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101
Moderate Physical Activity:
A Lifestyle Approach
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Define moderate physical activity and differentiate it from
light and vigorous physical activity.
▶ Describe the health benefits of moderate physical activity,
and explain why moderate physical
activity is the most popular form of physical activity .
▶ Describe and explain the FIT formula for moderate physical
activity.
▶ Plan a personal moderate physical activity program based on
SMART goals, and self-monitor
your plan.
▶ Evaluate your current environment and determine ways to
modify it to encourage moderate
physical activity.
C
o
n
c
e
p
t 6
The Physical Activity Pyramid ▶ Section III
Moderate-intensity activities,
including lifestyle activities, have
many health and wellness benefits
when performed regularly.
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102 Section 3 ▶ The Physical Activity Pyramid
regardless of fitness level or age. Moderate activities include
some activities of daily living as well as less intense sports
and recreational activities. Taking a brisk walk is the most
obvious example of incorporating
moderate activity into daily living.
However, activities of daily living,
such as walking the dog, garden-
ing, mowing the lawn, carpentry, or
housework can count as moderate activities. Moderate
sports and recreational activities not considered to be vig-
orous enough to be placed at step 3 of the physical activity
pyramid can also be used to meet the moderate physical
activity guideline (e.g., playing catch, shooting baskets,
recreational bike riding, and casual rollerblading).
Moderate physical activity can be distinguished
from “light” activity and “vigorous” activity. Scien-
tists have devised a method to classify levels of activity
by intensity. With this system, all activities are compared
against the amount of energy expended at rest.
Resting energy expenditure is defined as 1 “metabolic
equivalent” or 1 MET. Other activities are then assigned
values in multiples of METS. For generally healthy adults,
moderate-intensity activities require an energy expen-
diture of 3.0 to 6.0 METS.
This means that they require
between three and six times the
energy expended while at rest.
Moderate-intensity activities
are often referred to as aerobic
physical activities because the
aerobic metabolism can typi-
cally meet the energy demand
of the activity. This allows
moderate-intensity (aerobic)
activities to be performed com-
fortably for extended periods of
time by most people.
Activities above 6 METS
are considered to be vigorous
physical activities and these
cannot usually be maintained
as easily unless a person has a
good level of fitness. Examples
include more structured aero-
bic activities (e.g., jogging,
biking, swimming) or vigor-
ous sports (e.g., soccer). Activi-
ties below 3.0 METS can be
classified as “light intensity”
but researchers now distin-
guish light activity (1.5 to 3.0
METS) from sedentary activ-
ity (1.0 to 1.5 METS) which
primarily captures sitting and
lying time. Examples of light
H umans are clearly meant to move, but the nature of our
society has made it difficult for many people
to lead active lifestyles. Cars, motorized golf carts, snow-
blowers, elevators, remote control devices, and email are
just some of the modern conveniences that have reduced
the amount of activity in our daily lives. Only a small per-
centage of adults get enough regular physical activity to
promote health and wellness benefits. Moderate-intensity
physical activity (which includes many lifestyle tasks done
as part of normal daily living), provides most of the ben-
efits associated with active living. In Concept 5, you were
provided with an overview of each type of physical activ-
ity. In this concept, you will learn in more detail about
moderate physical activity, the FIT formula for achiev-
ing it, and how to plan a personal program to incorporate
moderate physical activity into your daily routine.
Adopting an Active Lifestyle
Moderate physical activity is the foundation of an
active lifestyle. Moderate physical activity is included
at the base of the physical activity pyramid (see Figure 1 )
because it can be performed by virtually all people,
VIDEO 1
Figure 1 ▶ The physical activity pyramid, step 1: moderate
physical activity.
Source: C. B. Corbin
Avoid Inactivity
Energy Balance
Energy Out
(Activity)
Energy In
(Diet)
STEP 5
STEP 4
STEP 3
STEP 2
Vigorous Sports
and Recreation
Vigorous
Aerobics
Moderate
Physical Activity
Flexibility
Exercises
Muscle
Fitness
Exercises
• Tennis
• Hike
• Yoga
• Stretch
• Jog
• Bike
• Aerobic dance
• Walk
• Yard work
• Golf
• Calisthenics
• Resistance
exercise
STEP 1
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Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach
103
activities include lower-intensity activities of daily living
such as showering, grocery shopping, washing dishes,
and casual walking. While public health goals focus on
moderate activity, minimizing time spent in sedentary
activity is also important (see In the News). Distinctions
among the types of activities are summarized in Table 1 .
Because moderate activities are relatively easy to
perform, they are popular among adults. Walking
is the most popular of all leisure-time activities among
adults. According to the National Sporting Goods Asso-
ciation, 96 million Americans say they walk for exercise,
nearly twice the number that participate in the second
and third most popular activities, exercising with equip-
ment and swimming. Women walk more than men, and
young adults (18–29) walk less than older adults, probably
because of more involvement in sports and other vigor-
ous activities. Walking behavior ranges from occasional
walks to walking regularly to meet national physical
activity guidelines. As many as 40 to 50 percent of adults
say they walk, but less than half that number report walk-
ing 30 minutes or more at least 5 days a week.
Walking is popular in all age groups, but participa-
tion in other moderate activities varies with age. Interest-
ingly, while overall activity levels tend to decline with age,
involvement in lifestyle activity actually tends to increase.
This is because many older adults move away from vigor-
ous sports and recreation and spend more time in lifestyle
activities, such as gardening and golf. Older adults tend to
have more time and money for these types of recreational
activities, and the lower intensity may be appealing.
The advantage of moderate activity is that there are
many opportunities to be active. Finding enjoyable activ-
ities that fit into your daily routine is the key to adopting
a more active lifestyle.
Sedentary Time Can Be Harmful
Along with finding ways to get daily moder-
ate activity, recent evidence suggests that
it is also important to minimize time spent being sedentary.
Recent studies have consistently shown that excess time
spent sitting can have negative health consequences, even
if you are a physically active person. One study showed that
time spent watching TV was associated with risk of being
overweight regardless of physical activity level. Another study
showed that sedentary behavior (sitting time) was associated
with mortality after adjusting for smoking status, diet, and
level of physical activity. Avoiding sustained periods of sitting
seems to be important for reducing these risks.
What can you do to avoid extended periods of sitting during the
day?
SS
A
a
ACTIVITY
In the News
Classification Intensity Range Examples
Sedentary 1.0–1.5 METS Sitting, lying
Light 1.5–3.0 METS Showering, grocery
shopping, playing
musical instrument,
washing dishes
Moderate 3.0–6.0 METS Walking briskly,
mowing lawn,
playing table tennis,
doing carpentry
Vigorous . 6.0 METS Hiking, jogging,
digging ditches,
playing soccer
Table 1 ▶ Classifi cations of Physical Activity
Intensities for Generally Healthy Adults
Moderate Physical Activities Activities equal in
intensity to brisk walking; activities three to six times
as intense as lying or sitting at rest (3–6 METs).
MET One MET equals the amount of energy a
person expends at rest. METs are multiples of rest-
ing activity (2 METs equal twice the resting energy
expenditure).
Aerobic Physical Activities Aerobic means “in the
presence of oxygen.” Aerobic activities are activities
or exercise for which the body is able to supply ade-
quate oxygen to sustain performance for long periods
of time.
Vigorous Physical Activities Activities that are
more vigorous than moderate activities with intensi-
ties at least six times as intense as lying or sitting at
rest (. 6 METS).
Light Activities Activities that involve standing and/
or slow movements with intensities 1.5 to 3 times as
intense as lying or sitting at rest (1.5–3.0 METS).
Sedentary Activities Activities that involve lying
or sitting with intensities similar to (or just slightly
higher) than rest (1.0–1.5 METS).
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104 Section 3 ▶ The Physical Activity Pyramid
Activity Classification by Fitness Level
Sample Lifestyle Activities Low Fitness Marginal Fitness Good
Fitness High Performance
Washing your face, dressing,
typing, driving a car Light Very light/light Very light Very light
Normal walking, walking
downstairs, bowling, mopping Moderate Moderate Light Light
Brisk walking, lawn mowing,
shoveling, social dancing Vigorous Moderate/Vigorous
Moderate Moderate
Table 2 ▶ Classifi cation of Moderate Physical Activities for
People of Different Fitness Levels
Brief walks throughout the day can help you meet recommended
levels of moderate activity.
Activity classifications vary, depending on one’s
level of fitness. Normal walking is considered light
activity for a person with good fitness (see Table 1 ), but
for a person with low to marginal fitness the same activity
is considered moderate. Similarly, brisk walking may be
a vigorous activity (rather than moderate) for individuals
with low fitness. Table 2 helps you determine the type
of lifestyle activity considered moderate for you. Begin-
ners with low fitness should start with normal rather than
brisk walking, for example. In Concept 7, you will learn
to assess your current fitness level. You may want to refer
back to Table 2 after you have made self-assessments of
your fitness.
The Health and Wellness Benefits
of Moderate Physical Activity
Moderate activity provides significant health ben-
efits. Research has clearly shown that even modest
amounts of moderate activity have significant health
benefits. Two early studies paved the way for this line of
research. One study reported that postal workers who
delivered mail had fewer health problems than workers
who sorted mail. Another study reported that drivers of
double-decker buses in England had more health prob-
lems than conductors who climbed the stairs during the
day to collect the tickets. The studies controlled for other
lifestyle factors, so the improved health was attributed to
the extra activity accumulated throughout the day. Since
then, hundreds of studies have further confirmed the
importance of moderate activity for good health. How-
ever, as described in Concept 5, additional health benefits
are possible if vigorous physical activity is also performed.
Moderate activity promotes metabolic fitness.
Metabolic fitness is fitness of the systems that provide
the energy for effective daily living. Indicators of good
metabolic fitness include normal blood lipid levels,
normal blood pressure, normal blood sugar levels, and
healthy body fat levels. Moderate physical activity pro-
motes metabolic fitness by keeping the metabolic system
active. Building and maintaining cardiovascular fitness
requires a regular challenge to the cardiovascular system
and building metabolic fitness requires a similar regular
challenge to the metabolic system. Individuals with good
levels of fitness will receive primarily metabolic fitness
benefits from moderate activity, but those with low fit-
ness will likely receive metabolic and cardiovascular
fitness benefits . Moderate activity is particularly impor-
tant for the large segments of the population that do not
participate in other forms of regular exercise. As previ-
ously described, some activity is clearly better than none.
Moderate physical activity has wellness benefits.
The health benefits from physical activity are impressive,
but the wellness benefits may have a bigger impact on
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Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach
105
our daily lives. Numerous studies have shown that physical
activity is associated with improved quality of life (QOL),
but it has proven difficult to determine the contributing
factors or underlying mechanisms. The influence may be
due to reduced stress, improved cognition, better sleep,
improved self-esteem, reduced fatigue or (more likely) a
combination of many different effects. A recent study in
college students sought to isolate some of the underlying
effects. The study reported that students who were more
physically active had more positive feeling states (“ pleasant-
activated feelings ”) than students who
were less physically active even after
controlling for sleep and previous
days’ activity and feeling states. They
also noted that feeling states improved on days when people
reported performing more activity than normal. The well-
ness benefits can impact young people every day whereas
health benefits may not be noticed until a person gets older.
Regular activity is important to achieving health, fit-
ness, and wellness benefits. For the benefits of activ-
ity to be optimal, it is important to exercise regularly. The
specific benefits from moderate activity tend to be more
dependent on frequency than on intensity. This is some-
times referred to as the last bout effect, because the effects
are short term (i.e., attributable to the last bout of activity
performed). For example, regular exercise promotes meta-
bolic fitness by creating the stimulus that helps maintain
insulin sensitivity and improve glucose regulation. Another
example is the beneficial effect of exercise on stress man-
agement. In this case, the periodic stimulus from exercise
helps directly counter the negative physical and physiologi-
cal responses to stress. To maximize the benefits of physical
activity, it is important to try to get some activity every day.
Sustained light-intensity activity may provide
health benefits and promote weight control. The
new physical activity guidelines have recommended that
activities be at least moderate in intensity. However, evi-
dence suggests that the accumulation of light-intensity
activity can have benefits, especially in those who are
sedentary. Some researchers have referred to this type of
activity as Non-Exercise Activity Thermogenesis (NEAT) to
emphasize the substantial number
of calories that can be burned by
performing light-intensity activity.
Meeting the recommendation for
moderate activity is best, but beginning some activity,
even light activity, is better than doing nothing at all.
How Much Moderate Physical
Activity Is Enough?
There is a FIT formula for moderate physical
activity. The concept of a threshold of training is used
in this book to describe the minimum activity needed for
benefits. As described in Concept 5, public health guide-
lines endorsed by the ACSM, the AHA, and the CDC
have recommended that adults accumulate 150 minutes
of moderate-intensity activity each week, an amount
equal to 30 minutes 5 days a week. The recommenda-
tion highlighted in the original Surgeon General’s Report
on Physical Activity called for adults to accumulate about
1,000 kcal/week (or about 150 kcal/day) from moderate
activity. Table 3 summarizes the threshold levels for fre-
quency, intensity, and time (duration). Note that these are
considered minimal, or threshold, levels. The target zone
calls for the accumulation of 30 or more minutes a day.
Physical activity above the recommended minimum pro-
vides additional health benefits.
Activity bouts of 10 minutes are recommended,
but shorter durations of moderate activity have
benefits. National physical activity guidelines suggest
that moderate activity bouts should be 10 minutes in
length or longer for optimal health and fitness benefits.
Nevertheless, short-duration moderate activity, sometimes
referred to as “incidental physical activity,” accumulated
throughout the day is also beneficial. The specification
of 10-minute sessions in the guidelines is somewhat
arbitrary as there is no absolute threshold defining how
VIDEO 2
Health is available to Everyone for a
Lifetime, and it’s Personal
Walking is by far the most commonly reported moder-
ate activity, but people often go out of their way to avoid
walking (such as driving around the lot to find the closest
parking spot; waiting for an elevator rather than climbing
a few flights of stairs).
Do you view walking as a “means to an end” (i.e., simply as a
way to get around) or as an “end in itself” (i.e., as a way to get
more physical activity)? How might this perception influence
your activity patterns?
ACTIVITY
Metabolic Fitness Benefits Improvements in meta-
bolic function that reduce risks of diabetes and meta-
bolic syndrome.
Cardiovascular Fitness Benefits Improvements
in cardiovascular function that contribute to cardio-
vascular fitness.
Wellness Benefits Increases in quality of life and
well-being.
Last Bout Effect A short-term effect associated
with the last bout of activity. Typically related to
improvements in metabolic fitness.
VIDEO 3
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106 Section 3 ▶ The Physical Activity Pyramid
(see Table 2 ), activity that is moderate for young adults
may be too intense for some older individuals or those
with health problems. Because of this, the guidelines
recommend that these individuals should focus on track-
ing minutes of activity. This allows the intensity to be a
self-determined level that corresponds to a person’s rela-
tive level of fitness.
Monitoring and Promoting
Physical Activity Behavior
Many people use pedometers to monitor daily
activity levels. Digital pedometers are a popular self-
monitoring tool used to track physical activity patterns.
They provide information about the number of steps a
person takes. Stride length and weight can be entered
into most pedometers to provide estimates of distance
traveled and/or calories burned. Some newer pedome-
ters include timers, which track the total amount of time
spent moving; some allow step information to be stored
over a series of days.
Pedometers provide a helpful reminder about the
importance of being active during the day. They also are
useful for tracking activity patterns over a series of days.
The interest in and popularity of pedometers has resulted
in media stories promoting the standard of 10,000 steps
as the level of activity needed for good health. This stan-
dard was originally developed in Japan, where pedometers
were popular before elsewhere in the world. Experts have
warned against using an absolute step count standard for
all people as it would be too hard for some and not hard
enough for others based on personal activity patterns.
Studies on large numbers of people provide data to
help classify people into activity categories based on step
counts (see Table 4 ), but actual step goals should vary
from person to person. Wear the pedometer for 1 week
to establish a baseline step count (average steps per day).
Then, set a goal of increasing steps per day by 1,000 to
long activity sessions must be. In general, the main
focus should be on the total volume of moderate activity
performed.
Vigorous activity can substitute for moderate
activity. The U.S. Physical Activity Guidelines released
by the Department of Health and Human Services
(DHHS) provide some flexibility for meeting activity
guidelines. Rather than requiring activity on 5 different
days, the DHHS guidelines specify that 150 minutes of
moderate physical activity can be accumulated during
the week. If you fail to meet the 30-minute guideline
on 1 day, you can make it up on another and still meet
the guideline. Vigorous-intensity activity can also be
substituted to meet the weekly targets. According to
the DHHS guidelines, each minute of vigorous activity
counts as 2 minutes of moderate. Therefore, the guide-
line can also be met by performing 75 minutes of vigor-
ous activity instead of 150 minutes of moderate activity.
The guidelines can also be expressed in total “MET-
minutes.” To compute MET-minutes, you simply multi-
ply the MET level of the activity you performed by the
number of minutes. For example, a 60-minute brisk walk
(approximately 3 METS) would yield 180 MET-minutes
(3 METS 3 60 minutes). However, note that this same
volume can also be achieved with a 30-minute run that
requires approximately 6 METS (6 METS 3 30 min-
utes). A total of 500 MET-minutes per week is recom-
mended to meet the minimum guidelines.
Special moderate activity guidelines have been
developed for children, older adults, and adults
with chronic health conditions. Guidelines for phys-
ical activity depend on the unique needs of the target
population. Children need more physical activity than
adults (at least 60 minutes and up to several hours of
activity each day).
Guidelines are also different for older adults and
adults with chronic conditions. As previously described
Threshold of Training (minimum)a Target Zone (optimal)
Frequency At least 5 days a week 5–7 days a week
Intensityb • Equal to brisk walkingb
• Approximately 150 calories accumulated per day
• 3 to 5 METsb
• Equal to brisk to fast walkingb
• Approximately 150–300 calories accumulated per day
• 3 to 6 METsb
Time (duration)c 30 minutes or three 10-minute sessions per
day 30–60 minutes or more accumulated in sessions of at least
10 minutes
a150 minutes per week is recommended by DHHS.
bHeart rate and relative perceived exertion can also be used to
determine intensity (see Concept 7).
cDepends on fitness level (see Table 2).
Table 3 ▶ The FIT Formula for Moderate Physical Activity
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Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach
107
3,000 steps. Keep records of daily step counts to help you
determine if you are meeting your goal. Setting a goal
that you are likely to meet will help you find success. As
you meet your goal, increase your step counts gradually.
Pedometers do have some limitations as indicators of
total physical activity. A person with longer legs will accu-
mulate fewer steps over the same distance than someone
with shorter strides (due to a longer
stride length). A person running will
also accumulate fewer steps over the
same distance than a person who
walks. There is considerable variability in the quality (and
accuracy) of commercial pedometers, so it is important to
consider this when purchasing one.
Energy expenditure can be used to monitor
physical activity. As shown in Table 3 , an energy expen-
diture of between 150 and 300 kcal/day from physical
activity is sufficient for meeting physical activity guide-
lines. While not as simple as tracking time, calories
expended from physical activity can be estimated if the
approximate MET value of the activity is known. The
energy cost of resting energy expenditure (1 MET) is
approximately 1 calorie per kilogram of body weight per
hour (1 kcal/kg/hour). An activity such as brisk walk-
ing (4 mph) requires an energy expenditure of about 4
METs, or 4 kcal/kg/hour. A 150 lb. person (~ 70 kg) walk-
ing for an hour would expend about 280 kcal (4 kcal/kg/
hour 3 70 kg 3 1 hr.). Note that a 30-minute walk would
burn approximately 150 calories and satisfy the guideline.
Commercial fitness equipment can provide energy
expenditure estimates. The devices use an estimated
MET level based on the selected intensity or a measured
heart rate (if a heart rate sensor is used). The timer on
the machine then tracks the time of the workout, and
this allows calories to be estimated during the work-
out. The estimate will only be somewhat accurate if the
machine also obtained a body weight value from you dur-
ing the setup process. If this wasn’t obtained, the calorie
estimates are probably based on some reference value of
weight and therefore may not be accurate. Table 5 lists
estimated METs for different activities, along with calo-
rie estimates (per hour of exercise) for people of different
body weights.
A variety of methods can be used to accumulate
moderate physical activity for health benefits.
Finding 30 minutes or longer for continuous physical
activity may be difficult, especially
on very busy days. However, the
physical activity guidelines empha-
size that moderate activity can be
accumulated throughout the day. Figure 2 illustrates the
Pedometers offer a useful way of monitoring physical activity.
Category Steps/Day
Sedentary < 5,000
Low active 5,000–6,999
Somewhat active Threshold 7,000–9,999
Active Target Zone 10,000–12,500
Very active . 12,500
Source: Based on values from Tudor-Locke.
