Ph ysic al A ctiv ity and Wome n’s

He alth 

Ch rist ine L. W ells 

ARI ZONA STA TE UNI VERS ITY

A NOTE FRO M TH E ED ITOR S

ORIGINALLY PUBLISHED AS SERIES 2, NUMBER 5, OF THE PCPFS RESEARCH DIGEST.

HI GHLI GHT

“W e h a ve fa iled —in p h ysic a l ed u ca t ion a n d m e d ici n e—t o cl a rif y

fo r wom en t h e im p ort a n ce of h a bit u a l p h ysic a l a c t ivi t y,

p h ysic a l fi t n es s, a n d m a in t e n a n c e of ‘n orm a l’ bo d y we igh t . We 

m u st m o u n t n e w ed u ca t ion a l ef fort s t o d e velo p cu lt u r a lly 

se n sit ive a n d et h n ic -sp e cifi c h e a lt h m e ssa g es a n d p r ogra m s.” 

Many more women are active today compared to when the first studies of activity in America

were conducted. However, as a group, girls and women are still less active than boys and men.

Some of this difference in activity between males and females can be explained by the

historical disparity in opportunities for females. Since 1972, when Title IX was implemented,

more females have become involved in organized sport. We have yet to discover the effects of

this increased participation on lifetime activity among females.

Much of the literature concerning health benefits of physical activity is based on studies

done primarily with men. Only recently have large-scale studies been initiated to investigate

the effects of physical activity on women’s health and wellness. Chris Wells, the author of this

paper, has been a pioneer in the study of physical activity for women. As you will see, much

more research studying girls and women is necessary, but much has been accomplished in

recent years. Diseases often thought to be “diseases of men” affect women as well as men.

The evidence now suggests there are many health benefits for females who become regularly

involved in physical activity.

This article clearly shows that women, especially women of color, are more likely to be

sedentary. Sedentary living increases risk of heart disease, various cancers, hypertension,

stroke, and non-insulin diabetes. Controlling body fatness, another factor that is related to

increased risk of chronic diseases, is also associated with inactivity. Continued efforts that

focus on increasing physical activity among girls and women will reduce the risk of chronic

diseases and death.
IN TROD UCTI ON

Healthy People 2000 sets forth the nation’s health goals for the next decade (Public Health

Service, 1990). One of three primary goals is to reduce health disparities among Americans.

This goal addresses reducing preventable disease and death from chronic diseases among

racial and ethnic minorities in the United States. Also of importance is the disparity that exists

among women as compared to men and among women of different racial and ethnic groups.

It is significant that of eight priorities for health promotion and disease prevention, increased

physical activity and fitness leads the list. If we could increase physical activity and decrease

obesity, the reasoning goes, much of the premature death, disease, and disability of high-risk

populations could be virtually eliminated. But, what is the relationship between physical

activity and health in women? Can a strong case be made for increasing physical activity in

women as a primary preventive measure for major chronic disease? Will increasing physical

activity reduce risk of disease and improve the health and wellness of women? Is physical

activity as beneficial for women as research has shown it to be for men?

This paper will address this issue by presenting the growing body of evidence for the

beneficial relationships between physical activity (including exercise and physical fitness) and

the major chronic diseases in women, with special reference to race and ethnicity. It will be

evident that American women need to make significant lifestyle modifications to alter their

health risks, and that health and educational professionals must mount new efforts to develop

culturally appropriate and sensitive health programs and educational materials.

But, first, how physically active are American women?

HO W PH YSIC ALLY ACT IVE ARE AMER ICAN WOM EN?

