American College of Sports Medicine
ACSM
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
FIT SOCIETY PAGE
EXERCISE FOR HEALTH
How Much Exercise is Enough?
ACSM Works with Others to
Avoid Misunderstanding
People generally approach exercise in the
winter months with an all-or-nothing
attitude. They mark the season with a
resolution that usually involves physical
activity, or they decide to hibernate from
the cold, and conserve their energy. For
the millions that choose to step up or start
an exercise program sometime this winter,
whether for weight loss or to enhance their
overall health, fitting exercise into a busy
daily schedule is often a challenge. We
know physical activity improves our health
and helps prevent disease, so making
time to move each day is important. But
how much is enough? An hour a day?
Or does 30 minutes suffice?
A prestigious scientific panel of the
Institute of Medicine (IOM) released a
report on dietary guidelines last fall that
called for 60 minutes of moderately
intense physical activity each day in order
to maintain weight. While a news release
and subsequent media coverage implied
otherwise, the report actually supported
the long standing recommendation from
the American College of Sports Medicine
(ACSM) and U.S. Centers for Disease
Control and Prevention (CDC) that health
gains can come from as little as 30
minutes of moderate intensity physical
activity most days of the week, with more
duration and intensity providing greater
health benefit. Additional scientific and
clinical evidence, including the Surgeon
General’s Report on Physical Activity and
Winter 2003
®
A Quarterly Publication of the
American College of Sports Medicine
Inside
Health, have supported the 30-minute LETTER FROM THE EDITOR
recommendation, noting more physical page 2
activity is even better. Following the
release of the IOM report, some media Q&A WITH ACSM
coverage implied the previous 30-minute page 2
recommendation was being replaced by
the 60-minute recommendation. This OBESITY
misinterpretation caused many to express
page 3
concern over confusion caused by two
“different” exercise recommendations. To
eliminate the confusion, ACSM and other EXERCISE VALUABLE
organizations are working together to FOR MENTAL HEALTH
emphasize impor tant points of page 4
consistency, even though the
recommendations serve different HYPERTENSION
purposes (30 minutes, which is a sufficient page 5
amount of physical activity to gain some
health benefit versus the 60-minutes THE ROLE OF EXERCISE
recommendation of activity, which may be IN RECOVERY FROM
required for many to avoid weight gain.)
CANCER TREATMENT
The report has opened the door for the
scientific and clinical community to further page 6
examine the research and evidence of
linkages among physical activity, diet, and FOODS TO KEEP
health. But in the interim, with the YOUR BODY HEALTHY
prevalence of people who get no daily page 7
exercise at all, and the rise of obesity in
the United States, it is important to clarify
and reinforce that just small increases in
physical activity, as little as 30 minutes a
day, can improve health.
Because many Americans already lead
sedentary lifestyles, 60 minutes of
(Continued on page 8, see Exercise for Health) www.acsm.org
®
Winter
1 2003
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org Winter 2003

American College of Sports Medicine Dixie L. Thompson, Ph.D., FACSM maintain and enhance physical performance, fitness

FIT SOCIETY PAGE

University of Tennessee health, and quality of life.

For more information on subjects discussed in this issue

® and/or a catalog of all ACSM publications, please send a
ACSM Fit Society® Page Editorial Board:
Jeffrey A. Potteiger, Ph.D., FACSM, Editor
Virginia Commonwealth University
Katherine A. Beals, Ph.D., R.D.
Ball State University
Lisa K. Lloyd, Ph.D.
Southwest Texas University
Jeffrey L. Roitman, Ed.D., FACSM
Chair, ACSM Publications Committee
Christa Dickey
Director of Communications & Public Information
D. Mark Robertson
Assistant Executive Vice President, Group Publisher
Beau Keyes
Director of Publications and Marketing
self-addressed, stamped envelope to: American College
of Sports Medicine, P.O. Box 1440, Indianapolis, IN
46206-1440.
Permission to reprint material from this publication is
granted by ACSM contingent upon manuscripts being
reprinted in total without alteration and on proper credit
given to ACSM by citing ACSM Fit Society Page, Issue
®

Martha Pyron, M.D.
Penn State Health System
Bryan W. Smith, M.D., Ph.D.
University of North Carolina
ACSM is the world’s largest association devoted to sports
medicine and exercise science. The College's mission is
to promote and integrate scientific research and practical
applications of sports medicine and exercise science to
and Page Number; e.g., “Reprinted with permission of the
American College of Sports Medicine, ACSM Fit Society
®
Page, Winter 2003, p. 3.”

