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Johns Hopkins Health - Spring into Shape!

Spring 2014
Issue No. 24

Spring into Shape!

Date: April 1, 2014

Want to get fit? Let a team of Johns Hopkins experts guide you


spring into shape

Every year around this time, the waiting rooms of doctors’ offices get a little more crowded, the appointments a little harder to come by.

“It’s spring, when people are looking at better weather,” says Andrew Cosgarea, M.D., director of the Johns Hopkins Division of Sports Medicine. “They’re optimistic and enthusiastic and they want to change things.”

No doubt, the motivation to change is a good thing—to get in shape for the warmer weather ahead, to drop a few pounds accumulated during winter. But it’s not good when you go charging out, without proper planning or preparation, trying to make up for what could be months, even years, of inactivity in a single, sun-splashed weekend.

“We have to remind people that getting in shape is not a sprint,” Cosgarea says. “It’s a marathon.”

That doesn’t mean you have to run long distances to get in shape, but you do need to think about your physical fitness as a long-term project. To help you make smart choices about starting and sticking with an exercise program, we’ve assembled a team of professionals to speak to the various facets of getting fit: exercise physiology, injury prevention, goal setting, nutrition, weight loss, and integration of activity into an overall healthy lifestyle.

Consider them your spring training team: Their evidence-based and experiential advice can help you spring into action—without having to make an unexpected stop at the doctor’s.

Get with the Program: Your Rx for Exercise
How much exercise do you need? How often? And what type? Kerry Stewart, Ed.D., director of clinical and research exercise physiology at Johns Hopkins, recommends that beginners shoot for the comprehensive physical activity guidelines recommended by such organizations as the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, the American Heart Association and the American College of Sports Medicine. Stewart has contributed to developing some of these guidelines, and his research has helped test their effectiveness in getting people fitter and healthier.

The guidelines recommend at least 150 minutes of moderate-intensity aerobic exercise each week (brisk walking, bicycling, jogging), preferably at least 30 minutes a day for five days; and resistance training, incorporating a regimen that works the major muscle groups, two sets per exercise, at least twice per week.

Stewart hastens to add that this kind of regimen is your goal, not your starting point. If you’ve been sedentary this past winter or are completely new to exercise, you should begin with whatever you can handle and gradually build up.

“Your workout needs to be more than you are accustomed to, but not too much more,” Stewart says. “You don’t start a weight-training program by getting on the bench press and trying to lift your body weight or by getting on the treadmill and cranking it up to maximum speed. You start slowly, at whatever load or intensity your body can handle, and progress gradually from there, making sure you have adequate rest or recovery between workouts.”

It’s generally preferable to follow this kind of structured program. And it’s even better to do so under supervision of a fitness professional, particularly for your weight training, where choosing the right movements and form comes into play. But you don’t need to join a fitness club or hire a personal trainer to get started. You can take the first steps toward better health by simply putting one foot in front of the other.

“Just getting out for a 15-minute walk in the morning and again at lunchtime or in the evening is a good way to start getting active,” Stewart says. “The 30 minutes of aerobics does not necessarily have to be done all at once. Two 15-minute walks can provide considerable health benefits.”

To develop muscular strength—so important to counter frailty as we age—add some calisthenics, using your own body weight as resistance, such as pushups and situps. “Even if that’s all you do,” Stewart says, “it will help maintain muscle strength and tone.”

No Excuses! Breaking Past the Barriers
Getting the benefits of physical activity requires consistency. The program you start for the spring shouldn’t end when the cold weather comes around again. You need to stick with it—and for a lot of people, that’s tough. There are lots of excuses for not exercising, and Akhil Chhatre, M.D., has heard them all. “Before we even get to the goals of an exercise program, we have to identify those barriers,” says Chhatre, director of spine rehabilitation at Johns Hopkins. Over the years working with patients, he has identified four key obstacles (OK, excuses) for not exercising and ways to overcome them.

Barrier No. 1: Time
What we say: “I don’t have the time to exercise. I’m too busy.”
What the expert says: “All you need is 30 minutes of daily activity. That’s one TV show!” Chhatre says. “If you can forgo one show, you can achieve all the health benefits that regular physical activity can bring you. And if you really don’t want to miss that show, you don’t have to.” There are a number of exercises you can do at home, within view of the TV. Let the commercials run and go up and down the stairs or do lunges down the hallway.

Barrier No. 2: Convenience
What we say: “I don’t have the equipment to exercise at home, and getting to a gym is a major hassle.”
What the expert says: “Convenience is really a question of how serious you are,” Chhatre says. “We could start with something simple like parking farther away from the store or the office and doing some extra walking just as part of your daily routine.” No special equipment or gym membership required! At home, take your activities outside, and make them fun. Go running, cycling or roller-skating. Or head back indoors and find a short video on YouTube to work out to.

