Dear Dr. Garner,
I am 28 years old and love to exercise. In fact, I believe I have become addicted. I feel very nervous when I don’t exercise. My mother has told me that too much exercise can cause problems. Could you verify this and give me some guidance as to how to cure this “addiction”?
Exercised out in Elmhurst

Dear Exercised out,
The benefit of exercise in women is well-known. It leads to reduction in cholesterol, blood pressure, weight loss, and even improvement in mood. Most studies in the past have studied the effects of exercise and men.

New studies show that the effects of exercise are not the same for men and women, and that women must be aware of possible hazards of excessive exercise. With normal moderate exercise, there can be phenomenal benefits for women. Excessive exercise, however, can cause many problems.

For example, excessive exercise is one of the general warning signs of an eating disorder. This has a significant association with anorexia and bulimia.
What is excessive? Excessive is defined as exercise two to three hours a day, or a focus on exercising that interferes with daily routines and impairs your ability to carry out other daily activities.

Anxiety and Perfection

Women with high levels of anxiety and perfectionism are particularly likely to exercise to an extreme. Doctors need to assess exercise behavior carefully as a clue to underlying problems. Loss of menstruation is common in women who exercise with high intensity and for long periods of time. The loss of periods is estimated to occur between five and 25%. The part of the brain that controls the hormonal cycle, the hypothalamus, gets turned off.

In young girls who exercise heavily there may be delayed onset of menstruation. In addition, these young girls are at risk for broken bones, curvature of the spine, and even hair loss. A recent study found that 24 - 40% of young ballet dancers had curvature of the spine related to decreased bone mass from exercising.

Swimmers who exercise to excess often lose their periods without necessarily having their weight decrease. The ovaries of female athletes may become polycystic. This is a condition in which there is infertility. Overuse of joints may lead to arthritis later on in life, becoming more common in those who participated in the “Jane Fonda” series.

There is a condition known as the “female athlete triad,” which consists of amenorrhea (no periods), osteoporosis (bone loss), and eating disorder (anorexia and bulimia). The key to prevention of this entity is moderation. Anywhere from 30 to 60 minutes a day of moderate exercise, including housework, walking upstairs, raking the lawn, or other such activities.

If you are doing more than this, I suggest a visit to your doctor and/or physical trainer to discuss your workout. As you note, you feel addicted to working out. This addiction can be similar, and as deadly as addiction to drugs and other medications. I urge you and your doctor to devise a plan, which may include medications, to help alleviate this addiction.

In summary, exercise is excellent, provided it is done in a sensible and moderate way.

Myths About Exercise

There are some myths about exercise and women that I would like to expose. The following are all untrue regarding exercise and women.

Women’s weight training makes the body bulky and muscular. (Women don’t have enough natural male hormone for this.)

Exercise increases breast size. (Breast is fat, not muscle.)

It is bad to exercise if you have arthritis (on the contrary, it is a key treatment for arthritis, and helps maintain flexibility and strength.)

If you stop training, your muscle turns to fat. (Muscle tissue can’t become fat tissue.)

Running is the best way to get fit. (There is no one best way to get fit.)
If you don’t exercise an hour a day, five to seven days a week, you might as well do nothing. (Even modest amounts of exercise one to two days a week have been shown to be helpful.)

You can lose weight and sustain it only with diet. (Diet and exercise are partners in the plan.)

No pain, no gain. (Not true. Pain is a sign from your body to be alert to possible danger. Listen!)

The best time to exercise is in the morning. (There is no best time – whenever you feel most motivated.)

If you drink water when you exercise you will get cramps. (The body needs to replenish water.)

You should not exercise during menstruation. (Only if you have severe cramps.)
It is good to carry light weights when you walk. (There is no benefit to carrying light weights, and it cuts down on your aerobic exercise.)

Exercise burns a lot of calories. (On the contrary, walking 30 minutes burns approximately 100 calories. Sitting for 30 minutes burns about 50 calories.)

Working out during pregnancy causes low birth weight babies. (Always check with your doctor before exercising in pregnancy.)

African Americans don’t get osteoporosis. (African Americans are catching up to Caucasians in the amount of osteoporosis and in the number of hip and spine fractures they experience.)

I hope this has been a helpful discussion regarding exercise in women. This is a topic that has long been ignored. As you can see, there are many potential pitfalls as well as benefits to exercising. Anyone contemplating an exercise plan should visit her physician, as well as a physical trainer prior to commencing a new program.

Next week we hear from a reader who wants to know about osteoporosis and possible treatment.

Until then, have a great week and be well, and I’ll see you on our next live Ask the Doctor Show on Tuesday, March 20, at 8 p.m.

Dr. Steven Garner is affiliated with the New York Methodist Hospital in Park Slope and he is a Fidelis Care provider. He is also the host of the popular call-in cable TV show “Ask the Doctor” seen locally on The Prayer Channel.