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Physical activity is an essential factor in bone health. The skeletal benefits
of exercise have been demonstrated throughout the life cycle. Exercise can positively
affect peak bone mass in children and adolescents; has been shown to help maintain
or even modestly increase bone density in adulthood and; can assist in minimizing
age related bone loss in older adults.
By age 18, skeletal growth is nearly complete. The amount of peak bone mass
achieved and the subsequent rate of bone loss are the key determinants of bone
density later in life. There is substantial evidence that exercise plays an
important role in the acquisition of bone mass in youth. Activities that are
high impact and weight-bearing, such as running, jumping, soccer and volleyball,
appear to be the most beneficial to the skeleton. The gains of such weight-bearing
activity seem to be more pronounced in the peripheral skeleton than in the
Muscle strengthening can also yield a bone-building effect. Even muscle activity
in areas distant from the spine and hip can positively impact bone density
at these sites. Not all physically active youth reap the skeletal benefits
of exercise. Girls and young women who experience a disruption in the menstrual
cycle from excessive exercise can endure bone loss that is never fully recovered
(it is estimated that the prevalence of amenorrhea in female athletes ranges
from 10-45 percent.) There is much concern that these young women are at an
increased risk of stress fractures and fractures of the hip and spine.
Clearly, several factors other than exercise can affect peak bone mass. Hormonal
status, body composition, nutritional intake and medication use are also important
predictors of bone density.
While 97% of bone mass is probably achieved by the age of eighteen, increases
in bone density have been observed throughout the third decade of life. In
some cases, even moderate increases in physical activity of women in their
twenties can increase bone density and, potentially, decrease long-term fracture
Most studies of pre-menopausal women demonstrate a positive bone benefit from
exercise, with greater loading and higher impact activities producing the greatest
skeletal benefit. The effects of physical activity tend to be the most pronounced
among individuals who are the least active, an observation that has been made
in other age groups, as well.
Exercise continues to confer a skeletal benefit for many postmenopausal women.
However, there is no evidence that physical activity alone is sufficient to
fully offset the damaging effects of estrogen withdrawal in the first three
to five years following menopause. Once the phase of accelerated bone loss
is complete, regular exercise can have a protective effect on bone. As with
other age groups, active postmenopausal women tend to have greater bone density
than sedentary postmenopausal women.
Due to musculoskeletal concerns, older women are less likely to participate
in higher impact activities. Regular activity such as walking, weight training
and low impact aerobics can safely help to offset age-related bone loss, decrease
fracture risk and improve the quality of life for older women.
Skeletal muscle mass and strength also decrease with age. Increased muscle
weakness can compound the problem of low bone density by increasing the risk
of falls and fracture. A multi-center study funded by the National Institute
on Aging has evaluated the effects of intervention programs designed to minimize
fracture risk in the elderly. The FICSIT trials (Frailty and Injuries: Cooperative
Studies of Intervention Techniques) evaluated the effects of various physical
activities in reducing the risk of falls. Strategies such as resistance training,
computerized balance training and Tai Chi have shown promise as effective interventions
for reducing falls and fall-related fractures.
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Are you exercising too much? Eating too little? Have your periods become irregular
or stopped? If so, you may be putting yourself at high risk for several serious
health problems that could affect your health, your ability to remain active,
and your risk for injuries. You also may be putting yourself at risk for developing
osteoporosis, a disease in which bone density is decreased, leaving your bones
vulnerable to fracture (breaking).
Some athletes see amenorrhea (the absence of menstrual periods) as a sign
of appropriate levels of training. Others see it as a great answer to a monthly
inconvenience. And some young women accept it blindly, not stopping to think
of the consequences. But missing your menstrual periods is often a sign of
decreased estrogen levels. And lower estrogen levels can lead to osteoporosis,
a disease in which your bones become brittle and more likely to break.
Usually, bones become brittle and break when women are much older, but some
young women, especially those who exercise so much that their periods stop,
develop brittle bones and may start to have fractures at a very early age.
Some 20-year-old female athletes have been described as "having the bones of
an 80-year-old woman." Even if bones don't break when you're young, low estrogen
levels during the peak years of bone-building, the pre-teen and teen years,
can affect bone density for the rest of your life. And studies show that bone
growth lost during these years may not ever be regained.
Broken bones don't just hurt--they can cause lasting deformities. Have you
noticed that some older women and men have a stooped posture? This is not a
normal sign of aging. Fractures from osteoporosis have left their spines permanently
By the way, missing periods isn't the only problem. Not eating adequate amounts
of calcium and vitamin D (among other nutrients) can also cause bone loss,
and may lead to decreased athletic performance, decreased ability to exercise
or train at desired levels of intensity or duration, and increased risk of
Girls and women who may be trying to lose weight by restricting their eating
and/or engaging in rigorous exercise regimes are at risk for these health problems.
This may include serious athletes, "gym rats" (who spend considerable amounts
of time and energy working out), and/or girls and women who believe "you can
never be too thin."
