Surgeon General Regina Benjamin remarks in her opening statement to the American public in the recently released publication, The Surgeon General's Vision for a Healthy and Fit Nation, that the historic progress that this nation has made to increase the quality and number of years of life is threatened by the current epidemic of overweight and obesity. A supplementary fact sheet to the Surgeon General's vision reveals these alarming statistics:

• Obesity rates more than doubled (from 15% to 43%) among American adults and more than tripled (from 5% to 17%) among American children and teenagers between the years 1980 and 2008.
• 2/3 of American adults are currently either overweight or obese.
• Almost 1 in 3 American children are currently either overweight or obese.
• Various racial and ethnic sub-populations and certain geographic regions in the U.S. are disproportionately affected by the epidemic of overweight and obesity. For instance, 70% of adults who are of American Indian or Alaskan Native descent are either overweight or obese. Non-Hispanic black teenagers are more likely to be obese than their Hispanic and non-Hispanic white peers.
• A teenager who is obese has more than a 70% chance of becoming an adult that is obese.

To combat the epidemic of overweight and obesity, the Surgeon General states we have to create a "new normal." In the past, emphasis has been placed on achieving certain numbers deemed "healthy" for body weight and body mass index (BMI). Dr. Benjamin remarks that although these standards of the "old normal" are important, the emphasis needs to be expanded to include attaining "an optimal level of health and well-being."

In her closing statement of The Surgeon General's Vision for a Healthy and Fit Nation, she further elaborates that Americans are more likely to change their behavior toward healthier habits if they have a meaningful reward for which to strive. She describes this reward as a "level of health that allows people to embrace each day and live their lives to the fullest - without disease, disability, or lost productivity." She discourages Americans from thinking in terms of attaining a certain number on the scale, but rather to think of achieving optimal health and well-being for a functionally fit life.

The change from the "old normal" to the "new normal" can only occur if Americans start to take responsibility for their own health by making nutritious food choices and increasing daily physical activity. These actions will create a greater demand for food products and community/work environments (e.g., recreational parks, sidewalks, corporate wellness programs, etc.,) subsequently affecting the marketing and city planning trends to foster better health and well-being of the American public.

For more information regarding The Surgeon General's Vision for a Healthy and Fit Nation, visit www.surgeongeneral.gov.

Resources:

U.S. Department of Health and Human Services. The Surgeon General's Vision for a Healthy and Fit Nation. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, January 2010.

U.S. Department of Health and Human Services. The Surgeon General's Vision for a Healthy and Fit Nation Fact Sheet. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, January 2010.

Yesterday, the U.S. Department of Health and Human Services released The Surgeon General's Vision for a Healthy and Fit Nation. Surgeon General Regina Benjamin, in her first release to the nation, calls upon all Americans, from parents and teachers to government and community leaders, to join her in the fight against the nation's overweight and obesity epidemic - a trend that is associated with other epidemics of chronic diseases, such as diabetes and heart disease. In her message to the nation, Dr. Benjamin states that researchers predict these conditions will afflict many of our children when they reach early adulthood, a track that could subsequently lead to a shorter lifespan than their parents.

The change toward a healthier and more fit nation begins with each individual assuming responsibility for his/her own health by making healthy choices. In The Surgeon General's Vision for a Healthy and Fit Nation, Dr. Benjamin states "we must all work together to share resources, educate our citizens, and partner with business and government leaders to find creative solutions in our neighborhoods, towns, and cities from coast to coast. Together, we can become a nation committed to become healthy and fit."

The recommended actions delineated in The Surgeon General's Vision for a Healthy and Fit Nation include:

Individual Healthy Choices and Healthy Home Environments

• Change starts with the individual. Americans should strive to decrease consumption of sugary beverages such as sodas and juice with added sugars as well as high caloric foods that have added sugars and/or solid fats; increase consumption of fruits, vegetables, whole grains, lean proteins, and water; exhibit portion control; choose dairy products that are low- or non-fat; increase physical activity throughout the day; decrease time spent watching television; and, for mothers, to breastfeed exclusively for 6 months.
• Parents and caregivers need to be positive role models of healthy lifestyle habits for their children.

Creating Healthy Child Care Settings

• Child care programs need to determine and devise a care plan that will incorporate expert recommendations on physical activity, television and computer time, proper nutrition, and healthy sleeping conditions which will promote the health of the children under their care.

