Can exercise make children smarter?  Researchers think there is a link.  In a cross-sectional study, published in the January 2009 issue of the Journal of School Health, researchers investigated the relationship between fitness levels and academic performance of children, in grades four through eight, from the Cambridge Public School District in Massachusetts.  Data from the 2004-2005 school year regarding students' standardized test scores, fitness levels and Body Mass Index (BMI) values were evaluated.  

     Academic performance was measured using the Massachusetts Comprehensive Assessment System (MCAS) achievements tests in Mathematics and English.  Physical fitness was assessed from standardized fitness tests (cardiovascular endurance, abdominal strength, flexibility, upper body strength, and agility) adapted from the Amateur Athletic Union (www.presidentschallenge.org/educators/program_details/physical_fitness_test.aspx) and Fitnessgram (www.cooperinst.org/products/grams/index.cfm) guidelines.  

     They found that there was a significant positive relationship between fitness levels and math and english scores achieved on the MCAS when gender, race, BMI, socioeconomic status, and grade level were held constant.  The relationship was strongest between mathematics and fitness achievement.  The odds of passing the math portion of the MCAS increased by 38% for each one-unit increase that occurred in the number of fitness tests passed by the students.  Although a weaker association was evident for the english portion of the MCAS, it was still statistically significant.  The researchers found that the odds of a student passing this portion increased by 24% for each one-unit increase in the number of fitness tests passed.

     The researchers do not know why a stronger relationship exists between fitness and math performance than that between fitness and english.  They also note that the role fitness plays in enhancing academic performance is not yet fully understood.  However, they offer some probable factors.  First, a child's level of motivation may play a role.  The assummption is that a highly motivated child is more likely to strive to excel in both academics and athletics or other fitness-related activities.  Second, they suggest that the overall health (appropriate weight for age, better nutritional status, and participation in physical activity) of the child may be a factor.  The researchers also indicate that better fitness may lead to better concentration and behavior in the classroom resulting in greater academic achievement.  Another possible factor is the association between physical activity and improved mental health.  It is possible that if a child is more relaxed it would have a positive effect on his/her performance in school.  Lastly, the researchers suggest that physical activity may affect how the brain functions, improving cognitive function (refer to my posting "Fit Body, Fit Brain").

     Although the researchers acknowledge that further research is needed to gain greater insight into the relationship between exercise and academic performance, they contend that their findings have great implications for both the school and home setting.  They suggest that school officials should consider ways to integrate physical activity into the school day, whether it be through increasing time spent in physical education classes and/or time on the playground during recess.  Parents/caregivers should consider ways to incorporate physical activity either before or after the school day.

Resources:

Chomitz VR, Slining MM, McGowan RJ, Mitchell SE, Dawson GF, Hacker KA. Is there a relationship between physical fitness and academic achievement? Positive results from public school children in the northeastern United States. J SCH Health.2009;79:30-37.

     Exercise makes sense, literally.  There is a growing body of evidence, from both human and animal studies, that routine aerobic exercise can boost brain power.  Cognitive decline was once thought to be inevitable as one aged.  Over recent years, however, investigators are discovering that regular exercise is associated with a reduced risk for and/or delayed onset of dementia in the aging population.  It appears that acquiring "brain fitness" is possible and is as important as achieving cardiovascular fitness for optimal health and well-being in the later years.

     According to Janet Fletcher Brady, M.S. Director of Medical Programs for LifeSpan (www.lifespanfitness.com), and cofounder/developer of Fitness Forever (www.fitnessforever.com/), "Age doesn't matter.  It is what you do as you age that has a big impact."  Living a healthy lifestyle overall, such as not smoking (smoking restricts blood flow and oxygen supply to the brain thereby impairing brain function), maintaining a healthy body weight, consuming a well-balanced diet that consists of antioxidant rich fruits and vegetables and foods rich in Omega 3's, engaging in intellectually challenging activities (crossword puzzles), and participating in regular physical activity preserve brain function.

     It has been long known and well established that routine exercise is good for the cardiovascular system and chronic disease prevention.  Now there is enough research to support its role in promoting brain health.  "What is good for the heart is great for the brain" states Brady.  "Exercise improves [blood] circulation which improves oxygen circulation, penetration, and pick-up at the cellular level" explains Brady.

