Fitness and Exercise Sourcebook
Fitness and Exercise Sourcebook
Fitness and Exercise Sourcebook
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Basic Consumer Health Information about the Benefits of Physical Fitness, Including Strength, Endurance, Longevity, Weight Loss, Bone Health, and Stress Management, with Exercise Guidelines for People of All Ages and Tips for Maintaining Motivation, Measuring Exercise Intensity, Preventing Injuries, and Exercising with a Health Condition Along with Information on Different Types of Exercises and Exercise Equipment, a Glossary of Related Terms, and a Directory of Resources for Additional Help and Information
Laura Larsen
Edited by
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__________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Basic Consumer Health Information about the __________________________________________________________________________________________________________________________________________ B enefits of Physical Fitness, Including Strength, Endur__________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ ance, Longevity, Weight Loss, Bone Health, and Stress __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Management, with Exercise Guidelines for People of All __________________________________________________________________________________________________________________________________________ Ages and Tips for Maintaining Motivation, Measuring __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Exercise Intensity, Preventing Injuries, and __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Exercising with a Health Condition __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Along with Information on Different Types of __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Exercises and Exercise Equipment, a Glossary of __________________________________________________________________________________________________________________________________________ Related Terms, and a Directory of Resources for __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Additional Help and Information __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Edited by __________________________________________________________________________________________________________________________________________ Laura Larsen __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ 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Bibliographic Note Because this page cannot legibly accommodate all the copyright notices, the Bibliographic Note portion of the Preface constitutes an extension of the copyright notice. Edited by Laura Larsen Health Reference Series Karen Bellenir, Managing Editor David A. Cooke, MD, FACP, Medical Consultant Elizabeth Collins, Research and Permissions Coordinator Cherry Edwards, Permissions Assistant EdIndex, Services for Publishers, Indexers *** Omnigraphics, Inc. Matthew P. Barbour, Senior Vice President Kevin M. Hayes, Operations Manager *** Peter E. Ruffner, Publisher Copyright 2011 Omnigraphics, Inc. ISBN 978-0-7808-1142-3
Library of Congress Cataloging-in-Publication Data Fitness and exercise sourcebook : basic consumer health information about the benefits of physical fitness, including strength, endurance, longevity, weight loss, bone health, and stress management, with exercise guidelines for people of all ages and tips for maintaining motivation, measuring exercise intensity, preventing injuries, and exercising with a health condition ... / edited by Laura Larsen. -- 4th ed. p. cm. Includes bibliographical references and index. ISBN 978-0-7808-1142-3 (hardcover : alk. paper) 1. Physical fitness--Handbooks, manuals, etc. 2. Exercise--Handbooks, manuals, etc. I. Larsen, Laura. GV436.F53 2010 613.7--dc22 2010037345
Electronic or mechanical reproduction, including photography, recording, or any other information storage and retrieval system for the purpose of resale is strictly prohibited without permission in writing from the publisher. The information in this publication was compiled from the sources cited and from other sources considered reliable. While every possible effort has been made to ensure reliability, the publisher will not assume liability for damages caused by inaccuracies in the data, and makes no warranty, express or implied, on the accuracy of the information contained herein. This book is printed on acid-free paper meeting the ANSI Z39.48 Standard. The infinity symbol that appears above indicates that the paper in this book meets that standard. Printed in the United States (c) 2011 Omnigraphics, Inc. All Rights Reserved.
Table of Contents
Visit www.healthreferenceseries.com to view A Contents Guide to the Health Reference Series, a listing of more than 15,000 topics and the volumes in which they are covered.
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Section 11.3Teenagers Exercising Far Less than Younger Kids ........................................... 112
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Chapter 16Encouraging Physical Fitness through the Community Environment .............................. 183
Chapter 19Overcoming Barriers to Exercise ......................... 217 Chapter 20Measuring Physical Activity Intensity and Physical Fitness............................................. 225
Section 20.1Measuring Physical Activity Intensity.................................... 226 Section 20.2Resting and Target Heart Rates ......................................... 230 Section 20.3Calories Burned per Hour.................................... 232 Section 20.4Physical Activity Chart ............ 239 Section 20.5Body Mass Index (BMI) ........... 242
Chapter 22Evaluating Exercise Equipment and Exercise Program Claims .................................................... 265
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Chapter 24Step Aerobics......................................................... 295 Chapter 25Kickboxing............................................................. 297 Chapter 26Dancing ................................................................. 301 Chapter 27Racquet Sports ...................................................... 307 Chapter 28Aquatic Exercise ................................................... 315
Section 28.1Water Fitness ........................... 316 Section 28.2Top 10 Reasons You Should Exercise in Water......... 319
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Chapter 33Stretching and Flexibility for Healthy Aging...... 383 Chapter 34Combined Exercise ............................................... 387
Section 34.1Cross Training .......................... 388 Section 34.2Interval Training...................... 390 Section 34.3Boot Camp Workouts................ 392
Chapter 36Power Training and Plyometrics for Athletes ..... 415 Chapter 37Wii.......................................................................... 421
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Section 40.2Sports Nutrition ....................... 450 Section 40.3Top Sports Nutrition Myths..... 453
Chapter 42Preventing Sports Injuries for Child Athletes .... 471 Chapter 43Fitness and Your Feet ........................................... 477 Chapter 44Overtraining and Compulsive Exercise............... 481
Section 44.1Overtraining in Women and the Risk to Bone Health ....................................... 482 Section 44.2Compulsive Exercise ................ 486
Chapter 48Physical Fitness for People Who Are Overweight ............................................ 519
Section 48.1Physical Fitness at Any Size.... 520
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Section 48.2Fat Loss and Weight Training Myths......................... 529 Section 48.3Abdominal Fat and Your Health ....................................... 533
Chapter 49Physical Fitness for People with Heart Conditions ............................................................. 537 Chapter 50Physical Fitness for People with Bone Disorders ............................................................... 543
Section 50.1Arthritis and Fitness................ 544 Section 50.2Exercising Safely with Osteoporosis.............................. 547
Chapter 52Physical Fitness for People with Diabetes .......... 561 Chapter 53Physical Fitness and Cancer ................................ 569
Section 53.1Physical Fitness and Cancer Prevention.................... 570 Section 53.2Exercise during Cancer Treatment ................................. 577
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Preface
Bibliographic Note
This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Centers for Disease Control and Prevention (CDC); Consumer Product Safety Commission (CPSC); National Cancer Institute (NCI); National Center for Complementary and Alternative Medicine; National Heart, Lung, and Blood Institute (NHLBI); National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institute on Aging (NIA); National Institutes of Health (NIH); Presidents Council on Physical Fitness and Sports; U.S. Department of Health and Human Services (HHS); and U.S. Department of Homeland Security. In addition, this volume contains copyrighted documents from the following organizations: Allergy and Asthma Network Mothers of Asthmatics; American College of Sports Medicine; American Council on Exercise; American Heart Association; American Orthopaedic Foot and Ankle Society; American Podiatric Medical Association; American Psychological Association; Aquatic Exercise Association; Asthma and Allergy Foundation of America; Boys Town Pediatrics; Cleveland Clinic; ExRx.net; Government of Ontario Ministry of the Environment; Harvard Health Publications; Helpguide (Center for Healthy Aging); IDEA Health & Fitness Association; Indiana University Office of University Communications; National Association for Sport and Physical Education; National Strength and Conditioning Association; Nemours Foundation; OrthoIndy; Oxford University Press; Rails-to-Trails Conservancy; United States Professional Tennis Association; University of Michigan Health System; University of Oxford; Wisconsin Department of Health and Family Services; Wolters Kluwer Health; Womens Sports Foundation; and World Health Organization (WHO). Full citation information is provided on the first page of each chapter or section. Every effort has been made to secure all necessary rights to reprint the copyrighted material. If any omissions have been made, please contact Omnigraphics to make corrections for future editions.
Acknowledgements
Thanks go to the many organizations, agencies, and individuals who have contributed materials for this Sourcebook and to medical consultant Dr. David Cooke and document engineer Bruce Bellenir. Special thanks go to managing editor Karen Bellenir and research and permissions coordinator Liz Collins for their help and support. xv
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A Contents Guide to the Health Reference Series was developed to direct readers to the specific volumes that address their concerns. It presents an extensive list of diseases, treatments, and other topics of general interest compiled from the Tables of Contents and major index headings. To access A Contents Guide to the Health Reference Series, visit www.healthreferenceseries.com.
Medical Consultant
Medical consultation services are provided to the Health Reference Series editors by David A. Cooke, MD, FACP. Dr. Cooke is a graduate of Brandeis University, and he received his M.D. degree from the University of Michigan. He completed residency training at the University of Wisconsin Hospital and Clinics. He is board-certified in Internal Medicine. Dr. Cooke currently works as part of the University of Michigan Health System and practices in Ann Arbor, MI. In his free time, he enjoys writing, science fiction, and spending time with his family.
felt it was necessary to implement a policy of updating volumes when warranted. Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to: Editor Health Reference Series Omnigraphics, Inc. P.O. Box 31-1640 Detroit, MI 48231 E-mail: [email protected]
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Chapter 1
All Americans should be regularly physically active to improve overall health and fitness and to prevent many adverse health outcomes. The benefits of physical activity occur in generally healthy people, in people at risk of developing chronic diseases, and in people with current chronic conditions or disabilities. This chapter gives an overview of research findings on physical activity and health. Physical activity affects many health conditions, and the specific amounts and types of activity that benefit each condition vary. In developing public health guidelines, the challenge is to integrate scientific information across all health benefits and identify a critical range of physical activity that appears to have an effect across the health benefits. One consistent finding from research studies is that once the health benefits from physical activity begin to accrue, additional amounts of activity provide additional benefits. Although some health benefits seem to begin with as little as 60 minutes (1 hour) a week, research shows that a total amount of 150 minutes (2 hours and 30 minutes) a week of moderate-intensity aerobic activity, such as brisk walking, consistently reduces the risk of many chronic diseases and other adverse health outcomes.
Excerpted from Chapter 2. Physical Activity Has Many Health Benefits, Physical Activity Guidelines for Americans, U.S. Department of Health and Human Services (www.hhs.gov), October 16, 2008.
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Aerobic Activity
In this kind of physical activity (also called an endurance activity or cardio activity), the bodys large muscles move in a rhythmic manner for a sustained period of time. Brisk walking, running, bicycling, jumping rope, and swimming are all examples. Aerobic activity causes a persons heart to beat faster than usual. 4
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Muscle-Strengthening Activity
This kind of activity, which includes resistance training and lifting weights, causes the bodys muscles to work or hold against an applied force or weight. These activities often involve relatively heavy objects, such as weights, which are lifted multiple times to train various muscle groups. Muscle-strengthening activity can also be done by using elastic bands or body weight for resistance (climbing a tree or doing push-ups, for example). Muscle-strengthening activity also has three components: Intensity, or how much weight or force is used relative to how much a person is able to lift Frequency, or how often a person does muscle-strengthening activity Repetitions, or how many times a person lifts a weight (analogous to duration for aerobic activity) The effects of muscle-strengthening activity are limited to the muscles doing the work. Its important to work all the major muscle groups of the body: the legs, hips, back, abdomen, chest, shoulders, and arms.
Bone-Strengthening Activity
This kind of activity (sometimes called weight-bearing or weightloading activity) produces a force on the bones that promotes bone 5
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The Beneficial Effects of Increasing Physical Activity: Its About Overload, Progression, and Specificity
Overload is the physical stress placed on the body when physical activity is greater in amount or intensity than usual. The bodys structures and functions respond and adapt to these stresses. For 7
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Premature Death
Strong scientific evidence shows that physical activity reduces the risk of premature death (dying earlier than the average age of death for a specific population group) from the leading causes of death, such as heart disease and some cancers, as well as from other causes of death. This effect is remarkable in two ways: First, only a few lifestyle choices have as large an effect on mortality as physical activity. It has been estimated that people who are physically active for approximately 7 hours a week have a 40% lower risk of dying early than those who are active for less than 30 minutes a week. 8
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Cardiorespiratory Health
The benefits of physical activity on cardiorespiratory health are some of the most extensively documented of all the health benefits. Cardiorespiratory health involves the health of the heart, lungs, and blood vessels. Heart diseases and stroke are two of the leading causes of death in the United States. Risk factors that increase the likelihood of cardiovascular diseases include smoking, high blood pressure (called hypertension), type 2 diabetes, and high levels of certain blood lipids (such as low-density lipoprotein, or LDL, cholesterol). Low cardiorespiratory fitness also is a risk factor for heart disease. People who do moderate- or vigorous-intensity aerobic physical activity have a significantly lower risk of cardiovascular disease than do inactive people. Regularly active adults have lower rates of heart disease and stroke and have lower blood pressure, better blood lipid profiles, and greater levels of fitness. Significant reductions in risk of cardiovascular disease occur at activity levels equivalent to 150 minutes a week of moderate-intensity physical activity. Even greater benefits are seen with 200 minutes (3 hours and 20 minutes) a week. The evidence is strong that greater amounts of physical activity result in even further reductions in the risk of cardiovascular disease. Everyone can gain the cardiovascular health benefits of physical activity. The amount of physical activity that provides favorable 9
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Metabolic Health
Regular physical activity strongly reduces the risk of developing type 2 diabetes as well as the metabolic syndrome. The metabolic syndrome is defined as a condition in which people have some combination of high blood pressure, a large waistline (abdominal obesity), an adverse blood lipid profile (low levels of high-density lipoprotein [HDL] cholesterol, raised triglycerides), and impaired glucose tolerance. People who regularly engage in at least moderate-intensity aerobic activity have a significantly lower risk of developing type 2 diabetes than do inactive people. Although some experts debate the usefulness of defining the metabolic syndrome, good evidence exists that physical activity reduces the risk of having this condition, as defined in various ways. Lower rates of these conditions are seen with 120 to 150 minutes (2 hours to 2 hours and 30 minutes) a week of at least moderate-intensity aerobic activity. As with cardiovascular health, additional levels of physical activity seem to lower risk even further. In addition, physical activity helps control blood glucose levels in persons who already have type 2 diabetes. Physical activity also improves metabolic health in youth. Studies find this effect when young people participate in at least three days of vigorous aerobic activity a week. More physical activity is associated with improved metabolic health, but research has yet to determine the exact amount of improvement.
Musculoskeletal Health
Bones, muscles, and joints support the body and help it move. Healthy bones, joints, and muscles are critical to the ability to do daily activities without physical limitations. Preserving bone, joint, and muscle health is essential with increasing age. Studies show that the frequent decline in bone density that happens during aging can be slowed with regular physical activity. These effects are seen in people who participate in aerobic, musclestrengthening, and bone-strengthening physical activity programs of moderate or vigorous intensity. The range of total physical activity for these benefits varies widely. Important changes seem to begin at 90 minutes a week and continue up to 300 minutes a week. 11
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Cancer
Physically active people have a significantly lower risk of colon cancer than do inactive people, and physically active women have a significantly lower risk of breast cancer. Research shows that a wide range of moderate-intensity physical activitybetween 210 and 420 minutes a week (3 hours and 30 minutes to 7 hours)is needed to significantly reduce the risk of colon and breast cancer; currently, 150 minutes a week does not appear to provide a major benefit. It also appears that greater amounts of physical activity lower risks of these cancers even further, although exactly how much lower is not clear. Although not definitive, some research suggests that the risk of endometrial cancer in women and lung cancers in men and women also may be lower among those who are regularly active compared to those who are inactive. Finally, cancer survivors have a better quality of life and improved physical fitness if they are physically active, compared to survivors who are inactive.
Mental Health
Physically active adults have lower risk of depression and cognitive decline (declines with aging in thinking, learning, and judgment skills). Physical activity also may improve the quality of sleep. Whether physical activity reduces distress or anxiety is currently unclear. 13
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Adverse Events
Some people hesitate to become active or increase their level of physical activity because they fear getting injured or having a heart attack. Studies of generally healthy people clearly show that moderateintensity physical activity, such as brisk walking, has a low risk of such adverse events. The risk of musculoskeletal injury increases with the total amount of physical activity. For example, a person who regularly runs 40 miles a week has a higher risk of injury than a person who runs 10 miles each week. However, people who are physically active may have fewer injuries from other causes, such as motor vehicle collisions or workrelated injuries. Depending on the type and amount of activity that physically active people do, their overall injury rate may be lower than the overall injury rate for inactive people. Participation in contact or collision sports, such as soccer or football, has a higher risk of injury than participation in noncontact physical activity, such as swimming or walking. However, when performing the same activity, people who are less fit are more likely to be injured than people who are fitter. Cardiac events, such as a heart attack or sudden death during physical activity, are rare. However, the risk of such cardiac events does increase when a person suddenly becomes much more active than usual. The greatest risk occurs when an adult who is usually inactive engages in vigorous-intensity activity (such as shoveling snow). People who are regularly physically active have the lowest risk of cardiac events both while being active and overall. The bottom line is that the health benefits of physical activity far outweigh the risks of adverse events for almost everyone.
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Chapter 2
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Action Is Underway
The WHO [World Health Organization]s development of a Global Strategy on Diet, Physical Activity, and Health reflects Member States increasing recognition that physical activity must be considered alongside diet in combating the growing chronic disease burden. WHO dedicated World No Tobacco Day 2002 to Tobacco Free Sports: Play it Clean. WHO and other agencies are actively collaborating with sports bodies in programs such as Sports for All, aimed at increasing access to sport across population groups. A special focus is being placed upon partnership-based action to promote physical activity and sport among both boys and girls, in and out of schools. 18
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Chapter 3
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ii. On the basis of several investigations it is suggested that exercise sufficient to burn 2,0002,500 kcal per week (1 min jogging = ~10 kcal) should be performed three to four times a week. In addition, life-style change should also include reduction of the BMI and a change in nutritional behavior. iii. Daily mental training (not by passive TV watching), e.g. participation in cultural events or personal hobbies such as arts and crafts, should be engaged in, because the immune system has its origin in the brain and accordingly can be influenced by the central nervous system. iv. A good relationship with children and grandchildren should be established (grand family feeling) in order to ensure the 23
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Chapter 4
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Section 4.1
Sir William Osler, the famous Canadian medical doctor, once quipped, Theres only one way to treat the common coldwith contempt. And for good reason. The average adult has two to three respiratory infections each year. That number jumps to six or seven for young children. Whether or not you get sick with a cold after being exposed to a virus depends on the many factors that affect your immune system. Old age, cigarette smoking, mental stress, poor nutrition, and lack of sleep have all been associated with impaired immune function and increased risk of infection.
Section 4.2
Being physically fit after age 60 helps you live longer, regardless of your bodys fat content, according to a new study. Although earlier research had suggested that obesity and low physical fitness each can increase the risk of dying during middle age, it was unclear whether this was also true in later years. In a new report from an ongoing study, Dr. Xuemei Sui of the University of South Carolina and her colleagues examined the links between fitness, fatness, and mortality in older adults. The scientists looked at more than 2,600 men and women, age 60 or older, who were participating in the Aerobics Center Longitudinal Study, funded by the National Institute of Health (NIH)s National Institute on Aging (NIA) and National Heart, Lung, and Blood Institute (NHLBI). Participants walked on a treadmill to determine their fitness levels. Their fat levels, or adiposity, were assessed by measuring their waist circumference, percent body fat, and body mass index (a ratio of weight to height). The results were reported in the December 5, 2007, issue of the Journal of the American Medical Association. During an average follow-up period of 12 years, 450 of the participants died. They were generally older, had lower fitness levels, and had more cardiovascular risk factors, such as high blood pressure, high cholesterol, and diabetes, than survivors. The percent of body fat did not appear to be related to the risk of dying. However, greater fitness, lower body mass index, and lower waist circumference each reduced the risk of death. The researchers grouped the participants into five categories based on their fitness levels. The least-fit group had a death rate four times higher than the fittest. Even those in the low-fitness group fared much better than the least-fit; the least-fit participants were twice as likely to die as those in the low-fitness group. In most cases, the death rates for those with higher fitness levels were less than half of the rates for those who were least fit but weighed similar amounts. 28
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Section 4.3
The least-fit segment of the population has twice the mortality risk of even those who are just a bit more in shape, according to a study published in the official journal of the American College of Sports Medicine. A research team from Stanford University led by Victor F. Froelicher, MD, and Jonathan Myers, PhD, FACSM, performed exercise tests and followed more than 4,300 subjects from 1986 to 2006, none of whom had a history of heart disease. Fitness and physical activity levels were measured using treadmill tests and questionnaires, and mortality rates were tracked during the 20-year study period. Sandra Mandic, PhD, and the research team from Stanford analyzed the results, and found that the mortality rate for the least-fit individuals was twice that of the second least-fit group, and more than four times the rate of the most-fit group. Fitness was the strongest predictor of mortality in this group of healthy individuals. The study suggests that reduced recent physical activity, rather than differences in health status, contributes to the striking difference in mortality rates between the least-fit individuals and those who are just a bit more fit. Nearly two-thirds of the least-fit individuals were not meeting the minimum recommended amount of physical activity 29
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Section 4.4
Vital at every age for healthy bones, exercise is important for treating and preventing osteoporosis. Not only does exercise improve your bone health, it also increases muscle strength, coordination, and balance, and it leads to better overall health.
Why Exercise?
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. For most people, bone mass peaks during the third decade of life. After that time, we can begin to lose bone. Women and men older than age 20 can help prevent bone loss with regular exercise. Exercising allows us to maintain muscle strength, coordination, and balance, which in turn helps to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.
Exercise Tips
If you have health problemssuch as heart trouble, high blood pressure, diabetes, or obesityor if you are age 40 or older, check with your doctor before you begin a regular exercise program. 31
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Section 4.5
The Effect of Physical Activity on the Risk for Coronary Heart Disease
Physical Activity and Weight Affect Coronary Heart Disease Risk, National Institutes of Health (www.nih.gov), May 12, 2008.
Researchers have long known that both physical activity and excess weight affect the risk of coronary heart disease. However, its been hard to tease apart how much each contributes. A new study found that being physically active can considerably, but not completely, lower the risk of cardiovascular disease associated with being overweight or obese. The research stems from the Womens Health Study, begun in 1992 by NIHs National Cancer Institute (NCI) and NHLBI. Its original goals were to evaluate the effects of vitamin E and low-dose aspirin on cardiovascular disease and cancer in healthy women. Recognizing the value of the data they were collecting, the researchers extended the study to do more follow-up and evaluate other cardiovascular risk factors. Dr. Amy Weinstein at the Beth Israel Deaconess Medical Center in Boston and colleagues at Brigham and Womens Hospital analyzed data collected in the Womens Health Study on almost 39,000 women who were 45 and older. They compared the participants body mass index (BMIa ratio of weight to height) and physical activity levels at the start of the study with cardiovascular outcomes (such as heart attacks) over an average of 11 years of follow-up. In the April 28, 2008, issue of Archives of Internal Medicine, the researchers reported that the group had 948 cases of coronary heart disease during the follow-up period. The risk of coronary heart disease, they found, increased as BMI increased. Obese women were over twice as likely to have a coronary event as women in the normal weight category. Overall, the women who were physically active were 31% less likely to have coronary heart disease than those who werent active. After the researchers adjusted the data to account for other known influences such as alcohol use, smoking, and dietthe physically active women still had an 18% lower risk of coronary heart disease. In particular, the 33
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Section 4.6
Children with asthma who improve their physical fitness are likely to experience beneficial effects on disease control and quality of life, according to a study published recently in Medicine & Science in Sports & Exercise, the official journal of the American College of Sports Medicine (ACSM). The results show aerobic training to be effective in improving cardiopulmonary fitness and decreasing daily use of inhaled steroids in asthmatic children, outcomes that should have positive implications for disease management in a group that tends to have lower cardiorespiratory fitness than their healthy counterparts. 34
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Chapter 5
Chapter Contents
Section 5.1Physical Activity Helps Control Stress................... 38 Section 5.2Exercise Fights Dementia....................................... 40 Section 5.3Physical Activity, Mood, and Serious Mental Illness............................................. 42
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Section 5.1
People who exercise regularly will tell you they feel better. Some will say its because chemicals called neurotransmitters, which are produced in the brain, are stimulated during exercise. Since its believed that neurotransmitters mediate peoples moods and emotions, they can make you feel better and less stressed. While theres no scientific evidence to conclusively support the neurotransmitter theory, there is plenty to show that exercise provides stress-relieving benefits. There are four ways in which exercise controls stress: Exercise can help you feel less anxious: Exercise is being prescribed in clinical settings to help treat nervous tension. Following a session of exercise, clinicians have measured a decrease in electrical activity of tensed muscles. People are often less jittery and hyperactive after an exercise session. Exercise can relax you: One exercise session generates 90 to 120 minutes of relaxation response. Some people call this postexercise euphoria or endorphin response. Many neurotransmitters, not just endorphins, are involved. The important thing, though, is not what theyre called, but what they do: They improve your mood and leave you relaxed. Exercise can make you feel better about yourself: Think about those times when youve been physically active. Havent you felt better about yourself? That feeling of self-worth contributes to stress relief. Exercise can make you eat better: People who exercise regularly tend to eat more nutritious food. And its no secret that good nutrition helps your body manage stress better. 38
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Section 5.2
Based on a review of studies on exercise and its effect on brain functioning in human and animal populations, researchers find that physical exercise may slow agings effects and help people maintain cognitive abilities well into older age. Animals seem to benefit from exercise too and perform spatial tasks better when they are active. Furthermore, fitness trainingan increased level of exercisemay improve some mental processes even more than moderate activity, say the authors of the review. Findings from the review will be presented at the 114th Annual Convention of the American Psychological Association (APA). Varying opinions still exist on the benefits of exercise and activity, said authors Arthur F. Kramer, PhD, Kirk I. Erickson, PhD, and Stanley J. Colcombe of the University of Illinois at UrbanaChampaign, but our review of the last 40 years of research does offer evidence that physical exercise can have a positive influence on cognitive and brain functions in older animal and human subjects. Different methodologies were examined to comprehensively study what effects exercise can have. The researchers first examined the epidemiological literature of diseases to determine whether exercise and physical activity can at certain points in a persons lifetime improve cognitive ability and decrease the likelihood of age-related neurological diseases, like Alzheimers. The authors then reviewed longitudinal randomized trial studies to see if specific fitness training had an effect on cognition and brain function in older adults. Finally, animal studies were examined to understand the molecular and cellular mechanisms responsible for exercise effects on the brain as well as on learning and memory. Based on a review of the epidemiological literature, the authors found a significant relationship between physical activity and later cognitive function and decreased occurrence of dementia. And the 40
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Section 5.3
A new study from Indiana University [IU] suggests that even meager levels of physical activity can improve the mood of people with serious mental illnesses (SMI) such as bipolar disorder, major depression, and schizophrenia. The study, published in the November [2008] issue of the International Journal of Social Psychiatry, both reinforces earlier findings that people with SMI demonstrate low levels of physical activity and supports the consideration of physical activity as a regular part of psychiatric rehabilitation. We found a positive association between physical activity level and positive mood when low to moderate levels of physical activity are considered, said study 42
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Chapter 6
Chapter Contents
Section 6.1Physical Activity for Weight Loss............................ 46 Section 6.2Exercise Does Not Over-Stimulate Appetite. .......... 49 Section 6.3The Effect of Exercise on Metabolism..................... 51
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Section 6.1
Physical Activity and a Healthy Weight How much physical activity do I need?
When it comes to weight management, people vary greatly in how much physical activity they need. Here are some guidelines to follow: To maintain your weight: Work your way up to 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent mix of the two each week. Strong scientific evidence shows that physical activity can help you maintain your weight over time. However, the exact amount of physical activity needed to do this is not clear since it varies greatly from person to person. Its possible that you may need to do more than the equivalent of 150 minutes of moderate-intensity activity a week to maintain your weight. To lose weight and keep it off: You will need a high amount of physical activity unless you also adjust your diet and reduce the amount of calories youre eating and drinking. Getting to and staying at a healthy weight requires both regular physical activity and a healthy eating plan.
Fitness and Exercise Sourcebook, Fourth Edition How many calories are used in typical activities?
The table 6.1 shows calories used in common physical activities at both moderate and vigorous levels.
Moderate Physical Activity Hiking Light gardening/yard work Dancing Golf (walking and carrying clubs) Bicycling (<10 mph) Walking (3.5 mph) Weight lifting (general light workout) Stretching
Vigorous Physical Activity Running/jogging (5 mph) Bicycling (>10 mph) Swimming (slow freestyle laps) Aerobics Walking (4.5 mph) Heavy yard work (chopping wood) Weight lifting (vigorous effort) Basketball (vigorous)
Approximate Calo- Approximate ries/30 Minutes for Calories/Hr for a 154-lb Person1 a 154-lb Person1 295 295 255 240 230 220 220 220 590 590 510 480 460 440 440 440
1. Calories burned per hour will be higher for persons who weigh more than 154 lbs (70 kg) and lower for persons who weigh less. Source: Adapted from Dietary Guidelines for Americans, U.S. Department of Health and Human Services, 2005, page 16, Table 4, at http://www.health.gov/ dietaryguidelines/dga2005/document/html/chapter3.htm#table4.
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Section 6.2
Leading experts in exercise and weight management have taken strong exception to assertions that exercise can inhibit weight loss by over-stimulating the appetite. According to John Jakicic, PhD, FACSM, There is strong evidence from the majority of the scientific literature that physical activity is an important component for initial weight loss. Responding to a statement recently published online and in print, Jakicic added that The statement in general, for weight loss, exercise is pretty useless is not supported by the scientific evidence when there is adherence to a sufficient dose of physical activity in overweight and obese adults. Jakicic chairs a committee on obesity prevention and treatment for the American College of Sports Medicine (ACSM) and helped write an ACSM Position Stand on strategies for weight loss and prevention of weight regain for adults. According to Jakicic and other experts, overwhelming evidence belies the assertion that exercise doesnt necessarily help people lose weight and may even make the task harder. Again, it is clear in this regard that physical activity is one of the most important behavioral factors in enhancing weight loss maintenance and improving long-term weight loss outcomes, Jakicic said. In fact, his own research, published in 2008, showed a high dose of physical activity (275 minutes above baseline levels) contributed to the greatest observed weight loss after a 24-month intervention. He noted that the scientific literature includes additional evidence to support physical activity, adding that a growing body of literature suggests the importance of physical activity to improve long-term weight loss following bariatric surgery. Another noted expert and ACSM member, Timothy Church, MD, PhD, described how his professional opinions were misrepresented in a recent news article. According to Church, the article should have touched on the following key concepts: 49
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Section 6.3
Summary
Regular exercise has many benefits and plays an important role in increasing our daily energy expenditure. However, despite what we may read in many popular magazines, the increase in energy expenditure from exercise occurs primarily while we are exercising, rather than due to any sizeable exercise-induced elevations in our resting energy expenditure. 53
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Chapter 7
Introduction
To understand whether genes can influence physical activity, lets begin by making a distinction between physical inactivity and level of physical activity. Physical inactivity is a construct of great importance for a proper understanding of the relationships between behavior and risks for a number of diseases and even premature death. Indeed, a sedentary lifestyle, which is dominated by physical inactivity, has been recognized as a major risk factor for hypertension, coronary heart disease, stroke, type 2 diabetes, obesity, and other conditions. The other important concept, level of physical activity, reflects the variation in activity from a small amount of light exercise performed occasionally to a large amount executed every day. Research has clearly shown that an active lifestyle, with even a moderate amount of physical activity almost every day, is quite beneficial in terms of prevention of cardiovascular events, type 2 diabetes, and premature death. Human variation in degree of physical inactivity or amount of physical activity in a typical day is quite large. For instance, physical inactivity is the way of life in quadriplegic individuals, is almost complete in people who are bedridden for some reasons or who have lost some of their mobility because of disease or senescence, and is
This chapter excerpted from Are People Physically Inactive Because of Their Genes? Presidents Council on Physical Fitness and Sports (www.fitness.gov), June 2006. The full publication, including references, is available at www.fitness .gov/digests/digest-june2006-lo.pdf.
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Summary
Research indicates that the inclination to be physically active or sedentary has a biological foundation. Twin and family studies confirm that physical activityrelated traits are characterized by familial aggregation and influenced by genetic factors. Results from animal model studies indicate that single genes can markedly influence physical activityrelated behavior. The first molecular genetic studies on physical activity traits in humans have been published during the last few years. They support the notion that it is possible to detect relatively small, yet biologically important genetic effects impacting the tendency to be sedentary or physically active at the molecular level. We are beginning to appreciate that the in utero environment and epigenetic events may play a role in postnatal physiology and behavior, but their impact on physical inactivity or physical activity level remains to be determined.
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Chapter 8
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References
1. U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. Hyattsville, MD: US Department of Health and Human Services; 2008. Available at www .health.gov/paguidelines. 2. U.S. Department of Health and Human Services. Objectives 22-2 and 22-3. In Healthy people 2010 (conference ed, in 2 vols). Washington, DC: U.S. Department of Health and Human Services; 2000. Available at www.healthypeople.gov. 3. CDC. Prevalence of physical activity, including lifestyle activities among adultsUnited States, 19942004, MMWR 2003;52:7649. 4. CDC. Prevalence of regular physical activity among adults United States, 2001 and 2005, MMWR 2007;56:120912. 5. Brownson RC, Jones DA, Pratt M, Blanton C, Smith GW. Measuring physical activity with the behavioral risk factor surveillance system. Med Sci Sports Exerc 2000;32:19138. 6. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 2008;40:1818. 7. Fahimi M, Link M, Schwartz D, Levy P, Mokdad A. Tracking chronic disease and risk behavior prevalence as survey participation declines: Statistics from the Behavioral Risk Factor Surveillance System and other national surveys. Prev Chronic Dis 2008;5(3). Available at www.cdc.gov/pcd/issues/2008/ jul/07_0097.htm. 8. CDC. Comparability of data: BRFSS 2007. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2007. Available at www.cdc.gov/brfss/technical_infodata/surveydata/2007/ compare_07.rtf. 71
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Chapter 9
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Lifespan Approach
The best way to be physically active is to be active for life. Therefore, the Guidelines take a lifespan approach and provide recommendations for three age groups: children and adolescents, adults, and older adults. The Physical Activity Guidelines are for Americans aged six and older. The Advisory Committee report did not review evidence for children younger than age six. Physical activity in infants and young children is, of course, necessary for healthy growth and development. Children younger than six should be physically active in ways appropriate for their age and stage of development.
Table 9.1. Classification of Total Weekly Amounts of Aerobic Physical Activity into Four Categories
Levels of Physical Activity Inactive Range of ModerateIntensity Minutes a Week No activity beyond baseline Summary of Overall Health Benefits None
Comment Being inactive is unhealthy. Low levels of activity are clearly preferable to an inactive lifestyle. Activity at the high end of this range has additional and more extensive health benefits than activity at the low end. Current science does not allow researchers to identify an upper limit of activity above which there are no additional health benefits.
Low
Activity beyond base- Some line but fewer than 150 minutes a week 150 minutes to 300 minutes a week Substantial
Medium
High
Additional
Introduction to Fitness Guidelines Assessing Whether Physical Activity Programs Are Consistent with the Guidelines
Programs that provide opportunities for physical activity, such as classes or community activities, can help people meet the Guidelines. These programs do not have to provide all, or even most, of the recommended weekly activity. For example, a mall walking program for older adults may meet only once a week yet provide useful amounts of activity, as long as people get the rest of their weekly recommended activity on other days. Programs that are consistent with the Guidelines meet the following criteria: Provide advice and education consistent with the Guidelines Add episodes of activity that count toward meeting the Guidelines May also include activities, such as stretching or warming up and cooling down, whose health benefits are not yet proven but that are often used in effective physical activity programs
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Chapter 10
Chapter Contents
Section 10.1Statistics on Physical Activity in Children........... 82 Section 10.2Physical Activity from Birth to Age Five.............. 87 Section 10.3Raising a Fit Preschooler....................................... 89 Section 10.4Fitness Guidelines for School-Aged Youth............ 93 Section 10.5Physical Fitness Education in Schools. ................. 99
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Section 10.1
National Recommendations
School-age youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate, enjoyable, and involves a variety of activities.9,10,11 83
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References
1. Hedley, A. A., Ogden, C. L., Johnson, C. L., Carroll, M. D., Curtin, L. R., & Flegal, K. M. (2004). Overweight and obesity among U.S. children, adolescents, and adults, 1999-2002. Journal of the American Medical Association, 291(23), 28472850. 2. Ogden, C. L., Flegal, K. M., Carroll, M. D., & Johnson, C. L. (2002). Prevalence and trends in overweight among U.S. children and adolescents, 1999-2000. Journal of the American Medical Association, 288(14), 17281732. 3. Freedman, D. S., Khan, L. K., Dietz, W. H., Srinivason, S. R., & Berenson, G. S. (2001). Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa heart study. Pediatrics, 108(3), 712718. 4. Grunbaum, J. A., Kann, L., Kinchen, S., Ross, J., Hawkins, J., Lowry, R., Harris, W. A., McManus, T., Chyen, D., & Collins, J. (2004). Youth risk behavior surveillanceUnited States, 2003. Morbidity and Mortality Weekly Report, 53(SS-2), 195. 5. Centers for Disease Control and Prevention. (2004). Participation in high school physical educationUnited States, 1991 2003. Morbidity and Mortality Weekly Report, 53(36), 844847. 6. Burgeson, C. R., Wechsler, H., Brener, N. D., Young, J. C., & Spain, C. G. (2001). Physical education and activity: Results from the School Health Policies and Programs Study, 2000. Journal of School Health, 71(7), 279293. 7. National Association for Sport and Physical Education. (2003). Parents views of childrens health & fitness: A summary of results [Executive summary]. Reston, VA: Author. 8. Robert Wood Johnson Foundation. (2003). National poll shows parents and teachers agree on solutions to childhood obesity [News release]. Princeton, NJ: Author. 9. Strong, W. B., Malina, R. M., Bumkie, C. J. R., Daniels, S. R., Dishman, R. K., Gutin, B., Hergenroeder, A. C., Must, A., Nixon, 85
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Section 10.2
NASPE position statement: All children from birth to age five should engage daily in physical activity that promotes movement skillfulness and foundations of health-related fitness.
