Exercise & Fitness for women over 40.

For most of her adult life, Phyllis Ingram of Barto, PA, was too busy raising her two children to even think about her own health. Consequently, by the time she turned 52, she carted an unhealthy 225 pounds around on her 5'6" frame. Just walking up the 12 steps in her house left her gasping for breath, and she suffered daily with a multitude of annoying aches and pains.

Today, Ms. Ingram is 50 pounds lighter and her body is rock solid with muscle. She rides hundreds of miles a year on her road bike (sometimes nearly 100 miles in a weekend) and is training for a cross-country bike ride sometime next year.

Ms. Ingram is a convert, convinced of the power of exercise and physical activity, determined never to return to the world of the unfit. "I find I get grouchy if I don't get my exercise in," she says.

Unfortunately, she's the exception. More than 60 percent of women don't get the recommended amount of physical activity, and one in four women aren't physically active at all. (1) That number jumps in women over 55--nearly 40 percent of whom say they get no leisure-time physical activity. (2)

Yet the benefits of physical activity and exercise if you're middle-age or older begin at the top of your head and continue to the tips of your toes, affecting every body system in between and contributing more to your overall health and longevity than any pill or diet ever will. And studies find that your mid-30s through your 40s is a critical time period for determining whether you'll remain physically active after menopause, (3) something you definitely want to strive for. The best reason? You'll likely live longer. One large study of older women found that exercise reduced all causes of death in postmenopausal women. (4)

Regular exercise lowers blood pressure, reduces levels of "bad" cholesterol while raising levels of good" cholesterol and slows your resting heart rate, enabling it to work more efficiently. In one study, women who walked briskly for three or more hours per week slashed their risk of heart disease 35 percent compared to women who walked less frequently. (5)

Several studies have found that physically active women experience less intense and fewer symptoms of menopause, including the ubiqu-tous hot flashes. In one survey of 625 runners aged 34 to 72 (average age 51), three-quarters said running had a positive impact on menopause, one-third said it improved their mood and overall emotional status, and one-fourth said it decreased menopausal symptoms. (19)

Physical activity also reduces your risk of colon cancel; perhaps by helping food move through the digestive tract more quickly, thus limiting the contact of cancer-causing chemicals with the cells that line the colon. (6) It reduces the risk of kidney stones, gallstone surgery and diverticular disease. (7,8) And, weight-bearing exercise, like walking, riding a bike or lifting weights, not only strengthens muscle, but also strengthens bone, helping increase bone density and prevent osteoporosis. (9)

Exercise can also lower the risk of the disease women fear most: breast cancer. A study published in the American College of Sports Medicine's Health Fitness Journal of 26,000 women found that women who exercised at least four hours a week had 37 percent fewer breast cancers than sedentary women. Researchers think that moderate to high activity levels lower a woman's lifetime exposure to estrogen, a primary risk factor for breast cancer. (10)

Exercise has numerous emotional benefits, too. It can help you fall asleep faster and sleep longer and deeper, (11) and relieve depression. One small study found that just 30 minutes of daily walking on a treadmill at various intensities worked faster than medication to lift depression. (12) Even if you're not depressed, the release of feel-good hormones called endorphins during physical activity can provide a euphoric feeling, according to Todd Stitik, MD, associate professor of physical medicine and rehabilitation at the University of Medicine and Dentistry of New Jersey.

Then there are exercise's well-studied stress-reducing benefits. In study after study, aerobic exercise (i.e., walking) reduces anxiety, improves depression, helps you better cope with stress and contributes to a positive mood, self-esteem and mental functioning. (18) Not bad for a brisk march around the block.

Blasting Through the Excuses

So if the benefits of exercise are so clearly significant, why isn't every woman out there running, biking, walking, swimming, lifting or any of the other numerous -ings that translate into physical activity?

"The number one barrier we hear is 'I don't have the time,'" says Bess H. Marcus, PhD, who directs the Physical Activity Research Center at Brown University Medical School in Providence, RI. The center conducts scientific research on various aspects of physical activity and health.

That may be due to the mistaken belief that physical activity means hard, intense exercise, the kind that makes you drip with sweat and leaves your muscles aching the next morning.

