Concepts of Fitness And Wellness

28 Section 1  c  Lifestyles for Health, Wellness, and Fitness that lifestyle changes occur in at least five different stages, called stages of change. The stages of change model (see Promoting wellness and fitness is a top public health Figure 1) has been applied to many different lifestyles. For priority since it can reduce prevalence of illness and example, smokers who are not considering quitting smok- debilitating conditions. As previously noted in the first Con- ing are in the precontemplation stage, whereas those who cept, adopting healthy lifestyles is a key factor in health, are considering the need to change are in the contemplation wellness, and fitness promotion, but evidence suggests that stage. These stages are very distinct, as is the next stage, many people are not able to make changes, even when they preparation, which is characterized by specific efforts at want to do so. Experts have determined that people who changing. Individuals who have bought a nicotine patch or a practice healthy lifestyles possess certain characteristics. book about smoking cessation are in the preparation stage; These characteristics, including personal responsibility, they have moved beyond contempla- can be modified to improve the health behaviors of all peo- tion and are preparing to take action. ple. Researchers have also identified several special skills, The action stage occurs when the referred to as self-management skills, that can be useful in smoker makes a change in behavior, VIDEO 1 altering factors related to adherence and ultimately in mak- ing lifestyle changes. Like any skill, self-management skills even a small one, such as cutting back must be practiced if they are to be useful. The factors relat- on the number of cigarettes smoked. The fifth stage, mainte- ing to adherence and the self-management skills described nance, is reached when a person finally stops smoking for a in this Concept can be applied to a wide variety of healthy relatively long time (e.g., 6 months). lifestyles. For example, skills such as “self-monitoring” can The stages can be used to describe status with regard to help you monitor your current status and track progress in physical activity habits. Those who are totally sedentary are behavior change. The key is to learn from your experiences considered to be in the precontemplation stage. Contempla- and adopt a long-term perspective to healthy living. tors are thinking about becoming active. A person at the preparation stage may have bought a pair of walking shoes Making Lifestyle Changes and appropriate clothing for activity. Those who have started activity, even if infrequent, are at the stage of action. Those Many adults want to make lifestyle changes but find who have been exercising regularly for at least 6 months are changes hard to make. Results of several national public at the stage of maintenance. opinion polls show that adults often have difficulty mak- Whether the lifestyle is positive or negative, people ing desired lifestyle changes. Examples include those who move from one stage to another in an upward or a down- believe that physical activity is important but do not get ward direction. Individuals in the action stage may move enough exercise to promote good health, those who have on to maintenance or revert to contemplation. Smokers tried numerous times to lose weight but have failed, those who succeed in quitting permanently report having stopped who know good nutrition is good for health but do not eat and started dozens of times before reaching lifetime main- well, and those who feel stress on a regular basis but have tenance. Similarly, those attempting to adopt positive life- not found a way to become less stressed. Changes in other styles, such as eating well, often move back and forth from lifestyles are frequently desired but often not accomplished. one stage to another, depending on their life circumstances. Practicing one healthy lifestyle does not mean you Once maintenance is attained, relapse is less likely will practice another, though adopting one healthy to occur. Although complete relapse is possible, it is gen- behavior often leads to the adoption of another. erally less likely after the maintenance stage is reached. At College students are more likely to participate in regular the maintenance stage, the behavior has been integrated into physical activity than are older adults. However, they are also much more likely to eat poorly and abuse alcohol. Many Maintenance “I regularly practice young women adopt low-fat diets to avoid weight gain and healthy lifestyles.” smoke because they mistakenly believe that smoking will contribute to long-term weight maintenance. These exam- Action “I have made some life- ples illustrate the fact that practicing one healthy lifestyle style changes.” does not ensure adherence to another. However, there is evidence that making one lifestyle change often makes it Preparation “I am getting ready to make easier to make other changes. For example, smokers who a lifestyle change.” have started regular physical activity programs often see improvements in fitness and general well-being and decide Contemplation “I am thinking about change.” to stop smoking. Precontemplation “I don't want to change.” People progress—forward and backward—through several stages of change when making lifestyle Figure 1  c  Stages of lifestyle change. changes. The widely used Transtheoretical Model suggests

Concept 3  c  Self-Management and Self-Planning Skills for Health Behavior Change   29 In the News Myths and Medical Conspiracy Theories There is considerable misinformation about information and medical treatments away from the public rather health and medicine in society, fueled in part than serve and protect citizens. This misinformation adds to by Web posts and media reports that popularize health myths the confusion about what and whom to believe. (See link in or that reinforce unsubstantiated medical conspiracies. A prom- Suggested Resources and Readings.) inent medical research study revealed that many Americans Why do some people choose to believe in miracle cures and believe these conspiracy theories and have little trust in health question the science related to health and medicine? How information. For example, many people believe that agen- can you ensure that you get accurate health information? cies like the Food and Drug Administration intentionally keep ACTIVITY a personal lifestyle, and it becomes easier to sustain. For example, a person who has been active for years does not have to undergo the same thought processes as a beginning exerciser—the behavior becomes automatic and habitual. Similarly, a nonsmoker is not tempted to smoke in the same way as a person who is trying to quit. Factors That Promote Lifestyle Change Various factors have been found to influence the adoption and maintenance of healthy lifestyles. A variety of theories have been proposed to understand health behavior (e.g., Social Cognitive Theory, Self-Determination Theory, Theory of Planned Behavior, Theory of Reasoned Access to healthy foods is an important predisposing factor for Action). Each theory offers some unique attributes or concepts, good nutrition. but they share many of the same components. The previously mentioned Transtheoretical Model integrates elements from Social-Ecological models have been combined to provide multiple theories and can be viewed as a “meta-theory.” The a simpler way to understand the various factors that influ- distinction between a “theory” and a “model” is important ence behavior. For ease of understanding, the various fac- in this case. The Transtheoretical Model does not provide a tors are classified as personal, predisposing, enabling, and new explanation of behavior (a theory) reinforcing factors (see Figure 2). Personal factors refer to but rather a guide or map that makes personal characteristics or conditions that may make it easier using and applying the theories easier or more difficult to make change. Predisposing factors help (a model). The unique advantage of the VIDEO 2 Adherence  Adopting and sticking with healthy behaviors, such Transtheoretical Model is that it dem- as regular physical activity or sound nutrition, as part of your onstrates that behavior is influenced in different ways depend- lifestyle. ing on the stage of change a person has reached. Stage of Change  The level of motivational readiness to adopt a Another meta-theory that has been used to explain the specific health behavior. challenges of changing health behaviors is the Social- Personal Factors Factors, such as age or gender, related to Ecological Model. This model also integrates multiple theo- healthy lifestyle adherence but not typically under personal control. ries, but a key point in this model is that a person’s behavior Predisposing Factors Factors that make you more likely to is strongly influenced by the nature of the environment adopt a healthy lifestyle, such as participation in regular physical in which she or he lives. If you are in a supportive social activity, as part of your normal routine. environment and have access to healthy foods and activity Enabling Factors  Factors that help you carry out your healthy resources, adopting healthier lifestyles is easier. lifestyle plan. You do not need a thorough understanding of the theo- Reinforcing Factors Factors that provide encouragement to ries and models, but you should be aware of the basic maintain healthy lifestyles, such as physical activity, for a lifetime. principles. Concepts from both the Transtheoretical and

30 Section 1  c  Lifestyles for Health, Wellness, and Fitness Staying in Reinforcing Success Maintenance Factors Family support Peer support Support of professionals Moving through Enabling Goal setting Performance skills Factors Self-assessment Coping skills Stages of Change Moving Self-monitoring Consumer skills Self-planning Time management into Action Self-confidence Keys to Predisposing Am I Self-e cacy Is it Self-motivation Preparation Factors able? Safe environment worth Enjoyment Access Balance of attitudes it? Beliefs/knowledge Age Beginning Personal Gender Education Contemplation Factors Heredity Friends Health/disability Setting Norms Precontemplation (“I Don’t Want to Change”) Figure 2  c  Different factors influence progress at various stages of change. to initiate behavior change—moving toward contemplation illustrated by the fact that women use health services more or even preparation. Enabling factors help those in contem- often than men. Women are more likely than men to have plation or preparation take a step toward action. Reinforcing identified a primary care doctor and are more likely to par- factors move people from action to maintenance and help ticipate in regular health screenings. As you will discover in those in maintenance stay there. more detail later, heredity plays a role in health behaviors. Personal factors affect health behaviors but are often For example, some people have a hereditary predisposition to out of your personal control. Age, gender, heredity, social gain weight, and this may affect their eating behaviors. status, and current health and fitness levels are all personal factors that affect your health behaviors. Personal factors also capture other conditions that influ- ence ability to make change. People with little education are Age effects are exemplified by differences in health more likely to have health problems and make less money. behaviors across the lifespan. For example, young adults are People with limited income often have less access to health more likely to smoke and drink excessively but to be more care and healthy foods. Social interactions also affect your physically active than older adults. Gender differences are ability to change. People who have friends who practice healthy habits have an easier time adopting healthy behaviors A CLOSER LOOK Blue Zones and Personal Responsibility important, each person ultimately has to make wise choices and manage his or her own lifestyle, regardless of the setting. Lifestyles have a big impact on both quality and quantity of life. (See link in Suggested Resources and Readings.) For his book Blue Zones, Dan Buettner researched commu- nities across the world that had higher life expectancies and Does your community provide a supportive environment for quality of life compared to other communities. The common your health behaviors? Does the environment dictate your characteristics in these healthy communities—including diet ability to be healthy, or is it your personal responsibility? and activity—were identified and described as being impor- tant for healthy lifestyles. Although a healthy environment is ACTIVITY

Concept 3  c  Self-Management and Self-Planning Skills for Health Behavior Change   31 Table 1  c  Self-Management Skills for Changing Predisposing Factors Self-Management Skill How Is It Useful? Overcoming Barriers Lifestyle Example Develop skills that make it possible to overcome problems or A person is tempted by snack foods and candy provided by challenges in adopting or maintaining healthy behaviors. By coworkers. Learning to resist these foods takes discipline, but conquering challenges, you learn skills that help you overcome overcoming barriers builds confidence that helps the person stay other barriers to healthy lifestyles. focused on long-term goals. Building Self-Confidence and Motivation Lifestyle Example Take small steps that allow success. With each small step, A person says, “I would like to be more active, but I have never confidence and motivation increase and you develop the been good at physical activities.” Starting with a 10-minute walk, feeling “I can do that.” the person sees that “I can do it.” Over time, the person becomes confident and motivated to engage in more physical activity. Balancing Attitudes Lifestyle Example Learn to balance positive and negative attitudes. Developing positive attitudes and reducing negative attitudes helps you A person is not active because he or she lacks support from friends, adhere to a healthy lifestyle. has no equipment, and does not like to get sweaty. These are negatives. Shifting the balance to positive things, such as fun, good Building Knowledge and Changing Beliefs health, and good appearance, can help promote activity. Build your beliefs on sound information. Knowledge does not Lifestyle Example always change beliefs, but awareness of the facts can play a role in achieving good health. A person says, “I don’t think what I eat has much to do with my health and wellness.” Acquiring knowledge is fundamental to being an educated person. Studying the facts about nutrition can provide the basis for changes in beliefs and lifestyles. than people who have friends or who have social interactions who have easy access to exercise equipment at home or the with people who practice destructive health behaviors. No workplace or who have a place to exercise within 10 minutes matter what your circumstances are, you can take responsi- of home are more likely to be active than those who do bility to change your health behaviors. Learning about pre- not. Similarly, access to healthy food options is critical for disposing, enabling, and reinforcing factors (see Figure 2) adopting a healthy diet. A supportive physical and social can help you overcome personal or social circumstances and environment can also make it easier to adopt healthy habits. help you to  make the most of your efforts to change your “Is it worth it?” People who say yes to this question are lifestyles to promote health, wellness, and fitness. willing to make an effort to change their behaviors. Pre- Predisposing factors are important in getting you disposing factors that make it worth it to change behaviors started with the process of change. Several predis- include enjoying the activity, balancing positive and nega- posing factors can help you move from contemplation to tive attitudes, believing in the benefits of a behavior, and preparation and then to taking action with regard to healthy having knowledge of the health bene- behavior. A person who possesses predisposing factors is fits of a behavior (see Figure 2). If you said to have self-motivation (also called intrinsic motiva- enjoy something and feel good about tion). If you are self-motivated, you will answer positively to it (have positive attitudes and beliefs), VIDEO 3 two basic questions: “Am I able?” and “Is it worth it?” you will be self-motivated to do it. It “Am I able to do regular activity?” “Am I able to change will be worth it. The lifestyle examples provided in Table 1 my diet or to stop smoking?” Figure 2 includes a list of four will help you understand how to apply these predisposing factors that help you say, “Yes, I am able.” Two of these factors to your own lifestyle. factors are self-confidence and self-efficacy. Both have to do with having positive perceptions about your own abil- Self-Confidence  The belief that you can be successful at ity. People with positive self-perceptions are more self- something (for example, the belief that you can be successful in motivated and feel they are capable of making behavior sports and physical activities and can improve your physical fitness). changes for health improvement. Other factors that help you Self-Efficacy  Confidence that you can perform a specific task feel you are able to engage in a healthy behavior include (a type of specific self-confidence). easy access and a safe environment. For example, people

32 Section 1  c  Lifestyles for Health, Wellness, and Fitness Table 2  c  Self-Management Skills for Changing Enabling Factors Self-Management Skills How Are They Useful? Goal-Setting Skills Lifestyle Example Establish what you want to achieve in the future. Goals should be A person wants to lose body fat. Setting a goal of losing 50 pounds realistic and achievable. Learning to set goals for behavior change makes success unlikely. Setting a process goal of restricting 200 is especially important for beginners. calories a day or expending 200 calories more each day for several weeks makes success more likely. Self-Assessment Skills Lifestyle Example Assess your own fitness, health, and wellness and learn to interpret A person wants to know his or her health strengths and your own self-assessment results. It takes practice to become good weaknesses. The best procedure is to select good tests and self- at doing self-assessments. administer them. Practicing the assessments in these Concepts will help you become good at self-assessment. Self-Monitoring Skills Lifestyle Example Monitor your behavior by keeping records. Many people think they In spite of restricting calories, a person can’t understand why he or adhere to healthy lifestyles, but they do not. They have a distorted she is not losing weight. Keeping records may show that the person view of what they actually do. Self-monitoring gives you a true is not counting all the calories consumed. Learning to keep records picture of your own behavior and progress. of progress contributes to adherence. Self-Planning Skills Lifestyle Example Plan for yourself rather than having others do all the planning A person wants to be more active, to eat better, and to manage for you. stress. Self-planning skills will help him or her plan a personal activity, nutrition, or stress-management program. Performance Skills Lifestyle Example Learn the skills necessary for performing specific tasks, such as A person avoids physical activity because he or she does not have sports or relaxation. These skills can help you feel confident and the physical skills equal to those of peers. Learning sports or other enjoy activities. motor skills allows this person to choose to be active. Coping Skills Lifestyle Example Develop a new way of thinking about things. Using this skill, A person is stressed and frequently anxious. Learning stress- you can see situations in more than one way and learn to think management skills, such as relaxation, can help a person cope. Like more positively. all skills, stress-management skills must be practiced to be effective. Consumer Skills Lifestyle Example Gain knowledge about products and services. You may also need A person avoids seeking medical help when sick. Instead, the to rethink untrue beliefs that lead to poor consumer decisions. person takes an unproven remedy. Learning consumer skills provides knowledge for making sound medical decisions. Time-Management Skills Lifestyle Example Keep records similar to self-monitoring, focusing on total time use A person wants more quality time with family and friends. rather than specific behaviors. Skillful monitoring of time can help Monitoring time can help him or her reallocate time to spend it in you plan and adhere to healthy lifestyles. ways that are more consistent with personal priorities. Enabling factors move you from the beginning Table  2 explains the importance of each skill and how stages of change to action and maintenance. A each one can contribute to behavior change. variety of skills help you follow through with decisions Reinforcing factors help you adhere to lifestyle to make changes in behaviors. Figure 2 lists eight self- changes. Once you have reached the action or maintenance management skills that contribute to behavior change. stage, it is important to stay at this high level. Reinforcing The labs in each Concept provide opportunities to learn factors help you stick with a behavior change (see Figure 2). and apply these self-management skills to your lifestyle.

