11.5: Implementing Your Fitness Plan

The Beneficial Effects of Increasing Physical Activity: It's About Overload, Progression, and Specificity

Creating a safe and effective fitness program involves knowing certain basic principles of physical fitness: overload, progression, and specificity. Overload is the physical stress placed on the body when physical activity is greater in amount or intensity than usual. The body's structures and functions respond and adapt to these stresses. For example, aerobic physical activity places a stress on the cardiorespiratory system and muscles, requiring the lungs to move more air and the heart to pump more blood and deliver it to the working muscles. This increase in demand increases the efficiency and capacity of the lungs, heart, circulatory system, and exercising muscles. In the same way, muscle–strengthening and bone-strengthening activities overload muscles and bones, making them stronger. Progression is closely tied to overload. Once a person reaches a certain fitness level, he or she progresses to higher levels of physical activity by continued overload and adaptation. Small, progressive changes in overload help the body adapt to the additional stresses while minimizing the risk of injury. Specificity means that the benefits of physical activity are specific to the body systems that are doing the work. For example, aerobic physical activity largely benefits the body's cardiovascular system. These principles should be taken into consideration during any exercise program if you expect to meet your goals.

Designing a program

Warm-up and Cool down Activities

Warm-up and cool-down activities are an important part of a person’s physical activity plan. Commonly, the warm-up and cool-down involve doing an activity at a slower speed or lower intensity. A warm-up before moderate-or vigorous-intensity aerobic activity allows a gradual increase in heart rate and breathing at the start of the episode of activity. A cool down after activity allows a gradual decrease at the end of the episode. Time spent doing warm-up and cool-down may count toward meeting the aerobic activity Guidelines if the activity is at least moderate intensity (for example, walking briskly as a warm-up before jogging). A warm-up for muscle-strengthening activity commonly involves doing exercises with lighter weight.

Physical Activity in a Weight Control Plan

The health benefits of physical activity are generally independent of body weight. The good news for people needing to lose weight is that regular physical activity provides major health benefits, no matter how their weight changes over time. Along with appropriate dietary intake, physical activity is an important part of maintaining healthy weight, losing weight, and keeping extra weight off once it has been lost. Physical activity also helps reduce abdominal fat and preserve muscle during weight loss. Adults should aim for a healthy, stable body weight. The amount of physical activity necessary to achieve this weight varies greatly from person to person.

The first step in achieving or maintaining a healthy weight is to meet the minimum level of physical activity in the Guidelines. For some people, this will result in a stable and healthy body weight, but for many it may not. People who are at a healthy body weight but slowly gaining weight can either gradually increase the level of physical activity (toward the equivalent of 300 minutes a week of moderate-intensity aerobic activity), or reduce caloric intake, or both, until their weight is stable. By regularly checking body weight, people can find the amount of physical activity that works for them.

Many adults will need to do more than the 150 minutes a week of moderate-intensity aerobic physical activity as part of a program to lose weight or keep it off. These adults should do more physical activity and/or further reduce their caloric intake. Some people will need to do the equivalent of 300 or more minutes of moderate-intensity physical activity a week to meet their weight-control goals. Combined with restricting caloric intake, these adults should gradually increase minutes or the intensity of aerobic physical activity per week, to the point at which the physical activity is effective in achieving a healthy weight.

Adults should strongly consider walking as one good way to get aerobic physical activity. Many studies show that walking has health benefits and a low risk of injury. It can be done year-round and in many settings. It is important to remember that all activities—both baseline and physical activity—“count” for energy balance. Active choices, such as taking the stairs rather than the elevator or adding short episodes of walking to the day, are examples of activities that can be helpful in weight control. For weight control, vigorous intensity activity is far more time-efficient than moderate-intensity activity. For example, an adult who weighs 165 pounds (75 kg) will burn 560 calories from 150 minutes of brisk walking at 4 miles an hour (these calories are in addition to the calories normally burned by a body at rest). That person can burn the same number of additional calories in 50 minutes by running 5 miles at a 10 minutes-per-mile pace.