The most current data on habitual physical activity are from the Behavioral Risk Factor

Surveillance System (BRFSS), a state-based, random-digit-dialed telephone survey that

collects self-reported information from a representative sample of people 18 years of age and

older. In 1992, BRFSS data were available from 55,506 women from 48 states and the District

of Columbia (Prevalence of recommended levels . . . , 1995). These women were asked about

the frequency, duration, and intensity of their leisuretime physical activity (LTPA) during the

preceding month. Respondents were categorized as having (1) no LTPA, (2) irregular activity

that did not meet the recommended criteria for either vigorous physical activity (≥20 minutes

per day of vigorous physical activity on ≥3 days per week) or the newer moderate activity

recommendation (accumulation of >30 minutes per day of moderate activity on ≥5 days per

week) (Summary Statement, CDC and ACSM, 1993). Only 27.1 % of these women reported

participation in recommended activity levels, and 30.2% reported no leisuretime physical

activity whatsoever. The prevalence of no LTPA increased with age from 25.6% among

women 18 to 34 years to 42.1 % among women over age 65. Racial/ethnic disparity was

clearly evident. Black non-Hispanic women were less likely to be active (43.6%) than

Hispanic women (40.2%) or white non-Hispanic women (27.6%). Physical inactivity was

inversely related to income. Women with ≤$14,999 annual household income were most

likely to have no LTPA (40.2%), and women with ≥$50,000 annual income were least likely

to have no LTPA (21.2%).
BRFSS data from 1991 and 1992 were combined to increase precision of prevalence

estimates for minority populations (Prevalence of selected . . . , 1994). Sedentary lifestyle was

defined as reported participation in fewer than three 20-minute sessions of LTPA per week

excluding usual job-related physical activity. A sedentary lifestyle was reported most

frequently among black women (68%) and least frequently among white women (56%).

When racial/ethnic data were further stratified by level of education, the prevalence of

sedentary lifestyle varied inversely with education within all five population groups. These

data are shown in Table 8.1.

TA BLE 8.1

Pr ev al en ce of se den t ar y li f est y le in U. S. wo m en , b y r a ce, et h n ic ity , an d

ed u cat ion le v el. Be h av i or al r i sk f a ctor su r v ei llan ce sy stem , Un ited St ates ,

19 91–1 992. 

Native American/ Asian/ Alaskan Pacific Women White Black Hispanic

Native Islander

Se dent ary

Li fest yle 56 .4 67 .7 61 .9 64 .1 64 .7

Education Level

<1 2 ye ars 72 .0 78 .2 73 .6 76 .6 68 .5

 1 2 ye ars 63 .3 70 .0 58 .2 70 .5 70 .0

>1 2 ye ars 48 .8 59 .5 53 .4 49 .9 62 .4

Adapted from: Prevalence of selected risk factors for chronic disease by education level in

racial/ethnic populations—United States, 1991–1992. Morbidity and Mortality Weekly

Report, 43(48), pp. 895, 897. December 9, 1994.

Other estimates of physical activity among American women have been equally low.

Caspersen et al. (1986) estimated that 30.2% of American women were sedentary, 31.3% were

irregularly active, 31.5% were regularly active at low levels of intensity, and that only 7% of

women were sufficiently active to achieve the 1990 physical activity objectives for the nation.

Ford et al. (1991) reported that women of higher socioeconomic status (SES) living in

Pittsburgh spent significantly more time per week in LTPA, job-related physical activity, and

household physical activity than did lower SES women. They estimated that only 7% of lower

SES women expended ≥2,000 kcal/week, the energy expenditure linked to lower allcause

mortality in college alumni (Paffenbarger et al., 1986), compared to 16.8% of higher SES

women.

