By Carol Krucoff
Special to the Washington Post
Tuesday, February 9, 1999; Page Z07 Throughout civilization, human beings have struggled to create devices to ease the body's burdens. From the wheel to the computer, labor-saving inventions have marked humanity's progress in gaining freedom from physical demands.
But now, health experts warn, the nation's passion for avoiding physical activity has spiraled out of control. The push-button, drive-through, remote-control mentality has resulted in a sedentary, overweight society where an "epidemic of inactivity" contributes to an estimated 250,000 deaths per year, according to a report published in the Journal of the American Medical Association.
Sedentary living and junk-food diets have combined to cause an alarming increase in obesity, even among children, many of whom are developing chronic illnesses--such as type 2 diabetes and high cholesterol--once seen only in adults. Inactivity-associated ailments, such as high blood pressure and osteoporosis, are also on the rise as the population ages. Nursing homes are filled with seniors who are institutionalized primarily because their under-used muscles and bones have left them incapacitated.
Despite the much-publicized fitness movement, less than one of every four adults exercises regularly. The vast majority of Americans still spend the vast majority of their days on their increasingly vast butts. "Most people don't realize how little physical activity they actually get and how important it is for them to use every opportunity they have to be active," says Yale University obesity expert Kelly Brownell. "We live in an increasingly toxic food and physical activity environment."
Brownell points to the greater use of moving walkways, automatic doors, computers and other "conveniences" that make it less necessary--or possible--to move during the day. The resulting inactivity is a health hazard on a par with smoking, high blood pressure and high cholesterol, say Brownell and other experts in the field.
Health vs. Fitness Benefits
One reason most people don't exercise is because they're confused about how to get fit. Fads and gimmicks promise impossible results and fitness trends change so that many people don't know what they're supposed to do to shape up.
In the 1970s, running was touted as the ticket to fitness, and people were told that exercise had to be vigorous and sustained or it didn't count. In the '80s, aerobics classes boomed, and exercisers were urged to go for the burn--while taking their pulses and figuring their target heart rates so they could work out at the proper intensity. In the early '90s, exercise machines exploded in popularity, and it seemed essential to wear Lycra--or at least Spandex--and join a gym to shape up.
Today the message is much simpler. Research shows that moderate activity can yield major health benefits. As a general recommendation, public health officials are promoting a basic fitness formula: Sit less, move more.
"Almost any activity that gets you up and moving around is probably better for you in some ways than continuing to sit," says Dallas epidemiologist Steven N. Blair, who served as senior scientific editor of the U.S. Surgeon General's 1996 Report on Physical Activity and Health. Designed to jump-start a sedentary society, the report summarized the scientific evidence of exercise's wide-ranging health benefits and offered this simple exercise prescription:
Burn 150 calories per day through physical activity such as a 30-minute walk, 15-minute run or 45 minutes of washing and waxing a car.
In other words, put back some of the physical energy expenditure that technology has removed from daily life. Americans expend about 800 fewer calories per day than their parents did (the equivalent of four glazed doughnuts), says Blair. He advises people to integrate more movement into their lives through simple practices like taking the stairs and parking in the farthest space. This kind of "lifestyle activity" can provide health benefits similar to a traditional gym-based workout, according to a study published last month in the Journal of the American Medical Association. The conclusion: Every step you take counts.
While this user-friendly activity prescription--dubbed "exercise lite"--will confer health benefits, it may not be enough to provide fitness benefits to those with more ambitious physical goals. A major finding of the past 20 years from research on physical activity is this distinction between the health benefits and the fitness benefits of exercise.
The health benefits of moderate activity are substantial, notes the Surgeon General's report. They include a reduced risk of numerous chronic diseases--including coronary heart disease, type 2 diabetes, hypertension and colon cancer--and improved mental health and enhanced physical functioning. In addition, most sedentary people who add 30 minutes of moderate activity to their days will lose some body fat and experience improvements in blood pressure, blood glucose and blood cholesterol.
But this modest amount of exercise probably won't be enough to reshape your body or win you a gold medal in the local 10-K race. People with appearance or athletic goals need to do more exercise than the 30 moderate minutes necessary for health effects.
Fitness benefits, such as increased muscle strength and improvements in heart and lung capacity generally require doing a specific kind of activity at a certain intensity, frequency and duration. For example, achieving cardiorespiratory fitness requires doing aerobic exercise at a "somewhat hard" intensity (55 to 65 percent to 90 percent of maximum heart rate) for 20 to 60 minutes, three to five days a week.
"There is a dose response to exercise," notes the American College of Sports Medicine in its newly revised guidelines for adult fitness. "Many significant health benefits are achieved by going from a sedentary state to a minimal level of physical activity; programs involving higher intensities and/or greater frequency/durations provide additional benefits."
Design-It-Yourself Exercise Program
To achieve optimal fitness as well as health benefits, it's necessary to participate in a well-rounded program that includes these three forms of exercise: cardiovascular (aerobic) activities that strengthen the heart and lungs and help control weight; resistance exercise that strengthens muscles and bones; and stretching to maintain flexibility.
And don't believe those television infomercials--there is no, single "best way" to get fit. There are countless exercise options, depending on your preferences, finances, abilities and location. The best exercise for you, say experts, is the one that you'll enjoy and will do regularly.
For example, those who like going to a health club (and can afford membership) can work out at a gym three times a week for an hour per session, doing 30 minutes on an aerobic machine, 15 to 20 minutes lifting weights and 5 to 10 minutes stretching. People who like fitness classes can enroll in a YMCA, recreation department or university-based program that meets three times a week for an hour each and includes aerobic, strengthening and stretching exercises.
