Musculoskeletal fitness: the keystone in overall well-

being and injury prevention.

Musculoskeletal fitness is an important and inadequately appreciated component of

overall health and well-being. Wellness as it applies to strength and conditioning has
numerous benefits. It allows maintenance of functional independence for longer periods
in older adults. It impacts the metabolic capabilities of children and adults affecting the
ability to maintain an ideal body weight. It has been shown to influence the prevalence
and possibly the prevention of many musculoskeletal disorders such as muscle sprains,
low back pain, osteoarthritis, osteoporosis, shoulder instability, and knee stability and
pain. The current author summarizes the most recent recommendations for achievement
and maintenance of musculoskeletal fitness for children and adults.

Components of Health-Related Fitness:

Health-related physical fitness is typified by an ability to perform daily activities with
vigor and is related to a low risk of chronic disease. Cardiorespiratory endurance,
musculoskeletal fitness (muscular strength and endurance, flexibility), and optimal body
composition are the measurable components of health-related fitness. Skill-related
fitness, on the other hand, has more to do with agility, balance, coordination, speed,
power, and reaction time (sport skills) and has little rela-tionship to health and disease
prevention.

The most frequently cited components of physical fitness fall into two groups, one related
to health and the other related to athletic skills (see figure 1.2). Skill-related fitness is
integral to success in sports such as tennis, football, baseball, volleyball, golf, and
basketball. However, most experts feel that these components have little if any bearing on
health and disease prevention. For example, there are no scientific data to suggest that
coordinated people live longer or suffer less disease than uncoordinated people.

Health-related fitness includes these components:

 Cardiorespiratory fitness: the ability to continue or persist in strenuous tasks
involving large muscle groups for extended periods of time. Also called aerobic
fitness, it is the ability of the circulatory and respiratory systems to adjust to and
recover from the effects of such activities as brisk walking, running, swimming,
cycling, and other moderate-to-vigorous activities.
 Body composition: the relative amounts of body fat and lean body tissue or fat-
free mass (muscle, bone, water, skin, blood, and other nonfat tissues). Body
composition is often expressed as percent body fat.
 Musculoskeletal fitness:
Flexibility: the ability of the joints to move through a full range of movement
(e.g., touching one’s toes with legs straight while seated on the floor).
Muscular strength: the maximal one-effort force that can be exerted against a
resistance (e.g., lifting the heaviest weight possible in the bench press or leg
 squat).
Muscular endurance: the ability of the muscles to supply a submaximal force
repeatedly (e.g., sit-ups, push-ups, chin-ups, or lifting weights 10 to 15 times in
the weight room).

There are many activities that develop components of both skill- and health-related
physical fitness. These include basketball, racquetball and handball, ice skating and roller
skating, and soccer. Many individuals prefer to play sports while getting fit rather than
engaging in ÒpureÓ fitness activities like running, cycling, or stair climbing. The
competitive and social aspects of sports make them enjoyable for many, and help promote
long-lasting compliance (one of the greatest challenges in exercise training).

However, many sports such as baseball, table tennis, golf (with a cart), volleyball, and
bowling, while demanding certain athletic skills, do little to promote the components of
health-related fitness. This is because they fail to stimulate the heart, lungs, and muscles
at a level sufficient to cause positive changes. These sporting activities should be
supplemented with fitness routines to ensure long-term health. Ath-letes who excel in
throwing a ball or swinging a golf club should understand that they may not have optimal
levels of body fat or cardiorespiratory fitness and as a consequence may be at higher risk
for chronic disease. Conversely, though individuals may possess poor coordination and
dislike athletic sports, they can still be physically fit and healthy if they engage regularly
in aerobic and musculoskeletal exercise.

Each of the components of health-related fitness can be measured separately from the
others, and specific exercises have been fashioned to develop each of the areas. These
will be reviewed later in this chapter. The important point here is that "total fitness" is
equated with the development of each of the major components through a well-rounded
exercise program. Some individuals weight train to develop muscular strength and
endurance but pay little attention to aerobic exercise for their cardiorespiratory system.
Some runners rank high in heart and lung fitness but low in upper-body strength.

There are some modes of exercise that "do it all," such as rowing, cross-country skiing,
swimming, and aerobic dance, which train both the upper- and lower-body musculature
while giving the heart and lung system a good workout. Table 1.1 rates various activities
according to their overall potential for developing "total fitness."

