Effects of follicular versus luteal phase-based strength training in young women

The effect of time of day and menstrual cycle on physical performance and psychological responses in elite female Tunisian volleyball players

BACKGROUND

The influence of circadian rhythms and menstrual cycle phases on athletic performance and psychological responses is critical for optimizing training and competition strategies for female athletes. This study aimed to investigate the effects of time of day and menstrual cycle phases on the physical performance and psychological responses of elite female Tunisian volleyball players.

METHODS

Thirteen elite female volleyball players were assessed during three different phases of their menstrual cycle (menstrual, follicular, and luteal) and at two different times of day (morning and evening). Physical performance was evaluated using the Modified Agility Test (MAT), Reactive Agility Test (RAT), and Repeated Sprint Ability (RSA) Test. Psychological responses were measured using the Profile of Mood States (POMS), Hooper's Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Vis-Morgen Questionnaire, and Spiegel Questionnaire.

RESULTS

Significant effects of menstrual cycle, time of day, and competition on physical performance, cognitive function, mood, and sleep parameters were found. Physical performance, including the Countermovement Jump (CMJ), the Modified Agility T-test (MAT) and the Reactive Agility test (RAT), was higher in the afternoon than in the morning across all menstrual phases (CMJ: p < 0.001, η² = 0.836; MAT: p < 0.001, η² = 0.777; RAT: p < 0.001, η² = 0.859). After the competition, performance decreased significantly, especially in the follicular and luteal phases. As measured by the Stroop test, cognitive function showed significant diurnal effects (p < 0.001, η² = 0.910), with pre-competition performance being better in the afternoon. Mood disturbances (POMS) increased after the competition, especially in the morning and during the luteal phase (p < 0.001, η² = 0.961). Sleep parameters were significantly influenced by time and menstrual cycle, with higher fatigue (Hooper score: p < 0.001, η² = 0.754) and poorer sleep quality (PSQI: p < 0.001, η² = 0.627) in the morning, especially after the competition.

CONCLUSION

Our results suggest that aligning high-intensity training and competitions with afternoon circadian peaks may enhance physical and cognitive performance in elite female athletes. Recovery strategies and workload adjustments should account for menstrual phases, particularly reducing morning demands during the luteal phase to mitigate fatigue and mood disruptions. Integrating circadian timing with menstrual cycle monitoring offers a practical, evidence-based approach to optimize athlete readiness and resilience.

Menstrual cycle phase does not influence muscle protein synthesis or whole-body myofibrillar proteolysis in response to resistance exercise

It has been hypothesised that skeletal muscle protein turnover is affected by menstrual cycle phase with a more anabolic environment during the follicular vs. the luteal phase. We assessed the influence of menstrual cycle phase on muscle protein synthesis and myofibrillar protein breakdown in response to 6 days of controlled resistance exercise in young females during peak oestrogen and peak progesterone, using stable isotopes, unbiased metabolomics and muscle biopsies. We used comprehensive menstrual cycle phase-detection methods, including cycle tracking, blood samples and urinary test kits, to classify menstrual phases. Participants (n = 12) completed two 6 day study phases in a randomised order: late follicular phase and mid-luteal phase. Participants performed unilateral resistance exercise in each menstrual cycle phase, exercising the contralateral leg in each phase in a counterbalanced manner. Follicular phase myofibrillar protein synthesis (MPS) rates were 1.33 ± 0.27% d-1 in the control leg and 1.52 ± 0.27% d-1 in the exercise leg. Luteal phase MPS was 1.28 ± 0.27% d-1 in the control leg and 1.46 ± 0.25% d-1 in the exercise leg. We observed a significant effect of exercise (P < 0.001) but no effect of cycle phase or interaction. There was no significant effect of menstrual cycle phase on whole-body myofibrillar protein breakdown (P = 0.24). Using unbiased metabolomics, we observed no notable phase-specific changes in circulating blood metabolites associated with any particular menstrual cycle phase. Fluctuations in endogenous ovarian hormones influenced neither MPS, nor MPB in response to resistance exercise. Skeletal muscle is not more anabolically responsive to resistance exercise in a particular menstrual cycle phase. KEY POINTS: It has been hypothesised that the follicular (peak oestrogen) vs. the luteal (peak progesterone) phase of the menstrual cycle is more advantageous for skeletal muscle anabolism in response to resistance exercise. Using best practice methods to assess menstrual cycle status, we measured integrated (over 6 days) muscle protein synthesis (MPS) and myofibrillar protein breakdown (MPB) following resistance exercise in females (n = 12) in their follicular and luteal phases. We observed the expected differences in oestrogen and progesterone concentrations that confirmed our participants' menstrual cycle phase; however, there were no notable metabolic pathway differences, as measured using metabolomics, between cycle phases. We observed that resistance exercise stimulated MPS, but there was no effect of menstrual cycle phase on either resting or exercise-stimulated MPS or MPB. Our data show no greater anabolic effect of resistance exercise in the follicular vs. the luteal phase of the menstrual cycle.

Power in the flow: how menstrual experiences shape women's strength training performance

Introduction

Hormone levels fluctuate significantly throughout the menstrual cycle (MC), potentially impacting physical performance during training. However, the number of studies examining women's experiences during strength training throughout the MC is limited. Therefore, the aim of this study was to explore women's perceptions of strength training during different MC phases.

Methods

In this study, a qualitative study design was used where five women (24-32 years) with recreational experience in strength training kept an exercise diary during a MC. Data were collected using semi-structured interviews and analyzed using qualitative conventional content analysis, with an inductive approach.

Results

From the analysis, three overarching themes describing the content of the interviews emerged: "Biopsychosocial Dynamics and Individual Variability in the Early Follicular Phase", "From Peak to Breaking Point: Performance Dynamics from Late Follicular Phase to Ovulation" and "Diversity in Mental and Physical Well-Being During the Luteal Phase". From women's perspectives, strength training performance seems to fluctuate across the different phases of the MC, influenced by both physiological and psychological challenges, though with individual variation.

Discussion

The findings highlight the need for a holistic approach to managing the physiological and psychological challenges that may arise during each phase of the MC, along with the importance of social support. The results also stress that performance fluctuations across the MC are unique, further emphasizing the inability to recommend general phase-based exercise protocols.

Effects of Hormonal Contraception and the Menstrual Cycle on Maximal Strength and Power Performance

INTRODUCTION

To evaluate the effects of oral contraceptive (OC) and hormonal intrauterine device (H-IUD) use, compared with an eumenorrheic (EUM) cycle, on maximal strength and power between hormone phases.

METHODS

One-repetition maximum (1RM) leg press and bench press, peak force from knee extension and upright row isometric dynamometry, and power from vertical jump height and reactive strength index (cm·s -1 ) were measured in 60 healthy, active women (mean ± SD; age: 26.5 ± 7.0 yr, body mass index: 23.8 ± 3.0 kg·m -2 ) who were monophasic OC users for ≥6 months ( n = 21), had an H-IUD for ≥6 months ( n = 20), or had regularly naturally occurring menstrual cycle for ≥3 months or were using a nonhormonal IUD (EUM; n = 19). Participants were randomly assigned to begin in the follicular phase/placebo pill (low hormone phase (LHP)) or in the luteal phase/active pill (high hormone phase (HHP)) and were tested once in each phase. Estimates of total lean mass (LM), leg LM, and arm LM were measured via dual energy x-ray absorptiometry. Separate univariate ANCOVAs were used to assess the change from HHP to LHP between groups, with LM and progesterone as covariates.

RESULTS

Leg press 1RM was significantly different across phases between groups ( P = 0.037), with higher leg press 1RM in the HHP for the OC group (mean difference [∆ HHP - LHP] ± standard error: ∆ 7.4 ± 15.9 kg; P = 0.043) compared with the H-IUD group (∆ -8.9 ± 23.8 kg; P = 0.043). All groups demonstrated similar bench press 1RM, peak force, vertical jump height, and reactive strength index between phases ( P > 0.05).

CONCLUSIONS

Lower body strength was greater in the HHP for OC users (5.6% increase) suggesting that lower body maximal strength outcomes may be influenced by hormonal contraception type.

Cycle Syncing and TikTok's Digital Landscape: A Reasoned Action Elicitation Through a Critical Feminist Lens

Cycle syncing is a menstrual health trend on TikTok that involves aligning exercise and diet with the four menstrual cycle phases. Cycle syncing is part of the conversation on social media about women's reproductive health. However, clinical research on the effects of cycle syncing is inconclusive, and there is the potential that this trend could further perpetuate misinformation and gender stereotypes. Research suggests that social media can affect health behaviors, highlighting the need to understand if women intend to participate in cycle syncing. Guided by the Reasoned Action Approach, this study used focus groups (n = 39) to examine young women's attitudes, normative beliefs, and control beliefs about participating in cycle syncing, and critical feminist theory to sensitize resulting themes. Results suggest that normative beliefs emphasize support for the behavior among women, yet participants suggest that men would not support this behavior. Additionally, positive beliefs about cycle syncing content sourced from inconclusive scientific literature underscores concerns regarding the potential dissemination of misinformation in women's health practices on social media. Findings also fit into a larger discussion about "hormonophobia" and contraception on social media. Theoretical implications for mixed methods research and future directions are discussed.

