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Lifetime Physical Fitness and Wellness: A Personalized Program (Available Titles Cengagenow)

Your Complete Solution for Health 쮿 Personalized Learning Plans 쮿 Online Personal Change Labs CengageNOW provides acces

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Your Complete Solution for Health 쮿 Personalized Learning Plans

쮿 Online Personal Change Labs CengageNOW provides access to the activities, surveys, and selfassessment tools from Lifetime Physical Fitness and Wellness: A Personalized Program in an online, interactive format. Some diverse examples include “Are You Ready to Become More Active?,” “How Healthful is Your Diet?,” “Body Composition Assessment and Recommended Body Weight Determination,” and “Designing Your Strength Training Program.”

CengageNOW allows you to gauge your own unique study needs using diagnostic pre-tests that generate Personalized Learning Plans that contain links for the resources you need, including sections from the e-book, video clips, and interactive exercises. Click through these resources to master the concepts, and then take the post-test to measure your improvement. The program’s unique diagnostic quizzes and study plan will help you get the most out of your study time and succeed in the course!

쮿 Behavior Change Planner

쮿 Pedometer Activities!

The CengageNOW Behavior Change Planner is a fun, interactive, and easy way to complete a course assignment while using practical tools for making healthy change.

Even small steps can move you toward better health

The CengageNOW Behavior Change Planner includes four main components: •



• •

A Wellness Inventory that asks you a series of questions related to the wellness categories of Physical Activity, Tobacco, Drugs and Alcohol, Safety, Sexuality, Weight Management, Nutrition, and Stress. The scores on the wellness inventory help to identify areas where change is most needed. A Behavior Change Contract that guides you into targeting an area that needs improvement, setting a goal, and formulating a committed plan for change. A Change Tracker for recording progress toward the goal of the Behavior Change Contract A Change Journal for reflection and comments on the process of working toward the behavior change goal

Track your daily number of steps, set activity goals, and see your progress over time! The program’s Health/Lifestyle Survey will show you the overall picture of how active you are. The easy-to-use “how to” tool will help you measure your stride length to determine the distance you travel during a day. This can be a great motivator . . . and a great help to reaching your fitness goals.

Easy to Order and Use Log on to CengageNOW™ by using the access code packaged with the text. With its simple, browser-based interface, CengageNOW is as easy to use as surfing the web. Just a click of the mouse allows you to enter and explore the system at any point with no instructor set-up necessary. Alternatively, you can purchase access at www.cengagebrain.com if access was not ordered with the text. Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Lifetime Physical Fitness and Wellness A PERSONALIZED PROGRAM

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

E L E V E N T H

E D I T I O N

Lifetime Physical Fitness and Wellness A PERSONALIZED PROGRAM

W E R N E R W. K . H O E G E R Boise State University and

SHARON A. HOEGER Fitness and Wellness, Inc.

Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Lifetime Physical Fitness and Wellness: A Personalized Program, 11th Edition Werner W. K. Hoeger, Boise State University Sharon A. Hoeger, Fitness & Wellness, Inc. Acquisitions Editor: Laura Pople Developmental Editor: Anna Lustig Assistant Editor: Samantha Arvin

© 2011, 2009 Wadsworth, Cengage Learning ALL RIGHTS RESERVED. No part of this work covered by the copyright herein may be reproduced, transmitted, stored, or used in any form or by any means, graphic, electronic, or mechanical, including but not limited to photocopying, recording, scanning, digitizing, taping, Web distribution, information networks, or information storage and retrieval systems, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the publisher.

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BRIEF CONTENTS

CHAPTER 1

Physical Fitness and Wellness

CHAPTER 2

Behavior Modification

33

CHAPTER 3

Nutrition for Wellness

63

CHAPTER 4

Body Composition

CHAPTER 5

Weight Management

CHAPTER 6

Cardiorespiratory Endurance

CHAPTER 7

Muscular Strength and Endurance

CHAPTER 8

Muscular Flexibility

CHAPTER 9

Comprehensive Fitness Programming

C H A P T E R 10

Preventing Cardiovascular Disease

C H A P T E R 11

Cancer Prevention

C H A P T E R 12

Stress Management

C H A P T E R 13

Addictive Behavior

C H A P T E R 14

Preventing Sexually Transmitted Infections

C H A P T E R 15

Lifetime Fitness and Wellness

APPENDIX A

Physical Fitness and Wellness Profile

APPENDIX B

Nutritive Value of Selected Foods

111 131

Glossary

209

285

319

351 381 415 447

465 489

491 503

515

517

Text Credits Index

173

259

Notes and Suggested Readings Answer Key

1

529

531 v

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

CONTENTS

CHAPTER 1

Physical Fitness and Wellness Life Expectancy Versus Healthy Life Expectancy

4

1 Assess Your Behavior

Leading Health Problems in the United States 4

Assess Your Knowledge

Lifestyle as a Health Problem

Media Menu

5

26 31

32

Physical Activity and Exercise Defined 6 Importance of Increased Physical Activity 7

2008 Federal Guidelines for Physical Activity 8 Monitoring Daily Physical Activity 9

Wellness

10

The Seven Dimensions of Wellness 14 Wellness, Fitness, and Longevity 16

Types of Physical Fitness 18 Fitness Standards: Health Versus Physical Fitness 19 Health Fitness Standards 19 Physical Fitness Standards 19

Which Program Is Best? 22 Health Benefits of a Comprehensive Wellness Program 22 Economic Benefits of a Comprehensive Wellness Program 22

The Wellness Challenge of the 21st Century 23 National Health Objectives for the Year 2010 23 Wellness Education: Using This Book A Personalized Approach Exercise Safety 26

25

25

CHAPTER 2

Behavior Modification

33

Living in a Toxic Health and Fitness Environment 34 Environmental Influences on Physical Activity 35

Environmental Influence on Diet and Nutrition 38 Barriers to Change

39

Self-Efficacy 43 Sources of Self-Efficacy 43

Motivation and Locus of Control 44 Changing Behavior

45

Behavior Change Theories

45

The Process of Change

49

Consciousness-Raising 50 Social Liberation 50 Self-Analysis 50 Emotional Arousal 50 Positive Outlook 50 Commitment 50 Behavior Analysis 50 Goals 50 Self-Reevaluation 50

vii Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

viii

Contents

Countering 51 Monitoring 51 Environment Control 52 Helping Relationships 52 Rewards 52

Techniques of Change

Goal Setting and Evaluation

54

SMART Goals 54 Goal Evaluation 59

Assess Your Behavior

60

Assess Your Knowledge

52

Media Menu

60

61

CHAPTER 3

Nutrition for Wellness Nutrients 65

63 Balancing the Diet

Carbohydrates 67 Fats (Lipids) 69 Proteins 72 Vitamins 73 Minerals 73 Water 73

75

Nutrition Standards 77 Nutrient Analysis 80

Achieving a Balanced Diet

83

Choosing Healthy Foods 85 Vegetarianism 86 Diets from Other Cultures 90

Nutrient Supplementation 93 Antioxidants 93 Benefits of Foods 96 Functional Foods 98 Genetically Modified Crops

98

Energy Substrates for Physical Activity 99 Energy (ATP) Production Nutrition for Athletes

99

100

Carbohydrate Loading 100 Hyponatremia 101 Creatine Supplementation 102

Bone Health and Osteoporosis

102

Hormone-Replacement Therapy 104

Iron Deficiency

105

2005 Dietary Guidelines for Americans

106

Proper Nutrition: A Lifetime Prescription for Healthy Living Assess Your Behavior Assess Your Knowledge Media Menu

108

109 109

110

CHAPTER 4

Body Composition

111

Essential and Storage Fat 113 Techniques to Assess Body Composition Dual-Energy X-Ray Absorptiometry Hydrostatic Weighing 114 Air Displacement 115 Skinfold Thickness 115 Girth Measurements 116 Bioelectrical Impedance 116

