Recommended Exercise Per Week

We all know we should exercise, but what comes next? Do you know how much, what to do, and how to get started? Here is what you should know so you can get motivated and get moving.

Exercise Is Medicine

---

Why exercise? There are so many reasons related to weight control, health, and wellbeing. Exercise can help with weight loss, since it burns calories and increases metabolism. It is even more closely tied to weight maintenance, or prevention of weight gain or regain, likely because it helps with discipline and motivation.

Another reason to exercise is for its health effects. Lark Diabetes Prevention Program is an example of a health program that promotes exercise. The American College of Sports Medicine (ACSM) goes so far as to promote Exercise as Medicine[1] through publicization, research, and education. Physical activity at any weight can lead to the following benefits, according to the Physical Activity Guidelines Advisory Committee[2].

• Increased insulin sensitivity, lower blood sugar, and reduced risk for diabetes.

• Lower blood pressure and reduced risk for hypertension.

• Reduced risk for stroke, cardiovascular disease, depression, and certain cancers.

• Improved cognition and reduced risk for dementia.

• Reduced risk for osteoporosis.

• Better function with conditions such as arthritis and multiple sclerosis.

The benefits of exercise in chronic disease are important, but exercise also offers more instantly tangible and gratifying rewards. People who exercise can feel less anxious, more confident, and energized. You can expect to fall asleep faster and sleep better, be more alert during the day, and feel happier in general. 

 From fitness to wellness to disease management, the amounts and types of recommended exercise per week are consistent for most people. In general, the following guidelines are appropriate for most people who are healthy or who are trying to prevent or manage diabetes or hypertension and have no interfering conditions. If you are unsure, just ask your doctor before getting started.

 Moderate-Intensity Physical Activity - Aerobic (“Cardio”) Activity

---

Aerobic exercise is what often comes to mind first when we think of exercise. Examples include walking and running, cycling, playing basketball or tennis, skiing, rowing, dancing, and weeding. Aerobic activity gets your heart rate up and makes you breathe faster, but it is not so intense that you have to stop after a few minutes. Regular aerobic activity offers most of the benefits that you think of with exercise, including weight control, better health, and improved mood and concentration.

The recommendation from the Center for Disease Control and Prevention (CDC) is for healthy adults to achieve at least 150 to 300 minutes per week (30 to 60 minutes 5 days a week) of moderate-intensity physical activity (MIPA)[3]. More can lead to additional benefits. The American Diabetes Association (ADA)[4] and American Heart Association (AHA)[5] agree with these recommendations for otherwise-healthy individuals with high blood glucose and blood pressure, respectively.

Moderate-Intensity Physical Activity (MIPA)

Most exercise programs rely on MIPA, so here are the basics.

What are some examples of MIPA? Brisk walking, cycling, water aerobics, low-impact aerobics, dancing, gardening, playing tennis, using an elliptical trainer, and hiking.

How can you recognize MIPA? You are doing MIPA if you can talk but not sing. Another test is if you are at a 5 or 6 on a scale of 0 to 10 where 0 is sitting and 10 is greatest possible effort.

Strength Training

---

Strength training is not just for body builders, and you do not need to avoid it for fear that you will “bulk up.” You can improve strength, tone up, and slim down without looking like a bodybuilder if you do not want to.

Strength training increases your metabolism throughout the day, lowers injury risk, and has many of the health benefits, such as improving insulin sensitivity and lowering blood pressure, as aerobic activity. It can also help in your daily life when you need to carry heavy objects.

You can use weights such as barbells, dumbbells, kettlebells, and weight machines. Cables, resistance bands, weighted balls, and body weight can give you the workout you need, too.

When strength training, components include the frequency (how often you perform the activities), intensity (how heavy the weight you use is), and sets and repetitions (how many times you lift).

• Frequency: aim to work each of your major muscle groups at least twice per week. You can work all of your muscle groups in a single day, or do a few muscle groups on one day and other groups on another.

• Intensity: the weight should be enough to get your muscles tired by the end, but light enough that you can maintain proper form and avoid injury.

• For strength-building and bone health benefits, aim to do 2 to 3 sets of 8 to 12 repetitions for a given exercise. That means you lift the weight 8 to 12 times (“repetitions”) to complete 1 “set,” rest, do another set of 8 to 12 repetitions, rest, and perform your third set of 8 to 12 “reps.”

