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The Fit Woman of the 21st Century: Making Lifelong Exercise the Norm

Angela D. Smith, MD


My great-grandmother worked the fields, helped out in the family corn-broom factory, and raised nine children who played as a team in neighborhood baseball games. Along the way she undoubtedly met the surgeon general's recommendations for fitness, with ample weight-bearing exercise and strength training to boot.

Since her time, exercise has not always been a woman's lot. Though the 20th century has witnessed the expansion of women's sports opportunities and the establishment of the long-term health benefits of an active life, many girls and women of all ages do not participate in sports and may not see those benefits unless we as sports medicine physicians strive to make exercise more desirable and accessible for the women of the next millennium.

Active and Sedentary Heritage

Our grandmothers. My grandmother, like my great-grandmother, was active all her life. She was a strong swimmer and head lifeguard at the community pool in the early 1930s. Hardly typical, she left the hills of Tennessee to become an advertising woman in New York City. As a young mother, she returned and became a civic leader, gardener, and summer lifeguard. In her 70s, she mowed her lawn with a push mower and frequently walked "up the hill" a mile for lunch or groceries.

The sedentary norm. My grandmother's sister, on the other hand, was virtually sedentary. Rarely did she or any of her women friends walk around the block. As the 1950s brought shopping centers, affordable cars, and effort-saving cleaning devices for the home, less physical activity became the norm.

Our mothers. My mother and her peers varied in their exercise patterns. My mother roller-skated everywhere as a child, played basketball through high school, competed in synchronized swimming and soccer in college, and golfed throughout pregnancy. As a 1950s mother, homemaker, and school teacher, she became much less physically active. In semi-retirement, she proudly resumed regular exercise—daily 3-mile walks and short neighborhood bike rides. In her 70s, she moved into a one-story house and was shocked to discover some time later that she could barely get up from washing the floor. So she quickly began stair climbing for quadriceps strengthening, and normal function returned.

Most of my mother's peers, though, never played sports and do little physical activity. Now these sedentary women—like my grandmother's sister and her friends—are learning the devastating effects. Many have been at least temporarily disabled by osteoporotic hip, spine, or wrist fractures. They are also at risk for cardiovascular disease and other deadly inactivity-related disorders such as hypertension, respiratory disease, and cancer.

Baby Boomers—A Mixed Bag

Activity levels have varied widely among my peers. Some primarily played with dolls as children, talked on the phone as teens, played bridge in college, and have pursued mainly sedentary pastimes as adults. Others enjoyed sports or aerobic classes for a few years but have remained relatively inactive overall.

Those few who were "tomboys" as children played daily sports in high school and college (in spite of sometimes being stigmatized as "different") and have continued intense, regular exercise as adults. Balancing regular exercise with the myriad demands of work, home, and other responsibilities to create a healthy lifestyle has been difficult. However, we know that doing so can slow bone loss and decrease the risk of other age-related disorders.

The Title IX Generation

Our children and grandchildren live in the era of Title IX, the 1972 statute that mandated equal access to educational programs—including athletics—for both sexes in federally funded schools.

Exercise benefits. This legislation coincided with an explosion of information on the short- and long-term benefits of exercise for women. In the short term, women may see improved weight control, stress relief, and sense of well-being. In the long term, women who exercise have decreased risk of cardiovascular and respiratory disease (1) and may have reduced risk of cancers (2). Exercise also decreases the risk of hip fracture, an injury that leads to death or greater dependence for almost half of the women who sustain it (3).

Expanded opportunities. Title IX also coincided with the burgeoning of women's sports participation. Now the first generation of young women whose team sport opportunities were mandated have watched American women win Olympic gold medals in softball, soccer, and ice hockey. Given the numbers of girls who started gymnastics after watching Nadia Comaneci and Mary Lou Retton, we can anticipate similar results for team sports among the young girls who emulate the athletes involved in these recent Olympic triumphs.

