A small amount of physical activity can have a relatively big impact on your health. In fact, the greatest health benefits from physical activity are derived not by the fit getting fitter, but by sedentary people who become just moderately active. In a twelve-year Swedish study, older people who exercised only once a week were 40 percent less likely to die than similar people who were totally sedentary. It seems that a little exercise goes a long way.
Exercise is the most effective way to keep from regaining the weight you lose on a healthy diet. This is not the only benefit of exercise, of course, but it is a persuasive argument for anyone who has successfully dieted and does not want to see her effort wasted, as so many women do when the weight comes back on. For women with PCOS, keeping their symptoms under control depends on not regaining the weight that they have lost.
In this chapter, I provide an exercise program divided into four levels. These levels are designed for women at different stages of fitness. As you become fitter, you progress from one level to another. You can select your own entry point at the appropriate level.
Level 1: First Steps. If you are sedentary, you may need to ease gently into very light or light activities and proceed from there. This two-week program helps you become consciously physically active, as opposed to being unthinkingly inactive.
Level 2: Walk for Fun. Once you are up and moving, it’s time to go places. This six-week program starts out at a leisurely stroll and quickens the pace each week. At the end of this program you will already be fulfilling the minimum daily requirement of thirty minutes a day of moderate physical activity.
Level 3: Off and Running. This six-week program means what it says: On completing it, you can be assured that you will have achieved a reasonably healthy fitness level.
Level 4: Mixing It Up. You are now ready to participate in most low-impact exercise and sports. Don’t allow yourself to become bored by a single activity. You’ll find that this is a secret of long-term fitness.
Moderate activity consists of walking briskly at three or four miles per hour or another activity that causes your heart to beat at an equivalent rate. Most of us have only vague—and often highly inaccurate—notions of how active we are in the course of a day. The Centers for Disease Control and Prevention sent out a survey to get an idea of how everyday activities contributed to fitness levels. About a quarter of the respondents exercised on a regular basis. About half were not moderately active for the minimum recommended time of thirty minutes on at least five days a week. And about a quarter reported no regular moderate physical activity at all.
Some people live in areas without sidewalks, that are many miles from stores, and find they have to drive to shop and run errands, even if they would prefer to walk. Most of us don’t have this excuse. In 2001, however, the average American over fifteen spent more than an hour a day behind a steering wheel. One simple way for a lot of us to become more active is to walk instead of drive to nearby destinations. Walking briskly for a mile burns about 100 calories. If you did that every day for a week, you would burn 700 calories. In a year, you would burn at least 35,000 calories. Let’s do some weight-loss math. For every 3,500 calories burned, you lose one pound, so walking instead of driving to the store could add up to ten pounds a year.
It sounds easy. What’s the catch?
The catch is that habits are harder to break than most people realize. We strongly resist even small changes in our lifestyles, even when they make us feel better almost immediately. We formed most of our habits in childhood and adolescence. A few of us formed healthful eating and exercise habits then and are currently reaping the rewards. A few of us inherited genes that seem to protect us from harm, no matter how we live or what we do. Most of us, unfortunately, don’t have ingrained healthy habits or all-protective genes. We need to look more closely at how we live and making some changes for the better. This is what the PCOS exercise program enables you to do, with as little effort and as much pleasure as possible.
Laura’s new house was only ten minutes from the train station, so she decided to commute by rail to her job in Manhattan after twenty years of driving. Although her trip involved a subway ride after her commuter train arrived at Grand Central, she no longer had to put up with traffic-clogged highways and high city garage fees. As she carried her briefcase up and down ramps and staircases in the rush hour crowds, Laura at first often became winded. With time, the physical effort took less out of her. From the beginning, she had noticed that people on public transportation were noticeably thinner than people who drove to work in the city. New York City was hardly a health spa, but she had to say she was feeling great and was gradually losing weight after her workday treks through the Big Apple’s subterranean passageways.
Laura’s account fits in with the results of a San Diego study in which 65 percent of people who lived in less walkable areas (no sidewalks, far from stores) were overweight, in comparison with 35 percent of people in walkable city neighborhoods. One researcher observed that these people were not more active because they wanted to be. They often had to walk.