114

114

Body Mass Index 117 Waist Circumference 118

Determining Recommended Body Weight

120

Importance of Regular Body Composition Assessment

Assess Your Behavior Assess Your Knowledge Media Menu

129

129 130

130

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Contents

CHAPTER 5

Weight Management

131

Overweight Versus Obesity 134

The Simple Truth

Tolerable Weight 135

Assess Your Behavior

Weight Loss Dilemma 135

Assess Your Knowledge

Diet Crazes 136 Low-Carb Diets 136

Eating Disorders

Media Menu

159 171 171

172

140

Anorexia Nervosa 141 Bulimia Nervosa 142 Binge-Eating Disorder 142 Emotional Eating 142 Treatment 143

Physiology of Weight Loss 143 Energy-Balancing Equation 143 Setpoint Theory 144

Diet and Metabolism

146

Sleep and Weight Management 147 Exercise: The Key to Weight Management 147 Light-Intensity Versus Vigorous-Intensity Exercise for Weight Loss 151 Healthy Weight Gain 152 Weight Loss Myths 152

Losing Weight the Sound and Sensible Way 153 Monitoring Your Diet with Daily Food Logs 156 Low-Fat Entrees 157 Behavior Modification and Adherence to a Weight Management Program 157

CHAPTER 6

Cardiorespiratory Endurance Basic Cardiorespiratory Physiology: A Quick Survey 176 Aerobic and Anaerobic Exercise Benefits of Aerobic Training

176

176

Physical Fitness Assessment 179 Responders Versus Nonresponders

179

Assessment of Cardiorespiratory Endurance 180 Components of Oxygen Uptake (VO2) 180 Tests to Estimate VO2MAX 181 Interpreting the Results of Your Maximal Oxygen Uptake 187 Assessment of Resting Heart Rate and Blood Pressure 187 Mean Blood Pressure 188

173 Guidelines for Cardiorespiratory Exercise Prescription

193

Intensity of Exercise 193 Duration (Quantity) of Exercise 197 Frequency of Exercise 198 Rate of Progression 199

Fitness Benefits of Aerobic Activities

199

Getting Started and Adhering to a Lifetime Exercise Program 203

A Lifetime Commitment to Fitness 204 Assess Your Behavior Assess Your Knowledge Media Menu

207 207

208

Principles of Cardiorespiratory Exercise Prescription 188 Readiness for Exercise

188

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

ix

x

Contents

CHAPTER 7

Muscular Strength and Endurance Benefits of Strength Training

210

209 Strength-Training Exercises 227

Muscular Strength and Aging 210 Gender Differences 212 Changes in Body Composition 213

Assessment of Muscular Strength and Endurance 214 Muscular Strength: Hand Grip Strength Test 214 Muscular Endurance Test 215 Muscular Strength and Endurance Test 215

Strength-Training Prescription 216

Dietary Guidelines for Strength Development 229 Core Strength Training 229 Pilates Exercise System 229 Stability Exercise Balls 230 Elastic-Band Resistive Exercise 230

Exercise Safety Guidelines

Setting Up Your Own Strength-Training Program 232 Assess Your Behavior

Factors That Affect Strength 221

237

Assess Your Knowledge

Principles Involved in Strength Training 222 Mode of Training 222 Resistance 224 Sets 225 Frequency 226 Training Volume 226

231

Media Menu

237

238

Strength-Training Exercises without Weights 239 Strength-Training Exercises with Weights 244 Stability Ball Exercises 256

Plyometrics 227 Strength Gains 227

CHAPTER 8

Muscular Flexibility Benefits of Good Flexibility

260

Flexibility in Older Adults 261

259 Factors Affecting Flexibility 261 Assessment of Flexibility 262 Interpreting Flexibility Test Results 263

Principles of Muscular Flexibility Prescription 263 Modes of Training 263 Intensity 268 Repetitions 268 Frequency of Exercise 268 When to Stretch? 268

Flexibility Exercises 269 Contraindicated Exercises 269

Preventing and Rehabilitating Low Back Pain 271 Effects of Posture 274 Effects of Stress 274 Personal Flexibility and Low Back Conditioning Program 275

Assess Your Behavior

275

Assess Your Knowledge Media Menu

275

276

Flexibility Exercises 279 Exercises for the Prevention and Rehabilitation of Low Back Pain 283

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Contents

CHAPTER 9

Comprehensive Fitness Programming Choices of Aerobic Activities

Exercise Intolerance 303 Side Stitch 304 Shin Splints 304 Muscle Cramps 305

286

Walking 286 Hiking 288 Jogging 288 Deep-Water Jogging 288 Aerobics 289 Swimming 289 Water Aerobics 290 Cycling 290 Spinning 292 Cross-Training 292 Rope Skipping 293 Cross-Country Skiing 293 In-Line Skating 293 Rowing 294 Stair Climbing 294 Racquet Sports 294

Specific Exercise Considerations Exercise-Related Injuries

285

Exercise and Aging

305

Physical Training in the Older Adult 305

Preparing for Sports Participation

306

Base Fitness Conditioning 306 Sport-Specific Conditioning 307 Overtraining 308 Periodization 308

Personal Fitness Programming: An Example 310

295

302

Acute Sports Injuries 303 Muscle Soreness and Stiffness 303

Cardiorespiratory Endurance 310 Muscular Strength and Endurance 310 Muscular Flexibility 311 Body Composition 311 You Can Get It Done 312

Assess Your Behavior

312

Assess Your Knowledge Media Menu

312

313

C H A P T E R 10

Preventing Cardiovascular Disease

319

Prevalence of Cardiovascular Disease 320

Assess Your Knowledge

Stroke 320

Media Menu

Coronary Heart Disease

348

349

322

Coronary Heart Disease Risk Profile 322 Leading Risk Factors for CHD 322 Physical Inactivity 323 Abnormal Electrocardiograms 327 Abnormal Cholesterol Profile 329 Elevated Triglycerides 334 Elevated Homocysteine 336 Inflammation 337 Diabetes 338 Metabolic Syndrome 340 Hypertension 340 Excessive Body Fat 344 Cigarette Smoking 344 Tension and Stress 346 Personal and Family History 346 Age 347 Other Risk Factors for CHD 347

Cardiovascular Risk Reduction 348 Assess Your Behavior

348

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

xi

xii

Contents

C H A P T E R 11

Cancer Prevention Incidence of Cancer

351

355

Guidelines for Preventing Cancer 356 Dietary Changes 356 Abstaining from Tobacco 360 Avoiding Excessive Exposure to Sun 360 Monitoring Estrogen, Radiation Exposure, and Potential Occupational Hazards 361

Physical Activity 363 Early Detection 363 Other Factors 363

Warning Signals of Cancer

364

Cancer: Assessing Your Risks Common Sites of Cancer

367

367

Lung Cancer 367 Colon/Rectum Cancer 367 Skin Cancer 367 Breast Cancer 374 Cervical Cancer (Women) 374 Endometrial Cancer (Women) 374 Prostate Cancer (Men) 375 Testicular Cancer (Men) 375 Pancreatic Cancer 376 Kidney and Bladder Cancer 376 Oral Cancer 376 Esophageal and Stomach Cancer 376 Ovarian Cancer (Women) 377 Thyroid Cancer 377 Liver Cancer 377 Leukemia 377 Lymphoma 378

What Can You Do?

