Why Your Workouts Don't Work

How to Change Your Workout to Get the Results You Want

Did you know the average health club exerciser quits after just six months for one of the following
reasons:

1. Not Enough Time

2. Not Seeing Results

Sadly, most people become frustrated and quit exercising before they see any real results. But
it's not surprising given the common mistakes many people make with their training programs.
Are you making these workout mistakes?

Common Reasons Your Workouts Don't Work

• All Quantity, No Quality

Take a look around the gym (if you haven't quit going yet) and see how many people are really
getting a quality workout. I'm always amazed by how many people are wandering aimlessly,
walking leisurely on a treadmill while reading a book, lifting weights so light that not one hair
moves out of place, or simply look bored. A lot of exercisers head to the gym out of habit, and as
if on automatic pilot, put in some time and head back to work or home. If you are one of these
people, ask yourself, "What do I want to get out of this?" If you want serious results, you need to
do serious exercise. That doesn't mean you can't enjoy it and have fun. But it does means you
need to focus on what you are doing and increase the quality of every movement. Once you start
exercising with a real purpose and pushing both your aerobic capacity and your strength you will
find your workouts take half the time and give better results.

Tips for More Effective Training

Tips for athletes who want to get the most from their training time
Whether you're training hard for a marathon, or just looking to get the most from your exercise routine, these
tips can help you achieve your goal:

1. Get a Personal Trainer or Coach or Advisor

Sometimes to get the most out of your training program you need objective advice from a professional. We
get very set in our ways and habits, which can be a good thing for consistency. However, it's hard to make
upward progress when you do the same thing week after week, year after year. Following a program written
by someone else can take the pressure off and give you new ideas.
2. Eat Well
Proper nutrition and effective training go hand-in-hand. Eating right is an essential component of all athletic
activities.

Eating well is the best way to be sure you get the most from your training and performance. What you eat
before, during, and after exercise has a major impact on how well you perform and how well you feel. Good
nutrition also allows you to maintain high quality training, good recovery and good race day performance.

3. Rest and Recover

This is an often overlooked part of effective training. If you don't plan rest or schedule recovery days in your
training, you limit your ability to train. Your body actually gets stronger after exercise stress, so you need to
allow down time for rebuilding muscle tissue. An effective training program will have regular periods of rest
 and recovery. This also allows adaptation to the exercise -- you return bigger, stronger and faster. Rest also
allows you to recover mentally and emotionally and avoid exercise burn-out.
4. Get Support
It's extremely helpful to have support for your training program, whether it's from training partners, friends or
family. But it's also important to be sure that you follow your own training plan and needs. If you work out
with others, be careful that you don't get sucked into training at their intensity or for their duration. If you
scheduled an easy day, but your buddy decides to hammer, you need to let go and follow your plan. All too
often training partners can encourage us to over or under train. Do what you need to do for your program.
5. Listen to Your Body
Effective training requires you to follow a game plan, but have enough flexibility to alter the plan based on
how you feel. If you are tired, ill, stressed, injured, or notice your heart rate is elevated, you need to be able
to pay attention to the message these signs are sending. Slowing down, resting, or changing the activity are
all appropriate compromises. You should also learn the Warning Signs of a Serious Injury .
6. Cross Train
Alternating exercise is a great way to train effectively. Not only do you develop overall muscle conditioning,
but you allow muscles to rest and recover without losing your fitness and get a mental boost from alternating
activities.
7. Strength Train
Building strength is one of the fastest ways to improve your sports performance and train more efficiently.
You can spend hours running, cycling or playing your sport, but a few weight training sessions each week
will add strength, power, and help reduce your risk of injury.
8. Consider Interval Training
Interval training has been the basis for exercise routines for years. It involves alternating short, fast bursts of
intense exercise with slow, easy activity. Interval training works both the aerobic and the anaerobic system,
and it results in improved conditioning of the cardiovascular system. It also helps prevent injuries often
associated with repetitive exercise by allowing you to increase training intensity without overtraining or burn-
out.

Efficient Strength Training

Strength training doesn’t have to be time consuming. Here are some ways to make sure you get the most
from a limited training time.

For general conditioning and strength gains research shows that one high quality set can provide as much
benefit as multiple sets. An efficient strength-training program can be done using nearly any type of
equipment from free weights to rubber tubing if you apply the following principles.

Intensity of Exercise
This may be the most important factor in an efficient strength-training program. In general, the greater the
intensity, the better the strength gains. High intensity means working each muscle to the point of fatigue,
when no more repetitions can be performed. This relates to the Overload Principle that says to increase
muscular size and strength, a muscle must be stressed, or "overloaded," with a workload that is beyond its
present capacity and trigger an adaptive response (muscular growth).

Simply, exercise that does not produce enough muscular fatigue will not stimulate muscular growth.

Progression
To build muscle strength you must continually do more work over time. Muscles must be overloaded and
weight or repetitions increased steadily and systematically over several weeks. Each time the maximum
number of repetitions are attained, the resistance should be increased for the next workout. The increase in
resistance should be small, about five percent or less, but should still be challenging.

Number of Sets
Performing one set to fatigue has been shown as effective as multiple sets when it comes to strength gains.
For this to be productive, the set must be done with an appropriate level of intensity (to the point of muscular
fatigue) and a thorough warm-up should be done before to prevent injury.
Number of Repetitions
To increase in size and strength, muscles must be exercised for a certain length of time. Research seems to
indicate that optimal time frames are as follows:
90 to 120 seconds for the gluts (butt)
60 to 90 seconds for the rest of the lower body
40 to 70 seconds for the upper torso

Use this as a guideline for the most efficient lifting program. (each lift is raised in about two seconds,
lowered in four seconds, so each repetition is six seconds long). Therefore the gluts require 15 to 20 reps,
the lower body 10 to 15 reps and the upper body about six to 12 reps.

These guidelines are for healthy adults. For children, teenagers, the elderly or anyone with medical
conditions, higher repetitions with lighter weight is advised. **Consult a physician prior to beginning a
strength training program.

Proper Lifting Technique

When lifting weights use slow, controlled movements and never jerk the weight. It should take about 2 full
seconds to move through the full range of motion. Pause for a second and slowly lower the weight with a
slow, gradual movement to increase efficiency. It should take about four seconds to lower the weight back to
the starting position.

Exercises Performed
A solid strength training routine can be done with as little as 7 exercises. The major muscle groups should
be targeted: the gluts, hips, quads, hamstrings, calves, biceps, triceps, abdominals and lower back. The
shoulder joint can be effectively worked with two exercises each for the chest, the lats and the deltoids. Start
with the largest muscle groups first.

Frequency
Efficient strength training includes intense exercise coupled with rest. During workouts muscle tissue is
broken down. It is the recovery phase that allows the muscle to rebuild itself and get stronger. About 48 to
72 hours is a good recovery phase timeframe.

If you want to maximize strength gains and minimize time spent in the gym, use these tips and focus on
quality of training rather than the quantity. You may find that strength gains come quickly when you use your
time wisely

Rating of Perceived Exertion Scale

A simple way to determine exercise intensity
There are a variety of methods for determining exercise intensity levels. Common methods include the‘talk
test’, the target heart rate range and the Borg Rating of Perceived Exertion (RPE).

The following article, from the CDC, provides an explanation of the Rating of Perceived Exertion (RPE).

Perceived exertion is how hard you feel your body is working. It is based on the physical sensations a
person experiences during physical activity, including increased heart rate, increased respiration or
breathing rate, increased sweating, and muscle fatigue. Although this is a subjective measure, a person's
exertion rating may provide a fairly good estimate of the actual heart rate during physical activity* (Borg,
1998).

Practitioners generally agree that perceived exertion ratings between 12 to 14 on the Borg Scale suggests
that physical activity is being performed at a moderate level of intensity.
 During activity, use the Borg Scale to assign numbers to how you feel (see instructions below). Self-
monitoring how hard your body is working can help you adjust the intensity of the activity by speeding up or
slowing down your movements.

Through experience of monitoring how your body feels, it will become easier to know when to adjust your
intensity. For example, a walker who wants to engage in moderate-intensity activity would aim for a Borg
Scale level of "somewhat hard" (12-14). If he describes his muscle fatigue and breathing as "very light" (9 on
the Borg Scale) he would want to increase his intensity. On the other hand, if he felt his exertion was
"extremely hard" (19 on the Borg Scale) he would need to slow down his movements to achieve the
moderate-intensity range.

*A high correlation exists between a person's perceived exertion rating times 10 and the actual heart rate
during physical activity; so a person's exertion rating may provide a fairly good estimate of the actual heart
rate during activity (Borg, 1998). For example, if a person's rating of perceived exertion (RPE) is 12, then 12
x 10 = 120; so the heart rate should be approximately 120 beats per minute. Note that this calculation is only
an approximation of heart rate, and the actual heart rate can vary quite a bit depending on age and physical
condition. The Borg Rating of Perceived Exertion is also the preferred method to assess intensity among
those individuals who take medications that affect heart rate or pulse.

How to Use the Perceived Exertion Scale

While doing physical activity, we want you to rate your perception of exertion. This feeling should reflect how
heavy and strenuous the exercise feels to you, combining all sensations and feelings of physical stress,
effort, and fatigue. Do not concern yourself with any one factor such as leg pain or shortness of breath, but
try to focus on your total feeling of exertion.

Look at the rating scale below while you are engaging in an activity; it ranges from 6 to 20, where 6 means
"no exertion at all" and 20 means "maximal exertion." Choose the number from below that best describes
your level of exertion. This will give you a good idea of the intensity level of your activity, and you can use
this information to speed up or slow down your movements to reach your desired range.

Try to appraise your feeling of exertion as honestly as possible, without thinking about what the actual
physical load is. Your own feeling of effort and exertion is important, not how it compares to other people's.
Look at the scales and the expressions and then give a number.

6 No exertion at all
7 Extremely light
8
9 Very light - (easy walking slowly at a comfortable pace)
10
11 Light
12
13 Somewhat hard (It is quite an effort; you feel tired but can continue)
14
15 Hard (heavy)
16
17 Very hard (very strenuous, and you are very fatigued)
18
19 Extremely hard (You can not continue for long at this pace)
20 Maximal exertion

• Overestimating Your Exercise

Most exercisers are far too generous with estimates of exercise intensity and time, weight lifted
and the frequency of their workouts. To avoid overestimating it's helpful to keep an exercise log
and track these items. Additionally, many people mistakenly believe that if they exercise at a
moderate pace for 30 minutes they have burned lots and lots of calories and fat. Unfortunately,
it's not that simple. While exercise does burn calories over time and consistent exercise is one of
the best ways to lose weight and keep it off, it's hard to lose body fat through exercise alone.
Which brings us to the next mistake. . .

Short, High Intensity Exercise Burns More Calories

When it comes to calorie burning during exercise, research shows that short, high-intensity aerobic session
burn more calories than longer, lower-intensity aerobic workouts. According to the American College of
Sports Medicine, more calories are burned in short, high intensity exercise.

For example, a 154 pound person who runs at a pace of 8 mph will burn 320 calories in 20 minutes. That
same person, walking at 3 mph for an hour, will burn 235 calories.

Safety Considerations
Although shorter, high-intensity workouts burn the most calories, they aren't always the best option. They
are not recommended for a novice exerciser because they can contribute to injuries in individuals who aren't
prepared for the physical demands of this type of workout. They are also hard to maintain and should be
used sparingly.

Even a highly fit athlete should vary his workout and have some long and slow days for endurance and
recovery. Finally, if you work at a high intensity, odds are you will fatigue sooner and be forced to stop after
about 20 minutes. If you go slow, you will likely to be able to continue exercising for several hours.

If you're already exercising regularly and progressing in your exercise intensity, you may want to try shorter,
more intense workouts to enhance your calorie burning. However, if you're just starting an exercise program,
a slow and steady progression of longer and less intense exercise is probably a better option.

