Women's Health Archives - MedFitNetwork

Understanding and Conquering the Relative Insulin Resistance of Midlife – Beyond the Blood Tests

Carla DiGirolamo, MD, CF-L1, PN-1/3 January 2024/ All MFN blog/

One of the most common things my midlife clients struggle with is weight gain. “The things that worked before just don’t work anymore” is the mantra of so many during this phase of life. They visit their healthcare provider with concerns about “waking up in someone else’s body”. The doc runs some tests – thyroid levels, blood sugar studies, and insulin – and all the results come back in the normal range. “Great news!” says their doc. “There’s no problem. You’re just getting older”. End of story.

Many of you who have heard me on various podcasts know that I’m not a fan of the notion that hormone testing reflects the entirety of the Human experience as many “practitioners” would have you believe. The relative insulin resistance of midlife is a perfect example. One does not have to meet the criteria for “pre-diabetes” or metabolic syndrome for there to be real changes for which there are interventions. Isn’t the goal of medical care to prevent these things in the first place rather than just send you away until you actually become diabetic?

One does not need to meet the criteria for “pre-diabetes” or “metabolic syndrome” for there to be changes for which there are interventions. Isn’t the goal of medical care to prevent these things in the first place rather than just send you away until you actually become diabetic?

This is where understanding what’s happening inside your body during the various phases of hormonal life keeps you one step ahead of mainstream medicine. Today we will discuss the phenomenon of relative insulin resistance – the physiologic changes to energy utilization occurring in your body as a result of the normal hormonal changes of midlife – and how to mitigate the effects of these changes so that you can be your healthiest self.

Your Body on Carbs

In a nutshell, carbohydrate is consumed in the diet, digested and absorbed as glucose (among other simple carbohydrates), and utilized as fuel by the tissues in the body. Excess glucose that is not used is stored as glycogen in the liver and muscles, but also as fat. The hormone, “insulin”, is secreted by the pancreas in response to glucose entry into the bloodstream. Insulin drives glucose into the cells so that the cells can use the glucose as fuel to carry out their functions. The “efficiency” of insulin function is impacted by cycling estrogen and estrogen receptors on the surface of cells.

The two bodily systems that use the greatest amount of blood glucose are the brain and skeletal muscle – the voluntary muscles that move our bodies. During midlife, there is a decrease in cycling estrogen and estrogen receptor presence on the surface of skeletal muscle cells. As the ovarian hormonal cycles change and become irregular, there is less circulating estrogen. As a result, muscle mass, strength, and power decline along with the efficiency of the muscle’s ability to utilize blood glucose through insulin-mediated pathways.

A prominent player in cellular and insulin efficiency is an intracellular organelle called the mitochondria: the “batteries” that supply energy to cells. Below is an excerpt from my course Menopause Health and Fitness Specialist Course through MedFit Classroom that explains the science behind how skeletal muscle function is impacted by changes in estrogen and its receptors.

As we just mentioned, when blood glucose is not used as fuel, the excess is stored as fat. When the hormonal changes of midlife reduce the efficiency of glucose utilization by skeletal muscle, the result is a greater excess of unused glucose and increased storage of fat which results in changes in body composition.

Your End-Run Around Relative Insulin Resistance

There are three basic approaches to mitigating the impact of the hormonally-driven changes in how our bodies manage glucose. Resistance training (particularly weight training), nutrition, and neuroendocrine activation.

Resistance Training

If you want your muscles to use more glucose, then you need to increase the activity of those muscles. This looks different for different individuals. If you are sedentary, then starting with walking for 30 minutes 4-5 times per week is a great start! From there, add a weighted backpack, then maybe add some hills or even hiking trails. Simultaneously, engage a personal trainer for 6 weeks and become familiar with weight training. If you are an endurance athlete, make friends with the barbell. If you are a powerlifter, explore different ways to stimulate the muscles that add cardiovascular stimulation like combining running segments with heavy deadlifts. The point is, no matter what your fitness level or expertise, there are new and exciting ways to increase the functional capacity of your skeletal muscle.

Why does this work? The Human body is an amazing machine designed for survival. Mother Nature has programmed redundancies within our physiologic systems to promote longevity. We discussed the impact of our cycling reproductive hormones on how our muscles utilize blood glucose. Fortunately, other physiologic pathways facilitate glucose entry into the muscle cells that depend less on cycling hormones, most notably, the GLUT4 pathway. GLUT4 is a glucose transporter protein that works with muscle contraction to transport glucose into the cells. So when we stimulate muscle contraction through resistance training, this activates the GLUT4 pathway to facilitate the entry of glucose into the cells to be used as fuel, leaving less excess to be stored as fat.