Here are some signs to look for:
||missed or irregular menstrual periods
||extreme and/or "unhealthy-looking" thinness
||extreme or rapid weight loss
||frequent dieting behaviors such as:
||eating very little
||not eating in front of others
||trips to the bathroom following meals
||preoccupation with thinness or weight
||focus on low-calorie and diet foods
||possible increase in the consumption of water and other no- and low-calorie
foods and beverages (possible increase in gum chewing, as well)
||limiting diet to one food group or eliminating a food group
||frequent intense bouts of exercise such as:
||continuous exercise or training sessions (e.g., taking an aerobics
class, then running five miles, then swimming for an hour, followed by
||an "I can't miss a day of exercise/practice" attitude
||an overly anxious preoccupation with an injury
||exercising in spite of conditions that might lead others to "take the
day off," including illness, inclement weather, injury, etc.
||high levels of self-criticism and/or self-dissatisfaction
||high levels of psychological or physical stress, such as:
||anxiety or nervousness
||inability to concentrate
||low levels of self-esteem
||feeling cold all the time
||talking about weight constantly
If you recognize some of these signs in yourself, the best thing you can do
is to begin eating a more healthful diet, including enough calories to support
your activity level. It's best to check with a doctor to make sure your missed
periods aren't a sign of some other problem, and to get his or her help as
you work toward a more healthy balance of food and exercise. Also, a doctor
can help you take steps to protect your bones from further damage.
First, be supportive. Approach your friend or teammate carefully and sensitively.
She probably won't appreciate a lecture about how she should be taking better
care of herself. But maybe you could share a copy of this brochure with her,
or suggest that she talk to a trainer, coach, or doctor about the symptoms
Often, girls and women who may be dieting will drink diet sodas rather than
much-needed milk. (Milk and other dairy products are a good source of calcium,
an essential ingredient for healthy bones.) Drinking sodas instead of milk
can be a problem, especially during the teen years when peak bone growth occurs.
If you (or your friend) find yourself addicted to sodas, try drinking half
as many sodas each day, and gradually add more milk and dairy products to your
diet. A frozen yogurt shake can be an occasional low fat, tasty treat. Or try
a fruit smoothie made with frozen yogurt, fruit, and/or calcium-enriched orange
For Fitness Instructors and Trainers:
It's important for you to be aware of problems associated with
bone loss in today's active young women. As an instructor or trainer,
you are the one who sees, leads, and perhaps even evaluates the
training sessions and performances of your clients. You may know
best when something seems to be amiss. You also may be best for
the role of helping a zealous female exerciser, who may be putting
herself at risk for bone loss and other health problems, to recognize
the risks of her behaviors and to help her establish new goals.
Trainers and instructors should also be aware of the implicit
or explicit messages they send to their clients. An emphasis on
health, strength, and fitness should be stressed, rather than an
emphasis on thinness. Use caution when advising female clients
to lose weight, and if such a recommendation is deemed necessary,
education and assistance regarding proper, safe weight management
should be offered by knowledgeable personnel. As an instructor
or trainer, it's best to maintain a professional rapport with your
clients, so they can feel comfortable approaching you with concerns
about their exercise training programs, appropriate exercise goals
and time lines, body image and nutrition issues, as well as more
personal problems regarding eating practices and menstruation.
Years ago, it was not unusual for coaches to encourage athletes to be as thin
as possible for many sports (dancing, gymnastics, figure skating, swimming,
diving, running, etc.). However, many coaches are realizing that being too
thin is unhealthy and can negatively affect performance. It is important to
exercise and watch what you eat. However, it's also important to develop and
maintain healthy bones and bodies. Without these, it will not matter how fast
you can run, how thin you are, or how long you exercise each day. Balance is
Brittle bones may not sound as scary as some other fatal or rare disease.
The fact is, osteoporosis can be very painful. It can cause disability. Imagine
having so many spine fractures that you've lost inches in height and walk bent
over. Imagine looking down at the ground everywhere you go because you can't
straighten your back. Imagine not being able to find clothes that fit you.
Imagine having difficulty breathing and eating because your lungs and stomach
are compressed into a smaller space. Imagine having difficulty walking, let
alone exercising, because of pain and deformity. Imagine constantly having
to be aware of what you are doing and having to do things so slowly and carefully
because of a very real fear and dread of a fracture...a fracture that could
lead to a drastic change in your life - including pain, loss of independence,
loss of mobility, loss of freedom and more.
But osteoporosis isn't just an "older person's" disease. Young women also
experience fractures. Imagine being sidelined because of a broken bone and
not being able to get those good feelings you get from regular activity.
It is very important to your bone health that you receive adequate daily amounts
of calcium, vitamin D, phosphorus, and magnesium. These are the vitamins and
minerals that are most influential in building bones and teeth. This chart
will help you decide how much calcium you need.
|Recommended Calcium Intakes (mg/day)
|Source: National Academy of Sciences,
Dairy products are the primary food sources of calcium. Choose milk, yogurt,
cheeses, ice cream, or products made or served with these choices to fulfill
your daily requirement. Three servings of dairy products per day should give
you at least 900 milligrams of calcium. Green vegetables are another source.
