Watching Women's Health

Spend more of your day moving, having fun

More than two-thirds of adult Americans are overweight or obese, according to a recent national survey. Approximately 10% of children are also above a healthy weight. Fortunately, among both adults and children, the percentage who are overweight and obese is no longer increasing.

One way to address this national public health challenge is to get Americans moving again, through both individual and societal changes. Here are nine ways an individual can be more physically active.

1. Find physical activities you truly enjoy. This is the most important suggestion of all. If you are doing something you like to do, you are not working out, you are having fun. It takes planning, but not really discipline, to make an enjoyable activity part of your day.

2. Find ways to be active in all seasons. In Minnesota, staying active in the winter is a challenge. Many women occupy the summer with gardening, yard work, walking and cycling, but these activities fall by the wayside in the winter. It is actually not hard to dress for the weather and continue usual activities or switch to winter sports. Even in my state, only a handful of winter days are unbearable.

In other parts of the country, a hot and humid summer limits most outdoor exercise to early morning. Be realistic about where you live and either find ways to be out in all kinds of weather or move your activities indoors for part of the year.

3. Be active with friends. I first started exercising as a young adult by swimming at noon with a work friend. We later switched to running when the community pool became too crowded to swim laps. Our friendship made it easy for us to get fit together.

Most of my close adult friendships have been formed because we share physical activities as well as sensibilities. For the past two years, I have admired from afar four women who walk together every morning, regardless of weather. They are always happy and animated - clearly getting together is not a chore for them.

4. Go places under your own power. Day to day, most of us feel pressed for time.  Perhaps the most time-efficient way of getting more exercise is combining it with transportation. Try walking or cycling to work, run errands or get together with friends. To cover long distances, find ways to combine self-locomotion with public transportation.

Many baby-boomers who are downsizing houses would also like to downsize their car fleet as well as their clothing size. When moving, look for neighborhoods that are pedestrian and bicycle-friendly. At least one helpful website lets you analyze the walkability of any address in larger US cities.

Similarly, consider vacation spots that allow you to get around under your own power. This is not only economical but will help counteract the weight gain that seems inevitable with most vacations.

5. Get a dog and give it a great life.  A great life for a dog is a healthy, active life for you. A recent study showed people who walk their dogs see more improvement in their fitness than people who walk with humans. Unlike human companions, dogs don't come up with excuses not to walk. Dogs will happily go out in almost any weather and you find out you can, too.

6. Spend less time sitting. Sitting at a desk at work, watching TV, or at a home computer occupies most of the day for a lot of people. Along with sleeping, sitting in a comfortable chair is the least active thing our bodies can do. Most calorie expenditure charts show standing uses roughly twice as many calories as sitting, and calorie expediture goes up from there with more intense activities. Be creative about finding ways to sit less; when you do sit, try using an exercise ball part of the time (even though the TV comedy The Office made huge fun of this).

Wearing a pedometer is an easy way to quantify how much you are moving around during an average day and has been shown to increase sedentary women's activity levels.

7. Increase your activity gradually. Once you've made up your mind to be more active, don't risk injury by overdoing it in the first several weeks. Remember you're in this for the long haul. Give the weakest parts of your body time to catch up to the strongest. 

8. Mix things up. Humans like variety. If you involve yourself in a variety of activities, you are less likely to get tired of what you are doing and to have overuse injuries. Part of the beauty of living in a place with distinct seasons is engaging in different seasonal activities. For instance, here in Minnesota, we never get tired of cross-country skiing because, believe it or not, the winter is too short.

9. Have a mindset that exercise is a priority, not a luxury. To be healthy, we need physical activity just as we need fluids, nourishment, mental stimulation and sleep. Physical activity should be a normal part of virtually every day, not something we'll do if we have time and inclination. Each day, figure out a way to fit some sort of exercise into even the busiest schedule. 

I've gathered these ideas from talking with my friends and patients, and from my own experience of being physically active throughout my adult life. Even if you have never liked to "exercise," you'll do good things for your health (and have fun) if you move more and sit less.