The sort of exercise you chose depends upon your ultimate goal. If you are training for mountaineering or
backpacking, you'd better plan some long, steady days of hiking. If you want to lose those newly acquired
holiday pounds, give the high intensity workout a try.

Keep in mind that if you have specific training goals you should adhere to the principles of conditioning and
follow an appropriate training program for your sport.

It is recommended that you see your doctor before starting an exercise program if you're older than age 40
and have never exercised, a smoker, overweight or have a chronic health condition.

How Much Exercise Does It Take?

How much training do you really need?
It’s not a simple question to answer. It all depends upon your goals and your current level of fitness. If your
main goal is to improve your health, most experts agree that moderate exercise for 30 minutes every other
day is all you need. This amount of exercise has been linked with improving cardiovascular function,
lowering cholesterol and blood pressure, losing weight, and reducing stress.

A moderate exercise intensity means that your heart rate is between 60 and 80 percent of your maximum
heart rate. Less than that and your aren’t taxing the cardiovascular system enough to really see
improvement. More than that and you simple can’t keep up with your body’s demand for oxygen and you
‘run out of gas.’
 To determine your heart rate range, subtract your age from 220, then multiply the result by 0.6 to determine
the low and by 0.8 to find the high end of your heart rate range.

While exercising, you can stop and check your pulse every so often to determine if you are in this range then
adjust the intensity of your exercise as needed.

If your goals extend beyond simple health improvement, you will need to adjust your exercise time, type and
intensity accordingly. By gradually increasing the duration and intensity of your aerobic sessions, you will
continue to improve your cardiovascular efficiency. By focusing on sport-specific training, you will develop
skills for a particular event. Weight training can also be added and for a well-rounded program.

Once you reach a base level of fitness, other goals are often in sight. Weight loss, sports training, fun runs,
marathons, century bike ride and other goals such as achieving a personal best. The amount of exercise
and the type of training required to achieve these goals are very specific to your event and your current
fitness, but there are many tried-and-true training programs for every possible goal.

• Underestimating Your Eating

Many people are in denial about the foods they eat and especially the quantity consumed. If you
really want to lose weight you need to be honest with yourself about what you put into your mouth
and how that helps or hinders your weight loss goals. To get real with yourself, write it down.
Tracking what you eat in a food diary will help you break the cycle of food denial. (Besides, you
are the only one who needs to know).

• Doing the Wrong Type of Workout

Where did you learn your current exercise routine? Watching others at the gym (who are
exercising incorrectly)? From your friends, coworkers, the web, tv, newspaper, the latest research
findings, or perhaps your 5th grade gym teacher? What you are doing for exercise directly
determines the results you will get. To learn what you should do, there is no better place to start
then by writing down your goals and then working with a professional trainer to design the right
workout to meet those goals. Haphazard exercise will provide haphazard results.

• Never Changing Your Workout

When you do the same thing day after day, you get very good at it. In exercise this is called the
principle of adaptation. It basically means that we become very efficient by doing the same
exercise over and over. This is great for sports performance, but not that great for weight lose,
strength increases or physical fitness progression. If you always do the same workout for the
same amount of time you will eventually hit a plateau where you fail to see any additional change.
One way of overcoming this plateau is to modify your workouts every few weeks or months. You
can change the type of exercise you do, the length, the amount of weight lifted or the number or
reps. This is why professional athletes change their program during the off-season.

The Principles of Sports Conditioning

How to get the most from your training plan
There are several universally accepted scientific training principles that must be followed in order to improve
conditioning and performance. These principles include:

1. The Principle Of Individual Differences

Because every athlete is different, each person's response to exercise will vary. A proper training program
should be modified to take individual differences into account. Some considerations:
• Large muscles heal slower than smaller muscles.
• Fast or explosive movements require more recovery time than slow movements.
• Fast twitch muscle fibers recover quicker than slow twitch muscle fibers.
• Women generally need more recovery time than men.
• Older athletes generally need more recovery time than younger athletes.
• The heavier the load lifted, the longer it will take the muscles to recover.

2. The Principle of Overload

The principle of overload states that a greater than normal stress or load on the body is required for training
adaptation to take place. The body will adapt to this stimulus. Once the body has adapted then a different
stimulus is required to continue the change. In order for a muscle (including the heart) to increase strength, it
must be gradually stressed by working against a load greater than it is used to. To increase endurance,
muscles must work for a longer period of time than they are used to. If this stress is removed or decreased
there will be a decrease in that particular component of fitness. A normal amount of exercise will maintain
the current fitness level.

3. The Principle of Progression

The principle of progression implies that there is an optimal level of overload that should be achieved, and
an optimal timeframe for this overload to occur. Overload should not be increased too slowly or improvement
is unlikely. Overload that is increased too rapidly will result in injury or muscle damage. Exercising above the
target zone is counterproductive and can be dangerous. For example, the weekend athlete who exercises
vigorously only on weekends does not exercise often enough, and so violates the principle of progression.

The Principle of Progression also makes us realize the need for proper rest and recovery. Continual stress
on the body and constant overload with result in exhaustion and injury. You should not (and can not) train
hard all the time. Doing so will lead to overtraining and a great deal of physical and psychological damage
will result.

4. The Principle of Adaptation

Adaptation is the way the body 'programs' muscles to remember particular activities, movements or skills. By
repeating that skill or activity, the body adapts to the stress and the skill becomes easier to perform.
Adaptation explains why a beginning exercisers are often sore after starting a new routine, but after doing
the same exercise for weeks and months the athlete has little, if any, muscle soreness. This also explains
the need to vary the routine and continue to apply the Overload Principle if continued improvement is
desired.

5. The Principle of Use/Disuse

The Principle of Use/Disuse implies that you "use it or lose it." This simply means that your muscles
hypertrophy with use and atrophy with disuse. It is important to find a balance between stress and rest.
There must be periods of low intensity between periods of high intensity to allow for recovery. The periods of
lower intensity training, or the rest phase, is a prime time for a bit of crosstraining.

6. The Principle of Specificity

The Specificity Principle simply states that training must go from highly general training to highly specific
training. The principle of Specificity also implies that to become better at a particular exercise or skill, you
must perform that exercise or skill. To be a good cyclist, you must cycle. The point to take away is that a
runner should train by running and a swimmer should train by swimming.

While there may be other 'principles' of training you will find on the web and in text books, these 6 are the
cornerstone of all other effective training methods. These cover all aspects of a solid foundation of athletic
training. Once put together, the most logical training program involves a periodized approach which cycles
the intensity and training objectives. The training must be specific not only to your sport, but to your
individual abilities (tolerance to training stress, recoverability, outside obligations, etc). You must increase
the training loads over time (allowing some workouts to be less intense than others) and you must train often
enough not only to keep a detraining effect from happening, but to also force an adaptation.

Strength Training Plateaus

How to get unstuck
Strength training programs require constant adjustment throughout the year or you risk hitting plateaus. If
you are new to strength training, such a plateau usually arrives after about six months of training. During the
first months of training you will likely make some dramatic strength gains. Soon, however, these gains begin
to level off. To continue making gains, you will need to vary your training techniques and understand basic
conditioning principles. You can use the following techniques to break out of your plateau.
Increase Training Intensity
One of the easiest ways to break out of your plateau is by making your muscles work harder, rather than
longer. At this point in your training you should try "high weight - low reps" rather than "low weight - high
reps".

If you had been lifting 3 sets of 10-12 reps, drop down to 1 set of 6-8 reps. Always warm up for 5 - 10
minutes before lifting and lift in a slow and controlled motion to get the most out of each lift. Bouncing the
weight and using momentum in your back and legs does little to build strength in the target muscle.

Vary Your Exercises

Varying your equipment or exercise (cross training)will work your muscles in a new way and help you
develop new skills. If you always use machines, try free weights or a medicine ball for a change. If you use
the bench press for chest, start doing pushups instead. This new form of training forces you to use the
muscles in a slightly different way and allow stale muscles a chance to rest. It keeps your program
interesting and stimulates a different pattern of motor unit recruitment.
Change the Order
Another way to break out of a plateau is to change the sequence of exercises you normally do. When
muscles get fatigued in a different order they will adapt in a different way, allowing a variation in muscle
strength gains.
Remove Some Exercises and Add Others
There may be some exercises in your routine that you have outgrown. Look at your routine critically for
unnecessary or redundant exercises. You might consider scheduling a session or two with a personal trainer
who can provide you with recommendations for adding or removing exercises you have in your routine.

Get Adequate Rest

If you train too hard for too long, you will undoubtedly hit a plateau. It is also likely that you will develop an
injury. Adequate rest and recovery is an essential element in continuing to make progress in your training
program. Most world class athletes train in a 'rest - recover' fashion. There may even be times during the
year that you should reduce your strength training altogether.

Eat Wisely
Proper nutrition will help your muscles rebuild as well as fuel your workouts. Don't be taken in by the high
protein hype. Protein intake of greater than 2 gr/kg of body weight per day does nothing to increase muscle
growth. Carbohydrates are the primary fuel for intense muscular effort, and should not be reduced or
avoided in the name of performance. (see: High Protein Diets and Protein and Muscle Building for more
about nutrition for strength training).
Finally, If you plateau before you reach your strength goals you have to vary your program. Consider
reading How to Achieve a Personal Best. These strategies can also help you break out of a slump and
remind you of the key factors in developing a successful training program. By following such principles, you'll
find

Cross Training Improves Fitness and Reduces Injury

Varying your workouts can improve performance and reduce burn-out.
 You consider yourself to be in better than average shape. You run several times a week for health and
fitness and maybe do an occasional fun run on the weekend. Some friends come into town for the holidays
and you decide to go skiing. No problem, you're in great shape, right? Wrong. After a day on the slopes you
feel like you've been run over by Santa's sleigh and all his reindeer. What's going on?

You may be in great shape, for the sort of exercise you do routinely. But if that's all you do, day after day,
you may be setting yourself up for injury or mental burnout and that is not a good way to get fit. What can
help prevent injury and burnout? Cross training.

Cross training is a great way to condition different muscle groups, develop a new set of skills, and reduce
boredom that creeps in after months of the same exercise routines.

Cross training also allows you the ability to vary the stress placed on specific muscles or even your
cardiovascular system. After months of the same movements your body becomes extremely efficient
performing those movements, and while that is great for competition, it limits the amount of overall fitness
you possess and reduces the actual conditioning you get while training; rather than continuing to improve,
you simply maintain a certain level of fitness. Cross training is also necessary to reduce the risk of injury
from repetitive strain or overuse.

The term cross training refers to a training routine that involves several different forms of exercise. While it is
necessary for an athlete to train specifically for their sport if they want to excel, for most exercisers cross
training is a beneficial training method for maintaining a high level of overall fitness. For example, you may
use both biking and swimming each week to improve your overall aerobic capacity, build overall muscle
strength and reduce the chance of an overuse injury. Cross training limits the stress that occurs on a specific
muscle group because different activities use muscles in slightly different ways.

Benefits of Cross Training

• Reduces exercise boredom

• Allows you to be flexible about you training needs and plans (if the pool is closed, you can go for a
run instead).
• Produces a higher level of all around conditioning
• Conditions the entire body, not just specific muscle groups
• Reduces the risk of injury
• Work some muscles while others rest and recover
• Can continue to train while injured
• Improves your skill, agility and balance

What exercises should make up a good cross training routine?

• Cardiovascular Exercise (Think about adding three different exercises from the list below):
o Running
o Swimming
o Cycling
o Rowing
o Stair Climbing
o Rope jumping
o Skating (inline or ice)
o Skiing
o Racquetball / basketball / other court sports
• Strength Training
o Calisthenics (push ups and crunches and pull ups)
o Free Weights
o Machines
o Tubing and Bands
• Flexibility (stretching, yoga)
• Speed, agility, and balance drills
• Circuit training, sprinting, plyometrics and other forms of skill conditioning
 With cross training, you can do one form of exercise each day, or more than one in a day. If you do both on
the same day, you can change the order in which you do them. You can easily tailor cross-training to your
needs and interests; mix and match you sports and change your routine on a regular basis.