Guidelines
Guidelines for Infants
Guideline 1: Infants should interact with caregivers in daily physical activities that are dedicated to exploring movement and the environment. Guideline 2: Caregivers should place infants in settings that encourage and stimulate movement experiences and active play for short periods of time several times a day. Guideline 3: Infants physical activity should promote skill development in movement. Guideline 4: Infants should be placed in an environment that meets or exceeds recommended safety standards for performing largemuscle activities. 87
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Section 10.3
Preschoolers have a lot of energy, and they use it in a more organized way than when they were toddlers. Instead of just running around in the backyard, a preschooler has the physical skills and coordination to ride a tricycle or chase a butterfly. Preschoolers are also discovering what it means to play with a friend instead of just alongside another child, as toddlers do. By being around other kids, a preschooler gains important social skills, such as sharing and taking turns. Despite occasional disputes, preschoolers learn to cooperate and interact during play.
Structured Play
Preschoolers are likely to get structured play at child care or in preschool programs through games like Duck, Duck, Goose and London Bridge. Consider enrolling your child in a preschool tumbling or dance class. Your preschooler can get structured outdoor play at home, too. Play together in the backyard or practice motor skills, such as throwing and catching a ball. Preschoolers also love trips to the playground. Though many kids tend to gravitate toward the outdoors, lots of fun things can be organized indoors: a child-friendly obstacle course, a 90
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Unstructured Play
Unstructured or free play is when kids are left more to their own deviceswithin a safe environment. During these times, they should be able to choose from a variety of activities, such as exploring, playing with toys, painting and drawing, doing a puzzle, or playing dress-up. During pretend play, preschoolers often like to take on a gender-specific role because they are beginning to identify with members of the same gender. A girl might pretend to be her mother by working in the garden, while a boy might mimic his dad by pretending to cut the lawn. 91
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Safety Concerns
No matter what type of physical activity your child gets, its important to keep safety concerns in mind. Remember that preschoolers are still developing coordination, balance, and judgment. So as preschoolers play, a parents challenge is to find a balance between letting them try new things and doing what is necessary to keep them safe and prevent injuries. A child on a tricycle or bike should always wear a helmet. If you havent done so already, its time to talk about street safety, because even the most cautious preschooler may dart into the street after a ball. A preschooler in a swimming pool needs constant adult supervision, even if he or she has learned to swim. Its a tricky age because kids want more independence, and should have some, but cannot be left unsupervised. Preschoolers still need their parents to set limits. Giving kids safe opportunities to play in both organized and unstructured ways builds a foundation for a fit lifestyle that can carry them through life.
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Section 10.4
Regular physical activity in children and adolescents promotes health and fitness. Compared to those who are inactive, physically active youth have higher levels of cardiorespiratory fitness and stronger muscles. They also typically have lower body fatness. Their bones are stronger, and they may have reduced symptoms of anxiety and depression. Youth who are regularly active also have a better chance of a healthy adulthood. Children and adolescents dont usually develop chronic diseases, such as heart disease, hypertension, type 2 diabetes, or osteoporosis. However, risk factors for these diseases can begin to develop early in life. Regular physical activity makes it less likely that these risk factors will develop and more likely that children will remain healthy as adults. Youth can achieve substantial health benefits by doing moderateand vigorous-intensity physical activity for periods of time that add up to 60 minutes (one hour) or more each day. This activity should include aerobic activity as well as age-appropriate muscle- and bonestrengthening activities. Although current science is not complete, it appears that, as with adults, the total amount of physical activity is more important for achieving health benefits than is any one component (frequency, intensity, or duration) or specific mix of activities (aerobic, muscle strengthening, bone strengthening). Even so, bonestrengthening activities remain especially important for children and young adolescents because the greatest gains in bone mass occur during the years just before and during puberty. In addition, the majority of peak bone mass is obtained by the end of adolescence. This chapter provides physical activity guidance for children and adolescents aged 6 to 17 and focuses on physical activity beyond baseline activity. Parents and other adults who work with or care for youth should be familiar with the guidelines in this chapter. These adults should 93
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Table 10.1. Examples of Moderate- and Vigorous-Intensity Aerobic Physical Activities and Muscle- and Bone-Strengthening Activities for Children and Adolescents
Type of Physical Activity: Moderate-intensity aerobic Age Group Children Active recreation, such as hiking, skateboarding, rollerblading Bicycle riding Brisk walking Age Group Adults Active recreation, such as canoeing, hiking, skateboarding, rollerblading Bicycle riding (stationary or road bike) Brisk walking Housework and yard work, such as sweeping or pushing a lawn mower Games that require catching and throwing, such as baseball and softball Type of Physical Activity: Vigorous-intensity aerobic Age Group Children Active games involving running and chasing, such as tag Bicycle riding Jumping rope Martial arts, such as karate Running Sports such as soccer, ice or field hockey, basketball, swimming, tennis Age Group Adults Active games involving running and chasing, such as flag football Bicycle riding Jumping rope Martial arts, such as karate Running Sports such as soccer, ice or field hockey, basketball, swimming, tennis
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Section 10.5
Physical Education
69.3% of elementary schools, 83.9% of middle schools, and 95.2% of high schools required physical education. Among schools that required physical education, 20.8% of elementary schools, 22.7% of middle schools, and 30.9% of high schools allowed students to be exempted from physical education requirements for at least one of the following reasons: high physical competency test score, participation in community service activities, participation in community sports activities, and participation in school activities other than sports (e.g., band or chorus). 3.8% of elementary schools, 7.9% of middle schools, and 2.1% of high schools provided daily physical education or its equivalent 99
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Table 10.2. Percentage of Schools in Which Teachers Used Criteria in at Least One Required Physical Education Class or Course to Assess Student Performance in Physical Education
Criterion Level of participation Student attitude Attendance Improvement in movement skills test scores Final scores on movement skills tests Physical fitness test scores Demonstration of self-management skills Participation in physical activity outside of physical education Schools 95.8 89.3 56.9 53.7 49.3 45.9 39.7 11.8
Among the 78.3% of schools that required physical education, 36.0% had a maximum allowable student-to-teacher ratio for required physical education. The median maximum allowable ratio among these schools was 29.6 students per teacher. The percentage of states that prohibited schools from using physical activity to punish students for bad behavior in physical education increased from 2.1% in 2000 to 16.0% in 2006, and the percentage of states that actively discouraged schools from this practice also increased, from 25.5% in 2000 to 56.0% in 2006. 100
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Physical Fitness and Children Table 10.3. Percentage of States and Districts That Provided Funding for Staff Development or Offered Staff Development to Those Who Teach Physical Education during the Two Years Preceding the Study, 2000 and 2006
States 2000 30.6 54.0 24.5 28.0 States 2006 61.2 71.4 59.2 55.1 Districts 2000 49.8 48.0 28.0 32.6 Districts 2006 62.5 62.2 51.0 54.3
Topic Administering or using fitness tests Assessing or evaluating student performance in physical education Encouraging family involvement in physical activity Methods to increase the amount of class time students are physically active
In 25.6% of middle and high schools, teachers in at least one required physical education class or course required students to develop individualized physical activity plans. During the two years preceding the study, the percentage of states that provided funding for staff development or offered staff development to those who teach physical education on using technology such as computers or video cameras for physical education increased from 40.0% in 2000 to 55.1% in 2006. 84.2% of districts required newly hired elementary school physical education teachers to be certified, licensed, or endorsed by the state to teach physical education, 86.5% had this requirement at the middle school level, and 92.6% at the high school level. In 80.1% of elementary schools, physical education was taught only by a physical education teacher or specialist, and in 73.3% of middle schools and 66.3% of high schools, physical education was taught only by a physical education teacher. The following were true during the two years preceding the study: 77.6% of states and 90.9% of districts provided funding for staff development or offered staff development to those who teach physical education on at least one physical education topic. 87.7% of physical education classes or courses had a teacher who received staff development on at least one physical education topic. 101
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Physical Activity
The following occurred during the two years preceding the study: The percentage of states that provided funding for staff development or offered staff development on physical activity and fitness to those who teach health education increased from 68.8% in 2000 to 82.4% in 2006.1 The percentage of districts that provided funding for staff development or offered staff development on physical activity and fitness to those who teach health education increased from 43.3% in 2000 to 75.3% in 2006.
Table 10.4. Percentage of Schools in Which Teachers Taught* Physical Activity Topics as Part of Required Instruction, by School Level
Topic Decreasing sedentary activities (e.g., TV watching) Health-related fitness (i.e., cardiovascular endurance, muscular endurance, muscular strength, flexibility, and body composition) Physical, psychological, or social benefits of physical activity Elementary 72.7 63.8 Middle 71.5 72.0 High 75.6 76.2
72.1
70.3
78.0
* In at least one elementary school class or in at least one required health education course in middle schools or high schools.
96.8% of elementary schools provided regularly scheduled recess for students in at least one grade. Among these schools, students were scheduled to have recess an average of 4.9 days per week for an average of 30.2 minutes per day. 79.1% of elementary schools provided daily recess for students in all grades in the school. 48.4% of schools offered intramural activities or physical activity clubs to students, and 22.9% of these schools provided transportation home for students participating in these activities or clubs. The percentage of schools with intramural activities or physical activity clubs that required students to pay a fee for these activities increased from 23.0% in 2000 to 35.0% in 2006. 77.0% of middle schools and 91.3% of high schools offered students opportunities to participate in at least one interscholastic sport, and 29.1% of these schools provided transportation home for participating students. 102
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Physical Fitness and Children Table 10.5. Percentage of Schools That Offered Selected Intramural Activities or Physical Activity Clubs and Interscholastic Sports, by School Level
Activity, Club, or Sport Intramural Activity or Physical Activity Club Baseball, softball, or whiffleball Basketball Dance Frisbee, Frisbee golf, or ultimate Frisbee Jump rope Running or jogging Soccer Volleyball Walking Interscholastic Sport Baseball Basketball Bowling Cheerleading or competitive spirits Cross-country Fast pitch or slow pitch softball Football Ice hockey Track and field Volleyball Wrestling NA = not asked. NA NA NA NA NA NA NA NA NA NA NA 35.7 76.4 3.0 50.9 38.9 45.2 53.0 2.4 52.1 57.3 28.7 79.6 90.9 17.2 77.3 68.4 77.9 71.0 14.3 73.2 71.4 49.6 27.7 38.3 15.0 10.8 22.9 28.6 28.6 24.6 20.0 28.0 42.4 16.2 15.9 19.1 29.0 27.7 35.5 19.2 22.2 37.2 13.6 14.5 16.2 24.1 18.8 27.4 20.4 Elementary Middle High
Outside of school hours or when school was not in session, children and adolescents used the schools physical activity or athletic facilities for community-sponsored sports teams in 68.9% of schools, for supervised open-gym or free-play in 40.3% of schools, and for community-sponsored classes or lessons (e.g., tennis or gymnastics) in 33.3% of schools. 103
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Chapter 11
Chapter Contents
Section 11.1Statistics on Physical Activity in Teenagers....... 106 Section 11.2Teenagers and Physical Fitness.......................... 109 Section 11.3Teenagers Exercising Far Less than Younger Kids. ............................................... 112
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Section 11.1
Table 11.1. Percentage of High School Students Participating in Physical Activity and Physical Education, by Sex, 20077
Type of Activity At least 60 minutes/day of physical activity Attended physical education class dailyb a. Any kind of physical activity that increased heart rate and made them breathe hard some of the time for at least 60 minutes per day on five or more of the seven days preceding the survey. b. Attended physical education classes five days in an average week when they were in school.
a
References
1. U.S. Department of Health and Human Services. Physical activity guidelines advisory committee report. Washington, DC: U.S. Department of Health and Human Services, 2008. 2. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Journal of the American Medical Association 2003;289(1):7679. 3. Ogden CL, Carroll MD, Flegal KM. High Body Mass Index for Age among U.S. Children and Adolescents, 20032006. JAMA. 2008;299(20):24012405. 4. Ferraro KF, Thorpe RJ Jr, Wilkinson JA. The life course of severe obesity: Does childhood overweight matter? Journal of Gerontology 2003;58B(2):S110S119. 5. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: The Bogalusa Study. Pediatrics 2001;108(3):712718. 6. CDC. Physical activity levels among children aged 913 yearsUnited States, 2002. Morbidity and Mortality Weekly Report August 22, 2003; 52(SS-33):785788. 7. CDC. Youth Risk Behavior SurveillanceUnited States, 2007. Morbidity and Mortality Weekly Report 2008;57(No.SS-4).
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Section 11.2
Kids who enjoy sports and exercise tend to stay active throughout their lives. Immediate benefits include maintaining a healthy weight, feeling more energetic, and promoting a better outlook. Participating in team and individual sports can boost self-confidence, provide opportunities for social interaction, and offer a chance to have fun. And regular physical activity can help prevent heart disease, diabetes, and other medical problems later in life.
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Section 11.3
Young kids are naturally compelled to be activethey run, jump, tumble, and climb their way through the day without even realizing theyre wracking up countless hours of healthy exercise. But as kids get older their social and school calendars usually become busier. Plus, theyre often increasingly more interested in a veritable buffet of technologiessocial networking sites, video games, wireless texting, instant messaging, TV, DVDsthat often keep them plopped down in one very sedentary spot. So, its no surprise that kids fitness time starts to plummet in adolescence. But a new study reveals just how drastically different activity levels among school-aged kids vs. teens really are. From 20002006, researchers recorded the movements of more than 1,000 kids using a special device (called an accelerometer) attached to their belts for one week a year (at ages 9, 11, 12, and 15). Turns out, not even a third of 15-year-olds are getting the recommended bare minimum amount of physical activity during the week (at least an hour of moderate-to-vigorous exercise per day). And a mere 17% got that much on weekends. But just six years younger, at age 9, kids were active for about three hours a day during both the week and weekends. And at age 11 almost all of the kids were meeting the suggested activity levels just fine. So, when did their habits start changing? At about age 13, girls generally stopped getting enough exercise during the week, whereas boys stayed active for a little longeruntil just before 15. But weekend exercise went downhill even sooner for both sexesabout 12 for girls and roughly 13 for boys. 112
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Chapter 12
Chapter Contents
Section 12.1Motivating Children and Teenagers to Be Active......................................... 116 Section 12.2Fitness for Kids Who Dont Like Sports. ............. 120 Section 12.3Tips on Promoting Physical Fitness for Girls................................................... 124
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Section 12.1
Age-Appropriate Activities
The best way for kids to get physical activity is by incorporating physical activity into their daily routine. Toddlers to teens need at least 60 minutes on most (preferably all) days. This can include free play at home, active time at school, and participation in classes or organized sports. 117
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Section 12.2
Team sports can boost kids self-esteem, coordination, and general fitness and help them learn how to work with other kids and adults. But some kids arent natural athletes and they may tell youdirectly or indirectlythat they just dont like sports. What then?
Stage Fright
Kids who arent natural athletes or are a little shy might be uncomfortable with the pressure of being on a team. More self-conscious kids also might worry about letting their parents, coaches, or teammates down. This is especially true if a child is still working on basic skills and if the league is very competitive. What you can do: Keep your expectations realisticmost kids dont become Olympic medalists or get sports scholarships. Let your child know the goal is to be fit and have fun. If the coach or league doesnt agree, its probably time to look for something new.
Other Barriers
Different kids mature at different rates, so expect a wide range of heights, weights, and athletic abilities among kids of the same age group. A child whos much bigger or smaller than other kids of the same ageor less coordinated or not as strongmay feel self-conscious and uncomfortable competing with them. Kids also might be afraid of getting injured or worried that they cant keep up. Kids who are overweight might be reluctant to participate in a sport, for example, while a child with asthma might feel more comfortable with sports that require short outputs of energy, like baseball, football, gymnastics, golf, and shorter track and field events. What you can do: Give some honest thought to your childs strengths, abilities, and temperament and find an activity that might be a good match. Some kids are afraid of the ball, so they dont like softball or volleyball but may enjoy an activity like running. If your child is overweight, he or she might lack the endurance to run, but might enjoy a sport like swimming. A child whos too small for the basketball team may enjoy gymnastics or wrestling. Remember that some kids will prefer sports that focus on individual performance rather than teamwork. The goal is to prevent your child from feeling frustrated, wanting to quit, and being turned off from sports and physical activity altogether. Try to address your childs concerns. By being understanding and providing a supportive environment, youll help foster success in whatever activity your child chooses.
Smart Start
Before beginning any sport or fitness program, its a good idea for your child to have a physical examination from the doctor. Kids with undiagnosed medical conditions, vision or hearing problems, or other disorders may have difficulty participating in certain activities. 122
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Section 12.3
Youve heard many of the reasons girls should be active. We know that if a girl does not participate in sports by the age of 10, there is only a 10% likelihood she will be participating at age 25. Research suggests that physical activity is an effective tool for reducing the symptoms of stress and depression among girls. Sports help girls develop leadership and teamwork skills. Girls who participate in sports have higher self-esteem and pride in themselves. So how do you get the girls in your life to get on the path to being physically active and reaping all of these rewards? These tips will give you all the information you need to introduce physical activity to a girl and make a critical difference in her life.
Keep It Fun!
Debby Burgard runs a nonprofit organization called The Body Positive based in Berkeley, California, that works to help teens and children with body image issues. She believes that fears about embarrassment (that we discussed earlier) can get in the way of embracing being ac126
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Chapter 13
Chapter Contents
Section 13.1Fitness Guidelines for Adults.............................. 132 Section 13.2Daily Exercise Dramatically Lowers Mens Death Rates.................................. 138 Section 13.3Women, Physical Fitness, and Heart Health................................................. 141 Section 13.4Physical Activity for Pregnant and Postpartum Women. ...................................... 144 Section 13.5Research Shows Overweight Women Improve Quality of Life through Exercise.......... 146 Section 13.6Statistics and Research on Women and Physical Activity.............................. 149
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Section 13.1
Adults who are physically active are healthier and less likely to develop many chronic diseases than adults who are inactive. They also have better fitness, including a healthier body size and composition. These benefits are gained by men and women and people of all races and ethnicities who have been studied. Adults gain most of these health benefits when they do the equivalent of at least 150 minutes of moderate intensity aerobic physical activity (2 hours and 30 minutes) each week. Adults gain additional and more extensive health and fitness benefits with even more physical activity. Muscle-strengthening activities also provide health benefits and are an important part of an adults overall physical activity plan. This section provides guidance for most men and women aged 18 to 64 years and focuses on physical activity beyond baseline activity (the usual light or sedentary activities of daily living). The guidelines for adults focus on two types of activity: aerobic and muscle strengthening. Each type provides important health benefits.
Aerobic Activity
Aerobic activities, also called endurance activities, are physical activities in which people move their large muscles in a rhythmic manner for a sustained period. Running, brisk walking, bicycling, playing basketball, dancing, and swimming are all examples of aerobic activities. Aerobic activity makes a persons heart beat more rapidly to meet the demands of the bodys movement. Over time, regular aerobic activity makes the heart and cardiovascular system stronger and fitter. The purpose of the aerobic activity does not affect whether it counts toward meeting the guidelines. For example, physically active occupations can count toward meeting the guidelines, as can active transportation choices (walking or bicycling). All types of aerobic activities 132
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How Intense?
The guidelines for adults focus on two levels of intensity: moderateintensity activity and vigorous-intensity activity. To meet the guidelines, adults can do either moderate-intensity or vigorous-intensity aerobic activities, or a combination of both. It takes less time to get the same benefit from vigorous-intensity activities as from moderate-intensity activities. A general rule of thumb is that 2 minutes of moderateintensity activity counts the same as 1 minute of vigorous-intensity activity. For example, 30 minutes of moderate-intensity activity a week is roughly the same as 15 minutes of vigorous-intensity activity. There are two ways to track the intensity of aerobic activity: absolute intensity and relative intensity. Absolute intensity is the amount of energy expended per minute of activity. The energy expenditure of light-intensity activity, for example, is 1.1 to 2.9 times the amount of energy expended when a person is at rest. Moderate-intensity activities expend 134
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Muscle-Strengthening Activity
Muscle-strengthening activities provide additional benefits not found with aerobic activity. The benefits of muscle-strengthening activity include increased bone strength and muscular fitness. Musclestrengthening activities can also help maintain muscle mass during a program of weight loss. Muscle-strengthening activities make muscles do more work than they are accustomed to doing. That is, they overload the muscles. Resistance training, including weight training, is a familiar example of muscle-strengthening activity. Other examples include working with resistance bands, doing calisthenics that use body weight for resistance (such as push-ups, pull-ups, and sit-ups), carrying heavy loads, and heavy gardening (such as digging or hoeing). Muscle-strengthening activities count if they involve a moderate to high level of intensity or effort and work the major muscle groups of the body: the legs, hips, back, chest, abdomen, shoulders, and arms. Muscle strengthening activities for all the major muscle groups should be done at least two days a week. No specific amount of time is recommended for muscle strengthening, but muscle-strengthening exercises should be performed to the point at which it would be difficult to do another repetition without help. When resistance training is used to enhance muscle strength, one set of 8 to 12 repetitions of each exercise is effective, although two or three sets may be more effective. Development of muscle strength and endurance is progressive over time. Increases in the amount of weight or the days a week of exercising will result in stronger muscles.
Section 13.2
Increased exercise capacity reduces the risk of death in AfricanAmerican and Caucasian men, researchers reported in Circulation: Journal of the American Heart Association. The government-supported Veterans Affairs study included 15,660 participants and is the largest known to assess the link between fitness and mortality. It is important to emphasize that it takes relatively moderate levels of physical activitylike brisk walkingto attain the associated health benefits. Certainly, one does not need to be a marathon runner. This is the message that we need to convey to the public, said Peter Kokkinos, PhD, lead author of the study and director of the Exercise 138
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Section 13.3
Conclusions
CHD is a major health threat to women. Consequently, it is vital to increase the awareness of women, health, and fitness professionals about this fact. Preventive strategies have the potential to significantly lower the risk of CHD in both women and men. Increasing physical activity is the lifestyle change most likely to have far-reaching consequences in the primary and secondary prevention of CHD. Physical activity has been shown to favorably alter the MS and related CHD risk factors including dyslipidemia, obesity, Type 2 DM, and high blood pressure. Further, for women and men with CHD, improved risk factor profiles are likely to result in improved survival and enhanced quality of life. In view of these facts, the American College of Sports Medicine strongly endorses physical activity as a means to improve heart health among women of all ages.
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Section 13.4
Physical activity during pregnancy benefits a womans overall health. For example, moderate-intensity physical activity by healthy women during pregnancy maintains or increases cardiorespiratory fitness. Strong scientific evidence shows that the risks of moderate-intensity activity done by healthy women during pregnancy are very low and do not increase risk of low birth weight, preterm delivery, or early pregnancy loss. Some evidence suggests that physical activity reduces the risk of pregnancy complications, such as preeclampsia and gestational diabetes, and reduces the length of labor, but this evidence is not conclusive. During a normal postpartum period, regular physical activity continues to benefit a womans overall health. Studies show that moderate-intensity physical activity during the period following the birth of a child increases a womans cardiorespiratory fitness and improves her mood. Such activity does not appear to have adverse effects on breast milk volume, breast milk composition, or infant growth. Physical activity also helps women achieve and maintain a healthy weight during the postpartum period, and when combined with caloric restriction, helps promote weight loss.
Key Guidelines for Women during Pregnancy and the Postpartum Period
Healthy women who are not already highly active or doing vigorous-intensity activity should get at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity per week during pregnancy and the postpartum period. Preferably, this activity should be spread throughout the week. 144
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Section 13.5
Sedentary, overweight, or obese women can improve their quality of life by exercising as little as 10 to 30 minutes a day, researchers reported at the American Heart Associations Conference on Nutrition, Physical Activity, and Metabolism. The Dose Response to Exercise in postmenopausal Women (DREW) study, first reported in 2007, was the largest randomized, controlled trial examining the role of exercise in postmenopausal women. These secondary results focus on quality of life among 430 women divided into four groups: three groups exercising at various levels and one control group that did not exercise. While the women who participated in the highest exercise group saw the greatest improvements in most quality of life scales, the women in the lowest exercise group also saw improvements, said Angela Thompson, MSPH, co-author of the study and research associate at Pennington Biomedical Research Center in Baton Rouge, Louisiana. The public health message is tremendous, because it provides further support for the notion that even if someone cannot exercise an hour or more daily, getting out and exercising 10 to 30 minutes per day is beneficial, too. All participants in the exercise groups reported a statistically significant improvement in social functioning compared to those in the control group of women who didnt exercise. However, women who participated in more exercise, from 135 to 150 minutes a week, also showed significant improvements in general health, vitality, and mental health. The women who exercised more also improved in physical functioning, role limitations in work or other activities due to physical problems, and role limitations due to emotional problems, the researchers said. None of the women reported a statistically significant improvement in pain. 146
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Section 13.6
This compilation of facts is a representative sample of the data that exists in womens sports as of the publication date. If a reference appears old (i.e., 1975, 1985), it generally means that either there has been so much research on the topic that researchers see no need to replicate the studies or that the Foundation has found no more recent credible studies on the topic.
Benefits of Participation
Of those students attending NCAA Division I schools, female athletes post the highest graduation rates, followed by female students in general, male students, and male athletes. (NCAA Research Related to Graduation Rates of Division I StudentAthletes, 1984-2000. NCAA, 2007). Of the female student-athletes who entered NCAA Division I programs on scholarship in 1998, 71% graduated within six years of enrollment. This is 8% higher than the overall rate for female students (63%) and 16% higher than the overall rate for male student-athletes (55%). (2005 Graduation-Rates Report for NCAA Division I Schools. NCAA, 2005.) Both white female athletes (68%) and female athletes of color who are on scholarship (55%) graduated at higher rates than their counterparts in the general student population (54% and 42%, respectively). (Butler, J. & Lopiano, D. (2003). The Womens Sports Foundation Report: Title IX and Race in Intercollegiate Sport. Womens Sports Foundation.) 149
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Fitness
In the United States, physical inactivity and unhealthy eating contribute to obesity, cancer, cardiovascular disease, and diabetes, which are responsible for at least 300,000 deaths each year. (Physical Activity and Good Nutrition: Essential Elements to Prevent Chronic Diseases and Obesity, 2002. Centers for Disease Control and Prevention, 2002.) Between 20012004, 30% of men and 34% of women 2074 years of age were obese (age adjusted). The prevalence of obesity among women differed significantly by racial and ethnic group. In 20012004, one-half of non-Hispanic black women were obese compared with nearly one-third of non-Hispanic white women. In contrast, the prevalence of obesity among men was similar by race and ethnicity. (Health, United States, 2006, With Chartbook on Trends in the Health of Americans. Centers for Disease Control and Prevention, 2006.) The overall cost of health care in the United States doubled between 1993 and 2004, and in 2004, health care spending topped $1.9 trillion, or 16% of the nations economic output the largest share on record. (Center for Medicare and Medicaid Services, 2006.) 155
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Chapter 14
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Section 14.1
The exciting news from recent scientific studies is that exercise benefits everyoneregardless of age. Exercise can help you take charge of your health and maintain the level of fitness necessary for an active, independent lifestyle. Many people think that as we age, we tend to slow down and do less; that physical decline is an inevitable consequence of aging. For the most part, this is not true. According to the Presidents Council on Physical Fitness and Sports, much of the physical frailty attributed to aging is actually the result of inactivity, disease, or poor nutrition. But the good news ismany problems can be helped or even reversed by improving lifestyle behaviors. One of the major benefits of regular physical activity is protection against coronary heart disease. Physical activity also provides some protection against other chronic diseases such as adult-onset diabetes, arthritis, hypertension, certain cancers, osteoporosis, and depression. In addition, research has proven that exercise can ease tension and reduce the amount of stress you feel. To put it simplyexercise is one of the best things you can do for your health. The exercise program in this chapter is a daily routine that takes 20 to 30 minutes. Performing each exercise properly is as important as spending enough time on them. You are what you eat: No matter what your age, a balanced, nutritious diet is essential to good health. Older adults need to eat a balanced diet with foods from all the food groups. Eating a variety of foods helps ensure adequate levels of vitamins and minerals in the body. The U.S. Dietary Guidelines also recommend that adults reduce the fat, saturated fat, cholesterol, sodium, and sugar in the foods they eat. Some adults find they have problems being overweight as they age. This is generally due to overeating and inactivity. If you are overweight, 160
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Flexibility
Exercises in this category will help you maintain your range of motion. Through the normal aging process, muscles tend to lose elasticity and tissues around the joints thicken. Exercise can delay this process by stretching muscles to prevent them from becoming short and tight. It also helps slow down the development of arthritis, one of the most common and painful diseases associated with advancing age. In addition to performing flexibility exercises, you should try to bend, move, and stretch every day to keep joints flexible and muscles elastic. Avoid reliance on push buttons and conveniences that take away the need for personal motion. And, compliment this program with such recreational activities as dancing, yoga, swimming golfing, gardening, and housework. 162
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Flexibility Level I
Finger Stretching: to maintain finger dexterity. With the palm of the right hand facing down, gently force fingers back toward forearm, using left hand for leverage; then place left hand on top and push fingers down. Suggested repetitions: five each hand. (o) Hand Rotation: to maintain wrist flexibility and range of motion. Grasp right wrist with left hand. Keep right palm facing down. Slowly rotate hand five times each clockwise and counter-clockwise. Suggested repetitions: five each hand. (o) Ankle and Foot Circling: to improve flexibility and range of motion of ankles. Cross right leg over opposite knee, rotate foot slowly, making large complete circles. Ten rotations to the right, 10 to the left, each leg. (o) Neck Extension: to improve flexibility and range motion of neck. Sit up comfortably. Bend head forward until chin touches chest. You may want to stretch forward by simply jutting your chin out. Return to starting position and slowly rotate head to left. Return to starting position and slowly rotate head to right. Return to starting position. Suggested repetitions: five. (o) Single Knee Pull: to stretch lower back and back of leg. Lie on back, hands at sides. Pull one leg to chest, grasp with both arms and hold for five counts. Repeat with opposite leg. Suggested repetitions: three to five. Simulated Crawl Stroke/Back Stroke/Breast Stroke: to stretch shoulder girdle. Stand with feet shoulder-width apart, arms at sides, relaxed. Bend knees and alternately swing right and left arms backward upward and forward as if swimming. Suggested repetitions: six to eight movements on each stroke. (o) Reach: to stretch shoulder girdle and rib cage. Take deep breath, extend arms overhead. If standing, rise on toes while reaching. Exhale slowly, lowering arms. Can be done in a seated position. Suggested repetitions: six to eight. (o) Backstretch: to improve the flexibility of the lower back. Sit up straight. Bend far forward and straighten up. Repeat, clasping hands 163
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Flexibility Level II
Double Knee Pull: to stretch lower back and buttocks. Lie on back, hands at sides. Pull legs to chest, lock arms around legs, pull buttocks slightly off ground. Hold for 10 to 15 counts. Suggested repetitions: three to five. Seated Pike Stretch: to stretch lower back and hamstrings. Sit on floor, with legs forward, knees together. Exhale and stretch forward, slowly sliding hands down to ankles. Stretch only as far as is comfortable and use your hands for support. Hold for five to eight counts. Dont bounce; inhale deeply. Repetitions: three to four. Chest Stretch: to stretch muscles in chest and shoulders. Stand arm-length distant from a doorway opening. Raise one arm shoulder height with slight bend in elbow. Place hand against door jamb and turn upper body away so that the muscles in chest and shoulders are stretched. Suggested repetitions: three to four each arm. Seated Stretch: to stretch lower back and hamstrings. Sit on floor one leg extended to your side and one leg bent comfortably in front of your body. Supporting your body weight with your hands and keeping your back straight, lean forward until you feel a comfortable leg and hamstring. Hold the stretch for a few seconds, exhaling. Switch sides. Suggested repetitions: three to five each side.
Strength
Exercises designed to build strength can help prevent premature loss of muscle tissue and can improve muscle strength, size, and endurance at any age. The benefits of strength exercises also include improving reaction time, reducing the rate of muscle atrophy, increasing work capacity, and helping prevent back problems and injury. The following program of muscle conditioning exercises for the whole body has been designed specifically for older adults. Calisthenics work muscles against resistance, enabling them to grow and maintain muscle tone. In addition to the strength exercises suggested in this section, other physical activities that are essentially recreational can provide benefits to help maintain muscle integrity. Such activities include bicycling and swimming,
Strength Level I
Finger Squeeze: to strengthen the hands. Extend arms in front at shoulder height, palms down. Squeeze fingers slowly, then re1ease. Suggested repetitions: five. Turn palms up, squeeze fingers, release. Suggested repetitions: five. Extend arms in front, shake fingers. Suggested repetitions: five. Touch Shoulders: to increase flexibility of the shoulders and elbows and tone the upper arm; can be done in a seated position. Touch shoulders with hands, extend arms out straight. Bring arms back to starting position. Suggested repetitions: 1015. 165
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Strength Level II
Arm Curl: to strengthen arm muscles. Use a weighted object such as a book or a can of vegetables or small dumbbell. Stand or sit erect with arms at side, holding weighted object. Bend your arm, raising the weight. Lower it. Can be done seated. Suggested repetitions: 1015 each arm. (o) Arm Extension: to tone muscles in the back of the arm. Sit or stand erect with arms at sides, holding a weighted object of less than five pounds overhead. Slowly bend arm until head, then slowly extend arm overhead again. The arm curl and arm extension can be done separately or together. Can be done seated. (o) 166
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Section 14.2
The symptoms of menopause are numerous, and they can affect the quality of life of women moving through this stage. The good news is that exercise can often help reduce menopause-related symptoms. Menopause is the term commonly used to refer to the period of time both before and after a womans last menstrual period. Technically, menopause is a womans last menstrual period, while the time period immediately prior to menopause is referred to as peri-menopause and the time following menopause is referred to as post-menopause. This process of changing hormone levels can last for more than 10 years and women may experience widely varying hormone levels, specifically estrogen, progesterone, follicle stimulating hormone, and luteinizing hormone. These hormones alone, and in combination, are responsible for a wide range of processes within the body. The changes that occur during this stage of life may result in disruptions to normal daily living. These disruptions may include hot flashes, sleep disruption, weight gain, loss of libido, short-term memory impairment or a lack of focus, increased anxiety, fatigue, depression and drastic mood swings, joint/muscle aches and pains, irregular periods, heavy bleeding, dry eyes, vaginal changes, hair loss, osteoporosis, and cardiovascular diseasemost of which can be lessened with an effective exercise program. It is important to note that not all women experience the same changes or with similar intensity, which is one reason why menopause can be quite frustrating for many women. Research has demonstrated the positive effects of exercise and physical activity on reducing menopausal symptoms. Interestingly, the positive changes do not seem to be brought on by correction of hormonal concentration but rather from the acute effects of exercise and the long-term positive adaptations that result from exercise training. The positive outcomes resulting from regular exercise and/or physical activity programs include increased cardiovascular fitness, improvements 169
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Chapter 15
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Section 15.1
Regular physical activity is essential for healthy aging. Adults aged 65 years and older gain substantial health benefits from regular physical activity, and these benefits continue to occur throughout their lives. Promoting physical activity for older adults is especially important because this population is the least physically active of any age group. Older adults are a varied group. Most, but not all, have one or more chronic conditions, and these conditions vary in type and severity. All have experienced a loss of physical fitness with age, some more than others. This diversity means that some older adults can run several miles, while others struggle to walk several blocks. This chapter provides guidance about physical activity for adults aged 65 years and older. The chapter focuses on physical activity beyond baseline activity. The guidelines seek to help older adults select types and amounts of physical activity appropriate for their abilities. The guidelines for older adults are also appropriate for adults younger than age 65 who have chronic conditions and those with a low level of fitness. For adults aged 65 and older who are fit and have no limiting chronic conditions, the guidance in this chapter is essentially the same as that for active adults [see Chapter 13 Section 1, Fitness Guidelines for Adults].
How Intense?
