Monday, November 30, 2020

Keeping Male Bodies Out of Women’s Rugby

Linda Blade, ChPC, PhD Kinesiology, is a sport performance coach. She tweets at @coachblade.
September27, 2020

From November 2015 until February 2020, World Rugby, rugby’s global governing body, incorporated guidelines established by the International Olympic Committee (IOC) on transgender participation in sports. According to these rules, males who wish to self-identify into women’s rugby could do so if they committed to reducing their testosterone levels to 10 nmol per liter or lower for at least 12 months. (The average level for men is about seven times that level.)

During this period, instances of biological males playing in the women’s game increased, and some participants began to express alarm. One rugby referee posted on the website Fair Play for Women, for instance, that “being forced to prioritize hurt feelings over broken bones exposes me to personal litigation from female players who have been harmed by players who are biologically male. This is driving female players and referees out of the game.” Another wrote, “I volunteer my time to officiate matches because I love my sport. But I won’t continue much longer if I have stay quiet about the unfairness I see on the pitch or risk abuse by getting called transphobic if I turned a player away.” A chairperson of one UK rugby club expressed shock upon discovering that, as she reported, “If anyone suspects someone on the opposing team might have an advantage because they are transgender, ‘they must not ask.’ They must simply accept that all teams will be ‘complying with the rules.’”

In some cases, female rugby players and their coaches would show up to matches to discover that there was a biologically male athlete playing on the opposing team. As one player put it, “I have to play or forfeit my place even when I know it’s unsafe for me.” Those who enjoyed the advantage of having a trans-identifying player on their team, on the other hand, were sometimes found to be lacking in sympathy. On one occasion, a team captain was quotedas saying that their male-bodied player had “folded an opponent like a deck chair.”

With worries mounting about safety—especially concussions—and financial liability, World Rugby undertook a review of its transgender policy in February 2020. This might seem to be a common-sense step. Yet among global sports federations, it was actually seen as a ground-breaking moment. World Rugby turned out be the first sport to bring to the table experts on all sides of the eligibility issue, including sociologists, biologists, kinesiologists (my own specialty), and those with a background in human rights. The consultation is reported to have been respectful and thorough. All relevant opinions were heard.

The dominant view that emerged from this summit was that World Rugby would have to amend its policy. It was simply too risky to continue to allow male bodies into the women’s game. The decision-makers relied on data that had been published by the renowned Karolinska Institute (Sweden) in September 2019. Even after a full year of hormonal reduction in accordance with IOC guidelines, the researchers concluded, there was no appreciable loss of mass, muscle mass, or strength in transitioning males. In physical terms, it was just a man playing with women.

World Rugby had to come to terms with reality: Irrespective of hormonal intervention, male athletes are, on average, 40 percent heavier, 15 percent faster, 30 percent more powerful, and 25–50 percent stronger than their female counterparts. And these differences pose obvious risks for female players in full-contact rugby. World Rugby’s new policy document has not yet been made public. But according to those who’ve seen it (and the various media leaks), the organization is proposing a comprehensive ban on biological men in the women’s sport—though these recommendations won’t become official policy until they are reviewed and voted upon by the World Rugby Council later this year.

Women’s rugby isn’t a particularly popular mass-participation sport. But because World Rugby’s proposal, if enacted, would represent one of the first big cracks in the dam for those who insist trans-identified males should be allowed to compete with women, the case has attracted plenty of lobbying. The Canadian Women’s Sex-Based Rights group (CaWsbar), for instance, sent a letter to CEO Brett Gosper, thanking World Rugby for becoming “the first world sports federation to have undertaken a thorough and balanced review of the 2015 International Olympics Committee consensus.” Social-media commentary has been abundant. Even my own little August 20th tweet urging readers to send their appreciation to World Rugby generated (what was for me) unprecedented public support (and, notably, scant pushback).

Activist groups opposed to any reconsideration of the IOC’s rules, on the other hand, put out statements—many of them picked up by the press—with headlines suggesting that World Rugby was implementing a “ban” on trans athletes. In fact, no one would be “banned” under the proposal. Athletes would simply be required to compete with athletes of their own sex, as had been the case in rugby, and numerous other sports, until very recently.

Some observers may be tempted to conflate World Rugby’s proposal with the controversy surrounding elite runner Caster Semenya, which was the subject of a recent decision by Switzerland’s Federal Supreme Court. Under World Athletics guidelines introduced in 2019, which were subsequently upheld by the Court of Arbitration for Sport, Semenya would be allowed to compete in long-distance running events only if she agreed to take testosterone-reducing drugs, a condition that Semenya opposes. But that case is distinct, because Semenya is one of a small number of people who exhibit differences of sexual development (DSD)—“a group of congenital conditions associated with atypical development of internal and external genital structures,” as experts define it. The trans rugby players who seek to participate in women’s leagues, on the other hand, are simply biological males who have changed their pronouns and social identity.

