Physical performance

0:00 Afternoon um everybody. If you're just tuning in, I am Sergeant Analise Hall, one of the Burnham Gymnasium PTIs. I'm
0:07 here helping facilitate uh this conversation this afternoon. We're extremely lucky to have Dr. Stacy Sims
0:14 dialing in from Boulder, Colorado this afternoon. Um, just a quick note here, today's presentation has been brought to
0:20 you by the Army Welfare and Culture, and it's in collaboration with the Physical Performance Squadron as part of our ongoing commitment to supporting the
0:29 health, well-being, and performance of our people. And if you weren't aware, it's actually uh women's health month this month being October. So, um, it's a
0:37 great opportunity to have these sorts of conversations. Before we get into it, I'll do a really quick kaka. I'll go through a couple of um housekeeping I
0:46 guess points and then we'll dive straight into it with Dr. Stacy Sims.
1:02 Timote order.
1:11 Oh, thank you, Dr. Sims. I'm just going to get you to humor me for a moment because I've got a bit of a spiel here
1:18 about your career and your background just to kind of bring everyone on the same page. So, you'll just have to hang in there for a moment.
1:26 Right. So, Dr. Stacy Sims is an internationally recognized exercise physiologist and nutrition scientist with a career spanning more than 25
1:35 years focusing on understanding female physiology, health, and performance. She holds a master's degree in exercise
1:42 physiology and a PhD and has conducted research at leading institutions such as Stanford University, Oakland University
1:49 of Technology, and the University of Wetto.
1:53 Dr. Sims has published more than 100 peer-reviewed papers and is internationally recognized for her work examining the differences between male
2:02 and female physiology particularly in relation to exercise, nutrition, recovery, ministration, pmenopause and
2:09 menopause. Many of you will also know her through her bestselling books raw and next level and her influential TED
2:16 talk women are not small men. Her work has helped challenge the traditional approach of applying predominantly
2:23 male-based research to women and has brought female specific physiology and performance into much greater focus.
2:30 What makes today particularly relevant to us within the defense force is that opportunity to translate this research into practical strategies that can
2:38 support women to remain healthy, resilient, and physically capable throughout their careers. We're very fortunate enough to have someone of Dr.
2:47 expertise joining us today and I'm really looking forward to hearing your insights and um kind of learning as much as I can especially in my space about
2:55 how we can help our soldiers both men and women um with these challenges.
3:01 Wasn't too painful. You've heard it all before.
3:04 No, I always I always go, who is that person? [laughter] Did I miss anything?
3:11 Yeah. No, I'm like just one day at a time. One day at a time. Yeah.
3:15 Awesome. Bill. So, just for our listeners, um we've got a bunch of questions that have been sent through.
3:21 We are going to work through them um one at a time. It's going to be more of a conversational sort of format and if there are any questions that pop up um
3:29 for those watching from a distance, pop them into um the meeting chat and we'll do our best to answer as much of those
3:37 questions as we can and if we can't um we'll send them through to our high performance cell and they can hopefully provide their their feedback and input
3:44 as well. We do know that we've only got you for a short period of time, uh, Dr.
3:48 Sim, so we'll try and maximize that as much as we can. Cool.
3:52 This um, presentation is also being recorded and will be put on the Defense Health website um, for anyone that has
4:01 missed out or wants to rewatch everything.
4:04 Uh, for you, Dr. Sims, today we have a mixed audience of PTIs, soldiers, commanders, and personnel who are simply
4:12 interested in understanding this area a little bit better. I want to frame today's discussion quite deliberately.
4:18 This isn't a conversation only for women. Um, nor is it about creating different operational standards for men and women. Um, I do know that we've got
4:27 um plenty of men that are in our audience today that are really keen to learn a little bit more. Um, in a defense environment, the task remains
4:34 the task. People still need to carry the same equipment, move under the same load, recover, think clearly, and
4:41 perform when required. What we want to explore is whether understanding female physiology better can help us prepare
4:49 people more effectively to meet those requirements. We've received a lot of questions from across the organization.
4:55 So rather than work through them individually, I've grouped them into four different areas. These are career longevity, training, operational
5:03 performance and recovery, and what defense can do differently at an organizational level. So, um, Dr. Sims,
5:12 I'll let you take these wherever you think the conversation, I suppose, needs to go with your, um, with your expertise. Sure.
5:19 And I'm also aware that you have a military background in your family.
5:25 Yes. Yes. It kind of ended with me and then picked up again just recently with
5:31 my nephew going into the army. So it continues in the lineage of 180 years. So it's exciting.
5:39 Wow. Okay. So you don't only have the understanding of the the physiology but also the military context which is really exciting for us today. Oh. Should we crack into it?
5:49 Sure. Let's go.
5:51 All right. Let's go. So the very first question we've got here, military careers can span several decades. If we
5:58 want women to remain healthy, physically capable, and deployable throughout that career, what do we need to understand differently about female physiology?
6:10 So there are sex differences we know from birth. And the way I like to frame it, especially we're looking at tactical athletes. And I say every soldier is an
6:18 athlete because you have to be ready to go, is we want to look at what are our inherent strengths as being a woman
6:26 versus what are the inherent strengths of being a man. And as I frame this up, I have to kind of stick to XX versus XY
6:35 because that's really the only research we have. So we know that XX by design is very endurancetoriented.
6:42 like our muscle fibers are very endurance oriented. We're very good at um fat burning. We're very good at uh
6:50 cognition under load. Uh we also see with sleep deprivation, women tend to do better with decision and reaction time
6:59 than our male counterparts. So if we're trying to think of how are we going to leverage this to maintain a very high
7:06 standard team, we want to look at pushing women a bit more for fast twitch and and higher intensity as we lean into
7:14 the men to to be able to do more endurance. And this is across the lifespan because we also see that as
7:21 women tend to get older, we lose fast twitch, we lose agility, propriception, the uh ability to think really well
7:30 under pressure. But if we're looking at training our type two fibers, we're looking at producing lactate, that all feeds forward across the lifespan of
7:39 improving our ability to maintain that high standard of cognition underload, brain function, eliminating brain fog,
7:46 allowing our muscles to not only be endurance, but also quickfire.
