Advertisement

Physical activity and its effects on reproduction

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      The reproductive system is tightly coupled with energy balance, and thereby changes in the status of energy balance through changes in physical activity can impact on the reproductive system. In light of the new physical activity for health recommendations, it is therefore important to understand the inherent effects, both positive and negative, of physical activity on the reproductive system. At both extremes of the energy spectrum, disorders of chronic energy excess and energy deficiency are characterized by a wide range of reproductive disorders, including menstrual irregularity, anovulation, polycystic ovarian syndrome, and infertility in women, and erectile dysfunction and altered spermatogenesis in men. Although laboratory research indicates that individuals may be able to prevent or reverse reproductive disruptions, either by increasing energy expenditure in cases of energy excess or by dietary reform in cases of energy deficits, there is an acute need for applied research to confirm this idea and to identify mechanisms by which the availability of energy per se regulates reproductive function in humans.

      Keywords

      To read this article in full you will need to make a payment

      References

        • Arce JC
        • De Souza MJ
        • Pescatello LS
        • Luciano AA
        Subclinical alterations in hormone and semen profile in athletes.
        Fertility and Sterility. 1993; 59: 398-404
        • Ayers JW
        • Komesu Y
        • Romani T
        • Ansbacher R
        Anthropomorphic, hormonal, and psychologic correlates of semen quality in endurance-trained male athletes.
        Fertility and Sterility. 1985; 43: 917-921
        • Bachmann GA
        • Kemmann E
        Prevalence of oligomenorrhea and amenorrhea in a college population.
        American Journal of Obstetrics and Gynecology. 1982; 144: 98-102
        • Bacon CG
        • Mittleman MA
        • Kawachi I
        • et al.
        Sexual function in men older than 50 years of age: results from the health professionals follow-up study.
        Annals of Internal Medicine. 2003; 139: 161-168
        • Bagatell CJ
        • Bremner WJ
        Sperm counts and reproductive hormones in male marathoners and lean controls.
        Fertility and Sterility. 1990; 53: 688-692
        • Baker ER
        • Lueker R
        • Stumf PG
        • et al.
        Relationship of exercise to semen parameters and fertility success of artificial insemination of donors.
        Fertility and Sterility. 1984; 41: 107S
        • Baker ER
        • Mathur RS
        • Kirk RF
        • Williamson HO
        Female runners and secondary amenorrhea: correlation with age, parity, mileage, and plasma hormonal and sex-hormone-binding globulin concentrations.
        Fertility and Sterility. 1981; 36: 183-187
        • Balen AH
        • Conway GS
        • Kaltsas G
        • et al.
        Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients.
        Human Reproduction. 1995; 10: 2107-2111
        • Bauman AE
        Updating the evidence that physical activity is good for health: an epidemiological review 2000–2003.
        Journal of Science and Medicine in Sport. 2004; 7: 6-19
        • Beals KA
        • Manore MM
        Disorders of the female athlete triad among collegiate athletes.
        International Journal Sport, Nutrition, Exercise and Metabolism. 2002; 12: 281-293
        • Bjercke SP
        • Dale O
        • Tanbo T
        • et al.
        Impact of insulin resistance on pregnancy complications and outcome in women with polycystic ovary syndrome.
        Gynecology and Obstetric Investigation. 2002; 54: 94-98
        • Bonde JP
        • Ernst E
        • Jensen TK
        • et al.
        Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners.
        Lancet. 1998; 352: 1172-1177
        • Bronson FH
        • Manning JM
        The energetic regulation of ovulation: a realistic role for body fat.
        Biology of Reproduction. 1991; 44: 945-950
        • Bullen BA
        • Skrinar GS
        • Beitins IZ
        • et al.
        Induction of menstrual disorders by strenuous exercise in untrained women.
        New England Journal of Medicine. 1985; 312: 1349-1353
        • Burrows M
        • Nevill AM
        • Bird S
        • Simpson D
        Physiological factors associated with low bone mineral density in female endurance runners.
