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13 t h
EDITION
Fitness &
Wellness
Werner W. K. Hoeger
Boise State University
Sharon A. Hoeger
Amber L. Fawson
Cherie I. Hoeger
Fitness & Wellness, Inc.
Australia ● Brazil ● Mexico ● Singapore ● United Kingdom ● United States
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Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Fitness & Wellness, 13th Edition © 2019, 2017 Cengage Learning, Inc.
Werner W. K. Hoeger, Sharon A. Hoeger,
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Printed in the United States of America

Print Number: 01 Print Year: 2017
Contents
Chapter 1 SMART Goals 23
Goal Evaluation 24
Introduction to Physical Fitness and Wellness 1 A Word of Caution Before You Start Exercise 24
Lifestyle, Health, and Quality of Life 3 Assess Your Behavior 24
Life Expectancy 4 Assess Your Knowledge 25
The Need to Prevent Disease, Not Only Cure It 5
Physical Activity Affects Health and Quality of Life 5
Physical Activity and Exercise Defined 5
Chapter 2
Assessment of Physical Fitness 32
Federal Guidelines for Physical Activity 7
Benefits of Physical Fitness 8 The Value of Fitness Testing 33
Types of Physical Fitness 11 Responders versus Nonresponders 34
Health-Related Fitness 11 Fitness Assessment Battery 34
Skill-Related Fitness 11 Health Fitness Standard 34
Wellness 12 Physical Fitness Standard 35
The Path to Fitness and Wellness 13 Cardiorespiratory Endurance 36

Behavior Modification 13 Assessing Cardiorespiratory Endurance 37
Values and Behavior 14 Muscular Fitness 40

Muscular Strength and Muscular Endurance 40
Your Brain and Your Habits 15
Determining Strength 41
Changing Habits through Mindfulness and Repetition 15
Changing Habits by Focusing on Long-Term Values 16 Muscular Flexibility 44
Benefits of Good Flexibility 44
Planning and Willpower 16
What Factors Affect Flexibility? 44
Implementation Intentions 16
Assessing Flexibility 44
Motivation and Locus of Control 17
Body Composition 46
Fear of Implementation versus Joy of Implementation 18
Body Shape and Health Risk 48
Changing Behavior 18
Subcutaneous and Visceral Fat 48
The Transtheoretical Model for Changing Behavior 18
Assessing Body Composition 48
The Process of Change 20
Effects of Exercise and Diet on Body Composition 55
Assess Your Behavior 55
Assess Your Knowledge 55
Chapter 3
Exercise Prescription 59
Monitoring Daily Physical Activity 60
Readiness for Exercise 62
© Fitness & Wellness, Inc.
Exercise Prescriptions 62
Cardiorespiratory Endurance 62
Cardiorespiratory Exercise Prescription 63
Daily Active Lifestyle 68
iv Contents
Deep-Water Jogging 104

Strength Training 104
Group Exercise Classes 104
Swimming 105
Water Aerobics 106
Cycling 106
Cross-Training 108
Cross-Country Skiing 108

Rowing 109
Elliptical Training/Stair Climbing 109
Racquet Sports 110
Yoga 110
High-Intensity Interval Training 110
Muscular Fitness (Muscular Strength and Muscular New Fitness Trends 113
Endurance) 70 Ultra-Short Workouts 113
Overload Principle 70 Core Training 113
Specificity of Training 70 Group Personal Training 113
Periodization 71 Outdoor Training 114
Muscular Strength-Training Prescription 71 Circuit Training 114
Strength-Training Exercises 76 Functional Fitness 114
Strength-Training Exercise Guidelines 77 Dance Fitness 115
Core Strength Training 78 CrossFit 115
Designing Your Own Strength-Training Program 78 Flexibility and Mobility Rollers 115
Dietary Recommendations for Strength Development 78 Rating the Fitness Benefits of Aerobic Activities 115
Flexibility 79 Skill-Related Fitness 117
Muscular Flexibility Prescription 79 Team Sports 119
Designing a Flexibility Program 82 Tips to Enhance Your Aerobic Workout 119
Exercises that May Cause Injury 82 Assess Your Behavior 121
Preventing and Rehabilitating Low Back Pain 83 Assess Your Knowledge 121
Causes of Low Back Pain 83
Improving Body Posture 84
When to Call a Physician 84
Chapter 5
Treatment Options 84 Nutrition for Wellness 124
Designing a Low-Back Conditioning Program 87 The Essential Nutrients 126
Getting Started 87 Carbohydrates 126
Setting Fitness Goals 87 Fats 129
Assess Your Behavior 89 Proteins 131
Assess Your Knowledge 89 Vitamins 132
Minerals 132
Water 132
Chapter 4 Nutrition Standards 132
Evaluating Fitness Activities 101 Dietary Reference Intakes 133
Traditional Fitness Activities 102 Daily Values 133
Walking 103 Macronutrient Composition Guidelines 136
Jogging 103 Caloric Content of Food 136
Contents v
Tolerable Weight 157
Fad Dieting 157
Principles of Weight Management 159
Energy-Balancing Equation 159
Diet and Metabolism 160
Recommendation 161
Sleep and Weight Management 162
Light Exposure and BMI 162

Monitoring Body Weight 163
Physical Activity and Weight Management 163
Strength Training and Weight Loss 164
The Myth of Spot Reducing 165
The Role of Exercise Intensity and Exercise Duration in
Balancing the Diet 137 Weight Management 165
Nutrient Analysis 138 Overweight and Fit Debate 167
Vegetarianism 138 Designing Your Own Weight Loss Program 168
Nutrient Supplementation 140 Estimating Your Caloric Intake 168
Antioxidants 141 Monitoring Your Diet Through Daily Food Logs 170
Multivitamins 142 Foods that Aid in Weight Loss 171
Vitamin D 142 Protein Intake 171
Folate 144 Effect of Food Choices on Long-Term Weight Gain 171
Are Supplements Recommended? 144 Behavior Modification and Adherence to a Lifetime
Benefits of Foods 144 Weight Management Program 172
Probiotics 145 You Can Do It! 175
Fish 146 Assess Your Behavior 175
Advanced Glycation End Products 146 Assess Your Knowledge 176
Eating Disorders 146
Anorexia Nervosa 147
Bulimia Nervosa 148 Chapter 7
Binge-Eating Disorder 148 Stress Management 182
Emotional Eating 149
The Mind/Body Connection 183
Eating Disorder Not Otherwise Specified (EDNOS) 149
Emotions Can Trigger Physical
Treatment 149 Responses 183
2015–2020 Dietary Guidelines for Americans 149 What Is Stress? 184
Key Recommendations 150 Eustress and Distress 184
Physical Activity Recommendations 150 How the Body Responds and Adapts to Stress 184
A Lifetime Commitment to Wellness 150 Alarm Reaction 184
Assess Your Behavior 151 Resistance 185
Assess Your Knowledge 151 Exhaustion/Recovery 186
Examples of General Adaptation Syndrome 186
Chapter 6 Thirty-Second Body Scan 187
Weight Management 154 How Behavior Patterns Affect Health 187
An Epidemic of Excessive Body Weight and Certain Type A Behavior Increases Risk for Disease 187
Obesity 155 Vulnerability to Stress 188
Overweight versus Obese 156 Sources of Stress 190
vi Contents
Diseases of the Cardiovascular System 208

Types of Cardiovascular Disease and Prevalence 209
Risk Factors for CHD 210
Cancer 222
DNA Mutations and Tumor Formation 222
Metastasis 223
Guidelines for Preventing Cancer 224
Make Dietary Changes 224

Monitor Alcohol Consumption 226
Abstain from Tobacco 227
Avoid Excessive Sun Exposure 227
Monitor Estrogen, Radiation Exposure, and Potential
Occupational Hazards 228
Be Physically Active 229
Sleep Management 192 Other Risk Factors for Cancer 229
How Much Sleep Do I Need? 192 Genetics versus the Environment 229
What Happens If I Don’t Get Enough Sleep? 192 Early Detection 230
College Students Are Among the Most Chronic Lower Respiratory Disease 230
Sleep-Deprived 193 Accidents 230
Does It Help to “Catch Up” on Sleep on Weekends? 193 Substance Abuse 231
Time Management 194 Alcohol 231
Five Steps to Time Management 194 Illegal Drugs 232
Managing Technostress 195 Treatment for Chemical Dependency 234
Coping with Stress 196 Sexually Transmitted Infections 234
Identify and Change Stressors Within Your Types and Causes of Sexually Transmitted Infections 234
Control 196
HIV/AIDS 234
Accept and Cope with Stressors Beyond Your
Preventing STIs 236
Control 196
Assess Your Behavior 237
Physical Activity 196
Relaxation Techniques 198 Assess Your Knowledge 237
Progressive Muscle Relaxation 198
Breathing Techniques for Relaxation 200
Visual Imagery 200
Chapter 9
Meditation 201 Relevant Fitness and Wellness Issues 241
Which Technique Is Best? 202 Wellness Behavior Modification Issues 242
Assess Your Behavior 202 Safety of Exercise Participation and Injury
Assess Your Knowledge 202 Prevention 243
Considerations for Women 252
Nutrition and Weight Control 257
Chapter 8 Exercise and Aging 261
A Healthy Lifestyle Approach 206 Fitness/Wellness Consumer Issues 263
A Wellness Lifestyle 207 What’s Next? 268
Spiritual Well-Being 207 Assess Your Behavior 268
Causes of Death 208 Assess Your Knowledge 269
Contents vii
Appendix A: Strength-Training Exercises 272

Appendix B: Flexibility Exercises 281
Appendix C: Exercises for the Prevention
and Rehabilitation of Low Back Pain 284
Appendix D: Contraindicated Exercises 287
Answer Key 291
Glossary 292
Index 298
Preface
Most people go to college to learn how to make a living. capacity; increased energy; weight loss; improved
Making a good living, however, won’t help them unless mood, self-esteem, and physical appearance; decreased
they live a wellness lifestyle that will allow them to en- risk for many chronic ailments, including obesity, car-
joy what they have. Unfortunately, the current Ameri- diovascular disease, cancer, and diabetes; and a much
can lifestyle does not provide the human body with lower risk for premature mortality. As stated as far back
sufficient physical activity to enhance or maintain ade- as 1982 in the prestigious Journal of the American Medi-
quate health. As a result, the importance of a sound fit- cal Association, “There is no drug in current or pro-
ness and wellness program is of utmost importance to spective use that holds as much promise for sustained
lead a long and healthy life and reach one’s potential health as a lifetime program of physical exercise.”
and quality of life without physical limitations.
This book offers you the necessary information to start
Science has clearly determined that a lack of physical on your path to fitness and wellness by adhering to a
activity is detrimental to health. In fact, the office of the healthy lifestyle. The information in the following chap-
Surgeon General has identified physical fitness as a top ters and the subsequent activities at the end of each
health priority by stating that the nation’s top health chapter will enable you to develop a personal program
goals include exercise, increased consumption of fruits that promotes lifetime fitness, preventive health care,
and vegetables, smoking cessation, and the practice of and personal wellness. The emphasis throughout the
safe sex. All four of these fundamental healthy lifestyle book is teaching you how to take control of your life-
factors are addressed in this book. style habits so that you can do what is necessary to stay
healthy and realize your optimal well-being.
Many of the behaviors we adopt in life are a product of
our environment. Currently, we live in a “toxic” health/
fitness environment. We are so habituated to our mod-
ern-day environment that we miss the subtle ways it in- What the Book Covers
fluences our behaviors, personal lifestyles, and health
each day. The epidemic of physical inactivity and obe- As you study this book and complete the respective ac-
sity that is sweeping across America is so harmful to tivities, you will learn to do the following:
health that it actually increases the deterioration rate of ●● Understand the importance of good physical fitness
the human body and leads to premature aging, illness, and a wellness lifestyle in the achievement of good
and death. health and quality of life and a more productive and
Only about one-half of the adults in the United States longer life.
meet the recommended amount of weekly aerobic ●● Determine whether medical clearance is needed for
physical activity, whereas less than a fourth meet the your safe participation in exercise.
guidelines for muscular (strength) fitness. Among those
who meet the guidelines, many do not reap the full
●● Learn behavior modification techniques to help you
benefits because they simply do not know how to im- adhere to a lifetime fitness and wellness program.
plement and stay with a program that will yield the de- ●● Assess the health-related components of fitness
sired results. (cardiorespiratory endurance, muscular fitness
[strength and endurance] muscular flexibility, and
The good news is that lifetime wellness is within the
body composition).
grasp of most people. We know that most chronic and
debilitating conditions are largely preventable. Scientific ●● Write exercise prescriptions for cardiorespiratory
evidence has shown that improving the quality and endurance, muscular fitness, and muscular
length of our lives is a matter of personal choice. flexibility.
A regular exercise program is as close as we get to the

●● Analyze your diet and learn the principles that
miracle pill that people look for to enjoy good health govern sound nutrition.
and quality of life over a now longer lifespan. Myriad ●● Develop sound diet and weight-management
benefits of exercise include enhanced functional programs.
Preface ix
●● Understand stress, lessen your vulnerability to stress, ●● Expanded information on the benefits of flexibility
and implement a stress management program if and introductory information on factors that affect
necessary. flexibility: joint structure, genetics, age, gender, and
●● Implement a cardiovascular disease risk-reduction other factors.
program. ●● A new section explains the connection between
●● Follow guidelines to reduce your personal risk of body shape and risk for disease.
developing cancer.
Chapter 3, Exercise Prescription
●● Implement a smoking cessation program, if applicable.
●● The cardiorespiratory endurance, muscular fitness,
●● Understand the health consequences of chemical and muscular flexibility exercise prescription princi-
dependency and irresponsible sexual behaviors and ples are updated with the FITT-VP guidelines by the
learn guidelines for preventing sexually transmitted American College of Sports Medicine, including a
infections. more detailed explanation of the concepts of volume
●● Discern between myths and facts of exercise and and progression of exercise training.
health-related concepts.
Chapter 4, Evaluating Fitness Activities
New in the Thirteenth Edition ●● New illustrations help define options for completing
high-intensity interval training (HIIT).
All nine chapters in the 13th edition of Fitness & W
ellness
●● Two new sections explore the trends of Cross-Fit®
have been revised and updated according to recent
and ultra-short workouts and give practical tips for
advances published in the scientific literature and
students interested in trying these exercise
information reported at professional health, fitness,
modalities.
wellness, and sports medicine conferences. In addition
to the chapter updates listed below, selected new figures ●● Discussions of new fitness trends in areas including
and photographs are included in this edition. Note that group exercise classes and mobility rollers.
the numbered reference notes for each chapter and
Appendix E: Selective Nutrient Content of Common Chapter 5, Nutrition for Wellness
Foods have been made available in MindTap for this ●● New information has been included on the carbohy-
edition. Visit www.cengagebrain.com to access drate-to-fiber ratio, high starch consumption, glyce-
MindTap. The following are the most significant mic index and glycemic load, and benefits of nut
chapter updates: consumption.
Chapter 1, Introduction to Physical Fitness ●● Expanded information on the various types of unsat-
and Wellness urated fatty acids is provided.
●● A new section emphasizes the need to prevent ●● The 2015–2020 Dietary Guidelines for Americans
disease. are included.
●● All statistics regarding disease risk, mortality, and
healthcare costs in the United States and worldwide Chapter 6, Weight Management
are updated. ●● Updates to all statistics on the overweight and obe-
sity problem in the United States are based on the
●● A new section on implementation intentions offers a
latest data from the Centers for Disease Control and
practical tool for carrying out goal behavior.
Prevention.
Chapter 2, Assessment of Physical Fitness ●● Updates on the detrimental consequences of exces-
●● The cardiorespiratory endurance, muscular fitness, sive body weight are provided.
and flexibility assessments conform with the newly ●● Additional information is provided on the mislead-
released 2018 Guidelines for Exercise Testing and ing rule of thumb that to lose 1 pound of fat all a
Prescription by the American College of Sports person has to do is produce a caloric deficit of 3,500
Medicine (ACSM). calories.
●● Editorial changes were made throughout the chapter ●● The principle of dynamic energy balance and its role
to update the various fitness assessment techniques. in the energy–balancing equation are introduced.
x Preface
●● The various-calorie diet plans (daily food logs) have
been revised to emphasize the importance of
sufficient protein intake throughout the day and
minimize/eliminate the use of processed foods in
the diet.
●● There is an emphasis on the critical role of regular
protein intake for adequate weight management.
●● Foods that are most commonly associated with
weight gain and weight loss are discussed, as well as
the principle that “a calorie may not always be a
calorie.”
Chapter 7, Stress Management

●● A new figure details the real-time effects of the fight-
or-flight mechanism on the body and the long-term
physiological risks of repeated activation of this
mechanism due to chronic stress.
●● A new key term, allostatic load, is defined and ex-
plained in accordance with current research as the
primary cause of disease vulnerability during the ex-
haustion stage of the general adaptation syndrome.
●● Expanded information on the role of mindfulness
meditation for stress management and the role ade-
quate sleep plays in managing stress is explained.
Chapter 8, A Healthy Lifestyle Approach