Individuals who engage in regular physical activity to develop cardiorespiratory

endurance, musculoskeletal fitness, and optimal body fat levels improve their basic
energy levels and place themselves at lower risk for heart disease, cancer, diabetes,
osteoporosis, and other chronic diseases. Scientific evidence supporting this perspective
will be reviewed throughout the rest of this book. In accordance with this viewpoint, the
American College of Sports Medicine (ACSM) has defined health-related physical fitness
as "a state characterized by an ability to perform daily activities with vigor and a
demonstration of traits and capacities that are associated with low risk of premature
development of the hypokinetic diseases (i.e., those associated with physical inactivity)."

Physically fit individuals can accomplish the ordinary tasks of life (e.g., carrying
groceries, climbing stairs, gardening) with less fatigue, storing up an energy reserve for
leisure-time exercise or unforeseen emergencies. As summarized by Dr. Harrison Clarke,
one of America’s most noted fitness leaders during the 1960s, "Physical fitness is the
ability to last, to bear up, to withstand stress, and to persevere under difficult
circumstances where an unfit person would give up. Physical fitness is the opposite to
being fatigued from ordinary efforts, to lacking the energy to enter zestfully into life’s
activities, and to becoming exhausted from unexpected, demanding physical exertion."

Nutrition – Role Played in our Health

Nutrition as it applies to our daily lives means that we take in what we need to maintain
our body’s healthy state. Nutrition has become an important word thanks to the
involvement of the USDA in our daily food requirements, and the FDA’s involvement in
determining what is and is not dangerous for us to consume.

What about eating habits? What about vitamins? What role does our daily intake play in
our health? More than you have been lead to believe or understand. The body’s ability to
remain well under anything other than ideal conditions is a direct result of the nutrition
received on a daily basis.

The mind’s ability to remain well is, again, a direct result of our nutritional intake. For
instance, the human brain doesn’t develop well without the necessary input of protein in
our daily diet. No protein, no intelligence.

Nutrition refers to the nurturing of our body, in our ability to keep it healthy and
functioning as it is supposed to do. Our ability to provide the body with all it’s necessary
food, vitamins, and minerals so that we continue to thrive in our daily life processes.

How do we determine that we are providing the essential nutritional needs? That
knowledge comes by educating ourselves about what our individual needs are, the needs
of our family, and then taking that knowledge and applying it to the foods we buy, that we
prepare, and that our families consume.

Health is taught as a science course, and addresses matters of personal hygiene, diseases,
and the broad spectrum of health as it applies to the masses.

Eating Habits

No individual attention is given to how to attain optimal health via our eating habits. It’s
funny that we skip the most important, fundamental building block to good health: our
nutritional and caloric consumption in our food.
I personally believe we should have the field of nutrition and physical activity married
into something combined to provide every person that enters the school system with a
personal knowledge of their bodies’ needs, caloric, and nutritional, so that they complete
their education with mental and physical competencies, as well as analytical and
mathematical competence.

Nutritional Requirements

Nutrition is a concept that should be as important to our educational process as our ability
to count. The ability to recognize our nutritional requirements, find the foods we need to
fulfill those requirements, and differentiate between healthy food consumption and
“unhealthy” eating habits is not an option. Not for a healthy, happy, long, and quality life

What we should absorb as we travel along life’s daily path is a way to incorporate good
nutrition into our lifestyle. There is generally just as much room for good nutrition as
there is bad nutrition. It just so happens that bad nutritional habits hold more appeal.

Bad nutrition receives more advertising dollars than healthy nutritional options, and is
often more visible. But that doesn’t mean it’s any easier, more convenient, or cheaper.
Habits, generally take about two weeks to make the switch from conscious action to
unconscious thought.

Two weeks is not long, it’s not long at all for decisions that will affect you for the rest of
your life. It’s also not long for the potential reward that comes from setting an example
your children can follow, and you can be proud for them to follow.

You teach them daily about the good habits you want them to develop, and then you
demonstrate a bad one in your nutrition choices. C’mon, mom and dad, let’s practice
what we preach.

Fitness Exercise
Fitness Exercise is vital for shedding excess weight and keeping it off. The body was
meant to be active, and that is often a challenge in today’s often-sedentary lifestyles.
White collar workers, security workers, and drivers make up a large part of the
workforce, and get very little fitness exercise daily.

Especially if you fit into this category of fitness exercise, a concerted effort must be made
in order to ensure that an fitness exercise regimen is followed that will afford you a level
of activity that will provide the amount of activity you need to stay healthy and avoid
obesity.

