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[EXERCISE ADVISER]

Choosing Exercise for Better Health

Wilma Wooten, MD, MPH

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 7 - JULY 96


If a miracle drug could help you lose weight, build muscles, avoid disease, stave off bone loss, and improve your mental health, would you take it? Before you answer, know that you need to take the drug three to five times a week, and each dose takes 30 to 45 minutes to administer. Also, the drug causes most people to sweat and breathe heavily, but only during its administration.

Still interested? With benefits like that, who could refuse?

The "drug," of course, is exercise. So why don't more women "take" it? Maybe exercise needs an ad agency.

An ad for exercise would tell you that even moderate activities like walking will improve health in many ways. Coupled with proper nutrition, physical activity is the cornerstone to healthy living.

Look more closely at all that exercise has to offer:

Strength and fitness. Moderate exercise helps build strength, endurance, and flexibility of muscles, which will contribute to the health of muscles and bones. It also promotes cardiovascular (heart-related) fitness and endurance. Exercise may help in avoiding low-back pain, preventing falls due to inflexibility, and improving daily stamina. Vigorous activity improves fitness even more.

Weight control. Obesity is a risk factor for heart disease and a culprit in other diseases as well. Exercise coupled with a healthy diet is the key to effective weight loss (see "Tips for Shedding Pounds").

Mental health. Physical activity can improve self-esteem and impart a general sense of well-being. It can also augment medications to improve depression and anxiety.

Muscle and bone health. Osteoporosis. Exercise can protect against osteoporosis (gradual bone loss that can lead to fractures). Women's bone density is typically greatest in their mid-20s to mid-30s, but then declines slowly until menopause, a time of rapid bone loss. Physical activity performed during younger years will help you have good bone mass at menopause. Even physical activity begun during menopause will help slow the loss of bone.

Arthritis. Exercise strengthens muscles and increases joint flexibility and motion.

Disease prevention. Heart attacks and strokes. The American Heart Association has identified physical inactivity as a risk factor for cardiovascular diseases—primarily heart attacks and strokes—which are the leading causes of death in the United States. All women are susceptible to the same predisposing factors for cardiovascular disease, but black women have the highest disease and death rates (see "Black Women at Risk"). Before menopause, women have less cardiovascular disease than men do, but after menopause women's risk is close to men's.

Certain risk factors for cardiovascular disease can be reduced with exercise. These include high blood pressure, high cholesterol, obesity, and inactivity. Regular exercise can lower your risk of dying from cardiovascular diseases by 40% (1). Quitting smoking is also important.

High blood pressure. Inactive people are more likely to develop high blood pressure than those who are active. In addition, aerobic exercise can reduce blood pressure in people who have high blood pressure.

High fat and cholesterol.Exercise lowers triglycerides (fatty substances that can contribute to clogged blood vessels) and elevates "good" cholesterol (which may help clear blood vessels). People who exercise, eat a low-fat, low-cholesterol diet, and lose weight will benefit the most.

Diabetes. Because physical activity helps regulate blood sugar, it can decrease the need for drugs. In type II ("adult onset") diabetes, 80% of patients are obese. Regular activity, with the assistance of a nutritionist, a trained exercise physiologist, or both, may help with weight loss.

Cancer. Some studies show that ovarian, cervical, uterine, vaginal, and colon cancers are lower in active than in inactive people.

Activity in All Things

In addition to starting an exercise program (see "Intro to Exercise"), it's wise to live an active life in general. An extra 30 minutes of exercise such as taking the stairs or walking instead of driving for short errands has benefits. For a moderate exercise program, walking is the safest and least expensive activity.

So get started! Lifestyle choices such as proper diet, exercise, a positive attitude, and avoiding drugs are some of the most important steps a person can take to ensure a long, healthy, and prosperous life.

Tips for Shedding Pounds

(Back up to article)

  • Losing 1 pound of fat per week requires a deficit of 3,500 calories a week. Achieve this by eating less and exercising more.
  • Drink plenty of water, at least six to eight 8-ounce glasses a day—more if you exercise regularly.
  • Eat at least five servings of fruits and vegetables each day.
  • Decrease fat intake to 30 grams or less per day. No more than 30% of your total calories should come from fat (10% from saturated fat).
  • Include a lot of fiber (from fruits, vegetables, and whole grains) and complex carbohydrates (such as pasta, rice, or potatoes) in your diet.

Black Women at Risk

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Women of African descent have special motivation to exercise. One-third more black women than white women die from cardiovascular disease. They die from heart attacks twice as often as white women, and three times as often as women of other races. Black women also have more problems from high blood pressure, a higher death rate from stroke, and twice the diabetes rate of white women.

The reasons for these staggering statistics are not fully known. One theory is that black women (and men) have more risk factors, making them more likely to have cardiovascular disease. For example, about half of black women are overweight after age 20, and half have elevated cholesterol levels. But exercise can help lower many risk factors, which may very well translate into a longer, healthier life.


Intro to Exercise

(Back up to article)

Several steps can help shift you into exercise gear:

  • Select activities that you enjoy. Include a variety to prevent boredom and to involve more muscles.
  • Decide when, where, how often, and with whom you will work out.
  • Seek support from your friends and family, and believe that you can succeed. Having a positive mind-set is vital.
  • Have a backup plan for bad weather or other interruptions.
  • Set a goal and stick to it! Start gradually and progress as tolerated.
  • Attach an exercise log to your refrigerator and record each session.
  • Exercise at least three to five times per week at moderate intensity—daily for weight loss. Walking is ideal; bicycling, swimming, running, tennis, skiing, and weight lifting are other good options. If you've been inactive, begin at 10 to 15 minutes per session and work up to 45 to 60 minutes.
  • Wear comfortable shoes and clothing to prevent injury.
  • Know your environment; exercise in well-lighted locations.

References

  1. Siscovick DS, Weiss NS, Fletcher RH, et al: The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med 1984;311(14):874-877

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Wooten is an assistant clinical professor in the Department of Family and Preventive Medicine at the University of California, San Diego.


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