●● An update on the health benefits of spiritual wellness
is provided.
●● Information on the leading causes of death, includ-
ing cardiovascular disease and cancer, in the United
States is updated.
●● Many updates are provided for the individual risk
factors for cardiovascular disease, with greater em-
phasis on blood lipids, type 2 diabetes, and personal
and family history. Additional Course Resources
●● A new figure illustrates how cancer develops and ●● Health MindTap for Fitness & Wellness. MindTap
spreads. is well beyond an eBook, a homework solution or
●● Information on preventing cancer with diet has been digital supplement, a resource center website, a
updated with new guidelines, including those for course delivery platform, or a Learning Management
processed meat and red meat intakes. System. More than 70 percent of students surveyed
said it was unlike anything they have seen before.
Chapter 9, Relevant Fitness and Wellness MindTap is a personal learning experience that com-
Issues bines all your digital assets—readings, multimedia,
●● Updates are provided to many of the most frequently activities, and assessments—into a singular learning
discussed issues related to physical fitness and well- path to improve student outcomes.
ness, including but not limited to questions addressing ●● Diet & Wellness Plus. The Diet & Wellness Plus App
behavioral change, sequence of aerobic and strength in MindTap helps you gain a better understanding of
training, and potential detrimental consequences of how nutrition relates to your personal health goals. It
excessive intense physical training in older adults. enables you to track your diet and activity, generate
Preface xi
reports, and analyze the nutritional value of the food Jessica Mays, Eastern Florida State College
you eat! It includes over 55,000 foods in the data-
Dr. Tammy Sabourin, Valencia College
base, custom food and recipe features, and the latest
dietary references, as well as your goal and actual
percentages of essential nutrients, vitamins, and Reviewers for the 12th edition:
minerals. It also helps you to identify a problem be-
Craig Newton, Community College of Baltimore County
havior and make a positive change. After completing
the Wellness Profile Questionnaire, Diet & Wellness Kristin Bartholomew, Valencia College
Plus will rate the level of concern for eight different
Sharon Brunner, Carroll Community College
areas of wellness, helping you determine the areas
where you are most at risk. It then helps you put to- Carl Bryan, Central Carolina Community College
gether a plan for positive change by helping you se-
Rosanne Caputo, College of Staten Island
lect a goal to work toward—complete with a reward
for all your hard work. William Chandler, Brunswick Community College
●● Instructor Companion Site. Everything you need Keith Fritz, Colorado Mesa University
for your course in one place! This collection of
Lurelia A. Hardy, Georgia Regents University
book-specific lecture and class tools is available on-
line via http://www.cengage.com/login. Access and Cynthia Karlsson, Virginia Tech, Virginia Western
download PowerPoint presentations, images, in- Community College
structor’s manual, videos, and more.
Gloria Lambertz, Carroll College
●● Cengage Learning Testing Powered by Cognero. Vince Maiorino, John Jay College
Cengage Learning Testing Powered by Cognero is a
flexible, online system that allows you to do the Craig Newton, Community College of Baltimore
following: County
●● Author, edit, and manage test bank content from Nancy A. Winberg, Western Technical College
multiple Cengage Learning solutions. Bruce Zarosky, Lone Star College, Tomball
●● Create multiple test versions in an instant.
Kym Atwood, University of West Florida
●● Deliver tests from your LMS, your classroom, or
wherever you want. Laura Baylor, Blue Ridge Community College
Laura Brieser-Smith, Front Range Community College
Cynthia Burwell, Norfolk State University
Acknowledgments
Lisa Chaisson, Houston Community College
This 13th edition of Fitness & Wellness was made possi-
Kelli Clay, Georgia Perimeter College
ble through the contributions of many individuals. In
particular, we would like to express our gratitude to the Karen Dennis, Illinois State University
reviewers of the 13th edition. Their valuable comments
Ali El-Kerdi, Philadelphia University
and suggestions are most sincerely appreciated. We
would also like to thank Celeste Brown, Alyssa Woo, Leslie Hedelund, St. Clair County Community College
Gina Jepson, and Jessica Eakins for their kind help with
Scott Kinnaman, Northwest Nazarene University
new photography used in this book.
Jerome Kotecki, Ball State University
Reviewers for the 13th edition: Justin Kraft, Missouri Western State University
Jordan A Daniel, Ph.D., Angelo State University Wayne Lee Jr., Delta State University
Carol Hirsh, Austin Community College Julia Leischner, Benedictine University
Amy Howton, MFA, Kennesaw State University Becky Louber, Northwest Nazarene University
Pam Massey, University of Wisconsin Colleges Paul McDonald, Vermillion Community College
xii Preface
Kason O’Neill, East Tennessee State University

Kathryn Perry, Olivet College
William Pertet, Young Harris College
Deonna Shake, Abilene Christian University
Vicki Shoemaker, Lake Michigan College
Christine Sholtey, Waubonsee Community College
Carole Sloan, Henry Ford College
John Stroffolino, Germanna Community College
Linda Villarreal, Texas A&M International University

Reviewers for the 11th edition:
Chip Darracott, Georgia Regents University
Kathy Gieg, Missouri Baptist University
Laurelia Hardy, Georgia Regents University
of the Permian Basin in Odessa, Texas (1983–1986);
Candace Hendershot, University of Findlay and briefly taught for one semester in 2012, 2013,
Kevin B. Kinser, Tarrant County College and 2016 as an adjunct faculty at Brigham Young
University–Hawaii in Laie, Hawaii. He remains active in
Linda J. Romaine, Raritan Valley Community College research and continues to lecture in the areas of exer-
William Russell, Missouri Western State University cise physiology, physical fitness, health, and wellness.
Staci Jo Smith, Tarrant County College Dr. Hoeger completed his undergraduate and master’s
degrees in physical education at the age of 20 and re-
ceived his doctorate degree with an emphasis in exer-
Reviewers for the 10th edition: cise physiology at the age of 24. He is a Fellow of the
Lisa Augustine, Lorain Community College American College of Sports Medicine and also of the Re-
search Consortium of SHAPE America (Society of Health
Vicki Boye, Concordia University and Physical Educators). In 2002, he was recognized as
Michael Dupper, University of Mississippi the Outstanding Alumnus from the College of Health
and Human Performance at Brigham Young University.
Nicholas Farkouh, College of Staten Island He is the recipient of the first Presidential Award for Re-
Megan Franks, Lone Star College–North Harris search and Scholarship in the College of Education at
Boise State University in 2004.
Misti Knight, Tarrant County College Northwest
In 2008, he was asked to be the keynote speaker at the
Colleen Maloney-Hinds, California State University– VII Iberoamerican Congress of Sports Medicine and Ap-
San Bernadino plied Sciences in Mérida, Venezuela, and was presented
with the Distinguished Guest of the City recognition. In
2010, he was also honored as the keynote speaker at the
Brief Author Biographies Western Society for Kinesiology and Wellness in Reno,
Nevada.
Werner W. K. Hoeger is a professor emeritus of the
Department of Kinesiology at Boise State University, Using his knowledge and personal experiences,
where he taught between 1986 and 2009. He had previ- Dr. Hoeger writes engaging, informative books that
ously taught at the University of the Andes in Venezuela thoroughly address today’s fitness and wellness issues in
(1978–1982); served as Technical Director of the Fitness a format accessible to students. Since 1990, he has been
Monitoring Preventive Medicine Clinic in Rolling the most widely read fitness and wellness college text-
Meadows, Illinois (1982–1983); The University of Texas book author in the United States. He has published a
Preface xiii
total of 63 editions of his nine fitness and wellness- Christopher. It was the first, and so far only time, in
related titles. Among the textbooks written for Winter Olympics history that father and son competed
Wadsworth/Cengage Learning are Principles and Labs in the same event. In 2006, at the age of 52, he was the
for Fitness and Wellness: A Personalized Program, 14th oldest competitor at the Winter Olympics in Turin,
edition; Lifetime Physical Fitness & Wellness, 15th Italy. At different times and in different distances
edition; Fitness & Wellness, 13th edition; Principles and (800 m, 1,500 m, and the mile) in 2012, 2014, 2015,
Labs for Physical Fitness, 10th edition; Wellness: and 2016, Dr. Hoeger reached All-American standards
Guidelines for a Healthy Lifestyle, 4th edition; and Water for his age group by USA Track and Field (USATF). In
Aerobics for Fitness & Wellness, 4th edition (with Terry- 2015, he finished third in the one-mile run at the
Ann Spitzer Gibson). USATF Masters Indoor Track and Field National
Championships, and third and fourth, respectively, in
Dr. Hoeger was the first author to write a college fitness
the 800- and 1,500-meter events at the Outdoor Na-
textbook that incorporated the wellness concept. In
tional Senior Games. In 2016, he advanced to the finals
1986, with the release of the first edition of Lifetime
in both the 800 m and the 1,500 m at the World
Physical Fitness & Wellness, he introduced the principle
Masters Track and Field Championships held in Perth,
that to truly improve fitness, health, and quality of life
Australia. He finished seventh (out of 12 finalists)
and to achieve wellness, a person needed to go beyond
in the 800 m and eighth (out of 16 finalists) in the
the basic health-related components of physical fitness.
1,500 m.
His work was so well received that every fitness author
in the field immediately followed his lead. Sharon A. Hoeger is Vice-President of Fitness & Well-
ness, Inc. of Boise, Idaho. Sharon received her degree in
As an innovator in the field, Dr. Hoeger has developed
computer science from Brigham Young University. She
many fitness and wellness assessment tools, including
is extensively involved in the research process used in
fitness tests such as the Modified Sit-and-Reach, Total
retrieving the most current scientific information that
Body Rotation, Shoulder Rotation, Muscular Endur-
goes into the revision of each textbook. She is also the
ance, and Muscular Strength and Endurance and Soda
author of the software written specifically for the fitness
Pop Coordination Tests.
and wellness textbooks. Her innovations in this area
Proving that he “practices what he preaches,” he was the since the publication of the first edition of Lifetime
oldest male competitor in the 2002 Winter Olympics in Physical Fitness & Wellness set the standard for fitness
Salt Lake City, Utah, at the age of 48. He raced in the and wellness computer software used in this market
sport of luge along with his then 17-year-old son today.

© Ricardo Raschini
xiv Preface
freelance writer and editor; writing research and mar-

keting copy for client magazines, newsletters, and web-
sites; and contracting as a textbook copy editor for
Cengage Learning (previously under Thomson
Learning and the Brooks/Cole brand).
Amber and Cherie have been working for Fitness &
Wellness, Inc. for several years and have now taken on a
more significant role with the research, updates, and
writing of the new editions. There is now a four-person
team to sort through and summarize the extensive liter-
ature available in the health, fitness, wellness, and
sports medicine fields. Their work has greatly enhanced
the excellent quality of these textbooks. They are firm

believers in living a healthy lifestyle, they regularly at-
tend professional meetings in the field, and they are ac-
tive members of the American College of Sports
Medicine.
Sharon is a co-author in five of the seven fitness and

wellness titles. She also served as Chef de Mission
(Chief of Delegation) for the Venezuelan Olympic Team
at the 2006 Olympic Winter Games in Turin, Italy. Hus-
band and wife have been jogging and strength training
together for more than 41 years. They are the proud
parents of five children, all of whom are involved in
sports and lifetime fitness activities. Their motto: “Fam-
ilies that exercise together, stay together.”
Amber L. Fawson and Cherie I. Hoeger received their
degrees in English with an emphasis in editing for pub-
lication. For the past 17 years Amber has enjoyed work-

ing in the publication industry and has held positions
as an Editorial Coordinator for BYU Studies, Assistant
Editor for Cengage Learning, and freelance writer and
editor for tertiary education textbooks and workbooks.
During the last decade, Cherie has been working as a
1
Introduction to
Physical Fitness
and Wellness
Daily physical activity is the miracle
medication that people are looking for.
It makes you look and feel younger,
boosts energy, provides lifetime weight
management, improves self-confidence
and self-esteem, and enhances
independent living, health, and quality
of life. It further allows you to enjoy a
longer life by decreasing the risk of many
chronic conditions, including heart
disease, high blood pressure, stroke,
diabetes, some cancers, and osteoporosis.
Objectives
1.1 Understand the importance of lifetime
fitness and wellness.
1.2 Learn the recommended guidelines for
weekly physical activity.
1.3 Define physical fitness and list components
of health-related and skill-related fitness.
1.4 Understand the benefits of a comprehensive
fitness and wellness program.
1.5 Learn motivational and behavior
modification techniques to enhance
compliance with a healthy lifestyle

program.
1.6 Learn to write SMART goals to aid with the
process of change.
1.7 Determine whether medical clearance is
required for safe participation in exercise.
2 Fitness and Wellness
REAL LIFE STORY | Jordan’s Experience
Last year as a freshman in college, strength workouts I toned up, I had so

I was advised to enroll in a gener- according to an much more energy,
al ed fitness and wellness course. exercise prescrip- and I actually started
I played high school sports and tion I wrote myself. to enjoy exercise. It
thought I knew all there was to I didn’t even know is fun to work out! I
© EugeneF/Shutterstock.com
know about being fit and in shape. there was such a now know that how
As the course started, I realized thing as an “exercise well I will live the
I didn’t really know how impor- prescription.” I even rest of my life has a
tant it was to exercise regularly stretched once in a lot to do with well-
and take good care of myself. It while and started ness choices I make.
quickly became my favorite class, to eat better. As I My goal is to never
and I couldn’t wait to try what I became more fit, I started to feel stop exercising and take good care
was learning. I started cardio and better about myself, I lost weight, of myself.
M
ost people believe school will teach them how middle age and the “golden years” is more often related
to make a better living. A fitness and wellness to wise choices initiated during youth and continued
course will teach you how to live better—how to throughout life.
truly live your life to its fullest potential. Real success is Unfortunately, the current way of life in most devel-
about more than money: Making a good living will not oped nations does not provide the human body with
help you unless you live a wellness lifestyle that will allow sufficient physical activity to maintain adequate health.
you to enjoy what you have. Your lifestyle is the most Furthermore, many lifestyle patterns are such a serious
important factor affecting your personal well-being, but threat to health that they actually speed up deterioration
most people don’t know how to make the right choices to of the human body. In a few short years, lack of wellness
live their best life. leads to loss of vitality and gusto for life, as well as pre-
The benefits of an active and healthy lifestyle have mature morbidity and mortality.
been clearly substantiated by scientific evidence linking Even though most people in the United States believe
increased physical activity and positive habits to better a positive lifestyle has a great impact on health and lon-
fitness, health, and improved quality of life. Even though gevity, most do not know how to implement a fitness and
a few individuals live long because of favorable genetic wellness program that will yield the desired results. Patty
factors, for most people, the quality of life during Neavill is an example of someone who frequently tried to

© Jonathan Hoeger
© Jonathan Hoeger
Physical activity and exercise lead to less disease, a longer life, and enhanced quality of life.
Chapter 1 Introduction to Physical Fitness and Wellness 3
change her life but was unable to do so because she did in lean tissue lost during the weight-reduction phase.
not know how to implement a sound exercise and weight Despite only a slight drop in weight during the second
control program. At age 24, Patty, a college sophomore, year following the calorie-restricted diet, Patty’s 2-year
was discouraged with her weight, level of fitness, self- follow-up revealed a further decrease in body fat, to
image, and quality of life in general. 19.5 percent. Patty understands the new quality of life
She had struggled with weight most of her life. Like reaped through a sound fitness program.
thousands of other people, she had made many unsuc-
cessful attempts to lose weight. Patty put aside her fears
and decided to enroll in a fitness course. As part of the 1.1 L ifestyle, Health, and Quality
course requirement, she took a battery of fitness tests at
the beginning of the semester. Patty’s cardiorespiratory of Life
fitness and strength ratings were poor, her flexibility
classification was average, she weighed more than Research findings have shown that physical inactivity
200 pounds, and she was 41 percent body fat. and negative lifestyle habits pose a serious threat to
Following the initial fitness assessment, Patty met with health. Movement is a basic function for which the hu-
her course instructor, who prescribed an exercise and man body was created. But advances in technology have
nutrition program such as the one presented in this almost completely eliminated the necessity for physical
book. Patty fully committed to carry out the prescrip- exertion in daily life. Most nations, both developed and
tion. She walked or jogged five times a week, worked out developing, are experiencing an epidemic of physical
with weights twice a week, and played volleyball or bas- inactivity.
ketball two to four times each week. Her daily caloric Today we live in an automated society. Most of the
intake was set in the range of 1,500 to 1,700 calories. She activities that used to require strenuous physical exer-
took care to meet the minimum required amounts from tion can be accomplished by machines with the simple
the basic food groups each day, which contributed about push of a button. We grow up in communities that lack
1,200 calories to her diet. The remainder of the calories sidewalks, bike lanes, or amenities that are near enough
came primarily from complex carbohydrates. By the end to walk to. We go about life being transported by car,
of the 16-week semester, Patty’s cardiorespiratory fitness, and we are driven walkable distances to save time, to
strength, and flexibility ratings all had improved to the avoid unpleasant weather, or to keep clothes and appear-
“good” category, she had lost 50 pounds, and her percent ance pristine. We may not own weather-protective
body fat had dropped to 22.5! clothes because we go from home to car to school or
A thank-you note from Patty to the course instructor work. During a visit to a multilevel shopping mall,
at the end of the semester read: nearly everyone chooses to ride the escalators instead of
taking the stairs.
Thank you for making me a new person. I truly With the developments in technology, three additional
appreciate the time you spent with me. Without factors have changed our lives significantly and have had
your kindness and motivation, I would have never a negative effect on human health: nutrition, stress, and
made it. It’s great to be fit and trim. I’ve never had environment. Fatty foods, sweets, alcohol, tobacco, ex-
this feeling before and I wish everyone could feel like cessive stress, and environmental hazards have detri-
this once in their life. mental effects on people’s health.
Thank you, your trim Patty! One of the most significant detrimental effects of
Patty never had been taught the principles governing a modern-day technology has been an increase in chronic
sound weight loss program. She needed this knowledge, diseases related to a lack of physical activity. These include
and, like most Americans who have never experienced hypertension (high blood pressure), heart disease, diabe-
the process of becoming physically fit, she needed to be tes, chronic low back pain, and obesity, among others.
in a structured exercise setting to truly feel the joy of They sometimes are referred to as hypokinetic diseases.
fitness. (Hypo means low or little, and kinetic implies motion.)
Of even greater significance, Patty maintained her
aerobic and strength-training programs. A year after GLOSSARY
ending her calorie-restricted diet, her weight actually Chronic diseases Hypokinetic diseases
increased by 10 pounds—but her body fat decreased Illnesses that develop and Diseases related to a lack of
from 22.5 percent to 21.2 percent. As discussed in Chap- last over a long time. physical activity.
ter 6, the weight increase was related mostly to changes
Figure 1.1 Causes of deaths in the United States for

selected years.
36% 40% 38%

47% 49% 46%
53%
Percent of all deaths

32% 28% 30%
17%
13% 27% 29%

13% 15% 12%
13% 23% 23%
9% 19%
12% 11%
5%
5% 7% 5% 3% 5% 5%
4% 3% 4% 4%
4% 5% 4% 2%
Public bikes make it easier for individuals to adopt a 1900 1920 1940 1960 1980 2000 2010
physically active lifestyle and also act as a cue that bike- Year
commuting is an accepted and supported behavior in a Influenza and
pneumonia Cancer
community.
Cardiovascular
Tuberculosis disease
Accidents All other causes
In the United States, physical inactivity is the second
SOURCE: National Center for Health Statistics, Division of Vital
greatest threat to public health (after tobacco use) and Statistics.
is often referenced in new concerns about sitting dis-
ease and sedentary death syndrome (SeDS). Accord-
ing to the World Health Organization (WHO), chronic
diseases account for 60 percent of all deaths world-
wide.1 If we want to enjoy contemporary commodities and a tenth is influenced by the health care the indi-
and still expect to live life to its fullest, a personalized vidual receives. Only 16 percent is related to genetic
lifetime exercise program must become a part of our factors. Thus, the individual controls as much as
daily lives. 80 percent of his or her vulnerability to disease—and
The leading causes of death in the United States today consequently quality of life. In essence, most people in
are lifestyle-related (see Figure 1.1). About 48 percent of the United States are threatened by the very lives they
all deaths in the United States are caused by cardiovas- lead today.
cular disease and cancer.2 Almost 80 percent of these
deaths could be prevented by adhering to a healthy life-
style. The third and fourth leading causes of death 1.2 Life Expectancy
across all age groups, respectively, are chronic lower re-
spiratory disease and accidents. From the ages of 1 to 44, Currently, the average life expectancy in the United
accidents are the leading cause of death, with automo- States is 78.9 years (76.6 years for men and 81.4 years for
bile accidents being the leading cause of death in the women).5 In the past decade alone, life expectancy has
5-to-24 age group.3 increased by over 1 year—the news, however, is not all
Even though not all accidents are preventable, many good. The data show that people now spend an extra
are. Consider automobile accidents, the leading cause of 1.2 years with a serious illness and an extra 2 years of
death for teens. Across the United States, fewer than 15 disability.
percent of people taking trips in automobiles choose not While the United States was once a world leader in life
to wear seatbelts, yet these people account for half of all expectancy, over recent years, the increase in life expec-
automobile deaths. As for the cause of automobile acci- tancy in the United States has not kept pace with that of
dents themselves, fatal accidents are often related to other developed countries. Based on data from the
failure to stay in the correct lane or yield the right of way World Health Organization (WHO), the United States
due to driver distraction or alcohol use.4 ranks thirty-first in the world for life expectancy (see
Based on estimates, more than half of disease is life- Figure 1.2).6 Japan ranks first in the world with an over-
style related, a fifth is attributed to the environment, all life expectancy of 83.7 years.7
Figure 1.2 Life expectancy at birth for selected

