Professional Documents
Culture Documents
WFE 101
• Environmental • Occupational
Physical Emotional
Social Spiritual
• Financial • Intellectual
Cultural
To watch a video about the nine dimensions The link below is to Healthy People 2030’s
of wellness, click on the following link: website, which contains data and technical
information about this organization’s
Video on the Nine Dimensions of Wellness objectives:
• Stage 1: Precontemplation
The Transtheoretical Model, also called the In this stage, people do not intend
Stages of Change Model, was developed by to take action in the foreseeable
James Prochaska and Carlo DiClemente in future (defined as within the next 6
the late 1970s. Considered the dominant months). People are often unaware
model for describing how behavior changes that their behavior is problematic or
occur, it evolved through studies examining produces negative consequences.
the experiences of smokers who quit on People in this stage often
their own and comparing them with the underestimate the pros of changing
experiences of those requiring further behavior and place too much
treatment. The goal of those studies was to emphasis on the cons of changing
understand why some people were capable behavior. 2
of quitting on their own. It was determined
that people quit smoking if they were ready
to do so. Thus, the Transtheoretical Model
(TTM) focuses on the decision-making of
Healthy Behaviors and Wellness 4
Figure 1 Boston University School of Public Health Behavioral Change Models. (n.d.). Retrieved January 19, 2021, from
https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/BehavioralChangeTheories6.html
To read more about these barriers to • Make a plan that will stick.
change, including strategies for overcoming Your plan is a map that will guide
these barriers, read Dr. Olson’s entire you on this journey of change. You
article linked below: can even think of it as an adventure.
When making your plan, be specific.
Psychological Barriers to Behavior Change Want to exercise more? Detail the
time of day when you can take walks
A presentation on overcoming barriers to and how long you will walk. Write
change by the National Institute for Health everything down, and ask yourself if
and Clinical Excellence (NHS) is linked you are confident that these
below: activities and goals are realistic for
you. If not, start with smaller steps.
Overcoming Barriers to Change Post your plan where you will most
often see it as a reminder.
Barriers- something that stands in the way of you achieving your goals
3. Which of the following is the least likely to affect a college student’s wellness?
a. Retirement income
b. School
c. Screen time
d. Drugs
5. Visualization is
a. Picturing a pro-con list
b. Seeing yourself laying on the beach
c. Seeing yourself accomplish a goal
d. Picturing yourself falling asleep
Objectives:
• Describe the origins of exercise
• Define physical activity and exercise
• Discuss principles of adaptation to stress
• Provide guidelines for creating a successful fitness program
• Identify safety concerns
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Flynn | FITNESS PRINCIPLES
and activities. Ancient Mayans organized the there is indisputable evidence that regular
first team game called the Ball Game. It exercise promotes healthy functioning of the
consisted of two teams trying to get a ball brain, heart, and the skeletal and muscular
through a hoop mounted approximately 23 feet systems. Exercise also reduces risk for chronic
on a wall. The rules were to get the ball through diseases, such as cancer, diabetes, and obesity.
the hoop using certain parts of the body. In Regular exercise can even improve emotional
some cases the captain of the losing team gave health and overall wellbeing.
himself as a human sacrifice to the winning
team, an act that was believed by the Mayans Physical Activity and
to be a vital part of prosperity.
Exercise
American Indians are thought to have founded
the modern game of lacrosse, as well as other Physical activity is defined as any movement
stick games. Lacrosse, which received its name carried out by skeletal muscles that requires
from French settlers, was more than a form of energy. Health benefits include improved blood
recreation. It was a cultural event used to settle pressure, blood-lipid profile, and heart health.
disputes between tribes. Acceptable physical activity includes yard work,
house cleaning, walking the dog, or taking the
stairs instead of the elevator. Physical activity
does not have to be done all at once. It can be
accumulated through various activities
throughout the day. Although typing on a
phone or laptop or playing video games does
involve skeletal muscle and requires a minimal
amount of energy, the amount required is not
sufficient to improve health.
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repetitive movement pattern intended to • Flexibility
improve or maintain fitness. As a positive side- Flexibility is the ability to move your
effect, it significantly improves health and joints through a full range of motion.
wellness too. Fitness improvements include the
heart’s ability to pump blood, increased muscle
• Body Composition
size, better flexibility, and even improved brain
Body composition is the relative
function.
amount of fat mass to fat-free (lean)
mass.
Components of Health-Related
Fitness As previously stated, these areas are significant
in that they influence your quality of life and
In order to carry out daily activities without overall health and wellness.
being physically overwhelmed, a minimal level
of fitness is required. To perform daily activities
without fatigue, it is necessary to maintain
Skill-Related Components of Fitness
health in five areas: cardiorespiratory
In addition to the five health-related
endurance, muscular strength, muscular
components, there are six skill-related
endurance, flexibility, and body composition.
components of fitness. These assist in
These five areas are called the components of
developing neuromuscular fitness used in
health-related fitness. Development of these
sports and activities: speed, agility,
areas will improve your quality of life, reduce
coordination, balance, power, and reaction
your risk of chronic disease, and optimize your
time. Although important, these areas do not
health and wellness. Each of these five areas
directly affect a person’s health. However, they
will be explored in depth at a later time. Below
may indirectly affect the five areas associated
is a brief description of each.
with health-related fitness. For example,
coordination of muscle movements may be
• Cardiorespiratory endurance helpful in developing muscular strength through
Cardiorespiratory endurance is the resistance training. Skill-related components
ability to carry out prolonged, large are more often associated with sports
muscle, dynamic movements at a performance and skill development. They are
moderate to high level of intensity. This also important to prevent injury (especially falls
involves the ability of your heart, blood, in older adults).
blood vessels, and lungs to supply
oxygen to working muscles.
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example, a computer programmer who sits the lifter notices the 150 pounds feels
at a desk all day may push his/her easier during the lift and afterwards causes
cardiorespiratory system to its limits simply less fatigue. The lifter adds 20 pounds and
by walking up several flights of stairs. For an continues with the newly established stress
avid runner, resistance training may expose of 170 pounds. The lifter will continue to
the runner’s muscles to muscular get stronger until his/her maximum
contractions the athlete is not accustomed capacity has been reached, or the stress
to feeling. Although stress is relative to stays the same, at which point the lifter’s
each individual, there are guiding principles strength will simply plateau. This same
in exercise that can help individuals manage principle can be applied not only to gain
how much stress they experience to avoid muscular strength, but also to gain
injury and optimize their body’s capacity to flexibility, muscular fitness, and
adapt. Knowing a little about these cardiorespiratory endurance.
principles provides valuable insights needed
for organizing an effective fitness plan. FITT
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not enough to adequately stress the
system. According to the overload principle, Type of Exercise
as fitness improves, so must the stress to
ensure continued gains and to avoid Simply put, the type of exercise performed
plateauing. should reflect a person’s goals. In
cardiorespiratory fitness, the objective of
The duration of exercise, or time, also the exercise is to stimulate the
contributes to the amount of stress cardiorespiratory system. Activities that
experienced during a workout. Certainly, a accomplish this objective include walking,
30-minute brisk walk is less stressful on the jogging, swimming, biking, dancing, cross
body than a 4-hour marathon. country skiing, aerobic classes, and much
more. As such, these activities can be used
Although independent of one another, to build lung capacity and improve cellular
frequency and time are often combined and heart function.
into the blanket term, volume. The idea is
that volume more accurately reflects the However, the more specific the exercise,
amount of stress experienced. This can be the better. While vigorous ballroom dancing
connected to the progression principle. For will certainly help develop the
example, when attempting to create a cardiorespiratory system, it will unlikely
jogging plan, you may organize 2 weeks like improve a person’s 10k time. To improve
this: performance in a 10k, athletes spend the
majority of their time training by running,
• Week 1: three days a week at 30 as they will have to do in the actual 10k.
minutes per session Cyclists training for the Tour de France,
• Week 2: four days a week at 45 spend up to six hours a day in the saddle,
minutes per session peddling feverishly. These athletes know
the importance of training the way they
At first glance, this might appear to be a want their body to adapt. This concept,
good progression of frequency and time. called the principle of specificity, should be
However, when calculated in terms of taken into consideration when creating a
volume, the aggressive nature of the training plan. A good way to think of
progression is revealed. In week 1, three specificity is “you get what you train for”.
days at 30 minutes per session equals 90
minutes of total exercise. In week two, this In this discussion of type and the principle
amount was doubled with four days at 45 of specificity, a few additional items should
minutes, equaling 180 minutes of total be considered. Stress, as it relates to
exercise. Doing too much, too soon, will exercise, is very specific. There are multiple
almost certainly lead to burnout, severe types of stress. The three main stressors are
fatigue, and injury. The progression metabolic stress, force stress, and
principle relates to an optimal overload of environmental stress. Keep in mind, the
the body by finding an amount that will body will adapt based on the type of stress
drive adaptation without compromising being placed on it.
safety.
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Metabolic stress results from exercise
sessions when the energy systems of the In summary, to improve performance, being
body are taxed. For example, sprinting short specific in your training, or training the way
distances requires near maximum intensity you want to adapt, is paramount.
and requires energy (ATP) to be produced
primarily through anaerobic pathways, that
is, pathways not requiring oxygen to Intensity
produce ATP. Anaerobic energy production
can only be supported for a very limited Intensity, the degree of difficulty at which
time (10 seconds to 2 minutes). However, the exercise is carried out, is the most
distance running at steady paces requires important variable of FITT. More than any
aerobic energy production, which can last of the other components, intensity drives
for hours. As a result, the training strategy adaptation. Because of its importance, it is
for the distance runner must be different imperative for those beginning a fitness
than the training plan of a sprinter, so the program to quantify intensity, as opposed
energy systems will adequately adapt. to estimating it as hard, easy, or
somewhere in between. Not only will this
Likewise, force stress accounts for the numeric value provide a better
amount of force required during an activity. understanding of the effort level during the
In weightlifting, significant force production exercise session, but it will also help in
is required to lift heavy loads. The type of designing sessions that accommodate
muscles being developed, fast-twitch individual goals.
muscle fibers, must be recruited to support
the activity. In walking and jogging, the How then can intensity be measured? Heart
forces being absorbed come from the body rate is one of the best ways to measure a
weight combined with forward momentum. person’s effort level for cardiorespiratory
Slow twitch fibers, which are unable to fitness. Using a percentage of maximum
generate as much force as the fast twitch lifting capacity would be the measure used
fibers, are the type of muscle fibers for resistance training.
primarily recruited in this activity. Because
the force requirements differ, the training
strategies must also vary to develop the Rest, Recovery, and Periodization
right kind of musculature.
For hundreds of years, athletes have been
Environmental stress, such as exercising in challenged to balance their exercise efforts
the heat, places a tremendous amount of with performance improvements and
stress on the thermoregulatory systems. As adequate rest. The principle of rest and
an adaptation to the heat, the amount of recovery (or principle of recuperation)
sweating increases as does plasma volume, suggests that rest and recovery from the
making it much easier to keep the body at a stress of exercise must take place in
normal temperature during exercise. The proportionate amounts to avoid too much
only way to adapt is through heat exposure, stress. One systematic approach to rest and
which can take days to weeks to properly recovery has led exercise scientists and
adapt.
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athletes alike to divide the progressive overcome the symptoms of overtraining
fitness training phases into blocks, or syndrome. Symptoms include the following:
periods. As a result, optimal rest and
recovery can be achieved without • weight loss
overstressing the athlete. This training • loss of motivation
principle, called periodization, is especially • inability to concentrate or focus
important to serious athletes but can be • feelings of depression
applied to most exercise plans as well. The • lack of enjoyment in activities
principle of periodization suggests that normally considered enjoyable
training plans incorporate phases of stress • sleep disturbances
followed by phases of rest. • change in appetite
Training phases can be organized on a daily,
weekly, monthly, and even multi-annual Reversibility
cycles, called micro-, meso-, and
macrocycles, respectively. An example of Chronic adaptations are not permanent. As
this might be: the saying goes, “Use it or lose it.”
The principle of reversibility suggests that
Week Frequency Intensity Time Type
1 3 days 40% HRR 25 min walk activity must continue at the same level to
2 4 days 40% HRR 30 min walk keep the same level of adaptation. As
3 4 days 50% HRR 35 min walk activity declines, called detraining,
4 2 days 30% HRR 30 min other adaptations will recede.
As this table shows, the volume and In cardiorespiratory endurance, key areas,
intensity changes from week 1 to week 3. such as VO2max, stroke volume, and cardiac
But, in week 4, the volume and intensity output all declined with detraining while
drops significantly to accommodate a submaximal heart rate increased. In one
designated rest week. If the chart were study, trained subjects were given bed rest
continued, weeks 5-7 would be “stress” for 20 days. At the end of the bed rest
weeks and week 8 would be another rest phase, VO2max had fallen by 27% and stroke
week. This pattern could be followed for volume and cardiac output had fallen by
several months. 25%. The most well-trained subjects in the
study had to train for nearly 40 days
Without periodization, the stress from following bed rest to get back into pre-rest
exercise would continue indefinitely condition. In a study of collegiate
eventually leading to fatigue, possible swimmers, lactic acid in the blood after a 2-
injury, and even a condition known as minute swim more than doubled after 4
overtraining syndrome. Overtraining weeks of detraining, showing the ability to
syndrome is not well understood. However, buffer lactic acid was dramatically affected.2
experts agree that a decline in performance
resulting from psychological and Not only is endurance training affected, but
physiological factors cannot be fixed by a muscular strength, muscular endurance,
few days’ rest. Instead, weeks, months, and
sometimes even years are required to
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and flexibility all show similar results after a recommendations, notice how closely they
period of detraining. follow the FITT pattern described earlier in
the chapter.
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consider attendance at fitness centers also balanced and reasonable. They do not
during the month of January. Attendance leave you feeling depressed and deprived
increases dramatically, driven by the after a few days. Find a balance between
number 1 New Year’s resolution in America: what you want to achieve and what you are
losing weight. Unfortunately, as time realistically able to do. Finally, you must do
marches on, most of these new converts do more than simply change your behaviors.
not. By some estimates, as many as 80% You must also modify your mental
have stopped coming by the second week in perception to promote long-term health.
February. As February and March approach, Find a compelling reason for incorporating
attendance continues to decline, eventually healthier behaviors into your daily routine.
falling back to pre-January levels.