7:51 And what we're seeing across the board is that we tend to fall everyone into the same kind of training instead of going, "Okay, let's see if we have this
8:00 block. We want to increase the intensity and strength. We do that in a group setting, but we try to air a little bit
8:07 more on higher intensity and we look a little bit on what is the quality over quantity.
8:15 It's easier hash, you know, in quotes as we get further up the ranks to be able to dictate that. And then we see in boot
8:23 camp and the initial stages where everyone's coming together and trying to learn the discipline, the really
8:30 critical factor for both men and women is food intake. We see that both sexes
8:38 will get into a low energy availability and have subsequent injury and repercussions after they finished a a 10
8:45 to 12 week boot camp session. But the repercussions are longerlasting in women. We're seeing greater bone density loss. We're seeing greater endocrine
8:53 dysfunction. And it comes down to food intake. So, this is one of the big pushes that we can put at the very start of a career is getting women to
9:02 understand you need to fuel and you need to have abundance and you need to be able to maintain endocrine function in order to have stress resilience. Not
9:11 sure if that fully answers how do we keep people evolving through the lifespan, but it comes down to what are we doing at the beginning of the career
9:18 to set things up to be very stress resilient and on it and mission ready for both sexes within the team.
9:27 Yeah. No, I think you've definitely um covered a whole bunch of things there.
9:31 That's that's super important. I suppose just going back a step um just for those
9:37 of us that aren't so um in the world of I guess like exercise physiology all the
9:45 way back to when you talked about XX and XY. We're just talking about um males and females in terms of gender and then
9:53 those differences. I just wanted to clarify that for um yeah I guess those that were tuning in that weren't really too sure. Um right.
10:02 So I guess my my major question with this one is right from the beginning of both a man's and woman's career in the
10:11 military, the way that we go through recruit training and then our trade training or our core training is all um quite scripted and regimental.
10:22 Do you see um any like any benefits of
10:29 um because you've spoken about the the females and the endurance and the males and the power. We're quite constrained
10:36 with our time and our resources. Is it feasible or possible to create any difference in that training with the
10:44 risk of creating two different armies essentially or training two different armies? How do you see that coming together?
10:50 Um I look at as when we're looking at um training a a mixed gendered sports team as well. So you might have like the
10:57 women's who are doing X and the men that are doing Y. But when you're in a training scenario um let's say if we are looking at doing
11:07 a ruck right and it's long slow endurance and everybody has to do the rock.
11:14 One of the big factors that comes into play there is the speed of of what's happening. And women are always feeling like they have to catch up until the
11:22 | half because that's when their endurance kicks in and the men don't have that kind of endurance. And you can see this play out in early days of
11:30 what's happening. So it's just the encouragement to think to tell everybody across the board that when you are
11:37 starting a long ruck, it's about maintaining a particular posture so you can carry the load. The other thing about the load
11:46 is where are we putting the different components so that a woman's center of gravity that is lower and across the hips more so than a man's that's higher
11:55 up midchest. If we carry more of the load for women down around the hips and the lower back, they're able to go
12:03 longer further without injury. So it's just not changing training. It's looking at the adjustments of where we're
12:10 putting different loads to make it not easier but more applicable to the biomechanics and the physiology of the female versus the male body.
12:20 Okay. Yeah, that makes absolutely perfect sense. So, kind of like what we've just mentioned is that the tasks remain the same, the kit remains the
12:28 same, the length of the ruck or the pack march remains the same. It's just a matter of us being able to as women understand our bodies and know where our
12:36 strengths and our weaknesses lie and then mitigate those strengths and weaknesses by um changing the way that
12:42 we we do things slightly and to not be disheartened that the men may take off at the very beginning but the women can
12:50 creep their way back up in those sorts of events. I think um yeah, that's really key for our women to understand
12:57 how to use and set up their their packs and their um their webbing and their SPE correctly for their bodies in order to
13:06 feel um comfortable and feel like they can perform in those sorts of scenarios.
13:14 Because often what I'll see is that women will be more in jack knife position because their load is up higher just like their male counterpart parts.
13:24 But when they lower it, then they can come upright and be more over their hips, reducing fatigue across the entire body. And then all of a sudden, here's
13:32 the men, here are the women, they're all doing the same. It's amazing. So I'm just really kind of like they're just small shifts makes a huge difference.
13:43 Absolutely. And I' I've felt that myself in terms of wearing the waist uh belt on the packs. I've always preferred to carry a lot of the weight on my hips
13:52 rather than my shoulders, which um tends to fire out a lot quicker, I suppose.
14:00 Um right, so we've had um quite a few questions and a bit of interest around pmenopause
14:09 and menopause. So by the time many women reach per menopause, they've already had 15 to 20 years potentially of that load
14:17 carriage, being on field exercises, regular physical training um and accumulated injuries behind them. How
14:25 can the physiology uh physiological changes occur during menopause interact with that injury history and what should
14:32 us physical trainers and commanders be looking for in that regard?
14:37 Yeah. So, one of the things that really starts to happen, we see around age 45 to 48 is a lot of planter fascia and
14:46 frozen shoulder, a lot of tendon and ligament type issues. And it's because all of our stabilizer and smaller
14:54 muscles are also losing strength and power because that's something that happens when estrogen starts to go all over the show is we lose the ability to
15:02 generate a fast contractile and strong contraction for our muscles. So, we start looking at um injury prevention or
15:11 prehabbing. So, we do a lot of calf work for women uh especially when they're getting into their permenopausal years,
15:18 looking at maintaining mobility and shoulder rotation and really doing more isometric work within the tendons and the ligaments to keep them robust and
15:27 strong. We also need to lean into more strengthbased instead of hypertrophy type work in resistance training. Uh,
15:35 and I mean this is really good when we think about um a lot of the the like standardized tests that might come out.