Creating Healthy Schools

• Throughout the school day, there are multiple opportunities for students to be educated about the importance of adopting healthy lifestyle habits, such as participating in regular exercise and making healthier food choices; thus, schools play a pivotal role in preventing childhood obesity.
• Schools should provide fresh fruits and vegetables, whole grains, and low-fat or non-fat beverages in their cafeterias.
• Schools need to require student participation in physical education classes. Time spent in the classes should allow for the accumulation of 150 minutes per week of exercise for elementary school-aged children and 225 minutes per week of exercise for secondary school-aged children.

Creating Healthy Work Sites

• Employees spend a significant amount of time per week in the work environment. Employers should strive to implement corporate wellness programs which promote healthy lifestyle habits. Such programs should encourage healthy food choices and group physical activity classes.
• Employers should offer incentives to employees to participate in corporate wellness programs.

Mobilizing the Medical Community

• Health care professionals should make it a priority to teach their patients about the importance of adopting healthy lifestyle habits that will result in weight maintenance and a reduction in risk for chronic diseases.

Improving Our Communities

• Communities need to incorporate the concept of the "built" environment, one which develops land use patterns that encourage active modes of transportation (e.g., walking and bicycling) and readily accessible recreational facilities as well as supermarkets.
• Safety needs to be improved to foster participation in active modes of transportation.

There are many things that each individual American can do to help our nation become a healthy and fit one. Challenge yourself to adopt at least one new healthy habit a day. This can be as simple as adding a piece of fruit at lunch or drinking a glass of low-fat milk instead of a milkshake.

To view the complete publication of The Surgeon General's Vision for a Healthy and Fit Nation, visit www.surgeongeneral.gov.

Resource

U.S. Department of Health and Human Services. The Surgeon General's Vision for a Healthy and Fit Nation. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General, January 2010.

Exercising outdoors during the winter months can be invigorating. The cold, fresh air can awaken your senses and the sunlight can boost your mood (as well as your Vitamin D stores). Beware, however, that "Jack Frost" can blow a mighty wind creating weather conditions, such as frigid temperatures, wind chill factors, and icy conditions that jeopardize your safety. To ensure you receive warm returns from your cold weather workout, follow these rules:

Check with your doctor.

• Certain medical conditions, such as asthma and heart disease, may require special precautionary measures before heading outdoors to exercise.

Hear what the weatherman has to say.

• When the temperature drops below minus 20 degrees Fahrenheit, including the wind chill factor (the effects of temperature and wind together), exposed skin is in danger. When this weather conditions exists, it is best to exercise indoors.
• Note that fast-moving exercise (e.g., skiing, snowboarding, running, etc.,) generates a wind chill since it facilitates air movement across your body. This should be taken into account when deciding if weather conditions are conducive to outdoor exercise.

Protect your extremities.

• Cold weather causes blood to be shunted away from your hands and feet and toward your core to keep your internal organs warm.
• Wear mittens, rather than gloves, to help the heat circulate around your fingers.
• Choose thermal socks and footwear that will keep your feet warm and dry.

Cover your head.

• About 40% of your body's heat can be lost through your head. Wearing a hat can reduce the amount of heat dissipated from your body.

Cover your mouth.

• Wear a scarf to help warm the air as you breath. This can help to reduce the likelihood of bronchospasm in susceptible individuals.

Dress in layers.

• Dressing in layers provides extra protection/insulation by trapping warm, dry air between your articles of clothing.
• You can remove outer garments or put them back on as your body heats up or cools-off, respectively.

Stay hydrated.

• Water can be lost from your body through breathing, sweating, and urine production - thus putting you at risk for becoming dehydrated, even in cold weather.

Start your exercise by heading into the wind, if possible.

• Heading into the wind at the start will reduce your chances of getting chilled near the end of your workout. This way, as you return the wind will be at your back - when you are at your sweatiest.

Be able to recognize the signs of frostbite (the freezing of body tissue) and hypothermia (dangerously low body temperature).

• Frostbite manifests as a numb feeling in the effected body part (usually your fingertips, toes, ears, and/or nose). The effected extremity will be pale in appearance.
• Hypothermia initially involves intense shivering and cold extremities. As it progresses, disorientation, slurred speech, impaired judgement, and decreases in heart rate, breathing, and reflexes can occur.

The cold weather doesn't have to keep you indoors all winter. Keep "cabin fever" at bay by ensuring that you get some outdoor exercise this season. Just take the necessary precautions to make your outings both safe and enjoyable.

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 Weather Channel

"Exercise and cold weather: Stay motivated, fit and safe," The Mayo Clinic

If you are one of those individuals who struggles to maintain a healthy body weight, despite following a healthy diet and engaging in regular exercise, you are not alone. Weight management can prove to be a challenge for many - hence, the large market for weight loss products. It is easy to become discouraged when your attempt to lose weight is unsuccessful. However, you should not perceive your struggle as a failure. Rather, view the setback as an opportunity for personal growth.