Obesity replaces smoking as top US health burden

The good news is that smoking is no longer the biggest health threat to Americans.  The not-so-good news is that, while fewer people are smoking, many more, including record numbers of children, have become obese.

The medical definition of obesity is a body mass index (BMI) greater than 30. For example, for a woman who is 5'5", any weight above 180 lbs is in the obese range. BMI for normal weight ranges from 18.5-24.9; the overweight range is from 25-29.9. To be in the normal range, a 5'5" woman would weigh between 112 and 150, a fairly generous spread.

While smoking rates in the US have declined in recent years, obesity has been on the rise. Between 1993 and 2008, obesity in the US increased by 85%.

The risks from smoking and obesity are different. Smoking increases risk of premature death whereas obesity increases risks of morbidity, or ill health.  Both can result in fewer years of quality living, with obesity now edging out smoking as a robber of quality years.

If everyone in our country miraculously became a nonsmoker of normal weight, on average Americans would gain 5 quality years of life.

Obesity can limit normal activities through early arthritis, diabetes and heart disease.  And these progressive conditions lead to less and less physical activity. Like smoking, the problem of obesity is best addressed by prevention. Once a woman has become obese, it is a difficult condition to change.

Physicians regularly encourage smokers to quit and discuss approaches to weight loss with our overweight and obese patients. In my practice, I see smokers quitting and overweight women getting back into a normal weight range far more often than I see obese women succeed in losing weight. Their lack of success seems in large part due to the obesity-related physical ills that do not allow them to be physically active. 

Much has been written about the causes of obesity in the US. At or near the top of everyone's list is a sedentary life style that is so much more common now than even a few decades ago. In my next post, I'll discuss practical approaches to being more physically active.

How not to have a stroke

Many people say having a stroke is one of the medical events they want most to avoid. A British study provides some strategies for individuals who want to reduce their personal risk of stroke.

Researchers followed just over 20,000 men and women aged 40-79 for an average of 11 years. After controlling for other stroke risk factors, they identified four lifestyle habits that reduced risk.

These habits were: not smoking, some level of physical activity, moderate alcohol use and eating five fruits and vegetables daily. 

Physical activity was defined as either having an active job or getting at least 30 minutes of leisure exercise daily. Moderate alcohol use was having between 1 and 14 drinks per week.

Fruit and vegetable intake was verified by serum vitamin C levels. (How they determined serum vitamin C levels reflected food intake, not use of supplements, was not made clear.)

Each healthy behavior was found to reduce risk of stroke and the risk reduction was additive. If an individual practiced all four behaviors, risk of stroke was about half that of people without these habits.

More women than men practiced all four healthy habits. The four healthy habits provided stroke protection regardless of body mass index.  Refraining from tobacco had single greatest impact on women's stroke risk.

If you don't drink alcohol, few physicians would recommend that you start. But alcoholic beverages do have some health benefits for moderate users.

The key is to keep alcohol use moderate, since excessive use adds a host of other risks. Elsewhere, moderate alcohol use for women has been defined at a lower cutoff, somewhere between 7 and 11 drinks per week.

There are some stroke risks that we inherit and can't change. This study identifies four habits most of us can adopt to reduce whatever stroke risk we do have.

Physical fitness is good for the mind, too

Every time I see a patient for an annual exam, we talk about what she is doing to be physically fit. Most people think exercising regularly will help with weight management and cardiovascular health — and it does. Here's another benefit.

A new small study in Neurobiology of Aging suggests that the physically fit have a reduced risk of developing Alzheimer's disease because of improved blood flow within the brain.

42 women between the ages of 50 and 90 were evaluated for their fitness level, vascular function in the brain and cognitive function. The study showed the more physically fit women had better vascular and cognitive function than sedentary women. 

Dementia can wreak havoc on individuals and their families and we all wonder whether it could be in our future. Continuing to do mentally complex tasks as we get older — mental exercise — appears to help. Since it is becoming clear that physical exercise helps, too, fast forward to your sharp-as-a-tack older self thanking you as you start your workout today.