A cup of broccoli, for example, has about 136 milligrams of calcium. Sunlight
is one important source of vitamin D, but when the sun isn't shining, milk
is also a good source of vitamin D.
There are many great snack and meal items that contain calcium. With a little
planning and "know how," you can make meals and snacks calcium-rich!
Wouldn't a tall, cold glass of this refreshing thirst quencher
be great right now? If you're concerned about fat and calories,
you can drink 1% or skim milk. You can drink it plain, or with
a low/no-fat syrup or flavoring, such as chocolate syrup, vanilla
extract, hazelnut flavoring, cinnamon, etc.
||Cheese is another winner...
Again, you can choose the low/no fat varieties. Use all different
types of cheese for sandwiches, bagels, omelets, vegetable dishes,
pasta creations...or as a snack by itself!
||Puddings (prepared with milk)...
You can now purchase (or make your own from a mix) a variety of
flavors with little or no fat. Rocky road, butterscotch, vanilla,
chocolate, pistachio....Try them all!
Add fruit. Eat it plain. Add a low/no fat sauce or syrup. No matter
how you choose to eat this calcium-rich food, it remains a quick,
easy, and convenient choice. It's also available in a variety
of flavors. Try mocha-fudge-peppermint-swirl for the more adventurous
at heart, and vanilla for the more traditional yogurt snacker!
||Frozen yogurt (or fat free ice cream)...
Everybody loves ice cream...And now, without the unnecessary fat
grams, you can enjoy it more often! Mix yogurt, milk, and fruit
to create a breakfast shake. Have a cone at lunchtime or as a
snack. A scoop or two after dinner can be cool and refreshing.
Many foods you already buy and eat may be "calcium-fortified". Try calcium-fortified
orange juice or calcium-fortified cereal. Check food labels to see if
some of your other favorite foods may be good sources of calcium. By
the way, you can also take calcium supplements if you think you may not
be getting enough from your diet.
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This booklet answers general questions about arthritis and exercise.
The amount and form of exercise recommended for each individual will
vary depending on which joints are involved, the amount of inflammation,
how stable the joints are, and whether a joint replacement procedure
has been done. A skilled physician who is knowledgeable about the medical
and rehabilitation needs of people with arthritis, working with a physical
therapist also familiar with the needs of people with arthritis, can
design an exercise plan for each patient.
There are over 100 forms of arthritis and other rheumatic diseases.
These diseases may cause pain, stiffness, and swelling in joints and
other supporting structures of the body such as muscles, tendons, ligaments,
and bones. Some forms can also affect other parts of the body, including
various internal organs.
Many people use the word "arthritis" to refer to all rheumatic diseases.
However, the word literally means joint inflammation; that is, swelling,
redness, heat, and pain caused by tissue injury or disease in the joint.
The many different kinds of arthritis comprise just a portion of the
rheumatic diseases. Some rheumatic diseases are described as connective
tissue diseases because they affect the body's connective tissue--the
supporting framework of the body and its internal organs. Others are
known as autoimmune diseases because they are caused by a problem in
which the immune system harms the body's own healthy tissues. Examples
of some rheumatic diseases are:
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Juvenile rheumatoid arthritis
- Ankylosing spondylitis
Yes. Studies have shown that exercise helps people with arthritis in
many ways. Exercise reduces joint pain and stiffness and increases flexibility,
muscle strength, cardiac fitness, and endurance. It also helps with weight
reduction and contributes to an improved sense of well-being.
Exercise is one part of a comprehensive arthritis treatment plan. Treatment
plans also may include rest and relaxation, proper diet, medication,
and instruction about proper use of joints and ways to conserve energy
(that is, not waste motion) as well as the use of pain relief methods.
Three types of exercise are best for people with arthritis:
- Range-of-motion exercises (e.g., dance) help maintain normal joint
movement and relieve stiffness. This type of exercise helps maintain or increase
- Strengthening exercises (e.g., weight training) help keep or increase
muscle strength. Strong muscles help support and protect joints affected by
- Aerobic or endurance exercises (e.g., bicycle riding) improve cardiovascular
fitness, help control weight, and improve overall function. Weight control
can be important to people who have arthritis because extra weight puts extra
pressure on many joints. Some studies show that aerobic exercise can reduce
inflammation in some joints.
Most health clubs and community centers offer exercise programs for
people with physical limitations.
People with arthritis should discuss exercise options with their doctors
and other health care providers. Most doctors recommend exercise for
their patients. Many people with arthritis begin with easy, range-of-motion
exercises and low-impact aerobics. People with arthritis can participate
in a variety of, but not all, sports and exercise programs. The doctor
will know which, if any, sports are off-limits.
The doctor may have suggestions about how to get started or may refer
the patient to a physical therapist. It is best to find a physical therapist
who has experience working with people who have arthritis. The therapist
will design an appropriate home exercise program and teach clients about
pain-relief methods, proper body mechanics (placement of the body for
a given task, such as lifting a heavy box), joint protection, and conserving
Step Up to Exercise: How To Get Started
- Discuss exercise plans with your doctor.
