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Mind + Body Fitness Self-Assessment

Are you currently practicing mind + body fitness?
Do you understand the connection between being physically fit and mentally fit, and why it is important to your overall well-being?
Take a few minutes to ask yourself the following questions. Your answers will reveal how aware you are of the connection between mental and physical health.

EXERCISE AND DEPRESSION *

Depression is a prevalent problem in today’s society. Clinical depression affects 2–5% of Americans each year (Kessler et al., 1994) and it is estimated that patients suffering from clinical depression make up 6–8% of general medical practices (Katon & Schulberg, 1992). Depression is also costly to the health care system in that depressed individuals annually spend 1.5 times more on health care than nondepressed individuals, and those being treated with antidepressants spend three times more on outpatient pharmacy costs than those not on drug therapy (Simon, VonKorff, & Barlow, 1995). These costs have led to increased governmental pressure to reduce health care costs in America. If available and effective, alternative low-cost therapies that do not have negative side effects need to be incorporated into treatment plans. Exercise has been proposed as an alternative or adjunct to more traditional approaches for treating depression (Hales & Travis, 1987; Martinsen, 1987, 1990).

The research on exercise and depression has a long history of investigators (Franz & Hamilton, 1905; Vaux, 1926) suggesting a relationship between exercise and decreased depression. Since the early 1900s, there have been over 100 studies examining this relationship, and many narrative reviews on this topic have also been conducted. During the 1990s there have been at least five meta-analytic reviews (Craft, 1997; Calfas & Taylor, 1994; Kugler et al., 1994; McDonald & Hodgdon, 1991; North, McCullagh, & Tran, 1990) that have examined studies ranging from as few as nine (Calfas & Taylor, 1994) to as many as 80 (North et al., 1990). Across these five meta-analytic reviews, the results consistently show that both acute and chronic exercise are related to a significant reduction in depression. These effects are generally “moderate” in magnitude (i.e., larger than the anxiety-reducing effects noted earlier) and occur for subjects who were classified as nondepressed, clinically depressed, or mentally ill. The findings indicate that the antidepressant effect of exercise begins as early as the first session of exercise and persists beyond the end of the exercise program (Craft, 1997; North et al., 1990). These effects are also consistent across age, gender, exercise group size, and type of depression inventory.

Exercise was shown to produce larger antidepressant effects when: (a) the exercise training program was longer than nine weeks and involved more sessions (Craft, 1997; North et al., 1990); (b) exercise was of longer duration, higher intensity, and performed a greater number of days per week (Craft, 1997); and (c) subjects were classified as medical rehabilitation patients (North et al., 1991) and, based on questionnaire instruments, were classified as moderately/severely depressed compared to mildly/moderately depressed (Craft, 1997). The latter effect is limited since only one study used individuals who were classified as severely depressed and only two studies used individuals who were classified as moderately to severely depressed. Although limited at this time, this finding calls into question the conclusions of several narrative reviews (Gleser & Mendelberg, 1990; Martinsen, 1987, 1993, 1994), which indicate that exercise has antidepressant effects only for those who are initially mild to moderately depressed.

The meta-analyses are inconsistent when comparing exercise to the more traditional treatments for depression, such as psychotherapy and behavioral interventions (e.g., relaxation, meditation), and this may be related to the types of subjects employed. In examining all types of subjects, North et al. (1990) found that exercise decreased depression more than relaxation training or engaging in enjoyable activities, but did not produce effects that were different from psychotherapy. Craft (1997), using only clinically depressed subjects, found that exercise produced the same effects as psychotherapy, behavioral interventions, and social contact. Exercise used in combination with individual psychotherapy or exercise together with drug therapy produced the largest effects; however, these effects were not significantly different from the effect produced by exercise alone (Craft, 1997).

