A Harvard Medical School Special Health Report

Exercise
A program you can live with

In this report:
Strength and stretching
workouts
Tips for staying
motivated
How exercise improves
your health

Special Bonus Section

Getting in gear: Tools
to get your exercise
program moving

Price: $26
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exercise
SPECIAL HEALTH REPORT
Medical Editors Contents
L. Howard Hartley, M.D.
Associate Professor of Medicine, The inside scoop: Exercise and your body. . . . . . . . . . . . . . 2
Harvard Medical School Energy to burn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Staff Cardiologist, Brigham and Women’s Hospital
Heart and blood vessels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
I-Min Lee, M.B., B.S., Sc.D.
Associate Professor of Medicine,
Lungs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Harvard Medical School Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Associate Professor of Epidemiology, Bones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Harvard School of Public Health
Immune system. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Associate Epidemiologist,
Brigham and Women’s Hospital
What can exercise do for you? . . . . . . . . . . . . . . . . . . . . . . 6
Writer
Karin Leinwand
Prevents cardiovascular disease. . . . . . . . . . . . . . . . . . . . . . . . 7
Diminishes diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Editor
Annmarie F. Dadoly Offers a dose of cancer prevention . . . . . . . . . . . . . . . . . . . . . 10
Editor, Special Health Reports
Fights fractures and reduces falls . . . . . . . . . . . . . . . . . . . . . . 12
Kathleen Cahill Allison Tunes up immune function . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Art Director Prevents gallstones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Heather Derocher Eases arthritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Production Editors Helps you attain a healthy weight . . . . . . . . . . . . . . . . . . . . . . 13
Mary Kenda Allen, Melissa Rico Extends life span. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Illustrators
Harriet Greenfield, Michael Linkinhoker,
The fundamentals: What you need to know to get started. . 18
Scott Leighton How much exercise do I need? . . . . . . . . . . . . . . . . . . . . . . . . 18
Photographer How often should I exercise? . . . . . . . . . . . . . . . . . . . . . . . . . 18
Michael Carroll How long must my exercise sessions be? . . . . . . . . . . . . . . . . 19
Published by Harvard Medical School How vigorously should I exercise?. . . . . . . . . . . . . . . . . . . . . . 19
Anthony L. Komaroff, M.D., Editor in Chief
Edward Coburn, Publishing Director Creating a personal exercise plan. . . . . . . . . . . . . . . . . . . 21
Copyright ©2012 by Harvard University. Written permission is
required to reproduce, in any manner, in whole or in part, the SPECIAL BONUS SECTION: Getting in gear. . . . . . . . . . . . 27
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Harvard Health Publications
10 Shattuck St., 2nd Floor, Boston, MA 02115 Staying motivated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
617-432-1485 Fax: 617-432-4719 Getting back on track. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Website
For the latest information and most up-to-date publication Exercising safely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
list, visit us online at [Link]. 10 tips for avoiding injuries . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Customer Service
For all subscription questions or problems (rates, subscrib- Choosing exercise equipment wisely. . . . . . . . . . . . . . . . . 38
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10 tips for smart consumers. . . . . . . . . . . . . . . . . . . . . . . . . . 40
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Big Sandy, TX 75755-9308. Strength and stretching routines. . . . . . . . . . . . . . . . . . . . 42
Ordering Special Health Reports Home and travel strength routine. . . . . . . . . . . . . . . . . . . . . . . 43
Harvard Medical School publishes Special Health Reports 8 basic stretches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
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 Dear Reader,

At your last visit to the doctor, you may have received one of the most important
prescriptions of your life—one that only you can fill: exercise. Hundreds of studies show
exercise lowers your risk for serious health problems, including heart disease, diabetes,
stroke, high blood pressure, and some forms of cancer. What’s more, it eases arthritis and
preserves independence while trimming your silhouette. Put simply, exercise helps you feel
better, look great, and live a longer, more joyful life.

Just how active do you need to be to reap these gains? Scientists say burning at least 500
to 1,000 calories a week through exercise lessens the odds for many chronic diseases and
helps extend life. The federal guidelines for physical activity, issued by the U.S. Department
of Health and Human Services in 2008, spell this out more practically by urging almost all
adults to aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous
activity (or an equivalent mix of the two) every week. Additionally, the guidelines encourage
strengthening activities for all adults, plus balance exercises for older adults at risk for falls.
Raising the bar by doubling time spent on aerobic exercise, or adding bouts of vigorous
exercise, further enhances fitness and health benefits.

If knowledge were action, wouldn’t we all be in excellent shape? Clearly, that’s not the
case. Incidence of diabetes, high blood pressure, heart disease, and stroke—four of many
ailments that regular exercise helps you ease or avoid—is skyrocketing. Sixty-eight percent
of Americans are overweight or obese. Not surprisingly, many Americans spend little leisure
time on activities that could prompt them to break a sweat. Reasons range from jam-packed
days to disabling health issues to plain old disinclination. At the same time, people spend
more sedentary time in front of screens, whether for work or entertainment.

Breaking that pattern will pay dividends in terms of health, well-being, longevity, and
independence. This Special Health Report can help you create a well-rounded exercise plan—
one that fits your life and that you will be likely to stick with. The report details the right
blend of exercises to undertake and gets you started with a walking plan and stretching and
strength-building exercise routines.

Sincerely,

L. Howard Hartley, M.D. I-Min Lee, M.B., B.S., Sc.D.

Medical Editor Medical Editor

Harvard Health Publications | Harvard Medical School | 10 Shattuck Street, Second Floor | Boston, MA 02115
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 The inside scoop: Exercise and your body

Energy to burn
W hat goes on inside your body when you pedal
a bike or take a stroll? These activities set off
complicated physical processes that affect nearly
Like all machinery, your muscles must have fuel. This
fuel comes from the food you eat and your body’s
every organ system. When you exercise several times reserves of fat and glucose. The catch is that nutri-
a week or more, your body adapts so you’re able to ents from food cannot be turned directly into usable
do so more efficiently. Knowing about this process energy for the trillions of cells in your body. Each cell
will help you understand why physical activity has so has one primary source of energy: a molecule called
many benefits. adenosine triphosphate (ATP).
Your body’s ability to create ATP is critical because
Figure 1 Food, oxygen, and energy it determines your capacity for physical exertion. And
the reverse is also true: your physical conditioning
➋ Oxygen ➎ Oxygen and nutrients influences how well you can generate ATP.
breathed into
the lungs used by mitochondria The food you eat contains energy stored in a vari-
to produce ATP
ety of forms—proteins, fats, and carbohydrates. Your
➏ ATP used as the energy body needs to extract that energy and capture it in
source by cells
the form of ATP. To do this, your stomach and small
➊ Food broken Mitochondria
down from intestines break the food into millions of tiny mole-
stomach and cules, which enter the bloodstream and find their way
intestine
to every cell in the body (Figure 1). There, in small cell
structures called mitochondria, the food molecules
ATP
undergo a series of chemical reactions that ultimately
lead to the creation of ATP.
Your body stores only a small amount of ATP,
but makes it as quickly as it’s needed. When demand
➌ Oxygen increases—such as when you are exercising—your
carried by the
bloodstream
body must churn out more. To do this, it taps into glu-
Muscle
to muscles cell cose stored in the muscle and liver and fats from vari-
ous places in the body. These substances make their
way through the bloodstream to the muscles.
Stored glucose (also known as glycogen) and fat
Red blood cells can be broken down for ATP production in two ways:
➍ Oxygen and nutrients aerobic (requiring oxygen) and anaerobic (requiring
transported to cells
no oxygen). Aerobic processes produce more ATP, but
Once the food you eat is digested in your stomach, its com- grind to a halt without oxygen. When your body is
ponents are absorbed into your bloodstream and delivered to working so hard that it is unable to deliver enough
cells throughout the body. Oxygen from your lungs also travels
oxygen to support aerobic metabolism of food for fuel,
to your cells, where tiny structures called mitochondria use it
to convert the food nutrients into a chemical called adenosine it switches to anaerobic production of ATP, which cre-
triphosphate (ATP), which provides energy for everything from ates a byproduct known as lactic acid. The lactic acid
walking to thinking. enters the bloodstream, creating an acid imbalance.

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To compensate, your breathing speeds up to take in without placing excess demand on their circulatory
more oxygen, and your heart beats faster to move that and respiratory systems. When you exercise more
oxygen to your muscles. intensely, however, your muscles’ need for oxygen
But you can’t sustain anaerobic activity. Your increases. Your heart must pump harder and faster.
lungs and heart reach their maximum work efforts, The amount of blood your heart pumps and the oxy-
and your body can only neutralize the resulting acid gen your body consumes rise in direct proportion
imbalance for a short time. The lactic acid generated to the amount of work your muscles are performing.
from the anaerobic process also leaves muscles feeling And once again, your level of physical conditioning
fatigued. Eventually, you need to slow down. By doing dictates how well this system works.
so, you are able to take in enough oxygen that once Arteries in your working muscles dilate to
again you can rely primarily on aerobic production of accommodate their increased need for blood. At
ATP. Lactic acid production stops, the muscles start tothe same time, the heart’s increased output causes
recover, and your body restores normal acid balance. your blood pressure to rise. Arterioles (tiny arteries)
Your level of fitness determines how swiftly this in your skin expand, allowing for more blood flow
happens. Regular exercise conditions the lungs, heart, there. This engorges capillaries near the skin surface,
and blood vessels, enabling them to deliver oxygen to helping to discharge into the cooler air around you
muscle cells more quickly and efficiently. Walking up the heat your body generates as you exert yourself.
As you continue to exercise, especially in hot, humid
a hill with a fitter friend illustrates this nicely. While
weather, more blood is diverted to your skin to main-
you’re still huffing and puffing, your friend isn’t strug-
gling to catch her breath. tain a safe body temperature.
When you engage in physical activity, your body While your arteries dilate, veins serving distant
doesn’t rely solely on one process or the other; both parts of your body contract. When you are resting,
are used to generate ATP, but one more so than the the venous system stores roughly 65% of the body’s
blood supply. But when veins contract, it turns down
other. Because of this distinction, exercise is classified
into two broad categories—aerobic and anaerobic— the tap on the peripheral blood supply, making more
depending on which process is predominantly used blood available to your heart and exercising mus-
cles. Your body further optimizes the distribution of
for ATP production. If the intensity of exercise is such
that your lungs and heart are able to supply oxygen forblood by limiting the amount sent to the kidneys, liver,
energy production, then the activity is almost exclu- digestive system, and other organs not immediately
sively aerobic. But if intensity rises so that demand involved in the exercise process.
for oxygen outstrips supply, then the activity becomes When you exercise regularly, your circulatory sys-
anaerobic. Walking, jogging, cycling, or swimming at tem adapts by boosting your cardiorespiratory endur-
ance. Your body creates more plasma, the saltwater
an even pace are aerobic activities. Activities in which
your body tends to go anaerobic more quickly include fluid that carries glucose and other nutrients to cells
wind sprints and weight lifting. and ferries away waste. Because plasma is a compo-
nent of blood (along with blood cells), a greater vol-
ume of blood is available to pump. That blood is
Heart and blood vessels slightly thinner than usual, which lowers the resis-
Your cardiovascular system transports tance it encounters while circulating. The main pump-
oxygen to cells and removes carbon ing chambers of your heart, called the ventricles,
dioxide, carries away metabolic waste products, and stretch to hold more blood and contract with greater
shuttles hormones to the intended organs. In addi- force. Over the long term, the heart muscle increases
tion, it helps maintain body temperature and preserve in size, which strengthens the heart.
your body’s acid balance. Most people can engage in Likewise, the capillaries that serve the working
light activity, about the equivalent of walking 2 mph, muscles—including the heart—increase in number.

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These additional blood vessels serve two valuable reverse the movement, your brain signals fibers in
functions. First, they feed the muscles more oxygen- the opposing muscle group to tighten. For example,
rich blood. Second, the presence of more vessels when you contract your biceps, the triceps on the
means that the heart’s powerful pumping chamber, back of your arm relaxes.
the left ventricle, has a more plentiful energy supply Exercises that involve continuous motion, such
and is able to pump the blood with greater ease. The as rowing, walking, or swimming, result in the rhyth-
more efficient pumping action allows you to do more mic tightening and releasing of muscle fibers. In addi-
work with less effort. tion to moving your body, this process produces a
The greater need for oxygen-rich blood that occurs “milking” action that helps move blood through your
during aerobic exercise can also lead to an increase in veins and back to your heart. With aerobic exercise,
the size and number of branches of the coronary arter- an increase in fibers containing iron-rich myoglobin
ies feeding the heart. This provides other channels also occurs, permitting more oxygen to enter and be
for oxygenated blood to reach heart muscle. So if an stored in the muscle.
artery serving the heart becomes blocked, heart mus- Combined with the greater number of capillar-
cle damage is less likely because alternative channels ies and increased blood flow to the muscles, these
keep the blood supply flowing. The boost in oxygen changes improve muscular endurance. Fit muscles
and other benefits of exercise offer some protection adapt in other ways, too. Muscles become fatigued
against dangerous heart rhythm disturbances as well. when their supply of glycogen is depleted. Thus, larger
reserves can prolong endurance. Well-trained muscles
not only are able to stockpile more glycogen, but they
Lungs also can burn fat for energy more directly, which pre-
As you use more energy, minute fibers serves glycogen stores.
in your muscles sense indications of
increased ATP production, including higher levels of
carbon dioxide in your blood, increased body tem- Bones
perature, and greater acid production. These changes Throughout your life, your body is con-
signal your lungs to take faster and deeper breaths to stantly building and dismantling bone
release carbon dioxide and refresh cellular supplies tissue. This maintains your skeleton by replacing old
of fresh oxygen. More blood travels to the capillaries bone with new and frees calcium, the main building
surrounding the alveoli (the network of millions of block of bone, for other tasks. Calcium is vital to many
small air sacs where carbon dioxide passes out of the physical processes, including maintaining heart rate
bloodstream and is exchanged for oxygen) to further and blood pressure, and a small amount of it circu-
boost energy production. A greater concentration of lates in your blood. When the amount of calcium in
oxygen in the alveoli causes more oxygen to pass from your blood gets low, your body draws on the reservoir
the lungs into the bloodstream, as well. Although your of calcium stored in the bones.
overall lung capacity doesn’t change as you become Early in your life, your body builds bone faster
more conditioned, normal lung capacity is more than than it loses it. But, with age, bone is lost more rap-
enough to handle the additional work. idly than it’s formed. Eventually, this leaves bones
more fragile and susceptible to breaks. Exercise plays
a key role in slowing bone loss. Muscle is tethered to
Muscles bone by cords of tissue called tendons. Tendons tug
When you decide to move a part of your on bones during physical activity. This stress increases
body, your brain transmits the message bone strength and density. Exercises that work against
to your muscle fibers via your nerves. The fibers gravity (such as walking, jogging, tennis, basketball,
respond by contracting, which creates motion. To and strength training) provide the greatest benefit.

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 Hormones Immune system
Exercise affects nearly all of the Experts believe that moderate exercise
dozens of hormones your body reduces levels of stress hormones and other
produces. Two of these substances, epinephrine and chemicals that suppress immune system functioning
norepinephrine, are key players in promoting physi- and increase inflammatory activity. Other changes occur,
cal changes while you are exercising. When your too. A 2005 study measured immune components in 15
brain detects more muscle movement, it responds healthy women during exercise and at rest. Researchers
by releasing this pair of chemicals, which speed your noted modest, short-term upswings in natural killer cells
heartbeat, contract arteries serving non-exercising and white blood cells after 30 minutes of walking com-
parts of your body, and stimulate the release of sugars pared with sitting.
and fats from body stores for energy. Although the immune system returns to a pre-
Endorphins, natural opiates that help block pain exercise state shortly after the exercise session is done,
perception and may improve mood, rise after 30 min- moderate activity on a daily or almost-daily basis
utes or more of exercise. These hormones are probably seems to have a cumulative benefit for your immune
responsible for the sense of euphoria endurance ath- system, improving its ability to fight off infection (see
letes are said to experience, sometimes called a “run- “Tunes up immune function,” page 13).
ner’s high.” Norepinephrine also regulates mood.
Insulin, a hormone made in the pancreas, fluctu-
ates in response to exercise. Insulin’s main function Exercise by the numbers
is to help usher glucose from the bloodstream into While you exercise:
cells. While exercise boosts the concentrations of • Unless you are taking medications, your heart rate can
most hormones, levels of insulin drop during and for reach 130 to 150 beats per minute (sometimes higher, par-
ticularly in young, fit individuals). That nearly doubles the
a short while after vigorous activity. This seems coun-
resting norm of 70 to 80 beats per minute for most people.
terintuitive, because exercise accelerates the muscles’
• Your heart may pump up to 20 liters of blood per minute
demand for fuel in the form of glucose. However, (40 liters for well-trained endurance athletes), which is
insulin transports glucose more effectively during quad­ruple the 5 liters per minute that’s typical while resting.
exercise, so less of it is needed. Also, exercise seems • Your skin and muscles receive 80% of your total blood
to enhance your body’s ability to draw energy directly flow. This quadruples the usual 20% of blood flow these
from fat stores. areas get during rest.
Research has found that exercise can also affect • Systolic blood pressure (the top number) increases by 20
millimeters of mercury (mm Hg) or more during the first
levels of the female hormone estrogen. After meno-
few minutes of exercise before leveling off. The diastolic
pause, when a woman’s ovaries stop producing estro- reading (bottom number) remains largely unchanged.
gen, fat tissue becomes her body’s major source of After you cease strenuous activity, however, blood pres-
estrogen. Some evidence suggests regular vigorous sure drops to lower than pre-exercise levels for two to
activity—and possibly moderate activity as well— three hours. Over time, regular exercise can help you
maintain lower blood pressure.
may reduce circulating estrogens on an ongoing basis,
• Millions of capillaries open up to feed muscle fibers.
partly because women who exercise tend to be leaner.
• Your lungs pass up to 200 pints of air in and out each
This would expose breast cells to less of this hormone,
minute. When not exercising, the average for most people
which fuels many cancers (see “Offers a dose of cancer is 12 pints a minute.
prevention,” page 10).

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 What can exercise do for you?

M any people spend more than half their wak-

ing hours sitting down. And activities that don’t
enhance health account for quite a lot of the remainder.
the women spent watching television each day, they
had a 23% greater risk of becoming obese and a 14%
greater risk of developing diabetes. Sitting at work for
This growing trend may cause more trouble than most many hours also heightened their risks for obesity and
people realize. Observational studies suggest habitual diabetes. When planning your day, it may be benefi-
inactivity raises risks for obesity, diabetes, cardiovascular cial not only to increase the time you spend exercising
disease, deep-vein thrombosis, and metabolic syndrome. but also to try to reduce your “sitting time.”
In fact, one study that followed more than 50,000 The case for exercise is strong. Decades of solid
middle-aged women for six years found that even science confirm that adding as little as half an hour
among women who were avid exercisers, the more of moderately intense exercise to your day improves
television they watched, the more likely they were to health and extends life. As the in-depth information
gain weight or develop diabetes—regardless of how throughout this section attests, exercise delivers pow-
much physical activity they did. For every two hours erful, wide-ranging health benefits.

