As with any physical activity, please consult your physician first as to what activity he or she recommends for you to begin at this time. Always remember results don’t appear overnight. Always keep your body guessing by changing your routine. Don’t be afraid to take a break. Your body usually needs recovering after 6-8 weeks of resistance training. Remember to breathe out or exhale on the exertion or hard part of the movement.

2. Why is activity and exercise important to overall good health?
The old saying, if you don’t use it, you lose it is not a myth. Exercise and staying active will help slow down the aging process while increasing bone strength, muscular endurance and lung capacity to extract oxygen from the air we breathe. Most importantly, it increases our heart’s strength, which is a muscle (i.e., if you strengthen a muscle, it will last longer).

3. What exercises burn the most fat?
Everyone burns calories differently. However, slow rhythmic exercise such as jogging, swimming or riding a bicycle at a lower intensity has proven to burn fat more efficiently than higher intensity exercises such as sprinting. The reasoning behind this philosophy is that fat is a good source of fuel during low-intensity exercises when your breathing rate and oxygen use can keep up with the demands of the exercise. This type of exercise is often referred to as aerobic meaning with oxygen. Carbohydrates, on the other hand, are better suited as a fuel during high-intensity efforts when breathing rate or oxygen needs fall short of the energy demands of the exercise. This type of high-intensity exercise is called anaerobic or without oxygen.

4. What exercises are good for strength and which ones are good for cardiovascular health?
The bench press and squat have been the strongman’s focus for years because they concentrate on the major muscle groups. Other exercises for strength include bicep curls, triceps extensions, shoulder shrugs and hamstring curls. These auxiliary exercises often target minor or smaller muscle groups. As for cardiovascular health, jogging, riding a bike, swimming, rowing and jumping rope all help improve the cardiovascular system. The exercise must be continuous in nature using large muscle groups.

5. What are some assessments one can do on their own to gage their need for fitness and exercise?
Self-assessments include:

Basic push-up test to assess muscular strength
1 mile jog/run times to assess cardiovascular strength
Chin-ups to assess body strength
Squats or leg press to measure lower body strength

1.Why is weight training/weight bearing exercises important to your overall health?
Some of the many benefits of weight training include improved flexibility, balance, mobility and stability. It also helps improve and restore bone density which can decrease the risk of osteoporosis. Incorporating resistance exercises into your workout increases lean body mass and increases your resting metabolic rate, which causes your body to burn more calories. In addition, cholesterol and blood pressure are lowered, which decreases the risk of coronary artery disease. Other benefits include injury prevention and looking and feeling great!

2.What is the importance of your heart rate while exercising?
Target heart rate is described as a rate attained during aerobic exercise that represents your level of exertion. Keeping your heart rate within this zone ensures you are strengthening your heart and lungs, as well as burning body fat. When your target heart rate is determined, there are two given numbers a lower limit and a higher limit. Heart rate should be within this range at all times. If you work within the higher range or at a higher intensity, your body will perform a crossover effect where fat metabolism is decreased and more calories will be burned in the form of carbohydrates. When exercising beyond 30 minutes, but still maintaining a low intensity workout level, there is a slow, yet continuous change from a reliance on carbohydrates to an increasing dependency on fat as a fuel source.

3.What is the most efficient workout for someone who is pressed for time?
It is suggested that 30 minutes a day is an adequate amount of cardiovascular exercise to incorporate into your day, but if time constraints keep you from getting the full amount, two 15-minute workouts a day is still sufficient. Some fitness centers have developed organized circuit training sessions or “express classes”, as the National Training Center provides, so that fitness members can get in a quick workout and return to their daily activities.

4.Should you do cardio exercises before weight exercises or visa versa?
When deciding to perform weights first or cardiovascular fitness first, it all depends on the goal of the workout that day. It would be difficult to have a beneficial strength workout if you just ran for 45 minutes. Likewise, if you did a strength workout, you wouldn’t be able to do one hour on an elliptical machine at your desired intensity. It is always beneficial to warm up a bit before beginning a resistance workout, even if it is only for 10-15 minutes. Warm up does not necessarily have to be cardio, you can do a dynamic warm up, which is a type of stretching that involves controlled movements such as step-ups or lunges.

5.How do you lift weights to tone muscles versus building mass?
When the goal of your resistance training workout is to tone your muscles, you want to lift low weights paired with high repetitions; for example 2-3 sets of 12-15 repetitions. When you want to build mass, you would lift heavy weights with low repetitions. One might also include more sets with longer rest periods.

