Attention deficit hyperactivity disorder (ADHD) involves a spectrum of characteristics that vary in severity and presentation based on the affected individual.  In general, it is characterized by impulsive behavior, an inability to focus or pay attention, and overactivity (hyperactivity).  According to the Center for Disease Control and Prevention (CDC), approximately 3-7% of school-aged children have been diagnosed with ADHD - with that number possibly being higher in some communities.  The exact cause of ADHD is unknown, however, it is speculated that genetics, environmental factors, brain injury, and/or dietary habits may be factors.

ADHD can be very frustrating for the affected individual, as well as, those with whom they interact on a regular basis.  Medication and psychotherapy are common forms of treatment, as well as dietary adjustment.  Recently, research is indicating the important role that exercise plays in managing and treating ADHD.

It is believed that physical activity alleviates ADHD symptoms because exercise boosts the levels of serotonin, dopamine, and norepinephrine - hormones that play a role in the brain's ability to focus and pay attention.  Furthermore, as is the case with the general population, exercise is known to boost mood, decrease stress and anxiety, and foster memory and creativity - all traits that can impact ADHD behavior indirectly.

How often and how long should individuals with ADHD exercise?
As is with the general population, exercise should occur on most days of the week for at least 30 minutes per day.  Adults should aim for 150-300 minutes per week of moderate-intensity physical activity.  Children and adolescents need at least 6o minutes per day of active play/exercise.

What is the best form of exercise for the individual with ADHD?
Exercise that requires attention to body movement in space, such as gymnastics, aerobic dance, and martial arts.  Evidence supporting the role of Tai Chi in reducing the symptoms of ADHD was presented earlier this week at the American Psychiatric Association (APA) 2010 Annual Meeting.  Researcher Dr. Peng Pang found that the practice of Tai Chi improved hyperactivity, ADHD index scores, and cognitive skills of adolescent subjects who participated in these exercises for 6 weeks during a summer respite program.

Although exercise that requires "mindful" movements may be of particular benefit to the individual with ADHD, any form of exercise that is enjoyable and that can be maintained as part of a healthy lifestyle is encouraged for its other health benefits.  It should also be noted that exercise should be part of a combination of approaches that manage and treat ADHD symptoms.  Individuals affected by ADHD are encouraged to discuss any questions or concerns regarding the disorder with their personal physician or health care professional.

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:
HelpGuide.org "ADD/ADHD Treatment and Help," Block, J and Smith, M.

Medscape Medical News, May 26, 2010, "Tai Chi May Improve Some ADHD Symptoms," Helwick, C.

The differences between men and women do not stop at their approach to exercise.  Gender plays a role in factors that motivate an individual to exercise and stick with it.  Two recent studies highlight these differences.  One investigation (February 2007) conducted on college students at Indiana University found that many factors played a role in adherence to an exercise program for female students.  These reasons and personality traits included:

• To promote positive body image
• Presence of confidence in personal ability to use exercise equipment
• Preference for aerobic exercise (e.g., running or swimming)

There was only one predominate factor predicting exercise adherence for the male students - weight training.  The study found that the male subjects were more likely to exercise if strength training was part of their program than if the regimen consisted of aerobic exercise alone.  Furthermore, the study results indicated that those factors that motivate women to stick to an exercise program (positive body image and confidence in abilities) have no affect on maintenance for men. Women were consistent with exercise regardless of whether strength training was a part of the program or not.

Another study comparing the influence of gender on exercise behavior was conducted at Temple University in Philadelphia (April 2010).  Researchers studied 906 marathon runners.  They found that female marathon runners were more likely to focus on the achievement of personal goals (e.g., improvement of mood and overall mental and physical health) to motivate their participation, while men were more likely to emphasize competition as a predominate motivator.

The findings of these recent studies support similar results from investigations conducted in the past. Women tend to exercise more for health and fitness reasons.  Men concentrate more on numbers (e.g., number of pounds lifted during weight training) and competition (e.g., overall placement in a race).

Why is this information important?  It is a reminder that there is not a "one-size fits all" approach when it comes to exercise.  Understanding the factors that play a role in motivation can help individuals to set personal fitness goals and to develop a plan to achieve those goals.

