complete guide to fitness health hướng dãn tạp thể hình gym

Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, 2011, Adding physical activity to your life..

Trang 2

Complete Guide to Fitness & Health

Second Edition

Barbara A Bushman, PhD

Editor

Trang 3

Library of Congress Cataloging-in-Publication Data

Names: Bushman, Barbara Ann, editor | American College of Sports Medicine.

Title: ACSM’s complete guide to fitness & health / Barbara Bushman, PhD.,

editor.

Other titles: Complete guide to fitness & health | American College of

Sports Medicine’s complete guide to fitness and health

Description: Second edition | Champaign, IL : Human Kinetics, [2017] |

Revised edition of: Complete guide to fitness & health / Barbara Bushman,

editor (Champaign, IL : Human Kinetics, c2011) | Includes bibliographical

references and index.

Identifiers: LCCN 2016048914 (print) | LCCN 2017000135 (ebook) | ISBN

9781492533672 (print) | ISBN 9781492548782 (ebook)

Subjects: LCSH: Exercise | Physical fitness | Health.

Classification: LCC RA781 C575 2017 (print) | LCC RA781 (ebook) | DDC

613.7 dc23

LC record available at https://lccn.loc.gov/2016048914

ISBN: 978-1-4925-3367-2 (print)

All rights reserved Except for use in a review, the reproduction or utilization of this work in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including xerography, photocopying, and recording, and in any information storage and retrieval system, is forbidden without the written permission of the publisher.

This publication is written and published to provide accurate and authoritative information relevant to the subject matter sented Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application

pre-of the information in this publication and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication It is published and sold with the understanding that the authors, editors, and publisher are not engaged in rendering legal, medical, or other professional services by reason of their authorship or publication of this work If medical or other assistance is required, it is the responsibility of the reader or user to obtain the services of a doctor or other competent professional Application of this information in an educational or any other situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and uni- versal recommendations THE AMERICAN COLLEGE OF SPORTS MEDICINE and the publisher disclaim responsibility for any injury to person or property resulting from any ideas or products referred to in this publication If you do not agree to these limitations, do not buy this publication or employ the practices discussed in it.

The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are

in accordance with the current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice, and it is the responsibility of the user or patient to ensure that he or she has obtained the advice of a doctor

or other appropriate, competent medical professional before taking any drug or using any medical device.

Notice: Permission to reproduce the following material is granted to instructors and agencies who have purchased ACSM’s

Complete Guide to Fitness & Health, Second Edition: pp 35, 73, 211, 212, 225, 243, 245, 259, and 260-262.The reproduction of other parts of this book is expressly forbidden by the above copyright notice.Persons or agencies who have not purchased ACSM’s

Complete Guide to Fitness & Health, Second Edition,may not reproduce any material.

Permission notices for material reprinted in this book from other sources can be found on page(s) ix-xii.

The web addresses cited in this text were current as of October 2016, unless otherwise noted.

Acquisitions Editor: Michelle Maloney; Developmental Editor: Laura Pulliam; Managing Editor: Caitlin Husted; tor: Joyce Sexton; Indexer: Andrea Hepner; Permissions Manager: Martha Gullo; Graphic Designers: Dawn Sills and Nancy

Copyedi-Rasmus; Cover Designer: Keith Blomberg; Photographer (cover): klenova/Getty Images/iStockphoto; Photographs (interior): Neil Bernstein, unless otherwise noted; Photo Asset Manager: Laura Fitch; Visual Production Assistant: Joyce Brumfield;

Photo Production Manager: Jason Allen; Senior Art Manager: Kelly Hendren; Illustrations:© Human Kinetics, unless

otherwise noted; Printer: Versa Press

Printed in the United States of America 10 9 8 7 6 5 4 3 2 1

The paper in this book is certified under a sustainable forestry program.

Human Kinetics

Website: www.HumanKinetics.com

United States: Human Kinetics, P.O Box 5076, Champaign, IL 61825-5076, 800-747-4457, e-mail: info@hkusa.com

Canada: Human Kinetics, 475 Devonshire Road Unit 100, Windsor, ON N8Y 2L5, 800-465-7301 (in Canada only),

Trang 4

To Tobin, my dear husband and partner in all life brings our way Your encouragement and support are pivotal to completion of this project and all the other ventures (and adventures) that I “just can’t pass up.” We are, and always will be, Team Bushman.

BB

Trang 5

Barbara A Bushman

Stella Lucia Volpe and Joseph R Stanzione

Barbara A Bushman

Building a Better You

Barbara A Bushman

Avery D Faigenbaum

Jan Schroeder and Michelle Kulovitz Alencar

Nicholas H Evans

Trang 6

Shannon Lennon-Edwards and William B Farquhar

Sheri R Colberg

Kathryn H Schmitz

Brad A Roy and Linda Fredenberg

Kara A Witzke and Kerri M Winters-Stone

A Lynn Millar

Laura J Kruskall

Lanay M Mudd and Jean M Kerver

Heather Chambliss and Tracy L GreerReferences 397

Index 423

About the ACSM 430

About the Editor 430

About the Contributors 431

Trang 7

PREFACE

Step one toward better health is already done! You have taken the first step by opening this book in order to see what additional steps you can take to promote your health

and fitness ACSM’s Complete Guide to Fitness & Health, Second Edition, is unique in

the merging of research-based, scientific information with practical and adaptable plans that you can use Your choices related to physical activity and nutrition can have

a major impact on your current and future health The Complete Guide provides you

with simple ways to assess your status and then, using insights gained, to enhance your exercise program as well as to make optimal nutrition decisions that fit with your personal goals

The book is divided into four parts Part I provides overviews and motivation to

be more active and make positive dietary choices Part II looks at the various fitness components and how you can include these elements in your exercise program Part III gets specific with nutrition and physical activity recommendations for various age groups Part IV expands discussion of diet and exercise to various medical and health conditions The entire book has been refreshed and updated from the first edition.More specifically, part I includes introductory chapters that set the stage for the following chapters, covering both physical activity and nutrition These foundational chapters are packed with usable information plus encouragement to make healthy choices Knowing what to do to improve health is nice, but, in order for this to be

meaningful, you need to actually take action The Complete Guide is focused on

help-ing you link knowhelp-ing and dohelp-ing

Part II focuses on the four elements of a complete exercise program: aerobic ness, muscular fitness, flexibility, and neuromotor fitness An entire chapter is devoted

fit-to each one of these fitness elements The chapters clearly outline health and fitness benefits of various exercise components, offer simple fitness assessments, explain development of an effective exercise plan, and provide sample programs, pictures,

and descriptions of exercises You will understand both the why and the how of a

complete exercise program after reading these chapters Whether you are just starting

or are looking for ways to progress your current exercise program, these chapters offer the guidance you need

Part III includes nutrition and physical activity information specific to given age groups and provides sample programs for the age group covered Chapters for each age group underscore the value of healthy choices over the lifespan These chapters clearly illustrate how you can benefit from physical activity regardless of age, whether you are younger, older, or in between Nutrition issues specific to the various age groups are included to help you make the best food selections

Trang 8

porosis, Alzheimer’s, arthritis, and depression can be affected by exercise and diet; entire chapters are devoted to each of these areas In addition, chapters are dedicated

to weight management and pregnancy

The first edition of this book was an excellent resource, and with expanded topics and fresh content, this second edition is a tremendous new resource you can use to promote your personal health and fitness The chapters are written by experts, provid-

ing scientifically-based guidance on optimizing health and fitness You will continue to use this book as a resource for content as well as encouragement Health and fitness are not destinations but a lifelong journey You have many individual decisions every day that add up to influence your health and thus your life With a solid foundation

of health and fitness, you can live each day to the fullest Embrace the journey and keep stepping forward!

Trang 9

ACKNOWLEDGMENTS

The first edition of this book provided readers from around the world with solid and research-based guidance on promoting personal health and fitness This second edi-tion continues in that effort with extensive updates and a number of new chapters As with the first edition, specialists in various areas have generously contributed to this book A heart-felt thank you to each of them for their willingness to be part of this project; the time and effort put forth have been significant The level of knowledge these specialists have is coupled with a passion for their topic areas that comes through

in their writing In addition, I acknowledge the contribution of Drs Peter Grandjean and Jeffrey Potteiger who contributed within the American College Sports Medicine review process, a key element of this publication to ensure that the material is based

on the most current research The chapter critiques were thorough, and as a result, this book is set apart from others that may rely on opinion or individual impressions

I also acknowledge the contributions of the ACSM staff, Katie Feltman, and Angela Chastain In addition, I appreciate all the work of the staff at Human Kinetics: acquisi-tions editor Michelle Maloney as well as developmental editor Laura Pulliam, managing editor Caitlin Husted, photographer Neil Bernstein, and graphic designers Dawn Sills and Nancy Rasmus A project of this nature is a reflection of the dedicated efforts of

many individuals, and I humbly thank each one, even if not named specifically, for

making this second edition a tremendous resource

Barbara Bushman

Trang 10

CREDITS

Photo Monkey Business/fotolia.com on page 14

Photo Doug Olson/fotolia.com on page 17

Photo © Human Kinetics on page 20

Photo Maria Teijeiro/Digital Vision/Getty Images on page 38

Photo Leonid Tit/fotolia.com on page 57

Photo Leonid Tit/fotolia.com on page 68

Photo ferrantraite/Getty Images on page 80

Photo Vasko Miokovic Photography/Getty Images on page 94

Photo Thomas Perkins/fotolia.com on page 219

Photo Maria Teijeiro/Digital Vision/Getty Images on page 221

Photo iStockphoto/Jacom Stephens on page 230

Photo kali9/Getty Images on page 251

Photo falkjohann/fotolia.com on page 253

Photo yellowdog/Cultura RF/Getty Images on page 255

Photo Siri Stafford/Digital Vision/Getty Images on page 281

Photo Christopher Futcher/Getty Images on page 285

Photo Steve Debenport/Getty Images on page 331

Photo Christopher Futcher/Getty Images on page 344

Photo Steve Debenport/Getty Images on page 362

Photo Xavier Arnau/Getty Images on page 388

Figure 1.1—Source: U.S Department of Health and Human Services and U.S Department of Agriculture,

2015, Scientific report of the 2015 Dietary Guidelines Advisory Committee [Online] Available: http://health.

gov/dietaryguidelines/2015-scientific-report/ [July 26, 2016].

