DOCUMENT RESUME

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AUTHOR Cundiff, David E., Ed. TITLE Implementation of Health Fitness Exercise Programs. INSTITUTION American Alliance for Health, Physical Education, Recreation and Dance, Reston, VA. REPORT NO ISBN-0-88314277-5 PUB DATE 85 NOTE 102p.; Photographs will not reproduce well. AVAILABLE FROMAAHPERD Publications, P.O. Box 704, Waldorf, MD 20601 ($11.95). PUB TYPE Guides Non-Classroom Use (055)

EDRS PRICE MF01 Plus Postage. PC Not Available from EDRS. DESCRIPTORS Aerobics; Curriculum Development; Elementary Secondary Education; *Exercise; *Health Needs; Medical Research; *Physical Fitness; Program Development; *Program Implementation

ABSTRACT This monograph includes the following articles to aid in implementation of fitness concepts:(1) "Trends in Physical Fitness: A Personal Perspective" (H. Harrison Clarke); (2) "A Total Health-Fitness Life-Style" (Steven N. Blair); (3) "Objectives for the Nation--Physical Fitness and Exercise" (Jack H. Wilmore); (4) "A New Physical Fitness Test" (Steven N. Blair, Harold B. Falls, and Russell R. Pate); (5) "Health Related Physical Fitness" (Russell R. Pate); (6) "Distance Running Performance Tests in Children--What Do They Mean?" (Kirk J. Cureton); (7) "Measurement of Body Composition in Children" (T.G, Lohman); (8) "Flexibility--A Major Component of Physical Fitness" (Charles B. Corbin and Larry Noble); (9) "Medical Problems Encountered by Women in Aerobic Exercise" (Dorothy V. Harris); (10) "Psychological Benefits of Aerobic Exercise" (Dorothy V. Harris); (11) "Physiological Responses of Females to Endurance Exercise" (Harold B. Falls); (12) "How Much Exercise Is Enough?" (Michael L. Pollock); (13) "Teaching Physical Fitness Concepts in Public Schools" (Russell R. Pate); (14) "Teaching Health-Related Fitness in the Secondary Schools" (Charles B. Corbin); (15) "The Hope-Kellogg Health Dynamics Program" (Richard A. Peterson); (16) "The Aerobics PrJgram at Oral Roberts University" (Paul Brynteson); (17) "Helping Adults To Stay Physically Fit--Preventing Relapse Following Aerobic Exercise Training" (G. Ken Goodrick, Don R. Warren, G. Harley Hartung, and Jean A. Hoepfel); (18) "A Corporate Health and Fitness Program--Motivation and Management by Computers" (William B. Baun and Michelle Baun); (19) "Physical r-tness--Programming Issues for Total Well Being" (Kenneth H. Cooper and Thomas R. Collingwood); (20) "Incorporation of Aerobic Exercise into Health Maintenance Programs of Business and Industry" (Dennis Colacino); and (21) "Prevention of Orthopedic Injuries Related to Aerobic (Jogging) Exercise" (David E. Cundiff). Articles include references, tables, figures, and photographs. (JD) Programs

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ar, NW. U S DEPARTMENT OF EDUCATION Once of EduCatonat Research and improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) P TM Document nas been reproduced as rece,ved from the person or organization onginatmg C Sknor changes nave . n mas,to improve reproduction quality If . ...,,...Ai; . Pt:m.115ot view or opontonSstate(, t - .4.0 ment do not necessarily represent official bi4...ie. OERI DOS)1, or policy .417- .orli.711rwIl 4, Z.. ...-..4,1111Pl- .....,,,-.,t.. sitC..... F Plos:M.T; I ...a t OM...Y 'ERMISSION TO REPRODUCE THIS AV MA CERIAL IN MICROFICHE ONLY HAf., BEEN GRANTED BY

TO THE EDUCATIONAL RESOURCES 2 INFORMATION CENTER (ERIC)." Sponsored by the Association for Research and Professional Councils and Societies an association of American Alliar -..?. for Health, Physical Education, Recreation and Dance

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David E. Cundiff Editor

3 Credits "A New Physical Fitness Test" (Vol 11, No 41983) and "How Much Exercise is Enough'?" (Vol 6, No 6 1978) reprinted bypermission of The Physician and Sportsmedicine, a McGraw Hill publication

Cover Photo by Liz Elliott, courtesy of American. ig and Fitness Association

Copyright © 1985 American Alliance for Health, Physical Education, Recreation and Dance 1900 Assocation Drive Reston, Virginia 22091 ISBN 0-88314-277-5 1 PURPOSES OF THE AMERICAN ALLIANCE FOR HEALTH, PHYSICAL EDUCAT!ON, RECREATION AND DANCE

The American Alliance is an educational organization, structured for the purposes of supporting, encouraging, and providing assistance to member groups and their personnel throughout the nation as they seek to initiate, develop, and conduct programs in health, leisure, and movement-related activities for the enrichment of human life.

Alliance objectives include: 1. Professional growth and developmentto support, encourage, and provide guidance in the development and conduct of programs in health, leisure, and movement-related activities which are based on the needs, interests, and inherent capacities of the individual in today's society. 2. Communicationto facilitate public and professional understanding and appreciation of the importance and value of health, leisure, and move- ment-related activities as they contribute toward human well-being. 3. Researchto encourage and facilitate research which will enrich the depth and scope of health, leisure, and movement-related activities; and to disseminate the findings to the profession and other interested and concerned publics. 4. Standards and guidelinesto further the continuous development and evaluation of standards within the profession for personnel and programs in health, leisure, and movement-related activities. 5. Public affairsto coordinate and administer a planned program of professional, public, and governmental relations that Hill improve education in areas of health, leisure, and movement-related activities. 6. To conduct such other activities as shall be approved by the Board of Governors and the Alliance Assembly, provided that the Alliance shall not engage in any activity which would be inconsistent with the status of an educational and charitable organization as defined in Section 501(c)(3) of the Internal Revenue Code of 1954 or any successor provision thereto, and none of the said purposes shall at ary time be deemed or construed to be purposes other than the public bent it purposes and objectives consistent with such educational and charitable status. Bylaws, Article III

Jt- Contents

Preface I. Historical Overview of Physical Fitness and Future Objectives Trends in Physical Fitness A Personal Perspective, H Harrison Clarke 1 A Total Health-Fitness Life-Style, Steven N. Blair 7 Objectives for the Nation Physical Fitness and Exercise, Jack H Wilmore 14 11. Definition of Health Related Physical Fitness and Exercise A New Physic: AI Fitness lest, Steven N Blair Harold B Falls, and Russuil R. Pate 19 Ill. Scientific BMW Health Related Physical Fitness, Russell R Pate 29 Distance Running Pe.formance Tests in Children What Do They Mean?, Kirk J Cureton 30 Measurement of BoCy Composition in Children, TG Lohman 33 Flexibility A Major Compolieri. of Physical Fitness, Charles B Corbin and Larry Noble Medical Problems Encountered by Women in Aerobic Exercise, Dorothy V. Harris L2 Psychological Benefits of Aerobic Eyercise, Dorothy V Harris 46 Physiological Responses of Females to Endi mance Exercise, Harold B Falls IV. Implementation of Health Related Fitness Programs How Much Exercise is Enough?, Michael L Pollock 59 Teaching Physical Fitness Concepts in Public Schools, Russell R Pate 70 Teaching Health-Related Fitness in the Secondary Schools, Charles B. Corbin 73 The Hope-Kellogg Health Dynamics Program, Richard A Peterson 76 The Aerobics Program at Oral Roberts University, Paul Brynteson 79 Helping Adults to Stay Physically FitPreventing Relapse Following Aerobic Exercise Training, G Ken Goodrick, Don R Warren, G Harley Hartung, and Jean A Hoeptel 84 A Corporate Health and Fitness Program Motivation and Manage- ment by Computers, William B Baun and Michelle Baun 86 Physical Fitness Programming Issues for Total Well Being, Kenneth H. Cooper and Thomas R. Collingwood 90 Incorporation of Aerobic Exercise into Health Maintenance Programs of Business and Industry, Dennis Colacino 93 Prevention of Orthopedic Injuries Related to Aerobic (Jogging) Exercise, David E Cundiff 95

6 Preface

Some of the articles in this book were pre- last few years A special feature is the article by sented at a national conference in 1976 on H Harrison Clarke, "Trends in Physical Fit- "Aerobic Exercise: Scientific Basis and Imple- ness A Personal Perspective." His insight will mentation of Programs" which was cospon- be of value to many future professionals in this sored by the Physical Fitness Council of the field Association for Research and Professional This volume provides articles divided into Councils and Societies and Oral Roberts Uni- four general sections: versity. This resulted in the first edition, Imple- Section l Historical Overview of Physical mentation of Aerobic Programs, published by Fitness and Future Objectives the American Alliance for Health, Physical SectionII-Definition of Health Related Education, Recreation and Dance, in 1979 Physical Fitness The success of the first edition gave impetus Section III Scientific Basis of Health Related to this second edition. Since the Health Related Fitness Physical Fitness Test is being used more Section IV Implementation of Health Related widely, it was felt that this edition should be Fitness Programs expanded to include information for proles We hope this volume will be of value to those sionals interestedinimplementing Health who desire assistance in implementing the Related Fitness Programs in public schools, Alliance's health related fitness concept in colleges and universities, and business and industry Papers have been added on body their programs composition and musculoskeletal function that were published in the Journal of Health, Physi David E Cundiff, Ph.D cal Education, Recreation and Dance over the Editor Historical Overview of Physical Fitness and Future Objectives Trends in Physical Fitness: A Personal Perspective

H. Harrison Clarke

My professional interest and concern for physical fitness century. Therapeutic exercise and calisthenics evolved from began with my acceptance of a physical education and this system, utilized to improve and condition the musculature coaching position in the Chautauqua, New York, public of the body. schools upon my graduation from Springfield College in 3. Between the Civil War and World War I, most of the 1925. It was during my Chautauqua tenure that Frederick physical education leaders were trained in medicine. These Rand Rogers, Director of the Health and Physical Education men and women physicians were attracted to physical Division in the New York State Education Department, education (physical training as it was known at that time) introduced his Physical Fitness Index Test and follow-up because of the potential health values of appropriate physical program into the schools of the state. It seemed to me then, a activity properly applied a form of preventive medicine. belief that became stronger as the years went by, that this test However, although the care and development of the body was measured two of the basic components of physical fitness, a primary concern, they also recognized that physical educa- muscular strength and muscular endurance, and that a tion could contribute dynamically to the individual's mental, program designed to help physically subpar boys and girls emotional, and social effectiveness. should be a primary concern of physical educators. As we wc11 know the tragic lesson of Wcrld War I, when a The perspective presented here is not an historical report large proportion of our youth were found physically unfit for per se; no attempt was made tc 'ocate and evalute historical military service in defense of the nation, resulted in a sources systematically. Rather, it is an observational report of tremendous expansion of physical education in educational one professional physical educator with a life-long involve- institutions throughout the United States. Prior to this time, ment with physical fitness, one who has observed first hand only three states had state laws requiring physical education in occurrences, trends, and influences pertaining to this field for their schools. By 1932, thirty-six states, representing ninety over a half-century. Conceivably, this account does have percent of the population, had such a law. Also, colleges and historical significance, although it may shoe. bias as reflect& universities throughout the country established similar in the author's experiences and the influences peculiarly requirements. exerted upon him and is restricted to his limited observations, primarily in schools and colleges. Between World Wars

Antedating 1925 This period of rapid expansion brought significant changes to physical education in the United States. Medical leadership Physical education in the United States had its origins in waned and was eventually supplanted by leaders and teachers physical fitness. Generally speaking, it was the only objective primarily prepared in pedagogy, psychology, and the bio- of physical education prior to World War I, although some logical sciences. In increasing numbers, men and women who transition to other objectives was evident in the early 1900s. could teach, evaluate, and administer physical education Observations to support this assumption follow. graduated from colleges and universities. Graduate programs 1. The first school and college gymnasia A e r e opened in with attendant research were established, with the first Ph.D. 1825 at the Round Hill School, Northampton. Massachusetts, awarded to a physical educator in 1925. Physical education and in 1826 at Harvard University. The apparatus. activities, and athletic facilities were established extensively throughout and methods were transplants from the Jahn system of the country. gymnastics in Germany. This system aimed primarily at the And, of special significance for this report. a consistent development of the physical organism. et fort was made to aiign physical education with total school 2. Another transplant from European physical education purposes. In so doing, a reevaluation of objectives occurred, was the Swedish, or Ling, system of "medical gymnastics." as physical educators studi,c1 ways by which they could While first utilized by physicians around 1850, this system was contribute uniquely to the growth and development of accepted and practiced by physical educators late in the 19th children and to their education for lifetime living. Thus, multiple objectives were proposed for this field. Although variously stated, three objectives were recognized: physical H. Harrison Clarke is professor emeritus at the University of fitness, socialefficiency, and recreational competency. Oregon. Eugene, OR. This article was first presented at the Physical Methods, materials, and procedures were developed to realize Fitness Council meeting, April 14, 1981, A A H PERD Convention, these objectives based on physiological, psychological, and "Boston, Massachusetts. sociological principles.

1 9 However, tragically, in the rush to espousenew objectives, Brownell, Elmer D. Mitchell, and Theodore P. Banks served physical education generally abandoned its biological heritage. as consultants, wrote physical training manuals, constructed The understandings and tested procedures developedover a motor fitness tests, and served as commissioned officers century were largely rejected.1 the rush to adopt new ideas directing physical training programs. Arthur A. Esslinger and and procedures. Too frequently, the improvement and main- Arthur S. Daniels headed physical reconditioningprograms tenance of physical fitness became a concomitant of an in army and army air force hospitals, respectively. activity program designed to realize other objectives.The Time does not permit a chronicling of the extensive expression"education through the physical" became prevalent, involvement cf physical educators in thewar effort. Suffice it when it should have been "educationofandthrough" the to say, this involvement included army, navy, and army/air physical. Data were and still are lacking that physical fitness force physical training programs, the physical reconditioning can be developed systematically and effectively under such program.; in hospitals and convalescent centers of these same circumstances. Contrarily, considerable experiential and services, and the preflight training pi ograms of thearmy and scientific evidence exists indicating that the activityprogram navy and the Army Specialized Training Program at many and procedures designed to realize this objective-mist be colleges and universities throughout the country. President specifically planned and carried out. Franklin Delano Roosevelt called on physical educators in There were, of course, exceptions to this dismAl picture of schools and colleges to provide vigorous physical fitness physical fitness programs in schools and colleges between the programs for all boys and girls as a vital contribution to the world wars; some realistic physical educators developed war effort, although he appointed a nonphysical educator (a programs to meet the physical, psychological, emotional, and former famous oarsman) to direst that effort. Other embar- social needs of individual boys and girls. Excellenttexts on rassing appointments from a professional viewpointwere corrective and remedial physical education appeared auring former world heavyweight boxing champions to head the this time, written by physical educators,as were books on navy and coast guard physical training programs. kinesiology and physiology of exercise. Earlytexts cn Co l f-xtive exercise has a long history in physical education measurement appeared that included procedures for th. going back well over a century. Therapeutic applications of evaluation of physical fitness components. Numerous relevant exercise were developed between thewars, not only in researchs were completed by the newly emerging scientific physical education but in medicine. Following World War 11, community in physical education. Consistent recognition of the application of physical and motoractivitiesin physical the place o- remedial physical education was evident in the and mental therapy reached an all-time high in Veterans structure of the American Association for Health, Physical Administration hospitals, especially in the treatment of Education and Recreation, now knownas the American severely handicapped and chronically ill patients. Many of the Alliance for Health, Physical Education,Recreation and practitioners were former physical reconditioning personnel Dance (AAH PERD). This national association and several of in the armed services. Many civilian hospitals and rehabilita- the district organizations formed therapeutic sections. Physical tion centers adopted similar programs. The corrective education p; ograms for handicapped studentswere common- therapists involved founded a professional organization,now place in co eges and universities, especially at the larger known as the American Corrective Therapy Association, institutions. which, since 1948, has published a bimonthly magazine, the In speaking of the AA H PE RD structure as related insome American Corrective Therapy Journal. way to physical fitness, although out of chronological sequence, In 1968, A AH PERD established a headquarters uniton the Physical Fitness Council, then known as Fitness Section, programs for the handicapped. Julian U. Stein was appointed originated in 1957 with a petition submitted by fifty-six as a full-time consultant. This Alit provided a consultative physical educators from around the country. In accordance service, a leadership preparation program, program interpreta- with association operating procedures for formingnew tion, and research. In 1972, an Information and Research sections, the board of directors approved a tentative section Utilization Center in Physical Education and iecreation for and authorized providing a program at the next annual the Handicapped was established. The purpose of this center convention; this arrangement was continued for twoyears, was to collect, categorize, interpret, and disseminate informa- after which the section was officially recognized by the tion about materials, methods, ongoing programs, promising association. The first program for the sectionwas held in 1958 practices, research, and demonstrations in adapted physical at the Kansas City convention. There were two meetings: education and therapeutic recreation. In 1975, anAnnotated "Basic Components of Physical Fitness" and 'Essential Bibliography in Physical Education, Recreation, and Psycho- Program Procedures for the Development of Fitness." The motor Function of Mentally Retard..d Personswas published. distinguished speakers at these meetings were: C. H. McCloy, Arthur A. Steinhaus, Henry J, Montoye, Laurence E. Morehouse, Mabel Lee, Marjorie Phillips, Ellis H. Champlin, Karl W. Bookwalter, Donald K. Mathews, Margaret S. Poley, and Joseph B. Wolffe. These sessions were exceptionally President's Council on Physical Fitness and Si)orts (9) well attended; the estimates were 500 at the first and 400at the second. As can be seen from the German and Swedish transplants mentioned earlier, an essential motivation of European systems of physical education in the 19th century was preparation for war. European nations have been bounded by During and Following World War II potentially powerful enemies, so vigorous physical activity to maintain a strong and enduring citizenry has been vitalto Physical educators were utilized in important capacities them. In the United States, preparation for defense has not pertaining to the physical fitness programs of the armed forces been a concern of physical education,exceptduring periods of during World War 11. Such physical educatorsas Charles H. armed conflict, since great oceans have been effective barriers McCloy, Arthur A. Esslinger, Leonard A. Larson,Clifford L. to invasion by major powers elsewhere in the world. Today,

