Fitness Medicine

What is Exercise?

Exercise is defined as a subclass of physical activity and is a planned structured and repetitive bodily movement with a goal of improving or maintaining fitness.

Benefits of exercise

Given that participation in regular exercise has proven to increase blood flow and cardiovascular improvements, healthcare professionals and exercise physiologists advocate that individuals should participate in adequate levels of exercise training. Some physiological, metabolic, and psychologic health benefits of regular exercise include:

  • Reduction in blood pressure
  • Increased HDL-cholesterol
  • Decreased total cholesterol
  • Decreased body fat stores
  • Increased aerobic work capacity
  • Decreased clinical symptoms of anxiety, tension, and depression
  • Reduction in glucose-stimulated insulin secretion
  • Reduction in mortality on post myocardial infraction patients (heart attack)
  • Adaptive physiologic responses
  • Increased lactate threshold
  • Decreased resting heart rate
  • Increased heart volume, oxygen consumption, and cardiac output
  • Increased mobilisation and utilisation of fat
  • Decreased incidence in some cancers
  • Reduced all-cause mortality

The Basic Principles of Exercise

There are some basic principles that govern the world of exercise, and knowing them can help you set up and manipulate different components of your workout.

The F.I.T.T. Principle

FITT is an easy way to remember the exercise variables you can manipulate to avoid boredom and to keep your body challenged:

Frequency - how often you exercise
Intensity - how hard you exercise
Time - how long you exercise
Type - the type of exercise you are doing (e.g. running, walking)

When you workout at sufficient intensity, time and frequency, your body will improve (also called the Training Effect) and you will start to see changes in your weight, body fat percentage, cardio endurance and strength. When your body adjusts to your current FITT levels, it's time to manipulate one of more of them. For example, if you have been walking 3 times a week for 20 minutes and you have stopped seeing improvement, you could change your program by implementing one or more of the following ideas:

Frequency - Add one more day of walking
Intensity - Add short bursts of jogging, speed walking or hill training
Time - Add 10-15 minutes to your usual workout time
Type - Do a different activity such as cycling, swimming or aerobics

Changing any of these variables every 4 to 6 weeks can help you keep that training effect going. In addition, the F.I.T.T principle is highly recommended to decrease ones blood pressure.

Progressive Resistance (the Overload Principle) 

In order to improve your strength, endurance and fitness, you have to progressively increase the frequency, intensity and time of your workouts. A simple way to stimulate your body is to try different activities. If you normally walk on the treadmill, try riding the bike which will use different muscles and allow you to burn more calories. If you have been doing biceps curls with dumbbells, change to a barbell.


This principle is just how it you exercise should be specific to your goals. If you're trying to improve your racing times, you should focus on speed workouts. If your main goal is simply health, fitness and weight loss, you should focus on total body strength, cardio and a healthy diet. Make sure your training matches your goals.

Rest and Recovery 

While we often focus on getting in as much exercise as possible, rest and recovery is also essential for reaching your weight loss and fitness goals. While you can often do cardio every day (though you may want to rest after very intense workouts) you should have at least a day of rest between strength training workouts. Make sure you don't work the same muscles two days in a row to give your body the time it needs to rest and recover.
How much and what type of exercise you do will depend on your fitness level, goals and time constraints, but a complete exercise program should include cardio, strength training and flexibility exercises.

Cardiovascular Fitness

Cardiovascular exercise is any exercise that increases your heart and breathing rates, such as jogging, running, brisk walking, and aerobics are considered cardiovascular fitness.

Cardiovascular exercise strengthens the heart and lungs, increases endurance and burns calories which help you lose weight. Engaging in exercise for a total of 30 minute on most day of week can significantly improve ones overall health. Combine everyday chores with moderate level sporting activities, such as walking around the block, recreational swimming or cycling to achieve your exercise goals.

Cardiovascular Fitness Guidelines

While you should always stick with a cardiovascular programme that fits with your fitness level, the general guidelines for cardiovascular exercise include:

 20-60 minutes of continuous or short-bout exercise
 3-5 days a week
 Working between 77% and 90% of your maximum heart rate
 Varying the intensity, time and type of your workouts

You do not have to do all your cardio at once. You can get the weight loss benefits from cardio even if you do a few short workouts throughout the day.

