Thankfully, there is not a "one size fits all" exercise routine that must be followed. Simply put, your fitness goals dictate the exercise order. This gives you the freedom to focus on the areas of your interest and needs. For the average recreational athlete whose goal is to achieve overall fitness and good health, exercise order is a matter of personal preference and comfort.  Competitive athletes seeking improvements in performance and skill, however, need to pay closer attention to the order in which they train their muscles and cardiovascular system to ensure they are getting the most from their exercise session. Here are a few points to consider when deciding the proper protocol for you:


Improvements in Aerobic Capacity
If your goal is to increase cardiovascular endurance, then aerobic training should occur first in the exercise session. Weight training prior to the aerobic phase could fatigue your muscles. As a result, you may need to either reduce your exercise intensity or prematurely end your aerobic workout, both of which could impair your aerobic capacity in the long run.

Improvements in Muscular Strength and Power
Weight training should occur first in the exercise session when greater muscular strength and power are desired.*  Weight lifting is most effective when your muscles can be challenged at maximum ability.  Performing cardio training first will lower the threshold and limit the amount of weight that you can lift. Furthermore, your ability to maintain proper form while lifting may be compromised if your muscles have been fatigued from aerobic exercise, increasing your risk for injury. Improved muscle recovery is another advantage of weight training prior to aerobic training. The aerobic exercise will help to enhance blood flow and nutrients to the taxed muscles and will facilitate waste removal.

Other Points to Consider
Regardless of whether you do cardio or resistance training first, you should always start with a warm-up. The warm-up should consist of 5 to 10 minutes of mild aerobic activity, such as walking or cycling. A warm-up allows your muscles and cardiorespiratory system to adequately adapt to the increased demands of the training session. A cool-down should also be performed at the end of the exercise session. This will help to facilitate blood flow back to the heart and brain, reducing your risk for untoward events, such as abnormal heart beat or fainting spell.


*Note: during the resistance training phase, exercises to improve muscular power should be performed before exercises to enhance muscular strength.


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. 
 
 
References
American College of Sports Medicine Position Stand: Progression Models in Resistance Training for Healthy Adults
 
American Council on Exercise

"I have learned that success is to be measured not so much by the position that one has reached in life as by the obstacles which he has overcome while trying to succeed."

-- Booker T. Washington

Let's face it, setbacks can be down right devastating, but they needn't be. Maintaining a healthy lifestyle is challenging for many. It is a journey inherent with detours. The good news is, however, that you can regain control with a few strategies.

Tips for a Strong Come Back:

Shake it off and move forward.  Too often a lapse is misconstrued as a failure that ends all; and so, we go back to the old ways. Instead, a setback should be viewed as a learning experience that can propel us forward.

"One can choose to go back toward safety or forward toward growth. Growth must be chosen again and again; fear must be overcome again and again."

-- Abraham Maslow

Find your motivation. At the core of successful change is the desire and determination to become a better you, a happier you, and a healthier you.

"He who has a why to live for can bear almost any how."

--Friedrich Nietzsche

Redefine your goals. Sometimes, a setback occurs because the goal was unrealistic and a new goal needs to be defined.

"Fixing your objective is like identifying the North Star--you sight your compass on it and then use it as the means of getting back on track when you tend to stray."

--Marshall E. Dimock

Think progress, not perfection. Failure is inevitable when perfection is expected. Healthy living is a process, a task that requires continued effort.

"It is good to have an end to journey toward, but it is the journey that matters in the end."

--Ursula K. Le Guin

Negative energy balance -- that's the goal if you want to achieve weight loss. Some say you can facilitate this process by exercising on an empty stomach. The reasoning is that your glycogen stores are low from fasting; therefore, your body will have to tap into your fat stores to provide energy to fuel the exercise.  It seems plausible, but evidence from a small study conducted in Italy suggests the contrary.

Researchers evaluated the differences in fat metabolism between training in the fed and fasting states. Each subject underwent two testing conditions. They were randomly assigned to exercise either under the fasting or fed condition first. They then returned to be tested in the opposite circumstance, with an interval of one week between testing situations.