Older adults can meet the guidelines by doing relatively moderateintensity activity, relatively vigorous-intensity activity, or a combination of both. Time spent in light activity (such as light housework) and sedentary activities (such as watching TV) does not count. The relative intensity of aerobic activity is related to a persons level of cardiorespiratory fitness. 174
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Physical Fitness and the Elderly Table 15.1. Examples of Aerobic and Muscle-Strengthening Activities for Older Adults
Aerobic Walking Dancing Swimming Water aerobics Jogging Aerobic exercise classes Bicycle riding (stationary or on a path) Some activities of gardening, such as raking and pushing a lawn mower Tennis Golf (without a cart) Muscle-Strengthening Exercises using exercise bands, weight machines, hand-held weights Calisthenic exercises (body weight provides resistance to movement) Digging, lifting, and carrying as part of gardening Carrying groceries Some yoga exercises Some tai chi exercises
Moderate-intensity activity requires a medium level of effort. On a scale of 0 to 10, where sitting is 0 and the greatest effort possible is 10, moderate-intensity activity is a 5 or 6 and produces noticeable increases in breathing rate and heart rate. Vigorous-intensity activity is a 7 or 8 on this scale and produces large increases in a persons breathing and heart rate. A general rule of thumb is that two minutes of moderate-intensity activity count the same as one minute of vigorous-intensity activity. For example, 30 minutes of moderate-intensity activity a week is roughly same as 15 minutes of vigorous-intensity activity.
Muscle-Strengthening Activities
At least two days a week, older adults should do muscle-strengthening activities that involve all the major muscle groups. These are the muscles of the legs, hips, chest, back, abdomen, shoulders, and arms. Muscle-strengthening activities make muscles do more work than they are accustomed to during activities of daily life. Examples of muscle-strengthening activities include lifting weights, working with 175
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Section 15.2
Each year, U.S. hospitals have 300,000 admissions for broken hips, and falling is often the cause of those fractures. Balance exercises can help you stay independent by helping you avoid the disabilityoften permanentthat may result from falling. There is a lot of overlap between strength and balance exercises; very often, one exercise serves both purposes. Lower-body exercises for strength also are balance exercises. They include plantar flexion, hip flexion, hip extension, knee flexion, and side leg raise. These exercises can improve your balance even more if you add the following modifications. Note that these exercises instruct you to hold onto a table or chair for balance. Hold onto the table with only one hand. As you progress, try holding on with only one fingertip. Next, try these exercises without holding on at all. If you are very steady on your feet, move on to doing the exercises using no hands, with your eyes closed. Have someone stand close by if you are unsteady.
Plantar Flexion
1. Stand straight; hold onto a table or chair for balance. 2. Slowly stand on tiptoe, as high as possible. 3. Hold position for one second. 4. Slowly lower heels all the way back down. Pause. 5. Repeat 8 to 15 times. 6. Rest; then do another set of 8 to 15 repetitions. 7. Add modifications as you progress. 179
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Hip Flexion
1. Stand straight; hold onto a table or chair for balance. 2. Slowly bend one knee toward chest, without bending waist or hips. 3. Hold position for one second. 4. Slowly lower leg all the way down. Pause. 5. Repeat with other leg. 6. Alternate legs until you have done 8 to 15 repetitions with each leg. 7. Rest; then do another set of 8 to 15 alternating repetitions. 8. Add modifications as you progress.
Hip Extension
1. Stand 12 to 18 inches from a table or chair, feet slightly apart. 2. Bend forward at hips at about 45-degree angle; hold onto a table or chair for balance. 3. Slowly lift one leg straight backward without bending your knee, pointing your toes, or bending your upper body any farther forward. 4. Hold position for one second. 180
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Anytime/Anywhere
These types of exercises also improve your balance. You can do them almost anytime, anywhere, and as often as you like, as long as you have something sturdy nearby to hold onto if you become unsteady. Walk heel-to-toe. Position your heel just in front of the toes of the opposite foot each time you take a step. Your heel and toes should touch or almost touch. Stand on one foot (for example, while waiting in line at the grocery store or at the bus stop). Alternate feet. Stand up and sit down without using your hands. 181
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Chapter 16
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Studies of Youth
Krizek proposed a model of the relevance of community design for youth physical activity. Though youth have different issues, such as commuting to school, access to play areas, and role of parents, many of the walkability associations with physical activity are presumed to be the same for youth and adults. Two studies using GIS measures of walkability and accelerometer measures of physical activity supported the relevance of walkability for adolescents. In one study, a walkability index explained about the same amount of variance as sex and ethnicity. However, a finding that higher street connectivity was related to lower activity levels in girls suggests that young people may use culde-sacs and suburban streets as play areas. Thus, street connectivity could encourage walking for transportation while discouraging play. Active commuting to school can contribute to overall physical activity, and there appears to be a connection with community design. Kerr and colleagues found active commuting was higher in high-walkable neighborhoods, but this effect was seen for higher-income children only. Braza et al. reported more active commuting to school in high-density neighborhoods, but no relation to street connectivity. Ewing and colleagues found more active commuting when sidewalks were present, but no association with density and land use mix. A significant effect of sidewalks was replicated by Fulton et al. McMillan confirmed high active commuting in walkable neighborhoods but found other contributors, such as perceived safety, traffic, and attitudes. Timperio and colleagues reported the surprising finding that higher street connectivity was associated with less active commuting. The few studies of community design and youth physical activity generally support a positive association of walkability indicators with both 185
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Studies of Adults
Humpel and colleagues reviewed the health literature on the environment and physical activity recently and found only 19 studies. Only access to recreation facilities, access to opportunities (such as activity programs), and aesthetic factors were consistently associated with higher levels of physical activity. Godbey and colleagues summarized findings of leisure science research related to active living. Parks are commonly used for a variety of physical activities, with walking being the most common. Distance to recreation facilities is strongly related to their use, and degree of naturalness was positively related to park use. Lee and Vernez-Moudon incorporated an urban planning and transportation perspective in their review of correlates of recreational physical activity. They pointed out neighborhood sidewalks are a common place for recreational walks, so sidewalks may be important for both recreational and transportation physical activity. Trails can also be used for transportation and recreation purposes. Recent studies have confirmed and expanded early results. Access to parks and trails is consistently related to activity levels, with few exceptions. The evidence is growing on the importance of aesthetics of recreation facilities and neighborhoods in general for walking, running, and total leisure-time physical activity. Presence and quality of sidewalks is emerging as an important correlate of leisure walking and physical activity. It is important to identify specific characteristics of recreation facilities that are strongly related to physical activity, because these findings can be translated into policies and design guidelines. Giles-Corti et al. identified people were very likely to walk in parks when they were nearby, large, and had a variety of attractive features. Lindsey and colleagues reported the most used urban trails were in densely populated neighborhoods with mixed land uses and convenient parking. 187
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Studies of Youth
In addition to their own yards, the main places where children are physically active seem to be the neighborhood streets and sidewalks, parks, and school grounds. So it is not surprising an early review found proximity to recreation facilities and opportunities such as programs were consistent correlates of physical activity in children and adolescents. Recent studies mainly have confirmed these early findings, but some studies report significance only in some groups or no significant associations. There is new evidence that proximity to schools and their activity facilities is related to physical activity. New studies extended adult findings by showing aesthetics of recreation facilities and neighborhoods are related to youth physical activity. There is consistent evidence that children and adolescents with recreation facilities near their homes are more likely to be active than those with few facilities. One study showed quality of facilities was more important than simple proximity so examining the role of quality and amenities at public recreation facilities is a priority. Because youth of different ages vary widely in common types of activity and use different equipment and supplies, it is important to learn how to design and equip parks and other recreation facilities so they serve youth of all ages.
Conclusion
Knowledge about the built environment and physical activity is growing rapidly, and efforts already are being made to use research findings to guide policy changes. The built environment is a direct reflection of policies, and creating more activity-friendly environments will involve collaboration among multiple government departments and sectors of society outside government. Government agencies dealing with zoning, planning, transportation, building codes, education, and recreation are directly responsible for the built environment variables described throughout this section. Industries dealing with construction of buildings and roads, real estate, recreation, and health have important stakes in the built environment, so they need to be engaged in efforts to change policies. Because physical activity is a significant determinant of health and health care costs, there is a strong rationale for adopting and implementing policies to create built environments that make it convenient, safe, and attractive for people of all ages and circumstances to be physically active. 190
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Chapter 17
Chapter Contents
Section 17.1Get Active............................................................. 194 Section 17.2Exercise Opportunities in Your Daily Life................................................. 200
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Section 17.1
Get Active
This section excerpted from Be Active Your Way: A Guide for Adults, Physical Activity Guidelines for Americans, U.S. Department of Health and Human Services (www.hhs.gov), October 16, 2008.
Getting Started
Thinking about adding physical activity to your life, but not sure how to get started? Sometimes taking the first step is the hardest part. If you have not been active in some time, start at a comfortable level and add a little more activity as you go along. Some people find that getting active with a friend makes it easier to get started.
Fitness and Exercise Sourcebook, Fourth Edition Planning Your Activity for the Week
Physical activity experts say that spreading aerobic activity out over at least three days a week is best. Also, do each activity for at least 10 minutes at a time. There are many ways to fit in 2 hours and 30 minutes a week. For example, you can do 30 minutes of aerobic activity each day for five days. On the other two days, do activities to keep your muscles strong. Find ways that work well for you. Other Ways to Add Physical Activity to Your Life Join a fitness group. Talk to your health care provider about good activities to try. Speak to the worksite wellness coordinator at your job. Visit www.healthfinder.gov and type activity in the search box.
Section 17.2
At Home
Its convenient, comfortable, and safe to work out at home. It allows your children to see you being active, which sets a good example for them. You can combine exercise with other activities, such as watching TV. If you buy exercise equipment, its a one-time expense and other family members can use it. Its easy to have short bouts of activity several times a day. Try these tips: Do housework yourself instead of hiring someone else to do it. Work in the garden or mow the grass. Using a riding mower doesnt count! Rake leaves, prune, dig, and pick up trash. Go out for a short walk before breakfast, after dinner, or both! Start with 510 minutes and work up to 30 minutes. Walk or bike to the corner store instead of driving. When walking, pick up the pace from leisurely to brisk. Choose a hilly route. When watching TV, sit up instead of lying on the sofa. Better yet, spend a few minutes pedaling on your stationary bicycle while watching TV. Throw away your video remote control. Instead of asking someone to bring you a drink, get up off the couch and get it yourself. 200
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At the Office
Most of us have sedentary jobs. Work takes up a significant part of the day. What can you do to increase your physical activity during the work day? Why not: Brainstorm project ideas with a co-worker while taking a walk. Stand while talking on the telephone. Walk down the hall to speak with someone rather than using the telephone. Take the stairs instead of the elevator. Or get off a few floors early and take the stairs the rest of the way. Walk while waiting for the plane at the airport. Stay at hotels with fitness centers or swimming pools and use them while on business trips. Take along a jump rope in your suitcase when you travel. Jump and do calisthenics in your hotel room. Participate in or start a recreation league at your company. Form a sports team to raise money for charity events. Join a fitness center or Y near your job. Work out before or after work to avoid rush-hour traffic, or drop by for a noon workout. Schedule exercise time on your business calendar and treat it as any other important appointment. Get off the bus a few blocks early and walk the rest of the way to work or home. Walk around your building for a break during the work day or during lunch. 201
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At Play
Play and recreation are important for good health. Look for opportunities such as these to be active and have fun at the same time: Plan family outings and vacations that include physical activity (hiking, backpacking, swimming, etc.). See the sights in new cities by walking, jogging, or bicycling. Make a date with a friend to enjoy your favorite physical activities. Do them regularly. Play your favorite music while exercising, something that motivates you. Dance with someone or by yourself. Take dancing lessons. Hit the dance floor on fast numbers instead of slow ones. Join a recreational club that emphasizes physical activity. At the beach, sit and watch the waves instead of lying flat. Better yet, get up and walk, run, or fly a kite. When golfing, walk instead of using a cart. Play singles tennis or racquetball instead of doubles. At a picnic, join in on badminton instead of croquet. At the lake, rent a rowboat instead of a canoe.
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Chapter 18
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Section 18.1
If you are even thinking about ways to fit exercise into your burstingat-the-seams schedule, you are on the right track. Research indicates that modest amounts of exerciseeven just 15 minutes a dayhelps ease depression, enhances self-image, relieves stress, and much more. Thats right, exercise makes you happy, and you dont have to be a gym rat to do it. By making start slow and have fun your mottos, youll be well on your way to using physical activity as a tool to make you feel better every day.
Make a Fitness Plan and Stick with It Safety Tips for Beginning Exercisers
If youve never exercised before, or its been a significant amount of time since youve attempted any strenuous physical activity, keep in mind the following general health precautions: Get medical clearance. If you have special health issues such as an existing heart condition or high blood pressure, talk with your doctor or health practitioner and let him or her know your plans. Stretch. No matter what form of exercise you choose, youll benefit from adding stretching exercises to gain flexibility and range of motion. Stretching is the best form of injury prevention for new exercisers. Drink plenty of water. Your body performs best when its properly hydrated. Failing to drink enough water when you are exerting yourself over a prolonged period of time, especially in hot conditions, can be dangerous. If you feel pain or discomfort while working out, stop and gently stretch. If you feel better, slowly and gently resume your workout. If you are sweating, even lightly, your heart rate has increased. In the beginning, theres no need to pressure yourself to exercise for a specific amount of time. Try exercising for even five minutes once or twice a day and gradually build up. And remember, short spurts of activity are just fine.
Section 18.2
Goal Setting
This section from Motivation, Define Your Goals, Stay Motivated, and Celebrate Your Achievements, Physical Activity: Strength Training for Older Adults, Centers for Disease Control and Prevention (www.cdc .gov), December 3, 2008.
If you want to make positive, lasting change in your life, it helps to spend some time thinking about motivation. What are your reasons for wanting to exercise? What are your personal goals? What obstacles do you anticipate and how might you overcome them? Its also a good idea to visualize your success and consider how you might celebrate your achievements.
Stay Motivated
Consider these factors that motivate people to begin and stick with their exercise program. Then identify which ones motivate you. Pleasure: People often really enjoy strength-training exercises; they find them less taxing than aerobic workouts and love the results. Health and fitness benefits: Strength training increases muscle mass and bone density. It makes you feel strong and energized, alleviates stress and depression, and gives you a better nights sleep. And it can help prevent the onset of certain chronic diseases or ease their symptoms. Improvements in appearance: Lifting weights firms the body, trims fat, and can boost metabolism by as much as 15%, which helps with weight control. Social opportunities: Exercising with friends or family gives you a chance to visit and chat while you work out. Thrills: People who start strength training later in life often find that they are willing and able to try new, exciting activities, such as parasailing, windsurfing, or kayaking.
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Chapter 19
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Place Barriers
Barrier: My neighborhood does not have sidewalks. Solutions: Find a safe place to walk. Instead of walking in the street, walk in a friend or family members neighborhood that has sidewalks. Walk during your lunch break at work. Find out if you can walk at a local school track. 220
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Health Barriers
Barrier: I have a health problem (diabetes, heart disease, asthma, arthritis) that I do not want to make worse. Solutions: Talk with your health care professional. Most health problems are helped by physical activity. Find out what physical activities you can safely do and follow advice about length and intensity of workouts. Start slowly. Take it easy at first and see how you feel before trying more challenging workouts. Stop if you feel out of breath, dizzy, faint, or nauseated, or if you have pain. Barrier: I have an injury and do not know what physical activities, if any, I can do. Solutions: Talk with your health care professional. Ask your doctor or physical therapist about what physical activities you can safely perform. Follow advice about length and intensity of workouts. Start slowly. Take it easy at first and see how you feel before trying more challenging workouts. Stop if you feel pain. 221
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2. See your health care provider if necessary. If you are a man and over age 40 or a woman and over age 50, or have a chronic health problem such as heart disease, high blood pressure, diabetes, osteoporosis, or obesity, talk to your health care provider before starting a vigorous physical activity program. You do not need to talk to your provider before starting an activity like walking. 3. Answer questions about how physical activity will fit into your life. Think about answers to the following four questions. You can write your answers on a sheet of paper. Your answers will be your roadmap to your physical activity program. What physical activities will you do? List the activities you would like to do, such as walking, energetic yard work or housework, joining a sports league, exercising with a video, dancing, swimming, bicycling, or taking a class at a fitness or community center. Think about sports or other activities that 222
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Chapter 20
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Section 20.1
Relative Intensity
The level of effort required by a person to do an activity. When using relative intensity, people pay attention to how physical activity affects their heart rate and breathing. The talk test is a simple way to measure relative intensity. As a rule of thumb, if youre doing moderate-intensity activity you can talk, but not sing, during the activity. If youre doing vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath.
Absolute Intensity
The amount of energy used by the body per minute of activity. The following list provides examples of activities classified as moderate intensity or vigorous intensity based upon the amount of energy used by the body while doing the activity. Moderate Intensity Walking briskly (3 miles per hour or faster, but not race walking) Water aerobics Bicycling slower than 10 miles per hour Tennis (doubles) 226
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Fitness and Exercise Sourcebook, Fourth Edition Instructions for Borg Rating of Perceived Exertion (RPE) 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 following rating scale 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 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 peoples. Look at the scales and the expressions and then give a number.
6 7
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Section 20.2
Your maximum heart rate is about 220 minus your age. The figures in the table are averages, so use them as general guidelines. Note: A few high blood pressure medications lower the maximum heart rate and thus the target zone rate. If youre taking such medicine, call your physician to find out if you need to use a lower target heart rate.
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Section 20.3
Find the activity you participate in and use the column closest to your body weight (130, 155, or 190 pounds) to estimate calories burned per hour.
Activity Aerobics, general Aerobics, high impact Aerobics, low impact Archery (nonhunting) Automobile repair Backpacking, general Badminton, competitive Badminton, social, general Basketball, game Basketball, nongame, general Basketball, officiating Basketball, shooting baskets Basketball, wheelchair Bicycling, <10 mph, leisure Bicycling, >20 mph, racing Bicycling, 1011.9 mph, light effort Bicycling, 1213.9 mph, moderate effort
Calories burned based on body weight 130 lbs 354 413 295 207 177 413 413 266 472 354 413 266 384 236 944 354 472 155 lbs 422 493 352 246 211 493 493 317 563 422 493 317 457 281 1,126 422 563 190 lbs 518 604 431 302 259 604 604 388 690 518 604 388 561 345 1,380 518 690
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Section 20.4
To track your physical activity for a month, copy the chart shown in Figure 20.1 and track the points for activities you participate in during that month. Use the points-to-calories conversion based on your body weight to determine your monthly calorie expenditure related to your physical activities. 239
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Approximate calories burned during activity 1 point = 40 calories for a 105-pound person 1 point = 50 calories for a 130-pound person 1 point = 60 calories for a 155-pound person 1 point = 70 calories for a 180-pound person 1 point = 80 calories for a 210-pound person 1 point = 90 calories for a 235-pound person 1 point = 100 calories for a 260-pound person Resting metabolic rate = about 1 to 2 points/hour
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Section 20.5
What is BMI?
Body Mass Index (BMI) is a number calculated from a persons weight and height. BMI is a fairly reliable indicator of body fatness for most people. BMI does not measure body fat directly, but research has shown that BMI correlates to direct measures of body fat, such as underwater weighing and dual energy x-ray absorptiometry (DXA).1,2 BMI can be considered an alternative for direct measures of body fat. Additionally, BMI is an inexpensive and easy-to-perform method of screening for weight categories that may lead to health problems.
Why does CDC [Centers for Disease Control and Prevention] use BMI to measure overweight and obesity?
Calculating BMI is one of the best methods for population assessment of overweight and obesity. Because calculation requires only height and weight, it is inexpensive and easy to use for clinicians and for the general public. The use of BMI allows people to compare their own weight status to that of the general population.
What are some of the other ways to measure obesity? Why doesnt CDC use those to determine overweight and obesity among the general public?
Other methods to measure body fatness include skinfold thickness measurements (with calipers), underwater weighing, bioelectrical impedance, dual-energy x-ray absorptiometry (DXA), and isotope dilution. However, these methods are not always readily available, and they are either expensive or need highly trained personnel. Furthermore, many of these methods can be difficult to standardize across observers or machines, complicating comparisons across studies and time periods.
With the metric system, the formula for BMI is weight in kilograms (kg) divided by height in meters (m) squared. Since height is commonly measured in centimeters (cm), divide height in centimeters by 100 to obtain height in meters. Example: Weight = 68 kg, Height = 165 cm (1.65 m) Calculation: 68 (1.65)2 = 24.98 243
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If an athlete or other person with a lot of muscle has a BMI over 25, is that person still considered to be overweight?
According to the BMI weight status categories, anyone with a BMI over 25 would be classified as overweight and anyone with a BMI over 30 would be classified as obese. It is important to remember, however, that BMI is not a direct measure of body fatness and that BMI is calculated from an individuals weight, which includes both muscle and fat. As a result, some individuals may have a high BMI but not have a high percentage of body fat. For example, highly trained athletes may have a high BMI because of increased muscularity rather than increased body fatness. Although some people with a BMI in the overweight range (from 25.0 to 29.9) may not have excess body fatness, most people with a BMI in the obese range (equal to or greater than 30) will have increased levels of body fatness. It is also important to remember that weight is only one factor related to risk for disease. If you have questions or concerns about the appropriateness of your weight, you should discuss them with your health care provider.
What are the health consequences of overweight and obesity for adults?
The BMI ranges are based on the relationship between body weight and disease and death.5 Overweight and obese individuals are at increased risk for many diseases and health conditions, including the following:6 245
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Is BMI interpreted the same way for children and teens as it is for adults?
Although the BMI number is calculated the same way for children and adults, the criteria used to interpret the meaning of the BMI number for children and teens are different from those used for adults. For children and teens, BMI age- and sex-specific percentiles are used for two reasons: The amount of body fat changes with age. The amount of body fat differs between girls and boys. Because of these factors, the interpretation of BMI is both age and sex specific for children and teens. The CDC BMI-for-age growth charts take into account these differences and allow translation of a BMI number into a percentile for a childs sex and age. For adults, on the other hand, BMI is interpreted through categories that are not dependent on sex or age.
References
1. Mei Z, Grummer-Strawn LM, Pietrobelli A, Goulding A, Goran MI, Dietz WH. Validity of body mass index compared with 246
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Chapter 21
Chapter Contents
Section 21.1Choosing a Health Club....................................... 250 Section 21.2Choosing a Personal Trainer............................... 254 Section 21.3Exercising with Friends. ..................................... 259 Section 21.4Making Exercise Fun for the Whole Family. .......................................... 261
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Section 21.1
What makes a fitness facility a place in which you have a safe, effective, fun exercise experience and also feel cared for? A combination of the staff, the programs, the members, and physical environment work together to compose your ideal facility. Most facilities will have people to give you a tour. Ask to see the entire facility. Observe the facility closely, ask questions, and use this section to compare two facilities that interest you.
2. Does the facility have adequate room for the number of members who want to work out?
This is especially a concern if you plan to exercise during peak times (usually before work, during lunch, and after work).
3. Does the aerobics room have a floor that provides shock absorption?
Ask if the facility has installed a floor that was designed to reduce shock. The greater the shock absorption, the more protective the floor 250
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4. Does the facility have the type of weight training and cardiovascular equipment you want to use?
Do you want to use weight machines or free weights? Do you like cycles or treadmills? Look for the types of equipment that interest you.
6. Are there signs or posters near the equipment that explain how to use it?
In the event that a staff member is not available to help you, signs near the equipment can help you figure out how to use it.
7. Is the facility kept at a comfortable temperature, and does it have good air circulation, either through the use of fans or through some kind of air circulation system?
You want to be comfortable when you exercise. Since you will probably sweat, you dont want to overheat.
8. Does the facility have established emergency procedures for the staff, and does it have first aid equipment and a trained person on-site to administer treatments?
In case of an injury, accident, or emergency, you want to make sure that someone can assist you immediately to forestall further problems.
10. Will you be allowed to try out the facility before committing to a membership?
Ask if you can obtain a free day pass to see if you like and feel comfortable in the facility. 251
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Fitness and Exercise Sourcebook, Fourth Edition 11. Does the facility thoroughly explain payment methods, policies, and cancellation procedures?
You should find out how you will pay for membership and what will happen if you move or need to cancel your membership for some reason.
16. Are people available to help you if you have questions about the equipment? Will someone show you how to work the equipment?
You cant get much use out of the equipment if you dont know how to use it! 252
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Choosing Physical Fitness Partners 17. Do the instructors treat each member individually and offer exercise alternatives for different people, depending on their fitness level and goals?
Instructors should be able to show moves that are suitable for beginner, intermediate, and advanced participants and those with a variety of health concerns. They should encourage you to go at your own pace and stop and rest if you feel extreme discomfort or fatigue.
18. Do the employees seem to care about you as a person and not just as a revenue source?
Ask other members how happy they are with the customer service the facility provides. Ask if the employees build a personal relationship with the members. You want to know if employees are easily accessible, knowledgeable, and friendly.
21. Are the classes or programs you are interested in scheduled at times that are convenient for you?
You want to make sure the classes that appeal to you are convenient to your busy schedule. If you dont like those that are scheduled for your free times, you wont go, and that means less value for your dollar.
22. Does the facility offer a variety of programs that interest you?
Variety can improve adherence to an exercise program in the long run. Make sure the facility offers programs that you are excited about. 253
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Section 21.2
So you are thinking about hiring a personal trainer. That is terrific, because more people are working out with their very own exercise consultant than ever before. Personal trainers are not just for Hollywood stars and the rich and famous anymore! For good reason, since personal trainers can make the difference between a great workout and a ho-hum oneor even no workout at all. Your personal trainer will motivate you, keep you on track, and make sure your workouts are safe, enjoyable, and effective. Of course, you want your personal trainer to exhibit the same qualities you demand of any provider of professional services, say, your tax preparer or dentista high degree of knowledge in their field, demonstrated expertise, plus a personality thats compatible with yours. As The Health & Fitness Source, IDEA has provided information, education, and training to personal trainers for more than 10 years. A recent IDEA survey showed that personal trainers provide a wide variety of clients with an extensive list of services, including nutritional guidance, fitness assessment, lifestyle management advice, weight control programs, and many more. To help you choose the personal trainer whos just right for you, weve developed this handy guide. It takes you through the steps of identifying potential candidates and provides specific questions to ask. We recommend that you interview at least three personal trainers carefully before making your decision.
What is your exercise and educational background? Are you certified by a nationally recognized organization?
To properly design a safe and effective workout, a personal trainer should have a good grounding in exercise technique, including exercise physiology, anatomy, and injury prevention. A four-year degree in a fitness-related field or certificationor, preferably, bothindicates the personal trainer knows at least the basics of conducting a quality session. 255
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Fitness and Exercise Sourcebook, Fourth Edition What is your level of personal training experience? How do you keep current on the latest personal training techniques, research, and trends?
Fitness is a fast-moving field, and you want to be able to rely on your personal trainer for current information on fitness, exercise, and healthy lifestyle activities. Membership in a professional association such as IDEA is one way to tell the personal trainer is staying abreast of the latest information on a variety of important topics.
Can you give me references from other clients and industry professionals familiar with your knowledge and abilities?
People choose to hire a personal trainer for many reasons, including weight loss, cardiovascular improvement, marathon or triathlon training, injury or illness rehabilitation, pre/postnatal fitness, and many more. It is important to hire someone who has experience in the type of training you seek. Calling references can help you gauge whether the personal trainer has the expertise to properly serve your needs.
Will you keep track of my workouts, chart my progress, and update my medical history periodically?
Your personal trainer will help you establish realistic short- and long-term goals and assess your progress towards them. He or she might chart areas such as weight, percent body fat, body measurements, 256
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What is your rate per session? Do you offer any discounts or package deals?
The personal trainer you select will most likely be an experienced professional with a high degree of expertise, and expects to be compensated as such. Expect to pay anywhere from $20 to $100 per hour-long session, and be sure to ask about any discounts available for multisession purchases, for higher frequency (three times a week instead of two), and training two or more clients at a time.
Fitness and Exercise Sourcebook, Fourth Edition Do you have a network of professionals, such as physicians, dietitians, physical therapist, and other fitness/ health professionals?
A quality personal trainer will have established sources for specialized questions and referrals to provide you with the best service possible.
Parting Thoughts
Keep in mind that while personal trainers are business people, most got into the profession because they care about the well-being of their clients and want to see them succeed. Your personal trainer should ask questions about your lifestyle, including your eating habits, whether you smoke or drink, and other activities that could affect your ultimate health. He or she should also take steps to tailor your program to your unique needs and make you feel comfortable in the relationship. You should feel free to bring up questions or concerns you have at any time. Give careful consideration to personality. Make sure your personal trainers approachenergetic versus relaxed, aggressive versus lowkeyfits your personal style. Gender is also important, since some people like working with a trainer of the same sex, while others prefer one of the opposite sex. The bottom line is, you will experience good results if you are comfortable with your personal trainer. We hope you will use this section to go out and find the right personal trainer for you. Good luck, and stay active!
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Section 21.3
A study of Oxford rowers shows that members of a team who exercised together were able to tolerate twice as much pain (an index of endorphin release) than when they trained on their own. In the study, published in the Royal Society journal Biology Letters on September 16 [2009], researchers from the University of Oxfords Institute of Cognitive and Evolutionary Anthropology found the pain threshold of 12 rowers from the Oxford Boat Race squad was greater after group training than after individual training. They conclude that acting as a group and in close synchrony seems to ramp up pain thresholds. The underlying endorphin release may be the mechanism that underpins communal-bonding effects that emerge from activities like religious rituals and dancing. Each of the 12 rowers participated in four separate tests. They were asked to row continuously for 45 minutes in a virtual boat in the gym (as in normal training), in an exercise carried out in two teams of six, and then in a separate session as individuals, unobserved by other team members. After each of the sessions, the researchers measured their pain threshold by how long they could stand an inflated blood pressure cuff on the arm. The study found there was a significant increase in the rowers pain threshold following exercise in both conditions (a well-established response to exercise of any kind), but there was a significantly larger increase in the group condition as compared with the individual condition. Since close synchrony is the key to successful competition-class racing, these results suggest that doing a synchronised activity as a group increases the endorphin rush that we get from physical exertion. The study says since endorphins help to create a sense of bonhomie and positive affect, this effect may underlie the experience of warmth and belonging that we have when we do activities 259
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Section 21.4
Parenting Tips
Walk to the park. Bring Fido, stroll with your small children in a wagon, or race to the slide. And. while youre at the park, be sure to push each other on a swing, play tag, or climb on the monkey bars together! Dance, dance, dance. Turn on your favorite song and make up a dance routine. Each family member can make up his/her own dance moves and other family members can judge each other on talent and difficulty. Run or walk for charity. Pick a walk/run geared toward families with kid entertainment and activities. You will be putting in 261
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Chapter 22
Abstract
Learning objective: This chapter explains to readers how to cope with the sometimes incredible claims made by manufacturers about exercise equipment. Infomercials and other forms of advertisement continue to make bold claims for exercise equipment. Burns twice as many calories as a treadmill! Lose four inches from your waist in two weeks! Get a complete workout in just four minutes a day! In most cases, the equipment can be effectively used to train clients, although the claims may be exaggerated.
Exercise Equipment: Assessing the Advertised Claims, by David Swain, PhD, FACSM, ACSMs Health & Fitness Journal, September/October 2009, pp 811. 2009 American College of Sports Medicine. Reprinted with permission from Wolters Kluwer Health, Inc.
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Fat-Burning Zone
Most cardio machines display a heart rate guide with suggested target heart rates for a fat-burning zone versus a cardio fitness zone. Lower target values are given for fat burning than for developing cardio fitness. The implication that lower intensities are better for fat burning and, therefore, for weight loss is based on a common misapplication of exercise physiology. Lower intensities 268
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References
1. Achten J, Gleeson M, Jeukendrup AE. Determination of the exercise intensity that elicits maximal fat oxidation. Med Sci Sports Exerc. 2002;34:927. 2. Bergh U, Kanstrup IL, Ekblom B. Maximal oxygen uptake during exercise with various combinations of arm and leg work. J Appl Physiol. 1976;41:1916. 3. Escamilla RF, Babb E, DeWitt R, et al. Electromyographic analysis of traditional and nontraditional abdominal exercises: Implications for rehabilitation and training. Phys Ther. 2006;86:65671. 4. Gormley SE, Swain DP, High R, et al. Effect of intensity of aerobic training on VO2 max. Med Sci Sports Exerc. 2008;40:133643. 5. Stromme SB, Ingjer F, Meen HD. Assessment of maximal aerobic power in specifically trained athletes. J Appl Physiol. 1977;42:8337. 6. Swain DP. Exercise prescription. In: Ehrman J, deJong A, Sanderson B, Swain DP, Swank AM, Womack CJ, editors. ACSMs Resource Manual for Guidelines for Exercise Testing and Prescription. 6th ed. Philadelphia (PA): Lippicott Williams & Wilkins; 2008. 7. Swain DP, Franklin BA. Comparative cardioprotective benefits of vigorous vs. moderate intensity aerobic exercise. Am J Cardiol. 2006;97(1):1417.
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Part Four
Exercise Basics
Chapter 23
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Section 23.1
The four main types of physical activity are aerobic, muscle strengthening, bone strengthening, and stretching. Aerobic activity is the type that benefits your heart and lungs the most.
Aerobic Activity
Aerobic activity moves your large muscles, such as those in your arms and legs. Running, swimming, walking, bicycling, dancing, and doing jumping jacks are examples of aerobic activity. Aerobic activity also is called endurance activity. Aerobic activity makes your heart beat faster than usual. You also breathe harder during this type of activity. Over time, regular aerobic activity makes your heart and lungs stronger and able to work better.
Section 23.2
Elliptical Trainers
Selecting and Effectively Using an Elliptical Trainer. Reprinted with permission of the American College of Sports Medicine. Copyright 2005 American College of Sports Medicine. All rights reserved. Reviewed by David A. Cooke, MD, FACP, March 2010.
Safety
Make sure the equipment is properly fitted to your size and movement range. If the machine is motorized, there should be a safety turn-off control. When in use, the machine should be very sturdy and should neither move nor have the tendency to tip over. The side rails should also be sturdy and provide for adequate balance. Check the area around the machine for adequate headroom and space for leg and arm motion.
Other Considerations
Make certain the pedals will comfortably accommodate the size of your feet. Pedals with a textured non-slip surface and high curved ridges will also prevent your feet from sliding around or even off the pedal when exercising. The stride length permitted by the trainer is also an important factor. Avoid purchasing a trainer if the stride length is too limited for your leg movement range. Some machines allow you to adjust the stride length. Overall fit is very important. A good fit should allow you to move comfortably and smoothly, with a good upright posture and without the chance of your knees bumping into the console. The fixed hand-support rails should also allow you to maintain a comfortable upright posture versus a tendency to lean too far forward (which can be stressful to the back). If the machine provides upper-body handles or poles, make sure that the handles are sturdy, easy to reach, and that the handgrips are comfortable. Avoid trainers with upper-body poles that infringe on your range of motion or cause contact with your knees. Familiarize yourself with the options that increase the intensity of the workout. Some machines have elevating ramps under each pedal. Others increase the intensity through faster movement or by changing the resistance of the pedals with a tension control.
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Section 23.3
Treadmills
Selecting and Effectively Using a Home Treadmill. Reprinted with permission of the American College of Sports Medicine. Copyright 2005 American College of Sports Medicine. All rights reserved. Reviewed by David A. Cooke, MD, FACP, March 2010.
Safety
Stability of platform when level and with elevation: feels solid, not wobbly. Doesnt have parts that hit you or cramp your movements in an unnatural fashion. Automatic emergency shut-off key, clip, or tether. Side rails or safety bars for balance: They should be reachable and sturdy, but out of the way of swinging arms. 283
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Operation
Is the control panel accessible and easy to read? Does the control panel have the capacity for manual use separate from software used for automated programming? 284
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Other Considerations
Weight of treadmill. Space available and height of ceiling. Aesthetics. Storage potential. How accurate is the calibration?
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Section 23.4
Rowing Machines
Selecting and Effectively Using a Rowing Machine. Reprinted with permission of the American College of Sports Medicine. Copyright 2005 American College of Sports Medicine. All rights reserved. Reviewed by David A. Cooke, MD, FACP, March 2010.
Section 23.5
Stair Climbers
Selecting and Effectively Using a Stair Stepper/Climber. Reprinted with permission of the American College of Sports Medicine. Copyright 2005 American College of Sports Medicine. All rights reserved. Reviewed by David A. Cooke, MD, FACP, March 2010.
Safety
It is essential that your machine have solid construction and a stable frame. In steppers, the stepping action should be smooth and independent (pushing one step down should not push the other step up). Self-leveling pedals will allow the user to keep the step flat throughout the workout. It is important that these machines be ergonomically sound and that you position yourself to maximize the safety and effectiveness of your workout. This means that the handrails should be positioned so that your workout posture is upright with the knees behind the toes. Bending forward places a great amount of stress on the back. Using the handrails to support part of the body weight reduces the total caloric expenditure and may result in a posture that is biomechanically unsound. Last, but not least, read all of the manufacturers instructions to get the most out of your machine!