Table 4 ▶ Activity Classifi cation for Pedometer
Step Counts in Healthy Adults
A CLOSER LOOK
Every Body Walk
Every Body Walk is a national movement committed to
“get Americans up and moving.” The organization has
developed a variety of social media applications that
help to connect organizations, people, and communities
across the country. Customized (free) apps for smart-
phones are available to help track and personalize your
walking plan, connect with walking communities, and
share stories. Associated Facebook links and Twitter
feeds (follow @everybodywalk) provide inspirational mes-
sages and opportunities to network and share stories.
The website (www.everybodywalk.org) features a hub
for walking-related blogs and video clips showing how
groups across America are finding a new sense of com-
munity through walking.
What are other ways social media can be used to spur
community involvement in physical activity?
Every B
A
WalkBody WBody W
ACTIVITY
VIDEO 4
VIDEO 5
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108 Section 3 ▶ The Physical Activity Pyramid
Calories Used per Hour for Different Body Weights
Activity Classification / Description METsa
100 lb.
(45 kg)
120 lb.
(55 kg)
150 lb.
(70 kg)
180 lb.
(82 kg)
200 lb.
(91 kg)
220 lb.
(100 kg)
Gardening Activities
Gardening (general) 5.0 227 273 341 409 455 502
Mowing lawn (hand mower) 6.0 273 327 409 491 545 599
Mowing lawn (power mower) 4.5 205 245 307 368 409 450
Raking leaves 4.0 182 218 273 327 364 401
Shoveling snow 6.0 273 327 409 491 545 599
Home Activities
Child care 3.5 159 191 239 286 318 350
Cleaning, washing dishes 2.5 114 136 170 205 227 249
Cooking / food preparation 2.5 114 136 170 205 227 249
Home / auto repair 3.0 136 164 205 245 273 301
Painting 4.5 205 245 307 368 409 450
Strolling with child 2.5 114 136 170 205 227 249
Sweeping / vacuuming 2.5 114 136 170 205 227 249
Washing / waxing car 4.5 205 245 307 368 409 450
Leisure Activities
Bocci ball / croquet 2.5 114 136 170 205 227 249
Bowling 3.0 136 164 205 245 273 301
Canoeing 5.0 227 273 341 409 455 501
Cross-country skiing (leisure) 7.0 318 382 477 573 636 699
Cycling (<10 mph) 4.0 182 218 273 327 364 401
Cycling (12–14 mph) 8.0 364 436 545 655 727 799
Dancing (social) 4.5 205 245 307 368 409 450
Fishing 4.0 182 218 273 327 364 401
Golf (riding) 3.5 159 191 239 286 318 350
Golf (walking) 5.5 250 300 375 450 500 550
Horseback riding 4.0 182 218 273 327 364 401
Swimming (leisure) 6.0 273 327 409 491 545 599
Table tennis 4.0 182 218 273 327 364 401
Walking (3.5 mph) 3.8 173 207 259 311 346 387
Occupational Activities
Bricklaying / masonry 7.0 318 382 477 573 636 699
Carpentry 3.5 159 191 239 286 318 350
Construction 5.5 250 300 375 450 500 550
Electrical work / plumbing 3.5 159 191 239 286 318 350
Digging 7.0 318 382 477 573 636 699
Farming 5.5 250 300 375 450 500 550
Store clerk 3.5 159 191 239 286 318 350
Waiter / waitress 4.0 182 218 273 327 364 401
Note: MET values and caloric estimates are based on values
listed in Compendium of Physical Activities (see Suggested
Readings).
aBased on values of those with “good fitness” ratings.
Table 5 ▶ Calories Expended in Lifestyle Physical Activities
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Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach
109
Figure 2 ▶ Comparison of people performing moderate activity
in different ways.
Noon-hour treadmill walk
Moderate structured activity
0
6
Time (hours)
6 7 2 3 4 5 6 7 8 9 10 11110 11
1
3
0
6
AM PM
8 9 noon
1
3
Moderate
Light
Vigorous
Energy expenditure (METS)
Moderate lifestyle activity
Work Work Walkto
bus
Walk
to bus
0
6
6 7 2 3 4 5 6 7 8 9 10 11110 11
1
3
0
6
AM PM
8 9 noon
1
3
Moderate
Light
Vigorous
Energy expenditure (METS)
Time (hours)
0
6
Time (hours)
6 7 2 3 4 5 6 7 8 9 10 11110 11
1
3
0
6
AM PM
8 9 noon
1
3
Moderate
Light
Vigorous
Walk to car Walk to car
Sedentary
Energy expenditure (METS)
activity profiles for three different people. The red line
profiles a person who is inactive except for brief walks
from the car to the office in the morning and from the
office to the car in the evening. This person is seden-
tary and does not meet the moderate activity guidelines.
Because some activity is better than none, the brief walks
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110 Section 3 ▶ The Physical Activity Pyramid
are better than no activity at all. The blue line represents
a person who is sedentary most of the day but meets the
moderate activity guideline by taking a long walk during
the noon hour. The green line represents the activity of
a person who meets the moderate activity standard in
multiple bouts, including lifestyle activities such as walk-
ing to and from work, walking to lunch, and climbing
the stairs. You can accumulate activity using the method
that you prefer as long as you meet the guidelines out-
lined in Table 2 .
Moderate Activity and the Built
Environment
The sedentary nature of our society is due in
large part to environmental factors. Many people
would like to be more active, but they may not live in
an area conducive to activity. Studies have conclusively
demonstrated that the physical or “built environment”
has important influences on physical activity patterns
and risk for overweight and obesity. Some early studies
had inherent limitations that have made it difficult to
determine if the relationship was causal. It is possible, for
example, that active people choose to move to environ-
ments with less urban sprawl and more access to parks
and green spaces. Recent research, however, has demon-
strated that changes in the environment (e.g., more trails,
safer and more accessible walking routes) can lead to
changes in levels of physical activity. This type of evidence
has been important because it indicates that our environ-
ment does contribute to our physical activity patterns.
The results also help justify expenses to create environ-
ments more conducive to physical activity.
Building active community environments has
become an important national priority. Many pub-
lic health organizations have developed awareness cam-
paigns and strong advocacy networks to support the
creation of healthier environments. One organization
called Active Living by Design is dedicated to promot-
ing more active environments in society. The vision is
for neighborhoods that allow physical activity to be built
into a person’s normal routine (going to the store, visit-
ing friends) and communities with integrated biking
and walking paths. These concepts are consistent with
other recommendations for urban planning (e.g., Smart
Growth Movement). Other groups such as the National
Coalition of Walking Advocates, the Alliance for Biking
and Walking, and Walkable Communities are positioned
to play key roles in promoting awareness and advocat-
ing at the state and national levels to improve federal
practices and funding decisions that influence biking and
walking. These groups encourage community activism
since consumers ultimately influence social norms and
decision making. See the Web Resources to learn more
about these organizations.
Walkability is an important consideration for
consumers and homeowners. The national Com-
munity Preference Survey conducted by the National
Association of Realtors revealed that nearly 60 percent
of Americans would prefer to live in neighborhoods that
would allow them to easily walk to stores and other busi-
nesses. Walkable access to grocery stores was rated as
being an important consideration by 75 percent of the
respondents.
T E C H N O L O G Y U P D A T E
Electronic Bikes
The e-bike (electric bike) is a new type of bicycle designed
to promote active commuting. Traveling at speeds up to
about 15 mph, the e-bike has a small electric engine that
gives support to the rider only when he or she is pedaling.
It was first developed in Switzerland to encourage people
who live in hilly terrains to ride bicycles. A recent study
showed that the effort necessary to ride an e-bike to work
(about 6 METS) was less than the effort needed to ride
a regular bike. Most of the commuters in the study were
easily able to use the bike to commute to work. The e-bike
is now gaining popularity in other countries because it
is comfortable, practical, and contributes to cleaner air.
The e-bike also encourages otherwise inactive people to
become active.
Would you consider using an e-bike as a way to get more
activity? To help the environment?
ACTIVITY
Built Environment A term used to describe aspects
of our created physical environment (e.g., buildings,
roads).
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Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach
111
Distance is one major consideration but researchers
have determined that a number of characteristics influ-
ence the walkability of an environment. Walking is more
likely when the weather is warm, but factors such as avail-
ability of sidewalks, good lighting, safe neighborhoods,
and aesthetic surroundings are the key factors in making
an area walkable. A number of websites now provide tools
to rate the walkability of communities (search “walkscore”
on the Internet). According to recent rankings, the most
walkable of the 50 largest U.S. cities were New York,
San Francisco, Boston, and Chicago. In Lab 6B you will
evaluate the walkability of your community based on
similar criteria.
Consider personal strategies for increasing
moderate activity. While the environment has an
impact on population levels of physical activity, it does
not determine individual behavior. People are autono-
mous beings and can make decisions about where they
go and what they do. The key is to take stock of your
lifestyle and your environment and
determine ways to integrate more
activity into your daily routine.
Active commuting is one way to
add physical activity to your lifestyle. It takes additional
preparation and the logistics can be challenging, but it is
a great way to build activity into your day. In addition to
providing beneficial amounts of physical activity, this can
save time, reduce gas, save money, and help the environ-
ment. Another option is to take a few active trips to the
store. Research suggests that the overwhelming majority
of our car trips are 1 mile or less. Walking or biking even a
few of these trips can have a big impact. The ability to walk
or bike to work or to the store may not be possible for you
because of the nature of your community or the safety of
the roads. However, there are a number of other strate-
gies you can use to get more activity in your day. Consider
parking farther away from store entrances, using the stairs
rather than the elevator, taking walking breaks, and even
standing (instead of sitting) when convenient. Adopting an
active lifestyle in a sedentary society is challenging, but it is
within your control.
Bike commuting is an effective way to add physical activity to
your day.
VIDEO 6
Strategies for Action
A regular plan of moderate physical
activity is a good place to start.
Moderate physical activity is something that virtually anyone
can do. In Lab 6A, you can set moderate physical activity
goals and plan a 1-week lifestyle physical activity program.
For some, this plan may be the main component of a lifetime
plan. For others, it may be only a beginning that leads to the
selection of activities from other levels of the physical activity
pyramid. Even the most active people should consider regular
moderate physical activity because it is a type of activity that
can be done throughout life.
Self-monitoring moderate physical activity can help
you stick with it. The self-monitoring chart in Lab 6A not
only helps you keep a log of moderate activities (or step
counts), it also lets you hone your self-management skills.
Charts like this can be copied to make a log book for long-
term activity self-monitoring.
Environmental factors influence our moderate physical
activity patterns. In Lab 6B, you will conduct an evalu-
ation of the walkability of your community and an evalua-
tion of community resources available for physical activity.
The purpose of this lab is to increase your awareness of
the importance of active, safe environments for promoting
physical activity. Becoming an advocate for physical activ-
ity in your community is a great way to help promote local
change.
ACTIVITY
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112 Section 3 ▶ The Physical Activity Pyramid
Web Resources
Alliance for Biking and Walking www.peoplepowered
movement.org
America On the Move www.americaonthemove.org
Bike Commute.com www.bikecommute.com
Compendium of Physical Activities http://prevention.sph
.sc.edu/tools/compendium.htm
National Coalition for Promoting Physical Activity
www.ncppa.org
National Coalition of Walking Advocates
www.americawalks.org/
The Pedestrian and Bicycle Information Center (PBIC)
www.walkinginfo.org
Public Broadcasting System/America’s Walking Homepage
www.pbs.org/americaswalking
Walkable Cities (walkscores) www.walkscore.com
Walkable Communities Inc www.walkable.org
Suggested Readings
ACSM. 2010. ACSM’s Guidelines for Exercise Testing and
Prescription. 8th ed. Philadelphia: Lippincott, Williams &
Wilkins, Chapters 2 and 7.
Ainsworth, B. E. 2000. Compendium of physical activities: An
update of activity codes and MET intensities. Medicine and
Science in Sports and Exercise 32 (Suppl):S498–S516.
Chaloupka, F. J., et al. 2010. The association between
community
physical activity settings and youth physical activity, obesity,
and body mass index. Journal of Adolescent Health. Published
online June 10, 2010, www.jahonline.org
Foti, K. K., et al. 2011. Sufficient sleep, physical activity, and
sedentary behaviors. American Journal of Preventive Medicine
41(6):596–602.
Garber, C. E., et al. 2011. Quantity and quality of exercise for
developing and maintaining cardiorespiratory, musculo-
skeletal, and neuromotor fitness in apparently healthy
adults: Guidance for prescribing exercise. Medicine and
Science in Sports and Exercise 43(7):1334–1359.
Healy, G. N., et al. 2011. Sedentary times and cardio-metabolic
biomarkers in US adults: NHANES 2003-06. European
Heart Journal 32(5):590–597.
Hyde, A. L., et al. 2012. Unpacking the feel-good effect of
free-time physical activity: Between- and within-person
associations with pleasant-activated feeling states. Journal of
Sport & Exercise Psychology 33(6):884–902.
Kohl, H. W., and T. D. Murray. 2012. Foundations of Physical
Activity and Public Health. Champaign, IL: Human Kinetics.
Matthews, C. E., et al. 2012. Amount of time spent in seden-
tary behaviors and cause-specific mortality in US adults.
American Journal of Clinical Nutrition 95(2):437–445.
Mowen, A., and A. Kaczynski. 2008. The potential of parks
and recreation in addressing physical activity and fitness.
President’s Council on Physical Fitness and Sports Research
Digest 9(1):1–8.
Owen, N., et al. 2010. Too much sitting: The population health
science of sedentary behavior. Exercise and Sport Sciences
Reviews 38(3): 105–113.
Russ, R., and McGuire, K. A. 2011. Incidental physical activity
is
positively associated with cardiorespiratory fitness. Medicine
and Science in Sports and Exercise 43(11):2189–2194.
Sattelmair, J., et al. 2011. Dose response between physical
activity and risk of coronary heart disease: A meta-analysis.
Circulation 124(7):789–795.
Healthy People
ACTIVITY
2020
The objectives listed below are societal goals designed to
help all Americans improve their health between now and
the year 2020. They were selected because they relate to the
content of this concept.
• Reduce proportion of adults who do no leisure-time
activity.
• Increase proportion of adults who meet guidelines for
aerobic activity.
• Increase proportion of adults who meet guidelines for
muscle fitness activity.
• Increase proportion of trips made by walking.
• Increase proportion of youth who meet guidelines for
TV viewing and computer use and overuse (overuse is 2
hours a day or more).
• Create social and physical environments that promote
good health for all.
• Promote quality of life, healthy development, and healthy
behaviors across all stages of life.
A national goal is to increase walking trips (moderate physical
activity). Describe three ways that you can increase walking
trips
during the week and comment on whether you think you are
likely to
carry out any of these methods as part of your normal routine.
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113
Lab
6A
S
etting G
oals for M
od
erate P
hysical A
ctivity and
S
elf-M
onitoring
(Logging) P
rogram
Lab 6A Setting Goals for Moderate Physical Activity
and Self-Monitoring (Logging) Program
Name Section Date
Purpose: To set moderate activity goals and to self-monitor
(log) physical activity
Procedures
1. Read the five stages of change questions below. Place a
check by the stage that best represents your current
moderate physical activity level. If you are at stages 1–3
(precontemplation, contemplation, or preparation), you
may want to set goals below the threshold of 30 minutes per day
to get started. Those at the action or mainte-
nance stage should consider goals of 30 minutes or more per
day.
2. Determine moderate activity goals for each day of a 1-week
period. In the columns (Chart 1) under the heading
“Moderate Activity Goals,” record the total minutes per day that
you expect to perform OR the total steps per day
that you expect to perform. Record the specific date for each
day of the week in the “Date” column.
3. The goals should be realistic for you, but try to set goals that
would meet current physical activity guidelines. If you
choose step goals, you will need a pedometer. Use Table 4 on
page 107 to help you to choose daily step goals.
4. If you choose minutes per day as your goals, use Chart 2 to
keep track of the number of minutes of activity that
you perform on each day of the 7-day period. Record the
number of minutes for each bout of activity of at least
10 minutes in length performed during each day (Chart 2).
Determine a total number of minutes for the day and
record this total in the last column of Chart 2 and in the
“Minutes Performed” column of Chart 1.
5. If you choose steps per day as your goals, determine the
total steps per day accumulated on the pedometer and
record that number of steps in the “Steps Performed” column for
each day of the week (Chart 1).
6. Answer the questions in the Conclusions and Implications
section (use full sentences for your answers).
Determine your stage for moderate physical activity. Check
only the stage that represents your current moderate
activity level.
Precontemplation: I do not meet moderate activity guidelines
and have not been thinking about starting.
Contemplation: I do not meet moderate activity guidelines but
have been thinking about starting.
Preparation: I am planning to start doing regular moderate
activity to meet guidelines.
Action: I do moderate activity, but I am not as regular as I
should be.
Maintenance: I regularly meet national goals for moderate
activity.
Select a goal for each day in a 1-week plan. Keep a log of the
activities performed to determine if your goals are met.
Moderate Activity Goals Summary Performance Log
Date: Minutes/day Steps/day Minutes Performed Steps
Performed
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Chart 1 Moderate Physical Activity Goals and Summary
Performance Log
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114
La
b
6
A
S
et
tin
g
G
oa
ls
f
or
M
od
er
at
e
P
hy
si
ca
l A
ct
iv
ity
a
nd
S
el
f-
M
on
ito
rin
g
(L
og
gi
ng
) P
ro
gr
am
.
Did you meet your moderate activity goals for at least 5 days of
the week? Yes No
Do you think you can consistently meet your moderate activity
goals? Yes No
What activities did you perform most often when doing
moderate activity?
List most common activities in the spaces below.
Conclusions and Interpretations
1. Do you feel that you will use moderate physical activity as a
regular part of your lifetime physical activity plan,
either now or in the future? Use several sentences to explain
your answer.
2. Did setting goals and logging activity make you more aware
of your daily moderate physical activity patterns?
Explain why or why not.
If you choose minutes per day as goals, write the number of
minutes for each bout of moderate activity performed each day.
Record a daily total (total minutes of moderate activity per day)
in the “Daily Total” column. Record daily totals in Chart 1.
Moderate Activity Bouts of 10 Minutes or More
Date Bout 1 Bout 2 Bout 3 Bout 4 Bout 5 Daily Total
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Chart 2 Moderate Physical Activity Log (Daily Minutes
Performed)
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115
Lab
6B
E
valuating P
hysical A
ctivity E
nvironm
ents
Lab 6B Evaluating Physical Activity Environments
Name Section Date
Purpose: To help you assess community factors that may infl
uence your ability to perform lifestyle physical activity
Procedures
1. Use the community audit forms on the next page to conduct
an evaluation of the walkability of your community
and the availability of community resources for physical
activity. The walkability audit requires that you take a brief
walk in your neighborhood to note key features in the
environment that may help or hinder walking. The community
audit will require you to evaluate the quality of resources and
programming available in your community. You can
choose your campus community or your hometown.
2. For each question, first use the check boxes to note the
presence or absence of key features in the environment.
Then base your score for this question on the number of checks
and your overall perception.
3. After you have completed both the Walkability Audit and the
Community Resource Audit, total the scores for each
tool and report the total scores in the bottom. Add up both
scores to compute the Combined (physical activity)
Environmental Audit.
Results: Record your rating for each of three healthy lifestyles
in the following chart.
Conclusions and Implications
Provide a brief summary of the physical activity environment in
your community. Describe your experiences in evaluat-
ing the walkability of and resources in your community. If the
environment is close to ideal, comment on how this may
facilitate active lifestyles. If the environment is not ideal,
comment on what needs to be done to improve it.
Comments on Walkability Audit
Comments on Community Resource Audit
Score Rating
Walkability Audit
Community Resource Audit
Combined Environmental Audit
Environmental Activity Scoring Chart
Good Marginal Poor
Walkability 15–20 11–14 <11
Community 15–20 11–14 <11
Combined 30–40 22–29 <22
Rating Chart for Environmental Audits
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116
La
b
6
B
E
va
lu
at
in
g
P
hy
si
ca
l A
ct
iv
ity
E
nv
iro
nm
en
ts
Walkability Audit Rating
1. Did you have room to walk? 1 2 3 4
Sidewalks blocked or not continuous
Sidewalks were broken, cracked
No sidewalks, paths, or shoulders
Too much traffi c on sidewalk
Other _______________________
2. Was it easy to cross streets? 1 2 3 4
Road was too wide
Traffi c signals were too short/too long
Parked cars blocked view of street
No striped or designated crosswalks
Other ______________________
3. Was it safe for walking? 1 2 3 4
Too much traffi c
Drivers too fast /too close
Inadequate lighting
Area of high crime
Other _______________________
4. Were there places to go? 1 2 3 4
No stores in the area
No restaurants in the area
No friends nearby
Nothing interesting to see in area
Other ________________________
5. Was your walk pleasant? 1 2 3 4
Not enough grass and trees
Scary dogs or people
Not well lighted
Too dirty
Other ________________________
Community Resource Audit Rating
6. Are there walking/biking paths 1 2 3 4
in the area?