You may need to reevaluate your weight loss plan. If it is not working for you, it may mean that you simply need to change your approach. Maybe you need to alter the timing of your meals or change your mode of exercise. Everyone's physiology is different; therefore, not all diet plans and exercise regimens will have the same effect. Consider the following points below and determine if they would fit into your journey toward better health:

• Weight Train To Maintain - muscle mass starts to decline around the age of 30, by about 1% per year. This can have a negative impact on your metabolism. Weight training increases your energy expenditure and some research indicates that it mobilizes fat from your abdominal region (decreases visceral fat). Muscle tissue has a greater metabolic demand than fat tissue. To boost your metabolism as you age, ensure you are including at least 2 days of weight training as part of your exercise regimen. Exercises should work the major muscle groups of your body. The average adult should attempt to perform 2-3 sets of 8-12 repetitions per strength training exercise (this may need to be altered based on your personal goals and fitness level).
• Add Yoga To Your Exercise Routine - A study published in the Journal of the American Dietetic Association found that those individuals who performed yoga were more likely to practice "mindful" eating in which they ate more slowly and stopped eating when they were satiated compared to subjects who did not practice yoga. Yoga goers also had lower BMIs.
• Watch When You Eat - Although consumption of a post-exercise meal that is rich in carbohydrates is recommended for athletes to maximize their performance, it may not be the best option for the average individual looking to lose weight. A study published in the August 2005 issue of the Journal of Applied Physiology found that the exercise-induced caloric deficit achieved by walking on a treadmill was negated when a carbohydrate-rich supplement was consumed immediately after exercise. Therefore, if weight loss is your goal, you do not want to consume a high carbohydrate meal immediately after exercise.
• Manage Your Stress - when your body is in a stressed state it releases cortisol. Cortisol plays a role in mobilizing energy for the body in these situations. Chronic stress results in high concentrations of cortisol. High levels of this hormone can result in fat being deposited in the abdomen (visceral fat), subsequently leading to obesity if not controlled. High levels of cortisol can also increase your appetite and cravings for "sugary" and high-fat foods. Over-consumption of these foods can cause weight gain. If stress is a problem for you, try scheduling "down" time, reducing your workload by delegating tasks, and/or engage in stress management techniques (e.g., deep breathing exercises, yoga, etc.,).

Achieving a healthy lifestyle is a process. It requires frequent "checks-and-balances" to stay the course. Setbacks should not be viewed as failures, just indicators that changes are needed.

Resources:

Journal of Applied Physiology, August 2005, pp. 2285-2293, "Improved Insulin Action Following Short-Term Exercise Training: Role of Energy and Carbohydrate Balance," Black, S.E., et al.

Journal of the American Dietetic Association, August 2009, pp. 1439-1444, "Development and Validation of the Mindful Eating Questionnaire." Framson, C. et al.

ACSM's Health & Fitness Journal, September/October 2005, pp. 20-23, "Cortisol Connection: Tips on Managing Stress and Weight," Maglione-Garves, C.A. et al.

I keep a pad of paper and a pencil on the magazine holder attached to my stationary bike. Why? Interestingly, amidst my huffing and puffing and ensuing muscular fatigue while cycling, I find that my brain seems to awaken with creative solutions to life's problems, fundraising projects for my children's school, tasty recipe ideas, and thoughts for article posts which I need to jot down lest I forget. Some would argue that my heightened mental processing at this time is a direct result of a quiet household - everyone else is still in bed; and so, I have the opportunity to think without interruption. Although this fact may contribute some, I believe that it is the physical activity itself that fosters my creativity at this hour.

The correlation between improved cognitive function and participation in regular exercise has received recognition and support in the research community over the last several years. Less well understood, however, is the specific relationship between enhanced creativity and routine physical activity. Much of the research on the topic is anecdotal and inconclusive, partly because testing creativity in a quantitative manner proves to be difficult. However, the trend appears to be that a positive correlation does exist.

The results of a study conducted by Steinberg et al., which were published in the September 1997 issue of the British Journal of Sports Medicine, support this concept. Sixty-three subjects were exposed to two different testing conditions: "video then exercise" and "exercise then video" in which the video session consisted of watching an emotionally "neutral" documentary and the exercise component entailed participation in either aerobic exercise or aerobic dance. The subjects were asked to complete questionnaires that assessed mood (modified adjective list) and creative thinking (3 measures of the Torrance Test - fluency, flexibility, and originality). Mood was evaluated both before and after the video viewing and exercise sessions. Creativity was only measured after the video viewing and exercise sessions.