Exercise can strengthen the cardiovascular system, bones, muscles, joints, reduce body fat and improve
flexibility, balance and coordination. But if you want to see all of these benefits, you'll need to start cross
training. What better time to start than now? I hear your friends have taken up snowboarding.

• Using Incorrect Form or Technique

Learning the right way to exercise is essential to getting results. Form does matter, especially
when doing any strength training exercise. Incorrect form or technique also sets you up for
potential injuries, pain and soreness. To learn proper technique, there is no better place to start
than with a personal trainer or coach.

• Setting Unrealistic Goals

So, what are your goals? Are they realistic for you? If your goal is to be the next Lance
Armstrong, and you only have 30 minutes a day to train, or wanting to lose 25 pounds in a month,
well, how realistic is that? Again, it comes back to being honest with yourself about your abilities,
your level of commitment and your lifestyle. We need to set appropriate goals that start from
where we are and progress at an attainable pass or we are sure to get frustrated and quit.

How to stick with your fitness program

Finding motivation to train or stick with exercise on a regular basis isn't always easy. Demanding schedules,
burn-out, and illness are just a few of the things that may interrupt your fitness routine. However, sometimes
motivation can be found by following a very simple formula. Goal setting based upon the S.M.A.R.T.
approach, is a simple technique that provides structure for your training program. Many athletes and
coaches successfully use this formula to set both short and long-term training goals.

The S.M.A.R.T. principle

1. Set Specific Goals. Research shows that specific goals are the most motivating. A specific goal is
to reduce your 5K time by 30 seconds within 6 months. Many people just say they want to get faster. This
goal is far too general to really motivate you in your training.
2. Set Measurable Goals. Simply saying that you want to get faster is not enough detail. You need to
be able to chart and document progress toward your goal. One way to measure your progress is to
document your performance at set intervals. In the above example you may want to time your 5K
performance once a month so you have a good measurement.
3. Set Adjustable Goals. This means your goals are flexible enough to accommodate unexpected
challenges without becoming obsolete. An injury may force your to modify your goal. If you goal is too run a
certain marathon and you are injured, you may need to change your goal to do the half marathon, or some
other event. An injury doesn't need to mean you abandon all your plans. At the same time, you may find you
are progressing quickly and need to raise your goal.
o Set Action-Oriented Goals Another important aspect of goal-setting to to keep them
focused on personal action. Don't forget to consider not only what you want to achieve, but how you plan to
acieve it. Consider reading How to Design a Personal Exercise Program and The Principles of Sports
Conditioning for tips on fitness training plans.

• Set Realistic Goals. Start where you are, and increase your goals accordingly. If you haven't ever run a
5K it's probably not a wise goal to say you want to run a marathon. While that may be your long-term goal, in
the short-term you may want to shoot for the 5K and 10K and half marathon on the way to your marathon
goal. This sort of progression is healthy and realistic. Also, keep in mind that as you become more and more
fit and near your full potential the room for continued improvement gets smaller. Similarly, if your goals are
too simple, you won't feel much satisfaction by attaining them. Only you truly know what is realistic for you.
• Set Time-based Goals. Look again at first example: reduce your 5K time by 30 seconds within 6 months.
This is specific and time-based. Without a time line there is a tendency to procrastinate or get bored. You
may also need to set interim goals with shorter timelines to keep you on track. Consider the previous
example of working up to a marathon by completing shorter distances first. each of those because a
separate goal with a shorter timeline. In general, goals that stretch out beyond 6 months are too long to keep
you interested and motivated. Try to re-evaluate your goals every 2-3 months.

Goal setting is an art as well as a science, but if you make sure your goals follow the S.M.A.R.T. formula,
you will find you are more likely to stay motivated and reach goal after goal.

Start Small
Exercise is not an all or none endeavor. It is a continuum. Keep in mind that a little is better than none and
you can do something today, so don’t worry about what you will do next month. This perspective is hard for
anyone who expects a lot from themselves and sets long-term fitness goals. Don’t expect results overnight.
But do expect to take small steps every day.

Start Where You Are

Your exercise program doesn’t need to be elaborate. It doesn’t require you to join a gym or sweat for an
hour every day. Look at your current routine and you may discover you already walk 15 minutes at a time
taking the dog around the block or walking to the store for milk.

That’s exercise. You can use that as a jumpstart and add another 5 minutes or walk at a faster pace -- start
from where you are.

Go Low Tech
Technology is a wonderful thing, but much of it reduces us to very lazy people. If you want to fit activity into
your daily life, just go low-tech and you will probably burn another few hundred calories a day. Walk or ride
your bike for errands, take the stairs, mow your lawn with a push mower, give up your television remote and
actually get up to change the channel, walk down the hall to your co-workers office rather than calling.

Surround Yourself with Good Role Models

If all your friends are couch potatoes, odds are you will have a hard time becoming active while hanging out
with them. If you surround yourself with people who are healthy and active, odds are it will be easy for you to
stay active as well. Peer pressure is a wonderful thing if you use it in positive ways!

Set Weekly Goals

Check in with yourself each week by setting attainable, yet realistic goals. Try to set a plan to go faster,
farther or longer with your routine. You can even set nutrition goals such as getting 5 servings of fruit and
vegetables each day. Your goal can be as simple as taking a daily 15 minute walk or as intense as
completing your first marathon. Only you know what is realistic for you.

Try Something New

If you always try to start a walking program, and always drop out after a few weeks take heart. It may not be
the exercise you can’t stick with but the type of exercise. You may need to try a variety of activities before
you find one that you really like and want to do long-term. Sign up for a yoga class or snowboarding lesson.
Try running or biking instead of walking, go with others or go alone, try exercising at different times of the
day. Keep your options open and find exercise you enjoy so you never view exercise as a chore. It should
be fun and fulfilling!

Write it Down
Keep an exercise log book. Simply writing down what you did, how long and how you felt can be great
motivation. Not only can you view your progress and look back at your accomplishments, but you can plan
ahead and decide where you want to be in a week, a month or more.
 Psychology of Exercise
Some people enjoy being distracted while exercising while others prefer to pay attention to how their body
feels while exercising. Try both tactics and see what works best for you. If you're new to exercise, being
distracted by music, television, reading material, conversation or a personal trainer may help you stick with
it. After you’ve been exercising a while it may be helpful to pay attention to your body sensations. Athletes
often focus on their breathing, cadence or body movement to stay focused.

Make Exercise Part of Your Daily Routine

Rather than trying to go to the gym, or squeeze in more time for exercise look for ways you can add exercise
to what you already do. Walk the dog, bike to the store or to work, do crunches or push-ups during
commercials, pedal your exercise bike during your favorite tv show, meet friends for walking dates rather
than dinner & drinks. If you are creative, you will realize you don’t need to change your routine much to fit
exercise into your life.

Find a Buddy
Even if this person doesn’t exercise with you, let someone know of your plans and goals to help support
your efforts. Making yourself accountable to another is a great way to keep you honest about your success
and challenges with starting a new exercise program.

Make Exercise a Priority

If your exercise plans and goals are at the bottom of your priority list, you will never reach them. Period. You
have to believe that this is important enough to make it happen. Take a serious look at your words, desires
and behavior. Do you always talk about wanting to get active, but never actually do anything about it? If so,
you are only fooling yourself and continuing the cycle of helplessness. Get honest with yourself about what
you really want and how much you are willing to work to make it happen. You’ll be surprised how easy it falls
into place once you put your energy into action rather than excuses.

• Measuring the Wrong Results

Many people think their workout isn't working because they don't measure the right things.
Looking for proof in a scale is often a set-up for disappointment because some new exercisers
build muscle and lose fat, but the scale doesn't provide information about body composition.
Better ways to measure your fitness progress include tracking your heart rate at a given pace,
measuring the distance you can cover in a certain amount of time, tracking the amount of weight
you can lift, or even writing down how you feel -- physically -- at the end of each day. Many of the
benefits from exercise are subtle and not visible by looking into the mirror, but things such as
cholesterol level, blood pressure, and the ease with which you can do daily chores are every bit
as motivating -- if you monitor them.

Exercise

Highlights

Chronic Conditions and Exercise:

• A new study found that aerobic and resistance training significantly reduced fatigue in men
undergoing radiation treatments for prostate cancer. Fatigue is a common side effect of such
treatments.
• Doctors at the Mayo Clinic found that exercise improves the physical and emotional well-being of
patients with Alzheimer's disease. The patients exercised for as little as 60 minutes each week.
Doctors noted improvements in areas ranging from depression to wandering.

Exercise and Smoking:

 • A 2007 review of existing studies found that moderate exercise, for as little as 5 minutes, can help
combat the nicotine withdrawal symptoms people experience when they try to stop smoking.

Exercise and Aging:

• A 2006 report found that older and elderly adults who exercised twice a week for 4 months
significantly increased their body strength, flexibility, balance, and agility. The average age of the
study participants was 83.5.

Before and After Exercising:

• You should do warm-up exercises for 5 - 10 minutes at the beginning of an exercise session. Low-
level aerobic exercise is the best warm-up.
• To cool down, you should walk slowly until your heart rate is 10 - 15 beats above your resting heart
rate. Stopping too suddenly may sharply reduce blood pressure or cause muscle cramping.
• You must be careful when stretching during your warm-up to avoid injuring cold muscles.

Definitions:

• Aerobic exercise: Aerobic exercise forces the heart and lungs to work harder for longer periods. It
builds endurance, improves blood flow throughout the body, and increases the levels of "good"
cholesterol.
• Resistance Training: Resistance training works muscles against a force (usually weights). It burns
fat and builds muscle.

Introduction

Everyone's goal of living a long and healthy life should include a healthy diet,
regular exercise, and maintaining normal weight. The combination of inactivity
and eating the wrong foods is the second most common preventable cause of
death in the United States (smoking is the first).

Most research on the benefits of exercise focuses on heart protection. Studies

clearly show that exercise helps the heart. In addition, new studies are reporting
that even people at higher risk for heart disease may lower their risk of dying
from it if they exercise.
Evidence suggests that our genes evolved to favor exercise. In other words,
during prehistoric times, if a person couldn't move quickly and wasn't strong, he
or she died. Those who were fit survived to reproduce and pass on these "fitter"
genes. Some researchers believe that with our current inactive lifestyle, these
genes produce a number of bad effects, which can lead to many chronic
illnesses.

The benefits of exercise include:

• Improved oxygen delivery throughout the body

• Improved metabolic processes - the way the body breaks down and builds necessary substances
• Improved strength and endurance
• Decreased body fat
• Improved movement of joints and muscles
• Improved sense of well-being

In addition, exercise can help change other dangerous lifestyle habits. A 2007
review of existing studies found that moderate exercise, for as little as 5 minutes
at a time, can help combat the nicotine withdrawal symptoms people experience
when they try to stop smoking.

No one is too young or too old to exercise. The United States Surgeon General
recommends at least 30 minutes of moderate exercise, such as brisk walking,
nearly every day. However, vigorous exercise carries risks that people should
discuss with a doctor. You should always check with your doctor before starting a
new exercise program, especially if you have any of the following risk factors:

• History of smoking
• Obesity
 • Family history of a long-term disease
• A symptom you havent told your doctor about
• Chest pain
• Shortness of breath
• Heart palpitations
• Blood clots
• Infections
• Fever
• Unexplained weight loss
• Foot or ankle sores that wont heal
• Joint swelling
• Pain or trouble walking after a fall
• Eye injury or eye surgery
• Hernia
• Hip surgery

Fifty percent of all people who begin a vigorous training program drop out within
a year. The key to reaching and maintaining physical fitness is to find activities
that are exciting, challenging, and satisfying.

Recommended Exercise Methods

A few simple rules are helpful as you develop your own routine.

• Don't eat for 2 hours before vigorous exercise.

