Exercise is defined as physical activity that is performed to maintain fitness and health. It is a vital part of any healthy lifestyle and has long been shown to provide many health benefits, including:

• Reducing the risk of cardiovascular disease
  
  
• Reducing or managing weight and body fat
  
  
• Improving ability to manage diabetes
  
  
• Reducing high blood pressure

• Easing chronic and acute pain
  
  
• Reducing the risk of many cancers, such as breast and colon cancer
  
  
• Improving mental health disorders such as depression
  
  
• Preventing osteoporosis
  
  
• Improving sleep and digestion

Studies have shown that a combination of lack of exercise and poor diet may account for about 14 percent of total mortality rates in the United States and are second only to smoking as the biggest killer of Americans. It is because of this that regular moderate-intensity exercise – between 30 to 60 minutes a day, four to six times a week – has become the cornerstone for both the treatment and prevention of many chronic diseases. For example, exercise provides significant benefits for cardiovascular patients and those wishing to reduce their risk of heart disease, such as:

• Decreasing the heart’s need for oxygen
  
  
• Strengthening the heart muscle
  
  
• Reducing levels of LDL “bad” cholesterol while increasing levels of HDL “good” cholesterol
  
  
• Lowering blood pressure
  
  
• Stimulating the creation of new blood vessels
  
  
• Reducing the buildup of plaque
  
  
• Reversing the process of “hardening of the arteries” (atherosclerosis)

Regular exercise can also help people to manage their diabetes by providing the following benefits:

• Lowering glucose (blood sugar) levels
  
  
• Reducing insulin resistance
  
  
• Promoting weight loss and management
  
  
• Reducing dietary restrictions
  
  
• Relieving stress
  
  
• Helping reduce the risk of numerous diabetes-related disorders

Exercise is defined as physical activity that is performed to maintain fitness and health. Combined with proper nutrition, moderate-intensity exercise is an important element in the effort to maintain a healthy lifestyle. In addition to promoting general well-being, regular physical activity has proven effective in preventing and controlling many medical conditions, including:

• Cardiovascular disease
• Obesity
• Diabetes
• Osteoporosis
• Depression
• Chronic low back pain
• Constipation
• General fatigue or low sex drive
• Low sex drive (libido)
• Hemorrhoids

The effect of not exercising has been compared to the effect of smoking a pack of cigarettes per day. A combination of lack of exercise and poor diet accounts for about 14 percent of all deaths every year (second only to smoking), including deaths from coronary artery disease, colon cancer and type 2 diabetes according to a 1990 study by the National Center for Health Statistics. Studies have shown that the benefits of an exercise regime begin to accrue rapidly, even when people begin with just one exercise session a week. To fully experience the healthy benefits of exercise, many physicians recommend that people get between 30 and 60 minutes of exercise, four to six times a week.

Nearly all the benefits of exercise fall into one of the following six categories:

• Cardiovascular fitness. Helps the heart, lungs and blood to use oxygen. Higher levels of fitness improve stamina and endurance. This will also promote a lower heart rate over time.
  
  
• Muscular strength. The ability to use a muscle to exert force during activity. People who improve their muscle strength will more easily be able to lift greater amounts of weight with less chance of injury.
  
  
• Muscular endurance. The ability of the muscle to exert force over longer periods of time. People who improve their muscular endurance will be able to lift a heavy object for longer periods of time.
  
  
• Flexibility. Ability to easily move a joint through its full range of motion. People who improve their flexibility can bend and stretch more easily.
  
  
• Body composition. Ratio of lean muscle to fat tissue. People who are fit will have a healthy ratio of lean muscle to fat tissue.
  
  
• Mental health. The ability to cope with life’s trials and stresses. Regular exercise improves self-esteem, reduces stress and depression, and increases alertness. It provides opportunities for social interaction and teaches numerous life lessons, such as perseverance, and setting and achieving goals. Some studies have suggested that exercise may also imporve cognitive function in some patients.

Exercise can also help with sexual dysfunction. Controlling blood pressure, glucose and weight with exercise reduces the odds of sexual problems. Kegel exercises, clenching exercises that strengthen the pelvic floor muscles, can improve sexual response and help prevent urinary incontinence in women and men.

