Written by Megan Dame, Accredited Exercise Physiologist

What is the Menstrual Cycle? 

The menstrual cycle plays a pivotal role in preparing a Woman’s body for pregnancy (Better Health). If a Woman is not pregnant the uterus sheds its lining from signals sent from the uterus and marks her period (Better Health).

A menstrual cycle is measured from the first day of your period until the first day of your next period (Better Health). The menstrual cycle on average length is 28-29 days (Better Health).

Four Phases of Menstrual Cycle

 There are four main phases of the menstrual cycle (Better Health):

1. Menstruation: This is referred to commonly as a period, where the uterus lining sheds and flows out of your vagina as blood, some cells, and mucus. A period on average last three to seven days.
2. The follicular phase: This is the part of a woman’s menstrual cycle when the egg matures in her ovaries (Better Health). It occurs on the first day of your period and goes for 13-14 days (Better Health).
3. Ovulation: The matured egg is released by the ovary and travels along the fallopian tube to the uterus (Better Health). It occurs two weeks before the Woman’s next period and last for 16-32 hours (Better Health).
4. The Luteal phase: This is when cells in the ovary release the hormones progesterone and estrogen, which increase the thickness of the lining in the uterus to prepare for pregnancy. If a fertalised egg is implanted in the lining of the uterus progestogen is continued to be produced to sustain the thickness of the lining, and if pregnancy does not occur progesterone production drops and the uterus will shed causing her period to start again.

                                                                                               (Aunt Flow)

Effect of Menstrual Cycle on your Exercise

The hormones in our body play a pivotal role in many bodily functions, they are the body’s form of chemical messengers that send signals into the bloodstream and tissues. Research has found that female hormone levels of estrogen and progesterone can have an impact on the following (Exercise Right):

• Muscle development
• Utilisation of energy
• Fat gain and loss
• Thermoregulation
• Energy expenditure

Why Train in Sync with your Menstrual Cycle

Learning how to train in sync with your Menstrual cycle could help (Exercise Right):

• Manage stress
• Increase your immunity
• Improve performance
• Leave you with a sense of feeling stronger
• Reduce fatigue
• Manage symptoms of Premenstrual Syndrome (PMS)
• Increase sustained energy.

What is Cycle Syncing?

Cycle syncing involves choosing a type of exercise that pairs with one of the four phases of a Women’s menstrual cycle (Exercise Right).

During each phase the hormone levels change which can affect energy levels. Cycle Syncing guides you on how to modify your exercise routine in accordance with these changes in hormone levels, to gain maximum benefits from your routine (Exercise Right).

How to Cycle Sync with Exercise

During the four stages of a Women’s Menstrual Cycle, different modes of exercise are recommended (Exercise Right):

1. The Menstrual Phase: Optimal time to engage in light movements like yoga, walking or light strength training as a drop in hormone levels can cause you to feel low in energy during this phase.
2. The Follicular Phase: Optimal time to make progress in your training performing

High-intensity training (HIIT) and sprinting. During this phase, the body is found to have higher pain tolerance, increased endurance levels, and the increased ability of the body to use carbohydrates as fuel.

3. The Ovulation Phase: Optimal time to perform light resistance training. A phase where the body has a greater chance of being prone to injury and strength levels are high.
4. The Luteal Phase: Optimal time to perform active recovery (mobility and stretching) and deloading (reduce the intensity of training for a short period) strength training. This phase results in the body relying on fat as a greater fuel source, body temperature can increase, and retain greater amounts of water which can reduce energy levels.

 (Vecteezy)

Ultimately, what you chose to do is up to you and how your body feels. An Accredited Exercise Physiologist can help you tailor an exercise program taking these phases into consideration to suit you best.

How Do you Track a Menstrual Cycle?

 One alternative to tracking your Menstrual Cycle and working out what phase you are entering is through apps. Below are some suggestions of apps that can track your Menstrual Cycle:

• Clue
• Flo
• Ovia Fertility

Keep in mind that the length of periods and menstrual cycle can vary not only from person to person, but also from cycle to cycle, and using an app is providing an estimate but not a perfect prediction. A Woman’s Menstrual cycle can be affected by things like physical and emotional stress and changes in routine.

]]> https://strongandstable.com.au/prostate-cancer-exercise/ Thu, 11 May 2023 03:21:32 +0000 https://strongandstable.com.au/?p=17919

Written by Curtis Allderidge, Accredited Exercise Physiologist

What is Prostate Cancer?

The prostate is a male sex gland located at the base of the bladder (size of a walnut) and its primary function is to produce seminal fluid. Prostate cancer (PCa) happens when an abnormal growth of the cells in the prostate gland develops (malignant tumour) which is driven by the hormone testosterone. PCa is the second most common cancer diagnosis in men (first is lung cancer) and the fifth leading cause of death worldwide.¹

What Are the Signs and Symptoms of Prostate Cancer?

• Frequent urge to urinate, trouble urinating or pain during urination.
• Blood in urine or semen.
• Unexplained pain in lower back, upper thighs, or hips.
• Unexpected weight loss.

