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Editor’s comment: Is feeling safe the foundation for better health and wellbeing?

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Most women know what it feels like to walk home alone at night. Maybe you call a friend, or discreetly slide your keys between your fingers, you probably share your location with a loved one just in case. But we also know how it feels to be cat-called while out running, or have inappropriate jokes made about us in the workplace. 

In a post-Me Too world, women are more empowered to speak out about these incidents, yet  sexual harassment is still too often dismissed as an inevitable part of women’s everyday lives, ignoring the profound and lasting impact it can have on our health and well-being. 

Harassment and sexual violence are not just social harms. The World Health Organization has classified sexual violence as a major public-health issue with research linking it to measurable short-and long-term physical impacts, from cardiovascular health to sleep and chronic pain. 

Earlier this month, a study found that women who had experienced stalking were 41 per cent more likely to have a heart attack or stroke. This increased to 70 per cent among those who had filed a restraining order.

Elsewhere, studies have linked childhood sexual abuse and trauma to an increased risk of endometriosis, while women with a history of violence are thought to be twice as likely to develop chronic pain conditons. 

Not everyone will experience incidents of these extremes, but the stress that is placed on the mind and body as a result of having to be hypervigilant every time you leave the house to go for a run or enter the workplace, will inevitably take its own toll, even if the true extent of this is difficult to measure. 

I recently interviewed the founder of Danish startup, All U Me, which is addressing sexual harassment by developing a range of jewellery that also acts as a safety device. If a woman finds herself in a situation where she feels unsafe, pushing the device three times will alert nearby bystanders via an app, who are trained in how to intervene.

During the interview with All U Me founder, Dorte Knusden, we had an interesting discussion about whether she considered it to be a ‘femtech company’, and where she felt it fit best in the space. It is, of course, femtech in the sense that it is a technological innovation designed primarily to address an unmet need affecting women. The broader sense of community and safety that the app is designed to bring also addresses the fact that women who experience harassment are more likely to go on to develop mental health conditions like anxiety and depression. 

But we both agree that All U Me pushes the boundaries of what is typically seen as ‘femtech’. The sector is more often than not associated with reproductive or gynaecological health, health conditions that disproportionately impact women, and occasionally sex and gender differences in diseases. But it often overlooks one important factor in women’s health and wellbeing: feeling safe.

Enabling women to live in a world where they feel safe is crucial for gender equality. When women feel safe, they can fully participate in their communities and contribute to wider society, which we know is important for living a full and meaningful life. But by preventing harassment and violence against them, we would also reduce the risk of women developing mental and physical health conditions further down the line, contributing to long-term health disparities and exacerbating the gender health gap

Women are more informed and empowered about their health than ever before. We can predict our next period, monitor our glucose levels and test our hormones all from home. Yet we still can’t go for a run without fear of being harassed in the street. 

If we want to live in a world where women’s health is taken seriously – and treated equally – we must start from the bottom up, by first examining how society is set up for women and how this could better serve them. The best innovations are not always about the most advanced and expensive technological developments, but those that force us to think differently and put what we already have to better use. 

Knusden openly admits that the technology used in her jewellery is no more advanced than Bluetooth and GPS, which all of us access every day via our smartphones. But it’s innovative in the way it shifts the responsibility of women’s safety from the individual to a collective, and in how it centres feeling safe as the foundation to better health, wellbeing and overall quality of life for women. Are these not, after all, the very core principles which underpin all ‘femtech’?

Wellness

Pregnant women may reduce key health risk through more light exercise, study finds

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Light exercise and less sitting may reduce pregnant women’s risk of serious blood pressure complications, according to a new study.

Researchers have proposed a daily activity and sleep guide that they say was linked to a nearly 30 per cent lower risk of hypertensive disorders of pregnancy.

The suggested pattern includes fewer than eight hours of sedentary time, at least seven hours of light physical activity, around 22 minutes of more intense activity and nearly nine hours of sleep.

The University of Iowa-led study examined the daily behaviours of 470 pregnant women across all stages of pregnancy.

Participants wore monitors that measured physical activity over 24-hour periods and recorded how long they spent asleep.

Hypertensive disorders of pregnancy include chronic high blood pressure, gestational hypertension and pre-eclampsia.

Gestational hypertension is high blood pressure that develops during pregnancy, while pre-eclampsia is a potentially serious condition involving high blood pressure and signs that organs may be affected.

Sedentary behaviour means being mostly inactive, such as sitting or lying down.

Light physical activity can include casual walking, moving around the home or standing.

Moderate to vigorous activity includes movement such as brisk walking, where breathing and heart rate increase.