Strength Training 

Strength training is another type of exercise that works the body in a different way than cardio. With strength training, you lift weights (dumbbells, barbells, resistance bands, machines, etc.) to strengthen the muscles, bones and connective tissue. Strength training is just as important for weight loss as cardio. By lifting weights, you build lean muscle tissue which raises metabolism and reduces body fat as long as you're also watching your calorie intake.

Strength Training Guidelines

The general guidelines for strength training are:

Choose 8-10 exercises, targeting the major muscle groups (lower body, chest, back, shoulders, biceps, triceps and abs)
For beginners, do one set of 8-16 reps of each exercise to fatigue. More advanced exercisers can do 2-3 sets.
Train each muscle group 2-3 non-consecutive days a week
Work each exercise through its full range of motion and use good form

While stretching is often the most overlooked exercise, it's one of the most important for keeping us agile as we get older. And, unlike the rigors of cardio and strength training, it's relaxing and it feels good. Stretching can be done anytime throughout the day, but it's also important to stretch after your workouts, especially if you have any chronically tight areas.

Flexibility Guidelines

 The guidelines for stretching are:

 Stretch your muscles when they are  warm (after your warm up or, even better, after your workout)
 Do static stretches with a focus on tight areas such as the hamstrings and lower back
 Stretch a minimum of 2-3 days a week...even better would be every day
 Stretch within your range of motion. Stretching should not hurt.
 Hold each stretch for about 15-30 seconds and do 2-4 reps of each stretch

Do not forget that yoga workouts are a great way to both stretch your body at the same time you build endurance and promote relaxation and stress-reduction. Pilates also promotes flexibility along with core strength and stability. Both of these activities are a great addition to a traditional cardio and strength training routine.

Sherldine Tomlinson.

The Beginner's Guide to Strength Training

The Beginner's Guide to Strength Training
Part 1: Weight Training Principles

There are four different training parameters that will assist you in determining the proper amount of sets and reps for your own specific goals.

 1. Muscular Endurance – Muscular endurance individuals are a long distance runner, cyclist or tri-athlete. These individuals do not concern themselves with adding muscle in the way a bodybuilder would. The goal is to improve the muscle endurance fibres, also referred to as slow twitch fibres. Endurance people should use 55-65 percent of their one-rep maximum. In other words, if they can perform 150 pounds for one rep on the bench press, their working weight would be 85-100 pounds. 

I would advise 2-3 sets per exercise, performing 20 total sets for the workout. Approximately 15-17 reps are the best range for this individual. I do not advise more than 17 reps, because the muscle requires some degree of overload, even for endurance athletes. The pace of the workout should also be brisk, resting no longer than 30-45 seconds between sets. The whole idea is to keep the weight relatively light, and the reps high with minimal rest between sets in order to continually train and challenge the endurance of the individual.

2. Hypertrophy - If you are interested in putting on muscle, this is where you belong. The individual whose goal is hypertrophy should use 70-80 percent of their one-rep maximum in order to increase the size of the muscle fibres. Once again, using the bench press as an example, if your one-rep maximum is 150 pounds, then you should use 105-120 pounds as your working weight. 

The goal is to perform 7-12 reps for 3-5 sets per exercise. The total number of sets per muscle group (chest, back, etc.) can be anywhere from 5-12 depending upon experience and recovery ability, as well as the size of the specific muscle group being worked. For example, chest may require 9 total sets, but biceps may require only 4. I would not recommend more than 15 total sets for larger muscle groups even for experienced bodybuilders. The goal of hypertrophy is to stimulate a muscle. 

Just remember, the more damage you inflict on the muscle, the longer the recovery period between workouts. Concerning time between sets, I would recommend one to two minutes. It is important to give the muscle a bit of time to recover in order to use additional weight loads. If your goal is to put on just a bit of muscle, then stay in the higher rep range. However, keep in mind that a muscle cannot change unless it is overloaded. In addition, for maximum muscle, cardiovascular activity must be kept to a minimum. The body functions most efficiently, when it has one goal at a time.

