Frequently asked questions

Q: How often should I exercise?

A: Researchers and health professionals are recommending that healthy women work their way up to exercising aerobically most days of the week — at least five. Strength training should be done two to three times a week, and stretching every other day.

Q: How long should I exercise?

A: Aerobically, for at least 30 minutes on most days of the week. Strength training should take about 30 minutes to an hour for each session, and stretching should be done for about 10 minutes.

Q: How hard should I exercise?

A: If you are healthy and under age 65, you should work your way up to being able to exercise at an intensity that causes your heart rate to rise to between 70 percent and 85 percent of your maximum. Your maximum heart rate is 220 minus your age. If you are older, you should aim for 60 percent to 75 percent of your maximum heart rate.

Q: What if I've never exercised before?

A: It's never too late to start. First, consult your healthcare professional for a thorough assessment. Then, start slowly. Some people start with as little as two minutes of cardiovascular exercise a day. You will be amazed at how your body responds, allowing you to add a little time each week until you work your way up to the level of exercise recommended for you.

Q: What's the best exercise for me?

A: The key to sticking with an exercise program is choosing activities you enjoy. For strength training, you can choose to work out on weight machines in a gym or health club, or you can work out with hand weights or resistance equipment like rubber bands and a weighted vest either in a class or at home, using a video or book for guidance. Walking, jogging, cycling, swimming, and aerobics and other types of classes — from dancing to boxing — are all good cardiovascular exercise choices. Again, you can choose to exercise in group settings with others or in the privacy of your own home. Cross-training, which is doing different activities on different days, is often recommended to combat boredom.

Q: What if I have a chronic condition?

A: Many health care professionals recommend exercise for a wide variety of chronic conditions. In these cases, your exercise program needs to be tailored by a professional to your needs. Strong muscles can help women with arthritis protect their joints by improving stability and absorbing shock. Regular exercise also helps women with chronic lung disease improve endurance and reduce shortness of breath, is an important part of controlling blood sugar for women with diabetes, strengthens the bones of women suffering from osteoporosis, and helps protect your bones as you age and may even increase life expectancy for women with heart disease.

Q: What if I'm pregnant?

A: Exercising when you're pregnant can help you achieve better posture, less back pain, less stress, better digestion, more energy, fewer complications and an easier delivery and less "postpartum belly." It can also prevent or control gestational diabetes. Be sure to consult with your OB/GYN about what exercises are appropriate and at what intensity, as the rules do change somewhat for pregnant women. If you were already active before becoming pregnant, you should be able to continue, within reason. If you are new to exercise, be sure to start slowly and do not overdo.

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Your program should include the main components of fitness:

• Aerobic activities, which involve using the large muscles of your body in rhythmic, continuous motion, improve cardiovascular conditioning and help reduce body fat. Aerobic exercises include walking, jogging, bicycling, swimming and aerobics or exercise classes or videos.
• Strength training, such as weight lifting, improves muscular strength and endurance, helps maintain bone density, and raises metabolism, causing you to burn more calories
• Stretching exercises, which include slow, gentle movements that elongate your muscles, improve flexibility. These exercises are often worked into exercise classes or videos and also are a part of yoga.

How Much Exercise Is Enough?

One of the most common questions is, "How much do I need to exercise?" The U.S. Centers for Disease Control and Prevention and other professional groups recommend that healthy women do some sort of aerobic exercise on most or all days of the week for 30 to 45 minutes. These minutes can be accumulated — 15 minutes of an aerobics video in the morning and 15 minutes of brisk walking in the evening, for example. Intermittent exercise can be part of a good weight-loss strategy because your metabolism is elevated following each bout of exercise.

If you have been inactive, you need to work up slowly to this amount. Start with five or 10 minutes — or whatever you're comfortable with — every other day, and add one minute every other session. If you do too much too soon, you can become injured, fatigued and discouraged. At the top end, professionals recommend experienced exercisers do no more than 200 minutes per week of aerobic exercise with no more than 60 minutes per session.

