Most people do not need any special testing before starting to exercise, but it is best to check with your medical provider before starting a new routine or type of exercise. People with diabetes or multiple risk factors for heart disease may need a stress test before starting an exercise program. A stress test is performed in a doctor’s office or hospital and usually involves walking or running on a treadmill with monitoring leads on the chest. If you do not normally get much exercise, start by exercising for a few minutes at a low intensity (for example, walking). As physical fitness improves, you can slowly begin to exercise harder, more frequently, or for a longer time, with a goal of getting at least 30 minutes of exercise on five days each week. Exercise does not need to be continuous to produce health benefits; it can be broken up into three or four 10-minute sessions per day. Moderate-intensity exercise should be performed on most days of the week. However, exercising only one or two days per week is better than not exercising at all. Further, any physical activity is better than no physical activity. The greatest health benefits are seen in those who change from a sedentary lifestyle to being moderately active. Moderate exercise can be integrated into your daily routine with activities such as brisk walking (at three to four miles per hour), yard work, or dancing. A simple way to start exercising is to walk. Start by walking a comfortable distance; establish a personal baseline by walking at a speed and for a length of time that is easily tolerated. Doing too much too fast may result in discomfort, disappointment, or disability from muscle pulls and strains. Try to increase your baseline distance by 10 percent each week. Measure out the distance in a neighborhood, walking trail, or shopping mall. After reaching 45 to 60 minutes per day, you can increase the intensity of exercise by walking a greater distance in the same time. The goal is to develop a habit of regular physical activity at a level that is comfortable.

Exercise Programs

An exercise program should include a warmup, aerobic exercise, resistance training, stretching and a cool-down.

Warmup

Exercise sessions should begin with a 5- to 10-minute period of warm-up. Start with some low-level aerobic exercises (walking, stationary cycling, calisthenics) and then do stretches and flexibility movements. The warm-up period allows for a gradual increase in the heart rate and may reduce the risk of injuries.

Aerobic Exercise

When choosing a workout, it is a good idea to mix up aerobic exercise, strength training, and stretching to keep the workout fun and interesting. Walking is an excellent aerobic activity. Cycling, rowing, stair machine climbing, and other endurance-type activities are also great. Swimming and water aerobics are excellent for people with arthritis. Low-impact activities are recommended because they are less likely to result in physical injury. Running on a street is a higher-impact activity because of the stresses on the feet and legs as they strike the ground with each step. The exercise you choose should be enjoyable and simple to encourage long-term commitment. It may be best to vary the exercises you do each week (such as swimming on three of the days and walking on three of the days) to decrease repetitive strain to your muscles and other tissues. There is no age specific heart rate recommendation; a specific heart rate is not necessary to achieve health benefits. If you are breathless, fatigued, and sweating, you have worked hard enough. During moderate-intensity exercise, you should be able to carry on a conversation. The 2018 Physical Activity Guidelines recommend 150 to 300 minutes a week of moderate-intensity, or 75 to 150 minutes a week of vigorous-intensity (or an equivalent combination) aerobic activity. This recommendation is in addition to routine, light-intensity activities of daily living (e.g., cooking, casual walking, shopping, etc.).

Resistance training

Resistance training can be done with weights, machines, or exercise bands. However, you can do resistance exercises even if you do not have access to a gym or special equipment; for example, you can strengthen your muscles by lifting household objects or doing exercises like pushups in your home. It should be performed at least twice a week with at least 48 hours of rest between sessions. Resistance training is commonly described in terms of “sets” of “repetitions.”

• A repetition is a single completed back and forth motion of a resistance exercise, such as bending and extending the arm at the elbow while holding a weight (or other heavy object) in the hand.
• A set is a number of repetitions done without resting.
• Most experts recommend at least one set of exercises, including 8 to 12 repetitions, for each of the major muscle groups.
• Begin with minimal resistance (light weights, resistive bands, or something like a can of food or bottle of water) to allow the muscles and other tissues to adapt.
• It is important to use proper technique. If you belong to a health club or gym you might ask a trainer to observe technique. Be sure to breathe normally while lifting weights. Do not hold your breath; instead, exhale with exertion. Do not perform resistance training if you are in pain or have swelling anywhere.

Stretching

Stretching and flexibility exercises should include every major joint (hip, back, shoulder, knee, upper trunk, neck). It is best not to stretch “cold” muscles, so engage in a few minutes of low-intensity aerobic exercise first. Movement into a stretch should be slow, and the stretch itself should be held for approximately 10 to 30 seconds. Do not bounce while beginning or performing a stretch.

Cool-down

Spend approximately five minutes cooling down at the end of an exercise session. Like the warm-up period, cool-down may include low-level aerobic exercise (such as slow walking), calisthenics, and stretching. This allows the body to clear acid that has built up in the muscles and allows more blood back into the circulation because less is sent to the muscles. This helps to prevent muscle cramps and sudden drops in blood pressure that can cause lightheadedness.

Tips to a Successful Exercise Program

Exercise should fit into the daily schedule, be enjoyable, and feel safe. After beginning an exercise program, most people start to notice that they feel healthier. It is common for an exercise program to be disrupted by health problems, work-related challenges, personal relationships, and vacations. Getting back on track can be tough but is an important step in maintaining the benefits of exercise. If your exercise program does not fit into your daily life, try to find ways to integrate exercise so that it can remain a part of your daily routine. For example, take the stairs instead of the elevator, park in a space that is further from the door, or take a longer route to walk from one place to another.

When to Seek Help

In order to exercise safely, it’s important to know the warning signs that could indicate a problem. If any of these problems occur, you should stop the exercise or activity and contact your health care provider immediately:

• Pain or pressure in the chest, arms, throat, jaw or back
• Nausea or vomiting during or after exercise
• Palpitations or heart flutters or a sudden burst of a very fast heart rate
• Inability to catch your breath
• Lightheadedness, dizziness or feeling faint during exercise (feeling lightheaded after exercise may mean that a longer cool-down period is needed)
• Feeling very weak or very tired
• Pains in joints, shins, heels or calf muscles (this is not an emergency but should be evaluated if it does not resolve)

Cautions and Things to Keep in Mind

• Remember to drink fluids during and after exercise. Thirst is a good indicator that more fluids are needed.
• Do not exercise outdoors if the temperature is too hot or too cold.
• In cooler weather, it is better to wear layers of clothes while exercising outdoors. A layer of clothing can be removed if needed.
• Wear supportive, well-fitting running or walking shoes. Replace shoes when signs of deterioration develop (e.g., cracking, separation of shoe from the sole, imprint of the foot in the insole). The amount of time exercise shoes will last depends upon several factors, including how often and where the shoes are worn.