Menstrual cycle phase differences in myofiber damage and macrophage infiltration following electrical stimulation-induced muscle injury

The purpose of this study was to examine the effects of menstrual cycle phase on myofiber injury, regenerative events, and inflammation after electrical stimulation (ES)-induced myofiber damage. Twenty-eight premenopausal women (20.8 ± 2 yr) were randomized into early follicular (EF; n = 14) and late follicular (LF; n = 14) groups. After menstrual cycle tracking and phase confirmation, subjects underwent 200 electrically stimulated eccentric muscle contractions 1 wk after providing a muscle biopsy. Seven days post-ES, subjects provided a final biopsy. Primary outcomes included serum estradiol, indirect markers of muscle damage, direct indicators of myofiber necrosis and regeneration, satellite cell number, and macrophage infiltration. Women in the LF group had higher serum estradiol (122.1 ± 23.4 vs. 81.7 ± 30.8 pg/mL; P < 0.001) than in the EF group on the day of ES. Although the EF group recovered baseline maximal isometric strength by 4 days post-ES, the LF group did not. Only women in the LF group showed significant and consistent evidence of myofiber necrosis and regeneration pre- to post-ES. Despite showing more evidence of myofiber damage, women in the LF group also experienced reduced total and CD206+ macrophage infiltration relative to the EF group. Satellite cell quantity increased significantly post-ES in both groups, with no differences between groups. Collectively, the data suggest that the high-estrogen LF phase may be associated with increased susceptibility to myofiber injury while also limiting the subsequent intramuscular inflammatory response.NEW & NOTEWORTHY The menstrual cycle has widespread physiological effects across many systems, including skeletal muscle. In this study, we show that women in the late follicular phase of the menstrual cycle may be more susceptible to myofiber necrosis following electrical stimulation. We also show reduced evidence of inflammation in the late follicular phase. This is the first study to demonstrate a difference in the response of human skeletal muscle to a necrotic stimulus across a menstrual cycle.

Hormones, Hypertrophy, and Hype: An Evidence-Guided Primer on Endogenous Endocrine Influences on Exercise-Induced Muscle Hypertrophy

We review the evidence indicating that endogenous changes in these hormones, including testosterone, growth hormone, insulin growth factor-1, and estrogen, and their proposed anabolic effects contribute to and augment resistance exercise training (RET)-induced hypertrophy. Additionally, we provide recommendations for gold-standard methodological rigor to establish best practices for verifying menstrual phases as part of their research, ultimately enhancing our understanding of the impact of ovarian hormones on RET-induced adaptations.

Restoring Skeletal Muscle Health through Exercise in Breast Cancer Patients and after Receiving Chemotherapy

Breast cancer (BC) stands out as the most commonly type of cancer diagnosed in women worldwide, and chemotherapy, a key component of treatment, exacerbates cancer-induced skeletal muscle wasting, contributing to adverse health outcomes. Notably, the impact of chemotherapy on skeletal muscle seems to surpass that of the cancer itself, with inflammation identified as a common trigger for muscle wasting in both contexts. In skeletal muscle, pro-inflammatory cytokines modulate pathways crucial for the delicate balance between protein synthesis and breakdown, as well as satellite cell activation and myonuclear accretion. Physical exercise consistently emerges as a crucial therapeutic strategy to counteract cancer and chemotherapy-induced muscle wasting, ultimately enhancing patients' quality of life. However, a "one size fits all" approach does not apply to the prescription of exercise for BC patients, with factors such as age, menopause and comorbidities influencing the response to exercise. Hence, tailored exercise regimens, considering factors such as duration, frequency, intensity, and type, are essential to maximize efficacy in mitigating muscle wasting and improving disease outcomes. Despite the well-established anti-inflammatory role of aerobic exercise, resistance exercise proves equally or more beneficial in terms of mass and strength gain, as well as enhancing quality of life. This review comprehensively explores the molecular pathways affected by distinct exercise regimens in the skeletal muscle of cancer patients during chemotherapy, providing critical insights for precise exercise implementation to prevent skeletal muscle wasting.

Menstrual cycle patterns and their relationship with measures of well-being and perceived performance metrics in competitive and recreational resistance-trained athletes

BACKGROUND

There is mixed evidence on how the menstrual cycle (MC) affects sports performance, with many studies showing variations in performance during different phases of the MC, while other evidence shows that the MC's effects on performance may be trivial. Therefore, this exploratory longitudinal monitoring study was designed to investigate MC characteristics and symptoms in a resistance-trained (RT) population to look for associations between measures of well-being and perceived performance metrics across the MC.

METHODS

RT females reported their workout habits, perceived performance metrics, and measures of well-being while tracking their MC with detailed methods via daily check-ins in an app.

RESULTS

Most MC characteristics and symptoms in the present RT population aligned with previous research on the general population. However, the frequency of irregular cycles was higher than in previous research on the general population. The amount of individual variation and within-subject cycle-to-cycle variation in MC characteristics and MC symptoms was also high. All measures of well-being were significantly associated with specific days of the MC, demonstrating a change in well-being based on the timing of the MC. Several perceived performance metrics were significantly associated with changes across the MC, while others were not.

CONCLUSIONS

Overall, with the current evidence as it stands, a highly individualized approach should be taken for any training or performance considerations surrounding the MC due to the high levels of individual variation.

Effects of the Menstrual Cycle and Hormonal Contraceptive Use on Metabolic Outcomes, Strength Performance, and Recovery: A Narrative Review

The effects of female sex hormones on optimal performance have been increasingly recognized as an important consideration in exercise and sport science research. This narrative review explores the findings of studies evaluating the effects of menstrual cycle phase in eumenorrheic women and the use of hormonal contraception (oral contraceptives and hormonal intrauterine devices) on metabolism, muscular strength, and recovery in active females. Ovarian hormones are known to influence metabolism because estrogen is a master regulator of bioenergetics. Importantly, the menstrual cycle may impact protein synthesis, impacting skeletal muscle quality and strength. Studies investigating muscular strength in eumenorrheic women report equivocal findings between the follicular phase and luteal phase with no differences compared to oral contraceptive users. Studies examining recovery measures (using biomarkers, blood lactate, and blood flow) do not report clear or consistent effects of the impact of the menstrual cycle or hormonal contraception use on recovery. Overall, the current literature may be limited by the evaluation of only one menstrual cycle and the use of group means for statistical significance. Hence, to optimize training and performance in females, regardless of hormonal contraception use, there is a need for future research to quantify the intra-individual impact of the menstrual cycle phases and hormonal contraceptive use in active females.

Sex differences in muscle-quality recovery following one week of knee joint immobilization and subsequent retraining

This manuscript represents the second phase of a clinical trial designed to examine the effects of knee joint immobilization and retraining on muscle strength and mass. In Phase 2, we examined sex differences in the recovery of multiple indices of muscle quality after a resistance training-based rehabilitation program. Following 1 week of immobilization, 27 participants (16 males, 11 females) exhibiting weakness underwent twice weekly resistance training sessions designed to re-strengthen their left knee. Unilateral retraining sessions utilizing leg press, extension, and curl exercises were conducted until participants could reproduce their pre-immobilization knee extension isometric maximal voluntary contraction (MVC) peak torque. Post-immobilization, both sexes demonstrated impaired MVC peak torque (males = -10.8%, females = -15.2%), specific torque (-9.8% vs. -13.1%), echo intensity of the vastus lateralis (+6.9% vs. +5.9%) and rectus femoris (+5.9% vs. +2.1), and extracellular water/intracellular water ratio (+7.8% vs. +9.0%). The number of retraining sessions for peak torque to return to baseline for males (median = 1, mean = 2.13) versus females (median = 2, mean = 2.91) was not significantly different, though the disparity in recovery times may be clinically relevant. Following retraining, specific torque was the only muscle-quality indicator that improved along with MVC peak torque (males = 20.1%, females = 22.4%). Our findings indicate that measures of muscle quality demonstrate divergent recovery rates following immobilization, with muscle mass lagging behind improvements in strength. Greater immobilization-induced strength loss among females suggests that sex-specific rehabilitation efforts may be justified.

