Women’s Health

Posted on Exercise, Women's Health

Stay active – or get active – to boost quality of life while ageing, study suggests to middle-aged women

Stay active – or get active – to boost quality of life while aging, study suggests to middle-aged women

Data from more than 10,000 Australian women showed a significant link between regular exercise during middle age and physical health in later life, even when the exercise routine was not started until their mid-50s

Consistent adherence to physical activity guidelines throughout middle-age is associated with a higher health-related quality of life in women, according to a new study publishing May 2nd in the open-access journal PLOS Medicine by Binh Nguyen of University of Sydney, Australia, and colleagues.

The evidence for an association between physical activity and health-related quality of life has been based primarily on cross-sectional studies and short-term randomized controlled trials. Few longitudinal studies have measured physical activity at more than one-time point and examined the long-term causal effects of exercise.

In the new study, researchers used data collected at three-year intervals beginning in 1996 from 11,336 participants in the Australian Longitudinal Study on Women’s Health. Women were born from 1946 through 1951, making them 47 to 52 years old at the study outset. Participants were classified as either meeting WHO physical activity guidelines — of 150 minutes of activity a week — consistently throughout the fifteen-year exposure period, not initially meeting the guidelines but starting to meet them at age 55, 60 or 65, or never meeting the guidelines. Health-related quality of life was assessed using the physical health composite score (PCS) and mental health composite score (MCS) from the Short Form 36 Health Survey, which includes 36 questions about functional health and well-being.

On average, people who consistently met physical activity guidelines and those who first started to meet guidelines at age 55 had a three-point higher PCS (46.93 [95% CI 46.32 to 47.54] and 46.96 [95% CI 45.53 to 48.40], respectively), compared to those that did not meet physical activity guidelines (43.90 [95% CI 42.79 to 45.01]). The effect of physical activity on the PSC was significant even after controlling for socioeconomic factors and pre-existing health diagnoses. However, there was no significant association between physical activity and MCS.

“Combined with existing evidence, this study contributes to growing evidence of the benefits of maintaining or adopting an active lifestyle in mid-age,” the authors say. “An important public health message is that being active for as many years as possible, even if women start to meet physical activity guidelines in their mid-50s, could have important health benefits in terms of physical health, especially in physical functioning.”

The authors add, “Our study shows that it’s important for women to be active throughout mid-age to gain the most benefits for physical health in later life. Ideally, women should increase their activity levels to meet the guidelines by age 55.”

Posted on Exercise, Women's Health

Women get the same exercise benefits as men, but with less effort.

Smidt Heart Institute Study, published in Journal of the American College of Cardiology, shows women get more heart health benefit from exercise than men
Smidt Heart Institute Study, published in Journal of the American College of Cardiology, shows women get more heart health benefit from exercise than men

A new study from the Smidt Heart Institute at Cedars-Sinai shows there is a gender gap between women and men when it comes to exercise.

The findings, published in the Journal of the American College of Cardiology (JACC), show that women can exercise less often than men, yet receive greater cardiovascular gains.   

“Women have historically and statistically lagged behind men in engaging in meaningful exercise,” said Martha Gulati, MD, director of Preventive Cardiology in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, the Anita Dann Friedman Chair in Women’s Cardiovascular Medicine and Research and co-lead author of the study. “The beauty of this study is learning that women can get more out of each minute of moderate to vigorous activity than men do. It’s an incentivizing notion that we hope women will take to heart.”

Investigators analyzed data from 412,413 U.S. adults utilizing the National Health Interview Survey database. Participants between the time frame of 1997 to 2019—55% of whom were female—provided survey data on leisure-time physical activity. Investigators examined gender-specific outcomes in relation to frequency, duration, intensity and type of physical activity.

“For all adults engaging in any regular physical activity, compared to being inactive, mortality risk was expectedly lower,” said Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science, director of the Institute for Research on Healthy Aging in the Department of Cardiology in the Smidt Heart Institute, and senior author of the study. “Intriguingly, though, mortality risk was reduced by 24% in women and 15% in men.”

The research team then studied moderate to vigorous aerobic physical activity, such as brisk walking or cycling, and found that men reached their maximal survival benefit from doing this level of exercise for about five hours per week, whereas women achieved the same degree of survival benefit from exercising just under about 2 ½ hours per week.

