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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 prof.cdecree@earthlink.net. Background. First World Championships: Males: Tokyo, 1956

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

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  1. 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 prof.cdecree@earthlink.net 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

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

  3. Dedicated to the women who started it all … 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

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

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

  6. Meanwhile … • Important case study information 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

  7. Ulla Werbrouck vs. Heidi Rakels ?The Prize: -72 kg Olympics 1992 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

  8. Rakels’ Statistics • 5’10 (1.78m) • Lbs. 169.5 (77 kg) • Generally dropped 5kg  -72 kg • Challenge: Olympics -66kg ! 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

  9. The Method • Strict diet • Strict training regime • Severely intense training regime • Careful definition & monitoring using hydrostatic weighing • Dietary supplements • Mental strength: tunnel vision 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

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

  11. The Result – Part 2 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

  12. The Results – Part 3 • Weight increase (low metabolism) • Emotional breakdown • Wrist fracture • Stress fractures • ACL • Bone & muscle integrity  5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

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

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

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

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

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

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

  19. 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

  20. What is happening ? 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

  21. The ‘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 ð 20 ng/mL) 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

  22. The ‘normal’ menstrual cycle 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

  23. 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

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

  25. Normal Muscle • Requires normal hormones: • estrogens, testosterone, growth hormone, insu-lin, protein and … testosterone/cortisol ratio • Requires normal diet, rest, recovery 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

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

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

  28. Awareness of Risks • Overtraining • Eating disorders • Stress fractures • Musculotendinous injuries, • Myoglobinuria & rhabdomyolysis • Emotional instability • Temporary subfertility 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

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

  30. References Baeyens 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. 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007

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