1. Physical inactivity is one of the primary risks for cardiovascular disease. The American Heart Association has released a free, Web-based tracking tool (www.heart.org) that allows individuals to record and monitor changes in key risk factors over time, including blood pressure, cholesterol, blood glucose, inactivity, and body mass index (BMI). With this tool, you create a secure “health vault” account to save confidential health data. The site evaluates your risk profiles and provides links to educational resources. If your physician has a provider account, you can share results with your physician. The Heart tracking tool provides valuable information about cardiovascular disease risk factors.
Visit the Heart website and consider how it might help you in tracking your risk factors. Would this type of tool help you adopt a heart-healthy lifestyle? Why or why not? Would the connection with your physician make you more accountable?
Charles Corbin Greg Welk William Corbin Karen Welk
T E N T H E D I T I O N
A
Comprehensive
Lifestyle Approach
Fitness &
Wellness
Concepts of
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
1
Health, Wellness, Fitness,
and Healthy Lifestyles:
An Introduction
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Describe the HELP philosophy and discuss its implications in making personal
decisions about health, wellness, and fitness.
▶ Define the dimensions of health and wellness, and explain how they interact to
influence health and wellness.
▶ Distinguish health-related and skill-related dimensions of physical fitness.
▶ Identify the determinants of health, wellness, and fitness, and explain how they each
contribute to health, wellness, and fitness.
▶ Identify related national health goals and show how meeting personal goals can
contribute to reaching national goals.
▶ Use health behavior change strategies to carry out self-assessments
of personal
lifestyles and wellness perceptions.
C
o
n
c
e
p
t 1
Lifestyles for Health, Wellness, and Fitness ▶ Section I
Good health, wellness, fitness,
and healthy lifestyles are
important for all people.
cor22568_ch01_001-020.indd 1 27/07/12 11:47 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
2 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
provide principles and guidelines that help you adopt pos-
itive lifestyles. The labs provide experiences for learning
behavioral skills needed to maintain these lifestyles.
A personal philosophy that emphasizes health can
lead to behaviors that promote it. The H in HELP
stands for health. One theory that has been extensively
tested indicates that people who believe in the benefit
s
of healthy lifestyles are more likely to engage in healthy
behaviors. The theory also suggests that people who state
intentions to put their beliefs into action are likely to
adopt behaviors that lead to health, wellness, and fitness.
Everyone can benefit from healthy lifestyles. The E
in HELP stands for everyone. Anyone can change a behav-
ior or lifestyle. Nevertheless, many adults feel ineffective
in making lifestyle changes. Physical activity is not just for
athletes—it is for all people. Eating well is not just for other
people—you can do it, too. All people can learn stress-
management techniques and practice healthy lifestyles.
Healthy behaviors are most effective when
practiced for a lifetime. The L in HELP stands for
lifetime. Young people sometimes feel immortal because
the harmful effects of unhealthy lifestyles are often not
immediate. As we grow older, we begin to realize that
unhealthy lifestyles have cumulative negative effects. Start-
ing early in life to emphasize healthy behaviors results in
long-term health, wellness, and fitness benefits. One study
showed that the longer healthy lifestyles are practiced, the
greater the beneficial effects. This study also demonstrated
that long-term healthy lifestyles can even overcome hered-
itary predisposition to illness and disease.
Healthy lifestyles should be based on personal
needs. The P in HELP stands for personal. No two peo-
ple are exactly alike. Just as no single pill cures all illnesses,
no single lifestyle prescription exists for good health, well-
ness, and fitness. Each person must assess personal needs
and make lifestyle changes based on those needs.
You can adopt the HELP philosophy. As you progress
through this book, consider ways that you can implement
the HELP philosophy. In each concept, HELP boxes are
provided to stimulate your thinking about key health issues.
National Health Goals
Healthy People 2020 (HP2020) is a comprehensive
set of health promotion and disease prevention
objectives with the primary intent of improving the
nation’s health . The objectives, developed by experts
from hundreds of national health organizations and pub-
lished in 2010, provide benchmarks to determine prog-
ress over the period from 2010 to 2020. The objectives
N
inety-nine percent of American adults say that “being
in good health” is of primary importance. Good
health—for them and those they care about—is more
important than money and other material things. Having
good health, wellness, and fitness can make us feel good,
look good, and enjoy life fully. This book is designed to
help you achieve good health by providing information to
help you make good decisions. You will also learn essen-
tial self-management skills. With practice, use of these
skills promotes healthy lifestyles that lead to good health,
wellness, and fitness throughout life. An overview of basic
self-management skills is provided in Concept 2.
The HELP Philosophy
The HELP philosophy provides a basis for making
healthy lifestyle change possible. The four-letter
acronym HELP summarizes the overall philosophy used
in this book. Each letter in HELP characterizes an impor-
tant part of the philosophy: Health is available to Everyone
for a Lifetime —and it’s Personal. The concepts in the book
Health and wellness is available to everyone for a lifetime.
cor22568_ch01_001-020.indd 2 14/09/12 6:36 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction
3
also serve as goals to motivate and guide people in mak-
ing sound health decisions as well as to provide a focus
for public health programs.
The national health goals for the year 2010 were
established in 2000. Studies show that significant prog-
ress was made in that 10-year period: For example,
23 percent of all goals were met and progress was made
on 48 percent. The hope is that similar progress can be
made in the 10 years leading to 2020.
In addition to helping change the health of society at
large, HP2020 goals also have implications for personal
health behavior change. Societal changes can occur only
when individuals adjust personal behaviors and work
together to make changes that benefit other people. Not
all objectives will have personal implications for each
individual, but societal awareness of the objectives may
lead to future changes in the health of our country.
Specific HP2020 goals are provided at the end of each
concept to show the links between the content of this text
and the national health goals. Four of the “overarching
goals” of HP2020 are described in more detail in the sec-
tions that follow. The section at the end of each concept,
“Strategies for Action,” offers assessment and planning
tips for improving health, wellness, and fitness and for
working toward meeting HP2020 goals.
A primary goal of HP2020 is to help all people
have high-quality, longer lives free of preventable
disease, injury, and premature death. Over the past
century, the average life expectancy in the United States
has increased by 60 percent. Although different reports
yield slightly different results, studies have generally
shown that Americans now live longer than ever before.
Results included in Figure 1 are from the most recent
World Health Organization (WHO) life expectancy
report. These data provide statistics for healthy life expec-
tancy in North American countries. Globally, according
to the most current World Factbook, Canada ranks 12th,
the United States ranks 50th, and Mexico ranks 72nd in
life expectancy.
Living a long life is important, but so is having a high-
quality life. This means feeling good, looking good, and
being happy. It also means being fit enough to enjoy your
leisure and to be able do what you want to do without lim-
itation. An index called HALE (Healthy Life Expectancy)
is often used to determine the number of years of life a
person has a good quality of life as opposed to having ill-
ness or impaired function. Figure 1 uses information from
HALE to show the number of years of high-quality life
(green) and years of life with low quality (orange). Adopt-
ing healthy lifestyles when we are young can increase the
length of life and can also increase quality of life.
Achieving health equity, eliminating disparities,
and improving the health of all groups is another
primary goal of HP2020. Health varies greatly with
ethnicity, income, gender, and age. For example, African
Americans, Hispanics, and Native Americans have a
shorter life expectancy than White non-Hispanics, and
men have a shorter life expectancy than women. Health
disparities also exist in quality of life. One method of
assessing disparities in quality of life is to compare the
number of healthy days diverse groups experience
each month. Minorities, including African Americans,
Hispanics, and Native Americans, experience about 24
healthy days each month compared to 25 for White
Figure 1 ▶ Healthy life expectancy for North America.
Sources: World Health Organization and National Center for Health Statistics.
9
9
8
8
8
Country Total
life
expectancyUS
A
Females
Canad
a
Females
Mexico
Females
Males
All
72 9
68 8
87
0
81
76
78
Males
All
7
5
69
71 7
73
83
78
81
Males
All
65
67
78
73
76
Years
55 60 65 70 75 80
Healthy life
expectancy
Unhealthy
years
Self-management Skills Skills that you learn to
help you adopt healthy lifestyles and adhere to them.
Health Optimal well-being that contributes to one’s
quality of life. It is more than freedom from disease
and illness, though freedom from disease is impor-
tant to good health. Optimal health includes high-
level mental, social, emotional, spiritual, and physical
wellness within the limits of one’s heredity and per-
sonal abilities.
World Health Organization (WHO) WHO is the
United Nations’ agency for health and has 193 mem-
ber countries. Its principal goal is the attainment of
the highest possible level of health for all people.
WHO has been instrumental in making health pol-
icy and in implementing health programs worldwide
since its inception in 1948.
Healthy Days A self-rating of the number of days
(per week or month) a person considers himself or
herself to be in good or better than good health.
cor22568_ch01_001-020.indd 3 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
4 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
non-Hispanics. People with very low income typically
have 22 healthy days per month, compared with 26 days
for those with high income. Men have a higher number
of healthy days than women.
The reason for such differences in the number of
healthy days varies. The relatively higher number of
unhealthy days for women is, at least in part, because they
live longer and their unhealthy years later in life factor
into their average number of healthy days. Disparities in
healthy days by level of income may be due to environ-
mental, social, or cultural factors as well as less access to
preventive care. Both physical and mental health problems
are the most frequent reasons for unhealthy days. Physical
illness, pain, depression, anxiety, sleeplessness, and limita-
tions in ability to function or perform enjoyable activities
are the problems people most frequently reported.
Another primary goal of HP2020 is to create social
and physical environments that promote good
health for all. The environment, both social and physical,
has much to do with both quality of life and length of life.
Environmental factors are discussed in greater detail on
page 13 and in several of the later concepts in this book.
The final primary goal of HP2020 is to promote
quality of life, healthy development, and healthy
behaviors across all stages of life. Healthy days
decrease as we age. Young adults experience more healthy
days each month than older adults. Over the past two
decades, there has been a steady decline in healthy days
for the average person, no doubt because of the increase
in the number of older adults in our society. The num-
ber of healthy days takes its biggest drop after age 75. It
is interesting that in recent national surveys older adults
(ages 50 to 75) report being happier and more secure
than younger people age 20 to 40.
A recent national report ( Blueprint for a Healthier
America ) underscores the need to focus future efforts on
prevention and preparedness, including changing both
the social and physical environment to increase emphasis
on physical activity, nutrition, and prevention of tobacco
use. The report indicates that an investment of $10 per
person per year in proven community-based programs
that focus on healthy lifestyles could save the country
$16 per person over a five-year period.
Health and
Wellness
Health is more than freedom from illness and
disease. Over 60 years ago, the World Health Organi-
zation defined health as more than freedom from illness,
disease, and debilitating conditions.
Prior to that time, you were con-
sidered to be “healthy” if you were
not sick. HP2020 refers to quality of
life in two of its four overarching goals, highlighting the
importance of the wellness component of health.
Figure 2 illustrates the modern concept of health. This
general state of being is characterized by freedom from
disease and debilitating conditions (outer circle), as well
as wellness (center circle).
Physical activity is for everyone. An active lifestyle promotes health
and wellness. Healthy lifestyles are the principal contributor to health and wellness.
VIDEO 1
cor22568_ch01_001-020.indd 4 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 5
Wellness is the positive component of optimal
health. Disease, illness , and debilitating conditions are
negative components that detract from optimal health.
Death can be considered the ultimate opposite of optimal
health. Wellness , in contrast, is the positive component
of optimal health. It is characterized by a sense of well-
being reflected in optimal functioning, health-related
quality of life , meaningful work, and a contribution to
society. HP2020 objectives use the term health-related
quality of life to describe a general sense of happiness and
satisfaction with life.
Health and wellness are personal. Every individual is
unique—and health and wellness are influenced by each
person’s unique characteristics. Making comparisons
to other people on specific characteristics may produce
feelings of inadequacy that detract from one’s profile of
total health and wellness. Each of us has personal limita-
tions and strengths. Focusing on strengths and learning
to accommodate weaknesses are essential keys to optimal
health and wellness.
Health and wellness are multidimensional. The
dimensions of health and wellness include emotional-
mental, intellectual, social, spiritual, and physical. Table 1
describes the various dimensions, and Figure 3 illustrates
the importance of each one for optimal health and well-
ness. Some people include environmental and vocational
dimensions in addition to the five shown in Figure 3 .
Fr
ee
do
m fr
om illness and disease
Wellness
Freedom from debilitating c
ond
iti
on
s
HEALTH
Quality of life
Sense of well-being
Figure 2 ▶ A model of optimal health, including wellness.
Physical
Emotional/
Mental
Spiritual
Social
Intellectual
Figure 3 ▶ The dimensions of health and wellness.
Illness The ill feeling and/or symptoms associated
with a disease or circumstances that upset homeostasis.
Wellness The integration of many different compo-
nents (social, emotional/mental, spiritual, and physical)
that expand one’s potential to live (quality of life) and
work effectively and to make a significant contribution
to society. Wellness reflects how one feels (a sense of
well-being) about life, as well as one’s ability to func-
tion effectively. Wellness, as opposed to illness (a nega-
tive), is sometimes described as the positive component
of good health.
Quality of Life A term used to describe wellness.
An individual with quality of life can enjoyably do
the activities of life with little or no limitation and
can function independently. Individual quality of life
requires a pleasant and supportive community.
A CLOSER LOOK
Social Determinants of Health
Healthy People 2020 and related documents from the
World Health Organization (WHO) emphasize the impor-
tance of understanding the determinants of health. The
WHO reports outline the importance of social determi-
nants in reducing health disparities throughout the world.
They note that people’s circumstances are shaped by
distribution of money, power, and resources at local,
national, and global levels, which can result in “unfair but
avoidable” differences in health status in different places.
For example, the lack of pure water, medical facilities,
and medicine result in higher rates of disease (particu-
larly infectious disease) and lower quality of life in third
world countries than in more technologically advanced
countries.
How do social determinants influence health status within the
United States?
Social D
minaDetermi l Determ
ACTIVITY
cor22568_ch01_001-020.indd 5 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
6 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
In this book, health and wellness are considered to be
personal factors, so environmental and vocational well-
ness are not included in Tables 1 and 2 . However, the
environment (including your work environment) is very
important to overall personal wellness, and for this rea-
son, environmental factors are prominent in the model of
wellness described on page 13 and are featured through-
out this book. The final concept in the book links envi-
ronmental and vocational factors to the personal wellness
dimensions described in Table 1 .
Wellness reflects how one feels about life, as well
as one’s ability to function effectively. A positive total
outlook on life is essential to each of the wellness dimen-
sions. As illustrated in Table 2 , a “well” person is satis-
fied in work, is spiritually fulfilled, enjoys leisure time, is
physically fit, is socially involved, and has a positive emo-
tional/mental outlook. He or she is happy and fulfilled.
The way one perceives each dimension of wellness
affects one’s total outlook. Researchers use the term self–
perceptions to describe these feelings. Many researchers
believe that self-perceptions about wellness are more
important than actual circumstances or a person’s actual
state of being. For example, a person who has an impor-
tant job may find less meaning and job satisfaction than
another person with a much less important job. Appar-
ently, one of the important factors for a person who has
achieved high-level wellness and a positive outlook on
life is the ability to reward himself or herself. Some peo-
ple, however, seem unable to give themselves credit for
their successes. The development of a system that allows
a person to perceive the self positively is essential, along
with the adoption of positive lifestyles that encourage
improved self-perceptions. The questionnaire in Lab 1A
will help you assess your self-perceptions of the various
wellness dimensions. For optimal wellness, it is impor-
tant to find positive feelings about each dimension.
Health and wellness are integrated states of being.
The segmented pictures of health and wellness shown in
Figure 3 and Tables 1 and 2 are used only to illustrate the
multidimensional nature of health and wellness. In real-
ity, health and wellness are integrated states of being that
Table 1 ▶ Defi nitions of Health and Wellness Dimensions
Emotional/mental health—Freedom from emotional/mental
illnesses, such as clinical depression, and possession of
emotional wellness. The goals for the nation’s health refer
to mental rather than emotional health and wellness. In this
book, mental health and wellness are considered to be the
same as emotional health and wellness.
Emotional/mental wellness—The ability to cope with daily
circumstances and to deal with personal feelings in a positive,
optimistic, and constructive manner. A person with emotional
wellness is generally characterized as happy instead of
depressed.
Intellectual health—Freedom from illnesses that invade the
brain and other systems that allow learning. A person with
intellectual health also possesses intellectual wellness.
Intellectual wellness—The ability to learn and to use
information to enhance the quality of daily living and optimal
functioning. A person with intellectual wellness is generally
characterized as informed instead of ignorant.
Physical health—Freedom from illnesses that affect the
physiological systems of the body, such as the heart and the
nervous system. A person with physical health possesses an
adequate level of physical fitness and physical wellness.
Physical wellness—The ability to function effectively in
meeting the demands of the day’s work and to use free
time effectively. Physical wellness includes good physical
fitness and the possession of useful motor skills. A person
with physical wellness is generally characterized as fit
instead of unfit.
Social health—Freedom from illnesses or conditions that
severely limit functioning in society, including antisocial
pathologies.
Social wellness—The ability to interact with others
successfully and to establish meaningful relationships that
enhance the quality of life for all people involved in the
interaction (including self). A person with social wellness is
generally characterized as involved instead of lonely.
Spiritual health—The one component of health that is totally
composed of the wellness dimension; it is synonymous with
spiritual wellness.
Spiritual wellness—The ability to establish a values system
and act on the system of beliefs, as well as to establish and
carry out meaningful and constructive lifetime goals. Spiritual
wellness is often based on a belief in a force greater than the
individual that helps her or him contribute to an improved
quality of life for all people. A person with spiritual wellness is
generally characterized as fulfilled instead of unfulfilled.
Table 2 ▶ The Dimensions of Wellness
Wellness Dimension Negative – – – – – – – – Positive
Emotional/mental Depressed – – – – – – – Happy
Intellectual Ignorant – – – – – – – – Informed
Physical Unfit – – – – – – – – – – Fi
t
Social Lonely – – – – – – – – – Involved
Spiritual Unfulfilled – – – – – – – – Fulfilled
Total outlook Negative – – – – – – – – Positive
cor22568_ch01_001-020.indd 6 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 7
can best be depicted as th
s woven together to pro-
duce a larger, integrated fabric. Each dimension relates
to each of the others and overlaps
all the others. The overlap is so fre-
quent and so great that the specific
contribution of each thread is almost
indistinguishable when looking at the total ( Figure 4 ).
The total is clearly greater than the sum of the parts.
It is possible to possess health and wellness while
being ill or possessing a debilitating condition.
Many illnesses are curable and may have only a tempo-
rary effect on health. Others, such as Type I diabetes,
are not curable but can be managed with proper eating,
physical activity, and sound medical treatment. Those
with manageable conditions may, however, be at risk for
other health problems. For example, unmanaged diabetes
is associated with a high risk for heart disease and other
health problems.
Debilitating conditions, such as the loss of a limb or
loss of function in a body part, can contribute to a lower
level of functioning or an increased risk for illness and
thus to poor health. On the other hand, such conditions
need not limit wellness. A person with a debilitating con-
dition who has a positive outlook on life may have better
overall health than a person with a poor outlook on life
but no debilitating condition.
Just as wellness is possible among those with illness
and disability, evidence is accumulating that people with
a positive outlook are better able to resist the progress of
disease and illness than are those with a negative outlook.
Thinking positive thoughts has been associated with
enhanced results from various medical treatments and
surgical procedures.
Wellness is a term used by the uninformed as well
as experts. Unfortunately, some individuals and groups
have tried to identify wellness with products and ser-
vices that promise benefits that cannot be documented.
Because well-being is a subjective feeling, unscrupulous
people can easily make claims of improved wellness for
their product or service without facts to back them up.
Holistic health is a term that is similarly abused. Con-
sider that optimal health includes many areas; thus, the
term holistic (total) is appropriate. In fact, the word health
originates from a root word meaning “wholeness.” Unfor-
tunately, questionable health practices are sometimes pro-
moted under the guise of holistic health. Care should be
used when considering services and products that make
claims of wellness and/or holistic health to be sure that
they are legitimate.
Physical Fitness
Physical fitness is a multidimensional state of being.
Physical fitness is the body’s ability to function efficiently
and effectively. It consists of at least five health-related and
six skill-related components, each of which contributes
to total quality of life. Physical fitness is associated with a
person’s ability to work effectively, enjoy leisure time, be
healthy, resist hypokinetic diseases
or conditions , and meet emergency
situations. It is related to, but dif-
ferent from, health and wellness.
Although the development of physical fitness is the result
of many things, optimal physical fitness is not possible
without regular physical activity.
The health-related components of physical fitness
are directly associated with good health. The five
components of health-related physical fitness are body
composition, cardiovascular fitness, flexibility, muscular
Physical
Emotional/Mental
Spiritual
SocialIntellectual
Figure 4 ▶ The integration of wellness dimensions.
VIDEO 2
VIDEO 3
Lifestyles Patterns of behavior or ways an individ-
ual typically lives.
Physical Fitness The body’s ability to function
efficiently and effectively. It consists of health-related
physical fitness and skill-related physical fitness, which
have at least 11 components, each of which contributes
to total quality of life. Physical fitness also includes
metabolic fitness and bone integrity. Physical fitness
is associated with a person’s ability to work effectively,
enjoy leisure time, be healthy, resist hypokinetic dis-
eases, and meet emergency situations. It is related to,
but different from, health, wellness, and the psycho-
logical, sociological, emotional/mental, and spiritual
components. Although the development of physical
fitness is the result of many things, optimal physical fit-
ness is not possible without regular exercise.
Hypokinetic Diseases or Conditions Hypo- means
“under” or “too little,” and -kinetic means “movement”
or “activity.” Thus, hypokinetic means “too little activ-
ity.” A hypokinetic disease or condition is one associ-
ated with lack of physical activity or too little regular
exercise. Examples include heart disease, low back
pain, Type II diabetes, and obesity.
cor22568_ch01_001-020.indd 7 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
8 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
Figure 5 ▶ Components of health-related physical fitness.
Dimensions
of Health-
Related
Physical
Fitness
The ability of the muscles to exert
themselves repeatedly. A fit person can
repeat movements for a long period
without undue fatigue.
Muscular Endurance
The relative percentage of muscle,
fat, bone, and other tissues that make
up the body. A fit person has a
relatively low, but not too low,
percentage of body fat (body fatness).
Body Composition
Flexibili
ty
The range of motion available in a
joint. It is affected by muscle length,
joint structure, and other factors. A
fit person can move the body joints
through a full range of motion in
work and in play.
The ability of the heart, blood
vessels, blood, and respiratory
system to supply nutrients and
oxygen to the muscles and the ability
of the muscles to utilize fuel to allow
sustained exercise. A fit person can
persist in physical activity for
relatively long periods without
undue stress.
Cardiovascular Fitness
Strength
The ability of the muscles to exert an
external force or to lift a heavy weight.
A fit person can do work or play that
involves exerting force, such as lifting
or controlling one’s own body weight.
cor22568_ch01_001-020.indd 8 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 9
endurance, and strength (see Figure 5 ) . Each health–
related fitness characteristic has a direct relationship to
good health and reduced risk for hypokinetic disease. It is
for this reason that the five health-related physical fitness
components are emphasized in this book.
Possessing a moderate amount of each component
of health-related fitness is essential to disease preven-
tion and health promotion, but it is not essential to have
exceptionally high levels of fitness to achieve health ben-
efits. High levels of health-related fitness relate more to
performance than to health benefits. For example, mod-
erate amounts of strength are necessary to prevent back
and posture problems, whereas high levels of strength
contribute most to improved performance in activities
such as football and jobs involving heavy lifting.
The skill-related components of physical fitness are
associated more with performance than with good
health. The components of skill-related physical fitness
are agility, balance, coordination, power, reaction time, and
speed (see Figure 6 ). They are called skill-related because
people who possess them find it easy to achieve high levels
of performance in motor skills, such as those required in
sports and in specific types of jobs. Power is sometimes
referred to as a combined component of fitness, since
it requires both strength (a health-related component)
and speed (a skill-related compo-
nent). Because most experts consider
power to be associated more with
performance than with good health,
it is classified as a skill-related component of fitness in this
book. Skill-related fitness is sometimes called sports fit-
ness or motor fitness.
It is important to recognize that skill-related fitness
is multidimensional and highly specific. For example,
coordination could be hand-eye coordination, such as
batting a ball; foot-eye coordination, such as kicking a
ball; or many other possibilities. The six parts of skill-
related fitness identified here are those commonly asso-
ciated with successful sports and work performance.
Each could be measured in ways other than those pre-
sented in this book. Measurements are provided to help
you understand the nature of total physical fitness and to
help you make important decisions about lifetime physi-
cal activity.
Metabolic fitness is a nonperformance component
of total fitness. Physical activity can provide health
benefits that are independent of changes in traditional
health-related fitness measures. Physical activity promotes
good metabolic fitness , a state associated with reduced
risk for many chronic diseases. People with a cluster of
low metabolic fitness characteristics are said to have meta-
bolic syndrome (also known as Syndrome X). Metabolic
syndrome is discussed in more detail in Concept 4.
Bone integrity is often considered to be a
nonperformance measure of fitness. Traditional def-
initions do not include bone integrity as a part of physical
fitness, but some experts feel they should. Like metabolic
fitness, bone integrity cannot be assessed with perfor-
mance measures the way most health-related fitness parts
can. Regardless of whether bone integrity is considered a
part of fitness or a component of health, strong, healthy
bones are important to optimal health and are associated
with regular physical activity and sound diet.
The many components of physical fitness are
specific but are also interrelated. Physical fitness is a
combination of several aspects, rather than a single char-
acteristic. A fit person possesses at least adequate levels of
each of the health-related, skill-related, and metabolic fit-
ness components. Some relationships exist among various
fitness characteristics, but each component of physical fit-
ness is separate and different from the others. For exam-
ple, people who possess exceptional strength may not have
good cardiovascular fitness, and those who have good
coordination do not necessarily possess good flexibility.
Good physical fitness is important, but it is not the
same as physical health and wellness. Good physi-
cal fitness contributes directly to the physical component
of good health and wellness and indirectly to the other
four components. Good fitness has been shown to be
associated with reduced risk for chronic diseases, such
as heart disease, and has been shown to reduce the con-
sequences of many debilitating conditions. In addition,
good fitness contributes to wellness by helping us look
our best, feel good, and enjoy life. Other physical factors
can also influence health and wellness. For example, hav-
ing good physical skills enhances quality of life by allow-
ing us to participate in enjoyable activities, such as tennis,
golf, and bowling. Although fitness can assist us in per-
forming these activities, regular practice is also necessary.
Another example is the ability to fight off viral and bac-
terial infections. Although fitness can promote a strong
immune system, other physical factors can influence our
susceptibility to these and other conditions.
Metabolic Fitness A positive state of the physi-
ological systems commonly associated with reduced
risk for chronic diseases such as diabetes and heart
disease. Metabolic fitness is evidenced by healthy
blood fat (lipid) profiles, healthy blood pressure,
healthy blood sugar and insulin levels, and other
nonperformance measures.
Bone Integrity Soundness of the bones is associ-
ated with high density and absence of symptoms of
deterioration.
VIDEO
4
cor22568_ch01_001-020.indd 9 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
10 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
Figure 6 ▶ Components of skill-related physical fitness.
Dimensions
of Skill-Related
Physical
Fitness
The ability to rapidly and accurately
change the direction of the movement
of the entire body in space. Skiing and
wrestling are examples of activities
that require exceptional agility.
Agility
The maintenance of equilibrium while
stationary or while moving. Performing
tai chi movements and performing
stunts on the balance beam are
activities that require exceptional
balance.
Balance
The ability to use the senses with the
body parts to perform motor tasks
smoothly and accurately. Juggling,
hitting a tennis ball, and kicking a ball
are examples of activities requiring
good coordination.
Coordination
The ability to transfer energy into force
at a fast rate. Kicking in martial arts
and throwing the discus are activities
that require considerable power.
Power
The time elapsed between stimulation
and the beginning of reaction to that
stimulation. Reacting to a soccer ball
and starting a sprint race require good
reaction time.
Reaction Time
The ability to perform a movement in
a short period of time. Sprinters and
wide receivers in football need good
foot and leg speed.
Speed
cor22568_ch01_001-020.indd 10 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction 11
Determinants of Lifelong Health,
Wellness, and Fitness
Many factors are important in developing lifetime
health, wellness, and fitness, and some are more
in your control than others. Figure 7 provides a model
for describing many of the factors that contribute to
health, wellness, and fitness. Central to the model are
health, wellness, and fitness because these are the states of
being (shaded in green and gold) that each of us wants to
achieve. Around the periphery are the factors that influ-
ence these states of being. Those shaded in dark blue are
the factors over which you have the least control (hered-
ity, age, and disability). Those shaded in light blue (health
care and environmental factors) are factors over which you
have some control but less than the factors shaded in red
(personal actions/interactions, cognitions, and emotions).
Those shaded in light red are the
factors over which you have greatest
control (healthy lifestyles).
Heredity (human biology) is a factor over which we
have little control. Experts estimate that human biology,
or heredity, accounts for 16 percent of all health prob-
lems, including early death. Heredity influences each part
of health-related physical fitness, including our tenden-
cies to build muscle and to deposit body fat. Each of us
reaps different benefits from the same healthy lifestyles,
based on our hereditary tendencies. Even more important
is that predispositions to diseases are inherited. For exam-
ple, some early deaths are a result of untreatable heredi-
tary conditions (e.g., congenital heart defects). Obviously,
some inherited conditions are manageable (e.g., diabetes)
with proper medical supervision and appropriate lifestyles.
Personal actions and interactions
Cognitions and emotions
Health
Wellness
More control
Least control
Some controlMost control
Physical
fitness
Heredity
Age
Disability
Healthy lifestyles
Engaging in regular physical
activity*
Eating well*
Managing stress*
Avoiding destructive habits
Practicing safe sex
Managing time
Being an informed consumer
Adopting good health habits
Adopting good safety habits
Learning first aid
*These lifestyles are viewed as “priority lifestyles.”
Environmental factors
Physical, social and
cultural, spiritual,
worksite, other
Health-care system
Access
Compliance
Figure 7 ▶ Determinants of health, fitness, and wellness.
VIDEO 5
cor22568_ch01_001-020.indd 11 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
12 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
Heredity is a factor over which we have little control and
is, therefore, illustrated in dark blue in Figure 7 . Each
of us can limit the effects of heredity by being aware of
our personal family history and by making efforts to best
manage those factors over which we do have control.
In the concepts that follow, you will learn more about
heredity and how it affects health, wellness, and fitness.