Letter from the Editor

Welcome to the Winter 2003 issue of the ACSM Fit Society® Page. In this edition of the newsletter, sports medicine and exercise
science experts examine Exercise for Health. If you are interested in learning how an exercise program can help improve your
cardiovascular and immune system function, this is the issue for you. Specific articles on hypertension, cancer and obesity provide
information on how exercise can help you effectively manage those conditions. As always, we have regular features including the
Athlete’s Kitchen and popular Question and Answer section.

We hope you enjoy this issue of ACSM Fit Society® Page and find information that you can use to enhance you and your family’s
health and wellness. If you have any questions or comments please be sure to contact us.

Jeffrey A. Potteiger, Ph.D., FACSM

Editor, ACSM Fit Society® Page
Email: jpottei@mail1.vcu.edu

Q&A with ACSM

by Bryan W. Smith, M.D., Ph.D., FACSM

Q: Can too much exercise make you sick?
A: Studies have shown that people who
exercise excessively can depress their
immune function. This increases
susceptibility to upper respiratory
illnesses and other viral illnesses. During
flu season, someone training heavily or
in their competitive season may want to
get immunized.
Q: If one’s blood pressure is well
controlled on medication, what’s the value
of exercise?
A: Exercise is beneficial in the
management and prevention of
hypertension. Hormonal and vascular
factors, as well as simple weight loss,
have been proposed to explain the effect
of exercise on lowering blood pressure.
Exercise therapy in addition to medication
may lead to a lower dose or complete
reduction in medication to control high
blood pressure.
Q: Since being placed on medication for
hypertension, I have not been able to
exercise like before. Could the medication
be the problem?
A: Yes, many blood pressure medications
may limit one’s ability to exercise.
Common antihypertensives that may
cause exercise intolerance are diuretics
and beta-blockers. If this is a problem,
don’t stop taking your medicine. Talk with
your doctor about other medications.
Q: What might place an athlete at risk for
depression?
A: Most studies suggest athletes
demonstrate fewer psychiatric problems.
However, the highly driven, perfectionistic,
goal-oriented athlete in which those
attributes likely contribute to athletic
success can place the athlete at risk for
depression if he/she is inflexible when
dealing with adversity. Inappropriate
increases in training volume and intensity
leading to chronic fatigue may signal a
problem. Disordered eating may
accompany overtraining.
Q: My child has diabetes and just started
playing on a local soccer team. What
problems should the coach and I watch
for and what should my child have with
her at practices and games?
A: The most common complication of
exercising with diabetes is hypoglycemia
(low blood sugar). This may occur during
or up to 24 hours after exercise. The extent
of the drop in blood sugar usually depends
on the duration and intensity of the activity.
Have your child eat more carbohydrates
one to three hours before exercise, and
drink juice or a sports drink every 20 to
30 minutes during exercise. A diabetic
should always bring a glucometer, food,
and fast-acting carbohydrates (hard
candy or juice) to the sporting venue.

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A Quarterly Publication of the American College of Sports Medicine • www.acsm.org Winter 2003

Feature
OBESITY:
Trying to Figure it All Out
by Jeffrey A. Potteiger, Ph.D., FACSM

