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Exercise

Description:

An in-depth report about the benefits and types of exercise.



Highlights: Overview
  • Exercise is important for physical health and mood.
  • The American Heart Association recommends that individuals do moderate exercise for at least 150 minutes per week, or vigorous exercise for 75 minutes per week.
  • No one is too young or too old to exercise.
  • Find an activity you enjoy, vary your activity daily, or join a group exercise program. Group exercise can take place in a number of settings including community (local centers and churches), hospital, and workplace.
Benefits of Exercising
  • Exercise is associated with lower all-cause mortality in healthy individuals, as well as those with chronic diseases, diabetes, and older adults.
  • Studies clearly show that exercise helps the heart, both by improving exercise capacity and reducing the risk of heart disease and premature death. In addition, studies report that even people with heart disease can gain important benefits from exercising, though they need medical clearance and special precautions.
  • A recent review of available studies has shown that exercise benefits patients at all stages of dementia, improving balance, mobility, and the ability to perform basic activities of daily living.
  • Aerobic exercise and resistance training, alone or in combination, improves blood sugar control in patients with type 2 diabetes.
Tips for Exercising
  • Drink plenty of fluids before, during, and after a workout.
  • Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and can help prevent soreness or injury, especially in older people.
  • Wear clothing that wicks moisture away from the body if you plan to sweat a lot. These include Dri-FIT, Supplex, and CoolMax fabrics.
  • Be aware of temperature, humidity, and air quality when exercising indoors or outside. Exercising in very hot or cold temperatures can pose a hazard if you are not prepared.
  • When exercising, listen to your body for warning symptoms, such as pain, numbness, or trouble breathing.
Motivation:
  • Develop an interest or hobby that requires physical activity.
  • Adopt simple routines such as climbing the stairs instead of taking the elevator, walking instead of driving to the local newsstand, or canoeing instead of zooming along in a powerboat.
  • Try cross training (alternating between several types of exercises).
  • Exercise with friends. Walking in groups can be an effective way to increase physical activity.


Introduction:
Exercise

To enjoy a long and healthy life, everyone should make wise lifestyle choices that include eating a healthy diet, exercising regularly, and maintaining normal weight. The combination of inactivity and eating the wrong foods is the second most common preventable cause of death in the United States (smoking is the first).

Most research on the benefits of exercise focuses on heart protection. Studies clearly show that exercise helps the heart. In addition, studies are reporting that even people with heart disease may gain important benefits from exercising, though they need medical clearance and special precautions.

Evidence suggests that our genes evolved to favor exercise. In other words, during prehistoric times, if a person couldn't move quickly and wasn't strong, that person died. Those who were fit survived to reproduce and pass on their "fitter" genes. Some researchers believe that with our current inactive lifestyle, these genes produce a number of bad effects, which can lead to many chronic illnesses.

The benefits of exercise include:

  • Decreased risk of cardiovascular (heart) disease, high blood pressure, and stroke
  • Decreased risk of colon and breast cancers
  • Decreased risk of diabetes
  • Decreased risk of osteoporosis
  • Decreased risk of depression and dementia
  • Decreased body fat
  • Improved metabolic processes -- the way the body breaks down and builds necessary substances
  • Improved movement of joints and muscles
  • Improved oxygen delivery throughout the body
  • Improved sense of well-being
  • Improved strength and endurance
  • Reduced inflammation

In addition, exercise can help change other dangerous lifestyle habits. In one trial, exercise more than doubled the likelihood of not smoking after 12 months, but more research is necessary due to the limitations of other studies. Trials are underway to assess the effects of exercise on nicotine cravings and smoking cessation. The Quit For Health (QFH) trial, for example, may help to determine the efficacy of aerobic exercise as an adjunct smoking cessation treatment among women.