2 10 however, this situation has changed. No longer is our sports for all and the other on physical fitness and sports geographical isolation an effective deterrent to attack; with medicine. And, the council has gone international: under the development of aviation and transcontinental missiles, all Conrad's leadership in collaboration with Jurgen Palm of countries have become neighbors. (7) West Germany, biannual International Conferences on Thus, when President Dwight D. Eisenhower formed his Physical Fitness and Sports for all have been held beginning Council on Youth Fitness twenty-five years ago, it is quite in 1973; only nations that have government agencies devoted understandable that his concern for a physically fit nation to physical fitness are eligible for membership; at the 1979 stemmed from his knowledge, as general of the armies, of the meeting in Portugal, thirty-six countries were represented. inadequate fitness for military service of too many young Consistently throughout its existence, the council has men. However, he also treated with respect and concern the cooperated with physical education and health-related associa- findings by Hans Kraus showing that the United States tions. For example, AAHPERD has responsibility for ad- children had many more failures than did Italian, Austrian, ministering the Presidential Physical Fitness Awards program; and Swiss children on his tests of "minimum muscular the American Medical Association, the Department of Health fitness." (15) In his executive order forming the council, and Human Services, and the Defense Department were President Eisenhower stated, "Since the youth of our Nation associated in conducting a White House Symposium on is one of its greatest assets, it is imperative that the future of Physical Fitness and Sports Medicine. Private enterprise has our youth he improved and promoted to the greatest extent contributed greatly by financing and promoting films, publica- possible." As is well known, this council in some form has tions, and special projects. been continued by all subsequent presidents. The impact of the President's Council on Physical fitness Over the quarter century history of the council, various and Sports on the physical fitness of youth and adults has presidential physical fitness consultants were appointed. All been tremendous; never before have so few individuals but one of these consultants served on a part-time basis; some contributed so dynamically. This effort has not gone unrecog- relied on an administrative assistant to prepare and implement nized. Citations were made to the council by AAHPERD in council plans. These appointments were: Chayne McCarthy, 1972 and by the American Academy of Physical Education in by President Eisenhower; Cliar les "Bud" Wilkinson by 1975. His Majesty, King Carl Gustaf XVI of Sweden bestowed President Kennedy; Stan Musial, with Robert Stewa:t as the Royal Order of the North Star, First Class, upon C. assistant, by President Johnson; James A. Lovell, with John Carson Conrad. Honors have also been bestowed on Glenn P. Wilbern as assistant, also by President Johnson; James A. Swengros by the Association of Fitness Directors in Business Lovell, Jerry Apadoca, and Al McGuire, with C. Carson and Industry and on Richard Keeler by the U.S. Attorney Conrad as a newly designated executive director, by Presidents General, Griffin Bell, in behalf of the Justice's Department of Nixon, Ford, Carter, and Reagan. Conrad, a council consul- Occupational Health and Physical Fitness Program. Matthew tant since 1961, was formerly state director of health, physical (Wry recently received the JC Penney Annual Community education, and sports in California. The council staff has Service Award. consistently been a small one, about four professional and unusually effective physical educators, some of whom have continued through several administrations. including Glenn Swengros, Simon A. McNee!y, Theodore Forbes, James I.ow Strength Program Winthers, Robert Stewart, William L. Haskell, Richard 0. Keeler, A .E. "Ash" Hayes, and Matthew Guidry. In the public At the start of this address, it was indicated that my relations area, the council has been unusually well served by professional involvement in physical fitness began in the Richard Snider, V.L. Nicholson, and Kaye Buchanan. public schools at Chautauqua, New York, with use of Rogers' Physical Fitness Index (PFI), in order to Identify boys who A strong public relations program has been a consistent were muscularly we. and to apply appropriate follow-up feature of the council throughout its existence. Starting with procedures for their improvement. The PFI is a test of relative Wilkinson's tenure, it began to exert a national influence on muscular strength and muscular endurance. It is derived from the nature and content of physical fitness programs in schools a Strength Index (SI), which is a gross measure of dynamo- and colleges, youth-serving agencies, community recreation metric strengths and arm/shoulder endurance; the SI is centers, business and industry, and the adult population at related to norms based on sex, age, and weight. Thus, in large. An er umeration of coureil projects include: publication understanding this program, it is essential to recognize that of pamphl As a nd brochures, preparation of instructional and the primary concern is for those who are muscularly under- motivatir,nal films, establishment of pilot programs and developed relatively, rather than totally strong. demons Lration centers, conduct of regional physical fitness Generally speaking, the follow-up procedures for low PFI clinics, establishment of Presidential Physical Fitness Awards boys and girls consist of: applying muscular strength and for Youth and Presidential Sports Awards for adults, publica- muscular endurance activities, while not neglecting circulatory- tion of a quarterly Physical Fitness! Sports Medicine bibliog- respiratory endurance; conducting case studies of those who raphy in collaboration with the National Library of Medicine do not improve on periodic retests in order to discover the and of Physical Fitness Research Digest, the formation of the cause or causes of their continuing unfit condition; referring American Association of Fitness Directors in Business and to other specialists, classroom teachers, and parents when Industry, and conduction of medical symposia in conjunction physical defects, organic lesions, nutritional disturbances, or with the American Medical Association, the American Heart personality maladjustments are found Or 4uspected as a result Association, and other medical groups. of the case study process; providing healtu advice, relaxation Governor's councils on physical fitness and sports have procedures, guidance and activities to enhance social and been formed in 28 states a.xl many more are in prospect; a personal adjustment, and medical treatment when indicated National Association of Governor's Councils has recently in individual cases; and retesting the subfit group at intervals been established. Two White House sponsored meetings were of approximately six weeks and redirecting individual pro- recently held in Washington: one on physical fitness and giams in light of retest and restudy results. (I I) 311 This approach to meeting the individual physical fitness Thomas K. Cureton, Jr. needs of boys and girls was developed by physical educators through use in scho' Is and colleges,so it is not just theoretical Several physical educators over the years have made highly or imaginative. I- arther, several extensive demonstration significant contributions to physical fitness concepts,pro- projects have been conducted by public schools in cooperation cesses, and programs. One such person who has been with nearby colleges or universities. Typically, university preeminent is Thomas K. Cureton. Starting at Springfield professionals assisted in planning theprogram and in provid- College in 1930, and continuing since 1941 at the University of ing physical education major students for administeringthe Illinois, Dr. Cureton has been and still is a teacher, researcher, PFI test. Local adaptations were made in consultationwith author, lecturer, consultant, and clinician. He has served school physical educators, administrators, physicians,nurses, school-age youth, university students, and adults. In 1944, he counselors, and health education specialists. Among formal established the Physical Fitness Research Laboratoryat projects were: Illinois, a laboratory that produced some 600 graduate theses and is still operating. Seventy persons received Doctor of Central New York State Project (18):For four years, nine Philosophy degrees as his advisees (14); manyon this list are public schools participated in cooperation withSyracuse now among our outstanding physical fitness leaders and University and the New York State Bureau ofPhysical scientists, an occurrence that has indirectly expanded his Education. influence many fold. Highlights of his significant contributions Springfield College Projects(2, p. 328): For several years, are briefly mentioned. (13) Springfield College sponsored projects in schools in New 1.In the 1930s, Cureton did considerable research and Britain, Connecticut, and in Holyoke and Longmeadow, published books, monographs, and articles on aquatics and Massachusetts. the improvement of physical fitness through aquatics. During Oregon Pilot Physical Fitness Project(6): During one World Waf II, he conducted aquatics training programs at school year, eleven high schools throughout Oregonco- various U.S. army, navy, marine, and coast guard bases. operated in a pilot project developed bya committee of the From 1941-1963, he chaired the AAH PER Aquatics Leader- state's Association for Health, Physical Education and Recrea- ship Committee; about 600 aquatic fitness clinics were tion; testers were from the Univerity of Oregonand Southern sponsored throughout the country by t' Oregon College. is committee. He worked extensively in the YMCA's of the country on their Moses Lake Project (IS).Moses Lake Junior High School, aquatic. and fitness programs. Washington, participated in a project developed bya Wash- ington State Fitness Committee composed of representatives 2. The summer University of Illinois Sports Fitness School from the Washington Association for Health, Physical Educa- for boys was started by Cureton in 1948 and has continuedto tion and Recreation, the State Department of PublicHealth, the present. It has been a model for physical educators at other and the State Department of Public Instruction;testers were universities desiring to conduct similarprograms. from Washington State University. 3. Cureton's extensive studies of adult physical fitness Project Broadfront(3): This project was conducted for five started in 1944. Numerous publications resulted, including years in the Ellensburg, Washington, public schools. As part five books. HisPhysical Fitness and Dynamic Healthappeared of a much broader project, PFI testswere administered semi- on the 100 best-book list of the American Library Association annually and the low fitness programwas conducted; cooperat- and was a Bock-of-the-Month Club selection. ing institutions were Stanford University, Universityof 4. Cureton has conducted numerous clinics in YMCA's and Oregon, and Central Washington College. The American universities for many years. For overa decade, he was a Academy of Physical Education cited Lloyd Rowleyfor his regular lecturer and clinician for the six regional clinics administration of Project Broadfront and theEllensburg sponsored each year by the President's Councilon Physical School District for its support. Fitness and Sports. He has served in a similar capacity for physicians, dentists, police, and industrialconcerns. He has Time and again, the effectiveness of thisprogram to spread his gospel abroad, lecturing and demonstrating in improve the condition of boys and girls who are muscularly Germany, Belgium, Canada, Venezuela, and other countries. weak for their sex, age, and weight has proven effective in 5. The publications by Cureton have beenenormous. 56 actual school situations. When properly applied,it has booK- and monographs and 340 of his articles between 1930 contributed significantly to the totality of the individual, and 1969 are listed inEducation and Fitness 1969 (14).He physically, mentally, psychologically, and emotionally. Mus- is now serving as o :s-all editor for the four volumeen- cular strength, hoth gross (SI) and relative (PFI), is related cyclopedia of physical education, fitness and sports, and has intricately to the entire physical/ motor complex of the shared editorship on single volumes. An early contributionto individual, including his or her maturity, physique type, body fitness testing was hisPhysical Fitness Appraisal and Guidance, size, motor fitness, and athletic prowess. (4, 8) 1947. He developed the now well recognizedsystem of At this point, may I inject a tribute to the late Frederick progressive, rhythmical, nonstop exercise. Rand Rogers whose contributions to physical fitnessprocesses 6. The honors bestowed on Cureton have beennumerous. through physical education have not enjoyed the recognition He has received the A A H PE RD's highest award, the Luther they deserve. He was the originator of the Physical Fitness Halsey Gulick Medal, and the Hetherington Award by the Index; it was his insight, energy, and drive that initiated and American Academy of Physical Education. He has been cited promoted PFI programs, first in New York State, then in New by the President's Council on Physical Fitness and Sports, the England and other parts of the country. Despite allsorts of American College of Sports Medicine, the National YMCA, obstacles end disappointments, he continued to fight for the and the American Dental Association. He has received basic principles and practices of this program. For his prime honorary Doctor of Science degrees from the University of time in physical education, he had by far the most realistic Guawa and Southern Illinois University. concept of muscular strength and its fundamental relation- 7. And, believe it or not, Cureton stillnot only exercises ships to body, mind, and spirit. vigorously on a regular basis, but he competes. Justone 4 12 illustration: At the 1079 Senior Olympics, hc entered I I events Mania." Some periodicals are now devoted to running, in swimming, running, and bicycling and won them all; his in riding Runner's World, The Jogger, The Runner, On the wife Portia, entered six events and wen five. Run, and Marathoner. Some 30 books on running and During the past 50 years, Cureton has realistically and exercise for the lay public have been published recently. dynamically put the "physical" back into physical education. Famous among these is The Complete Book of Running by James F. Fixx, which has sold well over a half million copies, The Current Physicaln.:essScene in th. United States and it was on Time's ten best-seller list of nonfiction books for several months. Also, associations devoted to jogging have Indications of Growth bten formed, such as the National Jogging Association, the American Medical Joggers Association, and the Road A National Adult Physical Fitness Survey (5) was conducrA Runners of America. seven yee-s Igo by the Opinion Research Corporation, An outgrowth of the jogging phenomenon that has swept Princeton, New Jersey. Of this sample of 3,875 men and the country is competitive distance running. A national women, 55 percent indicated that they engaged regularly in calendar of running events throughout the country, appearing some form of exercise. For those who exercised, the main in the September 1978 issue of The Jogger, although incom- reason was for good health. Adults who participated in plete, listed 88 "Fun Runs" in 35 states and 161 road races in physical education when they were in school were more likely 36 states. For many years, the Boston Marathon was the only to e .ercise as adults. More than ninety percent of the adults one around. Now, marathons are being held :.-, many pieces, believed that all people should have physical education from as well as runs of lesser distarces. And, competitors number in elementary school through college. the thotr,..nds. There is also the master's competition sod C. Carson Conrad (12) made a status report on physical Seim "Nympics with categories of runners from middy: to fitness today at the 1979 White House Symposium on old age. Also, women are now competing in distance runs, Physical Fitness aid Sports Medicine, in which he gave some in-' .4 ink; marathons. According to one source ( I), 50,000 startling facts, in zluding: (a) fitness trails were built in more Americans have completed at least one marathon and 4,000 of than 1,000 cities during the 1970s, (b) there are nearly two them have done it under three hours. According to a story by m'llion permare nt, or in ground, swimming pools in the Kenny Moore in Sports Illustrated (17), 14,000 men, women, United States, 1 14,300 of which were constructed last year, (c) and children ran in the 1980 New York City marathon; 20,000 there are 3,000 commercial health spas and figure salons with applicants were rejected. Of the participants 1,142 were three million members, which grossed $400 million in member- lawyers and 546 were physicians; 2,000 were foreign entries ship fees last year, (d) private enterprises are spending an from 43 countries; 2,500 volu-teers readied 450,000 drinking estimated $5 billion a year on employee fitness programs, and cuts and used 130 gallons of blue paint to put down the line the American Association of Fitness Directors in Business for the course through the five borroughs of New York City. and Industry gas more than 1,750 corporate and individual One might well ask whether the current accelerated participa- members, (e) sales of sporting goods and related equipment tion in jogging and in co mpetitive distar^, running is a fad or and clothing approached $15.4 billion in 1979, a six-fold a trend. Jogging for health, should cert. ,nly be a trend, since increase over 1960, (f) approximately 18 million boys and girls research has demonstrated its essential value. for cardio- took the National Youth Fitness Test last year, (g) nearly 30 vascular fitness. weight control, and physical fitness generally. million young people aged 6-12 years of age are involved in All the ballyhoo on distance and marathon running should out-of-school sports programs. not obscure er negate these vital values; the need is ever In his address, Cc sad did sound a pessimistic note, despite present in a sedentary soci.',. As for competitive distance all the great progress in physical fitness during the past two running, it could be a far but does not need to be. These long decades. On: concern was that school physical education has competitive runs may be iltened to our interscholastic and not kept pace with national growth in participation; it appears ercollegiate athletic programs, an outlet for superior to be in a state of decline with requirements, staffing, and p,. formers (runners in this case) to express themselvesfully. financing aeing reduced. Of greatest concern in this regard is Proper jogging regimens are undeniably valuable to the the tendency of states to eliminate the physical education individual, but whether they must be increased in d..ration rez,uirement, placing it on an elective basis in some or all and intensity to compe :tive long-distance running is question- grades, in spite of the fact that parents in a notional poll able. overwhelming! favored the requirement. It should be realized, however, that, despite jogging's value, other activities, such as swimming, bicycling, rope skipping, hiking, and some sports, also, are effective in developing and The Jogging-Running Phenomenon maintaining cardiovascular fitness. Further, we must con- stantly recognize that components, especially muscular According to a statement by the President's Council on strength and muscular endurance, are basic to physical fitness Physical Fitness and Sports (10), the number of runners and must not be neglected, especially for those who are throughout the United States has doubled in the past five physically underdeveloped. years; it is a present-day phenomenon of considerable propor- tion. This phenomenon has taken two f. irections: jogging for cardiovascular fitness and competitive distance running. Physical vitness Research Just a few years ago, an article on physical fitness or some aspect of it, such as jogging was a rarity in the press or in Although research has been an important. endeavor of popular magazines. Now they are commonplace, thus reflect- physical educators for well over a century, the transition ing a new and continuing interest by the public. The weekly mentioned earlier from medical to educational leadership magazine, Nev-. vek, has put joggers on its cover, as did resulted in research primarily becoming a function of graduate Sports Illustrated for the 1980 New !A ; k City marathon; U.S. education after Work I, which was also in its initial stage News and World Report has written abou' "The Fitness in the United States. Very few physical education research 5.13 laboratories existed prior to World War II, the most noted of In Comiusion which were at Springfield College, State University of Iowa, and George Williams College; such laboratoi .s were starting We saw physical fitness as the only objective o. physical at the University of Illinois and University of California at education in the early days of physical education; its value was Berkeley. At AAH PERI), the research section was recognized associated with preparation for defense and with preventive in 1928 and the research council was propose I in 1942; the medicine while other values of exercise were realized concur- Research Quarterlyoriginated in 1930. rently. then, we saw physical fitness wane in imporance, to become concomitant to other objectives of physical education. Following World War II, the increase in research labora- Finally, we saw a resurgence in emphasis on physical fitness tories was dramatic, so that prtient:y many graduate depart- triggered and promoted by presidents of the United States ments of physical education have well established and through their physicrl fitness councils and dynamically equipped laboratories with well prepared and experienced supported by research .rom many sources that demonstrated professors in charge. Interdisciplinary research has become its value for the total well-being and effectiveness of the prevalent. From the standpoint of physical fitness research, individual. We are now riding a crest that should continue to ona manifestation of this was the formation of the American mount ever higher as more and more Americans realize the College of Sports Medicine in 1954; in this organization, importance of exercise as a way of life and incorporate it physical education scientists are associated with physicians appropriately into their everyday life-styles. and exercise physiologists in a common research endeavor In schools and colleges, physical educators need to stress that has become increasingly productive. the importance of physical fitness and should mount and Physical fitness research, most certainly, has not been maintain effective daily programs with emphasis on those confined to physical education. In recent years, several other who are deficient in basic physical fitness components. At the discip lines have contributed greatly, although in some in- same time, physical educators should remember that physical stances physical education scientists have been jointly in- education has other essentia; purposes in the preparation of volved. Some of these are: epidemiologists, who have con- boys and girls for living that should not be neglected. trasted the incidence of degenerative diseases among physically active and physically sedentary populations; nutritionists, who have shown that exercise is an effective partner to proper diet in fat reduction; cardiologists, who have shown the need for exercise in the prevention c; and rehabilit :tion from heart References attacks; physicians, who have recognized the desirability of early ambulation and exercise following major surgery; 1 President's Council on Physical Fitness and Sports An introduction to exercise physiologists, who have found that exercise favorably running One step at a time (pamplet) affects blood pressure, resting and exercising heart rates and 2Clarke, HHarrisonApplication of Measurement to Health and concentrations of cholesterol and triglyceride in the blood Physical Education (5th Ed) Englewood Cliffs, N JPrentice-Hall, stream; physiatrists who showed the extreme deleterious Chapter 7, 1976 3 Clarke, H Harrison, Exemplary and innovated practicesPhtsical effects of confined bed rest upon the total organism; psy- Fitness Ness s Letter, Series XVII (4)I, 1970 chiatrists who demonstrated the value of exercise in the 4Clarke, H HarrisonMuscular Strength and Endurance in Man treatment of mental and emotional disorders; and geron- Englewood Cliffs, N J . Prentice-Hall, 1966 tologists, who established the value of proper exercise in 5 Clarke, H Harrison (Ed ). National physical fitness survey PhYsical Fitness Research Digest 4 (2), 1974 slowing physiological aspects associated with the aging 6Clarke, H Harrison Oregon pilot physical fitness project The PhYsical proses_ Also, in business and industry, studies have shown Educator 14 (2) 55, 1957 the value of physical fitness in reducing absenteeism, in 7 Clarke, Fl Harrison Physical educationand national survival Education improving workers' effectiveness, and in prolonging working 75 (2) 96, 1954 8Clarke. H Harmon Physical and Motor Tests in the Medford Boys' careers of employees and executives. Physical educators have Growth Studs Englewood Cliffs, N JPrentice-Hall, Chapter 5, 1971 shown the totality of man, physically, mentally, psycho- 9 Clarke, H Harrison President's Council on Physical Fitness and Sports logically, and socially; and they have studied the nature, The At ademv Papers 8 88, 1974 extent, and significance of physical differences between 10Clarke, HHarrisonThe jogging-running phenomenonPhysical individuals. Fitness News Letter, 25(1)I. 1978 11 Clarke, H Harrison and ['avid H Clarke Developmental and Adapted Speaking of physicians, a great change in the attitude of the PhYsical Education (2nd tng!ewood Cliffs, N JPrentice-Hall, tnedical profession toward exercise has occurred: twenty-five Chapter 6, 1978 years ago, most "could care less"; today, medical associations 12Conrad, C Carson Physical Fitness Today A Status Report Address, and leaders are strong advocates of the proper kind and White House Symposium on Physical Fitne,s and Sports Medicine. amount of exercise as a health-promotion means. Some October I1, 1980 13 Cureton, Thomas K. Personal correspondence, December 20, 1980, and physicians, such as Hans Kraus, Kenneth Cooper, Samuel January 20, 1981 Fox, and George Sheehan, are well known in this field. 14Frank, B Don (Ed )Erertiise and Fitness ;969 Chicago The All aspects of relevant research constitute an essential part At dem Institute, 1969 of the present physical fitness scene. The research results of 15 Kraus, Hans, and Ruth P H irschL nd Muscular fitness and orthopedic disabilities New York State Journal of Meduine 54 (2) 212, 1954 many aspects of physical fitness have been widely disseminated 16 Mathews, Donald KVirginia Shaw, and Philip Risser The Moses Lake in the professional literature and in media presentations for project Journal of Health, Phi sit al Education and Recreation 29(4) 18, the lay pubilc. These results are convincing proof that the 1958 proper kind and amount of exercise are essential for an 17 Moore, Kenny There are only 26 miles to go Sports Illustrated November 3. 1980 effective life-style for all Americans. They constitute the basic 18 Robbins, C R Central New York State demonstration St hoc, At times justification and motivation for exercise as a way of life. 11 (7) 296, 1940

6 14 A Total Health-Fitness Life-Style

Steven N. Blair

ur human ancestors have been on Othis planet for perhaps 2 million body and appropriate levels of physical world. Of course, we zannot all suddenly years ''or 99.5 percent of that time they fitness. become hunters and gatherers, nor do I existed as hunters and gatherers. The The bushmen appear to have ample advocate a destruction of civilization development of agriculture began some time and inclination for singing, dancing, and a return to those simpler times. 10,000 years ago; we have had cities for and storytc!!ing as leisure activities. What I am suggesting, however, is that about 8,000 years, and our dependence They also spend considerable time rest- many of our current problems, and I on fossil fuel came about only within ing in the shade in camp. By and large will fools on health matters, can best be the past few hundred years. Today's they appear to have a simple yet pleasant understood when interpreted in the modern technological society with nu- life. This is possible even though they perspective of historical anthropology. clear energy and computers has de- have been pushed Into one of the most Perhaps some life-style changes can be veloped within our short lifetimes. The inhospitable geographical areas of the made that will simplify our lives, im- life-style of modern Americans is so globe. Itis easy to imagine that the prove our health, and a, the same time different from that of our hunting and earlier hunters and gatherers, who had permit continued enjoyment of the high gathering ancestors that we can scarcely access to the lush savannas and semi- culture produced by several thousand comprehend it. tropical areas full of game and vegeta- years of civilization. Few hunting and gather ng societies tion, had an even more enjoyable are left, but those still extant can tell us existence. Life-Style, Health Problems, and Health something about how our ancestors Itis occasionally fun to ask philo- Status lived. The bushmen of the Kalahari sophical questions and let the mind play have been studied and provide some with answers. We frequently hear the Most of us learned some common- insight into those earlier life-styles.' term "quality of life." What does it sense health rules from our parents, Although their lives are difficult by our mean? How can quality of life be defined? grandparents, and doting aunts and standards, particularly during the dry What is optimal quality of life? Are we uncles. Don't eat between meals. Break- season, they appear to be healthy and really any better off than our hunting fast is the most important meal of the happy. The major tasks, of course, are and gathering ancestors in terms of day. Smoking will stunt your growth. concerned with obtaining food and quality of life? Civilization has brought Don't get fat, and so on ad museum. As water. Shelter in their mild climate is many advances for humankind, but we became educated we began to doubt not a problem. Clothing needs are few there are also negative developments. these statements as lacking scientific and simple (the fashion houses of Paris The high technology that provides us proof and dismissed them as old wives' and New York are unknown and there with modern creature comforts has also tales. Now it appears that those con- is apparently no planned obsolescence). provided the means to destroy the cerned relatives and friends were right There is no mass advertising to create planet. Itmatters little whether this after all, and we can support those artificial needs for worthless products occurs suddenly in nuclear holocaust or conczpts with evidence. and no department stores for purchasing by degrees in the form of resource Recent research from all three avenues them, therefore their material posses- depletion and pollution. The bushmen of medical research (clinical. epidemio- sions are few. seem rather happy and well-adjusted; is logical, and experimental) implicate The hunting and gathering tasks are our quality of life superior? Civilization many health habits as etiological factors somewhat physically demanding, al- has produced art, music, and literature in a wide variety of major disease though not overly arduous. The dura- for uplifting human spirit and intellect. problems. tion, frequency, and intensity of this It has also produced feminine-hygiene Cigarette smoking probably causes enforced exercise prescriptionis ap- spray, dozens of plastic kitchen or home more morbidity and excess mortality parently adequate to maintain a lean appliances advertised on late night TV, each year than any other single health and a materialistic society that cries habit. This one habit has been con- more, more. vincingly implicated as a contributing My conclusion is that man's tech- cause to chronic lung disease, various nology has outstripped his evolution. types of cancer (especially lung), cor- We simply are not meant to live as we onary heart disease (CHD), and other Steven N. Blair is with the Institute of do in highly developed, technological circulatory ailments. Literally hundreds Aerobics Research, Dallas, TX. overkill that exists in the industrialized of studies on smoking and health are

7 15 published annually around the world, and additional woi k needs to be done, it notion of the relationship between heaith and summaries of this research are appears that it is better to be active than practices and health. This certainly readily availabl2,3 sedentary.23 seems clear and straightforward, but in A second major health behavior spe- Regular physical activity has also science itis necessary sometimes to cifically linked to various ailments is the been linked with a reduction in confirm the obvious. broad category of diet. The eating pat- obesity,28'29 prevention of low-back Studies like the onc. e discusscd pre- tern is admittedly one of the two major pain,20 as an antidote for "stress,"31,32 viously have given a great impetus to components to energy balance (the other and "feeling better."33 the concept of preventive health prac- being physical activity) and as such, a Other life-style components can ob- tices. It app .ars to be an idea whose contributor to obesity. Obesity has been viously affethealth and well-being. time has come. One can scarcely pick recognized as a major public health Violent deaths due to accidents and up a scientific journal from the health problem in the United States4,5,697 and a homicides are a major problem.34 Al- or medical disciplines without finding contributor to various diseases.8,90° though many of the causes are difficult an article or editorial suggesting that The eating pattern is also thought by to identify, itis evident that lack of CHD or cancer can and should be pre- many to be related to CHD. Research safety consciousness (failure to wear vented.35,39-50Politicians have also over the last two or three decades has seat belts, for example) or drug abuse joined this movement.51952 shown that thr high-calorie, high-fat, (especially alcohol) are prime candidates. The most comprehensive and organ- and high-cholesterol diet of Americans It is also difficult to ascertain how ized approach to the issue of preventive causes high levels of blood lipids, es- many Americans succumb to ennui or health practices has been presented by pecially cholesterol. These lipid abnor- are "just in a rut." They drift through the Canadians.53954,55 Their approach to malities are definitely related to the life without fully e,:periencing "joie de "Operation Life-Style" states (among development of atherosclerosis, the major vivre." The causes of these symptoms other things) that: cause of heart attack and stroke.11,12,13 are probably impossible to identify, but These findings meet the criteria for it is safe to say .hat persons in that I.It is better to be slim than fat. determining causal relationships be- condition are ce:tair_ j not functioning 2. It is better not to smoke cigarettes. tween risk factors and disease." It is at top social and emotional health. Are 3. Excessive use of medication is to be important that controlled experimental there life-style components related to avoided. studies now provide us with reasonable these problems? Perhaps. Perhaps not. 4. Exercise and fitness are better than explanations of pathogenetic mechan- But it would be interesting to see if the sedentary living and lack of fitness. isms to support the earlier epidemio- symptoms would disappear if the other 5. Alcohol is a danger to health, partic- logical and clinical findings." more tangible health behaviors discussed ularly when driving a car. The American diet is also perhaps previously were practiced. related to certain cancers. The second- Several reports on the relationships I have tried to show that there are read- leading cause of cancer mortality is between health practices and health ily identifiable common-sense health colorectal cancer,15 for which diet has status have been published by the Cali- practices that should be followed. If this been suggested as a cause.16070809 Diet fornia Human Population Lab- is done, it is reasonable to expect im- has also been tenta.ively linked to cancer oratory.35936937,38 More than 6,000 per- proved health and longer life. It is per- of the stomach, breast, and uterus.19 sons ranaomly selected from Alameda hapc also necessary to point out the A third major life-style component County (Oakland), California, were sur- obvious, that the responsibility for these related to health is physical activity. veyed for health. 'atus (physical, mental, life-style changes rests with the individ- Sedentary living produces low levels of and social) and aealth practices. They ual. A recent editorial in the Jourpal of physical fitness or physical work capac- were followed for 5 years to determine the American Medical Association ity (PWC).20 Work physiologists fre- mortality rates. Summary findings from states, "Perhaps the most promising quently express PWC in METS. One these studies indicate a definite relation- potential for improving the public health MET equals the amount of energy ship between health practices and lon- resides in what people can be motivated expended in a resting state, 10 METS gevity. Seven significant health practices to do for themselves. "56 That is sound refers to an energy expenditure of 10 were identified: (I) eating breakfast, (2) advice. times resting. Sedentary adult Amer- eating regularly with no snacks, (3) Major societal issues are on the cir- icans typically have a PWC of 7-9 eating in moderation, (4) smoking ab- cumference of the circle. It is my con- M E TS.2 Since sustained work capacity stinence, (5) moderation in alcohol con- tention that these issues are related in for 12-16 hours is probably limited to sumption (if drinking at all), (6) engaging part to the major causes of morbidity 15-20 percent of PWC,22 the average in regular physical exercise, and (7) and mortality listed in the first ring of sedentary person can average only 1.5- regularly sleeping 7-8 hours a night. the circle. These health problems are 2.0 METS over the curse of a day The researchers found that 45-year-old further related to the intermediate steps without fatigue. Trained persons not males who followed 0-3 of these habits depicted in the next ring. Finally, 1 pro- only have a higher PWC, they can use a could expect to live to age 67; those who pose that the health practices listed in greater fraction of it over long time followed 4-5 habits could expect to live the center are major causative factors periods. Thus, it seems reasonable to to age 73; and those who followed 6-7 related to the health problems and conclude that many sedentary persons habit, could expect to live to age 78. issues displayed in the model. It is also are so unfit that it limits their ability to The data for 45-year-old women showed perhaps possible to extend the reason- enjoy life. Numerous worldwide epi- a similar trend; however, the difference ing at least one more step. The initia- demiological studies have shown that in life expectancy between the top and tion, establishment, and maintenance more active groups tend to have less bottom groups was 7 years rather than of these health practices is complicated. CHD.23,24,25,26Although these studies the 1 i years for men. They are probably dependent upon tended to have methodological flaws,25927 These studies tend to support the environmental, cultural, and personal

