STARTING AN EXERCISE PROGRAM

STARTING AN STARTING AN EXERCISE EXERCISE PROGRAMPROGRAM

Mary Ann Burke, P.T., M.S., Mary Ann Burke, P.T., M.S., G.C.S.G.C.S.

BENEFITS OF EXERCISEBENEFITS OF EXERCISE

Weight ControlWeight Control Combat Health Combat Health

Conditions & Conditions & DiseaseDisease

Improve Improve Psychological Psychological Well-BeingWell-Being

Boost EnergyBoost Energy Improve SleepImprove Sleep

WEIGHT CONTROLWEIGHT CONTROL Non-Dieting/Non-Dieting/

Overweight Overweight Controls gained weightControls gained weight Low-amount exercise Low-amount exercise

groups lost weight/fatgroups lost weight/fat High-amount exercise High-amount exercise

group lost more of each group lost more of each in a dose-response in a dose-response mannermanner

Slentz CA, et al. Effects of the amount of Slentz CA, et al. Effects of the amount of exercise on body weight, body composition, exercise on body weight, body composition, and measures of central obesity: STRRIDE-a and measures of central obesity: STRRIDE-a randomized controlled study. Arch Intern randomized controlled study. Arch Intern Med 2004 Jan;164(1):31-9Med 2004 Jan;164(1):31-9

BLOOD PRESSUREBLOOD PRESSURE A single episode of A single episode of

exercise reduces BP in exercise reduces BP in hypertensive subjectshypertensive subjects

Regular aerobic Regular aerobic exercise reduces BP in exercise reduces BP in hypertensive subjects.hypertensive subjects.

No proof of resistance No proof of resistance training reducing BPtraining reducing BP

Cardoso, CG, et al. Acute and chronic effects of Cardoso, CG, et al. Acute and chronic effects of aerobic and resistance exercise on ambulatory aerobic and resistance exercise on ambulatory blood pressure in normotensive and blood pressure in normotensive and hypertensive subjects. Clinics 2010 hypertensive subjects. Clinics 2010 Mar;65(3):317-25Mar;65(3):317-25

TYPE 2 DIABETESTYPE 2 DIABETES

Structured interventions combining Structured interventions combining exercise and weight loss have been exercise and weight loss have been shown to lower type 2 diabetes by up to shown to lower type 2 diabetes by up to 58% in high risk populations.58% in high risk populations.

Most benefits of physical activity on Most benefits of physical activity on diabetes management are realized diabetes management are realized through acute and chronic improvements through acute and chronic improvements in insulin action, accomplished with both in insulin action, accomplished with both aerobic and resistance training.aerobic and resistance training.

Colberg SR, et al. Exercise and type 2 diabetes. Diabetes Care 2010 Dec;33(12):e147-Colberg SR, et al. Exercise and type 2 diabetes. Diabetes Care 2010 Dec;33(12):e147-6767

CANCERCANCER

66% of cancer mortality in the USA can 66% of cancer mortality in the USA can be linked to tobacco use, poor diet and be linked to tobacco use, poor diet and lack of exercise.lack of exercise.

Moreover, only 5-10% of most types of Moreover, only 5-10% of most types of cancer are caused by defects in single cancer are caused by defects in single genes that run through families, and genes that run through families, and only a similar small percentage are only a similar small percentage are because of occupational and because of occupational and environmental factors.environmental factors.

Havard Report on Cancer Prevention. Vol. 1: Causes of Human Cancer. Cancer Havard Report on Cancer Prevention. Vol. 1: Causes of Human Cancer. Cancer Causes Control 1996Causes Control 1996

CANCERCANCER

Mounting evidence indicates Mounting evidence indicates that exercise may significantly that exercise may significantly reduce the risk of some cancers.reduce the risk of some cancers. The strongest evidence comes from The strongest evidence comes from

research on colon cancer, where research on colon cancer, where physical activity has been shown to physical activity has been shown to reduce the risk by up to 50%.reduce the risk by up to 50%.