Moderators of Resistance Training Effects in Healthy Young Women: A Systematic Review and Meta-analysis

ABSTRACT

Molinari, T, Radaelli, R, Rech, A, Brusco, CM, Markarian, AM, and Lopez, P. Moderators of resistance training effects in healthy young women: A systematic review and meta-analysis. J Strength Cond Res 38(4): 804-814, 2024-To systematically review and analyze the effects of resistance-based exercise programs and potential moderators of change in body fat percentage, whole-body fat and lean mass, muscle hypertrophy, muscle strength, and muscle power/rapid force in healthy young women (between 18 and 35 years). A systematic search was undertaken in 7 databases from inception to May 2022. Eligible randomized controlled trials examined the effects of resistance-based exercise programs on outcomes of interest in healthy young women. Meta-analysis was undertaken with a 3-level mixed-effects model. Associations between standardized mean difference (SMD) and potential moderators (number of sessions, weekly volume, and intensity) were tested by meta-regression models. Statistical significance was set at an α level of 0.05, whereas an α level of 0.05-0.10 was also considered for potential moderators of resistance training effects. Forty articles ( n = 1,312) were included. Resistance-based exercise programs resulted in a significant improvement of 0.4 SMD (95% confidence intervals [95% CI]: 0.2 to 0.5, p < 0.001) in lean mass/muscle hypertrophy and 1.2 SMD (95% CI: 0.9 to 1.5, p < 0.001) in muscle strength. A higher number of sessions was associated with changes in lean mass/muscle hypertrophy ( β = 0.01 ± 0.00, p = 0.009), whereas a higher weekly volume approached statistical significance to moderate changes in muscle strength ( β = 0.01 ± 0.01, p = 0.053). Body fat percentage (-0.4 SMD, 95% CI: -0.6 to -0.1, p = 0.006) and muscle power/rapid force (0.6 SMD, 95% CI: 0.2 to 1.1, p = 0.011) were significantly improved. In conclusion, a higher resistance training volume was associated with greater improvements in lean mass/muscle hypertrophy, muscle strength, and body fat percentage, whereas muscle power/rapid force improvements were observed irrespective of prescription characteristics. These findings may help in designing resistance training programs for muscle hypertrophy, strength and power, and body fat percentage in healthy women.

Perspectives on Concurrent Strength and Endurance Training in Healthy Adult Females: A Systematic Review

BACKGROUND

Both strength and endurance training are included in global exercise recommendations and are the main components of training programs for competitive sports. While an abundance of research has been published regarding concurrent strength and endurance training, only a small portion of this research has been conducted in females or has addressed their unique physiological circumstances (e.g., hormonal profiles related to menstrual cycle phase, menstrual dysfunction, and hormonal contraceptive use), which may influence training responses and adaptations.

OBJECTIVE

The aim was to complete a systematic review of the scientific literature regarding training adaptations following concurrent strength and endurance training in apparently healthy adult females.

METHODS

A systematic electronic search for articles was performed in July 2021 and again in December 2022 using PubMed and Medline. This review followed, where applicable, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the included studies was assessed using a modified Downs and Black checklist. Inclusion criteria were (1) fully published peer-reviewed publications; (2) study published in English; (3) participants were healthy normal weight or overweight females of reproductive age (mean age between > 18 and < 50) or presented as a group (n > 5) in studies including both females and males and where female results were reported separately; (4) participants were randomly assigned to intervention groups, when warranted, and the study included measures of maximal strength and endurance performance; and (5) the duration of the intervention was ≥ 8 weeks to ensure a meaningful training duration.

RESULTS

Fourteen studies met the inclusion criteria (seven combined strength training with running, four with cycling, and three with rowing or cross-country skiing). These studies indicated that concurrent strength and endurance training generally increases parameters associated with strength and endurance performance in female participants, while several other health benefits such as, e.g., improved body composition and blood lipid profile were reported in individual studies. The presence of an "interference effect" in females could not be assessed from the included studies as this was not the focus of any included research and single-mode training groups were not always included alongside concurrent training groups. Importantly, the influence of concurrent training on fast-force production was limited, while the unique circumstances affecting females were not considered/reported in most studies. Overall study quality was low to moderate.

CONCLUSION

Concurrent strength and endurance training appears to be beneficial in increasing strength and endurance capacity in females; however, multiple research paradigms must be explored to better understand the influence of concurrent training modalities in females. Future research should explore the influence of concurrent strength and endurance training on fast-force production, the possible presence of an "interference effect" in athletic populations, and the influence of unique circumstances, such as hormone profile, on training responses and adaptations.

Impact of Menstrual cycle-based Periodized training on Aerobic performance, a Clinical Trial study protocol-the IMPACT study

BACKGROUND

The menstrual cycle and its impact on training and performance are of growing interest. However, evidence is lacking whether periodized exercise based on the menstrual cycle is beneficial. The primary purpose of this proposed randomized, controlled trial, the IMPACT study, is to evaluate the effect of exercise periodization during different phases of the menstrual cycle, i.e., comparing follicular phase-based and luteal phase-based training with regular training during the menstrual cycle on physical performance in well-trained women.

METHODS

Healthy, well-trained, eumenorrheic women between 18 and 35 years (n = 120) will be recruited and first assessed for physical performance during a run-in menstrual cycle at different cycle phases and then randomized to three different interventions: follicular phase-based training, luteal phase-based training, or regular training during three menstrual cycles. The training intervention will consist of high-intensity spinning classes followed by strength training. The menstrual cycle phases will be determined by serum hormone analysis throughout the intervention period. Assessment of aerobic performance (primary outcome) and muscle strength, body composition, and blood markers will be performed at baseline and at the end of the intervention.

DISCUSSION

With a robust methodology, this study has the potential to provide evidence of the differential effects of exercise periodization during different phases of the menstrual cycle in female athletes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05697263 . Registered on 25 January 2023.

The Influence of Menstrual Cycle Phases on Maximal Strength Performance in Healthy Female Adults: A Systematic Review with Meta-Analysis

Maximal strength is a significant factor in achieving peak performance and injury prevention in athletes. In individualization strategies for the efficient development of athletes, it is necessary to consider the respective components separately. The purpose of this study was to systematically examine the effects of the different cycle phases on isometric, isokinetic, and dynamic maximum strength. A systematic literature review was conducted; databases were searched from January 1960 to September 2023. The included studies focused on the expression of maximal strength in the earlier follicular phase as well as at least one comparative phase. Of the initial 707 articles identified, 22 met the selection criteria and were included. The studies considered a total of 433 subjects. Our results revealed medium effects (weighted mean standardized mean difference (SMD) = 0.60; seven studies) for isometric maximal strength in favor of the late follicular phase, small effects (weighted mean SMD = 0.39; five studies) for isokinetic maximal strength in favor of the ovulation phase, and small effects (weighted mean SMD = 0.14; three studies) for dynamic maximal strength in favor of the late follicular phase. The results indicate that the early follicular phase is unfavorable for all strength classes. Peak performance in isometric strength is seen in the late follicular phase, whereas isokinetic strength peaks during ovulation. Dynamic strength is optimal in the late follicular phase.

Effects of a training intervention tailored to the menstrual cycle on endurance performance and hemodynamics

BACKGROUND

This study aimed to compare the effects of block periodized training and training adapted to the menstrual cycle (MC) phases on endurance performance, cardiovascular parameters, recovery, and MC-related symptoms in active females.

METHODS

Fourteen naturally menstruating, moderately trained females (age: 24±3 years; BMI: 22.3±2.7) were randomized into an intervention (INT) and a control (CON) group. Throughout an 8-week intervention period, both groups participated in a polarized training program. In the INT, the training sessions were adapted to the MC with higher training loads within the mid and late follicular phase. Before and after the intervention maximal oxygen consumption (VO2max), velocity and heart rate at ventilatory thresholds one and two (vVT1, vVT2, hrVT1, hrVT2), systolic and diastolic blood pressure (sBP, dBP), root mean square of successive RR interval differences (RMSSD), standard deviation of NN intervals (SDNN), pulse wave velocity (PWV), and the premenstrual assessment form (PAF) were assessed.

RESULTS

There were no significant time × group interaction effects in all physiological parameters (VO2max: P=0.890; vVT1: P=1.000; hrVT1: P=0.464; vVT2: P=0.356; hrVT2: P=0.762 sBP: P=0.948; dBP: P=0.203; RMSSD: P=0.257; SDNN: P=0.241; PWV: P=0.818), or psychological parameters (PAF: P=0.745).

CONCLUSIONS

Tailoring a polarized training program to the MC did not augment training responses compared to a regular training program in active females. However, a substantial portion of the training intervention in the CON was coincidentally matched to the MC.