- Start with supervision from a physical therapist or qualified athletic
- Apply heat to sore joints (optional; many people with arthritis
start their exercise program this way).
- Stretch and warm up with range-of-motion exercises.
- Start strengthening exercises slowly with small weights (a 1- or
2-pound weight can make a big difference).
- Progress slowly.
- Use cold packs after exercising (optional; many people with arthritis
complete their exercise routine this way).
- Add aerobic exercise.
- Consider appropriate recreational exercise (after doing range-of-motion,
strengthening, and aerobic exercise). Fewer injuries to joints affected
by arthritis occur during recreational exercise if it is preceded
by range-of-motion, strengthening, and aerobic exercise that gets
your body in the best condition possible.
- Ease off if joints become painful, inflamed, or red, and work with
your doctor to find the cause and eliminate it.
- Choose the exercise program you enjoy most and make it a habit.
There are known methods to help stop pain for short periods of time.
This temporary relief can make it easier for people who have arthritis
to exercise. The doctor or physical therapist can suggest a method that
is best for each patient. The following methods have worked for many
- Moist heat supplied by warm towels, hot packs, a bath, or a shower
can be used at home for 15 to 20 minutes three times a day to relieve symptoms.
A health professional can use short waves, microwaves, and ultrasound to deliver
deep heat to noninflamed joint areas. Deep heat is not recommended for patients
with acutely inflamed joints. Deep heat is often used around the shoulder
to relax tight tendons prior to stretching exercises.
- Cold supplied by a bag of ice or frozen vegetables wrapped in a towel
helps to stop pain and reduce swelling when used for 10 to 15 minutes at a
time. It is often used for acutely inflamed joints. People who have Raynaud's
phenomenon should not use this method.
- Hydrotherapy (water therapy) can decrease pain and stiffness. Exercising
in a large pool may be easier because water takes some weight off painful
joints. Community centers, YMCAs, and YWCAs have water exercise classes developed
for people with arthritis. Some patients also find relief from the heat and
movement provided by a whirlpool.
- Mobilization therapies include traction (gentle, steady pulling),
massage, and manipulation (using the hands to restore normal movement to stiff
joints). When done by a trained professional, these methods can help control
pain and increase joint motion and muscle and tendon flexibility.
- TENS (transcutaneous electrical nerve stimulation) and biofeedback
are two additional methods that may provide some pain relief, but many patients
find that they cost too much money and take too much time. In TENS, an electrical
shock is transmitted through electrodes placed on the skin's surface. TENS
machines cost between $80 and $800. The inexpensive units are fine. Patients
can wear them during the day and turn them off and on as needed for pain control.
- Relaxation therapy also helps reduce pain. Patients can learn to
release the tension in their muscles to relieve pain. Physical therapists
may be able to teach relaxation techniques. The Arthritis Foundation has a
self-help course that includes relaxation therapy. Health spas and vacation
resorts sometimes have special relaxation courses.
- Acupuncture is a traditional Chinese method of pain relief. A medically
qualified acupuncturist places needles in certain sites. Researchers believe
that the needles stimulate deep sensory nerves that tell the brain to release
natural painkillers (endorphins). Acupressure is similar to acupuncture,
but pressure is applied to the acupuncture sites instead of using needles.
- Range-of-motion exercises can be done daily and should be done at
least every other day.
- Strengthening exercises should be done every other day unless you
have severe pain or swelling in your joints.
- Endurance exercises should be done for 20 to 30 minutes three times
a week unless you have severe pain or swelling in your joints. According to
the American College of Rheumatology, 20- to 30-minute exercise routines can
be performed in increments of 10 minutes over the course of a day.
This varies depending on personal preference, the type of arthritis
involved, and how active the inflammation is. Strengthening one's muscles
can help take the burden off painful joints. Strength training can be
done with small free weights, exercise machines, isometrics, elastic
bands, and resistive water exercises. Correct positioning is critical,
because if done incorrectly, strengthening exercises can cause muscle
tears, more pain, and more joint swelling.
There are many types of arthritis. Experienced doctors, physical therapists,
and occupational therapists can recommend exercises that are particularly
helpful for a specific type of arthritis. Doctors and therapists also
know specific exercises for particularly painful joints. There may be
exercises that are off-limits for people with a particular type of arthritis
or when joints are swollen and inflamed. People with arthritis should
discuss their exercise plans with a doctor. Doctors who treat people
with arthritis include rheumatologists, orthopaedic surgeons, general
practitioners, family doctors, internists, and rehabilitation specialists
Most experts agree that if exercise causes pain that lasts for more
than 1 hour, it is too strenuous. People with arthritis should work with
their physical therapist or doctor to adjust their exercise program when
they notice any of the following signs of strenuous exercise:
- Unusual or persistent fatigue
- Increased weakness
- Decreased range of motion
- Increased joint swelling
- Continuing pain (pain that lasts more than 1 hour after exercising)
It is appropriate to put joints gently through their full range of motion
once a day, with periods of rest, during acute systemic flares or local
joint flares. Patients can talk to their doctor about how much rest is
best during general or joint flares.