People often dread fitness exercise, projecting a gruelling task that will leave them
without energy and with sore muscles. This does not have to be and should not be the
case. It is not necessary to employ a vigorous workout in order to have an effective
exercise plan.

Simple Fitness Exercises

Any regular fitness exercise plan that is cardiovascular, raising the heart rate for at least a
half hour straight, will do wonders for your body. Simply taking a walk, starting slow,
then working your way up to power walking, is an excellent method of fitness exercise.

If your time is limited, or you live in a location where weather may impede your workout
schedule, you may want to invest in a treadmill so that you can work out daily without
interruption. Riding a bike, whether a regular bike or a stationary one, can be equally as
effective as fitness exercise.

Again, you may want to employ both options to add variety, yet to make sure that
weather does not impede you from your daily routine. Skipping days becomes addictive,
and before you know it weeks begin to compile where you have not worked out, so avoid
the trap.

The 5 Components of Physical Fitness

Believe it or not, there is an objective standard that can be used to determine overall
physical fitness, and it’s broader than whether you can put a basketball in a hoop or sport
a great six pack.

While athletic ability or a lean physique may be outward signs of physical fitness, they
alone aren’t enough to qualify a person as physically fit. To determine true fitness, you
need to evaluate that person (as well as yourself) against the five recognized components
of physical fitness.

Physical fitness is broken down into five fundamental components:

1. Cardiovascular Endurance
2. Muscular Strength
3. Muscular Endurance
4. Flexibility
5. Body Composition

While you may not have heard physical fitness broke down this neatly in the past, these
are the main components of physical fitness, and should be at the core of any discussion
around exercise, athletic performance and general health and fitness. In order to be
considered truly fit, you’ll need to exhibit certain characteristics within each of these
components.
Practically speaking, having a good understanding of these components of physical
fitness can also help you make sure that your training and exercise routine (as well as
your diet) supports improved fitness levels.

1. Cardiovascular Endurance

Cardiovascular endurance (also known as cardio-respiratory endurance) basically refers

to ability of the lungs to transfer oxygen to the blood and to the heart’s ability to pump
that oxygen-rich blood to your muscles and tissues. This is a critical component of
physical fitness, since without that oxygen-rich blood, your body and muscles won’t be
able to effectively perform work.

But cardiovascular endurance isn’t just about providing the oxygen you need to power
your workouts or daily activities. It also has a wide range of health benefits. As
cardiovascular endurance improves, your resting heart rate decreases — putting less
stress on the heart even when performing light activity. This is one of the reasons that
doctors almost always prescribe light cardiovascular exercise as preventative treatment
for heart disease or high blood pressure.

Even if your goal is to train for muscle mass (for instance, if you are a bodybuilder),
improving your cardiovascular endurance can help increase your stamina during weight
training, reduce fatigue and even allow you to lift more weight or perform more reps.

2. Muscular Endurance

Muscular endurance is the second key component of physical fitness.

Muscular endurance is the ability to hold a particular position (muscle contraction) for a
sustained period of time, or to repeat a movement many times without excessive
fatigue. This could be the capability required to hold a two-pound weight above your
head for five minutes or the effort required to lift that weight 20 consecutive times. In
both cases, muscular endurance is involves the extended contraction of muscles against
less-than-maximum weight.

Muscular endurance is important because it allows the muscle to work longer without
fatigue, which is critical during for sports and recreational or daily activities. Without
muscular endurance, you would be unable to run more than a few hundred yards, stand
for long-periods of time, or participate in sports like biking, swimming or cross-country
skiing.

3. Muscular Strength

The third component of physical fitness is muscular strength.

Muscular strength is the ability to exert maximum force, such as lifting the heaviest
weight you can move, one time. It’s typically expressed as your One Rep Max (1RM) —
or the amount of resistance you can move in a single rep.

Muscular strength may be localized to certain muscle groups, for instance you could have
muscular strength in your legs, but not in your arms. Overall, you should aim for
muscular strength across all muscle groups, especially your core (your torso, which
includes back, abs and chest), since your torso is heavily involved in supporting and
assisting in nearly all movement and activities.

Imbalances in muscular strength between opposing muscle groups (for example lower
back and abdominal muscles) can increase the risk of acute and chronic injuries,
including muscle pulls and tears and strains to connective tissue.

Muscular strength is important, because without it, you would be unable to participate in
recreational sports, support your own body weight, or even lift yourself out of a chair.
Improving muscular strength also has broader health benefits, including:

 Improved bone density

 Reduced risk of osteoporosis
 Reduced risk for injury
 Improved insulin sensitivity, which can reduce the risk of developing Type II
diabetes and Metabolic Syndrome.