These are the major muscle groups and examples of exercises you can do.

Shoulders: shoulder raises, overhead presse	Abs/core: planks, crunches, side bends	Back: rows, pull-ups, lat pull-downs
Biceps: bicep curls, hammer curls	Glutes and hips: deadlifts	Chest: push-ups, chest flies, bench press
Triceps: triceps extension, bench dips	Calves: calf raises, single leg squats	Thighs (quads and hamstrings): squats, lunges, leg press, hamstring curls

Other Types of Activities

---

Other types of activities include flexibility, balance, and alternative activities. These activities can lower injury risk and speed recovery. They can also provide mental benefits to make exercise more enjoyable so that you stay interested and motivated.

Flexibility. Stretching can increase flexibility and range of motion, and lower injury risk. Stretch gently after workouts when your muscles are warm. Yoga can also increase flexibility.

Balance. Better balance can lower your risk of falls. You can practice using a wobble board and by standing on one foot, walking heel-to-toe on a line, and walking backwards. Tai chi and yoga can also improve balance.

Getting Started and Making It a Habit

---

The benefits of exercise are greatest when you make exercise a habit, but how do you get started? First, get your doctor’s approval if you are an older adult or have any health conditions. Then, work up to recommendations gradually. Start with as little as a few minutes if that is right for you.

The easier you make exercise, the easier it will be to make it a habit. These are some tips.

• Schedule your workouts in your calendar so you are sure to set aside enough time.

• Get proper shoes, clothes, and any necessary equipment, and set them out the night before so they are ready when you need them the next day.

• Accommodate any health conditions, such as checking blood sugar before and after your workout and having fast-acting high-carb snacks handy in case of hypoglycemia if you have diabetes.

One of the most important strategies for long-term fitness is to find something you love. Exercise may be medicine, but it is the kind with sugar in it. There is an activity out there for everyone; it may just take a little digging to discover the one(s) for you (and yes, digging counts towards your recommendations!). You might consider the following.

• Alone, with a friend, or in a group class.

• Indoors or outdoors.

• Competitive or not.

Getting Help

---

Friends, family, a personal trainer, and fitness instructors can help you along the way. A personal health coach can also help. Lark is a fully-automated program that is available to users 24/7. You can chat with your coach anytime, set and work towards exercise and diet goals, and get customized feedback and coaching. With motivation, reminders, and tracking features, Lark DPP and other Lark programs can help you hit exercise recommendations.

---

Reference

1.  Exercise is Medicine. American College of Sports Medicine. http://exerciseismedicine.org/

2.  2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, DC: U.S. Department of Health and Human Services, 2018.

3.  U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services; 2018. https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf

4.  American Diabetes Association. Standards of medical care in diabetes – 2019. Diabetes Care 2019 Jan; 42(Supplement 1): S1-S2. https://doi.org/10.2337/dc19-Sint01. http://care.diabetesjournals.org/content/diacare/suppl/2018/12/17/42.Supplement_1.DC1/DC_42_S1_Combined_FINAL.pdf

5.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:e127-e248 http://www.onlinejacc.org/content/71/19/e127?_ga=2.204312528.1948270614.1550184802-608566656.1548798866

Disease Prevention (Definition)

As a health insurer or employer who offers healthcare to your employees, you probably know how healthcare works in this country. Many people avoid the doctor until they get sick. When they do go, they may use emergency room services or need costly prescription medications or treatments. In short, the sickest patients use the most healthcare resources, such as providers’ time, facilities, and dollars.

This pattern may seem unavoidable since it is so ingrained in our culture, but there are other ways to approach healthcare. One approach is a preventative approach that can help more people maintain better health. Improving quality of life by preventing disease is not just ethically the right thing to do. It makes economic sense, too.

Disease prevention is not yet the prevailing culture, but it is increasingly being recognized as being cost-effective and worthwhile. In addition, health technology, such as digital coaching, is available that can increase access to preventive care.

Importance of Disease Prevention

---

Why is chronic disease prevention important? There are two main reasons.

