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Charles Corbin Greg Welk William Corbin Karen Welk

T E N T H E D I T I O N

A Comprehensive Lifestyle Approach

Fitness & Wellness

Concepts of

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Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction

LEARNING OBJECTIVES

After completing the study of this concept, you will be able to:

▶ Describe the HELP philosophy and discuss its implications in making personal decisions about health, wellness, and fitness.

▶ Define the dimensions of health and wellness, and explain how they interact to influence health and wellness.

▶ Distinguish health-related and skill-related dimensions of physical fitness. ▶ Identify the determinants of health, wellness, and fitness, and explain how they each contribute to health, wellness, and fitness.

▶ Identify related national health goals and show how meeting personal goals can contribute to reaching national goals.

▶ Use health behavior change strategies to carry out self-assessments of personal lifestyles and wellness perceptions.

C o

n c

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t 1

Lifestyles for Health, Wellness, and Fitness ▶ Section I

Good health, wellness, fitness,

and healthy lifestyles are

important for all people.

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2 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

provide principles and guidelines that help you adopt pos- itive lifestyles. The labs provide experiences for learning behavioral skills needed to maintain these lifestyles.

A personal philosophy that emphasizes health can

lead to behaviors that promote it. The H in HELP stands for health. One theory that has been extensively tested indicates that people who believe in the benefits of healthy lifestyles are more likely to engage in healthy behaviors. The theory also suggests that people who state intentions to put their beliefs into action are likely to adopt behaviors that lead to health, wellness, and fitness.

Everyone can benefit from healthy lifestyles. The E in HELP stands for everyone. Anyone can change a behav- ior or lifestyle. Nevertheless, many adults feel ineffective in making lifestyle changes. Physical activity is not just for athletes—it is for all people. Eating well is not just for other people—you can do it, too. All people can learn stress- management techniques and practice healthy lifestyles.

Healthy behaviors are most effective when

practiced for a lifetime. The L in HELP stands for lifetime. Young people sometimes feel immortal because the harmful effects of unhealthy lifestyles are often not immediate. As we grow older, we begin to realize that unhealthy lifestyles have cumulative negative effects. Start- ing early in life to emphasize healthy behaviors results in long-term health, wellness, and fitness benefits. One study showed that the longer healthy lifestyles are practiced, the greater the beneficial effects. This study also demonstrated that long-term healthy lifestyles can even overcome hered- itary predisposition to illness and disease.

Healthy lifestyles should be based on personal

needs. The P in HELP stands for personal. No two peo- ple are exactly alike. Just as no single pill cures all illnesses, no single lifestyle prescription exists for good health, well- ness, and fitness. Each person must assess personal needs and make lifestyle changes based on those needs.

You can adopt the HELP philosophy. As you progress through this book, consider ways that you can implement the HELP philosophy. In each concept, HELP boxes are provided to stimulate your thinking about key health issues.

National Health Goals Healthy People 2020 (HP2020) is a comprehensive

set of health promotion and disease prevention

objectives with the primary intent of improving the

nation’s health . The objectives, developed by experts from hundreds of national health organizations and pub- lished in 2010, provide benchmarks to determine prog- ress over the period from 2010 to 2020. The objectives

N inety-nine percent of American adults say that “being in good health” is of primary importance. Good

health—for them and those they care about—is more important than money and other material things. Having good health, wellness, and fitness can make us feel good, look good, and enjoy life fully. This book is designed to help you achieve good health by providing information to help you make good decisions. You will also learn essen- tial self-management skills. With practice, use of these skills promotes healthy lifestyles that lead to good health, wellness, and fitness throughout life. An overview of basic self-management skills is provided in Concept 2.

The HELP Philosophy The HELP philosophy provides a basis for making

healthy lifestyle change possible. The four-letter acronym HELP summarizes the overall philosophy used in this book. Each letter in HELP characterizes an impor- tant part of the philosophy: Health is available to Everyone for a Lifetime —and it’s Personal. The concepts in the book

Health and wellness is available to everyone for a lifetime.

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Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 3

also serve as goals to motivate and guide people in mak- ing sound health decisions as well as to provide a focus for public health programs.

The national health goals for the year 2010 were established in 2000. Studies show that significant prog- ress was made in that 10-year period: For example, 23 percent of all goals were met and progress was made on 48 percent. The hope is that similar progress can be made in the 10 years leading to 2020.

In addition to helping change the health of society at large, HP2020 goals also have implications for personal health behavior change. Societal changes can occur only when individuals adjust personal behaviors and work together to make changes that benefit other people. Not all objectives will have personal implications for each individual, but societal awareness of the objectives may lead to future changes in the health of our country.

Specific HP2020 goals are provided at the end of each concept to show the links between the content of this text and the national health goals. Four of the “overarching goals” of HP2020 are described in more detail in the sec- tions that follow. The section at the end of each concept, “Strategies for Action,” offers assessment and planning tips for improving health, wellness, and fitness and for working toward meeting HP2020 goals.

A primary goal of HP2020 is to help all people

have high-quality, longer lives free of preventable

disease, injury, and premature death. Over the past century, the average life expectancy in the United States has increased by 60 percent. Although different reports yield slightly different results, studies have generally shown that Americans now live longer than ever before. Results included in Figure 1 are from the most recent World Health Organization (WHO) life expectancy report. These data provide statistics for healthy life expec- tancy in North American countries. Globally, according to the most current World Factbook, Canada ranks 12th, the United States ranks 50th, and Mexico ranks 72nd in life expectancy.

Living a long life is important, but so is having a high- quality life. This means feeling good, looking good, and being happy. It also means being fit enough to enjoy your leisure and to be able do what you want to do without lim- itation. An index called HALE (Healthy Life Expectancy) is often used to determine the number of years of life a person has a good quality of life as opposed to having ill- ness or impaired function. Figure 1 uses information from HALE to show the number of years of high-quality life (green) and years of life with low quality (orange). Adopt- ing healthy lifestyles when we are young can increase the length of life and can also increase quality of life.

Achieving health equity, eliminating disparities,

and improving the health of all groups is another

primary goal of HP2020. Health varies greatly with

ethnicity, income, gender, and age. For example, African Americans, Hispanics, and Native Americans have a shorter life expectancy than White non-Hispanics, and men have a shorter life expectancy than women. Health disparities also exist in quality of life. One method of assessing disparities in quality of life is to compare the number of healthy days diverse groups experience each month. Minorities, including African Americans, Hispanics, and Native Americans, experience about 24 healthy days each month compared to 25 for White

Figure 1 ▶ Healthy life expectancy for North America. Sources: World Health Organization and National Center for Health Statistics.

Country Total life

expectancyUSA

Females

Canada

Females

Mexico

Females

Males All

72 9 68 8

870

81 76 78

Males All

71 7 73

83 78 81

Males All

65 67

78 73 76

Years 55 60 65 70 75 80

Healthy life expectancy

Unhealthy years

Self-management Skills Skills that you learn to help you adopt healthy lifestyles and adhere to them. Health Optimal well-being that contributes to one’s quality of life. It is more than freedom from disease and illness, though freedom from disease is impor- tant to good health. Optimal health includes high- level mental, social, emotional, spiritual, and physical wellness within the limits of one’s heredity and per- sonal abilities. World Health Organization (WHO) WHO is the United Nations’ agency for health and has 193 mem- ber countries. Its principal goal is the attainment of the highest possible level of health for all people. WHO has been instrumental in making health pol- icy and in implementing health programs worldwide since its inception in 1948. Healthy Days A self-rating of the number of days (per week or month) a person considers himself or herself to be in good or better than good health.

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4 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

non-Hispanics. People with very low income typically have 22 healthy days per month, compared with 26 days for those with high income. Men have a higher number of healthy days than women.

The reason for such differences in the number of healthy days varies. The relatively higher number of unhealthy days for women is, at least in part, because they live longer and their unhealthy years later in life factor into their average number of healthy days. Disparities in healthy days by level of income may be due to environ- mental, social, or cultural factors as well as less access to preventive care. Both physical and mental health problems are the most frequent reasons for unhealthy days. Physical illness, pain, depression, anxiety, sleeplessness, and limita- tions in ability to function or perform enjoyable activities are the problems people most frequently reported.

Another primary goal of HP2020 is to create social

and physical environments that promote good

health for all. The environment, both social and physical, has much to do with both quality of life and length of life. Environmental factors are discussed in greater detail on page 13 and in several of the later concepts in this book.

The final primary goal of HP2020 is to promote

quality of life, healthy development, and healthy

behaviors across all stages of life. Healthy days decrease as we age. Young adults experience more healthy days each month than older adults. Over the past two decades, there has been a steady decline in healthy days for the average person, no doubt because of the increase in the number of older adults in our society. The num- ber of healthy days takes its biggest drop after age 75. It is interesting that in recent national surveys older adults (ages 50 to 75) report being happier and more secure than younger people age 20 to 40.

A recent national report ( Blueprint for a Healthier America ) underscores the need to focus future efforts on

prevention and preparedness, including changing both the social and physical environment to increase emphasis on physical activity, nutrition, and prevention of tobacco use. The report indicates that an investment of $10 per person per year in proven community-based programs that focus on healthy lifestyles could save the country $16 per person over a five-year period.

Health and Wellness Health is more than freedom from illness and

disease. Over 60 years ago, the World Health Organi- zation defined health as more than freedom from illness, disease, and debilitating conditions. Prior to that time, you were con- sidered to be “healthy” if you were not sick. HP2020 refers to quality of life in two of its four overarching goals, highlighting the importance of the wellness component of health.

Figure 2 illustrates the modern concept of health. This general state of being is characterized by freedom from disease and debilitating conditions (outer circle), as well as wellness (center circle).

Physical activity is for everyone. An active lifestyle promotes health and wellness. Healthy lifestyles are the principal contributor to health and wellness.

VIDEO 1

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Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 5

Wellness is the positive component of optimal

health. Disease, illness , and debilitating conditions are negative components that detract from optimal health. Death can be considered the ultimate opposite of optimal health. Wellness , in contrast, is the positive component of optimal health. It is characterized by a sense of well- being reflected in optimal functioning, health-related quality of life , meaningful work, and a contribution to society. HP2020 objectives use the term health-related quality of life to describe a general sense of happiness and satisfaction with life.

Health and wellness are personal. Every individual is unique—and health and wellness are influenced by each person’s unique characteristics. Making comparisons to other people on specific characteristics may produce feelings of inadequacy that detract from one’s profile of total health and wellness. Each of us has personal limita- tions and strengths. Focusing on strengths and learning to accommodate weaknesses are essential keys to optimal health and wellness.

Health and wellness are multidimensional. The dimensions of health and wellness include emotional- mental, intellectual, social, spiritual, and physical. Table 1 describes the various dimensions, and Figure 3 illustrates the importance of each one for optimal health and well- ness. Some people include environmental and vocational dimensions in addition to the five shown in Figure 3 .

Fr ee

do m fr

om illness and disease

Wellness

Freedom from debilitating c ond

iti on

HEALTH

Quality of life Sense of well-being

Figure 2 ▶ A model of optimal health, including wellness.

Physical

Emotional/ Mental

Spiritual

Social Intellectual

Figure 3 ▶ The dimensions of health and wellness.

Illness The ill feeling and/or symptoms associated with a disease or circumstances that upset homeostasis. Wellness The integration of many different compo- nents (social, emotional/mental, spiritual, and physical) that expand one’s potential to live (quality of life) and work effectively and to make a significant contribution to society. Wellness reflects how one feels (a sense of well-being) about life, as well as one’s ability to func- tion effectively. Wellness, as opposed to illness (a nega- tive), is sometimes described as the positive component of good health. Quality of Life A term used to describe wellness. An individual with quality of life can enjoyably do the activities of life with little or no limitation and can function independently. Individual quality of life requires a pleasant and supportive community.

A CLOSER LOOK

Social Determinants of Health Healthy People 2020 and related documents from the World Health Organization (WHO) emphasize the impor- tance of understanding the determinants of health. The WHO reports outline the importance of social determi- nants in reducing health disparities throughout the world. They note that people’s circumstances are shaped by distribution of money, power, and resources at local, national, and global levels, which can result in “unfair but avoidable” differences in health status in different places. For example, the lack of pure water, medical facilities, and medicine result in higher rates of disease (particu- larly infectious disease) and lower quality of life in third world countries than in more technologically advanced countries.

How do social determinants influence health status within the

United States?

Social D

minaDetermi l Determ

ACTIVITY

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6 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

In this book, health and wellness are considered to be personal factors, so environmental and vocational well- ness are not included in Tables 1 and 2 . However, the environment (including your work environment) is very

important to overall personal wellness, and for this rea- son, environmental factors are prominent in the model of wellness described on page 13 and are featured through- out this book. The final concept in the book links envi- ronmental and vocational factors to the personal wellness dimensions described in Table 1 .

Wellness reflects how one feels about life, as well

as one’s ability to function effectively. A positive total outlook on life is essential to each of the wellness dimen- sions. As illustrated in Table 2 , a “well” person is satis- fied in work, is spiritually fulfilled, enjoys leisure time, is physically fit, is socially involved, and has a positive emo- tional/mental outlook. He or she is happy and fulfilled.

The way one perceives each dimension of wellness affects one’s total outlook. Researchers use the term self– perceptions to describe these feelings. Many researchers believe that self-perceptions about wellness are more important than actual circumstances or a person’s actual state of being. For example, a person who has an impor- tant job may find less meaning and job satisfaction than another person with a much less important job. Appar- ently, one of the important factors for a person who has achieved high-level wellness and a positive outlook on life is the ability to reward himself or herself. Some peo- ple, however, seem unable to give themselves credit for their successes. The development of a system that allows a person to perceive the self positively is essential, along with the adoption of positive lifestyles that encourage improved self-perceptions. The questionnaire in Lab 1A will help you assess your self-perceptions of the various wellness dimensions. For optimal wellness, it is impor- tant to find positive feelings about each dimension.

Health and wellness are integrated states of being. The segmented pictures of health and wellness shown in Figure 3 and Tables 1 and 2 are used only to illustrate the multidimensional nature of health and wellness. In real- ity, health and wellness are integrated states of being that

Table 1 ▶ Defi nitions of Health and Wellness Dimensions

Emotional/mental health—Freedom from emotional/mental illnesses, such as clinical depression, and possession of emotional wellness. The goals for the nation’s health refer to mental rather than emotional health and wellness. In this book, mental health and wellness are considered to be the same as emotional health and wellness.

Emotional/mental wellness—The ability to cope with daily circumstances and to deal with personal feelings in a positive, optimistic, and constructive manner. A person with emotional wellness is generally characterized as happy instead of depressed.

Intellectual health—Freedom from illnesses that invade the brain and other systems that allow learning. A person with intellectual health also possesses intellectual wellness.

Intellectual wellness—The ability to learn and to use information to enhance the quality of daily living and optimal functioning. A person with intellectual wellness is generally characterized as informed instead of ignorant.

Physical health—Freedom from illnesses that affect the physiological systems of the body, such as the heart and the nervous system. A person with physical health possesses an adequate level of physical fitness and physical wellness.

Physical wellness—The ability to function effectively in meeting the demands of the day’s work and to use free time effectively. Physical wellness includes good physical fitness and the possession of useful motor skills. A person with physical wellness is generally characterized as fit instead of unfit.

Social health—Freedom from illnesses or conditions that severely limit functioning in society, including antisocial pathologies.

Social wellness—The ability to interact with others successfully and to establish meaningful relationships that enhance the quality of life for all people involved in the interaction (including self). A person with social wellness is generally characterized as involved instead of lonely.

Spiritual health—The one component of health that is totally composed of the wellness dimension; it is synonymous with spiritual wellness.

Spiritual wellness—The ability to establish a values system and act on the system of beliefs, as well as to establish and carry out meaningful and constructive lifetime goals. Spiritual wellness is often based on a belief in a force greater than the individual that helps her or him contribute to an improved quality of life for all people. A person with spiritual wellness is generally characterized as fulfilled instead of unfulfilled.

Table 2 ▶ The Dimensions of Wellness

Wellness Dimension Negative – – – – – – – – Positive

Emotional/mental Depressed – – – – – – – Happy

Intellectual Ignorant – – – – – – – – Informed

Physical Unfit – – – – – – – – – – Fit

Social Lonely – – – – – – – – – Involved

Spiritual Unfulfilled – – – – – – – – Fulfilled

Total outlook Negative – – – – – – – – Positive

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Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 7

can best be depicted as threads woven together to pro- duce a larger, integrated fabric. Each dimension relates to each of the others and overlaps all the others. The overlap is so fre- quent and so great that the specific contribution of each thread is almost indistinguishable when looking at the total ( Figure 4 ). The total is clearly greater than the sum of the parts.

It is possible to possess health and wellness while

being ill or possessing a debilitating condition.

Many illnesses are curable and may have only a tempo- rary effect on health. Others, such as Type I diabetes, are not curable but can be managed with proper eating, physical activity, and sound medical treatment. Those with manageable conditions may, however, be at risk for other health problems. For example, unmanaged diabetes is associated with a high risk for heart disease and other health problems.

Debilitating conditions, such as the loss of a limb or loss of function in a body part, can contribute to a lower level of functioning or an increased risk for illness and thus to poor health. On the other hand, such conditions need not limit wellness. A person with a debilitating con- dition who has a positive outlook on life may have better overall health than a person with a poor outlook on life but no debilitating condition.

Just as wellness is possible among those with illness and disability, evidence is accumulating that people with a positive outlook are better able to resist the progress of disease and illness than are those with a negative outlook. Thinking positive thoughts has been associated with enhanced results from various medical treatments and surgical procedures.

Wellness is a term used by the uninformed as well

as experts. Unfortunately, some individuals and groups have tried to identify wellness with products and ser- vices that promise benefits that cannot be documented. Because well-being is a subjective feeling, unscrupulous people can easily make claims of improved wellness for their product or service without facts to back them up.

Holistic health is a term that is similarly abused. Con- sider that optimal health includes many areas; thus, the term holistic (total) is appropriate. In fact, the word health

originates from a root word meaning “wholeness.” Unfor- tunately, questionable health practices are sometimes pro- moted under the guise of holistic health. Care should be used when considering services and products that make claims of wellness and/or holistic health to be sure that they are legitimate.

Physical Fitness Physical fitness is a multidimensional state of being.

Physical fitness is the body’s ability to function efficiently and effectively. It consists of at least five health-related and six skill-related components, each of which contributes to total quality of life. Physical fitness is associated with a person’s ability to work effectively, enjoy leisure time, be healthy, resist hypokinetic diseases or conditions , and meet emergency situations. It is related to, but dif- ferent from, health and wellness. Although the development of physical fitness is the result of many things, optimal physical fitness is not possible without regular physical activity.

The health-related components of physical fitness

are directly associated with good health. The five components of health-related physical fitness are body composition, cardiovascular fitness, flexibility, muscular

Physical

Emotional/Mental

Spiritual SocialIntellectual

Figure 4 ▶ The integration of wellness dimensions.

VIDEO 2

VIDEO 3

Lifestyles Patterns of behavior or ways an individ- ual typically lives. Physical Fitness The body’s ability to function efficiently and effectively. It consists of health-related physical fitness and skill-related physical fitness, which have at least 11 components, each of which contributes to total quality of life. Physical fitness also includes metabolic fitness and bone integrity. Physical fitness is associated with a person’s ability to work effectively, enjoy leisure time, be healthy, resist hypokinetic dis- eases, and meet emergency situations. It is related to, but different from, health, wellness, and the psycho- logical, sociological, emotional/mental, and spiritual components. Although the development of physical fitness is the result of many things, optimal physical fit- ness is not possible without regular exercise. Hypokinetic Diseases or Conditions Hypo- means “under” or “too little,” and -kinetic means “movement” or “activity.” Thus, hypokinetic means “too little activ- ity.” A hypokinetic disease or condition is one associ- ated with lack of physical activity or too little regular exercise. Examples include heart disease, low back pain, Type II diabetes, and obesity.

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8 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

Figure 5 ▶ Components of health-related physical fitness.

Dimensions of Health-

Related Physical Fitness

The ability of the muscles to exert themselves repeatedly. A fit person can repeat movements for a long period without undue fatigue.

Muscular Endurance

The relative percentage of muscle, fat, bone, and other tissues that make up the body. A fit person has a relatively low, but not too low, percentage of body fat (body fatness).

Body Composition

Flexibility

The range of motion available in a joint. It is affected by muscle length, joint structure, and other factors. A fit person can move the body joints through a full range of motion in work and in play.

The ability of the heart, blood vessels, blood, and respiratory system to supply nutrients and oxygen to the muscles and the ability of the muscles to utilize fuel to allow sustained exercise. A fit person can persist in physical activity for relatively long periods without undue stress.

Cardiovascular Fitness

Strength

The ability of the muscles to exert an external force or to lift a heavy weight. A fit person can do work or play that involves exerting force, such as lifting or controlling one’s own body weight.

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Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 9

endurance, and strength (see Figure 5 ) . Each health– related fitness characteristic has a direct relationship to good health and reduced risk for hypokinetic disease. It is for this reason that the five health-related physical fitness components are emphasized in this book.

Possessing a moderate amount of each component of health-related fitness is essential to disease preven- tion and health promotion, but it is not essential to have exceptionally high levels of fitness to achieve health ben- efits. High levels of health-related fitness relate more to performance than to health benefits. For example, mod- erate amounts of strength are necessary to prevent back and posture problems, whereas high levels of strength contribute most to improved performance in activities such as football and jobs involving heavy lifting.

The skill-related components of physical fitness are

associated more with performance than with good

health. The components of skill-related physical fitness are agility, balance, coordination, power, reaction time, and speed (see Figure 6 ). They are called skill-related because people who possess them find it easy to achieve high levels of performance in motor skills, such as those required in sports and in specific types of jobs. Power is sometimes referred to as a combined component of fitness, since it requires both strength (a health-related component) and speed (a skill-related compo- nent). Because most experts consider power to be associated more with performance than with good health, it is classified as a skill-related component of fitness in this book. Skill-related fitness is sometimes called sports fit- ness or motor fitness.

It is important to recognize that skill-related fitness is multidimensional and highly specific. For example, coordination could be hand-eye coordination, such as batting a ball; foot-eye coordination, such as kicking a ball; or many other possibilities. The six parts of skill- related fitness identified here are those commonly asso- ciated with successful sports and work performance. Each could be measured in ways other than those pre- sented in this book. Measurements are provided to help you understand the nature of total physical fitness and to help you make important decisions about lifetime physi- cal activity.

Metabolic fitness is a nonperformance component

of total fitness. Physical activity can provide health benefits that are independent of changes in traditional health-related fitness measures. Physical activity promotes good metabolic fitness , a state associated with reduced risk for many chronic diseases. People with a cluster of low metabolic fitness characteristics are said to have meta- bolic syndrome (also known as Syndrome X). Metabolic syndrome is discussed in more detail in Concept 4.

Bone integrity is often considered to be a

nonperformance measure of fitness. Traditional def- initions do not include bone integrity as a part of physical fitness, but some experts feel they should. Like metabolic fitness, bone integrity cannot be assessed with perfor- mance measures the way most health-related fitness parts can. Regardless of whether bone integrity is considered a part of fitness or a component of health, strong, healthy bones are important to optimal health and are associated with regular physical activity and sound diet.

