Classification

• Aerobic exercise corresponds to overall fitness.  Fitness of our cardiovascular system and respiratory system.  Anaerobic exercise corresponds to muscle maintenance / building.  Muscle atrophy and wasting occurs with aging and may lead to osteoporosis (bone softening) among other things.  Flexibility corresponds with stretching and is important for mobility and balance.  Particularly in the elderly, loss of balance with falls leads to significant morbidity and health deterioration.

• Aerobic - Decreases blood pressure and resting heart rate.  Increases HDL and cardiac output.  Decreases resting respiratory rate.  Increases blood flow to lungs.  Burns calories.

Dr. Andrew Weil

• All three forms are critical for healthy aging.  Favorite aerobic exercise is walking.  Recommends 45 min 5 days a week of brisk walking eg. 1 mile in 15 mins.

Dr. Mehmet Oz - renowned heart surgeon - see Oprah and RealAge

• Aerobic -The goal is to maintain your target heart rate during your exercise for at least 30 minutes.  To calculate your maximum heart rate, subtract your age from 220. Your target heart rate is between 60% and 85% of your maximum heart rate.  Brisk walking is fine.

• Anaerobic -  Anaerobic exercise is a good complement to your aerobic exercise program. Exercise activities that take less than 3 minutes are considered anaerobic activities.  Although anaerobic activities do not help strengthen your heart, they do help strengthen your muscles. Do anaerobic exercise 2 or 3 times a week.  The goal is to have each exercise workout last 30 to 60 minutes.

• Flexibility - Yoga helps improve strength and flexibility and can also help control blood pressure and regulate breathing and heart rate.  Stretching, weight-lifting and crunches should all be incorporated into your fitness routine. "A lot of folks think about how fast they run, but you've got to stay limber,"

Kenneth Cooper, M.D. - trailblazer concerning health and aerobics

• Exercise can be used in three general ways. It can be used as rest and relaxation, muscle building and figure contouring, and as cardiovascular pulmonary conditioning. All three have merit, but only one has the potential of prolonging life, and that is cardiovascular pulmonary conditioning. Studies clearly show that if you just walk briskly and cover two miles in 30 minutes, three times per week, it has the potential of reducing deaths from heart attack or stroke by 58% percent. Now that's too fast for most; slow it down, walk two miles in 40 minutes, five times per week and you get the same benefit.  But exercise is only a part of a total wellness program, and if you want to reduce risk of death by heart attack you're going to have to reduce cholesterol, stop smoking, control your body weight, and exercise. Those are the keys to good heart health.

• We have been trying to exercise the question of how little exercise is necessary to get cardiovascular benefits. If you know the aerobic point system that I developed 35 years ago, it's still very valid. That is, 15 points a week are the least number of points that you can earn and get heart benefits. An example is two miles of walking in less than 40 minutes, 5 days a week. Or you can walk three miles in 45 minutes, twice a week. Or two 45-minute aerobic dance classes per week will give you at least 15 points per week.  "get 15 aerobic points per week. That has been shown to reduce death from all causes: heart attacks, strokes, diabetes, and cancer by some 58%."

Newsweek - Benefits of Exercise - March 2007

• Unbelievable article with important news - the brain can regenerate and physical exercise benefits many cognitive functions - ie memory...... So get walking!

Weight Training - AARP Magazine - April 2007

• Page 1 - Live Longer, Get Stronger

• Page 2 - Specific Exercises

CDC - Growing Stronger - Strength Training for Older Adults

• 1. Can the Growing Stronger Exercise Program be done three times a week if I have the time? What about just once a week when I'm really busy?

  New guidelines from the American College of Sports Medicine suggest strength training two or three times a week. Be sure to give your muscles at least one day of rest between workouts. Two sessions is what is prescribed because it will confer benefits and is also quite manageable from a time perspective. However, if you have the time to do the program three times per week, you will gain the following benefits:

• More stimuli to the bones
• Extra physical activity—important for overall good health
• Strengthening muscles a bit more quickly

If you do decide to do the program three times per week, just make sure they are on non-consecutive days, such as Monday, Wednesday, and Friday. If you can only do the program one day per week when your schedule gets hectic that is certainly better than nothing. But we recommend you try to get in two days per week whenever possible.

• 5. What is the proper way to breathe during strength training?

  Exhale during the most strenuous phase of the movement—often referred to as "exhale on the exertion." Inhale during the less strenuous phase. It is also important to inhale and exhale fully between each repetition.