Similarly, strength training should not be overdone. Start slowly, with lighter weights, and work up to heavier weights and more repetitions or sets of repetitions. You don't need to strength-train more than three days per week; and always wait at least 48 hours before exercising the same muscle group to give those muscles adequate time to recover between sessions.

Stretching and flexibility exercises should be done for 10 to 12 minutes three times a week. They can follow an exercise session. Some lighter stretches can even be done at your desk or while you watch TV. Examples of stretching exercises include shoulder or arm circles. There are also a number of stretches specifically targeted to arm, back, chest, thigh and calf muscles.

How Hard Should You Exercise?

The second question is, "How hard do I need to exercise?" As you work on increasing the length of your exercise sessions, you also need to work on increasing their intensity. Low-intensity aerobic exercise, like housework, gardening and walking the dog, provides a great deal of general health benefits, but to truly enhance fitness, especially if weight loss is one of your goals, you need to up the ante and exercise at a moderate or higher intensity with vigorous activities like brisk walking or jogging, singles tennis, aerobics classes or cycling.

Because the goal of aerobic exercise is to work your heart muscle, your exercise needs to increase your heart rate. One way to determine if you are exercising intensely enough is to measure your heart rate. Your heart rate should be about 70 to 85 percent of its maximum. Maximum heart rate for one minute is your age subtracted from 220. After warming up and then sustaining an aerobic activity for about five minutes, take your pulse by placing two fingers on the radial artery on your wrist. Count the beats for 10 seconds. The number of beats you count should fall between the two numbers listed beside your age in the chart below. The following chart illustrates recommended 10-second heart rate counts.

Age / Number of beats in 10 seconds:

20 / 23 to 28

30 / 22 to 27

40 / 21 to 26

50 / 20 to 24

60 / 18 to 23

Older adults should exercise as often as others but aim for a lower number of beats per minute. To determine exactly what your heart rate should be during exercise, subtract your age from 220; divide that number by 6 for a 10-second heart rate count; then multiply that number by 0.6 for the lower end of the range and 0.75 for the higher end.

For example, if you're 70 years old:

220 - 70 = 150 (this would be your maximum heart rate for one minute)

150 ÷ 6 = 25 (this would be your maximum heart rate for 10 seconds)

25 x 0.60 = 15 (this would be your target heart rate for 10 seconds)

An easier way to judge intensity is the "talk test." You shouldn't be exercising so hard that you can't talk with a friend or recite a poem. If you can't talk without gasping for breath, slow down.

If you are taking medications for high blood pressure, your heart rate may be kept artificially low and intensity should be monitored using the talk test.

The intensity of your strength training exercise will increase over time as well. Again, don't strain to do more, but slowly work your way up to heavier weights or more repetitions. The last two reps should be difficult to achieve, because the idea is for the muscle to be challenged; if the last two are no longer difficult, it's time to move to heavier weights. You will be amazed at how much more you can do after even a few weeks. Generally, select a weight that you can lift only 10-15 times and perform two sets of each exercise. Gradually progress to a weight that you can only lift six to 10 times and perform two to three sets.

What Kind of Exercise?

The third question is, "What should I do?" The key to sticking with an exercise program is choosing activities you enjoy, and there are many to choose from.

Strength Training

The best way to start strength training may be to hire a certified personal trainer for three or four sessions to develop a plan for you and show you how to use the equipment properly. You can use weight machines, free weights or resistance equipment like specially made rubber bands or a weighted vest, and you can strength-train at a health club or at home. Strength training videos that show you how to use common household items such as food cans and water bottles can save expenditures on weights or other fancy equipment. In any case, if you don't use the proper form, you can injure yourself, so you do need to learn how to use the equipment, whether it's from a personal trainer, a video or a book. Be sure any video or book you use is up to date by looking at the date it was published as some once-popular strength training exercises have been found to be potentially harmful.