378

Assess Your Behavior

378

Assess Your Knowledge Media Menu

379

380

C H A P T E R 12

Stress Management Mind/Body Connection

382

Brain 382 Immune System 382 Sleep and Wellness 383 Stress 384

Stress Adaptation 386 Alarm Reaction 386 Resistance 386 Exhaustion/Recovery 386

Perceptions and Health

387

Self-Esteem 387 Fighting Spirit 387

381 Time Management

393

Five Steps to Time Management 393 Time Management Skills 394

Coping with Stress 397 Physical Activity 398 Relaxation Techniques 403 Visual Imagery 406 Autogenic Training 407 Meditation 407 Yoga 408

Which Technique Is Best? Assess Your Behavior

Sources of Stress 388

Assess Your Knowledge

Behavior Patterns

Media Menu

388

409

410 410

411

Vulnerability to Stress 393

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Contents

C H A P T E R 13

Addictive Behavior Addiction

415

416

Why People Smoke 434

Risk Factors for Addiction

Drugs and Dependence

417

Smoking Addiction and Dependency 434 “Why Do You Smoke?” Test 434 Smoking Cessation 435 “Do You Want to Quit?” Test 436 Breaking the Habit 436 Quitting Cold Turkey 440 Cutting Down Gradually 440 Nicotine-Substitution Products 440 Life After Cigarettes 444

418

Nonmedical Use of Prescription Drugs Marijuana 418 Cocaine 419 Methamphetamine 420 MDMA (Ecstasy) 422 Heroin 423 Alcohol 424

418

Treatment of Addictions 427

Assess Your Behavior

Tobacco Use

Assess Your Knowledge

427

Media Menu

Morbidity and Mortality 428 Effects on Cardiovascular System 431 Smoking and Cancer 431 Other Forms of Tobacco 432 Health Care Costs of Tobacco Use 433 Trends 433

445 445

446

C H A P T E R 14

Preventing Sexually Transmitted Infections Chlamydia

448

Gonorrhea

449

Pelvic Inflammatory Disease

449

Human Papillomavirus and Genital Warts Genital Herpes Syphilis

447

450

450

451

HIV and AIDS

452

Transmission of HIV 453 Risky Behaviors 454 Myths About HIV Transmission 455 Wise Dating 455 Trends in HIV Infection and AIDS 456 HIV Testing 456 HIV Treatment 456

Guidelines for Preventing Sexually Transmitted Infections 459 Reducing the Risks for STIs and HIV Infection 460

Assess Your Behavior Assess Your Knowledge Media Menu

462 462

463

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

xiii

xiv

Contents

C H A P T E R 15

Lifetime Fitness and Wellness

465

Life Expectancy and Physiological Age 466

APPENDIX A

Complementary and Alternative Medicine (CAM) 468

Physical Fitness and Wellness Profile

Quackery and Fraud

Deciding Your Fitness Future

477

Health/Fitness Club Memberships Personal Trainers 479

APPENDIX B 477

Nutritive Value of Selected Foods

Purchasing Exercise Equipment 479 Self-evaluation and Behavioral Goals for the Future Self-evaluation 480 Behavioral Goals for the Future

Notes and Suggested Readings 480

Assess Your Behavior Assess Your Knowledge

484 485

491

503

Answer Key 515

480

The Fitness/Wellness Experience and a Challenge for the Future

Media Menu

489

476

Glossary

517

483

Text Credits 529 Index

531

486

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

PREFACE

The American lifestyle does not provide the human body with sufficient physical activity to enhance or maintain adequate health. Actually, our way of life is such a serious threat to our health that it increases the deterioration rate of the human body and leads to premature illness and mortality. People in the United States say they believe that physical activity and positive lifestyle habits promote better health, but most do not reap these benefits because they simply do not know how to implement and stay with a sound physical fitness and wellness program that will yield the desired results. About one-half of the adults in the United States do not achieve the recommended amount of daily physical activity, and 16 percent are not physically active at all. A regular exercise program is as close as we get to the miracle pill that people look for to enjoy good health and quality of life over a now-longer lifespan. Among a myriad of benefits, exercise enhances functional capacity; increases energy; brings weight loss; improves mood, self-esteem, and physical appearance; and decreases the risk for many chronic ailments, including cardiovascular disease, cancer, and diabetes. As stated as far back as 1982 in the prestigious Journal of the American Medical Association: “There is no drug in current or prospective use that holds as much promise for sustained health as a lifetime program of physical exercise.” The benefits of exercise along with healthy lifestyle habits are reaped only through action. Along with the most updated health, fitness, and nutrition guidelines, the information in this book provides extensive behavior modification strategies to help you abandon negative habits and adopt and maintain healthy behaviors. The contents of this book will be of little value to you if you are unable to abandon your negative habits and adopt and maintain healthy behaviors. Many of the behaviors we adopt are a product of our environment. Unfortunately, we live in a “toxic” health and fitness environment. Becoming aware of how the environment affects our health is vital if we wish to achieve and maintain wellness. Yet we are so habituated to this modern-day environment that we miss the subtle ways it influences our behaviors, personal lifestyle, and health each day. As you study and assess physical fitness and wellness parameters, you will need to take a critical look at your behaviors and lifestyle—and most likely make selected lifetime changes to promote overall health and wellness.

The book is organized in the most efficient manner possible for students to derive the greatest benefit from its contents. Each chapter starts with the chapter objectives, followed by Frequently Asked Questions and Real Life Stories that will pique the students’ interest in the chapter’s topic. The chapter contents are presented next, with extensive use of graphs, charts, tables, activities, critical-thinking questions, informational boxes, behavior-modification boxes, definitions of key terms, and photography to maximize student learning and content retention and to motivate action for healthy lifetime behavioral change. As no other textbook, the Hoegers’ Fitness and Wellness series makes exceptional use of these special pedagogical aids and high-interest features. A unique feature of Lifetime Physical Fitness and Wellness is the activity (lab) experiences provided as key information is addressed in each chapter. These activities allow each student to develop A Personalized Program according to individual needs. All chapters conclude with Assess Your Behavior and Assess Your Knowledge sections so that students may evaluate the impact of the subject matter on their personal lifestyle and their understanding of the chapter contents through 10 multiple-choice questions. A Media Menu box is also provided at the end of the chapter for students to access the Internet for further information or interactive experiences on the topic. Scientific evidence has clearly shown that improving the quality—and most likely the length—of our lives is a matter of personal choice. The biggest challenge we face in the 21st century is to learn how to take control of our personal health habits to ensure better, healthier, happier, and more productive lives. The information presented in this book has been written with this goal in mind, providing the student with the necessary tools and guidelines to implement and adhere to a lifetime physical fitness and wellness program. The emphasis throughout the book is on teaching students how to take control of their personal lifestyle habits so that they can do what is necessary to stay healthy and realize their highest potential for well-being.

New in the Eleventh Edition All 15 chapters in the eleventh edition of Lifetime Physical Fitness and Wellness: A Personalized Program have been revised and updated according to recent advances and recommendations in the field, including information xv

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xvi

Preface

reported in the literature and at professional sports medicine and health and fitness conferences. A new feature added to this edition is individual Real Life Stories presented at the start of each chapter. Most students will be able to relate to these accounts, as they encounter similar situations in their lives. In addition to the individual chapter updates listed below, several new graphs and photographs are included throughout the textbook.





Chapter Updates • Chapter 1, “Physical Fitness and Wellness,” has been revised to include the newly released Federal Guidelines for Physical Activity. The federal guidelines include recommendations for children, adults, older adults, and pregnant and postpartum women. These guidelines supplement the landmark 1996 Surgeon General’s Report on Physical Activity and Health, as well as the 2007 American College of Sports Medicine and American Heart Association Physical Activity and Public Health Recommendations. • A discussion of the Humanistic Theory of Change has been added to Chapter 2, “Behavior Modification.” To further motivate individuals to change sedentary behavior, the impact of excessive sitting on premature mortality is also included in this chapter. The data show that greater mortality is present among individuals who spend most of the day sitting, even if they meet the minimum daily recommendation of moderate physical activity. • The ever-increasing importance of vitamin D is examined in Chapter 3, “Nutrition for Wellness,” with an expanded discussion on the benefits of this vitamin and how to obtain an adequate supply. Additional information is also included on probiotics, osteoporosis, and multivitamin supplements. • Revised figures on the incidence of overweight and obesity trends in the United States have been added to Chapter 4, “Body Composition.” • Chapter 5, “Weight Management,” has been revised to conform with the new Position Stand: Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults released in 2009 by the American College of Sports Medicine (ACSM). A new section on the role of sleep deprivation on weight management and weight loss has been added to the chapter as well. • In Chapter 6, “Cardiorespiratory Endurance,” the exercise prescription principles have been extensively revised, particularly in reference to the intensity and duration (quantity) of exercise, according to the newly released ACSM Guidelines for Exercise Testing and Prescription (2010) and the 2008 Federal Guidelines for Physical Activity. A section on Rate of Progression and additional information on the benefits of















