Author: S. Bledsoe, M.D.
Sometimes the thought of starting an exercise program can be overwhelming. I’ve had people in my office express significant concerns over how far they have to go in order to achieve health. They had let themselves deteriorate to the point that they would be 150 pounds overweight, and their physical fitness suffered greatly. A flight of stairs looked like the Matterhorn to them. Walking from their car to the entrance to the grocery store seemed like an eternity. Even tying their shoes would leave them breathless.
I’ll never forget one former Marine who came into my office. He was over 60 and needed to lose about 125 pounds. His diabetes was out of control. He blood pressure was steadily climbing. He said the final straw that drove him to pursue bariatric surgery was a vacation he took to see his daughter. He had to stay in their house most of the time. At Wal-Mart, they had to get him a motorized cart to help him get around. When he tried to carry his 4 year-old granddaughter from the car into the house, he didn’t have the strength to do even that. This proud ex-Marine cried like a baby at where he found himself. “Doc, I’ll be dead in a year if I don’t do something!” The crazy thing is, he was probably right.
Where do you start someone like this? If you are so deconditioned that you can’t walk around the grocery store, you are bad off. You may know a few people like this, but I often find people at this point. I am happy to say that no matter where you are starting, we can improve on your fitness with this 3-step approach.
Some common sense advice to start, get a physical from a physician prior to beginning any exercise program. If you have spent the past decade on the couch, make sure that you are safe to begin exercising. Get your heart checked out. If you are having symptoms of heart disease, you may need medications or interventions prior to beginning. If you are over 50 or extremely unfit, do not skip this step. After a qualified physician has examined you and determined that you are safe to begin, go Level 1.
Level 1- buy a good pair of walking shoes and begin walking every day. If you can only walk for 5 minutes, walk for 5 minutes multiple times a day. Each day try to add one minute onto your times. Continuously add time and distance until you can walk for an hour. This may take a few months, but keep at it. If you can walk for an hour, you have a relatively good baseline of aerobic fitness.
Many of my patients present with significant joint issues that limit their ability to walk. For these, water aerobics is perfect. The water creates buoyancy and lessens the pressure on hips and knees. If they don’t have access to a pool, I tell them to purchase an arm bike. Occasionally, I get excuse after excuse as to why they can’t exercise. It’s almost like they want an exemption from exercise because of their situation. I tell them the only people who can’t exercise are quadraplegics, so they need to exercise. Everyone can do something.
Make sure during this phase that you are warming-up well and stretching in order to avoid injury. Once you have a baseline of aerobic fitness and reasonable flexibility, it is time to proceed to Level 2.
Level 2- begin resistance training. The benefits of resistance training have been shown to be significant and independent from your aerobic fitness. Many of the aging effects are the result of decreasing muscle mass as we grow older. I also recommend a personal trainer at this level. Stepping into a gym and seeing all the options will often paralyze you into doing little to nothing. A personal trainer will provide you with a lot of information, set up a regiment, and teach you safety and proper form.
At this point, you are improving your flexibility with sensible stretching, increasing your aerobic capacity with aerobic training, and adding muscular strength with resistance training all under the watchful eye of a personal trainer. After 2-3 more months at this point, you are ready for Level 3.
Level 3- your final work-outs will be changed to be comprised of 4 components: high intensity, interval training, heavy weights, functional movements. It is beyond the scope of this article to fully describe each layer, but these 4 components will take your fitness to heights that you never thought possible. Don’t think of your aerobic fitness as separate from your muscular strength. View them as unified and work them simultaneously.
Crossfit is a great example of this, and I have written about Crossfit and the benefits of high-intensity interval training in other posts. Once you hit this level of fitness, you are beyond the vast majority of people. You may think that you can’t do it, but you can do it. Once you see the benefits, you won’t want to take a step back.
These are the three steps to fitness with your starting point being ground zero. Of course, everybody will progress through these steps at their own pace. Some people already have a decent level of fitness and strength. They should jump in at Level 3. For some, they may start at the beginning and progress to Level 3 in a month or two. For others, Level 3 doesn’t come for nearly a year. The amount of your deconditioning, your current health, and how hard you push yourself will determine how quickly you progress through the stages. Let me encourage you, though, to not stall at any level and be progressing to the final stage as quickly as possible.
As for my patient, today he is doing well. He has shed well over 100 pounds and hasn’t taken a drop of insulin in over a year. His friends can’t keep up with him, and he partakes in relatively vigorous exercise daily. It took the hard work, self-discipline, and a do-or-die attitude of an ex-Marine, but he did it! And so can you!