3. Strength - If strength increase is your goal, select a resistance that is approximately 85 percent of your one- rep maximum. Continuing with our bench press example, if your one-rep max is 150 pounds, then you should use a weight that is approximately 130 pounds. The repetition range will be about 4-6. In addition, sets will be 3-6 per exercise, with total working sets for the entire workout being no more than 20-25.
It is also important to take ample rest, waiting 3-5 minutes between sets. This is a very demanding workout with high levels of intensity and an excellent method for athletes who need to increase overall strength. When one handles excessive weight in this type of routine, proper form, technique and a spotter are necessary in order to prevent injury.

4. Power - For those looking to increase power, use resistances that are at 85 percent of your one-rep max range. The individual seeking power will occasionally perform a one-repetition maximum lift to test absolute power. Power lifters tend to focus on the bench press, deadlift and squat as their main exercises. 

On the other hand, an Olympic weightlifter tends to fall into a different category. They focus on exercises such as The Snatch, Clean and Jerk, and Clean and Press, all of which are extremely difficult and require technical proficiency. Do 1-5 repetitions with 5 minutes rest between sets, performing 3-5 sets per exercise. I recommend no more than 15 total sets. Once again, proper form, technique and a spotter are essential.
Depending on your goal, you may also wish to mix some of the above parameters into your workout scheme. 

If you incorporate any of the strength or power moves into your training, just make sure to perform them first during your workout.  Keep in mind, the effectiveness of a routine will always be determined by your individual genetics, nutrition, stress levels and sleep patterns. 

The Beginners Guide to Strength Training
Part 2: Overtraining

When training for strength in particular, a technique called overload is used. This works on the principle that to increase muscle size, strength and endurance the muscle must be placed under stress levels greater than those that it was previously used to. This should also be done in a way which is specific to the desired physiological outcome. 

This is all fine and good if we remember that the desired reaction and improvement from the muscles will only occur if they are given sufficient time in which to recover from these stresses. If these rest and recovery periods are provided, the results will be attained. However, if an athlete does not allow his/her body sufficient time in which to recover from individual overload sessions, the consequences can be serious. This is called 'Overtraining'. This is particularly true in the case of elite athletes who may well be training to a specific schedule. Overtraining on their part could rule them out for weeks at a time and ultimately result in them being out of shape for their intended competition. The condition is also common in Gung-Ho types who subscribe to the 'No Pain No Gain' theory. 

The effects of insufficient recovery time will manifest themselves in ways such as lethargy and general tiredness, joint & muscle pain, stomach upsets and weight loss. Although some people would look on this as lack of fitness, the truth is probably that the subject in question is showing the effects of overtraining. If you are training particularly hard for a specific event, the best way to avoid the pitfalls overtraining is to keep a diary. In this you should record schedules, exercises undertaken and perceived exertion of each session. 

This can provide a good objective indication of whether you are suffering from lethargy. Another good way to keep an eye on your fitness level is to monitor your waking pulse rate each morning. A gradual increase in the value can be an indicator of either illness or overtraining. This is the body's method of telling you that it needs a rest. 

How to Prevent Overtraining 

The best person to listen to when it comes to whether you are overtraining or not is, yourself. Your body has a very sophisticated internal feedback system which will tell you in various ways if it is not happy. Do you feel invigorated after a workout or sluggish? The ideal is to subscribe for yourself an exercise schedule which continues to stimulate you mentally and provide you with the optimum level of physical stress necessary for physiological development, without exceeding your body's abuse threshold. 

You should regard your rest days as being as important (if not more so) than your exercise days. After all, it is when you are resting that your body grows stronger and gathers itself for the next exertion. If you deny your body this opportunity to recover, you will just drive yourself further and further into injury prone territory. Try to aim for 4 days (5 max.) training per week with one or two days rest. This will ensure that, depending upon the intensity of the exercise, your body will strengthen gradually without being placed under too much stress. 

The Beginners Guide to Strength Training
Part 3: Answers to your most frequently asked questions

Can you explain proper lifting technique?  There are three important lifting techniques to observe when weight training: gripping the bar, starting from a stable stance, and lifting the bar with your legs, not your back. 