How is Prostate Cancer Diagnosed?

The average age of PCa diagnosis is 66 years old.² Most PCa are detected via elevated levels of Prostate-Specific Antigen (PSA). If PSA levels are greater than 4 ng/mL a biopsy will be performed and PCa will be suspected, but not all men with elevated PSA levels have PCa, some mean may have benign prostatic hyperplasia (enlarged prostate) or prostatitis (infection or inflammation of the prostate). If a diagnosis of prostate cancer is confirmed, PSA levels will continued to be monitored during and after treatment to check the effectiveness of the treatment.

Other forms of diagnosis include:

• Digital rectal exam: a doctor is able to feel the size of the prostate and check for any abnormalities.
• MRI (Magnetic Resonance Imaging): can assess the prostate size and identify any abnormalities as well as where the tumour might be located within the prostate.
• Biopsy: a small surgical procedure where a needle is used to remove multiple small samples of tissue from the prostate gland. The samples are sent to a lab for examination to confirm the presence of cancer.

Prostate Cancer Risk Factors

• Non-modifiable (cannot be changed):
  • Age (after the age of 50 years, the odds of developing PCa rapidly increase).
  • Family History (having father or brother with PCa doubles risk).
  • Ethnicity (African American men have the highest incidence of prostate cancer worldwide and are more likely to develop the disease earlier in life).
• Modifiable (can be changed):
  • Obesity (increases insulin resistance and inflammation).
  • Diet (increased consumption of animal fat and alcohol, and lower intake of fruits and vegetables).
  • Physical activity (increased levels of physical inactivity and sedentary behaviour increase cancer risk).
  • Environment (exposure to chemicals and carcinogens).

What Treatments Are Available for Prostate Cancer?

Active surveillance: is a strategy that involves monitoring your prostate cancer closely and choosing to undergo treatment if it advances. It’s an option for men who have *low-risk* prostate cancer.

Radiation therapy:

• External beam radiotherapy: High energy X-ray beams are directed at the prostate, with treatment often performed 5 days per week for 4-8 weeks.
• Internal beam radiotherapy: radioactive material is inserted directly into the prostate which releases concentrated amounts of radiation.
• Side effects:

• • Fatigue / Tiredness*
  • Rectal Bleeding
  • Tenderness
  • Erectile Dysfunction
  • Incontience
  • Insomnia
  • Weight Loss
  • Urinary toxicity

Surgery: Removing the prostate (radical proctectomy) is used to eliminate the cancer when it is confined to the prostate.

Hormone Therapy: Androgen deprivation therapy (ADT) is considered of the cancer has spread beyond the prostate (aggressive form) and is generally in the form of tablets or injections. Its goal is to reduce the amount of circulating testosterone in the body to slow the growth of the cancer.

• Side effects:
  • Fatigue / Tiredness*
  • Muscle and strength loss
  • Body fat gain
  • Lower Bone Mineral Density (BMD)
  • Depression
  • Hormonal Toxicity
  • Erectile Dysfunction
  • Gynaecomastia

Chemotherapy: kills cancer cells throughout the body, including those outside the prostate, so it is used to treat more advanced cancer and cancer that did not respond to hormone therapy. Treatment is usually intravenous and is given in cycles lasting 3-6 months.

• Side effects:
  • Fatigue / Tiredness*
  • Hair Loss
  • Nausea
  • Mouth Sores
  • Peripheral Neuropathy
  • Cardiotoxicity
  • Cognitive Impairment (Chemo Brain)
  • Muscle and Joint Pain

(Picture reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301662/)

How Can Exercise Help?

Unfortunately, cancer treatments come with a vast range of side effects but exercise can thankfully counteract the majority of them! The good news is, prostate cancer patients who commit to an exercise program display lower PSA levels, delay the initiation of ADT by 2 years, experience greater quality of life, less fatigue, and have a lower risk of developing cardiovascular diseases.²

There is evidence that exercise is essentially “medicine” for those on ADT. It addresses several adverse effects such as muscle loss, strength, fatigue, declining physical function, bone loss, and depression/anxiety.³ Recent studies have concluded that exercise is actually more effective at improving Cancer Related Fatigue (CRF) than pharmacological interventions.⁴

Exercise during chemotherapy and radiotherapy can combat fatigue, cardiotoxicity, muscle weakness, improve body composition, balance, muscle strength, and significantly reduced urinary toxicity (specific radiotherapy treatment side effect).⁵

How Can an Exercise Physiologist Help?

Exercise Physiology has an essential role in recovery during and post cancer treatment. Not only do Exercise Physiologists provide you with exercise, they can also provide you with education and fatigue management strategies.

Exercise Physiologists will provide an individualised exercise program – that means that each exercise program is different and tailored to a person’s needs and goals. There is not a “one program fits all” for all prostate cancer patients. Each person is undergoing different treatments, will respond differently to exercise, and experiences their own unique side effects from the cancer treatments.