Get over it, say exercise experts. You can gain significant benefits in as little as 30 minutes a day of physical activity, ranging from vigorously cleaning your house to riding your bike to swimming laps. And you don't need to do it all at once; you can break your exercise into smaller increments that together add up to 30 minutes. That's why many exercise experts were alarmed by the recent recommendation from the Institute of Medicine that Americans need 60 minutes of physical activity a day. "That's a recommendation for weight loss, not health," Dr. Marcus says reassuringly. So if you re trying to lose weight, yes, you need to increase the amount of physical activity you get (and decrease the amount you eat). But if you're focused on health, 30 minutes a day of moderate-intensity physical activity should do it.

Which brings us to the next confusing issue around physical activity: Just what do they mean when they say "moderate intensity?" "Moderate intensity is walking between three to four miles an hour with some urgency, like you're late for an appointment or to catch a bus," says Dr. Marcus. "It's definitely not strolling." You can still talk while doing it, but you're slightly breathless.

But don't get all hung up about time and intensity, says Dr. Marcus. "The most important way for people to be able to stick with physical activity is to be flexible in their approach. Particularly women." That means walking around the block while your child is at piano practice. Doing a light jog or a brisk walk around the soccer field while your kids practice. Using a 15-minute break at work to briskly walk up and down the stairs, or a free half hour at home to weed the garden or rake leaves. The important thing is to plan for the activity.

"We want people to make physical activity a priority so that they write it into their schedules," says Dr. Marcus. "But people also need to be flexible enough to roll with the punches and get away from all-or-nothing thinking," she says.

One thing that may help: Surround yourself with people who also are physically active. A national study conducted by researchers at Stanford University of nearly 3,000 women 40 and older found that if women didn't see other people exercising in the neighborhood, they didn't feel like exercising themselves. In the study of ethnically diverse women, only about nine percent met the definition of being regularly active. Other reasons the women didn't exercise: caregiving duties--whether for children or other adults, lack of energy and, believe it or not, a lack of hills in the neighborhood (the researchers speculate that a hilly neighborhood provides more interesting scenery and is more conducive to walking). The women also said they'd rather exercise on their own than in a group-led exercise class, a response that probably relates to women's needs for flexibility. And some women said they didn't want to exercise because they were self-conscious about their physical appearance. (13) Other research finds even a l ack of sidewalks or unsafe neighborhoods can keep people from exercising.

"The underlying message is that no matter how difficult it seems to be to find the time or resources or strength or mindset to go out and move, it is critical that you do so because it enhances the other 23.5 hours of your day," says James H. Rimmer, PhD, professor and exercise physiologist at the University of Illinois, Chicago.

For more information on fitness, nutrition and general women's health, visit: www.hea1thywomen.org

What's New at the Gym

Forget high-impact aerobic classes with blaring rock music. Today's health club offerings are likely to be mellower, featuring lots of stretching, flexibility exercises and even meditation through yoga, Pilates and Tai Chi classes. It makes sense that health clubs are expanding in this direction considering that those 55 and older make up the fastest growing demographic in their membership. (14)

Between 1994 and 1999, the percentage of health clubs offering yoga jumped from 36 to 74 percent, while one in four now offer Pilates, a method of exercise and physical movement designed to stretch, strengthen and balance the body.

"The popularity of these classes can be attributed to a few factors," says Bill Howland, director of public relations and research for the International Health, Racquet and Sports Club Association (IHRSA). "Mature members appreciate the low-impact workout, veteran members appreciate the variety these classes add to their weekly routine and more members are looking for a workout that benefits the mind and the body. Plus, these low-impact exercises ate perfect for those with arthritis or other chronic conditions, says Dr. Rimmer. And the stretching, increased flexibility and improved balance that are the hallmarks of these programs are particularly beneficial to older women, who often lose flexibility and balance as they age.

The aging Baby Boomers are also the reason why health clubs, including nonprofit ones like the YMCA and YWCA are hiring specially trained staff, who can work with people with disabilities, and designing programs for those with arthritis or other chronic conditions. Overall, about 15 percent of gyms now have some capacity to accommodate the disabled. By 2012, that figure is expected to reach 25 percent. (15) To locate one of these facilities near you, contact the National Center on Physical Activity and Disability at 1-800-900808 6, or go to its Web site at www.ncpad.org.

How hard are you working out?