Under the general assumption that low habitual energy expenditure results in obesity

(excessive body fat), another way to estimate population specific physical activity is to assess

body weight relative to height. BRFSS data on prevalence of overweight using body mass

index (BMI = weight in kilograms divided by height in meters squared) ≥27.3 as the

definition of overweight, indicates that black women have the highest prevalence of

overweight (37.7%), followed by American Indian/ Alaskan Native women (30.3%), Hispanic

women (26.5%), white women (21.7%), and Asian/Pacific Islander women (10.1%)

(Prevalence of selected . . . , 1994). In addition, the prevalence of overweight varied inversely

with level of education with all five population groups. Except for the low prevalence of

overweight in Asian/Pacific Islander women, these values correspond to those of Table 8.1 for

sedentary lifestyle.
LE ADIN G CA USES OF MORT ALIT Y IN AME RICA N

WO MEN

In 1990, four of the ten leading causes of death in American women were chronic diseases

directly associated with modifiable behavioral factors including physical inactivity or

sedentary lifestyle. They were heart disease, certain forms of cancer (specifically, breast and

colon cancers), cerebrovascular disease (hypertension and stroke), and non-insulin-dependent

diabetes mellitus (NIDDM) (National Center for Health Statistics, 1993). McGinnis and Foege

(1993) summarized reports that attributed dietary factors and sedentary lifestyles with 22 to

30% of cardiovascular deaths, 20 to 60% of cancer deaths, and 30% of diabetes deaths. The

only more prominent behavioral contributor to mortality than diet and physical inactivity was

use of tobacco.

Table 8.2 presents age-adjusted mortality rates for chronic diseases associated with

sedentary lifestyle in U.S. women by race and ethnicity. Coronary heart disease (CHD) and

cerebrovascular disease (stroke) are the two leading causes of death in all five population

groups. Diabetes ranks as the third leading cause of death from chronic disease in black,

Hispanic, Native American/Alaskan Native, and Asian/Pacific Islander women (exceeding

death rates from lung cancer, breast cancer, chronic obstructive pulmonary disease, and

colorectal cancer) (Centers for Disease Control, 1994).

TA BLE 8 .2

Ag e-ad ju st ed m or ta lity r at es* , U.S. wom en , 1990 .

Native American/ Asian/ Alaskan Pacific White Black Hispanic Native

Islander

CH D 13 0.2 14 8.3 14 7.1 74 .5 73 .7

St roke 45 .8 68 .7 45 .4 31 .4 43 .7

Breast Cancer 2 9.1 33 .4 25 .0 12 .1 11 .9

Co lore ctal 17 .0 22 .9 15 .0 9. 7 9. 9 Ca ncer 

Di abet es 14 .8 37 .1 27 .6 1. 0 11 .8

*Rate per 100,000 persons adjusted to the 1980 standard U.S. population.

Adapted from: Centers for Disease Control and Prevention (1994). Chronic Disease i n

Minority Populations, pp. C-3–C-4, Atlanta, GA: Centers for Disease Control and

Prevention.

Morbidity data correspond closely to mortality data. Table 8.3 provides age-adjusted

prevalence of chronic disease in U.S. women between 1986 and 1990. Health disparities

among racial/ethnic groups are evident with exceedingly high morbidity from chronic

diseases that are major causes of death among black, Hispanic, and Native American/Alaskan

Native women compared to white and Asian/Pacific Islander women.

TA BLE 8 .3

Ag e-ad ju st ed p r e v ale n ce* of ch r on i c di seas e, U. S. wo m en , 19 86–1 990. 

Native American/ Asian/ Alaskan Pacific White Black Hispanic Native

Islander

Hypertension10 .96 19 .73 10 .55 13 .82 8. 35
Di abet es 2 .36 4. 89 3. 53 5 .04 2. 38

Co rona ry

Heart Disease 1 .83 1. 42 3. 53 n .a. n .a.

St roke 0 .98 1. 20 1. 10 n .a. n .a.

*Per 100,000.

Adapted from: Centers for Disease Control and Prevention (1994). Chronic Disease i n

Minority Populations, Atlanta, GA: Centers for Disease Control and Prevention.

The remainder of this paper will describe evidence linking sedentary lifestyle/physical

inactivity with diseases of the heart, hypertension and stroke, breast and colorectal cancer, and

non-insulin-dependent diabetes mellitus.