15:44 We're looking at deadlift based on percent body weight. We look at sled pushpull. We look at um well, we've
15:51 talked about rocking and and pack marches. It's if we maintain the focus on being strong and durable and not so
16:00 much how much lean mass you're putting on, then it helps injury prevention. It helps with cognitive function because we
16:07 know that heavier loads and lifting heavier things improves what we call prefrontal cortex. So that's all the cognition in the front of the brain. And
16:16 we also know that it maintains the ability to produce power. So those are the ways that we try to look at women
16:24 going through pmenopause and how do we keep them very stress resilient and injuryfree. We put a precedence on the
16:32 heavier loads, the mobilization and mobility work and uh the isometric work with tendons and ligaments because those
16:40 are the three key things that keep the bones and the muscles and the brain all functioning at a high level.
16:47 Yeah, absolutely. And I suppose that can benefit both men and women, right? It goes for everybody. And I think we've seen a little bit of a shift in the way
16:56 that we think about our physical training over the last I guess 10 and 15 years. We kind of call it the um the smarter not harder method now where we
17:05 are very much more Yeah. We're more aware of we need to build those strong bones, those strong joints, ligaments,
17:12 and tendons to support our bodies when we are deployed overseas. um or we are carrying our pack or even just our
17:19 normal daily activities at work. So um I guess regardless and how um often do you think that both
17:29 men and women need to be doing the the heavy strength training in in their weeks to be able to maintain a really resilient body?
17:37 We know that if you're doing two total body days that is more of a maintenance.
17:42 If you're trying to build, then it's minimum three total body days. One of the other things that happens in pmenopause that gets women really upset
17:52 and start going down the negative selft talk is body composition change that they are like I'm doing all the things and what's going on? I'm still putting
18:00 on belly fat. I feel like I woke up squishy overnight. And it's not the fault of the training, but what we often see is um they're not eating enough
18:10 because their body is starting to change. And so they're like, "Oh, I need to cut back on what I'm eating and train harder." But in fact, you need to eat
18:18 more in and around training and really lean into the heavier and getting after it when you're doing the strength
18:26 training because that's what really helps dampen that body composition change. And it's really hard when we think about all the rhetoric that's
18:34 around us from the outside world of every woman needs to eat less and train more and fit in this little box. And
18:42 that is the exact opposite mentality. So I always tell women, what do you stand to gain when you lean into the heavier
18:49 loads and a little bit more high intensity? you stand to gain better composition, better brain co um focus
18:56 and cognition, better bones, better uh muscle and muscle function. And these are all the things that we want. What do
19:03 you stand to gain if you focus on weight loss? You stand to lose all the things that you actually want. So, it's just a
19:12 bit of a mind shift, but I was really want to press it here because so many women, I see it all the time. A lot of
19:19 tactical athletes start to go, I'm not as strong as I was. I'm the weak link.
19:25 My body composition is changing. And they default to the rhetoric that's around them in the outside. And they
19:32 shouldn't. They should realize it's a physiological change. And we can do things on the outside by leaning into the heavier loads and the push and the
19:41 pull and some sprint work and high intensity work as well as fueling really well in and around all of that activity
19:50 because that is what keeps your body composition in the positive rather than going down this negative rhetoric.
19:58 Absolutely. I think um I've definitely experienced that both myself and with the woman that I've worked with where we we do default to that panic where we we
20:07 fast and then we we don't want to eat and then the in training kind of like doubles and we're high intensity for as
20:14 long as we possibly can and um what I'm kind of hearing is that that's having the complete opposite effect um as to what we are wanting. So, in terms of the
20:23 fueling then, what would be your advice for women? Because we do do a lot of our physical training at 8:00 in the morning. And I know a lot of us, myself
20:32 included, guilty here. I'll roll out of bed, I'll head out, I'll have my cup of coffee and go straight to my training.
20:39 Um, is that okay or should I be doing something a little bit different? You should be doing something different.
20:46 And this is where sex differences really come into play. Um, and it comes down to circadian rhythm. So, men's circadian rhythm is a little bit longer than a
20:55 woman's and they're more robust with regards to nutrient density and not offsetting their circadian rhythm.
21:02 Women, our circadian rhythm is about 23 and 1/2 hours. Our appetite and our daily hormone pulses are tightly tied to
21:10 that circadian rhythm. So when you first wake up, seeing light and having some food is the way that your body's like, "Great, we're back on that 23 and 1/2
21:19 hour cycle, ready to go." If we end up rolling out of bed, having a black coffee, maybe a flat white, going to
21:27 training, and then we end up delaying food intake after that because we're not that hungry after a hard session because
21:34 we didn't eat beforehand. It doesn't mean you have to have a full meal. It could be half a banana. It could be a
21:40 piece of toast with some nut butter or um regular butter. Just something that's going to work with your body to say,
21:49 "Okay, new day. Let's go." Then you have your real meal within 45 minutes after finishing training. And that's how we keep our circadian rhythm going.
22:00 Otherwise, you'll find that you have really fatigue and what I call the wall lean in the afternoon and you start craving caffeine and simple
22:08 carbohydrates and you're just like really brain foggy and then you want to snack before dinner and then when dinner comes you tend to
22:16 overeat and then you go to bed a little bit too full. Maybe, maybe not. Or maybe at nine o'clock you're like, I want a little bit of chocolate and it all comes
22:23 back to what you did first thing in the morning. So, if we're trying to set our bodies up for adapting well, we need to fuel in and around training, even if it
22:32 is first thing in the morning. Most women will wake up and say, "I'm not hungry." And that's because cortisol, which naturally comes up when we wake up
22:41 as a awakening response, is tightly tied to our appetite hormones. And we need to untangle that by having something small.