That exercise is at least as effective as more traditional therapies is encouraging, especially considering the time and cost involved with treatments like psychotherapy. Exercise may be a positive adjunct for the treatment of depression since exercise provides additional health benefits (e.g., increase in muscle tone and decreased incidence of heart disease and obesity) that behavioral interventions do not. Thus, since exercise is cost effective, has positive health benefits, and is effective in alleviating depression, it is a viable adjunct or alternative to many of the more traditional therapies. Future research also needs to examine the possibility of systematically lowering antidepressant medication dosages while concurrently supplementing treatment with exercise. *

Daniel M. Landers

the relationship between exercise and anxiety reduction

There have been six meta-analyses examining the relationship between exercise and anxiety reduction (Calfas & Taylor, 1994; Kugler, Seelback, & Krüskemper, 1994; Landers & Petruzzello, 1994; Long & van Stavel, 1995; McDonald & Hodgdon, 1991; Petruzzello, Landers, Hatfield, Kubitz, & Salazar, 1991). These meta-analyses ranged from 159 studies (Landers & Petruzzello, 1994; Petruzzello et al., 1991) to five studies (Calfas & Taylor, 1994) reviewed. All six of these meta-analyses found that across all studies examined, exercise was significantly related to a reduction in anxiety. These effects ranged from “small” to “moderate” in size and were consistent for trait, state, and psychophysiological measures of anxiety. The vast majority of the narrative reviews and all of the meta-analytic reviews support the conclusion that across studies published between 1960 and 1995 there is a small to moderate relationship showing that both acute and chronic exercise reduces anxiety. This reduction occurs for all types of subjects, regardless of the measures of anxiety being employed (i.e., state, trait or psychophysiological), the intensity or the duration of the exercise, the type of exercise paradigm (i.e., acute or chronic), and the scientific quality of the studies. Another meta-analysis (Kelley & Tran, 1995) of 35 clinical trial studies involving 1,076 subjects has confirmed the psychophysiological findings in showing small (–4/–3 mm Hg), but statistically significant, postexercise reductions for both systolic and diastolic blood pressure among normal normotensive adults.

In addition to these general effects, some of these meta-analyses (Landers & Petruzzello, 1994; Petruzzello et al., 1991) that examined more studies and therefore had more findings to consider were able to identify several variables that moderated the relationship between exercise and anxiety reduction. Compared to the overall conclusion noted above, which is based on hundreds of studies involving thousands of subjects, the findings for the moderating variables are based on a much smaller database. More research, therefore, is warranted to examine further the conclusions derived from the following moderating variables. The meta-analyses show that the larger effects of exercise on anxiety reduction are shown when: (a) the exercise is “aerobic” (e.g., running, swimming, cycling) as opposed to nonaerobic (e.g., handball, strength-flexibility training), (b) the length of the aerobic training program is at least 10 weeks and preferably greater than 15 weeks, and (c) subjects have initially lower levels of fitness or higher levels of anxiety. The “higher levels of anxiety” includes coronary (Kugler et al., 1994) and panic disorder patients (Meyer, Broocks, Hillmer-Vogel, Bandelow & Rüther, 1997). In addition, there is limited evidence which suggests that the anxiety reduction is not an artifact “due more to the cessation of a potentially threatening activity than to the exercise itself” (Petruzzello, 1995, p. 109), and the time course for postexercise anxiety reduction is somewhere between four to six hours before anxiety returns to pre-exercise levels (Landers & Petruzzello, 1994). It also appears that although exercise differs from no treatment control groups, it is usually not shown to differ from other known anxiety-reducing treatments (e.g., relaxation training). The finding that exercise can produce an anxiety reduction similar in magnitude to other commonly employed anxiety treatments is noteworthy since exercise can be considered at least as good as these techniques, but in addition, it has many other physical benefits.

ANXIETY REDUCTION FOLLOWING EXERCISE

It is estimated that in the United States approximately 7.3% of the adult population has an anxiety disorder that necessitates some form of treatment (Regier et al., 1988). In addition, stress-related emotions, such as anxiety, are common among healthy individuals (Cohen, Tyrell, & Smith, 1991). The current interest in prevention has heightened interest in exercise as an alternative or adjunct to traditional interventions such as psychotherapy or drug therapies.