Revised guidelines released on January 12, 2005, by the departments of Agriculture and Health and Human Services emphasize that weight loss depends on caloric intake and regular exercise, rather than avoiding specific foods. While previous guidelines recommended thirty minutes of moderate exercise on most days of the week, the new guidelines stress that this amount of activity is a minimum rather than a desirable amount. Instead, the new guidelines recommend the following:
To many people the idea of an hour of exercise a day seems an almost impossible demand. Even if you are willing, who has the time? My suggestion is to focus on finding activities you truly enjoy doing. You’ll be amazed how motivated you become to find time for things you really love to do. That’s exactly where this exercise program takes you—at level 4, you pick and choose what you feel like doing.
Besides helping to prevent weight gain, exercise makes your body function better and builds muscles. Muscle tissue has a high metabolic rate, burning calories instead of storing them. Every pound of muscle that you develop burns an extra thirty-five to fifty calories a day. On a medical level, physical activity, regardless of its intensity, lowers your risk for diabetes and cardiovascular disease, as well as improves high blood pressure, insulin sensitivity, blood sugar control, and blood lipid levels.
When you burn calories through exercise, expect your body to fight back. We still have the bodies of our hunter-gatherer ancestors, who gorged themselves in times of plenty and spent the rest of the time on the brink of starvation. Like theirs, our bodies are designed to conserve the fuel we have stored in the form of fat. As you exercise, if you don’t eat enough food to replenish the calories you are burning, your body tries to conserve energy by becoming more efficient. The 100 calories you burn by running one mile today may be only 90 calories for the same distance tomorrow. This helped our ancestors survive, but acts as an obstacle to your weight loss agenda.
Small, everyday activities that burn calories add up over time to make a real difference. For example, walking up stairs at your workplace (if you can do so) instead of taking the elevator burns more than 100 calories a day, which could add up to a weight loss of more than ten pounds a year. Look for such possible mini activities during the course of your day.
Remember, too, that it takes very little food to cancel out the benefits of a lot of exercise. A single cookie or two apples can cancel out the 300 calories you burned by running for forty-five minutes.
The following are the approximate number of calories a 150-pound woman would burn if she continued the activity for half an hour.
You can check the number of calories burned in various activities at http://www.caloriecontrol.org/exercalc.html.
Fitness is a boon, regardless of your weight. This was shown in a four-year study on the cardiovascular health of 906 women. More than 75 percent of the women were overweight, 70 percent had low fitness levels, and almost 40 percent already had coronary artery disease. Those with low fitness levels were almost 50 percent more likely to have cardiovascular trouble, and fit, overweight women had better outcomes than unfit, thin women.
While fitness plays a great role in cardiac health, weight loss may be more important in diabetes. We know that in comparison with women of normal weight, overweight women are three times as likely to develop type 2 diabetes, and obese women are nine times as likely, and that these risk levels are little affected by the fitness levels of the women. However, according to Dr. Gerald M. Reaven, insulin resistance is related to physical fitness. He regards lack of fitness as important as obesity in predicting insulin sensitivity.
It can be difficult, of course, to separate the benefits of fitness and weight loss, because the two so often accompany each other. Physical activity helps you lose weight, and when you lose weight, physical activity keeps you from regaining it. That’s the happy relationship between the two that you need to keep in mind. Additionally, as you become fitter, you start to feel better, both physically and emotionally.
As mentioned earlier, the program has four levels. Read through the program and decide where you’re going to start. If you were too ambitious—or not ambitious enough—your body will tell you and you can either take a step back or ramp things up with the next level. You choose an entry point in one of the levels. Go backward in weeks or levels if the activity proves too hard, or forward if it is too easy. Rely on your judgment. Don’t rush things. Repeat a week when you feel the need for it. Listen to your body.
The chart below is for general reference. The intensity of effort that you put into a light activity can raise it to a moderate one, or make a moderate activity vigorous.
