Research consistently shows us that physically active people tend to live longer, healthier lives than people who move little throughout the day. Many people think of exercise as the boring or painful drudgery that’s required of them to lose weight. And often, when the weight doesn’t drop quickly, they quit the exercise. While it’s helpful to increase physical activity for weight loss, you will need to exercise a lot to see pounds melt off. Even though you may not drop a couple pants sizes by sweating in the gym or walking in your neighborhood after dinner, there are so many reasons to be physically active every day. And it doesn’t have to be drudgery!
How Will Exercise Help You?
Exercise is great medicine and great preventive medicine. You already know that regular exercise helps to prevent type 2 diabetes, and that’s clearly on your list of reasons to be physically active. Recall that the goal in the Diabetes Prevention Program (DPP) was for participants to exercise at least 150 minutes weekly. Interestingly, regular exercise does not need to lead to weight loss to help prevent type 2 diabetes, since activity makes your cells more responsive to insulin. Every single time you exercise, you do the body good!
What other reasons do you have to be physically active? Just like you identified your motivators to lose weight in Chapter 4, you will benefit from identifying your motivators to exercise. I’ve created a list below, but it’s by no means comprehensive. Again, I’ve included emotional benefits because these are often just as important as the physical benefits. Go through my list, putting a checkmark next to the benefits that speak to you. Or create a personalized list in your journal or another place where you can refer to it often, especially when your motivation for exercise drops. Add any other motivators you can think of.
• Improve insulin action and blood glucose control
• Celebrate every exercise session because blood glucose levels improve for 2–72 hours after exercise, depending on the length of time and intensity of your exercise.
• Lower blood pressure
• Raise HDL (good) cholesterol
• Reduce low levels of chronic inflammation
• Lessen risk for type 2 diabetes, prediabetes, metabolic syndrome, heart disease, stroke, diverticulitis, several types of cancer, osteoporosis, overweight, and obesity
• Improve circulation
• Improve sexual function
• Contribute to a healthy brain during aging
• Enhance your immune system
• Contribute to weight management, especially by helping to prevent weight regain
• Boost mood
• Possibly help to prevent or treat depression
• Contribute to a healthy appearance
• Create a sense of accomplishment
• Build self-esteem
• Aid good posture
• Contribute to less pain/more comfort during daily activities
• Help manage stress
• Improve sleep
• Contribute to feelings of energy and vitality
• Strengthen bones, muscles, and joints
• Be a good role model
• Other: ___________
• Other: ___________
• Other: ___________
Exercise Safely
It’s common to be very excited and motivated about starting a new exercise plan. But abruptly starting or changing an exercise routine is risky. Slow and steady is the smart way to go to avoid health risks, injuries, and burnout. Before getting started, check in with your health care provider to be certain that you are fit to exercise and to ask for advice about the types of activities that are good choices for you. Both prediabetes and type 2 diabetes are risk factors for heart disease, so this check-in with your health care provider is important. If you take medications for your blood glucose, or should you someday take them, ask about your risk for experiencing hypoglycemia or low blood glucose during physical activity. Fortunately, there are quite a number of medications to lower blood glucose that do not put you at high risk for hypoglycemia.
Exercise Recommendations
You may want to know how much you should exercise and what types of exercise you should do. Before getting into the recommendations, keep a few things in mind.
First, the word should, as in how much you should exercise, is anything but empowering. “I should exercise” sounds like it’s not a choice and that it’s not a desirable thing to do. I prefer more empowering words, so I try to avoid “shoulds” and “shouldn’ts” and reframe my statements when I catch myself saying them. I choose to exercise because of the many rewards it brings. It’s a subtle difference, but if you practice speaking in positive, empowering language, you’ll find you feel more positive and empowered. I promise. Just keep it up. More on that in Chapter 11.
