Women and Exercise

Most women are aware that participating in regular exercise or physical activity
is important for health. However, what they are often unsure of is exactly how much exercise is required and what forms of exercise are best. This uncertainty
is exacerbated by differing recommendations on levels of exercise. General recommendations can be unhelpful as they fail to take into consideration a person’s current activity level and physical ability. Mixed messages around exercise requirements are also generated by media articles. For example, the results of a study which found intense sprint training resulted in similar physiological changes to endurance training was misleadingly reported as “Fitness ‘takes 6 minutes a week’” (1).

Health benefits of exercise

Participating in regular exercise has a wide range of health benefits. Physical activity is, for example, an important factor in directly reducing the risk of cardiovascular disease. Indirectly, it has a positive effect on a number of risk factors for cardiovascular disease, including high blood pressure, high body
mass index (BMI) and blood cholesterol levels (2).

Many new cases of Type 2 diabetes could be prevented by adequate levels of physical activity, and it is also protective against some cancers. Weight-bearing exercise helps to build peak bone mass during one’s youth and continues to be
of benefit to our bones throughout life.

As well as our physical health, exercise has been shown to be beneficial for mental and emotional health. This is important for women as they experience these health problems in higher numbers than men. Exercise reduces the symptoms of stress, depression and anxiety. When you exercise the level of chemicals generated by stress, such as adrenaline, are lowered, resulting in a tranquilising effect. At the same time the body’s production of chemicals which elevate mood are increased. Exercise can also contribute to a more positive body image and improved self esteem. For someone suffering from depression or anxiety, exercise can promote interaction with other people, reducing feelings of isolation.

Types of exercise

There are different forms of exercise, including weight bearing, strengthening, aerobic and flexibility. Some activities actually provide a combination of several forms.

Weight bearing exercise is an activity that is “done on your feet so the force of gravity acts through the skeleton” (3). Jogging, walking, dancing, netball and tennis are just a few examples of weight bearing exercise. This type of exercise plays an important role in establishing and maintaining a person’s bone mass. Different weight bearing exercises produce different levels of force through the skeleton, with higher intensity exercises such as jogging or skipping having
more effect on the bones than walking.

Strengthening exercise involves lifting, pushing or pulling against a form of resistance. Weight training is an obvious example of this form of exercise but other strengthening exercise include the use of specially designed elastic bands and water aerobics (the water provides the resistance). These exercises assist
in strengthening the muscles, bones and tendons.

In aerobic exercise the lungs and heart have to work harder than usual to provide the body with increased oxygen intake. Examples of aerobic exercise include walking, jogging, swimming or cycling. Aerobic exercise has many health benefits but most importantly it is associated with good cardiovascular health
and maintaining a healthy weight.

Flexibility exercise affects the range of motion a person has in their joints. Performing this exercise can help improve a person’s mobility, particularly as they age. The exercise also helps lengthen the muscles and this assists with balance. Yoga, pilates and other stretching type exercises are examples of flexibility exercise.

Exercise across the life span

Exercise requirements change throughout our lives, a factor that is reflected in the Australian Government’s physical activity guidelines. There are three different sets of guidelines, for 5-12 year olds, 12-18 year olds and adults.

5-12 year olds

Children of this age need at least 60 minutes of moderate to vigorous physical activity every day. Moderate activity is defined as “about equal in intensity to a brisk walk” and includes activities like bike riding or any kind of active play. Examples of vigorous activity, which causes a child to “huff and puff”, include hockey, netball, running or swimming laps (4). Participating in a variety of
physical activities at this age is important as it assists children in developing the skills and confidence necessary for continuing with physical activity throughout their lives. This is particularly relevant for girls who appear to be less confident than boys of the same age in performing physical tasks. If girls are not encouraged to participate they may not acquire adequate basic motor skills (eg. running, catching and throwing) needed for certain sports and activities (5). The recommendations also specify that children “should not spend more than two
hours a day using electronic media for entertainment (eg. computer games, TV, Internet), particularly during daylight hours.” (6).

