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A presentation at NAVS
Summerfest 06/28/12

                 Stephan Esser MD
                www.esserhealth.com
Exercise:
  Myths and
Misconceptions
            Stephan Esser MD
           www.esserhealth.com
If you are over the age of 40 or have
     any chronic diseases or have a
  personal history or strong family
   history of heart disease, sudden
  cardiac death or the like then you
  should NOT begin a new exercise
program without first consulting your
          primary physician.
Goals
• Set some Ground Rules

• Provide basic Definitions

• Dispel common myths

• Discuss frequent misconceptions

• Provide tools for change
Defining Exercise


• Exercise:
 – movement of the body resulting in the
   enhancement of health and improvement
   of function
#1



Exercise is of no real value to
           my health
• I am a vegan…. I just don’t need to exercise
• I don’t have any health problems
• I’m healthy the way I am
• I’m skinny, I don’t need to exercise
• I’ve never exercised before why would I start
  now?
• That’s why they make medicine
• Hello “drive through”
• Aren’t we supposed to “conserve energy”?
Actual causes again
Exercise and Physical Health
• Reduces risk of
  –   Heart Disease ≈ 40%
  –   Obesity: ≈ 30-100%
  –   Stroke ≈ 50%
  –   Type 2 Diabetes ≈ 50%
  –   Hypertension ≈ 50%
  –   Disability delayed ≈15 years
  –   Colon Cancer ≈ 25-40%
  –   Breast Cancer ≈ 20%-44%
  –   Osteoporosis ≈ 20+%
• As many as 250,000 deaths per year in the United
  States are attributable to a lack of regular
  physical activity
Physical Health Cont’d
• Improve Balance
• Reduce Fall risk
• Improve Systemic Circulation
• Accelerate Skin Healing
• Bowel Regularity/  risk diverticulosis
• Improved Energy/Resilience
Exercise and Mental Health
• Regular Exercise:
  – Reduces risk/severity of:
     •   Depression
     •   Anxiety
     •   ADD/ADHD
     •   Alzheimers Dementia
  – Improves:
     • Mental Clarity, test scores, focus
Exercise and Emotional Health
• Regular Exercise:
  – Increases Self Confidence
  – Teaches skills to manage adversity
  – Enhances Self Esteem
  – Develops Discipline
  – Encourages Goal setting and self awareness
#2



Exercise is the fix for everything
• I can eat all the McDonald’s I want
• I run 4 miles a day and hit the gym every other
  day……… bring on the Dairy Queen
• I’m going bald….maybe I need to exercise
• See this tumor….if I run far enough it will
  definitely shrink.
• While exercise does have multi-system, multi-
  modal benefits there are many, many times
  where exercise is NOT the answer
• Acute Trauma
• Progressive Cancer
• Progressive Neurologic Impairment
• “Weird stuff”
• Too soon
#3



Exercise means pink spandex, going to a
 gym, sweating with a bunch of people I
         don’t even know or like!
Categories

• Leisure time Exercise: organized sports,
  running, gym activities, rehabilitation etc.


• Lifestyle Exercise: activity incorporated into our
  daily pattern of life
   – eg: parking in the distant portion of the parking lot rather then the first
     bumper, taking the stairs instead of the elevator etc.
#4



I’m too old to exercise
•   I’m just taking it easy now
•   I’ve paid my dues
•   Now is the time to relax
•   Don’t want to work myself too hard
•   I spent my whole life go-go-going
•   I’m too old for “that”
•   Those days are past
• “A review of biologic changes commonly
                      attributed to the process of aging
                     demonstrates the close similarity of
                   most of these to changes subsequent to
Disuse and Aging
                   a period of enforced physical inactivity.
                    The coincidence of these changes from
                  the subcellular to the whole-body level of
                   organization, and across a wide range of
                    body systems, prompts the suggestion
                  that at least a portion of the changes that
                   are commonly attributed to aging is in
                   reality caused by disuse and, as such, is
 Walter Bortz MD subject to correction. There is no drug in
                   current or prospective use that holds as
                   much promise for sustained health as a
                         lifetime program of physical
                         exercise.”(JAMA 1982;248:1203-1208)
CDC Exercise Stats
• <20% of all adults achieve recc. Levels