PH YSIC AL I NACT IVIT Y AN D DI SEAS ES O F TH E HE ART

IN WOM EN

According to the American Heart Association, in 1991, 51.8% of all deaths from “total

cardiovascular diseases” occurred in women (American Heart Association, 1994). The

National Heart, Lung, and Blood Institute (Public Health Service, 1992) reports that one in ten

women 45 to 64 years of age has some form of heart disease, and that this increases to one in

four in women over age 65. Major modifiable risk factors include smoking, high blood

cholesterol, high blood pressure, and physical inactivity. The following discussion will

exclude smoking.

Physical activity and blood cholesterol in women. A blood lipid profile that

places an individual at risk consists of elevated total cholesterol (TC), elevated low-density

lipoprotein-cholesterol (LDL-C), and elevated triglycerides (TG). High levels of high-density

lipoprotein-cholesterol (HDL-C) are considered protective from CHD. Women generally have

higher HDL-C and lower LDL-C values than men prior to menopause. This is attributed to

estrogen, which interferes with the uptake of LDL-C in arterial walls. Following menopause,

HDL-C values decline, LDL-C values increase, and TC values increase, sometimes well above

those of age-matched men.

Following a meta-analysis to examine the effect of exercise training on serum lipids in women,

Lokey and Tran (1989) concluded that training was associated with lower TC, TG, and TC/HDL-C,

but not to changes in HDL-C or LDL-C. The average age of the subjects was 29.5 years, and the

women with the most atherogenic lipid profiles benefited the most. In 20- to 40-year-old women,

24 weeks of walking yielded an increase in HDL-C independent of walking intensity (Duncan et

al., 1991). In the Healthy Women’s Study, a longitudinal study that is following originally

premenopausal women through menopause, women with higher physical activity had the least agerelated weight gain and the least decline in HDL-C (Owens et al., 1992). At the beginning of the

study, only women reporting >2000 kcal/week energy expenditure had significantly better profiles

for TC, TG, LDL-C, and HDL2-C (Owens et al., 1990).

In their review, Shoenhair and Wells (1995) concluded that cross-sectional data strongly

support an inverse relationship between current physical fitness and TC, TG, TC/HDL-C, and

HDL-C/LDL-C. HDL-C values appear to be elevated in only the most highly fit women. Preand postmenopausal athletes have less atherogenic lipid profiles than sedentary or less active

women matched for age and menopausal status (Rainville & Vaccaro, 1984; Harting et al.,

1984; Stevenson et al., 1995).
Ph ysic a l a c t ivi t y a n d bl ood p r essu re in wo m en . In the Healthy Women’s

Study, systolic blood pressure was lower in women expending >500 kcal per week, and

diastolic blood pressure was lower in those expending >1000 kcal/week compared to

sedentary women (Owens et al., 1990). In the Stanford Community Health Survey, lower

diastolic blood pressure was associated with both vigorous exercise (Sallis et al., 1986a) and

moderate intensity exercise (Sallis et al., 1986b). In 1991, Reaven et al. reported a significant

inverse relationship between physical activity and blood pressure in women. They reported

that the most active women had systolic blood pressures 9–24 mmHg lower and diastolic

blood pressures 3–13 mmHg lower than the least active women after accounting for

differences in body mass index.

A strong relationship also appears to exist between physical fitness and blood pressure in

women. In the Aerobics Center Longitudinal Study, Gibbons et al. (1983) reported that

cardiovascular fitness was independently associated with lower blood pressure. In Canadian

women, blood pressure was significantly lower in subjects with the highest fitness

classification (Jette et al., 1992).