Achieving Your Physical Activities: The Possibilities are endless

These examples show how it’s possible to meet the Guidelines by doing moderate-intensity or vigorous-intensity activity or a combination of both. Physical activity at this level provides substantial health benefits.

Ways to get the equivalent of 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic physical activity a week plus muscle-strengthening activities:

• Thirty minutes of brisk walking (moderate intensity) on 5 days, exercising with resistance bands (muscle strengthening) on 2 days;
• Twenty-five minutes of running (vigorous intensity) on 3 days, lifting weights on 2 days (muscle strengthening);
• Thirty minutes of brisk walking on 2 days, 60 minutes (1 hour) of social dancing (moderate intensity) on 1 evening, 30 minutes of mowing the lawn (moderate intensity) on 1 afternoon, heavy gardening (muscle strengthening) on 2 days;
• Thirty minutes of an aerobic dance class on 1 morning (vigorous intensity), 30 minutes of running on 1 day (vigorous intensity), 30 minutes of brisk walking on 1 day (moderate intensity), calisthenics (such as sit-ups, push-ups) on 3 days (muscle strengthening);
• Thirty minutes of biking to and from work on 3 days (moderate intensity), playing softball for 60 minutes on 1 day (moderate intensity), using weight machines on 2 days (muscle-strengthening on 2 days); and
• Forty-five minutes of doubles tennis on 2 days (moderate intensity), lifting weights after work on 1 day (muscle strengthening), hiking vigorously for 30 minutes and rock climbing (muscle strengthening) on 1 day.

Ways to be Even More Active

For adults who are already doing at least 150 minutes of moderate-intensity physical activity, here are a few ways to do even more. Physical activity at this level has even greater health benefits.

• Forty-five minutes of brisk walking every day, exercising with resistance bands on 2 or 3 days;
• Forty-five minutes of running on 3 or 4 days, circuit weight training in a gym on 2 or 3 days;
• Thirty minutes of running on 2 days, 45 minutes of brisk walking on 1 day, 45 minutes of an aerobics and weights class on 1 day, 90 minutes (1 hour and 30 minutes) of social dancing on 1 evening, 30 minutes of mowing the lawn, plus some heavy garden work on 1 day;
• Ninety minutes of playing soccer on 1 day, brisk walking for 15 minutes on 3 days, lifting weights on 2 days; and
• Forty-five minutes of stationary bicycling on 2 days, 60 minutes of basketball on 2 days, calisthenics on 3 days.

Be Safe and Active

Although physical activity has many health benefits, injuries and other adverse events do sometimes happen. The most common injuries affect the musculoskeletal system (the bones, joints, muscles, ligaments, and tendons). Other adverse events can also occur during activity, such as overheating and dehydration. On rare occasions, people have heart attacks during activity.

The good news is that scientific evidence strongly shows that physical activity is safe for almost everyone. Moreover, the health benefits of physical activity far outweigh the risks. Still, people may hesitate to become physically active because of concern they’ll get hurt. For these people, there is even more good news: They can take steps that are proven to reduce their risk of injury and adverse events.

The Guidelines in this module provide advice to help people do physical activity safely. Most advice applies to people of all ages. Specific guidance for particular age groups and people with certain conditions is also provided.

Physical Activity is Safe for Almost Everyone

Most people are not likely to be injured when doing moderate-intensity activities in amounts that meet the Physical Activity Guidelines. However, injuries and other adverse events do sometimes happen. The most common problems are musculoskeletal injuries. Even so, studies show that only one such injury occurs for every 1,000 hours of walking for exercise, and fewer than four injuries occur for every 1,000 hours of running.