Figure 1.2—Data from U.S Department of Health and Human Services Office of Disease Prevention and

Health Promotion, 2016, How to use data 2020 [Online] Available: https://www.healthypeople.gov/2020/

How-to-Use-DATA2020 [July 26, 2016].

Figure 1.3—Data from U.S Department of Health and Human Services Office of Disease Prevention and

Health Promotion, 2016, How to use data 2020 [Online] Available: https://www.healthypeople.gov/2020/

How-to-Use-DATA2020 [July 26, 2016].

Figure 1.4—Republished with permission of National Sleep Foundation, based on image available at http:// sleepfoundation.org/sites/default/files/STREPchanges_1.png [September 16, 2016] Permission conveyed through Copyright Clearance Center, Inc.

Figure 2.1—Reprinted with permission from the PAR-Q+ Collaboration and the authors of the PAR-Q+ (Dr Darren Warburton, Dr Norman Gledhill, Dr Veronica Jamnik, and Dr Shannon Bredin).

Figure 2.2—Adapted, by permission, from American College of Sports Medicine, 2018, ACSM’s guidelines

for exercise testing and prescription, 10th ed (Philadelphia: Lippincott, Williams & Wilkins).

Table 3.1—Adapted, by permission, from M.H Williams, 2007, Nutrition for health, fitness, & sport, 8th

ed (New York: McGraw-Hill), 404.

Trang 11

x

Table 3.2—Source: U.S Department of Agriculture, Agricultural Research Service, Nutrient Data tory USDA National Nutrient Database for Standard Reference, Release 28 Version Current: September

Labora-2015, slightly revised May 2016 Internet: http://www.ars.usda.gov/nea/bhnrc/ndl.

Figure 3.1—Source: U.S Department of Health and Human Services, n.d., How to understand and use the nutrition facts label [Online.] Available: http://www.fda.gov/Food/GuidanceRegulation/GuidanceD- ocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm#highlights [May 21, 2016].

Table 3.3—Source: U.S Department of Agriculture, Agricultural Research Service, Nutrient Data tory USDA National Nutrient Database for Standard Reference, Release 28 Version Current: September

Labora-2015, slightly revised May 2016 Internet: http://www.ars.usda.gov/nea/bhnrc/ndl.

Table 3.4—Source: U.S Department of Health and Human Services and U.S Department of Agriculture 2015-2020 Dietary Guidelines for Americans 8th Edition December 2015 Available at http://health.gov/ dietaryguidelines/2015/guidelines/.

Table 3.5—Sources: Food and Nutrition Board, Institute of Medicine, n.d., Dietary reference intakes [Online] Available: http://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes [October 28, 2015]; U.S National Library of Medicine, n.d., MedlinePlus [Online] Available: http://www.nlm.nih.gov/medlineplus/ [October 5, 2015].

Figure 3.2—Source: U.S Department of Health and Human Services, n.d., How to understand and use the nutrition facts label [Online.] Available: http://www.fda.gov/food/ingredientspackaginglabeling/ labelingnutrition/ucm274593.htm [May 21, 2016].

Figure 3.3—USDA Center for Nutrition Policy and Promotion

Figure 4.1—Adapted, by permission, from American College of Sports Medicine, 2014, ACSM’s

behav-ioral aspects of physical activity and exercise, edited by C.R Nigg (Philadelphia: Lippincott Williams &

Wilkins), 284.

Table 4.1—Reprinted from U.S Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, 2011, Adding physical activity to your life [Online.] Available: http://www.cdc.gov/physicalactivity/basics/adding-pa/barriers.html [November

16, 2015].

Table 4.2—Sources: USDA Center for Nutrition Policy and Promotion, n.d., ChooseMyPlate [Online] Available: http://www.choosemyplate.gov/ [November 4, 2015]; Health Canada, n.d., Overcome barriers [Online] Available: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/maintain-adopt/obstacles-eng.php [November 14, 2015].

Figure 4.3—Adapted from B Bushman and J.C Young, 2005, Action plan for menopause (Champaign,

IL: Human Kinetics), 188.

Figure 4.4—From ACSM, 2017, ACSM’s complete guide to fitness & health, 2nd ed (Champaign, IL: Human Kinetics) Adapted, by permission, from J Buckworth, 2012, Behavior change In Fitness professional’s

handbook, 6th ed., by E.T Howley and D.L Thompson (Champaign, IL: Human Kinetics), 432.

Table 5.1—Adapted, by permission, from American College of Sports Medicine, 2018, ACSM’s guidelines

for exercise testing and prescription, 10th ed (Philadelphia: Lippincott Williams & Wilkins.

Figure 5.3—Adapted, by permission, from R.E Rikli and C.J Jones, 2013, Senior fitness test manual, 2nd

ed (Champaign, IL: Human Kinetics), 76.

Table 5.2—Adapted, by permission, from R.E Rikli and C.J Jones, 2013, Senior fitness test manual, 2nd

ed (Champaign, IL: Human Kinetics), 89, 90.

Table 5.3—Adapted, by permission, from The Cooper Institute, 2017, FitnessGram administration manual:

The journey to MyHealthyZone, 5th ed (Champaign, IL: Human Kinetics), 86, 87.

Figure 5.4—Adapted from B Bushman and J.C Young, 2005, Action plan for menopause (Champaign,

IL: Human Kinetics), 35.

for exercise testing and prescription, 10th ed (Philadelphia: Lippincott Williams & Wilkins).

for exercise testing and prescription, 10th ed (Philadelphia: Lippincott, Williams & Wilkins).

Table 5.7—Source: B.E Ainsworth, W.L Haskell, S.D Herrmann, N Meckes, D.R Bassett Jr., C Locke, J.L Greer, J Vezina, M.C Whitt-Glover, and A.S Leon, n.d., The compendium of physical activities tracking guide Healthy Lifestyles Research Center, College of Nursing & Health Innovation, Arizona State University [Online.] Available: https://sites.google.com/site/compendiumofphysicalactivities [September

Tudor-21, 2015].

Trang 12

Table 6.4—Adapted, by permission, from The Cooper Institute, 2017, FitnessGram administration manual:

The journey to MyHealthyZone, 5th ed (Champaign, IL: Human Kinetics), 86, 87.

Table 8.1—Adapted from B.A Springer, R Marin, T Cyhan, H Roberts, and N.W Gill, 2007, “Normative

values for the unipedal stance test with eyes open and closed,” Journal of Geriatric Physical Therapy

30(1): 8-15.

Table 8.2—Adapted from P.W Duncan, D.K Weiner, J Chandler, and S Studenski, 1990, “Functional

reach: A new clinical measure of balance,” Journal of Gerontology 45(6): M192-M197.

Figure 8.3—Adapted from H Edgren, 1932, “An experiment in the testing of agility and progress in

bas-ketball,” Research Quarterly 3(1): 159-171.

Figure 8.4—Adapted from K Pauole, K Madole, J Garhammer, M Lacourse, and R Rozenek, 2000, ability and validity of the T-test as a measure of agility, leg power, and leg speed in college-aged men

“Reli-and women,” Journal of Strength “Reli-and Conditioning Research 14(4): 443-450.

Table 8.3—Adapted from K Pauole, K Madole, J Garhammer, M Lacourse, and R Rozenek, 2000, ability and validity of the T-test as a measure of agility, leg power, and leg speed in college-aged men

“Reli-and women,” Journal of Strength “Reli-and Conditioning Research 14(4): 443-450.

Figure 9.1(a-b)—Developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion, 2000 Available: http://www.cdc.gov/ healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html [August 9, 2016].

Table 9.1—Reprinted with permission, from S.G Gidding et al., 2005, “Dietary recommendations for

children and adolescents: A guide for practitioners,” Circulation 112(13): 2061-2075 © American Heart

Association, Inc.

Table 9.2—Data from USDA Center for Nutrition Policy and Promotion.

Table 9.3—Adapted from U.S Department of Health and Human Services, 2008, 2008 physical activity

guidelines for Americans [Online] Available: www.health.gov/paguidelines [August 10, 2016].

Figure 9.2—© Human Kinetics

Table 9.4—Adapted from U.S Department of Health and Human Services, 2008, 2008 physical activity

guidelines for Americans [Online] Available: www.health.gov/paguidelines [August 10, 2016].

