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Why Exercise is Essential
First Edition
By Jeff Schlict
Western Connecticut State University
Bassim Hamadeh, CEO and Publisher
Michael Simpson, Vice President of Acquisitions
Jamie Giganti, Managing Editor
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Copyright © 2014 by Cognella, Inc. All rights reserved. No part of this publication may be
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First published in the United States of America in 2014 by Cognella, Inc.
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are used only for identification and explanation without intent to infringe.
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Cover image copyright© 2012 by Depositphotos / Eric Simard.
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Printed in the United States of America
ISBN: 978-1-62131-999-3 (pbk) / 978-1-62661-694-3 (br)
Contents
Forewordvii
Sidebar
Chapter 1: Successful Behavior Change:
We are the 33 Percent!
3
Opening Statement
Chapter 2: Exercise Epidemiology, or What We
Know about Exercise, Morbidity, and Mortality13
Witnesses for the Prosecution
Chapter 3: Cardiovascular Disease—
Cholesterol, the Heart, and the Brain
19
Chapter 4: Obesity ← 20x → Type 2 Diabetes
27
Chapter 5: Colon, Breast, and Maybe Lung Cancer
35
Chapter 6: Osteoporosis
41
Witnesses for the Defense
Chapter 7: Cardiorespiratory Exercise
47
Chapter 8: Resistance Exercise
55
Chapter 9: Flexibility Exercise
65
Closing argument
Chapter 10: Nutrition Basics
79
Reducing Recidivism or How I made my parole officer happy
Appendix 1: Goal Setting
91
Appendix 2: Fitness Testing
93
Appendix 3: Biometric Goals and Objectives
103
Foreword
I
f you had five minutes to convince someone to make one behavior change
that would have the biggest impact on her health, what would you talk
about? Many public health advocates would focus on smoking, often referred to as the number one cause of preventable death. I would talk about
physical activity.
In this book, I present my case for why I think physical activity is the single
most important thing you can do to protect and enhance your health. I’ll begin
by answering the big question: WHY? Should you exercise just because I suggest it? Because the government recommends it? Because your doctor prescribes
it? Well yes, but that’s beside the point because most people won’t buy into a
behavior change until they understand WHY.
Just as a lawyer lays the foundation for a successful argument during his
opening statement, I begin by explaining everything we know about the relationship between health, disease, and physical activity, and everything we know
is quite a lot! We’ll start in the 1950s in England, jump to Texas in the 1980s,
and end up with a massive pile of data that show conclusively that physically
active people between about 40 to 80 years of age, when compared to their
inactive peers, are 50 percent less likely to die from any cause (THE MOST
IMPORTANT POINT OF THIS BOOK), and are at lower risk for many diseases, including heart disease, stroke, type 2 diabetes, osteoporosis, obesity, and
colon and breast cancer.
After I make the case for physical activity by presenting you with a veritable mountain of medical facts, I’ll address the next logical question: HOW
vii
viii | Why ExErcisE is important
MUCH? The answer to WHY is indisputable, as you’ll see after finishing the
first six chapters of this book. The HOW MUCH exercise prescription is an
evolving entity, but after a brief review of the history of exercise prescription in
the United States, we’ll discuss current, specific guidelines for cardiovascular,
muscle strength, and muscle flexibility exercise routines as suggested by the
American College of Sports Medicine (ACSM).
Finally, with WHY and HOW MUCH behind us, we’ll review MOTIVATION.
I know once you finish this book you will be motivated to exercise. However,
most people who begin a new exercise program fail to maintain it. I’ll do my
best to give you the tools you need to be one of the success stories. Then, like
a parent launching his child off into the world, I’ll let you go. But you’ll always
have this book to open again when you need reassurance and a reminder about
why you should be a physically active person.
Dog-ear this page now! Put it on your fridge! Paste it on your Facebook
page!
Going from being sedentary to participating
regularly in a modest cardiovascular exercise
program (i.e., walking) reduces your risk of
dying prematurely by 50 percent!
i.
sidEbar
A sidebar is a private conversation lawyers have with the judge during a trial.
Before I present my main case that explains WHY exercise is essential, I want
to start by addressing the elephant in the room: Most people don’t exercise. As
the judge and jury in this case, you—the reader—should wonder why this is so.
The reasons are varied and have made it very difficult for public health officials
to get more Americans moving. This first section is a discussion about behavior
change, a chat between the two of us. It may give you some ideas that increase
the likelihood of your success when starting a new exercise program.
1
1
Successful Behavior
Change: We Are the
33 Percent!
W
hen was the last time you successfully and permanently changed a longterm, deeply ingrained habit? Chances are the answer to that question
is, never. And the reason I can say that with confidence is because
research tells us that when a group of people attempt to change, 50 percent
drop out after a few months and perhaps as few as 33 percent of those people
are ultimately successful.1 The rest of this chapter will review two theoretical
constructs created by scientists to explain behavior (and thus suggest mechanisms for change), and give you some practical tools to facilitate change. These
tools will be fully developed in the Appendices located at the end of this book.
