A new book explores the history of discrimination in women’s health care and how it affects diagnosis and treatment today.Six years ago, Dr. Elizabeth Comen, a breast cancer specialist at Memorial Sloan Kettering Hospital in Manhattan, held the hand of a patient who was hours from death.As Dr. Comen leaned in for a final goodbye, she pressed her cheek to her patient’s damp face. “Then she said it,” Dr. Comen recalled.“‘I’m so sorry for sweating on you.’”In her two decades as a physician, Dr. Comen has found that women are constantly apologizing to her: for sweating, for asking follow-up questions, for failing to detect their own cancers sooner.“Women apologize for being sick or seeking care or advocating for themselves,” she said during an interview in her office: “‘I’m so sorry, but I’m in pain. I’m so sorry, this looks disgusting.’”These experiences in the exam room are part of what drove Dr. Comen to write “All in Her Head: The Truth and Lies Early Medicine Taught Us About Women’s Bodies and Why It Matters Today.” In it, she traces the roots of women’s tendency to apologize for their ailing or unruly bodies to centuries of diminishment by the medical establishment. It’s a legacy that continues to shape the lives of women patients, she argues.Today, women are more likely to be misdiagnosed than men are and take longer to be diagnosed with heart disease and some cancers; they may be less likely to be offered pain medication; their symptoms are more likely to be written off as anxiety — or, as the book title suggests, as being all in their head.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

I still remember the torturous feeling of hanging from the pull-up bars in elementary school gym class, struggling with all my meager might to lift myself up. While other kids seemed naturally gifted with physical power, I came to believe my arms were best used for answering a question in class.And yet, I have tasted physical strength since then. I took a weight lifting course in college and loved how the boost in muscle made me feel. Before my wedding, I got hooked on barre workouts, and discovered the satisfaction of being able to carry groceries for more than two minutes without resting.Beyond the visceral joys of feeling strong, I am also aware of the health benefits of building muscle. A recent study published in the British Journal of Sports Medicine found that combining aerobics with one to two weekly strength sessions not only lengthens life span but improves people’s quality of life and well-being. Numerous studies have found that resistance training is good for mental health: It has been shown to positively influence cognition and to decrease depression and anxiety. Evidence also suggests it allows us to simply feel better in our bodies.But every time I’ve done enough strength training to see progress, my commitment has ultimately petered out, mostly because of the demands of daily life. Consumed by cycles of work, child care and utter exhaustion, I’ve pursued the path of least resistance — literally and figuratively. The majority of Americans struggle to carve out time for strength training, too. While the U.S. Centers for Disease Control and Prevention recommends that adults do two muscle-building workouts a week, only 31 percent of us hit this benchmark.So I asked exercise psychologists, scientists, trainers and muscle evangelists for their best advice on launching a lasting strength-training routine. Here’s what I learned.Start small.For those of us who haven’t done much strength training — or if it’s been a while — experts suggest starting with short but consistent strength sessions. “Set some small goals for yourself,” said Mary Winfrey-Kovell, a lecturer in exercise science at Ball State University. “Some movement is better than no movement.”How small? Depending on one’s schedule, needs and desires, exercise scientists suggest devoting 20 minutes twice a week to strength training, or perhaps 10 to 15 minutes three times a week.If you miss a workout, go easy on yourself. The goal is to build long term habits.Ryan Frigillana for The New York TimesCan’t leave the couch after a long day? Couches can also make useful workout tools.Ryan Frigillana for The New York TimesThis is backed up by another recent study in the British Journal of Sports Medicine, which found that just 30 to 60 minutes a week of strength training can bring significant long-term rewards, including a 10 to 20 percent reduction in one’s risk of mortality, cardiovascular disease and cancer. (Notably, the benefits plateaued after an hour and decreased after two hours per week.)Start simple.Fitness marketing often tries to convince us that any routine worth doing must involve fancy devices or specialized gear, but in fact you need very little. “Strength training does not have to mean barbells and super heavy weights and lots of equipment,” said Anne Brady, a professor of kinesiology at the University of North Carolina-Greensboro.Muscle-building