4. Flexibility

Flexibility is the fifth component of physical fitness.

Flexibility is simply the ability to move a joint through its full range of motion. In other
words, how limber you are. A person’s level of flexibility is partly determined by
genetics and their joint structure, but nearly all people are able to improve flexibility
through regular static and dynamic stretching.

Flexibility is important because it allows you to perform certain daily activities like
stretching to reach an item on a high shelf or bending down to pick something up off the
floor.

Having a high-degree of flexibility discourages certain injuries and muscle-strains

because flexibility allows you to better use proper form when performing activities like
lifting objects. For example, people with tight, inflexible hamstring muscles (the muscles
on the backs of your legs) will often compensate for this lack of flexibility, by lifting
from the waist, versus through the legs and waist. This puts them at greater risk for lower
back injuries.

In sports and recreational activities, improved flexibility can also enhance athletic
performance, ensuring that you are using proper form and working a muscle through it’s
full and natural range-of-motion — for example during weight or resistance training.
Nearly all sports and activities can benefit from increased flexibility, but some — like
gymnastics – require a very high-level of flexibility. In recreational sports like softball,
basketball or soccer, increased flexibility can also improve power, balance and agility.

5. Body Composition

The final component of physical fitness is body composition.

Body composition simply is what your body is made up of. In other words, the proportion
of lean tissue like bone, muscle, connective tissue, internal organs and water to your body
fat levels.

Body composition is not based on your weight, hip-to-waist ratios, or inaccurate, one-
size-fits-all formulas like Body Mass Index (BMI.) Instead, body composition looks at
your percentage of lean tissue to fat ratio. This is important, because scale weight alone is
a poor representation of a person’s actual physical fitness and body composition. Two
people with the exact same height and weight, can have very different body
compositions, depending on how much body fat or lean muscle they are carrying.

For example, a 5′ 3″, 130 lb female gymnast at 13% body fat will look much leaner than
a woman with 25% body fat at the same weight and height. Because muscle takes up less
volume on the body than fat, a person with more muscle and less body fat will always
look leaner than someone at the same weight with less muscle and more body fat.

Having a body composition that reflects a higher muscle-to-body fat ratio is important,
because body fat typically gets in the way of most activities. Body fat is metabolically-
inactive and provides no strength or endurance advantage. It’s basically dead weight.
Excess body fat can impede activity, negatively enhance physical or athletic performance,
increase your risk of developing heart disease, stroke, Type II diabetes and Metabolic
Syndrome.

Body composition is most easily determined using a pair of inexpensive body fat calipers.
These calipers will give you an estimate (with a margin of error of about four percentage
points in either direction) of your body fat percentage. You can then use this to estimate
how much lean tissue you are carrying.

Because your goal should be to always shift your body composition in favor of muscle,
while reducing body fat, regularly measuring your body fat percentage is a much more
useful way to gauge your progress toward becoming leaner than a bathroom scale.

Benefits of Physical Fitness

Physical fitness isn’t something that only athletes can possess or something you tried to
develop in 6th grade gym class. It’s the foundation for an active, healthy life. Being
physically fit means being well rounded. And that requires attention to all five of these
components of physical fitness.

For example, if you all you do is spend time in the weight room, but can’t run 100 yards
without puking, then you’re not physically fit, regardless of what the mirror tells you or
how much you can bench. Likewise, if your idea of staying fit and in-shape is an hour of
cardio each day on the elliptical trainer, but you never touch a dumbbell or weight
machine, you’re only getting the health benefits of one component of physical fitness.
You’ll never achieve your potential with a pick-and-choose model like this.

By improving your performance in each of these five components of physical fitness, you
build the basis for solid physical health, which also can help you live longer, be more
mentally sharp and participate in activities that you enjoy. And these five components
also have health benefits that go far beyond how you look at the beach, including less risk
of heart disease, certain cancers, diabetes, better cholesterol-levels, improved mood, more
stamina and energy, a better sex life and less risk of injury as you age.

Definition of Body Composition

In physical fitness, body composition is defined as the percentage of fat, muscle,

and bone in the body. Usually it’s expressed as a ratio of lean mass to fatty mass. Lean
mass includes muscle, bone, skin, internal organs and body water. Fatty mass is mostly
composed of body fat (subcutaneous fat) as well as internal essential fat surrounding
organs. Body composition will typically be displayed as either a percentage of fat (body
fat percentage or %fat) or as a percentage of lean body mass (LBM).

