fitness · research

Of mice, men, and morning/evening exercise: the commenters weigh in

On Saturday I posted about a new study investigating whether morning or evening exercise is better (in what sense? they don’t say) for us. Spoiler: it doesn’t matter, at least as far as they know.

The investigators did their study using mice– male mice in particular. This did not go unnoticed by me, and certainly was noted plenty in the comments section.

The male bias remains. Even with mice.
The male bias remains. Even with mice.
Don't the most reliable studies include, uh, how do you say, women?
Don’t the most reliable studies include, uh, how do you say, women?
Let me know when researchers bother to study women and then I'll pay attention to them.
Let me know when researchers bother to study women and then I’ll pay attention to them.

Some made inquiries about where the female mice might be, along with plausible explanations:

Maybe no female mice were available.

Someone suggested they (the female mice) were tied up with other duties.

The females were holding the community together, as expected.

There were commenters who tried to defend the use of male-only mouse subjects on grounds of it-being-too-hard-to-do-science-on-female-organisms. Yeah, we’ve heard that before.

Longish quote claiming that organisms with estrogen cycles are way too complicated (and expensive) to do research on. Ah, okay.
Claim that organisms with estrogen cycles are way too complicated (and expensive) to do research on. Ah, okay.

You didn’t think I was going to let that one get by me, did you?

My response: testosterone cycles are complicated. Estrogen cycles are complicated. We don’t favor one over the other in doing research science. That would wrong. The NIH agrees.

Another attempted defense of the men-mice-only research plan came from this comment:

Using males and females in the same study would result in inadvertent mating, primarily among the most popular mice. ???
Using males and females in the same study would result in inadvertent mating, primarily among the most popular mice. ???

There’s a lot here, but let me just say that the mice could be held in separate cages, which would provide a low-tech solution. Am I missing something here?

In response to the male-mice-only defenders, someone suggested maybe doing more and better science might solve the air of mystery surrounding the ovulation cycles of female mice.

If we don't understand something, we should study it more. Duh.
If we don’t understand something, we should study it more. Duh.

And I’m sure this person was trying to help, but…

Bring out the lady mice!
Bring out the lady mice!

Finally, someone got to the heart of the matter, pointing out what scientifically aware readers want to know:

What we need to know is when is the best time to exercise to metabolize cheese? These subjects should be experts on the matter…

Readers, what do you think? Do you personally know any female mice who’ve been turned down for science experiments? Have you metabolized cheese after-hours or only during daylight? Is ovulation too mind-blowing even to think about, much less study in a scientific fashion? I’m hoping that future comments sections will enlighten me as much as this one opened up a host of new questions…

fitness · research

Why it doesn’t matter whether you exercise in the morning or evening

This week, the NY Times published an article with the headline “Is is better to exercise in the morning or evening?” The answer, when I dug into their article and the original research paper, was this: we learned many groovy facts about male mouse metabolism this week, but we still don’t know what time of day is best for you (a human) to exercise. Or even them (the mice), really.

Huh. You might be wondering why, after the NYT went to all the trouble to write this headline, that they don’t have an answer for us. And then there are those scientific researchers, who published this paper that shows a lot of results and many beautiful multicolored charts and graphs.

And yet. I maintain that we still don’t know what time of day is better for exercising. Why not? Here are some reasons.

No one has worked out and gotten other people to agree about what counts as a “better” or “best” time to exercise. Better in what sense? Feels best? Burns the most calories? Burns the least calories? Results in quickest muscle recovery? Contributes most efficiently to this or that training goal?

These are all really different ways to optimize on an exercise session. The researchers do mention time-dependent metabolic processes and effects on the mice-bros, but don’t offer general recommendations. The NYT article cites some studies (here and here) done on type-2 diabetic dudes (always and only the dudes… sigh) that show preferential effects from afternoon exercise. But that’s a particular sub-group, so the results don’t apply to everyone.

This study was done ON MICE. So, any effects they found, they found IN MICE. Yes, animal studies are common and often helpful in directing further investigation. But these results don’t tell us much of anything about humans. Which is no one’s fault, because the research subjects were MICE.

Mouse on a mouse-exercise wheel. Go mouse, go!
Mouse on a mouse-exercise wheel.

The study used only male subjects. In this case, it was male mice. Argh. So, if you’re a non-male person reading this, then you can’t know if the study results (if they had something even approaching advisory, which they don’t) apply to you. This is not a one-off case. Recall the research articles the NYT cited testing the metabolic effects of different exercise times on type-2 diabetes. They only used male subjects, too.