• Drink plenty of fluids before, during, and after a workout.
• Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.
• When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes
chest pain, irregular heartbeat, undue fatigue, nausea, unexpected breathlessness, or light-
headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It can
be determined by counting one's own pulse or with the use of a heart rate
monitor. To feel your own pulse, press the first two fingers of one hand gently
down on the inside of the wrist or under the jaw on the right or left side of the
front of the neck. You should feel a faint pounding as blood passes through the
artery. Each pounding is a beat.

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 - 80 beats
per minute. It is usually lower for people who are physically fit, and often rises as
you get older. You can determine your resting heart rate by counting how many
times your heart beats in one minute. The best time to do this is in the morning
after a good nights sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute
subtract your age from 220. For example, if you are 45, you would calculate your
maximum heart rate as follows: 220 - 45= 175.

Target heart rate. Your target rate is 50 - 75% of your maximum heart rate. You
should measure your pulse off and on while your exercise to make sure you stay
within this range. After about 6 months of regular exercise, you may be able to
increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates.
Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then
subtract 12 beats per minute. The reason for this is that swimming will not raise
the heart rate quite as much as other sports because of the so-called "diving
reflex," which causes the heart to slow down automatically when the body is
immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age Low High

(50% max.) (75% max.)
20 100 150
30 95 142
40 90 135
50 85 127
60 80 120
Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures
the amount of oxygen consumed during intensive, all-out exercise. The most
accurate testing method uses computers, but anyone can estimate V02 without
instrumentation (with an accuracy of about 95%):

• After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
• Divide that number by 15.
• Subtract 133.
 • Multiply the total by 0.172, then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. But for the
average person interested in fitness, a VO2 max equaling between 50 and 80 is
considered an excellent score for overall fitness.

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine.
They help the body make the transition from rest to activity and back again, and
can help prevent soreness or injury, especially in older people.

• Warm-up exercises should be practiced for 5 - 10 minutes at the beginning of an exercise session.
Older people need a longer period to warm up their muscles. Low-level aerobic exercise such as
brisk walking, swinging the arms, or jogging in place, is the best approach.
• To cool down, you should walk slowly until the heart rate is 10 - 15 beats above your resting heart
rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people.
It may also cause muscle cramping.
• Stretching may be appropriate for the cooling down period, but it must be
done carefully for warming up because it can injure cold muscles. (There
is no clear evidence, however, that stretching reduces muscle injuries.)

Warming up before exercise and cooling down after is just as important as the exercise itself. By properly
warming up the muscles and joints with low-level aerobic movement for 5 - 10 minutes, one may avoid injury
and build endurance over time. Cooling down after exercise by walking slowly, then stretching muscles, may
also prevent strains and blood pressure fluctuation.
For most people, exercise may be divided into three general categories:

• Aerobic or endurance
• Strength or resistance
• Flexibility

A balanced program should include all three. Speed training is also a major
category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following

benefits:

• Builds endurance
• Keeps the heart pumping at a steady and high rate for a long time
• Boosts HDL ("good") cholesterol levels
• Helps control blood pressure
• Strengthens the bones in the spine
• Helps maintain normal weight
• Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low

impact. Examples of each include the following:

• Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and
cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-
impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses
less risk for injury to muscle and bone.
• High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High-impact
exercises should be performed no more than every other day, and less often for those who are
overweight, elderly, out of condition, or have an injury or other medical problem that would rule out
high-impact.

Aerobic Regimens. As little as one hour a week of aerobic exercises is helpful,

but 3 - 4 hours per week are best. Some research indicates that simply walking
briskly for 3 or more hours a week reduces the risk for coronary heart disease by
65%. In general, the following guidelines are useful for most individuals:

• For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two
weekly workouts will maintain fitness, but three to five sessions a week are better.
• People who are out of shape or elderly should start aerobic training gradually. For example, they
may start with 5 - 10 minutes of low-impact aerobic activity every other day and build toward a goal
of 30 minutes per day, three to seven times a week. (For heart protection, frequency of exercises
may be more important than duration.)
 • Swimming is an ideal exercise for many elderly and certain people with physical limitations,
including pregnant women, individuals with muscle, joint, or bone problems, and those who suffer
from exercise-induced asthma.
• People who seek to lose weight should aim for six to seven low-impact workouts a week.

One way of gauging the optimal intensity of exercise is to aim for a "talking
pace," which is enough to work up a sweat and still be able to converse with a
friend without gasping for breath. As fitness increases, the "talking pace" will
become faster and faster.

Shoes. All that's really necessary for a workout is a good pair of shoes that are
made well and fit well. They should be broken in, but not worn down. They
should support the ankle and provide cushioning for impact sports such as
running or aerobic dancing. Airing out the shoes and feet after exercising
reduces chances for skin conditions such as athlete's foot.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor
nighttime exercise, a reflective vest and light-colored clothing must be worn.
Bikers, roller bladers, and equestrians should always wear safety devices such
as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for
indoor racquet sports. For vigorous athletic activities, such as football, ankle
braces may be more effective than tape in preventing ankle injuries.

Aerobic-Exercise Equipment. Home aerobic exercise machines can be adapted

to any fitness level and used day or night. Before investing in any exercise
machine, however, it is wise to first test it at a gym. In addition, initial supervised
training when using these machines can reduce the risk of injury that might occur
with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but
many sturdy machines are available at moderate prices. The higher-end models
may utilize computers to record calories burned, speed, and mileage. While their
readouts may provide motivation and gauge the intensity of a workout, however,
they are not always accurate.

The following are a few observations on specific equipment:

• A good floor mat is important to provide cushioning for all home exercises.
• A simple jump rope improves aerobic endurance for people who are able to perform high-impact
exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid
joint injury.
• For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing
machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be
even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
• Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The
pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should
be able to adjust intensity.
• Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may
be as effective as running with less chance of injury.
• Rowing and cross-country ski machines exercise both the upper and lower body.
Shoes for Sports

Aerobic Sufficient cushioning to absorb shock and pressure that are many
dancing times greater than ordinary walking. Arches that maintain side-to-side
stability. Thick upper leather support. Toe-box. Orthotics may be
required for people with ankles that over-turn inward or outward.
Soles should allow for twisting and turning.
Cycling Rigid support across the arch to prevent collapse during pedaling.
Heel lift. Cross-training or combination hiking/cycling shoes may be
sufficient for casual bikers. Toe clips or specially designed shoe
cleats for serious cyclers. In some cases, orthotics may be needed to
control arch and heel and balance forefoot.
Running Sufficient cushioning to absorb shock and pressure. Fully bendable
at the ball of the foot. Sufficient traction on sole to prevent slipping.
Consider insoles or orthotics with arch support for problem feet.
Tennis Allow side-to-side sliding. Low-traction soles. Snug fitting heels with
cushioning. Padded toe box with adequate depth. Soft-support arch.
Walking Lightweight. Breathable upper material (leather or mesh). Wide
enough to accommodate ball of the foot. Firm padded heel counter
that does not bite into heel or touch ankle bone. Low heel close to
ground for stability. Good arch support. Front provides support and
flexibility.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and

helps the heart, it does not build upper body strength or tone muscles. Strength-
training exercises provide the following benefits:

• Build muscle strength while burning fat

• Help maintain bone density
• Improve digestion

It is also associated with a lower risk for heart disease, possibly because it
lowers LDL (the so-called "bad") cholesterol levels.

Strength exercise is beneficial for everyone, even people in their 90s. It is the
only form of exercise that can slow and even reverse the decline in muscle mass,
bone density, and strength that occurs with aging. Please note: People at risk for
cardiovascular disease should not perform strength exercises without checking
with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions

involved in strength training:

• Isometric contractions do not change the length of the muscle. An example is pushing against a
wall.
• Concentric contractions shorten muscles. An example is the "up" phase of a bicep curl.
• Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.

Strength-Training Regimens. Strength training involves intense and short-

duration activities. For beginners, adding 10 - 20 minutes of modest strength
training two to three times a week may be appropriate. The following are some
guidelines for starting a strength regimen:

• The sequence of a strength training session should begin with training large muscles and multiple
joints at higher intensity and end with small muscle and single joint exercises at lower intensities.
• Both shortening and lengthening muscle actions should be performed. Emphasizing the
movements that lengthen muscles is of increasing interest. This approach involves slowing and
increasing the duration of these "down" movements. It appears to significantly increase blood flow,
and some evidence suggests it may achieve stronger muscles more quickly. It may also improve
heart function compared to standard movements. Exercises that lengthen muscles may be
particularly beneficial for older people and some people with chronic health problems. This type of
training increases the risk for muscle soreness and injury, however, and this approach is still
controversial.
• Strength training involves moving specific muscles in the same pattern against a resisting force
(such as a weight) for a preset number of times. This is called a repetition. Students should first
choose a weight that is about half of what would require a maximum effort in one repetition. In other
words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the
person would start with a five-pound dumbbell. In the beginning, most people can start with one set
of 8 - 15 repetitions per muscle group with low weights. As individuals are able to perform one or
two repetitions over their routine, weights can be increased by 2 - 10%.
• Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the
starting point.
• The first half of each repetition typically lasts 2 - 3 seconds. The return to the original position lasts
4 seconds.
• An alternative technique called "super slow" training stretches out one repetition to a 14-second
count. This method places far more stress on the muscle group, so fewer repetitions are needed. A
full week of recovery is required before repeating this workout. The goal is to initiate changes in the
muscles so that the body continues to burn calories after the exercise. Some people report
dramatic results from this approach, but scientific proof of these claims is not available. It is a very
tedious workout, and people have a hard time sticking with it. People with high blood pressure
should not use this approach.
• Joints should be moved rhythmically through their full range of motion during a repetition. Do not
lock up the joint while exercising it.
• For maximum benefit, one should allow 48 hours between workouts for full muscle recovery.
Strength-Training Equipment. Unlike aerobic exercise, strength training almost
always requires some equipment. Strength-training equipment does not,
however, have to cost anything.

• Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can
serve as a weight.
• Dumbbells (1 - 10 pounds) and resistance bands are inexpensive, portable, and effective.
• Wearable weights help strengthen and tone the upper body.
• Ankle weights strengthen and tone muscles in the lower body. Wearable ankle weights should not
be worn during high-impact aerobics or jumping.
• Hand grips strengthen arms and are good for relieving tension.
• A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also
available, costing from $100 to over $1,000. No one should purchase or use
strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many

stretching exercises are particularly beneficial for the back. In general, flexibility
training provides the following benefits:

• Prevents cramps, stiffness, and injuries

• Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and tai chi, also involve meditation and
breathing techniques that reduce stress. Such practices appear to have many
health and mental benefits. They may be very suitable and highly beneficial for
older people, and for patients with certain chronic diseases.

Flexibility Training Regiments. Doctors recommend performing stretching

exercises for 10 to 12 minutes at least three times a week. The following are
some general guidelines:

• When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 -
60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
 • Breathe evenly and constantly while holding the stretch.
• Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes
muscle contraction and raises blood pressure.
• When doing stretches that involve the back, relax the spine to keep the lower back flush with the
mat, and to work only the muscles required for changing position (often these are only the
abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. A report
published in the February 2006 Journal of Aging and Health found that elderly
adults who exercised twice a week for four months significantly increased their
body strength, flexibility, balance, and agility. The exercise program included
walking and lifting weights. The average age of the study participants was 83.5.
The study adds further evidence that even small improvements in physical fitness
and activity can prolong life and independent living.

Still, about half of Americans over 60 describe themselves as sedentary

(inactive). According to a 2004 report by the Centers for Disease Control and
Prevention, approximately 12% of people aged 65 - 75 years and 10% of people
aged 75 years or older meet current recommendations for strength training.