22:49 If you untangle that, then you have proper appetite hormones working throughout the day. You also have
22:57 cortisol responses that are appropriate for the situation.
23:02 Cool. Yeah. Okay. So, I'm definitely I'm definitely getting it wrong there. Then rolling out of bed with the black coffee. Is there um is there a macro
23:10 that we should be focusing on in terms of that fueling before training? A carb, uh protein, fats. What would be your recommendation?
23:18 depends on what you're doing. If you're rolling out of bed and just doing a strength training session, then protein is good. If you're going to be doing
23:26 more highintensity or more endurance stuff, you want protein and carb. I mean, this is why my protein coffee kind of went viral cuz people were asking me
23:35 what I do. And I was like, throughout my entire athletic career, I haven't been able to eat much in the morning, but I know I need to. So then I'm I have a a
23:43 double espresso that I chill and put it in the fridge the night before. Then I stir in um almond milk and and protein
23:51 and then it's like a protein fortified latte and then you go and then have real milk after that. If coffee is not your jam, that's fine. You could have um you
24:01 could have a little bit of of trim milk and protein powder next to your black coffee cuz that's giving you a little bit of of um carbohydrate and protein.
24:11 But it's not going to inundate you and feel really full. Uh and again, you can default to um half a smoothie or half a
24:20 bananas. Just something very small that's going to help you.
24:23 Okay, perfect. All right, so it doesn't have to be a full-on bowl of oats or couple of slices of bread. Okay, perfect. Do those energy requirements
24:32 change for women as they move into permenopause and menopause?
24:37 We want women to lean into having more protein. So, we look around
24:44 uh about two grams per kilogram of body weight, ideally 2.2.
24:50 And the idea behind that is we know that as women get older, we become more anabolically resistant to both protein
24:58 and resistance training. So, that means our bodies don't respond as well to it.
25:02 If we keep feeding it protein at regular intervals throughout the day, we're looking around 30 or 40 grams, which is
25:09 palm and a half size for your meal, then you're able to maintain that responsiveness
25:17 to protein and exercise. Uh, and that tends to be the one macronutrient that women find really hard to get in. So if
25:25 we are like at every eating opportunity want a little bit of protein and a little bit of fiber then that's how we're able to maintain really good gut
25:33 microbiome as well as adequate protein intake to be able to respond to the training and stresses that we're encountering.
25:41 Gotcha. Okay. Um, talking about that that nutrients when our soldiers are out
25:49 in the field on an exercise, everyone kind of has access to the same sort of ration packs and that's kind of how we
25:57 feel regardless of um the type of job we have, the um the size of the human being
26:04 or the gender I suppose. Um, is there anything that women could perhaps pack for themselves that would help in those high stress, high demand sort of environments?
26:15 I always have my um my soldiers pack extra protein powder so they can add it to water if they need
26:23 to. It's because protein plays such a huge role in our hormone health and also our ferotin. Um because what we see is
26:32 there's a a big draw on feritin when we're highly stressed and we're out um you know for long missions or even short
26:40 missions. And we know that if feritin drops below 50 it it also comes up as if we were having permenopausal symptoms.
26:48 We all have brain fog. We'll have poor eyesight because now our little eye muscles aren't getting enough oxygen.
26:56 Our hair doesn't grow well. Our nails are brittle. Um and then the brain fog part comes into play. So we really want
27:04 to drive to keep that ferotin up and feritin requires protein. So if we are looking at what extra kinds of things do
27:12 we need to pack, I mean you could be as easy as packing some extra meat sticks, but that's weight. So I always lean into
27:20 pl pack an unflavored high quality pea protein or whey protein isolate cuz it's not that heavy. You can
27:29 stir it into anything and it helps boost your protein intake when you're looking at the MREs that may or may not have enough protein in it for you.
27:39 Okay, cool. We've just had a um a couple of questions come through about that.
27:44 So, the first one is, can you please advise a protein powder best suited to menopausal women?
27:50 Yeah. So, it's really looking at the quality and it's if you are leaning more plant-based, then it's a pea protein
27:59 isolate. If you're looking more um dairy focused, then it's a whey protein isolate. There's a really fantastic
28:07 company in Auckland called Reactive Supplements.
28:12 And Mike on air is only selling unflavored stuff. It's highly tested.
28:18 It's very packable. when I'm in New Zealand, that's my go-to. Um, so you can get really high quality stuff from him.
28:26 If you want to lean in and pay a little bit extra, then you can look at using a third party certified um product and
28:35 that would be something like Momentous or the True Proteins that you can get from Australia. But keeping it local,
28:42 I'm always like go to Reactive. It's great.
28:46 Absolutely. You got to support the local. Cool. Thank you very much for your recommendation. And another question was about the feritin. So what
28:54 natural foods contain feritin that people can um use or seek?
29:00 Yes. So feritin is a storage form of iron. So you're looking at iron rich foods. The caveat is not having iron
29:09 rich foods with coffee or dairy because that in interferes with it. So, a lot of people are like, "Oh, I'm having an iron
29:17 rich smoothie or I'm having um my red meat, but then I'm also having it with cheese or I'm having it with yogurt."
29:25 And then you have a little bit of a disconnect there. Um so, it's looking at what are some of our other ironrich food sources. We know that are standard red
29:34 meat options, but things like spirulina, especially blue green spirulina, really high in iron, and you can mix that into
29:41 a fruit smoothie and the vitamin C from the fruit with the spirulina boosts your iron intake. So, just small little
29:48 things where you're looking at how do I improve my iron intake and that keeps your feritin elevated. If you have to supplement, then we usually recommend
29:57 every other day supplementation at night, hours or so after dinner. so that your body can absorb it well. You don't have an interference from what
30:05 you've eaten and you don't have any residual training inflammation that's going to impede your absorption.