Woman fit to be tied, about to pull her hair out. Yeah, that's me.
Woman fit to be tied, about to pull her hair out. Yeah, that’s me (metaphorically).

What the research article never mentions and what the NYT saves until the end of their piece is the number one reason why it doesn’t matter whether I exercise in the morning or evening: the best time to exercise is the time I actually can and will and do exercise; it doesn’t matter when I move; it matters THAT I move. Here’s what the NYT said:

…as additional studies build on this one’s results, we may become better able to time our workouts to achieve specific health goals. Follow-up studies likely will tell us, for instance, if an evening bike ride or run might stave off diabetes more effectively than a morning brisk walk or swim.

But for now, Dr. Chow said, “the best time for people to exercise would be whenever they can get a chance to exercise.”

Yes, I can fully endorse that recommendation.

Readers, do you need to know what ways you can optimize on your physical activity? Do these results matter to you? Do you have your own optimal times, or do you mix it up in your workout schedule? I’d love to hear from you.

fitness · health · research

Are pushups and grip strength the Magic 8 balls of longevity?

There are so many questions we don’t have answers for. Some are extremely important, like “what will life with COVID be like in 2-5 years?” Others are less serious but perhaps more urgent, as in “should I keep those bananas around another day in hopes of actually making banana bread, or give up and throw them out?”

Comic with old  banana saying it will be banana bread, and other banana (who is smoking) says "nobody is ever banana bread".
I never knew some bananas smoked.

Another area where we spend a lot of time and money searching for answers is human longevity. How long will we live? What will help us live longer? What will help us live better?

Chickens discussing bucket lists. One said that chickens don't do that because of the whole KFC thing.
Apparently, bucket list comics are a whole sub-genre.

A few years ago, I wrote about the sit-rise test, a candidate predictor of life expectancy. Sam wrote about it before me (we keep track of these things, so you don’t have to).

But life expectancy prediction science has moved on to other things, namely grip strength and pushups. What is their current revealed wisdom?

Magic 8 ball image saying "concentrate and ask again".
Magic 8 ball image saying “concentrate and ask again”.

Okay. WHAT DO WE KNOW ABOUT GRIP STRENGTH AND PUSHUPS AS PREDICTORS OF LIFE EXPECTANCY? (I thought louder might help).

In this 2019 Atlantic article, the author cites several studies that suggest grip strength is associated with mortality risk:

In 2018, a study of half a million middle-aged people found that lung cancer, heart disease, and all-cause mortality were well predicted by the strength of a person’s grip.

Yes, how hard you can squeeze a grip meter. This was a better predictor of mortality than blood pressure or overall physical activity. A prior study found that grip strength among people in their 80s predicted the likelihood of making it past 100. Even more impressive, grip strength had good predictive ability in a study among 18-year-olds in the Swedish military on cardiovascular death 25 years later.

So what’s going on here? Grip strength is standing in as a proxy for muscle strength and (possibly erroneously) fitness in people as they age. Muscle strength decreases as we age. There’s not overall consensus on how, at what rates, where, for whom, and why, though.

More importantly, health science doesn’t know to what extent muscle loss is genetic or the result of physical activity and nutrition. In this Washington Post article, one researcher even says that grip strength doesn’t necessarily change with exercise. If that’s the case, then why are these articles using this correlation to admonish us to get out there and exercise more (including, I assume, grabbing lots of heavy things)?

The Magic 8 Ball says, "don't ask me".
The Magic 8 Ball says, “don’t ask me”.

This Atlantic article does have an answer. But first, a few words about the potentially prognosticatory properties of pushups.

In a study done on firefighters, researchers found that pushup tests were better at predicting cardiovascular disease than a standard treadmill stress test. Some experts think this result could extend to the general population.

“Push-ups are another marker in a consistent story about whole-body exercise capacity and mortality,” says Michael Joyner, a researcher at the Mayo Clinic whose work focuses on the limits of human performance. “Any form of whole-body engagement becomes predictive of mortality if the population is large enough.”

Hmmm… I guess this means we can just set up hula hoop testing at the local registries of motor vehicles and polling places, and then we’ll know all we need to about people’s overall health?

You've got to be kidding. I'm with you, Magic 8 ball.
You’ve got to be kidding. I’m with you, Magic 8 ball.

What makes health expects so psyched about these sorts of one-and-done health tests is that they are 1) cheap; 2) quick and easy to administer; and 3) believed to offer a snapshot of someone’s overall physical capacities, says the Atlantic article. But do we know this, above and beyond the broad population correlation studies (which have their own limitations)?