Operation
Is the control panel accessible and easy to read? Does the control panel have the capacity for manual use separate from software used for automated programming? Can you customize programs for yourself?
Other Considerations
Do you have appropriate floor support for the weight of the machine? Are there rollers that allow you to move the stepper with reasonable ease? Does the ceiling height allow all users to use the machine safely? Determine your space considerations. Will you need to store the stepper periodically?
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Chapter 24
Step Aerobics
Step aerobics, which revolutionized the fitness industry when it was introduced in the late 1980s, is a versatile training modality that can be made more or less intense by simply changing the height of the step, performing movements through different ranges of motion, or adjusting the step cadence. The research-supported benefits of step training include cardiorespiratory fitness, weight management, and mood enhancement. Platform height: Platform height is dependent on the exercisers level of aerobic fitness, current skill with step training, and degree of knee flexion when the knee is fully loaded while stepping up. Deconditioned individuals should begin on 4-inch steps, while highly skilled and experienced steppers can use 10-inch steps. The most common height is 8 inches. Regardless of fitness level or skill, participants should not exercise on a platform height that causes the knee joint to flex deeper than 90 degrees when the knee is fully loaded (when all the body weight is on the leg of the first upward step). Individuals with chronic knee problems should seek their physicians approval to perform step training. Posture: The head should be up, shoulders down and back, chest up, abdominals lightly contracted, and buttocks gently tucked under the hips. Do not hyperextend the knees or back at any time. When
Step Aerobics Guidelines, reprinted with permission from the American Council on Exercise (www.acefitness.org), 2009. All rights reserved.
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Chapter 25
Kickboxing
Are you looking for a total body workout that totally kicks butt? How about a way to increase your stamina, flexibility, and strength while listening to your favorite dance mixes? If this sounds good to you, keep reading to find out what you need to know before you take the kickboxing challenge.
What Is Kickboxing?
Although the true roots of kickboxing date back to Asia 2,000 years ago, modern competitive kickboxing actually started in the 1970s, when American karate experts arranged competitions that allowed full-contact kicks and punches that had been banned in karate. Because of health and safety concerns, padding and protective clothing and safety rules were introduced into the sport over the years, which led to the various forms of competitive kickboxing practiced in the United States today. The forms differ in the techniques used and the amount of physical contact that is allowed between the competitors. Currently, one popular form of kickboxing is known as aerobic or cardiovascular (cardio) kickboxing, which combines elements of boxing, martial arts, and aerobics to provide overall physical conditioning and
Kickboxing, November 2008, reprinted with permission from www.kidshealth .org. Copyright 2008 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or www.TeensHealth.org.
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The Basics
Before you decide to jump in and sign up for a class, you should keep a few basic guidelines in mind: Know your current fitness level. Kickboxing is a high-intensity, high-impact form of exercise, so its probably not a good idea to plunge in after a long stint as a couch potato. You might try preparing yourself by first taking a low-impact aerobics course or less physical form of exercise and working up to a higher level of endurance. When you do begin kickboxing, allow yourself to be a beginner by working at your own pace and not overexerting yourself to the point of exhaustion. Check it out before you sign up. If possible, observe or try a class beforehand to see whether its right for you and to make sure the instructor is willing to modify the routine a bit to accommodate peoples different skill levels. Try to avoid classes that seem to move too fast, are too complicated, or dont provide the chance for any individual instruction during or after the class. Find a class act. Look for an instructor who has both a highlevel belt in martial arts and is certified as a fitness instructor by an organization such as the American Council on Exercise (ACE). Also, try to start at a level that suits you and slowly progress to a more intense, fast-paced kickboxing class. Many classes call for intermediate levels of fitness and meet two to three times a week. 298
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Kickboxing
Comfort is key. Wear loose, comfortable clothing that allows your arms and legs to move easily in all directions. The best shoes are cross-trainersnot tennis shoesbecause cross-trainers allow for side-to-side movements. Gloves or hand wraps are sometimes used during classesyou may be able to buy these where your class is held. Give your instructor a call beforehand so you can be fully prepared. Start slowly and dont overdo it. The key to a good kickboxing workout is controlled movement. Overextending yourself by kicking too high or locking your arms and legs during movements can cause pulled muscles and tendons and sprained knee or ankle joints. Start with low kicks as you slowly learn proper kickboxing technique. This is very important for beginners, who are more prone to developing injuries while attempting quick, complicated kickboxing moves. Drink up. Drink plenty of fluids before, during, and after your class to quench your thirst and keep yourself hydrated. Talk to your doctor. Its always a good idea to see your doctor and have a complete physical exam before you begin any type of exercise programespecially one with a lot of aerobic activity like kickboxing. This is extremely important if you have any chronic medical conditions such as asthma or diabetes or are very overweight.
Why Kickboxing?
Besides keeping your body fit, kickboxing has other benefits. According to a study by ACE, you can burn anywhere from 350 to 450 calories an hour with kickboxing! Kickboxing also reduces and relieves stress. Its rigorous workout controlled punching and kicking movements carried out with the discipline and skills required for martial artscan do wonders for feelings of frustration and anger. Practicing kickboxing moves can also help to improve balance, flexibility, coordination, and endurance. Kickboxing is also a great way to get a total body workout while learning simple self-defense moves. Kickboxing fans say the sport helps them to feel more empowered and confident. So get out there and jab, punch, and kick your way to fitness.
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Chapter 26
Dancing
If television mimicked the real world, Americans tuning into such popular television shows as So You Think You Can Dance and Dancing with the Stars wouldnt think twice about jumping onto Mary Murphys Hot Tamale Train or heating it up Latin-style with ballroom dancers bad boy Maksim Chmerkovskiy or the lovely Chelsie Hightower. Dream no more: The popularity of these shows has already set an entire railroad system in motion at a local dance studio near you. Whether you want to pack ballroom heels, hip-hop sneakers, tap shoes, ballerina flats, a belly dance costume, or even the hula hoop, fun dance classes are just around the corner. With so many dance techniques to choose from, its only a matter of time before you too can reap the benefits of feeling more energized and looking fit and toned. Dancing could even help you shed some extra pounds before the upcoming holiday season. To help you find your own dance style that doesnt break the bank, ACE [American Council on Exercise] has consulted four acclaimed dance instructors to talk about their varied professional and coaching careers, client profile, and the ubiquitous health benefits one can reap from dancing at any age.
So You Think You Can Dance? Well, Now You Can American Council on Exercise. Reprinted with permission from the American Council on Exercise (www.acefitness.org).
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Jennifer Curry, Principal Ballerina of the California Ballet Company/Certified Pilates Instructor
At age 40, Curry is still dancing strong. The principal ballerina for the California Ballet Company attributes her longevity as a professional dancer to her secret weaponPilates. Pilates teaches awareness of breath and alignment of the spine, and aims to strengthen the deep torso muscles. Its been a tough journey, said Curry about her 30-year career path at the San Diegobased ballet company. For the body, it becomes more challenging to keep up with performance and class routines, but Pilates helped me sustain my career, said Curry, and added I have better technique and better performances, because it gave me so much more core strength. Currys day begins in the morning with about two to five hours of ballet practice and continues with up to five hours of Pilates training and instruction, sometimes until 9 p.m. She offers private lessons at the Body Alchemist Pilates studio in San Diego. Her clients range from middle-aged working professionals to professional dancers. Curry charges $70 for a 60-minute private lesson; $26 a person for group sessions; and $35 per person for semiprivate lessons. By popular demand, the California Ballet School, part of the California Ballet Company, also recently expanded its classical ballet training to offer a wider and more diverse curriculum. Lately with the dance infusion in pop culture, more people are getting interested in hip hop, jazz, tap, and lyrical (fusing contemporary, modern, and ballet), Curry said. The finalists of So You Think You Can Dance have all trained extensively in these techniques. See the California Ballet School [www.californiaballetschool.com] for a class schedule. Additionally, for dance education information at the local, state, and national levels, check out the National Dance Education Organization [ndeo.org]. Curry said she is also excited about the heightened interest by high school students. Its becoming more cool, she said, noting an upsurge in the numbers of high school dance departments and arts programs. Meanwhile, the Dancing with the Stars series has bolstered interest in ballroom dancing among adults. But you dont have to be a rising TV star or a youngster to start formal dance training, including in classical ballet, Curry said. Anybody at any age can get started, Curry said. 302
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Dancing
Dance keeps you looking young and feeling young at heart. Curry is living proof that this is true.
Tesha Marie Jacobson, U.S. Latin Dance Champion and Ballroom Dance Instructor
Tesha Marie Jacobson left behind a successful career as an internationally acclaimed ballroom dancer to coach professional and aspiring ballroom dancers and amateur dancers. She agrees with Curry that dance shows have bolstered interest in ballroom dancing. People want to learn ballroom dancing for wedding parties and I also got a lot more younger people involved, noted Jacobson. She began dancing at the tender age of 11 after watching a friend in a dance class. Certainly, the earlier one starts formal dance training, the better the chances for a professional career. Hence, its nice to see more studios pop up with kids in mind, she said. Compared to Europeans, who enroll children at a young age in ballroom dance classes to learn about etiquette and classical dance, American children prefer dancing ballet or tap. But as more TV shows feature 20-somethings or younger partnering up to dance a Viennese waltz or Quickstep, the greater the hip factor. So You Think You Can Dance has brought to light that ballroom and Latin dancing is a real art form that they have to train in, Jacobson said. Partner dancing isnt merely a full body workout; it trains the mind as well. Having taught at so many levels, you learn how to dance and control your muscles while using your mind to control muscle action and to create timing, Jacobson said. During formal competitions, partners sometimes dance up to five hours at a time. Ladies dance in heels and are so graceful on their feet that their heavy costumes appear weightless. Jacobson used to soak and rub her feet for hours to find relief. She didnt recognize until late in her career that adding weight lifting for strength and yoga for stretching can help significantly with injury prevention and overall performance. Since getting my ACE certification (as a Group Fitness Instructor) I know how muscles function and how the body works as Im getting people ready for competition, Jacobson said. I can pinpoint which muscles are working and make that movement happen. 303
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Dancing
It increases flexibility in your back, is low impact, and you can definitely feel it in your stomach, arms, legs, and glutes, Martin added. Its a sure way to tone your body. Martin sells her hoop creations online. Every hoop is handmade, collapsible, and colorful. Prices range from $30$50. Visit unityhoops. com for more detailed information or YouTube for a video demonstration of these portable hoops. To locate hooping instructors in your area, the best place to start is the international website hooping.org. Another valuable resource is hulahooping.meetup.com to find meetup groups all over the world focused on hooping.
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Chapter 27
Racquet Sports
The reasons for playing tennis are many and are listed and explained in this chapter. As for who should play, the answer is anyone at any age and at any skill level. The following describes several groups of people and how, based on their stage of life, they can enjoy both the physical and psychological benefits of playing what many people call the sport for a lifetime. To see for yourself how science has proved that tennis contributes to health and fitness, keep reading! Young children (or their parents, who are looking for healthy activities for their children): Tennis not only provides children with much-needed exercise but also has been shown to help psychological skill development and improve bone growth and general fitness. (These benefits are very important to stemming the problem of childhood obesity). Physical activity also strengthens the immune system of every child who plays the game. Preteens and teens: People in this age group will have tons of fun, increase their social skills, and build friendships. Tennis will help preteens and teens increase their self-confidence and generally feel better about themselves. Also, tennis can enhance their cognitive abilities, thus helping this group improve their grades.
This chapter excerpted from TennisFor the Health of It! 2008. This copyright material is reprinted with permission of the United States Professional Tennis Association and was originally published on its website at www .uspta.com.
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Racquet Sports
Racquet Sports
13. Bone strength: For years, scientists and physicians have recommended impact exercises for people who want to increase bone strength and density and prevent osteoporosis. Experts usually recommend running, jogging, or even walking to build bones, but when it comes to an activity that will create impact with the ground, as well as impact when striking the ball, nothing beats tennis. Bone development for children is critical, and bone growth and maintenance for seniors is equally important. 14. Improved immune system: Tennis, through its conditioning effects, promotes overall health, fitness, and resistance to disease. Studies have demonstrated that the more active you are the stronger and healthier your immune system will be. And, the intensity of exercise helps to strengthen the immune system even more. It makes sense, then, that tennis, with its inherent demands for heart rate, interval training, impact, agility, etc., is one of the most beneficial activities in which you could participate. Schneider and Greenburg cited tennis specifically as an activity in which participants were less likely to be obese, smoke, or be involved in other forms of threatening activities than those who participate in team sports and an aggregate of other sports. And, Laforest, with other scientists, discovered that recreational tennis players who participate twice a week had a lower body fat percentage than age-matched control groups. Finally, Houston and colleagues published a longitudinal investigation of more than 1,000 male students examined after an average of 22 and 40 years. Sustained playing of activities such as tennis was associated with a lower risk of cardiovascular disease. They inferred that a primary factor for this beneficial health profile may be that tennis was the sport played most often through mid-life. 15. Better nutritional habits: Tennis players learn how to eat to enhance energy production during a match and recovery after a match. 16. Good hand-eye coordination: Tennis players develop good hand-eye coordination because they must constantly judge the timing between the oncoming ball and the proper contact point. 17. Flexibility: Because tennis players continually stretch and maneuver to return the ball to their opponent they become more flexible.
Racquet Sports
which is huge preparation for life skills. It is a continual battle with your opponent, but also with yourself. Every point has the capacity to become an emotional slap in the face. Yet, the more you play, the more effectively you learn to manage all of the stresses that life and tennis competition create. 25. Recover and adapt: Because of the nature of tennis, a player must learn to recover quickly, adapting to the stress that each point presents. 26. Planning and implementation: In tennis, you naturally learn how to plan and implement a strategy based on your anticipation of your opponents moves. 27. Develop problem-solving skills: Tennis forces you to learn to solve problems based on angles, geometry, and physics. 28. Develop performance rituals: Tennis is a game of rhythm and preparation. In between points you will learn how to prepare yourself physically, emotionally, and mentally for the next point. 29. Sportsmanship: Tennis teaches all of us about fairness, honesty, integrity, and overall sportsmanship. 30. Win with grace and lose with honor: Gloating after a win or making excuses after a loss doesnt work in tennis or in life. 31. Teamwork: Successful doubles play depends on you and your partners ability to communicate well and play as a cohesive unit. 32. Develop social skills: Tennis encourages participants to be social, especially recreational players. There are many opportunities for players to interact and communicate during a matchbefore play begins, during changeovers, and after a match. 33. Fun: People who play tennis experience healthy feelings of enjoyment, competitiveness, and physical challenge. And, reason No. 34: Tennis is the sport for a lifetime. When all is said and done, its hard to argue against these reasons for playing tennis! Tennis, as sports science supports, is a great choice for many reasons. Not only does it contribute to physical fitness and health, it also enhances mental focus, self-esteem, and a host of other personality traits that positively affect a persons overall sense of wellbeing. 313
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Chapter 28
Aquatic Exercise
Chapter Contents
Section 28.1Water Fitness....................................................... 316 Section 28.2Top 10 Reasons You Should Exercise in Water................................................. 319
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Section 28.1
Water Fitness
Health Benefits of Water-Based Exercise, Centers for Disease Control and Prevention (www.cdc.gov), December 23, 2009.
Swimming is the third most popular sports activity in the United States and a good way to get regular aerobic physical activity.1 Just two and a half hours per week of aerobic physical activity, such as swimming, bicycling, or running, can decrease the risk of chronic illnesses.23 This can also lead to improved health for people with diabetes and heart disease.2 Swimmers have about half the risk of death compared with inactive people.3 People report enjoying waterbased exercise more than exercising on land.4 They can also exercise longer in water than on land without increased effort or joint or muscle pain.56
Aquatic Exercise
A Good Choice
Exercising in water offers many physical and mental health benefits and is a good choice for people who want to be more active. When in the water, remember to protect yourself and others from illness and injury by practicing healthy and safe swimming behaviors. 1. U.S. Census Bureau. 2010 Statistical Abstract of the United States. Recreation Table 1212. Participation in Selected Sports Activities: 2007. Available at www.census.gov/compendia/ statab/2010/tables/10s1212.pdf. 2. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans: Be active, healthy, and happy! In Chapter 2: Physical Activity Has Many Health Benefits. Available at www.health.gov/paguidelines. 3. Chase, N.L., Sui, X., Blair, S.N. 2008. Swimming and all-cause mortality risk compared with running, walking, and sedentary habits in men. Int J of Aquatic Res and Educ. 2(3): 21323. 4. Lotshaw, A.M., Thompson, M., Sadowsky, S., Hart, M.K., and Millard, M.W. 2007. Quality of life and physical performance in land- and water-based pulmonary rehabilitation. Journal of Cardiopulmonary Rehab and Prev. 27: 24751. 5. Broman, G., Quintana, M., Engardt, M., Gullstrand, L., Jansson, E., and Kaijser, L. 2006. Older womens cardiovascular responses to deep-water running. Journal of Aging and Phys Activ. 14: 2940. 6. Cider, A., Svealv, B.G., Tang, M.S., Schaufelberger, M., and Andersson, B. 2006. Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure. Eur J Heart Fail. 8(3): 30813. 7. Westby, M.D. 2001. A health professionals guide to exercise prescription for people with arthritis: a review of aerobic fitness activities. Arthritis Care and Res. 45(6): 50111. 317
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Aquatic Exercise
Section 28.2
Aquatic fitness has come out of the shadows and is drawing fans of all shapes, sizes, and ages. Men, women, and children are diving in and discovering fluid fun and cool challenges as they splash their way to a fitter body. Check out your local pool schedule and you may find aquatic kickboxing, cycling, boot camp, jogging, walking, Pilates, yoga, and much more! Here are ten reasons to get wet! #10: Follow the trend. The boomers are aging and so are their hips and knees. Watch out because new pool construction is going gang busters and will continue to do so over the next 15 years. Due to the fact that aquatic fitness is soaring in popularity, most locations are building more than one pool. A cooler pool is built for lap swimming and aggressive aquatic fitness programs, while a warmer pool meets the needs of senior programming, rehabilitation, and mind/body classes. New and exciting programming will continue to crop up as innovative aquatic equipment and technology develops due to increased demand! #9: Provides excellent cross training. If you always do what you always did you will always get what you always got! Eventually your body will plateau on an exercise program if you do not introduce variation, or worse you could make yourself vulnerable to overuse injuries. Water offers the perfect solution to cross training. Do you like to jog? Try deep water jogging or lap swimming. Do you like to strength train with weights? Try an aquatic class that uses equipment or webbed gloves. Your body will thank you for introducing aquatic fitness into your exercise routine and that frustrating plateau will surely wash away! 319
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Aquatic Exercise
belt on in the shallow end and experiment with some suspended movement. Better yet, float onto your back and treat yourself to some killer crunches in the water. #4: Exercising in water is fun. Lets face itthere are people who just dont like to exercise. Common psychology dictates that if you dislike an exercise activity you will distract yourself with every excuse you can think of to avoid it. On the other hand, if you enjoy a fitness activity you will move heaven and earth to participate in that planned exercise session. Exercising in water is fun! There is something about romping around in a pool that makes you feel young and vibrant. If you enjoy a fitness activity you will commit to an exercise plan. If you commit to planned exercise sessions over a period of time you will change your body, your mind, and your life! #3: Exercising in water is a good workout. Everyone wants to work hard, including seniors! Water provides an excellent opportunity for allowing variations in the intensity of a workout. Unlike land fitness, working out in a pool you are surrounded by a source of resistance and each individual can decide how hard to push, pull, and move that resistance during the workout. Water exercise allows people of all fitness levels to work at a pace that is appropriate for their exercise goals. The more forceful you push the harder the workout. The secret must be getting out because aquatic fitness formats like kickboxing, boot camp, and cycling are bringing younger exercise enthusiasts into the pool along with more men! #2: Reduced joint impact. Unlike todays children, the baby boomers participated in lots of sports and spent their childhoods playing outdoors. As they got older they kept in shape with running, aerobics, biking, and more. Unfortunately, joint impact issues have sidelined many boomers from the land fitness activities they once enjoyed. Doctors are encouraging water fitness for good reason. The buoyant property of water unloads joints and allows for vigorous physical activity with minimal or zero joint impact. For example, if you are in water that is at chest level you will be bearing only about 2535% of your body weight. If you simply flex at your hips and knees and lower into the water at shoulder level you will virtually eliminate impact during fitness activity. It gets better! Deep water training is vigorous exercise with zero impact100% of the time! #1: Burn calories and lose weight. Whether you need to slim down or work hard at maintaining your weight, exercising in water is a safe and efficient method of burning calories. When you work out in 321
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Chapter 29
Chapter Contents
Section 29.1Beginning a Walking Program............................ 324 Section 29.2Selecting and Using a Pedometer. ....................... 328 Section 29.310,000 Steps a Day Walking Program. ................ 332 Section 29.4Hiking for Health................................................. 337
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Section 29.1
Walking is one of the easiest ways to be physically active. You can do it almost anywhere and at any time. Walking is also inexpensive all you need is a pair of shoes with sturdy heel support. Walking may accomplish the following: Give you more energy and make you feel good Reduce stress and help you relax Tone your muscles Increase the number of calories your body uses Strengthen your bones and muscles Improve your stamina and your fitness Lower your risk of chronic diseases, such as heart disease and type 2 diabetes Give you an opportunity to socialize actively with friends and family For all of these reasons, people have started walking programs. If you would like to start your own program, read and follow the information in this section.
Safety Tips
Keep safety in mind when you plan your route and the time of your walk. If you walk at dawn, dusk, or night, wear a reflective vest or brightly colored clothing. Walk in a group when possible. Notify your local police station of your groups walking time and route. Do not wear jewelry. Do not wear headphones. Be aware of your surroundings.
How Do I Stretch?
Stretch gently after you warm up your muscles with an easy fiveminute walk, and again after you cool down. Try doing the stretches listed here. Do not bounce or hold your breath when you stretch. Perform slow movements and stretch only as far as you feel comfortable. 326
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If you walk less than three times per week, give yourself more than a week before increasing your pace and frequency.
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Section 29.2
About Pedometers
The pedometer is a device about the size of a pager that typically attaches to the belt or waistband and is designed primarily to count steps. More recently, some pedometers are also capable of counting steps while placed in a shirt pocket or in a bag if its held snug to the body. Interestingly, Leonardo da Vinci is credited with the invention of the pedometer. Although the early mechanical pedometers were deemed unreliable, the electronic pedometer developed in the early 1990s is significantly more accurate and reliable. 328
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Choosing a Pedometer
The following questions should be considered when selecting a pedometer: What feature(s) am I most interested in? Step counting is what most pedometers do best. Therefore, purchasing an accurate stepcounting pedometer should be a primary objective. 329
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Section 29.3
Walking worksin many ways. A brisk-paced walk can help you and your family look and feel better, increase energy, and pick up your spirits. Walking can work to improve your health, too. A daily routine of 30 minutes or more of brisk walking can help you control your weight, lower cholesterol, strengthen your heart, and reduce the likelihood of serious health problems down the road. And since America is spending more than ever on preventable health problems such as obesity, heart disease, and type 2 diabetes, every step you take can help build a healthier nation. The U.S. Surgeon General reports that a minimum of 30 minutes of moderate physical activity, such as brisk walking, on most days of the week can produce long-term health benefits. The Presidents Council on Physical Fitness and Sports recommends at least 30 minutes a day, on five or more days a week, or 10,000 steps daily measured by a pedometer. Not everyone can achieve 10,000 steps a day, but almost everyone can find ways to build walking into each day to accumulate at least 30 minutes of physical activity. If you cant walk for 30 minutes at one time, take 5-, 10-, or 15-minute walks throughout the day. It all adds up to better health. Youre probably already walking more than you think. And by taking advantage of opportunities all around you to walk more every day, youll be surprised at how quickly the steps add up! Walk up the stairs instead of riding the escalator at the mall; take an after-dinner walk with your family; choose the farthest spot in the lot at work; eat lunch outdoors instead of at your desk. By walking 30 minutes or more a day at a brisk pace, youre on your way to better health! In this section, youll find everything you need to start a regular walking routineno matter what your fitness level. Its easy. All you need is a comfortable pair of shoes and the determination to stick to your program. 332
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On Your Mark
Walking has gained acceptance as an excellent way to improve health and maintain a healthy weight. The Presidents Council on Physical Fitness and Sports reports that walking one mile burns about 100 calories, depending on intensity, pace, and speed. According to the Mayo Foundation for Medical Education and Research, when done briskly on a regular basis, walking can accomplish the following: Decrease your risk of a heart attack Decrease your chance of developing type 2 diabetes Help control your weight Improve your muscle tone Promote your overall sense of well-being Regular physical activity helps prevent many chronic diseases and conditions, such as heart disease, colon cancer, type 2 diabetes, osteoporosis, and conditions associated with obesity, such as stroke and arthritis. If most Americans adopted a daily routine of brisk walking, the result would be a savings of billions of dollars in health-care costs related to these conditions (U.S. Department of Health and Human Services).
Get Set
Walking is a simple and flexible way to improve your health, and its free. You can walk alone or with friends, indoors or outdoors, on a city sidewalk or a country trail, any time of the year. But before you start your walking program, be sure to follow a few basic principles to keep you safe and comfortable: 333
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Go
Its important to know your own starting point before you set your personal walking goals. This knowledge will help you create a personalized walking program that is right for you.
Baseline
If you are using a pedometer, count your steps for seven days; if you dont have a pedometer, follow the recommendations of the Presidents Council on Physical Fitness and Sportsbegin with 30 minutes of brisk walking at least five days each week. Keep a log to track the amount of daily walking activity you are currently doing. This will establish your baseline. Include all of your normal walking activities, such as walking up the stairs at home, walking to work, etc. At the end of each day, write down your total number of steps in the log. If you are not using a pedometer, keep track of the minutes you spend walking.
Benchmark
Your benchmark is the highest number of steps you walked on any given day while establishing your baseline the first week. Use that number as your daily goal for the second and third weeks. Log your daily walks, and at the end of the third week, review your log. If you averaged your goal, add another 500 steps or several more minutes to your daily goal for the fourth and fifth weeks. 334
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Keep Going
A key part of your walking program is to log your progress every day. Reward yourself as you make progress toward your goals. As you record your steps, take a few minutes to sit down and relax. Think about the good feelings exercise gives you and reflect on what youve accomplished. This type of internal reward can help you make a longterm commitment to regular walking. There are other ways to help keep you motivated. When you reach your personal goal, consider treating yourself to a new pair of walking shoes or a new walking outfit or T-shirt. If you are walking as a family, treat children and teens to a special activity excursionto the park, the beach, the skating rink, or other outdoor funas a reward for reaching their daily goals for the week. Avoid using food, snacks, or candy as a reward. Children can earn a Presidential Active Lifestyle Award from the Presidents Council on Physical Fitness and Sports for any kind of physical activity done for 60 minutes a day, five days a week, for six weeks. Your commitment to a healthier you can also mean a healthier America. You and your family are eligible to take the Presidents Challenge and receive a Presidential Active Lifestyle Award. This award is sponsored by the Presidents Council on Physical Fitness and Sports to recognize Americans of all ages for committing to a program of regular physical activity. Adults and children can achieve the award togetherits a great way for families to work togethereveryone benefits! Log on to www .presidentschallenge.org to find out more about Americas way to recognize your commitment and achievement of a healthy, active lifestyle.
Section 29.4
Hiking is a great way to exercise and develop an appreciation for the great outdoors. However, before hitting the trail, all hikers should adhere to some basic guidelines to have a safe and enjoyable experience.
Planning
Prior to leaving for any hike, take the time to properly plan. The first step is to obtain trail maps or guidebooks which include distances as well as the estimated times required to hike the trails. Maps should be securely placed in a waterproof plastic bag since they may come into contact with moisture from streams, rain, or perspiration. Once you have decided where you are going, let someone know where you will be hiking and when you expect to return. You should plan to start early so that you have plenty of time to enjoy your hike and the destination. More importantly, you should plan to head back early; allowing extra time for unforeseen activities, accidents, or misjudgments is paramount for ensuring that you arrive back prior to losing daylight. Check the weather, as this information is critical for planning your choice of clothing as well as how much water you should bring. One item that you should always keep on your person is a whistle. Three short bursts on a whistle means you are in trouble and need assistance. If you are injured and perhaps off the trail due to unforeseen circumstances, a whistle will be heard from a long distance and will alert others to your location. 337
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Clothing
You probably own some or most of the clothing necessary for hiking. Ideally, hiking wear should hold sufficient heat for warmth but release surplus heat and moisture. This is best accomplished by wearing layers of clothing; to adjust to temperature changes and varying activity levels, you simply add or remove clothing accordingly. Choose clothing made from synthetic or polyester materials such as Polartec, Synchilla, and Capilene, but avoid cotton. Cotton retains moisture and does not breathe, while the previously mentioned fabrics wick moisture away from the skin which will keep you warm when the temperature is cool and cool when it is warm. If you are hiking in an area prone to rain, always carry some sort of waterproof outer layer. A thin shell made from Gortex or some other wind and waterproof material is all that it will take to turn a wet miserable venture into an enjoyable hike in the rain. Your feet arguably deserve the most attention because if they hurt, you will not enjoy yourself. Your footwear should provide stability, warmth, and comfort. As a general rule, wear a hiking boot thats onehalf size larger than your street shoe size. The extra room will help with blister prevention by allowing you to wear two layers of socks, a thin polyester sock liner to wick away moisture and a thicker outer sock to reduce friction. Wearing one sock means the material rubs directly against your foot creating a blister; with two, the socks friction point is against each other, sparing your feet from pain.
Food
Since hiking will burn many calories, this is not a day when you should restrict your diet. You will need all of the energy possible to traverse the terrain and complete the hike. Therefore, you should pack snacks that are high in calories and will not spoil. Do not pack empty calories, but instead, bring along high-quality fuel foods that are simple to pack and carry, such as dried fruits, nuts, trail mix, or any highenergy bar. Just remember to pack out whatever you pack in.
Water
Whether hiking in the cold or heat, your body will require a lot of water. A good rule is to bring along at least two to three quarts per person and always drink before you are thirsty. Avoid drinking soda or alcohol when hiking, as these beverages will dehydrate you. Also avoid drinking the untreated water found in streams, rivers, and creeks. 338
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Insects
If you are hiking, chances are there will be insects around. Most are merely annoying and not harmful, while others such as mosquitoes and black flies swarm and bite. Steps you can take to avoid being the target of most insects: Avoid applying scented products to your skin and hair. Keep cool, as insects are attracted to your sweat. Apply an insect repellant. Wear light-colored, long-sleeved clothing. While most insects are only bothersome, ticks should not be taken lightly since they can transmit Lyme disease. This is the most common arthropod-borne illness in the United States and it is often difficult to diagnose. Avoid exposure to ticks by wearing a light-colored, long-sleeved shirt tucked into your pants. You should frequently check yourself and have someone else check you for ticks since finding and removing a tick within 36 hours is the key to the prevention of Lyme disease. If you find one, gently pull it from your skin while taking care to avoid pinching it.
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Chapter 30
Bicycling
Chapter Contents
Section 30.1Biking and Walking for Transportation and Obesity Prevention....................................... 342 Section 30.2Spinning/Indoor Cycling...................................... 350
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Section 30.1
Approximately 300,000 premature deaths per year in the United States are caused by being obese or overweight. In 2005, more preventable diseases and deaths occurred from excessive weight than from cigarette smoking. Our country has struggled for more than a decade to overcome the obesity epidemic, without notable success. Simply put, obesity results from an imbalance between energy intake and energy output. We eat more calories than we burn through physical activity. In 2007, less than half of all Americans met the Centers for Disease Control and Preventions (CDC) recommendation of at least 30 minutes of modest physical activity on most days. Americas car-focused transportation system is a major contributor to our sedentary lifestyles. Not only are cars now used for almost all trips, including the shortest, but the large volumes of motorized traffic combined with the lack of adequate infrastructure have made bicycling and walking difficult and dangerous in many communities. Investing in bicycling and walking offers a unique opportunity to reintegrate physical activity into our daily routines.
Bicycling
rise of fat-free, low-calorie, and diet products; multitudes of fad diets promising weight loss; sporadic bans of unhealthy foods; the development of pharmaceutical weight-loss drugs; gastric bypass surgery; and even lawsuits against fast food companies. However, none of these efforts have reduced obesity rates. Today, 32% of American adults are obese, and 67% are overweight or obese. Americas weight problem doesnt spare our youth either: Nineteen percent of all teenagers and 17% of all children between ages 6 and 11 are overweight. The childhood obesity rate has almost tripled since 1980 and the adolescent rate has more than quadrupled. The childhood obesity epidemic is a national catastrophe, says acting U.S. Surgeon General Steven Galson. And theres a huge burden of disease that we can anticipate from the growing obesity in kids, according to William H. Dietz, director of the Division of Nutrition, Physical Activity, and Obesity at the federal CDC. The costs in medical expenses and loss of productive lives associated with the obesity epidemic place a heavy financial burden on our nations future. The annual medical costs of physical inactivity have been estimated at $76 billion, or close to 10% of all medical expenses. The human burden is of no less relevance. Because obesity decreases life expectancy by several years, for the first time in history, the current generation of youth may not live as long as their parents. Obesity is a major risk factor for many of our most deadly diseases. The number one cause of death is heart disease, and five of its six risk factors are associated with obesity: excessive weight, inactivity, high blood pressure, high cholesterol, and diabetes. Diabetes is the sixth leading cause of death in the United States. More than 21 million Americans (7% of the population) have Type 2 diabetes. Obesity is the number one risk factor for this dramatically expanding disease, which had 1.5 million new diagnoses in 2005.
Bicycling
Absenteeism: Obese employees miss 12 times more work days than their normal-weight colleagues
Do the Math: Exercise Gains from Bicycling and Walking for Transportation
The information in Tables 30.1 and 30.2 is based on average speed of 3 mph for walking and 10 mph for bicycling. Bicycle share among active transportation miles is assumed to increase from 20% (Status Quo) to 30% (Modest) and 50% (Substantial) across scenarios. Per person averages are based on U.S. population of 300 million. CDC recommendation is 30 minutes of moderate exercise on most days.
20%
30%
50%
Table 30.2. Health Benefits from Bicycling and Walking (averaged over all Americans)
Daily Exercise Gain (minutes) Status Quo 2 1 Modest Scenario 3 2 Substantial Scenario 4 4 Daily Energy Burned (calories) Status Quo 10 5 Modest Scenario 17 12 Substantial Scenario 25 26
15
29
51
Physical activity provides additional health benefits independent of body weight, such as the prevention of cardiovascular disease, osteoporosis, arthritis, and mental disorders like anxiety and depression. In short, active people are likely to be healthier and happier people. Active workers are also more productive and have significantly lower health costs than their obese colleagues. 345
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Bicycling
How Much Activity Could Result from Bicycling and Walking for Transportation?
Transportation offers opportunities to routinely engage in physical activity because many trips are short and ideal for bicycling and walking. About half of all trips taken in the United States are three miles or less. By replacing some of these short car trips with bicycling or walking, many Americans could significantly increase their activity levels. Using the CDC recommendation of 30 minutes of daily activity as a benchmark, it is a reasonable estimate that insufficiently active Americans would, on average, need to increase their daily level of activity by 15 minutes. Shifting some of these trips as outlined in our scenario calculations would result in an average of 5 (Modest Scenario) to 9 minutes (Substantial Scenario) of additional exercise for each American, every day, or the recommended 30 minutes of daily exercise for 50 (Modest) to 90 million (Substantial) Americans. Commuting two or three miles by bicycle takes only 15 minutes, and the complete round-trip satisfies the recommendations for daily physical activity. Similarly, a two-mile, round-trip walk to run errands, access transit, or take children to school provides the recommended 30 minutes of physical activity. Nearly two-thirds of all households say they have satisfactory shopping available within walking distance of their home. Fifty-seven percent of parents with children 13 years or younger live within one mile of a public elementary school. Bicycling and walking for short trips require little additional time, if any at all, fitting into very tight schedules because the activity occurs during time already allocated for transportation. The additional time needed for walking trips of less than a mile, compared to using a car, is at most minimal due to the short distance and elimination of the need for parking. Currently, two-thirds of these short trips are taken by car. Bicycling and walking are physical activities which require no training or preparation, and anyone can engage in them. Young children find great joy through bicycling and love this form of physical activity. For elderly people, bicycling and walking provide safe, low-impact exercise that helps maintain their health. A crucial advantage of bicycling and walking as transportation, rather than solely for exercise, is the motivation factor. For utilitarian trips, much less motivation and discipline are required to participate in it regularly because the person must make the trip anyway. For 347
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Bottom LineTransportation: First a Driver of the Problem, Now a Step toward the Solution!
