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Making Fitness Easy

There's no magic elixir for a long and healthy life, but exercise comes darned close. So get moving

By Katherine Hobson

(Reprinted from the June 26, 2006 Issue of U.S. NEWS & WORLD REPORT)

When it comes to exercise, everybody's got an excuse. Or 10. "I had a list," says Farai Chideya, a 36-year-old Los Angeles journalist who recently began lifting weights and taking dance classes. "I'm too busy. Maybe I'll hurt myself. Shouldn't I be out meeting new people instead?"

Despite the well-documented health benefits of exercise, fewer than half of adults in the United States get the minimum amount necessary for those rewards: 30 minutes of aerobic activity, most days a week. A quarter of Americans are sedentary. And the older people get, the less likely they are to exercise. That's a lot of people with a lot of excuses. And yet few of them are valid, say experts. There are just not that many people who truly can't exercise. The next few pages offer a field guide to overcoming inertia. Be honest. Your favorite excuse is probably among them.


Why bother?

Imagine the line outside the office of a doctor who is dispensing a treatment that incontrovertibly shows it can help prevent chronic diseases and early death. That's what a comprehensive review of medical research published in March in the Canadian Medical Association Journal said about regular physical activity. The authors found that there was "irrefutable evidence" that consistent exercise lowers the risk of illnesses including heart disease, cancer, osteoporosis, depression, high blood pressure, diabetes, and obesity. The U.S. Centers for Disease Control and Prevention recommends moderate-intensity exercise, which means your heart rate gets going but not so much that you are huffing and puffing and unable to carry on a conversation. Think biking, inline skating, using an elliptical trainer, and swimming. Strength training like lifting weights can also help prevent bone and muscle loss and shore up joints stressed by arthritis or pain (box, Page 61).

While the link between better health and exercise is clear, scientists are still nailing down exactly how physical activity reduces the risk of certain diseases and which of its effects stem in part from the weight loss that can result when working out is coupled with good nutrition. Several different factors, for example, most likely reduce the odds of developing heart disease. Exercise increases blood flow, for one, which stimulates the release of a chemical that relaxes artery walls and lowers blood pressure. It also seems to egg on the release of an enzyme that improves cholesterol balance, driving more of the "good" kind and less of the artery-clogging "bad" kind. It may also cut systemwide inflammation, which has been implicated in heart disease and a host of other ailments. And, of course, exercise can help control weight, which reduces the harmful effects of excess fat.

With cancer, the mechanisms are less clear. Exercise may limit estrogen circulation, which can stimulate some types of breast cancer, possibly through reducing body fat. And it may lower colon cancer risk by keeping the digestive system active, cutting the exposure of colon tissue to cancer-causing agents in food. "There is so much evidence that allows us to really prescribe exercise for someone," says Paul Ribisl, chair of health and exercise science at Wake Forest University in Winston-Salem, N.C. "The most difficult issue challenging us is how to change [people's] physical activity and eating patterns."

Although there is no precise prescription for thwarting any one disease, the overall message is clear: Get up, and get moving.



Experts say the "life is too hectic" excuse is by far the most common one. Trying to cram in an exercise regimen with work, personal relationships, friends, family, and errands may seem futile. But people who exercise are busy, too. They just make working out a priority. "Anything that is important to you, you'll find the time for," says Chris Imbo, managing director of health lifestyle company Welldome and a personal trainer. His client Jonathan Tisch, cochairman of the board of Loews Corp., works out five to six mornings a week, either with Imbo--usually lifting weights in the gym--or on his own, running in Central Park or using a treadmill or elliptical trainer indoors. "It's embedded in my way of thinking," says Tisch, 52. "It's like brushing my teeth."

Working out also may not take as much time as you think. "You can spend a relatively minimal amount of time--30 minutes on most days--and it will give you such a big return," says Cedric Bryant, chief science officer with the American Council on Exercise. You can also accumulate exercise throughout the day, say, by taking the dog for a brisk 15-minute walk in the morning and then again after dinner.

Experts also say the best way to fit in exercise, as Tisch does, is to work out first thing in the morning. You're a lot less likely to have competing demands on your time at 6 a.m. than in the evening. Many gyms open at the crack of dawn, and some are even open around the clock. If you are not a morning person, schedule sessions when you are less likely to blow them off and try writing them on your calendar or BlackBerry like a meeting. There will be trade-offs. "Everyone has different demands on their time and money," says Chideya, who is chronicling her efforts to get in shape on the National Public Radio show News & Notes with Ed Gordon. "That's just the way it is."