By: Sara Raschiatore, B.S., M.S. ACMS H/FI, NTC

6.What type of food should you eat before and after exercising to maximize your metabolism?
Eating the right foods before and after exercise can be a tricky subject for most. The body uses two sources of fuel during exercise; carbohydrates and fats. The length of the planned exercise session may determine what exactly your body needs to perform and recover at its best. During a high moderate intensity exercise, more carbohydrates are used for fuel, because carbohydrates are stored in the muscle and liver therefore it is readily available at any time. On the other hand, for exercise sessions that last longer than 60 minutes at a lower intensity, fat may be the main source of fuel.

The best advice is to eat a meal about three to four hours prior to exercise and also eating a small snack about one hour prior to exercise. Both meals and snacks should have a higher amount of complex carbohydrates to prepare the body for prolonged activity and also for restoring the muscle storage in the muscle and liver that may have been depleted from the prior exercise session.

Examples of meal ideas before exercise included baked potato, baked beans, cottage cheese, pasta and sauce, whole grain toast with peanut butter and banana and rice and vegetables.

Examples of snack ideas before exercise include yogurt, a piece of fruit, cereal bar and a small bowl of cereal.

7.What is the importance of proper breathing?
It is very important to practice proper breathing during exercise. Proper breathing will allow for more efficient exchange of gases between the lungs, muscles and blood. Oxygen is the more important of the two gases that the body utilizes; with carbon dioxide begin the other gas, which is considered to be the waste that the body needs to get rid of.

During exercise it may be harder to breathe efficiently because most people tend to take shorter, more forceful breaths. In actuality, it is more beneficial to take slow, deep breaths during exercise.

To get the most out of your breathing, try inhaling through the nose and exhaling through the lips (keeping the lips pursed like you would when trying to whistle). By doing this, it will allow you to exhale slower instead of a quick, short exhale.

8.Why are exercise balls good investments?
Exercise balls, also known as stability or Swiss balls, are great investments because they can be used for a variety of different exercises. They are fairly inexpensive and can be used for a total body workout at anytime and anywhere. They are of particularly good use when you may not have time to make it to the gym and need to get in a whole body workout in your own home. Exercise balls are very durable and can last for many years if taken care of properly.

9.How can you protect the longevity of muscles and bones while exercising?
Protecting the longevity of your muscle and bones can be achieved by following a few simple rules. First of all, make sure that you are consistently and continually stretching the muscle properly when it is warm. This can help prevent any injures to both the muscle and/or bone that may result in overuse, such as a stress fracture, tear or inflammation.

Secondly, it is helpful to make sure that you are getting the proper amount of calcium from your diet or supplement to prevent early decrease in bone density, which can lead to osteoporosis.

Lastly, make sure that there is added variety in your exercise program. This should include an activity that is non-weight bearing (i.e., swimming, biking, elliptical training). This will allow for proper recovery of the bones and muscles, however it is still very important to continue with activities that are weight bearing the majority of the time (strength training, running, walking) to help strengthen and increase bone density.

10.What are the pros and cons of using an elliptical-type machine versus running outside or on a track?
Elliptical-type machines can add variety to any exercise program without having to sacrifice the cardiovascular benefit that you get from running outside. The elliptical is also a good method to use for cross-training to allow the muscles and bones to recover from the stress that a hard surface may contribute. It is also a great way to escape any inclement weather, while at the same time getting a great workout.

However, although the elliptical is a great way to get a good cardiovascular workout, it is not recommended to use as your primary method to achieving your cardiovascular fitness. It is extremely important to do the majority of your exercise sessions as part of some sort of weight bearing activity (running outside/track/hard surface). This will strengthen your bones and give you a better workout when having to deal with the different elements such as the weather or adapting to change in terrain or inclination. Running outside will also keep you from getting bored of being stuck indoors, which can lead to staleness or burn-out in your exercise program.

Sara Raschiatore, B.S., M.S. ACMS H/FI, NTC Exercise Specialist Raschiatore was a six-time All-American in collegiate track and cross country and has completed two half-marathons, two half Ironman triathlons and several sprint/Olympic distance triathlons.

It may be the very last thing you expect, but someday you might become one of the millions of people who participate in a physical rehabilitation program each year. If you’ve experienced chronic back pain, a fall or sports injury, a stroke, heart disease or even cancer, physical rehabilitation also called physical therapy or rehab may be just what you need to regain your strength, your mobility and get back to a normal life.

