Question: Do women obtain the same benefits from exercise as men?

Answer:

While many studies showing the positive effects of exercise have been done with men, studies that have included women indicate that women may benefit even more than men from being physically fit. Early indications show the reduced rates of death by heart disease are higher for women who are physically fit than for men. Thus, exercise for women is very beneficial and at least of the same value and benefit. Also, women that do not exercise are at double the risk of dying from heart disease than women who do exercise, just as women who smoke are at double risk of dying from heart disease than women who don’t smoke. While women may live longer than men, they don’t necessarily live better. Research studies also indicate that elderly women who have been physically inactive experience more disability in their daily function than women who have been active.

The majority of women in sport derive significant health and social benefits from a wide variety of intense exercises and being on a sports or athletic team. However, everyday thousands of women may be at risk of significant harm from their participation in sport. Girls and women who may consider themselves at peak health may, in fact, be in danger of severe injury, illness, and even death. The cause of this risk is the Female Athlete Triad.

First described in the early 1990’s, the female athlete triad refers to disordered eating, amenorrhea, and osteoporosis. No one currently knows how commonly the triad occurs, but there is concern that it may go largely unrecognized by female athletes, coaches, trainers, and health care professionals. The major concern is that in addition to affecting current performance, ones health could be severely affected in the long term.

The components of the Female Athlete Triad are:

1. Disordered eating – the precipitating event for the triad. Rather than restrict this description to a narrower focus of “eating disorders”, the term, “disordered eating” refers to a broader array of abnormal eating behavior. At the severe end of the spectrum are those athletes who fulfill the diagnostic criteria for anorexia nervosa or bulimia nervosa. At the other end are those who may inadvertently be taking in fewer calories than they need. They may appear to be eating a healthy diet, which may be adequate for a sedentary individual, but for a female athlete is calorie restrictive. Regardless of how disordered eating develops it is thought that the mismatch between food intake and energy expenditure creates an “energy drain” on the endocrine system, which in turn leads to the second and third parts of the triad.

2. Amenorrhea – cessation of menstruation (periods) for 3 or more consecutive cycles. It is the result of inadequate estrogen production by the ovaries. Although some athletes may not be bothered by the absence of periods, such is an easily recognizable warning sign that something is not right. There are many causes of amenorrhea, including pregnancy thus, an athlete should seek qualified medical care. Once amenorrhea develops the athlete should not ignore it or attempt to minimize its significance.

3. Osteoporosis, the final part of the triad, is a consequence of inadequate estrogen. It is well documented that inadequate estrogen is not good for bones. In one of the original descriptions of the triad osteoporosis was termed, “premature bone loss or inadequate bone formation”. Although this is different from the World Health Organization’s more strict definition of osteoporosis, failure to build bone at a normal rate or losing bone density at a young age is not healthy. This can lead to short and/or long-term problems. In the immediate time horizon, poor bone formation spells trouble for an athlete in the form of stress fractures. Also, during young adult years, a woman reaches maximum bone mineral density and after age 30 can expect to lose an average of 0.5% of bone density per year. This rate that accelerates to 2% after menopause. Consequently, it is vital to maximize bone density when younger. There is concern that the female athlete triad poses significant risk of osteoporosis later in life.

While any one component of the Triad is harmful by itself, together they can cause a decrease in performance, medical and psychological harm, mental duress, and in severe cases, death. As a female athlete, coach, trainer, parent, administrator, or team physician, it is your responsibility to know about the Triad, how to recognize it, its causes, how to prevent it from occurring, and what to do if it occurs.

Causes of the Female Athlete Triad:

The causes of disordered eating can be very complex. External and internal pressures to be thin, i.e., body image, may cause the Triad to develop in an athlete. Unwittingly, coaches, fellow athletes, trainers, and many others may encourage athletes to be thin because they believe this will enhance performance or appearance. Nothing could do greater harm to an athlete who is susceptible to disordered eating.