Menstrual cycle hormones and oral contraceptives: a multimethod systems physiology-based review of their impact on key aspects of female physiology

Hormonal changes around ovulation divide the menstrual cycle (MC) into the follicular and luteal phases. In addition, oral contraceptives (OCs) have active (higher hormone) and placebo phases. Although there are some MC-based effects on various physiological outcomes, we found these differences relatively subtle and difficult to attribute to specific hormones, as estrogen and progesterone fluctuate rather than operating in a complete on/off pattern as observed in cellular or preclinical models often used to substantiate human data. A broad review reveals that the differences between the follicular and luteal phases and between OC active and placebo phases are not associated with marked differences in exercise performance and appear unlikely to influence muscular hypertrophy in response to resistance exercise training. A systematic review and meta-analysis of substrate oxidation between MC phases revealed no difference between phases in the relative carbohydrate and fat oxidation at rest and during acute aerobic exercise. Vascular differences between MC phases are also relatively small or nonexistent. Although OCs can vary in composition and androgenicity, we acknowledge that much more work remains to be done in this area; however, based on what little evidence is currently available, we do not find compelling support for the notion that OC use significantly influences exercise performance, substrate oxidation, or hypertrophy. It is important to note that the study of females requires better methodological control in many areas. Previous studies lacking such rigor have contributed to premature or incorrect conclusions regarding the effects of the MC and systemic hormones on outcomes. While we acknowledge that the evidence in certain research areas is limited, the consensus view is that the impact of the MC and OC use on various aspects of physiology is small or nonexistent.

Effects of physical training programs on female tennis players' performance: a systematic review and meta-analysis

Background: Tennis is among the world's most popular and well-studied sports. Physical training has commonly been used as an intervention among athletes. However, a comprehensive review of the literature on the effects of physical training programs on female tennis players' performance is lacking. Therefore, this systematic review and meta-analysis aimed to determine the effects of physical training on performance outcomes in female tennis players. Methods: A comprehensive search was conducted on Web of Science, PubMed, SPORTDicus, Scopus, and CNKI from inception until July 2023 to select relevant articles from the accessible literature. Only controlled trials were included if they examined the effects of physical training on at least one measure of tennis-specific performance in female tennis players. The Cochrane RoB tool was employed to assess the risk of bias. The CERT scale was used to examine the quality of program information. The GRADE approach was adopted to evaluate the overall quality of the evidence. The Comprehensive Meta-Analysis software was used for the meta-analysis. Results: Nine studies were selected for the systematic review and seven for the meta-analysis, totaling 222 individuals. The study's exercise programs lasted 6-36 weeks, with training sessions ranging from 30 to 80 min, conducted one to five times per week. Muscle power (ES = 0.72; p = 0.003), muscle strength (ES = 0.65; p = 0.002), agility (ES = 0.69; p = 0.002), serve velocity (ES = 0.72; p = 0.013), and serve accuracy (ES = 1.14; p = 0.002) demonstrated significant improvement following physical training, while no notable changes in linear sprint speed (ES = 0.63; p = 0.07) were detected. Conclusion: Although research on physical training in sports is diversified, studies on training interventions among female tennis players are scarce. This review found that existing training programs yield some favorable outcomes for female tennis players. However, further research with high methodological quality is warranted on the tailoring of specific training programs for female tennis players. There should be more consistent measuring and reporting of data to facilitate meaningful data pooling for future meta-analyses.

Effect of ovulation on postural sway in association with sex hormone variation across the menstrual cycle in college students: an observational study

Background

Poor balance associated with increased postural sway is a risk factor for the high incidence of injuries found during specific menstrual cycle phases. This fact led to the hypothesis that female reproductive hormones affect soft tissue and neuromuscular function, reducing postural balance and resulting in a high injury prevalence among female college students. So, the current study aimed to identify the influence of ovulation in association with sex hormone variation across the menstrual cycle on postural sway in college students.

Material and methods

Forty female college students were enrolled in this study. They were recruited among physical therapy students at Deraya University, New Minya, Egypt. They were aged from 17 to 22 years. They were allocated to a single group. Progesterone and estradiol blood levels were measured to detect the timing of the follicular and luteal phases, and a urine luteinizing hormone (LH) strip test was used to determine when ovulation occurred. The dynamic postural sway index was assessed by using the Biodex Balance system. All measurements were taken on the early follicular (1st–3rd) day, the ovulatory (11th–13th) day, and the mid-luteal phase (21st–23rd) day from the onset of menstruation.

Results

Statistical analysis showed that the anteroposterior, mediolateral, and overall sway index increased significantly during the ovulatory phase compared to the earlier follicular and mid-luteal menstrual cycle phases in female college students (P < 0.05). There was no significant variance between the early follicular and mid-luteal phases (P > 0.05).

Conclusions

It can be concluded that increased female sex hormones during ovulation affect postural sway, which may disturb balance and increase the risk of injuries in college students.

The effects of resistance training to near failure on strength, hypertrophy, and motor unit adaptations in previously trained adults

Limited research exists examining how resistance training to failure affects applied outcomes and single motor unit characteristics in previously trained individuals. Herein, resistance-trained adults (24 ± 3 years old, self-reported resistance training experience was 6 ± 4 years, 11 men and 8 women) were randomly assigned to either a low-repetitions-in-reserve (RIR; i.e., training near failure, n = 10) or high-RIR (i.e., not training near failure, n = 9) group. All participants implemented progressive overload during 5 weeks where low-RIR performed squat, bench press, and deadlift twice weekly and were instructed to end each training set with 0-1 RIR. high-RIR performed identical training except for being instructed to maintain 4-6 RIR after each set. During week 6, participants performed a reduced volume-load. The following were assessed prior to and following the intervention: (i) vastus lateralis (VL) muscle cross-sectional area (mCSA) at multiple sites; (ii) squat, bench press, and deadlift one-repetition maximums (1RMs); and (iii) maximal isometric knee extensor torque and VL motor unit firing rates during an 80% maximal voluntary contraction. Although RIR was lower in the low- versus high-RIR group during the intervention (p < 0.001), total training volume did not significantly differ between groups (p = 0.222). There were main effects of time for squat, bench press, and deadlift 1RMs (all p-values < 0.05), but no significant condition × time interactions existed for these or proximal/middle/distal VL mCSA data. There were significant interactions for the slope and y-intercept of the motor unit mean firing rate versus recruitment threshold relationship. Post hoc analyses indicated low-RIR group slope values decreased and y-intercept values increased after training suggesting low-RIR training increased lower-threshold motor unit firing rates. This study provides insight into how resistance training in proximity to failure affects strength, hypertrophy, and single motor unit characteristics, and may inform those who aim to program for resistance-trained individuals.

The Effect of Monophasic Oral Contraceptives on Muscle Strength and Markers of Recovery After Exercise-Induced Muscle Damage: A Systematic Review

CONTEXT

Oral contraceptives (OCs) manipulate hormonal fluctuations of the menstrual cycle and affect physical performance. Most investigations on the effect of OCs on physical performance did not discriminate between different types of OCs. Thus, the effects of monophasic OCs (MOCs) - the most common type of OCs - on muscle strength and recovery from exercise are largely unknown.

OBJECTIVE

To examine the effect of MOC use on muscle strength and markers of recovery after exercise-induced muscle damage (EIMD) in premenopausal women.

DATA SOURCES

Electronic databases Embase, PubMed, SportDiscus, and Web of Science were searched for studies examining the effect of MOCs on acute muscle strength and recovery.

STUDY SELECTION

Keywords applied for the study selection were oral contraceptive* AND muscle strength or oral contraceptive* AND muscle damage.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Lowest quality assessed for an included study in this review was serious risk of bias using ROBINS-I tool made from Cochrane for nonrandomized studies.

DATA EXTRACTION

A total of 104 studies on muscle strength were identified, of which 11 met the inclusion criteria. Concerning recovery, 51 studies were identified, of which 4 met the inclusion criteria.

RESULTS

Of the 11 studies included, 10 showed no effect of MOCs on acute muscle strength. Of the 4 studies on recovery, 2 found a greater decrease in muscle strength, and 3 found higher creatine kinase (CK) levels after EIMD in MOC users than in nonusers. The included studies were all rated with moderate-to-serious risk of bias.

CONCLUSION

These findings suggest that MOCs may impair recovery from EIMD as indicated by lowered muscle strength and elevated CK levels. There is insufficient evidence to conclude whether MOCs acutely affect muscle strength. Moderate-to-serious risk of bias in studies makes interpretation challenging.

