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	EXERCISE/WEIGHT CONTROL

Exercise has become an important aspect of the life style of many women. From recreational participants to elite athletes, women are using exercise to control weight, to feel better, and to compete.  How can more exercise help you?

 

Exercise can improve lipid profiles by increasing high-density lipoprotein (HDL) and reducing low-density lipoprotein (LDL), helping to prevent heart disease. Exercise is a major component of "fitness", a broad term that encompasses cardiovascular fitness, endurance, and weight control.  Cardiovascular fitness occurs when the body increases its aerobic capacity by increasing oxygen storage capacity at the cellular level. A major byproduct of the increase in aerobic capacity is the ability to prolong the capacity for physical activity, resulting in more energy.

 

An exercise program is helpful for women who wish to lose or maintain weight.  A weight control program that combines diet and exercise is more effective and longer lasting than either program alone.  Once a desired weight has been achieved, exercise can help to maintain it. In addition, exercise can increase muscle strength, flexibility, and coordination.

 

An active fitness program that includes weight bearing exercise can also increase bone density, an important factor in preventing osteoporosis.

 

WHAT IS CARDIOVASCULAR FITNESS?

 

Oxygen storage capacity increases with the duration of exercise. This response is usually referred to by the patient as "conditioning".  In the laboratory, this response is called aerobic capacity and is measured by determining maximum oxygen uptake (VO2 max).  Measurement of the heart rate during exercise is an excellent method by which to evaluate cardiovascular fitness and estimate the VO2 max.  As conditioning (i.e. cardiovascular fitness) improves, the heart rate will stabilize at a fixed rate of exercise.  It is possible to establish the heart rate at which conditioning will develop by using the following formula to determine the target range: (220 - age) x 60-80% = target range.  For example, a 45 year old patient would have a target range of 105-140 (220-45 =175 x 0.6-0.8).  During her exercise program, she would need to maintain her heart rate within these parameters to achieve fitness levels.
 

To attain cardiovascular fitness, you must exercise at a level that elevates your heart rate into a target range, based on your age, for 20 or more minutes, at least three times a week. A gradual "warm up period" of approximately 5 minutes should precede exercise at the target heart rate.  By slowly increasing activity, there is a more uniform supply of blood to large muscle groups, which helps prevent muscle injury. Likewise, slowly decreasing activity in a "cool-down period" allows the large quantity of blood in the skin and muscles to return to the central vasculature, thus help to prevent dizziness, nausea, and fainting as the heart rate returns to normal.

 

WEIGHT CONTROL

Weight loss from exercise is based on the premise that more calories are used than ingested, and the resulting deficit is met by modifying fat stores.  Thus, for any exercise program designed for weight control to be effective, a negative caloric balance must be achieved (i.e. caloric intake must be less than calories expended).

Since each pound of body fat contains 3,500 kcal, if you use 500 kcal/d exercising and do not increase your caloric intake, you will lose 1 lb/week. Thus, weight loss will take time, but it will come off!  Furthermore, as you exercise, you will gain muscle, and muscle per unit volume is approximately twice as heavy as fat.  Therefore, you may be losing fat without losing weight.  You need to be aware of these facts when entering a weight loss program so that you do not soon become discouraged and quit. The good news is however that you will notice your clothes starting to bag, your posture will improve, and energy level will increase.  You may also notice a beneficial effect on your stress level, PMS, depression, and sleep (increased endorphins - brain chemicals).  We will help you by evaluating your weight on a regular basis, which also provides an opportunity to review the level of activity of your exercise program.  We also have nutritional counseling available. 

 

DEVELOPING A PROGRAM

 

An exercise program can be designed to fit your needs.  First we need to identify your goals.  Do you want to lose weight, lose inches, maintain your weight, gain weight, etc.?  We can set up a time to talk this over.  If you are over 45 and have never exercised, a lipid profile and EKG would be reasonable as a baseline.  Warning signs of overexertion at any age group include sudden sharp pain, excessive fatigue, difficulty breathing, persistent lethargy, nausea, vomiting, faintness, dizziness, excessive muscle soreness or pain, or heart beat irregularities. If any of those signs occur, please contact your physician.