No, says Magic 8 Ball.
No.

We do know, for instance, that grip strength declines over time in the absence of disease. We know that osteoarthritis and lots of other common physical conditions interfere with pushup abilities. We don’t know how lower grip strength in younger populations correlates with anything. And, we have no idea whether these statistically significant mortality risks are clinically significant (that is, whether the increased risk will translate into diagnosed clinical conditions).

We do have a lot of evidence that physical activities of many sorts are good for us. They can feel good, they can help us feel good after doing them, and they can bring us together with other people, which also feels good. That’s good.

One last question, Magic 8 Ball: will I make banana bread with those overripe bananas in my kitchen?

All signs point to yes, or maybe no.
All signs point to yes, or maybe no.

Readers, what do you think about these one-and-done overall life expectancy tests? Are you working on your grip strength while reading this? Let me know what you think.

fitness · research

What’s in a name? A lot, if the word ‘obesity’ is gone

Instead of opening my post by chatting and eventually getting around to my topic, let me make like a journalist and offer an actual lede. Here goes:

The main research center for food policy and weight discrimination research, the Rudd Center, just changed its name this week.

You may be thinking, okay, thanks for the info. Now onto the next thing.

Hang on a sec! I forgot the most important part of the name change. The Rudd Center used to be called The Rudd Center for Food Policy and Obesity.

Logo of the UConn Rudd Center for Food Policy and Obesity (with a globe that looks like an apple)

As of Monday (that’s when I got the email), the Rudd Center had changed its name to The Rudd Center for Food Policy and Health.

New banner for the UConn Rudd Center for Food Policy and Health, with apple graphic on the left and image of extremely cute kid in the background, possibly holding a piece of fruit.
New banner for the UConn Rudd Center for Food Policy and Health, with apple graphic on the left and image of extremely cute kid in the background, possibly holding a piece of fruit.

Wow.

A "wow" emoji as the o in wow, for emphasis. Cool.
A “wow” emoji as the o in wow, for emphasis. Cool.

This is big. No longer using the word “obesity” which I really dislike (read more about why in my post here) represents a shift in the ways a major research and policy center thinks and acts about food practices and population health. Here’s what the Rudd folks have to say about it:

This change reflects how our work has evolved over the past 15 years. When the Rudd Center was founded, the majority of our research focused on strategies to reduce obesity rates. Although many of our current initiatives remain grounded in the idea that improving the food environment will promote better nutrition, we now study a range of health outcomes, and focus on several specific populations. Among our newer areas of work are: food insecurity; the whole school, whole community, whole child model; minimum wage policies; and LGBTQ youth.  

We remain dedicated to using research to inform policy; fighting weight bias and discrimination through research, education, and advocacy; studying the social, economic, and structural drivers of diet quality and health equity; and reducing the harm of food marketing to youth. 

For years, the Rudd Center has been at the vanguard of research into ways our industrial food system and flawed healthcare system harms children, exacerbates health disparities and discriminates against fatter people. But this conscious and very public shift away from research on obesity rates, including getting rid of that word (ob*sity), sends a clear message: we’re not interested in researching about body weight. We’re interested in researching about food policy, access and discrimination. Here’s what they’re focusing on these days:

  • early care and education
  • food marketing
  • food policy
  • food security
  • schools
  • weight bias and stigma
List of research areas from Rudd Center website

Name changes are powerful. They signify changes in identity, changes in the ways we view the world and changes in the ways we view ourselves. This name change is one that I welcome with open arms.

If you are interested in learning more about the work the Rudd Center does, check out their website here.

Readers, does this seem like good news to you? Do you dislike the word ob*sity as much as I do? Any thoughts you have are most welcome.

fitness · research · sports nutrition

Dear exercise scientists: Where are the women?

Alex Hutchinson, writing in the Globe and Mail, asks “Why are female test subjects still being excluded from exercise research?” Lots of friends shared that story on social media, expressing WTF? levels of surprise. To those of us writing here on this blog, it wasn’t news.

Pretty much whenever I share stories about the results of some new fitness research, either I point out on our Facebook page that YMMV since the results came from research which tested university age men or I neglect to point it out and a helpful reader chimes in asking where are the women.

Here are some issues where we’ve pointed out the absence of research on women. There’s Catherine on women and concussions, me on intermittent fasting, Catherine again on women’s hearts. (Catherine is our go-to person for helping readers understand studies. As a public health ethics researcher that’s her bread and butter, as they say.)

Gretchen Reynolds wrote about this 2010, What exercise science doesn’t know about women.

