Exercise

Highlights

Overview

Benefits of Exercising

Tips for Exercising

Motivation:

Introduction

To enjoy a long and healthy life, everyone should make wise lifestyle choices that include eating a healthy diet, exercising regularly, and maintaining normal weight. The combination of inactivity and eating the wrong foods is the second most common preventable cause of death in the United States (smoking is the first).

Most research on the benefits of exercise focuses on heart protection. Studies clearly show that exercise helps the heart. In addition, studies are reporting that even people with heart disease may gain important benefits from exercising, though they need medical clearance and special precautions.

Exercise

Evidence suggests that our genes evolved to favor exercise. In other words, during prehistoric times, if a person couldn't move quickly and was not strong, that person died. Those who were fit survived to reproduce and pass on their "fitter" genes. Some researchers believe that with our current inactive lifestyle, these genes produce a number of bad effects, which can lead to many chronic illnesses.

The benefits of exercise include:

In addition, exercise can help change other dangerous lifestyle habits. In one trial, exercise more than doubled the likelihood of not smoking after 12 months, but more research is necessary due to the limitations of other studies. Trials are underway to assess the effects of exercise on nicotine cravings and smoking cessation. The Quit For Health (QFH) trial, for example, may help to determine the efficacy of aerobic exercise as an adjunct smoking cessation treatment among women.

No one is too young or too old to exercise. The American Heart Association recommends that individuals do moderate exercise, such as brisk walking, for at least 150 minutes per week, or vigorous exercise for 75 minutes per week. However, vigorous exercise carries risks that people should discuss with a health care provider. You should always check with your provider before starting a new exercise program, especially if you have any of the following risk factors:

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

Recommended Exercise Methods

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

When exercising, listen to the body's warning symptoms, and consult a health care provider if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their provider. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

Radial pulse

Click the icon to see an image of checking your pulse on your wrist.
Taking your carotid pulse

Click the icon to see an image of taking your carotid pulse.

There are different types of heart rates.

Resting heart rate.

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

Maximum heart rate.

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

Target heart rate.

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

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

Note:

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

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max.

Serious exercisers may use a

VO2 max calculation

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

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

Exercise and heart rate

Click the icon to see an image of exercise and heart rate.

Warm-Up and Cool-Down

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

Warming up and cooling down

By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

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

Aerobic (Endurance) Training

Benefits of Aerobic Exercise

Regular aerobic exercise provides the following benefits:

Types of Aerobic Exercise

Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

Aerobic exercise

Click the icon to see an image of aerobic exercise.

Aerobic Regimens

As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

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

Shoes.

Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing.

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

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it is not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot.

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials.

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

You may want to wear form-fitted, stretchy clothing for activities like:

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment

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

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

The following are a few observations on specific equipment:

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.

Sports such as Basketball, Football, Soccer

Choose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise

While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

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

HDL and LDL

Click the icon to see an image of HDL and LDL.

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note:

People at risk for cardiovascular disease should not perform strength exercises without checking with a provider.

Types of Muscle Contractions

There are three types of muscle contractions involved in strength training:

Isometric exercise

Click the icon to see an image of isometric exercise.

Strength Training Regimens

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


Click the icon to see an image of proper breathing during exercise.

Strength Training Equipment

Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

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

Flexibility Training (Stretching)

Benefits of Flexibility Training

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

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

Flexibility exercise

Click the icon to see an image of flexibility exercise.

Flexibility Training Regiments

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

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Even small improvements in physical fitness and activity can prolong life and independent living, even those who increase their physical activity at age 50.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 to 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

How Exercise Affects the Heart

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

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

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

Circulation of blood through the heart

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

Effects of Exercise on Heart Disease and Cholesterol

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

The American Heart Association recommends that individuals perform moderate exercise for at least 150 minutes per week, or 75 minutes per week of vigorous exercise. Muscle strengthening activities at least two days a week are also recommended. This recommendation supports similar exercise guidelines issued by the Centers for Disease Control and Prevention.

