Carrie Sandgren

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Feb 222015

This is the fourth and final installment in a series entitled Fitting Exercise into Your Daily Routine.

senior woman exercisingFunctional workouts can be quick and to the point. Functional workouts use motions that mimic things you do in the course of your day. You can take almost any activity of daily living (ADL) and turn it into an exercise by emphasizing correct form and technique. For example, if you pick something up off the floor by properly using your leg and back muscles, or if you blow-dry your hair while standing up straight and using full shoulder movements, or if you stretch to reach something on the top shelf while properly using your ankles, abdominal muscles, shoulders and neck, you have potentially created an exercise. If these movements reveal weakness or stiffness in any muscles or joints, you can turn that ADL into something useful.

Here’s an example: getting up and down off the floor. It requires flexibility and lower body strength.

How to Get Off the Floor by Mia

VAN board member, Mia Bremer, is owner of Ablebodies, a fitness consulting firm for older adults. She has created this 6-minute video to illustrate techniques for getting up off the floor. This is a vitally important skill and one that can be learned and acquired, even if you are currently not able to get up from the floor.

You may want to view this video repeatedly and memorize its techniques. If the movements are difficult, turn it into an exercise! Perhaps do as many of these different moves as you are able three times in a row each day. Too challenging? Then you may need a special program of strength and flexibility. Consider consulting a fitness trainer.

Exerciser, Know Thyself

I’ve been impressed, ever since researching my material for Part 4 of the first series, Think of Exercise as a Pill, just how much exercise the U.S. Department of Health and Human Services (HHS) suggests we do, even in our later years. HHS recommends exercise that challenges us—as much as we can safely handle. Gains in health and stamina occur when we overload our muscles; the trick is in knowing how much overload is safe. Even if we are regular exercisers, we need to be aware that our bodies change with age. We become more susceptible to injury. Our backs aren’t as flexible; knee cartilage isn’t as resilient; shoulder ligaments aren’t as strong; sense of balance isn’t as acute; vision may not be as good.

As I said in Part 4 of Exercise as a Pill, adults over age 50 are the most diverse group when it comes to physical ability. It is important to assess your abilities realistically as you plan your workout program. Start gradually, listen to your body, and consult a fitness trainer if you don’t know where to start.

Correct posture and form are important in any exercise you do, be it aerobic or strength training. Any tempo or resistance that causes you to break out of good form is unhealthy and potentially dangerous. Do not risk finding yourself on the floor, for example, by turning up the speed on a treadmill too high. Any exercise that gives you pain or makes you feel faint or dizzy should be stopped immediately.

How Much Time Do You Have for Exercise Today?

In this series, Fitting Exercise into Your Daily Routine, I’ve tried to show that exercise can indeed be fit into a busy day. You may not have the time for a full workout every day, but you can do a lot in short time intervals to improve your health and improve how you feel. This current series has focused on short, simple exercises. Many of the concepts, recommendations, and precautions I’ve covered in this exercise series as well as in the previous series are discussed in the following book—in more detail and with more expertise. I recommend it highly, and it’s available at the library. (Like some other resources I’ve recommended, it does contain nutrition advice which I have not reviewed and cannot comment on.)

  •  The Exercise Cure: A Doctor’s All-Natural, No-Pill Prescription for Better Health & Longer Life by Jordan D. Metzl, MD, New York, NY: Rodale, Inc, 2013.

Space and time do not allow me to present all the exercise options that are available to you. There is a whole universe of functional exercise options like walking, jogging, water aerobics, swimming, dancing, cross-country skiing, and many others. With so many options available, both for short workouts and for longer workouts, how can you not find exercises that fit into every day of your busy life?


John SandgrenJohn Sandgren is a recent Evolve grad and a member of the Vital Aging Network’s Wellness 50+ Design Team. We are pleased to have his contribution to our knowledge base about how to age well. Thanks to Mia Bremer and Marcia Robert, MPH, for editorial assistance on this article.


Feb 112015

This is the third of a series of installments entitled: Fitting Exercise into Your Daily Routine

Vital senior couple exercising in the gym.Maximum time efficiency requires indoor settings with readily available equipment. The workouts you design here will be useful any time of year. In Part 2 of this series, I offered resources for chair and office workouts. Here, I am offering resources that don’t use chairs. From these, you’ll be able to create exercise routines as short as 3 minutes in length. The shorter the workout, the less complete it will be, but it will still be much better than nothing. Pick and choose exercises that work a variety of muscle groups and make you feel good.

Words of Caution

If you’re just beginning to exercise, remember that people who are out of shape often start too ambitiously and wind up with sore muscles or actual injuries. Start small and build up, ideally with a few exercises several times a day.

If, as you get stronger, you cannot find time to lengthen your workouts, then progress will necessitate raising the cardio speed or the weight resistance. Please be mindful that with more strenuous workouts, muscles will need more time for warming up and cooling down.