Exercise Guidelines

Progressive Resistance Training:

• 2 days per week
• 8-10 exercise (targeting major muscle groups, especially muscles around the hip and spine)
• 2-3 sets of 8-10 repetitions at a relatively high intensity (70%+ of 1RM)

Weight-Bearing Impact Exercises (i.e., jumping, bounding, hopping, skipping):

• 4 days per week
• 2-4 impact exercises, progressing from a total of 50-100 jumps per session
• Progressive resistance training is recommended before beginning weight-bearing impact exercises

Aerobic Exercises:

• 5-7 days per week
• 30 minutes of continuous training such as cycling, walking, rowing.
• Aerobic training can be broken into 10 minutes blocks spread throughout the day.

Other Things to Consider:

• Pelvic floor Assessment
• Mental health supports
• Dietician
• Support groups

Websites for further information regarding Prostate Cancer:

1. https://www.pcfa.org.au/#
2. https://www.cancer.org.au/cancer-information/types-of-cancer/prostate-cancer
3. https://www.astrazeneca.com/our-therapy-areas/oncology/prostate-cancer.html
4. https://australianprostatecancer.org.au/about-prostate-cancer/

References

1. Rawla P. Epidemiology of Prostate Cancer. World J Oncol. 2019 Apr;10(2):63-89. doi: 10.14740/wjon1191. Epub 2019 Apr 20. PMID: 31068988; PMCID: PMC6497009.
2. Keogh JW, MacLeod RD. Body composition, physical fitness, functional performance, quality of life, and fatigue benefits of exercise for prostate cancer patients: a systematic review. J Pain Symptom Manage. 2012 Jan;43(1):96-110. doi: 10.1016/j.jpainsymman.2011.03.006. Epub 2011 Jun 2. PMID: 21640547.
3. Edmunds K, Tuffaha H, Scuffham P, Galvão DA, Newton RU. The role of exercise in the management of adverse effects of androgen deprivation therapy for prostate cancer: a rapid review. Support Care Cancer. 2020 Dec;28(12):5661-5671. doi: 10.1007/s00520-020-05637-0. Epub 2020 Jul 22. PMID: 32699997.
4. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncol. 2017 Jul 1;3(7):961-968. doi: 10.1001/jamaoncol.2016.6914. PMID: 28253393; PMCID: PMC5557289.
5. Lin KY, Cheng HC, Yen CJ, Hung CH, Huang YT, Yang HL, Cheng WT, Tsai KL. Effects of Exercise in Patients Undergoing Chemotherapy for Head and Neck Cancer: A Pilot Randomized Controlled Trial. Int J Environ Res Public Health. 2021 Feb 1;18(3):1291. doi: 10.3390/ijerph18031291. PMID: 33535507; PMCID: PMC7908197.
6. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE, Ligibel JA, Gerber LH, Morris GS, Patel AV, Hue TF, Perna FM, Schmitz KH. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019 Nov;51(11):2375-2390. doi: 10.1249/MSS.0000000000002116. PM

Written by Megan Dame (Accredited Exercise Physiologist)

What is Polycystic Ovary Syndrome?

Polycystic ovary syndrome (also known as PCOS) is a hormonal condition that affects 18-13% of women or people with uterus of reproductive age (Jean Hailes).

To be diagnosed with PCOS two of the following three criteria must be meet:

• Anovulation: Refers to when ovulation is skipped and an egg is not released from the ovary during the menstrual cycle, causing irregular or absent periods.
• Hyperandrogenism: An excess number of androgens (sex hormones) in the body. It can cause acne, increased body hair, and decreased breast size.
• Polycystic ovaries: Diagnosed with an ultrasound a condition involving enlarge ovaries with small cysts on the edges.

Unfortunately, 70-80% of women and people with uterus with PCOS have fertility issues

(Health Direct)

Cause of PCOS

PCOS’s exact cause is unknown, however, there appears to be an influence from the following factors (Jean Hailes):

• Family history: Women and people with uterus with PCOS are 50% more likely to have an immediate relative with PCOS
• Hormonal imbalance: An imbalance of insulin (a hormone that controls blood sugar levels) and androgens (male-type hormones, like testosterone) can cause PCOS symptoms
• Insulin resistance: 85% of Women and people with uterus with PCOS are diagnosed with insulin resistance, which is when the cells in your body don’t respond to the hormone insulin as well and cannot take up blood sugar from the body as well.
• Weight: PCOS can occur in all body types, although women with PCOS are at risk of being overweight or obese as they produce too much insulin or the insulin they produce does not work as it should causing weight gain or greater difficulty losing weight.

                                            Factors that contribute to PCOS (Jean Hailes)

Common Signs Symptoms  

Signs and Symptoms of PCOS can vary and present with different severity in women (Jean Hailes). Some symptoms of PCOS include (Jean Hailes):

• No period or irregular periods
• Excess hair growth on the face or body
• Mood changes
• Sleep apnoea (a sleeping disorder with abnormal breathing rate)

Exercises Benefits on Managing PCOS

Exercise can play a pivotal role in improving several signs and symptoms of PCOS (Exercise Right). The following benefits of engaging in exercise with PCOS include (Exercise Right):

• Stabilising mood, improving fertility, and reducing insulin resistance

This is best achieved by engaging in Cardiovascular Exercise such as walking, jogging, or swimming. As cardiovascular exercise can release the feel-good hormones endorphins improving mood, it can help balance hormones which can improve fertility, and increase sensitivity to insulin reducing a women’s resistance to the hormone.