Health, wellness, and fitness are influenced by the
aging of our population. In 2030 when post–World War
II baby boomers are over the age of 65, adults 65 or older
will make up 20 percent of the population. The number
of people over 85 will triple by 2050. There are currently
more than 100,000 people over the age of 100. The defini-
tion of old is changing, with most people believing that a
person is not old until age 71 or older. Nearly a quarter of
the population believes that being old begins at 81.
Whatever the standard for being old, age is a factor
over which we have no control. The major health and
wellness concerns of older adults include losing health,
losing the ability to care for oneself, losing mental abili-
ties, running out of money, being a burden to family, and
being alone. Chronic pain is also a major problem among
older adults. Nearly 30 percent of adults over 65 experi-
ence chronic pain, as opposed to 3 percent of those under
30. Nearly 60 percent of older adults experience frequent
pain, as opposed to 17 percent of those under 30. Older
adults have 36 percent more unhealthy days than young
adults.
Age is shaded in dark blue in Figure 7 because it is a
factor that you cannot control. However, healthy lifestyles
can reduce the effects of aging on health, wellness, and fit-
ness. As detailed later in this book, healthy lifestyles can
extend life and have a positive effect on quality of life.
Disabilities can affect, but they do not necessarily
limit, health, wellness, and fitness. Disabilities typi-
cally result from factors beyond your control (shaded in
dark blue in Figure 7 ). Many types of disabilities affect
health, fitness, and wellness. An objective disability (e.g.,
loss of a limb, impaired intellectual functioning) can
make it difficult to function in certain circumstances but
need not limit health, wellness, and fitness. All people
have a limitation of one kind or another. Societal efforts
to help all people function within their limitations can
help everyone, including people with disabilities, have a
positive outlook on life and experience a high quality of
life. With assistance from an instructor, it is possible for
all people to adapt the information in this book for use in
promoting heath, wellness, and fitness.
The health-care system affects our ability to
overcome illness and improve our quality of life.
Approximately 10 percent of unnecessary deaths occur as
a result of disparities in the health-care system. The qual-
ity of life for those who are sick and those who tend to be
sick is influenced greatly by the type of medical care they
receive. Health care is not equally available to all. A study
by the Institute of Medicine, entitled “Insuring America’s
Health,” indicates that 18,000 people die unnecessarily
in the United States each year because they lack health
insurance. Those without health insurance are less likely
to get high-quality medical care than those with insur-
ance. Many of those without insurance have chronic
conditions that go undetected and as a result become
untreatable. The passage of the Affordable Health Care
Act addresses this issue by enabling all Americans to have
health insurance.
Many people fail to seek medical help even though
care is accessible. Others seek medical help but fail to
comply with medical advice. For example, they do not
take prescribed medicine or do not follow up with treat-
ments. Men are less likely to seek medical advice than
women. For this reason, treatable conditions sometimes
become untreatable. Once men seek medical care, evi-
dence reveals, they get better care than women. Also,
ACTIVITY
T E C H N O L O G Y U P D A T E
Podcasts
Podcasts are compressed digital files containing audio
or video that can be downloaded from the Internet to a
portable media player or personal computer. The word
Pod refers to a personal media player, the receiver of the
information delivered by a podcaster. Originally used to
transmit music and news, podcasts of health information
are now common.
Do you think you would rely on this type of resource for health-
related information? Why or why not?
Health is available to Everyone for a
Lifetime, and it’s Personal
According to the National Institutes of Health, although
genes do not necessarily cause diseases, they do influ-
ence our risk of developing diseases, such as cancer,
heart disease, and addiction. The interaction between
our genes and our environments and experiences is a
complex one that is still being studied.
Would knowing you were genetically predisposed to a
particular disease change the lifestyle decisions you make?
ACTIVITY
cor22568_ch01_001-020.indd 12 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction
13
more of the medical research has been done on men. This
is of concern because treatments for men and women
often vary for similar conditions.
Wellness as evidenced by quality of life is also influ-
enced by the health-care system. Traditional medicine,
sometimes referred to as the medical model , has focused
primarily on the treatment of illness with medicine, rather
than illness prevention and wellness promotion. Efforts
to educate health-care personnel about techniques for
promoting wellness have been initiated in recent years.
Still, it is often up to the patient to find information
about health promotion. For example, a patient with risk
factors for heart disease might be advised to eat better
or to exercise more, but little specific information may
be offered. In Figure 7 , the health-care system is in light
blue to illustrate the fact that it is a factor over which you
may have limited control.
The environment is a major factor affecting our
health, wellness, and fitness. Environmental factors
account for nearly one-fourth of all early deaths and affect
quality of life in many ways. We do have more control
over environmental factors than heredity, but they are not
totally under our control. For this reason, the environ-
mental factors box is depicted in Figure 7 with a lighter
shade of blue than the heredity, age, and disability box.
You can exert personal control by selecting healthy envi-
ronments rather than by exposing yourself to unhealthy or
unsafe environments. This includes your choice of living
and work location, as well as the social, spiritual, and intel-
lectual environments. On the other hand, circumstances
may make it impossible for you to make the choices you
would prefer. Important environmental factors are dis-
cussed throughout the text, particularly in Concept 6 and
the final concept in the book. Some suggestions for how
you can work to alter the environment in a positive way
are also discussed in the last concept.
Personal actions, interactions, cognitions, and
emotions all have an effect on health, wellness, and
fitness. Some people think that good health, wellness, and
fitness are totally out of personal control. Others think that
they are totally in control. Neither statement is entirely true.
While heredity, age, and disability are factors you cannot
control, and health care and the environment are factors over
which you have limited control, there are things that you can
do relating to these factors. You can use your cognitive abili-
ties to learn about your family history and use that informa-
tion to limit the negative influences of heredity. You can learn
how to adapt to disabilities and personal limitations, as well
as to the aging process. You can research the health-care sys-
tem and the environment to minimize the problems associ-
ated with them.
Your personal interactions also influence your health,
wellness, and fitness. You are not alone in this world. Your
various environments, and how you interact with them,
influence you greatly. You have a choice about the envi-
ronments in which you place yourself and the people
with whom you interact in these environments.
Humans have the ability to think (cognitions) and to
use critical thinking to make choices and to determine the
actions they take and the interactions they engage in. Emo-
tions also affect personal actions and interactions. A major
goal of this book is to help you learn self-management
skills designed to help you use your cognitive abilities
to solve problems and make good decisions about good
health, wellness, and fitness, as well as to help you to be in
control of your emotions when taking action and making
decisions that affect your health.
None of us makes perfect decisions all of the time.
Sometimes we take actions and make choices based on
inadequate information, faulty thinking, pressure from
others, or negative influences from our emotions. While
the focus of this book is on healthy lifestyles, all of the
factors that influence health, wellness, and fitness will
be discussed in greater detail in the concepts that follow.
The goal is to help you consider all factors and to make
informed decisions that will lead to healthful behaviors.
Some strategies for action for each of the factors are pre-
sented in the final concept of this book.
Lifestyle change, more than any other factor, is
the best way to prevent illness and early death
in our society. Statistics show that more than half of
early deaths are the result of chronic diseases caused by
unhealthy lifestyles. Many of these chronic diseases are
targeted in the HP2020 report, and many of the new
health objectives focus on them. As shown in Figure 7 ,
these lifestyles affect health, wellness, and physical fit-
ness. The double-headed arrow between health/wellness
and physical fitness illustrates the interaction between
these factors. Physical fitness is important to health and
wellness development and vice versa.
The major causes of early death have shifted from
infectious diseases to chronic lifestyle-related
conditions. Scientific advances and improvements in
medicine and health care have dramatically reduced the
incidence of infectious diseases over the past 100 years
(see Table 3 ). Diphtheria and polio, both major causes of
death in the 20th century, have been virtually eliminated in
Western culture. Smallpox was globally eradicated in 1977.
Medical Model The focus of the health-care sys-
tem on treating illness with medicine, with little
emphasis on prevention or wellness promotion.
cor22568_ch01_001-020.indd 13 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
14 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
chronic lifestyle-related conditions because alteration of
lifestyles can result in reduced risk for these conditions.
Healthy lifestyles are critical to wellness. Just as
unhealthy lifestyles are the principal causes of modern-
day illnesses, such as heart disease, cancer, and diabetes,
healthy lifestyles can result in the improved feeling of
wellness that is critical to optimal health. In recogniz-
ing the importance of “years of healthy life,” the Public
Health Service also recognizes what it calls “measures
of well-being.” This well-being, or wellness, is associ-
ated with social, emotional/mental, spiritual, and physi-
cal functioning. Being physically active and eating well
are two healthy lifestyles that can improve well-being and
add years of quality living. Many of the healthy lifestyles
associated with good physical fitness and optimal wellness
will be discussed in detail later in this book. The Healthy
Lifestyle Questionnaire at the end of this concept gives
you the opportunity to assess your current lifestyles.
Regular physical activity, sound nutrition, and
stress management are priority healthy lifestyles.
Three of the lifestyles listed in Figure 7 are considered
to be priority healthy lifestyles: engaging in regular
physical activity or exercise , eating well, and managing
Health, Wellness, and Fitness: The Good News
The Gallup-Healthways Well-Being Index®
provides an indicator of how U.S. residents
rate their health and well-being over time. More than 1,000
adults are surveyed every day and results are summarized
each month. In addition to the overall Well-Being Index, sepa-
rate indices monitor life adjustment, emotional health, physi-
cal health, healthy behaviors, work environment, and health
access. The indices track trends at the national level as well
as by state, major cities, and congressional districts. Visit the
Well-Being Index at www.well-beingindex.com to see how
Americans feel about their health and well-being.
What do you think is needed to promote health and well-being at the
local, state, and national level?
H
T
p
ACTIVITY
In the News
Infectious diseases have been replaced with chronic
lifestyle-related conditions as the major causes of death.
Four of the top seven current causes of death (heart dis-
ease, cancer, stroke, and diabetes) fall into this category.
While heart disease remains the leading killer among all
adults, National Cancer Institute statistics indicate that
cancer is the leading cause of death for adults under the
age of 85. Death rates have recently decreased for 8 of
the top 10 causes of death. The incidence of kidney dis-
ease was unchanged, and suicide increased 1 percent.
HIV/AIDS, formerly in the top 10 causes of death, is
now 15th. The drop is primarily because of the devel-
opment of treatments to increase the life expectancy of
those infected. Many among the top 10 are referred to as
Physical Activity Generally considered to be a
broad term used to describe all forms of large muscle
movements, including sports, dance, games, work,
lifestyle activities, and exercise for fitness. In this
book, exercise and physical activity will often be used
interchangeably to make reading less repetitive and
more interesting.
Exercise Physical activity done for the purpose of
getting physically fit.
Table 3 ▶ Major Causes of Death in the United States
Current
Rank Cause
1900
Rank Cause
1 Heart disease 1 Pneumonia*
2 Cancer 2 Tuberculosis*
3 Lower respiratory disease 3 Diarrhea/enteritis*
4 Stroke 4 Heart disease
5 Injuries/accidents 5 Stroke
6 Alzheimer’s disease 6 Liver disease
7 Diabetes 7 Injuries
8 Influenza/pneumonia* 8 Cancer
9 Kidney disease 9 Senility
10 Suicide 10 Diphtheria*
*Infectious diseases: The only diseases among the top ten that are primarily
infectious in nature today are influenza/pneumonia.
cor22568_ch01_001-020.indd 14 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 1 ▶ Health, Wellness, Fitness, and Healthy Lifestyles: An Introduction
15
stress. There are several reasons for placing priority on
these lifestyles. First, they affect the lives of all people.
Second, they are lifestyles in which large numbers of
people can make improvement. Finally, modest changes
in these behaviors can make dramatic improvements in
individual and public health. For example, statistics sug-
gest that modest changes in physical activity patterns and
nutrition can prevent more than 400,000 deaths annu-
ally. Stress also has a major impact on drug, alcohol, and
smoking behavior, so managing stress can help individu-
als minimize or avoid those behaviors.
The other healthy lifestyles listed in Figure 7 are also
very important for good health. The reason that they
are not emphasized as priority lifestyles is that they do
not affect everyone as much as the first three do. Many
healthy lifestyles will be discussed in this book, but the
focus is on the priority healthy lifestyles because virtually
all people can achieve positive wellness benefits if they
adopt them.
The “actual causes” of most deaths are due to
unhealthy lifestyles. As illustrated in Table 3 , chronic
diseases (e.g., heart diseases, cancer) are the direct
causes of most deaths in our society. Public health
experts have used epidemiological statistics to show
that unhealthy lifestyles such as tobacco use, inactiv-
ity, and poor eating actually cause the chronic diseases
and for this reason are referred to as the “actual causes
of death.” Tobacco is the leading actual cause of death,
but inactivity and poor diet account for the next larg-
est percentage of deaths (see Table 4 ). The percentage
Strategies for Action
Self-assessments of lifestyles will
help you determine areas in which
you may need changes to promote optimal health,
wellness, and fitness. The Healthy Lifestyle Questionnaire
in the lab resource materials will help you assess your cur-
rent lifestyle behaviors to determine if they are contributing
positively to your health, wellness, and fitness. Because
this questionnaire contains some very personal information,
answering all the questions honestly will help you get an
accurate assessment. As you continue your study, refer back
to this questionnaire to see if your lifestyles have changed.
Initial self-assessments of wellness and fitness will
provide information for self-comparison. It is important to
assess your wellness and fitness at an early stage. These early
assessments will only be estimates. As you continue your
study, you will have the opportunity to do more comprehen-
sive self-assessments that will allow you to see how accurate
your early estimates were.
In Lab 1A, you will estimate your wellness using a Wellness
Self-Perceptions questionnaire, which assesses five well-
ness dimensions. Remember, wellness is a state of being that
is influenced by healthy lifestyles. Because other factors, such
as heredity, environment, and health care, affect wellness, it is
possible to have good wellness scores even if you do not do
well on the lifestyle questionnaire. However, over a lifetime,
unhealthy lifestyles will catch up with you and have an influ-
ence on your wellness and fitness. As each individual makes
progress toward improving wellness, we move closer to meet-
ing the HP2020 goal of living long, high-quality lives.
ACTIVITY
of deaths attributed to inactivity and poor diet has
recently been questioned, but their overall influence
on health is indisputable. The
information presented through-
out this book is designed to help
you change behaviors to reduce
your risk for early death from the actual causes listed
in Table 4 .
VIDEO 6
Table 4 ▶ Actual Causes of Death in the United States
Rank Actual Cause
Percentage
of Deaths
1 Tobacco use 18.1
2 Inactivity/poor diet 16.6
3 Alcohol consumption 3.5
4 Microbial agents (flu, pneumonia) 3.1
5 Toxic agents 2.3
6 Motor vehicles 1.8
7 Firearms 1.2
8 Sexual behavior 0.8
9 Illicit drug use 0.7
10 Other <.05
Source: Mokdad et al.
cor22568_ch01_001-020.indd 15 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
16 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
Web Resources
American Medical Association (AMA) www.ama-assn.org
Centers for Disease Control and Prevention (CDC) www.cdc.gov
Health Canada http://www.hc-sc.gc.ca
Healthier United States www.healthfinder.gov
Healthy People 2020 www.healthypeople.gov/HP2020
Institute of Medicine www.iom.edu
Kaiser Permanente, HealthAlliance Hospital, CDC, and the Insti-
tute for Healthcare Improvement. 2011. http://xnet.kp.org/
newscenter/pointofview/2010/032410healthylife.html
National Center for Chronic Disease Prevention and Health Pro-
motion Publications http://www.cdc.gov/chronicdisease/
index.htm
President’s Council on Fitness, Sports, and Nutrition
www.fitness.gov
Robert Wood Johnson Foundation www.rwjf.org
Trust for America’s Health http://healthyamericans.org/
U. S. Government Healthcare www.HealthCare.gov
Well-Being Index—Gallup Poll
www.gallup.com/poll/wellbeing.aspx
World Health Organization www.who.int
Web Podcasts
(Selected Websites)
Arizona State University on iTunes U—Introduction to Exer-
cise and Wellness http://itunes.asu.edu
CDC www2a.cdc.gov/podcasts
Johns Hopkins Medicine Podcasts www.hopkinsmedicine
.org/news/audio/podcasts/Podcasts.html
Journal of the American Medical Association Podcasts
http://jama.ama-assn.org/misc/audiocommentary.dtl
University of Maryland—Medical Podcasts (Medically Speak-
ing) www.umm.edu/podcasts/?source-google&gclid=C
NS2g7_8oo0CFRfOggodmDi_5g
U.S. Food and Drug Administration www.fda.gov/
AboutFDA/ContactFDA/StayInformed/RSSFeeds/
ucm144574.htm
U.S. Government Podcasts—Health Podcasts from the U.S.
Government www.usa.gov/Topics/Reference-Shelf/
Libraries/Podcasts/Health.shtml
Suggested Readings
Central Intelligence Agency. 2011. The World Factbook. Wash-
ington, DC: CIA. Available at https://www.cia.gov/
library/publications/the-world-factbook/
Owen, N., et al. 2010. Too much sitting: The population health
science of sedentary behavior. Exercise and Sport Sciences
Reviews. 38(3):105–1113.
Sebastiani, P., et al. 2010. Genetic signatures of exceptional
longevity in humans. Science. Published online July 1,
2010, www.sciencemag.org
Trust for America’s Health. 2008. Blueprint for a Healthier
America. Washington, DC: Trust for America’s Health.
Available at http://healthyamericans.org/report/55/
blueprint-for-healthier-america
United Nations Report on Non-Communicable Diseases.
2011. Available at www.un.org/en/ga/president/65/
issues/
World Health Organization. 2011. World Report on Disability.
Geneva: WHO. Available at www.who.int/
publications/en
World Health Statistics 2012. Available at www.who.int/gho/
publications/world_health_statistics/2012/en/index.html
Healthy People 2020
The Healthy People 2020 goals provide health targets for the
nation to achieve by the year 2020. The following goals relate
specifically to the content of this concept:
• Create a society in which all people live long, healthy
lives.
• Promote quality of life, healthy development, and healthy
behaviors (including being active, eating well, and avoid-
ing destructive habits) across all stages of life.
• Attain high-quality, longer lives free of preventable dis-
ease, injury, and premature death.
• Achieve health equity, eliminate disparities, and improve
the health of all groups.
• Create social and physical environments that promote
good health for all.
• Increase public awareness and understanding of the
determinants of health, disease, and disability.
The national health goals emphasize “high-quality” living and
“quality of life.” How do these national goals relate to health,
wellness, and fitness as defined in this concept?
ACTIVITY
cor22568_ch01_001-020.indd 16 9/3/12 10:39 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
L
a
b
R
e
s
o
u
rc
e
M
a
te
ria
ls
17
T
h
e
H
e
a
lth
y
L
ife
styl
e
Q
u
e
stio
n
n
a
ire
Lab Resource Materials: The Healthy Lifestyle Questionnaire
The purpose of this questionnaire is to help you analyze your lifestyle behaviors and to help you make decisions
concerning good health and wellness for the future. Information on this Healthy Lifestyle Questionnaire is of a personal
nature. For this reason, this questionnaire is not designed to be submitted to your instructor. It is for your information
only. Answer each question as honestly as possible, and use the scoring information to help assess your lifestyle.
Directions: Place an X over the “yes” circle to answer yes. If you answer “no,” make no mark. Score the questionnaire
using the procedures that follow.
1. I accumulate 30 minutes of moderate physi-
cal activity most days of the week (brisk
walking, stair climbing, yard work, or home
chores).
2. I do vigorous activity that elevates my
heart rate for 20 minutes at least 3 days a
week.
3. I do exercises for flexibility at least 3 days a
week.
4. I do exercises for muscle fitness at least 2
days a week.
5. I eat three regular meals each day.
6. I select appropriate servings from the major
food groups each day.
7. I restrict the amount of fat in my diet.
8. I consume only as many calories as I
expend each day.
9. I am able to identify situations in daily life that
cause stress.
10. I take time out during the day to relax and
recover from daily stress.
11. I find time for family, friends, and things I
especially enjoy doing.
12. I regularly perform exercises designed to
relieve tension.
13. I do not smoke or use other tobacco
products.
14. I do not abuse alcohol.
15. I do not abuse drugs (prescription or
illegal).
16. I take over-the-counter drugs sparingly and
use them only according to directions.
17. I abstain from sex or limit sexual activity to a
safe partner.
18. I practice safe procedures for avoiding sexu-
ally transmitted infections (STIs).
19. I use seat belts and adhere to the speed limit
when I drive.
20. I have a smoke detector in my house and
check it regularly to see that it is working.
21. I have had training to perform CPR if called
on in an emergency.
22. I can perform the Heimlich maneuver effec-
tively if called on in an emergency.
23. I brush my teeth at least twice a day and
floss at least once a day.
24. I get an adequate amount of sleep each
night.
25. I do regular self-exams, have regular medical
checkups, and seek medical advice when
symptoms are present.
26. When I receive advice and/or medication
from a physician, I follow the advice and take
the medication as prescribed.
27. I read product labels and investigate their
effectiveness before I buy them.
28. I avoid using products that have not been
shown by research to be effective.
29. I recycle paper, glass, and aluminum.
30. I practice environmental protection, such
as carpooling and energy conservation.
Overall Score—Total “Yes” Answers
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
yes
cor22568_ch01_001-020.indd 17 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
18
L
a
b
R
e
s
o
u
rc
e
M
a
te
ri
a
ls
T
h
e
H
e
a
lt
h
y
L
ife
st
yl
e
Q
u
e
st
io
n
n
a
ir
e
Scoring: Give yourself 1 point for each “yes” answer. Add your scores for each of the lifestyle behaviors. To calculate
your overall score, sum the totals for all lifestyles.
Avoiding Adopting
Physical Managing Destructive Practicing Safety
Activity Nutrition Stress Habits Safe Sex Habits
1. 5. 9. 13. 17. 19.
2. 6. 10. 14. 18. 20.
3. 7. 11. 15.
4. 8. 12. 16.
Total + Total + Total + Total + Total
+
Personal Using Being an Sum All
Knowing Health Medical Informed Protecting the Totals for
First Aid Habits Advice Consumer Environment Overall
Score
21. 23. 25. 27. 29.
22. 24. 26. 28. 30.
Total + Total + Total + Total + Total
=
Interpreting Scores: Scores of 3 or 4 on the four-
item scales indicate generally positive lifestyles. For the
two-item scales, a score of 2 indicates the presence
of positive lifestyles. An overall score of 26 or more
is a good indicator of healthy lifestyle behaviors. It is
important to consider the following special note when
interpreting scores.
Special Note: Your scores on the Healthy Lifestyle
Questionnaire should be interpreted with caution. There
are several reasons for this. First, all lifestyle behaviors
do not pose the same risks. For example, using tobacco
or abusing drugs has immediate negative effects on
health and wellness, whereas others, such as knowing
first aid, may have only occasional use. Second, you
may score well on one item in a scale but not on
another. If one item indicates an unhealthy lifestyle in an
area that poses a serious health risk, your lifestyle may
appear to be healthier than it really is. For example, you
could get a score of 3 on the destructive habits scale
and be a regular smoker. For this reason, the overall
score can be particularly deceiving.
Strategies for Change: In the space to the right,
make some notes concerning the healthy lifestyle areas
in which you could make some changes. You can refer
to these notes later to see if you have made progress.
Rating
Two-Item
Scores
Four-Item
Scores
Overall
Scores
Positive
lifestyles
2 3 or 4 26 to 30*
Consider
changes
Less than 2 Less than 3 Less than 26
*See Special Note.
Healthy Lifestyle Ratings
cor22568_ch01_001-020.indd 18 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
19
W
e
lln
e
ss S
e
lf-
P
e
rc
e
p
tio
n
s
L
a
b
1
A
Lab 1A Wellness Self-Perceptions
Name Section Date
Purpose: To assess self-perceptions of wellness
Procedures
1. Place an X over the appropriate circle for each question (4 = strongly agree, 3 = agree, 2 = disagree, 1 = strongly
disagree).
2. Write the number found in that circle in the box to the right.
3. Sum the three boxes for each wellness dimension to get your wellness dimension totals.
4. Sum all wellness dimension totals to get your comprehensive wellness total.
5. Use the rating chart to rate each wellness area.
6. Complete the Results section and the Conclusions and Implications section.
Strongly Strongly
Question Agree Agree Disagree Disagree Score
1. I am happy most of the time. 4 3 2 1
2. I have good self-esteem. 4 3 2 1
3. I do not generally feel stressed. 4 3 2 1
Emotional Wellness Total =
4. I am well informed about current events. 4 3 2 1
5. I am comfortable expressing my views and opinions. 4 3 2 1
6. I am interested in my career development. 4 3 2 1
Intellectual Wellness Total =
7. I am physically fit. 4 3 2 1
8. I am able to perform the physical tasks of my work. 4 3 2 1
9. I am physically able to perform leisure activities. 4 3 2 1
Physical Wellness Total =
10. I have many friends and am involved socially. 4 3 2 1
11. I have close ties with my family. 4 3 2 1
12. I am confident in social situations. 4 3 2 1
Social Wellness Total =
13. I am fulfilled spiritually. 4 3 2 1
14. I feel connected to the world around me. 4 3 2 1
15. I have a sense of purpose in my life. 4 3 2 1
Spiritual Wellness Total =
Comprehensive Wellness
(Sum of five wellness scores)
cor22568_ch01_001-020.indd 19 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
20
L
a
b
1
A
W
e
lln
e
ss
S
e
lf-
P
e
rc
e
p
ti
o
n
s
In the Results below, record your scores from the previous page; then determine your ratings for each score using the
Wellness Rating Chart. Record your ratings in the Results section.
Wellness Dimension
Score Rating
Emotional/mental
Intellectual
Physical
Social
Spiritual
Comprehensive
Rating
Wellness
Dimension Scores
Comprehensive
Wellness Scores
High-level wellness 10–12 50–
60
Good wellness 8–9 40–49
Marginal wellness 6–7 30–
39
Low-level wellness Below 6 Below
30
Conclusions and Implications: In the space provided below, describe your current state of wellness. Do you think
the ratings indicate your true state of wellness? Which areas need the most improvement?
Results
Wellness Rating Chart
cor22568_ch01_001-020.indd 20 27/07/12 11:48 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
21
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Identify and define the five stages of change and explain how the stages relate to
making lifestyle changes.
▶ Describe the four key factors that influence health behaviors, describe components
in each category, and explain how the factors relate to stages of change.
▶ Identify and describe the self-management skills that predispose and enable you to
change and reinforce changes once you have made them.
▶ Identify and describe the six steps in self-planning and explain how they can be
used to make personal plans for behavior change.
▶ Conduct self-assessments of your current stages for health behaviors and your self-
management skills for making health behavior change.
▶ Identify related national health goals and show how meeting personal goals can
contribute to reaching national goals.
Self-Management and
Self-Planning Skills for
Health Behavior Change
Learning and regularly using
self-management skills can help
you adopt and maintain healthy
lifestyles throughout life.
21
C
o
n
c
e
p
t 2
cor22568_ch02_021-042.indd 21 28/07/12 12:08 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
22 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
have started regular physical activity programs often see
improvements in fitness and general well-being and decide
to stop smoking.
People do not make lifestyle changes overnight.
People progress forward and backward through
several stages of change. When asked about a specific
healthy lifestyle, people commonly respond with yes or no
answers. If asked, “Do you exercise regularly?” the answer
is yes or no. When asked, “Do you eat well?” the answer is
yes or no. We know that there are many different stages of
lifestyle behavior.
James Prochaska (a well-known health psychologist)
and his colleagues developed the Transtheoretical Model
to explain the importance of stages of change for under-
standing behavior. They suggest that lifestyle changes occur
in at least five different stages, as illustrated in Figure 1 . The
stages were originally developed to help clarify negative
lifestyles, such as smoking. Smokers who are not consider-
ing stopping are at the stage of precontemplation. Those
who are thinking about stopping are classified in the con-
templation stage. Those who have bought a nicotine patch
or a book about smoking cessation are in the preparation
stage. They have moved beyond contemplation and are
preparing to take action. The action stage occurs when the
smoker makes a change in behavior, even a small one, such
as cutting back on the number of cigarettes smoked. The
fifth stage, maintenance, is reached when a person finally
stops smoking for a relatively long time (e.g., 6 months).
The stages of change model (as illustrated in Figure 1 )
has been applied to positive lifestyles as well as negative
ones. Those who are totally sedentary are considered to be
in the precontemplation stage. Contemplators are think-
ing about becoming active. A person at the preparation
stage may have bought a pair of walking shoes and appro-
priate clothing for activity. Those who have started activ-
ity, even if infrequent, are at the stage of action. Those who
have been exercising regularly for at least 6 months are at
the stage of maintenance.
Whether the lifestyle is positive or negative, people move
from one stage to another in an upward or a downward
R
educing illness and debilitating conditions and pro-
moting wellness and fitness are important public
health goals. As noted in Concept 1 , adopting healthy
lifestyles is a key factor in health, wellness, and fitness
promotion, but evidence suggests that many people are
not able to make changes, even when they want to do
so. Experts have determined that people who practice
healthy lifestyles possess certain characteristics. These
characteristics, including personal responsibility, can be
modified to improve the health behaviors of all people.
Researchers have also identified several special skills,
referred to as self-management skills, that can be useful
in altering factors related to adherence and ultimately in
making lifestyle changes. Like any skill, self-management
skills must be practiced if they are to be useful. The fac-
tors relating to adherence and the self-management skills
described in this concept can be applied to a wide vari-
ety of healthy lifestyles. The early sections of this book
focus on using self-management skills to become and
stay active throughout life. Later sections focus on using
these skills to adopt other healthy lifestyles that promote
good health and wellness. In the final section, you get an
opportunity to use the skills to make informed choices
and plan for healthy living.
Making Lifestyle Changes
Many adults want to make lifestyle changes but
find changes hard to make. Results of several national
public opinion polls show that adults often have difficulty
making desired lifestyle changes. Examples include those
who believe that physical activity is important but do
not get enough exercise to promote good health, those
who have tried numerous times to lose weight but have
failed, those who know good nutrition is good for health
but do not eat well, and those who feel stress on a regular
basis but have not found a way to become less stressed.
Changes in other lifestyles are frequently desired but
often not accomplished. More information about public
opinion polls related to health is presented in the “In the
News” feature.
Practicing one healthy lifestyle does not mean you
will practice another, though adopting one healthy
behavior often leads to the adoption of another.
College students are more likely to participate in regular
physical activity than are older adults. However, they are
also much more likely to eat poorly and abuse alcohol. Many
young women adopt low-fat diets to avoid weight gain and
smoke because they mistakenly believe that smoking will
contribute to long-term weight maintenance. These exam-
ples illustrate the fact that practicing one healthy lifestyle
does not ensure adherence to another. However, there is
evidence that making one lifestyle change often makes it
easier to make other changes. For example, smokers who Figure 1 ▶ Stages of lifestyle change.
