Exercise and adult women’s health Life-style modifications are probably the most important and cost-effective intervention in medicine. Regular physical activity is associated with higher levels of physical fitness, favorable chronic-disease risk-factor profiles, reduced risk of clinical events, and greater longevity. Amos Pines

Exercise improves cardiovascular risk profile Body mass index Total, abdominal (subcutaneous and visceral) fat Waist circumference Glucose metabolism/insulin resistance Blood pressure Lipids Endothelial function/intima-media thickness Looking at the major metabolic risk factors for cardiovascular disease, it appears that all of them may be improved by exercise. These include weight loss, reduction in total body fat and abdominal fat, smaller waist circumference (now regarded as an important risk factor in women), better glucose metabolism, lower triglycerides and higher high density lipoprotein (HDL), improved endothelial function and a thinner arterial intima-media width. IMPROVED

Exercise and cardiovascular morbidity The WHI observational trial data: Up to 45% decreased risk for cardiovascular events, correlated with the degree of energy expenditure (MET) 1.2 1.0 0.8 0.6 0.4 0.2 0.0 1.00 0.85 0.70 0.66 0.55 Cardiovascular morbidity is naturally the primary target of any exercise program. Here are data from the huge cohort of the WHI observational trial, clearly demonstrating that there is a good dose response between cardiovascular events and exercise. The more active, the less risk. Women in the highest physical activity quartile had up to 45% lower risk for cardiovascular events as compared with sedentary women, but even a slight increase in the degree of energy expenditure (quartile 1) already showed a beneficial effect. 1 2 3 4 5 Lowest Highest Quintile of total MET score White women (n = 61,574) p < 0.001 Manson JE, et al. N Engl J Med 2002;347:716

Exercise and breast cancer risk High calorie intake and high BMI are known risk factors for breast cancer in postmenopausal women 38,660 women (age 55–74); 10-year follow-up > 4 hours/week of vigorous physical activity resulted in 22% reduced risk for breast cancer as compared to non-actives Women with the most unfavorable energy balance (high energy intake, high BMI, physically inactive) demonstrated a two-fold risk versus those with most favorable data High body mass index (BMI) is a known risk factor for breast cancer. In this recent study, in a fairly large cohort and 10-year follow-up, 4 hours/week of vigorous exercise resulted in 22% reduced risk for breast cancer compared to non-active women. Those characterized by the triad of the highest energy intake, that is eating too many calories, the highest BMI, and having the lowest energy expenditure, that is physically inactive, had two-fold risk for breast cancer as compared to those with the most favorable relevant data. Chang SC, et al. Cancer Epidemiol Biomarkers Prev 2006;15:334

Counseling on exercise Mean age 57 years; 67% women; 12 months follow-up Conclusion: counselling patients in general practice on exercise is effective in increasing physical activity and improving quality of life over 12 months Raina Elley C, et al. BMJ 2003;326:793