High-Intensity Interval Training (HIIT)

HIIT is popular right now and is marketed as a way of creating shorter workouts. See the end of Part 4 of my previous series, Think of Exercise as a Pill, for a description of HIIT. When properly done, short intervals of high-intensity aerobic exertion inserted between longer intervals of low to moderate-intensity exertion can yield more average intensity per minute than longer, steady-tempo workouts, thereby burning the same amount of calories and fat in shorter time.[1]

Another way to shorten workouts is to do more resistance exercise than aerobic exercise, because lifting weights can take less time than cardio if you minimize reps and rest periods. Resistance exercise does benefit more than just muscle. It has been shown to burn fat, control glucose and blood pressure, and improve nerve function;[2] it may even protect the heart but it has not yet been shown to increase longevity. There are fitness gurus who advocate resistance exercise with heavy weights, claiming you don’t need aerobic workouts at all, but this is actually unproven. Current research suggests aerobic exercise and resistance exercise improve the body in rather different ways, and current science hasn’t yet figured out how to measure and compare these differing benefits.[3]

I offer three cautions about high-intensity interval training (HIIT) and resistance exercise with heavy weights. First, at present, resistance exercise appears to be healthiest when it complements aerobic exercise instead of replacing it. (See Parts 4 and 6 of Exercise as a Pill for how it can complement.) Second, any exercise at higher intensity carries a higher risk of injury, so attain some degree of fitness before considering HIIT. Third, exercise that is excessively strenuous can break down muscle tissue rather than strengthen it.[2] Listen to your body and avoid exercise that is too effortful. (Part 4 of Exercise as a Pill tells how you can measure effort.)

Recommended Sources

I searched the terms “efficient exercise” and time saving exercise,” and recommend the following good items. You can get the books and the DVD from your library, via inter-library loan if need be.

  • Get Moving: 15-Minute Cardio Workout with Lawrence Biscontini (YouTube). Practice and memorize these steps and someday they can become a warm-up for more advanced workouts. The moves here are low impact, whereas many other short cardio videos use jumping exercises to quickly get your heart pumping.


  • The Burst Workout (Book) by Sean Foy. This book includes 12 different High Intensity Interval Training workouts of varying difficulty, excellently written with good illustrations and good tips on posture and form. Some of these exercises can be done in the office. Advice on nutrition is included which I have not reviewed and cannot comment on.
  • Men’s Health 15-Minute Workout (DVD). Four demanding 15-minute workouts are presented, some using hand weights or a jump rope. The workouts are balanced regarding aerobic vs. resistance.
  • Quick Fit – The Complete 15-Minute No-Sweat Workout (Book) by Richard Bradley, III. A well-balanced, 15-minute workout that needn’t be intense plus an expanded workout requiring a bit more time. Hand weights are needed.
  • The 90-Second Fitness Solution (Book) by Pete Cerqua. These exercises are extreme time-savers, written for women but suitable for men too. However, they are resistance exercises only. I disagree with some of the teaching points in Chapter 1—you’ll recognize which ones from reading my series—and I haven’t read the nutritional advice. The squat on page 46 can be hard on knees if you squat all the way down. He does offer an exercise for bad knees on page 78.

Watch for Part 4 of this series, “The Value of Functional Workouts.”


John SandgrenJohn Sandgren is a recent Evolve grad and a member of the Vital Aging Network’s Wellness 50+ Design Team. We are pleased to have his contribution to our knowledge base about how to age well. Thanks to Marcia Robert, MPH, for editorial assistance on this article.



[1]Kravitz L and Vella C. ACSM Current Comment: Energy Expenditure in Different Modes of Exercise. Fact Sheet from the American College of Sports Medicine,

[2]Egan B and Zierath J. Exercise Metabolism and the Molecular Regulation of Skeletal Muscle Adaptation. Cell Metab (Cell Metabolism) 2013; 17:162-84.

[3]Borsheim E and Bahr R. Effect of Exercise Intensity, Duration, and Mode on Post-Exercise Oxygen Consumption. Sports Med (Sports Medicine) 2003; 33:1037-60

Jan 252015

This is the first of a series of  installments entitled: Fitting Exercise into Your Daily Routine


We’ve all heard people say they don’t have time to exercise but I would suggest that for many if not all of those people, time may not be the problem; it may be focus. Time management is always helpful, of course, but in the long run, focus combined with enthusiasm and resourcefulness is more apt to win out. The only time-management skill you absolutely must have is avoiding life in continuous crisis mode. Some suggestions:

  • Take stock of your many commitments and the customary pace of your day.
  • Manage or distribute these commitments to prevent crises.
  • Allow adequate time for nutrition and sleep.
  • Don’t fret over perceived lack of time.

Part 6 of the series just finished, Think of Exercise as a Pill That Promotes Long Life and a Whole Lot More, suggested you spell out an exercise program that identifies “every type of activity to be done, the level of effort at which it will be done, and the duration of that effort.” For those of you who are busy, try relaxing this strict scheduling as outlined in the bullet points below.