countries: 2005–2015 projections.*
1.3 P hysical Activity Affects
Health and Quality of Life
Brazil 71 78
United Arab Emirates 76 78 Among the benefits of regular physical activity and exer-
Mexico 74 79
cise are a significant reduction in premature mortality
and decreased risks for developing heart disease, stroke,
Argentina 72 80
metabolic syndrome, type 2 diabetes, obesity, osteoporo-
United States 77 81
sis, colon and breast cancers, high blood pressure, de-
United Kingdom 79 82 pression, and even dementia and Alzheimer’s.12 Regular
Germany 79 83 physical activity also is important for the health of mus-
Canada 80 84 cles, bones, and joints, and has been shown in clinical
Switzerland 81 85
studies to improve mood, cognitive function, creativity,
and short-term memory and enhance one’s ability to
France 79 86
perform daily tasks throughout life. It also can have a
Spain 80 86
major impact on health care costs and helps maintain a
Japan 81 87 high quality of life into old age.
65 70 75 80 85 90
Years
*Dark color is men; light color is women.
Physical Activity and Exercise Defined
SOURCE: World Bank, “Life Expectancy at Birth (Male), 2013” and
“Life Expectancy at Birth (Female), 2013,” http://data.worldbank.org
Abundant scientific research over the past three decades
/indicator/SP.DYN.LE00.FE.IN. has established a distinction between physical activity
and exercise. Exercise is a type of activity that requires
planned, structured, and repetitive bodily movement to
The Need to Prevent Disease, improve or maintain one or more components of physi-
Not Only Cure It cal fitness. Examples of exercise are walking, running,
cycling, doing aerobics, swimming, and strength train-
The United States has not invested the same resources in ing. Exercise is usually viewed as an activity that requires
preventing disease as it has in treating disease after on- a vigorous-intensity effort.
set. Ninety-five percent of our health care dollars are Physical activity is bodily movement produced by
spent on treatment strategies, and less than 5 percent are skeletal muscles. It requires energy expenditure and
spent on prevention. The latest data indicate that one in produces progressive health benefits. Physical activity
four adults in the United States has at least two chronic can be of light intensity or moderate to vigorous inten-
conditions. This trend has alarmed health officials, as the sity. Examples of daily light physical activity include
burden on a patient with multiple conditions is greater walking to and from work, taking the stairs instead of
than the sum of the individual diseases. elevators and escalators, grocery shopping, and doing
A report by the Organisation for Economic Coopera-
tion and Development (OECD) found that while the
United States far outspent every other country in health
GLOSSARY
care costs per capita, it also easily had the highest rates of
obesity of all 34 OECD countries.8 As a nation, we are Sedentary death Physical activity Bodily
seeing the consequences of these numbers unfold. Inci- syndrome (SeDS) Deaths movement produced by
dence of diabetes climbed dramatically in parallel step that are attributed to a lack skeletal muscles that
with the increased incidence of obesity.9 Today, nearly of regular physical activity. requires energy expenditure
half of the people in the United States have diabetes or Exercise A type of physical and produces progressive
prediabetes, but the rising U.S. diabetes rates have begun activity that requires health benefits.
to plateau, as obesity rates have done the same.10 planned, structured, and Light physical activity
In terms of yearly health care costs per person, the repetitive bodily movement Any activity that uses less
United States ranks in the top three of OECD countries. done to improve or maintain than 150 calories of energy per
Per capita U.S. health care costs are about 2.5 times the one or more components of day, such as casual walking
OECD average. An estimated 5 percent of the people ac- physical fitness. and light household chores.
count for 50 percent of health care costs.11
household chores. Physical inactivity, by contrast, im- during the remainder of the day. This self-defeating be-
plies a level of activity that is lower than that required to havior can lead to frustration that exercise is not provid-
maintain good health. ing the weight management benefits it should. It is
Extremely light expenditures of energy throughout the important to keep daily NEAT levels up regardless of
day used to walk casually, perform self-care, or do other exercise levels.
light work like emptying a dishwasher are of far greater A growing number of studies are showing that the
significance in our overall health than we once realized. body is much better able to maintain its energy
We now understand the impact of accumulating con- balance—and, therefore, keep body weight at a healthy
stant/small movements. Every movement conducted level—when overall daily activity level is high. An active
throughout the day matters. person can vary calories from day to day with fewer
To better understand the impact of all intensities of swings in body weight, while a sedentary person who
physical activity, scientists created a new category of changes caloric intake will see those changes amplified,
movement called nonexercise activity thermogenesis observed by greater swings in body weight.
(NEAT).13 Any energy expenditure that does not come A person with a desk job who has the option to stand
from basic ongoing body functions (such as digesting and move about throughout the day will expend 300
food) or planned exercise is categorized as NEAT. A more calories a day than a person who sits at the desk
person, on an average day, may expend 1,300 calories most of the day (see Figure 1.3). People who spend most
simply maintaining vital body functions (the basal meta- of the day working on their feet, such as a medical
bolic rate) and 200 calories digesting food (thermic assistant or a stay-at-home parent, expend 700 daily
effect of food). Any additional energy expended during calories more than a person with a sedentary desk job.
the day is expended either through exercise or NEAT. People with physically demanding jobs, such as con-
For an active person, NEAT accounts for a major por- struction workers, can easily burn 1,600 daily calories
tion of energy expended each day. Though it may not more than a sedentary worker.14
increase cardiorespiratory fitness as moderate or vigor- Beyond the workday are several hours of leisure time
ous exercise will, NEAT can easily use more calories in a that can also be spent quite differently on a vast variety
day than a planned exercise session. As a result, NEAT is of physical activities, from activities that are light physi-
extremely critical for keeping daily energy balance in cal activity to sports and exercise that are vigorous
check. Especially when beginning or intensifying an physical activity. Variations in NEAT add up over days,
exercise program, some individuals tend to adjust other months, and years and provide substantial benefits with
activities of daily living, so they sit more and move less weight management and health.
Figure 1.3 The importance of nonexercise activity thermogenesis (NEAT) and exercise.
−250 calories
from exercise
−350 calories from

exercise and NEAT
−700 calories from

exercise and NEAT
−1,000 calories from

exercise and NEAT
Types of activity: Planned Exercise NEAT Sedentary
Regular moderate physical activity provides sub- conditions, older adults should be as physically
stantial benefits in health and well-being for the vast active as their abilities allow. They should avoid
majority of people who are not physically active. For inactivity. Older adults should do exercises that
those who are already moderately active, even greater maintain or improve balance if they are at risk of
health benefits can be achieved by increasing the level falling.
of physical activity. Examples of moderate physical
activity are brisk walking or cycling, playing basketball Children 6 Years of Age and Older
or volleyball, recreational swimming, dancing fast, and Adolescents
pushing a stroller, raking leaves, shoveling snow, and ●● Children and adolescents should do 1 hour
gardening. (60 minutes) or more of physical activity every day.
Light physical activity (along with moderate physical ●● Most of the 1 hour or more a day should be either
activities lasting less than 10 minutes in duration) is not moderate- or vigorous-intensity aerobic physical
included as part of the moderate physical activity recom- activity.
mendation, though it is included as part of one’s NEAT ●● As part of their daily physical activity, children and
for a given day. adolescents should do vigorous-intensity activity
on at least 3 days per week. They also should do
muscle-strengthening and bone-strengthening
1.4 Federal Guidelines activities on at least 3 days per week.
for Physical Activity Pregnant and Postpartum Women

●● Healthy women who are not already doing
Because of the importance of physical activity to our vigorous-intensity physical activity should get at
health, the U.S. Department of Health and Human Ser- least 2 hours and 30 minutes (150 minutes) of
vices issued Physical Activity Guidelines for Americans.15 moderate-intensity aerobic activity a week.
Preferably, this activity should be spread
Adults Between 18 and 64 Years of Age throughout the week. Women who regularly
●● Adults should do 150 minutes a week of moderate- engage in vigorous-intensity aerobic activity or
intensity aerobic (cardio-respiratory) physical high amounts of activity can continue their activity
activity, 75 minutes a week of vigorous-intensity provided that their condition remains unchanged
aerobic physical activity, or an equivalent and they talk to their health care provider about
combination of moderate- and vigorous-intensity their activity level throughout their pregnancy.
aerobic physical activity (also see Chapter 3).
When combining moderate- and vigorous-intensity The guidelines state that some adults should be able to
activities, a person could participate in moderate- achieve calorie balance with 150 minutes of moderate
intensity activity twice a week for 30 minutes and physical activity in a week, while others will find they
high-intensity activity for 20 minutes on another need more than 300 minutes per week.16 This recom-
2 days. Aerobic activity should be performed in mendation is based on evidence indicating that people
episodes of at least 10 minutes long each, preferably who maintain healthy weight typically accumulate
spread throughout the week. 1 hour of daily physical activity.17 Between 60 and 90 min-
●● Additional health benefits are provided by utes of moderate-intensity physical activity daily is
increasing to 5 hours (300 minutes) a week of recommended to sustain weight loss for previously
moderate-intensity aerobic physical activity,
2 hours and 30 minutes a week of vigorous-
intensity physical activity, or an equivalent GLOSSARY
combination of both. Nonexercise activity that causes rapid breathing
●● Adults should also do muscle-strengthening thermogenesis (NEAT) and a substantial increase in
activities that involve all major muscle groups, Energy expended doing heart rate.
performed on 2 or more days per week. everyday activities not Moderate physical activity
related to exercise. Activity that uses 150
Older Adults (Ages 65 and Older) Vigorous physical activity calories of energy per day, or
●● Older adults should follow the adult guidelines. If An activity similar to jogging 1,000 calories per week.
this is not possible due to limiting chronic
overweight people.18 And 60 to 90 minutes of activity per Figure 1.5 Effects of fitness changes on mortality rates.
day provides additional health benefits.
122.0
125
1.5 Benefits of Physical Fitness 105
Death 85
The benefits to be enjoyed from participating in a regu- rate 67.7
lar fitness program are many. In addition to a longer life from 65
(see Figures 1.4 and 1.5), the greatest benefit of all is that all
39.6
causes* 45
physically fit people who lead a positive lifestyle have a
healthier and better quality of life. These people live life 25
to its fullest and have fewer health problems than inac-
tive individuals who also indulge in negative lifestyle 5
habits. Compiling an all-inclusive list of the benefits to
be reaped through participation in a fitness program is a Initial assessment Unfit Unfit Fit
challenge, but the list provided in Table 1.1 summarizes 5-year follow-up Unfit Fit Fit
many of these benefits.
In addition to the benefits listed in Table 1.1, *Death rates per 10,000 man-years observation.
epidemiological research studies linking physical activity SOURCE: S. N. Blair et al., “Changes in Physical Fitness and All-
habits and mortality rates have shown lower premature Cause Morality: A Prospective Study of Healthy Men and
Women,” Journal of the American Medical Association 273
mortality rates in physically active people. Pioneer work (1995): 1193–1198.
in this area demonstrated that, as the amount of weekly
physical activity increased, the risk of cardiovascular
deaths decreased.19 In this study, conducted among 16,936 A landmark study subsequently upheld the findings of
Harvard alumni, the greatest decrease in cardiovascular the Harvard alumni study.20 Based on data from 13,344
deaths was observed in alumni who burned more than individuals who were followed over an average of 8 years,
2,000 calories per week through physical activity. the results confirmed that the level of cardiorespiratory
Figure 1.4 Death rates by physical fitness levels.
39.5
64.0
70 40
60 35
50 30
40 26.3 24.6 25
16.4 16.3
30 20.3 20
20.3
20 15
9.7 7.4
7.8 7.4
10 10 3.9
7.3 4.8 2.9
3.1 1.0
5.8 1.0
4.7
ry
ry
s es
C
.8
C
se
o
o
au
au
s
g
g
u au
Lo
1.8
Lo
te
ca 5.4
te
se
lar
se
c
ca
er
w
w
ca
All All
o
cu
o
nc
f
er
s
f
as r
d
es
d
es
M
M
c Ca ula
ea
ea
v
od
od
an
n
n
dio sc
t
it
th
it
t
er
er
C nt
F
F
r n a
Ca iov
at
at
ide
H
H
ide
e
e
ig
ig
c Men rd c Women
h
h
Ac Ca Ac
SOURCE: Based on data from S. N. Blair, H. W. Kohl III, R. S. Paffenbarger, Jr., D. G. Clark, K. H. Cooper, and L. W. Gibbons, “Physical
Fitness and All-Cause Morality: A Prospective Study of Healthy Men and Women,” Journal of the American Medical Association 262
(1989): 2395–2401.
Table 1.1 Long-Term (Chronic) Benefits of Exercise

Regular participation in exercise
●● improves and strengthens the cardiorespiratory system.
●● maintains better muscle tone, muscular strength, and endurance.
●● improves muscular flexibility.
●● enhances athletic performance.
●● helps maintain recommended body weight.
●● helps preserve lean body tissue.
●● increases resting metabolic rate.
●● improves the body’s ability to use fat during physical activity.
●● improves posture and physical appearance.
●● improves functioning of the immune system.
●● lowers the risk for chronic diseases and illness (including heart disease, stroke, and certain cancers).
●● decreases the mortality rate from chronic diseases.
●● thins the blood so it doesn’t clot as readily (thereby decreasing the risk for coronary heart disease and strokes).
●● helps the body manage cholesterol levels more effectively.
●● prevents or delays the development of high blood pressure and lowers blood pressure in people with hypertension.
●● helps prevent and control type 2 diabetes.
●● helps achieve peak bone mass in young adults and maintain bone mass later in life, thereby decreasing the risk for osteoporosis.
●● helps people sleep better.
●● helps prevent chronic back pain.
●● relieves tension and helps in coping with life stresses.
●● raises levels of energy and job productivity.
●● extends longevity and slows the aging process.
●● improves and helps maintain cognitive function, decreasing the risk for dementia and Alzheimer’s disease.
●● promotes psychological well-being, including higher morale, self-image, and self-esteem.
●● reduces feelings of depression and anxiety.
●● encourages positive lifestyle changes (improving nutrition, quitting smoking, controlling alcohol and drug use).
●● speeds recovery time following physical exertion.
●● speeds recovery following injury or disease.
●● regulates and improves overall body functions.
●● improves physical stamina and counteracts chronic fatigue.
●● reduces disability and helps to maintain independent living, especially in older adults.
●● enhances quality of life: People feel better and live a healthier and happier life.
fitness is related to mortality from all causes. These find- in mortality risk when the study participants aban-
ings showed a graded and consistent inverse relationship doned a sedentary lifestyle and became moderately fit
between physical fitness and mortality, regardless of age (see Figure 1.5).21 The lowest death rate was found in
and other risk factors. people who were fit and remained fit, and the highest
In essence, the higher the level of cardiorespiratory fit- rate was found in men who remained unfit.
ness, the longer the life (see Figure 1.4). The death rate One study looked to specifically compare the efficacy
from all causes for the low-fit men was 3.4 times higher of commonly prescribed drugs against the impact of
than for the high-fit men. For the low-fit women, the regular exercise. The data are based on more than 14,000
death rate was 4.6 times higher than for the high-fit patients recovering from stroke, being treated for heart
women. The study also reported a greatly reduced rate of failure, or looking to prevent type 2 diabetes or a second
premature deaths, even at moderate fitness levels, which episode of coronary heart disease. The study looked at
most adults can achieve easily. People gain further protec- the effectiveness of exercise versus drugs on health
tion when they combine higher fitness levels with reduc-
tion in other risk factors such as hypertension, elevated
cholesterol, cigarette smoking, and excessive body fat. GLOSSARY
Additional research that looked at changes in fitness Epidemiological Of the study of epidemic diseases.
and mortality found a substantial (44 percent) reduction
outcomes. The results were revealing: Exercise programs feel short on time can gain major ground in their desire
were more effective than medical treatment in stroke to boost physical fitness by participating in high-intensity
patients and equally effective as medical treatments in interval training one to three times per week (for specific
prevention of diabetes and coronary heart disease. Only recommendations see Chapter 4, pages 110–111).
in the prevention of heart failure were diuretic drugs As compared with prolonged moderate-intensity ac-
more effective in preventing mortality than exercise.22 tivity, vigorous-intensity exercise has been shown to
While it is clear that moderate-intensity exercise does provide the best improvements in aerobic capacity, coro-
provide substantial health benefits, research data also nary heart disease risk reduction, and overall cardiovas-
show a dose-response relationship between physical ac- cular health.24 A word of caution, however, is in order.
tivity and health. Vigorous activity and longer duration Vigorous exercise should be reserved for healthy indi-
are preferable to the extent of one’s capabilities because viduals who have been cleared to do so (see Activity 1.2)
they are most clearly associated with better health and and who have been participating regularly in at least
longer life. Current recommendations suggest that a per- moderate-intensity activities.
son accumulate 150 minutes of moderate-intensity phys- While most of the chronic (long-term) benefits of ex-
ical activity each week. For an inactive person, following ercise are well-established, what many people fail to real-
this guideline is the most important step toward improv- ize is that there are immediate benefits derived by
ing health. Once a person is regularly achieving this participating in just one single bout of exercise. Most of
weekly minimum, the next step toward improving health these benefits dissipate within 48 to 72 hours following
through physical activity is to replace at least one-third exercise. The acute (immediate) benefits, summarized in
of weekly moderate physical activity with vigorous phys- Table 1.2, are so striking that they prompted Dr. William
ical activity.23 We are learning that even individuals who L. Haskell of Stanford University to state: “Most of the
Table 1.2 Immediate (Acute) Benefits of Exercise