Exercise: More potent than any potion

Here’s a quick snapshot of the benefits exercise provides— • Helps shore up bones. When combined with calcium, vita-
not just while you are engaging in the exercise, but also over min D, and bone-saving medications if necessary, weight-
the long term: bearing exercise like walking, running, and strength
• Lessens the likelihood of getting heart disease, the No. 1 training helps ward off age-related bone loss. And balance-­
killer of both women and men in America. Exercising regu- enhancing activities, including tai chi and yoga, help pre-
larly helps prevent plaque buildup by striking a healthier vent falls that may end in fractures.
balance of blood lipids (HDL, LDL, and triglycerides), helps • Helps protect joints by easing swelling, pain, and fatigue
arteries retain resilience despite the effects of aging, and and by keeping cartilage healthy. Strong muscles support
bumps up the number of blood vessels feeding the heart. It joints and lighten the load upon them. Activities that boost
also reduces inflammation and discourages the formation flexibility, such as stretching, yoga, and tai chi, extend range
of blood clots that can block coronary arteries. Even if you of motion.
already have heart disease, exercise lowers your chances of • May limit and even reverse knee problems by helping to
dying from it. control weight—quite a bang for the buck, since every
• Lowers blood pressure, a boon for many body systems. pound lost reduces the load on the knee by 4 pounds,
Long-term hypertension (high blood pressure) doubles or according to the Arthritis Foundation.
triples the odds of developing heart failure and helps pave • Lifts spirits by releasing mood-lifting hormones and reliev-
the way to other kinds of heart disease, stroke, aortic aneu- ing stress. In some studies, exercising regularly has helped
rysms, and kidney disease or failure. ease mild to moderate depression as effectively as medica-
• Helps prevent diabetes by paring off excess weight, mod- tions; combining exercise with medications, therapy, and
estly lowering blood sugar levels, and boosting sensitivity to social engagement is even better.
insulin so that less is needed to transport glucose into cells. • May boost your ability to fend off infection.
If you have diabetes, exercise helps control blood sugar.
• Adds years to your life. In the long-running Framingham
• Reduces risk for developing colon and breast cancers, and Heart Study, moderate activity tacked on 1.3 years of life
possibly cancers of the endometrium (uterine lining) and for men and 1.5 years of life for women versus low activity.
lung. By helping you attain a healthy weight, exercise less- Raising the bar to high activity added 3.7 years for men and
ens your risk for cancers in which obesity is a factor, too. 3.5 years for women.

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Prevents cardiovascular disease research tells us your risk of heart attack and stroke
One in every three deaths in the United States stems rises as systolic pressure creeps up beyond 115 mm Hg.
from cardiovascular disease, a catch-all term includ- Numerous studies have shown that physical activ-
ing heart attack, stroke, hypertension, atherosclerosis ity can significantly reduce the risk of developing high
(the buildup of fatty deposits on the inside of arteries), blood pressure. For example, a 12-year study of 6,000
and heart failure. Remember, too, that heart disease healthy people ages 20 to 65 found that those who
and stroke are major causes of disability. were least fit had a 52% greater risk for substantially
Studies dating back to the 1940s have confirmed higher blood pressure compared with fit people.
the link between higher levels of physical activity Regular exercise can trim both systolic and dia-
and lower rates of heart disease. In 2008, research- stolic blood pressure. This is true whether you have
ers sifting through data gleaned from multiple stud- high or normal blood pressure. An Annals of Internal
ies reported 27% and 12% drops in heart disease tied, Medicine analysis of 54 randomized, controlled trials
respectively, to high and moderate versus low levels of found that participating in aerobic exercise trimmed
physical leisure-time pursuits. systolic pressure by approximately 4 points and dia-
Other studies have yielded similar findings. One stolic pressure by about 3 points among previously
analysis of many studies found that even an hour of sedentary adults.
walking a week reduced the risk for stroke, heart dis-
ease, and overall cardiovascular disease in previously Prevents plaque buildup in arteries
inactive women. Again, risks dropped further among Atherosclerosis is another key factor in cardiovas-
those who exercised more. Similar findings apply to cular disease. Fatty deposits called plaques build
men as well. Likewise, combined evidence from many up as particles of LDL (bad) cholesterol pass out of
randomized trials showed that heart disease patients the bloodstream and lodge in vulnerable portions
who undertook exercise-based cardiac rehabilita- of artery walls, narrowing these vessels enough to
tion programs lowered their risks of dying from heart impede the supply of oxygen-rich blood to vital
problems or other causes during the follow-up period. organs like the heart and the brain (see Figure 2).
Exercise improves cardiovascular health in a num- When this happens in vessels carrying blood to the
ber of different ways. heart, it can lead to chest pain (angina). And if a vul-
nerable plaque ruptures, a blood clot can form, chok-
Lowers blood pressure ing off the blood supply to the heart (a heart attack)
One of those ways is by preventing or lowering high or brain (a stroke).
blood pressure (hypertension). The less active you are, Exercise combats atherosclerosis in a number of
the more likely you are to develop high blood pressure. ways. Studies have repeatedly confirmed that moder-
Long-term hypertension doubles or triples the risk for ate to vigorous aerobic activity increases healthy HDL
developing heart failure and can lead to heart disease, (good) cholesterol in your blood. HDL transports fats
stroke, aortic aneurysms, kidney disease and failure, back to your liver for metabolism, preventing their
and damage to other organs. accumulation in artery walls. Researchers report an
Blood pressure represents the force required to average 4.6% increase in HDL through exercise. This
push blood through your arteries. Two measurements effect is even more impressive when you consider
are taken to determine blood pressure: the first, or top, that every 1% increase in HDL lowers a person’s risk
number (systolic pressure) reflects pressure in your of dying from heart disease by 3.5%. Exercise also
arteries as your heart contracts; the second, or bot- benefits artery health by reducing the blood levels of
tom, number (diastolic pressure) reflects pressure in unhealthy LDL cholesterol and triglycerides, another
your arteries between contractions as the heart relaxes lipid (fat) linked with cardiovascular disease.
and refills with blood. While 120/80 millimeters of One New England Journal of Medicine study, for
mercury (mm Hg) has long been considered normal, example, found that walking or jogging regimens

ww w. h ealt h . h ar v ar d . e du Exercise 7
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improved lipid levels, even though changes in weight But exercise can help you counter this loss of resil-
were minimal. Again, investigators found that the ience. One study compared the arterial function of a
highest amount of exercise (20 miles per week) yielded sedentary group of people in their 20s and 30s with
the greatest gains, and concluded that the amount of that of a mixed group of subjects in their 60s. The
activity mattered more than its intensity in promoting researchers found that arteries belonging to the ath-
healthier lipid profiles. letic members of the older group dilated as efficiently
as the vessels of the younger people. A second study,
Protects arteries published in The New England Journal of Medicine,
Exercise protects your arteries in still another way. confirmed that intensive exercise can dramatically
Artery walls are lined with a very thin layer of cells improve the functioning of the endothelium even in
known as the endothelium. Injuries to the endothe- people who already have atherosclerosis.
lium—caused by high blood pressure, smoking, dia- Scientists believe that the regular expansion and
betes, high cholesterol, and the wear and tear of contraction of arteries during exercise keeps the ves-
aging—are often the starting points for plaque growth. sels “in shape” and maintains endothelial function.
In healthy vessels, the endothelium produces chemi- Another possible factor is that exercise limits the pro-
cals that relax, contract, and lubricate the arteries to duction of LDL cholesterol and other endothelium-
facilitate blood flow. As you age, the endothelium damaging substances.
loses some of its natural ability to secrete these chemi-
cals, which impairs the arteries’ resilience and leaves Enhances quality of life
them vulnerable to plaque buildup. Heart problems often snowball. Fatigue and trouble
breathing stemming from heart failure, for example,
Figure 2 Keeping arteries healthy lead some people struggling with this condition to
become increasingly housebound. Outings and social
occasions may seem like too much effort, which feeds
isolation and depression.
In 2009, The Journal of the American Medical Asso-
Normal coronary
artery ciation published results of a trial of 2,330 heart fail-
ure patients randomly assigned to two groups. One
received typical medical care and encouragement to
Artery
wall exercise. The other engaged in 36 sessions (three per
Clogged artery
week) of supervised walks, treadmill use, or stationary
cycling followed by a recommendation for a program
of home-based exercise five times a week. While both
groups made modest gains in the first three months
of the study, the exercise group reported greater
improvements in quality of life, with fewer physical
Plaque
formation ©Harriet Greenfield
and social limitations and symptoms.

Atherosclerosis occurs when fatty deposits called plaques build Makes clots less likely
up on artery walls. These plaques narrow arteries, which can lead Besides narrowing arteries and impairing blood flow,
to chest pain. If a plaque ruptures, a blood clot may form and plaques can jeopardize your health by rupturing, an
become lodged in a blood vessel, which can lead to a heart attack
event involved in about three-quarters of all heart
or stroke. But exercise helps prevent atherosclerosis by reducing
levels of unhealthy LDL cholesterol (a component of plaque) and attacks. Vulnerable plaques are covered only by a thin
increasing levels of healthy HDL cholesterol. HDL transports fats to cap rather than the thick, fibrous one that forms over
the liver, preventing them from accumulating on artery walls. other plaques. Over time, inflammation and a variety

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of cell changes weaken and degrade the thin cap until
it ruptures, exposing its fatty core (a soft gruel of cho- Physical activity vs. exercise
lesterol, inflammatory T cells, and white blood cells). A note about the terminology in this Special Health
When this occurs, your body dispatches platelets to Report: Physical activity consists of any movement that
prompts muscle contractions and a rise in metabolism.
adhere to the site. While that stems a hemorrhage, Under this umbrella is an endless list of activities, such as
it also forms a clot that may partially or completely rising from a chair, crossing the room, tossing a frisbee,
cut off blood flow to the heart muscle supplied by the running a marathon, or vacuuming a floor. When we use
blocked vessel. the term exercise, we are referring to any planned, struc-
tured, and repetitive program of activity aimed at improv-
However, exercise helps keep the inner lining of
ing or maintaining physical fitness.
the arteries healthy and thereby less prone to injuries
Keep in mind that mundane tasks like mopping floors and
that set the stage for plaque formation. It also inhib- leisure pursuits like gardening are a good way to keep
its clot formation by making platelets less “sticky” and moving. If sustained for at least 10 minutes, they may even
promotes the release of enzymes that break down clots. count toward your weekly exercise goal. But don’t stop
What’s more, it reduces inflammation (see below). there. Coupling these activities with regular exercise ses-
sions bumps up your total energy expenditure and improves
overall conditioning and your prospects for good health.
Promotes new coronary arteries
The greater need for oxygen-rich blood that occurs
during aerobic exercise can lead to an increase in the their incidence of heart attack and stroke fell by 54%
size and number of coronary arteries, which feed the and 48%, respectively, compared with those taking a
heart. This provides other channels for oxygenated placebo. While this study focused on statins instead
blood to reach heart muscle. If an arterial blockage of exercise as a means of lowering CRP levels, it pro-
does occur, there’s less risk of heart muscle damage vided evidence for the general connection between
because there are alternative channels to keep the lowering CRP levels and reducing inflammation and
blood supply flowing. The increased oxygen supply heart disease.
also offers some protection against dangerous heart Some research indicates that exercise, like statins,
rhythm disturbances. may lower the level of inflammation markers such as
CRP, although other research suggests that you need
Reduces inflammation to simultaneously reduce body weight for inflamma-
When there is inflammation in your body—whether tory levels to decrease. For example, a 2006 Journal
from arthritis, an infection, cancer, heart disease, or of the American Medical Association study found that
other conditions—levels of a substance produced in adults who weren’t physically active were more likely
the liver called C-reactive protein (CRP) rise. Several to have high CRP levels than those who exercised
studies have found that people with high CRP levels more regularly. Taken together with the results of the
are at greater risk of developing heart disease—even if JUPITER study, these findings make a case that reduc-
their cholesterol levels are normal. ing CRP levels, whether by statins or exercise with
Researchers at Boston’s Brigham and Women’s weight reduction, may reduce the risk of heart disease.
Hospital looked at the effect of using statins, power-
ful cholesterol-lowering drugs, on CRP levels and the
incidence of heart attack and stroke. The study, pub- Diminishes diabetes
lished in 2008 in The New England Journal of Medicine Diabetes affects more than 25 million Americans.
and known as the JUPITER trial, included more than When untreated or poorly treated, it can lead to blind-
17,000 men and women who had low LDL cholesterol ness, high blood pressure, kidney disease, all forms of
levels (less than 130 mg/dL) and relatively high CRP heart disease, and the loss of limbs. It’s also a major
(2 mg/L). The researchers found that the individuals factor in stroke—in fact, the risk of stroke is two to
taking a statin showed a 37% drop in CRP levels, and four times higher for people who have diabetes.

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 Other impressive findings have come from the
Lack of exercise may pave the way for Diabetes Prevention Program study, which assigned
metabolic syndrome more than 3,000 high-risk participants to three
Metabolic syndrome is a complex health problem marked groups. One group took part in a program of diet and
by high blood pressure; high levels of overall cholesterol, moderate exercise; the second received the diabetes
LDL (bad) cholesterol, and triglycerides; low levels of HDL
drug metformin (Glucophage); and the third, a con-
(good) cholesterol; a large waistline; and trouble regulating
blood sugar. It raises risks for heart disease and diabetes. A trol group, received a placebo. Both of the first two
study published in Circulation followed thousands of men groups did better than the control group, but the big
and women, ages 20 to 80, who initially had no signs of winners were the people in the diet and exercise group.
metabolic syndrome. The researchers measured their car- They lowered their risk for diabetes by 58%.
diorespiratory fitness using a treadmill. After an average
follow-up period of five years, investigators found that, in
Adding strength training (also called resistance
men and women alike, a low fitness level was strongly cor- training) to your aerobic exercise routine could yield
related with the later development of metabolic syndrome. even greater benefits. This form of exercise includes
weight training and other strength-building techniques.
(See page 43 for strength training exercises.) A 2010
All cells need sugar as a source of energy. Insulin, study published in The Journal of the American Medical
a hormone produced by your pancreas, helps cells Association found that a combination of aerobic exercise
extract sugar from the blood. When you have diabetes, and resistance training lowered blood sugar levels even
your body is unable to make or use insulin efficiently, more than either aerobic or resistance training alone,
so you have excess sugar (glucose) in your blood. even though participants in all three exercise groups
About 5% to 10% of people with diabetes cannot make reduced their waist circumference.
insulin at all; this condition is called type 1 diabetes.
Those who have it must take daily insulin shots.
In the other 90% to 95% of people with the disease, Offers a dose of cancer prevention
the body is less responsive to insulin and needs more of While results vary, some large observational studies lend
it to metabolize glucose. For a while, the pancreas rallies support to the idea that exercise can help protect you
and pumps out more insulin, but eventually it can’t keep from certain cancers. The bar is set fairly high: at least
up with the greater demand, and blood sugar levels rise. 30 to 60 minutes daily of moderate to vigorous activity
This is known as type 2 diabetes. This form of the disease lowers the risks for colon and breast cancers, accord-
can often be controlled by diet and exercise, although ing to the strongest available evidence. One way exer-
medications or insulin shots may be needed eventually. cise might do this is through changing hormone levels,
Type 2 diabetes, which is exacerbated by age, such as by decreasing circulating estrogen, insulin, and
obesity, and a sedentary lifestyle, is reaching near- growth factors that feed tumor cells. Plus, physi­cal
epidemic proportions among Americans. Physi- activity reduces inflammation (often accompanied by
cal activity helps control weight, of course, and also high levels of the inflammation marker C-reactive pro-
assists in two more ways. First, exercise seems to lower tein, known as CRP), which may be related to cancer,
blood sugar levels by modest amounts. Second, exer- though more evidence is needed to determine whether
cise boosts the body’s sensitivity to insulin. This can this is the case. It also may prevent cancer by improving
help control existing diabetes, and, perhaps more sig- energy metabolism, enhancing immune function, and
nificantly, it can help stave off the onset of the disease. accelerating the movement of food through the bowels.
Several large long-term studies have demonstrated ■ Colorectal cancer. After reviewing 52 studies pub-
this benefit. For example, brisk walking for at least lished through June 2008, investigators writing in the
two-and-a-half hours a week cut risk for diabetes by British Journal of Cancer found ample, consistent evi-
30%, according to an analysis of five studies involving dence that regular physical activity reduced risk for
more than 240,600 subjects. colon cancer. On average, the dip was 24% in men and

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 Pay attention to BMI and waist circumference
Most people realize that extra body fat is bad for your heart territory. And especially muscular folks—football players,
and your health. That plump roll of pudge around your middle for example—have deceptively high BMIs because muscle
or on your thighs influences blood lipids (HDL and LDL cho- weighs more than fat.
lesterol and triglycerides) and blood sugar. Therefore, it’s To determine your BMI, use Table 1, below, or a Web-based
important to pay attention to a few numbers: your BMI and calculator: [Link]
your waist circumference.
The size of your waist counts, too. Your waist circumference
Body mass index (BMI) is an estimate of body fat based measures what doctors call abdominal adiposity, and others
on a person’s weight and height. The normal range is call a spare tire, love handles, beer belly, or middle-age spread.
associated with the lowest rates of illness and death. The Ideally, waist circumference should be less than 40 inches
overweight and obese ranges are associated with pro- for a man or 35 inches for a woman. To check: Place a cloth
gressively higher rates of illness and death. Even though tape measure around your bare abdomen just above your hip
BMI is very useful, looking at these numbers alone can bones. Make sure the tape is snug and parallel to the floor.
be deceptive. The normal range in the BMI table covers a
lot of ground. A person at the lower end of the spectrum Exercising regularly helps trim abdominal fat and waist
could gain a significant amount of weight—that’s a risk circumference even when little weight is lost, according to
factor for disease by itself— and still remain in “healthy” several studies.

Table 1 What’s your body mass index?

The body mass index (BMI), an index of weight by height, is used to classify people as normal, overweight, or obese.

