Understanding Obesity, Osteoarthritis, Arthritis, and Women’s Health in Exercise

Posted on Dec 2, 2024 in Physical Education

Obesity

Definition

Obesity is a chronic metabolic disease characterized by excessive body fat accumulation and weight gain.

Causes

• Diet
• Inactivity
• Environmental factors (e.g., TV ads)
• Leptin gene alteration
• Positive energy imbalance (caloric intake exceeding consumption)
• Hormonal imbalance (e.g., thyroxine, growth hormone, norepinephrine, adrenaline, sex hormones)
• Biological determinants (e.g., race, gender, age, pregnancy)
• Metabolic and genetic factors
• Smoking
• Nutrition (lack of exercise converting carbohydrates to triglycerides)
• Socioeconomic factors
• Psychological factors (e.g., low self-esteem)

Causes of Maintenance

• Impaired insulin function (reduced sensitivity, decreased growth hormone, increased cholesterol synthesis)

Diagnosis

• BMI
• Waist-hip ratio

Consequences

• Osteoarthritis
• Hypertension
• Sleep apnea
• Heart disease
• Cardiac arrest
• Type II diabetes

Treatment

• Calorie reduction (minimum 1000 kcal)
• Appetite suppressants (short-term, often ineffective)
• Surgery (extreme solution with potential complications)
• Exercise (maintains weight but doesn’t significantly reduce it)

ACSM Recommendations

• Maintaining a 3% weight loss is beneficial; 5% is considered significant.
• Active individuals gain less weight.
• Recommended calorie limits for weight loss programs: 500-1500 kcal/day (less than 1000 kcal is not recommended).
• Exercise helps maintain weight loss: 80 min/day of moderate to vigorous physical activity or 150 min/week (equivalent to 1200-2000 kcal or 19 km).
• For greater effect: 250-300 min/week (approximately 2000 kcal/week).

Osteoarthritis

Definition

Osteoarthritis is a degenerative joint disease beginning at birth, involving cartilage breakdown. As it progresses, joint stability decreases, and bone growth attempts to compensate, but can damage other tissues.

Causes

• Age
• Excessive or repetitive mechanical stress
• Inflammatory or metabolic conditions (e.g., obesity, diabetes)
• Genetic factors
• Female gender

Symptoms

• Pain (becomes continuous as the disease progresses)
• Stiffness and joint deformities

Treatment

• Symptom management (pain relief)
• Pharmacological: Infiltration (for bone damage) and anti-inflammatories (potential stomach issues)
• Exercise (reduces pain, prevents muscle weakness, and maintains mobility; avoid overloading and tailor programs)

Motion Cycle

Disuse leads to atrophy, weakness, instability, fragility, injury, and pain.

Exercise Program

• Warm-up: 10-20 painless joint movements, gentle stretching, cardio (RPE 7)
• Cardio: 60-80% max heart rate (RPE 11-16), swimming (avoid breaststroke kick), daily
• Proprioception work
• Flexibility: Static stretches, hold for 10-90 seconds

Considerations

• Correct posture
• Slow movements, no bouncing
• Pain-free intensity
• Proper breathing to prevent Valsalva maneuver

Arthritis

Definition

Arthritis is joint inflammation, a defense mechanism of joint tissues against various aggressions.

Causes

• Injuries
• Infections
• Metabolic disorders

Types

• Acute: Abrupt onset, short duration, disappears without a trace
• Chronic: Slow onset, long duration, often leaves sequelae
• Osteoarthritis
• Rheumatoid arthritis
• Gout

Rheumatoid Arthritis

The immune system mistakenly attacks the body’s own tissues, causing uncontrolled inflammation and tissue damage.

Manifestations

• Begins in small joints of fingers, hands, and wrists
• Swelling, tenderness, redness, difficulty moving
• Small lumps under the skin
• Muscle pain
• Loss of appetite and weight, anemia
• Depression
• Increased susceptibility to infection

Stages

1. Inflammation of the synovial membrane
2. Cell growth thickens the membrane, forming abnormal tissue
3. Inflammatory cells release enzymes that damage bone and cartilage

Treatment

• Anti-inflammatories
• Pain relievers

Women and Exercise

Neuromuscular Response

• Women generally have less absolute strength than men.
• Women’s upper body strength is less than men’s in both absolute and relative terms, but leg strength relative to body weight is similar.
• Strength gains with training can be equal between sexes.

Cardiovascular Response

• Maximal heart rate is the same.
• Women have smaller hearts.
• Women’s maximal oxygen uptake (VO2 max) is about 50% lower in absolute terms.

Respiratory Response

• Lungs are often the limiting factor.
• Smaller airway diameter increases airflow resistance.

Metabolic Response

• Lower blood lactate concentration after maximal exercise.
• During moderate-intensity, long-duration exercise, women utilize less carbohydrates and protein, and more fat.

Hormonal Response

• Resting testosterone levels are 10 times lower.
• Ovarian steroids have little effect on triglyceride mobilization.
• Estrogen accelerates bone closure (early development).
• 12% body fat is required to maintain the reproductive cycle.

Exercise Prescription

• Women’s adaptation to endurance exercise is lower, but aerobic exercise is still beneficial.
• Strength training increases muscle mass and reduces fat mass.
• Flexibility training enhances this quality.