Influence of Menstrual Cycle on Internal and External Load in Professional Women Basketball Players

The menstrual cycle can be seen as a potential determinant of performance. This study aims to analyze the influence of the menstrual cycle in women on sports performance, more specifically on the internal and external load of professional women basketball players. The sample consisted of 16 women players and 14 training sessions were recorded. A descriptive analysis of the mean and standard deviation of the variables according to the different phases of the menstrual cycle was performed, as well as an ANCOVA, partial Eta2 effect size criteria, and Bonferroni’s Post Hoc test to identify differences among phases. The results establish that ovulation is the phase in which higher values of external load are recorded and, therefore, the late follicular phase is the time of the cycle where a greater intensity in explosive distance, accelerations and decelerations are recorded. Considering women’s hormonal cycles, understanding their function and the individual characteristics of each athlete is essential since it allows for the development of specific training, the prevention of injuries and therefore positively affects the performance of women players. To this end, individual training profiles should be created in specific contexts, not following general rules. In addition, psychological factors and the specific position of the athletes should be monitored.

Understanding the female athlete: molecular mechanisms underpinning menstrual phase differences in exercise metabolism

Research should equitably reflect responses in men and women. Including women in research, however, necessitates an understanding of the ovarian hormones and menstrual phase variations in both cellular and systems physiology. This review outlines recent advances in the multiplicity of ovarian hormone molecular signaling that elucidates the mechanisms for menstrual phase variability in exercise metabolism. The prominent endogenous estrogen, 17-β-estradiol (E2), molecular structure is bioactive in stabilizing plasma membranes and quenching free radicals and both E2 and progesterone (P4) promote the expression of antioxidant enzymes attenuating exercise-induced muscle damage in the late follicular (LF) and mid-luteal (ML) phases. E2 and P4 bind nuclear hormone receptors and membrane-bound receptors to regulate gene expression directly or indirectly, which importantly includes cross-regulated expression of their own receptors. Activation of membrane-bound receptors also regulates kinases causing rapid cellular responses. Careful analysis of these signaling pathways explains menstrual phase-specific differences. Namely, E2-promoted plasma glucose uptake during exercise, via GLUT4 expression and kinases, is nullified by E2-dominant suppression of gluconeogenic gene expression in LF and ML phases, ameliorated by carbohydrate ingestion. E2 signaling maximizes fat oxidation capacity in LF and ML phases, pending low-moderate exercise intensities, restricted nutrient availability, and high E2:P4 ratios. P4 increases protein catabolism during the luteal phase by indeterminate mechanisms. Satellite cell function supported by E2-targeted gene expression is countered by P4, explaining greater muscle strengthening from follicular phase-based training. In totality, this integrative review provides causative effects, supported by meta-analyses for quantitative actuality, highlighting research opportunities and evidence-based relevance for female athletes.

The perceived knowledge of the menstruation cycle and adjustment of swimming sets by swimming coaches based on menstrual-related issues

Background

Menstruation is the recurring discharge of the endometrial lining of the uterus as menstrual blood and tissue. The menstruation cycle affects most adolescent females and, although largely overlooked, affects women participating in sports.

Objectives

The aim of this study was to determine whether coaches were aware of their swimmers' menstrual cycles and whether coaches considered this information when adjusting training sets.

Methods

Within the case study, a partial mixed-method, sequential dominant status approach was used. Data were collected in the form of questionnaires, focus group discussions, and one-on-one interviews. Coaches' awareness of their female swimmers' menstrual cycles was based more on observation than communication from the swimmer.

Results

Coaches explained that training is adjusted based on their observations, but whether this is being done correctly during the menstrual cycle requires more research. Swimmers and coaches alike seem to have minimal knowledge of menstruation, its effects on training, and how to adapt to, or overcome, those effects during training or competition.

Conclusion

In future, this knowledge could ensure the longevity of female swimmers in the sport. Understanding whether coaches and swimmers recognise the effect of the menstrual cycle within training and competition provides a more inclusive approach to ensure athlete longevity after puberty. This approach is grounded in creating an understanding between the swimmer and coach about the effect of menstruation during training and competition. It ensures an extended and more successful participation which may also assist in dealing with the 'taboo' surrounding menstruation and the female athlete.

Muscle strength gains per week are higher in the lower-body than the upper-body in resistance training experienced healthy young women-A systematic review with meta-analysis

BACKGROUND

Women are underrepresented in resistance exercise-related studies. To date only one meta-analysis provides concrete training recommendations for muscle strength gains through resistance training in eumenorrhoeic women.

OBJECTIVE

This review aims to identify research gaps to advance future study in this area to expand the knowledge concerning resistance exercise-induced strength gains in women and to provide guidelines on the number of repetitions per set and the training frequency per week to enhance maximal muscle strength.

METHODS

The electronic databases PubMed and Web of Science were searched using a comprehensive list of relevant terms. After checking for exclusion criteria, 31 studies could be included in the final analysis using data from 621 subjects. From these data sets, the ideal number of repetitions per set and also the training frequency per week were analyzed.

RESULTS

In the lower body, the largest gains were achieved with 1 to 6 repetitions (17.4% 1RM increase). For lower-body exercises, the highest gains were achieved with 13 to 20 repetitions (8.7% 1RM increase). The lower body should be trained two times a week (8.5% 1RM increase). The upper body should be trained two (5.2% 1RM increase) to three times (4.5% 1RM increase) a week.

CONCLUSION

Women can increase their 1RM by 7.2% per week in the upper body and by 5.2% per week in the lower-body exercises. The upper body can be trained more than two times per week whereas the lower body should be trained two times. Women with intermediate experiences in RT and advanced performance level show more rapid increases in strength in the lower-body compared to the upper-body while no differences were found between upper and lower limb adaptations in RT-beginner subjects.

Current evidence shows no influence of women's menstrual cycle phase on acute strength performance or adaptations to resistance exercise training

Introduction

The bias towards excluding women from exercise science research is often due to the assumption that cyclical fluctuations in reproductive hormones influence resistance exercise performance and exercise-induced adaptations.

Methods

Hence, the purpose of this umbrella review was to examine and critically evaluate the evidence from meta-analyses and systematic reviews on the influence of menstrual cycle phase on acute performance and chronic adaptations to resistance exercise training (RET).

Results

We observed highly variable findings among the published reviews on the ostensible effects of female sex hormones on relevant RET-induced outcomes, including strength, exercise performance, and hypertrophy.

Discussion

We highlight the importance of comprehensive menstrual cycle verification methods, as we noted a pattern of poor and inconsistent methodological practices in the literature. In our opinion, it is premature to conclude that short-term fluctuations in reproductive hormones appreciably influence acute exercise performance or longer-term strength or hypertrophic adaptations to RET.

Reduced Dehydroepiandrosterone-Sulfate Levels in the Mid-Luteal Subphase of the Menstrual Cycle: Implications to Women's Health Research

The regulation of DHEA-sulfate by steroid sulfotransferase (SULT) and steryl-sulfatase (STS) enzymes is a vital process for the downstream formation of many steroid hormones. DHEA-sulfate is the most abundant steroid hormone in the human body; thus, DHEA-sulfate and its hydrolyzed form, DHEA, continue to be evaluated in numerous studies, given their importance to human health. Yet, a basic question of relevance to the reproductive-age female population-whether the two steroid hormones vary across the menstrual cycle-has not been addressed. We applied a validated, multi-step protocol, involving realignment and imputation of study data to early follicular, mid-late follicular, periovulatory, and early, mid-, and late luteal subphases of the menstrual cycle, and analyzed DHEA-sulfate and DHEA serum concentrations using ultraperformance liquid chromatography tandem mass spectrometry. DHEA-sulfate levels started to decrease in the early luteal, significantly dropped in the mid-luteal, and returned to basal levels by the late luteal subphase. DHEA, however, did not vary across the menstrual cycle. The present study deep-mapped trajectories of DHEA and DHEA-sulfate across the entire menstrual cycle, demonstrating a significant decrease in DHEA-sulfate in the mid-luteal subphase. These findings are relevant to the active area of research examining associations between DHEA-sulfate levels and various disease states.

Impact of Body Mass Index on Muscle Strength, Thicknesses, and Fiber Composition in Young Women

High body mass index (BMI) may influence muscle strength, muscle thickness (Mtk), and fiber composition. We evaluated these parameters in 31 and 27 women grouped in non-oral contraceptive (non-OC) groups and OC groups, respectively, and further divided them into groups based on BMI: BMI_low, BMI_norm, and BMI_high. Maximum isometric force (F_max), Mtk, and the relative percentage of muscle fiber composition (%) were examined in both groups. F_max and Mtk values were significantly greater in the BMI_high than the BMI_low within the OC group. However, there was no significant difference in the non-OC group. BMI_low and BMI_norm groups showed a difference in the distribution of muscle fiber types 1 and 2 with almost the same proportions in both non-OC and OC groups. However, the BMI_high group showed a difference in the distribution of muscle fiber types 1 and 2, with type 1 about 18.76% higher in the non-OC group. Contrastively, type 2 was about 34.35% higher in the OC group. In this study, we found that there was a significant difference in F_max and Mtk according to the BMI level in the OC group, but no significant difference was found in the non-OC group. Moreover, the distribution of type 2 muscle fibers tended to be higher in the OC group of BMI_high, although the sample size was small. Therefore, although no significant difference of F_max and Mtk was found according to BMI level in the non-OC group in this study, the increase in BMI level appeared to be more associative of muscle strength in the OC group. Based on the present results, future studies are needed that consider the BMI level as well as the presence or absence of OC in future research about women's muscle strength.