Shepard RJ & Shek PN. Associations between physical activity and Shepard RJ & Shek PN. Associations between physical activity and susceptibility to cancer. Sports Med 1998;26:293-315. susceptibility to cancer. Sports Med 1998;26:293-315.

OSTEOPOROSISOSTEOPOROSIS

A number of studies with A number of studies with postmenopausal women have postmenopausal women have shown that exercise can increase shown that exercise can increase bone density or prevent further bone density or prevent further bone loss when compared to non-bone loss when compared to non-exercise controls.exercise controls.

Dalsky GP, Stocke KS, & Ehsani AA, et al. Weight bearing exercise training and Dalsky GP, Stocke KS, & Ehsani AA, et al. Weight bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med lumbar bone mineral content in postmenopausal women. Ann Intern Med 1988;108:824-28.1988;108:824-28.

IMPROVE IMPROVE PSYCHOLOGCAL WELL-PSYCHOLOGCAL WELL-

BEINGBEING Exercise is a lifestyle Exercise is a lifestyle

that leads to that leads to improved physical improved physical and mental health and mental health throughout life.throughout life.

Hillman CH, et al. Be smart, exercise your heart: Hillman CH, et al. Be smart, exercise your heart: exercise effects on brain and cognition. Nat Rev exercise effects on brain and cognition. Nat Rev Neurosci 2008 Jan;9(1):58-65Neurosci 2008 Jan;9(1):58-65

DEPRESSIONDEPRESSION

Although antidepressant Although antidepressant medication may facilitate a more medication may facilitate a more rapid initial therapeutic response rapid initial therapeutic response than exercise, after 16 weeks of than exercise, after 16 weeks of treatment, exercise was equally treatment, exercise was equally effective in reducing depression effective in reducing depression among patients with major among patients with major depressive disorder.depressive disorder.

Blumenthal JA, et al. Effects of exercise training on older patients with major Blumenthal JA, et al. Effects of exercise training on older patients with major depression. Arch Intern Med. 1999 Oct 25;159(19):2349-56.depression. Arch Intern Med. 1999 Oct 25;159(19):2349-56.

MEMORYMEMORY Study on 120 older adults, half of whom Study on 120 older adults, half of whom

started a program of moderate aerobic started a program of moderate aerobic exercise.exercise.

After 1 year, MRI scans showed that the After 1 year, MRI scans showed that the brains of subjects who exercised brains of subjects who exercised increased their volume, while non-increased their volume, while non-exercising subjects brains lost up to 1.5% exercising subjects brains lost up to 1.5% of their volume.of their volume.

Further testing showed that increased Further testing showed that increased brain volume translated into better brain volume translated into better memory.memory.

NPR Report of a study by researcher Art Kramer.NPR Report of a study by researcher Art Kramer.

BOOST ENERGYBOOST ENERGY

Sedentary people Sedentary people who completed a who completed a regular exercise regular exercise program reported program reported improved energy improved energy levels compared to levels compared to groups that did not groups that did not exercise.exercise.

Puetz T. News release of a study review from the Puetz T. News release of a study review from the University of Georgia, 2006.University of Georgia, 2006.

IMPROVE SLEEPIMPROVE SLEEP

Exercise is a Exercise is a healthy, safe, healthy, safe, inexpensive, and inexpensive, and simple means of simple means of improving sleep.improving sleep.

Youngstedt SD. Effect of exercise on sleep. Clin Youngstedt SD. Effect of exercise on sleep. Clin Sports Med 2005 Apr;24(2):355-6Sports Med 2005 Apr;24(2):355-6

DEFINITIONSDEFINITIONS Aerobic/Cardiovascular Aerobic/Cardiovascular

ActivityActivityExercises that speed up Exercises that speed up

breathing and heart ratebreathing and heart rateRunning, Cycling, Running, Cycling, Walking, Swimming, Walking, Swimming, DancingDancing

Typically performed for Typically performed for long durationslong durations

DefinitionsDefinitions

Heart Rate (HR)Heart Rate (HR) Measured in beats per minute Measured in beats per minute

(BPM)(BPM)