vigorous- vs. moderate-intensity exercise and volume vs. intensity of training on health and longevity are also included. As with cardiorespiratory endurance, the principles of strength training and muscular flexibility prescription were updated according to the latest ACSM guidelines. An introduction to elastic-band resistive exercise is also new to Chapter 7, “Muscular Strength and Endurance.” Further updates on the best time to stretch and the relationship between stretching and injuries are provided in Chapter 8, “Muscular Flexibility.” In Chapter 9, “Comprehensive Fitness Programming,” revisions have been made to the descriptions of several of the aerobic activity choices, as well as to selected exercise-considerations questions. Chapter 10, “Preventing Cardiovascular Disease,” presents updated statistics on the prevalence of cardiovascular disease. The coronary heart disease riskfactor analysis has been revised according to current risk-factors data. The guidelines for a graded exercise stress electrocardiogram were also revised based on the 2010 ACSM Guidelines for Exercise Testing and Prescription. New information is provided on the effects of statin drugs on inflammation and on the risks of excessive body weight (in particular visceral fat) as an independent risk factor for heart disease. The latest available data on cancer incidence and mortality in the United States are provided in Chapter 11, “Cancer Prevention.” The dietary guidelines, which are so vital to the prevention of cancer, have been brought up to date in accordance to the latest recommendations. The benefits of “safe sun exposure” for adequate vitamin D production, the risks associated with excessive sun exposure, information on high meat consumption, and risks associated with grilling meat have all been revised for this edition. To address the increasing problem of sleep deprivation among college students, a new section on Sleep and Wellness has been added to Chapter 12, “Stress Management.” A complete update on the most current trends in drug abuse, including alcohol and cigarette smoking, according to the National Survey on Drug Use and Health by the U.S. Department of Health and Human Services is included in Chapter 13, “Addictive Behavior.” The most recent data available from the Centers for Disease Control and Prevention on the prevalence of sexually transmitted infections (STIs), including HIV, are included in Chapter 14, “Preventing Sexually Transmitted Infections.” The guidelines for the prevention of STIs have also been revised. Chapter 15, “Lifetime Fitness and Wellness,” includes the latest facts on complementary and alternative medicine use and practices in the United

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Preface

States. Using prevailing health information available in the literature, revisions and new questions have been added to the Life Expectancy and Physiological Age Prediction Questionnaire.

Ancillaries • CengageNOW™ with eBook 1-Semester Instant Access Code. ISBN-10: 0-538-45115-7. Get instant access to CengageNOW™! This exciting online resource is a powerful new learning companion that helps students gauge their unique study needs—and provides them with a Personalized Change Plan that enhances their problem-solving skills and conceptual understanding. A click of the mouse allows students to enter and explore the system whenever they choose, with no instructor setup necessary. The Personalized Change Plan section guides students through a behavior-change process tailored specifically to their needs and personal motivation. An excellent tool to give as a project, this plan is easy to assign, track, and grade, even for large sections. • CengageNOW™ with eBook Printed Access Code. ISBN-10: 0-538-45116-5. Get instant access to CengageNOW™! This exciting online resource is a powerful new learning companion that helps students gauge their unique study needs—and provides them with a “Personalized Change Plan” that enhances their problem-solving skills and conceptual understanding. A click of the mouse allows students to enter and explore the system whenever they choose, with no instructor setup necessary. The Personalized Change Plan section guides students through a behavior-change process tailored specifically to their needs and personal motivation. An excellent tool to give as a project, this plan is easy to assign, track, and grade, even for large sections. • Website (http://www.cengage.com/health/hoeger/ lifetime11e). When you adopt Lifetime Physical Fitness and Wellness, eleventh edition, you and your students will have access to a rich array of teaching and learning resources that you won’t find anywhere else. Resources include a downloadable study guide for students, Web links, flash cards, and more. • Online Instructor’s Manual with Test Bank. ISBN-10: 0-538-45103-3. This comprehensive resource provides learning objectives, detailed chapter outlines, classroom activities integrated with critical-thinking questions, and teaching strategies. The Test Bank provides matching, true/false, multiple-choice, and short-answer questions. • PowerLecture CD-ROM. ISBN-10: 0-538-45104-1. Designed to make lecture preparation easier, this CD-ROM includes over 500 customizable PowerPoint® presentation slides with images from the text,









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new ABC video clips, and electronic versions of the Instructor’s Manual and Test Bank. Also included is the ExamView® Computerized Test Bank, which allows you to create, deliver, and customize tests (both print and online) in minutes with this easy-to-use assessment and tutorial system. ExamView Computerized Testing CD. ISBN-10: 0-538-45105-X. Create, deliver, and customize tests and study guides (both print and online) in minutes with this easy-to-use assessment and tutorial system. ExamView offers a Quick Test Wizard that guides you step by step through the process of creating tests while allowing you to see the test you are creating on the screen exactly as it will print or display online. You can build tests of up to 250 questions and, using ExamView’s word-processing capabilities, you can enter an unlimited number of questions and edit existing questions. Instant Access Code for Diet Analysis 9.0. ISBN-10: 0-495-38786-X. Diet Analysis 9.0 is the market-leading software with a database of over 20,000 foods that enables students to track their diet, generate reports, complete assignments, and gain a better understanding of how nutrition relates to their personal health goals. The new 9.0 version has been enhanced with new robust features, easy navigation, custom reports, and new critical-thinking assignments. Printed Access Code for Diet Analysis 9.0. ISBN-10: 0-495-38788-6. Diet Analysis 9.0 is the market-leading software with a database of over 20,000 foods that enables students to track their diet, generate reports, complete assignments, and gain a better understanding of how nutrition relates to their personal health goals. The new 9.0 version has been enhanced with new robust features, easy navigation, custom reports, and new critical thinking assignments. Behavior Change Workbook. ISBN-10: 0-495-01145-2. The Behavior Change Workbook includes a brief discussion of the current theories behind making positive lifestyle changes along with exercises to help students make those changes in their everyday lives.

• Careers in Health, Physical Education, and Sports, 2e. ISBN-10: 0-495-38839-4. This unique booklet takes students through the complicated process of picking the type of career they want to pursue; explains how to prepare for the transition into the working world; and provides insight into different types of career paths, education requirements, and reasonable salary expectations. A designated chapter discusses some of the legal issues that surround the workplace, including discrimination and harassment. This supplement is complete with personaldevelopment activities designed to encourage students to focus on and develop better insight into their future.

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

xviii

Preface

• Walk4Life® Pedometer. ISBN-10: 0-495-01315-3. Provided through an alliance with Walk4Life, the Walk4Life Elite Model pedometer tracks steps, elapsed time, and distance. Including a calorie counter and a clock, it’s an excellent class activity and tool to encourage students to track their steps and walk toward better fitness awareness. • Readings for a Healthy Living. ISBN-10: 0-759-35944-X. This reader features 12 articles written by author Dianne Hales and published in PARADE magazine. Readings include “Take Your Meds—The Right Way,” “You Can Think Yourself Thin,” “Getting Yourself Back on Track,” “Too Tough to Seek Help,” and “The Best Medical Help Online.” • TestWell Online Assessment Access Card. ISBN-10: 0-495-01264-5. This Web-based assessment tool allows students to answer 100 questions specific to their health status in relation to the six dimensions of wellness. Students are provided a 10-Step Behavior Change Guide for long-term positive behavior modifications. It can be used as a pre-test or a post-test to assess students’ health status, and it can provide a venue for learning about the different dimensions of wellness. It executes immediate feedback based on students’ responses and can contribute to classroom participation and overall learning assessment. TestWell offers a fun and easy Web-based activity for student enrichment.

