Enjoy a higher quality of life

By health.usnews.com/Duke Medicine Updated at 2013-11-12 21:07:29 +0000


One of the most important things people can do for their health is to engage in regular physical activity. A life that includes exercise is one with less likelihood of serious physical and mental ailments. The benefits are wide-ranging, from stronger bones, greater lung power, and a healthier heart to a lower cancer risk, a sharper brain, and a happier spirit.

Unfortunately, most Americans are not active enough to reap these rewards. But a reasonably modest change in behavior can make a big difference, bringing benefits within reach. Most of us could improve our health significantly by making room in our lives for a half-hour of exercise most days of the week. And the exercise doesn't have to be intense—it can be a simple 30-minute walk at a moderate pace.

This discussion will include types of physical activity and their benefits, how to choose your goals, and how to monitor your progress.

1. Why is physical activity important?

Studies show that people who stay physically active enjoy a higher quality of life overall than those with sedentary lifestyles and reap numerous benefits that include:

Stronger ability to stave off illnesses such as diabetes
Quicker recovery from illnesses, injuries, and surgeries—and a more positive outlook during recovery
Reduced risk of many cancers, including breast and colon cancer
Improved overall cardiovascular health due to increased strength and resiliency in the heart muscle, arteries, and blood vessels
Higher levels of high-density lipoproteins ("good cholesterol")
More efficient metabolism
Decreased depression, anxiety, and stress
Improved mental ability. Studies suggest that people who start exercising in their 60s can significantly reduce the risk of developing Alzheimer's in their 70s; the risk drops even further if they start exercising in their 40s or 50s
Improved confidence and a feeling of independence
Despite all these positives, only 3 in 10 American adults get the recommended amount of physical activity, according to the President's Council on Physical Fitness and Sports.

2. What types of exercise—and how much of them—does my body need?

There are three primary categories of exercise:

Activities that promote cardiovascular health (aerobic)
Activities that build strength
Activities that increase flexibility and balance
Which activities you should perform, and how often and with what intensity, depend upon your medical issues, overall health, goals, and even your age. Everyone needs to take care of the heart, so aerobic exercise of some kind is good for all ages. And maintaining strength in other muscles is an important safeguard against injury throughout life. The physical abilities in the third category, flexibility and balance, are ones we often take for granted in young adulthood—we don't seem to have to work on them consciously. Later in life, as the joints tend to stiffen and the possible consequences of falling become more dire, it is important to practice movements that make your body supple and steady.

The American College of Sports Medicine and the American Heart Association recommend the following levels of exercise, broken into two age groups, for adults who are healthy. The amounts listed are the minimum recommended; more activity would yield even more benefits.

For people under 65

1. Cardiovascular exercise
Moderate level (walking, swimming, running, or biking, for example, at a pace that makes you break a sweat but still allows you to have a conversation) for 30 minutes, five days a week


Intense level (walking, swimming, running, or biking, for example, at a faster pace) for 20 minutes, three days a week

2. Strength-building exercise (lunges, heel lifts, curls, presses, and shrugs, for example, using leg and arm weights)
Moderate level (eight to 10 exercises, each one repeated eight to 12 times, using light weights) two nonconsecutive days a week


Intense level (more repetitions of each movement, using heavier weights) two nonconsecutive days a week

For people 65 and older

1. Cardiovascular exercise
Moderate level (walking, gardening, or housework, for example, at a pace that is demanding but still allows you to converse—a level 6 on a scale of 10) for 30 minutes, five days a week


Intense level (tennis, dancing, or speed or hill walking, for example) for 20 minutes, three days a week

2. Strength-building exercise (lunges, heel lifts, curls, presses, and shrugs, for example, using leg and arm weights)
Moderate exercise (eight to 10 exercises, each one repeated 10-15 times, using light weights) two or three days a week

3. Balance and flexibility
Exercises such as reaching up, twisting your upper body, standing on one foot, and rolling your neck and shoulders. It's important to do these exercises slowly and gently. They can be done at any time, but it's good idea to do some stretching every day. Balance-promoting activities are especially important for people prone to falls.

4. Create a plan for physical activity
Seniors and people suffering from chronic health conditions should work with their healthcare providers to develop a plan that will minimize risks and meet their individual needs.

3. Healthy or fit?

The type, amount, and intensity of the activities you choose depend upon whether your goal is basic good health (a reduced risk of chronic illness) or "fitness" (strong, toned muscles and flexible joints as well as the aerobic conditioning needed to be healthy).