GLUT4 is a glucose transporter protein that works with muscle contraction to transport glucose into the cells. So when we stimulate muscle contraction through resistance training, this activates the GLUT4 pathway to facilitate the entry of glucose into the cells to be used as fuel, leaving less excess to be stored as fat.

Nutrition

We have discussed how glucose enters the cells of our tissues through pathways involving insulin and GLUT4 and how unused, excess glucose is stored as fat. In this section, we will discuss the other important part of this equation, which is the load of glucose that enters the bloodstream by way of the foods we eat.

Glycemic Index – The glycemic index is a measure of how much a carbohydrate source will increase blood sugar over 2 hours from the time of consumption. There are low, medium, and high glycemic index foods with a great description in this resource from Healthline. A lower glycemic index reflects lower blood sugar following consumption and a higher index reflects greater increases in blood sugar. This is important because the glycemic index reflects the glucose “load” on the systems (such as insulin and GLUT4) that need to shuttle the glucose into the cells. When the glucose load is greater, the systems can become overloaded, leaving more excess to be stored as fat. When the load is less, insulin and GLUT4 can better “keep up” with transporting glucose into the cells for use as fuel leaving LESS excess to be stored as fat.

By focusing on carbohydrate sources with a lower glycemic index and minimizing those with a higher glycemic index, you can effectively decrease the glucose load that insulin and other glucose transport pathways see and thus more efficiently use carbohydrates as fuel and minimize the excess that is stored as fat.

Neuroendocrine Adaptation

Adaptation is the ability of the body to adjust or “make familiar” movements or tasks that we undertake. This is a coordinated effort by the muscles, joints, metabolic, and endocrine processes all driven by the master puppeteer we know as the Nervous System!

Because Mother Nature designed Humans for survival, our ability to adapt to physical stimuli and physical tasks is powerful! When we stimulate the muscles repetitively in the same way for an extended period of time, the body doesn’t need to work as hard to manage the load or task and effectively switches into “Auto-pilot”. This is great for elite athletes where the tasks that their sports require become second nature through adaptation.

However, from the standpoint of muscle physiology, they crave something more! This is why we train differently in the off-season: to keep the muscles guessing and thus contantly adapting to become fitter, faster and stronger so that we can crush it on game day! To learn more about this incredible phenomenon, check out Neuroendocrine Adaptation: Your End-Run Around the Menopause Transition.

Key Points for Combatting Midlife Relative Insulin Resistance

Get moving! The first step to using more glucose as fuel and storing less as fat is to move those muscles. For the sedentary, walking, backpacking, and hiking are great ways to start.
If you have never trained with weights, another great place to start is a group “boot camp” style fitness class. Find one at your local gym and sign up with a friend! My favorite group class for getting started with weights is Les Mills BodyPump.
Any level of athlete can benefit from a 4-6 week training program with a trainer or strength coach to gain some basic skills and techniques from basic to more advanced movements depending on your fitness level/familiarity.
Incorporate resistance/weight training at least 2-3x per week.
No equipment, no problem! Push-ups and their many variations are fantastic for anyone of any fitness level to add mass, strength, and power to the muscles of the upper body.
Take an inventory of your carbohydrate intake and using the resources in this LINK, identify carbohydrate sources and potential substitutions that can move the needle toward lower glycemic index choices.
Nutrient timing is a strategy where carbohydrate intake is timed within an hour before training and within an hour after when the muscles are “looking” to fuel movement during the workout and then looking to replenish glycogen stores in the liver following a training session.
Most importantly, be consistent, but be patient! It’s about progress, not perfection. Every little bit you can do has benefits.

Fit Pros: Offer menopausal and perimenopausal women an individualized approach to training, nutrition and wellness as a Menopause Health and Fitness Specialist.

Senior man in a gym talking to personal trainer

Where to Begin When You Are Working Out With a Health Condition

Robyn Kade/11 September 2023/ All MFN blog/

The gym can be a confusing place especially for individuals with health concerns. Many times, these clients are trying to navigate their workouts by themselves because they are unsure of the appropriate questions that they need to ask.

First of all, there are two different types of trainers. There are trainers who have a four year degree and certifications. These trainers are sometimes called Fitness Specialists and have had many hours of study related to a wide variety of diseases and injuries. They are used to modifying exercises and programs based on any specific condition you may have. Fitness Specialists are usually found in a medically based fitness facility affiliated with a hospital. Please note that some Fitness Specialists will specialize in a certain area. Some work with individuals with diseases and disabilities and some don’t. You can search the free MedFit Network directory to find a fitness pro in your area. In their MFN profile, you’ll find information about their condition-specific education and services.

When you finally narrow down who you might like to hire you will want to ask some questions. Please don’t be afraid to ask these questions as they will help you to decide which trainer is right for you. It is also recommended that you observe Fitness Specialists training clients.