Strength training is important to women of all ages. In young women, it can set the stage for a lifetime of stronger bones. In women over age 30, it can help slow or reverse the natural process of muscle degeneration. And studies have shown that older women who strength-train not only maintain bone density but have a much lower risk of hip fractures, due in part to the improvement in dynamic balance that often accompanies stronger muscles.

Functional or core strength training is a type of training that helps strengthen the muscles of the trunk, abdomen and pelvis. The idea is to strengthen these first muscles in the "movement chain" to prevent injury and to provide a solid base, so that the muscles further down the chain — the legs and arms — have a stable base supporting them and will also be strengthened safely and more efficiently. So, for instance, rather than strengthening your legs with hamstring curls and leg extensions — which don't have much application in real life — you do squats, step-ups or walking lunges that challenge your entire body and improve dynamic balance while strengthening your legs and thigh muscles.

Aerobic Exercise

The options for aerobic exercise are many and varied. Some of the more popular choices include the following:

• Brisk walking is the most popular aerobic exercise among women and is appropriate for women of all ages. Walking at a swift pace burns almost as many calories as running or jogging for the same distance, and poses less risk for injury. If you are a beginning walker, choose a level surface. Gradually increase your pace until you can do one mile in about 15 minutes. To intensify the exercise, add hills and varied terrain to your course. You can also use hand weights of one to three pounds, but avoid ankle weights as they can cause injury.
• Jogging burns more calories in less time and is as simple and convenient as walking, but it is too strenuous for some and may cause joint injuries. If you are a beginner, alternate walking and jogging for the first three or four weeks. Then gradually increase the jogging portion until you can comfortably run for the entire workout. Remember not to exceed your target heart rate; the talk test may be the best way to easily monitor your exertion level.
• Aerobics classes or home videos offer variety, music and choreography, and some women prefer the extra motivation an instructor provides. Start with beginner classes or videos, and watch the instructor carefully for proper foot placement and body alignment to avoid injury, especially to your knees. There are a variety of types of aerobics classes, including:
  • Step classes incorporate a low bench that allows you to step up and down while performing various moves.
  • Boxing classes and Tae Bo have become a craze in some parts of the country. Boxing classes consist of aerobic moves combined with boxing moves such as punching and footwork. Tae Bo adds martial arts moves, including karate-type punches and kicks, to the mix. The feet and upper body move for most of the class, providing a total-body workout.
  • Slide classes involve a special mat and booties that slip over your shoes and allow you to slide back and forth on the mat. Great for toning the lower body but should be avoided by those with knee injuries.
  • Interval classes combine step or floor aerobics with weight training using hand-held weights or special rubber bands.
  • Toning/sculpting classes incorporate floor aerobics with a concentration on isometric exercises for specific body parts.
  • High-impact classes incorporate moves such as jumping, running and hopping, and are not recommended for women with joint problems in the lower extremities.
  • Low-impact classes incorporate moves where one foot is always on the floor. They are not necessarily low-intensity exercises, though.
  • Don't forget to take particular care of your feet! According to the American Podiatric Medical Association, proper shoes are crucial to successful, injury-free aerobics. Shoes should provide sufficient cushioning and shock absorption to compensate for pressure on the foot many times greater than found in walking. They must also have good medial-lateral stability. Impact forces from aerobics can reach up to six times your own body weight, which is transmitted to each of the 26 bones in the foot. Because of the many side-to-side motions, shoes need an arch design that will compensate for these forces, and sufficiently thick upper leather or strap support to provide forefoot stability and prevent slippage of the foot and lateral shoe "breakup." Make sure shoes have a toe box that is high enough to prevent irritation of toes and nails. Major shoe companies today have designed special shoes for aerobics, which provide the necessary arch and side support; they also have soles that allow for the twisting and turning of an aerobics regimen.
• Spinning is an exciting aerobic exercise developed in the 1980s. Participants use a specially designed stationary bike, and the instructor leads the class on an imaginary ride accompanied by energizing music. During an average 45-minute class, you can burn 400 to 500 calories. Be sure to talk with the instructor before your first class to go over the type of clothing you might need (padded shorts), your target heart rate and your physical limitations.
• Swimming is an ideal exercise for pregnant women and those with physical limitations such as musculoskeletal problems and asthma. However, swimming does not raise the heart rate quite as much as other aerobic exercises because humans are equipped with a reflex that causes the heart to slow down when immersed in water. For swimming, use a heart rate target of 75 percent of the maximum minus 12 beats per minute. It is also not the very best activity for losing weight because the body tends to conserve body fat as insulation in cold environments. For those whose only option is swimming, however, it is certainly better than remaining inactive. If you have arthritis, try to find a facility with a warm water pool that conforms to Arthritis Foundation guidelines.

