When I was pregnant with my first child, my obstetrician, as well as the pregnancy-related literature, emphasized the importance of taking prenatal vitamins and consuming a nutrient dense diet because I was "eating for two."  The premise being that a proper diet would aid in the growth and the development of the baby inside me, giving it a healthier start once born.  Exercise was discussed, but the message focused more on the maternal health benefits and the infant's weight at birth.  Current research is now looking at the importance of "exercising for two" in regard to its long-term effects on the body size of children ages 8-10 years.
Investigators from Michigan Sate University evaluated the relationship between maternal leisure time physical activity and body mass index (BMI), body fat percentage, and waist circumference (WC) during a child's pre-adolescent years.  Subjects included 20 mother/child pairs.  Height, weight, percent body fat, BMI, WC (obtained from children only), and fitness levels were assessed for the pairs.

Results of the study indicated that a mother's pre-pregnancy leisure time physical activity level was inversely related to her child's percent body fat at ages 8-10 years.  Maternal leisure time physical activity level during the second trimester also appeared to have a significant inverse correlation with child body size in reference to WC.  A trend toward this pattern was noted for maternal activity levels during the third trimester.  However, no correlation was noted between maternal exercise habits during the first trimester and child body size.  Also of note was that an inverse relationship existed between current materanl fitness and BMI, percent body fat, and WC of the pre-adolescent.

The investigators concluded that leisure time physical activity during pregnancy, particularly during the second and third trimesters, has a positive effect on child body size later in childhood (8-10 years of age). And, mothers who are more fit during the years after giving birth are more likely to have children who have lower BMI, percent body fat, and WC levels.  The researchers also suggested that their findings provide evidence that maternal physical activity during pregnancy improves the in-utero environment, making it more conducive to developing a child who will have a healthier body size during the pre-adolescent years.

Pregnant women need to not only focus on eating well for two, but on participating in healthy exercise for two. Women should consult their physician regarding the safety of exercise during pregnancy.

Note:  Before beginning an exercise program or increasingthe 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.

Source:
Sports Medicine Bulletin, "Active Voice: More Maternal Physical Activity May Lead to Leaner Pre-Adolescent Children," Pivarnik, J.M.

Medicine & Science in Sports & Exercise, Vol. 42 No. 5 Supplement Abstract 998, "Maternal Physical Activity and Child Body Size at 8-10 years," Kuffel, E.E. et al.,.

New physical activity recommendations for cancer patients have been published in the July 2010 issue of the Medicine & Science in Sports & Exercise.  The guidelines are a result of the ACSM Cancer Roundtable held last June.  Thirteen experts in the fields of cancer, fitness and exercise training, and obesity convened to review and analyze the literature with respect to the safety and efficacy of participation in routine exercise programs for cancer patients.  In brief here is what they concluded:

• Physical activity is safe both during and after cancer treatments for certain cancer groups* (e.g., colon, breast, gynecologic, prostate, and hematologic forms of cancer).
• Cancer patients (e.g., those with colon, breast, gynecologic, prostate, and hematologic forms of cancer) who exercise improve their quality of life, decrease cancer-related fatigue, and increase physical functioning.
• The role of exercise in disease outcomes and survival rates is yet to be determined.

*Guidelines have not been developed for patients with other forms of cancer due to a lack of evidence at this point to support exercise recommendations.

The general goals** of an exercise program for the cancer patient, as outlined by the roundtable, are:

• To restore and increase physical function, aerobic fitness, muscular strength, and flexibility.
• To enhance body image.
• To improve quality of life.
• To improve body composition.
• To improve physiological and psychosocial outcomes.
• Management of anxiety.
• To minimize, alleviate, and counteract side effects of cancer treatment.
• Potentially, to decrease the risk of, and to delay the recurrence of, the existing form of cancer or the development of another type of cancer.

** Note: the goals will be case-dependent.

The findings of the roundtable are great news for cancer patients who, in the past, have been told to rest and avoid exercise.  The guidelines indicate that exercise programs should be individualized based on the cancer patient's form of treatment, physiological response to the medical interventions, presence of comorbidities, and pretreatment fitness level.  For example, patients with metastatic bone disease should participate in low impact exercise due to the increased risk for bone fracture.