1. Treatment is expensive.

2. These diseases are largely preventable.

3. Prevention is feasible and simple.

Treatment is expensive. The overwhelming medical and indirect costs of chronic diseases should provide ample motivation to prevent them. Medical expenditures for chronic and mental health account for 90% of healthcare spending in the United States.[1] The annual medical costs and costs of lost productivity associated with diabetes and obesity are $245 billion and $147 billion, respectively. The medical costs of hypertension add another $109.1 billion[2,3 ], before considering indirect costs such as lost productivity.

On their own, the outlandish costs of these conditions are not enough to spur action if there is no way to prevent them, but thankfully, they are preventable. 

These diseases are largely preventable. A harmful misconception about diseases is that they are inevitable, and the belief that the only thing that can be done with diseases is treat them has led to harmful and unnecessary consequences, including poor health outcomes and skyrocketing costs from medical expenses and lost productivity.

Dig a bit, though, and it becomes apparent that most prevalent diseases and their consequences are preventable. Losing excess weight, achieving physical activity goals and choosing a more nutrient-dense diet can dramatically lower risk of chronic diseases including type 2 diabetes, certain cancers, and cardiovascular disease. In fact, “90 percent of type 2 diabetes, 80 percent of coronary artery disease, and 70 percent of stroke” are considered attributable to poor lifestyle choices[4]. Regardless of genetic risk factors, addressing modifiable risk factors can improve outcomes.

Prevention is feasible and simple. Most chronic diseases could be prevented or delayed with simple and inexpensive solutions. These strategies do not involve high-tech, experimental genetic modification, expensive or risky surgery, or costly medications with short-term side effects and long-term risks. They do not even require extensive physician involvement – and that’s important, given that nearly 2 out of every 5 visits to the doctor are for chronic conditions[5]. 

Instead, the proven effective strategy to prevent the most common and costly chronic diseases is far simpler, less expensive, and without side effects. It involves individuals making healthy lifestyle choices on a daily basis to maintain health and reduce health risks. These behaviors require healthy choices and are largely considered the responsibility of the individual, although support has been found to be instrumental in promoting healthy choices. While in-person clinical support systems can increase the likelihood of patients achieving their goals, digital alternatives, such as Lark health coaches, can be more accessible and less expensive.

Preventing and mitigating the impact of chronic diseases can happen at any time in any population, from apparently healthy to long-ago diagnosed. The principles of primary, secondary, and tertiary prevention can help illustrate this.

Primary Prevention

---

Primary prevention refers to preventing diseases before they occur. Targeted individuals might have only few or minor risk factors. These are some examples of primary prevention. 

• Healthy individuals using Lark Wellness to establish healthy, disease-preventing habits such as getting regular physical activity, eating more vegetables, and getting adequate sleep.

• Educational campaigns or materials targeted to the general healthy population, such as anti-tobacco ads targeted to young people who do not smoke, or nutrition labels with calorie content available to people regardless of weight status.

• Establishing a culture of health in the workplace, such as distributing health newsletters and encouraging group walks during lunch hours. 

Secondary Prevention

---

Secondary prevention aims to minimize the effects of diseases in their earliest stages and to prevent their progression. It can include screening in order to enable early referrals and treatment. These are some examples of secondary prevention.

• Checking height and weight to calculate body mass index (BMI) to determine if someone is overweight or obese, and if so, referring him to a weight management program.

• Measuring blood pressure at each doctor’s visit to detect and then treat high blood pressure as soon as possible.

• People with prediabetes or other risk factors for diabetes using Lark Diabetes Prevention Program (DPP) to lower diabetes risk through weight loss, physical activity, healthy eating, and stress management.

• Diabetes patients attending recommended specialist appointments to check for changes in vision, reduced kidney function, and foot wounds before they become untreatable.

Tertiary Prevention

---

Tertiary prevention refers to managing established diseases to slow progression and reduce complications. These are some examples of tertiary prevention.

• Patients with diabetes using Lark Diabetes Pro to control blood sugar and lower risk of complications through weight management, physical activity, blood glucose monitoring, and medication adherence.

• Patients with hypertension lowering stroke and cardiovascular by adhering to the Dietary Approaches to Stop Hypertension (DASH) diet with the help of Lark Hypertension Pro.

• Obese individuals following a weight loss program.