Anxiety is associated with the emergence of a negative form of cognitive appraisal typified by worry, self-doubt, and apprehension. According to Lazarus and Cohen (1977), it usually arises “...in the face of demands that tax or exceed the resources of the system or ... demands to which there are no readily available or automatic adaptive responses” (p. 109). Anxiety is a cognitive phenomenon and is usually measured by questionnaire instruments. These questionnaires are sometimes accompanied by physiological measures that are associated with heightened arousal/anxiety (e.g., heart rate, blood pressure, skin conductance, muscle tension). A common distinction in this literature is between state and trait questionnaire measures of anxiety. Trait anxiety is the general predisposition to respond across many situations with high levels of anxiety. State anxiety, on the other hand, is much more specific and refers to the person’s anxiety at a particular moment. Although “trait” and “state” aspects of anxiety are conceptually distinct, the available operational measures show a considerable amount of overlap among these subcomponents of anxiety (Smith, 1989).

For meta-analytic reviews of this topic, the inclusion criterion has been that only studies examining anxiety measures before and after either acute or chronic exercise have been included in the review. Studies with experiment-imposed psychosocial stressors during the postexercise period have not been included since this would confound the effects of exercise with the effects of stressors (e.g., Stoop color-word test, active physical performance). The meta-analysis by Schlicht (1994), however, included some stress-reactivity studies and therefore was not interpretable.

Landers and Petruzzello (1994) examined the results of 27 narrative reviews that had been conducted between 1960 and 1991 and found that in 81% of them the authors had concluded that physical activity/fitness was related to anxiety reduction following exercise and there was little or no conflicting data presented in these reviews. For the other 19%, the authors had concluded that most of the findings were supportive of exercise being related to a reduction in anxiety, but there were some divergent results. None of these narrative reviews concluded that there was no relationship. *

Activity associated with restful sleep Activity associated with ability to respond to stress

Benefits (anxiety and depression) similar to those for other treatments

Activity associated with positive self-esteem

For some time now, it has been common knowledge that exercise is good for one’s physical health. It has only been in recent years, however, that it has become commonplace to read in magazines and health newsletters that exercise can also be of value in promoting sound mental health. Although this optimistic appraisal has attracted a great deal of attention, the scientific community has been much more cautious in offering such a blanket endorsement. Consider the tentative conclusions from the Surgeon General’s Report on Physical Activity and Health (PCPFS Research Digest, 1996) that “physical activity appears to relieve symptoms of depression and anxiety and improve mood” and that “regular physical activity may reduce the risk of developing depression, although further research is needed on this topic.”

The use of carefully chosen words, such as “appears to” and “may” illustrate the caution that people in the scientific community have when it comes to claiming mental health benefits derived from exercise. Part of the problem in interpreting the scientific literature is that there are over 100 scientific studies dealing with exercise and depression or exercise and anxiety and not all of these studies show statistically significant benefits with exercise training. The paucity of clinical trial studies and the fact that a “mixed bag” of significant and nonsignificant findings exists makes it difficult for scientists to give a strong endorsement for the positive influence of exercise on mental health. There is no doubt that the mental health area needs more clinical trial studies. This would be particularly useful in determining if exercise “causes” improvements in variables associated with sound mental health. However, until these clinical trial studies materialize, there is still much that can be done to strengthen statements made about exercise and mental health.

What evidence would prompt some scientists to “stick their necks out” in favor of more definitive statements? One reason for greater optimism is the recent appearance of quantitative reviews (i.e., meta-analyses) of the literature on a number of mental health topics. These reviews differ in several ways from the traditional narrative reviews. A meta-analysis allows for a summary of results across studies. By including all published and unpublished studies and combining their results, statistical power is increased. Another advantage of using this type of review process is that a clearly defined sequence of steps is followed and included in the final report so that anyone can replicate the studies. Two additional advantages that meta-analysis has over other types of reviews include: (a) the use of a quantification technique that gives an objective estimate of the magnitude of the exercise treatment effect; and (b) its ability to examine potential moderating variables to determine if they influence exercise-mental health relationships. Given these advantages, this paper will focus primarily on results derived from large-scale meta-analytic reviews.