The steps below will guide you through this
Why does this occur? Why aren’t these new process. Before beginning a fitness
customers able to persist and achieve their program, you should understand the safety
goal of a healthier, leaner body? One concerns associated with exercise.
possible explanation: patrons fail to view
their fitness program as a lifestyle. The
Safety First: Assessing Your Risk
beginning of a new year inspires people to
make resolutions and set goals, as they
ACSM Recommendations for Exercise
envision a new and improved version of
Preparticipation Health Screening
themselves. Unfortunately, most of them
expect this transformation to occur in a
short period of time. When this does not The physical challenges of beginning a new
happen, they become discouraged and give exercise program increase the risk of injury,
up. Returning to teen level weight and/or illness, or even death. Results from various
fitness may be an alluring, well-intended studies suggest vigorous activity increases
goal, but one that is simply unrealistic for the risk of acute cardiac heart attacks
most adults. The physical demands and and/or sudden cardiac death.3 While that
time constraints of adulthood must be cautionary information appears
taken into consideration for any fitness contradictory to the previously identified
program to be successful. Otherwise, any benefits of exercise, the long-term benefits
new fitness program will soon be of exercise unequivocally outweigh its risks.
abandoned and dreams of physical In active young adults (younger than 35),
perfection fade, at least until next January. incidence of cardiac events are still rare,
Like any other lifestyle habit, optimal health affecting 1 in 133,000 in men and 1 in
and fitness do not occur overnight. Time 769,000 in women. In older individuals, 1 in
and, more importantly, consistency, drive 18,000 experience a cardiac event. 4
successful health and fitness outcomes. The
very term lifestyle refers to changes that are Of those rare cardiac incidents that do
long term and become incorporated into a occur, the presence of preexisting heart
person’s daily routine. Unlike many fad disease is the common thread, specifically,
diets and quick fixes advertised on atherosclerosis. Atherosclerosis causes
television, successful lifestyle changes are arteries to harden and become clogged with
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Flynn | FITNESS PRINCIPLES
plaque, which can break apart, move to recommended ranges.
other parts of the body, and clog smaller
blood vessels. As such, it is important to • Obesity
screen individuals for risk factors associated Body mass index greater than 30,
with heart disease before they begin an waist circumference larger than 102
exercise program. cm for men and larger than 88 cm
for women, or waist to hip ratio of
The American College of Sports Medicine less than 0.95 men, or less than 0.86
recommends a thorough pre-screening to women increases risk of heart
identify any risk of heart disease. The 7 disease.
major risk factors associated with increased
risk of heart disease are identified below.5 • Sedentary lifestyle
Persons not meeting physical
• Family history activity guidelines set by US Surgeon
Having a father or first-degree male General’s Report have an increased
relative who has experienced a risk of heart disease.
cardiac event before the age of 55,
or a mother or first-degree female In addition to identifying your risk factors,
relative who has experienced a you should also complete a Physical Activity
cardiac event before age 65, could Readiness Questionnaire (PAR-Q) before
indicate a genetic predisposition to beginning an exercise program. The PAR-Q
heart disease. asks yes or no questions about symptoms
associated with heart disease. Based on
your responses on the PAR-Q, you will be
• Cigarette smoking
placed into a risk category: low, moderate,
The risk of heart disease is increased
high.
for those who smoke or have quit in
the past 6 months. • Low risk persons include men
younger than 45, and women
• Hypertension younger than 55, who answer no to
Having blood pressure at or above all of the PAR-Q questions and have
140 mm/HG systolic, 90 mm/Hg one or no risk factors. Although
diastolic is associated with increased further screening is a good idea,
risk of heart disease. such as getting physician’s approval,
it isn’t necessary.
• Hyperlipidemia
Having cholesterol levels that • Moderate risk persons are men of or
exceed recommendations (HDL greater than 45, women 55 or those
below 40 mg/dL), or total who have two or more risk factors.
cholesterol of greater than 200 mg/ Because of the connection between
dL increases risk. cardiac disease, the seven risk
factors, and risk during exercise, it is
• Impaired fasting glucose (diabetes)
recommended you get a physician’s
Blood sugar should be within the
approval before beginning an
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exercise program. • Set goals
What is your destination’s location?
• High risk persons answer yes to one • Create a plan
or more of the questions on the What route will you choose?
PAR-Q. Physician’s approval is • Follow through
required before beginning a Start driving!
program.
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to feel and look increases your chances of attainable and realistic (the degree of
success. Without specific goals to measure improvement is reasonable in that time
the success of your efforts, you could frame), and includes a time frame (a clear
possibly exceed your target and believe you deadline of 2 months).
failed.
Less effective goals would be stated like
The art of setting goals includes stating this:
them in a clearly defined and measurable
way. Consider exactly what you would like I will run farther next time I assess my
to accomplish, make certain your goals can fitness.
be measured, and establish a reasonable I want to jog faster.
timeframe in which to achieve your goals. I will lose weight
Goals that meet these guidelines are And a common one:
referred to as S.M.A.R.T. goals.
I will exercise 3 days a week at 60% max
• Specific heart rate for 45 minutes per session for
Be as specific and detailed as 2 months.
possible in creating your goal.
• Measurable: If your goal cannot be At a closer glance, none of these examples
measured, you will not know when contain all of the ingredients of a well-
you have successfully completed stated goal. How can “faster” be measured?
the goal. “Farther” is not specific enough, nor is “lose
• Attainable weight.” In the last example, this is not a
Consider whether you have the goal at all. It is a plan to achieve a goal that
resources—such as time, family has not been stated.
support, and financial means—to
obtain your goal. In the end, setting up well-stated goals will
give you the best chance to convert good
• Realistic
intentions into a healthier lifestyle.
While your goal should be
challenging, it should not exceed To complete this step, write down 2-3
reasonable expectations. personal goals, stated in the SMART format,
• Timeframe and put them in a place you will see them
Set a deadline to accomplish your frequently.
goal.
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Flynn | FITNESS PRINCIPLES
First, use your goals as the foundation for Unfortunately, the ability to stick with a
your program. If your goal is related to program proves difficult for most. To
weight loss, this should drive the frequency, prevent getting derailed from your
duration, and intensity of your daily program, identify barriers that may prevent
workouts as these variables will influence you from consistently following through.
your body’s use of fat for fuel and the One of the most common challenges cited
number of calories burned. If you feel more is a shortage of time. Work schedules,
interested in improving your speed, you will school, child care, and the activities of daily
need to dedicate your workout time to living can leave you with little time to
achieving those results. pursue your goals. Make a list of the items
that prevent you from regularly exercising
Another key principle is the importance of and then analyze your schedule and find a
safety. The importance of designing a time for squeezing in your exercise routine.
program that is safe and effective cannot be Regardless of when you schedule your
overstated. You can minimize any risks by exercise, be certain to exercise consistently.
relying on the expert recommendations of Below are a few additional tips for achieving
the US Department of Health and Human consistency in your daily fitness program:
Services and the American College of Sports
Medicine previously outlined and linked Think long term; think lifestyle.
here. These highly reputable organizations The goal is to make exercise an
have conducted extensive research to activity you enjoy every day
discover the optimal frequency, intensity, throughout your life. Cultivating a
and duration for exercise. love for exercise will not occur
overnight and developing your ideal
routine will take time. Begin with
Follow Through this knowledge in mind and be
patient as you work through the
Once you have assessed your current challenges of making exercise a
fitness levels, set goals using the SMART consistent part of your life.
guidelines, and created your personalized
fitness plan, you should feel very proud of Start out slowly.
yourself! You have made significant Again, you are in this for the long
progress toward achieving a healthier haul. No need to overdo it in the
lifestyle. Now is when the “rubber hits the first week. Plan for low intensity
road.” (Literally so, if your plan includes activity, for 3 days per week, and for
walking or jogging.) Now that you have realistic periods of time (20–30
invested time and energy to develop a minutes per session).
thoughtful, well-designed fitness program,
it is time to reap the returns of good Begin with low Intensity/low volume.
execution. The assessment, planning and As fitness improves, you will want to
preparation are really the hardest parts. gradually increase your efforts in
Once you know what to do and how to do terms of quantity and quality. You
it, success is simply a matter of doing it. can do this with more time and
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frequency (called volume) or you far more likely to achieve a lasting
can increase your intensity. In lifestyle change. While you cannot
beginning a program, do not change expect to be exhilarated about
both at the same time. exercising every day, you should not
dread your daily exercise regimen. If
Keep track. you do, consider varying your
Results from a program often occur activities more, or finding a new
slowly, subtly, and in a very anti- routine you find more enjoyable.
climactic way. As a result,
participants become discouraged Eat healthier.
when immediate improvements are Nothing can be more frustrating
not visible. Keeping track of your than being consistent in your efforts
consistent efforts, body without seeing the results on the
composition, and fitness test results scale. Eating a balanced diet will
and seeing those subtle accelerate your results and allow
improvements will encourage and you to feel more successful
motivate you to continue. throughout your activities.
Seek support.
Look for friends, family members, Additional Safety Concerns
clubs, or even virtual support using
apps and other online forums. As activity rates among Americans increase,
Support is imperative as it provides specifically outdoor activities, safety
motivation, accountability, concerns also rise. Unfortunately, the
encouragement, and people who physical infrastructure of many American
share a common interest, all of cities does not accommodate active
which are factors in your ability to lifestyles. Limited financial resources and
persist in your fitness program. de-emphasis on public health means local
and state governments are unlikely to
Vary your activities from time to allocate funds for building roads with
time. sidewalks, creating walking trails that
Your overall goals are to be surround parks, or adding bike lanes. In
consistent, build your fitness, and addition, time constraints and
reap the health benefits associated inconvenience make it challenging for
with your fitness program. Varying participants to travel to areas where these
your activities occasionally will amenities are available. As a result, exercise
prevent boredom. Instead of participants share roads and use isolated
walking, play basketball or ride a trails/pathways, inherently increasing the
bike. Vary the location of your safety risks of being active.
workout by discovering new hiking
trails, parks or walking paths. A key principle in outdoor safety is to
recognize and avoid the extremes. For
Have fun. example, avoid roads that experience heavy
If you enjoy your activities, you are traffic or are extremely isolated. Avoid
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heavy populated areas as well as places
where no one is around. Do not exercise in Heat-Related Illness
the early morning or late at night, during
extreme cold or extreme heat. To minimize Heat-related illnesses, such as heat cramps,
safety risks during these types of heat exhaustion, and heat stroke,
environmental conditions, do not use contributed to 7,233 deaths in the United
headphones that could prevent you from States between 1999 and 2009. A 2013
hearing well and remaining alert, do not report released by the Center for Disease
exercise alone, prepare for adequate Control stated that about 658 deaths from
hydration in the heat, and use warm heat-related illnesses occurred every year
clothing in extreme cold to avoid frostbite. which account for more deaths than
Extreme conditions require extra vigilance tornadoes, hurricanes, and lightning
on your part. combined. Of those deaths, most were
male, older adults.8
A second key principle, whether outdoor or
indoor, is to simply use common sense. The number one risk factor associated with
While this caveat seems obvious, it gets heat-related illness is hydration, the starting
ignored far too often. Always remember the point of all heat-related illness.
purpose of your exercise is for enjoyment Unfortunately, sweat loss can occur at a
and improved health. If these objectives faster rate than a person can replace with
could be compromised by going for a run at fluids during exercise, especially at high
noon in 95-degree heat, or lifting large intensities. Even when trying to hydrate,
amounts of weight without a spotter, you ingestion of large amounts of fluids during
should reconsider your plan. Before exercise can lead to stomach discomfort.
exercising in what could be risky conditions, What does this mean? Hydration must
ask yourself, “Is there a safer option begin before exercise and must become
available?” part of your daily routine.
Lastly, be aware of the terrain and weather Several practical methods of monitoring
conditions. Walking or jogging on trails is a hydration levels can assist in preventing
wonderful way to enjoy nature, but illness. One simple method, while not full
exposed roots and rocks present a hazard proof, is to simply monitor the color of your
for staying upright. Wet, muddy, or icy urine. In a hydrated state, urination will
conditions are additional variables to avoid occur frequently (every 2–3 hours) and
in order to complete your exercise session urine will have very little color. In a
without an accident. dehydrated state, urination occurs
infrequently in low volume and will become
more yellow in color.
Environmental Conditions
Another simple method involves weighing
When exercising outdoors, you must yourself before and after a workout. This is
consider the elements and other factors a great way to see firsthand how much
that could place you at increased risk of water weight is lost during an exercise
injury or illness. session primarily as a result of sweat. Your
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goal is to maintain your pre- and post-body
weight by drinking fluids during and after Cold-Related Illnesses
the workout to restore what was lost. This
method, when combined with urine- Much like extremely hot environmental
monitoring, can provide a fairly accurate conditions, cold weather can create
assessment of hydration levels. conditions equally as dangerous if you fail
The best preventative measure for to take proper precautions. To minimize the
maintaining a hydrated state is simply risk of cold-related illness, you must
drinking plenty of water throughout the prevent the loss of too much body heat.
day. In previous years, recommendations The three major concerns related to cold-
for the amount of water to drink were a related illnesses are hypothermia, frost-nip,
one size fits all of about 48–64 oz. per day, and frost bite.
per person. In an effort to individualize
hydration, experts now recommend basing As with heat-related illness, the objective of
fluid intake on individual size, gender, preventing cold-related illness is to
activity levels, and climate. Generally, half maintain the proper body temperature of
an ounce (fluid ounces) to 1 ounce per between 98.6 and 99.9 degrees Fahrenheit.
pound of body weight is recommended.9 If body temperature falls below 98.6 F,
For a 150-pound individual, this would multiple symptoms may appear, indicating
mean 75–150 ounces of water per day! the need to take action. Some of those
While there is still considerable debate over symptoms include:
the exact amounts, no one disputes the • shivering
importance of continually monitoring your • numbness and stiffness of joints and
hydration using one of the techniques appendages
described previously. Insufficient hydration • loss of dexterity and/or poor
leads to poor performance, poor health, coordination
and potentially serious illness. • peeling or blistering of skin,
especially to exposed areas
It should be noted that electrolyte “sport” • discoloration of the skin in the
drinks, such as Gatorade and PowerAde, are extremities
often used to maintain hydration. While
they can be effective, these types of drinks When walking or jogging in the cold, it is
were designed to replace electrolytes important to take the necessary steps to
(potassium, sodium, chloride) that are lost avoid problems that can arise from the
through sweating during physical activity. In environmental conditions.
addition, they contain carbohydrates to
• Hydration is key.
assist in maintaining energy during activities
of long duration. If the activity planned is Cold air is usually drier air, which
shorter than 60 minutes in duration, water leads to moisture loss through
is still the recommended fluid. For activities breathing and evaporation. Staying
beyond 60 minutes, a sports drink should hydrated is key in maintaining blood
be used. flow and regulating temperature.
27
Flynn | FITNESS PRINCIPLES
• Stay dry. Exercise: a subset of physical activity that is
Heat loss occurs 25x faster in water planned and structured aimed at improving
than on dry land. As such, keeping fitness.
shoes and socks dry and clothing
from accumulating too much sweat Health related components of fitness:
will allow for more effective body types of activities dedicated to improving
temperature regulation. physical fitness categorized as
cardiorespiratory endurance, muscular
• Dress appropriately.
Because of the movement involved, strength and endurance, flexibility, and
the body will produce heat during body composition.
the exercise session. Therefore, the
key point is to direct moisture Skills related components of fitness: types
(sweat) away from the skin. This is of activities dedicated to improving physical
controlled most effectively by skills categorized as speed, agility,
layering your clothing. A base layer coordination, balance, power, and reaction
of moisture-wicking fabric should be time.
used against the skin while
additional layers should be Principles of adaptations to stress:
breathable. This will channel guidelines related to managing the
moisture away from the skin, and application of stress during physical
any additional layers of clothing,
activity/exercise.
without it becoming saturated in
sweat. If exercising on a windy day, Overload Principle: a principle of
use clothing that protects from the
adaptation to stress suggesting the amount
wind and is adjustable so you can
breathe. of stress applied during exercise must
exceed a threshold level to stimulate
• Cover the extremities. adaptation (doing more than the body is
Those parts of the body farthest accustomed to).
away from the heart (toes, fingers,
and ears) tend to get coldest first. Volume: the term used to describe “how
Take the appropriate steps to cover much” stress is being applied by combining
those areas by using gloves (mittens the duration and frequency of exercise.
if possible), moisture-wicking socks,
and a winter cap to cover your head. Progression principle: a principle relating to
how much additional stress that can safely
be introduced to gradually improve fitness
Terminology Checklist without risking injury or overuse.
