Tottenham Court Road is busy as London’s iconic red double-decker buses travel up and down. These buses are modern and very different from the old buses that frequented London’s inner roads in the 1950’s. I wonder what London’s pioneering female bus driver, Jill Viner, would think of them, after being the first woman to drive a London bus in 1974.
As I walked past one of them on my recent trip to the UK, I looked to see if they still have the spiral stairs that take passengers up to the top deck. I spare a thought for the days when London Bus Conductors went up and down those stairs hundreds of times a day and wonder if there were any female Bus Conductors.
I hope that there were, because every time they went up and down those stairs, they may have been helping their heart health, providing a helpful risk reduction for their years spent in menopause.
Over 50 years ago, the London bus conductors study paved the way for our improved understanding of the link between physical activity and prevention of heart disease.
Professor Jerry Morris published his studies in the Lancet Medical Journal showing that London bus conductors, who had spent their working lives walking up and down the steps of double-decker buses had lower levels of coronary heart disease compared to the drivers of the same buses.
The drivers sat all day, the conductors moved.
It was the same for London postmen, who spent their days walking to deliver letters when compared to studies of more sedentary clerks and telephonists working in the postal offices at the time.
These studies conducted over 50 years ago opened up an incredible body of knowledge on the links between physical activity and fitness and cardiovascular disease. This comprises both heart disease and blood vessel disease, such as strokes.
Although nearly all of these pioneering studies were conducted on males, it was some of these early physical activity studies that led to the phenomenal growth in exercise and sport science research that has continued unabated since the late 1980’s.
But we must also be cautious in our interpretation of these earlier exercise and sport science studies too. A new report on the invisibility of midlife women in exercise and sports science research, shows that only 9% of this research has been conducted on women in midlife (McNulty et al, 2024).
Gaps in Women’s Physical Activity and Cardiovascular Health Research:
The notion that a high level of physical activity and/ or fitness might offer protection from the adverse cardiovascular consequences of obesity, has gained considerable momentum over the past 4 decades.
However, from the London Bus Conductors study in the 1950’s to the investigation of San Francisco Longshoremen (dockworkers), by Ralph Paffenburger in the 1970’s, to the famous Whitehall Study which looked at the cardiovascular fitness levels of over 9,000 English male civil servants and their risk for heart disease, there have been numerous gaps in research about women’s cardiovascular health and their physical activity levels.
In fact, it wasn’t until 2004, that women really got a look-in.
In the United States, one of the largest studies (over 100,000), was conducted on nurses. Thank you to those nurses and the researchers, because this was the start of improved understanding about gender differences in the dose-response relationship between physical activity and cardiovascular health.
Of note in this nurses study, were that several risk factors in women increased their risk for cardiovascular disease.
Smoking had the highest risk, and this continues today, but so too did:
- family history of heart disease,
- menopausal status and hormone use (although the hormone-use concerns have been better scrutinized in further work since and the jury is still out on this) and
- physical activity status.
Taken together, the weight of evidence from epidemiological studies of physical activity or fitness and body fatness over the past 50 years, indicates that a physically active lifestyle and/or a moderately high level of fitness (i.e. not in the bottom 20% of the population) reduces the risk of Cardiovascular disease and Coronary heart disease, especially in the overweight and obese. There is a dose–response relationship between physical activity and health which is the equivalent of expending approx. 200 kcal/day (where 1 kcal ≡ 4.184 kJ) in meaningful activity. Walking briskly for 3.2 km would meet this target.
How physical activity helps reduce women’s risk of cardiovascular disease is also being better understood, thanks to the work of Professor Hirofumi Tanaka.
His studies have highlighted that ageing affects the function and structure of arteries and increases the risk of cardiovascular diseases (CVD), especially in women. Ageing is associated with increased stiffness (reduced compliance) of large elastic arteries; impaired vascular endothelial function and other changes, however, moderate-intensity aerobic exercise intervention (brisk daily walking for 12 wk) improves carotid artery compliance and can restore vascular endothelial function in previously sedentary middle-aged and older adults. (Tanaka, 2019)
It is increasingly known that inflammation plays a central role in the progression of cardiovascular disease, whereby there is plaque formation in arteries.
I talk about inflammation a lot in my seminars, because as women in our 50’s we are the first generation to have been subjected to so many influences on changing inflammation in the body. From processed foods, to chemicals to too much, or not enough exercise, we often hold pockets of inflammation in and around our liver, gut, blood vessels and muscles, which also includes cardiac muscles.
As well, I remind women that menopause itself is the biological gateway to our ageing, and as Lifestyle Medicine Pioneer, Professor Garry Egger from Australia, mentions, “Ageing itself is inflammatory.”
Current United Kingdom, Australian, New Zealand and United States physical activity for health guidelines are that, all adults should ‘accumulate 30 min or more of moderate-intensity physical activity on most, preferably all, days of the week’.
But is this really enough to mitigate cardiovascular risk as we move into post-menopause? Possibly not, say researchers, but I say, “It’s a start, so aim for this at least.”
30 minutes of moderate physical activity/day is likely to be insufficient for the maintenance of a healthy body weight in many individuals and the optimal physical activity ‘dose’ for obesity prevention is still unclear, but in some studies, it is suggested that as much as 60–90 minutes of moderate activity/day in groups susceptible to weight gain is required.
Finding time for this is tough for women who have so much going on in their lives.
Especially if women live in a large city such as London. But if women can find pockets of time during their day to be active (snack-tivity) and also climb stairs briskly and walk briskly in the lunch-break, then this is a great start. Perhaps your clients can do more in weekends when they have more time.
Cardiovascular disease is the number one health concern for women living in western societies as they move into post-menopause, especially if they are overweight or obese.
Prevention during the vulnerable, menopause years is crucial and it’s this that I continue to share with women at my seminars and in the MyMT™ programmes, as well as in my Education Courses for Practitioners. I hope you can join me sometime.
References:
Daskalopouloua, C., Stubbs, B. et al (2017). Physical activity and healthy ageing: A systematic review and meta-analysis of longitudinal cohort studies. Ageing Research Reviews, 38, 6–17.
Egger, G. & Dixon, J. (2014). Beyond Obesity and Lifestyle: A Review of 21st Century Chronic Disease Determinants. BioMed Research International Volume, Article ID 731685, 1-12.
Gill, J. & Malkova, D. (2006). Physical activity, fitness and cardiovascular disease risk in adults: interactions with insulin resistance and obesity. Clinical Science,110, 409–425.
Tanaka, H. (2019). Antiaging Effects of Aerobic Exercise on Systemic Arteries. Hypertension, AHA Journals, 74(2)