Flexibility Training

Don't skip flexibility exercises, because they are beneficial in helping prevent cramps, stiffness and injuries. They also ensure a wide range of motion, particularly important as women age. Some flexibility/stretching regimes are popular enough now that you should be able to find a class for either that fits your needs and schedule:

• T'ai chi, an ancient Chinese practice, is becoming popular for older adults. T'ai chi incorporates slow, graceful movements with relaxation and breathing techniques. It is said to improve strength, flexibility, balance, coordination and posture, and is recommended by the National Institute on Aging because it may reduce older adults' risk of falling. The Arthritis Foundation calls it the ideal exercise for arthritis sufferers. Traditionally performed on land, t'ai chi can also be done in chest-deep water for added resistance and support.
• Yoga has been practiced for more than 3,000 years around the world, and now about 6 million Americans practice yoga. Yoga increases flexibility, strength, balance and range of motion. It also reduces stress and increases feelings of well-being. Everyone from high-powered executives to stay-at-home moms to people coping with illness or injuries can practice yoga. A typical yoga class involves breathing, a warm-up period, yoga postures that consist of specific ways of stretching and moving the body and relaxation and visualization. Be sure to find a qualified, certified yoga teacher and begin slowly.
• Pilates is a 70-year-old, low-impact exercise technique that was first developed by German immigrant Joseph Pilates. It has recently experienced an upsurge in popularity, in part because of the greater popularity of yoga, but also because numerous celebrities have begun using it for toning and stretching. Some Pilates programs use a special machine with pulleys and ropes that gently stretch all parts of the body with mild resistance; others use a series of floor exercises more akin to yoga. It is also called "The Movement," and much of its focus is on strengthening back and abdominal muscles, increasing flexibility and building core strength.

You can buy a video to show you how to do stretching exercises in the privacy of your own home, or you can have a personal trainer at a gym show you how to incorporate the exercises after your cool-down period.

Special Considerations: Exercising When Pregnant

Exercising when you're pregnant can help you achieve better posture, less back pain, less stress, better digestion, more energy, an easier delivery and less "postpartum belly." It can also prevent or control gestational diabetes and reduce the chance of complications during delivery. If you've exercised throughout your pregnancy, you will be rewarded with increased strength, flexibility and stamina during labor and delivery, as well as a faster recovery.

Be sure to consult with your OB/GYN or midwife about your exercise routine. If you were already active before becoming pregnant, you should be able to continue, within reason. If you are new to exercise, be sure to start slowly and do not overdo. Low-intensity or low-impact cardiovascular exercise like walking, swimming, low-impact aerobics classes or special exercise classes for pregnant women are best. You can engage in these activities three to four times per week for about 30 minutes per session. Ask your health care provider about a target heart rate; keeping it below 140 beats per minute is recommended. It's critical that you keep your body cool and well-hydrated (drink lots of water) during exercise. Don't forget to warm up and cool down.