Maintenance
”I regularly practice
healthy lifestyles.”
Action
”I have made some life-
style changes.”
Preparation
”I am getting ready to make
a lifestyle change.”
Contemplation ”I am thinking about change.”
Precontemplation ”I don’t want to change.”
cor22568_ch02_021-042.indd 22 28/07/12 12:08 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 23
direction. Individuals in the action stage may move on to
maintenance or revert to contemplation. Smokers who suc-
ceed in quitting permanently report having stopped and
started dozens of times before reaching lifetime mainte-
nance. Similarly, those attempting to adopt positive life-
styles, such as eating well, often move back and forth from
one stage to another, depending on their life circumstances.
Once maintenance is attained, relapse is less likely
to occur. Although complete relapse is possible, it is gen-
erally less likely after the maintenance stage is reached. At
the maintenance stage, the behavior has been integrated
into a personal lifestyle, and it becomes easier to sus-
tain. For example, a person who has been active for years
does not have to undergo the same thought processes as
a beginning exerciser—the behavior becomes automatic
and habitual. Similarly, a nonsmoker is not tempted to
smoke in the same way as a person who is trying to quit.
Factors That Promote
Lifestyle Change
Various factors have been found to influence the
adoption and maintenance of healthy lifestyles. A
variety of theories have been proposed to understand health
behavior (e.g., Social Cognitive Theory, Self-Determination
Theory, Theory of Planned Behavior, Theory of Reasoned
Action). Each theory offers some unique attributes or con-
cepts, but they share many of the same components. The
previously mentioned Transtheoretical Model integrates ele-
ments from multiple theories and can be viewed as a “meta-
theory.” The distinction between a “theory” and a “model” is
important in this case. The Transtheoretical Model does not
provide a new explanation of behavior (a theory) but rather
a guide or map that makes using and applying the theories
easier (a model). The unique advantage of the Transtheoreti-
cal Model is that it demonstrates that behavior is influenced
in different ways depending on the stage of change a person
has reached.
Another meta-theory that has been used to explain
the challenges of changing health behaviors is the
Adherence Adopting and sticking with healthy
behaviors, such as regular physical activity or sound
nutrition, as part of your lifestyle.
Stage of Change The level of motivational readi-
ness to adopt a specific health behavior.
Many organizations, both profit and nonprofit,
regularly poll Americans concerning their
health, wellness, and fitness, as well as their attitudes about
these subjects. Among the most well known polls are those by
CBS/New York Times, USA Today/CNN/Gallup, NBC/Wash-
ington Post, and Trust for America’s Health/Robert Wood
Johnson Foundation. Some results of surveys by the various
polls include the following:
• 76 percent of Americans favor increasing funding for pre-
vention programs.
• 77 percent believe that prevention programs will save money
over the long run.
• 72 percent want more investment in prevention—even if it
does not save money—because it will prevent disease and
save lives.
• 57 percent want to invest in prevention—even if money is
not saved—if it improves quality of life (wellness).
• 50 percent believe that more money should be spent on
medical and health research.
These results are from different sources and from different types
of polls but they collectively show an interest in health, preven-
tion, and wellness. While Americans overwhelmingly support
these ideas, there is relatively little money invested in prevention
and health promotion research. Funding is often in jeopardy for
existing work-site wellness programs and school health/physical
education programs.
Why is it hard for organizations to invest more fully in prevention?
Public Opinion Polls about Health, Wellness, and Fitness
ACTIVITY
In the News
M
r
P
I
Access to healthy foods is an important predisposing factor for
good nutrition.
cor22568_ch02_021-042.indd 23 9/3/12 10:58 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
24 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
Social-Ecological Model. This model also integrates
multiple theories, but a key point in this model is that a
person’s behavior is strongly influenced by the nature of
the environment in which she or he lives. If you are in a
supportive social environment and have access to healthy
foods and activity resources, adopting healthier lifestyles
is easier.
You do not need a thorough understanding of the the-
ories and models, but you should be aware of the basic
principles. Concepts from both the Transtheoretical and
Social-Ecological models have been combined to provide
a simpler way to understand the various factors that influ-
ence behavior. For ease of understanding, the various fac-
tors are classified as personal , predisposing , enabling ,
and reinforcing factors (see Figure 2 ). Predisposing
factors help precontemplators get going—moving them
toward contemplation or even preparation. Enabling fac-
tors help those in contemplation or preparation take a
step toward action. Reinforcing factors move people from
action to maintenance and help those in maintenance
stay there.
Personal factors affect health behaviors but are
often out of your personal control. Age, gender,
heredity, social status, and current health and fitness levels
are all personal factors that affect your health behaviors.
For example, there are significant differences in health
behaviors among people of various ages. According to one
survey, young adults between the ages of 18 and 34 are
more likely to smoke (30 percent) than those 65 and older
(13 percent). On the other hand, young adults are much
more likely than older adults to be physically active.
Gender differences are illustrated by the fact that
women use health services more often than men. Women
are more likely than men to have identified a primary care
doctor and are more likely to participate in regular health
screenings. As you will discover in more detail later in
this book, heredity plays a role in health behaviors. For
example, some people have a hereditary predisposition to
gain weight, and this may affect their eating behaviors.
Age, gender, and heredity are factors you cannot
control. Other personal factors that relate to health
behaviors include social status and current health and
Figure 2 ▶ Factors that influence health behaviors at various stages of change.
Reinforcing factors
Factors influencing change Stages of change
Preparation
Contemplation
Precontemplation
•Success
•Family support
•Peer support
•Support of health professionals
Enabling factors
•Goal setting
•Self-assessment
•Self-monitoring
•Self-planning
•Performance skills
•Coping skills
•Consumer skills
•Time management
Personal factors
Age
Gender
Heredity
Current health and fitness
Predisposing factors
Am I able? Is it worth it?
Self-confidence
Self-efficacy
Safe environment
Access
Self-motivation
Enjoyment
Balanced attitudes
Beliefs
Knowledge
Action
Maintenance
cor22568_ch02_021-042.indd 24 28/07/12 12:08 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change
25
fitness status. Evidence indicates that people of lower
socioeconomic status and those with poor health and
fitness are less likely to contemplate or participate in
activity and other healthy behaviors. No matter what
personal characteristics you have, you can change your
health behaviors. If you have several personal factors
that do not favor healthy lifestyles, it is important to
do something to change your behaviors. Making an
effort to modify the factors that predispose, enable,
and reinforce healthy lifestyles is essential. As shown in
Figure 2 , the factors influence behavior at different
stages of change.
Predisposing factors are important in getting you
started with the process of change. Several predis-
posing factors can help you move from contemplation
to preparation and then to taking action with regard to
healthy behavior. A person who possesses many of the
predisposing factors is said to have self-motivation (also
called intrinsic motivation). If you are self-motivated, you
will answer positively to two basic questions: “Am I able?”
and “Is it worth it?”
“Am I able to do regular activity?” “Am I able to change
my diet or to stop smoking?” Figure 2 includes a list of
four factors that help you say, “Yes, I am able.” Two of these
factors are self-confidence and self-efficacy . Both have
to do with having positive perceptions about your own
ability. People with positive self-perceptions are more self-
motivated and feel they are capable of making behavior
changes for health improvement. Other factors that help
you feel you are able to do a healthy behavior include
easy access and a safe environment. For example, people
who have easy access to exercise equipment at home or
the workplace or who have a place to exercise within 10
minutes of home are more likely to be active than those
who do not. Similarly, access to healthy food options is
critical for adopting a healthy diet. A supportive physical
and social environment can also make it easier to adopt
healthy habits.
“Is it worth it?” People who say yes to this question
are willing to make an effort to change their behaviors.
Predisposing factors that make it
worth it to change behaviors include
enjoying the activity, balancing posi-
tive and negative attitudes, believing
in the benefits of a behavior, and having knowledge of the
health benefits of a behavior (see Figure 2 ). If you enjoy
something and feel good about it (have positive attitudes
and beliefs), you will be self-motivated to do it. It will be
Personal Factors Factors, such as age or gender,
related to healthy lifestyle adherence but not typically
under personal control.
Predisposing Factors Factors that make you more
likely to adopt a healthy lifestyle, such as participa-
tion in regular physical activity, as part of your nor-
mal routine.
Enabling Factors Factors that help you carry out
your healthy lifestyle plan.
Reinforcing Factors Factors that provide encour-
agement to maintain healthy lifestyles, such as physi-
cal activity, for a lifetime.
Self-Confidence The belief that you can be suc-
cessful at something (for example, the belief that you
can be successful in sports and physical activities and
can improve your physical fitness).
Self-Efficacy Confidence that you can perform a
specific task (a type of specific self-confidence).
A CLOSER LOOK
ACTIVITY
Blue Zones
For his book Blue Zones, Dan Buettner researched com-
munities across the world that had higher life expec-
tancies and quality of life than other communities. He
identified their common characteristics to try to deter-
mine the underlying factors that influence good health.
He referred to these communities as “Blue Zones” and
came up with nine specific attributes that contributed
to the improved health. It is not surprising that physi-
cal activity (labeled as “Move Naturally”) was at the top
of the list. (To see the complete list of principles, visit
www.bluezones.com.) Some public health groups and
agencies have sought to promote broad application of
these principles as the basis for coordinated community
health programming. The book, in this case, can be viewed
as a guide or recipe for healthy communities. However, it
may also be likened to a fad diet that might promise an
easy path to health and wellness.
Is it possible for communities to follow these recommendations as
part of building a healthy community? Why or why not?
Blue ZonesBl Z nes
VIDEO 1
cor22568_ch02_021-042.indd 25 28/07/12 12:08 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
26 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
worth it. The lifestyle examples provided in Table 1 will
help you understand how to apply these predisposing fac-
tors to your own lifestyle.
Enabling factors move you from the beginning
stages of change to action and maintenance.
A variety of skills help you follow through with decisions
to make changes in behaviors. Figure 2 lists eight self-
management skills that contribute to behavior change.
The labs in each concept provide opportunities to learn
and apply these self-management skills to your lifestyle.
Table 2 explains the importance of
each skill and how each one can
contribute to behavior change.
Reinforcing factors help you adhere to lifestyle
changes. Once you have reached the action or main-
tenance stage, it is important to stay at this high level.
Reinforcing factors help you stick with a behavior change
(see Figure 2 ).
One of the most important reinforcing factors is
success. If you change a behavior and experience suc-
cess, this makes you want to keep doing the behavior.
If attempts to change a behavior result in failure, you
may conclude that the behavior does not work and give
up on it. Planning for success is essential for adhering
to healthy lifestyle changes. Using the self-management
Health is available to Everyone for a
Lifetime, and it’s Personal
Friends may have a bigger impact on us than we realize.
A recent study followed people over 32 years to examine
the impact of social connections on health and health
outcomes. According to the study, people are more likely
to become obese if a friend becomes obese. Similar
relationships were found for adult siblings and spouses,
though the connection between friends appears stron-
ger. This relationship was not found for neighbors. The
authors suggested that there is a clustering of health
behaviors in social groups that explain the shared
outcomes.
Do your friends hurt or help you maintain a healthy lifestyle?
ACTIVITY
skills described in this concept and throughout this book
can help you plan effectively and achieve success.
Social support from family, peers, and health profes-
sionals can also be reinforcing. There are, however, dif-
ferent kinds of support and some are more helpful than
others. Support for well-informed personal choices is
referred to as support of autonomy. One example is
VIDEO 2
Self-Management Skill How Is It Useful?
Overcoming Barriers Lifestyle Example
Develop skills that make it possible to overcome problems
or challenges in adopting or maintaining healthy behaviors.
By conquering challenges, you learn skills that help you
overcome other barriers to healthy lifestyles.
A person is tempted by snack foods and candy provided by
co-workers. Learning to resist these foods takes discipline, but
overcoming barriers builds confidence that helps the person stay
focused on long-term goals.
Building Self-Confidence and Motivation Lifestyle Example
Take small steps that allow success. With each small step,
confidence and motivation increase and you develop the
feeling “I can do that.”
A person says, “I would like to be more active, but I have never been
good at physical activities.” Starting with a 10-minute walk, the person
sees that “I can do it.” Over time, the person becomes confident and
motivated to do more physical
activity.
Balancing Attitudes Lifestyle Example
Learn to balance positive and negative attitudes. Developing
positive attitudes and reducing negative attitudes helps you
adhere to a healthy lifestyle.
A person does not do activity because he or she lacks support from
friends, has no equipment, and does not like to get sweaty. These are
negatives. Shifting the balance to positive things, such as fun, good
health, and good appearance, can help promote activity.
Building Knowledge and Changing Beliefs Lifestyle Example
Build your beliefs on sound information. Knowledge does not
always change beliefs, but awareness of the facts can play a
role in achieving good
health.
A person says, “I don’t think what I eat has much to do with my health
and wellness.” Acquiring knowledge is fundamental to being an
educated person. Studying the facts about nutrition can provide the
basis for changes in beliefs and lifestyles.
Table 1 ▶ Self-Management Skills for Changing Predisposing Factors
cor22568_ch02_021-042.indd 26 28/07/12 12:08 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change
27
encouragement from family, friends, or a doctor for start-
ing and sticking to a nutritious diet. The supporting per-
son might ask, “How can I help you meet your goals?”
One goal of this book is to help you take control of your
own behaviors concerning your personal health, fitness,
and wellness.
Not all feedback is perceived as reinforcing and sup-
portive. Although the people providing the feedback may
feel they are being helpful and supportive, some feedback
may be perceived as applying pressure or as an attempt to
control behavior. Scolding a person for not sticking to a
diet, for example, or offering the suggestion that “you are
not going to get anywhere if you don’t stick to your diet,”
will often be perceived as applying pressure. If you want
to help friends and family make behavior changes, avoid
applying pressure and attempt to provide positive forms
of support. Research also suggests it is desirable to pro-
mote autonomy and freedom of choice so that change is
Self-Management Skill How Is It Useful?
Goal-Setting Skills Lifestyle Example
Establish what you want to achieve in the future. Goals should
be realistic and achievable. Learning to set goals for behavior
change is especially important for beginners.
A person wants to lose body fat. Setting a goal of losing 50 pounds
makes success unlikely. Setting a process goal of restricting 200
calories a day or expending 200 more a day for several weeks makes
success more likely.
Self-Assessment Skills Lifestyle Example
Assess your own fitness, health, and wellness and learn to
interpret your own self-assessment results. It takes practice to
become good at doing self-assessments.
A person wants to know his or her health strengths and weaknesses.
The best procedure is to select good tests and self-administer them.
Practicing the assessments in this book will help you become good at
self-assessment.
Self-Monitoring Skills Lifestyle Example
Monitor your behavior by keeping records. Many people think
they adhere to healthy lifestyles, but they do not. They have a
distorted view of what they actually do. Self-monitoring gives
you a true picture of your own behavior and progress.
In spite of restricting calories, a person can’t understand why he or
she is not losing weight. Keeping records may show that the person
is not counting all the calories. Learning to keep records of progress
contributes to adherence.
Self-Planning Skills Lifestyle Example
Plan for yourself rather than having others do all the planning
for you.
A person wants to be more active, to eat better, and to manage
stress. Self-planning skills will help him or her plan a personal activity,
nutrition, or stress-management program.
Performance Skills Lifestyle Example
Learn the skills necessary for performing specific tasks, such
as sports or relaxation. These skills can help you feel confident
and enjoy
activities.
A person avoids physical activity because he or she does not have the
physical skills equal to those of peers. Learning sports or other motor
skills allows this person to choose to be active.
Coping Skills Lifestyle Example
Develop a new way of thinking about things. Using this skill,
you can see situations in more than one way and learn to think
more positively.
A person is stressed and frequently anxious. Learning stress–
management skills, such as relaxation, can help a person cope. Like
all skills, stress-management skills must be practiced to be effective.
Consumer Skills Lifestyle Example
Gain knowledge about products and services. You may also
need to rethink untrue beliefs that lead to poor consumer
decisions.
A person avoids seeking medical help when sick. Instead, the person
takes an unproven remedy. Learning consumer skills
provides
knowledge for making sound medical decisions.
Time-Management Skills Lifestyle Example
Keep records similar to self-monitoring, focusing on total time
use rather than specific behaviors. Skillful monitoring of time
can help you plan and adhere to healthy lifestyles.
A person wants more quality time with family and friends. Monitoring
time can help him or her reallocate time to spend it in ways that are
more consistent with personal priorities.
Table 2 ▶ Self-Management Skills for Changing Enabling Factors
cor22568_ch02_021-042.indd 27 28/07/12 12:08 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
28 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
self-directed. Table 3 provides life-
style examples of the key reinforcing
factors of social support and relapse
prevention.
Self-Management Skills
Learning self-management skills can help you
alter factors that lead to healthy lifestyle change.
Personal, predisposing, enabling, and reinforcing fac-
tors influence the way you live. These factors are of
little practical significance, however, unless they can
be altered to promote healthy lifestyles. Learning self-
management skills (sometimes called self-regulation
skills) can help you change the predisposing, enabling,
and reinforcing factors described in Tables 1 (page 26) ,
2 (page 27) , and 3 . In fact, some of the enabling fac-
tors are self-management skills. Learning these skills
takes practice, but with effort anyone can learn them.
This book offers many opportunities to learn and prac-
tice self-management skills.
It takes time to change unhealthy lifestyles. People
in Western cultures are used to seeing things happen
quickly. We flip a switch, and the lights come on. We
want food quickly, and thousands of fast-food restaurants
provide it. The expectation that we should have what we
want when we want it has led us to expect instantaneous
changes in health, wellness, and fitness. Unfortunately,
there is no quick way to health. There is no pill that
can reverse the effects of a lifetime
of sedentary living, poor eating, or
tobacco use. Changing your lifestyle
is the key. But lifestyles that have
been practiced for years are not easy to change. As you
progress through this book, you will have the opportu-
nity to learn how to implement self-management skills.
Learning these skills is the surest way to make permanent
lifestyle changes.
Adopting healthy lifestyle habits requires extra discipline and effort.
Self-Planning for Healthy
Lifestyles
Self-planning is a particularly important self-
management skill. In the final concept in this book,
after you have studied a variety
of concepts and self-management
skills, you will have the opportunity
VIDEO 3
VIDEO 4
VIDEO 5
Self-Management Skill How Is It Useful?
Social Support Lifestyle Example
Obtain the support of others for healthy lifestyles. You learn how to
get support from family and friends for your autonomous decisions.
Support of a doctor can help.
A person has gradually developed a plan to be active. Friends
and loved ones encourage activity and help the person develop a
schedule that will allow and encourage regular activity.
Relapse Prevention Lifestyle Example
Stick with a healthy behavior once you have adopted it. It can be
easy to relapse to an unhealthy lifestyle. Skills such as avoiding high-
risk situations and learning how to say no help you avoid relapse.
A person stops smoking. To stay at maintenance, the person can
learn to avoid situations where there is pressure to smoke. He or
she can learn methods of saying no to those who offer tobacco.
Table 3 ▶ Self-Management Skills for Changing Reinforcing Factors
cor22568_ch02_021-042.indd 28 28/07/12 12:08 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change
29
to develop a personal plan for several healthy lifestyles.
Several self-management skills, including self-assessment,
self-monitoring, and goal-setting, are used in the six-step
self-planning process (see Table 4 ).
Step 1: Clarifying Reasons
Clarifying your reasons for behavior change is the
first step in program planning. People at precontem-
plation stage are not considering a change in behavior;
they see no need. It’s when they reach the contemplation
stage that they consider changes in behavior. One of the
most common and most powerful reasons for contem-
plating a change in a lifestyle is the recommendation of a
doctor, often after a visit associated with an illness. Other
common reasons are to improve personal appearance,
lose weight, increase energy levels, improve the ability
to perform daily tasks, and improve quality of life (well-
ness). Identifying your reasons for wanting to change
helps you determine which behaviors to change first and
helps you establish specific goals. Reflect on your rea-
sons for wanting to make lifestyle changes before mov-
ing on to step 2.
Step 2: Identifying Needs
Self-assessments are useful in establishing
personal needs, planning your program, and
evaluating your progress. You have already done
some self-assessments of wellness, current activity levels,
and current lifestyles. In the labs for this concept and
others that follow, you will make additional assessments.
The results of these assessments help you build personal
profiles for a variety of health behaviors that can be
used as the basis for program planning. With practice,
self-assessments become more accurate. For this rea-
son, it is important to repeat self-assessments and to pay
careful attention to the procedures for performing them.
If questions arise, get a professional opinion rather than
making an error.
Self-Planning Description Self-Management Skill
1. Clarifying reasons Knowing the general reasons for changing a
behavior helps you determine the type of behavior
change that is most important for you at a specific
point in time. If losing weight is the reason for
wanting to change behavior, altering eating and
activity patterns will be emphasized.
Results of the Self-Management Skills
Questionnaire (Lab 2B) will help you determine
which self-management skills you use regularly
and the ones you might need to develop.
2. Identifying needs If you know your strengths and weaknesses, you
can plan to build on your strengths and overcome
weaknesses.
Self-assessment: In the concepts that follow,
you will learn how to assess different health,
wellness, and fitness characteristics. Learning
these self-assessments will help you identify
needs.
3. Setting personal goals Goals are more specific than reasons (see step
1). Establishing specific things that you want to
accomplish can provide a basis for feedback that
your program is working.
Goal setting: Guidelines in this concept will
help you set goals. In subsequent concepts,
you will establish goals for different lifestyles.
4. Selecting program
components
A personal plan should include the specific program
components that will meet your needs and goals
based on steps 1–3. Examples include meal plans
for nutrition and specific activities for your physical
activity plan.
Many self-management skills, including time
management, consumer, and performance
skills, are useful in developing plans for a
variety of healthy behaviors.
5. Writing your plan Once program components, such as meal plans for
nutrition and specific activities for physical activity,
have been determined, you should put your plan
in writing. This establishes your intentions and
increases your chances of adherence.
Self-planning: This includes writing down the
time of day, day of the week, and other details
you will include in your plan.
6. Evaluating progress Once you have used your plan, you will know what
works and what does not. Periodic self-assessments
can help you modify the plan to make it better.
Self-monitoring: This skill is used in keeping
records (logs) and determining if goals are
met. Self-assessment: This skill is used to help
you determine if goals are met.
Table 4 ▶ Self-Planning Skills
cor22568_ch02_021-042.indd 29 14/09/12 6:39 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
30 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
Periodic self-assessments can help determine if you
are meeting health, wellness, and fitness standards
and making progress toward personal health goals.
When performed properly, self-assessments help you deter-
mine if you have met your goals and if you are meeting
health standards (e.g., meeting health fitness standards, eat-
ing appropriate amounts of nutrients). Self-assessments also
offer a measure of independence and can help you avoid
unnecessary and expensive tests. They serve as a screening
procedure to determine if you need professional assistance.
However, because self-assessments may not be as accurate
as tests by health and medical professionals, it is wise to have
periodic tests by an expert to see if your self-assessments
are accurate.
Self-assessments also have the advantage of
consistent error rather than variable error. The
best type of assessments are done by highly qualified
experts using precise instruments. Following directions
and practicing assessment techniques will reduce error
significantly. Still, errors will occur. One advantage of a
self-assessment is that the person doing the assessment
is always the same—you. Even if you make an error in
a self-assessment, it is likely to be consistent over time,
especially if you use the same equipment each time you
make the assessment. For example, scales have limitations
for monitoring changes in weight (and fat). But if you
measure your own weight using a home scale and your
measurement always shows your weight to be 2 pounds
higher than it really is, you have made a consistent error.
You can determine if you are improving because you
know the error exists. Variable errors are likely when dif-
ferent instruments are used, when different people make
the assessments, and when procedures vary from test to
test. Differences in scores are harder to explain with vari-
able forms of error because they are not consistent.
Step 3: Setting Personal Goals
There are differences between short-term and
long-term goals. Short-term goals are goals that you
can accomplish in days or weeks. Long-term goals take
longer to accomplish—sometimes months or even years.
There are differences between general goals and
SMART goals. General goals are broad statements
of your reasons for wanting to accomplish something.
Examples include changing a behavior such as eating
better or being more active, or changing a physical char-
acteristic such as losing weight or getting fit. SMART
goals are less general and have several important char-
acteristics. SMART goals are specific ( S ). A specific goal
provides details, such as limiting calories to a specific
number each day. SMART goals are measurable ( M ).
They allow you to perform assessments before you estab-
lish your goals and again later to see if you have met your
goals. SMART goals are attainable ( A ). They are neither
too hard, nor too easy. If the goal is too hard, failure is
likely, which is discouraging. If the goal is too easy, it
is not challenging. SMART goals are also relevant ( R ).
They are your personal goals and should have meaning to
you personally. Personally relevant goals provide motiva-
tion. Finally, SMART goals are timely ( T ). Timely goals
are especially meaningful when you begin a program for
making personal changes. Choosing goals that are timely
helps you focus on the most salient changes that you want
to make.
There are differences between behavioral and
outcome goals. A behavioral goal is associated with
something you do. An example of a specific short-term
behavioral goal is to perform 30 minutes of brisk walking
6 days a week for the next 2 weeks. It is a behavioral goal
because it refers to a behavior (something you do). An
outcome goal is associated with a physical characteris-
tic (e.g., lowering your body weight, lowering your blood
pressure, building strength). Typically, it takes weeks or
months to reach outcome goals. This is because outcome
goals depend on many things other than your behavior.
For example, your heredity affects your body fat and
muscle development.
Different factors influence your success in meeting
goals. Consider these factors when setting your goals:
• Outcome goals are not recommended as short-term goals
because they take time to achieve. Typically, it takes weeks
or months to reach outcome goals so they make better
long-term goals than short-term goals.
• Outcome goals depend on many things other than your life-
style behavior. For example, your heredity affects your
ability to achieve an outcome goal such as achieving
a certain body weight and or achieving a fitness stan-
dard. The same lifestyle change program may produce
different results for different people. For this reason,
goals must vary from person to person, especially out-
come goals. For example, two people may establish an
outcome goal of losing 5 pounds over a 6-week period.
Because we inherit predispositions to body compo-
sition, one person may meet the goal, while another
may not, even if both strictly adhere to the same diet.
A similar example can be used for fitness and physi-
cal activity. People not only inherit a predisposition
to fitness but also inherit a predisposition to benefit
from training. In other words, if 10 people do the same
physical activities, there will be 10 different results.
One person may improve performance by 60 percent,
while another might improve only 10 percent. This
cor22568_ch02_021-042.indd 30 9/3/12 10:58 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 31
makes it hard for beginners to set realistic outcome
goals. Too often, people set a goal based on a compara-
tive standard rather than on a standard that is possible
for the individual to achieve in a short time.
Guidelines for beginners differ from guidelines for
people who are more experienced when setting
goals. Beginners should consider these guidelines:
• Start with general long-term goals in mind. It is good
to have your goals in mind when you begin a pro-
gram. But beginners may want to use general rather
than specific long-term goals. You may choose either
behavioral or outcome goals, but keep them general.
For example, choose a goal of losing weight or get-
ting fit. Getting too specific can be discouraging for
reasons discussed above.
• Focus on SMART short-term behavioral objectives. As
noted previously, an example of a specific short-term
behavioral goal is to perform 30 minutes of brisk walk-
ing 6 days a week for the next 2 weeks. It is a behavioral
goal because it refers to a behavior (something you do).
It is a SMART goal because it is specific, measurable,
attainable, realistic, and timely. When using behav-
ioral goals the principal factor associated with success
Short-Term Goals Statements of intent to change
a behavior or achieve an outcome in a period of days
or weeks.
Long-Term Goals Statements of intent to change
behavior or achieve a specific outcome in a period of
months or years.
General Goals Broad statements of your reasons
for wanting to accomplish something. Examples
include changing a behavior such as eating better or
being more active, or changing a physical characteris-
tic such as losing weight or getting fit.
SMART Goals Goals that are Specific (S ), Measur-
able (M ), Attainable (A ), Relevant (R ) and Timely (T ).
Behavioral Goal A statement of intent to perform
a specific behavior (changing a lifestyle) for a specific
period of time. An example is “I will walk for 15 min-
utes each morning before work.”
Outcome Goal A statement of intent to achieve a
specific test score (attainment of a specific standard)
associated with good health, wellness, or fitness. An
example is “I will lower my body fat by 3 percent.”
A goal to consume more fruits and vegetables is an example of a
behavioral goal.
Reducing blood pressure is an example of an outcome goal.
= Specific
= Measurable
= Attainable
= Relevant
= Timely
A
M
R
T
S
Make your personal goals SMART.
is your willingness to give effort. No matter who you
are, you can accomplish a behavioral goal if you give
regular effort. This type of goal will help you keep
your motivation level high and prevent you from being
discouraged.
• Avoid frequent outcome self-assessments, focus on self-moni-
toring of behavior. A self-assessment before setting goals
helps you to set SMART goals. Self-assessments can
also help you see if you have met your goals. For begin-
ners, however, frequent self-assessment—especially of
cor22568_ch02_021-042.indd 31 11/09/12 5:51 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
32 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
outcomes—is discouraged. For example, if the long-
term goal is to lose weight, weighing frequently can be
discouraging and even deceiving. Self-monitoring of
behavior is encouraged however. For the walking goal
discussed above, keeping an activity log of your daily
participation will help you comply.
• Use a series of short-term goals to make progress toward
long-term goals. Once short-term behavioral goals are
reached, establish new ones. After meeting a series of
short-term goals, consider goal-setting guidelines for
more experienced people.
Experienced people should consider these guidelines:
• Start with SMART long-term goals. Experience helps
people realize that it takes time to meet long-term
goals, especially outcome goals. Both SMART behav-
ioral and outcome goals can be considered.
• Use a series of short-term SMART goals (both behav-
ioral and outcome) as a means of accomplishing long-term
goals. Even experienced people are more likely to
achieve success if they realize that setting and meet-
ing a series of SMART short-term goals is impor-
tant. For example, a person who has high blood
pressure (160 systolic) may set a long-term outcome
goal of lowering systolic blood pressure to 120 over
a period of 6 months. Several behavioral goals can be
established for the 6-month period, including tak-
ing blood pressure medication (daily), performing
30 minutes of moderate physical activity each day,
and limiting salt in the diet to less than 100 percent
of the recommended dietary allowance. If the long-
term outcome goal is realistic, adhering to SMART
short-term behavioral goals will result in achieving
the outcome goal.
• Use self-assessments and self-monitoring to determine if you
are making progress. Self-assessments can be more fre-
quent for the experienced. Still, avoid expecting too
much, especially for outcome goals. Self-monitoring
of behavioral goals is good, even for the experienced.