Brief Author Biographies Werner W. K. Hoeger is a professor emeritus of the De-

partment of Kinesiology at Boise State University. He remains active in research and continues to lecture in the areas of exercise physiology, physical fitness, and wellness.

Dr. Hoeger completed his undergraduate and master’s degrees in physical education at the age of 20 and received his doctorate degree with an emphasis in exercise physiology at the age of 24. He is a Fellow of the American College of Sports Medicine and the Research Consortium of the American Alliance for Health, Physi-

cal Education, Recreation, and Dance. In 2002, he was recognized as the Outstanding Alumnus from the College of Health and Human Performance at Brigham Young University. He is the recipient of the 2004 first Presidential Award for Research and Scholarship in the College of Education at Boise State University. In 2008, he was asked to be the keynote speaker at the VII Iberoamerican Congress of Sports Medicine and Applied Sciences in Mérida, Venezuela, and was presented with the Distinguished Guest of the City recognition. Dr. Hoeger uses his knowledge and personal experiences to write engaging, informative books that thoroughly address today’s fitness and wellness issues in a format accessible to students. Since 1990, he has been the most widely read fitness and wellness college textbook author in the United States. He has published a total of 49 editions of his 9 fitness and wellness related titles. Among the textbooks written for Wadsworth Cengage Learning are Principles and Labs for Fitness and Wellness, tenth edition; Fitness and Wellness, eighth edition; Principles and Labs for Physical Fitness, seventh edition; Wellness: Guidelines for a Healthy Lifestyle, fourth edition; and Water Aerobics for Fitness and Wellness, third edition (with TerryAnn Spitzer Gibson). Dr. Hoeger was the first author to write a college fitness textbook that incorporated the “wellness” concept. In 1986, with the release of the first edition of Lifetime Physical Fitness and Wellness, he introduced the principle that to truly improve fitness, health, and quality of life and achieve wellness, a person needed to go beyond the basic health-related components of physical fitness. His work was so well received that every fitness author immediately followed his lead. As an innovator in the field, Dr. Hoeger has developed many fitness and wellness assessment tools, including fitness tests such as the Modified Sit-and-Reach, Total Body Rotation, Shoulder Rotation, Muscular Endurance, Muscular Strength and Endurance, and Soda Pop Coordination tests. Proving that he “practices what he preaches,” at 48 he was the oldest male competitor in the 2002 Winter Olympics in Salt Lake City, Utah. He raced in the sport of luge along with his then-17-year-old son Christopher. It was the first time in Winter Olympics history that father and son competed in the same event. In 2006, at the age of 52, he was the oldest competitor at the Winter Olympics in Turin, Italy. Sharon A. Hoeger is vice president of Fitness & Wellness, Inc. of Boise, Idaho. Sharon received her degree in computer science from Brigham Young University. She is extensively involved in the research process used in retrieving the most current scientific information that goes into the revision of each textbook. She is also the author of the software that accompanies all of the Fitness and Wellness textbooks. Her innovations in this area since the publication of the first edition of Lifetime Physical Fitness and Wellness set the standard for fitness and wellness computer software used in this market today.

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Preface

xix

Helen Hui, Philadelphia Biblical University Wayne Jacobs, LeTourneau University Beau Kjerkulf Greer, Sacred Heart University Paul McDonough, University of Texas, Arlington Kristin Moline, Lourdes College Jackie Moore, Western Carolina University Peggy Oberstaller, Lane Community College David Oster, Jefferson College Linda J. Romaine, Raritan Valley Community College Christopher Smith, College of San Mateo Karen Thomas, Montgomery College Timothy J. Voss, Trinity International University Sharon K. Woodard, Wake Forest University Sharon is a coauthor in five of the seven Fitness and Wellness titles. Husband and wife have been jogging and strength training together for over 32 years. They are the proud parents of five children, all of whom are involved in sports and lifetime fitness activities. Their motto: “Families that exercise together, stay together.” She also served as Chef de Mission (Head of Delegation) for the Venezuelan Olympic Team at the 2006 Olympic Winter Games in Turin, Italy.

Acknowledgments The completion of the eleventh edition of Lifetime Physical Fitness and Wellness: A Personalized Program was made possible through the contributions of many individuals. In particular we would like to express our gratitude to the reviewers of the eleventh edition; their valuable comments and suggestions are most sincerely appreciated.

Reviewers for the 11th edition: Franca Alphin, Duke Medical School Julia Bichelmeyer, Kansas City Kansas Community College Mark Blegen, College of St. Catherine Elaine Bryan, Georgia Perimeter College Leslie Hickcox, Portland Community College– Sylvania Richard Hsiao, Indiana University of Pennsylvania

Reviewers for the 10th edition: Hector Becerra, Jr., St. Philip’s College Wayne M. Chaffin, Austin Peay State University Augie Eosso, Raritan Valley Community College Carmen S. Forest, Pratt Community College Daniel Frankl, California State University, Los Angeles Janet S. Hamilton, Clayton State University Janelle Hennes, University of Texas, Arlington Wayne Jacobs, LeTourneau University Cathy Kennedy, Colorado State University Jacalyn J. McComb, Texas Tech University Paul McDonough, University of Texas, Arlington Dennis Mishko, Keystone College Kristin Moline, Lourdes College William J. Papin, Western Carolina University John Patzan, William Paterson University Patricia L. Rhea, Community College of Baltimore County John A. Richards, University of North Carolina, Greensboro Elizabeth Ridings, Montgomery College Sharon Rifkin, Broward Community College Sharon K. Woodard, Wake Forest University We also wish to thank all of the following individuals for their kind help with new photography for this edition: Kelly Stocks, David Gonzalez, Jorge Kleiss, Jonathan and Cherie Hoeger, Brent and Amber Fawson, Jo Engstrom, Erica González, and Angela Hoeger.

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

© Fitness & Wellness, Inc.

Physical Fitness and Wellness Chapter OBJECTIVES UNDERSTAND the health and









Chronicle your daily activities using the exercise log. Determine the safety of exercise participation using the health history questionnaire. Check your understanding of the chapter contents by logging on to CengageNOW and assessing the pre-test, personalized learning plan, and post-test for this chapter.







fitness consequences of physical inactivity. IDENTIFY the major health problems in the United States. LEARN how to monitor daily physical activity. LEARN the Federal Physical Activity Guidelines for Americans. DEFINE wellness and list its dimensions. DEFINE physical fitness and list health-related and skill-related components.









1

STATE the differences among physical fitness, health promotion, and wellness. DISTINGUISH between health fitness standards and physical fitness standards. UNDERSTAND the benefits and significance of participating in a comprehensive wellness program. LIST key national health objectives for 2010. IDENTIFY risk factors that may interfere with safe participation in exercise.

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

1

FAQ Why should I take a fitness and wellness course? Most people go to college to learn how to make a living, but a fitness and wellness course will teach you how to live—how to truly live life to its fullest potential. Some people seem to think that success is measured by how much money they make. Making a good living will not help you unless you live a wellness lifestyle that will allow you to enjoy what you earn. You may want to ask yourself: Of what value is a nice income, a beautiful home, and a solid retirement portfolio if at age 45 I suffer a massive heart attack that will seriously limit my physical capacity or end life itself?

Will the attainment of good physical fitness be sufficient to ensure good health? Regular participation in a sound physical fitness program will provide substantial health benefits and significantly decrease the risk for many chronic diseases. And although good fitness often motivates toward adoption of additional positive lifestyle behaviors, to maximize the benefits for a healthier, more productive, happier, and longer life, we have to pay attention to all seven dimensions of wellness: physical, social, mental, emotional, occupational, environmental, and spiritual. These dimensions are interrelated and one frequently affects the other. A wellness way of life requires a constant and deliberate effort to stay healthy and achieve the highest potential for well-being within all dimensions of wellness.

This is a common question. It is a mistake to think, though, that you can modify just one factor and enjoy wellness. Wellness requires a constant and deliberate effort to change unhealthy behaviors and reinforce healthy behaviors. Although it is difficult to work on many lifestyle changes all at once, being involved in a regular physical activity program and proper nutrition are two behaviors to work on first. Others should follow, depending on your lifestyle.