Physical activity: any activity that requires Specificity: the principle of stress
skeletal muscle and requires energy aimed suggesting activities should be closely
at improving health.
28
Flynn | FITNESS PRINCIPLES
centered around the primary outcome goal, b. Flexibility
i.e. you get what you train for. c. Balance
d. Agility
Reversibility: the principle that adaptations 3. During the initial phase of an
to stress can be lost over time if training is exercise program, a beginner
modified or stopped. should:
a. Begin slowly, exercising at a
Principle of rest and recovery: the concept low intensity and gradually
that adaptation not only requires overload increasing volume
b. Keep intensity high, exercise
but also requires rest to avoid overstressing
at the high end of the target
the body.
heart rate range
Periodization: a method of organizing c. Perform short but intense
bouts of activity
workouts into blocks or periods. These
d. Exercise 5-7 days per week
cycles consist of work/stress periods and 4. The body’s ability to adapt to
rest periods. gradual increases in the amount of
exercise is the principle of:
Overtraining syndrome: a condition of a. Overload
chronic stress from physical activity b. Specificity
affecting the physical and psychological c. Reversibility
states of an individual or athlete. d. Assessment
5. The amount of overload needed to
Detraining: the act of no longer training at maintain or improve one’s fitness
all or decreasing the amount of training. level is NOT determined by:
a. Time (duration)
Test Your Knowledge b. Intensity
c. Frequency
1. The term exercise refers to physical d. Specificity
activity that is: 6. Another term used for organizing
a. Discontinuous and your training into phases or cycles is:
unplanned but designed to a. Specificity
improve fitness b. Skill training
b. Planned, structured, and c. Periodization
repetitive designed to d. Overload
improve fitness
c. Not a contributor to physical
fitness Key
d. Random and unstructured 1. b
2. b
2. Which of the following is NOT 3. a
considered a skill-related fitness 4. a
5. d
component? 6. c
a. Coordination
29
Flynn | FITNESS PRINCIPLES
References:
1. Center for Disease Control and Prevention, Retrieved April 2017, CDC: Physical Activity, Data
and Statistics, https://www.cdc.gov/physicalactivity/data/facts.htm
2. Saltin, B., Blomqvist, G., Mitchell, J.H., Johnson, R.L., Jr., Wildenthal, K., Chapman, C.B.
Response to submaximal and maximal exercise after bed rest and training. 1968 Nov, Vol.
38 (Suppl. 5)
3. Noakes, Timothy D.; Sudden Death and Exercise, Sportscience, 1998, retrieved Dec. 2017,
http://www.sportsci.org/jour/9804/tdn.html
4. Van Camp SP, Boor CM, Mueller FO, et al. Non-traumatic Sports Death in High School and
college Athletes, Medicine and Science of Sports and Exercise 1995; 27:641-647
5. American College of Sports Medicine, 7th Edition, ACSM’s Guidelines for Exercise Testing
and Prescription, Philadelphia, PA, Lippincott, Williams and Wilkins, p. 10
6. American College of Sports Medicine, 7th Edition, ACSM’s Guidelines for Exercise Testing
and Prescription, Philadelphia, PA, Lippincott, Williams and Wilkins, p. 27
7. 7 Habits of Highly Effective People,2003, Covey, Stephen R. Habit 2, New York, Franklin
Covey Co. p. 40-61
8. Center for Disease Control and Prevention, Retrieved April 2017, CDC: Quick Stats: Number
of Heat-related Deaths, by Sex-National Vital Statistics System-United States, 1999-2010,
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6136a6.htm
9. Mayo Clinic, retrieved April 2017, Water: How Much Should You Drink Each Day?
http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-
depth/water/art-20044256
30
Flynn | FITNESS PRINCIPLES
Chapter 3:
Cardiorespiratory Fitness
Objectives:
• Define the cardiovascular and respiratory system
• Describe how the cardiorespiratory system works
• Identify the benefits of cardiorespiratory fitness
• What is the importance of this system?
• Identify methods for assessing and improving the CR system
These are the sensations many people with The Benefits of Good
cardiovascular or respiratory illnesses, such
as asthma, chronic bronchitis, or mild
Cardiorespiratory Health
cardiovascular disease, experience on a The link below provides a list of specific
daily basis. Climbing up a flight of steps may benefits:
leave them gasping for air, as would walking
briskly or even breathing in cold air. • List of Benefits
Regardless of the cause, being unable to
take in sufficient air can create a sense of
panic and cause serious physical discomfort.
31
The article linked below describes how • How the Cardiovascular System
exercise protects against Cardiovascular Works
Disease (CVD):
• Respiratory System Explained in
• Preventing CVD Detail
32
mile in less time. An example of this
adaptation comes from the world record
Immediate/Explosive Energy
mile time of 3 minutes and 43 seconds. The System
world record marathon time (26.2 miles) is
2 hours, 2 minutes, and 52 seconds. That While the oxidative system is the primary
equates to 4 minutes and 41 seconds per source of ATP production, it does require a
mile over the 26-mile course. That is some few minutes for the system to begin
serious ATP production! operating at full capacity during exercise.
How then could the body immediately
produce enough energy to perform a
Oxidative Energy System strenuous activity, such as sprinting 50
meters? Clearly, another energy system
(Aerobic) must drive ATP production. The immediate
or explosive energy system utilizes the
As oxygen and nutrients are delivered to storage of creatine phosphate (CP) and the
the cells, they are utilized to produce ATP. storage of adenosine diphosphate, which is
The workhorses of the cell for oxidative stored in very small amounts, to generate
metabolism are the mitochondria. This ATP. When needed, this energy system
form of energy production is contingent on provides enough ATP to sustain a short-
the ability of the CR system to deliver duration, explosive activity, approximately
oxygen and nutrients and the cell’s ability to 10–20 seconds or less. Once CP is depleted,
process that oxygen. Because of the other energy systems must assist in the ATP
importance of oxygen in this particular generating process.
energy-producing pathway, it is called the
oxidative energy system, or aerobic system.
33
ATP production for events lasting longer to the cells, the overall system must
than approximately 2 minutes. undergo changes to make this possible.
Here is a list of adaptations that occur to
As glucose is processed to produce ATP, the the CR system as a result of consistent
natural byproduct of this process, lactic aerobic exercise:
acid, also begins to accumulate. The result
of excessive lactic acid accumulation • Resting heart rate may decrease.
contributes to muscle fatigue, making it The average resting heart rate
impossible to continue exercise at a high hovers around 70–75 beats per
intensity. minute. Elite athletes may have
resting heart rates in the high 30s.
Generally, resting heart rate may
decrease by approximately 10 beats
Energy Systems Combine per minute with chronic exercise.
• Pulmonary adaptations, such as
It is important to understand that energy
increased tidal volume (the amount
systems do not operate in a compartmental
of oxygen entering the lungs with
fashion, but rather operate simultaneously,
each breath) and increased diffusion
each carrying some of the burden of ATP
capacity (the amount of oxygen that
production. For example, a professional
enters the blood stream from the
soccer player would spend most of the
lungs). This allows for more oxygen
match “cruising” at a light/moderate
to enter the pulmonary circulation
intensity level, thus primarily utilizing the
en route to the left side of the heart.
oxidative energy system. However, during
• The heart muscles, specifically the
the match, he or she may sprint for several
left side of the heart, increase in size
hundred meters, utilizing the explosive and
making it possible to contract more
non-oxidative system, or he or she may
forcefully. As a result, more blood
jump, requiring use of the explosive system.
can be pumped with each beat
Thus, both energy systems are utilized
meaning more oxygen can be routed
simultaneously throughout the match. To
to the systemic circulation.
improve performance, this player would
• More oxygen is delivered and
need to develop the energy system which is
transported into the cells where ATP
utilized the most during the match.
production can occur. This is called
the arterial-vein difference (a-
VO2diff)
Changes in the CR System
These changes in the system are not
An improvement in CR functioning, or permanent because of a process known as
fitness level, requires adaptation of the the principle of reversibility. Following a
system. Remember, the point is to more period of inactivity, the benefits from
effectively generate ATP so more work can chronic aerobic exercise will be reversed.
be accomplished. In order to process more
oxygen and deliver more oxygenated blood
34
Assessing CR Fitness Information on how to safely perform these
assessments will be provided at the end of
this chapter.
To adequately prepare for starting a
personal fitness program, it is important to
first assess your current level of fitness.
There are multiple methods for assessing a Measuring Heart Rate
person’s level of fitness. Each of the
walking/jogging assessments discussed here Those starting the VO2max assessments must
attempts to estimate a key physiological first measure their heart rate, an important
marker of the heart’s and lungs’ functioning component used in the calculations.
capacity and maximal oxygen consumption.
Maximal oxygen consumption, or VO2 max, Here is a video describing how to determine
measures the body’s maximum ability to heart rate:
take in and utilize oxygen, which directly
correlates to overall health and fitness. A • How to check your pulse
good estimate of VO2 max provides a one-
time glance at a person’s health and fitness
level and a baseline measurement for
reassessment at future dates to gauge Creating a Plan to Develop
improvements. CR Fitness
Some of the most common walking/jogging Once the assessments have been
assessments used to estimate VO2 max completed, the next step is to develop a
include the 12-Minute Walk, 1.5-Mile plan for maintaining or improving your
Run/Walk Test, 3-Minute Step Test, and 1- current level of fitness. This fitness plan
Mile Walk Test. Unfortunately, these field should include activities that are safe and
assessments, although practical and adapted to meet your personal goals. Once
inexpensive, only provide estimations. these fitness goals have been identified, the
More accurate assessments require a lab- principles of adaptation to change can be
based VO2max test using equipment that utilized to achieve those goals. These
measures the volume of oxygen and carbon principles include specificity, targeting
dioxide being moved in and out of the air specific areas in a workout, and overload,
passages during exercise. Although this test the practice of increasing exertion as the
is more accurate, the expense and body adapts to ensure continued gains in
availability make it impractical for most. fitness levels. Specifically, you need to apply
Unlike the lab test, the field assessments the FITT principle (Fitness, Intensity, Time,
are relatively cost free, user-friendly and and Type) described in detail in the
require very little expertise to conduct or previous chapter, “Fitness Principles”:
perform. In addition, the key point of the
assessment is measuring differences rather • Frequency: 3–5 days per week for
than absolute values, and the field tests healthy adults.
accurately meet that objective. • Intensity: moderate to vigorous
intensity, which equals 40–85% of
35
heart rate reserve, or 55–90% of target heart rate zones. Heart rate zones
percentage of max heart rate. (More represent an intensity range—a low end
information about intensity will be heart rate and a high end rate—within
provided later.) which a person’s heart rate would fall
• Time/duration: 20–60 minutes per during a walking or jogging session.
session or accumulation of 150
minutes per week. Sessions must be The first step in determining your target
continuous for 10 minutes or more. heart rate (THR), is to determine your
• Type/mode: Use large muscle maximum heart rate (MHR), both
groups and exercises specific to measured in beats per minute (bpm).
cardiorespiratory exercise. Generally, MHR is estimated to be your age
subtracted from 220 beats per minute. In
Click on the link below for ACSM’s latest other words, your heart rate should
recommendations on the quantity and theoretically stop increasing once it reaches
quality of exercise for adults: the calculated maximum. While helpful, it is
not uncommon to see variances in the
• ACSM's Official News Release laboratory tested maximum heart rate
versus the calculated method.
36
jogging session. By keeping the heart rate Clearly, the Karvonen formula requires a
within that range, you will drive adaptation few more steps, specifically, the
specific to that intensity. By using real, but incorporation of the resting heart rate.
random numbers, and plugging them into Using the same female in the example
the above equation this becomes apparent. above, along with a randomly selected RHR,
the THR looks like this:
Female, aged 20:
1. MHR = 220 – 20
1. MHR = 220 -20 MHR = 200
MHR = 200 bpm; 2. RHR = 72 bpm (randomly selected)
2. THRlow = 200 x .60 3. HRR = MHR – RHR
THRlow = 120 bpm HRR = 200 – 72
THRhigh =200 x .80 HRR = 128
THRhigh = 160 bpm 4. THRlow = HRR x .60 + RHR
3. THR = 120 - 160 bpm THRlow = 128 x .60 + 72
THRlow = 149 bpm
To achieve her self-established goals, the THRhigh = HRR x .80 + RHR
female in the example above will need to THRhigh = 128 x .80 + 72
stay within the range of 120 and 160 bpm. If THRhigh = 174 bpm
her efforts are intense enough that she 5. THR = 149 – 174 bpm
begins to exceed 160 bpm during her
session, or easy enough that her heart rate A comparison of the two methods, reveals
falls below 120 bpm, she would need to that the low and high end of the Karvonen
change her intensity mid-session to get the formula is much higher than the Max Heart
optimal results. Rate method, even though the exact same
percentages have been used. If the female
The Karvonen Formula or Heart Rate in this example used the Karvonen Formula,
Reserve Method she would find herself at a much higher
intensity, especially at the low end of the
1. Calculate MHR; MHR = 220 – age. range (120 vs. 149 bpm). How can this be?
2. Determine your resting heart rate Aren’t these formulas supposed to have the
(RHR). same objective?
3. Find the heart rate reserve (HRR);
HRR = MHR – RHR While it is true that both equations are used
4. Calculate high and low THR by to estimate a target heart rate range, only
plugging in a percentage range and the Karvonen Formula takes into account
then adding in the RHR. In this the RHR, the lowest possible heart rate that
example, 60% and 80% are being can be measured for that individual. The
used. Max Heart Rate method assumes the lowest
THRlow = HRR x .60 + RHR heart rate possible is “0,” a number to be
THRhigh = HRR x .80 + RHR avoided if at all possible! Because of the
5. The resulting low and high THR difference between 0 and the maximum
numbers represent the range, or heart rate, the calculated percentages
target intensity. result in a much lower number. In terms of
37
accuracy, the Karvonen method is superior. Walking and jogging not only benefit
It simply is a better representation of true physical health, but many enjoy the social
target ranges. benefits realized by exercising with friends.
When walking or jogging with friends,
intensity can easily be measured by
Other Ways to Determine Intensity monitoring your ability to carry on a
conversation. With the Talk Test, if you are
Since not everyone owns a heart rate only able to say short phrases or give one
monitor, other methods of determining word responses when attempting to
exercise intensity have been developed. converse during an exercise session, this
One particular method, called the rating of would suggest you are working at a high
perceived exertion (RPE), uses subjective enough intensity that your breathing rate
measurement to determine intensity. The makes conversation difficult. Certainly, if
method is as simple as asking the question, you can speak in full sentences without
Overall, how hard do I feel I am working? getting winded, the intensity would be very
The answer is given based on a scale of 6 to light. Just like RPE, the Talk Test is yet
20 with 6 being almost no effort and 20 another way to subjectively measure
being maximum effort. Studies have intensity, which can then be correlated with
indicated that when subjects are asked to heart rates.
exercise at a moderate or heavy intensity
level, subjects can accurately do so, even
without seeing their heart rate. As a result, Terminology Checklist
using the RPE scale can be an effective way
of managing intensity.
