Consequences of Cutting Weight on Indices of Bone Metabolic Health in Elite Female Judoists

5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

1

Consequences of Cutting Weight on Indices of Bone Metabolic

Health in Elite Female Judoists

Consequences of Cutting Weight on Indices of Bone Metabolic

Health in Elite Female Judoists

Dr. Carl De Crée, MD, PhD,Professor of Exercise Science, Sports Medicine,

& Reproductive Endocrinology

[email protected]


2

Background

First World Championships: Males: Tokyo, 1956

No weight classes Females: New York, 1980

Weight classes

First Olympics for Female Judo: Barcelona, 1980

Weight classes

Consequence: Change in behavior: weight cutting


3

Dedicated to the women who started it all …


4

First Studies on Judo & Bone Health

De Crée, et al., 1991: case of osteporosis in young female judoist

Kayal, et al., 1993: benefits of oral contraceptives (OC) for female judoists

Baeyens, 1994: reduce injury rate in OC takers


5

First Prospective Study Bone/Judo De Crée, et al., 1995 5-Week trial (1992) Heavy training Eucaloric Results:

Reduced estrogen levels Increased 3-MH, OHProl,

UA, MG, CPK, LDH, GOT


6

Meanwhile … Important case study information


7

Ulla Werbrouck vs. Heidi Rakels ?The Prize: -72 kg Olympics 1992


8

Rakels’ Statistics

5’10 (1.78m) Lbs. 169.5 (77 kg)

Generally dropped 5kg -72 kg

Challenge: Olympics -66kg !


9

The Method

Strict diet Strict training regime Severely intense training regime Careful definition & monitoring using

hydrostatic weighing Dietary supplements Mental strength: tunnel vision


10

The Result – Part 1

In 6 weeks: -11 kg Initially some dehydration Heart Rate: down to 29 bts/min Loss of fat + gain LBM Top condition No injuries! Most important: -66kg + Olympic Ticket !


11

The Result – Part 2


12

The Results – Part 3

Weight increase (low metabolism) Emotional breakdown Wrist fracture Stress fractures ACL Bone & muscle integrity


13

Decided to Expand Earlier Study Purpose: Further identify effects of weight cycling on

bone health Methods:

5-Wk program: aerobic, anaerobic, resistance, & judo Expanded subject group to 27 women 17-29 years old (+ age-matched controls) <72 kg (no heavy-weights ref. old classes) No OC’s, Anthropometric, cardiovascular, blood- & urinalysis


14

Methods (detailed): Anthropometry:

body mass, %IBW, body fat (5 skin folds), LBM Cardiorespiratory:

ECG-monitored incremental load test (cycle ergometer); VO2max (online gas analyzer) Hormone analysis:

follicular (FPh [day 7-10]) & luteal phase (LPh [day 23-25]) plasma estrone (E1), estra-diol (E2), progesterone (P4), LH, prolactin (Prl), & β-endorphin (β-End) by RIA

Blood biochemistry: lactate (Lct), uric acid (UA), crea-tine phophokinase (CPK), glutamic oxalacetic transa-minase (GOT), lactic

dehydrogenase (LDH), myoglo-bin (MG), and interleukin-1 (IL-1) Urinalysis:

24-hour collections for hydroxyproline to creatinine ratio (OH-Prol/Crt) [≈ bone breakdown], 3-methylhistidine [≈ muscle breakdown]

Experimental design: Training: five weeks of heavy aerobic, anaerobic, and resistance training as part of Olympic preparations; per day: 2-

h weight training + 2-h competitive randori + 2-h judo-technical drills + ≥ either 6-km run, 8 × 200 m or 16 × 100 m interval sprint (80% intensity)

Acute exercise test (submaximal & maximal): 50 W/4-min increments, followed by 1-min relative rest after 4 min at 150 W to allow submax (±60% VO2max) blood collection, followed by 50 W/min intensity increments till volitional exhaustion

