The BeWell! Tanger Center for Health Management, BIDMC's onsite wellness and exercise resource center, answers your questions in this ongoing column in BIDMCtoday. E-mail your health- or fitness-related questions to the BeWell! staff at makenned@bidmc.harvard.edu.


Q. I run five days per week. Is it really necessary to strength train my lower body, or is my running enough to build strength in my legs?

A. It is definitely important to strength train your legs, despite the fact that you are an avid runner. In fact, leg training is one of the best ways to help you become a stronger runner. Running is a cardiovascular activity that will condition your heart and lungs and help you to burn calories; however, it is not an effective way to build muscular strength. Running involves hundreds of repetitions (for your legs) of your own body weight. Completing a high number of repetitions is not the key to building strength. If it were, we would all have very muscular legs from walking around everyday. Instead, muscular strength is developed by challenging the fibers of a specific muscle to lift an amount of weight that will cause fatigue in the last few repetitions of a set of eight to twelve. Some good examples of exercises to strengthen your legs are lunges, squats and leg presses.



previous questions...

Q: I am thinking of joining the gym, but the only time I can go is before work and that will only allow me to work out for 45 minutes, five days per week. Is this enough time to even bother?

A: Absolutely. According to the American College of Sports Medicine, a well-rounded exercise program should include 30 to 60 minutes of aerobic exercise, three to five days per week; two to three days of strength training (which can take between 20 to 30 minutes) and a daily stretching routine (five to 10 minutes). If you have 45 minutes, five days per week, you will have more than enough time to complete a total exercise program. Be a little creative. Remember that all 30 to 60 minutes of aerobic exercise do not need to be completed at one time. Therefore, on the days that you strength train, you could cut your aerobic time down to 10 minutes. Then, on your way home, get off the train two stops early and walk briskly to your car in order to complete the rest of your aerobic workout for the day.

When it comes down to it, the most important thing is that you did something. Even if you are crunched for time, remember: 10 percent of something is better than 100 percent of nothing!




Q: I always get confused about when I am supposed to breathe while strength training. Can you help?

A: Learning how to breath correctly while strength training can be very difficult. It is quite common for people to “forget” to breathe while strength training. Instead of breathing, many people will actively hold their breath. This can be problematic because it will cause a rise in blood pressure.

The correct way to breathe when strength training is to exhale during the “lifting” or “positive” phase of the exercise and to inhale during the “lowering” or “negative” phase. Using a bicep curl as an example – you should breathe out when lifting the weight toward your shoulders and breathe in when lowering the weight toward the floor.


Q. I hate to run, and I often find myself in pain during runs. I am an avid lifter but I also want to try and get some cardio into my workout. What other types of “intense” cardio can I try, and how often should I incorporate it?

A. “Hate” and “pain” are two words that should never be associated with exercise – if they are, there is something wrong! Therefore, you are on the right track trying to find an alternative to running.

According to the American College of Sports Medicine, cardiovascular exercise (cardio) is defined as large muscle group activity performed in rhythmic fashion over a prolonged period of time. It should be completed three to five days per week for 30 to 60 minutes. It is a common misconception that running is the best or only way to get an intense cardio workout. Any activity that gets your heart rate into its target range and keeps it there for a prolonged period of time is an effective form of cardiovascular exercise. The best type of workout is one that you will enjoy and the intensity level will be dependent on the amount of effort you are willing to put forth when executing the activity – any activity can be intense if you are willing to make it that way!

Recreational sports are a great way to incorporate cardio into your current workout routine. An intense game of basketball, hockey or racquetball can provide you with a high-quality cardiovascular workout. Martial art activities such as Tae Kwon Do or Karate are another excellent option. You could also try an outdoor activity such as hiking, kayaking or rowing. If you are limited to a fitness center environment make an attempt to simulate one of these activities. For example, use the incline adjustment on the treadmill in order to mimic a hike, or find a friend and challenge each other to a “race” on the rowing machine. Be creative, but always keep in mind if it’s painful, stop -- and if you hate it, try something else!


Q. Is it a bad idea to do bring the bar behind your neck when doing shoulder presses?

A.There are three areas to the deltoid (a.k.a. shoulder) muscle - anterior, lateral and posterior. The shoulder press is meant to target the anterior portion of this muscle. Both the military style (in front of head) and the behind the neck version of the press will do this efficiently, however the military press is a much safer and more functional exercise. Sometimes people choose the behind the neck press in order to bring the posterior deltoids more into play. Due to the high risk of injury associated with the behind the neck press, it is a better idea to choose a separate exercise (such as the rear lateral raise) to specifically target the rear deltoid.