Considerations for Sex-Cognizant Research in Exercise Biology and Medicine

As the fields of kinesiology, exercise science, and human movement developed, the majority of the research focused on male physiology and extrapolated findings to females. In the medical sphere, basing practice on data developed in only males resulted in the removal of drugs from the market in the late 1990s due to severe side effects (some life-threatening) in females that were not observed in males. In response to substantial evidence demonstrating exercise-induced health benefits, exercise is often promoted as a key modality in disease prevention, management, and rehabilitation. However, much like the early days of drug development, a historical literature knowledge base of predominantly male studies may leave the exercise field vulnerable to overlooking potentially key biological differences in males and females that may be important to consider in prescribing exercise (e.g., how exercise responses may differ between sexes and whether there are optimal approaches to consider for females that differ from conventional approaches that are based on male physiology). Thus, this review will discuss anatomical, physiological, and skeletal muscle molecular differences that may contribute to sex differences in exercise responses, as well as clinical considerations based on this knowledge in athletic and general populations over the continuum of age. Finally, this review summarizes the current gaps in knowledge, highlights the areas ripe for future research, and considerations for sex-cognizant research in exercise fields.

Effects of oral contraceptive use on muscle strength, muscle thickness, and fiber size and composition in young women undergoing 12 weeks of strength training: a cohort study

BACKGROUND

It is suspected that hormonal fluctuations during menstruation may cause different responses to strength training in women who use oral contraceptives (OC) versus those who do not. However, previous studies that investigated the existence of such differences produced conflicting results. In this study, we hypothesized that OC use has no effect on muscle strength and hypertrophy among women undergoing strength training. Thus, we compared the differences in muscle strength and thickness among women who used OCs and those who did not.

METHODS

We investigated the influence of OC use on muscle strength (Fmax), muscle thickness (Mtk), type 1-to-type 2 muscle fiber (NO) ratio, muscle fiber thickness (MFT), and nuclear-to-fiber (N/F) ratio. Seventy-four healthy young women (including 34 who used OCs and 40 who did not) underwent 12 weeks of submaximal strength training, after which Fmax was evaluated using a leg-press machine with a combined force and load cell, while Mtk was measured using real-time ultrasonography. Moreover, the NO ratio, MFT, and N/F ratio were evaluated using muscle needle biopsies.

RESULTS

Participants in the non-OC and OC groups experienced increases in Fmax (+ 23.30 ± 10.82 kg and + 28.02 ± 11.50 kg respectively, p = 0.073), Mtk (+ 0.48 ± 0.47 cm2 and + 0.50 ± 0.44 cm2 respectively, p = 0.888), Fmax/Mtk (+ 2.78 ± 1.93 kg/cm2 and + 3.32 ± 2.37 kg/cm2 respectively, p = 0.285), NO ratio (type 2 fibers: + 1.86 ± 6.49% and - 4.17 ± 9.48% respectively, p = 0.169), MFT (type 2 fibers: + 7.15 ± 7.50 µm and + 4.07 ± 9.30 µm respectively, p = 0.435), and N/F ratio (+ 0.61 ± 1.02 and + 0.15 ± 0.97 respectively, p = 0.866) after training. There were no significant differences between the non-OC and OC groups in any of these parameters (p > 0.05).

CONCLUSIONS

The effects of 12 weeks of strength training on Fmax, muscle thickness, muscle fiber size, and composition were similar in young women irrespective of their OC use.

Effects of Follicular and Luteal Phase-Based Menstrual Cycle Resistance Training on Muscle Strength and Mass

There is an increasing interest in female athletic performance-especially concerning the impact of the female menstrual cycle on training response. Indeed, fluctuations in female sex hormones, estrogen and progesterone, during the menstrual cycle regulate protein metabolism and recovery processes in skeletal muscle and may thus impact exercise training-related outcomes. Studies demonstrate that anaerobic capacity and muscle strength are greatest during the follicular phase of the menstrual cycle, when estrogen levels peak. In addition, studies indicate that resistance training conducted in the follicular phase of the menstrual cycle (follicular phase-based resistance training) may be superior to luteal phase-based training in terms of enhancing muscle strength and mass. This raises the possibility that the physiological capabilities of skeletal muscle to adapt to exercise training are dependent on the menstrual cycle and can be important for female athletes in optimizing their training. In this paper, we critically review the current state of the art concerning the impact of menstrual cycle phase-based resistance training and highlight why follicular phase-based resistance training possibly is superior to luteal phase-based training in enhancing resistance training outcomes. Finally, we identify directions for further research.

The Dose-Effects of Caffeine on Lower Body Maximal Strength, Muscular Endurance, and Rating of Perceived Exertion in Strength-Trained Females

Caffeine supplementation has shown to be an effective ergogenic aid enhancing athletic performance, although limited research within female populations exists. Therefore, the aim of the investigation was to assess the effect of pre-exercise caffeine supplementation on strength performance and muscular endurance in strength-trained females. In a double-blind, randomised, counterbalanced design, fourteen strength-trained females using hormonal contraception consumed either 3 or 6 mg·kg-1 BM of caffeine or placebo (PLA). Following supplementation, participants performed a one-repetition maximum (1RM) leg press and repetitions to failure (RF) at 60% of their 1RM. During the RF test, rating of perceived exertion (RPE) was recorded every five repetitions and total volume (TV) lifted was calculated. Repeated measures ANOVA revealed that RF (p = 0.010) and TV (p = 0.012) attained significance, with pairwise comparisons indicating a significant difference between 3 mg·kg-1 BM and placebo for RF (p = 0.014), with an effect size of 0.56, and for 6 mg·kg-1 BM (p = 0.036) compared to the placebo, with an effect size of 0.65. No further significance was observed for 1RM or for RPE, and no difference was observed between caffeine trials. Although no impact on lower body muscular strength was observed, doses of 3 and 6 mg·kg-1 BM of caffeine improved lower body muscular endurance in resistance-trained females, which may have a practical application for enhancing resistance training stimuli and improving competitive performance.

Modelling menstrual cycle length in athletes using state-space models

The ability to predict an individual's menstrual cycle length to a high degree of precision could help female athletes to track their period and tailor their training and nutrition correspondingly. Such individualisation is possible and necessary, given the known inter-individual variation in cycle length. To achieve this, a hybrid predictive model was built using data on 16,524 cycles collected from a sample of 2125 women (mean age 34.38 years, range 18.00-47.10, number of menstrual cycles ranging from 4 to 53). A mixed-effect state-space model was fitted to capture the within-subject temporal correlation, incorporating a Bayesian approach for process forecasting to predict the duration (in days) of the next menstrual cycle. The modelling procedure was split into three steps (1) a time trend component using a random walk with an overdispersion parameter, (2) an autocorrelation component using an autoregressive moving-average model, and (3) a linear predictor to account for covariates (e.g. injury, stomach cramps, training intensity). The inclusion of an overdispersion parameter suggested that [Formula: see text] [Formula: see text] of cycles in the sample were overdispersed. The random walk standard deviation for a non-overdispersed cycle is [Formula: see text] [1.00, 1.09] days while under an overdispersed cycle, the menstrual cycle variance increase in 4.78 [4.57, 5.00] days. To assess the performance and prediction accuracy of the model, each woman's last observation was used as test data. The root mean square error (RMSE), concordance correlation coefficient and Pearson correlation coefficient (r) between the observed and predicted values were calculated. The model had an RMSE of 1.6412 days, a precision of 0.7361 and overall accuracy of 0.9871. In conclusion, the hybrid model presented here is a helpful approach for predicting menstrual cycle length, which in turn can be used to support female athlete wellness.

Physiological Characteristics of Female Soccer Players and Health and Performance Considerations: A Narrative Review

Female soccer has seen a substantial rise in participation, as well as increased financial support from governing bodies over the last decade. Thus, there is an onus on researchers and medical departments to develop a better understanding of the physical characteristics and demands, and the health and performance needs of female soccer players. In this review, we discuss the current research, as well as the knowledge gaps, of six major topics: physical demands, talent identification, body composition, injury risk and prevention, health and nutrition. Data on female talent identification are scarce, and future studies need to elucidate the influence of relative age and maturation selection across age groups. Regarding the physical demands, more research is needed on the pattern of high-intensity sprinting during matches and the contribution of soccer-specific movements. Injuries are not uncommon in female soccer players, but targeting intrinsically modifiable factors with injury prevention programmes can reduce injury rates. The anthropometric and physical characteristics of female players are heterogeneous and setting specific targets should be discouraged in youth and sub-elite players. Menstrual cycle phase may influence performance and injury risk; however, there are few studies in soccer players. Nutrition plays a critical role in health and performance and ensuring adequate energy intake remains a priority. Despite recent progress, there is considerably less research in female than male soccer players. Many gaps in our understanding of how best to develop and manage the health and performance of female soccer players remain.