Height weight in pounds

4’10” 91 96 100 105 110 115 119 124 129 134 138 143 167 191
4’11” 94 99 104 109 114 119 124 128 133 138 143 148 173 198
5’0” 97 102 107 112 118 123 128 133 138 143 148 153 179 204
5’1” 100 106 111 116 122 127 132 137 143 148 153 158 185 211
5’2” 104 109 115 120 126 131 136 142 147 153 158 164 191 218
5’3” 107 113 118 124 130 135 141 146 152 158 163 169 197 225
5’4” 110 116 122 128 134 140 145 151 157 163 169 174 204 232
5’5” 114 120 126 132 138 144 150 156 162 168 174 180 210 240
5’6” 118 124 130 136 142 148 155 161 167 173 179 186 216 247
5’7” 121 127 134 140 146 153 159 166 172 178 185 191 223 255
5’8” 125 131 138 144 151 158 164 171 177 184 190 197 230 262
5’9” 128 135 142 149 155 162 169 176 182 189 196 203 236 270
5’10” 132 139 146 153 160 167 174 181 188 195 202 209 243 278
5’11” 136 143 150 157 165 172 179 186 193 200 208 215 250 286
6’0” 140 147 154 162 169 177 184 191 199 206 213 221 258 294
6’1” 144 151 159 166 174 182 189 197 204 212 219 227 265 302
6’2” 148 155 163 171 179 186 194 202 210 218 225 233 272 311
6’3” 152 160 168 176 184 192 200 208 216 224 232 240 279 319
6’4” 156 164 172 180 189 197 205 213 221 230 238 246 287 328
BMI 19 20 21 22 23 24 25 26 27 28 29 30 35 40
Normal Overweight OBESE

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21% in women. Nurses’ Health Study researchers also fragile and subject to breaks. Osteoporosis—a bone
estimate that more than 15% of all colorectal cancers disorder marked by low density and weakened struc-
could be prevented if people added half an hour of ture—affects 10 million Americans and is responsible
walking to their daily routine. Preliminary evidence for 297,000 hip fractures every year. Not just pain-
also suggests that exercise can improve the prognosis ful and inconvenient, hip fractures often make once-­
of people who have been treated for colorectal cancer. simple activities of daily living impossible, leading to
Several recent studies of colorectal cancer survivors loss of independence and, in some cases, long-term
show that exercise may help ward off a recurrence of nursing home care. Complications following hip frac-
this type of cancer and reduce the likelihood patients tures can be fatal.
will die from it. The beneficial effects of exercise on Bone strength in later life depends upon your peak
both men and women with stage I to stage III colorec- bone mass in youth—which is 85% to 90% complete by
tal cancer appear to be independent of age, disease age 18 in girls and age 20 in boys—combined with the
stage, body mass index, or the patient’s activity level rate at which you lose bone mass as you age. Numer-
before diagnosis. ous studies demonstrate that exercise at a young age
■ Breast cancer. While the results of individual can significantly increase maximum bone density.
studies vary, the overall body of evidence indicates But if you’re older, exercise can still help by slow-
that active women have a lower risk of breast cancer, ing bone loss. A study of middle-aged women found
particularly postmenopausal breast cancer. A 2011 that those who exercised strenuously for 18 months in
review of over 90 studies found that women who the years just before menopause lost less bone mass
engaged in regular physical activity cut their risk for after menopause than women who weren’t as active.
breast cancer by an average of 25% compared with It is also clear that exercise can have dramatic
the least active women in the studies. The results effects on the most vulnerable of the elderly. Particu-
were strongest for moderate to vigorous activity per- larly effective are activities that build strength and bal-
formed regularly and sustained over a lifetime or ance (since better balance can mean fewer falls and
done after menopause. Moreover, two other studies subsequent breaks). Strong evidence shows that regu-
show that even women who have already been diag- lar physical activity can reduce falls by nearly a third
nosed with breast cancer may reduce their risk of in older adults at higher risk of falling.
dying of the disease simply by walking three to five Exercise is helpful because stress stimulates the
hours per week at a moderate pace or two to three growth of new bone tissue. But in order to benefit
hours per week at a brisk pace. bones, exercise must be weight-bearing, meaning
■ Other cancers. Data suggest that being active also that the activity works against gravity. Running, walk-
reduces risks for developing lung, endometrial, and ing, playing soccer, weight lifting, dancing, and stair
ovarian cancers by 20%, 30%, and 20%, respectively. climbing are good examples. Activities such as swim-
Currently, there is no solid evidence that exercise low- ming or biking aren’t weight-bearing and thus don’t
ers the risk for prostate cancer. However, a study pub- build bone. Generally, higher-impact activities or
lished in 2011 found that among men diagnosed with resistance exercises, such as strength training, have a
prostate cancer, those who walked briskly for three more pronounced effect on bone than lower-impact
hours per week had a 57% lower rate of progression exercises, such as walking.
of the disease than their counterparts who walked at Also, only bone that bears the load of the exercise
a slow pace. will benefit. For example, walking or running protects
bones in your lower body. A well-rounded strength
training plan can benefit practically all of your bones.
Fights fractures and reduces falls And strength training is the only type of exercise that
By age 30, bone strength and size peaks. After that, targets the very sites most likely to sustain fractures
bones tend to become less dense, making them more from osteoporosis—bones of the hip, spine, and arms.

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Tunes up immune function cles help support joints and lessen stress upon them.
Some research shows that regular, moderate exercise Strength training also enhances flexibility in many
may increase your ability to fend off infection. In several joints, according to one small study of older men. After
surveys, runners and other athletes reported that they 16 weeks of workouts, men doing strength training
had 60% to 90% fewer colds than their nonexercising alone or combined with cardiovascular training had
counterparts. This perception is supported by the results significantly better range of motion in seven out of 10
of three randomized trials. In these studies, women who joints tested than men who remained inactive. Among
walked briskly 35 to 45 minutes a day, five days a week, those assigned to do only cardiovascular activities,
for 12 to 15 weeks experienced half the cold symptoms range of motion improved in only two joints.
of a control group that performed no exercise. Despite all its benefits, it’s true that occasionally
In addition, a 2008 study of people ages 61 to 76 regular exercise can aggravate arthritis. The “Advice
suggested that moderate exercise helps counteract the for people with arthritis” section of this report (see
natural decrease in immune functioning that occurs page 36) may help you minimize this problem. You
with aging. may find that your doctor advises against certain
types of activity because of your particular character-
istics, but most people find some form of exercise they
Prevents gallstones can do despite their arthritis.
The links between gallstones and physical activity haven’t
been investigated extensively, but data from a half-dozen
studies show that exercise may help prevent the disease. Helps you attain a healthy weight
Studies on men and women suggest exercising regularly One important gain from exercise flows from what
could cut the risk for gallstones by 34% to 60%. you can lose—excess weight. In America, two out of
Excess weight is a primary risk factor for gallstones. three adults are overweight or obese.
Certainly, regular exercise can help control weight, and Being overweight or obese makes you more sus-
in that way exercise may help prevent gallstones. But a ceptible to scores of health problems, including high
number of studies suggest that apart from helping peo- blood pressure, high cholesterol, diabetes, heart dis-
ple avoid weight gain, exercise may act to prevent the ease, stroke, gallbladder disease, gout, sleep apnea, and
disease independently, but it is unclear how. erectile dysfunction. Excess weight clearly contributes
to cancers of the breast (in postmenopausal women),
colon, and uterus, and it may increase the risk of can-
Eases arthritis cers of the esophagus and kidney, according to the
Moderate exercise—whether aerobic or resistance— American Cancer Society. The higher your body mass
helps reduce swelling in joints, relieve pain, and limit index (see “Pay attention to BMI and waist circumfer-
fatigue. By contrast, when joints aren’t used, the carti- ence,” page 11), the greater the odds of disease.
lage thins and softens, making the joint more vulner- While the recommended minimum of 150 min-
able to arthritis. utes of exercise per week can decrease your risk of
By helping to control weight, exercise also reduces developing a host of diseases, it may not be enough
your chances of developing arthritis. Being over- to prevent weight gain, given the typical diet of
weight puts people at a much higher risk of developing many Americans. Still, it can certainly reduce the
arthritis—in fact, according to the Arthritis Founda- amount of weight you would gain if you didn’t
tion, for every pound you add, the load on your knees exercise at all. A study published in The Journal of
increases by 4 pounds. Paring off just 11 pounds may the American Medical Association in 2010 showed
halve the risk of developing knee osteoarthritis. that in order to prevent weight gain, women in the
Strength training can make a significant difference United States who consumed a typical diet had to do
to people with many types of arthritis. Strong mus- moderate-intensity physical activity for 60 minutes

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per day (420 minutes per week)—far longer than the exercise may enable people to counteract, at least in
exercise time recommended in the U.S. Department part, their genetic predisposition to obesity.
of Health and Human Services guidelines. Of par-
ticular importance is that this study focused on gen-
eral health rather than specifically on weight control Extends life span
and, consequently, it followed women over a 13-year Staying active not only improves your health, it
period, rather than for the one to two years that extends your life. When researchers working on the
many weight-loss studies typically last. renowned Framingham Heart Study compared low,
The study also showed that while women of nor- moderate, and high activity levels in men and women
mal weight gained less weight the more they exercised, over age 50, this is what they found:
heavier women didn’t enjoy the same benefit, pos­ • Moderate activity resulted in an additional 1.1 years
sibly because they consumed more calories than their free from cardiovascular disease for men and 1.3
normal-weight peers. The researchers suggested that years for women. Plus, it added 1.3 years of life for
heavier people, especially, should limit the calories men and 1.5 years for women.
they consume in addition to exercising if their goals
• High activity levels netted an additional 3.2 years
are to achieve a healthy weight and combat the typical
without cardiovascular disease for men and 3.3 years
American pattern of weight gain with age.
for women. Plus, high activity tacked on 3.7 years of
Scientists are studying the connection between
life for men and 3.5 years for women.
genetics, obesity, and exercise. It’s clear that some
genes predispose certain people to be heavier than One way that exercise may extend life span is by
others. However, preliminary genome-wide associa- keeping your cells young. Some studies have found that
tion studies have found that regular physical activity exercise may slow the erosion of telomeres, tiny tips
may blunt the effect of genes linked to obesity. More at the ends of chromosomes that serve as markers of
research using larger samples is needed to confirm a cell’s age (see “Understanding the link between telo-
this finding; however, research to date offers hope that meres and cell aging,” page 15). In a 2009 Circulation

Exercise and weight loss: Tools and tips to help you reach your goal
Need to lose weight? Cutting back on calories consumed while Counting calories: What it takes to burn a pound of fat
bumping up total activity level is the most effective method. • It takes roughly 3,500 additional calories spent in physical
Wolfing down a candy bar takes a mere minute or two; activity to burn a pound of fat.
walking off those calories would take most people about 40 • Walking or jogging uses up roughly 100 calories per mile.
minutes. To lose a single pound, you need to burn approxi- (Note: Your actual calorie expenditure depends on a num-
mately 3,500 calories. Doing so through activity alone could ber of factors, including your weight and pace.)
easily take a few weeks of regular, moderate exercise. On the
• You’ll shed approximately a pound of fat for every 35 miles
other hand, consuming 500 fewer calories a day will result
you walk, assuming your levels of food intake and other
in the loss of a pound a week. For that reason, dieting alone
physical activity remain the same.
seems as though it would be a fast path to weight loss.
• If you walk briskly (at a pace of 4 mph) for half an hour
But regular exercise offers certain benefits beyond calorie
on five out of seven days, you’ll log 10 miles a week. At
burning. It slightly increases your resting energy expendi-
the end of three-and-a-half weeks, it’s possible to lose 1
ture—that is, the rate at which you burn calories even when
pound even if the number of calories you consume stays
the workout is over and you are at rest. And pounds lost
the same.
through boosting your activity level consist almost entirely
of fat. Plus, some studies suggest exercise preferentially • If you also cut back on the amount of food you eat by a
targets abdominal fat, which plays a role in hypertension, few hundred calories a day, you can hasten the pace of
cardiovascular disease, and diabetes. your weight loss.

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study, German scientists looked at the telomeres of a sedentary lifestyle with a shorter telomere length
white blood cells from 104 adults: young and middle- and, possibly, accelerated aging.
aged sedentary adults, and young and middle-aged These studies suggest that long-term regular exer-
serious athletes who regularly ran 45 to 50 miles a week. cise could have anti-aging effects, but more research is
The researchers found that the telomere length needed to confirm these findings.
of the young people (average age 20–21), whether If you’re feeling too old, too heavy, or too sick
active or sedentary, was about the same. As expected, to start exercising, consider the following findings,
the telomeres of the sedentary middle-aged adults which reveal that no matter what your current physi-
(average age 50–51) were much shorter than those cal condition, exercise can have beneficial effects. One
of the younger study participants. The telomeres large study of Americans ages 65 and over demon-
of the middle-aged runners were also shorter than strated that men and women who were at least mod-
those of their young counterparts, but the amount erately active stood to gain between 3 and 5.7 years of
of telomere erosion was considerably smaller. Simi- additional life, depending on how often they exercised.
larly, a study published in 2008 in Archives of Inter- Just as importantly, a greater-than-average portion of
nal Medicine involving 2,400 twin volunteers linked those years were lived free from disability.

Understanding the link between telomeres and cell aging

Each of our cells has a finite life span. They divide, at first to help down. When the telomeres become too short, the cell enters
our bodies grow, and then in adulthood to replace cells that are senescence—a stage in which it no longer divides—and finally
damaged or have died. Each time a cell divides, its telomeres— dies. Thus, the shorter the telomere, the older the cell. Some
the tiny caps on the ends of long strings of DNA—are pared studies have found that exercise may slow telomere erosion.

Figure 3 The life and death of a cell

Cell division Telomere length
Chromosomes

Young chromosome, with long telomeres at its tips

Cell membrane

Middle-aged chromosome, with shorter telomeres

Paired The two copies of Two cells form,
chromosomes each chromosome each with
in a single cell move apart identical sets of
chromosomes
Old chromosome, with short telomeres
• Chromosomes are long strings of DNA with proteins
wrapped around them, tucked inside the nucleus (the center) Each time a cell divides, a little bit of the telomere at the tip
of every cell. The chromosomes contain almost all of a cell’s of the chromosome is lost, shortening it. Thus, telomeres of
genes. Each human cell has 23 pairs of chromosomes. young cells are longer than the telomeres of middle-aged
• At the tip of every chromosome are telomeres (see illustra- cells— which, in turn, are longer than the telomeres of old
tion at right). They protect the ends of the chromosome from cells. When the telomeres become very short, the cell can no
damage, just as do the aglets at the tips of shoelaces. Before longer divide and dies.
a cell divides, each chromosome makes a complete copy of
itself. Then, when the cell divides into two, one chromosome
goes to one cell and the copy goes to the other cell.

ww w. h ealt h . h ar v ar d . e du Exercise 15
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 What’s more, fit trumped fat in a 2007 study pub- of Epidemiology on community-living adults ages 70
lished in The Journal of the American Medical Asso- to 82 noted that men who burned a high number of
ciation. After evaluating cardiorespiratory fitness in calories each day walked faster and were less likely
adults ages 60 and older, researchers found that those to have developed mobility limitations at follow-up
in the lowest quintile for fitness had the highest risk of more than three years later, compared with those
dying during the 12-year follow-up period, indepen- who did not.
dent of their waist circumference or overall percent- Other research has shown that higher levels of
age of body fat. activity at midlife translate into a greater likelihood
Finally, even if you already have a chronic disease of better mobility in old age. And studies have also
or condition, the health benefits of exercise often hold shown that regular exercise can make falls—and,
up. For example, an analysis of studies on people who therefore, injuries from falls—less likely.
had suffered heart attacks showed that patients treated
with cardiac rehabilitation, consisting largely of exer- Wards off depression and anxiety
cise, lived significantly longer than those who received Can a few laps around the block solve emotional dif-
only medical care. ficulties? Probably not, but a regular exercise program
All this underscores that no matter your age, might help.
health status, or current fitness level, it’s never too late A variety of studies have found that exercise can
to start exercising. Regular exercise will enhance your boost mood. Nationwide samples show active Ameri-
health prospects. cans are 30% less likely to suffer from depression than
sedentary people. And a number of small, random-
ized trials indicate that supervised exercise programs
Improves quality of life can reduce symptoms of depression. In many of the
Exercise helps you not only live longer, but also live studies focusing on mild to moderate depression,
better. Maintaining a healthy level of activity through- aerobic exercise was as effective as drug therapy and
out your life can improve your mental, emotional, and bright light therapy.
physical functioning, as well as bolster your produc- Exercise may benefit your mind in a few ways.
tivity and intimate relationships. To begin with, aerobic exercise prompts the release
of mood-lifting hormones, which relieve stress and
Protects mobility and vitality promote a sense of well-being. In addition, the repeti-
It’s true that physical performance drops off as you age. tive cycle of muscle contraction and release that takes
However, regular exercise can slow the decline. By stay- place in yoga or in aerobic pursuits such as walking
ing active, older adults can keep their cardiovascular and swimming increases levels of the brain chemical
fitness, metabolism, and muscle function in line with serotonin, which combats negative feelings.
those of sedentary people who are considerably younger. How much huffing and puffing is needed to attain
Another benefit is that exercise can help you main- these effects? Some research sets the bar at a mini-
tain your vitality. As you age, you are at greater risk of mum of 30 minutes of moderate exercise five days a
losing your independence. For example, 37% of men week, or 20 minutes of vigorous exercise three times
and 55% of women ages 85 and over need help with the a week. In a randomized trial of adults with mild to
activities of daily living, whether they reside in a home moderate depression, physicians found that people
or institutional setting. However, one study found that assigned to that level of exercise experienced a 47%
compared with the most sedentary seniors, those who drop in distressing symptoms at the end of 12 weeks,
were most physically active were twice as likely to reach compared with a 30% reduction for a lower dose of
the end of their lives without suffering disability. exercise and 29% for a control group that did stretch-
Exercise also appears to protect mobility. In ing activities. Of course, as is the case for other treat-
2009, researchers reporting in the American Journal ments, exercise did not work for everyone.

16 Exercise w w w.h ealt h .ha r va r d.e du

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 Exercise may also prevent and alleviate anxiety affect how your body repairs cells and tissues, fights
disorders. There are few strong studies on this topic, infection, and uses energy.
but national samples show regular physical activ- Several studies have shown how regular aero-
ity lessens the odds of developing an anxiety disor- bic exercise can help alleviate sleep problems. In one
der by 28%. One small, randomized trial of patients study, 43 adults with sleep complaints were assigned
with panic disorder showed walking or jogging three to a 16-week program that included 30 to 40 min-
times a week for 10 weeks significantly eased anxi- utes of moderate exercise four times a week. At the
ety symptoms compared with taking daily placebo end of the period, the exercisers showed significant
capsules. Another trial of subjects with social phobia, sleep improvements, compared with a control group.
generalized anxiety, or panic disorder found adding Another small study found that a 12-week exercise
moderate exercises done at home to group cognitive program for the lower body helped relieve symptoms
behavioral therapy reduced anxiety more successfully of restless legs syndrome, a movement disorder that
than the group therapy and nutrition education. interferes with sleep.
Exercise is also the only known way for healthy
Sharpens wits adults to boost the amount of deep sleep they get.
Exercise helps in several ways to keep your brain sharp. Deep sleep seems to be a time for your body to renew
Physical activity improves blood flow to the brain, and repair itself: it’s the kind of sleep that helps you
which may help maintain brain function. It also pro- feel most rested and alert.
motes good lung function, a characteristic of people Generally, it’s best to exercise five or six hours
whose memories and mental acuity remain strong in before bedtime, which will encourage drowsiness
old age. Finally, exercise reduces the risk for diseases when it’s time to go to sleep. Strenuous activity too
such as hypertension and diabetes, which can lead to close to bedtime can keep you awake.
memory loss, and stroke, which damages brain tissue.
The landmark MacArthur Foundation Study of Enhances sex life
Successful Aging revealed that people whose mental Wish your sex life had more zip? Don’t confine your
functions remained strong were active on a near-daily workouts to the bedroom. Libido and performance
basis. Additionally, an Archives of Internal Medicine benefit from moderate to vigorous aerobic exercise.
study reported a link between cognitive decline and An Archives of Sexual Behavior study followed
lack of physical activity. The study followed nearly 78 healthy but sedentary middle-aged men for nine
6,000 women, ages 65 and over, for six to eight years. months and found that those in a group that exer-
Those who were most active had a 35% to 37% lower cised vigorously (for an hour a day, three to four days
rate of cognitive decline than the least active group. In a week) reported more frequent sex, improved sexual
addition, many studies show that aerobic exercise, in function, and higher levels of sexual satisfaction than
particular, improves cognitive function, but questions those in a control group.
remain about whether the exercise must be at a level The Harvard Health Professionals Follow-up
that also improves fitness. Study, a long-term study involving nearly 32,000
men, lends support here. Researchers noted that men
Improves sleep who exercised 30 minutes a day were 41% less likely
More than a simple annoyance, lack of sleep can to have erectile dysfunction compared with seden-
impair mood and performance, lead to accidents, and tary men. Exercise helps combat atherosclerosis, the
worsen health problems such as hypertension, obe- buildup of plaque on artery walls that can contribute
sity, and diabetes. Hormones released when you sleep to difficulties with erection.

