More women in the United States are working out than ever before – and it’s not just college athletes who are closing the gender gap. Between 1972 and 2000, the number of women of all ages participating in recreational and competitive sports jumped a whopping 800 percent. That’s great news, and not just because of the wide range of health benefits. Studies show women who exercise miss fewer days of work, have better body images and report being happier than their sedentary counterparts.
Yet whether they’re elite athletes or weekend warriors, women are susceptible to certain injuries and medical conditions because of their unique bodies. Knowing the facts can help women prevent common conditions ranging from ligament tears to back problems. What follows is a guide to help women exercise safely – and get the maximum benefits from their activities – at any stage of life.
Avoid the Triad
The high school and college years can be a great time to participate in sports. But young female athletes are at risk of an interrelated set of conditions that can be quite dangerous. These conditions include poor nutrition, irregular or absent menstrual periods and a premature reduction in bone mineral density (osteoporosis).
Called the female athlete triad, this trio of health problems has serious implications for a girl’s long-term health. The Medical College of Wisconsin studied Marquette University and UW-Milwaukee female athletes who had the triad and found they had evidence of premature heart disease. Another study of varsity athletes at Divine Savior Holy Angels High School revealed 16 percent had signs of early osteoporosis. Women can also develop fertility issues as a result of the triad. “These young high school and college girls have essentially hormonally put themselves in a position that is very similar to menopause,” says Dr. Anne Hoch, director of the Women’s Sports Medicine Program at Froedtert and the Medical College of Wisconsin.
When it comes to prevention and treatment, nutrition is key. “With half the girls, it’s inadvertent,” says Hoch. “They’re just not eating enough calories for the amount they’re [exercising]. If you educate them and set them up with a dietician, then they do fine.” Girls who suffer from eating disorders can be more difficult to treat.
Awareness on the part of coaches and parents, as well as the athletes themselves, is crucial. Many girls don’t see a doctor until they wind up with a stress fracture or haven’t had a period for a year – and contrary to popular opinion, it’s not normal for female athletes to miss periods. “It’s very common in athletes, but it’s not normal,” says Hoch. Missing a period for three months in a row is considered abnormal and should be discussed with a doctor. In addition to getting adequate nutrition, meeting calcium and vitamin D requirements is vital to helping female athletes prevent osteoporosis and stress fractures.
Childbearing Years
During pregnancy, a woman will experience a change to her center of gravity, so she should be aware of balance issues while exercising. Added weight may make high-impact exercises uncomfortable as the pregnancy progresses. In the final stages of pregnancy, hormones are released to loosen up the ligaments of the pelvis in anticipation of childbirth. “Some of those hormones can affect your other ligaments, so you may find that certain joints aren’t as stable as they were pre-pregnancy or early on in the pregnancy,” explains Dr. Czarina Helf, an obstetrician/gynecologist with Columbia St. Mary’s Community Physicians.
While such changes may require some modifications to your exercise routine, there’s no reason to stop exercising during pregnancy. In fact, research shows the outcomes will likely be better for you and your baby if you keep active. “I’m a big proponent of exercising throughout your pregnancy for as long as you want to, as long as you fulfill certain criteria,” Helf says. Pregnant women should be sure to keep their heart rate no higher than 140 to 150 beats a minute for sustained activity. They should also stay well-hydrated and not get overheated. “As long as you’re not dieting at the same time as you’re exercising and you’re not underweight to begin with, you’re going to be fine, and the baby’s going to be fine,” Helf notes.
For women raising young children, the biggest exercise challenge simply may be finding time to do it. But the benefits – from controlling your stress levels to setting an example for your children – are tremendous. “I think what inhibits a lot of people from exercising is, ‘I don’t have an hour to go to the gym.’ But if they change that mindset to, ‘I’ll walk down the street to the store rather than drive,’ those little pieces of exercise can really do a lot,” says Dr. JoAnne Hill, an internist for Froedtert and the Medical College of Wisconsin practicing at the Sunnyslope Health Center.
Empty Nest Exercise
As women get into their 50s, Hill finds some patients running into the opposite problem. “The kids are getting older, you have a little bit more time for yourself, and you want to make up for those years when you didn’t have time. But you can’t do it all at once,” she says. Whether you’re resuming an exercise program or becoming active for the very first time, it’s important to start slowly to avoid injuries – and to do the right exercises to maximize your fitness and health.
Back injuries, for example, tend to be a common problem for women in middle age, especially those who’ve had children. “Women who have carried a pregnancy tend to lose a great deal of abdominal strength, and the abdomen helps to strengthen and hold the back in place,” Hill says. Once women have strained or injured their backs, the likelihood of reinjury becomes higher. The solution? Work on building core strength; not only will it protect your back and build muscle, it may also help with knee pain, adds Dr. Rosemary Schultz, an orthopedic surgeon and sports medicine physician with Aurora Advanced Healthcare.