Scientific findings have shown that physical inactivity and a negative lifestyle seriously threaten health and hasten the deterioration rate of the human body. Movement and physical activity are basic functions for which the human organism was created. Advances in technology, however, have almost completely eliminated the necessity for physical exertion in daily life. Physical activity is no longer a natural part of our existence. We live in an automated society, in which most of the activities that used to require strenuous exertion can be accomplished by machines with the simple pull of a handle or push of a button. Most industrialized nations in the world are experiencing an epidemic of physical inactivity. In the United States, physical inactivity is the second greatest threat to public health and has been termed “Sedentary Death

Photos © Fitness & Wellness, Inc.

If a person is going to do only one thing to improve health, what would it be?

Modern-day conveniences lull people into a sedentary lifestyle.

Syndrome,” or SeDS (the number-one threat is tobacco use—the largest cause of preventable deaths). Widespread interest in health and preventive medicine in recent years, nonetheless, is motivating people to participate in organized fitness and wellness programs. The growing number of participants is attributed primarily to scientific evidence linking regular physical activity and positive lifestyle habits to better health, longevity, quality of life, and overall well-being. At the beginning of the 20th century, life expectancy for a child born in the United States was only 47 years. The most common health problems in the Western world were infectious diseases, such as tuberculosis, diphtheria, influenza, kidney disease, polio, and other diseases of infancy. Progress in the medical field largely eliminated these diseases. Then, as more people started to enjoy the “good life” (sedentary living, alcohol, fatty foods, excessive sweets, tobacco, drugs), we saw a

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3

Real Life Story

Ray’s Experience During our freshman year, everyone at my school has to take a lifetime wellness class. When I first started the class, I thought it would be a piece of cake, with not that much work involved. I was taking hard math and writing classes, and I thought I would spend all my time studying for those courses and that the wellness class would just be something I barely had to think about, like high school PE. As the class got started, I found out that I had to do a lot more than I thought to get a good grade. I also became really interested in the subject! I started spending more time studying fitness and wellness and reading the textbook just because I wanted to know more. In my

parallel increase in the incidence of chronic diseases such as cardiovascular disease, cancer, diabetes, and chronic respiratory diseases (see Figure 1.1). According to the World Health Organization (WHO), chronic diseases account for 60 percent of all deaths worldwide.1 As the incidence of chronic diseases climbed, we recognized that prevention is the best medicine. Consequently, a fitness and wellness movement developed gradually in the 1980s. People began to realize that good health is mostly self-controlled and that the leading causes of premature death and illness could be prevented by adhering to positive lifestyle habits. We all desire to live a long life, and wellness programs seek to

Figure 1.1

family, a lot of family members are really overweight, and a couple of them have diabetes. As I began to learn more about those problems, I decided to be the one who breaks the trend and does not have the same health problems my relatives do. It has been 6 months since I finished the class and I am still continuing with my healthy habits—eating well and exercising. I have lost 10 pounds, and my last physical showed that my blood sugar, blood pressure, and cholesterol were all in the healthy range!

enhance the overall quality of life—for as long as we live. There are three basic factors that determine our health and longevity: genetics, the environment, and our behavior (see Figure 1.2). Although we cannot change our genetic pool, we can exert control over the environment and our health behaviors so that we may reach our full physical potential based on our own genetic code. How we accomplish this goal will be thoroughly discussed through the chapters of this book.

Figure 1.2

Causes of deaths in the United States for selected years.

Factors that determine health and longevity.

Genetics

100

Percent of all deaths

90 80 70

Environment

60

Health & Longevity

Behavior

50 40 30 20 10 0

1900

1920

1940 1960 1980 2000 Year Influenza and Cancer pneumonia Cardiovascular Tuberculosis disease Accidents

All other causes

Sedentary Death Syndrome (SeDS) Cause of deaths attributed to a lack of regular physical activity. Health A state of complete well-being—not just the absence of disease or infirmity. Life expectancy Number of years a person is expected to live based on the person’s birth year. Chronic diseases Illnesses that develop as a result of an unhealthy lifestyle and last a long time.

SOURCE: National Center for Health Statistics, Division of Vital Statistics.

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

© Supri Suharjoto, 2009. Used under license from Shutterstock.com

Chapter 1 Physical Fitness and Wellness

4

Lifetime Physical Fitness and Wellness

Life Expectancy Versus Healthy Life Expectancy Based on 2009 government data, the average life expectancy in the United States is now 77.7 years: 75.1 years for men and 80.2 years for women. The WHO, however, has calculated healthy life expectancy (HLE) estimates for 191 nations. HLE is obtained by subtracting the years of ill health from total life expectancy. The United States ranked 24th in this report, with an HLE of 70 years; Japan was first with an HLE of 74.5 years (see Figure 1.3). This finding was a major surprise, given the status of the United States as a developed country with one of the best medical care systems in the world. The rating indicates that Americans die earlier and spend more time disabled than people in most other advanced countries. The WHO points to several factors that may account for this unexpected finding: 1. The extremely poor health of some groups, such as Native Americans, rural African Americans, and the inner-city poor. Their health status is more characteristic of poor developing nations rather than a rich industrialized country.

Healthy life expectancy for selected countries.

Figure 1.3

69.6

Ireland USA

70.0

Germany

70.4

Austria

71.6

Belgium

71.6

United Kingdom

71.7

Norway

2. The HIV epidemic, which causes more U.S. deaths and disability than in other developed nations. 3. The high incidence of tobacco use. 4. The high incidence of coronary heart disease. 5. Fairly high levels of violence, notably homicides, compared with other developed countries. Although life expectancy in the United States gradually increased by 30 years over the past century, scientists from the National Institute of Aging believe that in the coming decades the average lifespan may decrease by as much as 5 years. This decrease in life expectancy will be related primarily to the growing epidemic of obesity. According to Centers for Disease Control and Prevention estimates, 32 percent of the adult population in the United States is obese. Additional information on the obesity epidemic and its detrimental health consequences is given in Chapter 5.

Leading Health Problems in the United States The leading causes of death in the United States today are largely lifestyle related (see Figure 1.4). The U.S. Surgeon General has stated that 7 of 10 Americans die of preventable chronic diseases.2 Specifically, about 55 percent of all deaths in the United States are caused by cardiovascular disease and cancer.3 Almost 80 percent of the latter deaths could be prevented through a healthy lifestyle program. The third and fourth leading causes of death, respectively, are chronic lower respiratory disease (CLRD) and accidents. The most prevalent degenerative diseases in the United States are those of the cardiovascular system.

Figure 1.4

71.7

Netherlands

72.0

Canada

72.0

Greece

72.5

Switzerland

72.5

Leading causes of death in the United States in 2006.

Cardiovascular diseases 31.7%

Cancer 23.0%

Italy

72.7

Spain

72.8

Sweden

73.0

France

73.1

Others 35.2%

CLRD* Japan 60

5.1%

Accidents

74.5 65

70 Years

75

80

SOURCE: World Health Organization, http://www.who.int/inf-pr-2000/en/pr2000life.html. Retrieved June 4, 2000.

*Chronic Lower Respiratory Disease

5.0%

SOURCE: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics reports, Deaths: Final Data for 2006, 57:14 (April 2009).

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.