Why Is Body Composition Important?

Body composition is a much more accurate representation of a person’s leanness than

scale weight or Body Mass Index (BMI), because it does not rely on height and weight
alone to measure leanness. It measures the ratio of body fat to lean tissue and bone in the
body, not scale weight.

This is important, because a person may have a high-scale weight (even for their height),
yet have also have a high muscle-to-fat ratio which makes them extremely
lean. That same person might be labeled overweight using the standard BMI calculation,
which does not take into account body composition, only mass (weight) relative to your
height, weight, age and gender.

Excess body fat, or a body composition with a high fat-to-muscle ratio is unfavorable
because it increases the risk of cardiovascular disease, Type II diabetes, Metabolic
Syndrome and certain cancers. Excess body fat, especially at levels considered obese, can
also put stress on the joints and interfere with mobility and the ability to perform
everyday activities.
Body Composition and Physical Performance

For athletes — or even weekend warriors who participate in competitive or recreational

sports — excess body fat can impair physical performance. In general, the less body fat,
the better the performance. Body fat contributes no strength advantage to a person (unlike
muscle), and can interfere with endurance, speed and agility.

From a purely aesthetics perspective, two people can have the exact same height and
weight, yet look completely different due to variations in their body composition. Since
fat takes up more space on the body, a person who has a high body fat percentage — but
the same height and weight as a person with a low body fat percentage and more lean
muscle — will look larger and less lean. This is why it’s important to use body
composition, and not scale weight, to determine overall physical fitness and leanness.

Measuring Body Composition

There are a number of techniques and devices for testing and measuring body
composition, including:

 Body fat calipers (hand-held, manual or electronic) which measures

subcutaneous fat using a single or multiple skin fold tests
 Bioelectrical Impedance Analysis (BIA), which measures body composition by
passing a weak electrical current through the body. The most common BIA
devices are electronic body fat scales, although there are also hand-held versions.
 Hydrostatic Weighing,which involves submerging the body in a tank of water
and measuring the buoyancy of the body (more muscle mass causes the body to
sink, while more body fat causes it to rise.)
 Air Displacement Plethysmography (ADP) which uses the same principle as
hydrostatic weighing, but instead measures the displacement of air in a sealed
chamber, verses water.
 Dual X-ray Absorptiometry (DXA) uses a low-level X-ray to give very precise
measurements of bone mineral content (BMC), bone mineral density (BMD), lean
tissue mass, fat tissue mass, and % of fat.
 Magnetic Resonance Imaging or Computed Tomography, which like DXA,
provides very detailed and accurate body composition measures.

The most common, inexpensive and accessible forms of body composition testing for
most people continue to be calipers and bioelectrical impedance analysis.

Of the two, calipers are considered to be the most accurate — typically within four
percentage points of a person’s actual body fat percentage — which is usually sufficient
for most people. The difference in accuracy between single-point skin fold caliper
tests and multiple-point tests is marginal, and research has shown that a single-point test,
when properly done, can be almost as accurate as hydrostatic weighing.
Calculating Body Composition

Body composition is calculated by taking a person’s body fat percentage, and subtracting
it from a person’s total scale weight.

For instance, a 200 lb man with 10% body fat would have 180 lbs of lean mass, and 20
lbs of body fat, or 90% lean mass. Unlike BMI, height, age and gender are not a factor in
calculating body composition, although age and gender do come into play when
determining ideal body composition targets.

Strategies to Increase Your Physical Activity

by Kevin Fontaine, Ph.D.

 Introduction
 Does Physical Activity Really Help Arthritis?
 If it's so Beneficial, How Come I'm not doing it?
 Don't I have to Exercise Vigorously Many Times a Week to See Benefits?
 How Do I Start?
 Summary and Key Points
 Recommended Reading

Introduction

Arthritis is a difficult disease to live with because it affects every aspect of your life. It
influences your health, your fitness, your sense of well being, your ability to do the things
you'd like to do and, if you have persistent pain, it can really drag you down. However,
there are many things you can do to help yourself.

For example, if you are overweight, losing a few pounds and maintaining that lower
weight can do wonders for your arthritis. Another thing you can do for yourself to
manage your arthritis more successfully is to increase your level of physical activity
(PA). In this article we will outline the benefits that are likely to occur if you become
more physically active, the barriers to becoming more active, and the ways you can
begin to increase your level of physical activity (PA).

(top of page)

Does Physical Activity Really Help Arthritis?