Bicycling is a big part of the future. It has to be. Theres something wrong with a society that drives a car to work out in a gym. Bill Nye the Science Guy In light of all the advantages of increasing physical activity in our daily routines, it is obvious that, from a public health perspective, current levels of bicycling and walking are much too low. 348
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Bicycling
America is at a crucial crossroad in the battle against obesity. Only by providing Americans with routine opportunities to engage in physical activity are we likely to prevent this epidemic from putting an unfathomable burden on our society. Therefore it is important to think of our transportation system as more than just a means to get around. Transportation infrastructure defines the built environment we live in, and as such has a tremendous influence on our levels of activity and our general well-being. For this reason, the impact of transportation projects on public health should be taken into consideration just as routinely as we evaluate the financial costs of a project or its effects on the environment. For decades, car-focused transportation investment has contributed to a steady reduction in physical activity. To achieve an increase in physical activity through investments in transportation infrastructure, urban designers, city planners, medical professionals, and transportation engineers must realize the potential of routine bicycling and walking. Once bicycling and walking are widely accepted and treated as legitimate, viable, and healthy transportation modes, health professionals can recommend active transportation as an efficient and safe form of physical activity, allowing Americans to improve their health by bicycling and walking. To assure the maximum health benefits for our society from bicycling and walking, transportation policy must be held accountable for its impact on public health and make investing in bicycling and walking a priority.
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Section 30.2
Spinning/Indoor Cycling
Are You Ready for Indoor Cycling? 2009. Reprint permission granted from the copyright owner, IDEA Health & Fitness Inc., www.ideafit.com. All rights reserved. Reproduction without permission is strictly prohibited.
Imagine taking your trusty old three-speedor your rugged new mountain bikeonto the open road for an exhilarating 40-minute ride. Its a beautiful day . . . theres a gentle breeze . . . and before you know it, youre back home, tired but refreshed from a workout that seemed more like fun than work. The simple pleasure of riding a bicycle is so appealing that this traditional pastime has been revived as a hot new way to exercise indoorswhere weather, traffic, terrain, and plain old lack of motivation are less likely to foil your good intentions. Indoor cycling classes are popping up in gyms and studios around the world. If you havent witnessed the real thing, no doubt youve seen the advertisements: groups of exercisers huddled over stationary bikes, looking determined and even a little euphoric as they listen intently to an instructor and pedal their hearts out. Have you ever wondered about joining them?
Bicycling
Fitness experts agree that indoor cycling is an excellent cardiovascular workout, providing the same health and weight management benefits as other aerobic activities. It is particularly versatile because its a nonimpact activity, ideal for postrehab patients, pre/postnatal women, and people with overuse injuries, back pain, or arthritis. Perhaps the most unique aspect of indoor cycling is its special brand of motivation. Indoor cycling consists of continuous coaching, music, and visualization (which transports you to some imaginary terrain, such as a mountain or wilderness) that help you achieve your personal best. Its about physical, mental, and emotional development, says Johnny G. You can learn how to challenge yourself, overcome obstacles, and build inner strength to reach your goals.
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Chapter 31
Running
Chapter Contents
Section 31.1Running for Beginners. ........................................ 354 Section 31.2Training to Run Your First 5K............................ 358
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Section 31.1
Take stock of your current health and fitness level. If you have been sedentary; have or suspect health problems such as heart disease, diabetes, high blood pressure, high cholesterol, joint problems, etc.; or are over 40, it is recommended that you have a physical with your doctor before starting a vigorous exercise program. If you know you have no major health problems, starting a light- to moderate-intensity exercise program such as brisk walking usually does not require a physical, but check with your doctor for his or her opinion in your specific case. Remember that the health risks of a sedentary lifestyle are much greater than the risks of exercise. A renowned exercise physiologist, Per Olaf Astrand, quipped that if one plans a sedentary lifestyle, one should have a physical to see if the heart can stand it! Be safe. Dont run/walk in high crime areas. When running after dark, be sure to wear reflective clothing, carry a small flashlight, and assume drivers dont see you. Well-lighted neighborhoods are a good choice. Women should run with a partner or a dog if possible and consider carrying pepper spray. Runners and walkers should never use headphones outdoors, as it makes it impossible to hear traffic or an approaching attacker. Always carry ID. Start slowly and build up gradually. Most people should start with a brisk walking program and progress to a mix of alternating walking and jogging. Eventually you should be able to run the entire distance you desire at a comfortable pace. At that point you can increase weekly mileage about 10% every third week, depending on your goals. For health and fitness there is generally no need to run more than about 15 miles per week, along with some strength and flexibility training. Those wishing 354
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Running
to progress to competitive running should seek out experienced runners or coaches for advice. Check the Road Runners Club of America website for a running club in your area (www.rrca.org). Using the right type of shoes helps prevent injuries. Shin splints and runners knee are preventable with proper conditioning and the right running shoe type. There are three basic types for different running mechanics: 1. Motion control: Generally best choice for flat feet and floppy ankles (over pronation or rolling too far to the inside after foot touches down). Shoes should be straight lasted and often will have a full board last inside plus a harder rubber or plastic area on the inner (arch support) side of heel to control excess movement. 2. Stability: Generally best for normal arches, will have a semi-curved last and a moderate amount of motion control. 3. Cushioned: Generally best for high arches and clunk foot; these feet are usually very rigid and under pronate, i.e., feet do not roll to the inside far enough after foot touches down and therefore make poor shock absorbers. Shoes should have a curved or semi-curved last, extra cushioning, a full slip last (no board inside), and be very flexible. Another choice, for off-road running, are trail running shoes. These are made low to the ground and more stable to help prevent ankle sprains, have good traction, and help prevent foot bruises from roots, rocks, etc. Dont use any type running shoes for other sports, as they are not made for lateral movements, making ankle sprains more likely. They also last longer and maintain cushioning better if only used for running. Use only good quality court shoes or cross-trainers for other conditioning activities. Wrestling shoes are recommended for defensive tactics training on matted floors. Do the wet test to see what type of foot you have. Wet feet and step onto some paper on a hard surface. (Even better is to run a short distance barefoot on sand.) A blob footprint with little arch indicates flat feet. Two islands with a lot of space between the heel and ball indicates high arches. A normal arch will look like the classic cartoon footprint. Make sure the shoe fits! The best shoe for you is one that fits your foot type and running mechanics and also is the right 355
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Running
probably prevents arthritis, since the incidence in long-time runners is about half that of non-runners, including swimmers. Further information sources: Runners World (magazine): a great resource for advice on current running shoes on the market, injury prevention and treatment, training information, and other beginning to advanced runner advice (www.runnersworld.com). Running Times (magazine): a great resource for intermediate to advanced runners, plus good shoe reviews and advice (www.runningtimes.com). Road Runners Club of America: find a running club in your area suitable for beginners to advanced runners, plus loads of other running information (www.rrca.org). Lore of Running by Tim Noakes, MD. The definitive book on running, recently revised. Bill Rodgers Lifetime Running Plan by Bill Rodgers.
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Section 31.2
So youve started a walking program and, after a few weeks of consistent improvement, you feel youre ready to pick up the pace and run your first 5K race. A 5Ka 3.1-mile raceis the perfect length to aim for as a beginner. Begin by setting a realistic training schedule to keep you motivated and give yourself ample time to move to the next level. Beginning a running program may improve many facets of your life, as it builds your cardiovascular system, may boost your self-esteem, and may strengthen ties within your community while also allowing you to appreciate the outdoors. From the novice to the expert runner, a local 5K race is a great way to get in shape and improve your sense of health and well-being.
Running
Begin with a walk/run program four times per week for 20 to 25 minutes. Plan to add a little variety to your training by alternating every other day with 20 to 30 minutes of an aerobic cross-training activity to build your cardiovascular fitness. Select a starting distance that you are comfortable with. Perhaps it is 1.0 to 1.5 miles. Increase the distance (and duration) by approximately 10 to 15% each week. For example, increase the duration of your walk/run from 25 minutes to 28 minutes in week two. Vary your runs during the week to break the monotony. Choose one or two days a week to run your distance, and use the remaining days to focus on shorter, harder runs or interval-type sessions. Make sure to take one to two days off per week to let your body recover. Gradual training is the key to long-term success and rest time is just as important as the time you spend training.
Race Day
If you arent familiar with the race course, check it out on one of your training runs or do a drive-by. Its easy to get mentally and physically fatigued when you dont know where your run ends and how much farther you have to go. Also, be sure to avoid running at a pace that is faster than your training pace. For your first race, there is some running etiquette that you should be aware of: 359
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Chapter 32
Chapter Contents
Section 32.1Strength/Weight Training Basics........................ 362 Section 32.2Progression and Resistance Training. ................. 365 Section 32.3Best Ab-Strengthening Exercises. ....................... 373 Section 32.4Using Stability Balls and Resistance Bands................................................. 375
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Section 32.1
364
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Section 32.2
The popularity of resistance training has increased in recent times. Not only is resistance training used to increase muscular strength, power, endurance, and hypertrophy in athletes, but the adaptations to resistance training have been shown to benefit the general population as well as clinical (i.e., those individuals with cardiovascular ailments, neuromuscular disease, etc.) populations. Both scientific and anecdotal evidence points to the concept that progression is needed in order to create a more effective stimulus to promote higher levels of fitness. In fact, a threshold of activity/effort is necessary beyond the initial few months (which is characterized by enhanced motor coordination and technique) in order for the body to produce further substantial improvements in fitness. This threshold continually changes as ones conditioning level improves and is specific to the targeted goals of the exercise program. It is also bounded by each individuals genetic ceiling for improvement. Resistance training at or beyond this threshold level leads to progression. In 1998, the American College of Sports Medicine published a position stand entitled The Recommended Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory and Muscular Fitness, and Flexibility in Healthy Adults. In this document, an initial starting point consisting of performance of one set per exercise (810 exercises) for 812 repetitions (1015 for older adults) two to three days per week was recommended. This initial recommendation has been shown to be effective for progression during the first few months of training, but then benefits tended to plateau during subsequent months when variation in the program design was minimal. However, the question then arose, what type of programs would be recommended for those individuals who desire a higher level of fitness? Because it is important to make exercise a lifetime commitment, recommendations 365
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Strength and Resistance Exercise Table 32.1. General Benefits of Resistance Training
Increased muscular strength Increased muscular power Increased muscular endurance Increased muscle size Reduced body fat Increased balance, coordination, and flexibility Enhanced speed and jumping ability Enhanced motor performance and ability to perform activities of everyday living Increased bone mineral density Increased basal metabolic rate Lower blood pressure Reduced cardiovascular demands to exercise Greater insulin sensitivity and glucose tolerance Improved blood lipid profiles Reduced risk for injury and disease (i.e., osteoporosis, sarcopenia, low back pain, etc.) Enhanced well-being and self-esteem
Muscle Actions
The selection of muscle actions revolve around concentric (CON), eccentric (ECC), and isometric (ISOM) muscle actions. Most resistance training programs include mostly dynamic repetitions with both CON 367
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Resistance
The amount of weight lifted is highly dependent on other variables such as exercise order, volume, frequency, muscle action, repetition speed, and rest interval length, and has a significant effect on both the acute response and chronic adaptation to resistance training. Individual training status and goals are primary considerations when considering the level of resistance. Light loads of approximately 4550% of one repetition maximum (1 RM) or less can increase muscular strength in novices who are mostly improving motor coordination at that level. As one becomes progressively stronger, greater loading is needed to increase maximal strength (i.e., 8085% of 1 RM for advanced training). These findings have also been recently supported by a meta-analysis, which demonstrated that 85% of 1 RM yielded the highest effect size for strength gains in athletes. There is an inverse relationship between the amount of weight lifted and the number of repetitions performed. Several studies have indicated that training with loads corresponding to 16 RM (i.e., the maximal amount of weight that can be lifted 1 to 6 times) were most conducive to increasing maximal dynamic strength. This loading range appears most specific to increasing dynamic 1 RM strength. Although significant strength increases have been reported using loads corresponding to 712 RM, it is believed that this range may not be as specific to increasing maximal strength in advanced resistance-trained individuals compared to 16 RM (although it is very effective for strength training in novice and intermediate trainees). Although heavy loading (16 RM) is effective for increasing muscle hypertrophy, it has been suggested that the 712 RM range may provide the best combination of load and volume in direct comparison. Loads lighter than this (1315 RM and lighter) have only had small effects on maximal strength and hypertrophy but have been very effective for enhancing local muscular endurance. 368
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Training Volume
Training volume consists of the total number of sets and repetitions performed during a training session. Altering training volume can be accomplished by changing the number of exercises performed per session, the number of repetitions performed per set, or the number of sets per exercise. Volume and intensity are inversely related such that use of heavy loads results in lower volumes whereas use of light to moderate loads results in higher training volumes. Typically, high volume programs are synonymous with training for muscle hypertrophy and local muscular endurance whereas low volume programs are synonymous with strength and power training. The vast majority of studies that examined volume and resistance training have investigated the number of sets performed per exercise. Most comparisons have been made between single- and multiple-set programs. In novice individuals, similar results have been reported from single- and multiple-set (mostly three sets) programs, whereas some studies have shown multiple sets superior. Thus, either may be used effectively during the initial phase of resistance training. However, periodized (i.e., varied), multiple-set programs have been shown to be superior as one progresses to intermediate and advanced stages of long-term training in all. Within multiple-set training programs, two, three, four-five, and six or more sets per exercise have all produced significant increases in muscular strength in both trained and untrained individuals. Therefore, it appears that similar improvements, at least in novice-trained individuals, may be gained within various multipleset protocols. Less is known with intermediate and advanced training. Typically, three to six sets per exercise are common during resistance training, although more and less have been used successfully. Based on the aforementioned data, the American College of Sports Medicine has made the following strength training recommendations: 1) novice: 13 sets per exercise x 812 repetitions per set; 2) intermediate: multiple sets of 612 repetitions per set; and 3) advanced: multiple sets of 112 repetitions per set (periodized). 369
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Rest Intervals
Rest interval length depends on training intensity, goals, fitness level, and targeted energy system and affects acute performance and training adaptations. Acute force production may be compromised with short (i.e., one minute) rest periods. We have recently developed a continuum for rest interval length for the bench press in which three-to-five-minute rest 370
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Strength and Resistance Exercise Table 32.2. General Sequencing Strategies for Strength Training
Total Body Workout: 1. 2. 3. Large before small muscle group exercises Multiple-joint before single-joint exercises Rotation of upper and lower body exercises or opposing (agonistantagonist relationship) exercises Large before small muscle group exercises Multiple-joint before single-joint exercises Rotation of opposing exercises (agonist-antagonist relationship) Multiple-joint before single-joint exercises Higher intensity before lower intensity exercises
intervals were most effective for maintaining acute lifting performance, but 30 seconds to two minutes of rest produced significant reductions in set performance. Rest intervals will vary based on the goals of that particular exercise, i.e., not every exercise will use the same rest interval. Muscle strength may be increased using short rest periods but at a slower rate, thus demonstrating the need to establish goals (i.e., the magnitude of strength improvement sought) prior to selecting a rest interval. The American College of Sports Medicine recommends one-to-two-minute rest intervals for novice training, two-to-three-minute rest intervals for core exercise, and one-to-two-minute rest intervals for others for intermediate training, and at least three-minute rest intervals for core exercises and oneto-two-minute rest intervals for others for advanced strength training.
Repetition Velocity
The velocity at which dynamic repetitions are performed affects the responses to resistance exercise. When discussing repetition velocity, it is important to note that velocity applies mostly to submaximal loading. Heavy loading requires maximal effort in order to lift weight. For dynamic constant external resistance (also called isotonic) training, significant reductions in force production are observed when the intent is to lift the weight slowly. There are two types of slow-velocity contractions, unintentional and intentional. Unintentional slow velocities are used during high-intensity repetitions in which either the loading and/ or fatigue facilitate the velocity of movement (i.e., the resultant velocity is slow despite maximal effort). Intentional slow-velocity repetitions are 371
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Frequency
Frequency refers to the number of training sessions performed during a specific period of time (e.g., one week) and/or the number of times certain exercises or muscle groups are trained per week. It is dependent upon several factors such as volume and intensity, exercise selection, level of conditioning and/or training status, recovery ability, nutritional intake, and training goals. Numerous studies have successfully used frequencies of two to three alternating days per week in novices. Progression does not necessitate a change in frequency for training each muscle group, but may be more dependent upon alterations in other acute variables such as exercise selection, volume, and intensity. Advanced training frequency varies considerably. It has been shown that football players training four to five days/week achieved better results than those who trained either three or six days/week. Other advanced athletes have used frequencies higher than this (i.e., 812 workouts per week or more). It is important to note that not all muscle groups are trained specifically per workout using a high frequency. Rather, each major muscle group may be trained two to three times per week despite the large number of workouts. The American College of Sports Medicine recommends two to three days per week for novice training, two to four days per week for intermediate training, and four to six days per week for advanced strength training.
Summary
Resistance training poses numerous health and fitness benefits to all individuals, providing that a threshold of activity/effort is reached. Progressive overload, specificity, and variation are critical elements to resistance training programs targeting progression. These elements may be attained by proper manipulation of the acute program variables in order to obtain specific, individualized goals. The act of resistance training itself does not result in health-promoting benefits unless the training stimulus exceeds the individuals fitness threshold. Progression in program design entails gradual progressive overload, specificity, and variation in the training stimulus in order for the individual to improve his or her level of fitness. 372
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Section 32.3
Strong abdominal muscles can protect you from low-back pain and help you perform your daily activities efficiently. Bill Bejeck, CSCS, CCS, owner of HealthSport Fitness and Sport Training Services in the Washington, DC, area, offers some guidance on training the abdominals.
Functional Exercises
Functional abdominal exercises are valuable because they require all the muscles in the abdominal region to work together, as they often must do in real life. Here is one example: Kneel about 18 inches behind a stability ball. Lean forward and rest the forearms on the ball, clasping the hands together. Slowly push the ball away from the body until the arms are fully extended, then pull the ball back. To protect the lumbar spine, maintain a posterior tilt while performing this exercise. Perform 15 to 20 reps.
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Section 32.4
Safety
Using a stability ball safely starts with proper inflation and care (described earlier). To increase your safety while using a stability ball: Maintain the natural curves in your back while exercising. Increase your stability by placing your feet about shoulder-width apart (or wider for better balance). Put a mat in front of the ball to act as a cushion in case of a fall. Use a wall behind the ball to keep the ball from rolling out backwards from underneath you and to prevent you from falling directly to the floor should the ball slip forward. Place chairs on either side of the ball to provide lateral stability if needed while exercising in a seated position. Always use good movement technique and control. Remember to breathe throughout each exercise. Avoid ballistic movements (bouncing or fast movements of the joints) on the stability ball because they reduce your control of the movement and increase the risk of muscle strain and/or joint sprain. 376
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Other Considerations
As your core stability, balance, and strength improve, you can achieve a progressive overload (i.e., challenging yourself further in different ways in order to achieve additional fitness benefits) in a number of ways: Practice transitions from one position to another. Make your base of support less stable by moving feet or hands closer and farther away from the ball. Vary your position on the ball so it supports less of your body weight (e.g., in crunches or push-ups) so you are lifting more weight against gravity. Add a dynamic balance challenge by adding movement on, over, or around the ball with one or both limbs (on the same or opposite sides of the body). Increase your volume of training (e.g., increase the resistance used, or repetitions or sets performed). Use a larger stability ball, rather than a smaller one, for added challenge.
Strength Curves
Every exercise can be illustrated by a curve showing the force used over a range of motion. The three primary strength curves are: ascending (force increases over the range of motion); bell (force is greatest in the middle of the range of motion); descending (force decreases over the range of motion). Variations among exercises and individuals can affect the shape of these curves as well as the timing and degree of force used in each exercise. Exercise loading should match the strength curve to ensure that appropriate force is applied to the muscle. Take, for example, arm curl exercises using elastic bands. Too much resistance would prevent smooth motion through the entire range. Resistance that is below the starting strength of the arm curl movement allows normal repetition of the movement. It is important to be able to choose resistance to suit the exercise. For example, chest presses need more resistance than arm curls. The graph in Figure 32.1 shows the resistance of an elastic band (dotted line) compared with the strength curves of two different users. Greater strength gives User 1 force greater than the bands resistance, while User 2 has insufficient force throughout the entire range of motion. Neither user is well matched with this particular band.
Figure 32.1. The resistance of an elastic band compared with the strength curves of two different users.
How are the bands constructed? Understanding how bands are made can help you determine quality of construction and how they can be used in a variety of exercises. While any rubberized band provides resistance, heavier use requires a more durable product.
Exercises
Rubber band exercises can be used for a variety of drills, such as: running and agility side-to-side drills; 380
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Safety Questions
Before using a resistance band or rubber band machine, ask a number of questions, especially when there are multiple users. Rubber bands should be checked at rest and then when stretched to their usable length. Examine them carefully, asking: Is the resistance smooth and flexible in use? Are there signs of wear from repetitive use, including cracks or worn endings? Are there signs of weather exposuresuch as sun, water or coldmaking the rubber cracked or pale?
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Chapter 33
Defining Flexibility
To appreciate the impact of aging, we must establish a common definition of flexibility and understand the physiological changes affecting flexibility during aging. Flexibility enables muscles and joints to move through their full range of motion. It has been defined as the absolute range of movement in a joint or series of joints that is attainable in a momentary effort with the help of a partner or a piece of equipment. Flexibility varies for each muscle and joint group. The condition of the muscles, joints, and connective tissuesincluding muscle fascia, ligaments, tendons, collagen, and elastinaffects flexibility.
Flexibility in Aging: Stretching to Mend the Bend, by Diane Austrin Klein. Reprinted with permission of the American College of Sports Medicine, ACSM Fit Society Page, Summer 2003, pp 5, 11. Reviewed by David A. Cooke, MD, FACP, May 2010.
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Chapter 34
Combined Exercise
Chapter Contents
Section 34.1Cross Training...................................................... 388 Section 34.2Interval Training. ................................................. 390 Section 34.3Boot Camp Workouts........................................... 392
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Section 34.1
Cross Training
Cross Training: Get Fit and Dont Quit, 2010 OrthoIndy. All rights reserved. Reprinted with permission. For additional information, contact OrthoIndy at 317-802-2000, or on their website www.orthoindy.com.
Are you tired of doing the same exercise day after day? Do you have trouble sticking to a fitness program? Or, do you get bored easily with the different exercise programs you have tried? If you answered yes to any of the questions, cross training may be the perfect fitness program for you. According to the American Association of Orthopaedic Surgeons, cross training involves three components including: aerobic exercise, strength training, and flexibility. Aerobic exercise, such as walking, stair climbing, and rollerblading, will improve your cardiovascular capabilities. Weight lifting, push-ups, which are forms of strength training, help develop muscle mass, while flexibility exercises keep you limber. By incorporating these three components and picking fun activities, you are more likely to stick to your program. For those individuals starting an exercise program, cross training is excellent, said Dr. Mark DiLella, orthopaedic surgeon at OrthoIndy. Cross training uses different muscle groups, providing a total body workout. It also allows individuals to pick activities they are interested in, keeping them engaged in the workout, decreasing the chances of quitting, said Dr. DiLella. Not only will you more than likely stick to the program, but you will decrease your chances of having an injury. Like any fitness activity, there is a chance for injury. Individuals who only do one type of exercise are more prone to injury because they are focusing on a small group of muscles. Overuse injuries are decreased in a cross training program because you are working a number of muscles instead of a select few, more frequently. There are always risks associated with sports, however by cross training, you will increase your endurance, flexibility, and lessen the chances of injuries associated with your activities, said Dr. DiLella. 388
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Combined Exercise
In most cases, if an injury occurs to an individual that only does one specific workout, he or she may be unable to perform their normal workout routine. However, if you are cross training, there is a high chance that you will not give up all the components of your program and will continue to work out. Cross training isnt just for serious athletes. If you are looking for a program to get fit and not quit, starting a cross training program is perfect for you.
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Section 34.2
Interval Training
Interval Training for All. 2001. Reprint permission granted from the copyright owner, IDEA Health & Fitness Inc., www.ideafit.com. All rights reserved. Reproduction without permission is strictly prohibited. Reviewed by David A. Cooke, MD, FACP, May 2010.
Do you want to increase your fitness level? Then interval training, also known as interval conditioning, may be for you. Douglass Brooks, MS, coowner of Moves International and author of Program Design for Personal Trainers, describes how to use this method no matter how fit you are. If you have questions or would like a demonstration, ask your personal trainer. 1. Understand the work-rest concept. Interval conditioning utilized repeated cardiovascular work intervals performed at intensities above your typical exercise levels. To sustain and repeat these higher intensity work intervals, follow them with cardiovascular recovery (rest) intervals performed at a lower intensity. A work interval followed by a recovery interval is called a cycle. 2. Learn the benefits of interval training. Intervals help you build endurance, increase fat loss and calorie burning, and/or improve your performance in a sport or activity. 3. Build your lactate threshold. If you are not used to interval training, lactic acid in your muscles will most likely increase and accumulate quickly at 50 to 55% of your maximal aerobic capacity, also known as heart rate reserve (HRR). If you are highly conditioned, your threshold may not occur until 80 to 85%. When you accumulate too much lactic acid, you will have difficulty breathing and will be unable to continue exercise at the same intensity. You will need an active recovery period to accelerate lactic acid recovery and help prevent muscle cramps and stiffness. 4. Start with spontaneous speed play. If you are new to interval training, try this method during your workout: Speed up a little for 30 seconds, then continue the cardiovascular activity for 90 seconds at an easy effort. Do as many cycles as you desire. 390
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Combined Exercise
5. Monitor intensity. For the following models, measure intensity by using the rating of perceived exertion (RPE) scale: 1 is your easiest effort, and 10 is the most difficult. As your fitness level improves, you can train harder at a given RPE. 6. Use the fitness model. More structured than speed play, this model has you exercising cardiovascularly for three to five minutes at an RPE of 4 to 6 (somewhat hard to very hard), then recovering for three to five minutes at a 2 to 3 RPE. Perform as many cycles as you can comfortably, increasing the number of cycles as you become more experienced. 7. Work up to the challenging fitness model. To use this model, you should be moderately to extremely fit. Exercise hard for 30 to 90 seconds, then recover for three times the length of the work interval. For example, recover for 180 seconds if youve exercised hard for 60 seconds. Perform work intervals at an RPE of 7 to 10 and rest intervals at a 2 to 3 RPE. Repeat a number of times. 8. Train for sports with the performance model. If you are a competitive athlete or highly conditioned, use the performance model to increase cardiovascular fitness. Utilize the fitness model explained earlier, but work at an 80 to 85% HRR for three to five minutes before recovering. 9. Advance to the difficult performance model. If you are an advanced athlete who is experienced at interval training, try this workout model. Exercise for 30 to 90 seconds, then recover for just twice the time. Work at an RPE of 8 to 10 (extremely intense!) and rest by exercising at a 2 to 3 RPE. Repeat for a number of cycles. 10. Train safely. Precede intervals with a warm-up of at least 5 to 10 minutes and follow it with a cool-down of at least 5 minutes. Interval training should be challenging, yet enjoyable. Use common sense. If you need more time to recover after a work interval, give yourself more time! Interval train no more than twice a week. These programs are for apparently healthy adults. If you are pregnant or have special medical concerns, plan a program in conjunction with a physician and personal trainer.
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Section 34.3
Fitness fads come and go, but boot-camp workouts are still among the most popular. Back in the spring of 1998, the American Council on Exercise [ACE] first spotted the rapid growth of instructor-led workouts based loosely on the calisthenics used (like push-ups, squat thrusts, punches, kicks, etc.) to whip new recruits into shape in the U.S. Armys basic-training program. Ten years later, take a look at the class schedules of gyms and fitness centers across the country and youll still find boot camp. According to recent stats from the International Health, Racquet & Sportsclub Association, a trade organization for health clubs, 955 of its 3,306 member clubs offer boot campstyle fitness classes. And its not just hot in the gyms. A quick scan of the exercise videos offered on Amazon.com yields more than 30 different boot-camp videos. Theres a certain element of getting back to the basics and a more functional-training approach, says ACEs chief science officer Cedric X. Bryant, PhD. People are looking for different experiences. With boot camps, youre giving them something outside the traditional club environment. Maybe the boot-camp trend is still going strong because its not really trendy at all. The workout is simple and not tied to a single piece of equipment. Or maybe its the motivating team-oriented atmosphere thats created as fellow exercisers survive the workouts together. Whatever the reason, boot camp remains wildly popular, yet surprisingly its efficacy has never been formally studied. Boot camp is becoming more and more popular in the health club setting so obviously people want to know if theyre really going to get something out of it, and if its going to be worth their time, says Kirsten Hendrickson, a graduate student in exercise and sports science at the University of Wisconsin. So we decided to take a look at it. 392
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Combined Exercise
The Study
To analyze the health and fitness benefits of boot campstyle workouts, a team of exercise scientists from the University of Wisconsin, La Crosse Exercise and Health Program, led by John Porcari, PhD, and Hendrickson, recruited six men and six women ages 19 to 29. All volunteers were given an exercise test on a motorized treadmill to determine each subjects maximal heart rate (HR max) and maximal oxygen consumption (VO2 max) to establish a baseline of fitness. Ratings of perceived exertion using the 620 Borg Scale, a measure of how hard subjects feel theyre exercising, were also recorded throughout the exercise testing. Once that baseline was established, the subjects were invited back into the lab to view a 40-minute recorded boot-camp exercise video. Naturally there are many boot campstyle exercise videos on the market, so researchers reviewed a wide range of titles, eventually settling on The Method: Cardio Boot Camp with Tracey Mallett. We chose that DVD because it has a good blend of aerobic movements and strength moves that youd picture military guys doing at boot camp, notes Porcari. Plus we wanted to pick one where people were taxed pretty hard because thats what you picture when you think of boot camp. The study volunteers were given a copy of the DVD to take home and practice until they felt familiar enough with the choreography to be able to follow along easily with the workout. At that point, they were asked to return to the lab for testing. Each subject was then outfitted with the Cosmed portable analyzer, a backpack and facemask apparatus that measures oxygen consumption and caloric burn. Heart rate and perceived exertion were also tracked every three minutes throughout the 40-minute workout.
The Results
After analyzing the data, researchers found that the average exerciser burns approximately 9.8 calories per minute during a typical boot-camp workout, which equals nearly 400 calories during the entire 40-minute boot-camp video studied. The biggest benefit is youre burning an average of 600 calories per hour, says Porcari. Thats obviously going to help with weight loss, but youre also getting the muscle-building benefit from push-ups, arm curls, and squat thrusts that you wouldnt get just from going out for a fast walk or jog. According to recommendations set by the American College of Sports Medicine (ACSM), to enhance cardiorespiratory endurance individuals need to exercise at 70% to 94% of HR max and 50% to 85% of VO2 max. 393
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Chapter 35
Mind-Body Exercise
Chapter Contents
Section 35.1Introduction to Mind-Body Exercise................... 396 Section 35.2Yoga....................................................................... 401 Section 35.3Pilates................................................................... 407 Section 35.4Tai Chi.................................................................. 410
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Section 35.1
Mind-Body Exercise
While the exercises described in this section are not alternatives to medical or surgical treatments, they provide a powerful way for you to actively participate in your own health care, minimize pain and insomnia, and promote recovery.
Calming/Relaxation Exercises
The goal of calming and relaxation exercises is to help change the way you perceive a situation and react to itto help you feel more in control, more confident or secure, and to activate healing processes within the body. Become aware of any tension, anxiety, change in breathing, or symptoms that you recognize as being caused or worsened by stress. When you take about 15 minutes daily to practice these exercises to help quiet your mind and help your body become more relaxed, you can then call upon this ability with a shorter relaxation exercise at a stressful time.
Mind Relaxation
Close your eyes. Breathe normally through your nose. As you exhale, silently say to yourself the word one, or any other short word such as peaceful, or a phrase such as I feel quiet or Im safe. Continue for 10 minutes. If your mind wanders, gently remind yourself to think about your breathing and your chosen word or phrase. Let your breathing become slow and steady. Recall and focus on a pleasant memory. Take another deep breath and exhale slowly. You should feel more relaxed. Try this exercise that incorporates a few different relaxation techniques: Begin by interrupting your normal daily thoughts. Think about what is going on around you. Then switch your thoughts to yourself and your breathing. Take a few deep breaths, exhaling slowly. Mentally scan your body. Notice areas that feel tense or cramped, such as your neck or shoulders. Loosen up these areas. Let go of as much tension as you can. Slowly rotate your head to the left in a smooth, circular motion, leaning your left ear to your left shoulder. Rotate your head to the right in a smooth, circular motion, leaning your right ear to your right shoulder. (Stop any movements that cause pain.) Roll your shoulders forward and backward several times. Let all of your muscles completely relax. 398
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Mind-Body Exercise
Guided Imagery
Research shows that guided imagery and relaxation can decrease anxiety and pain and possibly shorten your hospital stay. Guided imagery is often presented on an audio program in which you are guided in using your imagination to induce peace, calm, strength, and control. The calming music accompanying guided imagery can be helpful in quieting the mind.
Massage Therapy
Massage can help reduce muscle tension, relieve stress, and soothe pain. A light, 10-minute massage (with your physicians approval) can assist your experience of well-being as you are healing.
Reiki
Reiki is a relaxing, nurturing energy therapy that uses gentle touch to help balance your physical, mental, emotional, and spiritual wellbeing to promote a deep sense of relaxation. Reiki works with your energy to support your natural ability to heal.
Mind-Body Coach
A mind-body coach is a trained professional who can teach you multiple ways to use your mind to reach a higher level of peace, calm, and comfort before surgery. Youll also learn the tools to help you during recovery, including guided imagery.
Spiritual Practices
Centering prayer and meditation are some of the oldest methods of relaxation involving a specific mental focus. These techniques induce a deep state of relaxation and well-being. Many people find spiritual practices helpful in achieving total mind-body relaxation.
Music Therapy
Under the supervision of a board-certified music therapist, music therapy combines music and therapeutic techniques and aids in the physiological, psychological, and emotional well-being of the individual during treatment of an illness. 399
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Art Therapy
Art therapy uses art media and the creative process to help patients in their healing and recovery. Art therapy can help patients decrease anxiety, manage stress, and deal with emotional issues.
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Mind-Body Exercise
Section 35.2
Yoga
Selecting and Effectively Using a Yoga Class. Reprinted with ermission of the American College of Sports Medicine. Copyright p 2009 American College of Sports Medicine. All rights reserved.
What Is Yoga?
Yoga is an ancient Indian practice and type of mind-body exercise that has been in existence for thousands of years. The term yoga means yoke or union, and yoga practice involves breath work (pranayama) to connect the mind and body, as well as to connect our thoughts and feelings with movement. Yoga provides a number of well-documented physical, mental, and emotional benefits. These include reduced blood pressure, enhanced feelings of relaxation, stress reduction, improved digestion, better posture, increased strength and flexibility, and improved balance, among others. Yoga also has been shown to benefit individuals with chronic diseases and disabilities through improved body awareness and orientation, the development of focus and concentration, the encouragement of learning and creativity, and increased awareness of our connectedness to others.
Mind-Body Exercise
Therapeutic: Addresses all levelsphysical, emotional, and spiritualof the healing process to promote health, function, and enhanced quality of life for special populations (e.g., heart patients, hypertensives, cancer survivors, or others with physical limitations). Viniyoga: A gentle yet powerful and transformative practice in which poses are synchronized with the breath in sequences determined by the practitioner. Vinyasa: A flow-style of yoga that melds breathing with movement, similar to Ashtanga but with less repetition or following of a set sequence. Yoga for Fitness: Based upon the Hatha yoga practice, this fitness-based approach is tailored for the mainstream health club member. It utilizes strength, flexibility, balance, and power to give you a full workout great for all levels.
Safety
There is an inherent safety partnership that exists between the participant and the instructor in yoga practice. The yoga instructor should be certified through or hold one or more credentials from an established and respected organization and have experience teaching yoga. Some certifications, such as Yoga Alliances Registered Yoga Teacher 200 and 500 hours (RYT-200 and RYT-500, respectively), require completion of a certain number and type of trainings along with a specified number of hours of yoga teaching. Ideally, the yoga instructor should minimize risk of injury to participants as well as have CPR/first aid training in order to be prepared to respond appropriately in the event of an emergency. With regard to minimizing risk of injury, the instructor should have and be able to demonstrate his/her ability to modify poses and flow sequences for different levels of ability and physical limitations. Your yoga instructor may ask at the beginning of a class or series of classes about physical injuries or parts of the body that are healing or need protection. If he/she doesnt inquire, its helpful to you and the instructor and in your best interests to let him/her know about any physical issues so he/she can offer modifications of poses and flow sequences before or during class. These modifications are important not only from a safety standpoint, but from the perspective of helping each participant optimize the yoga experience and reap as many of the potential benefits of a yoga practice as possible. 403
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Mind-Body Exercise
or online for $10$40. Yoga mats should be cleaned regularly to prevent bacterial growth, either with a damp cloth or sponge and mild soap or detergent, or following the manufacturers recommendations. Additional types of equipment that may be used in yoga classes, or that can be purchased for home use, include blocks, straps, bolsters, and blankets for modifying poses to enhance technique and body position and/or increase safety and comfort for the participant. Yoga clothing should be comfortable for the wearer and allow freedom of movement or full range of motion at all major joints of the body (e.g., shoulders, elbows, spine, hips, and knees.). Yoga clothing comes in a variety of colors and styles and at various prices and is designed for a variety of body types. Because the body is moved through a variety of positions and yoga classes are often co-ed, participants might wish to consider how their clothing fits and provides coverage as they move and bend.