exercises that rely on your own body weight — think push-ups, planks and sit-to-stands (sometimes called chair rises) — can be incredibly effective when done correctly and consistently, she said. You can always incorporate equipment as you progress in strength and knowledge.Embrace being a novice.Kicking off a strength-training routine when you have little or no experience can feel daunting — particularly if you work out in a gym or public space, in view of more experienced exercisers.Many of us “hold ourselves to a standard that we need to look like we already know what we’re doing,” said Casey Johnston, author of the popular lifting newsletter “She’s a Beast” and the book “Liftoff: Couch to Barbell.” “It’s OK to make mistakes. It’s OK to ask questions.”More than anything, learning proper form — and which movements are safest for your body — can help to avoid injury and promote a lasting routine. If you’re able to afford it, consider hiring a certified personal trainer for a few sessions, either virtual or in person, who will create a training plan and guide you through the exercises. And if you work out in a gym, don’t be afraid to ask staff for guidance.One upside to starting from scratch? Your strength will improve exponentially at first. “I think most people would be surprised by how quickly they can get a lot stronger than they are,” said Ms. Johnston. After a few sessions, she said, “you really will feel the difference in functionality in your body.”Do it early in the day.If you’re like me and frequently plan to strength train at night but find that, come 5 o’clock or later, you feel unable to will your weary self off the couch, experts advise making time early in the morning.There is a reason for this. Research suggests that the more self-control we expend throughout the day, the less we have to give at night. “So if you’ve sprinkled out self-control for various things, and your plan was to work out in the evening,” it’s not surprising if you give into a desire to veg out in front of your phone or TV instead of breaking a sweat, said Elizabeth Hathaway, a professor of exercise psychology and health behavior change at the University of Tennessee at Chattanooga. “Self-control is not an infinite resource.”Getting started, scientists suggest devoting 20 minutes twice a week, or perhaps 10 to 15 minutes three times a week, to strength training.Ryan Frigillana for The New York TimesTry “temptation bundling.”Need an extra push? Kelly Strohacker, a professor of exercise physiology at the University of Tennessee-Knoxville who researches health behavior change, suggests a behavioral economics hack called “temptation bundling.”It works like this: By “bundling” something we love and look forward to — for example, a favorite podcast or TV show, gripping audiobook or playlist — with an activity we find challenging, we can boost our chances of doing the latter. “Simply pairing those together can help ease a little bit of that initial, ‘I don’t really want to do it, but I know I should,’” said Dr. Strohacker. They key, however, is to only allow yourself to indulge in that particular pleasure while doing the workout.Wear (pretty much) whatever you want.If the thought of changing into specific “exercise clothes” presents a barrier to strength training, don’t bother!“Wear anything that you’re comfortable in,” said Dr. Brady. “The most important thing is to be able to move freely through different ranges of motion.” You might also benefit if your clothes “breathe” so you don’t become overheated, but no need to buy special moisture-wicking athletic gear if you’re more comfortable moving in your pajamas.Wear something comfortable. Buy some fancy workout clothes, if it puts you in the mood. Or else just wear pajamas.Ryan Frigillana for The New York TimesIf you have trouble getting excited to workout, “bundle” it with something you like — a podcast or show — that you only consume while exercising.Ryan Frigillana for The New York TimesRemember that the goal is forward progress.If you find that you need to miss sessions, show self-compassion, said Dr. Strohacker. Strength-training, like all exercise, is a long game, and the ultimate goal is to simply keep at it throughout our lives, despite setbacks along the way.“Our culture really pushes this narrative of ‘you can do it if you really want to,’” she said. “This is very oversimplifying.” Life happens. Research suggests the true path to longevity and consistency in any activity are “enjoying it and feeling accomplished,” she added. This becomes easier when we celebrate our progress, no matter how incremental, and find our way back when we stray off course.Consider a couch workout!If the desire to spend time on your couch feels overpowering, make your couch work for you: Use it as a piece of equipment to facilitate your workout.With a couch, you can do sit-to-stand exercises, said Dr. Brady. You can turn around and do push-ups or planks.And if you want to watch TV during your couch work, choose programs with commercials and try the “commercial challenge,” Ms. Winfrey-Kovell suggests. During these breaks, do leg marches or leg lifts, or keep hand weights next to you and lift until the program returns. Just make sure you can maintain good posture and form.