PART V: BALANCE

Written by Dr. Carl DuCharme

Did you know that worsening balance is not simply an inevitable consequence of aging?  

              Balance refers to the ability to control and stabilize your body’s position.

Many things can cause declining balance as we age including loss of muscle mass, inner ear problems, changes in eyesight, development of chronic diseases and side effects from medications amongst others.  Often the cause of balance problems is from a combination of these conditions.  Loss of balance contributes to falls which causes a high degree of fractures, disability and death as we age.  In fact, according to the CDC falls are the leading cause of injury-related death for ages 65 and older. Perhaps more striking is the rate of falls is increasing and specifically, the fall death rate amongst those age 65 and older has increased about 30% from 2009 to 2018.

Exercise combined with environmental-inspection and hazard-reduction programs can help reduce the number of falls.  This blog will address the importance of exercise, more specifically balance training and its benefits in health and to reduce one of the leading causes of morbidity and mortality associated with aging.

Balance is a key component to physical fitness and should be included in a well-rounded exercise regimen that includes resistance training, aerobic conditioning and flexibility.  The great news is that those who already perform those types of exercise are likely already benefiting from maintained and improved balance.  

Health Benefits

Improving and maintaining balance as we age can improve mobility and prevent falls and associated injury. Performing balance exercises can also help improve posture. Many who have sedentary jobs or lifestyles develop hunched shoulders, reduced upper-back mobility and anterior pelvic tilt. This type of posture can lead to back pain, stiff neck and even thoracic kyphosis (appearing hunched over as we age).  

This study showed balance training programs were effective in reducing the incidence of ankle sprains in athletes with and without a history of ankle sprains.

Types of balance

• Static – maintaining stability when stationary such as standing on one leg
• Dynamic – maintaining stability while moving such as riding a bicycle or hiking

How to test your own balance:

Here are 3 simple tests you can perform at home to evaluate your static balance:

1. Feet Together. Stand with your feet together with your arms at your sides and close your eyes. You should be able to stand still for more than 30 seconds without taking a step, losing your balance or unnecessarily swaying.
2. Stand and Reach. Stand with your feet together and arms held out forward in front of you.  Now reach forward as far as you can without losing balance, falling or taking a step. You should be able to reach forward at least 10 inches.
3. Stand On One Leg. Fold your arms across your chest so your hands are grasping the opposite shoulder. Now pick one foot off the floor and stand for at least 30 seconds without placing that foot back down, losing balance, hopping or taking a step.

If you cannot fully complete these tests you may have balance problems.  

There are multiple other tests to evaluate balance. A standardized dynamic balance test found on the CDC website is called The Up & Go (TUG) assessment. You begin by sitting back in an armchair and see how fast you can get up from the chair, walk forward to a predetermined spot 10 ft from the chair, then walk back to the chair and sit down. The goal is to do this task in less than 12 seconds.

PLAN INTO ACTION

Start by evaluating your balance with the tests above or others you may know about. If you pass with flying colors, pat yourself on the back (while standing on one leg with your eyes closed!) AND write down your test results. Save these test results so you can compare your results when you perform these same tests on an annual basis.  If you did not pass all of the tests do not worry, you now have a baseline to look back upon to chart your progress.

Depending on how well or poorly you did there a many options for improving or maintaining your balance. Unfortunately, there is no “one size fits all” program for everyone. If you did not do well on these tests I advise you to follow up with your physician as there may be consideration for formal evaluation and treatment with a licensed physical therapist. 

For those of you able to complete some of the tests but not perfectly, I would evaluate your current level of overall fitness and exercise capacity. The problem may be a lack of fitness and would be best addressed by regular exercise incorporating resistance training and flexibility along with balance specific exercises. This cannot be overstated enough; 

the foundation of good balance is appropriate strength and flexibility

If you have appropriate strength and flexibility your next step is dedicated balance training. Many options from balance boards to BOSU balls exist. These items can be purchased to use at home or are commonly found in most gyms or fitness centers. A quick YouTube search will reveal many videos from personal trainers such as this one that target balance, core and stability.  

Health Tip

Balance and flexibility training should be performed in addition to regular resistance training and aerobic exercise in order to truly optimize your physical health.  Remember that strength and flexibility are the foundation of good balance so try to prioritize them in your workouts. Often there is much overlap.  You can incorporate balance training as part of your dynamic stretching routine to warmup prior to resistance training or cardio.  Another option is to place it at the end of your workout with lighter weights or isolated stretching. Yoga or Pilates will incorporate balance, flexibility and body weight resistance all at once!