Kara Whitaker, associate professor in the department of health, sport, and human physiology at Iowa and corresponding author of the study, said: “We are identifying the optimal composition of movement behaviours across the day associated with the lowest risk of developing HDP and the most improved health outcomes.

“This blueprint holds for each and every trimester of pregnancy.”

Study participants were enrolled at sites in Iowa City, Pittsburgh and Morgantown, West Virginia.

The women wore activity and sleep monitors for at least one week during each trimester of pregnancy.

Four in five participants were non-Hispanic white and nearly a quarter lived in rural areas.

The data showed a steep rise in risk among pregnant women who were sedentary for more than 10 hours a day.

Women who increased light physical activity to at least four hours a day reduced their risk of hypertensive disorders of pregnancy to 15 per cent from 30 per cent.

Whitaker said: “Just moving around more seems to have significant health benefits.

“And I think it also may be a more feasible target for women who are pregnant who are not exercising regularly.”

The researchers said they were surprised that longer durations of moderate to vigorous physical activity did not appear to provide additional benefit.

Sleep beyond a certain duration also did not appear to bring major further benefits.

Whitaker said: “Through this study, we are providing evidence that reducing sedentary behaviour and engaging in light physical activity are important, and maybe more important, when it comes to pregnancy and health.”

The findings may be relevant beyond pregnancy because clinical research has shown that women who develop hypertensive disorders of pregnancy are more than twice as likely to develop heart disease later in life.

Cardiovascular disease includes conditions affecting the heart and blood vessels, such as heart disease and stroke.

Whitaker said: “We know that cardiovascular disease is the number one killer of women, and if we can intervene in pregnancy and prevent women from developing a hypertensive disorder of pregnancy, we are putting them on a better trajectory, away from cardiovascular disease and toward more optimal cardiovascular health.”

The study was published online on June 10.

A second study, published online on May 27, looked more closely at the ratio and type of sedentary behaviour and light physical activity linked to a lower risk of hypertensive disorders of pregnancy.

Whitaker is a lead co-author on that study.

Co-authors in the June 10 study include Alex Crisp, Jaemyung Kim, Karina Smith, Donna Santillan, Mark Santillan and Bridget Zimmerman, from Iowa; Jacob Gallagher, from Iowa State University; Melissa Jones, from Oakland University in Michigan; Bethany Barone Gibbs, Katrina Wilhite, Alexis Thrower and Iqra Sheikh, from West Virginia University; and Sabera Rahman, Janet Catov, Christopher Kline and Maisa Feghali, from the University of Pittsburgh.

The National Institutes of Health, the University of Iowa Institute for Clinical and Translational Science, the University of Pittsburgh Clinical and Translational Science Institute and the West Virginia Clinical and Translational Science Institute funded the research.

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Motherhood

Expectations about sleep affect postpartum sleep quality, study finds

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Pregnant women’s expectations about postpartum sleep may predict sleep quality after birth, outweighing prior sleep and psychiatric history, a study suggests.

The findings suggest attitudes and beliefs about sleep during pregnancy could be a modifiable risk factor for postpartum sleep concerns.

They also indicate that, among women expecting the poorest sleep, higher postpartum anxiety may further worsen sleep quality.

Sammy Dhaliwal, lead author is clinical health psychologist and research fellow in the department of obstetrics and gynaecology at the Perelman School of Medicine at the University of Pennsylvania.

Dhaliwal said: “Most pregnant women in our sample anticipated poor postpartum sleep before it occurred, and it was striking that those expectations predicted worse sleep outcomes even after accounting for factors such as prior sleep disorders, psychiatric history, and number of previous births.

“This suggests that attitudes and beliefs about sleep during pregnancy may represent a modifiable target for early intervention before postpartum sleep problems emerge.”

Sleep disturbance affects an estimated 60 to 80 per cent of postpartum women and is linked to a higher risk of depression and anxiety.

Researchers said it is often regarded as an expected part of life after childbirth rather than a health issue that may be addressed earlier.

The study enrolled 432 pregnant women at about 24 weeks of gestation, meaning around 24 weeks into pregnancy.

Participants completed measures of their expectations about postpartum sleep, current sleep quality using the Pittsburgh Sleep Quality Index, and mood using validated depression and anxiety scales.

Assessments were repeated at six, 12 and 24 weeks postpartum.

A subset of 49 women also wore wrist actigraphy devices at six to eight weeks postpartum.

Actigraphy uses a wearable device, similar to a watch, to estimate sleep and wake patterns based on movement.

