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“I consent to voluntarily  engage [emphasis added] in an exercise test to determine the state of my heart and circulation and to evaluate the ability of my heart to respond to stress. The test will be performed on a treadmill, with the amount of effort I must expend increasing gradually.  The increase in effort will continue until symptoms such as fatigue, shortness of breath or chest discomfort appear and indicate to me that I should stop the test. I understand that the possibility exists that during the test I could experience abnormal blood pressure, fainting or heart beat irregularities.  I further understand that there is, in a rare instance, the possibility that I could suffer a heart attack [emphasis added], or an even remoter possibility that I could die [emphasis added].  However, I am advised that emergency equipment and trained personnel will be available to deal with any unusual situation which may arise. Notwithstanding the foregoing, I agree to proceed with the test and not hold the diagnostic center or the personnel involved responsible if subsequent  life-threatening events or injury results.”
 

Amen.

to be continued next week…

 Vadim Vilensky

Flexibility is probably the most neglected aspect of fitness. Observations show that even people who exercise on a regular basis are not stretching enough. By definition, flexibility is the ability of the joint or series of joints to move through their full range of motion.

Flexibility is important in sports (gymnastics, golf) and the performing arts (ballet), as well as in the ability to carry out the activities of daily living. Aging and inactivity contribute to the loss of flexibility over time. Reductions in the joint’s range of motion affect our mobility and balance, which impacts our routine physical functioning status. According to the American College of Sports Medicine, it is important to maintain flexibility in the lower back and posterior thigh regions. Lack of flexibility in these areas may be associated with an increased risk of developing chronic lower back pain.

Decreased flexibility can also lead to postural changes such as shortened pectoral muscles (chest), which pulls the shoulders in and down leading to a round-shouldered condition.

The Center for Disease Control and Prevention has identified the need for adults to perform flexibility exercises, preferably daily. There are a few ways to stretch. Perhaps the simplest one is a static stretch. With this technique the risk of injury is low, and it requires little time and assistance. It is performed in a slow, sustained manner, holding the stretch at a point of mild discomfort for 30 seconds. The stretch should be felt in the muscle, not the joint.

Proprioceptive neuromuscular facilitation stretching (PNF) involves a combination of alternating the contraction and relaxation of opposite muscles through a series of motions. Research has suggested that PNF stretching produces the greatest improvements in flexibility. These stretches usually require a partner trained in the technique. Ideally, they should be done with your coach or personal trainer.

Ballistic stretching uses the momentum created by repetitive bouncing movements to produce muscle stretch. This type of stretch can result in muscle soreness or injury if the forces generated by the ballistic movements are too great.

Yoga, Pilates, and Tai Chi movements may also be used to improve flexibility.

It is a general recommendation to warm up muscles before stretching them. A study published in The Journal of Strength and Conditioning Research by a group of scientists from the University of Texas demonstrated that the best time to stretch for improved flexibility is right after a workout. PNF stretching after exercise significantly improved hamstring flexibility in a group of college athletes who participated in this study.

Flexibility training should be balanced with strength training to prevent connective tissues from becoming too loose and weak, subjecting them to damage through overstretching, or sudden, powerful muscle contractions.

Very often fitness instructors and coaches incorporate static stretches into a warm up routine. However, there are a number of studies that show that static stretches before exercise or competition can DECREASE performance and INCREASE the risk of injuries. There are numerous studies that demonstrated negative impact of static stretching on jumping and running performance, and even reaction time and balance.

Post-exercise stretching helps to relax and can create the sense of rejuvenation. Dr. Michael Yessis states that after completing a workout, the nervous system continues to contract muscles, and does not allow them to completely relax. Stretching will help to relax the muscle and accelerate recovery.

There is one study published in October 2007 involved 38 sedentary adults. The subjects in this study were performing static stretches for all major muscle groups of lower extremities.  They were stretching 40 minutes 3 times per week. There were no other exercises performed by any participants. After 10 weeks all participants gained strength and endurance in legs muscles they were stretching. These results suggest that people who are not able to participate in traditional strength training activities may be able to gain strength and endurance through stretching, which make them able to transition into more traditional exercise program.