Concept 3  c  Self-Management and Self-Planning Skills for Health Behavior Change   33 One of the most important reinforcing factors is success. behavior. Scolding a person for not sticking to a diet, for If you change a behavior and experience success, this makes example, or offering the suggestion that “you are not going to you want to keep doing the behavior. If attempts to change a get anywhere if you don’t stick to your diet” will often be per- behavior result in failure, you may conclude that the behav- ceived as applying pressure. If you want to help friends and ior does not work and give up on it. Planning for success is family make behavior changes, avoid applying pressure and essential for adhering to healthy lifestyle changes. Using the attempt to provide positive forms of support. Research also self-management skills described in this and other Concepts suggests it is desirable to promote autonomy and freedom of can help you plan effectively and achieve success. choice so that change is self-directed. Table 3 provides life- style examples of the key reinforcing factors of social support Social support from family, peers, and health professionals and relapse prevention. can also be reinforcing. There are, however, different kinds of support and some are more helpful than others. Support for well-informed personal choices is referred to as support of autonomy. One example is encouragement from family, friends, or a doctor for starting and sticking to a nutritious diet. The supporting person might ask, “How can I help you meet your goals?” This type of support helps you take con- trol of your own behavior and is not viewed as controlling. Not all feedback is perceived as reinforcing and support- ive. Although the people providing the feedback may feel they are being helpful and supportive, some feedback may be perceived as applying pressure or as an attempt to control HELP Health is available to Everyone for a Lifetime, and it’s Personal Learning to find positive social support is an important self-management skill. Studies of social connections over time have shown that people are more likely to become obese if they have obese friends. Similar relationships have been shown among spouses. Researchers suggest that health behaviors tend to be shared within social groups, resulting in shared outcomes. (See link in Sug- gested Resources and Readings.) Do your friends help you maintain a healthy lifestyle, or do they make it more difficult to do so? ACTIVITY Adopting healthy lifestyle habits requires extra discipline and effort. Table 3  c  Self-Management Skills for Changing Reinforcing Factors Self-Management Skill How Is It Useful? Social Support Lifestyle Example Obtain the support of others for healthy lifestyles. You learn how to A person has gradually developed a plan to be active. Friends get support from family and friends for your autonomous decisions. and loved ones encourage activity and help the person develop a Support of a doctor can help. schedule that will allow and encourage regular activity. Relapse Prevention Lifestyle Example Stick with a healthy behavior once you have adopted it. It can A person stops smoking. To stay at maintenance, the person can be easy to relapse to an unhealthy lifestyle. Skills such as learn to avoid situations where there is pressure to smoke. He or avoiding high-risk situations and learning how to say no help she can learn methods of saying no to those who offer tobacco. you avoid relapse.

34 Section 1  c  Lifestyles for Health, Wellness, and Fitness Self-Management Skills a visit associated with an illness. Other common reasons are to improve personal appearance, lose weight, increase Learning self-management skills can help you alter energy levels, improve the ability to perform daily tasks, and factors that lead to healthy lifestyle change. Personal, improve quality of life (wellness). Identifying your reasons predisposing, enabling, and reinforcing factors influence for wanting to change helps you determine which behaviors the way you live. These factors are of little practical to change first and helps you establish specific goals. Reflect significance, however, unless they can be altered to pro- on your reasons for wanting to make lifestyle changes before mote healthy lifestyles. Learning self- moving on to step 2. management skills (sometimes called self-regulation skills) can help you Step 2: Identifying Needs change the predisposing, enabling, VIDEO 4 Self-assessments are useful in establishing personal needs, planning your program, and evaluating your and reinforcing factors described in progress. You have already done some self-assessments Tables 1, 2, and 3. In fact, some of the enabling factors are of wellness, current activity levels, and current lifestyles. self-management skills. Learning these skills takes prac- In the labs for this Concept and others that follow, you will tice, but with effort anyone can learn them. Use the many make additional assessments. The results of these assess- lab activities to learn and practice self-management skills. ments help you build personal profiles for a variety of health behaviors that can be used as the basis for program planning. It takes time to change unhealthy lifestyles. People in With practice, self-assessments become more accurate. For Western cultures are used to seeing things happen quickly. this reason, it is important to repeat self-assessments and to We flip a switch, and the lights come on. We want food pay careful attention to the procedures for performing them. quickly, and thousands of fast-food restaurants provide it. If questions arise, get a professional opinion rather than The expectation that we should have what we want when we making an error. want it has led us to expect instantaneous changes in health, wellness, and fitness. Unfortunately, there is no quick way Periodic self-assessments can help determine if you to health. There is no pill that can reverse the effects of a are meeting health, wellness, and fitness standards lifetime of sedentary living, poor eating, or tobacco use. and making progress toward personal health goals. Changing your lifestyle is the key. But lifestyles that have When performed properly, self-assessments help you deter- been practiced for years are not easy to change. Learning mine if you have met your goals and if you are meeting self-management skills helps you make permanent lifestyle health standards (e.g., meeting health fitness standards, eat- changes, but only if you implement them and practice them. ing appropriate amounts of nutrients). Self-assessments also offer a measure of independence and can help you avoid Self-Planning for Healthy unnecessary and expensive tests. They serve as a screen- Lifestyles ing procedure to determine if you need professional assis- tance. However, because self-assessments may not be as Self-planning is a particularly important self-management accurate as tests by health and medical professionals, it is skill. In the final Concept, after you have studied a variety of wise to have periodic tests by an expert to see if your self- concepts and self-management skills, assessments are accurate. you will have the opportunity to develop a personal plan for several healthy Self-assessments also have the advantage of consistent lifestyles. Several self-management VIDEO 5 error rather than variable error. The best type of assess- ments are done by highly qualified experts using precise skills, including self-assessment, self- instruments. Following directions and practicing assessment monitoring, and goal-setting, are used in the six-step self- techniques will reduce error significantly. Still, errors will planning process (see Table 4). occur. One advantage of a self-assessment is that the per- son doing the assessment is always the same—you. Even if Step 1: Clarifying Reasons you make an error in a self-assessment, it is likely to be con- Clarifying your reasons for behavior change is the sistent over time, especially if you use the same equipment first step in program planning. People at the precontem- each time you make the assessment. For example, scales plation stage are not considering a change in behavior; they have limitations for monitoring changes in weight (and fat). see no need. It’s when they reach the contemplation stage But if you measure your own weight using a home scale and that they consider changes in behavior. One of the most com- your measurement always shows your weight to be 2 pounds mon and most powerful reasons for contemplating a change higher than it really is, you have made a consistent error. You in a lifestyle is the recommendation of a doctor, often after

Concept 3  c  Self-Management and Self-Planning Skills for Health Behavior Change   35 Table 4  c  Self-Planning Skills Self-Planning Description Self-Management Skill 1. Clarifying reasons Knowing the general reasons for changing a Results of the Self-Management Skills 2. Identifying needs behavior helps you determine the type of behavior Questionnaire (Lab 3A) will help you determine 3. Setting personal goals change that is most important for you at a specific which self-management skills you use regularly 4. Selecting program point in time. If losing weight is the reason for and the ones you might need to develop. wanting to change behavior, altering eating and components activity patterns will be emphasized. Self-assessment: In the Concepts that follow, 5. Writing your plan you will learn how to assess different health, If you know your strengths and weaknesses, you wellness, and fitness characteristics. These self- 6. Evaluating progress can plan to build on your strengths and overcome assessments will help you identify needs. weaknesses. Goal setting: Guidelines in this Concept will help Goals are more specific than reasons (see step 1). you set goals. In subsequent Concepts, you will Establishing specific things that you want to establish goals for different lifestyles. accomplish can provide a basis for feedback that your program is working. Many self-management skills, including time- management, consumer, and performance skills, A personal plan should include the specific program are useful in developing plans for a variety of components that will meet your needs and goals healthy behaviors. based on steps 1–3. Examples include meal plans for nutrition and specific activities for your physical Planning: This includes writing down the time of activity plan. day, day of the week, and other details you will include in your plan. Once program components, such as meal plans for nutrition and specific activities for physical activity, Self-monitoring: This skill is used in keeping have been determined, you should put your plan records (logs) and determining if goals are met. in writing. This establishes your intentions and Self-assessment: This skill is used to help you increases your chances of adherence. determine if goals are met. Once you have used your plan, you will know what works and what does not. Periodic self-assessments can help you modify the plan to make it better. can determine if you are improving because you know the losing weight or getting fit. SMART goals are less general error exists. Variable errors are likely when different instru- and have several important characteristics. SMART goals ments are used, when different people make the assessments, are specific (S). A specific goal provides details, such as lim- and when procedures vary from test to test. Differences in iting calories to a specific number each day. SMART goals scores are harder to explain with variable forms of error are measurable (M). They allow you to perform assessments because they are not consistent. before you establish your goals and again later to see if you Step 3: Setting Personal Goals Short-Term Goals  Statements of intent to change a behavior or There are differences between short-term and long-term achieve an outcome in a period of days or weeks. goals. Short-term goals are goals that you can accomplish in Long-Term Goals Statements of intent to change behavior or days or weeks. Long-term goals take longer to accomplish— achieve a specific outcome in a period of months or years. sometimes months or even years. General Goals Broad statements of your reasons for wanting There are differences between general goals and to accomplish something. Examples include changing a behavior SMART goals. General goals are broad statements of your such as eating better or being more active, or changing a physical reasons for wanting to accomplish something. Examples characteristic such as losing weight or getting fit. include changing a behavior such as eating better or being SMART Goals Goals that are Specific (S), Measurable (M), more active, or changing a physical characteristic such as Attainable (A), Realistic (R), and Timely (T).

36 Section 1  c  Lifestyles for Health, Wellness, and Fitness have met your goals. SMART goals are attainable (A). They different results for different people. For this reason, are neither too hard, nor too easy. If the goal is too hard, fail- goals must vary from person to person, especially out- ure is likely, which is discouraging. If the goal is too easy, it come goals. For example, two people may establish an is not challenging. SMART goals are also realistic (R). They outcome goal of losing 5 pounds over a 6-week period. are your personal goals. If you put in the time and effort, you Because we inherit predispositions to body composition, should have a realistic chance of meeting them. Realistic one person may meet the goal, while another may not, personal goals provide motivation. Finally, SMART goals even if both strictly adhere to the same diet. A similar are timely (T). Timely goals are especially meaningful when example can be used for fitness and physical activity. you begin a program for making personal changes. Choos- People inherit not only a predisposition to fitness but ing goals that are timely helps you focus on the most salient also a predisposition to benefit from training. In other changes that you want to make. words, if 10 people do the same physical activities, there will be 10 different results. One person may improve There are differences between behavioral and outcome performance by 60 percent, while another might improve goals. A behavioral goal is associated with something you by only 10 percent. This makes it hard for beginners to do. An example of a specific short-term behavioral goal is to set realistic outcome goals. Too often, people set a goal perform 30 minutes of brisk walking 6 days a week for the next based on a comparative standard rather than on a stan- 2 weeks. It is a behavioral goal because it refers to a behav- dard that is possible for the individual to achieve in a ior (something you do). An outcome goal is associated with short time. a physical characteristic (e.g., lowering your body weight, lowering your blood pressure, building strength). Typically, it Goal-setting guidelines vary depending on experience takes weeks or months to reach outcome goals. This is because and past history with the behavior. Beginners should outcome goals depend on many things other than your behav- consider these guidelines: ior. For example, your heredity affects your body fat and mus- ∙ Start with general long-term goals in mind. It is good cle development. to have your goals in mind when you begin a program. Different factors influence your success in meeting But beginners may want to use general rather than spe- goals. Consider these factors when setting your goals: cific long-term goals. You may choose either behavioral ∙ Outcome goals are not recommended as short-term goals or outcome goals, but keep them general. For example, choose a goal of losing weight or getting fit. Getting too because they take time to achieve. Typically, it takes specific can be discouraging for reasons discussed above. weeks or months to reach outcome goals, so they make ∙ Focus on SMART short-term behavioral objectives. As better long-term goals than short-term goals. noted previously, an example of a specific short-term ∙ Outcome goals depend on many things other than your behavioral goal is to perform 30 minutes of brisk walk- lifestyle behavior. For example, your heredity affects ing 6 days a week for the next 2 weeks. It is a behavioral your ability to achieve an outcome goal such as achiev- goal because it refers to a behavior (something you do). ing a certain body weight and or achieving a fitness stan- It is a SMART goal because it is specific, measurable, dard. The same lifestyle change program may produce attainable, realistic, and timely. When using behavioral A goal to consume more fruits and vegetables is an example of a Reducing blood pressure is an example of an outcome goal. behavioral goal.

Concept 3  c  Self-Management and Self-Planning Skills for Health Behavior Change   37 goals the principal factor associated with success is the new healthy blood pressure. Once a healthy outcome your willingness to give effort. No matter who you goal has been achieved, a new outcome goal of maintaining are, you can accomplish a behavioral goal if you give a systolic blood pressure of 120 is appropriate. Behavioral regular effort. This type of goal will help you keep goals will also have to be modified. For the person who has your motivation level high and prevent you from being reduced blood pressure to a healthy level, medication levels discouraged. might be reduced for maintenance. ∙ Avoid frequent outcome self-assessments; focus on self- monitoring of behavior. A self-assessment before setting Maintenance goals are appropriate in other areas as well. goals helps you to set SMART goals. Self-assessments For example, nutrition and exercise strategies for weight main- can also help you see if you have met your goals. For tenance will likely be different from those for losing weight. beginners, however, frequent self-assessment—especially When a person reaches a healthy level of fitness (or a healthy of outcomes—is discouraged. For example, if the long- body weight), maintenance may be the goal rather than con- term goal is to lose weight, frequent weighing can be tinued improvement. You cannot improve forever; at some discouraging and even deceiving. Self-monitoring of point, attempting to do so may be counterproductive to health. behavior is encouraged, however. For the walking goal Making improvement can motivate you to reach discussed earlier, keeping an activity log of your daily long-term goals. As noted earlier, setting short-term goals participation will help you comply. that are both attainable and realistic will help you reach your ∙ Use a series of short-term goals to make progress toward long-term goals. Meeting short-term goals encourages and long-term goals. Once short-term behavioral goals are motivates you to continue with your healthy lifestyle plan. reached, establish new ones. After meeting a series of Don’t expect to set perfect goals all the time. No matter how short-term goals, consider goal-setting guidelines for much self-assessing and self-monitoring you do, you may more experienced people. sometimes set goals too low or too high. If the goal is set too low, it is easily achieved, and a new, higher goal can be estab- Experienced people should consider these guidelines: lished. If the goal is set too high, you may fail to reach it, even though you have made considerable progress toward the goal. ∙ Start with SMART long-term goals. Experience helps people realize that it takes time to meet long-term goals, Rather than becoming discouraged when a goal is not especially outcome goals. Both SMART behavioral and met, consider the improvement you have made. Improve- outcome goals can be considered. ment, no matter how small, means that you are moving toward your goal. Also, you can measure your improvement ∙ Use a series of short-term SMART goals (both behavioral and use it to help set future goals. Of course, periodic self- and outcome) as a means of accomplishing long-term assessments and good record keeping (self-monitoring) are goals. Even experienced people are more likely to achieve necessary to keep track of improvements accurately. success if they realize that setting and meeting a series Putting your goals in writing helps formalize them. If of SMART short-term goals is important. For example, a you don’t write them down, your goals will be easy to forget. person who has high blood pressure (160 systolic) may set Putting goals in writing helps you to establish a commitment a long-term outcome goal of lowering systolic blood pres- to yourself and clearly establishes your goals. You can revise sure to 120 over a period of 6 months. Several behavioral them if necessary. Written goals are not cast in concrete. goals can be established for the 6-month period, includ- ing taking blood pressure medication (daily), performing Step 4: Selecting Program Components 30  minutes of moderate physical activity each day, and You can choose from many different program limiting salt in the diet to less than 100 percent of the rec- components to meet your goals. There are many dif- ommended dietary allowance. If the long-term outcome ferent lifestyle changes that can be made to improve goal is realistic, adhering to SMART short-term behav- health, wellness and fitness. They range from improving ioral goals will result in achieving the outcome goal. priority lifestyles (physical activity, nutrition, and stress ∙ Use self-assessments and self-monitoring to determine if Behavioral Goal A statement of intent to perform a specific you are making progress. Self-assessments can be more fre- behavior (changing a lifestyle) for a specific period of time. An quent for the experienced. Still, avoid expecting too much, example is “I will walk for 15 minutes each morning before work.” especially for outcome goals. Self-monitoring of behavioral Outcome Goal  A statement of intent to achieve a specific test goals is good, even for the experienced. If you commit to the score (attainment of a specific standard) associated with good behavior and stick to your plan, the outcomes will follow. health, wellness, or fitness. An example is “I will lower my body fat by 3 percent.” Maintenance goals are also appropriate once goals have been achieved or when improvements aren’t necessary. For example, the person who lowers systolic blood pressure from 160 to 120 need not continue to lower

38 Section 1  c  Lifestyles for Health, Wellness, and Fitness TECHNOLOGY UPDATE Health Apps Rapid changes in technology have created a huge mar- ket for customized applications (apps). There are apps for almost everything, including apps that help you to manage and organize your lifestyle and that provide supportive prompts and reminders. For example, Apple developed a health app that uses a dashboard system, so that you can review your health and fitness data, and a tool called HealthKit that allows several health apps to work together. Similar integrated features for personalized tracking of health data are available for Android users. (See link in Suggested Resources and Readings.) How useful are these types of health-related apps for promoting and maintaining healthy lifestyles? Are they simply fun technology, or do they support health behav- ior change? ACTIVITY Self-planning can help you implement a variety of changes to enhance health, wellness, and fitness. management) to adopting positive safety and personal health habits to avoiding destructive habits. The changes you starting and finishing times and specific details concerning decide to make depend on your program goals. For example, the activities to be performed. A dietary plan would include if the goal is to become more fit and physically active, the specific menus for each meal and between-meal snacks. program components will be the activities you choose. You In the labs that accompany the final Concept, you will will want to identify activities that match your abilities and write plans for several different life- that you enjoy. You will want to select activities that build styles. By then you will have learned a the type of fitness you want to improve. variety of self-management skills that will assist you. VIDEO 6 Other examples of program components are preparing menus for healthy eating, participating in stress-management Step 6: Evaluating Progress activities, planning to attend meetings to help avoid destruc- Self-assessment and self-monitoring can help you tive habits, and attending a series of classes to learn CPR evaluate progress. Once you have written a plan, you will and first aid. Preparing a list of program components that want to determine your effectiveness in sticking with your will help you meet your specific goals will prepare you for plan. Keeping written records is one type of self-monitoring. step 5, writing your plan. Step 5: Writing Your Plan Self-monitoring is a good way to assess success in Preparing a written plan can improve your adherence meeting behavioral goals. Keeping a dietary log or using to the plan. A written plan is a pledge, or a promise, to be a pedometer to keep track of steps are examples of self- active. Research shows that intentions to be active are more monitoring. Self-assessments are a good way to see if you likely to be acted on when put in writing. In the Concepts have met outcome goals. that follow, you will be given the opportunity to prepare written plans for becoming more active as well as for alter- In the following Concepts, you will learn to self-assess ing a variety of other lifestyles. A good written plan includes a variety of outcomes (e.g., fitness, body fatness) and self- daily plans with scheduled times and other program details. monitor behaviors (e.g., diet, physical activities, stress- For example, the daily written plan for stress management management activities). In step 2 of the self-planning process, could include the time of day when specific program activi- you used self-assessments to determine your needs and to ties are conducted (e.g., 15-minute quiet time at noon, yoga help you plan your goals (step 3). Once you have tried your class from 5:30 to 6:30). An activity plan would include a program, use the same self-assessments and self-monitoring schedule of the activities for each day of the week, including strategies to evaluate the effectiveness of your program. You can see if you have met the goals you established for yourself.

