A special report: Your ultimate guide to physical fitness
AN APPLE A DAY - Tyrone M. Reyes M.D. (The Philippine Star) - September 23, 2014 - 12:00am

Many Filipinos regard exercise as a fad, or chore, or merely a sign of personal virtue. But being physically active is natural for humans, as it is for all animals. We’re wired for it. Thus, the largely sedentary existence of vast numbers of people is a historical aberration of the past century, made possible primarily by labor-saving devices, motor vehicles, desk jobs, and increased leisure time spent in front of TVs and computers. Our sedentary lifestyles, together with the obesity epidemic they help foster, have taken a big toll on our health. They have put a drag on the improvements in well-being and longevity made possible by medical advances and positive lifestyle changes, such as the reduction in smoking rates in recent years.

It’s tempting to think that feeling fatigued, being winded when going up the stairs, and no longer being able to carry heavy bags, are natural parts of aging. But many of the declines in physiological functioning we associate with getting older are largely the consequence of inactivity and being unfit. Being physically fit won’t stop the biological clock, of course, but it can slow it down. “Use it or lose it” is truer than ever. Many people say that they do want to be fit, but they don’t know how. Today’s article offers a scientific but practical guide on how you can achieve lifelong fitness.

The elements of fitness

There are four main elements of fitness: aerobic (cardiovascular) fitness, muscle strength, flexibility, and balance. Some people, such as weightlifters or long-distance runners, excel in just one of these. To be truly fit, however, you should exercise to develop all of the elements, some of which overlap and work together.

Cardio exercise: The heart of the matter

Aerobic (meaning “requiring air”) exercise is any prolonged, moderate-intensity activity that depends primarily on the use of oxygen to generate energy from carbohydrates and fat. These “endurance” or “cardio” activities include cycling, swimming, running, brisk walking, and any activity that raises heart rate sufficiently for at least 10 minutes. Many sports, such as tennis, basketball, and soccer, are also largely aerobics.

Such exercise improves aerobic fitness, which is the sustained ability of the cardio-respiratory system (the heart, lungs, and circulatory system) to transport oxygen to cells, especially in muscles. Aerobic fitness decreases by about 10 percent each decade after age 30, on average, but exercise can help prevent or at least slow the decline.

The cardiovascular benefits of aerobic training include a stronger, more efficient heart that’s able to pump more blood with each contraction  which can result in lower heart rate and faster recovery from exertion. It also helps keep the blood vessels flexible, thus reducing blood pressure. And how can you determine if you’re exercising strenuously enough and long enough? Indeed, it’s easy to get confused by different exercise guidelines from government agencies, expert groups, and health gurus. Do you need 30 or 60 minutes a day for health benefits? Every day or just most days? Does the exercise have to be done in a continual session or can it be done in many short bouts?

The clearest guidelines come from the American College of Sports Medicine and the American Heart Association. Both advise that healthy people do moderate-intensity aerobic exercise for at least 150 minutes a week  for instance, at least 30 minutes five days a week. Or you can do vigorous aerobic exercise for at least 75 minutes a week  or else do some combination of moderate and vigorous activities. On average, one minute of vigorous activity is considered equivalent to two minutes of moderate activity. Up to a point, the more exercise you do each week, the greater the benefits, especially for weight control. Studies show that 10-minute workouts (and probably even shorter ones) are fine, as long as they add up to the weekly minimums.

Moderate intensity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation. This includes brisk walking and even strenuous house cleaning or gardening. Vigorous exercise, such as running, tennis, and jumping rope, increases heart rate and sweating even more. Simply put, you should exercise most (or all) days and work up to more strenuous activities, if possible. Any exercise is good, but more  in terms of duration or intensity  is better, within reason. However, if you are sedentary and over 65, or are younger with a condition such as arthritis or obesity, you should start with easier goals. If, like many Filipinos, you are largely inactive, don’t be discouraged or intimidated by exercise hurdles that are too high. Walking briskly for an hour a week is a good initial goal, working up to 30 minutes five times a week. In fact, the greatest relative benefits come from improvements in the least active people. That is, going from little or no exercise to a modest exercise program has bigger payoffs than going from a moderate to an intense regimen.

Strong muscles: More power to you

Not too long ago, strength (or resistance) training was thought of as something only for body builders or at least just for young men. Now it’s clear that it is crucial for everyone, especially women and older people, even those in their 80s and 90s. Most of us start losing muscle (and gain body fat) in our 30s, and by age 50, we’ve lost 10 percent of our muscle mass. After that the losses accelerate, unless we take steps to counteract this. The way to keep muscles strong is to use them, of course  and, in particular, to work them to their limit periodically.