Create Achievable Goals

It’s probably safe to assume goal-setting will assist us adults with exercise performance; after all, goal-setting does appear to benefit school athletes and professional athletes.[1] As discussed in Part 5 of Exercise as a Pill, the best goals are realistic, specific and incremental.

  • Top Priority: Move frequently during the day. Get up out of your chair every 30 minutes if possible. (The National Institutes of Health (NIH) says sitting down for long periods of time can lead to diabetes, heart disease, stroke, and other health problems even for people who are active at other times of the day.)2
  • Pressed for time? Set goals that specify several different times in the day when you will exercise, but as you begin, don’t worry too much about the durations of those exercises.

Exercise Several Times Each Day

Moving frequently during the day is important because recent research suggests physical inactivity allows noxious chemicals like free radicals to build up in muscles, and this might be a significant cause of muscle aging.[3] So why not fit exercise into several parts of your day?

  • While brushing your teeth in the morning, warm up some muscles, for example by doing side bends, hip swivels, or body twists. Perhaps try standing on one leg and then the other, or alternating between standing on your tip toes and rocking back on your heels. (Use your free hand to hang onto the sink, if needed.)
  • As you sit during the day, do chair exercises. (More on this next week.)
  • In the evening as you wash dishes or watch TV or talk on the phone, devise some additional exercises.

The point here is that focusing on exercise will help get you started. Focus is the key. In Exercise as a Pill, you learned the importance of exercise. Now you will actually begin to exercise, and frequently, provided you maintain mindfulness of it throughout your day!

Watch for Part 2 of this series next week, “Your Chair or Office as Fitness Studio.”

John SandgrenJohn Sandgren is a recent Evolve grad and a member of the Vital Aging Network’s Wellness 50+ Design Team. We are pleased to have his contribution to our knowledge base about how to age well. Thanks to Marcia Robert, MPH, for editorial assistance on this article.




1 Martin G, Thompson K, Regehr K. Studies using Single-Subject Designs in Sport Psychology: 30 Years of Research. The Behavior Analyst. 2004; 27:263.

[2] Weight-control Information Network, National Institute of Diabetes and Digestive and Kidney Diseases, Tips to Help You Get Active. Go to and click on “fitness” in the search box.  Under “Recommended NIH Resources” in the middle of the page, scroll down and click on “Weight-control Information Network.” Now, on the left-hand side, click on Publications • For the Public. Finally, scroll down the list of Publications – For the Public and click on “Tips to Help You Get Active.”

[3] Venturelli M, Morgan GR, Donato AJ, et al. Cellular Aging of Skeletal Muscle: Telomeric and Free Radical Evidence that Physical Inactivity is Responsible and not Age. Clin Sci [Lond] (Clinical Science [London]). 2014; 127:415.

Dec 142014

This is the seventh of a series related to physical fitness entitled: Think of Exercise as a Pill that Promotes Long Life and a Whole Lot More.

Two elderly women doing muscle exercises with weights in gym.One key to successful exercise is listening to your body. With awareness and experience comes the ability to recognize important signals. You’ll recognize and appreciate the healthy discomfort of well-used muscles, tendons, and ligaments. You’ll be able to distinguish it from the unhealthy discomfort of misuse which says back off or change what you’re doing.

Few pleasures exceed the gratifying sensations a strong, healthy, flexible body and being aware of these sensations will help you stay motivated. Let me share a personal story. Twenty years ago, after regularly exercising several times weekly for about 1 year, I suddenly noticed one afternoon as I exited from the gym into cool weather how pleasantly warm my muscles felt. My muscles distinctly felt like a warm blanket around me. I had never noticed such a feeling before and it was so invigorating that I remember the moment to this day!

Listening to your body is vitally important, and perhaps nowhere more important than when doing physical chores necessitated by Mother Nature. Think for a moment about things like snow shoveling, garden digging, gutter clearing, or house painting. In Part 6, I could have facetiously labeled these chores a fifth area of exercise, but humor is out of place here. It’s deceptively easy and dangerous to let Mother Nature dictate how hard to exert yourself, so be mindful of your body. Granted, you can limit the size of your garden or take days and weeks to clean out your gutters, but snow shoveling is different. You simply can’t get the car out of the garage until all the driveway is sufficiently cleared.

Snow shoveling is vigorous or near-vigorous activity and multiple studies have demonstrated that lifting snow, particularly wet, heavy snow, puts people at risk for heart attacks – especially sedentary people. The risk is not high, mind you, but it is there, and in addition, a subset of people may be vulnerable to heart attacks in cold temperatures. 1 Physical fitness offers substantial protection from shoveling-induced heart attacks, even for individuals with known coronary heart disease.

Listening to your mind and your thoughts is a second key to successful exercise. If you’re finding it hard to stick to a regular exercise program, cognitive behavioral psychology – the science of how attitude, perceptions, and self-image influence changes in behavior – may help. I offer here in italics some concepts from cognitive behavioral advocates. Many of the points here come from an insightful blog Christy Matta, MA wrote about dieting and losing weight. 2 Her advice could apply equally well to keeping up an exercise program.