Paths are in unsafe areas
Paths need to be repaired
Paths are too crowded
Paths are too far away to be useful
Other ________________________
7. Is there a community fitness/rec 1 2 3 4
center?
Center is too expensive
Center is not clean or updated
Center is too far away
Center has old or limited equipment
Other ________________________
8. Are there bicycle lanes on streets? 1 2 3 4
Lines not painted well
Lines not on all streets
Bike lanes not wide enough
Cars too close
Other _________________________
9. Are there parks, fields, and 1 2 3 4
playgrounds?
Parks in unsafe areas
Equipment/resources in poor repair
Too crowded
Too far away
Other ________________________
10. Are there community activity 1 2 3 4
programs?
Not enough programs
Not the right type of programs
Too expensive
Too far / inconvenient
Other ________________________
Total Score for Walkability Audit: (Sum of Questions 1–5)
Total Score for Community Resources Audit: (Sum of
Questions 6–10)
Combined Environmental Audit: (Sum of Questions 1–10)
Walkability checklist adapted from resources developed by the
Partnership for a Walkable America. For
information on this organization, visit this website:
www.walkableamerica.org.
Walkability and Community Resource Audits
Directions. Place a check by each box in each questionnaire.
Based on the number of boxes checked for each ques-
tion, place an X over the circle to rate each question (1=poor,
2=marginal, 3=good, 4=very good). Add rating numbers
to get walkability scores and community resource scores. Total
the two to get a combined environmental score.
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117
Cardiovascular Fitness
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Describe the different components of the cardiovascular
system.
▶ List the health benefits of cardiovascular fitness.
▶ Outline the FIT formula for moderate to vigorous physical
activity designed to
promote cardiovascular fitness.
▶ Identify several methods of determining exercise intensity
levels for promoting
cardiovascular fitness, select the method you think is most
useful to you, and
explain the reasons for your choice.
▶ Describe key guidelines for monitoring cardiovascular
exercise including self-
monitoring heart rate.
▶ Indicate several self-
assessments for
cardiovascular fitness,
select the self-assessment
you feel is most useful
to you, and explain the
reasons for your choice.
C
o
n
c
e
p
t 7
Cardiovascular fitness is probably
the most important aspect of physical
fitness because it has a major impact
on health and greatly influences
physical performance.
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118 Section 3 ▶ The Physical Activity Pyramid
is considered to be the best indicator of cardiovascular
fitness, and aerobic physical activity is the preferred
method for achieving it. Regardless of the words used to
describe it, cardiovascular fitness is complex because it
requires fitness of several body systems.
Good cardiovascular fitness requires a fit heart
muscle. The heart is a powerful muscle that pumps
blood through the body. The heart of a normal individual
beats reflexively about 40 million times a year. In a single
day, the heart pumps over 4,000 gallons of blood through
the body. To keep the cardiovascular system working
effectively, it is crucial to have a strong and fit heart.
Like other muscles in the body, the heart becomes
stronger if it is exercised. The size and strength of the
heart increases, and it can pump more blood with each
beat, accomplishing the same amount of work with
fewer beats. Typical resting heart rate (RHR) values are
around 70–80 beats per minute, but a highly trained
endurance athlete may have a resting heart rate in the
40s or 50s. There is some individual variability in RHR,
but a decrease in your RHR with training indicates clear
improvements in cardiovascular fitness.
Good cardiovascular fitness requires a fit vascular
system. The heart has four chambers, which pump
and receive blood in a rhythmical fashion to maintain
good circulation (see Figure 1 ). Blood containing a high
C ardiovascular fitness is generally considered to be the most
important aspect of physical fitness. Those who
possess reasonable amounts of fitness have a decreased
risk for heart disease, reduced risk for premature death,
and improved quality of life. Regular cardiovascular exer-
cise promotes fitness and provides additional health and
wellness benefits that extend well beyond reducing risks
for disease. This concept describes the function of the
cardiovascular system and explains how to determine the
appropriate intensity of exercise needed to promote car-
diovascular fitness.
Elements of Cardiovascular
Fitness
The term cardiovascular fitness has several
synonyms. Cardiovascular fitness is sometimes referred
to as cardiovascular endurance because a person who pos-
sesses this type of fitness can persist in physical activity
for long periods without undue fatigue. It has been
referred to as cardiorespiratory fitness because it requires
delivery and utilization of oxygen, which is only possible
if the circulatory and respiratory systems are capable of
these functions.
The term aerobic fitness has also
been synonymous with cardiovascu-
lar fitness because aerobic capacity
Figure 1 ▶ Cardiovascular system.
VIDEO 1
Superior vena cava CO2
CO2 CO2
O2
O2O2
CO2
O2
Lung capillaries Systemic
capillaries
Alveolus
Lung
Tissue cells
Left atrium
Bicuspid valve
Aortic valve
Left ventricle
Right ventricle
Aorta
Right atrium
Pulmonary valve
Tricuspid valve
Inferior vena cava
Tissue cells
Systemic
capillaries
Pul-
mon-
ary
vein
Pulmonary
artery
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Concept 7 ▶ Cardiovascular Fitness 119
concentration of oxygen is pumped by the left ventricle
through the aorta (a major artery), where it is carried to
the tissues. Blood flows through a sequence of arteries
to capillaries and to veins. Veins carry the blood contain-
ing lesser amounts of oxygen back to the right side of
the heart, first to the atrium and then to the ventricle.
The right ventricle pumps the blood to the lungs. In the
lungs, the blood picks up oxygen (O 2 ), and carbon diox-
ide (CO 2 ) is removed. From the lungs, the oxygenated
blood travels back to the heart, first to the left atrium and
then to the left ventricle. The process then repeats itself.
A dense network of arteries distributes the oxygenated
blood to the muscles, tissues, and organs (see Figure 2 ).
Healthy arteries are elastic, are free of obstruction, and
expand to permit the flow of blood. Muscle layers line the
arteries and control the size of the arterial opening upon
the impulse from nerve fibers. Unfit arteries may have
a reduced internal diameter (atherosclerosis) because of
deposits on the interior of their walls, or they may have
hardened, nonelastic walls (arteriosclerosis).
The blood in the four chambers of the heart does not
directly nourish the heart. Rather, numerous small arter-
ies within the heart muscle provide for coronary circula-
tion. Poor coronary circulation precipitated by unhealthy
arteries can be the cause of a heart attack.
Deoxygenated blood flows back to the heart through
a series of veins. The veins are intertwined in the skeletal
muscle, and this allows normal muscle action to facilitate
the return of blood to the heart. When a muscle is con-
tracted, the vein is squeezed, and this pushes the blood
back to the heart. Small valves in the veins prevent the
backward flow of the blood, but defects in the valves can
lead to pooling of blood in the veins. A common condi-
tion, known as varicose veins, is associated with the pool-
ing of blood in the leg. Regular physical activity helps
reduce pooling of blood in the veins and helps keep the
valves of the veins healthy.
Capillaries are the transfer stations where oxygen and
fuel are released, and waste products, such as carbon diox-
ide, are removed from the tissues. The veins receive the
blood from the capillaries for the return trip to the heart.
Good cardiovascular fitness requires healthy blood
and a fit respiratory system. The process of taking
in oxygen (through the mouth and nose) and deliver-
ing it to the lungs, where it is picked up by the blood, is
called external respiration. External respiration requires
fit lungs as well as blood with adequate hemoglobin .
Hemoglobin carries oxygen through the bloodstream.
Lack of hemoglobin reduces oxygen-carrying capacity—
a condition known as anemia .
Delivering oxygen to the tissues from the blood is
called internal respiration. Internal respiration requires
an adequate number of healthy capillaries. In addition
to delivering oxygen to the tissues, these systems remove
carbon dioxide. Good cardiovascular fitness requires fit-
ness of both the external and internal respiratory systems.
Cardiovascular fitness requires fit muscle tissue
capable of using oxygen. Once the oxygen is deliv-
ered, the muscle tissues must be able to use oxygen to
sustain physical performance (see Figure 2e ). Physical
activity that promotes cardiovascular fitness stimulates
changes in muscle fibers that make them more effective
in using oxygen. Outstanding distance runners have high
numbers of well-conditioned muscle fibers that can read-
ily use oxygen to produce energy for sustained running.
Training in other activities would elicit similar adapta-
tions in the specific muscles used in those activities.
During exercise the performance and function
of the cardiovascular system is maximized. Dur-
ing exercise, a number of changes occur to increase
the availability of oxygen to the muscles (see Table 1 ).
Breathing rate and depth increase, allowing the body to
take in more oxygen. The heart beats faster and pumps
more blood with each beat (increased stroke volume).
The higher heart rate and larger stroke volume allow
Rest
Maximal
Exercise
Lungs Breathing Rate
(# / Minute)
12 30
Heart Heart Rate
(Beats / Minute)
70 190–200
Stroke Volume
(mL / Beat)
75 150
Cardiac Outputa
(L / Minute)
5.2 28.5
Arteries Blood Flow
Distribution (%)
20% 70%
Muscle Oxygen
Extraction (%)
5% 20%
System V· O2
(mL/kg/min.)b
3.5 60
a Cardiac output 5 heart rate 3 stroke volume.
b V
̇ O2 5 oxygen consumption 5 CO 3 oxygen extraction.
Table 1 ▶ Changes in Cardiovascular Function
between Rest and Exercise for a Person with Good
Cardiovascular Fitness
Aerobic Capacity A measure of aerobic or cardio-
vascular fitness.
Hemoglobin The oxygen-carrying protein (molecule)
of red blood cells.
Anemia A condition in which hemoglobin and the
blood’s oxygen-carrying capacity are below normal.
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120 Section 3 ▶ The Physical Activity Pyramid
Major Blood Vessels
Carotid
artery
Subclavian
artery
Aorta
Heart
Iliac artery
Femoral artery
Subclavian
vein
Vena
cava
Iliac vein
Femoral vein
Cardiovascular Fitness Characteristics
Figure 2a. A Fit Heart
• Strong ventricles
• Open coronary vessels
• Good collateral circulation
Figure 2b. A Fit Respiratory
System and Healthy Blood
• Good capillaries
• Healthy blood with ample
hemoglobin
• Open coronary vessels
Figure 2c. Healthy Arteries
• Elastic
• Large diameter
• No obstructions
• No atherosclerosis
Figure 2d. Healthy Veins and
Valves
• Thinner, less elastic walls
• Large diameter
• Good valves
Figure 2e. Fit Muscles
• Good artery supply
• Efficient at using oxygen to
produce energy
Open, healthy
coronary arteries
Intima
Media (Muscle)
Adventitia
Intima
Media
Adventitia
Strong, thick
heart muscle
Muscle
Tendons
Figure 2 ▶ Major blood vessels and cardiovascular fitness
characteristics.
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Concept 7 ▶ Cardiovascular Fitness 121
more blood to be pumped each minute (increased car-
diac output). During exercise, the blood passing through
the lungs picks up more oxygen and distributes it more
quickly. Activation of the sympathetic nervous sys-
tem also leads to a redistribution of the blood flow, so
that more of it gets shunted to the working skeletal
muscle. During rest, the muscles get about 20 percent
of the available blood flow, but this increases to about
70 percent during vigorous exercise. Within the mus-
cles, a larger percentage of the available oxygen is also
extracted from the muscles during exercise. Collectively,
these changes help provide the muscles with the oxygen
needed to maintain aerobic metabolism.
Cardiovascular fitness is often evaluated using an
indicator known as maximum oxygen uptake, or ̇VO 2
max. A person’s maximum oxygen uptake ( ̇VO 2 max)
,
commonly referred to as aerobic capacity, is determined
in a laboratory by measuring how much oxygen a per-
son can use in maximal exercise. The test is usually done
on a treadmill using specialized gas analyzers to measure
oxygen use. The treadmill speed and grade are gradually
increased, and when the exercise becomes very hard, oxy-
gen use reaches its maximum. The test is a good indicator
of overall cardiovascular fitness because you cannot take
in and use a lot of oxygen if you do not have good fitness
throughout the cardiovascular system (heart, blood ves-
sels, blood, respiratory system, and muscles).
Elite endurance athletes can extract 5 or 6 liters of
oxygen per minute from the environment, and this high
aerobic capacity is what allows them to maintain high
speeds in both training and competition without becom-
ing excessively tired. In comparison, an average person
typically extracts about 2 to 3 liters per minute. V
̇ O2 max
is typically adjusted to account for a person’s body size
because bigger people may have higher scores due to
their larger size. Values are reported in milliliters (mL) of
oxygen (O 2 ) per kilogram (kg) of body weight per minute
(mL/kg/min.).
A number of field tests have been developed to pro-
vide estimates of maximum aerobic capacity (see Lab
Resource Materials on pages 131–134). These tests are
developed and validated based on comparisons with labo-
ratory protocols that directly measure the amount of oxy-
gen that is consumed.
Adaptations to regular aerobic exercise result in
improved cardiovascular fitness. Specific adaptations
occur within each of the components of the cardiovas-
cular system shown in Figure 2 . The heart muscle gets
stronger and pumps more blood with each beat, allow-
ing the heart to pump less frequently to deliver the same
amount of oxygen. The lungs and blood function more
efficiently in picking up oxygen and delivering it to the
muscles. The vessels more effectively deliver the blood
and the muscles adapt to use oxygen more efficiently.
These adaptations allow a person to take in and use
more oxygen during maximal exercise (increased aero-
bic capacity or V
̇ O2 max). The adaptations contribute to
improved endurance performance as well as health ben-
efits (as described in Concept 4).
Cardiovascular Fitness
and Health Benefits
Good cardiovascular fitness reduces risk for heart
disease, other hypokinetic conditions, and early
death. Numerous studies over the past 30 to 40 years have
confirmed that good cardiovascular fitness is associated
with a reduced risk for heart disease as well as a number
of other chronic, hypokinetic conditions. A recent review
of 33 studies involving nearly 200,000 people showed
that people with low fitness have had a 70 percent higher
death rate from all causes and a 56 percent higher death
rate from heart diseases than people of intermediate
Maximum Oxygen Uptake ( ̇VO 2 max) A labora-
tory measure held to be the best measure of cardio-
vascular fitness. Commonly referred to as V
̇ O2 max,
or the volume (V) of oxygen used when a person
reaches his or her maximum (max) ability to supply it
during exercise.
Figure 3 ▶ Risk reduction associated with cardiovascular
fitness.
Source: Adapted from Blair et al.
Low fitness Moderate fitness High fitness
Males
Females
High
Low
H
yp
ok
in
et
ic
d
is
ea
se
r
is
k
an
d
ri
sk
fo
r
ea
rl
y
de
at
h
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122 Section 3 ▶ The Physical Activity Pyramid
the health and wellness benefits described earlier in this
book. Cardiovascular fitness in the high-performance
zone enhances the ability to perform in certain athletic
events and in occupations that require high performance
levels (e.g., firefighters).
The FIT Formula for
Cardiovascular Fitness
The FIT formula for cardiovascular fitness varies
for people of different activity levels. Adaptations
to physical activity are based on the overload princi-
ple and the principle of progression. It is important to
provide an appropriate challenge to the cardiovascular
system (overload), but the challenge should be progres-
sive, increasing gradually as fitness improves. For most
people, vigorous physical activity
from steps 2 and 3 (see Figure 4 ) is
necessary to improve cardiovascular
fitness. However, for people with
low fitness, moderate physical activity (step 1) produces
improvements. Table 2 presents the FIT formulas for
people of five different fitness and activity levels. While
the frequency of exercise is similar for the different levels,
the intensity and amount of time spent in activity vary
considerably. The sections that follow provide added
information about the FIT formula.
The frequency (F) of physical activity to build
cardiovascular fitness ranges from 3 to 5 or more
days a week. The new ACSM guidelines for build-
ing cardiovascular fitness suggest a frequency of at
least 5 days a week for low fit people who do primar-
ily moderate physical activity. Moderate activity can be
safely performed every day and can provide additional
benefits. For more active people (and those with higher
levels of cardiovascular fitness), vigorous physical activity
fitness. The consensus is that low-fit individuals are three
to six times more likely to develop symptoms of metabolic
syndrome or diabetes than high-fit individuals. While the
specific amount of fitness needed to reduce risks varies by
condition and population, evidence clearly supports the
need for at least a moderate level of fitness. As shown in
Figure 3 , there are dramatic reductions in risk in moving
from the low fitness category to the moderate fitness cat-
egory for both males and females. In terms of longevity,
studies suggest that individuals with moderate fitness will
live 5–6 years longer than low-fit individuals.
The benefits of cardiovascular fitness are
independent of its beneficial effect on other risk
factors. Physical activity has been shown to have bene-
ficial effects on some other established heart disease risk
factors, such as cholesterol, blood pressure, and body
fat. It is important to note that the beneficial effects of
cardiovascular fitness on risk for
heart disease and early death are
considered to be independent of
these other effects. This means that
active/fit people would still have lower health risks even
if their cholesterol, blood pressure, and body fat levels
were identical to a matched set of inactive/unfit people.
This evidence contributed to the labeling of physical
inactivity as a major, independent risk factor for heart
disease. The risk associated with physical inactivity is as
large as (or larger than) risks associated with any of the
other established risk factors.
Good fitness reduces risks for normal weight,
overweight, and obese people. Some people think
they cannot be fit if they are overweight or overfat. It is
now known that appropriate physical activity can build
cardiovascular fitness in all types of people, including
those with excess body fat. In fact, numerous studies have
demonstrated that a fit, overweight person is at lower risk
of chronic disease than an unfit person who is normal
weight. These findings demonstrate that for chronic dis-
ease prevention, low fitness is a greater risk than excess
body fatness. The greatest risk is among people who are
both unfit and overfat.
Good cardiovascular fitness enhances the ability
to perform various tasks, improves the ability to
function, and is associated with a feeling of well-
being. Moving out of the low fitness zone is of obvious
importance to disease risk reduction. Achieving the good
zone on tests further reduces disease and early death risk
and promotes optimal wellness benefits, and a position
statement by the American College of Sports Medicine
shows an improved ability to function among older adults.
Other wellness benefits include the ability to enjoy lei-
sure activities and meet emergency situations, as well as
Health is available for Everyone for a
Lifetime, and it’s Personal
Physical activity patterns tend to vary with different
phases of life. Those who felt out of place in school
team sports may find themselves enjoying solo workouts
at the gym in college or adulthood. On the other hand,
people who are used to being active may not be able to
find time to exercise, at least for a while, when they are
adjusting to new family obligations.
How have your physical activity patterns changed over the
years, and what future changes do you anticipate?
ACTIVITY
VIDEO 2
VIDEO 3
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Concept 7 ▶ Cardiovascular Fitness 123
Fitness Level Very Low Low Marginal Good High Performance
Activity Level Sedentary Some light to
moderate activity
Sporadic moderate
to vigorous activity
Regular moderate to
vigorous activity
Habitual moderate
to vigorous activity
F 5 Frequency (days per week) 3–5 3–5 3–5 3–5 3–5
I 5 Intensity
Heart Rate Reserve (HRR) 30–40% 40–55% 55–70% 65–80%
70–85%
Max. Heart Rate (max HR) 57–67% 64–74% 74–84% 80–91%
84–94%
Relative Perceived Exertion (RPE) 12–13 12–13 13–14 13–15
14–16
T 5 Time (minutes per day) 20–30 30–60 30–90 30–90 30–90
Table 2 ▶ FIT Formula for Cardiovascular Fitness for People of
Different Fitness and Activity Levels
at least 3 days a week is rec-
ommended. Vigorous physi-
cal activity provides additional
benefits (compared to moder-
ate activity), however, it can
increase risk for orthopedic
injury if it is done too fre-
quently. Therefore, 5 days a
week is the maximal recom-
mended dose for most people.
Healthy people who are fit
and regularly active and have
no evidence of joint prob-
lems or injuries may train up
to 6 days a week, but most
experts agree that at least
1 day off a week is beneficial.
Use Table 2 to determine
the appropriate frequency
of exercise for you based on
your current activity and fit-
ness level. Complete the fit-
ness assessments at the end of
this concept before making
your decision. The ACSM
guidelines focus on exercise
for building cardiovascu-
lar fitness but are similar to
national guidelines designed
to produce health and well-
ness benefits.
The intensity (I) of physical
activity necessary to produce cardiovascular fitness
depends on a person’s level of fitness. In general, fit
people need to exercise at a higher intensity to provide a
sufficient challenge to the cardiovascular system. To deter-
mine the appropriate intensity, it is important to have some
Figure 4 ▶ Select activities from steps 2 and 3 of the pyramid
for optimal
cardiovascular fitness.