The many pressures to win, both internal and external, also may be a cause of the Triad. Undue pressure or control can cause athletes to feel they lack self control over their lives and sports. Thus, to gain perceived control over some aspect of their lives, athletes may turn to excessive exercise and controlling food intake, usually in the form of restricting it to lower than required amounts.

The primary cause of the amenorrhea component of the Triad is an energy imbalance brought on when athletes fail to eat enough to replenish the energy they expend in training. This energy imbalance, which is due to both under eating and intense workouts, negatively affects the body’s regulatory systems, which leads to both amenorrhea and osteoporosis. Examples include:

• Although any athlete may suffer from the Triad, those who participate in sports that place a premium on appearance or thinness are especially susceptible, including the following: Sports where athletes wear skimpy or revealing clothing (swimming, track & field, volleyball, diving, cross-country skiing, track and field, cheer leading).
• Sports where a pre-pubescent body is emphasized (diving, gymnastics, figure skating).
• Sports in which performance is subjectively judged (dance, diving, gymnastics, figure skating, Pro Fitness, aerobics).
• Sports with weight categories (judo, wrestling, weightlifting, rowing, martial arts).
• Endurance sports (cycling, cross-country skiing, marathons).

The main group at risk of suffering symptoms of the female athlete triad are young and older teen athletes in these sports learning to cope with peer pressure, biological changes, fame due to thinness, i.e., spectator glorification, and focus on body image that occur during puberty.

The analysis was part of the National Institute of Child Health and Human Development (NICHD) Women’s Contraceptive and Reproductive Experiences Study.

“It is reassuring that breast cancer risk begins to return to normal six months after women stop combined dose estrogen-progestin therapy,” said Director of the NICHD. “Women, in consultation with their physicians, need to make the most informed decision possible.”

This was the first large clinical trial to assess the risks and benefits of continuous combined hormone therapy. In this form of therapy, women take a combination of the hormones estrogen and progestin. Essentially, the hormone estrogen relieves such symptoms of menopause as hot flashes, night sweats, sleeplessness, and vaginal dryness. When taken alone estrogen also increases a woman’s risk for cancer of the uterine lining, or endometrium. Combining estrogen with progestin virtually eliminates the risk of endometrial cancer.

During the study, women used continuous combined hormone therapy and researchers monitored their health. When it became clear that the women were developing breast cancer at higher than normal rates, the researchers ceased the study immediately. Because of this, researchers were unable to tell yet whether the women in the study face any increased risk of breast cancer now that they stopped taking the hormones.

In contrast, researchers for the NICHD study began by questioning women who had been diagnosed with breast cancer about their hormone use and other potential risk factors for breast cancer. These women were then compared to a similar group of women who had not developed breast cancer. The data suggests a positive association between continuous combined HRT and breast cancer risk among current, longer term users and that Progestin administered in an uninterrupted regimen may be a contributing factor.

A total of 3823 postmenopausal white and black women were analyzed for the study. In all, the medical histories of 1870 women who had developed breast cancer were compared to the histories of 1953 women who did not have breast cancer.

The researchers found that women on continuous combined therapy for 5 years or more were 1.5 times more likely to developing breast cancer than other women their age not on this form of therapy. The risk of breast cancer increased the longer the women used this form of therapy. However, six months after the women discontinued the combined therapy; their risk of breast cancer began to return to normal. This held true for women who took the hormones for 5 years or longer before stopping, as well as for women who took the hormones for only about 6 months. The NICHD study also included former users, and our data indicate that the increased risk associated with use of continuous combined hormone therapy began returning to normal about 6 months after the women stopped using them.

Estrogen alone may be prescribed to women whose uterus has been surgically removed, as these women no longer have a risk of endometrial cancer. The NICHD study did not find any additional risk of breast cancer in women who took estrogen alone. A recent study by the NCI found, however, that women taking estrogen alone may be at increased risk for cancer of the ovary.

Question: I am a senior citizen. Is it too late for me to become physically active? And, should I take special precautions?