For years, we've been told to exercise to within 75 to 80 percent of our maximum heart rate, or MHR. At gyms throughout the country, charts listing the heart rate goals for various age groups decorate the walls.

But in recent years, the idea of the MHR as the ideal guide to exertion has lost favor. One reason is that the original formulas came out of studies on subjects who were under 55, some of whom were smokers, others of whom had heart disease. (16)

So some athletes (even weekend athletes) have begun using the Borg Perceived Exertion Scale to measure exercise intensity. This scale (below) scores how difficult a particular activity feels to you. A score of 13 to 15 should put you at roughly your target heart rate. If your score falls below 10, push yourself a little harder; if your score is over 17, ease back.

6-No exertion at all

7-Very, very light

9-Very light

11-Light

13-Somewhat hard

15-Hard

17-Very hard

19-Very, very hard

20-Maximal exertion

Another way to determine how much physical activity a movement or exercise provides is to find out its MET, or metabolic equivalent, which exercise researchers and physiologists use in evaluating activities. Basically, a MET is a way of measuring how much oxygen, or energy, you're using. So one MET is the amount of energy you use when you're not doing anything. Two METs is twice resting energy expenditure, three METs is three times resting energy expenditure, etc. (16) The number of METs you should aim for differs depending on your maximum MET level: five METs would be for an average healthy woman; women with disabilities would exercise at a lower MET level and achieve cardiovascular benefits.

At the same time you're tracking your METs, you want to gradually increase your Physical Activity Level, or PAL. For instance, if you're relatively sedentary, your PAL is between 1.0 and 1.4. An active lifestyle translates to a PAL of between 1.6 and 1.9 and a very active lifestyle to a PAL between 1.9 and 2.5.

The chart on this page shows how much your PAL would change for each hour of the particular activity. Aerobic exercise is when your heart rate increases to a target zone. Strength training--lifting weights, calisthenics, working against resistance as you do with pushups, for example--is designed to cause skeletal muscle, the muscles that move your arms and legs and other parts of your body, to contract. Ideally, you should try to do some form of strength training (it doesn't have to require weights) three times a week, and get 30 minutes of aerobic activity four to seven times a week.

PHYSICAL ACTIVITY LEVEL (PAL)

                           PAL Change   Weight   Aerobic/
Activity             METs   (1 hour)   bearing?  anaerobic

Lying quietly        1.0      0           No      Neither
Walking (2 mph)      2.5      0.09       Yes      Aerobic
Golf with cart       2.5      0.09       Yes      Slightly

Cycling (leisurely)  3.5      0.14       Yes      aerobic
Raking lawn          4.0      0.17       Yes      Aerobic

Golf without cart    4.4      0.19       Yes      Aerobic
Gardening            4.4      0.19       Yes      Both

Walking (4 mph)      4.5      0.2        Yes      Aerobic
Mowing lawn          4.5      0.2        Yes      Aerobic
(power mower)

Tennis (doubles)     5.0      0.23       Yes      Both
Dancing (aerobic)    6.0      0.29       Yes      Aerobic

Climbing hills       6.9      0.37       Yes      Both
(with no pack)
Swimming             7.0      0.34        No      Aerobic

Walking (5 mph)      8.0      0.40       Yes      Aerobic
Jogging              10.2     0.53       Yes      Aerobic
(10-minute miles)

AGES & STAGES

Exercise: the key to living well with chronic conditions. (Ages & Stages)

Artist Marilyn Bauman, 62, has been physically active since she turned 40, when a neighbor introduced her to running. But last year, after struggling with weight lifting at her gym, and after a diagnosis of osteoporosis, she hired a certified personal trainer she found through her health club.

