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Pain Tolerance and Cardiorespiratory Fftness in Women with Dysmenorrhea

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Pain Tolerance and Cardiorespiratory Fftness in Women with Dysmenorrhea Rev Dor. São Paulo, 2017 oct-dec;18(4):311-5 ORIGINAL ARTICLE Pain tolerance and cardiorespiratory fitness in women with dysmenorrhea Tolerância à dor e aptidão cardiorrespiratória em mulheres com dismenorreia Fábio Marcon Alfieri1, Karoline Mayara de Aquiles Bernardo2, Yasmim da Silva Pinto2, Natália Cristina de Oliveira Vargas e Silva1, Leslie Andrews Portes1 DOI 10.5935/1806-0013.20170121 ABSTRACT RESUMO BACKGROUND AND OBJECTIVES: Hormonal changes are JUSTIFICATIVA E OBJETIVOS: As mudanças hormonais known to affect quality of life of women and may interfere in afetam a qualidade de vida das mulheres e podem interferir na pain tolerance and cardiorespiratory exercise performance. Thus, tolerância à dor e no desempenho cardiorrespiratório. Assim, o the aim of this study was to evaluate and compare pressure pain objetivo deste estudo foi avaliar e comparar o limite de tolerância tolerance threshold and cardiorespiratory fitness in women in lu- de dor à pressão e a aptidão cardiorrespiratória em mulheres nas teal and follicular phases of the menstrual cycle. fases lútea e folicular do ciclo menstrual. METHODS: University students aged 18-30 years old with a MÉTODOS: Estudantes universitárias de 18 a 30 anos de idade regular menstrual cycle were evaluated for cardiorespiratory fit- com ciclo menstrual regular foram avaliadas quanto à aptidão ness (ergospirometry), pain perception through the visual analog cardiorrespiratória (ergoespirometria), percepção de dor pela es- scale and pressure pain tolerance (algometry). cala analógica visual e tolerância de dor à pressão (algometria). RESULTS: When evaluated in follicular phase, the 13 partici- RESULTADOS: Quando avaliadas na fase folicular, as 13 par- pants exhibited a significant increase (p<0.001) in pain percep- ticipantes apresentaram aumento significativo (p<0,001) na per- tion. Follicular phase also resulted in a significant reduction in cepção da dor. A fase folicular também resultou em uma redução pressure pain tolerance in all sites evaluated (p<0.05). At rest, significativa na tolerância de dor à pressão em todos os locais follicular phase resulted in a significant increase (p<0.05) in sys- avaliados (p<0,05). Em repouso, a fase folicular resultou em um tolic and diastolic blood pressure, but no effect was observed in aumento significativo (p<0,05) na pressão arterial sistólica e di- heart rate. At peak exercise, follicular phase caused a significant astólica, mas nenhum efeito foi observado na frequência cardía- reduction (p<0.05) in heart rate and peak VO2, without signifi- ca. No pico de exercício, a fase folicular causou uma redução cantly affecting speed, test duration and indicators of metabo- significativa (p<0,05) na frequência cardíaca e no VO2 máximo, lism efficiency. sem afetar a velocidade, a duração do teste e os indicadores de CONCLUSION: Healthy women with dysmenorrhea show eficiência do metabolismo. higher pain perception in follicular phase, which results in in- CONCLUSÃO: Mulheres saudáveis ​​com dismenorreia apre- creased pain sensitivity and prejudice in hemodynamic aspects sentam maior percepção de dor na fase folicular, o que resulta at rest and during exercise, as well as in cardiorespiratory fitness, em aumento da sensibilidade à dor e prejuízo em aspectos he- without significant alterations in metabolism. modinâmicos em repouso e durante o exercício, bem como na Keywords: Dysmenorrhea, Menstrual cycle, Pain threshold, aptidão cardiorrespiratória, sem alterações significantes no me- Physical fitness. tabolismo. Descritores: Aptidão física, Ciclo menstrual, Dismenorreia, Limiar de dor. INTRODUCTION During most part of life, women deal with hormonal cycles that generally occur at every 28 days, from menarche to meno- pause, regulated by the pituitary gland and ovaries through 1. Centro Universitário Adventista de São Paulo, Mestrado em Promoção da Saúde, São gonadotropic secretions1. These hormones affect psychological Paulo, SP, Brasil. 2. Centro Universitário Adventista de São Paulo, Faculdade de Fisioterapia, São Paulo, SP, Brasil. aspects, as well as musculoskeletal sensitivity and quality of life of women2. Submitted in May 31, 2017. A regular menstrual cycle can be divided into three consecutive Accepted for publication in November 01, 2017. Conflict of interests: none – Sponsoring sources: Taxa Capes/ppgeh/UPF. phases: follicular (which starts on the first day of menstruation), ovulatory (which can last up to 3 days), and luteal (from the end Correspondence to: Estrada de Itapecerica, 5859 of ovulation to the beginning of a new menstrual flow. There 05858-001 São Paulo, SP, Brasil. are reports of clinical conditions related to these phases, such E-mail: [email protected] as insulin resistance, supraventricular tachycardia, Raynaud syn- © Sociedade Brasileira para o Estudo da Dor drome, sleeping disorders and migraine3. 