If you commit to the behavior and stick to your plan,
the outcomes will follow.
Maintenance goals are also appropriate once goals
have been achieved or when improvements aren’t
necessary. For example, the person who lowers sys-
tolic blood pressure from 160 to 120 need not continue
to lower the new healthy blood pressure. Once a healthy
outcome goal has been achieved, a new outcome goal of
maintaining a systolic blood pressure of 120 is appropri-
ate. Behavioral goals will also have to be modified. For the
person who has reduced blood pressure to a healthy level,
medication levels might be reduced for maintenance.
Maintenance goals are appropriate in other areas
as well. For example, dietary restriction and extra exer-
cise for weight maintenance will likely be different from
those for losing weight. When a person reaches a healthy
level of fitness, maintenance may be the goal rather than
continued improvement. You cannot improve forever; at
some point, attempting to do so may be counterproduc-
tive to health.
The self-management skills of social support and
relapse prevention described in Table 3 are useful in main-
tenance. Several applications (apps) are now available to
help you get social support and prevent relapse (see Tech-
nology Update).
Making improvement can motivate you to reach
long-term goals. As noted earlier, setting short-term
goals that are both attainable and realistic will help you
reach your long-term goals. Meeting short-term goals
encourages and motivates you to continue with your
healthy lifestyle plan. Don’t expect to set perfect goals
all the time. No matter how much self-assessing and
self-monitoring you do, you may sometimes set goals
too low or too high. If the goal is set too low, it is easily
achieved, and a new, higher goal can be established. If
the goal is set too high, you may fail to reach it, even
though you have made considerable progress toward
the goal.
Rather than becoming discouraged when a goal is
not met, consider the improvement you have made.
Improvement, no matter how small, means that you
are moving toward your goal. Also, you can measure
your improvement and use it to help set future goals.
Of course, periodic self-assessments and good record
keeping (self-monitoring) are necessary to keep track of
improvements accurately.
Putting your goals in writing helps formalize
them. If you don’t write them down, your goals will be
easy to forget. Writing them helps establish a commit-
ment to yourself and clearly establishes your goals. You
can revise them if necessary. Written goals are not cast
in concrete.
Step 4: Selecting Program Components
You can choose from many different program
components to meet your goals. Concept 1
described 10 types of lifestyle change, ranging from
priority lifestyles (physical activity, nutrition, and stress
management) to avoiding destructive habits and adopt-
ing positive safety and personal health habits. The
components depend on the goals of your program. For
example, if the goal is to become more fit and physically
cor22568_ch02_021-042.indd 32 28/07/12 12:09 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 33
active, the program components will be the activities
you choose. You will want to identify activities that
match your abilities and that you enjoy. You will want
to select activities that build the type of fitness you
want to improve.
Other examples of program components are prepar-
ing menus for healthy eating, participating in stress-
management activities, planning to attend meetings to
help avoid destructive habits, and attending a series of
classes to learn CPR and first aid. Preparing a list of pro-
gram components that will help you meet your specific
goals will prepare you for step 5, writing your plan.
Step 5: Writing Your Plan
Preparing a written plan can improve your
adherence to the plan. A written plan is a pledge, or
a promise, to be active. Research shows that intentions
to be active are more likely to be acted on when put in
writing. In the concepts that follow, you will be given the
opportunity to prepare written plans for all of the activi-
ties in the physical activity pyramid, as well as for other
healthy lifestyles. A good written plan includes daily
plans with scheduled times and other program details.
For example, the daily written plan for stress manage-
ment could include the time of day when specific pro-
gram activities are conducted (e.g., 15-minute quiet time
at noon, yoga class from 5:30 to 6:30). An activity plan
would include a schedule of the activities for each day
of the week, including starting and finishing time and
specific details concerning the activities to be performed.
A dietary plan would include specific menus for each
meal and between-meal snacks.
In the labs that accompany the
final concept of this book, you will
write plans for several different life-
styles. By then you will have learned
a variety of self-management skills
that will assist you.
Step 6: Evaluating Progress
Self-assessment and self-monitoring can help you
evaluate progress. Once you have written a plan, you
will want to determine your effectiveness in sticking
with your plan. Keeping written records is one type of
self-monitoring.
Self-monitoring is a good way to assess success in
meeting behavioral goals. Keeping a dietary log or using
a pedometer to keep track of steps are examples of self-
monitoring. Self-assessments are a good way to see if you
have met outcome goals.
Throughout this book, you will learn to self-assess a vari-
ety of outcomes (e.g., fitness, body fatness) and self-monitor
behaviors (e.g., diet, physical activities, stress-management
activities). In step 2 in program planning, you used self-
assessments to determine your needs and to help you plan
your goals (step 3). Once you have tried your program, you
can use the same self-assessments and self-monitoring strat-
egies to evaluate the effectiveness of your program. You can
see if you have met the goals you established for yourself.
T E C H N O L O G Y U P D A T E
Health Apps for Smartphones
Rapid changes in cell phone technology have created a
huge market for customized applications (apps) that are
designed to run on these platforms. There are apps for
almost everything, including hundreds of apps designed
to help people manage and organize their lifestyles and
provide supportive prompts and reminders. Others help
people track health data or diet and activity behaviors.
How useful are these types of health-related apps for promoting
and maintaining healthy lifestyles? Are they simply fun technology
or do they support health behavior change?
ACTIVITY
Self-planning can help you implement a variety of changes to
enhance health, wellness,
and fitness.
VIDEO 6
cor22568_ch02_021-042.indd 33 9/3/12 10:58 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
34 Section 1 ▶ Lifestyles for Health, Wellness, and Fitness
Web Resources
ACSM’s Fit Society Page www.acsm.org/access-public-
information/newsletters/fit-society-page
ACSM’s Health and Fitness Journal www.acsm.org/access-
public-information/acsm-journals/acsm’s-health-
fitness-journal
American Heart Association Health and Fitness Center
www.heart.org/HEARTORG/
American Red Cross www.redcross.org
Centers for Disease Control and Prevention (overcoming
barriers) www.cdc.gov/physicalactivity/everyone/
getactive/barriers.html
Healthy People 2020 www.healthypeople.gov/HP2020
National Heart Lung and Blood Institute—Health Behavior
Change www.nhlbi.nih.gov/health/public/heart/obesity/
lose_wt/index.htm
Robert Wood Johnson Foundation www.rwjf.org
SMART goals www.projectsmart.co.uk/smart-goals.html
Trust for America’s Health—BluePrint for Healthier
America http://healthyamericans.org/report/55/
blueprint-for-healthier-america
Well-Being Index—Gallup Poll www.gallup.com/poll/
wellbeing.aspx
Strategies for Action
To be effective, self-management
and self-planning skills require a
commitment to make changes in lifestyle. As indicated
in Figure 1 on page 22, change occurs stage by stage, and
an individual is likely to be at different stages for different
health behaviors. For example, a person may be at the
maintenance stage for physical activity but at the contem-
plation stage for adopting sound nutrition practices. In this
book, many self-management skills are described for use
in progressing from one stage to another. Different skills are
important, depending on your current stage and the life-
style behavior you are attempting to change.
The lab worksheets that accompany each concept will
help you learn the self-assessment, self-management,
and self-planning skills necessary for behavior change.
Self-assessments of current health, wellness, and fitness
status, as well as self-monitoring of your current lifestyle,
can help you determine your reasons for making change
and help you establish SMART goals for change. Like all
skills, practice is necessary to improve self-management
skills. Table 5 refers you to labs in the text designed to
enhance specific self-management skills.
Assessing self-management skills that influence
healthy lifestyles provides a basis for changing your
health, wellness, or fitness. Self-assessments of your
current health, wellness, and fitness status, as well as self-
monitoring of your current lifestyles, can help you deter-
mine your reasons and establish reasonable goals for
healthy lifestyle change. The Healthy Lifestyle Question-
naire and the Wellness Self-Perceptions Questionnaire you
took in Concept 1 got you started. In this concept you can
use the Stage of Change Questionnaire (Lab 2A) to help
you decide which lifestyles you might need to modify. You
can use the Self-Management Skills Questionnaire (Lab
2B) to determine which self-management skills you may
need to improve to help you make effective changes in
your lifestyles. In later concepts, you will have the oppor-
tunity to make self-assessments for a variety of lifestyles.
ACTIVITY
Section 1 ▶ Lifesty
S
T
a
commitment to make
Self-Management Skill Lab Number
Overcoming barriers 6B, 15A, 17A, 24B
Building self-confidence
and motivation
2A, 2B
Balancing attitudes 1A, 2A, 2B, 3C, 8A, 19B
Building knowledge
and beliefs
1A, 4A, 7A, 12B, 14A, 15A, 15B,
18A, 18B, 19A, 19B, 20A, 21A,
22A, 22B, 23A, 23B
Goal setting 6A, 8B, 9B, 10C, 10D, 11C, 14B,
24B, 24C
Self-assessment 1A, 2A, 3A, 3C, 4A, 5A, 5B, 6B, 7B,
8A, 9A, 10A, 10B, 10D, 11A, 11B,
12A, 12B, 13A, 13B, 13C, 14A,
15B, 16A, 16B, 22A, 22B, 23B,
24A, 24B, 24C
Self-monitoring 2A, 5A, 6A, 7A, 8A, 8B, 9B, 10C,
11C, 17A, 17D, 19A, 22B, 24B, 24C
Self-planning 6A, 8B, 9B, 10C, 10D, 11C, 14B,
24B, 24C
Performance skills 3B, 12A, 17C
Adopting coping skills 16A, 16B, 17A, 17B, 17C, 17D
Learning consumer skills 14B, 15A, 18A, 20A, 23A, 23B,
24B, 24C
Managing time 17A
Finding social support 17D
Preventing relapse 15A, 19B, 24B, 24C
Table 5 ▶ Opportunities for Learning Self-
Management Skills
cor22568_ch02_021-042.indd 34 9/3/12 10:58 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 2 ▶ Self-Management and Self-Planning Skills for Health Behavior Change 35
Suggested Readings
Benson, G. A., et al. 2011. Telephone-based support for weight
loss surgery. ACSM’s Health and Fitness Journal 15(1):13–19.
Buettner, D. 2008. The Blue Zones: Lessons for Living Longer
from People Who’ve Lived the Longest. Washington: DC: The
National Geographic Society.
Glantz, K., B. K. Rimer, and K. Viswanath (Eds.). 2008. Health
Behavior and Health Education. 4th ed. San Francisco: John
Wiley and Sons.
Manson, P., and C. C. Butler. 2010. Health Behavior Change: A
Guide for Practitioners. New York: Churchill Livingstone/
Elsevier.
Marcus, B. E., and L. Forsyth. 2009. Motivating People to Be
Physically Active. 2nd ed. Champaign, IL: Human Kinetics.
Martin, L. R., et al. 2010. Health Behavior Change and Treatment
Adherence: Evidence-Based Guidelines for Improving Health
Care. New York: Oxford University Press.
Pate, R. R., et al. 2011. Overcoming barriers to physical activ-
ity. ACSM’s Health and Fitness Journal 15(1):7–12.
Pekmezi, D., et al. 2010. Using the transtheoretical model to
promote physical activity. ACSM’s Health and Fitness Journal
14(4):8–13.
Simons-Morton, B., McLeroy, K. R., and M. L. Wendel. 2012.
Behavior Theory in Health Promotion Practice and Research.
Burlington, MA: Jones and Bartlett Learning.
Sullivan, G. S., and J. P. Strode. 2010. Motivation through
goal setting: A self-determined perspective. Strategies
23(6):19–23.
Taylor, S. E. 2008. Health Psychology. 7th ed. New York:
McGraw-Hill Higher Education.
White, S. M., E. L. Mailey, and E. McAuley. 2010. Leading
a physically active lifestyle: Effective individual behavior
change strategy. ACSM’s Health and Fitness Journal 14(1):8–15.
Whiteley, J. A., and L. A. Milliken. 2011. Making weight loss a
family affair. ACSM’s Health and Fitness Journal 15(2):8–12.
Healthy People
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 con-
tent of this concept.
• Promote quality of life, healthy development, and healthy
behaviors (including being active, eating well, and avoid-
ing destructive habits) across all stages of life.
• Create a society in which all people live long,
healthy lives.
• Attain high-quality, longer lives free of preventable
disease, injury, and premature death.
• Increase public awareness and understanding of the
determinants of health, disease, and disability.
• Increase health literacy of the population.
A national goal is to promote health behaviors across all stages of
life. Explain how using self-management skills can help individuals
change health behaviors and how individual change can contribute
to achieving national goals.
ACTIVITY
cor22568_ch02_021-042.indd 35 9/3/12 10:58 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
36
L
a
b
R
e
s
o
u
rc
e
M
a
te
ri
a
ls
Reinforcing factors
Factors influencing change Stages of change
Preparation
Contemplation
Precontemplation
•Success
•Family support
•Peer support
•Support of health professionals
Enabling factors
•Goal setting
•Self-assessment
•Self-monitoring
•Self-planning
•Performance skills
•Coping skills
•Consumer skills
•Time management
Personal factors
Age
Gender
Heredity
Current health and fitness
Predisposing factors
Am I able? Is it worth it?
Self-confidence
Self-efficacy
Safe environment
Access
Self-motivation
Enjoyment
Balanced attitudes
Beliefs
Knowledge
Action
Maintenance
Lab Resource Materials
Use the diagram below in answering the questions in Lab 2A. It is a reproduction of Figure 2 and includes factors that
influence change in healthy behaviors.
cor22568_ch02_021-042.indd 36 28/07/12 12:09 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
37
T
h
e
S
ta
g
e
o
f C
h
a
n
g
e
Q
u
e
stio
n
n
a
ire
L
a
b
2
A
Lab 2A The Stage of Change Questionnaire
Name Section Date
Purpose: To help assess your current level in the stage of change hierarchy for a variety of health behaviors
Procedures
1. Determine your “readiness for change” different health behaviors using the Stage of Change Questionnaire.
2. Evaluate predisposing, enabling, and reinforcing factors for several selected behaviors.
3. Answer the questions in the Conclusions and Implications section.
Results: Complete the Stage of Change Questionnaire on the next page. List two behaviors (below) that you are inter-
ested in improving. Beside the behaviors, write your current stage for that behavior.
Behavior 1: ______________________________ Current Stage?_______________________
Behavior 2: _______________________________ Current Stage? _____________________
Conclusions and Implications: For each behavior, discuss the enabling, predisposing, and reinforcing factors
that you think are particularly important for you as you work to change this behavior (refer to the stages of change
model and Tables 1, 2, and 3 in the text).
Behavior 1:
Behavior 2:
cor22568_ch02_021-042.indd 37 28/07/12 12:09 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
38
T
h
e
S
ta
g
e
o
f
C
h
a
n
g
e
Q
u
e
st
io
n
n
a
ir
e
L
a
b
2
A
1. Physical Activity
Precontemplation—I am not active, and I do not plan to start.
Contemplation—I am not active, but I am thinking about starting.
Preparation—I am getting ready to become active.
Action—I do some activity but need to do more.
Maintenance—I have been active regularly for several months.
2. Eating Well (Nutrition)
Precontemplation—I do not eat well and don’t plan to change.
Contemplation—I do not eat well but am thinking about change.
Preparation—I am planning to change my diet.
Action—I sometimes eat well but need to do more.
Maintenance—I have eaten well regularly for several months.
3. Managing Stress
Precontemplation—I do not manage stress well and plan no changes.
Contemplation—I am thinking about making changes to manage stress.
Preparation—I am planning to change to manage stress better.
Action—I sometimes take steps to manage stress better but need to do more.
Maintenance—I have used good stress-management techniques for several months.
4. Adopting Good Safety Habits (e.g., seat belt use, safe storage of medicine)
Precontemplation—I have at least one unsafe habit but plan no changes.
Contemplation—I am thinking about making changes regarding a safety habit.
Preparation—I am planning to make a change regarding a safety habit.
Action—I have taken action concerning a habit but need to do more.
Maintenance—I have no safety habits that need to change (I practice good safety).
5. Adopting Good Personal Health Habits (e.g., brushing and flossing, adequate sleep)
Precontemplation—I have at least one health habit that needs change but plan no changes.
Contemplation—I am thinking about making changes related to a health habit.
Preparation—I am planning to make a change regarding a health habit.
Action—I have taken action concerning a habit but need to do more.
Maintenance—I have no health habits that need to change.
6. Learning First Aid (e.g., CPR/First Aid)
Precontemplation—I do not know CPR/first aid and do not plan to learn.
Contemplation—I am thinking about learning CPR/first aid.
Preparation—I have made plans to learn CPR/first aid.
Action—I once knew CPR/first aid but need an update.
Maintenance—I am up-to-date on my CPR/first aid and will keep updated.
Questions 7 and 8 are highly personal. Answer for your own use, but do not record answers on this sheet.
7. Avoiding Destructive Habits (e.g., tobacco, drugs, alcohol)
Precontemplation—I have at least one destructive habit but plan no change.
Contemplation—I am thinking about making changes related to a destructive habit.
Preparation—I am planning to make a change regarding a destructive habit.
Action—I have taken action concerning a habit but need to do more.
Maintenance—I have no destructive habits or have stopped the habit for months.
8. Practicing Safe Sex
Precontemplation—I have practiced unsafe sex and plan no change.
Contemplation—I am thinking about making changes to an unsafe habit.
Preparation—I am planning to make a change regarding an unsafe habit.
Action—I have taken action concerning a habit but need to do more.
Maintenance—I do not practice unsafe sex or have stopped the habit for months.
Stage of Change Questionnaire (make one choice for each question)
cor22568_ch02_021-042.indd 38 9/3/12 10:58 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
39
L
a
b
2
B
T
h
e
S
e
lf-M
a
n
a
g
e
m
e
n
t S
kills Q
u
e
stio
n
n
a
ire
Lab 2B The Self-Management Skills Questionnaire
Name Section Date
Purpose: To help you assess your self-management skills that are important for three priority lifestyles (physical activity,
healthy nutrition, stress management)
Procedures
1. Each question in the questionnaire on pages 41 and 42 reflects one of the self-management strategies described in
this text. Each of the 12 questions requires an answer about three different healthy behaviors. Answer each question
using a 3 for very true, 2 for somewhat true, or 1 for not true. Record the number of your answer in the appropriate
box for each of the three healthy lifestyles.
2. After you have answered all 12 questions for each of the three lifestyles, total the three columns to get a total score
for physical activity, nutrition, and stress management.
3. Determine your rating for each lifestyle using the Self-Management Skills Rating Chart. Record your rating in the
Results section.
4. Answer the
questions in the Conclusions and Implications section.
Results: Record your rating for each of three healthy lifestyles in the chart below.
Conclusions and Implications: In several sentences, discuss your ratings regarding self-management skills
related to physical activity. You may have a good total score but still have several self-management skills on which you
need improvement. Comment on your overall scores and those individual self-management skills on which you had
scores of 1 (not true).
Rating Score
Good 30–36
Marginal 24–29
Needs improvement <24
Self-Management Skills Results Rating
Physical activity
Nutrition
Stress management
Self-Management Skills Rating Chart
cor22568_ch02_021-042.indd 39 28/07/12 12:09 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
40
L
a
b
2
B
T
h
e
S
e
lf-
M
a
n
a
g
e
m
e
n
t
S
ki
lls
Q
u
e
st
io
n
n
a
ir
e
In several sentences, discuss your ratings regarding self-management skills related to nutrition. You may have a good
total score but still have several self-management skills on which you need improvement. Comment on your overall
scores and those individual self-management skills on which you had scores of 1 (not true).
In several sentences, discuss your ratings regarding self-management skills related to stress management. You may
have a good total score but still have several self-management skills on which you need improvement. Comment on
your overall scores and those individual self-management skills on which you had scores of 1 (not true).
cor22568_ch02_021-042.indd 40 28/07/12 12:09 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
41
L
a
b
2
B
T
h
e
S
e
lf-M
a
n
a
g
e
m
e
n
t S
kills Q
u
e
stio
n
n
a
ire
Very Somewhat Not Activity Nutrition Stress
The Self-Management Skills Questionnaire true true true Score Score Score
1. I regularly self-assess: (self-assessment)
personal physical fitness and physical activity levels 3 2 1
the contents of my diet 3 2 1
personal stress levels 3 2 1
2. I self-monitor and keep records concerning: (self-monitoring)
physical activity 3 2 1
diet 3 2 1
stress in my life 3 2 1
3. I set realistic and attainable goals for: (goal setting)
physical activity 3 2 1
eating behaviors 3 2 1
reducing stress in my life 3 2 1
4. I have a personal written or formal plan for: (self-planning)
regular physical activity 3 2 1
what I eat 3 2 1
managing stress in my life 3 2 1
5. I possess the skills to: (performance skills)
perform a variety of physical activities 3 2 1
analyze my diet 3 2 1
manage stress (e.g., progressive relaxation) 3 2 1
6. I have positive attitudes about: (balancing attitudes)
my ability to stick with an activity plan 3 2 1
my ability to stick to a nutrition plan 3 2 1
my ability to manage stress in my life 3 2 1
7. I can overcome barriers that I encounter: (overcoming barriers)
in my attempts to be physically active 3 2 1
in my attempts to stick to a nutrition plan 3 2 1
in my attempts to manage stress in my life 3 2 1
cor22568_ch02_021-042.indd 41 28/07/12 12:09 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
42
L
a
b
2
B
T
h
e
S
e
lf-
M
a
n
a
g
e
m
e
n
t
S
ki
lls
Q
u
e
st
io
n
n
a
ir
e
Very Somewhat Not Activity Nutrition Stress
The Self-Management Skills Questionnaire true true true Score Score Score
8. I know how to identify misinformation: (consumer skills)
relating to fitness and physical activity 3 2 1
relating to nutrition 3 2 1
relating to stress management 3 2 1
9. I am able to get social support for my efforts to: (social support)
be active 3 2 1
stick to a healthy nutrition plan 3 2 1
manage stress in my life 3 2 1
10. When I have problems, I can get back to: (relapse prevention)
my regular physical activity 3 2 1
my nutrition plan 3 2 1
my plan for managing stress 3 2 1
11. I am able to adapt my thinking to: (coping strategies)
stick with my activity plan 3 2 1
stick with my nutrition plan 3 2 1
stick with my stress-management plan 3 2 1
12. I am able to manage my time to: (time management)
stick with my physical activity plan 3 2 1
shop for and prepare nutritious food 3 2 1
perform stress-management activities 3 2 1
Total Activity Score
Total Nutrition Score
Total Stress Score
cor22568_ch02_021-042.indd 42 28/07/12 12:09 AM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
43
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Identify and describe key factors for safely participating in a moderate to vigorous
physical activity program.
▶ Describe the warm-up, the workout, and the cool-down and explain why each is
important.
▶ Explain the potential risks associated with exposure to heat, cold, and altitude and
describe precautions that can be taken to prevent problems.
▶ Identify the factors that contribute to soreness and injury from physical activity and
describe steps that can be
taken to recover from them.
▶ Identify and describe the
common positive and
negative attitudes about
physical activity and explain
how they relate to regular
participation.
▶ Identify related national
health goals and show how
meeting personal goals
can contribute to reaching
national goals.
▶ Assess your readiness
for physical activity and
demonstrate appropriate
warm-up activities.
Preparing for Physical
Activity
C
o
n
c
e
p
t 3
An Introduction to Physical Activity ▶ Section II
Proper preparation can help make
physical activity enjoyable, effective,
and safe.
cor22568_ch03_043-064.indd 43 11/09/12 4:56 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
44 Section 2 ▶ An Introduction to Physical Activity
F
or people just beginning a physical activity program,
adequate preparation may be the key to persistence.
For those who have been regularly active for some time,
sound preparation can help reduce risk of injury and
make activity more enjoyable. For long-term mainte-
nance, physical activity must be something that is a part
of a person’s normal lifestyle. Some factors that will help
you prepare for and make physical activity a part of your
normal routine are presented in this concept.
Factors to Consider Prior
to Physical Activity
Screening before beginning regular physical
activity is important to establish medical readiness.
The most recent guidelines for exercise testing and
prescription of the American College of Sports Medi-
cine (ACSM) suggest that there are two types of pre-
participation screening: self-guided screening and pro-
fessionally guided screening. For self-guided screening,
the ACSM endorses the basic recommendation of the
Surgeon General’s Report on Physical Activity and Health, that
“previously inactive men over age of 40 and women over
age 50, and people at high risk of cardiovascular disease
(CVD) should first consult a physician before embarking
on a program to which they are unaccustomed.”
An alternative method of self-screening involves the
use of the Physical Activity Readiness Questionnaire
( PAR-Q ). This seven-item questionnaire was designed
by the British Columbia (Canada) Ministry of Health
to help people know when it is advisable to seek medi-
cal consultation prior to beginning or altering an exer-
cise program. The goal is to prevent unnecessary medical
examinations while helping people to be reasonably
assured that regular moderate physical activity is appro-
priate. Other self-administered surveys recommended
by the ACSM include those given at a physician’s office
or those administered by certified health and fitness pro-
fessionals (e.g., AHA/ACSM Pre-participation Screen-
ing Questionnaire). If a pre-participation questionnaire
indicates the need, medical clearance is recommended.
A clinical exercise test may also be appropriate. Those
who do not identify health concerns using a self-screening
questionnaire (e.g., all “no” answers on the PAR-Q) typi-
cally are cleared for moderate self-planned activity pro-
grams. For more vigorous exercise and sports, additional
screening may be appropriate.
ACSM has developed additional guidelines to stan-
dardize professionally guided screening (e.g., assess-
ments conducted by a medical doctor or certified health/
fitness professional). As noted in Table 1 , the ACSM
divides people into three general risk categories: low,
moderate, and high risk. Some of the risk factors used
A clinical exercise test—an example of professionally guided
screening—is recommended for some individuals to ensure they
can exercise safely.
Source: American College of Sports Medicine.
Stratification
Category Criteria
Low risk People who have no heart disease
symptoms and have no more than one of
the risk factors listed below
Moderate risk People without heart disease symptoms
who have two or more of the risk factors
listed below
High risk People with known pulmonary or metabolic
disease, OR one or more signs or
symptoms in the list below
Risk Factors
Family history of heart disease; smoker; high blood pressure
(hypertension); high cholesterol; abnormal blood glucose
levels; obesity (high BMI, excess waist girth); sedentary
lifestyle; low HDL cholesterol level; men age 45 or older;
women age 55 or older
Signs and Symptoms
Chest, neck, or jaw pain from lack of oxygen to the heart;
shortness of breath at rest or in mild exercise; dizziness or
fainting; difficult or labored breathing when lying, sitting, or
standing; ankle swelling; fast heartbeat or heart palpitations;
pain in the legs from poor circulation; heart murmur; unusual
fatigue or shortness of breath with usual activities
Table 1 ▶ American College of Sports Medicine
Risk Stratification Categories and Criteria
cor22568_ch03_043-064.indd 44 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 3 ▶ Preparing for Physical Activity 45
to identify risk categories are identifiable without pro-
fessional consultation (e.g., age, family history, smoking,
sedentary lifestyle), while others may require profes-
sional screening (e.g., blood cholesterol, blood glucose).
Many health clubs now offer professional screening for
these variables. Individuals found to be at risk are then
referred to medical follow-up. Low-risk people who are
apparently healthy are typically cleared for moderate
and many forms of vigorous activity without a medi-
cal exam or an exercise test. Those with moderate risk
can participate in low to moderate activity without a
medical exam or exercise test; however, both are recom-
mended before initiating vigorous programs. For those
in the high-risk category, a comprehensive medical exam
is necessary before starting either a moderate or high-
intensity program and before taking an exercise test. For
those just beginning a program or those resuming physi-
cal activity after an injury or illness, consultation with
a physician is always wise, no matter what your age or
medical condition.
Consideration should also be given to altering exercise
patterns if you have an illness or a temporary sickness,
such as a cold or the flu. The immune system and other
body systems may be weaker at this time, and medicines
(even over-the-counter ones) may alter responses to exer-
cise. It is best to work back gradually to your normal rou-
tine after illness.
There is no way to be absolutely sure that you are
medically sound to begin a physical activity program.
Even a thorough exam by a physician cannot guarantee
that a person does not have some limitations that may
cause a problem during exercise.
Use of the PAR-Q (see Lab 3A) and
adherence to the ACSM guidelines
are advised to help minimize the
risk while preventing unnecessary medical cost. How-
ever, if you are unsure about your readiness for activity,
a medical exam and a clinical exercise test are the surest
ways to make certain that you are ready to participate.
It is important to dress properly for physical
activity. Clothing should be appropriate for the type
of activity being performed and the conditions in which
you are participating. Comfort is a much more impor-
tant consideration than looks. Table 2 provides guide-
lines for dressing for activity.
Shoes are an important consideration for safe and
effective exercise. Decisions about shoes should be
based on intended use (e.g., running, tennis), shoe and
foot characteristics, and comfort. Shoes are designed for
specific activities, and performance will typically be best
if you select and use them for their intended purpose
and fit, rather than how they look. Hybrid shoes, known
as “cross-trainers,” can be a versatile option, but they
typically don’t provide the needed features for specific
activities. For example, they may lack the cushioning and
support needed for running and the ankle support for
activities such as basketball. Features of common activity
shoes are highlighted in Figure 1 .
Most shoes have very thin sockliners, but supplemen-
tal inserts can be purchased to provide more cushioning
and support. Custom orthotics can also be used to correct
alignment problems or minimize foot injuries (e.g., plantar
fasciitis). A very important, and frequently neglected, con-
sideration is to replace shoes after extended use. Runners
typically replace shoes every 4 to 6 months (or 400 to
600 miles), even if the outer appearance of the shoe is still
good. The main functions of athletic shoes are to reduce
shock from impact and protect the foot—one of the best
prevention strategies for avoiding injuries is to replace
your shoes on a regular basis.
PAR-Q An acronym for Physical Activity Readiness
Questionnaire; designed to help determine if you are
medically suited to begin an exercise program.
Clinical Exercise Test A test, typically adminis-
tered on a treadmill, in which exercise is gradually
increased in intensity while the heart is monitored by
an EKG. Symptoms not present at rest, such as an
abnormal EKG, may be present in an exercise test.
VIDEO 1
General Guidelines
• Avoid clothing that is too tight or that restricts movement.
• Material in contact with skin should be porous.
• Clothing should protect against wind and rain but allow
for heat loss and evaporation—e.g., Gortex, Coolmax.
• Wear layers so that a layer can be removed if not needed.
• Wear socks for most activities to prevent blisters,
abrasions, odor, and excessive shoe wear.
• Socks should be absorbent and fit properly.
• Do not use nonporous clothing that traps sweat to lose
weight; these garments prevent evaporation and cooling.