The results, say her daughter, writer Alisa Bauman, are pretty incredible. Her posture, which I thought was permanently slouched from osteoporosis, is improving." Yet too many people think they have to limit their physical activity when a chronic condition or disability strikes--be it arthritis, diabetes, osteoporosis or heart disease. In truth, the opposite is true. Physical activity can be a literal lifesaver, or, at least, quality-of-lifesaver, for nearly every chronic condition. The only caveat: Make sure you check with your physician before beginning any exercise program if you've been doing little more than sitting on the couch punching the remote. Here, then, is how exercise can help with specific conditions:

* Arthritis. Exercise physiologist James H. Rimmer, PhD, is frustrated with his mother, who has arthritis but refuses to exercise. Her doctor tells her she can either have a total knee replacement or learn to walk with a cane. But her son, who specializes in physical activity for people with disabilities, knows that if his mother started taking a warm water exercise class, "she'd be a different woman." While exercise can't reverse or cure arthritis, it can reduce pain, primarily by strengthening the muscles that support the joints, says Todd Stitik, MD, associate professor of physical medicine and rehabilitation at the University of Medicine and Dentistry of New Jersey. It may also slow the progression of the disease. The key is to start slowly, Dr. Stitik says. While any exercise you enjoy works, weight-bearing exercise is best. Avoid high-repetition, high-resistance and high-impact muscle strengthening exercises. (6)

* Diabetes. Any aerobic exercise drives down blood sugar by making cells more sensitive to insulin, says Dr. Stitik. If you have diabetes, it's essential that you carefully monitor your blood glucose levels before, during and after exercise. And make sure you wear the proper footwear and maintain proper foot care. You should also avoid high-impact, weight-bearing activities, such as jogging on hard surfaces, which can cause repetitive foot trauma. (6) Exercise can also help prevent Type 2 diabetes (not Type 1). In one study, women who walked at least three hours a week had a 40 percent lower risk of diabetes than sedentary women. (20)

* Osteoporosis. Resistance training with machines or free weights that require you to stand puts greater force on your hips and spine, better for increasing or maintaining bone density than those in which you're sitting. If you have osteoporosis, avoid high-impact exercises such as jogging, and exercises that involve quick twists of your body or that put excessive force against your spine. (6)

* Coronary heart disease. If you have heart disease, the best exercise for you is brisk walking four to seven days a week for at least 30 minutes. Keep at it, and you may actually see a decline in your level of disease. (6)

If you get stuck, just do what Marilyn Bauman does when her motivation wanes: "Sometimes I just make myself do it because I know I will feel better if I do."

Another way to push beyond a lack of motivation is to exercise with someone, experts say. It's hard to slough off your work if someone is waiting for you at the gym or on the street corner.

ASK THE EXPERTS

Q No matter what I do, I just can't find the time to exercise consistently. What should I do?

Getting Started and Staying Safe

A You should stop thinking in terms of "exercise" and think in terms of movement. For instance, if you're gardening, that counts. If you walk briskly around the mall when you're shopping rather than lollygagging, that counts. You can also fit an activity into a spot that's already taken up by a daily activity. So if you watch the news every night at 6 p.m., watch it while riding a stationary bike or walking on the treadmill. If you read the paper every morning, read it while working out on your home machine. If you'd rather spend your free time curled up with a book, get a book on tape and take it with you on a walk around the neighborhood. Many of us are masters at multitasking. We need to make sure that getting our activity in is high enough up in our thinking that it's one of the things we multitask with. Another good way to find the time is to track how you do spend your time, including any exercise you did that day. Many of us are so busy we don't remember if we walked or not.

--Bess H. Marcus, PhD

Director, Physical Activity Research Center

Brown University Medical School, Providence, RI

Q My neighborhood isn't terribly safe for walking and the weather here is terrible. But I don't have room for a home gym. What should I do?

A Join a gym. Studies find that if you have to pay a membership fee, you're more likely to stick with your physical fitness routine. Other options include buying exercise videos, which can provide an excellent workout, or finding other places to walk. Malls, supermarkets, even public buildings with stairs that you can walk up and down provide excellent alternatives to walking in your neighborhood.

--Todd Stitik, MD

Associate Professor of Physical Medicine and Rehabilitation University of Medicine and Dentistry of New Jersey, Newark, NJ

Q What does being fit mean and what is the best exercise to do?

A To be fit means you're moving at least a few minutes every hour, and that's how you build up your physical fitness. If you do three minutes every hour in a 10-hour period, you've done 30 minutes. The best exercise is any exercise that you like. Whatever works and whatever you'll stick to. Ideally, you should aim for a combination of activity so you're nor just doing the same thing. Your overall goal, though, is minutes. Build them up throughout the day.

--James H. Rimmer, PhD

Professor, Department of Disability and Human Development

University of Illinois, Chicago

References

(1.) Centers for Disease Control, Health 2002 Chartbook.

