'Training on Cycle': Hitting the Weights Frequently (5x/WK), Alone, Very Unlikely to Trigger the 'Female Athlete Triad'

The squat was not part of the training regimen in the study at hand - that's bad because it would certainly have made the workout more intense and might thus have affected the results.

If you don't remember what it was, I suggest you (re-)read the classic 'SuppVersity Athlete Triad'-Series (read it)... and if you don't have the time to devour those classics, here's the gist: While it is often accompanied by eating disorders, the athlete triad can also arise in periods of either low energy availability or high training loads. Next to an ongoing decline of physical (and eventually also cognitive performance), the main features of the female athlete triad are amenorrhoea / oligomenorrhoea (no, or a disturbed menstrual cycle, respectively), and - in the long(er) run, i.e. after months and years - an often highly significant decrease in bone mineral density (osteoporosis and osteopenia).

As et al. point out in their latest paper, the female athlete triad "has shown to be related to both training intensity and duration" (Wikström-Frisén. 2016). It is thus a threat for endurance athletes, strength athletes and gymrats alike; and a very similar effect can be observed in men when they're overtraining - even though, their fertility is not threatened as easily.

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"Intensive exercise-associated disorders, such as the female athletic triad, generally originate from hypothalamic dysfunction failing to initiate a normal hypothalamic-pituitary-ovarian function. This is leading to a decrease in pituitary secretion of luteinizing hormone (LH), and follicle-stimulating hormone (FSH), which in turn limits ovarian stimulation and estradiol production" (Wikström-Frisén. 2016).
In spite of everything we know, evidence pertaining to the effects of increased resistance training load on the athlete triad is scarce. The aim of the scientists from the  Umeå University in Sweden was thus to investigate potential exercise-related negative consequences on components in the female athlete triad following high-frequency leg resistance training.

So far, so good. What is new, or at least almost new, in this 2nd paper by Lisbeth Wikström-Frisén et al. addressing the issue of what I previously called tongue in cheek "training on cycle" (read my 2015 article of mine) is that the subjects' training regimen were periodized according to different parts of the menstrual/OC cycle. Practically speaking, the participants, all of whom had regular menstrual cycles (at pre-test 27.9 ± 1.9 days), or were taking oral contraceptives (OC cycles of 28 days), and had previous experience of leg press and leg curl resistance training, were randomized into either one of two periodized training groups or a control group:

• one training group were allocated to high-frequency training (5 times per week) during the first two weeks of the menstrual/OC cycle (group 1), and 
• the other training group to high-frequency training during the last two weeks of the menstrual cycles (group 2), 
• the controls trained at a low frequency (3 times per week) during the whole cycle. 

During training, all participants performed leg resistance training according to current recommendations in order to achieve strength gains. The completed number of leg training sessions were logged and was equivalent in the three groups (group 1 = 41 ± 4.0, group 2 = 41 ± 4.8, control group = 42 ± 4.4).

Figure 2: While the relative changes (pre- vs. post-test) clearly indicate that training intensely in the latter phase of the menstrual cycle appears to have the most favorable effect on the women's hormonal profiles, none of the visible inter-group difference reached statistical significance - probably because of the rather small(ish) study size (N = 59 in three groups of 19, 19, and 21 subjects, respectively) as well as large inter-individual variation (Wikström-Frisén 2016).

At post-test, the participants reported how they perceived their leg training program during the four consecutive menstrual/OC cycles. Their perceptions were categorized on a three-graded scale; 1 = positive, 2 = neither positive nor negative, 3 = negative. The analysis revealed "a significant difference in regards to how the training was experienced, χ2(2) = 11.552, p = 0.003" with a significantly more positive perception of the leg training in the "on-cycle" group #1.

Figure 2: For those of you who are interested only in the takeaway messages, here are the implications of this (Study 2 / 2016) and the previous paper by Wikström-Frisén et al. (Study 1 / 2015) in a comprehensive form.

Now, the way you feel about your workouts is unquestionably important. The objectively measured hormonal response in Figure 1, however, is unquestionably a more objective measure of the training load or overload ... unfortunately, the lack of statistical inter-group differences (in spite of visible differences in the relative changes of the hormonal marker), doesn't allow for any definite conclusions on what's "best" hormone-wise (it's not even clear how to define "best" in this context, by the way). Nevertheless, the study does provide an important new insight, a result Wikström-Frisén et al. summarize as follows:

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"The results are in contrast to endurance training where negative exercise-related consequences are common when increasing the training load (Warren 2001). 