  However, the most important thing is simply to breathe regularly. Most people assume that they are automatically breathing when in fact they are actually holding their breath. Take a moment to focus on your breathing during your next strength training session and during other strenuous activities such as climbing up the stairs. You may be surprised to find that you are actually holding your breath.

• Why Strength Training?

  Research has shown that strengthening exercises are both safe and effective for women and men of all ages, including those who are not in perfect health. In fact, people with health concerns—including heart disease or arthritis—often benefit the most from an exercise program that includes lifting weights a few times each week.
  
  Strength training, particularly in conjunction with regular aerobic exercise, can also have a profound impact on a person's mental and emotional health.

  Benefits of Strength Training

  There are numerous benefits to strength training regularly, particularly as you grow older. It can be very powerful in reducing the signs and symptoms of numerous diseases and chronic conditions, among them:

• arthritis
• diabetes
• osteoporosis
• obesity
• back pain
• depression

• Arthritis Relief

  Tufts University recently completed a strength-training program with older men and women with moderate to severe knee osteoarthritis. The results of this sixteen-week program showed that strength training decreased pain by 43%, increased muscle strength and general physical performance, improved the clinical signs and symptoms of the disease, and decreased disability. The effectiveness of strength training to ease the pain of osteoarthritis was just as potent, if not more potent, as medications. Similar effects of strength training have been seen in patients with rheumatoid arthritis.

  
  Restoration of Balance and Reduction of Falls

  As people age, poor balance and flexibility contribute to falls and broken bones. These fractures can result in significant disability and, in some cases, fatal complications. Strengthening exercises, when done properly and through the full range of motion, increase a person's flexibility and balance, which decrease the likelihood and severity of falls. One study in New Zealand in women 80 years of age and older showed a 40% reduction in falls with simple strength and balance training.

  
  Strengthening of Bone

  Post-menopausal women can lose 1-2% of their bone mass annually. Results from a study conducted at Tufts University, which were published in the Journal of the American Medical Association in 1994, showed that strength training increases bone density and reduces the risk for fractures among women aged 50-70.

  
  Proper Weight Maintenance

  Strength training is crucial to weight control, because individuals who have more muscle mass have a higher metabolic rate. Muscle is active tissue that consumes calories while stored fat uses very little energy. Strength training can provide up to a 15% increase in metabolic rate, which is enormously helpful for weight loss and long-term weight control.

  
  Improved Glucose Control

  More than 14 million Americans have type II diabetes—a staggering three-hundred percent increase over the past forty years—and the numbers are steadily climbing. In addition to being at greater risk for heart and renal disease, diabetes is also the leading cause of blindness in older adults. Fortunately, studies now show that lifestyle changes such as strength training have a profound impact on helping older adults manage their diabetes. In a recent study of Hispanic men and women, 16 weeks of strength training produced dramatic improvements in glucose control that are comparable to taking diabetes medication. Additionally, the study volunteers were stronger, gained muscle, lost body fat, had less depression, and felt much more self-confident.

  
  Healthy State of Mind

  Strength training provides similar improvements in depression as anti-depressant medications. Currently, it is not known if this is because people feel better when they are stronger or if strength training produces a helpful biochemical change in the brain. It is most likely a combination of the two. When older adults participate in strength training programs, their self-confidence and self-esteem improve, which has a strong impact on their overall quality of life.

  
  Sleep Improvement

  People who exercise regularly enjoy improved sleep quality. They fall asleep more quickly, sleep more deeply, awaken less often, and sleep longer. As with depression, the sleep benefits obtained as a result of strength training are comparable to treatment with medication but without the side effects or the expense.

  
  Healthy Heart Tissue

  Strength training is important for cardiac health because heart disease risk is lower when the body is leaner. One study found that cardiac patients gained not only strength and flexibility but also aerobic capacity when they did strength training three times a week as part of their rehabilitation program. This and other studies have prompted the American Heart Association to recommend strength training as a way to reduce risk of heart disease and as a therapy for patients in cardiac rehabilitation programs.

  
  Research and Background About Strength Training

  Scientific research has shown that exercise can slow the physiological aging clock. While aerobic exercise, such as walking, jogging, or swimming, has many excellent health benefits—it maintains the heart and lungs and increases cardiovascular fitness and endurance—it does not make your muscles strong. Strength training does. Studies have shown that lifting weights two or three times a week increases strength by building muscle mass and bone density.
  