Weight-bearing activities, such as walking, aerobics or tennis, are also extremely important for women in this age group, because they can help prevent osteoporosis and fractures later in life. Women who find their joints can’t tolerate high-impact sports like running may want to try cycling or swimming along with weight-bearing exercises to maintain bone density. The most important thing, Hill says, is to do a variety of exercises. In fact, sticking to the same routine can work against you in several ways, causing you to lose interest and even suffer injuries, adds Schultz. And don’t forget to cool down – “that can become more important as we get older and are at risk for heart disease,” notes Hill.
In addition to strengthening and weight-bearing activities, middle-aged women may consider workouts that build flexibility and balance – both of which decrease as we age. Activities such as Wii Fit and yoga are both excellent for balance. Yoga can also help build core strength.
Finally, if you aren’t exercising currently, there’s no time like the present to get moving. “Women are doing more than prior generations, but we still don’t exercise enough,” says Hill. Getting a dog, committing to an exercise partner and focusing on small portions of time that are available to you – a 10-minute walk, for example – are all great ways to get started.
Know Your Body
Active women of all ages can also benefit by being proactive about their risks for particular sports injuries. For example, anterior cruciate ligament (ACL) tears are three to eight times more common in women than in men. “Research has shown us that girls run differently, jump differently and land differently than guys,” says Hoch. A woman’s muscles contract differently from a man’s, while her reaction time is slower and her hamstrings are weaker.
The tearing of the ACL is painful and typically requires expensive surgery and lengthy rehabilitation. Soccer, basketball and volleyball players are especially vulnerable. Yet ACL tears are highly preventable. “Obviously, your anatomy can’t be altered to any great degree, but your skill level and your technique can both be improved,” says Schultz. Prevention programs, available at Froedtert, Aurora and other sports medicine centers, help women modify their techniques and have been shown to reduce the risk of ACL tears by 88 percent, adds Hoch.
Runner’s knee – also known as patello-femoral pain syndrome – also affects women of all ages. Weaker hip abductors – the muscles on the outside of the thigh – tend to give women less control over the femur bone, contributing to a knock-kneed position. The role that the hip plays in kneecap pain is not generally well known among patients, notes Hoch, but strengthening those muscles can make a big difference.
Runner’s knee is treatable with the right rehab program, one in which women focus on stretching the hamstrings and building the inner quad and hip muscles. Middle-aged women may benefit from a lubricant injection to the knee to help with pain in addition to strengthening exercises. The bottom line, stress the experts, is that active women can reap the benefits of exercise throughout their lives.
Caroline Goyette is Milwaukee Magazine’s monthly health columnist.
Health Tips
A roundup of the latest health wisdom
Why men should pump iron. Men with low muscular strength had a 60 percent higher risk of cardiovascular disease and a higher mortality rate than stronger men, notes a study presented at the American College of Sports Medicine’s 55th Annual Meeting. The study examined strength based on leg presses and bench presses for various age groups. Muscular strength and cardio-respiratory fitness combine to reduce male mortality, the authors conclude.
Fight the top threats to men’s health.The Mayo Clinic lists the biggest threats to men’s health on its Web site at mayoclinic.com. They are heart disease, cancer, injuries, stroke, chronic lung disease, type 2 diabetes, flu, suicide, kidney disease and Alzheimer’s. The Web site offers proactive suggestions to reduce risks, such as medication-free strategies to help avoid heart disease, cancer-prevention tips and ways to ward off diabetes.
Local crisis line for young people.A first-ever telephone crisis line has been launched by the Medical College of Wisconsin to assist people under age 21 who are experiencing a drug- or alcohol-related crisis. The three leading causes of death among young adults – motor vehicle accidents, suicide and homicide – are often related to substance abuse. The confidential “mPower” line is staffed around the clock by trained crisis volunteers. Call the 24-hour service at 866-661-MPWR (6797), or text 55358, keyword MPOWER. For more info, visit mpowersupport.com.
Alcoholism tied to osteoporosis in younger men.Alcoholic men are more likely to show signs of osteoporosis before age 50 than alcoholic women, according to a study in Alcoholism: Clinical and Experimental Research. About one-quarter of the men in the study – compared to just one in 20 women – had lower-than-normal bone mass. The study involved patients ages 27 to 50. Researchers recommend that alcoholic patients in their 20s to 40s be screened for bone mass and bone metabolism. It’s believed that women’s estrogen levels provide some protection against developing brittle bones.
Save money on spine scans.There’s usually no advantage to having your spine X-rayed in the first few weeks after pain begins, according to an analysis of spinal imaging studies. Most back pain is caused by muscular problems, such as strains and weakness, rather than underlying conditions. The study reported in The Lancet says X-ray, MRI or CT scans are only recommended if your physician suspects a serious problem, such as a tumor or infection. Otherwise, routine scans are a waste of money and may expose you to unnecessary radiation.
– Scott R. Weinberger