Stages of Change (The Transtheoretical Model)
My favorite behavior change theory was created by Dr. James Prochaska at the
University of Rhode Island in the 1970s, when he was working with people
who were trying to quit smoking. It has since taken on a life of its own and
is popular with public health professionals, who use it to provide guidelines
for creating behavior change programs. Boiled down to its essence, Stages of
Change categorizes people into one of five stages, according to their awareness
of and readiness to change a behavior. The practical application of this theory is
that it directs us to consider different plans of action when we’re dealing with
1 DISHMAN, R.K. (1991). Increasing and maintaining exercise and physical activity. Behavior
Therapy, 22, 345–378.
3
4 | Why Exercise is Important
people in different stages of change. Using exercise as our habit for discussion
purposes, let’s briefly examine each stage of change.
Pre-contemplation: “I’m Not Thinking about This.”
Someone in the pre-contemplation stage regarding exercise never thinks about exercise unless someone else brings it up first. The easiest way to remember this stage is
to link the prefix “pre-” (= before) with the root word “contemplation” (= thinking
about). By definition, a person not thinking about exercise must be sedentary, and
this absence of physical activity, as we will learn shortly, puts them at risk for developing a number of illnesses. In order to help this person change his behavior, we have
to provide education. Depending on the pre-contemplator’s exact mindset, that
education could include information that explains:
• Healthy benefits of exercise
• Unhealthy side-effects of being sedentary
• How to overcome perceived barriers to exercise like time, lack of skill,
poor environment
Contemplation: “I’m Thinking about This but It Could Be Six
Months before I Start.”
Someone in the Contemplation stage has begun to consider changing her behavior, but it will be a month or more before she will actually begin an exercise
program. In other words, change is a small desire with no concrete plan in place
that would make it very likely to occur. In order to increase the likelihood that
this person will start to exercise, she needs further education about the benefits
of physical activity and the skills necessary to construct an action plan, including
how to:
• Create SMART goals2
• Locate allies and resources
• Set an exercise schedule
Preparation: “I Will Begin Exercising This Month.”
In Preparation, a person is taking concrete steps to facilitate behavior change,
and the initiation of change is imminent. These steps could include:
2 See Appendix 1.
Successful Behavior Change: We Are the 33 Percent | 5
• Contacting a local fitness club to ask about membership dues or signing
a club contract
• Buying new sneakers
• Verifying that the high school has a public quarter-mile track
• Coordinating exercise time with a friend
• Reviewing exercise goals
Action: “Today, I Begin.”
Day 1 of the exercise program marks the beginning of the Action stage. This
stage is often considered the most volatile stage in behavior change because
it is difficult to know if the person will show up for Day 2 or Day 13 of his
exercise plan. In order to stack the odds in his favor for continued success, it is
important to focus on strategies that support the behavior. These include:
• Praise and positive reinforcement3
• Fitness assessment4
• Exercise diaries
• Goal assessment
Maintenance: “Wow, I’ve Been Doing This for Six Months!”
Six months after starting and maintaining a new behavior is considered the point
at which most people have permanently adopted a new behavior. Someone in
Maintenance has become a person who will probably exercise regularly for the
rest of her life, barring any drastic, major life change.
Relapse: Prepare or Become One of the 66 Percent
In all stages except pre-contemplation and maintenance, the chance that someone moves to another stage is high. When he moves “backward” to a prior
stage of readiness to change, we call this relapse. The most important concept
to remember regarding relapse is that MOST PEOPLE SUCCUMB! If you fail
to successfully change your behavior, you are NORMAL. Failure to change is
the most common outcome of behavior change programs.
Generally we expect about two thirds, or 66 percent of people to be unable to
maintain a behavior change. If you want to be one of the 33 percent, then you need
to have a plan of action in place so that when you suffer a minor setback (which
3 See Appendix 1.
4 See Appendix 2.
6 | Why Exercise is Important
happens to everyone, even people who successfully alter their behavior), it does not
become a major failure. People who are prepared for relapse have considered this
possibility from multiple wellness perspectives, and they:
• Expect minor setbacks (are psychologically prepared)
• Have a support person/network in place (socially prepared)
• Have SMART short-term goals5 (intellectually prepared)
• Create flexibility in their work and home environments (occupationally
prepared)
• Recognize that in the scheme of things, minor setbacks are exactly that:
MINOR (spiritually prepared)
• Know how to treat exercise-induced discomfort and injury (physically
prepared)
Stages of Change Summary
The transtheoretical model says that people are in one of five stages of change. We
need to craft our motivational messages in at least five different ways to be able to
communicate effectively with people in different stages. Most people suffer setbacks
when they try to change behavior, and one important skill needed to successfully
change is to be prepared ahead of time to deal with small mistakes.
