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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 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
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
Dedicated to the women who started it all … 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007
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
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
Meanwhile … • Important case study information 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007
Ulla Werbrouck vs. Heidi Rakels ?The Prize: -72 kg Olympics 1992 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007
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
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
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
The Result – Part 2 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007
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
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
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
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
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
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
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
5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007
What is happening ? 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007
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
The ‘normal’ menstrual cycle 5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007
5th IJF World Judo Research Symposium, Rio de Janeiro, 12 September 2007
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
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
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
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
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
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
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