Children and Women in Sports Chapter Notes | Physical Education Class 12(XII) - Notes & Model Test Papers - Humanities/Arts PDF Download

Exercise Guidelines of WHO for Different Age Groups

World Health Organisation (WHO) has identified lack of physical activity, or physical inactivity, as the fourth leading risk factor for global mortality (6% of deaths globally).

• Regular participation in physical activities and sports provides ample opportunities to maintain physical, mental and social health.
• Participation in sports and physical activity results in benefits like an increase in self-confidence and self-esteem, a better control over emotions, reduction in levels of stress, anxiety and depression, maintenance of healthy weight, social interaction and achieving high performance in academics.
• Regular physical activities help in not just physical, but also social, emotional and mental growth and development of infants, children, adolescents and adults.
• Physical activities should be encouraged among children to ensure strong muscles and bones.
• Children and young people should not be allowed to sit for long hours watching TV, playing computer games and travelling by car.

WHO has developed certain guidelines – Global Recommendations on Physical Activity for Health. with the overall aim of providing national and regional level policy makers with guidance on the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of Non-Communicable Diseases or Lifestyle Diseases.

Recommendations for Children Under 5 Years of Age

The following guidelines are recommended for healthy children aged Under 5 years, irrespective of gender, race, ethnicity, cultural background, and the socio-economic status of the family.

Infants (Less than 1 year)

• Infants should be provided enough space and open environment to promote movement and minimize restrictive or sedentary behaviour so that they may explore their surroundings.
• Babies should be encouraged to be active throughout the day, every day. Before your baby begins to crawl, encourage her/him to be physically active by reaching and grasping, pulling and pushing, moving her/his head, body and limbs during daily routines, and during supervised floor play. This includes giving the baby 30 minutes in prone position (tummy time).
• Playing equipment should be carefully chosen and must not be so small that it can be swallowed or have sharp edges or be prepared with toxic material. Activities like crawling and rolling should be performed on mat or sheet that is at least 7 feet by 4 feet in size. Once babies can move around, encourage them to be as active as possible in a safe, supervised and nurturing play environment. During sedentary timing, the child must be engaged in reading and storytelling for encouragement.
• For 0-3 months of age14-17 hours and for 4-11 months of age baby should have 12-16 hours of good quality sleep that includes naps.

1-2 years

• Not restrained for more than 1 hour at a time or sit for extended periods of time. No screen time for 1-year-olds. For 2 years, sedentary screen time should be no more than 1 hour.
• Encourage reading and storytelling.
• At least 180 minutes in a variety of types of physical activities including moderate- to vigorous- intensity physical activity, spread throughout the day.
• 11-14 hours of good quality sleep, including naps, with regular sleep and wakeup times.

3-4

• Not restrained for more than 1 hour at a time or sit for extended periods of time.
• Sedentary screen time should be no more than 1 hour; less is better.
• At least 180 minutes in a variety of types of physical activities at any intensity, of which at least 60 minutes is moderate- to vigorous intensity physical activity, spread throughout the day.
• 10–13h of good quality sleep, which may include a nap, with regular sleep and wake-up times.

Toddlers (1-2 Years)

• Sedentary Activities: During this stage, toddlers should not be engaged in any sedentary activity lasting more than one hour. This includes being restrained in prams, strollers, high chairs, or strapped to a caregiver's back. Extended sitting should be avoided.
• Fundamental Physical Activities: Once toddlers learn to sit and stand, they should be encouraged to participate in basic physical activities such as walking, running, jumping, catching, throwing, and leaping.
• Sedentary Screen Time: Activities involving screens, such as computer games, watching TV, or videos, are not recommended for this age group.
• Reading and Storytelling: Engagement in reading and storytelling should be limited to no more than one hour.
• Sleep: Toddlers are recommended to get 11-14 hours of good quality sleep, including naps, with consistent sleep and wake-up times.