8 16 factors and situations. Horn's model 120 male apprentices in machine facto- mass-media campaign plus intensive for Personal Choice Health Behavior is ries. The subjects were assigned to a intervention. a theoretical example of how these fac- control group (N=60) and an experi- The results of this study suggest that tors interrelate.37 The application of mental group (N=60). The subjects in mass changes are possible and that they this and other models will be discussed the experimental group received a pro- can be done inexpensively. later. gram of health education consisting of Although there has been no organized lectures and exhibits. Leisure-time phys- campaign, considerable effort has been ical activities were also encouraged. expended in antismoking education. Efficacy of Prevention Developing a The findings after 4 years were impres- The surgeon general's report on smoking Healthful Life-Style sive as shown in Table 1. and health provided an impetus to These data clearly show that the health smoking cessation efforts by voluntary If one agrees with our previous argu- education program did not cause health agencies and professional organ- ments, it is clear that Americans would smokers and drinkers to quit, but it did izations.61 Antismoking spots on tele- benefit from changing certain health apparently prevent the experimental vision, community campaigns, and quit- behavio -- 'n the minds of many, how- subjects from starting the habits. The smoking clinics have been used. The ever, that assumption meets a major participants also engaged in more phys- available data do nc t permit an analysis stumbling block. A widely held pessimis- ical activity, showed greater improve- to determine specific causes for changes tic view is that persons are unable to ments in measures of physical fitness, in smoking behavior, but significant change these habits of long standing. and had fewer dental caries. changes have occurred.62 National prob- Folk wisdom indicates, "you cannot The Stanford University "Three-Com- ability samples have been drawn and teach an old dog new tricks," "you can- munity Study" has demonstrated that surveyed for smoking behavior for the not change human nature,""people will entire communities can be persuaded to National Clearinghouse for Smoking not change health habits," or "more change health behaviors.39,63 In this and Health. These surveys indicate that people are smoking now than ever study, one community was assigned as the prevalence of smoking in at before." I recognize that health-habit a control, one received health education declined sharply from the mid-1960s to changes are nc. easy, but neither are via mass media, and the third received the mid-1970s. Smoking by adult men they impossible. Americans are becom- the mass-media campaign plus intensive declined from 52 percent to 39 percent ing more and mot_ ..ealth conscious, in intervention. The intensive intervention for a drop of 25 percent. For adult m- opinion, and are making changes in consisted of selecting 100 high-risk par- women the figures were 32.5 percent to eater and greater numbers. Iwill ticipants who were offered face-to-face 28.(. cent for a drop of 11 percent. present some of the available evidence intervention from behavioral scientists Tool any people are still smoking, but on trends for some of these habits, but and dieticians. In the two experimental itis encouraging that significant de- perhaps a personal observational exam- communities the mass-media campaign creases have occurred. ple illustrates the concept just as well. I was directed by specialists in communica- Data from the Hypertension and have lived at my current address in tions, medical science, and behavioral Detection Follow-up Program (HDFP) Columbia for 6 years. When we first science. indicate an improvement in the treat- arrived, my wife and I were essentially The study design required a behavior- ment of hypertension.63 Control of high the only joggers in the neighborhood. al interview and a medical examination blood pressure is demonstrably impor- Now you see joggers going down my in all three communities. Surveys were tant but too few hypertensives are ad- street from 6 AM to I 1 PM. At any time I conducted at baseline and repeat annual equately treated. Only hal the hyper- doubt that you would have to wait examinations for 2 years of follow-sip. tensives are said to be aware of their more than a few minutes to see the next The behavioral interview consisted of a condition, only half of these are being one. I cannot quantify the amount of health knowledge component and also treated, and of those only half are change in jogging behavior in my neigh- surveyed attitudes relative to health adequately controlled. This "rule of the borhood, but I feel confident that it is behavior change. The medical examina- halves" predicts that only some 12 simply astounding. It is also encourag- tion included measures of blood chem- percent of the hypertensives are under ing that all ages, sizes, ability levels, and istry, blood pressure, weight, and ECG. adequate treatm -it. Recent studies cast both sexes are represented. A summary of the results after 2 years doubt on that model. The HDFP survey The proposition that people want to revealed no change in health knowledge found 38 percent of the hypertensives change health habits, are trying to or health behavior in the control com- were controlled. Further evidence of change, and are being somewhat suc- munity. The mass-media-only com- this improved control of hypertension cessful can be supported with hard evi- munity had significant changes in both is available from Chicago,64 where recent dence. It is clear that the studies reported knowledge and behavior. The greatest screening activities discovered only 12 represent isolated individual attempts knowledge and behavioral changes oc- percent previously undetected hyperten- at addressing the problem. We have not curred in the community receiving the sives compared to 57 percent four years yet mounted a comprehensive, organ- ized, and aggressive campaign, as has been proposed in Canada.35 It is encou- raging, however, that these individual projects are showing some positive re- Table 1 sults, and even more exciting to think Changes in Health Behavior Over 4 Years about what can be done with an all-out Cigarette Smoking AlcoholUse effort. Initially At end Initially At end One Swiss study offers hope for changing behavior in adolescence.38This Experimental group 24 25 26 33 four-year prospective study involved Control group 28 47 29 55 9 17 earlier. These data indicate a remarkable further component of this model is that values. Action may be taken if threat is public-health achievement, and demon- some cue to action is important. A perceived. strate what can be done with professional person might fervently hold the beliefs These models, and others similar to education coupled with public emphasis mentioned above and yet not make them, should help us begin to under- on the dangers of hypertension and the changes. Something is necessary to push stand the complex interactions among necessity of treatment. him over the line. This cue to action individuals,their environment, and It seems to me that there is ample might be the death of a friend or relative other demographic variables that relate evidence that the American public is or something less traumatic such as a to health behavior and health behavior concerned about health matters, and newspaper article about the disease and change. It is clear to me that educators that people are attempting to change the target behavior. Other variables must move beyond the belief that the undesirable health habits. The crucial such as age, sex, ethnicity, social class, educational process will ensure the estab- question, however, is whether these personality, etc., are also thought to lishment of a healthful life-style in our changes hay ot been meaningful. Evidence play a role. Examples of the application students. Students do not stop using suggesting that they have is available in of the Health Belief Model in behavior drugs after a lecture on drugs -..nd the the mortality statistics for the United change research are available.56,67,69 law by a local policeman. Venereal States for the past 25 years.65 Total disease will not be controlled by showing mortality has declined 23.7 percent and A model on Encounter in Health films of syphilitic chancres. All teenagers cardiovascular mortality has declined Education has been developed by Burt 69 will not stop smoking after seeing 29.7 percent. Most of the decrease in This model includes a partnership be- diseased lungs. We will not eliminate cardiovascular deaths has occurred since tween the health educator and partici- sedentary life-styles with lectures about 1968. All four major races and both sex pant. The participant is to evaluate C H D and low-back pain. I do not mean groups show similar dzclines in mor- selected life-style components, the health to denigrate the eduLational efforts that tality. Although many possible explan .- educator is to assist in an orderly evalua- we are making. They are important and tions exist for these decreases, including tion. The major question about any necessary, but they must be placed in improved medical and hospital care, it particular life-style component is perspective and fitted into a comprehen- appears reasonable to assume that at whether or not it is healthful, actualiz- sive pattern of developing a healthful least some of the improvement can be ing, and happiness promoting. Burt life-style. attributed to improved risk-factor status. proposes that this evaluation proceed in a systematic fashion by progressing An excellent and extensive review of Health Behavior Change How? risk-factor trends and changes in mor- through a seri--; of steps. These steps tality has been published by Starrier)! include separating knowledge from bias, rational from irrational thinking, ex- It would be encouraging to see sweep- amining hang-ups and priorities, confir- ingdianges and comprehensive program mation or disconfirmation of a belief, recommerdations for life-style adjust- and finally acccpting or rejecting a ments come from our institutions. The particular life-style component. This federal goverment has the resources to Hraith Behavior Change Why? particular model appears to place more implement integrated programs utilizing emphasis on the role of the health interdisciplinary support. Coordination The question of what prompts health professional as an agent of change. of these efforts at higher levels of the beahvior change has intrigued scientists. department of Health and Human Serv- What dynamic factors are operating A third model, Personal Choice ices (H HS) and a reordering of priorities when a smoker of two packs per day for Health Behavior (PC H B) has been pre- would be necessary. Less emphasis, and thirty years stops or someone who has sented by Horn.57 This approach places less money, would need to be placed on been sedentary for two decades since more emphasis on a comprehensive treatment and more on preventive ef- college starts jogging? It is stating the view of health behavior, and is not forts. State or local governments through obvious to say, "man a complex limited to cessation of bad habits. Ac- departments of public health, com- creature, whose behavior is affected by cording to Horn an individual proceeds munications, and education could de- many factors." In order for health be- through stages of initiation, establish- velop similar initiatives. Scholarly and havior change to occur, cognitive and ment, and maintenance of a particular professional associations from the med- affective components as well as social behavior. A behavior is more likely to ical, health, and behavioral sciences interactions and environmental condi- be Initiated if there is availability and an could also contribute. There are some tions are important. Theoretical models example to follow. It has been found, signs that such developments are under attempting to explain these processes for example, that children of smokers way. News reports indicate that various have been presented. are more likely to become smokers institutes at NI H are beginning to place Numerous scientists have contributed themselves.70 The establishment of a more emphasis on preventive health to the development of the Health Belief behavior is Influenced by such factors measures. During the Carter administra- Model. 66 This model predicts that pre- as costs-benefits analysis and psycho- tion, Secretary Califano made repeated ventive health behavior will occur under logical factors such as internal-external statements regarding DHEW's efforts a specific set of circumstances. A person locus of control. The maintenance of a in smoking contro1.71 A consortium of will attempt to avoid a disease if certain behavior is dependent, at least in part, government, professional societies, pri- beliefs are held: (I) personal suscep- on reinforcement, social support, and vate industry, and education could have tibility, (2) that the disease would be psychological utility. Cessation, or other a marked impact on Americans' life- severe, (3) that taking action would be modification, of PCHB involves some styles, but such a group is unlikely to be beneficial, (4) that the action will not aspects similar to those presented in the formed. In the first place, there is hardly present significant psychological bar- Health Belief Model. Motivation for unanimous opinion that these programs riers such as inconvenience or pain. A change may be influenced by one's should be started. Second, powerful 10 18 interests such as the tobacco, egg, and your community's resources to pro- families and friends to provide dairy industries are likely to actively duce the integrated interdisciplinary this support. oppose preventive health programs. programs of health-behaviorchange. Third, the simple problem of over- 3.It may also be useful to base your comin ; inertia and organizing such a More specifically, for the worker in approaches on some particular health massive program is a Herculean task. aerobic fitness programs, the following behavior change model. Read the Should we then throw up our hands suggestions may be helpful. papers on models, think about the in despair, and wait for a more oppor- various approaches, and discuss them tune time? I think not. The idea of with your fellow workers. An exam- preventing disease and achieving high- I. We should attempt to integrate ple of how this approach might be level wellness is an idea whose time has regular physical activity into a total used is given for Horn's PC H B model come. For example, approximately 90 life-style approach to good health. in relation to regular physical activity. percent of current adult cigarette Advise participants in exercise pro- In this case the application of the smokers say that smoking is hazardous grams about good nutrition, relaxa- model is for developing a positive to health and that they would like to tion or stress management tech- health habit, so only the first three quit.62 Furthermore, most smokers who niques, safety consciousness, and the stages are applicable. have quit, did so without professional benefits of smoking cessation. 2. Our exercise programs should be assistance:12 Although the data are not If one were to design an existence in based on sound behavioral science available, I doubt that very many of the which persons were to be likely to millions currently jogging began under principles. Several recent publica- initiate regular activity, what would professional supervision. tions provide useful information on you do? According to the PCH B model, this point.73-78 opportunities for activity should be I am not suggesting that health pro- Involve participants in t he decision- readily available, examples should be fe sionals have had no effect on the making process relative to their evident, and perhaps it should be re- ht. ilt"behavior changes that have oc- personal health habits. Introspec- warding (either physically or emotion- curred. However, it seems likely that tion and self-observation by the ally). To meet those criteria for our the effects have been indirect. Conduct- participant can identify potential example, one approach would be to ing an exercise class for adults may pitfalls to success. Self-collected make it convenient to exercise. This reach and influence a reasonably small data on behavior can be useful in could mean plenty of facilities such as number of people. There is probably a planning the change process. tennis courts, bike and jogging trails, ripple effect as those participants talk to Changes in health behaviors hould swimming pools, etc. It might also be their friends, co-workers, and families, be done gradually. Few persons possible to concomitantly make it less and as they begin to jog through their can completely reorganize their convenient not to exercise; for example, neighborhoods. Some of them may lives and change several habits at sidewalks and paths rather than streets even start additional classes or perhaps once. It may take months or even leading to shoppingand recreation area. initiate racing ...vents. Professional in- years to implement all desired It is important to have highly visible fluence is undoubtedly effective in other changes. This slow but steady examples. Adoption of a new or innova- ways. Every newspaper interview or TV approach is more likely to produce tive behavior or practice follows an S- talk show reaches large numbers of lasting changes.Itisalso im- shaped, exponential growth curve.79 As people. Every speaking engagement at a portant to help participants set more people adopt a behavior, the service club, PTA, or other group reasonable goals and undertand more likely others are to adopt it, at reaches more. In at least some instances, that the change process will likely least until most of the population has those efforts may provide the cue to be lengthy. changed and c nly a few die-hards are action described in the Health Belief Professional support over long left Mode1.66 periods of time is important. Many According to the PCHB model a I would make several recommenda- behavior change programs fail behavior may become established as a tions to professionals interestedin because of lack of follow-up. Main- result of a costs/ benefits analysis. For promoting health-behavior change and tain contact with participants via the case of exercise, if persons begin to high-level wellness. post cards, telephone, newsletters; feel good (both physically and emotion- have them keep a diary or log and ally) about their participation, and if I. Continue day-to-day responsibilties send it to you; and have occasional costs (giving up time or disrupting of teaching, counseling, and conduct- reunion or booster meetings. schedules) are minimal, then the activity ing research. The health professional should is more likely to become established. A 2. Keep in mind the niche these activities work to develop and improve perceptual stereotype may also develop. fill in a total health life-style model. counseling and communication If a person begins to see himself or 3. Seek to interrelate your own activities skills. Ask open-ended questions herself as an exerciser and like other with others. that elicit more than a yes of no exercisers,the habit may confirm!. 4. Be cognizant of the interdisciplinary response, be open, honest, and Various psychological factors may also nature of your work, and try to build assume an assertive approach to be important. If one receives positive on the strengths and abilities of the counseling session. reinforcement, the exercise is likely to others. Finally, be liberal in the use of be more firmly established. 5. Utilize the theoretical models de- positive reinforcement and sup- scribing health-behavior change to port. Seek ways to provide feed- plan future directions, new programs, back. Help the participant to de- Maintenance and research. sign intrinsic and extrinsic systems 6. Be a health activist and try to mobilize of support and reinforcement. Use According to Horn, at some point in 11 19 time either habituation or depeodence "Keys, A Coronary heart disease the global Proceedings of the national conference on emo- becomes operative and the person is picture Atherosclerosis,1975,22,149-192 tional stress and heart diseaseJournal of the likely to maintain the behavior. I sup- "Intercociety Commission for Heart Disease South Carolina Medical Assoc-anon,1976,72, Resources. Primary prevention of the athero- 78-91 pose that would be debatable as to sclerotic diseasesCirculation, 1970, 42,A55-A95 "Durbeck, D C Heinzelmann, Schacter, J whether regular runners become de- "Marx, J L & Kolata, G BCombating the no et al The National Aeronautics and Space Ad- pendent or habituated. My feeling (in 1 killerWashington American Association for ministration U S Public Health Service evalua- the absence of any data) is that they the Advancement of Science, 1978 tion and enhancement program Summary of "Levin, D L Devesa, S S Godwin, J D II, et results American Journal of Cardiology',1972, probably do both. al Cancer rates andrisks, (2nd ed ) Washington 30,784-790 The foregoing discussion is a brief U S Government Printing Office, 1974 "National Center for Health StatisticsVital example of how a theoretical model "Berg, J W Diet In Fraumeni, J F , Jr (Ed ). statistics of the United States, 1970Washington may be used to plan and implement Persons at high risk of cancer,New York U S Government Prirting Office, 1970 Academic Press, 1975, p 201 "Breslow, L A quantitative approach to the health behavior change rojects. The ''Wynder, E L. Overview Nutrition and cancer World Health Organization definition of health creative and dedicated professional can Preventive Medicine,I)75, 4, 322-327 physical, mental, and social well-beingInterna- think of many expansions and applica- "Dunn, J.E , Jr. Cancer epidemiology in popula- tional Journal of Epidemiology,1972,1, 347-355 tions of some of the ideas. tions of the United States emphasis on Havyan "Breslow, L A policy assessment of preventive and California and JapanCancer Research. healthpracticePreventive Medicine,1977,6, 1975, 35, 3240-3245 242 -251 Summary "Wynder, E L & Gon, 6.13 Contribution of "Belloc, N B & Breslow, L Relationship of the environment to cancer incidence An epi- physical health status and health practices I have tried *- illustrate that the demiologic exerciseJournal of the National Preventive Medicine,1972. /, 409 current American life-style contributes Cancer Institute,1977, :;8, 825-832 "Clark, H H. (Ed ), Health practices and phys- to our major health problems. In order 20Pollock, M L The quantification of endurance ical health statusPin sical Fitness Research, training programs In Wilmore, J H (Fd ),Exer- 1976,6,I-11. for us to achieve high-level wellness cise and sports sciences reviews(VolI) New "Cori, & Peters, J A Etiologynd preven- certain health behaviors need to be York. Academic Press, 1973, 155 tion ofcancer Preventive Medicine,1975, 4, changed. This message has been ac ".ept- 21Falls, H. B The relative energy requirements of 239-246 ed by large numbers of Americans various physical activities in relation to physio- G R The chal:,:nge to cancer control logical strain In Parmley, L F , Jr , Blair, S N Preventive Medicine,1974, 3, 307-311 Many beneficial changes have occurred Gazes, P C ,et al(Eds) )Proceedings of the K P & Turner, RRealism in the in recent years and the mortality statis- national workshop on exercise in the Prevention, preventuof coronary heart diseasePreventive tics show a decline. Organized programs in the Evaluation, in the Treatment of Heart Medici, g 975,4,390-397 for health behavior change have demon- DiseaseJournal of the South Carolina Medical 42Blackburn, H Concepts and controversies strated success, but much remains to be Association,1969,65(SupplI) about the prevention of coronary heart disease 22Astrand, P 0 & Rodanl, KTextbook of Postgraduate MechcalJournal, 1976,52, 417-423 done. Health status of Americans will work physiologyNew York McGraw-Hill, 1970 ''Blackburn, H Coronary disease prevention improve if citizens take the responsibility 2'Pate, R R & Blair, S N Exercise and the Controversy and professional attitudesAdvances for their own health and if dedicated prevention of atherosclerosis Pediatric implica- in Cardiology,1977,20,10-26 health professionals serve as catalysts to tions In Strong, W (Ed ),Atherosclerosis Its "Blackburn, H Coronary disease prevention. New York Grune and Stratton, Practice' approaches to risk factor changesAd- promote changes in life-style. pediatric aspects 1978 vances in Cardiology',1977,20. 1-9 2°Fox, S M, Naughton, J P,& Haskell, W L "Dock, W Atherosclerosis Why do we pretend Physical activity and the prevention of coronary the pathogenesis is mysterious')Circ ulation,1974, Bibliography heartdisease Annals of Clinical Research,1971. 50,747-749. 3, 404-432 "Haggerty, R J Changing life-styles to improve 'Thomas, E MThe harmless peopleNew York 2sFroelicher, V F , & Oberman, A Analysis of healthPreventive Medicine,1977,6,276-289 Vintage Books, 1959 epidemiologic studies of physical inactivity as a M S PreventionAmerican Journal 2Department of Health, Education, and Welfare risk factor for coronary artery diseaseProgress in of Public Health 67.353-356 The health consequences of smoking.Washing- Cardiovascular Diseases, 1972, 15, 41-65 "Holland, W W Prevention The only cure ton U S. Government Printing Office, 1975 26Leon, A S & Blackburn, H The relationship Preventive Medicine,1975, 4. 387 -389 'Department of Health, Education, and Welfare of physical activity to coronary heart disease and "Turner. R & Ball. K The cardiologist's respon- Bibliography on smoking and healthAtlanta life expectancy In Milvy, P (Ed ),The marathon sibility for preventing coronary heart disease Center for Disease Control, 1977. physiological, medical, epidemiological, and American Heart Journal.1576. 9/, 139-147 'Blair, S N What does scientific research indicate pstchologual studiesNew York Academy of "Arnold. C B& Banta. H D I- orum Social in regard to overweight9South Carolina Journal Sciences, 1977 policy for the primary prevention of illness. of Health, Physical Education and Recreation, 2'Keys, A Physical activity and the epidemiology Introduction Lessons from the past. deliberations 1972, 5, 9-11. of coronary heart disease In Bruner, D & Jokl. about thefuture Preventive Medicine,1977, 6, Department of Health, Education, and Welfare E (Eds ),Phvsical cumin and agingBaltimore 191-197 Obesity and healthWashington U S Govern- University Park Press, 1970, 250 "Carter, J Thenation's healthAddress present- ment Printing Office, 1966 2"Montoye, H JPhysical activity and health ed at the meeting of the American Public Health 6Mann, 6 V. Obesity the affluent disorder An epidemiologic studt of an entire communit Association, November 1976 Southern Medical Journal,1977,70,902-903 Englewood Cliffs, N JPrentice-Hall, 1975 '2Kennedy, E M Preventive medicine What it 'Levinson, M.L. Obesityand health Preventive 290scai, L BTherole ofexercise inweight can mean for you Family Health. January 1978, Medicine,1977,6,172-180 controlIn Wilmore, J H (Ed ),Exercise and pp 40-42, 62-64 liRabkin, S.W., Mathewson, F.A.L & Hsu, sport sciences reviews,(VolI)New York "Gellman, D I) & Lachaine, R. 1-ay., M M P.H. Relation of body weight to development of Academic Press, 1973, 103 The Canadian approach to health policies and ischemic heart disease in a .ohort of young North 'flKraus, H & Raab, WHipokinetic disease programsPreventive Me'hcine,1977,6, 265-275 American men after a 26-year observation period Springfield, IllCharles E Thomas, 1961 "Lalonde, M Beyond a new perspectiveAmer- The Manitoba studyAmerican Journal of "Fox, S M IIIIs exercise an antidote for ican Journal of Public Health,1977, 67, 357-360 Cardiology,1977,39, 452-458. stress. In Hendrix, G HCaston, J C Irvin, "Lalonde.M A nets perspective on the health 9Fajans, S S. (Ed.)Diabetes mellitus.Washing- C W , Jr., et al. (Eds ), Proceedings of the national ofeanadiansOttawa Trigraphic Printing, 1975 ton: U.S. Government Printing Office, 1976 conference on emotional stress and heart disease "Aring, C I) On improving the public health G.A (Ed.)Obesity inperspective.Wash- Joarnal of the South Carolina Medical Associa- Journal of the American Medical Association. ington: U S. Government Printing Office, 1973 tion,1976,72,1-6. 1978, 239. 2557-2558 "Stamler, J. 'de-styles, major risk factors, "Saunders, D Williams, R , Jr., Miller, M , et s"H orn, D A model for the study of personal proof and public policyCirculation,1978,58, al. Interyention in emotional stress In Hendrix, choice health behaviorInternational Journal of 3-19. H Caston, J C Irwin, C W Jr et al (Eds.), Health Education,1976, /9, 3-12 12 20 siBeiner. K.J The influence of health education oNational Heart, Lung and Blood Institute "Enlow, A H ,& Henderson, J B (Eds ) Apply- on the use of alcohol and tobacco in adolescence. Fifth report of the national heart, lung, and blood mg behavioral science to cardiovascular risks Preventive Medicine, 1975, 4, 252-257 advisory council,1977 (DHEW No (NIH) New York American Heart Assocition, 1975 Stern, M.P., Farquhar, J.W., Maccoby, N. et 78-1418 ) 75Shewchuck, L A Smoking cessation programs al. Results of a two-year ttealth education cam- 66Becker, M H (Ed ), The health belief model of the American Health Foundation Preventive paign on dietary behavior The Stanford three- and personal health behavior Thorofare, N J Medicine, 1976, 5, 454-474 community study. Circulawn, 1976,54, 876-833 Charles B. Slack, 1974 '6Zifferblatt, S M , & Wilbur, C S. Maintaining 60Maccoby, N., Farquhar, J W., Wood, P D , et oBecker, M. H , Maiman, 1 .A., Kirscht, J P , et a healthy heart Guidelines for a feasible goal al. Reducing the risk of cardiovascular disease. al The health belief model and prediction of Preventive Medicine, 1977, 6, 514-525 Effects of a community-based campaign on knowl- dietary compliance A field expenment Journal "Kaplun-Le Meitour, A , & Erben, R (Eds ), edge and behavior. Journal of Community Health, of Health and Social Behavior, 1977, 18, 348-366 Nutrition and physical activity The role of health 1977, 3, 100-114. " Becker, M H , Nathanson, C A , Drachman, education Cologne The German Federal Centre eilSurgeon General of the United States. Smoking R H., et al Mothers' health beliefs and children's for Health Education, 1976 and health. Report of the Advisory Committee to clinic visits. A prospective study Journal of '8Weiss, S M (Ed) ) Proceedings of the National the Surgeon General of the Public Health Service Community Health, I977, 3, 125-135 Heart and Lung Institute working conference on Washington: U.S. Government Pnnting Office, 69 Burt, J J Rational selection of life-style com- health behavior Washington U S Government 1964. ponents School Health Review, 1974. 5, 4-9 Printing Office, 1976 6 2Department of Health, Education, and Wel- ' °Department of Health, Education, and Welfare '9Green, L, & Perrin, D Summary of discus- fare. Adutt use of tobacco 1975. Washington The smoking digest. Washington U S Govern- mons a nd recommendation related to diffusion of U.S. Government Pnnting Office, 1976 ment Printing Office, 1977. nutrition innovations and use of educational 63Hypertensam Detection and Follow-up Pro- '' The nation's health. Washington Amencan technologyIn Tillotson, J I.(coordinator), gram Cooperative Group. Bloodpressure studies Public Health Association, February 1978, p 1 Proceedings of the nutritionbehavioral research in14 communities Journal of the American "Department of Health, Education, and Welfare conference Washington U S Government Print- Medical Association, 1977, 237, 2385-2391 The smoking digest Washington. U S GoA ern- tog Office, 1976 6Berkson, D M , Brown, M C , Stanton, H , et ment Printing Office, 1977 al. The cui rent status of hypertension detection "Martin, G , & Pear, J Behavior modification and treatment in Chicago Circulation, 1977, 56, What it is and hori to do itEnglewood Cliffs, 170 N JPrentice-Hall, 1978

21

13 Fitness and Health

Objectives for the Nation Physical Fitness and Exercise

Jack H. Wilmore

n 1979, the first Surgeon General" People. First drafts were developed by IReport on Health Promotion and the 167 experts invited to attend this Disease Prevention, Healthy People, conference. Subsequently, more than was issued. In that report, gains in 500 individuals and organizations health of the American people were from both the private and gov- chronicled over the previous century, ernmental sectors worked for over a existing preventable threats to health year to refine the original drafts. An were identified and reviewed, and fif- invitation for public comment was Health benefits teen priority areas were selected in published in the Federal Register, and which further health gains could be drafts were widely circulated to associated with regular expected over the decade with appro- people and agencies concerned with priate ..ction. The priority areas iden- the specific priority areas. Final revi- physical fitness and tified included: high blood pressure sions were made in the spring of 1980, exercise have not yet control; family planning; pregnancy and the final report, Promoting and infant health; immunization; sex- Health /Preventing Disease: Objec- been fully defined. Yet ually transmitted disease control; tives for the Nation, was published in based on what is now toxic agent control; occupational the fall of 1980. safety and health; accident prevention The purpose of this article is to known it appears Mat and injury control; fluoridation and summarize the essence of the report dental health; surveillance and con- and final draft of the Work Group on substantial direct and trol of infectious diseases; smoking Physical Fitness and Exercise. This indirect physical and and health; control of the misuse of report, like each of the other 14 pre- alcohol and drugs; nutrition; control vention areas, was presented in a emotional benefits are of stress and violent behavior; and stam'ard format which included: possible. It remains physical fitness and exercise. Broad the nature and extent of the prob- national goals were established for the lem, including health implications, that most Americans improvement of the health of Ameri- status and trends cans at the five major life stages: in- prevention/promotion measures il- do not engage in fancy, childhood, adolescence and lustrative of approaches in educa- young adulthood, adulthood, and tion and information, services, appropriate physical older adulthood. technology, legislation and regula- activity, either during On June 13 and 14, 1979, the De- tion, and economic incentives, fol- lowed by observations on the rela, recreation or in their partment of Health, Education, and tive strength of these measures Welfare (now the Department of specific national objectives for. work. The objectives for Health and Human Services) spon- improved hcalth status, reduced sored a working conference in At- risk factors, improved public/ the nation speak for lanta, Georgia, to define specific and professional awareness, improved quantifiable objectives necessary for services/protection, and improved physical education the attainment of the broad goals out- surveillance/evaluation professionals. We have lined in the previous report, Healthy the principal assumptions that underlie the framing of the objec- a job to donow. Jack H. Wilmore is a professor in the tives Department of Physical Education, the data necessary for tracking University of Arizona, Tucson, AZ progress. 85721. He served as chairperson of the With 12 members in each working work group on Physical Fitness and group, and a number of observers tak- Exercise for the Objectives for the ing an active role in the initial deliber- Nation report. ations, consensus was not always 14 22 Only about a third of children and adolescentsages 10 to 17 are estimated to participate in daily school physical education programs, and the share is declining.