Researchers are looking at the effects of exercise and sports on the
development of musculoskeletal disabilities, including arthritis. They
have found that people who do moderate, regular running have low, if
any, risk of developing osteoarthritis. However, studies show that people
who participate in sports with high-intensity, direct joint impact are
at risk for the disease. Examples are football and soccer. Sports involving
repeated joint impact and twisting (such as baseball and soccer) also
increase osteoarthritis risk. Early diagnosis and effective treatment
of sports injuries and complete rehabilitation should decrease the risk
of osteoarthritis from these injuries.
Researchers also are looking at the effects of muscle strength on the
development of osteoarthritis. Studies show, for example, that strengthening
the quadriceps muscles can reduce knee pain and disability associated
with osteoarthritis. One study shows that a relatively small increase
in strength (20-25 percent) can lead to a 20-30 percent decrease in the
chance of developing knee osteoarthritis. Other researchers continue
to look for and find benefits from exercise to patients with rheumatoid
arthritis, spondyloarthropathies, systemic lupus erythematosus, and fibromyalgia.
They are also studying the benefits of short- and long-term exercise
in older populations.
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Physical activity is any bodily movement produced by skeletal muscles;
such movement results in an expenditure of energy. Physical activity
is a critical component of energy balance, a term used to describe how
weight, diet, and physical activity influence health, including cancer
Researchers have established that regular physical activity can improve
- helping to control weight,
- maintaining healthy bones, muscles and joints,
- reducing the risk of developing high blood pressure and diabetes,
- promoting psychological well-being,
- reducing the risk of death from heart disease, and
- reducing the risk of premature death .
In addition to these health benefits, researchers are learning that
physical activity can also affect the risk of cancer. There is convincing
evidence that physical activity is associated with a reduced risk of
cancers of the colon and breast . Several studies also have reported
links between physical activity and a reduced risk of cancers of the
prostate, lung and lining of the uterus (endometrial cancer). Despite
these health benefits, recent studies have shown that more than 60 percent
of Americans do not engage in enough regular physical activity .
The Centers for Disease Control and Prevention (CDC) recommend that
adults: " engage in moderate-intensity physical activity for at least
30 minutes on five or more days of the week, or " engage in vigorous-intensity
physical activity for at least 20 minutes on three or more days of the
week. Examples of moderate-intensity and vigorous-intensity physical
activities can be found on the CDC Physical Activity Page.
Individuals who are physically active can reduce their risk of developing
colon cancer by 40 percent to 50 percent, with the greatest reduction
in risk among those who are most active. A decreased risk of colon cancer
has been consistently reported for physically active men. Many studies
have reported a reduction in colon cancer risk for physically active
women . The relationship between physical activity and risk in women,
however, has been less consistent . Physical activity most likely influences
the development of colon cancer through multiple, perhaps overlapping,
biological pathways. Many researchers believe physical activity aids
in regular bowel movements, which may decrease the time the colon is
exposed to potential carcinogens . Increased physical activity also causes
changes in insulin resistance, metabolism, and hormone levels, which
may help prevent tumor development . Physical activity has also been
found to alter a number of inflammatory and immune factors, some of which
may influence colon cancer risk.
Physically active women have up to a 40 percent reduced risk of developing
breast cancer . Most evidence suggests that physical activity reduces
breast cancer risk in both premenopausal and postmenopausal women . Although
a lifetime of regular, vigorous activity is thought to be of greatest
benefit, women who occasionally engage in physical activity also experience
a reduced risk compared to inactive women . A number of studies also
suggest that the effect of physical activity may be different across
levels of BMI, with the greatest benefit seen in women in the normal
weight range (generally a BMI under 25 kg/m-squared). For example, a
recent major report from the Women's Health Initiative found that among
postmenopausal women, walking 30 minutes per day was associated with
a 20 percent reduction in breast cancer risk. The health benefits of
physical activity were greatest among women who were of normal weight;
they experienced a 37 percent decrease in risk. The protective effect
of physical activity was not found among overweight or obese women. Researchers
have proposed several biological mechanisms that may explain the relationship
between physical activity and breast cancer development. Physical activity
causes changes in hormone metabolism, body mass, and immune function,
which may prevent tumor development.
Physical activity probably reduces men's risk for prostate cancer by
10 percent to 30 percent. The likely association between physical activity
and prostate cancer is based on a small number of studies that evaluated
the role of physical activity in men who developed prostate cancer. Most
of these studies indicate that inactive men have higher rates of prostate
cancer compared to men who are very physically active . While it is probable
that men who are physically active experience a reduction in risk for
prostate cancer, the potential biological mechanisms that may explain
this association are unknown.
Studies also suggest that women who are physically active have a 30
percent to 40 percent reduced risk of endometrial cancer , with the greatest
reduction in risk among those who are most active. The possible association
between physical activity and endometrial cancer is based on a limited
number of studies, some of which indicate that inactive women have higher
rates of endometrial cancer compared to physically active women. Changes
in body mass and alterations in level and metabolism of sex hormones,
such as estrogen, are the major biological mechanisms thought to explain
the association between physical activity and endometrial cancer. A few
studies have examined whether the effect of physical activity varies
according to the weight of the woman, but the results have been inconsistent.