• Improves body composition, increases metabolic rate, and reduces insulin resistance

Strength Exercises like squats and push-ups best achieve this. As strength training can increase muscle mass and reduce fat tissue, by also increasing lean muscle mass it increases your resting metabolic rate and insulin sensitivity.

• Decreasing waist circumference and increasing cardiorespiratory fitness

A high-intensity interval training (HIIT) program of alternating between a short bout of high to low intensity work can achieve this. Research has found interval training can reduce waist circumference more than going for a continuous brisk walk, which can reduce PCOS symptoms like reducing testosterone levels. PCOS women are two times more likely to have a cardiovascular event (like a stroke or heart attack) and engaging in HIIT can reduce your blood pressure reducing your risk of a cardiovascular event.

Exercise Role in Improving Insulin Sensitivity

One of the key factors that contributes to the development of PCOS is thought to be insulin resistance (Jean Hailes). This occurs when the body doesn’t respond to insulin, a hormone responsible for keeping blood sugar (glucose) levels in a normal range (Jean Hailes).

When a woman’s body has high levels of insulin, it can increase the production of male like hormones such as testosterone (Jean Hailes). This can impact ovarian function, including ovulation, which is why managing insulin resistance is important part of treating PCOS (Jean Hailes).

Exercise is a natural therapy that can help reduce insulin resistance and therefore manage PCOS. In fact, the positive effects of exercise on insulin resistance can happen almost immediately when you start exercising and can last for up to 48 hours (Exercise Right). Exercise can stimulate muscles to take up blood glucose and use it as fuel reducing glucose concentration whether or not insulin is present (Exercise Right). Exercise also increases insulin sensitivity, making it easier for muscle cells to use any available insulin to take up glucose during and after activity (Exercise Right).

So where to now?

The most effective form of exercise management for PCOS is one you enjoy and stick to. Seeking assistance from an Accredited Exercise Physiologist is a great way to start and ensure you are exercising appropriately for your condition. An Accredited Exercise Physiologist can develop a tailored exercise program along with providing you with lifestyle education to help you achieve your goals.

]]> https://strongandstable.com.au/exercise-and-multiple-sclerosis/ Thu, 27 Apr 2023 09:25:19 +0000 https://strongandstable.com.au/?p=17878 Written by Kelsie Vickery, Accredited Exercise Physiologist

Multiple Sclerosis (MS) is an autoimmune disease, characterised by demyelination (plaque development) throughout areas of the brain and spinal cord. This slows or interrupts the transmission of nerve impulses in the central nervous system, which can lead to a variety of symptoms, depending on the location of demyelination.

Common symptoms of MS include:

• Extreme fatigue
• Heat sensitivity
• Muscle weakness
• Tremors
• Loss of balance
• Walking impairments
• Cognitive concerns
• Depression and anxiety

(Shutterstock) 

These symptoms can have a significant impact on people’s lives, often resulting in reduced ability to complete activities of daily living, decreased participation in the community and decreased levels of physical activity (which increases the risk of a variety of other chronic health conditions). However, regular physical activity has a wide variety of benefits for individuals with MS, such as:

• Increases muscle strength and endurance, which will improve ability to complete daily activities/tasks
• Increases cardiorespiratory fitness and heart health
• Decreases risk of cardiovascular diseases
• Decreases fatigue
• Decreases pain
• Improves mood
• Improves mobility/gait
• Improves balance and decreases risk of falls
• Improves cognition
• Improves quality of life

(Shutterstock)                                                    (Exercise Right) 

What exercise is best?

Both aerobic and strength exercise is safe and recommended for individuals with MS. The recommended guidelines for individuals with mild to moderate MS include:

• 30 minutes of moderate intensity aerobic exercise on 2-3 days per week. Aerobic exercise is exercise that focuses on increasing heart rate and breathing. This includes walking, running, cycling, swimming, rowing and elliptical.
• Strength training of major muscle groups on 2-3 days per week. Strength training is exercise that uses resistance (e.g. weights and bands) to increase the demand on muscles.

For individuals who are new to exercise, or who have had a significant break from exercise, it is important to start slowly. Even 10 minutes of walking or small amounts of exercise broken up throughout the day is beneficial. The best type of exercise is the type that you enjoy and that is completing regularly.

(Charles Stuart University News)

Strategies to Common Barriers to Exercise

Fatigue

1. 1. Consider the time of day that you exercise. Some people find they have more energy at particular times in the day, so utilise this time to get some exercise in.
   2. Pay attention to how you feel each day – on days where you have had poor sleep, or are sick, reduce exercise intensity. Focusing on low level walking, stretching and balance exercise are best on these days.