(2.) Older Americans and Physical Activity, American Heart Association, December 2, 2002. www.americanheart.org

(3.) Evenson KR, Wilcox S, Pettinger M, Brunner R, King AC, McTiernan A. Vigorous leisure activity through women's adult life: the Women's Health Initiative Observational Cohort Study. Am J Epidemiol. 2002 Nov 15;156(10):945-53.

(4.) Kushi LH, Fee RM, Folsom AR, Mink PJ, Anderson KE, Sellers TA. Physical activity and mortality in postmenopausal women. JAMA. 1997 Apr 23-30;277(16):1287-92.

(5.) Manson JE, Greenland P, LaCroix AZ, Stefanick ML, Mouton CP, Oberman A, Perri MG, Sheps DS, Pettinger MB, Siscovick DS. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med. 2002 Sep 5;347(10):716-25.

(6.) Williams, MA, Eickhoff-Shemek, J. Exercise and Physical Activity: What to Recommend to Older Women. Women's Health in Primary Care. 2002 Oct; 5(10):624-637.

(7.) Leitzmann MF, Rimm EB, Willett WC, Spiegelman D. Grodstein F, Stampfer MJ, Colditz GA, Giovannucce E. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med. 1999 Sep 9;341(11):777-84.

(8.) A Dozen Other Reasons to Exercise, Nutrition Action Health Letter. Jan/Feb 2000.

(9.) Specker BL. Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. J Bone Miner Res. 1996 Oct;11(10):1539-44. Review.

(10.) Wells CL. Physical activity and cancer prevention: focus on breast cancer. ACSM's Health Fitness J. 1999;3:13-18.

(11.) Buchner DM. Physical activity and quality of life in older adults. JAMA. 1997 Jan 1;277(1):64-6.

(12.) Dimeo F, Bauer M, Varahram I, Proest G, Halter U. Benefits from aerobic exercise in patients with major depression: a pilot study. Br J Sports Med. 2001 Apr;35(2):114-7.

(13.) King AC, Castro C, Wilcox S, Eyler AA, Sallis JF, Brownson RC. Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women. Health Psychol. 2000 Jul;19(4):354-64.

(14.) International Health, Racquet & Sportsclub Association (IHRSA) surveys.

(15.) Fit for Everyone. Francesca Lunzer Kritz, Washington Post, Nov. 12, 2002.

(16.) Georgia Tech Sports Medicine & Performance Newsletter, June 2001.

(17.) Health Heart newsletter. www.healthyheart.org

(18.) Dietary Reference intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) Institute of Medicine report, 2002.

(19.) Exercise, Menopause and Aging, Melpome, Jan. 15, 2002. www.melpomene.org

(20.) Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, Speizer FE, Manson JE. Walking compared with vigorous physical compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA. 1999 Oct 20;282(15):1433-9.

Resources

American Association for Active Lifestyles and Fitness

1900 Association Drive

Reston, VA 20191

1-800-213-7193

www.aahperd.org

Promotes active lifestyles and fitness by disseminating information and collaborating with other organizations.

American College of Sports Medicine

PO Box 1440

Indianapolis, IN 46202-1440

317-637-9200

www.acsm.org

Promotes and integrates scientific research, education and practical applications of sports medicine; provides online database of ACSM-certified sports medicine and fitness professionals.

American Council on Exercise

4851 Paramount Drive

San Diego, CA 92123

1-800-825-3636

www.acefitness.org

National nonprofit organization that advocates physical activity; provides online database of certified fitness professionals, including personal trainers.

Fifty Plus Fitness Association

PO Box 20230

Stanford, CA 94309

650-323-6160

www.50plus.org

Promotes an active lifestyle for people 50 and older through publications, outreach and fitness events.

International Society for Aging and Physical Activity

Department Kinesiology

University of Illinois at Urbana-Champaign

Louise Freer Hall

906 S. Goodwin Avenue

Urbana, IL 61801

217-244-0823

www.isapa.org

Promotes research, clinical practice and public policy initiatives in the area of aging and physical activity.

National Association for Health and Fitness

401W. Michigan Street

Indianapolis, IN 46202-3233

317-955-0957

www.physicalfitness.org

Works to improve quality of life by promoting physical fitness, sports and healthy lifestyles; sponsors several national fitness programs.