30:12 What would be the um main red flags for someone that had say low iron and would need to supplement a feritin?
30:20 So there are two things. If you're using a wearable and you're looking at heart rate variability, we see that there is a decrease in your
30:29 heart rate variability, even if you are trying to de load your training and everything you're doing, you're like, I'm trying to bring my heart rate
30:36 variability up, it tanks. And that's because hemoglobin is dropping. And hemoglobin is what the wearables are
30:43 reading um for your heart rate variability. It's your blood flow is what it's reading. If not, then we go on symptomology.
30:53 Are you dead to the world, fatigued when you wake up, no matter what you do? Are you experiencing brain fog? Are you
31:00 experiencing puffy and really dark um circles regardless of if you're taking allergy medicine and sleeping? Um
31:10 biggest thing is just get your bloods tested. It's pretty easy to get your blood tested and have a baseline before a big uh block of training or a big
31:18 block where you're off doing um deep overnight missions and then if you are low then you can look at using an iron supplement.
31:29 Okay, cool. And is this um an something that women experiencing per menopause and intermenopause often suffer from?
31:37 Yeah. Yeah. and we even if you haven't before. And the other thing that a lot of permenopausal women suffer from is a
31:44 change in their blood lipids. So all of a sudden they've never had issues with their um LDL or their total cholesterol
31:51 and it's elevated and the doctor's like, "Whoa, what's going on?" Uh a lot of times we see highly stressed, underfueled women will have this as
32:00 well. It's also an offshoot of parmenopause. So you have to be able to untie it. If you get your blood results
32:07 back and you have low feritin, an elevation in your LDL, which is your low density lipoprotein or your quote bad
32:14 cholesterol, and an elevation in your total cholesterol, those three to me is a warning sign that you're not eating enough or you're eating at the wrong
32:23 times. So, first check your diet before you start going down a clinical route of statins or something else. But that's a
32:32 conversation to have with a doctor who understands what it is to be a tactical athlete.
32:37 Okay, cool. Thank you. And so, um, kind of like on that same regard then, how does menopausal hormone therapy fit into
32:44 this picture? Have you had much experience with that?
32:48 Oh my gosh. Yes. [laughter] Let's talk about the swings and the roundabouts. Um, so it's a tool in the
32:57 tool box. And what I what I really want people to understand is it's not the same as taking an oral contraceptive
33:05 pill or having your natural cycle. It is not the same levels. It's not a physiological level of estradile and testo or and progesterone.
33:14 It's designed to give you a very minimal steady state so that symptoms are attenuated. So that means if you're
33:22 having really bad anxiety, you're having really bad brain fog, you can't sleep, you're having panic attacks, then
33:29 menopause hormone therapy is a tool in the toolbox that you can definitely talk to your physician about. It does not
33:35 improve body composition. It does not um prevent dementia.
33:41 It is not shown to improve cardiovascular risk factors. These are all things that have come up with people
33:49 who have seen some research but not all of it or clickbait and have pushed it out into social media. So menopause hormone therapy is a excellent
33:58 pharmaceutical tool to get through the menopause transition but does not take the place of lifestyle intervention that
34:05 you need to do in order to keep progressing from a performance standpoint.
34:12 Okay. So, if you could speak on the top three like lifestyle protocols that you would incorporate for those women experiencing uh permenopause and menopause, what would be your top three?
34:24 Uh so the very first one is to nail sleep and this is one where people like oh I can't sleep and if you look at some
34:34 of the new researches coming out from the top sleep physicians and researchers it's not about a hormone shift. Yes, it
34:41 has some play in it, but it's a behavioral thing. More and more of the sleep wakeups and insomnia is coming
34:49 from a learned behavior. It's more of a subconscious learn behavior. If we nail sleep by getting into our good sleep
34:56 habits of cooling the room down, no screens, winding down, having a little bit of quiet time, so we are getting the
35:03 signals to our subconscious that we are getting ready to sleep. that helps improve parasympathetic.
35:10 Then if you have all these awakenings in night, you start to become subconsciously anxious. So then we can look at using something like CBT, which
35:19 is cognitive behavior therapy for insomnia. And after weeks, all of it is a pattern change and then you can
35:26 sleep. Yes, there are sleep aids like theine and apenine that you can use to get to sleep, but a lot of women don't
35:33 necessarily have problems getting to sleep and staying to sleep. Once we have sleep nailed then we also know that that
35:41 improves metabolic um profiles. It helps with body composition. It helps with stress resilience. So a lot of unfortunately a lot of people start
35:49 chasing these things over here stress resilience and body composition change through nutrition and exercise when first we need to nail sleep because you
35:58 can't change anything without sleep. And then the other two levers to pull is the physical activity part. And that is leaning into quality over quantity. So
36:07 that's looking at what kind of strength training we're doing. Not the high reps, but we're going low reps and heavier loads peppered with some sprint
36:16 intervals or some high intensity work because we really need to polarize our training because that's the external
36:23 stress that's going to make our body sit up and go, "Okay, I need to not have more visceral fat. I need to improve my
36:31 metabolic um profile. I need to improve my brain and the functionality of my brain and how I'm reacting to things.
36:39 And then from a nutritional standpoint, we look at the circadian rhythm thing that I've talked about and having
36:47 protein and fiber at every eating opportunity. Yes, when you're out in the field, it's different, especially if you're looking at MRIs or or um you're
36:55 looking at at the food that is prepared and you have to use and it's the same as someone who's doing a multi-day endurance event. You're just getting
37:04 through that and that is part of that event and you minimize what you can do by packing protein powder, but also know
37:11 that that is a small portion of time and that you recover from it afterwards.
37:17 Okay, perfect. And just going back to sleep, how much sleep do we need a night as women?