311 Rev Dor. São Paulo, 2017 oct-dec;18(4):311-5 Alfieri FM, Bernardo KM, Pinto YS, Silva NC and Portes LA Although regular exercise has been reported to reduce dysmen- Participants were assessed for anthropometry and body compo- orrhea and physical and psychological symptoms4, changes in sition at their first visit to the Exercise Physiology Laboratory, cardiorespiratory fitness and function may also occur, most likely where all study evaluations occurred. Height was measured with in response to changes in body temperature and metabolism, ac- an appropriate stadiometer, and body weight was assessed in a companying hormonal curves and influencing aerobic perfor- digital scale with minimum possible clothes. Body composition mance and muscle strength3,5. Regarding cardiorespiratory fit- was assessed by tetrapolar bioelectrical impedance, after 10 min- ness, due to the growing rate of estrogen and higher secretion of utes of rest. The data collection team was composed by an exer- noradrenalin in luteal phase, a significant improvement in exer- cise physiologist and a physical therapist. cise performance might be observed. However, in premenstrual All further assessments were conducted in two specific moments stage performance exhibits a noticeable reduction related to the of the menstrual cycle1,3: premenstrual or luteal phase (10 to 15 increase in progesterone levels6. days before menstruation) and menstrual or follicular phase (be- Chantler, Mitchell and Fuller7, found a significant reduction tween the first and third day of menstruation). in time of treadmill test and in heart rate of women with dys- menorrhea exercising at follicular phase. Furthermore, there are Pain perception also studies that could not identify any changes in flexibility, Data regarding pain intensity were collected by the visual ana- muscle strength, endurance, aerobic performance and reaction log scale (VAS). VAS consists of a straight line of 10cm that has time over the menstrual cycle1,8,9. These controversies justify the “zero” (no pain) in one extremity, and “10” (maximal pain) in expansion of information about cardiorespiratory fitness along the other. Every participant was asked to mark a cross on the line the menstrual cycle, especially with regard to determinants of indicating her discomfort level. The closest to zero, the less the cardiorespiratory performance: maximal oxygen uptake (VO2 level of perceived pain, and the closest to 10, the worse perceived max), ventilation (VE), ventilatory equivalent of oxygen (VE/ pain was. VO2) and carbon dioxide (VE/VCO2), anaerobic threshold (AT) Pressure pain tolerance threshold (PPT) corresponds to the and respiratory compensation point (RCP). To the best of our amount of pressure an individual can tolerate in a given site, knowledge no study so far has explored this issue. measured in pounds by algometry (JTech Medical, Salt Lake When it comes to pain, it is more pronounced when estrogen lev- City, UT, USA). Reliability of this test has already been dem- els fall10. However, a recent review6 points out that most recent onstrated11. Pressure was applied at a 90° angle (between the studies show no changes in sensitivity to pain during the phases of stimulation surface and the stimulated point) with a constant the menstrual cycle, yet the authors report that, as there is still no speed of 1kg/s. Volunteers were evaluated by the same examiner consensus on the influence of the cycle on the sensation of pain in and equipment. The test was interrupted once the volunteer in- healthy women, more studies on this topic are necessary. dicated the onset of pain, and the final amount of force applied Therefore, the aim of this study was to evaluate and compare was recorded. PPT was assessed bilaterally at the muscles vastus pressure pain tolerance threshold and cardiorespiratory fitness in medialis, vastus lateralis, gluteus maximus, gluteus medius, il- women with dysmenorrhea in luteal and follicular phases of the iopsoas, tibialis anterior, lumbar paraspinals, lumbar quadrate, menstrual cycle. pectoralis major and trapezius, as well as at the supraspinous liga- ments between L4-S112,13. METHODS Cardiorespiratory fitness was assessed by a ramp protocol in a breath-by-breath gas analysis system (Cortex Biophysik Metalyz- This transversal observational study, female university health stu- er 3B, Stationary CPX System, Leipzig, Germany). The test was dents (nursing, physical therapy, nutrition and physical educa- conducted in a treadmill with adjustable incline and speed (Al- tion) were recruited through public announcement in the class- batroz VT2500, Vitally, São Paulo, Brazil). Data were collected rooms of
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