concerning energy intake and physical

• Angina pectoris (chest pain) activity can lead to an energy imbalance.
• Congestive heart failure The changing environment in America
• Stroke has increased food options and changed
Many people are aware that the world’s
• Gallstones the way we eat. Stores stock their shelves
leading health experts agree we are in an
• Cholescystitis and cholelithiasis with a greater selection of products. Pre-
obesity epidemic. Rarely does a day go
• Gout packaged foods, fast food restaurants,
by that lacks a report or pivotal new finding
• Osteoarthritis and high calorie drinks are more
about weight control, diet, or physical
• Obstructive sleep apnea and accessible. While these foods are fast and
activity. How does one sort through all
respiratory problems convenient, they also tend to be high in
this information and determine what to do?
• Some types of cancer (endometrial, fat, sugar, and calories. Eating too many
Just as we need to be smart consumers
breast, prostate, and colon) of these foods may contribute to an
of the goods and ser vices that we
• Complications of pregnancy excessive calorie intake. Often foods are
purchase, individuals need to be intelligent
• Poor female reproductive health marketed as healthy, low fat, or fat-free,
about the information we consume. There
(menstrual irregularities, infertility, but may contain more calories than the
is likely no one cause for the obesity
irregular ovulation) fat containing food they are designed to
epidemic, and unfortunately there is no
• Bladder control problems (stress replace. Because portion size has also
easy cure.
incontinence) increased, people may be eating more
• Uric acid nephrolithiasis during a meal or snack. This results in
Obesity is a health risk
• Psychological disorders (depression, increased energy intake. If an individual
eating disorders, distorted body does not burn off the extra energy
Being overweight or obese has been
image, and low self esteem). consumed, then weight gain can occur.
linked to a number of health
consequences. Individuals with a Body
Mass Index, a calculation used to assess Our bodies need energy so we can
Factors contributing to obesity perform daily functions. Weight gain
appropriate weight relative to height, of
25 and higher are at increased risk for occurs when the energy consumed
Unfortunately in America, we too often exceeds the energy we expend. Physical
physical complications such as
blame something or someone when activity plays a key role in energy balance
cardiovascular disease and diabetes
things don’t go the way we would like. because it helps us use that energy we
(Table 1.)
There are a variety of factors that play a consume.
role in the development of overweight and
obese people, making it a difficult health Regular physical activity is good for overall
Table 1: Health Consequences of
issue to address. Obesity is a result of health. Physical activity helps control
Obesity (Adapted from the National
energy imbalance over a long period of weight and decreases the risk for a
Center for Chronic Disease Prevention
time resulting in weight gain. The cause number of diseases. Physical activity
and Health Promotion).
of weight gain for each individual may be does not have to be performed at a hard
• High blood pressure
due to a combination of factors including level to provide health benefits. For
• High blood cholesterol
individual behavior, such as the choices example, 30 minutes of brisk walking on
• Dyslipidemia
a person makes in eating and physical a daily basis can improve cardiovascular
• Type 2 (non-insulin dependent)
activity, environment, and genetics. fitness and decrease the risk of
diabetes
• Insulin resistance and glucose developing certain diseases. Despite the
Weight gain is a result of too many
intolerance
calories consumed, a decrease in calories
• Hyperinsulinemia
used, or a combination of both. The
• Coronary heart disease (Continued on page 8, see Obesity)
personal choices individuals make

