Stan Reents, PharmD
02/23/2011 10:24 AM
Last Revision: 01/24/2017 05:55 PM
Are you an "I'd rather do it myself" type of person? If so, this article is for you!
In 2009, Dr. Steven Blair, a leading exercise researcher at the U. South Carolina, wrote:
"A low level of cardiorespiratory fitness is a greater risk factor for death than hypertension, obesity, elevated cholesterol, diabetes, or smoking."
This is a pretty profound statement. What it means is that you have the power to lower your risk of cardiovascular events more than your physician does.
In my opinion, the medical profession is way behind when it comes to recommending and educating patients about the health-promoting effects of regular (and proper!) exercise. The American Medical Association (AMA) and the American College of Sports Medicine (ACSM) jointly launched the "Exercise Is Medicine" campaign in November 2007. But getting physicians to shift their focus from diagnosis and treatment of disease to the prevention of disease will take a long time.
While (primary care) physicians can be effective exercise counselors (Grandes G, et al. 2009), only 34% of patients stated that their physician had counseled them about exercise at their last medical visit (Lobelo F, et al. 2009).
But wait, the story gets worse:
According to an Institute of Medicine report, 78 million baby boomers began turning 65 in 2011. The report goes on to warn that the current US healthcare system isn't able to handle this influx of elderly citizens.
Do some back-of-the-envelop calculations. It is estimated that, currently in the US there are:
- 140 million Americans classified as either overweight or obese (and these are only the adults!)
- 105 million adults with an elevated cholesterol
- 75 million adults with hypertension
- 29 million adults with diabetes, but 86 million with pre-diabetes
Obviously, some patients have more than one of these conditions, but bear with me as I try to point out the burden of these problems on our health care system:
Compare these numbers above to the number of "family medicine" physicians in the USA: 85,400 (personal communication, American Academy of Family Physicians, January 17, 2011). If you compare the number of patients with an elevated cholesterol (105 million) to the number of family physicians, it means that each physician must treat 1220 patients. Even if you include internists, cardiologists (not really a primary-care physician), and pediatricians, the number of patients with lifestyle disease that each physician must manage is still quite high.
In 2014, BetterDoctor.com released data on the patient:physician ratios of major US cities. Some examples are listed below:
Top 5 Cities With The Highest Ratio of Residents to Primary Care Physicians
||RATIO OF RESIDENTS
PRIMARY CARE PHYSICIANS
|• New York City
||6,536 : 1
|• San Antonio, TX
||3,820 : 1
|• Los Angeles
||3,062 : 1
|• Greensboro, NC
||2,986 : 1
|• Jacksonville, FL
||2,710 : 1
Thus, for a variety of reasons, it is very important that you learn how to exercise "therapeutically." With that in mind, let me explain how you can do it......
PRACTICAL, LOW-COST OPTIONS FOR HOME EXERCISE GEAR
First, let me be clear: you do NOT need to join a gym or spend a lot of money on exercise gear to create an effective fitness program. Here are some suggestions:
• A Plastic Jug: Save several gallon-size sturdy plastic jugs that have handles. You can use these as dumbbells. You can also thread a rope or leather belt through the handle and use them as ankle-weights. One gallon of water weighs 8.3 lbs. If you fill one with sand, it will weigh about 13 lbs.
• A Back Pack: To add a little extra weight to exercises such as squats, lunges, and standing up from a seated position, you can wear a back-pack stuffed with text-books, phone books, or soup cans. But, note that there are a variety of weighted vests available for this purpose.
• A Chair: A sturdy chair with no arms or wheels can be used for inclined push-ups, back exercises (bend forward at the waist while seated, then back up) and others. Use 2 chairs (place one hand on each chair) for exercises such as dips. For some exercises, a chair with arms is helpful. Examples include: leg press (simply stand up!) and leg extension (lift one foot off the ground and straighten your leg). Chairs are also helpful during balance exercises.
• A Flight of Stairs: There are a variety of exercises you can perform on a flight of stairs. Just walking up and down will simulate leg presses, but, also, this will give you an aerobic workout. You can also do inclined push-ups. And, if you are very careful and are able to, hopping down to the floor from the bottom step is good for stimulating bone density. Don't do this if you have back or hip problems though!
• Stretch Bands: These are now widely available (see our Resistance Training Gear page). But, you could also use a bicycle inner tube. Either way, a variety of exercises can be performed.
• The Thera-Band® "First Step To Active Health®" Kit: This is an all-in-one exercise kit that you might be able to obtain from your personal physician. Thera-Band® products have been on the market for years. This kit contains a stretch band, some educational cards, and a log-book. It is a great tool for older adults who are beginning a new exercise program.