In that story she talks about research that interested me. The original study showed significant recovery benefit from consuming protein after a hard workout. However, the subjects were all men. When the same study used women as subjects, they got a different result. The women experienced no big benefits from consuming protein after tough workouts.

Pick your favourite chunk of research based exercise wisdom. Mine is the research on the effectiveness of sprint interval training on fitness. See here.

“The McMaster team has previously shown that the SIT protocol, which involved three 20-second ‘all-out’ cycle sprints, was effective for boosting fitness. The workout totaled just 10 minutes, including a 2-minute warm-up and 3-minute cool down, and two minutes of easy cycling for recovery between the hard sprints.

The new study compared the SIT protocol with a group who performed 45 minutes of continuous cycling at a moderate pace, plus the same warm-up and cool down. After 12 weeks of training, the results were remarkably similar, even though the MICT protocol involved five times as much exercise and a five-fold greater time commitment.”

Great news, right? Who doesn’t have ten minutes to workout? Except that the subjects were all men.

My worry here isn’t that there are huge differences between men and women. My worry is that basing exercise research solely on one group–university aged cis-men–is not likely to yield results that are generalizeable across persons.

There’s even a nice example in Hutchinson’s story from my new academic home the University of Guelph and the beet research of Kate Wickham.

“When Wickham set out to explore the performance-boosting effects of nitrate-rich beet juice during her master’s degree at the University of Guelph, she found more than 100 studies on the topic that features all-male subject populations. In comparison, there were just seven all-female studies.

Based on the extremely limited data available, it seems that women may actually get a bigger endurance boost from beet juice than men. But it’s not clear whether that reflects some subtle difference in physiology or whether it’s simply a result of women typically being smaller than men (and thus getting a higher nitrate dose from a bottle of beet juice), or the fact that women tend to eat more nitrate-rich foods such as spinach and arugula.”

Three red beets against a pink background. Photo by FOODISM360 on Unsplash.

fitness · research

Getting Fit at the Library (guest post)

This post is by Pamela Hayes-Bohanan: friend, colleague, and librarian extraordinaire. Read and enjoy, and don’t forget to check out the reference (properly formatted, of course). -catherine w

So, what does a librarian know about fitness anyway? Just as she doesn’t need to be an expert in chemistry to find the boiling point of iron (2750.0 °C; 3023.15 K; 4982.0 °F btw) she likewise doesn’t need to be an expert in exercise and nutrition to assist someone with locating the best information to help them help themselves.

As a reference and instruction librarian for the past 25 years, I have helped people do research on more topics than I can possibly remember. Sometimes I’m helping with a course assignment, but often the information is for personal use. It is hard to balance between helping someone simply find what they’ve asked for (a trendy new diet book perhaps) and wanting to do some real education with them about where they can find better or more evidence-based information on healthy eating, nutrition, and weight loss. Ultimately, however, it is my job not to judge, so if someone wants a recipe for a Paleo Shamrock Shake I will do my dangdest to find it, and I won’t roll my eyes or smirk, either. (And if I piqued your interest, here’s the recipe. Do trust me, though, that no caveman ever drank one of these.)

What I can do via this blog post though is provide some guidance on how to navigate the proliferation of information that one will find on just about anything, whether they ask for it or not. How can you tell if the advice you’re receiving is something to heed? There are several things you can look for to help determine its worthiness.

The first thing to do is to check your own bias. Are you only looking for information that supports what you already believe, or want to be true? If you want good information start with an open mind and be prepared to broaden your horizons.

Once you find some information consider the source. Remember that just because you trust the person who shared the link, tweet, or blog post, it does not necessarily follow that the information is trustworthy.

Look for an author name and organization attached to the site. Then LEAVE the site and start sleuthing. See what else you can find out about the person and/or organization. Once you start your investigation look for things like: What are the authors’ credentials? Do they have other publications? Do they have a medical degree? Or is there something (anything) else that leads you to believe they know what they’re talking about? Are there news stories, or reviews of the people or organizations you are researching?

Don’t take shortcuts. Often people are taught simple rules regarding domains. (e.g. It’s okay use .org, .gov, or .edu sites; don’t use .com). Organizations each have their own biases and need to be researched. For instance the National Rifle Association and Moms Demand Action both have .org domains, and each provides a very different view on gun control from the other. Government information is influenced by lobbyists (many of whom represent commercial interests), and government sites are vulnerable to the whims of the head of state as well. Not all educational institutions are created equal, and even scholarly research published on university websites may be influenced by religious, or political motivations. Commercial sites shouldn’t not necessarily be dismissed. Aggregated subscription databases found at your library are commercial websites. So, my rule of thumb is: eschew facile rules of thumb.