Both physical fitness and total amount of physical activity affect risk of musculoskeletal injuries. People who are physically fit have a lower risk of injury than people who are not. People who do more activity generally have a higher risk of injury than people who do less activity. To do physical activity safely and reduce risk of injuries and other adverse events, people should:

• Understand the risks and yet be confident that physical activity is safe for almost everyone.
• Choose to do types of physical activity that are appropriate for their current fitness level and health goals, because some activities are safer than others.
• Increase physical activity gradually over time whenever more activity is necessary to meet guidelines or health goals. Inactive people should “start low and go slow” by gradually increasing how often and how long activities are done.
• Protect themselves by using appropriate gear and sports equipment, looking for safe environments, following rules and policies, and making sensible choices about when, where, and how to be active.
• Be under the care of a health-care provider if they have chronic conditions or symptoms. People with chronic conditions and symptoms should consult their health-care provider about the types and amounts of activity appropriate for them.

Choose Appropriate Types and Amounts of Activity

People can reduce their risk of injury by choosing appropriate types of activity. The safest activities are moderate intensity and low impact, and don’t involve purposeful collision or contact. Walking for exercise, gardening or yard work, bicycling or exercise cycling, dancing, swimming, and golf are activities with the lowest injury rates. In the amounts commonly done by adults, walking (a moderate–intensity and low-impact activity) has a third or less of the injury risk of running (a vigorous-intensity and higher impact activity).

The risk of injury for a type of physical activity can also differ according to the purpose of the activity. For example, recreational bicycling or bicycling for transportation leads to fewer injuries than training for and competing in bicycle races. People who have had a past injury are at risk of injuring that body part again. The risk of injury can be reduced by performing appropriate amounts of activity and setting appropriate personal goals. Performing a variety of different physical activities may also reduce the risk of overuse injury. The risk of injury to bones, muscles, and joints is directly related to the gap between a person’s usual level of activity and a new level of activity.

Increase Physical Activity Gradually Over Time

Scientific studies indicate that the risk of injury to bones, muscles, and joints is directly related to the gap between a person’s usual level of activity and a new level of activity. The size of this gap is called the amount of overload. Creating a small overload and waiting for the body to adapt and recover reduces the risk of injury. When amounts of physical activity need to be increased to meet the Guidelines or personal goals, physical activity should be increased gradually over time, no matter what the person’s current level of physical activity. Scientists have not established a standard for how to gradually increase physical activity over time. The following recommendations give general guidance for inactive people and those with low levels of physical activity on how to increase physical activity:

• Use relative intensity (intensity of the activity relative to a person’s fitness) to guide the level of effort for aerobic activity.
• Generally, start with relatively moderate-intensity aerobic activity. Avoid relatively vigorous-intensity activity, such as shoveling snow or running. Adults with a low level of fitness may need to start with light activity, or a mix of light- to moderate-intensity activity.
• First, increase the number of minutes per session (duration), and the number of days per week (frequency) of moderate-intensity activity. Later, if desired, increase the intensity.
• Pay attention to the relative size of the increase in physical activity each week, as this is related to injury risk. For example, a 20-minute increase each week is safer for a person who does 200 minutes a week of walking (a 10 percent increase), than for a person who does 40 minutes a week (a 50 percent increase).

The available scientific evidence suggests that adding a small and comfortable amount of light- to moderate–intensity activity, such as 5 to 15 minutes of walking per session, 2 to 3 times a week, to one’s usual activities has a low risk of musculoskeletal injury and no known risk of severe cardiac events. Because this range is rather wide, people should consider three factors in individualizing their rate of increase: age, level of fitness, and prior experience. The amount of time required to adapt to a new level of activity probably depends on age. Youth and young adults probably can safely increase activity by small amounts every week or 2. Older adults appear to require more time to adapt to a new level of activity, in the range of 2 to 4 weeks.

Level of Fitness

Less fit adults are at higher risk of injury when doing a given amount of activity, compared to fitter adults. Slower rates of increase over time may reduce injury risk. This guidance applies to overweight and obese adults, as they are commonly less physically fit.

Prior Experience

People can use their experience to learn to increase physical activity over time in ways that minimize the risk of overuse injury. Generally, if an overuse injury occurred in the past with a certain rate of progression, a person should increase activity more slowly the next time.

Take Appropriate Precautions

Taking appropriate precautions means using the right gear and equipment, choosing safe environments in which to be active, following rules and policies, and making sensible choices about how, when, and where to be active.