Cardiorespiratory system: The term used to
The original RPE scale or Borg Scale, describe the relationship between the
designed by Dr. Gunnar Borg, was cardiovascular system (heart and blood
developed to mimic generalized heart rate vessels) and respiratory system (lungs).
patterns. The starting and ending point of
the scale are less intuitive than a typical Calorie: A term used to describe food
scale of 1-10. By design, the 6 represents a energy. Scientifically, it is the amount of
resting heart rate of 60 bpm and the 20 an energy needed to raise one kilogram of
exercise heart rate of 200 bpm, a beat water, 1 degree Celsius. More accurately, it
count someone might experience at is one kilocalorie.
maximum effort. Over time, a modified Adenosine Triphosphate (ATP): The basic
Borg Scale was developed using a simple 1– unit of energy used by the cells.
10 scale, with 1 being resting effort and 10
being maximum effort. Even though the Aerobic energy system: The term used to
modified scale is more intuitive, the describe the way cells produce ATP. In this
traditional scale is still used more case, the cells require oxygen to assist in
frequently. ATP production.
38
range—a low end heart rate and a high end
Creatine phosphate: a compound found in rate—used as a guide for exercise intensity.
the cells and used by the immediate energy
system that can be used to produce ATP. Max heart rate (MHR): The maximum
number of beats per minute the heart can
Non-oxidative energy system: a term used contract.
to describe the way cells produce ATP. In
this case, cells do not require oxygen to Resting Heart Rate (RHR): The minimum
produce ATP. number of beats per minute the heart
contracts.
Glucose: The simplest form of sugars found
in the blood. Heart Rate Reserve (HRR): The difference
between the maximum heart rate and the
Tidal volume: The amount of air measured resting heart rate. This term is also used to
during inspiration or expiration. describe a method for calculating target
heart rate.
Diffusion capacity: The amount of air that is
transferred from the lungs to the blood. Rating of Perceived Exertion (RPE): A self-
assessment used during exercise used to
Areterial-vein difference (aVO2diff): The estimate the intensity of the work being
difference between the oxygen found in performed. The scale used, called the Borg
arterial blood and venous blood. Scale, ranges from 6 to 20.
39
2. Cardiorespiratory endurance is
developed best by activities that:
a. Involve continuous rhythmic
movements of large muscle
groups.
b. Alternate between brief
periods of maximal exertion
and rest.
c. Gently extend joints beyond
their normal range of
motion.
d. Involve working with weights
or resistance.
3. Maximal oxygen consumption
(VO2max) is:
a. The body’s maximum ability
to take in and utilize oxygen
b. The velocity of oxygen
flowing through the blood
c. Solely determined by
genetics
d. Very difficult to predict
4. The non-oxidative energy system
could provide energy for up to:
a. Maximum of 10 second or
less
b. Up to 2 minutes
c. As long as needed
d. Up to 5 minutes
5. Adenosine triphosphate (ATP) is
defined as:
a. The building block of
proteins
b. The stored form of sugar
c. The simplest form of
carbohydrate in the blood
d. The basic form of energy
used by the cells.
40
Chapter 4:
Muscular Strength and Endurance
Objectives:
• Describe muscular structure and function
• Identify types of muscles
• Describe an effective resistance exercise program
• Assess your muscular strength and endurance
• Understand the dangers of supplements
Muscles are used for movement in the through the heart and moving food through
body. The largest portion of energy the digestive system, to blinking and
expenditure in the body happens in muscles chewing. Without muscle cells, we would
while helping us perform daily activities be unable to stand, walk, talk, or perform
with ease and improving our wellness. everyday tasks. 1
Muscular strength is the amount of force
that a muscle can produce one time at a
maximal effort, and muscular endurance is Types of Muscle
the ability to repeat a movement over an
extended period of time. Resistance There are three types of muscle: 1
training is the method of developing
muscular strength and muscular endurance, • Skeletal Muscle
which in turns improves wellness. This Responsible for body movement.
chapter explores many ways to resistance
train. However, achieving the best muscular • Cardiac Muscle
performance requires the assistance of a Responsible for the contraction of
trained professional. the heart.
• Smooth Muscle
Responsible for many tasks,
Muscular Physiology including movement of food along
intestines, enlargement and
Muscles are highly specialized to contract contraction of blood vessels, size of
forcefully. Muscles are powered by muscle pupils, and many other contractions.
cells, which contract individually within a
muscle to generate force. This force is
needed to create movement. 1
There are over 600 muscles in the human Skeletal Muscle Structure and
body; they are responsible for every Function
movement we make, from pumping blood
• Isometric • Type II
This is a static contraction where the Often called fast-twitch or low-
length of the muscle, or the joint oxidative muscle fibers
angle, does not change. An example
is pushing against a stationary object Additionally, Type II muscle fibers can be
such as a wall. This type of further split into Type IIa and Type IIb.
contraction is known to lead to rapid Type IIb fibers are the truly fast twitch
rises in blood pressure. 1 fibers, whereas Type IIa are in between
slow and fast twitch. Surprisingly, the
• Isotonic characteristics of Type IIa fibers can be
This is a moving contraction, also strongly influenced by the type of training
known as dynamic contraction. undertaken. Following a period of
Myofibrils- threadlike structures running the length of the muscle fiber Insertion-
Origin- point where the muscle is attached to a bone that remains in a fixed position
Strength- the maximal amount a force that can produced one time
5. Which of the following is not needed in order to be safe while doing resistance
exercises?
a. Working out in a mirror
b. Using proper technique
c. Using spotters
d. Not working out when injured
2Kraemer, W. J., Adams, K., Cafarelli, E., Dudley, G. A., Dooly, C., Feigenbaum, M. S.,
American, M. E. (2002, February). American College of Sports Medicine position stand.
Progression models in resistance training for healthy adults. Retrieved April 25, 2017, from
https://www.ncbi.nlm.nih.gov/pubmed/11828249
3 Bringing Together Top Strength and Fitness Professionals. (n.d.). Retrieved April 25, 2017,
from https://www.nsca.com/
Objectives:
• Define flexibility
• Examine the benefits of flexibility
• Identify ways to increase flexibility
• Create an effective stretching program
• Assess your own flexibility
Flexibility 59
proprioceptors are called muscle spindles
and Golgi tendon organs (GTOs).
Improving Flexibility
Research has identified multiple stretching
Muscles spindles lie parallel to the regular
techniques that aid in improving ROM.
muscle and help determine the length of
Regardless of the specific technique or
muscles when they are being stretched.
specific mode used, each technique can be
When a muscle is stretched, it sends signals
performed using either active or passive
to the central nervous system causing the
mode. Active stretching, also called
stretched muscle to contract. This
unassisted stretching, is done individually
resistance to the stretch, called the
without an external stimulus. Passive
myotatic or stretch reflex is generated by
stretching, or assisted stretching, is when a
the nervous system’s reflexive stimulus sent
partner or trainer is used as the stimulus in
to the stretching muscle. That same signal
the stretching exercise. Both modes are
also causes the antagonist, or opposing
effective and can be applied to each of the
muscle to relax, called reciprocal inhibition.
techniques described below.
As such, when the upper thigh (quadriceps)
are stretched, the hamstrings (antagonist to
the quadriceps) relax.
Static Stretching
The GTOs are located near the
musculotendon junction, the end points of The technique most commonly prescribed
the muscle, and relay messages to the and used to improve flexibility is the static
central nervous system regarding muscle stretch. A static stretch involves slow,
lengthening and tension of the muscle. gradual, and controlled movements. The
When activated, these signals will override muscle group is stretched toward the end
the stretch reflex causing a sudden of the joint’s ROM until the point of mild
relaxation of the stretching muscle. This is discomfort is reached. Once that point is
called autogenic inhibition or the inverse reached, the stretch is held in a “static”
myotatic reflex. This inhibitory reflex can position for 30 to 90 seconds. After the
only occur after the muscle has been prescribed time, the stretch can be
stretched for 5 seconds or longer. This is repeated. Common ways in which static
why, to effectively stretch, movements stretching is applied would be performing
must be sustained for long, slow increments Yoga routines or stretching after a workout
of time. Otherwise, the resistance or an athletic event. Some of the major
encountered from the stretch reflex will not advantages of static stretching are as
be overridden and lengthening cannot follows: 1) It is generally considered safe
occur. Whether signaling the muscles to (see Stretches to Avoid); 2) It is simple to
contract or relax, the neuromuscular perform; and 3) It is effective at increasing
system manipulates the stretched muscle, ROM. The only major disadvantage comes
presumably as a protective mechanism to from doing it too much, which can reduce
prevent injury. strength and may make joints unstable. Of
Flexibility 60
course, this potential risk applies to all of exaggerated stride lengths before a race to
the techniques. improve hip ROM.
Flexibility 62
• Intensity Additional information about improving
Stretch to the point of tightness or your flexibility and balance can be found by
mild discomfort. clicking on the link below:
Flexibility 63
Assessing Your Flexibility flexibility are Golgi Tendon Organs (GTO’s)
and muscle spindles.
Laboratory Exercises Joint Structure: the fixed arrangement of a
joint that is a determining factor for range
The first step in creating a successful of motion. An example would be ball-in-
flexibility program is to assess your own socket joint or modified hinge joint.
flexibility. Follow the link below for
instructions on how you can perform these Myotatic Reflex: a reflexive stimulus of the
assessments. The sections you may find muscle to contract as a muscle is being
most helpful include sections 5.1, 5.2, and stretched.
5.3.
Reciprocal Inhibition: the principle that
Assessment Exercises when one muscle is stimulated to contract
the opposing muscle will relax.
Terminology Checklist
Autogenic Inhibition: an inhibitory reflex
Static Flexibility: the outermost limit of a that allows one sensor in the muscle to
stretched muscle measured while holding a override the signals of another sensor. Also
stretch in place. This can also refer to a called the inverse myotatic reflex.
technique used to improve the outermost
limit of a stretched muscle performed by Active stretching: a mode for stretching
holding stretches for 15-60 seconds. that is unassisted or involves no internal
stimulus.
Dynamic Flexibility: the relative degree of
ease a muscle can move through a normal Passive stretching: a mode for stretching
range of motion. The can also refer to a that uses an external source such as a
technique used to improve static flexibility partner or gravity to assist in the
and ease of motion done by performing movements.
exaggerated movements.
Ballistic stretching: a technique used to
Elasticity: the ability of the muscle to return improve range of motion performed by
to its resting length after being stretched. gently bouncing back and forth to stretch
and relax the muscle.
Plasticity: the tendency of a muscle to
assume a greater length after stretching. Proprioceptive Neuromuscular Facilitation
(PNF): a technique used to improve range
Proprioceptors: sensors within muscles that of motion performed by a sequence of
send feedback to the central nervous stretching and contracting muscles. These
system conveying muscular length and sequences target the neuromuscular
tension. The two primary sensors related to structures to facilitate relaxation of
reflexive activity.
Flexibility 64
Test Your Knowledge
1. Experts, such as the American
College of Sports Medicine,
recommend performing flexibility
exercises:
a. A minimum of 2-3 days
p/week
b. At least 1-2 days p/week
c. Ideally, 5-7 days p/week
d. Both a and c
2. The best time to perform stretching
exercises is:
a. After a warm-up or after a
workout session
b. Immediately before all high-
performance activities.
c. To the point of pain
d. While holding one’s breath.
3. The technique of stretching that
emphasizes contracting followed by
relaxing a muscle is called:
a. Ballistic
b. Dynamic
c. PNF
d. Passive
4. The key objective of performing
flexibility exercises is to:
a. Increase elasticity and
plasticity of the muscles
b. Improve body composition
c. Release toxins that
accumulate in the blood
d. Improve lung capacity
5. The stretching technique most often
recommended by experts for
general fitness is:
a. Dynamic 1. D
b. Ballistic 2. A
3. C
c. PNF 4. A
d. Static 5. D
Flexibility 65
Sources
1. Gummelt, D, The Impact of Flexibility Training on Performance, 2015, ACE Fitness;
https://www.acefitness.org/education-and-resources/professional/expert-
articles/5598/the-impact-of-flexibility-training-on-performance
2. Neogi, T. (2013). The Epidemiology and Impact of Pain in Osteoarthritis. Osteoarthritis
and Cartilage / OARS, Osteoarthritis Research Society, 21(9), 1145–1153.
http://doi.org/10.1016/j.joca.2013.03.018
3. Arthritis Foundation; arthritis.org, retrieved April 2018; https://www.arthritis.org/about-
arthritis/understanding-arthritis/arthritis-statistics-facts.php
4. Kruse, NT, Sillete, CR, Scheuermann, BW; American Journal of Physiology; Heart and
Circulatory Physiology, 2016, May 1; 310 (9): H1210-21.
5. Millar, L, American College of Sports Medicine, ACSM.org, retrieved April 2018,
http://www.acsm.org/public-information/articles/2016/10/07/improving-your-
flexibility-and-balance
6. Hindle, K. B., Whitcomb, T. J., Briggs, W. O., & Hong, J. (2012). Proprioceptive
Neuromuscular Facilitation (PNF): Its Mechanisms and Effects on Range of Motion and
Muscular Function. Journal of Human Kinetics, 31, 105–113.
http://doi.org/10.2478/v10078-012-0011-y
Additional Readings
BIOMECHANICS OF STRETCHING
http://medind.nic.in/jau/t06/jaut06p3.pdf
Flexibility 66
Chapter 6: Body Composition
Objectives:
• What is body composition?
• How does body composition affect a person’s health?
• What are the health risks and costs associated with overweight and obesity?
• What is the significance of body fat distribution?
• What is Body Mass Index (BMI) and why is it important?
Macronutrients • Water
Water is made up of hydrogen and
• Carbohydrates oxygen and is the only
The word carbohydrate literally macronutrient that provides no
means "hydrated carbon," or carbon energy. It is necessary for all
with water. Thus, it is no surprise chemical reactions in the body to
that carbohydrates are made up of occur properly.
carbon, hydrogen, and oxygen.
Sucrose (table sugar) is an example
of a commonly consumed
Nutrition 78
Micronutrients Nutrient Energy (kcal/g)
Carbohydrate 4
• Vitamins Protein 4
Vitamins are chemical compounds Lipids 9
essential for normal physiologic Water 0
processes in the body. They provide Vitamins 0
no energy. While the body can Minerals 0
produce some vitamins, many must
be provided by one’s diet. As the table above illustrates, only
carbohydrates, protein, and lipids provide
• Minerals energy. However, there is another dietary
Minerals are the elements (think energy source that is not a nutrient—
periodic table) that are essential for alcohol. To emphasize, alcohol is not a
normal physiologic processes in the nutrient, but it does provide 7 kilocalories
body. They also provide no energy. of energy per gram.
The body is unable to produce any
minerals and they all must be Knowing the number of calories in each
provided by one’s diet. nutrient allows a person to
calculate/estimate the amount of calories
Calories (Food Energy) contained in any food consumed.
Nutrition 79
High-fructose corn syrup (HFCS) is grain products, legumes, nuts and
approximately 50% glucose and 50% seeds.
fructose, which is the same as sucrose.
Nevertheless, because increased • Functional fiber
consumption of high-fructose corn syrup This type of fiber is extracted and
has coincided with increased obesity in the isolated from whole foods, then
United States, a lot of controversy added to processed foods.
surrounds its use. Whether HFCS is better
or worse than traditional sucrose is an area • Total Fiber
of great debate. Regardless, you should try Total fiber on a food label refers to
to avoid all kinds of added sugar in your diet the combined amount of both
if possible. dietary and functional fiber in food
products.