Concept 3  c  Self-Management and Self-Planning Skills for Health Behavior Change   39 Strategies for Action To be effective, self-management current health, wellness, and fitness status, as well as self- and self-planning skills require a monitoring of your current lifestyles, can help you determine your commitment to make changes in lifestyle. As indicated in reasons for making change and help you establish SMART goals Figure 1, change occurs stage by stage, and an individual is for change. Like all skills, practice is necessary to improve self- likely to be at different stages for different health behaviors. For management skills. example, a person may be at the maintenance stage for physi- cal activity but at the contemplation stage for adopting sound Assessing self-management skills that influence healthy nutrition practices. Many self-management skills are described lifestyles provides a basis for changing your health, wellness, for use in progressing from one stage to another. Different skills or fitness. Self-assessments of your current health, wellness, are important, depending on your current stage and the life- and fitness status, as well as self-monitoring of your current life- style behavior you are attempting to change. styles, can help you determine your reasons and establish rea- sonable goals for healthy lifestyle change. The questionnaire in The lab worksheets that accompany each Concept will help you Lab 3A will help you identify your stages of change for various learn the self-assessment, self-management, and self-planning behaviors and self-management skills you can use to change skills necessary for behavior change. Self-assessments of the behaviors. ACTIVITY Suggested Resources ∙ Centers for Disease Control and Prevention: Overcoming Barriers and Readings to Physical Activity. ∙∙∙ CNET Review: Health Apps for Smartphones. The websites for the following sources can be accessed by searching National Public Radio (NPR): Medical Conspiracy Theories. online for the organization, program, or title listed. Specific scien- Oliver, J. E., & Wood, T. (2014). Medical conspiracy theories and health behaviors in the United States. JAMA Internal Medicine. tific references are available at the end of this edition of Concepts of ∙ ProChange: Transtheoretical Model and Stages of Change. Fitness and Wellness. ∙∙ Apple HealthKit Application. Blue Zones Project.



Lab 3A  Stages of Change and Self-Management Skills Name Section Date Lab 3A Purpose: To assess your current Stage of Change for three key priority lifestyle behaviors (physical activity, nutrition, and stress management) and your self-management skills related to each one. Procedures Stages of Change and Self-Management Skills 1. Complete the Stages of Change Questionnaire on the next page. Check one box for each of the three priority health behaviors (physi­cal activity, nutrition, and stress management). 2. Complete the Self-Management Skills Questionnaire (pages 43–44). Each question reflects one of the self-management skills described in this Concept. Each of the 12 questions requires a response about three different healthy behaviors. Respond to each question by using a 3 for very true, a 2 for somewhat true, or a 1 for not true. Record the appropriate number in the box beside each question. After you have answered all 12 questions for all three healthy lifestyles, total the numbers in the three columns to get a total score for physical activity, nutrition, and stress management. 3. Record your Stages of Change for the three healthy lifestyles (the word by the box you checked) in the Results section. 4. Record your Self-Management Scores for the three healthy lifestyles in the Results section. Use the Self-Management Skills Rating Chart to determine a rating for each healthy behavior. Record your ratings in the Results section. 5. Provide the appropriate information in the Conclusions and Implications section. Results Stage of Change Self-Management Score Self-Management Rating Health Behavior Physical Activity Nutrition Stress Management Self-Management Skills Rating Chart Rating Score Good 30–36 Marginal 24–29 Needs improvement ,24 41

Lab 3A Conclusions and Implications: Choose one of the three health behaviors (preferably a behavior for which you think you need improvement). In the space below, discuss your current ability to use the various self-management skills to Stages of Change Questionnaire help you change your stage for the health behavior. Which self-management skills did you score well on? Which ones could you possibly improve? Health Behavior: ______________________ Stages of Change Questionnaire. Check only one box for each question. 1. Physical Activity Precontemplation—I am not active, and I do not plan to start. Contemplation—I am not active, but I am thinking about starting. Preparation—I am getting ready to become active. Action—I do some activity but need to do more. Maintenance—I have been active regularly for several months. 2. Nutrition Precontemplation—I do not eat well and don’t plan to change. Contemplation—I do not eat well but am thinking about change. Preparation—I am planning to change my diet. Action—I sometimes eat well but need to do more. Maintenance—I have eaten well regularly for several months. 3. Stress Management Precontemplation—I do not manage stress well and plan no changes. Contemplation—I am thinking about making changes to manage stress. Preparation—I am planning to change to manage stress better. Action—I sometimes take steps to manage stress better but need to do more. Maintenance—I have used good stress-management techniques for several months. 42

Very Somewhat Not Activity Nutrition Stress Self-Management Skills Questionnaire True True True Score Score Score 1. I regularly self-assess: (self-assessment) Lab 3A personal physical fitness and physical activity levels 3 2 1 the contents of my diet 3 2 1 personal stress levels 3 2 1 2. I self-monitor and keep records concerning: (self-monitoring) physical activity 3 2 1 Self-Management Skills Questionnaire diet 3 2 1 stress in my life 3 2 1 3. I set realistic and attainable goals for: (goal setting) physical activity 3 2 1 eating behaviors 3 2 1 reducing stress in my life 3 2 1 4. I have a personal written or formal plan for: (self-planning) regular physical activity 3 2 1 what I eat 3 2 1 managing stress in my life 3 2 1 5. I possess the skills to: (performance skills) perform a variety of physical activities 3 2 1 analyze my diet 3 2 1 manage stress (e.g., progressive relaxation) 3 2 1 6. I have positive attitudes about: (balancing attitudes) my ability to stick with an activity plan 3 2 1 my ability to stick to a nutrition plan 3 2 1 my ability to manage stress in my life 3 2 1 7. I can overcome barriers that I encounter: (overcoming barriers) in my attempts to be physically active 3 2 1 in my attempts to stick to a nutrition plan 3 2 1 in my attempts to manage stress in my life 3 2 1 43

Very Somewhat Not Activity Nutrition Stress Self-Management Skills Questionnaire (cont.) True True True Score Score Score Lab 3A 8. I know how to identify misinformation: (consumer skills) relating to fitness and physical activity 3 2 1 relating to nutrition 3 2 1 relating to stress management 3 2 1 9. I am able to get social support for my efforts to: (social support) Self-Management Skills Questionnaire be active 3 2 1 stick to a healthy nutrition plan 3 2 1 manage stress in my life 3 2 1 10. When I have problems, I can get back to: (relapse prevention) my regular physical activity 3 2 1 my nutrition plan 3 2 1 my plan for managing stress 3 2 1 11. I am able to adapt my thinking to: (coping strategies) stick with my activity plan 3 2 1 stick with my nutrition plan 3 2 1 stick with my stress-management plan 3 2 1 12. I am able to manage my time to: (time management) stick with my physical activity plan 3 2 1 shop for and prepare nutritious food 3 2 1 perform stress-management activities 3 2 1 Total Activity Score Total Nutrition Score Total Stress Score 44

An Introduction to Physical Activity  c  Section II Concept 4 Preparing for Physical Activity LEARNING OBJECTIVES After completing the study of this Concept, you will be able to: c Identify and describe key factors for safely participating in a moderate to vigorous physical activity program. c Describe the warm-up, the workout, and the cool-down and explain why each is important. c Explain the potential risks associated with exposure to heat, cold, and altitude and describe precautions that can be taken to prevent problems. c Identify the factors that contribute to soreness and injury from physical activity and describe steps that can be taken to recover from them. c Identify and describe the common positive and negative attitudes about physical activity and explain how they relate to regular participation. c Identify related national health goals and show how meeting personal goals can contribute to reaching national goals. c Assess your readiness for physical activity and demonstrate appropriate warm-up activities. Proper preparation can help make physical activity enjoyable, effective, and safe. 45

46 Section 2  c  An Introduction to Physical Activity For people just beginning a physical activity program, adequate preparation may be the key to persistence. For those who have been regularly active for some time, sound preparation can help reduce risk of injury and make activity more enjoyable. For long-term maintenance, physical activ- ity must be something that is a part of a person’s normal life- style. Some factors that will help you prepare for and make physical activity a part of your normal routine are presented in this Concept. Factors to Consider Prior A clinical exercise test—an example of professionally guided to Physical Activity screening—is recommended for some individuals to ensure they can exercise safely. Screening before beginning regular physical activity is important to establish medical readiness. The most Table 1  c  American College of Sports Medicine recent guidelines for exercise testing and prescription of Risk Stratification Categories and Criteria the American College of Sports Medicine (ACSM) suggest that there are two types of pre-participation screening: self- Stratification Criteria guided screening and professionally guided screening. For Category self-guided screening, it is recommended that inactive men over 40, inactive women over 50, and people with a high risk Low risk People who have no heart disease of cardiovascular disease consult a physician before begin- symptoms and have no more than one of ning a new program. (See Table 1.) the risk factors listed below An alternative method of self-screening involves the use Moderate risk People without heart disease symptoms of the Physical Activity Readiness Questionnaire (PAR-Q). who have two or more of the risk factors This seven-item questionnaire was designed by the British listed below Columbia (Canada) Ministry of Health to help people know when it is advisable to seek medical consultation prior to High risk People with known cardiovascular, beginning or altering an exercise program (see Lab 4A). pulmonary, or metabolic disease, OR one The goal is to prevent unnecessary medical examinations or more signs or symptoms in the list below while helping people to be reasonably assured that regu- lar moderate physical activity is appropriate. Other self- Risk Factors administered surveys recommended by the ACSM include those given at a physician’s office or those administered Family history of heart disease; smoker; high blood pressure by certified health and fitness professionals (e.g., AHA/ (hypertension); high cholesterol; abnormal blood glucose levels; ACSM Pre-participation Screening Questionnaire). If a obesity (high BMI, excessive waist girth); sedentary lifestyle; low pre-participation questionnaire indicates the need, medical HDL cholesterol level; men aged 45 or older; women aged 55 clearance is recommended. A clinical exercise test may also or older be appropriate. Those who do not identify health concerns using a self-screening questionnaire (e.g., all “no” answers Signs and Symptoms on the PAR-Q) typically are cleared for moderate self- planned activity programs. For more vigorous exercise and Chest, jaw, or arm pain from lack of oxygen to the heart; sports, additional screening may be appropriate. shortness of breath at rest or in mild exercise; dizziness or fainting; difficult or labored breathing when lying, sitting, or ACSM has developed additional guidelines to stan- standing; ankle swelling; fast heartbeat or heart palpitations; dardize professionally guided screening (e.g., assessments pain in the legs from poor circulation; heart murmur; unusual conducted by a medical doctor or certified health/fitness fatigue or shortness of breath with usual activities professional). As noted in Table 1, the ACSM divides people into three general risk categories: low, moderate, and high Source: American College of Sports Medicine. risk. Some of the risk factors used to identify risk categories are identifiable without professional consultation (e.g., age, family history, smoking, sedentary lifestyle), while others may require professional screening (e.g., blood cholesterol, blood glucose). Many health clubs now offer professional screening for these variables. Individuals found to be at risk

Concept 4  c  Preparing for Physical Activity   47 are then referred for medical follow-up. Low-risk people Achilles notch who appear healthy are typically cleared for moderate and vigorous activity without a medical exam or an exercise test. Heel Those with moderate risk can participate in both moderate counter and vigorous activity without an exercise test (without medi- Arch cal supervision), but a medical exam is recommended before support beginning vigorous activity. For high-risk individuals, a Insole (sockliner) medical exam and an exercise test supervised by a physi- Insole (last) cian is recommended before beginning either moderate or Midsole vigorous activity. For those resuming physical activity after Outsole an injury or illness, consultation with a physician is always wise, no matter what your age or medical condition. Toe box Consideration should also be given to altering exercise Achilles notch: Protects tendon patterns if you have an illness or a temporary sickness, such Heel counter: Cradles heel to provide movement control; as a cold or the flu. The immune system and other body sys- reduces slippage and blistering; a sti counter reduces tems may be weaker at this time, and medicines (even over- pronation the-counter ones) may alter responses to exercise. It is best Arch support: Supports arch; height and shape of arch to work back gradually to your normal routine after illness. should vary with foot characteristics There is no way to be absolutely sure that you are medi- Insole (sockliner): Removable layer for additional shock and cally sound to begin a physical activity program. Even a sweat absorption; can be replaced periodically and/or thorough exam by a physician cannot guarantee that a per- customized son does not have some limitations Insole (last): Refers to shape of shoe bed; curved (allows that may cause a problem during exer- more mobility; better for those with high, rigid arches); cise. Use of the PAR-Q (see Lab 4A) straight (controls excessive motion, better for those with and adherence to the ACSM guide- VIDEO 1 abnormal pronation); or semicurved (moderate flexibility and stability) lines are advised to help minimize the Midsole: Provides cushion, stability, and motion control; risk while preventing unnecessary medical cost. However, if important for shock absorption you are unsure about your readiness for activity, a medical Outsole: Provides traction; determines shoe flexibility; type exam and a clinical exercise test are the surest ways to make depends on intended purpose of shoe certain that you are ready to participate. Toe box: Should have adequate height to wiggle toes and prevent rubbing on top of toes and adequate length so toes Shoes are an important consideration for safe and do not contact front of shoe effective exercise. Decisions about shoes should be based Figure 1  c  Anatomy of an activity shoe. on intended use (e.g., running, tennis), shoe and foot charac- teristics, and comfort. Shoes are designed for specific activi- It is important to dress properly for physical activity. ties, and performance will typically be best if you select and Clothing should be appropriate for the type of activity being use them for their intended purpose and fit, rather than how performed and the conditions in which you are participating. they look. Hybrid shoes, known as “cross-trainers,” can be a Comfort is a much more important consideration than looks. versatile option, but they typically don’t provide the needed Table 2 provides guidelines for dressing for activity. features for specific activities. For example, they may lack the cushioning and support needed for running and the ankle PAR-Q  An acronym for Physical Activity Readiness Question- support for activities such as basketball. Features of com- naire; designed to help determine if you are medically suited to mon activity shoes are highlighted in Figure 1. begin an exercise program. Clinical Exercise Test  A test, typically administered on a tread- Most shoes have very thin sockliners, but supplemen- mill, in which exercise is gradually increased in intensity while tal inserts can be purchased to provide more cushioning the heart is monitored by an EKG. Symptoms not present at rest, and support. Custom orthotics can also be used to correct such as an abnormal EKG, may be present in an exercise test. alignment problems or minimize foot injuries (e.g., plan- tar fasciitis). A very important, and frequently neglected, consideration is to replace shoes after extended use. Run- ners typically replace shoes every 4 to 6 months (or 400 to 600 miles), even if the outer appearance of the shoe is still good. The main functions of athletic shoes are to reduce shock from impact and protect the foot—one of the best prevention strategies for avoiding injuries is to replace your shoes on a regular basis.

