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Specific Populations: Female Athletes

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Textbook of Sports and Exercise Cardiology

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Abstract

Females participating in athletic activities have gained an enormous popularity in recent years. Female athletes are a different species and cannot be compared with their male counterparts. Female athletes differ from their male counterparts in several aspects, such as in anthropometry, in the hormonal system, in basic physiology and in psychology. Female athletes have a smaller heart muscle mass, skeletal muscle mass and a lower endurance capacity. Moreover, the peak oxygen uptake in females is lower too. In addition, female athletes have a lower number of circulating androgens, and the female hormonal cycle influences the athletic performance. While electrical and morphological cardiac adaptation to exercise in male athletes is often associated with increasing vagotonia, dilatation of the four cardiac cavities and hypertrophy of the ventricular walls, the cardiac adaptation in female athletes is far less pronounced. Furthermore, sudden cardiac death (SCD) among female athletes is less frequently observed: the SCD-male-to-female ratio is approximately 9:1. In contrast to these clinically relevant gender differences, a surprisingly low number of studies in sports cardiology have been performed in female athletes. Thus, this chapter describes the sports cardiology issues relevant to female athletes, e.g. physiologic cardiac adaptation, screening for eligibility to participate in exercise, and exercise during pregnancy are discussed.

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Author information

Authors and Affiliations

  1. MVZ DaVita CardioCentrum Düsseldorf, Düsseldorf, Germany

    Susanne Berrisch-Rahmel

  2. Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Meibergdreef, Amsterdam, Germany

    Nicole M. Panhuyzen-Goedkoop

  3. Department of Sports Cardiology, Sports Medical Centre Papendal, Arnhem, The Netherlands

    Nicole M. Panhuyzen-Goedkoop

Authors
  1. Susanne Berrisch-Rahmel
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  2. Nicole M. Panhuyzen-Goedkoop
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Corresponding author

Correspondence to Susanne Berrisch-Rahmel .

Editor information

Editors and Affiliations

  1. Private Center for Sports and Exercise Cardiology, München, Bayern, Germany

    Axel Pressler

  2. University Institute of Sports Medicine Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

Review

Review

1.1 Questions

  1. 1.

    A 24-year-old elite female volleyball player visits your out-patient sports cardiology clinic. Since two weeks she suffers from near-syncope during training sessions. The family history for SCA and inherited cardiovascular conditions is negative. Her physical examination is normal. The ECG demonstrates a sinus rhythm, no electrical axis deviation, PR-interval 210 ms, QRS duration 90 ms, QTc-interval 490 ms. No voltage criteria of ventricular hypertrophy.

    1. (a)

      What is your differential diagnosis?

    2. (b)

      Do you require additional cardiac evaluation? If yes, which? If no, why not?

    3. (c)

      What is your management, including recommendations for sports continuation?

  2. 2.

    A 28-year-old elite female middle distance runner visits you for a sport examination. She is looking to get pregnant. She is afraid having to stop training and undertaking competitions.

    1. (a)

      What is your recommendation?

    2. (b)

      Do you have any practical advice? If yes, which?

    3. (c)

      What is your management plan for the postpartum training?

  3. 3.

    Four months later the same 28-year-old elite female middle distance runner is pregnant and comes to a visit. She tolerates the training with higher exercise intensities (85–90% VO2peak) well but is exercising no longer than 45 min.

    1. (a)

      Which symptoms should prompt immediate termination of exercise, regardless of prior well being?

    2. (b)

      Which other sports are not recommended?

1.2 Answers

  1. 1.

    (a) The symptoms may indicate Torsades-de-Pointes in Long QT syndrome. Think of a high estrogen level prolonging the QTc-interval in females. (b) Additional evaluation is required here because of an exercise-related near-syncope: analysis of the QTC interval during with exercise stress testing and rhythm assessment by Holter monitoring; echocardiography to exclude structural causes of near-syncope. (c) In case Long QT syndrome is demonstrated, restrictions apply to this patient as outlined in Chap. 20 on channelopathies.

  2. 2.

    (a) Pregnant women who habitually engage in vigorous intensity aerobic activity or are highly active can continue this activity during pregnancy. It is not advisable to engage in marathons because of the increase of the body core temperature. Regular observation of maternal and fetal well-being is necessary.

    (b) Sufficient food intake and sufficient hydration is recommended before training to prevent hypoglycemia. A sufficient intake of calories is important to prevent weight loss, which can affect the growth of the fetus. In extremely warm weather conditions with high/humid ambient temperature and humidity, the training duration should be reduced.

    (c) Light physical activities are possible within a few days after delivery if there were no complications. Performance training can be started again 4 weeks after birth. Improved fitness parameters and a higher level of performance can be observed after birth.

  3. 3.

    (a) Warning signs to stop exercise are vaginal bleeding, amniotic fluid leakage, decreased fetal movement, contractions more frequent than every 6 min, chest pain, irregular heartbeat, shortness of breath, dizziness, syncope, calf pain, calf swelling.

    (b) It is not advisable to engage in sports with a risk of overstraining or even injuring the fetus:

    • contact sports such as ice hockey, football or basketball, martial arts, boxing;

    • Sports with increased risk of falling (mountain biking, inline skating, skating, horse riding, surfing, water skiing, trampoline jumping);

    • Extreme sports like bungee jumping, parachuting, paragliding, etc.;

    • Diving below 30 m (danger of decompression sickness for the fetus);

    • Hot Yoga and Hot Pilates

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Berrisch-Rahmel, S., Panhuyzen-Goedkoop, N.M. (2020). Specific Populations: Female Athletes. In: Pressler, A., Niebauer, J. (eds) Textbook of Sports and Exercise Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-35374-2_24

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  • DOI: https://doi.org/10.1007/978-3-030-35374-2_24

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