No one is too young or too old to exercise. The American Heart Association recommends that individuals do moderate exercise, such as brisk walking, for at least 150 minutes per week, or vigorous exercise for 75 minutes per week. However, vigorous exercise carries risks that people should discuss with a doctor. You should always check with your doctor before starting a new exercise program, especially if you have any of the following risk factors:

  • A symptom you have never told your doctor about
  • Arthritis of the hips or knees
  • Blood clots
  • Chest pain
  • Chronic lung disease
  • Diabetes
  • Eye injury or recent eye surgery
  • Family history of a cardiovascular disease
  • Foot or ankle sores that won't heal
  • Heart disease
  • Heart palpitations
  • Hernia
  • High blood pressure
  • History of smoking
  • Infections
  • Joint swelling
  • Obesity
  • Pain or trouble walking after a fall
  • Shortness of breath

Fifty percent of all people who begin a vigorous training program drop out within a year. The key to reaching and maintaining physical fitness is to find activities that are exciting, challenging, and satisfying.



Recommended Exercise Methods:



Warming up and cooling down





A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.



A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.




A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.



A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.





A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.



A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.




A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.



A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.


Warming up and cooling down





A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an accuracy of about 95%):

  • After running at top pace for 15 minutes, round off the distance run to the nearest 25 meters.
  • Divide that number by 15.
  • Subtract 133.
  • Multiply the total by 0.172, and then add 33.3.

Olympic and professional athletes train for VO2 max levels above 80. A VO2 max equaling between 50 and 80 is considered an excellent score for overall fitness. For the average person exercising for fitness and health, this value is not necessary.

 Click the icon to see an image of exercise and heart rate. 

Warm-Up and Cool-Down

Warming up and cooling down are important parts of every exercise routine. They help the body make the transition from rest to activity and back again, and may help prevent soreness or injury, especially in older people.

  • Perform warm-up exercises for 5 to 10 minutes at the beginning of an exercise session. Older people need a longer period to warm up their muscles. Stretching exercises, gentle calisthenics, and walking are ideal.
  • To cool down, you should walk slowly until the heart rate is 10 to 15 beats above your resting heart rate. Stopping too suddenly can sharply reduce blood pressure, and is dangerous for older people. It may also cause muscle cramping.
  • Stretching may be appropriate for the cooling down period, but it must be done carefully for warming up because it can injure cold muscles.
By properly warming up the muscles and joints with low-level aerobic movement for 5 to 10 minutes one may help avoid injury. Cooling down after exercise by walking slowly, then stretching muscles, may also prevent strains and blood pressure fluctuation.

For most people, exercise may be divided into three general categories:

  • Aerobic or endurance
  • Strength or resistance
  • Flexibility

A balanced program should include all three. Speed training is also a major category, but generally only competitive athletes practice it.

Aerobic (Endurance) Training

Benefits of Aerobic Exercise. Regular aerobic exercise provides the following benefits:

  • Protection from heart attack, stroke, diabetes, dementia, depression, colon and breast cancers, and early death
  • Builds endurance
  • Keeps the heart pumping at a steady and high rate for a long time
  • Boosts HDL ("good") cholesterol levels
  • Helps control blood pressure
  • Strengthens the bones
  • Helps maintain normal weight
  • Improves one's sense of well-being

Types of Aerobic Exercise. Aerobic exercise is usually categorized as high or low intensity. High intensity aerobic exercise is further classified as high or low impact. Examples of each include the following:

  • Low- to moderate-impact exercises: Walking, swimming, stair climbing, step classes, rowing, and cross-country skiing. Nearly anyone in reasonable health can engage in some low- to moderate-impact exercise. Brisk walking burns as many calories as jogging for the same distance and poses less risk for injury to muscle and bone.
  • High-impact exercises: Running, dance exercise, tennis, racquetball, squash. High impact exercises are excellent for cardiovascular conditioning, but they increase the risk of complications and are generally not suitable for people who are overweight, elderly, out of condition, or have an injury, arthritis, or other medical problem.
 Click the icon to see an image of aerobic exercise. 