PART IV: FLEXIBILITY

Written by Dr. Carl DuCharme

Many people simply don’t know the health benefits associated with flexibility and therefore, forget to include stretching when performing exercise.  Improved flexibility leads to better mobility, posture, range of motion, decreases joint stress and risk of musculoskeletal injury. Stretching is the most common way to improve flexibility.  Many types of stretching exist. For our purposes we will keep things simplified and focus on dynamic and isolated stretching styles.

Dynamic Stretching

Is performed by moving through your range of motion as you stretch. It usually involves transitioning from one body movement to another.  Many people use this type of stretching to improve mobility.  It is also a good way to warm prior to exercise.  Think of doing arm circles prior to performing chest press or walking lunges before lower body exercise. 

Isolated Stretching

This is the standard type of stretching most of us were taught as a child in school or athletics.  It is when you slowly move a muscle to the end of its range of motion and hold it there for a period of time. Often it is performed a few times with a short rest period in between stretches. Think of bending forward at the waist to touch your toes and holding it for several seconds before returning to a standing position.  This type of stretching is best performed after exercising when your muscles are warmed up in order to maximize benefits.  There are various styles of isolated stretching. A common one is called Active Isolated Stretching (AIS). This style only holds the stretch briefly (2 seconds) and is thought to target the muscle and nearby myofascial tissues in a more efficient manner.

Perhaps the best way to become more flexible is by performing a combination of both isolated and dynamic styles. The two most well-known forms of exercise that accomplish this are yoga and Pilates. Both will improve flexibility, body control, muscular endurance and strength. The biggest key difference is yoga incorporates mind, body and spirit into exercise using meditation and breathing techniques. However, there is a lot of crossover between the yoga and Pilates. Both can be relaxing or extremely physically challenging!

Specific Health Benefits

Active exercise therapies like Pilates have been shown to be more effective in treatment of non-specific chronic low back pain than other forms of treatment like passive physiotherapy, ultrasound, hot and cold therapy and hands-off treatments.

A 2020 study reports that muscle stretching exercises are an effective way to reduce arterial stiffness, heart rate, diastolic blood pressure and improve vascular endothelial function in middle-aged and older adults. This is good news because all of these things can increase the risk of cardiovascular disease which is the leading cause of death in the U.S.

Fibromyalgia is a debilitating condition causing widespread muscle pain and tenderness.  It is very difficult to treat and one of the mainstays of treatment involves exercise prescription. In 2017, this study found muscle stretching exercises to be beneficial in improving quality of life, physical function and pain in patients suffering from fibromyalgia.  Therefore, recommendations to treat fibromyalgia should include stretching in addition to traditional aerobic and resistance training treatment plans.

Another interesting fact is that stretching can improve chronic insomnia.  Stretching was also found to improve cognitive function and mood in physically active adults.

Let’s review the benefits of improving flexibility:

• Decreases risk of injury
• Improves mobility and range of motion
• Decreases joint stress
• Lowers blood pressure and heart rate
• Treats fibromyalgia and insomnia
• Improves mood and cognitive function

PLAN INTO ACTION

As stated above, there are so many benefits to improving flexibility we should make it a priority to incorporate stretching into our daily lives.  If you already exercise a few days per week the simplest way to incorporate it into your exercise program is prior to your exercise.  A quick dynamic stretching routine will help loosen up your joints and warm up your muscles prior to whatever your workout entails.  This is an example of a total body warmup by Athlean-XX For Women that incorporates dynamic stretching. 

If you prefer to stretch after you exercise, this is a poster that guides you through 5 upper body and 5 lower body isolated stretches.  Remember, the best time to perform isolated stretching is when your muscles are already warm and after you exercise.

For those of you that are looking to take your fitness and flexibility to another level I highly recommend performing yoga or Pilates 2-3 times weekly.  There are several apps you can download to your phone that offer on-demand or live sessions.  Of course, you can always join a real studio or gym that offers live classes as well.  Performing yoga or Pilates will help you put an emphasis on flexibility, body control and core strengthening.  