12-18 year olds

The exercise requirements for this age group are also at least 60 minutes of moderate to vigorous physical activity per day (7). Adolescent girls appear to be particularly susceptible to a decline in physical activity during this time. The NSW Schools Fitness and Physical Activity Survey found that the percentage of girls in Year 10 participating in vigorous activity was 58% compared to 73% of boys (8). Reasons for this drop may include less time due to homework and part-time work commitments as well as a lack of positive role models (ie. lack of media coverage of women’s sports).

Adults

There are three guidelines for adults to follow to enhance their health.

1) Think of movement as an opportunity, not an inconvenience- This guideline reflects the fact that people’s use of labour saving devices and the car mean there are far less opportunities for movement. There needs to be an attitudinal change to physical activity if we are to maintain good health long term.

2) Be active every day in as many ways as you can - This guideline recognises that people’s busy lifestyles has resulted in less opportunities to participate in physical activity. Therefore, people need to try and incorporate activity where they can, throughout their day. Even small amounts of activity are helpful as
they all add up. Examples include taking the stairs rather than the lift, parking further away from your destination, and getting off public transport a stop
earlier.

3) Put together at least 30 minutes of moderate-intensity physical activity on most, preferably, all days - This guideline allows for the accumulation of a few sessions of physical activity in order to achieve the minimum amount of 30 minutes.

Following all three guidelines will only provide enough physical activity to
enhance health but is not sufficient for high-level fitness, sports training or
weight loss. These require additional activity (minimum of 30 minutes a day)
at a vigorous level (9).

So are we meeting our exercise requirements?

Results from a National Physical Activity Survey conducted in 1999 found that many female respondents (aged 18-75) were not meeting the daily physical activity requirements. Almost 15% of women reported no physical activity during the previous week, with a further 31.5% not achieving ‘sufficient time’ (defined
as 150 minutes of physical activity a week). Women were less likely than men
to participate in sufficient physical activity (53.8% compared to 59.6%) and
vigorous activity on at least five occasions during the previous week (6.4 compared to 11.1%) (10).

Having children appears to be a significant factor in declining physical activity among women. A qualitative study of mothers and physical activity found that a combination of issues led to women not having sufficient time for physical
activity. Issues the women raised included:

• Participation in physical activity took a great deal of organisation
  and much longer than the ’30 minutes a day’ promoted in recommended guidelines
  
• The demands of women’s multiple roles meant that women’s lives were often unpredictable which limited their participation in physical activity.
  
• Strong expectations around their roles as mother and homemaker led to feelings of guilt when they took time out to participate in physical activity (11).
  

The women who were more physically active tended to receive support in
addition to that from their partners. For example, they had paid childcare, paid assistance with domestic tasks and/or support from family and friends (12).

Different types of exercise

Walking – An excellent physical activity that is both weight bearing and aerobic. Benefits are that it is suitable for women with a range of fitness levels and it requires very little equipment (ie. walking shoes). Limitations are that inclement weather can reduce opportunities and not everyone may have access to safe areas for walking, particularly after dark.

Swimming – An aerobic exercise that does not place stress on the body due to the weight of the body being supported by the water. It is, therefore, an ideal exercise for those who are overweight / obese or have injuries or conditions (eg rheumatoid arthritis) which make exercise more difficult.

Gymnasiums – These establishments offer access to a variety of equipment including cardiovascular and weight training as well as regular classes such as aerobics. Some gyms may a pool and/or provide classes in other activities like yoga and pilates. The disadvantage of gyms is that membership can be
expensive and women often find they do not attend as much as they
intended to.

Cycling – As the weight is taken off the body it is suitable as a lower impact exercise. It can provide a good aerobic workout, particularly when hills are involved. A disadvantage is that people may not have easy access to a bike path and may not wish to ride in traffic.

Yoga – This exercise is an ideal flexibility exercise. It also improves balance, coordination, posture and breathing and many people find it also assists with relaxation. There are several different types of yoga to choose from.

Pilates – This physical activity has recently grown in popularity. It was originally devised in the 1920s by Joseph Pilates to assist injured dancers and athletes
and consists of a series of exercises. There are two forms, that which uses specially designed equipment and that which is performed on a mat (13). Like yoga, pilates is good for flexibility, balance and posture.