To accomplish behavioral change, set specific, realistic goals. Overly ambitious goals can be discouraging. Surround yourself with people who will encourage your efforts. Valuable assistance can come from people in similar circumstances who have made the changes you want to make. Use a buddy system or join a group from church, health club, work, or community. Get regular feedback from your buddy(ies) on progress. [But don’t use their techniques for weight lifting. Remember Part 6?] You can use peers or lay health advisors to help tailor your program to your cultural beliefs, values, language, literacy, and customs.

Look at the way you think about yourself. Is your self-image setting up barriers? If you start a program with the expectation that you will fail, you greatly reduce your chances for success. What do you think your ability is to make the changes you want? The best way to improve your belief in that ability is to actually have some success in reaching specific goals.

When you self monitor, you begin to notice barriers and challenges to changing your behavior. Too often we rely on negative self-judgment to motivate us and in so doing, fail to see real barriers to change. Self monitoring requires that, rather than beating yourself up for not reaching a goal, you attend to your own individual experiences.

Christy Matta goes on to say, some employers now offer low-priced, onsite fitness facilities for exercising. Others offer cash. To that I would add that some health insurers offer incentives like gift cards or health-club-membership discounts when you exercise regularly, and some offer insurance premium discounts.

Cognitive behavioral experts will warn you, declining adherence to a program of change typically occurs at 4 to 6 months. I will personally attest that exercise can lose its shine and feel humdrum, particularly when I lose sight of a meaningful goal and competing interests or distractions threaten to interfere. Be on guard, and if something pulls you away from exercise, don’t get down on yourself. Instead, reflect on what this says about you and then take this new insight back to exercise, perhaps approaching it differently.

Read other entries in this seriesDownload a pdf of the entire Exercise as a Pill series.

John SandgrenJohn Sandgren is a recent Evolve grad and a member of the Vital Aging Network’s Wellness 50+ Design Team. We are pleased to have his contribution to our knowledge base about how to age well.



1 Thompson P, Franklin B, Balady G, et al. Exercise and Acute Cardiovascular Events, Placing the Risks into Perspective. A Scientific Statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 2007; 115:2358.

[2] Matta C. Cognitive Behavioral Strategies for Losing Weight that Work.

Dec 082014

This is the sixth of a series related to physical fitness entitled: Think of Exercise as a Pill that Promotes Long Life and a Whole Lot More.

Young instructor is helping to an elder man

Aerobic Exercise has been our focus thus far in this series and it certainly has the most data documenting its health benefits, but there are 3 other important areas of physical capacity to consider as you design your exercise program.

Strength Training is important for everyone, and for adults with osteoarthritis, it may be of primary importance. HHS makes the following recommendation in its 2008 Physical Activity Guidelines:1

“Adults should do muscle-strengthening activities that are moderate or high intensity and involve all the major muscle groups on 2 or more days a week… . Muscle strengthening activities provide additional benefits not found with aerobic activity. … One set of 8 to 12 repetitions of each exercise is effective, although two or three sets may be more effective.”

The term “major muscle groups” means arms, shoulders, torso (chest, abdomen, back), hips, and legs. For adults 65 and older, some experts offer a slightly different recommendation: 10 to 15 repetitions per set rather than 8 to 12.[2] More repetitions, of course, necessitates the use of slightly lighter weights, which harkens back to what was said in Part 5 of this series, namely that most older adults should focus on moderate rather than vigorous activity.

Muscle strengthening for the arms and shoulders can start with home-made equipment like soup cans or empty milk jugs filled with sand, but other muscle groups will require other equipment. Don’t start with weights that are uncomfortably heavy and don’t assume that every weight machine in a fitness club is safe to try. A wise person will not imitate the technique of just anyone in the weight room; most people use weight equipment incorrectly. Moreover, exercises that may be safe for the very young or the very strong may not be safe for you. Coaching for the beginner by an experienced fitness instructor or physical therapist can be invaluable, and such experts may teach you to strengthen important muscles you didn’t know you had.

Train regularly, train consistently, and be patient. Setting incremental goals and noting your progress may relieve some of the boredom that comes with weight training. Remember, you are preventing and/or treating disability.

Balance Training appears effective in reducing the risk of falling, but guidelines on balance training are not yet well-developed. The HHS Guidelines say:

“Older adults should do exercises that maintain or improve balance if they are at risk of falling. … Reduction in falls is seen for participants in programs that include balance and moderate-intensity muscle-strengthening activities… .”

Chapter 5 of the HHS Guidelines describes a few simple balance exercises and supports the contention made in Part 2 of this series that muscle strengthening enhances the benefits of balance training.

A medical provider, physical therapist, or fitness instructor can design balance exercises to suit you. Properly done, these exercises will test your nervous system so Steve Rukavina, former Evolve participant and tai chi instructor, suggests focusing and relaxing: “Start with calm as you begin balance work. Quietly exhale your breath. Exhaling is easy, like the falling of a feather, and when you exhale fully, you will naturally inhale more deeply. Use a chair for support if you’re unsteady. As you develop strength and stamina, move away from the chair. Gently push out of your comfort zone. Your balance program should progress and have incremental goals.”