Whether you’re a nine-year old gymnast bound for the Olympics who needs to tend to an overworked muscle, or an 80 year-old [gentleman] who is recovering from his second knee replacement surgery, your physician may prescribe several weeks of treatment under the guidance of a licensed physical therapist (PT) to get you back on your feet. The focal point of any program is physical exercise, but to get the most out of therapy, you also have to open up to new relationships with your body, your emotions, your friends and family, and your PT.

Like any challenging situation, the head and the heart play a tremendous role in rehabilitation. In my 24 years as a PT I’ve found that even patients who get through surgery with ease are often anxious and fearful about what rehabilitation may hold. As the rehabilitation services manager for the internationally known National Training Center, I get to experience the pleasure and the excitement of helping people face these fears and succeed beyond their expectations each day. I am always inspired by the resilience of the human spirit as I help our clients become partners in their rehabilitation and discover their bodies’ hidden strengths. Here’s my advice on excelling at PT:

Get to know your body. Most people begin physical therapy without a clue about how the body heals. The PT’s job is to help you understand that process so that you can fully grasp the task you have ahead of you.

You may want to ask your PT, for instance, what’s the inner working of my knee, hip, or muscle tissue? Or, what must happen for me to regain the strength on my left or right side? Once you understand the focus of your therapy, it’s easier to concentrate on certain parts of your body and learn your exercises.

Set your goals. Your PT will also need to ask you a range of questions about your health, lifestyle and what you hope to gain from rehabilitation. This is no time to be shy or hold back. If you really miss your yoga classes, tell your PT that going back to yoga twice a week is one of your personal goals. Think of your PT as a good friend with your best interests at heart and make sure they get to know you well enough to really help you return to the life you love.

They, in turn, will be honest about the level of commitment needed from you to meet your goals. For a knee injury, I might start a patient off walking in weeks one and two. Then in weeks three and four we will run. By weeks five and six, we’ll try a bike ride. In some instances I may explain to a patient that they need to achieve 45 degrees of motion in a jointa move that may cause some degree of pain–so that the scar tissue doesn’t solidify, rather just asking them to tough it out without an explanation. Your PT should always be willing to answer any questions you may have about possible pain or other complications. Never be afraid to ask about just what to expect or why you have to endure discomfort to get the job done.

Stay the course. I’ve seen people face all types of challenges in therapy: the basketball player trying to get his jump shot back after a major knee injury; the elderly patient struggling to regain strength and agility after a heart attack; the young mother trying to heal a back injury so that she can return to her growing family. The patients who do the best have one thing in commona fierce drive to get better. I often watch as patients martial an amazing combination of faith, patience, and tenacity to fight their way back to good health. To succeed at PT, you have to decide that you have the will and the strength to recover, no matter how tough it may seem.

Communicate. Talk to your PT, your physician and the people in your personal support network. Your therapist should be at the center of a circle of communication that includes your PT’s daily talks with your physician, frequent contact with any friends or family members who are assisting in your care, as well as any feedback you may want or need on your progress.

If you find you are unable to handle the emotional demands of PT, your therapist can also arrange counseling or a consultation with a psychologist. Building a strong support network to lean on should give you more energy to focus on getting better.

Connect. The human spirit can overcome tremendous barriers once it receives the right type of support, but sometimes the people closest to the patient do more harm than good. I’ve had young patients, for example, with overly protective parents who felt they should do all the talking. In those cases, the young patient never gets to speak for themselves. Gradually the patient becomes frustrated and disconnected from the healing process.

With adults, spouses may become tense because of the effects of an illness. I remember a recent case in which the husband had suffered a stroke that affected his speech. He could only express himself very slowly. His wife became impatient and began interrupting him to finish his sentences. After a while, they were both frustrated and unable to communicate effectively with me or each other. If you find yourself struggling to get your point across in PT, ask your therapist to intervene on your behalf and try to gently and tactfully resolve the problem. The patient always does better when everyone can work together.

Lean on your loved ones. Patients who work through their therapy with the help of a supportive friend or family member tend to heal faster, so try not to go it alone. To heal you have to do more than just build muscle and mend bone. You must let go of anger, stress, and frustration so that your mind and body can recover fully. Opening your heart to receive the support and encouragement around you is just as important as achieving your physical goals.

Leah K. Dearman, PT, MS, is the rehabilitation services manager for the National Training Center in Clermont, Florida

Over the past 25 years, the United States has experienced a steady decline in the number of deaths from cardiovascular disease (CVD), primarily in mortality caused by coronary heart disease and stroke. Still, coronary heart disease is the leading cause of death while stroke is third. Lifestyle improvements by the American public and better control of the risk factors for heart disease and stroke have been big reason for this decline.