As part of the guidelines, the expert panel provides cancer-specific contraindications for beginning an exercise program, as well as reasons for stopping activity.  Cancer patients need to consult their medical team prior to beginning an exercise program, or if they have any concerns about a current routine.

Resources:
Medicine & Science in Sports & Exercise, July 2010, pp. 1409-1426, "American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors," Schmitz, K.H. et al.,

Medical News Today, July 1, 2010, "Exercise is Good for Cancer Patients and Survivors Say Experts," Paddock, C.

U.S. Surgeon General, Regina Benjamin, M.D., M.B.A., in Downtown Baltimore's Inner Harbor District during the Exercise is Medicine Walk.

Last week, I had the honor of being one of the members of the American College of Sports Medicine who walked in the Exercise is Medicine Walk led by U.S. Surgeon General, Regina Benjamin, M.D., M.B.A., through the streets of downtown Baltimore, Maryland during ACSM's 57th Annual Meeting.  Prior to the walk, the U.S. Surgeon General gave a speech during which she emphasized these points:

• "Just get up and have fun."
• If we want people to be healthy, then we need to give them a healthy and safe place to do it.
• One person can make a difference - be that person.
• Too often we teach about the negative aspects of being overweight and sedentary and not enough time talking in a positive way about optimal well-being (e.g., the joy that can be brought from having good health).
• It used to be that kids were active all the time without realizing it by engaging in activities such as "double-dutch," disco dancing, and roller skating.  Kids didn't have to be "prescribed" exercise, they just did it as a matter of play.

Dr. Benjamin concluded her speech by saying that individuals will change their behavior if they have a meaningful reward - one that involves each person feeling and enjoying optimal health and embracing life to the fullest.

Dr. Benjamin discusses the important role of Exercise is Medicine.

The U.S. Surgeon General's Prescription for America is:

• Be active as much as possible
• Consume fruits and vegetables on a daily basis
• Engage the whole family
• Be creative and have fun

The U.S. Surgeon General's prescription for America.

I just returned from listening to the keynote lecture held at ACSM's 57th Annual Meeting and Inaugural World Congress on Exercise is Medicine in Baltimore, Maryland.  The keynote lecturer was Bente Klarlund Pedersen, DMSC from The Centre of Inflammation and Metabolism, University of Copenhagen, Copenhagen, Denmark.  She discussed "Exercise - Why does it Work?".

Pedersen presented some interesting facts as to why "Exercise is Medicine."  They are as follows:

• Inactive individuals have a life expectancy that is 5 years shorter than their active counterparts.
• Social and environmental factors significantly influence health.  Individuals who have a friend that becomes obese have an increased risk by 171% of becoming obese themselves. Interestingly, that increased risk is only 40% when a sibling becomes obese. 
• Obesity plays a role in chronic inflammation.  The presence of persistent chronic inflammation is associated with the development of chronic diseases such as type 2 diabetes, cardiovascular disease, and Alzheimer's disease.
• Exercise induces anti-inflammatory effects.
• Exercise is effective in the prevention, management, and treatment of colon cancer, breast cancer, type 2 diabetes, cardiovascular disease, dementia, and depression.
• Obesity and physical inactivity have environmental consequences.  The increased consumption of food leads to an increase in production and manufacturing of food, thus increasing greenhouse emissions.  Using a car to get to work, rather than riding a bicycle or walking, contributes to transportation emissions.
• "People change their behavior when a change in context compels them to."

A powerful point that Bente Klarlund Pedersen, DMSC raised that I would like to end this post on is: "Those individuals who say they do not have the time to exercise, will later have to find the time for disease."

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.

Have you finally decided to sign-up for that spinning class at the gym? Or, have you determined that you want to start swimming laps at your local recreation center? These are great options for increasing your activity level and improving your overall health. But, how do you know you can participate in these and similar exercises safely, especially if you have led an inactive lifestyle up to this point?

Many chronic health conditions, such as hypertension, can be "silent." That is, you can have the condition without experiencing any symptoms. If left unchecked, these conditions can put you at an increased risk for medical complications during exercise. Other health problems, such as orthopedic conditions, can be exacerbated if you participate in the wrong type of physical activity.