Flexibility is the fourth and final capability. Medical science has yet to prove any health benefits from flexibility exercises, but most likely this just means they haven’t been looked for. Common sense would say good flexibility of the body helps minimize injury in situations like falls and car accidents, and flexibility is certainly helpful for dancing, playing with the grandkids, picking things up off the floor, and seeing who or what is behind you. Flexibility exercises involve stretching, bending, and twisting. Use good judgment at the outset and proceed incrementally. Some people can bend over and touch their toes without thinking about it while others are doing well to reach their knees; both are acceptable starting points. The HHS Guidelines say:

“Older adults should maintain the flexibility necessary for regular physical activity and activities of daily life. When done properly, stretching activities increase flexibility.”

Exercise experts do recommend that stretching, bending, and twisting be done for at least 10 minutes twice a week, but even better is doing this each day following aerobic or muscle-strengthening activity when the muscles are warm.[2] Muscles shorten when used and metabolic waste products like lactate build up. Stretching muscles after exercise restores them to resting length and facilitates removal of the waste products. Stretching and walking around also facilitates proper constriction of dilated peripheral arteries and gradual return of blood to the central circulation, and a fuller reduction in resting heart rate is achieved compared to ceasing exercise abruptly without cool-down.

How much time you spend cooling down after aerobic or muscle-strengthening activity depends on just how hard you exercised; 10 minutes is standard practice for many. But be careful; when you stretch, there should be no bouncing, no pulsing of the muscles, not into the stretch and not during the stretch. Go gradually and steadily, and hold each maximal stretch for 10-30 seconds before slowly letting up.

A 5 or 10-minute warm-up preceding moderate or vigorous exercise is also advisable. Go easy here because the muscles are cold. Gently shake your muscles as you move about; loosen your muscles and joints with slow, exaggerated motions; and stretch lightly, forcing nothing. Blood flow to the muscles will increase, as will heart rate and breathing rate, before the more strenuous exercises to come really bump them up.

Read other entries in this seriesDownload a pdf of the entire Exercise as a Pill series.

John SandgrenJohn Sandgren is a recent Evolve grad and a member of the Vital Aging Network’s Wellness 50+ Design Team. We are pleased to have his contribution to our knowledge base about how to age well.



[1] Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans. Hyattsville, MD: U.S. Department of Health and Human Services 2008.

[2] Nelson M, Rejeski W, Blair S, et al. Physical Activity and Public Health in Older Adults, Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007: 116:1094.

Nov 302014

This is the fifth of a series related to physical fitness entitled: Think of Exercise as a Pill that Promotes Long Life and a Whole Lot More.

Getting older

If you panicked in Part 4 as you read how much aerobic activity the HHS Guidelines call for, why not begin your exercise program at an easier level and then advance in progressive increments? Use the HHS Guidelines as a goal. Chapter 6 of the Guidelines, under “Increase Physical Activity Gradually Over Time,” offers tips on deciding the pace at which to advance. But make no mistake, once you’ve developed (or now possess) reasonable physical capability, HHS is recommending that you do the level of aerobic activity they’re calling for, regardless of whether you are middle-aged, older, or much older. Just remember, if you’re not fully fit as you begin, start comfortably and wisely and keep advancing by appropriate amounts. Fitness trainers will tell you, exercising consistently, regularly, and frequently is vastly more important than how much you exert yourself on any one day or few days.

Each person really should begin by thoughtfully designing an exercise program that identifies every type of activity to be done, the level of effort at which it will be done, and the duration of that effort. Also identify how, when and where each activity will be performed and how often it will be performed per week or per month. It is particularly important that older adults make a plan like this. Design your program with disease prevention in mind; even if you already have one or more chronic medical conditions, you need preventative exercise to reduce the risk of acquiring another condition.

Therapeutic exercises may also need to be added your program. They sometimes differ from preventative exercises but are important for people with certain medical conditions. People with heart disease, lung disease, osteoarthritis, low back problems, and many other conditions can be helped immensely with properly-designed exercises. Therapeutic exercises are typically prescribed by a medical provider, and sometimes they are best taught by a fitness instructor or physical therapist.

Generally speaking, a medical evaluation prior to initiating exercise is not necessary for individuals who feel well and are at low risk for coronary heart disease, but such an evaluation should be done if you have any significant chronic condition affected by exercise. See your provider if you have heart, lung, or kidney disease, or a neurological condition, or if you have 2 or more factors like elevated cholesterol, hypertension, smoking, or diabetes that put you at risk for coronary heart disease. Also see your provider if you are taking medication for hypertension, heart disease, or diabetes. And finally, get checked out before exercising if you’ve had a close family member who suffered a heart attack or sudden death before age 60 or who was diagnosed with coronary heart disease before age 60.1

There are occasions and conditions where people should temporarily avoid exercise – for example, deep vein thrombosis (deep blood clots), certain retinal diseases like retinal detachment, and of course, recent surgery.