Coronary Artery Disease

People who maintain an active lifestyle have a 45% lower risk of developing heart disease than do sedentary people. Experts have been attempting to define how much exercise is needed to produce heart benefits. Beneficial changes in cholesterol and lipid levels, including lower LDL (bad cholesterol) levels, occur even when people performed low amounts of moderate- or high-intensity exercise, such as walking or jogging 12 miles a week. Benefits occur even with very modest weight loss, suggesting that overweight people who have trouble losing pounds can still achieve considerable heart benefits by exercising.

Some studies suggest that for the greatest heart protection, it is not the duration of a single exercise session that counts but the total weekly amount of energy expended.

Resistance (weight) training has also been associated with heart protection. It may offer a complementary benefit to aerobics. If you have heart disease or risk factors for heart disease, check with your health care provider before starting resistance training.

Effects of Exercise on Blood Pressure

Regular exercise helps keep arteries elastic (flexible), even in older people. This, in turn, ensures good blood flow and normal blood pressure. Sedentary people have a 35% greater risk of developing high blood pressure than physically active people do.

Untreated hypertension

Click the icon to see an image of hypertension.

For lowering blood pressure, the American Heart Association recommends an average of 40 minutes of moderate to vigorous aerobic activity 3 to 4 times per week. Experts recommend at least 30 minutes of exercise on most -- if not all -- days. Studies show that yoga and Tai chi, an ancient Chinese exercise involving slow, relaxing movements, may lower blood pressure almost as well as moderate-intensity aerobic exercises.

Yoga

Click the icon to see an image of yoga.

Anyone with existing high blood pressure should discuss an exercise program with their provider. Before starting to exercise, people with moderate-to-severe high blood pressure should lower their blood pressure, and be able to control it with medications. Everyone, especially people with high blood pressure, should breathe as normally as possible through each exercise. Holding your breath during strength exercises increases blood pressure.

Effects of Exercise on Heart Failure.

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

Progressive resistance training may be particularly useful for heart failure patients, since it strengthens muscles, which commonly weaken in this disorder. Simply performing daily handgrip exercises can improve blood flow through the arteries.

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

Effects of Exercise on Stroke

Physical activity lowers stroke risk.

All stroke survivors should have a medical evaluation before starting an exercise program.

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

Exercise Programs for High-Risk Individuals

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

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

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

Some people should get a cardiac evaluation and a stress test.

Stress Test

A stress test helps determine the risk for a heart problem resulting from exercise. Anyone with a heart condition or history of heart disease should have a stress test before starting an exercise program. Some health care professionals also recommend this test before a vigorous exercise program for older people who are sedentary, even in the absence of known or suspected heart disease. The test is expensive, however. Many providers believe that it is not necessary for older people who start low to moderate intensity exercise such as walking, and have no evident health problems or risk factors.

Heart Attack and Sudden Death from Strenuous Exercise

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

High-Risk Individuals

In general, the following people should avoid intense exercise or start it only gradually with careful medical supervision:

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

Episodes of exercise-related sudden death in young people are rare but of great concern. Some are preceded by fainting, which is due to a sudden and severe drop in blood pressure. It should be noted that fainting is relatively common in athletes, but it should always result in a careful medical evaluation. Young people with genetic or congenital (present at birth) heart disorders should avoid intensive competitive sports.

High dose anabolic steroids and products containing ephedra have been associated with cases of stroke, heart attack, and even death. Energy drinks and supplements have also raised concern.

Hazardous Activities for High-Risk Individuals

The following activities may pose particular dangers for high-risk individuals:

Listening for Warning Signs

Young men who die suddenly during a workout may have previously experienced, and ignored, warning signs of heart disease. In addition to avoiding risky activities, the best preventive tactic is simply to listen to the body and seek medical help at the first sign of symptoms during or following exercise. These symptoms include:

Coronary artery spasm

Click the icon to see an image of a coronary artery spasm.
Stable angina

Click the icon to see an image of angina.