Q. Now that it's nice out I would really like to start running outside. The only problem is, I get short of breath before I can get a good workout. Are walk/run intervals the best way to build up, and if so, how long should each interval be? How often do I need to do these intervals per week?

A. Yes, walk/run intervals are the best way to build your endurance for running. An interval workout is an aerobic workout and can be performed three to five days per week in order to meet the American College of Sports Medicine guidelines for aerobic activity. The length of the intervals depends upon your current cardiovascular conditioning level. A person currently involved in a regular walking program who would like to transition into running can begin with a 5:1 interval pattern - five minutes of walking, one minute of running - for the duration of the walk. Somebody who is more conditioned and able to tolerate five minutes of continuous running, can do a 5:1 interval pattern - five minutes of running, one minute of walking.

Try to increase the length of the running interval by one minute each week until you are ultimately able to run continuously for 30 minutes. If you are starting with a five minute walk: one minute run pattern, begin by decreasing the walk interval by one minute and increasing the run interval by one minute each week until you are at a five minute run: one minute walk pattern. Then progress by adding one minute to the run interval every week.

The goal of an aerobic workout is to elevate your heart rate into your target heart rate range and keep it there for the duration of your workout. Keep this in mind throughout your walk/run. Do not work yourself so hard through the run interval that you need to "stroll" through the walk interval. Walk does not mean relax!


Q. I am currently training for a half-marathon. I know that my "long run" is a very important part of my training, but I am having trouble finding the time to fit a "long run" into my schedule. Is it okay to break up my long run into two sessions (i.e. 14 miles - 10 miles in the morning, four miles in the evening)?

A. Two-a-day sessions are an acceptable method to choose if you are looking to add to your total weekly mileage, but a long run needs to be done in one continuous stretch in order to reap the most benefit. In order to be fully prepared for race day you will need to reproduce both the mental and physical stress your body will be up against. Practicing running continuous long runs is the only way to learn how your legs will cope, as well as how your body will need to be re-fueled come race day. Also, learning to overcome the mental challenge of a long run is a crucial component of successful distance running.



Q. Is it better to do three sets of one exercise, or one set of three exercises, for the same muscle group?

A. According to the American College of Sports Medicine if time permits, different exercises for a given muscle group should be performed in an effort to recruit different parts of each muscle. Varying the exercises that you choose for a given muscle group will allow you to work a particular muscle from different angles and give that muscle a "total" workout.



Q. If I am going to do cardiovascular exercise (cardio) and weights, is it better to do cardio or weights first?

A. The decision of which to do first - cardio or weights - is a matter of personal preference. Whichever works best for YOU is correct.

When trying to make this decision, take a few things into consideration. First, is there one portion of your workout that you enjoy more than another? It is a good idea to do the part of your workout that you enjoy the least first. That way you will be less likely to skip it. For example, if you look forward to walking on the treadmill, do the weight portion of your workout first. That way it will be impossible to find an excuse (e.g. ran out of time) not to strength train.

Next, consider the fact that your muscles will be more fatigued for the part of your routine that you do second. If you want to be "fresh" for strength training, you should do that first so you don't find yourself worn out from your cardio workout and vice versa.

Keep in mind that your muscles need to be warmed up before strength training. If you decide to do weights first, complete a five minute cardio warm up prior to starting your weight routine.

However, once a muscle has been warmed up there is not one “perfect” time for it to be stretched. It is a personal preference whether you choose to stretch after a brief warm-up or after completing a cardio and/or strength training program. Some people even choose to stretch in small segments throughout their workout. Each of these scenarios is safe and correct.

Stretching is an important component of an effective exercise program. Unfortunately it is the component that is most often neglected. When deciding when to fit stretching into your program, try to be realistic. If you find yourself consistently blowing off your stretching program after completing your cardio routine, consider stretching closer to the beginning of your workout instead.

A. In order to build strength in muscle tissue, a muscle needs to be pushed to the point of fatigue one time. Once a muscle has been pushed to fatigue (also known as failure) it will be stimulated to become stronger.

The choice to bring a muscle to fatigue one, two, or three times (through one, two or three sets) is an individual one strongly based upon one's motivation for exercise. Body builders and athletes often choose to engage in multi-set weight lifting routines. However, for the average exerciser who is looking for a time-efficient method of training, one set of properly performed exercises will produce nearly the same benefit as a multiple set regimen, according to research conducted by Wayne Westcott, Ph.D., fitness research director at the South Shore YMCA in Quincy, MA. Although people who perform multiple sets may see a small benefit (2 to 5 percent) over those who perform a single set, Westcott notes that for most people a single set regimen works fine.

