Saturday, June 13, 2009

New exercise guidelines: Don't just sit there, do something!

AN APPLE A DAY By Tyrone M. Reyes, M.D.

Exercise: It’s cheap, readily available, and the single most effective step people can take to avoid chronic and potentially fatal diseases. If it were being hawked on late-night TV, you’d think the phone lines would be tied up for hours.

But regular physical activity remains a hard sell. Despite mounting evidence that it lowers the risk for obesity, heart disease, diabetes, depression, and many forms of cancer, the average citizen has become increasingly sedentary. So the US Department of Health and Human Services (HHS) convened an expert committee in 2007 to evaluate the scientific evidence on the benefits of physical activity. It was the first thorough review of scientific research about physical activity and health in more than a decade and the committee spent nearly a year studying the data. They submitted their findings, and late last year, the US government issued a detailed exercise prescription for its citizens, the first ever by the federal government.

Miriam Nelson, PhD, director of the John Hancock Center for Physical Activity and Nutrition in Boston, and who served as vice chair of the expert panel, says, “It was so thorough, and we found so much evidence of the benefits of physical activity.” She adds, “It’s hard to believe more people don’t realize this. People have to wake up.” Nelson summarizes, “Any activity is better than nothing. That’s the really important message.”

The Exercise Ground Rules

The 2008 Physical Activity Guidelines ( are more extensive than most of those from other health organizations. While assuring us that a couple of hours a week of moderate physical activity provide important health benefits, the new guidelines also stress that more is indeed better — finding added benefit from exercising longer and doing so with greater intensity. As Dr. I-Min Lee of Harvard University, a member of the panel, puts it, “Any physical activity one can do is good, but more is better.” The guidelines are also more inclusive. They apply not just to the average adult but to almost everyone, age six and over — children, adolescents, pregnant women, seniors, and people with chronic diseases and disabilities.

Adults, whether 18 or 81, are urged to get no less than 150 minutes (two and a half hours) of moderate activity or 75 minutes (one hour and 15 minutes) of vigorous activity — or some combination of the two — each week (see chart). Sessions should last at least 10 minutes and be spread evenly through the week. Among the moderate exercise options are walking, water aerobics, ballroom dancing, golfing without a cart, and gardening. Vigorous activities include racewalking, jogging, running, swimming laps, and hiking. For more extensive benefits, healthy adults should increase their aerobic activity to five hours a week.

Adults are advised to fit in two weekly sessions of strength training as well. The authors urge even people with medical conditions to meet these standards, though they acknowledge this may require a gradual buildup. Children and adolescents should be getting even more than adults: at least an hour a day (420 minutes per week), including both aerobic activity and exercise that builds muscle and bone.

The guidelines also distinguish between different levels of physical activity. For example, for most middle-aged adults, moderate-intensity aerobic exercise is comparable to walking three to five miles an hour; vigorous exercise is anything higher. Or on a zero to 10 scale, with zero as the amount of activity involved in sitting, and 10 as the effort of running at top speed, moderate exercise begins at five and vigorous exercise at seven. Perhaps the simplest way to distinguish moderate from vigorous exercise is by trying to speak as you work out: If you can talk while working out but have a hard time singing, you’re exercising moderately; if you find it difficult even to talk, that’s vigorous.

Strength training should involve all the major muscle groups of the legs, hips, back, chest, stomach, shoulders, and arms. You should repeat each exercise for each muscle groups eight to 12 times. Many aerobic activities also provide strength: For example, race-walking strengthens legs and hips; rowing builds muscles in the arms, legs, chest, and shoulder.

How Much Is Enough?

Go beyond the basics if you can, say the new guidelines. Once you’re routinely logging the recommended levels of aerobic activity, start to add a few minutes a day. (Ramping up slowly reduces the likelihood of injury.) The HHS committee found that you can get even greater health benefits and more effective weight control when you reach twice the recommended weekly amount — that is, 300 minutes of moderate activity, 150 minutes of vigorous activity, or a combination of the two. More than that may be even better.

Get Going

Anyone who’s followed a regular exercise regimen knows that the hardest part is getting started. Often, it takes a wake-up call, whether that’s a heart attack or just the inability to zip your favorite skirt or pants. If you need a nudge but don’t want to wait for an unwelcome event, the President’s Council on Physical Fitness and Sports (PCPFS) has a tool that might help — the Adult Fitness test. The PCPFS is an instrument that adults can use to determine how fit they are in terms of aerobic capacity, muscle strength, and stretching exercise. If you’re unpleasantly surprised, the PCPFS offers some pointers to improve your score. The test can be downloaded at

The American College of Sports Medicine (ACSM) has developed two interactive questionnaires to help provide you with a realistic basis for establishing a routine. The first, a health assessment form, helps you gauge the factors that might pose risks or limit your ability to exercise. You can print out the results and share them with your doctor. The second questionnaire helps identify attitudes or habits that could undermine your resolve and generates personalized advice for overcoming them. Because research confirms that people with well-designed programs and goals are more likely to succeed, the ACSM also offers printable, customizable planning forms, an exercise time scheduler, a goal setter, and a form you sign pledging to make exercise a ritual. All are available at

Tips to Help You Get Active, from the National Institute of Diabetes and Digestive and Kidney Diseases, is a 24-page guide that could be subtitled “No More Excuses.” It offers helpful suggestions for overcoming just about every barrier to exercise you can think of — psychological, physical, or environmental. The guide is available at

Keep At It

If you find that sticking to a regimen is at least as challenging as starting one, several free offerings from health organizations may help you stay on board:

• Be Active Your Way is a quick reference for ways to incorporate the 2008 HHS activity recommendations into your life. The advice isn’t new, but it’s presented in an accessible and easy-to-follow way. You can order or download this booklet from the HHS guidelines web site:

• “Keys to Exercise,” a video series produced by the ACSM and the American Heart Association, presents exercises that help improve strength, flexibility, and endurance. To reinforce the message that you don’t have to go anywhere special to stay fit, many of these exercises are performed at home and require no special equipment. The videos can be viewed on your home computer, just go to www.exerciseismedicine. org/KeystoExercise.htm.

• Exercise: A Guide from the National Institute on Aging (NIA), dedicated to people over 65, emphasizes that our bodies don’t transcend the need for exercise when we get old. The 82-page guide does recognize and explain the changes that come with age, and it provides appropriate exercise programs, including suggestions for people with joint replacements, people who find it difficult to perform exercises on the floor, and people taking beta blockers (which can slow heart rate).

Whatever your situation, though, the first step is to get moving. “Being completely sedentary is the most risky,” Nelson says. “So do anything. I’m dead serious. Think, ’What’s the one activity I enjoy’ or ‘What activity do I detest the least?’ Then do it!”

The message is clear: Don’t just sit there, do something!

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