37:23 It's variable. We see that to N hour um you know window is what the research says for optimization. But if you're
37:32 someone who really errors on the short side of sleep and we make you stay in bed for hours instead of seven, it's a
37:39 waste of two hours because it's not really good quality sleep. But if you're someone who's like, I need more sleep, then you lean into, okay, don't go over
37:48 the 9h hour mark because then you start getting very lethargic. And it's the same as if you phase shifted into social jet lag.
37:56 Okay. Yeah. Cool. I can imagine we got a lot of women sitting here being like, seven hours, oh my gosh, I'd be blessed if I got that with like the kids and the
38:04 work and the house and all of the things. So I guess So this is where Yeah. So this is where part of sleep is
38:13 allowing the brain to recover. So we'll know that women in particular were overburdened with a lot of the invisible
38:20 women syndrome of the kids in the house and all the other things. Um so if we look at using non-sleep deep rest which
38:28 is about a 10-minute parasympathetic activation um you can look it up on Spotify and have a a calming you can use that at different points during the day.
38:38 It helps reset your brain into parasympathetic, which allows your brain to function as if it had more sleep. So, there are
38:46 small things to do if you're short on sleep to improve brain function.
38:51 Oh, so that could be something that people could do um during their their day at work or over their lunchtime or a
38:59 tea break. just go find a quiet space, chuck on the um the playlist, and just listen to a 10-minute
39:07 meditation voice. Yeah. And then and then what happens when you do that on a regular basis is that if you get to a
39:14 stressful point in your day, there are key messages that happen during that podcast that allow you to come back to
39:21 that one point in time and your brain remembers that relaxation and you can easily get back into that just through a
39:28 couple of um breath work mechanics that these 10-minute podcasts run you through. So if you start to get in a
39:35 very anxious situation, then you're just like, "Okay." And you bring yourself right back to that one point and your
39:43 brain gets into that parasympathetic and everything just calms down.
39:47 Okay. Can you just remind us what they're called? Because I am sure most of us are sitting here being like, "Okay, where do I find this?" Yeah. So it's called nonsleep deep rest.
39:57 NSDR. Yep. Cool. Perfect. Amazing. Thank you so much.
40:05 Um, oh, all right. We've got another couple of questions here. So, training during pregnancy and postnatally. Do you
40:14 have any specific recommendations with a goal to maintain health during pregnancy and return to fitness and restoring
40:22 cognitive function without compromising breastfeeding in the first year?
40:26 Yep. Absolutely. As long as you don't have contraindications from your physician. The idea of training through pregnancy is to maintain, not to gain.
40:36 So, you're not trying to hit a PR in your deadlift. You're just trying to maintain form and function and maintain the lifts that you can do. You also
40:45 really want to work with a pelvic floor specialist because all the mechanics change and we also see postpartum there
40:53 are still issues with pelvic floor. So, we don't want to encounter that. We want to work with a pelvic floor specialist.
41:00 Um, and then your body's going to tell you what you can do and what you can't do. Most women will find they cannot go anorobic once they get past months of
41:09 pregnancy. And that's your body's way of protecting the developing fetus. The mistake is not to do anything because we
41:18 see that women who are highly active and doing something almost every day, if not every day, it improves the blood flow to
41:25 the fetus, which makes everything better from the developmental standpoint. but also makes the latter half of pregnancy
41:32 a little bit easier and the first six months easier on the woman too. If we're looking at how are we going to improve
41:41 our health and status in postpartum period, remember you've had 10 months to get this is to to the point of birth and
41:48 it does take time to come out of it. So a lot of women have seen like athletes come back weeks later. Don't expect
41:56 that. That's normal. Not normal. I mean it takes about a year. But in that you want to think about okay I've maintained
42:03 I've had a massive injury to the body so to speak and I have to repair. So we start with pelvic floor functionality
42:12 see how we move and then we can start building from there. With um breastfeeding if you are maintaining
42:20 hydration and you're adequately fueling for yourself you're going to maintain adequate um breast milk production and
42:29 flow. And if you're looking at when do I train in and around breastfeeding, if you train before you pump, then you're
42:37 going to have to pump and dump. But if you pump or feed the baby and then train, then you're maintaining a really
42:43 good uh high quality breast milk and you're also able to train.
42:49 Okay, perfect. Yeah, I think um we're really lucky in the NZDF. We do have a lot of support for our young moms
42:57 especially um with the pelvic floor health and physios and whatnot. I think from my experience though I know that our women our wahini do put a lot of
43:05 pressure on themselves to get back to that operational fitness which is obviously at a standard or a level
43:12 that's a lot higher than just your normal everyday um woman. Um, so what what would your recommendations be to
43:21 our young moms that do kind of feel that pressure to to get back to it?
43:26 Yeah. So, a lot of people will try to jump right into it once they get the all clear after weeks and end up getting injured or sick. So, again, it's like
43:35 it's going to take some time. So, you want to set milestones or KPIs, right? So, you're like, I'm weeks out. I want to make sure I have
43:43 really good pelvic floor function and I want to get a biomechanical or have a physio look at me and see how I'm moving because my sitsbones have moved, my
43:52 mechanics have changed, and I don't want to get injured. All the while you're still doing functional movement. So, you might be doing mobility work, you might
44:00 be doing um lighter weight, but still working on the technique under the bar.
44:04 So you've never really left that situational awareness of movement but now we're looking at how we are moving
44:12 because there could be a disconnect and then you're slowly coming back to it.
44:17 The earliest that you would expect to have that um readiness fitness would be four months after you have a kid. And
44:24 that is really that you had a beautiful pregnancy, no in no issues during childirth. Your baby's a dream and
44:32 sleeps through the night like all the dream scenarios which is really rare. So it's like four to six months is when you
44:39 can start to really expect to get that spark back and be ready to go.
44:44 Okay, perfect. So our wahi don't need to put so much pressure on themselves then. No.