     Starting around the third decade of life, decreases in the brain's gray and white matter occur which impair function and result in cognitive decline.  Age-related changes are greatest in the frontal, parietal, and temporal lobes of the brain.  These areas are responsible for the brain's "executive control."  "Executive control" refers to those tasks that entail complex thought and attention.  These areas of the brain function so that you can formulate plans of action, coordinate tasks, switch between tasks, disregard irrelevant information, and retain and process information over a short period of time (working memory).  Declines in the "executive control" processes of the brain threaten independent living in the later years.  Fortunately, research has found that these areas of the brain are spared the greatest as a function of aerobic fitness.

     A study on "Ageing, Fitness and Neurocognitive Function" conducted by Kramer et al. and published in the July 29, 1999 issue of Nature, found that aerobic training in previously inactive adults (ages 60-75 years) led to significant improvements in performance on tasks that relied on the "executive control" processes of the brain.  In another study, conducted by Colcombe et al. and published in The Journals of Gerontology Series A: Biological Sciences and Medical Sciences (58:M176-M180 [2003]), the researchers found that declines in brain tissue density were greatly reduced as a function of cardiovascular fitness when they assessed fitness levels of 55 adults (mean age 66.5 years) and compared their high-resolution magnetic resonance imaging brain scans.  In a subsequent study conducted by Colcombe et al., the investigators found that brain volume increased, particularly in the prefrontal and temporal areas of the brain (those most affected by age), as a result of aerobic fitness training.

     Researchers are still investigating the mechanism by which aerobic exercise leads to improvements in brain function in humans.  However, based on the findings of research conducted on animals, aerobic training appears to lead to the formation of new neurons (brain cells) and blood vessels as well as increases in the number of synaptic connections and levels of neurotransmitters and nerve growth factors.

     Although any form of aerobic activity is better than none, Brady explains that certain types of physical exercise are best for optimal "brain fitness."  First, exercises that incorporate cross-lateral movements (those that cross the midline of your body) are best.  These movements lead to an increase in blood flow to all areas of the brain and result in an increase in the number of synaptic connections formed in the brain.  Second, activities that include "cued-movements" (actions performed after being prompted by a signal or cue to move, such as with an instructor led aerobic dance class) are beneficial.  These help to focus attention.  Your mind needs to be actively engaged in order to retain information.  Brady also states that any physical activity that requires you to develop a new skill is important to enhance brain function.

     So what does this mean  for your exercise routine?  Brady says to "Exercise smarter.  Break-out, don't be repetitive.  Add brain-based activity that involves cross-lateral and cued-exercise movements to your routine."  If you are a runner, for example, add a few sessions per week of aerobic dance class or other exercises that incorporate the above brain boosting movements.  Following these recommendations will not only lead to a fit body, but a fit brain.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

Phone Interview March 25, 2009 with Janet Fletcher Brady, M.S., Director of Medical Programs for LifeSpan (www.lifespanfitness.com); (www.fitnessforever.com/)

ACSM's Health & Fitness Journal March/April 2009 (13)2:27-31; "Exercising the Brain", Brady, J.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 58:M176-M180 (2003) "Aerobic Fitness Reduces Brain Tissue Loss in Aging Humans", Colcombe, S.J. et al.

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61:1166-1170 (2006) "Aerobic Exercise Training Increases Brain Volume in Aging Humans", Colcombe, S.J. et al.

Nature 400, 418-419 (29 July 1999) "Ageing, Fitness and Neurocognitive Function", Kramer, A.F. et al.

Proceedings of the National Academy of Sciences of the United States of America, 2004 March 2; 101(9): 3316-3321, "Cardiovascular Fitness, Cortical Plasticity, and Aging", Colcombe, S.J., et al.

"Nutrition and Brain Function: Food for the Aging Mind", USDA Agricultural Research Service (www.ars.usda.gov/is/AR/archive/aug07/aging0807.htm)

     

     Musculoskeletal injuries can occur during exercise if you are not careful.  Common injuries include strains, sprains, and broken bones.  The risk increases when you engage in a new level of activity (intensity) to which your body is unaccustomed.  Your baseline fitness level, as well as the total amount of exercise you perform, play a role.  For instance, if you have been previously inactive or are a "weekend-only" exerciser, your risk is greater than someone who has been consistently exercising for years.  However, engaging in excessive amounts of exercise increases the likelihood of developing overuse injuries such as stress fractures.  Participation in contact forms of exercise, such as football, increases your risk as well.  In addition, switching to a mode of exercise that requires different skill and muscle involvement from your current program predisposes you to injury. 