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A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Feature
EXERCISE VALUABLE FOR
MENTAL HEALTH
by Bradley Hack, Ph.D.
KEYWORDS:
Depression,
Exercise,
Treatment
Those who are depressed often feel a
sense of sadness, but sadness by itself
is a normal emotion to experience during
the course of life. Depression is more than
feeling sad, it is defined as a cluster of
symptoms. Clinical depression occurs
when a person experiences at least five
of nine symptoms for two weeks or longer.
The symptoms of depression can be
broken down loosely into physical and
cognitive-emotional symptoms. The
physical symptoms include changes in
sleep or appetite patterns, fatigue, and
psychomotor agitation or retardation (the
speeding up or slowing down of
movements). The cognitive-emotional
symptoms include sadness, decreased
concentration, a loss of interest and
pleasure, feelings of worthlessness or
guilt, and suicidal thoughts or actions.
Depression is by far the most common
psychological disorder. The prevalence
of depression in both U.S. and European
populations is estimated at any given time
to range from about five to six percent for
adolescents, to about 10 to 11 percent
for young adults, to as high as 21 percent
in elderly populations. The impact of
depression on people’s lives is
multifaceted and varies from individual to
individual. Those who suffer with it often
struggle to get out of bed each morning
and feel that it takes a Herculean effort to
accomplish the normal activities of daily
living. They may have difficulty making it
to work or school, and may be inclined to
avoid and withdraw from social
interactions. Their thinking also tends to
become skewed, as they will often view
themselves and the world through
negative “lenses.” They are often severely
self-critical and have great difficulty seeing
the bright side of things.
Benefits of Exercise
There are a number of treatments for
depression, including psychotherapy and
medication, both of which have been
found to be about equally effective by
themselves, with the combination of both
therapies typically being the most
effective. Not everyone is responsive to
these treatments, however, and
researchers and practitioners have turned
to exercise as an adjunct and alternative
to the traditional methods. Exercise has
long been recognized for its powerful
impact on improving physical health, and
now is increasingly recognized for
improving mental health. There are
consistent findings in research literature
that exercise is most helpful for those with
mild to moderate depression. Some
evidence suggests that its effectiveness
is comparable to individual, group, and
cognitive therapy, while other evidence
indicates that exercise is comparable to
antidepressant medications in reducing
symptoms and associated with a smaller
likelihood of relapse than medication.
As far as the specific type of exercise that
is most helpful, the research findings are
still a bit unclear. There are some who
have found aerobic exercise more
effective than resistance training, while
others have found that both are equally
effective in reducing depression. What
also remains to be determined is exactly
what accounts for this positive effect of
exercise on depression. Some believe
that there is a process that occurs during
and after exercise that confers an
4
Winter 2003
enduring resilience to stress, and
subsequently depression as well. This
process may occur through strictly
physiological changes that occur in the
body as a result of exercise (e.g., the
release of endorphins in the brain that can
lead to a “runner’s high”) or it may also
occur due in part to the psychological
interpretation of exercising (e.g., setting
and accomplishing goals, feeling
productive and capable). In all likelihood,
it is probably some combination of both
that will ultimately explain this process.
More and more physicians and therapists
are “prescribing” exercise for their
depressed patients. A clinician who
wishes to incorporate physical activity into
their treatment may help the patient
design concrete goals with reasonable
planned steps to accomplish them. For
the goals to be effective, they must be
SMART: Specific, Measurable, Attainable,
and Reasonable, with Targeted dates for
success. This process of setting and
achieving goals can help the depressed
person gain a sense of mastery and
accomplishment that is very concrete and
serves as evidence against their self-
critical thoughts. It can also help reduce
the sense of fatigue and improve sleep
and appetite patterns. Clinicians who are
not knowledgeable about various types
and routines of exercise should assist the
patient in finding a qualified and certified
personal trainer to design a safe and
effective exercise regimen. Furthermore,
as long as the exercise regimen is
reviewed with the patient’s physician and
approved, there are very few negative side
effects from this type of treatment. In other
words, it can definitely help and is not
likely to hurt.
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Feature
HYPERTENSION
Bring it Down With Exercise
by Cathryn Dooly, Ph.D., FACSM
KEYWORDS: high
blood pressure;
hypertension;
aerobic exercise;
risk factors; stroke,
heart attack; sedentary lifestyle;
strength training; arterial disease
Approximately 50 million adults in the
United States have hypertension, a
dangerous condition that may lead to
heart attack, stroke or kidney failure. It
occurs when small blood vessels (called
ar terioles) become constricted or
narrowed, making it very difficult for blood
to pass through them. As a result, blood
pressure increases, causing your heart to
work harder. This added strain contributes
to heart attacks and stroke, and damage
to the arterioles known as arterial disease.
When your heart is forced to work harder
than usual for an extended period of time,
it usually tends to enlarge. A slightly