Source: C. B. Corbin
Avoid Inactivity
Energy Balance
Energy Out
(Activity)
Energy In
(Diet)
STEP 5
STEP 4
Vigorous Sports
and Recreation
Vigorous
Aerobics
Moderate
Physical Activity
Flexibility
Exercises
Muscle
Fitness
Exercises
• Tennis
• Hike
• Yoga
• Stretch
• Jog
• Bike
• Aerobic dance
• Walk
• Yard work
• Golf
• Calisthenics
• Resistance
exercise
STEP 1
STEP 2
STEP 3
indicator of a person’s overall fitness. If the maximal aero-
bic capacity is known, an appropriate intensity can be set at
a percentage of the maximum level. Because these values
cannot be calculated without special equipment, other indi-
cators of relative intensity are more commonly used.
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124 Section 3 ▶ The Physical Activity Pyramid
Heart rate provides a good indicator of the relative
challenge presented by a given bout of exercise. There-
fore, guidelines for the intensity of physical activity to
build cardiovascular fitness are typically based on per-
centages of heart rate reserve (HRR) or maximal heart
rate (maxHR). Current guidelines as outlined in Table 2
specify different intensity levels based on current fitness
and activity levels. Calculations of HRR and maxHR will
be described in detail later, but the general range for HRR
is 30 to 85 percent and for maxHR, 57 to 94 percent.
Ratings of perceived exertion (RPE) refer to the
assessment of the intensity of exercise based on how the
participant feels; a subjective assessment of effort. RPE
has been shown to be useful in assessing the intensity
of aerobic physical activity. The RPE scale ranges from
6 (very very light) to 20 (very very hard), with 1-point
increments in between. If the values are multiplied by 10,
the RPE values loosely correspond to HR values (e.g.,
60 5 rest HR and 200 5 maxHR). Details will be pro-
vided later, but the target zone for aerobic activity is from
12 to 16 (see Table 2 ).
Regardless of what method is used, the important
point is that lower intensities provide a cardiovascular
fitness benefit for low-fit sedentary people, but higher
intensities are needed for more fit people. Use Table 2
to determine the appropriate intensity of exercise based on
your current activity and fitness level.
The amount of time (T) for building cardiovascular
fitness is typically based on minutes of activity
per day. Both the ACSM guidelines and the national
(DHHS) physical activity guidelines recommend a mini-
mum of 150 minutes of moderate activity per week, or
75 minutes of vigorous activity per week (or a combina-
tion of minutes from moderate and vigorous activity).
Extending the length time for exercise bouts has addi-
tional benefits for health and wellness, as well as car-
diovascular fitness. For example, 150 to 300 minutes of
moderate activity per week is beneficial in losing body fat
and maintaining a healthy body weight. For fit and active
people, extending bouts of vigorous activity from 20
up to 90 minutes has both health/wellness benefits and
enhanced cardiovascular fitness. Use Table 2 to deter-
mine the appropriate length of time for daily exercise for
you based on your current activity and fitness level.
Different patterns of activity can be used to achieve
the recommended dose of exercise. Some people
may prefer to perform regular 30-minute bouts of exer-
cise but others may prefer to accumulate it throughout
the day. The ACSM indicates a pattern involving three
10-minute bouts provides similar benefits to one 30-min-
ute session. The amount of physical activity can also vary
across days but, as noted in a previous concept, the ACSM
discourages a pattern of activity performed by “weekend
warriors”—long activity sessions on one day a week with
no regular activity in between. The prescriptions in
Table 2 are aimed at overall aerobic fitness. Specialized
training regimens are typically needed for those interested
in aerobic fitness events (e.g., running races, triathlons)
and competitive sports (see Concept 12 for suggestions).
Threshold and Target Zones
for Intensity of Activity to Build
Cardiovascular Fitness
There is a minimum intensity and an optimal
intensity range for activity designed to develop
cardiovascular fitness. As noted earlier, monitoring
heart rate and making ratings of perceived exertion are
the most practical methods of determining the intensity
of activity necessary to build cardiovascular fitness. The
threshold of training (minimum intensity) and the target
zone (optimal intensity range) can be determined using
several methods. Most methods are based on heart rate
so the target zone is typically referred to as target heart
rate zone. Ratings of perceived exertion (RPE) can also
be used to define the target zone for exercise intensity.
This section provides details of using these methods.
An estimate of maximal heart rate (maxHR) is
needed to determine appropriate target heart
rate zones for aerobic exercise. Your maxHR is the
highest heart rate attained in maximal exercise. It could
be determined using an electrocardiogram while exer-
cising to exhaustion; however, it can also be estimated
with formulas. MaxHR is known to decrease with age so
one simple and commonly used approach is to subtract
your age from 220 (i.e., maxHR 5 220 2 age). However,
studies have shown that this formula leads to inaccurate
estimates for most people. A number of more specialized,
Aerobic activities provide an ideal stimulus for improving
cardiovascular fitness.
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Concept 7 ▶ Cardiovascular Fitness 125
Calculating Maximal Heart Rate
Maximal heart rate 5 208 2 (.7 3 age)
5 208 2 (.7 3 22)
5 208 2 15.4
193
Calculating Heart Rate Reserve
Maximal heart rate 193 bpm
Minus resting heart rate 2 68 bpm
Equals heart rate reserve (HRR) 125 bpm
Calculating Threshold Heart Rate
HRR 125 bpm
× 65% 3 .65
Equals 81 bpm
Plus resting heart rate 168 bpm
Equals threshold heart rate 149 bpm
Calculating Upper Limit Heart Rate
HRR 125 bpm
× 80% 3 .80
Equals 100 bpm
Plus resting heart rate 168 bpm
Equals upper limit heart rate 168 bpm
Table 3 ▶ Sample Target Heart Zone Calculations
for a 22-Year-Old, Using the Percentage of Heart
Rate Reserve Method
Heart Rate Reserve (HRR) The difference between
maximum heart rate (highest heart rate in vigorous
activity) and resting heart rate (lowest heart rate
at rest).
Ratings of Perceived Exertion (RPE) The assess-
ment of the intensity of exercise based on how the
participant feels; a subjective assessment of effort.
Genetics Influence Adaptations to Exercise
One factor over which you have little control
is heredity. For years we have known that all
people do not respond equally to regular exercise, even when
it is done using the correct FIT formula. A recent study pub-
lished in the Journal of Applied Physiology found that about
80 to 85 percent of 423 men and women who participated in
a cardiovascular fitness program saw improvements in car-
diovascular fitness over a period of 20 weeks. However, 15 to
20 percent of the participants showed little fitness improve-
ment. The researchers found that a genetic profile predicted
which people would get the most improvement from exercise.
Some suggested that this was evidence that exercise is
of little value to some people. However, researchers who
conducted the study suggest that exercise is of value
to all, noting that exercise has many benefits in addition
to increases in cardiovascular fitness. Even those who do
not respond with big gains in CV fitness can have changes
in blood pressure, blood sugar, heart rate, and other bio-
logical markers.
Would you give up on exercise if you didn’t see tangible gains
in
fitness from your efforts?
GG
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ACTIVITY
In the News
nonlinear equations have been developed to avoid this
problem. For example, a new formula for women was
recently developed (MaxHR 5 206 3 [.88 3 age]).
However, there is currently no consensus on the most
accurate method. In this book, we use a relatively sim-
ple nonlinear method known as the Tanaka formula:
maxHR 5 208 2 (.7 3 age). Calculations made at a
variety of ages show little, if any, differences between the
formulas, so we use the one that makes calculations the
easiest (it limits use of fractions). Table 3 illustrates the
calculations for determining maxHR for a 22-year-old.
The heart rate reserve (HRR) method is the
preferred way to calculate target heart rate zones.
Table 2 provides five different intensity ranges for activ-
ity designed to build cardiovascular fitness. After you
have assessed your fitness using fitness tests (see Lab
Resource Materials and Lab 7B), determine which of the
five intensity ranges is best for you based on your current
activity and fitness. Table 3 provides a worked example
for calculating heart rate target zones using the HRR
method. The example is for a 22-year-old with good
cardiovascular fitness, who does regular moderate-to-
vigorous physical activity and who has a resting heart rate
of 68 beats per minute. The target heart rate zone for this
hypothetical person is 65 to 80 percent.
To determine the threshold of training (minimum
heart rate for building cardiovascular fitness), use
65 percent of the working heart rate, and then add that
value to the resting heart rate. To determine the upper
limit of the target zone, use 80 percent of the working
heart rate and add that value to the resting heart rate.
Because target zone heart rates vary for people of dif-
ferent fitness and activity levels and because resting
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126 Section 3 ▶ The Physical Activity Pyramid
and maximal heart rates vary, each person will have a
unique range of heart rates defining the target heart
rate zone. The chart in Figure 5 allows you to look up
similar threshold and target heart rate zones based on
your resting heart rate and age (up to age 65). Locate
your resting heart rate on the left and your age across
the top. The values at the point where they intersect rep-
resent your target heart rate (based on 65 percent and
80 percent of HR reserve). Look across the columns for
a given row to see how the target zone changes with age.
Look down the rows for a certain column and see how the
target zone changes with fitness. The chart shows that fit
individuals (lower rest HR values) have lower target heart
rate zones than unfit individuals (higher rest HR values).
This may seem somewhat paradoxical but the reason is
that fit individuals start exercise with a lower HR value
and therefore have a larger HRR.
The percentage of maximum heart rate method is
an alternative way to calculate target heart rate
zones. The percentage of maxHR method is simpler to
use than the HRR method, but it is not as accurate. This
procedure takes maximal heart rate into account but does
not factor in individual differences in resting heart rate.
People with a typical resting HR of 60 to 70 bpm will
tend to get similar values with both methods, but the per-
centage of maxHR method tends to be less accurate for
people with high or low resting heart rates.
To use the percentage of maxHR method, first find your
maximum HR with the formula (maxHR 5 208 2 (.7 3
age). Then multiply your maxHR by the appropriate
percentages from Table 2 . For a person with good fit-
ness and who performs regular moderate-to-vigorous activ-
ity, the percentages would be 80 to 91 percent. The maxHR
for our hypothetical 22-year-old is 193, so the target heart
rate zone would be 154 to 176 using this method (.80 3
193 5 154 and .91 3 193 5 176). As illustrated in Table 3 ,
this procedure yields somewhat similar but higher values
for the maxHR method than for the HRR method. The
differences between the two methods vary for people of
different ages, resting heart rates, and fitness/activity lev-
els. The percentage of maxHR method is considered an
acceptable alternative method, but the HRR method is
more precise. Threshold and target zone heart rates should
be used as general guidelines for cardiovascular exercise.
You should check your resting heart rate and learn to cal-
culate your target heart range based on the HRR method.
It is important to understand how to make the calcula-
tions, since the process explains the relationships.
The target heart ranges should be used as just that,
a general target to try for during your exercise session.
By bringing your heart rate above the threshold and into
the target zone, you will provide an optimal challenge to
your cardiovascular system and maintain/improve your
cardiovascular fitness. Guidelines for heart rate monitor-
ing are provided in the next section.
Figure 5 ▶ Effect of age and resting heart rate on target heart
range.
Effect of Age and Resting Heart Rate on Target Heart Range
Rest HR Threshold 20 25 30 35 40 45 50 60 6555
65% 144 141 139 137 135 132 130 125 12312850
80% 165 162 160 157 154 151 148 143 140146
55 65% 145 143 141 139 136 134 132 127 125129
80% 166 163 161 158 155 152 149 144 141147
60 65% 147 145 143 140 138 136 133 129 127131
80% 167 164 162 159 156 153 150 145 142148
65 65% 149 147 144 142 140 137 135 131 128133
80% 168 165 163 160 157 154 151 146 143149
70 65% 151 148 146 144 142 139 137 132 130135
80% 169 166 164 161 158 155 152 147 144150
75 65% 152 150 148 146 143 141 139 134 132136
80% 170 167 165 162 159 156 153 148 145151
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Concept 7 ▶ Cardiovascular Fitness 127
Ratings of perceived exertion can be used to
monitor the intensity of physical activity. The
ACSM suggests that regularly active people can use RPE
to determine if they are exercising in the target zone (see
Table 4 ). Ratings of perceived exertion have been shown
to correlate well with HRR. For this reason, RPE can be
used to estimate exercise intensity, avoiding the need to
stop and count heart rate during exercise. A rating of 12
is equal to threshold, and a rating of 16 is equal to the
upper limit of the target zone. With practice, most people
can recognize when they are in the target zone using rat-
ings of perceived exertion.
Guidelines for Heart Rate
and Exercise Monitoring
Learning to count heart rate can help you monitor
the intensity of your physical activity. Each time your
heart beats, it pumps blood into the arteries. The surge
of blood causes a pulse, which can be felt by holding a
finger against an artery. The major
arteries that are easy to locate and
are frequently used for pulse counts
are the radial just below the base of
the thumb on the wrist (see Figure 6 ) and the carotid on
either side of the Adam’s apple (see Figure 7 ). Counting
the pulse at the carotid is the most popular procedure,
Rating Description
6
7 Very, very light
8
9 Very light
10
11 Fairly light
12
13 Somewhat hard
14
15 Hard
16
17 Very hard
18
19 Very, very hard
20
Source: Data from Borg.
Table 4 ▶ Ratings of Perceived Exertion (RPE)
Figure 6 ▶ Counting your radial (wrist) pulse. Figure 7 ▶
Counting your carotid (neck) pulse.
VIDEO 4
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128 Section 3 ▶ The Physical Activity Pyramid
probably because the carotid pulse is easy to locate. The
radial pulse is a bit harder to find because of the many
tendons near the wrist, but it works better for some
people.
To count the pulse rate, simply place the finger-
tips (index and middle finger) over the artery at the
wrist or neck location. Move the fingers around until
a strong pulse can be felt. Press gently so as not to
cut off the blood flow through the artery. Counting
the pulse with the thumb is not recommended because
the thumb has a relatively strong pulse of its own, and
it could be confusing when counting another person’s
pulse.
Counting heart rates during exercise presents
some additional challenges. To obtain accurate exer-
cise heart rate values, it is best to count heart beats or
pulses while moving; however, this is difficult during
most activities.
The most practical method is to count the pulse imme-
diately after exercise. During physical activity, the heart
rate increases, but immediately after exercise, it begins
to slow and return to normal. In fact, the heart rate has
already slowed considerably within 1 minute after activity
ceases. Therefore, you must locate the pulse quickly and
count the rate for a short period in order to obtain accu-
rate results. For best results, keep moving while quickly
locating the pulse; then stop and take a 15-second count.
Multiply the number of pulses by 4 to convert heart rate
to beats per minute.
You can also count the pulse for 10 seconds and mul-
tiply by 6, or count the pulse for 6 seconds and multi-
ply by 10 to estimate a 1-minute heart rate. The latter
method allows you to calculate heart rates easily by add-
ing 0 to the 6-second count. However, short-duration
pulse counts increase the chance of error because a mis-
count of 1 beat is multiplied by 6 or 10 beats rather than
by 4 beats.
The pulse rate should be counted after regular activ-
ity, not after a sudden burst. Some runners sprint the last
few yards of their daily run and then count their pulse.
Such a burst of exercise will elevate the heart rate con-
siderably. This gives a false picture of the actual exercise
heart rate. Everyone should learn to determine resting
heart rate accurately and to estimate exercise heart rate
by quickly and accurately making pulse counts after
activity (see Lab 7A).
Declines in resting heart rate and exercise heart
rate signal improvements in cardiovascular fitness.
As described in this concept, the heart beats to provide
the body (and working muscles) with oxygen. Oxygen
is used to produce energy using aerobic metabolism.
During rest, the heart can beat relatively slowly to pro-
vide sufficient oxygen to the body. During exercise, the
demand for energy increases, so the body increases heart
rate (and respiration) to help distribute more oxygen to
T E C H N O L O G Y U P D A T E
New Technology in Activity Monitoring
Physical activity researchers have been using accelerometry-
based devices to monitor physical activity behavior for 15
to 20 years. However, the development and deploy-
ment of low-cost accelerometers in gaming devices
such as the Wii and Kinect made it possible for compa-
nies to develop more competitively priced monitoring
devices. The monitors are more expensive than stan-
dard pedometers but they can capture the intensity
of physical activity and most can link wirelessly to the
Internet or your cell phone through Bluetooth tech-
nology. Some devices also have built-in connections
with social media applications, including Facebook, to
enable friends to hold each other accountable as virtual
exercise buddies. The new devices provide consumers
advanced activity monitoring devices to keep track of
their exercise sessions.
Would real-time monitoring devices help you stay committed
to your exercise goals?
ACTIVITY
A CLOSER LOOK
Online Fitness Memberships
and Consulting
Many people take advantage of employee fitness pro-
grams to get advice about exercise. Others prefer to
enroll in private gyms where they may contract with a per-
sonal trainer. A relatively new option for exercisers is to
enroll in an online fitness program. One company offers
opportunities for individuals to enroll in the Lifespan Fit-
ness Club to access personalized health and exercise
tracking software and exercise tip sheets. Members can
also connect with online health coaches who review your
status and provide suggestions for programming.
Would you use this type of support to maintain your health
status or would you rather do it on your own?
A
Online Fitness MFitnessi e Fitness
ACTIVITY
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Concept 7 ▶ Cardiovascular Fitness 129
Figure 8 ▶ Comparison of resting and exercise heart
for three 22-year-old individuals (maxHR 5 193) with
different levels of fitness (A 5 low fitness, B 5 moderate
fitness, C 5 high fitness).
A
Low Fit
Rest HR
HR
RPE
90
160
17
70
130
14
50
100
11
Mod Fit High Fit
200
180
160
140
120
100
80
60
40
20
0
B C
H
ea
rt
r
at
e
Exercise
Resting
the body. Changes in resting heart rate and exercise heart
rate provide good indicators of improvements in fitness
because they indicate that the heart can pump fewer
times to provide the same amount of blood flow to the
body. A fit individual has a stronger heart and can pump
more blood with each beat.
A comparison of resting and exercise heart rates for
three hypothetical individuals performing the same bout
of exercise is shown in Figure 8 . The column labeled
“A” shows the response of an unfit person. This person
has a high resting heart rate of 90, and this increases to
160 during the exercise. This intensity would feel pretty
hard, so an RPE would likely be about 17. Compare this
response to the results for a moderately or highly fit
person. Both have a lower resting heart rate and a lower
exercise heart rate, so exercise is easier and can be main-
tained more easily.
Strategies for Action
An important first step in developing
and maintaining cardiovascular
fitness is assessing your current status. For an activity pro-
gram to be most effective, it should be based on personal needs.
Some type of testing is necessary to determine your personal
need for cardiovascular fitness. The best measure of cardiovas-
cular fitness is a laboratory assessment of V
∙
O2 max, but this is
not possible for most people. To provide alternatives, research-
ers have developed other tests that give reasonable estimates.
Commonly used tests are the step test,
the swim test, the 12-minute run, the
Astrand-Ryhming bicycle test, and the
walking test. These tests are developed
based on comparisons with measured V
∙
O2 max and are good
general indicators of cardiovascular fitness. In Lab 7B you will
be able to compare estimates from several tests.
The self-assessment you choose depends on your current
fitness and activity levels, the availability of equipment,
and other factors. The walking test is probably best for those
at beginning levels because more vigorous forms of activity
may cause discomfort and discourage future participation.
The step test is somewhat less vigorous than the running test
and takes only a few minutes to complete. The bicycle test is
also submaximal or relatively moderate in intensity. It is quite
accurate but requires more equipment and expertise than the
other tests. You may need help from a fitness expert to do this
test properly. The swim test is especially useful to those with
musculoskeletal problems and other disabilities. The running
test is the most vigorous and for this reason may be best for
more advanced exercisers with high levels of motivation.
Results on the walking, running, and swimming tests are
greatly influenced by the motivation of the test taker. If the test
taker does not try hard, fitness results are underestimated.
The bicycle and step tests are influenced less by motivation
because one must exercise at a specified workload and at a
regular pace. Because heart rate can be influenced by emo-
tional factors, by exercise prior to the test, and other factors,
tests using heart rate can sometimes give incorrect results.
Thus, do your self-assessments when you are relatively free
from stress and are rested.
Prior to performing any of these, be sure that you are physi-
cally and medically ready. Prepare yourself by doing some
regular physical activity for 3 to 6 weeks before actually taking
the tests. If possible, take more than one test and use the sum-
mary of your test results to make a final assessment of your
cardiovascular fitness. In Lab 7B, you
will have the opportunity to self-assess
your cardiovascular fitness using one
or more tests. A nonexercise estimate
of cardiovascular fitness is also provided for comparison.
Although this self-report tool has limitations, it is increasingly
being used as a screening tool in physicians’ offices to deter-
mine if patients have risks associated with poor fitness.