Another question to consider is whether the website is collecting information about you. Are you required to provide personal data in order to access the site? If so, the site may be more interested in gathering information than providing it. Also be aware that sites that appear to require you to enter more information may give you a choice to not provide it, but may make the opt-out button hard to find. Keep looking, it may be below the scroll line, or placed on the left side of the screen rather than the right side where more people look for it, or it may be timed to appear only after a few seconds have elapsed.

Finding information is as easy as typing some words into Google. Taking some time to determine its veracity is a not only worthwhile endeavor, it is, as Daniel Levitin says in his book A Field Guide to Lies, part of a deal we need to make with ourselves:


We’ve saved incalculable numbers of hours of trips to libraries and far-flung archives, of hunting through thick books for the one passage that will answer our questions. The implicit bargain we all need to make explicit is that we will use just some [emphasis in original] of that time we saved in information acquisition to perform proper information verification (p. 253).

If you want to give your brain a real workout, visit a library and ask a librarian for more information on evaluating information, and using it wisely.

Reference
Levitin, Daniel. A Field Guide to Lies: Critical Thinking in the Information Age. Dutton, 2016.

A person doing a handstand in a library.
advice · eating · food · research

Flip flopping my way down the grocery aisle

by MarthaFitat55

It’s hard to know what we are supposed to do these days. The most recent research suggests recommendations against red meat consumption are flawed, and it’s okay to plop a steak on the BBQ.

Published this week in the Annals of Internal Medicine, the study says researchers have not been able to conclude definitively that eating red meat or processed meat causes cancer, diabetes or heart disease:

The World Health Organization International Agency for Research on Cancer has indicated that consumption of red meat is “probably carcinogenic” to humans, whereas processed meat is considered “carcinogenic” to humans. These recommendations are, however, primarily based on observational studies that are at high risk for confounding and thus are limited in establishing causal inferences, nor do they report the absolute magnitude of any possible effects. Furthermore, the organizations that produce guidelines did not conduct or access rigorous systematic reviews of the evidence, were limited in addressing conflicts of interest, and did not explicitly address population values and preferences, raising questions regarding adherence to guideline standards for trustworthiness.”

Come again?

Three women of colour have shocked expressions on their faces.

I haven’t had time to read the study through, but let’s say that reaction was swift and blunt. After all, it was only last winter that Canada released its newly updated food guide recommending we eat less meat and more plant based options. I’m sure we are going to see more discussion because flip-flopping on food recommendations is something food scientists do really well.

Last month Catherine W looked at a study which assessed the life threatening properties of sugary drinks (aka sodas). Two years ago, the Independent trumpeted the value of sugar in maintaining our brain health. Apparently brains love sugar, even if our hearts, circulatory systems and pancreas do not.

Not even a year ago in October (18, 2018), BBC Food published an article extolling the virtues of eggs, saying the humble egg has impressive health credentials. But six months later, in March 2019, the New York Times weighed in on the risks posed by eating eggs (TLDR: cholesterol will kill you!). The study found: Each additional half-egg a day was associated with a 6 percent increased risk of cardiovascular disease and an 8 percent increased risk of early death.

In the 80s and 90s , we all ditched butter to embrace margarine because we were told the heart-clogging abilities of butter would hasten our demise that much faster (hey eggs, move over!). Butter has been somewhat rehabilitated since then because additional research says a little is okay given that margarine and other trans fasts are actually a whole lot worse.

Oh noes: buttered bread, a boiled egg and a cup of tea for breakfast! Photo by Steve Harvey on Unsplash

In all seriousness, what are we to do? The reality is, as Paul Taylor wrote in the Globe and Mail in March 2016, dietary studies, flawed as they may be, have a huge impact on public health and can shape nutritional habits and food buying patterns. More of us are reading labels, questioning sodium content, and looking more critically at the food we eat even when it’s being marketed as healthful (Beyond Meat Burger anyone?).

It’s a good thing when we can become more critical, and it is even better when we can vary our diet to eat from every part of the rainbow. Everything in moderation so we can ensure all foods can fit (some better than others).

About that study tho — as an omnivore, I will still keep eating meat, but my family and I have embarked on meatless Mondays with a goal to to eat meat free at least two to three meals a week. I’ll still consider the latest study, but I will place in the greater context to understand its implications fully. How about you, dear readers? Are you easily influenced by the latest food research, or are you likely to go your own way regardless of the latest fad?