Mental Health Benefits of Physical Activity

Reduced anxiety


• Best results with “aerobic exercise”
  
• Best after weeks of regular exercise
  
• Best benefits to those who are low fit to begin with
  
• Best benefits for those high in anxiety to begin with
  

Reduced depression


• Best after weeks of regular exercise
  
• Best when done several times a week
  
• Best with more vigorous exercise
  
• Best for those who are more depressed (needs more research)

The Influence of Exercise on Mental Health

Definitions

Acute. Acute refers to something that occurs at a specific time often for a relatively short duration. For example, acute exercise refers to a bout of exercise done at a specific time for a specific amount of time. Acute anxiety is anxiety that exists in a person in response to a specific event (same as state anxiety).

Anxiety. Anxiety is a form of negative self-appraisal characterized by worry, self-doubt, and apprehension.

Chronic. Chronic refers to something that persists for a relatively long period of time. Chronic depression, for example, would be depression that lasts a long time. A chronic exerciser is someone who does exercise on a regular basis.

Depression. Depression is a state of being associated with feelings of hopelessness or a sense of defeat. People with depression often feel “down” or “blue” even when circumstances would dictate otherwise. All people feel “depressed” at times, but a “depressed” person feels this way much of the time.

Clinical depression. This is depression (see definition) that persists for a relatively long period of time or becomes so severe that a person needs special help to cope with day-to-day affairs.

Meta-analysis. A type of statistical analysis that researchers use to make sense of many different research studies done on the same topic. By analyzing findings from many different studies, conclusions can be drawn concerning the results of all studies considered together. Both unpublished and published studies can be included in this type of analysis.

Positive mood. Positive self-assessments associated with feelings of vigor, happiness, and/or other positive feelings of well-being.

State anxiety. State anxiety is anxiety present in very specific situations. For example, state sports anxiety is present when a person is anxious in a specific sports situation even if the person is not generally anxious.

Trait anxiety. Trait anxiety is the level of anxiety present in a person on a regular basis. A person with high trait anxiety is anxious much of the time while a person low in trait anxiety tends to be anxious less often and in fewer situations.
ORIGINALLY PUBLISHED AS SERIES 2, NUMBER 12, OF THE PCPFS RESEARCH DIGEST

The 7 Things That Personal Trainers Do To Tick Clients Off

"Over the years we have had our share of both excellent and suspect Personal Trainers. From these experiences come the 7 things that they do to tick clients off.

1. Fail to keep appointments: perhaps this should be saved for number 7 as it is the most unbelievable; you know save the best for last. This is the case of the trainer that calls on the day of the appointment, sometimes within hours, and wants to let you know they will be unable to train because they got tied up. Still worse is the trainer that runs perpetually late. Picture yourself at the gym, warming up, and looking out for your trainer. At the appointed hour they are no where in sight so you begin to lightly workout. 10 minutes into the scheduled hour they come strolling in asking to be forgiven for running late. O.k., things happen. The question is do things happen 2 weeks out of 4. My advice? Get a new trainer.
2. Neglect to keep charts on their clients. How in the world is a trainer supposed to keep a mental note of all the particulars surrounding a clients health, contact information, goals, workout weights, injury areas, to name a few. Boggles my mind how many trainers simply write nothing down. They truly must have amazing memories.
3. Eating while training a client. Hey, I get hungry too and I also work a long day. It would be unimaginable for me to eat in front of a client unless we went out for a meal. Frankly it does not matter if it is a power bar, a peanut butter sandwich or a bag of trail mix. I pay you to work me out, eat on your own time.
4. Talking to other trainers, or familiar clients, while working me out. Here's a novel thought: my health and safety for that one hour is in your hands, your complete attention is required. It does not matter to me if your best friend from grade school that you have not seen in 10 years just walked in. Your attention is on your client for one hour.
5. Children do not belong in the gym. Not the client's kids or the trainer's. Last thing I want is to hear or see is kids when I am trying to concentrate on touching a cone while balancing on half a foam roller with a 20 pound jacket on my body. Don't get me wrong, I like children. I don't like children at the gym.
6. Talking on cell phones, or texting, while working out a client. This one might have been a contender for the number one position. As if the invasion of cell phones in not pervasive enough it has now entered the gym. Picture this: client is doing a deep lunge exercise down a lane at the gym. Following behind offering no words of encouragement, but "spotting" her is trainer on cell phone. Unbelievable. Unbelievable that the trainer is on the phone and equally nuts that the client does not care. Important caveat: clients are guilty too. Recently I witnessed a client doing step ups on to a platform while speaking on the phone. It was her husband who "always calls me when we hear this song". Could you just wretch?
7. Lack of creativity in workouts. Worse is the trainer who you know is making up the routine as we go along. Getting to the gym takes a certain amount of motivation for most clients. Help us out and add some variety to the exercise routine.
The last item is for the gym owners in the reading audience: stop being cheap and make sure the carpets are cleaned, the equipment is updated and in good working condition, the amenities in the locker room are clean and control your employees or contractors. At $50 to $75 per hourly session these are reasonable requests.