The short answer is, yes! Studies have consistently shown that exercise or PA, either
aerobic activity such as brisk walking or resistance exercises such as lifting weights, are
safe and effective ways of reducing pain and disability, and enhancing physical fitness in
arthritic patients. It is important to note that the studies have also shown that exercise
does not make your disease worse, a common fear of persons thinking about increasing
their PA.
In addition to less pain and disability, regular PA also helps your joint range of
motion or, at the very least, keeps them from getting worse. Because of this, the
American College of Rheumatology (ACR) recommends moderate intensity PA for the
management of osteoarthritis. Some newer studies are showing that patients with
rheumatoid arthritis can also benefit greatly from increasing their level of PA, and that PA
in these patients is safe and does not make the rheumatoid arthritis worse.

Table 1 below summarizes the benefits that are possible when persons with arthritis
increase their level of physical activity. As can be seen, the benefits are many and they
are not limited only to the arthritis itself; PA can also improve general health, fitness,
mental health, energy level, and sense of well being.

Table 1: Benefits of Physical Activity (PA) in Persons with Arthritis

Direction Magnitude
Domain Comments
of Effect of Effect
 PA can improve general health and reduce
your risk of certain illnesses (e.g.,
cardiovascular disease)
Health & Moderate to
Fitness Large
 PA can improve fitness level and your
capacity to perform your day-to-day
activities
Mental Small to  PA can improve your mood and give you
Health Moderate a more positive outlook on life
Moderate to  PA can increase your energy level and
Energy Level
Large vitality
 PA can improve your ability to perform
Functional Moderate to
the day-to-day tasks such as walking,
Capacity Large
carrying groceries, or climbing stairs
Small to  After a few days of PA, you may notice a
Pain
Moderate reduction in your joint pain and stiffness
 PA can improve your sense of well being
Quality of Moderate to
and your willingness to engage more fully
Life Large
in life

If it's so Beneficial, How Come I'm not doing it?

You're not alone. It's estimated that less than 30% of the adult US population meets the
Surgeon General's physical activity guidelines. There are many reasons for this, and we
can only touch on a few of the more common ones here. First, just like the general
population, barriers exist which prevent us from consistently being more physically
active. Among the most common are: lack of time, inclement weather, fear of over doing
it, dislike of sweating, poor motivation, lack of knowledge of the benefits of PA, no
access to equipment and so on.
Second, there are barriers to PA that are specific to arthritis. The most common of
these barriers are shown in Table 2 along with a series of possible ideas to address them.
Each of these barriers arises because of living with a chronic disease. As we talked about
earlier, arthritis is a disease that really affects every aspect of your life. So, it's not
surprising that your willingness to become more active would be limited by factors such
as pain, fear, fatigue, low confidence, and so on. However, the good news is that each of
these barriers can be addressed by taking a few simple actions, like those outlined in
Table 2 below that will start you on the path toward becoming more active.

Table 2: Barriers to Physical Activity in Persons with Arthritis

Barrier Strategies to Overcome The Barrier

 Realize that in the long run exercise will help to reduce paino
 Apply ice or heat 20-30 minutes prior to activity
 Take pain medication 30 minutes prior to activity
Pain
 Focus on how pain changes as you become more physically
active
 Focus on how increasing your activity will likely improve
your fitness and quality of life
 Realize that the chances of making your disease worse
Fear through physical activity are very small

 Start slow and gradual and always make safety your first
priority
 Realize that activity will likely improve your energy level
significantly
Fatigue
 Keep the progression gradual so you don't get too tired
 Make a deal with yourself that you'll give physical activity a
fair try
 Set specific goals for increasing your physical activity and
Low Confidence reward yourself when you achieve them

 Focus on the improvements you notice as you become more

physically active
 Realize that once you become more physically active your
mood and outlook are likely to improve greatly
Psychological  Be realistic; don't expect too much too soon
Distress
 Find ways to involve others in your physical activity

Don't I have to Exercise Vigorously Many Times a Week to See Benefits?

Perhaps the most important barrier to increasing your level of PA is the belief that in
order to get benefits you must exercise vigorously every day like an athlete. It was long
thought that measurable health benefits could only be obtained from vigorous exercise
performed for a minimum of 20 minutes per session at least three times per week. It is
now clear that this is simply not the case. It has been shown that simply accumulating
30 minutes of moderate-intensity PA on most, and preferably, all days of the week
substantially increases fitness and reduces the risk of developing a number of life
threatening disease. This means you can perform one bout of PA for 30 minutes or
multiple bouts of PA for shorter times (e.g. 3 ten minute bouts). It doesn't matter as long
as you meet the Surgeon General's recommendation of 30 minutes of moderate-intensity
PA on most, if not all, days of the week as a way of improving the health, fitness and well
being of the population.