Rate of Perceived Exertion (RPE)Rate of Perceived Exertion (RPE) A measure of how hard you’re A measure of how hard you’re

workingworking Rated on a Borg ScaleRated on a Borg Scale

Borg ScaleBorg Scale 6 – 20% effort6 – 20% effort 7 – 30% effort – Very, very light (Rest)7 – 30% effort – Very, very light (Rest) 8 – 40% effort8 – 40% effort 9 – 50% effort – Very light (Gentle 9 – 50% effort – Very light (Gentle

walking)walking) 10 – 55% effort10 – 55% effort 11 – 60% effort11 – 60% effort 12 – 65% effort12 – 65% effort 13 – 70% effort – Somewhat hard – steady 13 – 70% effort – Somewhat hard – steady

pacepace 14 – 75% effort14 – 75% effort 15 – 80% effort – Hard15 – 80% effort – Hard 16 – 85% effort16 – 85% effort 17 – 90% effort – Very Hard17 – 90% effort – Very Hard 18 – 95% effort18 – 95% effort 19 – 100% effort – Very, very hard19 – 100% effort – Very, very hard 20 - Exhaustion20 - Exhaustion

DefinitionsDefinitions

Flexibility Training/StretchingFlexibility Training/StretchingEnhances range of motion of Enhances range of motion of

jointsjoints

DEFINITIONSDEFINITIONS Strength/Resistance Strength/Resistance

TrainingTraining Improve strength and Improve strength and

function of musclesfunction of muscles Weight lifting, Resistance bandsWeight lifting, Resistance bands Body weight (push-ups, squats)Body weight (push-ups, squats)

SetSet Repeating the same exercise a Repeating the same exercise a

certain # of timescertain # of times RepetitionRepetition

Number of times an exercise Number of times an exercise is performed during a setis performed during a set

DEFINITIONSDEFINITIONS Warm UpWarm Up

Preparing for the stress of Preparing for the stress of exerciseexercise

Light intensity aerobic activityLight intensity aerobic activity Increase blood flow and heat up Increase blood flow and heat up

musclesmuscles

Cool DownCool Down Less strenuous exercise after Less strenuous exercise after

more intense workoutmore intense workout Slow down breathing and heart Slow down breathing and heart

raterate Stretching Stretching

BASIC TRAINING BASIC TRAINING GUIDELINESGUIDELINES

(ACSM/Centers for Disease Control and (ACSM/Centers for Disease Control and Prevention)Prevention)

Warm UpWarm UpReduce the risk of Reduce the risk of

injuryinjury10-15 minutes10-15 minutesAll major joints and All major joints and

muscles should be muscles should be engagedengaged

Walking, stretching, Walking, stretching, calisthenicscalisthenics


(ACSM/Centers for Disease Control and (ACSM/Centers for Disease Control and Prevention)Prevention) Aerobic TrainingAerobic Training

Frequency: 4-7 days/weekFrequency: 4-7 days/week Intensity: RPE 12-14Intensity: RPE 12-14 Duration: 10-60 minutesDuration: 10-60 minutes Mode: Aerobic activitiesMode: Aerobic activities Progression: Progression:

Phase 1: 6 weeks, low Phase 1: 6 weeks, low intensityintensity

Phase 2: 6 months, gradual Phase 2: 6 months, gradual increaseincrease

Phase 3: MaintenancePhase 3: Maintenance


(ACSM/Centers for Disease Control and (ACSM/Centers for Disease Control and Prevention)Prevention) Strength TrainingStrength Training

Frequency: 2-3 days/week Frequency: 2-3 days/week 48 hrs of rest between48 hrs of rest between

Intensity: RPE of 12-14Intensity: RPE of 12-14 Repetitions: 15Repetitions: 15 Sets: 1-3Sets: 1-3 Rest: 90-120 seconds Rest: 90-120 seconds

between setsbetween sets Progression: RPE of 12-14 Progression: RPE of 12-14

reassessed every 2-4 weeksreassessed every 2-4 weeks


(ACSM/Centers for Disease Control and (ACSM/Centers for Disease Control and Prevention)Prevention) Flexibility TrainingFlexibility Training

