“You’re stronger than you think,” said diabetes researcher Jane Yardley, as she clinked the 306-pound (138-kilogram) weight into place on the calf raise machine at the University of Alberta’s Physical Activity and Diabetes Lab.
Surprising myself about how much weight I can lift is just one of the personal takeaways I’ve gained as a participant in Yardley’s research study on how exercise affects post-menopausal females who have Type 1 diabetes.
Yardley is among the 160 researchers supported by the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute who are determined to fill the significant gaps that exist in our knowledge about women’s health.
We know that everything from medications to diseases operate differently in female bodies, but until 20 years ago few medical studies included female participants, who to this day still make up only about a third of research participants.
“I’m a firm believer that to prevent frailty in older adults with Type 1 diabetes, we need to encourage resistance exercise. It’s one of the best ways to stave off muscle loss and bone density loss, but there are literally no studies to date on the risks of hypoglycemia (low blood sugar) for this population,” said Yardley, associate professor of physical education at Augustana Campus and member of the world-renowned Alberta Diabetes Institute.
Personal benefits for study participants’ health
To be fair, one of the reasons older females with Type 1 diabetes haven’t been the subject of more research is that, until recently, there weren’t that many of us around. Diabetes can lead to many complications including renal failure, heart disease, blindness and nerve damage, so life expectancy is 10 to 15 years lower than for people without diabetes. But thanks to better treatment — and more people getting active — that’s improving all the time.
“People with Type 1 diabetes can live 10 years longer if they exercise regularly, with a lower risk of heart disease and depression and a higher quality of life,” Yardley told a class of fourth-year kinesiology students recently.
At age 59, I take that advice to heart, working out at the gym during the winter and dragon boating in summer, with lots of walking all year round. But even after 42 years with diabetes, exercising is complicated. If I don’t adjust my insulin or food intake properly, or if I’m having a stressful day, or if I go too hard or not hard enough — you get the idea — I risk running high or low blood sugar, which can be harmful and would defeat the purpose of a workout.
There are guidelines for how to manage diabetes while exercising, some of which Yardley helped to write, but they are based on studies that simply didn’t include people like me.
“A lot of our guidelines look at the physiology of young fit males and then put blanket recommendations out there, but they don’t really take into account why people are exercising,” said Yardley. “I have female participants come to my lab and say, ‘I don't really want to eat carbs before I exercise, because then I'm eating as many calories as I would be burning, and I'm exercising to maintain or lose weight.’”
The prospect of getting more refined recommendations made me eager to sign up when I learned about Yardley’s study, despite the commitment. I have to go to the lab to do three workouts on the weightlifting circuit, while Yardley monitors what happens to my blood sugar. For the day before, day of and day after each workout, I have to record all of my exercise, insulin and food intake, and try to repeat it identically for three days running. (That means oatmeal for breakfast and beef curry for supper every day for three days in a row, three times over a couple of months.)
Before any of the actual study work begins, Yardley orders a body scan for me to determine my bone density (no problems) and fat distribution (that would be my spare tire), as well as blood work and a heart stress test on an increasingly steep treadmill to ensure my heart is fit enough to undergo the weightlifting circuit. (I passed!)
The testing gives me solid personal health information as I head into my 60s, but the biggest benefit of participating in the study has been the opportunity to pick Yardley’s brain. She’s helped me better understand the recommendations on when and how much to dial back my insulin depending on the intensity of exercise I am doing, the time of day, what I’ve eaten, and so on. I’m doing better at keeping my blood sugars within target range during my workouts, and that makes me feel great.
“The big thing I say about participating in any study is, ‘Ask every question that comes to mind,’” Yardley said. “Don't feel like it's something you should already know.”
Questions lead to more study
In fact, Yardley said it’s those questions from participants that have led her to some of her best scientific questions.
“People ask me questions where I think, ‘I don't know, but let me go find that answer.’ And then the answer is not there so I think, ‘All right, maybe that’s my next study.’”
As a result, Yardley has looked at how menstruation affects glucose regulation during exercise, whether working out first thing in the morning on an empty stomach is safer than later in the day, and how sex or gender-related differences affect blood sugars during exercise. She’s also working on a qualitative study that asks men and women about their experience with exercise — barriers, facilitators, motivation and methods of managing blood glucose.
Yardley’s working hypothesis for the study I’m participating in is that post-menopausal females may see their blood sugar drop faster than younger females, because estrogen allows the body to burn more fat as fuel and rely less on blood sugar. It could be years until we have the complete picture, as Yardley is still recruiting participants for this and four other studies she has on the go.
“We’re probably looking for around 70 participants, and that could take some time to find,” Yardley said. “For this one study we are looking for postmenopausal females with Type 1 diabetes, so right there, you're cutting the population down substantially from whom you can recruit. And then we need participants who are able and willing to exercise. We're almost getting into needle-in-a-haystack territory.”
But Yardley is determined to continue her research so guidelines can be refined enough to make it easier for women like me to get and stay fit.
“It’s so important to remove as many barriers as possible,” she said. “There’s still going to be bad weather, there's still going to be a lack of motivation and time — and all the other barriers that everyone on the planet lists as the reasons they don’t exercise. When you add diabetes into the mix, it’s just an extra whammy.”
Jane Yardley’s research through the Alberta Diabetes Institute is funded by the Heart and Stroke Foundation of Canada, and is supported by the Alberta Women’s Health Foundation through the Women and Children's Health Research Institute.
If you have Type 1 diabetes, are physically active, are between the ages of 18 and 60 (male or female) and are interested in taking part in an exercise study, please email jane.yardley@ualberta.ca. You can browse for many more women’s health studies that are seeking participants at Be the Cure or through the Alberta Diabetes Institute.
The University of Alberta is hosting a free event on March 8 featuring a discussion of the disparities that exist for women in health research and care, and the importance of women advocating for themselves and their loved ones. Find out more and register.