Research has shown that it is never too early or too late to start enjoying the benefits of exercise. When children are fit at an early age, they are likely to remain active and physically fit throughout their lives. People who are physically active during their young adulthood (aged 18 to 30) appear to enjoy lower heart disease risk factors during middle age, including obesity and diabetes. Exercise also helps people maintain their flexibility, strength and endurance as they get older

In older adults, the importance of exercise is often overlooked, especially for those in the older age range who may feel they are too old to exercise safely. However, research has shown that people can benefit from regular exercise past the age of 90. Not only can exercise prevent or ease the symptoms of many of the diseases and conditions which accompany old age, it can also improve quality of life by allowing older adults to stay stronger and more independent for longer.

Any physical activity that raises the heart rate and increases breathing, such as walking or household chores, helps to improve the strength and health of the lungs, the heart and the circulatory system. Also, stretching regularly can help combat the effects of aging and inactivity, both of which cause the muscles, tendons and ligaments to shorten, reducing flexibility. Furthermore, stretching exercises can alleviate symptoms of stress, carpal tunnel syndrome and arthritis. Strength training – exercising with small weights or resistance bands – is believed to help reverse the muscle loss that comes with old age. For older adults, regular exercise makes it easier to perform everyday tasks and meet life’s physical challenges.

For women, exercise can have added benefit. Exercise can improve some common causes of menstrual discomfort such as cramps, bloating and headaches. Also, for menopausal women, exercising just once a week could significantly reduce the risk of early death. This is because exercise can lower high cholesterol, which is one of the effects of the decrease in estrogen following menopause. Exercise is also important in the prevention of osteoporosis.

Exercise has also been shown to improve quality and duration of sleep. Exercise tires the body out, making it easier to fall asleep and achieve deeper sleep stages for longer durations of time. However, it is important not to exercise too close to bedtime because exercise releases energy and raises the body temperature, both of which can make it difficult for some people to fall asleep.

Additionally, it is thought that exercise aids digestion by helping digested foods move through the intestine. This can reduce the risk of constipation. Also, because exercise decreases stress, it could be beneficial for those suffering from irritable bowl syndrome (IBS) and other disorders that are triggered by stress.

Exercise is perhaps the most important part of managing weight. It is virtually impossible to lose weight healthily without engaging in a certain amount of physical exercise. Exercise is a great motivator when following a weight-loss regimen and many individuals also find it easier to make healthy eating choices when they are following a daily exercise routine.

In order to lose one pound of body fat per week, individuals must create a deficit – either through diet restrictions or exercise – of 500 calories per day (3,500 calories per week). The United States Surgeon General recommends moderate physical activity for 30 minutes on most days of the week. However, this may not be sufficient to achieve weight loss or weight maintenance for some individuals. The Institute of Medicine (IOM) of the National Academy of Science (NAS) recommends 60 minutes of moderate physical activity on most days to prevent weight gain and to achieve the health-related benefits of regular activity. It is important to consult a physician to help determine an appropriate exercise regimen that is appropriate and safe.

The link between exercise and a healthy heart is well established. Exercise has clinically been shown to help prevent heart disease, as well as reduce the severity of existing heart disease. Because of its many benefits for the heart, exercise is strongly recommended by the U.S. Department of Health and Human Services (DHHS) and the American Heart Association.

Research has shown that people who get regular exercise are less likely to have a heart attack and/or die from heart disease. Conversely, lack of exercise has been linked in some studies to over 15 percent of all mortality in the United States, as well as a two-fold increase in the risk of coronary artery disease (CAD). The dramatic benefit that exercise has for the heart and blood vessels include:

• Decreasing the heart’s need for oxygen because the heart works more efficiently.
  
  
• Strengthening the heart muscle. The heart pumps fewer times while still meeting the body’s demand for oxygen-rich blood.
  
  
• Reducing the levels of triglycerides and LDL “bad” cholesterol. Both of these types of blood fats have been associated with an increased risk of heart disease.
  
  
• Increasing the level of HDL “good” cholesterol. Moderately high levels of HDL cholesterol have been identified as a protective factor against heart disease.
  

  

• Lowering blood pressure. High blood pressure (hypertension) puts an added strain on the cardiovascular system.
  
  
• Stimulating the natural process of angiogenesis, by which the body creates tiny new blood vessels to bypass clogged or diseased blood vessels.
  
  
• Helping to keep the blood vessels clear of blood clots and the buildup of plaque.
  
  
• Reversing the process of “hardening of the arteries” (atherosclerosis).
  
  
• Reducing inflammation throughout the body by lowering the production of pro-inflammatory chemicals in the blood. Inflammation has been linked to atherosclerosis.

Exercise may benefit patients with chronic heart failure as well. Recent studies indicate that proper amounts of exercise help heart failure patients live longer and reduce the number of times they must visit the hospital. However, heart failure patients are urged to follow their physician’s recommendations regarding exercise.