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:
MedicineNet.com  "Are Male Marathoners More Competitive Than Women?" April 17, 2010, Preidt. R

Indiana University Media Relations, February 2007 "The Exercise Hook:  It's different for men and women." Stednit,. B. and Arvin, C.

Percept Mot Skills, 1998 Apr;86(2):723-32, "Sex differences in exercise motivation and body-image satisfaction among college students," Smith, B.L. et al,.

Do you need to lose body fat?  Exercising four or more times per week can help you to achieve this goal, according to a study published in the November 2009 issue of The Journal of Strength and Conditioning Research.  Investigators evaluated the changes in body composition of 80 previously sedentary and deconditioned adults (ages 22-74 years) who began an exercise program based on the U.S. Surgeon General's guidelines to "exercise most days of the week."  The study was designed to specifically determine the role that frequency itself had on changing body composition.

The study lasted 8 weeks during which the subjects were instructed to exercise continuously for 30 minutes at a moderate-intensity (70% of their maximum heart rate), 4 times per week.  The participants exercised using either a 10-piece circuit training system or cardiovascular equipment.  Subjects were not prohibited from exercising more often than the prescribed amount.

The subjects' body composition values were determined before and after the study using a BodPod (air displacement plethysmography).  After completion of the study, the participants were divided into 4 categories based on their compliance to the frequency recommendation for exercise.  These categories included:

• Control group - individuals who chose not to exercise (20 subjects)
• Exercised less than 2 times per week (20 subjects)
• Exercised 2-3 times per week (20 subjects)
• Exercised 4 or more times per week (20 subjects)

With the exception of the control group (those who did no exercise), all groups lost body fat.  However, those subjects who exercised at least 4 times per week lost significantly more body fat than their counterparts (p=0.004).  The investigators conclude that the U.S. Surgeon General's recommendation to "exercise most days of the week" yields significant improvements in body composition for previously sedentary individuals.

Regular exercise is essential to improve overall health.  You can achieve favorable effects on body fat mass by following an exercise program that involves you to be physically active on at least four days per week.

Note:  Prior to beginning an exercise program or increasing the intensity level of an existing one, seek the approval of your physician, especially if you are at risk for or currently have chronic health conditions.


Resource:
J Strength Cond Res. 2009 Nov:23(8):2377-80 "Frequency of Exercise for Body Fat Loss: A Controlled, Cohort Study," Willis, F.B. et al,.

The American Heart Association (AHA) and Nintendo of America have joined forces to get Americans active through virtual play.  Approximately 70% of the nation's population do not meet the current recommendations for physical activity to promote health (approximately 150 minutes per week of moderate-intensity exercise).  Time constraints and perceptions that exercise is not enjoyable are top reasons for why Americans don't engage in physical activity.

The AHA and Nintendo hope that by joining forces they can reach a broader audience and "Inform", "Empower,"and get American's "Active".  Their goal is to increase the awareness that active-play video games, such as the Wii Fit Plus and Wii Sports Resort, can be a means by which individuals increase their physical activity levels as part of a healthy lifestyle.  This joint force will help Americans to:

• Get Informed:  Soon, American's will notice that the packaging for Nintendo's active-play video game products, such as Wii Fit Plus and Wii Sports Resort, will begin to carry the American Heart Association brand to remind people to "Get Active" for optimal health.  As part of their "Get Informed" campaign, the AHA and Nintendo have created an online resource, www.activeplaynow.com, where Americans can find tips and information about how to increase daily physical activity in an enjoyable way.
• Get Empowered:  Americans are encouraged to think "outside the box" and get creative with the ways they increase their daily physical activity.  The AHA and Nintendo want to help Americans take control of their health by making exercise fun through active-play video games and participating in the AHA's Start! Heart Walks.  
• Get Active:  Exercise can be fun and easily accessible.  Nintendo's active-play video games are enjoyable and can be performed in the comfort of your own home.