Health Tip

While flexibility is important, I would not prioritize performing stretching over resistance training or aerobic exercise if you have limited time.  This is because there are many more profound health benefits associated with resistance training and aerobic exercise as compared to those received from stretching.  

The next blog post is the 5^th and final blog of the Exercise Series. It will discuss the importance of maintaining balance as we age. Stay tuned!

PART III: AEROBIC EXERCISE

Written by Dr. Carl DuCharme

During part III of our Exercise Series we define what aerobic exercise is, examine its health benefits and finally, explore how to implement it into our lives.

According to Health.gov, about one half of Americans have a chronic disease that is fully preventable with regular exercise. Current national guidelines call for a minimum of 150 minutes a week of moderate-intensity or 75 minutes a week of vigorous-intensity physical activity. These guidelines also state that going beyond 300 minutes (5 hours) of moderate-intensity physical activity a week has additional health benefits.

What is aerobic exercise?

Aerobic exercise is commonly referred to as cardiovascular exercise or for short, cardio. This is because it utilizes your cardiovascular and respiratory systems to improve your body’s ability to use oxygen. During prolonged exercise at low-to-moderate intensity your heart and lungs have to work harder to keep blood, oxygen and nutrients flowing to those muscles being worked and throughout your body. The end result is overall improved levels of health and cardiorespiratory fitness. This is partly because when your body is more efficient at utilizing oxygen during stress i.e. exercise, it also becomes more efficient while at rest. Therefore, at rest your body will have improved blood flow, lower resting heart rate and lower respiratory rate.

Common types of aerobic exercise:

• Jogging or brisk walking
• Cycling
• Swimming
• Rowing
• Dancing or Zumba

What are the health benefits of aerobic exercise?

Multiple studies have demonstrated that modest aerobic physical activity will reduce all-cause mortality and may increase life expectancy.  A sedentary lifestyle is amongst the leading contributors to cardiovascular disease (CVD).  CVD is the number one killer in America, causing around 600,000 deaths each year.  Additionally, cardiorespiratory fitness levels are inversely related to death rates even amongst those with cardiovascular risk factors such as obesity, smoking, high blood pressure and high cholesterol.

The higher your cardiorespiratory fitness level = the lower your chance of dying

Those suffering from coronary artery disease have been found to benefit greatly with aerobic exercise.  Research has shown regular physical activity can lead to atherosclerotic plaque regression.  In laymen’s terms, this is reversing built up plaque in the arteries of the heart.

The American Heart Association recently reported regular aerobic exercise will lower systolic blood pressure (the top number) 7 points and diastolic blood pressure (the bottom number) 5 points amongst patients with high blood pressure. To me that sounds better than taking a pill every day!

Aerobic exercise even influences diabetes and the hallmark of prediabetes, insulin resistance. The more aerobic exercise you do, the more glucose your muscle cells take into their cells. This helps improve insulin sensitivity.  It has been shown that even one single episode of low-intensity activity burning 350 calories will significantly improve insulin sensitivity the next day. Now imagine if you can do that several days per week, many people would not have to be on medications to help control blood sugar!

Aerobic exercise lowers the risk of the following diseases:

• Cancer (13 different types)
• Dementia
• Cardiovascular disease
• Diabetes
• Obesity

What is the optimal amount of exercise? 

It has been reported that 50-60 minutes of daily vigorous exercise will provide the maximal reduction in mortality risk. However, even short bouts of daily exercise will reduce mortality. One study looking at over 400,000 people indicates that 15 minutes of daily moderate-intensity exercise reduced all-cause mortality 14% and increased life expectancy 3 years.  Additionally, this study indicates meeting the suggested guidelines of 150 minutes of moderate-intensity exercise weekly increases life expectancy 7 years when compared to those who do not exercise.

Moderate-intensity exercise is equivalent to walking briskly (>3.5 mph), whereas low-intensity exercise is walking at a slower pace (3 mph).  Examples of vigorous-intensity exercise are jogging 5 mph, cycling faster than 10 mph or freestyle swimming. 

PLAN INTO ACTION

As with any exercise regimen, set realistic goals and expectations for yourself. If you are currently sedentary or exercise minimally do not set your goal at 150 minutes of exercise per week. A good starting point will be 90 minutes of aerobic exercise per week if you are just starting. Once you get this mastered and your body becomes accustomed to it you can increase the amount.

For beginners, please refer to Part 1 of this Exercise Blog Series for recommendations on how to get started with walking.