The investigators found mood to be significantly increased after the exercise session and creativity, as measured by flexibility (the variety of the responses to the questionnaire), to have been significantly boosted by the physical activity. Furthermore, a trend of improvement in creativity, as measured by fluency (the number of responses), was noted after the exercise; however, it was not statistically significant. Finally, the researchers stated that their results revealed that creativity was enhanced independent of mood.

Indeed, research is limited on this topic. Hopefully further investigations will unveil a stronger positive correlation between exercise and enhanced creative thinking, as well as mechanisms by which it is achieved. Current theories include:

• Increased blood flow and oxygen supply to the brain as a result of the physical activity.
• Exercise-induced growth of new nerve cells and synapses by means of increased levels of neutrophins (hormones involved in new nerve cell growth).
• Increased release of endorphins during exercise which leads to a natural/"runner's" high.
• Reduction in cortisol (stress hormone) levels with physical activity. High levels of cortisol can interfere with brain performance.

For me, I will continue to keep my pad of paper and pencil at the ready while I exercise. Without a doubt, physical activity fuels my creative processes and energizes me to navigate the day ahead in an innovative, productive manner.

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.

Resource:

British Journal of Sports Medicine, September 1997; 31:240-245, "Exercise Enhances Creativity Independently of Mood," Steinberg, H. et a,l.

It is well known that Western cultures are struggling with rising obesity rates and the resultant ill effects on societal well-being and health care costs. Excess body fat is linked to an increased risk for several chronic health conditions. And, it is not just the total amount of body fat that is of concern, but where you tend to "carry" it on your body.

Excess body fat that is carried around your waist (i.e., "apple" shape) poses a greater health risk than extra body fat deposited in your hips and thigh region (i.e., "pear" shape). Furthermore, fat that lies deep within your abdomen and that surrounds your body's organs (e.g., liver and pancreas), known as visceral fat, poses a greater threat than subcutaneous fat, which is located just beneath your skin's surface. Research indicates that visceral fat is associated with the overproduction of hormones by your body that can promote such health complications as insulin resistance, among other ailments. Health risks associated with a higher percentage of visceral fat include:

• Metabolic Syndrome
• Type 2 Diabetes
• Cardiovascular Disease
• High Blood Pressure
• Cancer (Breast and Colon)
• Sleep Apnea
• Gallbladder Disease

Genetics plays a large role in the amount of visceral fat you may have. Gender can also influence the accumulation of visceral fat due to hormonal differences. In general, men tend to store fat around their middle while women typically carry it in their hips and thighs - that is until menopause. After menopause, women start to deposit more fat at their waistline, rather than in the region of their hips and thighs due to decreases in estrogen levels.

Fortunately, research has shown that adherence to a healthy lifestyle that incorporates proper dietary practices and regular physical activity is associated with lower levels of visceral fat accumulation. One recent study published in the journal Obesity found that after initial weight loss from adherence to a caloric-restricted diet, participants who engaged in 40 minutes of either aerobic or resistance training activities 2 days per week were less likely to experience significant increases in abdominal visceral fat percentages one year later than their non-exercising counterparts and those subjects who exercised less frequently.

It should be noted, however, that even though as little as 80 minutes per week of physical activity was associated with preventing regain of visceral fat in the active participants, the exercising subjects had gained some weight overall during the follow-up period. Therefore, for the purposes of weight maintenance, it is recommended that you adhere to the current guidelines which state that:

• 150 minutes/week of moderate-intensity exercise is needed to prevent weight gain
• 250-300 minutes/week of moderate-intensity exercise is needed to lose weight
• 200-300 minutes/week of moderate-intensity exercise is needed to prevent weight regain after loss.

How do you know if you are at an increased risk for having excessive amounts of visceral fat? Measure your waist circumference. To do this, take a tape measurer around the narrowest part of your torso. Keep your abdomen relaxed while you do this, do not tighten your stomach muscles and do not pull the tape tightly around your middle. Values greater than 35 inches for women and 40 inches for men are associated with an increased risk.

If you are overweight or obese, strive to not only lose weight, but to reduce the amount of visceral fat that you are carrying. As a result you will improve your overall health and decrease your risk for several chronic health conditions. Consult your physician to discuss a weight loss program that will work best for you.