Nevertheless, both situations highlight the tension that exists between biological determinants and human-rights claims when it comes to access to women’s sports. And in both cases, there are at least two clear lessons: (1) sports federations should assert their authority to set their own eligibility guidelines; and (2) the sooner a governing body asserts such boundaries, the better. Once opportunists have taken advantage of a lax regulatory regime, they will do everything in their power to resist change. And they will have the media on their side, because they will be able to present themselves as victims.

A decade ago, prevarication and a lack of corporate discipline by World Athletics—then known as the International Amateur Athletic Federation (IAAF)—resulted in a decade of unnecessary upheaval in the sport of athletics (which includes a broad range of pursuits, including track and field). Semenya had only recently broken onto the scene as a junior athlete, and already had demonstrated performance levels that were raising eyebrows. After failing to make the 800m finals at the 2008 World Junior Championships (with a time slower than 2:04), Semenya finished the 2009 season as reigning World Champion in the senior women’s division, with a time that was almost nine seconds faster. This kind of quantum-leap improvement isn’t normal, and the IAAF had no choice but to investigate.

Notoriously, this included a humiliating sex-verification test. It was supposed to be private, but somehow the information leaked. In the ensuing uproar, the IAAF chose to clear Semenya in 2010 without really dealing coherently with the results of the test. In one statement, it was announced that, “The IAAF accepts the conclusion of a panel of medical experts that she can compete with immediate effect.” In another, the general secretary said: “She is a woman but maybe not 100 percent.” Needless to say, this sort of comment set off lurid speculation about Semenya’s biology. So while Semenya continued to run, accumulate accolades, and win races, there was a cloud of suspicion that affected spectators and fellow runners. This is exactly the sort of protracted and degrading process that World Rugby can avoid by acting decisively.

What saddens me as a Canadian, someone who has long worked within the sports sector as both coach and provincial sport-association president, is the official response from Rugby Canada, which I had hoped would have endorsed the commitment made by World Rugby to “work with relevant groups to explore appropriate participation pathways for transgender athletes.” Placing male athletes in with female players for full-contact rugby isn’t the only option available for trans rugby players. There could very well be safer alternatives, if organizations such as Rugby Canada were interested in exploring them.

Instead, Rugby Canada used its voice to channel the opinions of one-note gender activists. Its official statement, released in early September, declared that the proposed new World Rugby rules “are not policy that can or will be adopted should they move forward.” Rugby participation in Canada, the organization said, would continue to be guided by the existing Trans Inclusion Policy, which states that players “should be able to participate as the gender with which they identify and not be subject to requirements for disclosure of personal information beyond those required of cisgender athletes. Nor should there be any requirement for hormonal therapy or surgery.” That’s right: The policy is pure, no-questions-asked self-identification. The only reference to safety in the entire document relates to the suggestion that someone might not feel “safe” if his “gender identity and gender expression” weren’t respected.

It seems to me that Rugby Canada can ill afford to posture against biological reality. It was only two years ago that a young man named Brodie McCarthy died as a result of a head injury suffered in a rugby tournament. Five years before that, it was a women’s team captain, Rowan Stringer, a 17-year-old from Ottawa, who died from a blow to the head during a game. In response, Ontario passed Rowan’s Law, requiring all youth sports, whether at the club or school level, to observe strict safety protocols pertaining to head injury and concussions. Canada’s federal government extended the movement nationally by developing its own public health advisory on the dangers of concussion. The advisory specifically identifies rugby as one of three especially dangerous sports: “Ice hockey, rugby and ringette are the sports with the highest proportion of brain injuries among children and youth 5–19 years of age, ranging from 27 percent to 44 percent of all injuries that happened while playing these sports.” Now imagine how much more dangerous it is for women who face men on the rugby pitch.

This month, British trans activist groups have been scrambling to update their policies to accord with new British government rules that prohibit schools from using materials that encourage children to question whether they are in the “wrong body.” These groups are doing this because failing to do so will now have legal and financial implications. Gender clinics, moreover, are now starting to get sued for recklessly transitioning children on the basis of flimsy or non-existing health science. And rightly so: Those who put women, children, and other vulnerable populations at risk for ideological reasons must face the legal consequences. One can only hope that Rugby Canada, and its counterparts all over the world, come to understand this before someone gets hurt—or goes bankrupt.

Friday, November 27, 2020

Association between physical exercise and mental health

Chekroud, Sammi R, Ralitza Gueorguieva, Amanda B Zheutlin, Martin Paulus, Harlan M Krumholz, John H Krystal, Adam M Chekroud. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross-sectional study. The Lancet:Volume 5. September 2018.