The New York Times article linked below
discusses the growing popularity of sugar Protein
compared to high fructose corn syrup:
Protein is another macronutrient that, like
"Sugar is Back on Food Labels, This Time as
carbohydrates, consists of small repeating
a Selling Point"
units. They serve as the building blocks and
The article linked below explains why the are the major structural and functional
Corn Refiners Association has asked for components of nearly all cells. Structural
permission to change the name of high proteins include keratin, collagen, elastin,
fructose corn syrup to corn sugar and why and muscle fibers. Functional proteins
the US Food and Drug Administration include enzymes, hemoglobin, hormones &
rejected that request: receptors, and membrane proteins
"FDA rejects industry bid to change name of Proteins are made up of repeating subunits
high fructose corn syrup to 'corn sugar'" known as amino acids. There are 11 non-
essential amino acids that can be produced
Fiber by the body. There are 9 essential amino
acids that cannot be produced by the body
and must be provided in the diet.
The simplest definition of fiber is
indigestible matter. Indigestible means that
Proteins can be classified as either
it survives digestion in the small intestine
complete or incomplete. Complete proteins
and reaches the large intestine. Fiber helps
provide adequate amounts of all nine
promote feelings of fullness, as well as
essential amino acids. Animal proteins, such
aiding in regular bowel movements and
as meat, fish, milk, and eggs, are good
maintaining colon health.
examples of complete proteins. Incomplete
proteins do not contain adequate amounts
• Dietary fiber of one or more of the essential amino acids.
This type of fiber occurs naturally in For example, if a protein does not provide
foods, including vegetables, fruits, enough of the essential amino acid leucine
Nutrition 80
it would be considered incomplete. Leucine phospholipids, and sterols (cholesterol).
would be referred to as the limiting amino Most people are familiar with triglycerides
acid because there is not enough of it for which are the fats referred to when we use
the protein to be complete. Most plant the terms saturated, monounsaturated, and
foods are incomplete proteins, with a few polyunsaturated fats. Fats serve multiple
exceptions, such as soy. For this reason, functions in the body. These include
people consuming a primarily plant-based cushioning/protection, regulation of body
diet must make sure to consume a variety temperature, serving as a precursor for the
of foods to assure consumption of all production of some hormones, and as a
essential amino acids. long-term energy source. As we saw earlier,
fat has more energy (calories) per gram
SELF magazine’s Nutrition Data website is a than carbohydrates or proteins. This makes
useful resource for determining protein fat a desirable storage molecule for excess
quality and identifying complementary calories in the body.
proteins. To use the site, go to
www.nutritiondata.com, type the name of Cholesterol
the food you want information on in the There is neither bad nor good cholesterol,
search bar and hit Enter. When you have despite the common use of these
selected your food from the list of descriptions in reference to LDL and HDL
possibilities, you will be given information cholesterol, respectively. In spite of these
about this food. Included in this information labels, both LDL and HDL have important
is the Protein Quality section. This will give functions in the body. However, excess LDL
you an amino acid score and a figure that in one’s diet has been linked to an
illustrates which amino acid(s) is limiting. If increased risk heart disease, hence the
your food is an incomplete protein, you can “bad” label. Because HDL has the ability to
click "Find foods with a complementary remove excess LDL from the body, it is
profile." This will take you to a list of dietary often referred to as the “good” cholesterol.
choices that will provide complementary
proteins for your food. It is not necessary to include cholesterol in
your diet because our bodies have the
The chapter linked below is from a book ability to synthesize the required amounts.
published by the National Academies of The linked article below gives you an idea of
Sciences, Engineering, and Medicine and the cholesterol content of a variety of
provides an exhaustive examination of the foods.
role protein and amino acids play in human
health. http://www.webmd.com/cholesterol-
management/foods-to-avoid-for-high-
Protein and Amino Acids cholesterol
Fat
Nutrition 82
Water People over 50, smokers, and pregnant
females or those wanting to become
Water makes up about 45-77% water pregnant may undertake specific
depending on age (decreases as we get supplementation if recommended by a
older). It is necessary for all chemical physician or registered dietician.
reactions in the body. The average adult
needs approximately 48-64 ounces of water My Plate
every day. In addition to beverages, water
can be obtained from fruits, vegetables, On average, a person needs an estimated
and other water-rich foods. 1500 to 2000 calories per day to sustain (or
carry out) daily activities. However, the
Phytochemicals actual number of calories needed by one
person is dependent on their body mass,
Phytochemicals are chemical compounds age, height, gender, activity level, and the
produced by plants, generally to help them amount of exercise per day. If exercise is
thrive or thwart competitors, predators, or regular part of one’s day, more calories are
pathogen. Tens of thousands of required. As a rule, people underestimate
phytochemicals have been identified so far the number of calories ingested and
and are an area of increased research to overestimate the amount they burn
determine their role in the body. through exercise. This can lead to ingestion
of too many calories per day. The
Research has shown that phytochemicals accumulation of an extra 3500 calories adds
may stimulate the immune system, block one pound of weight. If an excess of 200
substances we eat, drink, and breathe from calories per day is ingested, one extra
becoming carcinogenic. reduce pound of body weight will be gained every
inflammation, prevent D.N.A. damage and 18 days. At that rate, an extra 20 pounds
help with D.N.A. repair, reduce oxidative can be gained over the course of a year. Of
damage to cells, slow the growth of cancer course, this increase in calories could be
cells, trigger the destruction of damaged offset by increased exercise. For example,
cells, and help to regulate hormone running, jogging, or walking one mile burns
functions. roughly 100 calories.
Nutrition 83
Calories are in almost everything you ingest,
so when considering calorie intake,
beverages must also be considered.
Nutrition 84
Strategies for Improving Your Diet
Nutrition 85
Terminology Checklist Minerals: Inorganic substances found in
food or spices.
Macronutrients: are the nutrients the body
needs in larger amounts
Test Your Knowledge
Micronutrients: are the nutrients the body 1. The type of fiber that is known for
needs in smaller amounts lowering cholesterol levels:
a. Insoluble
Carbohydrates: The word carbohydrate b. Soluble
literally means "hydrated carbon," or c. Dietary
carbon with water. Can be either simple or d. No fiber is known for this
complex. 2. What type of protein is typically
found from animals?
Fats: Lipids consist of fatty acids, a. Insoluble
triglycerides, phospholipids, and sterols b. Soluble
(cholesterol). Can be either Saturated or c. Incomplete
Unsaturated. d. Complete
3. MyPlate tells you to make half your
Proteins: Protein is another major plate have:
macronutrient that, like carbohydrates, a. Red meat
consists of small repeating units. But b. Fruits and Veggies
instead of sugars, proteins are made up of c. Carbohydrates, specifically
amino acids. Can be either complete or simple ones.
incomplete. d. water
4. Macronutrients are:
Dietary fiber: This type of fiber occurs a. Vitamins and Minerals
naturally in foods, including vegetables, b. Water
fruits, grain products, legumes, nuts and c. Vitamins, Minerals and
seeds. Protein
d. Carbohydrates, Fats and
Functional fiber: This type of fiber is Proteins
extracted and isolated from whole foods, 5. The calories that are found in one
then added to processed foods. gram of fat is:
a. 3
Total Fiber: Total fiber on a food label b. 4
refers to the combined amount of both c. 6
dietary and functional fiber in food d. 9
products.
Key
1. b
Vitamins: Organic substances found in food 2. d
that can either be fat or water soluble. 3.
4.
b
d
5. d
Nutrition 86
References & Links
Lindshield, B. L. Kansas State University Human Nutrition (FNDH 400) Flexbook. goo.gl/vOAnR
Wardlaw GM, Hampl J. (2006) Perspectives in Nutrition. New York, NY: McGraw-Hill.
Schaafsma G. (2000) The protein digestibility-corrected amino acid score. The Journal of
Nutrition, 130(7), 1865S–1867S
OpenStax Anatomy & Physiology, Chapter 24 - You can download material for free at
http://cnx.org/contents/14fb4ad7-39a1-4eee-ab6e-3ef2482e3e22@8.108.
Nutrition 87
Chapter 8: Weight Management
Objectives:
• Discuss how to manage weight through diet
• Provide steps for starting a weight loss plan
• Reinforce the importance of physical activity in weight management
• Explain how to keep the weight off
The majority of Americans are unhappy However, it is also important for them to
with their current weight. Almost everyone know how many macronutrients are in the
would like to lose at least 5 pounds. A foods they eat. The most effective way to
growing percentage of Americans are do this is performing a 10-day nutritional
carrying enough excess weight to put them intake analysis. These analyses are best
at risk for many diseases and even death. done on consecutive days to account for
Few people, however, know enough about the habitual ebb and flow of one’s daily
their own bodies to successfully manage food intake.
their weight. Anyone planning to start a
weight loss program should begin by Remaining healthy during any weight loss
carefully considering the following factors: program is paramount. Fad diets that
promise quick results do not consider the
• How many calories are being effects of rapid weight loss on the body.
consumed daily? Restricting weight loss to 1 to 2 pounds a
• How many calories are being week is a far healthier approach. Slow
expended? weight loss also prevents the body from
• How much fluids are being burning lean muscle since the body can
consumed? only burn a certain amount of fat in a week.
• How well are electrolytes being Dieters who experience steady declines in
managed? weight are more likely to keep the weight
off. The term “diet” is often synonymous
with strict routines that require drastic
changes in one’s eating habits. In reality,
Weight Management the term
Through Diet “diet” simply describes the intake of food.
Achieving one’s ideal weight can be a real To lose weight, dieters need a clear
challenge. But like most endeavors in life, understanding of how weight loss occurs.
knowledge is power. The more people know One pound of fat loss is going to require a
about their diet, the better equipped they reduction in caloric intake of 3,500 calories.
will be to manage their weight. Most people When viewed in terms of daily food intake,
focus on the number of calories consumed. to lose a pound a week, a dieter needs to
reduce their daily food intake by 500
calories a day: 3,500 calories/7 days= 500
Weight Management 88
calories per day. To successfully lose 2 eating habits, and a plan for getting regular
pounds per week, that reduction would physical activity.
have to be doubled to 1,000 calories per Writing down the reasons why you want to
day. Attempting to lose 2 pounds or more lose weight can also help. It might be
per week would require a calorie reduction because you have a family history of heart
too drastic to be maintained and too disease, or because you want to see your
restrictive to be healthy. Thus the kids get married, or simply because you
recommendation of combining diet and want to feel better in your clothes. Post
exercise is the most effective method for these reasons where they serve as a daily
experiencing weight loss. Subtracting 500 reminder of why you want to make this
calories of food intake and exerting 500 change.
calories in exercise will provide that same
1000 calorie reduction, but in a manner that Step 2: Take stock of where you are.
is far easier to maintain, and certainly more Consider talking to your health care
enjoyable. provider. He or she can evaluate your
height, weight, and explore other weight-
No matter what your weight loss goal is, related risk factors you may have. Ask for a
even a modest weight loss, such as 5 to 10 follow-up appointment to monitor changes
percent of your total body weight, is likely in your weight or any related health
to produce health benefits, such as conditions.
improvements in blood pressure, blood
cholesterol, and blood sugars.1 Keep a "food diary" for a few days, in which
you write down everything you eat. By
doing this, you become more aware of what
Getting Started with Weight Loss you are eating and when you are eating.
This awareness can help you avoid mindless
The Centers for Disease Control and eating.
Prevention (CDC) recommends following
the step-by-step guide published on its Next, examine your current lifestyle.
website, on this page: Healthy Weight: Identify things that might pose challenges
Losing Weight. Getting Started. The same to your weight loss efforts. For example,
information is also reprinted below: does your work or travel schedule make it
difficult to get enough physical activity? Do
Step 1: Make a commitment. you find yourself eating sugary foods
Making the decision to lose weight, change because that is what you buy for your kids?
your lifestyle, and become healthier is a big Do your coworkers frequently bring high-
step to take. Start simply by making a calorie items, such as doughnuts, to the
commitment to yourself. Many people find workplace to share with everyone? Think
it helpful to sign a written contract through things you can do to help
committing to the process. This contract overcome these challenges.
may include things like the amount of
weight you want to lose, the date you Finally, think about aspects of your lifestyle
would like to lose the weight by, the dietary that can help you lose weight. For example,
changes you will make to establish healthy is there an area near your workplace where
Weight Management 89
you and some coworkers can take a walk at think about what you would do differently if
lunchtime? Is there a place in your a similar situation happens, to prevent
community, such as a YMCA, with exercise setbacks.
facilities for you and child care for your
kids? Keep in mind everyone is different—what
works for someone else might not be right
Step 3: Set realistic goals. for you. Just because your neighbor lost
Set some short-term goals and reward your weight by taking up running, doesn't mean
efforts along the way. If your long-term goal running is the best option for you. Try a
is to lose 40 pounds and to control your variety of activities: walking, swimming,
high blood pressure, some short-term tennis, or group exercise classes, to see
eating and physical activity goals might be what you enjoy most and can fit into your
to start eating breakfast, taking a 15-minute life. These activities will be easier to stick
walk in the evenings, or having a salad or with over the long term.
vegetable with supper.
Step 4: Identify resources for information
Focus on two or three goals at a time. and support.
Great, effective goals are — Find family members or friends who will
• Specific support your weight loss efforts. Making
• Realistic lifestyle changes can feel easier when you
• Forgiving (less than perfect) have others you can talk to and rely on for
support. You might have coworkers or
For example, "Exercise more" is not a neighbors with similar goals, and together
specific goal. But if you say, "I will walk 15 you can share healthful recipes and plan
minutes, 3 days a week for the first week," group exercise. Joining a weight loss group
you are setting a specific and realistic goal or visiting a health care professional, such
for the first week. as a registered dietitian, can help.
Remember, small changes every day can Step 5: Continually "check in" with yourself
lead to big results in the long run. Also, to monitor your progress.
remember that realistic goals are Revisit the goals you set for yourself in Step
achievable goals. By achieving your short- 3, and evaluate your progress regularly. If
term goals day by day, you will feel good you set a goal to walk each morning but are
about your progress and be motivated to having trouble fitting it in before work, see
continue. Setting unrealistic goals, such as if you can shift your work hours or if you
losing 20 pounds in 2 weeks, can leave you can get your walk in at lunchtime or after
feeling defeated and frustrated. work. Evaluate which parts of your plan are
Being realistic also means expecting working well and which ones need
occasional setbacks. Setbacks happen when tweaking. Then rewrite your goals and plan
you get away from your plan for whatever accordingly.
reason—maybe the holidays, longer work
hours, or another life change. When If you are consistently achieving a particular
setbacks happen, get back on track as goal, add a new goal to help you continue
quickly as possible. Also, take some time to on your pathway to success.
Weight Management 90
• Most weight loss occurs because of
Reward yourself for your successes! decreased caloric intake. However,
Recognize when you are meeting your goals evidence shows the only way to
and be proud of your progress. Use non- maintain weight loss is to be
food rewards, such as a bouquet of freshly engaged in regular physical activity.
picked flowers, a sports outing with friends,
or a relaxing bath. Rewards help keep you • Most importantly, physical activity
motivated on the path to better health.2 reduces risks of cardiovascular
disease and diabetes beyond that
produced by weight reduction
The Importance of alone.
Weight Management 91
moderate-intensity activity a week to
maintain your weight.
To lose weight and keep it off. You will • Light snow shoveling.
need a high amount of physical activity • Actively playing with children.
unless you also adjust your diet and reduce • Biking at a casual pace.
the amount of calories you are eating and •
drinking. Getting to and staying at a healthy Vigorous: If your heart rate is increased
weight requires both regular physical substantially, and you are breathing too
activity and a healthy eating plan. hard and fast to have a conversation, it is
What do moderate- and vigorous-intensity probably vigorously intense.
mean?