Ph ysic a l in a ct i vit y a n d ca rd io va sc u la r d i sea s e in wo m en . Very few

studies have been completed on physical inactivity and CVD in American women (for an

extensive review including international literature, see Schoenhair & Wells, 1995). In a

homogeneous population of 17,000 Seventh-Day Adventist women, a population at relatively

low risk for CVD, occupational and leisuretime activity was combined and subjects were

grouped into three activity classifications. A strong inverse relationship was found between

physical activity and CHD mortality. Relative risk ratios for the “high,” “moderate,” and

“low” activity groups were .41, .61, and 1.0, respectively (Fraser et al., 1992). After 24 years

of observation, an active lifestyle lowered the age-adjusted incidence of CHD and myocardial

infarction in Framingham women by a factor of 2.5 (Kannel & Sorlie, 1979).

In a classic prospective study of allcause mortality in the predominantly white, upper SES

population of the Aerobics Center Longitudinal Study, Blair et al. (1989) reported a strong inverse

relationship between cardiorespiratory fitness and death from cardiovascular disease. Women in the

lowest quintile of physical fitness had an age-adjusted death rate from cardiovascular disease of 7.4

(per 10,000 person-years) compared to 2.9 and 0.8 for women in fitness groups 2–3 and 4–5.

Women in the lowest fitness category had an age-adjusted relative risk of 8.0 when compared with

women in fitness quintiles 4 and 5.

In summary, there is strong observational and experimental evidence that physical

inactivity plays a significant role in the development of cardiovascular disease in women, and

that habitual physical activity and at least a moderate level of cardiorespiratory fitness offers

protection from these diseases in women as well as in men.

PH YSIC AL I NACT IVIT Y, H YPER TENS ION AND STRO KE

IN WOM EN

Nonfatal stroke is the leading cause of disability among American women. Risk factors for

stroke include hypertension, heart disease, and smoking. Approximately two-thirds of all

stroke victims have hypertension (HT). Until age 64, HT is more prevalent in men, and

thereafter is more prevalent in women (Cowley et al., 1992). There is increasing prevalence of

HT with age, and wide disparity among race/ethnic groups ranging from 2% in young white

women to 83% in black women over 65 (Public Health Service, 1990, p. 392).
In the subjects originally studied by Gibbons et al. (1983), and followed for one to 12

years, Blair et al. (1984) reported that low physical fitness was an independent contributor to

the risk of developing hypertension (RR = 1.52) after controlling for sex, age, baseline blood

pressure, baseline body mass index, and follow-up interval. In a related study, lower fitness

was significantly related to the increased incidence of nonfatal stroke (Blair et al., 1989).

A strong inverse relationship between LTPA and death from stroke was observed in

postmenopausal women (Paganini-Hill et al., 1988). Those who were physically active less

than 30 minutes per day had twice the age-adjusted mortality from stroke as women who were

active at least one hour per day.

Although there is less research available, it seems clear that habitual physical activity

reduces the risk of hypertension in women, and consequently, is a primary preventive

measure against stroke.

PH YSIC AL I NACT IVIT Y AN D BR EAST AND 

CO LORE CTAL CAN CERS IN WOME N

Data on cancer relative to physical activity have been inconsistent and difficult to interpret

because cancer represents not one disease, but many distinct, site-specific diseases. To further

complicate the situation, risk factors are specific to each disease. Nevertheless, over the past

decade, increasing evidence indicates that physical activity is associated with decreased overall

cancer mortality and decreased incidence of specific types of cancers (Sternfeld, 1992; Lee,

1995). The cancer site most frequently studied in relation to physical activity is colon cancer,

and findings overwhelmingly support an inverse relationship. The two most likely potential

mechanisms by which physical activity may be protective of colon cancer are (1) shortened

intestinal transit time, and (2) decreased levels of body fat. Shortened intestinal transit time is

thought to decrease the amount of contact between possible carcinogenic substances and

intestinal mucosa, but evidence remains controversial on this matter. For several cancers

(including colon and breast cancers), high levels of body fat are associated with increased

risk.