48 Section 2  c  An Introduction to Physical Activity Components of a Typical Bout of Physical Activity Table 2  c  Selecting Appropriate Clothing for Activity The warm-up phase prepares the body for more General Guidelines vigorous activity. According to the ACSM, the warm-up can improve range of motion and may reduce injury risk. It • Avoid clothing that is too tight or that restricts movement. increases body temperature, decreases the risk for an irreg- • Material in contact with skin should be porous. ular heartbeat, and may reduce after-exercise soreness. The • Clothing should protect against wind and rain but allow ACSM recommends a general aerobic and muscular endur- ance warm-up consisting of a minimum of 5 to 10 minutes for heat loss and evaporation—e.g., GORE-TEX, of low-to-moderate-intensity activity prior to a vigorous COOLMAX. workout. However, some individuals (and athletes engaged in specific sports or activities) may benefit from different • Wear layers so that a layer can be removed if not needed. types of warm-up routines. A structured stretch warm-up • Wear socks for most activities to prevent blisters, abrasions, includes exercises designed to stretch the muscles beyond their normal length. This is a traditional form of warm-up odor, and excessive shoe wear. that is an enjoyable part of the regular exercise routine for many. In general, recent research has not confirmed the • Socks should be absorbent and fit properly. long-standing notion that a stretch warm-up reduces injury • Do not use nonporous clothing that traps sweat to risk. Evidence that a stretch warm-up reduces post-exercise soreness is also uncertain. Athletes who participate in lose weight; these garments prevent evaporation and sports and activities requiring a larger-than-normal range cooling. of motion (e.g., gymnastics and diving) typically perform a stretch warm-up (after a general warm-up) as part of Special Considerations • Consider eye protection for racquetball and other sports. • Women should wear an exercise bra for support. • Men should consider an athletic supporter for support. • Wear helmets and padding for activities with risk of falling, such as biking or inline skating. • Wear reflective clothing for night activities. • Wear water shoes for some aquatic activities. • Consider lace-up ankle braces to prevent injury. • Consider a mouthpiece for basketball and other contact sports. A CLOSER LOOK CPR Guidelines and AEDs C B A To be prepared for physical activity, you also need to be pre- pared for emergencies. Active people in particular should C 5 Compress A 5 Airway B 5 Breath know cardiopulmonary resuscitation (CPR) and how to use an automated external defibrillator (AED). Guidelines from Push hard and fast Tip head back Give mouth-to-mouth the American Heart Association (AHA) use the letters C-A-B in the center of and lift the chin breaths to guide a rescuer to remember the three key steps in CPR the chest to open airway (C  5  Compressions;  A  5  Airway;  B  5  Breathing). If a person is unresponsive, a trained rescuer should first call for help How confident are you that you would be ready in an (including dialing 911) and then begin chest compression emergency? What steps would you take or have taken to be immediately (30 times at a rate of 100 times per minute). Then ready to perform CPR or use an AED if an emergency arises? open the airway and give mouth-to-mouth rescue breaths (2  times). Repeat the 30-2 compression-to-breath cycle. For the untrained rescuer, a “hands-only” approach (compression only) is recommended. Also, AEDs are available in many public places, including fitness centers and schools. The AHA offers free online training for CPR and AED devices at www.heart.org. (See link in Suggested Resources and Readings.) ACTIVITY

Concept 4  c  Preparing for Physical Activity   49 Table 3  c  Warm-Up Guidelines for Different Physical Activities Activity Guidelines Moderate Activity • For walking and activities of equal intensity, no warm-up is necessary. Vigorous Aerobics • For moderate recreation, such as golf, a sport-specific warm-up may be performed. • Depending on intensity, a general, dynamic or, stretch warm-up (after the general or dynamic Vigorous Sports warm-up) can be performed. Muscle Fitness Exercises Flexibility Exercises and Activities • For aerobic dance or similar dance activities, similar dance-related movements can be performed, Requiring Flexibility with gradually increasing intensity, as a general warm-up. Some may choose a stretch warm-up (after the general warm-up). • For jogging, biking, swimming, and similar aerobic activities, performing the activity slowly and then with increased intensity can serve as a general warm-up. A dynamic warm-up can also be used as a general warm-up. A stretch warm-up can be performed after the general warm-up. • A general warm-up is recommended but can be done using dynamic exercises. Sport-specific exercises are appropriate. If a stretch warm-up is chosen, it should be done after the general warm-up. Stretches should not exceed 60 seconds. • For sports that require strength, speed, and power, you should choose a dynamic warm-up (it can double as a general warm-up). The stretch warm-up is not recommended. • Prior to training for muscle fitness, including speed training, choose a dynamic warm-up (it can double as a general warm-up). The stretch warm-up is not recommended. • Prior to performing flexibility exercises as part of your workout, a general warm-up is recom- mended. Some may choose to do dynamic exercises as the general warm-up. • Prior to performing activities such as gymnastics, diving, and dance, a stretch warm-up is recom- mended after the general warm-up. their pre-exercise routine. In these activities, the stretching but stretching exercises designed to improve flexibility are is important for their performance. The stretch warm-up, considered part of a workout. (Additional information about however, can reduce strength, power, and/or speed perfor- stretching exercises is included in the Concept on flexibil- mance, especially if the stretches last more than 60 seconds. ity.) The specific type of warm-up that you will perform For athletes and those concerned with high-level perfor- depends on the nature of your workout. Table 3 provides mance in activities that require strength, power, or speed, information about types of warm-up activities for various a stretch warm-up is not recommended. Typical exercisers types of physical activity. who are not concerned with high-level performance, and who enjoy a stretch warm-up, may choose to perform a The workout is the principal component of an activity stretch warm-up after a general warm-up. program and occurs after the warm-up and before the cool-down. A workout can refer to physical activi- An alternative to a stretch warm-up is a dynamic warm-up ties designed as training for fitness and health, participation that includes moderate intensity, calisthenic-type activities in sport or recreation for fun and enjoyment, or participa- (see Lab 4B for examples). Unlike the stretch warm-up, the tion in moderate exercise for general health and wellness. goal is not to lengthen the muscles, but to move the joints through a full range of motion. The dynamic warm-up can Warm-Up  Light to moderate physical activity performed to pre- be substituted for a general warm-up in some cases and can pare for a more vigorous workout. be used instead of a stretch warm-up before strength, power, Stretch Warm-up  The performance of stretching exercises prior and/or speed activities (e.g., weight lifting, sprinting, or shot to a vigorous workout. putting). A specific type of dynamic warm-up known as the Dynamic Warm-up  The performance of calisthenics of gradu- sport-specific warm-up is recommended prior to sports. ally increasing intensity prior to a vigorous workout (e.g., jump- Examples include performing layups or shooting baskets ing jacks, jumping, skipping). before a basketball game or swinging a golf club or tennis Workout  The component of a total physical activity program racket before playing the actual game. designed to produce health, wellness, fitness, and other benefits using appropriate amounts of different types of physical activity. It is important to note that the stretch warm-up and dynamic warm-up are not the same as a workout to improve flexibility. A stretch warm-up prepares you for your workout,

50 Section 2  c  An Introduction to Physical Activity If performed as part of a more structured exercise routine, HELP Health is available to Everyone it is the component that provides the stimulus for adapta- for a Lifetime, and it’s Personal tions and improved conditioning. The specific benefits from To exercise safely, you need to consider environmental a workout depend on the type and intensity of activity that conditions such as weather, altitude, and air quality. You is performed (see the Concept on the health benefits of can use online weather and environmental resources to physical activity). Information about appropriate frequency, check the heat index, windchill, and even the environmen- intensity, and length of time for different types of physi- tal air quality (see www.airnow.gov). Use this information cal activities is included in subsequent Concepts (look for to determine the appropriate exercise-related precautions descriptions of the “physical activity pyramid”). you should take. A cool-down after the workout promotes an effective Do you pay attention to weather and safety warnings recovery from physical activity. After a more vigorous related to the environment? Would quick online access workout, it is wise to perform a cool-down to help the body to this type of information make it easier to do so? transition back to a resting state. The ACSM recommends a 5- to 10-minute cool-down phase consisting of light to mod- ACTIVITY erate physical activity, such as walking or slow jogging, and can also include stretching exercises. The moderate aerobic following vigorous activity. During physical activity, the activity promotes effective recovery by aiding the return of heart pumps a large amount of blood to supply the work- blood from the working muscles to the heart. In addition ing muscles with the oxygen needed to keep moving. The to helping reduce metabolic by-products, the general cool- muscles squeeze the veins, which forces the blood back to down helps the cardiovascular system (heart rate and blood the heart. Valves in the veins prevent the blood from flow- pressure) return to a normal state. Figure 2 depicts how muscle contractions influence cir- culation and why it is important to perform a cool-down ing backward. As long as exercise continues, muscles move the blood back to the heart, where it Relaxed Contracted is once again pumped to the body. If skeletal muscles skeletal muscles exercise is stopped abruptly, the blood Blood returns Blood returns is left in the area of the working mus- VIDEO 2 to heart to heart Valve cles and has no way to get back to the Closed open heart. In the case of a runner, the blood pools in the legs. valve Because the heart has less blood to pump, blood pressure Muscles may drop. This can result in dizziness and can even cause a person to pass out. The best way to prevent this problem is to slow down gradually after exercise and keep moving until blood pressure and heart rate have returned to near resting values. This phase is especially important for those with car- diovascular risk factors or disease. Vein Physical Activity in the Heat and Cold Closed valve Physical activity in hot and humid environments Figure 2  c  Muscle contractions help the veins return challenges the body’s heat loss mechanisms. During blood to the heart. vigorous activity, the body produces heat, which must be dissipated to regulate body temperature. The body has sev- eral ways to dissipate heat. Conduction is the transfer of heat from a hot body to a cold body. Convection is the transfer of heat through the air or any other medium. Fans and wind can facilitate heat loss by convection and help regulate tempera- ture. The primary method of cooling is through evapora- tion of sweat. The chemical process involved in evaporation transfers heat from the body and reduces the body tem- perature. When conditions are humid, the effectiveness of

Concept 4  c  Preparing for Physical Activity   51 evaporation is reduced, since the air is already saturated Adequate hydration is critical for safe exercise in the heat. with moisture. This is why it is difficult to regulate body temperature when conditions are hot and humid. Precautions should be taken when doing physical Heat-related illness can occur if proper hydration is activity in hot and humid environments. The heat index not maintained. Maximum sweat rates during physical (also referred to as apparent temperature) combines tem- activity in the heat can approach 1–2 quarts per hour. If this perature and humidity to help you determine when an fluid is not replaced, dehydration can occur. If dehydra- environment is safe for activity. The combination of high tion is not corrected with water or other fluid-replacement temperature and humidity presents the greatest risk of heat- drinks, it becomes increasingly difficult for the body to related problems in exercise. Physical activity is safe when maintain normal body temperatures. At some point, the the apparent temperature is below 808F (26.78C). Figure 3 rate of sweating decreases as the body begins to conserve shows the risk of exercise at progressively higher apparent its remaining water. It shunts blood to the skin to transfer temperatures. excess heat directly to the environment, but this is less effec- tive than evaporation. Hyperthermia and associated heat- Consider the following guidelines for exercising in the related problems can result (see Table 4). heat and humidity. ∙ Limit or cancel activity if the apparent temperature One way to monitor the amount of fluid loss is to moni- tor the color of your urine. Clear (almost colorless) urine reaches the danger zone (see Figure 3). produced in large volumes indicates that you are hydrated. ∙ Drink fluids before, during, and after vigorous activ- As water in the body is reduced, the urine becomes more concentrated and is a darker yellow color. This indicates ity. Guidelines suggest about 2 cups before activity and dehydration and a need for fluid replacement. Dietary sup- about 1 cup for each 15–20 minutes during activity. After plements that contain amphetamine derivatives and/or cre- activity, drink about 2 cups for each pound of weight lost. atine may contribute to undetected dehydration among some The thirst mechanism lags behind the body’s actual need individuals. for fluid, so drink even if you don’t feel thirsty. Fluid- Acclimatization improves the body’s tolerance in the replacement beverages (e.g., Gatorade, Powerade) are heat. Individuals with good fitness will respond better to designed to provide added energy (from carbohydrates) activity in the heat than individuals with poor fitness. With without impeding hydration. If you choose to use one of regular exposure, the body adapts to the heat. The majority of the adaptation to hot environments occurs in 7 to 14 days, Cool-Down  Light to moderate activity performed after a more but complete acclimatization can take up to 30 days. As you vigorous workout to help the body recover. adapt to the heat, your body becomes conditioned to sweat Dehydration  Excessive loss of water from the body, usually earlier, to sweat more profusely, and to distribute the sweat through perspiration, urination, or evaporation. more effectively around the body, and the composition of Hyperthermia  Excessively high body temperature caused by sweat is altered. This process makes it easier for your body excessive heat production or impaired heat loss capacity. Heat- to maintain a safe body temperature. stroke is a hyperthermic condition. Heat Index An index based on a combination of temperature Table 4  c  Types of Heat-Related Problems and humidity that is used to determine if it is dangerous to per- form physical activity in hot, humid weather (also called apparent Problem Symptoms Severity temperature). Heat cramps Heat exhaustion Muscle cramps, especially Least severe in muscles most used in Heatstroke exercise Muscle cramps, Moderately weakness, dizziness, severe headache, nausea, clammy skin, paleness Hot, flushed skin; dry Extremely skin (lack of sweating); severe dizziness; fast pulse; unconsciousness; high temperature

52 Section 2  c  An Introduction to Physical Activity Find air temperature on the top; then find the humidity on the left. Find the heat index where the columns meet. Relative Air Temperature (Degrees F) Humidity 70 75 80 85 90 95 100 105 110 115 120 (%) 72 80 91 108 132 “Apparent Temperatures” 100 71 79 89 105 128 (Heat Index) 95 90 71 79 88 102 122 = Extreme danger zone 85 71 78 87 99 117 141 = Danger zone 80 71 78 86 97 113 136 = Extreme caution zone 75 70 77 86 95 109 130 = Caution zone 70 70 77 85 93 106 124 144 = Safe 65 70 76 83 91 102 119 138 60 55 70 76 82 90 100 114 132 149 50 45 69 75 81 89 98 110 126 142 40 35 69 75 81 88 96 107 120 135 150 30 25 68 74 80 87 95 104 115 129 143 20 15 68 74 79 86 93 101 110 123 137 151 10 5 67 73 79 85 91 98 107 118 130 143 0 67 73 78 84 90 96 104 113 123 135 148 66 72 77 83 88 94 101 109 117 127 139 66 72 77 82 87 93 99 105 112 120 130 65 71 76 81 86 91 97 102 108 115 123 65 70 75 80 85 90 95 100 105 111 116 64 69 74 79 84 88 93 97 102 107 111 64 69 73 78 83 87 91 95 99 103 107 Figure 3  c  Heat index values (apparent temperatures). Source: Data from National Oceanic and Atmospheric Administration. these beverages, select one that contains electrolytes and attention if symptoms progress. Consider cold water no more than 4 to 8 percent carbohydrates. immersion for heatstroke. ∙ Avoid extreme fluid intake. Drinking too much water Physical activity in exceptionally cold and windy can cause a condition called hyponatremia, some- weather can be dangerous. Activity in the cold pre- times referred to as “water intoxication.” It occurs sents the opposite problems of exercise in the heat. In when you drink too much water, resulting in the dilu- the cold, the primary goal is to retain the body’s heat and tion of the electrolytes in the blood; interestingly, it avoid hypothermia and frostbite. Early signs of hypo- has symptoms similar to those of dehydration. If left thermia include shivering and cold extremities caused by untreated, it can result in loss of consciousness and blood shunted to the body core to conserve heat. As the even death. core temperature continues to drop, heart rate, respiration, ∙ Gradually expose yourself to physical activity in hot and and reflexes are depressed. Subsequently, cognitive func- humid environments to facilitate acclimatization. tions decrease, speech and movement become impaired, ∙ Dress properly for exercise in the heat and humidity. and bizarre behavior may occur. Frostbite results from water Wear white or light colors that reflect rather than absorb crystallizing in the tissues, causing cell destruction. heat. Select wickable clothes instead of cotton to aid When doing activity in cold, wet, and windy weather, evaporative cooling. Rubber, plastic, or other nonporous precautions should be taken. A combination of cold and clothing is especially dangerous. A porous hat or cap can wind (windchill) poses the greatest danger for cold-related help when exercising in direct sunlight. problems during exercise. Research conducted in Canada, ∙ Watch for signs of heat stress (see Table 4). If signs are in cooperation with the U.S. National Weather Service, present, stop immediately, get out of the heat, remove produced tables for determining windchill factor and the excess clothing, and drink cool water. Seek medical

Concept 4  c  Preparing for Physical Activity   53 Wind, cold, and altitude present some additional challenges time of exposure necessary to get frostbite (see Figure 4). for winter exercise. Consider the following guidelines for performing physical activity in cold and wind: ∙ Limit or cancel activity if the windchill factor reaches the danger zone (see Figure 4). ∙ Dress properly. Wear light clothing in several layers rather than one heavy garment. The layer of clothing closest to the body should transfer (wick) moisture away from the skin to a second, more absorbent layer. Polypropylene and capilene are examples of wickable fabrics. A porous windbreaker keeps wind from cool- ing the body and allows the release of body heat. The hands, feet, nose, and ears are most susceptible to frostbite, so they should be covered. Wear a hat or cap, mask, and mittens. Mittens are warmer than gloves. A light coating of petroleum jelly on exposed body parts can be helpful. Hyponatremia  A condition caused by excess water intake, called “water intoxication,” that results in a dilution of electro- lytes, leading to serious medical complications. Hypothermia  Excessively low body temperature (less than 958F), characterized by uncontrollable shivering, loss of coordi- nation, and mental confusion. Windchill Factor  An index that uses air temperature and wind speed to determine the chilling effect of the environment on humans. Actual Calm 5 Estimated Wind Speed (mph) Minutes Temperature 10 15 20 25 30 35 40 to Reading Frostbite (Degrees F) 40 36 34 32 30 29 28 27 27 40 30 25 30 20 13 21 19 17 16 15 14 13 20 10 1 10 9643 1 0 -1 0 0 -11 -10 -10 -22 -4 -7 -9 -11 -12 -14 -15 -20 -20 -34 -30 -30 -46 -16 -19 -22 -24 -26 -27 -29 30 -40 -40 -57 10 -28 -32 -35 -37 -39 -41 -43 5 -41 -45 -48 -51 -53 -55 -57 -53 -58 -61 -64 -67 -69 -71 -66 -71 -74 -78 -80 -82 -84 = Caution Zone = Risk Zone = High Risk Zone = Extreme Danger Zone Figure 4  c  Windchill factor chart. Source: National Weather Service.