When adults with medical conditions or disabilities choose activities suitable to their abilities, physical activity is almost always safe. Safest, of course, are moderate-intensity, low-impact activities. Injuries can and do occur but they are infrequent; most are musculoskeletal injuries from overuse or excessive straining. Heart attacks have occurred during exercise but are actually quite rare. The HHS Guidelines tell us that inactive people who gradually advance over time to moderate-intensity exercise have no known risk of sudden cardiac events and a very low risk of bone, muscle, or joint injuries. As a rule, older adults should concentrate on doing moderate-intensity exercises and leave high-intensity routines for those who have exceptional fitness, experience, and knowledge of exercise.

A related point to stress here is that people should avoid sitting continuously for long periods of time. A recent Minneapolis StarTribune issue headlined recent research by proclaiming, “…living a sedentary lifestyle is as dangerous as smoking, especially for older Americans….”[2]  Carol Garber, Ph.D. of Columbia University was reported as saying just a short duration of inactivity can affect muscles adversely.

Indeed, health experts are now saying that while it’s important to meet exercise recommendations, it’s also important to keep moving throughout the day. Light activities aren’t aerobic but they do good things for your muscles. Look for opportunities to do at least light activities in a way that breaks up periods of sitting – household chores, walking about, and even standing instead of sitting all help.

It comes down to this – some exercise is better than none. HHS stresses in its Guidelines: Every adult should avoid inactivity. Adults participating in any amount of physical activity gain some health benefits. One large study in Taiwan showed that individuals engaging in brief physical activity (15 minutes daily or 90 minutes weekly), even though the activity didn’t quite reach moderate intensity, still had a 14 percent reduction in all-cause mortality and a three-year longer life expectancy than inactive individuals.3

Bottom Line: Avoid being sedentary!

Read other entries in this seriesDownload a pdf of the entire Exercise as a Pill series.

[1] Peterson D. Overview of the Risks and Benefits of Exercise. UpToDate, Wolters Kluwer Health. August 20, 2014.

[2] The Good Life. Minneapolis Star Tribune, Wednesday, Oct 22, 2014

3 Wen C, Wai J, Tsai M, et al. Minimum Amount of Physical Activity for Reduced Mortality and Extended Life Expectancy: A Prospective Cohort Study. Lancet 2011; 378:1244.


Nov 242014

This is the fourth of a series related to physical fitness entitled: Think of Exercise as a Pill that Promotes Long Life and a Whole Lot More.

Senior man riding a bikeThe answer to the question posed here depends entirely on how fit and agile you are. The exercise program you design should be based on health guidelines but tailored to you.

In 2008, the U.S. Department of Health and Human Services (HHS) published its Physical Activity Guidelines for Americans1 and they are excellently written. They agree substantially with independent recommendations by the CDC, the American Heart Association (AHA), and the American College of Sports Medicine (ACSM). I will summarize the main points but I encourage you to go to and read the chapters that apply to you. They are concise and easy to read, and six years after publication they remain the standard. The footnote below gives instructions on how to access these Guidelines.

Aerobic capacity (endurance) is built by activities like walking, jogging, dancing, swimming and cross-country skiing, where people move their large muscles rhythmically for sustained periods. The 2008 HHS Guidelines state:

“For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week. … A general rule of thumb is that 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity.”

Let’s explore what this recommendation means. Physical activity for more than 10 minutes can qualify as aerobic if it’s done at sufficient intensity. Light activity like self care, cooking, or casual walking does not qualify. Moderate-intensity activity will not qualify if it’s done for less than 10 minutes, so walking around the home or office or walking in from a parking lot usually isn’t aerobic. However, some physically-active occupations may count as aerobic and so can active transportation choices like walking or bicycling.

So what is moderate-intensity exercise? For middle-aged adults free of functional limitations, the definition is fairly arbitrary. It’s walking briskly (3 or more miles per hour [mph]) but not race-walking. It’s water aerobics, general gardening, bicycling at less than 10 mph, doubles tennis, hiking, walking as you carry your golf clubs, mowing the lawn with a push mower, or jogging at less than 6 mph. The cardio equipment you find in health clubs (elliptical machines, stair-climbing machines, stationary bicycles, and treadmills) can also provide moderate-effort exercise.

Of course, vigorous exercise is more intense. It’s race-walking or running at more than 6 mph. Racquetball, singles tennis, stair climbing, heavy gardening like continuous digging or hoeing, bicycling at more than 10 mph, rope jumping, calisthenics (jumping jacks, push-ups, pull-ups, sit-ups), and team sports can also be vigorous forms of exercise.

But, adults do differ in their exercise capacities and these differences are most apparent in older adults. Moderate effort is a brisk walk for some and a slow walk for others. So for adults 65 and older and for adults of any age with functional limitations, HHS advises getting away from arbitrary definitions of effort and using an effort scale that relates to an individual’s aerobic capacity. Intensity can be estimated using a scale of 0 to 10, where no effort is 0 and 10 is the highest level of effort possible. On this scale, moderate-intensity activity is a 5 or 6 and vigorous-intensity activity is a 7 or 8. Be careful though because subjective perception of effort is not a precise measure of true effort. If there is uncertainty, a fitness instructor can guide you on the appropriate level of effort. In general, when people expend moderate effort, they are unable to sing and when people exercise vigorously, they are unable to utter more than a few words between breaths.