First you want to make sure that the trainer has had experience with your condition. If not, they should be willing to research it and or speak with your doctor with your permission. There are exercise guidelines that all Fitness Specialists should follow when working with clients who have health conditions.

You will also want to ask about the trainers background. It is alright to ask about education, certifications, and years of experience. You also want to hire someone who is patient with you. This is extremely important as you figure out which exercises work best for your body. I would also like to add that you need to be patient with yourself as well. Try to relax and enjoy your training session.

Asking the questions from above help to keep you feeling confident. Exercise can seem frustrating in the beginning but you have to keep a positive mindset. In the beginning, set small goals and do the best you can during each training session.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 15 years of experience in medical based fitness.

Keys to Empowering Women in the Weight Room, Part 2

Carla DiGirolamo, MD, CF-L1, PN-1/30 August 2023/ All MFN blog/

In Part 1, I reviewed the ACSM study goals, statistics and barriers to weightlifting unique to women

In this article, I’ll cover the three E’s for empowering women in the weight room, and translate these recommendations into strategies that non-professionals can implement for themselves.

1. ENVIRONMENT

Understanding how physical attributes of gyms perpetuate negative messaging regarding women’s bodies and harmful myths about women’s fitness.

Body image as the sole motivator for exercise with full-length mirrors and posters presenting unrealistic expectations for women’s bodies.
Insufficient equipment and scaling options.
An overwhelming male presence and masculine perceptions that can complicate women’s relationship with the gym environment and diminish their confidence to participate.

Overcoming these barriers:

When considering an environment that is the best fit for you, avoid those spaces with attributes that make you feel uncomfortable. You may prefer a gym with more limited mirror space, and that has a more balanced male/female demographic and female trainers. An example of a more supportive environment is a typical CrossFit “box” where the male-to-female demographic is often split and you will rarely find a mirror.
Consider a female-only gym space.
Consider group weightlifting classes. As a former BodyPump instructor, I can vouch for this program as a fantastic way for any beginner to gain confidence with weights and develop a base of sound movement patterns.
One-on-one training is an excellent way to get personalized instruction on safe weightlifting technique and individualized goal-setting to gain confidence in the basics of weightlifting.

2. EXPERIENCE

People will often gravitate toward their comfort zones and do exercise routines that are more familiar and that are easy to execute.

Unrealistic expectations for results and timelines to achieve them.
“Weightlifting is hard.
Fear of injury or “being sore”.
“I don’t want to exercise by myself.”
“I don’t have time to lift weights.”

Overcoming these barriers:

Focusing on realistic goals of improvements in strength, movement quality, well-being, and specifically for mid-life women, maintenance of bone density and muscle mass to prevent fractures and maintain a healthy metabolism and glucose control.
Working with a Coach or Trainer to create a personalized program design and dispelling the misconceptions that one needs to spend many hours per week and be sore after every workout to achieve benefits.
Effective workouts can be achieved in as little as 10-20 minutes provided that the sets, repetitions, and rest periods are programmed accordingly.
Seek out gym environments that promote small-group weightlifting classes and allow members to bring a guest.

3. EDUCATION

Knowledge is power. Promoting an understanding of the principles of weightlifting and its benefits is key to debunking myths and misconceptions and building a healthy relationship with the barbell.

Common myths and misconceptions about weightlifting:

Resistance training is less beneficial than cardiovascular exercise.
Weight training is “dangerous” for women.
I need to spend hours in the gym to see any benefits.
Resistance training is not optimal for fat burning.

Overcoming these barriers:

Seek out opportunities to work one-on-one with experienced trainers who have experience with resistance training in female clients of all ages.
Take a personal “inventory” of what is most important for you to feel comfortable incorporating weight training into your fitness program and your specific goals. Do you prefer one-on-one instruction? Do you prefer a women-only environment? Is a group setting important to you? Do you have injuries or physical limitations that need to be considered?
Advocate for yourself. Once you have an idea of what is important for you to succeed, don’t be afraid to ask questions when visiting a facility.
Do your homework. Read reviews of a facility before you join. Talk to other members. Review the credentials and experiences of the Coaches who work at the facility.
Seek out reliable sources of information about the benefits of weight training for women as well as safe and effective approaches to the barbell for any level of experience. Here are some of my go-to’s for reliable information:
- MedFit – Menopause Health and Fitness Specialist Course – a 13-hour course focusing on the female experience with the menopause transition, the unique physiology of this life stage and practical application of nutrition and fitness strategies specific to the needs of this population. Fit Pros can earn CEU credit with NASM, ISSA, and canfitpro.
- Dr. Stacy T Sims – blog
- Next Level – by Stacy Sims and Selene Yeager
- CrossFit.com
- Hit Play Not Pause Podcast
- Les Mills BodyPump
- .. and don’t forget the Athletic Aging Monday morning weekly workout series where you will find a treasure trove of resistance training workouts you can do at home (or in the gym) with minimal equipment and modifications for any fitness level.