For most others, the simplest way to get at least 150 minutes of moderate-intensity aerobic exercise per week is… WALKING! This is because you can literally leave your front door and start today.  There is no requirement for owning a treadmill, swimming pool, bicycle or a gym membership. Remember, we are trying to build healthy, life-long habits that fit seamlessly into your day.  Maybe you can fit a brisk 30-minute walk on your daily lunch break, prior to work or after dinner. Perhaps your best solution is 30 minutes on Friday after work and 60 minutes per brisk walk on Saturday and Sunday.  The minimum of 150 minutes is a cumulative weekly goal.

An alternative plan is targeting at least 75 minutes weekly of vigorous-intensity aerobic activity. Traditionally this is performed at 70-85% of maximum heart rate. An easy way to tell if your activity is vigorous or not is the talk test.  During vigorous exercise you will not be able to speak a full sentence and only be able to speak a few words at a time. One example of a weekly plan would be jogging (at least 5 mph) or cycling (at least 10 mph) three times per week for 25 minutes. 

Health Tip

Keep in mind the above suggestions are the minimum requirements and should be performed in addition to the minimum of twice weekly 30-minute sessions of resistance training.  Also, if doing resistance training and aerobic exercise in the same workout you should prioritize resistance training. Start with resistance training after properly warming up before moving on to cardio in order to maximize your health results.

Bonus Health Tip

It is not necessary to perform cardio on an empty stomach to lose fat.  While it is true your body may preferentially use ketones and fat as fuel during fasted cardio, it does not amount to greater fat loss than performing cardio in a fed (nonfasted) state.  Simply performing cardio, or even resistance training will help produce a calorie deficit that your body will have to account for whether using glucose or ketones as fuel. This, combined with a calorie-restricted diet will force your body to mobilize fat from your body to use as fuel.

Continue following Destination Health for the next blog in our 5-Part Exercise Series where we discuss the significance of Flexibility.

PART II: RESISTANCE TRAINING

Written by Dr. Carl DuCharme

In Part II of our Exercise Series we explore the multitude of benefits of resistance training and look at what current research has uncovered.

Much of the literature and research that has been published has focused on the health benefits of aerobic exercise such as walking, running, cycling, etc. This is because it is easier to measure time, distance, pace, calorie expenditure, etc. In my estimation, most people think the best way to burn body fat is with cardio. This is completely false. 

Resistance training:

• Builds muscle mass and strength
• Burns 2-3 times more calories (and fat) than other forms of exercise.
• Increases your basal metabolic rate (your body will burn more calories at rest). 
• Enables your body to utilize blood sugars more efficiently.   

Your heart does not know the difference between running on a treadmill versus an intense resistance training workout. Your heart just knows that it is beating 130 beats per minute. The difference is how your body reacts to the workout after you are done. When you get off the treadmill, your calorie burn is done. When you finish a resistance training session, your body will continue burning extra calories for up to 36 hours! 

Why is muscle mass and strength important? 

Midlife hand grip strength is highly predictive of functional limitations and disability 25 years later in life.  

Grip strength is regarded as an important biomarker of aging.  Much like your chronological age, you also have a physiological muscle age. You can be 30 years old, with 80-year-old muscles. Conversely, if you participate in a resistance training program, you can be 80 years old with 30-year-old muscles. This means the stronger you are the younger your muscles are and the longer you can expect to live.

It is widely accepted in medical literature that aging causes involuntary loss of muscle mass, strength and function. Some studies report muscle mass losses of 3-8% per decade after age 30 and even faster after age 60.  The PURE study looked at 35-70 year-olds across 17 countries and showed grip strength was a stronger predictor for all-cause and cardiovascular mortality than systolic blood pressure.

Having more muscle power as we age was found to be associated with living longer according to a 2019 study published by the European Society of Cardiology that looked at people aged 41-85 years old. Muscle power is more than strength. It is often measured by jump height, acceleration, or other types of explosive movements. When exercising, it can be measured by the weight you can leg press in an explosive fashion (accelerate quickly up) and still return to the starting position in a slow controlled fashion. Muscle power also helps us perform daily activities from doing yardwork to unloading the dishwasher.