Strength training should be done at least twice a week for all major muscle groups  back, chest, shoulders, arms, legs and abdominals. By strength training, we don’t mean lifting very heavy weights to build bulging muscles. As generally recommended, it calls for working out against moderate resistance in order to build muscle and endurance. The resistance can be provided by weights (dumbbells or barbells), weight machines, special elastic bands, medicine balls, or even cans of food. You can also use your own body weight as resistance, as in push-ups and pull-ups. Start with light weights or other resistance, then increase gradually. Work up to a weight you can lift only eight to 12 times in a row  this is known as a set. The standard number of sets is three for each exercise. Doing five or six sets with somewhat lighter weights would enhance muscle endurance more than strength.

Stretching, the truth

Flexibility, the ability to move your joints through their full range of motion, is a key element of fitness that can be improved by doing stretching exercises for muscles and tendons. Being more flexible can enhance physical performance  whether in sports or everyday activities. Stretching can help treat or prevent back pain, relieve muscle tension and stiffness, and improve posture. When done in a slow and controlled manner, as in yoga, flexibility training can be an excellent relaxation method. Stretching can  and should  feel good.

Stretching sessions should last 10 to 20 minutes, be done at least twice a week, and focus on all major muscle groups. (If you have arthritis or certain other musculoskeletal problems, you should probably stretch daily, based on the advice of your physician.) You should stretch slowly and in a relaxed manner; do not bounce. You should feel the stretch, but if there’s any pain, stop. At worst, any discomfort should be mild and brief. Overstretching can increase the risk of injury. Many people find it easier to stretch warm muscles, so doing five minutes of jogging or light exercises or taking a warm shower beforehand may help. Here are some ways to stretch:

1. Static stretching focuses on a single muscle, with the stretch held for 10 to 30 seconds, and each stretch repeated three to five times.

2. Dynamic stretching works groups of muscles as you move during the stretch. Walking lunges and standing leg swings are examples.

3. Proprioceptive neuromuscular facilitation, or PNF, is a technique in which you contract a muscle against resistance (an isometric contraction), usually provided by a partner, then relax into a static stretch of that muscle, allowing the partner to stretch it farther. There are several different PNF methods.

By the way, while many people assume that stretching, especially before a workout or sport, reduces the risk of exercise-induced injuries, most research has not supported this notion. But there many other good reasons why one should stretch.

Balance matters

People often don’t think of balance as an element of fitness, so they don’t focus on it  until they start having balance problems and begin to trip or fall. Having good balance involves the integration of various sensory and neuromotor systems, including vision, muscle strength, joint flexibility, reaction time, the vestibular system in the inner ear (which monitors motion and provides orientation clues), and the ability to sense where your body is in space. If any of these systems are not functioning properly, you can lose your balance even while just walking or standing up. Older people often have poor balance due to loss of muscle strength, as well as reduced vision and reaction time. The risk of inner ear dysfunction increases with age. Lack of exercise, obesity, neuropathy (nerve damage) in the lower legs, alcohol, certain drugs, and even wearing the wrong eyeglasses can also interfere with balance at any age.

If you have balance problems, it’s best to start with walking and simple exercises. Many kinds of exercise  including running, strength training, and most sports  can help improve balance and agility. In particular, any activity that increases strength, especially in your lower limbs, is worthwhile. Or you may want to try tai chi. Originally a Chinese martial art, this ancient practice involves slow, balanced, low-impact movements done in sequences; it improves coordination, muscle strength, and all-around fitness. Studies have documented its ability to improve balance and decrease falls. Workout props include wooden or plastic balanced boards, which sit on a short base that acts as fulcrum, as well as large vinyl exercise balls. Sold in sporting goods stores, they come with instructions about balance exercises. If you think you have serious balance problems, it’s a good idea to begin with a trainer at a gym or with a physical therapist or athletic trainer. At home, be sure to have someone “spot” you or at least have something to hold onto so you don’t fall. Try to do some sort of balance training for 10 to 15 minutes, three times a week.

It is unfortunate that more than half of Filipinos  including increasing number of young people  don’t exercise regularly, and many do not partake in any leisure-time physical activity. One of the best things we can do for our national health is to change that. I hope that this special article on physical fitness will help. Even if exercise is already an essential part of your life, I hope you have learned a thing or two that can improve your workouts.  





















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