Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1600-0838.2006.00520.x

Evidence for prescribing exercise as therapy in chronic disease.

Background— Cardiovascular disease (CVD) is the leading cause of mortality in men and women in the United States, yet prior research has shown a lack of awareness of risk among women. The purpose of this study was to assess the contemporary awareness, knowledge, and perceptions related to CVD risk among American women and to evaluate trends since 1997, when the American Heart Association initiated a national campaign to improve awareness of CVD among women. Methods and Results— A telephone survey of a nationally representative random sample of women was conducted in June and July 2003, with an oversampling of black and Hispanic women; results were compared with those of similar surveys in 2000 and 1997. The present survey included 1024 respondents age ≥25 years; 68% were white, 12% black, 12% Hispanic, and 8% other ethnicities. Awareness, knowledge, and perceptions about heart disease were evaluated by use of a standard interviewer-assisted questionnaire. A shift in awareness of heart disease as the leadi...

Tracking Women’s Awareness of Heart Disease An American Heart Association National Study

Six focus groups were conducted in South Carolina with African American women (n = 42) aged 19-51 years to identify factors that influence physical activity. Transcripts were analyzed using NUD*IST. Cultural influences were seen as more important in determining the type of physical activity than its level. Barriers to and enablers of physical activity were identified in the social and physical environments, as were policy issues affecting physical activity in the community and at the work site. Potential community and work site interventions were suggested. Child care and monetary costs were frequently cited as barriers to physical activity.

Environmental, policy, and cultural factors related to physical activity in African American women.

Males and females have different patterns of illness and different life spans . . . Understanding the bases of these sex-based differences is important to developing new approaches to prevention, diagnosis, and treatment. THE US CENSUS BUREAU PROJECTS that the US population will have increasing numbers of women in the next decades and a greater proportion of the population will be elderly and nonwhite persons. Women are the major consumers of health care, the major consumers of prescription drugs, and the primary decision makers about health care for their families. As attention is directed to improving health of and health care for women, sex and gender differences in research design and regulatory policies interface with clinical practice. An interdisciplinary, inclusive approach to health care based on sexand gender-specific data is sought by consumers of health care, especially women. Understanding the role of sex in health and disease begins with consistency in medical literature of the terms sex and gender. The recent Institute of Medicine report Exploring the Biological Contributions to Human Health: Does Sex Matter? provides clarification of these terms in its discussions of differences between men and women. The term sex is used when differences are primarily biological in origin and may be genetic or phenotypic (genetic or physiological characteristics of being a man or woman), and gender is used when referring to social and cultural influences based on sex (BOX). There is a long history of advocacy for health care specific to women in the United States, dating as far back as the Popular Health Movement of the 1800s. The efforts of women in medicine, government, and advocacy in the 1980s propelled improvement of women’s health through biomedical research and were primarily based in the public policy realm, relating to the inclusion of women in clinical studies. Results of these efforts included major revisions in policies for research as well as expanding what constitutes women’s health. This goes beyond reproductive health and addresses women’s health across their lifespan. As the women’s health movement focused on the inclusion of women in clinical research to provide basic fundamentals for gender-appropriate health care, there has also been realization that sex and gender comparisons are important factors in research design. Such research has valuable implications for the practicing physician in the care of both female and male patients. Not only may physicians need to make diagnostic and treatment decisions based on the sex of the patient, but they will also need to respond to gender differences in how women and men approach their physicians, their own health, and how they communicate their health concerns.

Sex and gender factors in medical studies: implications for health and clinical practice.

This study was part of a multi-site project carried out with seven universities throughout the United States to identify cultural, environmental, and policy determinants of physical activity in ethnic minority women aged 20 to 50 years. Following an extensive literature review, nine core research questions were created to examine potential barriers to physical activity as well as enabling factors. Methods and findings presented are from six focus groups of low-income, urban African American women. These focus groups were held at each of two health centers serving communities in Chicago, Illinois, that are predominantly African American and low income and have households usually headed by women. Forty-eight women participated, with 5 to 11 in each group. Most (85%) were unmarried, 40% had less than a high school education, and 33% were neither employed nor attending school. Findings reflected the influence of a culture of poverty and the importance of environmental safety and community support. The findings will be used to inform the development of community-based exercise interventions and policies that are culturally and socially sensitive to the needs of low-income, urban African American women.

Environmental, Policy, and Cultural Factors Related to Physical Activity in Urban, African American Women

Women's Cardiovascular Health Network members representing 10 Prevention Research Centers completed a literature review of approximately 65 population-based studies focused on improving women's cardiovascular health through behavior change for tobacco use, physical inactivity, or diet. A framework was developed for conducting the search. Databases (Medline, Psychlit, Smoking and Health, Cumulative Index to Nursing and Allied Health Literature) of studies published from 1980 to 1998 were searched. The review was presented at a meeting of experts held in Atlanta, Georgia. Output from the meeting included identification of what has worked to improve cardiovascular health in women and recommendations for future behavioral research. Additional information is available at www.hsc.wvu.edu/womens-cvh. Cardiovascular health interventions geared toward women are scant. Based on the available studies, program components that emerged as effective included personalized advice on diet and physical activity behaviors an...

Jim Davis

Papers

Cardiovascular Health Interventions in Women: What Works?