The following tips for exercising may be helpful:

• Any older person should have a complete physical and medical examination, as well as
professional instruction, before starting an exercise program.
• Start low and go slow. For sedentary, older people, one or more of the following programs may be
helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, tai chi, self-paced
walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the
nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant
benefits.
• Strength training assumes even more importance as one ages, because after age 30 everyone
undergoes a slow process of muscular erosion. The effect can be reduced or even reversed by
adding resistance training to an exercise program. As little as one day a week of resistance training
improves overall strength and agility. Strength training also improves heart and blood vessel health.
• Power training, which aims for the fastest rate at which a muscle or muscle group can perform
work, may be particularly helpful for older women in strengthening muscles and preventing falls.
• Flexibility exercises promote healthy muscle growth and help reduce the stiffness and loss of
balance that accompanies aging.
• Chair exercises may be performed by people who are unable to walk.
• Older women are at risk for incontinence accidents during exercise. This can be reduced or
prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the
bathroom frequently, and using leakage prevention pads or insertable devices.

Exercise's Effects on the Heart

Inactivity is one of the major risk factors for heart disease. However, exercise
helps improve heart health, and can even reverse some heart disease risk
factors.

Like all muscles, the heart becomes stronger as a result of exercise, so it can
pump more blood through the body with every beat and continue working at
maximum level, if need be, with less strain. The resting heart rate of those who
exercise is also slower, because less effort is needed to pump blood.

A person who exercises often and vigorously has the lowest risk for heart
disease, but any amount of exercise is beneficial. Studies consistently find that
light-to-moderate exercise is even beneficial in people with existing heart
disease. Note, however, that anyone with heart disease should seek medical
advice before beginning a workout program.

The heart is a large muscular organ that pumps blood throughout the body. Valves inside the heart open
and close. This controls how much blood enters or leaves the heart.

Effects of Exercise on Heart Disease and Cholesterol

Exercise has a number of effects that benefit the heart and circulation (blood flow
throughout the body). These benefits include improving cholesterol and fat levels,
reducing inflammation in the arteries, assisting weight loss programs, and
helping to keep blood vessels flexible and open. Studies continue to show that
physical activity and avoiding high-fat foods are the two most successful means
of reaching and maintaining heart-healthy levels of fitness and weight.

The American Heart Association recommends that individuals perform

moderately-intense exercise for at least 30 minutes on most days of the week.
This recommendation supports similar exercise guidelines issued by the Centers
for Disease Control and Prevention, and the American College of Sports
Medicine.

Coronary Artery Disease. People who maintain an active lifestyle have a 45%
lower risk of developing heart disease than do sedentary people. Experts have
been attempting to define how much exercise is needed to produce heart
benefits. In 2002, a well-conducted study on overweight adults confirmed
previous research that reported beneficial changes in cholesterol and lipid levels,
including lower LDL levels (bad cholesterol), even when people performed low
amounts of moderate- or high-intensity exercise such as walking or jogging 12
miles a week. However, more intense exercise is required to significantly change
cholesterol levels, notably increasing HDL (good cholesterol). An example of this
kind of program would be jogging about 20 miles a week. Such benefits in the
study occurred even with very modest weight loss, suggesting that overweight
people who have trouble losing pounds can still achieve considerable heart
benefits by exercising.

Some studies suggest that for the greatest heart protection, it is not the duration
of a single exercise session that counts but the total daily amount of energy
expended. Therefore, the best way to exercise may be in multiple short bouts of
intense exercise, which can be particularly helpful for older people.

Resistance (weight) training has also been associated with heart protection. It
may offer a complementary benefit to aerobics by reducing LDL levels. Exercises
that train and strengthen the chest muscles may prove to be very important for
patients with angina.

Effects of Exercise on Blood Pressure. Regular exercise helps keep arteries

elastic (flexible), even in older people. This, in turn, ensures good blood flow and
normal blood pressure. Sedentary people have a 35% greater risk of developing
high blood pressure than athletes do.

It should be noted that high-intensity exercise may not lower blood pressure as
effectively as moderate-intensity exercise. In one study, moderate exercise
(jogging 2 miles a day) controlled high blood pressure so well that more than half
the patients who had been taking drugs for the condition were able to discontinue
their medication. However, a small study published in 2005 suggests that
moderate exercise does not have a significant impact on systolic blood pressure
(the top number) in older adults. While those who exercised did have notable
drops in both the top and lower (diastolic) blood pressure levels, the only
statistically significant change was the decrease in the lower number.

Experts recommend at least 30 minutes of exercise on most -- if not all -- days.

Studies show that yoga and tai chi, an ancient Chinese exercise involving slow,
relaxing movements, may lower blood pressure almost as well as moderate-
intensity aerobic exercises.
Anyone with existing high blood pressure should discuss an exercise program
with their doctor. Before starting to exercise, people with moderate-to-severe
high blood pressure should lower their pressure, and be able to control it with
medications. Everyone, and especially people with high blood pressure, should
breathe as normally as possible through each exercise. Holding the breath
increases blood pressure.

Effects of Exercise on Heart Failure. Traditionally, heart failure patients have

been discouraged from exercising. Now, exercise performed under medical
supervision is proving to be helpful for select patients with stable heart failure.

• Studies continue to report benefits from exercise training. In one study, heart failure patients as old
as 91 years old increased their oxygen use significantly, after 6 months of supervised treadmill and
stationary bicycle exercises.
• Progressive resistance training may be particularly useful for heart failure patients, since it
strengthens muscles, which commonly weaken in this disorder. Even simply performing daily
handgrip exercises can improve blood flow through the arteries.

Experts warn, however, that exercise is not appropriate for all heart failure
patients.

Effects of Exercise on Stroke

All stroke survivors should have a pre-exercise evaluation done by their doctor
before starting an exercise program.

The effects of exercise on stroke are less established than those on heart
disease, but most studies show benefits. The following are some examples:

• According to one major analysis, men cut their risk for stroke in half if their exercise program was
roughly equivalent to about an hour of brisk daily walking 5 days a week. In the same study,
exercise that involved recreation was more protective against stroke than exercise routines
consisting simply of walking or climbing.
• A 2000 study of women also found substantial protection from stroke in brisk walking or striding
(rather than casual walking).

Exercise Programs for High-Risk Individuals

Anyone with heart disease or risk factors for developing heart disease or stroke
should seek medical advice before beginning a workout program. Patients with
heart disease can nearly always exercise safely as long as they work out under
medical supervision. Still, it is often difficult for a doctor to predict health
problems that might arise as the result of an exercise program. At-risk individuals
should be very aware of any symptoms warning of harmful complications while
they exercise.

Some experts believe that anyone over 40 years old, whether or not they are at
risk for heart disease, should have a complete physical examination before
starting or intensifying an exercise program. Some doctors use a questionnaire
for people over 40 to help determine whether they require such an examination.
The questions they use are as follows:

• Has any doctor previously recommended medically supervised activity because of a heart
condition?
• Is chest pain brought on by physical activity?
• Has chest pain occurred during the previous month?
• Does the person faint or fall over from dizziness?
• Is bone or joint pain intensified by exercise?
• Has medication been prescribed for hypertension (high blood pressure) or heart problems?
• Is the person aware of or has a doctor suggested any physical reason for not exercising without
medical supervision?

Those who answer "yes" to any of the above questions should have a complete
medical examination before developing an exercise program.

Stress Test. A stress test helps determine the risk for a heart problem resulting
from exercise. Anyone with a heart condition or history of heart disease should
have a stress test before starting an exercise program. Experts currently also
recommend this test before a vigorous exercise program for older persons who
are sedentary, even in the absence of known or suspected heart disease. The
test is expensive, however, and some experts believe that it may not be
necessary for many older people with no evident health problems or risk factors.

Heart Attack and Sudden Death from Strenuous Exercise

A small percentage of heart attacks occur after heavy physical work.

High-Risk Individuals. In general, the following people should avoid intense

exercise or start it only with careful monitoring:

• People who have certain medical conditions: These conditions include uncontrolled diabetes,
uncontrolled seizures, uncontrolled high blood pressure, a heart attack within the previous 6
months, heart failure, unstable angina, significant aortic valve disease, or aortic aneurysm.
• People with moderate-to-severe hypertension: Experts generally recommend that moderate or
severe high blood pressure (systolic blood pressure over 160 mm Hg or diastolic (bottom number)
pressure over 100 mm Hg) should be brought to lower levels before a person starts a vigorous
exercise program.
• Sedentary people should be cautious. One major study found that sedentary people who throw
themselves into a grueling workout significantly increase their risk of heart attack.
• Episodes of exercise-related sudden death in young people are rare but of great concern. Some
are preceded by fainting, which is due to a sudden and severe drop in blood pressure. It should be
noted that fainting is relatively common in athletes, and is dangerous only in people with existing
heart conditions. Young people with genetic or congenital (present at birth) heart disorders should
avoid intensive competitive sports.
 • Anabolic steroids or products containing ephedra have been associated with cases of stroke, heart
attack, and even death.

The risk for heart attack from exercise should be kept in perspective, however.
Some form of exercise, carefully personalized, has benefits for most of the
individuals mentioned above. In many cases, particularly when the only risk
factors are a sedentary lifestyle and older age, exercise can often be increased
over time until it is intense.

Hazardous Activities for High-Risk Individuals. The following activities may pose
particular dangers for high-risk individuals:

• Intense workouts (snow shoveling, slow jogging, speed walking, tennis, heavy lifting, heavy
gardening) may be particularly hazardous for people with risk factors for heart disease, especially
older people. They tend to stress the heart, raise blood pressure for a brief period, and may cause
spasms in the arteries leading to the heart. (See image: Coronary Artery Spasm)
• Some studies suggest that competitive sports, which couple intense activity with aggressive
emotions, are more likely to trigger a heart attack than other forms of exercise.

Listening for Warning Signs. It should be noted that according to one study, at
least 40% of young men who die suddenly during a workout have previously
experienced, and ignored, warning signs of heart disease. In addition to avoiding
risky activities, the best preventive tactic is simply to listen to the body and seek
medical help at the first sign of symptoms during or following exercise. These
symptoms include the following:

• Irregular heartbeat
• Shortness of breath
• Chest pain

Exercise's Effects on Diabetes

Moderate aerobic exercise can lower your risk for type 2 diabetes. An important
study found that adults who worked out 2 and 1/2 hours a week cut their risk by
58%.

Exercise has positive benefits for those who have diabetes. It can lower blood
sugar, improve insulin sensitivity, and strengthen the heart. Strength training,
which increases muscle and reduces fat, may be particularly helpful for people
with diabetes, but more evidence is needed to confirm this theory. One study
reported that yoga helped patients with type 2 diabetes reduce their need for oral
medications.

In 2005, researchers found that people with type 2 diabetes who walked a
minimum of 3 miles every day were in better health, and had lower medical
expenses, after 2 years of such exercise. Those who remained sedentary for that
time period experienced a decline in their overall health and higher health care-
related expenses. Study participants who worked out for an average of 38
minutes per day lowered their blood pressure, cholesterol ,and A1C levels
(glucose concentration over time). These participants also had lower heart
disease risk, even if they didn't lose weight. The increase in the study
participants' activity equaled about 2,200 extra steps a day. The findings were
reported in the journal Diabetes Care.

An earlier study found that healthy lifestyle changes may work better than the
prescription medication metformin (Glucophage), when it comes to preventing
metabolic syndrome. Metabolic syndrome is a combination of risk factors
including abdominal obesity, insulin resistance, high triglycerides, and
hypertension.

Some Precautions for People With Diabetes Who Exercise

The following are precautions for all people with diabetes, whether type 1 or 2:

• Because people with diabetes are at higher than average risk for heart disease, they should always
check with their doctors before starting a demanding exercise program. For best and fastest
results, frequent high-intensity (not high-impact) exercises are best for people who are cleared by
their doctor. For people who have been sedentary, or have other medical problems, lower-intensity
exercises are recommended, using programs the patients designed with their doctors.
• Strenuous strength training or high-impact exercise is not recommended for people with
uncontrolled diabetes. Such exercises can strain weakened blood vessels in the eyes of patients
with retinopathy (a common diabetic complication). High-impact exercise may also injure blood
vessels in the feet.

Patients who are taking medications that lower blood glucose, particularly insulin,
should take special precautions before starting a workout program.