The many components of physical fitness are

specific but are also interrelated. Physical fitness is a combination of several aspects, rather than a single char- acteristic. A fit person possesses at least adequate levels of each of the health-related, skill-related, and metabolic fit- ness components. Some relationships exist among various fitness characteristics, but each component of physical fit- ness is separate and different from the others. For exam- ple, people who possess exceptional strength may not have good cardiovascular fitness, and those who have good coordination do not necessarily possess good flexibility.

Good physical fitness is important, but it is not the

same as physical health and wellness. Good physi- cal fitness contributes directly to the physical component of good health and wellness and indirectly to the other four components. Good fitness has been shown to be associated with reduced risk for chronic diseases, such as heart disease, and has been shown to reduce the con- sequences of many debilitating conditions. In addition, good fitness contributes to wellness by helping us look our best, feel good, and enjoy life. Other physical factors can also influence health and wellness. For example, hav- ing good physical skills enhances quality of life by allow- ing us to participate in enjoyable activities, such as tennis, golf, and bowling. Although fitness can assist us in per- forming these activities, regular practice is also necessary. Another example is the ability to fight off viral and bac- terial infections. Although fitness can promote a strong immune system, other physical factors can influence our susceptibility to these and other conditions.

Metabolic Fitness A positive state of the physi- ological systems commonly associated with reduced risk for chronic diseases such as diabetes and heart disease. Metabolic fitness is evidenced by healthy blood fat (lipid) profiles, healthy blood pressure, healthy blood sugar and insulin levels, and other nonperformance measures. Bone Integrity Soundness of the bones is associ- ated with high density and absence of symptoms of deterioration.

VIDEO 4

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10 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

Figure 6 ▶ Components of skill-related physical fitness.

Dimensions of Skill-Related

Physical Fitness

The ability to rapidly and accurately change the direction of the movement of the entire body in space. Skiing and wrestling are examples of activities that require exceptional agility.

Agility

The maintenance of equilibrium while stationary or while moving. Performing tai chi movements and performing stunts on the balance beam are activities that require exceptional balance.

Balance

The ability to use the senses with the body parts to perform motor tasks smoothly and accurately. Juggling, hitting a tennis ball, and kicking a ball are examples of activities requiring good coordination.

Coordination

The ability to transfer energy into force at a fast rate. Kicking in martial arts and throwing the discus are activities that require considerable power.

Power

The time elapsed between stimulation and the beginning of reaction to that stimulation. Reacting to a soccer ball and starting a sprint race require good reaction time.

Reaction Time

The ability to perform a movement in a short period of time. Sprinters and wide receivers in football need good foot and leg speed.

Speed

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Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 11

Determinants of Lifelong Health, Wellness, and Fitness Many factors are important in developing lifetime

health, wellness, and fitness, and some are more

in your control than others. Figure 7 provides a model for describing many of the factors that contribute to health, wellness, and fitness. Central to the model are health, wellness, and fitness because these are the states of being (shaded in green and gold) that each of us wants to achieve. Around the periphery are the factors that influ- ence these states of being. Those shaded in dark blue are the factors over which you have the least control (hered- ity, age, and disability). Those shaded in light blue (health care and environmental factors) are factors over which you have some control but less than the factors shaded in red (personal actions/interactions, cognitions, and emotions).

Those shaded in light red are the factors over which you have greatest control (healthy lifestyles).

Heredity (human biology) is a factor over which we

have little control. Experts estimate that human biology, or heredity, accounts for 16 percent of all health prob- lems, including early death. Heredity influences each part of health-related physical fitness, including our tenden- cies to build muscle and to deposit body fat. Each of us reaps different benefits from the same healthy lifestyles, based on our hereditary tendencies. Even more important is that predispositions to diseases are inherited. For exam- ple, some early deaths are a result of untreatable heredi- tary conditions (e.g., congenital heart defects). Obviously, some inherited conditions are manageable (e.g., diabetes) with proper medical supervision and appropriate lifestyles.

Personal actions and interactions Cognitions and emotions

Health

Wellness

More control

Least control

Some controlMost control

Physical fitness

Heredity Age

Disability

Healthy lifestyles Engaging in regular physical activity* Eating well* Managing stress* Avoiding destructive habits Practicing safe sex Managing time Being an informed consumer Adopting good health habits Adopting good safety habits Learning first aid

*These lifestyles are viewed as “priority lifestyles.”

Environmental factors Physical, social and cultural, spiritual, worksite, other

Health-care system Access Compliance

Figure 7 ▶ Determinants of health, fitness, and wellness.

VIDEO 5

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12 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

Heredity is a factor over which we have little control and is, therefore, illustrated in dark blue in Figure 7 . Each of us can limit the effects of heredity by being aware of our personal family history and by making efforts to best manage those factors over which we do have control.

In the concepts that follow, you will learn more about heredity and how it affects health, wellness, and fitness.

Health, wellness, and fitness are influenced by the

aging of our population. In 2030 when post–World War II baby boomers are over the age of 65, adults 65 or older will make up 20 percent of the population. The number of people over 85 will triple by 2050. There are currently more than 100,000 people over the age of 100. The defini- tion of old is changing, with most people believing that a person is not old until age 71 or older. Nearly a quarter of the population believes that being old begins at 81.

Whatever the standard for being old, age is a factor over which we have no control. The major health and wellness concerns of older adults include losing health, losing the ability to care for oneself, losing mental abili- ties, running out of money, being a burden to family, and being alone. Chronic pain is also a major problem among older adults. Nearly 30 percent of adults over 65 experi- ence chronic pain, as opposed to 3 percent of those under 30. Nearly 60 percent of older adults experience frequent pain, as opposed to 17 percent of those under 30. Older adults have 36 percent more unhealthy days than young adults.

Age is shaded in dark blue in Figure 7 because it is a factor that you cannot control. However, healthy lifestyles can reduce the effects of aging on health, wellness, and fit- ness. As detailed later in this book, healthy lifestyles can extend life and have a positive effect on quality of life.

Disabilities can affect, but they do not necessarily

limit, health, wellness, and fitness. Disabilities typi- cally result from factors beyond your control (shaded in dark blue in Figure 7 ). Many types of disabilities affect

health, fitness, and wellness. An objective disability (e.g., loss of a limb, impaired intellectual functioning) can make it difficult to function in certain circumstances but need not limit health, wellness, and fitness. All people have a limitation of one kind or another. Societal efforts to help all people function within their limitations can help everyone, including people with disabilities, have a positive outlook on life and experience a high quality of life. With assistance from an instructor, it is possible for all people to adapt the information in this book for use in promoting heath, wellness, and fitness.

The health-care system affects our ability to

overcome illness and improve our quality of life.

Approximately 10 percent of unnecessary deaths occur as a result of disparities in the health-care system. The qual- ity of life for those who are sick and those who tend to be sick is influenced greatly by the type of medical care they receive. Health care is not equally available to all. A study by the Institute of Medicine, entitled “Insuring America’s Health,” indicates that 18,000 people die unnecessarily in the United States each year because they lack health insurance. Those without health insurance are less likely to get high-quality medical care than those with insur- ance. Many of those without insurance have chronic conditions that go undetected and as a result become untreatable. The passage of the Affordable Health Care Act addresses this issue by enabling all Americans to have health insurance.

Many people fail to seek medical help even though care is accessible. Others seek medical help but fail to comply with medical advice. For example, they do not take prescribed medicine or do not follow up with treat- ments. Men are less likely to seek medical advice than women. For this reason, treatable conditions sometimes become untreatable. Once men seek medical care, evi- dence reveals, they get better care than women. Also,

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T E C H N O L O G Y U P D A T E

Podcasts Podcasts are compressed digital files containing audio or video that can be downloaded from the Internet to a portable media player or personal computer. The word Pod refers to a personal media player, the receiver of the information delivered by a podcaster. Originally used to transmit music and news, podcasts of health information are now common.

Do you think you would rely on this type of resource for health-

related information? Why or why not?

Health is available to Everyone for a

Lifetime, and it’s Personal

According to the National Institutes of Health, although genes do not necessarily cause diseases, they do influ- ence our risk of developing diseases, such as cancer, heart disease, and addiction. The interaction between our genes and our environments and experiences is a complex one that is still being studied.

Would knowing you were genetically predisposed to a

particular disease change the lifestyle decisions you make?

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Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 13

more of the medical research has been done on men. This is of concern because treatments for men and women often vary for similar conditions.

Wellness as evidenced by quality of life is also influ- enced by the health-care system. Traditional medicine, sometimes referred to as the medical model , has focused primarily on the treatment of illness with medicine, rather than illness prevention and wellness promotion. Efforts to educate health-care personnel about techniques for promoting wellness have been initiated in recent years. Still, it is often up to the patient to find information about health promotion. For example, a patient with risk factors for heart disease might be advised to eat better or to exercise more, but little specific information may be offered. In Figure 7 , the health-care system is in light blue to illustrate the fact that it is a factor over which you may have limited control.

The environment is a major factor affecting our

health, wellness, and fitness. Environmental factors account for nearly one-fourth of all early deaths and affect quality of life in many ways. We do have more control over environmental factors than heredity, but they are not totally under our control. For this reason, the environ- mental factors box is depicted in Figure 7 with a lighter shade of blue than the heredity, age, and disability box.

You can exert personal control by selecting healthy envi- ronments rather than by exposing yourself to unhealthy or unsafe environments. This includes your choice of living and work location, as well as the social, spiritual, and intel- lectual environments. On the other hand, circumstances may make it impossible for you to make the choices you would prefer. Important environmental factors are dis- cussed throughout the text, particularly in Concept 6 and the final concept in the book. Some suggestions for how you can work to alter the environment in a positive way are also discussed in the last concept.

Personal actions, interactions, cognitions, and

emotions all have an effect on health, wellness, and

fitness. Some people think that good health, wellness, and fitness are totally out of personal control. Others think that they are totally in control. Neither statement is entirely true. While heredity, age, and disability are factors you cannot control, and health care and the environment are factors over which you have limited control, there are things that you can do relating to these factors. You can use your cognitive abili- ties to learn about your family history and use that informa- tion to limit the negative influences of heredity. You can learn how to adapt to disabilities and personal limitations, as well as to the aging process. You can research the health-care sys- tem and the environment to minimize the problems associ- ated with them.

Your personal interactions also influence your health, wellness, and fitness. You are not alone in this world. Your

various environments, and how you interact with them, influence you greatly. You have a choice about the envi- ronments in which you place yourself and the people with whom you interact in these environments.

Humans have the ability to think (cognitions) and to use critical thinking to make choices and to determine the actions they take and the interactions they engage in. Emo- tions also affect personal actions and interactions. A major goal of this book is to help you learn self-management skills designed to help you use your cognitive abilities to solve problems and make good decisions about good health, wellness, and fitness, as well as to help you to be in control of your emotions when taking action and making decisions that affect your health.

None of us makes perfect decisions all of the time. Sometimes we take actions and make choices based on inadequate information, faulty thinking, pressure from others, or negative influences from our emotions. While the focus of this book is on healthy lifestyles, all of the factors that influence health, wellness, and fitness will be discussed in greater detail in the concepts that follow. The goal is to help you consider all factors and to make informed decisions that will lead to healthful behaviors. Some strategies for action for each of the factors are pre- sented in the final concept of this book.

Lifestyle change, more than any other factor, is

the best way to prevent illness and early death

in our society. Statistics show that more than half of early deaths are the result of chronic diseases caused by unhealthy lifestyles. Many of these chronic diseases are targeted in the HP2020 report, and many of the new health objectives focus on them. As shown in Figure 7 , these lifestyles affect health, wellness, and physical fit- ness. The double-headed arrow between health/wellness and physical fitness illustrates the interaction between these factors. Physical fitness is important to health and wellness development and vice versa.

The major causes of early death have shifted from

infectious diseases to chronic lifestyle-related

conditions. Scientific advances and improvements in medicine and health care have dramatically reduced the incidence of infectious diseases over the past 100 years (see Table 3 ). Diphtheria and polio, both major causes of death in the 20th century, have been virtually eliminated in Western culture. Smallpox was globally eradicated in 1977.

Medical Model The focus of the health-care sys- tem on treating illness with medicine, with little emphasis on prevention or wellness promotion.

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14 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

chronic lifestyle-related conditions because alteration of lifestyles can result in reduced risk for these conditions.

Healthy lifestyles are critical to wellness. Just as unhealthy lifestyles are the principal causes of modern- day illnesses, such as heart disease, cancer, and diabetes, healthy lifestyles can result in the improved feeling of wellness that is critical to optimal health. In recogniz- ing the importance of “years of healthy life,” the Public Health Service also recognizes what it calls “measures of well-being.” This well-being, or wellness, is associ- ated with social, emotional/mental, spiritual, and physi- cal functioning. Being physically active and eating well are two healthy lifestyles that can improve well-being and add years of quality living. Many of the healthy lifestyles associated with good physical fitness and optimal wellness will be discussed in detail later in this book. The Healthy Lifestyle Questionnaire at the end of this concept gives you the opportunity to assess your current lifestyles.

Regular physical activity, sound nutrition, and

stress management are priority healthy lifestyles.

Three of the lifestyles listed in Figure 7 are considered to be priority healthy lifestyles: engaging in regular physical activity or exercise , eating well, and managing

Health, Wellness, and Fitness: The Good News The Gallup-Healthways Well-Being Index® provides an indicator of how U.S. residents

rate their health and well-being over time. More than 1,000 adults are surveyed every day and results are summarized each month. In addition to the overall Well-Being Index, sepa- rate indices monitor life adjustment, emotional health, physi- cal health, healthy behaviors, work environment, and health

access. The indices track trends at the national level as well as by state, major cities, and congressional districts. Visit the Well-Being Index at www.well-beingindex.com to see how Americans feel about their health and well-being.

What do you think is needed to promote health and well-being at the

local, state, and national level?

H T p

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In the News

Infectious diseases have been replaced with chronic lifestyle-related conditions as the major causes of death. Four of the top seven current causes of death (heart dis- ease, cancer, stroke, and diabetes) fall into this category. While heart disease remains the leading killer among all adults, National Cancer Institute statistics indicate that cancer is the leading cause of death for adults under the age of 85. Death rates have recently decreased for 8 of the top 10 causes of death. The incidence of kidney dis- ease was unchanged, and suicide increased 1 percent.

HIV/AIDS, formerly in the top 10 causes of death, is now 15th. The drop is primarily because of the devel- opment of treatments to increase the life expectancy of those infected. Many among the top 10 are referred to as

Physical Activity Generally considered to be a broad term used to describe all forms of large muscle movements, including sports, dance, games, work, lifestyle activities, and exercise for fitness. In this book, exercise and physical activity will often be used interchangeably to make reading less repetitive and more interesting. Exercise Physical activity done for the purpose of getting physically fit.

Table 3 ▶ Major Causes of Death in the United States

Current Rank Cause

1900 Rank Cause

1 Heart disease 1 Pneumonia*

2 Cancer 2 Tuberculosis*

3 Lower respiratory disease 3 Diarrhea/enteritis*

4 Stroke 4 Heart disease

5 Injuries/accidents 5 Stroke

6 Alzheimer’s disease 6 Liver disease

7 Diabetes 7 Injuries

8 Influenza/pneumonia* 8 Cancer

9 Kidney disease 9 Senility

10 Suicide 10 Diphtheria*

*Infectious diseases: The only diseases among the top ten that are primarily

infectious in nature today are influenza/pneumonia.

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Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 15

stress. There are several reasons for placing priority on these lifestyles. First, they affect the lives of all people. Second, they are lifestyles in which large numbers of people can make improvement. Finally, modest changes in these behaviors can make dramatic improvements in individual and public health. For example, statistics sug- gest that modest changes in physical activity patterns and nutrition can prevent more than 400,000 deaths annu- ally. Stress also has a major impact on drug, alcohol, and smoking behavior, so managing stress can help individu- als minimize or avoid those behaviors.

The other healthy lifestyles listed in Figure 7 are also very important for good health. The reason that they are not emphasized as priority lifestyles is that they do not affect everyone as much as the first three do. Many healthy lifestyles will be discussed in this book, but the focus is on the priority healthy lifestyles because virtually all people can achieve positive wellness benefits if they adopt them.

The “actual causes” of most deaths are due to

unhealthy lifestyles. As illustrated in Table 3 , chronic diseases (e.g., heart diseases, cancer) are the direct causes of most deaths in our society. Public health experts have used epidemiological statistics to show that unhealthy lifestyles such as tobacco use, inactiv- ity, and poor eating actually cause the chronic diseases and for this reason are referred to as the “actual causes of death.” Tobacco is the leading actual cause of death, but inactivity and poor diet account for the next larg- est percentage of deaths (see Table 4 ). The percentage

Strategies for Action

Self-assessments of lifestyles will

help you determine areas in which

you may need changes to promote optimal health,

wellness, and fitness. The Healthy Lifestyle Questionnaire in the lab resource materials will help you assess your cur- rent lifestyle behaviors to determine if they are contributing positively to your health, wellness, and fitness. Because this questionnaire contains some very personal information, answering all the questions honestly will help you get an accurate assessment. As you continue your study, refer back to this questionnaire to see if your lifestyles have changed.

Initial self-assessments of wellness and fitness will

provide information for self-comparison. It is important to assess your wellness and fitness at an early stage. These early

assessments will only be estimates. As you continue your study, you will have the opportunity to do more comprehen- sive self-assessments that will allow you to see how accurate your early estimates were.

In Lab 1A, you will estimate your wellness using a Wellness Self-Perceptions questionnaire, which assesses five well- ness dimensions. Remember, wellness is a state of being that is influenced by healthy lifestyles. Because other factors, such as heredity, environment, and health care, affect wellness, it is possible to have good wellness scores even if you do not do well on the lifestyle questionnaire. However, over a lifetime, unhealthy lifestyles will catch up with you and have an influ- ence on your wellness and fitness. As each individual makes progress toward improving wellness, we move closer to meet- ing the HP2020 goal of living long, high-quality lives.

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of deaths attributed to inactivity and poor diet has recently been questioned, but their overall influence on health is indisputable. The information presented through- out this book is designed to help you change behaviors to reduce your risk for early death from the actual causes listed in Table 4 .

VIDEO 6

Table 4 ▶ Actual Causes of Death in the United States

Rank Actual Cause Percentage of Deaths

1 Tobacco use 18.1

2 Inactivity/poor diet 16.6

3 Alcohol consumption 3.5

4 Microbial agents (flu, pneumonia) 3.1

5 Toxic agents 2.3

6 Motor vehicles 1.8

7 Firearms 1.2

8 Sexual behavior 0.8

9 Illicit drug use 0.7

10 Other <.05

Source: Mokdad et al.

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16 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

Web Resources American Medical Association (AMA) www.ama-assn.org Centers for Disease Control and Prevention (CDC) www.cdc.gov Health Canada http://www.hc-sc.gc.ca Healthier United States www.healthfinder.gov Healthy People 2020 www.healthypeople.gov/HP2020 Institute of Medicine www.iom.edu Kaiser Permanente, HealthAlliance Hospital, CDC, and the Insti-

tute for Healthcare Improvement. 2011. http://xnet.kp.org/ newscenter/pointofview/2010/032410healthylife.html

National Center for Chronic Disease Prevention and Health Pro- motion Publications http://www.cdc.gov/chronicdisease/ index.htm

President’s Council on Fitness, Sports, and Nutrition www.fitness.gov

Robert Wood Johnson Foundation www.rwjf.org Trust for America’s Health http://healthyamericans.org/ U. S. Government Healthcare www.HealthCare.gov Well-Being Index—Gallup Poll

www.gallup.com/poll/wellbeing.aspx

World Health Organization www.who.int

Web Podcasts (Selected Websites) Arizona State University on iTunes U—Introduction to Exer-

cise and Wellness http://itunes.asu.edu CDC www2a.cdc.gov/podcasts Johns Hopkins Medicine Podcasts www.hopkinsmedicine

.org/news/audio/podcasts/Podcasts.html

Journal of the American Medical Association Podcasts http://jama.ama-assn.org/misc/audiocommentary.dtl

University of Maryland—Medical Podcasts (Medically Speak- ing) www.umm.edu/podcasts/?source-google&gclid=C NS2g7_8oo0CFRfOggodmDi_5g

U.S. Food and Drug Administration www.fda.gov/ AboutFDA/ContactFDA/StayInformed/RSSFeeds/

ucm144574.htm

U.S. Government Podcasts—Health Podcasts from the U.S. Government www.usa.gov/Topics/Reference-Shelf/ Libraries/Podcasts/Health.shtml

Suggested Readings Central Intelligence Agency. 2011. The World Factbook. Wash-

ington, DC: CIA. Available at https://www.cia.gov/ library/publications/the-world-factbook/

Owen, N., et al. 2010. Too much sitting: The population health science of sedentary behavior. Exercise and Sport Sciences Reviews. 38(3):105–1113.

Sebastiani, P., et al. 2010. Genetic signatures of exceptional longevity in humans. Science. Published online July 1, 2010, www.sciencemag.org

Trust for America’s Health. 2008. Blueprint for a Healthier America. Washington, DC: Trust for America’s Health. Available at http://healthyamericans.org/report/55/ blueprint-for-healthier-america

United Nations Report on Non-Communicable Diseases. 2011. Available at www.un.org/en/ga/president/65/ issues/

World Health Organization. 2011. World Report on Disability. Geneva: WHO. Available at www.who.int/ publications/en

World Health Statistics 2012. Available at www.who.int/gho/ publications/world_health_statistics/2012/en/index.html

Healthy People 2020 The Healthy People 2020 goals provide health targets for the nation to achieve by the year 2020. The following goals relate specifically to the content of this concept:

• Create a society in which all people live long, healthy lives.

• Promote quality of life, healthy development, and healthy behaviors (including being active, eating well, and avoid- ing destructive habits) across all stages of life.

• Attain high-quality, longer lives free of preventable dis- ease, injury, and premature death.

• Achieve health equity, eliminate disparities, and improve the health of all groups.

• Create social and physical environments that promote good health for all.

• Increase public awareness and understanding of the determinants of health, disease, and disability.

The national health goals emphasize “high-quality” living and

“quality of life.” How do these national goals relate to health,

wellness, and fitness as defined in this concept?

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Lab Resource Materials: The Healthy Lifestyle Questionnaire

The purpose of this questionnaire is to help you analyze your lifestyle behaviors and to help you make decisions concerning good health and wellness for the future. Information on this Healthy Lifestyle Questionnaire is of a personal nature. For this reason, this questionnaire is not designed to be submitted to your instructor. It is for your information only. Answer each question as honestly as possible, and use the scoring information to help assess your lifestyle.

Directions: Place an X over the “yes” circle to answer yes. If you answer “no,” make no mark. Score the questionnaire using the procedures that follow.

1. I accumulate 30 minutes of moderate physi- cal activity most days of the week (brisk walking, stair climbing, yard work, or home chores).