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 The fundamentals: What you need to know
to get started
B efore you choose activities and hit the treadmill
or bike path, you probably have a few questions
about the amount, intensity, and type of exercise to
pare this down to at least one hour and 15 minutes
(75 minutes) per week. An equivalent combination of
the two also fills the bill. As a guide, one minute of
include in your personal plan. Reading this section vigorous-intensity activity equals about two minutes
will answer many basic questions, including these: of moderate-intensity activity.
• How much exercise do I need? Twice a week, also set aside time to do strength exer-
cises for all the major muscle groups (legs, hips, back,
• How often should I exercise?
chest, abdomen, shoulders, and arms). Older adults at
• How long must my exercise sessions be?
risk for falls benefit from including balance exercises,
• How vigorously should I exercise? too. Even if you are not able to reach the minimum exer-
The following sections delve into what blend of cise guidelines right away, it is important to do as much
activities your plan should include and get you started exercise as you are able and try to increase it gradu-
with them. ally. For more on building a well-rounded program, see
“Creating a personal exercise plan” on page 21.
The physical activity guidelines reflect the mini-
How much exercise do I need? mum amount of exercise recommended for adults.
You can track either your time or calories, or both, to For even greater health benefits, adults who are able
make sure you’re getting enough exercise. If you have should strive for five hours per week (300 minutes)
been sedentary for a long time or have certain health of moderate-intensity aerobic activity or two-and-a-
problems, be sure to work up to these goals gradually half hours (150 minutes) of vigorous-intensity aero-
(see “Building up,” page 19). bic exercise. Again, you can also mix the two. Adults
■ Time. The 2008 Physical Activity Guidelines for with health problems that limit their ability to exercise
Americans recommend at least two hours and 30 min- should strive to do as much as they can.
utes (150 minutes) of moderate aerobic activity per ■ Calories. Health benefits kick in when you expend
week. If you enjoy vigorous aerobic activities, you can between 500 and 1,000 calories per week through physi­
cal activity, although many studies find additional and
Calories, miles, and minutes: extended health benefits flow from expending closer to
How long will it take? 2,000 calories a week. For example, one New England
Journal of Medicine study analyzed research conducted
Say you’re aiming to burn 1,000 calories a week. How much
on 17,000 Harvard alumni. The greatest gains in lon-
time do you need to spend walking? It depends on your
pace. If you are middle-aged and healthy, you may find that gevity and lowered risk for disease occurred among
a moderate pace for you is 4 mph (which translates into those expending approximately 2,000 calories per week
approximately 400 calories per hour). In that case, it will through dynamic physical activity, such as walking,
take about 2.5 hours of walking per week (or half an hour a gardening, or sports. The most active group recorded
day, five days a week) to burn 1,000 calories. But if you are
older or have been sedentary, you may find that a pace of 2
an average two-year gain in life span.
mph (approximately 200 calories per hour) is moderate for
you. In that case, you’ll need to put in about five hours of
walking time per week (a little over 40 minutes a day, seven How often should I exercise?
days a week) to reach the 1,000-calorie threshold.
The 2008 Physical Activity Guidelines don’t spell out

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how many days a week you should exercise; instead,
they focus on overall time per week. Generally, though, Building up
experts recommend spreading activity throughout the Not everyone is capable of walking briskly or for long
week and being active at least three days a week. stretches right from the start. Remember, any exercise
is always better than none. Even a little regular exercise
Starved for time? It’s tempting to wonder if you
improves health, particularly when you’re first starting out.
can compress activities into one or two days a week. Plus, it can be a stepping stone to greater efforts.
While scientists haven’t delved into this extensively, If you are finding it difficult to walk briskly for half
some research tantalizingly suggests that “weekend an hour, try walking more slowly for 10 to 15 minutes a
warriors” who regularly burn through more than 1,000 day. Then gradually speed up your pace and extend your
walking time. Or, a few times a day, try walking briskly for
calories in one or two sessions a week do have a lower just five to 10 minutes out of each hour. Gradually add
risk of dying than entirely sedentary adults—that is, if minutes to each of these short walking sessions to boost
they have no major risk factors. However, safety issues, your endurance and net aerobic benefits.
common sense, and the bulk of research stressing Early on, set your sights on a 500-calories-a-week mini­
mum. Some weeks you may exceed your goal, and other
bene­fits that flow from regular activity on most days of
times you may need to ease up temporarily. Keep trying!
the week argue against adopting this pattern.

moderate, or vigorous (see Table 2). Called perceived

How long must my exercise exertion, it’s especially helpful for staying in a safe range
sessions be? of activity. As you improve your fitness, you’ll find your
Sessions as brief as 10 minutes of aerobic exercise perception of the intensity of a particular activity—
deliver health benefits, so do what works best for walking up a nearby hill, for example—changes.
you. For example, one person may prefer doing three Table 2 describes physical changes at each level of
10-minute exercise sessions a day for five days in order exertion. If you’re just getting started with an exercise
to meet the guidelines, while another may prefer walk- program, aim for a moderate pace. (If health prob-
ing 30 minutes twice a week and cycling along a bike
path for 90 minutes on a sunny weekend day.
Table 2 How hard are you working?
Intensity It feels You are…
How vigorously should I exercise? Light Easy • Breathing easily
Whether you are healthy or have medical issues, mod- • Warming up, but not yet
sweating
erate activity is safe for most people and does plenty to • Able to talk—or even sing an
improve your health. If you’re in good shape, adding aria, if you have the talent
vigorous activities to your workouts cuts time spent Light to You’re • B reathing easily
exercising and is a boon to health. If you’re not fit, moderate working, but • Sweating lightly
not too hard • Still finding it easy to talk or sing
work up to vigorous activities slowly. Higher-­intensity
activities raise your chances for muscle or joint injury Moderate You’re • B reathing faster
working • Starting to sweat more
and very slightly increase the odds of developing a • Able to talk, not able to sing
serious heart problem. This applies particularly to
Moderate to You’re really •  uffing and puffing
H
people who are unaccustomed to physical activity, vigorous working • Sweating
who suddenly start exercising vigorously (although • Able to talk in short sentences,
but concentrating more on
the overall risk of dying from heart disease is lower exercise than conversation
than if you did no exercise).
Vigorous You’re • B reathing hard
How can you judge the pace of your workout? The working very • Sweating
easiest way to measure exertion characterizes the inten- hard, almost • Finding talking difficult
out of gas
sity of an activity through broad categories, such as light,

ww w. h ealt h . h ar v ar d . e du Exercise 19
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lems or disabilities make moderate activity impossible, gains as exercises become easier. Whenever an activ-
simply do as much as you can.) As you build up, try a ity becomes easy, boost the length of your workout or
mix of moderate and vigorous activities to help build your intensity again.
endurance. As you work out more often, you’ll notice
Understanding METs
While most of us may think of exercise intensity in
Table 3 Real-life metabolic equivalents (METs)
terms of how many calories we burn, scientists often
Approximate calories
METs Sample activities used per hour by a use a different way to measure your level of exertion:
155-pound person a system called metabolic equivalents (METs). METs
Sitting, reading, desk work, express your body’s oxygen demand at a particular
1 70
watching TV level of exertion. It’s very difficult to accurately cal-
1.1–2.5
Office work, city driving,
175
culate the MET of an activity. That’s because METs
standing in line are not measured directly; they’re determined on the
Housework, normal basis of oxygen intake.
walking, light gardening,
2.6 – 4.4
bowling, slow dancing, tai
175–310 The amount of oxygen your body needs to func-
chi, yoga, brisk walking tion at rest equals 1 MET (see Table 3). As your activ-
Baseball, calisthenics, ities become more vigorous, your oxygen demands
4.5–5.9
downhill skiing, cycling,
315–415
go up, as do the METs assigned to that activity. For
swimming, golfing (carrying example, a moderate activity like walking at 4 mph
clubs)
takes four times the oxygen as resting. Therefore, it
Jogging, competitive sports,
6– 8.4
singles tennis
420–590 has a MET of 4. Running at 6 mph equals 10 METs.
Without special equipment, it’s impossible to cal-
Sprinting, jogging uphill,
8.5 or culate the MET of an activity as you’re doing it.
fast running, unusually 595+
more
heavy work Although some exercise machines estimate this value,
Adapted, with permission, from R. S. Paffenbarger and E. Olsen, LifeFit (Cham- as well as calories expended, they are often highly
paign, Ill.: Human Kinetics, 1996), pp. 39 – 40, and from I-M Lee, C. C. Hsieh,
and R. S. Paffenbarger, “Exercise Intensity and Longevity in Men,” Journal of the
inaccurate on both counts. The measurement is use-
American Medical Association (Apr. 19, 1995), Vol. 273, No. 15, pp. 1179–84. ful primarily as a way to compare the levels of exer-
Copyright 1995, American Medical Association.
tion involved in different activities.

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 Creating a personal exercise plan

W hat’s the best way to create an exercise routine

tailored to your needs? Find a blend of activities
you enjoy and a schedule you can stick with over the
a mix, 10 minutes of vigorous activity equals roughly 20
minutes of moderate activity.) Raising your weekly goal
to five hours of moderate activity, or two-and-a-half
long haul. Start out gradually, set realistic goals, and hours of vigorous activity, nets additional health bene­
reward yourself for accomplishments along the way. fits. Each session should last at least 10 minutes.
Current recommendations urge all adults to include
aerobic and strength training in their exercise routine, Get started
and suggest balance exercises for older adults at risk forOur walking program (see Table 4) provides an easy
falls. In this section, we also include information on flexi­
way to get started. Walking is usually safe for any age or
bility and relaxation exercises, because while the sciencelevel of fitness, and can easily be adjusted to a comfort-
supporting their benefits is not as plentiful and well- able speed. It doesn’t jar joints or raise your heart rate
established, the available evidence does suggest some to dangerous levels. Expanding a walking program is
health benefits. If you find that this is too broad a pro-simple—add time, distance, or hills to improve endur-
gram, though, simply focusing on meeting the guidelines ance. If you prefer another aerobic activity, though, feel
will give you most of the known health benefits. free to substitute it. Otherwise, follow these tips to get
the best workout from your walks:
■ Find a safe place to walk. Quiet streets with side-
Aerobic exercise walks, park trails, athletic tracks at local schools, or
Often called cardio or endurance shopping malls are often good choices.
activities, aerobic activities are ■ Buy a good pair of shoes. Look for thick, flexible
great for burning calories and par- soles that cushion your feet and elevate your heel one-
ing down unwanted fat. They con- half to three-quarters of an inch above the sole. Choose
sist of activities that require large shoes with “breathable” uppers, such as nylon mesh.
muscles to repeatedly contract and ■ Dress for comfort and safety. Wear lighter clothes
relax: think of walking, biking, running, and swim- than you’d need if standing still. Dress in layers so you
ming, for example. This temporarily boosts your heart can peel off garments if you get hot. Light-colored
rate and breathing, allowing more oxygen to reach clothes and a reflective vest help drivers notice you.
your muscles and tuning up cardiovascular endurance. Do a five-minute warm-up and cool-down. Start
These are the activities that are associated with lower off at a slower pace for your warm-up. During your
risk for many diseases and lengthening life span. Make cool-down, you could incorporate stretching, thus
aerobic exercise the centerpiece of your fitness program, accomplishing two goals at once.
since the bulk of research on disease-quelling benefits ■ Practice good technique:
of exercise revolves around cardiovascular activity. • Walk at a brisk, steady pace. Slow down if you’re too
breathless to carry on a conversation.
How much • Keep your back straight.
The 2008 Physical Activity Guidelines recommend
• Hold your head up. Lift your chest and shoulders.
accumulating a weekly total of at least two-and-a-half
hours of moderate aerobic activity, or one hour and 15 • Point your toes straight ahead.
minutes of vigorous aerobic activity. (Note: If you prefer • Let your arms swing loosely at your sides. If you want

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 to boost your speed, bend your elbows at a 90-degree vides the functional strength you need to do everyday
angle and swing your hands from waist to chest height. activities—­lifting groceries, climbing stairs, rising
• Land on your heel, then roll forward onto the ball of from a chair, rushing for the bus—with ease.
your foot, pushing off from your toes.
• Take long, easy strides, but don’t strain. To go faster, How much
take quicker steps instead of longer ones. The 2008 Physical Activity Guidelines recommend
strengthening exercises for all major muscle groups
• Lean forward slightly when walking faster or going
(legs, hips, back, chest, abdomen, shoulders, and arms)
up hills.
twice or more weekly. One set per session is effective,
■ Follow the plan in Table 4. If you haven’t been though two to three sets may be better, according to
exercising, start at the beginning. If you’re already limited evidence. Repeat each exercise eight to 12
exercising but want to increase your activity, start at times. Your body needs at least 48 hours for recovery
the level that best matches your current routine and and repairs between strength training sessions.
build from there.
Get started
Our eight strength training exercises are a good way
Strength training to start, though you can substitute another strength or
Strength or resistance training, resistance workout, if you prefer.
which typically employs equip- These tips for safe strength training will help you
ment such as weight machines, get the most from your workouts:
free weights, and resistance ■ Plan to warm up and cool down for five to 10 min-
bands or tubing, protects against utes. Walking is a fine way to warm up; stretching is an
bone loss and builds muscle. It excellent way to cool down.
also improves your body’s ratio of lean muscle mass ■ Focus on form, not weight. Align your body cor-
to fat. It, too, deserves an important place in your rectly and move smoothly through each exercise. Poor
exercise routine. form can prompt injuries and slow gains. Many experts
Technically, strength or resistance training takes suggest starting with no weight, or very light weight,
place any time your muscles face a stronger-than- when learning a strength training routine. Concentrate
usual counterforce, such as pushing against a wall on slow, smooth lifts and equally controlled descents
or lifting a dumbbell. Using progressively heavier while isolating a muscle group. You isolate muscles by
weights or increasing resistance makes muscles stron- holding your body in a specific position while con-
ger. Aside from toning you, strength training pro- sciously contracting and releasing certain muscles.
■ Tempo, tempo. Tempo helps you stay in control
rather than undercut strength gains through momen-
Step by step
tum. For example, count to three while lowering a
A moderate (brisk) walking speed is a safe goal for most dumbbell, hold, then count to three while raising it to
people. Since humans don’t come equipped with built-in the starting position.
speedometers, you need some way to measure your walk- ■ Breathe. Blood pressure rises even more if you
ing speed. One way is to count your steps per minute.
Provided you’re walking on level ground, you can use the hold your breath while performing strength exercises.
following as general guidance to gauge your pace: Exhale as you work against resistance by lifting, push-
Slow = 80 steps per minute ing, or pulling; inhale as you release.
Moderate (brisk) = 100 steps per minute ■ Keep challenging muscles. The right weight differs

Fast = 120 steps per minute depending on the exercise. Choose a weight that tires
Race walking = More than 120 steps per minute the targeted muscle or muscles by the last two repeti-
tions (reps) while still allowing you to maintain good

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form. If you can’t do the last two reps, choose a lighter lower-body exercises on Tuesday, upper-body exer-
weight. When it feels too easy to complete all the cises on Wednesday, lower-body exercises on Thurs-
reps, challenge your muscles again by adding weight day, etc., and also do aerobic exercise on as many
(roughly 1 to 2 pounds for arms, 2 to 5 pounds for legs), days as possible.
or by adding another set of reps to your workout (up
to three sets), or by working out additional days per
week. If you add weight, remember that you should be Balance exercises
able to do all the reps with good form and the targeted Our sense of balance typically
muscles should feel tired by the last two reps. worsens as we age. It can be fur-
■ Practice regularly. Working all the major muscles ther compromised by medical
of your body two or three times a week is ideal. You conditions like neuropathy (a
can choose to do one full-body strength workout two complication of diabetes) and cer-
or three times a week, or you may opt to break your tain chemotherapy drugs that can
strength workout into upper- and lower-body compo- cause tingling, pain, and numbness in the feet; other
nents. In this case, be sure that you perform each of medications; uncorrected vision problems; or a lack of
these components two or three times a week. flexibility. Poor balance often leads to falls, which can
■ Give muscles time off. Strenuous exercise like cause head injuries and temporarily or permanently
strength training causes tiny tears in muscle tissue. disabling injuries to the bones and nervous system.
These tears aren’t harmful, but they are important: Hip fractures, particularly, can lead to serious health
muscles grow stronger as the tears knit up. Always complications and can impair independence.
allow at least 48 hours between sessions for muscles Evidence suggests older adults at risk for falls
to recover. So, if you do a full-body strength work- bene­fit from a combination of walking, strength train-
out on Monday, wait until at least Wednesday to ing, and balance activities. Balance-enhancing activi-
repeat it. In this case, it may be easiest to do aerobic ties include tai chi, yoga, Pilates, and the five exercises
exercise on the days between your strength training. described below. Even walking on uneven surfaces,
If you’re doing a partial-body strength session, how- like cobblestones or hiking trails, helps improve bal-
ever, you might do upper-body exercises on Monday, ance over time.

