Exercise and health in reproductive aged women - 12 August 2011

Young women need to be encouraged to prioritise regular exercise – for reproductive and general health.

Author

Dr Cheryce Harrison BBNSc, PhD

Research Fellow School of Public Health & Preventive Medicine, Jean Hailes Research Unit, Monash University

Introduction

REGULAR physical activity has long been recognised as fundamental for physical and emotional wellbeing, and the benefits are well documented.

Despite this, most Australians – 70%– over the age of 15 years do not meet national recommendations for physical activity. Combined with increased availability of energy-dense foods and less movement overall, the Australian population, especially younger women of reproductive age, are gaining weight rapidly.

Large cross-sectional¹ and longitudinal² studies demonstrate that younger women prioritise physical activity less than men of the same age.

Results from a younger cohort within the Australian Longitudinal Study on Women's Health (ALSWH) found a downward trend in physical activity over time, especially in overweight women, and an upward trend in weight gain with increased sitting time.³

Psychological Health

Regular exercise has been linked to a number of psychological health outcomes including⁴:

Reduced depressive symptoms
Reduced symptoms of stress and anxiety
Improved mood
Improved self-efficacy.

The impact of regular exercise on the psychological health of young women is particularly important.

An extensive population-based study assessing psychological health and exercise in men and women reported a higher incidence of anxiety, depression and anxious depression in young women compared to men.

However, in comparison to young women who did not regularly exercise, those that did had a reduced prevalence across all three conditions.⁵

In the reproductive years, about 10–15% of women will experience postnatal depression.⁶

Walking groups have been associated with lowered postnatal depression scores and improved fitness in new mothers,⁷ which is likely to impact on stress, coping strategies, self-efficacy and sleeping patterns.

With pregnancy and childbirth shown to be a barrier for physical activity, advising women who have recently given birth without complication to exercise is likely to impact significantly on emotional wellbeing.

Physical Health

Regular exercise is a well documented preventive factor for many lifestyle-related diseases including:

Obesity
Insulin resistance or prediabetes
Type 2 diabetes
Metabolic syndrome
Cardiovascular disease.

While the benefits of exercise in weight loss independent of diet are less consistently demonstrated, exercise combined with diet appears to have an additive effect on percentage weight loss compared to diet alone.

There also appears to be an important role of regular exercise (one hour a day) in preventing weight regain following weight loss.⁸

In groups of young women with insulin resistance, such as those that are overweight or obese or who have been diagnosed with polycystic ovary syndrome (PCOS), exercise independently improves insulin sensitivity and menstrual regularity.⁹

In pregnancy, regular physical activity is associated with a reduced risk of gestational diabetes mellitus (GDM)^10,11 and excess gestational weight gain.

Overcoming Barriers

Often younger women are aware that regular physical activity is important, but simply don't prioritise it.

Barriers often include important life events such as moving out of home, completing university, childbearing and beginning a new career, as well as self-perceived barriers such as lack of motivation and time, fatigue, effort and low self-efficacy.

Identifying and overcoming barriers is essential to enable young women to exercise regularly. Young women may feel they can't afford gym memberships or exercise programs, and due to lack of time and immediate results, may think, "What's the point?" or believe it's "all too hard".

However, walking – the most popular form of exercise reported by women – is free, easily assessable, widely applicable and socially stimulating. Therefore, encouraging women to think simply about exercise may improve self-efficacy and likelihood to participate.

Advice for your female patients

Cardiovascular disease is the largest contributor to female mortality in Australia, and most young women underestimate their risk. Incorporating 30–45 minutes of moderate physical activity 3–5 times per week and some vigorous activity where possible, can reduce the risk of cardiovascular disease.
Highlight the benefits of regular exercise other than what women may expect to hear: e.g. it improves metabolic and heart health, fertility (if overweight) and self-confidence.
Identify barriers for not completing exercise and try problem solving (e.g. if too tired at night, exercise before work or walk during lunch time).
Set small yet achievable goals for completing exercise to help set realistic expectations and prevent relapse.
Walking groups with friends or families may be particularly useful during pregnancy, for young mothers or for those who are less confident.
Keep track of activity patterns by self-monitoring – pedometers, exercise diaries and phone applications can all be useful tools.

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References

1. Troiano, R.P., Berrigan, D., Dodd, K.W., et al. Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise40, 181-188.

2. Clarke, P.J., O'Malley, P.M., Johnston, L.D., et al. Differential trends in weight-related health behaviors among American young adults by gender, race/ethnicity, and socioeconomic status: 1984-2006. American Journal of Public Health99, 1893-1901.

3. Adamson, L., Brown W, Byles J, Chojenta C, Dobson A, Fitzgerald D, Hockey R, Loxton D, Powers J, Spallek M, Waters B, & Watson M. (2007) Women's Weight: Findings from the Australian Longitudinal Study on Women's Health. . Australian Government Department of Health and Ageing.

4. Ströhle, A. (2009) Physical activity, exercise, depression and anxiety disorders. Journal of Neural Transmission116, 777-784.

5. De Moor, M.H.M., Beem, A.L., Stubbe, J.H., et al. (2006) Regular exercise, anxiety, depression and personality: A population-based study. Preventive Medicine42, 273-279.

6. O'Hara, M.W. & Swain, A.M. (1996) Rates and risk of postpartum depression-A meta-analysis. International Review of Psychiatry8, 37-54.

7. Armstrong, K. & Edwards, H. (2003) The effects of exercise and social support on mothers reporting depressive symptoms: A pilot randomized controlled trial. International Journal of Mental Health Nursing12, 130-138.

8. Hill, J.O., Wyatt, H., Phelan, S., et al. The National Weight Control Registry: Is it Useful in Helping Deal with Our Obesity Epidemic? Journal of Nutrition Education and Behavior37, 206-210.

9. Harrison, C.L., Lombard, C.B., Moran, L.J., et al. (2010) Exercise therapy in polycystic ovary syndrome: a systematic review. Human Reproduction Update17, 171-183.

10. Dempsey, J., Sorensen TK, Williams MA, Lee IM, Miller MS, Dashow EE, et al. (2004) Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am. J. Epidemiol.159, 663-670.

11. Oken, E., Ning Y, Rifas-Shiman SL, Radesky JS, Rich-Edwards JW, Gillman MW. (2006) Associations of physical activity and inactivity before and during pregnancy with glucose tolerance. Obstetrics and Gynecology108, 1200-1207.