If you are shopping for a personal trainer, use this list to size up the trainer and the facility you are contemplating using. Know too that there a many, many simply excellent, diligent, qualified trainers that fit none of the faults mentioned above. In fact this article is a result of observations made while either warming up for, or working out with, my trainer who cannot be faulted for any of the issues sited."
R. Adam Shore - www.physicalfitnessarticles.net

Health And Fitness For People Above 50 *

Most aging adults don't get enough physical activity. Exercise, though, can improve health impairments and prevent some diseases. It can also improve mood and emotional well being. The keys, though, to a sensible senior workout are to take it slowly and keep it up. Older people need to find a realistic mild to moderate enjoyable program.

Let me give you 8 important reasons why You should work out.

1. Sleeping Aid for Seniors

Because exercise effects the body is so many positive ways, it is clearly the most natural option for helping address sleep related issues. Regular exercise will first of all help tire the body physically, ensuring a natural form of fatigue that the body will address with a
need to get appropriate rest.

2. Strength Training = Strong Bones

A critical aspect of aging is the general weakening of both muscle tissue and our bones themselves. One of the surest ways to reduce the stress on our weakening bones is to increase our muscles mass through strength training. Strength training has repeatedly been shown to be a safe and effective method of reversing muscle loss in the elderly

3. Strong Heart

People who exercise vigorously and often will reduce the risk of heart disease the greatest, but studies also show that any exercise can be beneficial. Studies have found that moderate exercise is also beneficial for those people with existing heart disease. *

Health And Fitness For People Above 50 - II *

4. Arthritis Help

Arthritis is defined as the inflammation of a joint, but it can certainly seem more painful than that. It can cause searing pain that leaves the body feeling weak for days. As people age, arthritis tends to develop from the extended every day uses of the body.

Exercise, though, can assist with arthritis by strengthening the muscles near the joint which helps reduce joint stress. While exercise is necessary for everyone, it is essential for those with arthritis

5. 58% lower risk for Type 2 diabetes

A study reported a 58% lower risk for Type 2 diabetes in adults who exercise for as little as 2.5 hours a week, even if the exercise was of a moderate level.

People with diabetes are at high risk for heart disease, so the protective effects of aerobic exercise on the heart are very important for people with Type 2 diabetes. Initial indications are that strength training to increase muscle mass and reduce patient fat is also helpful for people with diabetes.

6. Increased Overall Fitness

Being physically active appears to stimulate immune cells that target many viruses and infections. Though exercise appears to stimulate such cells, that stimulation appears to last only a few hours. However, regular exercise appears to lower the overall risk of being susceptible to the flu, colds, and other viruses.

7. Increased Stamina and Slowing the Aging clock

Physical fitness allows the body to perform to its full capacity. Fitness helps us appear, feel, and act to our full potential. Exercise is essentially the capability to complete everyday responsibilities energetically and actively, with energy remaining at the end of the day for appreciation of other activities.