Only 2.5% of companies and institutions withmore than 500 employees offer fitnessprograms for their workers.

achieved on each issue. The final doc- not routinely prescribed for the have an active exercise component; ument represents considerable com- treatment of these conditions. and tailoring education programs to promise on the part of individual par- Status and trends the needs and characteristics of spe- ticipants, but is one with which most Though physical fitness and exer- cific populations. or all of them feel reasonably com- cise activities have increased in re- Service measures include: provid- fortable. Che following summary is cent yearsand over 50% of adults ing physical fitness and exercise pro- taken from the original report. reported regular exercise in popu- grams to school children, and ensur- lar opinion pollsgenerous esti- ing that those programs emphasize ac- Nature and Extent of the Problem mates place the proportion of regu- tivities for all children rather than just larly exercising adults ages 18 to 65 The health benefits associated with at something over 35%. competitive sports for relatively few; regular physical fitness and exercise Regular runners include approxi- providing physical fitness and exercise have not yet been fully defined. Based mately 5% of all Americans over programs in colleges; providing on what is now known it appears that age 20, and 10% of men aged 20 to worksite-based fitness programs; and substantial physical and emoticnal 44. incorporating exercise and fitness benefits, direct and indirect, are pos- About 36% of adults ages 65 and protocols as regular clinical tools of sible. Yet most Americans do not en- older were estimated in 1975 to health providers. gage in appropriate physical activity, take regular walks. Technologic measures include: in- either during recreation or in the Only about a third of children and creasing the availability of existing course of their work. For the purposes adolescents ages 10 to 17 are esti- facilities and promoting the develop- mated to participate in daily school ment of new facilities by public, pri- of this discussion, "appropriate physi- physical education programs, and cal activity" refers to exercise which the share is declining. vate and corporate entities; and up- involves large muscle groups in Many high school programs focus grading existing facilities, especially in dynamic movement for periods of 20 on competitive sports that involve a inner city neighborhoods, and involv- minutes or longer, three or more days relatively small proportion of stu- ing the population to u; served at all per week, and which is performed at dents. levels of planning. an intensity requiring 60% or greater Though growing, the awareness of of an individual's cardiorespiratory the health benefits of regular exer- Legislative and Economic Measures capacity. Exercise to improve flexibil- cise is limited. ity and muscular strength may reduce Only a small proportion (about Legislative and regulatory mea- 2 5%) of companies and institu- the frequency of musculoskeletal tions with greater than 500 em- sures include: city council support for problems and is an important supple ployees offer fitness programs for bicycle and walking paths for use in ment to cardiovascular conditioning their workers. trips to work and school; developing raitivities. Certain groups demonstrate dis- and operating local, state and national Health Implications proportionately low rates of par- park facilities which can be used for ticipation in appropriate physical physical fitness activities in urban Most people feel better when they activity, including girls and women, areas; increasing the number of exercise older people, physically and men- school-mandated physical education Physical inactivity can result in de- tally handicapped people of all creased physical working capacity programs that focus on health-related ages, inner city and rural residents, physical fitness; establishing state and at all ages, with concomitant de- people of low socioeconomic status creases in physiologic function and and residents of institutions. local councils on health promotion health status. and physical fitness; and allowing ex- Physical inactivity is associated with penditure of funds of fitness-related an increased risk of developing Prevention/Promotion Measures activities under Federally funded pro- obesity and its disease correlates. Education and information mea- grams guided by federal regulations. Physical inactivity is associated with sures include: using television and Economic measures include: tax in- increased risk of coronary heart radio public service announcements centives for the private sector to offer disease. t ( ', provide information on appropri- physical fitness programs for em- Appropriate physical activity may ate physical activity and its benefits; ployees; erzouraging employers to be a valuable tool in therapeutic providing information in school and regimens for control and ameliora- permit employees to exercise on com- tion (rehabilitation) of obesity, college-based programs; providing in- pany time and/or giving employees coronary heart disease, hyperten- formation in health care delivery sys- flexible time fot use of facilities; and sion, diabetes, musculoskeletal tems; adopting an exercise compo- offering health and life insurance problems, respiratory diseases, nent by community service agencies; policies with reduced premiums for stress and depression/anxiety. Such assuring that all programs and mate- those who participate in regular vig- physical activity, however, is still rials related to diet and weight loss orous physical activity.

1 5 2 3 Professionals must make a personal Lommitment. How can we be effective in promoting health and fitness if our bodies are not living testimonies of our commitment? What we are L.ommunicates more than what we say!

Specific Objectives for 1990 be greater than 25%, compared to Our Challenge approximately 2.5% in 1979. Improved Health Status The objectives for 1990 have ,_een Improved Surveillance /Evaluation clearly defined. Can we meet the chal- Increased levels of physical fitness Systems may contribute to reduced heart lenge? Many states have already and lung disease rates, possibly re- By 1990, a methodology for sys- made substantial progress toward ac- duced injuries among the elderly, tematically assessing the physical complishing some of these objectives, and more broadly an enhanced fitness of children should be estab- but many others are far behind. The sense of well-being which may rein- lished, with at least 70% participa- American Alliance for Health, Physi- force positive health behaviors in tion in such an assessment. cal Education, Recreation and Dance other areas. By 1990, data should be available with which to evaluate the short and can and will provide the leadership at long-term health effects of partici- the top, but success in meeting these Reduced Risk Factors pation in programs of appropriate objectives depends primarily on the By 1990, the proportion of children physical activity. willingness of the membership to get and adolescents participating regu- By 1990, data should be available involved. larly in appropriate physical ac- to evaluate the effects of participa- tivities, particularly cardiorespira- tion in programs of physical fitness Where does one start? First and tory fitness programs which can be on job performance and health care foremost, each of us in the profession carried into adulthood, should be costs. must make a personal commitment to greater than 90%. By 1990, data should be available achieve or maintain a good level of By 1990, the proportion of children for regular monitoring of national physical fitness. How can we be effec- and adolescents participating in trends and patterns of participation tive in promoting health and fitness if daily school physical education in physical activity, including par- our bodies are not living testimonies programs should be greater than ticipation in public recreation pro- of our commitment? What we are 60%, compared to 33% in 1974- grams in community facilities. communicates so much more than 1975. what we say! By 1990, the proportion of adults 18 to 65 participating regularly in Prin-ipal kssumptions In addition to achieving optimal vigorous physical exercise should health status as individuals, we must be greater than 60%, compared to In formulating these objectives, a join the national effort to reach the an estimated 35% in 1978. set of principal assumptions was articulated goals for 1990. We must By 1990, 50% of adults 65 years adopted. It was assumed that in- be dedicated to helping others, from and older should be engaging in ap- creased physical activity by the Amer- propriate physical activity such as the cradle to the grave, to understand ican public will result in overall im- that good health is more choice than regular walking, swimming, or provements in health, and that a per- other aerobic activity, compared to chance. We are obliged as profession- and estimated 36% taking walks in sonal commitment to enhance health als to ensure a proper foundation of 1975. will become a prominent fat tor pro- knowledge on which to make this moting increased participation; that choice, and a variety of opportunities Increased Public /Professional voluntary agencies, private corpo- for participation in health-promoting Awareness rations and government will expand activity for those we teach. By 1990, Cite proportion of adults their commitment to physical fitness who can accurately identify the programs, and private industry and variety and duration of exercise retailers will support activities pro- thought to most effectively pro- moting physical fitness; that there will mote cardiorespiratory fitness be a reversal of the trend in reductions should be greater than 70%. of school-based programs aimed at By 1990, the proportion of primary promoting physical fitness, but that Note care physicians who include a care- such programs will not necessarily be ful exercise history as part of their founded in the traditional physical Sections of this article are adapted fromPro- initial examination of new patients moting Health /Preventing Disease Objectives shovkl be greater than 50%. education mold, and that new for the Nation,published in 1980 by the U S. school-based programs will embrace Government Printing Office Orders for the Improved Services/Protection activities which expand beyond com- book should be sent to the Superintendent of petitive sports. Finally, the increasing Documents, Government Printing Office, By 1990, the proportion of em- Washington DC 20402. Orders should include ployees of companies and insti- costs associated with health care will return address, check or money order for $5 00. tutions with more than 500 compel public policy to emphasize titleof thebook and itsstocknumber 017- employees offering employer- measures such as physical fitness to 001-00435-9. $6.25 should be included for or- sponsored fitness programs should enhance health. ders made from outside the U. S. 16 24 Definition of Health Related Physical Fitness and Exercise

25 A New PhysicalFitness Test

Steven N. Blair, PED .arold B. Falls, PhD Russell R. Pate, PhD Photos courtesy 4 Department 4 Physical Education, University 4South Carolina In brief: In 1980 Me American Alliancefor Health, Physical Education, Recreation and Dance (AAHPERD) developed a new fitness fast to emphasize health- related physical fitness instead of motor/athletic fitness. The new test measures cardiorespiratory fitness, body composition, and low-back and hamstring strength and flexibility. These components can be measured in the field, reflect changes in exercise habits, and are related to some aspect of health.

The preceding article has traced the historical development of physical fitness testing.' By the mid-1970s many members of the American Low-back/hamstring flexibility is judged by the sit-and-reachtest. The Alliance for Health, Physical Education and students alt with legs extended and stretch forwardas far as possible Recreation (AAHPER) became convinced that the existing fitness test emphasison motor/ athletic fitness was inappropriate. In 1975 a joint committee was formed from within AAHPER's Association for Research, Administration, and Professional Councils and Societies (ARAPCS) to study the need for revisions in the AAHPER Youth Fitness Test. Three ARAPCS councils wererepre- sented: Measurement and Evaluation, Physi- cal Fitness, and Research. The committee was chaired by A. S. Jackson of the Univer- sity of Houston. The committee held working conferences, solicited professional input via continued

Dr. Blair is a professor of public health and Dr. Pate is an associate professor of physical education at the Univer- sity of South Carolina in Columbia. Dr. Falls is a professor of health and physical education at Southwest Missouri State University in Springfield. They are fellows of the American College of Sports Medicine.

19 26 .11111MINEe

Strength and endurance of the abdominal musculature e s thitermMod by the number of 1W4d-lume sit-ups performed In one minute. Arms ere crossed on the chest with hands on the opposite shoulders.

AAHPER publications, and presented a con-Falls as chair of a task force on youth fitness vention program. Its work culminated in thethat was to implement the recommendations publication of a position paper on the fitnessof the position paper and develop a new test revision. The paper stated that it was timehealth-related physical fitness test. The task to differentiate physical fitness related toforce held several working conferences and health from motor performance related toagain solicited input from AAHPER athletic ability.' The committee decided thatmembers. The Board of Governors gave this new health.ated physical fitness testfinal approval of the new test in November should include the following criteria: 1979, and a test manual was published soon 1. Mean 7e the spectrum of abilities fromafter.' severely limited dysfunction to high levels of A technical manual that will include the functional capacity. scientific basis for the various test items will 2. Measure capacities that respond to ap-also be published. A detailed rationale for propriate physical training programs. each item will be presented along with infor- 3. Accurately reflect an individual's Wei-mation on reliability and validity, details of cal fitness status as well as changes in fu. the norming procedures, and descriptive sta- tional capacity by corresponding test scorestistics associated with the test items. The task and changes in the scores. force felt quite strongly that completion of The position paper with the above recom- the technical manua: was an important mendations was forwarded to the AAH PERaspect of its work. It represents a milestone Board of Governors. In 1977 LeRoy Walker,as far as test publication by AAHPERD is AAHPER president, appointed Harold B. concerned. It is the first attempt to provide this type of information to users of an AAHPERD test. It should also provide a base and .timulus for much needed addi- tional research on health-related physical fitness.

The Health-Related Physical Fitness Test Components of health - related fitness that meet the criteria established by the AAHPER committee are cardiorespiratory fitness, body composition, and low-back and hamstring strength and flexibility. These components can be assessed in the field, reflect changes in exercise habits, and are related to some aspect of health. Other fit- ness or motor perform= components that met some but not all of these criteria were not included. For example, the task force had lengthy debates on whether an upper extremity test of strength and endurance should be included. This quality is certainly important for some sports and other leisure- time activities as well as some occupational tasks. Therefore, activities to develop strength and endurance of the upper extrem- ities and tests to assess programs are appro- le priate for physical education curriculums. However, arm strength and endurance can- not be related to health status in any very direct way, so the health-related physical fit- ness test does not include items such as push- ups or pull-ups. Variables such as nutritional status ate obviously important to health status, out are not subject to improvement by Triceps and subecapular sklnfolds were included in the test battery physical activity and also were not included. because these sites are relatively accessible and easy to obtain. Cardiorspiratory Fitness. This compo- nent of health-related fitness has received a Frew deal of emphasis, and many physicalfor one's exercise habits (although we recog- litness tests over the past several decadesnize the confounding effects of genetic have attempted to assess cardiorespiratoryfacto, 3). function. Although cardiorespiratory fitness High levels of cardiorespiratory function does not directly affect such variables asindicate a high physical work capacity coronary heart disease risk factors,itis (PWC)the ability to release relatively large clearly associated with them.' A high level ofamounts of energy over an extended time. A cardiorespiratory function does not cause ahigh PWC has numerous advantages for more favorable lipoprotein profile; regular,leisure and occupational pursuits.' There is dynamic, vigorous, large-muscle physicalample evidence that cardiorespiratory func- activity causes changes in both cardiorespira- tion responds to training° and that it can be tory function and lipoprotein profile. Thus,validly assessed by field techniques.' cardiorespiratory function is a good marker A distance run is used in the health-related

21 28 OW contra Jed Triceps andfitness battery to assess cardiorespiratorytesting. There has beer, some question subscapularfunction. Extensive experience with this itemwhether body composition can be assessed in skinfoldshas shown it to be administratively feasiblethe field on a mass basis by relatively un- correlate highlyin a variety of settings." A teacher may electtrained testers. Reliability and validity stud- with totalto use a 1-mile run for time or a run in whichies using skinfold measurements to assess body fat.students are instructed to run as far as theybody composition convinced the task force can in nine minutes. Students 13 years of agethat field assessment was feasible." The task and older may use a 1.5-mile run for time orforce believed that measurement difficulties a 12-minute run for distance. Students arenotwithstanding, itis important to assess allowed to walk in all of these distance runbody composition because of the measure- tests, but they are encouraged to do theirraent's relation to the operational defmitior best. Students with medical problems thatof fitness. It lets students know what we contraindicate vigorous exercise are notthink 's important. Concern over the cost of allowed to participate in these running tests.skinfold calipers was alleviated by studies Furthermore, it is recommended that stu-showing high validity and reliability of inex- dents be given some instruction and practicepensive new tnoe :Is. in distance running before testing: Teachers Triceps and subscapular skinfolds were are encouraged to include appropriateselected for inclusion in the test battery. warm-u7, and cool-down activities beforeThese sites are relatively accessible, and skin- and after the test. Specific details of testfold measua .:ments easy to obtain. They also procedures are thoroughly described in thecorrelate highly with total body fat. In addi- test manual." Suggestions for administeringtion, national norms are available from the the test on a regulation track, 100-meterHealth and Nutrition Examination Survey?' straightaway, or playing field are given in theSpecific procedures for measuring these skin- manual folds are in the test manual.' Teachers who Body Composition. Body composition isare inexperienced in taking skinfold mea- defined as the relative percentage of fat andsurements are encouraged to practice and fat-free body mass. Excessive body fat is aobtain a consistent reproducibility of mea- health hazard and has been implicated assurement of 1 to 2 mm or less. contributing to a variety of conditions in- Musadoskdetal Function. One aspect of cluding hypertension, hyperlipoproteinemia,strength, endurance, and flexibility that can and accident proneness." While all thebe related to health involves the lower back/ mechanisms of how excess fat causes theseposterior thigh area. Low back pain is a rela- problems have not been completely ex-tively common malady that causes much plained, few health authorities would arguedisability." Clinical evidence implicates lack with the statement, "It is better to be lean,f flexibility in the lower back/ hamstring than to be fat." muscle groups combined with relatively Body composition is a function of caloricweak muscles of the abdominal wall as the balance, and although the emphasis has tra-cause of a majority of low back pain cases. ditionally been on the caloric input side ofPhysical therapists haw: long known that the equation, we are now increasingly awaremost people with these problems can have of the importance of energy output in regu-the condition corrected with appropriate lating body weight.'" Short-term experi-exercises. Recent exper:ence with the Y's mental trials" and large-scale communityWay to a Healthy Back program suggests a studies" show that vigorous physical activitypreventive role of exercise as well "" helps to reduce body fat. Assessment of these fitness components in Body composition not only is importantthe field is relatively easy. Strength and en- to health and influenced by exercise, but it isdurance of the abdominal musculature is also a massive public health problem," anddetermined by the number of flexed-knee sit- thus deserves increased attention in fitnessups performed in one minute. For this test,

22 29 students lie on their backs with the knees flexed, feet on the floor, and heels 12 to 18 in. from the buttocks. Arms are crossed on the chest with hands on the opposite shoul- ders (this prevents using the arms to gain momentum and help lift the trunk from the floor). The feet are held down by another student. The sit-up is executed by curling the trunk (chin tucked on the chest) and raising to an upright position. It is completed Wien .01 the elbows touch the thighs. The sit-up test is scored as the number of correctly performed sit-ups in one minute. As with all fitness test items, reliability and validity can be im- proved with prior instruction and practice. More detailed instructions are given in the manual.' Low-back/ hamstring flexibility Ls judged by the sit-and-reach test, in which a person

stretches his or her hands as far forward as Cardicresplratory function Is assessed bye distance run. Teachers may possible toward or past the toes while in a elect to use a 1-mile run for time or a nine-minute run for distance. sitting position. The test is administered with an easily constructed plywood cube with 30- cm (12-in.) sides. The top side is extended 23 ment of standards for fitness tests have been cm (9 in.) past the ,edge of the cube and isused. The traditional approach has involved marked in centimeters. The student sits onmeasurement of a large number of individu- the floor with legs completely extended andals and calculation of percentiles for each test with the feet touching the front edge of theitem. Such norm .tferenced standards per- cube. The 23-cm (9-in.) top overhang extendsmit comparison of any individual's scores towards the student. The student's hands arewith the norms. This technique is conceptu- placed one on top of the other on this cen-ally logical for athletic fitness tests in which timeter scale. The objective of the test is towe might conclude that "faster is always bet- stretch forward as far as possible and holdter." However, the practical significance of for one second. The legs must be keptpercentile norms is less clear when applied to extended (another student can place a handa test of health fitness. Suppose, for exam- on the subject's knees to hold them down).ple, that the population as a whole is Suite fit The sit-and-reach score is easily obtained byaccording to some criterion. That is, the reading from the centimeter scale. Studentsentire distribution is shifted to the right. In should be given instruction in the test proce- such a case an individual might score at the dure and allowed to warm up befoj e testing. 15th percentile and yet still possess an ade- A complete description of the Jesting boxquate amount of the characteristic being and more detailed instructions for aaminis- evaluated. Conversely, if the normative pop- tration are given in the manual.' ulation was quite unfit, a score at the 90th percentile might still not be adequate in Test Standards terms of health status. Norm-Referenced Standards. Establish- Criterion-Referenced Standards. This ment of standards for a fitness test raises aproblem has led some measurement experts difficult issue, particularly when the test pur-to recommend establishment of criterion- ports to measure health fitness as opposed toreferenced standards.'" Developing criteri- athletic fitness. Two approaches to develop-on-referenced standards requires the use of

23 30

4 testcontinued expert judgment to establish an "acceptable"pand in the future to allow development of and a "good" standard for each test item.true criterion-referenced standards. With tests of health fitness this approach is philosophically attractive because the desiredUses of the New Test goal is good health, not maximal perfor- The educational significance of a nation- mance. However, there are practical prob-ally promoted physical fitness test cannot be lems associated with establishment of crite-overemphasized. Advertising reaches a large rion-referenced standards for health-fitnessproportion of the physical education instruc- test items in children. Because many of thetors in this country as well as many in other health problems related to low fitness do notparts of the world. Physical education pro- manifest themselves until middle or latefessionals are responsible for promoting as 'thood, we need to know the level of fit-overall health and wellness, and physical fit- ne.), .n children that is associated with min-ness is an important aspect of that. The tests imal health risks in adulthood. Such knowl-we use and promote should measure com- edge is not presently available. ponents of health-related fitness identified as Confronted with this dilemma, the taskimportant by professional consensus. By force adopted a compromise. First, percen-doing so, we can show our youth that health- tile norms were developed by testing 12,000related physical fitness contributes to quality children from ages 5 to 17 in 13 states. Tests,living for everyone in our society. Because they measure athletic ability, most For related articles, of the items on the Youth Fitness Test have see pages 19 and 77. an ;nherent element of competitiveness. The studeot compares his or het performance excepting the skinfolds, were administered inwith others, and the test result often becomes a standardized manner by volunteer physicalan end initself. On the other hand, the education teachers. Percentile norms for theemphasis of the Health-Related Physical Fit- skinfold tests were obtained from the Na-ness Test is toward achieving an optimum tional Health Examination Survey.m The testscore that represents positive health status. manual contains age- (5 to 17 years) and sex-The test is thus a means to an end. To foster specific percentile norms for each item. this, the task force has provided a chapter in In an effort to address the need forthe manual titled "Guidelines for Physical criterion-referenced standards, recommenda-Fitness Maintenance and Development. " '.r. tions for interpretation of test results haveit the teacher and student are provided aid in been included in the test manual. Key recom-using the test results for improvement on mendations are: each component assessed. The student is 1. The 25th percentile in each test is con-encouraged to improve and/ or maintain his siuered the minimal acceptable score, andor her health and learn the important com- children ranking below this level should beponents of health-related fitness.In this provided with remedial training. regard, the test and its use have exceptional 2. The 50th percentile is achievable bycarry-over value into adult life because it is most children with proper conditioning, andthose same components with which the stu- it is recommended that all children strive to dents will want to be concerned as they grow attain at least this level on all test items. older. Although these guidelines are based on The new health-related test also can be percentiles and do not constitute criterion- useful for physicians and other medical prac- referenced standards in the pure sense, antitioners. As primary prevention of disease effort had been made to apply "expert judg-becomes a more powerful focus of the medi- ment" to the interpretation of the test scores. cal community, inexpensive screening proce- We hope that our knowledge base will ex-dures for low-risk patients will be in demand.