• > 60% of adults are not regularly active



• By age 75 1:3 men and 1:2 women engage in NO
  physical exercise
Aging and Exercise
•   Reduces Disability
•   Prolongs Independence
•   Slows Aging
•   Reduces risk of multiple Co-Morbidities
•   Reduces All-Cause Mortality
•   Reduces Medication use, Hospital Admission
•   Etc………
• “You have to work at living, period. You’ve got
  to train like you are training for an athletic
  event. Most older people just give up. They
  think, “I’m too old for that,” because they
  have an ache here or a pain there. Life is a
  pain in the butt; you’ve got to work at it.”
     - Jack LaLanne -
#5



I’m too young to exercise
• I don’t want to stress my childs body
• My child needs to rest inside more
• It’s too hot/cold etc to stay active
• All that running around is too much for little
  Johnny
• He needs to save his energy
• Working out will “stunt his growth”
• Exercise will make Janie look like a Johnny
• 50% of all youth ages 12-21 are not vigorously
  active on a regular basis

• 1 in 3 children overweight or obese

• Rates of Type 2 Diabetes sky-rocketing

• Rates of medication use, hospitalization
• 1. All adolescents should be physically active daily, or
  nearly every day, as part of play, games, sports,
  work, transportation, recreation, physical education,
  or planned exercise in the context of family, school,
  and community activities.
• 2. Adolescents should engage in three or more
  sessions per week of activities that last 20 minutes
  or more at a time and that require moderate to
  vigorous levels of exertion.
#6



No Pain, no Gain
Depends
Not good pain
• Chest Pain
• Joint Pain
• Pain that radiates
• Pain associated with neurologic changes
• Pain with swelling
• Pain that fails to improve with appropriate
  measures
• Pain that compromises other systems function
“Good Pain”
• Muscle “pain” while exercising

• Muscle soreness 1-2 days after exercise

• Moderately labored breathing during activity

• The opposite of the other page
#7



You have to exercise really hard or
        there is no benefit
Talk Test:
-Easy: Can Talk and Sing
-Moderate: Can Talk but not sing
-Intense: Can’t talk or sing
#8


Pregnant Women Shouldn’t
         Exercise
“   30 minutes or more of moderate exercise a
     day should occur on most, if not all, days of
                    the week “
In Pregnancy
• Exercise
  – Helps reduce backaches, constipation, bloating, and
    swelling
  – May help prevent or treat gestational diabetes
  – Increases your energy
  – Improves your mood
  – Improves your posture
  – Promotes muscle tone, strength, and endurance
  – Helps you sleep better
  – Weigh less to start, gain less weight during pregnancy
    and tolerate labor better than do sedentary women.
Factoids
• Pregnant women should NOT:
  – Downhill ski
  – Contact Sports
  – Scuba Diving
• Not the time to start new moderate to
  aggressive exercise programs
• Is the time to continue usual regimen or begin
  a new gentle regular habit
“Pregnant women shouldn't exercise or lift anything.” I roll
  my eyes at this one every time…………… I view labor as the
      Olympics, so I prepare to win gold - eating healthy,
    stretching, aerobic exercises for stamina, and lifting for
   strength. All of these have aided me in quick labors and
  smoother recoveries. However, when I eat awful or more
     conventional and let the Olympic training subside, my
   labors are more painful and recovery is more strenuous.
      It's no wonder so many women lose control of their
      weight while being pregnant and afterwards. They
  haven't trained for the Olympics of natural birth, but have
    waited as spectators for a medicated painless birth and
  now they are left with a whole lot of extra weight to lose
  and little time to lose it in with a newborn to take care of.
                      MB “Mother of 8”
• Already active ….stay active