8. No Brain Drain

How many times do you hear yourself or other seniors say, "Sorry, I'm just having another senior moment? Many seniors are making exercise more of a habit so their sharp and educated minds don't suffer. Studies across the country are showing that seniors who exercise their bodies have the least trouble exercising their minds. *

Calories Expended During Certain Activities:

Data from ACSM Resource Manual for Guidelines for Exercise Testing and Prescription Third Edition

ACTIVITY*	Calories expended in 30 minutes Male (175 lbs)	Calories expended in 30 minutes Female (135 lbs)
Biking 12-13.9 mph (moderate effort)	334	258
Circuit Training	334	258
Stretching, hatha yoga	167	129
Dancing - general	188	145
Dancing - ballet, modern	251	193
House Cleaning - vigorous (mop, wash car)	188	145
House Cleaning - light (dusting, vacuuming)	104	81
Playing w/ kids moderate - walk/run	167	129
Gardening	209	161
Mowing lawn - Hand mower	251	193
Running - 6 mph	418	322
Jogging	292	225
Basketball - Game	334	258
Children's Games	209	161
Football	334	258
Frisbee	125	97
Horseback Riding	167	129
Skating	292	225
Soccer	292	225
Softball/Baseball	209	161
Tennis	292	225
Hiking	251	193
Walking - 4 mph, level surface	167	129
Walking - leisure	146	113
Canoeing/Rowing - moderate	292	225
Kayaking	209	161
Swimming laps freestyle - moderate	334	258

"Exercise Lite" *

The American College of Sports Medicine (ACSM) and the U.S. Centers for Disease Control and Prevention (CDC) recommend the following as a means of physical activity:

• "Accumulate 30 minutes or more of moderate-intensity physical activity over the course of most days of the week"

• Incorporating more activity into your daily routine can improve your health status
• Daily activities may include:
• walking stairs (instead of taking the elevator)
• gardening
• raking leaves
• dancing
• mall walking while shopping
• carrying a grocery basket rather than pushing a cart (when applicable)
• parking in the farthest parking spot and walking to the office or store
• carrying or pushing a golf bag instead of taking a cart while golfing
  

• Alternately, 30 minutes of activity may come from planned exercise or recreation*

Facts in Keywords

• More than 60% of US adults do not engage in the recommended amount of activity.
• Approximately 25% of US adults are not active at all.
• A 1993 study concerning causes of death in the US: #1 Tobacco, #2 Lack of exercise/poor diet, #3 Alcohol.
• Chronic disease costs the US $655 Billion in healthcare costs.
• In this year, 1.5 million people will have a heart attack in the US and 500,000 will die.

So...

• Control your health status through a medical checkup before beginning a program.
• Progress slowly in the exercise program.
• Choose primarily activities which engage as large a muscle mass as possible, ie: jogging, cycling, swimming, cross-country skiing, etc.
• Remember, it is not necessary to be exhausted to achieve improvement in physical fitness.
• The training should be accomplished continuously and intermittently.
• The improvement in physical fitness will depend on your initial fitness level.
• It is never too late to start exercising regularly.

Signs and symptoms of inadequate hydration may include:

• Thirst
• Fatigue
• Loss of coordination
• Mental confusion
• Irritability
• Dry skin
• Elevated body temperature
• Diminished urine output

Water, Protein and Fats

Protein and fats: Important, but not your body's top fuel choice
Protein isn't your body's food of choice for fueling exercise, but it does play a role in muscle repair and growth. Most people can easily get the protein they need from such foods as meat, dairy products and nuts, and don't need additional protein supplements.

Fat is an important, although smaller, part of your diet. Fats, as well as carbohydrates, can provide fuel for your muscles during exercise. Try to get most of your fat from unsaturated sources such as nuts, fatty fish or vegetable oils. Avoid fatty foods just before exercising, though. Fats remain in your stomach longer, causing you to feel less comfortable.

