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James L. Holly, M.D. |
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| Norma Duncan,MSN, APRN-BC, FP |
| April 10, 2003 |
| Your Life Your Health - The Examiner |
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Energy is a wonderful thing to possess. I t must be hard to get because lack of energy is the number one complaint I hear from the women in my practice as a Nurse Practitioner. We all know women who seem to exude energy and health. They can really get on your nerves. Instead of being envious it might be a better idea to learn a thing or two from them.
What we see in these women is not necessarily what we see in magazines or on TV. Many of the role models who are held up as the ideal only capture the "physical" part of health. Most are young. The women whom I see as healthy excel in what I call their "self-care". It is this "self-care" that makes the woman endure and triumph over time.
What are some of the rules of self-care? How can we tap into the fountain of health versus the non-existent fountain of youth? Hopefully we will all live a life full of healthy days. It is the daily dedication to self-care that will help us fulfill our many roles. What does it meant to get a "daily dose of health"?
Let's begin with the cornerstone of health maintenance. That's daily vigorous exercise. As the Nike ad says, "Just do it." If you want to maintain your weight or lose the diabetes and heart attack fat around your middle, then you've got to move. A woman's metabolic rate drops 10% a decade. That's why many obese women can tell me truthfully that they don't eat "that much." They don't eat barrels of fried chicken. They eat the wrong foods at the wrong times for the wrong reasons and they do not exercise. They gain tremendous amounts of weight.
By the fourth decade, or sooner, we are treating hypertension, degenerative joint disease, and anticipating high blood sugars that will signal diabetes. Our young women are bigger than ever. Schools generally are not interested in fitness. I am. There is a link between vigorous physical health, academic performance and self esteem.
I enjoy seeing young women in the clinic because I like to think I can change their evil ways. I tell them that I can see them at forty. They would not like what I see. I prescribe exercise. Sometimes they do what I ask. If they do, they are never disappointed. They look better and they feel more confidence. This has a ripple effect on all aspects of their lives.
Exercise should come in three forms. Aerobic exercise is great for the cardiovascular system. Weight bearing exercise applies pressure on the bones to keep them from deteriorating. This can fend off the plague of osteoporosis that affects so many of our mothers and grandmothers. Remember this when people tell you their elderly relative "fell and broke her hip". It's more correct to say "she broke her hip and fell". She most likely has osteoporosis. Get off the couch and away from the computer and take a stroll. Alternate the weight bearing exercise with cycling or swimming, if your joints are painful. If you are unfit and out of shape, any exercise should begin slowly. Do the exercise daily and gradually begin to increase the time and intensity of the activity.
The next type of exercise that is vital is strength training. This can mean using weight or elastic bands to create resistance. This creates strong muscles. As we age our joints are bound to deteriorate. Keep them stronger and less painful by keeping strong muscles to support them. Popular exercise programs like "Pilates" can greatly assist in this process. Pilates emphasizes core body strengthening. This keeps you upright and mobile.
Upright and mobile people remain independent. Go by your local nursing home to pay a visit. It would be a kind thing to do and it should motivate you to become and stay strong.
The third and final type of exercise is stretching. A flexible woman is less likely to have back problems. She will bounce back from injuries faster. She will age more gracefully. After five minutes of slow aerobic warm-up a woman should stretch out gently and then resume her aerobic exercise at a higher intensity. At the end of each exercise session she should also stretch.
Remember that the metabolic rate will naturally decrease with age. Exercise acts as a buffer against weight gain, especially the dangerous "stress fat" around the middle. Don't make the mistake of doing the same activity everyday. You will plateau in your fitness and weight loss efforts. Create some confusion for your musculoskeletal system by changing up your routine. Variety of exercise makes the body work hard and it raises the metabolic rate. Thirty minutes a day is a minimum. More is necessary for weight loss. The last recommendation from the Institute of Medicine is an hour a day everyday for the rest of your life. Don't gasp and give up now. Start "slow and go low" but start today.
The next aspect of a woman's health is nutrition. Start by eating breakfast every day. The first meal of the day should be the largest and most calorie laden. Lunch should be less and dinner should be minimal. Obese women do exactly the opposite. They skip breakfast and eat a low fat, low calorie lunch with friends because "everybody can see I'm fat". They begin eating in earnest by mid afternoon and early evening. They have no fuel to run on when they are working their hardest throughout the day. They refuel to go to bed.
Why do all of us want to eat late in the afternoon and early evening? There are lots of social and behavioral reasons. There is also a sneaky, nasty physiologic culprit. Its name is cortisol. This hormone peaks between 3pm and 7 pm. It is a powerful appetite stimulator. Combine this time period with a starving woman who is exhausted and you have a recipe for lots of weight gain. A wonderful book to read on this subject is written by Dr. Pamela Peeke entitled Fight Fat after Forty. She is the real deal and knows her subject well.
The woman, especially a woman with a weight problem, needs to be proactive in her approach to nutrition. She needs to go to whole foods. These are the simplest foods that are not processed and don't come from boxes or packages. These are not found in the aisle of grocery stores. They are found in the perimeter. Keep your food shopping to these areas as much as possible.
We could spend a lot of time on nutrition. Remember that nutrition is a young science and things are likely to change. Therefore, using your good common sense it makes sense to eat a wide variety of whole healthy foods. By doing this you maximize your chances of getting everything you need, even things we don't know you need because we don't know about them yet. If you don't know about nutrition find a healthy woman friend and get some advice. Notice I didn't say skinny, I said healthy. Better yet, ask your health care provider.
The final frontier for daily health for women is the hardest. It is, of course, stress management. It is the hardest because there are so many irritating demanding people out there. By making the last statement, I am revealing the basic problem. We often believe that the problem and solution lies outside our grasp. After a while we all realize that we have limited control on the behavior of others, but we can learn how to control our response. Most of us can not retreat to the Himalayas to figure it all out. We have to deal with it today and for all the days we live.
Stress does go down a lot easier with daily exercise and proper nutrition. It is easier to find solutions when we have a good people around us. Find people who really are positive in a sensitive way. By this, I mean people who are willing to listen and who are willing to guide you in a solution that reflects your needs.
People who pray and worship also tend to lead healthier lives. A good book about dealing with stress is, Why Zebras don't get Ulcers by Paul Sapolski. He makes the point that a zebra can enjoy grazing on the plains of the Serengeti all the time knowing that the lion is in the weeds watching. The zebra still enjoys life. This is a neat trick that I have to keep learning everyday.
Women do need a "daily dose of health". A long life is made up of many days. There are many important details of preventive medicine are beyond the scope of this article. Today and everyday I will go into each exam room eager to teach any person who has come to see me. Whatever their problem is I will try to help them. Enabling a woman to see that she must exercise "self care" to have the energy to care for her family, her career, and her friends is always my overriding goal.
It is, after all, her life and her health.
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