 

Activities that are especially helpful include those that promote aerobic endurance. Jogging, running, Zumba, bicycling, brisk walking, cross- country skiing, swimming, kick-boxing, and aerobic dancing are all examples.  Other sports such as racquetball, tennis, and volleyball are also beneficial if they require continuous activity for greater than 20 minutes, and do not have significant rest periods.  Aerobic dance classes should be of the low impact type for beginners and patients who may need to avoid muscle, ligament, and bone injury.  Indoor exercise machines are good sources of physical activity.  You might want to consider investing in one.  To avoid boredom, watching TV, listening to an IPOD, or reading may be helpful while using the machines.  Strength training may be added to cardiovascular workouts.  Many city parks and recreation areas have circuit training programs which consist of running, climbing, pulling, pushing, and jumping. For example, there is one at Thornden Park in the City of Syracuse.  If strength alone is the goal, then a weight training program should be developed.  Many gyms have exercise trainers who can help you devise a program.

 

NUTRITION AND WEIGHT CONTROL

 

While your motivation to better nutrition and weight control may be to improve your appearance, we also encourage you to consider the health benefits.   All evidence indicates that diet influences the risk of several major chronic diseases, especially atherosclerotic cardiovascular diseases ("hardening of the arteries") and hypertension (high blood pressure). The evidence is highly suggestive for many forms of cancer especially breast, uterine, and colon.  Other health problems influenced by diet include dental caries, chronic liver disease,  gall bladder disease and stones, diabetes mellitus, sleep apnea with fatigue, osteoarthritis, and of course, obesity.

A high fat intake is associated with atherosclerotic cardiovascular disease and certain cancers.  Saturated fatty acid intake is the major determinant of the serum total cholesterol and LDL cholesterol levels. The substitution of polyunsaturated and monounsaturated fatty acids results in lowering of total cholesterol and LDL cholesterol.  Diets high in plant foods (fruits, vegetables, legumes, and whole-grain cereals) are associated with a lower occurrence of coronary heart disease (CHD) and cancers of the lung, colon, esophagus, and stomach. There is evidence that daily multiple vitamin-mineral supplements are beneficial in preventing heart disease.  Try our "Vitarays"-wholesome unisex multivitamins.

 

Please answer the following questions:

 

1) How do you feel about your present weight?

2) Please describe your eating habits on the attached 24 hour diet recall history

3) Please describe in several sentences what your weight history has been, diets you have been on, and any other procedures or medications for weight control. 

You may need to see a nutritional counselor. In addition, please read the following recommendations from the committee on diet and health of the National Research Council.

•  Total fat intake should be reduced to 30% of calories or less.  Saturated fatty acid intake should be less than 10% of calories, and the intake of cholesterol should be less than 300 mg daily.

•  Every day, five or more servings should be eaten of a combination of vegetables and fruits, especially green and yellow vegetables, and citrus fruits. The daily intake of complex carbohydrates should be increased by eating a combination of whole grain breads, cereals, and legumes.  Avoid white flour baked goods, potatoes, desserts, too much pasta, candy, etc.  Do not go to fast food restaurants as one McDonald's burger contains your entire fat for the day.

• Protein intake should be maintained at moderate levels. We will calculate the level for you.

• Alcoholic beverages should be limited to no more than 1 drink of alcohol per day.  Try a half a glass of white wine with seltzer-spritzer to save calories.  Drink only lite beer and sugarless drinks.

• Total daily intake of salt should be limited to 6 g or less unless you have high blood pressure in which case you should be on less than 2g/day (this refers to sodium in food). Most processed foods and canned foods contain preservatives like MSG. We prefer you not eat these types of foods. Whole foods and fresh foods are much healthier. If you salt your food use “real salt” – it contains minerals. Table salt has been bleached to make it white and this salt is not as healthy as “real salt”.

• Vitamin-mineral supplement intake should not exceed the recommended dietary intake per day.

If you have problems with eating disorders, malnutrition, or medical diseases, these may require special dietary adjustments. You will be referred to a nutritionist for this.