Diet: Lactovegetarian diet 2 days pre- & post-urine collection


15

Statistical Analysis Descriptive data:

Student’s two-tailed t-test; Responses to:

acute exercise via one-way ANOVA; pre- vs. post-training by two-way REANOVA (group × time); mean differences by post-hoc comparison u-sing least squares

(Δ serial blood sampling, inter-actions sampling & exercise times);

Pearson’s correlation between hormonal, biochemical & descriptive characteristics;

A priori set α= 0.05


16

Results: Increased (P<0.05) muscle breakdown (3-MH, 3-

MH/body mass, 3-MH·103/Crt Increases in both bone breakdown and build-up Sharp decreases in Luteal Phase estrogens (P<0.01) In women with most significant estrogen decreases,

bone breakdown outweighs bone build Significant increase in injuries strongly correlated to

estrogen decreases and extent of weight loss


17

Development of Bone Injuries in Female Judoists

X-Ray: Typical bone-deminaralization

effect seen after estrogen depletion in pre-menopausal women. Note decreased cortical thickness, and less opaque density


18

Discussion: Appreciation of Results

Athlete’s view: Accidental judo injuries

Coach’s view: Accidental judo injuries

Federation’s view: Accidental judo injuries

Science’s view: Dead wrong !


19


20

What is happening ?


21

The ‘normal’ menstrual cycleThe ‘normal’ menstrual cycle

+/- 28 days Normal LH/FSH pulsatility Normal plasma estrogen levels

Luteal phase: 100-300 pg/mL Peak: 200-600 pg/mL

Ovulation Normal corpus luteum development Normal P4 levels (LPh: 0.5 20 ng/mL)


22

The ‘normal’ menstrual cycleThe ‘normal’ menstrual cycle


23


24

Normal BoneNormal Bone

Calcium, Phosphorus, Hydroxyapatites Ca++: 1,200-1,400 mg in skeleton 5-7% of bone recycled/week Spongy bone replaced every 3-4 years

Requires: Normal estrogens, normal diet, normal caloric intake, normal rest


25

Normal Muscle

Requires normal hormones: estrogens, testosterone, growth hormone, insu-lin,

protein and … testosterone/cortisol ratio

Requires normal diet, rest, recovery


26

Summary

Consequences of High-Intensity Judo in Females: Female judoists are characterized by same

menstrual problems as certain other sports Evidence of high muscle catabolism & bone turnover Training prevalence of menstrual irregularities,

muscle catabolism & collagen turnover


27

Recent Literature Findings: Green, et al., 2007:

Sharp increase in judo injuries in women if weightloss >5%

Prouteau, et al., 2005: Increased C-terminal telopeptide of type-I collagen

(CTX) (P<0.0001)


28

Awareness of Risks

Overtraining Eating disorders Stress fractures Musculotendinous injuries, Myoglobinuria & rhabdomyolysis Emotional instability Temporary subfertility


29

Does this make judo unhealthy ?

No Necessity of proper knowledge & understanding

Coach’s role: Awareness of risks & athlete’s condition … Accountability Refer to specialists in time Common sense Diet (calcium-rich) Normal menstrual cycle; if not, contraceptive pill ?


30

ReferencesBaeyens L.: [Gynecological problems in young athletes] in French. Rév. Med. Brux. 15, 4: 184-187, 1994.Blumsohn K.E., Naylor K.E., Assiri A.M., Eastell R.: Different responses of biochemical markers of bone resorption to bisphosphon-ate therapy in Page disease. Clin.