Children (3-4 Years)

• Physical Activity: Children should engage in at least 180 minutes of various physical activities throughout the day, with a minimum of one hour spent on moderate to vigorous intensity activities. This can include both light activities like standing and moving around, as well as more energetic activities such as skipping, hopping, running, and jumping. Active play, such as climbing, riding a bike, playing in water, and participating in chasing and ball games, is encouraged.
• Sedentary Time: Sedentary time should be limited to no more than one hour, during which reading and storytelling should be encouraged.
• Sleep: Quality sleep of 10-13 hours is recommended, including a nap, with regular sleep and wake-up times.
• Overall Recommendations: The guidelines emphasize a balance of physical activity, limited sedentary behavior, and adequate sleep. Increasing moderate to vigorous intensity physical activity while reducing sedentary time, along with sufficient sleep, can provide additional health benefits.

Children and Youth (5-17 Years)

• Target Group: These recommendations are applicable to healthy children and youth aged 5 to 17, regardless of gender, race, ethnicity, or socio-economic status.
• Special Cases: Children and youth with specific medical conditions or disabilities can follow these guidelines under the advice of a medical professional or with assistance from a school special education teacher.
• Progressive Approach: Activities should be introduced progressively, starting with simpler exercises and gradually increasing the frequency, duration, and intensity.
• Stages of Growth: The type of activities recommended may vary at different stages of growth within this age group. The primary goal is to enhance cardiorespiratory and muscular fitness, bone health, cardiovascular and metabolic health markers, and to alleviate symptoms of anxiety and depression.

Intensity: Moderate to vigorous.

Volume/Duration: At least one hour per day; more than 60 minutes offers additional health benefits.

Frequency: One session of one hour or two sessions of 30 minutes each.

Types of Activities: Aerobic exercises, basic muscle-strengthening exercises, and fundamental activities such as jumping, running, throwing, turning, and twisting.

Benefits: Regular exercise contributes to the development of the musculoskeletal system (bones, muscles, and joints), cardiovascular system (heart and lungs), and the neuromuscular system (coordination, movement control, and motor learning). It also helps maintain a healthy body composition, improves psychological aspects (emotional control, anxiety, depression, and stress management), fosters social skills (interaction, integration, leadership), promotes healthy behaviors (avoidance of tobacco, alcohol, and drugs), and enhances academic performance.

Activities can include play, games, sports, recreation, physical education, planned or unplanned exercises with family, school, and community.

Adults (18-64 Years)

• Applicability: These recommendations are for healthy adults aged 18 to 64, regardless of gender, race, ethnicity, or socio-economic status. Adults with disabilities can follow these guidelines with necessary adjustments based on their capacities. Those with medical conditions should consult healthcare professionals for tailored advice.
• Activity Progression: Activities should be introduced progressively, starting with simpler exercises and advancing to more complex ones. The frequency, duration, and intensity of activities should gradually increase.
• Aerobic and Muscle-Strengthening Activities: Engage in 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity aerobic activities per week. Each aerobic session should last at least 10 minutes. Include muscle-strengthening activities targeting major muscle groups on two or more days a week.
• Health Benefits: Regular physical activity reduces the risk of various health issues, including heart diseases, high blood pressure, stroke, type 2 diabetes, metabolic syndrome, certain cancers (colon and breast), and depression. It also lowers the risk of hip or vertebral fractures, enhances cardiorespiratory and muscular fitness, helps maintain a healthy weight, and improves body composition and bone health. Additionally, it reduces the risk of non-communicable diseases and depression.

Physical Activity Recommendations for Older Adults (65 Years and Above)

The following guidelines are suitable for healthy older adults aged over 65, regardless of their gender, race, ethnicity, or socio-economic background. These recommendations are also applicable to individuals with chronic non-communicable diseases (NCDs).

• Muscular Strengthening and Aerobic Activities: Aim for 150 to 300 minutes of moderate-intensity aerobic activity per week, or 75 to 150 minutes of vigorous-intensity activity. Each bout of aerobic activity should last at least 10 minutes.
• Major Muscle Activities: Engage in activities involving major muscle groups on two or more days each week.
• Balance-Enhancing Activities: Older adults with poor mobility should perform balance-enhancing exercises to prevent falls on three or more days per week.

Importance of Regular Physical Activity:

• Regular physical activity is crucial for reducing the risk of various health issues, including:
• Heart disease
• High blood pressure
• Stroke
• Type 2 diabetes
• Metabolic syndrome
• Colon and breast cancers
• Depression
• Hip or vertebral fractures

Additionally, it helps improve cardiorespiratory and muscular fitness, maintain a healthy weight and body composition, and support bone health. Moreover, regular physical activity lowers the risk of non-communicable diseases, depression, and cognitive decline.

