Managing Hormonal Imbalances Through Rehabilitation

Physiotherapists should have a basic understanding of the endocrine system and how hormones are regulated, as it can influence their approach to rehabilitation and exercise plan prescribed to patients.

Role of Physiotherapy in Managing Musculoskeletal Aspects of Hormonal Problems

• Osteoporosis - help improve bone density and reduce the risk of fractures.
• Diabetes - diabetic neuropathy
• Hypothyroidism - manage muscle weakness and joint pain
• Hyperthyroidism - manage muscle weakness, tremors, and heart palpitations
• Polycystic Ovary Syndrome (PCOS) - comprehensive approach to managing like weight gain and insulin resistance
• Growth Hormone Disorders - address developmental delays and musculoskeletal issues.
• Cushing's Syndrome - syndrome manage muscle weakness and osteoporosis associated with the condition.
• Adrenal Disorders - muscle weakness and fatigue
• Menopause-related Symptoms - issues like pelvic floor dysfunction, incontinence, and musculoskeletal pain
• Hormone Replacement Therapy (HRT) - experience changes in muscle mass and bone density

Insulin

Insulin works in two major domains that affect individual’s capacity to perform exercise i.e. energy metabolism and glucose utilization during physical activity.

How insulin affects exercise physiology:

Glucose Uptake (especially during higher-intensity activities):

This is important for maintaining stable energy levels during exercise.

• Exercise  ➡ increased muscle contraction  ➡ increase glucose uptake into muscles cell ➡ lowering blood sugar levels

Protein Synthesis:

• Resistance exercise ➡ transport of amino acids into muscle cells ➡ muscle recovery plus adaptation
• endurance activities ➡ reducing muscle protein breakdown ➡ preserve muscle mass and provide energy

Fat Metabolism:

• lower-intensity but long duration activities ➡ increased fat oxidation ➡ even with elevated insulin levels 

Hormonal Response:

• Intense exercise ➡ adrenaline released ➡ opposes effect of insulin ➡ promoting glucose release from the liver

 

Glucagon:

Glucagon is produced by the pancreas and has important effects on exercise physiology. Here's how glucagon influences exercise:

• stored in liver ➡ during prolonged or endurance exercise ➡ converted to glucose
• prevent hypoglycemia ➡ increasing glucose release from liver (example - diabetes)
• promote fat Metabolism ➡ during endurance activities
• glucagon counteracts effects of insulin ➡ glucose uptake by muscle cells ➡ ensuring balance of glucose availability 

 

Cortisol: 

Cortisol, known as the "stress hormone," plays a important role in exercise physiology. It is produced by the adrenal glands and can have both positive and negative effects. Here's how cortisol affects exercise:

Carbohydrate Metabolism:

• promoting gluconeogenesis ➡ during long duration or intense activities

Anti-Inflammatory Response:

• suppress inflammation ➡ exercise-induced muscle inflammation
• excessive cortisol release ➡ suppression of the immune system ➡ susceptible to illness

Protein Breakdown:

• prolonged exercise ➡ break down muscle tissue ➡ for energy ➡ exceeds muscle repair ➡ muscle loss

Fat Metabolism:

• promotes lipolysis ➡ low-intensity, longer-duration activities
• chronic stress ➡ high levels of cortisol ➡ fat storage especially in abdominal areas

Blood Pressure Regulation: 

• It can increase blood pressure in response to the increased demand for oxygen and nutrients by working muscles. This can help maintain adequate blood flow to these muscles.

Adrenaline (Epinephrine)

Adrenaline act as a hormone and neurotransmitter. It causes "fight or flight" response, which is the body's acute stress response to a perceived threat. Adrenaline has several important effects:

• Increased Heart Rate - allows heart to pump more blood thus providing nutrients to the muscles helping meet the increased demand for oxygen
• Improved Cardiac Output - adrenaline enhances cardiac output, which is the amount of blood the heart pumps per minute
• Adrenaline dilates the bronchioles in the lungs ➡ increased air intake ➡ improved oxygen delivery to the bloodstream 
• Enhanced Blood Flow to Muscles - by constricting blood vessels in areas like the skin and digestive system where requirement is less 
• Utilization of Stored Glycogen - adrenaline stimulates the breakdown of glycogen ➡ immediate use during exercise
• It also promotes the release of fatty acids from adipose tissue ➡  used for long duration exercises
• Improves Muscle Strength - advantageous for short bursts of intense activity, such as sprinting or lifting heavy weights
• Adrenaline improves mental alertness, reaction time, and concentration ➡ used for activities that require quick decision-making and precise motor skills
• Reduce perception of pain ➡  mostly during high-intensity exercise