Examples include:
Moderate: While performing the physical • Jogging/running.
activity, if your breathing and heart rate is • Swimming laps.
noticeably faster but you can still carry on a • Rollerblading/inline skating at a
conversation, it is probably moderately brisk pace.
intense. • Cross-country skiing.
• Most competitive sports (football,
Examples include: basketball, or soccer).
• Walking briskly (a 15-minute mile). • Jumping rope.
• Light yard work (raking/bagging
leaves or using a lawn mower).
The table on the next page provides a list of common physical activities and the average
calories expended during those activities.
Weight Management 92
Calories Used per Hour in Common Physical Activities
Moderate Physical Activity Approximate Calories/30 Min. Approximate Calories/Hr. for a
for a 154 lb. Person1 154 lb. Person1
Hiking 185 370
Light gardening/yard work 165 330
Dancing 165 330
Golf (walking and carrying 165 330
clubs)
Bicycling (<10 mph) 145 290
Walking (3.5 mph) 140 280
Weight lifting (general light 110 220
workout)
Stretching 90 180
Vigorous Physical Activity Approximate Calories/30 Min. Approximate Calories/Hr.
for a 154 lb. Person1 for a 154 lb. Person1
Running/jogging (5 mph) 295 590
Bicycling (>10 mph) 295 590
Swimming (slow freestyle laps) 255 510
Aerobics 240 480
Walking (4.5 mph) 230 460
Heavy yard work (chopping 220 440
wood)
Weightlifting (vigorous effort) 220 440
Basketball (vigorous) 220 440
1. Calories burned per hour will be higher for persons who weigh more than 154 lbs. (70 kg) and lower
for persons who weigh less.
Source: Adapted from Dietary Guidelines for Americans 2005, page 16, Table 4.
Weight Management 93
You may access that section on their to pat yourself on the back for the
website by clicking Healthy Weight: things you are doing right. Maybe
Improving Your Eating Habits. It is also you almost always eat fruit for
reprinted below. dessert, or you drink low-fat or fat-
free milk. These are good habits!
Reflect, Replace, Reinforce: A Recognizing your successes will help
process for improving your eating encourage you to make more
changes.
habits
• Create a list of "cues" by reviewing
• Create a list of your eating habits.
your food diary to become more
Keeping a food diary for a few days,
aware of when and where you are
in which you write down everything
"triggered" to eat for reasons other
you eat and the time of day you ate
than hunger. Note how you are
it, will help you uncover your habits.
typically feeling at those times.
For example, you might discover
Often an environmental "cue," or a
that you always seek a sweet snack
particular emotional state, is what
to get you through the mid-
encourages eating for non-hunger
afternoon energy slump. Use this
reasons.
diary to help. It's good to note how
• Common triggers for eating when
you were feeling when you decided
not hungry are:
to eat, especially if you were eating
- Opening up the cabinet and seeing
when not hungry. Were you tired?
your favorite snack food.
Stressed out?
- Sitting at home watching
television.
• Highlight the habits on your list that
- Before or after a stressful meeting
may be leading you to overeat.
or situation at work.
Common eating habits that can lead
- Coming home after work and
to weight gain are:
having no idea what's for dinner.
- Eating too fast
- Having someone offer you a dish
- Always cleaning your plate
they made "just for you!"
- Eating when not hungry
- Walking past a candy dish on the
- Eating while standing up (may lead
counter.
to eating mindlessly or too quickly)
- Sitting in the break room beside
- Always eating dessert
the vending machine.
- Skipping meals (or maybe just
- Seeing a plate of doughnuts at the
breakfast)
morning staff meeting.
- Swinging through your favorite
• Look at the unhealthy eating habits
drive-through every morning.
you have highlighted. Be sure you
- Feeling bored or tired and thinking
have identified all the triggers that
food might offer a pick-me-up.
cause you to engage in those habits.
Identify a few you would like to
Circle the "cues" on your list that you face
work on improving first. Don't forget
on a daily or weekly basis. Going home for
Weight Management 94
the Thanksgiving holiday may be a trigger attention to how quickly—and how much—
for you to overeat, and eventually, you you are eating.
want to have a plan for as many eating cues
as you can. But for now, focus on the ones Here are more ideas to help you replace
you face more often. unhealthy habits:
Ask yourself these questions for each "cue" Eat more slowly. If you eat too quickly, you
you have circled: may "clean your plate" instead of paying
attention to whether your hunger is
Is there anything I can do to avoid the cue satisfied.
or situation? This option works best for
cues that don't involve others. For example, Eat only when you are truly hungry instead
could you choose a different route to work of when you are tired, anxious, or feeling an
to avoid stopping at a fast food restaurant emotion besides hunger. If you find yourself
on the way? Is there another place in the eating when you are experiencing an
break room where you can sit so you are emotion besides hunger, such as boredom
not next to the vending machine? or anxiety, try to find a non-eating activity
to do instead. You may find a quick walk or
For things I cannot avoid, can I do phone call with a friend helps you feel
something differently that would be better.
healthier? Obviously, you cannot avoid all
situations that trigger your unhealthy eating Plan meals ahead of time to ensure that you
habits, like staff meetings at work. In these eat a healthy well-balanced meal.
situations, evaluate your options. Could you Reinforce your new, healthy habits and be
suggest or bring healthier snacks or patient with yourself. Habits take time to
beverages? Could you offer to take notes to develop. It doesn't happen overnight. When
distract your attention? Could you sit you do find yourself engaging in an
farther away from the food so it won't be as unhealthy habit, stop as quickly as possible
easy to grab something? Could you plan and ask yourself: Why do I do this? When
ahead and eat a healthy snack before the did I start doing this? What changes do I
meeting? need to make?
Replace unhealthy habits with new, healthy Be careful not to berate yourself or think
ones. For example, in reflecting upon your that one mistake "blows" a whole day's
eating habits, you may realize that you eat worth of healthy habits. You can do it! It
too fast when you eat alone. So, make a just takes one day at a time!
commitment to share a lunch each week
with a colleague, or have a neighbor over Health Risks of Being Underweight
for dinner one night a week. Other The 2003–2006 National Health and
strategies might include putting your fork Nutrition Examination Survey (NHANES)
down between bites or minimizing other estimated that 1.8 percent of adults and 3.3
distractions (i.e., watching the news during percent of children and adolescents in the
dinner) that might keep you from paying United States are underweight. Being
underweight is linked to nutritional
Weight Management 95
deficiencies, especially iron-deficiency anorexia. The exact causes of anorexia are
anemia, and to other problems such as not completely known, but many things
delayed wound healing, hormonal contribute to its development including
abnormalities, increased susceptibility to economic status, as it is most prevalent in
infection, and increased risk of some high-income families. It is a genetic disease
chronic diseases such as osteoporosis. In and is often passed from one generation to
children, being underweight can stunt the next. Pregnancy complications and
growth. The most common underlying abnormalities in the brain, endocrine
cause of underweight in America is system, and immune system may all
inadequate nutrition. Other causes are contribute to the development of this
wasting diseases, such as cancer, multiple illness.
sclerosis, tuberculosis, and eating disorders. The primary signs of anorexia are fear of
People with wasting diseases are being overweight, extreme dieting, an
encouraged to seek nutritional counseling, unusual perception of body image, and
as a healthy diet greatly affects survival and depression. The secondary signs and
improves responses to disease treatments. symptoms of anorexia are all related to the
Eating disorders that result in underweight caloric and nutrient deficiencies of the
affect about eight million Americans (seven unbalanced diet and include excessive
million women and one million men). weight loss, a multitude of skin
abnormalities, diarrhea, cavities and tooth
Anorexia Nervosa loss, osteoporosis, and liver, kidney, and
Anorexia nervosa, more often referred to as heart failure. There is no physical test that
“anorexia,” is a psychiatric illness in which a can be used to diagnose anorexia and
person obsesses about their weight and distinguish it from other mental illnesses.
about food that they eat. Anorexia results Therefore, a correct diagnosis involves
in extreme nutrient inadequacy and eliminating other mental illnesses,
eventually to organ malfunction. Anorexia is hormonal imbalances, and nervous system
relatively rare—the National Institute of abnormalities. Eliminating these other
Mental Health (NIMH) reports that 0.9 possibilities involves numerous blood tests,
percent of females and 0.3 percent of males urine tests, and x-rays. Coexisting organ
will have anorexia at some point in their malfunction is also examined. Treatment of
lifetime but it is an extreme example of how any mental illness involves not only the
an unbalanced diet can affect health. individual, but also family, friends, and a
Anorexia frequently manifests during psychiatric counselor. Treating anorexia
adolescence and it has the highest rate of also involves a dietitian, who helps to
mortality of all mental illnesses. People with provide dietary solutions that often have to
anorexia consume, on average, fewer than be adjusted over time. The goals of
1,000 kilocalories per day and exercise treatment for anorexia are to restore a
excessively. They are in a tremendous healthy body weight and significantly
caloric imbalance. Moreover, some may reduce the behaviors associated with
participate in binge eating, self-induced causing the eating disorder. Relapse to an
vomiting, and purging with laxatives or unbalanced diet is high. Many people do
enemas. The very first time a person starves recover from anorexia, however most
him- or herself may trigger the onset of continue to have a lower-than-normal
Weight Management 96
bodyweight for the rest of their lives
(see Note 11.33 "Video 11.3"). Binge-Eating Disorder
Similar to those who experience anorexia
Video 11.3 and bulimia, people who have a binge-
What I Gained in Recovery from Anorexia eating disorder have lost control over their
(click to see video) eating. Binge-eating disorder is not
On a more positive note, watch this currently diagnosed as a distinct psychiatric
personal account of what can be gained illness, although there is a proposal from
from anorexia recovery. the American Psychiatric Association to
categorize it more specifically. People with
binge-eating disorder will periodically
Bulimia overeat to the extreme, but their loss of
Bulimia, like anorexia, is a psychiatric illness control over eating is not followed by
that can have severe health consequences. fasting, purging, or compulsive exercise. As
The NIMH reports that 0.5 percent of a result, people with this disorder are often
females and 0.1 percent of males will have overweight or obese, and their chronic
bulimia at some point in their lifetime. disease risks are those linked to having an
Bulimia is characterized by episodes of abnormally high body weight such as
eating large amounts of food followed by hypertension, cardiovascular disease, and
purging, which is accomplished by vomiting Type 2 diabetes. Additionally, they often
and with the use of laxatives and diuretics. experience guilt, shame, and depression.
Unlike people with anorexia, those with Binge-eating disorder is commonly
bulimia often have a normal weight, making associated with depression and anxiety
the disorder more difficult to detect and disorders. According to the National
diagnose. The disorder is characterized by Institute of Mental Health NIMH, binge-
signs similar to anorexia such as fear of eating disorder is more prevalent than
being overweight, extreme dieting, and anorexia and bulimia, and affects 3.5
bouts of excessive exercise. Secondary signs percent of females and 2.0 percent of
and symptoms include gastric reflux, severe males at some point during their lifetime.
erosion of tooth enamel, dehydration, Treatment often involves antidepressant
electrolyte imbalances, lacerations in the medication as well as nutritional and
mouth from vomiting, and peptic ulcers. psychiatric counseling.
Repeated damage to the esophagus puts
people with bulimia at an increased risk for
esophageal cancer. The disorder is also
highly genetic, linked to depression and
anxiety disorders, and most commonly
occurs in adolescent girls and young
women. Treatment often involves
antidepressant medications and, like
anorexia, has better results when both the
family and the individual with the disorder
participate in nutritional and psychiatric
counseling.
Weight Management 97
5. The % of Americans currently
Overweight:
Terminology Checklist a. 33
Binge Eating Disorder: Eating large b. 45
amounts (typically an entire day’s worth) of c. 66
calories in one sitting. Often done at night d. 90
and alone.
Key
1. d
Anorexia Nervosa: A disorder where 2. b
someone constricts caloric intake leading to 3.
4.
a
c
extreme leanness. 5. c
Weight Management 98
References:
1. https://www.cdc.gov/nchs/data/hestat/underweight/underweight_children.htm
2. https://www.cdc.gov/healthyweight/losing_weight/getting_started.html.
3. https://www.cdc.gov/healthyweight/prevention/index.html
4. https://www.cdc.gov/healthyweight/losing_weight/eating_habits.html
5. https://health.gov/sites/default/files/2020-01/DGA2005.pdf#page=16
6. https://www.dietaryguidelines.gov/sites/default/files/2020-12/DGA_2020-
2025_Infographic_MakeEveryBiteCount.pdf
7. https://www.cdc.gov/healthyweight/pdf/food_diary_cdc.pdf
8. https://www.youtube.com/watch?v=Q7mYmEhh2fY
9. https://www.mentalhealth.gov/what-to-look-for/eating-disorders/anorexia
10. https://www.nimh.nih.gov/health/statistics/eating-disorders
Weight Management 99
Chapter 9: Stress
Objectives:
• Define stress
• Describe the effects of stress on wellbeing
• Identify effective strategies for managing stress
• Assess your own levels of stress
In today’s fast-paced society, most people Additionally, not all levels of stress are
complain about being stressed. However, detrimental. The stress athletes experience
when they use the term stress, they rarely right before a big game or college students
know its true meaning. The word carries feel right before an exam can enhance
many negative connotations and is focus and increase their ability to
associated with an unpleasant or traumatic concentrate. Stress is either good or bad
event. As such, people mistakenly believe depending on how long it persists and how
that stress is simply the nervousness and it is perceived by the individual.
tension experienced prior to, during, or
after a negative event. In fact, the effects of This chapter will provide a deeper
stress are physiological, emotional, and understanding of what stress is and provide
psychological. effective strategies for managing stress.
Stress 100
their situation, everyone experiences stress scaling a cliff can enhance these
on a regular basis. The good news is, not all experiences. Regardless of whether the
stress is bad! Small levels of stress can stress experienced is negative or positive,
enhance cognitive brain function. Stress the effects on the body are identical.
may provide the motivation and When a person senses that a situation
concentration you need to write an essay, demands action, the body responds by
practice a speech, or prepare for a job releasing chemicals into the blood. The
interview. For most people, these types of hypothalamus signals the adrenal glands to
stressors are manageable and not harmful. release a surge of hormones that include
Stressors that have the potential for harm adrenaline and cortisol. The physiological
include the sudden loss of a loved one, the effects of those chemicals—enhanced
unexpected ending of a romantic focus, quicker reaction time, and increased
relationship, or the unfair demands of an heart rate, energy, and strength—are quite
unreasonable boss. beneficial when faced with a potentially
dangerous situation that is temporary.
What is stress and what causes it? What Are the Strategies for
Managing Stress?
Effects of Stress on Wellness
Although stress in everyday life is
unavoidable, there are ways to cope with it
As stated previously, not all stress is bad. In
that will minimize or eliminate its harmful
fact, the stress associated with riding a
effects.
roller coaster, watching a scary movie, or
Stress 101
The Anxiety and Depression Association of • Get involved. Volunteer or find
America (ADAA) provides a list of effective another way to be active in your
strategies for coping with stress. That community, which creates a support
document is linked here: Tips: Coping network and gives you a break from
Strategies. For your convenience, it is also everyday stress.
reprinted below with the ADAA’s • Learn what triggers your anxiety. Is
permission. it work, family, school, or something
else you can identify? Write in a
When you are feeling anxious or stressed, journal when you’re feeling stressed
these strategies will help you cope: or anxious and look for a pattern.