Most research on physical activity and colon cancer has focused on occupational physical

activity in men. Clearly, men with sedentary jobs have increased risk of colon cancer

(Sternfeld, 1992). One of the most comprehensive studies that included women was a casecontrol study of Utah residents that took into account differences in dietary patterns and

body weight, confounding factors not usually controlled (Slattery et al., 1988). Comparing

both occupational and leisuretime activities, the sedentary individuals of both sexes were at

nearly two-fold increased risk for colon cancer.

The relationship between physical activity and breast cancer is less clear, but several

studies in American women suggest that risk may be lowered in those who are habitually

active. An extensive review of this subject is now available including international studies

(Kramer & Wells, 1996). Only studies utilizing American subjects are reviewed here. In 1985,

Frisch et al. assessed prevalence of breast cancer in 5,398 former collegiate women athletes

and nonathletes from 10 colleges and universities from classes spanning 56 years. A higher

percentage of former athletes reported they were currently exercising than nonathletes.

Comparing the prevalence of breast cancer between the two groups, the nonathletes had 1.85

times the risk of the former athletes, strong evidence for an inverse relationship between

lifetime physical activity and breast cancer.
From the National Health and Nutrition Examination Survey database (NHANES I),

Albanes et al. (1989) examined breast cancer incidence relative to baseline recreational and

nonrecreational physical activity levels. After 10 years of follow-up, premenopausal women

with high levels of activity were associated with slightly increased risk of breast cancer.

Among postmenopausal women, however, high physical activity conferred a protective effect.

More recently, Bernstein et al. (1994) studied the timing of physical activity relative to

estrogen exposure in premenopausal women from Los Angeles County. Using a case-control

study design, they report a strong dose response relationship between leisuretime exercise

since menarche and decreased risk of breast cancer. Women reporting 3.8 or more hours per

week of exercise since menarche had a 50% reduction in breast cancer risk. A 30% reduction

was observed in women reporting one to three hours per week of exercise since menarche. A

slightly weaker relationship was observed among nulliparous women. The observed benefit of

exercise was attributed to reduced exposure to endogenous estrogen subsequent to shorter

luteal phases and higher incidence of anovulatory menstrual cycles. An even more recent

study (Thune et al., 1996) confirmed the beneficial relationship between physical activity and

breast cancer and reported the largest benefits in premenopausal women, the period when

age-specific mortality rates for breast cancer are highest.

High to moderate levels of habitual physical activity may decrease lifetime exposure to

endogenous sex hormones in two ways: (1) prior to menopause, high levels of physical

activity may delay menarche, decrease the number of ovulatory cycles, and hence reduce

exposure to endogenous estrogen (Frisch et al., 1980; Bernstein et al., 1987), and (2)

following menopause, maintenance of low levels of adipose tissue may mediate the

conversion of androgenic compounds to extraglandular estrogen (Siiteri, 1987; Hershcopf &

Bradlow, 1987).

In summary, lifetime physical activity appears to reduce the risk of colon cancer and

breast cancer in white women, but there is an obvious need to incorporate minority women

into future research on these topics.

PHYSICAL INACTIVITY AND NON–INSULIN-DEPENDENT DIABETES

MELLITUS IN WOMEN

About 14 million Americans have diabetes, with 95% having non–insulin-dependent diabetes

mellitus (NIDDM). Tables 8.2 and 8.3 indicate that certain minority women have exceedingly

high mortality and prevalence rates from this adult-onset chronic disease. Diabetes is a

leading cause of death in women, and a leading cause of adult blindness, leg and foot

amputations, circulatory disease, kidney failure, and birth defects. In NIDDM, the pancreas

may secrete insulin, but cells and tissues of the body are insulin resistant, and consequently,

patients are characterized by high levels of insulin (hyperinsulinemia) and blood glucose

(hyperglycemia). Those at highest risk for NIDDM include the overweight or obese, and

particularly, those over 40 years of age (American Diabetes Association, 1992).
According to the American Diabetes Association (1990), an appropriate exercise program

should be an adjunct to diet and/or drug therapy to improve glycemic control, reduce

cardiovascular risk facto rs, an d in crea se ps ycho logi cal we llbe ing in women with NIDDM.