ACTIVITY
VIDEO 5
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130 Section 3 ▶ The Physical Activity Pyramid
Healthy People
ACTIVITY
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101 Moderate Physical Activity A Lifestyle Approach .docx

  • 1. 101 Moderate Physical Activity: A Lifestyle Approach LEARNING OBJECTIVES After completing the study of this concept, you will be able to: ▶ Define moderate physical activity and differentiate it from light and vigorous physical activity. ▶ Describe the health benefits of moderate physical activity, and explain why moderate physical activity is the most popular form of physical activity . ▶ Describe and explain the FIT formula for moderate physical activity. ▶ Plan a personal moderate physical activity program based on SMART goals, and self-monitor your plan. ▶ Evaluate your current environment and determine ways to modify it to encourage moderate physical activity. C o n c e
  • 2. p t 6 The Physical Activity Pyramid ▶ Section III Moderate-intensity activities, including lifestyle activities, have many health and wellness benefits when performed regularly. cor22568_ch06_101-116.indd 101 10/09/12 6:41 PM F O S T E R , C E D R I C 1 6 9 2 T S
  • 3. 102 Section 3 ▶ The Physical Activity Pyramid regardless of fitness level or age. Moderate activities include some activities of daily living as well as less intense sports and recreational activities. Taking a brisk walk is the most obvious example of incorporating moderate activity into daily living. However, activities of daily living, such as walking the dog, garden- ing, mowing the lawn, carpentry, or housework can count as moderate activities. Moderate sports and recreational activities not considered to be vig- orous enough to be placed at step 3 of the physical activity pyramid can also be used to meet the moderate physical activity guideline (e.g., playing catch, shooting baskets, recreational bike riding, and casual rollerblading). Moderate physical activity can be distinguished from “light” activity and “vigorous” activity. Scien- tists have devised a method to classify levels of activity by intensity. With this system, all activities are compared against the amount of energy expended at rest. Resting energy expenditure is defined as 1 “metabolic equivalent” or 1 MET. Other activities are then assigned values in multiples of METS. For generally healthy adults, moderate-intensity activities require an energy expen- diture of 3.0 to 6.0 METS. This means that they require between three and six times the energy expended while at rest. Moderate-intensity activities
  • 4. are often referred to as aerobic physical activities because the aerobic metabolism can typi- cally meet the energy demand of the activity. This allows moderate-intensity (aerobic) activities to be performed com- fortably for extended periods of time by most people. Activities above 6 METS are considered to be vigorous physical activities and these cannot usually be maintained as easily unless a person has a good level of fitness. Examples include more structured aero- bic activities (e.g., jogging, biking, swimming) or vigor- ous sports (e.g., soccer). Activi- ties below 3.0 METS can be classified as “light intensity” but researchers now distin- guish light activity (1.5 to 3.0 METS) from sedentary activ- ity (1.0 to 1.5 METS) which primarily captures sitting and lying time. Examples of light H umans are clearly meant to move, but the nature of our society has made it difficult for many people to lead active lifestyles. Cars, motorized golf carts, snow- blowers, elevators, remote control devices, and email are just some of the modern conveniences that have reduced the amount of activity in our daily lives. Only a small per- centage of adults get enough regular physical activity to
  • 5. promote health and wellness benefits. Moderate-intensity physical activity (which includes many lifestyle tasks done as part of normal daily living), provides most of the ben- efits associated with active living. In Concept 5, you were provided with an overview of each type of physical activ- ity. In this concept, you will learn in more detail about moderate physical activity, the FIT formula for achiev- ing it, and how to plan a personal program to incorporate moderate physical activity into your daily routine. Adopting an Active Lifestyle Moderate physical activity is the foundation of an active lifestyle. Moderate physical activity is included at the base of the physical activity pyramid (see Figure 1 ) because it can be performed by virtually all people, VIDEO 1 Figure 1 ▶ The physical activity pyramid, step 1: moderate physical activity. Source: C. B. Corbin Avoid Inactivity Energy Balance Energy Out (Activity) Energy In (Diet) STEP 5 STEP 4
  • 6. STEP 3 STEP 2 Vigorous Sports and Recreation Vigorous Aerobics Moderate Physical Activity Flexibility Exercises Muscle Fitness Exercises • Tennis • Hike • Yoga • Stretch • Jog • Bike • Aerobic dance • Walk • Yard work • Golf • Calisthenics • Resistance
  • 7. exercise STEP 1 cor22568_ch06_101-116.indd 102 11/09/12 3:38 PM F O S T E R , C E D R I C 1 6 9 2 T S Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach 103 activities include lower-intensity activities of daily living such as showering, grocery shopping, washing dishes, and casual walking. While public health goals focus on
  • 8. moderate activity, minimizing time spent in sedentary activity is also important (see In the News). Distinctions among the types of activities are summarized in Table 1 . Because moderate activities are relatively easy to perform, they are popular among adults. Walking is the most popular of all leisure-time activities among adults. According to the National Sporting Goods Asso- ciation, 96 million Americans say they walk for exercise, nearly twice the number that participate in the second and third most popular activities, exercising with equip- ment and swimming. Women walk more than men, and young adults (18–29) walk less than older adults, probably because of more involvement in sports and other vigor- ous activities. Walking behavior ranges from occasional walks to walking regularly to meet national physical activity guidelines. As many as 40 to 50 percent of adults say they walk, but less than half that number report walk- ing 30 minutes or more at least 5 days a week. Walking is popular in all age groups, but participa- tion in other moderate activities varies with age. Interest- ingly, while overall activity levels tend to decline with age, involvement in lifestyle activity actually tends to increase. This is because many older adults move away from vigor- ous sports and recreation and spend more time in lifestyle activities, such as gardening and golf. Older adults tend to have more time and money for these types of recreational activities, and the lower intensity may be appealing. The advantage of moderate activity is that there are many opportunities to be active. Finding enjoyable activ- ities that fit into your daily routine is the key to adopting a more active lifestyle.
  • 9. Sedentary Time Can Be Harmful Along with finding ways to get daily moder- ate activity, recent evidence suggests that it is also important to minimize time spent being sedentary. Recent studies have consistently shown that excess time spent sitting can have negative health consequences, even if you are a physically active person. One study showed that time spent watching TV was associated with risk of being overweight regardless of physical activity level. Another study showed that sedentary behavior (sitting time) was associated with mortality after adjusting for smoking status, diet, and level of physical activity. Avoiding sustained periods of sitting seems to be important for reducing these risks. What can you do to avoid extended periods of sitting during the day? SS A a ACTIVITY In the News Classification Intensity Range Examples Sedentary 1.0–1.5 METS Sitting, lying Light 1.5–3.0 METS Showering, grocery shopping, playing musical instrument, washing dishes
  • 10. Moderate 3.0–6.0 METS Walking briskly, mowing lawn, playing table tennis, doing carpentry Vigorous . 6.0 METS Hiking, jogging, digging ditches, playing soccer Table 1 ▶ Classifi cations of Physical Activity Intensities for Generally Healthy Adults Moderate Physical Activities Activities equal in intensity to brisk walking; activities three to six times as intense as lying or sitting at rest (3–6 METs). MET One MET equals the amount of energy a person expends at rest. METs are multiples of rest- ing activity (2 METs equal twice the resting energy expenditure). Aerobic Physical Activities Aerobic means “in the presence of oxygen.” Aerobic activities are activities or exercise for which the body is able to supply ade- quate oxygen to sustain performance for long periods of time. Vigorous Physical Activities Activities that are more vigorous than moderate activities with intensi- ties at least six times as intense as lying or sitting at rest (. 6 METS). Light Activities Activities that involve standing and/ or slow movements with intensities 1.5 to 3 times as intense as lying or sitting at rest (1.5–3.0 METS). Sedentary Activities Activities that involve lying or sitting with intensities similar to (or just slightly higher) than rest (1.0–1.5 METS). cor22568_ch06_101-116.indd 103 8/10/12 11:29 PM
  • 11. F O S T E R , C E D R I C 1 6 9 2 T S 104 Section 3 ▶ The Physical Activity Pyramid Activity Classification by Fitness Level Sample Lifestyle Activities Low Fitness Marginal Fitness Good Fitness High Performance Washing your face, dressing, typing, driving a car Light Very light/light Very light Very light Normal walking, walking
  • 12. downstairs, bowling, mopping Moderate Moderate Light Light Brisk walking, lawn mowing, shoveling, social dancing Vigorous Moderate/Vigorous Moderate Moderate Table 2 ▶ Classifi cation of Moderate Physical Activities for People of Different Fitness Levels Brief walks throughout the day can help you meet recommended levels of moderate activity. Activity classifications vary, depending on one’s level of fitness. Normal walking is considered light activity for a person with good fitness (see Table 1 ), but for a person with low to marginal fitness the same activity is considered moderate. Similarly, brisk walking may be a vigorous activity (rather than moderate) for individuals with low fitness. Table 2 helps you determine the type of lifestyle activity considered moderate for you. Begin- ners with low fitness should start with normal rather than brisk walking, for example. In Concept 7, you will learn to assess your current fitness level. You may want to refer back to Table 2 after you have made self-assessments of your fitness. The Health and Wellness Benefits of Moderate Physical Activity Moderate activity provides significant health ben- efits. Research has clearly shown that even modest amounts of moderate activity have significant health benefits. Two early studies paved the way for this line of research. One study reported that postal workers who delivered mail had fewer health problems than workers who sorted mail. Another study reported that drivers of double-decker buses in England had more health prob-
  • 13. lems than conductors who climbed the stairs during the day to collect the tickets. The studies controlled for other lifestyle factors, so the improved health was attributed to the extra activity accumulated throughout the day. Since then, hundreds of studies have further confirmed the importance of moderate activity for good health. How- ever, as described in Concept 5, additional health benefits are possible if vigorous physical activity is also performed. Moderate activity promotes metabolic fitness. Metabolic fitness is fitness of the systems that provide the energy for effective daily living. Indicators of good metabolic fitness include normal blood lipid levels, normal blood pressure, normal blood sugar levels, and healthy body fat levels. Moderate physical activity pro- motes metabolic fitness by keeping the metabolic system active. Building and maintaining cardiovascular fitness requires a regular challenge to the cardiovascular system and building metabolic fitness requires a similar regular challenge to the metabolic system. Individuals with good levels of fitness will receive primarily metabolic fitness benefits from moderate activity, but those with low fit- ness will likely receive metabolic and cardiovascular fitness benefits . Moderate activity is particularly impor- tant for the large segments of the population that do not participate in other forms of regular exercise. As previ- ously described, some activity is clearly better than none. Moderate physical activity has wellness benefits. The health benefits from physical activity are impressive, but the wellness benefits may have a bigger impact on cor22568_ch06_101-116.indd 104 8/10/12 11:29 PM F O
  • 14. S T E R , C E D R I C 1 6 9 2 T S Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach 105 our daily lives. Numerous studies have shown that physical activity is associated with improved quality of life (QOL), but it has proven difficult to determine the contributing factors or underlying mechanisms. The influence may be due to reduced stress, improved cognition, better sleep, improved self-esteem, reduced fatigue or (more likely) a combination of many different effects. A recent study in college students sought to isolate some of the underlying effects. The study reported that students who were more physically active had more positive feeling states (“ pleasant- activated feelings ”) than students who
  • 15. were less physically active even after controlling for sleep and previous days’ activity and feeling states. They also noted that feeling states improved on days when people reported performing more activity than normal. The well- ness benefits can impact young people every day whereas health benefits may not be noticed until a person gets older. Regular activity is important to achieving health, fit- ness, and wellness benefits. For the benefits of activ- ity to be optimal, it is important to exercise regularly. The specific benefits from moderate activity tend to be more dependent on frequency than on intensity. This is some- times referred to as the last bout effect, because the effects are short term (i.e., attributable to the last bout of activity performed). For example, regular exercise promotes meta- bolic fitness by creating the stimulus that helps maintain insulin sensitivity and improve glucose regulation. Another example is the beneficial effect of exercise on stress man- agement. In this case, the periodic stimulus from exercise helps directly counter the negative physical and physiologi- cal responses to stress. To maximize the benefits of physical activity, it is important to try to get some activity every day. Sustained light-intensity activity may provide health benefits and promote weight control. The new physical activity guidelines have recommended that activities be at least moderate in intensity. However, evi- dence suggests that the accumulation of light-intensity activity can have benefits, especially in those who are sedentary. Some researchers have referred to this type of activity as Non-Exercise Activity Thermogenesis (NEAT) to emphasize the substantial number of calories that can be burned by performing light-intensity activity. Meeting the recommendation for
  • 16. moderate activity is best, but beginning some activity, even light activity, is better than doing nothing at all. How Much Moderate Physical Activity Is Enough? There is a FIT formula for moderate physical activity. The concept of a threshold of training is used in this book to describe the minimum activity needed for benefits. As described in Concept 5, public health guide- lines endorsed by the ACSM, the AHA, and the CDC have recommended that adults accumulate 150 minutes of moderate-intensity activity each week, an amount equal to 30 minutes 5 days a week. The recommenda- tion highlighted in the original Surgeon General’s Report on Physical Activity called for adults to accumulate about 1,000 kcal/week (or about 150 kcal/day) from moderate activity. Table 3 summarizes the threshold levels for fre- quency, intensity, and time (duration). Note that these are considered minimal, or threshold, levels. The target zone calls for the accumulation of 30 or more minutes a day. Physical activity above the recommended minimum pro- vides additional health benefits. Activity bouts of 10 minutes are recommended, but shorter durations of moderate activity have benefits. National physical activity guidelines suggest that moderate activity bouts should be 10 minutes in length or longer for optimal health and fitness benefits. Nevertheless, short-duration moderate activity, sometimes referred to as “incidental physical activity,” accumulated throughout the day is also beneficial. The specification of 10-minute sessions in the guidelines is somewhat arbitrary as there is no absolute threshold defining how VIDEO 2
  • 17. Health is available to Everyone for a Lifetime, and it’s Personal Walking is by far the most commonly reported moder- ate activity, but people often go out of their way to avoid walking (such as driving around the lot to find the closest parking spot; waiting for an elevator rather than climbing a few flights of stairs). Do you view walking as a “means to an end” (i.e., simply as a way to get around) or as an “end in itself” (i.e., as a way to get more physical activity)? How might this perception influence your activity patterns? ACTIVITY Metabolic Fitness Benefits Improvements in meta- bolic function that reduce risks of diabetes and meta- bolic syndrome. Cardiovascular Fitness Benefits Improvements in cardiovascular function that contribute to cardio- vascular fitness. Wellness Benefits Increases in quality of life and well-being. Last Bout Effect A short-term effect associated with the last bout of activity. Typically related to improvements in metabolic fitness. VIDEO 3 cor22568_ch06_101-116.indd 105 12/09/12 6:36 PM F O S
  • 18. T E R , C E D R I C 1 6 9 2 T S 106 Section 3 ▶ The Physical Activity Pyramid (see Table 2 ), activity that is moderate for young adults may be too intense for some older individuals or those with health problems. Because of this, the guidelines recommend that these individuals should focus on track- ing minutes of activity. This allows the intensity to be a self-determined level that corresponds to a person’s rela- tive level of fitness. Monitoring and Promoting Physical Activity Behavior Many people use pedometers to monitor daily activity levels. Digital pedometers are a popular self- monitoring tool used to track physical activity patterns.
  • 19. They provide information about the number of steps a person takes. Stride length and weight can be entered into most pedometers to provide estimates of distance traveled and/or calories burned. Some newer pedome- ters include timers, which track the total amount of time spent moving; some allow step information to be stored over a series of days. Pedometers provide a helpful reminder about the importance of being active during the day. They also are useful for tracking activity patterns over a series of days. The interest in and popularity of pedometers has resulted in media stories promoting the standard of 10,000 steps as the level of activity needed for good health. This stan- dard was originally developed in Japan, where pedometers were popular before elsewhere in the world. Experts have warned against using an absolute step count standard for all people as it would be too hard for some and not hard enough for others based on personal activity patterns. Studies on large numbers of people provide data to help classify people into activity categories based on step counts (see Table 4 ), but actual step goals should vary from person to person. Wear the pedometer for 1 week to establish a baseline step count (average steps per day). Then, set a goal of increasing steps per day by 1,000 to long activity sessions must be. In general, the main focus should be on the total volume of moderate activity performed. Vigorous activity can substitute for moderate activity. The U.S. Physical Activity Guidelines released by the Department of Health and Human Services (DHHS) provide some flexibility for meeting activity guidelines. Rather than requiring activity on 5 different
  • 20. days, the DHHS guidelines specify that 150 minutes of moderate physical activity can be accumulated during the week. If you fail to meet the 30-minute guideline on 1 day, you can make it up on another and still meet the guideline. Vigorous-intensity activity can also be substituted to meet the weekly targets. According to the DHHS guidelines, each minute of vigorous activity counts as 2 minutes of moderate. Therefore, the guide- line can also be met by performing 75 minutes of vigor- ous activity instead of 150 minutes of moderate activity. The guidelines can also be expressed in total “MET- minutes.” To compute MET-minutes, you simply multi- ply the MET level of the activity you performed by the number of minutes. For example, a 60-minute brisk walk (approximately 3 METS) would yield 180 MET-minutes (3 METS 3 60 minutes). However, note that this same volume can also be achieved with a 30-minute run that requires approximately 6 METS (6 METS 3 30 min- utes). A total of 500 MET-minutes per week is recom- mended to meet the minimum guidelines. Special moderate activity guidelines have been developed for children, older adults, and adults with chronic health conditions. Guidelines for phys- ical activity depend on the unique needs of the target population. Children need more physical activity than adults (at least 60 minutes and up to several hours of activity each day). Guidelines are also different for older adults and adults with chronic conditions. As previously described Threshold of Training (minimum)a Target Zone (optimal) Frequency At least 5 days a week 5–7 days a week
  • 21. Intensityb • Equal to brisk walkingb • Approximately 150 calories accumulated per day • 3 to 5 METsb • Equal to brisk to fast walkingb • Approximately 150–300 calories accumulated per day • 3 to 6 METsb Time (duration)c 30 minutes or three 10-minute sessions per day 30–60 minutes or more accumulated in sessions of at least 10 minutes a150 minutes per week is recommended by DHHS. bHeart rate and relative perceived exertion can also be used to determine intensity (see Concept 7). cDepends on fitness level (see Table 2). Table 3 ▶ The FIT Formula for Moderate Physical Activity cor22568_ch06_101-116.indd 106 8/10/12 11:30 PM F O S T E R , C E D R
  • 22. I C 1 6 9 2 T S Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach 107 3,000 steps. Keep records of daily step counts to help you determine if you are meeting your goal. Setting a goal that you are likely to meet will help you find success. As you meet your goal, increase your step counts gradually. Pedometers do have some limitations as indicators of total physical activity. A person with longer legs will accu- mulate fewer steps over the same distance than someone with shorter strides (due to a longer stride length). A person running will also accumulate fewer steps over the same distance than a person who walks. There is considerable variability in the quality (and accuracy) of commercial pedometers, so it is important to consider this when purchasing one. Energy expenditure can be used to monitor physical activity. As shown in Table 3 , an energy expen- diture of between 150 and 300 kcal/day from physical activity is sufficient for meeting physical activity guide- lines. While not as simple as tracking time, calories
  • 23. expended from physical activity can be estimated if the approximate MET value of the activity is known. The energy cost of resting energy expenditure (1 MET) is approximately 1 calorie per kilogram of body weight per hour (1 kcal/kg/hour). An activity such as brisk walk- ing (4 mph) requires an energy expenditure of about 4 METs, or 4 kcal/kg/hour. A 150 lb. person (~ 70 kg) walk- ing for an hour would expend about 280 kcal (4 kcal/kg/ hour 3 70 kg 3 1 hr.). Note that a 30-minute walk would burn approximately 150 calories and satisfy the guideline. Commercial fitness equipment can provide energy expenditure estimates. The devices use an estimated MET level based on the selected intensity or a measured heart rate (if a heart rate sensor is used). The timer on the machine then tracks the time of the workout, and this allows calories to be estimated during the work- out. The estimate will only be somewhat accurate if the machine also obtained a body weight value from you dur- ing the setup process. If this wasn’t obtained, the calorie estimates are probably based on some reference value of weight and therefore may not be accurate. Table 5 lists estimated METs for different activities, along with calo- rie estimates (per hour of exercise) for people of different body weights. A variety of methods can be used to accumulate moderate physical activity for health benefits. Finding 30 minutes or longer for continuous physical activity may be difficult, especially on very busy days. However, the physical activity guidelines empha- size that moderate activity can be accumulated throughout the day. Figure 2 illustrates the Pedometers offer a useful way of monitoring physical activity.