Gripping the bar - Depending on the exercise, you will grip the bar using an underhand (supinated) or overhand (printed) grip. In the underhand grip, your palms face upward or toward you, while the thumbs face away from each other. If you are using an overhand grip, your palms are face down, and it's crucial that the thumbs wrap around the bar so that the bar doesn't roll out of your hands onto your face or feet, causing injury. 

Starting from a stable stance - If you are lifting a barbell from a standing position, stand near the bar so that your shins are almost touching it. This keeps the weight closer to the body during the lifting/pulling action, enabling you to exert an effective force with your legs and helping you to prevent back strain. Make sure you start with your feet flat on the floor, the toes pointing slightly outward and the feet shoulder width apart or slightly wider. This wide stance provides greater stability and a more balanced lifting position. Keep your pelvis "tucked" so that your back does not arch during the lift. Beginning with a stable position is especially important when performing overhead exercises with dumbbells or barbells. 

Lifting the bar - When lifting barbells or dumbbells from the floor, always lift with your legs, not your back. Bend at the knees and grab the weight. While keeping your back straight, push up to a standing position, keeping all motion below your torso. Some exercises, such as the deadlift, require a motion that seems to conflict with this advice. Those exercises should be attempted only after you've been shown proper technique by a qualified professional. 

Is it necessary to have a "spotter?"- For some exercises, yes! A spotter can help you lift a heavy weight when you are ready to seriously challenge yourself. If you are performing a bench press without a spotter, for example, and that last rep is too much for you to handle, you're stuck there with the bar on your chest. A spotter helps you lift it and keeps you safe. 

Other exercises do not require a spotter. Biceps curls, for example, pose no threat to the weight lifter if the dumbbell or barbell can't be lifted. The lifter simply lowers the weight to the ground. 

Is it acceptable behaviour to let weights drop to the floor in the gym? - No. It is annoying and dangerous. If one of those weights drops on a foot, the foot is going to sustain serious damage - and so will you if the victim gets you in his grip. 
Now that you are all caught up on equipment, reps, warm-ups, pace and technique, it's time to get down and dirty. In Part 2 of The Beginners Guide to Strength Training, we will put those weights to work in a routine that will reverse the effects of aging and keep you energetic, strong and healthy for years to come. 

What is the best exercise equipment for starting a weight training programme? - Just purchase a set of dumbbells (small bars for single-arm exercises) and/or a barbell (the long bar used in two-arm exercises) at your local sporting goods store. Then buy a few weights to give those bars some attitude. Most beginners start with pairs of 2.5-, 5- and 10-pound weights for dumbbells, and maybe a couple 25-pounders for the barbell. (You might want to buy a few extra pairs of the 5- and 10-pounders - you'll need them in no time.) 

What does "rep" stand for? - Rep is short for repetition - the execution of a single movement. When you do one bicep curl, for instance, you begin with your hand lowered to your side, raise it to your shoulder and then lower it back to the starting position. That's a rep. A set is simply a group of repetitions. If your goal is two sets of 10 reps, you do 10 consecutive reps, rest for a moment, then follow up with another 10 reps. 

How many reps should I do? - The number of reps you do strongly influences how weight training will affect your body. To develop maximum strength and large muscles, use a weight that takes your muscles to exhaustion in fewer than eight reps. To define your muscles and develop the strength you need for everyday life, use enough weight to allow eight to 15 repetitions. 

How do I know when it's time to increase the weight? - When you can easily do the maximum number of reps you are aiming for, increase the weight by a small amount. If you have trouble pumping out the same number or reps, drop your reps by two or three. Be careful not to increase the weight to more than you can handle. If you're grunting and contorting your body into weird shapes, you're lifting too much weight, and you're likely to get hurt. 

Does pace matter in weight training? - Yes. Your goal is a controlled movement without any jerking. Otherwise, you will be relying on momentum instead of muscle. As a general rule (and there are many variations in training techniques), each rep should last four seconds - two seconds to lift the weight and two seconds to ease it back into the starting position. Going slow yields far better results. 

Do I have to pay attention to my breathing? -Yes. Many people make the mistake of holding their breath as if they are underwater or something. In general, you want to exhale through your mouth as you lift the weight and inhale deeply through your nose as you lower it. 