Regardless of the number of sets being performed, no results can be achieved unless each exercise is performed with proper form and technique. Choose a weight can be lifted for at least eight repetitions, but make sure that it is not so light that 13, 14 or 15 repetitions can easily be completed. Go slowly and make every repetition count. The lifting phase of an exercise should take approximately 2 seconds and the lowering phase should take approximately 4 seconds.

NOTE: This column is meant to offer general advice only. Always consult your physician before starting any new diet or exercise program.

For more information about the programs available at BeWell!, visit us at www.bidmc.harvard.edu/bewell.

Q. In your last Ask BeWell! piece you mentioned "increasing intensity" during exercise. What does that mean and why is it important?

A. To increase the intensity of an exercise means to increase its degree of difficulty. There are many different methods you can use to increase the intensity of a workout. For example, walking faster will cause a workout to become more intense, as will walking up an incline. Increasing the resistance on a piece of exercise equipment (i.e. making a bike harder to pedal) is another way to increase the intensity of a workout. It is also possible to increase the intensity of a strength training workout by increasing the amount of weight that is being lifted or by decreasing the amount of rest time taken between sets.

People periodically increase the intensity of their workout for a variety of reasons. An increase in intensity equals an increase in caloric expenditure. Many people are looking to expend a certain amount of calories during their workout to help them achieve or maintain a goal weight. Increasing the intensity of a workout will allow people to reach their calorie expenditure goal faster.

People looking to improve on their performance in a specific activity often increase the intensity of their workout as well. Practicing running at a faster pace will eventually lead to faster race times.

Finally, many people like the challenge of a more intense workout. They may not be looking to achieve specific results - they are just looking to a reach personal goal they have set for themselves.

There are a few things to keep in mind if you are considering increasing the intensity of your workouts. First - stay within your target heart rate range. Second - remember the recommendations for aerobic exercise are 30 to 60 minutes three to five times per week and for strength training it is 8-12 repetitions of a given exercise 2-3 times per week. Do not increase the intensity of a workout so much that you cannot meet these recommendations. Finally - be safe. Do not increase by too much too fast. You will not be able to achieve any results if you are injured.


Q. Is it a good idea to carry hand weights while I walk?

A. It is a common misconception that walking with small hand or ankle weights will cause an increase in strength and/or be a good way to increase the intensity of a workout. Often, the only thing gained by adding these weights to your workout is an injury. Consider this: during an average 30-minute walk your hands will swing back and forth thousands of times. If you force them to move against the resistance of extra weight, it is probable that you will produce a strain that will ultimately lead to tendonitis in the elbows and shoulders. To make matters worse, the weight used during these workouts will not cause any significant increase in strength.

Another consideration is that hand and/or ankle weights have the potential to change your stride by altering your balance and disturbing the mechanics of walking. They can also be dangerous for people with hypertension due to the fact that gripping the weights will cause an increase in blood pressure.

There are many safe alternatives to using hand/ankle weights when looking to step-up your workout. If you are want to increase your strength, you should engage in a structured strength training routine that will target specific muscle groups using a weight that is heavy enough to lift for only 8-12 repetitions. If you are interested in increasing the intensity of your workouts, try adding intervals. Intervals are brief periods (1-3 minutes) of higher intensity work. Try by starting to walk at a comfortable pace for 5 minutes, then increase to a slightly faster pace for 1 minute. At the end of that minute, return to your comfortable pace for another 5 minutes. Repeat this pattern for the duration of your workout.


Q. I want to start an aerobic exercise program. What type of exercise will get me in the best shape?

A. The type of aerobic exercise that will get you into the best shape is the one that you enjoy the most and that will keep you coming back for more. It is hard to find the time and the energy to begin an exercise program and it will only become more difficult if you force yourself to do a type of exercise that you hate. Just because your co-worker is a runner does not mean that you have to be. Try out different activities, machines and/or classes until you find something that you personally enjoy and that makes you feel good. Just be sure that your joints and muscles like it as much as you do - don't expose them to any undue stress.


Q. I am just beginning an exercise program and I am unsure whether I am working out at an appropriate pace. How can I tell?

A. Checking your heart rate periodically during your workout is one of the best ways to gauge how hard you are exercising. The goal of cardiovascular exercise is to raise your heart rate into your target heart rate zone and keep it there for the duration of your workout. Exercising within your heart's target exercise zone will provide you with the most benefits.