Similarly, when it came to muscle-strengthening activity, such as weightlifting or core body exercises, men reached their peak benefit from doing three sessions per week and women gained the same amount of benefit from about one session per week.

Cheng said that women had even greater gains if they engaged in more than 2 ½ hours per week of moderate to vigorous aerobic activity, or in two or more sessions per week of muscle-strengthening activities. The investigators note their findings help to translate a longstanding recognition of sex-specific physiology seen in the exercise lab to a now-expanded view of sex differences in exercise-related clinical outcomes.

With all types of exercise and variables accounted for, Gulati says there’s power in recommendations based on the study’s findings. “Men get a maximal survival benefit when performing 300 minutes of moderate to vigorous activity per week, whereas women get the same benefit from 140 minutes per week,” Gulati said. “Nonetheless, women continue to get further benefit for up to 300 minutes a week.”

Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology, says concrete, novel studies like this don’t happen often.

“I am hopeful that this pioneering research will motivate women who are not currently engaged in regular physical activity to understand that they are in a position to gain tremendous benefit for each increment of regular exercise they are able to invest in their longer-term health,” said Albert, professor of Cardiology.

Posted on Rheumatoid arthritis, Women's Health

Early menopause and HRT among hormonal factors linked to heightened rheumatoid arthritis risk

Having 4 or more children and fewer than 33 reproductive years also seem to be influential
Having 4 or more children and fewer than 33 reproductive years also seem to be influential

Early menopause—before the age of 45—taking hormone replacement therapy (HRT), and having 4 or more children are among several hormonal and reproductive factors linked to a heightened risk of rheumatoid arthritis in women, finds a large long term study published in the open access journal RMD Open.

Women are more susceptible to this autoimmune disease than men, note the researchers. They are 4–5 times as likely as men to develop rheumatoid arthritis under the age of 50, and twice as likely to do so between the ages of 60 and 70. And the disease seems to take a greater physical toll on women than it does on men.

While hormonal and reproductive factors are thought to contribute to women’s heightened susceptibility to the disease, it’s not entirely clear which factors might be particularly influential.

In a bid to find out, the researchers drew on 223,526 UK Biobank participants whose health was tracked for an average of 12 years.

During this time, 3313 (1.5%) women developed rheumatoid arthritis, and several hormonal and reproductive factors were associated with heightened disease risk, after accounting for potentially influential factors, such as lifestyle, level of social and economic deprivation, ethnicity and weight (BMI). 

Starting periods after the age of 14 was associated with a 17% higher risk when compared with starting them at the age of 13, while going through the menopause below the age of 45 was associated with 46% heightened risk compared with going through it at the age of 50-51. 

Fewer than 33 reproductive years—defined as the interval between starting periods and going through the menopause—was associated with a 39% heightened risk. And compared with having 2 children, 4 or more was associated with an 18% higher risk.

Hysterectomy or removal of one or both ovaries (oophorectomy) was associated with 40% and 21% higher risks, respectively, although only a few women had these procedures. 

While no clear association emerged between the use of the Pill and rheumatoid arthritis risk, HRT use and to a lesser extent, its duration, were associated with, respectively, 46% and 2% higher risks.

This is an observational study, albeit over a reasonably long period, and therefore can’t establish cause and effect, and the researchers acknowledge various limitations to their findings.

For example, the UK Biobank is made up of relatively healthy and affluent people of white ethnic background, so isn’t representative of the UK population at large.

Nevertheless, the findings prompt the researchers to suggest that hormonal and reproductive factors should be carefully evaluated in women diagnosed with rheumatoid arthritis. 

And they conclude: “The findings of this study are significant and form a basis on which novel and target-specific intervention measures to curb the risk of [rheumatoid arthritis] in women may be developed.”

Posted on autoimmune conditions, Women's Health

Clear link between autoimmune disease and perinatal depression

Women with autoimmune disease are more likely to suffer from depression during pregnancy and after childbirth; conversely, women with a history of perinatal depression are at higher risk of developing autoimmune disease, a new study from Karolinska Institutet published in the journal Molecular Psychiatry reports.

In autoimmune disease, the immune system mistakenly attacks the body’s own healthy tissue. Some of the most common autoimmune diseases are gluten intolerance (coeliac disease), autoimmune thyroiditis, rheumatoid arthritis, type 1 diabetes, and multiple sclerosis (MS).