Second, any amount of exercise is better than none! Too many people fail to exercise because they can’t find the 30 minutes they think they need. But if they have 15 minutes, they could use it and would surely benefit. If you don’t have even 15 minutes, maybe you have 10 or 8 or even 5 minutes. Do you have time to do a few pushups and sit-ups before getting dressed in the morning? If the answer is “yes,” do pushups and sit-ups! Sometimes when I have early-morning appointments, I choose to jog around the block instead of jogging my usual 40 minutes. Why? Because every exercise session is good for me and because sticking as closely as possible to my routine makes me feel good and maintain my habit.
Third, you are not like everyone else, so tailor your exercise plan to your likes, needs, and schedule. And as you progress in your exercise plan, you’ll find that your needs and likes continue to change, so don’t get stuck in an exercise rut or a one-size-fits-all plan.
And finally, you may have specific health concerns, so it’s smart to seek the approval of your health care provider before starting a new exercise program.
CDC Exercise Guidelines
To lower the risk of many chronic diseases, the Centers for Disease Control and Prevention (CDC) recommends the following for adults:
• Aim for or build up to at least 150 minutes of moderate-intensity aerobic activity (such as brisk walking) each week or at least 75 minutes of vigorous-intensity aerobic activity (such as running) each week.
• Strive to engage in muscle-strengthening activities (such as weight machines and elastic bands) involving all major muscle groups at least twice weekly.
• By doing more, you’ll likely experience even greater benefits.
The American Diabetes Association concurs with these general recommendations. The Association adds that for the greatest effects on insulin resistance and for enhanced insulin action, daily exercise is ideal. Aim to have at least no more than two days elapse between exercise sessions.
Components of an Exercise Plan
A complete exercise program includes four types of exercises: aerobic, muscle-strengthening, flexibility, and balance exercises.
Aerobic Exercise
This type of exercise is sometimes called cardiovascular or cardiorespiratory exercise. Aerobic activities use large muscle groups and cause your heart rate to increase and your breath to come faster and more heavily. When you engage in walking, running, biking, swimming, rowing, dancing, jumping rope, cross-country skiing, rollerblading, and many more activities, you are performing aerobic exercise. These activities improve insulin activity, blood vessel function, lung function, and immune function. They help manage weight, lower blood pressure and cholesterol levels, and contribute to feelings of well-being. Now that’s a lot to be motivated about!
• Begin at any level you are able. For some people that means a 5-minute walk at a moderate or light intensity, and that’s okay. Others are fit to jump into a 60-minute cardio dance class. You should not begin at an intensity more advanced than your abilities. Start slowly and build up.
• Three 10-minutes sessions throughout your day is as adequate as one 30-minute session.
• Work toward engaging in cardiovascular exercise nearly every day with no more than 2 consecutive days without exercise. Gradually increase the length of time of your exercise sessions, the intensity of your exercise, and the frequency of your workouts. But increase just one of these three variables at a time. Aim for at least 150 minutes of moderate-intensity exercise weekly.
• If you are medically able and already fit, you may enjoy high-intensity interval training (HIIT). Please check in with your health care provider before starting this because the intensity of exercise comes with additional risk. HIIT involves short bursts of intense exercise alternated with longer periods of lower-intensity exercise or recovery exercise. An example is alternating 20 seconds of sprinting with 4 minutes of slower recovery jogging.
Muscle-Strengthening Exercise
This type of exercise is also called resistance exercise. Lifting weights, using elastic bands, and lifting your own body weight when performing squats, sit-ups, and pushups are examples of resistance exercises. These types of exercises increase muscular strength (how much your muscles can lift) and muscular endurance (how long your muscles can exert force). Having both good muscular strength and endurance helps prevent injury. When you build muscle, you boost your metabolic rate. Unfortunately, the effect is small, and many people overestimate the role of weight training on weight loss. Regular strength training increases bone mass and bone strength, helps you maintain independence in activities of daily living as you age, improves insulin sensitivity at least as well as aerobic exercise, lowers blood pressure and cholesterol levels, and improves mental health. A recent study looked at the exercise habits of more than 35,000 healthy women. Compared to women who did no strength training, those who performed strength training exercises were 30% less likely to develop type 2 diabetes and 17% less likely to develop heart disease over an average 10-year follow-up period. The combination of aerobic and muscle-building exercises was associated with an even greater reduction in risk. Again, these are big reasons to be motivated! Unfortunately, a lot of people seem to dismiss the benefits of including strength training and avoid it. Maybe it’s not as much fun or perhaps it feels awkward. Try to keep an open mind. Every one of us can benefit.
