(Abstracted from The American College of Obstetricians and Gynecologists)

There is compelling evidence that combining an exercise program with a healthy diet can help prevent many diseases, decrease the symptoms of many chronic diseases, and prolong life.

Benefits of Exercise

Regular physical activity is associated with lower death rates for adults of any age; even when only moderate levels of physical activity are performed.
In summary regular physical activity:

• Decreases the risk of death from heart disease
• Decreases the risk of developing diabetes
• Decreases the risk of colon cancer
• Helps prevent and reduce high blood pressure
• Increases muscle and bone strength
• Increases lean muscle and helps decrease body fat
• Aids in weight control and is a key part of any weight loss effort
• Enhances psychologic well-being and may even reduce the risk of depression

Cardiovascular Health

Cardiovascular fitness should be the major goal of most exercise programs. The usual routine consists of a low-intensity program that lasts for 30 - 60 minutes 3 - 5 times per week. Recent reports indicate daily activities may be more effective. Even repeated episodes of exercise in short bursts, such as two 15 - minute segments or three 10 - minute segments can be beneficial. Even moderate exertion can have an effect on cardiovascular fitness. Walking at a brisk pace will improve fitness over time. The goal is to walk 10,000 steps per day. Systolic blood pressure and diastolic blood pressure levels are lower in women who participate in vigorous exercise. There is even an inverse relationship between death from stroke in those who are physically active. To establish the heart rate at which conditioning will develop, use this simple formula:

(220 - age) x 60-80% = target heart rate range

For instance, a 35-year-old woman will have a target heart rate of 111 - 148 beats per minute. The target rate must be maintained for at least 20 - 30 minutes and repeated at least 3 - 4 times per week. By following this exercise program, it will take the average woman 12 or more weeks to develop significant fitness. Another, less precise way to monitor the level of exertion is to advise women to exercise at a pace that makes it difficult to carry on a conversation. A cool-down period should be added to the end of each program, such as walking until the heart rate has returned to near-normal levels. This prevents dizziness, fainting and nausea. Hot baths, showers, and saunas should be avoided until the heart rate is back to the resting level.

Target Heart Rate for Women

Weight Control

A weight reduction program that combines both exercise and diet is more effective and results in maintaining weight loss longer than a program based on either one alone. Exercise alters pattern of fat distribution by reducing the abdominal fat component to a greater extent than other body areas. Because abdominal fat has a more significant finding even if total weight loss is less than desired.

Weight loss from exercise is slow and it takes 1 hour to utilize 300 - 600 calories. Calorie utilization during the active exercise period will extend through the post exercise period. Because muscle is twice the weight of fat per unit volume, you can lose fat without losing weight. An excellent measure of fat loss is the fit of your clothing. If your clothes are becoming looser without appreciable weight loss, you are losing fat. You should avoid trying to lose weight by dieting strenuously while in an aerobic exercise program. The resulting energy loss and feeling of exhaustion prohibits further exercise. A sensation of being tired after exercise should never last longer than 2 hours. Hydration is a critical component of exercise and weight should only be measured when you are well hydrated. Loss of water during exercise needs to be replaced even before thirst occurs. An easy way to monitor hydration is to check the color your urine; a light yellow color indicates adequate hydration.

It is probably acceptable to eat a light meal before exercise but save any heavy meals until after the exercise. Strenuous exercise appears to reduce appetite and, thus, can help reduce the caloric intake. How much exercise is necessary to achieve results? The optimal amount of exercise is still not known. Recommendations vary from 30 minutes of moderate activity daily to 60 minutes daily. A recent report, however, concluded that during a 12-week program, no differences were found in a group of sedentary, obese women who exercised at different durations and intensities. We advise our patients to keep active in any activity they can keep up and even enjoy exercising.

Muscle Strength

To strengthen a muscle, the muscle must be subjected to a repeated increase in workload or resistance. The muscle will begin to hypertrophy and be capable of greater force or strength. Evidence is accumulating that individuals who participate in appropriately planned programs involving the upper arms also can develop some cardiovascular fitness. Most weight training programs, however, do not accomplish a significant improvement in cardiovascular fitness, even with significant gains in strength. As a result, a woman who is seeking cardiovascular fitness should concentrate on an aerobic type of program and avoid those designed only to increase strength.

Bone Density

Recent studies have shown that women who engage in active fitness programs that include weight-bearing exercises have higher bone densities than sedentary. For those who began exercise as an adolescent, this benefit is extended well into adult life. Weight-bearing exercises include impact aerobics; resistance training and other activities that involve the use of large muscle groups to resist counter pressures; in contrast, swimming and casual walking cause only minimal changes in bone density. Stress on the bone causes an increase in bone density. Even postmenopausal women can increase their bone density with a moderate exercise program.

