Exercise

Prescriptions for Tranquillity,
Flexibility and Energy

Carol Doepfner was losing hope: Climbing just one flight of stairs left her gasping for air. The slightest exertion made her sweat. Her doctor told her that her cholesterol was dangerously high. And after many years of being out of shape and overweight, the Dallas housewife wondered if she'd ever be fit and trim.

Then Doepfner started spending just 30 minutes a day on a treadmill. Instead of losing hope, Doepfner lost weight: 60 pounds, to be exact. And she lowered her cholesterol, reducing her risk of heart disease, stroke, diabetes and other life-threatening conditions. As a bonus, she also resolved a chronic back pain problem.

And what did Doepfner, who's in her early fifties, gain? A better, healthier body--and a new attitude. "I just feel so much better about myself," she says. "I have so much more energy. Like this morning, I got off the treadmill and started cleaning everything in the kitchen. Before, I was lucky if I could make a cup of coffee."

Of course, daily exercise wasn't the only answer. Doepfner now watches what she eats and simply moves whenever possible. "Instead of making one trip to pick things up around the house, I make two. When I do errands, I park farther away from the store so that I have to walk a bit," says Doepfner, who also has fewer colds and flus these days.

BETTER THAN DRUGS

Results like Doepfner's come as no surprise to Nicholas A. DiNubile, M.D., clinical assistant professor of orthopedics at the University of Pennsylvania in Philadelphia and author of The Exercise Prescription. Dr. DiNubile is convinced that exercise is as useful and as powerful as any drug.

"Doctors don't use exercise as a treatment for problems nearly enough," he says. "It's a medicine in itself; they could be using it as a first-line defense. I can hardly think of any woman--no matter what her age or condition--who wouldn't benefit from exercise. In fact, the Surgeon General's report demonstrates that inactivity is hazardous to your health. Being inactive is as bad for you, from a health standpoint, as smoking."

For many women like Doepfner--plagued by nagging health complaints and at risk for even bigger problems such as heart disease and high blood pressure--exercise can be the ticket to good health. Solid evidence shows that, performed regularly, even moderate exercise, such as treadmill walking, can:

* Reduce risk of heart disease

* Trim unwanted pounds

* Maintain weight loss

* Prevent excessive weight gain during pregnancy

* Shorten labor during childbirth

* Lower high blood pressure

* Strengthen bone

* Help diabetes

* Relieve lower-back pain

* Ease arthritis

* Ease menstrual discomfort

* Reduce risk of certain cancers, such as colon and breast

* Ease depression and boost self-esteem

* Sharpen memory

* Lessen the incidence of colds and flus

Research at the University of California, San Francisco, shows that exercise benefits both body and mind. In a two-year study of 1,758 adults with chronic conditions such as diabetes, high blood pressure, congestive heart failure or depression, people who exercised more tended to have more energy, less pain and fewer sleep problems and handled stress better than those who didn't.

BORN-AGAIN THERAPY

Like medicinal herbs, exercise has been valued for its therapeutic powers for hundreds--even thousands--of years. Ancient Greek philosophers and physicians extolled the benefits of exercise--at least for men. By the 1880s, a small segment of Americans was using weight machines, following the lead of Dr. Dudley Allen Sargent at Harvard University. In 1902, some 270 colleges had adopted physical education, 300 city schools required students to exercise and the YMCA had set up 500 gymnasiums--for men.

Until recent history, it seems, breaking a sweat was considered man's work. That changed in the 1970s, when Kenneth Cooper, M.D., discovered the benefits of aerobic exercise in his Dallas laboratory.

Joggers hit the road in droves--men and women both, says Dr. DiNubile. Several years later, weight lifting changed from something that only 250-pound he-men attempted into a craze that even grandmothers could (and should) do, he notes.

"It took someone like Arnold Schwarzenegger to bring weight lifting into the mainstream in the 1970s and 1980s," says Dr. DiNubile. "Before that, only an isolated group of so-called fanatics did it--definitely no women. Now we're seeing that it's even more important for women than men because of its benefits to bone health."