• Begin at your own pace, but not more than moderate-intensity training. Lift weights or perform an exercise 10–15 times. This is one set of exercises. You are using the right weight if you can perform the exercise properly 10–15 times, but reach the point of failure after that.
• Aim to perform 8–10 exercises targeting different body parts each exercise session.
• Strength train 2 days each week without targeting the same muscle groups two days in a row.
• Progress to heavier weights only when you are consistently able to exceed your target number of repetitions.
• Moderate-intensity training is lifting a particular weight about 15 times and being unable to perform a 16th repetition in good form. Vigorous intensity is lifting a heavier weight six to eight times before failing.
• When you are ready to progress again, you can increase the number of sets to two or three. Finally, add an additional strength training session for a total of three sessions on nonconsecutive days.
• Be certain you are performing the exercise correctly. Lifting a weight that is too heavy will impair your form. It is prudent to work with a skilled certified personal trainer. See Working with a Trainer on page 197.
Flexibility Exercises
Stretching exercises will help you maintain or improve the range of motion of your joints, which can reduce your risk of injury. Joint flexibility tends to decrease with aging, but regular flexibility exercises can improve your range of motion no matter how old you are. Yoga and tai chi include basic stretching movements. Follow these guidelines for safe and effective stretching.
• Stretch warm muscles to reduce the risk of injury. It’s smart to warm your muscles by walking around for a few minutes.
• Stretch to the point of tightness or slight discomfort for 10–30 seconds. Increase the length of time as you are able. Repeat for a total of two to four repetitions.
• Perform stretching exercises for all major muscle groups at least twice weekly. Increase the frequency of your stretching sessions as able.
Balance Exercise
Balancing exercises are especially important for older adults because they may help prevent falls. Improving balance can be as simple as practicing standing on one leg, walking backwards, and performing similar exercises several times per week. Yoga and tai chi often combine flexibility, balance, and core-strengthening movements.
• Practice balance exercises at least twice weekly. Progress to more frequent and longer sessions as your skill improves.
Getting Started on an Exercise Plan
As I’ve already stated, it’s a good idea to check in with your health care provider before starting an exercise routine. It’s also smart to ease into your program, especially if you’ve been inactive for some time or if you have a health condition or injury that could get in the way of your progress. Getting into the habit of being active is critical. I feel strongly that developing a solid habit is more important than the immediate physical benefits of exercise. The habit will help you realize those health benefits next month, next year, and all the years after that. To develop the habit, set yourself up to be successful. Create SMART goals (see page 195). I often encourage my clients to build the habit of walking by setting aside at least 5 minutes every day rather than longer periods just two or three times weekly. A daily habit is more likely to stick than a sometimes habit. Tiny successes are the building blocks of greater successes, so start small and keep creating slightly more challenging goals.
Determine the Intensity of Aerobic Exercise
Is your exercise moderate or vigorous intensity? For guidance, try one of these measures.
Talk-sing test
If you’re engaging in moderate-intensity activity, you can talk easily enough to hold a conversation, but you cannot sing. If you can sing, you are performing light activity. During vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath.