It is possible that individuals who are physically active have a 30
percent to 40 percent reduced risk of developing lung cancer . The possible
link between physical activity and lung cancer is based on a limited
number of studies that have found higher rates of lung cancer among those
who are physically inactive compared to those who are active, after accounting
for smoking status. The relationship between physical activity and lung
cancer risk is less clear for women than it is for men .
However, the results of many of these studies are difficult to interpret
because smokers who are able to engage in physical activity may have
much better lung function. Investigators hypothesize that improvements
in pulmonary function and ventilation in active, compared to inactive
individuals, may explain the possible association between lung cancer
and reduced physical activity .
NCI-funded studies are exploring the ways in which physical activity
may improve the quality of life of cancer patients and survivors. One
study is examining the feasibility and benefits of a home-based moderate
exercise program among breast cancer survivors (home-based). Another
is testing the effectiveness of a nurse-directed walking exercise program
to mitigate fatigue and maintain physical functioning during treatment
for prostate, breast, or colorectal cancer.
A number of NCI-funded studies are answering questions about the relationship
between physical activity and the risk of developing cancer. For example,
one study is investigating whether women who engage in moderate and strenuous
physical activity have a reduced risk of endometrial and ovarian cancer,
and if strenuous physical activity reduces this risk more than moderate
physical activity. Another is examining the effect of one year of moderate
aerobic and strength training exercise among patients with colorectal
NCI funds a number of research projects and interventions aimed at helping
vulnerable populations reduce their risk for cancer by becoming more
active, changing their nutritional behavior, and/or maintaining an optimal
weight. Populations included in these projects include multiethnic working
poor populations, African-American women, African-American church communities,
rural church communities, overweight women, overweight men, and adolescents.
For example, one study involving rural churches is exploring methods
of helping participants to change their nutrition, activity, and exercise
patterns to meet cancer risk reduction guidelines.
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Being healthy and active can help you stay fit and feel fabulous over
the years. If you are overweight and inactive, you are more likely to
- Type 2 diabetes (high blood sugar)
- High blood pressure
- Heart disease
- Certain forms of cancer.
You can improve your health if you Move More and Eat Better! This
booklet gives you tips on how to get moving and eat well throughout your
Being active and making smart food choices is good for your health.
But that’s not the only reason to move more and eat better. You can:
- Have more energy
- Reduce stress
- Feel better about yourself
- Relieve boredom or depression
- Set an example for your family.
Try to do at least 30 minutes of moderate-intensity physical activity
(like brisk walking) most days of the week. It is not as hard as you
may think, and you do not have to do the whole 30 minutes at on time.
Try these tips to get past things that keep you from being active.
"It's too late for me to get physically active."
It is never too late to start moving more. Physical activity can help
you manage health problems like arthritis, osteoporosis (bone loss),
and heart disease. It may also help:
- Keep your body flexible
- Keep your bones and muscles strong
- Keep your heart and lungs healthy
- Control high blood sugar, especially if you lose weight
- Let you keep living in your own home without help.
TIP: If you are over 50 or have chronic health problems such as heart
disease, high blood pressure, diabetes, osteoporosis, or obesity, talk
to your health care provider before starting a vigorous physical
activity program. You do not need to talk to your provider before starting
less strenuous activity like walking.
"Physical activity is a chore."
Walk or take an exercise class with a friend or a group—that way,
you can cheer each other on, have company, and feel safer when you
Start a small garden in your yard or a community garden.
Break it up into short blocks of time – taking three 10-minute walks
during your day may be easier than taking one 30-minute walk.
Do stretches or walk in place while watching TV.
"its too expensive."
There are lots of ways to be physically active that are free or low-cost.
Find a local park or school track where you can walk.
Walk around a mall.
Join a recreation center or fitness center at work or near your
Be active with your grandchildren —take a walk, toss a softball,
or ride bikes. Physical activity is good for them too.
- Walk your dog. If you do not have a dog, pretend that you do.
You may not know where to start on the road to making healthier food
choices. Try these tips to eat better, save time, and stretch your food
Get started on eating well
These tips can help you have healthy eating habits:
Start every day with breakfast. Try oatmeal, a whole-grain cereal
like raisin bran with nonfat or low-fat milk, whole wheat toast spread
with jam, or nonfat or low-fat yogurt. Enjoy some fruit with your
Try kidney or butter beans in hot dishes, on salads, or plain. Protein
is important to your health as you age. Beans are loaded with protein
and cost less than meat.
Choose nonfat or low-fat milk, yogurt, and cheese instead of full
fat dairy products.
Choose whole-grain foods like whole wheat bread, oatmeal, brown
rice, and whole wheat pasta more often than refined-grain foods,
like white bread, white rice, and white pasta. Whole-grain foods
offer dietary fiber, which helps keep you regular.