Resources:

"The Dangers of Hidden Abdominal Fat," McCoy, K

Mayo Clinic "Belly fat in women: How to keep it off"

Medicine & Science in Sports & Exercise, February 2009, "Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults."

Obesity, 2009, "Exercise Training Prevents Regain of Visceral Fat for 1 year Following Weight Loss," Hunter, G.R., et al.

Meeting your energy and nutrient needs can be challenging if you are an active individual always on-the-go; but, it is essential if you want to perform at your best - both in and out of the gym. Although I am a strong advocate for meeting your body's nutritional needs by consuming whole foods, sometimes that just is not possible. And, when you are about to debunk and are faced with choosing between an empty calorie, fat-ladened meal from a fast food restaurant or an enriched energy bar, the latter choice wins out. Care needs to be taken, however, when choosing the best meal replacement bar for you. With all of the different choices on the market today this can prove to be a challenge.

Manufacturers of supplement bars strive to reach different consumer targets. Usually, the label tells all. Descriptors such as "low-carb," "high-performance," or "high-fiber" give an indication as for whom the bar is made and what nutritional "needs" it is intended to meet. Supplement bars basically fall under two main categories - performance and meal replacement. Subcategories within these would include bars engineered to meet the energy requirements of various athletes (e.g., bodybuilders, marathon runners, etc.,), the nutritional needs of different gender and age groups, and/or those individuals with special dietary requirements/preferences (e.g., "vegan," "organic", "gluten-free," etc.,).

When choosing the best bar for you, consider the following:

• What are your goals? Do you want to build muscle mass? Lose weight? Run longer?
• Is the bar to replace a regular meal or to act as a nutritional supplement in your diet?

Performance Bars

• Although there is a range, performance bars can contain a higher caloric content than diet bars targeted for weight loss in order to meet the energy needs of an active individual.
• Supplement bars that target bodybuilders tend to have the highest protein content, around 20-30 grams. Choose a bar that lists high-quality protein (whey, casein, or soy) as one of the main sources.
• Athletes who are looking for an energy bar to consume prior to a moderate- to high-intensity workout should look for one that is high in carbohydrates (around 25-40 grams). Avoid bars that are high in fat and fiber which can interfere with digestion and cause gastrointestinal distress.
• Endurance athletes looking for a supplement bar to be consumed during a prolonged exercise session (longer than an hour) would benefit from bars that are high in quick-digesting carbohydrates (glucose). Ideally, these individuals want to consume 30-60 grams of carbohydrate per hour of exercise.
• Energy bars consumed post-workout should be relatively high in carbohydrates (30 grams or more) to replenish energy stores and have a moderate amount of protein (10 grams) to aid in muscle tissue repair.

Meal Replacement Bars

• Individuals interested in using supplement bars as part of their weight loss program want to ensure that the bars provide a nutritional equivalent to what would be achieved by consuming a small meal composed of whole foods. These bars should contain fiber (at least 3-5 grams) to provide a sense of fullness. Diet bars should be relatively low in fat (no more than 5 grams), contain a moderate amount of protein (10-15 grams), and should be enriched with a third of your daily requirement for vitamins and minerals.
• To round out your nutritional needs, eat a piece of fruit, some yogurt, or drink a glass of skim milk along with your meal replacement bar.

What to Look for in all Supplement Bars

• The fat source should primarily come from mono-and poly-unsaturated fats such as whole grains and nuts (e.g., oats, almonds, etc.). Avoid bars high in trans and saturated fats.
• Limit bars sweetened with sugar alcohols which can lead to gastrointestinal upset. Instead, choose bars that are sweetened with natural sugars (e.g., fruit purees, honey, etc.,).
• The protein should come from quality sources such as eggs, soy, whey and casein.

Performance and meal replacement bars are a convenient source of energy and can have a place in your diet when chosen wisely. Care should be taken to avoid going "overboard" on supplement bars. Since many can contain mega amounts of carbohydrates and protein, you are at risk for consuming more calories than you expend, which can lead to weight gain. If you are considering using meal replacement bars, meeting with a dietitian can help you find the best one for your goals and nutritional needs.

Resources

OnFitness, June/July 2006, pp.62-64, "Honest Facts about Supplement Bars"

MedicineNet.com "Meal Replacements: Choose Those Bars and Drinks Carefully," Zelman, K.

Running Times Magazine, April 2007 "Raising the Bar - How to find the best energy bar for you," Eberle, S.G.