How can you reduce your risk for exercise-related musculoskeletal injuries?

• Exercise on a regular basis to develop a solid foundation of fitness.
  
• Start and end each exercise session with a proper warm-up and cool-down, respectively (refer to my postings in the February Archives on Warming-Up and Cooling-Down).
  
• Choose activities that are appropriate for current fitness and skill level.
• Gradually increase the duration and intensity level to allow your muscles and cardiovascular system to adapt to the new activity.
  
• Engage in a variety of exercises (cross-train) to reduce overuse injuries.  For instance, alternate days of low-impact activities (bicycling) with days of high-impact activities (running).
  
• Wear appropriate exercise/protective gear for the activity such as helmets, pads, guards, goggles/eyewear, and footwear.
  
• Check to make sure sports/exercise equipment is in working order and free of broken/worn parts.
  
• Avoid exercise environments that have not been maintained or that have an uneven terrain (e.g. playing fields with holes).
  

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

American Academy of Orthopaedic Surgeons/American Association of Orthopaedic Surgeons  www.aaos.org/

2008 Physical Activity Guidelines for Americans www.health.gov/paguidelines

     How physically taxing is your job?  Some vocations require a lot of physical effort, others very little.  Here is a look into the energy requirements (metabolic equivalent or METS*) to perform a particular job and the amount of energy expended (kcals) per half-hour of work for various occupations.  Calculations are based on a 150 pound individual.

Baker:  4.0 METS; 143 kcals

Desk Job:  1.5 METS; 54 kcals

Firefighter, general tasks:  12.0 METS; 430 kcals

Mason:  7.0 METS; 251 kcals

Nurse, patient care requiring lifting: 4.0 METS; 143 kcals

Physical Education Teacher, participating in class activities: 6.5 METS; 233 kcals

Store Clerk: 2.3 METS; 82 kcals

     It is important to note that the above values are estimates and that the actual energy demands of a particular job can be altered due to such factors as the pace of work, worker's body size, climate of work environment, and types of technical/automated devices used.

*A metabolic equivalent or MET is a unit of measure that describes the energy expenditure of a particular activity or its intensity.  It is the ratio of the amount of energy expended during an activity to the amount of energy expended at rest.  One MET is the amount of energy expended at rest.  A 3 MET activity requires energy to be expended at 3 times the rate of energy expended at rest.

Resources:

The Compendium of Physical Activities Tracking Guide www.prevention.sph.sc.edu/tools/docs/documents_compendium.pdf

2008 Physical Activity Guidelines for Americans www.health.gov/paguidelines

     Body composition refers to your body weight relative to the amount of muscle, bone, fat, organ and other vital tissues that make up that weight.  Much emphasis is placed on the amount of fat versus muscle tissue.  This is because optimal health is achieved through appropriate amounts of both.  Although the exact body fat percentage identifying risk has yet to be agreed upon, values that range between 10-22% for men and 20-32% for women are generally considered appropriate for health.

     Excess body fat is associated with heart disease, stroke, high blood pressure, type 2 diabetes, abnormal blood lipid (cholesterol) levels and the metabolic syndrome.  In addition to the amount of fat that you have, where it is located on your body is of concern.  Fat that is primarily located around your abdomen ("apple" shape) puts you at greater risk than if the fat is more concentrated around your hips and thighs ("pear" shape).

     There are different methods to estimate your body composition that vary in cost and complexity.  These include: 

• Skin-fold measurements in which various sites on your body are "pinched" by a caliper.  The values are put into a formula to determine percent body fat.  However, results are affected by skill level of the health professional conducting the measurements.
  
• Circumference measurements, such as the waist-to-hip ratio (WHR), involve measuring the girth of various body parts.  Different equations are used based on age and gender to compute the values.
  
