The goal is to progress to a level that is is perceived as difficult, strengthens the musculature, and over time (4-8 months), has a positive effect on the bone density (as seen by DEXA scan). According to the sports medicine literature, the MES (minimal essential strain) is about 1/10th the amount of force required to fracture a bone, so the amount of stress placed on bones through strength training does not have to be in maximal exertions. Medically, the density should improve from Ð10% loss to normal (0% loss in bone).
Both of the phases of training can be manipulated by the therapist depending on the initial conditioning level of the participant. Training should proceed in phases, as staying with the same level of resistance will not improve bone density or muscle strength.
Rehab in Women's Cardiovascular Diseases
As women are increasing their risks for developing both heart disease and lung cancer, rehabilitation programs should play an important role in both reducing the complications of these diseases, and health care costs associated with long term affliction.
In the area of cardiovascular therapy, this area is not as pronounced as orthopedic rehabilitation. None the less, basic cardiovascular education and treatment programs are necessary for the following reasons: First Ð more women are being diagnosed with cardiovascular events (heart disease, emphysema, cancer, peripheral vascular disease). With this increase in the number of cases, the health care costs also rise concomitantly. Second Ð the current medical system is ill prepared to give patients the necessary time for information regarding therapy and education strategies. This is where allied health professionals (physical therapy, dietetics, exercise physiology, occupational therapy, etc.) play such a vital role. The cost of a referral, assessment, education, and therapy plan is far less than medical intervention that may occur within one year of the initial diagnosis.
Information from the Women's Health Data Book (1992 Ð Jacob's Institute, Washington, DC) states that although women make more frequent visits to physician offices than do men, they do not receive as much intervention. This may be seen in the fact that many oncologists do not refer women who have had surgery for breast cancer for physical therapy. It would seem a logical extension of their health care, but it is not routine.
Rehab and Health Care Costs
In 1994, futurist John Naisbitt predicted a $188 billion cost savings by the implementation of wellness programs in major businesses in the US. If this amount may be extrapolated to include the health care system, might we see an even greater savings. Although rehab per se is not primary prevention, any type of patient education may have a preventive effect on patients in the future. Rehab programs that promote healing for an acute event, but also give education on ADL may save unforeseen medical costs.
The Importance of Women's Health Issues
As issues of prevention and cost savings become more of a fixture in women's health, professionals who wish to work with in this area should have an understanding of the elements that comprise a complete women's health package. Some of the most important areas are summarized below:
- Reproductive Health - From nutritional information, to moderate exercise, to sexuality issues, to post partum guidance, many health promotion topics during pregnancy are not discussed in the physician's office. Therefore, a complete strategy on diet, stress reduction, posture and mobility, exercise, hygiene, etc. should be made available during pregnancy, and perhaps should be the responsibility of allied health care professionals.