For many healthy adults who are interested in starting a moderate-intensity exercise program, the risk of heart attack or sudden death is low. This risk increases, however, as the intensity of the exercise becomes vigorous. The risk also increases in individuals with cardiovascular disease. According to the American College of Sports Medicine, one death per year for every 15,000-18,000 people occurs from sudden cardiac arrest that was evoked from vigorous exercise. It should be noted that the rates for experiencing a heart attack or sudden death disproportionately increase in individuals who have been previously inactive and perform physical activity to which they are unaccustomed. Because of the lower prevalence of cardiovascular disease in individuals younger than 40 years of age compared to older counterparts, their risk of sudden death from exercise is very low. The most common causes of exercise-related death for the younger population are congenital and hereditary anomalies.

How do you know if you are an individual who is at risk when you exercise or if you should see a physician prior to beginning a program? To determine this, the American College of Sports Medicine advocates a risk stratification approach to classifying individuals into three categories: low, moderate, and high risk. The level of risk is determined by the presence or absence of known chronic diseases, the presence or absence of signs and symptoms of chronic diseases, and the presence or absence of risk factors for cardiovascular disease. The category descriptions are as follows:

Low Risk: In general, individuals who fall into this category can pursue exercise safely without getting medical clearance from their physician.

• Absence of signs and symptoms for cardiovascular, pulmonary, and/or metabolic disease
• Absence of cardiovascular, pulmonary, and/or metabolic disease
• Have no more than one risk factor for cardiovascular disease

Moderate Risk: In general, individuals who fall into this category can pursue low- to moderate-intensity exercise safely without getting medical clearance from their physician, but need doctor approval before engaging in vigorous-intensity exercise.

• Absence of signs and symptoms for cardiovascular, pulmonary, and/or metabolic disease
• Absence of cardiovascular, pulmonary, and/or metabolic disease
• Have two or more risk factors for cardiovascular disease

High Risk: Individuals who fall into this category need medical clearance from their physician prior to pursuing exercise at any intensity.

• Presence of one or more signs and symptoms of cardiovascular, pulmonary, and/or metabolic disease
• Presence of cardiovascular, pulmonary, and/or metabolic disease

Because the risk for exercise-related heart attack and sudden cardiac arrest increases with age, it is advisable that women who are 55 years of age and older and men who are 45 years of age and older seek physician approval prior to engaging in exercise. A good tool for you to use to determine if you need to seek medical advice prior to beginning an exercise program or before increasing the difficulty level of a current routine is the Physical Activity Readiness Questionnaire (PAR-Q), originally developed by the British Columbia Ministry of Health and later revised by the Canadian Society for Exercise Physiology and Fitness Canada. The PAR-Q is a self-guided screening tool for individuals between the ages of 15-69 years. It asks various questions about your current and past health history. Answering the questions truthfully will help you to determine if you need a physician's approval to engage in exercise.

Exercise can be both enjoyable and safe if you take the proper precautions. To get a general idea of your risk for a medical emergency during exercise, follow the link above to the PAR-Q form and answer the questions. If you answer yes to one or more of the questions, contact your doctor prior to beginning an exercise program or increasing the difficulty level of a current routine. Share your results of the PAR-Q with your physician so that issues of concern can be addressed. If at any point in your journey to improve or maintain your fitness level you question your health and safety during exercise contact your doctor for a thorough medical screening.

Resources

ACSM Current Comment "Off the Couch and Active: When to see a Physician Before Exercising," Kohl, H.W.

ACSM Guidelines for Exercise Testing and Prescription, Eighth Edition

Canadian Society for Exercise Physiology

     Each generation has nutritional and exercise requirements unique to its age group.  The period during which you were raised influences your health behavior and practices as an adult.  Advancements in the field of medicine and a greater understanding of the importance of healthy lifestyle habits has changed the view of aging for the baby boomer population.