Posture

Posture refers to the position of the body, either with support during muscular activity or due to the coordinated effort of a group of muscles working together to maintain stability. There are two main types of posture:

1. Dynamic Posture: This refers to how we hold ourselves while moving, such as walking, running, or bending down to pick something up. Dynamic posture is essential for efficient movement, as muscles and non-contractile structures must adapt to changing conditions.

2. Static Posture: This involves how we hold ourselves when stationary, like sitting, standing, or sleeping. In static posture, body segments are aligned and maintained in fixed positions, which is achieved through the coordination and interaction of various muscle groups working to counteract gravity and other forces.

Importance of Good Posture

• Maintaining good posture is crucial because it aligns all body parts in a way that minimizes stress on joints and muscles, preventing fatigue.
• Good posture also enhances productivity and promotes a physically and mentally stress-free state.
• Postural deformities can arise from various factors such as genetics, illness, injury, poor habits, inappropriate clothing, unsanitary living conditions, unhealthy diet, lack of exercise, obesity, socioeconomic status, etc.

Common Postural Deformities

There are several postural deformities, each with corrective measures. It is essential to perform corrective exercises under the guidance and supervision of a qualified physician or physiotherapist.

Knock Knees (Genu Valgum)

• Knock knees, or genu valgum, is a condition where the knees are misaligned and turn inward, causing the knees to touch or knock against each other while there is a gap of 3-4 inches between the ankles in a standing position.
• This condition is typically observed in early childhood and often corrects itself by the age of 7-8 years. However, in some cases, it may persist into adolescence or develop due to factors like injury, infection, rickets, vitamin D and calcium deficiency, obesity, or arthritis in the knee.
• Knock knees can adversely affect walking, running, and overall leg movement, impacting performance. If genu valgum continues beyond childhood, it may be accompanied by symptoms such as stiff joints, knee pain, limping, and pain in the hips, ankles, or feet due to stressed ligaments and muscles.
• If only one knee is misaligned, it can lead to an unbalanced stance.

Corrective Measures
Treatment for Genu valgum:

• Cause and Severity: Treatment varies based on the underlying cause and how severe the condition is.
• Exercises: Activities like horse-riding, placing a pillow between the knees while sleeping, and standing upright for extended periods can be beneficial. Regular practice of yoga, particularly poses like padmasana and gomukhasana, helps in realigning and stabilizing the knees by strengthening the leg muscles.
• Strengthening Exercises: Simple exercises such as leg raises, either while sitting or lying down, can help strengthen the muscles around the knees.
• Walking Calipers: Using walking calipers can be particularly helpful in the pre-puberty stage to correct the alignment.
• Weight Management: Excess body weight can exacerbate Genu valgum as it puts additional strain on the legs and knees. Weight loss through a balanced diet and regular exercise can alleviate the condition.

Flat Foot

• Definition: Flat foot, or pes planus, is characterized by little to no arch in the foot, causing the entire sole to touch the ground when standing.
• Causes: This condition can be genetic or environmental. Factors such as foot or ankle injuries, obesity, improper footwear (like tight shoes or high heels), carrying heavy loads, arthritis, or early forced walking in babies can contribute to flat feet. Tightness in calf muscles can also lead to temporary flat feet.
• Impact: Arches are crucial for distributing body weight and providing spring in steps. Flat feet can affect posture, walking, running, and may lead to issues in the ankles and knees. Most infants are born with flat feet, but the arch typically develops with physical activity.
• Exercises: Activities such as walking, standing, or jumping on toes and heels in various directions, skipping rope, and picking up marbles with toes can help develop the foot arch. Yoga poses like Adhomukhsavasana, Vajrasana, and therapeutic foot massages are also beneficial.

Round Shoulders

• Definition: Round shoulders refer to a postural deformity where the shoulders are positioned forward, leading to a narrower upper back curve. This condition can progress to hyperkyphosis (hunchback) and forward head posture, potentially causing chronic neck pain, thoracic outlet syndrome, and reduced shoulder mobility over time.
• Causes: Round shoulders can develop at any age due to factors like poor posture habits (using smartphones, computers, driving, carrying heavy weights, prolonged sitting), genetic predisposition, muscle imbalances, tight clothing, injuries, and certain diseases.
• Correction Measures: Strengthening and stretching the chest muscles are crucial to correct muscle imbalances. Exercises such as chest stretches, T stretches, wall stretches, handclasp stretches, planks, pull-ups, and reverse shoulder stretches can be helpful. Additionally, yoga asanas like Chakrasana and Dhanurasana promote better posture. Developing the habit of maintaining a straight spine is also beneficial.