Getting healthy

Aerobic exercise protects you from illness in several ways. It reduces the risk of diseases such as diabetes, cardiovascular disease, and cancer. It also promotes weight loss, decreased blood pressure, a healthy ratio of "good" to "bad" cholesterol, lower triglyceride counts, and improved glucose tolerance.

Data from Duke University's "Studies of a Targeted Risk Reduction Intervention Through Defined Exercise" showed that a modest amount of moderate exercise—as opposed to a large amount of vigorous activity—is the best way to significantly lower the level of triglycerides, which are a key blood marker linked to higher risk of heart disease and diabetes.

STRRIDE also showed that as little as two weeks of inactivity raises a number of risk factors for heart disease, from weight gain to elevated cholesterol and blood sugar levels.

To be healthy, you should get moderate aerobic exercise for a total of 30 minutes most days of the week, according to the U.S. surgeon general. Aerobic exercise is activity such as walking, swimming, or biking that builds your heart and lung power.

Increasing the intensity and frequency of your exercise will increase the health benefits.

Getting fit

Exercising for fitness means that in addition to conditioning the heart, lungs, and circulatory system, you work all the major muscles of the body. The goals are to build strength and endurance, so that you can lift heavier objects as well as using the muscles for longer periods of time before they get too fatigued. You also work on flexibility, making sure that your joints can move and your body doesn't stiffen up.

To achieve the overall objective of fitness—being strong, supple, and healthy—the following types and minimal amounts of exercise are recommended:

Moderate to vigorous aerobic exercise for a total of 30 minutes at least three days a week
Eight to 10 different strength-building activities that work all the major muscle groups, two to three times a week
Stretching of the major muscle groups at least five minutes after each exercise session, when the body temperature and muscles are warm

4. Do I need to join a gym, buy exercise equipment, or work with a trainer to be physically fit?

No. While many people benefit from the guidance of a personal trainer or other fitness expert, the convenience of home exercise equipment, or the variety of fitness programs and equipment offered at the average gym, those things may not fit into your schedule or budget, and they certainly aren't necessary for the average person to stay physically fit.

Many experts would argue that all one really needs is a good pair of shoes for walking or running. Both activities offer an aerobic workout, don't require fancy equipment, and can be done virtually any time, anywhere.

5. I am far from fit. Is it too late for me?

It is never too late to improve your fitness level. Studies have shown that even for elderly sedentary people, a boost in physical activity can have a significant impact, increasing strength and overall fitness.

Some people are so accustomed to living a sedentary lifestyle that the mere thought of getting the recommended amount of exercise is overwhelming. Experts suggest the following tips for getting and staying motivated:

If you smoke, quit—or at least cut back. The fewer cigarettes you smoke, the more effectively your lungs function. The more effectively your lungs function, the more physical activity your body is capable of—and the healthier and more fit it can become.

Choose physical activities you truly enjoy. Whether it's working in the yard, joining a bowling league, jogging with the dog, or taking a yoga class, pick a few things you like to do and make time for them most days of the week.
Start with simple, sustainable changes in physical activity and build gradually. People often try to do too much too soon. They get discouraged and perhaps even injure themselves, and then they stop exercising.
Buddy up. Many people enjoy the social interaction that comes with exercising with a partner, and partners can help keep each other motivated and on track.
Don't focus too much on the numbers at first. Thinking about repetitions, distances, and times can be discouraging and distracting. Just listen to your body and focus on becoming more active initially; tracking the numbers can come later.

6. What should I do before beginning an exercise program?

If you've slacked off on physical activity or have never exercised regularly, it's a good idea to see your doctor or a sports medicine physician, especially if you haven't had a recent checkup. It's important for your doctor to identify any medical concerns before you increase your activity levels.

People who particularly need a doctor's clearance include those who:

Are suffering or recovering from a serious illness, injury, and/or musculoskeletal problem
Have known cardiovascular, pulmonary, and/or metabolic diseases (including diabetes) or are experiencing symptoms that could indicate these conditions
Have risk factors such as a history of smoking, high glucose levels, high blood pressure, high cholesterol, obesity, and/or a family history of heart attack
Have recently undergone surgery
Are pregnant or have recently given birth
Goals. The best exercise plan is one that is built around your personal goals. A 35-year-old training for a marathon has goals that are much different from those of an 80-year-old who'd like to get up and down the stairs more easily. So before you take on a list of new physical activities, figure out what you're working toward, whether that's losing 10 pounds, being able to mow the lawn without getting winded, participating in a 5-kilometer run, or simply adopting a more healthful lifestyle. Strength, endurance, flexibility, and balance are good general goals of fitness, but your personal objectives should guide your choices of exercise.