Use Protective Gear and Appropriate Equipment

Using personal protective gear can reduce the frequency of injury. Personal protective gear is something worn by a person to protect a specific body part. Examples include helmets, eyewear and goggles, shin guards, elbow and knee pads, and mouth guards. Using appropriate sports equipment can also reduce risk of injury. Sports equipment refers to sport or activity-specific tools, such as balls, bats, sticks, and shoes. For the most benefit, protective equipment and gear should be:

1. The right equipment for the activity
2. Appropriately fitted
3. Appropriately maintained
4. Used consistently and correctly.

Be Active in Safe Environments

People can reduce their injury risks by paying attention to the places they choose to be active. To help themselves stay safe, people can look for:

• Physical separation from motor vehicles, such as sidewalks, walking paths, or bike lanes;
• Neighborhoods with traffic-calming measures that slow down traffic;
• Places to be active that are well-lighted, where other people are present, and that are well-maintained (no litter, broken windows);
• Shock-absorbing surfaces on playgrounds;
• Well-maintained playing fields and courts without holes or obstacles;
• Breakaway bases at baseball and softball fields; and
• Padded and anchored goals and goal posts at soccer and football fields.

Follow Rules and Policies That Promote Safety

Rules, policies, legislation, and laws are potentially the most effective and wide-reaching way to reduce activity-related injuries. To get the benefit, individuals should look for and follow these rules, policies, and laws. For example, policies that promote the use of bicycle helmets reduce the risk of head injury among cyclists. Rules against diving into shallow water at swimming pools prevent head and neck injuries.

Make Sensible Choices about How, When, and Where To Be Active

A person’s choices can obviously influence the risk of adverse events. By making sensible choices, injuries and adverse events can be prevented. Consider weather conditions, such as extremes of heat and cold. For example, during very hot and humid weather, people lessen the chances of dehydration and heat stress by:

• Exercising in the cool of early morning as opposed to mid-day heat;
• Switching to indoor activities (playing basketball in the gym rather than on the playground);
• Changing the type of activity (swimming rather than playing soccer);
• Lowering the intensity of activity (walking rather than running); and
• Paying close attention to rest, shade, drinking enough fluids, and other ways to minimize effects of heat.

Inactive people who gradually progress over time to relatively moderate-intensity activity have no known risk of sudden cardiac events, and very low risk of bone, muscle, or joint injuries.

Exposure to air pollution is associated with several adverse health outcomes, including asthma attacks and abnormal heart rhythms. People who can modify the location or time of exercise may wish to reduce these risks by exercising away from heavy traffic and industrial sites, especially during rush hour or times when pollution is known to be high. However, current evidence indicates that the benefits of being active, even in polluted air, outweigh the risk of being inactive.

Advice from Health-Care Providers The protective value of a medical consultation for persons with or without chronic diseases who are interested in increasing their physical activity level is not established. People without diagnosed chronic conditions (such as diabetes, heart disease, or osteoarthritis) and who do not have symptoms (such as chest pain or pressure, dizziness, or joint pain) do not need to consult a health-care provider about physical activity.

Inactive people who gradually progress over time to relatively moderate-intensity activity have no known risk of sudden cardiac events, and very low risk of bone, muscle, or joint injuries. A person who is habitually active with moderate-intensity activity can gradually increase to vigorous intensity without needing to consult a health-care provider. People who develop new symptoms when increasing their levels of activity should consult a health-care provider.

Health-care providers can provide useful personalized advice on how to reduce risk of injuries. For people who wish to seek the advice of a health-care provider, it is particularly appropriate to do so when contemplating vigorous-intensity activity, because the risks of this activity are higher than the risks of moderate-intensity activity.

The choice of appropriate types and amounts of physical activity can be affected by chronic conditions. People with symptoms or known chronic conditions should be under the regular care of a health-care provider. In consultation with their provider, they can develop a physical activity plan that is appropriate for them. People with chronic conditions typically find that moderate-intensity activity is safe and beneficial. However, they may need to take special precautions. For example, people with diabetes need to pay special attention to blood sugar control and proper footwear during activity.