Thus, we observed no evidence that the high frequency periodized menstrual/OC cycle based resistance training resulted in exercise-related negative consequences which could contribute to a suppression of LH, FSH, and further decrease of the estradiol production (Meczekalski 2000)" (Wikström-Frisén 2016).

This conclusion is corroborated by the lack of changes in body composition and/or bone mineral density, but should still be taken with a large quantity of healthy skepticism.

Figure 3: Relative changes in lean mass (DXA data), measures power and strength (torque) in 59 trained women in response two weeks of frequent leg-training in the first or second two weeks of their estrous cycle (Wikström-Frisén. 2015).

After all, the long-term results of the 5-days-a-week approach to leg training cannot be accurately predicted based on these findings from a 4x28-day study and the higher motivation and previously detected performance increments (see Figure 3, from Wikström-Frisén 2015; learn more in my previous article about this study from 2015) speak in favor of a (maybe non-hormonal) advantage of training more intense in the first two weeks.

Read my analysis of the previous paper on this matter | learn more

So, how do I train, now? While the paper and hand suggests that it does not matter when you plan to increase the volume, a previously discussed study by the same researchers found that leg resistance training performed during the first two weeks of the menstrual/OC cycle will additionally improve physical performance in women (Wikström-Frisén 2015), the authors recommend to periodize accordingly: if you want to increase the training frequency, do it in the first two weeks of your menstrual cycle, ladies - your performance and, as the study at hand shows - your training experience will benefit! Comment on Facebook!

References:

• Meczekalski, Blazej, et al. "Hypothalamic amenorrhea with normal body weight: ACTH, allopregnanolone and cortisol responses to corticotropin-releasing hormone test." European journal of endocrinology 142.3 (2000): 280-285.
• Warren, M. P., and N. E. Perlroth. "The effects of intense exercise on the female reproductive system." Journal of Endocrinology 170.1 (2001): 3-11.
• Wikström-Frisén, Lisbeth, Carl Johan Boraxbekk, and Karin Henriksson-Larsén. "Effects on power, strength and lean body mass of menstrual/oral contraceptive cycle based resistance training." Journal of Sports Medicine and Physical Fitness (2015).
• Wikström-Frisén, Lisbeth, Carl J. Boraxbekk, and Karin Henriksson-Larsén. "Increasing training load without risking the female athlete triad: menstrual cycle based periodized training may be an answer?." The Journal of sports medicine and physical fitness (2016).

Training "On Cycle", Done Right - Women See Much Better Results When Periodization is in Line W/ Menstrual Cycle

Yes, I could have exploited the ambiguity and called this article "Training 'On Cycle', Done Right - Women See Much Better Results When Periodization is in Line W/ Their Period", but let's be honest: This is a science website and that's neither scientific, nor actually funny, is it?

As a man, I have to admit to being at best well-read, yet not experienced in all things "menstrual cycle". So, while I do only know the (very different) things I've heard from (ex-)girlfriends about how they feel during the different phases, I do know that the hormonal differences in the luteal phase, with high levels of progesterone and estrogen, and the follicular phase with low progesterone and eventually increasing estrogen levels are pronounced enough to cause much more than just mood disturbances.

For many trainers, however, the estrous cycle is still a closed book. "Can you train, or not!?" Especially male trainers are not just insensitive when they ask their protégées this question, they may also be missing out on a chance to maximize their clients' training progress. That's at least what a recent 4-months study from the Umea University in Sweden (Wikström-Frisén. 2015) suggests.

Learn more about the (often ;-) small but significant difference at the SuppVersity

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According to Wikström-Frisén and colleagues, "high frequency periodized leg resistance training during the first two weeks of the menstrual cycle is more beneficial to optimize training, than the last two weeks" (ibid. 2015). Now, "beneficial" is obviously a very loosely defined term. When I am telling you, though, that power, strength and lean body mass gains all benefited from the right timing of the workouts (in the first two weeks of the estrous cycle), I will hopefully have every women's and every trainers' attention (even though, I guess I will lose even more of the male bros, now).