 

Thyroid Hormones (T3 and T4): 

Metabolic Rate:

• Metabolic Rate increase ➡ in individuals with increase levels of thyroid hormones tend to burn more calories even when they're not exercising
• Enhance the breakdown of carbohydrates, fats, and proteins allowing for energy production during exercise

Cardiovascular Function:

• increase in thyroid hormones ➡ higher heart rate ➡ can enhance exercise capacity and the delivery of oxygen to muscles

Protein Metabolism:

• promote muscle protein synthesis ➡ important for exercise adaptation and recovery

Abnormalities:

• hypothyroidism ➡ lead to intolerance to cold which can impact exercise performance, especially in cold environments
• associated with symptoms like fatigue, depression, and reduced motivation, which can affect an individual's willingness to engage in physical activity
• hyperthyroidism ➡ experience weight loss due to increased fat metabolism. impact body composition and, to some extent, exercise performance

  

Testosterone: 

• enhances protein synthesis in muscle cells leading to muscle hypertrophy and maintaining of muscle mass.
• strenuous workouts ➡ testosterone supports repair and growth of muscle tissue, enabling individuals to recover more quickly
• for maintaining bone density and strength ➡ promotes the production of bone-forming cells and helps prevent bone loss ➡ useful in high-impact activities
• stimulates the production of red blood cells (erythropoiesis)
• higher testosterone level can support the reduction of body fat  

Estrogen:

• it influence the development of lean muscle mass which aid individuals mainly female to build and maintain muscle strength, which is important for overall exercise performance
• helps maintain bone density ➡ Reduced estrogen levels ➡ during menopause ➡ higher risk of osteoporosis and fractures (thus engage in weight bearing and resistance exercises for proper bone health) 
• higher estrogen levels leads to increased energy and motivation.
• higher estrogen levels are associated with more fat storage in the hips and thighs
• Changes in estrogen levels can affect ligament and tendon laxity ➡ increasing the risk of injury

 

Melatonin 

• regulate sleep patterns and promotes restful sleep ➡ body repairs and regenerates muscle tissue
• maintain the body's circadian rhythms ➡ morning exercisers experience different physiological responses compared to those in the evening

Growth Hormone (GH):

• promotes the synthesis of proteins and the development of lean muscle mass ➡ resistance training are helpful
• promotes lipolysis ➡ reduction of body fat
• promotes bone growth ➡ reduce the risk of osteoporosis and fracture ➡ weight-bearing exercises useful
• development and repair of cartilage and connective tissues
• increase exercise capacity ➡ improving oxygen transport ➡ erythropoiesis ➡ greater oxygen-carrying capacity in the blood

Parathyroid hormone (PTH)

Calcium Homeostasis:

• increases the concentration of calcium ➡ stimulating the release of calcium from bones and increasing calcium reabsorption in the kidneys ➡ during high-intensity exercise ➡ the demand for calcium in muscle contraction and neuromuscular function increases

Bone Health:

• promote bone resorption (breakdown) and bone formation ➡ contributing to bone adaptation and strengthening in response to exercise

Mineral Balance:

• regulates phosphate levels in the blood balance during physical activity

Vitamin D Metabolism:

• stimulates production of active vitamin D (calcitriol) ➡ essential for calcium absorption in the intestines

 

Calcitonin:

• Calcitonin helps regulate bone density and the balance of calcium in the body ➡  weight-bearing and resistance exercises have profound impact on bone health by promoting bone growth, density, and strength.
• reducing bone resorption (breakdown) ➡ important for high-impact and weight-bearing activities that place stress on the bones.

Aldosterone:

• Fluid Balance Maintain ➡ reabsorption of sodium and water ➡ expansion of blood volume ➡ adequate blood pressure ➡ to prevent dehydration
• electrolytes like potassium and magnesium ➡ proper muscle function ➡ During prolonged or intense exercise
• imbalance in electrolytes ➡ can lead to muscle cramps and fatigue
• Proper kidney function ➡  maintain the body's acid-base balance. During exercise, the kidneys play a role in clearing metabolic waste products produced by working muscles
• Vasopressin (Antidiuretic Hormone, ADH) ➡ Regulates water balance and blood pressure