Barrier No. 3: Tiredness
What we say: “I’m too tired to exercise. I don’t have enough energy as it is.”
What the expert says: “Start getting active, and you will notice the change in your energy from day one,” Chhatre says. “The reason is that endorphins and enkephalins—chemicals involved in pain perception and pleasure—are triggered when you exercise. That’s why you feel energized and happy afterward.” Preliminary results of a study by Chhatre and his colleagues suggest that moderate physical activity will help improve mood, even for people with clinical depression.

Barrier No. 4: Boredom
What we say: “Exercise is so boring. What am I supposed to do while I’m walking on the treadmill or riding on the stationary bike?”
What the expert says: “I hear this all the time,” Chhatre says. “I tell my patients to find a friend to exercise with, or get a digital music player and listen to music or an audiobook. We’ve worked hard as a society to find ways to reduce boredom. Take advantage of these in your pursuit of fitness.”

Looking to Lose Weight? Exercise Isn’t Enough
For many of us, an exercise program is not complete without the goal of losing a few pounds.

That’s fine, but be forewarned: Although it has many benefits, from improved heart health to elevated mood, exercise alone is not the best way to weight loss.
“I think this is a real challenge for many people,” says Kimberly Gudzune, M.D., M.P.H., a weight management specialist and obesity researcher at Johns Hopkins. “They start exercising, they get frustrated because they don’t lose weight, and they give it up.”

Reducing calorie intake along with being physically active can result in 10 to 15 pounds lost over about six months. By contrast, it is difficult to lose weight by exercise alone, says Lawrence Appel, M.D., director of the Johns Hopkins Welch Center for Prevention, Epidemiology and Clinical Research.

Rather than rely on a specific diet—or even use the term “diet,” which implies a switch to some extreme kind of eating—”we focus on the source of excess calories,” Appel says.

“In today’s society, where there are calories lurking in every corner, you have to be very conscious of where your calories come from,” he says. An overabundance of food, often in the form of empty calories, leads to the phenomenon of “mindless eating”—scarfing up a handful of chocolate candies because there is a bowl of them in the kitchen; grabbing a Danish pastry or a bagel because someone brought a dozen into the office; or taking a second helping at the buffet, simply because it’s there.
“These are the kind of challenges we face routinely,” he says.

Becoming aware of and reducing mindless eating can be a key step toward trimming excess calories and, therefore, losing weight.

Another strategy might be to talk to a dietitian or a health coach, and not only because you’ll get expert, individualized advice. A 2011 study published in the New England Journal of Medicine by Appel and his colleague, registered dietitian Arlene Dalcin, shows that simply having accountability can help with compliance. In their study, Dalcin explains, “we provided a website where people could enter their daily calorie intake, exercise and weight, and then their health coach could see what was going on,” she says. “Participants were accountable to themselves and to their health coach.”

And it worked, as the subjects in the study lost about 5 percent of their weight—that’s 10 pounds for a 200-pound person—and kept it off for the two-year duration of the program.

Four Tips for Getting Fit—Without Getting Hurt
Andrew Cosgarea, M.D., director of the Johns Hopkins Division of Sports Medicine, and Sameer Dixit, M.D., a sports medicine physician, weigh in.

  1. Consult the pros. “If your goal is to do a triathlon, going to a coach would be appropriate,” Cosgarea says. “If you want to become a competitive swimmer, your local aquatics center probably has a swimming program you can get involved with. And if you haven’t exercised at all, you need to start with your primary care physician to get the green light to start.”
  2. Be realistic in your expectations. “If you’re 50 years old and you’ve been sedentary, you can’t just go out and train hard and expect fast results,” Dixit says. “You have to accept that it’s going to take time—weeks, maybe even months—before you’re really feeling comfortable and making progress. A lot of this is common sense, but you’d be amazed at how many people we see who don’t use common sense when it comes to exercise.”
  3. Heed the warning signs. “If your muscles are sore after exercise, that’s generally OK, as long as it’s within reason,” Cosgarea says. If you can’t walk without a limp or pain lasts more than three days, you should see a doctor.
  4. Remember that it’s called a workout for a reason. “To get something out of exercise, you have to put something into it,” Dixit says. “You need to make an effort, you need to do it consistently. But you’ll reap the benefits if you put in the work.”


Kick-Start Your Fitness Routine!
Discover safe and innovative ways to design and implement an exercise program from the Johns Hopkins Health Library. Visit hopkinsmedicine.org/healthlibrary.

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