Frequency: 2-7 days/weekFrequency: 2-7 days/week Intensity: Range gently Intensity: Range gently

increased in each positionincreased in each position Mild muscular tension, not Mild muscular tension, not

painpain Duration: Position held for Duration: Position held for

5-40 sec5-40 sec Repetitions: 1-5 per stretchRepetitions: 1-5 per stretch Progression: Develop fuller Progression: Develop fuller

ranges naturally with time ranges naturally with time and practiceand practice


(ACSM/Centers for Disease Control and (ACSM/Centers for Disease Control and Prevention)Prevention)

Cool DownCool Down Reduce the risk of Reduce the risk of

injuryinjury 10-15 minutes10-15 minutes Slowed down Slowed down

movementsmovements Continue until Continue until

heart rate is < 100 heart rate is < 100 bpmbpm

LAND BASED LAND BASED EXERCISE PROGRAMSEXERCISE PROGRAMS

Gym ProgramsGym ProgramsAerobic and Aerobic and

strengthening strengthening equipmentequipment

Exercise classesExercise classesAreas for Areas for

stretchingstretchingTrainersTrainers

LAND BASED LAND BASED EXERCISE PROGRAMSEXERCISE PROGRAMS HomeHome

Exercise EquipmentExercise Equipment TreadmillTreadmill Stationary BikeStationary Bike WeightsWeights Exercise BallExercise Ball DVD’sDVD’s

WalkingWalking BikingBiking HikingHiking

POOL EXERCISE POOL EXERCISE PROGRAMSPROGRAMS

Aqua-kinetics/Aqua-Aqua-kinetics/Aqua-aerobicsaerobics

Group exerciseGroup exercise SwimmingSwimming

FIVE TIPS TO FIVE TIPS TO HELP YOU GET HELP YOU GET

STARTEDSTARTED

1. Assess Your Fitness 1. Assess Your Fitness LevelLevel

Consult with your Consult with your physicianphysician

Record BaselinesRecord Baselines Heart rate before and after Heart rate before and after

walking 1 milewalking 1 mile Time to walk 1 mileTime to walk 1 mile # of push-ups# of push-ups Forward reachForward reach Waist circumferenceWaist circumference Body Mass Index (BMI)Body Mass Index (BMI)

2. Design Your Fitness 2. Design Your Fitness ProgramProgram

Set goalsSet goals Balanced routineBalanced routine

Aerobic activityAerobic activity 150 minutes of moderate 150 minutes of moderate

intensity or 75 minutes intensity or 75 minutes of vigorous activity per of vigorous activity per weekweek

Strength trainingStrength training 2 or more days/week2 or more days/week

Go at your own paceGo at your own pace Schedule timeSchedule time

2. Design Your Fitness 2. Design Your Fitness ProgramProgram

Include different Include different activitiesactivities

Keep boredom at bayKeep boredom at bay Decrease risk of injuryDecrease risk of injury Emphasize different Emphasize different

body partsbody parts Allow time for Allow time for

recoveryrecovery Put it on paperPut it on paper

3. Assemble Your 3. Assemble Your EquipmentEquipment

Athletic shoesAthletic shoes Pick shoes designed for Pick shoes designed for

the activity in mindthe activity in mind Pick shoes that are right Pick shoes that are right

for your footfor your foot Choosing EquipmentChoosing Equipment

PracticalPractical EnjoyableEnjoyable Easy to UseEasy to Use

4. Get Started4. Get Started

Start slowly, build graduallyStart slowly, build gradually Warm up and cool downWarm up and cool down Speed up to a pace you can Speed up to a pace you can

continue for 10 mincontinue for 10 min Gradually increase amount of Gradually increase amount of

timetime Work up to 30-60 min of exerciseWork up to 30-60 min of exercise

Break things upBreak things up Shorter but more frequent Shorter but more frequent

exercise has aerobic benefits exercise has aerobic benefits tootoo

4. Get Started4. Get Started Be CreativeBe Creative

Include various Include various activities (walking, activities (walking, cycling, rowing)cycling, rowing)