Nice try. Almost no one is too old or too frail to exercise. Because of the natural decline in muscle mass--about 10 percent per decade starting around age 50--and dwindling aerobic capacity, the need to stay active may be more apparent in old age than at any other life stage, says Kerry Stewart, director of clinical and research exercise physiology at Johns Hopkins University School of Medicine. "It's really important for young people to stay active to maintain health, but for older people," says Stewart, "it may be even more important to stay active to have some way of fighting off the natural processes of aging and resist chronic diseases." The American College of Sports Medicine recommends that older adults follow the same 30-minutes-a-day routine, including aerobic activity and strength training. For the homebound, strength training can be done using a chair. For example, an elderly person could hold on to it for balance while slowly lifting and lowering the leg to build up hip and thigh muscles. A study presented at the ACSM's annual meeting last month found that gardening activities like weeding, mulching, and transplanting seedlings were enough to qualify as low- or medium-intensity exercise and easily fulfill the 30-minutes-a-day plan. And research published in the spring showed that older adults who participated in an hourlong tai chi class three times a week for 12 weeks improved their balance, strength, endurance, and flexibility.

In fact, studies show that both aerobic exercise and functional fitness exercises help prevent daily hazards like falls and may help stave off dementia and Alzheimer's disease. "Independent living is a good motivator," says Karen Ross, a geriatrician at the University of Oklahoma Health Sciences Center. "I can talk to people all day about how their arthritis will be better if they exercise, but when I tell them they'll remain independent longer and improve their memory, that's a good carrot."



Some people work out to get away from it all, including other people. But for others, the idea of that much alone time, especially doing something they consider tedious, is totally unappealing. So exercise with someone else. Pairing up will make the time go by faster and up the odds of fulfilling the commitment. "You never want to be the person who leaves her friends on the corner at 5:30 a.m.," says Lindsey Spindle, 33. When she moved to a new neighborhood in suburban Maryland last summer, Spindle joined a group of women who had been running together for 20 years. Their weekly routine (four days of running, one of yoga) and consistency (they run in all weather except thunder- and ice storms) keeps her from flaking out, and the social aspect adds to her resolve. "We talk about family, jobs, about silly stuff," says Spindle. "It's hard to make and keep friends, and this is a creative way to stay fit and have a tight-knit group."

It also helps to find an exercise buddy with similar motivations and fitness level. That way no one gets frustrated by someone who can't keep up: Eleven-minute milers and 6-minute milers, for example, don't make the best running partners. If you can't find a group, taking a class with a core following or hiring a personal trainer can serve the same function. You're less likely to skip a session at the gym if someone's waiting for you, especially if you're paying for it.



The first key to workout dedication is to find an appealing exercise. "I fell in love with the act of running the very first time I went out," says John "the Penguin" Bingham, a columnist at Runner's World. (He gave himself the nickname after seeing a reflection of himself running and deciding he looked short and dumpy, like the bird.) "I still suck," says Bingham, "but I don't care. I'm having so much fun!" For Michael Bondanza, a jewelry designer in New York City, fun means boxing workouts. "I don't like going to a gym where I'm going to be on a machine," he says. "I have to be doing some kind of sport." Many people get off on the wrong foot by defining the best exercise as "whatever burns the most calories," like running hard, says Bryant. "Experiment with different activities until you find the things that float your boat."

Still, even a favorite class or cycling route can get tedious after a while. And as the body adapts, progress in things like weight loss and increased strength may diminish, which may also lead to burnout. To avoid both plateaus and boredom, shake up your routine every month or so. "If you're a runner, get on the bike," says Jason Pulido, vice president of personal training at Crunch. "If you lift weights, use heavier ones and do fewer reps." Some gyms have roving trainers who can offer free advice or new routines. Or set a motivational goal, perhaps training for a 5k run or walk, swimming a certain number of miles in the pool over the course of a summer, or attending a certain class three days a week for three months. The MTV generation or tech-obsessed can take advantage of some of the newer computerized gadgets to spice things up. There are numerous cycling and running workouts for MP3 players and fitness videos online. Or try one of the new exercise games (like Eye Toy: Kinetic, which leads you through a series of exercises) available for PlayStations.



After giving birth in 2003, Nancy Toby really wanted to get back to her regular exercise routine. She missed training for marathons and triathlons and the stress release it offered. Her triplets were born prematurely with health problems, and one baby died six months later. "I needed some time to myself," she says. "Exercise really helped me recover and keep a level head." The 48-year-old in Arlington, Va., has returned to her training regimen and plans to take on an Ironman triathlon in November. Toby fits it all in by going to the gym early when her husband and two 3-year-olds are sleeping. She also walks with her double baby jog stroller and, when her husband is around to watch the kids, rides her bike on a stationary trainer set up in front of the television.

Some parents incorporate their children into the activity. Mom and baby yoga classes are popping up around the country, while some workouts use baby strollers. And, of course, many gyms provide childcare facilities. When the kids get older, exercise can be viewed as family time. "Go bike riding, or hiking, or kayaking, or Rollerblading, or play tennis with your family," says Kathie Davis, executive director of the IDEA Health and Fitness Association. "If they see you exercising, they're going to model your behavior."