Kyphosis

• Overview: Kyphosis, commonly known as hunchback or round upper back, involves an exaggerated forward curvature of the upper spine. The term "kyphosis" comes from the Greek word meaning "bent" or "bowed."
• Causes: Kyphosis can result from various factors, including heredity, aging, diseases like arthritis and osteoporosis, malnutrition, prolonged heavy lifting, unstable furniture, poor posture, and muscle weakness. While it can occur at any age, it is most prevalent in older women due to age-related weakness in spinal bones. In infants and teenagers, kyphosis may arise from spinal malformation or wedging of spinal bones over time.
• Symptoms: Mild kyphosis may cause few problems, but severe cases can lead to pain and disfigurement. The condition can create instability during activities like walking and running, increasing the risk of falls and injuries.
• Management: Strengthening and stabilizing back muscles through exercises, physical therapy, swimming, and yoga asanas like Dhanurasana, Chakrasana, and Bhujangasana can be beneficial. Using a flat bed with a thin pillow while sleeping may also help alleviate symptoms.

Lordosis

Lordosis, derived from the Greek word "lordos," meaning "bent backward," refers to a condition where the spine exhibits an exaggerated inward curve, particularly in the lower back. This condition is also known as "sway back." The spine naturally has curves in the neck, upper back, and lower back, contributing to its S shape. These curves are called kyphotic (upper back) and lordotic (neck and lower back). In lordosis, the angle of the lower back's arc is reduced, leading to an increased and exaggerated concavity in the lumbar region.

Causes: Lordosis can be caused by various factors, including:

• Obesity
• Improper muscle development
• Muscular or skeletal diseases
• Accidents
• Poor posture while standing, sitting, and walking
• Malnutrition
• In some cases, the cause may be unknown.
• Lordosis is commonly observed in children due to the weakening or tightening of hip area muscles, but most children recover as they grow and their muscles strengthen.

Treatment: Most individuals with lordosis do not require medical treatment unless the condition is severe. In severe cases, especially in children and teenagers, treatment options may include:

• Braces
• Surgery
• For mild cases, weight loss to improve posture and daily physical therapy to strengthen muscles and increase range of motion are beneficial.
• Exercises to strengthen the pelvic region, such as sit-ups, wall sits, and raising the upper body and legs while lying on the back, are helpful.
• Yoga poses like Dhanurasana (Bow Pose) and Halasana (Plow Pose) can also be beneficial.
• Maintaining good posture, using braces, and following a balanced diet are recommended to alleviate the condition.

Scoliosis

Definition: Scoliosis, from the Greek word "skolios," meaning "bent," is a condition characterized by an exaggerated lateral (sideways) curvature of the spine. In scoliosis, the spine may bend, twist, or rotate, forming a C or S shape. This condition is more commonly observed in girls than in boys and often occurs during the growth spurt just before puberty.

Causes: Scoliosis can be caused by various conditions and factors, including:

• Cerebral palsy
• Muscular dystrophy
• Arthritis
• Paralysis
• Rickets
• Lifting heavy weights
• Living in an unhealthy environment
• Prolonged poor posture while standing or sitting
• In many cases, the exact cause of scoliosis remains unknown.

Treatment: Treatment for scoliosis varies depending on the severity of the condition:

• Mild Cases: No treatment is necessary for mild scoliosis.
• Moderate Cases: Some children may need to wear a brace to prevent the curve from worsening.
• Severe Cases: Surgery may be required to prevent further deterioration and to straighten the spine.

Exercises: Certain exercises can help manage scoliosis, such as:

• Hanging on horizontal bars and swinging, performed on the opposite side of the C-shaped curve.
• Aerobic activities with a slow pace and breaststroke swimming.
• Yoga poses like Trikonasana (Triangle Pose) and Adhomukhasana (Downward-Facing Dog Pose) to help straighten the spine.