        British Journal of Sports Medicine. 2003; 37: 67-71
        • Calle EE
        • Teras LR
        • Thun MJ
        Adiposity and physical activity as predictors of mortality.
        New England Journal of Medicine. 2005; 352 (author reply 1381–1384): 1381-1384
        • Carroll S
        • Dudfield M
        What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome.
        Sports Medicine. 2004; 34: 371-418
        • Chen EC
        • Brzyski RG
        Exercise and reproductive dysfunction.
        Fertility and Sterility. 1999; 71: 1-6
        • Clark AM
        • Thornley B
        • Tomlinson L
        • et al.
        Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment.
        Human Reproduction. 1998; 13: 1502-1505
        • Clark AM
        • Ledger W
        • Galletly C
        • et al.
        Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women.
        Human Reproduction. 1995; 10: 2705-2712
        • Constantini NW
        • Warren MP
        Menstrual dysfunction in swimmers: a distinct entity.
        Journal of Clinical Endocrinology and Metabolism. 1995; 80: 2740-2744
        • Crosignani PG
        • Colombo M
        • Vegetti W
        • et al.
        Overweight and obese anovulatory patients with polycystic ovaries: parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet.
        Human Reproduction. 2003; 18: 1928-1932
        • Dahlgren E
        • Janson PO
        • Johansson S
        • et al.
        Polycystic ovary syndrome and risk for myocardial infarction. Evaluated from a risk factor model based on a prospective population study of women.
        Acta Obstetrica Gynecology Scandinavia. 1992; 71: 599-604
        • Dal Grande E
        • Gill T
        • Taylor AW
        • et al.
        Obesity in South Australian adults–prevalence, projections and generational assessment over 13 years.
        Australia and New Zealand Journal of Public Health. 2005; 29: 343-348
        • De Souza MJ
        • Arce JC
        • Pescatello LS
        • et al.
        Gonadal hormones and semen quality in male runners. A volume threshold effect of endurance training.
        International Journal of Sports Medicine. 1994; 15: 383-391
        • Department of Health and Human Services and Department of Agriculture
        Dietary Guidelines for Americans. Agriculture Department, Human Nutrition Information Service and Health and Human Services Department, Washington DC, USA2005
        • Esposito K
        • Giugliano F
        • Di Palo C
        • et al.
        Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial.
        Journal of the American Medical Association. 2004; 291: 2978-2984
        • Farquhar CM
        • Birdsall M
        • Manning P
        • et al.
        The prevalence of polycystic ovaries on ultrasound scanning in a population of randomly selected women.
        Australia and New Zealand Journal of Obstetrics and Gynaecology. 1994; 34: 67-72
        • Flegal KM
        • Carroll MD
        • Kuczmarski RJ
        • Johnson CL
        Overweight and obesity in the United States: prevalence and trends, 1960–1994.
        International Journal of Obesity and Related Metabolic Disorders. 1998; 22: 39-47
        • Foreyt JP
        • Poston WS
        Obesity: a never-ending cycle?.
        International Journal of Fertility and Womens Medicine. 1998; 43: 111-116
        • Friedl KE
        • Moore RJ
        • Hoyt RW
        • et al.
        Endocrine markers of semistarvation in healthy lean men in a multistressor environment.
        Journal of Applied Physiology. 2000; 88: 1820-1830
        • Frisch RE
        • McArthur JW
        Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset.
        Science. 1974; 185: 949-951
        • Gambineri A
        • Pelusi C
        • Vicenatti V
        • et al.
        Obesity and the polycystic ovary syndrome.
        International Journal of Obesity and Related Metabolic Disorders. 2002; 26: 883-896
        • Gebreegziabher Y
        • Marcos E
        • McKinon W
        • Rogers G
        Sperm characteristics of endurance trained cyclists.
        International Journal of Sports Medicine. 2004; 25: 247-251
        • Hackney AC
        The male reproductive system and endurance exercise.