Resistance training promotes longevity by:

• Improving cholesterol, blood pressure and blood sugar
• Releasing myokines from muscle cells which help fight chronic inflammation and aging
• Improving coordination and balance
• Increasing a brain protein BDNF that is highly neuroprotective
• Lowering risk of osteopenia and osteoporosis by increasing bone mineral density
• Fighting age-related loss of muscle mass

As we age, we all have a common concern: “How do I stay upright?” Participating in a resistance training program will maintain strength, muscle mass and balance in order to prevent falls and disability later in life.

How many people do resistance training?

Despite a large, growing body of recent research proving the health benefits and importance of resistance training, most of us aren’t reaping the benefits. The American Journal of Preventive Medicine reports 60% of Americans ages 18-80 perform no muscle strengthening activity.  The same study reports that only 30% of the population meet nationally recommended guidelines of performing a minimum of two, 30-minute sessions of resistance training weekly.

How do we change this and what can you do?

Plan your week. Make resistance training a priority. The minimum is 30 minutes two times per week to see major health benefits. You need to make it become a habit. This isn’t a chore or something you do if you can fit it in. You deserve a higher quality of life. When you reach retirement, you should be able to enjoy many more years of good health and regular activity without restriction. This small weekly investment can pay huge dividends. It can even boost confidence, mood and mental health.

How do I get started?

For beginners, I recommend a total-body workout 2-3 times per week for at least 30 minutes per session. Keep in mind, the outcome of health benefits will only come if the input and effort is there. Simply “going through the motions” does not replace pushing yourself and trying your best. This is why, for beginners I would highly recommend seeking expert counsel from a certified personal trainer to help you learn proper exercise selection, form and appropriate amount of weight/resistance to use.

Having a gym membership or personal trainer is not mandatory. An alternative option is to exercise at home with bodyweight exercises or purchase resistance bands. Here is a set of workout bands for under $20 and 4.5+ star rating on Amazon.

A good total-body workout will include all major muscle groups and usually have 8-12 different exercises. Start with larger muscle groups like legs, back, chest, shoulders before moving to smaller muscle groups like arms (biceps/triceps). I recommend choosing a weight/resistance for each exercise that you can do for 30 seconds without going to muscle failure. Muscle failure is when you cannot physically complete one more repetition (squat, press, curl, etc.).  I recommend stopping two repetitions short of failure. It is not always necessary to train to failure to see results and can increase your risk of injury. Sometimes, it can help but I would do it only at the end of the workout if you choose. Also, if your schedule permits allow 48 hours between workouts to allow your muscles time to rebuild and recover.   

PLAN INTO ACTION

This is a sample workout routine from Athlean-XX For Women on YouTube. It can be done in your home and is only 15 minutes. A workout like this you should perform 3-4 times per week.  

Another option involving resistance bands can be found here from ACHV PEAK on YouTube.

Eventually, you will need to increase the resistance, decrease rest periods or add more time to the workout in order to challenge yourself and continue seeing results. After 6-8 weeks you should switch to a new workout program that incorporates different exercises or style of resistance training. The body is really good at adaptation. This decreases results in strength and muscle building. Therefore, we need to bring change to your workouts in order to maximize returns on your investment.

The next installment, Part III of the Exercise Series will focus on the importance and health benefits of aerobic exercise… Yes, we will discuss the dreaded “C Word”… Cardio!

Written by Dr. Carl DuCharme

What is exercise? 

Exercise is physical activity of moderate to vigorous intensity that has the intention of enhancing or maintaining physical health, fitness and overall well-being. A complete exercise regimen will contain 4 major components:

1. Resistance Training
2. Aerobic (Cardiovascular) Training
3. Flexibility
4. Balance

Over the next few weeks, we will explore the role that exercise plays in your health, the specific benefits, types of exercise and the ways to incorporate exercise into your life. The first installment of this 5-part series will focus on the importance of exercise and activity and how to get started.

PART I: EXERCISE AND ACTIVITY

According to the Department of Health and Human Services less than 5% of adults get 30 minutes of activity each day, and only one in three adults receive the recommended amount of moderate physical activity each week of 150 minutes. Not to pile on too much, but did you know only 6 states require physical education in every grade, K-12? It is reported that roughly 1/3 of high school students spend 3 or more hours playing video games each day.

What are the benefits of exercise? 