54 Section 2  c  An Introduction to Physical Activity ∙ Keep from getting wet in cold VIDEO 3 Soreness and Injury weather. If you get wet because of unavoidable circumstances, seek a Understanding soreness can help you persist in warm place to dry off. physical activity and avoid problems. A common experience for many exercisers is a certain degree of Physical Activity in Other muscle soreness that occurs 24–48 hours after intense Environments exercise. This soreness, termed delayed-onset muscle soreness (DOMS), typically occurs when muscles are exer­ High altitude may limit performance and require cised at levels beyond their normal use. Some people adaptation of normal physical activity. The ability to do mistakenly believe that lactic acid is the cause of muscle vigorous physical tasks is diminished as altitude increases. In soreness. Lactic acid (a by-product of anaerobic metab- addition, exercise at higher altitudes may produce symptoms olism) is produced during vigorous exercise, but levels such as a faster heart rate, shortness of breath, headache, return to normal within 30 minutes after exercise, while dizziness, fatigue, and upset stomach (nausea and vomit- DOMS occurs 24 hours after exercise. DOMS is caused ing). With proper acclimation (gradual exposure), the body by microscopic muscle tears that result from the exces- adjusts to the lower oxygen pressure found at high altitude, sive loads on the muscles. Soreness is not a normal part performance improves, and symptoms lessen. Nevertheless, of the body’s response to exercise but occurs if an indi- performance ability at high altitudes, especially for activities vidual violates the principle of progression and does more requiring cardiorespiratory endurance, is usually less than exercise than the body is prepared for. While it may be would be expected at sea level. At extremely high altitudes, uncomfortable to some, it has no long-term consequences the ability to perform vigorous physical activity may be and does not predispose one to muscle injury. To reduce impossible without an extra oxygen supply. When moving the likelihood of DOMS, it is important to progress your from sea level to a high altitude, vigorous exercise should program gradually. be done with caution. To minimize the effects of altitude on performance, spend at least two weeks at a higher alti- The most common injuries incurred in physical tude before performing high-intensity exercise, gradually activity are sprains and strains. A strain occurs when the increasing length and intensity of activity. Pace yourself, fibers in a muscle are injured. Common activity-related inju- drink adequate water, take rest stops, listen to your body, and ries are hamstring strains that occur after a vigorous sprint. avoid alcohol. Other commonly strained muscles include the muscles in the front of the thigh, the low back, and the calf. Exposure to air pollution should be limited. Various pollutants can cause poor performance and, in some cases, A sprain is an injury to a ligament—the connective tissue health problems. Ozone, a pollutant produced primarily that connects bones to bones. The most common sprain is to by the sun’s reaction to car exhaust, can cause symptoms, the ankle; frequently, the ankle is rolled to the outside (inver- including headache, coughing, and eye irritation. Similar sion) when jumping or running. Other common sprains are symptoms result from exposure to carbon monoxide, a to the knee, the shoulder, and the wrist. tasteless and odorless gas, caused by combustion of oil, gasoline, and/or cigarette smoke. The Environmental Tendonitis is an inflammation of the tendon; it is most Protection Agency provides up-to-date pollution advi- often a result of overuse rather than trauma. Tendonitis can sories (see AirNow.gov) based on an “air quality index” be painful but often does not swell to the extent that sprains (AQI). Ratings range from “good” to “hazardous” to let do. For this reason, elevation and compression are not as people know if it is safe to be outside. Some individuals effective as ice and rest (see below). A physician should be may need to modify their activity routines based on the consulted for an appropriate diagnosis. AQI in their region. Exercisers wishing to avoid ozone and carbon monoxide may want to exercise indoors early in the Being able to treat minor injuries will help reduce their morning or later in the evening and avoid areas with a high negative effects. Minor injuries, such as muscle strains concentration of traffic. and sprains, are common to those who are persistent in their exercise. If a serious injury should occur or if symptoms Plant pollens, dust, and other pollutants in the air may persist, it is important to get immediate medical attention. cause allergic reactions for certain people. Weather reports However, for minor injuries, follow- of pollens and particulates may help exercisers determine ing the RICE formula will help you the best times for their activities and when to avoid vigorous reduce the pain and speed recovery. In activities. this acronym, R stands for rest. Mus- VIDEO 4 cle sprains and strains heal best if the injured area is rested. Rest helps you avoid further damage to the muscle. I stands for ice. The quick application of cold

Concept 4  c  Preparing for Physical Activity   55 In the News Extreme Exercise and the Heart (e.g., ultramarathons or 24-hour exercise events) can cause cardiovascular disease. More research is needed to confirm Competition and personal challenge lead this finding, but it may cause some athletes to rethink their many individuals to push the limits of exer- exercise regimens. (See link in the Suggested Resources and cise performance. While moderate amounts of exercise are Readings.) clearly beneficial, a prominent cardiologist has suggested that exercise beyond certain levels can actually increase Do you agree with the notion that too much exercise can be your risk for developing cardiovascular disease. It has been harmful? Would this deter you from participating in extreme well established that exercise can precipitate a heart attack forms of exercise? in people who have cardiovascular disease risk factors, but the shocking conclusion in this study is that extreme exercise (ice or ice water) to a minor injury minimizes swelling and ACTIVITY speeds recovery. Cold should be applied to as large a surface area as possible (soaking is best). If ice is used, it should be cramps among runners and other sports participants, can be wrapped to avoid direct contact with the skin. Apply cold relieved using the calf stretcher exercise, which is part of the for 20 minutes, three times a day, allowing 1 hour between warm-up in this Concept. applications. C stands for compression. Wrapping or com- pressing the injured area also helps minimize swelling and TECHNOLOGY UPDATE speeds recovery. Elastic bandages or elastic socks are good for applying compression. Care should be taken to avoid Sensing Your Personal Health wrapping an injury too tightly because this can result in loss of circulation to the area. E stands for elevation. Keeping Technological innovations are leading to dramatic changes the injured area elevated (above the level of the heart) is in health care. A technology competition known as the effective in minimizing swelling. If pain or swelling does Nokia Sensing XChallenge presents a compelling vision of not diminish after 24  to 48 hours, or if there is any doubt what might be possible with advances in sensing technol- about the seriousness of an injury, seek medical help. Some ogy and related software: “Envision a future where every- experts recommend adding a P to RICE (PRICE) to indicate one has access to affordable, personalized healthcare that prevention (P) is as important as treatment of injuries. through sophisticated sensing technologies that put you Building strength and flexibility, warming up, beginning in charge of your own health. Where sensors and devices gradually when starting a new activity, and wearing pro- recognize and measure your personal health information, tective equipment, such as lace-up ankle braces, are simple provide insights and recommendations relevant to you methods of prevention. and communicate that information to your physician.” The development and refinement of various sensors will lead Taking over-the-counter pain remedies can help reduce to many changes, including remote monitoring, virtual test- the pain of muscle strains and sprains. Aspirin and ibupro- ing, and real-time imaging. fen have anti-inflammatory properties. However, acetamino- Would you embrace virtual monitoring by your physician, phen (e.g., Tylenol) does not. It may reduce the pain but will or would you favor in-person testing? not reduce inflammation. Muscle cramps can be relieved by statically stretching Source: X Prize, 2015. http://sensing.xprize.org/. All rights reserved. a muscle. Muscle cramps are pains in the large muscles that Used with permission. result when the muscles contract vigorously for a continued period of time. Muscle cramps are usually not considered ACTIVITY to be an injury, but they are painful and may seem like an injury. They are usually short in duration and can often be DOMS  An acronym for delayed-onset muscle soreness, a com- relieved with proper treatment. Cramps can result from lack mon malady that follows relatively vigorous activity, especially of fluid replacement (dehydration), from fatigue, and from a among beginners. blow directly to a muscle. Static stretching can help relieve RICE  An acronym for rest, ice, compression, and elevation; a some cramps. For example, the calf muscle, which often method of treating minor injuries.

56 Section 2  c  An Introduction to Physical Activity Table 5  c  Common Excuses People Give for Not Being Active Excuse Description Strategy for Change I don’t have the time. This is the number one reason people give Planning a daily schedule can help you find It’s too inconvenient. for not exercising. Invariably, those who the time for activity and avoid wasting time feel they don’t have time know they should on things that are less important. do more exercise. They say they plan to do more in the future when “things are less If you have to travel more than 10 minutes hectic.” to do activity or if you do not have easy access to equipment, you will avoid activity. Many people who avoid physical activity Locating facilities and finding a time when do so because it is inconvenient. They say, you can shower is important. “It takes too long to get to the gym” and “It makes me sweaty and messes up my hair.” There are many activities to choose from. If you don’t enjoy vigorous activity, try more I just don’t enjoy it. Many people do not find activity to be moderate forms of activity, such as walking. enjoyable or invigorating. They may I’m no good at physical activity. assume that all forms of activity have to be Selecting activities properly, avoiding strenuous and fatiguing. comparisons to others, and learning skills I am not fit, so I avoid activity. can help anyone to be more active. “People might laugh at me,” “Sports make I have no place to be active, me nervous,” and “I am not good at physical There are good medical reasons for not especially in bad weather. activities” are reasons some people give for doing activity, but many people with not being active. problems can benefit from exercise if it is I am too old. properly designed. Some people avoid exercise because of health reasons. Some who are unfit lack If you cannot find a place, if it is not safe, energy. Starting slowly can build fitness or if it is too expensive, consider using low- gradually. cost equipment at home, such as rubber bands or calisthenics. Regular activity is more convenient if facilities are easy to reach and the weather Older people who are just beginning is good. Most popular activities require activity should start slowly. Setting realistic little equipment and can be done in or near goals can help, as can learning to do home. resistance training and flexibility exercises. As people grow older, many begin to feel that activity is something they cannot do. Properly planned exercise for older adults is not only safe but also has many health benefits. Attitudes about Physical Activity strategies in Table 5 can help inactive people become more active. Knowing the most common reasons for inactivity can help you avoid sedentary living. Most people want to be active but find many barriers get in the way. The Knowing the reasons people give for being active can help you adopt positive attitudes toward activity. To most common excuses given by peo- enhance the promotion of physical ple who do not do regular physical activity in society, many researchers activity are listed in Table 5. Experts have sought to determine why some consider many of these attitudes to VIDEO 5 people choose to be active and others VIDEO 6 be barriers that can be overcome. In do not. The most common reasons for fact, a key self-management skill that predicts long-term physical activity are highlighted in Table 6. The table also behavior change is the ability to overcome barriers. The offers strategies for adopting these behaviors.

Concept 4  c  Preparing for Physical Activity   57 Table 6  c  Common Reasons for Doing Regular Physical Activity Reason Description Strategy for Change I am active because I simply The sense of fun, well-being, and general Find activities that you enjoy. Many people find enjoy it! enjoyment associated with physical activity is well walking to be a simple and enjoyable activity documented. because it doesn’t require skill or extreme effort. I enjoy being active because Improving health is a primary reason for many people, Learning about the powerful benefits of fitness can I care about my health. and it takes only moderate amounts to benefit. provide motivation to start. I enjoy being active because Improving appearance is a major reason some Setting realistic goals and avoiding comparisons it helps me look great. people participate in regular exercise. Regular with others can help you to be more successful. activity can help you look your best. I enjoy being active because Physical activity provides an outlet from daily Build in time to take short activity breaks and allow it helps me relax and frustrations and can help reduce depression and your mind to be freed up from daily hassles while reduces stress in my life. anxiety. you are active. I enjoy being active because The challenge of doing something you have Seek opportunities to learn new skills and try new it challenges me. never done before can build a sense of personal things. Reward yourself for accepting challenges accomplishment. This is a powerful motivator for associated with physical activity. physical activity. I enjoy being active because Physical activity provides opportunities to spend Find ways to be active with family and friends. it is a fun way to be with quality time with friends and family. Select partner or team activities that deemphasize friends. competition. I enjoy being active because Many people find “the thrill of victory” and “sports If you don’t enjoy the “competing” aspect, focus on how you are improving versus winning or losing. I like to compete. competition” very satisfying. I enjoy being active because For many people, participation in physical activity Physical activity is something that is self- it helps me feel good about is an important part of their identity. It can help you determined and within your control. Schedule myself. feel good about yourself, build your confidence, and activity just as you would any important priority to increase self-esteem. accomplish during the week. I enjoy being active because Spending time outside and experiencing nature Seek out parks, bike and walking trails, and other it is a fun way to enjoy the pair well with many physical activities. outdoor settings for your activities. outdoors. Strategies for Action Screening for risks can help make provides a sample flexibility-based warm-up and cool-down activity safer. Athletes in competitive routine that may be helpful. Determine what works best for sports often undergo pre-participation physical examinations your needs. to screen for potential cardiac arrhythmias or conditions known to increase risks during exercise. Recreational athletes may not Assess your attitudes concerning physical activity. Active take the same precautions. The best advice is to get a physical people generally have more positive attitudes than negat­ive prior to beginning serious training. This is especially critical if ones. This is referred to as a “positive balance of attitudes.” The you have a family history of heart problems. Lab 4A will help questionnaire in Lab 4C gives you the opportunity to assess you determine if you should consult a physician. your balance of attitudes. If you have a “negative balance” score, you can analyze your attitudes and determine how you A proper warm-up can prepare your body for activity can change them to view activity more favorably. and a gradual cool-down can improve recovery. Lab 4B ACTIVITY

58 Section 2  c  An Introduction to Physical Activity Suggested Resources ∙ American Heart Association: Heartsaver® First Aid CPR AED and Readings Training. ∙ Environmental Protection Agency: Air Quality Index (AQI) from AirNow.gov. The websites for the following sources can be accessed by searching online for the organization, program, or title listed. Specific scientific ∙ Institute of Medicine. (2012). Fitness Measures and Health references are available at the end of this edition of Concepts of Outcomes in Youth. National Academies Press. Fitness and Wellness. ∙∙ The New Yorker: Extreme Exercise and the Heart. Shape Up America: Online Physical Activity Readiness ∙∙ American College of Sports Medicine: Injury Prevention Concepts. Questionnaire. American College of Sports Medicine: Key Position Statements. ∙ WebMD: Understanding Heat-Related Illness Symptoms.