Flexibility

Flexibility depends on ligaments, muscles, and bones. Flexibility is accomplished through a routine of systematic stretching of the muscles and slowly warming up. Disagreement exists over the appropriate time to stretch. It is still recommended that stretching be performed before and after an exercise program. One advantage of a water aerobics program is the ease of flexibility in the water. Water aerobics helps improve strength without trauma to the joints.

Coordination and Balance

The more muscle repeats an activity, the more efficient the muscle becomes. The neuromuscular pathways develop patterns that become reflexive in nature. As in any coordinative activity; as you train, the ability to perform improves greatly. In the case of older women, exercise that promotes better balance can help prevent falls and injures.

Safety Guidelines

We recommend the average patient to improve her physical fitness through exercise without incurring an excessive risk of injury.

Safety Guidelines for Aerobic Exercise:

For impact activities, it is recommended that exercise routines involving repeated foot impact be limited to 30 minutes in duration at intensities not exceeding 75% of maximal heart rate. There should be 1 day of rest between such sessions.

A resilient floor should be selected for exercise that involves repeated foot impact. If such a surface is not available, the exercise routines should be modified to ensure that the feet remain close to the floor throughout the program.

Aerobic exercise should be preceded by a gentle warm-up routine that uses the full range of motion of the joints. This increases that elasticity of the muscles and will help prevent potentially injurious movements.

Muscles that are used repeatedly during aerobic exercise must be carefully stretched before and afterward.

To reduce the severity of impact shock on the lower extremities, repetitive jumping on the same foot should not exceed 4 consecutive jumps.

Extremes of joint flexion and extension (such as deep knee bends and ballistic hyperextension of the knee) should be avoided.

The feet should be moved repeatedly to prevent cramping in the intrinsic muscles of the foot.

Trunk rotation should be avoided while on the feet with hips or lower spine flexed. Rotational activity in this position subjects the intervertebral disks to very high mechanical stress.

Intense physical activity should be followed by a cool-down period of at least 10 minutes of lighter activity to prevent pooling of blood in the extremities. Hot showers and baths should be avoided immediately after intense physical activity.

Participants should be given a specific means of assessing physical status and progress. Working heart rate should be measured during peak levels of exercise to ensure that the intensity of activity is within the desired range. Regular measurement of the recovery heart rate will motivate participants by documenting their progress. Failure to progress as measured by this method may indicate the need for more intense activity during the aerobic phase or may signal the presence of other problems.

Guidelines for Strengthening Exercises:

Strengthening exercises should not be performed on the same muscles on consecutive days resistance.

Muscle-strengthening exercises should be preceded and followed by stretching exercises that are specific for the muscles that are made to work against resistance.

All strengthening exercises should be performed in a slow and controlled manner. Ballistic (rapid or jerky) movements increase the risk of injury.

The most efficient way to improve strength is to allow brief rest periods between hours of vigorous exercise. Repetitions should be limited to short sets (10 or fewer) that are repeated later.

When the strength of one muscle or muscle group is disproportionate to that of the antagonist(s) for that muscle or group, the weaker muscle should be strengthened to restore balance around the joint.

The breath should not be held during strength-training exercises. Exhalation should take place during the exertion phase of each repetition.

Guidelines for Stretching Exercises:

Stretching exercises may be performed as often as desired, preferably at least once per day.

A general warm-up routine should be performed before muscles are stretched.

Stretching routines should be performed statically, without holding the breath. Rapid, jerky movements should be avoided.

Each stretch should be held long enough so that relaxation will occur sufficiently to achieve the maximum benefit of the stretch. This can vary from as little as 6 seconds in some individuals to 20 seconds in others.

Muscles should be stretched only to the point of tension. Pain should be regarded as a signal that a stretch has gone too far.

Warning Signs of Overexertion:

• Sudden sharp pain
• Excessive fatigue
• Difficulty breathing
• Persistent lethargy
• Nausea
• Vomiting
• Faintness
• Dizziness
• Excessive muscle soreness or pain
• Any irregularity of the heartbeat

Treatment of Minor Injuries

Abrasions should be cleaned and either treated with a topical antibiotic cream and dressed or allowed to dry. Contusions require little or no therapy. Strains and sprains require treatment. A treatment regimen that should be considered is RICE (rest, ice, compression, and elevation).