Is it necessary to warm up before lifting weights? - Before you do a weight training session, it is important to do at least five minutes of aerobic exercise to get your muscles warm and prepared for the training. Warm-up activities include brisk walking or jogging in place for about five minutes, followed by an appropriate stretching routine. The stretching will improve your ability to move joints through a full range of motion, and in so doing, may help prevent injury. Remember not to bounce when you stretch. In addition, it is a good idea to stretch after your strength training session since this helps speed your recovery from muscle soreness. 

Sherldine Tomlinson.

Measuring The Intensity Of Your Workout 

As you begin a cardiovascular programme you can measure the intensity. Knowing your level allows you to increase the intensity to maximise your workout or slow down to avoid overdoing it. To measure you the intensity, measure your health rate. Your training heart rate zone is a critical element in exercise. Taking your pulse and figuring your heart rate during a workout is one of the primary indicators in ascertaining the intensity level at which you and your heart is working. There are many ways to measure exercise intensity. The Karvonen Formula is one of most effective methods used to determine your heart rate. The Ratings of Perceived Exertion and Talk Test methods are subjective measurements that can be used in addition to taking a pulse.

The Karvonen Formula

This is a heart rate reserve formula and it is one of the most effective methods used to calculate training heart rate. The formula factors in your resting heart rate, therefore, you will need to determine your resting heart rate by doing the following: 

  1. Prior to getting out of bed in the morning, take your pulse on your wrist (radial pulse) or on the side of your neck (carotid pulse). 
  2. Count the number of beats, starting with zero, for one minute. If you do not have a stopwatch or a second hand in your bedroom, you can measure the time by watching for the number to change on a digital alarm clock. Find your pulse and start counting when the minute number changes the first time, stop counting when it changes again. 
  3. To help assure accuracy, take your resting heart rate three mornings in a row and average the 3 heart rates together. 
Another element in finding your training heart rate zone is determining the intensity level at which you should exercise. As a general rule, you should exercise at intensity between 50% - 85% of your heart rate reserve. Your individual level of fitness will ultimately determine where you fall within this range. 

Use the following table as a guide for determining your intensity level: 

Beginner or low fitness level . . .50% - 60%  
Average fitness level . . . . . . . . 60% - 70%
High fitness level . . . . . . . . . . . 75% - 85%

Now that we have determined and gathered the information needed, we can pull the information together in the Karvonen Formula: 
220 - Age = Maximum Heart Rate
Max Heart Rate - Rest. Heart Rate x Intensity + Rest. Heart Rate = Training Heart Rate

For example, Diane is 33 yrs old, has a resting heart rate of 75 and she’s just beginning her exercise program (her intensity level will be 50% - 60 %.) Sally’s training heart rate zone will be 131-142 beats per minute: 

Diane's Minimum Training Heart Rate:
220 - 33 (Age) = 187
187 - 75 (Rest. HR) = 112
112 x .50 (Min. Intensity) + 75 (Rest. HR) = 131 Beats/Minute 

Diane's Maximum Training Heart Rate:
220 - 33 (Age) = 187
187 - 75 (Rest. HR) = 112
112 x .60 (Max. Intensity) + 75 (Rest. HR) = 142 Beats/Minute

Periodically, take your pulse during your exercise session to gauge your intensity level. Typically, the easiest location for taking a pulse is on the side of your neck, the carotid pulse. Be sure not to press too hard on the carotid artery or you will get an inaccurate reading. Count the number of beats, always beginning with zero, for 6 seconds (then multiply by 10), or for 10 seconds (then multiply by 6) to get the number of times your heart is beating per minute. If your pulse is within your training heart rate zone, you are right on track! If not, adjust your exercise workload until you get into your zone. 

Ratings of Perceived Exertion (Borg Scale)

Another method that can be used in conjunction with taking your pulse is the Ratings of Perceived Exertion (RPE). This is a subjective method that allows you to rate how hard you feel you're working. RPE can be the primary means of measuring exercise intensity if you do not have typical heart rate responses to graded exercise. These people include those on beta blocking medications, some cardiac and diabetic patients, pregnant women, and others who may have an altered heart rate response. 

On a scale of 0 - 10, rate how you are feeling in terms of exercise fatigue, including how you feel both physically and mentally. You should be exercising between an RPE of 4 (somewhat strong) and an RPE of 5 or 6 (strong). 