  • 24. Category Steps/Day Sedentary < 5,000 Low active 5,000–6,999 Somewhat active Threshold 7,000–9,999 Active Target Zone 10,000–12,500 Very active . 12,500 Source: Based on values from Tudor-Locke. Table 4 ▶ Activity Classifi cation for Pedometer Step Counts in Healthy Adults A CLOSER LOOK Every Body Walk Every Body Walk is a national movement committed to “get Americans up and moving.” The organization has developed a variety of social media applications that help to connect organizations, people, and communities across the country. Customized (free) apps for smart- phones are available to help track and personalize your walking plan, connect with walking communities, and share stories. Associated Facebook links and Twitter feeds (follow @everybodywalk) provide inspirational mes- sages and opportunities to network and share stories. The website (www.everybodywalk.org) features a hub for walking-related blogs and video clips showing how groups across America are finding a new sense of com- munity through walking.
  • 25. What are other ways social media can be used to spur community involvement in physical activity? Every B A WalkBody WBody W ACTIVITY VIDEO 4 VIDEO 5 cor22568_ch06_101-116.indd 107 10/09/12 6:41 PM F O S T E R , C E D R I C 1 6 9 2
  • 26. T S 108 Section 3 ▶ The Physical Activity Pyramid Calories Used per Hour for Different Body Weights Activity Classification / Description METsa 100 lb. (45 kg) 120 lb. (55 kg) 150 lb. (70 kg) 180 lb. (82 kg) 200 lb. (91 kg) 220 lb. (100 kg) Gardening Activities Gardening (general) 5.0 227 273 341 409 455 502 Mowing lawn (hand mower) 6.0 273 327 409 491 545 599 Mowing lawn (power mower) 4.5 205 245 307 368 409 450
  • 27. Raking leaves 4.0 182 218 273 327 364 401 Shoveling snow 6.0 273 327 409 491 545 599 Home Activities Child care 3.5 159 191 239 286 318 350 Cleaning, washing dishes 2.5 114 136 170 205 227 249 Cooking / food preparation 2.5 114 136 170 205 227 249 Home / auto repair 3.0 136 164 205 245 273 301 Painting 4.5 205 245 307 368 409 450 Strolling with child 2.5 114 136 170 205 227 249 Sweeping / vacuuming 2.5 114 136 170 205 227 249 Washing / waxing car 4.5 205 245 307 368 409 450 Leisure Activities Bocci ball / croquet 2.5 114 136 170 205 227 249 Bowling 3.0 136 164 205 245 273 301 Canoeing 5.0 227 273 341 409 455 501 Cross-country skiing (leisure) 7.0 318 382 477 573 636 699 Cycling (<10 mph) 4.0 182 218 273 327 364 401 Cycling (12–14 mph) 8.0 364 436 545 655 727 799
  • 28. Dancing (social) 4.5 205 245 307 368 409 450 Fishing 4.0 182 218 273 327 364 401 Golf (riding) 3.5 159 191 239 286 318 350 Golf (walking) 5.5 250 300 375 450 500 550 Horseback riding 4.0 182 218 273 327 364 401 Swimming (leisure) 6.0 273 327 409 491 545 599 Table tennis 4.0 182 218 273 327 364 401 Walking (3.5 mph) 3.8 173 207 259 311 346 387 Occupational Activities Bricklaying / masonry 7.0 318 382 477 573 636 699 Carpentry 3.5 159 191 239 286 318 350 Construction 5.5 250 300 375 450 500 550 Electrical work / plumbing 3.5 159 191 239 286 318 350 Digging 7.0 318 382 477 573 636 699 Farming 5.5 250 300 375 450 500 550 Store clerk 3.5 159 191 239 286 318 350 Waiter / waitress 4.0 182 218 273 327 364 401 Note: MET values and caloric estimates are based on values listed in Compendium of Physical Activities (see Suggested
  • 29. Readings). aBased on values of those with “good fitness” ratings. Table 5 ▶ Calories Expended in Lifestyle Physical Activities cor22568_ch06_101-116.indd 108 14/09/12 6:40 PM F O S T E R , C E D R I C 1 6 9 2 T S Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach 109 Figure 2 ▶ Comparison of people performing moderate activity in different ways.
  • 30. Noon-hour treadmill walk Moderate structured activity 0 6 Time (hours) 6 7 2 3 4 5 6 7 8 9 10 11110 11 1 3 0 6 AM PM 8 9 noon 1 3 Moderate Light Vigorous Energy expenditure (METS)
  • 31. Moderate lifestyle activity Work Work Walkto bus Walk to bus 0 6 6 7 2 3 4 5 6 7 8 9 10 11110 11 1 3 0 6 AM PM 8 9 noon 1 3 Moderate Light Vigorous Energy expenditure (METS)
  • 32. Time (hours) 0 6 Time (hours) 6 7 2 3 4 5 6 7 8 9 10 11110 11 1 3 0 6 AM PM 8 9 noon 1 3 Moderate Light Vigorous Walk to car Walk to car Sedentary
  • 33. Energy expenditure (METS) activity profiles for three different people. The red line profiles a person who is inactive except for brief walks from the car to the office in the morning and from the office to the car in the evening. This person is seden- tary and does not meet the moderate activity guidelines. Because some activity is better than none, the brief walks cor22568_ch06_101-116.indd 109 8/10/12 11:30 PM F O S T E R , C E D R I C 1 6 9 2 T S
  • 34. 110 Section 3 ▶ The Physical Activity Pyramid are better than no activity at all. The blue line represents a person who is sedentary most of the day but meets the moderate activity guideline by taking a long walk during the noon hour. The green line represents the activity of a person who meets the moderate activity standard in multiple bouts, including lifestyle activities such as walk- ing to and from work, walking to lunch, and climbing the stairs. You can accumulate activity using the method that you prefer as long as you meet the guidelines out- lined in Table 2 . Moderate Activity and the Built Environment The sedentary nature of our society is due in large part to environmental factors. Many people would like to be more active, but they may not live in an area conducive to activity. Studies have conclusively demonstrated that the physical or “built environment” has important influences on physical activity patterns and risk for overweight and obesity. Some early studies had inherent limitations that have made it difficult to determine if the relationship was causal. It is possible, for example, that active people choose to move to environ- ments with less urban sprawl and more access to parks and green spaces. Recent research, however, has demon- strated that changes in the environment (e.g., more trails, safer and more accessible walking routes) can lead to changes in levels of physical activity. This type of evidence has been important because it indicates that our environ- ment does contribute to our physical activity patterns. The results also help justify expenses to create environ- ments more conducive to physical activity.
  • 35. Building active community environments has become an important national priority. Many pub- lic health organizations have developed awareness cam- paigns and strong advocacy networks to support the creation of healthier environments. One organization called Active Living by Design is dedicated to promot- ing more active environments in society. The vision is for neighborhoods that allow physical activity to be built into a person’s normal routine (going to the store, visit- ing friends) and communities with integrated biking and walking paths. These concepts are consistent with other recommendations for urban planning (e.g., Smart Growth Movement). Other groups such as the National Coalition of Walking Advocates, the Alliance for Biking and Walking, and Walkable Communities are positioned to play key roles in promoting awareness and advocat- ing at the state and national levels to improve federal practices and funding decisions that influence biking and walking. These groups encourage community activism since consumers ultimately influence social norms and decision making. See the Web Resources to learn more about these organizations. Walkability is an important consideration for consumers and homeowners. The national Com- munity Preference Survey conducted by the National Association of Realtors revealed that nearly 60 percent of Americans would prefer to live in neighborhoods that would allow them to easily walk to stores and other busi- nesses. Walkable access to grocery stores was rated as being an important consideration by 75 percent of the respondents. T E C H N O L O G Y U P D A T E Electronic Bikes
  • 36. The e-bike (electric bike) is a new type of bicycle designed to promote active commuting. Traveling at speeds up to about 15 mph, the e-bike has a small electric engine that gives support to the rider only when he or she is pedaling. It was first developed in Switzerland to encourage people who live in hilly terrains to ride bicycles. A recent study showed that the effort necessary to ride an e-bike to work (about 6 METS) was less than the effort needed to ride a regular bike. Most of the commuters in the study were easily able to use the bike to commute to work. The e-bike is now gaining popularity in other countries because it is comfortable, practical, and contributes to cleaner air. The e-bike also encourages otherwise inactive people to become active. Would you consider using an e-bike as a way to get more activity? To help the environment? ACTIVITY Built Environment A term used to describe aspects of our created physical environment (e.g., buildings, roads). cor22568_ch06_101-116.indd 110 8/10/12 11:30 PM F O S T E R , C E
  • 37. D R I C 1 6 9 2 T S Concept 6 ▶ Moderate Physical Activity: A Lifestyle Approach 111 Distance is one major consideration but researchers have determined that a number of characteristics influ- ence the walkability of an environment. Walking is more likely when the weather is warm, but factors such as avail- ability of sidewalks, good lighting, safe neighborhoods, and aesthetic surroundings are the key factors in making an area walkable. A number of websites now provide tools to rate the walkability of communities (search “walkscore” on the Internet). According to recent rankings, the most walkable of the 50 largest U.S. cities were New York, San Francisco, Boston, and Chicago. In Lab 6B you will evaluate the walkability of your community based on similar criteria. Consider personal strategies for increasing moderate activity. While the environment has an impact on population levels of physical activity, it does not determine individual behavior. People are autono-
  • 38. mous beings and can make decisions about where they go and what they do. The key is to take stock of your lifestyle and your environment and determine ways to integrate more activity into your daily routine. Active commuting is one way to add physical activity to your lifestyle. It takes additional preparation and the logistics can be challenging, but it is a great way to build activity into your day. In addition to providing beneficial amounts of physical activity, this can save time, reduce gas, save money, and help the environ- ment. Another option is to take a few active trips to the store. Research suggests that the overwhelming majority of our car trips are 1 mile or less. Walking or biking even a few of these trips can have a big impact. The ability to walk or bike to work or to the store may not be possible for you because of the nature of your community or the safety of the roads. However, there are a number of other strate- gies you can use to get more activity in your day. Consider parking farther away from store entrances, using the stairs rather than the elevator, taking walking breaks, and even standing (instead of sitting) when convenient. Adopting an active lifestyle in a sedentary society is challenging, but it is within your control. Bike commuting is an effective way to add physical activity to your day. VIDEO 6 Strategies for Action A regular plan of moderate physical activity is a good place to start.
  • 39. Moderate physical activity is something that virtually anyone can do. In Lab 6A, you can set moderate physical activity goals and plan a 1-week lifestyle physical activity program. For some, this plan may be the main component of a lifetime plan. For others, it may be only a beginning that leads to the selection of activities from other levels of the physical activity pyramid. Even the most active people should consider regular moderate physical activity because it is a type of activity that can be done throughout life. Self-monitoring moderate physical activity can help you stick with it. The self-monitoring chart in Lab 6A not only helps you keep a log of moderate activities (or step counts), it also lets you hone your self-management skills. Charts like this can be copied to make a log book for long- term activity self-monitoring. Environmental factors influence our moderate physical activity patterns. In Lab 6B, you will conduct an evalu- ation of the walkability of your community and an evalua- tion of community resources available for physical activity. The purpose of this lab is to increase your awareness of the importance of active, safe environments for promoting physical activity. Becoming an advocate for physical activ- ity in your community is a great way to help promote local change. ACTIVITY cor22568_ch06_101-116.indd 111 10/09/12 6:41 PM F O S T
  • 40. E R , C E D R I C 1 6 9 2 T S 112 Section 3 ▶ The Physical Activity Pyramid Web Resources Alliance for Biking and Walking www.peoplepowered movement.org America On the Move www.americaonthemove.org Bike Commute.com www.bikecommute.com Compendium of Physical Activities http://prevention.sph .sc.edu/tools/compendium.htm National Coalition for Promoting Physical Activity www.ncppa.org National Coalition of Walking Advocates
  • 41. www.americawalks.org/ The Pedestrian and Bicycle Information Center (PBIC) www.walkinginfo.org Public Broadcasting System/America’s Walking Homepage www.pbs.org/americaswalking Walkable Cities (walkscores) www.walkscore.com Walkable Communities Inc www.walkable.org Suggested Readings ACSM. 2010. ACSM’s Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia: Lippincott, Williams & Wilkins, Chapters 2 and 7. Ainsworth, B. E. 2000. Compendium of physical activities: An update of activity codes and MET intensities. Medicine and Science in Sports and Exercise 32 (Suppl):S498–S516. Chaloupka, F. J., et al. 2010. The association between community physical activity settings and youth physical activity, obesity, and body mass index. Journal of Adolescent Health. Published online June 10, 2010, www.jahonline.org Foti, K. K., et al. 2011. Sufficient sleep, physical activity, and sedentary behaviors. American Journal of Preventive Medicine 41(6):596–602. Garber, C. E., et al. 2011. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculo- skeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine and Science in Sports and Exercise 43(7):1334–1359.
  • 42. Healy, G. N., et al. 2011. Sedentary times and cardio-metabolic biomarkers in US adults: NHANES 2003-06. European Heart Journal 32(5):590–597. Hyde, A. L., et al. 2012. Unpacking the feel-good effect of free-time physical activity: Between- and within-person associations with pleasant-activated feeling states. Journal of Sport & Exercise Psychology 33(6):884–902. Kohl, H. W., and T. D. Murray. 2012. Foundations of Physical Activity and Public Health. Champaign, IL: Human Kinetics. Matthews, C. E., et al. 2012. Amount of time spent in seden- tary behaviors and cause-specific mortality in US adults. American Journal of Clinical Nutrition 95(2):437–445. Mowen, A., and A. Kaczynski. 2008. The potential of parks and recreation in addressing physical activity and fitness. President’s Council on Physical Fitness and Sports Research Digest 9(1):1–8. Owen, N., et al. 2010. Too much sitting: The population health science of sedentary behavior. Exercise and Sport Sciences Reviews 38(3): 105–113. Russ, R., and McGuire, K. A. 2011. Incidental physical activity is positively associated with cardiorespiratory fitness. Medicine and Science in Sports and Exercise 43(11):2189–2194. Sattelmair, J., et al. 2011. Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation 124(7):789–795. Healthy People
  • 43. ACTIVITY 2020 The objectives listed below are societal goals designed to help all Americans improve their health between now and the year 2020. They were selected because they relate to the content of this concept. • Reduce proportion of adults who do no leisure-time activity. • Increase proportion of adults who meet guidelines for aerobic activity. • Increase proportion of adults who meet guidelines for muscle fitness activity. • Increase proportion of trips made by walking. • Increase proportion of youth who meet guidelines for TV viewing and computer use and overuse (overuse is 2 hours a day or more). • Create social and physical environments that promote good health for all. • Promote quality of life, healthy development, and healthy behaviors across all stages of life. A national goal is to increase walking trips (moderate physical activity). Describe three ways that you can increase walking trips during the week and comment on whether you think you are likely to carry out any of these methods as part of your normal routine.
  • 44. cor22568_ch06_101-116.indd 112 10/09/12 6:41 PM F O S T E R , C E D R I C 1 6 9 2 T S 113 Lab 6A S etting G oals for M od
  • 45. erate P hysical A ctivity and S elf-M onitoring (Logging) P rogram Lab 6A Setting Goals for Moderate Physical Activity and Self-Monitoring (Logging) Program Name Section Date Purpose: To set moderate activity goals and to self-monitor (log) physical activity Procedures 1. Read the five stages of change questions below. Place a check by the stage that best represents your current moderate physical activity level. If you are at stages 1–3 (precontemplation, contemplation, or preparation), you may want to set goals below the threshold of 30 minutes per day to get started. Those at the action or mainte- nance stage should consider goals of 30 minutes or more per day. 2. Determine moderate activity goals for each day of a 1-week period. In the columns (Chart 1) under the heading “Moderate Activity Goals,” record the total minutes per day that you expect to perform OR the total steps per day
  • 46. that you expect to perform. Record the specific date for each day of the week in the “Date” column. 3. The goals should be realistic for you, but try to set goals that would meet current physical activity guidelines. If you choose step goals, you will need a pedometer. Use Table 4 on page 107 to help you to choose daily step goals. 4. If you choose minutes per day as your goals, use Chart 2 to keep track of the number of minutes of activity that you perform on each day of the 7-day period. Record the number of minutes for each bout of activity of at least 10 minutes in length performed during each day (Chart 2). Determine a total number of minutes for the day and record this total in the last column of Chart 2 and in the “Minutes Performed” column of Chart 1. 5. If you choose steps per day as your goals, determine the total steps per day accumulated on the pedometer and record that number of steps in the “Steps Performed” column for each day of the week (Chart 1). 6. Answer the questions in the Conclusions and Implications section (use full sentences for your answers). Determine your stage for moderate physical activity. Check only the stage that represents your current moderate activity level. Precontemplation: I do not meet moderate activity guidelines and have not been thinking about starting. Contemplation: I do not meet moderate activity guidelines but have been thinking about starting. Preparation: I am planning to start doing regular moderate
  • 47. activity to meet guidelines. Action: I do moderate activity, but I am not as regular as I should be. Maintenance: I regularly meet national goals for moderate activity. Select a goal for each day in a 1-week plan. Keep a log of the activities performed to determine if your goals are met. Moderate Activity Goals Summary Performance Log Date: Minutes/day Steps/day Minutes Performed Steps Performed Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Chart 1 Moderate Physical Activity Goals and Summary Performance Log cor22568_ch06_101-116.indd 113 8/10/12 11:30 PM F
  • 50. on ito rin g (L og gi ng ) P ro gr am . Did you meet your moderate activity goals for at least 5 days of the week? Yes No Do you think you can consistently meet your moderate activity goals? Yes No What activities did you perform most often when doing moderate activity? List most common activities in the spaces below. Conclusions and Interpretations 1. Do you feel that you will use moderate physical activity as a regular part of your lifetime physical activity plan,
  • 51. either now or in the future? Use several sentences to explain your answer. 2. Did setting goals and logging activity make you more aware of your daily moderate physical activity patterns? Explain why or why not. If you choose minutes per day as goals, write the number of minutes for each bout of moderate activity performed each day. Record a daily total (total minutes of moderate activity per day) in the “Daily Total” column. Record daily totals in Chart 1. Moderate Activity Bouts of 10 Minutes or More Date Bout 1 Bout 2 Bout 3 Bout 4 Bout 5 Daily Total Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Chart 2 Moderate Physical Activity Log (Daily Minutes Performed) cor22568_ch06_101-116.indd 114 8/10/12 11:30 PM F
  • 53. Lab 6B Evaluating Physical Activity Environments Name Section Date Purpose: To help you assess community factors that may infl uence your ability to perform lifestyle physical activity Procedures 1. Use the community audit forms on the next page to conduct an evaluation of the walkability of your community and the availability of community resources for physical activity. The walkability audit requires that you take a brief walk in your neighborhood to note key features in the environment that may help or hinder walking. The community audit will require you to evaluate the quality of resources and programming available in your community. You can choose your campus community or your hometown. 2. For each question, first use the check boxes to note the presence or absence of key features in the environment. Then base your score for this question on the number of checks and your overall perception. 3. After you have completed both the Walkability Audit and the Community Resource Audit, total the scores for each tool and report the total scores in the bottom. Add up both scores to compute the Combined (physical activity) Environmental Audit. Results: Record your rating for each of three healthy lifestyles in the following chart. Conclusions and Implications
  • 54. Provide a brief summary of the physical activity environment in your community. Describe your experiences in evaluat- ing the walkability of and resources in your community. If the environment is close to ideal, comment on how this may facilitate active lifestyles. If the environment is not ideal, comment on what needs to be done to improve it. Comments on Walkability Audit Comments on Community Resource Audit Score Rating Walkability Audit Community Resource Audit Combined Environmental Audit Environmental Activity Scoring Chart Good Marginal Poor Walkability 15–20 11–14 <11 Community 15–20 11–14 <11 Combined 30–40 22–29 <22 Rating Chart for Environmental Audits cor22568_ch06_101-116.indd 115 8/10/12 11:30 PM F O S
  • 56. g P hy si ca l A ct iv ity E nv iro nm en ts Walkability Audit Rating 1. Did you have room to walk? 1 2 3 4 Sidewalks blocked or not continuous Sidewalks were broken, cracked No sidewalks, paths, or shoulders Too much traffi c on sidewalk Other _______________________
  • 57. 2. Was it easy to cross streets? 1 2 3 4 Road was too wide Traffi c signals were too short/too long Parked cars blocked view of street No striped or designated crosswalks Other ______________________ 3. Was it safe for walking? 1 2 3 4 Too much traffi c Drivers too fast /too close Inadequate lighting Area of high crime Other _______________________ 4. Were there places to go? 1 2 3 4 No stores in the area No restaurants in the area No friends nearby Nothing interesting to see in area Other ________________________
  • 58. 5. Was your walk pleasant? 1 2 3 4 Not enough grass and trees Scary dogs or people Not well lighted Too dirty Other ________________________ Community Resource Audit Rating 6. Are there walking/biking paths 1 2 3 4 in the area? Paths are in unsafe areas Paths need to be repaired Paths are too crowded Paths are too far away to be useful Other ________________________ 7. Is there a community fitness/rec 1 2 3 4 center? Center is too expensive Center is not clean or updated Center is too far away
  • 59. Center has old or limited equipment Other ________________________ 8. Are there bicycle lanes on streets? 1 2 3 4 Lines not painted well Lines not on all streets Bike lanes not wide enough Cars too close Other _________________________ 9. Are there parks, fields, and 1 2 3 4 playgrounds? Parks in unsafe areas Equipment/resources in poor repair Too crowded Too far away Other ________________________ 10. Are there community activity 1 2 3 4 programs? Not enough programs Not the right type of programs
  • 60. Too expensive Too far / inconvenient Other ________________________ Total Score for Walkability Audit: (Sum of Questions 1–5) Total Score for Community Resources Audit: (Sum of Questions 6–10) Combined Environmental Audit: (Sum of Questions 1–10) Walkability checklist adapted from resources developed by the Partnership for a Walkable America. For information on this organization, visit this website: www.walkableamerica.org. Walkability and Community Resource Audits Directions. Place a check by each box in each questionnaire. Based on the number of boxes checked for each ques- tion, place an X over the circle to rate each question (1=poor, 2=marginal, 3=good, 4=very good). Add rating numbers to get walkability scores and community resource scores. Total the two to get a combined environmental score. cor22568_ch06_101-116.indd 116 8/10/12 11:30 PM F O S T E R
  • 61. , C E D R I C 1 6 9 2 T S 117 Cardiovascular Fitness LEARNING OBJECTIVES After completing the study of this concept, you will be able to: ▶ Describe the different components of the cardiovascular system. ▶ List the health benefits of cardiovascular fitness. ▶ Outline the FIT formula for moderate to vigorous physical activity designed to promote cardiovascular fitness. ▶ Identify several methods of determining exercise intensity levels for promoting cardiovascular fitness, select the method you think is most
  • 62. useful to you, and explain the reasons for your choice. ▶ Describe key guidelines for monitoring cardiovascular exercise including self- monitoring heart rate. ▶ Indicate several self- assessments for cardiovascular fitness, select the self-assessment you feel is most useful to you, and explain the reasons for your choice. C o n c e p t 7 Cardiovascular fitness is probably the most important aspect of physical fitness because it has a major impact on health and greatly influences physical performance. cor22568_ch07_117-138.indd 117 8/10/12 10:57 PM
  • 63. F O S T E R , C E D R I C 1 6 9 2 T S 118 Section 3 ▶ The Physical Activity Pyramid is considered to be the best indicator of cardiovascular fitness, and aerobic physical activity is the preferred method for achieving it. Regardless of the words used to describe it, cardiovascular fitness is complex because it requires fitness of several body systems. Good cardiovascular fitness requires a fit heart muscle. The heart is a powerful muscle that pumps blood through the body. The heart of a normal individual beats reflexively about 40 million times a year. In a single
  • 64. day, the heart pumps over 4,000 gallons of blood through the body. To keep the cardiovascular system working effectively, it is crucial to have a strong and fit heart. Like other muscles in the body, the heart becomes stronger if it is exercised. The size and strength of the heart increases, and it can pump more blood with each beat, accomplishing the same amount of work with fewer beats. Typical resting heart rate (RHR) values are around 70–80 beats per minute, but a highly trained endurance athlete may have a resting heart rate in the 40s or 50s. There is some individual variability in RHR, but a decrease in your RHR with training indicates clear improvements in cardiovascular fitness. Good cardiovascular fitness requires a fit vascular system. The heart has four chambers, which pump and receive blood in a rhythmical fashion to maintain good circulation (see Figure 1 ). Blood containing a high C ardiovascular fitness is generally considered to be the most important aspect of physical fitness. Those who possess reasonable amounts of fitness have a decreased risk for heart disease, reduced risk for premature death, and improved quality of life. Regular cardiovascular exer- cise promotes fitness and provides additional health and wellness benefits that extend well beyond reducing risks for disease. This concept describes the function of the cardiovascular system and explains how to determine the appropriate intensity of exercise needed to promote car- diovascular fitness. Elements of Cardiovascular Fitness The term cardiovascular fitness has several synonyms. Cardiovascular fitness is sometimes referred
  • 65. to as cardiovascular endurance because a person who pos- sesses this type of fitness can persist in physical activity for long periods without undue fatigue. It has been referred to as cardiorespiratory fitness because it requires delivery and utilization of oxygen, which is only possible if the circulatory and respiratory systems are capable of these functions. The term aerobic fitness has also been synonymous with cardiovascu- lar fitness because aerobic capacity Figure 1 ▶ Cardiovascular system. VIDEO 1 Superior vena cava CO2 CO2 CO2 O2 O2O2 CO2 O2 Lung capillaries Systemic capillaries Alveolus Lung Tissue cells
  • 66. Left atrium Bicuspid valve Aortic valve Left ventricle Right ventricle Aorta Right atrium Pulmonary valve Tricuspid valve Inferior vena cava Tissue cells Systemic capillaries Pul- mon- ary vein Pulmonary artery cor22568_ch07_117-138.indd 118 8/10/12 10:58 PM F O S T
  • 67. E R , C E D R I C 1 6 9 2 T S Concept 7 ▶ Cardiovascular Fitness 119 concentration of oxygen is pumped by the left ventricle through the aorta (a major artery), where it is carried to the tissues. Blood flows through a sequence of arteries to capillaries and to veins. Veins carry the blood contain- ing lesser amounts of oxygen back to the right side of the heart, first to the atrium and then to the ventricle. The right ventricle pumps the blood to the lungs. In the lungs, the blood picks up oxygen (O 2 ), and carbon diox- ide (CO 2 ) is removed. From the lungs, the oxygenated blood travels back to the heart, first to the left atrium and then to the left ventricle. The process then repeats itself. A dense network of arteries distributes the oxygenated blood to the muscles, tissues, and organs (see Figure 2 ).