Special Considerations
• Consider eye protection for racquetball and other
sports.
• Women should wear an exercise bra for support.
• Men should consider an athletic supporter for support.
• Wear helmets and padding for activities with risk of falling,
such as biking or inline skating.
• Wear reflective clothing for night activities.
• Wear water shoes for some aquatic activities.
• Consider lace-up ankle braces to prevent injury.
• Consider a mouthpiece for basketball and other contact
sports.
Table 2 ▶ Selecting Appropriate Clothing for Activity
cor22568_ch03_043-064.indd 45 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
46 Section 2 ▶ An Introduction to Physical Activity
Factors to Consider during Daily
Physical Activity
There are three components of the daily activity
program: the warm-up, the workout, and the
cool-down. The key component of a fitness program is
the daily workout. Experts agree, however, that the work-
out should be preceded by a warm-up and followed by a
cool-down. The warm-up prepares the body for physical
activity, and the cool-down returns the body to rest and
promotes effective recovery by aiding the return of blood
from the working muscles to the heart (see Figure 2 ).
A general warm-up is recommended prior
to vigorous exercise. ACSM recommends a
general aerobic and muscular endurance warm-
up consisting of a minimum of 5 to 10 minutes
of low-to-moderate aerobic and muscular endur-
ance activity prior to a vigorous workout. Some
examples of warm-up activities include walking,
slow jogging, slow swimming, slow biking, or
low-intensity sport specific movements (e.g., a
layup drill in basketball). The general warm-up
is intended to prepare the heart, blood vessels,
muscles, and other bodily systems for more vig-
orous activity to follow. The ACSM indicates that
the general warm-up increases body temperature
and reduces the potential for after-exercise mus-
cle soreness and stiffness, as well as allowing the
body to adapt to the demand of the workout that
follows. This general warm-up also decreases the
risk of irregular heartbeats associated with poor
coronary circulation. For those performing mod-
erate activities for their workout (e.g., walk, bike
ride, swim), no special general warm-up is neces-
sary since the activity itself is light to moderate
in nature. Starting at a slower pace and gradually
increasing intensity is recommended.
Consider a muscle-stretching warm-up. Until
recently, a muscle-stretching warm-up (stretch
warm-up) was recommended after the general
warm-up and prior to the workout. A stretch warm-
up was thought to help reduce risk of injury, reduce
soreness after exercise, and improve performance
in sports activities. Recent studies have questioned
the value of the stretch warm-up in preventing
injury. A recent review also indicates that while
stretching may reduce soreness in some, reduc-
tions in soreness are only modest. Several studies
have indicated that stretching before sports and
other types of activities that require strength and
power can result in reduced performance. A recent
review, however, indicates that performance is
only affected if the stretches last 60 seconds or longer.
As noted in Concept 10, the recommended length of
stretching exercises is 15 to 30 seconds.
The recent evidence, however, does not mean that
you should not do a stretch warm-up. Those planning to
participate in sports such as gymnastics and diving typi-
cally perform a stretch warm-up as do those who per-
form recreational activities such as dance. For those who
have been doing a stretch warm-up prior to other activi-
ties, and enjoy it, there is no reason not to continue. A
sample of a stretch warm-up is included in Lab 3B. For
best results, the stretch warm-up should be done after the
general warm-up because stretch is most effective when
the muscles are warm. If you plan to do activities in your
Figure 1 ▶ Anatomy of an activity shoe.
Achilles notch
Toe box
Heel
counter
Arch
support
Insole (sockliner)
Outsole
Insole (last)
Midsole
Achilles notch: Protects tendon
Heel counter: Cradles heel to provide movement control; reduces
slippage and blistering; a stiff counter reduces pronation
Arch support: Supports arch; height and shape of arch should vary with
foot characteristics
Insole (sockliner): Removable layer for additional shock and sweat
absorption; can be replaced periodically and/or customized
Insole (last): Refers to shape of shoe bed; curved (allows more mobility;
better for those with high, rigid arches); straight (controls excessive
motion, better for those with abnormal pronation); or semicurved
(moderate flexibility and stability)
Midsole: Provides cushion, stability, and motion control; important for
shock absorption
Outsole: Provides traction; determines shoe flexibility; type depends on
intended purpose of shoe
Toe box: Should have adequate height to wiggle toes and prevent
rubbing on top of toes and adequate length so toes do not contact front
of shoe
cor22568_ch03_043-064.indd 46 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 3 ▶ Preparing for Physical Activity 47
workout that involve strength and power, you should not
do stretches that last longer than 60 seconds.
The stretch warm-up is not intended to substitute for
a regular program of stretching to build flexibility. In
other words, if you have not trained regularly to build
flexibility, a warm-up is not the best way to get flexible.
Figure 2 ▶ Muscle contractions help the veins return
blood to the heart.
Blood returns
to heart
Blood returns
to heart
Contracted
skeletal muscles
Vein
Relaxed
skeletal muscles
Valve
open
Closed
valve
Muscles
Closed
valve
ACTIVITY
T E C H N O L O G Y U P D A T E
Minimalist Running
Running shoes have historically emphasized high-tech
shock absorption and cushioning technology, but “mini-
malist” running and even barefoot running have become
increasingly popular. One company best known for mak-
ing shoe soles has captured runners’ imagination with
a line of shoes known as the Vibram FiveFingers®. The
shoes (which look more like slippers or gloves for your
feet) are designed to simulate the feeling of barefoot run-
ning while providing protection. They allow you to more
easily adopt a forefoot running style rather than striking
first on your heel. This change in stride is thought to
improve balance, reduce impacts, and improve propulsion.
Some studies show that the shoes may reduce chronic
knee problems, but it is too early to determine the long-
term effects on health or performance. While there is
some evidence to support this new approach, experts
note that it takes time to retrain your gait. Runners that
switch too abruptly can expect to experience consider-
able soreness, particularly in the calf muscle. Almost all
shoe companies now make minimalist shoes or forefoot
running shoes and there are varieties for different sports or
activities. Advocates of forefoot running include Alberto
Salazar, a former U.S. marathon runner and current run-
ning coach. Search “minimalist running” or “forefoot run-
ning” on the Internet to learn more.
How open would you be to minimalist shoes or forefoot running?
Cool-Down Light to moderate activity done after a
workout to help the body recover; often consisting of
the same exercises used in the warm-up.
Warm-Up Light to moderate physical activity per-
formed before a more vigorous workout, including
a general aerobic/muscular endurance warm-up and
often a stretch warm-up.
Dynamic Warm-Up The performance of calisthen-
ics of gradually increasing intensity (e.g., jumping
jacks, jumping, skipping).
Sport-Specific Warm-Up The performance of sports-
related movements of gradual intensity (e.g., layup
drill in basketball, swinging a club in golf or racket in
tennis).
You may choose to do flexibility exercises as part of your
workout or after your workout (as part of the cool-down).
Consider other warm-up options. People who plan
to perform resistance training or play a vigorous sport
should consider a dynamic warm-up or a sport-specific
warm-up . A dynamic warm-up includes the performance
cor22568_ch03_043-064.indd 47 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
48 Section 2 ▶ An Introduction to Physical Activity
near resting values. This phase is especially important for
those with cardiovascular risk factors or disease.
The cool-down can also include a stretching
phase. Stretching the muscles at the end of the work-
out, or after the workout, can help relieve muscle spasms
in fatigued muscles, and stretching is more effective
in building flexibility when the muscles are warm. The
ACSM recommends 10-plus minutes for stretching to
build flexibility. To be effective, as a complete flexibility
program, stretching performed in a cool-down would
need to be personalized and include exercises for all mus-
cle groups (see Concept 10).
Physical Activity in the
Heat and Cold
Physical activity in hot and humid environments
challenges the body’s heat loss mechanisms.
During vigorous activity, the body produces heat, which
must be dissipated to regulate body temperature. The
body has several ways to dissipate heat. Conduction is the
transfer of heat from a hot body to a cold body. Convec-
tion is the transfer of heat through the air or any other
medium. Fans and wind can facilitate heat loss by con-
vection and help regulate temperature. The primary
method of cooling is through evaporation of sweat. The
chemical process involved in evaporation transfers heat
from the body and reduces the body temperature. When
conditions are humid, the effectiveness of evaporation is
reduced, since the air is already saturated with moisture.
This is why it is difficult to regulate body temperature
when conditions are hot and humid.
Heat-related illness can occur if proper hydration
is not maintained. Maximum sweat rates during physi-
cal activity in the heat can approach 1–2 liters per hour.
If this fluid is not replaced, dehydration can occur. If
of calisthenics of gradually increasing intensity. Those
interested in high-level performance (e.g., movements
requiring great force, and fast movements) should choose
a dynamic warm-up of calisthenics that simulates the types
of movements to be used in the vigorous phase of the
workout or event. The sport-specific warm-up includes
sports-related movements of gradual intensity. Examples
include performing layup, shooting, and other drills before
a basketball game or swinging a golf club or tennis racket
before playing. A general warm-up may be performed
before the dynamic and sports-related warm-up or may be
used as a general warm-up; however, the initial activities
should be of moderate intensity and gradually increase in
intensity. As noted previously, if the workout is of mod-
erate intensity, no warm-up is necessary (e.g., 30-minute
brisk walk). Some people who plan to perform a more vig-
orous workout may prefer only a general warm-up.
The workout is the principal component of an
activity program and occurs after the warm-up and
before the cool-down. The workout , also referred
to as the conditioning phase of a training session, is
the component of the physical activity program that is
designed to provide health and other benefits, depend-
ing on the type of activity performed (see Concept 4).
Workout information, including appropriate frequency,
intensity, and length of time for many types of physical
activities in the physical activity pyramid (Concept 5), is
included in subsequent concepts.
A cool-down after the workout promotes an
effective recovery from physical activity. The ACSM
recommends a 5- to 10-minute cool-down similar to
the general warm-up (e.g., light to
moderate activity) after a vigor-
ous workout. In addition to helping
reduce metabolic by-products, the
general cool-down helps the cardiovascular system (heart
rate and blood pressure) return to a normal state.
During physical activity, the heart pumps a large
amount of blood to supply the working muscles
with the oxygen necessary to keep moving. The
muscles squeeze the veins (see Figure 2 ), which forces
the blood back to the heart. Valves in the veins prevent
the blood from flowing backward. As long as exercise
continues, muscles move the blood back to the heart,
where it is once again pumped to the body. If exercise is
stopped abruptly, the blood is left in the area of the work-
ing muscles and has no way to get back to the heart. In
the case of a runner, the blood pools in the legs. Because
the heart has less blood to pump, blood pressure may
drop. This can result in dizziness and can even cause a
person to pass out. The best way to prevent this problem
is to slow down gradually after exercise and keep mov-
ing until blood pressure and heart rate have returned to
VIDEO 2
Health is available to Everyone for a
Lifetime, and it’s Personal
Exercising can lead to serious heat-related problems
if the body becomes dehydrated. The body’s thirst
mechanism usually lags behind the true need for fluids.
Experts recommend drinking 1 to 2 cups of water or
another hydrating liquid before exercise and then an
additional cup every 20 minutes thereafter.
Do you follow these guidelines or could you be dehydrated
during or after your typical exercise sessions? What strategies
can you use to drink more water?
ACTIVITY
cor22568_ch03_043-064.indd 48 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 3 ▶ Preparing for Physical Activity 49
A CLOSER LOOK
ACTIVITY
CPR Guidelines and AEDs
To be prepared for physical activity, you also need to be pre-
pared for emergencies. For example, it is important to know
basic first aid and cardiopulmonary resuscitation (CPR) if
needed. Guidelines from the American Heart Association (AHA)
have been revised, shifting the order used for performing CPR.
The previous method used the A-B-C method to denote airway,
breathing, and compressions. The new guidelines emphasize
doing compressions first (C-A-B). Proper certification is recom-
mended, but the guidelines were revised to get more people
to help even when not certified (some CPR is better than no
CPR). If a person is unresponsive, call for help and begin chest
compressions immediately, then open the airway and give
mouth-to-mouth rescue breaths along with alternating com-
pressions. Also, automated external defibrillators (AED) are
available in many public places, including fitness centers and
schools. The AHA offers free online training for CPR and AED
devices (visit www.heart.org and search for “Heartsaver® First
Aid CPR AED”). The AHA also has a 3-minute video on You-
Tube titled AHA Guidelines for CPR that shows the basic steps.
How might the revised guidelines encourage more bystanders to help
in a crisis situation? Would you be more inclined to provide aid?
Adequate hydration is critical for safe exercise in the heat.
dehydration is not corrected with water or other fluid-
replacement drinks, it becomes increasingly difficult for
the body to maintain normal body temperatures. At some
point, the rate of sweating decreases as the body begins to
conserve its remaining water. It shunts blood to the skin
to transfer excess heat directly to the environment, but
this is less effective than evaporation. Hyperthermia and
associated heat-related problems can result (see Table 3 ).
One way to monitor the amount of fluid loss is to
monitor the color of your urine. The American College
of Sports Medicine indicates that clear (almost color-
less) urine produced in large volumes indicates that you
are hydrated. As water in the body is reduced, the urine
Workout The component of a total physical activity
program designed to produce health, wellness, fitness,
and other benefits using appropriate amounts of dif-
ferent types of physical activity.
Dehydration Excessive loss of water from the body,
usually through perspiration, urination, or evaporation.
Hyperthermia Excessively high body temperature
caused by excessive heat production or impaired heat
loss capacity. Heatstroke is a hyperthermic condition.
Problem Symptoms Severity
Heat cramps Muscle cramps, especially
in muscles most used in
exercise
Least
severe
Heat exhaustion Muscle cramps, weakness,
dizziness, headache, nausea,
clammy skin, paleness
Moderately
severe
Heatstroke Hot, flushed skin; dry skin
(lack of sweating); dizziness;
fast pulse; unconsciousness;
high temperature
Extremely
severe
Table 3 ▶ Types of Heat-Related Problems
Compressions
Push hard and fast
on the center of
the victim’s chest
Airway
Tilt the victim’s head
back and lift the chin
to open the airway
Breathing
Give mouth-to-mouth
rescue breaths
American Heart
Association
®
Learn and Live©2010 American Heart Association 10/10DS3849
cor22568_ch03_043-064.indd 49 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
50 Section 2 ▶ An Introduction to Physical Activity
becomes more concentrated and is a darker yellow color.
This indicates dehydration and a need for fluid replace-
ment. Dietary supplements that contain amphetamine
derivatives and/or creatine may contribute to undetected
dehydration among some individuals.
Acclimatization improves the body’s tolerance
in the heat. Individuals with good fitness will respond
better to activity in the heat than individuals with poor
fitness. With regular exposure, the body adapts to the
heat. The majority of the adaptation to hot environments
occurs in 7 to 14 days, but complete acclimatization can
take up to 30 days. As you adapt to the heat, your body
becomes conditioned to sweat earlier, to sweat more pro-
fusely, and to distribute the sweat more effectively around
the body, and the composition of sweat is altered. This
process makes it easier for your body to maintain a safe
body temperature.
Precautions should be taken when doing physical
activity in hot and humid environments. The heat
index (also referred to as apparent temperature) com-
bines temperature and humidity to help you determine
when an environment is safe for activity. The combi-
nation of high temperature and humidity presents the
greatest risk of heat-related problems in exercise. Physical
activity is safe when the apparent temperature is below
80 8 F (26.7 8 C). Figure 3 shows the risk of exercise at pro-
gressively higher apparent temperatures.
Consider the following guidelines for exercising in the
heat and humidity.
• Limit or cancel activity if the apparent temperature
reaches the danger zone (see Figure 3 ).
• Drink fluids before, during, and after vigorous activity.
Guidelines suggest about 2 cups before activity and
about 1 cup for each 15–20 minutes during activ-
ity. After activity, drink about 2 cups for each pound
of weight lost. The thirst mechanism lags behind
the body’s actual need for fluid, so drink even if you
don’t feel thirsty. Fluid-replacement beverages (e.g.,
Gatorade, Powerade) are designed to provide added
energy (from carbohydrates) without impeding hydra-
tion. If you choose to use one of these beverages,
select one that contains electrolytes and no more than
4 to 8 percent carbohydrates.
Figure 3 ▶ Heat index values (apparent temperatures).
Source: Data from National Oceanic and Atmospheric Administration.
Relative
Humidity
(%) 70
Air Temperature (Degrees F)
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
72
71
71
71
71
70
70
70
70
69
69
68
68
67
67
66
66
65
65
64
64
80
79
79
78
78
77
77
76
76
75
75
74
74
73
73
72
72
71
70
69
69
91
89
88
87
86
86
85
83
82
81
81
80
79
79
78
77
77
76
75
74
73
108
105
102
99
97
95
93
91
90
89
88
87
86
85
84
83
82
81
80
79
78
1
32
1
28
122
117
113
109
106
102
100
98
96
95
93
91
90
88
87
86
85
84
83
141
136
130
124
119
1
14
110
107
104
101
98
96
94
93
91
90
88
87
144
138
132
126
120
115
110
107
104
101
99
97
95
93
91
149
142
135
129
123
118
113
109
105
102
100
97
95
150
143
137
130
123
117
112
108
105
102
99
75 80 85 90 95 100 105 110
151
143
135
127
120
115
111
107
103
115
148
139
130
123
1
16
111
107
120
“Apparent Temperatures”
(Heat Index)
= Extreme danger zone
= Danger zone
= Extreme caution zone
= Caution zone
= Safe
Find air temperature on the top; then find the humidity on the left. Find the heat index where the columns meet.
cor22568_ch03_043-064.indd 50 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 3 ▶ Preparing for Physical Activity 51
• Avoid extreme fluid intake. Drinking too much water
can cause a condition called hyponatremia , some-
times referred to as “water intoxication.” It occurs
when you drink too much water, resulting in the dilu-
tion of the electrolytes in the blood; interestingly, it
has symptoms similar to those of dehydration. If left
untreated, it can result in loss of consciousness and
even death.
• Gradually expose yourself to physical activity in hot
and humid environments to facilitate acclimatization.
• Dress properly for exercise in the heat and humid-
ity. Wear white or light colors that reflect rather than
absorb heat. Select wickable clothes instead of cotton
to aid evaporative cooling. Rubber, plastic, or other
nonporous clothing is especially dangerous. A porous
hat or cap can help when exercising in direct sunlight.
• Watch for signs of heat stress (see Table 3 ). If signs are
present, stop immediately, get out of the heat, remove
Wind, cold, and altitude present some additional challenges for
winter exercise.
Heat Index An index based on a combination of
temperature and humidity that is used to determine
if it is dangerous to perform physical activity in hot,
humid weather (also called apparent temperature).
Hyponatremia A condition caused by excess water
intake, called “water intoxication,” that results in a
dilution of electrolytes, leading to serious medical
complications.
Hypothermia Excessively low body temperature (less
than 958F), characterized by uncontrollable shivering,
loss of coordination, and mental confusion.
Windchill Factor An index that uses air temperature
and wind speed to determine the chilling effect of the
environment on humans.
excess clothing, and drink cool water. Seek medical
attention if symptoms progress. Consider cold water
immersion for heat stroke.
Physical activity in exceptionally cold and windy
weather can be dangerous. Activity in the cold pre-
sents the opposite problems as exercise in the heat. In the
cold, the primary goal is to retain the body’s heat and
avoid hypothermia and frostbite. Early signs of hypo-
thermia include shivering and cold extremities caused
by blood shunted to the body core to conserve heat. As
the core temperature continues to drop, heart rate, res-
piration, and reflexes are depressed. Subsequently, cog-
nitive functions decrease, speech and movement become
impaired, and bizarre behavior may occur. Frostbite
results from water crystallizing in the tissues, causing cell
destruction.
When doing activity in cold, wet, and windy
weather, precautions should be taken. A combina-
tion of cold and wind (windchill) poses the greatest
danger for cold-related problems during exercise.
Research conducted in Canada, in cooperation
with the U.S. National Weather Service, pro-
duced tables for determining windchill factor
and the time of exposure necessary to get
frostbite (see Figure 4 ). Consider the fol-
lowing guidelines for performing physical
activity in cold and wind:
• Limit or cancel activity if the windchill
factor reaches the danger zone (see
Figure 4 ).
• Dress properly. Wear light clothing in several layers
rather than one heavy garment. The layer of clothing
closest to the body should transfer (wick) moisture
away from the skin to a second, more absorbent layer.
cor22568_ch03_043-064.indd 51 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
52 Section 2 ▶ An Introduction to Physical Activity
Polypropylene and capilene are examples of wick-
able fabrics. A porous windbreaker keeps wind from
cooling the body and allows the release of body heat.
The hands, feet, nose, and ears are most susceptible to
frostbite, so they should be covered. Wear a hat or cap,
mask, and mittens. Mittens are warmer than gloves. A
light coating of petroleum jelly on exposed body parts
can be helpful.
• Keep from getting wet in cold
weather. If you get wet because of
unavoidable circumstances, seek
a warm place to dry off.
Physical Activity in Other
Environments
High altitude may limit performance and require
adaptation of normal physical activity. The ability
to do vigorous physical tasks is diminished as altitude
increases. Breathing rate and heart rates are more ele-
vated at high altitude. With proper acclimation (gradual
exposure), the body adjusts to the lower oxygen pres-
sure found at high altitude, and performance improves.
Nevertheless, performance ability at high altitudes, espe-
cially for activities requiring cardiovascular fitness, is usu-
ally less than would be expected at sea level. At extremely
high altitudes, the ability to perform vigorous physical
activity may be impossible without an extra oxygen sup-
ply. When moving from sea level to a high altitude, vigor-
ous exercise should be done with caution. Acclimation to
high altitudes requires a minimum of 2 weeks and may
not be complete for several months. Care should be taken
to drink adequate water at high altitude.
Exposure to air pollution should be limited. Various
pollutants can cause poor performance and, in some cases,
health problems. Ozone, a pollutant produced primarily
by the sun’s reaction to car exhaust, can cause symptoms,
including headache, coughing, and eye irritation. Similar
symptoms result from exposure to carbon monoxide, a
tasteless and odorless gas, caused by combustion of oil,
gasoline, and/or cigarette smoke. Most news media in
metropolitan areas now provide updates on ozone and
carbon monoxide levels in their weather reports. When
levels of these pollutants reach moderate levels, some
people may need to modify their exercise. When levels
are high, some may need to postpone exercise. Exercis-
ers wishing to avoid ozone and carbon monoxide may
want to exercise indoors early in the morning or later in
the evening and avoid areas with a high concentration of
traffic.
Plant pollens, dust, and other pollutants in the air
may cause allergic reactions for certain people. Weather
reports of pollens and particulates may help exercisers
determine the best times for their activities and when to
avoid vigorous activities.
Soreness and Injury
Understanding soreness can help you persist in
physical activity and avoid problems. A common
experience for many exercisers is a certain degree of
muscle soreness that occurs 24–48 hours after intense
Actual
Temperature
Reading
(Degrees F)
Calm
Estimated Wind Speed (mph)
40
30
20
10
0
-10
-20
-30
-40
40
30
20
10
0
-10
-20
-30
-40
36
25
13
1
-11
-22
–
34
-46
-57
34
21
9
-4
-16
-28
-41
-53
-66
32
19
6
-7
-19
-32
-45
-58
-71
30
17
4
-9
-22
-35
-48
–
61
-74
29
16
3
-11
-24
-37
-51
-64
-78
28
15
1
-12
-26
-39
-53
-67
-80
27
14
0
-14
-27
-41
-55
-69
-82
27
13
-1
-15
-29
-43
-57
-71
-84
30
10
5
5 10 15 20 25 30 35 40
Minutes
to
Frostbite
= Extreme Danger Zone= High Risk Zone= Risk Zone= Caution Zone
Figure 4 ▶ Windchill factor chart.
Source: National Weather Service.
VIDEO 3
cor22568_ch03_043-064.indd 52 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 3 ▶ Preparing for Physical Activity 53
exercise. This soreness, termed delayed-onset muscle
soreness (DOMS) , typically occurs when muscles are
exercised at levels beyond their normal use. Some peo-
ple mistakenly believe that lactic acid is the cause of
muscle soreness. Lactic acid (a by-product of anaerobic
metabolism) is produced during vigorous exercise, but
levels return to normal within 30 minutes after exercise,
while DOMS occurs 24 hours after exercise. DOMS is
caused by microscopic muscle tears that result from the
excessive loads on the muscles. Soreness is not a normal
part of the body’s response to exercise but occurs if an
individual violates the principle of progression and does
more exercise than the body is prepared for. While it may
be uncomfortable to some, it has no long-term conse-
quences and does not predispose one to muscle injury. To
reduce the likelihood of DOMS, it is important to prog-
ress your program gradually.
The most common injuries incurred in physical
activity are sprains and strains. A strain occurs when
the fibers in a muscle are injured. Common activity-
related injuries are hamstring strains that occur after
a vigorous sprint. Other commonly strained muscles
include the muscles in the front of the thigh, the low
back, and the calf.
A sprain is an injury to a ligament—the connective
tissue that connects bones to bones. The most common
sprain is to the ankle; frequently, the ankle is rolled to
the outside (inversion) when jumping or running. Other
common sprains are to the knee, the shoulder, and the
wrist.
Tendonitis is an inflammation of the tendon; it is most
often a result of overuse rather than trauma. Tendonitis
can be painful but often does not swell to the extent that
sprains do. For this reason, elevation and compression
are not as effective as ice and rest. A physician should be
consulted for an appropriate diagnosis.
Being able to treat minor injuries will help reduce
their negative effects. Minor injuries, such as muscle
strains and sprains, are common to those who are per-
sistent in their exercise. If a serious injury should occur
or if symptoms persist, it is important to get immedi-
ate medical attention. However, for minor injuries, fol-
lowing the RICE formula will help you reduce the pain
and speed recovery. In this acronym, R stands for rest.
Muscle sprains and strains heal best if the injured area
is rested. Rest helps you avoid further damage to the
muscle. I stands for ice. The quick application of cold
(ice or ice water) to a minor injury minimizes swelling
and speeds recovery. Cold should be applied to as large a
surface area as possible (soaking is best). If ice is used, it
should be wrapped to avoid direct contact with the skin.
Apply cold for 20 minutes, three times a day, allowing
1 hour between applications. C stands for compression.
Wrapping or compressing the injured area also helps
minimize swelling and speeds recovery. Elastic bandages
or elastic socks are good for applying compression. Care
should be taken to avoid wrapping an injury too tightly
because this can result in loss of circulation to the
area. E stands for elevation. Keep-
ing the injured area elevated (above
the level of the heart) is effective
in minimizing swelling. If pain or
swelling does not diminish after 24 to 48 hours, or if
there is any doubt about the seriousness of an injury,
seek medical help. Some experts recommend adding a
P to RICE (PRICE) to indicate that prevention (P) is as
important as treatment of injuries. Building strength
and flexibility, warming up, beginning gradually when
starting a new activity, and wearing protective equip-
ment, such as lace-up ankle braces, are simple methods
of prevention.
Taking over-the-counter pain remedies can help
reduce the pain of muscle strains and sprains. Aspirin
and ibuprofen (e.g., Excedrin, Motrin) have anti-inflam-
matory properties. However, acetaminophen (e.g., Tyle-
nol) does not. It may reduce the pain but will not reduce
inflammation.
Muscle cramps can be relieved by statically
stretching a muscle. Muscle cramps are pains in the
large muscles that result when the muscles contract vig-
orously for a continued period of time. Muscle cramps are
usually not considered to be an injury, but they are pain-
ful and may seem like an injury. They are usually short in
duration and can often be relieved with proper treatment.
Cramps can result from lack of fluid replacement (dehy-
dration), from fatigue, and from a blow directly to a mus-
cle. Static stretching can help relieve some cramps. For
example, the calf muscle, which often cramps among run-
ners and other sports participants, can be relieved using
the calf stretcher exercise, which is part of the warm-up
in this concept.
Attitudes about Physical Activity
Knowing the most common reasons for inactivity
can help you avoid sedentary living. Most people
want to be active but find many barriers get in the way.
DOMS An acronym for delayed-onset muscle sore-
ness, a common malady that follows relatively vigor-
ous activity, especially among beginners.
RICE An acronym for rest, ice, compression, and
elevation; a method of treating minor injuries.
VIDEO 4
cor22568_ch03_043-064.indd 53 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
54 Section 2 ▶ An Introduction to Physical Activity
The most common reasons given by people who do not
do regular physical activity are listed
in Table 4 . Experts consider many
of these attitudes to be barriers that
can be overcome. In fact, as men-
tioned in Concept 2, a key self-management skill that
predicts long-term behavior change is the ability to over-
come barriers. The strategies in Table 4 can help inactive
people become more active.
Knowing the reasons people give for being active
can help you adopt positive attitudes toward
activity. To enhance the promotion of physical activity
in society, many researchers have
sought to determine why some peo-
ple choose to be active and others
do not. The most common reasons
for physical activity are highlighted in Table 5 . The table
also offers strategies for changing behaviors.
Reason Description Strategy for Change
I don’t have the time. This is the number one reason people give for not
exercising. Invariably, those who feel they don’t have
time know they should do more exercise. They say
they plan to do more in the future when “things are
less hectic.” Young people say they will have more
time to exercise in the future. Older people say they
wish they had taken the time to be active when they
were younger.
Planning a daily schedule can help you find the time
for activity and avoid wasting time on things that are
less important. Learning the facts in the concepts
that follow will help you see the importance of activity
and how you can include it in your schedule with a
minimum of effort and with time efficiency.
It’s too inconvenient. Many who avoid physical activity do so because it
is inconvenient. They say, “It takes too long to get to
the gym” and “It makes me sweaty and messes up
my hair.”
If you have to travel more than 10 minutes to
do activity or if you do not have easy access to
equipment, you will avoid activity. Locating facilities
and finding a time when you can shower is important.
I just don’t enjoy it. Many do not find activity to be enjoyable or
invigorating. These people may assume that all
forms of activity have to be strenuous and fatiguing.
There are many activities to choose from. If you don’t
enjoy vigorous activity, try more moderate forms of
activity, such as walking.
I’m no good at
physical activity.
“People might laugh at me,” “Sports make me
nervous,” and “I am not good at physical activities”
are reasons some people give for not being active.
Some people lack confidence in their own abilities.
This may be because of past experiences in physical
education or sports.
With properly selected activities, even those who
have never enjoyed exercise can get hooked. Building
skills can help, as can changing your way of thinking.
Avoiding comparisons with others can help you feel
successful.
I am not fit, so I avoid
activity.
Some people avoid exercise because of health
reasons. Some who are unfit lack energy. Starting
slowly can build fitness gradually and help you
realize that you can do it.
There are good medical reasons for not doing
activity, but many people with problems can benefit
from exercise if it is properly designed. If necessary,
get help adapting activity to meet your needs.