Vera went from tennis in her twenties, to hiking in her thirties, to shopping in her forties, to finding her car in her fifties. Sometimes a week passed without her ever walking a hundred yards at a time. She had PCOS and, needless to say, a weight problem. You could call Vera highly sedentary, and I have no problem in placing her at Level 1 in our exercise program.
Researchers have estimated that for sedentary people, basic metabolic processes account for 80 percent of the energy burned, with physical activity accounting for only 10 percent. Digestion of food accounts for the final 10 percent. As you know, additional calories not burned for energy are stored in the body, often as body fat. Thus, for very inactive people, the kind of food they eat becomes very important. For them, surplus calories from high-calorie foods go directly to storage. The more active you are, the less you need to worry about the calorie content of the foods you eat.
The average person takes about 6,000 steps a day, which amounts to three miles. Walking another 2,000 steps (an extra mile) would make a positive difference in the health of most of these people. Small changes like this can be an ideal way for previously inactive people to embark on a more active lifestyle. It’s too soon for them to wonder what exercises might best suit them—their primary goal is to simply to make time for some form of exercise on their daily agenda. It almost goes without saying that if you are not sure whether you are active, you are almost certainly inactive.
People who have been nearly totally sedentary for years may read, see, or hear something that inspires them to lead a more active life from that moment onward. Rather than consider what kind of low-impact activity might best suit their unfit condition, they may decide to run a mile or attempt to lift sixty pounds. Fortunately for most, they’re confronted with reality before they hurt themselves. I believe in taking things very gradually at first. In fact, if you are sedentary, I recommend that during the two weeks that you are at this level, and before you progress to Level 2, have your physician advise you on the kinds of physical activity that are safest for you.
The thirty or sixty minutes required can be divided into shorter periods, and the very light or light physical activities can be as various as you wish. The point is to be active without over-doing it.
Roni is overweight and has PCOS. I once considered her very sedentary for a thirty-two-year-old, but after following the program for two weeks she already feels more flexible, something she notices every time she gets up from an armchair or in and out of her car.
While walking, wear loose-fitting clothes and comfortable shoes or sneakers. Stay in safe, well-traveled areas, and don’t assume that everyone outdoors in the early morning is there for fresh air. Avoid unpleasantly hot times of the day by walking earlier or later.
The fact that this is a six-week program does not mean that you must complete it in six weeks. If you miss a few days in any particular week, repeat that week again. Also, if for any reason you feel unready for the next step, there is no need to push yourself to the next level. Simply repeat the week at which you are comfortable, and continue to do so until you are ready to move on.
You can substitute any similar activity for walking briskly. Swimming is a popular alternative.
Many women find that sharing an activity with a friend— pets included—makes the whole enterprise a lot more fun. Plus, you’re more motivated to stick with it—your friend’s expecting you!
Weighing 204 pounds at age 24 and just having been diagnosed with PCOS, Julie started the program at Level 2 and repeated the week to get used to everyday activity before trying anything more strenuous. She now feels she should perhaps have started at Level 3. Julie has plenty of energy but is not the most patient person. Is she ready to structure a new lifestyle? Will she stay with the program, or discard it for some new thing? Repeating the first week at Level 2 is a good sign that she’s committed to doing this for good. If she goes, she can always come back. For now, she is at an enthusiastic Level 3.
It’s always a good idea to mention to your doctor that you will be participating in more vigorous activities. Even if you have cardiovascular problems, he or she will probably welcome the news.
Wear sneakers and a track suit in colder weather or a T-shirt and shorts in warmer weather. You don’t need to spend lots of money on the latest gear to get fit, but well-fitting clothes made of moisture-wicking material are a great way to pat yourself on the back for sticking with the program.
If you become too flushed or out of breath, stop until you recover and then go home. Don’t push yourself to finish that day—in fact, skip the next day if you do not feel well. Never try to run through the pain.
This is a six-week program, but my advice for Level 2 applies here, too: Repeat weeks when you feel you’re not ready to go on to the next. You can also swim rather than jog, if you prefer. (Julie update: She completed the program, lost more than fifteen pounds, and noted a real improvement in her PCOS symptoms.)