• Bioelectrical impedance analysis (BIA) is a method in which the speed of a signal sent between electrodes placed on your feet and hands determines the amount of body fat.  A slower signal indicates greater amounts of fat because fat impedes the signal.  However, results can be skewed based on your state of hydration.
  
• Hydrostatic weighing (underwater weighing) is known as the "gold standard".  The amount of water you displace when submerged in a tank of water after blowing out all of the air in your lungs is measured.  The more water that is displaced the less fat you have.
  
• BOD POD is a fiberglass chamber in which you sit and the amount of air that is displaced by your body is measured to determine body composition.
  
• Dual energy X-ray absorpiometry (DXA) distinguishes the tissue densities of your body by exposing you to low amounts of radiation.
  

     Underwater weighing, the BOD POD, and DXA are typically used in university, hospital, and laboratory settings due to the cost and complexity of equipment and procedures required.  A simple way to estimate body fat percentage that many doctors use is the waist-to-hip ratio.  The WHR is the circumference of your waist at its narrowest point divided by the circumference of your hips at the largest point of your buttocks.  It provides insight into your body's distribution of fat.  If your WHR is high, it may indicate that you have a large amount of visceral fat, that is, fat deep within your abdomen.  An excess amount of visceral fat is associated with the chronic health conditions listed above.  

     The WHR's associated with a greater risk for disease based on age and gender are listed below.

Men:

• very high risk if under 20 years with a WHR that is at least 0.95
  
• very high risk if 60-69 years with a WHR that is at least 1.03
  
• high risk if 20-70 years with a WHR that is at least 0.89-0.99

Women: 

• very high risk if under 20 years with a WHR that is at least 0.86
  
• very high risk if 60-69 years with a WHR that is at least 0.90
  
• high risk if 20-70 years with a WHR that is at least 0.78-0.84

     Body Mass Index (BMI) is another means by which your physician may determine your risk for developing chronic health conditions.  The National Heart, Lung, and Blood Institute (NHLBI) defines BMI as "a measure of your weight relative to your height".  It is calculated by dividing body weight (in kilograms) by height (in meters) squared.  To easily determine your BMI, the NHLBI has a chart on their website that you can use www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm.  

     The NHLBI states that a BMI of 30 or more indicates obesity.  A BMI of 25-29.9 qualifies as being overweight.  Normal weight is a BMI of 18.5-24.9.  And, a BMI below 18.5 is underweight.  Health problems can occur at both extremes.  BMI's greater than 25 are typically associated with an increased risk for obesity-related health problems.  BMI's greater than 30 are associated with a higher incidence of high blood pressure, abnormal blood lipids, heart disease and death.

     There are limitations with calculating BMI.  It does not distinguish between fat and muscle weight.  If you have a muscular build, such as with athletes, it could classify you as being overweight or obese because muscle weighs more than fat.  Health risk tends to be underestimated in individuals who are older or who have lost muscle mass.

     You should consult your physician to determine what the appropriate weight is for you.  Your physician will give you advice on how to lose and maintain body weight in order to achieve optimum health.

Resources:

The National Heart, Lung, and Blood Institute www.nhlbi.nih.gov

ACSM's Guidelines for Exercise Testing and Prescription eight edition

     Good news for chocolate milk lovers.  A recent study published in the February 2009 issue of Applied Physiology, Nutrition, and Metabolism concluded that chocolate milk is an acceptable option to replenish energy stores (glycogen) depleted during endurance exercise.  Researchers investigated the effectiveness of chocolate milk (Mars Refuel) compared to two commercially available sport drinks, one a carbohydrate replacement drink (Endurox R4) and the other a fluid replacement drink (Gatorade), on endurance performance.  Endurance performance is affected by levels of glycogen stores in the body.

     The best source of energy for muscles is glucose (a simple sugar).  Glucose is stored in your muscles and liver in the form of glycogen.  Glycogen is the primary source of glucose for your muscles during prolonged bouts of endurance exercise.  An enzyme in your body, known as glycogen synthetase, forms glycogen.  High levels of this enzyme circulate in your body during the first two hours post-exercise.  It is within this time frame that health professionals recommend consuming carbohydrates to replenish depleted stores.

