Because the female fitness myths just kept on coming! We just kept on busting them! It is also interesting how many myths are true for men, but not true for women – it fuels our passion to get female-centric education out there for personal trainers!
A C Section is the Easy Way to Birth
We’ve all heard the term “too posh to push”, but today I want to dispel the idea that a C-Section is the easy way to birth a baby. It seems a bit off topic, but I cannot tell you how many times I’ve asked a mum how they birthed their babies and they said “just” a C-Section; inferring that because they birthed that way that they won’t have pelvic dysfunctions or further healing to do.
NOT true. The way your female clients birth is of utmost importance to you, as their trainer, or you, as the person exercising. Let me tell you why:
- Maternal complications are higher when you’ve had a c-section1. These include infections, haemorrhage, and death.
- Whilst having a planned C-Section reduces the risk of vaginal tears, it carries an increased risk of scar tissue build up in the abdomen, which can increase the chance of the placenta attaching to a scar than the uterine wall in subsequent pregnancies2. Scar tissue has further implications that have not yet been fully explored, from adhering to your intestines, to affecting how your fascia slides, to your posture.
- A C-Section Surgery cuts through at least 10 layers of tissue, and there are at least 4 methods of achieving this. It is a complicated procedure, and the surgeon will cut each layer in a variety of different directions in order to handle the tissues appropriately, making sure they minimise external blood flow while ensuring maximum blood flow to surrounding tissues and organs, avoiding organ injuries, preventing infections, and keeping adhesion’s to a minimum3.
- In the long term, there are ongoing considerations, such as future c-sections. If your client has a vertical scar, she’s required to have c sections in future. For every c-section she has, her risk of complications increases4.
- Diastasis is higher among women who have a c section5 6. The abdominal muscles are not actually “cut” in the process, however women who have had this surgery have higher rates of abdominal separation.
- There is no difference in urine or faecal incontinence between a c section or vaginal delivery7, pelvic dysfunction is still of concern.
- Women who give birth via c section are 50% more likely to have a hysterectomy later on8.
The moral of this story is not to scare you or judge the woman who elects (or needs) to have a c section. Rather, it is to drive home how big this decision is, to understand that it’s major surgery, and to handle our recovery from this surgery accordingly. For personal trainers, this means understanding the issues, and getting appropriate core-rehab training qualifications.
Rice/Carbs/Bread/Fruit Will Make you Fat
What is common among all these foods is the simple carbohydrates/sugars… HOWEVER:
Firstly, let me agree that western societies in general are probably eating too much processed carbohydrates, from too few sources, to have optimal health. However, having said that, consuming whole grains from a variety of sources, is essential for thriving health, and will not make you fat if consumed in appropriate quantities.
Women aged 19-50 are recommended to eat 6 serves of WHOLE grains per day, as well as 5 serves of legumes and vegetables, 2 serves of fruit, 2.5 serves of lean meat, fish, eggs, nuts, seeds, and 2.5 serves of dairy or dairy alternatives9.
For women aged 51-70 years, grains should drop down to 4 serves a day, and dairy (and dairy alternatives) increases to 4 serves a day too.
The issues most women have with this in the IntoYou gym is real food, and VARIETY. In the western world, most of our grains and cereals come in the form of highly processed bread, pasta, and cereal. The trick for health is to consume these grains in their whole grain form, and to get them from wheat, rice, quinoa, barley, oats, millet, and all the other variations they come in!
It’s true, you can eat too much of any of these grains, and you will store them if you do, so make sure you understand what a “serve” is. Likewise, you can over-eat fruit, and the abundance of sugar contained in them may be conserved in the form of fat later on, but if you’re sticking to your two serves, and getting enough fibre and protein, these two serves are unlikely to be to cause of your wait gain.