Exercise is necessary, but it shouldn't feel like a chore.  If physical activity is enjoyable you are more likely to continue it for a lifetime.  By getting creative and thinking "outside the box," you can find ways to include exercise as part of a healthy lifestyle.  Active-play video games is one way to accomplish this.

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.

My decision to write today's post was inspired by a comment left in response to my posting, "Fitness Personality."  In that post I neglected to address those individuals who hate to exercise, a category under which I know many people would claim they fall.  So, what are you to do if you don't like to exercise?  How do you get yourself to do something that you despise?  I offer some advice below.

• Make it informal.  If traditional modes of exercise bring about negative flashbacks to elementary school gym class, forgo them.  Health can be improved just by increasing your daily activity above and beyond what you are doing currently.  For instance, a grocery shopping trip is a great way to sneak in a little extra exercise.  Park further away from the entrance so that you have to walk an extra distance to and from the car.  Once in the store, before loading your cart, walk the perimeter of the store's interior, then begin shopping.
• Make it fun.  If you don't enjoy it, you won't do it.  Make a "game" out of it.  For instance (going back to the grocery shopping example), before walking the perimeter of the store give yourself a challenge, such as trying to make it around the store before the last customer in line is waited upon.  Or, see how many times you can make it around the store before the last customer in line is checked out.
• Make it social.  Invite friends and family to join you in a walk around the block after dinner.  It can be a good way to catch up on what happened during the day.
• Put it in writing. Journal your adventure and share your writings with others (through a blog perhaps?) who may learn from your experience.

You do not have to exercise for prolonged periods of time or engage in traditional forms of activity to get health benefits.  As little as 10 minutes at a time, performed at least 3 times throughout the day can have a protective effect.  The point is to reduce the time you spend sitting and to increase the time your body is moving.

Are you someone who doesn't like to exercise, but has found ways to motivate yourself to do it?  I would like to hear your thoughts and suggestions. Comment below so that we may all benefit.

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.

Businesses big and small around the country are looking to cut costs while at the same time trying to improve the well-being of their employees.  Both goals can be accomplished by providing a corporate wellness program for workers.  Approximately 130 million Americans are in the workforce, with many of these jobs entailing long periods of sitting - a situation that is associated with an increased risk for the development of chronic diseases.

Companies are spending an estimated 25-30% per year in health care costs as a result of risk factors for heart disease and stroke, such as high blood pressure, abnormal cholesterol levels, smoking, diabetes, obesity, and physical inactivity.  Worksite fitness and health education programs are a proven solution.

Benefits of a Corporate Wellness Program:

• Decreased absenteeism rates (which translate into an estimated savings of $2.73 per every dollar spent on providing a worksite wellness program)
• Increased worker productivity
• Lower employee turnover
• Reduced health care costs (an estimated savings of $3.27 per every dollar spent on providing a worksite wellness program)
• The "ripple effect" - health benefits extend beyond the workplace as families of enrolled employees tend to adopt healthier lifestyle choices as a result of the employee's experiences from the corporate wellness program 

Worksite wellness programs run the gamut of sophistication, from fully equipped fitness centers and weekly nutrition and health lectures to only the presence of "point-of-decision" prompts (e.g., signs posted by elevators that recommend using the stairs instead).  Some easily incorporated practices that employers can use to promote health and physical activity in the workplace include:

• Designate a walking route:  Distance markers can be placed in the halls of the office building or around the outside perimeter of the complex.
• Form walking groups:  Employees can sign up to join an office walking club.  Multiple groups can be formed and friendly competitions and challenges can be initiated to increase motivation.
• Offer employees incentives for enrolling in the program and/or achieving health and fitness goals. Ideally, incentives should promote health - such as a free yoga class if the employee stops smoking.
• Send out weekly emails and/or newsletters promoting healthy lifestyle habits and offering practical tips and heart-healthy recipes.
• Offer free blood pressure screenings and fitness assessment tests.
• Provide a monthly inservice devoted to increasing the awareness of risk factors associated with chronic diseases

Institutions, such as the American Heart Association (AHA), offer corporate wellness program toolkits for companies interested in offering such programs for their employees.  The AHA's Start! Fit-Friendly Companies Program acknowledges and rewards companies who take the initiative to promote their employees health and well-being.