It took Martha nine weeks to arrive at Level 4. Like most of us, between work and family there are too many demands on her time. But she never gave up. At thirty-six, she does not allow her PCOS, type 2 diabetes, or high blood pressure to limit her life. A teacher, she rarely misses a day of school, even when she feels truly awful. Reaching Level 4 for her is a real achievement and gives her confidence that she can do and achieve whatever she wants.
Don’t get stuck feeling you have to do the same thing day after day. Walk or jog when you feel like it, or try a low-impact exercise or sport. Experiment until you find several things that you really enjoy. Then follow your fancy. After work and on weekends, ask friends if you can tag along on their favorite outings. Join clubs or teams on a trial basis. Word of mouth, free newspapers, and the Internet are your best sources of information on what is happening locally. Stores that sell shoes and fitness or sports equipment can be sources of info for clubs and teams. A friend who recently bought a pair of running shoes told me that the clerk asked her if she wanted her name on an e-mail list to receive announcements of local programs and events.
I think it’s a good idea to take a few classes before attempting to work out at home, with or without videotapes. Alignment is important in many of these activities, and with an instructor you can do things right from the very beginning.
There are no specific daily guidelines for the multiple activities at this level. My only concern is that you don’t overexert or overtire yourself. Stop the activity if you feel that you are becoming too hot or winded. Don’t fixate on one activity or do any one thing for hours on end. Here are some popular activities that you may find of interest.
Functional training. This popular new trend combines a cardiovascular workout with rehab techniques that help prepare you for small, unexpected challenges such as uneven or icy sidewalks, running for a bus, or reaching at an awkward angle. The exercises focus on your body’s core abdominal and spinal muscles and on improving your reaction speed, agility, and balance. Weaving at speed between plastic cones, stepping quickly over inches-high hurdles, muscle toning with exercise balls, and working out on drill mats are part of the hour-long classes.
Yoga. Finding a good teacher is more important than finding the kind of yoga that might best suit you. A good teacher will inquire about neck, lower back, or knee problems that can be aggravated over time by certain yoga poses or asanas, as most teachers call them. He or she may offer modifications or alternative poses.
Pilates. As with yoga, finding a good teacher is the most important thing. This technique helps build abdominal and back muscles.
Tai chi. A good teacher is also essential in this activity, to make sure you are doing the movements correctly. Both tai chi and yoga are wonderful for restoring body flexibility, loss of which is often one of the most evident signs of aging.
Exercise ball. If you prefer to work out at home, an exercise ball that costs $20 to $40 may be just right for you. Most exercises involve sitting or lying facedown or faceup on the ball. Many of the exercises are those commonly performed on the floor, but when you do them on a ball, its instability forces you to use far more muscles than you would if you were doing the same exercises on a floor mat—mostly abdominal muscles.
Weight lifting. It’s a myth that women who lift weights develop muscles in their arms and legs like a man’s. Women who avoid the weight room for this reason miss out on a great way to prevent osteoporosis, as well as build shapely, feminine muscle tissue. Muscle tissue burns calories even when you are at rest.
If you worry about injury while exercising, see your doctor before rather than afterward. If you exercise to excess, you can hurt yourself. Throwing yourself into strenuous activities that you are not conditioned for makes injury not only possible but likely It is said that vigorous exercise triggers up to 17 percent of sudden cardiac deaths in the United States, which amounts to tens of thousand of deaths a year. In this case, you can do too much of a good thing.
At what kinds of exercise do women most often hurt themselves? The following emergency room admission data were collected by the Sports Medicine Center at the University of Rochester.
Respect your limitations. Age may be one of them. Your present state of fitness is one. A chronic or temporary illness may be another. For example, women with diabetes over the age of thirty-five to forty should undergo stress testing before participating in moderate or more physical activity. Much of this is common sense.
You don’t drive your car at a hundred miles per hour, so don’t put your foot too heavily on the gas when driving your body. You’re in this for the long haul, so pace yourself. Start and progress slowly and rest assured that exercise prolongs far more lives than it cuts short.