• Interested in starting…check with
  physician

• Start low…go slow
#9


Exercise costs too much
• I can’t afford a gym membership

• I live too far from a gym

• I don’t have room for gym equipment in my
  house

• I can’t afford new shoes, clothes etc..
#10



I have a bad shoulder….I can’t
            exercise
“Many people have arthritis and rheumatism;
 they get bum knees, a bum back. A lot of guys
get a little pain in the toe or knee and then they
won't exercise. Well gee, you have 640 muscles
in your body. There may be a few exercises you
   can't do, but there are hundreds you can
                        do !”
                 Jack Lallane
#11


I don’t have the time to exercise
• I work double shifts…not gonna happen

• Between my job, the kids…no way

• I commute 2 hours and work 8 hour days
Response
• Remember Lifestyle and Leisure time
  definitions

• Be creative
                          Even small amounts
• Be proactive                  count!


• Be optimistic
#11




I have a disability, I can’t exercise
#12



Resistance Training
Basic Principles
• Progressive Overload is needed:

  – Gradual increase in stress upon the body results in
    increases in tolerance and eventual plateau


  – SAID (Specific Adaptations to Imposed Demands)


  – Greater Demand = Greater Adaptation within
    genetic potential
“Eating alone will not keep a man well; he must
  also take exercise. For food and exercise……
        work together to produce health.”
                       Hippocrates
                      Regimen 400 BC
“Exercise is just as essential as a rational diet”
          Dr. William Esser N.D. DC.
Transition
Stages of Change   (Prochaska and DiClemente)



1: Pre-contemplation
2: Contemplation
3: Preparation/planning
4: Action
5: Maintenance
6: Permanent Maintenance
 (Termination)
My Reasons to Exercise
•   Feel good in my skin
•   Increase energy, Reduce stress
•   Increase my confidence, discipline
•   Be a role model, socialize, family time
•   It’s fun, I love to sweat and work hard
•   I love challenges
•   Reduce disease risk
•   Lower disability risk
•    Maintain independence
What are your reasons?
My Reasons NOT to Exercise
•   Time
•   I’m tired or lazy
•   Inconvenience (I forgot my clothes etc…)
•   Money (shoes, travel, racquets)
•   Other priorities
•   Hate Change
•   Don’t know what to do
•   I’m Injured
What are your reasons
        NOT
    to Exercise?
“Physical fitness can neither be
achieved by wishful thinking nor
              outright
purchase.”
            Joseph Pilates
You are never too old to set another goal
       or to dream a new dream
                C.S. Lewis
Defining Success

• What is success for you?

• Are such goals achievable, legitimate?

• What will you do if you fail to “succeed”?
Setting Goals
• Specific
• Measureable
• Achievable
• Realistic
• Timely
Establishing Priorities

• Potential responsibilities, limitations

• Discover balance

• Be dynamic, flexible
If you have decided
       to start or increase
your activity level…….now what?
FITT
• Frequency

• Intensity

• Time

• Type
Lasting Change
• Track your efforts and progress

• Re-visit your goals regularly

• Adjust to meet your needs

• Thrive!
Conclusion
• Exercise is a powerful component of health

• More wide ranging and powerful then any
  “medicine’s” effects

• An ancient intervention with little to no cost

• Should be pursued as a part of regular
  “healthcare”: with the advice of a physician
“There’s a book, Profound Simplicity, that has
  nothing to do with health, but this is exactly
 what “our” system is—profound simplicity. It
  is profound in that it holds the truth in all its
   splendor within itself and still it is so simple
       that unfortunately most people are
          unimpressed by the truth.”
               Dr. William Esser ND
                  NH Keynote Address 1980
“First say to yourself what you would be; and
         then do what you have to do”
                  Epictectus
           Greek Stoic Philosopher AD 55–AD 135
Thank
            You!
Stephan Esser MD
www.esserhealth.com
Enjoy more powerpoints and
   educational resources at
    www.esserhealth.com