Etiquette
When attending a yoga class in any setting, there are a few guidelines to follow to ensure that you and everyone in your class have a positive experience. Arrive early: Allow ample time for your mat and prop setup as well as personal preparation. Enter quietly: Enter the room/studio gently, so as not to disturb others. Be free of distraction: Do not bring a cell phone, pager, etc. to class. This can disrupt you and others around you. Be considerate: Allow plenty of room between you and your neighbor for free movement. Also, if you must leave the room during class, do so quietly and discretely.
Other Considerations
It is more comfortable to practice yoga on a somewhat empty or empty stomach, so participants might choose to eat lightly in the minutes or hour before practice, or have a bigger meal two or more hours before, depending on what is comfortable and allows the maintenance of appropriate blood sugar levels. Yoga participants may want to have a bottle of water at hand if they get thirsty during practice as well as to rehydrate themselves after practice. 405
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Mind-Body Exercise
Section 35.3
Pilates
Pilates, April 2007, reprinted with permission from www.kidshealth.org. Copyright 2007 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or www.TeensHealth.org.
Pilates (pronounced: puh-lah-teez) improves your mental and physical well-being, increases flexibility, and strengthens muscles. Pilates uses controlled movements in the form of mat exercises or equipment to tone and strengthen the body. For decades, its been the exercise of choice for dancers and gymnasts (and now Hollywood actors), but it was originally used to rehabilitate bedridden or immobile patients during World War I.
What Is Pilates?
Pilates is a body conditioning routine that seeks to build flexibility, strength, endurance, and coordination without adding muscle bulk. In addition, Pilates increases circulation and helps to sculpt the body and strengthen the bodys core or powerhouse (torso). People who do Pilates regularly feel they have better posture, are less prone to injury, and experience better overall health. Joseph H. Pilates, the founder of the Pilates exercise method, was born in Germany. As a child he was frail, living with asthma in addition to other childhood conditions. To build his body and grow stronger, he took up several different sports, eventually becoming an accomplished athlete. As a nurse in Great Britain during World War I, he designed exercise methods and equipment for immobilized patients and soldiers. In addition to his equipment, Pilates developed a series of mat exercises that focus on the torso. He based these on various exercise methods from around the world, among them the mind-body formats of yoga and Chinese martial arts. Joseph Pilates believed that our physical and mental health are intertwined. He designed his exercise program around principles that 407
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Getting Started
The great thing about Pilates is that just about everyonefrom couch potatoes to fitness buffscan do it. Because Pilates has gained lots of attention recently, there are lots of classes available. Youll probably find that many fitness centers and YMCAs offer Pilates classes, mostly in mat work. Some Pilates instructors also offer private classes that can be purchased class by class or in blocks of classes; these may combine mat work with machine work. If your health club makes Pilates machines available to members, make sure theres a qualified Pilates instructor on duty to teach and supervise you during the exercises. The fact that Pilates is hot and classes are springing up everywhere does have a downside, though: inadequate instruction. As with any form of exercise, it is possible to injure yourself if you have a health condition or dont know exactly how to do the moves. Some gyms send their personal trainers to weekend-long courses and then claim theyre qualified to teach Pilates (theyre not!), and this can lead to injury. So look for an instructor who is certified by a group that has a rigorous training program. These instructors have completed several hundred hours of training just in Pilates and know the different ways to modify the exercises so new students dont get hurt. The Pilates mat program follows a set sequence, with exercises following on from one another in a natural progression, just as Joseph Pilates designed them. Beginners start with basic exercises and build up to include additional exercises and more advanced positioning. Keep these tips in mind so that you can get the most out of your Pilates workout. Stay focused. Pilates is designed to combine your breathing rhythm with your body movements. Qualified instructors teach ways to keep your breathing working in conjunction with the exercises. You will also be taught to concentrate on your muscles and what you are doing. The goal of Pilates is to unite your mind and body, which relieves stress and anxiety. 408
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Mind-Body Exercise
Be comfortable. Wear comfortable clothes (as you would for yogashorts or tights and a T-shirt or tank top are good choices), and keep in mind that Pilates is usually done without shoes. If you start feeling uncomfortable, strained, or experience pain, you should stop. Let it flow. When you perform your exercises, avoid quick, jerky movements. Every movement should be slow, but still strong and flexible. Joseph Pilates worked with dancers and designed his movements to flow like a dance. Dont leave out the heart. The nice thing about Pilates is you dont have to break a sweat if you dont want tobut you can also work the exercises quickly (bearing in mind fluidity, of course!) to get your heart rate going. Or, because Pilates is primarily about strength and flexibility, pair your Pilates workout with a form of aerobic exercise like swimming or brisk walking. Most fans of Pilates say they stick with the program because its diverse and interesting. Joseph Pilates designed his program for varietypeople do fewer repetitions of a number of exercises rather than lots of repetitions of only a few. He also intended his exercises to be something people could do on their own once theyve had proper instruction, cutting down the need to remain dependent on a trainer. Before you begin any type of exercise program, its a good idea to talk to your doctor, especially if you have a health problem.
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Section 35.4
Tai Chi
Tai Chi: An Introduction, National Center for Complementary and Alternative Medicine (nccam.nih.gov), April 2009.
Tai chi, which originated in China as a martial art, is a mind-body practice in complementary and alternative medicine (CAM). Tai chi is sometimes referred to as moving meditationpractitioners move their bodies slowly, gently, and with awareness, while breathing deeply.
Key Points
Many people practice tai chi to improve their health and wellbeing. Scientific research is under way to learn more about how tai chi may work, its possible effects on health, and chronic diseases and conditions for which it may be helpful. Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
Overview
Tai chi developed in ancient China. It started as a martial art and a means of self-defense. Over time, people began to use it for health purposes as well. Accounts of the history of tai chi vary. A popular legend credits its origins to Chang San-Feng, a Taoist monk, who developed a set of 13 exercises that imitate the movements of animals. He also emphasized meditation and the concept of internal force (in contrast to the external force emphasized in other martial arts, such as kung fu and tae kwon do). The term tai chi (shortened from tai chi chuan) has been translated in various ways, such as internal martial art and supreme ultimate fist. It is sometimes called taiji or taijiquan. 410
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Mind-Body Exercise
Tai chi incorporates the Chinese concepts of yin and yang (opposing forces within the body) and qi (a vital energy or life force). Practicing tai chi is said to support a healthy balance of yin and yang, thereby aiding the flow of qi. People practice tai chi by themselves or in groups. In the Chinese community, people commonly practice tai chi in nearby parksoften in the early morning before going to work. There are many different styles, but all involve slow, relaxed, graceful movements, each flowing into the next. The body is in constant motion, and posture is important. The names of some of the movements evoke nature (e.g., Embrace Tiger, Return to Mountain). Individuals practicing tai chi must also concentrate, putting aside distracting thoughts, and they must breathe in a deep and relaxed but focused manner.
Mind-Body Exercise
If you have a medical condition or have not exercised in a while, consult with your health care provider before starting tai chi. Keep in mind that learning tai chi from a video or book does not ensure that you are doing the movements correctly and safely. If you are considering a tai chi instructor, ask about the individuals training and experience. Look for published research studies on tai chi for the health condition you are interested in. Tell your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see NCCAMs Time to Talk campaign (nccam .nih.gov/timetotalk/).
Selected References
Adler PA, Roberts BL. The use of tai chi to improve health in older adults. Orthopaedic Nursing. 2006;25(2):122126. Barnes PM, Bloom B, Nahin R. Complementary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistics Report #12. 2008. Chu DA. Tai chi, qi gong, and Reiki. Physical Medicine and Rehabilitation Clinics of North America. 2004;15(4):773781. Farrell SJ, Ross AD, Sehgal KV. Eastern movement therapies. Physical Medicine and Rehabilitation Clinics of North America. 1999;10(3):617 629. Irwin MR, Olmstead R, Oxman MN. Augmenting immune responses to varicella zoster virus in older adults: a randomized, controlled trial of tai chi. Journal of the American Geriatrics Society. 2007;55(4):511517. Lan C, Lai JS, Chen SY. Tai chi chuan: an ancient wisdom on exercise and health promotion. Sports Medicine. 2002;32(4):217224. Lewis D. Tai chi chuan. Complementary Therapies in Nursing & Midwifery. 2000;6(4):204206. Robins JL, McCain NL, Gray DP, et al. Research on psychoneuroimmunology: tai chi as a stress management approach for individuals with HIV disease. Applied Nursing Research. 2006;19(1):29. 413
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Chapter 36
Power Defined
Physics defines power as the rate at which work is performed. Human physiology defines power as the ability to generate enough energy to accomplish a specific feat or task in the least amount of time possible. Simply put, if you want to perform better in a specific sport or in daily activities, you should incorporate some form of power training into your workouts. For the endurance athlete this is no exception. In fact, power training may considerably improve running times by enhancing both physiological and mental functions. The very nature of the word endurance suggests that power is not a significant part of the equation. For power to truly exist, the duration of
Power Training for Endurance Athletes, by David Sandler, MS, CSCS,*D, NSCAs Performance Training Journal, March/April 2008. 2008 National Strength and Conditioning Association (www.nsca-lift.org). Reprinted with permission.
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Fitness and Exercise Sourcebook, Fourth Edition Table 36.1. Workouts for Combining Power and Strength Exercises
Upper Body Day Exercise Speed/Power/Plyometrics Medicine Ball Chest Pass Medicine Ball Power Drop Plyo Push Up Basic Strength/Hypertrophy Flat Bench Press Incline Dumbbell Press Seated Row Lat Pulldown Overhead Press Lower Body Day Exercise Speed/Power/Plyometrics Box Jump Split Jump Lateral Hurdle Hops Leg Press (timed for speed) Leg Extension (timed for speed) Basic Strength/Hypertrophy Leg Curl Romanian Deadlift Standing Calf Raise * performed to each side 3 4 3 12 8 15 4 4 3* 3 3 6 6 6 10 12 1 min 1 min 1 min 90 sec 90 sec Sets Reps Rest 3 2 3 2 3 12 10 12 10 10 90 sec 90 sec 90 sec 90 sec 90 sec 4 4 2 6 6 6 1 min 1 min 1 min Sets Reps Rest
This resistance workout should be performed twice per week for three to four weeks provided that a good strength base already exists. To keep time in the gym to a minimum, alternate exercises between upper and lower body after plyometrics. Resistance sets are timed so that all lifts become explosive in nature. Rather then using a controlled slow rep speed, you should look to complete your reps in the time allotted. 418
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Rest for two minutes then perform this workout for two more circuits.
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Chapter 37
Wii
It all really started going downhill with TV remotes. Those little handheld devices saved us the trouble of getting off the sofa to change the channel and successfully sucked yet another tiny bit of movement from our daily lives. Then came video games, which gave Americans, especially our kids, more reason to keep their rear ends firmly planted on the couch. In fact, people in this country now spend an average of 19 to 25 hours per week watching TV and playing video games. In the fall of 2006, a new video game system called the Nintendo Wii hit the streets. It became an instant hit and is now a full-fledged craze, selling more than 11 million consoles in the Americas alone since its release. At first blush, this would seem like another sad blow to the battle between fit and fat, but thankfully the Wii is actually an exergame. That is, its a video game that requires players to use actual physical movements to manipulate the action. Employing a wireless handheld controller (about the size of a TV remote, ironically) with acceleration sensors and an infrared camera built into the console, the Wii senses players motions and translates them into on-screen movement. For instance, in Wii Tennis you swing the controller like a racket; for Wii Golf, the controller is your club. When my brother-in-law and sister first got Wii they were saying, Oh were getting a workout from it. I thought they were just being ridiculous, but then I played it, says Karel Schmidt, a graduate
As Good as the Real Thing? reprinted with permission from the American Council on Exercise (www.acefitness.org), 2008. All rights reserved.
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The Study
To test the potential fitness benefits of playing Wii, a team of exercise scientists at the University of Wisconsin, La Crosse Exercise and Health Program, led by John Porcari, Ph.D., and Schmidt, recruited 16 volunteers8 men, 8 womenall between the ages of 20 to 29 years old. First, all volunteers were given an exercise test on a motorized treadmill to determine each subjects maximal heart rate and maximal oxygen uptake (i.e., VO2 max). Once that fitness baseline was established, the subjects were given a quick demonstration on how to use the video game system. Researchers used the standard Nintendo Wii ($250; www.nintendo.com/wii) bundled with Wii Sports, which includes baseball, boxing, bowling, golf, and tennis games. Previous Wii experience was not required as subjects were given 15 minutes of practice time for each of the five sports and allowed to continue practicing until they felt theyd mastered the skills needed to play each one successfully. Though its possible to manipulate the onscreen players using minimal body movement, researchers instructed the subjects to simulate the body movements used in each actual sport. With the tennis game, I could just stand in one spot and flick my wrist and the ball will go back. You can do minimal movement, but we tried to teach the participants to mimic the real game as closely as possible, says lead researcher John Porcari, Ph.D. We told them when you hit a forehand, swing your arm the way you would swing a racket. When youre doing a backhand, change your stance and really use your body. Actual testing on the Wii was conducted on a subsequent day. At that time, subjects played each of the five sports in random order. Each game lasted 10 minutes and researchers recorded heart rate and VO2 at one-minute intervals. Researchers also interviewed the subjects during the final minute of each sport to determine their perceived exertion levels using the Borg rating of perceived exertion (RPE). A 422
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Wii
five-minute break was given between each game to return the subjects heart rates to within 10 beats of their normal resting heart rate prior to beginning testing for the next game.
The Results
Data compiled from all subjects showed that playing Wii Sports increases heart rate, VO2, and perceived exertionand thus calorie burn. Specifically, playing the golf game burns approximately 3.1 calories per minute while eliciting 50% of HR max and 20% of VO2 max. The bowling game burns slightly more at 3.9 calories per minute with 52% of HR max and 23% of VO2 max. Calorie expenditure for the baseball game was recorded at 4.5 calories per minute with 55% of HR max and 28% of VO2 max. And finally, the energy expenditure for the tennis game (at 5.3 calories per minute, 59% of HR max, and 33% of VO2 max) was significantly greater than all of the other sports except boxing, which weighed in at 7.2 calories per minute, 74% of HR max, and 44% of VO2 max. When you play the lower-intensity games like bowling or golf you can see that youre not really doing that much, says Schmidt, but then when you play tennis or boxing you really do feel like youre getting a workout, like youre getting breathy. And thats exactly what we found and thats what our subjects reported to us as well. In fact, in addition to burning the most calories, boxing was the only Wii game tested that would be considered intense enough to maintain or improve cardiorespiratory endurance as defined by the American College of Sports Medicine (ACSM). People were increasing their oxygen consumption, or how many calories theyre burning, by five or six times above their normal resting values, notes Porcari. Even the golf game was two or three times higher than resting rates. To compare Wii Sports to the average calorie burn of playing the actual sports, researchers turned to values described in McArdle, Katch, and Katchs Exercise Physiology, a standard text for caloric expenditure information. Compared to golfing at a driving range (3.9 calories per minute), playing Wii Golf burned 0.8 calories less per minute. Actual bowling burns nearly twice as much (7.2 calories per minute) as Wii Bowling, while baseball burns 7.3 calories per minute and Wii Baseball burns 2.8 calories per minute less. Similarly, Wii Tennis burns 2.8 calories per minute less than the actual game (8.1 calories per minute). Finally, Wii Boxing burns about 3.0 calories per minute less than conventional sparring at 10.2 calories per minute. 423
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Web Sightings
exergamelab.blogspot.com: Hosted by Stephen Yang, co-director of the Physical Activity Research Laboratory at the State University 424
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of New YorkCortland, this blog explores the latest developments in the exergame trend. www.gamesforhealth.org: An arm of the nonprofit Serious Games Initiative (founded at the Woodrow Wilson Center for International Scholars in Washington, D.C.), Games for Health offers news and hosts conferences based on how exergames and other computer-based games can best impact health care and policy.
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Part Five
Fitness Safety
Chapter 38
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Table 38.1. The Continuum of Injury Risk Associated with Different Types of Activity
Injury Risk Level (Risk Level from Lower to Higher) Lowest risk Lower risk Medium risk Higher risk Highest risk Activity Type Commuting Lifestyle Recreation/sports (no contact) Recreation/sports (limited contact) Recreation/sports (collision/contact) Examples Walking, bicycling Home repair, gardening/yard work Walking for exercise, golf, dancing, swimming, running, tennis Bicycling, aerobics, skiing, volleyball, baseball, softball Football, hockey, soccer, basketball
Note: The same activity done for different purposes and with different frequency, intensity, and duration leads to different injury rates. Competitive activities tend to have higher injury rates than noncompetitive activities, likely due to different degrees of intensity of participation.
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Chapter 39
Workout Safety
Chapter Contents
Section 39.1Warming Up......................................................... 438 Section 39.2Avoiding Mistakes in the Gym............................ 440 Section 39.3Choosing an Athletic Shoe................................... 441 Section 39.4Helmets. ................................................................ 443
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Section 39.1
Warming Up
Exercise Right: Proper Warm-Up and Cool-Down, by Melissa Burgemeister, ATC. 2005. Reprinted with permission of the American College of Sports Medicine, ACSM Fit Society Page, Winter 2005, pp 45. Reviewed by David A. Cooke, MD, FACP, May 2010.
Adequate warm-up prior to physical activity is important to ensure a safe and effective exercise session. A simple warm-up will increase blood flow throughout the body, especially to muscles, and will begin to raise the internal body temperature. Warm muscles and tendons are less prone to injury and may improve physical performance. A proper warm-up also helps to mentally prepare for exercise. The warm-up can be divided into a simple three-step process: 1) general warm-up, 2) stretching, and 3) specific warm-up.
General Warm-Up
The warm-up routine should begin with a low-intensity exercise which slightly increases your heart rate. The general warm-up can be personalized to include equipment you may access. If your exercise is jogging, begin your warm-up with a steady walk. If you are in for a game of basketball, begin with some free throws and relaxed shooting. Remember, start slow and dont wear yourself out during the warm-up.
Stretching
Once your muscles are warm, take time to stretch. Muscles are much more flexible when they have been warmed compared to when they are cold. Focus on stretching large muscle groups such as the hamstrings and quadriceps. Specifically, stretch the muscles that you will be using to perform your activity. To maximize the benefit received from the stretch and to help improve flexibility, hold each stretch for 20 to 60 seconds. Be sure not to stretch so far that you induce pain, and maintain proper breathing during each stretch. Hamstring, calf, and quadriceps stretching is essentially for lower body activities. Pectoralis major, deltoid, and neck stretches should be included for upper-body activities. 438
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Workout Safety
Specific Warm-Up
The final stage of the warm-up is to do exercises specific to the activity you will be completing. If you plan to lift weights, begin with a light weight and perform a few reps before increasing the weight and repetitions. Run up and down the sidelines prior to a basketball or soccer game. The warm-up should last at least 5 to 10 minutes, although more time may be necessary if preparing for more intense exercise. If you are exercising in cold weather, take additional time to ensure that your body is adequately warmed-up. Once you are sufficiently warm and flexible, your body is ready for exercise.
Cool Down
The cool-down period following a workout is just as important as the warm-up. This time is used to reduce your heart rate and breathing rate, and to help with recovery following exercise. Performing a cool-down has been shown to decrease light-headedness and prevent pooling of the blood within the muscles, which can lead to fainting and soreness. A cool-down also allows waste products to be removed from your muscles, possibly minimizing soreness after activity. Begin the cool-down by decreasing the intensity of the activity you were performing or by walking or jogging at a lower intensity than the exercise. Remaining active is an important component of the cool-down. The cool-down should last 5 to 10 minutes and be followed by light stretching to help relax the muscles. The stretching should focus on the muscles used during the activity. Upon completion of your exercise routine, be sure to drink plenty of water and replenish lost nutrients.
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Section 39.2
This survey of 3,000 ACE [American Council on Exercise]-certified fitness professionals points out the biggest mistakes in the gym. In some cases, these mistakes may simply mean the difference between an effective and an ineffective workout. Other mistakes, however, can be more costly, leading to strain and injury. ACE, Americas Authority on Fitness, shares the following mistakes commonly made in the gym and offers tips to help individuals stay safe during their workout. Not stretching enough: Stretch immediately following an aerobic activity while your muscles are warm and pliable to prevent injuries. Lifting too much weight: Never lift more than your muscles can handle. Gradual, progressive resistance is a far more effectiveand safeway to increase muscle strength. Not warming up prior to activity: Muscles need time to adjust to the new demands aerobic activity places on them. Start slowly and gradually increase intensity. Not cooling down after any type of workout: Take a few minutes to lower your heart rate and stretch your muscles. This improves flexibility and helps prepare the body for your next workout. Exercising too intensely: Its more effective to sustain a moderate workout for longer periods of time than to exercise intensely for only a few minutes. Not drinking enough water: Dont wait until youre thirsty to drink wateryoure already on your way to dehydration. Keep a water bottle close at hand during exercise and throughout the day. Leaning heavily on a stair stepper: Leaning on the stair stepper is hard on both the wrists and the back. Lower the intensity to 440
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Workout Safety
the point at which you can maintain good posture while lightly resting your hands on the rails for balance. Not exercising intensely enough: Exercise intensely enough to work up a light sweat and get your heart beating in your training zone. Jerking while lifting weights: When you have to jerk the weight, its likely youre jerking other muscles as well. This can lead to strain and injury, with the muscles of the back being particularly vulnerable. Control the weight, dont let it control you. Consuming energy bars and sports drinks during moderate workouts: Unless youre working out for longer than two hours per day, you dont need to supplement with high-energy bars and drinks. (High-energy is often a code word for high-calorie.)
Section 39.3
Proper-fitting sports shoes can enhance performance and prevent injuries. Follow these specially designed fitting facts when purchasing a new pair of athletic shoes. Try on athletic shoes after a workout or run and at the end of the day. Your feet will be at their largest. Wear the same type of sock that you will wear for that sport. When the shoe is on your foot, you should be able to freely wiggle all of your toes. The shoes should be comfortable as soon as you try them on. There is no break-in period. Walk or run a few steps in your shoes. They should be comfortable. Always relace the shoes you are trying on. You should begin at the farthest eyelets and apply even pressure as you crisscross a lacing pattern to the top of the shoe. 441
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Workout Safety
Section 39.4
Helmets
Which Helmet for Which Activity? Consumer Product Safety Commission (www.cpsc.gov), 2006.
CPSC, ASTM F2032 CPSC, ASTM F1952 ASTM F1492, Snell N-94
Individual ActivitiesWheeled Large Motor ATV Riding; Dirt-, and Mini-Bike Riding; Motocrossing Karting/Go-Karting Moped Riding; Powered Scooter Riding Individual ActivitiesNon-Wheeled Horseback Riding Rock and Wall Climbing Equestrian Mountaineering ASTM F1163, Snell E-2001 EN 12492, Snell N-94 Motocross or Motorcycle Karting or Motorcycle Moped or Motorcycle DOT FMVSS 218, Snell M-2005 DOT FMVSS 218, Snell K-98, Snell M-2005 DOT FMVSS 218, Snell L-98, Snell M-2005
The federal CPSC Safety Standard for Bicycle Helmets is mandatory for those helmets indicated by CPSC. This helmet is designed to withstand more than one moderate impact, but protection is provided for only a limited number of impacts. Replace if visibly damaged (e.g., a cracked shell or crushed liner) and/or when directed by the manufacturer.
Helmets specifically marketed for exclusive use in an activity other than bicycling (for example, go-karting, horseback riding, lacrosse, and skiing) do not have to meet the requirements of the CPSC bicycle helmet standard. However, these helmets should meet other federal and/or voluntary safety standards. Dont rely on the helmets name or claims made on the packaging (unless the packaging specifies compliance with an appropriate standard) to determine if the helmet meets the appropriate requirements for your activity. Most helmets that meet a particular standard will contain a special label that indicates compliance (usually found on the liner inside of the helmet).
Are there helmets that I can wear for more than one activity?
Yes, but only a few. You can wear a CPSC-compliant bicycle helmet while bicycling, recreational roller or in-line skating, and riding a 444
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Workout Safety
Table 39.1. Matching Activities and Helmets, continued
1. Activity Team Sport Activities Baseball, Softball, and T-Ball Baseball Batters Baseball Catchers Football Ice Hockey Lacrosse Winter Activities Skiing; Snowboarding Snowmobiling Ski Snowmobile ASTM F2040, CEN 1077, Snell RS-98 or S-98 DOT FMVSS 218, Snell M-2000 Football Hockey Lacrosse NOCSAE ND022 NOCSAE ND024 NOCSAE ND002, ASTM F717 NOCSAE ND030, ASTM F1045 NOCSAE ND041 2. Helmet Type 3. Applicable Standard(s)
Although a helmet has not yet been designed for the following two activities, until such helmets exist, wearing one of the three listed types of helmets may be preferable to wearing no helmet at all. Ice Skating; Sledding Bicycle Skateboard Ski CPSC, ASTM F1447, Snell B-90/95 or N-94 ASTM F1492, Snell N-94 ASTM F2040, CEN 1077, Snell RS-98 or S-98
Team sport helmets are designed to protect against multiple head impacts typically occurring in the sport (e.g., ball, puck, or stick impacts; player contact; etc.), and, generally, can continue to be used after such impacts. Follow manufacturers recommendations for replacement or reconditioning. Definitions: ASTMASTM International; CENEuropean Committee for Standardization; DOTDept. of Transportation; ENEuro-norm or European Standard; NOCSAENational Operating Committee on Standards in Athletic Equipment; SnellSnell Memorial Foundation.
nonpowered scooter. Look at the table for other activities that may share a common helmet.
Are there any activities for which one shouldnt wear a helmet?
Yes. Make sure your child takes off his/her helmet before playing on playgrounds or climbing trees. If a child wears a helmet during these activities, the helmets chin strap can get caught on the equipment or tree and pose a risk of strangulation. The helmet itself may present an entrapment hazard.
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Chapter 40
Chapter Contents
Section 40.1Healthy Hydration............................................... 448 Section 40.2Sports Nutrition................................................... 450 Section 40.3Top Sports Nutrition Myths................................ 453
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Section 40.1
Healthy Hydration
American College of Sports Medicine (ACSM) Offers Guidance to Athletes on Preventing Hyponatremia and Dehydration during Upcoming Races. News release, 2005. Reprinted with permission of the American College of Sports Medicine (www.acsm.org). Reviewed by David A. Cooke, MD, FACP, March 2010.
A new report, which appears in the June [2005] issue of Current Sports Medicine Reports, addresses key issues and reviews research findings on the topics of hyponatremia and dehydration for endurance athletesa subject that has generated significant media attention this year. The published report, ACSM Roundtable Series: Hydration and Physical Activity, is based on findings from an international panel of hydration experts who conducted an evidence-based analysis on numerous past published studies. Based on the findings of this report as well as previously published statements, ACSM [American College of Sports Medicine] is issuing the following guidelines to the endurance community: Work to minimize risk of both hyponatremia and dehydration. Hyponatremia is a dangerous condition that occurs when an athlete consumes too much fluid (either water or other fluids), diluting the bodys sodium levels. Despite heightened media attention to this issue this year, the international ACSM panel concluded that exertional hyponatremia is relatively rare and appears to occur most often in slow-paced athletes (running events lasting longer than 4 hours or triathlons lasting longer than 913 hours). The incidence of symptomatic hyponatremia during endurance exercise events such as the marathon and triathlon is generally low (probably less than one in 1,000 finishers). The panel also concluded that especially during hot-weather training, dehydration occurs more frequently and has severe consequences, increasing the risk of heat exhaustion and heat stroke during and immediately after activity. Fluid deficits in athletes can affect physical and mental performance, increase cardiovascular strain, and decrease heat tolerance. 448
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Section 40.2
Sports Nutrition
Fast Facts about Sports Nutrition, Presidents Council on Physical Fitness and Sports (www.fitness.gov), April 23, 2008. Reviewed by David A. Cooke, MD, FACP, March 2010.
A Weighty Matter
Your calorie needs depend on your age, body size, sport, and training program. The best way to make sure you are not getting too many or too few calories is to check your weight from time to time. If youre keeping within your ideal weight range, youre probably getting the right amount of calories.
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Section 40.3
The field of sports nutrition is filled with myths that people follow blindly. This section looks at the top sports nutrition myths, and what science has to say about them.
Myth: Vitamin C will prevent me from getting sick during my training season.
Truth: While vitamin C has been shown to lessen the symptoms and severity of a cold, research to date does not show that vitamin C supplements help individuals ward off colds.3 The best method to avoid getting sick is regular hand washing and a healthy diet. Vitamin C does play a role in respiratory defense mechanisms, so taking in additional vitamin C when you first feel a cold coming on may help.
Nutrition and Exercise Myth: I need to watch my weight because my BMI [body mass index] is too high.
Truth: Trained athletes typically have more skeletal muscle and less body fat than sedentary individuals. Therefore, BMI is not an appropriate disease risk screening tool for athletes.2 The Centers for Disease Control and Prevention (CDC) recommends that athletes use methods other than BMI to assess body composition.1 Waist circumference is a good indicator of risk, as abdominal fat is a strong predictor of obesity-related diseases.1 The CDC also recommends using bioelectric impedance (BIA), underwater weighing, or dual-energy X-ray absorptiometry (DXA) to determine body fat percentage.1
References
1. Centers for Disease Control and Prevention. BMI for Adults. Retrieved July 21, 2008, from www.cdc.gov/nccdphp/dnpa/bmi/ adult_BMI/ about_adult_BMI.htm, n.d. 2. Dunford, M, and Doyle J. Nutrition for Sport and Exercise. Belmont, CA: Thomson Wadsworth. 2008. 3. Hemil H, Chalker E, Treacy B, Douglas B. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews. 2007. 4. Institute Of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients), Sodium, Chloride, Potassium, and Sulfate, Washington, D.C: National Academy Press, 2005. 455
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Chapter 41
Chapter Contents
Section 41.1Common Sports Injuries and Their Prevention........................................... 458 Section 41.2Sports-Related Concussions: What You Need to Know to Be Safe.................... 466
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Section 41.1
Compartment Syndrome
In many parts of the body, muscles (along with the nerves and blood vessels that run alongside and through them) are enclosed in a compartment formed of a tough membrane called fascia. When muscles become swollen, they can fill the compartment to capacity, causing interference with nerves and blood vessels as well as damage to the muscles themselves. The resulting painful condition is referred to as compartment syndrome. Compartment syndrome may be caused by a one-time traumatic injury (acute compartment syndrome), such as a fractured bone or a hard blow to the thigh, by repeated hard blows (depending upon the sport), or by ongoing overuse (chronic exertional compartment syndrome), which may occur, for example, in long-distance running.
Shin Splints
Although the term shin splints has been widely used to describe any sort of leg pain associated with exercise, the term actually refers 459
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Fractures
A fracture is a break in the bone that can occur from either a quick, one-time injury to the bone (acute fracture) or from repeated stress to the bone over time (stress fracture). Acute fractures: Acute fractures can be simple (a clean break with little damage to the surrounding tissue) or compound (a break in which the bone pierces the skin with little damage to the surrounding tissue). Most acute fractures are emergencies. One that breaks the skin is especially dangerous because there is a high risk of infection. Stress fractures: Stress fractures occur largely in the feet and legs and are common in sports that require repetitive impact, primarily running/jumping sports such as gymnastics or track and field. Running creates forces two to three times a persons body weight on the lower limbs. 460
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Dislocations
When the two bones that come together to form a joint become separated, the joint is described as being dislocated. Contact sports such as football and basketball, as well as high-impact sports and sports that can result in excessive stretching or falling, cause the majority of dislocations. A dislocated joint is an emergency situation that requires medical treatment. The joints most likely to be dislocated are some of the hand joints. Aside from these joints, the joint most frequently dislocated is the shoulder. Dislocations of the knees, hips, and elbows are uncommon.
Acute Injuries
Acute injuries, such as a sprained ankle, strained back, or fractured hand, occur suddenly during activity. Signs of an acute injury include the following: Sudden, severe pain Swelling Inability to place weight on a lower limb Extreme tenderness in an upper limb Inability to move a joint through its full range of motion Extreme limb weakness Visible dislocation or break of a bone
Chronic Injuries
Chronic injuries usually result from overusing one area of the body while playing a sport or exercising over a long period. The following are signs of a chronic injury: 461
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Immobilization
Immobilization is a common treatment for sports injuries that may be done immediately by a trainer or paramedic. Immobilization involves reducing movement in the area to prevent further damage. By enabling the blood supply to flow more directly to the injury (or the site of surgery to repair damage from an injury), immobilization reduces pain, swelling, and muscle spasm and helps the healing process begin. Following are some devices used for immobilization: Slings, to immobilize the upper body, including the arms and shoulders. Splints and casts, to support and protect injured bones and soft tissue. Casts can be made from plaster or fiberglass. Splints can be custom made or ready made. Standard splints come in a variety of shapes and sizes and have Velcro straps that make them easy to put on and take off or adjust. Splints generally offer less support and protection than a cast and, therefore, may not always be a treatment option. Leg immobilizers, to keep the knee from bending after injury or surgery. Made from foam rubber covered with fabric, leg immobilizers enclose the entire leg, fastening with Velcro straps.
Surgery
In some cases, surgery is needed to repair torn connective tissues or to realign bones with compound fractures. The vast majority of sports injuries, however, do not require surgery.
Rehabilitation (Exercise)
A key part of rehabilitation from sports injuries is a graduated exercise program designed to return the injured body part to a normal level of function. 464
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Rest
Although it is important to get moving as soon as possible, you must also take time to rest following an injury. All injuries need time to heal; proper rest will help the process. Your health care professional can guide you regarding the proper balance between rest and rehabilitation. 1. Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory. 465
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Section 41.2
Sport-related concussions continue to be a serious public health concern, as approximately 1.6 to 3 million concussions occur annually in the United States. Recent studies have shown increases in the prevalence and incidence of concussion in both high school and college athletes. Approximately 8.9% of all high school athletic injuries are concussions, while incidence rates for college athletes range from 5 to 7.9%. This section will provide a general overview of the signs, symptoms, management, and treatment of sport-related concussion.
Definition of a Concussion
A concussion occurs when an athletes skull contacts another object (i.e., an opponent, the ball, or the ground) or comes to an abrupt halt (as in whiplash), causing the brain to rebound off of, or twist up against, the inside of the skull. These shearing forces can damage blood vessels that cause swelling and bleeding in the brain. Neurons can also be damaged, which impairs the brains ability to transmit important information from one area of the brain to another. This damage causes 466
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Concussion Management
The initial management of concussion begins by addressing the ABCs (airway, breathing, circulation) of life support. If the athlete is unconscious, one must assume a neck or spine injury until proven otherwise. When a spinal injury has been ruled out, the extent of symptoms such as head and neck pain, dizziness, confusion, and amnesia must be determined. If the athlete has any signs and symptoms of a concussion, he or she should not return to play and should be referred to a physician. If you are not sure if an athlete has suffered a concussion, follow this motto: When in doubt, sit them out!
Concussion Treatment
Concussed athletes should also be regularly monitored for any signs of deterioration and receive a full medical evaluation following injury. The recommended return-to-play process includes: 1. no activity, complete rest; 2. light aerobic exercise such as walking or stationary cycling, no resistance training; 3. sport-specific exercise and progressive addition of resistance training; 4. non-contact training drills; 5. full-contact training after medical clearance; 6. game play. 468
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Conclusion
In summary, each sport-related concussion should be treated individually. Concussions can be a serious injury if mismanaged, but with proper education and precautionary measures, concussed athletes can experience a full recovery and return to participation.
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Chapter 42
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Proper Preparation
Just as you wouldnt send a child who cant swim to a swimming pool, its important not to send kids to play a sport that theyre unprepared to play. Make sure that your child knows how to play the sport before going out on the field. Your child should be adequately prepared with warm-ups and training sessions before practices as well as before games. This will help ensure that your child has fun and reduce the chances of an injury. In addition, your child should drink plenty of fluids and be allowed to rest during practices and games.
Acute Injuries
Acute injuries occur suddenly and are usually associated with some form of trauma. In younger children, acute injuries typically include minor bruises, sprains, and strains. Teen athletes are more likely to sustain more severe injuries, including broken bones and torn ligaments. More severe acute injuries that can occur, regardless of age, include: eye injuries, including scratched corneas, detached retinas, and blood in the eye; broken bones or ligament injuries; brain injuries, including concussions, skull fractures, brain hemorrhages; and spinal cord injuries. Acute injuries often occur because of a lack of proper equipment or the use of improper equipment. For example, without protective eyewear, eye injuries are extremely common in basketball and racquet sports. In addition, many kids playing baseball and softball have suffered broken legs or ankles from sliding into immobile bases. 473
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Reinjuries
Reinjury occurs when an athlete returns to the sport before a previous injury has sufficiently healed. Athletes are at a much greater risk for reinjury when they return to the game before recovering fully. Doing so places stress upon the injury and forces the body to compensate for the weakness, which can put the athlete at greater risk for injuring another body part. Reinjury can be avoided by allowing an injury to completely heal. Once the doctor has approved a return to the sport, make sure that your child properly warms up and cools down before and after exercise. Sudden exertion can also cause reinjury, so your child should reenter the sport gradually. Explain that easing back into the game at a sensible pace is better than returning to the hospital!