Barriers to Sports Participation

The female athlete triad. In spite of these known benefits and the Olympic publicity, not all girls and young women look up to elite athletes. Some may be frightened by the high-profile reports of young women who suffer from the female athlete triad of disordered eating, amenorrhea, and osteoporosis. This association is unfortunate because the benefits of exercise undoubtedly far outweigh the risks for most women, and the triad often stems from pressures on athletes to be unrealistically thin and not from the activity itself. Athletes, coaches, and healthcare professionals must watch carefully for signs of the triad so that appropriate preventive measures can be taken early.

Elite athletes' lifestyle. Some parents may steer their daughters away from sports because they consider the lifestyle of successful athletes too atypical. Many people cannot conceive of adolescence without afternoon hang-outs, lengthy telephone calls, and regular weekend dances and movies.

Certainly, young, elite athletes must now make unprecedented choices. Tara Lipinski, Olympic figure skating gold medalist and a millionaire at 15, turned professional so she could see her father more frequently, since her training would be less rigorous, and then embarked on a 3-month, 59-city skating tour. What parents may not realize, however, is that teenaged gymnasts, tennis players, figure skaters, and swimmers generally profess great personal satisfaction in devoting nearly all of their time to their sport.

Social and cultural restraints. Many of today's girls and young women are learning about the benefits of exercise, and their schools emphasize lifelong physical activities such as aerobics and strength and flexibility training. However, other schools have decreased physical education requirements or still stress activities such as football or baseball technique and scoring rather than individual activities or games that maximize participation. School budget cuts threaten even the current, inconsistent elementary, middle, and high school physical education programs.

Some adolescent girls play organized sports or exercise at home or sports centers, while others, for social, cultural, or safety reasons—especially those who live in the inner city—choose to be inactive. In addition, television and computers occupy children and teens who might otherwise play outdoors or join in other physical activities (4).

For older women, too. Older women who are interested in sports and fitness activities may face cultural taboos against appearing in public in exercise garb or may feel unsafe exercising outdoors at night, which may be the only available time. Furthermore, they may be unsure about how to start an exercise program, or they may begin too rapidly and develop an injury that makes them wary of trying to exercise in the future.

Goals for the Next Millennium

With the new millennium just around the corner, it's time to think about what we in sports medicine want for 21st-century women. Eliminating the barriers that hinder women's fitness should be our main goal. We can begin to achieve this end if we do the following:

  • Keep children and teens active by working to reinstitute or maintain physical education from kindergarten through high school;
  • Ensure healthful sports and fitness activities for teens and young women;
  • Determine what problems prevent 40- to 75-year-old women from participating in sport and fitness activities and help them to find solutions; and
  • Increase the availability of fitness information and programs for women over 75.

By promoting such initiatives, we encourage our mothers, sisters, daughters, wives, partners, and patients to improve their physical and mental well-being by staying as active as possible. We also begin to establish a community of women whose physical activity throughout life reinforces exercise as the norm for all women. In doing so, we create a sense of generational continuity by linking the physically active lives of our great-grandmothers to our own and to those of the women who will help shape the next century.


  1. Kushi LH, Fee RM, Folsom AR, et al: Physical activity and mortality in postmenopausal women. JAMA 1997;277(16):1287-1292
  2. Blair SN, Kohl HW III, Paffenbarger RS Jr, et al: Physical fitness and all-cause mortality: a prospective study of healthy men and women. JAMA 120219;262(17):2395-2401
  3. Cummings SR, Kelsey JL, Nevitt MC, et al: Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 120215;7:178-208
  4. Andersen RE, Crespo CJ, Bartlett SJ, et al: Relationship of physical activity and television watching with body weight and level of fatness among children. JAMA 192021;279(12):938-942

Dr Smith is an assistant professor of orthopedics at Case Western Reserve University School of Medicine in Cleveland. She is a fellow of the American College of Sports Medicine and an editorial board member of The Physician and Sportsmedicine. Address correspendence to Angela D. Smith, MD, Dept of Orthopaedics, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106.



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