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	James L. Holly, M.D.

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Your Life Your Health - A Healthy Woman is a Fit Woman

Norma Duncan,MSN, APRN-BC, FP

May 01, 2003

Your Life Your Health - The Examiner

"Are you a fit woman?" This is a question I ask of my patients during most office visits. Many women focus on a number on the bathroom scale to tell me the answer. I have to explain that this is not what I am referring to when I ask about fitness.

"Can you take a few flights of stairs without too much difficulty?"
"Are you worn out most of the day?"

These questions refer to your ability to perform daily duties. Weight doesn't mean everything when referring to a person's general health. To many women, the number on the scale is the central focus of their efforts. Many patients also point to their genetics and family history when looking at their health. My response is that "genetics loads the gun but behavior pulls the trigger."

You have probably heard about the measurement BMI which stands for "body mass index". BMI is a measurement of lean body mass to body fat composition. It is calculated by a complex relationship between your height and weight measurements. The BMI is objective and allows us to classify people as underweight, overweight, obese, and morbidly obese. However, it tells me nothing about fitness.

I have some heavier patients who are very fit and some skinny patients who are poorly conditioned. By measuring the waistline, I can assess some aspects of cardiovascular risk. Greater than 35 inches in a woman and greater than 40 inches in a male send up red flags for health risks. Excess abdominal girth is a strong negative health risk factor, principally because it represents excess total body fat stores. This means that if there is excess fat around the abdomen, there also is excess fat around the heart, liver and other vital organs.

However, even if your BMI is normal, you can still be "out of shape," and if you have excess pounds, you can have reasonable good cardiopulmonary aerobic function. Want to measure your own aerobic capacity? Walk up a flight of stairs rapidly; if you are out of breath, you are out of shape. If you can do that and not be breathless and your heart rate doesn't go up dramatically, try another. If you can do three or four flights of stairs without being exhausted or totally out of breath, then whether you are fat or skinny, you are in reasonably "good shape."

The real question for me as a healthcare provider is, "Can my patient handle even mild aerobic activity, lift small weights repetitively, and function well day-to-day without back pain?" Those activities highlight the three forms of fitness that I want to measure. A Texas Doctor who coined the term "aerobics" refers to these activities as striking, strengthening, and stretching.

Striking

Striking exercise accomplishes two important goals for fitness. Striking means you are bearing your own body weight as you exercise. Walking, running, rowing are examples of striking exercise. These movements strengthen the heart (which is just a big muscle which pumps blood) and the bones which you and I will need to be strong into our old age. Bicycling and swimming strengthen the heart but are not thought to provide strength to the skeletal system to ward off osteoporosis. Many of us alternate striking aerobic activities with non-striking activities. These new activities give our knees, hips, and lower back a rest. Alternating activities can also increase our metabolic rate and calorie burn. If you walk the same path at the mall or in your neighborhood every day you will find that you plateau as far as weight and fitness go, even though you are a faithful exerciser. The body learns and adjusts quickly and will conserve calories and energy unless you find a way of challenging it with new activities.

Strengthening

Strengthening exercises can refer to weight lifting, but a better description would be resistance exercises. Certainly, classic weight lifting is a great activity. It does require a certain amount of training and space. Many of these exercises that strengthen certain muscle groups can be accomplished with simple hand weights, elastic bands (easy to pack on trips), and floor exercises. As we age, a larger proportion of our exercise efforts should be directed toward strengthening. I often tell my patients that our joints deteriorate with age, but we can strengthen the muscles that hold them in place. This will lessen the pain and help keep them upright and mobile. This can help keep them independent. Without strengthening exercises the muscle strength takes a real downturn after age 50. Group classes in Pilates or those that emphasize strength training can be a good safe way to get into the swing of this form of exercise.

Stretching

Stretching exercises keep us supple and less prone to injury. They should be a central focus or every exercise program. This is often left out of the picture and results in injuries. Cold muscles should not be stretched. A five-minute brisk walk followed by stretching is recommended as well as stretching at the end of your workout.

Keeping On

How can we keep interested in exercise? How can we keep increasing our strength and fitness? Let me begin by telling you: exercise is not something nice to do for your health. It is central to your health. Also, no, you are not too old, or too fat, or too out of shape to exercise. You have to "begin slow and stay low" if you fit these descriptions. You will amaze yourself with how fit you can become by consistent progressive exercise. Remember that the metabolism operates 24 hours a day, seven days a week and you can best "fuel the furnace" by daily exercise. The goal for an adult should be an hour a day. This is not achieved quickly, but it can be achieved.

Think of what you would like to do when you are 70 or 80. It is unlikely that you will be able to do it if you don't start now with daily exercise. No, housework and gardening does not count. These are worthwhile activities and they do burn calories, but they are unlikely to be sustained long enough to really achieve the level of fitness you need.

Sustaining Your Interest

Sustaining interest in exercise is hard for many of us. Varying the activity and the setting are helpful options. When I was training for a half-marathon I had to run for long periods of time. My daughter provided me with "Mom's Running Mix- Part I". I found it fun to run on the treadmill listening to my own personal CD. I am up to "Mom's Running Mix Part 3" and my current take-it-home tune is Chuck Berry's "Johnny Be Good". The only downside is that I often sing with it and I am usually off key. Headphones are fine when you are in a safe environment. Running or cycling outside with music in your ears can prove deadly, so bypass the music when you are on public streets.

The time you set aside to exercise can affect your progress. Morning exercisers are more likely to stay the course. It may be more relaxing and stress relieving to exercise at the end of the day, but we often have to skip it because of family or work needs. I find it easier to exercise before most people are awake. I am also helped by a supportive husband who gets our children off to school. Find your time and make it happen everyday for the rest of your life.

Fitness should be a moving target. There should always be a goal you are trying to reach. Some people who run like to compete. We are lucky in Southeast Texas to have an organization called the "Sea Rim Striders". They welcome new members at all ability levels.

When you think about exercise progression think about three things:

Frequency,
Intensity, and
Duration.

To sustain an increased metabolic rate, the exercise program should be daily whenever possible. Intensity refers to effort. Increasing the speed of exercise and gradual increase in the weights and repetitions accomplish the increased intensity. The final factor is duration. As working adults who "have a life," this is the hardest thing to vary. Time is a treasure and it is not limitless. An hour a day is recommended. Sometimes you have to split it up. When you reach an hour and you have no more "give" in your schedule, you have to be more intense and/or faster in the time that you set aside.

Remember, it is your life and your health.

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