Notice that, according to HHS, aerobic exercise can be performed for short periods several times a day and integrated into the course of one’s daily schedule; the focus is on total aerobic activity. By making no mention of measuring heart rate, the Guidelines keep things simple. Studies, in fact, have shown that the benefits of exercise can be readily obtained without setting or achieving goal heart rates.[2]

Notice also that the recommendations above are considered minimal – that is, the minimum most adults need to really benefit from exercise. Not all the health benefits of exercise occur at this minimum level, so the HHS Guidelines go on to say:

“For additional and more extensive health benefits, adults should increase their aerobic physical activity to 300 minutes (5 hours) a week of moderate-intensity, or 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity.”

Chapter 4 of the Guidelines, under “How Much Total Activity a Week?” lists the additional health benefits achievable with this doubling of aerobic activity.

The upper limit of exercise, beyond which no significant benefits accrue, is not known. Upon making its recommendation for 300 minutes of moderate exercise weekly or 150 minutes of vigorous exercise weekly, HHS goes on to add:

“Additional health benefits are gained by engaging in physical activity beyond this amount.”

One way to achieve the benefits of higher-intensity activity may be with interval exercise and this has become quite popular recently. One example would be high-intensity interval walking, such as repeated three-minute sets of high-intensity walking (basically race-walking) alternating with three-minute sets of low-intensity walking. High-intensity interval training has been found to have several short-term physiologic benefits when compared to steady-tempo training, including improved cardiorespiratory fitness. However, the long-term health effects of high-intensity interval training are not known and there is more potential for injury with high-intensity exercise.[3]  The research is still preliminary. Varying the pace of your aerobic workouts may be beneficial, but it is perhaps best to avoid extreme changes in tempo.

Suggestion: Remembering the relative-effort scale, pay attention this week to whether you’re doing any aerobic activity that truly qualifies as moderate or vigorous. Then estimate how many minutes of that activity you do in a typical week.

Read other entries in this seriesDownload a pdf of the entire Exercise as a Pill series.

1 Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans. Go to In the middle of this page, there are 6 boxes arranged 3×3. The lower left box is labeled “Physical Activity Guidelines.” Click on “Learn more” and you’ll be taken to another page with 5 boxes in the middle. The box on the left of the second row has the heading “Guidelines.” Click on that heading and you’ll be taken to the index of the 2008 Guidelines. Chapter 4 on Active Adults and Chapter 5 on Active Older Adults are essential reading. You can also write to: The U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. Toll Free: 1-877-696-6775.

[2] Douglas P. Exercise and Fitness in the Prevention of Cardiovascular Disease. UpToDate, Wolters Kluwer Health. August 29, 2014.

[3] Peterson D. Overview of the Risks and Benefits of Exercise. UpToDate, Wolters Kluwer Health. August 20, 2014.

Nov 172014

This is the third of a series related to physical fitness entitled: Think of Exercise as a Pill that Promotes Long Life and a Whole Lot More.

Vegetable gardenIn parts 1 and 2, we learned that regular exercise delays death for many people and enhances quality of life in many wonderful ways. But surely for the very old and for individuals in very poor health, there can’t be much point in exercising, right? Doesn’t “the perfect life” imply gently fading away in a rocking chair?

Well, the Centers for Disease Control and Prevention (CDC) in Atlanta, along with other research institutions including the University of Minnesota, studied exercise in a large group of older women in the 1990s, asking them how far and how vigorously they walked each day and how often they danced or gardened, did aerobics or swam.1 The average age of these women was 77 years at the beginning of the study. The researchers found that those women who were sedentary at the start of the study but began exercising regularly during the 10-year observation period reduced their risk of death from all causes by 48 percent. In their data analysis, the researchers classified these women into groups according to overall health, ranging from good health to poor health, and found that basically this 48 percent reduction in mortality rate held true for every one of these health groups. This piece of evidence and many others like it have shown that regular exercise not only prevents chronic diseases like heart disease and diabetes, it also benefits people who already have these diseases, even people in poor health.

These same researchers went on to find that recent physical activity was a more important predictor of longevity than past physical activity. Sedentary women who became active over the course of the study had mortality rates similar to those who had exercised all along, and women who stopped exercising during the study had mortality rates similar to women who had been sedentary all along. This means that, in this trial, ongoing exercise was important for longevity.