Figure 9.4—Reprinted from Journal of Pediatrics 146(6), W.B Strong, R.M Malina, C.J.R Blimkie, et al.,

Figure 10.1—Source: U.S Department of Health and Human Services Office of Disease Prevention and Health Promotion, n.d., Healthy people 2020 [Online] Available: https://www.healthypeople.gov/2020/ How-to-Use-DATA2020 [September 2, 2015].

Table 10.1—Sources: U.S Department of Health and Human Services, National Institutes of Health, Office

of Dietary Supplement, n.d., Vitamin and mineral supplement fact sheets [Online] Available: https:// ods.od.nih.gov/factsheets/list-VitaminsMinerals/ [October 29, 2015]; and U.S Department of Health and Human Services, Office of Disease Prevention and Health Promotion, n.d., Dietary guidelines [Online] Available: http://health.gov/dietaryguidelines/ [November 4, 2015].

Table 10.2—Source: U.S Department of Health and Human Services and U.S Department of Agriculture 2015-2020 Dietary Guidelines for Americans 8th Edition December 2015 Available at http://health.gov/

Trang 13

Avail-Institute, 2005, Your guide to lowering your cholesterol with TLC [Online] Available: https://www.nhlbi.

nih.gov/files/docs/public/heart/chol_tlc.pdf [August 10, 2016].

Table 12.3—Source: U.S Department of Health and Human Services, National Heart, Lung, and Blood Institute, n.d., Following the DASH eating plan [Online] Available: https://www.nhlbi.nih.gov/health/ health-topics/topics/dash/followdash [August 10, 2016].

Figure 13.1—© Human Kinetics

Figure 15.1—Source: National Institutes of Health and Human Services, National Institute on Aging, n.d., Alzheimer’s Disease fact sheet [Online] Available: https://www.nia.nih.gov/alzheimers/publication/ alzheimers-disease-fact-sheet#changes [August 10, 2016].

Table 15.2—Adapted from M.C Morris, C.C Tangney, Y Wang, F.M Sacks, D.A Bennett, and N.T

Aggar-wal, 2015, “MIND diet associated with reduced incidence of Alzheimer’s disease,” Alzheimer’s & Dementia

11(3): 1007-1014.

Table 16.1—Adapted from Institute of Medicine, 2011, Dietary reference intakes for calcium and vitamin

D (Washington, DC: National Academies), 349.

Table 16.2—Source: National Osteoporosis Foundation, n.d., A guide to calcium-rich foods [Online] Available: https://www.nof.org/patients/treatment/calciumvitamin-d/ [September 16, 2016].

Table 16.3—Data from National Institutes of Health Office of Dietary Supplement, n.d., Vitamin D fact sheet for professionals [Online.] Available: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ [September 2, 2016].

Table 16.4—Adapted from Institute of Medicine, 2005, Dietary reference intakes for energy, carbohydrate,

fiber, fat, fatty acids, cholesterol, protein, and amino acids (Washington, DC: National Academies), 621-649.

Figure 18.1—Adapted from U.S Department of Health and Human Services, National Heart, Lung, and

Blood Institute, 1998, Clinical guidelines on the identification, evaluation, and treatment of overweight

and obesity in adults: The evidence report [Online] Available:

http://www.nhlbi.nih.gov/health/educa-tional/lose_wt/BMI/bmi_tbl.pdf

[September 22, 2016].

Table 18.2—Source: U.S Department of Health and Human Services and U.S Department of Agriculture 2015-2020 Dietary Guidelines for Americans 8th Edition December 2015 Available at http://health.gov/ dietaryguidelines/2015/guidelines/.

Table 19.1—From Institute of Medicine and National Research Council of the National Academies, Weight gain during pregnancy: Reexaminining the guidelines Adapted with permission from the National Acad- emies Press, Copyright 2009, National Academy of Sciences.

Table 19.2—Reprinted with permission from Physical activity and exercise during pregnancy and the postpartum period Committee Opinion No 650 American College of Obstetricians and Gynecologists Obstet Gynecol 2015; 126: e135–e142.

Table 19.3—Adapted, by permission, from J.M Pivarnik and L Mudd, 2009, “Oh baby! Exercise during

pregnancy and the postpartum period,” ACSM’s Health & Fitness Journal 13(3): 8-13.

Trang 14

Part I

Fit, Active, and Healthy

Although many aspects of life may feel out of one’s control, you have choices each

day that can affect your fitness and health Physical activity and nutrition are two areas that have a major impact on many aspects of your life in regard to both disease risk and daily function Chapters 1 to 4 will help you to place scientifically-based recom-mendations into the context of your life so you can tackle the challenge of establishing healthy habits for the long term

Trang 15

This page intentionally left blank.

Trang 16

Rather than viewing healthy choices as distinct, unrelated activities, consider how various influences in your life interact to promote, or challenge, your efforts to make healthy choices As you opened this book and started to peruse the pages, you have already taken the first step toward improving your health and wellness In the upcoming pages, you will find research-based recommendations for exercise and dietary choices, with chapters on many specific topics written by experts in their fields The value of

these recommendations can be realized only when placed within the context of your life and your experiences Armed with this perspective, you can develop your action

plan to begin, or improve, your wellness journey Time to jump on board!

You: Living Well

How do you define wellness? Your definition will reflect your personal experiences and perspectives One way to consider the concept of wellness centers on engaging

in activities in order to avoid negative consequences—for example, exercising in order

to be free of disease and debilitating conditions, or substituting water for sweetened beverages to keep from gaining weight To take a more positive viewpoint, contempo-

rary approaches to wellness focus on balancing the many aspects, or dimensions, of life to promote health (8) Examples include exercising in order to develop a level of fitness that allows for full participation in recreational activities you enjoy, or consuming

Trang 17

ACSM’s Complete Guide to Fitness & Health

Health outcomes

Systems

and sectors

Household, social, and cultural factors

Public and private sector policies

Community and environmental factors

Health promotion

Chronic disease prevention

Physical fitness and function

Healthy

weight

Healthy nutritional status

Diet and physical activity patterns and behaviors

FIGURE 1.1 Diet and physical activity, health promotion, and disease prevention across the lifespan

Source: U.S Department of Health and Human Services and U.S Department of Agriculture, 2015.

a balanced diet in order to provide your body with needed nutrients for optimal tion Outcomes may be similar, but the mindset is one of pursuing health rather than avoiding illness

func-Wellness reflects physical, emotional, social, intellectual, spiritual, and occupational aspects (11) Wellness exists across a continuum between the presence and the absence

of each dimension or aspect of life Table 1.1 provides a brief definition and a pair of terms reflecting the presence or absence of each wellness dimension Take a moment

to consider where you fall on the continuum between two sample indicators listed for each dimension Wellness isn’t a static or all-or-none situation but rather is dynamic and changing At any time, you may find some dimensions to be more present than others in your life By adopting healthy behaviors, you can have greater balance in each dimension and therefore a greater sense of well-being and health

Wellness touches all aspects of life, and fully discussing all areas is beyond the scope of this book The focus of this book is physical wellness, and the following sec-tions introduce the benefits of physical activity and a healthy diet In addition, insights into two areas that can affect physical wellness—sleep and stress management—are discussed

Trang 18

Making Healthy Lifestyle Choices 5

Promoting Health and Wellness

Seeking better health involves many daily decisions and actions This section explores the benefits of physical activity and exercise as well as dietary choices In addition, taking steps to ensure adequate sleep and manage stress are integral to your pursuit

of health and wellness

Physical Activity and Exercise

Physical activity recommendations are not new, although the message has been fied in recent years In 1996, the U.S Surgeon General’s Report on Physical Activity and Health was described as “a passport to good health for all Americans,” and the goal was to weave physical activity into the fabric of daily life as highlighted by these take-home points of the report (27):

clari-• Americans can substantially improve their health and quality of life by including moderate amounts of physical activity in their daily lives

• For those who are already achieving regular moderate physical activity, additional benefits may be gained by further increases in activity levels

• Health benefits from physical activity are achievable for most Americans

Armed with increased awareness of the value of physical activity provided by the Surgeon General’s report, the U.S Department of Health and Human Services pro-

vided clear recommendations on physical activity in its Physical Activity Guidelines for

Americans (25) The Physical Activity Guidelines for Americans is based on hundreds

of research studies conducted to examine the effects of physical activity on health Following are some of the major findings:

• Regular physical activity reduces the risk of many unwanted health outcomes and diseases

TABLE 1.1 Dimensions of Wellness Indicators

Indicator

Absent Present

Physical Ability to carry out daily activities with

vigor and relative ease Unfit FitEmotional Ability to understand feelings, accept

limitations, and achieve stability

Miserable Content

Social Ability to relate well to others within

and outside the family unit Disengaged ConnectedIntellectual Ability to learn and use information for

personal development

Mindless Aware

Spiritual Ability to find meaning and purpose in

life and circumstances

Lost Secure Occupational Ability to find personal satisfaction and

enrichment through work Frustrated Fulfilled

Trang 19

6

Q&A

What are current activity levels in the United States?