Physiological Changes During Pregnancy

Cardiovascular

• Increased peripheral oxygen demand
• 40% increase in cardiac output
• Decreased peripheral resistance due to vasodilation
• Venous return increases more than oxygen consumption, so more oxygenated blood returns to the heart.

Hematology

• Plasma volume increases by 30-60%, causing physiological anemia of pregnancy.
• Increased vein capacity
• Increased red blood cell count and volume

Respiratory

• Increased minute ventilation at rest
• Increased CO2 removal and pH, leading to increased bicarbonate excretion by the kidneys
• Increased chemoreceptor sensitivity to CO2

Renal and Urinary Tract

• Dilation of ureters and renal pelvis
• Renal plasma flow increases in the first trimester, then decreases
• Increased glomerular filtration rate
• Activation of the renin-angiotensin system (without causing hypertension)

Gastrointestinal

• Changes in appetite
• Nausea and vomiting
• Predisposition to cavities
• Enlarged uterus displaces the stomach and can cause constipation

Metabolic

• Increased basal and lipid metabolism

Risks of Exercise During Pregnancy

Severe Hypoglycemia

• Can occur during acute, intense exercise
• The fetus can adapt to use lactate as an energy source

Chronic Fatigue

• Basal heart rate is approximately 15 bpm higher
• Vigorous exercise during the third trimester can cause overtraining-like symptoms

Musculoskeletal Injury

• Body mass increases by 15-30% on average, affecting posture (lumbar lordosis)
• Increased ligament elasticity, decreased motor skills

Risks of Exercise on the Fetus

Acute Hypoxia

• Can occur during aerobic exercise due to blood flow redistribution from the uterus to the muscles
• Fetal heart rate is typically 120-160 bpm; response varies depending on maternal fitness level

Acute Hyperthermia

• Fetal temperature is 0.5°C higher than maternal temperature
• Exercise in extreme heat (+40°C) is not advisable
• Pregnant women have thermoregulatory mechanisms to protect the fetus
• Reduced glucose availability due to muscle utilization of carbohydrates

Gestational Diabetes

• Insulin resistance develops in the second half of pregnancy
• Can lead to malnutrition, low birth weight, or organ/tissue growth abnormalities in the fetus
• Risk of miscarriage in the first trimester, preterm delivery, or low birth weight
• Exercise generally does not cause changes unless it’s inappropriate for the mother’s physical condition, performed in extreme heat, or involves impacts

Physiological Mechanisms Protecting the Fetus

• Placental blood flow
• Increased maternal hematocrit and oxygen-carrying capacity
• Changes in the hemoglobin dissociation curve

Benefits of Exercise for Pregnant Women

• Improved VO2 max
• Reduced insulin resistance
• Lower heart rate and higher stroke volume
• Reduced back pain
• 50-75% reduction in gestational diabetes risk
• Psychological benefits
• Reduced weight gain
• Easier delivery

Benefits of Exercise for the Fetus

• More active children with better motor skills
• Leaner children with better intelligence levels

Exercise Recommendations During Pregnancy

• 3-5 times per week
• Pregnancy is not the time to start a new exercise program; gradual introduction benefits both mother and fetus
• Use RPE to monitor intensity; heart rate is not a reliable indicator
• Avoid competitions
• Avoid quick changes in direction and anaerobic activities
• Avoid supine exercises in the first trimester and monitor abdominal exercises

Recommended Activities

• Birth preparation
• Walking, cycling, swimming, running
• Weight training
• Pilates

Activities Not Recommended

• Scuba diving
• Boxing, wrestling
• High-altitude exercise
• Soccer, skiing, horseback riding, climbing, gymnastics, skating

Exercise Prescription During Pregnancy Based on Fitness Level

Osteoarthritis

Definition

Osteoarthritis is a degenerative joint disease where enzymes break down cartilage. It has a genetic component and is linked to obesity. Bone-on-bone contact occurs (hip and knee).

Osteoporosis

Definition

Osteoporosis is a skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to increased fracture risk.

Causes

• Female gender
• Higher body weight
• Older age
• Genetic factors (e.g., Black ethnicity)
• Endocrine factors (e.g., testosterone and estrogen levels)
• Calcium and vitamin D deficiency
• Smoking, alcohol, glucocorticoid use
• Rheumatoid arthritis
• Prolonged amenorrhea
• Hormone therapy for breast or prostate cancer

Symptoms

• Hip or spinal fractures
• Dowager’s hump
• Loss of height
• Bone pain or tenderness, neck pain

Treatment

Objectives

• Pain management
• Slowing or stopping bone loss
• Fracture prevention
• Minimizing fall risk

Pharmacological

• Parathyroid hormone and vitamin D
• Bisphosphonates
• Calcitonin
• Estrogen

Non-Pharmacological

• Physical activity: Start slowly, progress to moderate and then high intensity. Aerobic activity is beneficial.
• Fall prevention

ACSM Recommendations: Exercise in Postmenopausal Women

• Brisk walking, jogging, stair climbing, rowing, strength training, jumping
• Recent walking
• Activities with high mechanical loads have a more positive effect on the musculoskeletal system

ACSM Recommendations: Exercise in Premenopausal Women

• Strength training: 2-3 sets of 6-10 repetitions at 80% of 1RM, 3 days/week

ACSM Recommendations: Exercise in Women with Osteoporosis

• Strength training: 3 sets of 5-8 repetitions using body weight, 2-3 days/week
• Avoid impact exercises, spinal flexion, compressive forces, and rotational exercises