MarthaFitat55 is a writer in St. John’s.

feminism · fitness · Guest Post · research · walking

Are women, people of color, and kids more likely to get bumped when walking on the street? (Guest post)

By Sage Krishnamurthy McEneany

Introduction:

Women often complain about how they have to move out of the way for people walking on the street. Beth Breslaw did an experiment showing that this is exactly the case. She walked down the street while consciously not moving out of the way for people. People started slamming into her, specifically men. She began to call this ‘man-slamming’. I wanted to find out if this was true for kids, and women of color – members of other underrepresented groups – but I wanted things to be less confrontational. So, I decided to do my own experiment.

Method:

I gathered a group of four people: one white man, one white woman, one woman of color, and one kid (which happened to be me). We all took turns walking down one street, and counted how many times we each had to move out of the way of other people. We did our experiment two times.

Hypothesis:

The white man would have to move out of the way the least. The white woman next, and then the kid. The woman of color would have to move out of the way the most.

Materials:

A busy street and people willing to participate in your test (one white man, one white woman, one woman of color, and one kid. You could always add more.)

Participants:

Image description: four photos in a grid with descriptions underneath. Top left  "P.M. (white male)"; top right "M.F. (white female)"; bottom left "S.K.M. (child / white passing)"; bottom right "M.K. (brown female)
Image description: four photos in a grid with descriptions underneath. Top left “P.M. (white male)”; top right “M.F. (white female)”; bottom left “S.K.M. (child / white passing)”; bottom right “M.K. (brown female)
Image description: bar graph depicting how many times each person moved out of the way. Trial 1.
Image description: bar graph depicting how many times each person moved out of the way. Trial 2.

As the graphs show, PM has to move out of the way less than MF. MF has to move out of the way less than MK. MF and MK have to move out of the way less than SKM. PM has to move out of the way less than MF, MK, and SKM. This disproves my hypothesis that women of color had to move out of the way more than kids.

Discussion/Conclusion:

My experiment shows that women, no matter their age or race, have to move out of the way much more than men. But when you add race to gender, it turns out women of color have to move out of the way more than white women. If you add age, white (passing) kids that are girls have to move out of the way more than white women and women of color. Extra labor is placed on the shoulders of women, kids, and people of color.

Why would extra labour be placed on these individuals and especially on kids? They are the most underrepresented and their social status is the least. This is why they carry the biggest burden.

Although I have drawn a few conclusions on race and gender through my experiment, I still have many unanswered questions. What would my results be if I were a boy? What if I were less polite and didn’t care if I bumped into someone? What if a black man or a black woman participated in my experiment? What if a senior citizen did? 

I wanted to learn about the unobvious inequalities. This is my first step of what I hope will be many.

Sage McEneany is in grade six. She enjoys reading fantasy, science fiction and graphic novels. She intends to publish her own book when she is older, and to continue to work on the issues of race and other inequalities. She likes to play soccer and would like to do track this year.

fitness · health · Martha's Musings · motivation · research

Guilt-free heart health for women

By MarthaFitat55

February is Heart Month and there are lots of messages across multiple platforms on how to be heart healthy. In the past two decades, we’ve seen a lot of attention being paid to heart health and its links to obesity, diabetes and high cholesterol.

The messages fall into three camps: what to eat, how to exercise, and why it all matters. There are multiple diets focusing on optimal cardiac health, an almost equally dizzying array of guidelines on exercise, and tonnes of research on the risks and genetic factors present in 21-century populations.

In more recent years, there’s been significant work looking at women and heart health. We are often misdiagnosed, we don’t get the right treatments, and we are less likely to have the better outcomes. In its landmark report in 2018,  aptly named Ms. Understood, the Canadian Heart and Stroke Foundation said the following:

  • Heart disease is the leading cause of premature death for women in Canada (dying before reaching their expected lifespan).
  • Early heart attack signs were missed in 78% of women.
  • Every 20 minutes a woman in Canada dies from heart disease.
  • Five times as many women die from heart disease as breast cancer.
  • Two-thirds of heart disease clinical research focuses on men.
  • Women who have a heart attack are more likely to die or suffer a second heart attack compared to men.

Why this matters became even more critical this year when the the Foundation released a new piece of research demonstrating the link between heart disease and increased rates of dementia. The report (found here as a PDF) says its research “mapped the connections between heart, brain and mind diseases and conditions for the first time and found even stronger links and a much greater impact than anticipated. People managing these conditions are overwhelmed and the system is overloaded. This is a crisis and it is not sustainable. We need to find solutions now.”