Examples of moderate intensity PA include: brisk walking, recreational swimming,

bicycling, pushing a lawn mower, gardening and yard work, thorough house cleaning and
the like (see Table 3 below for more suggestions to help get you moving).

The most important thing is to start getting more active and to find the types of activities
that you can stick to long term. It is better to do a little bit of PA consistently than it is
to develop an elaborate program that you cannot stick to for more than a couple of
weeks.

Table 3: Ways to Get Yourself Moving

Find an activity that you can perform that produces little or no joint pain such as
walking, cycling or swimming
If these sorts of activities produce too much pain, try some or all of the following:
 Gardening or home repairs
 Try an exercise video
 Wash your car
 Play with kids
 Avoid labor saving devices (elevators, escalators)
 Vacuum your carpets

 Do some gentle exercises while watching TV

How Do I Start?

That's simple: just START. Talk with your doctor, get the okay, and then make a
commitment to yourself that you will become more physically active. Again, the
important thing is to do something; it doesn't really matter what it is as long as it gets
you moving and that it's the sort of activity that you can do safely and consistently.
Use the questions in Table 4 below to help you to finalize your commitment and develop
your PA program. Remember keep it simple, fun, and safe. Now get out there and do
something!
Table 4: Questions to Consider When You Decide to Get More Active

 What are the consequences of doing nothing at all?

 What barriers keep me from being more active?
 How can I address these barriers?
 What can I do to get more active?
 When am I going to start?
 Would I be better at sticking to it if I get someone to do it with me?
 How will I know if it is working?
 What will I do if I get bored with the activity I'm doing?

Read Getting Active: A Real Life Example, an article that outlines step-by-step a physical
activity program that worked for patients in a research study.

(top of page)

Summary and Key Points

 Increasing your level of physical activity is likely to benefit your overall health, as
well as your arthritis and its symptoms
 You don't have to commit to taking part in a traditional exercise program to derive
the benefits of increased physical activity
 Accumulating short bouts of physical activity over the course of the normal day is
likely to improve your health and your arthritis
 It's more beneficial to do a little bit of physical activity consistently than to do a
lot of physical activity inconsistently
 Start slow and gradually increase your level of physical activity
 Set specific physical activity goals and be sure to reward yourself when you
accomplish them
 Focus on the benefits of increasing your physical activity and give yourself a pat
on the back for doing something on your own to manage your arthritis
 As you become more active and are feeling better, consider increasing the
intensity of your PA.
 Before you start increasing your level of physical activity, discuss it with your
doctor
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Why is being physically active important for urban Indians?

India, like many other developing countries, is experiencing a rapid health transition. This
means that health disorder like heart diseases, cancers, diabetes, mental illnesses, chronic
lung diseases, accidents and injuries are becoming major public health problems even as
we are getting better control of infectious diseases and nutritional deficiencies. India
tops the world list in terms of the disability burden due to heart and blood vessel
diseases (more than all industrial countries put together!) and the death rates due to heart
diseases are expected to double in another 25 years. India already is the diabetes capital
of the world. This figure would increase 3 fold by 2025. High blood pressure is a rapidly
increasing problem. Many of these are striking at a younger age, with many deaths in
mid-life.

As we urbanise and change our patterns of eating and physical activity, more and more
people in India are becoming over weight or obese-even at a young age. Indians have a
tendency to accumulate fat in the abdomen (pot belly). This 'central obesity' predisposes
to diabetes, heart attacks, abnormal blood fats and high blood pressure.

Much of this multiple diseases burden can be avoided by regular physical activity which
keeps body weight and body fat in check and helps to prevent diseases. Since diagnosis
and treatment of many of these disorders are very expensive and treatment lifelong, it is
best to prevent them. Of all preventive methods, regular physical activity and avoiding
tobacco are the least expensive and have multiple health benefits. Along with a balanced
diet (low in salt and certain types of fats; high in fruit and vegetables), these can provide
the best protection against many diseases.

Physical Activity takes the sting out of stress!

Stress does not harm the individuals who are physically active- Physical Activity
takes the sting out of stress!