Chapter 1 Physical Fitness and Wellness

Almost 32 percent of all deaths in this country are attributed to diseases of the heart and blood vessels. According to the American Heart Association (AHA), 80 million people in the United States are afflicted with diseases of the cardiovascular system, including 73.6 million with hypertension (high blood pressure) and 16.8 million with coronary heart disease (many of these people have more than one type of cardiovascular disease). About 1.25 million people suffer from coronary heart disease and 935,000 have heart attacks each year, and nearly 600,000 of them die as a result of these two conditions. The estimated cost of heart and blood vessel disease in 2008 exceeded $475 billion.4 A complete cardiovascular disease prevention program is outlined in Chapter 10. The second leading cause of death in the United States is cancer. Even though cancer is not the numberone killer, it is the number-one health fear of the American people. Twenty-three percent of all deaths in the United States are attributable to cancer. More than 562,340 people died from this disease in 2009, and an estimated 1,479,350 new cases were reported the same year.5 The major contributor to the increase in the incidence of cancer during the last five decades is lung cancer, of which 87 percent is caused by tobacco use. Furthermore, smoking accounts for more than 30 percent of all deaths from cancer. Another 33 percent of deaths are related to nutrition, physical inactivity, excessive body weight, and other faulty lifestyle habits. The American Cancer Society maintains that the most influential factor in fighting cancer today is prevention through health education programs. Evidence indicates that as much as 80 percent of all human cancer can be prevented through positive lifestyle behaviors. A comprehensive cancer-prevention program is presented in Chapter 11. CLRD, the third cause of death, is a general term that includes chronic obstructive pulmonary disease, emphysema, and chronic bronchitis (all diseases of the respiratory system). Although CLRD is related mostly to tobacco use (see Chapter 13 for discussion on how to stop smoking), lifetime nonsmokers also can develop CLRD. Precautions to prevent CLRD include:6 1. Consuming a low-fat, low-sodium, nutrient-dense diet (similar to a cardio- and cancer-protective diet). 2. Staying physically active. 3. Not smoking and staying clear of cigarette smoke. 4. Avoiding swimming pools for chlorine-vapor– sensitive individuals. 5. Getting a pneumonia vaccine if older than age 50 and a current or ex-smoker. Accidents are the fourth leading cause of death. Even though not all accidents are preventable, many are. Fatal accidents are often related to abusing drugs and not wearing seat belts. Most people do not perceive accidents as a health problem. Even so, accidents affect the total well-being of

5

millions of Americans each year. Accident prevention and personal safety are part of a health-enhancement program aimed at achieving a better quality of life. Proper nutrition, exercise, stress management, and abstinence from cigarette smoking are of little help if the person is involved in a disabling or fatal accident as a result of distraction, a single reckless decision, or not wearing seat belts properly. Accidents do not just happen. We cause accidents, and we are victims of accidents. Although some factors in life, such as earthquakes, tornadoes, and airplane accidents, are completely beyond our control, more often than not, personal safety and accident prevention are a matter of common sense. Most accidents stem from poor judgment and confused mental states, which occur when people are upset, are not paying attention to the task at hand, or are abusing alcohol or other drugs. Alcohol abuse is the number-one cause of all accidents. About half of accidental deaths and suicides in the United States are alcohol related. Further, alcohol intoxication is the leading cause of fatal automobile accidents. Other commonly abused drugs alter feelings and perceptions, generate mental confusion, and impair judgment and coordination, greatly enhancing the risk for accidental morbidity and mortality (see Chapter 13). The underlying causes of death in the United States (see Figure 1.5) indicate that eight of the nine causes are related to lifestyle and lack of common sense. Of the approximately 2.4 million yearly deaths in the United States, the “big three”—tobacco use, poor diet and inactivity, and alcohol abuse—are responsible for about 637,000 deaths each year.

Lifestyle as a Health Problem As the incidence of chronic diseases rose, it became obvious that prevention was—and remains—the best medicine. According to Dr. David Satcher, former U.S. Surgeon General, more than half of the people who die in this country each year die because of what they do. Based on estimates, more than half of disease is lifestyle related, a fifth is attributed to the environment, and a tenth is influenced by the health care the individual receives. Only 16 percent is related to genetic factors (see Figure 1.6). Thus, the individual controls as much as 84 percent of his or her vulnerability to disease—and thus quality of life. The same data indicate that 83 percent of deaths before age 65 are preventable. In essence, most

Healthy life expectancy (HLE) Number of years a person is expected to live in good health; this number is obtained by subtracting ill-health years from the overall life expectancy. Morbidity A condition related to or caused by illness or disease.

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6

Lifetime Physical Fitness and Wellness

Figure 1.5 Drug abuse Sexual behavior

Underlying causes of death in the United States, year 2000.

Figure 1.6

Factors that affect health and well-being.

17,000 Lifestyle 53%

20,000 29,000

Firearms Motor vehicles Toxic agents Microbial agents

Health care 10%

43,000 Environment 21%

55,000

Genetics 16%

75,000

Alcohol

85,000

Poor diet/ inactivity

112,000

Tobacco

440,000 0

100,000

200,000

300,000

400,000

500,000

SOURCE: Centers for Disease Control and Prevention, Atlanta, 2003.

Abundant scientific research over the past three decades has established a distinction between physical activity and exercise. Physical activity is bodily movement produced by skeletal muscles. It requires energy expenditure and produces progressive health benefits. Physical activity typically requires only a low to moderate intensity of effort. Examples of physical activity include walking to and from work, taking the stairs instead of elevators and escalators, gardening, doing household chores, dancing, and washing the car by hand. Physical inactivity, by contrast, implies a level of activity that is lower than that required to maintain good health.

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people in the United States are threatened by the very lives they lead today. Because of the unhealthy lifestyles that many young adults lead, their bodies may be middle-aged or older! Many physical education programs do not emphasize the skills necessary for youth to maintain a high level of fitness and health throughout life. The intent of this book is to provide those skills and help to prepare you for a lifetime of physical fitness and wellness. A healthy lifestyle is self-controlled, and you can learn how to be responsible for your own health and fitness. Healthy choices made today influence health for decades.

Physical Activity and Exercise Defined

An active lifestyle increases health, quality of life, and longevity.

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Chapter 1 Physical Fitness and Wellness

Table 1.1

7

Physical Activity Guidelines

Benefits

Duration

Intensity

Frequency per Week

Weekly Time

Health Health and fitness Health, fitness, and weight gain prevention Health, fitness, and weight regain prevention

30 min ≥20 min 60 min 60–90 min

MI* VI* MI/VI† MI/VI†

≥5 times ≥3 times 5–7 times 5–7 times

≥150 min ≥75 min ≥300 min ≥450 min

*MI = moderate intensity, VI = vigorous intensity †MI/VI = You may use MI or VI or a combination of the two

Exercise is a type of physical activity that requires planned, structured, and repetitive bodily movement to improve or maintain one or more components of physical fitness. Examples of exercise are walking, running, cycling, aerobics, swimming, and strength training. Exercise is usually viewed as an activity that requires a vigorous-intensity effort.

Importance of Increased Physical Activity The U.S. Surgeon General has stated that poor health as a result of lack of physical activity is a serious public health problem that must be met head-on at once. Regular moderate physical activity provides substantial benefits in health and well-being for the vast majority of people who are not physically active. For those who are already moderately active, even greater health benefits can be achieved by increasing the level of physical activity. Among the benefits of regular physical activity and exercise are significantly reduced risks for developing or dying from heart disease, stroke, type 2 diabetes, colon and breast cancers, high blood pressure, and osteoporotic fractures.7 Regular physical activity also is important for the health of muscles, bones, and joints, and it seems to reduce symptoms of depression and anxiety, improve mood, and enhance one’s ability to perform daily tasks throughout life. It also can help control health care costs and maintain a high quality of life into old age. Moderate physical activity has been defined as any activity that requires an energy expenditure of 150 calories per day, or 1,000 calories per week. The general health recommendation is that people strive to accumulate at least 30 minutes of physical activity a minimum of 5 days per week (see Table 1.1). Whereas 30 minutes of continuous activity is preferred, on days when time is limited, three activity sessions of at least 10 minutes each still provide substantial health benefits. Examples of moderate physical activity are brisk walking or cycling, playing basketball or volleyball, swimming, water aerobics, dancing fast, pushing a stroller, raking leaves, shoveling snow, washing or waxing a car, washing windows or floors, and even gardening. Light-intensity activities of daily living such as casual walking, self care, shopping, or those lasting less than 10 minutes in duration cannot be included as part of the moderate physical activity recommendation.