Coronary heart disease and stroke have many causes. Modifiable risk factors include smoking, high blood pressure, blood lipid levels, obesity, diabetes, and physical inactivity. National trends observed with smoking, high blood pressure, and high blood cholesterol have improved, but obesity and physical inactivity have not. Advanced technologies have taken the place of physical activity in many daily tasks. Unfortunately, most Americans are physical inactive.

Physical activity protects against the development of CVD and also improves other CVD risk factors, including high blood pressure, blood lipid levels, insulin resistance, and obesity. Physical activity is also important in the treatment and management of patients with CVD or increased risk, including those who have hypertension, stable angina, a prior myocardial infarction, peripheral vascular disease, or heart failure. Physical activity is important for cardiac rehabilitation, and people with CVD may benefit from it.

Advantages to an Active Lifestyle
Physical inactivity among the U.S. population is now widespread. About one in four adults (more women than men) currently have sedentary lifestyles with no leisure time physical activity. An additional one-third of adults are insufficiently active to achieve health benefits. The prevalence of inactivity varies by gender, age, ethnicity, health status, and geographic region but is common to all demographic groups.

Girls become less active than boys as they grow older. Children become far less active as they move through adolescence. Obesity is increasing among children. It is related to an energy imbalance (i.e., calories consumed in excess of calorie expenditure.) Data indicate that obese children and adolescents have a high risk of becoming obese adults, and obesity in adulthood is related to coronary artery disease, hypertension, and diabetes. Thus, the prevention of childhood obesity has the potential of preventing CVD in adults.

There is evidence that increased physical activity leads to weight loss and that combining physical activity with reducing food intake can increase and help to maintain loss of body weight and body fat mass.

Middle-aged and older men and women who engage in regular physical activity have significantly higher high-density lipoprotein (HDL) cholesterol levels than do those who are sedentary. When exercise training has extended to at least 12 weeks, the HDL cholesterol levels are even more improved.

What Type, Intensity, and Quantity of Exercise Are Best?
You don’t need a structured or vigorous exercise program to reduce CVD risk factors and gain many other health benefits. Most benefits of physical activity can be gained by performing moderately intense activities.

Everyone should maintain regular physical activity at a level appropriate to his or her abilities and interests. Both children and adults should have at least 30 minutes or more of moderate-intensity physical activity on at least five, if not all days of the week. However, physical activity must be performed regularly to maintain positive effects. Intermittent or shorter bouts of activity (at least 10 minutes), including tasks of daily living, also have similar cardiovascular and health benefits if performed at a level of moderate intensity (such as brisk walking, cycling, vacuuming, and yard work) for a total of 30 minutes daily. People who currently meet the recommended minimal standards may gain additional health and fitness benefits from increasing their activity. Higher intensity or longer duration activity could be performed approximately three times weekly and achieve cardiovascular benefits, but low-intensity or shorter duration activities should be performed more often to achieve cardiovascular benefits.

People who are not currently active should gradually build up to the recommended goal of 30 minutes of moderate activity daily by adding a few minutes each day until reaching their personal goal to reduce the risk of injury.

Developing muscular strength and joint flexibility is also important for an overall activity program to improve one’s ability to perform tasks and to reduce the potential for injury. Resistance training may contribute to better balance, coordination, and agility that may help prevent falls in the elderly.

Physical activity carries risks as well as benefits. The most common adverse effects of activity relate to musculoskeletal injury and are usually mild and self-limited. The risk of injury increases with increased intensity, frequency, and duration of activity and also depends on the type of activity. Exercising in moderation can reduce these injuries.

Because the risks of physical activity are very low compared with the health benefits, most adults do not need medical consultation before starting a moderate-intensity physical activity program. However, those with known CVD and men over age 40 and women over age 50 with multiple cardiovascular risk factors should have a medical evaluation prior to initiating such a program.

Material from The Relationship Report Card: Grading Myself copyright 1997 by Western Psychological Services. Format adapted by The Healing Continuum Inc., for specific, limited clinical use under license of the publisher, WPS, 12031 Wilshire Boulevard, Los Angeles, California 90025, U.S.A. (www.wpspublish.com). No additional reproduction, in whole or in part, by any medium or for any purpose, may be made without the prior, written authorization of WPS. All rights reserved.

Upon completion of purchase please print the document and either mail to The Healing Continuum: 4327 South Highway 27, Suite 428, Clermont, FL. 34711. For faster response or you can scan the document and e-mail to it info@thehealingcontinuum.com. Please be certain to include your e-mail address and a day and evening phone number so we may reach you.