In the fasting scenario, subjects exercised in the morning after a 12 hour fast; they then ate a standard breakfast. In the fed condition, subjects ate a standard breakfast before exercising. In both testing conditions, all subjects exercised for 36 minutes on the treadmill at an energy expenditure that was equivalent to 65 percent of their heart rate reserve. Oxygen consumption was measured before, during and at 12 and 24 hours post exercise. Substrate utilization (e.g., fat versus carbohydrate metabolism) was estimated from the respiratory exchange ratio (i.e., the amount of carbon dioxide produced to oxygen consumed).

The results indicated that although an increase in carbohydrate metabolism occurred initially under the feeding condition compared to the fasting state, metabolism later shifted toward utilizing fat stores at 12 and 24 hours post exercise for the fed scenario. Furthermore, oxygen consumption values remained higher at 12 and 24 hours post exercise in the fed state, indicating that metabolism was faster.

The investigators concluded that eating prior to exercise will result in a greater improvement of fat utilization over long periods when compared to exercising on an empty stomach. It should be noted, however, that the subject sample of this study was quite small--only 8 men were tested. Further research with a larger sample size is warranted. 

An important point is that individuals react differently. You may need to experiment with the timing of meals and the type of foods consumed in order to find the weight management protocol that works best for you.


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

Reference
International Journal of Sport Nutrition and Exercise Metabolism, 21, 2011, 48-52, Antonio Paoli, et al.

If I were to ask you to name a type of athlete, would singer come to mind? Probably not, but now think about George Frideric Handel's "Halleluljah Chorus" from his musical masterpiece "Messiah." Can you imagine the degree of stamina and the amount of lung capacity that is required by choral singers to perform this piece?

The Centers for Disease Control and Prevention state that "singing while actively moving about" requires an energy expenditure of about 3 to 6 METS. On the lighter intensity side, this would require an effort equivalent to ballroom dancing.  On the more vigorous end, singing would equate to playing a match of doubles tennis.

Strong epidemiological evidence to support the role of signing in promoting health and well-being is still somewhat lacking; however, there is preliminary evidence to suggest that it may be beneficial physically, mentally, emotionally and socially--especially for older adults and individuals with lung disease.


Proposed Health Benefits of Singing

• Stronger respiratory (breathing) muscles
• Increased lung capacity
• Greater aerobic endurance
• Improved posture
• Stronger immune system
• Increased blood circulation
• Improved memory/mental alertness
• Increased energy
• Decreased stress and anxiety
• Enhanced mood
• Increased self-esteem/self-confidence
• Greater social connectedness

Although there is not enough evidence currently to suggest that singing can be used to replace a traditional exercise program, it is an activity that can be used to complement such a regimen.  At the very least, singing a happy tune can help you to pass the time during your workout -- something that I, myself, have been known to do.

References
Centers for Disease Control and Prevention

Singing and Health: Summary of a Systemic Mapping and Review of Non-Clinical Research: Stephen Clift, Rosalia Staricoff and Christine Whitmore; 2008

The advice seems easy enough to execute -- if you do not want your child exposed to media content you deem unacceptable then simply "change the channel or turn off the television." Unfortunately, pulling the plug on the TV in your own home may not be enough to curtail the beginnings of an eating disorder in your son or daughter. Data from recent research conducted by investigators from Harvard Medical School's Department of Global Health and Social Medicine indicates that the nature of the television shows viewed by your child's friend is a greater predictor of whether or not your child will develop an eating disorder than is the type of shows she watches directly.

The study, which was published in The British Journal of Psychiatry, investigated the impact of direct and indirect television viewing on adolescent girls in Fiji. Why Fiji? Broadcast television only became available in Fiji in the mid-1990's and home ownership of television sets still varies among the Fiji communities.  These circumstances create an ideal situation in which to test the impact of television on eating behaviors.

Traditionally, a more "robust body shape" has been favored in Fiji.  Broadcast television challenged this perception by introducing the concept of a thinner body frame. Prior research conducted by the investigators of the current study found that symptoms of disordered eating increased in Fijian adolescent girls when broadcast television became accessible. The current study was designed to determine the impact of direct and indirect mass media exposure on eating behaviors.