     The researchers of this study wanted to determine if chocolate milk would be a good source of carbohydrate to aid in the resynthesis of glycogen.  The subjects tested were trained athletes (cyclists).  The participants underwent experimental trials on three separate occasions, each at least one week apart from the previous trial.  A testing session included an initial bout of exercise that resulted in depletion of muscle glycogen stores, a 4 hour recovery period (during which the subjects ingested either chocolate milk, a carbohydrate replacement drink, or a fluid replacement drink one minute and then again 2 hours post-exercise), and an endurance exercise session to exhaustion.  The subjects were allowed to drink as much water as they desired throughout the testing sessions to ensure proper hydration.

     The results of the study revealed that when the participants drank chocolate milk they were able to exercise 51% longer than when the carbohydrate replacement drink was ingested and 43% longer than when the fluid replacement drink was consumed.  Although the investigators suggest that further research is needed to clarify the means by which chocolate milk enhances performance during endurance exercise, they offer some possibilities.

      The researchers suggest that one of the types of carbohydrate (sucrose) present in the milk, but not in the carbohydrate replacement drink, could be a factor in improved performance.  This is because research has shown that sucrose ingestion results in a greater storage of glycogen in the liver when compared to glucose consumption.  

     The investigators also attribute the higher fat content in the chocolate milk to play a role.  They believe that it may lead to a greater amount of free fatty acids in the blood, which in turn, may delay the depletion of glycogen. 

     A final factor that may have led to enhanced performance was that the athletes consumed more water during the exercise session when they drank chocolate milk than when they consumed the sport drinks.  

     Regardless of whether it was the type of carbohydrate, the fat content, or the increased water consumption associated with the ingestion of chocolate milk, I think I will pour myself a glass upon completion of my exercise session tomorrow.

Resources:

Appl Physiol Nutr Metab. 2009 Feb; 34(1):78-82. Improved endurance capacity following chocolate milk consumption compared with 2 commercially available sport drinks. Thomas, K., Morris, P., Stevenson, E.

Int J Sport Nutr Exerc  Metab. 2006 Feb; 16(1):78-91. Chocolate milk as a post-exercise aid. Karp, JR. Johnston, JD, Tecklenburg S., Mickleborough, TD., Fly, AD., Stager, JM.

     

     Functional fitness has once again been named as one of the top trends in the fitness industry by an international survey published in the November/December 2008 issue of ACSM's Health & Fitness Journal.  Functional fitness workouts are designed to help you perform everyday movements and tasks such as lifting a laundry basket or carrying your luggage with greater ease and efficiency.  A key element of functional fitness training, and one that differentiates it from traditional machine-based muscle conditioning exercises, is that it concentrates on developing muscle integration throughout the body during an activity.  That is, it strengthens and trains various muscle groups of your body to work together to carry out a task.  

     Traditional machine-based muscle training isolates a muscle group through a fixed range of motion.  It doesn't "teach" the muscle to work with other muscles in the body.  Consider the tasks you perform throughout the day and the muscles involved in carrying them out.  How often do you use one muscle group or bend at one joint to perform a daily task?  Although traditional methods build muscular endurance and strength, the carryover into everyday activities, which require different muscle groups to work together, is not as great as it is with functional fitness training.  Think in terms of a seated biceps curl machine. Your torso and arms are stabilized against pads, your lower body is inactive and the only joint being used is that of the elbow.  Contrast this against lifting a bag of groceries in which you not only need to recruit your biceps muscles to lift the bag, but you need to activate your leg muscles by squatting and engage your abdomen and back muscles to stabilize your spine while performing the lift.  All of these movements need to be coordinated in order to prevent strain and injury.

     The goal of a functional fitness exercise program is to train your body for the routine and customary movements of daily life situations.  To serve this purpose, these types of exercises consist of multi-joint/multi-muscle activities that involve coordination of upper- and lower-body movements.  Disciplines such as Pilates and Yoga fall under the functional fitness category.  A variety of equipment can be used to develop functional fitness as well such as weighted balls (medicine/kettle balls); balance discs, boards, and balls; resistance bands and tubing; and step boards.  However, you do not need special equipment to improve your functional fitness. 

     Using one's own body weight, especially if you are starting a functional fitness program for the first time, can improve your ability to perform everyday tasks with ease.  Examples of exercises that teach your body to support its own weight include push-ups (can be done against the wall or countertop if unable to do "traditional" push-ups), squats, and lunges.  Activities such as balancing on one foot, performing one-legged squats, and standing leg abductions and adductions can promote balance and muscle coordination needed in everyday life.