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Chapter 43
Fitness Planning
Striving for physical fitness is not to be taken lightly. The Presidents Council on Physical Fitness and Sports cautions that unless you are convinced of the benefits of fitness and the risks of unfitness, you will not succeed. Patience is essential. Dont try to do too much too soon; give yourself a chance to improve. As you exercise, pay attention to what your body, including your feet, tells you. If you feel discomfort, you may be trying to do too much too fast. Ease up a bit or take a break and start again at another time. Drink fluids on hot days or during very strenuous activities to avoid heat stroke and heat exhaustion.
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Chapter 44
Chapter Contents
Section 44.1Overtraining in Women and the Risk to Bone Health. ...................................... 482 Section 44.2Compulsive Exercise............................................ 486
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Section 44.1
Are you exercising too much? Eating too little? Have your menstrual periods stopped or become irregular? If so, you may be putting yourself at high risk for several serious problems that could affect your health, your ability to remain active, and your risk for injuries. You also may be putting yourself at risk for developing osteoporosis, a disease in which bone density is decreased, leaving your bones vulnerable to fracture (breaking).
How can I tell if someone I know, train with, or coach may be at risk for bone loss, fracture, and other health problems?
Here are some signs to look for: Missed or irregular menstrual periods Extreme or unhealthy-looking thinness Extreme or rapid weight loss Behaviors that reflect frequent dieting, such as eating very little, not eating in front of others, trips to the bathroom following meals, preoccupation with thinness or weight, focus on low-calorie and diet foods, possible increase in the consumption of water and other noand low-calorie foods and beverages, possible increase in gum chewing, limiting diet to one food group, or eliminating a food group Frequent intense bouts of exercise (e.g., taking an aerobics class, then running five miles, then swimming for an hour, followed by weight-lifting) An I cant miss a day of exercise/practice attitude An overly anxious preoccupation with an injury Exercising despite illness, inclement weather, injury, and other conditions that might lead someone else to take the day off An unusual amount of self-criticism or self-dissatisfaction Indications of significant psychological or physical stress, including depression, anxiety or nervousness, inability to concentrate, 483
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My friend drinks a lot of diet sodas. She says this helps keep her trim.
Girls and women who may be dieting often drink diet sodas rather than milk. Yet, milk and other dairy products are a good source of calcium, an essential ingredient for healthy bones. Drinking sodas instead of milk can be a problem, especially during the teen years when rapid bone growth occurs. If you (or your friend) find yourself drinking a lot of sodas, try drinking half as many sodas each day, and gradually add more milk and dairy products to your diet. A frozen yogurt shake can be an occasional low-fat, tasty treat. Or try a fruit smoothie made with frozen yogurt, fruit, or calcium-enriched orange juice.
My coach and I think I should lose just a little more weight. I want to be able to excel at my sport!
Years ago, it was not unusual for coaches to encourage athletes to be as thin as possible for many sports (e.g., dancing, gymnastics, figure skating, swimming, diving, and running). However, many coaches now realize that being too thin is unhealthy and can negatively affect performance. Its important to exercise and watch what you eat. However, its also important to develop and maintain healthy bones and bodies. Without these, it will not matter how fast you can run, how thin you are, or how long you exercise each day. Balance is the key!
Im still not convinced. If my bones become brittle, so what? Whats the worst thing that could happen to me?
Brittle bones may not sound as scary as a fatal or rare disease. The fact is that osteoporosis can lead to fractures. It can cause disability. Imagine having so many spine fractures that youve lost inches in height and walk bent over. Imagine looking down at the ground everywhere you go because you cant straighten your back. Imagine not being able to find clothes that fit you. Imagine having difficulty breathing and eating because your lungs and stomach are compressed into a smaller space. Imagine having difficulty walking, let alone exercising, because of pain and misshapen bones. Imagine constantly having to be aware of what you are doing and having to do things so slowly and carefully because of a very real fear and dread of a fracturea fracture that could lead to a drastic change in your life, including pain, loss of independence, loss of mobility, loss of freedom, and more. 485
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Section 44.2
Compulsive Exercise
Compulsive Exercise, November 2007, reprinted with permission from www.kidshealth.org. Copyright 2007 The Nemours Foundation. This information was provided by KidsHealth, one of the largest resources online for medically reviewed health information written for parents, kids, and teens. For more articles like this one, visit www.KidsHealth.org, or www .TeensHealth.org.
Melissa has been a track fanatic since she was 12 years old. She has run the mile in meets in junior high and high school, constantly improving her times and winning several medals. Best of all, Melissa truly loves her sport. Recently, however, Melissas parents have noticed a change in their daughter. She used to return tired but happy from practice and relax with her family, but now shes hardly home for 15 minutes before she heads out for another run on her own. On many days, she gets up to run before school. When shes unable to squeeze in extra runs, she becomes irritable and anxious. And she no longer talks about how much fun track is, just how many miles she has to run today and how many more she should run tomorrow. Melissa is living proof that even though exercise has many positive benefits, too much can be harmful. Teens, like Melissa, who exercise compulsively are at risk for both physical and psychological problems.
Warning Signs
A child may be exercising compulsively if he or she: wont skip a workout, even if tired, sick, or injured; doesnt enjoy exercise sessions, but feels obligated to do them; seems anxious or guilty when missing even one workout; does miss one workout and exercises twice as long the next time; is constantly preoccupied with his or her weight and exercise routine; 488
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Chapter 45
Chapter Contents
Section 45.1Outdoor Exercise Safety...................................... 492 Section 45.2Air Pollution and Exercise................................... 495
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Section 45.1
Avoid Injury
It cant be said too often: Start your activity program gradually, and work up slowly. Be sure to warm up, cool down, and stretch each and every time you are physically active. Exercising too much, too fast, can cause injuries. A certain amount of stiffness is normal at first. But if you do hurt a joint or pull a muscle, stop the activity for several days to avoid more serious injury. Rest and over-the-counter painkillers can heal most minor muscle and joint problems. Use proper equipment. Wear good shoes with adequate cushioning in the soles for jogging or walking. Use goggles to protect your eyes for sports such as handball or racquetball. Joggers should run on soft, even surfaces such as a level grass field, a dirt path, or a track. Hard or uneven surfaces, such as cement or rough fields, are more likely to cause injuries. Also, try to land on your heels, rather than on the balls of your feet, to minimize strain on your feet and lower legs. If you jog or walk on the street, watch for cars. Wear lightcolored clothing with a reflecting band at night so that drivers can see you more easily. Always face oncoming traffic. Remember, drivers cant see you as well as you can see their cars. If you bicycle, always wear a helmet. Ride in the direction of traffic and try to avoid busy streets. At night, use lights and wheelmounted reflectors.
Eat Right
If youve just eaten a meal, avoid strenuous physical activity for at least two hours. 492
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Seek Company
If youre concerned about the safety of your surroundings, pair up with a buddy for outdoor activities. If possible, walk, bike, or jog during daylight hours. Check out the hours of nearby shopping malls. Many malls are open early and late for people who prefer to walk or jog at those times of day, but in a safe, well-lit area. (Indoor malls also make it possible to stay active during summer heat, winter cold, and allergy seasons.)
Section 45.2
Air pollution is a year-round problem, but smog levels are generally highest during hot, sunny days from May to Septemberwhen we most spend time outdoors. Staying healthy is important, but you should be aware of some of the risks of exercising outdoors when air quality is poor and plan accordingly.
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Chapter 46
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Additional Resources
The National Center on Physical Fitness and Disability: www.ncpad.org. Mayo ClinicExercise and Disability: Physical Activity Is within Your Reach: www.cnn.com/HEALTH/library/ SM/0042.html. American Academy of Physical Medicine and Rehabilitation: www.aapmr.org.
Breathing Conditions
Asthma Emphysema
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Chapter 47
Chapter Contents
Section 47.1Increasing Physical Activity for People with Disabilities. ................................ 506 Section 47.2Promoting Inclusive Physical Activity Communities for People with Disabilities....................................... 509
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Section 47.1
Why Be Active?
Children and adults who have a disability can gain numerous mental and physical benefits from being physically active on a regular basis. These benefits include the following: Reduced risk of developing a chronic condition, such as diabetes, stroke, or heart disease Reduced risk of developing a secondary condition related to the primary disability (for example, an individual who has a lower limb paralysis and utilizes a wheelchair may become overweight due to inactivity; over time, chronic shoulder pain or a rotator cuff tear may develop due to overuse or poor muscle development in the shoulders and arms, continuing the cycle of inactivity) Improved self-esteem Greater social interaction Ability to maintain a higher level of independence
Resources
U.S. Department of Health and Human Services, Office on Disability: Links to a variety of Web-based resources on topics ranging from health and wellness to education, employment, and information technology, www.hhs.gov/od/index.html. Adaptive Information Resource Center: Provides information on recreational and sports programs for adults and children. Website allows user to search by state or program type, www.adaptiveirc.org. Disabled Sports USA: Information on sports rehabilitation programs nationwide. Programs are open to anyone with a permanent disability and range from water and snow skiing to rafting and tennis, www.dsusa.org.
References
1. National Center for Health Statistics. DATA2010. Regular physical activity: moderate or vigorous, 2005. Available at: http://wonder.cdc.gov/scripts/broker.exe. Accessed June 21, 2007. 2. Rimmer J. (2005). The conspicuous absence of people with disabilities in public fitness and recreation facilities: lack of interest or lack of access? Am Jrnl Health Promotion, 19(5), 327329. 3. What is a pedometer and how can I benefit from using one? [Electronic fact sheet]. (2006). Chicago, IL: National Center on Physical Activity and Disability [Producer and Distributor]. Available from: http:// www.ncpad.org/exercise/fact_ sheet.php?sheet=420&view=all. Accessed June 15, 2007. 508
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Section 47.2
It is estimated that there are 40 to 50 million people in the United States who have a disability. This number is expected to increase over the next several decades as the baby boom generation reaches retirement age. An aging population brings with it a host of physical, cognitive, and sensory impairments that will increase the number of adults who are disabled in this nation and throughout the world. In addition to the growing number of people with disabilities over age 65, millions of children and younger people also have a disability. Thus, increased effective strategies are needed to improve and maintain function and quality of life among individuals with disabilities, older and younger alike. Increasing physical activity participation among people with disabilities is an important goal for the health and fitness profession. Despite the enormous health benefits that can be attained from regular physical activity, most people with disabilities are not achieving the U.S. recommended goal of 30 minutes a day five or more days of the week. This low level of physical activity participation could be an even greater issue for people with disabilities compared to a relatively sedentary population without existing comorbidity because people with disabilities are often having to deal with other health issues related to their disability such as secondary (e.g., pain, fatigue, deconditioning, depression, and weight gain) and associated conditions (e.g., spasticity, autonomic dysfunction, incontinence, seizures, balance, and thermoregulatory alterations). When these conditions overlay chronic conditions (e.g., cancer, type 2 diabetes, asthma, and heart disease), health becomes a front-and-center issue for millions of people with disabilities because it threatens their ability to work effectively, shop, participate in leisure and social activities, and live independently. 509
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A Framework for Promoting Physical Activity Participation among People with Disabilities
Health/fitness professionals must recognize that many physical activity programs, facilities, and services offered in their communities have an element of inaccessibility. From sports and recreation programs for youth to fitness equipment and swim classes for adults and seniors, accessibility is an inherent problem for many people with disabilities. When concentrating efforts on removing these environmental barriers to participation, a critical feature is to understand the type and nature of the barrier(s) that may prevent individuals with disabilities from engaging in physical activity. J.H. Rimmer and W.J. Schiller (Future directions in exercise and recreational technology for people with spinal cord injury and other disabilities, Top Spinal Cord Injury Rehabil, 2006; 11:82993) developed a framework for systematically addressing barriers in the built environment experienced by people with disabilities. The model uses the acronym RAMPRestoring Activity, Mobility, and Participationto reflect the broad need to create a barrier-free environment. The RAMP model consists of four componentsAccess, Participation, Adherence, and Health and Functioneach building on the previous component and reflecting the interconnectedness between components in achieving optimal health and well-being among people with disabilities. The metaphor also reflects the logical sequencing of the four components: access is necessary for participation, and regular participation and adherence are necessary to obtain benefits in health and function. The first component in the RAMP model is access. Within the context of physical activity, access refers to offering the individual an opportunity to experience typical use of the environment or exercise product (i.e., equipment). The most common access issues for people with disabilities involve physical accessgetting the person into the building, allowing full use of available facilities, and allowing access on and off the equipment. A more subtle aspect of access is information on the availability of facilities, services, programs, and equipment. Without at least awareness of the options available, the options are functionally unavailable. One way that health and fitness professionals can make their facilities more accessible is when purchasing new equipment, they could consider universal design features such as swivel-away seats that allow wheelchair users to access the machine from their wheelchair; easy reach to changing weight on various resistance machines; easy transfer onto cardiovascular exercise equipment such as seen on recumbent 513
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Conclusion
Health and fitness professionals have a unique opportunity to improve the health and well-being of millions of people with disabilities who are not engaging in moderate, health-enhancing physical activity. Physical, programmatic, and attitudinal barriers that affect the ability of many people with disabilities to become physically active must be eliminated if we are going to achieve higher levels of physical activity in this underserved segment of the population. Increased participation in physical activity and improved fitness levels could have substantial health benefits for this underserved audience. Small increments in physical activity could pay substantial dividends in reducing health care expenditures and caregiver burden. Lowering the incidence of chronic conditions, minimizing or eliminating secondary conditions directly or indirectly resulting from the disability, and reducing the need for personal assistance in performing ADL and IADL are important outcomes of regular physical activity. The focus of this effort should be on offering programs, services, and facilities that are universally designed and fully accessible to all people with and without disabilities. Public health programs and professionals who work in local and state health departments, fitness and recreation centers, and rehabilitation facilities must recognize the low rates of physical activity reported among people with disabilities and begin to develop effective and cohesive strategies that address this problem. While most of the financial resources in public health have been directed at prevention of disease, injury, and disability, there is growing recognition among public policy experts that prevention of secondary conditions is an equally important issue among people with disabilities. Health promotion activities, especially increased participation in physical activity, can have an enormous positive impact on reducing secondary conditions and improving health, function, and quality of life in people with disabilities.
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Chapter 48
Chapter Contents
Section 48.1Physical Fitness at Any Size............................... 520 Section 48.2Fat Loss and Weight Training Myths. ................ 529 Section 48.3Abdominal Fat and Your Health......................... 533
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Section 48.1
Would you like to be more physically active, but are not sure if you can do it? Good newsif you are a very large person, you can be physically activeand you can have fun and feel good doing it. There may be special challenges for very large people who are physically active. You may not be able to bend or move in the same way that other people can. It may be hard to find clothes and equipment for exercising. You may feel self-conscious being physically active around other people. Facing these challenges is hardbut it can be done! The information in this chapter may help you start being more active and healthierno matter what your size.
Physical Fitness for People Who Are Overweight Do I need to see my health care provider before I start being physically active?
You should talk to your health care provider if any of the following apply to you: You have a chronic disease or have risk factors for a chronic disease, such as asthma or diabetes You have high blood pressure, high cholesterol, or a personal or family history of heart disease You are pregnant You are a smoker You are unsure of your health status or have any concerns that exercise might be unsafe for you Chances are your health care provider will be pleased with your decision to start an activity program. It is unlikely that you will need a complete medical exam before you go out for a short walk.
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Section 48.2
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Section 48.3
Excess body weight has serious consequences for health. Obesity is responsible for high levels of LDL (bad) cholesterol and triglycerides. At the same time, it lowers HDL (good) cholesterol. It impairs the bodys responsiveness to insulin, raising blood sugar and insulin levels. Obesity contributes to major causes of death and disability, including heart attacks, strokes, high blood pressure, cancer, diabetes, osteoarthritis, fatty liver, and depression. Faced with these risks, its no wonder that you want to know how much you should weigh. But this common and important question is actually the wrong question. For health, the issue is not how much you weigh, but how much abdominal fat you have.
Evaluating Obesity
Methods have changed over the years. But when scientists recognized that what matters is not body weight but body fat, standards began to change. The body mass index (BMI) remains enshrined as the standard way to diagnose overweight and obesity.
Girth Control
Measuring your waist to learn if you have abdominal obesity and excess visceral fat is easybut doing something about it is much harder. Remember the basics. The only way to reduce visceral fat is to lose weightand the only way to do that is to burn up more calories with exercise than you take in from food. Sustained weight loss requires both caloric restriction and increased exercise.
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Chapter 49
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Great Moves
Given the numerous benefits of regular physical activity, you may be ready to get in motion! Three types of activity are important for a complete physical activity program: aerobic activity, resistance training, and flexibility exercises. Aerobic activity is any physical activity that uses large muscle groups and causes your body to use more oxygen than it would while resting. Aerobic activity is the type of movement that most benefits the heart. Examples of aerobic activity are brisk walking, jogging, and bicycling. If youre just starting to be active, try brisk walking for short periods such as 5 or 10 minutes, and build up gradually to 30 to 60 minutes at least five days per week. Always start with a 5-minute, slower paced walk to warm up, and end with a 5-minute, slower paced walk to cool down. Resistance trainingalso called strength trainingcan firm, strengthen, and tone your muscles, as well as improve bone strength, balance, and coordination. Examples of resistance training are pushups, lunges, and bicep curls using dumbbells. Flexibility exercises stretch and lengthen your muscles. These activities help improve joint flexibility and keep muscles limber, thereby preventing injury. An example of a flexibility exercise is sitting crosslegged on the floor and gently pushing down on the tops of your legs to stretch the inner-thigh muscles.
Family Fitness
When it comes to getting in shape, whats good for you is good for your whole family. Children and teenagers should be physically active for at least 60 minutes per day. A great way to pry kids off the couch and help you to stay fit as wellis to do enjoyable activities together. 540
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Creating Opportunities
Its easier to stay physically active over time if you take advantage of everyday opportunities to move around. Use the stairsboth up and downinstead of the elevator. Start with one flight of stairs and gradually build up to more. Park a few blocks from the office or store and walk the rest of the way. If you take public transportation, get off a stop or two early and walk a few blocks. While working, take frequent activity breaks. Get up and stretch, walk around, and give your muscles and mind a chance to relax. Instead of eating that extra snack, take a brisk stroll around the neighborhood or your office building. Do housework, gardening, or yard work at a more vigorous pace. When you travel, walk around the train station, bus station, or airport rather than sitting and waiting.
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Chapter 50
Chapter Contents
Section 50.1Arthritis and Fitness........................................... 544 Section 50.2Exercising Safely with Osteoporosis................... 547
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Section 50.1
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Section 50.2
Many people are unaware of the link between a broken bone and osteoporosis. Osteoporosis, or porous bone, is a disease characterized by low bone mass. It makes bones fragile and more prone to fractures, especially the bones of the hip, spine, and wrist. Osteoporosis is called a silent disease because bone loss occurs without symptoms. People typically do not know that they have osteoporosis until their bones become so weak that a sudden strain, twist, or fall results in a fracture. The following concerns address fitness for those who have had a fracture or who are at risk for a fracture.
Ive always been active, but I dont want to risk breaking another bone. Maybe I need to spend more time on the sidelines from now on.
It is perfectly understandable that you want to avoid another fracture. No one who has broken a bone wants to revisit that pain and loss of independence. However, living your life on the sidelines is not an effective way to protect your bones. Remaining physically active reduces your risk of heart disease, colon cancer, and type 2 diabetes. It may also protect you against prostate and breast cancer, high blood pressure, obesity, and mood disorders such as depression and anxiety. If that isnt enough to convince you to stay active, consider this: exercise is one of the best ways to preserve your bone density and prevent falls as you age.
Physical Fitness for People with Bone Disorders How can I exercise safely if I have osteoporosis?
If you have osteoporosis, it is important for you to get plenty of exercise. However, you will need to choose your activities carefully. Be sure to avoid activities with a high risk of falling, such as skiing or skating; those that have too much impact, such as jogging and jumping rope; and those that cause you to twist or bend, such as golf. Unfortunately, some people become so afraid of breaking another bone that they become more sedentary, which leads to further loss of bone and muscle. Rest assured, however, that by practicing proper posture and learning the correct way to move, you can protect your bones while remaining physically active. Every activity can be adapted to meet your age, ability, lifestyle, and strength. Your doctor or a physical therapist can help you design a safe and effective exercise program. In the meantime, here are some general guidelines for safe movement. Dont do the following: Wear shoes with slippery soles Slouch when standing, walking, or sitting at a desk Move too quickly Engage in sports or activities that require twisting the spine or bending forward from the waist, such as conventional sit-ups, toe touches, or swinging a golf club Do take the following precautions: Pay attention to proper posture. This includes lifting your breastbone, keeping your head erect and eyes forward, keeping your shoulders back, lightly pinching your shoulder blades, and tightening your abdominal muscles and buttocks. Make sure to use a handrail when climbing stairs. Bend from the hips and knees and never from the waist, especially when lifting. Before embarking on any exercise program, be sure to consult your doctor.
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Chapter 51
Chapter Contents
Section 51.1Exercise for People with Asthma. ....................... 552 Section 51.2Exercise-Induced Asthma.................................... 556
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Section 51.1
Fit to Breathe
Be honest. Youre among friendsyou can admit the truth. That New Years resolution to be fit and healthy is teetering just a wee bit, right? After all, this has been a tough asthma, cold, and flu season for most of the country, and darned near impossible to keep up with work, kids, and running errandsmuch less running a mile. The good news is that its never too late to regroup and get back on track. The key is knowing that a fit and healthy body means more than fitting into your jeans or getting rid of that muffin top from your kids. The more fit the family, the better everyone breathes. The Catch-22 for adults and parents of children with asthma is that were taught to slow down and rest during asthma flares. While this advice may be accurate, it was never intended as a long-term solution to controlling asthma. Its no secret that asthma rates have doubled in the past two decades. Its the fifth leading chronic disease among children under 18 in the United States, and its the third most common cause of child hospitalization for children 15 years and younger. But the lesser appreciated stats concern the correlation between obesity and asthma. Factor in the escalating rate of obesitywhich tripled from 6.1 to 17.6% over the past three decades, according to the Centers for Disease Control and Prevention (CDC)and its hard to ignore this dual issue. Obesity doesnt just happen overnight. It sneaks up on you, and in the case of adults and children with asthma and COPD [chronic obstructive pulmonary disease], the consequences are even more serious. So how do you fix things? Contrary to what many parents might think, exercise is great for children with asthma. A Johns Hopkins study found that 20% of all children with asthma dont exercise enough, primarily due to parents 552
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Smart Starts
Fuel up before and refuel after exercise. We lose fluids through sweat and our muscles use up carbohydrate energy. In order for our bodies to recover completely after exercise, we need to replenish these resources. Post-exercise fuel should be consumed within 30 minutes to two hours after exercising. An easy way to refuel is with a healthy shake.
Step by Step
Studies show that exercising on a routine basis reduces the amount of medication needed to control asthma symptoms, and also reduces the number of asthma attacks. Exercise improves lung capacitythe more fit you are, the less likely you are to experience an asthma attack. Resistance training (working out with weights and doing exercises that work your muscles) most likely wont provoke asthma attacks. Heres a customized routine created by Marta Montenegro, founder, CEO, publisher, and editor-in-chief of SOBeFiT magazine, specifically for people with asthma and other respiratory conditions. Before you begin any workout regimen, check with your doctor to determine how much you can exercise based on your fitness level and asthma condition. People with well-controlled asthma should be able to sleep, work, and play like everyone else. Keep asthma medications (such as a bronchodilator) handy when working out in case you become short of breath. Take plenty of time to warm up and cool downat least 10 minutes for each. Walking, baseball, gymnastics, and swimming are great activities for people with asthma! For more high-intensity sports and activities (such as running or soccer), start slow. Gradually increase the intensity over time. Avoid exercising outside on days when air pollution is high or in cold or dry air. If you have seasonal allergies, you might need to avoid activities on high pollen days, as well. Talk with an allergist about immunotherapy if your allergies keep you from doing your favorite activities. If you start to have asthma symptoms during exercisestop, and follow your asthma action plan, including medication if 555
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Section 51.2
Exercise-Induced Asthma
Exercise-Induced Asthma, 2005 Asthma and Allergy Foundation of America (www.aafa.org). All rights reserved. Reprinted with permission. Reviewed by David A. Cooke, MD, FACP, May 2010.
Everyone needs to exercise, even people with asthma! A strong healthy body is one of your best defenses against disease. But some people with asthma have exercise-induced asthma (EIA). But with proper medical prevention and management you should be able to walk, climb stairs, run, and participate in activities, sports, and exercise without experiencing symptoms. You dont have to let EIA keep you from leading an active life or from achieving your athletic dreams.
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Chapter 52
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Physical Fitness for People with Diabetes Can physical activity cause low blood glucose?
Physical activity can cause low blood glucose, also called hypoglycemia, in people who take insulin or certain types of diabetes medicines. Ask your health care team whether your diabetes medicines can cause low blood glucose. Low blood glucose can happen while you exercise, right afterward, or even up to a day later. It can make you feel shaky, weak, confused, grumpy, hungry, or tired. You may sweat a lot or get a headache. If your blood glucose drops too low, you could pass out or have a seizure. However, you should still be physically active. These steps can help you be prepared for low blood glucose: Before Exercise Ask your health care team whether you should check your blood glucose level before exercising. If you take diabetes medicines that can cause low blood glucose, ask your health care team whether you should take the following precautions: Change the amount you take before you exercise Have a snack if your blood glucose level is below 100 During Exercise Wear your medical identification (ID) bracelet or necklace or carry your ID in your pocket. Always carry food or glucose tablets so youll be ready to treat low blood glucose. If youll be exercising for more than an hour, check your blood glucose at regular intervals. You may need snacks before you finish. After Exercise Check to see how exercise affected your blood glucose level. If your blood glucose is below 70, have one of the following right away: 3 or 4 glucose tablets 1 serving of glucose gelthe amount equal to 15 grams of carbohydrate 1/2 cup (4 ounces) of any fruit juice 565
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Physical Fitness for People with Diabetes What can I do to make sure I stay active?
One of the keys to staying on track is finding some activities you like to do. If you keep finding excuses not to exercise, think about why. Are your goals realistic? Do you need a change in activity? Would another time be more convenient? Keep trying until you find a routine that works for you. Once you make physical activity a habit, youll wonder how you lived without it.
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Chapter 53
Chapter Contents
Section 53.1Physical Fitness and Cancer Prevention............ 570 Section 53.2Exercise during Cancer Treatment..................... 577
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Section 53.1
Physical Fitness and Cancer How much physical activity do adults need?
The Centers for Disease Control and Prevention (CDC) recommend that adults engage in moderate-intensity physical activity for at least 30 minutes on five or more days of the week, or engage in vigorousintensity physical activity for at least 20 minutes on three or more days of the week.1 Examples of moderate-intensity and vigorous-intensity physical activities can be found on the CDC Physical Activity website at www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Intensity_table_2_1.pdf.
What is the relationship between physical activity and colon cancer risk?
Colorectal cancer has been one of the most extensively studied cancers in relation to physical activity, with more than 50 studies examining this association. Many studies in the United States and around the world have consistently found that adults who increase their physical activity, either in intensity, duration, or frequency, can reduce their risk of developing colon cancer by 30 to 40% relative to those who are sedentary regardless of body mass index (BMI), with the greatest risk reduction seen among those who are most active.37 The magnitude of the protective effect appears greatest with high-intensity activity, although the optimal levels and duration of exercise are still difficult to determine due to differences between studies, making comparisons difficult. It is estimated that 30 to 60 minutes of moderate to vigorous physical activity per day is needed to protect against colon cancer.6,7 It is not yet clear at this time whether physical activity has a protective effect for rectal cancer, adenomas, or polyp recurrence.3 Physical activity most likely influences the development of colon cancer in multiple ways. Physical activity may protect against colon cancer and tumor development through its role in energy balance, hormone metabolism, insulin regulation, and by decreasing the time the colon is exposed to potential carcinogens. Physical activity has also been found to alter a number of inflammatory and immune factors, some of which may influence colon cancer risk.
What is the relationship between physical activity and breast cancer risk?
The relationship between physical activity and breast cancer incidence has been extensively studied, with over 60 studies published in North America, Europe, Asia, and Australia. Most studies indicate that physically active women have a lower risk of developing breast 571
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What is the relationship between physical activity and risk of endometrial cancer?
About 20 studies have examined the role of physical activity on endometrial cancer risk. The results suggest an inverse relationship between physical activity and endometrial cancer incidence. These studies suggest that women who are physically active have a 20 to 40% reduced risk of endometrial cancer,6 with the greatest reduction in risk among those with the highest levels of physical activity. Risk does not appear to vary by age.4 Changes in body mass and changes in the levels and metabolism of sex hormones, such as estrogen, are the major biological mechanisms thought to explain the association between physical activity and endometrial cancer. However, fewer than half of the studies in this area have also adjusted for the potential effect of postmenopausal hormone use, which may increase the risk of endometrial cancer. A few studies have examined whether the effect of physical activity varies according to the weight of the woman, but the results have been inconsistent. 572
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Physical Fitness and Cancer What is the relationship between physical activity and lung cancer risk?
At least 21 studies have examined the impact of physical activity on the risk of lung cancer. Overall, these studies suggest an inverse association between physical activity and lung cancer risk, with the most physically active individuals experiencing about a 20% reduction in risk.4,6 An analysis of many existing studies found evidence that higher levels of physical activity protect against lung cancer, but was unable to fully control for the effects of smoking or respiratory disease in estimating the magnitude of the potential benefit.6,8 The relationship between physical activity and lung cancer risk is less clear for women than it is for men.
What is the relationship between physical activity and risk of prostate cancer?
Research findings are less consistent about the effect of physical activity on prostate cancer, with at least 36 studies in North America, Europe, and Asia. Overall, the epidemiologic research does not indicate that there is an inverse relationship between physical activity and prostate cancer.4,7 Although it is possible that men who are physically active experience a reduction in risk of prostate cancer, the potential biological mechanisms that may explain this association are unknown, but may be related to changes in hormones, energy balance, insulin-like growth factors, immunity, and antioxidant defense mechanisms.7 One recent study suggested that regular vigorous activity could slow the progression of prostate cancer in men age 65 or older.9
Is the National Cancer Institute (NCI) exploring the role of physical activity in the prognosis and quality of life of cancer patients?
NCI-funded studies are exploring the ways in which physical activity may improve the prognosis and quality of life of cancer patients and survivors. For more information about current research in this area, please visit NCIs Cancer Survivorship Research website at cancercontrol .cancer.gov/ocs.
Physical Fitness and Cancer Do any of these studies focus on special populations who are at increased risk of cancer?
NCI funds a number of research projects and interventions aimed at helping vulnerable populations reduce their risk of cancer by becoming more active, changing their nutritional behavior, and/or maintaining an optimal weight. Populations included in these projects include multiethnic working poor populations, African American women, rural communities, overweight or obese individuals, and cancer survivors. Several NCI-funded studies have started examining the factors related to long-term behavior change and increases in physical activity. NCI is supporting national and regional surveys, as well as research methodology development, to gain more accurate information about physical activity across all age groups and diverse populations, as defined by race, ethnicity, income, and other factors known to influence levels of physical activity. This information will help identify groups who may benefit from programs to increase physical activity.
Selected References
1. National Center for Chronic Disease Prevention and Health Promotion and Centers for Disease Control and Prevention (1996). Physical Activity and Health: A Report of the Surgeon General. Retrieved June 26, 2009, from www.cdc.gov/nccdphp/sgr/sgr.htm. 2. National Center for Chronic Disease Prevention and Health Promotion and Centers for Disease Control and Prevention (2008). Preventing Obesity and Chronic Diseases through Good Nutrition and Physical Activity. Retrieved June 26, 2009, from www.cdc.gov/ nccdphp/publications/factsheets/Prevention/obesity.htm. 3. Slattery, ML. Physical activity and colorectal cancer. Sports Medicine 2004; 34(4): 239252. 4. IARC Handbooks of Cancer Prevention. Weight Control and Physical Activity. Vol. 6. 2002. 5. Ballard-Barbash R, Friedenreich C, Slattery M, Thune L. Obesity and body composition. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006. 6. Lee I, Oguma Y. Physical activity. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press, 2006. 575
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Section 53.2
What Is Cancer?
According to the American Cancer Society (ACS), there are more than 100 different diseases that are classified as cancer. The common thread among these different types of cancers is that they all start as abnormal cells that grow out of control in some part of the body. The ACS estimates that more than 1.4 million Americans were newly diagnosed with cancer and more than a half million were expected to die of the disease in 2008. The three most common cancers occurring in men are prostate, lung, and colorectal cancers; in women, breast, lung, and colorectal cancers are the three most common. Cancer may be treated by a number of methods, either alone or in combination. These treatments include surgery, radiation, chemotherapy, hormonal therapy, and biological therapy.
Special Considerations
Individuals are potentially different in their responses to cancer treatment. Exercise programs may need to be modified to allow for down days in the treatment cycle. In the case of chemotherapy or biological therapy, this may mean avoiding or scaling back exercise on days when side effects from treatment are more pronounced. In the case of radiation therapy, exercise may need to be reduced, or in some cases avoided, toward the end of treatment and/or in the early weeks following treatment. If an individual is not regularly active and wishes to start an exercise program during cancer treatment, they may need to start with low-intensity exercise, consisting of slow walks, and gradually progress exercise over time. If they will be receiving chemotherapy, it may be wise to wait one chemotherapy cycle to see the response to treatment prior to starting an exercise program. Individuals undergoing cancer treatment should: obtain approval from their oncologist (cancer doctor) before starting an exercise program; have vital signs (temperature, pulse/ heart rate, blood pressure, respiration rate) monitored regularly (if participating in moderate-to-vigorous exercise, have their blood pressure and heart rate monitored before, during, and after exercise to ensure that participation in exercise is appropriate and safe); exercise with a partner, caregiver, or exercise professional for safety reasons; avoid public fitness facilities and activities (e.g., swimming), where there may be an increased risk of exposure to viral and/or bacterial infection; avoid swimming if undergoing radiation therapy treatments or if they have an indwelling catheter (a tube that goes in the body), such as a central venous catheter or peripherally inserted central catheter; 578
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Exercise Precautions
Although exercise may be an effective intervention for cancer patients undergoing treatment, it is important to recognize there may be factors that make it unwise to exercise. In these cases, exercise may be still beneficial; however, the risks may be higher, and close medical supervision may be required. According to the ACS, the following are specific precautions to be aware of during cancer treatment: Anemia (low red blood cell count): If the red blood cell count is low, the bodys ability to carry oxygen to the tissues is reduced. Exercise may need to be scaled back and possibly avoided. Neutropenia (low white blood cell count): If the white blood cell count is low, the bodys ability to fight infection is reduced. Exercise should be avoided if there is a fever above 100.4 F (>38 C). Thrombocytopenia (low platelet count): If platelet count is low, there is an increased risk of bruising and bleeding. Avoid contact sports or activities with high risk of injury or falling. Report any unusual bruising or symptoms, such as nose bleeds, to a doctor. Side effects such as vomiting and diarrhea, and symptoms such as swollen ankles, unexplained weight loss/gain, or shortness of breath with low levels of exertion may make exercise unsafe. Check with a doctor before exercising. 579
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Conclusion
Research evidence suggests that individuals with cancer who follow recommended guidelines and observe specific precautions can safely exercise during cancer treatment.
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Chapter 54
accumulate: The concept of meeting a specific physical activity dose or goal by performing activity in short bouts, then adding together the time spent during each of these bouts. For example, a goal of 30 minutes a day could be met by performing three bouts of 10 minutes each throughout the day. adaptation: The bodys response to exercise or activity. Some of the bodys structures and functions favorably adjust to the increase in demands placed on them whenever physical activity of a greater amount or higher intensity is performed than what is usual for the individual. These adaptations are the basis for much of the improved health and fitness associated with increases in physical activity. aerobic exercise: Any continuous activity of large muscle groups that forces your heart and lungs to work harder. Aerobic means your heart and lungs are using oxygen. Examples include walking, swimming, stair climbing, and jumping rope.2 anaerobic exercise: Exercise that requires your body to perform at a great effort for a relatively short duration. This type of exercise
This glossary contains terms excerpted from glossaries produced by the following government agencies: Centers for Disease Control and Prevention (www.cdc.gov); National Womens Health Information Center (www.womenshealth.gov), marked with a superscript 1; U.S. Department of Agriculture Center for Nutrition Policy and Promotion (www.mypyramidtracker.gov), marked with a superscript 2; and the Weight-Control Information Network, National Institute of Diabetes and Digestive and Kidney Diseases (www.win.niddk.gov), marked with a superscript 3.