Answer:
Research studies indicate frequently that seniors are not too old to exercise. In fact, the older you are, the more you need regular exercise. However, if you have been inactive, there are a few precautions you should take. These include:

1) If you have a family history of heart disease or, even if you do not, check with your physician first and begin very gradually.

2) Exercise at an intensity level appropriate for your endurance level. This may include only a short walk, sit up, or push up each day until fitness level increases.

3) Choose activities that are fun, suit your needs, and that you can perform year-round.

4) Choose a location with a smooth, yet soft surface.

5) Take additional time to warm-up and warm-down before and after each workout.

6) Stretch slowly.

7) Drink water on a frequent schedule, i.e., sip water every 10 to 20 minutes, perhaps more frequently on hot days. Do not rely on your sense of thirst for water consumption.

Nonsmokers who were overweight, but not obese, lost an average of three years off their lives. Those who were obese died even sooner. Obese female nonsmokers lost an average 7.1 years, while men lost 5.8 years. Although similar studies have shown the same trends and it has been widely know among scientists, few large-scale studies have been able to pinpoint how many years are lost due to obesity.

The tragedy is that even if you are overweight in your mid 30s to 40s and then, lose the weight, you still have a higher risk of death. Consequently, if you want to reduce this risk, you must work early on your weight to maintain a healthier lifestyle because if you wait a long time, the damage may have already been done.

The results of the study showed that for smokers, the results were even worse. Obese female smokers died 7.2 years sooner than normal-weight smokers, and 13.3 years sooner than normal-weight nonsmoking women. Obese male smokers lived 6.7 years less than slim smokers, and 13.7 years less than normal-weight nonsmokers.

The results were gathered and analyzed by researchers at Erasmus Medical Center and the University of Gronigen in the Netherlands from vital statistics of 3,457 volunteers in Framingham, MA.

Obesity is defined as having a body-mass index of 30 or above. The index is a measure of weight relative to height. Healthy weight in relation to BMI is considered less than 25.

About 66% of U.S. adults are overweight or obese, according to the Centers for Disease Control and Prevention. Studies have also shown that people are becoming obese at a younger age. This corresponds to a rise in sugar intake per capita since 1930. Although this has not been proven, the trend in obesity follows the trend in the U.S. in sugar consumption during the last 70 years. In 1930, the average per capita sugar consumption was 20 pounds; it is now 150 pounds and climbing.

Thus, while smoking is on the decline, sugar consumption and increasing obesity of the population, especially in young adults, creates a new fear, which heralds another potentially preventable public health disaster.

Recent research studied 60 freshmen undergraduate students who had been vaccinated against meningitis C between 1-16 months before they were enrolled in the study. Based on blood samples, nearly three quarters (73%) of the students had a protective level of antibodies to the disease, while the remaining students had fewer antibodies against the pathogen.

The perception of high stress appears to be more important than whether or not you have actually experienced highly stressful events, the report suggests.

Students who experienced a traumatic or very stressful event such as the death of a loved one were no more likely than other students to exhibit a lessened immune response. But, those who reported high levels of perceived stress were five times more likely to have fewer antibodies, even among students who said they had not actually experienced many highly stressful events. Eight of 10 students in the study reported experiencing only low levels of stressful events. These students had a low level of antibodies in comparison to 65% of students who perceived their life as stressful and had gone through highly stressful events.

It appears to be the perception of stress and poor psychological well-being, rather than the actual stressful events that you experience, which appears to be detrimental to your antibody status following a vaccination. These are your typical stressed-out people and they may be the most likely to have physiological and psychological responses to stress.

Additionally, students who had high levels of psychological stress had a 4x increased risk of having lower antibody levels. This increased risk was especially true for students who were identified as high in anxiety, insomnia, and social dysfunction.

These results indicate that people who are vaccinated during periods of high stress, such as students during final examinations or soldiers about to be sent off to war, should be re-evaluated. This should be done to ensure they have the appropriate level of antibodies in their blood against the diseases they are immunized against. This also would be better than the current medical practice just “jab them and assume they’re okay.”