You can expect a number of benefits as a result of a single exercise session. Some of these benefits last up to 72 hours following your workout. Exercise
●● increases heart rate, stroke volume, cardiac output, pulmonary ventilation, and oxygen uptake.
●● begins to strengthen the heart, lungs, and muscles.
●● enhances metabolic rate or energy production (burning calories for fuel) during exercise and recovery. For every 100 calories you burn during
exercise you can expect to burn another 15 during recovery.
●● uses blood glucose and muscle glycogen.
●● improves insulin sensitivity (decreasing type 2 diabetes risk).
●● immediately enhances the body’s ability to burn fat.
●● lowers blood lipids.
●● improves joint flexibility.
●● reduces low-grade (hidden) inflammation (see pages 216–217 in Chapter 8).
●● increases endorphins (hormones), naturally occurring opioids that are responsible for exercise-induced euphoria.
●● increases fat storage in muscle, which can then be burned for energy.
●● improves endothelial function (Endothelial cells line the entire vascular system, providing a barrier between the vessel lumen and
surrounding tissue. Endothelial dysfunction contributes to several disease processes, including tissue inflammation and subsequent
atherosclerosis).
●● enhances mood and self-worth.
●● provides a sense of achievement and satisfaction.
●● decreases blood pressure the first few hours following exercise.
●● decreases arthritic pain.
●● leads to muscle relaxation.
●● decreases stress.
●● improves brain function.
●● promotes better sleep (unless exercise is performed too close to bedtime).
●● improves digestion.
●● boosts energy levels.
●● improves resistance to infections.
health benefits of exercise are relatively short term, so peo- Figure 1.7 Motor skill-related components of physical
ple should think of exercise as a medication and take it on fitness.
a daily basis.” Of course, as you regularly exercise a mini-
mum of 30 minutes five times per week, you will realize
the impressive long-term benefits listed in Table 1.1. Coordination
Agility Speed
1.6 Types of Physical Fitness Reaction
time
Individuals are physically fit when they can meet both
the ordinary and the unusual demands of daily life safely Balance Power
and effectively without being overly fatigued and still
have energy left for leisure and recreational activities.
Physical fitness can be classified into health-related and
skill-related fitness.
quality of life by helping people cope more effectively in
Health-Related Fitness emergency situations (see Chapter 4). The components
of skill-related fitness are agility, balance, coordination,
Health-related fitness has four components: cardiore-
power, reaction time, and speed (see Figure 1.7).
spiratory endurance, muscular fitness, muscular flexibil-
ity, and body composition (see Figure 1.6). 1. Agility: The ability to change body position and
direction quickly and efficiently. Agility is
1. Cardiorespiratory endurance: The ability of the
important in sports such as basketball, soccer, and
heart, lungs, and blood vessels to supply oxygen to
racquetball, in which the participant must change
the cells to meet the demands of prolonged
direction rapidly and at the same time maintain
physical activity (also referred to as aerobic
proper body control.
exercise).
2. Balance: The ability to maintain the body in
2. Muscular fitness (muscular strength and muscular
equilibrium. Balance is vital in activities such as
endurance): The ability of the muscles to generate
gymnastics, diving, ice skating, skiing, and even
force.
football and wrestling, in which the athlete
3. Muscular flexibility: The achievable range of
attempts to upset the opponent’s equilibrium.
motion at a joint or group of joints without causing
3. Coordination: Integration of the nervous system
injury.
and the muscular system to produce correct,
4. Body composition: The amount of lean body mass
graceful, and harmonious body movements. This
and adipose tissue (fat mass) in the human body.
component is important in a wide variety of motor
activities such as golf, baseball, karate, soccer, and
Skill-Related Fitness racquetball, in which hand-eye or foot-eye
Fitness in motor skills is essential in activities such as movements, or both, must be integrated.
basketball, racquetball, golf, hiking, soccer, and water 4. Power: The ability to produce maximum force in
skiing. Good skill-related fitness also enhances overall the shortest time. The two components of power
Figure 1.6 Health-related components of physical

fitness.
GLOSSARY
Physical fitness The endurance, muscular flexibility,

Cardiorespiratory general capacity to adapt and body composition.
endurance and respond favorably to Skill-related fitness
Muscular Body physical effort. Components of fitness
flexibility composition
Health-related fitness A important for successful
Muscular fitness physical state encompassing motor performance in athletic
(strength and
endurance) cardiorespiratory endurance, events and in lifetime sports
muscular strength and and activities.
are speed and force (strength). An effective Improving skill-related fitness affords an individual
combination of these two components allows a more enjoyment and success in lifetime sports, and regu-
person to produce explosive movements such as lar participation in skill-related fitness activities also
those required in jumping; putting the shot; and helps develop health-related fitness. Further, total fitness
spiking, throwing, and hitting a ball. is achieved by taking part in specific programs to im-
5. Reaction time: The time required to initiate a prove health-related and skill-related components alike.
response to a given stimulus. Good reaction time is
important for starts in track and swimming; for
quick reactions when playing tennis at the net; and 1.7 Wellness
in sports such as table tennis, boxing, and karate.
6. Speed: The ability to propel the body or a part of After the initial fitness boom swept across the United
the body rapidly from one point to another. States in the 1970s, it became clear that improving physi-
Examples of activities that require good speed for cal fitness alone was not always enough to lower the risk
success are soccer, basketball, stealing a base in for disease and ensure better health. For example, indi-
baseball, and sprints in track. viduals who run three miles a day, lift weights regularly,
participate in stretching exercises, and watch their body
In terms of preventive medicine, the main emphasis of
weight can be classified as having good or excellent fit-
fitness programs should be on the health-related compo-
ness. If these same people, however, have high blood
nents. Skill-related fitness is crucial for success in sports
pressure, smoke, are under constant stress, consume too
and athletics, and it also contributes to wellness.
much alcohol, and eat too many fatty and processed
foods, they are exposing themselves to risk factors for
disease of which they may not be aware. Once the idea
took hold that fitness by itself would not necessarily de-
crease the risk for disease and ensure better health, the
wellness concept developed in the 1980s.
Wellness is an all-inclusive umbrella covering a vari-
ety of health-related factors. A wellness lifestyle requires
the implementation of positive programs to change be-
havior and thereby improve health and quality of life,
prolong life, and achieve total well-being. To enjoy a
wellness lifestyle, a person has to practice behaviors that
will lead to positive outcomes in seven dimensions of
wellness: physical, emotional, intellectual, social, envi-
ronmental, spiritual, and occupational (Figure 1.8).
These dimensions are interrelated; one frequently affects
Figure 1.8 Dimensions of wellness.
Social
Occupational Physical
Wellness
Emotional Spiritual
Mental Environmental
Good skill-related fitness enhances success in sports
performance.
●● Assess your overall level of physical fitness,

including cardiorespiratory endurance, muscular
fitness (strength and endurance), muscular
flexibility, and body composition.
●● Prescribe personal programs for total fitness
development.
●● Use behavior modification techniques that will
allow you to change unhealthy lifestyle patterns.
●● Develop sound diet and weight-control
programs.
●● Implement a healthy lifestyle program that includes
prevention of cardiovascular diseases and cancer,
stress management, and smoking cessation, if
applicable.
Discern myths from facts pertaining to exercise

●●
and health-related concepts.
1.9 Behavior Modification

Time spent in natural settings has been clinically shown to
Despite scientific evidence of the benefits derived from
improve wellness.
living a healthy lifestyle, many people still don’t make
healthy daily choices. To understand why this is so, one
has to examine what motivates people and what actions
the others. For example, a person who is “emotionally are required to make permanent changes in behavior,
down” often has no desire to exercise, study, go to work, which are called behavior modification.
socialize with friends, or attend church. Let’s look at an all-too-common occurrence on col-
The concept behind the seven dimensions of wellness lege campuses. Most students understand that they
shows that high-level wellness clearly goes beyond opti- should be exercising. They contemplate enrolling in a
mum fitness and the absence of disease. Wellness incor- fitness course. The motivating factor might be enhanced
porates fitness, proper nutrition, stress management, physical appearance, health benefits, or simply fulfill-
disease prevention, social support, self-worth, nurtur- ment of a college requirement. They sign up for the
ance (a sense of being needed), spirituality, personal course, participate for a few months, finish the course—
safety, substance control and not smoking, regular physi- and stop exercising! Various excuses are offered: too
cal examinations, health education, and environmental busy, no one to exercise with, already have the grade,
support. Additional information on wellness and how to inconvenient open-gym hours, or job conflicts. A few
implement a wellness program is given in Chapter 8. months later, they realize once again that exercise is vital
and repeat the cycle (see Figure 1.9). The information in
this book will be of little value to you if you are unable
1.8 T he Path to Fitness to abandon negative habits and adopt and maintain new,
healthy behaviors.
and Wellness
Because fitness and wellness needs vary from one person GLOSSARY
to another, exercise and wellness prescriptions must be
Risk factors Characteristics Behavior modification
personalized for best results. This book provides the
that predict the chances for The process used to
necessary guidelines for developing a lifetime program
developing a certain disease. permanently change
to improve fitness and promote preventive health care
Wellness The constant and negative behaviors in favor
and personal wellness. As you study the book and com-
deliberate effort to stay healthy of positive behaviors that
plete the assignments in each chapter, you will learn to
and achieve the highest will lead to better health and
●● Determine whether medical clearance is required potential for well-being. well-being.
for you to participate safely in exercise.
Behavior Modification Planning
Healthy Lifestyle Habits 8. Drink alcohol moderately or not at all.

Research indicates that adherence to the following 12 lifestyle 9. Surround yourself with healthy friendships.
habits will significantly improve health and extend life: 10. Seek to live and work in a healthy environment.
1. Participate in a lifetime physical activity program. 11. Use the mind: Keep your brain engaged throughout life to
2. Do not smoke cigarettes. maintain cognitive function.
3. Eat right. 12. Take personal safety measures to lessen the risk for
avoidable accidents.
4. Avoid snacking.
5. Maintain recommended body weight through adequate Try It
nutrition and exercise. Look at the list above and indicate which habits are already a
6. Sleep seven to eight hours each night. part of your lifestyle. What changes could you make to incorpo-
7. Lower your stress levels. rate additional healthy habits into your daily life?
Complete This Online

Visit www.cengagebrain.com to access MindTap, a complete digital course that includes interactive quizzes, videos, and more.
Change is incredibly difficult for most people. Our manner that will influence emotions and not just the
behaviors are based on our core values and actions that thought process. Once the problem behavior is under-
are rewarded. Whether we are trying to increase physical stood and “felt,” the person may become uncomfortable
activity, quit smoking, change unhealthy eating habits, or with the situation and will be more inclined to address
reverse heart disease, it is human nature to resist change the problem behavior or adopt a healthy behavior.
even when we know that change will provide substantial
benefits in the near future.
People pursue change when it’s rewarded (for example,
lower health care premiums if you quit smoking) or they
1.10 Values and Behavior
start contemplating change when there is a change in Values are defined as the core beliefs and ideals that
core values that will make them feel uncomfortable with people have. Values govern priorities. Life is full of trade-
the present behavior (for example, a long and healthy life offs, and values decide which opportunities will be sacri-
is more important than smoking). Core values change ficed for others that are viewed as more important. Values
when feelings are addressed. The challenge is to help govern behavior as people look to conduct themselves in
people understand the problems and solutions in a a manner that is conducive to living and attaining goals
consistent with their beliefs and what is important to
Figure 1.9 Exercise/exercise dropout cycle.
them. A person’s values reflect who they are.
Values are established through experience and learn-
Contemplate ing, and their development is a lifelong process. Values
exercise are first developed within a person’s family circles, im-
Find
excuses for not Realize need mediate community, and media and wider culture, ac-
exercising for exercise
cording to what is acceptable or unacceptable, desirable
or undesirable, and rewarded or ignored/punished. Edu-
Stop
cational experiences play a key role in the establishment
Consider
exercising fitness course of values. Education is power: It provides people with
knowledge to form opinions and allows them to better
internalize and visualize future outcomes from today’s
Course Enroll in choices. This is especially important because human
ends fitness course
nature is to focus on the present when making decisions,
Participate to give extra weight to immediate benefits and immedi-
in exercise
ate feedback rather than to greater positive impact. Edu-
cation forces people to question issues and take stands.
Values are also learned through examples and role or bad, and we are less likely to consider deliberate
models. According to behavioral scientists, people have a choice, core values, and long-term goals. Members of
need to maintain a positive view of themselves, which is Alcoholics Anonymous are instructed, for example, that
why it is often helpful and pleasant for people to associ- they are less likely to relapse if they can avoid situations
ate themselves with positive role models. As people look where they become hungry, angry, lonely, or tired
to develop values, they typically search for and emulate (H.A.L.T.).
people of high ethical values and accomplishments that There is a biological explanation for the way habits go
make them feel positive both about the people whose from planned to automatic behavior. The area of our
behaviors they are trying to emulate and themselves. brain where habits are formed is activated by events that
Core values change throughout life based on educa- are rewarding, exciting, unexpected, and intense, as
tion and the environment in which people live. Learning well as by cues from the environment that are associ-
and gaining a belief about a particular issue is most criti- ated with those events. That part of the brain then
cal in the establishment of values. For example, indi- memorizes events that are pleasurable and rewarding
viduals who lead a sedentary lifestyle and never exercise and helps the individual seek opportunities to repeat
lack an understanding of and don’t experience the myr- those events again in the future. As these behaviors be-
iad benefits and vibrant quality of life obtained through come ingrained in the brain, we lose awareness as they
fitness participation. Part of their decision not to exer- are carried out. Once we recognize the familiar trigger,
cise may be due to negative feelings and associations we often follow the habit, whether it is helpful or detri-
that intuitively arise when they think about exercise. mental, and therefore often sabotage the desire for will-
Behavioral scientists refer to these immediate associa- ful change.
tions as affect.
Through a book, class, sports participation, or a friend, Changing Habits through Mindfulness
the person may first be exposed to exercise and an active
lifestyle. The individual may then seek an environment
and Repetition
where he/she can learn and actively participate in a There are steps you can take to change unwanted behav-
physical activity or exercise program. The feelings of iors that have been ingrained in the brain or to create
well-being and increased health, functional capacity, and helpful behaviors. First, recognize that there are biologi-
quality of life and the education gained about the bene- cal processes that lead to behavioral habits. Take note of
fits of fitness in turn become the reward for program the situational cues or stressful experiences that trigger a
participation. The individual now associates exercise habit. Researchers have found that 45 percent of our be-
with positive feelings and a positive view of themselves. haviors are conducted in uniform contexts and locations
Often, deliberate effort is required to be in an environ- from day to day.25
ment that rewards the behaviors the individual is trying As you are adopting a new habit, repetition is critical.
to live. You must also consciously prepare to eliminate bad hab-
its, such as not eating while watching television. Instead,
use commercial breaks as a cue to stand up and find a
1.11 Your Brain and Your Habits quick household task that requires movement. Finally,
realize that excessive stress (distress—see Chapter 7) of-
Habits are a necessary tool for everyday brain function. ten triggers old habits. For example, an argument with a
Our minds learn to use familiar cues to carry out auto- roommate may lead to excessive time watching a TV
matic behavior that has worked successfully in the past. series while eating unhealthy food. You must prepare
While we carry out these automatic behaviors, we allow for an adequate response in these situations. If you
our minds to spend energy working on other tasks and made a mistake and did not adequately respond to that
puzzling through other problems. If you’ve ever found specific situation, chalk it up to experience, use it as a
yourself driving a familiar route when you had intended learning tool, and next time come back with the proper
to turn off and drive elsewhere, you are performing a response.
habit.
Habits happen in familiar environments and not in
new environments. Habits, however, can be changed by GLOSSARY
deliberate choice. During times of stress or when our Affect Immediate associations and feelings (either positive
minds are preoccupied with other problems, we are or negative) that influence choices.
much more prone to return to and rely on habits, good
Changing Habits by Focusing Any new behavior you are trying to adopt should be
equated with your own personal long-term values (see
on Long-Term Values the section on SMART goals on pages 23–24 of this
Understanding how to create and break habits through chapter). One series of studies enlisted participants who
mindfulness and repetition is a powerful tool. There are were attempting to make healthy lifestyle changes. When
greater forces at work in behavioral change than just participants met with temptation, they were instructed
pathways of automatic behavior, however. Those greater to respond with a phrase: Half the participants were in-
forces are our core values and understanding of who we structed to say “I don’t” and the other half were in-
are and what greater long-term desires we hold. Change structed to say “I can’t.” For example, when met with
in core values often overrules instant rewards as we seek temptation, an individual may say something like, “I
long-term gratification. This ability to change according don’t check text messages while driving,” versus, “I can’t
to values also has a biological explanation. check text messages while driving.” Or an individual may
An entirely separate portion of the brain, sometimes say, “I don’t buy food that has trans fat,” versus, “I can’t
referred to as the executive portion, is responsible for buy food that has trans fat.” The phrase “I don’t” was
reminding us of who we are and of our long-term goals. chosen by researchers because it connotes self-driven
When you find yourself leaving your warm, comfortable change, while the phrase “I can’t” connotes restrictions
bed in the morning to go to work, you are experiencing from an outside source.
the executive portion of your brain at work, placing The large majority of participants who used the phrase
long-term desires ahead of short-term urges. “I don’t,” which connotes self-driven change, were suc-
As you work to change behavior, you will notice com- cessful at their chosen behavior change. Those who used
peting desires, especially as you begin change. Find ways the phrase “I can’t” were likely to be unsuccessful. The
to guide yourself toward new behaviors by first recogniz- phrase “I don’t” helped participants connect the new
ing that you have two desires, a short-term urge and a behavior with their own long-term goals and desires and
long-term desire. Take a few extra minutes to understand kept them from feeling that behavior was an imposed
and visualize the reward you are seeking, and to educate restriction.26
yourself about the best way to obtain it. Remind yourself Willpower is believed by some scientists to be a lim-
often of your core values, and look for opportunities ited daily resource.27 Some suggest it is highest in the
throughout the day to align your behaviors with those core morning and is depleted as we use it throughout the day,
values. People can improve their chances of overcoming primarily when confronted with difficult challenges and
urges for unhealthy behavior by simply being in a frame of stress. Some behavioral scientists suggest that the simple
mind where they are thinking of the long-term benefits. belief that willpower is limited will make an individual
underestimate human resilience and become more
tempted to give up on a goal.28
1.12 Planning and Willpower Perhaps the best advice is taken from both points of
view. When you are planning to take on a significant
Understanding the concept of willpower, or self-control, task, help yourself be successful by choosing a time when
is helpful in the process of behavioral change. Many sci- you can put aside as many other demands and stressors
entists believe that self-restraint against impulses can be as possible. And when you meet a failure, do not give up.
built, like a muscle, if built slowly and gradually. Re- Instead, become a person who pushes past failure and
search suggests starting with something small. If you feel recognizes failure for what it is: a natural process of
you need to read every text message the moment it ar- learning on the way to success.
rives, you may try to learn to wait a few minutes and Studies indicate that willpower reserve can be in-
finish the activity you are working on and then read your creased through exercise, balanced nutrition, a good
text message. As you do so, you find you are able to carry night’s sleep, and quality time spent with important peo-
out your new behavior with positive results, and your ple in your life. On the other hand, willpower decreases
ability to exert self-control over that behavior increases. in times of depression, anxiety, anger, and loneliness.
The most effective use of willpower may be in its use
as a planning tool. Individuals who plan ahead, whether
it is their weekly schedule or their response in a certain
Implementation Intentions
situation, are able to align behavior with their long-term Another simple way to keep your values foremost in
desires. Planning ahead allows individuals to be consci- your mind is by using a research-based strategy that
entious about their choices. behavior scientists call implementation intentions.29
The strategy follows what you might expect from the

name. You consider a situation in which you are likely to
encounter temptation. You then make a plan for the ac-
tion you will take when faced with that situation. When
the situation arises, you are much more likely to succeed
with your goal by implementing the planned behavior.
For example, if a friend comes into town on a day you
plan to exercise, you can opt for a hike together in place
of your workout.
Johannes Kroemer/The Image Bank/Getty Images