In other words, when an individual is physically active his body automatically develops a
shield to the harmful effects of stress

Stress was an essential survival mechanism which evolved in the days of our hunter-
gatherer ancestors who had to fight or flee from the beast. The response to these
challenges produced increased activity of the sympathetic nervous system and of the
adrenal glands. Adrenaline raised the pulse rate and blood pressure so that more blood
would flow to the exercising muscles. The surge of adrenaline and steroids broke down
glucose stores and raised blood glucose levels so that the brain (which had to make life
saving decisions in a split second) and the muscles (which had to help in fighting or
fleeing) were well supplied with their fuel. Blood clotting tendency also increased, to
quickly seal off blood loss from any injury sustained during the fight or flight.

When we were catapulted into modernity, the nature of the threats have changed. They
are, more often than not, threats to our self-esteem or our tranquillity than to our physical
survival. Secondly, the originally intended outlet of fight or flight does not usually
operate in current times. So, what happens is that the adrenaline and steroids do surge but
the racing pulse, raised blood pressure, elevated blood sugar and thickening blood serve
no ‘useful’ purpose. The result is damage to blood vessels, heart attacks, paralytic strokes,
diabetes and many more health hazards associated with modern living.
Physical activity and exercise help in coping with stress and minimizing its adverse
effects. Physical activity, especially if vigorous, evokes acute stress like responses with
respect to pulse rate, blood pressure etc. However, repetitive activity conditions the body
to accept more and more challenges with less and less adrenaline rise. Gradually, the
body gets used to performing a lot of work at lower heart rates and blood pressure, with
higher reserves left to meet further challenges.

Exercise breeds cross tolerance to mental stress too. Persons who are physically active
have a less intense adrenaline response to mental or emotional challenges and cope better
with stressful situations.

Remember !
The original outlet for the stress response was physical activity (when our
forefathers ran after or away from the beast). What better way to release your stress,
than to spiritedly chase a shuttlecock or tennis ball or skilfully evade the pursuit of your
soccer opponent? Perhaps an office worker too could persuade his or her boss to install a
table tennis table in office! That would relieve office stress and build workplace
solidarity. Regular physical activity, even around home, will act as a shield against school
or workplace stress.

Exercise: precautions to take!

Don’t exercise if-

 If, your blood pressure is 250 mm systolic or 120 mm diastolic or more. In such a
situation the Blood Pressure needs to be controlled first before you start
exercising..
 If, you have advanced eye disease consult your doctor before getting into it..
 If, your plasma glucose levels are more than 250 mg/dl. In such a situation blood
glucose needs to be controlled first.

Footwear

Make sure that your foot-wear is extremely comfortable. Be extra careful, especially, if
you have diabetes. Feeling inside the footwear with your hands, wearing a size bigger
than your own size is especially important if you have diabetes. Also, wear
cotton/woollen socks depending on the weather. Nylon socks should be avoided.

How to get started?

 Start slowly- gradually build up to half an hour per day.

 Wear comfortable shoes and clothing.
 Drink a glass of water before and after your walk.
 In summer, have a lot of other fluids too, like nimbu paani, coconut water, etc.
  If you have any serious disease or heart trouble, then speak to the doctor.
 If you experience chest pain or nausea while exercising, then stop and arrange to
meet the doctor.
 Increase the activity levels in your daily life, at work and also at home – as
suggested above.

Knowing how much to exercise

It is important to warm up before exercising. It will prevent injury and aching the next
day. Build up fitness gradually and slowly. Always, start with gentle movements. While
exercising, it is important to exercise at a level that will improve fitness without over-
exerting. As a rule of the thumb, always exercise to a limit where, if you were to speak
out or shout, someone should be able to hear you.

If your body suddenly sends out warning signals such as pain, tingling, or breathlessness,
then stop immediately.

We need a supportive environment

Even as we make personal choices to become more physically active, we also need a
supportive environment in workplaces, schools, and community settings:

 Safe pedestrian paths. Prevent encroachment of pedestrian paths.

 Protected cycle lanes.
 Parks and playgrounds in residential areas
 Playgrounds + sports equipment
 Protected time for school sports.
 Worksite facilities for physical activity & sports

Fostering a supportive environment

We need a supportive environment

Even as we make personal choices to become more physically active, we also need a
supportive environment in workplaces, schools, and community settings:

 Safe pedestrian paths. Prevent encroachment of pedestrian paths.

 Trees for shade on pedestrian pathways encourage people to walk.Trees increase
oxygen levels, clean the environment and provide shade.
 Protected cycle lanes.This will encourage more people to cycle.
 Parks and playgrounds in residential areas
 Playgrounds + sports equipment in schools, colleges and other institutions.
 Protected time for school sports.
 Worksite facilities for physical activity & sports