This is the time of our lives when we need to kick the societal status quo to the curb and take our health and wellness into our own hands and away from destructive narratives. The world is our oyster. We have established our careers, raised our children, and had our share of triumphs and failures. With that comes the wisdom to pave our own way into this new prime of our lives.

So, whether it’s your first back squat with a PVC pipe or a deadlift PR (personal record), congratulations on forging a new frontier to being your fittest, strongest, most vital self!

Fit Pros: Offer menopausal and perimenopausal women an individualized approach to training, nutrition and wellness as a Menopause Health and Fitness Specialist.

References

Ford, C, Kercher VM, Kercher KA; The 3 E’s – Keys to Empowering Women in the Weight Room. ACSM’s Health & Fitness Journal 27(3):p 14-19, 5/6 2023.
Harne AJ and Bixby WR. The benefits of and barriers to resistance training among college-age women. Journal of Sport Behavior 19(2):151-66, 2005

Keys to Empowering Women in the Weight Room, Part 1

Carla DiGirolamo, MD, CF-L1, PN-1/28 August 2023/ All MFN blog/

The hormonal changes of mid-life bring our muscle and bone mass under assault. As circulating estrogen declines and estrogen receptors in skeletal muscle become scarcer, changes in bone density, muscle mass, and metabolism become apparent.

Shoulder to shoulder with the importance of cardiovascular health, optimizing our muscle and bone health helps stave off decline in bone density which can lead to fracture, and can help mitigate the increasing insulin resistance that wreaks havoc on our changing metabolism.

To coin a phrase from Dr. Stacy Sims, there is a great benefit to women in this stage of life (and all stages of life) who “Lift heavy sh*t”. Now, if you have never lifted weights, this can sound intimidating. But don’t worry. You are not alone.

Historically, there have been many barriers to women in the weight room. Training environments where achieving a certain body image is the focus rather than building strength, healthy movement patterns, and improving body composition can be unmotivating and intimidating. The stigma of weightlifting as “masculine” or that it “makes you bulky” and the misconceptions that weightlifting is not beneficial for women are also among the many obstacles that women of all ages face.

In the May/June issue of ACSM Health and Fitness Journal, Claire Ford et al. do an excellent job of defining the obstacles that women face in the weight room and have created a framework called “The 3 E’s” that outlines strategies to overcome these barriers. I’ll take the summary points from this article and translate them into practical solutions for women and fitness professionals to empower themselves in the world of weightlifting.

The 3 E’s – Keys to Empowering Women in the Weight Room

Ford, C, Kercher VM, Kercher KA; ACSM’s Health & Fitness Journal 27(3):p 14-19, 5/6 2023.

Goal of the study

Use a socioecological model to provide insight into the nature of women’s unique experiences with weightlifting and describe a practical approach for empowering women in this environment.

Some statistics

Just 2 days per week of resistance training can reap physical, mental, and emotional health benefits.

Only 25% of the US population meets these recommendations.

17.5% of women engage in weightlifting on a regular basis

Benefits of Weightlifting

Improves body composition.
Helps prevent bone loss.
Maintenance of healthy metabolism.
Maintenance of quality movements over the lifespan.
Promotes emotional well-being and self-concept.

Barriers to weightlifting unique to women

The notion that women face unique barriers to weightlifting has been a subject of investigation. Harne and Bixby organized these barriers into the following 3 categories:

Time / effort

“I don’t want to get bulky”.
”I’m afraid I’ll hurt myself”.
“I don’t want to be sore”.
“I’m in terrible shape”.

Physical Effect

“I don’t have time to lift weights”
“It’s too hard”
“It’s easier to hop on the treadmill”
“I’m overwhelmed at the gym

Social

“I don’t have anyone to go to the gym with”
“Isn’t weightlifting better for men?”
“I like the group classes because my friends can come with me”
“There are too many men. I feel like I don’t belong”

The 3 E’s: A framework through which we can understand and address women’s barriers to weightlifting

After identifying and categorizing these unique barriers to weightlifting that women face, the authors created a framework upon which to overcome these barriers. This framework is called “The 3 E’s”.

This ACSM article speaks to an audience of fitness professionals and how the fitness industry can work to overcome these barriers.

In Part 2 of this article, I take this a step further and translate these recommendations for fitness professionals into strategies that non-professionals can implement for themselves.

Fit Pros: Offer menopausal and perimenopausal women an individualized approach to training, nutrition and wellness as a Menopause Health and Fitness Specialist.