enlarged heart can still function well, but
a significantly enlarged heart cannot.
Are you at risk?
The following risk factors may increase
your chances of developing hypertension:
• History of hypertension in your family
• A pre-existing condition such as
diabetes or kidney disease
• Male; are of African American descent
• Over 35 years of age
• Smoking
• Obesity
• Use of oral contraceptives (birth control)
• Frequent consumption of alcoholic
beverages
• Leading a sedentary lifestyle.
If your blood pressure at rest stays at 140/
90 or greater, you may have hypertension.
Your physician or health care professional
should be able to confirm that you have
hypertension, and help you manage the
condition effectively.
Unfortunately, hyper tension has no
concrete symptoms. On occasion, people
may complain of headaches or dizziness,
but for the most part, there really are no
symptoms to warn you of the condition.
Because of this, the best way to assess
whether you have hypertension is to have
your blood pressure checked regularly.
Blood pressure should be checked
regularly at least once every two years
regardless of age.
Below are guidelines for the classification
of hypertension, according to the Joint
National Committee on Detection,
Evaluation and Treatment of High Blood
Pressure (1997).
Classification SBP DBP
Optimal <120 <80
Normal <130 <85
High Normal 130-139 85-89
Mild Hypertension 140-159 90-99
Moderate
Hypertension 160-179 100-109
Severe
Hypertension >180 >110
Manage Hypertension with Exercise
Mild to moderate hypertension can be
treated through behavior modification
such as diet and exercise. Dietary
changes include consuming more whole
grains, fresh fruits and vegetables, cutting
down on high sodium foods such as chips,
processed meats, fast foods, cured or
smoked products, and prepared foods.
Cholesterol intake should be limited to no
more than 100 mg/1000 calories of food
and saturated fat to no more than 10
5
Winter 2003
percent of daily calories.
It is unfortunate that more than 50 percent
of those with hypertension also maintain
a sedentary lifestyle. The outcome of a
regular exercise program can bring about
significant decreases in blood pressure,
and even reduce the need for medication
in some cases. The American College of
Sports Medicine (ACSM) recommends
“aerobic” exercise for mild and moderate
hypertensives (blood pressures in the
range of 140-180/90-105), since this type
of exercise training will elicit an average
reduction of about 10 mmHG for both
systolic and diastolic blood pressures. An
effective exercise training program
involves activities that are rhythmic,
repetitive, and which stress the
cardiovascular system as well as large
muscle groups. The term “aerobic” refers
to activities that significantly increase
blood flow to the working muscles for an
extended period of time, such as walking,
hiking, jogging, cycling, swimming,
jumping rope and roller-skating. The
duration of exercise should be in the range
of 20 to 60 minutes at a frequency of three
to five days/week, and an intensity of 70-
85 percent of your age-predicted maximal
heart rate. To find your exercise intensity,
subtract your age from 220 to get your
age-predicted maximal heart rate. Then,
multiply by 70 percent and 85 percent to
get your intensity range. If just beginning
your exercise program, you should
exercise at the lower end of the range (70
percent) and slowly progress to the higher
end (85 percent).
Research shows that physically active and
aerobically-fit patients with hypertension
have significantly lower rates of mortality
than sedentary, unfit hyper tensive
(Continued on page 9, see Hypertension)
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Feature
THE ROLE OF EXERCISE IN RECOVERY
FROM CANCER TREATMENT
by Carole M. Schneider, Ph.D., FACSM and Susan D. Carter, M.D., Rocky Mountain Cancer Rehabilitation Institute
Keywords:
exercise, cancer,
recovery,
rehabilitation
Significant reductions in cancer mortality
have been aided by advances in
technology and enhanced educational
strategies. Approximately 8.9 million
Americans are surviving cancer, but
between 70 to 95 percent of all cancer
patients experience negative physiological
and psychological side effects from the
treatment regimen, which can last for
years beyond the treatment. Loss of
energy, debilitating fatigue, muscular
weakness, abnormal blood profiles, and
changes in emotional status are some of
the effects of cancer treatment, which
often times result in a decline in normal
daily activity and loss of quality of life.
Exercise intervention for cancer patients
during and following treatment has been
receiving substantial support to enhance
their quality of life. Research on exercise
rehabilitation for the cancer patient has
demonstrated significant improvements in
functional (energy) capacity, muscular
strength and endurance, fatigue,
depression, anxiety, and quality of life.
Beginning a Cancer Rehabilitation
Program
To begin a rehabilitation program involving
exercise, cancer patients should work with
their health professionals to develop
specific routines that have been proven
effective. The Rocky Mountain Cancer
Rehabilitation Institute has found that the
essential components of a cancer
rehabilitation program should include: 1)
collection and analysis of complete
medical and cancer histories; 2) medical
evaluation by a physician prior to any
fitness assessment or exercise
intervention; 3) comprehensive fitness
assessment that includes evaluation of
cardiovascular function, pulmonary
function, muscular strength, muscular
endurance, range of motion, and flexibility;
4) development of individualized exercise
prescriptions and individualized exercise
interventions; 5) reassessments every six
months until cancer treatment-related
symptoms are diminished or eliminated;
and 6) trained and certified cancer
exercise specialists.