Investigators studied 523 adolescent girls, ages 15 to 20 years. Every participant's body weight and height was recorded. Each subject's eating behavior was assessed using the Eating Disorder Examination Questionnaire. The influence of mass media on each individual was determined via the Sociocultural Attitudes Towards Appearance Questionnaire. Furthermore, the type of media exposure was evaluated using four measures: frequency of personal TV viewing; accessibility of household electronic media; frequency of parental TV viewing; and, social network media exposure (e.g. how many of the subject's friends and schoolmates watched TV).

The results of the investigation revealed that both direct and indirect exposure to mass media increased the risk for disordered eating; however, indirect exposure to mass media was associated with a greater prevalence of eating pathology after adjusting for factors such as age, community location, and cultural orientation. The researchers concluded that as the perceptions of friends and schoolmates within one's social network change to favor a thinner body shape as a result of television viewing, the individual's likelihood of developing an eating disorder is increased.

Symptoms of Eating Disorders

• Restricted eating (e.g., limiting calories, eliminating food groups from the diet, etc.,)
• Purging (e.g., excessive exercise, vomiting after meals, use of laxatives, etc.,)
• Binging (e.g., compulsive eating, over eating, etc.,)
• Eating rituals (e.g., eating foods in a specified order or only eating at specific times of the day)
• Excessive weighing
• Preoccupation with appearance
• Intense fear of gaining weight
• Low self-esteem
• Distorted body image
• Excessive weight loss
• Disturbances in menstrual  cycle

If you suspect that a loved one has an eating disorder, seek the advice of your health care professional.

Reference
The  British Journal of Psychiatry (2011), 198, 43-50 "Social Network Media Exposure and Adolescent Eating Pathology in Fiji"; Anne E. Becker et al.,.

ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, Sixth Edition

Maintenance of a healthy body weight, improved cholesterol levels, reduced risk for chronic diseases, elevated mood--all of these benefits of exercise are readily discussed; but, are you aware that regular exercise can enhance your sexual health as well? Humans are sexual beings; and, sexual intimacy is a means by which healthy relationships can be fostered.  Sexual dysfunction can lead to stress and anxiety and decreased self-esteem.  Several studies have shown that regular exercise is associated with a decreased risk for sexual dysfunction.

What Research Has Shown:

• Erectile dysfunction is more likely to occur in men who are overweight and/or are sedentary. (ACE)
• For both men and women, a higher body mass index is associated with decreased sexual satisfaction. (Lindeman 2007)
• Individuals who engage in increased levels of physical activity are more likely to report higher levels of sexual satisfaction, with active men reporting greater levels of satisfaction than active women; however, women who perceive themselves as having increased physical flexibility report higher levels of sexual satisfaction than those women who perceive themselves as being less flexible. (Lindeman 2007)
• For men, an increased fitness level is associated with improved perceptions of sexual desirability and performance. For women, an increased fitness level is associated with an improved perception of sexual desirability. (Penhollow and Young, 2004)
• Exercise facilitates sympathetic nervous system activity and improves blood flow and circulation to the genital area, enhancing arousal. (Hamilton 2008 and LaFalce & McNamara, 2010)
• Regular physical activity improves endurance and strength, both of which are related to improved sexual function. (Penhollow and Young 2004)
• Short bursts of intense exercise increases testosterone levels in men, which can enhance sexual interest and behavior. (Penhollow and Young 2004)
• Exercise that burns an extra 200 calories per day has been shown to have the most benefit: however, over training can decrease testosterone levels, thereby decreasing sexual desire. (ACE and Penhollow & Young 2004)

Sexuality can effect quality of life. Regular physical activity can increase and help to maintain robust sexual health.

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.

References
American Council on Exercise (ACE)

Californian Journal of Health Promotion 2007, Volume 5, Issue 4, 40-51; "Effect of Exercise on Reported Physical Sexual Satisfaction of university Students"; Holly Lindeman et al.,.

Electronic Journal of Human Sexuality, Volume 7, October 5, 2004; "Sexual Desirability and Sexual Performance: Does Exercise and Fitness Really Matter?"; Tina M. Penhollow and Michael Young.

International Society for Sexual Medicine 2008; "The Roles of Testosterone and Alpha-Amylase in Exercise-Induced Sexual Arousal in Women"; Lisa Hamilton et al.,.

The Chronicle, November 15, 2010; interview with Dr. Erin McNamara by Maggie LaFalce