   Paul Jason

Chapter 1: Every Journey Has a Beginning
It was a clear, dry March day in New York, the type so much appreciated as the cold of Winter begins to recede into the warmth of Spring.  After a light lunch, leisurely eaten at my desk as I surfed the Internet to learn the latest world and local events, I grabbed my attache case and began the two-block walk to my car.  I was on the way to an appointment that afternoon and the case, together with the documents contained within, weighed about fifteen pounds.  A two-block  walk carrying a fifteen-pound attache case was a non-event for me prior to that day.  But, on that particular day, as I walked towards my car, I began to experience a sensation that I can best describe as “slight indigestion” in my upper chest, which I immediately recognized as being unlike any other indigestion I had ever experienced.  It wasn’t located in the abdomen (isn’t that where upset stomachs are supposed to strike?).  And it  wasn’t a sharp pain in the chest (isn’t that what heart attacks are supposed to feel like?) No, this was different, and I knew it.
Upon reaching my car, I placed the attache on the rear seat, and sat down in the driver’s seat.  Within a minute, the unusual sensation was gone.  Cause for concern?  I didn’t know.
My appointment was uneventful - - I negotiated the short distance to and from my parked car with no difficulty; but, when I returned to my hometown, parked my car in its usual spot, and began the two-block walk back to my own office, I once again experienced this unusual upper chest sensation.  And, once again, when I sat down for a minute, it went away.
Much to my chagrin, I experienced that sensation several times during the next few days, each time while carrying relatively light objects.
Thus I decided it was time to visit my primary care physician to investigate further.
Now, my doctor is, I believe (based upon recommendation and experience) a  competent and concerned internist.  At the time of our first meeting in September, 1995, he wrote down in great detail not only my medical history, but the medical histories of both of my parents and my three siblings.  In the approximately five years that he had been attending to my health needs, he had demonstrated genuine concern  for my  welfare, and undistracted attention to my medical complaints.
 
On this occasion, he conducted a rather thorough examination, including  blood pressure, pulse, reflexes, electrocardiogram (ECG), and drew blood for lab tests.  At the conclusion of the exam, he advised me that he had found nothing out of the ordinary compared to my prior records.  However, he indicated that based upon my family history of heart disease he thought it advisable to have a cardiologist examine me. I was quickly referred to a local, recognized cardiology group.
 
I had never before met the cardiologist with whom I consulted, although I was casually familiar with one of his partners. The group of five doctors had a good reputation, and this particular physician was pleasant, direct and professional.  Looking lean and fit, this forty-something young man, a graduate of the Albany Medical College, with specialty training at  Mount Sinai Hospital and Montefiore Medical Center, both in New York,  took a medical history from me and proceeded to conduct a physical examination similar to the one I had received from my internist.  One of his staff assistants also performed an electrocardiogram. At the conclusion, the cardiologist stated that he had not detected anything significant, but that my family history was sufficient to merit further investigation. He indicated that his preference was to have me undergo a non-invasive test before recommending an invasive one.  Therefore, he scheduled a nuclear stress test for me, to be conducted right there in his suite of offices, within a matter of days.
The purpose of a stress test of the heart is to ascertain whether the heart muscle receives sufficient blood when it has to exert itself.  A normal heart is capable of increasing its output (measured by the volume of blood pumped per minute) to several times its usual output when it is stressed.  The goal of the test is to provoke the heart to boost its output.
  