Although the Surgeon General’s report gave high-level attention to the importance of physical activity, it did not ultimately spark the increase in physical activity desired and needed Figure 1.2 shows the percentage of adults who engage in aerobic and muscular activity and also the percentage who are not active during leisure time (26) In a perfect scenario, 100 percent of people would exercise (aerobically and with resistance training), and no one would remain inactive during leisure time The most active age group is the youngest; unfortunately, activity decreases and inactivity increases with age Currently, the percentages are far from ideal Now is the time for everyone to increase physical activity and find enjoyable ways to be more active

E6843/ACSM/F01.02/547902/mh-R1

Aerobic

Muscular

Both aerobic and muscular

No leisure-time activity

FIGURE 1.2 Percentages of Americans who engage in moderate aerobic activity and resistance training and those who are inactive in their leisure time

Data from U.S Department of Health and Human Services Office of Disease Prevention and Health Promotion, 2016.

• Some physical activity is better than none The greatest health risk comes from being totally sedentary Getting up and moving is important to start reducing disease risk and claiming benefits Some health benefits have been identified with as little as 60 minutes of activity a week

• A target of 150 minutes per week of moderate-intensity activity provides significant health benefits (additional benefits accrue to those who do more) An example

of moderate-intensity activity is brisk walking

• If you are already active, additional benefits are possible for most health outcomes

if you increase the amount of physical activity by exercising at a higher intensity, more often, or for a longer period of time

• When one considers risks versus benefits, the benefits of physical activity weigh possible adverse outcomes

out-• Regular exercise, week after week and year after year, is the goal Maintaining such a program can produce both short-term and long-term benefits Starting early in life and continuing throughout the lifespan is recommended

Current recommendations from the American College of Sports Medicine (ACSM) continue to support the value of a comprehensive exercise program (1, 10) The upcom-

Trang 20

ing chapters reflect these research-based guidelines, providing more detail on the components of a balanced exercise program and the role that activity and nutrition play in promoting health and fitness throughout the lifespan, as well as when people are faced with special health conditions

Both physical activity and exercise are valuable Although similar in some ways, there is a subtle difference between these two terms (1) “Physical activity” is the appropriate wording to use to refer to movement of the body that takes effort and requires energy above that required at rest Day-to-day tasks such as light gardening, household chores, and taking the stairs at work are examples of baseline physical activ-ity Including activities like these in your daily routine is helpful, but adding exercise

to your schedule provides additional health and fitness benefits Exercise is a specific, planned type of physical activity that is done in a structured manner to promote physi-cal fitness Going for a brisk walk with the purpose of increasing your aerobic fitness

or lifting weights to improve muscular fitness are both physical activity options that fall under the category of exercise Thus physical activity is a broader, umbrella term, and exercise is one category of physical activity (i.e., all exercise is physical activity but not all physical activity is exercise) Over the past few years, the value of both physical activity (see Sit Less, Move More) and exercise has been supported The focus of this book is exercise, but realize that exercise is a type of physical activity and that the terms are often used interchangeably

Sit Less, Move More

Reflect on the amount of time you spend sitting over the course of the waking hours of the day: sitting while commuting, when working at the computer, during television watch-ing, and at other times throughout the day One study reported the following averages for nonsleeping activity levels (19):

• Moderate to vigorous physical activity = 0.3 hours

• Light physical activity = 4.1 hours

to “good” cholesterol levels) (23) Thus, finding ways to infuse more activity into the day appears to be key Here are some examples:

• Stand or walk while talking on the phone

• Get up and move during commercials when watching TV

• Include some movement time every half hour when working on the computer or doing desk activities

• Go for a short walk after meals

Keep looking for additional ways to infuse activity into your day!

Trang 21

8

Being active is one of the most important habits people of all ages can develop

to improve their health (1, 25) Why are physical activity and exercise so important

to your well-being? Children who are active are more likely to be at a healthy body weight, perform better in school, and have higher self-esteem (22) They are also less likely to develop risk factors for heart disease, including obesity (25) Adults who exercise are better able to handle stress and avoid depression, perform daily tasks without physical limitation, and maintain a healthy body weight; they also lower their risk of developing a number of diseases (10, 25) Exercise continues to be important for older adults by ensuring quality of life and independence; regular exercise boosts immunity, combats bone loss, improves movement and balance, aids in psychological well-being, and lowers the risk of disease (9) Physical activity and nutrition informa-tion for children and adolescents is found in chapter 9, for adults in chapter 10, and for older adults in chapter 11

Although disabilities may affect one’s ability to be physically active, research ports the health benefits for avoiding inactivity and becoming as regularly active as possible within one’s ability An appropriate physical activity level can be determined

sup-in consultation with a health care provider (25) Similarly, people with chronic medical conditions should consult with their health care providers regarding the appropriate types and amounts of activity (25) Chronic medical conditions encompass a wide range

of situations, including arthritis, type 2 diabetes, and cancer Within the limitations of their ability, adults with chronic medical conditions can obtain health benefits from regular physical activity (25) Chapters 12 to 17 include nutrition and physical activity recommendations unique to a number of chronic conditions, including heart disease, high blood pressure, high cholesterol, diabetes, cancer, Alzheimer’s disease, osteoporo-sis, and arthritis In addition, the value of regular physical activity and healthy dietary choices is reviewed for weight management (chapter 18), pregnancy and postpartum (chapter 19), and depression (chapter 20)

The benefits of a regular exercise program extend into many areas of life ments in body function as a result of exercise are well documented and are highlighted

Improve-in this chapter In addition to physiological benefits, psychological and mental health benefits can also be realized Exercise appears to provide relief from symptoms of depression and anxiety; in addition, exercise enhances well-being and quality of life and is associated with a lower risk of dementia (10) Exercise also has the potential

to enhance emotional well-being and improve mood (21) Researchers continue to explore why exercise promotes mental well-being Potential reasons include offering

a distraction, increasing self-confidence, providing physical relaxation, and promoting

a positive body image (13)

Stated simply, exercise is the best prescription! No other “product” can provide so many positive changes with so few side effects To underscore this, take a moment to review the impressive summary list of health benefits related to physical activity, for all age groups, in table 1.2 The scientists working with the U.S Department of Health and Human Services rated available evidence as strong, moderate, or weak based on the type, number, and quality of the research studies (25) Only the health benefits with at least moderate evidence are included in this table

As a reader of this book, you can claim these benefits for yourself Be encouraged! Regardless of your current level of physical activity, the information provided in the upcoming chapters will help you create a realistic, workable exercise plan that has the potential to change your life for the better Fitness is multifaceted, including health-

Trang 22

TABLE 1.2 Health Benefits Associated With Regular Physical Activity

Children and adolescents (ages 6 to 17)

• Improved bone health

• Improved cardiovascular and metabolic health biomarkers

• Favorable body composition

Adults and older adults (ages 18 and older)

• Lower risk of coronary heart disease

• Lower risk of stroke

• Lower risk of high blood pressure

• Lower risk of adverse blood lipid profile

• Lower risk of type 2 diabetes

• Lower risk of metabolic syndrome

• Lower risk of colon cancer

• Lower risk of breast cancer

• Prevention of weight gain

• Weight loss, particularly when combined with reduced calorie intake

• Improved cardiorespiratory and muscular fitness

• Better functional health (for older adults)

• Reduced abdominal obesity

• Lower risk of lung cancer

• Lower risk of endometrial cancer

• Weight maintenance after weight loss

• Increased bone density

• Improved sleep quality

*The Advisory Committee (of the 2008 Physical Activity Guidelines) rated the evidence of health benefits of physical

activity as strong, moderate, or weak based on an extensive review of the scientific literature including the type, number, and quality of studies available as well as the consistency of findings across the various studies.

related and skill-related components Health-related components include aerobic fitness, muscular fitness, flexibility, and body composition; skill-related components include agility, coordination, balance, reaction time, power, and speed (1)

Although skill-related components of fitness are clearly important in sport and athletic competitions, they are also involved directly or indirectly in your day-to-day activities Consider your ability to navigate around children’s (or pets’) toys scattered

on the floor while carrying a full basket of laundry You need to be able to physically handle the weight of the basket while maintaining a stable and upright body posi-tion Within this book, individual chapters are dedicated to aerobic fitness, muscular fitness, flexibility, and neuromotor exercise training This latter category encompasses

Trang 23

10

many of the aspects of skill-related fitness Each component contributes to ensuring that your body is operating at its optimal level This influences your ability to engage

in exercise and also in activities of daily living The following sections offer insights

on specific health benefits related to given components of fitness

Aerobic Fitness

The word “aerobic” means “with oxygen.” Your heart, lungs, and blood vessels work together to supply your muscles with needed oxygen during aerobic, or cardiorespira-tory endurance, exercise Examples of aerobic exercises are walking, jogging, running, cycling, swimming, dancing, hiking, and sports such as tennis and basketball

Regular activity is associated with lowering risk factors related to heart disease such as high blood pressure and unhealthy cholesterol levels (10) If you are already somewhat active, you can further reduce your risk by engaging in additional physi-cal activity Cardiovascular health, including heart disease, high blood pressure, and high cholesterol, is discussed in more depth in chapter 12, and weight management is discussed in chapter 18 Aerobic activity also reduces the risk of type 2 diabetes (10) Progression from prediabetes (elevated blood glucose levels that increase the risk of developing diabetes in the future) to diabetes can be delayed or even prevented by losing weight and increasing physical activity (2) Lifestyle modifications can have a definite impact In addition, physical activity can also help control blood glucose levels

in people diagnosed with either type 1 or type 2 diabetes (see chapter 13 for details) Chapter 5 explains more fully the recommendations on aerobic activity as well as how you can progress over time

Muscular Fitness

Muscular fitness refers to how your muscles contract to allow you to lift, pull, push, and hold objects Muscular fitness can be improved with resistance training As with aerobic fitness, many exercise options are available, including lifting weights, using resistance bands or cords, and performing body weight exercises such as push-ups and curl-ups The key is to find activities that you enjoy and that are available to you Chapter 6 provides details on various types and modes of activity that can help strengthen your muscles, as well as specific exercises and how-to photos to help you get started or improve your current resistance training program

When you consider muscular fitness, the first picture in your mind might be a competitive athlete with large muscles Although increases in muscle size are possible

Q&A

Why is it important to engage in aerobic exercise?