Do not let sweets like cookies, candy, or soda crowd out healthy
TIP: If you cannot digest lactose (the sugar found in milk) try nonfat
or low-fat lactose-reduced milk. Or try nonfat or low-fat yogurt or hard
cheeses like cheddar, which may be easier to digest than milk. You can
also get the calcium from calcium-fortified juices, soy-based beverages,
and cereals. Eating dark leafy vegetables like collard greens and kale,
and canned fish with soft bones like salmon, can also help you meet your
body's calcium needs.
Make healthy meals that taste good
You might like the taste of fried foods and fatty meats, but these foods
can put too much saturated fat in your diet if you eat them too often
or in large amounts. Saturated fat is not healthy for your heart. There
are other ways you can add flavor to your food. Try:
Baking, roasting, broiling, grilling, or oven-frying chicken or
fish – season with herbs, spices, lemon, lime, or vinegar (but not
Cooking collard greens or kale with onions, garlic, chicken broth,
bouillon, smoked turkey, turkey bacon, or turkey ham (use broth,
bouillon, and cured meats in small amounts because they are high
Topping baked potatoes with salsa or low-fat sour cream
Making salads and casseroles with low-fat or nonfat salad dressing
or mayonnaise, flavored vinegar like balsamic, or a small amount
of mustard (mustard is high in sodium).
Save time and money when you cook
You do not have to spend a lot of time in the kitchen or a lot of money
to eat well.
Cook enough to last. Casseroles, meat loaf, and whole cooked chicken can
last for several days. (Be sure to freeze or refrigerate leftovers right
away to keep them safe to eat.)
Buy frozen or canned vegetables (no salt added) and canned fruit packed
in juice. They are just as good for you as fresh produce, will not go bad,
and make quick and easy additions to your meals.
- If your local store does not have the foods you want or their prices
are too high, go to another store. Start a weekly shopping carpool, share
the cost of a taxi with friends, or ask a relative or neighbor for a
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Food labels may help you make smart choices. But they can be confusing.
Here are some quick tips for reading food labels:*
Serving Size: All the information on a food label is based on the serving
size. Be careful—one serving may be much smaller than you think. Compare
what you eat to the serving size on the label.
Calories: Most women need to eat almost 1,600 calories per day, with
no more than 30% (about 480 calories) from total fat.**
% Daily Value (%DV): This tells you if a food is high or low in nutrients.
Foods that have more than 20 percent daily value (20% DV) of a nutrient
are high. Foods that have 5 percent daily value (5% DV) or less are low.
Saturated Fat: Saturated fat is not healthy for your
heart. Compare labels on similar foods and try to choose foods with a
5% DV or less for saturated fat.***
Trans Fat: Trans fat is not healthy
for your heart. When reading food labels, add together the grams (g)
of trans fat and saturated fat, and choose foods with the lowest combined
Cholesterol: Too much cholesterol is not healthy for
your heart. Keep your intake of saturated fat, trans fat, and cholesterol
as low as possible.
Sodium: Salt contains sodium. High sodium intake is
linked to higher blood pressure. Foods that contain more than 20% DV
are high in sodium. Look for labels that say “sodium-free” or “low sodium.”
Foods that are low in sodium contain no more than 5% DV for sodium.
TIP: Many food labels say “low-fat,” “reduced fat,” or “light.” That does
not always mean the food is low in calories. Remember, fat free does not
mean calorie free and calories do count!
Fiber: Choose foods that are rich in fiber, such as
whole grains, fruits, and vegetables.
Sugar: Try to choose foods with little or no added
sugar (like low-sugar cereals).
Calcium: Choose foods that are high in calcium. Foods
that are high in calcium have at least 20% DV.
* For more information on reading nutrition labels, see Using the
Dietary Guidelines for Americans, available from the Federal Consumer
Information Center, 1-888-878-3256 or read Guidance on How to Understand
and Use the Nutrition Facts Panel on Food Labels from the Food and
Drug Administration (FDA) at www.cfsan.fda.gov/~dms/foodlab.html.
** From Dietary Guidelines for Americans, 2000, U.S. Department
of Agriculture and U.S. Department of Health and Human Services. If you
need a special diet, check with your health care provider before following
Many people think that bigger is better. We are so used to value-sized
portions—especially in restaurants—that it is easy to eat more than our
bodies need. Eating smaller portions will help you cut down on calories
and fat (and might save money, too). Here is a 1,600 calorie sample menu
with sensible portion sizes:*
Breakfast 1/2 cup oatmeal 1 English muffin with 1 tablespoon low-fat
cream cheese 1 cup low-fat milk 3/4 cup orange juice
Lunch 2 ounces baked chicken without skin (a little smaller than a deck
of cards) Lettuce, tomato, and cucumber salad with 2 teaspoons oil and
vinegar dressing 1/2 cup rice seasoned with 1/2 teaspoon tub or liquid
margarine 1 small whole wheat roll with 1 teaspoon margarine
TIP: Try keeping a food diary. Writing down what you eat, when you eat,
and how you feel when you eat can help you understand your eating habits.
