Fitness
Well-balanced fitness includes stamina, strength, and flexibility.
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Regular Moderate Excercise
*Always talk to your physician before starting an exercise program.
The emphasis in the Dr. Dean Ornish Lifestyle Program is on regular, moderate exercise. Research studies have shown that most of the health benefits from exercise are achieved when an individual transitions from not exercising to becoming moderately active. Slightly more benefits are gained from increasing the duration or intensity of the exercise. But, there is a risk-benefit ratio that may be different for each person. Therefore, the comprehensive lifestyle change program encourages participants to exercise aerobically a minimum of 30 minutes a day or for an hour every other day for a total of 3-5 hours of aerobic exercise per week. More intense exercise is allowed if medically appropriate and if desired by the participant. Resistive or strength training exercise is also crucial to maintaining health. If medically appropriate, participants are also encouraged to engage in strength training exercise 2-3 times per week.
Benefits of Regular Aerobic Exercise
Benefits of Regular Aerobic Exercise
Activity and aerobic exercise can improve one’s physical health in many ways. As stated earlier, most of the health benefits of physical activity are gained with only moderate levels of activity. A proper aerobic exercise program will:
- increase the efficiency of the heart by making it able to pump more blood (increased stroke volume) with fewer beats (decreased heart rate) resulting in increased oxygen availability to the heart
- increase the ability of muscles to pick up, carry and use oxygen efficiently
- decrease the oxygen requirements of the heart during rest and activity
- decrease resting blood pressure such that blood pressure medications may be decreased
- increase the ability to exercise at higher workloads for longer periods of time, before being limited by fatigue, shortness of breath or chest pain
- decrease triglyceride levels in the blood and increase the HDL-Cholesterol (good cholesterol) levels, thus making it harder for fats to collect inside artery walls
- decrease blood sugar and triglyceride levels in the blood such that the types and amounts of blood sugar lowering drugs may be decreased or changed for those individuals with diabetes
- decrease the blood’s ability to clot and stick to blood vessel walls which decreases the risk for blood clots to block small arteries
- increase one’s ability to move, thus making it easier to perform daily activities
- decrease body fat and increase muscle mass
- increase metabolism
- increase tolerance to stress by improving one’s outlook on life
- decrease hostility
- increase control of stress hormones
- increase one’s self-confidence and general sense of well-being
- decrease risk for osteoporosis
Aerobic Exercise Guidelines
The comprehensive lifestyle change program exercise recommendations are based on the distinction of three levels of exertion: inactivity, activity and exercise. Inactivity involves no effort and is illustrated by sedentary pastimes such as watching television or sitting at the computer. The effects of inactivity on the body are negative. In fact, most of the benefits of exercise previously discussed are reversed with inactivity. The next level of exertion is activity. This category includes stop-and-go or low intensity movements such as gardening or golfing. The third level is exercise, or more specifically, “aerobic” exercise. Aerobic exercise is continuous movement, using arms and/or legs at a moderate to high level of intensity, and lasts at least 20 minutes. Some examples of aerobic exercise are swimming, biking and walking. While it is best to minimize the amount of inactivity and important to increase our general level of activity, it is essential that exercise be an integral part of our daily lives.
The “FITT Principle” of Aerobic Exercise
There are four conditions that must be met for aerobic exercise to produce the desired cardiovascular training benefits. These conditions are adjusted according to the interests and level of fitness of each individual.
F – Frequency (How often to exercise)
This will vary from several times per day to 3-6 times per week depending on the exercise intensity and time.
I – Intensity (How hard to exercise)
45%-80% of an individual’s maximal functional capacity determined by a treadmill test.
T – Time (How long to exercise)
Exercise should be sustained for 30-60 minutes, for a minimum of 3 hours per week up to 5 hours per week.
T – Type (The type of exercise)
Walking, jogging, aerobic dance, bicycling, swimming, rowing, cross-country skiing, etc.