24 31 Tests such as the health-related fitness test related rather than motor performance items. could be administeredinthe traditionalThis new trend seems consistent with recent school environment with results being re-research on the effects of exercise on health ferred on to the child's personal physician. and alsc with the current trend of participa- Mediral groups are coming to recognize thattion in aerobic exercise by millions of Amer- physical fitness is a key component of a per-icans. Broad implementation of the test and son's overall health profile. Thus it seemsfurther diffusion of the health-related fitness likely that tests of health fitness will comeconcepts needs to be continued. A consor- into wider use in the clinical setting in the tium of exercise physiologists, physical edu- future. cators, physicians, and other health profes- sionals can help achieve acceptance. Summary Address correspondence to Steven N. Blair. PhD. Dept of A new phase of physical fitness testing is Physical Education. University of South Carolina. Columbia under way. Emphasis is now given to health- 29208

References I Pate RR: A new definition of youth fitness Phys 2723-2733, 1979 Sportsmed 11(April):77-83. 1983 14. Wooley SC, Wooley OW, Dyrenforth SR: Theo- 2. Plowman SA, Falls HB: AAH PER youth fitness retical, practical, and social issues in behavioral test revision: JOPER 49(November-December): treatments of obesity. J Appl Behav Anal 12 22-24, 1980 (Spring):3-15, 1979 3. American Alliance for Health, Physical Educa- 15. Epstein LH, Wing RR: Aerobic exercise and tion, Recreation and Dance: AAHPERD Health weight. Addict Behav 5(4):371-388, 1980 Related Physical Fitness Test Manual. Washing- 16. Blair SN, Blair A, Pate RR, et al: Interactions ton, DC, AAHPERD, 1980 among dietary pattern, physical activity and skin- 4.Cooper KH, Pollock ML, Martin RP, et al: fold thickness. Res Q Exerc Sport 52(December): Physical fitness levels vs selected coronary risk 505-511, 1981 factors: a cross-sectional study. JAMA 236(Jul 17. Montoye HJ: Physical Activity and Health: An 12): 166-169, 1976 Epidemiological Study of an F fire Community. 5. Haskell WL, Blair SN: The physical activity Englewood Cliffs, NJ, Prentice-Hall Inc, 1975 component of health promotion in occupational 18. Hannon BM, Lohman TG: The energy cost of settings. Public Health Rep 95(March-April):109- overweight in the United States. Am J Public 118, 1980 Health 68(August):765-767, 1978 6. Pollock ML: How much exercise is enough? Phys 19. Pollock ML, Schmidt DH, Jackson AS: Mea- Sportsmed 6(June):50-64, 1978 surement of cardio-respiratory fitness and body 7. Cooper KH: Aerobics. New York City, Bantam composition in the clinical setting. Compr Ther Books Inc, 1976 6(September):12-27, 1980 8.South Carolina Dept of Health and Environmen- 20.US National Center for Health Statistics: Skin- tal Control: South Carolina Physical Fitness Test fold thickness of youths l'z-17 years (Vital and Manual. Columbia, SCDHEC, 1978 Health Statistics, Series 11, No. 132). Washing- 9.Manitoba Dept of Education: Manitoba Physical ton, DC, Government Printing Office, 1974 Fitness Performance Test Manual and Fitness 21.Belkin SC, Quigley TB: Finding the cause of low Objectives. Winnipeg, MOE, 1977 back pain. Med Times 105(July):59.63, 1977 10.Texas Governor'., Commission on Physical Fit- 22.Kraus H: The Y's way to a healthy back. JOPER ness: Physical Fitness Motor Ability Test. Austin, 73(J uly-August): 190-191, 1976 TGCPF, 1973 23.Golding L, Meyers C, Sinning W (eds): The Y's 1 I. Blue Cross and Blue Shield of Delaware: First Way to Physical Fitness, rev ed. Chicago. Na- State Physical Fitness Test. Newark, DE, tional Board of YMCA, 1982 BCBSD, 1980 24.Baumgartner TA. Jackson AS: Measurement for 12. Wiley JA, Comacho TC: I. ife-style and future Evaluation in Physical Education. Boston, health: evidence from the Alameda County study. Houghton Mifflin Co. 1975 Prev Med 9(January):I-21, 1980 25.Safrit JF: Evaluation in Physical Education, ed 2 13. Van Willie Tr!: Obesity: adverse effects on health Englewood Cliffs, NJ, Prentice-Hall Inc. 1973 end longevity. Am J Clin Nutr 32(December):

25 32

Health Related Physical Fitness in 1980 the American Alliance inau- departure from the fitness testing easy to administer. However, in- 1gurated a Health Related Physical practices and philosophies that have terpretation of distance run test re- Fitness Test (HRPFT). The new test prevailed over the past thirty years. sults is not always a straightforward battery was designed to evaluate Philosophically the HRPFT reflects a matter. Kirk Cureton's discussion of those physical fitness components as- heightened appreciation of the con- these tests provides guidance regard- sociated with prevention of disease tribution regular exercise can make to ing their interpretation and research and promotion of physical health. The maintenance of good health. This concerning their validity as measures fitness components selected for eval- philosophical shift has been spurred of cardiorespiratory capacity. uation were cardiorespiratory endur- by the rapid expansion of the body of One of the most novel components ance, body composition and neuro- knowledge linking physical fitness to of the Alliance HRPFT is the skinfold muscular function of the lower trunk disease prevention. The new test, in test. While skinfold measures have (muscular strength/endurance and focusing exclusively on health related been used for many years in research flexibility). The designated test items fitness components, does not purport and in assessing body composition in are as follows: to measure "overall fitness" or "ath- adults, only recently have they be- letic fitness." Its philosophical base, come widely used with children. The Cardiorespiratory One mile run therefore, is substantially different HRPFT Manual provides percentile endurance Or from that of many previously estab- norms for skinfold measures but does Nine minute run lished physical fitness tests. not provide norms for percentage of Body compose- Sum of triceps On a practical level the HRPFT body fat. T.G. Lohman explains why tion and subscapular prescribes the use of several test items this approach was adopted and discus- skinfolds that have not been included in tradi- ses our current knowledge of body Neuromuscular tional fitness test batteries. For exam- composition assessment in children. function of ple, the new test recommenes dis- The HRPFT is a state-of-the-art lower trunk tance runs which are longer than those field measure of health fitness. Re- Abdominal One minute sit-up used in traditional tests and employs search may never settle all the debates muscle skinfold measures to assess body and answer all the questions raised by strength and endurance composition. adoption of the HRPFT. However, it Tests of distance running ability can lead to the development of im- Lower back/ham- Sit-and-reach have come into common usage over proved fitness tests and to the better string flexibil- ity the past ten years. Such tests have use of existing tests. proved to be acceptably valid predic- Russell R. Pate, The Alliance Health Related Phys- tors of maximal oxygen consumption Editor ical Fitness Test represents a marked (weight relative) and are relatively

29 34 Distance Running Performance Tests in Oilldren What Do They Mean?

Kirk J. Cureton

Distance running performance tests min- as the acceptable criterion of are widely used as part of a battery cardiorespiratory capacity. In addition of test items to evaluate the physical to reflecting cardiorespiratory capacity, fitness of children. The American Al- this measure is also related to the de- liance Youth Fitness Test, the Ameri- gree of body fatness (% fat) 6.7" Be- can Alliance Health Related Physical cause % fat negatively affects both VO2 Fitness Test, the Texas Physical Fit- max (mlkg BW-'nun-') and dis- ness/Motor Ability Test, and the South tance running performance,28 correla- Carolina Physical Fitness Test, for tions (validity coefficients) between example, all include a running test GI VO2 max (mlkg BW-'min-') and 600 yards to 1.5 miles in distance or 9 to distance running performance reflect, 12 minutes in duration. The purpose of in part, the negative influence of % fat these tests is to evaluate "endurance" or on both measures. 11::.;kirk and Taylor' "cardiorespiratory capacity or endur- concluded many years ago that VO2 ance." The use of distarce running per- max expressed relative to fat-free formance tests to evaluate cardiores- weight was probably the best available piratory capacity in children has been measure of cardiorespiratory capacity, criticized because of individual differ- because it is not affected by body fat- ences in other factors relating to chil- ness. Although investigators have ac- dren, such as body fatness, running skill knowledged VO2 max (ml kg FFW-' or efficiency, motivation, and use of min-') to be the best cotenon,9 few proper pace. have used it in the validation of distance Are distance running performance running tests, assuming that VO2 max tests in children valid indicators of car- (ml kg BW-1min-') was adequate. diorespiratory capacity? This question The importance of using the appro- has been debated for years and it is not priate criterion of cardiorespiratory simple to answer. To answer it we must capacity can be seen by comparing the also ask: What is an acceptable criterion correlations of VO2 max (ml kg of cardiorespiratory capacity, and to BW-1 inin-') and VO2 max (mlkg what degree are distance pinning per- FFW-1 min-') with distance running formance and cardiorespiratory capac- performance tests. Table 1 contains ity related in typica )opulations of chil- correlations of a number of studies on dren? adults and one study on children. VO2 Most exercise physiologists agree max (mlkg FFW-' min-') correla- that the maximal oxygen uptake (VO2 tions with distance runs are consis- max) is a good overall measure of the tently lower by an average of about 2. cardiorespiratory capacity.' VO2 max in This trend is independent of the 1 min -', however, is strongly related length of the running test. The aver- to body size, especially during the years age correlation between VO2 max (ml of growth and development,` and thus is kg FFW-1 min-') and distance run- most often expressed relative to body FFW-' min-', in an attempt to adjust ning performance in these studies weight, in ml kg BW-' min-', or, for differences in body size. In studies (approximately .5) indicates that only relative to fat-free weight, in ml kg evaluating the validity of distance run- 25% of the variance in distance run- ning tests, VO2 max (ml kg BW-1 ning performance is related to cardio- Kirk Cureton is associate professor and min-') is the expression most widely respiratory capacity, whereas an av- director of the Human Performance used to measure cardiorespiratory ca- erage of almost 50% of the variance Laboratory, Department of Physical pacity.' on distance running tests is related to Education, University of Georgia, A strong case can be made, however, VO2 max (ml kg BW-1 min-'). Athens, GA 30602. against VO2 max (ml kg BW-1 Since the only difference in the two 30 VO, max expressions is the presence indicate, what do they measure? Re- Important in children, who often have or absence of fat weight (in the de- search on both children' and adults'' short attention spans and who may be nominator). variability in body fat- Indicates that the biological deter- inexperienced in distance running ness accounted for almost half of the minants of distance running perfor- It is frequently argued that while relation betweenVO, max (ml kg mance are complex. Biological vari- differences between individuals on BW 'min-1) and the distance run- ables, including cardiorespiratory ca- distance running performance tests ning performance tests in the samples pacity. body fatness, anaerobic may not reflect only cardiorespiratory cited. Basing the validity of distance threshold and running efficiency or capacity, changes in distance running running tests as measures of car- skill (and others), have significant In- performance within an individual. chorespiratory capacity on correla- dependent effects on distance running particularly Improvements associated tions with V02 max (mlkg BW -I performance The relative Impor- with endurance training, are valid in- min-1) has left the mistaken impres- tance of these factors varies depend- dicators of changes in cardiorespira- sion that the correlation between car- ing on the degree of variability of each tory capacity. This conclusion is based diorespiratory capacity and distance within the population studied. In on the fact that endurance training in running performance is stronger than groups heterogeneous in level of phys- both adults and children Improves it really is and, therefore, that the va- ical condition, body fatness, and run- cardiorespiratory capacity Although lidity of these tests is better than It ning skill, no single physiological vari- improved cardiorespiratory capacity really is. able accounts for a predominant pro- can improve distance running per- In studies that have used samples of portion of the variance in distance formance in an individual, other fac- at least 25 children or adolescents and running tests. Consequently, interpre- tors affecting distance running per- distance runs of approximately one tation of distance running test scores fol mance also change quite dra- mile or more in distance or 9 minutes should not be simple, implying that matically during the years of growth or more in duration, correlations be- they reflect only a single physiological and development. Without a control tween distance running performance attribute. as reference, it is usually impossible to and V02 max (mlkg BW-1 min-l) Based on an average correlation of distinguish growth and/or maturation have ranged from approximately .6 to approximately .7 between V02 max related changes from changes related .8,2 ' indicating that, on the aver- (mlkg BW-1min -I) and distance to physical activity. age, approximately one-half (50%) of running performance, and on studies Based on the 50th percentile values the variance on distance running tests that have used multiple regression to for the 9 minute run norms published reflects variance in V02 max (mlkg evaluate the relative importance of by the Alliance," distance runmpg BW-' m in-' ). Although limited data several of the dete. minants of dis- performance improves steadily in on the relation of V02 max (mlkg tance running performance,'" it ap- boys between the ages 5 and 17. Dis- FFW-1min-') and distance running pears that the combination of differ- tance running performance in girls performance in children are avail- ences in body fatness and cardiores- also improves over these ages, but at a able,' Table 1 suggests that only 25% piratory ca lacity may account for as slower rate after age 12. V02 max (ml or less of the variance in distance run- much as half of the variance on a dis- kg BW-'min -') in boys remains ning performance is actually related tance running performance test. Dif- constant over this period of years (af- to cardiorespiratory capacity in chil- ferences in running skill and efficiency ter age 7), whereas in girls it remains dren. This degree of association is cer- account for additional variance in constant up to age 12 and tends to tainly too low to interpret distance adults and probably in children, al- decline during adolescence.' An im- running tests as reflecting predomi- thoui:'i there is little direct informa- portant reason for the systematic in- nantly cardiorespiratory capacity. tion on this relationship in children. crease in running performance during If distance running performance Differences in the extent to which the years of growth and development tests in children do not predominantly anaerobic energy is used, in motiva- appears to be an age-related im- reflect cardiorespiratory capacity, as tion, and in the use of proper pace provement in running efficiency, the the relatively low correlations with probably contribute to performance V02 max (mlkg BW-1min -') re- V02 max (mlkg FFW-1 min-') as well. This variable is particularly quired to run at various submaximal

Table 1. ftnpmison of Completions flahmen Distance Testa and V02 max Explosmod Oaths to Body Wild and P*141mmsqM

31 3 6 speeds decreases systematically be- capacity, any more than do differ- `Baumgartner, T A and Jackson. A S Mea- tween ages 5 and 17 in both boys and ences in distance running perfor- surement for evaluation in physical education girls.' A longitudinal study by Daniels Boston. Houghton-Mifflin, 1974 mance between children. 'Buskirk. E R and Taylor. H L Maximal and Oldridge" supports this conclu- If a number of factors contribute to oxygen intake and its relation to body composi- sion. They found that improvements individual differences in distance run- tion, with special reference to chronic physical in distance running performance in 14 ning performance, and distance run- ac:".ity and obesity Journal of applied pht stol- boys, ages 10 to 15 years, over a 22- op 1957, I I , 72-78 ning tests do not reflect only car- 'Welch, B E, Reindeau, R P Crisp. C E. month period of training were associ- diorespiratory capacity, are distance and Esenstein, R S Relationship of maximal ated with a progressive improvement running tests valuable in the assess- oxygen uptake to various components of body in running efficiency. V02 max (ml ment of physical fitness in children', composition Journal of applied physiology kg BW-I min-') did not change sig- The answer to this question is an un- 1958, 12, 395-398 nificantly during the study. "Cureton, K J . Spading, P B, Evans, qualified, Yes. Distance running tests B W, Johnson, S M, Kong, U D, and Pur- Age-related changes in body fat- evaluate a unique physical ability that vis. J W Effect of experimental alterations in ness'5 and anaerobic capacity' also is an important component of many excess weight on aerobic capacity and distance occur in both boys and girls and other physical tasks. Factor analytic running performance Medwitte and sc.ence in probably contribute to age-related studies have clearly shown that dis- sports 1978. 10, 194-199 changes in distance running perfor- 'Cooper, K A means of assessing maximal tance running tests assess underlying oxygen intake Journal of the American medical mance. Both of these variables -an abilities and physiological capacities association 1968, 203, 201-204 change with training. The increase in that are different from those assessed "Jackson, A S and Coleman. A E Valida- % fat in girls that occurs following with runs of shorter duration." " tion of distance run trsts for elementary school puberty is particularly important in children Research quarterly 1975. 47. 86-94 More importantly, however, because "Krahenbuhl. G S et alField testing of explaining the progressive widening distance running tests require rela- cardiorespiratory fitness in primary school chil- of the sex difference in distance run- tively prolonged exertion, they also dren Medicine and science in sports 1978. 10, ning performance that develops dur- reflect the level of energy expenditure 208-213 ing adolescence. The increase in body that a person can sustain over an ex- "Spading, P B and Cureton, K J Biological ft- t is regarded as the primary cause of determinants in the sex difference in 12-minute tended period of time, or the physical run performance Manuscript submitted for tht decrease in V02 max (ml kg work capacity in weight-bearing exer- publication, 1982 BW-' min-') that occurs in girls dur- cise. Performance on distance running "AAHPERD Health related physugl fitness ing this period.' In equally trained tests reflects, to some extent, the ca- test manual Reston, the Alliance. 1980 young adult men and v omen, the sex "Daniels. Jand Oldridge, N Changes in pacity for performance in other oxygen consumption of young boys during difference in body fatness may ac- weight-bearing tasks requiring similar growth and running training Medicine and sci- count for as much as 70% of the sex high levels of energy expenditure. ence in sports 1971, 3, 161-165 difference in distance running per- Along side their use in evaluating one "Panzkova, J Body composition and exer- formance.'2 cise during growth and development Physical type of motor skills, this is probably activity human growth and development, the most significant meaning of such Rand, G L editor. New York. Academic tests in relation to physical fitness. Press, 1974 'Disch. J , Frankiewicz, R and Jackson. A Construct validation of distance run tests Re- References search quarterly 1975, 46, 169-1 , "Falls, H 13, Ismail, A H, and Macleod, D 'Corbin, (' B A Textbook of Motor De- F Estimation of maximal oxygen uptake from velopmentDubuque, IA. Wm C Brown, the AAHPER test items Research quarterly, 1973, p 87 1966. 37. 192-201 'Cureton, K J, Boileau, R A, Lohman, T "Katch, F Iet al Relationship between in- G , and Misncr, J E Determinants of distance It is clear that changes in distance dividual differences in a steady pace endurance running performance in children analysis of a running performance and maximal oxygen in- running performance, particularly path modelResearch quarterly 1977, 48, take Research quarterly 1973, 44, 207-215 those that occur over a period of 270-279 "Gun, E L , Olerud, JE . and Corroll, years, occur as a result of a number of 'Taylor, H L , Buskirk E R , and Henschel, J W Maximal oxygen uptake based on lean biological changes. There appears to A Maximal oxygen intake as an objective mea- body mass a meaningful measure of physical be little evidence to support the claim sure of cardiorespiraOry performance Journal fitness' Journal of applied physiology 1974, of applied physiology 1955, 8, 73-80. 36, 757-760 that changes in distance runniog per- 'Asir nd, P 0 Experimental studies of phys- "Burke, E J Validity of selected laboratory formance in a given child necessarily ical working capacity in relation to age and sex and field tests of physical working capacity Re- reflect changes in cardiorespiratory Copenhagen, Munksgaard, 1952 search quarterly, 1976, 46, 95-104

37

32 Measurement of Body Composition inChildren

T. G. Lohman

Research in recent years on obesity titioners to estimate body composition water content of 72 %, and a potassium has focused on children and the re- in children within tolerable limits of contentof 2.66 gm/kg of fat-free body. lation of childhood obesity to adult error and without extensive training. At Using thesemethodsin prepubescent obesity. Identification and treatment of present neither validlaboratory children, a mean fat content of 20% is obesity in children is believed to be an methods nor field methods have been usually found.For example, Boileau' important factor in its control during developed to estimate body composi- found a mean densityof 1.052 gm/cc for the adult years. There is a need, there- tion in children, although good strides 8 to 11 year old childrenmeasuredin fore, for the development of valid labo- have been made in this direction and Illinois and 1.056 gm/cc for 8 to 11 year ratory and field methods of estimating the prognosis for future success is olds measuredinDavis, California. body composition in children of all ages. good. Using Siri's2equation for converting density into fat content (% fat =495/ Valid laboratory methods are needed to Laboratory Methods establish standards and norms for per- density 450), wefind that these chil- cent fat in children. Practical field The most often used laboratory dren havea predicted fat content of methods are needed to enable prac- methods for body composition mea- about 20%.Mellitis and Cheek'and surement in children are those that yield Schutte4 found a water content of estimates of body density, body water about 60% in 10 to 12 yearold chil- T.G. Lohman is an associate professor content, and body potassium content. dren.This 60% water content gives a in the Department of Physical Educa- All are based on the assumption that predicted fat content of 17% in chil- tion at the University of Illinois, children are chemically mature with a dren, assuming a 72% fat-freebody Urbana-Champaign, IL 61801. fat-free body density of 1.10 gm/cc, a water content. Lohman and others5

Table 1. Percentile Norms. Ages b-18a for Sum of Triceps plus Subscapular Skinfolds (mm) for Girls°

Age 6 7 8 9 10 11 12 13 14 15 16 17 Percentile 99 7 7 7 7 7 8 8 7 7 8 8 8 95 8 9 9 9 9 9 9 9 9 9 9 9 90 9 9 9 10 10 10 10 10 9 10 10 10 85 10 10 10 10 11 11 10 10 10 11 11 11 80 10 10 10 11 11 12 11 11 11 11 11 12 12 12 12 75 11 11 11 11 12 12 11 12 11 12 13 70 11 11 11 12 12 12 12 12 12 12 13 13 13 65 11 11 12 12 10 13 13 12 12 60 12 12 12 13 13 14 13 13 13 13 13 14 55 12 12 13 13 1y 15 14 14 13 14 14 14 50 12 12 13 14 14 16 15 15 14 14 14 15 45 13 13 14 14 15 16 15 16 14 15 15 16 40 13 13 14 15 16 17 16 17 15 16 16 16 35 13 14 15 16 17 19 17 18 16 18 17 17 19 19 18 18 18 19 30 14 14 16 17 18 20 To 25 14 15 17 18 19 22 21 22 20 20 20 21 24 20 15 16 18 20 21 24 24 25 23 22 22 15 16 17 19 23 24 28 27 29 27 25 24 26 31 30 29 30 cc 10 18 18 21 26 28 33 33 36 cc 5 20 24 28 34 33 38 44 46 37 40 37 38 'The norms for no 17 may be used for age 18. °Based on datafrom Johnston,F. E., D. V. Hamill, and S. Lemeshow. (1) Skinfold Thickness of Children 6-11 Years(Series II, No. 120, F, 1972), and (2) Skinfold Thickness of Youths 12-17 Years (Series II, No. 132, 1974). U.S.National Center for Health Statistics, U.S. Department of HEW, Washington, DC13 38 33 found 8 to 11 year old boys to average underway should help to establish these ship between anthropometric dimen- 73.4 grams of potassium. Assuming developmental changes in fat-free body sion and body density cannot be used 2.66 gm/kg of fat-free body, the fat con- composition. for quantification of body fat content tent estimate was 20.4%. Similar results in children The most valid approach have been found by Forbes and Field Met hods for body composition prediction using Amirhakimi.' field methods at present is to use nor- J. Brozek has printed out that we Skinfolds, circumferences and mative anthropometric data rather know very little about the chemical skeletal widths have been used to es- than convert skinfolds, circumfer- maturation of the fat-free body in man.' timate body composition in several ences or skeletal widths. This ap- Data available in infants indicate a populations of subjects. Practical ap- proach was adopted for the new higher water content and lower potas- proaches have been developed for AAHPERD Health Related Fitness sium and mineral content of the fat-free adult men and women ranging inage Test which utilizes skinfold data ob- body. Various animal species reach from 20 to 50.K.9.1" Equations forpre- tained from the National Health Sur- chemical maturity around pubertyat dicting body composition from an- vey collected on 13,882 children be- about 4% of their life span. This 4% in thropometric dimensions appear to be tween 6 and 17 years of age. These man corresponds to 3 to 4 years of age, valid for various populations of this norms, based on the sum of two skin- much before puberty. It is, therefore, age group although additional cross folds, are presented in Tables 1 and 2. reasonable to suspect that children be- validation is needed. Standard errors Children with skinfolds below the 25 tween 4 and 14 years of age may not be of prediction from these equations for percentile are encouraged to reduce chemically mature and may have a an individual are usually between 3 body fatness through an increase in higher water content and lower potas- and 5% fat. physical activity and a decrease in sium and mineral content. Both of these For children, anthropometric di- caloric intake. components, water and mineral, would mensions are also helpful in predict- Whenever an indirect method is act to lower overall body density; not ing percent fat as estimated from body used to estimate body composition, it because a child is fatter but because a density or potassium. Standard errors is important to be aware of its limi- higher water content and lower mineral of estimate are only slightly larger tations. We cannot at present estimate content lead to overall lower body den- than in adults. However, the predic- body fat content from anthropometric sity. The lower density valuescom- tion equations applicable to adults do dimensions for children, for example. monly found in children might be ex- not apply to children. Moreover, the measurement error of plained on this basis. The result of this The relationship between an- inexperienced investigators can be uncertainty regarding fat-free body thropometric dimensions and body somewhat larger than experienced in- composition in children is a reluctance density appears to vary between 8 and vestigators, and completely erroneous to use the constants of 1.10 gm/cc, 72% 15 years of age. Further research is values have been obtained due to water and 2.66 grams of potassium per needed to determine when this rela- faulty technique." Until one hundred kilogram of fat free body that are used tionship becomes stable. Until such children have been measured, it is in- for adults. Current research now research is conducted, the relation- advisable to convert the scores ob- tained to percentiles, as in Tables i and 2. Furthermore, the national Table 2. Percentile Norms. Ages6-18afor Sum of Triceps norms were developed using the plus Subscapular Skinfolds (mm) for Girls° Lange skinfold calipers. Results from Age 6 7 8 9 10 11 12 13 14 15 16 17 other calipers may be different. Percentile To aid in the measurement of skin- 99 8 8 8 9 9 8 9 10 folds, detailed procedures have been 10 11 11 12 described in the new Health Related 95 9 10 10 10 10 11 11 12 13 14 14 15 90 10 11 11 12 12 12 12 13 15 16 16 16 Physical Fitness Manual and in the 85 11 12 12 12 13 13 13 14 16 17 18 18 article by Lohman and Pollock." For 80 12 12 12 13 13 14 14 15 17 18 19 19 the first year of measurement, two in- , 75 12 12 13 14 14 15 15 16 18 20 20 20 structors should independently mea- 70 12 13 14 15 15 16 16 17 19 21 21 22 sure all children A check on mea- 65 13 13 14 15 16 16 17 18 20 22 22 23 surement error can be made by com- 60 13 14 15 16 17 17 17 19 21 23 23 24 paring the results. Two out of three 55 14 15 16 16 18 18 19 20 22 24 24 26 50 14 15 16 17 18 19 measurements should fall within 3 19 20 24 25 25 27 mm at both the triceps and subscapu- 45 15 16 17 18 20 20 21 22 25 26 27 28 40 15 16 18 19 20 21 22 23 26 28 29 30 lar sites. If consistently larger errors 35 16 17 19 20 22 22 24 25 27 29 30 32 are found, techniques should be com- 30 16 18 20 22 24 23 25 27 30 32 32 34 pared so as to find the sources of vari- 25 17 19 21 24 25 25 27 30 32 34 34 36 ation. Finally, novice measurers 20 18 20 23 26 28 28 31 33 35 37 37 40 should attend a workshop on the new 15 19 22 25 29 31 31 35 39 39 42 42 42 Fitness Test and should contact their 10 22 25 30 34 35 36 40 43 42 48 46 46 state representative about plans for 5 26 28 36 40 41 42 48 31 52 56 57 58 testing. Names of state representa- 'The norms for age 17 may be used for age 18. tives are published in this issue. By °Based ondata from Johnston, F. E., D. V. Hamill, and S. Lemeshow.(1) Skinfold attending a workshop, proper tech- Thickness of CI. Wren 6-11 Years(SeriesII,No. 120, 1972), and(2) Skinfold Thickness niques can be developed. This will be of Youth 12-17 Years(Series II, No. 132, 1974). U.S. National Center forHealth of great help in standardizing the Statistics, U.S. Department of HEW, Washington, DC14 measurement procedure nationwide. 34 39 Estimates of Body Fat Content From Anthropometric Dimensions Unfortunately, procedures are available which encourage the unin- formed practitioner to predict the fat contentofchildrenfroman- thropometric dimensions. Caution shouIC exercised in this regard be- cause of change in fat-free body com- position during growth and develop- ment and change in the relation of skinfolds to bndy density. Projections as to the magnitude of errors likely to occur need further work. Some investigators have calcu- lated the fat content in children by assuming that chemical maturity has been reached. Parizkova, for exam- ple, developed regression equations 4 between skinfolds and density in both boys and girls." By using the median skinfolds (triceps and sub- scapular) in the National Health Sur- vey, the following density and pre- dicted fat content can be computed (Tables 3 and 4). The fat content is calculated from Siri's equation' where fat % = 495/body density 450. For boys (Table 3) the median fat content varies from 17 to 20%, depending on age. Several investigators have found similar value.. based on body density. yx All of these estimates may overstate the actual fat content if the fat-free