For the acute injury, placing freezing water in as Styrofoam cup and gently massaging the area with the cup until the skin is numb is very effective. This can be performed every 3 - 4 hours during the first 24 - 48 hours. If the injury is to a joint, ice should be applied around the joint. The ice is best applied using a plastic bag with a thin towel around the skin. This icing should persist for at least 30 minutes. If the injury is minimal, this will relieve the discomfort and can be repeated every 3 - 4 hours. If there is significant pain and swelling, X-rays and referral are indicated. Compression with an elastic bandage also should be used to help minimize the swelling at the injury of a joint. This can be used to hold the ice in place.

With a lower extremity injury, it is important to elevate the injured part. This will help reduce the swelling. Anti-inflammatories and anti-prostaglandins can be used for minor injuries. They also can be used for the aches and pains associated with exercise.

Exercise During Pregnancy and the Postpartum Period

Generally, in the absence of either medical or obstetric complications, pregnant women can continue to participate in an exercise program. Exercise may be beneficial in the primary prevention of gestation diabetes.

Guidelines for Exercise in Pregnancy

Absolute Contraindications to Aerobic Exercise During Pregnancy:

• Hemodynamically significant heart disease
• Restrictive lung disease
• Incompetent cervix or cerclage
• Multiple gestation at risk for preterm labor
• Persistent second-trimester or third-trimester bleeding
• Placenta previa after 26 weeks of gestation
• Preterm labor during the current pregnancy
• Ruptured membranes
• Preclampsia or pregnancy induced hypertension

Relative Contraindications to Aerobic Exercise During Pregnancy:

• Severe anemia
• Unevaluated maternal cardiac arrhytmia
• Chronic bronchitis
• Poorly controlled type 1 diabetes
• Extreme morbid obesity
• Extreme underweight (body mass index <12)
• History of extremely sedentary lifestyle
• Intrauterine growth restriction in current pregnancy
• Poorly controlled hypertension
• Orthopedic limitations
• Poorly controlled seizure disorder
• Poorly controlled hyperthyroidism
• Heavy smoker

Warning Signs to Terminate Exercise While Pregnant:

• Vaginal bleeding
• Dyspnea before exertion
• Dizziness
• Headache
• Chest pain
• Muscle weakness
• Calf pain or swelling (need to rule out thrombephlebitis)
• Preterm labor
• Decreased fetal movement
• Amniotic fluid leakage

Special Consideration Regarding Pregnancy and Exercise:

Recreational and competitive athletes with uncomplicated pregnancies can remain active during pregnancy and should modify their usual exercise routines as medically indicated. The information on strenuous exercise is scarce; however, women who engage in such activities require close medical supervision.

Previously inactive women and those with medical or obstetric complications should be evaluated before recommendations for physical activity during pregnancy are made. Exercise during pregnancy may provide additional health benefits to women with gestational diabetes.

A physically active woman with a history of or risk for preterm labor or fetal growth restriction should be advised to reduce her activity in the second and third trimesters.

Menopause to Age 65 Years

This also is a time when medical problems can and do manifest themselves. Most women in this age group are healthy and can exercise.

Young - Old (Ages 65 - 74 Years)

Today, many women continue to work after age 65 years, and healthy retirees at 65 years often will find another career. Physical activity at this time is important because it allows women to maintain agility, strength, and their weight.

Middle - Old (Ages 75 - 84 Years)

As age increases, flexibility, strength, and coordination could be reduced. Experience in cardiac rehabilitation programs has shown the value of exercise to both men and women in this age group. The preferred program usually is walking, although water aerobics is becoming popular. Senior Olympics has competition for women in this and older age groups so competitive activities are still available.

Old - Old (Ages 85 Years and Older)

Exercise can have a beneficial effect in women aged 85 years and older. By maintaining strength, flexibility, and reduced body fat, a woman can continue many everyday activities that allow her to maintain an independent lifestyle.

Conclusion

A well-planned and conscientiously maintained exercise program can be an essential component of developing a healthy lifestyle. A key component of any exercise program is the development of cardiovascular fitness. A sustained exercise program that occurs 3 - 6 times per week for 30 or more minutes at 60 - 80 % of the maximum heart rate will increase the patient's aerobic capacity. An increase in the patient's aerobic capacity will allow her to perform her daily activities without fatigue and will improve preexisting conditions, such as diabetes and hypertension. Continued activity is important in weight loss, flexibility, prevention or at least reduction of osteoporosis, and coordination. Patients in their post-reproductive years can start and should continue an appropriate exercise plan.