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Staying healthy through the decades: an owner's manual for women

Miami Herald (FL)


June 30--Our bodies don't come with an extended warranty.

The good news is they can last quite a while, but keeping the parts moving smoothly, and warding off the natural effects of aging, is the owner's responsibility. Each decade of a woman's life brings forth new challenges and work-arounds to maintain the best possible health.

The overall message?

"Good nutrition and good movement and good calories and making sure people are moving, staying agile, flexible and strong," said Dr. Judi Woolger, medical director of executive medicine at the University of Miami Miller School of Medicine.

Exercise is a key component of living well, into the 90s and beyond.

"The teens and 20s, those are the ages that will play a big role later in life, that's when women reach their maximum bone density and that starts to taper down with age," says Dr. Luis Roca, a gynecologist with South Miami Hospital's Center for Women and Infants.

Dr. Vivian Birnbaum, internal medicine specialist at Mount Sinai Medical Center, recommends that women exercise five days a week for 30 minutes apiece with a mix of cardiovascular activities like walking, swimming, dancing or biking, along with stretching such as yoga or Pilates, and strengthening exercises of the arms, shoulders, legs and abdominals.

"And that's a minimum, ideal would be more than that," she says.

Haven't started yet? Don't fret.

"The biggest change anyone can make in life is changing from non-exercise to exercise," says cardiologist Dr. Adam Splaver, director of echocardiography for the Memorial Cardiac and Vascular Institute at Memorial Regional Hospital in Hollywood. "I tell my patients all the time: if you're not exercising, try once a week. You kept your appointment with me, now put an appointment on the calendar to exercise for 15 to 20 minutes, for a month. At the end of the month, put the appointment on twice. And then three times. And when you are done with that, increase the intensity.

"Crawl before you can walk, walk before you run and it's the same with exercise."

Here, then, is a guide to dancing through the decades.

The 20s

-- Girl, you're a woman now: "Before 20, patients should have all of their vaccines. It's important women get the human papillomavirus (HPV) vaccine to prevent sexually transmitted diseases related to cancer in the uterus and cervix and vagina and genital areas," Birnbaum says.

Once sexually active, check for cervical cancer via a pap smear test every two years unless abnormalities are detected, upon which testing should be more frequent.

-- Watch for the Freshman 15: ""We break our routines, some women are a lot more active in high school and athletics and get to the collegiate level and may not want to, or have the ability to, compete at the higher level and they become more sedentary,'' said Roca. "Diet becomes an issue ... a lot of women are now away from home and have to determine what they'll eat.''

Avoid processed foods, simple sugars and empty carbs, Splaver adds.

During annual check-ups have your lipid profiles checked, meaning tests for cholesterol, blood pressure. Begin performing breast self-exams.

-- Forbidden fruit: If you haven't begun smoking as a teenager, don't start now. Seek counseling if using tobacco, recreational drugs or abusing alcohol.

The 30s

-- Family and career: "Metabolism in the 30s is not the same as in the 20s," Roca says. "As the decades come we get more involved with our careers, and have families that need our time, and it becomes tougher to stay active. Some women fall into that pitfall where they neglect themselves and focus all of their attention on families and careers and care for everyone else and these type of things can lead to weight gain."

Women start losing bone mass in this decade. Make sure you are consuming calcium, preferably from food sources like cheese, dried herbs such as celery seed, parsley, sage, rosemary and thyme, along with sesame and flax seeds, almonds, yogurt and milk and green leafy vegetables.

Check the thyroid at annual exams.

-- Dental hygiene: You already should have a routine of twice-yearly cleanings and regular dental exams. If not, begin now. The American Dental Association identifies an association between maternal periodontal disease and preterm delivery, preeclampsia and low birth weight infants. Later, periodontal disease can lead to cardiovascular disease.

The 40s

-- Is it hot in here? The perimenopausal period can lead to irregularities as menopause approaches. Hot flashes, mood swings and difficulty sleeping may occur for some women.

Estrogen levels start to drop and, thus, fat storage builds around the abdomen.

"There's a rapid drop in bone density in the perimenopausal [period] because of the loss of estrogen," says Dr. Erin N. Marcus, associate professor of clinical medicine at the University of Miami. Thus, exercise becomes even more important, especially strength training to reduce the risk of osteoporosis. Work on the abdominals, too.

-- Begin annual mammograms: If there is a family history of breast cancer, begin these tests in the preceding decade.

Birnbaum recommends a BRCA test to check for the gene mutation that can predispose a woman to breast or ovarian cancer if a first-degree family member (mother, sister or blood aunt) had breast or ovarian cancer.

The 50s

Have a heart-to-heart with your physician: "As women start to lose the protective effects of estrogen, they are more susceptible to heart disease in this decade and in future decades," Roca says.

"Cardiac risk starts to go up around 55," Marcus says, "and we see more women developing hypertension. Lifestyle modification for prevention is important. Maintain a normal body weight which means activity and diets rich in fruits and vegetables. Avoid sodium. If you have to use canned food, rinse the can's contents to get rid of some of the sodium."

Cardiovascular disease causes one death per minute among women in the United States, more than cancer, respiratory disease, Alzheimer's and accidents combined.

While some women get the classic symptoms such as chest pain or numbness on the left side, a pending heart attack in a woman can reveal itself through neck and back pain, nausea, and feelings of fatigue.

-- Have your first colonoscopy. Depending on the results and family history, the test will be repeated every five to 10 years, more frequently if polyps are found.

-- Screen for diabetes.

The 60s

-- Seek balance: Women should incorporate yoga or tai chi into their fitness routines to promote balance and reduce the risk of falls.

Perform strength training exercises while standing, with good posture, says Beth Jones, program coordinator and clinical exercise physiologist at Memorial West. "Doing things while standing in your 60s and 70s helps bone density. Whether it's cardio or strength training, this helps bone density in the hips and the spine."

Include dancing as part of your cardio training, Jones adds. "It intuitively includes many side to side and turning movements that can fall to the wayside as we age.''

-- Vaccinate for flu, pneumonia and shingles. Get a yearly flu shot but also consider the less-publicized shingles virus. Shingles is a painful, blistering skin rash that can strike at any age among people who have had chickenpox.

-- Eat more, eat smarter: "I see so many people who attempted to lose weight by skipping meals but that's slowing metabolism in the process. Everyone can eat and train like an athlete," Jones says. "You just need to eat more frequently, trying to keep that metabolism revving and be smart with your choices.''

The 70s

-- Feeling blue? Talk it over with your physician. "I always check on depression," Woolger says. "As people get older they might be living alone and getting more mood issues or sadness. I also check functional ability. Do they need help getting to the phone? Driving? Managing money?"

-- Functional fitness: Check around the house to make sure you are better protected against injury, Woolger suggests. Do you need handrails in the shower? Better lighting? How's your hearing?

Water aerobics and walking against the water's resistance while waist-deep in a pool can be among the best and least injurious exercises at this age and beyond.

Rethink some tests. Discuss the continued need for mammogram screening and colonoscopy procedures with your physician if 75 and older. "The breast cancer benefit declines after 75," Birnbaum says. "Also, colonoscopy.''

The 80s and up

-- Don't stop. "You have to be careful starting anything at any age, but for the 80s and up, continue activity as much as possible," Roca says.

Finally, as Jones says, "Keep striving to incorporate the healthy habits learned in earlier years to retain your quality of life."

Follow @HowardCohen on Twitter.


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