2. I do vigorous activity that elevates my heart rate for 20 minutes at least 3 days a week.

3. I do exercises for flexibility at least 3 days a week.

4. I do exercises for muscle fitness at least 2 days a week.

5. I eat three regular meals each day.

6. I select appropriate servings from the major food groups each day.

7. I restrict the amount of fat in my diet.

8. I consume only as many calories as I expend each day.

9. I am able to identify situations in daily life that cause stress.

10. I take time out during the day to relax and recover from daily stress.

11. I find time for family, friends, and things I especially enjoy doing.

12. I regularly perform exercises designed to relieve tension.

13. I do not smoke or use other tobacco products.

14. I do not abuse alcohol.

15. I do not abuse drugs (prescription or illegal).

16. I take over-the-counter drugs sparingly and use them only according to directions.

17. I abstain from sex or limit sexual activity to a safe partner.

18. I practice safe procedures for avoiding sexu- ally transmitted infections (STIs).

19. I use seat belts and adhere to the speed limit when I drive.

20. I have a smoke detector in my house and check it regularly to see that it is working.

21. I have had training to perform CPR if called on in an emergency.

22. I can perform the Heimlich maneuver effec- tively if called on in an emergency.

23. I brush my teeth at least twice a day and floss at least once a day.

24. I get an adequate amount of sleep each night.

25. I do regular self-exams, have regular medical checkups, and seek medical advice when symptoms are present.

26. When I receive advice and/or medication from a physician, I follow the advice and take the medication as prescribed.

27. I read product labels and investigate their effectiveness before I buy them.

28. I avoid using products that have not been shown by research to be effective.

29. I recycle paper, glass, and aluminum.

30. I practice environmental protection, such as carpooling and energy conservation.

Overall Score—Total “Yes” Answers

yes

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Scoring: Give yourself 1 point for each “yes” answer. Add your scores for each of the lifestyle behaviors. To calculate your overall score, sum the totals for all lifestyles. Avoiding Adopting

Physical Managing Destructive Practicing Safety

Activity Nutrition Stress Habits Safe Sex Habits

1. 5. 9. 13. 17. 19.

2. 6. 10. 14. 18. 20.

3. 7. 11. 15.

4. 8. 12. 16.

Total + Total + Total + Total + Total +

Personal Using Being an Sum All

Knowing Health Medical Informed Protecting the Totals for

First Aid Habits Advice Consumer Environment Overall Score

21. 23. 25. 27. 29.

22. 24. 26. 28. 30.

Total + Total + Total + Total + Total =

Interpreting Scores: Scores of 3 or 4 on the four- item scales indicate generally positive lifestyles. For the two-item scales, a score of 2 indicates the presence of positive lifestyles. An overall score of 26 or more is a good indicator of healthy lifestyle behaviors. It is important to consider the following special note when interpreting scores.

Special Note: Your scores on the Healthy Lifestyle Questionnaire should be interpreted with caution. There are several reasons for this. First, all lifestyle behaviors do not pose the same risks. For example, using tobacco or abusing drugs has immediate negative effects on health and wellness, whereas others, such as knowing first aid, may have only occasional use. Second, you may score well on one item in a scale but not on another. If one item indicates an unhealthy lifestyle in an area that poses a serious health risk, your lifestyle may appear to be healthier than it really is. For example, you could get a score of 3 on the destructive habits scale and be a regular smoker. For this reason, the overall score can be particularly deceiving.

Strategies for Change: In the space to the right, make some notes concerning the healthy lifestyle areas in which you could make some changes. You can refer to these notes later to see if you have made progress.

Rating

Two-Item

Scores

Four-Item

Scores

Overall

Scores

Positive lifestyles

2 3 or 4 26 to 30*

Consider changes

Less than 2 Less than 3 Less than 26

*See Special Note.

Healthy Lifestyle Ratings

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Lab 1A Wellness Self-Perceptions

Name Section Date

Purpose: To assess self-perceptions of wellness

Procedures

1. Place an X over the appropriate circle for each question (4 = strongly agree, 3 = agree, 2 = disagree, 1 = strongly disagree).

2. Write the number found in that circle in the box to the right. 3. Sum the three boxes for each wellness dimension to get your wellness dimension totals. 4. Sum all wellness dimension totals to get your comprehensive wellness total. 5. Use the rating chart to rate each wellness area. 6. Complete the Results section and the Conclusions and Implications section.

Strongly Strongly

Question Agree Agree Disagree Disagree Score

1. I am happy most of the time. 4 3 2 1

2. I have good self-esteem. 4 3 2 1

3. I do not generally feel stressed. 4 3 2 1

Emotional Wellness Total =

4. I am well informed about current events. 4 3 2 1

5. I am comfortable expressing my views and opinions. 4 3 2 1

6. I am interested in my career development. 4 3 2 1

Intellectual Wellness Total =

7. I am physically fit. 4 3 2 1

8. I am able to perform the physical tasks of my work. 4 3 2 1

9. I am physically able to perform leisure activities. 4 3 2 1

Physical Wellness Total =

10. I have many friends and am involved socially. 4 3 2 1

11. I have close ties with my family. 4 3 2 1

12. I am confident in social situations. 4 3 2 1

Social Wellness Total =

13. I am fulfilled spiritually. 4 3 2 1

14. I feel connected to the world around me. 4 3 2 1

15. I have a sense of purpose in my life. 4 3 2 1

Spiritual Wellness Total =

Comprehensive Wellness (Sum of five wellness scores)

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In the Results below, record your scores from the previous page; then determine your ratings for each score using the Wellness Rating Chart. Record your ratings in the Results section.

Wellness Dimension Score Rating

Emotional/mental

Intellectual

Physical

Social

Spiritual

Comprehensive

Rating

Wellness

Dimension Scores

Comprehensive

Wellness Scores

High-level wellness 10–12 50–60

Good wellness 8–9 40–49

Marginal wellness 6–7 30–39

Low-level wellness Below 6 Below 30

Conclusions and Implications: In the space provided below, describe your current state of wellness. Do you think the ratings indicate your true state of wellness? Which areas need the most improvement?

Results

Wellness Rating Chart

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LEARNING OBJECTIVES

After completing the study of this concept, you will be able to:

▶ Identify and define the five stages of change and explain how the stages relate to making lifestyle changes.

▶ Describe the four key factors that influence health behaviors, describe components in each category, and explain how the factors relate to stages of change.

▶ Identify and describe the self-management skills that predispose and enable you to change and reinforce changes once you have made them.

▶ Identify and describe the six steps in self-planning and explain how they can be used to make personal plans for behavior change.

▶ Conduct self-assessments of your current stages for health behaviors and your self- management skills for making health behavior change.

▶ Identify related national health goals and show how meeting personal goals can contribute to reaching national goals.

Self-Management and Self-Planning Skills for Health Behavior Change

Learning and regularly using

self-management skills can help

you adopt and maintain healthy

lifestyles throughout life.

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22 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

have started regular physical activity programs often see improvements in fitness and general well-being and decide to stop smoking.

People do not make lifestyle changes overnight. People progress forward and backward through

several stages of change. When asked about a specific healthy lifestyle, people commonly respond with yes or no answers. If asked, “Do you exercise regularly?” the answer is yes or no. When asked, “Do you eat well?” the answer is yes or no. We know that there are many different stages of lifestyle behavior.

James Prochaska (a well-known health psychologist) and his colleagues developed the Transtheoretical Model to explain the importance of stages of change for under- standing behavior. They suggest that lifestyle changes occur in at least five different stages, as illustrated in Figure 1 . The stages were originally developed to help clarify negative lifestyles, such as smoking. Smokers who are not consider- ing stopping are at the stage of precontemplation. Those who are thinking about stopping are classified in the con- templation stage. Those who have bought a nicotine patch or a book about smoking cessation are in the preparation stage. They have moved beyond contemplation and are preparing to take action. The action stage occurs when the smoker makes a change in behavior, even a small one, such as cutting back on the number of cigarettes smoked. The fifth stage, maintenance, is reached when a person finally stops smoking for a relatively long time (e.g., 6 months).

The stages of change model (as illustrated in Figure 1 ) has been applied to positive lifestyles as well as negative ones. Those who are totally sedentary are considered to be in the precontemplation stage. Contemplators are think- ing about becoming active. A person at the preparation stage may have bought a pair of walking shoes and appro- priate clothing for activity. Those who have started activ- ity, even if infrequent, are at the stage of action. Those who have been exercising regularly for at least 6 months are at the stage of maintenance.

Whether the lifestyle is positive or negative, people move from one stage to another in an upward or a downward

R educing illness and debilitating conditions and pro- moting wellness and fitness are important public

health goals. As noted in Concept 1 , adopting healthy lifestyles is a key factor in health, wellness, and fitness promotion, but evidence suggests that many people are not able to make changes, even when they want to do so. Experts have determined that people who practice healthy lifestyles possess certain characteristics. These characteristics, including personal responsibility, can be modified to improve the health behaviors of all people. Researchers have also identified several special skills, referred to as self-management skills, that can be useful in altering factors related to adherence and ultimately in making lifestyle changes. Like any skill, self-management skills must be practiced if they are to be useful. The fac- tors relating to adherence and the self-management skills described in this concept can be applied to a wide vari- ety of healthy lifestyles. The early sections of this book focus on using self-management skills to become and stay active throughout life. Later sections focus on using these skills to adopt other healthy lifestyles that promote good health and wellness. In the final section, you get an opportunity to use the skills to make informed choices and plan for healthy living.

Making Lifestyle Changes Many adults want to make lifestyle changes but

find changes hard to make. Results of several national public opinion polls show that adults often have difficulty making desired lifestyle changes. Examples include those who believe that physical activity is important but do not get enough exercise to promote good health, those who have tried numerous times to lose weight but have failed, those who know good nutrition is good for health but do not eat well, and those who feel stress on a regular basis but have not found a way to become less stressed. Changes in other lifestyles are frequently desired but often not accomplished. More information about public opinion polls related to health is presented in the “In the News” feature.

Practicing one healthy lifestyle does not mean you

will practice another, though adopting one healthy

behavior often leads to the adoption of another. College students are more likely to participate in regular physical activity than are older adults. However, they are also much more likely to eat poorly and abuse alcohol. Many young women adopt low-fat diets to avoid weight gain and smoke because they mistakenly believe that smoking will contribute to long-term weight maintenance. These exam- ples illustrate the fact that practicing one healthy lifestyle does not ensure adherence to another. However, there is evidence that making one lifestyle change often makes it easier to make other changes. For example, smokers who Figure 1 ▶ Stages of lifestyle change.

Maintenance ”I regularly practice healthy lifestyles.”

Action ”I have made some life- style changes.”

Preparation ”I am getting ready to make a lifestyle change.”

Contemplation ”I am thinking about change.”

Precontemplation ”I don't want to change.”

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Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 23

direction. Individuals in the action stage may move on to maintenance or revert to contemplation. Smokers who suc- ceed in quitting permanently report having stopped and started dozens of times before reaching lifetime mainte- nance. Similarly, those attempting to adopt positive life- styles, such as eating well, often move back and forth from one stage to another, depending on their life circumstances.

Once maintenance is attained, relapse is less likely

to occur. Although complete relapse is possible, it is gen- erally less likely after the maintenance stage is reached. At the maintenance stage, the behavior has been integrated into a personal lifestyle, and it becomes easier to sus- tain. For example, a person who has been active for years does not have to undergo the same thought processes as a beginning exerciser—the behavior becomes automatic and habitual. Similarly, a nonsmoker is not tempted to smoke in the same way as a person who is trying to quit.

Factors That Promote Lifestyle Change Various factors have been found to influence the

adoption and maintenance of healthy lifestyles. A variety of theories have been proposed to understand health behavior (e.g., Social Cognitive Theory, Self-Determination Theory, Theory of Planned Behavior, Theory of Reasoned Action). Each theory offers some unique attributes or con- cepts, but they share many of the same components. The previously mentioned Transtheoretical Model integrates ele- ments from multiple theories and can be viewed as a “meta- theory.” The distinction between a “theory” and a “model” is

important in this case. The Transtheoretical Model does not provide a new explanation of behavior (a theory) but rather a guide or map that makes using and applying the theories easier (a model). The unique advantage of the Transtheoreti- cal Model is that it demonstrates that behavior is influenced in different ways depending on the stage of change a person has reached.

Another meta-theory that has been used to explain the challenges of changing health behaviors is the

Adherence Adopting and sticking with healthy behaviors, such as regular physical activity or sound nutrition, as part of your lifestyle. Stage of Change The level of motivational readi- ness to adopt a specific health behavior.

Many organizations, both profit and nonprofit, regularly poll Americans concerning their

health, wellness, and fitness, as well as their attitudes about these subjects. Among the most well known polls are those by CBS/New York Times, USA Today/CNN/Gallup, NBC/Wash- ington Post, and Trust for America’s Health/Robert Wood Johnson Foundation. Some results of surveys by the various polls include the following:

• 76 percent of Americans favor increasing funding for pre- vention programs.

• 77 percent believe that prevention programs will save money over the long run.

• 72 percent want more investment in prevention—even if it does not save money—because it will prevent disease and save lives.

• 57 percent want to invest in prevention—even if money is not saved—if it improves quality of life (wellness).

• 50 percent believe that more money should be spent on medical and health research.

These results are from different sources and from different types of polls but they collectively show an interest in health, preven- tion, and wellness. While Americans overwhelmingly support these ideas, there is relatively little money invested in prevention and health promotion research. Funding is often in jeopardy for existing work-site wellness programs and school health/physical education programs.

Why is it hard for organizations to invest more fully in prevention?

Public Opinion Polls about Health, Wellness, and Fitness

ACTIVITY

In the News

M r

Access to healthy foods is an important predisposing factor for good nutrition.

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24 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

Social-Ecological Model. This model also integrates multiple theories, but a key point in this model is that a person’s behavior is strongly influenced by the nature of the environment in which she or he lives. If you are in a supportive social environment and have access to healthy foods and activity resources, adopting healthier lifestyles is easier.

You do not need a thorough understanding of the the- ories and models, but you should be aware of the basic principles. Concepts from both the Transtheoretical and Social-Ecological models have been combined to provide a simpler way to understand the various factors that influ- ence behavior. For ease of understanding, the various fac- tors are classified as personal , predisposing , enabling , and reinforcing factors (see Figure 2 ). Predisposing factors help precontemplators get going—moving them toward contemplation or even preparation. Enabling fac- tors help those in contemplation or preparation take a step toward action. Reinforcing factors move people from action to maintenance and help those in maintenance stay there.

Personal factors affect health behaviors but are

often out of your personal control. Age, gender, heredity, social status, and current health and fitness levels are all personal factors that affect your health behaviors. For example, there are significant differences in health behaviors among people of various ages. According to one survey, young adults between the ages of 18 and 34 are more likely to smoke (30 percent) than those 65 and older (13 percent). On the other hand, young adults are much more likely than older adults to be physically active.

Gender differences are illustrated by the fact that women use health services more often than men. Women are more likely than men to have identified a primary care doctor and are more likely to participate in regular health screenings. As you will discover in more detail later in this book, heredity plays a role in health behaviors. For example, some people have a hereditary predisposition to gain weight, and this may affect their eating behaviors.

Age, gender, and heredity are factors you cannot control. Other personal factors that relate to health behaviors include social status and current health and

Figure 2 ▶ Factors that influence health behaviors at various stages of change.

Reinforcing factors

Factors influencing change Stages of change

Preparation

Contemplation

Precontemplation

•Success •Family support •Peer support •Support of health professionals

Enabling factors

•Goal setting •Self-assessment •Self-monitoring •Self-planning •Performance skills •Coping skills •Consumer skills •Time management

Personal factors

Age Gender Heredity Current health and fitness

Predisposing factors

Am I able? Is it worth it?

Self-confidence Self-efficacy Safe environment Access

Self-motivation Enjoyment Balanced attitudes Beliefs Knowledge

Action

Maintenance

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Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 25

fitness status. Evidence indicates that people of lower socioeconomic status and those with poor health and fitness are less likely to contemplate or participate in activity and other healthy behaviors. No matter what personal characteristics you have, you can change your health behaviors. If you have several personal factors that do not favor healthy lifestyles, it is important to do something to change your behaviors. Making an effort to modify the factors that predispose, enable, and reinforce healthy lifestyles is essential. As shown in Figure 2 , the factors influence behavior at different stages of change.

Predisposing factors are important in getting you

started with the process of change. Several predis- posing factors can help you move from contemplation to preparation and then to taking action with regard to healthy behavior. A person who possesses many of the predisposing factors is said to have self-motivation (also called intrinsic motivation). If you are self-motivated, you will answer positively to two basic questions: “Am I able?” and “Is it worth it?”

“Am I able to do regular activity?” “Am I able to change my diet or to stop smoking?” Figure 2 includes a list of four factors that help you say, “Yes, I am able.” Two of these factors are self-confidence and self-efficacy . Both have to do with having positive perceptions about your own ability. People with positive self-perceptions are more self- motivated and feel they are capable of making behavior changes for health improvement. Other factors that help you feel you are able to do a healthy behavior include easy access and a safe environment. For example, people who have easy access to exercise equipment at home or the workplace or who have a place to exercise within 10 minutes of home are more likely to be active than those who do not. Similarly, access to healthy food options is

critical for adopting a healthy diet. A supportive physical and social environment can also make it easier to adopt healthy habits.

“Is it worth it?” People who say yes to this question are willing to make an effort to change their behaviors. Predisposing factors that make it worth it to change behaviors include enjoying the activity, balancing posi- tive and negative attitudes, believing in the benefits of a behavior, and having knowledge of the health benefits of a behavior (see Figure 2 ). If you enjoy something and feel good about it (have positive attitudes and beliefs), you will be self-motivated to do it. It will be

Personal Factors Factors, such as age or gender, related to healthy lifestyle adherence but not typically under personal control. Predisposing Factors Factors that make you more likely to adopt a healthy lifestyle, such as participa- tion in regular physical activity, as part of your nor- mal routine. Enabling Factors Factors that help you carry out your healthy lifestyle plan. Reinforcing Factors Factors that provide encour- agement to maintain healthy lifestyles, such as physi- cal activity, for a lifetime. Self-Confidence The belief that you can be suc- cessful at something (for example, the belief that you can be successful in sports and physical activities and can improve your physical fitness). Self-Efficacy Confidence that you can perform a specific task (a type of specific self-confidence).

A CLOSER LOOK

ACTIVITY

Blue Zones For his book Blue Zones, Dan Buettner researched com- munities across the world that had higher life expec- tancies and quality of life than other communities. He identified their common characteristics to try to deter- mine the underlying factors that influence good health. He referred to these communities as “Blue Zones” and came up with nine specific attributes that contributed to the improved health. It is not surprising that physi- cal activity (labeled as “Move Naturally”) was at the top of the list. (To see the complete list of principles, visit

www.bluezones.com.) Some public health groups and agencies have sought to promote broad application of these principles as the basis for coordinated community health programming. The book, in this case, can be viewed as a guide or recipe for healthy communities. However, it may also be likened to a fad diet that might promise an easy path to health and wellness.

Is it possible for communities to follow these recommendations as

part of building a healthy community? Why or why not?

Blue ZonesBl Z nes

VIDEO 1

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26 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

worth it. The lifestyle examples provided in Table 1 will help you understand how to apply these predisposing fac- tors to your own lifestyle.

Enabling factors move you from the beginning

stages of change to action and maintenance.

A variety of skills help you follow through with decisions to make changes in behaviors. Figure 2 lists eight self- management skills that contribute to behavior change. The labs in each concept provide opportunities to learn and apply these self-management skills to your lifestyle. Table 2 explains the importance of each skill and how each one can contribute to behavior change.

Reinforcing factors help you adhere to lifestyle

changes. Once you have reached the action or main- tenance stage, it is important to stay at this high level. Reinforcing factors help you stick with a behavior change (see Figure 2 ).

One of the most important reinforcing factors is success. If you change a behavior and experience suc- cess, this makes you want to keep doing the behavior. If attempts to change a behavior result in failure, you may conclude that the behavior does not work and give up on it. Planning for success is essential for adhering to healthy lifestyle changes. Using the self-management

Health is available to Everyone for a

Lifetime, and it’s Personal

Friends may have a bigger impact on us than we realize. A recent study followed people over 32 years to examine the impact of social connections on health and health outcomes. According to the study, people are more likely to become obese if a friend becomes obese. Similar relationships were found for adult siblings and spouses, though the connection between friends appears stron- ger. This relationship was not found for neighbors. The authors suggested that there is a clustering of health behaviors in social groups that explain the shared outcomes.

Do your friends hurt or help you maintain a healthy lifestyle?

ACTIVITY

skills described in this concept and throughout this book can help you plan effectively and achieve success.

Social support from family, peers, and health profes- sionals can also be reinforcing. There are, however, dif- ferent kinds of support and some are more helpful than others. Support for well-informed personal choices is referred to as support of autonomy. One example is

VIDEO 2

Self-Management Skill How Is It Useful?

Overcoming Barriers Lifestyle Example

Develop skills that make it possible to overcome problems or challenges in adopting or maintaining healthy behaviors. By conquering challenges, you learn skills that help you overcome other barriers to healthy lifestyles.

A person is tempted by snack foods and candy provided by co-workers. Learning to resist these foods takes discipline, but overcoming barriers builds confidence that helps the person stay focused on long-term goals.

Building Self-Confidence and Motivation Lifestyle Example

Take small steps that allow success. With each small step, confidence and motivation increase and you develop the feeling “I can do that.”

A person says, “I would like to be more active, but I have never been good at physical activities.” Starting with a 10-minute walk, the person sees that “I can do it.” Over time, the person becomes confident and motivated to do more physical activity.

Balancing Attitudes Lifestyle Example

Learn to balance positive and negative attitudes. Developing positive attitudes and reducing negative attitudes helps you adhere to a healthy lifestyle.

A person does not do activity because he or she lacks support from friends, has no equipment, and does not like to get sweaty. These are negatives. Shifting the balance to positive things, such as fun, good health, and good appearance, can help promote activity.

Building Knowledge and Changing Beliefs Lifestyle Example

Build your beliefs on sound information. Knowledge does not always change beliefs, but awareness of the facts can play a role in achieving good health.

A person says, “I don’t think what I eat has much to do with my health and wellness.” Acquiring knowledge is fundamental to being an educated person. Studying the facts about nutrition can provide the basis for changes in beliefs and lifestyles.

Table 1 ▶ Self-Management Skills for Changing Predisposing Factors

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Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 27

encouragement from family, friends, or a doctor for start- ing and sticking to a nutritious diet. The supporting per- son might ask, “How can I help you meet your goals?” One goal of this book is to help you take control of your own behaviors concerning your personal health, fitness, and wellness.

Not all feedback is perceived as reinforcing and sup- portive. Although the people providing the feedback may feel they are being helpful and supportive, some feedback

may be perceived as applying pressure or as an attempt to control behavior. Scolding a person for not sticking to a diet, for example, or offering the suggestion that “you are not going to get anywhere if you don’t stick to your diet,” will often be perceived as applying pressure. If you want to help friends and family make behavior changes, avoid applying pressure and attempt to provide positive forms of support. Research also suggests it is desirable to pro- mote autonomy and freedom of choice so that change is

Self-Management Skill How Is It Useful?

