Exercise Exercise can help control or prevent hypertension, diabetes mellitus, hypercholesterolemia, and cardiovascular disease and helps to promote overall good health, psychological wellbeing, and a healthy body weight. Moderate exercise along with calcium supplementation can help retard bone loss in postmenopausal women. During early menopause, weight-bearing exercise alone is not sufficient to prevent bone loss, although it will slow the rate of bone loss (45). Exercise helps promote weight loss, strength and fitness, and stress reduction. Federal exercise guidelines from the U.S. Department of Health and Human Services note that “regular physical activity reduces the risk of many adverse health outcomes; some physical activity is better than none; for most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration; most health benefits occur with at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity physical activity, such as brisk walking. Additional benefits occur with more physical activity; both aerobic (endurance) and muscle-strengthening (resistance) physical activity are beneficial; health benefits occur for children and adolescents, young and middle-aged adults, older adults, and those in every studied racial and ethnic group; the health benefits of physical activity occur for people with disabilities; and the benefits of physical activity far outweigh the possibility of adverse outcomes” (46). To sustain weight loss in adulthood, 60 to 90 minutes of daily moderate-intensity physical activity are recommended. Cardiovascular conditioning, stretching exercises for ﬂexibility, resistance exercises, or calisthenics for muscle strength and endurance are recommended for most people. Most healthy adults do not need to see a physician before starting a moderate-intensity exercise program, although those with chronic diseases and women over 50 who plan a vigorous program have been advised to do so (40). Women should be counseled about safety guidelines for exercise. Factors that should be considered in establishing an exercise program include medical limitations, such as obesity or arthritis, and careful selection of activities that promote health and enhance compliance (1).
Cardiovascular fitness can be evaluated by measurement of heart rate during exercise. As conditioning improves, the heart rate stabilizes at a fixed level. The heart rate at which conditioning will develop is called the target heart rate (1). The traditional formula for calculating the target heart rate is 220 minus the patient’s age times 0.75. A 2010 study examined the definition of a normal heart rate response to exercise stress testing in women and noted that the traditional male-based calculation of target heart rate may not be appropriate for women (47). The new formula for target heart rate, based on this research, is 206 minus the patient’s age times 0.88.
Smoking Cessation Smoking is a major cause of preventable illness, and every opportunity should be taken to encourage patients who smoke to quit. Patient education about the benefits of smoking cessation, clear advice to quit smoking, and physician support improve smoking cessation rates, although 95% of smokers who successfully quit do so on their own. Self-help materials are available from the National Cancer Institute, and community-based support groups and local chapters of the American Cancer Society and the American Lung Association. The combination of counseling and medication (nicotine and nonnicotine options) is more effective than either used alone, and Clinical Practice Guidelines on treating tobacco use and dependence from the
U.S. Department of Health and Human Services provide recommendations (48).