So we know what’s happening, and we know what we are supposed to do. But are we actually doing the work we need to prevent and reduce the risks? Well, there is another piece of research, this time at the University of Alberta, which challenges some of our assumptions on the messages we use in promoting heart health.  Says one of the co authors, Tami Oliphant: “Women are told they need to exercise more, they need to lose weight, they need to be social and all these heart-healthy activities, but we found that these messages made the women feel guilty, like they had caused their heart disease,”

We know we should reduce the stress we feel, but hey, women deal with a lot of stress. Reducing it isn’t necessarily an easy option. Many of us can’t afford some of the more common stress reducers recommended to women. And then there is the social pressures women face in keeping family and community together, let alone taking time for themselves.

While I am a big fan of the concept behind putting my own mask on first so I can help others, it’s a bit of a juggle and for some, a bit of a fight. Not being able to meet those recommended guidelines can pile on guilt which leads to more stress, etc etc etc.

The research at the U of A suggests we tailor our health messages to the needs of different audiences. That means creating different messages for women compared to men.The symptoms for heart attack in women are different, so the messages building awareness have to differentiate between male and female experiences of cardiac disease to be effective.

It also means letting women know what the alternatives can be for reducing risk. As one of the researchers noted, if you hate running and you can’t find something else in the “sports” field to get your 150 minutes of cardio in a week, what else is there? Ordinary activity for one. Vacuuming is a form of activity and while it may not help you run marathons, it does keep you moving.

The most positive aspect of this focus on women’s experience of heart disease is the empowerment of women. For quite a long time, we have not had control of many aspecs of our health, especially reproductive health. Researcher Oliphant said: “Women’s bodies are perceived as problematic, post-menopausal, whereas when you’re treating men for heart disease it’s about efficiency and getting them back up to speed. So women are diagnosed later, they delay treatment, they can be disbelieved and sometimes they’re even discouraged from seeing a health-care practitioner.”

There is some work on understanding the experience different groups of women will have with heart disease. What else can we be doing to support heart health in women beyond the healthy weight, be active, live smoke-free messages?

Image: A red heart on a square yellow sheet of paper clothespinned to a strong and hanging on a white wall.

Photo by Debby Hudson on Unsplash
athletes · gender policing · Guest Post · Olympics · research · stereotypes

The Latest Nonsense from the Gender Police (Guest Post)

When the Court of Arbitration for Sports struck down the IAAF’s Rules on Hyperandrogenism, Sebastian Coe wasn’t amused. When Caster Semenya took the 800 meters gold at the 2016 Rio Olympics, Coe was downright unhappy, and he announced that the IAAF was working to deliver the evidence that the CAS had found missing in its 2015 ruling: evidence for the proposition that elevated testosterone levels in women athletes provided these athletes with an unfair competitive advantage.

In 2017, the IAAF presented what they took to be such evidence; and last week, they presented their new rules on gender eligibility. According to the new rules, in all races from 400 meters to the mile, women with elevated testosterone levels will be forced to either lower them – or to give up their sport.

These rules, to take effect in November, are no better than their predecessors. In fact, they might be worse.

There is, first, the glaring ethical issue of forcing athletes to accept an unnecessary medical intervention in order to be allowed to compete. (The Rules on Hyperandrogenism were used to justify castrations, vaginoplasties, and clitoroplasties on young women athletes, who may not have been in a position to give informed consent to these procedures.)

Second, there is the selectivity of the new rules. They only apply to four (Olympic) disciplines out of 21. The justification for this is a study commissioned by the IAAF, published last year. The authors of the study purport to show that the correlation between “free testosterone” levels and performance at the top level is significant in these disciplines. What the new rules do not reflect is that the authors also found a significant correlation in two other disciplines, the pole vault and the hammer throw. No other discipline showed a significant correlation.

The study was based on blood samples taken during the IAAF World Championships in Daegu 2011 and Moscow 2013. Every athlete who finished her competition and went through an anti-doping control was counted – even those whose high testosterone levels could be traced to doping. The study took the highest and the lowest tertile of testosterone levels and compared the athletes’ performances to the mean performance. Yet the testosterone levels in the highest tertile ranged from “somewhat elevated” to “extremely elevated” (or “in the normal male range”, in IAAF doctor speak). There is no way to tell from the study whether extremely elevated levels also lead to an extremely enhanced performance. Nor is there a way to tell what specific advantage testosterone is supposed to confer in the disciplines that showed a significant correlation; the authors speculate that it might be enhanced visuo-spatial coordination in the pole vault and increased lean body mass and aggressiveness in middle distance running – but the study itself doesn’t give any definite clues; and the question remains why, if testosterone can have such varied effects, they show up in less than 40% of all Olympic disciplines.