     Does this mean you should eliminate all forms of traditional exercise in your quest to achieve functional fitness?  No.  Traditional means of gaining and maintaining fitness have their place, and a very important one at that.  Aerobic activities such as walking and biking help to build cardiovascular endurance and weight lifting with machines can lay a solid foundation of strength upon which to build.  

     As stated by Shelley Rubinstein, Co-coordinator of the Optimal Aging Program - a medically-based program promoting fitness in healthy adults 60 years of age and older - at William Beaumont Hospital's Beaumont Health Center in Royal Oak, "Exercise in general improves function".  What do we need to function independently?  The ability to "reach, bend, carry and lift" according to Rubinstein.  "Simulating those moves [in your exercise routine] helps to strengthen muscle memory" explains Rubinstein.  Muscle memory, also known as motor memory, involves performing a particular activity repeatedly over time so that your muscles "learn" the movement and it becomes automatic.  Performing the above movements in your exercise routine will carry over into your day-to-day activities improving your ability to function in real-life situations.  An ideal exercise program is one that incorporates a variety of modes and methods to develop a body that is capable of meeting the demands placed on it throughout life.

Resources:

ACSM Fit Society Page Summer 2006 pp. 3-4, "Exercising for Functional Fitness". Yoke, M.

ACSM's Health & Fitness Journal VOL .12/NO. 6, pp. 7-14. "Worldwide Survey Reveals Fitness Trends for 2009". Thompson, W.R.

www.webmd.com WebMD Feature Article "Working out for Real Life Functions". Shaw, G.

William Beaumont Hospital's Optimal Aging Program; Beaumont Health Center, 4949 Coolidge Highway, Royal Oak, MI 48073; (248) 655-5034.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

    

Facts About Health and Fitness:

1. Substituting 150 minutes of vigorous-intensity exercise for 300 minutes of moderate-intensity exercise throughout the week yields similar health benefits and is a more time-efficient option for busy schedules.
2. Being moderately obese (a body mass index of 30-35) can shorten your lifespan by 3 years and being severely obese (a body mass index of 40 to 50) can shorten your lifespan by 10 years according to a recent study published in The Lancet (www.thelancet.com).
3. Regardless of the purpose of the physical activity (bicycling to work, walking the dog, raking the yard), all forms of aerobic exercise count toward meeting the recommendations as long as they are of a duration of at least 10 minutes.
4. You can reduce your risk of musculoskeletal injury and undue fatigue by spreading your physical activity throughout the week (spread over at least three days).
5. You can boost your energy expenditure during walking by using walking poles according to a study by The Cooper Institute investigating Nordic Walking (using poles) versus regular walking.
   

Resources:

www.health.gov/paguidelines

The Lancet. 2009 Mar; 373 (9669):1083-1096.

Res Q Exerc Sport. 2002 Sep; 73(3):296-300.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

     It is well known that regular exercise promotes health and can prevent chronic conditions such as cardiovascular disease.  However, in certain situations, acute exercise can induce adverse events such as heart attack and sudden death, particularly in individuals who have been previously inactive.  In general, these events do not occur in individuals with a normal functioning cardiovascular system.

     Apparently healthy individuals engaging in moderate-intensity exercise are at low risk for these rare occurrences.  But, the risk of these events increases with participation in vigorous-intensity exercise in the presence of either diagnosed or silent (not yet evident to the affected individual) cardiovascular disease.  Adults are at a greater risk for exercise-induced adverse events than younger individuals because of the higher incidence of cardiovascular disease in this population.  Risk of heart attack and sudden death also increase with increased prevelance of cardiovascular disease in the population exercising.