Lab 4A  Readiness for Physical Activity Name Section Date Lab 4A Purpose: To help you determine your physical readiness for participation in a program of regular exercise. Procedures Readiness for Physical Activity 1. Read the directions on the “PAR-Q & You” on the next page. 2. Answer each of the seven questions on the form. 3. If you answered “yes” to one or more of the questions, follow the directions just below the PAR-Q questions regarding medical consultation. 4. If you answered “no” to all seven questions, follow the directions at the lower left-hand corner of the PAR-Q. 5. Answer the five questions about physical readiness for sports or vigorous training in Chart 1 below. 6. Record your scores below and answer the question in the Conclusions and Implications section. Results Chart 1  Physical Readiness for Sports or Vigorous Training Answer the PAR-Q before using this chart. If your answer to any of these questions is “yes,” you should consult with your personal physician by telephone or in person to determine if you have a potential problem with sports or vigorous training. Yes No 1. Do you plan to participate on an organized team that will play intense competitive sports (e.g., varsity team, ­professional team)? 2. If you plan to participate in a collision sport (even on a less organized basis), such as football, boxing, rugby, or ice hockey, have you been knocked unconscious more than one time? 3. Do you currently have symptoms from a previous muscle injury? 4. Do you currently have symptoms from a previous back injury, or do you experience back pain as a result of involvement in physical activity? 5. Do you have any other symptoms during physical activity that give you reason to be concerned about your health? Determine your PAR-Q score. Place an X over the circle that includes the number of “yes” answers that you had for the PAR-Q on the next page). 0 1 2 3 4 5 6 7 Determine your readiness for sports or rigorous training (see Chart 1 above). Place an X over the number of “yes” answers that you had for the Physical Readiness for Sports or Vigorous Training chart. 0 1 2 3 4 5 Conclusions and Implications: In several sentences, discuss your readiness for physical activity. Base your comments on your questionnaire results and the types of physical activities you plan to perform in the future. 59

Lab 4A Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. Readiness for Physical Activity If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of fifteen and sixty-nine, the PAR-Q will tell you if you should check with your doctor before you start. If you are over sixty-nine years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO. YES NO 1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? 2. Do you feel pain in your chest when you do physical activity? 3. In the past month, have you had chest pain when you were not doing physical activity? 4. Do you lose your balance because of dizziness or do you ever lose consciousness? 5. Do you have a bone or joint problem that could be made worse by a change in your physical activity? 6. Is your doctor currently prescribing drugs(for example, water pills) for your blood pressure or heart condition? 7. Do you know of any other reason you should not do physical activity? Yes YES to one or more questions If you Talk with your doctor by phone or in person BEFORE you start becoming much more physically active answered or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. No You may be able to do any activity you want—as long as you start slowly and build up gradually. Or you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his or her advice. Find out which community programs are safe and helpful for you. NO to all questions DELAY BECOMING MUCH MORE ACTIVE: If you answered NO honestly to all PAR-Q questions, you can If you are not feeling well because of a temporary illness, be reasonably sure that you can such as a cold or a fever—wait until you feel better or If you are or may be pregnant—talk to your doctor before Start becoming much more physically active—begin you start becoming more active. slowly and build up gradually. This is the safest and easiest way to go. Please note: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health Take part in a fitness appraisal—this is an excellent way professional. Ask whether you should change your physical to determine your basic fitness so that you can plan the activity plan. best way for you to live actively. Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity. You are encouraged to copy the PAR-Q but only if you use the entire form *Developed by the British Columbia Ministry of Health. Physical Activity Readiness Questionnaire PAR-Q Produced by the British Columbia Ministry of Health and the Department of National Health & Welfare (revised 2002) © Canadian Society for Exercise Physiology www.csep.ca/forms Note: It is important that you answer all questions honestly. The PAR-Q is a scientifically and medically researched pre-exercise selection device. It comple- ments exercise programs, exercise testing procedures, and the liability considerations attendant with such programs and testing procedures. PAR-Q, like any other pre-exercise screening device, will misclassify a small percentage of prospective participants, but no pre-exercise screening method can entirely avoid this problem. 60

Lab 4B  The Warm-Up Name Section Date Lab 4B Purpose: To familiarize you with possible warm-up and cool-down exercises. Procedures The Warm-Up 1. Consider the specific type of workout you are planning to perform and place a check in the Results section (e.g., walk, jog, slow jump rope). When completed, place a check mark in the box in the Results Section that corresponds to your planned workout. 2. Perform a general cardiovascular warm-up. 3. Perform each of the exercises in Chart 1 on the next page. Perform dynamic exercises several times. Perform stretching exercises three times for 15–30 seconds each. 4. After you perform the specific warm-up exercises, place a check (results section) beside the warm-up exercises that you think you would most likely include in your personal warm-up for the workout you checked. 5. Answer the questions in the Conclusions and Implications section. Type of Workout (check one): Moderate-intensity recreational activity Vigorous aerobics Long jog Muscle fitness exercises Vigorous-intensity recreational activity Sports (game or practice) Other _____ Cardiovascular Warm-Up Warm-Up Exercises (check those that you would include in your warm-up): Dynamic Warm-Up Stretch Warm-Up Grapevine Calf stretch Knee stride and reach Hamstring stretch High skip and reach Seated side stretch Inchworm Leg hug Backward jog Conclusions and Implications: In several sentences, explain the reasons for your selections. 61

Chart 1  The Warm-up. Dynamic Exercises. If you choose a dynamic exercise warm-up, perform the five exercises below and/or exercises from the Basic 8 Calisthenics in the Concept on muscle fitness. Lab 4B Grapevine Inchworm With feet at shoulder width and From pushup position, walk the feet arms out at shoulder height, move toward the hands several steps, sideways. With right leg, step across keeping the hands still. Then walk left leg, then step to left with left leg, the hands forward keeping the right leg step behind left leg, step feet still. Repeat several times. left leg to left. Repeat in the opposite direction, starting with left leg. Repeat several times. The Warm-Up Knee Stride and Reach Backward Jog Take a long stride forward with the right Jog backward slowly using moderately leg, touch the left knee to the floor. long steps. Pump your arms back and Reach across the body with the right forth. Cover a distance of 10 yards, arm and back with the left arm. Stand turn around, and backward jog in and repeat with left stride and right opposite direction. Repeat several knee touch. Repeat 10–20 times. times. High Skip and Reach Do a slow high skip. Alternate swinging one arm up and high above the head. Right arm up when on the right foot; left arm up when on the left foot. Repeat 10–20 times. When performing a dynamic warm-up in the future you may want to consider the exercises from the Basic 8 Calisthenics in the Concept on Muscle Fitness, as well as the exercises here. Stretching Exercises. If you choose to do a stretch warm-up, perform the four stretching exercises below and/or other stretching exercises from the Concept on flexibility. Perform each stretch for at least 15–30 seconds. Calf Stretch Seated Side Stretch This exercise stretches the calf muscles This exercise stretches the muscles (gastrocnemius and soleus). Face a of the trunk. Begin in a seated wall with your feet 2 or 3 feet away. position with the legs crossed. Step forward on your left foot to allow Stretch the left arm over the head both hands to touch the wall. Keep the to the right. Bend at the waist (to heel of your right foot on the ground, right), reaching as far as possible to toe turned in slightly, knee straight, the left with the right arm. Hold. Do and buttocks tucked in. Lean forward by not let the trunk rotate. Repeat to the bending your front knee and arms and allowing opposite side. This exercise can be done in your head to move nearer the wall. Hold. Repeat the standing position but is less effective. with the other leg. Leg Hug Hamstring Stretch This exercise stretches the hip and This exercise stretches the muscles of back extensor muscles. Lie on your the back of the upper leg (hamstrings) back. Bend one leg and grasp as well as those of the hip, knee, and your thigh under the knee. Hug ankle. Lie on your back. Bring the right it to your chest. Keep the other knee to your chest and grasp the toes leg straight and on the floor. Hold. with the right hand. Place the left hand Repeat with the opposite leg. on the back of the right thigh. Pull the knee toward the chest, push the heel toward the ceiling, and pull the toes toward the shin. Attempt to straighten the knee. Stretch and hold. Repeat with the other leg. When performing a stretch warm-up in the future, consider the four stretching exercises above and/or other stretching exercises from the Concept on flexibility. 62

Lab 4C  Physical Activity Attitude Questionnaire Name Section Date Lab 4C Purpose: To evaluate your feelings about physical activity and to determine the specific reasons you do or do not partici- pate in regular physical activity. Directions: The term physical activity in the following statements refers to all kinds of activities, including sports, formal Physical Activity Attitude Questionnaire exercises, and informal activities, such as jogging and cycling. Make an X over the circle that best represents your answer to each question. Strongly Strongly Item Attitude Disagree Disagree Undecided Agree Agree Score Score   1. I should do physical activity regularly for my 1 2 3 45 Health and Fitness health. 2. Doing regular physical activity is good for my 1 Score fitness and wellness. 1 2 3 45 5 3. Regular exercise helps me look my 1 2 3 45 best. Appearance 4. I feel more physically attractive when I do regular 1 Score physical activity. 1 2 3 45 5 5. One of the main reasons I do regular physical 1 2 3 45 activity is that it is fun. Enjoyment 1 Score 6. The most enjoyable part of my day is when I am 1 2 3 45 5 exercising or doing a sport. 7. Taking part in physical activity helps me relax. 1 2 3 45 Relaxation 8. Physical activity helps me get away from the 1 Score pressures of daily living. 1 2 3 45 5 9. The challenge of physical training is one reason 1 2 3 45 I do physical activity. Challenge 10. I like to see if I can master sports and activities 1 Score that are new to me. 1 2 3 45 5 11. I like to do physical activity that involves other 1 2 3 45 Social people. 1 Score 12. Exercise offers me the opportunity to meet other 1 2 3 45 5 people. 13. Competition is a good way to make physical 1 2 3 45 Competition activity fun. 1 Score 1 4. I like to see how my physical abilities compare 1 2 3 45 5 with those of others. 1 5. When I do regular exercise, I feel better than 1 2 3 45 Feeling when I don’t. Good 1 6. My ability to do physical activity is something 1 Score that makes me proud. 1 2 3 45 5 17. I like to do outdoor activities. 1 2 3 45 Outdoor 18. Experiencing nature is something I look forward 1 Score to when exercising. 1 2 3 45 5 63

Lab 4C Procedures 1. Read and answer each question in the questionnaire. 2. Write the number in the circle of your answer in the box labeled “Item Score.” 3. Add scores for each pair of scores and record in the “Attitude Score” box. 4. Record each attitude score and a rating for each score (use Rating Chart) in the chart below. 5. Record the number of good and excellent scores in the box provided. Use the score in the box to determine your rating using the Balance of Feelings Rating Chart. Results: Record your results as indicated in the Procedures section. Physical Activity Attitude Questionnaire Results Attitude Rating Chart Physical Activity Attitude Questionnaire Attitude Score Rating Rating Category Attitude Score Health and fitness Excellent 9–10 Appearance Good 7–8 Enjoyment Fair 5–6 Relaxation Poor 3–4 Challenge Very poor 2 Social Competition Feeling good Balance of Feelings Rating Chart Outdoor How many good or excellent scores Excellent 6–9 do you have? Good 5 Fair 4 Balance of Feeling Score Having 5 or more in the box above indicates that you have Poor 2–3 a positive balance of feelings (more positive than negative Very poor 0–1 attitudes). In a few sentences, discuss your “balance of feelings” rating. Having more positive than negative scores (positive balance of feelings) increases the probability of being active. Include comments on whether you think your ratings suggest that you will be active or inactive and whether your ratings are really indicative of your feelings. Do you think that the scores on which you were rated poor or very poor might be reasons you would avoid physical activity? Explain. 64

The Health Benefits of Physical Activity LEARNING OBJECTIVES After completing the study of this Concept, you will be able to: Concept 5 c Define the term hypokinetic and explain how physical activity can reduce risk of hypokinetic diseases and conditions. c Identify several cardiovascular diseases/conditions associated with physical inactivity and explain how physical activity can help reduce risk. c Describe metabolic syndrome and explain how physical activity can help reduce risk of this hypokinetic condition. c Explain how physical activity can help reduce risk of other hypokinetic conditions. c Explain the role of physical activity in preventing conditions associated with aging. c Explain the role of physical activity in promoting optimal wellness. c Present an overview of the health and wellness Physical activity and good physical fitness can reduce the risk of illness benefits of physical activity and fitness. and contribute to optimal health c Identify related national health goals and show and wellness. how meeting personal goals can contribute to reaching national goals. c Assess your heart disease risk factors. 65

66 Section 2  c  An Introduction to Physical Activity Regular physical activity promotes healthy aging and high quality of life. The primary goal of Healthy People 2020 is to help all understood, but we know what the people have high-quality, longer lives free of prevent- able disease, injury, and premature death. Three major ways Greeks knew: that intelligence and VIDEO 1 in which regular physical activity contributes to meeting skill can only function at the peak this goal have been well established. First, physical activity improves physical fitness and contributes to high-quality life of their capacity when the body is (wellness, the positive component of good health). Second, regular physical activity contributes to longer life (lifespan) healthy and strong, and that hardy spirits and tough minds free of preventable disease and injury (healthspan). Finally, physical activity is a significant contributor to disease/ usually inhabit sound bodies. Physical fitness is the basis illness treatment. Even with the best disease prevention practices, some people will become ill. Regular exercise of all activities in our society.” and good fitness have been shown to be effective in alleviat- ing symptoms and aiding rehabilitation after illness. In the Regular physical activity contributes to optimal pages that follow, information is presented to substantiate wellness. Regular physical activity promotes high quality the three major ways in which physical activity benefits you. of life by contributing to each of the five dimensions of wellness. Physical Activity, Fitness, and Wellness ∙ Physical: Regular physical activity enhances physical wellness by promoting good physical fitness (see previ- Regular physical activity contributes to good physical ous section). Active people are less likely to miss work or fitness. Regular physical activity can lead to many physical school. Good fitness from regular physical activity helps fitness benefits (see Figure 1): you look your best. ∙ Good physical fitness helps you to function effectively ∙ Emotional/Mental: Regular physical activity promotes (functional fitness). Although the need for each com- emotional/mental wellness as evidenced by positive ponent of physical fitness is specific to each individual, mood states, reduced anxiety and depression, improved every person requires enough fitness to perform normal self-concept, and greater independence. daily activities without undue fatigue. Whether it be walking, performing household chores, or merely enjoy- ∙ Intellectual: Regular physical activity fosters intellec- ing the simple things in life without pain or fear of injury, tual wellness by stimulating new brain cell develop- good fitness is important to all people. ment, enhancing higher-order brain functions such as ∙ Good physical fitness can help an individual work more efficiently. A person who can resist fatigue, muscle sore- ness, back problems, and other symptoms associated with poor health-related fitness is capable of working produc- tively and still has energy at the end of the day. ∙ Good physical fitness can help an individual enjoy leisure time. A fit person is more likely to get and stay involved in leisure-time activities than an unfit person. Enjoying your leisure time may not add years to your life, but it can add life to your years (wellness). ∙ Good physical fitness can help you handle unexpected emergencies. Emergencies often demand performance that requires good fitness. For example, flood victims may need to fill sandbags for hours without rest, and accident victims may be required to walk or run long dis- tances for help. ∙ Good physical fitness is the basis for dynamic and cre- ative activity. Although the following quotation by Presi- dent John F. Kennedy is more than 50 years old, it clearly points out the importance of physical fitness: “The rela- tionship between the soundness of the body and the activ- ity of the mind is subtle and complex. Much is not yet

Concept 5  c  The Health Benefits of Physical Activity    67 Health, Wellness, and Fitness Benefits of Physical Activity Improved Cardiovascular Health Enhanced Mental Health and Function Opportunity for Successful Experience Stronger heart muscle fitness Relief of depression and Social Interactions and health Improved sleep habits Lower heart rate Fewer stress symptoms Improved self-concept Better electric stability of heart Ability to enjoy leisure and work Opportunity to recognize and Decreased sympathetic control of Improved brain function accept personal limitations heart Improved sense of well-being Increased O2 to brain Enjoyment of life and fun Reduced blood fat, including Improved quality of life low-density lipoproteins (LDLs) Increased protective high-density Improved Appearance lipoproteins (HDLs) Better figure/physique Delayed development of Better posture atherosclerosis Fat control Increased work capacity Improved peripheral circulation Greater Lean Body Mass Improved coronary circulation and Less Body Fat Resistance to “emotional storm” Reduced risk for heart attack Greater work e ciency Reduced risk for stroke Less susceptibility to disease Reduced risk for hypertension Improved appearance Greater chance of surviving a heart Less incidence of self-concept attack problems related to obesity Increased oxygen-carrying capacity Improved Flexibility of the blood Greater work e ciency Less chance of muscle injury Improved Strength and Less chance of joint injury Muscular Endurance Decreased chance of developing low back problems Greater work e ciency Improved sports performance Less chance for muscle injury Reduced risk for low back problems Improved Wellness Bone Development Improved performance in sports Improved quality of life Greater peak bone density Quicker recovery after hard work Leisure-time enjoyment Less chance of developing Improved ability to meet emergencies Improved work capacity osteoporosis Resistance to Fatigue Ability to meet emergencies Ability to enjoy leisure Improved creative capacity Reduced Cancer Risk Improved quality of life Reduced risk for colon and breast Improved ability to meet some cancers stressors Possible reduced risk for rectal and Other Health Benefits prostate cancers Decreased diabetes risk Quality of life for diabetics Reduced E ect of Acquired Aging Improved metabolic fitness Improved ability to function in daily Extended life life Decrease in dysfunctional years Better short-term memory Aids for some people who have Fewer illnesses arthritis, PMS, asthma, chronic pain, Greater mobility fibromyalgia, or impotence Greater independence Improved immune system Greater ability to operate an automobile Lower risk for dementia Figure 1  c  Health, wellness, and fitness benefits of physical activity. attention and concentration, and improving cognitive It can create camaraderie and teamwork through sports performance (better short-term memory and better and recreational activities. In addition, it offers opportuni- scores on tests). ties for group and individual challenges. ∙ Social: Regular physical activity promotes social wellness ∙ Spiritual: Regular physical activity can promote spiritual through physical activities with friends in social settings. wellness through outdoor and meditative activities.