Figure 1: Relative changes in lean mass (DXA data), measures power and strength (torque) in 59 trained women in response two weeks of frequent leg-training in the first or second two weeks of their estrous cycle (Wikström-Frisén. 2015).

While all the aforementioned increases in the women who trained in the first two weeks of their estrous cycle were statistically significant (for all, but the quad torque test | +4.4% the statistical significance also survived the Benferroni corrections), the women in the group for whom the periodization scheme had a focus on the second two weeks of their menstrual cycle, saw no significant changes in lean mass and power and a significant reduction in quad strength (see Figure 1). Since the latter lost its statistical power, after Benferroni corrections, though, one could say that the changes the Swedish researchers observed in the 2nd weeks group were practically meaningless.

What about women on oral contraception? The scientists recruited 32 young women on oral contraceptives and 27 women who didn't use oral contraceptives and a re-analysis of the data in Figure 1 didn't show significant inter-group differences between the two groups. In other words, the data in Figure 1 and thus the main findings are relevant for "all" resistance training young women, irrespective of whether they're taking contraceptives, or not. The only difference is that you go by the contraceptive (CC), instead of the estrous cycle and place the high frequency training period in the first, not the last two weeks of the CC cycle.

"Meaningless changes", however, are not meaningless results. In fact, the exact opposite is the case. These results tell trainers and female trainees, alike, that abandoning their protégées / their own

• regular non-periodized training, i.e. three leg training workouts per week that consisted of leg presses and leg curls (3x sets @ 8-10RM, 1-2 minutes rest between sets; progressive increase of weight by 2-10% whenever the subjects could perform 3x10 reps with a given weight) 

for 4-months and switching to a periodized 2-week high- vs. 2-week low-frequency training, where they would perform the same 48 workouts in either

• high-frequency first cycles, i.e. 5 workouts per week in the first two weeks, 1 workout per week for the last two weeks of each menstrual / contraceptive cycle, or
• high-frequency last cycles, i.e. 1 workout per week in the first two weeks, 4 workouts per week for the last two weeks of each menstrual / contraceptive cycle,

would have beneficial effects on their progress only if they increase the frequency during the early phase of the cycle. 

Figure 2: Comparison of the relative changes in the periodization group (high frequency in the first two weeks of the menstrual / CC cycle) vs. control group (three workouts per week for 4 months | Wikström-Frisén. 2015).

Ok, if you compare the periodization group to the control group which kept the regular "three workouts per week"-frequency (see Figure 2, green bars) was maintained, the "advantages" of periodizing "correctly" are not as pronounced as they are in comparison to doing it the "wrong" way. Even though, only the hamstrings appear to benefit to a large extent from periodization, though, benefits exist.

What's even more important, though, is the simple, but really important revelation (or for the few of you who have read about this before e.g. in Reis et al. (1995) "confirmation") that a woman's menstrual and similarly her contraceptive cycle must be aligned to her training schedule. Obviously, the implications will have to be further explored in future studies. Studies, of which I hope, that they will be using smarter periodization schemes which acknowledge that training only once a week is simply not enough... ;-)

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Bottom line: Before I try to put things into perspective, I should mention that the participants of the study who were recruited at local gyms, were not jut healthy, non-smokers and had regular menses, they were also experienced trainees. All of them had been doing leg presses and leg-curls for several months - in fact, on average for 3.5 years. Against that background, even non-statistical significant inter-group differences as they were observed between the periodization (5 per week, 1 per week) and the control group (3 per week) may be practically relevant, because they may help experienced trainees to break through plateaus.

With that being said, I personally think of this study as one study in a series of studies that will hopefully elucidate how women can adapt their training regimen to the repetitive changes in the hormonal milieu of their bodies.

If we are honest with ourselves, the fact that Wikström-Frisén's results come as a surprise to most of us is only further evidence of how wantonly exercise scientists and trainers, alike, have hitherto neglected the peculiarities of the female physiology and endocrinology | Comment on Facebook!

References:

• Reis, E., U. Frick, and D. Schmidtbleicher. "Frequency variations of strength training sessions triggered by the phases of the menstrual cycle." International journal of sports medicine 16.8 (1995): 545-550.
• Wikström-Frisén, L., C. J. Boraxbekk, and K. Henriksson-Larsén. "Effects on power, strength and lean body mass of menstrual/oral contraceptive cycle based resistance training." The Journal of sports medicine and physical fitness (2015).