DESIGNING AN EFFECTIVE EXERCISE PROGRAM
Once you collect some of the materials listed above, then you can develop an exercise program. (NOTE: Before beginning a new exercise program, make sure you obtain clearance from your personal physician first!)
You don't have to be a healthcare professional or an exercise physiologist to design a therapeutically-effective exercise program. For optimum health, your weekly exercise routine should include:
- aerobic exercise (example: brisk walking)
- strength exercise (example: use the jugs or stretch bands mentioned above)
- balance exercise (in my opinion, this activity is not stressed enough for older adults)
- flexibility exercise (example: stretching)
The most current ACSM exercise guidelines for adults are as follows (Garber CE, et al. 2011):
if moderate intensity
|• brisk walking
• slow jogging
all major muscle groups
|• free weights
• weight-stack machines
• stretch bands
• body-weight exercises
||• Bosu ball
• tai chi
per muscle group
|• simple stretching
Even if you can't meet all of these guidelines, try to perform all 4 of the activities listed above each week. And, keep in mind that, to improve your health, you don't have to exercise "hard" (see Exercise Intensity below). Most of the health benefits from exercise occur with surprisingly little effort....ie., plain 'ol walking may do it for many people (Pate RR, et al. 1995).
MONITORING YOUR EXERCISE INTENSITY
Certainly, everyone knows that when you exercise, your heart rate (HR) and respiratory rate (RR) increase. If you monitor your heart rate (HR) and your respiratory rate (RR) while you are exercising, this will give you a very good idea of how hard you are exercising. Here's how:
Target Exercise Heart Rate: Your "exercise" HR is the HR you should shoot for while you are exercising. But, to calculate that, you first need to know your "maximum" HR.
• Calculate your maximum HR: The most common formula for this is: 220 - age. Recently, this formula has been questioned. The formula was based on data collected only in males, so, it is not the perfect choice for women. If you would like to be more precise, then, see my other review "Heart Rate, Exercise Intensity, and Training." For people who are just getting started, it is OK to use 220 - age.
• Calculate your target HR: Now that you know your maximum HR, you can calculate your target exercise HR. For health benefits, most people only need to exercise at about 50-60% of their maximum.
Here is an example. Let's say you are 65 yrs old:
First, calculate your maximum HR:
220 - 65 = 155 bpm
Next, calculate your target exercise HR:
155 bpm x 50% = 78 bpm
155 bpm x 60% = 93 bpm
So, the target exercise HR for a person who is 65 yrs old should be 78-93 bpm (during actual exercise).
Respiratory Rate: One of the drawbacks of trying to monitor your HR while you are exercising is that, well, it's sometimes a little hard to do that! One solution is to wear a heart rate monitor. These are great devices. But, if you don't want to spend the money, then, you can simply monitor how hard you are breathing.
In 1960, a researcher named Gunnar Borg developed a numerical scale to help determine how hard someone was exercising, without the need to measure their heart rate. This was called the Borg Scale and has been used in exercise research for many decades.
Recently, it has been shown that being able to speak in full sentences while exercising is also a fairly useful monitoring clue. This has been termed the "Talk Test." (Foster C, et al. 2008) (Norman JF, et al. 2008) (Persinger R, et al. 2004). If you are breathing so hard that you cannot talk comfortably, then you are exercising too hard.
ASSESSING YOUR PROGRESS
Every month or two, you might want to evaluate your progress.
I explained in detail how aerobic capacity is measured in the review "Measuring Fitness: Aerobic Capacity." But, there are several really simple things you can do yourself that are just as useful as a VO2max test:
Resting Heart Rate: As you get more and more aerobically fit, your resting HR will gradually decline. This is a good thing. In fact, it's a VERY good thing! Some very important research shows that an elevated resting HR is a sign of an unhealthy heart and cardiovascular system: In one study, subjects who had a resting HR above 75 bpm had an increased risk of sudden death from a myocardial infarction (Jouven X, et al. 2005).
The best time to obtain your resting HR is within seconds of waking up, even before you sit up in bed. You should not have consumed alcohol the night before, and, you don't want to wake up by having the dog jump on you! Learn how to take your pulse and do this once or twice per month.
Several tests have been developed to estimate your VO2max:
|• For healthy fit adults
||Cooper 1.5-mile run
|• For out-of-shape adults
||Rockport 1-mile walk
|• For older adults
|• For kids
To assess your performance on these tests, you'll need a copy of the ACSM book "Complete Guide to Fitness & Health." (see below).
Here are some resources that will be helpful:
EXERCISE RESOURCES: Web Sites
At times, it seems there is as much misleading information on the Internet as there is quality information. How can you separate the good from the bad?
As far as I know, no group rates or evaluates the quality of information on "exercise" web sites. In my opinion, this is needed, because exercise really is a highly effective "treatment" of a wide range of health conditions. Further, it is possible to exercise too much, and/or, do the wrong kinds of exercise.
