A regular exercise program is a requirement for health.   Most of my patients admit that they do not keep up with a minimum level of exercise, at least 30 minutes of aerobic exercise on 5 out of 7 days of the week.  In addition, it is important to incorporate resistance exercises, with weights or machines, at least two days per week for 15 to 20 minutes.  Lastly, stretching activities should be conducted at least twice a week for at least 5 or 10 minutes.  This may seem like a lot, but all of it can be accomplished with a commitment of at least 30 minutes a day. 

The benefits of maintaining an exercise program transcend the mere burning of additional calories.  Other benefits include increased clarity of thought, mood elevation through release of endorphins, increased energy levels during the day, increased stamina and decreased fatigue.

Starting an aerobic exercise program should be preceded by a wellness visit to your primary care physician to assess whether it is safe for you to exercise.  Conditions such as heart disease, arthritis, or other chronic conditions will require a customized approach.  For example persons with degenerative spine disease and chronic back pain may not be able to walk or jog, but may be able to bike or swim. 

Me and my wife Connie on our tandem bike

Patients often mention that they like to play basketball, tennis, golf or racquetball.  Even though these are beneficial activities, they are, for the most part, anaerobic rather than aerobic activities and should be considered as supplemental to your core aerobic activity.  Aerobic activities are those for which an elevated heart rate can be maintained for the entire time of the exercise.  These include activities such as brisk walking, jogging, running, biking, swimming or using “aerobic” machines such as treadmill, rowing or elliptical devices.   Many people enjoy changing activity types for variety.  I encourage this, although most will have a “favorite” activity or machine that they prefer.  I encourage most patients to start out with a walking program, but to try machines or swimming along the way and try to lock in on an activity that you are most likely to consistently maintain.

When starting a program, it will take about 12 weeks to go from a de-conditioned state to cardiovascular fitness.  The goal of 30 minutes or more, for five days a week should be achieved by incrementally increasing time and intensity.  I usually recommend starting with 15 minutes, three days a week, with the admonition to advance your time by about 10% per week until you reach the goal of 30 minutes 5 x per week. 

This can either be maintained at the 12 week level or, if increased performance is desired, time and intensity can continue to be increased.  I usually don’t encourage going beyond 45 minutes for 5 sessions per week.  I encourage using the other two days of the week to conduct weight work and stretching activities.  On the latter, for example, I like to do “bicycle” exercises on the floor to work my abdominal muscles, with 100 leg movements; an alternative to this is to do 100 crunches with not much more than a lift of the head for 1 crunch. Then, I do three sets of 10 repetitions each of curls with 20 pound dumb bells.  Each set should be separated by about 1 to 2 minutes of rest.  When I finish a set, I lean over with dumb bells in hands to do a standing forward bend, holding the stretch for about a minute, trying to get as close to the floor as possible.  When I’m finished with the curls, I then do three sets of military presses with 25 pound dumb bells, followed by the same stretches described above.  If you are stronger or want to push for greater resistance, simply increase the weight of your dumb bells.  These are easily obtainable and inexpensive,and can be purchased at a WalMart or Dick’s Sporting goods store.

For those who want to push further, I suggest one “long workout” per week. This allows gradual increase in strength and stamina and can be extended for up to a 90 minute session, usually on a weekend day.

Motivation and consistency can be difficult, until you reach a comfortable routine and fitness level.  It may be very helpful to engage the support of a friend or family member to walk or exercise with you.  One reason people give for not exercising is not having enough time.  This may be a manifestation of unconscious resistance to this difficult, but rewarding, lifestyle change.  Make no mistake, exercise is work and you will face many days in which you just won’t want to do it.  I often tell patients that they actually DO have time; they just have to make the time.  It requires a major adjustment to your daily schedule, and may require getting up an hour earlier, going to bed an hour earlier, or rearranging your evening so that you can exercise.  Many wonder whether it works better to exercise in the early morning, before they leave for work or to wait til after work.  This is a matter of personal preference, but I strongly prefer to do the workout in the morning.  If I wait til I get home, I have more stronger competing interests, including a desire to catch up on the day’s activities with my wife, making dinner plans, reading, watching a sports event or other. 