Feet first. You might need to check your wardrobe—or at least your shoes. Many activities don't require special clothing, but you should dress appropriately for the weather and invest in a good pair of shoes that are designed for the activity you'll be doing. Experts recommend visiting a store that specializes in athletic footwear, where trained staff can help you find a shoe that fits your needs and safeguards against injury.

7. I've just begun exercising. What rules of thumb should I keep in mind?

Start slowly and build gradually. Studies show that a fitness program is much more likely to stick long term when people steadily incorporate simple, sustainable activities into their lifestyles.

Consider starting with miniworkouts. A good first goal is to accumulate 30 minutes of moderate physical activity most days of the week—the current recommendation for good health. You can realize significant health benefits by squeezing in just five or 10 minutes of exercise several times throughout the day.

For example, try parking your car farther from the door or getting off the bus a few blocks early. Give up the remote control. Try walking around your office or around the block while you talk on the phone. At home, opt for the rake instead of the leaf blower...and remember that these types of "active chores" count.

Listen to your body and adjust your level of activity accordingly. If you experience pain, swelling, dizziness, shortness of breath, or excessive fatigue, for example, your body is telling you to slow down, as these symptoms could indicate serious health concerns.

Stay hydrated. Drink water before and after you exercise, even if you're not thirsty. If it's especially hot or humid, or if you're exercising vigorously, drink a cup of water every 15 minutes during your workout, as well.

Weigh yourself before and after you exercise. If you've lost 5 percent or more of your body weight during your workout, you are dehydrated and need to replenish your fluids.

Stretch. To prevent soreness and injury and increase flexibility, stretch for five to 10 minutes after workouts, when body temperature and muscles are warm, and hold each stretch for 20 to 30 seconds.

Challenge yourself—slowly. Start by walking 20 to 30 minutes at a comfortable pace four days a week. Then try alternating two to five minutes of brisk walking with two to five minutes of easy walking, gradually increasing the ratio of brisk to easy. Once you can comfortably manage 30 minutes of brisk walking, you may want to add running to your repertoire.

At first, run 30 seconds, then walk 90 seconds, and repeat for 30 minutes. When you can do that comfortably, try 45 seconds of running and 75 seconds of walking. You can progress to 75 seconds running and 45 seconds of walking...then 90 running and 30 walking, until you're running for 30 minutes. This process can take from eight weeks to four months. Listen to your body, and don't feel pressured to progress more quickly than you're ready to.

Allow muscles time to heal. After a strength-building activity, give the affected muscles a day to repair themselves before working them again.

8. Am I working hard enough?

The key to answering this question is knowing what's normal for you in terms of things like breathing, perspiration, and your overall feeling of wellness when you exercise. A general rule of thumb, however, is to use "the talk test": During a good workout, you should be breathing hard but not so hard that you can't participate in a conversation.

Overall, if activities that used to be extremely taxing become less challenging over time, you might consider increasing the intensity and/or duration of your workouts. And if a previously mastered activity suddenly becomes painful or exceedingly difficult, stop the activity until you speak with your doctor, trainer, sports therapist, or other appropriate professional.

If you're not seeing improvements in your overall health, well-being, and performance after three months, you should see your doctor to rule out any health problems that could be hindering your progress. You might also consider trying different activities, for longer durations and/or at greater intensities.

9. Related Links

More information on fitness is available at these websites recommended by the U.S.News & World Report library.

American Heart Association: Physical Activity in Your Daily Life
The AHA provides a wealth of information on exercise and fitness, including how to calculate body mass index, a chart on how many calories activities use, tips for success, cardiovascular health facts, and information for children and older Americans. Of special interest to women is Go Red BetterU, the AHA's 12-week physical activity program for women.

CDC: Physical Activity for Everyone
The Centers for Disease Control and Prevention offers a lengthy section on physical activity for everyone. Topics include why it's important to exercise, how to measure intensity, getting started, and how to make physical activity part of your life.

CDC: BAM! Body and Mind: Physical Activity
From the Centers for Disease Control and Prevention, BAM! aims to provide kids 9 to 13 with the information they need to make healthful lifestyle choices. In the physical activity section, users can create their own personalized fitness and activity calendar, get information on over 30 different activities, and take quizzes and share success stories.

MyPyramind.gov: Inside the Pyramid—What Is Physical Activity?
This page from the Department of Agriculture lists moderate and vigorous physical activities, describes how much is needed, tells how many calories are used, and gives tips to increase activity.

Healthier US.gov: Physical Activity
The HealthierUS initiative site includes a page on physical activity with links to help you make exercise a part of your day: getting started, keeping track, maintaining physical activity, and getting advice for different age groups.