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Exercise Myths NAVS 2012

  • 1. A presentation at NAVS Summerfest 06/28/12 Stephan Esser MD www.esserhealth.com
  • 2. Exercise: Myths and Misconceptions Stephan Esser MD www.esserhealth.com
  • 3. If you are over the age of 40 or have any chronic diseases or have a personal history or strong family history of heart disease, sudden cardiac death or the like then you should NOT begin a new exercise program without first consulting your primary physician.
  • 4. Goals • Set some Ground Rules • Provide basic Definitions • Dispel common myths • Discuss frequent misconceptions • Provide tools for change
  • 5. Defining Exercise • Exercise: – movement of the body resulting in the enhancement of health and improvement of function
  • 6. #1 Exercise is of no real value to my health
  • 7. • I am a vegan…. I just don’t need to exercise • I don’t have any health problems • I’m healthy the way I am • I’m skinny, I don’t need to exercise • I’ve never exercised before why would I start now? • That’s why they make medicine • Hello “drive through” • Aren’t we supposed to “conserve energy”?
  • 9. Exercise and Physical Health • Reduces risk of – Heart Disease ≈ 40% – Obesity: ≈ 30-100% – Stroke ≈ 50% – Type 2 Diabetes ≈ 50% – Hypertension ≈ 50% – Disability delayed ≈15 years – Colon Cancer ≈ 25-40% – Breast Cancer ≈ 20%-44% – Osteoporosis ≈ 20+% • As many as 250,000 deaths per year in the United States are attributable to a lack of regular physical activity
  • 10. Physical Health Cont’d • Improve Balance • Reduce Fall risk • Improve Systemic Circulation • Accelerate Skin Healing • Bowel Regularity/  risk diverticulosis • Improved Energy/Resilience
  • 11. Exercise and Mental Health • Regular Exercise: – Reduces risk/severity of: • Depression • Anxiety • ADD/ADHD • Alzheimers Dementia – Improves: • Mental Clarity, test scores, focus
  • 12. Exercise and Emotional Health • Regular Exercise: – Increases Self Confidence – Teaches skills to manage adversity – Enhances Self Esteem – Develops Discipline – Encourages Goal setting and self awareness
  • 13. #2 Exercise is the fix for everything
  • 14. • I can eat all the McDonald’s I want • I run 4 miles a day and hit the gym every other day……… bring on the Dairy Queen • I’m going bald….maybe I need to exercise • See this tumor….if I run far enough it will definitely shrink.
  • 15. • While exercise does have multi-system, multi- modal benefits there are many, many times where exercise is NOT the answer • Acute Trauma • Progressive Cancer • Progressive Neurologic Impairment • “Weird stuff” • Too soon
  • 16. #3 Exercise means pink spandex, going to a gym, sweating with a bunch of people I don’t even know or like!
  • 17. Categories • Leisure time Exercise: organized sports, running, gym activities, rehabilitation etc. • Lifestyle Exercise: activity incorporated into our daily pattern of life – eg: parking in the distant portion of the parking lot rather then the first bumper, taking the stairs instead of the elevator etc.
  • 18. #4 I’m too old to exercise
  • 19. I’m just taking it easy now • I’ve paid my dues • Now is the time to relax • Don’t want to work myself too hard • I spent my whole life go-go-going • I’m too old for “that” • Those days are past
  • 20.
  • 21.
  • 22. • “A review of biologic changes commonly attributed to the process of aging demonstrates the close similarity of most of these to changes subsequent to Disuse and Aging a period of enforced physical inactivity. The coincidence of these changes from the subcellular to the whole-body level of organization, and across a wide range of body systems, prompts the suggestion that at least a portion of the changes that are commonly attributed to aging is in reality caused by disuse and, as such, is Walter Bortz MD subject to correction. There is no drug in current or prospective use that holds as much promise for sustained health as a lifetime program of physical exercise.”(JAMA 1982;248:1203-1208)