More likely, causes of weight gain include:
- Chronic stress
- Underlying health conditions, for example thyroid dysfunction
- Hormone imbalance, for example PCOS
- Over eating (ie. Getting more than 6 serves of grains a day, or continuing to consume more than 4 serves a day post menopause)
- Consuming mainly processed, packaged, and “fast” foods
- Sleep disorders
If you or your clients are gaining weight for no reason, resist the urge to increase the intensity of their sessions, particularly if they’re stressed or having problems with sleep. Refer them to a GP, and start building a team around them, including naturopaths, nutritionists, chinese herbalists, homeopaths, doctors, endocrinologists, etc, until you have an answer. Your role is primarily to advocate, not to diagnose, or prescribe.
You’ve Got to Calorie Restrict to Lose Weight.
I see this all over the internet, unfortunately perpetuated by trainers and fitness influencer’s more than any other profession. The argument goes:
“if you were in a concentration camp you’d lose weight” – you’d also loose your teeth and hair.
“if I dropped you in the desert, you’d walk out thinner” – you’d also walk out delirious and malnourished…
I really believe that personal trainers are in the HEALTH industry, not the HARM industry. I think all of us genuinely want to help people, but attitudes around calorie restriction aren’t helpful, in many cases they’re harmful.
I do understand that all of us, myself included, have clients who calorie restricted and lost weight. I also have tonnes that didn’t. I have clients who have lost weight by:
- seeking counselling
- walking regularly
- engaging in sport
- contracting parasites, worms, or another infection
- following the Mediterranean diet
- simply eating whole foods only
- following a keto or paleo diet
- training three times a day
- loosing a family member
I also have had tonnes of clients GAIN weight in those instances.
The issue with calorie restriction and women’s health is that chronic calorie restriction has an impact on their hormone balance – sometimes for good sometimes for evil. Intermittent fasting (which is not the same as calorie restricting) has been good for the hormone balance in female diabetics, but is bad for chronically stressed menstruating women10 11 because of the impacts on her cortisol levels. In studies of overweight women, a balanced deficit diet has been shown to positively impact thyroid hormone, but a very low calorie diet has been shown to negatively impact it12.
I should also point out that calorie restriction is not the same as a starvation diet (as in the case in a concentration camp or desert) and people in the studies around calorie restriction diets are often taking a range of supplements to ensure they meet their nutritional needs.
Personal trainers are not qualified to prescribe supplements.
If you’re prescribing a calorie restrictive diet (which you can only do if you are a nutritionist as well as personal trainer), then you need to collaborate with a naturopath to ensure their nutrient needs are adequate (not just macros!).
In addition to affecting a woman’s hormonal balance, calorie restrictive diets have been shown to increase bone loss, a major concern for all women13.
So no, calorie restriction is not the be-all-and-end-all of weight loss. In fact, if you have a client who is chronically stressed, it could have the opposite effect. If you’re one of those trainers who is using the concentration camp or desert analogy, I don’t have to point out the ethics and health risks of recommending that to ANY of your clients, not just your female ones… do I??
You’ve got to Calorie Restrict to Lose Weight – Peri Menopause edition!
I received a message after our talk last week, which pointed out, quite rightly, that all my “myth busting” was centred around women of menstruating age. So the question was:
Just wondering about cal restricted diets for menopausal women? Not the hormone balance issue? Aware of the bone density and loss of muscle mass issues. Always feel like info is geared for pre menopause and post we r a bit of a different ballgame!
So while it’s true that post menopausal women’s hormones are different, they still have hormones! For optimal health, women who are transitioning through menopause or are post menopausal should reduce the carbohydrate/grain intake by 2 serves a day (ie. go from 6 serves to 4 serves a day) and increase their protein and dairy consumption by 1-2 serves a day – so it’s less about calorie restriction and more about where those calories come from!
Maintaining a healthy weight throughout and after the menopause transition is essential for ongoing good health for women. Maintaining a healthy weight will reduce inflammation generally, and also reduce bio markers and risk for certain cancers and diseases14. The greater the weight loss, in overweight and obese postmenopausal women, the greater the hormonal changes that reduce risk of developing breast cancer 15.