        Medicine and Science in Sports and Exercise. 1996; 28: 180-189
        • Hackney AC
        • Dolny DG
        • Ness RJ
        Comparison of resting reproductive hormonal profiles in select athletic groups.
        Biology of Sport. 1988; 4: 200-204
        • Hakkinen K
        • Pakarinen A
        • Alen M
        • et al.
        Relationships between training volume, physical performance capacity, and serum hormone concentrations during prolonged training in elite weight lifters.
        International Journal of Sports Medicine. 1987; 8: 61-65
        • Hamilton-Fairley D
        • Kiddy D
        • Watson H
        • et al.
        Association of moderate obesity with a poor pregnancy outcome in women with polycystic ovary syndrome treated with low dose gonadotrophin.
        British Journal of Obstetrics and Gynaecology. 1992; 99: 128-131
        • Hartz AJ
        • Barboriak PN
        • Wong A
        • et al.
        The association of obesity with infertility and related menstural abnormalities in women.
        International Journal of Obesity. 1979; 3: 57-73
        • Hoeger KM
        • Kochman L
        • Wixom N
        • et al.
        A randomized, 48-week, placebo-controlled trial of intensive lifestyle modification and/or metformin therapy in overweight women with polycystic ovary syndrome: a pilot study.
        Fertility and Sterility. 2004; 82: 421-429
        • Hollmann M
        • Runnebaum B
        • Gerhard I
        Impact of waist-hip-ratio and body-mass-index on hormonal and metabolic parameters in young, obese women.
        International Journal of Obesity and Related Metabolic Disorders. 1997; 21: 476-483
        • Hu FB
        • Willett WC
        • Li T
        • et al.
        Adiposity as compared with physical activity in predicting mortality among women.
        New England Journal of Medicine. 2004; 351: 2694-2703
        • Huber-Buchholz MM
        • Carey DG
        • Norman RJ
        Restoration of reproductive potential by lifestyle modification in obese polycystic ovary syndrome: role of insulin sensitivity and luteinizing hormone.
        Journal of Clinical Endocrinology and Metabolism. 1999; 84: 1470-1474
        • Jensen TK
        • Andersson AM
        • Jorgensen N
        • et al.
        Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men.
        Fertility and Sterility. 2004; 82: 863-870
        • Kaye SA
        • Folsom AR
        • Prineas RJ
        • et al.
        The association of body fat distribution with lifestyle and reproductive factors in a population study of postmenopausal women.
        International Journal of Obesity. 1990; 14: 583-591
        • Kiddy DS
        • Hamilton-Fairley D
        • Bush A
        • et al.
        Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome.
        Clinical Endocrinology (Oxford). 1992; 36: 105-111
        • Kirchengast S
        • Huber J
        Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome.
        Human Reproduction. 2001; 16: 1255-1260
        • Koloszar S
        • Daru J
        • Kereszturi A
        • et al.
        Effect of female body weight on efficiency of donor AI.
        Archives in Andrology. 2002; 48: 323-327
        • Leibovitch I
        • Mor Y
        The vicious cycling: bicycling related urogenital disorders.
        European Urology. 2005; 47: 277-286
        • Lord JM
        • Flight IH
        • Norman RJ
        Metformin in polycystic ovary syndrome: systematic review and meta-analysis.
        British Medical Journal. 2003; 327: 951-953
        • Loucks AB
        • Thuma JR
        Luteinizing hormone pulsatility is disrupted at a threshold of energy availability in regularly menstruating women.
        Journal of Clinical Endocrinology and Metabolism. 2003; 88: 297-311
        • Loucks AB
        • Verdun M
        • Heath EM
        Low energy availability, not stress of exercise, alters LH pulsatility in exercising women.
        Journal of Applied Physiology. 1998; 84: 37-46
        • Lucia A
        • Chicharro JL
        • Perez M
        • et al.
        Reproductive function in male endurance athletes: sperm analysis and hormonal profile.
        Journal of Applied Physiology. 1996; 81: 2627-2636
        • McColl EM
        • Wheeler GD
        • Gomes P
        • et al.