How Exercise Affects Diabetes

Moderate aerobic exercise can lower your risk for type 2 diabetes.

Exercise has positive benefits for those who have diabetes. It can lower blood sugar levels, improve insulin sensitivity, and strengthen the heart. Strength training, which increases muscle and reduces fat, may be particularly helpful for people with diabetes. In a recent study of overweight adults, intensive lifestyle interventions (frequent individual and group diet and activity counseling) were shown to be more effective than three annual diabetes support and education (DSE) visits in improving type 2 diabetes remission rates.

People with diabetes who begin a new or vigorous exercise program should have their eyes examined, and discuss footwear and heart risks with their doctor.

Type 1 Diabetes

Aerobic exercise has significant and particular benefits for people with type 1 diabetes. It increases sensitivity to insulin, lowers blood pressure, improves cholesterol levels, and decreases body fat.

Type 2 Diabetes

Aerobic exercise and resistance training, alone or in combination, improves control of blood sugar levels in patients with type 2 diabetes. Training of more than 150 minutes per week is associated with better control, but even shorter time periods improve control.

For improving blood sugar control, the American Diabetes Association recommends at least 150 minutes per week of moderate-intensity physical activity (50 to 70% of maximum heart rate) or at least 90 minutes per week of vigorous aerobic exercise (more than 70% of maximum heart rate). Exercise at least 3 days a week, and do not go more than 2 consecutive days without physical activity.

Strength Training

Strength training, which increases muscle and reduces fat, is also helpful for people with diabetes who are able to do this type of exercise. The American Diabetes Association recommends performing resistance exercise three times a week. Build up to three sets of 8 to 10 repetitions using weight that you cannot lift more than 8 to 10 times without developing fatigue. Be sure that your strength training targets all of the major muscle groups.

Some Precautions for People with Diabetes Who Exercise

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

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

Glucose test

A person with diabetes must regularly check their blood sugar (glucose) level.

How Exercise Affects the Bones and Muscles

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

Exercise may help kids lower their risk of chronic pain in the future.

The structure of a joint

Joints are complex structures. They are designed to bear weight and move the body. Above the knee is the femur (thigh bone). Below the knee is the tibia (shin bone) and fibula. The kneecap is also called the patella. It rides on top of the lower portion of the femur and the top portion of the tibia. The muscles and ligaments connect these bones, and the space between them is cushioned by fluid-filled capsules (synovia) and cartilage. When you exercise, the muscles pull on the bones, strengthening them. The range of motion of a joint represents how far it can be flexed (bent) and extended (stretched).

Effects of Exercise on Osteoarthritis

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

Osteoporosis

Click the icon to see an image of osteoporosis.

The following are useful exercises for osteoarthritis patients:

Exercises Effect on Fractures and Falls

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

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

Bone-building exercise

Click the icon to see an image of bone-building exercise.

Note on Female Athlete Triad.

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

Effect of Exercise on Back Pain

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

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

Benefits for Chronic Back Pain

People with sudden and severe back pain should not exercise. Exercise plays a very beneficial role in relieving chronic back pain, however.

Exercise should be considered as part of a broader program to return to normal home, work, and social activities. In this way, the positive benefits of exercise not only affect strength and flexibility but they also alter and improve the patients' attitudes toward their disability and pain.

Repetition is the key to increasing flexibility, building endurance, and strengthening the specific muscles needed to support the spine. Some exercise programs used for prevention or treatment of chronic low back pain include:

It is important for any person who has low back pain to have an exercise program guided by professionals who understand the limitations and special needs of back pain, and who can address individual health conditions.

Negative Effects on the Back

Improper or excessive exercise can also cause back pain.