  • 68. Healthy arteries are elastic, are free of obstruction, and expand to permit the flow of blood. Muscle layers line the arteries and control the size of the arterial opening upon the impulse from nerve fibers. Unfit arteries may have a reduced internal diameter (atherosclerosis) because of deposits on the interior of their walls, or they may have hardened, nonelastic walls (arteriosclerosis). The blood in the four chambers of the heart does not directly nourish the heart. Rather, numerous small arter- ies within the heart muscle provide for coronary circula- tion. Poor coronary circulation precipitated by unhealthy arteries can be the cause of a heart attack. Deoxygenated blood flows back to the heart through a series of veins. The veins are intertwined in the skeletal muscle, and this allows normal muscle action to facilitate the return of blood to the heart. When a muscle is con- tracted, the vein is squeezed, and this pushes the blood back to the heart. Small valves in the veins prevent the backward flow of the blood, but defects in the valves can lead to pooling of blood in the veins. A common condi- tion, known as varicose veins, is associated with the pool- ing of blood in the leg. Regular physical activity helps reduce pooling of blood in the veins and helps keep the valves of the veins healthy. Capillaries are the transfer stations where oxygen and fuel are released, and waste products, such as carbon diox- ide, are removed from the tissues. The veins receive the blood from the capillaries for the return trip to the heart. Good cardiovascular fitness requires healthy blood and a fit respiratory system. The process of taking in oxygen (through the mouth and nose) and deliver- ing it to the lungs, where it is picked up by the blood, is
  • 69. called external respiration. External respiration requires fit lungs as well as blood with adequate hemoglobin . Hemoglobin carries oxygen through the bloodstream. Lack of hemoglobin reduces oxygen-carrying capacity— a condition known as anemia . Delivering oxygen to the tissues from the blood is called internal respiration. Internal respiration requires an adequate number of healthy capillaries. In addition to delivering oxygen to the tissues, these systems remove carbon dioxide. Good cardiovascular fitness requires fit- ness of both the external and internal respiratory systems. Cardiovascular fitness requires fit muscle tissue capable of using oxygen. Once the oxygen is deliv- ered, the muscle tissues must be able to use oxygen to sustain physical performance (see Figure 2e ). Physical activity that promotes cardiovascular fitness stimulates changes in muscle fibers that make them more effective in using oxygen. Outstanding distance runners have high numbers of well-conditioned muscle fibers that can read- ily use oxygen to produce energy for sustained running. Training in other activities would elicit similar adapta- tions in the specific muscles used in those activities. During exercise the performance and function of the cardiovascular system is maximized. Dur- ing exercise, a number of changes occur to increase the availability of oxygen to the muscles (see Table 1 ). Breathing rate and depth increase, allowing the body to take in more oxygen. The heart beats faster and pumps more blood with each beat (increased stroke volume). The higher heart rate and larger stroke volume allow Rest Maximal
  • 70. Exercise Lungs Breathing Rate (# / Minute) 12 30 Heart Heart Rate (Beats / Minute) 70 190–200 Stroke Volume (mL / Beat) 75 150 Cardiac Outputa (L / Minute) 5.2 28.5 Arteries Blood Flow Distribution (%) 20% 70% Muscle Oxygen Extraction (%) 5% 20% System V· O2 (mL/kg/min.)b 3.5 60
  • 71. a Cardiac output 5 heart rate 3 stroke volume. b V ̇ O2 5 oxygen consumption 5 CO 3 oxygen extraction. Table 1 ▶ Changes in Cardiovascular Function between Rest and Exercise for a Person with Good Cardiovascular Fitness Aerobic Capacity A measure of aerobic or cardio- vascular fitness. Hemoglobin The oxygen-carrying protein (molecule) of red blood cells. Anemia A condition in which hemoglobin and the blood’s oxygen-carrying capacity are below normal. cor22568_ch07_117-138.indd 119 8/10/12 10:58 PM F O S T E R , C E D R I C 1 6 9 2
  • 72. T S 120 Section 3 ▶ The Physical Activity Pyramid Major Blood Vessels Carotid artery Subclavian artery Aorta Heart Iliac artery Femoral artery Subclavian vein Vena cava Iliac vein Femoral vein Cardiovascular Fitness Characteristics Figure 2a. A Fit Heart
  • 73. • Strong ventricles • Open coronary vessels • Good collateral circulation Figure 2b. A Fit Respiratory System and Healthy Blood • Good capillaries • Healthy blood with ample hemoglobin • Open coronary vessels Figure 2c. Healthy Arteries • Elastic • Large diameter • No obstructions • No atherosclerosis Figure 2d. Healthy Veins and Valves • Thinner, less elastic walls • Large diameter • Good valves
  • 74. Figure 2e. Fit Muscles • Good artery supply • Efficient at using oxygen to produce energy Open, healthy coronary arteries Intima Media (Muscle) Adventitia Intima Media Adventitia Strong, thick heart muscle Muscle Tendons Figure 2 ▶ Major blood vessels and cardiovascular fitness characteristics. cor22568_ch07_117-138.indd 120 8/10/12 10:58 PM F O
  • 75. S T E R , C E D R I C 1 6 9 2 T S Concept 7 ▶ Cardiovascular Fitness 121 more blood to be pumped each minute (increased car- diac output). During exercise, the blood passing through the lungs picks up more oxygen and distributes it more quickly. Activation of the sympathetic nervous sys- tem also leads to a redistribution of the blood flow, so that more of it gets shunted to the working skeletal muscle. During rest, the muscles get about 20 percent of the available blood flow, but this increases to about 70 percent during vigorous exercise. Within the mus- cles, a larger percentage of the available oxygen is also extracted from the muscles during exercise. Collectively, these changes help provide the muscles with the oxygen
  • 76. needed to maintain aerobic metabolism. Cardiovascular fitness is often evaluated using an indicator known as maximum oxygen uptake, or ̇VO 2 max. A person’s maximum oxygen uptake ( ̇VO 2 max) , commonly referred to as aerobic capacity, is determined in a laboratory by measuring how much oxygen a per- son can use in maximal exercise. The test is usually done on a treadmill using specialized gas analyzers to measure oxygen use. The treadmill speed and grade are gradually increased, and when the exercise becomes very hard, oxy- gen use reaches its maximum. The test is a good indicator of overall cardiovascular fitness because you cannot take in and use a lot of oxygen if you do not have good fitness throughout the cardiovascular system (heart, blood ves- sels, blood, respiratory system, and muscles). Elite endurance athletes can extract 5 or 6 liters of oxygen per minute from the environment, and this high aerobic capacity is what allows them to maintain high speeds in both training and competition without becom- ing excessively tired. In comparison, an average person typically extracts about 2 to 3 liters per minute. V ̇ O2 max is typically adjusted to account for a person’s body size because bigger people may have higher scores due to their larger size. Values are reported in milliliters (mL) of oxygen (O 2 ) per kilogram (kg) of body weight per minute (mL/kg/min.). A number of field tests have been developed to pro- vide estimates of maximum aerobic capacity (see Lab Resource Materials on pages 131–134). These tests are developed and validated based on comparisons with labo- ratory protocols that directly measure the amount of oxy- gen that is consumed.
  • 77. Adaptations to regular aerobic exercise result in improved cardiovascular fitness. Specific adaptations occur within each of the components of the cardiovas- cular system shown in Figure 2 . The heart muscle gets stronger and pumps more blood with each beat, allow- ing the heart to pump less frequently to deliver the same amount of oxygen. The lungs and blood function more efficiently in picking up oxygen and delivering it to the muscles. The vessels more effectively deliver the blood and the muscles adapt to use oxygen more efficiently. These adaptations allow a person to take in and use more oxygen during maximal exercise (increased aero- bic capacity or V ̇ O2 max). The adaptations contribute to improved endurance performance as well as health ben- efits (as described in Concept 4). Cardiovascular Fitness and Health Benefits Good cardiovascular fitness reduces risk for heart disease, other hypokinetic conditions, and early death. Numerous studies over the past 30 to 40 years have confirmed that good cardiovascular fitness is associated with a reduced risk for heart disease as well as a number of other chronic, hypokinetic conditions. A recent review of 33 studies involving nearly 200,000 people showed that people with low fitness have had a 70 percent higher death rate from all causes and a 56 percent higher death rate from heart diseases than people of intermediate Maximum Oxygen Uptake ( ̇VO 2 max) A labora- tory measure held to be the best measure of cardio- vascular fitness. Commonly referred to as V ̇ O2 max, or the volume (V) of oxygen used when a person reaches his or her maximum (max) ability to supply it
  • 78. during exercise. Figure 3 ▶ Risk reduction associated with cardiovascular fitness. Source: Adapted from Blair et al. Low fitness Moderate fitness High fitness Males Females High Low H yp ok in et ic d is ea se r is k an
  • 80. 6 9 2 T S 122 Section 3 ▶ The Physical Activity Pyramid the health and wellness benefits described earlier in this book. Cardiovascular fitness in the high-performance zone enhances the ability to perform in certain athletic events and in occupations that require high performance levels (e.g., firefighters). The FIT Formula for Cardiovascular Fitness The FIT formula for cardiovascular fitness varies for people of different activity levels. Adaptations to physical activity are based on the overload princi- ple and the principle of progression. It is important to provide an appropriate challenge to the cardiovascular system (overload), but the challenge should be progres- sive, increasing gradually as fitness improves. For most people, vigorous physical activity from steps 2 and 3 (see Figure 4 ) is necessary to improve cardiovascular fitness. However, for people with low fitness, moderate physical activity (step 1) produces improvements. Table 2 presents the FIT formulas for people of five different fitness and activity levels. While the frequency of exercise is similar for the different levels, the intensity and amount of time spent in activity vary considerably. The sections that follow provide added information about the FIT formula.
  • 81. The frequency (F) of physical activity to build cardiovascular fitness ranges from 3 to 5 or more days a week. The new ACSM guidelines for build- ing cardiovascular fitness suggest a frequency of at least 5 days a week for low fit people who do primar- ily moderate physical activity. Moderate activity can be safely performed every day and can provide additional benefits. For more active people (and those with higher levels of cardiovascular fitness), vigorous physical activity fitness. The consensus is that low-fit individuals are three to six times more likely to develop symptoms of metabolic syndrome or diabetes than high-fit individuals. While the specific amount of fitness needed to reduce risks varies by condition and population, evidence clearly supports the need for at least a moderate level of fitness. As shown in Figure 3 , there are dramatic reductions in risk in moving from the low fitness category to the moderate fitness cat- egory for both males and females. In terms of longevity, studies suggest that individuals with moderate fitness will live 5–6 years longer than low-fit individuals. The benefits of cardiovascular fitness are independent of its beneficial effect on other risk factors. Physical activity has been shown to have bene- ficial effects on some other established heart disease risk factors, such as cholesterol, blood pressure, and body fat. It is important to note that the beneficial effects of cardiovascular fitness on risk for heart disease and early death are considered to be independent of these other effects. This means that active/fit people would still have lower health risks even if their cholesterol, blood pressure, and body fat levels were identical to a matched set of inactive/unfit people.