  • 23. CDC Exercise Stats • <20% of all adults achieve recc. Levels • > 60% of adults are not regularly active • By age 75 1:3 men and 1:2 women engage in NO physical exercise
  • 24. Aging and Exercise • Reduces Disability • Prolongs Independence • Slows Aging • Reduces risk of multiple Co-Morbidities • Reduces All-Cause Mortality • Reduces Medication use, Hospital Admission • Etc………
  • 25.
  • 26.
  • 27. • “You have to work at living, period. You’ve got to train like you are training for an athletic event. Most older people just give up. They think, “I’m too old for that,” because they have an ache here or a pain there. Life is a pain in the butt; you’ve got to work at it.” - Jack LaLanne -
  • 28.
  • 29. #5 I’m too young to exercise
  • 30. • I don’t want to stress my childs body • My child needs to rest inside more • It’s too hot/cold etc to stay active • All that running around is too much for little Johnny • He needs to save his energy • Working out will “stunt his growth” • Exercise will make Janie look like a Johnny
  • 31. • 50% of all youth ages 12-21 are not vigorously active on a regular basis • 1 in 3 children overweight or obese • Rates of Type 2 Diabetes sky-rocketing • Rates of medication use, hospitalization
  • 32. • 1. All adolescents should be physically active daily, or nearly every day, as part of play, games, sports, work, transportation, recreation, physical education, or planned exercise in the context of family, school, and community activities. • 2. Adolescents should engage in three or more sessions per week of activities that last 20 minutes or more at a time and that require moderate to vigorous levels of exertion.
  • 33.
  • 36. Not good pain • Chest Pain • Joint Pain • Pain that radiates • Pain associated with neurologic changes • Pain with swelling • Pain that fails to improve with appropriate measures • Pain that compromises other systems function
  • 37. “Good Pain” • Muscle “pain” while exercising • Muscle soreness 1-2 days after exercise • Moderately labored breathing during activity • The opposite of the other page
  • 38. #7 You have to exercise really hard or there is no benefit
  • 39.
  • 40. Talk Test: -Easy: Can Talk and Sing -Moderate: Can Talk but not sing -Intense: Can’t talk or sing
  • 42. 30 minutes or more of moderate exercise a day should occur on most, if not all, days of the week “
  • 43. In Pregnancy • Exercise – Helps reduce backaches, constipation, bloating, and swelling – May help prevent or treat gestational diabetes – Increases your energy – Improves your mood – Improves your posture – Promotes muscle tone, strength, and endurance – Helps you sleep better – Weigh less to start, gain less weight during pregnancy and tolerate labor better than do sedentary women.
  • 44. Factoids • Pregnant women should NOT: – Downhill ski – Contact Sports – Scuba Diving • Not the time to start new moderate to aggressive exercise programs • Is the time to continue usual regimen or begin a new gentle regular habit
  • 45. “Pregnant women shouldn't exercise or lift anything.” I roll my eyes at this one every time…………… I view labor as the Olympics, so I prepare to win gold - eating healthy, stretching, aerobic exercises for stamina, and lifting for strength. All of these have aided me in quick labors and smoother recoveries. However, when I eat awful or more conventional and let the Olympic training subside, my labors are more painful and recovery is more strenuous. It's no wonder so many women lose control of their weight while being pregnant and afterwards. They haven't trained for the Olympics of natural birth, but have waited as spectators for a medicated painless birth and now they are left with a whole lot of extra weight to lose and little time to lose it in with a newborn to take care of. MB “Mother of 8”