44:49 Um just kind of swinging a little bit from um pregnancy pre-postnatal stuff into the menstrual cycle and training.
44:56 So it's kind of been the fad over the last couple of years. There's been a lot of chat online especially on social media about cycle syncing and um all
45:06 that sort of stuff when it comes to your training. in the military environment, we don't have the luxury of the freedom and the time and resources to be able to
45:15 do that. Um, I think women understanding a lot more about their bodies is super important and and amazing. Um, but yeah, like I said, a lot of information online
45:23 telling women they should train differently depending on where they are at their cycle. How much of that is genuinely useful and how much of it are we over complicating?
45:34 So about sixish years ago when all this started, it was based on some of the molecular data that was coming out. And
45:42 when you look from the physiological molecular standpoint, it makes sense the way hormones will affect your ability to push harder and carbohydrate versus fat.
45:54 But the critical factor that was not in that conversation was ovulation. We know that there is greater and greater an46:02 ovulatory cycles especially in a high stress environment but you won't necessarily know that you're an ovulatory because you'll still have a
46:11 bleed. So this is where it becomes complex. So what we're telling women now is there is so much variability within
46:19 your own cycle from cycle to cycle as well as from woman to woman. Ovulation is a critical factor because without
46:26 ovulation you don't produce progesterone. So you won't get into a ludal phase. So what we're now telling women is you want to pay attention to
46:35 your own trends over time. And so if you know that the day before your period you're going to rock everything in the
46:42 gym and hit your PR, great. Then you want to put heavier training days on in your schedule. Push a little bit more.
46:49 You're not modifying everything.
46:52 Maybe on day 22 of your cycle, you're like, I feel a bit flat. This is where you go in and you're not trying to hit a PR. You're just backing it down, maybe
47:01 using it as a D lo day. There's lots of things that we can do once you know what your own patterns are to improve
47:08 cognition, to improve your body's ability to get that extra up and go, but it's not about during my ludal phase,
47:16 I'm not going to do any highintensity work because we just don't have the availability to say, hey, you've
47:24 ovulated or not. And every woman is different. So some women feel fantastic, some don't. So listen to your body, find
47:32 your own patterns, and then you can adjust the training on the schedule according to how you feel.
47:39 Okay, perfect. So rather than trying to prescribe training around like a textbook menstrual cycle or as part of a
47:46 unit training program, would an autoregulated approach using RP, for example, rate of perceived exertion, um
47:54 would that be much better woman. Okay.
47:58 Yeah. And I also tell women that um you might find that one one day you wake up
48:05 particularly in your cycle and mentally you were two physically you might be a five or a six. Don't discount the day
48:12 for training. Go in do your warmup and you might find your mental capacity comes up to a six or seven. Your physical capacity might only go up to a
48:21 seven or an eight. But that's way more than what you started with. So you work wi within that. So I always tell women it's a physical and a mental and see how
48:30 far away they are before you push yourself in the gym. Do a good warm up.
48:34 And usually they come pretty close together, but if they don't, then call it a recovery or a de lo day.
48:42 Okay. All right. So in terms of thinking about u myself and my colleagues um we don't have to change anything drastic
48:50 about the physical training that we're delivering our soldiers. I guess we just need to be aware that maybe a woman that might perform to this standard on one
48:58 particular day for a different reason is not quite hitting that mark based on her cycle and her own individual experience.
49:07 Correct. And then if you if if your soldier has trends over time and can talk to you about it, then that's golden
49:14 because then you're like, ah, they're not slacking. It's just that part of their cycle where they're not mentally or physically as capable to hit that
49:22 high mark and it's not a big deal because we're just in training. If it was a mission or if it's a performance metric that you need to hit for a
49:31 standard for a yearly assessment, then we go, okay, well, we know that we can use some more branch chain amino acids
49:39 or improved carbohydrate intake because that can supersede some of the hormonal influences, but first we have to have
49:46 that baseline knowledge of how your cycle is affecting you before we can put in strategic interventions to level the playing field.
49:54 Okay. And so, how would you recommend women do that then? Because um for me, I'm embarrassed to say that it wasn't until I was into my 30s and started
50:02 following you and your work that I kind of really understand more about my body.
50:08 Um, and now I I use an app. But what would be your recommendation with regards to how our women can understand their bodies a little bit more and track such things?
50:17 Just start with your next cycle. So day one is the first day of bleeding and the basic metric we want to know is how long
50:24 is that cycle from day one to day one and when you have that then you can start to see fluctuations. We know that
50:31 when women get highly stressed their cycle lengthens because the follicular phase is getting longer because the body
50:37 is trying to get a really robust area or a robust body to be able to produce an
50:44 egg in a vile a viable pregnancy. If it gets really super short, then we know that's more an ovulatory. And if you
50:52 have subsequent really super short cycles, then that's something to be aware of and seek medical help with. So,
50:59 it's really good just to start knowing what the length of your cycle is. And then on top of that, you can start looking at sleep patterns or how you
51:07 feel in training. But the very first thing is to find out what your cycle length is.
51:14 Okay, cool. Thank you. Uh, we've got a question that's come up on the chat. How can we flip the narrative to prove that acknowledging the differences between
51:23 female and male and male anatomy is vital to operational effect?
51:29 Oh my gosh, this is the big one, but it's very important. And this is where I'm like, we have to flip the language
51:36 that we use where there isn't a weaker and a stronger. It's we're maximizing how a woman's body moves and how
51:45 endurance it is and the biomechanics and the cognition under load versus the absolute power and strength that a man
51:53 might have in comparison. So we know what both are the strengths and we also know what are not quite the strengths.