How Exercise Affects the Lungs

Patients with chronic lung problems have difficulty exercising. Shortness of breath is a major limitation in most patients, but in about a third, muscle fatigue is an even greater problem. Although exercise does not improve lung function, training helps many patients with chronic lung disease by helping limb muscles use oxygen effectively, thus improving endurance and reducing breathlessness.

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

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

Effects of Exercise on Asthma

People with asthma who enjoy running should consider using an indoor track, to avoid pollutants and cold winter air. Swimming is particularly beneficial for people with asthma. Yoga practice, which uses stretching, breathing, chest expansion, and meditation techniques may have specific benefits that include stress reduction as well as airway opening.

Exercise-Induced Asthma (EIA)

Exercise-induced asthma occurs when exercise triggers coughing, wheezing, or shortness of breath. It occurs most often in children and young adults and during intense exercise in cold dry air. EIA is triggered only by exercise. Unlike allergic asthma, there is no long-term increase in airway activity. People who have only EIA do not need long-term maintenance therapy. The warm-up and cool-down periods, which are important for any exercise regimen, may help reduce EIA events. EIA is not a reason to exclude people from physically demanding occupations.

Hints for Reducing EIA

EIA occurs only after exercise and is more likely to occur with regularly-paced activities in cold, dry air. The following are some suggestions for reducing the impact of EIA:

Exercise-induced asthma

Exercise-induced asthma is distinct from allergic asthma in that it does not produce a long-term increase in airway activity. People who have asthma only when they exercise may be able to control their symptoms with preventive measures, such as warm-up and cool-down exercises.

Effects of Exercise on Emphysema

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

Strengthening Exercises for the Limbs.

Exercising and strengthening the muscles in the arms and legs helps some patients improve their endurance and reduce breathlessness.

Inspiratory muscle training involves exercises and devices that make inhaling (breathing in) more difficult, in order to strengthen breathing muscles. Yoga or martial arts exercises, such as Tai chi, which emphasize breathing techniques and balanced movements, may be particularly beneficial for patients with emphysema.

How Exercise Affects Weight

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

Thirty minutes of moderate-intensity exercise may be adequate to maintain cardiovascular health, but it might not prevent weight gain. An hour or more of daily moderate exercise may be needed to promote weight loss. Children may need more activity.

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

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

Exercising without dieting still adds health benefits, maybe even lowering the death rate of overweight, unfit people. People who have trained for a long time may develop more efficient mechanisms for burning fat and are able to stay leaner.

Weight lifting and weight loss

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

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

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

How Exercise Affects Other Conditions

Benefit of regular exercise

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

Effect of Exercise on Cancer

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

Regular exercise may protect against breast cancer. Exercise can help reduce body fat, which in turn lowers levels of cancer-promoting hormones, such as estrogen. The American Cancer Society (ACS) recommends engaging in 45 to 60 minutes of physical activity at least 5 days a week.

Exercise can also help women who have been diagnosed with breast cancer and may help reduce the risk of breast cancer recurrence. Studies indicate that both aerobic and weight training exercises benefit the body and the mind, and improve quality of life for breast cancer survivors.

A sedentary lifestyle increases the risk of developing colorectal cancer. Regular exercise may help reduce risk.

Exercise also has a beneficial effect on people receiving treatment for cancer. Aerobic and resistance training can reduce fatigue in patients undergoing chemotherapy or radiation treatments for cancer. Fatigue is a common side effect of such treatments.

In patients who have completed their cancer treatments, exercise improves physical well-being and quality of life.

Effects on the Gastrointestinal Tract

Endurance athletes often report stomach problems, such as bloating, diarrhea, and gas, even at rest. Moderate regular exercise, however, might reduce the risk for some intestinal disorders. These disorders include irritable bowel syndrome, indigestion, and diverticulosis. Older people who exercise moderately may have a lower risk for severe gastrointestinal bleeding.