Table 3. Body Density and Fatness in Male Youth Estimated from Skinfolds Using the Equations of Parizkova" and Dumin and Womersley' Age Males 6 7 8 9 10 11 12 13 14 15 Predicted Density' 1.060 1.060 1.056 1.052 1.052 1.050 1.053 1.057 1.060 1.060 % Fat2 17.0 17.0 18.7 20.5 20.5 21.4 20.1 18.3 17.0 17.0 Predicted Density3 1.078 1.078 1.076 1.074 1 074 1.070 1.072 1.072 4.074 1.074 Fat2 9.0 9.0 10.0 11 0 11.0 12.6 11.8 11.8 11.0 11.0 ' Parizkova" Density = 1.108 .027 log triceps .039 log subsc.; density = 1.130 .055 log triceps .026 log subscapular; 13 to ld year olds. 2Body fatness ( %) = 495/body c...Insity 450. 3Dumin and Wormersly7 Density = 1.1526 .0687 log (e 4m of 2 skinfolds), 20-29 year old men

Table 4. Body Density and Fatness in Female Youth Estimated from Skinfolds Using the Equation of Parukova" and Durnin and Wormersley'

Body Fatness Age Females 6 7 8 9 10 11 12 13 14 15 Predicted density' 1.050 1.049 1.046 1.045 1.045 1.042 1.042 1 043 1.038 1 036 % Fat2 21.4 21.9 23.2 23.7 23.7 25.0 25.0 24 6 26 9 27.8 Predicted Density3 1.065 1.063 1.0 A 1.058 1.056 1.054 1.054 1 052 1.044 1.044 % Fat2 14.8 15.8 16 8 17.8 18.7 19.6 19.6 20 4 23.9 23.9 'Panzkova" Density = 1.088.014 log (triceps) .036 log (subsc.), 9 to 12 year olds; Density = 1.114 .031 log (tricep) 041 log (subsc), 13 to 16 year olds. 2Body fatness = 4.95/density 4.50. 3Dumin and Wormersley7 Y = 1.1582 .0813 log (sum of 2 skinfolds), 20-29 year old women 35 40 body density in boys is less than 1.10 vents more accurate estimates trom "Forbes. G B and Aniirhakimi, G H Skin- gm/cc. laboratory methods. Field methods fold thickness and body fat in childicn Human Another approach is to extrapolate involving anthropometry and data ob- biology 1970, 42, 401 -418 1 from adult equations for prediction of 13rozek, J Interaction of human and animal tained from a large sample of children research on body composition Body composi- body density from anthropometry. as part of the National Health Survey tion in animals and man National academy of For example, one can predict the den- can be used to indicate either a rela- science 1968, 1-15 sity of children from the same two tively low or high fat content. Future "Durnin,J V G A and Womersley. J Body skinfold sites mentioned by using the research should enable the develop- fat assessed from total body density and its es- equations of Durnin and Wormers ley' timation from skinfold thicknessmea- ment of norms for body fatness and surements on 481 men and women aged from formulated for 20 to 29 year old the conversion of anthropometric di- 16-72 years British journal of nutrition I y74, adults (Tables 3 and 4). Using these mensions to body fat content 32, 77-97 equations and the median skinfolds 'Jackson. A S and Pollock, M L General- from the National Health Survey, the References ized equations for predicting body density of menBritish journal of nutrition 1978, 40, fat content varies from 9 to 12% in 'Bateau, R A, Wilmore J H , Lohman. 497- 5f)-1 boys (Table 3). These approaches ap- T G. Slaughter, M H, and Riner, W F Esti- '"Jackson, A S, PolloA, M L and Ward. A pear to underestimate the median fat mation of body density from skinfold thick- Generalized equation, for predicting body den- nesses, body circumferences and skeletal sity of women Medicine and science in sports content of boys which further re- widths in boys aged 8 to 11 years comparison search will probably show to lie be- and exercise 1980, 12, 175-182 of two samples Human biology 1981. 53 (In "Lohman, T u and Poll 'ck. M L Which tween 13 and 17%. For girls, a similar iressi caliper' How much training9 Journal of physi- discrepancy is found between the two 'Sin, W E Body composition from fluid cal education and recrerrion 1981. 52. 27-29 approaches, athough the magnitude spaces and density: analysis of m'nods Tech- "Parizkova, J Total body fat and skinfold of the difference is somewhat less. -vies for measuring body composition 1961 thickness in childrenMetabolism 1961, 10, 14ational Academy Science-National Research 794-807 This smaller discrepancy is consistent Council, Washington, DC, pp 223-244 ''National Center for Health Statistics Skin- ,it,i the smaller changes in fat-free 'Mellitis, E D. and Cheek, D 3. The assess- fold thickness izichildren 6-11 years United bcly composition that take place in ment of body water and fatness from Infancy to States, Vital and Health Statistics. DHEW Pub. girls during puberty. adulth..d. Monog soc res child Bevel ser No 7' -1602, Series 11, No20, 1972, PHS, 1970, 140, 35: 12-26 U S Government Printing Office. Washington, Preset methodology leads to the 'Schulte, J E Prediction of total body water CC conclusion that the meat' fat content in adolescent males Human biology 1980, 52. "National Center for Health Statistics, Skin- of childre.. appears to be between 10 fold thickness of Youth 12-17 Years. United and 20%. Limited knowledge of the 381'1.o.-3h9m1an,T G . Bollea,'2 A , and Massey. States Vital and Health Statistics DHEW Pub B H Prediction of lean u,dy mass in young No 74-1614, Series 11, No 132, 1974, PHS, changes in fat-free body composition boys from skinfold thickness and body weight during growth and development pr-:- U S Government Printing Office. Washington, Human biology 1975, f'7. 245-262 DC I

1

41

36 FLEXIBILITY a major component of physical fitness By Charles B. Corbin and Larry Noble

lexibilityhas long been considered an interest in flexibility in recent years are many. The Nature of Flexibility Fimportant component of physical fitness Flexibility is now recognized by most phys- Considerable research has been conducted and good health. interest in the study of flex- ical educators and exercise experts as an im- concerning the nature of flexibility in recent ibility increased in the early 1900s partly portant component of health related fitness. years and there is some inconsistency ( i -°- because of the increased number of 0:- Kraus and colleagues' early work has helped suits. In some areas it is impossible to wake thopedic cases resulting from World War 1 us recognize the importance of flexibility to generalizations about the research findings. and partly because of the epidemic of polio such good health practices as proper care of However, there is one thing about which at the start of the century. Though techniques the back and good posture. Fleischman's fac- there is almost unanimous agreement. Flex- for measuring flexibility have improved dra- tor analytic work in the 1960s also clearly ibility is specific! Flexibility, though co-- matically since the turn of the century, in- established the existence of flexibility as a reedy identified as a health related compo- terest in flexibility has been sporadic. Cur- specific component (or group of components) nent of fitness, is notone thing, it is many eton and a few other fitness pioneers continued of fitness. things.For operational purposes flexibility to research flexibility through the 1930s and Not to be discounted is de Vries' work is defined as, "The range of joint motion 1940s but it was not until the late 1950s that which pointed cut the value of passive stretch available in a joint or group of joints, mo pub7:c attention again focused on flexibility in developing flexibility and reducing muscle bility."2 The amount of range of motion is as an important fitness and health concern. soreness. de Vries' research has been widely specific to each joint. Range of motion in the It was at this time thatSports Illustrated cites: and at least one current author indicated shoulder does not ensure range of motion in magazine labeled a research paper published with the title of his article, "Flexibility: Day the hip. In fact, range of motion in one shoul- by Kraus and colleagues, "The Report that of the Static Stretch,"' that flexibility and der may not be highly related to range of Shocked the President." Tne report indicated static stretch is the "in thin among those motion in the other shoulder. that large numbers of American children were who exercise regularly. In taLt it is difficult The use of freedom to move as a definition unable to perform simple muscular strength to find current articles on fitness which do is reinforced by the classic studies of Fleisch- and flexibility tasks. Though the test used, not expound on the importance of doing reg- man which identified specificstaticanddy- the Kraus-Weber test, has drawn much crit- ular flexibility exercises. Among those par- namiccomponents of flexibility. Simply put, icism over the years since the original re- ticularly extolling the virtue of flexibility static o: passive flexibility is the ability to ports, the research by Kraus and others did exercises are physical educators, coaches, move tnrough a range of me'ion with no rejuvenate an interest in flexibility testing, referees, athletic trainers, and medical doc- emphasis on speed. To slowly bend and touch especially among children, and was 'argely tors. Professional as well as collegiate and the floor,evenwith assistance demonstrates responsible for the development of the Pres- scholastic athletic teams now endorse regular static flexibility. Fleischman's dynamic flex- ident's Council on Youth Fitness, now the flexibility programs, not so many years ago ibility is the ability to use a range of Joint ['resident's Council on Physical Fitness and thought to be unimportant. Not to be over- movement in the performance of a physical Sport. looked are those associated with the Jogging - activity at its normal, or at a rapid rate of In spite of the interest created b) .oe Kraus- running boom. Jogging - running enthusiasts speed. For example, in gymnastics the "splits" Weber test results of the 1950s, flexibility and auth'rs in the magazines of the move- may be done in the midst of a routine of items were not included in the AAHPERD ment have pointed out the values of str:tching several other important movements. To be test batteries which were endorsed by the exercises and warm ups for all those who able to perform the movement slowly or with President's Council and which were used as participate. an assist is irrelevant. For most sports and a basis for national youth fitness awards. It The interest in flexibility is encouraging physical activities the specific factors of dy- hi s only been in the last few years that in- to exercise scientists; however, as with any namic flexibility are most relevant. Dynamic terest has been generated for including a flex- topic deserving of our interest, periodic re- flexibility truly reprec,ts "freedom to ibility item in the fitness battery. The new view of the "state of the facts" seems in move." test battery includes such an item. The rea- order. The following information is based on It should now be noted that in addition to sons for the inclusion of I, flexibility test in a review of current research on flexibility. being specific to each joint and to dynamic the new fitness test battery and the increased Because r interest in flexibility, espe- and static components, there is also some cially among lay people, it is important that degree of within joint and around joint spec- we, the practitioners in our field, be aware ificity. The range of motion or freedom of Charles B. Corbin and Larry Noble are of the facts so that we can effectively perform mop-sment of a joint is influenced by many in the Department ofHYPER, Kansas Stateour functions as exercise, fitness, and human things. While the actual structure of the joint University, Manhattan, KS 66506. movement experts. is important (i.e., knees are designed to flex

37 42 and extend but not hyperextend), within the on a specific test but results are only for self evidence that even senior adults benefit from "expected" or normal range of motion for comparisonnot for comparison to others. flexibility training With proper training, and that joint, other factors are more important Compound flexibility measures such as the bamng disease, dramatic increases are not in determining flexibility. Though studies are sit and reach test, which involve more than necessary with age. not uniform in their findings, it is generally one joint, are acceptable for these compari- Sex. There is also conflicting evidence agreed that muscles and ligaments arc most sons. However, for interindividual compar- concerning the relationship between flexi- important in determining flexibility while isons more :Erect tests such as single joint bility and the sex of the subject. However, tendons are considerably less important. For measures are encouraged. a synthesis of the evidence suggests that as this reason it can be seen that the elasticity a general rule girls may be more flexible than of muscle and connective tissue, particularly Why IsFlexibility Important? boys. Though scientific evidence is limited, ligaments, is especially important to flexi- The high level of current interest in flex- veral authors suggest the flexibility advan- bility. ibility is exemplified by the increasing prev- tage to females may persist throughout life. Within or around joint specificity depends alence of stretching programs among athletes In the absence of empirical data it seems fair on how flexibility is measured. There is evi- and among adult Americans who exercise for to conclude that anatomical differences and/ dence that when only single dimensional enjoyment or health and fitness. Kraus and or regular activity differences between the measurements are made a joint may be con- Rub and other authors interested in the pre- sexes may account for the flexibility differ- sidered quite flexible yet when rotational, vention and care of the back have shown that ences which may exist between the sexes. torque, or two/three dimensional measure- there is good theoretical and clinical evidence Body Build. There are a few studies which ments are made, quite different results may to indicate that many back problems are as- indicate that slight positive relationships exist be obtained. Clearly, the status of the muscle- sociated with too short or too weak muscles. between various body proportion measures connective tissue support to the joint and In fact it was the high incidence of muscu- and flexibility measures. However, in total, elasticity of the muscles and connective tis- loskeletal problems among adults which the evidence leads one to conclude that body sues affecting the movement of the joint are prompted the testing of youth with the Kraus- build has little practical effect on flexibility. associated with the specificity of within/around Weber test (a test originating from a battery Length of body parts, including height, does joint flexibility. Because elasticity and ex- to screen for back problems) in the 1950s. not seem to significantly affect flexibility. tensibility of muscle and connective tissue Also, problems with posture can be linked Strength Training. Most researchers agree are important to range of joint movement, to muscle imbalance and lack of flexibility. on this point With proper training, including length of muscle and connective tissue will The relationships between back problems, weight training, in which the exercise is per- be considered in this paper as an alternate poor posture, and lack of flexibility coupled formed through the full range of movement, definition of flexibility. Thus, either range with the fact that muscle soreness, including "muscle boundness" or diminished flexi- of joint movement or length of muscle/con- e may be more prevalent among bility need not result. Weight trainers and nective tissue will be used in discussing fit-x- those who lack flexibility establishes flexi- body builders who do both regular strength- ibility. However, emphasis in this paper %..11 bility as an important and complex compo- ening and lengthening exercises have been be on one and two plane movements rather nent of health related fitness. Further, flex- shown to have flexibility equal to or greater than on joint torque and three plane move- ibility is said by many to be useful in improving than the normal population. ments. sports performance, in reducing muscle in- The body of knowledge concerning flex- jury, and relieving some forms of muscle Flexibility and Good Health ibility has increased since the early 1900s soreness. Each of these claims for the ben- As mentioned earlier, one of the important largely because of the shift from subjective eficial effects of flexibility will be examined c!aims for flexibility as a physical fitness to more objective measurement techniques. in the following pages of this paper. component is that possession of this fitness Among the devices currently used to measure factor relates to good health. The ways in General Information AboutFlexibility flexibility are simple tape measures, rulers, which flexibility is said to contribute to good and calipers. More sophisticated measure- Before examining the validity of the claims health are discussed below. ment devices include arthrometers, instru- concerning flexibility and health, flexibility Care of the Back. It can be documented ments for measuring joints; fleximeters, in- and performance, and flexibility and muscle that one of the most prevalent medical com- struments for measuring degree of bending; injury, a synthesis of the general research plaints in our country is low back pain Sta- and goniometers, for measuring angles. The information seems in order. Included is a tistics accumulated in medical centers indi- most simple is a protractor modified to be brief discussion of flexibility and strngth cate that many, if not most, back problems an arthrometer, perhaps the most often used training. The observations made in thissec- result from weak or inflexible muscles. The is the flexometer developed by Leighton. tion are generalizations resulting from an prescription for such problems is a length- More complex are the goniometers which are extensive review of specific research studies. ening-strengthening program for the muscles electric (electrogoniometers), photographic It is recognized that, given the specific nature and connective tissue. Though much of the (photogoniometers), and radio (radiogo- of flexibility, such generalizations can be evidence is theoretical or clinical, most ex- niometers). There is evidence to indicate that dangerous. Nevertheless the generalizations perts agree that in addition to strengthening .exibility may be specific to the way it is seem warranted. the abdon .aal and back muscles, a flexibility measured. This may account for ti.. lack of Age. There is contradictory evidence con- program for lengthening the iliopsoas, lower agreement in some areas concerning flexi- cerning age and flexibility. Given all the re- back, and hamstring muscles is important for bility. search reviewed, it seems fair to say that sound care of the back. Conversely, there are In addition to considering the need to test young children are quite flexible. During the those who believe that excessive strength- specific body parts u. measuring flexibility, school years flexibility increases until early ening of the iliopsoas, or lengthening of the the practitioner would he wise to consider adolescence when a leveling off or decrease abdominals is counter-productive to good back two simple guidelines when testing flexibility begins. When evaluating the flexibility of care. or teaching people to test their own flexibil- children and adolescents, growth (especially Posture. The evidence concerning flexi- ity. For determining improvement in flexi- individual differences in growth rates) should bility and good posture is similar to that con- bility, intraindividual comparisons may be be considered. Though older adults have less cerning good care of the back; it is largely used. That is, a person is tested several times flexibility than younger individuals, there is theoretical and clinical. Nevertheless, most 38 43 authorities agree that imbalance iimuscular reason it is difficult to generalize about the flexibility may not enhance performance development and lack of flexibility in certain flexibility charactenstics of athletes. how- Scientific evidence and statisticsarenot muscle groups are contributing factors to poor ever, a synthesis of the reasearch does sup- necessary to verify that activities emphasiz- posture. For example, poor flexibility in the port the notion that athletes who participate il,g qualitative performance often require a front chest area and lack of muscular endur- in sports tend to have patterns of flexibility significant degree of flexibility to ensure suc- ance in the shoulder girdle adductors are unique to their spurt of involvement. Base- cess Clearly, a ballet dancer who cannot lift thought to be associated with rounded shoul- ball and track athletes in general excel in his/her foot to the barre is not going to excel, ders. many, but not all flexibility neez.;ures. Weight neither is a diver who cannot point his'her Muscle Soreness and Muscle Injury.An- lifters and gymnasts also do well on many toes or a gymnast who cannot assume a pike other of the health benefits alleged to result flexibility tests but different ones from the position There is little doubt that for these from developing specific types of flezibilities baseball and track athletes. Wrestlers are least and other "qualitative" activities flexibility is decreased muscle soreness. Those who jog flexible of all athletes. There is some Indi- is important to performance. and exercise, including athletes of all types, cation that weight lifters, gymnasts, and Flexibility and Activities Requiring Exten- are now encouraged to do terlar flexibility wrestlers exhibit lease flexibility around joints sive Joint Mobility.To be sure, the categories exercises before and after exercise to reduce used for support in their various events (i e.. used here are somewhat arbitrary. All sports muscle soreness and muscle iniury. wrists of gymnasts) Swimmers have been and activities possess some "qualitative" Research results appear to umformly sup- shown to excel on many measures of flexi- components (see previous section) and all port the beneficial role of passive stretching bility. sports require <-^tne joint mobility. Clearly, exercises in reducing and sometimes elimi- While the evidence does show that sports those considered as emphasizing qualitative nating muscle soreness, although there is participants ma), have predictable flexible performance also require extensive joint mo- disagreement as to the physiological expla- characteristics, the correlational nature of the bility. Examples of activities classified as nation of soreness, particularly delayed lo- data does not allow us to establish cause and requinng extensive joint mobility are swim- calized soreness (muscle spasms vs. irritation effect. It is not known for sure whether peo ming, fencing, and track and field. of the connective tissues). Regardless of the pidevelop these flexibility characteristics More research is available on swimming theoretical reasons for it, passive stretching as a result of the activit:, or choose the activity than on any other sport. As early as 1930 appears to reduce acute muscle soreness Im- because they possess these unique charac- Curelon conducted studies concerning the mediately following exercise and may be teristics. flexibility of swimmers. Ne can now say that similarly effective in relieving pain cf de- Flexibility and Specific Performance Com- swimmers possess better flexibility on many layed localized soreness. ponents.Much of the re.earch concerning measures than normal people. Further, there It should be r ned that there is support for flexibility and performance nas been labo- is indication that those with good ankle flex- the notion that some cases of dysmenorrhea ratory research. In such studies performance ibility may perform the flutter kick , tore (painful menstruation) can be prevented or components thought to be important to the effectively than those who have lesser mo- at least reduced in severity through regular performance of various sports and activities bility of that joint. Whether this provides stretching of the muscles and connective tis- have been isolated. This is done so that well- better propulsion or merely better stability sue in the pelvic area. Two flexibility ex- controlled rsearch can be done on one spe- le the evar,.1, most agree that it would enhance ercises most often recommended are Mother's cific component and other extraneou. tactors performance. On the oasis of other research and Billig'r exercise. The basic findings of --.1 be eliminated or- -ontrolled. Research it has been suggested that good shoulder flex- de skies' work provides a theoretical four, ngs to date suggest that specific types ihility enhan:.es stroke efficiency, and that dation to explain the reason for the effec lex ibility can enhance perf-mmance of tile the supenor trunk flexion of swimmers may tiveness of these and other exercises for those . g jump, agility as measured by an obstacle zontnbute to more effective performances who have pain which isnotassocieted with. mn (though one study disagrees), sprint time, Evidence is lacking concerning other sports a pathology. ball throwing for distance, and ball hitting. classified as requinng extensive joint mo- Flexibility and Performance To the extent that theseidenticalperformance bility. Research with joggers showed no greater Of great concern is the question, "Does amponents are important to a given sport performances among the more flexible than or physical activity, possession of a specific flexibility improve performarce in sport and those who were less flexible. However, the flexibility type can enhance performance physical activity?" With the recent focus of lack of evidence does not mean that flexi- attention on flexibility tt ere: have been many Flexibility and Activities Emphasizing bility is not necessary for these activities claims made for the importance of flexibility Qualitative Performance.Activities empha- only that in most instances It is not a limiting to improved performance. It must be said sizing qualitative performances are opera- factor. On observation alone It can be verified that some of these cla ms may have gener- tionally defined here as those such as gym- that some flexibility is required for activities alized beyond the facts. To sort out the claims nastics, diving, ice-skating, and dance. In in this category. For example, a hurdler can- from the facts, the following topics will be these sports and activities the emphasis is on not perform well without some flexibility nor explored: (I) the flexibility charactenstics of aesthetic inclgenents of the quality of the per- can a fencer thrust effectively with a limited athletics, (2) flexibility end specific perform- formance, rather titan on the quantity of per- range of joint movement. ance components, (3) flcitibility and activi- formance (i.e.. how far or how fast). Though Flexibility .rend Other Activities. Nomatter ties emphasizing qualitative performance, research has indicated that gymnastics per- what activities you Include in the categones (4) flexibility and activities requiring exten formance could not be predicted from flex- previously listed, there are sports and activ- sive joint mobility, and (5) flexibility and ibility test results among varsity gymnasts, ities which do not fall in either of the two other activities. this does not mean that flexibility is not im- already considered. A few of the other sports Flexibility Characteristics of Athletes.Just portant to gymnastics performance. It is not not included are team sports such as football, as flexibility is a specific charactenstic, each difficult to see that specific flexibility com- basketball, baseball and volleyball. For most sport has unique characteristics and Imposes ponents are necessary for performances of of these sports, evidence relating flexibility unique demands on participants. Even within different kinds and that if all gymnasts have and performance capabilities is lacking. Evi- each sport there are specific requirements for at least the minimai amounts of flexibility dence is available which indicates that both athletes playing different positions. For this necessary to perform the event, additional basketball ar d football players are lower than 39 4 4 normal on several flexibility components and normal range of extensibility than one which that flexibility can be improved with regular wrestlers and combative sport participants has been lengthened through training. The flexibility training. While there is some dis- are particularly low in flexibility when com- logic of this point of view makes it attractive agreement as to which technique is most ef- pared to other athletes. High flexibility did to the practitioner, yet conclusive data are fective in developing flexibility, it is clear not improve speed skating performance, al- still not available to document whether lack that whatever technique is used, the muscle though, as already mentioned, it may en- of flexibility predisposes one to injury and, and/or connective tissue which is to be hance throwing and hitting ability in base- if so, the minimal amount of flexibility nec- lengthened mucr be stretched beyond its nor- ball. Obviously, more research on flexibility essary to prevent such injuries. Studies show mal length to be effective. This is an appli- and performance in these sports is necessary. a high rate of leg and foot injuries among cation of the overload principle. Some sug- Flexibility aid Performance: A Summary. those just beginning a jogging program, as gest that the muscle must be 'overstretched" At this point it can be said, based on scientific opposed to lower injury rates among more by approximately 10%, but no more than evidence, that some performance compo- persistent exercisers. Also, studies show a that. Others suggest that pain is the key. nents can be enhanced by increasing flexi- lessening of ski injuries since the advent of These people suggest that the muscle should bility. Further, there au isolated studies which preparatory exercise programs including be stretched until it hurts. Neither formula show that certain activities may require spe- flexibility training. These results lend sup- is well documented, though each has been cial amounts of flexibility. Also, data indi- port to flexibility/injury claims. Among used by practitioners in flexibility programs. cate that athletes in given sports tend to pos- women athletes, more than 50% of all in- This "pain" formula may be ineffective for sess specific flexibility profiles. Couple this juries are sprains and strains which most fre- use with active stretching procedures. quently occur in the legs and feet. These data scientific information with what we know to Static vs. Active Stretching.One of the be true about various sports and physical also might lead one to believe that improved more controversial topics among exercise activities and it is clear that flexibility can training programs, including regular stretch- scientists is the relative value of static vs. and does affect physical performance. What ing, might reduce injury rates. These bits of active stretching programs for developing is not clear is just how much flexibility is evidence are indirect at best. Clear and com- flexibility. Static stretch, also known as pas- prehensive longitudinal data must be col- necessary for optimal performance in a given sive or slow stretching, refers to ". .. slow, activity. Two generalizations on this point lected if we are to answer questions about sustained stretching exercises, that place a seem warranted. First, it is evident that for flexibility and muscle injury. muscle in a lengthened position and hold that most activities and sports there is at least a Another point of view which relates to position for a few seconds."' (One study sports injuries and flexibility states that too certain minimum or threshold amount of flex- suggests the muscle or connective tissues must much flexibility or range of joint movement ibility necessary for effective performance. be stretched and held for at least six seconds. can be as dangerous as an inadequate amount. The exact minimum or threshold level nec- Most programs recommend stretching for six This point of view suggests that too much essary is probably specific to each sport. It to twelve seconds several times daily.) Static flexibility may make a joint unstable, for may be that flexibility in excess of threshold stretch may be done with or without the help example as in a "loose knee." Those sup- levels does not enhance performance. of gravity or some outside force to pn duce porting this point of view suggest that both Even in gymnastics, an activity obviously overstretch such as pressure applied by an- lengthening and strengthening are important, requiring considerable minimal amounts of other person. Active stretch, also known as flexibility, exceptionally high levels of flex- but lengthening the wrong connective tissue dynamic, ballistic, bobbing, bouncing, or ibility do not seem to enhance performance or overlengthening the wrong muscles is con- fast stretching, refers to "...a type of traindicated. There is support for this point Second, it should be pointed out that unique stretching exercise involving a bouncing or of view among those in the sports medicine patterns of flexibility for athletes in a given jerking to gain momentum in the body part sport may be a result of participation in the field (i.e., effect of exercise such as the duck to enhance overstretching."' Like static walk and deep squat on knee joint stability), activity. Though cause and effect has not stretching the assistance of another person but data as to the exact amount of lengthening definitively been shown, Clarke' on the basis may be used to produce the force to over- .. that cr strengthening for each specific joint other of existing data has generalized ". stretch the muscle or connective tissue. than the knee are not available. extensive and prolonged participation in dif- There is a considerable amount of research In summary, there is a wealthof clinical ferent physical activities or kinds of perform- which indicatesthat bothmethods are effec- support for the need for doing flexibility ancesproducesunique patterns of flexibil- tive in developing flexibility. There has been aining to prevent muscle and connective no consistent evidence to show one technique tissue injuries, particularly in the legs, an- to be superior to the other. In view of the kles, feet, shoulders, arms, and hip. The Flexibility and Spot a Injuries apparent si-nilarity of the effectiveness, most conventional wisdom suggests that shortness Performance improvement is not the only authorities Suggest static stretching, espe- of MUS-le and connective tissue which limits benefit claimed for those who possess good cially for beginners and those who are not joint mobility may I Tedispose that muscle or flexibility. Literally hundreds of books, pe- Gaining for high level competition. Since conaective tissue to injury. Also, there is a riodicals, and newspaper accounts are avail- most sports are ballistic in nature, active stretch general belief that too much flexibility in a able extolling the value of flexibility training may be quite appropriate for athletes. How- joint without sufficient stability may predis- in preventing muscle injury. In 1941 Cureton ever, most experts recommend that a penod pose the joint to injury. Though a wealth of reported the importance of flexibility in pre- of static stretch precede active stretching. empirical data on the subject is lacking, com- venting muscle injury. Since then anynum- The tendency of practitioners to favor static mon sense suggests that adherence to length- berof ideas have been presented to establish stretching is based principally on de Vnes' ening-strengthening programs for athletes, the importance of flexibility in prevent; research. That is, static stretch is less likely vocational or avocations], would be wise. joint, muscle, and connective tissue injuries. to evoke the stretch reflex and is thereforc Most common is the notion that muscles which less likely to precipitate muscle soreness. Developing flexibility are too short are susceptible to overstretch, Further, some suggest that there is less dan- particularly in vigorous activity, and thus are Just as the concept of the specificity of ger of accidently overstretching a muscle using predisposed to injury. A shortened muscle flexibility is one area of consensus, there is static stretch. Based on the available evi- is apparently much more likely to exceed its also general agreement among regarchers dence, the use of static stretch appears to be 40 45 sound practice for moss people. ers attest to the importance of regular flex- Imlay and associated length of muscle and Proprioceptive Neuromuscular Facilita- "Ray training, most are also convinced of connective tissues. There are several effec- tion. This technique, commonly referred to the value of a flexibility or stretch warm-up tive techniques for developing flexibility. Of as PNF, was originated at the Kabat-Kaiser Joggers, for example, have developed a spe- these techniques, the available research and Institute as a physical therapy procedure for cific set of stretching exercises to be used as good common sense suggest that static or the rehabilitation of paralytic patients Since a warm-up. Before examining the value of passive procedures are best for most people. its origin, the procedure, which requires the such a warm-up, the difference between a For those involved in vigorous sports, be- performer to sequentially contract the muscle flexibility training program and a flexibility cause they require dynamic movements, ac- to be stretched, then contract the antagonist warm-up should be clarified. A flexibility tive stretching is effective and appropnate. while stretching the desired muscle, has been training program consists of static, active, Above all, It is clear that flexibility is specific used with nonpathological populations. Those or PNF exercises included in a regular pro- to each joint and probably is specific in other who enaorse the procedure suggest that PNF, gram designed to improve flexibility over a ways as well. A person cannot be deemed because of the myotatic reflex, reciprocal long period of time. On the other hand, a flexible on the basis cf one test or even on innervation, inhibitory impulses from the Golgi flexibility warm-up is a group of exercises the basis of a limited battery of tests. tendon organ, and resultant muscle relaxa- done immediately before an activity designed These writers also conclude that until ad- tion, enhances the benefits of static muscle to improve performance or to reduce the ditional evidence is produced to show oth- lengthening exercises. Thus, the procedure chances of injury in that activity. The evi- erwise, persons who expect to participate in is basically a modification of static stretch- dence supports the fact that chronic training regular activity would be wise to establish ing. One problem in trying to determine its can produce flexibility gains, but what of the a regular flerhility program and to do effectiveness has been the wide variation of warm-up? stretching exercises before and after exercise. PNF procedures used in conducting research. Research has shown that passive,etching How much flexibility the person should de- The early literature relating the use of PNF just before a trunk flexion test can result in velop is open to question but at least minimal emphasized the need for working the muscle improved performance on the fle: ibility test. levels seem necessary to optimal perform- at diagonal patterns, while procedures cited Nonetheless, it should be noted that there is ance and prevention of injury. Those in- in the literature rarely indicate the use of the no evidence that a "one time only" warm- volved in sports and activities involving a diagonal method. Further, .n.le author rec- up can replace a regular exercise program for high degree of injury would do well to ommends the use of a passive assist while developing flexibility. strengthen as well as lengthen muscles around another does not. One suggests several iso- Some have suggested that flexibility can vulnerable joints. It is possible that too much metric contractions of the agonist (muscle to be improved by passive warm-up techniques flexibility may result in joint instability and be stretched) while another uses only one. whicl, increase muscle temperature. Phys- susceptibility to injury. Because of differences in procedures used iologists generally agree that the elasticity in studies comparing PNF, the results of these of muscle and connective tissue is affected P"Flexibility. Day of the Static studies should be viewed with caution. How- 'Schultz, by temperature. While the limited research Stretch The Physician and Sportsmedicine 7 109- ever, results do seem to indicate that what- available suggests that warming the muscle 117, November, 1979 ever the procedure used, PNF is as effective via a hot shower may produce some im- 'Corbin, C B, Dowell,L.J., Lindsey, R .and as static and active stretching procedures. At provement in test performance, the benefits Tolson,H(3rd ed ), Concepts in Physical Edu- least one study has been reported in the recent canon, Dubuque, Iowa: W.C. Brown. 1978 are not equal to those resulting from stretch- 'Clarke,H.H.(ed.) "Joint and Body Range of literature which indicates a form of PNF to ing exercises, and cannot be considered as Movement." Physical Fitness Research Digest be superior to either static or active stretch- permanent gains in flexibility. Washington, D C . President's Council on Phys- ing. Additional research is necessary ical Fitness and Sporn, October, 1975 Concluding Points of View `Corbin, op, cit The Flexibility Warm-Up 'Corbin, op, cit Regular training can result in flexibility A complete bibliographyis available from the au- Just as exercise enthusiasts and practition- improvements as determined by joint mo- thors on request