Bow Legs

• Definition: Bow legs, medically known as genu varum, is a condition where the legs curve outward at the knees while the feet and ankles remain touching. This creates a bow-like appearance. Bow legs are common in infants and toddlers.
• Causes: Bow legs can be caused by a deficiency of vitamin D, phosphorus, and calcium. However, in most cases, it is a normal variation in leg development and does not cause pain or discomfort. Bow legs are usually resolved on their own by the time a child is 3 to 4 years old and do not affect a child's ability to crawl, walk, or run.
• Concerns: While bow legs are generally not a serious issue, parents may be concerned about the appearance of their child's legs or an awkward walking pattern. Some children with bow legs may exhibit pigeon-toeing (toes pointed inward) or appear clumsy due to tripping. In rare cases, bow legs can be a sign of underlying conditions such as Blount's disease, rickets, or arthritis.

Women participation in Sports – Physical, Psychological and Social benefits

• Women’s participation in sports, both amateur and professional, has a long history worldwide, including in India. Historical records show that women in ancient India engaged in physical activities for recreation. However, over time, societal norms restricted their participation in sports despite their potential and talent.
• In recent years, especially since the late 20th century, there has been a significant increase in female participation and popularity in sports, reflecting a shift towards gender equality. While progress has been made, there is still a noticeable gap between the participation rates of women and men in sports.
• To address this disparity, initiatives like the Khelo India scheme and the National Sports Talent Search Scheme (NSTSS) have been introduced to promote women’s participation in sports in India. Historical Context
•  In ancient India, women like Shakuntala, Madhuri, and Kunti engaged in physical activities as a form of recreation, as depicted in the Mahabharata. 
•  Despite their potential, women were historically marginalized and denied the opportunity to participate in sports due to various societal constraints. 
•  The late 20th century witnessed a dramatic increase in women’s participation and popularity in sports, reflecting changing attitudes towards gender parity. 

Present Scenario

•  Women’s participation in sports is now generally accepted and promoted, although there is still a significant disparity between the participation rates of women and men. 
•  Programs like Khelo India and NSTSS aim to mainstream and encourage women’s participation in sports in India. 
•  Historically, women faced psychological barriers such as low self-confidence, high stress and anxiety levels, and social challenges like lack of support and a male-dominated social structure that hindered their participation in sports. 
•  Economic factors also played a role in negatively impacting women’s participation in sports, but these issues are gradually being addressed. 

Global Context

•  The trend of lower participation rates for women in sports is not limited to India but is a global phenomenon. 
•  Women’s participation at all levels, from regional to international, is limited, affecting various domains such as sports activities, administration of associations and federations, and participation in national and international committees. 
•  Female athletes continue to face challenges such as lower pay, less media coverage, and different injury patterns compared to male athletes. 
•  Many female athletes have resorted to peaceful protests, social media campaigns, and legal actions to address these inequalities. 
•  The International Olympic Committee (IOC) promotes women’s participation not only in sports but also in National Olympic Committees and International Federations, and conducts regional seminars for female administrators, coaches, technical officials, and journalists. 
•  In a recent initiative, the IOC announced that 49% of participants in the next Olympic Games will be women. 
•  The Constitution of India also supports gender equality and aims to eliminate any form of gender bias or hindrance, positioning sports as a medium for gender equity and empowerment. 

Benefits of Women Participation in Sports
1. Physical Benefits

•  Sports participation helps women stay active, reducing the risk of lifestyle diseases such as diabetes, high blood pressure, and obesity, leading to a healthier life. 
•  Women are at a higher risk of osteoporosis than men. Sports activities help increase bone density and strengthen bones. 
•  Regular exercise and participation in sports improve muscle tone in women, helping them stay strong and fit. 
•  Engaging in regular exercise enhances the number of capillaries, improving oxygen intake. This allows women to participate in sports for extended periods without excessive fatigue. 
•  Obesity is a prevalent lifestyle disease worldwide, with women being more susceptible to it. Regular participation in sports helps women maintain a healthy weight and stay fit. 

2. Psychological Benefits

•  Participation in sports has a significant positive impact on women's psychology, boosting their confidence and self-esteem. It instills a sense of achievement that empowers them to overcome obstacles. 
•  Engaging in sports provides women with a sense of accomplishment, which enhances their self-worth and motivates them to tackle challenges. 