Goal-Setting Skills Lifestyle Example

Establish what you want to achieve in the future. Goals should be realistic and achievable. Learning to set goals for behavior change is especially important for beginners.

A person wants to lose body fat. Setting a goal of losing 50 pounds makes success unlikely. Setting a process goal of restricting 200 calories a day or expending 200 more a day for several weeks makes success more likely.

Self-Assessment Skills Lifestyle Example

Assess your own fitness, health, and wellness and learn to interpret your own self-assessment results. It takes practice to become good at doing self-assessments.

A person wants to know his or her health strengths and weaknesses. The best procedure is to select good tests and self-administer them. Practicing the assessments in this book will help you become good at self-assessment.

Self-Monitoring Skills Lifestyle Example

Monitor your behavior by keeping records. Many people think they adhere to healthy lifestyles, but they do not. They have a distorted view of what they actually do. Self-monitoring gives you a true picture of your own behavior and progress.

In spite of restricting calories, a person can’t understand why he or she is not losing weight. Keeping records may show that the person is not counting all the calories. Learning to keep records of progress contributes to adherence.

Self-Planning Skills Lifestyle Example

Plan for yourself rather than having others do all the planning for you.

A person wants to be more active, to eat better, and to manage stress. Self-planning skills will help him or her plan a personal activity, nutrition, or stress-management program.

Performance Skills Lifestyle Example

Learn the skills necessary for performing specific tasks, such as sports or relaxation. These skills can help you feel confident and enjoy activities.

A person avoids physical activity because he or she does not have the physical skills equal to those of peers. Learning sports or other motor skills allows this person to choose to be active.

Coping Skills Lifestyle Example

Develop a new way of thinking about things. Using this skill, you can see situations in more than one way and learn to think more positively.

A person is stressed and frequently anxious. Learning stress– management skills, such as relaxation, can help a person cope. Like all skills, stress-management skills must be practiced to be effective.

Consumer Skills Lifestyle Example

Gain knowledge about products and services. You may also need to rethink untrue beliefs that lead to poor consumer decisions.

A person avoids seeking medical help when sick. Instead, the person takes an unproven remedy. Learning consumer skills provides knowledge for making sound medical decisions.

Time-Management Skills Lifestyle Example

Keep records similar to self-monitoring, focusing on total time use rather than specific behaviors. Skillful monitoring of time can help you plan and adhere to healthy lifestyles.

A person wants more quality time with family and friends. Monitoring time can help him or her reallocate time to spend it in ways that are more consistent with personal priorities.

Table 2 ▶ Self-Management Skills for Changing Enabling Factors

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28 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

self-directed. Table 3 provides life- style examples of the key reinforcing factors of social support and relapse prevention.

Self-Management Skills Learning self-management skills can help you

alter factors that lead to healthy lifestyle change.

Personal, predisposing, enabling, and reinforcing fac- tors influence the way you live. These factors are of little practical significance, however, unless they can be altered to promote healthy lifestyles. Learning self- management skills (sometimes called self-regulation skills) can help you change the predisposing, enabling, and reinforcing factors described in Tables 1 (page 26) , 2 (page 27) , and 3 . In fact, some of the enabling fac- tors are self-management skills. Learning these skills takes practice, but with effort anyone can learn them. This book offers many opportunities to learn and prac- tice self-management skills.

It takes time to change unhealthy lifestyles. People in Western cultures are used to seeing things happen quickly. We flip a switch, and the lights come on. We want food quickly, and thousands of fast-food restaurants provide it. The expectation that we should have what we want when we want it has led us to expect instantaneous changes in health, wellness, and fitness. Unfortunately, there is no quick way to health. There is no pill that can reverse the effects of a lifetime of sedentary living, poor eating, or tobacco use. Changing your lifestyle is the key. But lifestyles that have been practiced for years are not easy to change. As you progress through this book, you will have the opportu- nity to learn how to implement self-management skills. Learning these skills is the surest way to make permanent lifestyle changes.

Adopting healthy lifestyle habits requires extra discipline and effort.

Self-Planning for Healthy Lifestyles Self-planning is a particularly important self-

management skill. In the final concept in this book, after you have studied a variety of concepts and self-management skills, you will have the opportunity

VIDEO 3

VIDEO 4

VIDEO 5

Self-Management Skill How Is It Useful?

Social Support Lifestyle Example

Obtain the support of others for healthy lifestyles. You learn how to get support from family and friends for your autonomous decisions. Support of a doctor can help.

A person has gradually developed a plan to be active. Friends and loved ones encourage activity and help the person develop a schedule that will allow and encourage regular activity.

Relapse Prevention Lifestyle Example

Stick with a healthy behavior once you have adopted it. It can be easy to relapse to an unhealthy lifestyle. Skills such as avoiding high- risk situations and learning how to say no help you avoid relapse.

A person stops smoking. To stay at maintenance, the person can learn to avoid situations where there is pressure to smoke. He or she can learn methods of saying no to those who offer tobacco.

Table 3 ▶ Self-Management Skills for Changing Reinforcing Factors

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Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 29

to develop a personal plan for several healthy lifestyles. Several self-management skills, including self-assessment, self-monitoring, and goal-setting, are used in the six-step self-planning process (see Table 4 ).

Step 1: Clarifying Reasons

Clarifying your reasons for behavior change is the

first step in program planning. People at precontem- plation stage are not considering a change in behavior; they see no need. It’s when they reach the contemplation stage that they consider changes in behavior. One of the most common and most powerful reasons for contem- plating a change in a lifestyle is the recommendation of a doctor, often after a visit associated with an illness. Other common reasons are to improve personal appearance, lose weight, increase energy levels, improve the ability to perform daily tasks, and improve quality of life (well- ness). Identifying your reasons for wanting to change helps you determine which behaviors to change first and

helps you establish specific goals. Reflect on your rea- sons for wanting to make lifestyle changes before mov- ing on to step 2.

Step 2: Identifying Needs

Self-assessments are useful in establishing

personal needs, planning your program, and

evaluating your progress. You have already done some self-assessments of wellness, current activity levels, and current lifestyles. In the labs for this concept and others that follow, you will make additional assessments. The results of these assessments help you build personal profiles for a variety of health behaviors that can be used as the basis for program planning. With practice, self-assessments become more accurate. For this rea- son, it is important to repeat self-assessments and to pay careful attention to the procedures for performing them. If questions arise, get a professional opinion rather than making an error.

Self-Planning Description Self-Management Skill

1. Clarifying reasons Knowing the general reasons for changing a behavior helps you determine the type of behavior change that is most important for you at a specific point in time. If losing weight is the reason for wanting to change behavior, altering eating and activity patterns will be emphasized.

Results of the Self-Management Skills Questionnaire (Lab 2B) will help you determine which self-management skills you use regularly and the ones you might need to develop.

2. Identifying needs If you know your strengths and weaknesses, you can plan to build on your strengths and overcome weaknesses.

Self-assessment: In the concepts that follow, you will learn how to assess different health, wellness, and fitness characteristics. Learning these self-assessments will help you identify needs.

3. Setting personal goals Goals are more specific than reasons (see step 1). Establishing specific things that you want to accomplish can provide a basis for feedback that your program is working.

Goal setting: Guidelines in this concept will help you set goals. In subsequent concepts, you will establish goals for different lifestyles.

4. Selecting program components

A personal plan should include the specific program components that will meet your needs and goals based on steps 1–3. Examples include meal plans for nutrition and specific activities for your physical activity plan.

Many self-management skills, including time management, consumer, and performance skills, are useful in developing plans for a variety of healthy behaviors.

5. Writing your plan Once program components, such as meal plans for nutrition and specific activities for physical activity, have been determined, you should put your plan in writing. This establishes your intentions and increases your chances of adherence.

Self-planning: This includes writing down the time of day, day of the week, and other details you will include in your plan.

6. Evaluating progress Once you have used your plan, you will know what works and what does not. Periodic self-assessments can help you modify the plan to make it better.

Self-monitoring: This skill is used in keeping records (logs) and determining if goals are met. Self-assessment: This skill is used to help you determine if goals are met.

Table 4 ▶ Self-Planning Skills

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30 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

Periodic self-assessments can help determine if you

are meeting health, wellness, and fitness standards

and making progress toward personal health goals. When performed properly, self-assessments help you deter- mine if you have met your goals and if you are meeting health standards (e.g., meeting health fitness standards, eat- ing appropriate amounts of nutrients). Self-assessments also offer a measure of independence and can help you avoid unnecessary and expensive tests. They serve as a screening procedure to determine if you need professional assistance. However, because self-assessments may not be as accurate as tests by health and medical professionals, it is wise to have periodic tests by an expert to see if your self-assessments are accurate.

Self-assessments also have the advantage of

consistent error rather than variable error. The best type of assessments are done by highly qualified experts using precise instruments. Following directions and practicing assessment techniques will reduce error significantly. Still, errors will occur. One advantage of a self-assessment is that the person doing the assessment is always the same—you. Even if you make an error in a self-assessment, it is likely to be consistent over time, especially if you use the same equipment each time you make the assessment. For example, scales have limitations for monitoring changes in weight (and fat). But if you measure your own weight using a home scale and your measurement always shows your weight to be 2 pounds higher than it really is, you have made a consistent error. You can determine if you are improving because you know the error exists. Variable errors are likely when dif- ferent instruments are used, when different people make the assessments, and when procedures vary from test to test. Differences in scores are harder to explain with vari- able forms of error because they are not consistent.

Step 3: Setting Personal Goals

There are differences between short-term and

long-term goals. Short-term goals are goals that you can accomplish in days or weeks. Long-term goals take longer to accomplish—sometimes months or even years.

There are differences between general goals and

SMART goals. General goals are broad statements of your reasons for wanting to accomplish something. Examples include changing a behavior such as eating better or being more active, or changing a physical char- acteristic such as losing weight or getting fit. SMART goals are less general and have several important char- acteristics. SMART goals are specific ( S ). A specific goal provides details, such as limiting calories to a specific number each day. SMART goals are measurable ( M ).

They allow you to perform assessments before you estab- lish your goals and again later to see if you have met your goals. SMART goals are attainable ( A ). They are neither too hard, nor too easy. If the goal is too hard, failure is likely, which is discouraging. If the goal is too easy, it is not challenging. SMART goals are also relevant ( R ). They are your personal goals and should have meaning to you personally. Personally relevant goals provide motiva- tion. Finally, SMART goals are timely ( T ). Timely goals are especially meaningful when you begin a program for making personal changes. Choosing goals that are timely helps you focus on the most salient changes that you want to make.

There are differences between behavioral and

outcome goals. A behavioral goal is associated with something you do. An example of a specific short-term behavioral goal is to perform 30 minutes of brisk walking 6 days a week for the next 2 weeks. It is a behavioral goal because it refers to a behavior (something you do). An outcome goal is associated with a physical characteris- tic (e.g., lowering your body weight, lowering your blood pressure, building strength). Typically, it takes weeks or months to reach outcome goals. This is because outcome goals depend on many things other than your behavior. For example, your heredity affects your body fat and muscle development.

Different factors influence your success in meeting

goals. Consider these factors when setting your goals:

• Outcome goals are not recommended as short-term goals because they take time to achieve. Typically, it takes weeks or months to reach outcome goals so they make better long-term goals than short-term goals.

• Outcome goals depend on many things other than your life- style behavior. For example, your heredity affects your ability to achieve an outcome goal such as achieving a certain body weight and or achieving a fitness stan- dard. The same lifestyle change program may produce different results for different people. For this reason, goals must vary from person to person, especially out- come goals. For example, two people may establish an outcome goal of losing 5 pounds over a 6-week period. Because we inherit predispositions to body compo- sition, one person may meet the goal, while another may not, even if both strictly adhere to the same diet. A similar example can be used for fitness and physi- cal activity. People not only inherit a predisposition to fitness but also inherit a predisposition to benefit from training. In other words, if 10 people do the same physical activities, there will be 10 different results. One person may improve performance by 60 percent, while another might improve only 10 percent. This

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makes it hard for beginners to set realistic outcome goals. Too often, people set a goal based on a compara- tive standard rather than on a standard that is possible for the individual to achieve in a short time.

Guidelines for beginners differ from guidelines for

people who are more experienced when setting

goals. Beginners should consider these guidelines:

• Start with general long-term goals in mind. It is good to have your goals in mind when you begin a pro- gram. But beginners may want to use general rather than specific long-term goals. You may choose either behavioral or outcome goals, but keep them general. For example, choose a goal of losing weight or get- ting fit. Getting too specific can be discouraging for reasons discussed above.

• Focus on SMART short-term behavioral objectives. As noted previously, an example of a specific short-term behavioral goal is to perform 30 minutes of brisk walk- ing 6 days a week for the next 2 weeks. It is a behavioral goal because it refers to a behavior (something you do). It is a SMART goal because it is specific, measurable, attainable, realistic, and timely. When using behav- ioral goals the principal factor associated with success

Short-Term Goals Statements of intent to change a behavior or achieve an outcome in a period of days or weeks. Long-Term Goals Statements of intent to change behavior or achieve a specific outcome in a period of months or years. General Goals Broad statements of your reasons for wanting to accomplish something. Examples include changing a behavior such as eating better or being more active, or changing a physical characteris- tic such as losing weight or getting fit. SMART Goals Goals that are Specific (S ), Measur- able (M ), Attainable (A ), Relevant (R ) and Timely (T ). Behavioral Goal A statement of intent to perform a specific behavior (changing a lifestyle) for a specific period of time. An example is “I will walk for 15 min- utes each morning before work.” Outcome Goal A statement of intent to achieve a specific test score (attainment of a specific standard) associated with good health, wellness, or fitness. An example is “I will lower my body fat by 3 percent.”

A goal to consume more fruits and vegetables is an example of a behavioral goal.

Reducing blood pressure is an example of an outcome goal.

= Specific = Measurable = Attainable = Relevant = Timely

A M

R T

Make your personal goals SMART.

is your willingness to give effort. No matter who you are, you can accomplish a behavioral goal if you give regular effort. This type of goal will help you keep your motivation level high and prevent you from being discouraged.

• Avoid frequent outcome self-assessments, focus on self-moni- toring of behavior. A self-assessment before setting goals helps you to set SMART goals. Self-assessments can also help you see if you have met your goals. For begin- ners, however, frequent self-assessment—especially of

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32 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

outcomes—is discouraged. For example, if the long- term goal is to lose weight, weighing frequently can be discouraging and even deceiving. Self-monitoring of behavior is encouraged however. For the walking goal discussed above, keeping an activity log of your daily participation will help you comply.

• Use a series of short-term goals to make progress toward long-term goals. Once short-term behavioral goals are reached, establish new ones. After meeting a series of short-term goals, consider goal-setting guidelines for more experienced people.

Experienced people should consider these guidelines:

• Start with SMART long-term goals. Experience helps people realize that it takes time to meet long-term goals, especially outcome goals. Both SMART behav- ioral and outcome goals can be considered.

• Use a series of short-term SMART goals (both behav- ioral and outcome) as a means of accomplishing long-term goals. Even experienced people are more likely to achieve success if they realize that setting and meet- ing a series of SMART short-term goals is impor- tant. For example, a person who has high blood pressure (160 systolic) may set a long-term outcome goal of lowering systolic blood pressure to 120 over a period of 6 months. Several behavioral goals can be established for the 6-month period, including tak- ing blood pressure medication (daily), performing 30 minutes of moderate physical activity each day, and limiting salt in the diet to less than 100 percent of the recommended dietary allowance. If the long- term outcome goal is realistic, adhering to SMART short-term behavioral goals will result in achieving the outcome goal.

• Use self-assessments and self-monitoring to determine if you are making progress. Self-assessments can be more fre- quent for the experienced. Still, avoid expecting too much, especially for outcome goals. Self-monitoring of behavioral goals is good, even for the experienced. If you commit to the behavior and stick to your plan, the outcomes will follow.

Maintenance goals are also appropriate once goals

have been achieved or when improvements aren’t

necessary. For example, the person who lowers sys- tolic blood pressure from 160 to 120 need not continue to lower the new healthy blood pressure. Once a healthy outcome goal has been achieved, a new outcome goal of maintaining a systolic blood pressure of 120 is appropri- ate. Behavioral goals will also have to be modified. For the person who has reduced blood pressure to a healthy level, medication levels might be reduced for maintenance.

Maintenance goals are appropriate in other areas as well. For example, dietary restriction and extra exer- cise for weight maintenance will likely be different from those for losing weight. When a person reaches a healthy level of fitness, maintenance may be the goal rather than continued improvement. You cannot improve forever; at some point, attempting to do so may be counterproduc- tive to health.

The self-management skills of social support and relapse prevention described in Table 3 are useful in main- tenance. Several applications (apps) are now available to help you get social support and prevent relapse (see Tech- nology Update).

Making improvement can motivate you to reach

long-term goals. As noted earlier, setting short-term goals that are both attainable and realistic will help you reach your long-term goals. Meeting short-term goals encourages and motivates you to continue with your healthy lifestyle plan. Don’t expect to set perfect goals all the time. No matter how much self-assessing and self-monitoring you do, you may sometimes set goals too low or too high. If the goal is set too low, it is easily achieved, and a new, higher goal can be established. If the goal is set too high, you may fail to reach it, even though you have made considerable progress toward the goal.

Rather than becoming discouraged when a goal is not met, consider the improvement you have made. Improvement, no matter how small, means that you are moving toward your goal. Also, you can measure your improvement and use it to help set future goals. Of course, periodic self-assessments and good record keeping (self-monitoring) are necessary to keep track of improvements accurately.

Putting your goals in writing helps formalize

them. If you don’t write them down, your goals will be easy to forget. Writing them helps establish a commit- ment to yourself and clearly establishes your goals. You can revise them if necessary. Written goals are not cast in concrete.

Step 4: Selecting Program Components

You can choose from many different program

components to meet your goals. Concept 1 described 10 types of lifestyle change, ranging from priority lifestyles (physical activity, nutrition, and stress management) to avoiding destructive habits and adopt- ing positive safety and personal health habits. The components depend on the goals of your program. For example, if the goal is to become more fit and physically

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active, the program components will be the activities you choose. You will want to identify activities that match your abilities and that you enjoy. You will want to select activities that build the type of fitness you want to improve.

Other examples of program components are prepar- ing menus for healthy eating, participating in stress- management activities, planning to attend meetings to help avoid destructive habits, and attending a series of classes to learn CPR and first aid. Preparing a list of pro- gram components that will help you meet your specific goals will prepare you for step 5, writing your plan.

Step 5: Writing Your Plan

Preparing a written plan can improve your

adherence to the plan. A written plan is a pledge, or a promise, to be active. Research shows that intentions to be active are more likely to be acted on when put in writing. In the concepts that follow, you will be given the opportunity to prepare written plans for all of the activi- ties in the physical activity pyramid, as well as for other healthy lifestyles. A good written plan includes daily plans with scheduled times and other program details. For example, the daily written plan for stress manage- ment could include the time of day when specific pro- gram activities are conducted (e.g., 15-minute quiet time at noon, yoga class from 5:30 to 6:30). An activity plan would include a schedule of the activities for each day of the week, including starting and finishing time and specific details concerning the activities to be performed. A dietary plan would include specific menus for each meal and between-meal snacks.

In the labs that accompany the final concept of this book, you will write plans for several different life- styles. By then you will have learned a variety of self-management skills that will assist you.

Step 6: Evaluating Progress

Self-assessment and self-monitoring can help you

evaluate progress. Once you have written a plan, you will want to determine your effectiveness in sticking with your plan. Keeping written records is one type of self-monitoring.

Self-monitoring is a good way to assess success in meeting behavioral goals. Keeping a dietary log or using a pedometer to keep track of steps are examples of self- monitoring. Self-assessments are a good way to see if you have met outcome goals.

Throughout this book, you will learn to self-assess a vari- ety of outcomes (e.g., fitness, body fatness) and self-monitor behaviors (e.g., diet, physical activities, stress-management activities). In step 2 in program planning, you used self- assessments to determine your needs and to help you plan your goals (step 3). Once you have tried your program, you can use the same self-assessments and self-monitoring strat- egies to evaluate the effectiveness of your program. You can see if you have met the goals you established for yourself.

T E C H N O L O G Y U P D A T E

Health Apps for Smartphones Rapid changes in cell phone technology have created a huge market for customized applications (apps) that are designed to run on these platforms. There are apps for almost everything, including hundreds of apps designed to help people manage and organize their lifestyles and provide supportive prompts and reminders. Others help people track health data or diet and activity behaviors.

How useful are these types of health-related apps for promoting

and maintaining healthy lifestyles? Are they simply fun technology

or do they support health behavior change?

ACTIVITY

Self-planning can help you implement a variety of changes to enhance health, wellness, and fitness.

VIDEO 6

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34 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness

Web Resources ACSM’s Fit Society Page www.acsm.org/access-public-

information/newsletters/fit-society-page

ACSM’s Health and Fitness Journal www.acsm.org/access- public-information/acsm-journals/acsm’s-health-

fitness-journal

American Heart Association Health and Fitness Center www.heart.org/HEARTORG/

American Red Cross www.redcross.org Centers for Disease Control and Prevention (overcoming

barriers) www.cdc.gov/physicalactivity/everyone/ getactive/barriers.html

Healthy People 2020 www.healthypeople.gov/HP2020 National Heart Lung and Blood Institute—Health Behavior

Change www.nhlbi.nih.gov/health/public/heart/obesity/ lose_wt/index.htm

Robert Wood Johnson Foundation www.rwjf.org SMART goals www.projectsmart.co.uk/smart-goals.html Trust for America’s Health—BluePrint for Healthier

America http://healthyamericans.org/report/55/ blueprint-for-healthier-america

Well-Being Index—Gallup Poll www.gallup.com/poll/ wellbeing.aspx

Strategies for Action

To be effective, self-management

and self-planning skills require a

commitment to make changes in lifestyle. As indicated in Figure 1 on page 22, change occurs stage by stage, and an individual is likely to be at different stages for different health behaviors. For example, a person may be at the maintenance stage for physical activity but at the contem- plation stage for adopting sound nutrition practices. In this book, many self-management skills are described for use in progressing from one stage to another. Different skills are important, depending on your current stage and the life- style behavior you are attempting to change.

The lab worksheets that accompany each concept will

help you learn the self-assessment, self-management,

and self-planning skills necessary for behavior change.

Self-assessments of current health, wellness, and fitness status, as well as self-monitoring of your current lifestyle, can help you determine your reasons for making change and help you establish SMART goals for change. Like all skills, practice is necessary to improve self-management skills. Table 5 refers you to labs in the text designed to enhance specific self-management skills.

Assessing self-management skills that influence

healthy lifestyles provides a basis for changing your

health, wellness, or fitness. Self-assessments of your current health, wellness, and fitness status, as well as self- monitoring of your current lifestyles, can help you deter- mine your reasons and establish reasonable goals for healthy lifestyle change. The Healthy Lifestyle Question- naire and the Wellness Self-Perceptions Questionnaire you took in Concept 1 got you started. In this concept you can use the Stage of Change Questionnaire (Lab 2A) to help you decide which lifestyles you might need to modify. You can use the Self-Management Skills Questionnaire (Lab 2B) to determine which self-management skills you may need to improve to help you make effective changes in your lifestyles. In later concepts, you will have the oppor- tunity to make self-assessments for a variety of lifestyles.