1.13 otivation and Locus
M
of Control
Motivation often explains why some people succeed and
others do not. Although motivation comes from within,
external factors are what trigger the inner desire to ac-
complish a given task. These external factors, then, con-
trol behavior.
Understanding locus of control is helpful to the study Many people refrain from physical activity because they lack
of motivation. People who believe they have control over the necessary skills to enjoy and reap the benefits of regular
participation.
events in their lives are said to have an internal locus of
control. People with an external locus of control, by con-
trast, believe that what happens to them is a result of competence is to master the skills you need for
chance or environmental factors and is unrelated to their participation. Most people are not born with all-
behavior. inclusive natural abilities, including playing sports.
People with an internal locus of control are apt to be A college professor continuously watched a
healthier and have an easier time initiating and adhering group of students play an entertaining game of
to a wellness program than those who perceive that they basketball every Friday at noon. Having no
have little control and think of themselves as powerless basketball skills, he was reluctant to play.
and vulnerable. People with an external locus of control Eventually, however, the desire to join in the fun
also are at greater risk for illness. When illness does was strong enough that he enrolled in a beginning
strike, restoring a sense of control is vital to regaining course at the college so he would learn to play the
health. game. To his surprise, most of the students were
Few people have either a completely external or a impressed that he was willing to do this. Now, after
completely internal locus of control. They fall some- taking gradual steps toward his goal, he is able to
where along a continuum. The more external, the greater join in on Friday’s “pick-up games.”
is the challenge in changing and adhering to exercise Another alternative is to select an activity in
and other healthy lifestyle behaviors. Fortunately, a per- which you are skilled. It may not be basketball, but
son can develop a more internal locus of control. Under- it could be aerobics. And don’t be afraid to try new
standing that most events in life are not determined activities. Similarly, if your body weight is a
genetically or environmentally helps people pursue goals problem, you could learn to cook low-calorie
and gain control over their lives. Three impediments, meals. Try different recipes until you find foods
however, can keep people from acting on their desire to you like.
change: problems of competence, confidence, and
motivation. GLOSSARY
1. Problems of competence. Lacking the skills to get a Motivation The desire and believes he or she can
given task done leads to less competence. If your will to do something. influence the external
friends play basketball regularly but you don’t Locus of control The environment.
know how to play, you might not be inclined to extent to which a person
participate. The solution to this problem of
2. Problems of confidence. Problems with confidence walk without chest pain, play with children, and even
arise when you have the skills but you don’t believe resume an intimate relationship.
you can get it done. Fear and feelings of
inadequacy often interfere with the ability to
perform the task. 1.14 Changing Behavior
Don’t talk yourself out of something until you
have given it a fair try. If the skills are there, the sky The first step in addressing behavioral change is to rec-
is the limit. Initially, try to visualize yourself doing ognize that indeed a problem exists. Five general catego-
the task and getting it done. Repeat this several ries of behaviors are addressed in the process of willful
times, then actually give it a try. You will surprise change:
yourself. 1. Stopping a negative behavior
Sometimes, lack of confidence sets in when the 2. Preventing relapse of a negative behavior
task seems to be insurmountable. In these 3. Developing a positive behavior
situations, dividing a goal into smaller, realistic 4. Strengthening a positive behavior
objectives helps to accomplish the task. You may 5. Maintaining a positive behavior
know how to swim, but the goal of swimming a
continuous mile could take you several weeks to Changing chronic, unhealthy behaviors to stable,
accomplish. Set up your training program so you healthy behaviors is often challenging. Change usually
swim a little farther each day until you are able to does not happen all at once but, rather, is a lengthy pro-
swim the entire mile. If you don’t meet your cess with several stages.
objective on a given day, try it again, reevaluate, cut The simplest model of change is the two-stage model
back a little, and, most important, don’t give up. of unhealthy behavior and healthy behavior. This model
3. Problems of motivation. With problems of states that either you do it or you don’t. Most people who
motivation, both the competence and the use this model attempt self-change but end up asking
confidence are there, but individuals are unwilling themselves why they’re unsuccessful: They just can’t do it
to change because the reasons for change are not (start and adhere to exercise or quit smoking, for exam-
important to them. For example, a person begins ple). Their intention to change may be good, but to ac-
contemplating a smoking cessation program when complish it, they need knowledge about how to achieve
the reasons for quitting outweigh the reasons for change. The following discussion may help.
smoking.
The Transtheoretical Model
Fear of Implementation for Changing Behavior
versus Joy of Implementation To aid in this process, psychologists James Prochaska,
Many people are unaware of the magnitude of benefits of John Norcross, and Carlo DiClemente developed a be-
a wellness program. When it comes to a healthy lifestyle, havioral change model.30 The model’s five stages are im-
however, you may not get a second chance. A stroke, a portant to understanding the process of willful change.
heart attack, or cancer can have irreparable or fatal con- The stages of change describe underlying processes that
sequences. Greater understanding of what leads to dis- people go through to change most problem behaviors
ease can help initiate change. Joy, however, is a greater and adopt healthy behaviors. Most frequently, the model
motivator than fear. Even fear of dying often doesn’t in- is used to change health-related behaviors such as physi-
stigate change. cal inactivity, smoking, nutrition, weight control, stress,
Two years following coronary bypass surgery (heart and alcohol abuse.
disease), most patients’ denial returns, and surveys show The five stages of change are precontemplation, con-
that they have not done much to alter their unhealthy templation, preparation, action, and maintenance. A sixth
lifestyle. The motivating factor for the few who do stage of change, termination/adoption, was subsequently
change is the “joy of living.” Rather than dwelling on the added to this model.
“fear of dying” and causing patients to live in emotional After years of study, researchers found that applying
pain, physicians help patients visualize the way positive specific behavior-change techniques during each stage of
changes will help them feel better. They will be able to the model increases the rate of success for change. Un-
enhance their quality of life by carrying out activities of derstanding each stage of this model will help you deter-
daily living without concern for a heart attack, go for a mine where you are in relation to your personal
healthy-lifestyle behaviors. It also will help you identify Action

techniques to make successful changes. The action stage requires the most commitment of time
and energy by the individual. Here, people are actively
Precontemplation
doing things to change or modify the problem behavior
People in the precontemplation stage are not consider- or to adopt a new healthy behavior. The action stage re-
ing or do not want to change a specific behavior. They quires that the person follow the specific guidelines set
typically deny having a problem and do not intend to forth for that specific behavior. For example, a person
change. These people are usually unaware or underaware has actually stopped smoking completely, is exercising
of the problem. Other people around them, including aerobically three times per week according to exercise
family, friends, health care practitioners, and coworkers, prescription guidelines (see Chapter 3), or is maintain-
however, identify the problem quite clearly. ing a healthy diet.
Precontemplators do not care about the problem be- Relapse, in which the individual regresses to a previ-
havior and might even avoid information and materials ous stage, is common during this stage. Once people
that address the issue. They avoid free screenings and maintain the action stage for six consecutive months,
workshops that could help identify and change the they move into the maintenance stage.
problem, even if they receive financial incentives for at-
tending. Frequently, these people actively resist change Maintenance
and seem resigned to accept the unhealthy behavior as During the maintenance stage, the person continues to
their “fate.” adhere to the behavior change for up to 5 years. The
Precontemplators are the most difficult people to maintenance phase requires continuously adhering to
reach for behavioral change. They often think that the specific guidelines that govern the target behavior
change isn’t even a possibility. Educating them about (for example, complete smoking cessation, aerobic exer-
the problem behavior is critical to helping them start cise three times per week, or proper stress management
contemplating the process of change. It is said that techniques). At this time, a person works to reinforce the
knowledge is power, and the challenge is to find ways to gains made through the various stages of change and
help them realize that they will be ultimately responsi- strives to prevent lapses and relapses.
ble for the consequences of their behavior. Sometimes
they initiate change only when under pressure from Termination/Adoption
others. Once a person has maintained a behavior more than
5 years, he or she enters the termination/adoption stage
Contemplation without fear of relapse. In the case of negative behaviors
In the contemplation stage, people acknowledge that
they have a problem and begin to think seriously about GLOSSARY
overcoming it. Although they are not quite ready for Precontemplation stage behavior or adopting a new,
change yet, they are weighing the pros and cons. People Stage of change in which healthy behavior.
may remain in this stage for years, but in their mind they people are unwilling to Relapse Slipping or falling
are planning to take some action within the next change their behavior. back into unhealthy
6 months or so. Education and peer support are valuable
during this stage. Contemplation stage behavior(s) or failing to
Stage of change in which maintain healthy behaviors.
Preparation people are considering Maintenance stage Stage
In the preparation stage, people are seriously consider- changing behavior in the next of change in which people
ing and planning to change a behavior within the next 6 months. maintain behavioral change
month. They are taking initial steps for change and may Preparation stage Stage for up to 5 years.
even try it for a short while—for instance, stopping of change in which people Termination/adoption
smoking for a day or exercising a few times during this are getting ready to make a stage Stage of change in
month. In this stage, people define a general goal for change within the coming which people have eliminated
behavior change (say, to quit smoking by the last day of month. an undesirable behavior or
the month) and write specific actions to accomplish this Action stage Stage of maintained a positive
goal (see the discussion on SMART goals, pages 23–24). change in which people are behavior for more than
Continued peer and environmental support are recom- actively changing a negative 5 years.
mended during the preparation phase.
Figure 1.10 Identifying your current stage of change.
Please indicate which response most accurately describes your current _________________________________________
behavior (in the blank space identify the behavior: smoking, physical activity, stress, nutrition, weight control, etc.).
Next, select the statement below (select only one) that best represents your current behavior pattern. To select the most
appropriate statement, fill in the blank for one of the first three statements if your current behavior is a problem behav-
ior. (For example, you might say, “I currently smoke, and I do not intend to change in the foreseeable future,” or “I
currently do not exercise, but I am contemplating changing in the next 6 months.”) If you have already started to make
changes, fill in the blank in one of the last three statements. (In this case, you might say: “I currently eat a low-fat diet,
but I have done so only within the last 6 months,” or “I currently practice adequate stress management techniques, and I
have done so for more than 6 months.”) As you can see, you may use this form to identify your stage of change for any
type of health-related behavior.
1. I currently __________________________________, and I do not intend to change in the foreseeable future.
2. I currently __________________________________, but I am contemplating changing in the next 6 months.
3. I currently _______________________________________ regularly but intend to change in the next month.
4. I currently ________________________________________, but I have done so only within the last 6 months.
5. I currently ____________________________________________, and I have done so for more than 6 months.
6. I currently ______________________________________________, and I have done so for more than 5 years.
STAGES OF CHANGE
1 Precontemplation 4 Action
2 Contemplation 5 Maintenance
3 Preparation 6 Termination/Adoption
that have been terminated, this stage of change is re- the next 3 months. Developing new behavioral patterns
ferred to as termination. If the person has adopted a takes time, and trying to work on too many components
positive behavior for more than 5 years, this stage is at once most likely will lower your chances for success.
designated the adoption stage. Many experts believe Start with components in which you think you will have
that after this period of time, any former addictions, a high chance for success.
problems, or lack of compliance with healthy behaviors
no longer present an obstacle in the quest for wellness.
The change has become a part of one’s lifestyle. This
!
phase is the ultimate goal for everyone who seeks a Critical Thinking
healthier lifestyle. What factors do you think keep you from participating in
Use the form provided in Figure 1.10 to determine a regular exercise program? ● How about factors that
where you stand in respect to behaviors that you want keep you from managing your daily caloric intake?
to change or new ones that you wish to adopt. As you
fill out this form, you will realize that you are at differ-
ent stages for different behaviors. For instance, you may
be in the termination stage for aerobic exercise and 1.15 The Process of Change
smoking, in the action stage for strength training, but
only in the contemplation stage for a healthy diet. Real- Timing is important in the process of willful change.
izing where you are at with respect to different behav- People respond more effectively to selected processes of
iors will help you design a better action plan for a change in keeping with the stage of change they have
healthy lifestyle. reached at any given time. Thus, applying appropriate
Using the form provided in Activity 1.1, pages 26–27, processes at each stage of change enhances the likelihood
select two or three behaviors that you have targeted for of changing behavior permanently. The following
description of 16 of the most common processes of whether they help or hinder you from adopting a healthy
change will help you develop a personal plan for change. lifestyle. Do you value ambition over a healthy lifestyle?
Do you admire an artist or celebrity who abuses drugs?
Consciousness-Raising Do you value smoking because it has become part of your
The first step in a behavior modification program is self-identity and helps you feel like part of your social
consciousness-raising. This step involves obtaining in- group? In your self-analysis, you may want to prepare a
formation about the problem so that you can make a list of reasons for continuing or discontinuing the behav-
better decision about the problem behavior. Possibly, you ior. When the reasons for changing outweigh the reasons
don’t even know that a certain behavior is a problem, for not changing, you are ready for the next stage—either
such as being unaware of saturated and total fat content the contemplation stage or the preparation stage.
in many fast-food items. Consciousness-raising may
continue from the precontemplation stage through the Emotional Arousal
preparation stage. In emotional arousal, a person experiences and expresses
feelings about the problem and its solutions. Also re-
Social Liberation ferred to as “dramatic release,” this process often involves
Social liberation stresses external societal acceptance of deep emotional experiences. Watching a loved one die
and support for positive change. Individuals who receive from lung cancer caused by cigarette smoking may be all
cues that a new behavior will be accepted and supported that is needed to make a person quit smoking. As in
in their community will be more likely to succeed at other examples, emotional arousal might be prompted
adopting that behavior. Examples of social liberation in- by a dramatization of the consequences of drug use and
clude pedestrian-only traffic areas, health-oriented cafete- abuse, a film about a person undergoing open-heart sur-
rias and restaurants, advocacy groups, civic organizations, gery, or a book illustrating damage to body systems as a
policy interventions, and self-help groups. result of unhealthy behaviors.
Self-Analysis Positive Outlook
The next process in modifying behavior is developing a Having a positive outlook means taking an optimistic ap-
decisive desire to do so, called self-analysis. If you have no proach from the beginning and believing in yourself. Be-
interest in changing a behavior, you won’t do it. You will havioral scientists believe that the ability to remain positive
remain a precontemplator or a contemplator. Take a mo- is a trait that can be learned.31 Following the guidelines in
ment to consider your values. Examine your beliefs and this chapter will help you design a plan so that you can
The Power of Positive Self-Talk

Individuals who are able to reframe problems in a positive learned what does not work for me. I am going to use next week
way are better able to maintain health and well-being. They to reset and approach my days in a way that has worked well for
can approach imperfect situations productively. They are also me in the past.”
able to practice self-compassion and treat themselves with
the same kindness they would extend to other people. One way
individuals can improve their outlook is by fostering the habit
of positive self-talk. Individuals may not notice whether their
self-talk leans positive or negative until they have monitored
themselves for a time. For example, after a stressful week when
© Anastasiia Kazakova/Shutterstock.com
you realize you have eaten poorly you may find yourself saying
something negative, like, “Why do I think I can do these things?
I can barely keep my life together, let alone eat well.” Say-
ing the phrase aloud may help you notice that your thought is
destructive to your goal. Or by saying the phrase aloud, you may
be happy to discover that you are thinking something positive,
like, “That week was not easy, but I made it through. I certainly
work toward change and remain enthused about your behavior can be reevaluated at this time. For example,
progress. Studies of individuals who are trying to quit an you may decide that strength training will help you get
addictive behavior have found that asking such persons to stronger and tone up, but implementing this change will
reconnect with positive and meaningful goals in their life require you to wake up earlier three times per week. If
greatly improves chances for success. In many cases, goals you remember a time when you enjoyed feeling fit and
that will bring the person enjoyment and purpose will be capable of meeting daily physical demands with ease, you
incompatible with the undesired behaviors. may feel good about weight loss and enhanced physical
capacity as a result of a strength-training program.
Commitment
Upon making a decision to change, you accept the re- Countering
sponsibility to change and believe in your ability to do so. The process whereby you substitute healthy behaviors for
During the commitment process, you engage in prepara- a problem behavior, known as countering, is a critical
tion and may draw up a specific plan of action. Write part of the action and maintenance stages of changing
down your goals and, preferably, share them with others behaviors. You need to replace unhealthy behaviors with
or announce them! In essence, you are signing a behav- new, healthy ones. You can use exercise to combat seden-
ioral contract for change. You will be more likely to ad- tary living, smoking, stress, or overeating. Or you may use
here to your program if others know you are committed exercise, yard work, volunteer work, or reading to prevent
to change. overeating and achieve recommended body weight.
Mindfulness Monitoring
The simple act of being aware of thoughts and choices is During the action and maintenance stages, continuous
a powerful tool. A person should not feel that having an behavior monitoring increases awareness of the desired
urge means that they have to act on it. A common tech- outcome. Sometimes, this process of monitoring is suf-
nique of mindfulness is referred to as urge surfing, which ficient in itself to cause change. For example, keeping
directs the person to notice the urge, pay attention to the track of daily food intake reveals sources of excessive fat
way the urge feels as it builds, and then simply continue in the diet. This can help you gradually cut down or
noticing it as the urge subsides. completely eliminate high-fat foods. If the goal is to in-
crease daily intake of fruits and vegetables, keeping track
Behavior Analysis of the number of servings consumed each day raises
How you determine the frequency, circumstances, and awareness and may help increase intake.
consequences of the behavior to be altered or imple-
mented is known as behavior analysis. If the desired out- Environment Control
come is to consume less trans and saturated fats, you first In environment control, the person restructures the
must find out what foods in your diet are high in these physical surroundings to avoid problem behaviors and
fats, when you eat them, and when you don’t eat them— decrease temptations. If you bring baby carrots and nuts
all part of the preparation stage. Knowing when you don’t to work instead of chips, you are likely to snack better. If
eat them points to circumstances under which you exert you put your favorite workout gear neatly folded at eye
control over your diet, which will help as you set goals. level in your closet, you may associate more pleasant
feelings with getting ready to exercise.
Goals
Goals motivate change in behavior. The stronger the goal Helping Relationships
or desire, the more motivated you’ll be either to change Surround yourself with people who will work toward a
unwanted behaviors or to implement new, healthy be- common goal with you or those who care about you and
haviors. The discussion on goal setting (beginning on will encourage you along the way. “Helping relation-
page 23) will help you write goals and prepare an action ships” will be supportive during the action, maintenance,
plan to achieve them. This will aid with behavior and termination/adoption stages.
modification. Attempting to quit smoking, for instance, is easier
when a person is around others who have already quit or
Self-Reevaluation are trying to quit as well. One particular research study
During the process of self-reevaluation, individuals ana- examined a large social network of people to understand
lyze their feelings about a problem behavior. The pros the smoking habits of individuals who personally knew
and cons or advantages and disadvantages of a certain someone who had quit. They found that knowing
someone who had quit smoking boosted an