46

41 Medical Problems Encountered by Women in Aerobic Exercise

Dorothy V. Harris

hile females are generally 5 inches shorter, 30 to 40 maturation among 6- yea * -old boys and 72 months' difference wpounds lighter, and 10 percent fatter on the average in 13-year-old boys. Wide variation does not prevail among than males, they respond and adapt to chronic exercise and females, most of whom have reached their mature height and physical training much as do males. Efforts to determine the growth soon after the onset of menarche. One cannot recruit a quantitative and qualitative differences in response to physical gir; from high school for basketball and assume that she will training of males and females have generally demonstrated grow several more inches while in college. Most males, that observed differences are not mediated by sex but b:' however, will continue to grow during those years. physical fitness. In short, the differences are influenced more D'Iring late childhood the female may be bigger than her by factors other than biological sex. More differences exist same aged male peer because of reaching her growth spurt within a sex than between the sexes when fitness levels are sooner. During this time she may be faster and stro:tger and controlled. outperforn --mys in athletic feats provided she has had the In spite of the fact that the female does respond to exercise opportunity to learn skills and has been reinforced in a in much the same pattern as the male, she performs at a positive manner for her performance and involvement. Once substantially lower level in almost all athletic contests. In physical maturity has been reached, there are average dif- running events (based on 1977 records) the percentage of ferences between males and females that have spsvific implica- differences in performance was 9.62 in the 100 meters, 11.02 in tions for athletic performance. the 400 meters, 13.0 in the 1,000 meters, 15.3 in the 2,000 Males, because they mature later, therefore grow longer meters, 18.15 in the 10,000 meters, and 17.0 in the marathon. and are generally bigger than females. The higher levels of Are tnese differences truly biological ones, are they only the androgens (male hormones) also influence development. result of sex differences, or are they reflective of social and Males have longer trunk length, broader shoulders, greater cultural restrictions and expectations placed on the female? muscle development in the shoulder area, and less body fat. Smaller, slower, weaker persons are discriminated against Higher estrogen levels (female hormones) in the female close in selection for sports participation. Only about 20 percent of off the epiphyses of the long bones sooner, resulting in lesser the body types are represented in the Olympics. Generally, height. Body fat is increased with the female being 10 percent there is less difference in the body types of males and females fatter than the male. Her him are broader in relation to her who excel in the same athletic events that.' there is between shoulders, she has less muscle mass in the shoulder girdle, and males and females in general or perhaps between males who tends to have a longer trunk in relation to length of leg. Body are selected and males who are not. In other words, the high type is also influenced by genetics, nutrition, exercise, and jumper, male or female, who uses the Fosbury flop will be other factors beyond those of the endocrine system. quite similar in body type. Much the same can be said about As indicated, there are average differences between males the basketball player, the marathoner, and so on. and females that have specific implications for sport per- The female matures sooner than the male; 20 weeks after formance. Wilmore and Brown (1974) examined 78 female conception she is 2 to 3 weeks more mature and at birth she distance runners and found that 12 had less than 10 percent may be as much as 20 weeks ahead of the male's maturation. body fat, 32 less than 15 percent or under that of the average This is (mini; to the fact that the male must wait for college male. These trained women were significantly less fat "something to be added" or the Y chromosome to indicate than their untrained female peers who have approximately 25 that the gonads will be testicles. These cells must mature and percent body fat. While low body fat may be a genetic multiply sufficiently to begin to produce androgen or the male endowment, high-intensity endurance-type exercise is also a hormone that will then begin to differentiate to mile develop- significant factor. It appears that females can approach ment. This lag behind the female in development is not closed relative fat values of male athletes with strenuous training. It until the male reaches age 20. Great variation exists in the also appears that the average fat values of untrained females maturation rate with this being more obvious in the male. are higher than ideal; regular exercise could reduce those Seefeldt (1978) reported as much as 40 months' difference in stores. A greater percent of body fat in the female provides her with advantages for some activities. She is more buoyant in water and has better insulation in cold temperatures. This Dorothy V. Harris is a professor at Pennsylvania State University, University Park, PA. She pre-,,nted a paper similar to this article at combined advantage has ena bled females to better the world the Sports Medicine Syn,sit m, Hahemann Med:cal School, records in distance open-water swimming. A young Canadian Philadelphia, September 1978. woman swam the English Channel round trip in the fall of 42 47 1977 and knocked more than 10 hours off the male record. type of iron supplement is frequently recommended for the Ullyot (1976) said that women "run off their fat," that the female athlete. additional fat that women have provides them with extra fuel Russell Lane reported in The Jogger 9978) that sports for energy. Women may be able to use their fatstores more anemia in endurance exercise is a result of a training effect efficiently than males. It is possible that they burna higher brought on by hypervolemia or increased fluid volume. It has percentage of fat mixed with glycogen, thus glycogen lasts been shown that the iron content of sweat during endurance longer and females feel better after running a marathon than exercise increases somewhat. The cardiac volume is up, and do males. While the biochemical mechanisms have not been the red-cell mass changes to a lesser extent than either the isolated, there appears to be a difference in the adaptation and volume or heart stroke volume. The important change is the coping to strenuous enduranx -type exercise between males increase in the circulating blood volume with the associated and females. lowered blood viscosity and faster flow. The so-called "anemia" Strength differences between males and females have may in fact be beneficial to the athlete in providing more rapid traditionally been acknowledged. However, Wilmore (1977) delivery of oxygen. Furthermore, Lane suggested that the s'....ted that leg strength is nearly identical in the twosexes. process must involve some genetic factor to explain the When expressed relative to body size it is identical. In fact, variable appearance and individual difference in response. In when expressed relative to lean body mass, the femalesare some athletes the process seems to outdo itself and lead to slightly stronger. The difference between males and females in clinical and dysfunctional anemia thatsome have called strength is greatest in the shoulders, somewhat less in the "maladaptive" training effect. In summary of the issue, it does trunk, and appears to be similar in leg strength. The female s, an worthwhile to suggest to aerobic exercisers that low responds to strength training in much the samemanner as the hemoglobin may be a positive factor and not necessarily a male in terms of percent gained. While resistive weight negative one. Those persons who appear to be anemic without training produces large gains in strength in the female, a..y symptoms may be members of a select group possessing concomitant gains in muscle bulk do not result. In the fall of genetic constitutions to Atness this "training effect" in sport 1977 a 114-pound female broke the males' lift record in that rathe. than needing iron pills for treatment. weight class by lifting 225 pounds. There is much to learn Menstruation and factors relating to that process have about factors relating to strength, strength development, and probably produced more concern and misinformation than maximizing one's potential development in strength. any other difference in males and females. Females have made Efforts to determine qualitative and quantitative differences and broken their own personal best performances at all phases in the aerobic capacity of males and females have demonstrated of the menstrual cycle. It appears that there isno decrement in that the female has a maximal oxygen uptake that is less th-n performance for females who have made a serious commit- that of the male. in general the level of physical fitness ment to sport pursuits. However, itis possible that the overrides the effect of sex. Hermanson and Andersen (1965) population is biased toward these women who experienced no reported that female cross-country skiers hadan average of 55 impairments. Those who did may have been systematically ml/ kg min while the average male had 44 ml/ kg min. Female eliminated. athletes have higher oxygen-carrying capacity than untrained The 1970s have witnessed an awareness of another pattern male peers. While athletic males are noticeably superior, of response in females who are training strenuously (Harris trainee females are 25 percent more efficient than untrained 1977; Brozan 1978). Perhaps 15 to 20 percent experience males. Body composition and level of training generally secondary amenorrhea or cessation of menstruation. Several explain the observed differencm between males and females. theories attempt to explain this respons-. The percent body Whether the lean body mass of the female can approach that fat is the most often expressed rationale. Ullyot (1976) says of the male with the same training is a moot point. The female that it is Mother Nature's way of protecting the female. must deliver oxygen to her fat tissue as well as her working Because of reduced body fat, for whatever reasons (starvation, muscle as part of her work load; she cannot leave her fat tissue disease, exercise, etc.) the body does not have sufficient fat in the locker room. storage to support a pregnancy so the system "shuts down." In addition to body composition and level of training, other Frisch (1974) supports this theory to some extent. She factors influence the maximal oxygen uptake. The female developed a method for predicting age for onset of menarche generally has a smaller heart, lungs, chest muscles, blood by charting the height and weight of girls every year during volume, etc. She compensates for these average differences their 9 to 13 age span. She co -,eluded that the ratio of lean with the ability to increase her heart rate to levels higher than body weight to fat is an important determinant of sexual that observed in most males. Another significant difference is maturation in the female. However, this relationship is not a observed in the percent hemoglobin with the female havingas cause-effect one since increasing level° of estrogen cause the much as 10 percent less than the male (Harris 1977). No female to begin to store body fat as yell as triggering the significant differences are observed until puberty between menstrual cycle. In essence, body fat and menarche are both males and females. The assumption has been that the female's caused by elevating levels of estrogen, therefore, increased hemoglobin is reduced through blood loss with menstruation. body fat is not the cause of the onset of menarche. They However, Lamb (1975) reported a 20 percent increase in coincide. hemoglobin in castrated male animals when testosteronewas In several situations a significant decrease in body fat does injected and concluded that testosterone promoted red blood appear to be related to secondary amenorrhea. Starvation, cell production. It appears that males significantly increase anorexia nervosa, and a drastic reduction in caloric intake, their hemoglobin as testosterone increases and that females resulting in a rapid and significant weight loss, produce do not necessarily reduce theirs through normal menstruation. secondary amenorrhea. At the same time obesity can al: o However, males have approximately one millionmore red cause cessation of menstruation. Other stressful situations cells than females and can store 850 mg of iron as compared to such as being in a concentration camp, entering college, the female's 250 mg. Compensatory factors do notappear to experiencing the loss of a loved one, divorce, fear of failure, adjust for this difference in males and females, therefore,some etc., can also alter the menstrual cycle. 43 48 Since reduction of body fat does not hold in all cases of training done by long-distance runners." She suggested secondary amenorrhea reported, other explanations have to further that if there is a correlation between very low body fat be explored. Females who are on the same training program, levels and fertility problems, this may mean that runners of who have no significant differences in percent body fat, and both sexes will have to decrease their running if they wish to who have not lost a significant amount of body fat can be on have children. For women, until their cycles return; for men, the same track team. Some of these women will experience who knows? Shangold suggested that a male with a low sperm secondary amenorrhea while others will not. Individual count who wished to restore it to normal may have to stop differences in response to stress may be the explanation. Why running for 74 days because it takes that long for sperm to some endure stress without any noticeable changes while mature. others do not seems currently a medical mystery. This may be To date there is nothing in the literature to support the the case whether that stress is exercise, quick reduction of belief that there is a high infertility rate among runners, male budy fat, enotional stress, competitive stress, or whatever. or female. The problem may be on a very small scale indeed There is need to examine a whole array of responses tt.-, because of great individual differences and responses to understand why some women experience secondary ame- exercise and stress. The cardiovascular, psychological, and norrhea. other benefits of running far outweigh potential adverse The magnitude of the problem has not actually been erects on reproduction. Further, there is no evidence to established. It appears that several different patterns occur. suggest that any reproductive problems that develop while First, those who have had normal cycles, then experience training are irreversible. secondary amenorrhea with an increase in physical training Another concern about which even less is known is the and exercise, generally resume normal cycles with detraining. possibility of strenuous exercise delaying the onset of In many cases persons did not menstruate for 2 or more years, menarche. The New York Times quoted Dr. Jack Wilmore as stopped hard training, resumed their cycles, and had normal saying, "We know there is a tendency for girls who participate pregnancies and deliveries of healthy babies. in heavy competition before menarche to have onset delayed Second, some women experiencing cessation of menstrua- until they are 17 or 18 but we do not know whether that is tion did not alter their training programs or replace the lost fat good or bad." The average age of onset is between 12 and 1 J tissue, yet their cycles reappeared with time. This would years; however, beginning menstruation at age 15 or 16 is still suggest that the body adapted to the stresses placed upon it considered normal. At a discussion of the ;ssue at the and accommodated them without long-term endocrine altera- American College of Sports Medicine meeting in Chicago in tion. A 1978 survey study completed a`.. Boulder, Colorado, May 1977, physicians could not agree as to the age at which suggests thP.t the percent of those experiencing secondary one should become conerned if the female has not begun to amenorrhea increases significantly as mileage increases. Run- menstruate. At this point it is not known whether strenuous ning 60 or more miles a week may be the critical factor. At this training prior to puberty can be detrimental to normal point no one knows for sure whether exercise per se or low development of the endocrine or reproductive systems. No body fat causes the condition. As Dr. John Marshall, one knows whether it is possible to delay development and cochairman of New York Medical Society's Committee on the then make up for that delay with a decrease in training Medical Aspects of Sports, said, "The body-fat percentage is routine. not the cause; all kinds of things we don't know about the Apparently there is little reason to drastically alter one's delicate balance of hormones have an effect. It may have to do exercise pattern with pregnancy if that pattern has been a part with the kind of training, it may be psychological." Certainly, of one's life-style for some time. Pregnant athletes have the medical profession does not know. accomplished all sorts of athletic feats during the early stages In response to an article in WomenSports (Harris 1977) of their pregnancies. Lynn Blackstone, during her ninth nearly 200 letters relating case studies were received I must month, ran twice around Central Park's reservoir, which is say that I was dismayed at the medical treatment and approximatley 3 miles, each evening. She finished 58th out of guesswork that some women were subjected to, not to 102 women in the 1977 Boston marathon. Mary Jones ran a mention the almost total disregard of even considering that half-marathon race at the Dallas White Rock Marathon in 2 vigorous exercise had anything to do with their secondary hours anc; 3 minutes in December 1976 when she was nearly 9 amenorrhea. One woman spent 6 years with different physi- months pregnant. She returned to marathon running 10 cians experimenting with various tests and theories. She weeks after giving birth saying, "Pregnancy is not a disease. I underwent brain scans, injections of hormones, oral hormone listened to my body and let it dictate what I could do and I'm medication, and exploratoy surgery. Finally, it was concluded healthier for it." Many others report the same experience. that she was "having identity problems ,-. nd denying her Trina Hosmer, U.S. Olympic cross-country skier in 1972, ran femininity" since nothing irregular or abnormal appeared 4 miles 2 h. 'Es before her first child was born. She barely hati beyond the fact that she did not menstruate. time to change and get to the hospital for delivery. While While alterations and changes in the female cycle are Trina may be exceptional, no evidence exists that regular obvious, males may have similar alterations and not even exercise and running during pregnancy have to be discontinued know about them. A little-known 1973 Finnish study reported if the female is used to regular exercise. in the 1976 British Journal of Steroid Biochemistry involved Osteoporosis is far more prevalent among women than hormonal assays before and after in males running a marathon. men; several reasons may account for this. First, growing girls Statistically significant changes were observed in several are not generally socialized to participate in vigorous exercise hormones which impact on male sexuality. A rise or fall in during those years when bones are developing and growing so their levels can adversely affect fertility, both in decreasing sex that stresses placed on them during this time can result in drive and lowering sperm cot nt. Almost no one has examined stronger, denser bones. Second, estrogen levels decrease with this relationship. Dr. Mona Shangold, physician-endo- aging and onset of menopause and the effect that estrogen has crinologist, suggested, "There may be a relationship between in stimulating bone maintenance is lost to some degree. Third, reproductive problems and chronic exercise such as extensive females do not exercise enough throughout their lives to 44 49 stimulate bone maintenance. Running, jogging, or other types that she compensates for these differences. Or,we could say of regular exercise are especially important for aging women, that the male compensates, as in thecase of his having to sweat yet the emphasis has been on males' getting exercise. The sooner in order to cool his body. harmful effects of inactivity on bone tissueare well doc- When training and conditioning are equal, thereappears to umented; long-term bed rest can lead to early osteoporosis. be no difference in the injury predisposition betweenmales Even bones that are briefly in a plaster cast tend to become and females. Statistics suggest that femalesare more vulner- lighter because of mineral loss. The astronauts experienced able to leg and knee injuries. Again, the level of physical alteration in bone metabolism during periods of weightlessness conditioning and fitness is more importantthan one's sex. As and physical confinement. increasing emphasis is placedon this for female athletes, the On the other hand, exercise stimulates bone growth and injury statistics are associatingmore with the type of sport maintenance; one has only to examine one's dominantarm to played rather than sex. In short, basketball players will compare the difference between it and the lesser-used one. experience similar types and rates of injuries that willnot be Prevention and/ or delay of osteoporosisappears to be related sex linked. Much research is needed before full understanding to vigorous exercise during the growing years to maximize the and i night into iust what differences do existbetween the skeletal development, then continued exercise throughout response of males and females to long-term strenuous exei cise. one's lifetime with some attention paid to theamount of Right now it appears that the sauce for the gander is goodfor calcium in the diet. the goose. The female gains all the '!fits and pleasure of Females may be more efficient in heat dissipation,or less having as healthy fit bodyas the male and certainly the joys efficient than the male, depending on how the research is and challenges of sport participation and competitionare not interpreted. Studies show that males do sweatsooner and sex-linked. From everything available in the literature,the more profusely than females in response to increased body responses are all positive in physiological and psychological temperatures. However, males may be prolific wasteful ways. sweaters. The female may adjust her sweat ratemore efficiently, that is, she can compensate for the observed differences. On the average, females have more sweat glands References than males. Generally, her body temperaturegets 2 to 3 Brozan, Nadine April 17. 1978. Training linked to disruption of female degrees warmer than that of the male's before she beginsto reproductive cycle The New York Times sweat. Females sweat less than males and can perform the Frisch, Rose E 1974 A method of prediction ofage of menarche from height same work loads with less water loss. Both males and females and weight at ages 9 through 13 years Pediatrics 53(3).384. Harris. Dorothy V. 1977 The anemic athlete WomenSports 4(12) 52 acclimatize to work or exercise in heat; however, femalesare Harris, Dorothy V 1977 The monthly mystery WomenSporis 4(9) 49 able to do so without increasing their sweat rates. Theremay Hermanson. L and Andersen, K.L 1965 Aerobic work capacity in young be some explanations that have not been examined. First, Norwegian men and women Journal of Applied Physiology 20 425-431 higher levels of estrogen in females tend to providegreater Lamb, David R. 1975 Androgens and exercise Medicine and Sciencein vascularization, therefore the female may be able Sports 7(1) I. to get more Lane. R. Sports anemia 1978 The Jogger September blood to the surface of her body for cooling which would Seefeldt, Vern D 1978 Scope of youth sports programs in the state of delay the sweating process. This factmay allow her to Michigan. In Smoll, Frank L and Smith, Ronald E (Ed ). Psychological compensate for her additional fat insulation and smaller body rw2rspectives youth sports New York John Wiley & Sons surface. Second, since the female has more active sweat glands Ullyot, Joan Women's running1976 Mountain View. CalifWorld Publications than the male, her sweat is distributedmore evenly over her Wells, Christine L Sexual differences in heat-stressresponse 1977Tice body for maximal cooling by evaporation, againcompensat- Physician and Sporismedicine 5(9).79 ing for her smaller body surface. Wilmore, Jack H The female athlete 1977 The Journal of School Health April While the male sweats sooner, the femalemay sweat better. Wilmore, Jack H and Brown. C tIarrnon 1974 Physio:Jgical profiles of Wells (1977) also suggested that womenmay regulate their women distance runners Medicine and Science in Sports 6(3) 178 body temperature more effectively than males do fromher research in heat environments. Perhaps it is time to examine Additional Reading this response more carefully and stop perpetuating the notion DeWkin, J F DeJongste, J LMosterd. W , and Willebrand, D 1971 that females may be less effective in heat dissipation Oncethe Hemoglobin, packed cell volume, serum iron, and iron binding capacity of selected athletes during training Journal of Sports Medicine and Physical next generation is socialized out of the notion that men sweat, Fitness 11 42-51. gentlemen perspire, and ladies glow, wemay observe a Morimoto. T, Slabochova, Z Naman. R K, et al 1967 Sex differences in different response to heat stress. physiological reactions to thermal stress Journal of Applied Physiology. In summary it appears that while the mcle and female do 22 526-532 differ in many respects in terms of their response to vigorous Scott, D F and Pritchard, J A 196/ Iron deficiencyin healthy young college exercise, there are more differences within a women Journal of the American Medical Association 199 897-900 sex than between Weinman, K P., Slabochova, Z Bernauer, E M, et at 1967 Reactions of the sexes. The level of physical fitness mediates the difference men and women to repeated exposure to humid heat Journal of Applied to a greater extent than sex. Further, when differences- _ Physiology 22 533-538 observed in trained males and females, in mostcases the Wyndham. C H , Morrison, J F, and Williams, C G 1965 Heat reactions of response is one of adapting and conditioning to chronic male and female Caucasians Journal of qpplied Physiology 20 357-364 Yoshimura, H 1970 Anemia during physical training (sports anemia) exercise. In many situations the female adapts differently it Nutrition Review 28 251-253