• Glucose levels swing dramatically during exercise. People with diabetes should monitor their levels
carefully before, during, and after workouts.
• Patients should probably avoid exercise if glucose levels are above 300 mg/dL or under 100 mg/dL.
• To avoid hypoglycemia (low blood sugar), people with diabetes should inject insulin in sites away
from the muscles they use the most during exercise.
• People with diabetes should drink plenty of fluids. Before exercising, they should avoid alcohol,
which increases the risk of hypoglycemia.
• Insulin-dependent athletes may need to decrease insulin doses, or take in more carbohydrates,
prior to exercise. However, they may need to take an extra dose of insulin after exercise. Stress
hormones released during exercise may increase blood glucose level (in people without diabetes,
insulin is released to control this increase). People with diabetes must regularly test their blood
sugar, and take any medications as instructed by their doctor.
A person with diabetes must regularly check their blood sugar (glucose) level.

Exercise's Effects on Bones and Muscles

Exercise is critical for strong muscles and bones. Muscle strength declines as
people age, but studies report that when people exercise they are stronger and
leaner than others in their age group.

Exercise helps kids lower their risk of chronic pain in the future. Research has
shown that it helps them prevent back and neck pain. The more flexible men are
as teenagers, the lower their risk of neck tension in the future, according to a
study published in the February 2006 British Journal of Sports Medicine. The
same report found that women who had the greatest endurance strength as
teenagers had a lower risk of tension neck than those with lower teenager
endurance strength. However, men with the greatest endurance strength had
higher rates of knee injuries later on.
Joints are complex structures. They are designed to bear weight and move the body. Above the knee is the
femur (thigh bone). Below the knee is the tibia (shin bone) and fibula. The kneecap is also called the patella.
It rides on top of the lower portion of the femur and the top portion of the tibia. The muscles and ligaments
connect these bones and the space between them is cushioned by fluid-filled capsules (synovia) and
cartilage. When you exercise, the muscles pull on the bones, strengthening them. The range of motion of a
joint represents how far it can be flexed (bent) and extended (stretched).

Effects of Exercise on Osteoarthritis

Joints require motion to stay healthy. Long periods of inactivity cause the arthritic
joint to stiffen and the adjoining tissue to weaken. A moderate exercise program
that includes low-impact aerobics, power, and strength training has benefits for
osteoarthritic patients, even if exercise does not slow down the disease
progression. Many patients who start an exercise program report less disability
and pain. They are also better able to perform daily chores, and remain
independent longer than their inactive peers. Older patients and those with
medical problems should always check with their doctor before starting an
exercise program.

The following are useful exercises for osteoarthritis patients:

• Strengthening exercises builds muscle strength. Some experts encourage patients to emphasize
strengthening leg muscles as a first treatment step, even before using pain relievers. They fear that
patients who rely on painkilling drugs may overuse knees, which do not have strong enough
muscle tissue to protect the joints from further damage. Strengthening the thigh muscles is certainly
protective for those who have not developed osteoarthritis.
 • Range-of-motion exercises increase the amount of movement in a joint and muscle. The best
examples are yoga and tai chi, which focus on flexibility, balance, and proper breathing. In one
2001 study, older adults who practiced the gentle movement, breathing, and meditation exercises
of tai chi for 10 weeks reported less pain than their peers who did not learn the technique.
• Low-impact aerobic workouts help stabilize and support the joints. Cycling and walking are
beneficial, and swimming or exercising in water is highly recommended for people with arthritis.
Patients with arthritis should avoid high-impact sports, such as jogging, tennis, and racquetball.
• Some researchers are now focusing on "power" training, which involves improving the muscle's
ability to move more rapidly against resisting forces, such as gravity. For example, such training
helps people stand up or climb stairs more quickly. Muscle power declines more rapidly than
muscle strength, and may be particularly important in older people.

Exercises Effect on Fractures and Falls

Exercise is very important for slowing the progression of osteoporosis, and

extremely important for reducing the risk of falling, which causes fractures. Falls
are one of the leading causes of death in people over the age of 65. Exercise
helps build balance and flexibility, which reduces the risk of falling.

Specific exercises may be especially helpful for reducing the risk of fractures:

• Weight-bearing exercise is very beneficial for bones in people of all ages, even older people. This
approach applies tension to muscle and bone, and the body responds to this stress by increasing
bone density, in young adults by as much as 2 - 8% a year. Careful weight training can also be very
beneficial for elderly people, particularly women. In addition to improving bone density, weight-
bearing exercise reduces the risk of fractures by improving muscle strength and balance, thus
helping to prevent falls.
• Regular brisk long walks improve bone density and mobility. In one 2002 study, for example, older
women reduced their risk of hip fracture by over 40% by working out just four hours a week.
• Exercises specifically targeted to strengthen the back can be beneficial in improving posture, and
may even reduce kyphosis (hunchback) in people with osteoporosis.
• Low-impact exercises, particularly yoga and tai chi, which improve balance and strength, have
been found to decrease the risk of falling. In one study, tai chi reduced this risk by almost half.

Note on Female Athlete Triad. Some young female athletes who exercise very
intensely, and are subject to intense pressure to remain thin, are at risk for the
female athlete triad. This syndrome is a combination of three disorders -- an
eating disorder, loss of menstrual periods, and osteoporosis.

Effect of Exercise on Back Pain

People who do not exercise regularly face an increased risk for low back pain,
especially during times when they suddenly have to perform stressful, unfamiliar
activities. These activities may include shoveling, digging, or moving heavy
items. Although no definitive studies have been done to prove the relationship
between lack of exercise and low back pain, sedentary living is probably a
primary nonmedical cause contributing to this condition.

Lack of exercise leads to the following conditions that may threaten the back:

• Muscle inflexibility can restrict the back's ability to move, rotate, and bend.
• Weak stomach muscles can increase the strain on the back and can cause an abnormal tilt of the
pelvis (hip bones).
• Weak back muscles may increase the load on the spine and the risk of disk compression.
• Obesity puts more weight on the spine and increases pressure on the vertebrae and disks. Studies
report only a weak association between obesity and low back pain, however.

Benefits for Chronic Back Pain. People in with sudden and severe back pain
should not exercise. Exercise plays a very beneficial role in relieving chronic
back pain, however. In one study, patients with back pain lasting for an average
of 18 months were assigned eight 1-hour exercise sessions over 4 weeks. They
showed greater improvement in nearly every area, including reduced pain,
compared to patients who did not exercise.

Exercise should be considered as part of a broader program to return to normal

home, work, and social activities. In this way, the positive benefits of exercise not
only affect strength and flexibility but they also alter and improve the patients'
attitudes toward their disability and pain.

Repetition is the key to increasing flexibility, building endurance, and

strengthening the specific muscles needed to support the spine. Some exercise
programs used for prevention or treatment of chronic low back pain include the
following:

• Low-impact Aerobic Exercises: Low-impact aerobic exercises, such as swimming, bicycling, and
walking, can strengthen muscles in the abdomen and back without over-straining the back.
Programs that use strengthening exercises while swimming may be a particularly beneficial
approach for many patients with back pain. In one study, for example, pregnant women who
engaged in a water gymnastics program had less back pain, and were able to continue working
longer.
• Lumbar Extension Strength Training: Exercises called lumbar extension strength training are
proving to be effective. Generally, these exercises attempt to strengthen the abdomen, and
improve lower back mobility, strength, and endurance. They also enhance flexibility in the hip and
hamstring muscles, and in the tendons at the back of the thigh.
• Yoga, Tai Chi, and Chi Kung: These exercises combine low-impact physical movements and
meditation. They are based on principles of disciplining the mind to achieve a physical and mental
balance, and can be very helpful in preventing recurrences of low back pain. In one study of
Pilates, an exercise practice that uses yoga principles, the exercises were helpful in a woman with
progressive and disabling severe low back pain resulting from early scoliosis. This approach
deserves further research.
• Flexibility Exercises: Whether flexibility exercises alone offer any significant benefit for chronic back
pain is uncertain. One study suggested that any benefits derived from flexibility exercises are lost
unless the exercise programs are sustained.
• Retraining Deep Muscles: Studies are finding a link between low back pain and poor motor control
of deep muscles in the back and trunk. According to these studies, contraction exercises
specifically designed to retrain these muscles may be effective for patients with both acute and
chronic pain.
It is important for any person who has low back pain to have an exercise program
guided by professionals who understand the limitations and special needs of
back pain and who can address individual health conditions. One study indicated
that patients who planned their own exercise did worse than those in physical
therapy or doctor-directed programs.

Hazardous Effects on the Back. Improper or excessive exercise can also cause
back pain.

Exercise's Effects on the Lungs

Patients with chronic lung problems have difficulty exercising. Shortness of

breath is a major limitation in most patients, but in about a third, muscle fatigue is
an even greater problem. Although exercise does not improve lung function,
training helps many patients with chronic lung disease by strengthening their limb
muscles, thus improving endurance and reducing breathlessness.

Effects of Exercise on Respiratory Infections (Colds and the Flu)

In people who already have colds, exercise has no effect on the illness' severity
or duration. People should avoid strenuous physical activity when they have
fevers, muscle aches, or other symptoms of a widespread viral illnesses.

Effects of Exercise on Asthma

Long-term exercise may help control asthma and reduce hospitalization. One
2000 study found that aerobic exercise improves breathing capacity and function
in patients with mild asthma. People with asthma who enjoy running should
probably choose an indoor track, to avoid pollutants. Swimming is particularly
excellent for people with asthma. Yoga practice, which uses both stretching,
breathing, chest expansion, and meditation techniques may have specific
benefits that include stress reduction as well as airway opening. One study
reported that two thirds of patients who practiced yoga regularly were able to
reduce or eliminate their asthma medications.

Exercise-Induced Asthma. About 40 - 90% of asthma cases are exercise-induced

asthma (EIA), in which exercise triggers coughing, wheezing, or shortness of
breath. It occurs most often in children and young adults and during intense
exercise in cold dry air. EIA is triggered only by exercise. Unlike allergic asthma,
there is no long-term increase in airway activity. People who only have EIA do
not require long-term maintenance therapy. The warm-up and cool-down periods,
which are important for any exercise regimen, may help reduce EIA events. A
study of military recruits found that exercise-induced asthma attacks did not
hinder their ability to perform or train, suggesting that EIA is not a reason to
exclude people from physically demanding occupations.
Exercise-induced asthma is distinct from allergic asthma in that it does not produce long-term increase in
airway activity. People who only experience asthma when they exercise may be able to control their
symptoms with preventive measures such as warm-up and cool-down exercises.

Effects of Exercise on Emphysema

Walking is the best exercise for people with emphysema. Patients should try to
walk three to four times daily for 5 - 15 minutes each time. Devices that assist
ventilation may reduce breathlessness that occurs during exercise.

Inspiratory muscle training involves exercises and devices that make inhaling
(breathing in) more difficult, in order to strengthen breathing muscles. In a 2001
study, patients who took part in an inspiratory muscle training group improved
their breathing, walking capacity, and quality of life. Yoga or martial arts
exercises, such as tai chi, which emphasize breathing techniques and balanced
movements, may be particularly beneficial for patients with emphysema.

Exercise's Effects on Weight

Exercising helps people reduce their weight, maintain weight loss, and fight
obesity. Research has shown that women who regularly exercise but do not
change their diet can lose significantly more weight than less active women.

Thirty minutes of moderate-intensity exercise may be adequate to maintain

cardiovascular health, but it might not prevent weight gain. Recommendations
published in 2003 and 2004 suggest that 45 - 60 minutes of exercise per day is
necessary to promote weight loss. Children may need more activity.

Losing significant weight requires both exercise and calorie restriction. In

addition, if a person exercises without dieting, any actual weight loss may be
minimal because dense and heavier muscle mass replaces fat. Nonetheless,
regardless of weight loss, a fit body will look more toned and be healthier.

People who exercise are more apt to stay on a diet plan. Exercise improves
psychological well-being and replaces sedentary habits that usually lead to
snacking. Exercise may even act as a mild appetite suppressant.