     It is important for you to understand what the warning signs and symptoms are of an adverse cardiovascular event.  Then, you will know when to seek immediate medical attention.  They include, but are not limited to, the following:

1.  Pain and Discomfort (note symptoms can start slowly

     with mild discomfort/pain or can be of sudden onset)
a.  Location: chest, shoulders, one or both arms, neck, back, 

      jaw, teeth, and/or cheeks
b.  Sensation:  pressure, squeezing, fullness, burning, 

      constricting, and/or heaviness that may radiate or 

     remain localized
2.  Shortness of Breath (defined as unusually difficult or 

      uncomfortable breathing)
3.  Nausea/Vomiting
4.  Cold Sweats
5.  Lightheadedness
6.  Dizziness
7.  Fainting
8.  Rapid or Irregular Heartbeat
9.  Unusual Fatigue 

Gender Differences in Symptoms:

     Chest discomfort or pain is the most common sign of a heart attack for both men and women.  However, women are more likely than men to experience atypical signs and symptoms such as shortness of breath, nausea/vomiting, back, and/or jaw pain.

     If you experience any of the above symptoms, even if you are uncertain that they are a result of a life-threatening condition, you should STOP EXERCISING and SEEK MEDICAL ATTENTION IMMEDIATELY.  MINUTES MATTER in cardiovascular emergencies.  When in doubt CALL 911.

Resources:

American Heart Association www.americanheart.org

ACSM's Guidelines for Exercise Testing and Prescription, eighth edition

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

     Are you looking for an efficient and effective way to burn extra calories throughout the day?  Why not engage in a little "double duty" as you spring clean?  Get the satisfaction of having a clean home while accumulating minutes to meet the federal government's recommendations for physical activity (www.health.gov/paguidelines).  Take a look below to see the amount of calories you can burn while engaging in these common spring cleaning tasks.

Calories Burned in 30 minutes (totals are calculated for an individual weighing 150 pounds)

Vacuuming:  125 kcals

Mopping:  125 kcals

Scrubbing Bathroom/Bath Tub:  136 kcals

General Household Cleaning:  107 kcals

Washing Windows:  107 kcals

Moving Household Items (such as furniture and carrying boxes):  215 kcals

Cleaning Garage (general):  107 kcals

Sweeping Garage/Sidewalk/Driveway:  143 kcals

Cleaning Gutters:  179 kcals

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

The Compendium of Physical Activities Tracking Guide www.prevention.sph.sc.edu/tools/docs/documents_compendium.pdf

     I realized this weekend that the saying "home is where the heart is" holds true for me.  These past few days also confirmed for me that a healthy heart is more than just a physically fit heart.  It is one that is filled with content, validation, appreciation, and love.  

     What prompted these insights?  We are visiting my parents who are "snow-birding" in St. Augustine, Florida.  I have never been to the condominium unit that they are renting; nor have I ever been to St. Augustine.  Yet, I feel like I have come home.  My parents' bikes are parked in the entrance way.  I am reminded of the family bike rides we took when I was a child.

     Much of our family time growing up was oriented around some type of physical activity.  Whether it was a family hike, a cross-country skiing trip or a day of swimming we did it as a family.  Strong family bonds and great memories were created from these adventures that have carried over into my adulthood.

     I am a strong believer that the steps toward a healthy heart start with family-oriented fitness.  I attribute my own journey toward better health and fitness to the healthy habits my parents instilled in me as a child.  I hope to pass this example on to my children.

     An important component to make family fitness successful is to create an exercise experience that provides physical activity without you or your child thinking about it as getting exercise.  In our celebration of "World Day for Physical Activity" today we did just that.  After the adults engaged in their own exercise sessions this morning, we took the kids for a walk along the beach.  As we walked, the kids were focused on collecting shells and running into the waves.  Exercise was the last thing on their minds, yet they were getting it.  Their memory of this event will be "Do you remember when we visited Grandma and Grandpa and collected shells on the beach?" - not the 45 minute walk on which their search took them.

     I admire my parents for the lessons that they have taught me during our family fitness time.  I am in awe that their own personal journeys toward better fitness have led them to good health and the ability to take walks, play, and go for a swim with their grandchildren.  My hope, as my children embark on their own journeys toward better fitness and health, is for them to develop a sense that no matter the location of the heart they are always at home, especially with a healthy heart.  

     As Spring brings warmer weather you may be motivated to get moving outdoors.  But before you do, consider these tips to ensure safe and enjoyable exercise.  Now is a good time to schedule an appointment with your physician for a physical, especially if you have been inactive or sporadic with your exercise over the winter or have not had a recent check-up.  Your physician will be able to identify medical conditions that may make exercise unsafe until they are controlled or resolved.  