Menstrual variation in the acute testosterone and cortisol response to laboratory stressors correlate with baseline testosterone fluctuations at a within- and between-person level

Studies have compared HPA and HPG stress reactivity across the follicular and luteal phases to assess the menstrual impact of estradiol and progesterone fluctuations. Ovulatory shifts in baseline and stressor-induced testosterone among athletic women offer a new framework to explore these responses. Here we investigated menstrual variation in baseline testosterone as a predictor of the acute testosterone and cortisol response to laboratory stressors in female athletes. Using a semi-randomized crossover design, thirty athletic women completed a physical (4 × 6-s bike sprints) and psychological (5 × 2-min cognitive tests with social evaluation) stressor on day seven (D7), 14 (D14), and 21 (D21) of a menstrual cycle. Baseline fluctuations and acute changes in salivary testosterone and cortisol were measured. The D14 testosterone response to both stressors (13.7%) exceeded D7 (7.3%) and D21 (7.0%), whereas cortisol was less responsive on D14 (9.8%) than D7 (13.0%) and D21 (12.0%); all moderate to large effect size differences (p < 0.01). Baseline testosterone, which presented large individual and menstrual variation with a D14 peak, was significantly related (moderate correlations) to testosterone and cortisol stress reactivity on a between-person level. Both outcomes were related (weak correlations) to within-person fluctuations in baseline testosterone, but these effects were mediated by testing day. In conclusion, menstrual variation in baseline testosterone concentration correlated with testosterone and cortisol reactivity to a physical and psychological stressor. Thus, gradients of stressor-induced hormonal change showed some dependency to endogenous testosterone, both individual differences and fluctuations over time, among naturally cycling athletic women.Lay summaryThe female menstrual cycle is accompanied by dramatic shifts in estradiol and progesterone concentration, but less is known about testosterone variability and its role in stress regulation. In this study, menstrual fluctuations in baseline testosterone concentration correlated with acute testosterone and cortisol reactivity to laboratory stressors.

The Specificities of Elite Female Athletes: A Multidisciplinary Approach

Female athletes have garnered considerable attention in the last few years as more and more women participate in sports events. However, despite the well-known repercussions of female sex hormones, few studies have investigated the specificities of elite female athletes. In this review, we present the current but still limited data on how normal menstrual phases, altered menstrual phases, and hormonal contraception affect both physical and cognitive performances in these elite athletes. To examine the implicated mechanisms, as well as the potential performances and health risks in this population, we then take a broader multidisciplinary approach and report on the causal/reciprocal relationships between hormonal status and mental and physical health in young (18-40 years) healthy females, both trained and untrained. We thus cover the research on both physiological and psychological variables, as well as on the Athlete Biological Passport used for anti-doping purposes. We consider the fairly frequent discrepancies and summarize the current knowledge in this new field of interest. Last, we conclude with some practical guidelines for eliciting improvements in physical and cognitive performance while minimizing the health risks for female athletes.

The Effects of Menstrual Cycle Phase on Elite Athlete Performance: A Critical and Systematic Review

Background: In elite athletes, training individualization is widely recommended to optimize competitive performance. Previous studies have evidenced the impact of hormonal fluctuations on different performance parameters among female athletes. While consideration of menstrual cycle (MC) phases as a parameter in training individualization strategies is necessary, systematic evidence identifying such impacts in elite athletes should be evaluated. Objective: Systematically review publications that have investigated the link between MC phases and performance in elite female athletes. The overarching aim is to identify whether a consensus across studies exists enabling evidence-based recommendations for training individualization depending on menstrual cycle phases. Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three major scientific publication databases were searched from inception until November 3, 2020. Studies included focused on the influence of physiological or psychological parameters throughout at least one phase of the menstrual cycle of elite athletes. Results: A total of 780 search results were yielded and 26 references from a past bibliography were added manually. About 662 papers were reviewed of which 218 studies were assessed for eligibility. Of these, only seven (1%) precisely investigated the influence of a performance or physical parameter during at least one menstrual cycle phase. These seven studies included a total of 314 elite female participants (20.58 ± 1.91 years). Three used interviews, questionnaires or prospective analyses of reports. Four conducted several performance tests or included physical measures although only two performed tests during training or before/during competition. Among the seven studies, five performed hormonal testing through sampling of blood, saliva, or urine. The remaining relied on athletes' menstruation diaries. The current evidence suggests a variable association between menstrual cycle and a few performance-related outcomes, such as endurance or power resistance, ligament stiffness, decision making skills, psychology, or competitiveness. Conclusion: Different sports performance-related parameters are affected during the menstrual cycle among elite athletes, but the parameters themselves and the magnitude and the direction of the effects are inconclusive. Additional longitudinal and prospective studies to systematically monitor on-field performance parameters are urgently required in order to enable recommendations and training individualization in female elite athletes.

Body Composition Over the Menstrual and Oral Contraceptive Cycle in Trained Females

Purpose: The influence of female sex hormones on body fluid regulation and metabolism homeostasis has been widely studied. However, it remains unclear whether hormone fluctuations throughout the menstrual cycle (MC) and with oral contraceptive (OC) use affect body composition (BC). Thus, the aim of this study was to investigate BC over the MC and OC cycle in well-trained females. Methods: A total of 52 eumenorrheic and 33 monophasic OC-taking well-trained females participated in this study. Several BC variables were measured through bioelectrical impedance analysis 3 times in the eumenorrheic group (early follicular phase, late follicular phase, and midluteal phase) and on 2 occasions in the OC group (withdrawal phase and active pill phase). Results: Mixed linear model tests reported no significant differences in the BC variables (body weight, body mass index, basal metabolism, fat mass, fat-free mass, and total body water) between the MC phases or between the OC phases (P > .05 for all comparisons). Trivial and small effect sizes were found for all BC variables when comparing the MC phases in eumenorrheic females, as well as for the OC cycle phases. Conclusions: According to the results, sex hormone fluctuations throughout the menstrual and OC cycle do not influence BC variables measured by bioelectrical impedance in well-trained females. Therefore, it seems that bioimpedance analysis can be conducted at any moment of the cycle, both for eumenorrheic women and women using OC.

The Female Menstrual Cycles Effect on Strength and Power Parameters in High-Level Female Team Athletes

Purpose

The female menstrual cycle (MC) is characterized by hormonal fluctuations throughout its different phases. However, research regarding its effect on athletic performance in high level athletes is sparse. The aim of this study was to (i) investigate the female MCs effect on strength and power performance in highly trained female team athletes throughout the MC and (ii) examine whether eumenorrheic participants with natural hormonal fluctuations displayed enhanced performance in the follicular phase (FP) versus the luteal phase (LP), compared to controls using hormonal contraceptives.

Materials and Methods

A total of 29 athletes (Age 21.2 ± 3.3 years; weight 65.6 ± 8.7 kg; height 170.2 ± 8.0 cm; and fat free mass 52.7 ± 7.1) completed the study after a 6-week testing period (8 eumenorrheic participants and 21 hormonal contraceptive controls). Participants were recruited from the team sports soccer, handball and volleyball. Testing protocol consisted of maximal voluntary isometric grip strength, 20-m sprint, countermovement jump and pneumatic leg-press. Based on self-reported use of hormonal contraceptives, participants were divided into non-hormonal contraceptive group and hormonal contraceptive group, the latter working as a control group. Differences in performance between the FP and LP were investigated. MC phase was confirmed by serum hormonal levels through venous blood samples in the non-hormonal contraceptive group.

Results

There were no statistically significant changes for the two different phases of the MC, in terms of physical performance for the whole group. Further, there was no significant difference between groups during the MC for any of the outcome variables, maximal voluntary isometric grip strength F(3.29) = 0.362; 20-m sprint F(3.24) = 0.710; countermovement jump F(3.26) = 2.361; and leg-press F(3.26) = 1.746.

Conclusion

In high level female team athletes, no difference in performance was observed based on hormonal contraceptive status. This suggests that the MC does not alter acute strength and power performance on a group level in high level team athletes.