  One 12-month study conducted on postmenopausal women at Tufts University demonstrated 1% gains in hip and spine bone density, 75% increases in strength and 13% increases in dynamic balance with just two days per week of progressive strength training. The control group had losses in bone, strength, and balance. Strength training programs can also have a profound effect on reducing risk for falls, which translates to fewer fractures.

Tuft's University Nutrition Program

• 	Equipment Needs Strength training requires little special equipment, but there are a few basic necessities: A sturdy chair and exercise space Find a strong, stable chair without arms that does not rock or sway when you sit in it or move when you stand up from it. When you’re seated in the chair, your knees should be at a 90-degree angle and your feet should be flat on the ground. If the chair is too high, find one with shorter legs; if it’s too low, try putting a pillow or a folded blanket on the seat to give you a slight boost. For your exercise space, choose an open area, preferably carpeted, with at least enough space for your chair and ample room to walk around it. Carpeting will prevent the chair from sliding. On bare floor, put your chair against the wall. If you think you might like to exercise to music or while watching television, plan your space accordingly. Good shoes Good shoes are essential for any exercise. For strength training, try athletic shoes with good support, such as walking, running, or cross-training sneakers. The sole should be rubber, but not too thick, as fat soles may cause you to trip. If you don’t already have shoes that fit this description, you can find them at sporting goods, discount, and department stores. Comfortable clothing Wear loose, cool, comfortable clothing that breathes well during exercise-for example, a cotton T-shirt and cotton shorts or pants. If you want to purchase new workout clothes, look for materials that readily absorb moisture and breathe well. Dumbbells (hand-held weights) and ankle weights You can complete the first part of the exercise program without weights, but as you get stronger and add new exercises, you will need dumbbells and ankle weights. It’s a good idea to buy these before you begin strength training, or as soon as possible after you start, so that you’ll have them on hand when you’re ready to add them to your program. Your minimum purchase should include a set of two dumbbells in each of the following weights: Women Men One pound Three pounds Three pounds Five pounds Five pounds Eight pounds The best ankle weights for this program are the adjustable type. These allow you to add weight gradually in increments of a half-pound or full pound, until you reach as much as ten or twenty pounds per leg. In purchasing this equipment, you have several choices: Options Benefits Drawbacks Newspaper, want-ads Inexpensive Used; can’t return Sporting goods store Can test product Slightly more expensive Mail order Convenient Shipping costly Some stores and mail-order companies offer specials that include a set of one-pound, three-pound, and five-pound weights at substantial savings. This is a good starter kit; later you can buy heavier dumbbell sets. Storage container For safety reasons, consider storing your weights in a floor-level cupboard or in a container such as a wooden box or canvas bag-preferably on a cart with wheels for easy relocation to your exercise spot. Storage containers and wheeled carts are usually available at local department and discount stores. If you choose not to use a cart, try to keep your weights in the area where you exercise to minimize transporting the weights from one area to another. Also, be mindful to store weights out of the reach of children and in a place where people will not trip over them.

  • Exercise Intensity Working at proper intensity: how to judge your effort It is important to find the right balance between exercising conservatively to prevent injury and consistently progressing to increase strength. This easy-to-use scale will help you determine the proper intensity of your workout. It’s important to adhere to your strength-training regimen as much as you can. You may find that you make a few false starts before you succeed at making this program a regular part of your life. There may be times when interruptions such as vacation, illness, or family or work demands conspire to prevent you from doing your exercises for a week or two-or even longer. Try not to feel guilty or disappointed in yourself. Just restart your routine as quickly as you can. You may not be able to pick up exactly where you left off-you may need to decrease your weights a bit. But stay with it, and you will regain lost ground. If you have trouble getting back into the swing of things, start back into the program slowly. Remember why you started strength training in the first place, why you chose your particular goals. (It may help to reassess your goals and make new ones; as time passes, your motivations may change.) Most important, remember how your past successes made you feel: healthy, strong, independent, and empowered! Exercise Intensity Indicator Ask yourself these questions after each exercise. Were you able to complete two sets of ten repetitions in good form? No: Reduce the weight to an amount that you can lift ten times in good form; rest for one to two minutes; then repeat for a second set. Yes: Please continue to question two. After completing ten repetitions, do you need to rest because the weight is too heavy to complete more repetitions in good form? Yes: You are working at the proper intensity and should not increase weight. No: Please continue to questions three and four to determine how to safely increase the intensity of your workout. Could you have done a few more repetitions in good form without a break? Yes: If you can do only a few more repetitions (not the entire next set of ten without a break), then at your next workout you should do the first set of repetitions with your current weight and your second set with the next weight up. For example, if you’re currently using one-pound dumbbells, use two- or three-pound dumbbells for your second set. Could you have done all twenty repetitions at one time, without a break? Yes: At your next session, use heavier dumbbells for both sets of repetitions. SIDE NOTE #1: Remember that you should complete each repetition in proper form, using the “two-up, four-down” count. SIDE NOTE #2: When you start doing the exercises with the adjustable ankle weights, you will be able to increase intensity by adding half- or one-pound weights to each leg.