ACTIVITY

Section 1 ▶ Lifesty

commitment to make

Self-Management Skill Lab Number

Overcoming barriers 6B, 15A, 17A, 24B

Building self-confidence and motivation

2A, 2B

Balancing attitudes 1A, 2A, 2B, 3C, 8A, 19B

Building knowledge and beliefs

1A, 4A, 7A, 12B, 14A, 15A, 15B, 18A, 18B, 19A, 19B, 20A, 21A, 22A, 22B, 23A, 23B

Goal setting 6A, 8B, 9B, 10C, 10D, 11C, 14B, 24B, 24C

Self-assessment 1A, 2A, 3A, 3C, 4A, 5A, 5B, 6B, 7B, 8A, 9A, 10A, 10B, 10D, 11A, 11B, 12A, 12B, 13A, 13B, 13C, 14A, 15B, 16A, 16B, 22A, 22B, 23B, 24A, 24B, 24C

Self-monitoring 2A, 5A, 6A, 7A, 8A, 8B, 9B, 10C, 11C, 17A, 17D, 19A, 22B, 24B, 24C

Self-planning 6A, 8B, 9B, 10C, 10D, 11C, 14B, 24B, 24C

Performance skills 3B, 12A, 17C

Adopting coping skills 16A, 16B, 17A, 17B, 17C, 17D

Learning consumer skills 14B, 15A, 18A, 20A, 23A, 23B, 24B, 24C

Managing time 17A

Finding social support 17D

Preventing relapse 15A, 19B, 24B, 24C

Table 5 ▶ Opportunities for Learning Self- Management Skills

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Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 35

Suggested Readings Benson, G. A., et al. 2011. Telephone-based support for weight

loss surgery. ACSM’s Health and Fitness Journal 15(1):13–19. Buettner, D. 2008. The Blue Zones: Lessons for Living Longer

from People Who’ve Lived the Longest. Washington: DC: The National Geographic Society.

Glantz, K., B. K. Rimer, and K. Viswanath (Eds.). 2008. Health Behavior and Health Education. 4th ed. San Francisco: John Wiley and Sons.

Manson, P., and C. C. Butler. 2010. Health Behavior Change: A Guide for Practitioners. New York: Churchill Livingstone/ Elsevier.

Marcus, B. E., and L. Forsyth. 2009. Motivating People to Be Physically Active. 2nd ed. Champaign, IL: Human Kinetics.

Martin, L. R., et al. 2010. Health Behavior Change and Treatment Adherence: Evidence-Based Guidelines for Improving Health

Care. New York: Oxford University Press.

Pate, R. R., et al. 2011. Overcoming barriers to physical activ- ity. ACSM’s Health and Fitness Journal 15(1):7–12.

Pekmezi, D., et al. 2010. Using the transtheoretical model to promote physical activity. ACSM’s Health and Fitness Journal 14(4):8–13.

Simons-Morton, B., McLeroy, K. R., and M. L. Wendel. 2012. Behavior Theory in Health Promotion Practice and Research. Burlington, MA: Jones and Bartlett Learning.

Sullivan, G. S., and J. P. Strode. 2010. Motivation through goal setting: A self-determined perspective. Strategies 23(6):19–23.

Taylor, S. E. 2008. Health Psychology. 7th ed. New York: McGraw-Hill Higher Education.

White, S. M., E. L. Mailey, and E. McAuley. 2010. Leading a physically active lifestyle: Effective individual behavior change strategy. ACSM’s Health and Fitness Journal 14(1):8–15.

Whiteley, J. A., and L. A. Milliken. 2011. Making weight loss a family affair. ACSM’s Health and Fitness Journal 15(2):8–12.

Healthy People 2020 The objectives listed below are societal goals designed to help all Americans improve their health between now and the year 2020. They were selected because they relate to the con- tent of this concept.

• Promote quality of life, healthy development, and healthy behaviors (including being active, eating well, and avoid- ing destructive habits) across all stages of life.

• Create a society in which all people live long, healthy lives.

• Attain high-quality, longer lives free of preventable disease, injury, and premature death.

• Increase public awareness and understanding of the determinants of health, disease, and disability.

• Increase health literacy of the population.

A national goal is to promote health behaviors across all stages of

life. Explain how using self-management skills can help individuals

change health behaviors and how individual change can contribute

to achieving national goals.

ACTIVITY

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Reinforcing factors

Factors influencing change Stages of change

Preparation

Contemplation

Precontemplation

•Success •Family support •Peer support •Support of health professionals

Enabling factors

•Goal setting •Self-assessment •Self-monitoring •Self-planning •Performance skills •Coping skills •Consumer skills •Time management

Personal factors

Age Gender Heredity Current health and fitness

Predisposing factors

Am I able? Is it worth it?

Self-confidence Self-efficacy Safe environment Access

Self-motivation Enjoyment Balanced attitudes Beliefs Knowledge

Action

Maintenance

Lab Resource Materials

Use the diagram below in answering the questions in Lab 2A. It is a reproduction of Figure 2 and includes factors that influence change in healthy behaviors.

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Lab 2A The Stage of Change Questionnaire

Name Section Date

Purpose: To help assess your current level in the stage of change hierarchy for a variety of health behaviors

Procedures

1. Determine your “readiness for change” different health behaviors using the Stage of Change Questionnaire. 2. Evaluate predisposing, enabling, and reinforcing factors for several selected behaviors. 3. Answer the questions in the Conclusions and Implications section.

Results: Complete the Stage of Change Questionnaire on the next page. List two behaviors (below) that you are inter- ested in improving. Beside the behaviors, write your current stage for that behavior.

Behavior 1: ______________________________ Current Stage?_______________________

Behavior 2: _______________________________ Current Stage? _____________________

Conclusions and Implications: For each behavior, discuss the enabling, predisposing, and reinforcing factors that you think are particularly important for you as you work to change this behavior (refer to the stages of change model and Tables 1, 2, and 3 in the text).

Behavior 1:

Behavior 2:

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1. Physical Activity

Precontemplation—I am not active, and I do not plan to start. Contemplation—I am not active, but I am thinking about starting. Preparation—I am getting ready to become active. Action—I do some activity but need to do more. Maintenance—I have been active regularly for several months.

2. Eating Well (Nutrition)

Precontemplation—I do not eat well and don’t plan to change. Contemplation—I do not eat well but am thinking about change. Preparation—I am planning to change my diet. Action—I sometimes eat well but need to do more. Maintenance—I have eaten well regularly for several months.

3. Managing Stress

Precontemplation—I do not manage stress well and plan no changes. Contemplation—I am thinking about making changes to manage stress. Preparation—I am planning to change to manage stress better. Action—I sometimes take steps to manage stress better but need to do more. Maintenance—I have used good stress-management techniques for several months.

4. Adopting Good Safety Habits (e.g., seat belt use, safe storage of medicine)

Precontemplation—I have at least one unsafe habit but plan no changes. Contemplation—I am thinking about making changes regarding a safety habit. Preparation—I am planning to make a change regarding a safety habit. Action—I have taken action concerning a habit but need to do more. Maintenance—I have no safety habits that need to change (I practice good safety).

5. Adopting Good Personal Health Habits (e.g., brushing and flossing, adequate sleep)

Precontemplation—I have at least one health habit that needs change but plan no changes. Contemplation—I am thinking about making changes related to a health habit. Preparation—I am planning to make a change regarding a health habit. Action—I have taken action concerning a habit but need to do more. Maintenance—I have no health habits that need to change.

6. Learning First Aid (e.g., CPR/First Aid)

Precontemplation—I do not know CPR/first aid and do not plan to learn. Contemplation—I am thinking about learning CPR/first aid. Preparation—I have made plans to learn CPR/first aid. Action—I once knew CPR/first aid but need an update. Maintenance—I am up-to-date on my CPR/first aid and will keep updated.

Questions 7 and 8 are highly personal. Answer for your own use, but do not record answers on this sheet.

7. Avoiding Destructive Habits (e.g., tobacco, drugs, alcohol)

Precontemplation—I have at least one destructive habit but plan no change. Contemplation—I am thinking about making changes related to a destructive habit. Preparation—I am planning to make a change regarding a destructive habit. Action—I have taken action concerning a habit but need to do more. Maintenance—I have no destructive habits or have stopped the habit for months.

8. Practicing Safe Sex

Precontemplation—I have practiced unsafe sex and plan no change. Contemplation—I am thinking about making changes to an unsafe habit. Preparation—I am planning to make a change regarding an unsafe habit. Action—I have taken action concerning a habit but need to do more. Maintenance—I do not practice unsafe sex or have stopped the habit for months.

Stage of Change Questionnaire (make one choice for each question)

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Lab 2B The Self-Management Skills Questionnaire

Name Section Date

Purpose: To help you assess your self-management skills that are important for three priority lifestyles (physical activity, healthy nutrition, stress management)

Procedures

1. Each question in the questionnaire on pages 41 and 42 reflects one of the self-management strategies described in this text. Each of the 12 questions requires an answer about three different healthy behaviors. Answer each question using a 3 for very true, 2 for somewhat true, or 1 for not true. Record the number of your answer in the appropriate box for each of the three healthy lifestyles.

2. After you have answered all 12 questions for each of the three lifestyles, total the three columns to get a total score for physical activity, nutrition, and stress management.

3. Determine your rating for each lifestyle using the Self-Management Skills Rating Chart. Record your rating in the Results section.

4. Answer the questions in the Conclusions and Implications section.

Results: Record your rating for each of three healthy lifestyles in the chart below.

Conclusions and Implications: In several sentences, discuss your ratings regarding self-management skills related to physical activity. You may have a good total score but still have several self-management skills on which you need improvement. Comment on your overall scores and those individual self-management skills on which you had scores of 1 (not true).

Rating Score

Good 30–36

Marginal 24–29

Needs improvement <24

Self-Management Skills Results Rating

Physical activity

Nutrition

Stress management

Self-Management Skills Rating Chart

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In several sentences, discuss your ratings regarding self-management skills related to nutrition. You may have a good total score but still have several self-management skills on which you need improvement. Comment on your overall scores and those individual self-management skills on which you had scores of 1 (not true).

In several sentences, discuss your ratings regarding self-management skills related to stress management. You may have a good total score but still have several self-management skills on which you need improvement. Comment on your overall scores and those individual self-management skills on which you had scores of 1 (not true).

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Very Somewhat Not Activity Nutrition Stress

The Self-Management Skills Questionnaire true true true Score Score Score

1. I regularly self-assess: (self-assessment)

personal physical fitness and physical activity levels 3 2 1

the contents of my diet 3 2 1

personal stress levels 3 2 1

2. I self-monitor and keep records concerning: (self-monitoring)

physical activity 3 2 1

diet 3 2 1

stress in my life 3 2 1

3. I set realistic and attainable goals for: (goal setting)

physical activity 3 2 1

eating behaviors 3 2 1

reducing stress in my life 3 2 1

4. I have a personal written or formal plan for: (self-planning)

regular physical activity 3 2 1

what I eat 3 2 1

managing stress in my life 3 2 1

5. I possess the skills to: (performance skills)

perform a variety of physical activities 3 2 1

analyze my diet 3 2 1

manage stress (e.g., progressive relaxation) 3 2 1

6. I have positive attitudes about: (balancing attitudes)

my ability to stick with an activity plan 3 2 1

my ability to stick to a nutrition plan 3 2 1

my ability to manage stress in my life 3 2 1

7. I can overcome barriers that I encounter: (overcoming barriers)

in my attempts to be physically active 3 2 1

in my attempts to stick to a nutrition plan 3 2 1

in my attempts to manage stress in my life 3 2 1

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Very Somewhat Not Activity Nutrition Stress

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8. I know how to identify misinformation: (consumer skills)

relating to fitness and physical activity 3 2 1

relating to nutrition 3 2 1

relating to stress management 3 2 1

9. I am able to get social support for my efforts to: (social support)

be active 3 2 1

stick to a healthy nutrition plan 3 2 1

manage stress in my life 3 2 1

10. When I have problems, I can get back to: (relapse prevention)

my regular physical activity 3 2 1

my nutrition plan 3 2 1

my plan for managing stress 3 2 1

11. I am able to adapt my thinking to: (coping strategies)

stick with my activity plan 3 2 1

stick with my nutrition plan 3 2 1

stick with my stress-management plan 3 2 1

12. I am able to manage my time to: (time management)

stick with my physical activity plan 3 2 1

shop for and prepare nutritious food 3 2 1

perform stress-management activities 3 2 1

Total Activity Score

Total Nutrition Score

Total Stress Score

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LEARNING OBJECTIVES

After completing the study of this concept, you will be able to:

▶ Identify and describe key factors for safely participating in a moderate to vigorous physical activity program.

▶ Describe the warm-up, the workout, and the cool-down and explain why each is important.

▶ Explain the potential risks associated with exposure to heat, cold, and altitude and describe precautions that can be taken to prevent problems.

▶ Identify the factors that contribute to soreness and injury from physical activity and describe steps that can be taken to recover from them.

▶ Identify and describe the common positive and negative attitudes about physical activity and explain how they relate to regular participation.

▶ Identify related national health goals and show how meeting personal goals can contribute to reaching national goals.

▶ Assess your readiness for physical activity and demonstrate appropriate warm-up activities.

Preparing for Physical Activity

C o

n c

e p

t 3

An Introduction to Physical Activity ▶ Section II

Proper preparation can help make

physical activity enjoyable, effective,

and safe.

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44 Section 2 ▶ An Introduction to Physical Activity

F or people just beginning a physical activity program, adequate preparation may be the key to persistence.

For those who have been regularly active for some time, sound preparation can help reduce risk of injury and make activity more enjoyable. For long-term mainte- nance, physical activity must be something that is a part of a person’s normal lifestyle. Some factors that will help you prepare for and make physical activity a part of your normal routine are presented in this concept.

Factors to Consider Prior to Physical Activity Screening before beginning regular physical

activity is important to establish medical readiness. The most recent guidelines for exercise testing and prescription of the American College of Sports Medi- cine (ACSM) suggest that there are two types of pre- participation screening: self-guided screening and pro- fessionally guided screening. For self-guided screening, the ACSM endorses the basic recommendation of the Surgeon General’s Report on Physical Activity and Health, that “previously inactive men over age of 40 and women over age 50, and people at high risk of cardiovascular disease (CVD) should first consult a physician before embarking on a program to which they are unaccustomed.”

An alternative method of self-screening involves the use of the Physical Activity Readiness Questionnaire ( PAR-Q ). This seven-item questionnaire was designed by the British Columbia (Canada) Ministry of Health to help people know when it is advisable to seek medi- cal consultation prior to beginning or altering an exer- cise program. The goal is to prevent unnecessary medical examinations while helping people to be reasonably assured that regular moderate physical activity is appro- priate. Other self-administered surveys recommended by the ACSM include those given at a physician’s office or those administered by certified health and fitness pro- fessionals (e.g., AHA/ACSM Pre-participation Screen- ing Questionnaire). If a pre-participation questionnaire indicates the need, medical clearance is recommended. A clinical exercise test may also be appropriate. Those who do not identify health concerns using a self-screening questionnaire (e.g., all “no” answers on the PAR-Q) typi- cally are cleared for moderate self-planned activity pro- grams. For more vigorous exercise and sports, additional screening may be appropriate.

ACSM has developed additional guidelines to stan- dardize professionally guided screening (e.g., assess- ments conducted by a medical doctor or certified health/ fitness professional). As noted in Table 1 , the ACSM divides people into three general risk categories: low, moderate, and high risk. Some of the risk factors used

A clinical exercise test—an example of professionally guided screening—is recommended for some individuals to ensure they can exercise safely.

Source: American College of Sports Medicine.

Stratification Category Criteria

Low risk People who have no heart disease symptoms and have no more than one of the risk factors listed below

Moderate risk People without heart disease symptoms who have two or more of the risk factors listed below

High risk People with known pulmonary or metabolic disease, OR one or more signs or symptoms in the list below

Risk Factors

Family history of heart disease; smoker; high blood pressure (hypertension); high cholesterol; abnormal blood glucose levels; obesity (high BMI, excess waist girth); sedentary lifestyle; low HDL cholesterol level; men age 45 or older; women age 55 or older

Signs and Symptoms

Chest, neck, or jaw pain from lack of oxygen to the heart; shortness of breath at rest or in mild exercise; dizziness or fainting; difficult or labored breathing when lying, sitting, or standing; ankle swelling; fast heartbeat or heart palpitations; pain in the legs from poor circulation; heart murmur; unusual fatigue or shortness of breath with usual activities

Table 1 ▶ American College of Sports Medicine Risk Stratification Categories and Criteria

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Concept 3 ▶ Preparing for Physical Activity 45

to identify risk categories are identifiable without pro- fessional consultation (e.g., age, family history, smoking, sedentary lifestyle), while others may require profes- sional screening (e.g., blood cholesterol, blood glucose). Many health clubs now offer professional screening for these variables. Individuals found to be at risk are then referred to medical follow-up. Low-risk people who are apparently healthy are typically cleared for moderate and many forms of vigorous activity without a medi- cal exam or an exercise test. Those with moderate risk can participate in low to moderate activity without a medical exam or exercise test; however, both are recom- mended before initiating vigorous programs. For those in the high-risk category, a comprehensive medical exam is necessary before starting either a moderate or high- intensity program and before taking an exercise test. For those just beginning a program or those resuming physi- cal activity after an injury or illness, consultation with a physician is always wise, no matter what your age or medical condition.

Consideration should also be given to altering exercise patterns if you have an illness or a temporary sickness, such as a cold or the flu. The immune system and other body systems may be weaker at this time, and medicines (even over-the-counter ones) may alter responses to exer- cise. It is best to work back gradually to your normal rou- tine after illness.

There is no way to be absolutely sure that you are medically sound to begin a physical activity program. Even a thorough exam by a physician cannot guarantee that a person does not have some limitations that may cause a problem during exercise. Use of the PAR-Q (see Lab 3A) and adherence to the ACSM guidelines are advised to help minimize the risk while preventing unnecessary medical cost. How- ever, if you are unsure about your readiness for activity, a medical exam and a clinical exercise test are the surest ways to make certain that you are ready to participate.

It is important to dress properly for physical

activity. Clothing should be appropriate for the type of activity being performed and the conditions in which you are participating. Comfort is a much more impor- tant consideration than looks. Table 2 provides guide- lines for dressing for activity.

Shoes are an important consideration for safe and

effective exercise. Decisions about shoes should be based on intended use (e.g., running, tennis), shoe and foot characteristics, and comfort. Shoes are designed for specific activities, and performance will typically be best if you select and use them for their intended purpose and fit, rather than how they look. Hybrid shoes, known

as “cross-trainers,” can be a versatile option, but they typically don’t provide the needed features for specific activities. For example, they may lack the cushioning and support needed for running and the ankle support for activities such as basketball. Features of common activity shoes are highlighted in Figure 1 .

Most shoes have very thin sockliners, but supplemen- tal inserts can be purchased to provide more cushioning and support. Custom orthotics can also be used to correct alignment problems or minimize foot injuries (e.g., plantar fasciitis). A very important, and frequently neglected, con- sideration is to replace shoes after extended use. Runners typically replace shoes every 4 to 6 months (or 400 to 600 miles), even if the outer appearance of the shoe is still good. The main functions of athletic shoes are to reduce shock from impact and protect the foot—one of the best prevention strategies for avoiding injuries is to replace your shoes on a regular basis.

PAR-Q An acronym for Physical Activity Readiness Questionnaire; designed to help determine if you are medically suited to begin an exercise program. Clinical Exercise Test A test, typically adminis- tered on a treadmill, in which exercise is gradually increased in intensity while the heart is monitored by an EKG. Symptoms not present at rest, such as an abnormal EKG, may be present in an exercise test.

VIDEO 1

General Guidelines

• Avoid clothing that is too tight or that restricts movement. • Material in contact with skin should be porous. • Clothing should protect against wind and rain but allow

for heat loss and evaporation—e.g., Gortex, Coolmax. • Wear layers so that a layer can be removed if not needed. • Wear socks for most activities to prevent blisters,

abrasions, odor, and excessive shoe wear. • Socks should be absorbent and fit properly. • Do not use nonporous clothing that traps sweat to lose

weight; these garments prevent evaporation and cooling.

Special Considerations

• Consider eye protection for racquetball and other sports. • Women should wear an exercise bra for support. • Men should consider an athletic supporter for support. • Wear helmets and padding for activities with risk of falling,

such as biking or inline skating. • Wear reflective clothing for night activities. • Wear water shoes for some aquatic activities. • Consider lace-up ankle braces to prevent injury. • Consider a mouthpiece for basketball and other contact

sports.

Table 2 ▶ Selecting Appropriate Clothing for Activity

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46 Section 2 ▶ An Introduction to Physical Activity

Factors to Consider during Daily Physical Activity There are three components of the daily activity

program: the warm-up, the workout, and the

cool-down. The key component of a fitness program is the daily workout. Experts agree, however, that the work- out should be preceded by a warm-up and followed by a cool-down. The warm-up prepares the body for physical activity, and the cool-down returns the body to rest and promotes effective recovery by aiding the return of blood from the working muscles to the heart (see Figure 2 ).

A general warm-up is recommended prior

to vigorous exercise. ACSM recommends a general aerobic and muscular endurance warm- up consisting of a minimum of 5 to 10 minutes of low-to-moderate aerobic and muscular endur- ance activity prior to a vigorous workout. Some examples of warm-up activities include walking, slow jogging, slow swimming, slow biking, or low-intensity sport specific movements (e.g., a layup drill in basketball). The general warm-up is intended to prepare the heart, blood vessels, muscles, and other bodily systems for more vig- orous activity to follow. The ACSM indicates that the general warm-up increases body temperature and reduces the potential for after-exercise mus- cle soreness and stiffness, as well as allowing the body to adapt to the demand of the workout that follows. This general warm-up also decreases the risk of irregular heartbeats associated with poor coronary circulation. For those performing mod- erate activities for their workout (e.g., walk, bike ride, swim), no special general warm-up is neces- sary since the activity itself is light to moderate in nature. Starting at a slower pace and gradually increasing intensity is recommended.

Consider a muscle-stretching warm-up. Until recently, a muscle-stretching warm-up (stretch warm-up) was recommended after the general warm-up and prior to the workout. A stretch warm- up was thought to help reduce risk of injury, reduce soreness after exercise, and improve performance in sports activities. Recent studies have questioned the value of the stretch warm-up in preventing injury. A recent review also indicates that while stretching may reduce soreness in some, reduc- tions in soreness are only modest. Several studies have indicated that stretching before sports and other types of activities that require strength and power can result in reduced performance. A recent review, however, indicates that performance is

only affected if the stretches last 60 seconds or longer. As noted in Concept 10, the recommended length of stretching exercises is 15 to 30 seconds.

The recent evidence, however, does not mean that you should not do a stretch warm-up. Those planning to participate in sports such as gymnastics and diving typi- cally perform a stretch warm-up as do those who per- form recreational activities such as dance. For those who have been doing a stretch warm-up prior to other activi- ties, and enjoy it, there is no reason not to continue. A sample of a stretch warm-up is included in Lab 3B. For best results, the stretch warm-up should be done after the general warm-up because stretch is most effective when the muscles are warm. If you plan to do activities in your

Figure 1 ▶ Anatomy of an activity shoe.