You may be able to see ways to make your eating habits healthier. You can
also use your diary to plan weekly menus, make shopping lists, and keep track
of recipes you would like to try. For more information about keeping track
of food portions, read WIN’s brochure, Just Enough for You.
Dinner 3 ounces lean roast beef (about the size of a deck of cards)
with 1 tablespoon beef gravy 1/2 cup turnip greens seasoned with 1/2
teaspoon margarine 1 small baked sweet potato with 1/2 teaspoon margarine
1 slice cornbread 1/4 honeydew melon
Snack 2 1/2 cups low-fat microwave popcorn 1 1/2 teaspoons margarine
TIP: Use tub or liquid margarine instead of butter. Choose a soft
margarine that has no more than 2 grams of saturated fat per tablespoon
and that lists "liquid vegetable oil" as the first ingredient on the ingredient
list. American Heart Association
* Adapted from National Heart, Lung, and Blood Institute sample menus.
In real life, you cannot always cook your meals. Here are some ways
to make healthy choices when you are away from home:
- Use a small plate at social functions to help keep you from eating too much.
- At restaurants, order a half portion, share a meal with a friend, or take
half of your order home for another meal.
- Balance your meals throughout the day. If you have a high-fat or high-calorie
breakfast or lunch, make sure you eat a low-fat dinner. If you know you will
be having a higher fat dinner, make lower fat choices earlier in the day.
Set goals. Move at your own pace. Celebrate your successes. Allow for
setbacks. Let your family and friends help you. And keep trying—you can
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Walking is one of the easiest ways to be physically active.
You can do it almost anywhere and at any time. Walking is also inexpensive.
All you need is a pair of shoes with sturdy heel support. Walking will:
- Give you more energy
- Make you feel good
- Help you to relax
- Reduce stress
- Help you sleep better
- Tone your muscles
- Help control your appetite
- Increase the number of calories your body uses.
For all these reasons, people have started walking programs.
If you would like to start your own program, read and follow the information
provided in this pamphlet.
Answer the following questions before you begin a walking program.
- Has your health care provider ever told you that you have heart trouble?
- When you are physically active, do you have pains in your chest or on your
left side (neck, shoulder, or arm)?
- Do you often feel faint or have dizzy spells?
- Do you feel extremely breathless after you have been physically active?
- Has your health care provider told you that you have high blood pressure?
- Has your health care provider told you that you have bone or joint problems,
like arthritis, that could get worse if you are physically active?
- Are you over 50 years old and not used to a lot of physical activity?
- Do you have a health problem or physical reason not mentioned here that
might keep you from starting a walking program?
If you answered yes to any of these questions, please check with your
health care provider before starting a walking program or other form
of physical activity.
Leave time in your busy schedule to follow a walking program that will
work for you. In planning your walking program, keep the following points
- Choose a safe place to walk. Find a partner or group of people to walk with
you. Your walking partner(s) should be able to walk with you on the same schedule
and at the same speed.
- Wear shoes with thick flexible soles that will cushion your feet and absorb
- Wear clothes that will keep you dry and comfortable. Look for synthetic
fabrics that absorb sweat and remove it from your skin.
- For extra warmth in winter, wear a knit cap. To stay cool in summer, wear
a baseball cap or visor.
- Do light stretching before and after you walk.
- Think of your walk in three parts. Walk slowly for 5 minutes. Increase your
speed for the next 5 minutes. Finally, to cool down, walk slowly again for
- Try to walk at least three times per week. Add 2 to 3 minutes per week to
the fast walk. If you walk less than three times per week, increase the fast
walk more slowly.
- To avoid stiff or sore muscles or joints, start gradually. Over several
weeks, begin walking faster, going further, and walking for longer periods
- The more you walk, the better you will feel. You also will use more calories.
A sample walking program and examples of easy stretches are shown on
Keep safety in mind when you plan your route and the time of your walk.
- Walk in the daytime or at night in well-lighted areas.
- Walk in a group at all times.
- Notify your local police station of your group’s walking time and
- Do not wear jewelry.
- Do not wear headphones.
- Be aware of your surroundings.
Before you start to walk, do the stretches shown here. Remember
not to bounce when you stretch. Perform slow movements and stretch only
as far as you feel comfortable.
Reach one arm over your head and to the side. Keep your hips steady
and your shoulders straight to the side. Hold for 10 seconds and repeat
on the other side.
Lean your back against a wall. Keep your head, hips, and feet in a straight
line. Pull one knee to your chest, hold for 10 seconds, then repeat with
the other leg.
Lean your hands on a wall with your feet about 3-4 feet away from the
wall. Bend one knee and point it toward the wall. Keep your back leg
straight with your foot flat and your toes pointed straight ahead. Hold
for 10 seconds and repeat with the other leg.
Pull your right foot to your buttocks with your right hand. Keep your
knee pointing straight to the ground. Hold for 10 seconds and repeat
with your left foot and hand.
Taking the first step
is very important.
Walk with your chin up and your shoulders held slightly back.
Walk so that the heel of your foot touches the ground first. Roll
your weight forward.
Walk with your toes pointed forward.
- Swing your arms as you walk.
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