Exercising without dieting still adds health benefits. One study found that
overweight but fit people have half the death rate of overweight, unfit people.
Research suggests that people who have trained for a long time develop more
efficient mechanisms for burning fat and are able to stay leaner.

Lifting weights builds muscle, which burns calories more efficiently than other body tissues.

The following are some suggestions and observations on exercise and weight
loss:

• The treadmill burns the most calories of standard aerobic machines. It may be particularly effective
when used in short multiple bouts during the day. Exercise sessions as short as 10 minutes, which
are done frequently (about four times a day), may be the most successful program for obese
people.
• The more strenuous the exercise, the longer the body continues to burn calories before returning to
its resting level. This state of fast calorie burning can last for as little as a few minutes after light
exercise, to as long as several hours after prolonged or heavy exercise.
• Resistance (strength) training is excellent for replacing fat with muscles. It should be performed two
or three times a week.
• Fidgeting may be very helpful in keeping pounds off. Regular exercise is certainly the best course,
but for people who must sit for hours at work, frequently shifting positions while sitting may have
some benefit.
• It is important to realize that as people slim down, they burn fewer calories per mile of walking or
jogging. The rate of weight loss slows down, sometimes discouragingly so, after an initial dramatic
head start using diet and exercise combinations. People should be aware of this trend and keep
adding to their daily exercise routine.
 • Changes in fat and muscle distribution may differ between men and women as they exercise. Men
tend to lose abdominal fat (which lowers their risk for heart disease faster than reducing general
body fat). Exercise, however, does not appear to have the same effect on weight distribution in
women. A study of women who practiced aerobic and strength training showed the training resulted
in fat loss in the women's arms and trunk. However, they did not gain muscle tissue in those areas.

Because obesity is one of the risk factors for heart disease, anyone who is
overweight must discuss their exercise program with a physician before starting.

Exercise's Effects on Other Conditions

Physical activity makes you healthier. It lowers your risk for cardiovascular disease and reduces bone loss.
Physical activity also helps the body use calories more efficiently, which helps you eliminate body fat and
lose weight. It also helps you maintain weight loss by increasing your metabolism and reducing your
appetite.

Effect of Exercise on Cancer

A number of studies have indicated that regular exercise may reduce the risk of
breast, colon, and possibly prostate cancers.

Studies confirm that exercise significantly reduces the risk of both colon cancer
(by up to 50%) and breast cancer (by up to 30%).

A 2006 study found that, though protection from breast cancer may vary among
the types of tumor, exercise offered the most marked protection from the more
aggressive tumors. A second study, also done in 2006, supported this finding.
Several studies also suggested that more intense exercise is more protective
against breast cancer. Exercising consistently throughout life gives the best
protection. Exercise not only lowers a woman's chance of getting breast cancer,
it can help those who have received chemotherapy for the disease fight off
fatigue.
While endurance athletes may suffer from stomach problems, low intensity
exercise has a marked protective effect against colon cancer, according to
studies, including the Nurses Health Study and the American Cancer Society's
Cancer Prevention Study II. Furthermore, a 2006 study found that people with
colon cancer who exercise reduce their risk of a recurrence.

Exercise also has a beneficial effect on people receiving treatment for prostate
cancer. A new study found that aerobic and resistance training significantly
reduced fatigue in men undergoing radiation treatments for prostate cancer.
Fatigue is a common side effect of such treatments. In this study, 122 patients
received supervised aerobic training, resistance training, or neither. At the end of
24 weeks, participants in both exercise groups noted significant improvement in
their fatigue symptoms, compared to the control group. Participants in the
resistance training group also lost a significant percentage of their body fat.

Effects on the Gastrointestinal Tract

Endurance athletes often report stomach problems, such as bloating, diarrhea,

and gas, even at rest. Experts suggest that moderate regular exercise might
reduce the risk for some intestinal disorders. These disorders include ulcers,
irritable bowel syndrome, indigestion, and diverticulosis. Older people who
exercise moderately may have a lower risk for severe gastrointestinal bleeding.

Effects on Kidney Disease

Patients with end-stage kidney disease who exercise four to five times per week
have better survival rates than those who are less active, according to
researchers involved in the Dialysis Morbidity and Mortality Wave 2 study.
However, the majority of study participants said that severe physical limitations
prevented them from exercising so often.

Effects on Neurological Diseases and Mental Decline

Studies have shown that regular exercise, particularly walking, helps reduce
one's risk for memory loss. A 2005 study found that older men who walked less
than a mile daily had a 71% higher risk of dementia than those who walked more
than two miles a day. A 2006 study found that people older than 65 who exercise
regularly had lower risk of developing dementia, particularly Alzheimer's disease.
An earlier study found that walking regularly protects women from mental
decline. To date, there are no clear explanations for this apparent benefit. A
preliminary study in mice suggests that physical activity changes the way brain-
damaging proteins are processed in the brain, thus slowing the development of
Alzheimer's disease. Aerobic exercise has been linked with improved reaction
time, perception, and math skills in people of all ages.

Doctors found that exercise improves the physical and emotional well-being of
patients who already have Alzheimer's disease. The patients exercised
moderately for as little as 60 minutes each week. Doctors noted patients who
exercised were less depressed, wandered away less, suffered fewer falls, and
were placed in nursing homes later, compared to patients who did not exercise.

People with existing neurological diseases, such as multiple sclerosis,

Parkinson's disease, and Alzheimer's disease, should be encouraged to
exercise. Specialized exercise programs that improve mobility are particularly
valuable for patients with Parkinson's disease. Patients with neurological
disorders who exercise experience less stiffness, as well as reduction in, and
even reversal of, muscle wasting. In addition, the psychological benefits of
exercise are extremely important in managing these disorders. Exercise
machines, aquatic exercises, and walking are particularly useful.

Effects on Emotional Disorders

Some research has suggested that exercise may have antidepressant effects.
Although there is little strong evidence that exercise can help manage
depression, a number of studies have suggested benefits. Research findings
include:

• Just 30 minutes of brisk exercise three times a week was as effective as medication in relieving
symptoms, and reducing relapse, in many patients with mild-to-moderate depression.
• Over half of older women with depression that did not respond to medication improved with 10
weeks of exercise. (About a third of women who did not exercise also improved during that time.)
• Studies on elderly, depressed patients report modest benefits from exercise, even in those who do
not response to antidepressants. Simply participating in a group activity may help improve mood.
• Teenagers who are active in sports have a greater sense of well-being than their sedentary peers.
The more vigorously they exercise, the better their emotional health.
• Physical inactivity is strongly linked to depression in children 8 - 12 years of age.

Specific exercises may be particularly beneficial:

Aerobics. Either brief periods of intense training or prolonged aerobic workouts

can raise levels of certain chemicals in the brain. These chemicals -- which
include endorphins, adrenaline, serotonin, and dopamine -- produce the so-called
runner's high. Weight loss and increased muscle tone can boost self-esteem.

Yoga. Yoga practice, which involves rhythmic stretching movements and

breathing, has been found to positively affect mood. It may have clinical potential
as a technique for improving and stabilizing mood. A study comparing yoga to
aerobic exercise found that men have significantly lower levels of tension,
fatigue, and anger after yoga, compared with levels after swimming. Yoga and
swimming tended to produce equal benefits in women.

.
Effect of Exercise on Pregnancy

Moderate exercise in healthy pregnant women does not increase the risk for
miscarriage, preterm labor, or rupture of the membrane. Not exercising increases
the risk for complications, including low-birth weight babies. Exercising increases
the fetal heart rate, which in turn protects the baby.

Healthy women with normal pregnancies should exercise at least three times a
week, being careful to warm up, cool down, and drink plenty of liquids. Many
prenatal calisthenics programs are available.

The following are specific exercises that may benefit the pregnant woman:

• Swimming and water aerobics may be the best option for most pregnant women. Swimming has
special benefits for those with fluid buildup. Water exercises involve no impact, overheating is
unlikely, and swimming face down promotes optimum blood flow to the uterus.
• Performing yoga exercises under the guidance of informed instructors can be very helpful.
• Walking is also beneficial.

To strengthen pelvic muscles, women should perform Kegel exercises at least

six times a day. This involves contracting the muscles around the vagina and
urethra for three seconds 12 - 15 times in a row.

Experts generally recommend the following precautions for pregnant women who
exercise:

• Fit women who have exercised regularly before pregnancy may work out intensely as long as the
doctor approves and no discomfort occurs.
• As a rule for previously sedentary, low-risk expectant mothers, the pulse rate should not exceed 70
- 75% of the maximum heart rate, or more than 150 beats per minute. Any sedentary expectant
mother should check with her doctor before starting an exercise program.
• According to one study, vigorous exercise may improve the chances for a timely delivery. All
pregnant women, however, should avoid high-impact, jerky, and jarring exercises, such as aerobic
dancing, which can weaken the pelvic floor muscles that support the uterus.
• During exercise, women should monitor their temperature to avoid overheating, a side effect that
can damage the fetus. (Pregnant women should also not use hot tubs or steam baths, which can
cause fetal damage and miscarriage.)

Note: Strenuous exercise may affect the flavor of breast milk for a short time
afterward. Nursing mothers who engage in such activity might want to wait about
an hour after exercising before they feed their infant.

Complications

Exercise may lead to injury if not done properly. Always exercise with care.

Injuries from High-Impact Exercise

Competitive running or high-impact aerobics pose a high risk of a number of

injuries to the bones and muscle. The effect of high-impact exercise on the back
is not entirely clear. Some research suggests that over time, high-impact
exercise may increase the risk for degenerative disk disease. A survey of people
who played tennis, however, found no increased risk for low back pain or
sciatica.

High-impact exercise can also cause dizziness, ringing in the ear, motion
sickness, or loss of high-frequency hearing.

Some research further suggests that in people unused to exercise, intense

activity increases production of harmful particles in the body called free radicals.
These unstable oxygen particles injure muscle tissue. Muscle pain in this case
does not occur until 24 - 48 hours after exercise.

Some people have a higher than average risk for injury:

• About half of people at any age who participate in competitive running or high-impact aerobics
experience minor injuries at least once a year. Young, intensely competitive athletes may be at risk
for permanent injury. Studies are mixed over whether intensive high-impact sports in younger
people cause long-term degenerative joint disease.
• As the number of older people who start exercising increases, there has also been an increase in
injuries for this age group. Between 1990 and 1996, injuries from active sports increased by 54% in
people age 65 and older.
• Women are far more likely than men to suffer knee injuries.
• Urinary incontinence affects many female athletes who engage in high-impact exercise.
• Tennis players are at high risk for injuries from repetitive force on the shoulder joint.

Preventing High-Impact Injuries. The following may be helpful for preventing

injury:

• Wear shock-absorbing footwear with weight-dampening inserts.

• Combine weight lifting with jumping exercises. This may prevent injury by strengthening hamstrings
and improving coordination.
• Vary training and alternate easy and harder workouts.
• Be careful to warm up, cool down, and stretch. Flexibility is the key to preventing many muscle
strains.
• Take days off now and then. The risk of injury increases when athletes train more than five times a
week.

Because of the association between high-impact exercises and oxidation, some

experts suggest eating foods rich in antioxidants, such as vitamins A, C, and E.
Such foods, which may protect against damage from free radicals, include many
fresh fruits and vegetables.

Treating Minor Injuries. Most mild or moderate injuries respond well to a simple,
four-step treatment: rest, ice, compression, and elevation (RICE). This
combination works well for both spot injuries and chronic problems. Ice packs,
which reduce inflammation and pain, can help new injuries, and can be useful for
the first few hours after a chronically injured area is exercised. How much or how
long to compress the injury is unclear.
Evidence suggests that early movement is helpful, although taping or bracing in
people with a recurrent ankle sprain is known to be protective. It may not be
helpful in those without a previous ankle injury.

Minor injuries like sprains may be treated at home if broken bones are not suspected. The acronym RICE
can help you remember how to treat minor injuries: "R" stands for rest, "I" is for ice, "C" is for compression,
and "E" is for elevation. Pain and swelling should decrease within 48 hours. Gentle movement may help, but
pressure should not be put on a sprained joint until pain is completely gone. This can take up to a few
weeks.