     However, advancing age, regardless of fitness level and nutritional status, does result in inevitable changes to the body.  One of the better known physiological changes is a decrease in muscle mass, at an average rate of 0.5-1.0% per year after the age of 40.  Bone mass also declines.  Energy needs change as a result of these alterations in body composition.  In the baby boomer generation, compared to the preceding generation (individuals born between 1926-1945, a.k.a., the "silent generation"), increased rates of obesity at an earlier age have been noted.  Associated with this is an increased relative risk of arthritis for boomers.

     Another age-related change of which the boomer needs to be cognizant is a decrease in gastrointestinal (GI) function.  GI tract motility is reduced and the absorption of calcium, Vitamins B6 and B12, and possibly iron and zinc, is decreased.  

     Older boomers may experience a decreased capacity to dissipate heat, increasing the risk of developing heat exhaustion or heat stroke during exercise.  With advancing age, blood flow to the skin is reduced and sweat production per gland is decreased.  Both processes are mechanisms by which the body cools itself.  

     As a result of these age-related changes, there are some general health tips that the boomer should follow.  It is important for members of the boomer generation to note that, as they age, their nutritional requirements change.  Thus, protein needs may be higher to attenuate muscle mass loss.  However, since many Americans already consume more than the RDA for protein (46 grams/day for women over 31 years and 56 grams/day for men over 31 years), baby boomers should concentrate on the form, not just the quantity, of protein that they consume.

     Boomers should aim to meet the RDA for protein by eating protein sources that have a high biological value (contain the essential amino acids).  These sources are referred to as complete proteins and include eggs, lean meats, poultry, fish, and low-fat dairy products.  Foods that have a low biological value, also known as incomplete proteins because they are missing at least one essential amino acid, can be combined to constitute a high biological value protein source.  These sources include whole grains, vegetables, legumes, and seeds.

     Other nutrients that members of the boomer generation should concentrate on getting adequate amounts of are calcium, folate, zinc, and Vitamins B6, B12, and D.  Fiber and fluid consumption should be increased to counteract the changes in GI tract motility.  Adequate fluid replacement will also help to prevent dehydration, especially from exercise.  Boomers should note that with advancing age, the desire to eat may lessen interfering with consuming the proper amount of nutrients.  Eating smaller, more frequent meals may help to overcome this. 

     Regular exercise of at least 150 minutes per week at a moderate-intensity level will attenuate changes in body composition and decrease the risk of chronic diseases.  The overweight boomer should aim to get in at least 250 minutes of moderate-intensity exercise per week for weight management.  Strength training exercises should also be incorporated to improve body composition and to promote bone health.  Individuals with arthritis may find it best to participate in low-impact activities such as swimming and bicycling.

     Although the physiological changes associated with aging are inevitable, baby boomers can attenuate these changes by adopting and adhering to healthy lifestyle habits.  By so doing, they increase their likelihood of living an independent and active life in their golden years.

Resources:

The Coaches Guide to Sports Nutrition, 2007; pp. 213-219. Benardot, D. and Thoompson, W.R.

American Dietetic Association, www.eatright.org

ACSM's Certified News, November/December 2008, "Nutrition and Physical Activity for Baby Boomers," p. 9-10. Volpe, S.

     Making the decision to start an exercise program is an important step toward better health.  However, it can be a challenging one to make if you don't know where to begin.  Seeking the advice of a personal trainer can help you to get started with, and maintain, a program that is safe and appropriate for you.  A personal trainer will help you to develop achievable, yet challenging, fitness goals and provide you with a plan to follow that will effectively meet those goals.  

     In your search for a personal trainer there are certain important points to keep in mind to ensure you sign up with a qualified and properly trained professional.  Below is a list of criteria that your trainer should meet.

Certification:  

     Your trainer should hold a current certification by a nationally recognized organization that has been accredited by the National Commission for Certifying Agencies (NCCA).  Associations for personal training certification that hold this accreditation are: the Academy of Applied Personal Training (AAPTE), the American College of Sports Medicine (ACSM), the American Council on Exercise (ACE), and the National Exercise and Sports Trainers Association (NESTA).  Your trainer should also be certified in first-aid and CPR.  Additional certifications for specialized training, such as a certified Cancer Exercise Trainer, could be of benefit based on your health and fitness goals.

Education:

     Your personal trainer should have a college degree in a health- and fitness-related field such as exercise science, exercise physiology, or kinesiology.