  • 46. • Already active ….stay active • Interested in starting…check with physician • Start low…go slow
  • 48. • I can’t afford a gym membership • I live too far from a gym • I don’t have room for gym equipment in my house • I can’t afford new shoes, clothes etc..
  • 49.
  • 50. #10 I have a bad shoulder….I can’t exercise
  • 51. “Many people have arthritis and rheumatism; they get bum knees, a bum back. A lot of guys get a little pain in the toe or knee and then they won't exercise. Well gee, you have 640 muscles in your body. There may be a few exercises you can't do, but there are hundreds you can do !” Jack Lallane
  • 52. #11 I don’t have the time to exercise
  • 53. • I work double shifts…not gonna happen • Between my job, the kids…no way • I commute 2 hours and work 8 hour days
  • 54.
  • 55. Response • Remember Lifestyle and Leisure time definitions • Be creative Even small amounts • Be proactive count! • Be optimistic
  • 56. #11 I have a disability, I can’t exercise
  • 57.
  • 59.
  • 60. Basic Principles • Progressive Overload is needed: – Gradual increase in stress upon the body results in increases in tolerance and eventual plateau – SAID (Specific Adaptations to Imposed Demands) – Greater Demand = Greater Adaptation within genetic potential
  • 61. “Eating alone will not keep a man well; he must also take exercise. For food and exercise…… work together to produce health.” Hippocrates Regimen 400 BC
  • 62. “Exercise is just as essential as a rational diet” Dr. William Esser N.D. DC.
  • 64. Stages of Change (Prochaska and DiClemente) 1: Pre-contemplation 2: Contemplation 3: Preparation/planning 4: Action 5: Maintenance 6: Permanent Maintenance (Termination)
  • 65. My Reasons to Exercise • Feel good in my skin • Increase energy, Reduce stress • Increase my confidence, discipline • Be a role model, socialize, family time • It’s fun, I love to sweat and work hard • I love challenges • Reduce disease risk • Lower disability risk • Maintain independence
  • 66. What are your reasons?
  • 67. My Reasons NOT to Exercise • Time • I’m tired or lazy • Inconvenience (I forgot my clothes etc…) • Money (shoes, travel, racquets) • Other priorities • Hate Change • Don’t know what to do • I’m Injured
  • 68. What are your reasons NOT to Exercise?
  • 69. “Physical fitness can neither be achieved by wishful thinking nor outright purchase.” Joseph Pilates
  • 70. You are never too old to set another goal or to dream a new dream C.S. Lewis
  • 71. Defining Success • What is success for you? • Are such goals achievable, legitimate? • What will you do if you fail to “succeed”?
  • 72. Setting Goals • Specific • Measureable • Achievable • Realistic • Timely
  • 73. Establishing Priorities • Potential responsibilities, limitations • Discover balance • Be dynamic, flexible
  • 74. If you have decided to start or increase your activity level…….now what?
  • 76. Lasting Change • Track your efforts and progress • Re-visit your goals regularly • Adjust to meet your needs • Thrive!
  • 77. Conclusion • Exercise is a powerful component of health • More wide ranging and powerful then any “medicine’s” effects • An ancient intervention with little to no cost • Should be pursued as a part of regular “healthcare”: with the advice of a physician
  • 78.
  • 79. “There’s a book, Profound Simplicity, that has nothing to do with health, but this is exactly what “our” system is—profound simplicity. It is profound in that it holds the truth in all its splendor within itself and still it is so simple that unfortunately most people are unimpressed by the truth.” Dr. William Esser ND NH Keynote Address 1980
  • 80. “First say to yourself what you would be; and then do what you have to do” Epictectus Greek Stoic Philosopher AD 55–AD 135
  • 81. Thank You! Stephan Esser MD www.esserhealth.com
  • 82. Enjoy more powerpoints and educational resources at www.esserhealth.com