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Chapter 55
The resources listed in this chapter were compiled from many sources deemed accurate. Inclusion does not constitute endorsement and there is no implication associated with omission. All contact information was verified in April 2010.
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Fitness and Exercise Sourcebook, Fourth Edition National Cancer Institute (NCI) NCI Public Inquiries Office 6116 Executive Boulevard Suite 300 Bethesda, MD 20892-8322 Toll-Free: 800-4-CANCER (422-6237), Monday through Friday 9:00 a.m. to 4:30 p.m., EST Live chat: http://cissecure.nci .nih.gov/livehelp/welcome.asp Website: http://www.cancer.gov National Center for Complementary and Alternative Medicine (NCCAM) NCCAM Clearinghouse P.O. Box 7923 Gaithersburg, MD 20898 Toll-Free: 888-644-6226 TTY: 866-464-3615 Fax: 866-464-3616 Website: http://nccam.nih.gov National Diabetes Information Clearinghouse 1 Information Way Bethesda, MD 20892-3560 Toll-Free: 800-860-8747 Toll-Free TTY: 866-569-1162 Fax: 703-738-4929 Website: http://diabetes.niddk .nih.gov E-mail: [email protected] National Heart, Lung, and Blood Institute (NHLBI) NHLBI Health Information Center Attention: Web site P.O. Box 30105 Bethesda, MD 20824-0105 Phone: 301-592-8573 TTY: 240-629-3255 Fax: 240-629-3246 Website: http://www.nhlbi.nih .gov E-mail: [email protected] .nih.gov National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse National Institutes of Health 1 AMS Circle Bethesda, MD 20892-3675 Toll Free: 877-22-NIAMS (226-4267) Phone: 301-495-4484 TTY: 301-565-2966 Fax: 301-718-6366 Website: http://www.niams.nih .gov E-mail: [email protected] .gov
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Directory of Fitness Resources National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Office of Communications & Public Liaison Building 31, Room 9A06 31 Center Drive, MSC 2560 Bethesda, MD 20892-2560 Phone: 301-496-3583 Website: http://www.niddk.nih .gov National Institute of Mental Health (NIMH) 6001 Executive Boulevard Room 8184, MSC 9663 Bethesda, MD 20892-9663 Toll-Free: 866-615-NIMH (615-6464) Toll-Free TTY: 866-415-8051 Phone: 301-443-4513 TTY: 301-443-8431 Fax: 301-443-4279 Website: http://www.nimh.nih .gov E-mail: [email protected] National Institute on Aging (NIA) Building 31, Room 5C27 31 Center Drive, MSC 2292 Bethesda, MD 20892 Toll-Free: 800-222-2225 (Publications Only) Toll-Free TTY: 800-222-4225 Phone: 301-496-1752 Fax: 301-496-1072 Website: http://www.nia.nih.gov National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, MD 20892 Phone: 301-496-4000 TTY: 301-402-9612 Website: http://www.nih.gov E-mail: [email protected] National Library of Medicine Reference and Web Services 8600 Rockville Pike Bethesda, MD 20894 Toll-Free: 888-FIND-NLM (346-3656) Toll-Free TDD: 800-735-2258 (via Maryland Relay Service) Phone: 301-594-5983 Fax: 301-402-1384 Interlibrary loan fax: 301-496-2809 Website: http://www.nlm.nih.gov E-mail: [email protected] National Womens Health Information Center U.S. Department of Health and Human Services 8270 Willow Oaks Corporate Drive Fairfax, VA 22031 Toll-Free: 800-994-9662 Toll-Free TTD: 888-220-5446 Website: http://www. womenshealth.gov
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Fitness and Exercise Sourcebook, Fourth Edition Presidents Council on Physical Fitness and Sports (PCPFS) Department W Tower Building, Suite 560 1101 Wootton Parkway Rockville, MD 20852 Phone: 240-276-9567 Fax: 240-276-9860 Website: http://www.fitness.gov E-mail: [email protected] Smallstep U.S. Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201 Toll-Free: 877-696-6775 (Hotline) Website: http://www.smallstep .gov U.S. Consumer Product Safety Commission 4330 East West Highway Bethesda, MD 20814 Toll-Free: 800-638-2772 (Hotline; 8:00 a.m.5:30 p.m. EST) Toll-Free TTY: 800-638-8270 (Hotline; 8:00 a.m.5:30 p.m. EST) Phone: 301-504-7923 (General Information; MondayFriday 8:00 a.m.4:30 p.m. EST) Fax: 301-504-0124 and 301-5040025 Website: http://www.cpsc.gov U.S. Department of Health and Human Services (HHS) 200 Independence Avenue, SW Washington, DC 20201 Toll-Free: 877-696-6775 (Hotline) Website: http://www.hhs.gov Weight-Control Information Network (WIN) National Institute of Diabetes and Digestive and Kidney Diseases 1 WIN Way Bethesda, MD 20892-3665 Toll-Free: 877-946-4627 Fax: 202-828-1028 Website: http://win.niddk.nih.gov E-mail: [email protected]
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Directory of Fitness Resources American Academy of Orthopaedic Surgeons (AAOS) 6300 North River Road Rosemont, IL 60018-4262 Phone: 847-823-7186 Fax: 847-823-8125 Website: http://www.aaos.org E-mail: [email protected] American Alliance for Health, Physical Education, Recreation, & Dance 1900 Association Drive Reston, VA 20191-1598 Toll-Free: 800-213-7193 Phone: 703-476-3400 Website: http://www.aahperd.org American College of Sports Medicine (ACSM) P.O. Box 1440 Indianapolis, IN 46206-1440 Phone: 317-637-9200 Fax: 317-634-7817 Website: http://www.acsm.org American Council on Exercise (ACE) 4851 Paramount Drive San Diego, CA 92123 Toll-Free: 888-825-3636 Phone: 858-279-8227 Fax: 858-576-6564 Website: http://www.acefitness .org E-mail: [email protected] American Diabetes Association 1701 North Beauregard Street Alexandria, VA 22311 Phone: 800-DIABETES (342-2383) Website: http://www.diabetes .com American Heart Association 7272 Greenville Avenue Dallas, TX 75231-4596 Toll-Free: 800-AHA-USA1 (242-8721) Website: www.americanheart .org American Stroke Association 7272 Greenville Avenue Dallas TX 75231 Toll-Free: 888-4-STROKE (478-7653) Website: http://www .americanheart.org American Lung Association National Headquarters 1301 Pennsylvania Avenue, NW Suite 800 Washington, DC 20004 Toll-Free: 800-LUNGUSA (800-586-4872) Toll-Free: 800-548-8252 (Helpline) Phone: 202-785-3355 Fax: 202-452-1805 Website: http://www.lungusa.org E-mail: [email protected]
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Fitness and Exercise Sourcebook, Fourth Edition American Orthopaedic Society for Sports Medicine (AOSSM) 6300 North River Road Suite 500 Rosemont, IL 60018 Phone: 847-292-4900 Website: http://www.sportsmed .org E-mail: [email protected] American Physical Therapy Association (APTA) 1111 North Fairfax Street Alexandria, VA 22314-1488 Toll-Free: 800-999-2782 Phone: 703-684-APTA (684-2782) TDD: 703-683-6748 Fax: 703-684-7343 Website: http://www.apta.org E-mail: [email protected] American Physiological Society 9650 Rockville Pike Bethesda, MD 20814-3991 Phone: 301-634-7164 Fax: 301-634-7241 Website: http://www.the-aps.org American Running Association (ARA) 4405 East-West Highway Suite 405 Bethesda, MD 20814 Phone: 800-776-2732 ext. 13 or ext. 12 Fax: 301-913-9520 Website: http://www .americanrunning.org Arthritis Foundation (AF) P.O. Box 7669 Atlanta, GA 30357-0669 Toll-Free: 800-283-7800 Website: http://www.arthritis.org Asthma and Allergy Foundation of America (AAFA) 8201 Corporate Drive, Suite 1000 Landover, MD 20785 Toll-Free: 800-7-ASTHMA (727-8462) Website: http://www.aafa.org E-mail: [email protected] Aquatic Exercise Association (AEA) P.O. Box 1609 Nokomis, FL 34274-1609 Website: http://www.aeawave .com Cleveland Clinic 9500 Euclid Avenue Cleveland, OH 44195 Toll-Free: 800-223-2273 Phone: 216-444-2200 TTY: 216-444-0261 Website: http://www .clevelandclinic.org Disabled Sports USA (DS/USA) 451 Hungerford Drive Suite 100 Rockville, MD 20850 Phone: 301-217-0960 Fax: 301-217-0968 Website: http://www.dsusa.org E-mail: [email protected]
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Directory of Fitness Resources HealthyWomen 157 Broad Street Suite 106 Red Bank, NJ 07701 Toll-Free: 877-986-9472 Fax: 732-530-3347 Website: http://www .healthywomen.org IDEA Health & Fitness Association 10455 Pacific Center Court San Diego, CA 92121 Toll-Free: 800-999-4332, ext. 7 Phone: 858-535-8979, ext. 7 Fax: 858-535-8234 Website: http://www.ideafit.com E-mail: [email protected] International Fitness Association (IFA) 12472 Lake Underhill Road #341 Orlando, FL 32828 Toll-Free: 800-227-1976 Phone: 407-579-8610 Website: http://www.ifafitness .com Kidshealth.org Nemours Foundation Website: http://www.kidshealth .org National Alliance for Youth Sports (NAYS) National Headquarters 2050 Vista Parkway West Palm Beach, FL 33411 Toll-Free: 800-688-KIDS (729-2057) Phone: 561-684-1141 Fax: 561-684-2546 Website: http://www.nays.org E-mail: [email protected] National Association for Health and Fitness (NAHF) c/o Be Active New York State 65 Niagara Square Room 607 Buffalo, NY 14202 Phone: 716-583-0521 Fax: 716-851-4309 Website: http://www .physicalfitness.org E-mail: wellness@city-buffalo .org National Center on Physical Activity and Disability (NCPAD) University of Illinois at Chicago Department of Disability and Human Development Toll-Free: 800-900-8086 Website: http://www.ncpad.org E-mail: [email protected]
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Fitness and Exercise Sourcebook, Fourth Edition National Coalition for Promoting Physical Activity 1100 H Street, NW Suite 510 Washington, DC 20005 Phone: 202-454-7521 Fax: 202-454-7598 Website: http://www.ncppa.org E-mail: [email protected] National Osteoporosis Foundation (NOF) 1150 17th Street, NW Suite 850 Washington, DC 20036 Toll-Free: 800-231-4222 Phone: 202-223-2226 Website: http://www.nof.org National Recreation and Park Association (NRPA) 22377 Belmont Ridge Road Ashburn, VA 20148-4501 Toll-Free: 800-626-NRPA (626-6772) Website: http://www.nrpa.org National Strength and Conditioning Association (NSCA) 1885 Bob Johnson Drive Colorado Springs, CO 80906 Toll-Free: 800-815-6826 Phone: 719-632-6722 Fax: 719-632-6367 Website: http://www.nsca-lift.org E-mail: [email protected] PE Central P.O. Box 10262 1995 South Main Street Suite 902 Blacksburg, VA 24062 Phone: 540-953-1043 Fax: 540-301-0112 Website: http://www.pecentral .org E-mail: [email protected] Shape Up America P.O. Box 149 506 Brackett Creek Road Clyde Park, MT 59018-0149 Phone: 406-686-4844 Website: http://www.shapeup.org Womens Sports Foundation National Office Eisenhower Park 1899 Hempstead Turnpike Suite 400 East Meadow, NY 11554 Toll-Free: 800-227-3988 Phone: 516-542-4700 Fax: 516-542-4716 Website: http://www .womenssportsfoundation.org E-mail: Info@ WomensSportsFoundation.org World Health Organization Avenue Appia 20 1211 Geneva 27 Switzerland Phone: +41 22 791 21 11 Fax: +41 22 791 31 11 Website: http://www.who.int E-mail: [email protected]
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Index
Page numbers followed by n indicate a footnote. Page numbers in italics indicate a table or illustration.
A
AAFA see Asthma and Allergy Foundation of America abdominal muscles, exercises 37374 abdominal obesity, described 53435 Abdominal Obesity and Your Health (Harvard University) 533n About BMI for Adults (CDC) 242n absolute intensity adults 587 defined 587 measurement 22627 accumulate, defined 583 ACE see American Council on Exercise Achilles stretch 16465 Achilles tendon injuries, described 460 ACSM see American College of Sports Medicine Action for Healthy Kids, contact information 594 Active at Any Size (NIDDK) 520n
Active Start: A Statement of Physical Activity Guidelines for Children from Birth to Age 5 (NASPE) 87n Active Transportation for Americans: The Case for Increased Federal Investment in Bicycling and Walking (Gotschi; Mills) 342n acute fractures, described 460 acute injuries children 473 described 461 adaptation, defined 583 adolescents body mass index 246 fitness guidelines 9799 physical activity benefits 6 physical activity motivations 11619 physical activity recommendations 112 physical fitness overview 10614 tennis 307 adults community environment 18485 fitness guidelines 13238 physical activity benefits 67 recreation environments 18788 tennis 308 adverse events, physical activity 14 AEA see Aquatic Exercise Association
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Index
Americans with Disabilities Hotline, contact information 591 anaerobic exercise defined 58384 tennis 309 Ananda yoga 401 animal studies dementia 4041 physical inactivity 61 ankle circling 163 anorexia athletica 486 AOSSM see American Orthopaedic Society for Sports Medicine appetite, exercise 4950 APTA see American Physical Therapy Association Aquatic Exercise Association (AEA), contact information 596 ARA see American Running Association Are People Physically Inactive Because of Their Genes? (PCPFS) 57n Are You Ready for Indoor Cycling? (IDEA Health and Fitness Inc.) 350n arm curl 166 arm extension 166 arthritis, exercise 54446 Arthritis Basics: Frequently Asked Questions (CDC) 544n Arthritis Foundation (AF), ontact information 596 art therapy, described 400 As Good as the Real Thing? (ACE) 421n Ashtanga yoga 402 asthma exercise-induced 55659 exercise overview 55256 physical fitness 3435 Asthma and Allergy Foundation of America (AAFA) contact information 596 exercise-induced asthma publication 556n athletic shoes, described 44142
B
back leg swing 166 backstretch 16364 bad cholesterol see low-density lipoprotein (LDL) cholesterol balance, tennis 310 balance exercises, older adults 161, 176, 17981 balance training, defined 584 baseball helmets 445 physical education 103 baseline, walking programs 334 baseline activity defined 584 fitness guidelines 75 basketball calories used 48 physical education 103 Be Active Your Way: A Guide for Adults (DHHS) 194n Beginning Strength Training (University of Michigan) 362n Behavioral Risk Factor Surveillance System (BRFSS) 6772 The Benefits of Exercise: How to Get Moving and Supercharge Your Life (Kovatch; Smith) 204n Berch, Rama 402 bicycling calories used 48 helmets 44344 intensity 226, 227 older adults 175 osteoporosis 548 overview 34249 overweight 525 Bikram yoga 402 Birch, Bender 402 BMI see body mass index body compensation, defined 584 body fat, weight training myths 52932 body mass index (BMI) abdominal fat 53335 defined 584 obesity 588 overview 24247
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C
calf raise 167 calisthenics, defined 584 calorie, defined 584 calorie balance, defined 58485 calorie expenditure bicycling 346 defined 585 physical activities 48, 23239, 241 physical activity 5395407 Calories Burned per Hour (Wisconsin DHFS) 232n cancers exercise 15455 physical activity 13 physical fitness 57076 physical inactivity 1516 cancer treatment, exercise 57780 Can Exercise Reduce Your Risk of Catching a Cold? (ACE) 26n carbohydrates, defined 585 cardio machines, described 26970 cardiorespiratory endurance, defined 585 cardiorespiratory health, physical activity 910
604
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
Index
Cohen, Emma 260 Colcombe, Stanley J. 40 common cold, immune system 2627 community environment disabled people 50917 physical fitness 18390 compartment syndrome, described 459 Compulsive Exercise (Nemours Foundation) 486n compulsive exercise, overview 48690 concussion, overview 46668 Consumer Product Safety Commission (CPSC), helmets publication 443n Cooke, David A. 15n, 19n, 51n, 141n, 232n, 278n, 283n, 287n, 290n, 328n, 332n, 337n, 373n, 383n, 428n, 448n, 450n, 544n, 556n cool down defined 585 older adults 178 safety considerations 439 coordination, tennis 310 coronary heart disease see heart disease Courneya, Kerry 577n Covassin, Tracey 466n CPSC see US Consumer Product Safety Commission cross-country, physical education 103 cross training overview 38889 tennis 310 water based exercise 319 Cross Training: Get Fit and Dont Quit (OrthoIndy) 388n Curry, Jennifer 3023 dancing, continued overweight 524 physical education 103 death rates, daily exercise 13840 Define Your Goals (CDC) 212n dehydration defined 585 described 44849 dementia, physical activity 4042 Department of Health and Human Services (DHHS; HHS) see US Department of Health and Human Services depression, exercise 205 Desai, Amrit 402 Developing Grade-A Abs (IDEA Health and Fitness Inc.) 373n DHHS see US Department of Health and Human Services diabetes mellitus defined 58586 physical fitness 56167 women 14243 diet and nutrition asthma 55455 immune system 27 older adults 16061 osteoporosis prevention 32 outdoor exercise safety 49293 overtraining 484 sports activities 45056 Dietary Guidelines for Americans 7379, 160, 487 Dietz, William H. 343 DiLella, Mark 388 disabilities children 99 physical activity overview 50617 disabled children, fitness guidelines 99 Disabled Sports USA (DS/USA), contact information 596 disease prevention, fitness guidelines 76 dislocations, described 461 Does Exercise Affect Resting Metabolism? (Melby) 51n Dose Response to Exercise in postmenopausal Women (DREW) 146
D
Daily Exercise Dramatically Lowers Mens Death Rates (American Heart Association) 138n dancing calories used 48 intensity 227 older adults 175 osteoporosis 548 overview 3016
605
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
E
elastic band resistance exercise 37881 elderly, fitness guidelines 17278 elliptical trainers, overview 27882 endometrial cancer, physical activity 572 endurance exercise, metabolic rate 5253 energy, exercise 205 energy balance, physical activity 1011 epigenetic effects, described 6263 erector spinae 374 Erickson, Kirk I. 40 Eschbach, Chris 169n ethnic factors, women, fitness 155 exercise arthritis 54446 barriers 21723, 512, 521 benefits 2046 defined 586 friends 25860 life satisfaction 1920 metabolic rate 5253 myths 2056 osteoporosis 54749 women 15155 see also physical activity Exercise and Arthritis (DHHS) 544n Exercise and Bone Health (NIAMS) 31n, 482n Exercise and Life-SatisfactoryFitness (Jennen; Uhlenbruck) 19n Exercise Can Help Control Stress (ACE) 38n
F
fall prevention, physical activity 1213 family issues exercise 26163 exercise programs 210 physical activity 54041 family studies, physical inactivity 6061 Fast Facts about Sports Nutrition (PCPFS) 450n Fat Loss and Weight Training Myths (ExRx.net LLC) 529n fats, defined 586 see also body fat
606
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
Index
financial considerations health care 155 obesity 34445 personal trainers 255 physical inactivity 1516, 150 finger squeeze 165 finger stretching 163 fitness, women 15558 Fitness and Your 13- to 18-Year-Old (Nemours Foundation) 109n Fitness and Your Feet (American Podiatric Medical Association) 477n Fitness for Kids Who Dont Like Sports (Nemours Foundation) 120n fitness guidelines adolescents 9799 adults 13238 baseline activity 75 children 9799 disabled children 99 disease prevention 76 elderly 17278 lifestyle choices 7374 overview 7379 school-aged youth 9399 fitness instructors, health clubs 25253 fitness model, interval training 391 Fitness Predicts Longevity in Older Adults (NIH) 28n fitness training, dementia prevention 4041 fitness yoga 403 Fit to Breathe (Allergy and Asthma Network Mothers of Asthmatics) 552n flexibility benefits 207 defined 586 older adults 178 tennis 311 flexibility exercises described 540 older adults 16265 overview 38385 Flexibility in Aging: Stretching to Mend the Bend (Klein) 383n fluids see hydration football helmets 445 physical education 103 foot care, overview 47780 foot circling 163 fractures, described 46061 frequency aerobic activity 5 muscle strengthening activity 5 resistance training programs 372 Froelicher, Victor F. 29 functional ability physical activity 1213 tai chi 412 functional exercises, abdominal muscles 374 functional limitations, older adults 178
G
Galson, Steven 343 gardening calories used 48 intensity 227 older adults 175 osteoporosis 548 gender factor leisure time activities 22 life satisfaction 20 girls compulsive exercise 488 physical fitness 12429 sports activities 15152 goal setting exercise programs 211 overview 21216 golf calories used 48 older adults 175 good cholesterol see high-density lipoprotein (HDL) cholesterol Gotschi, Thomas 342n Government of Ontario Ministry of the Environment, air pollution publication 495n Grevelding, Mark 319n guided imagery, described 399
607
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
H
half bow 165 hand rotation 163 Harvard University, abdominal fat publication 533n Hatha yoga 402, 403 head and shoulder curl 166 Health Benefits of Water-Based Exercise (CDC) 316n health clubs, overview 25053 health conditions, exercise overview 5014 health enhancing physical activity, fitness guidelines 75 Healthy People 2010 6772, 7379 healthy weight, defined 586 Healthy Women, contact information 597 heart disease defined 586 physical activity 3334 physical fitness 53741 women 14143 heart rate defined 587 perceived exertion rating 229 see also resting heart rate; target heart rate heat exhaustion, described 49394 heat stroke, described 49394 heel raises 166 helmets, overview 44346 Hendrickson, Kirsten 392, 394 heredity, physical inactivity 5763 HHS see US Department of Health and Human Services high blood pressure see hypertension high-density lipoprotein (HDL) cholesterol, described 585
I
IDEA Health and Fitness Association contact information 597 publications abdominals 373n health clubs 250n indoor cycling 350n interval training 390n personal trainers 254n IFA see International Fitness Association immobilization, sports injuries 464 immune system physical activity 2627 tai chi 412 tennis 311 In Brief: Your Guide to Physical Activity and Your Heart (NHLBI) 537n Increasing Physical Activity in People with Disabilities (PCPFS) 506n
608
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
Index
Indiana University, mental illness publication 42n indoor cycling, overview 35052 insurance coverage health clubs 251 personal trainers 257 intensity adults 13435 aerobic activity 5, 277 defined 587 muscle strengthening activity 5 older adults 17475 International Fitness Association (IFA), contact information 597 interval training defined 587 overview 39091 power training 416 Interval Training for All (IDEA Health and Fitness Inc.) 390n Iyengar, B.K.S. 402 Iyengar yoga 402 Kramer, Arthur F. 4041 Kress, Jeffrey 337n Kripalu yoga 402 Kundalini yoga 402
L
lactic acid, interval training 390 leg extensions 166 leisure-time physical activity defined 58788 life satisfaction 20, 24 lifestyle activities defined 588 diabetes mellitus 56162 overweight 526 see also sedentary lifestyles lifestyle choices, fitness guidelines 7374 Little League elbow 474 Lloyd, Lisa K. 51n longevity, fitness 2829 low-density lipoprotein (LDL) cholesterol, described 585 lung cancer, physical activity 573
J
Jacobson, Tesha Marie 3034 Jakicic, John 49 Jennen, Christiane 19n Jivamukti yoga 402 jogging see running jump rope intensity 227 physical education 103
M
McCormick, Bryan 43 McNeely, Margaret 577n Making Exercise Fun for the Whole Family (Boys Town Pediatrics) 261n Mallett, Tracey 393 Mandic, Sandra 2930 Martin, Valentina 3045 massage therapy, described 399 maximal oxygen uptake (VO2 max), defined 588 Maximizing Metabolism for Weight Loss (Miller; Lloyd) 51n Measuring Physical Activity Intensity (CDC) 226n medications exercise-induced asthma 55758 sports injuries 46364 meditation, described 399 Melby, Chris 51n menopause, exercise 16970
K
Kenney, W. Larry 449 Kickboxing (Nemours Foundation) 297n kickboxing, overview 297300 Kidshealth.org, website address 597 Klein, Diane Austrin 383n knee flexion 180 knee injuries children 474 described 459 knee lift 166 Kokkinos, Peter 13840 Kovatch, Sarah 204n
609
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
N
NAF see National Osteoporosis Foundation NAHF see National Association for Health and Fitness NASPE see National Association for Sport and Physical Education National Alliance for Youth Sports (NAYS), contact information 597 National Association for Health and Fit ness (NAHF), contact information 597 National Association for Sport and Physical Education (NASPE), physical activity, children, publications 82n, 87n National Cancer Institute (NCI) cancer prevention, physical fitness publication 570n contact information 592 National Center for Complementary and Alternative Medicine (NCCAM) contact information 592 tai chi publication 410n National Center on Physical Activity and Disability (NCPAD), contact information 597 National Coalition for Promoting Physical Activity, contact information 598 National Diabetes Information Clear inghouse, contact information 592 National Heart, Lung, and Blood Institute (NHLBI) contact information 592 publications aerobic exercise 276n outdoor exercise safety 492n physical fitness, heart conditions 537n National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) contact information 592 publications bone health 31n osteoporosis 547n sports injuries 458n women, bone health 482n
610
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
Index
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) contact information 593 publications diabetes mellitus, physical fitness 561n exercise barriers 217n overweight, physical activity 520n walking program 324n National Institute of Mental Health (NIMH), contact information 593 National Institute on Aging (NIA) contact information 593 Exercise and Physical Activity: Your Everyday Guide, Chapter 4: Sample Exercises - Strength/Balance Exercises 179n National Institutes of Health (NIH) contact information 593 publications coronary heart disease 33n longevity 28n National Library of Medicine (NLM), contact information 593 National Osteoporosis Foundation (NAF), contact information 598 National Recreation and Park Association (NRPA), contact information 598 National Strength and Conditioning Association (NSCA), contact information 598 National Womens Health Information Center (NWHIC), contact information 593 NAYS see National Alliance for Youth Sports NCCAM see National Center for Complementary and Alternative Medicine NCI see National Cancer Institute NCPAD see National Center on Physical Activity and Disability neck extension 163 Nemours Foundation publications adolescent fitness 109n, 112n, 116n compulsive exercise 486n kickboxing 297n pediatric sports injuries 471n Pilates 407n preschoolers 89n sports, fitness 120n website address 597 NHLBI see National Heart, Lung, and Blood Institute NIA see National Institute on Aging NIAMS see National Institute of Arthritis and Musculoskeletal and Skin Diseases NIDDK see National Institute of Diabetes and Digestive and Kidney Diseases Nieman, David 26 NIH see National Institutes of Health NIMH see National Institute of Mental Health NLM see National Library of Medicine nonsteroidal anti-inflammatory drugs (NSAID), sports injuries 46364, 466 NRPA see National Recreation and Park Association NSAID see nonsteroidal antiinflammatory drugs NSCA see National Strength and Conditioning Association Nurses Health Study 155 NWHIC see National Womens Health Information Center
O
obesity adolescents 106 asthma 552 bicycling 34249 body mass index 24344 defined 588 health consequences 24546 overview 53335 physical activity 1011
611
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
P
PCPFS see Presidents Council on Physical Fitness and Sports PE Central, contact information 598 pedometers defined 589 disabled people 5078 overview 32831 walking programs 334 Penix, Leilainia 3056 Pep Up Your Life: A Fitness Book for Mid-Life and Older Persons (PCPFS) 160n Perceived Exertion (CDC) 226n personal fitness plan, overview 20412 personal trainers, overview 25458 physical activity calorie expenditures 23239, 241 cardiorespiratory health 910 chart 23942 children, overview 82104 daily life 200202 dementia prevention 4042 disease prevention overview 2635 energy expenditure, described 5152 four levels 7778, 78 health benefits overview 314 intensity measurement 22629 life satisfaction 1924 mental illness prevention 4244 osteoporosis prevention 3132 safety considerations overview 42935 starting suggestions 194200 statistics 6772 stress management 3839 weekly durations 13334 weight loss 4648 see also exercise Physical Activity (WHO) 15n Physical Activity, Mood, and Serious Mental Illness (Indiana University) 42n
612
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
Index
Physical Activity and Cancer (NCI) 570n Physical Activity and the Built Environment (PCPFS) 183n Physical Activity and the Health of Young People (CDC) 106n Physical Activity and Weight Affect Coronary Heart Disease Risk (NIH) 33n Physical Activity and Your Heart (NHLBI) 276n Physical Activity for a Healthy Weight (CDC) 46n Physical Activity from Birth to Age Five (NASPE) 87n Physical Activity Guidelines for Americans (DHHS) 7379 Chapter 1: Introducing the 2008 Physical Activity Guidelines for Americans 73n Chapter 2: Physical Activity Has Many Health Benefits 3n Chapter 3: Active Children and Adolescents 93n Chapter 4: Active Adults 132n Chapter 5: Active Older Adults 172n Chapter 6: Safe and Active 429n Chapter 7: Additional Considera tions for Some Adults 144n physical education adolescents 1078 girls 128, 15658 long term effects 153 statistics 99104 physical fitness childhood asthma 3435 community environment 18390 defined 589 diabetes mellitus 56167 Physical Fitness Improves Asthma Management in Children (ACSM) 34n physical inactivity cancer prevention 1516 health burden 1518 heredity 5763 long term consequences 106 mortality 2930 physical therapists, described 463 Pilates (Nemours Foundation) 407n Pilates, Joseph 407, 409 Pilates, overview 4079 plantar flexion 179 plyometrics, described 41719 podiatrists, described 47780 Porcari, John 39394, 42224 positive physical education pledge 8485 power training, overview 41519 Power Training for Endurance Athletes (Sandler) 415n power yoga 402 prayer, described 399 pregnancy, physical activity 14445 premature death, physical activity 89 preschoolers fitness recommendations 8992 physical activity guidelines 88 physical activity motivations 118 Presidents Council on Physical Fitness and Sports (PCPFS) contact information 594 publications community environment 183n disabled people 506n, 509n exercise program, older adults 160n heredity 57n progression, resistance training 365n sports nutrition 450n walking program 332n Prevalence of Self-Reported Physically Active Adults - United States, 2007 (CDC) 67n Preventing Childrens Sports Injuries (Nemours Foundation) 471n progression defined 589 physical activity 8 Progression and Resistance Training (PCPFS) 365n progression training, overview 36572 Promoting Inclusive Physical Activity Communities for People with Disabilities (PCPFS) 509n prostate cancer, physical activity 573
613
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
R
racial factor, daily exercise 13940 Raising a Fit Preschooler (Nemours Foundation) 89n RAMP model 51316 Rankin, Janet 50 reach exercise 163 recreation environments, physical fitness 18790 rectus abdominis muscles 373 rehabilitation, sports injuries 46465 Reiki, described 399 relative intensity adults 135 defined 587 measurement 226 relaxation exercises, described 397400 repetitions defined 589 fat loss 53032 muscle strengthening activity 5 repetition velocity, resistance training programs 37172 resistance training asthma 555 described 540 overview 36572 rubber band exercise 37881 resting heart rate defined 589 described 230 Resting Heart Rate (American Heart Association) 230n resting metabolic rate, described 5153 RICE treatment, sports injuries 46263 rowing machines, overview 28790 rubber band resistance exercise, overview 37881
S
safety considerations 5K training 359 air pollution 49597 barriers to exercise 221 cancer treatment exercise 579 children, sports injuries 47273 elliptical trainers 280 exercise programs 209 gym mistakes 44041 interval training 391 outdoor exercise 49295 overweight 52728 physical activity 199200, 42935 Pilates 408 preschoolers 92 running 354 stability balls 37677 stair steppers 291 tai chi 412 treadmills 283 walking programs 326 yoga 4034 safety helmets, overview 44346 Sandler, David 415n Schmidt, Karel 421, 423 school-aged youth fitness guidelines 9399 physical activity motivations 118 school-based physical activity, statistics 8283 School Health Policies and Programs Study 2006: Physical Activity (CDC) 99n School Health Policies and Programs Study 2006: Physical Education (CDC) 99n seated alternate dumbbell curls 167 seated pike stretch 164 seated stretch 164
614
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
Index
sedentary lifestyles adolescents 110, 112 exercise recommendations 344 see also physical inactivity Selecting and Effectively Using a Home Treadmill (ACSM) 283n Selecting and Effectively Using an Elliptical Trainer (ACSM) 278n Selecting and Effectively Using a Pedometer (ACSM) 328n Selecting and Effectively Using a Rowing Machine (ACSM) 287n Selecting and Effectively Using a Stair Stepper/Climber (ACSM) 290n Selecting and Effectively Using a Yoga Class (ACSM) 401n Selecting and Effectively Using Rubber Band Resistance Exercise (ACSM) 375n Selecting and Effectively Using Stability Balls (ACSM) 375n Selecting Athletic Shoes (American Orthopaedic Foot and Ankle Society) 441n self-esteem, exercise 205 Shape of the Nation (NASPE) 82n Shape Up America, contact information 598 shin splints children 474 described 45960 side leg raise 181 side-lying leg lift 167 simulated swimming 163 single knee pull 163 sitting stretch 164 Sivananda yoga 402 skating, helmets 445 skiing, helmets 445 sledding, helmets 445 sleep, older adults 161 slings, sports injuries 464 Smallstep, contact information 594 Smith, Melinda 204n Smog Matters: Physical exercise and smog dont mix. Protect your health when air quality is poor (Government of Ontario Ministry of the Environment) 495n snowmobiling, helmets 445 soccer, physical education 103 social environment exercise programs 210 physical fitness 190 softball helmets 445 physical education 103 So You Think You Can Dance? Well, Now You Can (ACE) 301n specificity physical activity 8 resistance training programs 366 spinning, overview 35052 spiritual practices, described 399 splints, sports injuries 464 spondylolysis, children 474 Sport-Related Concussions (Covassin) 466n sports activities adolescents 11011, 11314 barriers 219 calorie expenditures 23239 exercise-induced asthma 559 girls 12428 life satisfaction 1924 optional activities 119, 12023 stress management 39 women, statistics 14958 Sports Injuries (NIAMS) 458n sports injury prevention children 47176 concussion 46668 overview 45869 sports nutrition, overview 45056 spot reduction, described 529 sprains, described 458 stability balls, overview 37578 stage fright, sports activities 121 stair steppers osteoporosis 548 overview 29093 statistics physical activity, women 14958 physical education 99104 physically active adults 6772 Statistics on Physical Activity in Children (NASPE) 82n Stay Motivated (CDC) 212n
615
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
T
tai chi osteoporosis 548 overview 41014 Tai Chi: An Introduction (NCCAM) 410n target heart rate defined 589 described 23031 Target Heart Rates (American Heart Association) 230n
616
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
Index
treadmills barriers 218 overview 28386 overweight 527 twins studies, physical inactivity 60 type 1 diabetes mellitus, described 58586 type 2 diabetes mellitus described 586 heart disease 538 women 14243 visualization, goal setting 21213 volleyball, physical education 103
W
waist circumference, versus body mass index 535 walking calories used 48 heart disease 3334 intensity 226, 227 older adults 175, 178 osteoporosis 548 physical education 103 program overview 32437 women 153 Walking: A Step in the Right Direction (NIDDK) 324n Walking Works (PCPFS) 332n warm up defined 590 older adults 161, 178 safety considerations 43839 water aerobics intensity 226 older adults 175 water based exercise overview 31622 overweight 52425 see also swimming weight bearing activity bone health 31 see also bone strengthening activity Weight-Control Information Network (WIN) contact information 594 exercise barriers publication 217n weight lifting calories used 48 metabolic rate 53 weight loss metabolic rate 5455 physical activity 4648 weight management arthritis 54546 children 98 exercise 154 girls 15758
U
Uhlenbruck, Gerhard 19n University of Michigan, strength training publication 362n University of Oxford, athlete teams publication 259n US Consumer Product Safety Commission (CPSC) contact information 594 US Customs and Border Protection, running publication 354n US Department of Health and Human Services (DHHS; HHS) contact information 594 publications active adults 132n activity guidelines 194n arthritis, exercise 544n fitness guidelines 73n older adults 172n, 179n physical activity benefits 3n physical activity safety 429n pregnancy 144n school-aged children 93n see also Physical Activity Guidelines for Americans US Professional Tennis Association, racquet sports publication 307n
V
variation, resistance training programs 366 Viniyoga 403 Vinyasa yoga 403
617
(c) 2011 Omnigraphics, Inc. All Rights Reserved.
Y
yoga overview 4016 stress management 39 Your Guide to Physical Activity and Your Heart (NHLBI) 492n youth community environment 18586 physical disabilities 51112 recreation environments 188 Youth Risk Behavior Survey 511
618
(c) 2011 Omnigraphics, Inc. All Rights Reserved.