Table 4 A walking program to try

Sessions
Warm-up Walking time Cool-down Total
per week
Week 1 2 5 minutes slow walking 5 minutes brisk walking 5 minutes slow walking 15 minutes
Week 2 3 5 minutes slow walking 5 minutes brisk walking 5 minutes slow walking 15 minutes
Week 3 4 5 minutes slow walking 10 minutes brisk walking 5 minutes slow walking 20 minutes
Week 4 5 5 minutes slow walking 10 minutes brisk walking 5 minutes slow walking 20 minutes
Week 5 6 5 minutes slow walking 10 minutes brisk walking 5 minutes slow walking 20 minutes
Weeks 6–7 6 5 minutes slow walking 15 minutes brisk walking 5 minutes slow walking 25 minutes
Week 8 6 5 minutes slow walking 20 minutes brisk walking 5 minutes slow walking 30 minutes
Week 9 6 5 minutes slow walking 25 minutes brisk walking 5 minutes slow walking 35 minutes
Week 10 6 5 minutes slow walking 30 minutes brisk walking 5 minutes slow walking 40 minutes
Week 11 6 5 minutes slow walking 40 minutes brisk walking 5 minutes slow walking 50 minutes
Week 12 7 5 minutes slow walking 50 minutes brisk walking 5 minutes slow walking 60 minutes

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How much Frequently performing exercises that isolate and
For older adults at risk for falls, the 2008 guidelines stretch elastic fibers surrounding muscles and tendons
recommend 30 minutes of balance training and mus- helps counteract this. A well-stretched muscle more eas-
cle strengthening exercises three times a week, plus at ily achieves its full range of motion. This improves ath-
least 30 minutes of walking activities twice or more letic performance—imagine an easier, less restricted golf
weekly. Consider adding the heel-to-toe walk and swing or tennis serve—and functional abilities, such as
single-­leg stance, described below, to your warm-ups reaching, bending, or stooping during daily tasks.
or cool-downs, and including other balance-promot- At one time, experts prescribed stretching before
ing exercises in your strength training program. exercise to help avoid injuries, but newer research
suggests this does no good. (Instead, experts recom-
Get started mend starting off your exercise with a warm-up, such
Three of our strength training exercises have the as a light jog or a sport-specific routine such as serv-
added advantage of improving balance: ing some tennis balls and practicing ground strokes
• heel raise (see page 45) before a match.) Stretch when muscles are warm and
• chair stand with staggered legs (see page 43) pliable—so, before stretching, walk for five to 10 min-
• standing side leg lift (see page 45). utes, dance to a few songs, or take a warm shower. Or,
If these exercises are already part of your strength even better, do your flexibility exercises as your post-
training routine, bravo. If you use a different strength workout cool-down. Stretching between exercises
routine, try working these three exercises into it to may be fine, too, and possibly helps boost flexibil-
enhance balance. Also, try these two exercises three ity, as shown in a small 2008 study on lower-leg and
times a week or even daily: ankle stretching sponsored by the American College
■ Heel-to-toe walk. Position your heel right in front of Sports Medicine.
of the toes of the opposite foot each time you take a To achieve lasting effects, stretch daily or at least
step. Heel and toes should touch as you walk forward several times a week. This is easier than you might think.
for eight to 12 steps. If necessary, steady yourself by Try our stretching program on page 46. Activities such
putting one hand on a counter as you walk. Then work as yoga and Pilates combine stretching and relaxation
toward doing the exercise without support. Repeat and also improve balance, a wonderful combination.
two to four times.
■ Single-leg stance. Stand on one foot for up to How much
30 seconds. Put your foot down and steady yourself, The 2008 Physical Activity Guidelines present no spe-
then repeat on the opposite leg. Perform two to four cific recommendations for making flexibility exercises
times on each leg. If necessary, hold on to the back of part of your routine. However, the American Col-
a chair or counter. Then work toward doing the exer- lege of Sports Medicine recommends doing flexibility
cise without support. exercises for older adults on the same days as aerobic
or strength activities, or at least twice a week.

Flexibility exercises Get started

Flexibility exercises like stretch- Our eight basic stretches (see page 46) will help you
ing, yoga, and Pilates gen- become more flexible. The more often you do these
tly reverse the shortening and stretches—or any routine that you prefer, including
tightening of muscles that typi- yoga or Pilates—the more limber you’ll become. Fol-
cally occur with disuse and age. low these tips for safety:
Shorter, stiffer muscle fibers may ■ Check with your doctor. If you have joint disease
make you vulnerable to injuries and contribute to or arthritis, or if you’ve had a joint replacement, check
back pain and balance problems. with your doctor before starting stretching exercises.

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 ■ Warm up first. Warm muscles are more flexible. yoga, tai chi, and meditation. Or try the mindfulness
Warm up for five to 10 minutes first, or save stretching exercise described here to get yourself started.
for your cool-down routine after exercising. Mindfulness is a relaxation technique that encour-
■ Stretch all muscle groups. Just as with strength ages you to slow a racing mind and embrace each
training, stretching should include all muscle groups. moment as it unfolds. Blended with a simple, repeti-
■ No bouncing. Never bounce as you stretch. This tive exercise like walking, running, or swimming, it
triggers a contracting reflex that actually tightens the eases stress wonderfully. By fully engaging all of your
muscle you’re trying to loosen. senses, mindfulness teaches you to focus attention on
■ Feel mild tension only. Extend your muscle to the what is happening in the present and accept it without
point where you feel mild tension and hold that posi- judgment. This enhances your appreciation of simple
tion. You should never feel pain. everyday experiences. To treat your body and mind to
■ Breathe. Breathe easily through your nose while a mindful walk, try the following:
stretching. ■ Focus on breathing. As you walk, first narrow your
■ Hold and repeat. The best results come from hold- concentration by focusing on an aspect of your breathing:
ing the stretch for 10 to 30 seconds and repeating each the sensations of air flowing into your nostrils and out of
stretch four times. your mouth, your belly rising as you inhale and falling as
you exhale. Try counting from one to five as you inhale,
then five to one as you exhale. Do this for a few minutes.
Relaxation exercises ■ Soak in the sights, sounds, and smells around you.
Relaxation exercises are not, Then begin to widen your focus. While you continue
strictly speaking, a component of breathing in and out in a measured way, open up your
most fitness programs. Yet reduc- senses to become aware of sounds, scents, and sensa-
ing stress enhances quality of life tions. Enjoy the rhythmic thump of each foot hitting
and health. So consider carving the ground and the whisper of clothes rubbing lightly
out time for activities that promote against each other. Feel the touch of a cool or warm
calm and relaxation, such as mindfulness or meditation. breeze against your face, notice shadows cast as you
Or simply relax into the rhythmic movements of aero- move, or soak in the sun beaming down. Listen for nat-
bic exercise, such as walking, running, and swimming. ural sounds even when walking on city blocks: the chirp
Stretching, too, releases muscles and promotes a of crickets, bird songs, rustling leaves, wind blowing. As
sense of tranquility. And some disciplines like Pilates, you tune in to your breathing, your body, and your sur-
yoga, and tai chi meld tension-melting movements roundings, you will notice much beyond these examples.
with mental focus and meditation. While improv- ■ Keep breathing deeply. Throughout your walk,
ing strength, flexibility, and balance, practitioners continue to breathe slowly and deeply while remain-
ease stress, relieve pain, and gain an overall sense of ing fully aware and staying in the moment.
well-being. ■ Try not to rush. Proceed slowly and with delibera-
tion, engaging your senses fully to savor every sensa-
How much tion. If your mind starts to race, return your focus to
Relaxation exercises aren’t a necessary part of your your breathing. Then expand your awareness again.
fitness routine, and current guidelines don’t include Consider how you feel physically and psychologically
them. But many people find them worthwhile. If before, during, and after your walk.
you’re so inclined, aim for a daily dose.

Get started Designing your program

A variety of activities can leave you feeling more Now that you know the components of an exercise
relaxed and peaceful. Some popular options include program, it’s time to put one together. The most suc-

ww w. h ealt h . h ar v ar d . e du Exercise 25
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cessful exercise program is one well suited to you. To a good choice. Likewise, if you live in a particularly
give yourself the best odds of sticking with exercise, hot or cold climate, certain outdoor activities may
stack the deck in your favor by considering the follow- not be sustainable. On the other hand, if there’s a net-
ing points before you start. work of biking and jogging trails near your office, a
■ What’s your current level of fitness? If you’ve been routine of lunchtime exercise might be just the ticket.
sedentary for a while, it’s unrealistic, not to mention And if your town or city has sidewalks, try walking to
dangerous, to attempt a five-mile run your first day do errands: shopping for groceries, mailing a letter, or
out. Weekend warriors all too often wind up with picking up books at the library.
sore muscles, or worse. An injury is one of the quick- ■ Do you like exercising alone or with others? Many
est ways to sabotage any exercise program. So, be people find the solitude of swimming or running ideal
practical. Start with our walking program (see Table for contemplation. Others enjoy the motivation and
4), which ramps up very slowly. Over time, work up support of a group aerobics class or the company of a
to greater levels of intensity as you become more fit. walking companion.
Generally, moderate exercise is safe for all. If you’ve ■ How much money do you want to spend? Weigh
had previous injuries or suffer from a chronic disease, expense against other factors, such as the ability to
talk to your doctor about your physical limitations exercise indoors or participate in a particular activity.
and get advice about a well-rounded exercise plan tai- Many exercise options are available at a range of prices.
lored to your needs. You can get great workouts for virtually no money by
■ What are your exercise goals? Your program walking, running, or hiking. Check bike shops and
should include aerobic and strength training exer- sports resale shops for bargains on used equipment.
cises, but you may want to focus on a particular area, A set of inexpensive home barbells can produce the
depending on your goals. If you want to lose weight, same results as a health club membership. However,
stress calorie-burning aerobic activities. If flexibility some people feel that the money they spend for gym
and balance are your main concerns, spend more time privileges is a motivating factor. Only you know what
practicing tai chi or yoga. works best, though it may take some trial and error to
■ What do you like to do? If you hate jogging, you figure it out.
won’t be able to maintain a jogging program no matter ■ When can you fit in exercise? You might like to
how good it is for you. On the other hand, if you love start the day with exercise—it’s invigorating and you’ll
to swim or dance you may find it easier to stick with have punched your ticket before embarking on work
an exercise program that’s built around these activities. or projects. Or perhaps you’re just not a morning per-
Don’t expect to change your likes and dislikes, espe- son. If it’s difficult to devote a large chunk of time to
cially when starting out. exercise, you could map out 10-minute time slots for
■ What kind of setting works for you? Do you have aerobic exercise. Or you could work out a combination
easy access to a pool? If not, swimming probably isn’t of long and short bouts that totals up to weekly goals.

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 S pe c ial S e c t io n

Getting in gear
Tips and tools to get your exercise program moving

T
Finding support helps. Hir-
his special section shows you how to map out an effective,
ing a personal trainer or tap-
enjoyable exercise plan and stick with it. You’ll also see ping a buddy for walks can
how many calories you can burn through different activi- supply motivation. Friends who
ties, learn great strategies to keep your routine fresh, and find can cheer you on and hold you
out about a variety of ways to measure your gains. The first step accountable to your plan help,
too. And give yourself a reward
on this healthy path is setting goals.
if you meet weekly or daily goals.
A written record of your goals routine. So make a copy of the (Avoid food rewards or keep
is a good reminder when life “Planning worksheet” on page 28, them small, lest they scrub out
intrudes and interest wanes. and put it where it can act as a any benefits gained through
You may find that simply jotting daily nudge. As you complete exercise.) One reward is sim-
down your goals serves as moti- this form, refer to the exercise ply seeing progress, so consider
vation when you need it, and can recommendations outlined in measuring your progress at cer-
help you identify and overcome “Creating a personal exercise plan” tain intervals (see “Measuring
any roadblocks in your exercise on page 21. gains,” page 30).

Keeping it fresh
Want to change the way you experience exercise? These tips can make workouts more enjoyable.
1. Set your own calendar. one lengthy bout of activ- 2. Wear a pedometer.
Bored by the same- ity. Three 10-­m inute blocks on The simplest step-
old, same-old sched- Tuesday, one 10-minute block counter can up the ante on exer-
ule of exercise? Mix up your on Wednesday, two 10-minute cise, according to a 2007 Journal
activities and time spent on blocks on Friday, plus a 90-min- of the American Medical Associa-
each. People who plan ahead are ute hike or bike ride on Saturday tion review of 26 studies. Over all,
more likely to follow through. meets aerobic goals for the week. those who clipped on a pedom-
So, once a week, pencil in your Choose combinations and activ- eter raised their physical activity
choices on your calendar. Carv- ities that appeal to you. Remem- by nearly 27%, adding about 2,100
ing out room for several short ber, though, it’s best to be active to 2,500 steps a day. Other results
daily stints is often easier than at least three days a week. were promising, too: a drop of 3.8

ww w. healt h . h ar v ar d . e d u E x ercis e 27
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 Special Section | Getting in gear

Planning worksheet
This worksheet can help you identify gaps in your current exercise routine, set goals to help you improve your program
and your health, and find ways to fit regular exercise into your weekly routine.

My goals exercise routine and the national exercise guidelines. For

❏P  rimary goal: To improve my health example, perhaps you are currently doing strength training
The emphasis of this Special Health Report is to improve twice a week but you are only performing an hour of moder-
your health and longevity, so that should serve as your ate aerobic exercise each week. In that case, you would want
primary goal. But sometimes identifying additional goals can to focus on adding an additional 90 minutes of moderate
provide some of the motivation needed to set an exercise aerobic exercise to your weekly routine.
goal and stick with a program. Look at the following
I’d like to
supplementary goals and check off the ones you are also
striving for. ❏ exercise ___ times a week for ___ minutes at__________
intensity
Additional goals: ❏ add aerobic exercise to my weekly routine
❏ strengthen and tone my muscles ❏ add strength training to my weekly routine
❏ extend my endurance ❏ add balance exercises to my weekly routine
❏ lose ___ pounds in the next ___ weeks ❏ add flexibility exercises to my weekly routine
(a pound a week is reasonable, so break down bigger
❏ change up my weekly routine
goals into smaller, manageable chunks)
❏ step up my game in ____________________ (a sport) My new plan:
❏ be able to enjoy _______________________________ Fill in some goals for a week, writing in aerobic sessions like
(Here consider what tasks and fun you are missing out 30 minutes of brisk walking (remember, this can be in two or
on. Are you finding it hard to make it up stairs, smash an three chunks) or the workouts you plan to try.
overhead in tennis, or dig deep while gardening?)
I can do
My current exercise routine ❏ ______________ on Monday at___________________
Think about the amount of exercise you typically do each ❏ ______________ on Tuesday at___________________
month and fill in the following. ❏ ______________ on Wednesday at________________
❏ ______________ on Thursday at__________________
Right now, I
❏ ______________ on Friday at ____________________
❏ exercise rarely or never ❏ ______________ on Saturday at__________________
❏ exercise for ___ minutes per week at _______________ ❏ ______________ on Sunday at___________________
(low, moderate, or vigorous) intensity
❏ do or ___ do not meet the guidelines for aerobic activity I will gain support for my new plan by
by getting at least 150 minutes of moderate aerobic ❏ lining up an exercise partner for walks or workouts on
activity or 75 minutes of vigorous activity each week these days:
❏ do or ___do not meet strength training guidelines by ❏ Monday ❏ Tuesday ❏ Wednesday
performing strength training exercises for all major ❏ Thursday ❏ Friday ❏ Saturday ❏ Sunday
muscle groups twice a week ❏ telling a friend about my plan and asking her to check in
❏ do or ___ do not perform balance exercises at least with me once a week on ____________ to cheer me on
twice each week and encourage me to stay the course
❏ hiring a personal trainer on these days:
Going forward
❏ Monday ❏ Tuesday ❏ Wednesday
Compare your current routine with the exercise guidelines
❏ Thursday ❏ Friday ❏ Saturday ❏ Sunday
supplied in “The right mix” on page 29. This will help you
identify where you need to shore up your routine. When set- ❏ rewarding myself by doing _______________________
ting goals, focus on filling any gaps between your current at the end of the week if I follow my plan

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 Getting in gear | Special Section

mm Hg in systolic blood pressure strength exercises for home and Sports. Or work up a sweat stamp-
and a decrease in body mass index gym. Easier variations on strength ing out the beat to music videos on
(see “Pay attention to BMI and waist exercises are included. Dance Dance Revolution, a video
circumference,” page 11). Setting a game that is available for PlaySta-
■ Shape Magazine ([Link])
step goal counted for a lot. Those tion, XBox, and Wii.
Create an account and log on for a
who did so significantly increased
free virtual trainer, which helps you
activity; those who didn’t generally 4. Rise to the challenge.
plan workouts and track progress,
remained at baseline. If your workouts aren’t
plus access to free workout videos.
So it may be worthwhile to challenging or interesting enough,
invest in a pedometer and to set a Or go interactive with a video expand your horizons. The Presi-
step goal for yourself. To translate game. Change up your weekly dential Active Lifestyle Award
aerobic exercise guidelines from exercise routine by balancing, and Presidential Champions chal-
the page to the pavement, aim for bowling, boxing, or trying any lenge (www.­presidentschallenge.
3,000 steps in 30 minutes—that’s number of other active options org/­celebrate) encourages you to
100 steps a minute. Five days of available through Wii Fit and Wii become more fit. The Presidential
this (or three days of 5,000 steps in
50 minutes) enables you to meet
your weekly goal of 150 minutes The right mix: Exercise goals at a glance
of moderate aerobic activity. Can’t Our five-component exercise plan appears in detail in “Creating a personal
find a chunk of free time that long exercise plan” on page 21. Briefly, we suggest the following weekly goals:
in your schedule? Try 10-minute Aerobic: Accumulate at least 150 minutes of moderate activity or 75 minutes
chunks—that is, 1,000 steps in 10 of vigorous activity, or an equivalent combination of the two. Keep in mind that
minutes—throughout the week. 10 minutes of vigorous activity equals approximately 20 minutes of moderate
activity. Sustain activities for at least 10 minutes at a time.
Strength: Strength exercises for all major muscle groups (legs, hips, back,
3. Plug in.
chest, abdomen, shoulders, arms) at least twice weekly. Repeat each exercise
Turn on your computer eight to 12 times per set, aiming for two to three sets. Rest muscles for at least
and power up with the great range 48 hours between strength training sessions.
of individual exercises and work- Balance: For older adults at risk for falls, activities that enhance balance at
outs on these websites: least twice a week.

■ American Council on Exercise Flexibility: Stretching or other flexibility-enhancing exercises, preferably on

days when you do aerobic or strength activities, or at least twice a week. Hold
([Link]/exerciselibrary)
stretches for 10 to 30 seconds, repeating each stretch three to four times.
Browse an extensive library of
Relaxation: A daily dose of relaxation through exercise, meditation, or
exercises sorted by ability level, mindfulness.
muscles targeted, or equipment
Ask your doctor if these goals are right for you. Doubling time spent on moder-
needed, then view selected exer- ate or vigorous aerobic activities expands health benefits. If you have certain
cises in motion. health problems—such as heart disease, arthritis, or diabetes—your doctor
might modify these goals, ask you to avoid certain activities, or recommend
■ Centers for Disease Control exercising consistently throughout the week. And if you’re shaking your head
([Link]/physicalactivity/ at the thought of managing far less activity, keep in mind that any amount of
everyone/videos) exercise beats none. Try to do as much as possible. Even short stints of activity
View video clips describing inten- (five minutes of walking several times a day to help you build endurance) are a
good first step toward meeting a bigger goal.
sity levels as well as aerobic and

ww w. h ealt h . h ar v ar d . e du E x ercis e 29
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 Special Section | Getting in gear

Active Lifestyle challenge helps you ski jumping or skydiving, along progress toward Bronze (40,000
set activity and healthy eating goals with many more plebeian pastimes. points), Silver (90,000 points),
over the course of six weeks, while The more effort an activity requires, and Gold (160,000 points) med-
the Presidential Champions chal- the more points you rack up while als. There’s even a Platinum medal
lenge allows you to earn points for doing it. Log in alone or as a group for those earning 1 million points.
all sorts of activities: badminton or (you can start your own group or (Point requirements are higher for
baton twirling, jai alai or juggling, join an existing one) to track your advanced athletes.)