     If it is safe for you to exercise, but you were relatively inactive during the last few months, you will want to start back slowly.  This will reduce the risk of musculoskeletal discomfort and/or injuries.  Once you have developed a solid fitness base, you can start to increase the duration, intensity, and frequency of your workouts to meet your goals.  It is recommended that you start by increasing your duration first by 5 to 10 minutes per session every 1 to 2 weeks.  Do not increase duration and intensity in the same session.  To ensure safety while progressing your workload, do not exceed a 10% increase in total training volume in any given week.

     Other safety tips to consider as you "Spring" into shape are listed below.

If bicycling:

1. Wear a helmet, regardless of the length of your bike trip.  Your helmet should sit on top of your head, not tipped to the back.  As a general rule of thumb, there should be about a 2 fingers-width between the front of your helmet and your eyebrows.
2. Obey traffic rules and ride in a straight line.  Do not weave in and out of cars.
3. Ride with the flow of traffic (to the right).
4. Signal your turns.  To signal a left turn your shoulder should be extended to the side with your arm out straight.  To signal a right turn your shoulder should be extended to the side with your elbow bent at a 90 degree angle and hand pointed up toward the sky.  To signal a stop your shoulder should be extended to the side with your elbow bent at a 90 degree angle and your hand pointing toward the ground.  To view pictures of proper hand signals visit www.state.il.us/KIDS/isp/bikes/tips/default.htm.
5. Ride on the shoulder of the road or designated bike route.  Try to avoid riding on the sidewalk.  Motorists are not expecting you and you risk a vehicle/bike collision at  intersections and driveways.
6. Use headlights, twilights, and reflectors if bicycling in the dark

If walking, running, rollerblading:

1. Exercise against the flow traffic.  This allows you to see vehicles coming your way.
2. Cross the road at intersections and/or designated cross walks.
   

General Safety Tips:

1. If exercising alone let someone know where you will be going and when to expect your return.
2. Wear brightly colored clothes so that motorists can easily see you.
3. Check the weather forecast and dress appropriately.  Wearing layers is best.  Extra garments may be removed and wrapped around your waist if needed.
4. If exercising in the dark wear reflective gear and use a flashlight.
5. It is best not to wear headphones, but if you choose to do so set the volume so that you can still hear what is happening in the surrounding environment. 
6. Maintain adequate hydration.  Weigh yourself both prior to and after exercise to determine the amount of water lost from exercise.  Drink about 17 ounces of fluid 2 hours prior to exercise.  Bring a water bottle with you to replace fluids while exercising.  After exercise, drink about 1 pint of fluids for each pound of body weight lost.

Following these guidelines will allow for safer exercise and greater enjoyment as you embrace the return of warmer weather over the next several months.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

National Center for Injury Protection and Control; www.cdc.gov/ncipc/bike

ACSM's Guidelines for Exercise Testing and Prescription, 8th edition

ACSM Fitness Book a proven step-by-step program from the experts

     Are you ready to celebrate "World Day for Physical Activity" on Monday April 6th? (See my posting from Wednesday, April 1 for an explanation of this event.)  Here is a look at who is around the world.  According to Victor Matsudo from the Agita Mundo Network, the organization promoting this campaign, Venezuela and Guatemala will be launching national programs to promote physical activity that day.  He states that in Sorocaba, Sao Paulo, Brazil "the municipality will be promoting a 24 hour walk contest".  The day before, on April, 5th it is anticipated that over 20,000 people will participate in Sao Paulo's traditional "Agita Mundo Walking Parade" according to Matsudo.

     In Anoka, Minnesota they will be celebrating with their fourth-annual Challenge Obesity 5K Run/Walk on April 4th.  In Pennsylvania, Pittsburgh's Chatham University will host a one-mile fitness walk on April 7th.  In Milton Massachusetts, they will be using "World Day for Physical Activity" as a kick off event for an 8 week walking program.  Free basic health assessments, "passports to physical activity", and unique fitness classes will be offered in Indianapolis, Indiana at The National Institute of Fitness and Sport. 

     What will you do to become a "physically active citizen"?  Post a comment below to let me know.  Be sure to check back and I will let you know how my family celebrated "World Day for Physical Activity".