Achilles notch

Toe box

Heel counter

Arch support

Insole (sockliner)

Outsole

Insole (last) Midsole

Achilles notch: Protects tendon

Heel counter: Cradles heel to provide movement control; reduces slippage and blistering; a stiff counter reduces pronation

Arch support: Supports arch; height and shape of arch should vary with foot characteristics

Insole (sockliner): Removable layer for additional shock and sweat absorption; can be replaced periodically and/or customized

Insole (last): Refers to shape of shoe bed; curved (allows more mobility; better for those with high, rigid arches); straight (controls excessive motion, better for those with abnormal pronation); or semicurved (moderate flexibility and stability)

Midsole: Provides cushion, stability, and motion control; important for shock absorption

Outsole: Provides traction; determines shoe flexibility; type depends on intended purpose of shoe

Toe box: Should have adequate height to wiggle toes and prevent rubbing on top of toes and adequate length so toes do not contact front of shoe

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Concept 3 ▶ Preparing for Physical Activity 47

workout that involve strength and power, you should not do stretches that last longer than 60 seconds.

The stretch warm-up is not intended to substitute for a regular program of stretching to build flexibility. In other words, if you have not trained regularly to build flexibility, a warm-up is not the best way to get flexible.

Figure 2 ▶ Muscle contractions help the veins return blood to the heart.

Blood returns to heart

Contracted skeletal muscles

Vein

Relaxed skeletal muscles

Valve open

Closed valve

Muscles

Closed valve

ACTIVITY

T E C H N O L O G Y U P D A T E

Minimalist Running Running shoes have historically emphasized high-tech shock absorption and cushioning technology, but “mini- malist” running and even barefoot running have become increasingly popular. One company best known for mak- ing shoe soles has captured runners’ imagination with a line of shoes known as the Vibram FiveFingers®. The shoes (which look more like slippers or gloves for your feet) are designed to simulate the feeling of barefoot run- ning while providing protection. They allow you to more easily adopt a forefoot running style rather than striking first on your heel. This change in stride is thought to improve balance, reduce impacts, and improve propulsion. Some studies show that the shoes may reduce chronic knee problems, but it is too early to determine the long- term effects on health or performance. While there is some evidence to support this new approach, experts note that it takes time to retrain your gait. Runners that switch too abruptly can expect to experience consider- able soreness, particularly in the calf muscle. Almost all shoe companies now make minimalist shoes or forefoot running shoes and there are varieties for different sports or activities. Advocates of forefoot running include Alberto Salazar, a former U.S. marathon runner and current run- ning coach. Search “minimalist running” or “forefoot run- ning” on the Internet to learn more.

How open would you be to minimalist shoes or forefoot running?

Cool-Down Light to moderate activity done after a workout to help the body recover; often consisting of the same exercises used in the warm-up. Warm-Up Light to moderate physical activity per- formed before a more vigorous workout, including a general aerobic/muscular endurance warm-up and often a stretch warm-up. Dynamic Warm-Up The performance of calisthen- ics of gradually increasing intensity (e.g., jumping jacks, jumping, skipping). Sport-Specific Warm-Up The performance of sports- related movements of gradual intensity (e.g., layup drill in basketball, swinging a club in golf or racket in tennis).

You may choose to do flexibility exercises as part of your workout or after your workout (as part of the cool-down).

Consider other warm-up options. People who plan to perform resistance training or play a vigorous sport should consider a dynamic warm-up or a sport-specific warm-up . A dynamic warm-up includes the performance

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48 Section 2 ▶ An Introduction to Physical Activity

near resting values. This phase is especially important for those with cardiovascular risk factors or disease.

The cool-down can also include a stretching

phase. Stretching the muscles at the end of the work- out, or after the workout, can help relieve muscle spasms in fatigued muscles, and stretching is more effective in building flexibility when the muscles are warm. The ACSM recommends 10-plus minutes for stretching to build flexibility. To be effective, as a complete flexibility program, stretching performed in a cool-down would need to be personalized and include exercises for all mus- cle groups (see Concept 10).

Physical Activity in the Heat and Cold Physical activity in hot and humid environments

challenges the body’s heat loss mechanisms.

During vigorous activity, the body produces heat, which must be dissipated to regulate body temperature. The body has several ways to dissipate heat. Conduction is the transfer of heat from a hot body to a cold body. Convec- tion is the transfer of heat through the air or any other medium. Fans and wind can facilitate heat loss by con- vection and help regulate temperature. The primary method of cooling is through evaporation of sweat. The chemical process involved in evaporation transfers heat from the body and reduces the body temperature. When conditions are humid, the effectiveness of evaporation is reduced, since the air is already saturated with moisture. This is why it is difficult to regulate body temperature when conditions are hot and humid.

Heat-related illness can occur if proper hydration

is not maintained. Maximum sweat rates during physi- cal activity in the heat can approach 1–2 liters per hour. If this fluid is not replaced, dehydration can occur. If

of calisthenics of gradually increasing intensity. Those interested in high-level performance (e.g., movements requiring great force, and fast movements) should choose a dynamic warm-up of calisthenics that simulates the types of movements to be used in the vigorous phase of the workout or event. The sport-specific warm-up includes sports-related movements of gradual intensity. Examples include performing layup, shooting, and other drills before a basketball game or swinging a golf club or tennis racket before playing. A general warm-up may be performed before the dynamic and sports-related warm-up or may be used as a general warm-up; however, the initial activities should be of moderate intensity and gradually increase in intensity. As noted previously, if the workout is of mod- erate intensity, no warm-up is necessary (e.g., 30-minute brisk walk). Some people who plan to perform a more vig- orous workout may prefer only a general warm-up.

The workout is the principal component of an

activity program and occurs after the warm-up and

before the cool-down. The workout , also referred to as the conditioning phase of a training session, is the component of the physical activity program that is designed to provide health and other benefits, depend- ing on the type of activity performed (see Concept 4). Workout information, including appropriate frequency, intensity, and length of time for many types of physical activities in the physical activity pyramid (Concept 5), is included in subsequent concepts.

A cool-down after the workout promotes an

effective recovery from physical activity. The ACSM recommends a 5- to 10-minute cool-down similar to the general warm-up (e.g., light to moderate activity) after a vigor- ous workout. In addition to helping reduce metabolic by-products, the general cool-down helps the cardiovascular system (heart rate and blood pressure) return to a normal state.

During physical activity, the heart pumps a large

amount of blood to supply the working muscles

with the oxygen necessary to keep moving. The muscles squeeze the veins (see Figure 2 ), which forces the blood back to the heart. Valves in the veins prevent the blood from flowing backward. As long as exercise continues, muscles move the blood back to the heart, where it is once again pumped to the body. If exercise is stopped abruptly, the blood is left in the area of the work- ing muscles and has no way to get back to the heart. In the case of a runner, the blood pools in the legs. Because the heart has less blood to pump, blood pressure may drop. This can result in dizziness and can even cause a person to pass out. The best way to prevent this problem is to slow down gradually after exercise and keep mov- ing until blood pressure and heart rate have returned to

VIDEO 2

Health is available to Everyone for a

Lifetime, and it’s Personal

Exercising can lead to serious heat-related problems if the body becomes dehydrated. The body’s thirst mechanism usually lags behind the true need for fluids. Experts recommend drinking 1 to 2 cups of water or another hydrating liquid before exercise and then an additional cup every 20 minutes thereafter.

Do you follow these guidelines or could you be dehydrated

during or after your typical exercise sessions? What strategies

can you use to drink more water?

ACTIVITY

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Concept 3 ▶ Preparing for Physical Activity 49

A CLOSER LOOK

ACTIVITY

CPR Guidelines and AEDs To be prepared for physical activity, you also need to be pre- pared for emergencies. For example, it is important to know basic first aid and cardiopulmonary resuscitation (CPR) if needed. Guidelines from the American Heart Association (AHA) have been revised, shifting the order used for performing CPR. The previous method used the A-B-C method to denote airway, breathing, and compressions. The new guidelines emphasize doing compressions first (C-A-B). Proper certification is recom- mended, but the guidelines were revised to get more people to help even when not certified (some CPR is better than no CPR). If a person is unresponsive, call for help and begin chest compressions immediately, then open the airway and give mouth-to-mouth rescue breaths along with alternating com- pressions. Also, automated external defibrillators (AED) are available in many public places, including fitness centers and schools. The AHA offers free online training for CPR and AED devices (visit www.heart.org and search for “Heartsaver® First Aid CPR AED”). The AHA also has a 3-minute video on You- Tube titled AHA Guidelines for CPR that shows the basic steps.

How might the revised guidelines encourage more bystanders to help

in a crisis situation? Would you be more inclined to provide aid?

Adequate hydration is critical for safe exercise in the heat.

dehydration is not corrected with water or other fluid- replacement drinks, it becomes increasingly difficult for the body to maintain normal body temperatures. At some point, the rate of sweating decreases as the body begins to conserve its remaining water. It shunts blood to the skin to transfer excess heat directly to the environment, but this is less effective than evaporation. Hyperthermia and associated heat-related problems can result (see Table 3 ).

One way to monitor the amount of fluid loss is to monitor the color of your urine. The American College of Sports Medicine indicates that clear (almost color- less) urine produced in large volumes indicates that you are hydrated. As water in the body is reduced, the urine

Workout The component of a total physical activity program designed to produce health, wellness, fitness, and other benefits using appropriate amounts of dif- ferent types of physical activity. Dehydration Excessive loss of water from the body, usually through perspiration, urination, or evaporation. Hyperthermia Excessively high body temperature caused by excessive heat production or impaired heat loss capacity. Heatstroke is a hyperthermic condition.

Problem Symptoms Severity

Heat cramps Muscle cramps, especially in muscles most used in exercise

Least severe

Heat exhaustion Muscle cramps, weakness, dizziness, headache, nausea, clammy skin, paleness

Moderately severe

Heatstroke Hot, flushed skin; dry skin (lack of sweating); dizziness; fast pulse; unconsciousness; high temperature

Extremely severe

Table 3 ▶ Types of Heat-Related Problems

Compressions Push hard and fast

on the center of

the victim’s chest

Airway Tilt the victim’s head

back and lift the chin

to open the airway

Breathing Give mouth-to-mouth

rescue breaths

American Heart Association

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50 Section 2 ▶ An Introduction to Physical Activity

becomes more concentrated and is a darker yellow color. This indicates dehydration and a need for fluid replace- ment. Dietary supplements that contain amphetamine derivatives and/or creatine may contribute to undetected dehydration among some individuals.

Acclimatization improves the body’s tolerance

in the heat. Individuals with good fitness will respond better to activity in the heat than individuals with poor fitness. With regular exposure, the body adapts to the heat. The majority of the adaptation to hot environments occurs in 7 to 14 days, but complete acclimatization can take up to 30 days. As you adapt to the heat, your body becomes conditioned to sweat earlier, to sweat more pro- fusely, and to distribute the sweat more effectively around the body, and the composition of sweat is altered. This process makes it easier for your body to maintain a safe body temperature.

Precautions should be taken when doing physical

activity in hot and humid environments. The heat index (also referred to as apparent temperature) com- bines temperature and humidity to help you determine

when an environment is safe for activity. The combi- nation of high temperature and humidity presents the greatest risk of heat-related problems in exercise. Physical activity is safe when the apparent temperature is below 80 8 F (26.7 8 C). Figure 3 shows the risk of exercise at pro- gressively higher apparent temperatures.

Consider the following guidelines for exercising in the heat and humidity.

• Limit or cancel activity if the apparent temperature reaches the danger zone (see Figure 3 ).

• Drink fluids before, during, and after vigorous activity. Guidelines suggest about 2 cups before activity and about 1 cup for each 15–20 minutes during activ- ity. After activity, drink about 2 cups for each pound of weight lost. The thirst mechanism lags behind the body’s actual need for fluid, so drink even if you don’t feel thirsty. Fluid-replacement beverages (e.g., Gatorade, Powerade) are designed to provide added energy (from carbohydrates) without impeding hydra- tion. If you choose to use one of these beverages, select one that contains electrolytes and no more than 4 to 8 percent carbohydrates.

Figure 3 ▶ Heat index values (apparent temperatures). Source: Data from National Oceanic and Atmospheric Administration.

Relative Humidity

(%) 70

Air Temperature (Degrees F)

100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 0

72 71 71 71 71 70 70 70 70 69 69 68 68 67 67 66 66 65 65 64 64

80 79 79 78 78 77 77 76 76 75 75 74 74 73 73 72 72 71 70 69 69

91 89 88 87 86 86 85 83 82 81 81 80 79 79 78 77 77 76 75 74 73

108 105 102 99 97 95 93 91 90 89 88 87 86 85 84 83 82 81 80 79 78

132 128 122 117 113 109 106 102 100 98 96 95 93 91 90 88 87 86 85 84 83

141 136 130 124 119 114 110 107 104 101 98 96 94 93 91 90 88 87

144 138 132 126 120 115 110 107 104 101 99 97 95 93 91

149 142 135 129 123 118 113 109 105 102 100 97 95

150 143 137 130 123 117 112 108 105 102 99

75 80 85 90 95 100 105 110

151 143 135 127 120 115 111 107 103

115

148 139 130 123 116 111 107

120

“Apparent Temperatures” (Heat Index)

= Extreme danger zone = Danger zone = Extreme caution zone = Caution zone = Safe

Find air temperature on the top; then find the humidity on the left. Find the heat index where the columns meet.

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Concept 3 ▶ Preparing for Physical Activity 51

• Avoid extreme fluid intake. Drinking too much water can cause a condition called hyponatremia , some- times referred to as “water intoxication.” It occurs when you drink too much water, resulting in the dilu- tion of the electrolytes in the blood; interestingly, it has symptoms similar to those of dehydration. If left untreated, it can result in loss of consciousness and even death.

• Gradually expose yourself to physical activity in hot and humid environments to facilitate acclimatization.

• Dress properly for exercise in the heat and humid- ity. Wear white or light colors that reflect rather than absorb heat. Select wickable clothes instead of cotton to aid evaporative cooling. Rubber, plastic, or other nonporous clothing is especially dangerous. A porous hat or cap can help when exercising in direct sunlight.

• Watch for signs of heat stress (see Table 3 ). If signs are present, stop immediately, get out of the heat, remove

Wind, cold, and altitude present some additional challenges for winter exercise.

Heat Index An index based on a combination of temperature and humidity that is used to determine if it is dangerous to perform physical activity in hot, humid weather (also called apparent temperature). Hyponatremia A condition caused by excess water intake, called “water intoxication,” that results in a dilution of electrolytes, leading to serious medical complications. Hypothermia Excessively low body temperature (less than 958F), characterized by uncontrollable shivering, loss of coordination, and mental confusion. Windchill Factor An index that uses air temperature and wind speed to determine the chilling effect of the environment on humans.

excess clothing, and drink cool water. Seek medical attention if symptoms progress. Consider cold water immersion for heat stroke.

Physical activity in exceptionally cold and windy

weather can be dangerous. Activity in the cold pre- sents the opposite problems as exercise in the heat. In the cold, the primary goal is to retain the body’s heat and avoid hypothermia and frostbite. Early signs of hypo- thermia include shivering and cold extremities caused by blood shunted to the body core to conserve heat. As the core temperature continues to drop, heart rate, res- piration, and reflexes are depressed. Subsequently, cog- nitive functions decrease, speech and movement become impaired, and bizarre behavior may occur. Frostbite results from water crystallizing in the tissues, causing cell destruction.

When doing activity in cold, wet, and windy

weather, precautions should be taken. A combina- tion of cold and wind (windchill) poses the greatest

danger for cold-related problems during exercise. Research conducted in Canada, in cooperation

with the U.S. National Weather Service, pro- duced tables for determining windchill factor

and the time of exposure necessary to get frostbite (see Figure 4 ). Consider the fol- lowing guidelines for performing physical activity in cold and wind:

• Limit or cancel activity if the windchill factor reaches the danger zone (see Figure 4 ).

• Dress properly. Wear light clothing in several layers rather than one heavy garment. The layer of clothing closest to the body should transfer (wick) moisture away from the skin to a second, more absorbent layer.

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52 Section 2 ▶ An Introduction to Physical Activity

Polypropylene and capilene are examples of wick- able fabrics. A porous windbreaker keeps wind from cooling the body and allows the release of body heat. The hands, feet, nose, and ears are most susceptible to frostbite, so they should be covered. Wear a hat or cap, mask, and mittens. Mittens are warmer than gloves. A light coating of petroleum jelly on exposed body parts can be helpful.

• Keep from getting wet in cold weather. If you get wet because of unavoidable circumstances, seek a warm place to dry off.

Physical Activity in Other Environments High altitude may limit performance and require

adaptation of normal physical activity. The ability to do vigorous physical tasks is diminished as altitude increases. Breathing rate and heart rates are more ele- vated at high altitude. With proper acclimation (gradual exposure), the body adjusts to the lower oxygen pres- sure found at high altitude, and performance improves. Nevertheless, performance ability at high altitudes, espe- cially for activities requiring cardiovascular fitness, is usu- ally less than would be expected at sea level. At extremely high altitudes, the ability to perform vigorous physical activity may be impossible without an extra oxygen sup- ply. When moving from sea level to a high altitude, vigor- ous exercise should be done with caution. Acclimation to high altitudes requires a minimum of 2 weeks and may

not be complete for several months. Care should be taken to drink adequate water at high altitude.

Exposure to air pollution should be limited. Various pollutants can cause poor performance and, in some cases, health problems. Ozone, a pollutant produced primarily by the sun’s reaction to car exhaust, can cause symptoms, including headache, coughing, and eye irritation. Similar symptoms result from exposure to carbon monoxide, a tasteless and odorless gas, caused by combustion of oil, gasoline, and/or cigarette smoke. Most news media in metropolitan areas now provide updates on ozone and carbon monoxide levels in their weather reports. When levels of these pollutants reach moderate levels, some people may need to modify their exercise. When levels are high, some may need to postpone exercise. Exercis- ers wishing to avoid ozone and carbon monoxide may want to exercise indoors early in the morning or later in the evening and avoid areas with a high concentration of traffic.

Plant pollens, dust, and other pollutants in the air may cause allergic reactions for certain people. Weather reports of pollens and particulates may help exercisers determine the best times for their activities and when to avoid vigorous activities.

Soreness and Injury Understanding soreness can help you persist in

physical activity and avoid problems. A common experience for many exercisers is a certain degree of muscle soreness that occurs 24–48 hours after intense

Actual Temperature

Reading (Degrees F)

Calm

Estimated Wind Speed (mph)

-10

-20

-30

-40

-10

-20

-30

-40

-11

-22

-34

-46

-57

-4

-16

-28

-41

-53

-66

-7

-19

-32

-45

-58

-71

-9

-22

-35

-48

-61

-74

-11

-24

-37

-51

-64

-78

-12

-26

-39

-53

-67

-80

-14

-27

-41

-55

-69

-82

-1

-15

-29

-43

-57

-71

-84

5 10 15 20 25 30 35 40

Minutes to

Frostbite

= Extreme Danger Zone= High Risk Zone= Risk Zone= Caution Zone

Figure 4 ▶ Windchill factor chart. Source: National Weather Service.

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Concept 3 ▶ Preparing for Physical Activity 53

exercise. This soreness, termed delayed-onset muscle soreness (DOMS) , typically occurs when muscles are exercised at levels beyond their normal use. Some peo- ple mistakenly believe that lactic acid is the cause of muscle soreness. Lactic acid (a by-product of anaerobic metabolism) is produced during vigorous exercise, but levels return to normal within 30 minutes after exercise, while DOMS occurs 24 hours after exercise. DOMS is caused by microscopic muscle tears that result from the excessive loads on the muscles. Soreness is not a normal part of the body’s response to exercise but occurs if an individual violates the principle of progression and does more exercise than the body is prepared for. While it may be uncomfortable to some, it has no long-term conse- quences and does not predispose one to muscle injury. To reduce the likelihood of DOMS, it is important to prog- ress your program gradually.

The most common injuries incurred in physical

activity are sprains and strains. A strain occurs when the fibers in a muscle are injured. Common activity- related injuries are hamstring strains that occur after a vigorous sprint. Other commonly strained muscles include the muscles in the front of the thigh, the low back, and the calf.

A sprain is an injury to a ligament—the connective tissue that connects bones to bones. The most common sprain is to the ankle; frequently, the ankle is rolled to the outside (inversion) when jumping or running. Other common sprains are to the knee, the shoulder, and the wrist.

Tendonitis is an inflammation of the tendon; it is most often a result of overuse rather than trauma. Tendonitis can be painful but often does not swell to the extent that sprains do. For this reason, elevation and compression are not as effective as ice and rest. A physician should be consulted for an appropriate diagnosis.

Being able to treat minor injuries will help reduce

their negative effects. Minor injuries, such as muscle strains and sprains, are common to those who are per- sistent in their exercise. If a serious injury should occur or if symptoms persist, it is important to get immedi- ate medical attention. However, for minor injuries, fol- lowing the RICE formula will help you reduce the pain and speed recovery. In this acronym, R stands for rest. Muscle sprains and strains heal best if the injured area is rested. Rest helps you avoid further damage to the muscle. I stands for ice. The quick application of cold (ice or ice water) to a minor injury minimizes swelling and speeds recovery. Cold should be applied to as large a surface area as possible (soaking is best). If ice is used, it should be wrapped to avoid direct contact with the skin. Apply cold for 20 minutes, three times a day, allowing 1 hour between applications. C stands for compression.

Wrapping or compressing the injured area also helps minimize swelling and speeds recovery. Elastic bandages or elastic socks are good for applying compression. Care should be taken to avoid wrapping an injury too tightly because this can result in loss of circulation to the area. E stands for elevation. Keep- ing the injured area elevated (above the level of the heart) is effective in minimizing swelling. If pain or swelling does not diminish after 24 to 48 hours, or if there is any doubt about the seriousness of an injury, seek medical help. Some experts recommend adding a P to RICE (PRICE) to indicate that prevention (P) is as important as treatment of injuries. Building strength and flexibility, warming up, beginning gradually when starting a new activity, and wearing protective equip- ment, such as lace-up ankle braces, are simple methods of prevention.

Taking over-the-counter pain remedies can help reduce the pain of muscle strains and sprains. Aspirin and ibuprofen (e.g., Excedrin, Motrin) have anti-inflam- matory properties. However, acetaminophen (e.g., Tyle- nol) does not. It may reduce the pain but will not reduce inflammation.

Muscle cramps can be relieved by statically

stretching a muscle. Muscle cramps are pains in the large muscles that result when the muscles contract vig- orously for a continued period of time. Muscle cramps are usually not considered to be an injury, but they are pain- ful and may seem like an injury. They are usually short in duration and can often be relieved with proper treatment. Cramps can result from lack of fluid replacement (dehy- dration), from fatigue, and from a blow directly to a mus- cle. Static stretching can help relieve some cramps. For example, the calf muscle, which often cramps among run- ners and other sports participants, can be relieved using the calf stretcher exercise, which is part of the warm-up in this concept.