“We don’t want to exercise with our back in a shrimp position,” she said. But “if the hips are in the proper position, the spine is in alignment, the shoulders are back, and your feet can touch the ground,” there’s a lot you can do on a couch.Try this 20-minute starter routine.Ready to get started? Dr. Brady recommends beginning with this basic strength-building routine. The only equipment you’ll need is your own body and a set of resistance bands, which you can purchase for under $20 online. (See Wirecutter’s list of the best options.)Complete each exercise, in order, 10 to 15 times, then go back and do it again for a second set. The exercises alternate muscle groups, and should be performed with a moderate level of intensity — whatever that feels like for you.1. Push-ups (or modified push-ups)2. Squats3. Seated rows with resistance band4. Glute bridges5. Overhead presses with resistance band6. Bird dogs7. Pulldowns with resistance bandDanielle Friedman is a journalist in New York City and author of “Let’s Get Physical: How Women Discovered Exercise and Reshaped the World.”

The 21st Century Cures Act gave patients easy access to their health information. Now, some diagnoses delivered without context are causing high anxiety.Late last fall I suffered a second-trimester pregnancy loss. The experience was devastating, and the weeks after were a blur of grief, anger and physical turmoil. About a month later, on a day when I was feeling more like myself than I had in a while, I was folding clothes in my 3-year-old son’s room when I received an alert from MyChart, an app that gives patients access to their records and doctors’ messages, with a new test result to view.But I was not prepared for what I saw on the screen — a fetal autopsy report.Later, my OB-GYN explained that I had received the alert without hearing from her first because of a provision in the 21st Century Cures Act, a federal law that requires all medical testing centers to release results to patients “without delay.” In practice, this means that doctors and patients often receive results simultaneously — and some patients are seeing them before their doctors have a chance to look.President Barack Obama signed the Cures Act, which also provided billions of dollars for medical research, in December 2016. But the provision governing access to patient records didn’t take effect until April 2021, when the U.S. Department of Health and Human Services began enforcing a rule declaring that “blocking” patients from their own health information was against the law and could result in fines for hospitals and doctors.Its intention was to bring health care into the modern era. And the provision has successfully given patients easy access to their medical records, empowering them to play a more active role in their care by eliminating the doctor as gatekeeper.But it has also led to experiences like mine, in which patients are confronted with material they never wanted to see. Some have learned about life-altering diagnoses and developments — from cancer to chronic illness to miscarriage — through emails and online portals, left to process the information alone.Most doctors support the Cures Act as a whole. “We’re big supporters of the move in this direction” in general, said Dr. Jack Resneck, president of the American Medical Association and a dermatologist in San Francisco. But this provision, he said, is leading to “emotional and mental harm.”Nicki Swann, 38, a professor in Eugene, Ore., was shocked and confused when she learned through an app that she had colon cancer after having polyps removed. She was home alone — her husband had taken their infant daughter on a walk — when she received an email letting her know that results were ready. “I couldn’t imagine that anything but good news would be shared in that way,” she said.She immediately called her doctor’s office. But it was a Friday afternoon, and the physician was unavailable. They didn’t speak until the following week. “Any cancer diagnosis is going to cause trauma,” she said. “But I think it was much worse to receive it in that way.”“When information is just given in black-and-white type on MyChart, that’s not the full expression of compassionate care,” said Dr. Elizabeth Comen, an oncologist at Memorial Sloan Kettering Cancer Center in New York City. “Yes, it is immediate care, but it’s care out of context.”How did we get here?Before the Cures Act provision, doctors had different approaches to giving patients their test results. Some offices would contact patients within hours or days; others sent paper results via mail. Some would take a “no news is good news” approach, sharing results only if they revealed something worrisome; others waited to share results in person.Lawmakers hoped to standardize the way we get results and increase transparency, said Micky Tripathi, the national coordinator for health information technology at the U.S. Department of Health and Human Services. With the Cures Act’s provision on releasing medical records, there was to be no more wondering, waiting or spending time trying to track down answers.