Effects on Neurological Diseases and Mental Decline

Studies have shown that regular exercise, particularly walking, may help reduce one's risk for memory loss or cognitive decline. Epidemiologic studies have found an association between increased exercise and slower rate of functional decline in older adults. To date, there are no clear explanations for this apparent benefit. Aerobic exercise has been linked to improved reaction time in people of all ages.

Exercise seems to improve the physical and emotional well-being of patients who already have Alzheimer disease. A little as 60 minutes each week may reduce depression, wandering, and falls.

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

Effects on Emotional Disorders

In The American Psychiatric Association's guidelines for the treatment of patients with major depressive disorder, exercise and other healthy behaviors (good nutrition, sleep hygiene, reducing use of tobacco, alcohol, and other harmful substances) are recommended for helping improve mood symptoms.

Both aerobic exercise and resistance training can help provide some improvement in mood symptoms for patients with depression. Aerobic workouts can raise chemicals in the brain, such as endorphins, adrenaline, serotonin, and dopamine that produce the so-called runner's high. Yoga practice, which involves rhythmic stretching movements and breathing, may help improve and stabilize mood. Meditation may also be helpful.

Although there is little evidence that exercise can correct major depression, studies have suggested benefits in mild-to-moderate depression in adults.


Click the icon to see an image of the benefits of flexibility exercise on body and mind.

Effect of Exercise on Pregnancy

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

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

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

To strengthen pelvic muscles, women should do Kegel exercises at least 6 times a day. This involves contracting the muscles around the vagina and urethra for three seconds 12 to 15 times in a row.

The following precautions are generally recommended for pregnant women who exercise:

Note:

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

Complications

Exercise may lead to injury. Always exercise with care. Be sure you have clear instructions on how to perform your exercises and how to use any equipment you exercise with.

Injuries from High-Impact Exercise

Competitive running or high-impact aerobics pose a high risk of a number of injuries to the bones and muscle. Injuries to knees, ankles, hips, back, shoulders, and elbows are all possible.

Preventing High-Impact Injuries

The following may be helpful for preventing injury:

Treating Minor Injuries

Most mild or moderate injuries respond well to a simple, four-step treatment: rest, ice, compression, and elevation (RICE). This combination works well for both spot injuries and chronic problems. Ice packs, which reduce inflammation and pain, can help new injuries, and can be useful for the first few hours after a chronically injured area is exercised. How much or how long to compress the injury is unclear.

Evidence suggests that early movement is helpful, although taping or bracing in people with a recurrent ankle sprain is known to be protective. It may not be helpful in those without a previous ankle injury.

Early treatment of injury

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

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

Female Athlete Triad

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

Improper Mechanics and Its Effect on the Back and Shoulders

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

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

Dehydration

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

Anyone who exercises intensely should take the following precautions:

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

Hyperthermia (Overheating)

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

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

Heat stroke

Heat stroke is the most dangerous complication of hyperthermia. The victim may suddenly stop sweating, after which symptoms such as altered consciousness, seizures, and even coma may quickly follow. Heat stroke is a medical emergency and requires immediate cooling of the victim in an ice-water bath or with ice packs. Complications from exercising in high temperatures may persist as late as the following day, even if the weather has cooled down.

Heat emergencies

Click the icon to see an image of heat emergencies.

Try these tips to help prevent heat-related illness:

Frostbite and Hypothermia

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

Get plenty of food and fluids. You need both food and fluids to fuel your body and keep you warm. If you skimp on either, you increase your risk for cold weather injuries. Eating foods with carbohydrates give you quick energy. If you are only out for a short time, you may want to carry a snack bar to keep your energy going. If you are out all day skiing, hiking, or working, be sure to also bring food with protein and fat to fuel you during many hours. Drink plenty of fluids before and during activities in the cold. You may not feel as thirsty in cold weather, but you still lose fluids through your sweat and when you breathe.