The “nuclear” part of the test refers to the use of either thallium or sestamibi, radioactive substances (isotopes).  When introduced into the bloodstream, these substances collect in those portions of the heart muscle that have good blood flow.  If one of the coronary arteries is blocked or partially blocked, less of these substances accumulates in the portion of the muscle supplied by that artery.
For those not familiar with the procedure, it is a test in two parts.  In part one, the radioactive isotope is injected into the patient and allowed to circulate for about an hour.  Then the patient is placed in a horizontal position while a special camera (it looked like an x-ray machine to me) takes “pictures” of his heart for about twenty minutes from a variety of angles.  These images provide a baseline profile of the blood flow in and around the heart.  This is the “rest” part of the test.
The second  part of the test consists of  the patient  being  hooked up  to an
electro-cardiogram machine and placed on a treadmill or stationary bicycle.  A blood pressure cuff is placed on one arm.  Sometimes a little sensor is clipped onto the tip of an index finger to measure the amount of oxygen in the blood.  The patient is asked to commence exercise and to continue while the energy demands are gradually increased.  The patient is expected to continue for as long as he is capable, or until a predetermined peak heart rate is achieved. Usually, there is a point at which the patient can no longer keep up because of fatigue, or because symptoms such as chest pain, shortness of breath or lightheadedness occur. This is the “stress” part of the test.
At that zenith - - the maximum level of exercise - - the isotope is once again injected into the body and the patient is allowed to come to rest.  Throughout the procedure the patient’s heart rate and blood pressure are monitored.  At the conclusion of the stress portion of the test, images are again taken of the patient’s heart from a variety of angles, allowing for an analysis of the flow during both rest and at the point of maximum exertion. Thus, the use of  thallium or sestamibi greatly increases the accuracy of the stress test in diagnosing coronary artery disease.
The test can also measure the functional capacity of the patient. If, for example, signs of ischemia (insufficient supply of oxygenated blood to the heart) occur at a low level of exercise, the arterial blockages are likely to be significant.  On the other hand, if ischemia does not occur, or if it occurs only at high levels of exercise, the blockages are likely to be less significant.
Since exercise also raises the level of adrenaline, a stress test can be an aid in diagnosing certain cardiac arrhythmias that tend to occur when adrenaline levels are elevated.
The level of exercise to which the patient is exposed is based upon a carefully calculated scale, known as the Bruce Protocol.  Robert Bruce was the developer of the standardized treadmill test for diagnosing and evaluating heart and lung diseases. The Bruce Protocol, a multi-stage test, was first introduced in 1963.  The Protocol consists of seven stages, each lasting three minutes.  During each stage the treadmill moves at a pre-set speed and pre-set elevation, as shown on the following chart:

                                            
It is estimated that about 70% of the millions of stress tests currently performed annually in the United States to evaluate heart function use this protocol.
 

Of course I didn’t know all of this when I had my test.  I did know that the exercise would be performed on a treadmill. And, this particular medical group prefers to conduct the two parts of the test on different days.  This was contra to the procedure followed in the two similar stress tests I had undergone during the prior twenty years (at approximately 10 year intervals).
 

I was surprised, and more than a little concerned, to learn that the treadmill test was to be administered by a Nurse Practitioner, not an M.D.  Of course, I was advised, one of the cardiologists in the group would be present “somewhere in the suite” of offices during the test, but the Nurse Practitioner would actually be the one to conduct it.
 

I wasn’t familiar with the title “Nurse Practitioner”.  I knew that there were Registered Nurses (”RNs”) and Licensed Practical Nurses (”LPNs”) around; but, what was a Nurse Practitioner (”NP”)?   I subsequently learned that a lot of other people are not familiar with the term either.  I wasn’t particularly comfortable with the idea that anyone less than a licensed  physician would be in charge of a test that I knew begins with the patient signing a disclaimer form stating that he knows that there are potential risks involved with the procedure, including the possibility of heart attack or stroke.  Nevertheless, anxiety over a determination of the status of my health prevailed and I submitted to the ministrations of the NP.
 

Later, when I had the time to make inquiry I learned that she has more experience and ability to administer that test than most cardiologists do.
 

But I must return to the stress test itself, which was conducted on Friday, March 17, 2000: St. Patrick’s Day. (Whatever happened to those St. Patrick’s Days when I celebrated with corned beef and cabbage, boiled potatoes, lots of mustard, Irish soda bread and just enough beer to wash the whole, happy meal down???).  For a few minutes, with the NP and a young RN present, I seemed to be doing well.  Then, my worst fears were realized;  I began to feel the same discomfort in my upper chest that had brought me to this moment to begin with.  I immediately advised the NP and the “stress” portion of the test was terminated shortly thereafter, but not before the isotope had been introduced into my body. Afterward, with the aid of that isotope pictures of my heart were taken from a variety of angles. I was advised to call the cardiologist on the following Monday afternoon for the results.
 