“We should be adopting modern internet conventions,” Dr. Tripathi said, which includes making information accessible to consumers as soon as it is available.“I think that is the normal internet expectation all of us have.”Genevieve Morris, a senior director at the health technology company Change Healthcare who, in a previous role, helped draft the Cures Act, said she thought patients had become used to not having access to personal data. “We now have to adjust to a world where we are going to have all of our data at our fingertips,” she said.Many patients I spoke with appreciated having direct access to their health information. “I feel more in control,” said Yasi Noori-Bushehri, 32, an engineer in San Diego who has Graves’ disease, an autoimmune disorder that requires her to closely monitor her thyroid hormone levels. Having access to her medical information has given Ms. Noori-Bushehri confidence to ask for changes in her treatment plan: When her doctor suggested tweaking her thyroid medication, she pointed to previous lab reports suggesting that the change might throw her hormones out of whack. After talking it through, the doctor agreed.Some patients said receiving test results — even difficult ones — before speaking with their doctor had allowed them to feel more prepared when they did connect. “You can go into the next appointment having done your homework,” said Teresa Christopherson, 59, who regularly gets updates on the status of her breast cancer via an online portal. She said that gave her the opportunity to “ask the right questions” about next steps. “Everyone has the right to their own medical information in real time, not on the doctor’s time,” she said.Many doctors said they supported instant access, too, in most cases. “If your cholesterol has gone up, that might not be good news, but it’s not the same as finding out that you have a lung nodule in a chest X-ray,” Dr. Resneck said.But when difficult, life-changing information is delivered in this way, “it cuts off any opportunity for doctors to get ahead of things,” said Dr. Emily Porter, an emergency room and sexual health physician in Austin, Texas, who has criticized the policy on social media.The Cures Act does offer a “preventing harm exception” to its provision requiring the swift release of test results. But the bar for what counts as harm is high: The provider must be able to anticipate that the test results could lead a patient to harm himself or herself.This exception also doesn’t account for cases in which a routine test reveals an unexpected finding. A weekend spent searching online for medical information with knots in your stomach — or, in my case, seeing an upsetting report — does not qualify as harm.The emotional cost of instant accessLast month, the A.M.A. released the results of a survey of 1,000 people about the Cures Act’s provision on test results. Roughly 42 percent of the patients surveyed wanted test results as soon as they were available, while about 43 percent preferred to hear from their doctors first. But among those who wanted instant access, more than half said that, in the case of a “debilitating, life-limiting or terminal illness,” they would like to speak with a doctor first.Since the provision took effect, Dr. David Gerber, a lung cancer specialist at the University of Texas Southwestern Medical Center in Dallas, has met with many patients and caregivers who have shared their emotional distress over receiving results without context. In an editorial he wrote for an oncology medical journal last year, he described the experience of trying to get to a patient before the patient could receive results through an app as if it were a race. “I still remember the first time we lost,” he wrote, referring to a time when a patient’s wife was convinced that her husband’s cancer had returned after she misinterpreted a technical report delivered via email.In an interview, Dr. Gerber said that he had previously provided results to patients within 72 hours — that was enough time to review them, confer with other physicians and come up with a treatment plan. “Things seemed a little bit smoother and less turbulent,” he said, “but not necessarily slower in a way that was clinically meaningful.” He would also release full medical reports to patients, but only after discussing the results with them. Dr. Comen also acknowledged that previous systems had been imperfect. “We have to honor the reality that waiting can feel impossibly hard,” she said. “But I don’t think anything replaces a doctor holding your hand and looking you in the eye and saying: ‘I’m going to go