Heart rate zone
To determine your heart rate zone, you need to know your estimated maximum heart rate, which is your age subtracted from 220. For example, if you are 50 years old, your estimated maximum age-related heart rate is 170 beats per minute (bpm). For example:
220 – age = estimated maximum age-related heart rate
200 – 50 = 170 bpm
You are exercising at a moderate intensity when your heart rate is 50–70% of your maximum heart rate. For example:
50% of maximum heart rate for a 50-year-old person:
170 × 0.5 = 85 bpm
70% of maximum heart rate for a 50-year-old person:
170 × 0.7 = 119 bpm
Thus, a 50-year-old person whose heart rate falls between 85 and 119 beats per minute is exercising at a moderate intensity.
You are exercising at a vigorous intensity when your heart rate is 70–85% of your maximum heart rate. For example:
70% of maximum heart rate for a 50-year-old person:
170 × 0.7 = 119 bpm
85% of maximum heart rate for a 50-year-old person:
170 × 0.85 = 144 bpm
Thus, a 50-year-old person whose heart rate falls between 119 and 144 beats per minutes is exercising at a vigorous intensity.
Calorie burn
According to the CDC, we can also classify exercise as moderate intensity or vigorous intensity based on the amount of calories the body uses per minute of activity.
Moderate Intensity |
Vigorous Intensity |
Walking briskly (3 mph or faster) |
Race walking |
Water aerobics |
Jogging or running |
Bicycling slower than 10 miles per hour |
Bicycling faster than 10 miles per hour |
Tennis (doubles) |
Tennis (singles) |
Ballroom dancing |
Swimming laps |
General gardening |
Heavy gardening Jumping rope Hiking uphill |
Measuring Your Heart Rate
To measure your heart rate, stop exercising briefly to take your pulse. Find your pulse on your wrist below your thumb. Place the tips of your index and middle fingers over the artery and press lightly to feel your pulse. Count the beats for 30 seconds and multiply by 2 to determine your heart rate for a full minute. Alternatively, you can count the beats for 60 seconds. Count the first beat as zero and continue counting for the designated time.
Use FITT Principles to Guide Your SMART Goals
The above descriptions of the four components of an exercise plan briefly include guidelines for getting started and progressing. Use the following FIIT principles to give yourself a more specific plan.
• F: Frequency—how often will you do a particular type of exercise
• I: Intensity—how vigorously will you exercise
• T: Time—how many minutes will you perform the exercise
• T: Type—what type of exercise will you do
You can apply the FITT principle to each of the four components of a fitness plan. To build your aerobic fitness, your FITT goal might look like this:
• F: at least five times per week
• I: at a moderate intensity (At this pace, you can hold a conversation.)
• T: for at least 10 minutes
• T: dancing (aerobic activity)
Using the above FITT principles, you might create the following SMART goal.
For this week, every weekday (Monday through Friday) after breakfast, I’ll dance to lively music in the den for 10 minutes (at a moderate intensity).
This goal is specific enough that even a stranger would understand your plan. You know that it’s measurable because you can identify the number of times you accomplish the goal during the 5-day workweek. Dancing is an action. The goal is realistic if you are fairly confident that you can achieve it with the resources you have available. Finally, this goal identifies important information about time: you will try this goal out for a week and you’ll exercise in the time between breakfast and when you get ready to start your day.
As your fitness level improves, you can increase the frequency, intensity, or time. Increase just one of these elements at a time. Eventually, you can increase all three. Use the FITT principle to plan each component of your fitness program.
Working with a Trainer
There are so many reasons to work with a personal trainer. Many of my patients like the accountability that a trainer provides. If they know that a trainer is expecting them to show up and work out, they’re less likely to skip out on a fitness session. A skilled trainer also helps you with motivation and pushes you hard enough without pushing you too hard, which helps prevent exercise burnout and injuries. Everyone can benefit from a personalized fitness program, but anyone with health conditions or a history of injuries is an especially good candidate for working with a trainer.
Choosing a qualified, skilled trainer with whom you can have a good relationship is key.