Available information on exercise and migraines can appear to be conflicting and can lead to confusion about the role that physical activity plays in the onset of symptoms for migraine sufferers. Fear of triggering a migraine from engaging in exercise has led to many sufferers avoiding physical activity, and consequently, missing out on its associated health benefits. And, indeed, for a minority of sufferers, exercise does bring on a migraine attack. This type of migraine is known as an "exertional migraine/headache" and usually occurs with the initiation of sudden, intense exercise.

In general, however, exercise can be beneficial in the management of migraine symptoms. The release of endorphins (the body's natural painkillers) from exercise can reduce the severity and frequency of migraine attacks. Exercise also helps to manage stress, which can be a trigger for some migraine sufferers. A study published in the September 2008 issue of Headache, found that subjects who underwent an aerobic training program (indoor cycling) 3 days/week for 12 weeks were able to significantly improve their maximal oxygen uptake (a measure of aerobic fitness) without a concomitant worsening of migraine symptoms. In fact, participants experienced significant decreases in the number and severity of migraine attacks, the length (in days) of a migraine, as well as a significant reduction in the amount of headache medication needed.

It is thought that those individuals who experience migraines may have a nervous system that is more "vulnerable" or sensitive to abrupt changes either within the body or in the surrounding environment. Because of this, care must be taken in the approach to exercise.

Exercise Tips for Migraine Sufferers:

• Engage in a prolonged warm-up of 15 minutes
• Avoid abrupt increases in intensity
• Participate in moderate-intensity activities, avoid strenuous; vigorous exercise
• Choose low impact workouts such as cycling
• Exercise on a regular basis to maintain internal physiology
• Exercise in the morning or early afternoon; avoid evening exercise which may interfere with sleep patterns, and subsequently, trigger a migraine
• Stay adequately hydrated
• Do not skip meals, especially prior to exercise, which could lead to low blood sugar levels which can precipitate a migraine
• Avoid exercising in environmental extremes (e.g., high altitude and excessively cold or hot/humid settings)

In general, engaging in a regular exercise program is safe for migraine sufferers. If you experience frequent migraines, it is suggested that you keep a "headache" journal in which you record precipitating factors, associated symptoms, and methods of relief so that you may discuss your situation with your health care professional. Anytime that you experience a sudden onset of head pain with exertion, a worsening of symptoms, or new symptoms associated with an attack, consult your physician. Likewise, individuals who suffer from exercise-induced or exertional migraines need to discuss their personal exercise plan with their physician.

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:

"Exercise Can be a Pain in the -- Head," Sorgen, C.

Guide to Managing Migraines - Migraine Overview

Exercise and Migraine Fact Sheet

Headache 2009;49:563-570, "A Study to Evaluate the Feasibility of an Aerobic Exercise Program in Patients with Migraine," Varkey, E., et al

If you are going to stay true to your commitment to improve your physical fitness in 2010, you need a game plan. The first step is to determine if it is safe for you to exercise. Completing the Physical Activity Readiness Questionnaire can help you to decide if you need to seek the approval of a physician prior to beginning a program. Once you have confirmed that it is safe for you to start exercising, the next step in your plan of action is to get a fitness assessment.

Exercise centers and fitness facilities may offer this service to you as part of a package. However, if this option is not available to you, or if you choose not to spend the money on having an evaluation done, there are simple fitness assessment tests that you can perform in the comfort of your own home. Getting an objective measure of your current cardiovascular endurance, muscular strength, and flexibility is of benefit to you in many ways:

• Knowledge of your starting point will help you to set attainable goals.
• Allows you to develop an exercise program that focuses on the components of fitness upon which you need to improve (e.g., adding extra time for stretching activities to improve flexibility)
• Baseline values provide a measure for improvement and an evaluation of your progress when compared to results of future tests.
• Serves as a means for motivation.

Below are 5 basic fitness tests you can perform. They are commonly used field fitness tests. For more information regarding the tests, visit TopendSports. Most require the help of another individual. Items that are needed for each individual test are listed with the description of the test. A warm-up of about 5 minutes should be performed before initiating any of the tests. If you choose to do all of the tests in one day, allow a period of rest between tests for the most accurate results.

Step Test: measures cardiovascular endurance

Equipment: a step/bench that is 12" in height and a stop watch

Technique: Have someone time you for 3 minutes as you step on and off of the bench at a steady pace. Your stepping pattern should be as follows: Step up with your right foot first, followed by your left. Next, step down with your right foot followed by your left. To maintain a consistent pace state "up, up, down, down" as you perform the sequence. At the end of the 3 minutes, immediately sit down and take your pulse for 1 minute. Refer to the chart found at TopendSports to determine your status. Lower values correspond with a higher level of fitness.