Needless to say, I spent a very apprehensive weekend wondering what, if anything, was wrong with me.  Afraid to exert myself lest I unintentionally trigger a heart attack, I nevertheless continued to mull over in my mind my actions over the past several years: moderate exercise; low fat/low sodium diet; medication to successfully lower my cholesterol; regular blood tests to oversee all of this; a diet high in fruits and vegetables; and periodic medical check-ups to monitor my general health.
 

At the appointed hour, I called the cardiologist=s office.  He informed me that he detected some “abnormality” from the results of my stress test and recommended that I  undergo cardiac catheterization. He advised me that one of his partners routinely  performed these procedures and that he could arrange to have it performed at either Columbia- Presbyterian Medical Center in Manhattan, or Montefiore Medical Center (Moses Division) in The Bronx.  Since Montefiore was more convenient for me, I chose to have it done there.  The procedure was scheduled for March 29^th.
 

In addition to being concerned about my health, I was also very disappointed.  I had been hoping to vacation in Costa del Sol (Spain) for more than five years, but had never  been able to actually schedule that trip. At long last, I was scheduled to leave on that vacation on March 30^th.  Ironically, compared to many of my peers, I allowed myself a meager number of days each year as vacation time, and I was particularly looking forward to this trip.  Nevertheless, prudence dictated that I not wait until March 29^th to find out if I was in good enough physical condition to leave for Europe the next day.  So, sadly, I called the travel agent and cancelled the trip. Perhaps I could re-book it, after the catheterization,  for some time in April or early May. 

to be continued next week….

  Vadim Vilensky

Medical studies have demonstrated the safety and efficacy of exercise in patients with HIV. Documented benefits include improvements in cardiorespiratory fitness, the ability to perform activities of daily living, muscular strength, lean body mass, mood, and coping behaviors. Decreases in anxiety, fatigue, and depression have also been observed.

There are conflicting reports about the effect of exercise training on immune function. Some clinical trials demonstrated improvement in immunologic function, while others have not shown a change. However, one study published in 1999 in “Annals of Epidemiology” observed delayed disease progression and reduced risk of developing AIDS in a trial group of 156 homosexual men with HIV. More studies are needed to better explain the immunologic response to exercise, but it is safe to say that exercise has no detrimental effect on immune system function.

For people with HIV, it is probably best to start a fitness program with exercise testing. Fatigue and neuromuscular complications are common during the advanced stage of HIV. Fitness tests can provide valuable information for an exercise prescription based on an individual’s exercise tolerance, balance, and coordination levels. Due to HIV related muscle wasting, a body composition analysis may be desirable.

Patients with HIV can benefit from both cardiorespiratory and progressive resistance training programs. Resistance training increases lean body weight, and improves physical appearance. It offers an effective treatment modality that may halt, and potentially reverse, the muscle catabolism due to drug therapy and the later stages of AIDS. A group of scientists in California studied the effects of resistance exercise, combined with testosterone supplementation, in 61 HIV-infected men with low testosterone level and weight loss. A report published in the “Journal of American Medical Association” found that resistance exercise promoted significant increase in muscle mass and strength.

Exercise training represents an important adjunctive therapy for people with HIV. The emphasis should be on proper technique and a consistent training schedule. Different modalities can be utilized, incorporating exercises for strength, balance, control, and coordination. Getting professional help can add motivation, track your progress more effectively, make your workout safer and more fun, and make the whole process more comfortable and convenient. Don’t let setbacks end your fitness program. Medication side effects, acute infections, and fatigue can influence your ability to exercise on any given day. Don’t overreact when something doesn’t work the way you expected. Fitness is a long-term commitment and you have to be prepared to meet some obstacles and to cope with them.

  Vadim Vilensky

A few years ago personal training was considered an expensive luxury that only celebrities could afford. Today, more and more people are using the help of professional trainers. A good trainer will make your workout more fun, increase motivation, set goals, track your progress, help to avoid injuries, get results faster, and make the whole process more comfortable and convenient. Personal trainers are also good resources for the latest information on health and fitness.