Activities in which you move only intermittently or that are “stop and go”, such as golf, basketball, baseball or bowling, tend to activate the anaerobic system and thus do not help to achieve as much of a training effect.
The Components of Each Aerobic Exercise Session
- Warm-up. 5-10 minutes of several range-of-motion exercises and slow aerobic activity designed to prepare the muscular and cardiovascular system for exercise. If you begin exercising too quickly, without warming up, you’ll draw too heavily on your anaerobic system, a system that is relatively inefficient due to a lack of oxygen available for the working muscles. As a result, you increase the risk for angina (pain in the chest or another part of the body) and you’ll fatigue quickly and build up a lot of lactic acid, which causes muscle cramps and pain.
- Aerobic Activity. 30-60 minutes consisting of continuous, rhythmic exercise performed at the target heart rate and perceived exertion level prescribed by the staff and your physician.
- Cool Down. 8-10 minutes of slower aerobic activity and stretching designed to allow the body to gradually return to its pre-exercise state and increase the body’s flexibility. If the body does not have enough time to “cool-down,” it generates large amounts of lactic acid (the same problem outlined in “Warm-up”), which causes muscle soreness and pain. This is the easiest area to cut short when “hurrying” from exercise to your next activity. It is very important to allow the body enough time to return to its pre-exercise state. In order to achieve the effects of the relaxation response that occur after exercise — the sense of calmness and well-being — you need to cool down fully.
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Strength Training
Now that your heart and lungs are developing strength, stamina and efficiency, it’s time to start working on the other muscles of the body! In the past, we have emphasized the value of cardiovascular exercise, but we are becoming aware of how crucial resistive or strength training is in maintaining muscle tone and function. Incorporating strength training into your daily routine will allow you to continue doing the things you’ve always done, from carrying groceries and climbing stairs, to playing tennis and dancing till dawn. After the age of 20, people who don’t engage in physical activity will begin to lose muscle. The most significant loss comes after the age of 60. Aging may contribute to some of this loss, but it is primarily caused by a decrease in physical activity. Cardiovascular exercise such as walking may be good for the heart, but it will have little effect on muscle mass. Only strength training has been shown to dramatically slow down the process of muscle loss. Two research studies by Dr. Maria Fiatarone and colleagues at the Center for Aging at Tufts University demonstrated that people in their 80’s and 90’s can make strength gains in just a few months of resistance training. Study results showed that subjects increased their strength by at least 100%, and improved their walking speed and stair-climbing ability. So remember, it’s never too late to start. Strength training works on the “overload principle,” which involves making the muscles work a little harder than they are accustomed to by increasing the resistance to movement or the frequency and duration of an activity. In the past, strength training was used primarily by athletes to improve performance, or for physical rehabilitation after an injury. This kind of training used to be considered unsafe for populations like the elderly or people with cardiovascular disease, but recent studies have shown that strength training can be safe and effective for both of these groups when appropriately prescribed and supervised. Strength training does NOT require expensive equipment and large amounts of time. It can be practiced at home, for 20-30 minutes per session, 2-3 times per week, using a minimum amount of resources. Hand weights, resistive bands and tubing, calisthenics and even plain old water jugs or soup cans can be used to provide the needed resistance. Create a balanced exercise program by combining cardiovascular exercise, resistive/strength training and stretching for flexibility.
Benefits of Regular Strength Training Exercise
- increased strength and flexibility of muscles, tendons and ligaments
- increased functional capacity
- increased lean tissue and metabolism
- increased bone density (which may help prevent bone loss)
- better balance and stability
- injury prevention
- increased self-confidence, improved self-image
- improved ability to perform occupational and
- leisure time activities
- improved exercise adherence (because of the diversity of exercises)
Strength Training Guidelines
- Breathe! Exhale (blow out) during the exertion phase of the lift. Remember this: Exhale on Effort.
- Maintain proper speed of motion with slow, controlled movements.
- A repetition is the lifting and lowering of the weight. Lift on a 2 count and lower on a 4 count.