Team sports – This type of physical activity has a number of benefits. Apart from providing exercise they also involve social interaction which can reduce women’s feelings of isolation.Women may also be more likely to continue participating in a team sport as they are aware of letting other team members down if they do not attend.

The need to get people in the community participating in more physical activity has also led to the formation of a number of walking based programs, including ‘10 000 Steps’ (Queensland Health) and ‘Just Walk It’ (Heart Foundation). These programs encourage people to take part in regular physical activity through walking. Pedometers (a device that counts how many steps one does) are used to keep track of the amount of physical activity taking place.

When exercise becomes too much

While exercise provides many health benefits, too much exercise can be detrimental. This is particularly the case with women for whom excessive
exercise can lead to the cessation of menstruation (amenorrhoea). Exercise-related amenorrhoea occurs due to a number of factors including weight loss, decreased percentage of body fat and an insufficient calorie intake to match the calories being expended during exercise. Long term amenorrhoea can put
women at risk of low bone mass and the development of osteoporosis. Women with an eating disorder commonly use over-exercising as way of reducing their weight.

In addition, it seems some people can become ‘exercise-dependent’. Exercise dependence can be defined as an “unhealthy preoccupation with exercising”
(14). This preoccupation may relate to the frequency and/or duration of exercise performed. Typically a person with exercise dependence will find that exercise dominates their life, significantly interfering with all other aspects (work, social activities, relationships). Other common characteristics of exercise dependence are experiencing withdrawal type symptoms when unable to exercise. People report feeling anxious, depressed, angry or guilty when they cannot exercise to the degree they would like (15).

Exercise during pregnancy

Participating in exercise when pregnant has a range of benefits for the mother
to be. It can help women to carry the extra weight gained more easily and
reduce some of the symptoms that women experience during pregnancy such as sleeping difficulties, constipation, fatigue and backache (16). Maintaining a reasonable level of fitness during pregnancy can also help women cope with the demands of a new baby.

Many women, however, are unsure of how much they should exercise during pregnancy and the types of exercise that are safe. Women should firstly consult their doctor to ensure there are no medical reasons why exercise should be limited or avoided. Conditions like high blood pressure, placenta praevia, obesity, anaemia, diabetes or a history of miscarriages or a weak cervix may all impact on a woman’s ability to exercise during pregnancy. Women should also refrain from starting a vigorous exercise program if they have not participated in regular exercise before.

It appears one of the risks of exercising during pregnancy is prolonged overheating. This is because the foetus does not have its own mechanism for cooling down and so can be affected by the mother’s body temperature. The foetus is thought to be particularly vulnerable to prolonged overheating in the first trimester. The risk of prolonged overheating during pregnancy can be reduced by steps such as drinking adequate water to avoid dehydration, exercising in cool and well ventilated venues, avoiding exercising in the hottest part of the day and reducing exercise intensity as the pregnancy
progresses (17).

Pregnant women are also more prone to certain types of injuries such as those associated with the joints or connective tissue. This is because during pregnancy the body produces a hormone called relaxin which works by loosening the joints so the pelvis can expand to allow the baby to pass through. Pregnant women, therefore, may be more susceptible to injuries from high impact exercises like jogging or from overstretching.

Exercises that involve lying on your back can also cause problems as this position can cause the uterus to place pressure on the vena cava, the major vein that returns blood from the legs to the heart. This pressure can lead to dizziness, shortness of breath, spots before the eyes, tingling fingers and nausea.

Activities that should be avoided include scuba diving, parachuting, waterskiing, martial arts, gymnastics, horseriding and trampolining (17).

In 1999, Netball Australia was found to have discriminated against a player who was banned from planning the sport due to being pregnant. Following this high profile case, the Australian Sports Commission released guidelines on pregnancy in sport. The guidelines explain that “Medical professionals currently consider
that women with normal pregnancies who are already active can continue to play many sports without affecting the course or outcome of their pregnancy. Women who are not active can begin a training program of moderate intensity and low impact after seeking medical advice” (18).