Benefits of Women Participation in Sports

Sports and physical activities are essential for women as they offer various advantages that contribute to their overall well-being and empowerment. Here are some key points highlighting the benefits of women participating in sports:

I. Health Benefits
Fitness:

• Sports and physical activities are effective in combating obesity among women. Regular participation helps in burning calories and maintaining a healthy weight.
• Engaging in sports enhances overall fitness levels, including improved endurance, strength, and flexibility.
• Women involved in sports tend to develop healthy eating habits, further contributing to their fitness and well-being.

Immunity:

• Regular physical activity through sports strengthens the immune system, reducing the risk of illnesses and infections.
• A robust immune system is crucial for overall health, especially for women who may have specific health concerns.

Longevity:

• Women who participate in sports and lead active lifestyles tend to have a longer lifespan.
• Physical activity is linked to a reduced risk of chronic diseases, contributing to increased longevity.

Mental Health:

• Sports participation is associated with lower levels of stress, anxiety, and depression among women. The physical activity involved in sports releases endorphins, which are natural mood boosters.
• Engaging in sports helps women develop better coping mechanisms for stress and emotional challenges, contributing to improved mental health.

Sexual Health:

• Women who participate in sports are more likely to have a healthy sex life. Regular physical activity is linked to improved sexual health and satisfaction.
• Sports can positively impact hormonal balance and overall reproductive health in women.

Menstrual Health:

• Participation in sports can lead to better menstrual health for women. Regular exercise is known to alleviate menstrual discomfort and regulate menstrual cycles.
• Women involved in sports may experience fewer menstrual-related issues, contributing to their overall well-being.

II. Psychological Benefits
Stress Management:

• Physical activity, such as participating in sports, releases hormones that promote happiness and reduce stress levels.
• Sportspersons, both men and women, who engage in sports are better equipped to manage stress compared to those who do not participate in any physical activities.

Control Emotions:

• Women who participate in sports learn to manage their emotions effectively.
• Facing challenging situations in sports helps them become emotionally stronger and better equipped to handle difficulties.

Confidence:

• Every small victory in sports boosts the confidence of the participant.
• When a woman wins in sports, it not only boosts her confidence but also inspires other women athletes, creating a ripple effect of increased self-belief.

Self – Esteem:

• Sports help women realize their self-worth.
• Achieving or even participating in sports activities enhances their self-image and helps them understand their own value, which is crucial for personal development.

Leadership:

• Sports foster leadership qualities in individuals.
• Women who excel in sports are better equipped to lead and inspire others, not just in sports but in various aspects of life.

III. Social Benefits
Coordination:

• Sports improve coordination among team players.
• Women who participate in sports learn the skill of working in harmony with others, which is valuable in various social settings.

Communication:

• Communication is a vital aspect of sports, as players need to communicate effectively on the field.
• Women participants in sports become more vocal and expressive, enhancing their communication skills.

Inter-relationships:

• Sports are a team effort, and players must maintain good relationships with their teammates and supporting staff.
• Women participants learn to build and respect relationships both on and off the field, fostering a sense of camaraderie.

Cooperation:

• Sports teach women the importance of cooperation and working together towards a common goal.
• This skill transcends the field and becomes a part of their daily lives, promoting harmony and teamwork.

Special Consideration (Menarche & Menstrual Disfunction)

Menarche

• Menarche marks the beginning of a girl’s ability to become pregnant. It is the time when the female reproductive system becomes capable of supporting a pregnancy. This process is linked to the onset of secondary sexual characteristics, such as breast development and the widening of hips.
• During adolescence, girls experience various physical and biological changes that lead to sexual maturity. This period is known as puberty. Menarche is considered a key milestone in this process.
• The average age for a girl to get her first period varies between 8 to 15 years old. Several factors may influence the timing of menarche, including genetics, socioeconomic conditions, overall health, nutritional status, certain types of exercise, seasonal factors, and family size.
• Over the past century, there has been a trend of earlier menarche, although the reasons for this change are not yet fully understood.
• Menstruation, also known as a period or bleeding, involves the shedding of blood and other materials from the uterus lining through the vagina. This process occurs approximately once a month from puberty until menopause, except during pregnancy. Menstruation typically lasts about 3 to 5 days.
• Women usually continue to have periods until around ages 45 to 55, with menopause commonly occurring around age 50. Menopause signifies the end of ovulation and the ability to become pregnant. The timing of menopause can vary among women and may occur over several years.