Water: Drink plenty to avoid dehydration
Your body uses the water in your blood to carry nutrients such as sugar (glucose) to cells and to remove waste products from the cells. The presence of water in your body ensures that you can safely sustain physical activity. As you exercise, your body produces heat. This heat leaves your body as you perspire, taking with it electrolytes — elements, such as potassium, calcium, sodium and chlorine. If you don't replace the fluid you lose during exercise, your heart rate increases and your temperature rises, putting you at risk of dehydration as well as compromising your workout.

To stay well hydrated during exercise, the American College of Sports Medicine recommends that you drink eight glasses of water every day and more on days when the temperature and humidity are high.

Drink at least one glass of water before and after your workout and every 10 to 15 minutes during your workout to replace fluid lost in perspiration. Avoid substituting coffee, tea or soda for water, because they often contain caffeine, which acts as a diuretic that causes your body to lose even more water.

Water is generally the best way to replace lost fluid, unless you're exercising for more than 60 minutes. In that case, sip a sports drink to help maintain your electrolyte balance and give you a bit more energy from the carbohydrates in it. The sodium in sports drinks also helps you rehydrate more quickly.

What to eat: Getting the right fuel for your best performance

Food provides your body with necessary energy. To make the most of your workouts, focus on:

Carbohydrates: Your body's chief source of fuel

You'll feel better when you exercise if you eat foods high in carbohydrates and low in fat. Your body stores excess carbohydrates as glycogen — primarily in your muscles and liver. Your muscles use stored glycogen when needed for energy.

Cereals, breads, vegetables, pasta, rice and fruit are good sources of carbohydrate. But right before an intense workout, avoid carbohydrates high in fiber, such as beans and lentils, bran cereals and fruit. High-fiber foods may give you gas or cause cramping. Fructose, a simple sugar found in fruit, can increase the tendency for diarrhea with high-intensity exercise.

If you don't like to eat solid foods before exercising, drink your carbohydrates in sports beverages or fruit juices. "Research shows it makes no difference in performance whether you drink your carbohydrates or eat them," says DeBoer. Do what feels best to you.

A diet containing at least 40 percent to 50 percent of calories from carbohydrates allows your body to store glycogen, but if you're a long-distance runner or you exercise for long periods of time, you might want to consume more carbohydrates regularly and consider carbohydrate loading before a big athletic event.

To get the most from your workout, follow these guidelines:

• Eat a full breakfast. Wake up early enough to eat a full breakfast. "Most of the energy you got from dinner last night is used up by morning," says DeBoer. "Your blood sugar is low. If you don't eat, you may feel sluggish or lightheaded while exercising." If you plan to exercise within an hour after breakfast, eat a smaller breakfast or drink something to raise your blood sugar, such as a sports drink.

• Time your meals. Eat large meals at least three to four hours before exercising. If you're having a small meal, eat two to three hours before exercising.

  Most people can eat snacks right before and during exercise. The key is how you feel. Some people feel lightheaded during the first 10 to 15 minutes of their workout if they eat within the hour before exercise. Do what works best for you.

• Don't skip meals. Skipping meals may cause low blood sugar, which can make you feel weak and lightheaded. If you're short on time before your workout, and your choice is candy or nothing, eat the candy because it can improve your performance, compared with eating nothing. But keep in mind, all candy is high in sugar and low on nutrients, so a snack of yogurt and a banana would be a better choice.
• Eat after your workout. To help your muscles recover and to replace their glycogen stores, eat a meal that contains both protein and carbohydrates within two hours of your exercise session if possible.

Eating and exercise: Time it right to maximize your workout

Knowing when and how much to eat and drink before you exercise can make a big difference in how you feel during and after your workout. Here are some tips.

When you eat and what you eat can affect your performance and the way you feel while you're exercising. Coordinate your meals, snacks and what you drink to make the most of your exercise routine.

Eating a lot before exercise can slow you down

When you exercise after a large meal, you may feel sluggish or have an upset stomach, cramping and diarrhea. That's because your muscles and your digestive system are competing with each other for energy resources.