GOOD NEWS FOR WOMEN

If women were more active and also ate right and didn't smoke or drink, major health problems that often accompany menopause, such as breast cancer, heart disease and osteoporosis, might not occur as frequently, says William Wilkinson, M.D., medical director of the Cooper Institute for Aerobics Research in Dallas, founded by Dr. Cooper.

Evidence strongly shows that exercise can reduce your risk of breast cancer, for example. Researchers at Arizona State University in Tempe, in analyzing numerous studies, reported that women who pursued very active jobs, such as teaching physical education, could have up to a 50 percent less chance of getting breast cancer than those with sedentary jobs, such as office work.

Researchers suggest that moderate physical activity is a deterrent to certain cancers because exercise helps lower weight and body fat, which means that the body is exposed to lower levels of estrogen, a female hormone. Exposure to high levels of estrogen has been linked with breast, ovarian and endometrial cancers. Also, physical activity during adolescence delays the onset of your menstrual cycle, which means over the years your cumulative exposure to estrogen will also be reduced. Further, exercise boosts immunity--the body's natural way of fighting disease.

Among women in the United States, coronary heart disease outpaces everything else, including breast cancer, as the leading cause of death. Heart-smart workouts help make costly, risky medical procedures such as coronary bypass operations unnecessary, says Jerome Brandon, Ph.D., associate professor of kinesiology and health at Georgia State University in Atlanta.

In a study of 478 premenopausal and 44 postmenopausal women, those who exercised the most had 25 percent more high-density lipoprotein (HDL), or good cholesterol, and 20 percent less low-density lipoprotein (LDL), or bad cholesterol, than those in the low-fitness category. The HDL is desirable because it transports the bad LDL away from the artery walls, where it tends to accumulate and slow or block the flow of blood to the heart.

Exercise can also make pregnancy more manageable. "Pregnancy is like a marathon, and you're better off if you've been training for it," notes Dr. DiNubile. "It helps prevent excessive weight, it reduces prolonged labor and helps you feel better overall. Pregnancy is hard work!"

Being fit could help make for an easier childbirth, notes Dr. Wilkinson. "During delivery, you rely on lower abdominal muscles, so having these muscles in good shape is a tremendous help. If you've been exercising, the body is able to use and deliver oxygen to the muscles much more efficiently."

TRANQUILIZER, ENERGIZER

Every day, countless women call their doctors to renew their prescriptions for alprazolam (Xanax), a sedative that has long surpassed diazepam (Valium) as the anti-anxiety drug of choice among physicians and the women they treat. Millions of other women rely on regular jolts of coffee to get through their days. Performed regularly, exercise can serve as both a nondrug remedy for nervous tension and a natural energizer.

The benefits of exercise aren't just physical, says Dr. DiNubile. Exercise triggers biochemical changes, such as the release of natural painkilling compounds called endorphins. So a good workout can lift your spirits. Exercise has also been shown to ease anxiety and depression. It's a great stress-buster. And, he adds, breaking a sweat can even make you sharper mentally.

THE EXERCISE PRESCRIPTION

One of the best things about exercise is that it's never too late to start, says Dr. DiNubile. And you don't have to run marathons to adopt exercise as therapy. One study found that men and women who went from a sedentary lifestyle to doing just moderate activity, such as walking or gardening, saw relatively bigger gains in overall health status than those going from moderate to vigorous exercise, he notes.

In other words, just getting out and moving--doing anything that
requires you to move your arms and legs and raises your heart rate for more than a minute or two--adds up to huge benefits later on, says Dr. DiNubile. Avoiding inactivity is the key.

You need to get your "exercise prescription" in three important ways, he adds.