        The effects of acute exercise on pulsatile LH release in high-mileage male runners.
        Clinical Endocrinology (Oxford). 1989; 31: 617-621
        • Moran LJ
        • Noakes M
        • Clifton PM
        • et al.
        Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome.
        Journal of Clinical Endocrinology and Metabolism. 2003; 88: 812-819
        • Myers J
        • Kaykha A
        • George S
        • et al.
        Fitness versus physical activity patterns in predicting mortality in men.
        American Journal of Medicine. 2004; 117: 912-918
        • Norman RJ
        • Noakes M
        • Wu R
        • et al.
        Improving reproductive performance in overweight/obese women with effective weight management.
        Human Reproduction Update. 2004; 10: 267-280
        • Pasquali R
        • Gambineri A
        Role of changes in dietary habits in polycystic ovary syndrome.
        Reproductive BioMedicine Online. 2004; 8: 431-439
        • Pate RR
        • Pratt M
        • Blair SN
        • et al.
        Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.
        Journal of the American Medical Association. 1995; 273: 402-407
        • Pettersson F
        • Fries H
        • Nillius SJ
        • et al.
        Epidemiology of secondary amenorrhea. I. Incidence and prevalence rates.
        American Journal of Obstetrics and Gynecology. 1973; 117: 80-86
        • Polson DW
        • Kiddy DS
        • Mason HD
        • Franks S
        Induction of ovulation with clomiphene citrate in women with polycystic ovary syndrome: the difference between responders and nonresponders.
        Fertility and Sterility. 1989; 51: 30-34
        • Redman LM
        • Loucks AB
        Menstrual disorders in athletes.
        Sports Medicine. 2005; 35: 747-755
        • Rich-Edwards JW
        • Goldman MB
        • Willett WC
        • et al.
        Adolescent body mass index and infertility caused by ovulatory disorder.
        American Journal of Obstetrics and Gynecology. 1994; 171: 171-177
        • Rickenlund A
        • Carlstrom K
        • Ekblom B
        • et al.
        Hyperandrogenicity is an alternative mechanism underlying oligomenorrhea or amenorrhea in female athletes and may improve physical performance.
        Fertility and Sterility. 2003; 79: 947-955
        • Roberts AC
        • McClure RD
        • Weiner RI
        • Brooks GA
        Overtraining affects male reproductive status.
        Fertility and Sterility. 1993; 60: 686-692
        • Roemmich JN
        • Sinning WE
        Weight loss and wrestling training: effects on growth-related hormones.
        Journal of Applied Physiology. 1997; 82: 1760-1764
        • Rogers J
        • Mitchell Jr, GW
        The relation of obesity to menstrual disturbances.
        New England Journal of Medicine. 1952; 247: 53-55
        • Rosen RC
        • Riley A
        • Wagner G
        • et al.
        The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction.
        Urology. 1997; 49: 822-830
        • Rosetta L
        • Harrison GA
        • Read GF
        Ovarian impairments of female recreational distance runners during a season of training.
        Annals of Human Biology. 1998; 25: 345-357
        • Rotterdam ESHRE/ASRM-Sponsored Consensus Workshop Group
        Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.
        Fertility and Sterility. 2004; 81: 19-25
        • Ryder JW
        • Gilbert M
        • Zierath JR
        Skeletal muscle and insulin sensitivity: pathophysiological alterations.
        Frontiers in Bioscience. 2001; 6: D154-D163
        • Sanborn CF
        • Martin BJ
        • Wagner Jr, WW
        Is athletic amenorrhea specific to runners?.
        American Journal of Obstetrics and Gynecology. 1982; 143: 859-861
        • Schneider JE
        Energy balance and reproduction.
        Physiology and Behavior. 2004; 81: 289-317
        • Schwarzer U
        • Wiegand W
        • Bin Saleh A
        • et al.
        Genital numbness and impotence rate in long distance cyclists.