individual’s likelihood to quit or avoid start-
ing in the first place. People were much less
likely to be a smoker than the national aver-
age if the person who had quit was their
spouse, a friend, or a sibling.32 Researchers
found that, consistently, it was the closeness
of the relationship, and not geographical
closeness, that made the difference in health
behaviors.
© Tyler Olson/Shutterstock.com
In some cases, people who have achieved
the same goal already may not be supportive
either. For instance, someone may say, “I
can do six consecutive miles.” Your response
should be, “I’m proud that I can jog three
consecutive miles.”
Social support enhances regular participation and the process of behavior
Rewards modification.
People tend to repeat behaviors that are
rewarded and to disregard those that are not rewarded or witness the contract you made with yourself by
are punished. Rewarding oneself or being rewarded by signing alongside your signature.
others is a powerful tool during the process of change in Once you have identified and written down a
all stages. If you have successfully cut down your caloric specific goal, write the specific actions that will
intake during the week, reward yourself by going to a help you reach that goal. These actions are the
movie or buying a new pair of shoes. Do not reinforce necessary steps required to reach your goal.
yourself with destructive behaviors such as eating a calo- 2. Measurable. Whenever possible, goals and actions
rie-dense dinner. If you fail to change a desired behavior should be measurable. For example, “I will lose
(or to implement a new one), you may want to put off weight” is not measurable, but “I will reduce body
buying those new shoes you had planned for that week. fat to 20 percent” is measurable.
When a positive behavior becomes habitual, give your- 3. Acceptable. Goals that you set for yourself are more
self an even better reward. Treat yourself to a weekend motivational than goals that someone else sets for
away from home or buy a new bicycle. you. These goals will motivate and challenge you
and should be consistent with other goals that you
have. As you set an acceptable goal, ask yourself:
1.16 SMART Goals Do I have the time, commitment, and necessary
skills to accomplish this goal? If not, you need to
Only a well-conceived action plan will help you attain goals. restate your goal so that it is acceptable to you.
Determining what you want to accomplish is the starting In instances where successful completion of a
point, but to reach your goal you need to write SMART goal involves others, such as an athletic team or an
goals. The SMART acronym means that goals are Specific, organization, an acceptable goal must be
Measurable, Acceptable, Realistic, and Time-specific: compatible with those of the other people involved.
1. Specific. When writing goals, state in a positive If a team’s practice schedule is set Monday through
manner exactly what you would like to accomplish. Friday from 4:00 p.m. to 6:00 p.m., it is
For example, if you are overweight at 150 pounds unacceptable for you to train only three times per
and at 27 percent body fat, simply stating “I will week or at a different time of the day.
lose weight” is not a specific goal. Instead, rewrite
your goal to state, “I will reduce my body fat to GLOSSARY
20 percent (137 pounds) in 12 weeks.” SMART An acronym for Actions Steps required to
Be sure to write down your goals. An unwritten Specific, Measurable, reach a goal.
goal is simply a wish. A written goal, in essence, Acceptable, Realistic, and
becomes a contract with yourself. Show this goal to Time-specific goals.
a friend or an instructor and have him or her
4. Realistic. Goals should be within reach. If you after you have fully committed and put all your effort
currently weigh 190 pounds and your target weight into a goal, that goal may be unreachable. If so, reassess
(at 20 percent body fat) is 140 pounds, setting a goal the goal.
to lose 50 pounds in a month would be unsound, if Recognize that you will face obstacles and that you will
not impossible. Such a goal does not allow for the not always meet your goals. Use your setbacks and learn
implementation of adequate behavior modification from them. Rewrite your goal and create a plan that will
techniques or ensure weight maintenance at the help you get around self-defeating behaviors in the fu-
target weight. Unattainable goals only set you up for ture. Once you achieve a goal, set a new one to improve
failure, discouragement, and loss of interest. upon or maintain what you have achieved. Goals keep
On the other hand, do not write goals that are you motivated.
too easy to achieve and that do not challenge you. In addition to previously discussed guidelines,
If a goal is too easy, you may lose interest and stop throughout this book you will find information on
working toward it. behavioral change. For example, Chapter 3 includes
At times, problems arise even with realistic the Exercise Readiness Questionnaire, tips to start
goals. Try to anticipate potential difficulties as and adhere to an exercise program, and how to set
much as possible and plan for ways to deal with your fitness goals; Chapter 4 offers tips to enhance
them. If your goal is to jog for 30 minutes on your aerobic workout; Chapter 6 gives suggestions on
6 consecutive days, what are the alternatives if the how to adhere to a lifetime weight management pro-
weather turns bad? Possible solutions are to jog in gram; Chapter 7 sets forth stress management tech-
the rain, find an indoor track, jog at a different niques; and Chapter 8 outlines a six-step smoking
time of day when the weather is better, or cessation plan.
participate in a different aerobic activity such as
stationary cycling, swimming, or step aerobics.
Monitoring your progress as you move toward a 1.17 A Word of Caution Before
goal also reinforces behavior. Keeping an exercise
log or doing a body composition assessment You Start Exercise
periodically enables you to determine your
progress at any given time. Even though exercise testing and participation are rela-
5. Time-specific. A goal always should have a specific tively safe for most apparently healthy individuals, a
date set for completion. The above example to small but real risk exists for exercise-induced abnormali-
reach 20 percent body fat in 12 weeks is time- ties in people with a history of cardiovascular problems
specific. The chosen date should be realistic but and those who are at higher risk for disease. These peo-
not too distant in the future. Allow yourself ple should be screened before initiating or increasing the
enough time to achieve the goal, but not too much intensity of an exercise program.
time, as this could affect your performance. With a Before you engage in an exercise program or partici-
deadline, a task is much easier to work toward. pate in any exercise testing, at a minimum you should fill
out the Physical Activity Readiness Questionnaire
(PAR-Q) found in Activity 1.2. A “yes” answer to any of
Goal Evaluation these questions may signal the need for a physician’s
In addition to the SMART guidelines already provided, approval before you participate. If you don’t have any yes
you should conduct periodic evaluations of your goals. responses, you may proceed to Chapter 2 to assess your
Reevaluations are vital for success. You may find that current level of fitness.
Assess Your Behavior

1. Are you aware of lifestyle factors that may negatively 3. Do you participate in vigorous-intensity physical activity
impact your health? a minimum of two times per week?
2. Do you accumulate at least 30 minutes of moderate- 4. Do you make a constant and deliberate effort to stay
intensity physical activity 5 days per week? healthy and achieve the highest potential for well-being?
Assess Your Knowledge

1. Bodily movement produced by skeletal muscles is called 6. Research on the effects of fitness on mortality indicates
a. physical activity. that the largest drop in premature mortality is seen
b. kinesiology. between
c. exercise. a. the average and excellent fitness groups.
d. aerobic exercise. b. the least fit and moderately fit groups.
e. muscle strength. c. the good and high fitness groups.
2. The Physical Activity Guidelines for Americans state that d. the moderately fit and good fitness groups.
adults between 18 and 64 years of age should e. The drop is similar among all fitness groups.
a. do 2 hours and 30 minutes a week of moderate- 7. What is the greatest benefit of being physically fit?
intensity aerobic physical activity. a. absence of disease
b. do 1 hour and 15 minutes (75 minutes) a week of b. a higher quality of life
vigorous-intensity aerobic physical activity. c. improved sports performance
c. do an equivalent combination of moderate- and d. better personal appearance
vigorous-intensity aerobic physical activity listed e. maintenance of ideal body weight
under choices a and b above. 8. Which of the following is a stage in the behavioral
d. do muscle-strengthening activities that involve all modification model?
major muscle groups on two or more days per week. a. recognition
e. All of the above choices are correct. b. motivation
3. The leading cause of death in the United States is c. relapse
a. cancer. d. preparation
b. accidents. e. goal setting
c. chronic lower respiratory disease. 9. A precontemplator is a person who
d. diseases of the cardiovascular system. a. has no desire to change a behavior.
e. drug-related illness. b. is looking to make a change in the next 6 months.
4. The constant and deliberate effort to stay healthy and c. is preparing for change in the next 30 days.
achieve the highest potential for well-being is defined as d. willingly adopts healthy behaviors.
a. health. e. is talking to a therapist to overcome a problem
b. physical fitness. behavior.
c. wellness. 10. A SMART goal is effective when it is
d. health-related fitness. a. realistic.
e. metabolic fitness. b. measurable.
5. Which of the following is not a component of health- c. specific.
related fitness? d. acceptable.
a. cardiorespiratory endurance e. All are correct choices.
b. body composition Correct answers can be found on page 291.
c. agility
d. muscular strength and endurance
e. muscular flexibility
Activity 1.1 Behavior Modification: Stages of Change
Name Date
Course Section
Instructions
Please indicate which response most accurately describes If you have already started to make changes, fill in the
your stage of change for three different behaviors (in the blank in one of the last three statements. (In this case, you
blank space identify the behavior: smoking, physical activity, might say: “I currently eat a low-fat diet but I have done so
stress, nutrition, weight control, etc.). Next, select the only within the last 6 months,” or “I currently practice
statement (select only one) that best represents your current adequate stress management techniques and I have done so
behavior pattern. To select the most appropriate statement, for more than 6 months.”) You may use this technique to
fill in the blank for one of the first three statements if your identify your stage of change for any type of health-related
current behavior is a problem behavior. (For example, you behavior.
might say, “I currrently smoke and I do not intend to change Now write SMART goals (see pages 23–24) and identify
in the foreseeable future,” or “I currently do not exercise, but three processes of change (pages 21–23) that will help you
I am contemplating changing in the next 6 months.”) achieve your goal.
Behavior 1:
1. I currently , and I do not intend to change in the foreseeable future.
2. I currently , but I am contemplating changing in the next 6 months.
3. I currently regularly but intend to change in the next month.
4. I currently , but I have done so only within the last 6 months.
5. I currently , and I have done so for more than 6 months.
6. I currently , and I have done so for more than 5 years.
Stage of change: (see Stages of Change list below)
Specific goal and date to be accomplished:
Process of change to be used:
Behavior 2:
3. I currently regularly but intend to change in the next month.

Activity 1.1 Behavior Modification: Stages of Change (continued)
Behavior 3:
3. I currently regularly, but I intend to change in the next month.
Stages of Change
1 Precontemplation 4 Action
2 Contemplation 5 Maintenance
3 Preparation 6 Termination/Adoption
Self-Reflection
In your own words, indicate barriers (what may keep you from changing) that you might encounter during the process of change
and how can you best prepare to overcome these barriers.

Activity 1.2 Physical Activity Readiness Questionnaire (PAR-Q)
2015 PAR-Q+
The Physical Activity Readiness Questionnaire for Everyone
more people should engage in physical
activity every day of the week. Participating in physical activity is very safe for MOST people. This
questionnaire will tell you whether it is necessary for you to seek further advice from your doctor
GENERAL HEALTH QUESTIONS
Please read the 7 questions below carefully and answer each one honestly: check YES or NO. YES NO
1) Has your doctor ever said that you have a heart condition OR high blood pressure ?
2) Do you feel pain in your chest at rest, during your daily activities of living, OR when you do
physical activity?
3) Do you lose balance because of dizziness OR have you lost consciousness in the last 12 months?
Please answer NO if your dizziness was associated with over-breathing (including during vigorous exercise).
4) Have you ever been diagnosed with another chronic medical condition (other than heart disease
or high blood pressure)? PLEASE LIST CONDITION(S) HERE:
5) Are you currently taking prescribed medications for a chronic medical condition?
PLEASE LIST CONDITION(S) AND MEDICATIONS HERE:
6) Do you currently have (or have had within the past 12 months) a bone, joint, or soft tissue
(muscle, ligament, or tendon) problem that could be made worse by becoming more physically
active? Please answer NO if you had a problem in the past, but it does not limit your current ability to be physically active.
PLEASE LIST CONDITION(S) HERE:
7) Has your doctor ever said that you should only do medically supervised physical activity?
If you answered NO to all of the questions above, you are cleared for physical activity.
Go to Page 31 to sign the PARTICIPANT DECLARATION. You do not need to complete Pages 29 and 30.
Start becoming much more physically active – start slowly and build up gradually.
Follow International Physical Activity Guidelines for your age (www.who.int/dietphysicalactivity/en/).
You may take part in a health and fitness appraisal.
If you are over the age of 45 years and NOT accustomed to regular vigorous to maximal effort exercise,
consult a qualified exercise professional before engaging in this intensity of exercise.
If you have any further questions, contact a qualified exercise professional.
If you answered YES to one or more of the questions above, COMPLETE PAGES 29 AND 30.
Delay becoming more active if:

You have a temporary illness such as a cold or fever; it is best to wait until you feel better.
You are pregnant – talk to your health care practitioner, your physician, a qualified exercise professional, and/or
complete the ePARmed-X+ at www.eparmedx.com before becoming more physically active.
Your health changes – answer the questions on Pages 29 and 30 of this document and/or talk to your doctor or a
qualified exercise professional before continuing with any physical activity program.
Copyright © 2015 PAR-Q+ Collaboration 1 / 4

08-01-2014
SOURCE: Physical Activity Readiness Questionaire (PAR-Q) © 2015. Used with permission from the Canadian Society for Exercise
Physiology www.csep.ca.
Activity 1.2 Physical Activity Readiness Questionnaire (PAR-Q) (continued)
2015 PAR-Q+
FOLLOW-UP QUESTIONS ABOUT YOUR MEDICAL CONDITION(S)
1. Do you have Arthritis, Osteoporosis, or Back Problems?
If the above condition(s) is/are present, answer questions 1a-1c If NO go to question 2
YES NO
(Answer NO if you are not currently taking medications or other treatments)
1b. Do you have joint problems causing pain, a recent fracture or fracture caused by osteoporosis or cancer,
displaced vertebra (e.g., spondylolisthesis), and/or spondylolysis/pars defect (a crack in the bony ring on the YES NO
back of the spinal column)?
1c. Have you had steroid injections or taken steroid tablets regularly for more than 3 months? YES NO
2. Do you have Cancer of any kind?

If the above condition(s) is/are present, answer questions 2a-2b If NO go to question 3
2a. Does your cancer diagnosis include any of the following types: lung/bronchogenic, multiple myeloma (cancer of YES NO
plasma cells), head, and neck?
2b. Are you currently receiving cancer therapy (such as chemotheraphy or radiotherapy)? YES NO
3. Do you have a Heart or Cardiovascular Condition? This includes Coronary Artery Disease, Heart Failure,
Diagnosed Abnormality of Heart Rhythm
If the above condition(s) is/are present, answer questions 3a-3d If NO go to question 4
YES NO
3b. Do you have an irregular heart beat that requires medical management? YES NO
3c. Do you have chronic heart failure? YES NO
3d. Do you have diagnosed coronary artery (cardiovascular) disease and have not participated in regular physical YES NO
activity in the last 2 months?
4. Do you have High Blood Pressure?