Aerobic Regimens. As little as 1 hour a week of aerobic exercises is helpful, but 3 to 4 hours per week are best. Some research indicates that simply walking briskly for 3 or more hours a week reduces the risk for coronary heart disease by 45%. In general, the following guidelines are useful for most individuals:

  • For most healthy young adults, the best approach is a mix of low- and higher-impact exercise. Two weekly workouts will maintain fitness, but three to five sessions a week are better.
  • People who are out of shape or elderly should start aerobic training gradually. For example, they may start with 5 to 10 minutes of low-impact aerobic activity every other day and build toward a goal of 30 minutes per day, three to seven times a week. (For heart protection, weekly total is the key.)
  • Swimming is an ideal exercise for many elderly people, and for certain people with physical limitations. People with physical limitations include pregnant women, individuals with muscle, joint, or bone problems, and those who suffer from exercise-induced asthma.
  • People who seek to lose weight should concentrate on calories burnt each week, not the number of workout sessions.

One way of gauging the aerobic intensity of exercise is to aim for a "talking pace," which is enough to work up a sweat and still be able to converse with a friend without gasping for breath. As fitness increases, the "talking pace" will become faster and faster.

Shoes. Choose a good pair of athletic shoes that are made well and fit well. They should support the ankle and provide cushioning for walking as well as for impact sports such as running or aerobic dancing. See the chart below.

Airing out the shoes and feet after exercising reduces chances for skin conditions such as athlete's foot. You can also purchase socks made with quick-drying fabrics that absorb sweat.

Clothing. Comfort and safety are the key words for workout clothing. For outdoor nighttime exercise, a reflective vest and light-colored clothing must be worn. Bikers, inline skaters, and equestrians should always wear safety devices such as helmets, wrist guards, and knee and elbow pads. Goggles are mandatory for indoor racquet sports. For vigorous athletic activities, such as football, ankle braces may be more effective than tape in preventing ankle injuries.

If you are going to sweat, or workout in warm conditions, choose fabrics that pull sweat away from your skin and dry quickly. Many quick-drying fabrics are synthetic, made of polyester or polypropylene. Look for terms like moisture-wicking, Dri-FIT, CoolMax, or Supplex. Wool is also a good choice to keep you cool, dry, and naturally odor-free. Some workout clothing is made with special antimicrobial solutions to combat odor from sweat.

Cotton clothing is OK for light activities, but it is not the best choice. Cotton absorbs sweat, and does not dry quickly. Because it stays wet, it can make you cold, which can be dangerous in cold weather. In warm weather, it’s not as good as synthetic fabrics at keeping you cool and dry if you sweat a lot. 

Avoid working out in fabrics that do not breathe, like Gortex, plastics, or rubber-based materials. 

In general, make sure your clothing does not get in the way of your activity. You want to be able to move easily. Clothing should not catch on equipment, or slow you down.

You can wear loose-fitting clothing for activities like:

  • Walking
  • Gentle yoga
  • Strength training
  • Basketball

You may want to wear form-fitted, stretchy clothing for activities like:

  • Running
  • Biking
  • Advanced yoga/Pilates
  • Swimming

You may be able to wear a combination of loose and form-fitting clothing. For example, you might wear a moisture-wicking loose t-shirt, with fitted shorts.

Aerobic Exercise Equipment. Home aerobic exercise machines can be adapted to any fitness level and used day or night. Before investing in any exercise machine, however, it is wise to first test it at a gym. In addition, initial supervised training when using these machines can reduce the risk of injury that might occur with self-instruction.

Very inexpensive exercise machines tend to be flimsy and hard to adjust, but many sturdy machines are available at moderate prices. The higher-end models may utilize computers to record calories burned, speed, and mileage. Their readouts may provide motivation and gauge the intensity of a workout; however, they are not always accurate.