Background Exercise is known to be associated with reduced risk of all-cause mortality, cardiovascular disease, stroke, and diabetes, but its association with mental health remains unclear. We aimed to examine the association between exercise and mental health burden in a large sample and to better understand the influence of exercise type, duration, and intensity.



In this cross-sectional study, we analyzed data from 1,237,194 people aged 18 years or older in the USA from the 2011, 2013, and 2015 Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System survey. We compared the number of days of bad self-reported mental health between individuals who exercised and those who did not, using an exact non-parametric matching procedure to balance the two groups in terms of age, race, gender, marital status, income, education level, body-mass index category, self-reported physical health, and previous diagnosis of depression. We examined the effects of exercise type, duration, frequency, and intensity using regression methods adjusted for potential confounders, and did multiple sensitivity analyses.



Individuals who exercised had 1.49 (43·2%) fewer days of poor mental health in the past month than individuals who did not exercise but were otherwise matched for several physical and sociodemographic characteristics (W=7.42 ×10¹⁰, p<2.2 × 10–¹⁶). All exercise types were associated with a lower mental health burden (minimum reduction of 11.8% and maximum reduction of 22.3%) than not exercising (p<2.2 × 10¹⁶ for all exercise types). The largest associations were seen for popular team sports (22.3% lower), cycling (21.6% lower), and aerobic and gym activities (20.1% lower), as well as durations of 45 min and frequencies of three to five times per week. 



In a large US sample, physical exercise was significantly and meaningfully associated with self-reported mental health burden in the past month. More exercise was not always better. Differences as a function of exercise were large relative to other demographic variables such as education and income. Specific types, durations, and frequencies of exercise might be more effective clinical targets than others for reducing mental health burden, and merit interventional study.

Friday, November 13, 2020

How’s this Sound?

We’re putting together a new program designed to grow our participation and audiences. Over the span of the next several weeks, I’m going to run some ideas up the flag pole. 

While in Irving last month, I had a lot of quality time with many of the WCXXIX attendees. Here’s the first idea: The Significant Other Tandem. 

This concept has been kicked around in past few years. Now’s the time to formalize the event. I spoke with some of our competitors who were very enthusiastic about the idea. 

What we need is a protocol. Exactly what does this look like? We want to integrate the wives and/or girlfriends; but exactly how. Perhaps they do the hose advance?

A lot of these women have called themselves “Challenge Widows.” But why not raise the ante and give them a shot at getting out on the course. 

What is critical to our success is raising the entertainment level and thereby keeping more people in the seats. The Relay category, by far, is the most entertaining of all the races. Especially in the last heats. Bob Ramsey, our venerable long-term announcer from the ESPN days says “I can call a race between two turtles and make it exciting as long as it’s close.”

I’d like to see us as an attractive entertainment event at major functions such as fairs and festivals. This may take on the form of an “audition” or qualification, clinic, or trials first day, followed by the Main Event, or the Big Show on the second day. 

Following this paradigm, the Relay categories could be sorted into multiple Flights, based upon finish time. In a recent luncheon meeting with one of the legacy teams, they remarked that they were just getting to the dummy when the opposing team was turning in their Air-Paks. “It’s humiliating.” 

I’d like to hear from you; via email or phone call. 

You can leave a message on my 24hr Voice Mail: 301.421.4433 x 104. 

Or, send me an email to

Friday, November 6, 2020

COVID-19 reveals how obesity harms the body in real time, not just over a lifetime

Cate Varney 
November 6, 2020, 8.31am EST 

The COVID-19 pandemic has thrust the obesity epidemic once again into the spotlight, revealing that obesity is no longer a disease that harms just in the long run but one that can have acutely devastating effects. New studies and information confirm doctors’ suspicion that this virus takes advantage of a disease that our current U.S. health care system is unable to get under control. 

In most recent news, the Centers for Disease Control and Prevention reports that 73% of nurses who have been hospitalized from COVID-19 had obesity. In addition, a recent study found that obesity could interfere with the effectiveness of a COVID-19 vaccine. 

I am an obesity specialist and clinical physician working on the front lines of obesity in primary care at the University of Virginia Health System. In the past, I often found myself warning my patients that obesity could take years off their life. Now, more than ever, this warning has become verifiable. 

More damage than believed 
Initially, physicians believed that having obesity increased only your risk of getting sicker from COVID-19, not your chance of being infected in the first place. Now, newer analysis shows that not only does obesity increase your risk of being sicker and dying from COVID-19; obesity increases your risk of getting infected in the first place. 