And even if the study constituted proof that testosterone conferred an unfair advantage, there’d be no reason whatsoever to exclude pole vault and hammer throw from the new rules. So as things stand, the new rules look completely arbitrary even on their very own terms – and it seems obvious that they primarily target Semenya. They affect her disciplines (the 400, 800, and 1500 meters) and Semenya is the most prominent and by far the most successful athlete to have come to the attention of the IAAF gender police. Bluntly put, it seems that the IAAF either wants to get rid of Semenya or force her to artificially lower her performance levels to a point where she’s no longer winning.

The IAAF has been trying to come up with definitive rules for eligibility in women’s competition for over half a century. (Access to men’s competitions was never regulated.) Their efforts have largely been unsuccessful. By now, they have largely given up on the specter of the “male impostor” (suggesting that men might pose as women for “easy” athletic success) which ruled the introduction of eligibility rules in the 1960s. But they still insist that not every woman should be allowed to compete. In other words: while they have accepted that Semenya is a woman, they still cannot accept that she ought to be allowed to compete as she is.

Third, the IAAF still hasn’t explained convincingly why they insist on regulating eligibility in (pseudo-)medical terms in the first place (other than the obvious and obviously poor reason that they don’t like the media attention for Semenya and the races she participates in). They claim that they want to ensure fair competition, but on the basis of the (pseudo-)medical terms they have introduced into women’s track and field, there can’t be fair competition.

The IAAF’s obsession with testosterone suggests that by leveling one anatomical factor, they can level the entire playing field for professional sport. But that’s obvious nonsense. Not only is the commissioned study unclear about what exactly the relevant advantage conferred by testosterone might be, there’s also no mention of other obvious anatomical factors that confer an advantage: for instance, height in high jumping. (If high jumping had a scoring system that was adjusted to the jumpers’ height, Stefan Holm, one of the smallest-ever high jumpers to compete at the top level, would have been literally unbeatable.)

So either a lot more anatomical factors would have to be regulated, and consequently, a number of height, weight, flexibility, etc. classes created – or the IAAF could simply accept that one’s social and legal identity as a woman is enough to be allowed to compete in women’s competitions.

But what about Semenya’s obvious dominance? – one might ask. (After all, many of her opponents have complained about having to compete against her without standing a chance). If we look at Semenya’s 800 meter races in the most recent international events, she was dominant, but not beyond what “dominance” means in other disciplines. (In the 1500 meters and the 400 meters, she can compete for international medals, but she isn’t dominant at all).

Consider the pole vault and the hammer throw, the two discplines excluded from the new rules. For years, the pole vault was dominated by Yelena Isinbayeva – to such a degree that the only interesting question in a high-profile competition was whether Isinbayeva would set a new world record (she set 30 world records during her career; Semenya’s times haven’t come anywhere near a senior world record).

The hammer throw is currently dominated by Anita Włodarczyk. Włodarczyk has improved the world record seven times, became Olympic Champion in 2012 and 2016, World Champion in 2015 and 2017 (in 2013 losing only to Russian Tatiana Lysenko, a repeat doping offender, whose Olympic Gold from 2012 went to Włodarczyk) and European Champion in 2012, 2014, and 2016. If Włodarczyk is in shape and mentally sharp during the competition, her opponents typically don’t stand a chance. Yet if this is not an issue of fairness, why is Semenya’s performance? After all, we can assume that Włodarczyk, like Semenya, has an athletic predisposition that makes her exceptionally suited for her discipline – and that she trains extremely hard to stay on top of her game. Yet only in the case of Semenya is it assumed that somehow her predisposition is unfair (and thereby implied that she could be so successful even without training).

And what, finally, about the possibility that national sports federations could specifically seek out “intersexual” women with athletic talent? – This, too, is widely accepted practice, as long as it does not concern women who might have intersex traits. And it’s called “scouting for talent,” not scouting for intersex traits. Of course, physical features will play a role, but consider, for instance, the criteria any basketball scout would use to find promising young players. So in this case, it is not clear either why testosterone – or intersex traits more broadly speaking – should make a significant difference.

And so the supposed concern with ensuring fair competition still look like it’s really about policing gender presentation.

M.B. is currently a post-doc at the Institute for Christian Social Ethics at the University of Münster, Germany. She specializes in the ethics of sexuality and gender and the ontology of social groupings.