52:01 And ideally and ironically, both sexes help boost each other because the strengths of a woman help boost the
52:10 weaknesses of the men and the weaknesses of the men are, you know, like I said, they're boosted
52:17 by the women and then the reverse. So if we're switching that conversation, we have to get out of that male lens and of
52:24 comparing women to the baseline, that broken baseline of men and say, "Here are all the great positive things that we see and these are all the benefits
52:33 that we see and this is how we can benefit the team from a female perspective." And then on the male side, these are all the things that we see
52:40 that are beneficial for the men through the male lens and how they come together to actually create a better and cohesive team, especially if we're trying to be mission ready.
52:51 Okay, perfect. Cool. Um, right, we've just got another question that's popped up. This is regards going back to the
53:00 cycle tracking. How can you work out tracking your cycle if you don't have a period?
53:06 Oh, so if we don't have a period, is it because it's gone or is it because you're using an IUD or an oral
53:15 contraceptive pill? If it is gone, we call that hypothalamic amenorhea, | ary amenora. And that is a medical
53:23 condition that we need to get checked out because if you don't have a period, that means your endocrine system is not working how it should. So, you want to
53:32 get that checked out. If you don't have a period because you're using an IUD, you can do temperature check. You can
53:38 use a basil body thermister or thermometer. And you can see that around ovulation, you'll have a a a drop in
53:47 your temperature first and then sudden increase. So, you can start kind of getting an idea of how long your cycle is that way. Um, and then if you're
53:55 using an oral contraceptive pill, note that you don't have a period, you have a withdrawal bleed and your body is
54:04 responsive to the exogenous hormones. So then that is something that's controllable because your cycle is dependent on the active pill format.
54:15 Okay. Yeah. I do know that a lot of our military women are on um contraceptives that do stop their periods because it
54:23 become it becomes hard work when you are out in the field for a couple of weeks on exercise or on a um a course.
54:32 So could you briefly go over if if that's a bad thing, if it's a good thing, how it can affect our women and the lead into I guess permenopause if there is one.
54:42 Yeah, I have most my tactical athletes use a IUD if they can because then you're not downregulating your ovarian hormones, but you don't necessarily get
54:51 a bleed. For women who are on a combined oral contraceptive pill, um especially tactical athletes, right? Because you
54:58 want to be able to have control of that withdrawal bleed. The one big concern is bone density because the estradile
55:06 component of an oral contraceptive pill is not protective. So we know if you're using a transdermal estradile then that
55:13 is protective but an oral contraceptive pill no. So if you can get an annual DEXA which is kind of hard to get but I
55:22 know that in New Zealand you can get a really good um bone density uh scan for 150 bucks. I know that can
55:31 be a little bit of a stretch if the military isn't covering it, but this is how we really want to keep track of bone density. um we start to see a lot of
55:39 stress reactions. So if you don't have the capacity of getting a DEXA and you're on an OC and you're starting to get a lot of stress reactions, then
55:47 that's a warning sign that you need to get some medical intervention or or talk to a physician who understands what's
55:55 going on from an endocrinology standpoint.
55:58 Perfect. Okay, cool. Thank Thank you so much for that. I'm just really conscious of the time. Um, and we've asked a bunch of questions and you've covered so much
56:07 and we really do appreciate it. And I know there's more questions that are coming through in the chat. Um, so we
56:13 will work with the um the PPS and and our high performance team to try and answer as many of these questions as we
56:21 can. But I do just want to thank you so much uh for giving your time to us today. I know that our wahi have learned a lot from you. Um, and we understand
56:30 you're a super busy woman. So, thank you so much Dr. to Stacy Sims for joining us today for this presentation.
56:36 You're welcome. We might have to do a part two.
56:39 I would love Oh my gosh, I would love to do that. That'd be fantastic. [laughter] We'll schedule it. That'd be fine. Excellent. I love that.
56:47 Awesome. Thanks, everyone.
56:49 Thank you so much. Um yeah, we're also just going to take a little
56:56 bit of um a chance in time while we've got a few people online to promote the health and readiness booklet that has
57:04 just recently been released. Um it has just hit the defense health centers and I know that it's going to be sent out
57:13 around the camps and bases. I'm just wondering if um would like to have a bit of a chat about it.
57:21 Thank you, Yanise. Uh yes, thank you.
57:24 You've already um displayed that the handbook. So, this is uh a new resource that's uh just available from this week.
57:31 Uh you can pick up a copy at your health center. Um hopefully the other viewing locations have some handbooks on hand.
57:37 Um and just to put a plug in for next Tuesday the 13th, we've got a midday panel, military women's health. um a
57:45 chance again for Q&A. We'll have a pelvic health uh specialist physio there uh as well as some of our amazing health
57:52 providers. So yeah, do um tune into that uh live at Defense House but also online. Thank you.
58:03 Beautiful. Thank you.
58:05 And um I just wanted to um find finish off as well with a very special thank you to Dr. Sims. And we've got one room
58:15 um that I can show you now, but I know that there are many uh people around the camps and bases at group hosting locations
58:23 um that will also love to give Dr. Sims a round of applause. So, I'll just bring um our group on the screen and thank you
58:32 everyone for yeah showing our gratitude to you Dr. Sim. So, thank you so much um for all of your um your knowledge, your
58:41 experience. Uh it's obviously a life of work. Um and we just really are so grateful that you you can share this
58:48 with us. So, thank you so much. And thank you to um Sergeant Hall as well for your wonderful chat. Thank you.
58:57 I will say that we launched a new company today. Okay, it's called Collective X and we have peer-reviewed
59:05 over a 100,000 journal articles that are based specifically on female physiology and vetted it. So you can go in and have
59:13 a chat question like AI because most AI is wrong. So we've correct corrected it
59:19 with collective X health. So you can put in your health questions there and you'll get real answers.
59:27 Fantastic. Certainly will do that. Thank you so much, Dr. Sims.
59:31 Thanks, Khaki, everyone. And thank you for tuning in. Um, we'll leave you under
59:39 your local physical training instructors and hosts uh for whatever activity they have planned for you next. Thank you.