I have no place to be
active, especially in
bad weather.
Regular activity is more convenient if facilities
are easy to reach and the weather is good.
Opportunities have increased considerably in recent
years. Some of the most popular activities require
little equipment, can be done in or near home, and
are inexpensive.
If you cannot find a place, if it is not safe, or if it is
too expensive, consider using low-cost equipment at
home, such as rubber bands or calisthenics. Lifestyle
activity can be done by anyone at almost any time.
I am too old. As people grow older, many begin to feel that
activity is something they cannot do. For most
people, this is simply not true! Properly planned
exercise for older adults is not only safe but also
has many health benefits—e.g., longer life, fewer
illnesses, an improved sense of well-being, and
optimal functioning.
Older people who are just beginning activity should
start slowly. Lifestyle activities are a good choice.
Setting realistic goals can help, as can learning to do
resistance training and flexibility exercises.
Table 4 ▶ Common Reasons People Give for Not Being
Active
VIDEO 5
VIDEO 6
cor22568_ch03_043-064.indd 54 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 3 ▶ Preparing for Physical Activity 55
Reason Description Strategy for Change
I do activity for my
health, wellness,
and fitness.
Surveys show this is the number one reason for
doing regular physical activity. Unfortunately, many
adults say that a “doctor’s order to exercise” would
be the most likely reason to get them to begin a
program. For some, however, waiting for a doctor’s
order may be too late.
Gaining information contained in this book will
help you see the value of regular physical activity.
Performing the self-assessments in the various
concepts will help you determine the areas in which
you need personal improvement.
I do activity to
improve my
appearance.
In our society, looking good is highly valued; thus,
physical attractiveness is a major reason people
participate in regular exercise. Regular activity can
contribute to looking your best.
Setting realistic goals and avoiding comparisons with
others can help you be more successful.
I do activity
because I enjoy it.
A majority of adults say that enjoyment is of
paramount importance in deciding to be active.
Statements include the “peak experience,” the
“runner’s high,” or “spinning free.” The sense
of fun, well-being, and general enjoyment
associated with physical activity is well
documented.
People who do not enjoy activity often lack
performance skills or feel that they are not competent
in activity. Improving skills with practice, setting
realistic goals, and adopting a new way of thinking can
help you be successful and enjoy activities.
I do activity because
it relaxes me.
Relaxation and release from tension rank high as
reasons people do regular activity. It is known that
activity in the form of sports and games provides
a catharsis, or outlet, for the frustrations of daily
activities. Regular exercise can help reduce
depression and anxiety.
Activities such as walking, jogging, or cycling are ways
of getting some quiet time away from the job or the
stresses of daily living. In a later concept, you will learn
about exercises that you can do to reduce stress.
I like the challenge
and sense
of personal
accomplishment I
get
from physical
activity.
A sense of personal accomplishment is frequently
a reason for people doing activity. In some cases,
it is learning a new skill, such as racquetball or
tennis; in other cases, it is running a mile or doing
a certain number of crunches. The challenge of
doing something you have never done before is
apparently a powerful experience.
Taking lessons to learn skills or attempting activities
new to you can provide the challenge that makes
activity interesting. Also, adopting a new way of
thinking allows you to focus on the task rather than on
competition with others.
I like the social
involvement I get
from physical
activities.
Physical activity can have social benefits.
People say, “It is a good way to spend time with
members of my family.” “It is a good way to
spend time with close friends.” “Being part of
the team is satisfying.” Activity settings can also
provide an opportunity for making new friends.
If you find activity to be socially unrewarding, you may
have to find activities that you, your family, or your
friends enjoy. Taking lessons together can help. Also,
finding a friend with similar skills can help. Focus on
the activity rather than the outcome.
Competition is the
main reason I enjoy
physical activity.
“The thrill of victory” and “sports competition” are
two reasons given for being active. For many, the
competitive experience is very satisfying.
Some people simply do not enjoy competing. If this
is the case for you, select noncompetitive individual
activities.
Physical activity
helps me feel good
about myself.
For many people, participation in physical activity
is an important part of their identity. They feel
better about themselves when they are regularly
participating.
Physical activity is something that is self-determined
and within your control. Participation can help you
feel good about yourself, build your confidence, and
increase your self-esteem.
Physical activity
provides
opportunities to get
fresh air.
Being outside and experiencing nature are reasons
that some people give for being physically active.
Many activities provide opportunities to be outside. If
this is an important reason for you, seek out parks and
outdoor settings for your activities.
Table 5 ▶ Common Reasons for Doing Regular Physical Activity
cor22568_ch03_043-064.indd 55 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
56 Section 2 ▶ An Introduction to Physical Activity
Web Resources
American College of Sports Medicine (ACSM) Position
Statements www.acsm.org/access-public-information/
position-stands
• Exercise and Acute Cardiovascular Events
• Exertional Heat Illness during Training and Competition
• Exercise and Fluid Replacement
• Prevention of Cold Injuries during Exercise
ACSM’s Fit Society Page www.acsm.org/access-public-
information/newsletters/fit-society-page
ACSM’s Health and Fitness Journal www.acsm.org/access-
public-information/acsm-journals/acsm’s-health-
fitness-journal
American Red Cross (AED information) www.redcross.org
National Physical Activity Plan
Public health experts realize that compre-
hensive efforts are needed to increase par-
ticipation in physical activity in society. The Centers for
Disease Control and Prevention (CDC) led efforts to create
a National Physical Activity Plan to provide a framework for
coordinated action (www.physicalactivityplan.org). The plan
includes specific strategies for how activity can be promoted
through different settings (business, education, health care,
mass media, parks/recreation, public health, transportation,
and nonprofits). Each sector presents strategies aimed at
promoting physical activity. Each strategy also outlines spe-
cific tactics that communities, organizations and agencies,
and individuals can use to address the strategy. Separate
strategies for promoting physical activity are provided for
each sector. Recommendations are also provided to help
communities, organizations, agencies, and individuals apply
these strategies.
Does this type of coordinated effort help increase participation in
physical activity? Why or why not?
ACTIVITY
In the News
Strategies for Action
Screening for risks can help make
activity safer. Athletes in competi-
tive sports often undergo pre-participation physical examina-
tions to screen for potential cardiac arrhythmias or conditions
known to increase risks during exercise. Recreational athletes
may not take the same precautions. The best advice is to get
a physical prior to beginning serious training. This is especially
critical if you have a family history of heart problems. Lab 3A
will help you determine if you should consult a physician.
A proper warm-up can prepare your body for activity
and a gradual cool-down can improve recovery. Lab 3B
provides a sample flexibility-based warm-up and cool-down
routine that may be helpful. Determine what works best for
your needs.
Assess your attitudes concerning physical activity. Active
people generally have more positive attitudes than negative
ones. This is referred to as a “positive balance of attitudes.”
The questionnaire in Lab 3C gives you the opportunity
to assess your balance of attitudes. If you have a “nega-
tive balance” score, you can analyze your attitudes and
determine how you can change them to view activity more
favorably.
ACTIVITY
Med Watch www.fda.gov/medwatch
National Athletic Trainers Association www.nata.org
WebMD www.webmd.com
Suggested Readings
ACSM. 2010. ACSM’s Guidelines for Exercise Testing and Prescrip-
tion. 8th ed. Philadelphia: Lippincott, Williams & Wilkins.
ACSM. 2010. ACSM’s Resource Manual for Guidelines for Exer-
cise Testing and Prescription. 6th ed. Philadelphia: Lippincott,
Williams & Wilkins.
Barwood, M. J., Thelwell, R. C., and M. J. Tipton. 2008. Psycho-
logical skills training improves exercise performance in the
heat. Medicine and Science in Sports and Exercise 40(2):387–396.
Bernardot, D. 2007. Timing of energy and fluid intake. ACSM’s
Health and Fitness Journal 11(4):13–19.
N
P
h
I
S
S
a
tive sports often underg
cor22568_ch03_043-064.indd 56 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 3 ▶ Preparing for Physical Activity 57
Lowry, R., et al. 2007. Physical activity–related injury and body
mass index among U.S. high school students. Journal of
Physical Activity and Health 4(3):225–342.
Perberdy, M. A., and J. P. Ornato. 2008. Progress in resuscita-
tion: An evolution, not a revolution. Journal of the American
Medical Asssociation 299(10):1188–1190.
Rea, T. D., et al. 2010. CPR with chest compression alone or
with rescue breathing. New England Journal of Medicine
363(5):423–433.
Stover, B., and B. Murray. 2007. Drink up: Science of hydra-
tion. ACSM’s Health and Fitness Journal 11(3):7–12.
Walter, T., et al. 2011. Active movement warm-up routines.
Journal of Physical Education Recreation and Dance 82(3):23–31.
Young, S. 2010. From static stretching to dynamic exercise:
Changing the warm-up paradigm. Strategies 24(1):13–17.
Healthy People 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 con-
tent of this concept.
• Reduce sports and recreation injuries.
• Reduce injuries from overexertion.
• Reduce emergency department visits for nonfatal
injuries.
• Increase the proportion of public and private schools that
require students to wear appropriate protective gear when
engaged in school-sponsored physical activities.
• Increase health literacy of the population.
A national goal is to reduce sports and recreational injuries, as well
as injuries from overexertion. Explain how using the information
related to preparing for exercise can help you and others contribute
to meeting this national goal.
ACTIVITY
Carlson, M. 2012. Exercising in the cold. ACSM’s Health and
Fitness Journal. 16(1):8–12.
Fradkin, A., et al. 2009. Warm-up and physical performance:
What is the relationship? A systematic review with meta
analysis (abstract). Medicine and Science in Sports and Exercise
41(5 Supplement):151–152.
Henschke, N., and C. C. Lin. 2011. Stretching before or after
exercise does not reduce delayed-onset muscle soreness.
British Journal of Sports Medicine 45:1249–1250 .
Herbert, R. D., de Noronha, M., and S. J . Kamper. 2011.
Stretching to prevent or reduce muscle soreness after exer-
cise. Cochrane Database Systematic Reviews 7:CD0045771 .
Kay, A. D., and A. J. Blazevich. 2011. Effect of acute static
stretch on maximal muscle performance: A systematic review.
Medicine and Science in Sports and Exercise 44(1):154–164.
cor22568_ch03_043-064.indd 57 9/3/12 11:16 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
cor22568_ch03_043-064.indd 58 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
59
L
a
b
3
A
R
e
a
d
in
e
ss fo
r P
h
ysic
a
l A
c
tivity
Lab 3A Readiness for Physical Activity
Name Section Date
Purpose: To help you determine your physical readiness for participation in a program of regular exercise
Procedures
1. Read the directions on the “PAR-Q & You” on page 60.
2. Answer each of the seven questions on the form.
3. If you answered “yes” to one or more of the questions, follow the directions just below the PAR-Q questions
regarding medical consultation.
4. If you answered “no” to all seven questions, follow the directions at the lower left-hand corner of the PAR-Q.
5. Answer the five questions about physical readiness for sports or vigorous training in Chart 1 below.
6. Record your scores below and answer the question in the Conclusions and Implications section.
Results
Determine your PAR-Q score. Place an X over the circle that includes the number of “yes” answers that you had for the
PAR-Q (see page 60).
0 1 2 3 4 5 6 7
Determine your readiness for sports or rigorous training (see Chart 1 above). Place an X over the number of “yes”
answers that you had for the Physical Readiness for Sports or Vigorous Training chart.
0 1 2 3 4 5
Conclusions and Implications: In several sentences, discuss your readiness for physical activity. Base your com-
ments on your questionnaire results and the types of physical activities you plan to perform in the future.
Answer the PAR-Q before using this chart. If your answer to any of these questions is “yes,” you should consult with your
personal physician by telephone or in person to determine if you have a potential problem with sports or vigorous training.
Yes
No
1. Do you plan to participate on an organized team that will play intense competitive sports (e.g., varsity team,
professional team)?
2. If you plan to participate in a collision sport (even on a less organized basis), such as football, boxing, rugby,
or ice hockey, have you been knocked unconscious more than one time?
3. Do you currently have symptoms from a previous muscle injury?
4. Do you currently have symptoms from a previous back injury, or do you experience back pain as a result of
involvement in physical activity?
5. Do you have any other symptoms during physical activity that give you reason to be concerned about your
health?
Chart 1 Physical Readiness for Sports or Vigorous Training
cor22568_ch03_043-064.indd 59 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
60
L
a
b
3
A
R
e
a
d
in
e
ss
f
o
r
P
h
ys
ic
a
l
A
c
ti
vi
ty
Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more
active is very safe for most people. However, some people should check with their doctor before they start becoming much more
physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below.
If you are between the ages of fifteen and sixty-nine, the PAR-Q will tell you if you should check with your doctor before you start.
If you are over sixty-nine years of age, and you are not used to being very active, check with your doctor.
Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly:
check YES or NO.
DELAY BECOMING MUCH MORE ACTIVE:
• If you are not feeling well because of a temporary illness,
such as a cold or a fever—wait until you feel better or
• If you are or may be pregnant—talk to your doctor before
you start becoming more active.
Please note: If your health changes so that you then answer
YES to any of the above questions, tell your fitness or health
professional. Ask whether you should change your physical
activity plan.
Produced by the British Columbia Ministry of Health and the Department of National Health & Welfare
*Developed by the British Columbia Ministry of Health.
Physical Activity Readiness
Questionnaire • PAR-Q
(revised 2002)
You are encouraged to copy the PAR-Q but only if you use the entire form
If
you
answered
• Start becoming much more physically active—begin
slowly and build up gradually. This is the safest and
easiest way to go.
• Take part in a fitness appraisal—this is an excellent way
to determine your basic fitness so that you can plan the
best way for you to live actively.
NO to all questions
YES NO
YES to one or more questions
Talk with your doctor by phone or in person BEFORE you start becoming much more physically active
or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you
answered YES.
• You may be able to do any activity you want—as long as you start slowly and build up gradually. Or
you may need to restrict your activities to those that are safe for you. Talk with your doctor about
the kinds of activities you wish to participate in and follow his or her advice.
• Find out which community programs are safe and helpful for you.
Informed Use of the PAR-Q: The Canadian Society for Exercise Physiology, Health Canada, and their agents assume no liability for persons who undertake physical activity, and
if in doubt after completing this questionnaire, consult your doctor prior to physical activity.
If you answered NO honestly to all PAR-Q questions, you can
be reasonably sure that you can
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity
recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?
7. Do you know of any other reason you should not do physical activity?
Yes
No
Note: It is important that you answer all questions honestly. The PAR-Q is a scientifically and medically researched pre-
exercise selection device. It complements exercise programs, exercise testing procedures, and the liability considerations
attendant with such programs and testing procedures. PAR-Q, like any other pre-exercise screening device, will misclassify
a small percentage of prospective participants, but no pre-exercise screening method can entirely avoid this problem.
cor22568_ch03_043-064.indd 60 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
61
L
a
b
3
B
T
h
e
S
tre
tc
h
W
a
rm
-U
p
a
n
d
C
o
o
l-D
o
w
n
Lab 3B The Stretch Warm-Up and Cool-Down
Name Section Date
Purpose: To familiarize you with a sample group of stretch warm-up and cool-down exercises
Procedures
1. Perform a 2- to 5-minute cardiovascular warm-up (walk, jog, slow jump rope, swim).
2. Perform the exercises in Chart 1 on page 62, including the alternative exercises, three times each. Hold the stretch
for 15 to 30 seconds.
3. Complete the Results section below and answer the questions in the Conclusions and Implications section.
Results: In the following, put an X over the circle that represents the amount of tightness you felt when performing
each of the stretching warm-up and cool-down exercises. Tightness indicates that you may have shortness of a spe-
cifi c muscle group and that stretching exercises at times other than the warm-up or cool-down are needed.
Amount of Tightness
None Moderate Severe
Calf stretch
Hamstring stretch
Leg hug
Seated side stretch
Zipper
Alternative Exercises
Side stretch
Hip and thigh stretch
One-leg stretch
Conclusions and Implications: The general cardiovascular warm-up is recommended for all people. In addition,
you may want to consider a stretch warm-up and stretch cool-down (as shown in this lab), or a dynamic or sport-specifi c
warm-up option. In several sentences, discuss your experiences with the warm-up/cool-down and what you would plan
to use in the future.
cor22568_ch03_043-064.indd 61 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
62
L
a
b
3
B
T
h
e
S
tr
e
tc
h
W
a
rm
-U
p
a
n
d
C
o
o
l-
D
o
w
n
The exercises shown here can be used before a workout as a warm-up or after a workout as a cool-down. Perform these exercises
slowly, preferably after completing a cardiovascular warm-up. Do not bounce. Hold each stretch for at least 15–30 seconds.
Perform each exercise at least once and up to three times. Other stretching exercises are presented in the concept on flexibility,
and they can be used in a warm-up or cool-down.
Cardiovascular Warm-Up
Before you perform a vigorous
workout, walk or jog slowly for 2
minutes or more. After exercise,
do the same. Do this portion of the
warm-up prior to muscle stretching.
Calf Stretch
This exercise stretches the calf muscles
(gastrocnemius and soleus). Face a wall with
your feet 2 or 3 feet away. Step forward
on your left foot to allow both hands to
touch the wall. Keep the heel of your
right foot on the ground, toe turned in
slightly, knee straight, and buttocks
tucked in. Lean forward by bending
your front knee and arms and
allowing your head to move nearer the
wall. Hold. Repeat with the other leg.
Hamstring Stretch
This exercise stretches the muscles of the back of the
upper leg (hamstrings) as well as those of the
hip, knee, and ankle. Lie on your back.
Bring the right knee to your chest and
grasp the toes with the right hand.
Place the left hand on the back of the
right thigh. Pull the knee toward the
chest, push the heel toward the ceiling,
and pull the toes toward the shin.
Attempt to straighten the knee. Stretch
and hold. Repeat with the other leg.
Leg Hug
This exercise stretches the hip
and back extensor muscles. Lie
on your back. Bend one leg and
grasp your thigh under the knee.
Hug it to your chest. Keep the
other leg straight and on the floor.
Hold. Repeat with the opposite leg.
Seated
Side Stretch
This exercise stretches the muscles of the
trunk. Begin in a seated position with
the legs crossed. Stretch the left arm
over the head to the right. Bend
at the waist (to right), reaching as
far as possible to the left with the
right arm. Hold. Do not let the trunk
rotate. Repeat to the opposite side.
For less stretch, the overhead arm
may be bent. This exercise can be done
in the standing position but is less effective.
Zipper
This exercise stretches the muscle on
the back of the arm (triceps) and the
lower chest muscles (pecs). Lift
the right arm and reach behind
the head and down the spine
(as if pulling up a zipper). With
the left hand, push down on the
right elbow and hold. Reverse arm
position and repeat.
ALTERNATE EXERCISES
Because of location (wet or hard surface), you may choose to substitute exercises that do not require you to lie down. The side
stretch (standing) can be substituted for the seated side stretch, the hip and thigh stretch for the leg hug (does not stretch the
same muscles), and the one-leg stretch (standing) for the hamstring stretch.
Side Stretch
This exercise
stretches the
trunk lateral
flexors. Stand
with feet
shoulder-width
apart. Stretch
left arm overhead
to right. Bend to right
at waist reaching as far as possible
with left arm; reach as far as
possible with right arm. Hold. Do not
let trunk rotate or lower back arch.
Repeat on opposite side. Note: This
exercise is made more effective if
a weight is held down at the side in
the hand opposite the side being
stretched. More stretch will occur
if the hip on the stretched side is
dropped and most of the weight is
borne by the opposite foot.
One-Leg Stretch
This exercise stretches the lower back
muscles. Stand with one foot on a
bench, keeping both legs straight.
Contract the hamstrings and gluteals
by pressing down on bench with the
heel for three seconds; then relax and
bend the trunk forward, toward the
knee. Hold for 10–15 seconds. Return
to starting position and repeat with
opposite leg. As flexibility improves,
the arms can be used
to pull the chest
toward the legs.
Do not allow
either knee
to lock. This
exercise is
useful in relief
of backache
and correction of
swayback.
Hip and Thigh Stretch
This exercise stretches the hip (iliopsoas)
and thigh muscles (quadriceps) and is
useful for people with lordosis and back
problems. Place right knee directly above
right ankle and stretch left leg backward
so knee touches floor. If necessary, place
hands on floor for balance.
1. Tilt the pelvis backward by tucking in
the abdomen and flattening the back.
2. Then shift the weight forward until a
stretch is felt on
the front of the
thigh: hold.
Repeat on
opposite
side.
Caution: Do
not bend
front knee
more than 90
degrees.
1
2
Chart 1 Sample warm-up and cool-down exercises
cor22568_ch03_043-064.indd 62 03/08/12 2:08 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
63
L
a
b
3
C
P
h
ysic
a
l A
c
tivity A
ttitu
d
e
Q
u
e
stio
n
n
a
ire
Lab 3C Physical Activity Attitude Questionnaire
Name Section Date
Purpose: To evaluate your feelings about physical activity and to determine the specifi c reasons you do or do not
participate in regular physical activity
Directions: The term physical activity in the following statements refers to all kinds of activities, including sports, for-
mal exercises, and informal activities, such as jogging and cycling. Make an X over the circle that best represents your
answer to each question.
Strongly Strongly Item Attitude
Disagree Disagree Undecided Agree Agree Score Score
1. I should do physical activity regularly for my
health.
2. Doing regular physical activity is good for
my fitness and wellness.
3. Regular exercise helps me look my
best.
4. I feel more physically attractive when I do
regular physical activity.
5. One of the main reasons I do regular physi-
cal activity is that it is fun.
6. The most enjoyable part of my day is when I
am exercising or doing a sport.
7. Taking part in physical activity helps me
relax.
8. Physical activity helps me get away from the
pressures of daily living.
9. The challenge of physical training is one
reason I do physical activity.
10. I like to see if I can master sports and activi-
ties that are new to me.
11. I like to do physical activity that involves
other people.
12. Exercise offers me the opportunity to meet
other people.
13. Competition is a good way to make physical
activity fun.
14. I like to see how my physical abilities com-
pare with those of others.
15. When I do regular exercise, I feel better than
when I don’t.
16. My ability to do physical activity is some-
thing that makes me proud.
17. I like to do outdoor activities.
18. Experiencing nature is something I look
forward to when exercising.
1
Health and
Fitness
Score
1
Outdoor
Score
1
1
1
1
1
1
1
1
1
1
1
1
1
432
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
1 5
5
5
5
5
5
5
5
5
5
5
5
5
5
+
=
Feeling
Good
Score+
=
Competition
Score+
=
Social
Score+
=
Challenge
Score+
=
Relaxation
Score+
=
Enjoyment
Score+
=
Appearance
Score+
=1 5
5
+
=1 5
5
cor22568_ch03_043-064.indd 63 03/08/12 2:09 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
64
L
a
b
3
C
P
h
ys
ic
a
l
A
c
ti
vi
ty
A
tt
it
u
d
e
Q
u
e
st
io
n
n
a
ir
e
Procedures
1. Read and answer each question in the questionnaire.
2. Write the number in the circle of your answer in the box labeled “Item Score.”
3. Add scores for each pair of scores and record in the “Attitude Score” box.
4. Record each attitude score and a rating for each score (use Rating Chart) in the chart below.
5. Record the number of good and excellent scores in the box provided. Use the score in the box to determine your
rating using the Balance of Feelings Rating Chart.
Results: Record your results as indicated in the Procedures section.
How many good or excellent scores do
you have?
Having 5 or more in the box above indicates that you have
a positive balance of feelings (more positive than negative
attitudes).
Balance of
Feeling Score
In a few sentences, discuss your “balance of feelings” rating. Having more positive than negative scores (positive balance of feelings)
increases the probability of being active. Include comments on whether you think your ratings suggest that you will be active or inactive
and whether your ratings are really indicative of your feelings. Do you think that the scores on which you were rated poor or very poor
might be reasons you would avoid physical activity? Explain.
Attitude Score Rating
Health and fitness
Appearance
Enjoyment
Relaxation
Challenge
Social
Competition
Feeling good
Outdoor
Physical Activity Attitude Questionnaire Results
Rating Category Attitude Score
Excellent 9–10
Good 7–8
Fair 5–6
Poor 3–4
Very poor 2
Attitude Rating Chart
Excellent 6–9
Good 5
Fair 4
Poor 2–3
Very poor 0–1
Balance of Feelings Rating Chart
cor22568_ch03_043-064.indd 64 03/08/12 2:09 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
6565
The Health Benefits
of Physical Activity
LEARNING OBJECTIVES
After completing the study of this concept, you will be able to:
▶ Define the term hypokinetic and explain how physical activity can reduce risk of
hypokinetic diseases and conditions.
▶ Identify several cardiovascular diseases/conditions associated with physical
inactivity and explain how physical activity can help to reduce risk.
▶ Describe metabolic syndrome and explain how physical activity can help to reduce
risk of this hypokinetic condition.
▶ Describe additional hypokinetic conditions and explain how physical activity can
help reduce risk of them.
▶ Explain the role of physical activity in preventing conditions associated with aging.
▶ Explain the role of physical activity in promoting optimal wellness.
▶ Present an overview of the health and wellness
benefits of physical activity and fitness.
▶ Identify related national health goals and show
how meeting personal goals can contribute to
reaching national goals.
▶ Assess your heart disease risk factors.
C
o
n
c
e
p
t 4
Physical activity and good
physical fitness can reduce the
risk of illness and contribute to
optimal health and wellness.
cor22568_ch04_065-084.indd 65 02/08/12 4:18 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
66 Section 2 ▶ An Introduction to Physical Activity
Second, physical activity and fitness can be significant
contributors to disease/illness treatment. Even with the
best disease prevention practices, some people will become
ill. Regular exercise and good fitness have been shown to
be effective in alleviating symptoms and aiding rehabilita-
tion after illness for such hypokinetic conditions as diabe-
tes, heart disease, and back pain.
Finally, physical activity and fitness contribute to qual-
ity of life and wellness, the positive component of good
health. In the process, they aid in meeting many other
national health goals.
Too many adults suffer from hypokinetic disease,
and the economic cost is high. In 1961, Kraus and
Raab coined the term hypokinetic disease to describe health
problems associated with lack of physical activity. They
showed how sedentary living, or as they called it, “take it
easy” living, contributes to the leading killer diseases in
our society.
A public advocacy group coined the term sedentary
death syndrome (SeDS) to describe inactive living and
associated hypokinetic disease risk factors. They indicate
that SeDS is responsible for the epidemic of chronic dis-
ease in our society and resulting increases in health costs. In
the next few years, expenditures for health care are expected
to account for one-fifth of all spending in the United States.
Regular physical activity over a lifetime may
overcome the effects of inherited risk. People with
a family history of disease may believe they can do noth-
ing because their heredity works against them. There is
no doubt that heredity significantly affects risk for early
death from hypokinetic diseases. New studies of twins,
however, suggest that active people are less likely to die
early than inactive people with similar genes. This sug-
gests that long-term adherence to physical activity can
overcome other risk factors, such as heredity.
T
he landmark Surgeon General’s Report on Physical
Activity and Health informed the general public of
the risks of sedentary living and the health benefits
of physical activity. Since that document was pub-
lished, even more evidence has accumulated support-
ing the benefits of an active lifestyle. The first chapter
of ACSM’s Guidelines for Exercise Testing and Prescrip-
tion and Chapter 2 of the 2008 Physical Activity Guide-
lines for Americans are devoted to the benefits and risks
associated with physical activity. Both Healthy People
2020 and Achieving Health for All (Canada) highlight
the importance of regular physical activity for improv-
ing population health in the 21st century. This con-
cept summarizes the health benefits of regular physical
activity and good fitness.
Physical Activity
and Hypokinetic Diseases
Regular physical activity and good fitness can
promote good health, help prevent disease, and
be a part of disease treatment. There are three
major ways in which regular physical activity and good
fitness can contribute to optimal health and wellness.
First, they can aid in disease/illness prevention. There
is considerable evidence that the risk of hypokinetic
diseases or conditions can be greatly reduced among
people who do regular physical activity and achieve
good physical fitness. Virtually all chronic diseases that
plague society are considered to be hypokinetic, though
some relate more to inactivity than others. Nearly three-
quarters of all deaths among those 18 and older are a
result of chronic diseases. Leading public health officials
have suggested that physical activity may offer the most
promising public health solution to control chronic dis-
eases, much as immunization controls infectious diseases.
A government report by the Surgeon Gen-
eral’s Office (The Surgeon General’s Vision
for a Healthy and Fit Nation) emphasizes the importance of
healthy lifestyles for improving our nation’s health. The report
specifically focuses on “helping Americans lead healthier
lives through better nutrition and regular physical activity.”
Combating overweight and obesity through healthy choices
is the major goal. The report emphasizes that the current
epidemic of overweight and obesity threatens the historic
progress we have made in increasing the quality and years
of healthy life in Americans. Projections suggest that if trends
continue, the current generation will have a shorter lifespan
(on average) than their parents.
Does this projected outcome surprise you? What needs to happen
to reverse this trend?
The Surgeon General’s Vision for a Healthy and Fit Nation
ACTIVITY
In the News
A
e
TT
I
cor22568_ch04_065-084.indd 66 9/3/12 11:14 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 4 ▶ The Health Benefits of Physical Activity 67
Physical Activity and
Cardiovascular Diseases
The various types of cardiovascular disease are
the leading killers in automated societies. There
are many forms of cardiovascular disease (CVD).
Some are classified as coronary heart disease (CHD)
because they affect the heart muscle and the blood vessels
that supply the heart. Coronary occlusion (heart attack)
is a type of CHD. Atherosclerosis and arteriosclerosis
are two conditions that increase risk for heart attack and
are considered to be types of CHD. Angina pectoris
(chest or arm pain), which occurs when the oxygen sup-
ply to the heart muscle is diminished, is sometimes consid-
ered to be a type of CHD, though it is really a symptom of
poor circulation.
Hypertension (high blood pressure), stroke (brain
attack), peripheral vascular disease, and congestive
heart failure are other forms of CVD. Inactivity relates
in some way to each of these types of disease.
In the United States, CVD accounts for more
than 34 percent of all deaths. More than 81 million
people currently have one or more forms of CVD.
Men are more likely to suffer from heart disease than
women, although the differences
have narrowed in recent years.
African American, Hispanic, and
Native American populations are
at higher than normal risk. Heart
disease and stroke death rates are similar in the United
States, Canada, Great Britain, Australia, and other
automated societies.
There is a wealth of statistical evidence that
physical inactivity is a primary risk factor for CHD.
Much of the research relating inactivity to heart disease
has come from occupational studies that show a high
incidence of heart disease in people involved only in
sedentary work. There are limitations in some of these
studies but they collectively present convincing evi-
dence that the inactive individual has an increased risk
for coronary heart disease. A study summarizing all of
the important occupational studies shows a 90 percent
reduced risk for coronary heart disease for those in
active versus inactive occupations.
