Patient Fact Sheet: Exercise

Over the past few decades, our lifestyle has changed beyond all recognition. We all have access to multiple cars, use all sorts of gadgets and gizmos at home and work, to help us do all those things that make life “difficult”. In short, there is no need in our lives to expend much energy and do any physical exercise. In addition to this very sedentary lifestyle, we have never had such easy access to so much high fat and high calories food, wherever and whenever we want it, usually 24 hours a day. Unfortunately, most animals, including humans, were never designed to live this sort of life and we are therefore beginning to pay the price for such an “easy” existence with an increasing incidence of medical illnesses related to eating too much and exercising too little. We are becoming overweight, obese, unfit and unhealthy. This trend is growing since we are finding it increasingly difficult to motivate ourselves to exercise.

This fact sheet is therefore designed to give you access to the basics as to why and how you should start to exercise. However, you will of course need to discuss your individual needs with either your doctor if you suffer from any pre-existing medical illnesses or a personal trainer or suitably qualified instructor at your local gym if you have little or no experience of exercising. This is vital as exercising incorrectly can also be damaging as it may lead to an injury and further illness.

The key to exercising is understanding the benefits of what you do, both in terms of medical benefits, but also general lifestyle and living. It is thought that those who attend gyms tend to have a more positive approach to other aspects of life and also a healthier diet, thus leading to further health gains.

Different people will exercise to different degrees and some will strive for regular strenuous workouts. But it is also a well known fact that some exercise, no matter how gentle, is better than none. For the best health gains however, you should strive for some exercise everyday, even if that means a brisk walk only.

What are the medical benefits of exercise?

These are numerous and well known and include the following:

  • a reduction in heart attacks and strokes,
  • lower blood pressure and better circulation,
  • lower cholesterol,
  • a lower risk of diabetes, especially in later life,
  • a reduced risk of some types of cancer,
  • lower body weight and body fat and therefore a better quality of life generally,
  • better mobility and suppleness,
  • increased life expectancy and quality of life, especially in later years,
  • improved posture,
  • can provide natural pain relief,
  • increased energy levels and therefore very useful for those who feel lethargic and tired all the time,
  • a positive outlook to life.

So there are many medical reasons why you should consider exercise. Exercise can also be very useful in treating mild to moderate depression and because of its effects in producing a more positive approach to life, exercise can help to prevent the recurrence of depression in some people.

So why doesn’t everyone exercise if it’s so good for you?

Like so many other things in our hectic lives, we all have to make difficult decisions on our time. Sometimes we lack the motivation to start and even if we do start, we often lack the motivation to continue exercising and give up. Here are a few common excuses for either not exercising or giving up:

  • I don’t have the time,
  • It’s boring,
  • I’ve tried to exercise but I still don’t loose any weight,
  • I’m not fit enough to exercise,
  • I don’t know how to exercise or what to do.

It’s all about knowing why you should exercise and knowing where to get the help you need. Losing weight can be a slow process but again, the health benefits are clear. There are many different ways you can exercise and not all methods will suit all individuals. If you find continually running on a treadmill boring, then try doing something else such as cycling outside or swimming. Or alternate what you do so that you vary your activities, thus making exercise less boring.

Remember, anything is better than nothing and the more you do, the better it is. Finding the time to exercise is critical to all of this and this more than anything else will dictate whether you develop the right habit of exercising. And once again, having the right motivation is the key to finding the time you need.

The question of weight loss is a difficult subject since we all would like to somehow lose weight overnight and without thinking about it. Of course, this will never happen and so it’s important to know how and why you lose (and gain) weight. Generally speaking, weight is gained by most of us over the course of many years or even decades. It is therefore not surprising that it will take several months or even a few years in extreme cases to get back down to a normal weight. Although a healthier diet will help, it is well known that exercising in addition to a change in diet is far more effective in longer term weight loss and maintenance of that healthier weight into the future.

Even simple changes to lifestyle will help, such as leaving the car behind when going to the shops, some simple gardening or even a little housework. Use the stairs rather than the lift. But for more dramatic benefit, a structured approach to exercise is required.

But why is losing weight such a slow process?

Our regular daily intake of energy should be somewhere between 2000 to 3000 calories per day. But to lose just 2 pounds (1 kilogram) in weight, we need to use 7000 to 8000 more calories than we consume as there are approximately 7000 to 8000 calories in every 2 pounds (or 1 kilogram) of excess body fat we have. This means that even if you are doing well to eat less, you will only be able to loose 1-2 pounds (½-1 kilogram) per week. As you can calculate, losing even a single stone in weight (14 pounds or 6.5 kilograms) will take several months.

However, adding exercise to this equation does have major benefits as it is very difficult to eat 7000 calories a week less than you need. But exercising not only uses up more calories but also increases your body’s metabolic rate. This means in effect that if you do regular exercise, you will use up more fat even when you’re resting than if you never exercise at all as your body’s requirements for energy will be increased all of the time.