through every aspect of this with you in real time. You can ask me your questions. I will read your body language. I will give you tissues. I will be there with you.’”What’s next for patient care?For the past several months, the A.M.A. has been urging the Department of Health and Human Services to make what Dr. Resneck calls “common sense” exceptions to the current rule. Last month, the group published a statement laying out its concerns and requesting language to “explicitly allow physicians, using their professional judgment, to withhold some information if immediate or proactive release could cause a patient mental or emotional harm.”While such exceptions are allowed currently, they must be requested beforehand by a patient or caregiver. And with the existing technology, few providers have the practical ability to prevent a patient’s results from being automatically released electronicallyDr. Tripathi of Health and Human Services said, “We recognize this is a really big transition for all of us.” But he added that department officials hoped the Cures Act would encourage patients to become more engaged with their own care and talk with their doctors about how they want to receive information. They would also like to see health care apps introduce more flexibility — including options for physicians to indicate a patient’s preferences on a case-by-case basis and ways for patients to opt out of receiving certain results in real time.So what can patients do right now?If you are undergoing a medical test, ask your doctor for expectations around timing, doctors said — both in terms of when results might be released electronically and when you can expect to hear from the doctor’s office, so you can prepare mentally and emotionally.For Ashley Collins, 39, a breast cancer survivor in Durham, N.C., this kind of conversation was crucial to easing her emotional distress after a mastectomy.After the surgery, Ms. Collins was eager to learn the results of biopsies that would reveal whether chemotherapy had eliminated her breast cancer. But before leaving the hospital, she spoke with her surgeon about timing, and her doctor told her that she would call her as soon as possible after the results were posted online. Knowing that she would be hearing from her doctor within a certain time frame, Ms. Collins opted not even to look at the MyChart report and waited for her call.“From the time that you get the ding on your Apple Watch that says, ‘New results are in your chart,’ it’s a sort of Pavlovian response of anxiety that kicks in,” Ms. Collins said. “Mercifully, my surgeon called me very soon after the result was posted.”

It’s high time for women to reclaim the real strength behind exercise.When I was a teenager in the mid-90s, I didn’t think much about exercising to become strong. I ran a season of track and cross-country my freshman year of high school, but I was at the back of the pack. (OK, behind the pack.) I didn’t aspire to become athletic. I aspired to mold, refine, perfect my post-puberty body — which was decidedly less lean than my childhood body — into a conventionally beautiful one. Which meant a smaller one. And the now fully hatched fitness industrial complex offered me a cornucopia of resources promising to help me achieve this goal.But working out for strength? That was a fringe benefit. The pursuit of visible muscle — once a bold feminist action — had become, for many women, a secondary goal. It would be years before that would change for me, and for many American women.A child of the 80s, I had grown up playing with Mattel’s Great Shape Barbie, who sported a teal spandex catsuit, leg warmers and the not-so-subtle tagline: “She works out & looks great!” I coveted Hasbro’s Get in Shape, Girl! workout sets — toy kits “for today’s young girl” that came with various combinations of exercise books, audiocassettes and kid-sized workout equipment, including pastel hand weights, a ballet barre and a floor mat. I remember how exercising to the tapes made me feel like a grown-up, in the same way that wearing my mom’s lipstick did. Working out, I gathered, was just what ladies did.In middle school, my fitness bible was “Beauty and Fitness With ‘Saved by the Bell,’” a slim 1992 manual featuring inspiration from stars Tiffani-Amber Thiessen, Elizabeth Berkley and Lark Voorhies. “Working out can be a total blast!” the book promises. “Elizabeth, Lark and Tiffani all work out regularly, and they love it.” I devoured issues of Seventeen and YM for tips on how to improve each region of my body, awkwardly attempting to follow along with the photo guides of sweatless, perfectly made-up teen girls exercising on neon-hued mats.As I entered high school, I became most loyal to a home workout VHS series called The Firm. (Get it?) Night after night, I summoned a shirtless fitness model named Tracy James onto our old wood-paneled television and followed his advice, delivered in a thick Jersey accent, for developing six-pack abs. (Mr. James, I