• Talk to someone. Tell friends and
• Take a time-out. Practice yoga, family you’re feeling overwhelmed,
listen to music, meditate, get a and let them know how they can
massage, or learn relaxation help you. Talk to a physician or
techniques. Stepping back from the therapist for professional help.
problem helps clear your head. • Get help online. Online programs
• Eat well-balanced meals. Do not guided by professional coaches to
skip any meals. Do keep healthful, help you turn healthy anxiety
energy-boosting snacks on hand. management into a habit.
• Limit alcohol and caffeine, which o Listen to podcasts on a wide
can aggravate anxiety and trigger range of topics
panic attacks.
• Get enough sleep. When stressed, Fitness Tips: Stay Healthy, Manage
your body needs additional sleep
Stress
and rest.
• Exercise daily to help you feel good
To receive the greatest benefits from
and maintain your health. Check out
exercising, try to include at least 2½ hours
the fitness tips below.
of moderate-intensity physical activity (e.g.,
• Take deep breaths. Inhale and
brisk walking) each week, 1¼ hours of a
exhale slowly.
vigorous-intensity activity (such as jogging
• Count to 10 slowly. Repeat, and
or swimming laps), or a combination of the
count to 20 if necessary.
two.
• Do your best. Instead of aiming for
• 5 X 30: Jog, walk, bike, or dance
perfection, which isn't possible, be
three to five times a week for 30
proud of however close you get.
minutes.
• Accept that you cannot control
• Set small daily goals and aim for
everything. Put your stress in
daily consistency rather than perfect
perspective: Is it really as bad as you
workouts. It is better to walk every
think?
day for 15–20 minutes than to wait
• Welcome humor. A good laugh goes
until the weekend for a three-hour
a long way.
fitness marathon. Lots of scientific
• Maintain a positive attitude. Make
data suggests that frequency is most
an effort to replace negative
important.
thoughts with positive ones.
Stress 102
• Find forms of exercise that are fun
or enjoyable. Extroverted people
Assess Your Stress Level
often like classes and group
Are you more or less stressed than your
activities. People who are more
peers? The website linked below contains a
introverted often prefer solo
stress test. On the website, scroll down to
pursuits.
the “Quiz: Are You Stressed?”
• Distract yourself with an iPod or
other portable media player to
How Stressed Are You?
download audiobooks, podcasts, or
music. Many people find it is more
Below is a link to the Lab for this chapter on
fun to exercise while listening to
stress.
material they enjoy.
• Recruit an “exercise buddy.” It is
Lab for Chapter on Stress
often easier to stick to your exercise
routine when you have to stay
committed to a friend, partner, or
colleague.
• Be patient when you start a new
exercise program. Most sedentary
people require about four to eight
weeks to feel coordinated and
sufficiently in shape so that exercise
feels easier.
Additional strategies for coping with stress
are linked below:
Stress Management
Stress 103
Terminology Checklist:
Stress 104
Test Your Knowledge
1. The stage of stress where the stressor can cause death or health problems
a. Alarm
b. Resistance
c. Exhaustion
d. Relapse
2. Which of the following does not occur when the body first encounters
stress
a. Heart rate increase
b. Breathing increase
c. Increased sweating
d. Faster digestion
Stress 105
Chapter
10:Cardiovascular
Disease and Stroke Things that lead to Cardiovascular Disease
What is Heart Disease • Sex. Males are higher risk for CVD,
especially at younger ages. Women
can be at high risk in later parts of
Heart disease is the leading killer of
their lives. To help with some of this
Americans — there are about 425,000
risk women can look at this:
deaths each year from heart disease. In
https://www.nhlbi.nih.gov/health-
addition, stroke, the third most common
topics/education-and-
cause of death, has declined by about 75
awareness/heart-truth/listen-to-
percent since the early 1960s (NIH, 2017).
your-heart
While its root causes were unknown at that
time, today, researchers can trace the
problem to changes in the American lifestyle
• Race. African American have the
highest risk factor for CVD
after World War II. Postwar prosperity led to
more sedentary lifestyles and fattier diets.
And cigarettes, which were introduced to
• Family History/ Race This can be one
of the strongest predictors of CVD,
soldiers during the war, became broadly
but also has the smallest correlation
popular. Researchers believe that the
to to CVD overall.
epidemic can be reversed if people eat
healthier diets, exercise more, and stop
smoking. (GPB, 2017)
These 4 things can be linked to
cardiovascular disease that you can change:
https://gpb.pbslearningmedia.org/resource/e
nvh10.health.heartdisease/heart-disease-
americas-leading-cause-of- • Tobacco. The strongest predictor of
CVD is the use of tobacco. The use
death/#.WQaEiVK-LR0
of tobacco accounts for 30% of CVD
106
risk. There is a significant reduction and blood vessel system. Other
in risk for those who don’t use cardiovascular diseases include stroke, high
tobacco. blood pressure, angina (chest pain), and
rheumatic heart disease. (NIH, 2017)
• Obesity. Those who have a BMI
greater than 30 have a higher than Heart Attack
normal risk than those that do not A Myocardial Infarction is otherwise known
have a BMI greater than 30. “The as a heart attack. This MI can be seen with
“obesity epidemic” experienced by the symptoms of Angina Pectoris (crushing
the United States over the past chest pains, profound shortness of breath,
several decades threatens to reverse left arm pain, radiating jaw pain or middle
important progress against heart back pain. These signs and symptoms of
disease. The NIH has undertaken heart attack are very serious and should be
several efforts to prevent or reduce recognized as soon as possible and should
obesity in children and young adults, be taken care of ASAP.
including a set of randomized trials to
identify effective approaches in
individuals and a large project to
evaluate community approaches to
reduce obesity in children" (NIH,
2017).
107
• Chew and swallow an aspirin, unless
you are allergic to aspirin or have
been told by your doctor never to What is your Number?
take aspirin. But seek emergency
help first, such as calling 911. Lipoprotein Profile:
108
• Why: To find out if you have high https://www.cdc.gov/diabetes/basics/gettin
blood pressure (also called g-tested.html
hyper- tension) or
prehypertension. Both are risk
factors for heart disease. Stroke
• When: At least every 2 years, or A cerebrovasucular accident or stroke is a
more often if you have high blockage that occurs on the way to the
blood pressure or brain. This ischemic stroke that is a
prehypertension. blockage that occurs on the way to the brain
is different than a hemorrhagic stroke, which
https://www.health.harvard.edu/heart- is a rupture in the arteries of the brain. It
health/reading-the-new-blood- accounts for only 20% of all strokes.
pressure-guidelines
109
Terminology Checklist c. Sudden Cardiac Death
d. Arrhythmia
Heart Disease: The disease of the heart that
2. What acronym is used to help
can be deemed deadly to about 425,000
identify if someone is having a
people per year.
stroke?
a. SLOW
Atherosclerosis: The narrowing and
b. JUMP
hardening of the arteries.
c. FAST
d. DOWN
Angina Pectoris: Crushing chest pains.
3. Crushing chest pains are called:
Arrhythmia: A lack of “normal” heart
a. Angina Rhomboids
rhythm.
b. Angina Femurous
c. Angina Pectoris
Myocardial Infarction: Heart Attack
d. Angina Visceralis
Cerebrovascular accident: Also known as
CVA, is a term used for strokes
4. Which of the following is not a
factor that increases risk of CVD?
Ischemic Stroke: A stroke happening in the
a. Being Female
vessels on the way to the brain, most likely
b. Smoking
from a blockage
c. Having family history of CVD
d. Being older than 65
Hemorrhagic stroke: A stroke that happens
when vessels in the brain rupture causing
5. A fasting blood glucose level to be
heavy bleeding within the brain.
normal should be less than
a. 100
HDL Cholesterol: High-Density Lipoprotein,
b. 110
also known as the good type of cholesterol.
c. 125
d. 150
LDL Cholesterol: Low-Density Lipoprotein
also known as the good type of cholesterol.
110
Notes:
111
Chapter 11: Cancer Development
By Althea K. Moser M.A., MCHES®
Objectives:
• Define cancer and how cancer arises
• Describe different types of cancer
• Identify cancer risks and methods for cancer prevention
• Assess personal cancer risk
Cancer statistics also help us see trends. By • The rate of new cases of cancer
looking at cancer rates over time, we can (cancer incidence) is 442.4 per
track changes in the risk of developing and 100,000 men and women per year
dying from specific cancers as well as cancer (based on 2013–2017 cases).
overall.
• The cancer death rate (cancer
mortality) is 158.3 per 100,000 men
People who are at increased risk of Some screening tests for lung cancer
colorectal cancer because of a family include:
history of colorectal cancer or documented
advanced polyps or because they have • Low-dose Computed Tomography
inflammatory bowel disease or certain (LDCT)
inherited conditions (such as Lynch A procedure that uses low-dose radiation to
syndrome and familial adenomatous make a series of very detailed pictures of
polyposis) may be advised to start screening areas inside the body using an x-ray
earlier and/or have more frequent machine that scans the body in a spiral
screening. path. This procedure is also called spiral
scan or helical scan.
Lung Cancer
Screening with LDCT scans has been shown
Key Points: to decrease the risk of dying from lung
cancer in heavy smokers.
• Lung cancer is a disease in which
malignant (cancer) cells form in the • Chest X-ray
tissues of the lung. An x-ray of the organs and bones inside the
chest.
Almost all testicular cancers start in the • Physical Exam and History:
germ cells. The two main types of testicular An exam of the body to check general
germ cell tumors are seminomas and signs of health, including checking for
nonseminomas. These 2 types grow and signs of disease, such as lumps or
spread differently and are treated anything else that seems unusual. The
differently. Nonseminomas tend to grow testicles will be examined to check for
and spread more quickly than seminomas. lumps, swelling, or pain. A history of the
Seminomas are more sensitive to radiation. patient's health habits and past illnesses
A testicular tumor that contains both and treatments will also be taken.
seminoma and nonseminoma cells is
treated as a nonseminoma. • Ultrasound Exam of the Testes:
A procedure in which high-energy sound
Testicular cancer is very rare, but it is the waves (ultrasound) are bounced off
most common cancer found in men internal tissues or organs and make
between the ages of 15 and 34. echoes. The echoes form a picture of
body tissues called a sonogram.
White men are four times more likely than
black men to have testicular cancer. Certain treatments for testicular cancer can
cause infertility that may be permanent.
Signs and symptoms of testicular cancer Patients who may wish to have children
include swelling or discomfort in the should consider sperm banking before
scrotum. having treatment. Sperm banking is the
process of freezing sperm and storing it for
Testicular cancer can usually be cured. later use.
Although the number of new cases of The following video explains how to
testicular cancer has doubled in the last 40 perform a testicular self-exam:
years, the number of deaths caused by
testicular cancer has decreased greatly Testicular Self-Exam
because of better treatments.
Cancer risk factors include exposure to Some of the most studied risk factors for
chemicals or other substances, as well as cancer are listed below.
certain behaviors. They also include
circumstances that people cannot control, Age
like age and family history. A family history
of certain cancers can be a sign of a possible Advancing age is the most important risk
inherited cancer syndrome. factor for cancer overall, and for many
specific types of cancer. According to the
Cancer Development 122
most recent statistical data from the evidence exists that drinking red wine
National Cancer Institute’s Surveillance, reduces the risk of cancer.
Epidemiology, and End Results program, the
median age of a cancer diagnosis is 66
years. This means that half of cancer cases Cancer-Causing Substances in the
occur in people below this age and half in Environment
people above this age. One-quarter of new
cancer cases are diagnosed in people aged
Cancer is caused by changes to certain
from 65 to 74.
genes that alter the way our cells function.
Some of these genetic changes occur
But the disease can occur at any age. For
naturally when DNA is replicated during the
example, bone cancer is most frequently
process of cell division. But others are the
diagnosed among people under age 20,
result of environmental exposures that
with more than one-fourth of cases
damage DNA. These exposures may include
occurring in this age group. And 10 percent
substances known as carcinogens, any
of leukemias are diagnosed in children and
substance that causes cancer, such as the
adolescents under 20 years of age, whereas
chemicals in tobacco smoke; and radiation,
only 1 percent of cancer overall is
such as ultraviolet rays from the sun.
diagnosed in that age group.
People can avoid some cancer-causing
exposures, such as tobacco smoke and the
sun’s rays. But others are harder to avoid,
Alcohol especially if they are found in the air, water,
and food, or the materials people use to do
Drinking alcohol can increase a person’s risk their jobs. Scientists are studying which
of cancer of the mouth, throat, esophagus, exposures may cause or contribute to the
larynx (voice box), liver, and breast. The development of cancer. Understanding
more a person consumes alcohol, the which exposures are harmful, and where
higher his or her risk. The risk of cancer is they are found, may help people avoid
much higher for those who drink alcohol them.
and also use tobacco.
Simply because a substance has been
Doctors advise people who drink to do so in designated as a carcinogen, however, that
moderate amounts. The federal does not mean that the substance will
government’s Dietary Guidelines for necessarily cause cancer. Many factors
Americans defines moderate alcohol influence whether a person exposed to a
drinking as up to one drink per day for carcinogen will develop cancer, including
women and up to two drinks per day for the amount and duration of the exposure
men. and the individual’s genetic background.
But with few exceptions, studies of human Studies have also shown that a woman’s
populations have not yet shown definitively risk of breast cancer is related to the
that any dietary component causes or estrogen and progesterone made by her
protects against cancer. Sometimes the ovaries, known as endogenous estrogen
results of epidemiologic studies, which and progesterone. Being exposed for a long
compare the diets of people with and time and/or to high levels of these
without cancer have indicated that people hormones has been linked to an increased
with and without cancer differ in their risk of breast cancer. Increases in exposure
intake of a particular dietary component. can be caused by starting menstruation
early, going through menopause late, being
However, these results show only that the older at first pregnancy, and never having
dietary component is associated with a given birth. Conversely, having given birth is
change in cancer risk, not that the dietary a protective factor for breast cancer.
component is responsible for, or causes, the
change in risk. For example, participants
with and without cancer could differ in Obesity
other ways besides their diet, and it is
possible that some other difference People who are obese may have an
accounts for the variance in cancer risk. increased risk of several types of cancer,
including cancers of the breast (in women
who have been through menopause), colon,
Hormones rectum, esophagus, kidney, pancreas,
gallbladder, and the lining of the uterus,
Estrogens, a group of female sex hormones, called the endometrium.
are known human carcinogens. Although
these hormones have essential Conversely, eating a healthy diet, being
physiological roles in both females and physically active, and maintaining a healthy
males, they have also been associated with weight may reduce the risk of some
an increased risk of certain cancers. For cancers. These healthy behaviors also
instance, taking combined menopausal lessen the risk of other illnesses, such as
hormone therapy (estrogen plus progestin, heart disease, type II diabetes, and high
which is a synthetic version of the female blood pressure.
2. When comparing groups based on race/ethnicity and sex, cancer mortality is highest in:
a) Caucasian women
b) African-American men
c) Pacific Islander women
d) Caucasian men
3. Cancer of the lung, larynx (voice box), mouth, esophagus, throat, pancreas, as well as acute
myeloid leukemia are often the result of:
a) alcohol abuse
b) exposure to UV radiation
c) tobacco use
d) hormonal imbalances
Source:
Copyright Disclaimer:
Most of the information on the National Cancer Institute (NCI) website, www.cancer.gov, is in
the public domain and is not subject to copyright restrictions. No special permission is required
to use or reproduce public domain material. NCI's public domain information includes health
professional and patient information in NCI's Physician Data Query (PDQ®) cancer information
database and patient education brochures, booklets, and fact sheets.