Editor's Notes

  1. Some people think only of sports teams, athletics events, lengthy workouts in expensive gyms etc….not the case Others try to say the activity must be planned, directed etc….but I disagree…..
  2. http://www.healthierus.gov/STEPS/summit/prevportfolio/power/index.html#we
  3. ( Journal of the American Medical Association JAMA: 2000, Vol. 283. No. 22, pp. 2961-2967) http://www.news.harvard.edu/gazette/1999/10.21/diabetes.html http://www.reuters.com/article/healthNews/idUSTRE53E71N20090415?feedType=RSS&amp;feedName=healthNews http://www.nature.com/bjc/index.html http://www.ncbi.nlm.nih.gov/pubmed/18599492?ordinalpos=18&amp;itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
  4. http://www.projectsmart.co.uk/smart-goals.html http://www.goal-setting-guide.com/smart-goals.html
  5. In fact in studies regular exercise has been proven as effective as antidepressants and anxiolytics in controlling mild-moderate depression
  6. Weird stuff= adrenal, endocrine problems, strange genetic disorders such us Neurofibromatosis…or epilepsy..etc….
  7. http://www.countryliving.com/cm/countryliving/images/rocking-chairs-de.jpg mcleancountyil.gov
  8. Dysfunction, weakness, immobility and disability are NOT the normal consequence of aging…………….Let me explain
  9. Seminal paper published by Walter Bortz in JAMA 1982 http://www.walterbortz.com/ http://www.phasesofwomanhood.org/media/Image/elderly%20woman.jpg Disuse and AgingWalter M. Bortz II, MD JAMA. 1982;248(10):1203-1208.
Abstract
  10. ----http://www.cdc.gov/nccdphp/dnpa/physical/health_professionals/index.htm over half of US adults do not engage in physical activity at levels consistent with public health --http://books.nap.edu/openbook.php?record_id=1627&amp;page=118 IOM: Greater then 1/2 of all US children do not get enough exercise to develop a healthy heart and lungs --http://www.cdc.gov/nccdphp/sgr/intro.htm Daily enrollment in physical education classes has declined among high school students from 42 percent in 1991 to 25 percent in 1995. --Only 19 percent of all high school students are physically active for 20 minutes or more, five days a week, in physical education classes. high school students are physically active for 20 minutes or more, five days a week, in physical education classes.
  11. http://www.plosone.org/article/fetchArticle.action?articleURI=info:doi/10.1371/journal.pone.0000465
  12. http://www.safesport.co.uk/images/451.jpg
  13. http://www.aap.org/family/physicalactivity/physicalactivity.htm
  14. http://www.cretafarms.com/retail/products/images/bologna.jpg
  15. http://www.mehn.org.au/images/stories/mehn/Ex_RPE_Scale.jpg http://lh4.ggpht.com/_hbZ_aIisSu8/Sj4dT9_2kPI/AAAAAAAAAbo/r-Hmqox_oJs/Table_thumb.jpg http://www.cvtoolbox.com/cvtoolbox1/exercise/supports/Exercise_METS.gif
  16. http://www.acog.org/publications/patient_education/bp119.cfm
  17. bayareafitnessgym.com
  18. Example…if you take up running for the first time…success should not be running a marathon in 2 hours……rather 15 minutes without running may be a legitimate goal etc
  19. SpecificWell definedClear to anyone that has a basic knowledge of the project MeasurableKnow if the goal is obtainable and how far away completion is Know when it has been achievedAgreed UponAgreement with all the stakeholders what the goals should be RealisticWithin the availability of resources, knowledge and time Time BasedEnough time to achieve the goalNot too much time, which can affect project performance
  20. I hope you moved one step down the path of change…from thinking to doing, or from doing to embracing….
  21. Frequqncy: How often? Intensity……..start slowly…build up gradually…….
  22. Imagine if a doctor came to you and said if you take this pill you will have a longer, healthier life with less disability, fewer health concerns, more energy, greater vitality and it only costs a few drops of sweat and a little bit of you time……….would you buy in……well this is the message today….you and I have the capacity to transform our lives, remake our bodies, from the nucleus up to each hair on our head……..what a profoundly simple and beautiful message……………that statement is of course nothing new………
  23. May you and I never be unimpressed by the truth but instead strive to incorporate this message in all of it’s rich potential and elegant simplicity into our daily lives. Thank you!