• Work with a trainer who has been certified by a nationally recognized and accredited certifying organization such as the American College of Sports Medicine (ACSM), the American Council on Exercise (ACE), or the National Academy of Sports Medicine (NASM). Some certifications require very little training and expertise. Be sure to ask enough questions that you are satisfied. Some trainers also have college backgrounds in exercise science, kinesiology, or a related field. Do not take medical advice from a trainer, and do not take nutrition advice unless your trainer is also a registered dietitian nutritionist.
• Hire someone with experience working with people like you—your age, fitness level, health conditions, etc. Ask for references and take the time to check them out.
• Your trainer should ask you about your health history, a previous history of injuries, and your fitness goals. A skilled trainer will customize your program based on a thorough assessment.
• Your trainer should carry professional liability insurance and be trained to perform CPR.
• Ask about the trainer’s fees and cancellation policy. Ask if you can share the session and the fee with a friend, if that interests you.
• Chat with a potential trainer to be sure you are a good fit for one another before signing a contract. Even better, find out if you can pay for a single session before agreeing to a long-term program. Do you like this trainer’s style? Does the trainer encourage you to work hard or simply tell you what to do and count the reps? Let your trainer know if you like to try new things often or move more slowly. Share all of your concerns.
Make Exercise Fun
Often I hear people say that they hate exercise. To me, this is like saying that they hate food. How could that be? The body is meant to both move and receive nourishment. And just like there are so many types of food, there are so many types of exercise. How could someone hate them all? I suspect that people who say this really dislike the formal exercise programs they have tried in the past. Maybe they find bicep curls and squats difficult and counting reps boring, or they don’t like classes in which the instructors sound harsh. Perhaps they don’t like the exertion or bouncing that comes with running. When I have conversations with clients about this, it’s the rare person who doesn’t remember or discover some form of exercise that he or she actually enjoys on some level.
Determine What Specific Part of Exercise You Don’t Like
After figuring this out, try to find a solution. Once a client didn’t like walking, but it turns out that she didn’t have good walking shoes. So what is it exactly that you don’t like? Do you feel discomfort or boredom? Do you feel that you look silly? Is your exercise too difficult?
Think Back to Your Childhood
Try an exercise that you enjoyed then. I loved skating, biking with friends, dancing to music, playing tennis, hula hoops, and my pogo stick. Today I mountain bike with my family, play Just Dance on the Wii, and use a weighted hula hoop now and then when I watch TV. Think about what you can bring back into your life.
Start Small
It’s better to do less than you are capable of than to do so much that you dislike it and quit. Build your skill at whatever rate is appropriate for you.
Focus on the Habit
That’s what really matters. I’d much rather you perform 10 sit-ups a day and build to a long-term habit than start out with bigger goals only to quit next week. Take another look at the section about building habits in Chapter 2. Recall that habits are built more readily when we have some sort of reward. When you finish exercising, reward yourself with some praise. Do that even if it feels a bit silly. Remind yourself that you moved and that it’s good for you. Hold on to those thoughts for several seconds or longer.
Match Exercise to Your Personality and to Your Other Goals
If you want more social activity, try a team sport like tennis or bowling or join an exercise class. If you enjoy one-on-one activities, hire a personal trainer, ask a friend to walk or jog with you, or schedule a walk and phone chat with a friend who lives far away. Are you the competitive type? Train for a 5K walk or run. If you like a scavenger hunt or a treasure hunt, try geocaching or use the Pokemon Go app.
Combine Exercise with Other Activities
If you enjoy photography, for example, take photos on scenic walks. If you like TV movies, find an exercise to do in front of the TV. Read while using a treadmill. Listen to an audio book while walking outside, or dance to music in your living room. If you crave new knowledge, listen to Ted Talks or podcasts while working out.
Build Pride
Keep an exercise record to remind yourself of your achievements. One successful client created the type of sticker chart that we often see parents use when their kids are working on new skills. Other clients enjoy sharing their workouts on social media, either by posting directly on social media or sharing with a select group of friends through an app.