The following are a few observations on specific equipment:

  • A good floor mat is important to provide cushioning for all home exercises.
  • A simple jump rope improves aerobic endurance for people who are able to perform high-impact exercise. Jumping rope should be done on a floor mat plus a surface that has some give to avoid joint injury.
  • For burning calories, the treadmill has been ranked best, followed by stair climbers, the rowing machine, cross-country ski machine, and stationary bicycle. (Elliptical trainers, however, may be even better than treadmills for increasing heart rate, calorie expenditure, and oxygen consumption.)
  • Stationary bikes condition leg muscles and are fairly economical and easy to use safely. The pedals should turn smoothly, the seat height should adjust easily, and the bike's computer should be able to adjust intensity.
  • Stair machines also condition leg muscles. They offer very intense, low-impact workouts and may be as effective as running with less chance of injury.

Rowing and cross-country ski machines exercise both the upper and lower body.

Shoes for Sports

Aerobic dancing

Sufficient cushioning to absorb shock and pressure that are many times greater than ordinary walking. Arches that maintain side-to-side stability. Thick upper leather support. Toe-box. Orthotics may be required for people with ankles that over-turn inward or outward. Soles should allow for twisting and turning.

Cycling

Rigid support across the arch to distribute pressure during pedaling. Heel lift. Cross-training or combination hiking/cycling shoes may be sufficient for casual bikers. Toe clips or specially designed shoe cleats for serious cyclers. In some cases, orthotics may be needed to control arch and heel and balance forefoot.

Running

Sufficient cushioning to absorb shock and pressure. Flexible at the ball of the foot. Sufficient traction on sole to prevent slipping. Consider insoles or orthotics with arch support for problem feet.

Tennis

Low-traction soles. Snug fitting heels with cushioning. Padded toe box with adequate depth. Soft-support arch.

Walking

Lightweight. Breathable upper material (leather or mesh). Wide enough to accommodate ball of the foot. Firm padded heel counter that does not bite into heel or touch ankle bone. Low heel close to ground for stability. Good arch support. Front provides support and flexibility.                     

Sports such as Basketball, Football, SoccerChoose sport-specific sneakers or cleats that match the activity.

Strength or Resistance Training

Benefits of Strength Exercise. While aerobic exercise increases endurance and helps the heart, it does not build upper body strength or tone muscles. Strength-training exercises provide the following benefits:

  • Build muscle strength while burning fat
  • Help maintain bone density

Strength training exercises are also associated with a lower risk for heart disease, possibly because it lowers LDL (the so-called "bad" cholesterol) levels.

 Click the icon to see an image of HDL and LDL. 

Strength exercise is beneficial for everyone, even people in their 90s. It is the only form of exercise that can slow and even reverse the decline in muscle mass, bone density, and strength that occur with aging.

Note: People at risk for cardiovascular disease should not perform strength exercises without checking with a doctor.

Types of Muscle Contractions. There are three types of muscle contractions involved in strength training:

  • Isometric contractions do not change the length of the muscle. An example is pushing against a wall.
  • Concentric contractions shorten muscles. An example is the "up" phase of the biceps curl.
  • Eccentric contractions lengthen muscles. An example is the "down" phase as weights are lowered.
 Click the icon to see an image of isometric exercise. 

Strength Training Regimens. Strength training involves intense and short-duration activities. For beginners, adding 10 to 20 minutes of modest strength training two to three times a week may be appropriate. The following are some guidelines for starting a strength regimen:

  • The sequence of a strength training session should begin with training large muscles and multiple joints at higher intensity, and end with small muscle and single joint exercises at lower intensities.
  • You should perform both shortening and lengthening muscle actions. Emphasizing the movements that lengthen muscles is of increasing interest. This approach involves slowing and increasing the duration of these "down" movements. It appears to significantly increase blood flow, and some evidence suggests it may achieve stronger muscles more quickly. It may also improve heart function compared to standard movements. Exercises that lengthen muscles may be particularly beneficial for older people and some people with chronic health problems. This type of training increases the risk for muscle soreness and injury, however, and this approach is still controversial.
  • Strength training involves moving specific muscles in the same pattern against a resisting force (such as a weight) for a preset number of times. This is called a repetition. People should first choose a weight that is about half of what would require a maximum effort in one repetition. In other words, if it would take maximum effort to do a single repetition with a 10-pound dumbbell, the person would start with a five-pound dumbbell. In the beginning, most people can start with one set of 8 to 15 repetitions per muscle group with low weights. As individuals are able to perform one or two repetitions over their routine, weights can be increased by 2 to 10%.
  • Breathe slowly and rhythmically. Exhale as the movement begins. Inhale when returning to the starting point.
  • The first half of each repetition typically lasts 2 to 3 seconds. The return to the original position lasts 4 seconds.
  • Joints should be moved rhythmically through their full range of motion during a repetition. Do not lock up the joint while exercising it.
  • For maximum benefit, allow 48 hours between workouts for full muscle recovery.
 Click the icon to see an image of proper breathing during exercise. 

Strength Training Equipment. Unlike aerobic exercise, strength training almost always requires some equipment. Strength-training equipment does not, however, have to cost anything.

  • Any heavy object that can be held in the hand, such as a plastic bottle filled with sand or water, can serve as a weight.
  • Dumbbells (1 to 10 pounds) and resistance bands are inexpensive, portable, and effective.
  • Wearable wrist weights help strengthen and tone the upper body.
  • Ankle weights strengthen and tone muscles in the lower body. They should not be worn during high-impact aerobics or jumping.
  • Hand grips strengthen arms and are good for relieving tension.
  • A pull-up bar can be mounted in a doorway for chin-ups and pull-ups.

More elaborate and expensive home equipment for working body muscles is also available, costing from $100 to more than $1,000. No one should purchase or use strength-training equipment without instruction from a professional.

Flexibility Training (Stretching)

Benefits of Flexibility Training. Flexibility training uses stretching exercises. Many stretching exercises are particularly beneficial for the back. In general, flexibility training provides the following benefits:

  • Prevents cramps, stiffness, and injuries
  • Improves joint and muscle movement (improved range of motion)

Certain flexibility practices, such as yoga and Tai chi, also involve meditation and breathing techniques that reduce stress. Such practices appear to have many health and mental benefits. They may be very suitable and highly beneficial for older people, and for patients with certain chronic diseases.

 Click the icon to see an image of flexibility exercise. 

Flexibility Training Regiments. Doctors recommend performing stretching exercises for 10 to 12 minutes at least three times a week. The following are some general guidelines:

  • When stretching, exhale and extend the muscles to the point of tension, not pain, and hold for 20 to 60 seconds. (Beginners may need to start with a 5- to 10-second stretch.)
  • Breathe evenly and constantly while holding the stretch.
  • Inhale when returning to a relaxed position. Holding your breath defeats the purpose; it causes muscle contraction and raises blood pressure.
  • When doing stretches that involve the back, relax the spine to keep the lower back flush with the mat, and to work only the muscles required for changing position (often these are only the abdominal muscles).

Specific Exercise Tips for Older People

Studies continue to show that it is never too late to start exercising. Elderly adults who exercise twice a week can significantly increase their body strength, flexibility, balance, and agility. Studies show that even small improvements in physical fitness and activity can prolong life and independent living. A recent study based on a 35-year follow-up showed that in men who increased their physical activity at age 50, the reduction in mortality rate was similar to that of smoking cessation. In fact, after 10 years of increased physical activity, these men had the same mortality rate for their age group as men who were highly physically active throughout entire adult their lives.