Having said that, it can be harder for post menopausal women to lose weight, due to a variety of factors, including:
- They have less muscle mass, therefor a slower base metabolic rate (ie. They burn fewer calories at rest than they did pre-menopause)
- Appetite-related hormones increase, the brain’s eating reward response is enhanced
- Post menopausal women who lose weight through calorie restriction are less likely to keep it off long term, compared to those who undergo Health Education Groups and Lifestyle Change programs; with those in the latter programs voluntarily eating less fried foods, sugary drinks, meat and cheese, and increasing their consumption of fruit and vegetables16.
Calorie restrictive diets have conflicting results17:
- The weight loss itself has a positive impact on longevity, and disease risk
- Losing weight through calorie restriction has an adverse effect on bone health
- Calorie restrictive diets inhibit the action of the mTOR pathway, which is involved in several illnesses including Alzheimer disease, cancer, type 2 diabetes, and heart disease – which post menopausal women are at higher risk of developing.
- However, the same calorie restrictive diets that showed the above benefits also showed an increase in muscle deterioration…
So, the moral of the story is that in women currently transitioning, or who have transitioned, calorie restrictive diets are good in the short term, but should be accompanied by those things that build and maintain muscle and bone mass:
- Protein (not just from animals)
- Calcium (not just from dairy)
- Plyometric loading (done in a pelvic floor safe way)
- Heavy weights, and I mean heavy, <6 reps x 4-5 sets (also done in a pelvic floor safe way)
Training Harder is Better
Otherwise known as no pain no gain…
Or more is better. Longer. Heavier. And so on…
Let me start by acknowledging that HIIT training has been shown to help obese women lose weight, and shows body composition improvements in young women18. The myth we are busting today is that ALL sessions have to be as hard as possible ALL the time.
This can be for you to take on board as a personal trainer, and I’ll give you some considerations to take on board when planning intensity below. OR this could be as a woman, let me give you permission to back off the intensity at certain times, to maximise the effectiveness of your training – because in some instances harder can be detrimental.
For women, training harder isn’t always better, mostly because women:
- Generally, have more problems with sleep (otherwise known as recovery)…
- Are more susceptible to ligament injury at certain times of the month…
- Need to consciously manage their stress more, and are affected by stress differently to men (mainly in the way that our heart rate becomes elevated at times of stress, making high heart rate training even more stressful…)
- Who’s resilience, tolerance to high intensities, and injury risk will fluctuate day to day, week to week, and month to month,
- Are often time-poor, which sometimes translates in to nutrient-poor, which can lead to menstrual disturbances and less-than-optimal health. This means high intensities can add to their deficiencies rather than boost their health.
- Are at a higher risk of heart disease, where hard and high intensity exercise is often contraindicated19
To name just a few.
For women, especially if they’re sleep deprived, stressed, nutrition-poor, poorly hydrated, at a certain time of the month (for menstruating women), training less or reducing the intensity is often better. Depending on her circumstances, less:
could yield you better results than flogging her to death – and this is especially true for women, but should probably be considered across the board.
In studies done on resistance training women, for example, less sets yielded better strength results in than more sets (up to 20)20. Low rep ranges and sets of 5 to 10 yielded better strength and size gains than if you kept on going and did more – so in this sense less is better regardless of their stress/sleep/nutrition status!
In other studies done on endurance training, the law of diminishing returns appears to apply21 – the larger their volume of exercise the smaller the health and longevity return. For women, there’s the added consideration of adequate nutrient intake, the loss of their cycle, and their increased risk of osteoporosis if both of the former things occur.
So if you’re training women, the dose matters – whether it’s intensity, load, reps, sets, time, rest period, volume, or frequency. If you need a rule, for everyday women who are training for health, aim for hitting high intensities and/or 90% max loads once a month – when they’re mentally, emotionally, and physically at their peak, and only if they’ve slept well, are fully recovered, have eaten a wide variety of nutritious foods, are hydrated, are feeling resilient, and if strength training, are in their follicular phase. The rest of the month should be sub-maximal and intensity dependant on:
What’s going on in their life (at work and in the home)
How well they’ve slept
How well they’ve recovered from previous sessions
The quality of their food intake
How well they’re hydrated
Where they are emotionally
What phase of their cycle they’re in
After all, if their goal is health and happiness, you may never chose to flog them – there is absolutely no research that says going harder makes you happier!
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