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Exercise And Women's Health:  A Critical Part Of Overall Health.

Women's health issues will play a more prominent role in today's and tomorrow's health care system. By promoting exercise and healthy diets to women during childbearing years, they can reduce the risk of acquiring many diseases.

By: Eric P. Durak

If you were asked to name the worst medical epidemic in the United States today, you might guess heart disease. It would be a noble guess, but it would be wrong. Today, half of all women over the age of 62 suffers from osteoporosis. It will afflict more than 40 million women by the year 2,000, and cost billions in health care dollars. How will rehabilitation fit in? Two ways - prevention, and prompt treatment.

By promoting exercise and healthy diets to women during childbearing years (ages 20-38), they can certainly reduce the risk of acquiring the disease in the first place. By having referrals for orthopedic assessments, and complete exercise programming immediately after diagnosis, we may save most of the health care dollars in medical treatments that would normally be spent on these patients.

A diet rich in leafy green vegetables (phytonutrients), fiber, low in fat, and of course, high in calcium (among the other 72 trace minerals, according to Dr. Joel Wallach) is the first step in prevention. Exercise - especially strength training, is the second most important step. A properly prescribed program will increase density in the femoral neck, radial wrist, and lumbar vertebrae, where it is needed most. This section will concentrate on the most important areas of the body to strengthen, what types of exercises to perform, and the proper progression in which to perform them to enhance muscular and bone development.

Section #1 - Hip Area.

Comprising the largest muscles in the body, the hip area is the foremost set of muscle groups to exercise. The most important types of machines to condition this area are the leg press, and total hip machine. The leg press is a compound exercise, working the muscles of the hip and thigh. The hip machine is an isolation exercise, concentrating the gluteus maximus. These machines are preferable to free weights to start out with because the learning curve is less, and improvements can be made with less chance of injury.

Section #2 - Upper Body.

Working the upper body major muscles (chest, shoulders, back) comprises section #2, and provides resistance to the long bones of the upper vertebrae, long bones of the arms, and ribs.

The most important element of program design for this group is training progression, as the goal is to strengthen weak and porous bone to its natural density. A beginning program would start with low intensity, and more repetitions. It would look something like this:

Phase 1: (Low intensity)

    Exercise Sets Reps* Rest Period
    Chest Dips 2-3 10-15 2-3 minutes
    Lat Pulls 2-3 10-15 2-3 minutes
    Hip Extensions 3-4 10-15 2-3 minutes
    Leg Press 3-4 10-15 2-3 minutes

Click Here For A Printable Log Of Phase 1!

After a period of adaptation (phase I), it is time to increase the intensity, and change the number of sets and reps.
* Where 30 repetitions are possible with a maximum effort.

Phase 2: (Medium intensity)

    Exercise Sets Reps* Rest Period
    Chest Dips 3 10-10-8 3-5 minutes
    Lat Pulls 3 10-10-8 3-5 minutes
    Hip Extensions 4-(5) 10-8-6-4-(2) 3-5 minutes
    Leg Press 4-(5) 10-8-6-4-(2) 3-5 minutes

* Leave 4-6 reps to spare at the end of each set

Click Here For A Printable Log Of Phase 2!

The goal - progressing to a level that is perceived as difficult - strengthens the musculature, and over time (4-8 months), has a positive effect on the bone density (as seen by DEXA scan). According to the sports medicine literature, the MES (minimal essential strain) is about 1/10th the amount of force required to fracture a bone, so the amount of stress placed on bones through strength training does not have to be in maximal exertions. Medically, the density should improve from minus 10% mineral loss to a normal value (0% bone loss).

Both of the phases of training can be manipulated by the therapist, depending on the initial conditioning level of the participant. Training should proceed in phases, as staying with the same level of resistance will not improve bone density or muscle strength.

Rehab In Women's Cardiovascular Diseases

As women are increasing their risks for developing both heart disease and lung cancer, rehabilitation programs should play an important role in both reducing the complications of these diseases, and health care costs associated with long term affliction.

In the area of cardiovascular therapy, this area is not as pronounced as orthopedic rehabilitation. None the less, basic cardiovascular education and treatment programs are necessary for the following reasons: First - more women are being diagnosed with cardiovascular events (heart disease, emphysema, breast cancer, peripheral vascular disease). With this increase in the number of cases, the health care costs also rise concomitantly. Second - the current medical system is ill prepared to give patients the necessary time for information regarding therapy and education strategies.

This is where allied health professionals (physical therapy, dietetics, exercise physiology, occupational therapy, etc.) play such a vital role. The cost of a referral, assessment, education, and therapy plan is far less than medical intervention that may occur within one year of the initial diagnosis.

Information from the Women's Health Data Book (1992 - Jacob's Institute, Washington, DC) states that although women make more frequent visits to physician offices than do men, they do not receive as much intervention. This may be seen in the fact that many oncologists do not refer women who have had surgery for breast cancer for physical therapy (exercise, range of motion, pain reduction techniques). It would seem a logical extension of their health care, but it is not yet routine.

Rehab & Health Care Costs

In 1994, futurist John Naisbitt predicted a $188 billion cost savings by the implementation of wellness programs in major businesses in the US. If this amount may be extrapolated to include the health care system, we might see an even greater savings. Although rehab per se is not primary prevention, any type of patient education may have a preventive effect on patients in the future. Rehab programs that promote healing for an acute event, but also give education on Activities for Daily Living may save unforeseen medical costs.

In conclusion, women's health issues will play a more prominent role in today's and tomorrow's health care system. The aspects of prevention and quality rehabilitation will be factors because of their long-term intervention strategies and ability to reduce health care costs. The role in which health promotion and rehab can affect change in the above-discussed aspects of women's health will be key to the success and growth of both of these important elements of the health care system.

References

1. Greenwald, S. Menopause, Naturally. Volcano Press, Volcano, CA, 1984.
2. Whitney, E.N., Hamilton, E.M.N. Understanding Nutrition, 3rd Edition. West Publishing Company, St. Paul, MN, 1984.
3. Bompa, T.O. Periodization of Strength: The New Wave in Strength Theory. Veritas Publishing, Toronto, Canada 1993.
4. A Profile of Women's Health in America. Women's Health Data Book. Coyright 1992 by the Jacobs Institute, 409 12th St.,Washington, DC 20024.
5. Baechle, T. (ed). Essentials of Strength and Conditioning. Human Kinetics Publishers, Champaign, IL 1994.
6. Naisbitt, J. The wellness re-dux. Naisbitt Megatrends Newsletter. vol. 13, no. 20, October 13, 1994.

Thanks,

Eric P. Durak

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