What's getting in the way? Helping Women and Girls to be more active

Women and girls are generally less physically active than men and boys, but the reasons why are often much more complex than simply finding the motivation to exercise.

Here Dr Vicky Carre explores some of the barriers women can face at different stages of life, and why understanding what’s getting in the way can be the first step towards becoming more active.

I've been thinking a lot about women and physical activity recently. I was invited by the Health Improvement Commission to take part in a short podcast for healthcare professionals about how we can support women and girls to be more physically active. It got me thinking that perhaps we need to change the conversation.

The World Health Organization reports that women and girls are generally less physically active than men and boys, with differences emerging from childhood and becoming particularly apparent during adolescence. Research has found that 43% of teenage girls who previously enjoyed and actively participated in sport disengaged after primary school, compared with 24% of boys.

If we want healthy, active women, we need to start by keeping girls engaged. Traditional team and competitive sports don't appeal to everyone, and the same goes for PE lessons (speaking from experience!), so we need to make sure all girls have opportunities to discover forms of movement that they genuinely enjoy.

Body image and societal expectations

Body image, fear of judgement and lack of confidence can all be significant barriers. Girls and women are so often judged by how their bodies look, rather than what their bodies can do.

That's why positive female role models matter. The Lionesses have been an extraordinary example of what visibility and representation can achieve, inspiring a new generation of girls to get involved in football.

But unfortunately, we continue to be exposed to examples of the female body used inappropriately. Just last week, we saw Sydney Sweeney posing with sporting equipment, semi-naked, for an ill-judged advertising campaign, promoting sport through hyper-sexualised fake images. Fortunately, female athletes have responded with a strong backlash, filling social media with images of what women in sport really look like: strong, sweaty, muddy, gritty and diverse. A celebration of real bodies in action rather than perfect bodies on display.

What about periods?

Periods can be another barrier to physical activity.

There is no reason why having a period automatically means stopping exercise, although hormonal changes across the menstrual cycle can affect energy, mood and exercise tolerance, and these effects vary considerably between women.

There is growing interest in tailoring training around the menstrual cycle, particularly in elite sport. But for most of us exercising for general health, the message is probably much simpler: listen to your body and adapt when you need to. Physical activity may actually help some women with period pain, fatigue and mood symptoms.

But there's an important distinction between normal variation and symptoms that significantly interfere with everyday life. Severe period pain that regularly stops you going to school or work, exercising or socialising should not be accepted as normal. If this sounds like you, then see your GP to discuss investigation and treatment. Issues like endometriosis can go overlooked for years, partly because diagnosis can be difficult, but also I find I'm continually surprised by what women are willing to put up with for years as "normal for them".

The demands of life

Then there is life itself. Work, children, partners, caring for ageing parents, commuting, school runs, running the household and trying to get enough sleep can leave very little time or energy for exercise.

This is where I think we need to broaden our definition of physical activity.

For some people, exercise might mean intense gym sessions or training for a marathon. But equally it might be cycling to work, swimming a couple of evenings a week, running along the beach with the children, taking a brisk walk after dinner, dancing in the kitchen while the pasta boils, taking the stairs rather than the lift, or parking at the far end of North Beach car park to get a few extra steps. All physical activity counts - it doesn't have to look like "exercise".

The menopause

And then, just when you've navigated body image, periods and the demands of everyday life, along comes another potential barrier: perimenopause and menopause.

Hormonal changes can affect sleep, mood, body composition, muscle health and bone density, and many women find that exercise suddenly feels harder than it used to. But this is not the time to give up - although it may be the time to recalibrate.

Strength and resistance exercise become particularly important for maintaining muscle, weight-bearing exercise is needed to support bone health, and balance, coordination and functional strength become increasingly important to prevent frailty.

And what about weight?

We're also living through a new era of weight management, with GLP-1 medications such as Wegovy and Mounjaro becoming important treatment options for some people living with obesity. But the arrival of these medications certainly hasn't made physical activity redundant.

For people taking GLP-1 medicines and losing significant amounts of weight, maintaining muscle mass is a critical consideration, making resistance exercise and adequate nutrition particularly relevant.

And physical activity has never just been about weight. It supports cardiovascular health, mental wellbeing, bone health, sleep, physical function and independence. Those benefits are huge, whether you are on GLP-1 medicines or not.

So what's getting in your way?

Perhaps this is the question we should be asking more often.

Are you worried about how you look? Are your periods painful? Are you exhausted because you're not sleeping? Are you struggling to juggle work and childcare? Are menopausal symptoms making exercise harder? Do you simply not enjoy the type of exercise you've been told you should be doing? Do you need to mix it up and try something new?

Once you’ve identified your barriers, you can start looking for solutions. And sometimes that solution will involve medical help. If pain, heavy periods, fatigue, musculoskeletal problems, mental health issues, or menopausal symptoms are stopping someone from being active, telling them to "exercise more" isn't particularly helpful. We need to understand the problem and help them overcome it- so that is where seeing your GP might be helpful.

Other barriers require change beyond the consulting room. Schools, employers, families, the education system, the media and society all have a role to play in creating spaces where women and girls feel able and encouraged to move. Every move counts!