68 Section 2  c  An Introduction to Physical Activity Regular physical activity can improve fitness and summarized in Figure 1. Detailed descriptions of the vari- functioning among older adults. Approximately 30 percent ous hypokinetic diseases and the benefits of regular physical of adults aged 70 and over have difficulty with one or more activity are included on the pages that follow. activities of daily living. Women have more limitations than Regular physical activity over a lifetime may overcome men, and low-income groups have more limitations than the effects of inherited risk. People with a family history higher-income groups. Nearly one-half of these adults also get of disease may believe they can do nothing because their no assistance in coping with their limitations. heredity works against them. There is no doubt that hered- ity significantly affects risk for early death from hypokinetic The inability to function effectively as you grow older diseases. New studies of twins, however, suggest that active is associated with lack of fitness and inactive lifestyles. people are less likely to die early than inactive people with This loss of function is sometimes referred to as “acquired similar genes. This suggests that long-term adherence to aging,” as opposed to “time-dependent” aging. Because so physical activity can overcome other risk factors, such as many people experience limitations in daily activities and heredity. find it difficult to get assistance, it is especially important for older people to stay active and fit. Physical Activity and Cardiovascular Diseases In general, older adults are much less active than younger adults. Losses in muscle fitness are associated The various types of cardiovascular disease are the with loss of balance, greater risk of falling, and less ability leading killers in automated societies. There are many to function independently. Studies also show that exercise forms of cardiovascular disease (CVD). Some are classi- can enhance cognitive functioning and perhaps reduce risk fied as coronary heart disease (CHD) because they affect for dementia. Though the amount of activity performed the heart muscle and the blood vessels that supply the must be adapted as people grow older, fitness benefits dis- heart. Coronary occlusion (heart attack) is a type of CHD. cussed in the next section and in later Concepts apply to Atherosclerosis and arteriosclerosis are two conditions people of all ages. that increase risk for heart attack and are considered to be Regular physical activity can increase healthspan. types of CHD. Angina pectoris (chest or arm pain), which An important national health goal is to increase the years occurs when the oxygen supply to the heart muscle is dimin- of healthy life. Living longer is important, but being able ished, is sometimes considered to be a type of CHD, though to function effectively during all years of life (healthspan) it is really a symptom of poor circulation. is equally—if not more—important. Compression of illness, Stroke (brain attack), hypertension (high blood pressure), also called compression of morbidity, refers to shortening peripheral vascular disease, and congestive heart failure the total number of years that illnesses and disabilities occur. are other forms of CVD. Inactivity relates in some way to Healthy lifestyles, including regular physical activity, have each of these types of disease. been shown to compress illness and increase years of effec- In the United States, CVD accounts for more than tive functioning. Inactive people not only have a shorter 32  percent of all deaths. More than 83.5 million peo- lifespan, but also have more years of illness and disability ple currently have one or more forms of CVD. Men are than active people. more likely to suffer from heart dis- ease than women, although the dif- Physical Activity and ferences have narrowed in recent Hypokinetic Diseases years. African American, Hispanic, VIDEO 2 Regular physical activity reduces risk of the major and Native American populations chronic diseases. Most of the leading killers in our are at higher than normal risk. Heart disease and stroke society are preventable chronic diseases (e.g., heart dis- death rates are similar in the United States, Canada, Great ease, cancer). These diseases are frequently referred to as Britain, Australia, and other developed countries. hypokinetic diseases or conditions because regular physi- cal activity reduces risk of these conditions. Virtually all Physical inactivity is a primary risk factor for CHD. The chronic diseases that plague society are considered to be American Heart Association recognizes physical inactiv- hypokinetic, though some relate more to inactivity than ity as one of five primary risk factors for CHD. The other others. Nearly three-quarters of all deaths among those established risk factors (high blood pressure, high blood 18 and older are a result of chronic diseases. Leading pub- cholesterol, obesity, and smoking) are each important, but lic health officials have suggested that physical activity may note that physical inactivity exerts an independent effect. offer the most promising public health solution to control This means that an inactive person would be at greater risk chronic diseases, much as immunization controls infec- than an active person even if the two had similar profiles tious diseases. Many of the benefits of physical activity are

Concept 5  c  The Health Benefits of Physical Activity    69 or values for the other risks. These effects have been sup- Physical Activity ported in numerous studies and populations. The Surgeon and Atherosclerosis General’s Report on Physical Activity and Health con- cluded in 1996 that “physical inactivity is causally linked Atherosclerosis, which begins early in life, is implicated to atherosclerosis and coronary heart disease.” in many cardiovascular diseases. Atherosclerosis is a con- dition that contributes to heart attack, stroke, hypertension, and Physical Activity peripheral vascular disease. Deposits on the walls of arteries and the Healthy Heart restrict blood flow and oxygen supply to the tissues. Athero- sclerosis of the coronary arteries, the vessels that supply the Regular exercise increases the heart muscle’s ability heart muscle with oxygen, is particularly harmful. If these to pump oxygen-rich blood. A fit heart muscle can han- arteries become narrowed, the blood supply to the heart muscle dle extra demands placed on it. Through regular exercise, is diminished, and angina pectoris may occur. Atherosclerosis the heart muscle gets stronger, contracts more forcefully, increases the risk of heart attack because a fibrous clot is more and therefore pumps more blood with each beat. The heart likely to obstruct a narrowed artery than a healthy, open one. is just like any other muscle—it must be exercised regularly to stay fit. The fit heart also has open, clear arteries free of Current theory suggests that atherosclerosis begins when atherosclerosis (see Figure 2). damage occurs to the cells of the inner wall, or endothe- The “normal” resting heart rate is said to be 72 beats per lium, of the artery (see Figure 3). Substances associated minute (bpm). However, resting rates of 50 to 85 bpm are with blood clotting are attracted to the damaged area. These common. People who regularly do physical activity typi- substances seem to cause the migration of smooth mus- cally have lower resting heart rates than people who do no cle cells, commonly found only in the middle wall of the regular activity. Some endurance athletes have heart rates in artery (media), to the endothelium. In the later stages, fats the 30 and 40 bpm range, which is considered healthy or (including cholesterol) and other substances are thought to normal. Although resting heart rate is not considered to be a good measure of health or fitness, decreases in individual Hypokinetic Diseases or Conditions Hypo- means “under” heart rate following training reflect positive adaptations. or “too little” and kinetic means “movement” or “activity.” Thus, Low heart rates in response to a standard amount of physical hypokinetic means “too little activity.” A hypokinetic disease or activity are a good indicator of fitness. The bicycle and step condition is associated with lack of physical activity or too little tests presented later use your heart rate regular exercise. Examples include heart disease, low back pain, response to a standard amount of exer- and Type II diabetes. cise to estimate your cardiovascular Chronic Diseases  Diseases or illnesses associated with lifestyle fitness. VIDEO 3 or environmental factors, as opposed to infectious diseases; hypokinetic diseases are considered to be chronic diseases. Open, healthy Cardiovascular Disease (CVD) A broad classification of coronary arteries diseases of the heart and blood vessels that includes CHD, high blood pressure, stroke, and peripheral vascular disease. Strong, thick Coronary Heart Disease (CHD)  Diseases of the heart muscle heart muscle and the blood vessels that supply it with oxygen, including heart Figure 2  c  The fit heart muscle. attack. Coronary Occlusion The blocking of the coronary blood vessels; sometimes called heart attack. Atherosclerosis  The deposition of materials along the arterial walls; a type of arteriosclerosis. Arteriosclerosis  Hardening of the arteries due to conditions that cause the arterial walls to become thick, hard, and nonelastic. Hypertension  High blood pressure; excessive pressure against the walls of the arteries that can damage the heart, kidneys, and other organs of the body. Stroke  A condition in which the brain, or part of the brain, receives insufficient oxygen as a result of diminished blood supply; sometimes called apoplexy or cerebrovascular accident (CVA). Peripheral Vascular Disease  A lack of oxygen supply to the working muscles and tissues of the arms and legs, resulting from decreased blood flow. Congestive Heart Failure  The inability of the heart muscle to pump the blood at a life-sustaining rate.

70 Section 2  c  An Introduction to Physical Activity Cholesterol Table 1  c  Cholesterol Classifications (mg/dL)* crystals Fat Total (TC) LDL-C HDL-C TC/HDL-C Optimal ——— ,100 ——— Near optimal ——— 100–129 ——— ——— Damaged Desirable ,200 ——— 601  ——— area Endothelium Borderline 200–239 130–159 40–59 3.6–5.0 Smooth muscle cells High risk 2401  160–189 ,40 5.01  Intima Very high risk ——— .190 ——— ——— Media Source: Third Report of the National Cholesterol Education Program. *Different classification systems are used for each of the four measures (two to five categories). Blank (---) spaces are included for categories not used for each measure. Figure 3  c  Atherosclerosis. be deposited, forming plaques, or protrusions, that diminish are borderline, 200 to 499 are high, and above 500 are very the internal diameter of the artery. This process was once high. It would be wise to include triglycerides in a blood thought to occur later in life but research indicates that the lipid profile. Physical activity is often prescribed as part of a first signs of atherosclerosis begin in early childhood. treatment for high triglyceride levels. Physical activity can help prevent atherosclerosis Physical activity can help prevent atherosclerosis by lowering blood lipid levels. There are several kinds by increasing HDL in the blood. Whereas LDLs carry of lipids (fats) in the bloodstream, including lipoproteins, a core of cholesterol that is involved in the development of phospholipids, triglycerides, and cholesterol. Cholesterol is atherosclerosis, high-density lipoprotein (HDL) picks up the most well known, but it is not the only culprit. Many cholesterol and carries it to the liver, where it is eliminated blood fats are manufactured by the body itself, whereas oth- from the body. HDL is often called the “good cholesterol” ers are ingested in high-fat foods, particularly saturated fats and is desirable. When having a blood test, ask for infor- (fats that are solid at room temperature). mation about HDL as well as the other measures included in Table  1. Individuals who have regular physical activity As noted earlier, blood lipids are thought to contribute usually have lower total cholesterol, lower LDL, and higher to the development of atherosclerotic deposits on the inner HDL levels than inactive people. walls of the artery. One substance, called low-density Physical activity can help prevent atherosclerosis by lipoprotein (LDL), is a major contributor to the devel- reducing blood coagulants. Fibrin and platelets (types opment of atherosclerosis. LDL is basically a core of of cells involved in blood coagulation) deposit at the site of cholesterol surrounded by protein and another substance an injury on the wall of the artery, contributing to the pro- that makes it water soluble. The benefit of regular exercise cess of plaque buildup, or atherosclerosis. Regular physical is that it can reduce blood lipid levels, including LDL-C (the activity has been shown to reduce fibrin levels in the blood. cholesterol core of LDL). People with high total cholesterol The breakdown of fibrin seems to reduce platelet adhesive- and LDL levels have a higher than normal risk for heart dis- ness and the concentration of platelets in the blood. ease (see Table 1). New evidence indicates that there are Other indicators of inflammation of the arteries are subtypes of LDL cholesterol (characterized by their small predictive of atherosclerosis. A number of other con- size and high density) that pose even greater risks. These stituents in the blood have been shown to be associated with subtypes are hard to measure and not included in most cur- risk for cardiovascular disease. These compounds are not rent blood tests, but future research will no doubt help us necessarily causes of atherosclerosis, but they are indica- better understand and measure them. tors of inflammatory processes that lead to plaque forma- tion. Inflammatory processes also soften existing plaque and Triglycerides are another type of blood lipid. Elevated increase the likelihood of plaque rupture or the formation of levels of triglycerides are related to heart disease. Triglycer- clots, which can directly precipitate heart attacks. You may ides lose some of their ability to predict heart disease with want to ask your physician about including some of these the presence of other risk factors, so high levels are more measures when doing your next physical exam. difficult to interpret than other blood lipids. Normal levels are considered to be 150 mg/dL or less. Values of 151 to 199

Concept 5  c  The Health Benefits of Physical Activity    71 Clot (thrombus) enlarged Heart muscle Collaterals Death to tissue Clot and Figure 5  c  Coronary collateral circulation. narrowed artery sedentary. Possible reasons are less atherosclerosis, greater Figure 4  c  Heart attack. diameter of arteries, and less chance of a clot forming. Physical activity can improve coronary circulation ∙ C-reactive protein (CRP) is one of the most studied indi- and, thus, reduce the chances of having a heart attack cators of arterial plaque. Screening for elevated levels of or dying from one. Within the heart, many tiny branches CRP is now commonly done to identify patients that may extend from the major coronary arteries. All of these vessels be at risk of heart disease. supply blood to the heart muscle. Active people are likely to have greater blood-carrying capacity in these vessels, prob- ∙ Interleukin-6 (IL-6), Chlamydia pneumonia heat shock ably because the vessels are larger and more elastic. Also, protein (Cp-HSP60), and tumor necrosis factor-a (TNF-a) active people may have more profuse distribution of arter- are other plaque indicators of arterial inflammation. ies within the heart muscle (see Figure 5), which results in greater blood flow. A few studies show that physical activity ∙ High levels of the amino acid homocysteine have also may promote the growth of “extra” blood vessels, which are been associated with increased risk for heart disease, thought to open up to provide the heart muscle with the nec- though the American Heart Association says it is too essary blood and oxygen when the oxygen supply is dimin- early to begin screening for it. ished, as in a heart attack. Blood flow from extra blood vessels is referred to as coronary collateral circulation. Recent research suggests that healthy lifestyles can help reduce the risk of arterial inflammation. For example, Lipids  All fats and fatty substances. studies show that regular physical activity can promote Lipoproteins  Fat-carrying proteins in the blood. endothelial health, and nutrition can help reduce markers of Low-Density Lipoprotein (LDL) A core of cholesterol sur- inflammation. Adequate levels of folic acid, vitamins B-6 rounded by protein; the core is often called “bad cholesterol.” and B-12 help prevent high blood homocysteine levels, so Triglycerides  A type of blood fat associated with increased risk eating foods that ensure adequate daily intake of these vita- for heart disease. mins is recommended. High-Density Lipoprotein (HDL)  A blood substance that picks up cholesterol and helps remove it from the body; often called Physical Activity and Heart Attack “good cholesterol.” Fibrin  A sticky, threadlike substance that, in combination with Physical activity reduces the risk for heart attack, blood cells, forms a blood clot. the most prevalent and serious of all cardiovascular Coronary Collateral Circulation  Circulation of blood to the heart diseases. A heart attack (coronary occlusion) occurs when muscle associated with the blood-carrying capacity of a specific a coronary artery is blocked (see Figure 4). A clot, or throm- vessel or development of collateral vessels (extra blood vessels). bus, is the most common cause, reducing or cutting off blood flow and oxygen to the heart muscle. If the blocked coronary artery supplies a major portion of the heart muscle, death will occur within minutes. Occlusions of lesser arteries may result in angina pectoris or a nonfatal heart attack. People who perform regular physical activity have half the risk for a first heart attack, compared with those who are

72 Section 2  c  An Introduction to Physical Activity Improved coronary circulation may provide protection Table 2  c  Blood Pressure Classifications for Adults* against a heart attack because a larger artery would require more atherosclerosis to occlude it. In addition, the development Category Systolic Diastolic of collateral blood vessels supplying the heart may diminish Blood Pressure Blood Pressure the effects of a heart attack, as these extra (or collateral) blood vessels may take over the function of regular blood vessels. (mm Hg) (mm Hg) The heart of an inactive person is less able to resist Normal ,120 ,80 stress and is more susceptible to an emotional storm that may precipitate a heart attack. The heart is ren- Prehypertensive 121–139 81–89 dered inefficient by one or more of the following circum- stances: high heart rate, high blood pressure, and excessive Stage 1 hypertension 140–159 90–99 stimulation. All of these conditions require the heart to use more oxygen than is normal and decrease its ability to adapt Stage 2 hypertension .160 .100 to stressful situations. Source: National Heart, Lung, and Blood Institute. The inefficient heart beats rapidly because it is dominated *Not taking antihypertensive drugs and not acutely ill. When the systolic and by the sympathetic nervous system, which speeds up the diastolic blood pressure categories vary, the higher reading determines the heart rate. Thus, the heart continuously beats rapidly, even at blood pressure classification. rest, and never has a true rest period. High blood pressure also makes the heart work harder and contributes to its inefficiency. higher than normal but not high enough to be considered hypertension (see Table 2). Prehypertension has been linked Research indicates that regular physical activity can: to higher than normal risk of heart attack and, though not as ∙ lead to dominance of the parasympathetic nervous serious as hypertension, should be taken seriously. Nearly one-third of American adults have high blood pressure. system, which slows the heart rate and helps the heart High blood pressure is associated with heart disease, stroke, work efficiently; diabetes, and many other diseases. African Americans, His- ∙ help the heart rate return to normal faster after emotional panics, and Native Americans have higher incidence than stress; White non-Hispanics. Older people have higher incidence ∙ strengthen the heart muscle, making it better able to than younger people. weather an emotional storm; ∙ reduce hormonal effects on the heart, thus lessening the High blood pressure is sometimes referred to as the “silent chances of circulatory problems; killer” because nearly one-third of people with elevated blood ∙ reduce the risk of sudden death from ventricular fibrilla- pressure do not know they have it. It is important to moni- tion (arrhythmic heartbeat). tor your blood pressure on a regular basis. With practice and good equipment, you can accurately measure your own blood Regular physical activity is one effective means of pressure. Because blood pressure can be elevated by emotions rehabilitation for a person who has coronary heart and circumstances, a single measurement may not be accu- disease or who has had a heart attack. Not only does rate, so at least two separate measurements are recommended. regular physical activity seem to reduce the risk of develop- While self-assessments can be helpful, they are not a substi- ing coronary heart disease, but also those who already have tute for periodic assessments by a qualified medical person. the condition may reduce the symptoms of the disease through regular exercise. For people who have had heart attacks, regular Exceptionally low blood pressures (below 100 systolic and progressive exercise can be an effective prescription when and 60 diastolic) do not pose the same risks to health as high carried out under the supervision of a physician. Remember, blood pressure but can cause dizziness, fainting, and lack of however, that exercise is not the treatment of preference for all tolerance to change in body positions. heart attack victims. In some cases, it is harmful. Regular physical activity has been shown to be a signifi- Physical Activity and Other cant factor in reducing high blood pressure, independent of Cardiovascular Diseases age, body fatness, and other factors. Inactive, less fit individ- uals have a 30 to 50 percent greater chance of being hyper- Regular physical activity is associated with a reduced tensive than active, fit people. Regular physical activity can risk for high blood pressure (hypertension). “Normal” also be one effective method of reducing blood pressure for systolic blood pressure is 120 mm Hg or less, and normal those with prehypertension or hypertension. Physical inac- diastolic blood pressure is 80 mm Hg or less. Prehyperten- tivity in middle age is associated with risk for high blood sion is a condition that exists when your blood pressure is pressure later in life. The most plausible reason is a reduc- tion in resistance to blood flow in the blood vessels, prob- ably resulting from dilation of the vessels. Regular physical activity can help reduce the risk for stroke. Stroke is a major killer of adults. People with high blood pressure and atherosclerosis are susceptible to stroke.