The American Heart Association, after carefully
examining the research literature, elevated seden-
tary living from a secondary to a primary risk factor,
comparable to high blood pressure, high blood cho-
lesterol, obesity, and cigarette smoke. The reason for
this change is that inactivity increases risk in multiple
ways and large numbers of adults are sedentary and
vulnerable to these risks. The Surgeon General’s Report
on Physical Activity and Health concluded that “physical
inactivity is causally linked to atherosclerosis and coro-
nary heart disease.”
Hypokinetic Diseases or Conditions Hypo- means
“under” or “too little” and kinetic means “movement” or
“activity.” Thus, hypokinetic means “too little activity.” A
hypokinetic disease or condition is associated with lack
of physical activity or too little regular exercise. Exam-
ples include heart disease, low back pain, and Type II
diabetes.
Chronic Diseases Diseases or illnesses associated
with lifestyle or environmental factors, as opposed to
infectious diseases; hypokinetic diseases are consid-
ered to be chronic diseases.
Sedentary Death Syndrome (SeDS) A group of
symptoms associated with sedentary living, including
low health-related fitness (low cardiovascular fitness
and weak muscles), low bone density, and the pres-
ence of metabolic syndrome (poor metabolic fitness).
Cardiovascular Disease (CVD) A broad clas-
sification of diseases of the heart and blood vessels
that includes CHD, high blood pressure, stroke, and
peripheral vascular disease.
Coronary Heart Disease (CHD) Diseases of the
heart muscle and the blood vessels that supply it with
oxygen, including heart attack.
Coronary Occlusion The blocking of the coronary
blood vessels; sometimes called heart attack.
Atherosclerosis The deposition of materials along
the arterial walls; a type of arteriosclerosis.
Arteriosclerosis Hardening of the arteries due to
conditions that cause the arterial walls to become
thick, hard, and nonelastic.
Angina Pectoris Chest or arm pain resulting from
reduced oxygen supply to the heart muscle.
Hypertension High blood pressure; excessive pres-
sure against the walls of the arteries that can damage
the heart, kidneys, and other organs of the body.
Stroke A condition in which the brain, or part of
the brain, receives insufficient oxygen as a result of
diminished blood supply; sometimes called apoplexy
or cerebrovascular accident (CVA).
Peripheral Vascular Disease A lack of oxygen
supply to the working muscles and tissues of the arms
and legs, resulting from decreased blood flow.
Congestive Heart Failure The inability of the heart
muscle to pump the blood at a life-sustaining rate.
VIDEO 1
cor22568_ch04_065-084.indd 67 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
68 Section 2 ▶ An Introduction to Physical Activity
Physical Activity
and the Healthy Heart
Regular exercise increases the heart muscle’s
ability to pump oxygen-rich blood. A fit heart muscle
can handle extra demands placed on it. Through regular
exercise, the heart muscle gets stronger, contracts more
forcefully, and therefore pumps more blood with each
beat. The heart is just like any other muscle—it must be
exercised regularly to stay fit. The fit heart also has open,
clear arteries free of atherosclerosis (see Figure 1 ).
The “normal” resting heart rate is said to be 72 beats per
minute (bpm). However, resting rates of 50 to 85 bpm are
common. People who regularly do physical activity typi-
cally have lower resting heart rates than people who do no
regular activity. Some endurance athletes have heart rates
in the 30 and 40 bpm range, which is considered healthy or
normal. Although resting heart rate is not considered to be
a good measure of health or fitness, decreases in individual
heart rate following training reflect positive adaptations.
Low heart rates in response to a stan-
dard amount of physical activity are a
good indicator of fitness. The bicycle
and step tests presented later in this
book use your heart rate response to a standard amount of
exercise to estimate your cardiovascular fitness.
Physical Activity
and Atherosclerosis
Atherosclerosis, which begins early in life, is
implicated in many cardiovascular diseases.
Atherosclerosis is a condition that contributes to heart
attack, stroke, hypertension, angina pectoris, and peripheral
vascular disease. Deposits on the walls of arteries restrict
blood flow and oxygen supply to the tissues. Atheroscle-
rosis of the coronary arteries, the vessels that supply the
heart muscle with oxygen, is particularly harmful. If these
arteries become narrowed, the blood supply to the heart
muscle is diminished, and angina pectoris may occur. Ath-
erosclerosis increases the risk of heart attack because a
fibrous clot is more likely to obstruct a narrowed artery
than a healthy, open one.
Current theory suggests that atherosclerosis begins
when damage occurs to the cells of the inner wall, or
endothelium, of the artery (see Figure 2 ). Substances
associated with blood clotting are attracted to the dam-
aged area. These substances seem to cause the migra-
tion of smooth muscle cells, commonly found only in the
middle wall of the artery (media), to the endothelium.
In the later stages, fats (including cholesterol) and other
substances are thought to be deposited, forming plaques,
or protrusions, that diminish the internal diameter of the
artery. This process was once thought to occur later in
life but research indicates that the first signs of athero-
sclerosis begin in early childhood.
Regular physical activity can help prevent
atherosclerosis by lowering blood lipid levels.
There are several kinds of lipids (fats) in the bloodstream,
including lipoproteins, phospholipids, triglycerides, and
cholesterol. Cholesterol is the most well known, but it is
not the only culprit. Many blood fats are manufactured
by the body itself, whereas others are ingested in high-
fat foods, particularly saturated fats (fats that are solid at
room temperature).
As noted earlier, blood lipids are thought to con-
tribute to the development of atherosclerotic deposits
on the inner walls of the artery. One substance, called
Figure 1 ▶ The fit heart muscle.
Open, healthy
coronary arteries
Strong, thick
heart muscle
VIDEO 2
Figure 2 ▶ Atherosclerosis.
Cholesterol
crystals
Fat
Damaged
area
Endothelium
Smooth
muscle cells
Media
Intima
cor22568_ch04_065-084.indd 68 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 4 ▶ The Health Benefits of Physical Activity 69
low-density lipoprotein (LDL) , is a major contributor
to the development of atherosclerosis. LDL is basically
a core of cholesterol surrounded by protein and another
substance that makes it water soluble. The benefit of
regular exercise is that it can reduce blood lipid levels,
including LDL-C (the cholesterol core of LDL). People
with high total cholesterol and LDL levels have a higher
than normal risk for heart disease (see Table 1 ). New evi-
dence indicates that there are subtypes of LDL choles-
terol (characterized by their small size and high density)
that pose even greater risks. These subtypes are hard to
measure and not included in most current blood tests, but
future research will no doubt help us better understand
and measure them.
Triglycerides are another type of blood lipid. Elevated
levels of triglycerides are related to heart disease. Triglyc-
erides lose some of their ability to predict heart disease
with the presence of other risk factors, so high levels are
more difficult to interpret than other blood lipids. Normal
levels are considered to be 150 mg/dL or less. Values of
151 to 199 are borderline, 200 to 499 are high, and above
500 are very high. It would be wise to include triglycer-
ides in a blood lipid profile. Physical activity is often pre-
scribed as part of a treatment for high triglyceride levels.
Regular physical activity can help prevent
atherosclerosis by increasing HDL in the blood.
Whereas LDLs carry a core of cholesterol that is
involved in the development of atherosclerosis, high-
density lipoprotein (HDL) picks up cholesterol and
carries it to the liver, where it is eliminated from the
body. HDL is often called the “good cholesterol” and
is desirable. When having a blood test, ask for informa-
tion about HDL as well as the other measures included
in Table 1 . Individuals who have regular physical activ-
ity usually have lower total cholesterol, lower LDL,
and higher HDL levels than inactive people.
Regular physical activity can help prevent
atherosclerosis by reducing blood coagulants.
Fibrin and platelets (types of cells involved in blood
coagulation) deposit at the site of an injury on the wall
of the artery, contributing to the process of plaque
buildup, or atherosclerosis. Regular physical activity has
been shown to reduce fibrin levels in the blood. The
breakdown of fibrin seems to reduce platelet adhesive-
ness and the concentration of platelets in the blood.
Other indicators of inflammation of the arteries are
predictive of atherosclerosis. Recently, a number of
other constituents in the blood have been shown to be
associated with risk for cardiovascular disease. Among
these are indicators of inflammation inside the arteries,
such as C-reactive protein (CRP), interleukin-6 (IL-6),
Chlamydia pneumonia heat shock protein (Cp-HSP60),
and tumor necrosis factor-a (TNF-a). These compounds
are not necessarily causes of atherosclerosis, but they are
indicators of inflammatory processes that lead to plaque
formation. Inflammatory processes also soften existing
plaque and increase the likelihood of plaque rupture or
the formation of clots, which can directly precipitate
heart attacks.
The inner wall of the artery (endothelium) was once
thought to be a relatively passive layer of tissue that
merely lines the artery. However, recent evidence sug-
gests that it is an active layer of tissue that functions in
several ways in addition to providing a protective bar-
rier. For example, sensing units in the endothelium
stimulate production of agents that regulate blood flow
by dilating and constricting the artery. The released
substances can help prevent the buildup of deposits on
the arterial wall. However, when the inner wall of the
artery ceases to function effectively, it increases the risk
of plaque buildup.
CRP is one of the most studied indicators of a dysfunc-
tional endothelium. Screening for elevated levels of CRP is
now commonly done to identify patients that may be at risk
Lipids All fats and fatty substances.
Lipoproteins Fat-carrying proteins in the blood.
Low-Density Lipoprotein (LDL) A core of choles-
terol surrounded by protein; the core is often called
“bad cholesterol.”
Triglycerides A type of blood fat associated with
increased risk for heart disease.
High-Density Lipoprotein (HDL) A blood sub-
stance that picks up cholesterol and helps remove it
from the body; often called “good cholesterol.”
Fibrin A sticky, threadlike substance that, in combi-
nation with blood cells, forms a blood clot.
Total (TC) LDL-C HDL-C TC/HDL-C
Optimal ——— <100 ———
Near optimal ——— 100–129 ——— ———
Desirable <200 ——— 60+ ———
Borderline 200–239 130–159 40–59 3.6–5.0
High risk 240+ 160–189 <40 5.0+
Very high risk ——— >190 ——— ———
Source: Third Report of the National Cholesterol Education Program.
*Different classification systems are used for each of the four measures (two
to five categories). Blank ( —) spaces are included for categories not used for
each measure.
Table 1 ▶ Cholesterol Classifications (mg/dL)*
cor22568_ch04_065-084.indd 69 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
70 Section 2 ▶ An Introduction to Physical Activity
People who perform regular physical activity have
half the risk for a first heart attack, compared with those
who are sedentary. Possible reasons are less atheroscle-
rosis, greater diameter of arteries, and less chance of a
clot forming.
Regular exercise can improve coronary circulation
and, thus, reduce the chances of a heart attack or
dying from one. Within the heart, many tiny branches
extend from the major coronary arteries. All of these
vessels supply blood to the heart muscle. Active people
are likely to have greater blood-carrying capacity in
these vessels, probably because the vessels are larger and
more elastic. Also, the active person may have a more pro-
fuse distribution of arteries within the heart muscle (see
Figure 4 ), which results in greater blood flow. A few stud-
ies show that physical activity may promote the growth
of “extra” blood vessels, which are thought to open up
to provide the heart muscle with the necessary blood
and oxygen when the oxygen supply is diminished, as
in a heart attack. Blood flow from extra blood vessels is
referred to as coronary collateral circulation.
Improved coronary circulation may provide protec-
tion against a heart attack because a larger artery would
require more atherosclerosis to occlude it. In addition,
the development of collateral blood vessels supplying the
heart may diminish the effects of a heart attack, as these
extra (or collateral) blood vessels may take over the func-
tion of regular blood vessels.
The heart of an inactive person is less able to resist
stress and is more susceptible to an emotional
storm that may precipitate a heart attack. The heart
is rendered inefficient by one or more of the following
circumstances: high heart rate, high blood pressure, and
excessive stimulation. All of these conditions require the
for heart disease. Preliminary standards from the American
Heart Association suggest that levels below 1 mg/L indi-
cate low risk, levels between 1 mg/L and 3 mg/L indicate
moderate risk, and above 3 mg/L indicate high risk.
High levels of the amino acid homocysteine have
also been associated with increased risk for heart dis-
ease, though the American Heart Association says it is
too early to begin screening for it. Tentative fasting val-
ues have been established at 5 to 15 millimoles per liter
of blood for the normal range, 16 to 30 as moderate, 31
to 100 as intermediate, and above 100 as high. Recent
research suggests that healthy lifestyles can help reduce
the risk of arterial inflammation. For example, studies
show that regular physical activity can promote endo-
thelial health, and nutrition can help reduce markers of
inflammation. Adequate levels of folic acid, vitamins B-6
and B-12 help prevent high blood homocysteine levels,
so eating foods that ensure adequate daily intake of these
vitamins is recommended.
Physical Activity and Heart Attack
Regular physical activity reduces the risk for
heart attack, the most prevalent and serious of all
cardiovascular diseases. A heart attack (coronary
occlusion) occurs when a coronary artery is blocked
(see Figure 3 ). A clot, or thrombus, is the most common
cause, reducing or cutting off blood flow and oxygen to
the heart muscle. If the blocked coronary artery supplies
a major portion of the heart muscle, death will occur
within minutes. Occlusions of lesser arteries may result in
angina pectoris or a nonfatal heart attack.
Figure 4 ▶ Coronary collateral circulation.
Heart muscle
Collaterals
Figure 3 ▶ Heart attack.
Clot and
narrowed
artery
Clot (thrombus)
enlarged
Death
to tissue
cor22568_ch04_065-084.indd 70 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 4 ▶ The Health Benefits of Physical Activity 71
heart to use more oxygen than is normal and decrease its
ability to adapt to stressful situations.
The inefficient heart beats rapidly because it is domi-
nated by the sympathetic nervous system , which speeds
up the heart rate. Thus, the heart continuously beats rap-
idly, even at rest, and never has a true rest period. High
blood pressure also makes the heart work harder and
contributes to its inefficiency.
Research indicates that regular physical activity can:
• lead to dominance of the parasympathetic nervous
system , which slows heart rate and helps the heart
work efficiently;
• help the heart rate return to normal faster after emo-
tional stress;
• strengthen the heart muscle, making it better able to
weather an emotional storm;
• reduce hormonal effects on the heart, thus lessening
the chances of circulatory problems;
• reduce the risk of sudden death from ventricular fibril-
lation (arrhythmic heartbeat).
Regular physical activity is one effective means of
rehabilitation for a person who has coronary heart
disease or who has had a heart attack. Not only
does regular physical activity seem to reduce the risk of
developing coronary heart disease, but those who already
have the condition may reduce the symptoms of the dis-
ease through regular exercise. For people who have had
heart attacks, regular and progressive exercise can be an
effective prescription when carried out under the super-
vision of a physician. Remember, however, that exercise
is not the treatment of preference for all heart attack vic-
tims. In some cases, it is harmful.
Physical Activity and Other
Cardiovascular Diseases
Regular physical activity is associated with a
reduced risk for high blood pressure (hypertension).
“Normal” systolic blood pressure is 120 mm Hg or less
and normal diastolic blood pressure is 80 mm Hg or
less. Prehypertension is a condition that exists when your
blood pressure is higher than normal but not high enough
to be considered hypertension (see Table 2 ). Prehyperten-
sion has been linked to higher than normal risk of heart
attack and, though not as serious as hypertension, should
be taken seriously. Nearly one-third of American adults
have high blood pressure. High blood pressure is associ-
ated with heart disease, stroke, diabetes, and many other
diseases. African Americans, Hispanics, and Native Ameri-
cans have higher incidence than White non-Hispanics.
Older people have higher incidence than younger people.
High blood pressure is sometimes referred to as the
“silent killer” because nearly one-third of people with ele-
vated blood pressure do not know they have it. It is impor-
tant to monitor your blood pressure on a regular basis.
With practice and good equipment, you can accurately
measure your own blood pressure. Because blood pressure
can be elevated by emotions and circumstances, a single
measurement may not be accurate, so at least two separate
measurements are recommended. While self-assessments
can be helpful, they are not a substitute for periodic assess-
ments by a qualified medical person.
Exceptionally low blood pressures (below 100 systolic
and 60 diastolic) do not pose the same risks to health as
Coronary Collateral Circulation Circulation of
blood to the heart muscle associated with the blood-
carrying capacity of a specific vessel or development
of collateral vessels (extra blood vessels).
Sympathetic Nervous System The branch of the
autonomic nervous system that prepares the body for
activity by speeding up the heart rate.
Parasympathetic Nervous System The branch of
the autonomic nervous system that slows the heart rate.
Emotional Storm A traumatic emotional expe-
rience that is likely to affect the human organism
physiologically.
Systolic Blood Pressure The upper blood pres-
sure number, often called working blood pressure. It
represents the pressure in the arteries at its highest
level just after the heart beats.
Diastolic Blood Pressure The lower blood pres-
sure number, often called “resting pressure.” It is the
pressure in the arteries at its lowest level occurring
just before the next beat of the heart.
Category
Systolic
Blood Pressure
(mm Hg)
Diastolic
Blood Pressure
(mm Hg)
Normal <120 <80
Prehypertensive 121–139 81–89
Stage 1 hypertension 140–159 90–99
Stage 2 hypertension >160 >100
Source: National Heart, Lung, and Blood Institute.
*Not taking antihypertensive drugs and not acutely ill. When the systolic and
diastolic blood pressure categories vary, the higher reading determines the
blood pressure classification.
Table 2 ▶ Blood Pressure Classifications for Adults*
cor22568_ch04_065-084.indd 71 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
72 Section 2 ▶ An Introduction to Physical Activity
high blood pressure but can cause dizziness, fainting, and
lack of tolerance to change in body positions.
A recent research summary indicates that the effects
of physical activity on blood pressure are more dramatic
than previously thought and are independent of age,
body fatness, and other factors. Inactive, less fit indi-
viduals have a 30 to 50 percent greater chance of being
hypertensive than active, fit people. Regular physical
activity can also be one effective method of reducing
blood pressure for those with prehypertension or hyper-
tension. Physical inactivity in middle age is associated
with risk for high blood pressure later in life. The most
plausible reason is a reduction in resistance to blood
flow in the blood vessels, probably resulting from dila-
tion of the vessels.
Regular physical activity can help reduce the risk
for stroke. Stroke is a major killer of adults. People with
high blood pressure and atherosclerosis are susceptible to
stroke. Since regular exercise and good fitness are impor-
tant to the prevention of high blood pressure and ath-
erosclerosis, exercise and fitness are considered helpful in
the prevention of stroke.
Regular physical activity is helpful in preventing
peripheral vascular disease. People who exercise reg-
ularly have better blood flow to the working muscles and
other tissues than inactive, unfit people. Since peripheral
vascular disease is associated with poor circulation to
the extremities, regular exercise can be considered one
method of preventing this condition.
Many factors in addition to healthy lifestyle have
led to a significant reduction in cardiovascular
disease deaths in recent years. While lifestyle
changes such as being active, eating well, managing
stress, and abstaining from tobacco use are important in
the prevention and treatment of cardiovascular diseases,
a variety of other factors have contributed to the recent
decrease in deaths associated with the diseases. Heart
disease is still the leading killer of both men and women.
In the late 1990s deaths exceeded one million per year,
but death rates from heart disease have decreased by
more than 29 percent. Some of the reasons for that
decline, other than healthy lifestyle change, include ear-
lier and better detection (e.g., exercise tests, angiograms,
T E C H N O L O G Y U P D A T E
Heart360
Physical inactivity is one of the primary risks for cardio-
vascular disease. The American Heart Association has
released a free, Web-based tracking tool (www.Heart360
.org) that allows individuals to record and monitor changes
in key risk factors over time, including blood pressure,
cholesterol, blood glucose, inactivity, and body mass
index (BMI). With this tool, you create a secure “health
vault” account to save confidential health data. The site
evaluates your risk profiles and provides links to educa-
tional resources. If your physician has a provider account,
you can share results with your physician.
Would this type of tool help you adopt heart-healthy life-
styles? Would the connection with your physician make you
more accountable?
ACTIVITY
Figure 5 ▶ Mechanism and effects of metabolic syndrome.
Genetic factors
(e.g., family history)
Environmental
factors
(e.g., activity, diet)
Cardiovascular
disease
(Heart attack/stroke)
Diabetes
Metabolic
Syndrome
Insulin
resistance
High blood
pressure
Large abdominal
girth
High blood
triglyceride
High blood
sugar levels
Low blood
HDL
cor22568_ch04_065-084.indd 72 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 4 ▶ The Health Benefits of Physical Activity 73
CT scans) and better emergency care.
Improved medications for lowering
blood fat levels (e.g., blood thinners,
including aspirin) and lowering blood
pressure levels have also played a role
and less invasive surgical methods (e.g.,
angioplasty, stents) and improvements in
postcoronary care.
Physical Activity and
Metabolic Syndrome
Physical inactivity is associated
with metabolic syndrome. Metabolic
syndrome is the opposite of good metabolic fitness, as
discussed in Concept 1 . Several groups, including the
American Heart Association and the American Medical
Association, have defined the characteristics of metabolic
syndrome (see Figure 5 ). People with at least three of the
following characteristics have metabolic syndrome: blood
pressure above 130/85, a fasting blood sugar level of 100
or higher, blood triglycerides of 150 or above, a low blood
HDL level (less than 40 for men and less than 50 for
women), and/or a high abdominal circumference (equal
to or above 40 inches for men or 35 inches for women).
People with metabolic syndrome have a higher than
normal risk of chronic diseases, such as diabetes,
heart disease, and stroke. A questionnaire developed
by researchers who conducted the Framingham Heart
Study uses metabolic measures and several other mea-
sures to predict heart disease. This questionnaire is bet-
ter at predicting heart disease than metabolic syndrome
alone, but metabolic syndrome is a better predictor of
diabetes. Lab 4A at the end of the concept can be used by
those who do not have the necessary metabolic syndrome
measures, though having a metabolic fitness assessment is
advised periodically, especially as you grow older.
Physical Activity and Other
Hypokinetic Conditions
Physical activity reduces the risk of some forms
of cancer. According to the American Cancer Society
(ACS), cancer is a group of many different conditions
characterized by abnormal, uncontrolled cell growth. As
illustrated in Figure 6 , the abnormal cells divide, form-
ing malignant tumors (carcinomas). If the abnormal
cells reach the blood, they can spread, causing tumors
elsewhere in the body. Benign tumors are generally
not considered to be cancerous because their growth
is restricted to a specific area of the body by a protec-
tive membrane. The first editions of this book did not
include any form of cancer as a hypokinetic disease. We
now know, however, that overall death rates from some
types of cancer are lower among active people than those
who are sedentary. These cancers are described in Table 3
with possible reasons for the cancer/inactivity link. The
Malignant Tumors (carcinomas) An uncon-
trolled and dangerous growth capable of spreading to
other areas; a cancerous tumor.
Benign Tumors An abnormal growth of tissue con-
fined to a particular area; not considered to be cancer.
Normal cells
Abnormal cell Cell divides.
Malignant cell
invades blood.
Malignant
tumor.
Blood vessel
Figure 6 ▶ The spread of cancer (metastasis).
Cancer Type Effect of Physical Activity
Colon Exercise speeds movement of food and
cancer-causing substances through the
digestive system, and reduces prostaglandins
(substances linked to cancer in the colon).
Breast Exercise decreases the amount of exposure
of breast tissue to circulating estrogen.
Lower body fat is also associated with lower
estrogen levels. Early life activity is deemed
important for both reasons. Fatigue from
therapy is reduced by exercise.
Rectal Similar to colon cancer, exercise leads to
more regular bowel movements and reduces
“transit time.”
Prostate Fatigue from therapy is reduced by exercise.
Regular exercise, especially vigorous
exercise, may reduce death rate.
Table 3 ▶ Physical Activity and Cancer
cor22568_ch04_065-084.indd 73 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
74 Section 2 ▶ An Introduction to Physical Activity
entries in Table 3 are listed in order based on the strength
of evidence supporting the cancer/inactivity link.
As indicated in Concept 1, cancer is a leading cause
of death. In the United States cancer causes more than
560,000 deaths annually. However, the five-year survival
rate for people diagnosed with cancer is up 50 percent
over the past three decades. Many factors are responsible,
including early diagnosis and improved medical treat-
ments. Healthy lifestyles can also play a role. The American
Cancer Society (ACS) guidelines highlight the importance
of regular physical activity and a
healthy diet in preventing cancer
and early death. Physical activity is
also considered to be important to
the wellness of the cancer patient in many ways, includ-
ing improved quality of life, physical functioning, and
self-esteem, as well as less dependence on others, reduced
risk for other diseases, and reduced fatigue from disease
or disease therapy. The ACS and the Lance Armstrong
Foundation ( www.Livestrong.org ) are two good sources of
information about cancer and cancer treatments.
Physical activity plays a role in the management
and treatment of Type II diabetes. Diabetes mellitus
(diabetes) is a group of disorders that results when there
is too much sugar in the blood. It occurs when the body
does not make enough insulin or when the body is not
able to use insulin effectively.
Type I diabetes, or insulin-dependent diabetes,
accounts for a relatively small number of the diabetes
cases and is not considered to be a hypokinetic condi-
tion. Type II diabetes (often not insulin-dependent) was
formerly called “adult-onset diabetes.” Reports indicate
more cases of Type II diabetes among children than in
the past, in part because of better record keeping but
also because of increases in obesity among children in
recent years.
Diabetes is the seventh leading cause of death among
people over 40. It accounts for at least 10 percent of
all short-term hospital stays and has a major impact on
health-care costs in Western society. According to the
American Diabetes Association (ADA), there are nearly
24 million people in the United States with diabetes
(7.8 percent of the population). Unfortunately,
5.7 million of those don’t know it. An estimated addi-
tional 57 million are prediabetic; they have metabolic
profiles characteristic of those with diabetes (see Web
Resources, ADA, or Canadian Diabetes Association, for
more statistics).
People who perform regular physical activity are
less likely to suffer from Type II diabetes than seden-
tary people. For people with Type II diabetes, regular
physical activity can help reduce body fatness, decrease
insulin resistance , improve insulin sensitivity , and
improve the body’s ability to clear sugar from the blood
in a reasonable time. With sound
nutritional habits and proper medi-
cation, physical activity can be
useful in the management of both
types of diabetes.
Regular physical activity is important to maintaining
bone density and decreasing risk for osteoporosis.
As noted in Concept 1 , some experts consider bone integ-
rity to be a health-related component of physical fitness.
Bone density cannot be self-assessed. It is measured using
a dual X-ray absorptiometry (DXA) machine, an expen-
sive and sophisticated form of X-ray machine that can
also be used to measure body fatness. Healthy bones are
dense and strong. When bones lose calcium and become
less dense, they become porous and are at risk for fracture.
The bones of young children are not especially dense, but
during adolescence and early adulthood (see Figure 7),
bones increase in density to a level higher than any other
time in life (peak bone density). Though bone density
often begins to decrease in young adulthood, it is not until
older adulthood that bone loss becomes dramatic. Over
time, if bone loss continues, older adults become suscep-
tible to a condition called osteoporosis (bone density
drops below the osteoporosis threshold). Some will have
crossed the fracture threshold, putting them at risk for
fractures, especially to the hip, vertebrae, and other “soft”
or “spongy” bones of the skeletal system. Active people
have a higher peak bone mass and are more resistant to
osteoporosis (see blue line in Figure 7 ) than sedentary
people (see red line in Figure 7 ).
Women, especially postmenopausal women, have a
higher risk of osteoporosis than men, but it is a disease
of both sexes. Although Figure 7 reflects the combined
bone density status for men and women, males typically
have a higher peak bone mass than females, and for this
reason, males can lose more bone density over time with-
out reaching the osteoporosis or fracture threshold. More
women reach the osteoporosis and fracture thresholds at
Figure 7 ▶ Changes in bone density with age.
High
Osteoporosis threshold
Fracture Threshold
Active
Sedentary
0 10 20 30 40 50 60 70 80
Low
Bone
density
VIDEO 4
VIDEO 3
cor22568_ch04_065-084.indd 74 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 4 ▶ The Health Benefits of Physical Activity 75
earlier ages than men. Other risk factors for osteoporosis
are age, family history/heredity, frame size, smoking, caf-
feine use, alcohol use, current or previous eating disor-
ders, early menstruation, low dietary calcium intake, low
body fat, amenorrhea, and extended bed rest.
The National Osteoporosis Foundation (NOF) rec-
ommends five steps to bone health and osteoporosis
prevention:
• Get daily recommended amounts of calcium and vita-
min D. Eat a diet rich in both nutrients. Exposure to
the sun provides a source of vitamin D. The NOF rec-
ommends 1,000 mg of calcium daily for people under
50, and 1,200 mg for those over 50. Adults under age
50 need 400–800 IU of vitamin D, and adults over 50
need 800–1,000 units. If you have difficulty getting
enough of these nutrients from food or sunlight, your
health-care provider may recommend a supplement.
• Engage in regular weight-bearing exercise. Weight-
bearing exercise (e.g., walking, dancing, jogging) and
resistance training are good choices. The load bearing
and pull of muscles build bone density.
• Avoid smoking and excessive alcohol.
• Talk to your health-care provider about bone health.
• When appropriate, have a bone density test and take
medication. There is no cure for osteoporosis, but the
FDA has approved a variety of treatments for osteo-
porosis to help reduce bone loss over time. When
appropriate, a physician may prescribe FDA-approved
medications such as raloxifene (sold as Evista), alen-
dronate (sold as Fosamax), or other approved drugs.
Hormone treatments such as thyroid-based Calcito-
nin treatments and estrogen are approved. Estrogen
replacement therapy (ERT), also known as hormone
replacement treatment (HRT),
can reduce risk of osteoporosis
among postmenopausal women,
but may increase risk for cancer
and other diseases. Medical consultation based on
individual factors is recommended.
Active people who possess good muscle fitness
are less likely to have back and musculoskeletal
problems than are inactive, unfit people. Because
few people die from it, back pain does not receive the
attention given to such medical problems as heart disease
and cancer. But back pain is the second leading medical
complaint in the United States, second only to headaches.
Only the common cold and the flu cause more days lost
from work. At some point in our lives, approximately
80 percent of all adults experience back pain that lim-
its the ability to function normally. In National Safety
Council data, the back was the most frequently injured of
all body parts, and the injury rate was double that of any
other part of the body.
The great majority of back ailments are the result of
poor muscle strength, low levels of endurance, and poor
flexibility. Tests on patients with back problems show
weakness and lack of flexibility in key muscle groups.