Flexibility Tests

• Various tests to determine limited range of motion over various joints and muscles

2008 US Gov Guidelines

• ADULTS - 2 hrs and 30 mins weekly of moderate aerobic exercise ( walking briskly, dancing, doubles tennis) in 10 min or longer blocks of time 0r 1 hr and 15 mins of vigorous exercise per week.  Strength training two days a week.

• 2008 Complete Guidelines 

• Health Benefits -  adults, children

• Advisory Committee Complete Report -  Excellent resource

Health benefits of physical activity - review article in 2006 CMAJ

Variety of Risk Factors for death - all improved with increasing physical exercise

All deaths over 13 yrs comparing physical fitness in 4 groups - better fitness, less chance of dying

Metabolic Equivalents - How much to exercise

• Background on METs

    What is a MET? One MET is the rate at which adults burn kcal at rest: This is

    approximately 1 kcal per kilogram (kg) of body weight per hour (expressed as 1

    kcal/kg/hr). MET stands for metabolic equivalent and is defined as "the ratio of

    the work metabolic rate to the resting metabolic rate" (Ainsworth).

    MET Value of 1. In The Compendium of Physical Activities Tracking Guide, an

    activity with a MET value of "1" (e.g., sitting quietly and reading or watching TV)

    would have an energy expenditure of 1 kcal/kg/hr. Therefore, sitting quietly does

    not require any more kcal than one would burn just to rest. Sitting quietly and

    other "activities" that have MET values close to 1 are considered "sedentary"

    activities.

    MET Values > 1. The Compendium lists a MET value of 3.3 for walking at a

    moderate pace on level ground. Accordingly, walking at a moderate pace on

    level ground would have an energy expenditure of 3.3 kcal/kg/hr (3.3 times that

    of the resting metabolic rate, which is 1 kcal/kg/hr).

    Compendium of MET Values. For information on using the MET values of the

    600+ different activities listed in the Compendium, see "Understanding and

    Using the MET Values." The information below focuses only on using METs

    walking.

•                    "  A range of 500 to 1,000 MET-
  minutes of activity per week provides substantial
  benefit, and amounts of activity above this range
  have even more benefit. Amounts of activity below
  this range also have some benefit. The dose-response
  relationship continues even within the range of 500 to
  1,000 MET-minutes, in that the health benefits of
  1,000 MET-minutes per week are greater than those
  of 500 MET-minutes per week."
  

How fast should you walk - Dr. Weil

• 

  How Quickly Should You Walk?

  The benefits of moderate physical activity to general health and well-being have been widely publicized, but what, exactly, constitutes moderate activity? Now, researchers have a specific answer: walking at a rate of at least 100 steps per minute.

  This means that a simple pedometer-based recommendation of workouts consisting of 3,000 steps in 30 minutes can get people started on a meaningful, moderate exercise program. The study reaching this conclusion was published in the May 2009 issue of the American Journal of Preventive Medicine.

  The researchers monitored oxygen intakes as a study group of 58 woman and 39 men completed four six-minute sessions at different treadmill speeds of between 65 and 110 meters per minute. All wore pedometers and their heart rates were recorded. Using 3 METs, or metabolic equivalents, as the minimum level of oxygen demand which approximates moderate exercise, participants were monitored to determine whether, and when, participants had reached the moderate-exercise level. The researchers found that for men, step counts associated with walking at 3 METs were between 92 and 102 steps per minute. For women, the range was between 91 and 115 steps per minute.

  This is very useful information. Too often, people put off starting an exercise program because they simply don’t know how much they should do, or how vigorously they should do it. Now, an inexpensive pedometer and a wristwatch are all you need to begin walking 30 minutes a day, five days a week, confident that you are meeting the minimum requirement. You can, as I do, vary your walking regime with swimming, biking or even vigorous yard work for equivalent periods of time, but many people find that walking fits into their lifestyle most comfortably. Enjoy!

Core Exercises - back sparing - Stuart McGill

• 2009 NY Times Video - flv