Chronic Disease Prevention and Management Strategies

---

Chronic disease prevention and management strategies can be multi-faceted and targeted towards all three levels of prevention. Realistic strategies must consider cost and cost-effectiveness, reach, and effectiveness. These are some approaches to chronic disease prevention that can have widespread impact.

• Ad campaigns, such as “Five a Day” to promote fruit and vegetable consumption or “Got Milk?”

• Wellness fairs with information and free screenings, such as blood pressure measurement and diabetes risk questionnaires.

• Policies that promote healthy choices, such as prohibiting smoking in and near buildings, or subsidizing fruits and vegetables to make them more affordable.

• Cultures of wellness in workplaces to make healthy choices easier, such as having vending machines with fresh fruit and encouraging walk breaks for employees.

• Providing reimbursement for prevention programs, such as Medicare coverage for CDC-recognized Diabetes Prevention Programs.

• Promotion of healthy behaviors by individuals and families, such as using food logging apps for weight loss.

Primary care and specialty doctors, nurses, and other healthcare providers are indispensable for chronic disease management, but patients shoulder the brunt of the responsibility for their own wellness. Their decisions about food choices, physical activity, and, if warranted, medication adherence and self-monitoring of blood glucose or blood pressure, have a great influence on chronic disease development and risk. 

These behaviors are tough to implement, and many people can do better with support from nurses, nutritionists, and other healthcare professionals. Live support from these types of professionals is in short supply. Many people have minimal access, and even those with excellent support systems are likely to be limited in the amount of contact they get and the hours the support is available.

Digital apps, such as Lark health coach, can address these shortcomings with unlimited, anytime access for users. The coaching programs are powered by artificial intelligence and backed by nutrition, exercise, sleep, and other specialists to allow delivery of personalized, evidence-backed behavior change programs to all users. The system allows for instant and infinite scalability at cost.

Benefits of fully automated health coaches can include the following.

• High engagement rates and health outcomes comparable or superior to in-person interventions.

• Reduced shortfalls in healthcare since each patient can have a 24/7 personal coach.

• Fewer disparities, due to distance, socioeconomic status, or race/ethnicity, in healthcare access due to off-site, digital access.

• More economical use of doctors and nurses, with not contacting them if unnecessary but contacting them if needed, which can reduce the time they spend and reduce emergency room visits. 

This is an exciting time in healthcare. Chronic diseases are dominating medical care, healthcare costs, and productivity in the workplace, but the opportunity is there to make a difference. Primary, secondary, and tertiary prevention allow for health and economic improvements at any point on the wellness-disease spectrum, and a single intervention, Lark, offers coaching for healthy behavior changes for weight loss, wellness, diabetes prevention management, and hypertension. Employers and healthcare providers can get full support when implementing their chronic disease prevention programs.s

Name *

Name

First Name

Last Name

Email Address *

Preventing Diabetes is an important long-term goal of my organization

Preventing Diabetes is an important long-term goal of my organization

Answer

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

Do you currently offer a Diabetes Prevention Program to members?

Yes

No, not yet

Thank you!

---

Reference

1.  National Center for Chronic Disease Prevention and Health Promotion. Health and Economic Costs of Chronic Diseases. https://www.cdc.gov/chronicdisease/about/costs/index.htm. Reviewed February 2, 2017. Accessed February 4, 2019.

2.  Zhang D, Wang G, Zhang P, Fang J, Ayala C. Medical Expenditures Associated With Hypertension in the U.S., 2000-2013. Am J Prev Med. 2017;53(6S2):S164-S171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823517/

3.  Centers for Disease Control and Prevention. High Blood Pressure Costs. https://www.cdc.gov/bloodpressure/facts.htm Reviewed November 30, 2016.

4. Walter C. Willett, Jeffrey P. Koplan, Rachel Nugent, Courtenay Dusenbury, Pekka Puska, and Thomas A. Gaziano. Chapter 44: Prevention of Chronic Disease by Means of Diet and Lifestyle Changes. Disease Control Priorities in Developing Countries. 2nd edition. Jamison DT, Breman JG, Measham AR, et al., editors. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; New York: Oxford University Press; 2006.

5.  Ashman JJ, Rui P, Okeyode T. Characteristics of office-based physician visits, 2015. NCHS Data Brief, no 310. Hyattsville, MD: National Center for Health Statistics. 2018.