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Do we get enough exercise from our daily activities?

Most Americans get little vigorous exercise at work or during leisure hours.

Today, only a few jobs require vigorous physical activity. People usually ride in cars or buses & watch TV during their free time rather than be physically active.

Activities like golfing & bowling provide people with some benefit. But they don't provide the same benefits as regular, more vigorous exercise.

Evidence suggests that even low to moderate intensity activities can have both short & long-term benefits. If done daily, they help lower your risk of heart disease.

Such activities include pleasure walking, stair climbing, gardening, yardwork, moderate to heavy housework, dancing & home exercise. More vigorous exercise can help improve fitness of the heart & lungs, which can provide even more consistent benefits for lowering heart disease risk.

Today, many people are rediscovering the benefits of regular, vigorous exercise - activities like swimming, brisk walking, running, or jumping rope. These kinds of activities are sometimes called "aerobic" - meaning the body uses oxygen to produce the energy needed for the activity.

Aerobic exercises can condition your heart & lungs if performed at the proper intensity for at least 30 minutes, 3-4 times a week.

But you don't have to train like a marathon runner to become more physically fit! Any activity that gets you moving around, even it it's done for just a few minutes each day, is better than none at all. For inactive people, the trick is to get started.

One great way is to take a walk for 10-15 minutes during your lunch break. Other ideas in this pamphlet will help you get moving & living a more active life.


What are the benefits of regular physical activity?

These are the benefits often experienced by people who get regular physical activity.

Feeling better

Regular physical activity -

  • gives you more energy
  • helps in coping with stress
  • improves your self-image
  • increases resistance to fatigue
  • helps counter anxiety & depression
  • helps you to relax & feel less tense
  • improves the ability to fall asleep quickly & sleep well
  • provides an easy way to share an activity with friends or family & an opportunity to meet new friends

Looking better

Regular physical activity

You need to burn off 3,500 calories more than you take in to lose 1 pound. If you want to lose weight, regular physical activity can help you in either of 2 ways.

First, you can eat your usual amount of calories, but be more active; i.e., A 200-pound person who keeps on eating the same amount of calories, but decides to walk briskly each day for 1 1/2 miles will lose about 14 pounds in 1 year.

Or second, you can eat fewer calories & be more active. This is an even better way to lose weight.

About 3/4 of the energy you burn every day comes from what your body uses for its basic needs, such as:

  • sleeping
  • breathing
  • digesting food 
  • reclining

A person burns up only a small amount of calories with daily activities such as sitting. Any physical activity in addition to what you normally do will burn up extra calories.

The average calories spent per hour by a 150-pound person are listed below. (A lighter person burns fewer calories; a heavier person burns more.) Since exact calorie figures aren't available for most activities, the figures below are averaged from several sources & show the relative vigor of the activities.


Activity calories burned
Bicycling 6 mph 240 cals./hr.
Bicycling 12 mph 410 cals./hr.
Cross-country skiing 700 cals./hr.
Jogging 5 1/2mph 740 cals./hr.
Jogging 7 mph 920 cals./hr.
Jumping rope 750 cals./hr.
Running in place 650 cals./hr.
Running 10 mph 1280 cals./hr.
Swimming 25 yds/min. 275 cals./hr.
Swimming 50 yds/min. 500 cats./hr.
Tennis-singles 400 cals./hr.
Walking 2 mph 240 cals./hr.
Walking 3 mph 320 cals./hr.
Walking 41/2 mph 440 cals./hr.

The calories spent in a particular activity vary in proportion to one's body weight; i.e., a 1 00-pound person burns 1/3 fewer calories, so you would multiply the number of calories by 0.7. For a 200-pound person, multiply by 1.3.

Working harder or faster for a given activity will only slightly increase the calories spent. A better way to burn up more calories is to increase the time spent on your activity.


Working better

Regular physical activity -

  • helps you to be more productive at work
  • increases your capacity for physical work
  • builds stamina for other physical activities
  • increases muscle strength
  • helps your heart & lungs work more efficiently

Consider the benefits of a well-conditioned heart:

In 1 minute with 45 to 50 beats, the heart of a well-conditioned person pumps the same amount of blood as an inactive person's heart pumps in 70 to 75 beats. Compared to the well-conditioned heart, the average heart pumps up to 36,000 more times per day, 13 million more times per year.

Feeling, looking & working better - all these benefits from regular physical activity can help you enjoy your life more fully.


Comparing the benefits & the risks

Should you begin a regular exercise program? Consider the ways physical activity can benefit you & weigh them against the possible risks.

Potential benefits

Potential risks

  • muscle or joint injuries
  • heat exhaustion or heat stroke on hot days (rare) aggravation of existing or hidden heart problems

Should I consult a doctor before I start an exercise program?

Most people don't need to see a doctor before they start since a gradual, sensible exercise program will have minimal health risks. However, some people should seek medical advice.

Use the following checklist to find out if you should consult a doctor before you start or significantly increase your physical activity.*

what if I've had a heart attack? I'm concerned....

What if I've had a heart attack?

Regular, brisk physical activity can help reduce your risk of having another heart attack. People who include regular physical activity in their lives after a heart attack improve their chances of survival. Regular exercise can also improve the quality of your life - how you feel & look. It can help you do more than before without pain (angina) or shortness of breath.

If you've had a heart attack, consult your doctor to be sure you are following a safe & effective exercise program. Your doctor's guidance Is very Important because It could help prevent heart pain & for further damage from overexertion.

5 common myths about exercise

Myth 1. Exercising makes you tired.

As they become more physically fit, most people feel physical activity gives them even more energy than before. Regular, moderate-to-brisk exercise can also help you reduce fatigue & manage stress.

Myth 2. Exercising takes too much time.

It only takes a few minutes a day to become more physically active. To condition your heart & lungs, regular exercise doesn't have to take more than about 30 to 60 minutes, 3 or 4 times a week. If you don't have 30 minutes in your schedule for an exercise break, try to find two 15-minute periods or even 3 10-minute periods.

Once you discover how much you enjoy these exercise breaks, you may want to make them a habit! Then physical activity becomes a natural part of your life.

Myth 3. All exercises give you the same benefits.

All physical activities can give you enjoyment. Low-intensity activities - if performed daily - also can have some long-term health benefits & lower your risk of heart disease.

But only regular, brisk & sustained exercises such as brisk walking, jogging or swimming improve the efficiency of your heart & lungs & burn off substantial extra calories.

Other activities may give you other benefits such as increased flexibility or muscle strength, depending on the type of activity.

Myth 4. The older you are, the less exercise you need.

We tend to become less active with age & therefore need to make sure we're getting enough physical activity. In general, middle-aged & older people benefit from regular physical activity just as young people do.

Age need not be a limitation. In fact, regular physical activity in older persons increases their capacity to perform activities of daily living. What is important, no matter what your age, is tailoring the activity program to your own fitness level.

Myth 5. You have to be athletic to exercise.

Most physical activities don't require any special athletic skills. In fact, many people who found school sports difficult have discovered that these other activities are easy to do & enjoy. A perfect example is walking - an activity that requires no special talent, athletic ability or equipment.

How do different activities help my heart & lungs?

Some types of activity will improve the condition of your heart and lungs if they are brisk, sustained and regular. Low-intensity activities don't condition the heart & lungs much. But they can have other long-term health benefits.

The columns below describe 3 types of activities & how they affect your heart.

Column A - These vigorous exercises are especially helpful when done regularly. To condition your heart & lungs, the AHA recommends that you do them for at least 30 minutes, 3 or 4 times a week, at more than 50% of your exercise capacity. (See target heart rate zones.)

Other health experts suggest a shorter period for higher-intensity activities. These exercises can also burn up more calories than those that are not so vigorous.

Column B - These activities are moderately vigorous but still excellent choices. When done briskly for 30 minutes or longer, 3 or 4 times a week, they can also condition your heart & lungs.

Column C - These activities are not vigorous or sustained. They still have benefits - they can be enjoyable, improve coordination & muscle tone, relieve tension & also help burn up some calories.

These & other low-intensity activities - like gardening, yard- work, housework, dancing & home exercise - can help lower your risk of heart disease if done daily.

slowly absorb the information....

Do condition
heart and lungs

Can condition
heart and lungs

Do not
condition much

Aerobic Dancing

Downhill Skiing





Cross-Country Skiing

Field Hockey


Hiking (uphill)



Ice Hockey






Jumping Rope


Golf (on foot or by cart)




Running in Place

Tennis (singles)





Stationary Cycling

Walking Moderately

Social Dancing




Walking Briskly


Walking Leisurely

get the picture in your mind of "exercise success"

The key to success

How do I begin?

The key to a successful program is choosing an activity (or activities) that you will enjoy. Even moderate levels of activity have important health benefits. Here are some questions that can help you choose the right kind of activity for you:

1. How physically fit are you?

If you've been inactive for a while, you may want to start with walking or swimming at a comfortable pace. Beginning with less strenuous activities will allow you to become more fit without straining your body. Once you are in better shape, you can gradually change to a more vigorous activity if you wish.

2. How old are you?

If you are over 40 and have not been active, avoid very strenuous programs such as jogging when you're first starting out. For the first few months, build up the length and intensity of your activity gradually. Walking and swimming are especially good forms of exercise for all ages.

3. What benefits do you want from exercising?

If you want the benefits of exercise that condition your heart and lungs, check the activities in columns A and B. These activities - as well as those listed in column C - also give you other benefits as described in this booklet.

4. Do you like to exercise alone or with other people?

Do you like individual activities such as swimming, team sports such as soccer, or two-person activities such as racquetball? How about an aerobics class or ballroom dancing? Companionship can help you get started and keep going. If you would like to exercise with someone else, can you find a partner easily and quickly? If not, choose another activity until you can find a partner.

5. Do you prefer to exercise outdoors or in your home?

Outdoor activities offer variety in scenery and weather. Indoor activities offer shelter from the weather and can offer the convenience of exercising at home as with stationary cycling. Some activities such as bench stepping, running in place or jumping rope can be done indoors or outdoors. If your activity can be seriously affected by weather, consider choosing a second, alternate activity. Then you can switch activities and still stay on your regular schedule.

6. How much money are you willing to spend for sports equipment or facilities?

Many activities require little or no equipment. For example, brisk walking only requires a comfortable pair of walking shoes. Also, many communities offer free or inexpensive recreation facilities and physical activity classes.

7. When can you best fit the activity into your schedule?

Do you feel more like being active in the morning, afternoon, or evening? Consider moving other activities around. Schedule your activity as a regular part of your routine. Remember that exercise sessions are spread out over the week and needn't take more than about 10 to 15 minutes at a time.

By choosing activities you like, you will be more likely to keep doing them regularly and enjoying the many benefits of physical activity.

How do I pace myself?

Build up slowly If you've been inactive for a long while, remember it will take time to get into shape.

Start with low to moderate level activities for at least several minutes each day. See the sample walking program, i.e. You can slowly increase your time or pace as you become more fit. And you'll feel more fit after a few weeks than when you first started.

How hard should I exercise?

It's important to exercise at a comfortable pace, i.e., when jogging or walking briskly you should be able to keep up a conversation comfortably. If you don't feel normal again within 10 minutes of stopping exercise, you're pushing yourself too much.

Also, if you have difficulty breathing, experience faintness or prolonged weakness during or after exercising, you're exercising too hard. Simply cut back.

If your goal is to improve the fitness of your heart & lungs, you can find out how hard to exercise by keeping track of your heart rate. Your maximum heart rate is the fastest your heart can beat. Exercise above 75% of your maximum heart rate may be too strenuous unless you're in excellent physical condition. Exercise below 50% gives your heart & lungs little conditioning.

Therefore, the best activity level is 50 to 75% of this maximum rate. This 50-75% range is called your target heart rate zone.

When you begin your exercise program, aim for the lower part of your target zone (50%) during the first few months. As you get into better shape, gradually build up to the higher part of your target zone (75%).

After 6 months or more of regular exercise, you can exercise at up to 85% of your maximum heart rate - if you wish. However, you don't have to exercise that hard to stay in good condition.

To find your target zone, look for the age category closest to your age in the table below & read the line across; i.e., if you're 30, your target zone is 95 to 142 beats per minute. If you're 43, the closest age on the chart is 45; the target zone is 88 to 131 beats per minute.

Age Target HR Zone
Average Maximum
Heart Rate 100%
20 100-150 beats/ min. 200
25  98-146 beats/ min. 195
30 95-142 beats/ min. 190
35 93-138 beats/ min. 185
40 90-135 beats/ min. 180
45 88-131 beats/ min. 175
50  85-127 beats/ min. 170
55 83-123 beats/ min. 165
60 80-120 beats/ min. 160
65  78-116 beats/ min. 155
70 75-113 beats/ min. 150

Your maximum heart rate is approximately 220 minus your age. However, the above figures are averages & should be used as general guidelines.

Note: A few high blood pressure medicines lower the maximum heart rate & thus the target zone rate. If you're taking high blood pressure medications, call your physician to find out if your exercise program needs to be adjusted.

To see if you are within your target heart rate zone, take your pulse immediately after you stop exercising.

  1. When you stop exercising, quickly place the tips of your first two fingers lightly over one of the blood vessels on your neck (carotid arteries) located to the left or right of your Adam's apple. Another convenient pulse spot is the inside of your wrist just below the base of your thumb.

  2. Count your pulse for 10 seconds & multiply by 6.

  3. If your pulse falls within your target zone, you're doing fine. If it is below your target zone, exercise a little harder next time. And if you're above your target zone, exercise a little easier. Don't try to exercise at your maximum heart rate - that's working too hard.

  4. Once you're exercising within your target zone, you should check your pulse at least once each week during the first 3 months & periodically after that.

A special tip:

Some people find that exercising within their target zone seems too strenuous. If you start out lower, that's okay, too. You'll find that with time you'll become more comfortable exercising & can increase to your target zone at your own rate.

How long should I exercise?

That depends on:

  • your age
  • your level of physical fitness
  • the level of intensity of your exercise

If you're inactive now, you might begin slowly with a 10 -15 minute walk or other short session, 3 times a week. As you become more fit, you can do longer sessions or short sessions more often.

If you're active already & your goal is to condition your heart & lungs, try for a minimum of 30 minutes at your target heart rate zone. Each exercise session should include:

Warm up 5 minutes

Begin exercising slowly to give your body a chance to limber up & get ready for more vigorous exercise. Start at a medium pace & gradually increase it by the end of the 5-minute warm-up period.

Note: With especially vigorous activities such as jumping rope, jogging or stationary cycling, warm up for 5-10 minutes by jumping rope or jogging slowly, warming up to your target zone.

It's often a good idea to do stretching exercises after your warm-up period & after your exercise period. Many of these stretching exercises can be found in books on sports medicine & running.

Below are 3 stretches you can use in your warm-up period & after your cool down period. Each of these exercises help stretch different parts of your body.

Do stretching exercises slowly & steadily & don't bounce when you stretch.

Wall push: Stand about 1 1/2 feet away from the wall. Then lean forward pushing against the wall, keeping heels flat. Count to 10 (or 20 for a longer stretch), then rest. Repeat 1 to 2 times.

Palm touch: Stand with your knees slightly bent. Then bend from the waist and try to touch your palms to the floor. Count to 10 or 20, then rest. Repeat 1 to 2 times. If you have lower back problems, do this exercise with your legs crossed.

Toe touch: Place your right leg level on a stair, chair, or other object. With your other leg slightly bent, lean forward & slowly try to touch your right toe with right hand.

Hold & count to 10 or 20, then repeat with left hand. Don't bounce. Then switch legs & repeat with each hand. Repeat entire exercise 1 to 2 times.

Exercising within your target zone 30-60 minutes

Build up your exercising time gradually over the weeks ahead until you reach your goal of 30-60 minutes.

Once you get in shape, your exercising will last from 30 to 60 minutes depending on the type of exercise you're doing & how briskly you do it; i.e., for a given amount of time, jogging requires more energy than a brisk walk.

Jogging will thus take less time than walking to achieve the same conditioning effect. For 2 examples of how to build up to the goal of 30-60 minutes, see "Two Sample Exercise Programs".

Cool down 5 minutes

After exercising within your target zone, slow down gradually; i.e., swim more slowly or change to a more leisurely stroke. You can also cool down by changing to a less vigorous exercise, such as changing from running to walking.

This allows your body to relax gradually. Abrupt stopping can cause dizziness. If you've been running, walking briskly, or jumping rope, repeat your stretching & limbering exercises to loosen up your muscles.

How often should I exercise?

If you are exercising in your target zone, exercise at least three or four times per week (every other day). If you are starting with less intense exercise, you should try to do at least something every day.

Exercising regularly is one of the most important aspects of your exercise program. If you don't exercise at least 3 times a week, you won't experience as many of the benefits of regular physical activity as you could or make as much progress.

Try to spread your exercise sessions throughout the week to maximize the benefits. An every-other-day schedule is recommended & may work well for you.

What if I miss a few sessions?

Whenever you miss a few sessions (more than a week), you may need to resume exercising at a lower level than before. If you miss a few sessions because of a temporary, minor illness such as a cold, wait until you feel normal before you resume exercising.

If you have a minor injury, wait until the pain disappears. When you resume exercising, start at 1/2 to 2/3 your normal level, depending on the number of days you missed & how you feel while exercising.

Whatever the reasons for missing sessions, don't worry about the missed days. Just get back into your routine & think about the progress you'll be making toward your exercise goal.

Is there a top limit to exercising?

That depends on the benefits you are seeking.

Anything beyond 60 minutes daily of a vigorous or moderately vigorous activity, such as those in columns A & B, will result in little added conditioning of your heart and lungs. And it may increase your risk of injury.

If you want to lose extra pounds or control your present weight, there is no upper limit in that the longer you exercise, the more calories you burn off. But remember that the most effective weight loss program includes cutting down on calories in addition to exercise.

Remember: How you exercise is just as important as the kind of activity you do. Your activity should be brisk, sustained & regular - but you can do it in gradual steps. Common sense & your body will tell you when you're exercising too long or too hard. Don't push yourself to the point where exercise stops being enjoyable.

How do I keep going?

Here are some tips to help you stay physically active:

  1. Set your sights on short-term as well as long-term goals. For example, if your long-term goal is to walk 1 mile, then your short- term goal can be to walk the first quarter mile. Or if your long-term goal is to lose 10 pounds, then focus on the immediate goal of losing the first two or three pounds. With short-term goals you will be less likely to push yourself too hard or too long. Also, think back to where you started. When you compare it to where you are now, you will see the progress you've made.

  2. Discuss your program and goals with your family or friends. Their encouragement and understanding are important sources of support that can help you keep going. Your friends and family might even join in.

  3. If you're having trouble sticking to your regular activity program, use the questions on pages 20 and 21 to think through the kinds of things that can affect your exercise enjoyment.

  4. What were your original reasons for starting an activity program? Do these reasons still apply or are others more important? If you are feeling bored or aren't enjoying a particular activity, consider trying another one.

By continuing to be active regularly, you'll be building a good health habit with benefits you can enjoy throughout your life.

How can I become more active throughout my day?

To become more physically active throughout your day, take advantage of any opportunity to get up and move around. Here are some examples:

  • Use the stairs - up and down - instead of the elevator. Start with one flight of stairs and gradually build up to more.

  • Park a few blocks from the office or store and walk the rest of the way. Or if you ride on public transportation, get off a stop or two before and walk a few blocks.

  • Take an activity break - get up and stretch, walk around and give your muscles and mind a chance to relax.

  • Instead of eating that extra snack, take a brisk stroll around the neighborhood.

  • Do housework, such as vacuuming, at a more brisk pace.

  • Mow your own lawn.

  • Carry your own groceries.

  • Go dancing instead of seeing a movie.

  • Take a walk after dinner instead of watching TV.

If you have a family, encourage them to take part in an exercise program and recreational activities they can either share with you or do on their own. It is best to build healthy habits when children are young. When parents are active, children are more likely to be active and stay active after they become adults.

Whatever your age, moderate physical activity can become a good health habit with lifelong benefits.

Are there any risks in exercising?

Muscles and joints

The most common risk in exercising is injury to the muscles and joints. This usually happens from exercising too hard or for too long - particularly if a person has been inactive for some time. However, most of these injuries can be prevented or easily treated as explained in "Effective ways to avoid injuries".

Heat exhaustion and heat stroke

If precautions are not taken during hot, humid days, heat exhaustion or heat stroke can occur - although they are fairly rare. Heat stroke is the more serious of the two. Their symptoms are similar:

Heat exhaustion Heat stroke
dizziness dizziness
headache headache
nausea nausea
confusion thirst
body temperature below normal muscle cramps
sweating stops
high body temperature

The last two symptoms of heat stroke are important to know. If the body temperature becomes dangerously high, it can be a serious problem.

Both heat exhaustion and heat stroke can be avoided if you drink enough liquids to replace those lost during exercise. 

Heart problems

In some cases, people have died while exercising. Most of these deaths are caused by overexertion in people who already had heart conditions. In people under age 30, these heart conditions are usually congenital heart defects (heart defects present at birth). In people over age 40, the heart condition is usually coronary artery disease (the buildup of deposits of fats in the heart's blood vessels). Many of these deaths have been preceded by warning signs such as chest pain, lightheartedness, fainting and extreme breathlessness. These are symptoms that should not be ignored and should be brought to the attention of a doctor immediately.

Some of the deaths that occur during exercise are not caused by the physical effort itself. Death can occur at any time and during any kind of activity - eating, sleeping, sifting. This does not necessarily mean that a particular activity caused the death - only that the two events happened at the same time.

No research studies have shown that physically active people are more likely to have sudden, fatal heart attacks than inactive people. In fact, a number of studies have shown a reduced risk of sudden death for people who are physically active.

Exercising too hard is not beneficial for anyone, however, and is especially strenuous for out-of-shape, middle-aged and older persons. It is very important for these people to follow a gradual and sound exercise program.

If you consider the time your body may have been out of shape, it is only natural that it will take time to get it back into good condition. A gradual approach will help you maximize your benefits and minimize your risks.

Effective ways to avoid injuries

The most powerful medicine for injuries is prevention. Here are some effective ways to avoid injuries:

1. Build up your level of activity gradually over the weeks to come.

  • Try not to set your goals too high - otherwise you will be tempted to push yourself too far too quickly.

  • For activities such as jogging, walking briskly and jumping rope, limber up gently and slowly before and after exercising.

  • For other activities, build up slowly to your target zone, and cool down slowly afterwards.

2. Listen to your body for early warning pains.

  • Exercising too much can cause injuries to joints, feet, ankles and legs. So don't make the mistake of exercising beyond early warning pains in these areas or more serious injuries may result. Fortunately, minor muscle and joint injuries can be readily treated by rest and aspirin.

3. Be aware of possible signs of heart problems such as:

  • Pain or pressure in the left or mid-chest area, left neck, shoulder or arm during or just after exercising. (Vigorous exercise may cause a side stitch while exercising - a pain below your bottom ribs - which is not the result of a heart problem.)

  • Sudden lightheartedness, cold sweat, pallor or fainting. Ignoring these signals and continuing to exercise may lead to serious heart problems. Should any of these signs occur, stop exercising and call your doctor,

4. For outdoor activities, take appropriate precautions under special weather conditions.

On hot, humid days:

  • Exercise during the cooler and/or less humid parts of the day such as early morning or early evening after the sun has gone down.

  • Exercise less than normal for a week until you become adapted to the heat.

  • Drink lots of fluids, particularly water - before, during and after exercising. Usually, you do not need extra salt because you get enough salt in your diet. (And a well-conditioned body is better able to conserve salt so that most of the sweat is water.) However, if you exercise very vigorously for an extended time in the heat (for example, running a marathon), it's a good idea to increase your salt intake a little.

  • Watch out for signs of heat stroke - feeling dizzy, weak, light- headed, and/or excessively tired; sweating stops; or body temperature becomes dangerously high.

  • Wear a minimum of light, loose-fitting clothing.

  • Avoid rubberized or plastic suits, sweatshirts, and sweat pants. Such clothing will not actually help you lose weight any faster by making you sweat more. The weight you lose in fluids by sweating will be quickly replaced as soon as you begin drinking fluids again. This type of clothing can also cause dangerously high temperatures, possibly resulting in heat stroke.

On cold days:

  • Wear one layer less of clothing than you would wear if you were outside but not exercising. It's also better to wear several layers of clothing rather than one heavy layer. You can alwaysremove a layer if you get too warm.

  • Use old mittens, gloves, or cotton socks to protect your hands.

  • Wear a hat, since up to 40 percent of your body's heat is lost through your neck and head.

On rainy, icy or snowy days:

  • Be aware of reduced visibility (for yourself and for drivers) and reduced traction on pathways.

5. Other handy tips are:

  • If you've eaten a meal, avoid strenuous exercise for at least 2 hours. If you exercise vigorously first, wait about 20 minutes before eating.

  • Use proper equipment such as goggles to protect your eyes for handball or racquetball, or good shoes with adequate cushioning in the soles for running or walking.

  • Hard or uneven surfaces such as cement or rough fields are more likely to cause injuries. Soft, even surfaces such as a level grass field, a dirt path, or a track for running are better for your feet and joints.

  • If you run or jog, land on your heels rather than the balls of your feet. This will minimize the strain on your feet and lower legs.

  • Joggers or walkers should also watch for cars and wear light- colored clothes with a reflecting band during darkness so that drivers can see you. Remember, drivers don't see you as well as you see their cars. Face oncoming traffic and do not assume that drivers will notice you on the roadway.

  • If you bicycle, you can help prevent injuries by always wearing a helmet and using lights and wheel-mounted reflectors at night. Also, ride in the direction of traffic and try to avoid busy streets.

  • Check your shopping malls. Many malls are open early and late for people who do not wish to exercise alone in the dark. They also make it possible to be active in bad weather and to avoid summer heat, winter cold or allergy seasons.

Feeling Defeated... What's that about?
My personal problem for exercise is that I fractured my leg three years ago. I broke both the tibia & the fibula about 1 inch above my ankle. I ended up having a non union fracture; meaning that the bone wouldn't heal. I ended up in a wheelchair for almost two years.
Now that healing has occurred, it's three years approximately after the original history, and I'm feeling disabled because of the pain I endure still, as well as the fact that I'm overwhelmed with fear over breaking the bone in the same place again. I had an operation to keep the fibula broken, so to speak, so that it wouldn't heal anymore at the angle it was healing it would press against the fracture of the tibia. Now I believe that the leg is very weak. I also have pain in my ankle as they had put in a metal plate, but the plate hurt my ankle on the inside of my leg. When they took out the metal plate because I was allergic to it, my ankle still hurts like that plate is pinching it.
I have gained way too much weight because of this injury. I'm very frightened to do anything that might break it again... it's causing me to feel defeated, believe me.
I'm going to try to take a new route. You can try it too! First I'm going to investigate fractures!!! If you want to investigate the problem that's causing you to feel defeated just follown my lead...



A fracture is a break in a bone, usually accompanied by injury to the surrounding tissues.

Fractures vary greatly in size, severity, and the treatment needed. They can range from a small, easily missed crack in a hand bone to a massive, life-threatening break of the pelvis. Serious injuries, including injuries to the skin, nerves, blood vessels, muscles, and organs, may occur at the same time as the fracture. These injuries can complicate treatment of the fracture.

Trauma is the most common cause of fractures. Low-energy trauma, such as a fall on level ground, usually causes minor fractures. High-energy trauma, such as high-speed motor vehicle accidents and falls from buildings, can cause severe fractures that involve several bones.

Certain underlying disorders can weaken parts of the skeleton so that breaks are more likely to occur. Such disorders include certain infections, benign bone tumors, cancer, and osteoporosis.

Symptoms and Complications

Pain is the most obvious symptom. Fractures hurt, especially when force is applied, such as when a person tries to put weight on an injured limb. The area around the broken bone is also tender to touch. Swelling of soft tissue around the fracture begins within a few hours. The limb may not function properly, so that moving an arm, standing on a leg, or gripping with a hand is very painful. For a person who cannot speak (for example, a very young child, a person with a head injury, or an older person with dementia), refusal to move an extremity may be the only sign of a fracture. People with pathologic fractures often experience steadily increasing pain beginning weeks before the fracture actually occurs.

Internal bleeding may occur with a closed fracture (one in which the skin is not torn). The bleeding may occur from the bone itself or from surrounding soft tissues. The blood eventually works its way to the surface, forming a bruise, which at first is purplish-black then slowly turns to green and yellow as the blood is broken down and reabsorbed back into the body. The blood can move quite a distance from the fracture, and the entire process takes a few weeks to complete. The blood can cause temporary pain and stiffness in surrounding structures. Shoulder fractures, for instance, can bruise the entire arm and cause pain in the elbow and wrist. Some fractures, especially hip fractures, can lose quite a lot of blood into the surrounding tissues, causing low blood pressure.

The person usually feels some discomfort with activities even after fractures have healed sufficiently to allow full weight bearing. For example, although a fractured wrist may be strong enough to allow some use in about 2 months, the wrist will not have completely undergone remodeling, and it will be painful with forceful gripping for up to 1 year. The person may also notice increased pain and stiffness when the weather is damp, cold, or stormy.

Most fractures heal with few problems. However, sometimes even with proper treatment, fractures can cause serious complications.

How Bones Heal

When tissues, such as those of the skin, muscles, and internal organs, become injured, they tend to mend by having scar tissue take the place of healthy tissue. The scar tissue often compromises the tissue's appearance or function in some way. In contrast, bone is unique in that it heals with its own tissue—bone—rather than with scar tissue. This unusual capacity for regeneration enables a mending bone to heal itself after a fracture. Even shattered fragments of bone, with proper treatment, can often be restored to their normal function.

Fractures heal in three overlapping phases: inflammation, repair, and remodeling. Healing begins immediately with the inflammatory phase. In this phase, damaged soft tissue, bone fragments, and lost blood caused by the injury are removed by cells of the immune system. The region around the fracture becomes swollen and tender as cell activity and blood flow increase. The inflammatory phase reaches peak activity in a couple of days, but takes weeks to subside. This process accounts for most of the early pain people experience with fractures.

The repair phase begins within days of the injury and lasts for weeks to months. New repaired bone, called the external callus, is formed during this phase. When first produced, the callus has no calcium; it is soft and rubbery and cannot be seen on an x-ray. This new bone is neither strong nor stable, so that during this period the fractured bone can easily collapse and become displaced (that is, slip out of its proper place). At 3 to 6 weeks, the callus calcifies and becomes much stiffer and stronger and becomes visible on x-rays.

The remodeling phase (in which the bone is built back to its normal state) lasts many months. The bulky external callus is slowly resorbed and replaced by stronger bone; in this phase, the normal contours and architecture of the bone are restored. It is not likely that the bone will fracture again during this phase; however, people may experience mild pain with exertion.

Compartment Syndrome Compartment syndrome is a serious limb-threatening condition caused by excessive swelling of injured muscles, which may occur as a result of a fracture or crush injury to a limb. Muscles are surrounded by a fibrous covering that forms a closed space (compartment). An injured muscle swells; when the swelling is significantly confined by the muscle's compartment, and particularly when it is further confined by a cast, the pressure within the muscle tissue may increase. This increase in pressure decreases the normal blood flow that provides oxygen to the muscle. When the muscle is deprived of oxygen for too long, further injury to the muscle occurs, which leads to further swelling and higher tissue pressures. After only a few hours, irreversible injury and death of muscle and nearby soft tissues may result.

A doctor becomes concerned about compartment syndrome when the person feels increasing pain in an immobilized limb after a fracture, pain when the fingers of an immobilized arm or toes of an immobilized leg are moved gently, or numbness in the limb. The diagnosis of compartment syndrome can be confirmed using a device that measures pressure in the muscles.

Pulmonary Embolism Pulmonary embolism is the sudden blocking of a lung artery by an embolus, nearly always resulting from a blood clot that can travel to the lungs, especially from the deep veins of the leg (see Pulmonary Embolism). Pulmonary embolism is the most common fatal complication of serious hip and pelvic fractures. People with hip fractures are at high risk of pulmonary embolism because of the combination of trauma to the leg, forced immobilization for hours or days, and swelling around the fracture site blocking blood flow in the veins. Of people with a hip fracture who die, about one third die of pulmonary embolism. Pulmonary embolism occurs much less commonly with fractures of the lower leg and very rarely with fractures of the upper body.

Doctors may suspect pulmonary embolism based on a range of symptoms, including chest pain, cough, and shortness of breath. Confirmation may involve chest x-ray, electrocardiogram, and one or more of a variety of imaging studies.


X-rays are the most important tool for diagnosing a fracture. They not only show the fracture but also help a doctor understand how the fragments of bone are misaligned. Small or nondisplaced fractures can be difficult to see on routine x-rays, and sometimes additional x-rays are taken at special angles. Occult or stress fractures may take days or weeks to show clearly on x-rays. Pathologic fractures are diagnosed by x-rays that show bone abnormalities, such as punched-out (lytic) areas caused by infection, benign tumors, or cancer.

Computed tomography (CT) and magnetic resonance imaging (MRI) can show features not seen on routine x-rays. CT can show the fine details of a fractured joint surface or can reveal areas of a fracture hidden by overlying bone. MRI shows the soft tissue around the bone, which helps to detect injury to nearby tendons and ligaments, and can show evidence of cancer. MRI also shows injury (swelling or bruising) within the bone and can thus reveal occult fractures before they appear on x-rays.

Bone scanning (see Symptoms and Diagnosis of Musculoskeletal Disorders: Bone Scanning) is an imaging procedure that involves use of a radioactive substance (technetium-99m-labeled pyrophosphate) that is taken up by any healing bone. Occult fractures can be detected on bone scans 3 to 5 days after the injury. If a pathologic fracture is suspected, bone scans help to check for problems in other bones—ones that might not yet be producing symptoms.


Fractures require immediate attention because they cause pain and loss of function for the person. After initial emergency care, fractures usually require further treatment, including immobilization with casts or traction, or fixation with surgery.

Fractures in children are often treated differently than those in adults because bones in children are smaller, more flexible and less brittle, and most importantly, still growing. Treatment with casts or traction is often preferred over surgery to avoid damage to the growth plate.

Types of Fractures






The skin & soft tissue covering the bone are torn; dirt, debris or bacteria can easily contaminate the wound



The skin isn't torn




Small fragments of bone detach from where tendons or ligaments attach to bones; usually affect hand, foot, ankle, knee, shoulder





Certain areas of the skeleton are selectively weakened by osteoporosis, making them more likely to break; occur in older people, usually in the hip, wrist, spine, shoulder, pelvis



The bone collapses into itself; occur in older people, most commonly affecting the spine


Joint (intraarticular)


Occur within a joint; lead to a loss of motion & gradually developing osteoarthritis




An underlying disorder (such as infection, a noncancerous bone tumor, cancer) weakens a bone, leading to a fracture




A bone becomes stressed repeatedly over time because of certain activities, such as walking with a heavy pack or running




Fractures that are difficult or impossible for a doctor to see on an initial x-ray; may appear as dark or white lines days to weeks after injury




A partial crack & a bend in the bone but not a break thru the bone completely; occur in children only


Growth plate


A break thru part of the bone that allows bones to lengthen (growth plate); may cause a bone to stop growing or to grow crookedly; occur only in children


Simple transverse


A clean square break that divides a bone cleanly across




The broken ends of the bones are separated or bent at an angle




The normal shape & alignment of a bone are maintained despite cracks completely thru the bone




Sharp, triangular bone ends




The bone is broken into multiple pieces, often because of high-energy trauma or weakening by osteoporosis

Initial Treatment When a fracture is suspected, the person should call his or her doctor, who will determine the appropriate facility for treatment. The choice of a facility depends on the severity of the injury. For example, people with minor wrist and shoulder fractures can be treated in medical offices. Because people with hip fractures are in severe pain and are unable to move, they must be transported by ambulance to a hospital with surgical facilities.

Open fractures need to be treated immediately with surgery to carefully clean and close the wound. Massive open fractures with great losses of the skin, muscle, and blood supply to the bone are the most serious and difficult to treat.

For most closed fractures, treatment with casts or surgery can be delayed up to 1 week without affecting the long-term result. However, there is usually no advantage to waiting, because until they are treated, people are troubled by pain and loss of function. Before seeing a doctor, the person should immobilize and support the injured limb with a makeshift splint, sling, or a pillow; elevate the limb to the level of the heart to limit swelling; apply ice to control pain and swelling; and take only acetaminophenSome Trade Names
to relieve pain. AspirinSome Trade Names
and other nonsteroidal anti-inflammatory drugs (NSAIDs) should not be taken because they may worsen bleeding (see Pain: Nonsteroidal Anti-Inflammatory Drugs).

The doctor may recommend the person continue to keep an injured arm or leg elevated to control swelling. For arm fractures, pillows are used for elevation. For leg fractures, the person should periodically lie flat with the leg on a pillow. The doctor compares the swelling of the injured limb with the normal appearance of the uninjured limb to help determine how long or often elevation is needed. During the later stages of healing, elastic stockings may be used during the daytime to help control swelling when the person is sitting or standing.

Immobilization Most fractures can be treated without surgery. They are immobilized with a splint, sling, or cast until they heal sufficiently. Displaced fractures must be aligned (by a procedure called reduction) before being immobilized. When minor fractures (such as those of the fingers or wrist) are aligned, the person may need an injection of a local anesthetic, such as lidocaineSome Trade Names
, to prevent pain. When major fractures of the arm, shoulder, or lower leg are aligned, the person may need general or spinal anesthesia; this procedure is called closed reduction.

A splint is a long, narrow slab of plaster or fiberglass applied with elastic wrap or tape. The slab does not completely encircle the limb, which allows for some expansion due to tissue swelling. For this reason, splints are often used for initial treatment of fractures. For finger fractures, aluminum splints covered with foam are commonly used.

A sling by itself provides sufficient support for many shoulder and elbow fractures. The weight of the arm pulling downward helps to keep many shoulder fractures well aligned. A strap passing around behind the back can be added to keep the arm from swinging outward, especially at night. Slings permit some use of the hand.

A cast is made by wrapping rolls of plaster or fiberglass strips that harden once wetted. Plaster is often chosen for the initial cast when a displaced fracture is being treated. It molds well and has less of a tendency to cause painful contact points between the body and cast. Otherwise, fiberglass has the advantage of being stronger, lighter, and more durable. In either case, the cast is lined with soft cottony material to protect the skin from pressure and rubbing. If the cast becomes wet, it is often impossible to completely dry the lining; this can lead to skin softening and breakdown (maceration). For partially healed fractures, a special, more expensive and less protective waterproof lining is sometimes substituted.

After a cast is applied (especially for the first 24 to 48 hours), it should be kept elevated when possible to the level of the heart to combat swelling. Regular flexion and extension of the fingers or wiggling of the toes helps the blood to drain from the limb and also helps to prevent swelling. Pain, pressure, or numbness that remains constant or worsens over time should be reported to a doctor immediately. These conditions may be due to a developing bedsore or compartment syndrome.


Traction is sometimes used to keep the bones aligned while a fracture heals. An array of ropes, pulleys & weights are used to continuously pull on the limb.

In adults, traction is used only until the fracture can be safely treated with a cast or surgery.

In children, certain fractures are best treated with traction because the healing time is shorter than in adults.

Also, traction doesn't injure the growth plate, whereas surgery may do so.

Surgical Treatment

Fractures sometimes require surgical treatment; i.e., the doctor must explore & carefully clean open fractures to ensure that no foreign material has contaminated the bone ends.

When a bone fragment or a tendon is trapped in the bone ends, a doctor may not be able to align a displaced fracture & surgery is needed.

Comminuted fractures are often too unstable for a cast to maintain alignment against the forces of muscle contraction, which can cause the bone to shorten or angle. Joint fractures require a near-perfect alignment of the joint surfaces or the person will later develop arthritis.

If possible, pathologic fractures are stabilized surgically before they break through completely. This approach avoids the pain, disability, & the more complex surgery involved with a displaced fracture.

Finally, if fractures of the femur (thighbone), which includes most hip fractures, aren't treated surgically, they'd require months of immobilization in bed before the person is strong enough to bear weight.

In contrast, surgical stabilization usually permits the person to walk with crutches or a walker within days.

Surgical stabilization involves first accurately reducing the fracture to restore the bone's original shape & length. The surgeon uses anesthesia to relax the muscles & x-ray equipment to help align the bones.

A surgeon exposes the fracture to see & manipulate the fragments with special instruments. Then, the bone fragments are securely fixed using some combination of metal wires, pins, screws, rods & plates.

Metal plates are contoured & fixed to the outside of the bone with screws. Metal rods are inserted from one end of the bone into the marrow cavity. These implants are made of stainless steel, high-strength alloy metal, or titanium.

All such implants made in the last 15 years are compatible with the strong magnets that are used for magnetic resonance imaging (MRI). Most will not set off security devices at airports.

A joint replacement procedure (arthroplasty) may need to be performed when fractures severely damage the upper end of the femur (thighbone) or humerus (armbone) that form the outer half of the hip & shoulder joints.

Bone grafting may be used to assist healing of fractures initially, if the gap between fragments is too large, or later, if the healing process has slowed (delayed union) or stopped (nonunion).

Treatment of Complications

For compartment syndrome, initial treatment consists of immediately removing or loosening anything that may be confining the limb, such as a splint or a cast. When the muscle compartment continues to cause increased pressure, an emergency surgery called fasciotomy must be performed to open this constricting tissue.

Otherwise, the muscles & nerves could die because of a lack of oxygen. If this occurs, it may be necessary to amputate the limb.

Pulmonary embolism can be prevented with drugs such as heparin, low-molecular-weight heparin, warfarin.

Some Trade Names

COUMADIN & fondaparinux (a new drug similar to heparin). These drugs reduce the tendency of the blood to clot & are given to people with fractures that put them at risk of forming a pulmonary embolism. If an embolus occurs, emergency treatment is needed (see Pulmonary Embolism: Treatment).

Rehabilitation & Prognosis

Children's fractures heal much faster & more perfectly than adult fractures do. Several years after most fractures in children, the bone can look almost normal on x-ray.

In addition, children develop less stiffness with cast treatment & are more likely to regain normal motion if a fracture involves a joint.

Healing in older people is often slower than in younger adults. Fractures significantly impair an older person's ability to perform normal daily activities. Diminished strength, flexibility & balance can impair a person's independence in eating, dressing, bathing & even walking (if the person is dependent on a walker).

Nonuse of muscles can lead to stiffness, weakness & further impairment. Nurses & caregivers must assist older people in regaining their ability to perform normal daily activities.

Older people with poor circulation are at risk for bedsores when an injured limb rests on the cast (see Peripheral Arterial Disease: Diagnosis). The areas in which the skin is in contact with the cast (contact points) - especially the heels - should be padded & inspected diligently for any sign of skin breakdown.

Nurses & caregivers should be sure an older person periodically changes position to avoid stiffness. For example, prolonged sitting can lead to the hip & knee becoming fixed in a bent position.

Periods of standing & walking or, in someone who is bedridden, lying down supine with the legs straight, alternating with periods of sitting with the knees bent, can help to prevent stiffness.

After surgery, people with leg fractures usually start walking with crutches or a walker for a time. Sometimes supplemental casting is needed as well. Healing time varies from days to weeks to months, depending on the nature of the fracture.

People with arm fractures have similar initial activity restrictions.

Stiffness & loss of strength are natural consequences of immobilization. A joint of a fractured limb immobilized in a cast becomes progressively stiffer each week, eventually losing its ability to fully extend & flex.

Wasting away of muscle (atrophy) also can be severe. For instance, after wearing a long leg cast for a few weeks, most people can insert their hand into the formerly tight space between the cast & their thigh.

When the cast is removed, the weakness resulting from muscle atrophy is very apparent.

Daily exercise using range-of-motion & muscle-strengthening exercises (see Rehabilitation: Muscle-Strengthening Exercises) helps to combat stiffness & regain strength.

While the fracture is healing, the joints outside the cast can be exercised. The joints within the cast can't be exercised until the fracture has healed sufficiently & the cast can be removed.

When exercising, the person should pay attention to how the injured limb feels & avoid exercising too forcefully. Passive exercises (in which a therapist applies external force (see Increasing the Shoulder's Range of Motion) must be used when muscles are too weak for effective motion & when strong muscle contractions might displace a fracture.

Ultimately, active exercise (in which the person uses his own muscle force) against gravity or weight resistance is necessary to regain full strength of an injured limb.

slowly absorb the information....

Taking Care of a Cast

  • When bathing, enclose the cast in a plastic bag & carefully seal the top with rubber bands or tape. Commercially available waterproof covers are convenient to use & are more fail-safe. If a cast becomes wet, the underlying padding may retain moisture. A hair dryer can remove some dampness. Otherwise, the cast must be changed to prevent the breakdown of skin.

  • Never push a sharp or pointed object down inside the cast (i.e., to scratch the skin).

  • Check the skin around the cast every day & apply lotion to any red or sore area.

  • When resting, position the cast carefully, possibly using a small pillow or pad, to prevent the edge from pinching or digging into the skin. Chafing or pressure sores may develop where the skin is in contact with the edge of the cast. If the edge of the cast feels rough, it can be padded with soft adhesive tape, moleskin, tissues, or cloth.

  • Elevate the cast regularly, as directed by the doctor, to control swelling.

  • Contact a doctor immediately if the cast causes persistent pain or excessive tightness. Pressure sores or unexpected swelling may require immediate removal of the cast.

a personal note to my visitors:
Right now, (at this writing 9/10/06) I'm still experiencing the after effects of my own injury 3 years ago when I broke my tibia & fibula in a very serious break over a very small fall. It all came down to the position of my foot during the fall causing an extreme amount of torque on my leg... SNAP!!!! .... I heard it break before I felt it!
Just as described briefly above, I ended up with a nonunion fracture! It simply stopped healing. It was horrible. I was non-weight bearing for almost 1 1/2 years and then partially able to hop around for another six months. For two years of my life I had to live on the main level of our home, which included visiting the bathroom, from the living room and sometimes the dining room and kitchen. I couldn't get around very well through our very small house in a wheel chair.
It was a very traumatic time in my life and in the lives of all my family members.
After one experiences an injury of this magnitude, it's extremely difficult to go back to a normal life once the injury finally heals. Sometimes there are physical limitations that can't be corrected. Sometimes, just as I had to, people have to learn how to walk all over again. Quite often a persons' weight has been elevated from no physical activity over such a long time period.
Having an injury like this is a mind game! Your mental health may be affected as well. It's difficult to manuever your mind back into action to restore confidence and self esteem, once you can go out of your home again on your own. It's hard!!!
Exercise is difficult to incorporate into your life. You know in your head that you've gained weight that needs to come off your body, but it's so difficult to get up and get moving because of the extreme sedantary lifestyle you've had for a few years of your life. You've established survival habits that now must be stopped and new healthy and independent habits must be developed!
It's part of your true strength in journey when the time comes to stop making excuses for yourself and grab onto the bull by the horns and step out of your comfort zone. That's right, I'm included. It's time to put your nose to the grindstone, gather up your information, make a plan and work out some goals, organize, prioritize, get it together, quit blaming, excusing and rationalizing. Stop denying that you must overcome this problem! It's time to be happy and wholesome!
So - if you have had an injury, medical condition including a mental health factor, trauma, crisis, disaster, divorce or just old age pain... don't speak... just do.... it will be great if you just plunge into it then get your bearings and trust it.
Let's look at some more problems! Kathleen

Benefits of Exercise

Regular exercise makes the heart stronger & the lungs fitter, enabling the cardiovascular system to deliver more oxygen to the body with every heartbeat & increasing the maximum amount of oxygen that the body can take in & use.

Exercise lowers blood pressure & reduces the levels of total & low density lipoprotein (LDL) cholesterol (the bad cholesterol), which in turn reduces the risk of heart attack, stroke & coronary artery disease.

Other conditions that are less likely to occur with regular exercise include colon cancer & some forms of diabetes.

Exercise makes muscles stronger, allowing people to perform tasks that they otherwise might not be able to do. Most everyday tasks require muscle strength & good range of motion in joints & regular exercise can improve both.

Exercising stretches muscles & joints, which in turn can increase flexibility & help prevent injuries. Weight-bearing exercise strengthens bones & helps prevent osteoporosis. Exercise can improve function & reduce pain in people with osteoarthritis, although exercises that put undue stress on joints, such as running, may need to be avoided.

Exercise increases the body's level of endorphins. Endorphins are chemicals in the brain that reduce pain & induce a sense of well-being. Thus, exercise appears to help improve mood & energy levels & may even help alleviate depression. Exercise also helps boost self-esteem by improving a person's overall health & appearance.

Besides the ways in which exercise benefits people of any age, regular exercise helps older people remain independent by improving functional ability & by preventing falls & fractures. It can strengthen the muscles of even the frailest older person living in a nursing home. It tends to increase appetite, reduce constipation & promote sleep.

The benefits of exercise diminish within months after a person stops exercising. Heart strength, muscle strength & the level of high-density lipoprotein (HDL) cholesterol (the good cholesterol) decrease, whereas blood pressure & body fat increase.

Even former athletes who stop exercising don't retain measurable long-term benefits. They have no greater capacity to perform physical activities & no fewer risk factors for heart attacks those who've never exercised, nor do they regain fitness any faster.

Athletic Heart Syndrome

Athletic heart syndrome refers to the normal changes that the heart undergoes in people who regularly perform strenuous aerobic exercise (i.e., very well conditioned athletes).

In a person with athletic heart syndrome, the heart is larger & its walls thicker than in nonathletes. The chambers inside the heart, thru which the blood passes, get somewhat larger.

This increase in size & thickening of walls allow the heart to pump out substantially more blood per heartbeat without much increase in heart rate. The large volume of blood flowing thru the heart results in a slower, stronger pulse (which can be felt at the wrist & elsewhere on the body) & sometimes in a heart murmur.

These murmurs, which are specific sounds created as blood flows thru the valves of the heart, are perfectly normal in an athlete & aren't dangerous. The heartbeat of a person with athletic heart syndrome may be irregular at rest but becomes regular when exercise begins. Blood pressure is virtually the same as in any other healthy person.

The enlarged heart can be seen on a chest x-ray. A variety of changes are detectable on an electrocardiogram. These changes would be considered abnormal in a nonathlete but are perfectly normal in the athlete with athletic heart syndrome.

When an athlete stops training, the athletic heart syndrome slowly disappears - that is, heart size & heart rate tend to return gradually to that of the nonathlete.

Athletic heart syndrome isn't thought to affect health in any way. They're sudden deaths of athletes are usually due to underlying heart disease that wasn't previously detected rather than to any danger resulting from athletic heart syndrome.

personal note added here...

I can understand how some people who may have been told that they have a heart murmur would have some fear in thinking of exercising too strenuously. I can understand the underlying words going thru your minds if you have any chronic physical ailment that may keep you from making the "action" part of your desire to exercise from happening.

It's to you... all you people who desperately want to get up out of your chairs, away from your computer, up & outside your house for a walk, just a simple little walk, 15 minutes to start.... who have this underlying fear of not being able to do it. A fear that you'll get 5 minutes down the sidewalk & you won't be able to make it back; or any other fear that runs thru your minds.... it's to you this page is for.

This page is especially for you. Just for you because you are so special, so in need, and so urgently hoping with everything within you that you can someday put your first step outside your door to take that first 5 minute walk, and then do it again the next day and the next. It's for you that need to simply bend over and touch your toes that very first time ... after wanting or needing really to do exercises right in the comfort of your living room.

I can understand because I am one of you. I am here with the same underlying apprehensions, fears and anxieties. I am here dealing with the same discomforts of an existing injury that made my life different, never again free from pain while exercising. I'm here and I'm thinking about you. I'm thinking about you and praying for you as well. I know we can do it... we all just have to put our minds into it. It doesn't have anything to do with that first move to reach out and stretch... it has everything to do with our thoughts, our will, and our individual growing respect we must acquire for our own bodies and selves.


Choosing the Right Exercise

There are many forms of exercise & each type of exercise has its advantages & disadvantages; i.e., 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 burns fewer calories than does running. Swimming rarely results in muscle tears, because the muscles are supported by the water.

However, because swimming isn't a weight-bearing exercise, it doesn't help prevent osteoporosis. Bicycles are pedaled in a smooth circular motion that doesn't jolt the muscles, but bicycling requires balance & it isn't always possible to enjoy this sport free of traffic & the dangers of cars.

Other choices regarding exercise exist as well. Some people prefer to exercise in a gym or at home, whereas others prefer to exercise outdoors.

Some people have a very structured exercise routine, whereas others simply incorporate exercise into their lifestyle, i.e., by walking rather than driving. click here to read more about that! Choosing the right exercise is a matter of finding an activity that's fun, safe & sustainable.

Walking is a well-balanced form of exercise for most people, regardless of age. Many older people are able to keep fit thru regular walking programs.

However, walking slowly will not make a person very fit. To walk faster, a person can take longer steps in addition to moving the legs faster. 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 don't reach as far forward as they would if they were pointed straight ahead.

Therefore, a walker should always try to point the toes straight ahead. Moving the arms faster helps the feet move faster. To move the arms faster, a person bends the elbows to shorten the swing & reduce the time the arms take to swing back & forth from the shoulder.

People with instability or severe joint injury may find walking difficult.

personal note regarding the above statement:

If your doctor has cleared you for walking remember this...

Every person who feels slightly instable in balance or who has severe joint pain may find the initial days extremely uncomfortable feels as though there is no use in exercising or trying to take that 5 minute walk. Although you may not receive the optimal benefits of physical conditioning thru your walk or your initial attempts to walk, you are still getting outside, you are still absorbing sunshine, you are still breathing in fresh air and the emotional benefits are astounding!

I love to be outside although I can't walk far. I just need to make myself go as far as I can and then take one or two steps further each day to develop more strength. Walking may not be the right exercise for me to develop physical conditioning but mentally, being outside and combining any kind of movement possible is worth every effort I make.


Swimming exercises the whole body - the legs, arms & back -without stressing the joints & muscles. Often, swimming is recommended for people who have muscle & joint problems.

Swimmers, moving at their own pace & using any stroke, can gradually work up to 30 minutes of continuous swimming. If weight loss is one of the main goals of exercise, however, swimming isn't the best choice.

Exercise out of water is more effective because air insulates the body, increasing body temperature & metabolism for up to 18 hours. This process burns extra calories after exercise as well as during exercise.

In contrast, water conducts heat away from the body, so that body temperature doesn't rise & metabolism doesn't remain increased after swimming.

personal note again... but if swimming is the most comfortable for you... please swim anyway! It's beneficial to have an exercise that is also fun and enjoyable. It also builds stamina that will enable you to perform another type of exercise that may be more physically beneficial to meet your individual goals.

Riding a bicycle is good exercise for cardiovascular fitness. Pedaling a bicycle strengthens the upper leg muscles. 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 they progress, riders can gradually increase the tension & the cadence up to 90 rotations per minute. A regular bicycle adds the challenges & joys of balance & coping with changes in terrain but adds the dangers of dealing with traffic.

However, some people can't maintain their balance, even on a stationary bicycle & others will not use one because the pressure of the narrow seat against the pelvis feels uncomfortable.

A recumbent stationary bicycle is both secure & comfortable. It has a contoured chair that even a person who has had a stroke can sit in. 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, many of whom have weak upper leg muscles. As a result of having weak upper leg muscles, many older people have difficulty rising from a squatting position, getting up from a chair without using their hands, or walking up stairs without holding on to the railing.

Aerobic dancing, a popular type of exercise offered in many communities, exercises the whole body. People can exercise at their own pace with guidance from experienced instructors.

Lively music & familiar routines make the workout fun & committing to a schedule & exercising with friends can improve motivation. Aerobic dancing also can be done at home with videotapes. Low-impact aerobic dancing eliminates the jumping & pounding of regular aerobic dancing, thus decreasing stress on the knee & hip joints.

However, the benefits of aerobic dancing, especially in terms of weight loss, are proportional to the intensity.

Step aerobics stresses primarily the muscles in the front & back of the upper legs (the quadriceps & hamstrings) as a person steps up & 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 & return to step aerobics a couple of days later.

Water aerobics is an excellent choice for older people & for those with weak muscles because it prevents falls on a hard surface & provides support for the body.

It's often used for people with arthritis. Water aerobics involves doing various types of muscle movements or simply walking in waist- to shoulder-deep water.

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. 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.

Rowing strengthens the large muscles of the legs, shoulders, and back and helps protect a healthy back from injury. 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, a person who has back problems should not row without a doctor's approval.

Resistance training is an anaerobic exercise meant to build strength and muscle mass. It is far more effective than other forms of exercise for achieving these goals but is less effective than aerobic exercise for burning calories (and thus losing weight) or improving cardiovascular performance at similar intensity. However, increased muscle mass may eventually help maintain a lean body weight, because muscle uses more calories than fat. The aerobic component of resistance training can be increased by increasing the repetitions performed at each station and by decreasing the time for rest between each set.

Weight lifting carries a higher risk of injury to muscles and joints if exercises are not done properly. Most people who intend to lift weights benefit from initial supervision that includes instruction on how to set the weights and seat levels and how to breathe during repetitions (out as one pushes or pulls; in during relaxation). For most people, weights should be set so 10 to 15 repetitions of each exercise can be performed. Weights that are too heavy increase the risk of injury. The part of the body trained should be varied so that a particular body part is not exercised more than every few days.

another personal notation!
Recognize your individual attempts for exercise - give yourself permission to be happy about the 10 minutes that you walked in that individual attempt to do what you need to do.
Eliminate the word, "should" from your vocabulary. "I should really get out an walk again today." The word "should" evokes feelings of guilt into your mind - which is somewhere you just don't want to go to. Why deal with feelings of guilt as well as the apprehension you are already feeling about exercise? With little words you use in your vocabulary, you are setting yourself up for failure without realizing it.
I "need" to walk for 5 minutes today is more self assuring. It says what it means. You do need to walk for 5 minutes. Once you know that you need to do something it becomes a normal task like brushing your teeth. Think of your 5 minute walk that will lead to a 6 minute walk eventually as a simple task - like brushing your teeth, combing your hair, doing the dishes. It's an everyday simple task that you need to get done!
p.s. Take the time right now to click on the underlined link words. I know that you know the meaning of the word "recognize," but the magic of the English Language has so many emphasis and meanings on certain words that you may not realize the simple strength that the word, "recognize" can have. Recognizing things can make a huge difference in your life. How you recognize your accomplishments, recognize the true need for exercise and recognize what you need to fight every time you begin to think about exercising can set you up for success instead of disappointment in yourself.

Preventing Injury

More than 6 out of 10 people who start an exercise program drop out in the first 6 weeks, often because of an injury. Injuries can be prevented by scheduling workouts 48 hours apart, as described above. In addition, people should stop exercising immediately if they feel pain.

Two types of muscle discomfort may be felt after exercise. The desirable type, delayed-onset muscle soreness, does not start until several hours after exercising intensely. Usually it affects both sides of the body equally, goes away 48 hours later, and feels better after the warm-up for the next workout. The undesirable type, in which pain indicates injury, is usually felt soon after it occurs, is worse on one side of the body, does not disappear 48 hours later, and becomes much more severe if a person tries to exercise.

Injury is best prevented by warming up the muscles before exercising, followed by stretching and cooling down after exercising.

Warming Up Starting exercise at lower intensity (for example, walking rather than running or using lighter weights) raises the temperature of muscles by increasing blood flow. Warm muscles are more pliable and less likely to tear than cold muscles, which contract sluggishly. Therefore, warming up helps prevent injuries.

Stretching Stretching lengthens muscles and tendons, and thereby improves flexibility. Longer muscles can generate more force around joints, helping a person jump higher, lift heavier weights, run faster, and throw farther. However, stretching, unlike exercising against resistance (as in weight training), does not strengthen muscles. There is scant evidence that stretching prevents injuries or delayed-onset muscle soreness, which is caused by muscle fiber damage. A person should stretch only after warming up or exercising, when the muscles are warm and less likely to tear.

Cooling Down Slowing down gradually (cooling down) at the end of exercise helps prevent dizziness. When the leg muscles relax, blood collects (pools) in the veins near them. To return the blood toward the heart, the leg muscles must contract. When exercise is suddenly stopped, blood pools in the legs and not enough blood goes to the brain, causing dizziness. By preventing blood from pooling, cooling down also helps the bloodstream to speed up its removal of lactic acid, a waste product that builds up in the muscles after exercise. Lactic acid does not cause delayed-onset muscle soreness, so cooling down does not prevent this soreness.

Specific Problems
For many problems - i.e., heart disease, stroke & other brain injuries, spinal injuries, hip fracture, amputation & loss of hearing, speech, or vision - specific rehabilitation programs are available.
Rehabilitation is sometimes needed for other types of fractures (see Fractures: Rehabilitation & Prognosis).

Heart Disease

Cardiac rehabilitation may be useful for some people who've had a recent heart attack (see Coronary Artery Disease: Rehabilitation), a sudden onset or worsening of heart failure, or cardiac surgery.

The goal is to maintain or regain independence, at least with activities of daily living, within the constraints of abnormal heart function.

Remaining in bed for longer than 2 or 3 days can lead to deconditioning & even depression. Therefore, cardiac rehabilitation is started as soon as medical care for an event such as a heart attack has been stabilized, usually while the person is still in the hospital.

Rehabilitation programs typically begin with light activity, such as transferring to & sitting in a chair. When these activities can be performed comfortably, usually by the 2nd or 3rd day, more moderate activities, such as dressing, grooming & walking short distances, are begun.

If fatigue or discomfort occurs as a person increases his activity (i.e., walking the length of the hall), the person is instructed to stop immediately & rest until symptoms disappear. The doctor then reassess the person's readiness to continue rehabilitation.

After discharge, the amount & intensity of activity is slowly increased & a full range of normal activities can be resumed after about 6 weeks.

However, most people benefit from an outpatient cardiac rehabilitation program, which is usually about 12 weeks long, because of the instruction & monitoring they receive. Cardiac rehabilitation programs include help with handling the psychologic effects of having had a heart attack or heart surgery.

They also include instruction about why changes in lifestyle are necessary & how to make them - so that risk factors are modified. Quitting smoking, losing weight, controlling blood pressure, reducing blood cholesterol levels thru diet or drugs & performing daily aerobic exercises all help prevent or slow the progression of coronary artery disease & reduce the risk of another heart attack.

Similarly, modification of risk factors may help slow the progression of heart failure.

Brain Injuries

Rehabilitation can help people who have had a stroke or other brain injury regain some or all of their functional abilities. Although rehabilitation helps people recover lost function, the extent of functional recovery depends heavily on the brain's natural repairing of the damaged area.

Most of this natural healing process occurs during the first 6 months after the stroke or injury but may continue for as long as 2 years. The amount & rate of natural healing can't be predicted with certainty. Because of this unpredictability & to prevent other disabilities (such as muscle contractures) & depression, rehabilitation is begun as soon as the person is medically stable.

What part of the brain was injured affects what functions are lost. A detailed evaluation of the person, including psychologic testing, helps the rehabilitation team identify the type & severity of damage.

The members of the rehabilitation team then assess which lost functions may benefit from rehabilitation therapy & create a program addressing the person's specific needs. The success of rehabilitation depends on the person's general condition, range of motion, muscle strength, bowel & bladder function, functional ability before the brain injury, social situation, learning ability, motivation, coping skills & ability to participate in a rehabilitation program.

The damaged areas of the brain after stroke are limited to where the blocked or bleeding arteries are located in the brain. Thus, the area damaged & the symptoms of stroke are relatively well defined. The extent of brain damage due to a traumatic brain injury depends on the severity & direction of force & what part of the brain was injured.

The brain can also be injured during surgery performed to remove a brain tumor. The extent & location of the surgery determine what functional problems a person will have afterward.

Some people require joint movement to prevent or relieve contractures. Others need coordination exercises. Because stroke often causes one-sided paralysis, exercise of the unaffected arm or leg is usually encouraged.

The person is expected to practice other activities as well, such as moving in bed, turning, changing position & sitting up. Regaining the ability to get out of bed & to transfer to a chair or wheelchair safely & independently is important to a person's physical & mental health.

Rehabilitation therapists treat problems with walking, lack of coordination, spastic muscles, vision problems (including partial or complete blindness in one or both eyes) & speech problems with specific therapies.

For example, an ambulation exercise program is begun for people who are having trouble walking; this program may include learning how to prevent falls. Heat or cold therapy may temporarily decrease spasticity in muscles & allow muscles to be stretched.

People with one-sided blindness are given special training to avoid bumping into door frames or other obstacles. Fine motor coordination may be improved with occupational therapy.

Cognitive impairment can also occur with stroke & other brain injury, especially concussion (see Head Injuries: Concussion). Cognitive impairment can include problems with orientation, attention & concentration, perception, comprehension, learning, organization of thought, problem solving & memory.

However, not every person has all of these symptoms.

Cognitive rehabilitation is a very slow process, has to be tailor-made to each person's situation & requires one-on-one treatment. It encourages desirable behavior & discourages undesirable action through conditioning & repetition.

Spinal Injuries

Recovery from spinal cord injury depends on the location & degree of damage. The higher up the level of injury, the greater the physical impairment. Injury at the level of the chest or below usually involves weakness or paralysis of the legs (paraplegia).

Injury at the level of the neck usually involves weakness or paralysis of all 4 limbs (quadriplegia). If the level of injury is very high in the neck, the muscles that control breathing may be paralyzed & a ventilator may be needed to assist breathing.

If the spinal cord is completely severed or destroyed, the body below that level becomes paralyzed. If the spinal cord is partly severed or damaged, the body below that level becomes spastic. There is little or no skin sensation in the affected area. In almost all cases of spinal cord damage, bowel & bladder control are lost (incontinence).

The two most important aspects of caring for people with quadriplegia or paraplegia are preventing bedsores & maintaining joint mobility. To prevent bedsores, the person moves or is turned frequently & a special bed or bedding material is used (see Pressure Sores).

When the person is seated in a wheelchair, a special cushion is used. To maintain joint mobility & prevent spasticity, heat, massage & some medications are used.

A paraplegic person can live an independent life. Range-of-motion & strengthening exercises of the arms & hands enable the paraplegic person to use a wheelchair & to transfer from bed to a wheelchair & from a wheelchair to a toilet or to a car seat.

A paraplegic person can be very independent in activities of daily living & many engage in gainful employment. Some paraplegics are able to drive a car with the help of assistive devices.

A quadriplegic person can use a motorized wheelchair for independent mobility, but the person must be lifted into the wheelchair manually or mechanically. Some quadriplegics can move their hands or fingers slightly, in which case they can operate the motorized wheelchair with a hand switch.

For quadriplegics whose hands & arms are completely motionless, a special device on the motorized wheelchair allows it to be controlled by chin movements or even by the person's breath, but this requires very intensive training.

People with quadriplegia generally need support 24 hours a day.

Hip Fracture

Rehabilitation therapy is begun as soon as possible after hip fracture surgery, often within a day. The initial goals of therapy are to maintain the level of strength the person had before the fracture occurred by preventing loss of motion and atrophy of muscle and to prevent problems that result from bedrest. An additional goal is to restore the person's ability to walk as well as he was able to before the fracture occurred.

As soon as possible, sometimes within hours of surgery, the person is encouraged to sit in a chair, which reduces the risk of bedsores and blood clots and eases the transition to standing. The person is taught to perform daily exercises to strengthen the trunk and arm muscles and is sometimes taught exercises to strengthen the large muscles of both legs as well.

Usually within the first day after surgery, the person is encouraged to stand up on the uninjured leg, often with the assistance of another person or while holding onto a chair or a bed rail. While performing these exercises, the person is directed to touch only the tips of toes of the injured leg on the floor. Full weight bearing on the injured leg is often encouraged on the second day after surgery but depends on the kind of fracture and repair.

Ambulation (walking) exercises are started after 4 to 8 days as long as the person can bear full weight on the injured leg without discomfort and has sufficient balance. Stair-climbing exercises are started soon after walking is resumed. In addition, the person may be taught how to use a cane or other assistive device and how to reduce the risk of falls.

Arm and Leg Amputation

Most arm amputations result from accidents. A small number are performed surgically to treat a medical condition (for example, to remove a cancerous tumor). The arm can be amputated below the elbow, above the elbow, or at the shoulder.

After amputation, a person is usually fitted for an artificial arm (an upper extremity prosthesis). The prosthesis consists of a terminal device (a hook or hand), a wrist unit, an elbow unit for an above-the-elbow amputation, and a socket. Movement of the hook or hand is controlled by movement of the shoulder muscles. A hook may be more functional, although most people prefer the appearance of a hand. Control of an above-the-elbow prosthesis is more complicated than that of a below-the-elbow prosthesis. Recently, battery-operated and microcomputer-controlled prostheses have been developed, allowing a person more precisely controlled movements.

Rehabilitation after arm amputation includes general conditioning exercises, stretching of the shoulder and elbow, and strengthening of the arm muscles. Endurance exercises may also be necessary. The specific exercise program prescribed depends on whether one or both arms were amputated and whether the amputation was above or below the elbow.

Leg amputations occur almost equally as the result of an accident or as a surgical procedure performed to treat a consequence of a medical condition (for example, as the result of poor blood supply due to diabetes). The leg can be amputated below the knee, above the knee, or at the hip.

An artificial leg (a lower extremity prosthesis) consists of the terminal device (foot), a knee unit for an above-the-knee amputation, and a socket. Newer prostheses, which are battery operated or microcomputer controlled, allow a person to control movements with more precision.

Rehabilitation after leg amputation includes exercises for general conditioning, stretching of the hip and knee, and strengthening of all arm and leg muscles. The person is encouraged to begin standing and balancing exercises with parallel bars as soon as possible. Endurance exercises may be needed. The specific program prescribed depends on whether one or both legs were amputated and whether the amputation was above or below the knee.

Contracture (a shortening of muscle, producing limited range of motion) develops easily at the amputated limb, hip, or knee joint and usually results from prolonged sitting in a chair or wheelchair or improper body positioning in bed. If contracture is severe, a prosthesis may not fit properly, or the person may lose the ability to use a prosthesis. Therapists or nurses must teach methods of preventing contracture.

Therapists help people learn how to condition the stump, which promotes the natural process of stump shrinking (which must occur before a prosthesis is fitted). An elastic stump shrinker or bandages worn 24 hours a day can help taper the stump and prevent fluid buildup in the tissues. Early walking with a temporary prosthesis helps shrink the stump as well. Various temporary prostheses with adjustable sockets are available. A person with a temporary prosthesis can start ambulation exercises on parallel bars and progress to walking with crutches or a cane until a permanent prosthesis is made.

If the prosthesis is made before the stump stops shrinking, adjustments may be needed for comfort and to allow a good gait pattern. Manufacture of a permanent prosthesis is generally delayed for several weeks to allow the stump time to shrink completely.

Therapists teach amputees how to walk with a prosthesis. Strength and balance training are included in the program. Walking begins with direct assistance and progresses to walking with a walker, then with a cane. Within a few weeks, many amputees walk without a cane. The therapist teaches the amputee to use stairs, walk up and down hills, and traverse other uneven surfaces. Younger amputees may be taught to run and indeed participate in many athletic activities. Progress is slower and more limited for those who have above-the-knee amputation, for older people, and for those who are weak or poorly motivated.

The prosthesis needed for an above-the-knee amputation weighs much more than that for a below-the-knee amputation, and controlling a prosthetic knee joint requires skill. Walking requires 10 to 40% more energy after below-the-knee amputation and 60 to 100% more energy after above-the-knee amputation.

After arm or leg amputation, a sensation called "phantom limb" may be experienced, in which the person feels as if he still has the amputated limb. When this sensation occurs in the case of an amputated leg, for example, the person may stand up and thus fall back down. This kind of accident usually occurs at night when the person wakes to use the bathroom. Phantom limb can be extremely painful (phantom limb pain). Use of a prosthesis seems to accelerate the disappearance of a phantom limb. Massaging the stump also often helps.

Speech Disorders

Aphasia Aphasia is a defect or loss in the ability to comprehend or express words, often resulting from a stroke or another type of brain injury that affects the language center in the brain (see When Specific Areas of the Brain Are DamagedFigures).

The goal of therapy for people with aphasia is to establish the most effective means of communication. For people with mild impairment, the speech therapist uses an approach that emphasizes ideas and thoughts rather than words. Pointing to an object or picture, gesturing, nodding, and relying on facial expressions are often sufficient for rudimentary communication. For people with more severe impairment, a stimulation approach (in which words are repeatedly spoken to the person) and a programmed stimulation approach (in which words are spoken and objects are presented that can be touched and seen) help the person reacquire language ability. Caregivers of an aphasic person need to be very patient and appreciate the person's frustration. Caregivers must also realize that an aphasic person is not demented and should not be spoken to in baby language, which is insulting. Instead, the caregiver must speak normally and, if necessary, use gestures or point to objects.

Dysarthria Dysarthria is an inability to articulate words properly because of problems in muscular control caused by damage to the nervous system. Rehabilitation goals depend on the cause of the dysarthria.

If the cause of dysarthria is stroke, head trauma, or brain surgery, the goal is to restore and preserve speech. For mild cases of dysarthria, repetition of words or sentences may sufficiently allow the person to relearn how to use facial muscles and the tongue for proper pronunciation. For severe cases of dysarthria, a letter or picture board or electronic communication device may be helpful.

If the dysarthria is caused by a progressive problem with the nervous system, such as amyotrophic lateral sclerosis (Lou Gehrig's disease) or multiple sclerosis, the goal of therapy is to maintain speech function for as long as possible. The person exercises to increase control of the mouth, tongue, and lips and is taught more appropriate speech rate and proper phrase length. Poor control of breathing muscles may force the person to take a breath in the middle of a sentence. Breathing exercises and planning punctuation within a sentence are helpful.

Verbal Apraxia A person with verbal apraxia cannot produce the basic sound units of speech because of an abnormality in initiating, coordinating, or sequencing the muscle movements needed to talk. Verbal apraxia is often caused by brain injury, such as occurs with stroke or head trauma. In one therapeutic approach, the therapist has the person practice making sound patterns over and over again. In another approach, the therapist teaches the person to use natural melodic patterns for common phrases. Every phrase has its own melodic rhythm depending on the mood of the speaker. For example, "Good morning! How are you?" can be said in a flat melodic patter if the speaker is not up in the mood. However, when these phrases are said in a very cheerful manner, there is almost musical melodic rhythm. In treatment of verbal apraxia, the practitioner encourages the patient to repeat very exaggerated natural melody and rhythm patter. As the patient progresses, melody and rhythm cues are gradually faded.


For rehabilitative purposes, blindness is classified into two groups: blindness present at birth (congenital) or at a very young age and blindness that develops later in life. Children who are born blind or who become blind at a very young age usually receive special education and become well adjusted. People who become blind later in life, however, must learn new ways of dealing with daily living. One activity of daily living, feeding oneself, is commonly taught to blind people with use of the clock method, in which, for example, the dinner plate is located at 6 o'clock, the salad plate at 3 o'clock, and the beverage at 9 o'clock. The person also has to learn how to use a cane, and family members and other caregivers must learn how to walk with the blind person. The family is also instructed not to change the location of furniture or other objects without telling the blind person. Use of a seeing eye dog and learning Braille come much later. In the interim, audio books help the blind participate in reading.

Hearing Loss

Aural rehabilitation is used for people who became deaf in adulthood. Those deaf at a young age receive training in school. Rehabilitation teaches lip reading and how to optimally use a hearing aid (see Hearing Aids: Amplifying the SoundFigures). Training also teaches the deaf person how to modulate his speaking volume, since without training a deaf person tends to speak loudly. Therapists can also recommend other assistive devices, such as door bells, phones, and alarms that display a flashing light when they ring.

Enter content here

9 Least Effective Exercises
Experts name their top picks for fitness moves that are best to avoid.

Experts explain why some people should try for 30 minutes of exercise a day, while others need up to 90 minutes.

The Skinny on Diet Scams

Experts weigh in on the top 5 diet scams and howThe Skinny on Diet Scams

Lifestyle Activity As Healthy As A Gym Workout
by Carol Krucoff

One woman started walking laps around the soccer field instead of sitting during her child's practice. One man stopped driving to restaurants for lunch & started walking to lunch instead.

These were some of the small changes that added up to major health benefits for participants in Project Active, a 2 year study conducted at the Cooper Institute for Aerobics Research in Dallas. Researchers randomly assigned 235 sedentary men & women into 2 groups:

  • a lifestyle group that learned behavioral skills to help them gradually fit more physical activity into their daily routines
  • a structured group that used a fitness center to do traditional forms of vigorous exercise such as aerobics, swimming, stair climbing & walking

The results suggest that lifestyle activity is as effective as a structured exercise program in improving health.

i.e., both groups:

  • decreased body fat by "about one clothing size 
  • 2.4% for the lifestyle group 
  • 1.9% for the structured group

notes the study's lead author, exercise psychologist Andrea Dunn.

"This is good news for people whose barriers to exercise may include lack of time, lack of access to facilities or dislike of vigorous exercise," says Dunn.

"Many people think exercise is an 'either - or' phenomenon, where you either go to the gym & work out for 30 minutes or you do nothing.

This study helps demonstrate that every step you take counts."

Many people don't realize how little physical activity they actually get & how important it is for them to use every opportunity they have to be active.

In fact, researchers estimate that adults burn an estimated 800 fewer calories (about the equivalent of four glazed donuts) per day than did previous generations, largely because technology has engineered physical activity out of our lives.

i.e., one 49-year-old aerospace engineer was able to drop 10 pounds & lower his cholesterol from 210 to 195 simply by taking a few extra steps at the office whenever he needed to use the restroom or get a bite to eat.

25 Ways To Add Movement To Your Day

Here's a starter list of 25 life "activating" strategies:

  • Don't use the nearest bathroom. Use one that requires you to walk a bit, preferably up or down some stairs.
  • Balance on one foot while brushing your teeth. Balance on the other foot while combing your hair.
  • Park in the furthest space.
  • Move with your kids. Instead of just watching soccer practice, walk up and down the sidelines. Join in your child's karate class. At the playground, get off the bench and swing, climb, hang and slide.
  • Hide your TV remote, so you have to get up and walk across the room to push the buttons.
  • Never take an elevator fewer than 3 flights, take the stairs.
  • Get rid of your electric can opener & use a manual one.
  • Turn your coffee break into a walk break. Walk to a distant vending machine, cafeteria or coffee shop to get your snack.
  • Stretch or walk while you're talking on the (cordless) phone, preferably with a headset.
  • Set an "activity" timer or program your computer to remind you to take periodic walking and/or stretching breaks.
  • Take a five-minute walk before you sit down to eat.
  • Walk or bike to do errands instead of driving.
  • Take a minute to stretch your arms, legs, back, shoulders and neck whenever you get up from sitting or lying down.
  • Sweep your floors, patio and/or front walk every day.
  • During TV commercials, get up and walk or get down and stretch.
  • Socialize actively. Instead of sitting and talking, go for a walk with family and/or friends. Or go bowling, play Ping-Pong, basketball, bocce ball or line dancing.
  • Put your favorite mug on a very low shelf, so you'll have to squat down to get it out and put it back.
  • Take your dog for a walk every day. If you don't have a dog, borrow your neighbor's, or just walk your "inner dog."
  • Practice "aerobic shopping" by taking a lap around the mall or grocery store before you go into a store or put an item in your cart.
  • Avoid "drive-thrus." Park your car and walk in.
  • Practice good posture when you're forced to wait in line. Stand firmly on both feet and try to raise the top of your head to touch an imaginary hand held a quarter-inch above you. Let your spine extend, stomach lift, shoulders relax and arms fall at your sides.
  • Don't automatically drive. If the dry cleaner is across the parking lot from the bank, walk there. (Wear decent walking shoes or keep a good pair in your car.)
  • Install a chin-up bar in a convenient doorway, then use it often to chin-up, pull-up or simply hang.
  • Try musical housework. Put on dancing music and sweep, vacuum or wash windows to the beat.
  • Every time you hear a bell ring (phone bell, doorbell, church bell, etc.) take a deep breath and smile. Think of it as "mouth yoga" that relaxes hundreds of muscles in your face. And it's contagious, so pass it on.

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