Attitudes about Physical Activity Knowing the most common reasons for inactivity

can help you avoid sedentary living. Most people want to be active but find many barriers get in the way.

DOMS An acronym for delayed-onset muscle sore- ness, a common malady that follows relatively vigor- ous activity, especially among beginners. RICE An acronym for rest, ice, compression, and elevation; a method of treating minor injuries.

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54 Section 2 ▶ An Introduction to Physical Activity

The most common reasons given by people who do not do regular physical activity are listed in Table 4 . Experts consider many of these attitudes to be barriers that can be overcome. In fact, as men- tioned in Concept 2, a key self-management skill that predicts long-term behavior change is the ability to over- come barriers. The strategies in Table 4 can help inactive people become more active.

Knowing the reasons people give for being active

can help you adopt positive attitudes toward

activity. To enhance the promotion of physical activity in society, many researchers have sought to determine why some peo- ple choose to be active and others do not. The most common reasons for physical activity are highlighted in Table 5 . The table also offers strategies for changing behaviors.

Reason Description Strategy for Change

I don’t have the time. This is the number one reason people give for not exercising. Invariably, those who feel they don’t have time know they should do more exercise. They say they plan to do more in the future when “things are less hectic.” Young people say they will have more time to exercise in the future. Older people say they wish they had taken the time to be active when they were younger.

Planning a daily schedule can help you find the time for activity and avoid wasting time on things that are less important. Learning the facts in the concepts that follow will help you see the importance of activity and how you can include it in your schedule with a minimum of effort and with time efficiency.

It’s too inconvenient. Many who avoid physical activity do so because it is inconvenient. They say, “It takes too long to get to the gym” and “It makes me sweaty and messes up my hair.”

If you have to travel more than 10 minutes to do activity or if you do not have easy access to equipment, you will avoid activity. Locating facilities and finding a time when you can shower is important.

I just don’t enjoy it. Many do not find activity to be enjoyable or invigorating. These people may assume that all forms of activity have to be strenuous and fatiguing.

There are many activities to choose from. If you don’t enjoy vigorous activity, try more moderate forms of activity, such as walking.

I’m no good at

physical activity. “People might laugh at me,” “Sports make me nervous,” and “I am not good at physical activities” are reasons some people give for not being active. Some people lack confidence in their own abilities. This may be because of past experiences in physical education or sports.

With properly selected activities, even those who have never enjoyed exercise can get hooked. Building skills can help, as can changing your way of thinking. Avoiding comparisons with others can help you feel successful.

I am not fit, so I avoid

activity. Some people avoid exercise because of health reasons. Some who are unfit lack energy. Starting slowly can build fitness gradually and help you realize that you can do it.

There are good medical reasons for not doing activity, but many people with problems can benefit from exercise if it is properly designed. If necessary, get help adapting activity to meet your needs.

I have no place to be

active, especially in

bad weather.

Regular activity is more convenient if facilities are easy to reach and the weather is good. Opportunities have increased considerably in recent years. Some of the most popular activities require little equipment, can be done in or near home, and are inexpensive.

If you cannot find a place, if it is not safe, or if it is too expensive, consider using low-cost equipment at home, such as rubber bands or calisthenics. Lifestyle activity can be done by anyone at almost any time.

I am too old. As people grow older, many begin to feel that activity is something they cannot do. For most people, this is simply not true! Properly planned exercise for older adults is not only safe but also has many health benefits—e.g., longer life, fewer illnesses, an improved sense of well-being, and optimal functioning.

Older people who are just beginning activity should start slowly. Lifestyle activities are a good choice. Setting realistic goals can help, as can learning to do resistance training and flexibility exercises.

Table 4 ▶ Common Reasons People Give for Not Being Active

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Concept 3 ▶ Preparing for Physical Activity 55

Reason Description Strategy for Change

I do activity for my

health, wellness,

and fitness.

Surveys show this is the number one reason for doing regular physical activity. Unfortunately, many adults say that a “doctor’s order to exercise” would be the most likely reason to get them to begin a program. For some, however, waiting for a doctor’s order may be too late.

Gaining information contained in this book will help you see the value of regular physical activity. Performing the self-assessments in the various concepts will help you determine the areas in which you need personal improvement.

I do activity to

improve my

appearance.

In our society, looking good is highly valued; thus, physical attractiveness is a major reason people participate in regular exercise. Regular activity can contribute to looking your best.

Setting realistic goals and avoiding comparisons with others can help you be more successful.

I do activity

because I enjoy it.

A majority of adults say that enjoyment is of paramount importance in deciding to be active. Statements include the “peak experience,” the “runner’s high,” or “spinning free.” The sense of fun, well-being, and general enjoyment associated with physical activity is well documented.

People who do not enjoy activity often lack performance skills or feel that they are not competent in activity. Improving skills with practice, setting realistic goals, and adopting a new way of thinking can help you be successful and enjoy activities.

I do activity because

it relaxes me.

Relaxation and release from tension rank high as reasons people do regular activity. It is known that activity in the form of sports and games provides a catharsis, or outlet, for the frustrations of daily activities. Regular exercise can help reduce depression and anxiety.

Activities such as walking, jogging, or cycling are ways of getting some quiet time away from the job or the stresses of daily living. In a later concept, you will learn about exercises that you can do to reduce stress.

I like the challenge

and sense

of personal

accomplishment I

get from physical

activity.

A sense of personal accomplishment is frequently a reason for people doing activity. In some cases, it is learning a new skill, such as racquetball or tennis; in other cases, it is running a mile or doing a certain number of crunches. The challenge of doing something you have never done before is apparently a powerful experience.

Taking lessons to learn skills or attempting activities new to you can provide the challenge that makes activity interesting. Also, adopting a new way of thinking allows you to focus on the task rather than on competition with others.

I like the social

involvement I get

from physical

activities.

Physical activity can have social benefits. People say, “It is a good way to spend time with members of my family.” “It is a good way to spend time with close friends.” “Being part of the team is satisfying.” Activity settings can also provide an opportunity for making new friends.

If you find activity to be socially unrewarding, you may have to find activities that you, your family, or your friends enjoy. Taking lessons together can help. Also, finding a friend with similar skills can help. Focus on the activity rather than the outcome.

Competition is the

main reason I enjoy

physical activity.

“The thrill of victory” and “sports competition” are two reasons given for being active. For many, the competitive experience is very satisfying.

Some people simply do not enjoy competing. If this is the case for you, select noncompetitive individual activities.

Physical activity

helps me feel good

about myself.

For many people, participation in physical activity is an important part of their identity. They feel better about themselves when they are regularly participating.

Physical activity is something that is self-determined and within your control. Participation can help you feel good about yourself, build your confidence, and increase your self-esteem.

Physical activity

provides

opportunities to get

fresh air.

Being outside and experiencing nature are reasons that some people give for being physically active.

Many activities provide opportunities to be outside. If this is an important reason for you, seek out parks and outdoor settings for your activities.

Table 5 ▶ Common Reasons for Doing Regular Physical Activity

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56 Section 2 ▶ An Introduction to Physical Activity

Web Resources American College of Sports Medicine (ACSM) Position

Statements www.acsm.org/access-public-information/ position-stands

• Exercise and Acute Cardiovascular Events

• Exertional Heat Illness during Training and Competition

• Exercise and Fluid Replacement

• Prevention of Cold Injuries during Exercise

ACSM’s Fit Society Page www.acsm.org/access-public- information/newsletters/fit-society-page

ACSM’s Health and Fitness Journal www.acsm.org/access- public-information/acsm-journals/acsm’s-health-

fitness-journal

American Red Cross (AED information) www.redcross.org

National Physical Activity Plan Public health experts realize that compre- hensive efforts are needed to increase par-

ticipation in physical activity in society. The Centers for Disease Control and Prevention (CDC) led efforts to create a National Physical Activity Plan to provide a framework for coordinated action (www.physicalactivityplan.org). The plan includes specific strategies for how activity can be promoted through different settings (business, education, health care, mass media, parks/recreation, public health, transportation, and nonprofits). Each sector presents strategies aimed at

promoting physical activity. Each strategy also outlines spe- cific tactics that communities, organizations and agencies, and individuals can use to address the strategy. Separate strategies for promoting physical activity are provided for each sector. Recommendations are also provided to help communities, organizations, agencies, and individuals apply these strategies.

Does this type of coordinated effort help increase participation in

physical activity? Why or why not?

ACTIVITY

In the News

Strategies for Action

Screening for risks can help make

activity safer. Athletes in competi- tive sports often undergo pre-participation physical examina- tions to screen for potential cardiac arrhythmias or conditions known to increase risks during exercise. Recreational athletes may not take the same precautions. The best advice is to get a physical prior to beginning serious training. This is especially critical if you have a family history of heart problems. Lab 3A will help you determine if you should consult a physician.

A proper warm-up can prepare your body for activity

and a gradual cool-down can improve recovery. Lab 3B

provides a sample flexibility-based warm-up and cool-down routine that may be helpful. Determine what works best for your needs.

Assess your attitudes concerning physical activity. Active people generally have more positive attitudes than negative ones. This is referred to as a “positive balance of attitudes.” The questionnaire in Lab 3C gives you the opportunity to assess your balance of attitudes. If you have a “nega- tive balance” score, you can analyze your attitudes and determine how you can change them to view activity more favorably.

ACTIVITY

Med Watch www.fda.gov/medwatch National Athletic Trainers Association www.nata.org WebMD www.webmd.com

Suggested Readings ACSM. 2010. ACSM’s Guidelines for Exercise Testing and Prescrip-

tion. 8th ed. Philadelphia: Lippincott, Williams & Wilkins. ACSM. 2010. ACSM’s Resource Manual for Guidelines for Exer-

cise Testing and Prescription. 6th ed. Philadelphia: Lippincott, Williams & Wilkins.

Barwood, M. J., Thelwell, R. C., and M. J. Tipton. 2008. Psycho- logical skills training improves exercise performance in the heat. Medicine and Science in Sports and Exercise 40(2):387–396.

Bernardot, D. 2007. Timing of energy and fluid intake. ACSM’s Health and Fitness Journal 11(4):13–19.

N P h

tive sports often underg

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Concept 3 ▶ Preparing for Physical Activity 57

Lowry, R., et al. 2007. Physical activity–related injury and body mass index among U.S. high school students. Journal of Physical Activity and Health 4(3):225–342.

Perberdy, M. A., and J. P. Ornato. 2008. Progress in resuscita- tion: An evolution, not a revolution. Journal of the American Medical Asssociation 299(10):1188–1190.

Rea, T. D., et al. 2010. CPR with chest compression alone or with rescue breathing. New England Journal of Medicine 363(5):423–433.

Stover, B., and B. Murray. 2007. Drink up: Science of hydra- tion. ACSM’s Health and Fitness Journal 11(3):7–12.

Walter, T., et al. 2011. Active movement warm-up routines. Journal of Physical Education Recreation and Dance 82(3):23–31.

Young, S. 2010. From static stretching to dynamic exercise: Changing the warm-up paradigm. Strategies 24(1):13–17.

• Reduce sports and recreation injuries.

• Reduce injuries from overexertion.

• Reduce emergency department visits for nonfatal injuries.

• Increase the proportion of public and private schools that require students to wear appropriate protective gear when engaged in school-sponsored physical activities.

• Increase health literacy of the population.

A national goal is to reduce sports and recreational injuries, as well

as injuries from overexertion. Explain how using the information

related to preparing for exercise can help you and others contribute

to meeting this national goal.

ACTIVITY

Carlson, M. 2012. Exercising in the cold. ACSM’s Health and Fitness Journal. 16(1):8–12.

Fradkin, A., et al. 2009. Warm-up and physical performance: What is the relationship? A systematic review with meta analysis (abstract). Medicine and Science in Sports and Exercise 41(5 Supplement):151–152.

Henschke, N., and C. C. Lin. 2011. Stretching before or after exercise does not reduce delayed-onset muscle soreness. British Journal of Sports Medicine 45:1249–1250 .

Herbert, R. D., de Noronha, M., and S. J . Kamper. 2011. Stretching to prevent or reduce muscle soreness after exer- cise. Cochrane Database Systematic Reviews 7:CD0045771 .

Kay, A. D., and A. J. Blazevich. 2011. Effect of acute static stretch on maximal muscle performance: A systematic review. Medicine and Science in Sports and Exercise 44(1):154–164.

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Lab 3A Readiness for Physical Activity

Name Section Date

Purpose: To help you determine your physical readiness for participation in a program of regular exercise

Procedures

1. Read the directions on the “PAR-Q & You” on page 60. 2. Answer each of the seven questions on the form. 3. If you answered “yes” to one or more of the questions, follow the directions just below the PAR-Q questions

regarding medical consultation. 4. If you answered “no” to all seven questions, follow the directions at the lower left-hand corner of the PAR-Q. 5. Answer the five questions about physical readiness for sports or vigorous training in Chart 1 below. 6. Record your scores below and answer the question in the Conclusions and Implications section.

Results

Determine your PAR-Q score. Place an X over the circle that includes the number of “yes” answers that you had for the PAR-Q (see page 60).

0 1 2 3 4 5 6 7

Determine your readiness for sports or rigorous training (see Chart 1 above). Place an X over the number of “yes” answers that you had for the Physical Readiness for Sports or Vigorous Training chart.

0 1 2 3 4 5

Conclusions and Implications: In several sentences, discuss your readiness for physical activity. Base your com- ments on your questionnaire results and the types of physical activities you plan to perform in the future.

Answer the PAR-Q before using this chart. If your answer to any of these questions is “yes,” you should consult with your personal physician by telephone or in person to determine if you have a potential problem with sports or vigorous training.

Yes No

1. Do you plan to participate on an organized team that will play intense competitive sports (e.g., varsity team, professional team)?

2. If you plan to participate in a collision sport (even on a less organized basis), such as football, boxing, rugby, or ice hockey, have you been knocked unconscious more than one time?

3. Do you currently have symptoms from a previous muscle injury?

4. Do you currently have symptoms from a previous back injury, or do you experience back pain as a result of involvement in physical activity?

5. Do you have any other symptoms during physical activity that give you reason to be concerned about your health?

Chart 1 Physical Readiness for Sports or Vigorous Training

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Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are between the ages of fifteen and sixty-nine, the PAR-Q will tell you if you should check with your doctor before you start. If you are over sixty-nine years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly: check YES or NO.

DELAY BECOMING MUCH MORE ACTIVE: • If you are not feeling well because of a temporary illness, such as a cold or a fever—wait until you feel better or • If you are or may be pregnant—talk to your doctor before you start becoming more active.

Please note: If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan.

Produced by the British Columbia Ministry of Health and the Department of National Health & Welfare

*Developed by the British Columbia Ministry of Health. Physical Activity Readiness Questionnaire • PAR-Q (revised 2002)

You are encouraged to copy the PAR-Q but only if you use the entire form

If you

answered

• Start becoming much more physically active—begin slowly and build up gradually. This is the safest and easiest way to go. • Take part in a fitness appraisal—this is an excellent way to determine your basic fitness so that you can plan the best way for you to live actively.

NO to all questions

YES NO

YES to one or more questions

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES.

• You may be able to do any activity you want—as long as you start slowly and build up gradually. Or you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his or her advice.

• Find out which community programs are safe and helpful for you.

Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire, consult your doctor prior to physical activity.

If you answered NO honestly to all PAR-Q questions, you can be reasonably sure that you can

1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?

2. Do you feel pain in your chest when you do physical activity?

3. In the past month, have you had chest pain when you were not doing physical activity?

4. Do you lose your balance because of dizziness or do you ever lose consciousness?

5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?

6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?

7. Do you know of any other reason you should not do physical activity?

Yes

Note: It is important that you answer all questions honestly. The PAR-Q is a scientifically and medically researched pre- exercise selection device. It complements exercise programs, exercise testing procedures, and the liability considerations attendant with such programs and testing procedures. PAR-Q, like any other pre-exercise screening device, will misclassify a small percentage of prospective participants, but no pre-exercise screening method can entirely avoid this problem.

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Lab 3B The Stretch Warm-Up and Cool-Down

Name Section Date

Purpose: To familiarize you with a sample group of stretch warm-up and cool-down exercises

Procedures

1. Perform a 2- to 5-minute cardiovascular warm-up (walk, jog, slow jump rope, swim). 2. Perform the exercises in Chart 1 on page 62, including the alternative exercises, three times each. Hold the stretch

for 15 to 30 seconds. 3. Complete the Results section below and answer the questions in the Conclusions and Implications section.

Results: In the following, put an X over the circle that represents the amount of tightness you felt when performing each of the stretching warm-up and cool-down exercises. Tightness indicates that you may have shortness of a spe- cifi c muscle group and that stretching exercises at times other than the warm-up or cool-down are needed.

Amount of Tightness

None Moderate Severe

Calf stretch

Hamstring stretch

Leg hug

Seated side stretch

Zipper

Alternative Exercises

Side stretch

Hip and thigh stretch

One-leg stretch

Conclusions and Implications: The general cardiovascular warm-up is recommended for all people. In addition, you may want to consider a stretch warm-up and stretch cool-down (as shown in this lab), or a dynamic or sport-specifi c warm-up option. In several sentences, discuss your experiences with the warm-up/cool-down and what you would plan to use in the future.

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The exercises shown here can be used before a workout as a warm-up or after a workout as a cool-down. Perform these exercises slowly, preferably after completing a cardiovascular warm-up. Do not bounce. Hold each stretch for at least 15–30 seconds. Perform each exercise at least once and up to three times. Other stretching exercises are presented in the concept on flexibility, and they can be used in a warm-up or cool-down.

Cardiovascular Warm-Up

Before you perform a vigorous workout, walk or jog slowly for 2 minutes or more. After exercise, do the same. Do this portion of the warm-up prior to muscle stretching.

Calf Stretch

This exercise stretches the calf muscles (gastrocnemius and soleus). Face a wall with your feet 2 or 3 feet away. Step forward on your left foot to allow both hands to touch the wall. Keep the heel of your right foot on the ground, toe turned in slightly, knee straight, and buttocks tucked in. Lean forward by bending your front knee and arms and allowing your head to move nearer the wall. Hold. Repeat with the other leg.

Hamstring Stretch

This exercise stretches the muscles of the back of the upper leg (hamstrings) as well as those of the hip, knee, and ankle. Lie on your back. Bring the right knee to your chest and grasp the toes with the right hand. Place the left hand on the back of the right thigh. Pull the knee toward the chest, push the heel toward the ceiling, and pull the toes toward the shin. Attempt to straighten the knee. Stretch and hold. Repeat with the other leg.

Leg Hug

This exercise stretches the hip and back extensor muscles. Lie on your back. Bend one leg and grasp your thigh under the knee. Hug it to your chest. Keep the other leg straight and on the floor. Hold. Repeat with the opposite leg.

Seated Side Stretch

This exercise stretches the muscles of the trunk. Begin in a seated position with the legs crossed. Stretch the left arm over the head to the right. Bend at the waist (to right), reaching as far as possible to the left with the right arm. Hold. Do not let the trunk rotate. Repeat to the opposite side. For less stretch, the overhead arm may be bent. This exercise can be done in the standing position but is less effective.

Zipper

This exercise stretches the muscle on the back of the arm (triceps) and the lower chest muscles (pecs). Lift the right arm and reach behind the head and down the spine (as if pulling up a zipper). With the left hand, push down on the right elbow and hold. Reverse arm position and repeat.

ALTERNATE EXERCISES

Because of location (wet or hard surface), you may choose to substitute exercises that do not require you to lie down. The side stretch (standing) can be substituted for the seated side stretch, the hip and thigh stretch for the leg hug (does not stretch the same muscles), and the one-leg stretch (standing) for the hamstring stretch.

Side Stretch

This exercise stretches the trunk lateral flexors. Stand with feet shoulder-width apart. Stretch left arm overhead to right. Bend to right at waist reaching as far as possible with left arm; reach as far as possible with right arm. Hold. Do not let trunk rotate or lower back arch. Repeat on opposite side. Note: This exercise is made more effective if a weight is held down at the side in the hand opposite the side being stretched. More stretch will occur if the hip on the stretched side is dropped and most of the weight is borne by the opposite foot.

One-Leg Stretch

This exercise stretches the lower back muscles. Stand with one foot on a bench, keeping both legs straight. Contract the hamstrings and gluteals by pressing down on bench with the heel for three seconds; then relax and bend the trunk forward, toward the knee. Hold for 10–15 seconds. Return to starting position and repeat with opposite leg. As flexibility improves, the arms can be used to pull the chest toward the legs. Do not allow either knee to lock. This exercise is useful in relief of backache and correction of swayback.

Hip and Thigh Stretch

This exercise stretches the hip (iliopsoas) and thigh muscles (quadriceps) and is useful for people with lordosis and back problems. Place right knee directly above right ankle and stretch left leg backward so knee touches floor. If necessary, place hands on floor for balance. 1. Tilt the pelvis backward by tucking in

the abdomen and flattening the back. 2. Then shift the weight forward until a

stretch is felt on the front of the thigh: hold. Repeat on opposite side. Caution: Do not bend front knee more than 90 degrees.

1 2

Chart 1 Sample warm-up and cool-down exercises

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Lab 3C Physical Activity Attitude Questionnaire

Name Section Date

Purpose: To evaluate your feelings about physical activity and to determine the specifi c reasons you do or do not participate in regular physical activity

Directions: The term physical activity in the following statements refers to all kinds of activities, including sports, for- mal exercises, and informal activities, such as jogging and cycling. Make an X over the circle that best represents your answer to each question.

Strongly Strongly Item Attitude Disagree Disagree Undecided Agree Agree Score Score

1. I should do physical activity regularly for my

health.

2. Doing regular physical activity is good for

my fitness and wellness.

3. Regular exercise helps me look my

best.

4. I feel more physically attractive when I do

regular physical activity.

5. One of the main reasons I do regular physi-

cal activity is that it is fun.

6. The most enjoyable part of my day is when I

am exercising or doing a sport.

7. Taking part in physical activity helps me

relax.

8. Physical activity helps me get away from the

pressures of daily living.

9. The challenge of physical training is one

reason I do physical activity.

10. I like to see if I can master sports and activi-

ties that are new to me.

11. I like to do physical activity that involves

other people.

12. Exercise offers me the opportunity to meet

other people.

13. Competition is a good way to make physical

activity fun.

14. I like to see how my physical abilities com-

pare with those of others.

15. When I do regular exercise, I feel better than

when I don’t.

16. My ability to do physical activity is some-

thing that makes me proud.

17. I like to do outdoor activities.

18. Experiencing nature is something I look

forward to when exercising.

1 Health and

Fitness Score

Outdoor Score

432

1 5

Feeling Good Score+

Competition Score+

Social Score+

Challenge Score+

Relaxation Score+

Enjoyment Score+

Appearance Score+

=1 5

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Procedures

1. Read and answer each question in the questionnaire. 2. Write the number in the circle of your answer in the box labeled “Item Score.” 3. Add scores for each pair of scores and record in the “Attitude Score” box. 4. Record each attitude score and a rating for each score (use Rating Chart) in the chart below. 5. Record the number of good and excellent scores in the box provided. Use the score in the box to determine your

rating using the Balance of Feelings Rating Chart.