Complete medical and cancer histories
are essential for health and fitness
professionals to develop and understand
the cancer patient’s tolerance and special
considerations for exercise. Significant
information about the individual should be
relayed to the cancer exercise specialists
performing the fitness assessments,
developing the individualized exercise
prescription, and conducting the exercise
intervention program prior to any
procedures being conducted on the
patient.
Medical examinations overseen by a
physician should be performed prior to
any testing or intervention to provide
critical information about the patient’s
health status. Specific modifications can
be incorporated into the assessment
process and used to adapt the exercise
prescription to insure safety and enhance
the success of the exercise program.
Health care professionals working with
exercise and the cancer patient should be
trained and certified cancer exercise
specialists. Cancer patients have special
considerations during rehabilitation,
particularly due to their exposure to
treatment therapies. Individuals working
with these patients must have an
understanding of cancer, cancer
6
Winter 2003
treatments, cancer treatment toxicities,
and the role of exercise for these
individuals.
People beginning an exercise program
should expect a complete fitness
assessment, including cardiovascular
evaluation using a graded exercise test
on a treadmill or bicycle ergometer,
pulmonary function assessment using a
spirometer, muscular strength and
endurance assessments on specific
muscle groups using dumbbells and/or
weight machines (light weight), and range
of motion and flexibility using the modified
sit and reach and wall and hand-held
goniometers. The exercise specialist will
guide the individual through this process
in order to compile patient information and
determine both their health and fitness
status. The assessment data are used to
develop an exercise prescription that is
moderate to low intensity and
individualized for each patient. Exercise
for cancer patients should not
compromise the immune system, so
individuals should not exercise at high
intensities.
Personalized Prescriptions are Key
An individualized exercise prescription
should be given by a cer tified
professional, and contain appropriate
recommendations as to the type, duration,
frequency, intensity, and progression of
exercise specific to the patient. Cancer
patients, or those recovering from
treatment, should strictly adhere to the
personalized prescription. Physicians or
certified exercise specialists should
monitor the exercise progress in order to
modify it if the patient’s health status
changes. Considerations that help define
the individualized exercise prescription
(Continued on page 9, see Recovery)
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
The Athlete’s Kitchen
FOODS TO KEEP YOUR BODY
HEALTHY
by Nancy Clark, M.S., R.D.
Once upon a time,
certain foods, such
as bacon and eggs,
burgers and fries,
and ice cream and
cookies, were eaten
without a twinge of guilt. But as the
years pass and good health becomes
more fragile, these meals have become
known as heart-attacks-on-a-plate.
People repeatedly ask, “What are the best
foods to eat to enhance my health?” and
“What are the worst foods to eat and what
foods should I avoid?” Indeed, food can
be powerfully harmful. A bad diet
contributes not only to heart disease, but
also cancer, hypertension, osteoporosis,
obesity, kidney disease, macular
degeneration (damage to the retina) and
a plethora of other ailments. Yet, the
answer to the question about “bad foods”
is simple: the foods to avoid are items that
are moldy, poisonous, or those to which
you are allergic. Other than that, all foods
in moderation can be balanced into a
healthful diet.
Eat More of the Best
To tip the balance in favor of your good
health, focus your menu on health-
protective foods. By eating more of the
best foods and less of the rest, you can
have a powerful impact on your future
health and well being. Because genetics
play a big role in health, you also want to
take a careful look at your family’s health
history. For example, genetics likely
explains why a seemingly healthy, 48-
year-old marathoner was found dead on
a running trail. He’d stopped his watch
after running for two hours, and then
collapsed from a massive heart attack, a
death similar to that of his father’s.
Genetics also explains why some women
“shrink” at an early age, ending up in pain
from osteoporosis at age 60.
We cannot change our genetics, but we
can change our diets to optimize our
health and longevity. These suggestions
are easy ways to improve the quality of
your daily diet, so even if you are a junk
food junkie, you can take steps to reach
your life’s potential.
Tip #1: Front-load your calories
Do not “hold off” until dinner to eat a huge
meal. People who skimp on daytime
meals tend to get too hungr y and
consequently experience powerful
cravings for sweets, fats, and “junk.” Your
good intentions to eat apples and carrots
can get trampled in a stampede to devour
apple pie and carrot cake. By eating a
heartier breakfast, lunch and a planned
afternoon snack (or even a second lunch,
if dinner won’t be until after 7 p.m.), you’ll
consume more nourishing foods. Cereal,
milk and a banana at 7 a.m. can cure
cravings for donuts, pastries or croissants
at 10 (and even at 10 p.m. for that matter)
and reduce the risk of gaining weight. A
survey of dieters who lost weight and have
kept it off suggests eating breakfast is a
key to successful weight management.
When you fuel your body with wholesome,
hearty meals by day, you are able to eat
less at night. Make it your goal to wake
up hungry for breakfast!
Tip #2: Eat more whole foods
Enjoy more whole apples instead of apple
juice; more whole wheat breads instead
of breads, pitas and wraps made from
refined white flour; more whole grain