- Exercise through the full range of motion but within your comfort level. Emphasize complete extension of the limbs when lifting.
- Pause for a brief moment at the end of a movement (extension) to avoid using momentum (swinging).
- Never sacrifice form for resistance. Stay within your limits!
- Use a partner to help you when necessary.
- Select exercises for both the upper and lower extremities.
- Loosely hold handgrips when possible; sustained, tight gripping may evoke an excessive blood pressure response to lifting.
- Because resistance training is muscle specific, each exercise may require a different weight.
- Stop exercise in the event of warning signs or symptoms, especially dizziness, arrhythmias, unusual shortness of breath and/or angina pectoris (chest pain).
- Do not perform strength-training exercises with any kind of musculoskeletal pain or injury.
The “FITT Principle” of Strength Training
F – Frequency (How often to exercise)
- Weight train a minimum of 2-3 times per week with one rest day between sessions.
I – Intensity (How hard to exercise)
- To prevent soreness and injury, initially choose a weight that will allow the performance of 12-15 repetitions (1 set) comfortably.
- Avoid straining. Ratings of perceived exertion (6-20 scale) should not exceed fairly light (10) to somewhat hard (15) during lifting.
T – Time (How long to exercise)
- Initially, perform 1 set of each exercise.
- Keep rest periods between sets relatively short (30-90 seconds).
- Complete 10-15 repetitions of 8-10 different types of resistive exercises that concentrate on large muscle groups of the upper and lower body.
T – Type (The type of exercise)
- Free weights/barbells/heavy hands/ankle weights
- machines
- resistance bands/ surgical tubing
- calisthenics (body weight)
- household items (water jugs, canned food)
Pollock, ML, et al. Resistance Exercise in Individuals With and Without Cardiovascular Disease. Circulation. 2000; 101; 828.
The Progression in Your Strength Training Routine
- After the initial training phase is completed (2-4 weeks), select a weight that provides a challenge without sacrificing form at the completion of each set.
- Increase the weight gradually by 1-5 pounds when 12-15 repetitions can be comfortably completed. This is important in order to see continuing improvements in muscle strength.
The Components of Each Strength Training Session
Warm-up/Cool-down 5-10 minutes of general, rhythmical-type exercise with some stretching and range of motion movements should be done before and after each session. Your aerobic exercise can be your “warm-up” for your strength training.
Strength Training Activity 15-30 minutes consisting of 12-15 types of resistive exercises that concentrate on large muscle groups of the upper and lower body. Perform 1-3 sets of each exercise. Keep rest periods between sets relatively short (30-90 seconds). Rule of Thumb You should always be able to carry on a conversation while exercising. If you can’t, there is not enough oxygen available for the working muscles. Slow down. Remember the phrase: “You should be able to talk while you walk”
Pathways to Success with Exercise
Fulfill the 3 C’s: Comprehension, Commitment and Confidence.
- Comprehension – understand the reason why it is important for you to exercise on a regular basis by talking with a health care professional or by reading educational exercise materials. This will provide a strong base for your commitment.
- Commitment – make a personal decision to place exercise as a priority in your day’s activities. Make exercise a ritual. Write time for exercise in your appointment book — in ink.
- Confidence – set small, reasonable goals. Reward and praise yourself when reaching the steps that will lead you to your ultimate objective. Don’t let small setbacks sabotage your long-term success.
Bring Physical Activity Into Daily Life
The most efficient way to increase your physical activity is to make it part of your daily routines.
- Instead of driving, walk or bicycle to work or to the store. If that’s not practical, park a little farther away (where the parking places are usually easier to find, thereby also reducing your stress level).
- Take the stairs instead of an elevator, especially if you’re going only one or two floors.
- If you use the moving sidewalks at airports, don’t just stand there — walk!
- If you play golf, walk instead of using an electric cart.
- Exercise with family or friends to provide social support, for more motivation and a double benefit.
- On a vacation, walk rather than drive to see and experience the sights.