Dr. Carla DiGirolamo is a double Board-Certified Obstetrician/Gynecologist and Reproductive Endocrinologist who specializes in the care of reproductive age and mid-life women. Carla completed her residency training in Obstetrics and Gynecology at Brown University Medical School/Women and Infants’ Hospital and her Reproductive Endocrinology training at the Massachusetts General Hospital at Harvard Medical School. She is a North American Menopause Society (NAMS) Certified Menopause Practitioner and has been featured in multiple podcasts and speakerships at various events discussing the physiology of the hormonal changes of menopause, hormone therapy and functional fitness training.

References

Ford, C, Kercher VM, Kercher KA; The 3 E’s – Keys to Empowering Women in the Weight Room. ACSM’s Health & Fitness Journal 27(3):p 14-19, 5/6 2023.
Harne AJ and Bixby WR. The benefits of and barriers to resistance training among college-age women. Journal of Sport Behavior 19(2):151-66, 2005

group of happy pregnant women talking in gym

Pelvic Floor Dysfunction in Pregnant Women and New Mothers, Preventable & Treatable

Danielle Spangler/10 February 2023/ All MFN blog/

Pelvic floor dysfunction, or PFD, is a broad term used to describe several physical conditions that occur mainly as a result from pregnancy and childbirth. As a pre and postnatal fitness specialist for over 20 years, almost every one of my clients has had some form of PFD. What does this mean and why is it relevant to women’s fitness? I will further define PFD in detail and explain how it changes the way we as exercise professionals program design for this clientele.

First, let’s look at the pelvic floor muscles. The pelvic floor looks like a sling or hammock that forms the floor of the bony pelvis and it serves several important functions in our bodies. The internal layer or “pelvic diaphragm” work with the external muscles of the pelvic floor to support our internal organs, stabilize our bodies, allow for sexual function, urinary and bowel movements and assist in contracting and pushing in the birthing process. These muscles are prone to trauma from the various functions they perform. The stress of the growing uterus in the body during pregnancy coupled with the changing gravity, posture and production of the hormone Relaxin all contribute to weakening the pelvic floor muscles.

Second, consider the whole Neuromuscular Core system. Pelvic floor muscles connect to the Transverse Abdominus (TVA) and they work together in harmony essentially hold the body upright. It is almost impossible to engage one without the other. Tightness in the hips combined with weak pelvic floor muscles creates PFD.

Diastasis Recti, Symphosis Pubis Dysfunction (SPD), Urinary and or fecal incontinence, pelvic pain, chronic lower back pain, Piraformis syndrome, sciatic pain, pelvic organ prolapse are all conditions under the pelvic floor dysfunction umbrella. Below these conditions are listed and defined in more detail.

Diastasis Recti: This is a separation of the right and left side of the Rectus Adbdominus in the Linea Alba connective tissue more than 2 cm in width

Pubic Symposis Disorder: A separation of the pubic bones, which often occurs during birth but sometimes during the third trimester.

Urinary incontinence: Uncontrollable leakage from bladder.

Fecal incontinence: Uncontrollable leakage of fecal matter from colon. Usually as a result from severe tearing during birth.

Pelvic pain: This type of pain can be during sex or when performing a movement that is irritating or uncomfortable, many possible underlying issues.

Chronic lower back pain: Unexplainable chronic lower back pain

Sciatica: Pain that radiates from lower back down one leg along the sciatic nerve as a result of compression of the sciatic nerve

Piraformis syndrome: Also a result of an inflamed sciatic nerve but more localized

Pelvic organ prolaps: When organs of the pelvis fall as a result of weak pelvic floor muscles.

These conditions can be limiting for many women and go untreated because they are embarrassed or told that they are normal “experiences” after giving birth. Until recently, very few fitness programs existed to help women strengthen pelvic floor muscles. It is my opinion that every pregnant woman and new mother should be automatically screened for PFD and treated right away. If women do not learn proper strengthening exercises of pelvic floor muscles they can potentially live in discomfort for years. The sooner preventative care is offered the better the quality of life for these women.

As mentioned earlier, many of these conditions are preventable and remedied through a combination of functional strength with corrective, posture-based range of motion exercises. When a woman becomes pregnant there is an immediate increase in pressure to the pelvic floor muscles. The body begins to produce relaxin which affects the joints throughout the body, especially the pelvis as it prepares to accommodate the growing uterus and eventually for birth. If treatment begins to help women continue strengthening the muscles surrounding the hips immediately, the pressure on the pelvic floor muscles will be reduced.