When you exercise so that your heart beats faster and you breathe at a quicker rate, you are providing a positive type of stress on your cardiorespiratory system as well as your entire body This stress, or overload, is needed in order to improve fitness and health An inactive lifestyle does not provide this positive stress and therefore leads to inactivity-related diseases such as heart disease A sedentary lifestyle and obesity have been described as “parallel, interrelated epidemics in the United States” with reference

to their contribution to the risk of heart disease (14) It is vital to find ways to fit physical activity into your daily life

Trang 24

with resistance training, for most people a more relevant reason to include resistance training is to improve muscle function in order to handle activities of daily living with less stress For example, sufficient muscular fitness will allow you to complete yard-work with less relative effort or climb stairs more easily Of course, improved muscular fitness will also make recreational sport and athletic endeavors more enjoyable and give you a competitive edge

Muscular fitness is important for everyone throughout the lifespan Children efit from activities that strengthen muscles such as climbing and jumping as well as calisthenics (e.g., jumping jacks, push-ups, or other activities in which the body is moved without needing any equipment) and more organized resistance training (25) For adults, resistance training improves quality of life and limits the muscle losses typically seen with aging

ben-In addition to promoting muscular strength, regular resistance training provides other health benefits, including improving body composition and blood pressure (10) Benefits of resistance training related to preventing or managing diabetes include improving glucose levels and the body’s sensitivity to insulin (10)

Another aspect of your health that benefits from resistance training is bone strength (1, 9) As muscles contract to lift, push, or pull a heavy object, a stress is placed on the bone by way of connections between muscles and bones called tendons When

a bone is exposed to this force, it responds by increasing its mass This makes bones stronger over time Bone health is outlined in more detail in chapter 16

Not to be ignored is the way resistance training can make you look and feel Firm, toned muscles can inspire confidence Stronger muscles can give you a real boost as you accomplish daily activities with greater ease and improve in competitive sport

as well For all these reasons, resistance training is an important part of your weekly activity plan

Flexibility

Flexibility refers to the ability to move a joint through a full range of motion Whether you are focusing on your golf swing or more practical aspects of daily life such as reaching for a high shelf in your closet, maintaining flexibility is important Loss of flexibility as a result of injury, disuse, or aging can limit your ability to carry out daily activities Flexibility can be maintained or even improved through a comprehensive stretching program (1) Chapter 7 outlines stretches for all the muscle groups in the body and discusses the benefits of including activities focused on improving range

Adults have a real need to maintain resistance training because typically, over the course

of adulthood, the amount of muscle decreases while the amount of body fat increases

(9) Declines in muscle mass begin around age 40, and the decline accelerates after

around age 65 to 70 (9)

Trang 25

12

treatment of arthritis, 38 percent of people with arthritis report no leisure-time ity (compared with about 27 percent of people without arthritis) (7) Full details on flexibility as well as muscular and cardiorespiratory exercises for people with arthritis and joint pain are provided in chapter 17

activ-Neuromotor Exercise

Neuromotor exercise training, also referred to as functional fitness training, includes activities that improve balance, coordination, gait, agility, and one’s perception of physical location within space (i.e., proprioception) (1) Many activities include com-binations of neuromotor, resistance, and flexibility, for example, yoga, tai ji (tai chi), and qigong (1)

Researchers have noted improvements in balance, agility, and muscular strength for older adults who engage in functional fitness training In addition, older adults lower their risk of falling (1) Although most of the research studies have focused on older adults, younger adults likely can reap benefits as well Regardless of your age, reflect

on activities that occur over the normal course of the day when improved balance, coordination, or agility would be valuable—for example, sidestepping around a puddle

on a busy sidewalk or juggling full bags of groceries when walking up stairs Then, consider how all the facets of neuromotor exercise training can affect enjoyment in recreational activities or athletic endeavors Examples are hiking with a loaded back-pack, balancing on a surf- or skateboard, and playing basketball or soccer It actually becomes hard to think of activities that are not affected by functional fitness! Chapter

8 unpacks this often overlooked aspect of fitness

Body Composition

Body composition refers to the makeup of your body The body is made up of lean tissue (including muscle) and fat tissue Typically, the focus of body composition is the relative amounts of muscle versus fat Although the bathroom scale can help you track your overall body weight, this measurement is general and does not reveal the amount

of fat compared to muscle Excessive amounts of body fat are related to poor health outcomes, and this is especially true for fat around the abdominal area (1) Chapter 18 discusses body weight management

Whether you are looking to begin an exercise program or optimize the time you are already investing in exercise, the upcoming chapters show you what to include as well as how to track your progress This book will help you balance the various fitness components so you can maximize the benefits from your personal exercise program

Diet and Nutrition

Choices related to what to eat and drink are made over and over throughout the day Determining what items to select can be a real challenge, even with the best of inten-tions Unfortunately, many people associate good nutrition with a restrictive diet filled with unappealing options This is unfortunate, as a healthy diet is one full of nutritious

and delicious foods Note that that the word “diet” in this context refers to what you

eat, not a particular weight loss plan

To help provide a foundation for nutritional choices, every five years the Dietary

Guidelines for Americans is updated (28) Most recently, the 2015 Dietary Guidelines

Trang 26

Advisory Committee reviewed the most current research and evidence in order to provide updates to the 2010 Guidelines This review was guided by two realities (29) First, the committee noted that about two-thirds of American adults are overweight or obese and about half have at least one preventable chronic disease (see figure 1.3 for percentages of Americans who are obese [26], realizing that prevalence is even higher when one considers overweight in addition to obesity) Contributing factors include poor dietary patterns, calorie overconsumption, and physical inactivity Second, the committee acknowledged the personal, social, organizational, and environmental con-text in which lifestyle choices—nutrition and physical activity—are made Each person has a unique frame of reference, and, within that context, can develop optimal dietary patterns along with adequate physical activity to promote health (28)

Dietary patterns are linked to potential risk of obesity and chronic diseases, such

as heart disease, high blood pressure, diabetes, and some cancers (29) Researchers are exploring potential relationships between dietary patterns and neurocognitive disorders and congenital anomalies (29) Thus, one’s diet really does matter! The key question is, what does a healthy diet look like? A healthy eating pattern includes veg-etables, fruits, grains (with at least half being whole grains), fat-free or low-fat dairy, and a variety of protein foods (e.g., seafood, lean meats and poultry, eggs, legumes, nuts, seeds, soy products) while limiting saturated and trans fats, added sugars, and sodium (28) Rather than dictating a single, stringent diet pattern, these strategies can

be individualized to fit within one’s health needs, dietary preferences, and cultural

Q&A

Considering a typical eating pattern in the United States,

what are areas of concern?

In comparison with recommendations, about 75 percent of Americans do not consume

adequate vegetables, fruits, dairy, and oils In contrast, added sugars, saturated fats, and

sodium are overconsumed Overall calorie intake is another area of concern, as many

eating patterns include too many calories (28) Consuming more calories than needed

results in weight gain over time

FIGURE 1.3 Percentage of Americans classified as obese

Data from U.S Department of Health and Human Services Office of Disease Prevention and Health Promotion, 2016.

Trang 27

14

traditions The focus is on flexibility

and combining foods in a variety

of ways to promote healthy dietary

patterns (29)

Understanding the various

com-ponents of a healthy diet is helpful

in developing nutritional patterns

that meet your body’s needs and

promote optimal health Chapter 3

provides an overview of the various

nutrients and how each affects how

your body functions

Sleep and Stress

Management

The previous sections have

high-lighted the myriad benefits that

are possible when one embraces a

physically active lifestyle and enjoys

healthy food selections In addition

to these areas of physical wellness,

sleep and stress influence health

and, given the significant potential

impact, are included here

Influence of Sleep

If you struggle with getting a good

night’s sleep, you are not alone

Chronic sleep loss or sleep disorders are estimated to affect up to 70 million people (15) Obtaining adequate sleep—in terms of both quantity and quality—contributes to how you feel and function A restful night of sleep provides the energy and alertness necessary to handle daily challenges In contrast, the lack of adequate sleep negatively affects productivity, relationships, and physical health

Sleep is important for many reasons and significantly affects many dimensions of wellness and quality of life Sleep requirements vary from person to person, but in general, adults typically need between 7 and 8 hours per night to feel well rested (15) For a helpful visual on typical sleep requirements across the age spectrum see figure 1.4 (18) Although some adults can function normally on less sleep, others may require significantly more How can you know if you are getting enough sleep? Sleepiness during the day is a simple but clear indicator that your body requires more sleep Sig-nificant sleepiness during the day suggests the need for more or better sleep, or both You may also benefit from tracking your sleep habits and trends (18)

Lack of sleep is more than just an annoyance Sleep is important for the body to function as intended; such functions include the following (15):

Good nutritional choices are part of physical ness.