RELATED ARTICLE: LIFESTYLE CORNER

Talk about competitive. Margaret Hagerty has competed in marathons on every continent (including Antarctica), has run the Marine Corps Marathon 11 times (one time when Oprah also participated) and won several medals, including a gold, in the Olympics.

Is There a Marathon in Your Future?

The Senior Olympics, that is. Ms. Hagerty is 79, and she didn't even slip on a pair of running shoes until age 64. That's when her doctor told her to quit smoking and get moving. The next morning, instead of coffee and a cigarette, she started jogging. She's been at it ever since.

Want more proof that extreme sports are not just for the young? On Nov. 4, 2001 to I led 12 of my women patients--all over 40-in the New York Marathon. Some walked and others ran, but we all finished the 26.2 mile course. The AARP gets hundreds of participants in its mini-triathlons for those 50 and older, which features a 300-meter swim, a 20-kilometer bike course and a 5-kilometer race (for more information go to www.aarp.org/triumph). Ms. Hagerty competed in one earlier this year as part of her training for next summer's Senior Olympics triathlon.

According to Margaret Hawkins, AARP's health campaign manager, the majority of the participants are "first timers" who have never completed a triathlon before, and they rave about "getting into shape" in a fun, supportive environment among their peers. Ms. Hawkins says it's truly inspiring to see the competitors crossing the finish line and see their delight in completing the event, proving that it's never too late to start a physical activity routine.

The key to meeting such a goal-whether it's hiking a mountain or running or walking a marathon-is training. But, fitness experts like Mindy Solkin, a running coach and owner of The Running Center in New York City, say there's no one way to train for such events. There are many training myths that may keep people from even considering a marathon. The most common myth, according to Ms. Solkin, is that you must run at least 60 miles a week and run every day if you're training for a marathon. Actually, current training advice is to ramp up slowly.

That's how Ms. Hagerty does it: She generally runs about four days a week, her distance ranging depending on the weather and how she's feeling, but usually ranging between four and 10 miles. She also swims and works out with weights one day a week. She's careful to stretch and pay attention to her body, and is happy to report she's never had any major injuries since she began her running career.

She considers herself lucky to have found something she really enjoys doing that's so good for her. So can you.

For the Rest of Us

Few women are going to run a marathon or climb a mountain, Heck, there are days you probably think you're doing well just to get out of bed. But if you're motivated by what you've read here and are ready to change your sedentary lifestyle into one filled with physical activity, follow these suggestions:

* Consider your lifestyle. Do you have a fairly regular schedule that would let you hit the gym every day, or sign up for a class? Or do you need the flexibility of exercising when and where you can, whether that's walking the dog or walking the mall?

* Start slowly. One of the primary reasons people quit exercising is they overdo it early on, get injured or become frustrated when they don't see quick results. But it could take up to 12 weeks to see measurable changes.

* Warm up and cool down before and after every exercise session to prevent injury and soreness. A warm-up consists of five minutes of low-level aerobic exercise followed by mild stretches (don't stretch first, when your muscles are cold), during which your heart rate slowly increases and your muscles slowly get warm as blood flow increases. To cool down, walk slowly until your heart rate is below 100 beats per minute (16 to 17 using a 10-second count). This is especially important for older women; skipping your cool-down can sharply reduce your blood pressure and cause muscle cramping.

* Rest when you're not feeling well.

* Wear the right shoes and clothing. It's worth going to a specialty athletic shoe store, or running shoe store, where employees have the expertise to make sure you get the right shoe, the right fit, for the right sport. Replace your shoes about once a year if you're a regular exerciser.

* Vary your activities. This is known as cross training. So one day you walk, the next you lift weights, the next you bicycle, and so on. It keeps you from getting bored and targets different muscle groups.

* Drink and eat right. That means hydrating before you even start exercising, and taking sips of water throughout your exercise period. Don't exercise on an empty stomach, but neither should you begin a strenuous workout after a heavy meal.

By Pamela Peeke, MD MPH NWHRC Medical Advisor

Dr. Peeke is a Pew Foundation Scholar in Nutrition and Metabolism, and Assistant Clinical Professor of Medicine at the University of Maryland in Baltimore. She writes about health and lifestyle issues important to all women.