Exercising, the smart way
By Dr. Mitchell Kahn, M.D.

So you (and everybody else) have made your New Year’s resolution: Get more exercise. Where do you start? What do you do next? Which activity — yoga, walking, swimming, tennis — is best?

First and most important: Find something you enjoy doing. The goal is to develop a new habit of exercising regularly and if you find an activity you like, you are much more likely to stay with it. Even mild exercise is a lot better than none.

The main goals of exercise are to help maintain normal joint movement, increase muscle flexibility and strength, help maintain weight, and keep bone and cartilage tissue strong and healthy, improve endurance and cardiovascular fitness, and reduce stress. A physical fitness program includes range-of-motion, strength-building and endurance-building exercises. Different activities have different balances of these components.

Know your limits
Taking up a new sport or physical conditioning activity requires some thought – especially if you have been inactive. Choose an exercise you like, but also one that fits your limitations. Tennis or jogging, for example, would not be a successful endeavor for someone with bad knees.

Before starting anything more than a gentle walking or stretching program, consult with your doctor. Anyone with risk factors for heart disease would be wise to get a stress test before any vigorous exercises are attempted. A general check-up could identify factors which would point towards or away from a particular activity.

All exercise programs should start with range-of-motion (also called stretching or flexibility) exercises, which help maintain normal joint function by increasing and preserving mobility and flexibility. In this group of exercises, gently straightening and bending the joints in a controlled manner as far as they comfortably will go, can help condition affected joints. During a range-of-motion exercise program the joints are stretched progressively farther (maintaining comfort levels) until normal or near-normal range is achieved and maintained.

Range-of-motion exercises are also an important form of warm-up and stretching, and should be done prior to performing strengthening or endurance exercises, or engaging in any other physical activity.

Walking is one of the easiest exercises to begin because it requires no special skills or equipment other than good, supportive walking shoes, and it’s less stressful on joints than running or jogging. Biking and swimming are good choices because they place less stress on knee, foot and ankle joints.

Start with 15 to 20 minutes of aerobic activity at least three times a week, then gradually build up to 30 minutes daily. The activity also should include at least five to 10 minutes of warm-up plus five to 10 minutes of cool-down.

Although peak benefits are achieved when an aerobic activity is performed continuously for at least 30 minutes, aerobic exercise can be spread out in smaller segments of time throughout the day to suit your comfort level, without overexerting yourself. Aerobic exercise should be performed at a comfortable, steady pace that allows you to speak normally and easily during the activity.

During exercise, your heart’s “training range” or target heart rate should be closely monitored. To improve your body’s aerobic condition, calculate your estimated maximum heart rate by subtracting your age from 220. Then exercise at a level of intensity between 60% and 80% of your maximum heart rate.

Start slowly
If you are just beginning an exercise program, spend some time conditioning with only range-of-motion and strengthening exercises, depending on your physical condition and level of fitness. Endurance exercises should be added gradually, and only after you feel comfortable with your fitness level.

Be aware that your body will need time to adapt to your new program. During the first few weeks, you may notice changes in the way your muscles feel, your sleep patterns or energy levels. These changes are to be expected with increased activity. However, improper exercise levels or programs may be harmful, putting excess strain on joints or your cardiovascular system. Check with your doctor and adjust your program if you experience unusual or persistent fatigue, sharp or increased pain, increased weakness, decreased range of motion, increased joint swelling or just continuing pain.

Regardless of the exercise program you select, it’s important to begin slowly and have fun so that you will continue to do it. Make exercise part of your daily routine so that it becomes a lifetime habit.

Mitchell Kahn, M.D. is Assistant Clinical Professor of Medicine at Columbia Medical School and is Director of the Miller Health Care Institute at New York’s St. Luke’s-Roosevelt Hospital.