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 Heart Association

AHA Policy Statement, October 27, 2009, "Worksite Wellness Programs for Cardiovascular Disease Prevention," Carnethon, M. et al,.

A common sale's pitch made by many manufacturers of weight loss products is, "Fight Fat with ...[insert said product]."  These companies want you to believe that you can effortlessly lose weight by using their product.  It is interesting that the word "fight" is chosen regarding weight management.  In a way, it seems to undermine their message that weight loss can be effortless.  Personally, I have always defined "fight" as a struggle or a battle - something that takes effort in order to be triumphant.

The hope of effortless weight management is all too tempting, something that, ironically, many Americans have put more time and effort into trying to achieve than if they just did the physical work needed to manage body weight in the first place.  This wish for an "easy way out" has resulted in a major public health crisis that transcends many levels.  As a society, we are now faced with a true "fight," if not an all out war, against fat.

Earlier this week, the first National Physical Activity Plan was released.  This Plan, the first of its kind, is devoted to "[creating] a national culture that supports physically active lifestyles."  That is, the nature of work and school environments, neighborhoods, and cities will be changed to encourage physical activity, allowing it to be readily incorporated throughout the day.

The goal of the Plan is to enhance quality of life by preventing disease and disability and by promoting health.  Under the Plan, 8 areas of society (Business and Industry; Education; Healthcare; Mass Media; Parks, Recreation, Fitness and Sports; Public Health; Transportation, Urban Design and Community Planning; and Volunteer and Non-profit Organizations) will collaborate to implement strategies for change.

The fight against fat is truly that - a fight.  There are no quick fixes where weight management is concerned.  It requires the realization that the attainment of health and well-being requires effort.  Fortunately, with the implementation of the Plan, it will be a collaborative one.

To learn more about the National Physical Activity Plan visit www.physicalactivityplan.org.

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.

Don't like to exercise you say?  Maybe you just haven't found the right activity for your personality.  Picking a mode of physical activity that appeals to you can be likened to buying a pair of shoes - you have to keep trying different types and styles until you find the one that fits.  Taking into consideration factors such as your personality and fitness goals can help you to determine which mode of exercise is the best and most enjoyable for you.

In a report released last month from the American College of Sports Medicine's 14th Annual Health & Fitness Summit & Exposition, sport physiologist, Michael Bracko, Ed.D, FACSM is cited as saying "those seeking motivation to start an exercise program should first determine their 'fitness desire.'"  He outlines 5 categories of fitness that you should consider when finding a regimen that works best for you.  They include:

• Recreational Athlete Fitness: If your goal is to attain general fitness through cross-training, this category depicts you.  The recreational athlete tends to be interested in a particular sport (e.g., softball).  This focus provides you with the motivation to be active.
• Health-Related Fitness:  You fall into this category if your goal is to improve your well-being in general.  Walking, Pilates and Yoga are examples of this form of training.
• Functional Fitness:  Examples of this category include gardening and bowling. Functional fitness exercises are for you if your desire is to achieve and maintain independence with advancing age and/or to be able to complete activities of daily living without undue fatigue.
• Physical Fitness:  A traditional exercise program that incorporates aerobic, strength building, and flexibility activities is an example of this category.  Going to a health club to participate in group classes (e.g., Spinning, Zumba, etc.,) or using the facility's weight machines would suit you if you fall under this category.
• Elite Athlete Fitness:  The goal is to succeed in a specialized sport or event, such as a triathlon.  This category involves intense, sport-specific training to improve your performance rather than to enhance your fitness level and/or health.

In which category do you fall?  Not certain?  Keep trying different forms of activity until you find the one that is the most enjoyable and meets your needs.  Keep in mind that a cross-over between categories is possible.  For instance, you can be interested in general fitness, but need the motivation of a little competition to keep you going.  In this scenario, training for a 5K road race might be the right choice for you.

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:

ACSM News Release April 9, 2010, "The Art of Finding Motivation For Lifelong Fitness," Bracko, M.