a man. Females however have less pressure and in many cases prefer not to win and hence prove that they are less of a man. DeBoer (1998) states that No one views a female athlete as less feminine than her conqueror; in fact just the opposite may be true. For female athletes loosing can be devastating, but winning is more likely to be associated with questioning gender identity than loosing. Both this confidence and competitive nature more or less predict the statement by Weinberg et and Gould (1995), .....males are more sensitive to social comparison and orientated toward winning, whereas females tend to be more interested in personal improvement. In a generic sense this can be seen in a large competitive event like a fun run. A male would be more concerned with where they placed whereas a female would be focussed on whether she beat her last time. Females also tend to be team or web orientated, they are conscious of where they fit in the team (DeBoer,1998). Being told that she is making herself look bad during poor performance would have less impact than telling her she is letting the team down. The coach must also realise that with the above psychological differences, women do not respond as well to the stereotypical male styled motivation. Harden up, You swing like a girl, I want you to go out there and destroy your opponent , these are all powerful stimuli for a male athlete but do little for the female athlete. Not only do females take criticism more harshly due to the athlete - coach relationship, but they also need enforcement as a team rather than just individuals, Go out and show your opposition how well you can play as a team will most likely have a better cohesive approach that the common destroy your opponents approach. When a male is seen as a star the rest of the team double their efforts to emulate or better him, a female star however is outside of the web and this often has a negative effect on the team. This means that coaches should again be aware of their choice of words when providing feedback. For example saying to a male player You are my star player go out there and lead this team to a win. whilst effective for a male athlete can have a negative effect on a female athlete who does not want to be outside of the team. Another example is the praise of an athlete, That was great play by John, I expect all of you to follow his example. whilst urging males on, can lead to the nominated female being pushed out of the web. These slight nuances and differences need to be considered by the coach and as such the coachs mannerisms, coaching styles, attitudes and motivational techniques should reflect this.
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POINTS TO REMEMBER WHEN TO COACHING FEMALE ATHLETES

Females value friendship and support higher than male athletes. They are also more sensitive to team mates and their feelings. This could provide problems if two team mates do not like each other. Female athletes like to establish a personal relationship with a coach and as such the coach should ensure that the athlete does not become reliant on them and, as such, should develop the athletes independence. Female athletes hold a higher value over personal improvement that victory. Therefore goals must be realistic for if they do not see improvements, motivation will become threatened. Female athletes respond better to positive feedback and confidence boosting motivation than they do to criticism. Decrease competitive situations when coaching. Avoid sex-typing of activities. Female athletes respond best to a democratic coach. Coaches should ensure that female athletes are receiving sufficient iron and calcium in their diets (especially if suffering from amenorrhoea), and are sensitive to possible eating disorders.

At no time is there ever a need to genderise an activity or sport and all training sessions should be treated with a neutral gender approach. Above all, coaches should treat all athletes as individuals, taking into consideration not only gender, but experience, likes and dislikes, motivation and goals.

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Coaching Considerations

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ACOG AFTERBIRTH AMNIOTIC FLUID AMNIOTIC SAC BRACHICARDIA

American College of Obstetricians and Gynaecologists. The Placenta. The liquid the baby floats in. The waters. The membrane that holds the baby and the amniotic fluid. A low heart rate or resting heart rate of below 60 beats per minute. The neck of the uterus. The tightening of the womb muscle. A separation of the rectus abdominas along the Liena Alba. Difficult or laboured breathing Expected date of confinement. The name given to a baby after about 12 weeks. From gestare which means to carry A condition defined as glucose intolerance with onset or first recognition during pregnancy. The difference between resting heart rate and maximal heart rate Fear of being labelled Homosexual. High core body temperature which can be caused by several factors including illness, exercise and dehydration. An excessive curve of the lumbar vertebrae, (Lower back arch) The babys first felt movements. Royal Australian College of Obstetricians and Gynaecologists. Weeks 1 to 12. The most critical period of development where the foetus is at greatest risk. Weeks 13 to 27. Weeks 28 to 40.
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CERVIX CONTRACTION DIASTASIS RECTI DYSPNEA E.D.C. FOETUS GESTATION GESTATIONAL DIABETES

HEART RATE RESERVE HOMOPHOBIA HYPERTHERMIA

LORDOSIS QUICKENING RACOG 1ST TRIMESTER 2ND TRIMESTER 3RD TRIMESTER

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Considering Gender

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

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