Measuring gains
Six weeks of workouts won’t set you ■ Aerobic. Map out a course two reps in an eight-rep set. This is
up for Muscle Beach, but you should for walking, running, biking, or your baseline. In four to six weeks,
start noticing gains at or before that swimming laps in a pool. Time repeat this test. Are you able to use
point. Consider testing your cardio- yourself initially to get your base- a heavier weight or resistance band?
vascular fitness and strength every line. Every six weeks, repeat this ■ Flexibility. Do the V-sit
six or eight weeks to measure your test at the same level of perceived reach test described in the Presi-
progress. Jot this information down exertion (see Table 2, page 19). dent’s Challenge adult fitness
in an exercise log so you can see ■ Strength. Do the concentrated test ([Link].
your progress over time. You can biceps curl (below) and traveling org/challenge/physical/activities/
measure gains in many valid ways, side squat (page 31). Select a weight [Link]) or the ham-
some more formal than others: that tires the muscle by the last string stretch from our stretch-
ing routine (see page 46). Every
six weeks, repeat to see if you can
Concentrated biceps curl comfortably stretch farther or
hold the stretch longer.
Reps: 8–12 on each side Sets: 1–3
Intensity: Moderate to high Tempo: 3-1-3 ■ Balance. For your baseline,
Rest: 30–90 seconds between sets time how long you can stand on
Starting position: Sit on a stability ball or weight each leg. Every six weeks, repeat
bench, feet hip-width apart, holding a weight in your this test.
right hand. Hinge forward slightly from your hips and ■ Weight. See if the scale
anchor the elbow of your right arm inside your right
budges as you weigh yourself
inner thigh near the knee. Fully extend your arm,
thumb pointing forward, so the weight comes down once a week after rising. Keep
toward the floor, while keeping your elbow soft. in mind, though, that exercise
Movement: Keeping your shoulders down and back, bend your right arm at the elbow alone isn’t always enough to pare
to raise the weight toward your right shoulder. Pause, then slowly lower to the starting off pounds.
position. Finish all reps before repeating with your left arm. This is one complete set.
Tips and techniques: Other measures
• Be careful not to lock your elbow (hyperextension) as you straighten your arm You can also try the following to
to return to the starting position. take stock of the changes regular
• Keep your torso and your shoulders still throughout.
workouts can make in your body
• Exhale as you lift.
and your health.

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 Getting in gear | Special Section

■ Take your pulse. Every few skimming your body nicely when increasing ease? Scooping up sev-
weeks, jot down your resting heart you work out regularly. Maybe you eral heavy bags of groceries to
rate (before you rise in the morn- look sleeker (or more muscular) in make one trip inside, rather than
ing). It tends to be lower in people a sleeveless shirt or bathing suit. two? Able to run or walk faster or
who exercise regularly, so you may ■ Notice how fit you feel. Are for longer stretches of time? All
notice a healthy trend downward. you huffing less when you take of this counts toward health and
■ Roll out the measuring tape. the stairs? Biking or hiking with quality of life.
Before you start a regular pro-
gram of exercise, carefully mea-
sure your waist in centimeters Traveling side squat
at your navel or at the smallest Reps: 8–12 Sets: 1–3 Intensity: Moderate to high
circumference. If you like, also Tempo: 2-2 Rest: 30–90 seconds
measure calves, upper thighs, Starting position: Stand with your feet slightly
and upper arms at their largest apart and clasp your hands loosely in front of your
circumference. Make measure- chest. Place a resistance band around both thighs
ments again after six weeks. Over just above your knees.
time, you may be gaining muscle Movement: Step out to your right side as you
mass in some spots (bigger biceps, bend your knees and lower to a squat position. Rise
up as you bring your legs together just enough to
perhaps) and toning up in others maintain resistance on the band. Do 4–6 traveling
(smaller waist). squats to the right, then 4–6 to the left.
■ Check your closet. Perhaps
Tips and techniques:
you have a favorite pair of jeans • Keep your hips, knees, and toes all pointing forward.
that can serve as your fitness • Drop your buttocks no lower than your knees.
barometer by loosening up or just

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 Staying motivated

E xercise shouldn’t be something you do only when you

want to drop those 10 extra pounds or prepare for the
charity 10-kilometer run. To be successful, it should be
you get up half an hour earlier every morning for a
walk? Would this mean going to bed earlier? Be realis-
tic. Don’t schedule exercise after dinner if that’s when
as routine as eating, sleeping, and taking your morning kids need help with homework, unless you think the
shower. That can be difficult, as you may already know. entire family might benefit from a break and a brisk
Prepare yourself for challenges that await you, so walk. Look for ways to add bits of activity and recre-
you won’t be thrown off track. Below are tips and infor- ational exercise to scheduled activity time—an extra
mation to help you stay on course when motivation lap around the mall when you’re shopping, some stair
flags. Remember, the payoff in health dividends, over- climbing, or a Saturday morning bike ride. After the
all well-being, and independence is worth the effort. first week, adjust the weak points of your schedule. As
you become more conditioned, you’ll be able to boost
Keep it personal the intensity of your exercise without further exerting
Think about the kind of activities that suit your life- yourself. This means that you’ll be able to fit more into
style, time constraints, budget, and physical condition. your allotted time; for example, walking four miles in
Factor in your likes and dislikes. And switch it up so the time it used to take you to do three.
you don’t fall into a rut. See “Getting in gear” on page
27 for new ideas. Set a goal
Shifting overnight from being sedentary to becoming an
Make it fit exercise buff isn’t in the cards for most people. What’s
Are time constraints a big problem? Plan exercise ses- more, unrealistic expectations will set you up for frus-
sions by making a detailed schedule of your week. tration and failure. A better approach is to set a long-
Look for ways you can work in blocks of exercise. Can term goal, such as walking for 30 minutes five days a

Looking for help staying on track? Try an app

While smartphones or tablets can’t do your exercise for you, tion on the number of calories and amounts of fat and
they can freshen up a dull routine, give you friendly remind- cholesterol in various foods, tracking the number of calo-
ers, track your progress, and make the process more interest- ries you eat each day, and calculating an ideal daily calo-
ing, thanks to a wide assortment of fitness and health mobile rie intake based on your weight and how many calories
phone applications. Shape Magazine’s apps provide an exer- you burn.
cise log and several cardio and body sculpting routines—com- While these apps can spice up your usual exercise routine
plete with videos, photos, and descriptions so you can take and do some of the tedious tracking for you, do your research
these workouts to the gym or on trips. before you download. Look for apps that have received good
Other apps track distance, duration, pace, calories burned, and reviews by reputable organizations or publications. Consider
the route of your walk or run, and some apps store your routes price, too. Some apps are free or available for a nominal
and other data so you can review your progress or duplicate a charge, while others can be pricey and may require you to
route you liked. You can even download apps that take on the purchase additional equipment.
role of fitness coach, cheering you on and counting your repeti- Also, be sure to consider your fitness level when using a
tions as you do sit-ups, push-ups, and other basic exercises. cell phone app. Rome wasn’t built in a day. Nor would it be
In addition to apps related to exercise, there are a slew safe or realistic for you to think you can become an Ironman
of apps for managing your weight by providing informa- triathlete based on a phone app workout.

32 Exercise w w w.h ealt h .ha r va r d.e du

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week. Then break it into monthly targets. During the
Ongoing commitment, lasting gains
first month, focus on walking three days a week for at
least 10 minutes or longer each time. During the second The value of sticking with an exercise program became evi-
month, walk an additional day per week (so you’re up to dent years ago when The New England Journal of Medi­cine
published results from the Harvard Alumni Health Study.
walking four days a week). Add another day in the third Men who had always been active enjoyed a 29% lower risk
month. Then, every two weeks, extend each walking ses- of death during the study period, while those who started
sion by five minutes until you reach your goal. and kept up an exercise program lowered risk by 23%.
However, men who had been moderately active but later
became sedentary had the same death rate as men who
Chart your progress
had been sedentary all along. In this study, staying with the
Once you’ve set your goal, start measuring your per- program made quite a difference.
formance. Record minutes or steps walked each day Sadly, all of your body’s marvelous adaptations disappear
in a daily planner, or make a simple chart that you shortly after regular physical activity stops. For example,
can post on the refrigerator. Or if you’ve got a smart- a measurement called VO2 max represents the maximum
phone or tablet, try using an exercise app to track your amount of oxygen your body can use. It offers a snapshot
of cardiovascular fitness by indicating your body’s ultimate
progress. No matter which method you choose, keep a
work capacity. One study of highly trained athletes found
detailed record of what you have accomplished, includ- that it took just two weeks after stopping exercise for VO2
ing strength training, stretching, balance, and relaxation. max to begin to diminish. After two to eight months, all
Check it every week or two. If you’re backsliding, zero in the previous gains had disappeared. Muscle strength from
on the problem and shift your strategy to address it. resistance exercise fades at a slower rate, but it still takes
regular conditioning to maintain your strength. If you need
to throttle back one week, aim for your goals again the
Reward your efforts following week.
Celebrate short-term goals on your way to improving
your health or losing a few pounds. Find ways to pat
yourself on the back. Whether your reward is small or it’ll take to get started again. Once you resume your pro-
large, make sure it’s something meaningful and enjoy- gram, you’ll be amazed at how quickly it will begin to
able. Avoid rewards you may regret soon after, such feel natural. Try these tricks to rekindle your motivation:
as eating an ice-cream cone if your ultimate goal is
• Imagine yourself exercising. Recall the aspects of
losing weight. A better choice might be new music for
exercise you enjoy most—feeling strong, feeling
your MP3 player to listen to while you walk.
healthy, or even just the pleasure of being finished!
• Come up with a tantalizing reward to give yourself
Getting back on track when you meet your first goal after resuming your
Even the most dedicated exercisers sometimes go program.
astray. Almost anything can knock you off track: a bad • Line up walking partners for your next few outings.
cold, an out-of-town trip, or a stretch of bad weather. If no one can join you, ask a friend to check in with
So it’s important to learn to reclaim your routine. you about whether you managed to exercise alone.
When you’ve missed workout sessions, evaluate your
• If completing your whole exercise routine seems over-
current level of fitness and set goals accordingly. If
whelming, mentally divide it into smaller chunks, and
you’ve been away from your routine for two weeks or
give yourself the option of stopping at the end of each
more, don’t expect to start where you left off. Cut your
one. When you reach a checkpoint, encourage your-
workout in half for the first few days to give your body
self to move on to the next one instead of quitting.
time to readjust.
The bigger challenge may come in getting yourself • Rather than focus on why you don’t want to exercise,
back in an exercise frame of mind. Instead of expend- concentrate on how good you feel when you’ve fin-
ing energy on feeling guilty and defeated, focus on what ished a workout.

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 Exercising safely

W ithout a doubt, physical activity can help you

live a longer, healthier, and more productive
life. Like everything else in life, exercising does have
cal Activity Readiness Questionnaire” for a brief, help-
ful checklist ([Link]/documents/
[Link]). Definitely talk to a doctor if you
risks: largely treatable problems like sprains, strains, have any injuries or a chronic or unstable health con-
and overuse injuries or, far more rarely, situations that dition, such as heart disease or several risk factors for
could be life-threatening. So, it’s wise to take steps to heart disease, a respiratory ailment like asthma, high
ensure that your exercise routine is safe. Keep in mind, blood pressure, joint or bone disease (including osteo-
though, that inactivity, in most cases, poses greater porosis), a neurological illness, or diabetes. Also con-
risks than does exercising safely. sult your doctor if you suspect you may have an illness
that would interfere with an exercise program or if
you have been experiencing any symptoms such as
Should you talk to a doctor first? chest pain, shortness of breath, or dizziness.
Almost anybody can safely take up walking, and light In some cases, your doctor may suggest you meet
to moderate exercise is usually fine for healthy adults with a physiatrist. Physiatrists (rehabilitation physi-
with no troublesome symptoms. cians) are medical doctors who specialize in treat-
But it’s wise to talk to a doctor if you have any ing—and helping to prevent—nerve, muscle, and
questions about your health or plan to start strenu- bone conditions that affect how you move. Back prob-
ous workouts, especially if you haven’t been active lems, knee or shoulder injuries, debilitating arthritis or
recently. See the American Heart Association “Physi- obesity, stroke, and repetitive stress injuries are a few
examples of these conditions. A physiatrist can tailor an
exercise prescription to enhance recovery after surgery
When to call a doctor for advice or injuries, or for chronic problems that interfere with
Whenever you exercise, it’s safest to stop and call your exercise by sparking pain or limiting movements. He or
doctor for advice if you experience any of these symptoms: she can also tell you whether certain types of exercises
• upper-body discomfort, including chest pain, aching, will be helpful or harmful given your situation.
burning, tightness, or a feeling of fullness
• faintness or loss of consciousness
• wheezing or shortness of breath that takes more than
five minutes to go away
10 tips for avoiding injuries
Once your doctor gives you the go-ahead to exercise,
• pain in bones or joints.
the tips below can help you avoid injuries:
Delayed muscle soreness that starts 12 to 24 hours after a
workout and gradually abates is a normal response to tax- 1. Take five to 10 minutes to warm up and cool down
ing your muscles. By contrast, persistent or intense muscle properly.
pain that starts during a workout or right afterward,
2. Plan to start slowly and boost your activity level
or muscle soreness that persists more than one to two
weeks, merits a call to your doctor for advice. You should gradually unless you are already exercising fre-
also call your doctor if the routine you’ve been doing for a quently and vigorously.
while without discomfort starts to cause you pain.
3. Be aware that training too hard or too often can
Also, ask your doctor whether any other warning signs
cause overuse injuries like stress fractures, stiff or
specific to your health history warrant a call.
sore joints and muscles, and inflamed tendons and

34 Exercise w w w.h ealt h .ha r va r d.e du

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 ligaments. Sports prompting repetitive wear and release chemicals that trigger inflammation, further
tear on certain parts of your body—such as swim- constricting airways. If you have asthma and are
ming (shoulders), jogging (knees, ankles, and feet), exercising in cold weather, try to breathe through
or tennis (elbows)—are often overuse culprits, too. your nose, and wear a bandana or other covering for
A mix of different kinds of activities and sufficient your mouth. The cloth will retain some of the mois-
rest is safer. ture from your breath as you exhale, humidifying
4. Listen to your body. Decrease the intensity of your the air drawn in as you inhale.
workout if you are having difficulty finishing an
exercise session, feel fatigued for the rest of the
day after a workout, or suffer persistent aches and If you have health problems
pains in joints after exercising. If you feel sick, hold If you have health problems or disabilities, talk to your
off on exercise entirely until you feel well again for doctor about the best ways for you to be as active as
at least 24 hours. possible. Usually, you’ll be able to find safe, enjoyable
5. If you stop exercising for a while, drop back to a activities, though some precautions may be in order.
lower level of exercise initially. If you’re doing For example, if you have bone or joint disease, you
strength training, for example, lift lighter weights
or do fewer reps or sets.
Keeping risks in perspective
6. Stay hydrated. For most people, simply drinking
Over all, exercise does far more good than harm. Yet
plenty of water is sufficient. But if you’re working
exercise-­related injuries do occur. Risk goes up dramatically
out especially hard or it is a particularly hot day, with the intensity of your workout. For example, the injury
choose drinks that replace fluids plus essential rate for runners is 25% to 65%. Walkers report much lower
electrolytes. injury rates of 1% to 5%. One small study of exercisers ages
70 to 79 found injury rates of 5% among walkers and 57%
7. Choose clothes and shoes designed for your type among joggers. Your choice of sport matters, too: head inju-
of exercise. Replace shoes every six months as ries, impact injuries, and falls are hazards associated with
cushioning wears out. sports such as baseball, hockey, and football. Swimmers
can suffer from outer ear infections (swimmer’s ear), and
8. For strength training, good form is essential. Ini-
extreme endurance exercise, such as marathon training, can
tially use no weight, or very light weights, when make you more susceptible to upper respiratory infections.
learning the exercises. Never sacrifice good form The most frightening risk associated with exercise is sudden
by hurrying to finish reps or sets, or struggling to death. Sedentary people who abruptly embark upon vigor-
lift heavier weights. ous exercise slightly boost their odds of dying from a heart
attack or fatal heart arrhythmia. However, this occurs very
9. Exercising vigorously in hot, humid conditions can
rarely in apparently healthy individuals—less than once in
lead to serious overheating and dehydration. Slow every million hours of exercise. In most cases, those who
your pace when the temperature rises above 70° F. died had an undiagnosed or untreated serious heart condi-
On days when the thermometer is expected to tion. It is important to note that this increased risk occurs
reach 80° F, exercise during cooler morning or eve- only during vigorous exercise and for the 30 to 60 minutes
after the exercise. For the remainder of the time, the risk
ning hours or at an air-conditioned gym. Watch of dying is lower among those who are active compared
for signs of overheating, such as headache, dizzi- to those who are not, and the overall survival of vigorous
ness, nausea, faintness, cramps, or palpitations. exercisers exceeds that of people who are sedentary.
10. Dress properly for cold-weather workouts. Depend- Put this in perspective. Regular exercise plus a healthy
ing on the temperature, wear layers you can peel off lifestyle—including, for example, avoiding tobacco and
controlling weight, cholesterol, and blood pressure—can
as you warm up, and don’t forget gloves. Exercising
make arterial plaques less likely to rupture. Also, working
in cold weather can also bring on asthma symptoms. out at a moderate level (see Table 2, page 19) poses almost
Experts suspect that the cold, dry air narrows bron- no risk, regardless of the state of your health.
chial tubes and causes cells lining your airway to

ww w. h ealt h . h ar v ar d . e du Exercise 35
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may need to avoid certain strength training exercises nent, or see if there is one at a local hospital so you can
or high-impact sports. safely reap the benefits of exercise.
In this section, we offer tips to help you get the Aerobic exercise lowers blood pressure, adjusts
most out of exercise if you have heart disease, arthritis, blood lipid imbalances, and burns calories—all good
or diabetes. medicine for people with heart problems. Research
shows strength training is beneficial, too, despite the fact
Advice for people with heart conditions that doctors once cautioned people with heart disease
If you’ve suffered a heart attack or been diagnosed against it, fearing that the abrupt surges of blood pres-
with cardiac disease, not only is exercise permissible, sure that can accompany such exercises might be dan-
but it’s a must for a longer, healthier life. A study of gerous. Recommendations from the American Heart
British men with coronary artery disease, published Association suggest resistance training is safe and ben-
in Circulation, revealed that those who participated in eficial for low-risk cardiac patients, such as people who
at least light exercise were 58% less likely to die from don’t have heart failure, symptoms of angina during
any cause over the five-year research period than their exercise testing, or severe heart rhythm abnormalities.
sedentary counterparts. Ask your doctor if you are able to exercise at a level
In addition, moderate exercise—at least 40 min- that would meet the guidelines we’ve outlined in this
utes of walking per day—can reduce cardiovascular report (see “The right mix,” page 29). Generally, this
disease risk as effectively, if not more, than many med- regimen is safe even if you have mild cardiovascular
ications. Results from the British Regional Heart Study disease. Or check with local hospitals or health centers
found that this type of regular exercise cut risk even to see if they offer supervised exercise sessions for peo-
more than most drugs, while an analysis in The New ple with heart disease. This is particularly helpful when
England Journal of Medicine found little difference in learning proper form for strength training, or if you
success rates between cardiac rehabilitation programs have not been active for a considerable time. Whether
that relied heavily on exercise and those that empha- you exercise on your own or with supervision, plan to
sized drug therapy. Moreover, exercise, unlike drugs, start slowly and work gradually toward better fitness.
has few unwanted side effects.
Even patients with heart failure may benefit from Advice for people with arthritis
supervised, moderate exercise. A four-year controlled, Here’s a dilemma: exercise helps ease pain, stiffness,
randomized study of heart failure patients conducted and possibly swelling associated with arthritis, while
in the United States, Canada, and France—the larg- paring off pounds that further harm joints. Strength-
est of its kind—showed that supervised aerobic exer- ening muscles helps support and protect joints. Yet
cise was both safe and beneficial. The study compared pain, soreness, and disability triggered by arthritis
“usual care” alone against usual care plus 36 supervised may make it hard to be active. What should you do?
sessions of aerobic exercise. The patients in the super- Whenever possible, meet the 2008 Physical Activ-
vised exercise group transitioned to a defined aerobic ity Guidelines by mixing aerobic activities, strength
exercise regimen at home after they had completed training, stretching, and balance exercises (see “Creat-
the supervised sessions. On average, weekly walking ing a personal exercise plan,” page 21).
times were 75 minutes for the usual care group and If this is too ambitious, at least avoid inactivity
140 minutes for the exercise group after one year. The and work on becoming as active as possible. Discuss
addition of supervised exercise improved measures of options with your doctor, particularly if you haven’t
fitness and modestly reduced deaths or hospitaliza- been exercising. Try these tips, too:
tions for any cause as well as cardiovascular deaths or • A physiatrist, physical therapist, or personal trainer
hospitalizations from heart failure. If you have heart with experience in working with people who have
failure, ask your doctor to recommend a cardiac reha- arthritis can help you choose and adapt activities
bilitation program with a supervised exercise compo- that will work for you.