Or, you can get fit by yourself--or with friends and family--at home. One of the most accessible ways is by taking a brisk 30-minute walk, followed by five minutes of stretching, three to five days a week. Add 15 to 20 minutes of resistance exercises, two or three days a week, (by doing calisthenics or using dumbbells and ankle weights) and you'll be doing all you need to get fit. If you'd rather not walk, you can dance, cycle, swim, skate, jump rope, run, climb stairs, cross-country ski or do any other continuous activity that increases your heart rate for 20 to 60 minutes.
In fact, one of the major trends in the fitness industry has been the explosion in exercise options--at home and at the gym. Nearly one-third of U.S. households own exercise equipment, according to a 1997 study, sponsored by the Fitness Products Council, an association of equipment manufacturers. Treadmills and free weights are among the most popular home devices.
At health clubs, you can now choose from a smorgasbord of aerobic alternatives ranging from group stationary cycling--where high-energy instructors lead a class of pedal pushers on a sweat-soaked imaginary journey--to group weight training classes and MTV dance-inspired workouts.
There's also been a surge of interest in Eastern-influenced classes that focus on connecting the mind, body and spirit through the breath. These include yoga, tai chi, karate and qi gong, which are increasingly offered by recreation departments, health clubs and private studios. Boxing-style classes are hot with the twentysomething set, who punch and kick their way through cardio-kickboxing workouts. In addition, outdoor activities have boomed in popularity, particularly those that can be done by the whole family, such as hiking.
Yet despite the growing array of exercise options, most people still won't do the amount--or the intensity--of physical activity required to achieve fitness benefits.
Lack of time is the most commonly cited reason, followed by dislike of vigorous exercise and lack of access to facilities.
That's why public health officials are spreading the word that simply adding a relatively small amount of moderate activity into your life will at least confer major health benefits.
A Pyramid Theme
To help clarify the confusing array of exercise messages, leaders in the health and fitness field joined together in 1995 to form the National Coalition to Promote Physical Activity. The alliance has six lead organizations, including the American Heart Association and the National Association of Governor's Councils on Physical Fitness and Sports, plus more than 100 member organizations, such as the American Medical Association, the American Diabetes Association and the YMCA. The coalition has launched a major campaign to get Americans to become more active by distributing thousands of resource kits to organizations and groups under the slogan: "Ready. Set. It's everywhere you go." Produced by the Centers for Disease Control and Prevention in Atlanta, the kits are designed to help busy, sedentary adults think of creative, fun ways to fit activity into their lives.
A graphic illustration of this new approach to fitness is the Physical Activity Pyramid. Modeled after the Department of Agriculture's well-known Food Guide Pyramid, the Physical Activity Pyramid helps ordinary people "understand basic physical activity concepts," write Arizona State University professors Charles Corbin and Robert Pangrazi in the ACSM's Health and Fitness Journal.
The base of the pyramid--or level 1--represents lifestyle physical activity, the accumulated 30 minutes of moderate activity (such as raking leaves or walking) promoted by the Surgeon General's Report. Everyone should do at least this much activity to gain health benefits.
People who want to achieve fitness benefits, such as improving body composition and gaining cardiorespiratory endurance, need to move "up" to level 2 of the pyramid. This level consists of aerobics and active sports such as aerobic dance, jogging, tennis and racquetball. Doing these more vigorous activities at least three days a week for at least 20 minutes at a time can significantly boost fitness. (Note: Men over age 40 and women over age 50 who have been sedentary--and people of any age with risk factors for heart disease--should consult a physician before starting a program of vigorous activity.)
Level 3 includes flexibility and muscle strengthening exercises, which offer additional fitness benefits. Flexibility exercises should be done three to seven days a week, while muscle-strengthening exercises only need to be done two to three days a week.
At the top of the pyramid is inactivity. "Inactivity is not necessarily bad," Corbin and Pangrazi note. "But long periods of inactivity (other than normal sleep) should be limited."
In a culture where half the people who start an exercise program quit within six months, physicians are being encouraged to help their patients become more active. Until recently, the role daily physical activity plays in health had been neglected by most doctors. Only about 30 percent of physicians effectively counsel patients about regular physical activity, estimates the CDC, which has embarked on programs to increase that proportion to at least 50 percent.
At the same time, physicians should avoid rigid, one-size-fits-all advice. Instead, groups like the ACSM advocate "sliding-scale fitness," which means individualizing a program for each person that provides the maximal benefit at the lowest risk and encourages a lifetime of physical activity.
The best way to get people moving, many experts agree, is to focus on fun. Too many Americans view exercise as hard, painful work--another chore to cram into their busy day--instead of recognizing that activity can be a welcome release from the confines of their chairs. Some are casualties of the fitness revolution, turned off to exercise by embarrassment, anger or despair over inability to reach unrealistic goals--often about weight loss.
That's why many health professionals tell new exercisers not to worry about flattening abs or losing weight. Instead, it's better to find an enjoyable activity and do it daily, relishing the sensations of moving the body, breathing deeply and experiencing the moment.
As public health officials know, if activity is fun, it's more likely to be done.
Despite America's preoccupation with the cultural misconception that "thin equals fit," fitness has less to do with your scale weight than with your ability to climb stairs, carry groceries, open jars and--when necessary--run after a child or scamper across a busy street. Fitness is "the ability of your heart, blood vessels, lungs and muscles to carry out daily tasks and occasional unexpected bodily challenges with a minimum of fatigue and discomfort," states the "ACSM (American College of Sports Medicine) Fitness Book," (Human Kinetics, 1997).
Physical fitness has four components, the ACSM experts note: