Choosing the Right Exercise

Walking is a well-balanced form of exercise for most people, regardless of age. Many people are able to maintain a modest level of fitness through a regular walking program. Walking is relatively easy on the joints. During walking, at least one foot is on the ground at all times, so the force with which the foot strikes the ground is never much more than the person’s weight. However, walking expends fewer calories than does running and places fewer demands on the heart. Walking slowly will not alone make a person very fit.

To walk faster, a person can take longer steps and move the legs faster with an equally vigorous stroke (or swing) of the arms. Steps can be lengthened by swiveling the hips from side to side so that the feet can reach further forward. Swiveling the hips tends to make the toes point outward when the feet touch the ground, so the toes do not reach as far forward as they would if they were pointed straight ahead. In addition, excessive hip swiveling can strain the hip joints, contributing to osteoarthritis. Therefore, a person should always try to point the toes straight ahead while walking, unless this position causes discomfort. Moving the arms faster helps the feet move faster. To move the arms faster, a person bends the elbows to shorten the swing and reduce the time the arms take to swing back and forth from the shoulder. People with instability (whether due to poor balance or weakness) or severe joint injury may find walking difficult. Also, even vigorous walking does not strengthen the upper body and has little strengthening effect on the lower body unless the person is initially very deconditioned.

Swimming exercises the whole body—the legs, arms, and back—without straining most joints and muscles. Often, swimming is recommended for people who have muscle and joint problems. An exception is the shoulder joint, which can sometimes be stressed by swimming, contributing to rotator cuff disorders. Swimmers, moving at their own pace and using any stroke, can gradually increase endurance until they can swim for 30 minutes continuously.

For weight loss, exercise out of water is slightly more effective than other exercises of a similar intensity in the water because air insulates the body, increasing body temperature and metabolism for up to 18 hours. This process expends extra calories after exercise as well as during exercise. In contrast, water conducts heat away from the body, so that body temperature does not rise and metabolism does not remain increased after swimming. Also, swimming tends not to build muscle, because the muscles are supported by the water, which restricts the type of movements the muscles make. And because swimming is not a weight-bearing exercise, it does not help prevent osteoporosis. People who swim regularly or for long durations should take measures to prevent infection of the ear canal (called swimmer's ear).

Riding a bicycle is good exercise for cardiovascular fitness. Pedaling a bicycle strengthens the upper leg muscles. Bicycles are pedaled in a smooth circular motion that does not jolt the muscles. A rider can enjoy the variety and challenges of different scenes and terrains. However, bicycling can be harmful in some people with knee disorders because there is greater shearing force on the knee joint than with some other activities, such as walking. Bicycling requires balance. Some people cannot maintain balance, even on a stationary bicycle, and others find the pressure of the narrow seat against the pelvis uncomfortable. Also, outdoor bicycling may involve risks of falls, cars, traffic, and other road hazards.

With a stationary bicycle, the tension on the bicycle wheel should be set so that the rider can pedal at a cadence of 60 rotations per minute. As riders progress, they can gradually increase the tension and the cadence up to 90 rotations per minute. A recumbent stationary bicycle is both secure and comfortable, particularly for people who have pain around the tail bone (coccyx). It has a contoured chair so that even a person with functional limitations, such as those caused by a stroke, may be able to sit. Also, if one leg is paralyzed, toe clips can hold both feet in place, so that the person can pedal with one leg. A recumbent stationary bicycle is a particularly good choice for older people who have weak upper leg muscles. Strengthening the upper leg muscles makes it easier to rise from a squatting position, get up from a chair without using the hands, or walk up stairs without holding on to the railing.

This popular type of exercise (including Zumba), offered in many communities, exercises the whole body. Dancing with light to moderate weights can offer extra benefit because it increases the challenge and overall demands on the muscles. People can exercise at their own pace with guidance from experienced instructors. Lively music and familiar routines may make the workout more fun. Committing to a schedule and exercising with friends can improve motivation. Aerobic dancing also can be done at home with videotapes. Low-impact aerobic dancing eliminates the jumping and pounding of regular aerobic dancing, thus decreasing strain on the knee and hip joints. However, the benefits of aerobic dancing, especially in terms of weight loss, are proportional to the intensity. Consequently, muscle strengthening does not increase much with this type of activity.

Step aerobics works primarily the muscles in the front and back of the upper legs (the quadriceps, and hamstrings) and the gluteal muscles as a person steps up and down on a raised platform (a step) in a routine set to music at a designated pace. As soon as these muscles start to feel sore, exercisers should stop, do something else, and return to step aerobics a couple of days later. High-intensity step aerobics can strain the joints, particularly the knees and hips.

Water aerobics is an excellent choice for older people and for people with weak muscles, because it provides support for the body and eliminates the possibility of falling on a hard surface. It is often used for people with arthritis and sometimes for injury rehabilitation. Water aerobics involves doing various types of muscle movements or simply walking in waist- to shoulder-deep water. Aerobic exercises done out of the water, however, are more effective for weight loss and for helping to prevent osteoporosis.

Cross-country skiing exercises the upper body and the legs. Many people enjoy using machines that simulate cross-country skiing, but others find the motions difficult to master and stressful around the hip joints and inner thighs (although working with shorter leg strokes often helps). Because using these machines requires more coordination than most types of exercise, a person should try out a machine before buying one. Cross-country skiing outdoors is more enjoyable to some people but adds the challenges of exercising in the cold while maintaining balance.

Rowing strengthens the large muscles of the legs and upper arms and back. More people use rowing machines than row on water, although rowing outdoors adds the challenge of coordinating the oars and the joys of spending time in a boat. However, if the boat does not have a sliding seat, the leg muscles will not be strengthened. Proper form is essential to minimize injury. People who have back problems should not row without a doctor’s approval.

Strength training is meant to build strength and muscle mass and is the optimal exercise method to help prevent or treat osteoporosis due to the loads bearing down on the bones. These loads can be free or machine weights, cable weights, or even body weight (used in exercises such as push-ups, abdominal crunches, deep knee bends, and chin-ups).

Pilates is a series of exercises designed to increase flexibility and strengthen core (abdominal and back) muscles. Although Pilates is often thought of as a program for experienced athletes, Pilates programs can be designed for people of all fitness levels. Because Pilates techniques must be done correctly for people to achieve benefit, most experts suggest that people begin by taking a class or two with a Pilates instructor before trying it at home.

Tai chi is a system of gentle physical motions and stretches that are coordinated with specific breathing techniques. It is often used for stress reduction. Some forms of tai chi are more intense and vigorous than others, but generally tai chi is considered more of a stress reduction technique than true exercise.

Yoga usually is not exercise. Yoga stretches muscles and has benefits of mental and physical relaxation. Many people enjoy yoga. However, yoga does not benefit the heart, increase endurance, or help build muscle or improve muscle function unless doing the more demanding positions regularly.

Elliptical machines can be used for cardiovascular fitness. Benefits compared to running and bicycling, for example, are less stress on the spine and less joint strain, because there is no impact as the body glides when using an elliptical machine. Also, higher and more continuous muscle tension can facilitate better leg muscle development and endurance and strength. Most elliptical machines have handles to coordinate arm movements with leg strokes, thereby providing a full body workout that increases cardiovascular fitness.

Conditioning guidelines (for example, target heart rate, and frequency and duration of exercise) when using an elliptical machine are no different from those for other aerobic exercises, such as running or bicycling. Elliptical machines must fit the user. The machines must provide a comfortable leg stroke length to avoid causing the legs to extend too far forward or back and straining the hip muscles.

New forms of exercise, especially exercise classes, are always being developed. Some become widely popular and others are less popular but no less effective. Some people are more motivated to exercise when they vary their routine, and newer popular workouts can improve motivation. However, more familiar forms of exercise and even some activities that are not traditionally described as exercise (such as ballroom and other forms of dancing) can be equally effective. Interactive video games that encourage physical activity (sometimes called exergames) may provide some benefit, but they are not a substitute for a regular exercise program.