It was common practice until recently that women were advised to learn and perform Kegel Contractions. We understand more now as movement therapists that Kegel contractions are very hard to teach, very isolated, and in most cases, when examined internally by a women’s healthcare PT, women are not performing them correctly. A more effective approach to strengthening the pelvic floor muscles is to treat the entire hip complex as “one”– or a “global approach” — as described in applied functional science.

So, how do fitness professionals help create beneficial, safe and effective exercise programming for pregnant clients and new mothers that hone in on the core and pelvic floor? We must start by helping our clients improve their posture first and foremost, then work on proper breathing techniques and lastly incorporate larger exercises that do not isolate, but recruit many muscles from the hip complex and surrounding muscles groups. By incorporating all three planes of motion instead of working primarily in the sagittal plane (forward and backward) when performing even the most basic of exercises (i.e., the squat), you must change the movement by foot placement, arm placement, direction, tempo, range of motion etc. The variety in actions creates good stress to the pelvic floor and core muscles. Additionally, increasing the adduction and abduction action simultaneously while performing various exercises will help activate and recruit pelvic floor muscles subconsciously. Anatomically speaking, everything is connected in the body. Understanding that big global movements of the upper body and lower body together affect the position and strengthen of pelvic floor and core muscles is essential. The body is most efficient at strengthening the small muscles when big muscle groups are stimulated in combination. Throughout my years, I have seen much success with clients that incorporated these types of movements into their workout regimen and were safe and conscientious not to perform exercises that added bad stress to the external abdominal muscle group or impact exercises.

Each woman is different on how quickly it takes her to recover from PFD. The most important rule of thumb is to be reassuring and provide support and remember the time line is different for everyone depending on severity of PFD, the fitness level of the client, if the client is breast feeding and prior injuries that could prolong healing time.

Online Course for Fit Pros: Prenatal and Postpartum Exercise

Danielle Spangler, C.PT, has been a fitness professional for over 20 years. Danielle is the creator of “Coremom” (Corrective Obstetrical Related Exercises) for purposes of creating a pre and postnatal small group-training program in a variety of fitness facilities. Danielle’s goal is to train other qualified fitness professionals and group exercise instructors on teaching pre and postnatal small group exercise classes using her method. Visit her website, daniellespangler.com

Why Women Should Lift

Carla DiGirolamo, MD, CF-L1, PN-1/18 July 2022/ All MFN blog/

Just a generation ago, women’s weight-lifting was largely isolated to professional athletes and competitive body-builders. Men have been lifting weights for years, but it has not come into the mainstream for women until the past 10-15 years.

Some of the barriers to the barbell for women may include fear of injury, lack of accessibility to an environment where they can learn and lift weights safely, and even more compelling are concerns about body image: “I don’t want to get too bulky”. Today, we know so much more about the overall health and athletic performance benefits of weight training. As more women have flooded competitive and professional sports and with the emergence of CrossFit and other resistance based group fitness classes, weight training has become commonplace in women’s organized sports and recreational fitness programs. But still today, the barriers to the barbell still exist with many misconceptions about risk of injury and body image concerns.

The Effect of Aging on our Muscles and Joints

Being a well-rounded athlete includes not only endurance, flexibility and agility, but also muscular strength. Our muscles move our skeleton, protect our joints, are a major source of energy expenditure and play an important role in blood sugar management. Like our heart and lungs, our skeletal muscles need exercise to stay healthy so they can continue to carry out these functions for our entire lives. Over time, especially into the menopausal years, women begin to lose muscle mass and bone density. Decline in estrogen levels increases the rate of bone loss and joint laxity leaving us more vulnerable to injury and fractures. With the loss of muscle mass, our metabolism slows and activities may become limited. But it doesn’t have to be this way. One important weapon to combat these natural changes is the all-mighty barbell!

Health Benefits of Weight Training

As young women, weight training helps performance across a spectrum of recreational and professional sports and builds a solid foundation of lean body mass, strength and functionality for the future. Starting from puberty, bone density increases until it peaks in our early 30’s. Weight-bearing exercise, along with sound nutrition, optimizes bone density development to prevent osteoporosis and fractures later in life. Into our 40’s, 50’s and beyond, weight training and attention to nutrition and recovery can not only slow the loss of bone density and muscle mass that comes with menopause, but may even result in continued improvement– especially if weight training was not started until later in life. Increasing and maintaining muscle mass in this age group also affords stability to joints such as shoulders, knees and hips thus preventing injury. But what if I’m already in my 60’s and beyond and I have never lifted weights before? Is it too late to start? Absolutely not! At age 89, my mother started doing deadlifts and chair squats with gallon milk jugs. Weight training for beginners can start with weighted household items, progress to dumbbells and to group classes such as Boot Camps, Crossfit and other similar type classes. In all age groups, like with any new sport or activity, beginners should focus on strict technique and mechanics with an experienced coach or instructor before increasing load and intensity.

A Word about Body Image

When I started weight training in the mid-1980’s, skinny was in. I was always self-conscious about doing too much leg work because my legs became very muscular. So I stopped training my legs – for literally decades. And now I am paying the price. But through Crossfit I have regained a lot of what I could have developed in my younger years. Today, I very much regret surrendering to the societal ideal at the time. Because “society” doesn’t have to contend with my personal struggle to start rebuilding leg strength after age 45. Fortunately, today is different, “Strong is the new sexy”. But the body-shamers and the haters still exist and feel compelled to impose their beliefs and ideals on others. But the truth is that your strongest, healthiest, most confident self is your most beautiful self – not some societal ideal. So whether you are 18 or 80, grab those weights and give your body the gift of strength that will keep you healthy, active and living life to the fullest for years to come.

Fit Pros: Offer menopausal and perimenopausal women an individualized approach to training, nutrition and wellness as a Menopause Health and Fitness Specialist.

Why Suffer in Silence?

Robyn Kade/15 July 2022/ All MFN blog/

In America today, 40% of females, including women, children and teens, suffer in silence with either primary or secondary dysmenorrhea every month. Primary dysmenorrhea accompanies the monthly menstrual cycle without any underlying medical conditions. Secondary dysmenorrhea means that there is another medical issue present, such as endometriosis. This condition makes it hard to function, with most women being bedridden for three to five days or longer. Dysmenorrhea is not a weakness, but a real medical issue.

Generally, the female client will have severe throbbing pain from the waist down. They can feel it in their stomach, low back, legs and feet, making it hard to move. Other symptoms include nausea, vomiting, diarrhea, anxiety, stress, depression, lightheadedness, fatigue, headache, fever, and depression, weakness and fainting. Risk factors are smoking, obesity, being underweight, strong family history, high levels of stress, anxiety and/or depression. Women can still have painful stomach cramping well after menopause if they have Endometriosis.

This is a silent stressor for many women because they rarely choose to speak about it. Some have been living with the pain for twenty years or more and think there is nothing they can do. If a client comes to you and mentions that they have a lot of pain, urge them to see their doctor. This conversation is more likely to happen with a female personal trainer. The good news is that fitness professionals can help their clients to feel better during this painful time of the month.

It is important to acknowledge this painful condition because of the physical and mental implications that come along with it. As the trainer you, may be working with a therapist as well as an OB/GYN. You are trying to help your client feel better overall. We recommend scheduling an assessment first to understand the client’s medical history. As a fitness professional, you may want to refer your clients to other professionals as well. Acupuncture, for example, is well known for helping women to ease and reduce anxiety. When you network with other professionals, you form a referral system to obtain more clients for yourself, too.

After completing your assessment, you will develop a wellness program for your client. The program will include: exercise, meditation (specific to this condition), and aromatherapy, as well as other components. Try to have your client establish a regular daily wellness routine. Journaling is also important as it helps to connect your thoughts, feelings and behaviors. Support groups can also help as women share their experiences with others.

Robyn Kade is the President/CEO of The Stress Management Institute for Health and Fitness Professionals™ and the SMI Business Institute™. Robyn received her Bachelor’s Degree from Rowan University in Health Promotion and Fitness Management. She is an American Council on Exercise (ACE) personal trainer and group fitness instructor, received a certificate in PTSD through the Kew Training Academy, and is a Compassion Fatigue Resiliency and Recovery – Educator. Robyn is also certified through the American College of Sports Medicine for Exercise Is Medicine (EIM) Level 1. Robyn is currently pursuing her Master’s Degree in Wellness and Lifestyle Management with a concentration on Wellness Coaching at Rowan University.

References

The Benefits of Creatine Supplementation for Active Older Women

Carla DiGirolamo, MD, CF-L1, PN-1/24 June 2022/ All MFN blog/

Loss of muscle and bone mass is arguably the greatest potential threat to vitality and independence in the aging female population. As ovarian estrogen declines during the menopausal transition, muscle and bone undergo significant changes.

Muscle mass and strength decline and loss of bone density accelerates after the onset of menopause. When these losses become severe, there is an increased risk of disabling falls and fractures and associated higher rates of medical comorbidities including high blood pressure, type 2 diabetes, depression, and cardiopulmonary disease.

Previously, in Athletic Aging, I posted about this very issue. Grip Strength as a Marker of Vitality in Mid-Life Women and Body Composition and Hormone Therapy – Truth and Tales are two articles that discuss the interplay among female reproductive hormones, muscle mass and function, body composition, and metabolism.

But it’s not just about muscles and bones! Mid-life women also struggle with sleep deprivation, brain fog, depression, and mood lability.