cereals like granola instead of sweetened
brands. By choosing more whole foods,
you get more fiber. Fiber is satisfying; it
helps you feel full longer and curbs your
appetite so you end up eating fewer
7
Winter 2003
sweets and fats without feeling denied or
deprived. Whole foods also offer more
vitamins and health protective
phytochemicals that help your body’s
engine run smoother.
Tip #3: Eat fruit in the morning
Of all health-protective foods, fruits are
among the best. Yet most Americans eat
way too little fruit; it is often unable to
compete with chips, cookies and candy.
The easiest way to improve your fruit
intake is to make a point of eating fruit for
breakfast, such as a banana on cereal
plus a glass of orange juice. (Yes, eating
the whole orange would be preferable, but
when time is tight, drinking orange juice
is better than having no juice or fruit.
Calcium-fortified juice offers an extra
bonus). Choosing fruit for snacks
throughout the day can displace “junk.”
Some fruits offer more nutrients than
others, so try to eat more of the best:
oranges (or orange juice), grapefruit, kiwi,
bananas, cantaloupe, strawberries and
mango.
Tip #4: Eat more veggies
Munching on pre-dinner carrot sticks or
green pepper strips is a healthful
alternative to munching on chips. Frozen
broccoli, spinach or winter squash are
easy options for days when you lack time
to shop for fresh veggies. Your goal should
be to have veggies cover one-third of your
dinner plate. This can reduce your risk of
over-indulging in steak or French fries.
Tip #5: Eat more peanut butter and
nuts
Although nuts are high in fat, their oil is
health-protective. Research suggests
people who eat nuts (including peanut
butter) five or more times a week have a
(Continued on page 9, see Food)
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Exercise for
Health
(Continued from page 1)
exercise a day may be perceived as a
high, unattainable goal. While consensus
is that more physical activity is better, the
interpretation of 60 minutes as a
replacement “guideline” has been the
point of confusion. ACSM was pleased
the report so clearly recognized the role
of physical activity in health and weight
maintenance. After it was issued, ACSM
assembled an expert group to clarify to
the media the continuing validity that
numerous health benefits can be obtained
with 30 minutes of moderate activity on
most days of the week, particularly for
sedentary adults who may be intimidated
or frustrated by accomplishing an hour of
activity a day. Steven N. Blair, P.E.D.,
FACSM, who served as senior scientific
editor of the U.S. Surgeon General’s
Report on Physical Activity and Health;
Russell R. Pate, Ph.D., FACSM, an
international expert in physical activity and
youth, and lead author on the ACSM/CDC
public health recommendations for
physical activity; and Edward T. Howley,
Ph.D., FACSM, ACSM President, led the
ACSM response.
“If people perceive the recommendation
has been increased to 60 minutes of
moderate physical activity per day, and
less than that does no good, the
Obesity
(Continued from page 3)
benefits of being physically active, most
Americans remain sedentary. Modern
technology has created many time-and-
labor saving products. These recent
lifestyle changes have reduced the overall
amount of energy expended in our daily
lives.
The belief that physical activity is limited
to exercise or sports may keep people
from being active. Individuals also believe
that physical activity must be vigorous to
achieve health benefits. However, any
misunderstanding of the report has the
potential to dissuade the most sedentary
from initiating a pattern of moderate
physical activity that would be a healthy
lifestyle change. No one wants that,” said
Howley.
The IOM report cites 30 minutes of
moderate intensity activity (above activities
of daily living) is sufficient to raise the
Physical Activity Level (PAL) of an
individual from the sedentary to the low-
active category. According to Dr. Blair, a
half-hour of moderate intensity physical
activity is a good starting point for the 40
to 50 million U.S. adults who are sedentary;
and it’s a message that needs to be
reinforced.
“Previous physical activity recommendations
underscore numerous important health
benefits are obtained when 30 minutes of
moderate activity are done on most days
of the week. The scientific data supporting
this recommendation are conclusive, and
I think sedentary adults are well advised
to meet that consensus recommendation,”
said Dr. Blair. “Building up to 60 minutes
of moderate intensity per day may further
reduce the risk of weight gain over time
and will provide additional health benefits.”
The report emphasizes the importance of
balancing diet with exercise. However,
experts point out that the amount of
physical activity required for maximal or
optimal health benefits is unknown, and
physical activity that results in bodily
movement causes an increase in energy
expenditure. Moderate-intensity activities
such as household chores, cutting the
grass, gardening, and walking can provide
health benefits.
Our genetic makeup may also play a role
in obesity development. Genes can
directly cause obesity in disorders such
as Bardet-Biedl syndrome and Prader-
Willi syndrome, but genes do not always
predict one’s future health. More than 100
different genes have been identified that
may contribute to the development of
obesity. Genes alone may not be the sole
contributor to obesity development as
8
Winter 2003
more research is needed to advance our
understanding. “We also are uncertain
about the amount of activity necessary to
prevent weight gain, and there is extensive
individual variation. For example, some
individuals never exercise, yet also do not
gain any weight over their adult years, while
others gain a substantial amount of weight
despite daily jogging,” said Blair.
The earlier physical activity
recommendations acknowledge additional