  • 82. This evidence contributed to the labeling of physical inactivity as a major, independent risk factor for heart disease. The risk associated with physical inactivity is as large as (or larger than) risks associated with any of the other established risk factors. Good fitness reduces risks for normal weight, overweight, and obese people. Some people think they cannot be fit if they are overweight or overfat. It is now known that appropriate physical activity can build cardiovascular fitness in all types of people, including those with excess body fat. In fact, numerous studies have demonstrated that a fit, overweight person is at lower risk of chronic disease than an unfit person who is normal weight. These findings demonstrate that for chronic dis- ease prevention, low fitness is a greater risk than excess body fatness. The greatest risk is among people who are both unfit and overfat. Good cardiovascular fitness enhances the ability to perform various tasks, improves the ability to function, and is associated with a feeling of well- being. Moving out of the low fitness zone is of obvious importance to disease risk reduction. Achieving the good zone on tests further reduces disease and early death risk and promotes optimal wellness benefits, and a position statement by the American College of Sports Medicine shows an improved ability to function among older adults. Other wellness benefits include the ability to enjoy lei- sure activities and meet emergency situations, as well as Health is available for Everyone for a Lifetime, and it’s Personal Physical activity patterns tend to vary with different phases of life. Those who felt out of place in school
  • 83. team sports may find themselves enjoying solo workouts at the gym in college or adulthood. On the other hand, people who are used to being active may not be able to find time to exercise, at least for a while, when they are adjusting to new family obligations. How have your physical activity patterns changed over the years, and what future changes do you anticipate? ACTIVITY VIDEO 2 VIDEO 3 cor22568_ch07_117-138.indd 122 8/10/12 10:58 PM F O S T E R , C E D R I C 1 6 9 2
  • 84. T S Concept 7 ▶ Cardiovascular Fitness 123 Fitness Level Very Low Low Marginal Good High Performance Activity Level Sedentary Some light to moderate activity Sporadic moderate to vigorous activity Regular moderate to vigorous activity Habitual moderate to vigorous activity F 5 Frequency (days per week) 3–5 3–5 3–5 3–5 3–5 I 5 Intensity Heart Rate Reserve (HRR) 30–40% 40–55% 55–70% 65–80% 70–85% Max. Heart Rate (max HR) 57–67% 64–74% 74–84% 80–91% 84–94% Relative Perceived Exertion (RPE) 12–13 12–13 13–14 13–15 14–16 T 5 Time (minutes per day) 20–30 30–60 30–90 30–90 30–90
  • 85. Table 2 ▶ FIT Formula for Cardiovascular Fitness for People of Different Fitness and Activity Levels at least 3 days a week is rec- ommended. Vigorous physi- cal activity provides additional benefits (compared to moder- ate activity), however, it can increase risk for orthopedic injury if it is done too fre- quently. Therefore, 5 days a week is the maximal recom- mended dose for most people. Healthy people who are fit and regularly active and have no evidence of joint prob- lems or injuries may train up to 6 days a week, but most experts agree that at least 1 day off a week is beneficial. Use Table 2 to determine the appropriate frequency of exercise for you based on your current activity and fit- ness level. Complete the fit- ness assessments at the end of this concept before making your decision. The ACSM guidelines focus on exercise for building cardiovascu- lar fitness but are similar to national guidelines designed to produce health and well- ness benefits. The intensity (I) of physical
  • 86. activity necessary to produce cardiovascular fitness depends on a person’s level of fitness. In general, fit people need to exercise at a higher intensity to provide a sufficient challenge to the cardiovascular system. To deter- mine the appropriate intensity, it is important to have some Figure 4 ▶ Select activities from steps 2 and 3 of the pyramid for optimal cardiovascular fitness. Source: C. B. Corbin Avoid Inactivity Energy Balance Energy Out (Activity) Energy In (Diet) STEP 5 STEP 4 Vigorous Sports and Recreation Vigorous Aerobics Moderate Physical Activity Flexibility Exercises
  • 87. Muscle Fitness Exercises • Tennis • Hike • Yoga • Stretch • Jog • Bike • Aerobic dance • Walk • Yard work • Golf • Calisthenics • Resistance exercise STEP 1 STEP 2 STEP 3 indicator of a person’s overall fitness. If the maximal aero- bic capacity is known, an appropriate intensity can be set at a percentage of the maximum level. Because these values cannot be calculated without special equipment, other indi- cators of relative intensity are more commonly used. cor22568_ch07_117-138.indd 123 8/10/12 10:58 PM
  • 88. F O S T E R , C E D R I C 1 6 9 2 T S 124 Section 3 ▶ The Physical Activity Pyramid Heart rate provides a good indicator of the relative challenge presented by a given bout of exercise. There- fore, guidelines for the intensity of physical activity to build cardiovascular fitness are typically based on per- centages of heart rate reserve (HRR) or maximal heart rate (maxHR). Current guidelines as outlined in Table 2 specify different intensity levels based on current fitness and activity levels. Calculations of HRR and maxHR will be described in detail later, but the general range for HRR
  • 89. is 30 to 85 percent and for maxHR, 57 to 94 percent. Ratings of perceived exertion (RPE) refer to the assessment of the intensity of exercise based on how the participant feels; a subjective assessment of effort. RPE has been shown to be useful in assessing the intensity of aerobic physical activity. The RPE scale ranges from 6 (very very light) to 20 (very very hard), with 1-point increments in between. If the values are multiplied by 10, the RPE values loosely correspond to HR values (e.g., 60 5 rest HR and 200 5 maxHR). Details will be pro- vided later, but the target zone for aerobic activity is from 12 to 16 (see Table 2 ). Regardless of what method is used, the important point is that lower intensities provide a cardiovascular fitness benefit for low-fit sedentary people, but higher intensities are needed for more fit people. Use Table 2 to determine the appropriate intensity of exercise based on your current activity and fitness level. The amount of time (T) for building cardiovascular fitness is typically based on minutes of activity per day. Both the ACSM guidelines and the national (DHHS) physical activity guidelines recommend a mini- mum of 150 minutes of moderate activity per week, or 75 minutes of vigorous activity per week (or a combina- tion of minutes from moderate and vigorous activity). Extending the length time for exercise bouts has addi- tional benefits for health and wellness, as well as car- diovascular fitness. For example, 150 to 300 minutes of moderate activity per week is beneficial in losing body fat and maintaining a healthy body weight. For fit and active people, extending bouts of vigorous activity from 20 up to 90 minutes has both health/wellness benefits and enhanced cardiovascular fitness. Use Table 2 to deter-
  • 90. mine the appropriate length of time for daily exercise for you based on your current activity and fitness level. Different patterns of activity can be used to achieve the recommended dose of exercise. Some people may prefer to perform regular 30-minute bouts of exer- cise but others may prefer to accumulate it throughout the day. The ACSM indicates a pattern involving three 10-minute bouts provides similar benefits to one 30-min- ute session. The amount of physical activity can also vary across days but, as noted in a previous concept, the ACSM discourages a pattern of activity performed by “weekend warriors”—long activity sessions on one day a week with no regular activity in between. The prescriptions in Table 2 are aimed at overall aerobic fitness. Specialized training regimens are typically needed for those interested in aerobic fitness events (e.g., running races, triathlons) and competitive sports (see Concept 12 for suggestions). Threshold and Target Zones for Intensity of Activity to Build Cardiovascular Fitness There is a minimum intensity and an optimal intensity range for activity designed to develop cardiovascular fitness. As noted earlier, monitoring heart rate and making ratings of perceived exertion are the most practical methods of determining the intensity of activity necessary to build cardiovascular fitness. The threshold of training (minimum intensity) and the target zone (optimal intensity range) can be determined using several methods. Most methods are based on heart rate so the target zone is typically referred to as target heart rate zone. Ratings of perceived exertion (RPE) can also be used to define the target zone for exercise intensity. This section provides details of using these methods.
  • 91. An estimate of maximal heart rate (maxHR) is needed to determine appropriate target heart rate zones for aerobic exercise. Your maxHR is the highest heart rate attained in maximal exercise. It could be determined using an electrocardiogram while exer- cising to exhaustion; however, it can also be estimated with formulas. MaxHR is known to decrease with age so one simple and commonly used approach is to subtract your age from 220 (i.e., maxHR 5 220 2 age). However, studies have shown that this formula leads to inaccurate estimates for most people. A number of more specialized, Aerobic activities provide an ideal stimulus for improving cardiovascular fitness. cor22568_ch07_117-138.indd 124 8/10/12 10:58 PM F O S T E R , C E D R I C 1 6 9
  • 92. 2 T S Concept 7 ▶ Cardiovascular Fitness 125 Calculating Maximal Heart Rate Maximal heart rate 5 208 2 (.7 3 age) 5 208 2 (.7 3 22) 5 208 2 15.4 193 Calculating Heart Rate Reserve Maximal heart rate 193 bpm Minus resting heart rate 2 68 bpm Equals heart rate reserve (HRR) 125 bpm Calculating Threshold Heart Rate HRR 125 bpm × 65% 3 .65 Equals 81 bpm Plus resting heart rate 168 bpm Equals threshold heart rate 149 bpm Calculating Upper Limit Heart Rate HRR 125 bpm × 80% 3 .80 Equals 100 bpm Plus resting heart rate 168 bpm Equals upper limit heart rate 168 bpm
  • 93. Table 3 ▶ Sample Target Heart Zone Calculations for a 22-Year-Old, Using the Percentage of Heart Rate Reserve Method Heart Rate Reserve (HRR) The difference between maximum heart rate (highest heart rate in vigorous activity) and resting heart rate (lowest heart rate at rest). Ratings of Perceived Exertion (RPE) The assess- ment of the intensity of exercise based on how the participant feels; a subjective assessment of effort. Genetics Influence Adaptations to Exercise One factor over which you have little control is heredity. For years we have known that all people do not respond equally to regular exercise, even when it is done using the correct FIT formula. A recent study pub- lished in the Journal of Applied Physiology found that about 80 to 85 percent of 423 men and women who participated in a cardiovascular fitness program saw improvements in car- diovascular fitness over a period of 20 weeks. However, 15 to 20 percent of the participants showed little fitness improve- ment. The researchers found that a genetic profile predicted which people would get the most improvement from exercise. Some suggested that this was evidence that exercise is of little value to some people. However, researchers who conducted the study suggest that exercise is of value to all, noting that exercise has many benefits in addition to increases in cardiovascular fitness. Even those who do not respond with big gains in CV fitness can have changes in blood pressure, blood sugar, heart rate, and other bio- logical markers.
  • 94. Would you give up on exercise if you didn’t see tangible gains in fitness from your efforts? GG O is ACTIVITY In the News nonlinear equations have been developed to avoid this problem. For example, a new formula for women was recently developed (MaxHR 5 206 3 [.88 3 age]). However, there is currently no consensus on the most accurate method. In this book, we use a relatively sim- ple nonlinear method known as the Tanaka formula: maxHR 5 208 2 (.7 3 age). Calculations made at a variety of ages show little, if any, differences between the formulas, so we use the one that makes calculations the easiest (it limits use of fractions). Table 3 illustrates the calculations for determining maxHR for a 22-year-old. The heart rate reserve (HRR) method is the preferred way to calculate target heart rate zones. Table 2 provides five different intensity ranges for activ- ity designed to build cardiovascular fitness. After you have assessed your fitness using fitness tests (see Lab Resource Materials and Lab 7B), determine which of the five intensity ranges is best for you based on your current activity and fitness. Table 3 provides a worked example for calculating heart rate target zones using the HRR method. The example is for a 22-year-old with good cardiovascular fitness, who does regular moderate-to-
  • 95. vigorous physical activity and who has a resting heart rate of 68 beats per minute. The target heart rate zone for this hypothetical person is 65 to 80 percent. To determine the threshold of training (minimum heart rate for building cardiovascular fitness), use 65 percent of the working heart rate, and then add that value to the resting heart rate. To determine the upper limit of the target zone, use 80 percent of the working heart rate and add that value to the resting heart rate. Because target zone heart rates vary for people of dif- ferent fitness and activity levels and because resting cor22568_ch07_117-138.indd 125 8/10/12 10:58 PM F O S T E R , C E D R I C 1 6 9 2 T S
  • 96. 126 Section 3 ▶ The Physical Activity Pyramid and maximal heart rates vary, each person will have a unique range of heart rates defining the target heart rate zone. The chart in Figure 5 allows you to look up similar threshold and target heart rate zones based on your resting heart rate and age (up to age 65). Locate your resting heart rate on the left and your age across the top. The values at the point where they intersect rep- resent your target heart rate (based on 65 percent and 80 percent of HR reserve). Look across the columns for a given row to see how the target zone changes with age. Look down the rows for a certain column and see how the target zone changes with fitness. The chart shows that fit individuals (lower rest HR values) have lower target heart rate zones than unfit individuals (higher rest HR values). This may seem somewhat paradoxical but the reason is that fit individuals start exercise with a lower HR value and therefore have a larger HRR. The percentage of maximum heart rate method is an alternative way to calculate target heart rate zones. The percentage of maxHR method is simpler to use than the HRR method, but it is not as accurate. This procedure takes maximal heart rate into account but does not factor in individual differences in resting heart rate. People with a typical resting HR of 60 to 70 bpm will tend to get similar values with both methods, but the per- centage of maxHR method tends to be less accurate for people with high or low resting heart rates. To use the percentage of maxHR method, first find your maximum HR with the formula (maxHR 5 208 2 (.7 3
  • 97. age). Then multiply your maxHR by the appropriate percentages from Table 2 . For a person with good fit- ness and who performs regular moderate-to-vigorous activ- ity, the percentages would be 80 to 91 percent. The maxHR for our hypothetical 22-year-old is 193, so the target heart rate zone would be 154 to 176 using this method (.80 3 193 5 154 and .91 3 193 5 176). As illustrated in Table 3 , this procedure yields somewhat similar but higher values for the maxHR method than for the HRR method. The differences between the two methods vary for people of different ages, resting heart rates, and fitness/activity lev- els. The percentage of maxHR method is considered an acceptable alternative method, but the HRR method is more precise. Threshold and target zone heart rates should be used as general guidelines for cardiovascular exercise. You should check your resting heart rate and learn to cal- culate your target heart range based on the HRR method. It is important to understand how to make the calcula- tions, since the process explains the relationships. The target heart ranges should be used as just that, a general target to try for during your exercise session. By bringing your heart rate above the threshold and into the target zone, you will provide an optimal challenge to your cardiovascular system and maintain/improve your cardiovascular fitness. Guidelines for heart rate monitor- ing are provided in the next section. Figure 5 ▶ Effect of age and resting heart rate on target heart range. Effect of Age and Resting Heart Rate on Target Heart Range Rest HR Threshold 20 25 30 35 40 45 50 60 6555 65% 144 141 139 137 135 132 130 125 12312850
  • 98. 80% 165 162 160 157 154 151 148 143 140146 55 65% 145 143 141 139 136 134 132 127 125129 80% 166 163 161 158 155 152 149 144 141147 60 65% 147 145 143 140 138 136 133 129 127131 80% 167 164 162 159 156 153 150 145 142148 65 65% 149 147 144 142 140 137 135 131 128133 80% 168 165 163 160 157 154 151 146 143149 70 65% 151 148 146 144 142 139 137 132 130135 80% 169 166 164 161 158 155 152 147 144150 75 65% 152 150 148 146 143 141 139 134 132136 80% 170 167 165 162 159 156 153 148 145151 cor22568_ch07_117-138.indd 126 8/10/12 10:58 PM F O S T E R , C E D
  • 99. R I C 1 6 9 2 T S Concept 7 ▶ Cardiovascular Fitness 127 Ratings of perceived exertion can be used to monitor the intensity of physical activity. The ACSM suggests that regularly active people can use RPE to determine if they are exercising in the target zone (see Table 4 ). Ratings of perceived exertion have been shown to correlate well with HRR. For this reason, RPE can be used to estimate exercise intensity, avoiding the need to stop and count heart rate during exercise. A rating of 12 is equal to threshold, and a rating of 16 is equal to the upper limit of the target zone. With practice, most people can recognize when they are in the target zone using rat- ings of perceived exertion. Guidelines for Heart Rate and Exercise Monitoring Learning to count heart rate can help you monitor the intensity of your physical activity. Each time your heart beats, it pumps blood into the arteries. The surge of blood causes a pulse, which can be felt by holding a finger against an artery. The major arteries that are easy to locate and
  • 100. are frequently used for pulse counts are the radial just below the base of the thumb on the wrist (see Figure 6 ) and the carotid on either side of the Adam’s apple (see Figure 7 ). Counting the pulse at the carotid is the most popular procedure, Rating Description 6 7 Very, very light 8 9 Very light 10 11 Fairly light 12 13 Somewhat hard 14 15 Hard 16 17 Very hard 18 19 Very, very hard
  • 101. 20 Source: Data from Borg. Table 4 ▶ Ratings of Perceived Exertion (RPE) Figure 6 ▶ Counting your radial (wrist) pulse. Figure 7 ▶ Counting your carotid (neck) pulse. VIDEO 4 cor22568_ch07_117-138.indd 127 8/10/12 10:58 PM F O S T E R , C E D R I C 1 6 9 2 T S
  • 102. 128 Section 3 ▶ The Physical Activity Pyramid probably because the carotid pulse is easy to locate. The radial pulse is a bit harder to find because of the many tendons near the wrist, but it works better for some people. To count the pulse rate, simply place the finger- tips (index and middle finger) over the artery at the wrist or neck location. Move the fingers around until a strong pulse can be felt. Press gently so as not to cut off the blood flow through the artery. Counting the pulse with the thumb is not recommended because the thumb has a relatively strong pulse of its own, and it could be confusing when counting another person’s pulse. Counting heart rates during exercise presents some additional challenges. To obtain accurate exer- cise heart rate values, it is best to count heart beats or pulses while moving; however, this is difficult during most activities. The most practical method is to count the pulse imme- diately after exercise. During physical activity, the heart rate increases, but immediately after exercise, it begins to slow and return to normal. In fact, the heart rate has already slowed considerably within 1 minute after activity ceases. Therefore, you must locate the pulse quickly and count the rate for a short period in order to obtain accu- rate results. For best results, keep moving while quickly locating the pulse; then stop and take a 15-second count. Multiply the number of pulses by 4 to convert heart rate to beats per minute.
  • 103. You can also count the pulse for 10 seconds and mul- tiply by 6, or count the pulse for 6 seconds and multi- ply by 10 to estimate a 1-minute heart rate. The latter method allows you to calculate heart rates easily by add- ing 0 to the 6-second count. However, short-duration pulse counts increase the chance of error because a mis- count of 1 beat is multiplied by 6 or 10 beats rather than by 4 beats. The pulse rate should be counted after regular activ- ity, not after a sudden burst. Some runners sprint the last few yards of their daily run and then count their pulse. Such a burst of exercise will elevate the heart rate con- siderably. This gives a false picture of the actual exercise heart rate. Everyone should learn to determine resting heart rate accurately and to estimate exercise heart rate by quickly and accurately making pulse counts after activity (see Lab 7A). Declines in resting heart rate and exercise heart rate signal improvements in cardiovascular fitness. As described in this concept, the heart beats to provide the body (and working muscles) with oxygen. Oxygen is used to produce energy using aerobic metabolism. During rest, the heart can beat relatively slowly to pro- vide sufficient oxygen to the body. During exercise, the demand for energy increases, so the body increases heart rate (and respiration) to help distribute more oxygen to T E C H N O L O G Y U P D A T E New Technology in Activity Monitoring Physical activity researchers have been using accelerometry- based devices to monitor physical activity behavior for 15 to 20 years. However, the development and deploy-
  • 104. ment of low-cost accelerometers in gaming devices such as the Wii and Kinect made it possible for compa- nies to develop more competitively priced monitoring devices. The monitors are more expensive than stan- dard pedometers but they can capture the intensity of physical activity and most can link wirelessly to the Internet or your cell phone through Bluetooth tech- nology. Some devices also have built-in connections with social media applications, including Facebook, to enable friends to hold each other accountable as virtual exercise buddies. The new devices provide consumers advanced activity monitoring devices to keep track of their exercise sessions. Would real-time monitoring devices help you stay committed to your exercise goals? ACTIVITY A CLOSER LOOK Online Fitness Memberships and Consulting Many people take advantage of employee fitness pro- grams to get advice about exercise. Others prefer to enroll in private gyms where they may contract with a per- sonal trainer. A relatively new option for exercisers is to enroll in an online fitness program. One company offers opportunities for individuals to enroll in the Lifespan Fit- ness Club to access personalized health and exercise tracking software and exercise tip sheets. Members can also connect with online health coaches who review your status and provide suggestions for programming. Would you use this type of support to maintain your health status or would you rather do it on your own?
  • 105. A Online Fitness MFitnessi e Fitness ACTIVITY cor22568_ch07_117-138.indd 128 8/10/12 10:58 PM F O S T E R , C E D R I C 1 6 9 2 T S Concept 7 ▶ Cardiovascular Fitness 129 Figure 8 ▶ Comparison of resting and exercise heart
  • 106. for three 22-year-old individuals (maxHR 5 193) with different levels of fitness (A 5 low fitness, B 5 moderate fitness, C 5 high fitness). A Low Fit Rest HR HR RPE 90 160 17 70 130 14 50 100 11 Mod Fit High Fit 200 180 160 140 120 100 80 60 40
  • 107. 20 0 B C H ea rt r at e Exercise Resting the body. Changes in resting heart rate and exercise heart rate provide good indicators of improvements in fitness because they indicate that the heart can pump fewer times to provide the same amount of blood flow to the body. A fit individual has a stronger heart and can pump more blood with each beat. A comparison of resting and exercise heart rates for three hypothetical individuals performing the same bout of exercise is shown in Figure 8 . The column labeled “A” shows the response of an unfit person. This person has a high resting heart rate of 90, and this increases to 160 during the exercise. This intensity would feel pretty hard, so an RPE would likely be about 17. Compare this response to the results for a moderately or highly fit person. Both have a lower resting heart rate and a lower exercise heart rate, so exercise is easier and can be main- tained more easily.
  • 108. Strategies for Action An important first step in developing and maintaining cardiovascular fitness is assessing your current status. For an activity pro- gram to be most effective, it should be based on personal needs. Some type of testing is necessary to determine your personal need for cardiovascular fitness. The best measure of cardiovas- cular fitness is a laboratory assessment of V ∙ O2 max, but this is not possible for most people. To provide alternatives, research- ers have developed other tests that give reasonable estimates. Commonly used tests are the step test, the swim test, the 12-minute run, the Astrand-Ryhming bicycle test, and the walking test. These tests are developed based on comparisons with measured V ∙ O2 max and are good general indicators of cardiovascular fitness. In Lab 7B you will be able to compare estimates from several tests. The self-assessment you choose depends on your current fitness and activity levels, the availability of equipment, and other factors. The walking test is probably best for those at beginning levels because more vigorous forms of activity may cause discomfort and discourage future participation. The step test is somewhat less vigorous than the running test and takes only a few minutes to complete. The bicycle test is
  • 109. also submaximal or relatively moderate in intensity. It is quite accurate but requires more equipment and expertise than the other tests. You may need help from a fitness expert to do this test properly. The swim test is especially useful to those with musculoskeletal problems and other disabilities. The running test is the most vigorous and for this reason may be best for more advanced exercisers with high levels of motivation. Results on the walking, running, and swimming tests are greatly influenced by the motivation of the test taker. If the test taker does not try hard, fitness results are underestimated. The bicycle and step tests are influenced less by motivation because one must exercise at a specified workload and at a regular pace. Because heart rate can be influenced by emo- tional factors, by exercise prior to the test, and other factors, tests using heart rate can sometimes give incorrect results. Thus, do your self-assessments when you are relatively free from stress and are rested. Prior to performing any of these, be sure that you are physi- cally and medically ready. Prepare yourself by doing some regular physical activity for 3 to 6 weeks before actually taking the tests. If possible, take more than one test and use the sum- mary of your test results to make a final assessment of your cardiovascular fitness. In Lab 7B, you will have the opportunity to self-assess your cardiovascular fitness using one or more tests. A nonexercise estimate of cardiovascular fitness is also provided for comparison. Although this self-report tool has limitations, it is increasingly being used as a screening tool in physicians’ offices to deter- mine if patients have risks associated with poor fitness. ACTIVITY
  • 110. VIDEO 5 VIDEO 6 cor22568_ch07_117-138.indd 129 8/10/12 10:58 PM F O S T E R , C E D R I C 1 6 9 2 T S 130 Section 3 ▶ The Physical Activity Pyramid Healthy People ACTIVITY