Heat sensitivity

1. 1. Wear light clothing
   2. Exercise indoors or in the shade on hot days if possible
   3. Stay hydrated by drinking plenty of water during sessions

An Accredited Exercise Physiologist can help develop an exercise program that is safe and specific to your goals and individual needs, and can help work through some of the barriers to physical activity.

COVID-19

Covid-19 is an infectious respiratory disease caused by the SARS-CoV-2 virus. The latest evidence suggests that people with chronic diseases, conditions, or a compromised immune system are at the greatest risk of experiencing severe symptoms during and post-infection.

Symptoms

Majority of people will experience mild to moderate symptoms and recover without any special medical treatment, but some in rare and severe cases will require hospitalisation and urgent medical attention.

Symptoms vary from individual to individual but the most commonly reported symptoms include (1):

• Fatigue/Tiredness
• Dyspnea (shortness of breath)
• Cognitive Impairment (brain fog and memory issues)
• Angina (chest pain)
• Persistent Cough
• Muscle Weakness
• Joint Pain
• Insomnia (poor sleep quality)
• Memory and Cognitive Issues
• Heart Palpitations
• Dizziness

The current research notes that women are more susceptible to physical decline and fatigue following covid infection but there is not yet an identifiable reason as to why this is the case?!

What is Long Covid?

Long Covid is defined as a set of persistent physical and mental symptoms that lasts for more than 12-weeks after the initial Covid diagnosis and the symptoms being experienced cannot be explained by any other alternative diagnosis.

Benefits of exercise for Long Covid

Long Covid has been shown to cause deconditioning due to the prolonged experience of symptoms and sedentary behavior such as bed rest. Fortunately, exercise can counteract both deconditioning and sedentary behavior.

Exercise benefits:

• ↓ Severity of Symptoms
• ↑ Mental Health
• ↑ Immunity
• ↓ Joint Pain and Muscle Weakness
• ↑ Cardiovascular Fitness
• ↑ Muscle and Bone Strength
• ↑ Body Composition (increased muscle mass and reduced body fat percentage)
• ↓ Risk of Developing Cardiovascular and Chronic diseases
• ↓ Inflammation Biomarkers

How can an Exercise Physiologist help with Long Covid?

Exercise Physiologists will perform an assessment and then develop an individualised and periodised exercise rehabilitation program based on the severity of a person’s Long Covid condition.

Education and strategies will be given during consultations as to how better manage the prolonged symptoms being experienced i.e., fatigue, muscle stiffness, weakness, and joint pain etc.

It is well shown in the literature that any form of physical activity helps to improve mental health by releasing chemicals such as endorphins and hormones that help improve mood. (2).

Group exercise also helps to lower feelings of loneliness and isolation, so that might be something to look at, especially in regards to individuals suffering from Long Covid. (3)

Exercise is imperative as lung functioning and cardiac health are some of the most impacted bodily systems effected by covid. The exercise programs prescribed by Exercise Physiologists will appropriately and constantly challenge the cardiovascular, respiratory, and muscular systems.

If you’re suffering from long covid and are wanting to return to work, improve your quality of life and activities of daily living, Exercise Physiologists are here to help.

Websites for further information:

• https://www.coronavirus.vic.gov.au/long-covid
• https://www.coronavirus.vic.gov.au/
• https://www.health.gov.au/health-alerts/covid-19
• https://www.australia.gov.au/

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8806149/#:~:text=Mild%20COVID%2D19%20cases%20include,of%20lower%20respiratory%20tract%20disease.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928534/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398226/

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse also referred to as POP, is when one or more of the organs in the pelvis (bladder, rectum, or uterus) becomes weak or loose and protrudes into the vagina (Continence Foundation of Australia).

The pelvic organs are supported by the interaction of ligaments, muscles, and connective tissue that make up the pelvic floor (Continence Foundation of Australia).

When the pelvic floor becomes weak it can impair its function of (Women’s Health Collective):

1. 1. Supporting the pelvic organs
   2. Resisting downward pressure from Intra-abdominal Pressure (an increased abdominal pressure caused by actions like coughing and sneezing)
   3. Closing of sphincters.

(Photo Source: Jean Hailes)

How common is POP?

POP affects up to 50% of adult women, and commonly occurs after having menopause, if you are overweight or after giving birth (Continence Foundation of Australia).

Types of POP

There are three common types of POP, including (Office on Women’s Health):

• Dropped bladder (Cystocyele): This is when the bladder bulges into the vaginal space and is the most common form of POP.
• Dropped uterus (Uterine): This is when the uterus bulges into or out of the vagina.
• Dropped rectum (Rectocele): This is when the rectum bulges into or out of the vagina.

What are the Signs and Symptoms of POP?

Common signs and symptoms of POP, but are not limited to include (Continence Foundation of Australia):

• An observable bulging lump out of your vagina
• A dragging sensation in the vagina
• Difficulty emptying bladder or bowel
• Recurring urinary tract infections
• Pain in the lower back, pelvis, or abdominals
• Lack of sexual sensation
• Struggles to keep a tampon in.