Experience/Area of Expertise:

     Find out how long the personal trainer has been in practice.  Ask what types of clients he or she works with.  For example, are his or her clients primarily athletes or older adults?  If your trainer has experience with clients that have similar traits to yours, it is more likely that he or she will be able to devise a safe, appropriate, and effective exercise plan that meets your specific needs and goals.

Safety Procedures:

     The personal trainer should have you perform a pre-activity screening test and ask you about your personal health history to ensure that you do not have any medical conditions that need to be addressed by a physician before you can safely begin an exercise program.  A fitness assessment should be part of the pre-activity screening so that an appropriate level of activity can be prescribed for you.

References:

     Ask the trainer for a list of clients or testimonials of individuals with whom he or she has worked.  Contact the individuals on the list of referrals and inquire about the trainer's professionalism and training methods used during exercise sessions.

Professional Network:

     The trainer should be associated with other allied health care professionals to whom he or she can refer you for health needs and concerns beyond his or her expertise.  For example, does he or she know a sports nutritionist that can develop a meal plan for you if you are training for a marathon?

     

Professional Liability Insurance and Terms of Contract:

     The personal trainer should carry liability insurance.  Inquire about the trainer's fees, services included in the fees, length of the training sessions, billing and payment procedures, and cancellation policies.  Expect that the trainer will require you to sign an informed consent form or waiver prior to beginning.

Personality:

     Talk to the personal trainer to make sure he or she is the right fit for your personality and fitness needs.  The wrong one could lead to a lack of motivation and compliance on your part.

     

Final Notes:

     In your search for a personal trainer you may find it useful to talk to others who have had a personal training experience; such as friends, family members, neighbors, and co-workers.  Your physician may also have a list of individuals to whom he or she would refer.  Contacting the organizations that provide personal training certification with questions that you may have may also prove beneficial.  ACE will provide you with a list of certified trainers (www.acefitness.org/findanacepro/default.aspx).

Resources:

American Council on Exercise website www.acefitness.org

National Commission for Certifying Agencies www.noca.org/resources/nccaaccreditation/.../default.aspx

     For years exercise enthusiasts have touted the phrases "Go for the Burn" and "No Pain, No Gain" in hopes to motivate individuals to get active.  With a large percentage of our population still not acquiring the recommended amount of exercise to gain health benefits, the origin of these slogans can be understood.  However, exercise does not have to be performed at an intensity and/or volume level that unduly stresses the body in order to improve overall health and well-being.  In fact, too much exercise can be counterproductive, leading to conditions known as overreaching and overtraining.  Overreaching and overtraining conditions are not limited to the elite athlete, but can occur in individuals whose exercise goal is to improve overall health.

     Overreaching is excessive training that occurs on a short-term basis.  The body is overworked resulting in decreased exercise performance.  The decrements in performance, however, can be easily reversed with a decrease in exercise workload for several days.  When carefully prescribed by a qualified health fitness or sports medicine professional, overreaching can actually have a positive impact on exercise performance.  Substantial gains in strength and power can occur when the muscles are overworked for a period of time followed by a tapering down phase in which the training stimulus is reduced.  However, if not monitored properly and allowed to continue for an extended period of time, overreaching can lead to overtraining.

     Overtraining occurs when the intensity and/or volume of exercise is excessive over a prolonged period of time without a sufficient recovery period.  Overtraining not only impairs exercise performance, but alters the mood of the overtrained athlete.  It can lead to marked decrements in exercise performance, injury, and/or illness.  Unlike overreaching, overtraining can require months, if not years, for a full recovery to occur.  

     Overtraining is not fully understood and more research is needed in the area.  However, there are certain physiological and psychological symptoms, known as the Overtraining Syndrome (OTS), that are suggestive of overtraining.