Individuals who are most likely to respond favorably are those with moderate glucose

intolerance and hyperinsulinemia. Unfortunately, findings from the 1990 National Health

Interview Survey (Ford & Herman, 1995) indicate that women with diabetes are less likely to

report exercising regularly than women without diabetes. A comparison of the effects of

exercise on insulin sensitivity in women with NIDDM recently revealed that low intensity

exercise was as effective as high intensity exercise in enhancing insulin sensitivity (Braun et

al., 1995). Duration of the two exercise regimes was adjusted so that energy expenditure was

equal. This is important because obesity, diabetic complications, and general lack of physical

fitness are common in women with glucose intolerance or NIDDM. Prescription of low

intensity exercise is no doubt safer and more practicable, especially for older women with

NIDDM. A recent community-based study (San Luis Valley Diabetes Study) also

demonstrated this. Higher levels of physical activity were associated with improved insulin

action in individuals with impaired glucose tolerance (Regensteiner et al., 1995), further

supporting the concept that habitual physical activity reduces incidence of impaired glucose

tolerance and lowers morbidity from NIDDM.

Two studies directly indicate that habitual physical activity in women is a promising

approach to the primary prevention of NIDDM. In one, Frisch and colleagues (1986) report a

significantly lower prevalence of diabetes among every age group (20 to more than 70 years)

in 5,398 women who engaged in long-term athletic activity compared to their nonathletic

classmates. In the other investigation, reduced incidence of NIDDM among women who

exercised regularly was observed in a prospective cohort of 87,253 women 34 to 59 years

(Manson et al., 1991).

In summary, regular physical activity has an important role in both treatment and

prevention of NIDDM through its association with reduced body weight, and its independent

effects on insulin sensitivity and glucose tolerance.

OB ESIT Y, M ORBI DITY , AN D MO RTAL ITY IN W OMEN 

Data from nationally representative cross-sectional surveys reveal that prevalence of

overweight in U.S. women has increased in all age groups since the 1960s (Kuczmarski et al.,

1994). These data also indicate that the prevalence of obesity is substantially higher in black,

Hispanic, Pacific Islander, and Native American and Alaskan Native women than in white

women (Kuczmarski et al., 1994; Kumanyika, 1993). Altogether, about 32 million American

women are overweight or obese. In addition, the particularly high-risk upper-body fat

distribution (central adiposity) occurs to a greater extent in some minority populations than

in whites (Kumanyika, 1993).

High body weight or weight gain since age 18 in women has been associated with

coronary heart disease (Willett et al., 1995), allcause mortality (Manson et al., 1995), and

hyperinsulinemia (fasting insulin and insulin following glucose load) (Wing et al., 1992).

Lowest mortality among U.S. women was observed in those who weighed at least 15% less

than the U.S. average for women of similar age and whose weight had been stable since early

adulthood (Manson et al., 1995).
Clearly, high body weight and body fat in women is related to increased incidence of

coronary heart disease, hypertension, NIDDM, breast cancer, and allcause mortality. Greater

attention to prevention and treatment of obesity in minority populations may help to address

critical health issues in American women (St Jeor, 1993).

C ON CL US IO N

There is an obvious national shortfall in closing the gap in health disparities among

Americans—especially, American women. We have failed—in physical education and sport,

and in medicine—to clarify the importance of habitual physical activity, physical fitness, and

maintenance of “normal” body weight to good health. One major reason is that we have

attempted to use health messages, programs, and approaches based on white, middle-class

values and culture, and then wondered why they were not enthusiastically embraced. Research

and educational efforts must focus on conceptually based programs in schools and

communities that are culturally sensitive and ethnic-specific.

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