As you can see, it’s all about eating fewer calories and expending more. Therefore, if you are in negative calorie balance (i.e. if you use up more energy than you consume), you will lose weight. If you are in positive calorie balance (i.e. if you consume more energy than you need), you will accumulate the excess energy in fat stores and will gain weight.

Here are some examples of the types of activities you can do and their effects on using calories. These are approximate figures as the exact amounts of energy you expend very much depend on your weight, metabolic rate at the time and several other factors.

Activity

Intensity of Exercise

Time used to exercise

Calories used up

Aerobic Class

High

45 minutes

270

Cycling

Moderate

30 minutes

210

Jogging

Moderate

30 minutes

250

Rowing

Moderate

20 minutes

140

Running

Moderate

30 minutes

300

Swimming

Moderate

45 minutes

500

Walking

Low

60 minutes

150

What different types of exercises are there?

Apart from the different activities listed in the table above, exercise can be divided in different ways. Each of these will suit different people but all are important to some extent. Warming up and warming down are vital as this will prevent a lot of injuries and strains that occur if exercise is undertaken in an uncontrolled manner.

1. Warming up: this involves fairly gentle movements of the arms, legs, neck and body before the main exercise is undertaken and helps to keep muscles and joints supple. It also increases the heart rate slightly in preparation for exercising more vigorously.

2. Stretching: although this can be used to warm up as above, stretching is also used as an exercise in its own right. Disciplines such as Yoga and others employ extensive use of stretching techniques to maintain suppleness, posture and control of breathing.

3. Aerobic exercise: this is sometimes called cardiovascular exercise as it gets the heart rate going faster thus allowing more oxygen to the muscles and is important in weight loss. There are further details about aerobic exercise below.

4. Anaerobic exercise: this is sometimes called resistance training. There are further details about this below.

5. High impact exercise: these activities include jogging and running where there is a high impact on parts of the lower legs as you pound the tarmac or treadmill. However, they can be difficult for those with joint problems such as arthritis of the knees or hips.

6. Low impact exercise: with these activities such as swimming and cycling, there is less violent impact with hard surfaces and therefore, less chance of damage or strain. Both swimming and cycling are also aerobic exercises and therefore very useful for weight loss.

So how do I start?

A lot of what you need to know has already been mentioned above. But, here are the main points on how to start exercising;

1. Try to change how you view exercise and try to see how on a daily basis you could expend more energy. Even simple things such as a brisk walk for 30mins will help, some gardening, a cycle ride, a swim or even go dancing if you think you’ll enjoy such social activities.

2. If you find exercise boring, then get a friend to exercise with you or do a more social activity such as dancing, playing tennis or going out for a run together. Some people like to listen to music whilst exercising to make it less boring.

3. Start slowly and gradually build up your stamina and strength. This applies to any type of exercise you do whether it’s walking, jogging, running, cycling, swimming or aerobics classes such as circuit training. You will soon start to feel the health benefits as you get more and more comfortable doing these activities.

4. Don’t just do one thing. Mix different activities and do different things. Not only is this less monotonous but also has the advantage of using different groups of muscles in different parts of the body.

5. Make sure you don’t over do things. Warm up and warm down properly and make sure you rest enough between episodes of vigorous exercise so that the muscles are pain free before starting again.

6. Make sure your fluid intake is adequate since increasing your exercise level will increase your body’s fluid requirements. Therefore, drink plenty of water to prevent dehydration.

7. Most of all start enjoying yourself and enjoy the health benefits that increased exercise will bring.

8. Make sure you do not suffer side effects such as dizziness, feeling faint, chest tightness, chest pain or other symptoms. If you do, then STOP immediately. Seek medical advice before re-starting to exclude any underlying medical problems.

9. Take particular care if you are a pregnant woman or have only recently delivered a baby. You should seek further information from your doctor or midwife about when you can resume exercise.

What is Aerobic Exercise?

Doing this type of exercise gets your body working for a prolonged period of time, around 20minutes, in a steady way while keeping your heart rate going up to 80% of maximum. It therefore gets your circulation working and gets oxygen to muscles and body tissues via the lungs through the blood stream. It therefore builds stamina and endurance. Aerobic activities include:

  • walking
  • jogging
  • swimming
  • cycling
  • aerobic workout classes
  • cross country skiing
  • step exercise classes

Whilst doing aerobic exercise, you should be able to talk gently and for short periods. If this is not possible or you’re gasping for air, you have gone past your limit and should stop.