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

Motivation

Motivation for exercise

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

Differences in Motivation Between Men and Women

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

Motivating Children and Adolescents

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

Children who engage in moderate to vigorous physical activities are likely to have lower blood pressures, lower LDL (bad) cholesterol levels, and smaller waist circumferences than children who are less active. Lifestyle interventions can yield benefits for weight control and heart health.

Role of Parents

Parents must make conscious efforts to limit sedentary activities, and to encourage physical ones for their children. This includes monitoring the time children spend on the computer, in front of the TV, or playing video games. In fact, decreasing the amount of time children spend in front of a screen leads to a reduction in their body mass index (BMI), an indicator of obesity. This loss in BMI in children is the result of increased activity and reduced snacking.

Parents should suggest different forms of entertainment. Even children who aren't interested in joining a Little League team may enjoy a round of catch with their parents, walking in the park, or swimming in a local lake.

Role of Schools

Early school physical education (PE) programs can make a significant difference, and the earlier these routines are learned the more likely they will be carried forth into a healthy adulthood. There are also physical benefits to PE programs that are just now becoming known. For example, a study found that incorporating jumping exercises into an elementary school's PE program increased children's bone densities, a measure of bone strength. In general, school-based physical activity promotion programs have some positive effects on habits and health, such as reduced television viewing and lowered cholesterol. So far however, studies have not proven that these programs boost overall activity levels.

Schools should emphasize team cooperation or individual improvement and self-mastery. Studies have shown that people tend to give up more quickly and feel less competent if their perceptions of success are based only on comparison to their peers.

People mature at different rates, and there seems to be a genetic component to coordination, strength, speed, and one's response to resistance exercise. Nonetheless, everyone should strive to be as fit as they possibly can, given their strengths and limitations.

We Can! (Ways to Enhance Children's Activity & Nutrition) is a national program designed to help children live healthier lives. This program "focuses on three important behaviors: improved food choices, increased physical activity, and reduced screen time." We Can! Is a collaboration of the National Heart, Lung, and Blood Institute; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute of Child Health and Human Development; and the National Cancer Institute.

Stages for Adopting Healthy Behavior

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

Stage 1: Pre-Contemplation

People at this stage have no plans or desire to exercise. They are not even considering exercising. They are generally unaware of the specific benefits that exercise can bring -- exercise may seem more like a hassle than something worth doing. Or, they may simply have "failed" in the past and have given up.

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

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

Stage 2: Contemplation

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

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

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

Stage 3: Preparation

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

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

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

Stage 4: Action!

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

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

Stage 5: Maintenance

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

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

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

Resources

References

American Academy of Orthopaedic Surgeons. Safe Exercise. 2012. orthoinfo.aaos.org/topic.cfm?topic=A00418. September 17, 2015.

American Academy of Orthopaedic Surgeons. Sports Injury Prevention for Baby Boomers. 2011. orthoinfo.aaos.org/topic.cfm?topic=A00178. Accessed September 17, 2015.

American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Obesity Expert Panel, 2013.

Executive summary: Guidelines (2013) for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society published by the Obesity Society and American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Based on a systematic review from the The Obesity Expert Panel, 2013. Obesity (Silver Spring). 2014 Jul;22 Suppl 2:S5-39. PMID: 24961825. www.ncbi.nlm.nih.gov/pubmed/24961825.

American College of Exercise. Top 10 Signs You're Overtraining. www.acefitness.org/updateable/update_display.aspx?pageID=634. Accessed May 6, 2014.

American Diabetes Association. 3. Foundations of care and comprehensive medical evaluation. Diabetes Care. 2016 Jan;39 Suppl 1:S23-35. Review. PMID:26696676. www.ncbi.nlm.nih.gov/pubmed/26696676.

American Heart Association. American Heart Association guidelines: physical activity. Updated: 22 March, 2013. Last accessed November 2, 2013.

Anzuini F, Battistella A, Izzotti A. Physical activity and cancer prevention: a review of current evidence and biological mechanisms. J Prev Med Hyg. 2011;52(4):174-180.