If the above condition(s) is/are present, answer questions 4a-4b If NO go to question 5
YES NO
4b. Do you have a resting blood pressure equal to or greater than 160/90 mmHg with or without medication? YES NO
(Answer YES if you do not know your resting blood pressure)
5. Do you have any Metabolic Conditions? This includes Type 1 Diabetes, Type 2 Diabetes, Pre-Diabetes
If the above condition(s) is/are present, answer questions 5a-5e If NO go to question 6
YES NO
prescribed therapies?
during activities of daily living? Signs of hypoglycemia may include shakiness, nervousness, unusual irritability, YES NO
5c. Do you have any signs or symptoms of diabetes complications such as heart or vascular disease and/or YES NO
OR the sensation in your toes and feet?
5d. Do you have other metabolic conditions (such as current pregnancy-related diabetes, chronic kidney disease, or YES NO
liver problems)?
5e. Are you planning to engage in what for you is unusually high (or vigorous) intensity exercise in the near future? YES NO
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SOURCE: Physical Activity Readiness Questionaire (PAR-Q) © 2015. Used with permission from the Canadian Society for Exercise
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The best part of the kangaroo is its tail. Talk of ox-tail soup, ye
metropolitan gourmands! Commend us to the superb kangaroo-tail
soup of Australia, made from the tail weighing some 10 or 12 lbs., if
a full-grown forester.
The pademelon, a smaller species of kangaroo, weighs about 9 or
10 lbs., and when cooked like a hare, affords a dish with which the
most fastidious gourmand might be satisfied.
The following is the native mode of cooking a kangaroo steak:—It is
placed in a scooped out stone, which is readily found in the streams,
and pressed down by heavy stones on the top of it; the heat is
applied beneath and round the first top stone; at the critical moment
the stones are quickly removed, and the steak appears in its most
savoury state.
The aborigines of Australia always roast their food; they have no
means of boiling, except when they procure the service of an old
European saucepan or tin pot. ‘It is a very remarkable fact’ (remarks
Mr. Moore) ‘in the history of mankind, that a people should be found
now to exist, without any means of heating water, or cooking liquid
food; or, in short, without any culinary utensil or device of any sort.
The only mode of cooking was to put the food into the fire, or roast it
in the embers or hot ashes; small fish or frogs being sometimes first
wrapped in a piece of paper-tree bark. Such was their state when
Europeans first came among them. They are now extremely fond of
soup and tea.’
A native will not eat tainted meat, although he cannot be said to be
very nice in his food, according to our ideas. Their meat is cooked
almost as soon as killed, and eaten immediately.
The parts of the kangaroo most esteemed for eating are the loins
and the tail, which abound in gelatine, and furnish an excellent and
nourishing soup; the hind legs are coarse, and usually fall to the
share of the dogs. The natives (if they can be said to have a choice)
give a preference to the head. The flesh of the full-grown animal may
be compared to lean beef, and that of the young to veal; they are
destitute of fat, if we except a little being occasionally seen between
the muscles and integuments of the tail. The colonial dish, called a
steamer, consists of the flesh of the animal dressed, with slices of
ham. The liver when cooked is crisp and dry, and is considered a
substitute for bread; but I cannot coincide in this opinion.
The goto, or long bag of kangaroo skin, about two feet deep, and a
foot and a half broad, carried by the native females in Australia, is
the common receptacle for every small article which the wife or
husband may require or take a fancy to, whatever its nature or
condition may be. Fish just caught, or dry bread, frogs, roots, and
clay, are all mingled together.
Mr. George Bennett (Wanderings in New South Wales) thus speaks
of Australian native cookery:—
‘After wet weather they track game with much facility; and from the
late rains the hunting expeditions had been very successful; game
was, therefore, very abundant at the camp, which consisted of
opossums, flying squirrels, bandicoots, snakes, &c.
‘One of the opossums among the game was a female, which had
two large-sized young ones in her pouch; these delicate morsels
were at this time broiling, unskinned and undrawn, upon the fire,
whilst the old mother was lying yet unflayed in the basket.
‘It was amusing to see with what rapidity and expertness the animals
were skinned and embowelled by the blacks. The offal was thrown to
the dogs; but, as such a waste on the part of the natives does not
often take place, we can only presume it is when game, as it was at
present, is very abundant. The dogs are usually in poor condition,
from getting a very precarious supply of provender. The liver being
extracted, and gall-bladder removed, a stick was thrust through the
animal, which was either thrown upon the ashes to broil, or placed
upon a wooden spit before the fire to roast. Whether the food was
removed from the fire cooked, or only half dressed, depended
entirely on the state of their appetites. The flesh of the animals at this
time preparing for dinner, by our tawny friends, appeared delicate,
and was no doubt excellent eating, as the diet of the animals was in
most instances vegetable.’
Another traveller in the Bush thus describes the aboriginal practices
and food:—‘We had scarcely finished the snake, when Tomboor-
rowa and little Sydney returned again. They had been more
successful this time, having shot two wallabies or brush kangaroos
and another carpet-snake of six feet in length. A bundle of rotten
branches was instantly gathered and thrown upon the expiring
embers of our former fire, and both the wallabies and the snake were
thrown into the flame. One of the wallabies had been a female, and
as it lay dead on the grass, a young one, four or five inches long,
crept out of its pouch. I took up the little creature, and, presenting it
to the pouch, it crept in again. Having turned round, however, for a
minute or two, Gnunnumbah had taken it up and thrown it alive into
the fire; for, when I happened to look towards the fire, I saw it in the
flames in the agony of death. In a minute or two the young wallaby
being sufficiently done, Gnunnumbah drew it out of the fire with a
stick, and eat its hind-quarters without further preparation, throwing
the rest of it away.
‘It is the etiquette among the black natives for the person who takes
the game to conduct the cooking of it. As soon, therefore, as the
skins of the wallabies had become stiff and distended from the
expansion of the gases in the cavity of their bodies, Tomboor-rowa
and Sydney each pulled one of them from the fire, and scraping off
the singed hair roughly with the hand, cut up the belly and pulled out
the entrails. They then cleaned out the entrails, not very carefully by
any means, rubbing them roughly on the grass or on the bushes,
and then threw them again upon the fire. When they considered
them sufficiently done, the two eat them, a considerable quantity of
their original contents remaining to serve as a sort of condiment or
sauce. The tails and lower limbs of the two wallabies, when the latter
were supposed to be done enough, were twisted off and eaten by
the other two natives (from one of whom I got one of the vertebræ of
the tail and found it delicious); the rest of the carcases, with the large
snake, being packed up in a number of the Sydney Herald, to serve
as a mess for the whole camp at Brisbane. The black fellows were
evidently quite delighted with the excursion; and, on our return to the
Settlement, they asked Mr. Wade if he was not going again to-
morrow.’
The kangaroo rat, an animal nearly as large as a wild rabbit, is
tolerably abundant, and very good eating, when cooked in the same
manner. The natives take them by driving a spear into the nest,
sometimes transfixing two at once, or by jumping upon the nest,
which is formed of leaves and grass upon the ground.
It is less sought for than its larger relatives, except by thorough
bushmen, owing to the prejudice excited by the unfortunate name
which has been bestowed upon it. Those who have once tried it
usually become fond of it; and to the sawyers and splitters these
animals yield many a fresh meal, during their sojourn amidst the
heavily timbered flats and ranges of Victoria and New South Wales.
The animal is not of the rat species, but a perfect kangaroo in
miniature.
The flesh of the phalangers is of delicate flavor. The large grey
opossum (Phalangista vulpina) forms a great resource for food to the
natives of Australia, who climb the tallest trees in search of them,
and take them from the hollow branches. The flesh is very good,
though not much used by the settlers, the carcase being thrown to
the dogs, while the sportsman contents himself with the skin.
The common opossum (Didelphys Virginiana) is eaten in some of
the states and territories of America; it is very much like a large rat,
and is classed among the ‘vermin’ by the Americans. Their flesh is,
however, white and well-tasted; but their ugly tail puts one out of
conceit with the fare.
The wombat, a bear-like marsupial quadruped of Australia, (the
Phascolomys wombat,) is eaten in New South Wales and other parts
of the Australian Continent. In size it often equals a sheep, some of
the largest weighing 140 lbs.; and the flesh is said by some to be not
unlike venison, and by others to resemble lean mutton. As it is of
such considerable size, attaining the length of three feet, it has been
suggested that it might be worth naturalizing here.
RODENTIA.
Passing now to the rodents or gnawing animals, we find that the
large grey squirrel (Sciurus cinereus, Desm.) is very good eating.
The flesh of the squirrel is much valued by the Dyaks, and it will,
doubtless, hereafter be prized for the table of Europeans.
The marmot (Arctomys Marmotta), in its fat state, when it first retires
to its winter quarters, is in very good condition, and is then killed and
eaten in great numbers, although we may affect to despise it.
The mouse, to the Esquimaux epicures, is a real bonne bouche, and
if they can catch half-a-dozen at a time, they run a piece of horn or
twig through them, in the same manner as the London poulterers
prepare larks for the table; and without stopping to skin them, or
divest them of their entrails, broil them over the fire; and although
some of the mice may have belonged to the aborigines of the race,
yet so strong is the mastication of the natives, that the bones of the
animal yield to its power as easily as the bones of a rabbit would to a
shark.
There is a very large species of rat spoken of as found in the island
of Martinique, nearly four times the size of the ordinary rat. It is black
on the back, with a white belly, and is called, locally, the piloris or
musk rat, as it perfumes the air around. The inhabitants eat them;
but then they are obliged, after they are skinned, to expose them a
whole night to the air; and they likewise throw away the first water
they are boiled in, because it smells so strongly of musk.
The flesh of the musk rat is not bad, except in rutting time, for then it
is impossible to deprive it of the musky smell and flavour.
So fat and sleek do the rats become in the West Indies, from feeding
on the sugar cane in the cane fields, that some of the negroes find
them an object of value, and, with the addition of peppers and similar
spiceries, prepare from them a delicate fricassée not to be
surpassed by a dish of French frogs.
There is a professional rat-catcher employed on each sugar
plantation, and he is paid so much a dozen for the tails he brings in
to the overseer. Father Labat tells us that he made his hunters bring
the whole rat to him, for if the heads or tails only came, the bodies
were eaten by the negroes, which he wished to prevent, as he
thought that this food brought on consumption! The health of the
negroes was then a matter of moment, considering the money value
at which they were estimated and sold. A rat hunt in a cane field
affords glorious sport. In cutting down the canes, one small patch is
reserved standing, into which all the rats congregate, and the
negroes, surrounding the preserve, with their clubs and bill-hooks
speedily despatch the rats, and many are soon skinned and cooked.
The negroes in Brazil, too, eat every rat which they can catch; and I
do not see why they should not be well-tasted and wholesome meat,
seeing that their food is entirely vegetable, and that they are clean,
sleek, and plump. The Australian aborigines eat mice and rats
whenever they can catch them.
Scinde is so infested with rats, that the price of grain has risen 25
per cent. from the destruction caused to the standing crops by them.
The government commissioner has recently issued a proclamation
granting head-money on all rats and mice killed in the province. The
rate is to be 3d. a dozen, the slayer having the privilege of keeping
the body and presenting the tail.
In China, rat soup is considered equal to ox-tail soup, and a dozen
fine rats will realize two dollars, or eight or nine shillings.
Besides the attractions of the gold-fields for the Chinese, California
is so abundantly supplied with rats, that they can live like Celestial
emperors, and pay very little for their board. The rats of California
exceed the rats of the older American States, just as nature on that
side of the continent exceeds in bountifulness of mineral wealth. The
California rats are incredibly large, highly flavoured, and very
abundant. The most refined Chinese in California have no hesitation
in publicly expressing their opinion of ‘them rats.’ Their professed
cooks, we are told, serve up rats’ brains in a much superior style to
the Roman dish of nightingales’ and peacocks’ tongues. The sauce
used is garlic, aromatic seeds, and camphor.
Chinese dishes and Chinese cooking have lately been popularly
described by the fluent pen of Mr. Wingrove Cooke, the Times’
correspondent in China, but he has by no means exhausted the
subject. Chinese eating saloons have been opened in California and
Australia, for the accommodation of the Celestials who now throng
the gold-diggings, despite the heavy poll-tax to which they have
been subjected.
Mr. Albert Smith, writing home from China, August 22, 1858, his first
impressions, says:—
‘The filth they eat in the eating houses far surpasses that cooked at
that old trattoria at Genoa. It consists for the most part of rats, bats,
snails, bad eggs, and hideous fish, dried in the most frightful
attitudes. Some of the restaurateurs carry their cook-shops about
with them on long poles, with the kitchen at one end, and the salle-à-
manger at the other. These are celebrated for a soup made, I should
think, from large caterpillars boiled in a thin gravy, with onions.’
The following is an extract from the bill of fare of one of the San
Francisco eating houses—
Grimalkin steaks 25 cents.
Bow-wow soup 12 ”
Roasted bow-wow 18 ”
Bow-wow pie 6 ”
Stews ratified 6 ”
The latter dish is rather dubious. What is meant by stews rat-ified?
Can it be another name for rat pie? Give us light, but no pie.
The San Francisco Whig furnishes the following description of a
Chinese feast in that city:—‘We were yesterday invited, with three
other gentlemen, to partake of a dinner à la Chinese. At three o’clock
we were waited upon by our hosts, Keychong, and his partner in
Sacramento-street, Peter Anderson, now a naturalized citizen of the
United States, and Acou, and escorted to the crack Chinese
restaurant in Dupont-street, called Hong-fo-la, where a circular table
was set out in fine style:—
‘Course No. 1.—Tea, hung-yos (burnt almonds), ton-kens (dry
ginger), sung-wos (preserved orange).
‘Course No 2.—Won-fo (a dish oblivious to us, and not mentioned in
the cookery-book).
‘No. 3.—Ton-song (ditto likewise).
‘No. 4.—Tap-fau (another quien sabe).
‘No. 5.—Ko-yo (a conglomerate of fish, flesh, and fowl).
‘No. 6.—Suei-chon (a species of fish ball).
‘Here a kind of liquor was introduced, served up in small cups,
holding about a thimbleful, which politeness required we should
empty between every course, first touching cups and salaaming.
‘No. 7.—Beche-le-mer (a dried sea-slug, resembling India rubber,
worth one dollar per pound).
‘No. 8—Moisum. (Have some?)
‘No. 9.—Su-Yum (small balls, as bills of lading remark, ‘contents
unknown’).
‘No. 10.—Hoisuigo (a kind of dried oyster).
‘No. 11.—Songhai (China lobster).
‘No. 12.—Chung-so (small ducks in oil).
‘No. 13.—Tong-chou (mushrooms, worth three dollars per pound).
‘No. 14.—Sum-yoi (birds’ nests, worth 60 dollars per pound).
‘And some ten or twelve more courses, consisting of stewed acorns,
chestnuts, sausages, dried ducks, stuffed oysters, shrimps,
periwinkles, and ending with tea—each course being served up with
small china bowls and plates, in the handiest and neatest manner;
and we have dined in many a crack restaurant, where it would be a
decided improvement to copy from our Chinese friends. The most
difficult feat for us was the handling of the chop sticks, which mode
of carrying to the mouth is a practical illustration of the old proverb,
‘many a slip ’twixt the cup and lip.’ We came away, after a three
hours’ sitting, fully convinced that a China dinner is a very costly and
elaborate affair, worthy the attention of epicures. From this time,
henceforth, we are in the field for China, against any insinuations on
the question of diet à la rat, which we pronounce a tale of untruth.
We beg leave to return thanks to our host, Keychong, for his elegant
entertainment, which one conversant with the Chinese bill of fare
informs us, must have cost over 100 dollars. Vive la China!’
Mr. Cooke, in his graphic letters from China, speaks of the fatness
and fertility of the rats of our colony of Hong Kong. He adds: ‘When
Minutius, the dictator, was swearing Flaminius in as his Master of the
Horse, we are told by Plutarch that a rat chanced to squeak, and the
superstitious people compelled both officers to resign their posts.
Office would be held with great uncertainty in Hong Kong if a similar
superstition prevailed. Sir John Bowring has just been swearing in
General Ashburnham as member of the Colonial Council, and if the
rats were silent, they showed unusual modesty. They have forced
themselves, however, into a state paper. Two hundred rats are
destroyed every night in the gaol. Each morning the Chinese
prisoners see, with tearful eyes and watering mouths, a pile of these
delicacies cast out in waste. It is as if Christian prisoners were to see
scores of white sucking pigs tossed forth to the dogs by
Mahommedan gaolers. At last they could refrain no longer. Daring
the punishment of tail-cutting, which follows any infraction of prison
discipline, they first attempted to abstract the delicacies. Foiled in
this, they took the more manly course. They indited a petition in good
Chinese, proving from Confucius that it is sinful to cast away the
food of man, and praying that the meat might be handed over to
them to cook and eat. This is a fact, and if General Thompson
doubts it, I recommend him to move for a copy of the
correspondence.’
A new article of traffic is about to be introduced into the China
market from India, namely, salted rats! The genius with whom the
idea originated, it would appear, is sanguine; so much so, that he
considers himself ‘on the fair road to fortune.’ The speculation
deserves success, if for nothing else than its originality. I have not,
as yet however, observed the price that rules in Whampoa and Hong
Kong nor the commodity quoted in any of the merchants’ circulars,
though it will, doubtless, soon find its place in them as a regular
article of import.
A correspondent of the Calcutta Citizen, writing from Kurrachee, the
chief town of the before mentioned rat infested province of Scinde,
declares that he is determined to export 120,000 salted rats to
China. The Chinese eat rats, and he thinks they may sell. He says:
—‘I have to pay one pice a dozen, and the gutting, salting, pressing,
and packing in casks, raises the price to six pice a dozen (about
three farthings), and if I succeed in obtaining anything like the price
that rules in Whampoa and Canton for corn-grown rats, my fortune is
made, or rather, I will be on the fair road to it, and will open a fine
field of enterprise to Scinde.’
Rats may enter into consumption in other quarters, and among other
people, than those named, when we find such an advertisement as
the following in a recent daily paper at Sydney:—
‘Rats! Rats! Rats!—To-night at 8 o’clock, rattling sport; 200
rats to be entered at G. W. Parker’s Family Hotel.’
Query.—What ultimately becomes of these rats, and who are the
persons who locate and take their meals at this ‘Family Hotel?’
Probably they are of the rough lot whose stomachs are remarkably
strong.
Some classes of the Malabars are very fond of the bandicoot, or pig
rat (Perameles nasuta, Geoff. Desm.), which measures about
fourteen inches in length from head to tail, the tail being nearly as
long as the body. They are much sought after by the coolies, on the
coffee estates in Ceylon, who eat them roasted. They also eat the
coffee rat (Golunda Ellioti of Gray), roasted or fried in oil, which is
much smaller, the head and body only measuring about four or five
inches. These animals are migratory, and commit great damages on
the coffee tree, as many as a thousand having been killed in a day
on one estate. The planters offer a reward for the destruction of
these rodents, which brings grist to the mill in two ways to the coolies
who hunt or entrap them, namely, in money and food.
The fat dormouse (Myoxus glis, Desm.) is used for food in Italy, as it
was by the ancient Romans, who fattened them for the table in
receptacles called Gliraria.
Dr. Rae, in his last arctic exploring expedition, states, that the
principal food of his party was geese, partridges, and lemmings
(Arvicola Hudsonia). These little animals were migrating northward,
and were so numerous that their dogs, as they trotted on, killed as
many as supported them all, without any other food.
There is another singular little animal, termed by naturalists the
vaulting rat, or jerboa. On an Australian species, the Dipus Mitchelli,
the natives of the country between Lake Torrens and the Great
Creek, in Australia seem chiefly to subsist. It is a little larger than a
mouse, and the hind legs are similar to those of the kangaroo.
Captain Sturt and his exploring party once witnessed a curious
scene. They came to a native who had been eating jerboas, and
after they met him they saw him eat one hundred of them. His mode
of cooking was quite unique. He placed a quantity, for a few
seconds, under the ashes of the fire, and then, with the hair only
partially burnt off, took them by the tail, put the body in his mouth,
and bit the tail off with his teeth. After he had eaten a dozen bodies,
he took the dozen tails, and stuffed them into his mouth.
The flesh of the beaver is looked upon as very delicate food by the
North American hunters, but the tail is the choicest dainty, and in
great request. It is much prized by the Indians and trappers,
especially when it is roasted in the skin, after the hair has been
singed off; and in some districts it requires all the influence of the fur-
traders to restrain the hunters from sacrificing a considerable
quantity of beaver fur every year to secure the enjoyment of this
luxury. The Indians of note have generally one or two feasts in a
season, wherein a roasted beaver is the prime dish. It resembles
pork in its flavour, but it requires a strong stomach to sustain a full
meal of it. The flesh is always in high estimation, except when they
have fed upon the fleshy root of a large water lily, which imparts a
rank taste to it.
The flesh of a young porcupine is said to be excellent eating, and
very nutritious. The flavour is something between pork and fowl. To
be cooked properly, it should be boiled first, and afterwards roasted.
This is necessary to soften the thick, gristly skin, which is the best
part of the animal. The flesh of the porcupine is said to be used by
the Italians as a stimulant; but, never having tasted it myself, I
cannot speak from experience as to the virtue of this kind of food.
The Dutch and the Hottentots are very fond of it; and when skinned
and embowelled, the body will sometimes weigh 20 lbs. The flesh is
said to eat better when it has been hung in the smoke of a chimney
for a couple of days.
The flesh of the crested porcupine (Hystrix cristata) is good and very
agreeable eating. Some of the Hudson Bay trappers used to depend
upon the Hystrix dorsata for food at some seasons of the year.
Rabbits, which form so large an article of consumption with us, are
not much esteemed as an article of food by the negroes in the West
Indies, resembling, in their idea, the cat. Thus, a black who is
solicited to buy a rabbit by an itinerant vendor, would indignantly
exclaim, ‘Rabbit? I should just like to no war you take me for,
ma’am? You tink me go buy rabbit? No, ma’am, me no cum to dat
yet; for me always did say, an me always will say, dat dem who eat
rabbit eat pussy, an dem who eat pussy eat rabbit. Get out wid you,
and your rabbit?’
And yet, with all this mighty indignation against rabbits, they do not
object, as we have seen, to a less dainty animal in the shape of the
rat.
Although the negroes in the West Indies do not care for rabbits, yet
their brethren in the American States are by no means averse to
them. A field slave one day found a plump rabbit in his trap. He took
him out alive, held him under his arm, patted him, and began to
speculate on his qualities. ‘Oh, how fat. Berry fat. The fattest I eber
did see. Let me see how I’ll cook him. I’ll broil him. No, he is so fat he
lose all de grease. I fry him. Ah yes. He so berry fat he fry hisself.
Golly, how fat he be. No, I won’t fry him—I stew him.’ The thought of
the savory stew made the negro forget himself, and in spreading out
the feast in his imagination, his arms relaxed, when off hopped the
rabbit, and squatting at a goodly distance, he eyed his late owner
with cool composure. The negro knew there was an end of the stew,
and summoning up all his philosophy, he thus addressed the rabbit,
at the same time shaking his fist at him, ‘You long-eared, white-
whiskered rascal, you not so berry fat arter all.’
I need not here touch upon hare soup, jugged hare, or roasted hare,
from the flesh of our own rodent; but the Arctic hare (Lepus glacialis)
differs considerably from the English in the colour and quality of its
flesh, being less dry, whiter, and more delicately tasted; it may be
dressed in any way. When in good condition it weighs upwards of 10
lbs.
The capybara, or water hog (Hydrochœrus capybara), an ugly-
looking, tailless rodent, the largest of the family, is hunted for its flesh
in South America, and is said to be remarkably good eating. It grows
to the size of a hog two years old.
The flesh of the guinea pig (Cavia cobaya, Desm.) is eaten in South
America, and is said to be not unlike pork. When he is dressed for
the table his skin is not taken off as in other animals, but the hair is
scalded and scraped off in the same manner as it is in a hog.
The white and tender flesh of the agouti (Dasyprocta Acuti, Desm.),
when fat and well dressed, is by no means unpalatable food, but
very delicate and digestible. It is met with in Brazil, Guiana, and in
Trinidad. The manner of dressing them in the West Indies used to be
to roast them with a pudding in their bellies. Their skin is white, as
well as the flesh.
The flesh of the brown paca (Cœlogenus subniger, Desm.), a nearly
allied animal, is generally very fat, and also accounted a great
delicacy in Brazil.
Another South American rodent, the bizcacha, or viscascha
(Lagostomus trichodactylus), is eaten for food. It somewhat
resembles a rabbit, but has larger gnawing teeth, and a long tail. The
flesh, when cooked, is very white and good.
EDENTATA, OR TOOTHLESS ANIMALS.