Social Cognitive Theory
Another favored concept in behavior change planning comes from the Social
Cognitive model created by Dr. Alfred Bandura at Stanford University.
According to this model, I can predict people’s behavior if I know two things
about them: Outcome Expectation and Self-Efficacy. Furthermore, I can
increase the likelihood they will engage in a behavior if I improve those two
variables. Because these two variables are behavior specific, I’ll use exercise
behavior to explain them.
Outcome Expectations
Simply put, an Outcome Expectation is someone’s belief that when she engages
in exercise, a certain outcome will occur. That outcome could be perceived as
positive (burned calories) or negative (hot and sweaty). Someone with positive Outcome Expectation is someone who is likely to exercise. Someone with
5 See Appendix 1.
Successful Behavior Change: We Are the 33 Percent | 7
negative Outcome Expectation will not exercise. In order to make someone’s
Outcome Expectation positive, I need to:
• Educate them about the positive aspects of exercise
• Reorient their thinking about the negative aspects of exercise
–– Hot and sweaty = physical proof you are burning calories
Self-Efficacy
Self-Efficacy is the perception a person has about his own competency to engage in a behavior. Someone who feels incompetent (“I don’t know how to
use weight room equipment.”) is unlikely to engage in exercise, while feelings
of competency increase exercise participation. Someone with high exercise selfefficacy has confidence and competence and therefore is likely to perform it.
Bandura’s theory states that there are four ways to increase someone’s exercise
self-efficacy.
Performance Mastery
Performance mastery is the single most effective way to increase someone’s
self-efficacy. To quote a famous advertising slogan, it can be summarized as
“Just Do It.” Start walking. Use the weight equipment at your gym. Go to
a yoga class. The more frequently you do these things and have success (“I
WAS able to bench press the 45-pound bar with a little help from a friend who
spotted me.”), the greater your self-efficacy becomes. And as your self-efficacy
improves, your willingness to raise the bar improves.
Of course, it is important to have realistic expectations about your ability
to “Just Do It” because the key to Performance Mastery is a successful bout
of exercise. Therefore, when planning your exercise routine, you should build
steady progression into your workout. Start with something you have every
reason to expect you can accomplish (“My goal today is to walk two laps around
the quarter-mile track”) and then increase your output over time. (“Two weeks
from now my goal will be to walk four laps.”)
Vicarious Experience
When we turn to role models and emulate their behavior, we are using vicarious
experience to motivate us. If we choose good role models—that is, role models
who are appropriate for us, who resemble us across as many variables as possible
(age, sex, socioeconomic background, etc.)—their performance of the exercise
we hope to adopt can help us become more confident. “Well, if Rick can do
8 | Why Exercise is Important
that beginner’s yoga class, I definitely can. We grew up together, go to the same
school now—he isn’t different from me.”
When you’re thinking about adopting a new exercise behavior but still feel
shaky about the whole thing, find somewhere that people like you go to do it
and WATCH them. If you don’t know where people like you go to exercise,
ask your friends (who tend to be like you). If that doesn’t work, ask a trusted
mentor/teacher/adviser. Someone will have the information you need.
Social Persuasion
In one word: Encouragement. Find people around you who will encourage
you to exercise and compliment you when you are successful. Use your social
media outlets (Facebook, etc.) to document your exercise goals and progress
for your friends, and explicitly tell them to “like” your achievement posts and
to post their own words of encouragement on your page, particularly when you
mention you have accomplished something significant.
Consider hiring a personal trainer or wellness coach, particularly during your
early weeks in the Action stage.
Adopt technology that can act as a proxy for a personal trainer, giving you
positive feedback when you achieve your exercise goals. Personal tech could
include data-recording wristbands like Flex, FuelBand, or UP and mobile apps
like MyFitnessPal and RunKeeper. Web tech could include a site like MyPlate.
gov, where you can track your exercise in an electronic diary.
Physiological Awareness
During exercise, your body’s function changes drastically (the reason it is so
beneficial), but those changes may be interpreted as either good or bad. For
example, when your heart begins beating more rapidly when you are riding
your bike in a spinning class, you could wonder if that is normal, and if unsure,
start to worry that something bad is happening to you. If this physical stress
leads to psychological stress, your self-efficacy will decrease. It is important to
understand clearly what will happen to your body when you exercise (explained
later in this book), so you know when it is appropriate to worry that something
is wrong, or when to accept that, “Hey, this is just what exercise feels like.”
Social Cognitive Theory Summary
Performance Mastery is the best way to increase your self-efficacy. Start exercising. Turn to your friends if you are unsure what you can accomplish—if they
can do it, you can too, eventually. Ask your friends to actively support your
Successful Behavior Change: We Are the 33 Percent | 9
behavior change by giving compliments and kudos when you earn them. Use
technology supports. Educate yourself about the typical physiological changes
that accompany exercise. Exercise does change you, but that’s the whole point.