Fortunately, evaluations of "health" web sites do exist:
When searching for quality health information on the Internet, look for web sites that display either the "HON" logo and/or the "URAC" logo at the bottom of the home page. This means the content on that web site has been reviewed. If it displays the "HON" logo, it has met the standards of "Health On The Net", a European group that assesses the quality of health information web sites (www.HON.ch). If it displays the "URAC" logo, it has been certified by the US group URAC (www.URAC.org). An example of a health information web site that has obtained certifications from both organizations is www.WebMD.com.
• First Step to Active Health® (www.FirstStepToActiveHealth.com): This web site has a variety of outstanding resources for older adults who are just starting on a new exercise program. Resources for healthcare providers are also available. The information and guidance is "evidence-based" which means that there is solid scientific research backing up their approach. Note the "HON" logo at the bottom.
• Exercise & Physical Activity Guide from the National Institute on Aging (www.NIA.NIH.gov): In my opinion, this is a superb web resource for older adults.
EXERCISE RESOURCES: Online Advice
The web sites listed above are excellent, but you really are "on your own" with these. The information they provide is good, but who do you turn to when you have questions?
• AthleteInMe.com® (www.AthleteInMe.com): Don't forget that we offer private, personalized exercise advice, in addition to the tools and information that we provide. Because we have a network of health care professionals on our team, we specialize in guiding clients who have health problems.
EXERCISE RESOURCES: Books
There are some excellent books on exercise for beginners and older adults. Here are a couple I like:
The American College of Sports Medicine (ACSM) first published "ACSM Fitness Book" in 1992. The 3rd edition, pictured here, was published in 2003. Even though the 3rd edition has been replaced by the "Complete Guide to Fitness & Health" (see below), the 3rd edition is still a useful resource. The 3rd edition is 175-pages long and is loaded with full-color pictures of real people demonstrating proper technic on a variety of exercises.
In 2011, ACSM published their "Complete Guide to Fitness & Health." This book is also intended for consumers, however, it is much more detailed than the ACSM Fitness Book, 3rd edition (described above).
Fitness Over Fifty is published by the National Institute on Aging. This is an ideal resource for older adults. It is loaded with large photos of older adults doing various exercises.
"STEPS" YOU SHOULD TAKE
Before you start a new exercise program, there are 2 things you should do first:
1) Discuss it with your personal physician (this is very important!).
2) Make note of some measurements such as body weight, waist circumference, BMI, and resting heart rate. This will be your baseline and will be helpful to monitor your progress and keep you motivated to continue.
Then, using the books and web sites listed, plan out your program. Put a weekly schedule on your refrigerator.
Use the "Talk Test" to monitor how hard you are exercising and use the "Walk Test" to assess improvements in your aerobic capacity.
Once or twice per month, reassess the health parameters listed above.
FOR MORE INFORMATION
Readers may also be interested in the following reviews:
EXPERT HEALTH and FITNESS COACHING
Stan Reents, PharmD, is available to speak on this and many other exercise-related topics. (Here is a downloadable recording of one of his Health Talks.) He also provides a one-on-one Health Coaching Service. Contact him through the Contact Us page.
Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med 2009;43:1-2. Abstract
Foster C, Porcari JP, Anderson J, et al. The talk test as a marker of exercise training intensity. J Cardiopulm Rehabil Prev 2008;28:24-30. Abstract
Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011;43:1334-1359. Abstract
Grandes G, Sanchez A, Sanchez-Pinilla RO, et al. Effectiveness of physical activity advice and prescription by physicians in routine primary care. Arch Intern Med 2009;169:694-701. Abstract
Jouven X, Empana JP, Schwartz PM, et al. Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med 2005;352;1951-1958. Abstract
Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counseling practices. Br J Sports Med 2009;43:89-92. Abstract
Norman JF, Hopkins E, Crapo E. Validity of the counting talk test in comparison with standard methods of estimating exercise intensity in young healthy adults. J Cardiopulm Rehabil Prev 2008;28:199-202. Abstract
Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-407. Abstract
Persinger R, Foster C, Gibson M, et al. Consistency of the talk test for exercise prescription. Med Sci Sports Exerc 2004;36:1632-1636. Abstract
ABOUT THE AUTHOR
Stan Reents, PharmD, is a former healthcare professional. He is a member of the American College of Sports Medicine (ACSM) and holds current certifications from ACSM (Health & Fitness Specialist), ACE (Health Coach) and has been certified as a tennis coach by USTA. He is the author of Sport and Exercise Pharmacology (published by Human Kinetics) and has written for Runner's World magazine, Training and Conditioning, Club Solutions, and other fitness publications.
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