"Your body can digest food while you're active, but not as well as it can when you're not exercising," notes Stephen DeBoer, a registered dietitian at Mayo Clinic, Rochester, Minn. This is partly because your body is trying to do two things requiring blood supply and energy simultaneously — digesting the food you just ate and providing fuel to keep your muscles active.

Time it right: Before, during and after your workout

On the flip side, not eating before you exercise can be just as bad as eating too much. Low blood sugar levels that result from not eating can make you feel weak, faint or tired, and your mental abilities may be affected as well, making you slower to react. So what can you do?

Fitness Zone *

The next zone is the Fitness Zone, which is 60-70% of your max HR. Once again, 85% of your calories burned in this zone are fats, 5% are proteins and 10% are carbohydrates. Studies have shown that in this zone you can condition your fat mobilization (getting fat out of your cells) while conditioning your fat transportation (getting fat to muscles). Thus, in this zone, you are training your fat cells to increase the rate of fat release and training your muscles to burn fat. Therefore, the benefits of this zone are not only the same as the healthy heart zone training at 50-60% but you are now slightly increasing the total number of calories burned and provide a little more cardiorespiratory benefits. You burn more total calories at this zone simply because it is more intense.

Aerobic Zone

The third zone, the Aerobic Zone, requires that you train at 70-80% of your max HR. This is the preferred zone if you are training for an endurance event. In this zone, your functional capacity will greatly improve and you can expect to increase the number and size of blood vessels, increase vital capacity and respiratory rate and achieve increases in pulmonary ventilation, as well as increases in arterial venous oxygen. Moreover, stroke volume (amount of blood pumped per heart beat) will increase, and your resting heart rate will decrease. What does all this mean? It means that your cardiovascular and respiratory system will improve and you will increase the size and strength of your heart. In this zone, 50% of calories burned are from carbohydrates, 50% are from fat and less than 1% is from protein. And, because there is an increase in intensity, there is also an increase in the total number of calories burned.

Anaerobic Zone

The next training zone is called the Threshold or Anaerobic zone, which is 80-90% of your max HR. Benefits include an improved VO2 maximum (the highest amount of oxygen one can consume during exercise) and thus an improved cardiorespiratory system, and a higher lactate tolerance ability which means your endurance will improve and you'll be able to fight fatigue better. Since the intensity is high, more calories will be burned than within the other three zones. Although more calories are burned in this zone, 85% of the calories burned are from carbohydrates, 15% from fat and less than 1% are from protein.

*

Heart Zone Training *

How do you know if you are training too intensely or not intensely enough for what you want to achieve? This is where Heart Zone Training comes in. Refer to the chart below. The top of the chart reads "Maximum Heart Rate," which is 100% of your heart rate (the fastest your heart will beat). This is different for everyone. To use Heart Zone Training you must first determine your maximum heart rate (max HR).

You can determine your max HR one of two ways. One way is to use the age predicted max HR formula, whereby you subtract your age from 220. So, if you are 40 years old, your predicted max HR would be 180 bpm. The other method, which is much more accurate and more individualized, is actually having a medical or fitness professional administer a max HR test for you, which is usually done on a stationery bicycle or treadmill for several minutes and requires very hard work. Thus, only those cleared by a physician should do this test. We do not explain how to administer this test because only trained professionals should do so. Please refer to the Global Health and Fitness Personal Training Directory for professionals in your area (may or may not be trained in administering a max HR test).

Once you have determined your max HR, you will need to decide what zone you want to train at. There are five different training zones separated by 10% increments, each having different characteristics and benefits.

Healthy Heart Zone

The first zone is called the Healthy Heart Zone. This is 50-60% of your max HR. This is the easiest and most comfortable zone within which to train and is the one that is best for people who are just starting an exercise program or have low functional capacity. Those of you who are walkers most likely train at this zone. Although this zone has been criticized for not burning enough total calories, and for not being intense enough to get great cardiorespiratory benefits, it has been shown to help decrease body fat, blood pressure and cholesterol. It also decreases the risk of degenerative diseases and has a low risk of injury. In this zone, 10% of carbohydrates are "burned" (used as energy), 5% of protein is burned and a whopping 85% of fat is burned.

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