Still, according to the 2010 Healthy People report by the Centers for Disease Control and Prevention, 46% of people aged 65 - 74 did not engage in any leisure time physical activity in 2008, the last year for which figures were available. In people over age 75, the percentage of those not engaged in any leisure time physical activity was 56%.

The following tips for exercising may be helpful:

  • Any older person should have a complete physical and medical examination, as well as professional instruction, before starting an exercise program.
  • Start low and go slow. For sedentary, older people, one or more of the following programs may be helpful and safe: Low-impact aerobics, gait (step) training, balance exercises, Tai chi, self-paced walking, and lower legs resistance training, using elastic tubing or ankle weights. Even in the nursing home, programs aimed at improving strength, balance, gait, and flexibility have significant benefits.
  • Strength training assumes even more importance as one ages, because after age 30 everyone undergoes a slow process of muscular weakening (atrophy). This process can be reduced or even reversed by adding resistance training to an exercise program. As little as 1 day a week of resistance training improves overall strength and agility. Strength training also improves heart and blood vessel health.
  • Flexibility exercises promote healthy muscles and help reduce the stiffness and loss of balance that accompanies aging.
  • Chair exercises may be performed by people who are unable to walk.
  • Older women are at risk for incontinence accidents during exercise. This can be reduced or prevented by performing Kegel exercises, limiting fluids (without risking dehydration), going to the bathroom frequently, and using leakage prevention pads or insertable devices.

A few simple rules are helpful as you develop your own routine.

  • Do not eat for 2 hours before vigorous exercise.
  • Drink plenty of fluids before, during, and after a workout.
  • Adjust your activity level according to the weather, and reduce it when you are fatigued or ill.

When exercising, listen to the body's warning symptoms, and consult a doctor if exercise causes chest pain, irregular heartbeat, unusual fatigue, nausea, unexpected breathlessness, or light-headedness.

Heart Rate Goal

Heart rate is the standard guide for determining aerobic exercise intensity. It is useful for people training at aerobic intensity, or people with certain cardiac risk factors who have been set a maximum heart rate by their doctor. You can determine your heart rate by counting your pulse, or by using a heart rate monitor. To feel your own pulse, press the first two fingers of one hand gently down on the inside of the wrist or under the jaw on the right or left side of the front of the neck. You should feel a faint pounding as blood passes through the artery. Each pounding is a beat.

 Click the icon to see an image of checking your pulse on your wrist.   Click the icon to see an image of taking your carotid pulse. 

There are different types of heart rates.

Resting heart rate. The average heart rate for a person at rest is 60 to 80 beats per minute. It is usually lower for people who are physically fit, and often rises as you get older. You can determine your resting heart rate by counting how many times your heart beats in one minute. The best time to do this is in the morning after a good night's sleep before you get out of bed.

Maximum heart rate. To determine your own maximum heart rate per minute subtract your age from 220. For example, if you are 45, you would calculate your maximum heart rate as follows: 220 - 45 = 175.

Target heart rate. Your target rate is 50 to 75% of your maximum heart rate. You should measure your pulse off and on while you exercise to make sure you stay within this range. After about 6 months of regular exercise, you may be able to increase your target heart rate to 85% (but only if you can comfortably do so).

Certain heart medications may lower your maximum and target heart rates. Always check with your doctor before starting an exercise program.

Note: Swimmers should use a heart rate target of 75% of the maximum and then subtract 12 beats per minute. The reason for this is that swimming will not raise the heart rate quite as much as other sports because of the so-called "diving reflex," which causes the heart to slow down automatically when the body is immersed in water.

Target Heart Rates for a One-minute Pulse Count

Age

Low

High


(50% max.)

(75% max.)

20

100

150

30

95

142

40

90

135

50

85

127

60

80

120

Source: American Heart Association

VO2 Max. Serious exercisers may use a VO2 max calculation, which measures the amount of oxygen consumed during intensive, all-out exercise. The most accurate testing method uses computers, but anyone can estimate V02 without instrumentation (with an ac