Aerobic exercise improves the performance of both heart and lungs, thereby increasing your ability to continue working out for longer or more intensively. It also has most of the major health benefits as already mentioned near the beginning of this fact sheet. However, it is essential that you learn or are taught how to gauge your optimum performance level as this brings the best health benefits and longer term improvements in stamina. The best method for doing this is firstly to know what your maximum heart rate should be. This can be difficult as it varies with age and with general fitness. The maximum heart rate usually reduces as you get older by about 1 beat per year, but this decline in heart rate is slower if you are very active (in athletes for example). A rough approximation for maximum heart rate can be calculated by the following formula;

220 – age in years.

So for a 30 year old, the max heart rate should be 220 minus 30 equals 190 beats per minute. But for those who are very active regularly and therefore are fitter to start with, their max heart rate may be better calculated by the formula;

205 – (0.5 x age in years)

So for a 40 year old, the max heart rate would be 205 -20 which equals 185.

There are several different methods for gauging how intensively you should work out and how intensively you are working out. One method is described below but need not be the method you or your personal trainer use. This method is based on the percentage heart beat as calculated from the maximum heart rate as above and is split into zones of increasing activity.

1. Zone 1 (Daily Activity): this is the least intense activity that you should aim for as anything less than this does not give any health benefits. You should aim for a heart rate of 50-60% of maximum as at this rate the maximum energy you expend comes from fat. You should be able to converse easily at this level.

2. Zone 2 (Health): at this stage, you heart rate will be 60-70% of maximum and this will confer benefit to your heart and circulation if regular Zone 2 activity is undertaken. This usually involves steady exercise.

3. Zone 3 (Aerobic): at this stage, your heart rate will be 70-85% of maximum and will be the maximum you can do whilst keeping to an aerobic zone. This means that at this level, no lactic acid is being produced. As such, this is the most popular level of exercise for general fitness and will improve endurance.

Lactic Acid: this chemical builds up in muscles if they are over worked and starved of oxygen. If Zone 3 exercise is over-stretched, lactic acid will build up and the aerobic workout will become anaerobic. This can only be sustained for short periods as the muscles will start to ache. Proper resting and cooling down clears the lactic acid.

4. Zone 4 (High Performance): this is the top end or high performance zone and is generally carried out for short periods and by those who are already fit and capable of exercising such that their heart rates reach between 85-100% of maximum. It is generally anaerobic with lactic acid build up.

Of course, all of these zones are dependant on accurate assessment of heart rate, which in itself can be difficult. The best method for measuring heart rate is to buy a personal heart rate monitor. Many of the aerobic workout machines in gyms will have heart rate monitors already fitted.

What is Anaerobic Exercise?

To some extent, this is explained in the aerobic question above. Anaerobic exercise is when you exercise beyond the capability of you heart and lungs to supply oxygen to the muscles. This then creates lactic acid in those muscles, eventually causing aching.

Anaerobic exercise therefore concentrates on individual muscles or individual groups of muscles and on their size, strength and endurance. These exercises therefore carry no cardiovascular benefit but are a good supplement to aerobic workouts to increase power and strength. Such activities include:

  • weight lifting
  • sprinting
  • football
  • rugby

Anaerobic training is sometimes referred to as resistance training as this type of workout is done against an opposing force. This force may be in form of weights against gravity, working against your own body as in push ups or chin ups, rubber tubing against resistance or other methods.

Most gyms will have a combination of fixed weight machines which are simple to use, generally very safe but are expensive to buy and free weights which are very cost effective but require more care in use as they are more difficult to handle and require more balance and co-ordination.

Resistance training programmes are therefore used along with aerobic exercises and are also used for body building and rehabilitation after injuries or surgical procedures such as orthopaedic surgery.

If you are new to this type of exercise, it can become confusing trying to decipher some of the terminology used at the gym. Here is a guide which goes through the basics.

Reps (Repetitions): this is simply the number of times you do any one activity continuously without stopping. Therefore, if you do 10 consecutive press ups, you’ve done 10 reps. It does not tell you what activity has been undertaken but only how many times its been done.

Sets: this is a group of consecutive reps that you do with periods of rest between reps. For example, if you decide to have 12 reps per set, then you’ll complete 12 press ups to complete a whole set, have a break and return to do another 12 press ups to complete a second set. A set is therefore a cycle of activity.

Rest Periods: this is the resting time between each set of activity you carry out. A rest period might only be 30 seconds or be several minutes depending on your level of fitness and your goals.

Strength: this is the maximum force that a single muscle or a group of muscles acting together can exert against resistance. Fewer reps with heavier weights (or greater resistance) leads to increased muscle strength.

Hypertrophy: this means the enlargement of muscle gained from resistance training and is caused by an increase in muscle fibre size. For this, aim for 9-12 reps at moderate weights.

Muscular Endurance: this can be viewed as the opposite of strength. It is the ability of muscle to perform repeated actions and will be gained by aiming for 13-20 reps at lower weights.

Repetition Maximum (1RM): this measure enables you to work out what are light, moderate or heavy weights for a particular person. Although various tables exist to try to answer this question, it is best done by a qualified training instructor.

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