1. Conduct a needs analysis:
   1. Determine your resistance training goal.
   2. Conduct an evaluation or an assessment of your current fitness level.
2. Select an exercise:
   1. Become familiar with various types exercises targeting the upper and lower body.
   2. Understand the biomechanical movements and techniques in a traditional resistance training program. For example, if a weight is not steady, it’s too heavy. A common mistake is the rocking forward and backward while performing bicep curls.
   3. Inventory the equipment available
3. Decide on frequency:
   1. Remember that any resistance training program should be altered every 6 to 8 weeks to keep the body guessing.
4. Decide on exercise order:
   1. Considering split workouts for all workouts
      1. A split workout is when a person works two muscle groups on one day followed by two different groups on the next day. A typical three-day routine might be:
         1. Chest and back
         2. Biceps and triceps
         3. Legs and shoulders
         4. A total body workout targets all the major muscles of the body in one day. It is recommended that the participant perform this workout two to three days per week. This type of program is generally recommended for those with limited time available.
      2. Push and pull method:
         1. This method improves recovery between exercises by alternating pushing exercises with pulling exercises. For example, performing a bench press followed by lat pulldowns.
      3. Upper and lower method:
         1. Also improves recovery between sets
         2. This method is helpful for untrained participants who might find that completing several upper or lower body exercises in succession is too strenuous.
         3. If training time is limited, this method of arranging exercises minimizes the length of the rest period required between exercises and maximizes the rest between body areas. This results in a decrease in overall training time.
5. Training loads and repetitions:
   1. Training loads and repetitions are generally dictated by the participant’s training goals. For example, if the participant wants to get stronger, than the loads (weights) should be high. The loads should be equal to or higher than 85% of one repetition max. With that being so, the repetitions would normally be lower. Traditionally the repetitions in this case would be less than or equal to six. In contrast, to build hypertrophy (muscle) the person should consider loads that fall between 60 to 80% of the one RM, and the repetitions set at 6 to 12. For muscular endurance, loads should be equal to or less than 60% of 1 RM with the repetitions greater than 12.
   2. For beginners, the best load might be a weight that feels comfortable doing between 10-15 repetitions regardless of gender. With these ranges, you’re going to gain the best of both worlds. You’ll build strength, muscle and some level of endurance.
      

   Load and Repetitions Assignments Based on theTraining Goal
   Training Reps	Load (%1RM)	Goal
   Strength	<85	<6
   Hypertrophy	60-80	6-12
   Muscular Endurance	>60	>12

6. Number of sets: involves two exercises that stress two opposing muscle groups. For example, performing 10 repetitions of dumbbell bicep curls immediately followed by triceps pushdowns.
   1. Compound sets entails two different exercises working the same muscle group.
   2. Single sets are appropriate for untrained individuals or those that might have certain orthopedic conditions such as osteoporosis or osteopenia.
   3. Multiple sets will bring about continued strength gains. It is believed that performing multiple sets of 10 repetitions without going to muscle failure enhances strength better than one set to failure of 8 to 12 repetitions.
      

   Volume Assignments Based on the Training Goal
   Training Reps	Load (%1RM)	Goal
   Strength	<6	2-6
   Hypertrophy	6-12	3-6
   Muscular Endurance	>12	2-3

7. Rest Periods: This is the time dedicated to recovery between sets and exercises.
   1. The length of rest between sets and exercises is dictated by the goal of training, the relative load lifted and the participant’s fitness status.
   2. Strength training requires more rest period due to the load lifted per exercise.
   3. Training for hypertrophy (muscle tone) is achieved by limiting the rest period between 30 seconds and one minute.
   4. A typical rest period for someone who is trying to develop muscular endurance is less than 30 seconds. Short rest periods are characteristic of circuit weight training programs where it is common to alternate exercises and limit rest period lengths to 30 seconds or less.
      

   Training Period	Rest Length
   Strength	2-5 min.
   Hypertrophy	30s -1.5 min
   Muscular Endurance	<30 sec.

   Results don’t appear overnight. Always keep your body guessing by changing your routine. Don’t be afraid to take a break. Your body usually needs recovering after 6 to 8 weeks of resistance training. Remember to breathe out or exhale on the exertion or hard part of the movement. For example, when performing the chest press, one would breathe out as one pushes the weights away.

   The best advice that I can give to you is to stick to your plan, use safe practices and enjoy yourself.