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• Before exercising, apply heat to sore joints or take a Before diving in:
warm shower or bath. And take pain relievers rec- • Get the go-ahead from a doctor, who can offer the
ommended by your doctor an hour before exercising. best advice after checking your heart, blood ves-
After exercising, cold packs may be helpful. sels, eyes, kidneys, feet, and nervous system, says
• Try activities that are easy on the joints: swimming the American Diabetes Association. If you have
(especially in a heated pool), yoga, tai chi, or using severe diabetic eye disease, for example, your doc-
an elliptical machine, for example. Seated activities— tor may not want you to participate in high-impact
strengthening routines and even yoga—can be help- sports, which might cause bleeding into the eye. Or
ful, too. you may need special footwear to protect your feet.
Otherwise, ask your doctor if you can follow the
• Look for classes designed for people with arthritis
2008 exercise guidelines (see “Creating a personal
through local gyms, health centers, or the Arthritis
exercise plan,” page 21).
Foundation (see “Resources,” page 48).
• Talk to your health care team about maintaining safe
• Progress slowly and cut back on activity if your joints
levels of blood sugar during and after activity. You’ll
become warm, red, or painful. Work with your doc-
need to time eating and exercise sessions properly to
tor to find and eliminate the cause of the pain.
keep blood sugar levels steady. Before and after exer-
• If you have rheumatoid arthritis, balance rest and cising, carefully monitor your blood sugar level. You
exercise carefully: rest more to reduce inflamma- may need to adjust your diet or your insulin doses
tion, pain, and fatigue when your condition flares up; and injection sites if you take insulin.
exercise more when it calms down. Short rest breaks
tend to help more than long periods spent in bed. Once you have the go-ahead:
• Listen to your body. Never force a movement if • If you’re not sure where to start with exercise, the
you’re experiencing sharp pain or more discomfort American Diabetes Association recommends choos-
than usual in a joint. ing one aerobic activity that helps burn calories and
glucose (walking, biking, or swimming, for example)
and a muscle-strengthening activity (using resistance
Advice for people with diabetes bands, light weights, or weight machines). Over time,
By burning calories in the form of glucose and you may want to add stretching and balance exer-
making your body more sensitive to insulin, regu­ cises, since they can be helpful, too.
lar exercise helps regulate blood sugar. You may
• Keep carbohydrates like hard candy or glucose tab-
find you need to use less insulin or that your doc-
lets with you when you exercise in case your blood
tor can reduce the dosage of your diabetes medica-
sugar drops precipitously (hypoglycemia). Signs of
tion. You’ll also protect your heart and brain. You
hypoglycemia include sweating, trembling, dizziness,
do need to take certain precautions when exercising
hunger, and confusion.
to maintain blood glucose, though, especially if you
• Drink sufficient water during and after exercise.
use insulin injections to help manage your diabe-
tes. Talk to your health care team and follow these • Wear a diabetes bracelet or ID tag and carry phone
safety tips. numbers in case of an emergency while exercising.

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 Choosing exercise equipment wisely

Y ou can launch an effective exercise program using

only what nature gave you: your body. (To do just
that, combine our walking program on page 23 with
activity. The following are some of the more popular
types of aerobic exercise equipment.

the strength and stretching workouts on pages 42–47.) Cross-country ski machine
But because regular activity remains an elusive goal for This machine lets you exercise arms and legs simul-
most people, a multibillion-dollar industry has blos- taneously, as you would in cross-country skiing.
somed around the promise of surefire success. Health The sliding motion is easy on the knees. On some
club memberships and home exercise equipment are machines, you have to move one ski forward to make
excellent exercise solutions for many people. Do keep the other move back. On others, the skis move inde-
these cautions in mind, though: pendently. In addition, certain ski machines use ropes,
• Even the best equipment and the most tricked-out while others have stationary handgrips. Check out all
gyms only produce results when used regularly. these types to see which one is more comfortable for
you. Look for a wide foot bed for stability.
• Learn to use equipment properly to avoid injuries
that could sideline you temporarily or permanently.
Elliptical trainers
• Exercise equipment comes in all sizes, shapes, and
These machines provide a circular up-and-down motion
price ranges. It pays to check consumer ratings and
that’s a cross between a ski machine and a stair-stepper.
follow our other tips for smart consumers before
They provide a nearly impact-free workout, which is
making your purchase.
easy on the joints. Resistance and grade can be adjusted
Following are some basics you should know if automatically or manually on some models, and levers
you’re in the market. with handgrips to work the upper body may be available,
too. It may take a little while to get used to the unusual
motion. Look for comfortable handlebars and nonslip
Cardio equipment pedals with curved ridges. Try the machine out at vary-
If you stop by any gym, you’ll see rows of machines ing speeds and grades to make sure it feels stable.
designed to simulate cycling, walking and running,
kayak­ing, rowing, skiing, and stair climbing. Whether Rowing machines
motorized or not, sized for heavy-duty gym use or in Rowing machines work the back, arms, and legs simul-
lighter home versions, these machines offer good aerobic taneously, offering as close to a total-body workout as
workouts that burn calories and fat. What’s more, your available from a machine. Unless you’re used to row-
workout takes place indoors, away from fickle weather. ing, the motion initially may feel unfamiliar, and some
Price varies from a few hundred dollars to thou- people find it hard on the back. When purchasing one,
sands, depending upon whether a machine is motor- consider pulley models instead of piston models for a
ized or programmable and whether it has add-ons, more realistic rowing experience.
such as devices to measure heart rate, calories or
METs burned, time elapsed, and so forth. While this Stair-steppers
information tends not to be entirely accurate, it could These machines provide a low-impact workout that
encourage you to step up your workouts or may be approximates climbing flights of stairs. Some models
important if your doctor has advised you to limit have levers with handgrips to work arms, too. Begin-

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ners may find stepper machines strenuous, and the Exercise mat
motion can be hard on the knees. Look for machines Choose a nonslip, well-padded mat for floor exercises.
that provide independent foot action and are equipped A thick carpet or a layer of towels will do in a pinch.
with handrails and large stair platforms.
Hand weights
Stationary bicycle Depending on your current strength, start with sets
An exercise bike takes no training and is easy to use, of weights as low as 2 pounds and 5 pounds, or 5
although it can be uncomfortable for long stints. pounds and 8 pounds. Add heavier weights as needed.
While riding isn’t as effective in preventing osteopo- Dumbbells with padded center bars and D-shaped
rosis as weight-bearing exercise, it does provide an weights are easy to hold. Weighted bands that strap
excellent cardiovascular workout. Look for a model onto wrists and kits that let you screw weights onto
with a comfortable, adjustable seat and toe clips. If the a central bar are available, too. Weights are a good
seat is too hard, find out if you can replace the seat place to save cash by buying at sports resale stores.
with a cushioned model bought separately.
Resistance bands and tubing
Treadmill Resistance bands or tubing can be used for a full-body
This machine enables you to walk or run indoors. Some strength workout. Attractive features include low cost,
models offer a flexible, less joint-jarring surface. Opt light weight, portability, and ease of storage. As with
for a motorized treadmill. When purchasing one, look weights, you can measure how challenging the resistance
for a strong motor (the machine will last longer), a belt is by how many repetitions of an exercise you can do: if
that’s long and wide enough for your stride, a sturdy less than eight, resistance is too high; if more than 12, it
frame with front side rails for safety, and an emergency is too low. Positioning your hands or feet closer together
stop device. You should be able to adjust the speed and or farther apart on the band or tube before starting an
grade so you can walk at a comfortable pace. exercise helps vary resistance. Try different positions to
learn which make repetitions easier or harder.
■ Bands. These look like big, wide rubber bands.
Strength equipment They come in several levels of resistance from very
By harnessing gravity, body weight, external weight, light to very heavy, designated by color.
or tension as a resistance force, these devices help ■ Tubing. Look for tubing with padded handles on
you build strength. As with cardio equipment, styles each end. These also come in several levels of resis-
and prices range widely, from expensive professional tance from very light to very heavy, designated by
equipment most often found in gyms and health clubs color. Some brands come with a door attachment
to affordable, portable home models. helpful for anchoring tubing in place when doing cer-
If you’re just starting out, you can save a fortune tain strength exercises.
by selecting a few basics—comfortable walking shoes
plus hand weights or resistance bands or tubing— Stability balls
instead of investing a considerable sum of money in These are optional for some exercises designed to
weight-lifting machines. strengthen core muscles, as well as stretching and
balance exercises. These large, inflatable plastic balls
Ankle weights come in several sizes: 55 centimeters, 65 centime-
Look for comfortably padded ankle cuffs with pockets ters, and 75 centimeters are most common, though
designed to hold half-pound or 1-pound weight bars smaller and larger balls are available. Check the size
to add as you progress. Ankle weight sets are usually 5 chart on the package to select the right one for your
to 10 pounds. A single cuff may suffice, depending on height. When you sit on a ball, your hips and knees
the exercises you intend to do. should each form a 90-degree angle (an L). Maintain

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proper air pressure. A softer, less inflated ball makes Plus, some machines fail to support or adjust well for
for easier exercises, which helps if you are overweight, women and seniors.
older, or just beginning to use a stability ball. A firm, Try out any machine you’re considering. Check
tightly inflated ball makes exercises more challenging. how easy it is to increase resistance or add weight in
increments of 5 to 10 pounds. The next section offers
Weight training machines more general tips on buying exercise equipment.
Many types of weight training machines allow you
to perform a number of different strength training
exercises on one piece of equipment. Typically, the 10 tips for smart consumers
machine can be used to strengthen muscles through- Keep in mind that you do not need any equipment
out the body, including the legs, chest, abdomen, arms, to embark on an effective exercise routine. It’s easier
and shoulders. Popular brands include Nautilus, Body and a lot less expensive to start out walking or jog-
by Jake, Bowflex, and Precor. ging—plus, you’ll have no excuse for delaying! When
Generally, these machines tend to be easy to use you do choose equipment, be sure to select activities
and help ensure good form. It’s usually easy to add you’re likely to enjoy for a long time. If you hate taking
weight as needed. Most machines are designed to vary the stairs, a stair-stepper isn’t going to change that. A
the weight lifted throughout the range of motion of an treadmill might be a better match.
exercise so that the challenge to the muscle remains It might make sense to join a YMCA or other exer-
optimal; a few challenge the muscle only during the cise facility before buying your own equipment, because
pushing or pulling phase. But there are downsides, too. your membership will not only let you test the equipment
For starters, weight training machines are quite costly. but also will give you access to information about proper
They’re also bulky, so you need to have adequate use of the machines. If you decide to buy any type of
space. Momentum may make it easier to lift the load. exercise machine, these tips will help you choose wisely.

Health club savvy

Wishing you had a full range of exercise whom don’t remember to wipe down sweaty equipment after
equipment? A health club membership using it.
may be just the ticket. Much like buying
If you decide a health club membership is right for you, look
exercise equipment, though, joining a
for these features before signing on the dotted line:
gym can represent a considerable out-
• Convenient location and hours.
lay of money and guarantees success
only if you use it often. • Thorough orientation and training on equipment when you
join the club.
Among the advantages are access
• Opportunity for trial sessions before you commit, preferably
to a wide variety of equipment and
exercise classes, which makes it easy to change your routine on days and times when you would normally go.
and avoid boredom. Staff members can explain how to use • Comfortable environment: a clean locker room, music that’s
equipment properly, and personal trainers are often available not too loud, well-controlled room temperature, and a
to help you devise a new routine. Many people find member- friendly staff.
ship provides motivation: after paying an annual fee and • Good selection of equipment and activities. Make sure
monthly dues, they feel the need to exercise frequently to there are classes of various levels scheduled when you’ll be
get their money’s worth. coming and enough cardiovascular and strength training
On the downside, gym memberships are often expensive. machines to avoid waits.
Some gyms are so crowded that you may not get into • Well-trained staff available at all times. You may want to
the exercise class you want. The overall environment may ask some of the gym’s members how helpful and accessible
motivate some, yet turn off others. It can be unappealing to the staff is.
share exercise equipment with so many other people, some of • Well-maintained equipment.

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 1. Gather enough information to make a good deci- motorized), and a comfortable feel are all key
sion before spending money. Check fitness and elements. Also, ask the dealer about warranties,
consumer magazines. Go online to look at reviews return policies, repair records, and service costs.
and comments posted by people who’ve bought
7. Make sure you understand the full cost of the
the machine. Look for feedback from people of
equipment. Read the fine print to see if items such
your age and gender.
as shipping and handling, sales tax, and set-up fees
2. Get the biggest bang for your buck by choosing are included.
equipment that offers the most complete workout.
8. Look for features that you’ll really use. Fancy
If you’re setting up a home gym, a good strategy is
add-ons such as computer-programmed displays
to devote the bulk of your budget to a high-quality
are nice to have, but they can be grossly inaccu-
cardio machine. Supplement that with less expensive
rate and can inflate the price. However, you may
strength training pieces, such as hand weights and
feel some extras are worthwhile—for instance, if
resistance bands.
knowing how many calories you’re burning will
3. Measure the space where you plan to install equip- motivate you, or if features such as a reading rack,
ment and carry the dimensions with you when you water bottle holder, or seat and tension adjusters
shop. Stair-steppers, for example, are quite tall. If will make your workout more appealing.
the machine extends in any way as you use it, be
9. Learn how to use your equipment properly. From
sure that you allow enough space for it when it is
stair machines to stability balls, exercise equip-
in its full range of motion.
ment can be dangerous if used incorrectly. It’s
4. Bring a healthy skepticism about performance a good idea to consult a qualified fitness profes-
claims with you when you consider equipment. sional to learn how to use any new equipment
For example, most aerobic equipment will burn you purchase. Many dealers offer a complimen-
400 to 600 calories an hour, not the more than tary training session when you buy a large piece
1,300 calories that some manufacturers claim. And of equipment.
no device is going to produce “perfect abs” in just
10. Be careful when buying large equipment second-
three minutes a day. Skip products that sound too
hand. It is cheaper, but warranties aren’t likely to
good to be true. Spot reducing is a myth—you can-
apply, and usually you cannot return the equip-
not burn fat off just one part of the body! So are
ment. If you buy from a gym, the equipment is
easy or effortless muscle gain or weight loss, and
more likely to be heavy-duty. However, it’s also
super-speedy results. Don’t be swayed by emphatic
more likely to have seen heavy use.
testimonials or dramatic before-and-after pictures.
Remember, though, that the only things truly
5. Take a test drive before you buy by spending some
needed for a good exercise program are the ability
real time working out on the machine in proper
to exercise and the will to do it. Expensive exercise
exercise clothes and shoes. Don’t make your deci-
equipment isn’t necessary. By combining our walk-
sion after just minutes of use while still in your
ing program (see page 23) with our home and travel
street clothes. Reputable dealers will often allow you
strength routine (page 43) and our eight basic
to try out the machine for 30 days and return it for a
stretches (see page 46), you can create an excellent,
full refund if you’re not satisfied. Keep in mind that
well-rounded program that requires just a good pair
you’ll probably have to pay return costs, though—
of walking shoes, a chair, and a comfortable spot
and that can add up to plenty if a machine is heavy.
for floor exercises. This program is simple and low-
6. Look for well-built equipment. A sturdy frame, cost, but the health benefits it can deliver are sub-
smooth running parts, sufficient horsepower (if stantial.

ww w. h ealt h . h ar v ar d . e du Exercise 41
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 Appendix

Strength and stretching

routines
T
his section includes a complete strength training routine that you can do at home
or while traveling and a stretching routine. Both require no equipment, other than
a chair and a comfortable spot for the floor exercises.

Using the workouts means count to three as you and helps you maintain good
Here we explain the instructions lower a weight, then lift on one form. We specify a range of time
that you’ll find in the workouts count. Two other examples are to rest between sets (and some-
that follow. 4-4 (lift in four counts, no pause times between reps, for espe-
Repetitions (or reps). Each at all, lower in four counts) and cially tiring exercises). How
rep is a single complete exercise. 2-2-2-2 (lift in two counts, rotate much of this time you need will
If you cannot do all the reps at right in two counts, rotate back differ depending on your level
first, just do what you can, and to center in two counts, lower in of fitness and the intensity of
then gradually increase reps as two counts). Here’s how the 2-1-2 the exercises.
you improve. tempo works during the move- Starting position. This
Set. One set is a specific num- ments in the wall push-up (see describes how to position your
ber of repetitions. For example, 10 page 43): Slowly count to two body before starting the exercise.
to 12 reps often makes a single set. while bending your elbows to Movement. Here you’ll find
Usually, we suggest doing one to lower your upper body toward out how to perform one complete
three sets. the wall. Pause for one count. repetition correctly.
Intensity. Intensity measures Then take two counts to return to Tips and techniques. We offer
how hard you work during an the starting position. two or three pointers to help you
exercise. By paying attention to Hold. Hold tells you the num- maintain good form and make the
cues like breathing, talking, and ber of seconds to pause while greatest gains from the exercise.
sweating, you can measure inten- holding a pose during an exercise. Too hard? This section gives
sity through perceived exertion You’ll see this in stretches, which you an option for making the
(see Table 2, page 19). are held for up to 30 seconds, and exercise easier.
Tempo. This tells you the for the front plank (see page 44). Too easy? This section gives
count for the key movements Rest. Resting gives your you an option for making the
in an exercise. For example, 3-1 muscles a chance to recharge exercise more challenging.

