that's the battle cry of Dr. Patricia Gillett of the University of Utah College of Nursing, who holds the keys to a large research grant earmarked to investigate exercise strategies for overweight women ages 49-70.
As research for her doctoral dissertation, Gillett conducted a pilot project in 1984 aimed at overweight, women ages 35-58.Her findings on this and other research were sufficiently intriguing to encourage the National Institutes of Health, National Center for Nursing Research, to award $340,000 to the U. College of Nursing for a wider-based study covering five years, with Gillett as principal investigator.
The study will ultimately involve 300 overweight women, who must be generally healthy non-smokers, without diabetes or high blood pressure, weighing approximately 160-220 pounds. They must have written permission from their physicians, and they will undergo a complete battery of physical fitness tests, including cholesterol screening, at five points during the study. (Women interested in joining this study may call 581-8261.)
"Middle-aged and older women often become so involved with caregiving responsibilities, careers and other activities that they ignore their personal health and fitness," said Gillett. "A sedentary, overweight lifestyle may contribute to chronic health problems, low self-esteem, depression and increased dependence on doctors and medications.
"On the other hand, research has demonstrated that regular exercise can have a profound positive impact on older women's physical and mental health. An eight-year study on physical fitness has proved the biggest health gain was realized by sedentary persons who added only moderate amounts of exercise to their daily routines."
She feels there's a big future in geriatric exercise, and that people in the 40-50 age range should be encouraged to "start now." "It's hard to reverse aging changes later, but those who go into exercise early have far fewer such changes to deal with."
In the first project under her new grant, Gillett is training two geriatric nurse practitioners to move out among the women and exercise along with them, on different levels of difficulty. "I wanted to see how an ordinary nurse would do, teaching fitness exercise," she said. "I personally feel that exercise and fitness education would be a good field for nurse practitioners, whose special training would help them avoid injury and encourage safety for older and/or overweight women who exercise. In the future, the nursing profession will be much more concerned with exercise in health promotion than it is now."
Under the grant, Gillett will prepare nurse practitioners to educate the target group about exercise, personal health and fitness, and she will follow their progress over a two-year period. Nurses will teach weekly fitness management seminars, discussing weight control, exercise and other health issues.
She thinks learning exercise physiology is important to the program's success, to identify problems among high-risk clients and show how weight is lost by metabolic change. "The emphasis in weight loss now is too much on diet, not enough on metabolic change," she said.
For her 1984 pilot program, Gillett worked with 38 moderately overweight women, average weight 165.8 pounds and average age 41.9, though enrollment was open up to 58 years. They too were non-smokers, without high blood pressure, not pregnant, sedentary at least six months prior to the study, with their physicians' written medical clearance.
They participated in three one-hour exercise classes each week for 16 weeks, in the form of choreographed dance routines to music.
A control group was given the same routine as a typical commercial fitness class - 15 minutes of warmup, 20-23 minutes of cardiovascular work, four minutes of aerobic cool-down, 15 minutes of strengthening exercises, and six minutes of stretching and relaxation.
An individualized exercise prescription for an experimental group moved a little slower but brought them to the same intensity and duration as the control group within the 16 weeks.
Ninety-four percent finished the program. Of the four who dropped out, two had serious medical problems. "This was exceptionally good," said Gillett. "You would ordinarily see a dropout rate of 50 to 68 percent in 8-12 weeks, in a population such as the one studied." But the women knew they had signed up for an experimental project, hence were more than ordinarily committed.
"We have no glassed-in studios so people can watch, and no mirrors," said Gillett. "The women appreciated privacy, and they liked easy rhythm music, not hard rock. Heavy women are often strong, but not agile. Since they have much more heat buildup than thin women, they should have good ventilation, plenty of drinking water, fans to cool them, and dress coolly with a lot of bare skin."
She found that these women were especially grateful for group homogeneity. Being with people of their own age and size, rather than skinny women under 30, minimized intimidation and self-consciousness, as they worked toward similar goals. The women also enjoyed the social contacts, and many formed carpools that exerted subtle peer pressure in keeping them active.
At the end of the pilot period, the women commented that they felt such benefits as a marked increase in energy and fitness, ability to do housework in half the time, greater lightness on their feet, more alertness, less back and other pain, and increased self-esteem.
Participants felt that tangible improvements had occurred in many pre-existing conditions such as headache, backache, menstrual cramps, gastrointestinal disorders and skin problems. They also reported relief from shortness of breath after mild exertion, lessening of physical discomforts associated with obesity, and increased coordination, strength and stamina.
Many of them expressed hope of changing their body images, improving their general health and conquering health problems, with probable increase in longevity and youthful appearance and feelings.
Among her first group of overweights, Gillett found the average weight loss during the course was 10-12 pounds, some as much as 25 pounds. All said they would exercise after the class, and a followup 18 months later showed that 47 percent did so, though some had backslid part of the way. Some sought out aerobics classes, others walked.
She found these women responded to an instructor who looked something like themselves, near their own age - someone they could hope to look like, not a skinny girl. They also felt more safe and secure with a leader who had a health-care background, who they believed would not encourage them to overdo or injure themselves, and they appreciated Gillett's enthusiasm and optimism.
Based on her first study, Gillett has concluded that women love to dance for exercise. "But overweight women like low impact aerobics, they don't feel up to the professional videos," she said. "They drop out of an exercise program if it's too hard at first."
Gillett has just finished a 12-week fitness program with 30 carefully screened women between 60 and 70 years old, and 100 percent finished the program.
"I found that these older women needed time to socialize," she said. "They need friends as much as an understanding of the body and how it works."
Her success stories among these women include a 67-year-old who came in on a cane, and had to have help with her shoes. "By the end of the program she was walking without her cane," she said, "a classic example of an older person who had regained strength and flexibility."
Her emphasis with older overweight women is a very long warm-up, perhaps as much as 20 minutes, followed by low impact choreographic routines, gradually building to 15-20 minutes maximum exertion, some with light weights to build strength. She feels workouts should be 3-5 days a week.
She found her study groups so far have improved dramatically in overcoming depression, and their blood pressure has dropped. "We saw health changes, but I'm not sure we saw great fitness improvement," she said.
Gillett herself has been a ballerina, having danced with the University Ballet in the 1958 "Nutcracker." "I always danced," she said, "but then I married and had my family, and gained weight. When I found aerobic exercise, I lost 75 pounds and rekindled my love of dance. I thought, if me, why not others too?"
As for finding your own class, she suggests you look for a certified instructor and try different programs. Water aerobics and low-impact classes are to be found at most health facilities, and they are cheaper through continuing education classes and community schools. Eventually you will likely find a class you are comfortable with.