Since the 1950s scientific research has revealed profound health benefits with regular exercise. For example, having low levels of exercise or not exercising at all can increase mortality risk more than smoking or diabetes will. Increasing physical performance is inversely associated with long-term mortality with no observed upper limit of benefit. This means those with elite fitness levels have roughly 80% reduction in mortality.

The more you exercise = the more you benefit. 

Even if you have never exercised, studies show becoming active between ages of 41 and 60 can decrease the rate of mortality by 35%. These benefits were seen regardless of body mass index (BMI). Small amounts of exercise even less than 1 hour per week will benefit your health.  Moderately exercising for >150 minutes per week has been shown to reduce all-cause, cardiovascular disease-related, and cancer-related mortality.

In 2012, the British Journal of Pharmacology even went as far to publish a review paper with the following conclusion, “exercise is so effective that it should be considered as a drug”. In this review, the authors detailed how exercise promotes health, lifespan and acts as a psychoactive drug in most people to cause a very pronounced relaxing effect.

Exercise has even been shown to have a profound impact on cognition and memory. Regular exercise has been shown to reduce risk of dementia by about 30%. Specifically, the risk reduction for Alzheimer’s disease is even better at 45% reduction. One published study showed regular exercise is far better at reducing risk of dementia than not smoking, eating healthy, keeping ideal bodyweight or limiting alcohol intake to a moderate amount.

I have personally witnessed the power of exercise prescription in my patients. One man even reversed his diabetes in 3 months with exercise! It is part of my routine assessment and plan for each patient. Let’s face the facts, most patients want to get off of medications and avoid them if they can. Exercise can help you do this.

As an added bonus, exercise has anti-inflammatory effects. This helps do many things in the body like boost the immune system, which can help you stay healthy during cold and flu season. Exercise has even been shown to slow the process of aging.

Let’s review the benefits of exercise: 

• Increase your lifespan 
• Improve your health 
• Decrease risk of diabetes, high blood pressure, dementia and some cancers
• Slow the process of aging
• Decrease all-cause mortality

Now that I have your attention, you’re probably saying this sounds too good to be true, I want all of those things and where do I sign up?!

I know! All these statements sound too good to be true. As a physician, I can attest that those patients who have incorporated exercise into their lives have seen several improvements in their health. It all depends on how much exercise they can or are willing to do. 

How do I get started exercising? 

The simplest way to add more activity and exercise to your life is walking. Walking is free and easy to incorporate into your daily life. Let’s look at the scientific facts about walking and how it relates to increasing health.

A 2014 study showed the benefits of walking are equal to those of running or vigorous activity if the calorie expenditure was the same.  Additionally, just the act of walking any amount during the week is associated with lower all-cause mortality compared with inactivity. 

Multiple studies have shown that the more you walk each day, the more it lowers all-cause mortality. I should mention that most of these studies look at walking as a moderate-intensity exercise. Therefore, you need to keep a minimum walking speed of 3-4 mph. To ensure that you are keeping a good pace, consider downloading an app that will track not only the total distance and time, but also your speed. 

There is an expanding amount of research on interval walking. Interval walking is walking at a very brisk pace for a short burst and then returning to normal paced walking in intervals. These intervals have been shown to be more impactful on lowering blood pressure, lowering blood sugar, improving mood, and burning body fat. 

Whether you are currently inactive or walk or run several miles per day; most of us can take this opportunity to improve our health. 

PLAN INTO ACTION

For the beginners we want to focus on consistency to build discipline around a routine that is manageable. Start your goal with walking 30 minutes 3 times per week, or for 15 minutes daily. This is just to ease in and develop a habit like brushing your teeth or showering. Once you’ve mastered maintaining the habit of walking you can increase the duration or the frequency per week keeping in mind the more you do it, the more health benefits you will see. There appears to be no upper limit!

If you get bored easily, I recommend you start with interval walking. Short alternating speeds of walking will keep your attention (and give you better health benefits!). Start with a normal walking pace around 100-110 steps per minute or 3 mph for 15 seconds. Then for the next 15 seconds walk much quicker (like you are late for an important meeting) around 130-140 steps per minute or 3.7 mph. 

Once your fitness level is improving you can increase the amount of time spent in the quick phase or time spent walking. I recommend documenting your progress on a calendar or in a notebook. Not only does it feel good to write down a finished task, but it will help you stay on track each week to complete the number of days set as your goal. 

Stay tuned for Part II where we will explore resistance training and its innumerable benefits.