Trang 28

well-Making Healthy Lifestyle Choices 15

FIGURE 1.4 Sleep duration recommendations

Republished with permission of National Sleep Foundation.

10

9 5-6

Infant 4-11 months

Toddler 1-2 years

Pre-school 3-5 years

School age 6-13 years

Teen 14-17 years

Young adult 18-25 years

Adult 26-64 years

Older adult 65+

years

• Heart rate and blood pressure naturally fluctuate during sleep to promote diovascular health

car-• Cells and tissues are repaired as growth hormone is released during deep sleep

• Immune function is promoted with the creation of cytokines that target infections

• Hormones related to appetite change (leptin, which suppresses appetite, increases while ghrelin, which stimulates appetite, decreases)

In addition, inadequate sleep can make daily tasks like learning, concentrating, and reacting more difficult (15)

Changing behavior to obtain the sleep you need requires making a conscious health choice Implementing good sleep practices is key (see Tips for Better Sleep) One common recommendation to promote better sleep is exercise The National Sleep Foundation has stated, simply, “Exercise is good for sleep” (17) Although some rec-

ommendations in the past have suggested that exercise near bedtime is detrimental, newer recommendations encourage healthy adults to exercise without any limitation related to time of day, other than ensuring that exercise time is not replacing time needed for sleep (18)

Trang 29

16

Influence of Stress

“I’m stressed out.” Likely this statement has crossed your lips or you have heard another person utter these words The reality is that everyone experiences stress at various points in life So, what is stress? At the most basic level, stress is defined as the brain’s response to demands (16) Not all stress is the same Different types of stress have been identified, including acute stress, episodic acute stress, and chronic stress

Acute stress stems from demands and pressures that result from recent events or even events anticipated in the near future (5) These stressors are short-term—for example, losing your car keys or handling a customer complaint at work Common symptoms include irritability, anxiety, tension headache, muscular tensions, digestive system problems, and other physiological responses such as higher blood pressure, faster heart rate, sweating, and even shortness of breath or chest pain

Episodic acute stress occurs when acute stress is experienced frequently (5) Picture the person who has taken on too many tasks, who is always late and rushing, who seems to move from one crisis directly into another, or who suffers from ongoing worry Symptoms of episodic acute stress include persistent tension headaches, migraines, high blood pressure, chest pain, and heart disease

Chronic stress is ongoing, grinding stress that is unrelenting for long periods of time (5) The health conditions that result from untreated chronic stress include anxiety, insomnia, muscle pain, high blood pressure, and a weakened immune system (6) In addition, stress can contribute to the development of heart disease, depression, and obesity (6)

Short-term stress reflects those situations in which you respond and then return back

to a baseline state of relaxation Long-term stress can be more troubling as the body has

to continue in an alert state This has been described as taking a “sprint” mechanism intended to occur for a brief time (see Fight-or-Flight Response) and forcing the body into a “marathon” or ongoing situation with resulting breakdown and system failure

over time (12). Stress can affect almost every body system Examples are muscular

Tips for Better Sleep

Consider these tips to help promote a good night’s sleep (18):

• Stick to a sleep schedule, even on weekends

• Practice a relaxing bedtime ritual

• Exercise daily

• Evaluate your bedroom to ensure ideal temperature, sound, and light

• Sleep on a comfortable mattress and pillows

• Beware of hidden sleep stealers, like alcohol and caffeine

• Turn off electronics before bed

The National Sleep Foundation recommends consulting with your primary care physician

or a sleep professional if you are experiencing symptoms such as sleepiness during the day

or when you expect to be awake and alert; snoring; leg cramps or tingling; gasping or ficulty breathing during sleep; prolonged insomnia; or another symptom that is preventing you from sleeping well

Trang 30

dif-Making Healthy Lifestyle Choices 17

Exercising with a friend can be a great way to manage stress.

tension for the musculoskeletal system; diarrhea-constipation for the digestive system; elevated stress hormones and blood sugar levels for the endocrine system; and increased risk of high blood pressure, heart attack, or stroke for the cardiovascular system (3)

Chronic stress can bring feelings of being overloaded Responses may be due to positive or negative changes, and can be real or perceived (16) Common sources of stress are money, work, the economy, family responsibilities, and personal health (4)

Do any (or all) of these ring true? Symptoms of stress reported in a recent survey include feeling angry or irritated, feeling anxious or nervous, lacking motivation, feel-ing fatigued, being depressed or sad, or feeling overwhelmed (4) Can you picture yourself reacting in these ways?

Various approaches to dealing with stress have been proposed, including both prevention and management (12) Being prepared for life situations can be helpful in preventing stressors from having a negative impact Of course, not all stressors can be avoided, so management of one’s reaction is also important One valuable tool used routinely to help handle stress is regular participation in exercise (24) The role of exer-cise in stress reduction is not yet clear, but active people appear to be able to buffer stress more effectively than sedentary people do In addition, healthy diets facilitate a healthy state (see chapter 3 for current recommendations on healthy dietary patterns)

In addition to being active and eating well, other tools can be used to prevent or manage stress As you consider some of the following tips, realize that no one tool works for all people, or even within all situations

Trang 31

18

Fight-or-Flight Response

The fight-or-flight response is intended to be beneficial for survival when one is faced with

a threat The body gears up to act as needed, and in doing so, turns on some areas of the body while shutting down others that are not immediately needed When confronted with

an acute stress (e.g., being startled by a loud sound when walking on a darkened sidewalk), the body prepares to deal with the potential danger or to escape The responses that prepare the body for action include these: the heart beats faster, blood pressure increases, breathing becomes heavy, pupils dilate, and muscles tense At the same time the body increases the availability of glucose and fats to burn for fuel while shutting down areas not vital in the moment such as immune function, reproductive capacity, and digestion (12)

• Plan your schedule Being aware of and in charge of your schedule provides an

empowering feeling that helps to reduce the impact of stressful situations ning promotes effective time management

Plan-• Avoid procrastination Consider how stress can be prevented when a work-related

project is completed in advance of a deadline compared with procrastination that brings on a hectic rush to beat the cutoff date

• Relax with deep breathing The process of consciously slowing your breathing

rate as you increase the depth of each breath helps to counteract the fast and shallow breathing that is common when experiencing stress

• Limit alcohol consumption Although alcohol may reduce stress temporarily,

rely-ing on alcohol to cope with stress has the opposite effect and produces more bodily stress

• Talk to family and friends Discussing stressful events with others you trust can

be beneficial both because it helps you “get it off your chest” and because you might receive helpful recommendations

If faced with stress that cannot be managed with basic techniques, consider getting help from a psychologist or other licensed mental health professional (6)

Making healthy lifestyle choices can be a challenge, but developing healthy habits is well worth the effort Although some benefits have a long-term focus, such as promoting heart health, others can be realized more immediately, such as stress reduction Includ-ing regular physical activity along with healthy nutrition promotes physical wellness

Trang 32

TWO

Embracing Physical Activity:

A Complete Exercise Program

Getting started with an exercise program or finding ways to improve what you are already doing can seem like a daunting task To simplify the process of developing a

lifelong exercise habit, the Complete Guide proposes that you take two steps The first

is to examine your goals and consider how an exercise program can fit into your life (helpful pointers on goal setting and motivation are more fully explored in chapter 4) The second is to determine the specifics of what to include in your personal exercise program

Rather than being an exact formula, an exercise prescription is more like an old family recipe handed down from generation to generation Although instructions are given along with a list of ingredients, the actual cooking process gets interesting One person might add more of a particular ingredient for a spicier dish, and someone else might use a substitution if short on an item Exact measurements would ruin the cook-ing experience and would negate the opportunity to customize the dish Individual-izing the process personalizes the outcome Similarly, your exercise program will be based on solid guidelines and a list of “ingredients,” but then you will be presented with options to allow you to make the exercise program your own You are unique in terms of your health status, your current level of activity, and your fitness goals This chapter discusses some preliminary health screenings recommended before begin-ning, the basic guidelines and components of an exercise program (aerobic fitness, muscular fitness, flexibility, and functional [neuromotor] fitness), and some insights and considerations on personalizing that program

Checking Your Status: Preparticipation Health Screenings

Physical activity provides many health and fitness benefits and is typically mended for both prevention from and treatment for chronic diseases (e.g., heart disease, type 2 diabetes) (1) However, some may be hesitant to exercise for fear of injury or

Trang 33

recom-ACSM’s Complete Guide to Fitness & Health

20

even heart attack The Physical

Activity Guidelines for Americans

suggests that although the risk

of injury increases with one’s total amount of physical activ-ity, individuals who are more physically active may have fewer injuries from other causes (4) In addition, when doing the same activity, more fit individuals are less likely to be injured than those who are less fit Cardiac events (e.g., heart attack) are rare, and the risk is greatest for those who suddenly engage in activ-ity This underscores the value

of gradually progressing your exercise program (1) Regularly active individuals have a lower risk of cardiac events whether during exercise or at other times (4) Thus, the benefits outweigh the risks of adverse events for most people (4)

A key factor in ing safety during exercise is to consider your current level of activity as well as any health issues A preparticipation screening is an important first step to maximize safety and to establish whether you are ready to start or advance your exercise program The goals of screening are to determine if checking with your doctor is recommended before starting or progress-ing your program and—if you have a medical condition—if a medically supervised program or other intervention might be warranted (1)

maximiz-Many self-screening tools are available As an example, see the Physical Activity Readiness Questionnaire for Everyone in figure 2.1 (2) In addition, the American Col-lege of Sports Medicine has developed a step-by-step process designed to identify individuals who might be at a higher risk during or after exercise (1) Figure 2.2 reflects this screening process

By answering a few questions, you can determine if checking with your health care provider is recommended or if you are ready to begin (or to continue) with your exercise program The first question relates to your current level of physical activity

“Regular” exercise is defined as having performed planned, structured physical ity of at least 30 minutes at moderate intensity on at least three days each week for the past three months (i.e., both regular and established with your exercise program) The following two questions focus on current disease and then signs or symptoms of disease The disease status items take account of cardiovascular disease, which includes cardiac (heart) disease, peripheral vascular disease, or cerebrovascular disease; meta-bolic disease, which includes type 1 and type 2 diabetes; and renal disease Signs or symptoms reflect situations suggestive of disease (see footnote in figure 2.2 for signs and symptoms that should be considered)

activ-Preparticipation screening is an important first step

in assessing your fitness.