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 Appendix

Home and travel strength routine

Remember to bracket your workout with a brief warm-up (for example, five to 10 minutes of brisk walking) and a cool-
down. The stretching routine that follows makes an excellent cool-down. Equipment: Sturdy chair; mat, towels, or carpet
for comfort during floor exercises.

1. Wall push-up 2. Triceps dip

Reps: 8–12 Sets: 1–3 Reps: 8–12 Sets: 1–3
Intensity: Moderate Tempo: 2-1-2 Intensity: Moderate to high
Rest: 30–90 seconds between sets Tempo: 2-2
Rest: 30–90 seconds between sets
Starting position: Stand up straight
in front of a wall with your arms Starting position: Sit near the
extended at shoulder height. Put your edge of a sturdy chair with your
palms against the wall with the fin- legs partly extended, knees bent,
gers pointing upward. and heels touching the floor. Put
your palms down on the chair
Movement: Bend your elbows to
next to your hips and curve your fingers over the edge. Push-
lower your upper body as far as pos-
ing down on your hands, raise your buttocks up a bit and move
sible toward the wall, keeping a
them forward to clear the edge of the chair.
straight line from head to heel. Pause,
then push away from the wall to return to the starting position, Movement: Bend your elbows and lower your hips toward
maintaining neutral alignment from head to toe throughout the the floor. Straighten your arms to return to the starting
movement. position.
Tips and techniques: Tips and techniques:
• Keep your hands no higher than shoulder level. • Maintain a neutral spine throughout, keeping your back close
• Keep your elbows close to your sides as you bend them. to the chair.
• Keep your shoulders down and back. • Keep your arms near your sides and your elbows pointing
toward the back of the chair.
Too hard? Lower your upper body less toward the wall. • Exhale as you extend your arms.
Too easy? Lift one foot a few inches off the floor behind you
as you do the push-ups. Keep your arms at shoulder height Too hard? Lower your body less toward the floor.
and maintain neutral alignment. Too easy? Fully extend your legs in the starting position.

3. Chair stand with staggered legs

Reps: 8–12 Sets: 1–3 Intensity: Moderate Tempo: 3-1-3
Rest: 30–90 seconds between sets

Starting position: Sit up straight near the front edge of a sturdy chair with
your arms crossed and fingers touching opposite shoulders. Position your feet
hip-width apart and stagger them by moving one foot forward.
Movement: Smoothly stand up with your knees and hips pointing straight ahead.
Pause, then return to the starting position. After completing the 8–12 reps in one
set, move the opposite foot forward and repeat the movement for the next set.
Tips and techniques:
• Maintain neutral posture throughout the movement.
• Tighten the muscles in your abdomen and buttocks.

Too hard? Line up your feet evenly, hip-width apart, in the starting position.
Too easy? Lift your arms over your head. Keep your shoulders down and back throughout the move.

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 Appendix

4. Bridge with chair

Reps: 8–12 Sets: 1–3 Intensity: Moderate Tempo: 2-1-2
Rest: 30–90 seconds between sets

Starting position: Lie on your back with your knees bent and your arms at your
sides, palms up. Put your heels on the seat of a chair placed so that your knees
form a 90-degree angle. Relax your shoulders down and back into the floor.
Movement: Squeeze your buttocks as you lift your hips off the floor.
Pause, then slowly release to return to the starting position.
Tips and techniques:
• Maintain a neutral spine throughout.
• Keep your shoulders, hips, and knees in a straight line during the bridge.

Too hard? Put both feet flat on the floor rather than on the chair.
Too easy? Put your left heel on the chair and extend your right leg toward the ceiling before doing the bridge.
After completing the reps in one set, switch leg positions and repeat the movement for the next set.

5. Curl-up with one leg extended

Reps: 8–12 Sets: 1–3 Intensity: Moderate Tempo: 2-1-2
Rest: 30–90 seconds between sets

Starting position: Lie on your back with your fingertips lightly behind your
head, elbows out. Bend your right knee and place that foot flat on the floor
while keeping your left leg extended.
Movement: Tighten your abdominal muscles. Lift your head and shoulders off the floor as you curl upward. Exhale as you lift.
Pause, then return to the starting position.
Tips and techniques:
• Keep your fingertips resting lightly behind your head throughout the movement.
• If you have trouble maintaining a neutral neck, make a fist with one hand and place it under your chin for support.

Too hard? Put your fingertips behind your waist on the floor before starting the curl-up.
Too easy? Cross your arms over your chest before starting the curl-up, or increase the number of reps.

6. Front plank
Reps: 2–4 Sets: 1 Intensity: Moderate to high Hold: 15–60 seconds
Rest: 30–90 seconds between reps

Starting position: Start on your hands and knees.

Movement: Tighten your abdominal muscles and lower your upper body to
your forearms, clasping your hands together and aligning your shoulders directly over your elbows. Extend both legs with your feet
flexed and toes touching the floor so that you balance your body in a line like a plank. Hold. Breathe comfortably.
Tips and techniques:
• Keep your neck and spine in neutral alignment during the plank, not curving upward or downward.
• Keep your shoulders down and back.

Too hard? Put your knees on the floor instead of extending your legs. Too easy? While holding your body in a line like a plank, lift
your right foot and move it to the side six inches, tap the floor, and move it back to the center. Lift your left foot and move it to the
side six inches, tap the floor, and move it back to the center. Continue for 15 to 60 seconds.

44 Exe rc ise w w w.h ealt h .ha r va r d.e du

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 Appendix

7. Standing side leg lift 8. Heel raise

Reps: 8–12 on each side Reps: 8–12
Sets: 1–3 Sets: 1–3
Intensity: Moderate Intensity: Light to moderate
Tempo: 2-1-2 Tempo: 2-1-2
Rest: 30–90 seconds between sets Rest: 30–90 seconds between sets

Starting position: Stand up Starting position: Stand up straight with

straight with your feet together your hands on your hips.
and your hands on your hips. Movement: Slowly rise up on the balls of
Movement: Slowly lift your right both feet. Pause, then slowly lower your
leg straight out to the side. Pause, heels back to the floor.
then slowly lower the leg. Keep Tips and techniques:
your hips even throughout. Finish
• Maintain neutral posture and tighten
all reps before repeating with the
leg positions reversed. This is one your buttock muscles for balance.
complete set. • As you lift, keep your ankles firm to avoid
rolling to the outside of your foot.
Tips and techniques:
• Maintain neutral posture throughout.
• Tighten your abdominal muscles and squeeze the buttocks of
the supporting leg.
• Exhale as you lift. Too hard? Hold on to the back of a chair for balance while
doing the exercise.
Too hard? Hold on to the back of a chair for balance and Too easy? Try the exercise standing on your right leg only
lift your leg a shorter distance. while lifting your left foot slightly off the floor. Finish all reps
Too easy? Hold for 4 counts at the top of the lift during before repeating with the leg positions reversed. This is one
each repetition. complete set.

Appendix continued on page 46

Special thanks to the Equinox fitness club on Dartmouth Street in Boston for the use of its facilities and to the following
personal trainers for demonstrating the exercises depicted in this report: Peter Athans, Maryanne Blake, and Kristy Discipio.

ww w. healt h . h ar v ar d . e d u E x ercis e 45
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 Appendix

8 basic stretches
This routine enhances flexibility by stretching muscles throughout your body and mixes in calming yoga moves. When done regularly,
these simple stretches can help you stay limber, improve your balance and posture, and possibly avoid injury. Preferably, stretch on
days when you do aerobic or strength activities. It’s best to stretch after your workout, when your muscles are warm and limber.
Flow from one movement to another without rests in between. You’ll achieve best results by holding stretches for 10 to
30 seconds and doing these exercises at least two or three times a week. The longer you can hold a stretch, the better for
flexibility. Equipment: Mat, towels, or carpet for comfort during floor exercises.

1. Torso rotation 2. Hamstring

Reps: 4 stretch
Sets: 1 Reps: 4 on each side
Intensity: Light Sets: 1
Hold: 10–30 seconds Intensity: Light
Hold: 10–30 seconds
Starting position: Lie
on your back with your
knees bent and feet Starting position: Lie on your back with your right leg
together flat on the floor. Put your arms comfortably out to each extended on the floor. Hold your left leg with both hands behind
side just below shoulder level, palms up. the thigh so your knee is bent and directly above your hip.
Movement: Tighten your abdominal muscles as you lower both Movement: Flex the foot of the bent left leg and lift the heel
knees together toward one side of the floor. Keeping your shoul- toward the ceiling, straightening the leg as much as possible
ders still and flat on the floor, look in the opposite direction. Feel without locking the knee. As you do so, flex the foot on your
the stretch across your chest and torso. Hold. Return to the start- extended right leg to stretch the calf muscles and the hip flexor
ing position. Repeat in the opposite direction. at the front of the hip, a spot that is tight in many people. Hold.
Return to the starting position. Finish all reps before repeating
Tips and techniques:
with the leg positions reversed. This is one complete set.
• Stretch to the point of mild tension.
Tips and techniques:
• Keep your shoulders relaxed and pressing into the floor.
• Stretch the leg extended toward the ceiling to the point of
• Breathe comfortably.
mild tension without any pressure behind the knee.
• Breathe comfortably.
3. Upper hip
stretch 4. Upward dog
Reps: 4 Reps: 4
Sets: 1 Sets: 1
Intensity: Light Intensity: Light
Hold: 10–30 seconds Hold: 10–30 seconds

Starting position: Lie

Starting position: Lie on your back with your right knee bent on your stomach with
and your foot on the floor. Rest your left ankle on your right your hands next to your shoulders, palms facing down, and legs
kneecap. Your left knee should point toward the wall. Hold the comfortably extended.
back of the right thigh with both hands.
Movement: Slowly lift your head, shoulders, and chest off the
Movement: Relax your shoulders down and back as you lift floor by pressing your palms against the floor. Keep your head
your right foot up off the floor until you feel tightness in your and neck in neutral alignment as you try to fully straighten your
left hip and buttock. Hold. Return to the starting position. arms. Hold. Return slowly to the starting position.
Repeat on the opposite side.
Tips and techniques:
Tips and techniques: • Lift only to the point of mild tension.
• Stretch to the point of mild tension. • Be careful not to lock your elbows while fully straightening
• Hold the stretch as still as possible without bouncing. your arms.
• Breathe comfortably, or practice yoga breathing if you’ve been
• Breathe comfortably.
taught this.
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 Appendix

5. Child’s pose 6. Downward-

with diagonal facing dog
reach Reps: 4 Sets: 1
Reps: 4 Sets: 1 Intensity: Light to
Intensity: Light moderate
Hold: 10–30 Hold: 10–30
seconds seconds

Starting position: Start on your hands and knees. Walk your Starting position: Start on your hands and knees.
hands diagonally out to the right and place your left hand on Movement: Lift your knees off the floor until your legs extend
top of your right hand. Keep your shoulders down and back as so you are in an upside-down “V,” aligning your ears and arms
you do so. while maintaining a neutral neck and spine. Try to keep your
Movement: Slowly drop your buttocks back toward your heels. weight evenly distributed between hands and feet. If possible,
Hold. Return to the starting position. Repeat on the opposite press your heels toward the floor. Keep your shoulders down and
side. back. Hold. Return to the starting position.

Tips and techniques: Tips and techniques:

• Stretch to the point of mild tension. • Think of lengthening your spine as you engage your abdomi-
nal muscles.
• Breathe comfortably.
• Breathe comfortably, or practice yoga breathing if you’ve been
taught this.

7. Chest stretch 8. Shoulder stretch

Reps: 4 Sets: 1 with torso rotation
Intensity: Light to moderate Reps: 4 on each side
Hold: 10–30 seconds Sets: 1 Intensity: Light
Hold: 10–30 seconds
Starting position: Stand in a
doorway facing forward. Put your Starting position: Stand
right hand on the edge of the door with your feet hip-width
frame slightly below shoulder level, apart. Put your left hand
palm facing forward. Keep your on your right shoulder.
shoulders down and back. Cup your left elbow with
Movement: Slowly turn your body your right hand.
to the left, away from the door Movement: Roll your
frame, until you feel the stretch in shoulders down and back
your chest and shoulder. Hold. Finish all reps before repeating on as you gently pull your left elbow across your chest.
the opposite side. This is one complete set.
Pause, then rotate your torso to the right while keeping your
Tips and techniques: hips, knees, and feet facing forward. Hold. Return to the starting
• Stretch to the point of mild tension. position. Finish all reps before repeating on the other side.
• Breathe comfortably. Tips and techniques:
• Keep your shoulders down and back.
• Stretch to the point of mild tension.
• Breathe comfortably.

ww w. healt h . h ar v ar d . e d u E x ercis e 47
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 Resources
Organizations
American Academy of Physical Medicine and Rehabilitation Offers many helpful publications available to the public, includ-
ing the free booklet Exercise and Physical Activity: Your Every-
9700 W. Bryn Mawr Ave., Suite 200
day Guide. The booklet, available online or requested through a
Rosemont, IL 60018
phone call, includes simple tests to check your progress.
847-737-6000
[Link] The President’s Council on Physical Fitness, Sports & Nutrition
A national professional organization for physiatrists—medical 1101 Wootton Parkway, Suite 560
doctors trained in physical medicine and rehabilitation—which Rockville, MD 20852
promotes education and funds research in this area. A referral 240-276-9567
service on the website locates physiatrists by state. [Link]
[Link]
American College of Sports Medicine
The President’s Council on Physical Fitness, Sports & Nutrition
P.O. Box 1440
offers simple tips for healthy eating, weight loss, and an active
Indianapolis, IN 46206
lifestyle. The President’s Challenge website hosts activity logs and
317-637-9200
fitness calculators and two levels of fitness challenges.
[Link]
ACSM educates and certifies fitness professionals, such as per- Weight-control Information Network
sonal trainers, and funds research on exercise. A referral service 1 WIN Way
on the website locates ACSM-certified personal trainers. Bethesda, MD 20892
877-946-4627 (toll-free)
American Council on Exercise [Link]
4851 Paramount Drive
The Weight-control Information Network offers free publications
San Diego, CA 92123
on obesity, weight control, and nutrition.
888-825-3636 (toll-free)
[Link]
ACE is a nonprofit organization that promotes fitness and offers Publications
a wide array of educational materials, including information for
consumers on finding and evaluating a personal trainer. The No Sweat Exercise Plan
Harvey B. Simon, M.D.
American Heart Association (McGraw-Hill, 2006)
7272 Greenville Ave. A founding member of the Harvard Cardiovascular Health Center,
Dallas, TX 75231 Dr. Simon sets forth an engaging no-sweat exercise plan based
800-242-8721 (toll-free heart disease information) upon solid research. An easy-to-follow point system helps readers
888-478-7653 (toll-free stroke information) tailor fitness programs to their own needs and measure health
[Link] benefits from everyday activities and numerous sports.
The AHA website provides educational materials on all aspects of
heart disease and stroke. The organization also offers educational Strength and Power Training: A Guide for Adults of All Ages
services and materials. Jonathan Bean, M.D., M.S., M.P.H., and Walter Frontera, M.D., Ph.D.
(Harvard Medical School, 2010)
Arthritis Foundation This Special Health Report from Harvard Medical School features
P.O. Box 7669 an illustrated step-by-step weight training program. The report
Atlanta, GA 30357 includes two complete workouts, plus a stretching regimen.
800-283-7800 (toll-free)
[Link] Workout Workbook: 9 Complete Workouts to Help You Get
A national nonprofit organization with local chapters in many Fit and Healthy
states. The website offers educational materials on arthritis, pain Jonathan F. Bean, M.D., M.S., M.P.H., Joy Prouty, and Josie Gardiner
control, treatments, alternative therapies, and other topics. (Harvard Medical School, 2009)
This Special Health Report from Harvard Medical School includes
National Institute on Aging nine excellent workouts to try at home, take on the road, or mix
Building 31, Room 5C27 into your gym routine. Core, strength, stability ball, power chal-
31 Center Drive, MSC 2292 lenge, travel, and other workouts help you bump up activity and
Bethesda, MD 20892 enhance fitness. Also includes warm-up and cool-down routines.
800-222-2225 (toll-free)
[Link]/nia

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 Glossary
adenosine triphosphate (ATP): A chemical compound used flexibility: A component of physical fitness that refers to the
by the body to convert food into energy that can be used by range of motion available at a joint.
cells.
metabolic equivalents (METs): Units used to estimate the
aerobic exercise: Exercise involving repetitive use of large oxygen consumption, or metabolic cost, of physical activity,
muscles (as in walking, bicycling, or swimming) at a level and, hence, its intensity. One MET is the estimated energy cost
of intensity that increases your heart rate and respiration of your body at rest.
to maintain adequate delivery of oxygen to muscles; it
improves cardiorespiratory endurance. Also known as cardio muscular endurance: The ability of the muscle to continue
or endurance exercise. to perform without stopping from fatigue.

anaerobic exercise: Exercise that improves the efficiency physical activity: Any movement that prompts muscle
of energy-producing systems that do not rely on oxygen. contractions and a rise in metabolism. Under this umbrella is
Examples include sprinting and weight lifting. an endless list of activities like rising from a chair, crossing the
room, tossing a frisbee, running a marathon, or vacuuming a
balance: Ability to maintain equilibrium while stationary or floor.
moving.
physical fitness: A state of being physically sound and
calorie: A measurement of energy. healthy; having the ability to perform physical activity well.

cardiorespiratory endurance: A component of physical range of motion: The extent of movement—and thus
fitness that relates to the ability of the circulatory and flexibility—in a joint, measured in the degrees of a circle.
respiratory systems to supply oxygen during sustained
physical activity. Also known as cardiorespiratory fitness. strength: The ability of muscles to exert force.

coronary artery disease: Heart disease characterized by strength training: Exercise training designed to increase
a narrowing of the coronary arteries that limits the flow strength, power, and muscle endurance. Also known as
of oxygen to the heart. Can cause angina, abnormal heart resistance training.
rhythms, heart attack, and heart failure. VO2 max: The body’s maximum capacity for oxygen
exercise: A planned, structured, and repetitive program of consumption during peak exertion. Also known as aerobic
activity aimed at improving or maintaining physical fitness. power, maximal oxygen consumption, or cardiorespiratory
endurance capacity.

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