Menstrual Dysfunction

Menstrual dysfunction refers to irregularities in a woman’s menstrual cycle. A normal menstrual cycle ranges from 21 to 35 days. If the cycle is shorter than 21 days or longer than 35 days, it is considered abnormal.

Other menstrual problems include:

• Missing three or more periods
• Heavier or lighter menstrual flow compared to usual
• Cycle lasting longer than seven days
• Experiencing pain, cramping, or vomiting during periods
• Bleeding after menopause

Causes of abnormal menstrual cycles can include:

• Being overweight
• Stress
• Dietary disorders
• Illness
• Sudden changes in exercise routine
• Travel
• Other medical issues

Different types of menstrual disorders include: Pre-menstrual SyndromePre-menstrual Syndrome involves unpleasant symptoms that occur during the menstrual cycle, such as depression, anxiety, irritability, headaches, fainting, vertigo, and infections. These symptoms can last from a few hours to a few days and may be alleviated through moderate exercise, a balanced diet, adequate sleep, and rest.

• Amenorrhea: Amenorrhea refers to the absence of a normal monthly period or menstrual cycle. There are two types of amenorrhea:
• Primary amenorrhea occurs when menstruation does not begin at puberty.
• Secondary amenorrhea happens when menstruation is missed for three months or more, and it is the most common type of amenorrhea.
• Dysmenorrhea Dysmenorrhea is characterized by severe pain or frequent cramps during menstruation. Symptoms may include cramping in the lower abdomen, low back pain, leg pain, nausea, fatigue, and weakness.
• Menorrhagia Menorrhagia involves heavy and prolonged or continuous menstrual bleeding.
• Polymenorrhea Polymenorrhea refers to a menstrual cycle shorter than 21 days.
• Oligomenorrhea Oligomenorrhea is infrequent menstruation, with periods occurring at intervals greater than 35 days.
• Metrorrhagia Metrorrhagia involves missed, delayed, or erratic periods, or abnormal bleeding patterns.
• Postmenopausal bleeding Postmenopausal bleeding occurs after one year of menopause or after a woman has stopped having menstrual cycles due to menopause.

Hormonal Regulation

• Female hormones, particularly estrogen and progesterone, play a crucial role in overall body health and the regulation of menstrual cycles.
• Intense physical exercise and extreme thinness can lower the levels of these hormones, potentially leading to the disruption or cessation of menstrual cycles.

Female Athlete Triad

• Engaging in sports and physical activities offers numerous physical and social advantages, such as fostering leadership skills, promoting competition, and encouraging teamwork. Regular involvement in these activities is linked to a longer and improved quality of life, decreased risk of various diseases, and several psychological and emotional benefits.
• There is evidence indicating a positive correlation between physical activity and factors influencing girls' physical health, including diabetes management, blood pressure regulation, and the body's ability to utilize fat for energy, thereby preventing obesity. Early physical activity may lower the risk of chronic diseases later in life, as conditions like cancer, diabetes, and coronary heart disease often have their roots in childhood. Additionally, regular activity from a young age contributes to better bone health, reducing the risk of osteoporosis, which predominantly affects females.

Sports and Health Risks

• Despite the benefits, participation in sports carries certain health risks. Sports such as Judo, boxing, wrestling, and taekwondo impose significant pressure on athletes to maintain specific body shapes and weights. On the other hand, sports like distance running, cycling, and cross country require athletes to have a balanced diet to meet high energy demands and dietary needs.
• This pressure can jeopardize the athlete's health and lead to the Female Athlete Triad. The term "triad" was introduced by the American College of Sports Medicine in 1992 to describe the three components of this condition: disordered eating, amenorrhea, and osteoporosis.

Evolution of Terms

• The terminology used to describe the Female Athlete Triad has been updated. The new terms include: low energy availability with or without an eating disorder, menstrual dysfunction, and low bone density.
• This revision is significant because all three components can be effectively addressed through proper energy intake and expenditure. By ensuring an adequate caloric intake that meets the body's needs for physical activity and essential functions, athletes can promote healthy bones and normal menstrual function. These components are closely interconnected.