A group of scientists from The College of New Jersey conducted a study to investigate the influence of working with a personal trainer on self-selected Resistance Training Intensity.  Forty-six healthy young women were recruited from local health clubs in Pennsylvania and New Jersey. They were divided into two groups - those who were working out with a personal trainer (PT) and those who have never worked with a personal trainer (NO PT).
The results of the study showed that women who workout with a personal trainer have greater strength in major muscle groups.  The study also showed that they selected heavier weights and worked with greater exertion during their workouts.
In addition, women who never worked with a personal trainer were lifting weights that were much lighter than is recommended by major health organizations in order to improve muscular strength or endurance.
Another interesting finding was that women who use a personal trainer used free weights, such as dumbbells and barbells.  While the other group mostly used gym machines, which have limited benefitial.
More women in the NO PT group believed that resistance training will lead to large “bulky” muscles, which is a common myth despite the fact that there is no data to support it.  Fewer women in the PT group believed this myth.
Researchers concluded that the positive influences of personal trainers resulted in more educated clients and a better exercise prescription.
This study was published in “The Journal of Strength and Conditioning Research” in January 2008.

Choosing the right trainer for your needs can be a challenge. A recent survey found that there are over 62,000 personal trainers working in the United States. Unlike many other health professionals, personal trainers are not required by law to possess a license to practice. While there are about 200 certifying organizations in the United States, not all certifying agencies are the same. Some of them provide a comprehensive education and set high standards for certification. Others, just offer a weekend workshop or home study course. These provide very limited knowledge and skills for the future fitness professional. Testing levels can also vary greatly from one certifying agency to another. Therefore, being a “certified personal trainer” does not provide the credential to be a fully qualified and competent fitness professional.

Studies have been conducted to assess the possible relationship between formal education, type of certifying organization, and level of knowledge. One group of researchers identified 13 core courses that they considered important in preparing a personal trainer. These include anatomy, biomechanics, nutrition, and injury prevention. They conducted their study in the southwestern states from 1992 to 1995 and found that only those trainers certified by the American College of Sports Medicine (ACSM) or National Strength and Conditioning Association (NSCA) had completed an average of 74% of those courses. Fitness knowledge was the highest among the ACSM-certified trainers, whereas the NSCA-certified trainers were the most knowledgeable in the area of strength training. Both the ACSM and NSCA are non-profit organizations whose missions are to promote scientific research, education, and practical application of exercise science to enhance physical performance, fitness, and health.

Most recently, a survey was done by a group of researchers in southern California. They examined the relationship between commonly used indicators of knowledge in the five areas of nutrition, health screening, testing protocols, exercise prescription, and general training knowledge regarding special populations. The study revealed that a bachelor’s degree in the field of exercise science, and possession of ACSM or NSCA certifications were strong predictors of a personal trainer’s knowledge, whereas years of experience were not related to knowledge. Researchers concluded the fact that an individual who has worked for years as a personal trainer, or has met a minimum standard for passing a certification exam should not be taken as proof of competence in designing a safe and optimal fitness program. Although many believe that practical experience is key, the results of this study showed that formal education is a far better predictor of a personal trainer’s knowledge than years of experience. In addition, this study shows that certification by the ACSM or NSCA is associated with much higher levels of knowledge than certification from any other organization, or even certification from several other organizations.

Before you hire a personal trainer, the NSCA recommends that you take the time to conduct an interview to find one that best fits your needs, goals, and personality. Start by asking a few basic questions. Does the trainer have a fitness related degree? and/or Is the trainer certified by a nationally recognized organization such as the ACSM or NSCA? The results of current studies suggest that trainers who have a college degree and are certified by the ACSM or NSCA scored an average of 85% on the Fitness Instructor Knowledge Assessment, compared with only 36% for those who don’t have a college degree and certification from the ACSM or NSCA.

Other questions to ask are: Is the trainer CPR and AED certified? Does the trainer have liability insurance? Does the trainer conduct testing to evaluate your current fitness level, or perform a health screening?

A personal trainer should begin by learning about your past or current medical conditions. The trainer may also conduct fitness tests to determine a safe and effective exercise program, and set reasonable short and long-term goals. These fitness tests may be repeated every few months to assess your progress and modify your exercise prescription.