Links Between Testosterone, Oestrogen, and the Growth Hormone/Insulin-Like Growth Factor Axis and Resistance Exercise Muscle Adaptations

Maintenance of skeletal muscle mass throughout the life course is key for the regulation of health, with physical activity a critical component of this, in part, due to its influence upon key hormones such as testosterone, estrogen, growth hormone (GH), and insulin-like growth factor (IGF). Despite the importance of these hormones for the regulation of skeletal muscle mass in response to different types of exercise, their interaction with the processes controlling muscle mass remain unclear. This review presents evidence on the importance of these hormones in the regulation of skeletal muscle mass and their responses, and involvement in muscle adaptation to resistance exercise. Highlighting the key role testosterone plays as a primary anabolic hormone in muscle adaptation following exercise training, through its interaction with anabolic signaling pathways and other hormones via the androgen receptor (AR), this review also describes the potential importance of fluctuations in other hormones such as GH and IGF-1 in concert with dietary amino acid availability; and the role of estrogen, under the influence of the menstrual cycle and menopause, being especially important in adaptive exercise responses in women. Finally, the downstream mechanisms by which these hormones impact regulation of muscle protein turnover (synthesis and breakdown), and thus muscle mass are discussed. Advances in our understanding of hormones that impact protein turnover throughout life offers great relevance, not just for athletes, but also for the general and clinical populations alike.

A 10-Week Block of Combined High-Intensity Endurance and Strength Training Produced Similar Changes in Dynamic Strength, Body Composition, and Serum Hormones in Women and Men

Purpose: To examine the potential sex differences in adaptations to combined endurance and strength training in recreationally endurance trained (eumenorrheic) women (n = 9) and men (n = 10).

Methods: Isometric (ISOM_max) and dynamic bilateral leg press (1RM), countermovement jump (CMJ), running performance (3,000 m time trial), lean mass and body fat % (LEAN and FAT% determined by dual X-ray absorptiometry) as well as serum testosterone and cortisol (TES and COR, respectively, measured using hormone-specific immunoassay kits) were examined before a control period and pre, mid, and post a supervised 10-week combined high-intensity interval endurance training (4 × 4 min intervals and 3 × 3 × 100 m repeated sprints) and mixed maximal and explosive strength training. No more than 2 weeks separated training and testing for either women or men and all women were tested in the early follicular phase of the menstrual cycle to minimize the possible influence of menstrual cycle phase on performance measures.

Results: Absolute and relative changes in 1RM, CMJ, 3,000 m, LEAN, and FAT% were similar between groups. The only statistically significant differences observed between groups were observed at post and included a larger Δ% increase in ISOM_max force in men and a relatively greater Δ% decrease in serum TES in women.

Conclusion: Women and men can achieve similar relative adaptations in dynamic maximal strength and CMJ as well as endurance performance gains and body composition over the same high-intensity 10-week combined program, although relative adaptations in TES may differ.

Sex Differences in Lower Limb Proprioception and Mechanical Function Among Healthy Adults

Twenty-four healthy adults, including 12 females and 12 males, participated in the study. Each female participant completed three trials in three different phases of one menstrual cycle, which included follicular, ovulatory, and luteal phases. The study aimed to investigate whether there is any difference in joint kinetic sense, neuromuscular coordination, and isokinetic muscle strength (a) between healthy males and females at different phases of the menstrual cycle and (b) between females at different phases of the menstrual cycle. The outcome measures included the number of jumps in the square-hop test and ankle and knee proprioception, which were assessed by an electric-driven movable frame rotated at 0.4 deg/s and isokinetic muscle strength measured by a computerized dynamometer (Biodex). For the square-hop test (p = .006), ankle dorsiflexion/plantar flexion (p < .05), knee flexion/extension (p < .05), the relative peak torque of the isokinetic muscle strength at the 60° and 180° knee flexion/extension (p < .001), and the 30° and 120° ankle plantar flexion/dorsiflexion (p < .05) between females and males showed significant differences. For the females at different phases of the menstrual cycle, significant differences were found on ankle dorsiflexion (p = .003), plantar flexion (p = .023), knee extension (p = .029), the square-hop test (p = .036), and relative peak torque of isokinetic muscle strength at 180° knee flexion (p = .029). This study demonstrated that there are sex differences in lower limb proprioception and mechanical function. Females at ovulatory and luteal phases have better lower limb proprioception than at the follicular phase.

Understanding the effects of the menstrual cycle on training and performance in elite athletes: A preliminary study

Success at an Olympic level can come down to the smallest of margins. However little research has been conducted into how the menstrual cycle affects elite athletes' performance and decision making. This study uses a combination of quantitative and qualitative research methods to explore this question. Physiological performance data was collected from eight elite athletes for 7 months and analyzed as a function of menstrual phase. The Cambridge Gambling Task (CGT) was used to test decision making and testing occurred twice in one cycle, during the early follicular phase and during the mid-luteal phase. Menstrual cycle phase was determined using menstrual cycle mapping and urine ovulation tests. In the qualitative part of this project, two elite athletes, two Olympic level athletes, and two coaches participated in semi-structured interviews. The study found that physiological performance was significantly better during the menses phase (MP) compared to the proliferative and secretory phases (PSP). There was variation in how elite athletes were individually affected however. Oral contraceptive users showed a greater performance change from MP to PSP suggesting that oral contraceptives may be detrimental to performance in some athletes. The results of the CGT showed that impulsivity is significantly affected by menstrual cycle phase. Risk taking, error rates and response times were not affected. The qualitative interviews revealed that elite athletes and their coaches understand little of the menstrual cycle. Despite this, there are preconceptions that it negatively effects performance during the menses phase. The findings suggest that the menstrual cycle can have a significant effect on an elite athlete's performance and this paper discusses how individuals can possibly improve aspects of physiological and psychological performance by understanding and monitoring their menstrual patterns.

Influence of Second Generation Oral Contraceptive Use on Adaptations to Resistance Training in Young Untrained Women

Dalgaard, LB, Jørgensen, EB, Oxfeldt, M, Dalgaard, EB, Johansen, FT, Karlsson, M, Ringgaard, S, and Hansen, M. Influence of second generation oral contraceptive use on adaptations to resistance training in young untrained women. J Strength Cond Res XX(X): 000-000, 2020-The study purpose was to determine effects of using second generation oral contraceptives (OC) on muscle adaptations to resistance training in young untrained women. Twenty users and 18 nonusers of OC completed a 10-week supervised progressive resistance training program. Before and after the intervention, muscle cross-sectional area (mCSA) of the quadriceps was measured using magnetic resonance imaging and muscle fiber CSA (fCSA) was determined by immunohistochemistry. In addition, body composition (DXA, fat mass/fat-free mass), maximal isometric muscle strength (dynamometry), 5 repetition maximum (5RM) leg press strength, counter movement jump (CMJ) height, and average power using a modified Wingate test were determined. Serum hormone analysis ensured OC compliance and 4-day food records documented dietary intake. After the training period, quadriceps mCSA (OC: 11.0 ± 6.0% vs. non-OC: 9.2 ± 5.0%, p = 0.001), type II fCSA (OC: 19.9 ± 7.9% vs. non-OC: 16.6 ± 7.2%, p = 0.05), muscle strength (knee extension, knee flexion and 5RM, p < 0.001), and functional power (CMJ, AP, p < 0.001) were significantly increased with no significant difference between the groups. However, a tendency toward a greater increase in fat-free mass (FFM) in the OC group was observed (OC: 3.7 ± 3.8% vs. non-OC: 2.7 ± 3.5%, p = 0.08). Collectively, use of second generation OCs in young untrained women did not significantly improve adaptations to 10 weeks of resistance training compared with nonusers. The trend toward greater gains in FFM in the OC group warrant future studies.

Resistance Training and Skeletal Muscle Protein Metabolism in Eumenorrheic Females: Implications for Researchers and Practitioners

Resistance training is essential for health and performance and confers many benefits such as increasing skeletal muscle mass, increasing strength and power output, and improving metabolic health. Resistance training is a major component of the physical activity guidelines, yet research in female populations is limited. Recent increases in the promotion of, and the participation by, females in sport and exercise, highlight the need for an increase in understanding of evidence-based best practice exercise prescription for females. The aim of this review is to provide an overview of the current research regarding resistance training performance and skeletal muscle adaptation in females, with a focus on the hormonal variables that may influence resistance training outcomes. Findings suggest that the menstrual cycle phase may impact strength, but not skeletal muscle protein metabolism. In comparison, oral contraception use in females may reduce skeletal muscle protein synthesis, but not strength outcomes, when compared to non-users. Future research should investigate the role of resistance training in the maintenance of skeletal muscle protein metabolism during pregnancy, menopause and in athletes experiencing relative energy deficiency in sport. The review concludes with recommendations for researchers to assist them in the inclusion of female participants in resistance training research specifically, with commentary on the most appropriate methods of controlling for, or understanding the implications of, hormonal fluctuations. For practitioners, the current evidence suggests possible resistance training practices that could optimise performance outcomes in females, although further research is warranted.