1. Low Energy Availability with or Without Disordered Eating

• Low energy availability, with or without disordered eating, is a critical aspect of the Female Athlete Triad. This condition arises from an imbalance between energy intake and energy expenditure, leading to various health issues. Athletes must understand how to balance their energy intake effectively to maintain optimal health.
• Disordered eating refers to a significant disruption in eating behavior and encompasses a range of harmful and often ineffective eating practices aimed at weight reduction. These practices can vary from calorie restriction to severe eating disorders such as anorexia nervosa and bulimia nervosa. Athletes participating in sports that emphasize leanness or specific weight criteria are at a higher risk of developing eating disorders.
• Coaches, team physicians, parents, and support staff should be aware of the symptoms of disordered eating to ensure timely intervention. If left unaddressed, these disorders can have long-term physiological and psychological consequences, and in extreme cases, can be fatal.

Anorexia Nervosa

• Anorexia nervosa is characterized by an intense fear of gaining weight and a distorted perception of body weight. Individuals with this disorder prioritize controlling their weight and body shape to an extreme degree, which significantly disrupts their daily lives. To prevent weight gain or continue losing weight, individuals with anorexia typically restrict their food intake severely. They may also resort to unhealthy practices such as vomiting, misuse of laxatives, diet aids, or diuretics, and excessive exercise. Despite significant weight loss, individuals with anorexia continue to fear weight gain.
• Symptoms of anorexia nervosa may include: menstrual dysfunction, constipation, diarrhoea, bloating, unexpected weight loss, muscle weakness, stress fractures, bone weakness, overuse injuries, and anxiety.

Bulimia Nervosa

• Bulimia nervosa involves episodes of uncontrolled eating followed by compensatory behaviors to reduce calorie intake. Individuals with bulimia may engage in binge eating followed by vomiting, excessive exercise, or misuse of laxatives and diuretics.
• Symptoms of bulimia nervosa may include: dehydration, dental problems, edema, electrolyte imbalances, extreme weight fluctuations, menstrual irregularities, weakness, cramps, and depression.

Menstrual Irregularities

Menstrual irregularities are a part of the Female Athlete Triad and indicate the overall health quality of female athletes. These issues are common among sportswomen but often get overlooked. It's crucial for young female athletes to be aware of these problems and understand how to manage them. Timely management can positively impact athletic performance, while ignored irregularities can have lasting effects on bone mineralization. Treatment for these issues can take a long time, sometimes months or years.

Female athletes with menstrual irregularities tend to choose different sports compared to those with regular menstruation because delayed puberty leads to stronger bones and taller stature. However, menstrual dysfunction can affect sports performance in the long run and lead to complications. Recent studies suggest that weight training can strengthen bones without negatively impacting adolescent menstrual irregularities. Research also indicates that over 15% of female Olympic athletes may experience amenorrhea, and some athletes with amenorrhea may have poorer skeletal health than sedentary women.

Low Bone Mineral Density

Low bone mineral density, previously known as osteoporosis, is characterized by increased bone fragility and disturbances in bone structure, leading to low bone mineral density (BMD). This condition can result in fractures, pain, deformity, and disability. Low BMD is often caused by improper diet and amenorrhea. In female athletes, decreased levels of estrogen and progesterone contribute to weaker bones and mineral loss.

The consequences of low bone mineral density include a higher incidence of injuries, stress fractures, and an increased risk of early osteoporosis after menopause. Bone deposition occurs during childhood and adolescence, peaking in the 20s and 30s. BMD has a significant genetic component, with heritability estimated between 50-85%. Understanding family history and medical conditions related to BMD can help mitigate the risk of injuries and fractures in female athletes.

Treatment and Intervention

Addressing the female athlete triad involves correcting energy imbalance by adjusting energy expenditure and availability. The primary goal is to restore regular menstrual cycles to reestablish energy balance and improve bone mineral density. The best predictor for restoring normal menstrual function in young athletes is weight gain. Interventions such as family-based therapy and cognitive behavioral therapy have proven effective for disordered eating.

A sports nutritionist can assist athletes and their families in determining the necessary quantity and quality of food and dietary supplements to meet bodily needs, replace energy spent during training, and enhance bone health. Weight gain may also be essential to increase bone mineral density.