You are likely to experience repeated instances in which you slip behind in your fitness quest.  This can happen during times of high stress or depression, illness, or especially busy schedule.  My advice is to take these periods in stride, as they will occur, and just determine to get back on schedule as soon as it is feasible. 

I often get asked whether or not it is a good idea to continue to exercise through periods of minor illness such as a common cold.  Personally, I feel that stressing the body with exercise during the initial phase of a cold, with low grade fever, sore throat and cough are inadvisable.  So, feel free to take two to four days off to recover, then jump back into your routine.   A similar question is whether or not to work out through minor injury such as a pulled muscle.  I advise against this with the admonition to listen to your body and not resume your program until you can bear weight without any discomfort.  Continuing to walk or run when there is calf pain, for example, risks further injury.  Similarly, favoring the injured area often results in a strain somewhere on the opposite leg (ping pong injury).

People often do not exercise at the proper intensity level.  It is essential, for exercise to be effective as a health maintenance activity, for exercise to be primarily in the “aerobic zone”, defined as exercise that maintains the heart rate between 60 and 80% of its maximum level.  A person’s maximum heart rate can be estimated by subtracting age from 220.  Then the target heart rate can be determined by using a percentage between 60 and 80 percent.  Sixty is going to be fairly comfortable and eighty percent of maximum heart rate is more likely to feel like you are exercising near your peak capacity.  However, it is essential that you not exceed a level above which you aren’t able to maintain for the entire exercise period.  For this reason, I recommend starting at 60% and, as you become more fit, and if you want to increase your effort, increase your intensity toward 70 or 80%.  An example is provided here:

Age 50

Maximum heart rate:  220-50=170.

Starting heart rate target: 170 x .6= 102

So, taking the above example, I would recommend that the starting heart rate target be set at 100.  Determining your heart rate during exercise can be done in a variety of ways.  Many machines in fitness centers have heart rate monitors built into the machine, so this is easy to determine.  Another option is to stop periodically and manually check your pulse.  I usually recommend counting your pulse for 15 seconds and multiply by 4.  In order to do this, you will have to have a watch with a “second hand” or a digital indicator that shows seconds.  The most effective way to monitor pulse is to purchase some type of digital heart rate monitor that shows continuous heart rate display during exercise.  This allows minute adjustments in effort level in order to keep your heart rate at the proper target and, thus, achieve the maximum benefit from your exercise session. 

There is a much simpler, although less precise, method for determining the proper level of exertion.  This is called the Borg level of perceived exertion.  The table below shows the spectrum from no exertion to maximum exertion.  This has been shown to correlate accurately with heart rate, and the “aerobic level” is in the “somewhat hard” range of perceived exertion.  This is also defined as the level of exertion that will continue to allow you to speak a full sentence without losing your breath, but is still perceived as “somewhat hard exertion”.  It will be necessary for you to do some “trial and error”, increasing your activity level while you are continuing to talk to arrive at that level.  Once you determine the proper Borg level, you can gradually escalate your effort to that level and be confident that you are in the “aerobic zone” for your exercise session.

Table 1. Borg Level of Perceived Exertion

Level of Exertion
6 No exertion at all
7.5 Extremely light (7.5)
9 Very light
11 Light
13 Somewhat hard
15 Hard (heavy)
17 Very hard
19 Extremely hard
20 Maximal exertion

Whatever you do, whatever exercise you choose, or how seriously you pursue your program, get started on a regular program of daily exercise today.  Studies have shown that 70 year olds who exercise diligently compare favorable with people 30 to 40 years younger.  Exercise will bring benefits you can’t even dream of until you experience them for yourself.