* Aerobic activity, which gets your heart pumping and lowers your risk of heart disease and weight gain

* Strength training, also called resistance training or weight lifting, which strengthens muscle, increases bone growth and helps with weight control

* Stretching, which builds flexibility and prevents injuries

AEROBICS: PUMP UP YOUR HEART

Activities such as jogging, cycling and walking--movement that allows your muscles to work steadily with a constant supply of oxygenated blood--are known as aerobic exercise. This steady and sustained level of activity requires the heart to supply the muscles with oxygen, which is combined with fats and glucose to produce energy.

To best understand what aerobic exercise does, take a look at its effect on your most important muscle--the heart. If you get what doctors consider a good cardiovascular workout--30 minutes of exercise between 65 and 80 percent of your maximum effort--three times a week or more, your heart will become a more efficient pump that doesn't have to work as hard, says Dr. DiNubile.

"As you get into better shape, the heart doesn't have to work as hard to do its usual job," adds Dr. Brandon.

The result, says Dr. DiNubile, is a lower heart rate, lower blood pressure and lower incidence of heart disease.

For women, one of the biggest benefits of breaking a sweat is an increase in metabolic rate; that is, the rate at which your body burns calories. "If you consume more calories than you burn, you gain weight," says Jeffrey Rupp, Ph.D., associate professor of kinesiology and health at Georgia State University in Atlanta. "Conversely, to lose excess weight, you need to spend more calories than you take in. And there's no question that when you exercise, your metabolic rate increases." Taking in fewer calories isn't effective unless you exercise, though, says Dr. Rupp. The body reacts to food deprivation by lowering its resting metabolic rate to try to spare calories.

TAILOR YOUR WORKOUT

To incorporate aerobic exercise into your life, follow these guidelines.

Walk your dog (even if you don't have a dog). Dr. DiNubile says that he recommends walking most often for people who are just starting out. "It's easy, it's weight-bearing and anyone can do it. It's a good starting exercise."

Buy the right shoes. When you took your first steps as a toddler, your parents probably fitted you with supportive shoes to replace your crocheted booties. Now that you've gotten serious about walking (or other activities) as a form of aerobic exercise, supportive footwear is once again a high priority, says Dr. DiNubile. To prevent foot and leg injuries, he recommends a supportive walking or running shoe with good arch support and cushioning and plenty of room in the toe box at the front of the shoe.

"Every day in my office I see problems related to women's shoes and sneakers being too small," Dr. DiNubile says. "I recommend shopping at a store staffed by knowledgeable runners or athletes who can help you choose the best shoe for your particular foot type and activity."

Bring socks with you. Try on shoes with the socks that you're going to wear when you work out, says Dr. DiNubile. Also, feet tend to swell toward the end of the day, so this is the best time to shop for shoes.

Consider some variety. You could stick with walking as your primary exercise, says Dr. DiNubile. Or you could graduate to jogging or aerobic dance.

Other options include working out on a cross-country ski machine, biking, in-line skating or stair climbing, he says. Or you could cross-train, where you vary your activities to keep things interesting, says Dr. DiNubile. "That's a mixed-bag training program. One day you could be on the stationary bike, working your quads (thigh muscles), and the next day you could be swimming, working your back and upper body. They both effectively work your heart."

Most important, though, is that the workout you choose has to be something that you enjoy so that you'll stick with it. To determine which combination of exercise best meets your needs, see "A Mix and Match Guide to Exercise" on page 92.

Try before you buy. Before investing in a piece of aerobic equipment like a cross-country ski machine, a stair-climber or a stationary bicycle, it's a good idea to try it out for 20 minutes or so at the store or at a local health club, says Dr. DiNubile. "Make sure that you're comfortable using the equipment. And see how you feel the next day, to be sure that the machine isn't hard on some part of your body, like your knees." Most stores encourage such tryouts but, if not, shop somewhere else, he notes.

Slide into fitness. A great workout for the buttocks and tops and sides of your thighs is the slide board--a long, rectangular sheet of plastic on which you slide back and forth in nylon booties to simulate skating, notes Dr. DiNubile. You can also move your legs forward and backward to simulate cross-country ski movements. "It's not the same resistance as on a cross-country ski machine, but you can simulate the leg and arm movements. And it's a good aerobic program for balance and agility," he adds. It's also cheaper and easier to store than a machine.