Make sure that your trainer is listening to you. Your trainer should design a program to work towards your goals, and should motivate you without intimidating you or pushing you beyond your limits. Your trainer should be prepared with a plan for each workout session. Just taking you through a line of machines and counting repetitions is not worth the money you are paying. A workout plan should show that your trainer understands your limitations, needs, and goals.

People use trainers for many different reasons. Your trainer should have experience and expertise in working with people whose goals or medical conditions are similar to yours. For instance, if you have a heart disease it would be a good idea to find a trainer who has experience working in a cardiac rehabilitation center. You may ask your doctor to recommend a trainer who specializes in working with people who have a condition similar to yours. Other ways to find a trainer are to search web sites such as www.respond.com, www.acsm.org or www.nsca-lift.org. You can conduct a free search of personal trainers in your area listing their credentials, education, experience, fees, and other information. Don’t forget to ask about fees and cancellation policies. A trainer should provide you with a written copy of all policies on fees, scheduling, and cancellations. Fees may vary depending on area, length of the session, and the trainer’s experience. A higher fee is not always an indicator of a better trainer. Some trainers offer discounts for packages or prepaid sessions.

Don’t choose your fitness professional by appearance. Just because he or she is in good physical shape does not mean that he/she can help you to achieve similar results. Assumptions like “he has only 5 percent of body fat, so he has to know something” can be misleading. Some trainers may be slim because they are spending hours working out in the gym every day; or are consuming huge amounts of supplements, which may have numerous side effects.  Finally, you should feel comfortable, and get along well, with your trainer. A trainer’s personality is important. For most people who struggle to find an hour two times a week to exercise, the concept of becoming a “gym rat” is not acceptable. The goal of the trainer should be to maximize the efficiency of your workouts and to help you to get in the best shape while spending the least amount of time exercising.

  Vadim Vilensky

How long can a muscle get?  Many Pilates and Yoga instructors promote their classes to women by telling them that traditional training will make them look bulky and saying, “You don’t want to build muscle on top of fat.”  They tell these women that their classes “…will make your muscles leaner and longer.”

A muscle is any one of the body organs consisting of bundles of cells or fibers that can be contracted and expanded to produce bodily movement.
 (Webster’s dictionary)
Muscle cells are very different from fat cells, which are also called adipose tissue.  In other words, a muscle by definition is a lean tissue. Saying that muscle will get leaner is like saying that your brain or your bones will become leaner.  

A few studies have demonstrated that the caloric expenditure during most Pilates and Yoga classes is similar to walking.  Both Pilates and Yoga can make you stronger and more flexible; as well as improve your balance, coordination, and core stability. But, if you are starting an exercise program for weight loss, these classes are probably not your best option.

As far as making your muscles “longer” - each muscle has a point of origination and a point of insertion, which defines the function of the muscle. The muscle is attached to two bones, which are brought closer together by contraction. This action produces movements in your joints.  Your muscles grow during childhood, when your bones grow. Stretching your muscles will help your joints maintain a full range of motion, but will not make them longer than its anatomical position requires.Many women say “My thighs got bigger when I started to lift weights.  So, I stopped because I don’t want bulky muscles!”  Their thighs became bulky because these women rewarded themselves with extra snacks after their workouts, which added fat to their body.

The math here is very simple – in order to burn one pound of fat you need to create a deficit of 3500 Kcalories. To build one pound of muscle you need an excess of 2500 Kcalories. If you are on a diet which creates a caloric deficit, or even keeps you within caloric equilibrium, it is virtually impossible to gain a significant amount of muscle mass. That is why athletes and bodybuilders consume large amounts of food during periods of muscle building regimens.  Strength training can make your muscles stronger without increasing in size, and is crucial during diet attempts to preserve your lean body weight. Strength training will help you lose weight by creating a caloric deficit.  The likelihood of “building muscle on top of fat” is very slim, especially for women.
   

   Vadim Vilensky

In June 2002, President George W. Bush kicked off a fitness campaign encouraging Americans to exercise and be more physically active. According to the U.S. Government fitness problems, such as obesity and overweight, have reached truly epidemic proportions in the United States. In the last 20 years, obesity rates have increased by more then 60 percent among adults. This impacts other diseases such as diabetes.