To determine your personal target heart rate zone you must first figure your maximum heart rate. Your maximum heart rate represents the fastest rate your heart should beat. You can figure your maximum heart rate by subtracting your age from the number 220. For example, a person who is 20 years old would have a maximum heart rate of 200 beats per minute (bpm). Your target heart rate zone will fall between 60 and 90 percent of your maximum heart rate. Using the example of the 20 year-old, we can multiply 200 (his/her maximum heart rate) by 0.6 and 0.9 and we can see that his/her target heart rate zone falls between 120 and 180 bpm.

To check your heart rate, find your pulse (by placing two fingers on the side of your neck or on the thumb-side of the underside of your wrist) in the middle of or immediately after your cardiovascular workout. Count your pulse for 30 seconds, then multiply that number by two. This number should fall somewhere within your target heart rate zone. If you find the number to be much below the zone then you can increase the intensity of your workout, if it is above you will want to slow things down a bit.

Please note that when you start working out it is not recommended that you aim for the higher part (90 percent) of your target heart rate zone. That will come as you get in better shape. Instead, make the lower part (60 percent) your goal.

Q. I am interested in maintaining my outdoor running program through the winter, but I am afraid of freezing! Do you have any suggestions?

A. Winter can be a very enjoyable season to run through if you are adequately prepared for the elements. Here are a few basic tips to help you stand up to whatever mother nature may throw your way:

1. Be prepared to feel a little cold during the first 10 minutes or so of your workout. Exercise will cause you to generate natural body heat. If you do not anticipate this, you may dress too warmly and develop premature fatigue and discomfort.

2. Dress in layers so that you can quickly adjust to changing weather conditions by adding or peeling off clothing.

3. Make sure that the layer closest to your skin (the base layer) is made of a high-tech polyester material that "wicks" sweat away from your body. "Wicking" materials draw perspiration away from the skin to the outer surface of the garment where it can evaporate more quickly. Cotton clothing will absorb sweat, which will leave you with a wet layer of clothing closest to your skin. This can cause you to become severely chilled in very cold and windy conditions - especially if you are forced to slow down or walk.

4. Try to choose an outer layer that is wind- and water-resistant. This is important as wind is often the biggest contributor to winter coldness. Also, try to find an outer layer with zippers and other vents. This will allow you to adjust to a wide range of temperatures and conditions.

5. Protect your extremities - ears, toes and fingers. You can lose up to 50 percent of your body heat through your head - so finding a hat made of a breathable material that can be pulled over your ears is essential to staying warm. Be sure to wear socks made of "wicking" material. You may find that you will want to wear a little heavier sock than you are used to wearing in warm weather. Finally, be sure your hands are covered. It is a good idea to wear mittens in extremely cold and windy weather because they are better than gloves at protecting your hands.

6. Don't be too concerned about your legs. Windsuit pants or tights are often enough protection - a runner's legs will handle cold weather conditions surprisingly well. On extremely cold and windy days you can add a base layer of thermal underwear, but be sure it is made of "wicking" material.


Q. I am worried about finding a way to fit my regular exercise routine in during the busy holiday season. Can you help?

A. Although current recommendations suggest that one should engage in aerobic activity three to five days per week for 30 to 60 minutes, it is not necessary to fit in all 30 to 60 minutes of exercise during one session. In fact, according to a study published in the Oct. 2001 issue of the Journal of the American College of Nutrition, short bursts of activity are just as effective as one long session when it comes to burning calories, losing weight and improving aerobic fitness.
Try to break your workouts into smaller, more manageable chunks. Find time to squeeze in 10 minutes of exercise before you take a shower or during the commercials of your favorite TV show. Remember, it is better to fit in some of your workout than to skip it altogether!


Q. I am having trouble losing weight. Do you have any suggestions about how to burn more calories throughout the day?

Many people assume that in order to increase the number of calories that they burn, they need to go faster, longer and harder with their aerobic exercise routine. Although aerobic exercise is an important component in one's weight-loss efforts, it is not the only factor. Aerobic exercise contributes to only a fraction of the calories that a person expends.

The major factor in determining a person's metabolic rate (or the amount of calories someone burns throughout the day) is the amount of lean muscle mass he or she has. The more lean muscle a person's body contains, the more calories he or she burns both during a workout and throughout the day. Including even a modest strength-training program two to three days per week will get you started burning calories at a faster rate. Good luck!!

NOTE: This column is meant to offer general advice only. Always consult your physician before starting any new diet or exercise program.