Trang 34

FIGURE 2.1 Physical Activity Readiness Questionnaire for Everyone

Reprinted with permission from the PAR-Q+ Collaboration and the authors of the PAR-Q+ (Dr Darren Warburton, Dr Norman

Gledhill, Dr Veronica Jamnik, and Dr Shannon Bredin).

E6843/ACSM/F02.01a/547910/mh-R1

The Physical Activity Readiness Questionnaire for EveryoneThe health bene ts of regular physical activity are clear; more people should engage in physicalactivity every day of the week Participating in physical activity is very safe for MOST people Thisquestionnaire will tell you whether it is necessary for you to seek further advice from your doctor

OR a quali ed exercise professional before becoming more physically active

YES NO Please read the 7 questions below carefully and answer each one honestly: check YES or NO

1) Has your doctor ever said that you have a heart condition OR high blood pressure ?

4) Have you ever been diagnosed with another chronic medical condition (other than heart disease

or high blood pressure)? PLEASE LIST CONDITION(S) HERE:

5) Are you currently taking prescribed medications for a chronic medical condition?

7) Has your doctor ever said that you should only do medically supervised physical activity?

2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do

physical activity?

3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?

Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).

6) Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue

(muscle, ligament, or tendon) problem that could be made worse by becoming more physically

active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active

PLEASE LIST CONDITION(S) HERE:

GENERAL HEALTH QUESTIONS

If you answered NO to all of the questions above, you are cleared for physical activity.

Go to Page 4 to sign the PARTICIPANT DECLARATION You do not need to complete Pages 2 and 3.

If you answered YES to one or more of the questions above, COMPLETE PAGES 2 AND 3.

Delay becoming more active if:

You have a temporary illness such as a cold or fever; it is best to wait until you feel better.

You are pregnant - talk to your health care practitioner, your physician, a quali ed exercise professional, and/or

complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active

Your health changes - answer the questions on Pages 2 and 3 of this document and/or talk to your doctor or a

quali ed exercise professional before continuing with any physical activity program

01-01-2016

PLEASE LIST CONDITION(S) AND MEDICATIONS HERE:

Start becoming much more physically active – start slowly and build up gradually.

Follow International Physical Activity Guidelines for your age (www.who.int/dietphysicalactivity/en/).

You may take part in a health and tness appraisal

If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal e ort exercise,

consult a quali ed exercise professional before engaging in this intensity of exercise

If you have any further questions, contact a quali ed exercise professional

PAR-Q+

> continued

Trang 35

E6843/ACSM/F02.01b/560170/mh-R2

1 Do you have Arthritis, Osteoporosis, or Back Problems?

1a Do you have di culty controlling your condition with medications or other physician-prescribed therapies?

(Answer NO if you are not currently taking medications or other treatments)

1b Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer,

displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the

back of the spinal column)?

1c Have you had steroid injections or taken steroid tablets regularly for more than 3 months?

If the above condition(s) is/are present, answer questions 1a-1c If NO go to question 2

2 Do you have Cancer of any kind?

If the above condition(s) is/are present, answer questions 2a-2b

3 Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure,

Diagnosed Abnormality of Heart Rhythm

If the above condition(s) is/are present, answer questions 3a-3d

If the above condition(s) is/are present, answer questions 5a-5e

5 Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Diabetes, Pre-Diabetes

If NO go to question 3

4 Do you have High Blood Pressure?

If the above condition(s) is/are present, answer questions 4a-4b

4b Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication?

(Answer YES if you do not know your resting blood pressure)

2a Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of

plasma cells), head, and neck?

2b Are you currently receiving cancer therapy (such as chemotherapy or radiotherapy)?

3b Do you have an irregular heart beat that requires medical management?

(e.g., atrial brillation, premature ventricular contraction)

3c Do you have chronic heart failure?

3d Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical

activity in the last 2 months?

5a Do you often have di culty controlling your blood sugar levels with foods, medications, or other

physician-prescribed therapies?

5b Do you often su er from signs and symptoms of low blood sugar (hypoglycemia) following exercise and/or

during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability,

abnormal sweating, dizziness or light-headedness, mental confusion, di culty speaking, weakness, or sleepiness.

5c Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or

complications a ecting your eyes, kidneys, OR the sensation in your toes and feet?

5d Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or

YES NO YES NO YES NO

YES NO

FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)

YES NO

YES NO YES NO

YES NO

YES NO YES NO

01-01-2016

FIGURE 2.1 > continued

Trang 36

23 E6843/ACSM/F02.01c/560171/mh-R2

If the above condition(s) is/are present, answer questions 7a-7d

If the above condition(s) is/are present, answer questions 8a-8c

If the above condition(s) is/are present, answer questions 9a-9c

If you have other medical conditions, answer questions 10a-10c

YES NO YES NO

GO to Page 4 for recommendations about your current

medical condition(s) and sign the PARTICIPANT DECLARATION.

7 Do you have a Respiratory Disease? This includes Chronic Obstructive Pulmonary Disease, Asthma, Pulmonary High

Blood Pressure

7b Has your doctor ever said your blood oxygen level is low at rest or during exercise and/or that you require

supplemental oxygen therapy?

7c If asthmatic, do you currently have symptoms of chest tightness, wheezing, laboured breathing, consistent cough

(more than 2 days/week), or have you used your rescue medication more than twice in the last week?

7d Has your doctor ever said you have high blood pressure in the blood vessels of your lungs?

8 Do you have a Spinal Cord Injury? This includes Tetraplegia and Paraplegia

8b Do you commonly exhibit low resting blood pressure signi cant enough to cause dizziness, light-headedness,

and/or fainting?

8c Has your physician indicated that you exhibit sudden bouts of high blood pressure (known as Autonomic

Dysre exia)?

9 Have you had a Stroke? This includes Transient Ischemic Attack (TIA) or Cerebrovascular Event

9b Do you have any impairment in walking or mobility?

9c Have you experienced a stroke or impairment in nerves or muscles in the past 6 months?

10 Do you have any other medical condition not listed above or do you have two or more medical conditions?

10a Have you experienced a blackout, fainted, or lost consciousness as a result of a head injury within the last 12

months OR have you had a diagnosed concussion within the last 12 months?

10b Do you have a medical condition that is not listed (such as epilepsy, neurological conditions, kidney problems)?

10c Do you currently live with two or more medical conditions?

PLEASE LIST YOUR MEDICAL CONDITION(S)

AND ANY RELATED MEDICATIONS HERE:

01-01-2016

6 Do you have any Mental Health Problems or Learning Di culties? This includes Alzheimer’s, Dementia,

Depression, Anxiety Disorder, Eating Disorder, Psychotic Disorder, Intellectual Disability, Down Syndrome

If the above condition(s) is/are present, answer questions 6a-6b If NO go to question 7

6b Do you have Down Syndrome and back problems affecting nerves or muscles?

YES NO YES NO

Trang 37

For more information, please contact

Key References

www.eparmedx.com Email: eparmedx@gmail.com

1 Jamnik VK, Warburton DER, Makarski J, McKenzie DC, Shephard RJ, Stone J, and Gledhill N Enhancing the e ectiveness of clearance for physical activity participation; background and overall process APNM 36(S1):S3-S13, 2011.

2 Warburton DER, Gledhill N, Jamnik VK, Bredin SSD, McKenzie DC, Stone J, Charlesworth S, and Shephard RJ Evidence-based risk assessment and recommendations for physical activity clearance; Consensus Document APNM 36(S1):S266-s298, 2011.

Citation for PAR-Q+

Warburton DER, Jamnik VK, Bredin SSD, and Gledhill N on behalf of the PAR-Q+ Collaboration.

The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and Electronic Physical Activity

Readiness Medical Examination (ePARmed-X+) Health & Fitness Journal of Canada 4(2):3-23, 2011.

If you answered NO to all of the follow-up questions about your medical condition,

you are ready to become more physically active - sign the PARTICIPANT DECLARATION below:

If you answered YES to one or more of the follow-up questions about your medical condition:

You should seek further information before becoming more physically active or engaging in a tness appraisal You should complete

the specially designed online screening and exercise recommendations program - the ePARmed-X+ at www.eparmedx.com and/or

visit a quali ed exercise professional to work through the ePARmed-X+ and for further information

It is advised that you consult a quali ed exercise professional to help you develop a safe and e ective physical activity plan to meet your health needs.