In the present study, researchers used data from the Swedish Medical Birth Register and identified all women who had given birth in Sweden between 2001 and 2013. Out of the resulting group of approximately 815,000 women and 1.3 million pregnancies, just over 55,000 women had been diagnosed with depression during their pregnancy or within a year after delivery.

The researchers then compared the incidence of 41 autoimmune diseases in women with and without perinatal depression, controlling for familial factors such as genes and childhood environment by also including the affected women’s sisters.

Strongest association for MS

The results reveal a bidirectional association between perinatal depression and autoimmune thyroiditis, psoriasis, MS, ulcerative colitis, and coeliac disease. Overall, women with autoimmune disease were 30 per cent more likely to suffer perinatal depression. Conversely, women with perinatal depression were 30 per cent more likely to develop a subsequent autoimmune disease.

The association was strongest for the neurological disease MS, for which the risk was double in both directions. It was also strongest in women who had not had a previous psychiatric diagnosis.

“Our study suggests that there’s an immunological mechanism behind perinatal depression and that autoimmune diseases should be seen as a risk factor for this kind of depression,” says the study’s first author Emma Bränn, researcher at the Institute of Environmental Medicine at Karolinska Institutet.

Can have serious consequences

The researchers will now continue to examine the long-term effects of depression during pregnancy and in the first year following childbirth.

“Depression during this sensitive period can have serious consequences for both the mother and the baby,” says Dr Bränn. “We hope that our results will help decision-makers to steer funding towards maternal healthcare so that more women can get help and support in time.”

Since this was an observational study, no conclusions on causality can be drawn.

The study was financed by Karolinska Institutet, Forte (the Swedish Research Council for Health, Working Life and Welfare), the Swedish Research Councill and the Icelandic Research Fund. The researchers report no conflicts of interest.

Posted on Women's Health

Researchers find walkable communities are healthier for both mom and baby

Pregnant women that live in walkable communities—with more sidewalks, parks and walking paths—not only engage in more physical activity but are also more likely to experience favorable birth outcomes, according to research from the University of New Hampshire.

The study, published in the journal of Economics and Human Biology, found that expectant mothers living in walkable counties tend to engage in more walking and exercise and have fewer issues with premature births, low birth weight, gestational diabetes and hypertension. Walking is often recommended as a safer, more moderate activity for pregnant women, so the authors reasoned that living in a more walkable area could have health benefits for them.

“Gestational diabetes is a growing issue and low birth weight and preterm babies are always a concern, they can just have so many more complications,” said Karen Conway, professor of economics at UNH’s Peter T. Paul College of Business and Economics. “At the end of the day, the data shows walkable communities mean mom and the baby are both in better health.”

Conway and her co-author Andrea Menclova, associate professor of economics at the University of Canterbury, combined walkability measures created by the Environmental Protection Agency (EPA) with detailed data on physical activity from the Behavioral Risk Factor Surveillance System (BRFSS) and pregnancy outcomes from the National Vital Statistics Natality Detail Files (NDF). They found that a 10-point increase in the walkability index—equivalent to transitioning from the “least walkable” to the “most walkable” category—is associated with a more than 70-minute increase in weekly exercise among pregnant women. This same change results in an 0.8 percentage point increase in the likelihood of a full-term birth, a 0.07-week extension in gestational age, a 27g increase in birth weight, and a 27% reduction in the likelihood of gestational diabetes and 16% reduction in hypertension. The study did not find a clear connection between walking and its impact on a mother’s weight gain or high birth weight for the baby, known as macrosomia.

“We know that walkability may have other health benefits beyond encouraging more exercise,” said Conway. “Living in an area more suitable for walking gets people outside and interacting with neighbors and relating to others in the community and all of those types of social and intrinsic activities can contribute to better overall health.”

The professors applied the conceptual and empirical tools of economics to see if there was a causal relationship between walkability and pregnancy outcomes. They note that their study is part of a larger area of health economics that uses established data to analyze factors and policies that affect health outcomes, including those during and after pregnancy. The goal is to provide evidence that can help shape policies and inform city and town managers about cost-effective interventions that may help improve health outcomes of residents.