Modified Step Test: measures cardiovascular endurance and is recommended for older adults and individuals who have difficulty balancing

Equipment: tape and stop watch

Technique: Stand up against a wall and have someone mark on the wall, with tape, the midpoint between your knee and the top of your hip bone. Next, have the individual time you for 2 minutes while you march in place. As you march in place, your goal is to bring your knees to the height of the tape on the wall. During the 2 minutes, have the person count the number of times you bring your right knee to that height. If needed, you may support yourself on the wall or a chair. Refer to the chart at TopendSports to determine your status.

Wall Sit Test: measures lower body strength

Equipment: stop watch

Technique: Sit with your back flat against a wall and your knees bent to 90 degrees. Lift one foot off of the floor. Have someone time how long you can maintain this position, starting the time when you lift your foot off of the ground. Rest. Repeat with your other leg. Refer to the chart at TopendSports to determine your status.

Pushup Test: measures upper body strength

Equipment: none

Technique: For men, assume the traditional "military style" pushup position (see below). Perform, until fatigue, as many pushups as possible, while counting each one as you complete it. For women, assume either the traditional "military style" pushup position or the "bent knee" position in which you kneel on your knees rather than using your feet to support your lower body. Perform as many pushups as possible, until fatigue, while counting each one as you complete it. Refer to the chart at TopendSports to determine your status.

Sit-up Test: measures core strength (abdominal and hip-flexor muscle strength)

Equipment: stop watch and exercise mat or soft, cushioned surface

Technique: Lie on your back on an exercise mat, with your knees bent to 90 degrees and your feet flat on the floor. Keep your hands on your thighs. Tighten your stomach muscles to raise your upper back up off of the floor, brining your shoulders toward your knees. As you raise your back, let your hands slide toward your knees. Once your hands reach the top of your knees, lower your back and shoulders back to the floor. That counts as one sit-up. Have someone time you for 1 minute. Count the number of sit-ups you can complete in this time frame. Refer to the chart at TopendSports to determine your status.

Sit-And-Reach Test: measures flexibility of your back and hamstrings (back of thigh) muscles

Equipment: Step and ruler

Technique: Place the ruler on top of the step. With your shoes removed, sit on the floor with your feet flat against the step and slightly separated so that the ruler is in the middle of them. Your knees should be flat on the ground. Place one hand over the other and lean forward, reaching as far as you can with your hands. Hold the position for a count of two. Have someone measure where the tip of your fingers meet on the ruler. Repeat the test 3 times, taking the best score of the three. Refer to the chart at TopendSports to determine your status.

When performing the above tests, try to accurately follow the procedures. A variance in technique could result in erroneous scores. Do not be discouraged if you do not fare as well as you anticipated. Your objective should be to develop goals and an exercise program that will allow you to improve upon your fitness. After a month of following your exercise routine, repeat the testing.

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:

TopendSports

ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, sixth edition

You needn't worry about experiencing any delays when you take this flight. Prompt arrival to your destination is anything but short of a guarantee. No, I am not speaking about air travel, but I am suggesting that you ascend your way to fitness by climbing a flight of stairs (or two).

Public health officials strongly advocate that you opt to take the stairs instead of an elevator while your are at work and/or the mall in order to boost your daily activity level. I am challenging you to take this recommendation a "step" further. Why not swap a session of your regular exercise program for a workout on the stairs once or twice a week? Need a good reason? For one, you burn almost twice as many calories by climbing the stairs than you would if you were to walk at a brisk pace of 3.5 mph for the same amount of time (e.g., about 143 calories versus 72 calories, respectively, in a fifteen minute time period for a person weighing 150 pounds). Other benefits of stair climbing include:*

• Improved aerobic capacity
• Reduced body fat
• Smaller waist circumference
• Lower blood pressure (diastolic blood pressure)
• Decreased LDL (bad) cholesterol

*Information based on a study published in the European Heart Journal (2008) in which 69 subjects exclusively used the stairs for 12 weeks while at work in a hospital.

A bonus to a stair workout is that it strengthens your quadriceps (front thigh), calf, and buttocks muscles as you "carry" your own weight against gravity. You can easily adjust the intensity of your workout by how quickly you ascend the flight and whether you take one step at a time or skip a step. Depending on your fitness level, the stair landing can be used either to rest or to perform strength training exercises (wall push-ups).

Stair climbing is a readily accessible activity that can be taken indoors when weather conditions are inclement. Precautionary measures should be taken when choosing to use the stairs for your workout. Because stair climbing places great demands on your body, you should seek the approval of a physician to ensure you do not have any underlying conditions that warrant treatment and management prior to beginning a program. Stair climbing may not be a good exercise alternative for you if you have arthritis, particularly in your knees or hips. If you have back problems you might want to opt for another form of exercise.