Results: Record your results as indicated in the Procedures section.

How many good or excellent scores do you have?

Having 5 or more in the box above indicates that you have a positive balance of feelings (more positive than negative attitudes).

Balance of

Feeling Score

In a few sentences, discuss your “balance of feelings” rating. Having more positive than negative scores (positive balance of feelings) increases the probability of being active. Include comments on whether you think your ratings suggest that you will be active or inactive and whether your ratings are really indicative of your feelings. Do you think that the scores on which you were rated poor or very poor might be reasons you would avoid physical activity? Explain.

Attitude Score Rating

Health and fitness

Appearance

Enjoyment

Relaxation

Challenge

Social

Competition

Feeling good

Outdoor

Physical Activity Attitude Questionnaire Results

Rating Category Attitude Score

Excellent 9–10

Good 7–8

Fair 5–6

Poor 3–4

Very poor 2

Attitude Rating Chart

Excellent 6–9

Good 5

Fair 4

Poor 2–3

Very poor 0–1

Balance of Feelings Rating Chart

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6565

The Health Benefits of Physical Activity

LEARNING OBJECTIVES

After completing the study of this concept, you will be able to:

▶ Define the term hypokinetic and explain how physical activity can reduce risk of hypokinetic diseases and conditions.

▶ Identify several cardiovascular diseases/conditions associated with physical inactivity and explain how physical activity can help to reduce risk.

▶ Describe metabolic syndrome and explain how physical activity can help to reduce risk of this hypokinetic condition.

▶ Describe additional hypokinetic conditions and explain how physical activity can help reduce risk of them.

▶ Explain the role of physical activity in preventing conditions associated with aging. ▶ Explain the role of physical activity in promoting optimal wellness. ▶ Present an overview of the health and wellness benefits of physical activity and fitness.

▶ Identify related national health goals and show how meeting personal goals can contribute to reaching national goals.

▶ Assess your heart disease risk factors.

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Physical activity and good

physical fitness can reduce the

risk of illness and contribute to

optimal health and wellness.

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66 Section 2 ▶ An Introduction to Physical Activity

Second, physical activity and fitness can be significant contributors to disease/illness treatment. Even with the best disease prevention practices, some people will become ill. Regular exercise and good fitness have been shown to be effective in alleviating symptoms and aiding rehabilita- tion after illness for such hypokinetic conditions as diabe- tes, heart disease, and back pain.

Finally, physical activity and fitness contribute to qual- ity of life and wellness, the positive component of good health. In the process, they aid in meeting many other national health goals.

Too many adults suffer from hypokinetic disease,

and the economic cost is high. In 1961, Kraus and Raab coined the term hypokinetic disease to describe health problems associated with lack of physical activity. They showed how sedentary living, or as they called it, “take it easy” living, contributes to the leading killer diseases in our society.

A public advocacy group coined the term sedentary death syndrome (SeDS) to describe inactive living and associated hypokinetic disease risk factors. They indicate that SeDS is responsible for the epidemic of chronic dis- ease in our society and resulting increases in health costs. In the next few years, expenditures for health care are expected to account for one-fifth of all spending in the United States.

Regular physical activity over a lifetime may

overcome the effects of inherited risk. People with a family history of disease may believe they can do noth- ing because their heredity works against them. There is no doubt that heredity significantly affects risk for early death from hypokinetic diseases. New studies of twins, however, suggest that active people are less likely to die early than inactive people with similar genes. This sug- gests that long-term adherence to physical activity can overcome other risk factors, such as heredity.

T he landmark Surgeon General’s Report on Physical Activity and Health informed the general public of

the risks of sedentary living and the health benefits of physical activity. Since that document was pub- lished, even more evidence has accumulated support- ing the benefits of an active lifestyle. The first chapter of ACSM’s Guidelines for Exercise Testing and Prescrip- tion and Chapter 2 of the 2008 Physical Activity Guide- lines for Americans are devoted to the benefits and risks associated with physical activity. Both Healthy People 2020 and Achieving Health for All (Canada) highlight the importance of regular physical activity for improv- ing population health in the 21st century. This con- cept summarizes the health benefits of regular physical activity and good fitness.

Physical Activity and Hypokinetic Diseases Regular physical activity and good fitness can

promote good health, help prevent disease, and

be a part of disease treatment. There are three major ways in which regular physical activity and good fitness can contribute to optimal health and wellness. First, they can aid in disease/illness prevention. There is considerable evidence that the risk of hypokinetic diseases or conditions can be greatly reduced among people who do regular physical activity and achieve good physical fitness. Virtually all chronic diseases that plague society are considered to be hypokinetic, though some relate more to inactivity than others. Nearly three- quarters of all deaths among those 18 and older are a result of chronic diseases. Leading public health officials have suggested that physical activity may offer the most promising public health solution to control chronic dis- eases, much as immunization controls infectious diseases.

A government report by the Surgeon Gen- eral’s Office (The Surgeon General’s Vision

for a Healthy and Fit Nation) emphasizes the importance of healthy lifestyles for improving our nation’s health. The report specifically focuses on “helping Americans lead healthier lives through better nutrition and regular physical activity.” Combating overweight and obesity through healthy choices is the major goal. The report emphasizes that the current

epidemic of overweight and obesity threatens the historic progress we have made in increasing the quality and years of healthy life in Americans. Projections suggest that if trends continue, the current generation will have a shorter lifespan (on average) than their parents.

Does this projected outcome surprise you? What needs to happen

to reverse this trend?

The Surgeon General’s Vision for a Healthy and Fit Nation

ACTIVITY

In the News

A e

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Concept 4 ▶ The Health Benefits of Physical Activity 67

Physical Activity and Cardiovascular Diseases The various types of cardiovascular disease are

the leading killers in automated societies. There are many forms of cardiovascular disease (CVD). Some are classified as coronary heart disease (CHD) because they affect the heart muscle and the blood vessels that supply the heart. Coronary occlusion (heart attack) is a type of CHD. Atherosclerosis and arteriosclerosis are two conditions that increase risk for heart attack and are considered to be types of CHD. Angina pectoris (chest or arm pain), which occurs when the oxygen sup- ply to the heart muscle is diminished, is sometimes consid- ered to be a type of CHD, though it is really a symptom of poor circulation.

Hypertension (high blood pressure), stroke (brain attack), peripheral vascular disease, and congestive heart failure are other forms of CVD. Inactivity relates in some way to each of these types of disease.

In the United States, CVD accounts for more than 34 percent of all deaths. More than 81 million people currently have one or more forms of CVD. Men are more likely to suffer from heart disease than women, although the differences have narrowed in recent years. African American, Hispanic, and Native American populations are at higher than normal risk. Heart disease and stroke death rates are similar in the United States, Canada, Great Britain, Australia, and other automated societies.

There is a wealth of statistical evidence that

physical inactivity is a primary risk factor for CHD.

Much of the research relating inactivity to heart disease has come from occupational studies that show a high incidence of heart disease in people involved only in sedentary work. There are limitations in some of these studies but they collectively present convincing evi- dence that the inactive individual has an increased risk for coronary heart disease. A study summarizing all of the important occupational studies shows a 90 percent reduced risk for coronary heart disease for those in active versus inactive occupations.

The American Heart Association, after carefully examining the research literature, elevated seden- tary living from a secondary to a primary risk factor, comparable to high blood pressure, high blood cho- lesterol, obesity, and cigarette smoke. The reason for this change is that inactivity increases risk in multiple ways and large numbers of adults are sedentary and vulnerable to these risks. The Surgeon General’s Report

on Physical Activity and Health concluded that “physical inactivity is causally linked to atherosclerosis and coro- nary heart disease.”

Hypokinetic Diseases or Conditions Hypo- means “under” or “too little” and kinetic means “movement” or “activity.” Thus, hypokinetic means “too little activity.” A hypokinetic disease or condition is associated with lack of physical activity or too little regular exercise. Exam- ples include heart disease, low back pain, and Type II diabetes. Chronic Diseases Diseases or illnesses associated with lifestyle or environmental factors, as opposed to infectious diseases; hypokinetic diseases are consid- ered to be chronic diseases. Sedentary Death Syndrome (SeDS) A group of symptoms associated with sedentary living, including low health-related fitness (low cardiovascular fitness and weak muscles), low bone density, and the pres- ence of metabolic syndrome (poor metabolic fitness). Cardiovascular Disease (CVD) A broad clas- sification of diseases of the heart and blood vessels that includes CHD, high blood pressure, stroke, and peripheral vascular disease. Coronary Heart Disease (CHD) Diseases of the heart muscle and the blood vessels that supply it with oxygen, including heart attack. Coronary Occlusion The blocking of the coronary blood vessels; sometimes called heart attack. Atherosclerosis The deposition of materials along the arterial walls; a type of arteriosclerosis. Arteriosclerosis Hardening of the arteries due to conditions that cause the arterial walls to become thick, hard, and nonelastic. Angina Pectoris Chest or arm pain resulting from reduced oxygen supply to the heart muscle. Hypertension High blood pressure; excessive pres- sure against the walls of the arteries that can damage the heart, kidneys, and other organs of the body. Stroke A condition in which the brain, or part of the brain, receives insufficient oxygen as a result of diminished blood supply; sometimes called apoplexy or cerebrovascular accident (CVA). Peripheral Vascular Disease A lack of oxygen supply to the working muscles and tissues of the arms and legs, resulting from decreased blood flow. Congestive Heart Failure The inability of the heart muscle to pump the blood at a life-sustaining rate.

VIDEO 1

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68 Section 2 ▶ An Introduction to Physical Activity

Physical Activity and the Healthy Heart Regular exercise increases the heart muscle’s

ability to pump oxygen-rich blood. A fit heart muscle can handle extra demands placed on it. Through regular exercise, the heart muscle gets stronger, contracts more forcefully, and therefore pumps more blood with each beat. The heart is just like any other muscle—it must be exercised regularly to stay fit. The fit heart also has open, clear arteries free of atherosclerosis (see Figure 1 ).

The “normal” resting heart rate is said to be 72 beats per minute (bpm). However, resting rates of 50 to 85 bpm are common. People who regularly do physical activity typi- cally have lower resting heart rates than people who do no regular activity. Some endurance athletes have heart rates in the 30 and 40 bpm range, which is considered healthy or normal. Although resting heart rate is not considered to be a good measure of health or fitness, decreases in individual heart rate following training reflect positive adaptations. Low heart rates in response to a stan- dard amount of physical activity are a good indicator of fitness. The bicycle and step tests presented later in this book use your heart rate response to a standard amount of exercise to estimate your cardiovascular fitness.

Physical Activity and Atherosclerosis Atherosclerosis, which begins early in life, is

implicated in many cardiovascular diseases.

Atherosclerosis is a condition that contributes to heart attack, stroke, hypertension, angina pectoris, and peripheral

vascular disease. Deposits on the walls of arteries restrict blood flow and oxygen supply to the tissues. Atheroscle- rosis of the coronary arteries, the vessels that supply the heart muscle with oxygen, is particularly harmful. If these arteries become narrowed, the blood supply to the heart muscle is diminished, and angina pectoris may occur. Ath- erosclerosis increases the risk of heart attack because a fibrous clot is more likely to obstruct a narrowed artery than a healthy, open one.

Current theory suggests that atherosclerosis begins when damage occurs to the cells of the inner wall, or endothelium, of the artery (see Figure 2 ). Substances associated with blood clotting are attracted to the dam- aged area. These substances seem to cause the migra- tion of smooth muscle cells, commonly found only in the middle wall of the artery (media), to the endothelium. In the later stages, fats (including cholesterol) and other substances are thought to be deposited, forming plaques, or protrusions, that diminish the internal diameter of the artery. This process was once thought to occur later in life but research indicates that the first signs of athero- sclerosis begin in early childhood.

Regular physical activity can help prevent

atherosclerosis by lowering blood lipid levels.

There are several kinds of lipids (fats) in the bloodstream, including lipoproteins, phospholipids, triglycerides, and cholesterol. Cholesterol is the most well known, but it is not the only culprit. Many blood fats are manufactured by the body itself, whereas others are ingested in high- fat foods, particularly saturated fats (fats that are solid at room temperature).

As noted earlier, blood lipids are thought to con- tribute to the development of atherosclerotic deposits on the inner walls of the artery. One substance, called

Figure 1 ▶ The fit heart muscle.

Open, healthy coronary arteries

Strong, thick heart muscle

VIDEO 2

Figure 2 ▶ Atherosclerosis.

Cholesterol crystals

Fat

Damaged area

Endothelium

Smooth muscle cells

Media

Intima

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Concept 4 ▶ The Health Benefits of Physical Activity 69

low-density lipoprotein (LDL) , is a major contributor to the development of atherosclerosis. LDL is basically a core of cholesterol surrounded by protein and another substance that makes it water soluble. The benefit of regular exercise is that it can reduce blood lipid levels, including LDL-C (the cholesterol core of LDL). People with high total cholesterol and LDL levels have a higher than normal risk for heart disease (see Table 1 ). New evi- dence indicates that there are subtypes of LDL choles- terol (characterized by their small size and high density) that pose even greater risks. These subtypes are hard to measure and not included in most current blood tests, but future research will no doubt help us better understand and measure them.

Triglycerides are another type of blood lipid. Elevated levels of triglycerides are related to heart disease. Triglyc- erides lose some of their ability to predict heart disease with the presence of other risk factors, so high levels are more difficult to interpret than other blood lipids. Normal levels are considered to be 150 mg/dL or less. Values of 151 to 199 are borderline, 200 to 499 are high, and above 500 are very high. It would be wise to include triglycer- ides in a blood lipid profile. Physical activity is often pre- scribed as part of a treatment for high triglyceride levels.

Regular physical activity can help prevent

atherosclerosis by increasing HDL in the blood. Whereas LDLs carry a core of cholesterol that is involved in the development of atherosclerosis, high- density lipoprotein (HDL) picks up cholesterol and carries it to the liver, where it is eliminated from the body. HDL is often called the “good cholesterol” and is desirable. When having a blood test, ask for informa- tion about HDL as well as the other measures included in Table 1 . Individuals who have regular physical activ- ity usually have lower total cholesterol, lower LDL, and higher HDL levels than inactive people.

Regular physical activity can help prevent

atherosclerosis by reducing blood coagulants. Fibrin and platelets (types of cells involved in blood coagulation) deposit at the site of an injury on the wall of the artery, contributing to the process of plaque buildup, or atherosclerosis. Regular physical activity has been shown to reduce fibrin levels in the blood. The breakdown of fibrin seems to reduce platelet adhesive- ness and the concentration of platelets in the blood.

Other indicators of inflammation of the arteries are

predictive of atherosclerosis. Recently, a number of other constituents in the blood have been shown to be associated with risk for cardiovascular disease. Among these are indicators of inflammation inside the arteries, such as C-reactive protein (CRP), interleukin-6 (IL-6), Chlamydia pneumonia heat shock protein (Cp-HSP60), and tumor necrosis factor-a (TNF-a). These compounds are not necessarily causes of atherosclerosis, but they are indicators of inflammatory processes that lead to plaque formation. Inflammatory processes also soften existing plaque and increase the likelihood of plaque rupture or the formation of clots, which can directly precipitate heart attacks.

The inner wall of the artery (endothelium) was once thought to be a relatively passive layer of tissue that merely lines the artery. However, recent evidence sug- gests that it is an active layer of tissue that functions in several ways in addition to providing a protective bar- rier. For example, sensing units in the endothelium stimulate production of agents that regulate blood flow by dilating and constricting the artery. The released substances can help prevent the buildup of deposits on the arterial wall. However, when the inner wall of the artery ceases to function effectively, it increases the risk of plaque buildup.

CRP is one of the most studied indicators of a dysfunc- tional endothelium. Screening for elevated levels of CRP is now commonly done to identify patients that may be at risk

Lipids All fats and fatty substances. Lipoproteins Fat-carrying proteins in the blood. Low-Density Lipoprotein (LDL) A core of choles- terol surrounded by protein; the core is often called “bad cholesterol.” Triglycerides A type of blood fat associated with increased risk for heart disease. High-Density Lipoprotein (HDL) A blood sub- stance that picks up cholesterol and helps remove it from the body; often called “good cholesterol.” Fibrin A sticky, threadlike substance that, in combi- nation with blood cells, forms a blood clot.

Total (TC) LDL-C HDL-C TC/HDL-C

Optimal ——— <100 ———

Near optimal ——— 100–129 ——— ———

Desirable <200 ——— 60+ ———

Borderline 200–239 130–159 40–59 3.6–5.0

High risk 240+ 160–189 <40 5.0+

Very high risk ——— >190 ——— ———

Source: Third Report of the National Cholesterol Education Program. *Different classification systems are used for each of the four measures (two

to five categories). Blank ( ---) spaces are included for categories not used for

each measure.

Table 1 ▶ Cholesterol Classifications (mg/dL)*

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70 Section 2 ▶ An Introduction to Physical Activity

People who perform regular physical activity have half the risk for a first heart attack, compared with those who are sedentary. Possible reasons are less atheroscle- rosis, greater diameter of arteries, and less chance of a clot forming.

Regular exercise can improve coronary circulation

and, thus, reduce the chances of a heart attack or

dying from one. Within the heart, many tiny branches extend from the major coronary arteries. All of these vessels supply blood to the heart muscle. Active people are likely to have greater blood-carrying capacity in these vessels, probably because the vessels are larger and more elastic. Also, the active person may have a more pro- fuse distribution of arteries within the heart muscle (see Figure 4 ), which results in greater blood flow. A few stud- ies show that physical activity may promote the growth of “extra” blood vessels, which are thought to open up to provide the heart muscle with the necessary blood and oxygen when the oxygen supply is diminished, as in a heart attack. Blood flow from extra blood vessels is referred to as coronary collateral circulation.

Improved coronary circulation may provide protec- tion against a heart attack because a larger artery would require more atherosclerosis to occlude it. In addition, the development of collateral blood vessels supplying the heart may diminish the effects of a heart attack, as these extra (or collateral) blood vessels may take over the func- tion of regular blood vessels.

The heart of an inactive person is less able to resist

stress and is more susceptible to an emotional

storm that may precipitate a heart attack. The heart is rendered inefficient by one or more of the following circumstances: high heart rate, high blood pressure, and excessive stimulation. All of these conditions require the

for heart disease. Preliminary standards from the American Heart Association suggest that levels below 1 mg/L indi- cate low risk, levels between 1 mg/L and 3 mg/L indicate moderate risk, and above 3 mg/L indicate high risk.

High levels of the amino acid homocysteine have also been associated with increased risk for heart dis- ease, though the American Heart Association says it is too early to begin screening for it. Tentative fasting val- ues have been established at 5 to 15 millimoles per liter of blood for the normal range, 16 to 30 as moderate, 31 to 100 as intermediate, and above 100 as high. Recent research suggests that healthy lifestyles can help reduce the risk of arterial inflammation. For example, studies show that regular physical activity can promote endo- thelial health, and nutrition can help reduce markers of inflammation. Adequate levels of folic acid, vitamins B-6 and B-12 help prevent high blood homocysteine levels, so eating foods that ensure adequate daily intake of these vitamins is recommended.

Physical Activity and Heart Attack Regular physical activity reduces the risk for

heart attack, the most prevalent and serious of all

cardiovascular diseases. A heart attack (coronary occlusion) occurs when a coronary artery is blocked (see Figure 3 ). A clot, or thrombus, is the most common cause, reducing or cutting off blood flow and oxygen to the heart muscle. If the blocked coronary artery supplies a major portion of the heart muscle, death will occur within minutes. Occlusions of lesser arteries may result in angina pectoris or a nonfatal heart attack.

Figure 4 ▶ Coronary collateral circulation.

Heart muscle

Collaterals

Figure 3 ▶ Heart attack.

Clot and narrowed artery

Clot (thrombus) enlarged

Death to tissue

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Concept 4 ▶ The Health Benefits of Physical Activity 71

heart to use more oxygen than is normal and decrease its ability to adapt to stressful situations.

The inefficient heart beats rapidly because it is domi- nated by the sympathetic nervous system , which speeds up the heart rate. Thus, the heart continuously beats rap- idly, even at rest, and never has a true rest period. High blood pressure also makes the heart work harder and contributes to its inefficiency.

Research indicates that regular physical activity can:

• lead to dominance of the parasympathetic nervous system , which slows heart rate and helps the heart work efficiently;

• help the heart rate return to normal faster after emo- tional stress;

• strengthen the heart muscle, making it better able to weather an emotional storm;

• reduce hormonal effects on the heart, thus lessening the chances of circulatory problems;

• reduce the risk of sudden death from ventricular fibril- lation (arrhythmic heartbeat).

Regular physical activity is one effective means of

rehabilitation for a person who has coronary heart

disease or who has had a heart attack. Not only does regular physical activity seem to reduce the risk of developing coronary heart disease, but those who already have the condition may reduce the symptoms of the dis- ease through regular exercise. For people who have had heart attacks, regular and progressive exercise can be an effective prescription when carried out under the super- vision of a physician. Remember, however, that exercise is not the treatment of preference for all heart attack vic- tims. In some cases, it is harmful.

Physical Activity and Other Cardiovascular Diseases Regular physical activity is associated with a

reduced risk for high blood pressure (hypertension). “Normal” systolic blood pressure is 120 mm Hg or less and normal diastolic blood pressure is 80 mm Hg or less. Prehypertension is a condition that exists when your blood pressure is higher than normal but not high enough to be considered hypertension (see Table 2 ). Prehyperten- sion has been linked to higher than normal risk of heart attack and, though not as serious as hypertension, should be taken seriously. Nearly one-third of American adults have high blood pressure. High blood pressure is associ- ated with heart disease, stroke, diabetes, and many other diseases. African Americans, Hispanics, and Native Ameri- cans have higher incidence than White non-Hispanics. Older people have higher incidence than younger people.

High blood pressure is sometimes referred to as the “silent killer” because nearly one-third of people with ele- vated blood pressure do not know they have it. It is impor- tant to monitor your blood pressure on a regular basis. With practice and good equipment, you can accurately measure your own blood pressure. Because blood pressure can be elevated by emotions and circumstances, a single measurement may not be accurate, so at least two separate measurements are recommended. While self-assessments can be helpful, they are not a substitute for periodic assess- ments by a qualified medical person.

Exceptionally low blood pressures (below 100 systolic and 60 diastolic) do not pose the same risks to health as

Coronary Collateral Circulation Circulation of blood to the heart muscle associated with the blood- carrying capacity of a specific vessel or development of collateral vessels (extra blood vessels). Sympathetic Nervous System The branch of the autonomic nervous system that prepares the body for activity by speeding up the heart rate. Parasympathetic Nervous System The branch of the autonomic nervous system that slows the heart rate. Emotional Storm A traumatic emotional expe- rience that is likely to affect the human organism physiologically. Systolic Blood Pressure The upper blood pres- sure number, often called working blood pressure. It represents the pressure in the arteries at its highest level just after the heart beats. Diastolic Blood Pressure The lower blood pres- sure number, often called “resting pressure.” It is the pressure in the arteries at its lowest level occurring just before the next beat of the heart.