In addition to its many direct cardiovascular benefits, exercise also offers indirect benefits by helping to control two conditions that put strain on the heart: diabetes and obesity.

Exercise is a cornerstone in the management of diabetes and the prevention of diabetic complications. When combined with a nutritious diet and medication (if prescribed), regular exercise provides significant benefits for individuals with diabetes. These include:

• Lowering glucose (blood sugar) levels. Diabetes is characterized by the inability to produce or efficiently use insulin, a hormone that regulates glucose. Too much or too little glucose in the bloodstream can result in a variety of medical complications. Muscles use glucose for energy during exercise. The increased blood flow during exercise expands blood vessels and allows more glucose and oxygen to enter the muscles. The body taps into its blood glucose reserves during and after activity to fulfill this energy requirement, reducing blood glucose levels for several hours after exercise. The degree of reduction depends on the duration and intensity of the exercise session.
  
  
• Reducing insulin resistance (a condition in which the cells have a diminished response to insulin). Insulin resistance occurs when the body produces a sufficient amount of insulin but is unable to detect its presence or use it efficiently. Dysfunction in using insulin impairs control of glucose, which can be very dangerous. Insulin resistance is a key component of type 2 diabetes and gestational diabetes. People with type 1 diabetes who become sedentary and overweight can develop insulin resistance, a condition known as double diabetes.
  
  
• Reducing high blood pressure. Elevated blood pressure occurs when the tension of the blood in the walls of the arteries is greater than normal. It is a major risk factor for developing the cardiovascular problems common to people with diabetes.
  
  
• Improving cholesterol (a substance similar to fat that is present in all humans) profile. Studies indicate that regular physical activity helps improve total cholesterol in three ways:
  
  
• Increases high density lipoprotein (HDL) cholesterol. Commonly referred to as “good” cholesterol, HDLs travel freely throughout the bloodstream and do not cling to the walls of arteries. HDLs help prevent heart disease and stroke by carrying cholesterol away from the arteries, back to the liver and out of the body.
  
  
• Reduces low density lipoprotein (LDL) cholesterol. Also known as “bad” cholesterol, LDLs cling to artery walls and hinder blood flow to body parts.
  
  
• Reduces triglycerides (fatty material that circulates through the blood or is stored as fat tissue). Elevated triglyceride levels in the blood increase the risk of plaque buildup and heart disease.
  
  
• Promoting weight loss and management. Adhering to a regular exercise program helps patients achieve and maintain a healthy body weight. Research has demonstrated that it is almost impossible to maintain weight loss without an exercise program. Internal belly fat (fat that lies deep within the abdomen) has been linked to insulin resistance, type 2 diabetes and double diabetes. Frequent physical activity can dramatically reduce fat deposits in the midsection.
  
  
• Reduce dietary restrictions. Many people with diabetes need to limit the amount of food and calories they can eat each day. Because exercise burns calories (units of energy or heat) people with diabetes who participate in regular physical activity are generally able to eat more, control glucose and still maintain a healthy body weight.
  
  
• Relieve stress. Excess stress can raise blood glucose levels. During exercise, the body releases special hormones called endorphins, which induce feelings of relaxation and well-being. These endorphins counteract the effects of stress and lower glucose levels.

Exercise in people with diabetes can also help fight:

• Diabetic angiopathy. Disease that affects the blood vessels. Regular exercise can help reduce excess glucose and body weight, both of which lead to increased risk of angiopathy in people with diabetes.
  
  
• Diabetic neuropathy. Nerve damage that is caused by diabetes. Though the exact cause of neuropathy remains unknown, research indicates that diabetic patients with poor glucose control are more likely to develop this condition than those who regulate their glucose through exercise and nutrition. Exercise and diet in people with prediabetes can reduce neuropathic pain and possibly even reverse nerve damage, researchers have found.
  
  
• Diabetic nephropathy. A kidney disease that is caused by diabetes. It is the most common cause of chronic kidney failure in the United States. Regular physical activity is key in the prevention of this disorder because of the resulting improved glucose control and weight loss or maintenance. For patients undergoing dialysis, exercise has been found to increase effectiveness of sessions and to reduce side effects.
  
  
• Diabetic retinopathy. An eye disease in which the small blood vessels in the retina become swollen and leak fluid. Patients who control their glucose levels and body weight through consistent exercise are less likely to develop retinopathy and other eye conditions.
  
  
• Skin disorders and foot problems. Exercise helps prevent these common diabetic complications by improving circulation and glycemic control.
  