Many studies published over the last 10 years have shown the benefits of exercise for both men and women in their 70s and 80s. An observational study from Pennsylvania and Tennessee in 2006 recruited men and women ages 70-79 and looked at all kinds of physical activity, not just dedicated exercise activity.2 This study found that any physical activity, if sustained for some period of time, helped lower mortality rates. It didn’t need to be dedicated exercise; any physical activity helped. These researchers estimated from their findings that 1 ¼ hours of physical activity per day doing things like vacuuming, mopping floors, washing windows, caring for children, and walking 2.5 miles per hour would reduce mortality rates by 30 percent. And this reduction in mortality was just as apparent for people who had heart disease, vascular disease, lung disease, and diabetes, and also for people who were current or former smokers. As you might expect, these researchers showed that increased activity produced increased benefits.

The medical benefits of regular exercise appear to start accruing after about 1 year. Even individuals who have been previously sedentary but who initiate exercise as late as age 85 demonstrate a significant survival benefit in three years in comparison to individuals who are sedentary. 3

Read other entries in this seriesDownload a pdf of the entire Exercise as a Pill series.

1 Gregg E, Cauley J, Stone K, et al. Relationship of Changes in Physical Activity and Mortality Among Older Women. JAMA 2003: 289:2379.

2 Manini T, Everhart J, Patel K, et al. Daily Activity Energy Expenditure and Mortality Among Older Adults. JAMA 2006; 296:171.

3 Morey M. Physical Activity and Exercise in Older Adults. UpToDate, Wolters Kluwer Health. October 20, 2014.

Nov 102014

This is the second of a series related to physical fitness entitled: Think of Exercise as a Pill that Promotes Long Life and a Whole Lot More.

Woman doing qi gong tai chi exerciseAs I discussed in part 1 of this series, regular exercise prevents death and that’s certainly a wonderful benefit, but exercise also does a whole lot more. It imparts physical strength and stamina. It boosts energy levels and combats fatigue. Regular exercise has been shown to significantly reduce the risk of developing heart disease, chronic lung disease, high blood pressure, and type II diabetes. People with high blood pressure can safely exercise, provided their hypertension is controlled reasonably well, and regular exercise tends to lower blood pressure over time. Exercise can also prevent and treat obesity when combined with a weight loss diet; and exercise reduces the risk of osteoporosis, when it’s walking or jogging or a similar activity that gently jars the bones.

One of the great benefits of exercise is relief of stress and anxiety. Sleep improves. People suffering depression are helped, and some preliminary evidence suggests the risk of dementia and cognitive decline in older persons may lessen.

Many kinds of exercise promote balance and flexibility. Yoga and tai chi (also called tai chi chuan) are two examples. Combine balance work of this type with exercises that strengthen large muscles (legs, hips, torso [chest, abdomen and back], shoulders, and arms) and your risk of falling and injuring yourself will drop significantly. Randomized studies have shown that tai chi reduces the risk of falling in older people. Researchers have studied tai chi because it needn’t be strenuous, older people can perform it, and it utilizes sound principles of movement and posture.

One such randomized study from Connecticut demonstrated that tai chi did indeed help study subjects 75 years and older maintain balance skills, but the results suggested further that resistance exercises in combination with tai chi might do even better.1 The likely reason for the added benefit of resistance exercises is that, inevitably, sooner or later, people lose muscle mass as they age. Skinny legs and hips and weak backs and abdomens lead to more falls. Resistance training, where you exert your muscles against weights, springs, or elastic bands, increases both muscle strength and mass and slows down this loss. Pilates and weight-lifting are two good examples of resistance exercise and, quite honestly, it’s inspiring to see an 80 or 90-year-old suited up and working at a weight machine. Doing resistance exercises correctly and safely can be achieved with a few lessons from a fitness instructor.

Regular exercise has been shown to increase success rates for people who are trying to quit smoking. Exercise can help people who suffer from conditions of chronic pain, as in osteoarthritis. Regular exercise modestly reduces the risk of certain cancers like breast and colon cancer, and also endometrial, prostate, and pancreatic cancer. Furthermore, survival in persons who have these cancers is also improved by regular exercise.[2]

Exercise can be a stimulating social experience. Walking groups, fitness clubs, aerobic classes, ballroom dancing, and group classes for seniors can be social, informative, and motivating. And regular physical activity has been shown to improve the ease with which 70 to 78-year-olds perform activities of daily living (ADLs) and to increase the percentage of 78 to 85-year-olds who are still able to perform their ADLs independently.[3]

Chances are you’ve heard of some additional benefits with exercise, but here’s one you may not have heard: gallstones are less likely to cause trouble in people who exercise and happen to have gallstones in their gallbladders.

Read other entries in this seriesDownload a pdf of the entire Exercise as a Pill series.


[1] Wolfson L, Whipple R, Derby C, et al. Balance and Strength Training in Older Adults: Intervention Gains and Tai Chi Maintenance. J Am Geriatr Soc (Journal of the American Geriatrics Society) 1996; 44:498.

[2] Peterson D. Overview of the Risks and Benefits of Exercise. UpToDate, Wolters Kluwer Health. August 20, 2014.

[3] Stessman J, Hammerman-Rozenberg R, Cohen A, et al. Physical Activity, Function, and Longevity Among the Very Old. Arch Intern Med (Archives of Internal Medicine) 2009; 169:1476.