Heat, ultrasound, whirlpool, and massage may speed healing if applied a day or
two after the initial injury or for warm-up before another workout session.

Female Athlete Triad

Some young female athletes who exercise very intensely, and are subject to
intense pressure to remain thin, are at risk for a syndrome known as the female
athlete triad. This combination of symptoms includes loss of menstruation, eating
disorders, and osteoporosis. Eating disorders among young female athletes are
estimated at 15 - 62%. Women at higher risk include ballet dancers, gymnasts,
and divers. Continued intense exercise causes a stress response in which
estrogen (the primary female hormone) is lost. Estrogen loss can lead to infertility
and osteoporosis. Iron loss and anemia may also be a problem in women who
exercise frequently, even at moderate intensity. A doctor should be consulted for
any of these concerns.

Improper Mechanics and Its Effect on the Back and Shoulders

Incorrect movements can literally cause mechanical problems in the muscles.

These problems are usually the result of improper exercise instruction, and lack
of attention. A single jerky golf swing, or the incorrect use of exercise equipment
(especially free weights, nautilus, and rowing machines), can cause serious back
injuries.

Between 30 - 70% of cyclists experience low back pain. Pain may be improved
by adjusting the angle of the bicycle seat.

Dehydration

Everyone should drink lots of fluid during intense exercise. Thirst is often a poor
indicator of dehydration in people who exercise, particularly older people. During
a tough workout in a hot environment, the body can lose two liters of fluid per
hour through sweat.

Anyone who exercises intensely should take the following precautions:

• Drink 6 - 8 ounces of fluid about 15 minutes before a workout, and then pause regularly during
exercise to drink more.
• Water is the best choice for replenishing body fluids. Glucose-sodium-potassium solutions, the so-
called "sports drinks," which promise instant energy, appear to be no better than water at improving
endurance during prolonged intense running.
• Caffeinated beverages like coffee and soft drinks give short bursts of energy, but can actually
cause fluid loss. Caffeine before a workout has been shown to temporarily raise blood pressure,
and reduces blood flow to inactive limbs.

Contrary to popular belief, drinking fluids will not cause cramps. Drinking enough,
in fact, helps prevent the painful involuntary muscle spasms that sometimes
occur during exercise.

Hyperthermia (Overheating)

Overheating, or hyperthermia, can be a problem with hard exercise, or when

working out in hot weather. Overheating can cause mild to life-threatening
conditions. Heat exhaustion, a moderate form of hyperthermia, is characterized
by the following symptoms:

• Lightheadedness, nausea, headache, hyperventilation, fatigue, and loss of concentration

• A high temperature (above 103 F), possibly accompanied by complaints of chills and clammy skin

Individuals should rest in a cool, dry place, drink plenty of fluids, and bring down
their body temperature with ice packs pressed against the skin.

Heatstroke. Heatstroke is the most dangerous complication of hyperthermia. The

victim may suddenly stop sweating, after which symptoms such as altered
consciousness, seizures, and even coma may quickly follow. Heat stroke is a
medical emergency and requires immediate cooling of the victim in an ice-water
bath or with ice packs. One study suggests that risk for serious complications
from exercising in high temperatures may persist as late as the following day,
even if the weather has cooled down.
Frostbite and Hypothermia

Precautions are also necessary in cold weather. When exercising in winter dress
in layers, including gloves and socks, which create insulated air pockets that trap
heat. In cold weather, wear shoes with less ventilation than those worn in the
summer. Fingers, toes, ears, and nose are most susceptible to frostbite. Frostbite
progresses from stinging or aching to numbness. Fingers and toes may become
white. Soaking the hands and feet in warm water can help, but only once there is
no risk of refreezing, since a second bout of frostbite after thawing can quicken
tissue damage.

Hypothermia can be life-threatening and can occur even after long exposure to
temperatures that are above freezing. The condition is characterized by extreme
fatigue, mental confusion, apathy, and a lack of coordination. The victim should
be warmed as soon as possible with blankets, body heat, and warm fluids.

Motivation

Motivation, or a lack thereof, is one reason many people stop exercising. Here
are some tips for avoiding burnout:

• Think of exercise as a menu rather than a diet. Choose a number of different physical activities that
are personally enjoyable such as sports, dancing, or biking. Although experts say you should get
30 minutes of aerobic exercises at least five times a week, those times can be divided into shorter
 periods -- such as 10 minute sessions. In addition, people can achieve health benefits from other
exercise programs, including weight training, yoga, or tai chi.
• Stick to a prepared schedule and record progress.
• Develop an interest or hobby that requires physical activity.
• Adopt simple routines such as climbing the stairs instead of taking the elevator, walking instead of
driving to the local newsstand, or canoeing instead of zooming along in a powerboat.
• Try cross training (regularly switching from one type of exercise to another). Studies suggest it is
more beneficial than focusing only on one form of exercise.
• Exercise with friends.
• Join a gym or take classes. Many affordable programs are available.
• For those who can afford them, personal trainers can be very helpful and are available in many
gyms and exercise clubs. Personal trainers without any connection to a well-reputed gym or fitness
club should be certified by a major fitness organization, such as the Aerobics and Fitness
Association of America (AFAA) or the American Council on Exercise.
• Exercise videos may also be helpful, but people should be sure they are suited to their individual
age and health needs, and bear the seal of the AFAA.
• Consider getting a dog. A study in the February 2006 American Journal of Preventive Medicine
found that dog owners in Canada walk almost twice as much as those who dont own a dog.
Regular walking is a good way to improve health.

Differences in Motivation Between Men and Women. Motivation factors may

differ by gender, and women appear to have a harder time. In one study, weight
loss was the greatest motivator to exercise for women, and muscle tone was the
primary motivator for men. Unfortunately, effects on appearances may take a
long time to show, discouraging people from continuing an exercise program
even though their health is improving.

Motivating Children and Adolescents

Overweight among children and adolescents has now become an epidemic in the
United States. Experts say that children should be vigorously active for at least
20 - 60 minutes 3 - 5 days a week. Parents and schools must be imaginative and
rigorous in encouraging children to exercise.

Role of Parents. Parents must make conscious efforts to limit sedentary

activities, and to encourage physical ones for their children. This includes
monitoring the time children spend on the computer, in front of the TV, or playing
video games. Parents should suggest different forms of entertainment. Even
children who aren't interested in joining a Little League team may enjoy a round
of catch with their parents, walking in the park, or swimming in a local lake.

Role of Schools. Early school physical education programs can make a

significant difference and the earlier these routines are learned, the more likely
they will be carried forth into a healthy adulthood. Schools should emphasize
team cooperation or individual improvement and self-mastery. Studies have
shown that people tend to give up more quickly and feel less competent if their
perceptions of success are based only on comparison to their peers.

People mature at different rates, and there seems to be a genetic component to

coordination, strength, speed, and one's response to resistance exercise.
Nonetheless, everyone should strive to be as fit as they possibly can, given their
strengths and limitations.

Stages for Adopting Healthy Behavior

The decision to adopt a healthier behavior -- whether it's more exercise, weight
loss, or quitting smoking -- is not as simple as just deciding to do it. Behavior
change expert James Prochaska and his colleagues outlined a theory, which has
been supported by numerous studies, showing that people cycle through a
variety of stages before a new behavior is successfully adopted over the long
term. It may help you to understand how this works. As you read the description
of each stage -- specifically as it relates to exercise -- you may find yourself
nodding and saying to yourself, "Yes, that's me!"

Stage 1: Pre-Contemplation. People at this stage have no plans or desire to

exercise. They aren't even considering exercising. They are generally unaware of
the specific benefits that exercise can bring -- exercise may seem more like a
hassle than something worth doing. Or, they may simply have "failed" in the past
and have given up.

There's no point in talking about how to start an exercise program if you are at
this stage. Instead, it is important to think about how exercise might be good for
you personally -- by helping you to lose weight, feel better, have more
confidence, live longer, sleep better, or reduce your stress levels. The benefits
must be identified before a person will consider exercise.

If you are at this stage, a good activity is to ask four friends or family members
why they exercise. Their answers may show you some real-life benefits, and
inspire enough interest to compel you to take the next step.

Stage 2: Contemplation. A person at this stage is thinking, "I think I should

probably exercise, but I need help getting started." People at this stage know that
exercise is good for them, but it seems like a daunting task or they don't think
they can pull it off. Some may have tried and "failed" in the past, but they are still
receptive to another go-round.

It's important for people at this stage to consider some of the truths and
falsehoods of exercise. For example, it is helpful to know that there are many
forms of physical activity to select from, and that you can do your exercising in
small chunks. It is not true that exercise has to be painful, or that you either
succeed or fail. There is no such thing as "failure" -- people become more or less
active at different stages of their lives, and it is never too late to get moving
again. And people at this stage should find assurance that an exercise plan can
be very simple.

If you are at this stage, a good activity is to write down all the things that you
believe make exercise difficult -- and to learn strategies for overcoming or side-
stepping those hurdles. People at this stage might benefit from making a pledge,
contract, or other commitment that they are going to get more active in the near
future. The goal is to get un-stuck by identifying the roadblocks and the ways to
overcome these roadblocks. The final goal at this stage is to make a
commitment.

Stage 3: Preparation. These folks are primed and motivated. They are ready to
give exercise a try. The goal of this stage is to create a specific action plan that
takes all factors into account, so that the "launch" is successful. People at this
stage need to know how much they should be exercising, their target heart rate,
and the types of exercises. They should explore the different kinds of exercises
and decide which ones to try.

At this stage, people will evaluate exercise machines and health plans, if that
interests them, pick the proper clothing or accessories, and consult a doctor if
necessary. They also need to think about how they are going to fit their exercise
plans into their daily and weekly schedule.

If you are at this stage, you should also consider some backup plans -- what to
do if it rains, or if you don't feel like exercising. That way you are prepared to
overcome that hurdle when you encounter it. You should be aware of what to
expect realistically at the beginning -- for example, be aware that weight loss
takes time, but health benefits begin immediately.

Stage 4: Action! People at this stage have just started exercising. This stage is
where the biggest behavior change occurs -- these people have started to
exercise but it is not yet a long-term, ingrained habit. This stage requires
significant commitment and energy.

If you are at this stage, keep talking to friends and family for inspiration. Review
your backup plans. Reward yourself for small achievements. Give yourself notes
and reminders to exercise. Having a friend to exercise with can be very helpful as
you get through this stage. You want to build and maintain momentum, because
exercising gets easier once it is a habit!

Stage 5: Maintenance. The people at this stage have been exercising for at least
6 months. At this point, exercising has started to become a habit. The goal here
is to prevent relapse. If you are at this stage, identify ways that you can fine-tune
your program. Continue to identify roadblocks and improve your backup plans.
Think about what you have found most enjoyable about exercising.

What benefits have you gained? Keep reminding yourself of these perks. If giving
yourself a challenge was part of your initial motivation, set new goals and find
new challenges. If you risk getting bored with your routine, find ways to vary it. Or
maybe you have found a comfortable routine that you enjoy -- if it's working,
great! There is no need to change it. You might want to read or learn more about
your method of exercising, and develop a deeper level of understanding about it.
Soon you'll be a pro!

One point about this theory is that people do not proceed from one stage to
another in a simple, step-by-step fashion. They actually cycle or spiral back and
forth, so that they may move from stage 1 to 2 to 3, and then back to 2 again.
They may stay in maintenance mode for years and then fall back to stage 2.
Remember that this is normal -- if you tried exercising in the past and didn't stick
with it, don't consider yourself a failure. Just know that it's time to try again!

Resources

• http://fitness.gov -- The President's Council on Physical Fitness and Sports

• www.ncppa.org --National Coalition for Promoting Physical Activity
• www.acefitness.org --American Council on Exercise
• www.arthritis.org --The Arthritis Foundation offers tips on exercising with arthritis
• www.justmove.org -- Just Move (American Heart Association)