Concept 5  c  The Health Benefits of Physical Activity    73 TECHNOLOGY UPDATE Genetic factors Environmental (e.g., family history) factors Heart360: Heart Health Monitoring (e.g., activity, diet) Physical inactivity is one of the primary risks for cardiovas- cular disease. The American Heart Association has released High blood Metabolic High blood a free, Web-based tracking tool (www.Heart360.org) that pressure Syndrome sugar levels allows individuals to record and monitor changes in key cardiovascular risk factors over time, including blood pres- High blood Insulin Low blood sure, cholesterol, blood glucose, inactivity, and Body Mass triglyceride resistance HDL Index (BMI). With this tool, you create a secure “health vault” Large abdominal account to save confidential health data. The site evalu- ates your risk profiles and provides links to educational girth resources. If your physician has a provider account, you can share results. A quick personal assessment called ”My Life Check” provides a heart health score based on seven key risk indicators/behaviors. (See link in Suggested Resources and Readings.) Would tracking these indicators help you maintain healthy lifestyles? If these data were linked to your physi- cian’s office, would it help you be more accountable for your lifestyle? ACTIVITY Cardiovascular Diabetes disease (heart attack/stroke) Since regular exercise and good fitness are important to Figure 6  c  Mechanism and effects of metabolic syndrome. the prevention of high blood pressure and atherosclerosis, exercise and fitness are considered helpful in the prevention Sympathetic Nervous System  The branch of the autonomic of stroke. nervous system that prepares the body for activity by speeding up Physical activity decreases risk factors for metabolic the heart rate. syndrome. Metabolic syndrome is a metabolic disorder Parasympathetic Nervous System The branch of the auto- that is characterized by a clustering of metabolic risk factors. nomic nervous system that slows the heart rate. People with at least three of the following characteristics Emotional Storm A traumatic emotional experience that is are considered to have metabolic syndrome (see Figure 6): likely to affect the human organism physiologically. blood pressure above 130/85, a fasting blood sugar level of Systolic Blood Pressure The upper blood pressure number, 100 or higher, blood triglycerides of 150 or above, a low often called working blood pressure. It represents the pressure in blood HDL level (less than 40 for men and less than 50 for the arteries at its highest level just after the heart beats. women), and/or a high abdominal circumference (equal to Diastolic Blood Pressure The lower blood pressure number, or above 40 inches for men or 35 inches for women). Regu- often called resting pressure. It is the pressure in the arteries at its lar physical activity can have a positive impact on all of the lowest level just before the next beat of the heart. characteristics of metabolic syndrome. Regular physical activity is helpful in preventing peripheral vascular disease. People who exercise regu- larly have better blood flow to the working muscles and other tissues than inactive, unfit people. Since peripheral vascular disease is associated with poor circulation to the extremities, regular exercise can be considered one method of preventing this condition. Thus, physical activity can reduce risk of metabolic syn- drome as well as the various chronic conditions associated

74 Section 2  c  An Introduction to Physical Activity with it (e.g. diabetes, heart disease and stroke). Lab 5A can Table 3  c  Physical Activity and Cancer be used to screen for possible risk of metabolic syndrome. A periodic physical exam with blood profiles and a meta- Cancer Type Effect of Physical Activity bolic syndrome assessment is recommended, especially as Colon Exercise speeds movement of food and you grow older. cancer-causing substances through the Physical Activity and Other digestive system, and reduces prostaglandins (substances linked to cancer in the colon). Hypokinetic Conditions Breast Exercise decreases the amount of exposure Physical activity reduces the risk of some forms of breast tissue to circulating estrogen. Lower of cancer. According to the American Cancer Society body fat is also associated with lower estrogen (ACS), cancer is a group of many different conditions levels. Early life activity is deemed important for both reasons. Fatigue from therapy is characterized by abnormal, uncontrolled cell growth. As reduced by exercise. illustrated in Figure 7, the abnormal cells divide, forming Rectal Similar to colon cancer, exercise leads to more malignant tumors (carcinomas). If the abnormal cells reach regular bowel movements and reduces “transit the blood, they can spread, causing tumors elsewhere in the time.” body. Benign tumors are generally not considered to be can- Prostate Fatigue from therapy is reduced by exercise. cerous because their growth is restricted to a specific area of Regular exercise, especially vigorous exercise, the body by a protective membrane. The first editions of this may reduce death rate. book did not include any form of cancer as a hypokinetic dis- ease. We now know, however, that overall death rates from some types of cancer are lower among active people than among those who are sedentary. These cancers are described physical functioning, and self-esteem, as well as less depen- in Table 3 with possible reasons for the link between cancer dence on others, reduced risk for other diseases, and reduced and inactivity. The entries in Table 3 are listed in order based fatigue from disease or disease therapy. on the strength of evidence supporting the link. Physical activity plays a role in the management As previously indicated, cancer is a leading cause of and treatment of Type II diabetes. Diabetes mellitus death. In the United States, cancer causes more than 580,000 (diabetes) is a group of disorders that results when there is deaths annually. However, the five-year survival rate for too much sugar in the blood. It occurs when the body does people diagnosed with cancer is up 50 percent over the not make enough insulin or when the body is not able to use past three decades. Many factors are insulin effectively. responsible, including early diagno- sis and improved medical treatments. Type I diabetes, or insulin-dependent diabetes, accounts Healthy lifestyles can also play a role. VIDEO 4 for a relatively small number of the diabetes cases and is not considered to be a hypokinetic condition. Type II diabetes The ACS guidelines highlight the (often not insulin-dependent) was formerly called “adult- importance of regular physical activity and a healthy diet onset diabetes.” Reports indicate more cases of Type II in preventing cancer and early death. Physical activity is diabetes among children than in the past, in part because of also considered to be important to the wellness of the can- better record keeping but also because of increases in obe- cer patient in many ways, including improved quality of life, sity among children in recent years. Diabetes is the seventh leading cause of death among people over 40. It accounts for at least 10 percent of all short-term hospital Normal cells Malignant stays and has a major impact on health-care tumor. costs in Western society. According to the American Diabetes Association (ADA), there are nearly 29 million people in the United States with diabetes (9.3 percent of the population). Unfortunately, 8.1 million of those don’t know it. An estimated addi- Abnormal cell Cell divides. Blood vessel tional 86 million are prediabetic. Malignant cell People who perform regular physical invades blood. activity are less likely to suffer from Type II diabetes than sedentary people. For peo- Figure 7  c  The spread of cancer (metastasis). ple with Type II diabetes, regular physical

Concept 5  c  The Health Benefits of Physical Activity    75 In the News Diabetes Epidemic predominant form of diabetes (Type II) is a largely preventable condition. The dire news implies that the prevalence of obe- Twenty-four million people in the United sity will continue and that people will be even less active than States are diabetic, and this number is they are today. projected to increase to nearly 30 million by 2035. Of particular concern is the increase in diabetes among children Do statistics about negative health trends alarm, motivate, or and teens. Until recently, diabetes was considered to be an not even influence you? adult disease, but now it is an increasing problem in youth. Missing from these statistics, however, is the fact that the activity can help reduce body fatness, ACTIVITY decrease insulin resistance, improve insulin sensitivity, and improve the VIDEO 5 continues, older adults become susceptible to a condition called osteoporosis (bone density drops below the osteo- body’s ability to clear sugar from the porosis threshold). Some will have crossed the fracture blood in a reasonable time. With sound nutritional habits threshold, putting them at risk for fractures, especially to and proper medication, physical activity can be useful in the the hip, vertebrae, and other “soft” or “spongy” bones of management of both types of diabetes. the skeletal system. Active people have a higher peak bone mass and are more resistant to osteoporosis (see blue line in Physical activity is important to maintaining bone Figure 8) than sedentary people (see red line in Figure 8). density and decreasing risk for osteoporosis. As noted previously, some experts consider bone integrity to Women, especially postmenopausal women, have a be a health-related component of physical fitness. Bone higher risk of osteoporosis than men, but it is a disease of density cannot be self-assessed. It is measured using a both sexes. Although Figure 8 reflects the combined bone dual X-ray absorptiometry (DXA) machine, an expensive density status for men and women, males typically have a and sophisticated form of X-ray machine that can also be higher peak bone mass than females, and for this reason, used to measure body fatness. Healthy bones are dense and males can lose more bone density over time without reach- strong. When bones lose calcium and become less dense, ing the osteoporosis or fracture threshold. More women they become porous and are at risk for fracture. The bones reach the osteoporosis and fracture thresholds at earlier ages of young children are not especially dense, but during ado- than men. Other risk factors for osteoporosis are age, family lescence and early adulthood (see Figure 8), bones increase history/heredity, frame size, smoking, caffeine use, alcohol in density to a level higher than at any other time in life use, current or previous eating disorders, early menstruation, (peak bone density). Though bone density often begins to low dietary calcium intake, low body fat, amenorrhea, and decrease in young adulthood, it is not until older adulthood extended bed rest. that bone loss becomes dramatic. Over time, if bone loss Malignant Tumors (carcinomas) An uncontrolled and High Active dangerous growth capable of spreading to other areas; a cancerous Bone Sedentary tumor. density Benign Tumors An abnormal growth of tissue confined to a particular area; not considered to be cancer. Osteoporosis threshold Insulin  A hormone secreted by the pancreas that regulates levels of sugar in the blood. Low Fracture threshold Insulin Resistance A condition that occurs when insulin 0 10 20 30 40 50 60 70 80 becomes ineffective or less effective than necessary to regulate sugar levels in the blood. Figure 8  c  Changes in bone density with age. Insulin Sensitivity  A person with insulin resistance (see previ- ous definition) is said to have decreased insulin sensitivity. The body’s cells are not sensitive to insulin, so they resist it and sugar levels are not regulated effectively. Osteoporosis  A condition associated with low bone density and subsequent bone fragility, leading to high risk for fracture.

76 Section 2  c  An Introduction to Physical Activity The National Osteoporosis Foundation (NOF) recom- of back ailments, including poor posture, improper lifting mends five steps to bone health and osteoporosis prevention: and work habits, heredity, and diseases such as scoliosis and arthritis. ∙ Get your daily recommended amounts of calcium and vitamin D. Eat a diet rich in both nutrients. Exposure to Physical activity is important in maintaining a the sun provides a source of vitamin D. The NOF rec- healthy body weight and avoiding the numerous ommends 1,000 mg of calcium daily for people under health conditions associated with obesity. National 50, and 1,200 mg for those over 50. Adults under age 50 studies indicate that more than two-thirds of adults need 400–800 IU of vitamin D, and adults over 50 need are overweight and more than one-third are obese 800–1,000 units. If you have difficulty getting enough of (34.9 percent). Nearly a third of children are either over- these nutrients from food or sunlight, your health-care weight or obese. From 1950 through 1980, obesity and provider may recommend a supplement. overweight were fairly stable but increased dramatically from 1980 to the present. In the past few years the rate ∙ Engage in regular weight-bearing exercise. Weight- of increase in overweight and obesity has not been as bearing exercise (e.g., walking, dancing, jogging) and dramatic as during the previous decade (see Figure 9). resistance training are good choices. The load bearing Research has shown that fat people who are fit are not at and pull of muscles build bone density. especially high risk for early death. However, when high body fatness is accompanied by low cardiorespiratory ∙ Avoid smoking and excessive alcohol. endurance and low metabolic fitness, risk for early death increases substantially. For more information on obesity, ∙ Talk to your health-care provider about bone health. see the Concept on body composition. ∙ When appropriate, have a bone density test and take med- Physical activity reduces the risk and severity of a ication. There is no cure for osteoporosis, but the FDA variety of common emotional/mental health disorders. has approved a variety of treatments for osteoporosis Nearly half of adult Americans will report having a mental to help reduce bone loss over time. When appropriate, health disorder at some point in life. A recent summary of a physician may prescribe FDA-approved medications studies revealed that there are several emotional/mental dis- such as raloxifene (sold as Evista), alendronate (sold as orders associated with inactive lifestyles. Fosamax), or other approved drugs. Hormone treatments such as thyroid-based calcitonin treatments and estrogen Depression is a stress-related condition experienced by are approved. Estrogen replace- many adults. Thirty-three percent of inactive adults report ment therapy (ERT), also known that they often feel depressed. For some, depression is a seri- as hormone replacement treatment ous disorder that physical activity alone will not cure; how- (HRT), can reduce risk of osteo- VIDEO 6 ever, research indicates that activity, combined with other forms of therapy, can be effective. porosis among postmenopausal women, but may increase risk for cancer and other dis- Anxiety is an emotional condition characterized by eases. Medical consultation based on individual factors is worry, self-doubt, and apprehension. More than a few stud- recommended. ies have shown that symptoms of anxiety can be reduced by regular activity. Low-fit people who do regular aerobic Active people who possess good muscle fitness activity seem to benefit the most. In one study, one-third of are less likely to have back and musculoskeletal active people felt that regular activity helped them cope bet- problems than are inactive, unfit people. Because few ter with life’s pressures. people die from it, back pain does not receive the attention given to such medical problems as heart disease and can- 35 Adults cer. But back pain is the second leading medical complaint 30 in the United States, second only to headaches. Only the Children common cold and the flu cause more days lost from work. At some point in our lives, approximately 80 percent of all Percent 25 adults experience back pain that limits the ability to function 20 normally. In National Safety Council data, the back was the 15 most frequently injured of all body parts, and the injury rate 10 was double that of any other part of the body. 5 0 The great majority of back ailments are the result of poor muscle strength, low levels of endurance, and poor flexibil- 1970 1980 1990 2000 Today ity. Tests on patients with back problems show weakness and lack of flexibility in key muscle groups. Year Lack of fitness is probably the leading reason for back Figure 9  c  Incidence of obesity. pain in Western society. Other factors also increase the risk Source: National Center for Health Statistics.

Concept 5  c  The Health Benefits of Physical Activity    77 Physical activity is also associated with better and more Figure 10 indicates, too much exercise may cause problems restful sleep. People with insomnia (the inability to sleep) rather than solve them. seem to benefit from regular activity if it is not done too vigorously right before going to bed. A recent study indi- Recent evidence indicates that Alzheimer’s disease cates that 52 percent of the population feel that physical and dementia are hypokinetic conditions. More than a activity helps them sleep better. Regular aerobic activity is few studies indicate that factors relating to heart health also associated with reduced brain activation, which can result in contribute to brain health. The studies indicate that physical greater ability to relax or fall asleep. and challenging mental activities are especially important for preventing decline in cognitive function and reducing A final benefit of regular exercise is increased self- the risk of developing Alzheimer’s and dementia. Although esteem. Improvements in fitness, appearance, and the ability additional research is needed, this is important news for phy- to perform new tasks can improve self-confidence. sicians and public health officials looking for ways to reduce the prevalence of Alzheimer’s disease. Physical activity can help the immune system fight illness. Until recently, infectious disease and other diseases Physical activity during pregnancy can benefit both of the immune system were not considered to be hypoki- the mother and the child. In the not too distant past, netic. Recent evidence indicates that regular moderate to exercise during pregnancy was discouraged. Over the years, vigorous activity can actually aid the immune system in evidence has shown that appropriate exercise (including fighting disease. Each of us is born with an “innate immune resistance training and moderate to vigorous aerobic exer- system,” which includes anatomical and physiological bar- cise) by pregnant women can help prevent excess weight riers, such as skin, mucous membranes, body temperature, gain, help retain pre-pregnancy fitness levels, and result in and chemical mediators that help prevent and resist disease. shorter, less complicated labor. Physical activity does not We also develop an “acquired immune system” in the form cause miscarriage or damage to the baby and may help the of special disease-fighting cells that help us resist disease. baby developmentally. Figure 10 shows a J-shaped curve that illustrates the ben- efits of exercise to acquired immune function. Sedentary HELP Health is available to Everyone people have more risk than those who do moderate activity, for a Lifetime, and it’s Personal but with very high and sustained vigorous activity, such as A prominent research review of more than 400 stud- extended high performance training, immune system func- ies supports the relationship between exercise and tion actually decreases. academic performance. Physical activity and fitness are Regular moderate and reasonable amounts of vigorous associated with creative abilities, improved concentration activity have been shown to reduce incidence of colds and and attention, better short-term memory, reduced risk of days of sickness from infection. The immune system ben- Alzheimer’s disease, and better test-taking abilities. New efit may extend to other immune system disorders as well. research indicates that regular activity causes positive There is evidence that regular physical changes in cognitive performance over time. (See link in activity can enhance treatment effec- Suggested Resources and Readings.) tiveness and improve quality of life for those with HIV/AIDS. However, as VIDEO 7 Low immune function (high infection risk) Moderate immune Do you think that exercise helps you with cognitive function performance? (moderate risk) (Source: C. H. Hillman) High immune function ACTIVITY (low infection risk) Sedentary Moderate Very vigorous Intensity of activity Figure 10  c  Physical activity and immune function.