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.
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.
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….” 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.
Bottom Line: Avoid being sedentary!
 Peterson D. Overview of the Risks and Benefits of Exercise. UpToDate, Wolters Kluwer Health. August 20, 2014.
 The Good Life. Minneapolis Star Tribune, Wednesday, Oct 22, 2014
 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.