The results showed that 70 per cent of pregnant women, or 301 of 432 participants, expected poor sleep in the postpartum period.

Researchers found that predicted sleep disruption during pregnancy was a significant predictor of postpartum sleep concerns.

Among first-time pregnant women without prior health concerns, those who expected greater sleep disturbance had significantly more disrupted sleep after birth, measured by both actigraphy and self-report.

Among women who expected the worst sleep quality, higher postpartum anxiety significantly worsened both measured sleep and self-reported sleep, independent of anxiety levels during pregnancy.

Dhaliwal said the findings point to two possible areas for intervention: addressing sleep-related beliefs during pregnancy and treating postpartum anxiety.

Dhaliwal said: “Postpartum sleep disruption is often treated only after problems develop, but our findings suggest there may be an opportunity to intervene earlier during pregnancy.

“Addressing sleep-related beliefs and postpartum anxiety during prenatal and postpartum care may help improve sleep and emotional well-being in new mothers.”

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Mental health

Pilates may improve heart and metabolic health in sedentary women, study finds

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A four-week Pilates programme may improve heart, metabolic and stress measures in previously sedentary women, a small study suggests.

Pilates is a mind-body form of exercise that has been linked to better fitness, balance, posture, muscular endurance, mental wellbeing and quality of life in different groups.

Built around breathing, concentration, control, precision, centring and flow, Pilates is already used in physiotherapy, rehabilitation and preventive health. The new study looked at whether a structured four-week programme could affect cardiovascular, metabolic, body and stress-related measures in sedentary adult women.

The longitudinal study included 30 sedentary women split into two age groups, 30 to 40 and 50 to 60.

All participants completed a standardised, supervised Pilates programme lasting four weeks, with three sessions a week lasting 50 to 60 minutes.

Researchers measured resting heart rate, systolic and diastolic blood pressure, body mass index, abdominal circumference, fasting blood glucose and serum cortisol at the start and end of the programme.

Systolic and diastolic blood pressure are the top and bottom readings in a blood pressure test. Cortisol is a hormone linked to the body’s stress response.

The four-week Pilates programme was linked to improvements in cardiovascular, metabolic, body and neuroendocrine measures, although not every change reached statistical significance within each age group.

In the younger group, significant reductions were seen in heart rate, blood pressure, body mass index and fasting blood glucose after the intervention.

The reduction in blood pressure after the programme was significantly greater in the older group than in the younger group.

Older participants also showed a greater reduction in glucose and cortisol levels after the intervention than younger participants.

Analysis also found significant links between cardiovascular, metabolic and neuroendocrine changes.

In the younger group, this was particularly seen between heart rate and blood pressure responses.

In the older group, it was particularly seen between changes in body mass index and fasting glucose.

The findings suggest Pilates could be a useful multidimensional exercise approach for cardiometabolic health and stress regulation in previously sedentary women.

The researchers said the larger reduction in blood pressure seen in the older group may reflect a higher cardiometabolic burden at the start, leaving more room for improvement after the programme.

The greater reduction in fasting glucose and cortisol in older participants may similarly suggest that people with higher baseline metabolic and neuroendocrine dysfunction could benefit more from structured exercise such as Pilates.

Although Pilates is known to improve body composition through energy use, neuromuscular activation and support for healthier habits, the researchers said the fall in body mass index over four weeks is unlikely to be explained by Pilates alone.

They noted that participants were also told to avoid alcohol, sugar-containing products and sugar-sweetened drinks during the intervention, which may have contributed to the change.

In the younger group, the link between heart rate and blood pressure suggested coordinated cardiovascular responses after Pilates.

The researchers also found that cortisol appeared to be linked to blood pressure and body mass index, suggesting stress-related changes may be tied to cardiovascular and body regulation after the intervention.

In the older group, the link between body mass index and fasting glucose highlighted the relationship between body fat and metabolic regulation.

A positive link between blood pressure and body mass index in this group also suggested that improvements in vascular regulation may be associated with reductions in body mass.

Overall, the findings suggest Pilates-related physiological changes may involve interconnected cardiovascular, body, metabolic and neuroendocrine mechanisms, with different response patterns by age.

The study has important limits. It did not include a non-exercise control group, so it cannot prove Pilates directly caused the changes.

The sample size was also small, which limits how far the findings can be applied more widely.

The authors also noted that cortisol was measured using a single fasting morning sample, which limits conclusions about broader hypothalamic-pituitary-adrenal axis regulation, the system involved in the body’s stress response.

They said larger studies with longer follow-up will be needed to confirm whether Pilates causes these physiological changes over time.

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