Please see your General Practitioner if you are experiencing these above symptoms and have not been diagnosed with POP, for further investigation.

Stages of POP

There are 4 stages of POP that will help guide the most appropriate treatment pathway for you. These include (Women’s Health Collective):

• Stage 1: The organ is greater than 1cm away from the vaginal opening and is in the upper half of the vagina.
• Stage 2:  The organ has descended to nearly the vaginal opening.

Stages 1 and 2 are common stages in women postpartum and can be reversed.

• Stage 3:  The organ has everted 1cm and protrudes out of the vagina. Conservative interventions like exercise can manage symptoms.
• Stage 4: The organ has completely everted and outside of the vagina. Typically require a combination of approaches both surgically and conservative.

How does exercise help POP?

Whether you do or do not require surgery, exercise plays a pivotal role in strengthening your pelvic floor muscles and the muscles surrounding them. Particular exercises can greatly manage and improve symptoms from POP, however, certain exercises can make symptoms worse (Exercise Right).

An Accredited Exercise Physiologist is appropriately trained in prescribing exercises that are safe and effective for managing POP.

Exercises to Avoid if you have POP

The following exercises are advised against if you have POP as it can make your symptoms worse:

• Valsalva moves (holding your breath)
• Plyometric exercises (impact exercises like jumping and hopping)
• Wide legged exercises (side steps and wide legged squats)
• Weighted exercises that place a large amount of downward pressure (lat pull down, back squats, overhead press)
• Core exercises that result in poor recruitment of your core (sit-ups and crunches)
• Exercise involving prolonged static standing.

Safe Exercises if you have POP

The following exercises are supported if you have POP as they will not make your symptoms worse (Women’s Health Collective):

• Low impact cardiovascular exercise like walking
• Swimming
• High rep low to medium weights
• Speed walking.

Exercise Treatment for POP

In regards, to exercise treatment for managing POP an Accredited Exercise Physiologist can guide you through a tailored program that includes (Women’s Health Collective):

1. Teaching you how to correctly recruit the muscles that make up your true core (Transverse Abdominis and Pelvic Floor) to ensure correct support to your pelvic organs.
2. Ensure you have good posture as a forward posture can increase downward pressure on the pelvic floor and can impact bladder and bowel control.
3. Strengthen the muscles that surround your pelvis like your glutes, hamstrings, adductors, lower back, and abdominals as these muscles support your pelvic floor.

Top Tips to Consider when Strength Training with POP

Below are listed some important things to consider when performing strength training with POP to reduce downward pressure on the pelvic floor (Women’s Health Collective):

• Exhale on the hardest part of the movement and inhale on the easiest part of the movement (e.g., inhale as you squat down and exhale as you stand up)
• Vary the positions you are in during your training session, for instance, perform a range of sitting, standing, and lying exercises
• Start initially with feet in a narrow stance
• Progressively increase repetition of an exercise before increasing weight.

Further Resource

https://www.continence.org.au/who-it-affects/women/prolapse#signsandsymptomswilldependonthetypeandlevelofprolapse

What is Menopause?

Menopause marks a time in a Woman’s life when she stops having monthly periods (Health Direct). It is the end of her reproductive stage of life, as the ovaries no longer have eggs to release and there is a natural decline in her reproductive hormones (Health Direct).

The average age for menopause is 51 years old, with most Australian women experiencing it between the ages of 45-60 years old (Health Direct).

Menopause is reached when a woman has gone 12 consecutive months with no periods (Health Direct).

Stages of Menopause?

There are three stages of menopause (Exercise Right):

1. Perimenopause: This is the lead up to menopause where the woman’s menstrual cycle becomes erratic and irregular when hormones start to decline, on average it last 4-6 years. Side effects of menopause can start to present, such as hot flashes.

2. Menopause: This is the permanent end of menstruation and no periods for 12 months consecutive, caused by the cessation of hormone production that causes your menstrual period.

3. Post menopause: A point of time after menopause has occurred. Once the woman has entered this stage, she remains in this stage for the rest of her life.

A woman can also enter Early Onset Menopause which is when she experiences her final menstrual cycle before 45 years old and Premature Menopause is before the age of 40 years old. Menopause occurring early can be triggered by surgery, naturally occurring, or medication.

What are the Signs and Symptoms of Menopause?

Common symptoms of Menopause which are not limited to, include (Jean Hailes):

• Hot flashes and night sweats
• Impaired sleep
• Physical symptoms like irregular periods or sore breasts
• Emotional symptoms like lowered mood or forgetfulness
• Painful joints.

Long-term health risks of Menopause

A reduction in female hormones after menopause can lead to several increased health risks, like (Better Health):

• Osteoporosis which can weaken bones and increase the risk of fractures
• Heart diseases like high blood pressure, heart attack and stroke as it can lead to a build up of plaque in the arteries walls
• Urinary incontinence as lower hormone levels can weaken the urethra (tube through which urine leaves the body)
• Weight gain around your abdomen.