Easy does it. You'll want to work up to 30 minutes of exercise a day, says Dr. DiNubile. But whatever form of exercise you choose, start off slowly, he warns. If you haven't had a walking workout before, start out doing it five minutes a day and don't increase your distance or time by more than 10 percent each week. "The 10 percent rule goes for anything," he says. "Don't increase weights by more than 10 percent or increase your time on the stair-climber by more than 10 percent a week."

Sweat with a buddy. It really helps you stay with a workout plan if you can use the buddy system, says Dr. Brandon. "Having someone with you who can motivate you on the days that you don't feel like exercising makes a big difference," he says. "Plus, it's more fun."

Make the time. Set aside 30 minutes a day, at least three times a week, designated for exercise, says Dr. DiNubile. "The biggest excuse is not having enough time. I tell people that when you exercise, you create time because it makes you more efficient the rest of the time: First, because you're in better shape and, second, because you're more alert since blood is pumping to the brain," he says. "Also you add years to your life, so it's a great investment of time. All the busy, successful people that I know find time for that investment. The payback is great."

Dr. DiNubile points out that when he worked with Schwarzenegger on the President's Council for Physical Fitness and Sports, Schwarzenegger said that every hour you spend working out is one less that you have to spend in a doctor's office.

Pick a time, any time. Whether you work out in the morning, afternoon or evening isn't as important as sticking to a regular time, notes Dr. Brandon. "The vital thing is making it part of your routine and making it a priority--just like your job--so that you'll stick with it," he says.

Log in. For some people, recording the time or distance they walk, run or work out helps them make exercise part of their routine, like brushing their teeth, notes Dr. DiNubile. "Some people need that kind of feedback to stay motivated--to measure their progress and improve."

STRENGTH TRAINING: TONE UP FOR INNER HEALTH

Working your muscles against some form of resistance is, like aerobic exercise, important in the prescription for good health, says Alan Mikesky, Ph.D., exercise physiologist and director of the Human Performance and Biomechanics Laboratory at Indiana University Purdue University in Indianapolis. "That includes calisthenics, such as push-ups and leg lifts as well as weight lifting.

"Strength training improves strength, and it improves muscular endurance, which means you can work or play longer before you fatigue," he says. "It decreases the risk of injury, no matter what you're doing, and helps to maintain and improve flexibility."

As an added bonus, says Dr. Mikesky, building muscle increases your metabolism, helping to burn more calories, even while you're resting, which aids in maintaining weight. Strength training gives you added ammunition in the battle against excess weight.

And when it comes to bone health for women, nothing beats weight training, notes Susan Bloomfield, Ph.D., assistant professor in the Department of Health and Kinesiology at Texas A&M University in College Station. That's because the mechanical stress on the bones helps to improve bone density, which increases bone strength, in much the same way that muscle strength is influenced by repeated use of muscle, says Dr. Bloomfield. And the higher your bone mass, the better your odds of avoiding osteoporosis--a condition responsible for weak, easily broken bones in women past menopause.

By the way, don't worry that you'll look like the Incredible Hulk in heels after a few months of lifting weights, says Dr. Mikesky. "Women secrete very little testosterone, the hormone that contributes to the growth of muscle mass in men. So no matter how hard they work out, there's a natural limit to how large their muscles grow, he says.

GET PUMPED ON A BUDGET

So you've decided to put down that candy bar and pick up a barbell. Here's how to get started without spending hundreds of dollars on weight-training equipment and a membership at the gym.

Shop for free weights. "Strength training doesn't have to cost an arm and a leg," says Dr. DiNubile. If you don't belong to a gym, and a Nautilus-type machine may be out of your price range, you can purchase a pair of dumbbells, a barbell, a weight bench and free weights for far less money, he notes. "There's no magic equipment. For the most part, your muscles can't tell the difference between a $2,000 machine and a simple free weight."