Used to be that people with constant back pain were told to stay off their feet. No longer. "The general dogma for chronic back pain is that moving your body is a good thing," says Karen Sherman, a researcher at the Group Health Cooperative, a Seattle-based nonprofit health system. In fact, studies have shown that people with chronic back pain and disk degeneration were helped just as much by exercise as by spinal fusion surgery.

Talk to your doctor or physical therapist about specific exercises to strengthen other muscles and take some of the load off your back or stretches that can help minimize pain. A study by Sherman published in December in the Annals of Internal Medicine found that yoga may be especially helpful in keeping chronic back pain at bay. But be forewarned. Some yoga classes might be too strenuous. The class in the study "was gentler and simpler," says Sherman, who advises that back pain sufferers ask a health professional for referrals to classes aimed at people with special medical needs.



Unless you are severely obese, excess girth isn't a good reason to remain sedentary. Anyone with a body mass index (a measure of body fat taking into account height and weight) between 25 and 30, considered overweight, should be able to exercise, says Ribisl. As the BMI climbs above the 40 mark deemed morbidly obese, there are increasing risks, he says, such as strain on joints or the heart. "The key word is individualization," says Ribisl. For obese people, "the intensity would have to be lower, the duration would have to be shorter." A small study in the Archives of Internal Medicine in April revealed that elderly and frail people who were obese benefited from six months of regular exercise and a healthier diet. The group lost an average of 8.4 percent of body weight and improved strength, walking speed, and balance.

The point is, any physical activity is better than none for the overweight crowd, though some people might need to work up to an hour or more per day. A doctor can offer guidance on an exercise routine and provide a referral to a nutritionist, since it's difficult to lose weight without emphasizing both exercise and a healthier, lower-calorie diet. An increasing number of gyms and YMCAs have programs targeted specifically for those who are overweight or exercise newbies.



Wearing a size 2 is no guarantee of good health. It doesn't mean your heart is in good shape or that you are strong enough to lift your toddler without hurting your back. For example, a British study published last fall in the International Journal of Obesity found that lean people had healthier levels of "good" cholesterol and triglycerides regardless of exercise. What's more, the lean study participants who exercised three times a week had healthier levels of total cholesterol and lower levels of "bad" cholesterol than did their sedentary counterparts. Thin people may also have high blood pressure, which exercise can help lower. And thin women are at increased risk of osteoporosis. Weight-bearing exercise, like walking, running, or aerobics, and strength training are key to helping them maintain strong bones.



If you fear the gym because of the intimidation factor, remember what Dear Abby says about church: It's not a museum for saints; it's a hospital for sinners. Same goes for the gym. It's not just for people with perfect bodies. Many chains, from Crunch, with its "No judgments" philosophy, to Curves, which targets women who are just starting to exercise, actively seek out customers of all shapes and sizes. (It's good business, too, since few people are perfect 10s.) "The key is to go to a place where you feel comfortable," says Pulido.

That means shopping around for a place to exercise like you would for anything else. Visit a number of gyms and ask for a free trial membership. Prices vary widely depending on the level of luxe. In addition to affordability, seek a facility that has appealing classes and the kind of equipment you intend to use. No use in paying for a gym that doesn't have the rowing machine you like. Some gyms also offer outdoor classes for those who can't stand being cooped up inside.

Those who think a gym means being confined to the treadmill or stationary bike should take a second look. Clubs offer a variety of classes, from circus acrobatics to Afro-jazz dance, and anything that gets you moving and your heart beating faster is fine. The Life Time Fitness chain has rock-climbing walls, great for improving strength, and racquetball courts alongside the usual equipment. Velocity Sports Performance, a national chain, offers speed and agility classes aimed at improving sports performance. "People have grown tired of just sitting on a piece of equipment and pushing out more reps," says founder Loren Seagrave.



Arthritis can be a vicious circle. It hurts, so sufferers don't want to move much. But the inactivity brings weight gain and thus more pain to overstressed joints. The way to break the cycle of pain and joint deformities, researchers now know, is exercise. Miriam Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University, gets a call almost every day from physicians asking for an exercise program for arthritis-ridden patients. Building up muscles with strength exercises helps take the strain off joints, while aerobic exercise can keep off the weight that exacerbates the disease. The Arthritis Foundation recommends stretching, strengthening, and aerobic exercise. It also advises talking with a doctor about what to do during a flare-up. That may include taking pain medications before working out, says the University of Oklahoma's Ross.

Old habits--and old excuses--die hard. But they do die. Ask Tisch, who says he's been at the same weight for the past seven years, thanks in part to his regular workouts. "I feel a lot better, in terms of both a healthier body and outlook," he says. "Now exercise is part of my life. I don't consider it work."