In March 2020, observational studies noted hypertension, diabetes, and coronary artery disease as the most common other conditions – or co-morbidities – in patients with more severe COVID-19 disease. But it was the editors of Obesity journal who first raised the alarm on April 1, 2020, that obesity would likely prove to be an independent risk factor for more severe effects of COVID-19 infection. Additionally, two studies including nearly 10,000 patients have shown that patients who have both COVID-19 and obesity have a higher risk of death at days 21 and 45 compared to patients with a normal body mass index, or BMI. And a study published in September 2020 reported higher rates of obesity in COVID-19 patients who are critically ill and require intubation. 

It is becoming overwhelmingly evident from these studies and others that those with obesity are facing a clear and present danger. 

Stigma and lack of understanding 
Obesity is an interesting disease. It is one that many physicians talk about, often in frustration that their patients cannot prevent or reverse it with the oversimplified treatment plan that we have been taught in our initial training; “Eat less and exercise more.” 

It is also a disease that causes problems physically, such as sleep apnea and joint pain. It also affects one’s mind and spirit due to societal and medical professionals’ bias against those with obesity. It can even adversely affect the size of your paycheck. 

Can you imagine the outcry if the headline read “Patients with high blood pressure earn less”? We doctors and researchers have understood for quite some time the long-term consequences of excess weight and obesity. We currently recognize that obesity is associated with at least 236 medical diagnoses, including 13 types of cancer. 

Obesity can decrease one’s lifespan by up to eight years. Despite knowing this, U.S. physicians are not prepared to prevent and reverse obesity. In a recently published survey, only 10% of medical school deans and curriculum experts feel that their students were “very prepared” in regards to obesity management. Half of the medical schools responded that expanding obesity education was a low priority or not a priority. An average of 10 hours total was reported as dedicated to obesity education during their entire training in medical school. And doctors sometimes don’t know how or when to prescribe medications for patients with obesity. 

For example, eight FDA-approved weight loss medications are on the market, but only 2% of eligible patients receive prescriptions for them from their physicians. 

What goes on in the body 
So, here we are, with a collision of the obesity epidemic and the COVID-19 pandemic. And a question I find patients asking me more and more: How does obesity create more severe disease and complications from COVID-19 infection? 

There are many answers; let's start with structure. Excess adipose tissue, which stores fat, creates a mechanical compression in patients with obesity. This limits their ability to take in and completely release a full breath of air. Breathing takes more work in a patient with obesity. It creates restrictive lung disease, and in the more serious cases, lead to hypoventilation syndrome, which can cause a person to have too little oxygen in their blood. And then there is function. 

Obesity results in an excess of adipose tissue, or what we colloquially call “fat.” Over the years, scientists have learned that adipose tissue is harmful in and of itself. One may say that adipose tissue acts as an endocrine organ all its own. It releases multiple hormones and molecules that lead to a chronic state of inflammation in patients with obesity. When the body is in a constant state of low-grade inflammation, it releases cytokines, proteins that fight inflammation. They keep the body on guard, simmering and ready to fight disease. That’s all well and good when they are kept in check by other systems and cells. When they are chronically released, however, an imbalance can occur that causes injury to the body. 

Think of it like a small but contained wildfire. It’s dangerous, but it’s not burning the entire forest. COVID-19 causes the body to create another cytokine wildfire. When a person who is obese has COVID-19, two small cytokine wildfires come together, leading to the raging fire of inflammation that damages the lungs even more so than patients with normal BMI. Additionally, this chronic state of inflammation can lead to something called endothelial dysfunction. In this condition, instead of opening up, blood vessels close down and constrict, further decreasing oxygen to the tissues. 

In addition, increased adipose tissue may have more ACE-2, the enzyme that allows the coronavirus to invade cells and begin to damage them. A recent study has shown an association of increased ACE-2 in adipose tissue rather than lung tissue. This finding further strengthens the hypothesis that obesity plays a major role in more serious COVID-19 infections. So in theory, if you have more adipose tissue, the virus can bind to and invade more cells, causing higher viral loads that stay around longer, which can make the infection more severe and prolong recovery. 

ACE-2 can be helpful in counteracting inflammation, but if it otherwise bound to COVID-19, it cannot assist with this. 

The novel SARS COVID-19 virus has forced the medical profession to face the reality that many U.S. physicians inherently know. When it comes to prevention of chronic diseases such as obesity, the U.S. health care system is not performing well. Many insurers reward physicians by meeting metrics of treating the effects of obesity rather than preventing it or treating the disease itself. 

Physicians are reimbursed, for example, for helping patients with Type 2 diabetes to attain a certain A1C level, or a set blood pressure goal. I believe is time to educate physicians and provide them with resources to combat obesity. Physicians can no longer deny that obesity, one of the strongest predictors for COVID-19 and at least 236 other medical conditions, must become public enemy number one.

Incase You Missed Irving This Year

This a year that we’ll long remember, but hope to forget. The YouTube webcast gave you a bird’s eye view. But, here’s a special feature, done by the City of Irving that capsulates capsulated the shortened, four days of competition.