Americans should incorporate regular physical activity into their everyday lives. This does not necessarily mean joining a gym. It is sufficient to choose activities, such as walking, gardening, walking extra stairs, or mowing a lawn with a push mower, that fit into your daily routine. The Public Health Department’s recommendation is to accumulate 30 minutes of moderate physical activity, such as brisk walking, on most if not all days of the week. That is to say, a person can do a few bouts of physical activity or exercises throughout the day. This approach makes it easier to fit exercise into the  busy day of a working person.

Walking is the most popular leisure time activity. Some people walk intentionally for exercise or fun. For others, it’s just part of their daily activities at work or home. But how does the one accurately measure the accumulative walking a person does in a day? Some people try to count time or distance. A few recent studies have shown that using a pedometer is a convenient way to measure the daily amount of physical activity. A pedometer is a small device (the size of a pager or smaller) that counts the number of steps a person takes during the day. Pedometers are inexpensive and very convenient devices that can easily attach to your waistband or belt.

How many steps is enough? Research shows that for the average person 10,000 steps equals 300 kcals (kilocalories) of energy expenditure. Studies have demonstrated that people who spend about 2,000 kcal per week exercising have lower morbidity and mortality rates. If you multiply 300 kcals per day times 7 days a week, it would yield a weekly caloric expenditure of 2,100 kcal. Expending 2,100 kcal per week will significantly reduce your risk for cardiovascular disease and many other illnesses or problems related to inactivity. Dr. Yoshiro Hatano from Kyushu University of Health and Welfare in Japan has spent over two decades researching the use of pedometers. He reports that an average Japanese family has two pedometers. “Walk 10,000 steps per day to overcome inactivity” has become a very popular slogan that helps to improve the level of physical activity among people in Japan.

A study by Dr. Moreau and colleagues at the University of Tennessee in Knoxville showed that increasing daily walking by just one or two miles may be effective in lowering high blood pressure in postmenopausal women. As a result of walking 4,300 more steps (about 1.8 miles per day), the participants of the study brought their systolic blood pressure down by about 11 points after 24 weeks of exercise. Approximately 43 million adults in the United States have high blood pressure, which is a primary risk factor for heart disease and stroke. Lowering your blood pressure by 10 points will significantly reduce these risk factors. Doesn’t it seem well worth the effort to walk an extra 5000 steps per day?

A pedometer is a great motivational tool that encourages people to walk extra distances to increase their total step count. Some pedometers are capable of measuring both distance and caloric expenditure, when step length and body weight are entered. Some models have monitors which can read your pulse rate at rest or during exercise. If your goal is to lose weight, it is useful to know that one pound of fat contains 3,500 kcals. In addition to dieting, you can accelerate weight loss by walking. An extra 80,000 steps per week or about 12,000 steps per day will burn an extra pound of fat. Twelve thousand steps would be between 5-6 miles for an average person (about 2000 steps per mile, depending on person’s hight and pace of walking). That sounds like too much to fit into the busy day of a working American, but you can do it by trying to incorporate walking into your daily commute. Park further from work, or get off the train one stop earlier and walk the rest of the way. Take the stairs instead of the elevator. Take a walk during your lunch break, and ask a friend to do it with you. Change your weekend habits by incorporating physical activities into your leisure-time routines. Take a walk with your family after church or synagogue. Walk up and down the sidelines at your child’s baseball or soccer games. Go to the park or zoo with your family. Try it! You may be surprised by the numbers shown on your pedometer at the end of the day.

A study by Dr. Dena M. Bravata, et al. published in “The Journal of the American Medical Association” (JAMA) found that people who use pedometers walked an average of 2491 steps more than control participants. Dr. Bravata and her colleagues analyzed 26 studies with a total of 2767 participants. The mean age of the participants was 49 years.  Eighty-five percent of them were women. 

The study suggests that setting a “step goal” and keeping a step diary may be a key motivational factor in helping people walk an extra 2000 steps, or about 1 mile per day.  The study also reports that pedometer users had a significant reduction in body mass index (BMI); however this reduction was not a function of an in increase in their daily steps. This suggests that participants may have increased their physical activity, which was not measured by the pedometers, reduced their caloric consumption, or both.