Today we continue this important conversation and take a deep dive into the science that explores the potential benefits of creatine supplementation in mid-life women that go beyond our muscles and bones!

How Does Creatine Work?

Creatine is a naturally occurring compound that is synthesized in the Human body by the kidneys and liver from the amino acids glycine and arginine. It is stored as phosphocreatine which supplies the energy that fuels muscle movement. Creatine is also found in animal proteins such as red meat, fish, poultry, and organ meats.

The phospho in phosphocreatine is a critical component for the production of adenosine tri-phosphate (ATP) found in tiny cell components called “mitochondria” that exist in every type of cell throughout the body. Think of the mitochondria as the “batteries” that power the cells within our tissues, and ATP as the “charge”. The “T” stands for tri -or 3 phosphates which is like 3 “bars” on your cell phone. When energy is used, ATP is converted to ADP – the “D” is for di- or 2 bars on your phone. So to recharge your phone to 3 bars (ATP), you need to plug it into the electrical outlet. Creatine serves as the source of energy to fully charge the mitochondria and replenish the stores of ATP.

What the Science Tells Us

Athletes have effectively used creatine supplementation for decades to support performance. Creatine is among the safest and most well-studied supplements in the sports industry.

Most of what we know about creatine was learned through the study of young, male athletes. Creatine has been shown to be effective in enhancing muscle strength, mass, and performance in strength-based activities. Because the aging population is particularly vulnerable to loss of muscle mass and function, attention has been turned toward investigating the potential use of creatine supplementation for preserving muscle mass and function in older individuals – particularly menopausal women.

A review of several randomized control trials and meta-analysis of studies investigating creatine supplementation in older female adults has discovered the following:

Women have 70-80% lower creatine stores and consume lower dietary amounts of creatine compared to men.
Declining estrogen levels are associated with increased inflammation and oxidative stress and may contribute to the reduction in protein synthesis and response to anabolic stimuli. Creatine supplementation has been proposed as a counter-measure to the inflammatory effects of declining estrogen.
Creatine supplementation with a high-dose load and maintenance of 3-5g daily in the absence of resistance training had minimal impact on muscle mass, strength, function, and bone density parameters in menopausal women.
Although studies have shown mixed results, the vast majority of research shows improvement of muscle strength, function, and bone density parameters with supplementation of 5g of creatine daily when combined with a consistent, long-term strength-training program of 3 months or more in menopausal women ages 50-65+.
There were no significant adverse effects of creatine supplementation in menopausal women across multiple studies.
Clinical evidence has reported positive effects of creatine supplementation on mood by restoring brain energy levels and balance. Evidence also suggests that creatine supplementation may favorably impact the dopamine and serotonin systems.
Creatine supplementation has consistently demonstrated improved cognitive performance and brain function, particularly in cases of sleep deprivation and mental fatigue. This is important given many mid-life women struggle with vasomotor symptoms (hot flashes) and disrupted sleep.

Summary of Recommendations for Mid-Life Women

Engage in a program of consistent (at least 2-3 times weekly) resistance/strength training as a permanent part of your long-term workout program.
Daily supplementation of creatine monohydrate may improve muscle strength, mass, function, bone density parameters, and body composition when combined with a consistent resistance/strength training regimen.
Dosing: Many experts agree a loading dose is not necessary. A daily dose of 5g/day (ideally in a shake, beverage, or with food) over time will achieve appropriate tissue saturation levels. *Vegetarians may require a dose of 5-10g daily.
Check out this podcast featuring Dr. Darren Candow, one of the leading creatine researchers for an incredibly informative review of how creatine works and the potential benefits of supplementation.
If you have chronic conditions involving your kidneys or liver, check with your doctor before incorporating creatine into your nutrition plan.

Article reprinted from Athletic Aging with author permission.

References

Smith-Ryan, AE et al. Creatine Supplementation in Women’s Health: A Lifespan Perspective; Nutrients 2021, 13, 877. https://doi.org/10.3390/nu13030877Ellem

Pinheiro dos Santos, E et al. Efficacy of Creatine Supplementation Combined with Resistance Training on Muscle Strength and Muscle Mass in Older Females: A Systematic Review and Meta-Analysis; Nutrients 2021, 13, 3757. https://doi.org/10.3390/nu13113757

Why Physical Therapy is Good for Women’s Health

Tahmineh Kamza, DTP/13 June 2022/ All MFN blog/

Women’s health concerns are much more complex than men’s and with the help of physical therapy (also called physiotherapy in many parts of the world), many of these issues can easily be remedied or addressed. There are main factors that greatly differentiate men from women. Of these, it is important to highlight three: menstruation, pregnancy and lactation. These bodily changes in a woman are mostly influenced by hormonal fluctuations and can also be a reason for mood swings and differences in behavior.