recently learned, was essentially just a well-developed hunk The Firm hired to host this particular video. He was later voted Cosmopolitan’s Man of the Year and also appeared on the covers of romance novels.) After absorbing his introduction to the concept of situps, I followed along as nameless ladies in shiny leotards instructed me to reach, crunch and tune into my abdominals, my ankles wrapped in weights.I wanted muscle — badly. I wanted “well-defined” arms that, I thought, would look nice in tank tops. I wanted a firm stomach. I wanted sleek thighs and a compact butt. (I spotted my first patches of cellulite around age 16.) But the women’s fitness industry focus on cosmetic transformation had blinded me to exercise’s more profound potential.It wasn’t until I became pregnant, at 36, that I began to truly appreciate the value of strength. During most of my pregnancy, I felt powerful knowing I was growing a new life inside me. But after my son was born, I felt diminished. I’d endured a third-trimester blood pressure spike and an emergency C‑section. For the first time, I didn’t trust my body. For weeks that turned into months after giving birth, consumed by caring for a newborn, my husband and I rarely left home, and usually only to shuffle to the drugstore for diapers.When I tried to locate my abs, I couldn’t find them. And I don’t mean in the mirror. Standing in my bedroom one morning with my breast-milk-stained Gap sleep shirt raised, I poked and pressed, attempting to flex and feel at least a remnant of resistance. Instead, I felt only a void.I didn’t want my pre-baby body “back.” I didn’t feel like the person I was before I gave birth, and trying to re‑create her felt like going backward. Yet I did want to feel in control again, to feel strong again. Strong enough to nurture a baby, a marriage and a career. The pursuit of physical power now felt urgent.***In the last decade, the women’s fitness industry has started to change, slowly but steadily. As a culture, we still aren’t fully comfortable with women choosing to increase rather than decrease their size. Women’s bodybuilding remains a kind of sideshow sport, due in part to a fundamental lack of understanding of “Why?” Why would a woman feel compelled to get that big? But there are signs of progress, evidenced perhaps most potently by the rise of CrossFit, the popular hard-core strength-building regimen whose devotees are nearly 50 percent women.When women first show up to CrossFit gyms, writes journalist J. C. Herz in “Learning to Breathe Fire: The Rise of CrossFit and the Primal Future of Fitness,” they balk at the prospect of someday becoming as large — as “ripped” — as the more seasoned female lifters. “But then two months go by, and these women decide they want to climb a rope or dead lift their body weight.” And eventually, “their bodies become a byproduct of what they’re able to do.”Shannon Kim Wagner, founder of the Women’s Strength Coalition, a group dedicated to helping members of all gender identities build muscle, described her experience with weight training this way: “For me, picking up a barbell meant focusing on my body, for the first time, in a way that had nothing to do with shrinking or making myself smaller. It felt radical to search for safety in myself, as opposed to looking for it in approval from others. When I chose to stop getting smaller in my physical body, I stopped existing for other people.”Today, I exercise not only for physical but also mental strength. I exercise to feel the endorphin high of accomplishment and to manage life’s lows. I exercise to remind myself I can persevere, and that I am not alone. Most of the women I know (as well as the many women I’ve interviewed across the country) consider regular physical activity essential to their emotional and physical well-being. My mom, who is in her early 70s, calls her weekly cardio dance classes “a surefire source of joy.”Not long ago, when I mentioned Get in Shape, Girl! on social media, an acquaintance sent me this note: I totally remember Get in Shape, Girl! and could sing the ad jingle for you. I grew up chubby and was overweight by college — precisely because I started dieting by fifth grade. I remember asking for it for my birthday or Christmas, thinking, This will be the thing that makes me “normal,” by which I meant “thin.” Of course it wasn’t. It wasn’t until I was in my late 20s and early 30s that I realized physical exercise didn’t have to be punitive.I now know how fortunate I am to be living in an era when a growing number of fitness professionals sell exercise not as a punishment, but as a celebration of what our bodies can do; an era when women are encouraged to cultivate strength not for anyone else’s pleasure but our own. Increasingly, it’s just what ladies do.Danielle Friedman is a journalist in New York City. This essay was adapted from her new book, “Let’s Get Physical: How Women Discovered Exercise and Reshaped the World,” a cultural history of women’s fitness.