Physiological Symptoms Suggestive of OTS

• Decreased and/or plateaued exercise performance despite continued exercise training
• Time to recover from exercise is prolonged
• Poor/reduced coordination of body movements
• Chronic fatigue (both during exercise and daily life activities)
• Insomnia
• Sore/tender muscles 
• Painful joints
• Increased thirst
• Altered breathing, heart rate, and blood pressure at rest
• Disruption of menstrual cycle

Psychological Symptoms Suggestive of OTS

• Altered personality
• Lack of motivation to exercise
• Poor concentration
• Depression
• Poor self-esteem
• Irritability
• Apathy

     If you are experiencing one or more of these symptoms, you should schedule an appointment with your health care professional to determine the cause.  If it is determined that you are suffering from overtraining, your exercise regimen will have to be altered to allow for adequate recovery and rest.  If the thought of taking a break from exercise for a while is anxiety producing, discuss with your health care professional the possibility of alternative forms of activity such as light-intensity walking, calisthenics, stretching, or balance and stability exercises.

     If you want to avoid the pitfalls of overtraining, there are some preventative steps you can take.

Steps to Avoid OTS

• Vary your workouts, alternating days of low-, moderate-, and high-intensity exercise levels
• Cross-train to work different muscle groups (e.g. bike one day, run the next)
• Schedule at least one or two days of rest throughout the week, especially after an intense workout
• Consume a healthy, well-balanced diet that will allow for adequate repletion of glycogen stores depleted from exercise (see my nutrition postings during the week of May 4, 2009)
• Drink plenty of fluids to avoid dehydration

     It is important to listen to your body during your workout.  If you notice that your workouts are harder despite continued training, that you have lost the desire to exercise, and/or your mood and personality have become altered, then you need to reevaluate your exercise program.  The volume and/or intensity level of your activity may need to be reduced and extra recovery days added to your routine. 

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:

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

ACSM's Health & Fitness Journal, July/August 2007 vol. 11, Issue 4; "Overtraining: Undermining Success?", pp. 8-12. Kinucan, P. and Kravitz, L.

     

     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.

    

     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.

     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

     It is inevitable that at some point during your journey to better fitness you will acquire a cold or flu virus.  You will then be faced with the common question "Should I exercise while I am sick?".  According to the American College of Sport's Medicine's publication ACSM Current Comment: Exercise and the Common Cold, a resource available to the general public through their website www.acsm.org,  it is typically accepted that when symptoms are located at the neck and above it is safe to engage in mild to moderate physical activity.  Symptoms in this category tend to be associated with the "common cold" and include mild scratchy/sore throat, stuffy nose and/or head, but no fever or chest congestion.  It is also noted in the ACSM Current Comment: Exercise and the Common Cold publication that exercise during a mild cold may be beneficial.  On the other hand, if you are experiencing a fever, chills, achy joints, swollen lymph nodes, fatigue, chest congestion (such as with the "flu"), or severe symptoms that occur at the neck and above, then exercise should be discontinued until symptoms subside.  It should be noted that this recommendation may not hold true in all circumstances.  Contact your physician when in doubt and use common sense.

     There are a few guidelines that you should follow if it has been determined it is safe for you to exercise.  First, it is a good idea to exercise at a lower intensity level or for a shorter duration during the acute stages of the illness.  According to the ACSM Current Comment: Exercise and the Common Cold, resumption to a more intensive training regimen can occur a few days after symptoms have subsided.  Second, adequate amounts of fluids should be consumed in order to avoid dehydration from exercise which can be compounded by the illness.

     If your illness was severe enough to keep you from engaging in physical activity, there are a few tips to keep in mind when reestablishing your fitness routine.  First, recognize that you may need to re-examine your fitness goals and modify your approach accordingly (refer to my postings "Getting into Action: Parts One and Two").  Second, resumption of activity should be gradual, especially if you had to discontinue exercise for more than a week.  You can anticipate that it will take about 2-4 weeks to achieve your pre-illness training level.  However, if you only had to miss a few days, then you should be able to resume your pre-illness training level in a shorter period of time.  Do not get discouraged if it takes longer than expected to reach your pre-illness training level.  Remember, the achievement of physical fitness is a lifelong journey that will have setbacks, but with patience and perseverance, it is something that is attainable.

Resources:

ACSM Current Comment: Exercise and the Common Cold 

ACSM's Health & Fitness Journal. May/June 2006 p. 5. "Fitness Focus Copy-and-Share Injuries/Illness and Fitness"; D.L. Thompson, Ph.D., FACSM

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.