Bahr R, Shimer A, Onate J, Kaminski TW. Injury prevention. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 41.

Bergland A, Thorsen H, Kåresen R. Effect of exercise on mobility, balance, and health-related quality of life in osteoporotic women with a history of vertebral fracture: a randomized, controlled trial. Osteoporos Int. 2011;22(6):1863-1871.

Blankevoort CG, van Heuvelen MJ, Boersma F, et al. Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dement Geriatr Cogn Disord. 2010;30(5):392-402.

Bookspan J. Exercise, conditioning, and performance training. In Auerbach PS, ed. Wilderness Medicine. 4th ed. Philadelphia, PA: Elsevier Mosby; 2012:1936-1951.

Buchner DM. Physical activity. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 16.

Centers for Disease Control and Prevention. How much physical activity do adults need? Last updated December 1, 2011. Available online. Last accessed November 3, 2013.

Centers for Disease Control and Prevention. Physical Activity is Essential to Healthy Aging. Updated June 4, 2015. www.cdc.gov/physicalactivity/basics/older_adults/index.htm. Accessed August 20, 2015.

Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev. 2013;2:CD007651.

Durrani SR, Busse WW. Management of asthma in adolescents and adults. In: Adkinson NF Jr., Bochner BS, Burks AW, et al., eds. Middleton's Allergy Principles and Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 55.

Ekelund U, Luan J, Sherar LB, et al. Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA. 2012;307(7):704-712.

El Abd O, Amadera JED. Low back strain or sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 48.

Fong DY, Ho JW, Hui BP, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 2012 Jan 30;344:e70. PMID: 22294757. www.ncbi.nlm.nih.gov/pubmed/22294757.

Gaziano JM, Manson JE, Ridker PM. Primary and secondary prevention of coronary heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 45.

Giangregorio LM, Macintyre NJ, Thabane L, Skidmore CJ, Papaioannou A. Exercise for improving outcomes after osteoporotic vertebral fracture. Cochrane Database Syst Rev. 2013;1:CD008618.

Gregg EW, Chen H, Wagenknecht LE, et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308(23):2489-2496. PMID: 23288372. www.ncbi.nlm.nih.gov/pubmed/23288372.

Griffin L. The female athlete. In Miller MD, Thompson SR, eds. DeLee & Drez's Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:338-355.

Halson SL, Jeukendrup AE. Does overtraining exist? An analysis of overreaching and overtraining research. Sports Med. 2004;34:967-981. PMID: 15571428. www.ncbi.nlm.nih.gov/pubmed/15571428.

Hauer K, Schwenk M, Zieschang T, Essig M, Becker C, Oster P. Physical training improves motor performance in people with dementia: a randomized controlled trial. J Am Geriatr Soc. 2012;60(1):8-15

Herring MP, Puetz TW, O'Connor PJ, Dishman RK. Effect of exercise training on depressive symptoms among patients with a chronic illness: a systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(2):101-111. PMID: 22271118. www.ncbi.nlm.nih.gov/pubmed/22271118.

Ho M, Garnett SP, Baur L, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130(6):e1647-e1671.

Iversen MD. Introduction to physical medicine, physical therapy, and rehabilitation. In Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2013:528-539.

Johnson RM, Paine R. Overview of rehabilitation protocols. In Miller MD, Thompson SR, eds. DeLee & Drez's Orthopaedic Sports Medicine. Philadelphia, PA: Elsevier Saunders; 2015:386-400.

Johnson TRB, Gregory KD, Niebyl JR. Preconception and prenatal care: part of the continuum. In: Gabbe SG, Niebyl JR, Simpson JL, et al. (eds.) Gabbe: Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, PA: Churchill Livingstone; 2007.

Kirk S. The diabetic athlete. In Miller MD, Thompson SR, eds. DeLee & Drez's Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:242-250.