benefits can be obtained by greater
amounts of activity, but experts contend
the “more is better” exercise message is
better conveyed when emphasizing
sedentary people need to establish a
regular pattern of activity first, and then
ideally increase it over time. If achieving
60 minutes per day seems impractical,
experts recommend focusing on 30
minutes a day, or shorter bursts of activity
such as three 10 minute walks.
For more information on enhancing
physical activity in your life, please visit the
ACSM Web site at http://www.acsm.org.
For a free copy of the booklet, Fitting
Fitness In, Even When You’re Pressed for
Time, please send a self-addressed,
stamped letter-sized envelope to:
American College of Sports Medicine
Public Information
PO Box 1440
Indianapolis, IN 46206-1440
behavior and obesity promoting
environments may be needed for a person
to gain weight. In some cases multiple
genes may increase an individual’s
chances for weight gain, but
environmental and behavioral factors
such as an abundant food supply or little
physical activity are also required.
Where do we go from here?
The treatment of obesity is likely to be
difficult because the cause of obesity
appears to be a combination of genetic
influence, individual behavior, and
environmental conditions. As the long-
(Continued on page 9, see Obesity)
A Quarterly Publication of the American College of Sports Medicine • www.acsm.org
Hypertension
(Continued from page 5)
patients. This is probably because aerobic
exercise training also improves other
cardiovascular risk factors such as
obesity, high cholesterol in the blood, and
diabetes. But what about strength
training? At this time, ACSM is not
Recovery
(Continued from page 6)
include the type of cancer, the stage of
cancer, the type and severity of treatment,
the time out from treatment, the blood
profile exhibited during and following
treatment, and other symptoms that
manifest during and following treatment.
Exercise programs for cancer patients
should be developed from the screening
information, the exercise assessments,
and the exercise prescription. Patients
that are in treatment will not have “linear”
progression from exercise session to
exercise session. They should expect to
Foods
(Continued from page 7)
50 percent lower risk of heart disease.
While peanut butter on a whole-grain
bagel for breakfast may seem like a
decadent treat to some folks, it can be an
honorable breakfast choice. For more
balance, add a glass of lowfat milk and/or
a banana.
Peanuts are perfect for afternoon snacks;
you can easily file them under “emergency
food” in your desk drawer. They don’t spoil
Obesity
(Continued from page 8)
term management of obesity and its
associated disease conditions is
recommending strength training as the
only form of exercise training for
hypertensives, as it has not been shown
to produce a consistent decrease in blood
pressure. Rather, an aerobic exercise
training program should be combined with
strength training as the combination of the
two has been shown to reduce both SBP
and DBP by as much as 13 mmHG each.
Other lifestyle changes you can make that
experience “ups and downs” from the
cancer treatment; therefore before each
exercise session the cancer exercise
specialist should re-evaluate the exercise
prescription. Once treatment is
completed, exercise results may become
more consistent. During the exercise
program, whether for a patient during or
following cancer treatment, the “whole”
body approach is recommended. Cancer
treatments affect all physiological systems
in the body; therefore work the entire body,
not just one body segment each exercise
session. Keep exercise intensity at
moderate to low levels, such as walking
briskly on a treadmill. Reassessments of
and are satiating enough to reduce your
dinner appetite plus provide the energy
you need to cook a healthy dinner.
Tip #6: Eat fish at least twice a week
People who eat two or more fish meals
per week have a lower risk of heart
disease. If you have tuna for lunch once
or twice a week, and fish or seafood when
you dine in restaurants, you’ll easily
enhance your fish intake. Or, simply cook
fish at home a few times a week.
Tip #7: Eat more soy foods
Some folks enjoy a glass of chocolate soy
challenging and not cost-effective, it is
apparent that increased focus by
government officials, health care
providers, and individuals needs to be on
obesity prevention. Future issues will
Winter 2003
can lower cardiovascular disease risk
include reducing excess body weight;
limiting daily alcohol consumption to less
than two ounces of whiskey, 10 ounces
of wine, 24 ounces of beer; engaging in
relaxation techniques such as yoga or
deep breathing exercises; and smoking
cessation.
fitness status are necessary to monitor
the progress and specific changes that
result from the exercise intervention. They
should be conducted every six months
during exercise intervention programs, but
this time may vary depending on the
health status of the individual.
Patients and health and fitness
professional should work together to
include the appropriate components in a
cancer rehabilitation program in order to
assure the appropriate frequency,
duration, intensity, and progression to aid
in the recovery process.
milk for a bedtime snack. Others cook
soy sausage or soy bacon for breakfast.
Many prefer soy in native Indian, Chinese,
and Thai cuisines. Others choose soy
protein bars. Whatever your method, soy
is a healthful choice. The trick is to plan
ahead, so you can consume soy daily
(ideally three or four servings each day).
Tip #8: Plan time to food shop
If you schedule weekly time for food
shopping, you’ll enhance the likelihood of
having wholesome, health-protective
foods readily available. Good nutrition
starts in the supermarket!
address the role of physical activity,
exercise, and nutrition in the prevention
of weight gain and the treatment of
obesity.