Chem. 41, 11: 1592-1598, 1995.Callister R., Callister R.J., Fleck S.J.: Physiological and performance responses to overtraining in elite judo athletes. Med. Sci. Sports Exerc. 22, 6:816-824, 1990.De Crée C.: Effects of acute weight-cycling versus long-term practice of judo in male and female judo athletes ? Letter to the Editor. Med. Sci. Sports Exerc. 39, 1:

208, 2007.Nader S.: Female judoists: their hormones, muscles, and bones. Lancet 347: 919-920, 1996.De Crée C., Lewin R., Barros R.: Hypoestrogenemia and rhabdomyolysis in the female judoist: A new worrying phenomenon. J. Clin. Endocrinol. Metab. 80, 12:

3639-3646, 1995. De Crée C., Vermeulen A., Ostyn M.: Are high-performance young women athletes doomed to become low-performance old wives ? A reconsideration of the

increased risk of osteoporosis in amenorrheic women athletes. J. Sports Med. Phys. Fitn. 31: 108-115, 1991.Degoutte F., Jouanel P., Bègue R.J., Colombier M., Lac G., Pequignot J.M., Filaire E.: Food restriction, performance, biochemical, psychological, and endocrine

changes in judo athletes. Int J Sports Med. 27, 1: 9-18, 2006.Filaire E., Maso F., Degoutte F., Jouanel P., Lac G.: Food restriction, performance, psychological state and lipid values in judo athletes. Int. J. Sports Med. 22, 6:

454-459, 2001.Green C.M., Petrou M.J., Fogarty-Hover M.L., Rolf C.G.: Injuries among judokas during competition. Scand. J. Med. Sci. Sports. 17(3): 205-210, 2007.Imamura H., Yoshimura Y., Nishimura S., Nakazawa A.T., Teshima K., Nishimura C., Miyamoto N.: Physiological responses during and following karate training in

women. J. Sports Med. Phys. Fitness. 42, 4: 431-437, 2002. Kanō J.: Jūdō Kyōhon Jōkan. Tōkyō: Shushiki Kaisha, 1931, pp. 1-127.Kayal D., L’Hermite Balériaux M., Baeyens L.: Advantages of hormonal contraception for the athlete. Annual Reunion of the FGWO for Sports Medicine & Sports

Sciences, Charleroi, June 19, 1993 (Abstract).Nader S.: Female judoists: their hormones, muscles and bones. Lancet 347, 9006: 919-920, 1996.Prouteau S., Benhamou L., Courteix D.: Relationships between serum leptin and bone markers during stable weight, weight reduction and weight regain in male and

female judoists. Eur. J. Endocrinol. 154, 3: 389-395, 2006.Prouteau S., Pelle A., Collomp K., Benhamou L., Courteix D.: Bone density in elite judoists and effects of weight cycling on bone metabolic balance. Med. Sci. Sports

Exerc. 38, 4: 694-700, 2006. Pulkkinen W.J.: Rapid weightloss and overtraining ―Concerns for judo performance. In: The sport science of elite judo athletes. A review & application for training.

Guelph, Ontario (Canada): Pulkinetics, Inc., 2001, pp. 35-51.Umeda T., Nakaji S., Shimoyama T., Yamamoto Y., Totsuka M., Sugawara K.: Adverse effects of energy restriction on myogenic enzymes in judoists. J. Sports Sci.

22, 4: 329-338, 2004.Umeda T., Nakaji S., Yamamoto Y., Tanabe M., Kojima A., Mochida N., Yoshioka Y., Katagiri T., Sugawara K.: [Effects of gender-related weight reduction on the

physical condition of male and female college judoists]. Nippon Eiseigaku Zasshi. 59, 3: 326-334, 2004.Waslen P.E., McCargar L.J., Taunton J.E.: Weight cycling in competitive judokas. Clin. J. Sports Med. 3, 4: 235-241, 1993.Yoshioka Y., Umeda T., Nakaji S., Kojima A., Tanabe M., Mochida N., Sugawara K.: Gender differences in the psychological response to weight reduction in judoists.

Int. J. Sport Nutr. Exerc. Metab. 16, 2: 187-198, 2006.

Consequences of Cutting Weight on Indices of Bone Metabolic Health in Elite Female Judoists

Documents

Transcript of Consequences of Cutting Weight on Indices of Bone Metabolic Health in Elite Female Judoists