Buy secondhand. To find good dumbbells and barbells, check sporting goods stores that sell used equipment, suggests Dr. DiNubile. Or check out ads in newspapers or cruise yard sales. Gyms often get rid of their weights or machines when they upgrade their equipment, so keep your eyes open for sales, he adds.

Try elastic bands. If you don't want to use weights, elastic bands can do the trick as well, notes Dr. DiNubile. These large rubber band­like loops that resemble bike inner tubes can be looped around your ankles for leg workouts or pulled up by your hands while looped under one foot to work your shoulders and arms. "They're inexpensive, easy to store and allow you to work all areas. They are also great for travel workouts," he says.

Do it right. It's a good idea to have a trainer at a gym or health club show you how to properly perform the resistance exercises that you will be using--especially your first time out, says Dr. Mikesky.

Warm up first. It's important to loosen up for three to five minutes before you start pumping iron, notes Dr. Mikesky. Jogging in place, treadmill running or riding a stationary bike for a few minutes will increase breathing and heart rate and promote blood flow to your muscles, getting them ready for resistance work.

Work your way down. First work the larger muscle groups--the thighs, chest and back, says Dr. Mikesky. Then work the smaller muscle groups--the arms, calves and abdominals. Follow the step-by-step illustrations for strength training, shown below.

Know your limits. Knowing how much weight to use is trial and error, says Dr. Mikesky. If you can only do 10 lifts properly without overstraining, only do 10. Don't sacrifice exercise technique to lift a heavier weight or perform more repetitions. Most beginners should use a resistance that allows them to do between 10 and 15 lifts.

"If you can't get to 10 repetitions, then you're trying too much weight. If you can easily do more than 15, it's too light," he says. If you are a beginner to strength training, you'll do one set of repetitions for each muscle group in the course of a workout. As your training progresses over the next six to eight weeks, repeat the process until you can do three sets of repetitions for each exercise.

Bent-Over Dumbbell Row

With your left leg, kneel against one end of a padded weight bench while keeping your right leg on the floor, slightly bent. Support yourself with your left arm and hold a dumbbell in your right hand. Your back should be slightly arched.

Inhale and lift the dumbbell until your right elbow is a few inches higher than your back. Exhale and bring the dumbbell back to the starting position. Repeat, then switch sides.

	Bench Press Using Dumbbells Lie on a padded weight bench with your feet flat on the floor and shoulder-width apart. Hold a dumbbell in each hand at chest level with an inward grip.
Inhale and begin to raise the dumbbells. Exhale after passing the most difficult part of the lift, which may be slightly beyond the midway point. Pause when your weights have reached the top position and your arms are fully extended. Inhale as you lower the weights back to your chest. Pause for a second and then repeat.
	Dumbbell Front Lunge Hold dumbbells at arm's length with your palms facing in. Hold your head and your back straight, with your feet about six inches apart.
	Step forward with your left leg until your left thigh is almost parallel to the floor. Inhale as you step out. Keep your right leg as straight as possible. Step back to the starting position. Exhale as you step back. Repeat with the right leg.
	Standing Dumbbell Curl Hold dumbbells at arm's length with your palms facing in. Your head should be up, your back straight and your feet shoulder-width apart.
Keeping your upper arms close to your sides, bring the dumbbells up to shoulder height. Inhale as you are lifting. Bring the dumbbells back down. Exhale as you are bringing dumbbells back down. Repeat.
	Triceps Kickback Using Dumbbells With your left leg, kneel against one end of a padded weight bench while keeping your right leg on the floor and slightly bent. Support yourself with your left arm. Hold a dumbbell in your right hand with your upper arm against your side and your palm facing inward.
As you inhale slightly, extend your arm backward until it's straight. Hold your elbow close to your body.
	Pause for a moment. Then, keeping your arm as straight as possible, continue to move your arm backward and upward in an arc. Your reach should be well above the level of your back. Don't swing the dumbbell. Slowly lower your arm back to the startin