Lack of fitness is probably the leading reason for back
pain in Western society. Other factors also increase the
risk of back ailments, including poor posture, improper
lifting and work habits, heredity, and disease states such
as scoliosis and arthritis.
Physical activity is important in maintaining a
healthy body weight and avoiding the numerous
health conditions associated with obesity. National
studies indicate that more than two-thirds of adults are
overweight and more than one-third are obese (32.2
percent of men and 35.5 percent of women). Nearly a
third of children are either overweight or obese. From
1950 through 1980, obesity (15 percent) and overweight
were fairly stable but increased dramatically from 1980
to the present. In the past few years the rate of increase
in overweight and obesity has not been as dramatic as
during the previous decade (see Figure 8 ). Obesity is not
a disease state in itself but is a hypokinetic condition
associated with a multitude of far-reaching complica-
tions. Research has shown that fat people who are fit
Figure 8 ▶ Incidence of obesity.
Source: National Center for Health Statistics.
1970
0
5
10
15
20
25
30
35
1980 1990 2000 Today
Adults
Year
P
er
ce
n
t
Children
Insulin A hormone secreted by the pancreas that
regulates levels of sugar in the blood.
Insulin Resistance A condition that occurs when
insulin becomes ineffective or less effective than nec-
essary to regulate sugar levels in the blood.
Insulin Sensitivity A person with insulin resistance
(see previous definition) is said to have decreased
insulin sensitivity. The body’s cells are not sensitive
to insulin, so they resist it and sugar levels are not
regulated effectively.
Osteoporosis A condition associated with low
bone density and subsequent bone fragility, leading to
high risk for fracture.
VIDEO 5
cor22568_ch04_065-084.indd 75 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
76 Section 2 ▶ An Introduction to Physical Activity
are not at especially high risk for early death. However,
when high body fatness is accompanied by low cardio-
vascular and low metabolic fitness, risk for early death
increases substantially. For more information on obe-
sity, see Concept 13.
Physical activity reduces the risk and severity of
a variety of common emotional/mental health
disorders. Nearly half of adult Americans will report hav-
ing a mental health disorder at some point in life. A recent
summary of studies revealed that there are several emo-
tional/mental disorders associated with inactive lifestyles.
Depression is a stress-related condition experienced
by many adults. Thirty-three percent of inactive adults
report that they often feel depressed. For some, depres-
sion is a serious disorder that physical activity alone will
not cure; however, research indicates that activity, com-
bined with other forms of therapy, can be effective.
Anxiety is an emotional condition characterized by
worry, self-doubt, and apprehension. More than a few
studies have shown that symptoms of anxiety can be
reduced by regular activity. Low-fit people who do regu-
lar aerobic activity seem to benefit the most. In one study,
one-third of active people felt that regular activity helped
them cope better with life’s pressures.
Physical activity is also associated with better and
more restful sleep. People with insomnia (the inabil-
ity to sleep) seem to benefit from regular activity if it
is not done too vigorously right before going to bed.
A recent study indicates that 52 percent of the popu-
lation feel that physical activity helps them sleep bet-
ter. Regular aerobic activity is associated with reduced
brain activation, which can result in greater ability to
relax or fall asleep.
A final benefit of regular exercise is increased self-
esteem. Improvements in fitness, appearance, and the
ability to perform new tasks can improve self-confidence.
Physical activity can help the immune system
fight illness. Until recently, infectious disease and
other diseases of the immune system were not consid-
ered to be hypokinetic. Recent evidence indicates that
regular moderate to vigorous activity can actually aid the
immune system in fighting disease. Each of us is born
with an “innate immune system,” which includes ana-
tomical and physiological barriers, such as skin, mucous
membranes, body temperature, and chemical mediators
that help prevent and resist disease. We also develop an
“acquired immune system” in the form of special dis-
ease-fighting cells that help us resist disease. Figure 9
shows a J-shaped curve that illustrates the benefits of
exercise to acquired immune function. Sedentary people
have more risk than those who do moderate activity, but
with very high and sustained vigorous activity, such as
extended high performance training, immune system
function actually decreases.
Regular moderate and reasonable amounts of vigor-
ous activity have been shown to reduce incidence of colds
and days of sickness from infection. The immune system
benefit may extend to other immune system disorders as
well. There is evidence that regular
physical activity can enhance treat-
ment effectiveness and improve
quality of life for those with HIV/
AIDS. However, as Figure 9 indicates, too much exercise
may cause problems rather than solve them.
Physical activity during pregnancy can benefit
both the mother and the child. In the not too distant
past, exercise during pregnancy was discouraged. Over
the years, evidence has shown that appropriate exercise
(including resistance training and moderate to vigorous
aerobic exercise) by pregnant women can help prevent
excess weight gain, help retain pre-pregnancy fitness lev-
els, and result in shorter, less complicated labor. Physical
activity does not cause damage to the baby or miscarriage
and may help the baby developmentally.
Pregnant women are nearly twice as likely to be sed-
entary (fail to meet current activity guidelines) than
other women in spite of the fact that guidelines from the
American College of Obstetricians and Gynecologists
indicate that most women should meet national guidelines
as described in this book. More intense exercise is appro-
priate in many cases but should be done with “close medi-
cal supervision.”
Regular physical activity can have positive effects on
some nonhypokinetic conditions. The following non-
hypokinetic conditions can benefit from physical activity:
• Arthritis. Many, if not most, arthritics are in a decon-
ditioned state resulting from a lack of activity. The
traditional advice that arthritics should avoid physi-
cal activity is now being modified in view of the find-
ings that carefully prescribed exercise has a variety
Figure 9 ▶ Physical activity and immune function.
Low immune
function
(high infection risk)
Moderate immune
function
(moderate risk)
High immune
function
(low infection risk)
Moderate
Intensity of activity
Very vigorousSedentary
VIDEO 6
cor22568_ch04_065-084.indd 76 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 4 ▶ The Health Benefits of Physical Activity 77
of benefits. Common problems for both those with
rheumatoid arthritis (RA) and osteoarthritis (OA)
are decreased strength, loss of range of motion, and
poor cardiovascular endurance. Well-planned exer-
cise, designed to meet the needs of the specific type of
arthritis of the individual, can be beneficial in prevent-
ing and treating impairments, and enhancing function,
general fitness, and well-being.
• Asthma. Asthmatics often have physical activity limita-
tions, but with proper management activity can be part
of their daily life. In fact, when done properly, activ-
ity can reduce airway reactivity and medication use.
Because exercise can trigger bronchial constriction, it is
important to choose appropriate types of activity and to
use inhaled medications to prevent bronchial constric-
tion caused by exercise or other triggers, such as cold
weather. Asthmatics should avoid cold weather exercise.
• Premenstrual syndrome (PMS). PMS, a mixture of
physical and emotional symptoms that occurs prior to
menstruation, has many causes. However, changes in
lifestyle, including regular exercise, may be effective in
relieving PMS symptoms.
• Cystic fibrosis. A recent review indicates that exercise
helps cystic fibrosis patients by facilitating systemic
improvements and, more importantly, enhancing
quality of life.
• Other conditions. Low- to moderate-intensity aerobic
activity and resistance training are prescribed for some
people who have chronic pain (persistent pain without
relief) and/or fibromyalgia (chronic muscle pain). Evi-
dence also suggests that active people have a reduced
chance of having gallstones than inactive people.
Activity may also decrease risk of impotence.
Physical Activity and Aging
Regular physical activity can improve fitness and
functioning among older adults. Approximately
30 percent of adults age 70 and over have difficulty with
one or more activities of daily living. Women have more
limitations than men, and low-income groups have
more limitations than higher-income groups. Nearly
one-half of these adults also get no assistance in coping
with their limitations.
The inability to function effectively as you grow
older is associated with lack of fitness and inactive life-
styles. This loss of function is sometimes referred to as
“acquired aging,” as opposed to “time-dependent” aging.
Because so many people experience limitations in daily
activities and find it difficult to get assistance, it is espe-
cially important for older people to stay active and fit.
In general, older adults are much less active than
younger adults. Losses in muscle fitness are associ-
ated with loss of balance, greater risk of falling, and less
ability to function independently. Studies also show that
exercise can enhance cognitive functioning and perhaps
reduce risk for dementia. Though the amount of activity
performed must be adapted as people grow older, fitness
benefits discussed in the next section and throughout this
book apply to people of all ages.
Regular physical activity can compress illness
into a shorter period of our life. An important
national health goal is to increase the years of healthy
life. Living longer is important, but being able to func-
tion effectively during all years of life is equally—if not
more— important. Compression of illness, also called com-
pression of morbidity, refers to shortening the total num-
ber of years that illnesses and disabilities occur. Healthy
lifestyles, including regular physical activity, have been
shown to compress illness and increase years of effec-
tive functioning. Inactive people not only have a shorter
lifespan, but also have more years of illness and disability
than active people.
Recent evidence indicates that Alzheimer’s disease
and dementia are hypokinetic conditions. More than
a few studies indicate that factors relating to heart health
also contribute to brain health. The studies indicate that
physical and challenging mental activities are especially
important for preventing decline in cognitive function and
reducing the risk of developing Alzheimer’s and dementia.
Although additional research is needed, this is important
news for physicians and public health officials looking for
ways to reduce the prevalence of Alzheimer’s disease.
Physical Activity, Health,
and Wellness
Good health-related physical fitness and regular
physical activity contribute to optimal wellness.
Regular physical activity and good fitness not only help
prevent illness (see Figure 10 ) and disease but also pro-
mote quality of life and wellness. Good health-related
physical fitness can help you look good, feel good, and
enjoy life. Specific benefits of wellness associated with
good fitness are the following:
• Good physical fitness can help an individual work effec-
tively and efficiently. A person who can resist fatigue,
muscle soreness, back problems, and other symptoms
associated with poor health-related fitness is capable
of working productively and having energy left over at
the end of the day.
• Good physical fitness can help an individual enjoy lei-
sure time. A fit person is more likely to get and stay
involved in leisure-time activities than an unfit person.
Enjoying your leisure time may not add years to your
life but can add life to your years.
cor22568_ch04_065-084.indd 77 9/3/12 11:15 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
78 Section 2 ▶ An Introduction to Physical Activity
and fitness on intellectual functioning is positive. One
study shows activity to foster new brain cell growth.
Time taken to be active during the day has been shown
to help children learn more, even
though less time is spent in intel-
lectual pursuits.
• Good physical fitness may help you function safely and handle
unexpected emergencies. Emergencies are never expected,
but, when they do arise, they often demand perfor-
mance that requires good fitness. For example, flood
victims may need to fill sandbags for hours without
rest, and accident victims may be required to walk or
run long distances for help.
Physical activity is a major part of most employee
health promotion programs. Companies have come to
understand the importance of promoting healthy lifestyles
among their employees. Work-site health promotion pro-
grams typically use a broad focus on promoting a variety
of healthy lifestyles, but physical activity is considered the
mainstay of most programs. To facilitate active lifestyles,
many companies build their own fitness centers inside the
workplace or provide free or reduced-cost memberships for
employees. Work-site programs that promote activity can
reduce risk factors in employees and help companies control
the high cost of health care. Companies that offer compre-
hensive programs frequently save more than $4 for each dol-
lar invested. The expansion of work-site health programs is
viewed as a critical public health priority and one of the most
promising approaches for controlling health-care costs.
Too much activity can lead to hyperkinetic
conditions. The information presented in this con-
cept points out the health benefits of physical activ-
ity performed in appropriate amounts. When done
in excess or incorrectly, physical activity can result in
Regular physical activity promotes healthy aging and high quality of life.
• Good physical fitness is essential to effective living.
Although the need for each component of physi-
cal fitness is specific to each individual, every per-
son requires enough fitness to perform normal daily
activities without undue fatigue. Whether it be walk-
ing, performing household chores, or merely enjoying
the simple things in life without pain or fear of injury,
good fitness is important to all people.
• Physical fitness is the basis for dynamic and creative activity.
Though the following quotation by former President
John F. Kennedy is more than 50 years old, it clearly
points out the importance of physical fitness:
“The relationship between the soundness of the body and
the activity of the mind is subtle and complex. Much is not
yet understood, but we know what the Greeks knew: that
intelligence and skill can only function at the peak of their
capacity when the body is healthy and strong, and that
hardy spirits and tough minds usually inhabit sound bodies.
Physical fi tness is the basis of all activities in our society;
if our bodies grow soft and inactive, if we fail to encour-
age physical development and prowess, we will undermine
our capacity for thought, for work, and for the use of those
skills vital to an expanding and complex America.”
• President Kennedy’s belief that activity and fitness
are associated with intellectual functioning has now
been backed up with research. A recent research sum-
mary suggests that, though modest, the effect of activity
Health is available to Everyone for a
Lifetime, and it’s Personal
The benefits associated with regular physical activity are
enormous and have been well documented—but partici-
pation in exercise and physical activity still remains low.
A YouTube video by Dr. Mike Evans called “23 and
½ Hours” presents a compelling challenge to viewers—
commit 30 minutes a day to physical activity to ensure
that you get the basic health benefits that come from
physical activity. The video features the research of
Dr. Steve Blair, the editor of the Surgeon General’s Report
on Physical Activity and Health. (Search for “23 and 1/2
Hours” on the Internet.)
Do you think this type of video would change people’s
perception of activity if it went viral?
ACTIVITY
VIDEO 7
cor22568_ch04_065-084.indd 78 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 4 ▶ The Health Benefits of Physical Activity 79
hyperkinetic conditions . The most common hyperki-
netic condition is overuse injury to muscles, connec-
tive tissue, and bones. Recently, anorexia nervosa and
body neurosis have been identified as conditions asso-
ciated with inappropriate amounts of physical activ-
ity. These conditions will be discussed in the concept
on performance.
Hyperkinetic Conditions Diseases/illnesses or health
conditions caused, or contributed to, by too much physi-
cal activity.
Figure 10 ▶ Health and wellness benefits of physical activity and fitness.
Health and Wellness Benefits of Physical Activity and Fitness
Improved Cardiovascular Health
Improved Strength and
Muscular Endurance
Resistance to Fatigue
Other Health Benefits
Stronger heart muscle fitness
and health
Enhanced Mental Health and Function
Lower heart rate
Better electric stability of heart
Decreased sympathetic control of
heart
Increased O2 to brain
Reduced blood fat, including
low-density lipoproteins (LDLs)
Increased protective high-density
lipoproteins (HDLs)
Delayed development of
atherosclerosis
Increased work capacity
Improved peripheral circulation
Improved coronary circulation
Resistance to “emotional storm”
Reduced risk for heart attack
Reduced risk for stroke
Reduced risk for hypertension
Reduced risk for low back problems
Improved performance in sports
Quicker recovery after hard work
Ability to enjoy leisure
Quality of life for diabetics
Extended life
Aids for some people who have
arthritis, PMS, asthma, chronic pain,
fibromyalgia, or impotence
Improved immune system
Decrease in dysfunctional years
Improved metabolic fitness
Decreased diabetes risk
Improved quality of life
Improved ability to meet some
stressors
Improved ability to meet emergencies
Greater chance of surviving a heart
attack
Increased oxygen-carrying capacity
of the blood
Greater work efficiency
Less chance for muscle injury
Relief of depression
Opportunity for Successful Experience
and Social Interactions
Improved Appearance
Greater Lean Body Mass
and Less Body Fat
Improved Flexibility
Improved self-concept
Better figure/physique
Better posture
Fat control
Greater work efficiency
Greater work efficiency
Bone Development
Greater peak bone density
Reduced Cancer Risk
Reduced risk for colon and breast
cancer
Reduced Effect of Acquired Aging
Improved ability to function in daily
life
Better short-term memory
Fewer illnesses
Greater mobility
Greater independence
Greater ability to operate an
automobile
Lower risk for dementia
Possible reduced risk for rectal and
prostate cancers
Less chance of developing
osteoporosis
Less susceptibility to disease
Less chance of muscle injury
Less chance of joint injury
Improved sports performance
Decreased chance of developing
low back problems
Improved appearance
Less incidence of self-concept
problems related to obesity
Opportunity to recognize and
accept personal limitations
Improved sense of well-being
Enjoyment of life and fun
Improved quality of life
Improved Wellness
Improved quality of life
Leisure-time enjoyment
Improved work capacity
Ability to meet emergencies
Improved creative capacity
Ability to enjoy leisure and work
Improved brain function
Fewer stress symptoms
Improved sleep habits
cor22568_ch04_065-084.indd 79 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
80 Section 2 ▶ An Introduction to Physical Activity
Physical activity is now recognized as effective
“medicine” for prevention of chronic disease.
Since physical activity is still not widely prescribed
or promoted by medical professionals, the American
College of Sports Medicine (ACSM) initiated a pro-
gram called “Exercise Is Medicine (EIM)” designed to
“encourage primary care physicians, and other health
care providers, to assess and review every patient’s
physical activity program at every visit.” The initiative
has taken off both in the United States and interna-
tionally. The website ( www.exerciseismedicine .org)
provides information to the general public, health-
care providers, health and fitness professionals, and
the media.
There are many positive lifestyles that can reduce
the risk for disease and promote health and
wellness. Inactivity, poor nutrition, smoking, and inabil-
ity to cope with stress are all risk factors associated with
various diseases (see Table 4 ). Changing these behaviors
can dramatically reduce the risk for chronic diseases.
Recognize, however, that three risk factors (age, heredity,
and gender) are not within your control.
By adopting healthy lifestyles, you can take con-
trol over the preventable disease risks. For example,
controlling body fatness reduces the risk for diabetes,
hypertension, and back problems. Altering your diet can
reduce the chances of developing high levels of blood
lipids and reduce the risk for atherosclerosis. Being
active and adopting healthy lifestyles is a proactive
approach to health and wellness. While reducing risk
can alter the probability of disease, it does not assure
disease immunity.
A CLOSER LOOK
Exercise Is Medicine
Although the health benefits of physical activity are read-
ily accepted by scientists, it is not always integrated
into medical practice. The “Exercise Is Medicine” ini-
tiative from the American College of Sports Medicine
offers considerable promise for advancing the promo-
tion of physical activity. Specific programming is also
targeted for college campuses. Visit the website (www
.exerciseismedicine.org) to review the overall goals of this
bold international health initiative.
Think of the title “Exercise Is Medicine” and explain why you
believe it was chosen. Would you take exercise more seriously
if it was recommended by your physician?
Exercise
A
edice Is Mecise Is Me
ACTIVITY
Factors That Cannot Be Altered
1. Age. As you grow older, your risk of contracting hypokinetic
diseases increases. For example, the risk for heart disease
is approximately three times as great after 60 as before. The
risk of back pain is considerably greater after 40.
2. Heredity. People who have a family history of hypokinetic
disease are more likely to develop a hypokinetic condi-
tion, such as heart disease, hypertension, back problems,
obesity, high blood lipid levels, and other problems.
African Americans are 45 percent more likely to have high
blood pressure than Caucasians; therefore, they suffer
strokes at an earlier age with more severe consequences.
3. Gender. Men have a higher incidence of many hypokinet-
ic conditions than women. However, differences between
men and women have decreased recently. This is espe-
cially true for heart disease, the leading cause of death for
both men and women. Postmenopausal women have a
higher heart disease risk than premenopausal women.
Factors That Can Be Altered
4. Regular physical activity. Regular exercise can help
reduce the risk for hypokinetic disease.
5. Diet. A clear association exists between hypokinetic
disease and certain types of diets. The excessive intake
of saturated fats, such as animal fats, is linked to athero-
sclerosis and other forms of heart disease. Excessive salt
in the diet is associated with high blood pressure.
6. Stress. People who are subject to excessive stress are pre-
disposed to various hypokinetic diseases, including heart
disease and back pain. Statistics indicate that hypokinetic
conditions are common among those in certain high-stress
jobs and those having Type A personality profi les.
7. Tobacco use. Smokers have fi ve times the risk of heart
attack as nonsmokers. Most striking is the difference in
risk between older women smokers and nonsmokers.
Tobacco use is also associated with the increased risk for
high blood pressure, cancer, and several other medical
conditions. Apparently, the more you use, the greater the
risk. Stopping tobacco use even after many years can
signifi cantly reduce the hypokinetic disease risk.
8. Body (fatness). Having too much body fat is a primary
risk factor for heart disease and is a risk factor for other
hypokinetic conditions as well. For example, loss of fat
can result in relief from symptoms of Type II diabetes, can
reduce problems associated with certain types of back
pain, and can reduce the risks of surgery.
9. Blood lipids, blood glucose, and blood pressure lev-
els. High scores on these factors are associated with
health problems, such as heart disease and diabetes.
Risk increases considerably when several of these mea-
sures are high.
10. Diseases. People who have one hypokinetic disease are
more likely to develop a second or even a third condition.
For example, if you have diabetes,* your risk of having
a heart attack or stroke increases dramatically. Although
you may not be entirely able to alter the extent to which
you develop certain diseases and conditions, reducing your
risk and following your doctor’s advice can improve your
odds signifi cantly.
*Some types of diabetes cannot be altered.
Table 4 ▶ Hypokinetic Disease Risk Factors
cor22568_ch04_065-084.indd 80 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
Concept 4 ▶ The Health Benefits of Physical Activity 81
Baker, L. D., et al. 2010 Effects of aerobic exercise on middle
cognitive impairment. Archives of Neurology 67(1):71–79.
Blanchard, C. M. 2012. Heart disease and physical activity:
Looking beyond patient characteristics. Exercise and Sports
Sciences Reviews 40(1):30–36.
Chodzko-Zajko, W. J., et al., 2009. Exercise and physical activ-
ity for older adults. Medicine & Science in Sports & Exercise
41(7):1510–1530.
Egan, B. M., et al. 2010. US trends in prevalence, awareness,
treatment, and control of hypertension, 1988–2008 . Journal
of the American Medical Association 303(20):2043–2050 .
Flegal, K. M. 2010. Prevalence and trends in obesity among
US adults. Journal of the American Medical Association
303(3):235–241.
Geda, Y. E., et al. 2010. Physical exercise, aging, and mild cog-
nitive impairment. Archives of Neurology 67(1): 80–86.
Gunter, K. B., et al. 2012. Physical activity in childhood may be
key to optimizing lifespan skeletal health. Exercise and Sports
Sciences Reviews 40(1):13–21.
Ogden, C. L., et al. 2010. Prevalence of high body mass index
in U.S. children and adolescents. Journal of the American
Medical Association 303(3):242–249.
Regensteiner, J. G., et al. (Eds.). 2009. Diabetes and Exercise.
Totowa, NJ: Humana Press.
Sorace, P., et al. 2010. Peripheral arterial disease. ACSM’s
Health and Fitness Journal 14(1):16–22.
Tangka, F. K., et al. 2010. Cancer treatment costs in the
United States. Cancer. Published online May 10,
2010, www.canceronlinejournal.com
Umpierre, D., et al. 2011. Physical activity advice only or
structured exercise training and association with HbA 1c
Web Resources
Alzheimer’s Association www.alz.org
American Cancer Society www.cancer.org
American Congress of Obstetricians and Gynecologists
www.acog.org
American Diabetes Association www.diabetes.org
American Heart Association www.americanheart.org
American Lung Association www.lungusa.org
Arthritis Foundation www.arthritis.org
Canadian Diabetes Association www.diabetes.ca
Centers for Disease Control and Prevention www.cdc.gov
Exercise Is Medicine www.exerciseismedicine.org
Framingham Heart Study Risk Questionnaires and
Surveys www.framinghamheartstudy.org
Healthy People 2020 www.healthypeople/2020/
Lance Armstrong Foundation www.livestrong.org
National Osteoporosis Foundation www.nof.org
National Stroke Association www.stroke.org
Physical Activity 360 www.physicalactivity360.org
Surgeon General www.surgeongeneral.gov
Women’s Health Initiative www.nhlbi.nih.gov/whi/
U.S. Physical Activity Guidelines http://www.health.gov/
paguidelines/
YouTube video (“23 and 1/2 Hours”) by Mike Evans http://
www.youtube.com/watch?v=aUaInS6HIGo
Suggested Readings
ACSM. 2010. ACSM’s Guidelines for Exercise Testing and Pre-
scription. 8th ed. Philadelphia: Lippincott, Williams &
Wilkins, Chapter 1.
Strategies for Action
A self-assessment of risk factors
can help you modify your lifestyle to
reduce risk for heart disease.The Heart Disease Risk Factor
Questionnaire in Lab 4A will help you assess your personal risk
factors for heart disease. It is not a substitute, however, for a
regular medical exam that includes an assessment of other
cardiovascular disease risk factors, such as cholesterol and
blood glucose. This will allow you to use more sophisticated
and accurate risk factor assessments (see the Heart360.org
tool highlighted in the Technology Update feature).
It is never too early to start being active to improve health.
Many of the studies presented in this concept indicate that
being “active for a lifetime” prevents health problems. Young
adults often think “I’ll worry about these problems when I get
older.” But what you do early in life has much to do with your
current health, as well as your health later in life.
Subsequent concepts in this book cover the different com-
ponents of health-related fitness and the type and amount of
activity needed to improve these components. The lab activi-
ties in each of these concepts and the culminating lab activity
at the end of this book are designed to help you begin plan-
ning now for lifelong physical activity.
ACTIVITY
cor22568_ch04_065-084.indd 81 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
82 Section 2 ▶ An Introduction to Physical Activity
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 con-
tent of this concept.
• Attain high-quality, longer lives free of preventable dis-
ease, injury, and premature death.
• Increase overall cardiovascular health; reduce heart dis-
ease, stroke, high blood pressure, and high blood choles-
terol; increase screening; increase awareness; and increase
emergency treatment by professionals or bystanders.
• Reduce cancer incidence and death rates, increase can-
cer patient longevity, increase survivor’s quality of life, and
increase cancer screening.
• Reduce diabetes incidence and death rates; increase dia-
betes screening, education, and care.
• Reduce depression and increase screening for depression
and mental health.
• Reduce osteoporosis (related hip fractures), pain of arthri-
tis, and limitations from chronic back pain.
• Increase percentage of college students receiving risk
factor information.
• Decrease activity limitations, especially in older adults
and disabled.
• Increase percentage of physicians who counsel or edu-
cate patients about exercise.
A national goal is to increase the percentage of college students
receiving risk factor information. How can your campus or community
health center have a bigger impact on student health and wellness?
Provide suggestions along with examples of current efforts.
levels in Type 2 Diabetes: A systematic review and
meta-analysis. Journal of the American Medical Association
305(17):1790–1799 .
U.S. Department of Health and Human Services. 2008. 2008
Physical Activity Guidelines for Americans. Washington, DC:
USDHHS. Available at www.health.gov/paguidelines
Wheatley, C. M., Wilkins, B. W., and Snyder, E. M. 2011.
Exercise is medicine in cystic fibrosis. Exercise & Sport
Sciences Reviews. 39(3):155–160.
Willey, J. Z., et al. 2011. Lower prevalence of silent brain
infarcts in the physically active: The Northern Manhattan
Study. Neurology 76(24):2112–2118.
cor22568_ch04_065-084.indd 82 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
83
A
sse
ss
in
g
H
e
a
rt D
is
e
a
se
R
isk F
a
c
to
rs
L
a
b
4
A
Lab 4A Assessing Heart Disease Risk Factors
Name Section Date
Purpose: To assess your risk of developing coronary heart disease. See page 84 for directions.
Heart Disease Risk Factor Questionnaire
Risk Points
Score
Unalterable Factors
1. How old are you? 30 or less 31–40 41–54 55+
2. Do you have a history of None Grandparent Parent with More than
heart disease in your family? with heart heart disease one with
disease heart disease
3. What is your gender? Female Male
Total Unalterable Risk Score
Alterable Factors
4. Do you get regular physical 4–5 days 3 days Fewer than 3 No
activity? a week a week days a week
5. Do you have a high-fat diet? No Slightly high Above normal Eat a lot of
in fat in fat meat and fried
and fatty foods
6. Are you under Less than Normal Slightly above Quite high
much stress? normal normal
7. Do you use tobacco? No Cigar or pipe Less than 1/2 More than 1/2
pack a day pack a day
or use smokeless
tobacco
8. What is your percentage F = 17–28% 29–31% 32–35% 35+%
of body fat?* M = 10–20% 21–23% 24–30% 30+%
9. What is the systolic number 120 121–140 141–160 160+
in your blood pressure?
10. Do you have other diseases? No Ulcer Diabetes** Both
Extra Points: Add points for as many of the following test results as you have available: 1 point for CRP above 3, 1 point for
homocysteine above 100, 3 points for LDL above 130, 3 points for TC/HDL-C above 4. If only total cholesterol is available,
add 1 point for a score of 200–240 or 3 points for scores above 240.
Total Alterable Risk Score
Extra Points
Grand Total Risk Score
Adapted from CAD Risk Assessor, William J. Stone. Reprinted by permission.
*If unknown, estimate your body fat percentage or see Lab 13A.
**Diabetes is a risk factor that is often not alterable.
4321
cor22568_ch04_065-084.indd 83 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
84
A
ss
e
ss
in
g
H
e
a
rt
D
is
e
a
se
R
is
k
F
a
c
to
rs
L
a
b
4
A
Procedures
1. Complete the 10 questions and the extra points, if available, on the Heart Disease Risk Factor Questionnaire by
circling the answer that is most appropriate for you (see front of this lab).
2. Look at the top of the column for each of your answers. In the box provided at the right of each question, write down
the number of risk points for that answer.
3. Determine your unalterable risk score by adding the risk points for questions 1, 2, and 3.
4. Determine your alterable risk score by adding the risk points for questions 4 through 10.
5. Determine your total heart disease risk score by adding the scores obtained in steps 3 and 4.
6. Look up your risk ratings on the Heart Disease Risk Rating Scale and record them in the Results section. Answer the
questions in the Conclusions and Implications section.
Results: Write your risk scores and risk ratings in the appropriate boxes below.
Score Rating
Unalterable risk
Alterable risk
Total heart disease risk
Conclusions and Implications: The higher your score on the Heart Disease Risk Factor Questionnaire, the greater
your heart disease risk. In several sentences, discuss your risk for heart disease. Which of the risk factors do you need
to control to reduce your risk for heart disease? Why?
Rating Unalterable Score Alterable Score Total Score
Very high 9 or more 21 or more 31 or more
High 7–8 15–20 26–30
Average 5–6 11–14 16–25
Low 4 or less 10 or less 15 or less
Heart Disease Risk Rating Chart
Heart Disease Risk Scores and Ratings
cor22568_ch04_065-084.indd 84 02/08/12 4:19 PM
F
O
S
T
E
R
,
C
E
D
R
I
C
1
6
9
2
T
S
- read
- read (2)
- read (3)
9780078022562_cover_cvr
9780078022562_ch01_001-020_print
9780078022562_ch03_043-064_print
9780078022562_ch04_065-084_print