            The other benefit reported by the article was a reduction in systolic blood pressure by 4 mm Hg from baseline. This finding is consistent with other published studies about the effect of physical activity on blood pressure. A reduction of  blood pressure by 2 mm Hg is associated with a 10% reduction of death due to stroke, and a 7% reduction of death from vascular causes in the middle age population.

            This is the first published study providing evidence that the use of such a small inexpensive device can significantly increase physical activity, and improve some key health outcomes. 

 These results are supported by my own observations.  One of my clients, who had been documenting her caloric intake and working out 2-3 times per week, was having difficulty losing weight. She started wearing a pedometer, and became aware of  the number of steps she walked each day, resulting in an increase in weight loss.

You can find pedometers at most sporting goods and electronic retail stores. Prices vary from $15 to $80, depending on the number of functions.
Walking to raise money for the American Cancer Society, the American Heart Association,or other foundations, is always a good motivation.

    Vadim Vilensky

 Every New Year, millions of Americans make a resolution to “get in shape.” Sure, they’ve done it before, but this year they really mean it. Many people join fitness clubs, which are so crowded in January that they have to wait nearly an hour for the next available treadmill. Some buy exercise videos and equipment sold on TV. Others promise to jog or walk every day, or to start using equipment that was stored in their basements and garages for years.

Unfortunately, statistics show that by March only a few of those people are still exercising. Over 90% will face another broken self-promise to get in shape.

Here are few tips, which may help you avoid becoming a part of this statistic:

1. Do not repeat last year’s mistakes - try something different. Make your exercise more fun by trying a variety of activities. Attempt to find “your thing”, something you like to do. If you hate treadmills, don’t think that if you push yourself to run on it for a month you will “learn to like it”. You will hate it more and will start looking for excuses to skip a workout. Many fitness clubs offer a variety of classes such as spinning, tai chi, jazz dance, etc. Try them all until you find the one that you like and feel that you can stick with it.
2. Set reasonable short and long-term goals. Goals should be measurable and specific. Assess your progress regularly. Don’t wait a whole year just to realize that you are still in the same shape you were in when you started. If you feel your present routine doesn’t work for you - change it. Find an exercise program that delivers measurable and visible results. When people see results they are motivated to continue working out.
3. Change your behavior. I often see people coming to a fitness club, taking an elevator to the second floor, spending 30 minutes climbing a stairmaster, and then taking the elevator back to the first floor. Just showing up to the gym 3 times per week for an hour will not compensate for a sedentary lifestyle. You have to become physically active during your day: at work, at home, during your leisure time. The U.S. Surgeon General and the U.S. Center for Disease Control and Prevention have suggested that adults accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days of the week. These activities may include: leisure biking, walking, raking a lawn, house painting, or cleaning gutters. While many people do not enjoy formal exercise, these forms of activities can be just as beneficial.
4. Choose an exercise program that helps you do the things you like to do. In other words, exercise should help people to perform activities of daily living with ease. That’s why an exercise program should be specific to an individual’s needs. If you are trying to improve your golf swing, or lift up your grandchildren from the floor without getting pain in your lower back, your program should emphasize exercises which will help you to do that. A bodybuilding approach or dance aerobics class may not help you in this case. Just like for every sport there is a specific conditioning program that helps athletes to perform better at their game, you should have a customized exercise program that helps you to deal with the things you have to do or like to do in your life.
5. Get professional help. Personal training can be expensive, but it gives you a better chance to succeed. A good trainer will make your workout more fun, add motivation, set goals, track your progress, help you get results faster, avoid injuries, and make the whole process more comfortable and convenient. For people who have a history of breaking their fitness self-promises, or for those still waiting for the right moment to start, maybe it’s time for them to make an investment in their bodies by hiring a professional trainer.

   Finally, don’t let unexpected setbacks end your fitness program. Many people overreact when something doesn’t work the way they expected. Improving your body is a long-term commitment, and you have to be prepared to meet some obstacles and to cope with them. While there are many potential barriers, lack of time and inconvenience are cited as the most common. Try to divide an activity into shorter bouts and do it more often, exercising at home or on your way to work. Finding activities that fit your lifestyle and interests are key to maintaining regular exercise over a lifetime.