The good news is that these long-term health risks can be reduced by engaging in a well-structured exercise plan, which an Accredited Exercise Physiologist is specialised in designing.

Benefits of Exercising to Manage Menopause

Exercise can improve a Woman’s health long-term when entering menopause by (Exercise Right):

• Increasing bone mineral density, reducing the risk of Osteopenia and Osteoporosis
• Reducing the risk of factors of cardiovascular disease like decreasing blood pressure
• Improving pelvic floor health by increasing muscles that make up and surround the pelvic floor
• Maintaining a healthy weight range to reduce the risk of non-communicable diseases like diabetes.

Exercise can also help manage symptoms of menopause, like (Exercise Right):

• Improving mood through releasing the feel-good hormone endorphins
• Improving sleep quality by reducing disruptions and inducing deeper sleep
• Reducing joint pain by increasing the strength of the muscles surrounding the joint
• Reducing hot flashes by improving the control of the thermoregulatory system.

The Best form of Exercise for Menopause

Women who are entering or have entered Menopause should include the following forms of exercise in their routine (Exercise Right):

• Resistance training (e.g., squats, heel raises, glute bridges): In particular, weight-bearing strength exercises to increase bone mineral density, and strength exercises of muscles surrounding the pelvic floor to reduce the risk of incontinence and pelvic organ prolapse
• Aerobic training (e.g., walking, swimming): To increase cardiovascular fitness and increase energy expenditure to assist in maintaining body weight
• Balance training (e.g., single leg stance): To reduce the risk of falls, as changes in Women’s hormones are known to affect their inner ears which play a critical role in balance.

Safety Considerations Exercising during Menopause

Although women menopausal and post-menopausal are encouraged to engage in an active lifestyle, the following things should be considered when exercising to ensure their safety (Exercise Beyond Menopause):

• Avoid engaging in plyometric exercise (repetitive jumping and hoping) initially if they have been inactive for a significant period, as they are at a high risk of osteoporosis diagnosis and risk of a fracture
• Avoid performing sit-ups and crunches as these moves increase the stress on their spine which is more delicate due to menopause-related bone loss
• Avoid working out late at night if experiencing menopausal sleep disturbance, as intense exercise can elevate cortisol the stress hormone which can make falling asleep harder
• Take caution with performing Hot Yoga, as many menopausal women struggle with overheating.

According to Sports Medicine Australia, up to 70% of recreational and competitive runners experience overuse injuries annually.

• 42% of running injuries occur at the knee (most commonly ITB friction syndrome, patellofemoral pain syndrome, patella tendinopathy and meniscal injuries)
• 17% occur at the foot/ankle with plantar fasciitis being the most common in this category
• 13% occur in the lower leg, with the most common being shin splints
• 11% occur at the hip/pelvis

Most of these injuries are a result of training errors (such as increasing volume or intensity too quickly and/or inadequate recovery between sessions), poor running technique, low levels of strength or reduced range of motion.

Mobility is imperative for running recovery and performance and helps decrease risk of injury. It helps to decrease tissue tightness, decrease knots in the muscle, increase joint range of motion and increase blood flow to the tissue to aid in recovery. This ultimately enhances your running performance and reduces your risk of injury.

Let’s take a deep dive on the main muscles to mobilise for running and why!

Glutes
The gluteus maximus’ primary role is to create hip extension, while the glute medius acts to stabilise the leg each time it hits the ground. Tight glute muscles can pull on surrounding muscles such as the lower back and hamstrings, which in turn could lead to lower back pain, knee pain and piriformis syndrome.

Hip Flexors
The hip flexors complete the movement of hip flexion (surprising, I know), which is when you bring your knee up towards your chest. The hip flexors are often tight from being in seated positions all day, and this can inhibit the body’s ability to achieve full hip extension, which can ultimately prevent the powerful glute muscles from working properly. When these muscles are tight, it can also change our pelvis position and result in an increased arch in the lower back. This places excess length on the hamstrings, which may predispose you to increased risk of hamstring strain.

Quadriceps
The quadriceps primary role is to straighten the knee, however one of the quadricep muscles (the rectus femoris) also crosses the hip joint and acts as a hip flexor, so if this muscle is tight we can have the same issues as mentioned above.

Hamstrings
The hamstrings work to bend the knee so that the foot can be lifted off the ground, and works in partnership with the quads to control the straightening of the knee. As a result, tight hamstrings can reduce stride length in running if it is inhibiting adequate leg extension and may predispose you to risk of hamstring injury.

Calves
The calf muscles plantarflex the foot, pushing the front of the foot down and ultimately propelling the body forwards. If these muscles are tight, there is a reduction in dorsiflexion (which is movement of the toes pointing upwards) which can lead to increased pronation of the foot to compensate. Tighter calf muscles also don’t have the capacity to generate the same amount of power, decreasing running efficiency and performance.

Running is one of the most popular forms of physical activity, with an estimated 3 million Australians participating in either recreational or competitive running. It is a simple, cost-effective mode of physical activity that can be enjoyed by many and results in significant health benefits.