Try New Activities
Keep things fresh with new activities. Try out different classes at a gym or yoga studio. Sign up for a self-defense class or ballroom dance lessons. Visit a rock-climbing gym. Join an adventure group that organizes outings. Look for one on meetup.com. If you typically work out inside, take a nature walk or go for a bike ride. Never tried elastic bands or suspension straps like the TRX? Maybe now is a good time. Check out your local library to see the selection of exercise DVDs available to borrow.
Try New Gadgets
No active lifestyle requires gadgets, but let’s face it: They’re fun. And if a new gadget fits your budget and inspires your lifestyle reset or keeps you on track, then it is money well spent.
• Pedometer. A pedometer is perhaps the simplest fitness gadget. Strap it on to your waistband and start walking, and it will keep track of your steps. Be sure to get a reliable one. Expect to spend $30 or so. A good one will count your steps fairly accurately and will not count every slight move you make. Test it out by taking exactly 100 steps. If your pedometer registers 90–110 steps, it’s good enough.
• Fitness trackers. These fitness wristbands range substantially in price and function. Expect to pay as little as $50 or as much as a few hundred dollars. I’ve used the FitBit Flex, which tracks steps, estimates calories burned, sleep, and more. Some fitness bands have a GPS function, track the number of stairs you climb, or measure your heart rate.
• Heart rate monitor. Some strap to your chest. Others are worn like a watch on your wrist. The purpose is to help you stay in your targeted heart rate zone during exercise.
Crank Up the Music
The right music can make your workouts more fun and may even make them seem easier. Ideally, the tempo of the music matches the tempo of your activity. Use slower-tempo music for warm-ups and low-impact exercises. Increase the tempo for strength training sessions and even more for faster-paced activities like running and dancing.
Change Your Expectations
Few things make exercise less enjoyable than feeling like a failure. Be realistic. The rewards of exercise are first experienced where we don’t see them—inside the body. It takes a long time before we see physical changes.
Picking a Gym
Going to the gym should not feel like drudgery. You should walk into a clean and pleasant place and feel energy. The employees should be friendly and professional, and the gym-goers should look like they’re enjoying the experience. Visit the facility during the times you plan to work out. Ask yourself the following questions when looking for a gym.
• Is the location convenient? Using a gym close to work might be good for some, but for many people, a gym close to home is better.
• Are the hours of operation convenient? If you plan to take classes, is the class schedule convenient?
• Do they offer child care? Are the attendants qualified?
• Who is exercising? Does it look like a group with whom you will eventually feel comfortable? If you are a newbie and the gym caters to body builders, it may not be a good fit for you.
• Are the locker rooms, showers, fitness equipment, and exercise rooms clean?
• Are there enough machines available or are people waiting?
• Does it offer the equipment and the exercise experience you want? Is there a four-season pool, racquetball courts, an indoor track, spa facilities, or whatever you want out of your membership?
• Is the staff appropriately trained? Who will teach you how to use the exercise equipment?
• Is there an AED (automated external defibrillator) should someone have a heart attack? Are employees trained to use it? Do they know CPR?
• What do other people say about the facility? Ask a few members what they like or don’t like about the facility.
• Can you try out a 1-week membership for free?
• What are the contract terms? Is the cost agreeable to you? Is there an initiation fee? Is there a payment plan? Does the facility have a reciprocal program allowing you to work out in another city for free or a discounted price? Can you put your membership on hold if you’re sick, injured, or unavailable?
Be Empowered
• Using the list on pages 186 and 187, identify your motivators to engage in regular physical activity.
• Check in with your health care provider to see if you are free to begin an exercise program or ramp up an existing one.
• Consider the steps necessary to make exercise your habit.
• Using FITT principles, create SMART goals around physical activity. Consider any of the four components of a balanced fitness program.
• Purchase appropriate footwear, clothing, or supplies.