Take a weekend hikeTake a weekend hike Evening dancingEvening dancing

Listen to your bodyListen to your body If you feel pain, If you feel pain,

shortness of breath, shortness of breath, dizziness, nausea, take dizziness, nausea, take a breaka break

Be flexibleBe flexible Give yourself Give yourself

permission to take a day permission to take a day offoff

5. Monitor Your Progress5. Monitor Your Progress

ReassessReassess6 weeks after you 6 weeks after you

startstartEvery 3-6 monthsEvery 3-6 months

You may need to You may need to increase exercise increase exercise time to keep making time to keep making fitness gainsfitness gains

SAFETY!!!SAFETY!!! Don’t over exert yourselfDon’t over exert yourself

4-6 weeks of light intensity, 4-6 weeks of light intensity, then increasethen increase

Develop the habitDevelop the habit Develop a schedule and stick to Develop a schedule and stick to

itit Make adjustmentsMake adjustments

Listen to your bodyListen to your body If you feel pain, shortness of If you feel pain, shortness of

breath, dizziness, STOP.breath, dizziness, STOP. Moderately challenging but Moderately challenging but

tolerabletolerable

Common Exercise Common Exercise InjuriesInjuries

• Shoulder Pain/Rotator Cuff Shoulder Pain/Rotator Cuff TendonitisTendonitis• Discrepancy between Discrepancy between

overworking the power overworking the power muscles of the shoulder at the muscles of the shoulder at the expense of the smaller rotator expense of the smaller rotator cuff musclescuff muscles• Chest and incline pressChest and incline press• Overhead pressOverhead press• Lateral raisesLateral raises


• Back and Neck PainBack and Neck Pain• Improper weight lifting techniqueImproper weight lifting technique• Overloaded compressive forcesOverloaded compressive forces• Weak musculatureWeak musculature• Poor posturePoor posture

• Jarring activitiesJarring activities• Exercises that compress the Exercises that compress the spinespine

• Flexion/extension machinesFlexion/extension machines


• Elbow Pain/Golfer’s Elbow/Tennis Elbow Pain/Golfer’s Elbow/Tennis ElbowElbow

• Gripping & pulling a load that is Gripping & pulling a load that is too heavytoo heavy

• Improper lifting technique (wrist Improper lifting technique (wrist motion)motion)• Cable pull downsCable pull downs• RowsRows• Biceps curlsBiceps curls• Triceps extensionTriceps extension


• Plantar Fasciitis/Achilles' Plantar Fasciitis/Achilles' TendinitisTendinitis• Improper foot wearImproper foot wear• Weak hip musculatureWeak hip musculature• Over trainingOver training• RunningRunning• Inclined Walking/HikingInclined Walking/Hiking• JumpingJumping


• Knee PainKnee Pain• Anterior knee painAnterior knee pain• TendinitisTendinitis• Meniscus tearMeniscus tear• ArthritisArthritis

• Deep squatsDeep squats• Knee extension Knee extension • Bias toward quadriceps Bias toward quadriceps

strengtheningstrengthening• Neglecting hamstrings and hip Neglecting hamstrings and hip

abductorsabductors

Treatment Strategies for Treatment Strategies for Minor InjuriesMinor Injuries

• Decrease exercise intensityDecrease exercise intensity

• Make sure all 3 components are Make sure all 3 components are presentpresent• CardiopulmonaryCardiopulmonary• StrengtheningStrengthening• FlexibilityFlexibility

Treatment Strategies for Treatment Strategies for Minor InjuriesMinor Injuries

• Ice affected area 10-15 min/2-3 Ice affected area 10-15 min/2-3 x dayx day

• If swelling is involved…RICEIf swelling is involved…RICE• RestRest• IceIce• CompressionCompression• ElevationElevation

Treatment Strategies Treatment Strategies for More Severe for More Severe

InjuriesInjuries

• PhysicianPhysician• Physical TherapistPhysical Therapist• Orthopedic SpecialistOrthopedic Specialist

HAVE FUN!HAVE FUN!

STARTING AN EXERCISE PROGRAM

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