Pregnant sportswomen are advised to decide whether or not to play sport while pregnant, and for how long, in consultation with their medical advisers. Sports Medicine Australia recommends women stop exercising if they experience any abnormal symptoms, such as:

• pain, particularly chest and abdominal pain
• headache
• an usually high heart rate
• decreased foetal movements
• insufficient weight gain
• amniotic fluid leakage
• nausea
• uterine contractions
• vaginal bleeding
• sudden swelling or ankles, hands or face
• dizziness or
• shortness of breath (19).

References

1. CNN.com Fitness ‘takes 6 minutes a week’ CNN.com http://www.cnn.com/2005/HEALTH/06/06/sprint.training/ [website]
   date accessed: 13 th October 2005.
2. Armstrong T, Bauman A & Davies J. Physical Activity Patterns of Australian Adults Canberra : Australian Institute of Health and Welfare 2000; 5
3. Whitman, B. Osteoporosis: Prevention and Self Management Course Arthritis Foundation of Victoria 1991;15
4. Department of Health and Ageing. Active Kids Are Healthy Kids: Australia's Physical Activity Recommendations for 5-12 Year Olds Canberra: Commonwealth of Australia 2004
5. Sport and Recreation Queensland. Why Don’t Girls Play Sport? http://www.ausport.gov.au/fulltext/2001/qld/whydont.asp [website]
   date accessed: 17th October 2005
6. Department of Health and Ageing. Active Kids Are Healthy Kids: Australia's Physical Activity Recommendations for 5-12 Year
   Olds Ibid
7. Department of Health and Ageing. Get Out and Get Active: Australia ’s Physical Activity Recommendations for 12-18 Year Olds Canberra: Commonwealth of Australia 2004
8. Booth M et al. NSW Schools Fitness and Physical Activity Survey
   1997. Sydney : NSW Department of School Education
9. Department of Health and Aged Care. An Active Way to Better Health: National Physical Activity Guidelines for Adults Canberra : Australian Government 1999
10. Armstrong T, Bauman A & Davies J. Ibid
11. Lo Cascio M et al. Busy Mums Wanted: A Qualitative Study of Mothers and Physical Activity. Sydney : Social Health Research Unit, Central Sydney Area Health Service 1999
12. Lo Cascio M et al. Ibid
13. Better Health Channel. Pilates
    http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/
    pages/Pilates
    [website] date accessed: 15th November 2005.
14. Bamber DJ et al. Diagnostic criteria for exercise dependence in women
    Br J Sports Med 2003; 37:393-400.
15. Bamber DJ et al. Ibid
16. BabyCenter. Pregnancy Exercise: Eight Things You Should Know Before Your Get Started http://www.babycenter.com/refcap/
    758.htm [website] date accessed: 13 October 2005.
17. Australian Sports Commission. Pregnancy in Sport: Guidelines http://www.ausport.gov.au/women/pregmed.asp [website]
    date accessed: 10 November 2005.
18. Australian Sports Commission. Ibid
19. Australian Sports Commission. Ibid
20. Australian Sports Commission. Ibid

Further help and information from Women's Health Queensland Wide

Health Information Line:
Our free statewide line is staffed by women's health nurses and midwives. They provide women with up to date information, support and referral to health practitioners and services. Women can contact the Health Information Line by phone or email via the 'Ask a Health Question' page on the website. All phone calls and emails are confidential.
(07) 3839 9988 or 1800 017 676 (toll free outside Brisbane)

Library:
Our free lending library offers a select range of books on major women's health topics. Topic-based booklists are availableon our website, or can be posted out; books can be requested by phone or email and are posted to borrowers.
Contact on administration : (07) 3839 9962

Website:
All our factsheets and booklets are available on our website. The website also features articles on women's health from our newsletter, student factsheets, upcoming events, library services and 'Ask a Health Question' page. A list of reputable links is also available where women can search for further information on health topics.
www.womhealth.org.au

Further information

10 000 steps
http://www.10000steps.org.au/index2.htm

Just Walk It
http://www.heartfoundation.com.au/index.cfm?page=210

This article was written by Kirsten Braun and reviewed by the Editorial Committee for Health Journey, Vol IV 2005

Please note that this article is an archive. While every effort was made to ensure the information was accurate at the time of publication, the article has not been updated since this time. 

Last Modified: December 1, 2005