Use the following table to determine the intensity level:

0 . . . . .Nothing at all
0.5 . . . Very, very weak
1 . . . . .Very weak
2 . . . . .Weak
3 . . . . .Moderate
4 . . . . .Somewhat strong
5 . . . . .Strong
7 . . . . .Very strong
10 . . . .Very, very strong (Maximal)

The Talk-Test Method

Like the RPE, the talk test method is subjective and should be used in conjunction with taking a pulse. The talk test is quite useful in determining your comfort zone of aerobic intensity, especially if you are just beginning an exercise program. If you are able to talk during your workout without a great deal of strain, you're most likely in your comfort zone. Work at an intensity that allows you to breathe comfortably and rhythmically throughout all phases of your workout. This will ensure a safe and comfortable level of exercise.

How to take Your Heart Rate

Generally, to determine whether you are exercising within the heart rate target zone, you must stop exercising briefly to take your pulse. You can take the pulse at the neck, the wrist, or the chest. We recommend the wrist. You can feel the radial pulse on the artery of the wrist in line with the thumb. Place the tips of the index and middle fingers over the artery and press lightly. Do not use the thumb. Take a full 60-second count of the heartbeats, or take for 30 seconds and multiply by 2. Start the count on a beat, which is counted as "zero." If this number falls between 85 and 119 bpm in the case of the 50-year-old person, he or she is active within the target range for moderate-intensity activity.

Sherldine Tomlinson.

Home Exercise Equipment

Exercise does not have to be done at the gym. You can work out in the comfort of your own home. And with calisthenic-type exercises such as squats, lunges, push-ups, and sit-ups, you can use the resistance of your own weight to condition your body. To boost your strength and aerobic capacity, you may also want to invest in some home exercise equipment. 

Treadmill - The treadmill is great for cardiovascular exercise. It is recommended that you start out walking at a low intensity for 30 minutes and applying the talk test. Depending on how you do, adjust the intensity, incline, and/or time accordingly. 

Free weights - Barbells and dumbbells make up this category of strength-training equipment. Dumbbells are recommended for beginners. 

Other strength training equipment - This includes weight stacks (plates with cables and pulleys), flexible bands, and flexible rods. Flexible bands are good for beginners, especially since they come with instructions. It is recommended that flexible bands should not be used for long-term use as your muscles will likely adapt to the resistance and need more of a challenge. 

Exercise ball - Although instructions and/or a companion video can accompany this gadget, beginners may use exercise balls improperly. However if you enjoy working out with an exercise ball, it can provide a good workout. 

Exercise videos and DVDs - Before working out with a home exercise video or DVD, it has been suggested that you watch through the exercise programme at least once to observe the structure and proper form of the workout. To further improve form, she suggests working out in front of a mirror, if possible, or having someone else watch you do the exercise.

Sherldine Tomlinson. 

Cooling Down 

The cool down is similar to the warm-up in that it should last 5-10 minutes. After you have finished exercising and cooled-down properly, it is important that you stretch the primary muscles being used. Warming-up, stretching, and cooling-down are very important to every exercise session because it significantly help to decrease the risk of injury. 

Staying motivated

In order to benefit from physical activity, it has to become a part of your life and routine. Habits can be hard to change, so be prepared with a plan in case your motivation starts to fade. 

Here are tips for staying motivated.

  • Do something you like! It is hard to stick to an activity that is not fun. There are so many ways to stay active. It may take you a few tries before you find the activity that is right for you. 
  • Have a support network. Some people like to exercise alone, but still need a little push to get off the couch. Ask your family, friends and co-workers to help you stayed motivated. 
  • Some people find it very motivating to exercise with other people. Whether it’s a scheduled walk with a friend, or a group of people from a gym or community, try to find a structure and schedule that you will keep you involved and interested. 
  • Set small, attainable goals and celebrate when you reach them. Reward yourself in healthy ways. 
  • If you find it hard to stay motivated, remind yourself of all the health benefits you will enjoy when you are fit. Also, remind yourself of the dangers of not being fit. 
  • Seek out professional help from a gym, personal trainer, or someone knowledgeable who can help you find a fitness regimen that will work for you.

Sherldine Tomlinson