You are encouraged to start slowly and build up gradually - 20 to 60 minutes of low to moderate intensity exercise, 3-5 days per week including aerobic and muscle strengthening exercises.

As you progress, you should aim to accumulate 150 minutes or more of moderate intensity physical activity per week

If you are over the age of 45 yr and NOT accustomed to regular vigorous to maximal e ort exercise, consult a

quali ed exercise professional before engaging in this intensity of exercise

All persons who have completed the PAR-Q+ please read and sign the declaration below.

If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian or care provider must also sign this form

I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes I also acknowledge that a Trustee (such as my employer, community/ tness centre, health care provider,

or other designate) may retain a copy of this form for their records In these instances, the Trustee will be required to adhere

to local, national, and international guidelines regarding the storage of personal health information ensuring that the Trustee maintains the privacy of the information and does not misuse or wrongfully disclose such information

Delay becoming more active if:

You have a temporary illness such as a cold or fever; it is best to wait until you feel better

You are pregnant - talk to your health care practitioner, your physician, a quali ed exercise professional,

and/or complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.

Your health changes - talk to your doctor or quali ed exercise professional before continuing with any physical activity program

You are encouraged to photocopy the PAR-Q+ You must use the entire questionnaire and NO changes are permitted The authors, the PAR-Q+ Collaboration, partner organizations, and their agents assume no liability for persons who undertake physical activity and/or make use of the PAR-Q+ or ePARmed-X+ If in doubt after completing the questionnaire, consult your doctor prior to physical activity

The PAR-Q+ was created using the evidence-based AGREE process (1) by the PAR-Q+ Collaboration chaired by Dr Darren E R Warburton with Dr Norman Gledhill, Dr Veronica Jamnik, and Dr Donald C McKenzie (2) Production of this document has been made possible through nancial contributions from the Public Health Agency of Canada and the BC Ministry

of Health Services The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada or the BC Ministry of Health Services

01-01-2016

This document has been adapted (with permission) for inclusion in canfitpro documents.

Trang 38

Embracing Physical Activity 25

FIGURE 2.2 Preparticipation screening flowchart

*The question on cardiovascular, metabolic, or renal disease includes cardiac, peripheral vascular, or cerebrovascular disease; type 1 and 2 diabetes; and renal diseases.

**The question on signs and symptoms includes concerns at rest or during activity and includes pain or discomfort

in the chest, neck, jaw, arms, or other areas that may result from ischemia (impaired oxygen supply to the heart); shortness of breath at rest or with mild exertion; dizziness or syncope (fainting); orthopnea or paroxysmal nocturnal dyspnea (abnormally uncomfortable awareness of breathing when lying down that is relieved by sitting or stand-

ing); ankle edema (swelling); palpitations or tachycardia (rapid heart rate); intermittent claudication; known heart murmur; unusual fatigue or shortness of breath with usual activities.

Adapted by permission from American College of Sports Medicine, 2018.

E6843/ACSM/F02.02/547911/mh-R1

If yes, answer these questions

If no, answer these two questions

Do you currently participate in regular exercise?

(Defined as performing planned, structured physical activity at least 30 min

at moderate intensity on at least 3 days per week for at least the last 3 months)

If yes to either or both of these questions:

medical clearance is recommended before

beginning with light to moderate intensity

exercise, progressing as tolerated

If no to both of these questions:

start with light to moderate intensity

exercise and progress gradually over time

If no to both of these questions: continue with

moderate or vigorous intensity exercise and gradually progress over time as desired

Do you have any signs or symptoms suggestive of cardiovascular, metabolic, or renal disease?**

If yes:

discontinue exercise and seek medical clearance before returning

If yes:

medical clearance

is not necessary for moderate intensity exercise but is recommended before vigorous intensity exercise

If you do not currently engage in regular exercise, continue down the left side of the flowchart and answer the two questions related to diseases and signs or symptoms If your answer is “no” to both of the questions, then you can begin with light to moder-

ate activity (i.e., intensity that causes a slight increase in heart rate and breathing) and over time can continue to progress your exercise program as described in this book However, if you do have a known disease (even if you don’t have signs or symptoms currently) or if you have signs or symptoms (even if you have not been diagnosed with a disease), you should check with your health care provider before engaging in

Trang 39

flow-to exercise, gradually progress with your exercise program as appropriate based on your health status If you do not have signs or symptoms but have been diagnosed with disease, then recommendations related to checking with your health care pro-vider depend on the level of exercise you are doing If your exercise program focuses

on moderate-intensity activity (i.e., intensity that causes noticeable increases in heart rate and breathing), then medical clearance is not required However, if your exercise program includes vigorous exercise (i.e., intensity that causes substantial increases in heart rate and breathing), then medical clearance within the prior 12 months is recom-mended (assuming no changes in signs or symptoms) If you have no known disease and no signs or symptoms, then continue with your moderate- or vigorous-intensity exercise program, or progress as appropriate

Guidelines for selecting an appropriate level of activity and considerations for gressing your exercise program over time are introduced in the next section of this chapter and described in more detail in the chapters in part II of this book

pro-Components of a Complete Exercise Program

A balanced exercise program is like a sturdy, four-legged chair If one leg of a chair is weak or too short, the chair isn’t stable In the same way, ignoring one of the exercise components will put your fitness program out of balance Each component—aerobic, muscular, flexibility, and neuromotor exercise training—is important and should be considered (1, 3) Although you may have a slightly different focus than someone else,

to meet your own personal health or fitness goals, you need to address each of these fitness components

Aerobic Fitness

Aerobic fitness is also known as cardiorespiratory endurance Aerobic activities are those that require oxygen to provide energy and are typically described as involv-ing large-muscle groups used in a repeated or rhythmic fashion (1) One of the most popular aerobic exercises is walking Other examples are jogging, running, bicycling, swimming, using aerobic equipment (e.g., elliptical machines, stair climbers), tennis, and team sports (e.g., basketball, soccer) When you are engaged in these activities, you can feel your breathing rate go up and your heart beat faster as your body strives

to bring needed oxygen to your working muscles

You should engage in aerobic exercise three to five days per week (1, 3) The intensity (i.e., how hard you are working) depends on your fitness level and your current level

of activity Some general guidelines are outlined in table 2.1, including aerobic activity targets for intensity and overall time spent in aerobic activities each week (for now, focus

on the aerobic training column; resistance training is discussed in the next section).Note the gradual progression of intensity listed in the table—starting with light to moderate (e.g., walking) and then progressing to moderate-intensity activity (e.g., brisk walking) or even to more vigorous activity for those who so desire (e.g., jogging) Intensity and duration are inversely related, meaning if one is higher the other will be

Trang 40

Embracing Physical Activity 27

TABLE 2.1 Aerobic and Resistance Training Targets Based on Activity Status

No prior activity: Focus is on light- to

moderate-level activity for 20 to 30 min over the course of the day Accu- mulating time in 10-min bouts is an option Overall, your target is 60 to

100 min per week.

Some prior activity (i.e., once you

have met the target level of 60 to

100 min per week): Focus is on light-

to moderate-level activity for 30 to

45 min per day Accumulating time

in 10-min bouts is an option Overall, your target is 100 to 150 min per week.

Select six exercises (one ing each of the following muscle groups: hips and legs, chest, back, shoulders, low back, and abdominal muscles) Begin with one set

target-of 10 to 15 repetitions twice per week As you progress, your target

is one or two sets of 8 to 12 titions done two to three days per

repe-week (Note: For middle-age and

older adults with limited resistance training experience, 10 to 15 repetitions per set is recommended.)

Fair to average fitness: Focus is on

moderate activity for 30 to 60 min per day Overall, your target is 150 to

250 min per week.

Select 10 exercises (one ing each of the following muscle groups: hips and legs, quadriceps, hamstrings, chest, back, shoulders, biceps, triceps, low back, and abdominal muscles) Your target is two sets of 8 to 12 repetitions on

target-two to three days per week (Note:

For middle-age and older adults with limited resistance training experience, 10 to 15 repetitions per set is recommended.) Established

(regularly engaging

in moderate to

vig-orous exercise)

Regular exerciser (moderate to

ous): Focus is on moderate- to ous-intensity activity for 30 to 90 min per day Overall, your target is 150 to

vigor-300 min per week (duration depends

on intensity; more information on this concept is given in chapter 5)

You can continue with the mediate plan (but simply add more weight as you adapt), or you may want to consider splitting your workout and focusing more on specific muscle groups on a given day (more information on this option is given in chapter 6).

inter-lower For moderate-intensity activity, the target duration is greater (e.g., 150 to 300 minutes per week); for vigorous-intensity activity, the time spent is less (e.g., 75 to 150 minutes per week) One person may find walking 10 minutes before and after work, and during the lunch hour when at work, an effective way to reach 150 minutes per week of moderate aerobic activity Another person may enjoy jogging for 20 to 25 minutes three days per week for a total of 75 minutes per week of vigorous-intensity activity The options are almost unlimited The point of examining these recommenda-

tions is to highlight the ranges with regard to frequency, intensity, and time, with the understanding that benefits continue to increase at higher levels of activity—although scientists have not identified the upper limit at which no additional benefits will be realized (4) Chapter 5 includes more details on aerobic exercise, including two basic fitness tests that can be used to help you estimate your level of aerobic fitness (the one-mile walking test and the 1.5-mile run test)

Định dạng
Số trang	449
Dung lượng	19,64 MB