Wallace, in his travels on the Amazon, tells us that the Indians
stewed a sloth for their dinner, and as they considered the meat a
great delicacy, he tasted it, and found it tender and very palatable.
Among other extraordinary animals for which Australia is proverbial,
is the Echidna hystrix, or native porcupine, which is eaten by the
aborigines, who declare it to be ‘cobbong budgeree (very good), and,
like pig, very fat.’ Europeans who have eaten of them confirm this
opinion, and observe that they taste similar to a sucking pig. There
appear to be two species of this animal, the spiny echidna and the
bristly echidna; the first attains a large size, equalling the ordinary
hedgehog. It has the external coating and general appearance of the
porcupine, with the mouth and peculiar generic character of the ant-
eater.
The flesh of the great ant-eater (Myrmecophaga jubata, Linn.) is
esteemed a delicacy by the Indians and negro slaves in Brazil, and,
though black and of a strong musky flavour, is sometimes even met
with at the tables of Europeans.
The armadillo, remarkable for its laminated shell, when baked in its
scaly coat is a good treat, the flesh being considered delicate eating,
somewhat like a rabbit in taste and colour. The flesh of the large
twelve-banded Brazilian one (Dasypus Tatouay) is said to be the
best of all. In South America there are several species of armadillo,
all of which are used for food when met with.
Mr. Gosse states, that this animal feeds upon soft ground fruits and
roots, and also on carrion, whenever it can find it; and a large
proportion of the sustenance of this, as well as of other species, is
derived from the numberless wild cattle which are caught and
slaughtered on the Pampas for the sake of their hides and tallow, the
carcases being left as valueless to decay, or to become the prey of
wild animals. Notwithstanding the filthy nature of their food, the
armadillos, being very fat, are eagerly sought for by the inhabitants
of European descent, as well as by the Indians. The animal is
roasted in its shell, and is esteemed one of the greatest delicacies of
the country; the flesh is said to resemble that of a sucking pig.
PACHYDERMATA, OR THICK-SKINNED
ANIMALS.
What do our African brethren consider tit-bits? Ask Gordon
Cumming. He will enumerate a list longer than you can remember.
Study his ‘Adventures,’ and you will become learned in the mystery
of African culinary operations. What are sheep’s-trotters and insipid
boiled calves’ feet compared to baked elephants’ paws?
Listen to his description of the whole art and mystery of the process
of preparing them:—
‘The four feet are amputated at the fetlock joint, and the trunk, which
at the base is about two feet in thickness, is cut into convenient
lengths. Trunk and feet are then baked, preparatory to their removal
to headquarters. The manner in which this is done is as follows:—A
party, provided with sharp-pointed sticks, dig a hole in the ground for
each foot and a portion of the trunk. These holes are about two feet
deep and a yard in width; the excavated earth is embanked around
the margin of the holes. This work being completed, they next collect
an immense quantity of dry branches and trunks of trees, of which
there is always a profusion scattered around, having been broken by
the elephants in former years. These they pile above the holes to the
height of eight or nine feet, and then set fire to the heap. When these
strong fires have burnt down, and the whole of the wood is reduced
to ashes, the holes and the surrounding earth are heated to a high
degree. Ten or twelve men then stand round the pit and take out the
ashes with a pole about sixteen feet in length, having a hook at the
end. They relieve one another in quick succession, each man
running in and raking the ashes for a few seconds, and then pitching
the pole to his comrade, and retreating, since the heat is so intense
that it is scarcely to be endured. When all the ashes are thus raked
out beyond the surrounding bank of earth, each elephant’s foot and
portion of the trunk is lifted by two athletic men, standing side by
side, who place it on their shoulders, and, approaching the pit
together, they heave it into it. The long pole is now again resumed,
and with it they shove in the heated bank of earth upon the foot,
shoving and raking until it is completely buried in the earth. The hot
embers, of which there is always a great supply, are then raked into
a heap above the foot, and another bonfire is kindled over each,
which is allowed to burn down and die a natural death; by which time
the enormous foot or trunk will be found to be equally baked
throughout its inmost parts. When the foot is supposed to be ready, it
is taken out of the ground with pointed sticks, and is first well beaten,
and then scraped with an assagai, whereby adhering particles of
sand are got rid of. The outside is then pared off, and it is transfixed
with a sharp stake for facility of carriage. The feet thus cooked are
excellent, as is also the trunk, which very much resembles buffalo’s
tongue.’
Elephants’ petit(?) toes, pickled in strong toddy vinegar and cayenne
pepper, are considered in Ceylon an Apician luxury. As soon as it is
known that an elephant has been killed in Africa, every man in the
neighbourhood sets off with his knife and basket for the place, and
takes home as much of the carcase as he can manage to carry. The
flesh is not only eaten when fresh, but is dried and kept for months,
and is then highly esteemed.
The manner in which the elephant is cut up is thus described by the
author and sportsman I have already quoted:—‘The rough outer skin
is first removed, in large sheets, from the side which lies uppermost.
Several coats of an under skin are then met with. The skin is of a
tough and pliant nature, and is used by the natives for making water-
bags, in which they convey supplies of water from the nearest vey,
or fountain (which is often ten miles distant), to the elephant. They
remove this inner skin with caution, taking care not to cut it with the
assagai; and it is formed into water bags by gathering the corners
and edges, and transfixing the whole on a pointed wand. The flesh is
then removed in enormous sheets from the ribs, when the hatchets
come into play, with which they chop through and remove
individually each colossal rib. The bowels are thus laid bare; and in
the removal of these the leading men take a lively interest and active
part, for it is throughout and around the bowels that the fat of the
elephant is mainly found. There are few things which a Bechuana
prizes so highly as fat of any description; they will go an amazing
distance for a small portion of it. They use it principally in cooking
their sun-dried biltongue, and they also eat it with their corn. The fat
of the elephant lies in extensive layers and sheets in his inside, and
the quantity which is obtained from a full-grown bull, in high
condition, is very great. Before it can be obtained, the greater part of
the bowels must be removed. To accomplish this, several men
eventually enter the immense cavity of his inside, where they
continue mining away with their assagais, and handing the fat to
their comrades outside till all is bare. While this is transpiring with the
sides and bowels, other parties are equally active in removing the
skin and flesh from the remaining parts of the carcase.
‘In Northern Cachar, India, the flesh of the elephant is generally
eaten. The Kookies encamp in the neighbourhood of the carcase
until they have entirely consumed it, or are driven away by the
effluvia of decomposition. Portions of the flesh that they cannot
immediately eat are dried and smoked to be kept for future
consumption.
‘Fat of any kind is a complete godsend to the Bechuana and other
tribes of Southern Africa; and the slaughter of an elephant affords
them a rich harvest in disembowelling the carcase, and mining their
way into the interior of the huge cavity to remove the immense layers
furnished by such a large animal if in good condition.’
Galton, the African traveller, in his hints for bush cooking, tells us:—
‘The dish called beatee is handy to make. It is a kind of haggis made
with blood, a good quantity of fat shred small, some of the tenderest
of the flesh, together with the heart and lungs of the animal, cut or
torn into small shivers, all of which is put into the stomach and
roasted, by being suspended before the fire with a string. Care must
be taken that it does not get too much heat at first, or it will burst. It is
a most delicious morsel, even without pepper, salt, or any
seasoning.’
In all the large rivers of Southern Africa, and especially towards the
mouths, the hippopotami abound. The colonists give them the name
of sea-cows. The capture of one of these huge beasts, weighing, as
they sometimes do, as much as four or five large oxen, is an
immense prize to the hungry Bushman or Koranna, as the flesh is by
no means unpalatable; and the fat, with which these animals are
always covered, is considered delicious. When salted it is called zee-
koe speck, is very much like excellent fat bacon, and is greatly
prized by the Dutch colonists, not only for the table, but for the
reputed medicinal qualities which are attributed to it. In Abyssinia,
hippopotamus meat is commonly eaten.
The hog is one of those animals that are doomed to clear the earth
of refuse and filth, and that convert the most nauseous offal into the
nicest nutriment in its flesh. It has not altogether been unaptly
compared to a miser, who is useless and rapacious in his life, but at
his death becomes of public use by the very effects of his sordid
manners. During his life he renders little service to mankind, except
in removing that filth which other animals reject.
A delicate sucking pig, a Bath chap, or a good rasher of bacon are,
however, tit-bits not to be despised.
Lord Brougham hoped to see the day when every man in the United
Kingdom would read Bacon. ‘It would be much better to the
purpose,’ said Cobbett, ‘if his lordship would use his influence that
every man in the kingdom could eat bacon.’
In British India, only Europeans and the low Hindoos eat pork, but
wild hogs are very abundant, and afford good sport to the hunter.
The avoidance of pork arises as much from religious scruples as the
deep-rooted aversion to the domestic swine all must imbibe who
have only seen it in the East, where it is a tall, gaunt, half famished,
and half ferocious-looking brute, which performs the office of
scavenger.
The legend which ascribes to the eating of human flesh the origin of
one of the most loathsome of diseases, scarce offers a more horrible
picture to the imagination than is presented by a letter recently
published in the Ceylon Examiner. The beautiful islands of Mauritius
and Bourbon are largely supplied with pork from Patna, a province of
Hindostan that has been over-run by the cholera. Both there and at
Calcutta the bodies of the natives are consigned to the Ganges,
instead of being interred. ‘Let any person,’ says the writer in the
Ceylon paper, ‘at daybreak start from the gates of Government
House, Calcutta, and, whether his walk will be to the banks of the
river or to the banks of the canals which on three sides surround the
city, he will see pigs feeding on the dead bodies of the natives that
have been thrown there during the night. During the day the river
police clear away and sink all that remains of the bodies. Bad as is
the metropolis of India it is nothing compared to Patna. Hundreds
upon hundreds of human corpses are there strewed along the
strand; and fattening, ghoule-like, upon these are droves upon
droves of swine. These swine are slaughtered, cut up, and salted
into hams, bacon, and pickled pork, and then despatched to
Calcutta.... The great market for this poisonous swine produce is the
Mauritius and Bourbon, where it is foisted on the inhabitants as the
produce of Europe. Moreover, as these swine are sold in Calcutta at
3s. or 4s. each carcase, it is stated that the inferior class of
homeward-bound vessels are provisioned with them, and thus this
human-fed pork is introduced into Europe and America.’
Pork-eaters may believe as much of the following remarks as they
please. ‘It is said that the Jews, Turks, Arabians, and all those who
observe the precept of avoiding blood and swine’s flesh, are infinitely
more free from disease than Christians; more especially do they
escape those opprobria of the medical art, gout, scrofula,
consumption, and madness. The Turks eat great quantities of honey
and pastry, and much sugar; they also eat largely, and are indolent,
and yet do not suffer from dyspepsia as Christians do. The swine-fed
natives of Christendom suffer greater devastation from a tubercular
disease of the bowels (dysentery) than from any other cause. Those
persons who abstain from swine’s flesh and blood are infinitely more
healthy and free from humors, glandular diseases, dyspepsia, and
consumption; while in those districts, and among those classes, of
men, where the pig makes the chief article of diet, tubercle in all its
forms of eruptions, sore legs, bad eyes, abscesses, must prevail.’
These are the remarks of an American journalist, which, however,
have not, I conceive, the shadow of foundation.
‘It appears somewhat singular,’ remarks Mr. Richardson, in his
history of the pig, ‘that the flesh of the hog was prohibited in the
ceremonial of the Jewish law; the same prohibition being afterwards
borrowed by Mahomet, and introduced into the Koran.’ Great
difference of opinion prevails as to the cause of this prohibition;
some alleging that this food was unsuited to the land inhabited by
the Jews. As, however, the kinds of food to be eaten and rejected—
doubtless to prevent that luxurious epicurism unsuited to a growing
and prosperous nation—were to have a limit, this limit was fixed by
two distinctive marks: they must ‘divide the hoof, and chew the cud;’
that principle of restriction admitting only a limited range to the food
permitted. The pig, the horse, and the camel were excluded. It was
only in a state of low nationality, or in times of great degeneracy, that
the Jew ever tasted pork.
The food of the hog varies in different localities, and probably
materially influences the flavour of the meat. In the River Plata
provinces they feed them on mutton. After describing the purchase—
8,000 at eighteen-pence per dozen (?)—by a Mr. M. Handy, a
traveller adds, ‘As soon as the sheep became fattened on his own
lands, he killed about a thousand, sold the fleeces at five shillings
per dozen, and with the mutton he fed a herd of swine. Mentioning
this fact to a large party of Europeans, at the dinner table of Lord
Howden, when in Buenos Ayres, my statement was received with a
murmur of scepticism; but I offered to accompany the incredulous to
the pastures, where the remainder of the sheep were then
feeding.’—(Two Thousand Miles’ Ride through the Argentine
Provinces.) But the Yankees beat this, according to a late American
paper. In North America they generally feed them on maize, but in
some of the States, apples form a principal portion of their food, and
the ‘apple sauce’ thus becomes incorporated with the flesh. A
gentleman travelling down East, overtook a farmer dragging a lean,
wretched-looking, horned sheep along the road. ‘Where are you
going with that miserable animal?’ asked the traveller. ‘I am taking
him to the mutton mill, to have him ground over,’ said the farmer.

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The Path to Fitness and Wellness 13 Cardiorespiratory Endurance 36

Values and Behavior 14 Muscular Fitness 40

Deep-Water Jogging 104

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Diseases of the Cardiovascular System 208

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Appendix A: Strength-Training Exercises 272

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A regular exercise program is as close as we get to the

Chapter 7, Stress Management

Chapter 8, A Healthy Lifestyle Approach

Kason O’Neill, East Tennessee State University

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freelance writer and editor; writing research and mar-

© Fitness & Wellness, Inc.

Sharon is a co-author in five of the seven fitness and

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compliance with a healthy lifestyle

REAL LIFE STORY | Jordan’s Experience

Last year as a freshman in college, strength workouts I toned up, I had so

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Figure 1.1 Causes of deaths in the United States for

36% 40% 38%

Percent of all deaths

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Figure 1.2 Life expectancy at birth for selected

−350 calories from

−700 calories from

−1,000 calories from

Types of activity: Planned Exercise NEAT Sedentary

for Physical Activity Pregnant and Postpartum Women

1.5 Benefits of Physical Fitness 105

Figure 1.4 Death rates by physical fitness levels.

Table 1.1 Long-Term (Chronic) Benefits of Exercise

Table 1.2 Immediate (Acute) Benefits of Exercise

Figure 1.6 Health-related components of physical

Physical fitness The endurance, muscular flexibility,

Figure 1.8 Dimensions of wellness.

●● Assess your overall level of physical fitness,

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and health-related concepts.

1.9 Behavior Modification

Behavior Modification Planning

Healthy Lifestyle Habits 8. Drink alcohol moderately or not at all.

Complete This Online

The strategy follows what you might expect from the

Johannes Kroemer/The Image Bank/Getty Images

healthy-lifestyle behaviors. It also will help you identify Action