        Journal of Urology. 1999; 161: 178
        • Shah M
        • Hannan PJ
        • Jeffery RW
        Secular trend in body mass index in the adult population of three communities from the upper mid-western part of the USA: the Minnesota Heart Health Program.
        International Journal of Obesity. 1991; 15: 499-503
        • Singh KB
        Menstrual disorders in college students.
        American Journal of Obstetrics and Gynecology. 1981; 140: 299-302
        • Solomon S
        • Cappa KG
        Impotence and bicycling. A seldom-reported connection.
        Postgraduate Medicine. 1987; 81 (102): 99-100
        • Sommer F
        • Konig D
        • Graft C
        • et al.
        Impotence and genital numbness in cyclists.
        International Journal of Sports Medicine. 2001; 22: 410-413
        • Stubbs CO
        • Lee AJ
        The obesity epidemic: both energy intake and physical activity contribute.
        Medical Journal of Australia. 2004; 181: 489-491
        • van der Spuy ZM
        • Dyer SJ
        The pathogenesis of infertility and early pregnancy loss in polycystic ovary syndrome.
        Best Practice in Research Clinical Obstetrics and Gynaecology. 2004; 18: 755-771
        • Veldhuis JD
        • Evans WS
        • Demers LM
        • et al.
        Altered neuroendocrine regulation of gonadotropin secretion in women distance runners.
        Journal of Clinical Endocrinology and Metabolism. 1985; 61: 557-563
        • Wade GN
        • Schneider JE
        Metabolic fuels and reproduction in female mammals.
        Neuroscience and Biobehavior Reviews. 1992; 16: 235-272
        • Walczak MK
        • Lokhandwala N
        • Hodge MB
        • Guay AT
        Prevalence of cardiovascular risk factors in erectile dysfunction.
        Journal of Gender Specific Medicine. 2002; 5: 19-24
        • Wang JX
        • Davies MJ
        • Norman RJ
        Obesity increases the risk of spontaneous abortion during infertility treatment.
        Obesity Research. 2002; 10: 551-554
        • Wass P
        • Waldenstrom U
        • Rossner S
        • Hellberg D
        An android body fat distribution in females impairs the pregnancy rate of in-vitro fertilization-embryo transfer.
        Human Reproduction. 1997; 12: 2057-2060
        • Wheeler GD
        • Wall SR
        • Belcastro AN
        • Cumming DC
        Reduced serum testosterone and prolactin levels in male distance runners.
        Journal of the American Medical Association. 1984; 252: 514-516
        • Williams NI
        • Caston-Balderrama AL
        • Helmreich DL
        • et al.
        Longitudinal changes in reproductive hormones and menstrual cyclicity in cynomolgus monkeys during strenuous exercise training: abrupt transition to exercise-induced amenorrhea.
        Endocrinology. 2001; 142: 2381-2389
        • Williams NI
        • Helmreich DL
        • Parfitt DB
        • et al.
        Evidence for a causal role of low energy availability in the induction of menstrual cycle disturbances during strenuous exercise training.
        Journal of Clinical Endocrinology and Metabolism. 2001; 86: 5184-5193
        • World Health Organization
        • Vayena E
        • Rowe PJ
        • Griffin PD
        Current Practices and Controversies in Assisted Reproduction. Medical, Ethical and Social Aspects of Assisted Reproduction. World Health Organization, Geneva2002
        • Zaadstra BM
        • Seidell JC
        • Van Noord PA
        • et al.
        Fat and female fecundity: prospective study of effect of body fat distribution on conception rates.
        British Medical Journal. 1993; 306: 484-487

      Biography

      Dr Leanne Redman is a senior post-doctoral fellow in the Health and Performance Enhancement division at the Pennington Biomedical Research Centre. She is the recipient of a Neil Hamilton-Fairley clinical training fellowship from the NH & MRC in Australia and holds a joint appointment with Centre for Reproductive Health at the University of Adelaide, Australia. Her research is focused on studies of energy balance and physical activity on reproductive health in women.