Kreher JB, Schwartz JB. Overtraining syndrome: A practical guide. Sports Health. 2012;4:128-138. PMID: 23016079. www.ncbi.nlm.nih.gov/pubmed/23016079.

Kuijer PP, Verbeek JH, Visser B, et al. An evidence-based multidisciplinary practice guideline to reduce the workload due to lifting for preventing work-related low back pain. Ann Occup Environ Med. 2014;26:16. PMID 24999432. www.ncbi.nlm.nih.gov/pubmed/24999432.

Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012 Jan-Feb;62(1):30-67. PMID: 22237782. www.ncbi.nlm.nih.gov/pubmed/22237782.

Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006;144(2):73-81.

Lewiecki EM. In the clinic. Osteoporosis. Ann Intern Med. 2011 Jul 5;155(1):ITC1-1-15; quiz ITC1-16. PMID: 21727287. www.ncbi.nlm.nih.gov/pubmed/21727287.

Mikkelsson LO, Nupponen H, Kaprio J, Kautiainen H, Mikkelsson M, Kujala UM. Adolescent flexibility, endurance strength, and physical activity as predictors of adult tension neck, low back pain, and knee injury: A 25 year follow up study. Br J Sports Med. 2006;40(2):107-113.

Moyer VA; U.S. Preventive Services Task Force. Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(3):197-204.

National Institutes of Health, National Institute on Aging. Exercise and physical activity. Updated 2017. www.nia.nih.gov/health/exercise-physical-activity. Accessed August 7, 2017.

Reeves MJ, Rafferty AP, Miller CE, Lyon-Callo SK. The impact of dog walking on leisure-time physical activity: results from a population-based survey of Michigan adults. J Phys Activ Hlth. 2011;8(3):436-444.

Rimer J, Dwan K, Lawlor DA, et al. Exercise for depression. Cochrane Database Syst Rev. 2012;7:CD004366.

Rose DJ, Hernandez D. The role of exercises in fall prevention for older adults. Clin Geriatr Med. 2010;26:607-31. PMID: 20934613. www.ncbi.nlm.nih.gov/pubmed/20934613.

Schnohr P, Marott JL, Lange P, Jensen GB. Longevity in male and female joggers: The Copenhagen City Heart Study. Am J Epidemiol. 2013;177:683-689. PMID 23449779. www.ncbi.nlm.nih.gov/pubmed/23449779.

Svege I, Nordsletten L, Fernandes L, Risberg MA. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial. Ann Rheum Dis. 2015 Jan;74(1):164-9. Epub 2013 Nov 19. PMID: 24255546. www.ncbi.nlm.nih.gov/pubmed/24255546.

Thompson PD, Baggish A. Exercise and sports cardiology. In: Mann DL, Zipes DP, Libby P, Bonow RO. eds. Braunwald's heart disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2015:1771-1778.

Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305(17):1790-1799.

Ussher MH, Taylor A, Faulkner G. Exercise interventions for smoking cessation. Cochrane Database of Systematic Reviews. 2012;1:CD002295.

Vaccarino V, Bremner JD. Psychiatric and behavioral aspects of cardiovascular disease. In Mann DL, Zipes DP, Libby P, Bonow RO, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:1876-1889.

Weiler JM, Anderson SD, Randolph C, et al. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol. 2010;105(6 Suppl):S1-S47. PMID: 21167465. www.ncbi.nlm.nih.gov/pubmed/21167465.

Whellan DJ, Nigam A, Arnold M, et al. Benefit of exercise therapy for systolic heart failure in relation to disease severity and etiology-findings from the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise Training study. Am Heart J. 2011;162(6):1003-1010.

Williams DM, Ussher M, Dunsiger S, et al. Overcoming limitations in previous research on exercise as a smoking cessation treatment: rationale and design of the "Quit for Health" trial. Contemp Clin Trials. 2014;37(1):33-42.


Review Date: 5/11/2016
Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Editorial update 8/07/2017.
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