However, any reproduced material should acknowledge NCI as the originator and the NCI
website, www.cancer.gov, as the source.
Objectives:
• Address addiction and risk factors for addiction
• Define types of drugs, possible health effects, and treatment options
• Explore the abuse of alcohol, nicotine, e-cigarettes, and prescription drugs and their role in
addiction
• Assess personal risk for substance use and abuse
1. Scientists estimate that genetic factors account for between 25-50 percent T F
of a person’s vulnerability to addiction.
4. List three symptoms that people may experience when withdrawing from tobacco and
nicotine.
5. List three factors that may influence how a person reacts to alcohol.
Answers: 1. F, 2. T, 3. D
• Anxiety
• Irritability
• Headache
• Hunger
• Cravings for cigarettes and other sources of nicotine
• Age
• Sex.
• Race or ethnicity.
• Physical condition (e.g. weight, fitness level).
• Amount of food consumed before drinking.
• How quickly the alcohol was consumed.
• Use of drugs or prescription medicines.
• Family history of alcohol problems
(https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preface)
(https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts)
Copyright Disclaimer:
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addiction/preface on 2017, May 29
Objectives:
• Define STDs, explain how they are transmitted, and identify the most common STDs/
STIs
• Identify the incidence, prevalence, and cost of STIs in the United States
• Learn prevention techniques and treatment options
• Develop a personal plan for STI prevention
137
United States each year to become Social, Economic, and Behavioral
infertile.5 Factors
138
with the highest rates of STDs are often What Causes Sexually
the same groups for whom access to or
use of health services is most limited.10, Transmitted Diseases (STDs)
11
or Sexually Transmitted
• Substance abuse. Many studies
document the association of substance Infections (STIs)?
abuse with STDs.12 The introduction of
new illicit substances into communities There are three major causes of STDs/STIs:
often can alter sexual behavior
drastically in high-risk sexual networks, • Bacteria, including chlamydia,
leading to the epidemic spread of gonorrhea, and syphilis
STDs.13
• Viruses, including HIV/AIDS, herpes
• Sexuality and secrecy. Perhaps the most simplex virus, human
important social factors contributing to papillomavirus, hepatitis B virus,
cytomegalovirus (CMV), and Zika
the spread of STDs in the United States
are the stigma associated with STDs and
• Parasites, such as trichomonas
the general discomfort of discussing
vaginalis, or insects such as crab lice
intimate aspects of life, especially those
or scabies mites1
related to sex.14 These social factors
separate the United States from Any STI can be spread through sexual
industrialized countries with low rates activity including sexual intercourse, and
of STDs. some STIs also are spread through oral sex
and other sexual activity. Ejaculation does
• Sexual networks. Sexual networks refer not have to occur for an STI to pass from
to groups of people who can be person to person.
considered “linked” by sequential or
concurrent sexual partners. A person In addition, sharing contaminated needles,
may have only 1 sex partner, but if that such as those used to inject drugs, or using
partner is a member of a risky sexual contaminated body piercing or tattooing
network, then the person is at higher equipment also can transmit some
risk for STDs than a similar individual infections, such as HIV, hepatitis B, and
from a lower-risk network. hepatitis C. A few infections can be sexually
transmitted but are also spread through
The following information about what nonsexual, close contact. Some of these
causes STD’s or STI’s is Courtesy: Eunice infections, like CMV, are not considered
Kennedy Shriver National Institute of Child STIs even though they can be transmitted
Health and Human Development, is through sexual contact.
published by the US Department of Health Regardless of how a person is exposed,
and Human Services and found on the once a person is infected by an STI, he or
NICHD’s website on the page “What causes she can spread the infection to other
sexually transmitted diseases (STDs) or people through oral, vaginal, or anal sex,
sexually transmitted infections (STIs)?” even if he or she has no symptoms.
139
What are the Most Common • Can be transmitted to fetus during
pregnancy or to infant during
Types of STIs? delivery, causing eye infections or
pneumonia. Antibiotic ointment is
The following information about some usually applied to a baby's eyes after
types of STDs and STIs is Courtesy: Eunice birth to treat undetected chlamydia.
Kennedy Shriver National Institute of Child
Health and Human Development, is • Because chlamydia and gonorrhea
published by the US Department of Health often occur together, people who
and Human Services and found on the have one infection are typically
NICHD’s website on the page “What are treated for both by their health care
some types of sexually transmitted diseases provider.
or sexually transmitted infections
(STDs/STIs)?”: • To prevent health complications and
sexual transmission, treatment
should be provided promptly for all
Chlamydia persons testing positive for
infection, and recent sexual partners
• Caused by the bacterium Chlamydia should be treated at the same time
trachomatis to prevent reinfection.
140
• Like chlamydia, if left untreated, Genital Herpes
gonorrhea can cause pelvic
inflammatory disease, which can • Caused by the herpes simplex virus
lead to chronic pelvic pain and (HSV)4
permanent damage to a woman's
reproductive organs. This damage • There are two different strains, or
may lead to ectopic pregnancy (in types: HSV type 1 (HSV-1) and type 2
which the fetus develops outside of (HSV-2). Both can cause genital
the womb, a condition that can be herpes, although most cases of
life-threatening) and infertility.2 genital herpes are caused by HSV-2.5
141
infant from getting the virus during or PrEP, which consists of the HIV
birth.4 medication called Truvada, from
their doctor to take every day so
• Pregnant women, especially those they can prevent HIV infection. PrEP
who acquire genital herpes for the will not work if it is not taken
first time during pregnancy, may consistently.
pass the infection to their newborns,
causing life-threatening neonatal • AIDS can be prevented in those with
HSV, an infection affecting the HIV infection by early initiation of
infant's skin, brain, and other antiretroviral therapy.
organs.6
• Transmission of the virus primarily
occurs during unprotected sexual
HIV/AIDS activity and by sharing needles used
to inject intravenous drugs.
• HIV, human immunodeficiency
virus,7 is the virus that causes AIDS • HIV can also spread from mother to
fetus during pregnancy and from
• Destroys the body's immune system mother to infant during delivery and
by killing the blood cells that fight breastfeeding. However, treatments
infection. Once HIV destroys a are available that can virtually
substantial proportion of these cells, eliminate these types of
the body's ability to fight off and transmission.
recover from infections is
compromised. This advanced stage Click on the following link to learn more
of HIV infection is known as AIDS. about HIV:
• People whose HIV infection has HIV in the United States and Dependent
progressed to AIDS have a Areas
weakened immune system and are
very susceptible to opportunistic Human Papillomavirus (HPV)
infections that do not normally
make people sick and to certain • HPV8 is the most common STI. More
forms of cancer. than 40 HPV types exist, and all of
them can infect both men and
• In people who do not have HIV, the women.
infection can be prevented by many
tools, including abstaining from sex, • The types of HPVs vary in their
limiting the number of sexual ability to cause genital warts; infect
partners, never sharing needles, and other regions of the body, including
using condoms appropriately. the mouth and throat; and cause
Persons who may be at very high cancers of the cervix, vulva, penis,
risk of HIV infection may be able to anus, and mouth.8
obtain HIV Pre-Exposure Prophylaxis
142
• Cannot be cured but can be for a vast majority of syphilis
prevented with vaccines and cases.11
controlled with medications
• The first sign of syphilis is a chancre,
• Genital warts caused by the a painless genital sore that most
virus8 can also be treated. often appears on the penis or in and
around the vagina. Chancres
• Regular screening with a Pap smear typically resolve on their own, but
test can prevent or detect at an the body does not clear the
early stage most cases of HPV- infection on its own.
caused cervical cancer. (A Pap smear
test involves a health care provider • Chancres make a person two to five
taking samples of cells from the times more likely to contract an HIV
cervix during a standard gynecologic infection.10 If the person is already
exam; these cells are examined infected with HIV, chancres also
under a microscope for signs of increase the likelihood that the HIV
developing cancer). virus will be passed on to a sexual
partner.3
• Two available vaccines protect
against most (but not all) HPV types • Can be treated with antibiotics:
that cause cervical cancer. A group o If recognized during the early
advising the Centers for Disease stages, usually within the
Control and Prevention first year of infection, syphilis
recommends this vaccine for boys can be treated with a single
and girls starting at 11 or 12 years injection of antibiotic.
old.9
o If not recognized early, or
not treated immediately,
Syphilis syphilis may need longer
treatment with antibiotics.
• Caused by the bacterium Treponema
pallidum • Without treatment:
o Usually spreads to other
• Passes from person to person during organs, including the skin,
vaginal, anal, or oral sex through heart, blood vessels, liver,
direct contact with syphilis sores bones, and joints in
secondary syphilis.
• Syphilis can also be spread from an
infected mother to her fetus.10 o Other sores, such as a
syphilis rash, can break out in
• In 2001, the number of cases of later stages.
syphilis was at its lowest in 60 years.
Rates have increased among both o Tertiary syphilis can develop
men and women, but men account over a period of years and
143
involve the nerves, eyes, and • More likely if a woman douches
brain and can potentially frequently or has new or multiple
cause death. sexual partners
144
preterm labor or birth and infants
• Common in young, sexually active with low birth weight.
women but also infects men, though
less frequently • Stillbirth and newborn death are
more than twice as likely among
• The parasite can be transmitted pregnant women with Trichomonas
between men and women as well as infection than among uninfected
between women whenever physical pregnant women.16
contact occurs between the genital
areas.
Viral Hepatitis
• Can cause frequent, painful, or
"burning" urination in men and Viral hepatitis is a serious liver disease that
women as well as vaginal discharge, can be caused by several different viral
genital soreness, redness, or itching strains, which can be transmitted through
in women. However, it may not sexual contact.
cause any symptoms.
Hepatitis A virus (HAV):
• Because the infection can occur • Causes a short-term or self-limited
without symptoms, a person may be liver infection that can be quite
unaware that he or she is infected serious.
and continue to re-infect a sexual
partner who is having recurrent • Does not result in chronic infection.
signs of infection.
• Can be transmitted during sexual
• Can be treated with a single dose of activity and through oral-anal
an antibiotic, usually either contact.
metronidazole or tinidazole, taken
by mouth • Vaccination can prevent HAV
infection.17
• Because of re-infection, it is
important to make sure that the • May cause abdominal pain, nausea,
diagnosed individual and all sexual and vomiting.
partners are treated at the same
time. • Usually the infection gets better on
its own without requiring treatment.
• Retesting is recommended for all In some cases, however, individuals
sexually active women within 3 may have such severe nausea and
months after initial treatment even vomiting that they must be admitted
if they believe their partners were to the hospital or may have lasting
treated.15 damage to their livers.18
145
Hepatitis B virus (HBV): Hepatitis C virus (HCV):
• Causes a serious liver infection that • Serious infection of the liver that can
can result in both immediate illness cause an immediate illness but that,
and lifelong infection and disease, in most people, becomes a silent,
leading to permanent liver scarring chronic infection that leads to liver
(cirrhosis), cancer, liver failure, and scarring (cirrhosis), cancer, liver
death. failure, and death
146
What is the Incidence, injected or applied directly to the affected
area.
Prevalence, and Cost of
STIs? The treatments, complications, and
outcomes for viral STIs depend on the
particular virus (HIV, genital herpes, human
Click on the following link to learn more
papillomavirus, hepatitis, or
about the incidence, prevalence, and cost
cytomegalovirus). Treatments can reduce
estimates of STIs in the United States:
the symptoms and the progression of most
of these infections. For example,
Sexually Transmitted Infections Prevalence,
medications are available to limit the
Incidence, and Cost Estimates in the United
frequency and severity of genital herpes
States
outbreaks while reducing the risk that the
virus will be passed on to other people.
147
recommendations about how long to
abstain from sex after the treatment is
Terminology Checklist:
completed to avoid passing the infection
STDs: More than 35 infectious organisms
back and forth.
that are transmitted primarily through
sexual activity. 1
Developing a Personal Plan
for STI Prevention Chlamydia: Chlamydia1 is a common
STD/STI caused by the bacterium Chlamydia
trachomatis.
Complete the following lab to develop a
personal plan for STI prevention.
Gonorrhea: Gonorrhea2 is caused by the
bacterium Neisseria gonorrhoeae, which
Plan for Change: Preventing STIs
can grow rapidly and multiply easily in the
warm, moist areas of the reproductive
Lesbian, Gay, Bisexual, and tract.
Transgender Resources: Genital Herpes: Genital herpes4 is a
contagious infection caused by the herpes
Lesbian, Gay, Bisexual, and Transgender
simplex virus (HSV). There are two different
Health
strains, or types, of HSV: herpes simplex
virus type 1 (HSV-1) and type 2 (HSV-2).
CDC Fact Sheet: What Gay, Bisexual and
Both can cause genital herpes, although
Other Men Who Have Sex with Men Need
most cases of genital herpes are caused by
to Know About Sexually Transmitted
HSV-2.5
Diseases
HIV & AIDS: HIV, or the human
Helpful Resources and immunodeficiency virus,7 is the virus that
Testing Information: causes AIDS (acquired immunodeficiency
syndrome).
148
Bacterial vaginosis: Bacterial vaginosis13 Trichomoniasis: Trichomoniasis12 infection
occurs when problematic bacteria that are is caused by the single-celled protozoan
normally present only in small amounts in parasite Trichomonas vaginalis and is
the body increase in number. Their levels common in women but also infects men,
get so high that they replace normal vaginal though less frequently.
bacteria and upset the usual balance.
3. ___________ can develop over a period of years and involve the nerves, eyes, and brain and
can potentially cause death.
a) Tertiary syphilis
b) HIV
c) Human Papillomavirus (HPV)
d) Hepatitis C virus (HCV)
Answers: 1. F, 2. F, 3. A
4. Any 3 from the chapter including: 5. Any 3 from the chapter including:
• Reproductive health problems • Abstinence
• Fetal and perinatal health problems • Vaccination
• Cancer • Reduce Number of Sex Partners
• Facilitation of the sexual transmission of • Mutual Monogamy
HIV infection • Use Condoms
149
References by Section:
What are STDs?
Sexually Transmitted Diseases
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What Causes Sexually Transmitted Diseases (STDs) or Sexually Transmitted
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https://www.nichd.nih.gov/health/topics/stds/conditioninfo/causes#:~:text=Any%20STI%20ca
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The suggested citation for Healthy People is:
Healthy People 2030 [Internet]. Washington, DC: U.S. Department of Health and Human
Services, Office of Disease Prevention and Health Promotion [cited [Date URL was
accessed]]. Available from: [Specific URL].
3. NICHD – Eunice Kennedy Shriver Institute of Child Health & Human Development
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Publication Date
Spring 2018
Publisher
University System of Georgia
Keywords
fitness, wellness, health
Disciplines
Health and Physical Education
Recommended Citation
Jellum, Lisa; Flynn, Scott; Howard, Jonathan; Moser, Althea; Mathis, David; Collins, Christin; Henderson,
Sharryse; and Watjen, Connie, "Concepts of Fitness and Wellness, 3rd Edition" (2019). Nursing and
Health Sciences Open Textbooks. 4.
https://oer.galileo.usg.edu/health-textbooks/4
154