Safety Tips for the Stair Climbing Workout:

• Seek your doctor's approval.
• Wear comfortable, well-fitted shoes with good arch support.
• Inspect the stairwell to be used for hidden hazzards
• Watch out for doors opening at floor exits.
• Warm-up for 5 minutes prior to the session.
• Progress slowly, especially if you are new to exercise in general. For a novice, consider walking up 1 flight of stairs followed by a 1-2 minute rest period. Alternate this scenario until you have completed 10 minutes of actual stair climbing (do not factor in time spent resting). Your goal should be to progress to an uninterrupted 10 minute session of stair climbing (that is, you do not need to rest in between flights climbed). Once you can complete 10 minutes comfortably, continue the progression until you can climb for 20 minutes, and then eventually for 30 minutes. For individuals accustomed to exercise, consider walking up 1 flight of stairs, followed by running up the next. Continue this pattern for 30 minutes. For both groups, a goal may be to add a 1/2 to 1 flight of stairs per week.
• Cool-down for 5-10 minutes
• Choose a stairwell that is well-lit with adequate ventilation.
• Let someone know where you will be and your estimated time of return in the event of an emergency.
• Carry your cell phone with you, especially if choosing a public stairwell that is in a remote area of the building.
• Discontinue exercise if symptoms such as dizziness, lightheadedness, unusual shortness of breath, and/or chest discomfort occur. Seek medical attention if needed.

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:

Compendium of Physical Activities: Classification of Energy Costs of Human Physical Activities.

European Heart Journal (2008) 29 )Abstract Submission), pp. 385-386, Meyer, P. et. al

"The Stair Climbing Workout - Stairs are Everywhere and They Provide a Great Workout," April 19, 2007, Beecher, J.

If your goal is to increase your muscular strength this year, your first step should be to turn off the television. A recent Finnish study published in the November 2009 issue of Medicine & Science in Sports & Exercise found that young adults (mean age 19.1 years) who watched more than 2 hours of television per day had lower levels of muscular fitness, despite regular participation in moderate-vigorous physical activity, when compared to individuals who viewed less than 2 hours of TV per day. This effect was more pronounced in females who watched high amounts of television than in males, although both genders had lower muscular fitness levels associated with higher levels of television viewing.

The muscular fitness levels of 874 subjects (381 males and 493 females) were assessed from trunk flexion, extension, and rotation strength tests and a jumping height test (countermovement jump) which measured the speed-strength of the leg extensor muscles. Subjects self-reported hours of physical activity and television viewing. Males performed better on all strength tests than did the females and they were more physically active. However, there was no significant difference between genders in the amount of television viewed.

Males who watched high amounts of television had lower scores on the trunk extension and flexion tests compared to their male counterparts who viewed fewer hours. Those females who watched more than 2 hours of television per day scored significantly less on all tests compared to the women subjects who watched less than 2 hours of television per day. All subjects who reported participation in high levels of physical activity exhibited better scores on the muscular fitness tests.

Prior research has indicated that prolonged periods of sitting are associated with a greater incidence of mortality from cardiovascular disease and all causes, except cancer - irrespective of activity level (see "Don't Take it Sitting Down," May 14, 2009). Investigators from the recent Finnish study state that their research is the first to report findings of an association between high amounts of TV viewing and lower muscular fitness levels in young adults. The researchers also highlight that low levels of physical activity and an increased volume of television viewing are independently associated with poorer muscular fitness scores.

Investigators were stunned that about half of the Finnish subjects studied viewed at least 2 hours of television per day, accumulating almost a total of 15 hours of TV watching in a week's time. For Americans, who on average watch more than 4 hours of television per day according to Nielsen ratings, the impact on muscular fitness could be greater. The researchers note that this time could be spent participating in activities that promote health and fitness.

A limitation of this study is that the physical activity levels were self-reported and mode of exercise was not recorded. The poorer muscular fitness levels observed in the study, despite regular physical activity, could be a reflection of a lack of participation in strength training exercises. Investigators encourage young adults to follow recommendations to include strength training activities of the major muscle groups of the body at least 2 times per week. And, that television viewing should be limited to less than 2 hours per day.

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.

Resource:

Medicine & Science in Sports & Exercise, November 2009, Volume 41, Number 11, pp. 1997-2001, "Muscular Fitness in Relation to Physical Activity and Television Viewing among Young Adults," Paalanne, N.K. et al.