Strength training during pregnancy can also be beneficial in building stamina and strengthening muscles and bones. Use lighter weights or resistance because heavier weights increase your chances of injury. Remember to breathe normally. Keep these pointers in mind:

• don't do exercises performed while lying on your back after 20 weeks;
• avoid deep, unsupported knee bends, abdominal exercises while lying down, double-leg raises and straight-leg toe touches (your ligaments are more prone to injury during pregnancy and you must not compress your uterus after 20 weeks);
• because overheating can be dangerous to your baby, don't exercise in hot, humid weather or wear excessive clothing;
• always drink plenty of liquids; and
• stop and consult your health care professional if any unusual symptoms appear, including pain, bleeding, dizziness, shortness of breath, irregular heartbeat or difficulty walking.

Special Considerations: Women With Chronic Conditions

Today, exercise is often recommended as a management strategy for many chronic medical conditions. Of course, a thorough discussion of exercise with your health care professional is imperative prior to beginning any kind of program.

For example, for women who suffer from osteoporosis, a bone disease that causes bones to thin and weaken, exercise is highly recommended. A carefully designed exercise program can help protect your bones and retard development of the disease. Weight training, in particular, helps counter the effects of osteoporosis by stimulating bone formation. Begin with a weight that you can lift 10-15 times, and perform one to three sets. Progress to two to three sets of a weight that can be lifted only six to 10 times (up to 80 percent of your maximum). Walking, jogging and aerobics classes also help build bones. Bicycling and swimming, however, don't stimulate bone formation in the hips because you do not bear your full body weight on your feet. Flexibility exercises enhance your posture and increase your balance, making you less susceptible to dangerous falls.

Exercise also is extremely helpful if you have diabetes. Diabetics who are physically active have fewer complications. Exercise can lower your blood sugar level, helping reduce or eliminate the need for insulin. The American Diabetes Association recommends a combination of aerobic activity, strength training and stretching exercising three to five times per week for 20 to 40 minutes each time. Your health care professional will need to oversee the design of your fitness program. Always check your blood sugar level prior to exercise; if it's lower than 70 mg/dl or you are exercising more than one hour after a meal, you may need to decrease your insulin or have a light snack beforehand to avoid having your blood glucose level drop too low. Always have a fast-acting sugar source with you in case you do have a reaction, and wear a medical alert identification bracelet or necklace. There are several other precautions you need to be aware of, so be sure to consult your health care professional first.

For women at risk of developing heart disease — if you have a family history of heart disease, are overweight, smoke or have high cholesterol, diabetes or high blood pressure, for example — exercise is crucial. In fact, according to the American Heart Association, lack of physical activity itself is now clearly shown to be a risk factor for cardiovascular disease, the No. 1 killer in < xml="true" ns="urn:schemas-microsoft-com:office:smarttags" prefix="st1" namespace="">America. Studies have shown that people who are physically inactive are from 1.5 to 2.4 times more likely to develop heart disease — a risk as great as high cholesterol, high blood pressure and cigarette smoking. Even low- to moderate-intensity activities such as pleasure walking, climbing stairs, gardening, yard work, moderate to heavy housework or dancing can bring benefits when done for as little as 30 minutes a day. More vigorous aerobic activities such as brisk walking, running, group fitness classes, swimming, bicycling, roller-skating and jumping rope — done three or four times a week for 30 to 60 minutes — are best for improving the fitness of the heart and lungs. If you already have heart disease, you can exercise safely as long as you work out under medical supervision and carefully monitor warning symptoms. Check with your local hospital or university for monitored cardiac rehabilitation exercise programs. Strenuous physical exertion is never recommended for people who suffer from congestive heart failure, unstable angina, chest pain, significant aortic valve disease or aortic aneurysm. Some of these conditions, however, such as congestive heart failure, might benefit from mild or moderate exercise under controlled situations.

Exercise also is beneficial for and can help control obesity, high cholesterol, high blood pressure and back pain, and may improve the symptoms of some neurological and emotional disorders. It also has been shown to help prevent certain types of cancer.

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