Benefits of running:

• Improves overall fitness
• Helps with weight loss
• Improves bone density and bone health
• Decreases blood pressure
• Improves cognitive function and decreases Alzheimer’s in later life
• Improves glucose and insulin control for diabetics and lowers risk of developing diabetes
• Improves mental health and self-esteem
• Improves sleep quality
• Increases life expectancy

 
Honestly, if running was a pill, I think everyone would be taking it.

Strength training is essential so that our muscles and joints can withstand the huge forces being placed on them during running. If there is weakness in the muscular and fascial systems, the body will find a way to compensate so that it can continue running. These compensations can lead to poor running mechanics, poor running efficiency and eventually injury.

There are three general experience levels to define runners: novice, intermediate and experienced. Strength training is important for all three runners, but the number of running sessions, strength sessions and recovery days will vary accordingly. Novice runners are those who are new to the sport (anything under 1-2 years) and have a lot of room for improvement. Intermediate runners have been in the sport for several years and is the category that most runners fall into. Experienced runners are individuals who have been in the sport for a considerable number of years and have or almost have reached their full genetic potential (think elite athletes).

Novice runners should aim for 2 strength sessions and 2-3 running sessions per week. Start slowly, listen to your body, and focus on your recovery (rest, hydration, nutrition, sleep and mobility). After the first 4 weeks of training, consider adding in an additional non-weight bearing cardio session such as cycling, swimming, elliptical or rowing. Over the next few months, you can gradually add in additional running sessions. However, it is imperative that you allow the body adequate recovery between sessions. During exercise (both running and strength training), the body undergoes a considerable amount of stress, resulting in microscopic tears and degradation to the tissues and changes in bone structure. During the recovery process, these microscopic tears in the muscle are repaired, collagen production in tendons increases and bone mineral density increases. Ultimately, these adaptations increase the load that the body can withstand. Without adequate recovery over time, the body is unable to make these adaptations, which can lead to overuse injuries such as stress fractures and tendinopathies.

Therefore, our advice for each category of runner is as follows:

Novice

Runners should always complete training sessions on non-consecutive days (e.g., don’t run two days in a row or complete gym sessions two days in a row). You can alternate between running and strength training each day, or these can be completed on the same day. However, if both strength and running is being performed on the same day, complete your running session prior to your strength session, and allow at least 3-4 hours between the two.

Intermediate

Runners can run on consecutive days but be strategic on the types of running sessions being completed. For example, two high intensity running sessions shouldn’t be completed back-to-back. Instead, think high intensity, shorter duration running followed by a longer duration, lower intensity run the following day. As always, make sure you recover well after each session to maximise the quality of following sessions.

Experienced

Runners tend to run twice per day and usually have one complete rest day per week. This type of training is for advanced runners only, who have gradually built up their tissue tolerance over years and years of training. There will almost always be a qualified coach prescribing their training sessions to reduce risk of injury and maximise performance.

Stay tuned for an upcoming blog post on the best strength exercises to complete for running.

For more assistance with your running programming and strength program please call the studio to book an appointment with Kelsie (AES) 9762 0976.

Why should I do it?

Exercise is Medicine!!! Research has shown that regular exercise has proven to improve the following:

• Mental health
• The Immune System
• Musculoskeletal conditions such as back pain, knee pain, neck pain
• Bone density
• Blood glucose control and assist with the management of Type II and I diabetes
• Weight management
• Sleep
• Muscular strength

Regular exercise has also been linked to the following:

• Reducing the risk of heart disease and improve blood pressure
• Reducing the risk of cancer development as well as improve treatment outcomes
• Reduced treatment side effects for those undergoing cancer treatment (chemotherapy / immunotherapy / radiotherapy / surgery)
• Reducing your falls risk

What technology do I need?
In order to access this service, you will require one of the following, which allows video and microphone capabilities:

• Smart phone
• Tablet
• Computer
• Laptop

How does it work?

Once your appointment is booked your Exercise Physiologist will send you a PDF (see sample below) of instructions along with a secure link for your consultation. At the time of your consultation click on the link provided and you should be able to see your clinician!

Your consultation can be used to take you through an online exercise session or plan and prescribe a home-based exercise program.

What does it cost?

• Initial Assessment (60 mins) $60
• Review Appointment (60 mins) $60
• Review Appointment (45 mins) $45
• Review Appointments (30 mins) $30
• Enhanced Primary Care Sessions (20-60 mins) $53.80 bulk billed – NO GAP.
• NDIS Sessions (60 mins) $183.69 billed at the current NDIS rate – NO GAP.
• DVA fully funded NO GAP.

As it stands (2^nd April 2020) Private Health Insurance rebates are not applicable to Telehealth services.

How do I organise a Telehealth consultation?

Please contact us via email or phone on

Email:            info@strongandstable.com.au

Phone:           Strong & Stable on 9762 0976, or

Nicole Marlow (Exercise Physiologist & Managing Director Strong & Stable) directly on 0400 895 697

We look forwards to seeing you soon!