  
• Periodontal disease. Reducing hyperglycemia through physical activity can help prevent dental conditions.
  

Exercise therapy is one of the best methods for helping patients to reduce or eliminate many forms of acute or chronic pain. It can help patients strengthen muscles, increase joint range and achieve a state of physical fitness that allows them to perform everyday activities without pain or discomfort.

For many years, experts warned pain patients to rest and avoid exercise. At the time, the consensus was that too much physical activity would further damage joints and muscles, causing pain to worsen. However, experts now understand that exercise actually helps relieve chronic pain by strengthening muscles and other tissue and increasing a patient’s flexibility.

Exercise also causes the body to release chemicals such as endorphins and enkephalins, which block pain signals from reaching the brain and can help alleviate anxiety and depression. These emotions can make pain more difficult to manage. Exercise gives pain patients increased energy and helps them sleep better. It also helps patients maintain a healthy weight, which reduces the stress on joints and increases bone mass, which leaves patients less susceptible to injury.

Exercise offers health benefits for people regardless of whether or not they are suffering from pain. However, exercise programs can have special benefits for those suffering from various types of pain, including:

• Back pain. Exercise can help speed recovery from back problems and increase flexibility and strength so that injuries do not recur in the future. Exercise may also reduce back muscle spasms and hydrate intervertebral discs that become painful when they lose fluid. Back pain is usually treated by non–weight bearing exercises.
  
  
• Fibromyalgia. This condition is a chronic pain syndrome, predominantly affecting women, in which non–painful stimuli are translated by the central nervous system into pain. Studies show that aerobic exercise, such as swimming, walking or running improves muscle fitness and reduces muscle pain and tenderness. Exercise can also improve muscle endurance.
  
  
• Headaches. Exercises such as regular swimming can reduce the frequency and severity of migraine headaches.
  
  
• Neck and shoulder pain. Flexibility and strength exercises can increase the fitness of neck and shoulder muscles and reduce pain in those areas.
  
  
• Arthritis. Exercise strengthens muscles around joints, which allows the joints to pull apart and reduce the grinding that leads to further joint deterioration and pain. Exercise for arthritis often includes range–of–motion exercises to reduce stiffness and endurance exercises to reduce inflammation in joints.

Exercise is one of the most important steps people can take to both prevent and cope with osteoporosis. Osteoporosis is a disorder that causes bones to become porous, weak and brittle. It usually affects older adults and occurs when low levels of calcium, phosphorus and other minerals cause bones to lose mass. The Bone Estrogen Strength Test (BEST) study conducted by the University of Arizona showed that women who exercised and took at least 1000 micrograms (mg) of calcium daily increased bone density by one to two percent. Like muscles, bones also become stronger with exercise and many of the debilitating symptoms of osteoporosis such as pain, bad posture, falls and fractures can be reduced by engaging in regular exercise.

Exercises that are recommended for improving bone density and strength include:

• Weight-bearing activities. This is any activity that involves holding up the weight of the body. This type of activity usually strengthens the bones in the lower portion of the body, because the feet and legs support the upper body. Typical weight-bearing activities include:
  
  
• Walking, hiking or jogging
• Climbing stairs
• Aerobics, calisthenics or skipping
• Skiing or skating
• Tennis, racquetball, squash or handball
• Field hockey, soccer or other field sports
• Basketball
• Dancing
  
  
• Strength training. This involves using the resistance of weights or bands to strengthen the muscles. Strength training both improves balance (because of the extra support the muscles are able to give the body) and strengthens the bones. It is important for people who have been diagnosed with osteoporosis to strengthen their back muscles as this will reduce the pain and effects of poor posture. Exercises that involve gently arching the back (the opposite position from stooping), such as some yoga positions, may help to reduce posture problems.

Preparing questions in advance can help patients to have more meaningful discussions regarding their conditions. Patients may wish to ask their doctor the following questions related to exercise benefits:

1. What exercise program do you recommend for me?
   
   
2. Should I consult a personal trainer? Can you recommend one?
   
   
3. Does exercise pose any risks for me?
   
   
4. Should I exercise on days I don’t feel well?
   
   
5. What types of exercise are appropriate for my child?
   
   
6. Do any of my medical conditions restrict my ability to exercise?
   
   
7. At what level of intensity should I start?
   
   
8. Could any of my medications interfere with a regular exercise program?
   
   
9. Is it safe to exercise if I am pregnant?
   
   
10. Do I need to test my blood sugar before and after exercise?