Because of the ever-growing epidemic of obesity in the United States, the Institute of Medicine of the National Academy of Sciences increased the recommendation to 60 minutes of moderate-intensity physical activity every day.8 This recommendation was based on evidence indicating that people who maintain healthy weight typically accumulate one hour of daily physical activity. Subsequently, the 2005 Dietary Guidelines for Americans released by the U.S. Department of Health and Human Services and the Department of Agriculture recommend that up to 60 minutes of moderate- to vigorous-intensity physical activity per day may be necessary to prevent weight gain, and between 60 and 90 minutes of moderate-intensity physical activity daily is recommended to sustain weight loss for previously overweight people.9 In sum, although health benefits are derived with 30 minutes per day, people with a tendency to gain weight need to be physically active daily for an hour to an hour and a half to prevent weight gain. And 60 to 90 minutes of activity per day provides additional health benefits, including a lower risk for cardiovascular disease and diabetes.

CRITICAL THINKING Do you consciously incorporate physical activity into your daily lifestyle? ● Can you provide examples? ● Do you think you get sufficient daily physical activity to maintain good health?

Physical activity Bodily movement produced by skeletal muscles; requires expenditure of energy and produces progressive health benefits. Examples include walking, taking the stairs, dancing, gardening, yard work, house cleaning, snow shoveling, washing the car, and all forms of structured exercise. Exercise A type of physical activity that requires planned, structured, and repetitive bodily movement with the intent of improving or maintaining one or more components of physical fitness. Moderate physical activity Activity that uses 150 calories of energy per day, or 1,000 calories per week.

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Lifetime Physical Fitness and Wellness

2008 Federal Guidelines for Physical Activity Because of the importance of physical activity to our health, in October 2008, the U.S. Department of Health and Human Services issued Federal Physical Activity Guidelines for Americans for the first time. These guidelines complement the Dietary Guidelines for Americans published in 2005 (see Chapter 3, pages 106–108) and further substantiate previous recommendations issued by the American College of Sports Medicine (ACSM) and the AHA in 2007,10 and the U.S. Surgeon General in 1996.11 The federal guidelines provide science-based guidance on the importance of being physically active and eating a healthy diet to promote health and reduce the risk for chronic diseases. The federal guidelines include the following recommendations:12

Health Benefits of Physical Activity for Adults and Older Adults: A Review of the Strength of the Scientific Evidence There is strong evidence that physical activity: Lowers the risk of • early death • heart disease • stroke • type 2 diabetes • high blood pressure • adverse blood lipid profile • metabolic syndrome • colon and breast cancers Helps • prevent weight gain • with weight loss when combined with diet • improve cardiorespiratory and muscular fitness • prevent falls • reduce depression • improve cognitive function in older adults

There is moderate to strong evidence that physical activity: • • • • • • •

improves functional health in older adults reduces abdominal obesity helps maintain weight after weight loss lowers the risk of hip fracture increases bone density improves sleep quality lowers the risk of lung and endometrial cancers

SOURCE: U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans. www.health.gov./ paguidelines. Downloaded October 15, 2008.

Adults Between 18 and 64 Years of Age • Adults should do 2 hours and 30 minutes a week of moderate-intensity aerobic (cardiorespiratory) physical activity, 1 hour and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity (also see Chapter 6). When combining moderate- and vigorous-intensity activities, a person could participate in moderate-intensity activity twice a week for 30 minutes and high-intensity activity for 20 minutes on another 2 days. Aerobic activity should be performed in episodes of at least 10 minutes long each, preferably spread throughout the week. • Additional health benefits are provided by increasing to 5 hours (300 minutes) a week of moderateintensity aerobic physical activity, 2 hours and 30 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both. • Adults should also do muscle-strengthening activities that involve all major muscle groups, performed on 2 or more days per week. Older Adults (Ages 65 and Older) • Older adults should follow the adult guidelines. If this is not possible due to limiting chronic conditions, older adults should be as physically active as their abilities allow. They should avoid inactivity. Older adults should do exercises that maintain or improve balance if they are at risk of falling. Children 6 Years of Age and Older and Adolescents • Children and adolescents should do 1 hour (60 minutes) or more of physical activity every day. • Most of the 1 hour or more a day should be either moderate- or vigorous-intensity aerobic physical activity. • As part of their daily physical activity, children and adolescents should do vigorous-intensity activity on at least 3 days per week. They also should do muscle-strengthening and bone-strengthening activities on at least 3 days per week. Pregnant and Postpartum Women • Healthy women who are not already doing vigorous-intensity physical activity should get at least 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity a week. Preferably, this activity should be spread throughout the week. Women who regularly engage in vigorousintensity aerobic activity or high amounts of activity can continue their activity provided that their condition remains unchanged and they talk to their health care provider about their activity level throughout their pregnancy. In a 2007 report, the ACSM and the AHA also released a joint statement on physical activity recommendations for healthy adults.13 The ACSM/AHA report states that

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Chapter 1 Physical Fitness and Wellness

a greater amount of physical activity that exceeds the minimum recommendations provided above for adults between 18 and 64 years of age provides even greater benefits and is recommended for individuals who wish to further improve personal fitness, reduce the risk for chronic disease and disabilities, prevent premature mortality, or prevent unhealthy weight gain. The ACSM/AHA report also states that only 49.1 percent of the U. S. adult population meets the recommendations. College graduates are more likely to adhere to the recommendations (about 53 percent of them), followed by individuals with some college education, then high school graduates; and the least likely to meet the recommendations are those with less than a high school diploma (37.8 percent). In conjunction with the above report, the ACSM and the American Medical Association (AMA) have launched a nationwide “Exercise Is Medicine” program.14 The goal of this initiative is to help improve the health and wellness of the nation through exercise prescriptions from physicians and health care providers: “Exercise is medicine and it’s free.” All physicians should be prescribing exercise to all patients and participate in exercise themselves. Exercise is considered to be the much needed vaccine of our time to prevent chronic diseases. Physical activity and exercise are powerful tools for both the treatment and the prevention of chronic diseases and premature death.

Figure 1.7

Monitoring Daily Physical Activity According to the Centers for Disease Control and Prevention, the majority of U.S. adults are not sufficiently physically active to promote good health. The most recent data indicate that only 49 percent of adults meet the minimal recommendation of 30 minutes of moderate physical activity at least 5 days per week, 24 percent report no leisure physical activity at all, and 14 percent are completely inactive (less than 10 minutes per week of moderate- or vigorous-intensity physical activity). The prevalence of physical activity by state in the United States is displayed in Figure 1.7. Other than carefully monitoring actual time engaged in activity, an excellent tool to monitor daily physical activity is through the use of pedometers. A pedometer is a small mechanical device that senses vertical body motion and is used to count footsteps. Wearing a pedometer throughout the day allows you to determine the total steps you take in a day. Some pedometers also record distance, calories burned, speeds, and actual time of activity each day. A pedometer is a great motivational tool to help increase,

Pedometer An electronic device that senses body motion and counts footsteps. Some pedometers also record distance, calories burned, speeds, “aerobic steps,” and time spent being physically active.

Prevalence of recommended physical activity in the United States, 2007.

WA MT

ND

ID

ME

MN

OR

WI

SD

CA

IA

NE UT

AZ

CO

NM TX

OH

IN

KY

MO

OK

WV VA NC

TN AR

SC

LA MS

AL

AK

Guam

Puerto Rico

DC

RI

NJ DE MD

GA

FL

Hawaii

NH MA CT

PA IL

KS

VT

NY

MI

WY NV

9

> 55% 50–54.9% 45–49.9% 40–44.9% < 40%

Virgin Islands

Note: Recommended physical activity is accumulation of 30 minutes per day of moderate-intensity activity a minimum of 5 days per week or 20 minutes per day of vigorous-intensity activity a minimum of 3 days per week. SOURCE: Centers for Disease Control and Prevention, Atlanta, 2009.

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10

Lifetime Physical Fitness and Wellness

TABLE 1.2

ADULT ACTIVITY LEVELS BASED ON TOTAL NUMBER OF STEPS TAKEN PER DAY

Steps per Day

Category