50

45 Psychological Benefits of Aerobic Exercise

Dorothy V. Harris

Exhilaration, euphoria, ecstasy, peak experience getting feeling in his body movements. But he is also aware of the high, being spacy, or whatever one labels it, the experience muscular tensions that restrict his movement, for these too is basically the same for those persons who are physically fit create sensations ... Not being in touch withhis body and who pursue exercise as an end in itself. They are "tuned from within, it feels strange and awkward to him, which in" and "turned on" by exercise. They enjoy the psychological makes him feel self-conscious in his expression and movement. and physiological returns they get from such experiences and return again and again for these sensations. The pure joy of Exercise and physical activity can provide opportunities to participation in physical activity caa only be gained when the develop self-awareness through the integration of body, mind, activity is viewed as nonpurposeful in a utilitarian sense. The and feelings. Becoming aware of what is happening within the body is not thought of as a machine or object requiring body intensifies the experience and increases one's awareness. maintenance or something that works independently from the This awareness provides a type of feedback that produce' a mind or feelings. Nor can exercise be viewed as something the sense of mastery, control, and competence that can be reached body needs like medicine or a treatment if one wishes to in no other way. experience all that exercise can offer. Deci, in his book published in 1975, deals with human This is not to say that one does not get involved in exercise motivation. He presents a cognitive perspective in attempting initially to get into shape, to lose a few pounds, or to counter to account for the "whys" of voluntary behavior. He works ill effects of a sedentary life. However, in the process of under the assumption that most behaviors are voluntary and reaching these initial goals one may discover that other things that persons choose these behaviors because they desire the happen. One person who had just gone through a traumatic end result. Therefore, the person perceptions and cognitions divorce and knee surgery had this to say: "I was in a physical will be basic to his behavior. Tlie operational definition of and psychological rut. Running seemed a logical way to get intrinsic motivation suggests that activities engaged in are my knee back to normal. The unexpected dividend was that I ends in themselves as opposed to a means to an end. In other got my head together, too." words, intrinsically motivated involvements are ones for Regular participation continues long after the original which there is no apparent reward except th.t activity itself. As goals are reached. Persons dig ^^ that exercise is fun, that a result, persons participate in activities for the feedback they they experience a sense of total integration never reached get in the process 4 being involved and not because the before. They find that they are tuned intn their bodies and involvement leads to an extrinsic reward. Many activities are disco er things about themselves that are reinforcing in a intrinsically rewarding; persons spend much time playing most positive manner. Traditional physical education has sports, solving puzzles, practicing skills, and so on because been making claims such as these for y,rs; however, little they produce certain types of internal conditions that they systematic evidence exists to support such an idea. Most of the find rewarding. early research in personality and sport was based on the Another basic premise upon which the notion of intrinsic notion that a "sound body ensured a sound mind." Con- motivation is based is that people tend to be motivated to ceptually, the questions being askee were correct ones; the reduce uncertainty and to feel capable of dealing effectively method and instrumentation frequently prevented the in- with the environment. The concept of competence proposed vestigator from finding real insight into such a relationship. by White (1959), rejects the notion of a drive-reduction theory When one is out of touch with his body and his feelings, he and emphasizes the importance of the interaction of the cannot be a fully functioning, integrated being. As Alexander person with the environment. His concept of competence Lowen said in his book, Pleasure (1970): refers to one's ability to deal effectively with one's environment through a whole range of behaviors such as exploration, Self-awareness is a function of feeling. It is the summation percept:or., cognition, manipulation, and so on. According to of all body sensations at any one time. Through his self- White, the competence motivation or effectance motivation is awareness a person knows who he is. He is aware of what is what directs these behaviors that are motivated by the going on in every part of his body: in other words, he is in intrinsic need to cope effectively with the environment. White touch with himself. For example, he senses the flow of explained that young children have patterns of undifferen- tiated effectance motivation. However, with additional ex- Dorothy V. Harris is a professor at Pennsylvania State University; perience, behaviors are more differentiated intc specific University Park, PA. motives for mastery, cognizance or achievement. Ellis (1973)

46 51 indicated in his book that the proposition of White accounted explode when it comes off...it's such a mental climax." for behavior beyond the arousal-seeking behavior that Ellis One doesn't have to be an athlete to experience "flow"; had used to explain childrer's play. That is,White's continued participation is the key for young and old alike. The competence-effectance motive would explain the repetitious opportunity to reach altered states of awareness are created behavior that persists after the novelty has worn off; this when you forget about gaining any external reward for your behavior can be explained as manipulation to produce effects efforts. Once exercise is the end, not a means, sensations cone on the environment. through loud and clear and the body feels energetic, alive, Deci proposed that one's need to feel competent and tingling, and capable. When the body is "let go" in exercise, self-determining will produce two general classes of behavior. almost anything can happen. First, persons will seek out situations that providea reasonable Back in the early sixties when jogging was becoming the challenge; if one is bored, one will seek a challenge, if one is thing to do among some status groups, its benefits were overchallenged, a different situation will be sought that will measured in health and medical terms; one exercised to provide a challenge which can be handled. Inessence, this prevent a heart attack, or to develop a sexier body, or to lose a suggests that the motivational mechanism operating will lead few extra pounds. However, the benefits were too far removed persons to situations where they are challenged to make from the exercise to keep most persons motivated to continue. optimal use of their abilities. Those who did persevere discovered that in addition to doing The second class of behaviors motivated by the need for fantastic things for the body, exercise did something for the competence and self-determination that Deci described were head as well. From thic' joint on, they no longer exercised for those needs to be successful in challenge situations. That is, health; they exercised because they felt good. As a matter of persons are motivated to reduce dissonance when they fact, there is some evidence to suggest that one can become encounter it or create it. Many create dissonance or incon- addicted to exercise, that one feels less well without it and gruity just so they can have the challenge of masteringIt. suffers withdrawal effects when itis missed. Itis not Thrill addicts were once thought to have a death wish or an surprising, then, to have persons feel deprived when they can urge to self-destruction; however, research supports the fact no longer exercise. that they are exceptional in their emotional health. Dr. Baekeland (1970) explored sleep and psychological reac- Edward Stainbrook, head cf the Human Behavior Depart- tions to exercise deprivation. He found it was difficult to ment of the University of Southern California, said, "So much recruit subjects who exercised regularly and were willing to of life has become sedentary, inhibiting action. Thrill seeking give that up for a month or so. Even th ugh they were offered expresses an almost desperate need for assertive mastery of good pay and knew that they would make a contribution to something. In some cases, the aggressive defiancecan be science, they were unwilling to deprive themselves of their overdone and become a disguised suicidal drive. Butmore regular exercise habits. Many said they would not stop often, it's just a quest for control of self and for doing, exercising for any amount of money. Baekeland's subjects rather than thinking." v.ere persons who exercised three to four times a week. "Action is the adolescent antidepressant," said Dr. Gerald However, they too viewed the anticipated no-exercise period Polin, a psychiatrist who has researched this phenomenon. He as exercise deprivation rather than as exercise restriction. suggested that thrill sports may be a symptom of the depressed The subjects' sleep was studied for two nights several days feelings that many adolescents have. Many persons of allages apart while they were still exercising regularly. The no- express a petiodic need for extending themselves to absolute exercise period was sampled at intervals of about 2, 7, 14, and physical, emotional, and intellectual limits in order toescape 30 days after the last exercise bout. The EEG sleep records from the routine and boredom of everyday living. were scored for the conventionally defined stages of sleep. In Beyond Boredom and Anxiety, Mihaly Csikszentmi- REM frequencies were also recorded. A questionnaire halyi (1975), a psychologist at the University of Chicago, evaluated the psychological changes observed near the end of discusses the basis of experiencing enjoyment and fulfillment the no-exercise period. The findings reported indicated a through activities for which the primary reward is in the change in sleep patterns suggesting increased anxiety over the experience of the activity rather than other outcomes. In no-exercise period. The subjects' subjective reports indicated activities of this type the person experiences an altered state of a decrease in the quality of sleep at home, increased sexual consciousness that he calls "flow" where one is aware of his tension, and an increased need to be with others. actions but not aware of his awareness. Concentration is so In a book entitled Positive Addiction, Glasser (1976) focused on the process of doing that any thoughts of whatone reported that runners can become posit,, ely addicted to the is doing or how one is doing woule stop the "flow." In this euphoria of running and that this can providea source or sta..e the integration of mind, body, and feelings is so focused adaptive strength that can be transferred to otherareas of life. that "flow" provides a dimension in the activity that cannot be Glasser indicated that there were six steps one has to follow in reached intentionally; it just happens. .k.N\order for this positive addiction to take place. The physical While athletes have known about these "altered states of -activity pursued ...ust be noncompetitive and one chosen consciousness" for some time, they have only recently begun voluntarily. It must be an activity that onecan do easily, that to share their highly personal experiences. It is a nonverbal, does not require a great deal of mental effort, and at whichone almost overwhelming sensation. It can be felt during losing or could spend an hour or so a day pursuing. It must be during noncompetitive moments, too... by the parachutists something that can be done alone or with others butnot in flight, by the skier, by the runner running alone, Dwight dependent on others. The participant must believe that it has Stones talked about such an experience the day he broke the some positive value, either physical, mental, spiritual, or all world high jump record at the Munich Olympics. "The realiza- three. Further, the participant must believe that persistence tion of reaching 7-61,4 startled me...I just lost control. I will be rewarded by improvement. It should be noted, remember I couldn't wait to hit the pit...it seemed like an however, that only the participant will be the one to evaluate Aernity.... The whole thing was so spontaneous, so un- the improvement. Finally, the activity must be ofa type that planned. You know certain goals are within reach butyou still one can do withoot criticizing oneself; one must accept the self 47 52 1 at whatever level of performance. Glasser suggested that these three psychological inventories: Zung DepressionScale, are the reasons why running has become so popular with Eysenck's Introversion-Extroversion Scale, and the Human many persons who have never done any other type of regular Figure Drawing. In addition they were asked to keep a journal physical exercise. of their physical activity, mood states, and sleep habits. Other writers (Andrews 1976) report that there are definite The second study by Brown, et al., attempted to control psychological milestones that runners reach in the route to more variables and added several more inventories. There altered states of consciousness or heightened awareness. were three groups: a no-exercise, one running three times per These milestones have more to do with how long one runs week, and one running five times per week. Each treatment rather than how far one goes. Even the most accomplished lasted for 10 weeks. Several outcomes of these two studies and fit runner experiences general discomfort during the first were reported: ( I) subjects in the exercise group, depressed or 20 minutes or so and asks himself why he is doing this. After not, showed increases in mental well-being, (2) the number of about 30 minutes he begins to feel a mild sort of euphoria. He depressed subjects dropped from 37 to 14, (3) psychological has worked out the tensions and is being "lulled" by the scores of the subjects in the nonexercise group did not change. rhythm of his breathing and running. After about 40 minutes Brown, et al., also found that the amount of exercise was he loses the ability to organize thoughts and ideas flash in and significant; the more vigorous the activity, the more significant out without any conscious effort. After about an hour of the change. No significant difference was observed in those running one reaches an altered state. If running is continued, persons participating in sports requiring low levels of physical the runner feels a mystical unity with the surroundings and the activity. Brown, a psychiatrist at the University of Virginia, Zen of running can really be enjoyed. says that he has not observed anyone jogging on the track who Kostrubala (1976), a psychiatrist and a veteran mara- ever appeared to be depressed. He finds that exercise works thoner, says that running is a natural form of psychotherapy. better than pills in controlling depression. Approximately 70 Few people can run and worry at the same time. Kostrubala percent of his patients are depressed and all but about 15 to 20 has trained several of his assistants as "running therapists" percent show quick benefit after only a week of running. and claims some success in using jogging as a treatment for Folkins, Lynch, and Gardner (1972) have also used depression, drug addiction, and other psychological problems physical activity as a treatment for psychological d'sorders requiring treatment. He said, I think this is a new and with reported success. They used several adjective checklists powerful way of reaching the unconscious." to measure variables related to both depression and anxiety. A British medical team headed by Dr. Malcolm Carruthers Three college physical education classes formed the exper- reported that running does change the hormones of the body. imental and control groups; an archery class and a golf class As little as 10 minutes of endurance exercise can double the were used as controls with a jogging class serving as the body's level of norepinephrine. This neurohormone is experimental group. Preliminary testing showed that the associated with alertness, responsiveness, and a high level of two groups differed on the psychological variables; the mental and physical activity. This tends to reduce depression women in the experimental group were significantly less fit and anxiety for a period of time (Parker 1978). psychologically than the controls. They were more anxious, Several other investigaton support the notion that "action more depressed, less confident, and less well adjusted. After absorbs anxiety," or that exerciseis nature's own best 15 weeks of running, these females had shown significant tranquilizer. DeVries and Adams (1972) studied 10 patients, improvement in all these areas. The males also improved but 52-70 years old. One day they gave their patients a tranquilizer not to the same extent. No changes were observed in the and the next day had the patients walk vigorously enough to controls. raise their heart rates over 100 beats per minute. The exercise Driscoll (1976) used physical exercise to counter anxiety produced a greater calming effect than the tranquilizer with along with positive imagery a'id reported success, empha- positive rather than negative side effects. The paradox sizing the short time treatment took with exercise. Orwin appears to be that one must exercise to relax. Traditionally (1974) used running to overcome phobias and demonstrated relaxation has been associated with being sedentary yet all of that physical exhaustion interfered with anxiety. Using this the scientific evidence suggests just the contrary. treatment he found that persons could become conditioned The mystique of jogging, along with the claim to work to their fears much more read,'fter vigorous exercise than wonders for the body and soul, has begun to invade the without it. He concluded that s., le sort of physical exercise domain of American nsychiatry. Many are now prescribing should be included in all therapies for anxiety. exercise instead of pi..s for moderate depression. Writer In the late 1960s and early 1970s Morgan has produced Valerie Andrews, author of the book,The Psychic Power of more systematic evidence than any other investigator to Running(1978), argues that weekend jogging could well be date. He has completed a series of studies (Morgan 1967, the basis for the nation's first grass-roots movement in com- 1969,1970; Morgan etal.,1970) and concluded that munity health. UCLA psychiatrist Ronald M. Lawrence says, differences in depressed persons ability to perform physical "Mild depression is more common than the common cold, but tasks were psychological, not physical. In the second phase it can be markedly helped by slow endurance exercise." He of one study (Morgan et al.. 1970), 101 subjects participated said further, "Man was meant to be a moving animal, but he's in six weeks of physical activity: circuit training, jogging, become sedentary. Distance running can bring us back to the swimming, treadmill running, or bicycle ergometry. Through basics of what we're here for." While hard evidence is lacking, this phase Morgan reported that the depression scores oi Ismail and Young (1977) observed significant relationships those subjects in the normal range did not change; however, between changes in certain hormone levels of exercises and those persons who were depressed changed significantly at improvement in emotional stability. the .01 level. Brown, Ramirez, and Taub (1978) have also produced More recently Morgan (1976; Morgan and Pollock i976) evidence demonstrating a decrease in depression with exercise. has begun to make wider claims concerning depression as it Their first experiment involved 167 high school boys and girls is affected by regular physical activity. In one report he who were participating in a variety of sports. They completed indicated that "acute and chronic physical activity of a 48 53 vigorous nature offers a unique and effective method of Selected References reducing tension (state anxiety) and depression" (Morgan 1976, p. 17). In another paper (Morgan and Pollock 1976) Andrews, Valerie 1978 The Psychic Power of Running. New York Rawson, similar claims are made; however, the writers caution one to Wade Publishers, Inc. Andrews, Valene 1976 The joy of jogging Nev,' York 10 60-63 keep in mind that this "improved sensation of well-being Baekeland, Fredenck1970. Exercise depnvationArchive.) of General following acute ind chronic exercise" (p. 3) may have other Psychiatry 22.365-369 causes. The poir.t is the.t when one decides to make a change Brown, R S , Ramirez, D E & Taub, J M 1978 The prescnption of exercise in one's life-style such as embarking on a regular exercise for depression The Physician and Sportsmedicine 6 34-45 Csikszentmihalyi, M. 1975. Beyond boredom and anxiet I San Francisco. routine, this may influence one's psychological well-being in Josey-Bass, Inc. a positive manner. In addition, when one decides to exercise Deci, E L. 1976. Intrinsic motivation. New York. Plenum Press regularly, changes in other habits such as eating and sleeping deVries, H. A & Adams, G. 1972 Electromyographic companson of a single frequently occur, resulting in a generally more healthy life dose of exercise and meprobamate as to effects on muscular relaxation pattern overall. American Journal of Physical Medicine 51.130-141 Dnscoll, R 1976. Anxiety reduction using physical exertion and positive In summary, the literature search produced a significant images Psychological Review 26 (I) 87-94 amount of empirical evidence demonstrating the positive Ellis, M J. 1973 Wiy people play. Englewood Cliffs, N.JPrentice-Hall, relationship between exercise and an improved sense of Inc well-being. In general, this improved sense of well-being was Folio ns, C H., Lynch, S, & Gardner, M M 1972 Psychological fitness as a function of physical fitness Archives of physical medicine and rehabilitation attributed to a decrease in anxiety and depression. Without 53.503-508 question, the universal testimony to regular exercise is GL ser, W. Positive addiction 1976 New York: Harper & Row. "feeling better." This feeling better may also include other Ismail, A. H. & Young, R J.1977. Effect of chronic exercise on the components such as more positive body image, a sense of personality of adults. In Milvy, P (Ed ), The marathon: physiological, medical, epidemiological, and psychological studies New York. New York self-efficacy, more energy, and so on. Obviously much more Academy of Sciences. (AN YAA9 301 1-1090) research is needed before better insight and understanding Kostrubala, T. 1976. The joy of running. New York: J. B Lippincott, Co are reached. Lowen, Alexander. 1970. Pleasure. New York: Coward-McCann There is a dearth of systematic research addressing these Morgan, W. P. 1967. Selected physiological and psychomotor correlates of questions and the methodological problems are great. At the depression in psychiatnc patients Research Quarterly 391037-1043. same time, the relationship has been demonstrated :An- Morgan, W. P. 1969. A pilot investigation of physical working capacity in depressed and nondepressed psychiatric males. Research Quarterly ciently through personal testimony and the few studies that 40:859-861 are reported to encourage the participation in regular Morbsn, W P. 1970. Physical working capacity in depressed and nondepressed exercise to reduce psychological stress. While directions are psychiatnc females A preliminary study. American Correctional Therapy lacking with regard to length of time one should exercise, the Journal 24.15-16 Morgan, W. P. 1976. Psychological consequences of vigorous physical degree of effort that should be put forth, and how much activity and sport Paper presented at the annual meeting of the American one's perception of what is happening influences the out- Academy of Physical Education, Milwaukee, Wisconsin. come, the conclusion that regular exercise is associated with Morgan, W. P., Roberts, J A., Brand, F. R, & Femerman, A. D 1970 feeling bey n. can be made. When one feels better, one Psychological effect of chronic physical activity. Medicine and Science in Sports 2.213-217. behaves in a more positive manner; how one feels about Morgan, W P., & Pollock, M L. 1976. Physical activity and cardiovascular one's body has much to do with how one feels about oneself. health. Psychological aspectsPaper presented at the International In short, the bottom line may be self-esteem associated with Congress of Physical Activity Sciences, Quebec City, July 12 a sense of "I can do it" that produces the positive feedback. Orwin, A 1974. The nning treatment. A preliminary communication on a Whatever the cause-effect relationship, there appears to be new use for an old therapy (physical activity) in the agoraphobic syndrome British Journal of Psychiatry 125 195-198. enough evidence to associate psychological well-being with White, R W 1959 Motivation reconsidered The concept of competence regular vigorous exercise. Psychological Review 66 297-333

J '

49 The Physiological Responses of Females to Endurance Exercise

Harold B. Falls

his article focuses on female teems of the health aspects of aerobic point, and especially from a health Taerobic responses although perform exercise, emphasis should be on the standpoint, we are dealing primarily ance in endurance exercise may require cardiac output as the importa.it func- with cardiac output and with stroke other qualities. tion. However, if ,vs are going to talk volume of the heart as far as maximum "Aerobic" implies metabolig-t with aboL t physical performance in relating performance is c-ncerned because if we oxygen, i.e., the oxidative p..c,sphsr- the events in winning the Boston mara compare males and females, there is ylat ion "segment" of he total metabolic thon, we would also have to take into very little difference in maximum heart process involved in cl gading foodstuffs consideration A .A -Vo2. rate and actually very little change in in the muscle cell. This would exclude I disagree with one point made by maximum heart rate with training. the immediate energy that might be Dr. Harris, in a previous article. Ithink A legitimate qu-stion is, "Do males derived from (I) the splitting of adeno- most of the literature indicates that and femalesy .!spond differently to sine triphosphate (ATP), or (2) glycolysis there is not --Ally a difference 1:etween exercise?" First, let's look briefly at the (the glycogen to lactic acid pathway). A males and females on maximum heart overall male response to both exercise high level of functioning as far as rate if they are in..; same relative state training and sedent-,habits, again oxidative phosphorylation is concerned of training. Therefore, maximum c-~ ' from the work of Saltin et at (1968) requires a high .ate of oxygen delivery output iifferences between the sexes (Figure 2). to the muscle cells. This is directly are primarily a reflectio .4 differences In the study represented by Figure 2, measured to the maximum oxygen con- in maximal stroke voluna... max Vol, was measured before and sumption (max Vo2). Oxygen consump- The responses of max Vol, SV, after 21 days of bed rest in two trained VIII, in turn, is a function of cardiac and HR to aerobic exercise training and and three sedentary young adult males. output (0) and arteriovenow oxygen the reverse (sedentary habits) have been They were also measured during and difference (A A-Vo2). Thus demonstrated by Saltin et at (1958) after 8 weeks of exercise training that Figure 1). followed the bed rest. It is easily seen (1) Vol = 0 X A A-17/02 Again, I am just trying to emphasize ,hat all the subjects decreased in aerobic that from an aerobic-exercise stand- capacity with bed rest and increased cardiac output is a product of heart rate (HR) and stroke31ume (SV) of the MAXIMAL OXYGEN UPTAKE heart. y. (3 S'AJECTS ) 3 41 (2) 0 n HR X SV 5;0; 2.52 As far PS the health - related effects of 150r exercise are concerned, epidemiologists Q have not been able to identify any 10 0- 1.74 (SV), sgy adverse consequences of having a less than high t A-Vo2, or even one that is somewhat below normal. They have, 50 however, identified that there are prob- ably some relationships between the development of circulatory diseases and 20 DAYS 50 DAYS certain levels of cardiac output below normal or perhaps below an optimum level that is yet to be identified. Thus in Figure 1. Maximal oxygen uptake during tre,-dmiil running for three subjects ( I ) after bed rest (= 100%), (2) when they are habitually sedentary, and (3) after intensive training, respectively. The higher oxygen uptake under sedentary conditions compared with bed rest is due to an increased maximal cardiac output. The further int ease after :mining is possible due to a further increase in maximal cardiac output and a small increase in arteriovenous oxygen Harold B. Falls L. professor of health and difference. The maximal heart rate was the same throughout the experiment. Therefore. the physical edi-,:dtion, Southwest Missoun State increased cardiac output was due to a larger stroke volume. (From Astrand and Rodahi 1977. University, Springfield, MO. R-orinted with permission of McGraw -/fill Book Co.)

50 55 Min mon tin vexes and in relative position on a . ,I MAXIMAL OXYGEN UPTAKE continuum of aero')ic capacity. In the remainder of this presentation. I want 30 tc focus on some of the factors I feel seem to explain those differences. 4 0

The Continuum Of Aerobic. Power 30 I feel very strongly that we can view the entire range of aerobic power as a 2 0 continuum that includes both male and female values (Figure 4). Lowest valies (ml X kg X min-') in the population would likely be about 10-15. Highest know n values for males approach 95 ml 0 X kg'. The highest value of which I am aware for a female is 74 ml X kg '. This value compar_s very favorably with many male marathon champions and other world-class long-distance runners Figure 2. Changes in maximal oxygen uptake, measured during running on a treadmill, and Nordic skiers. before and after bed rest and at various intervals during training; individual dataon five Factors that contribute to high or subjects. Arrows indicate circulation studies. Heavy bars mark the time during the training low max Vol are shown in Figure 4. period at which the maximal oxygen uptake had returned to the ccitrol value before bedrest. Population averages are about 45-50 ml (From Sabin etal1968. By permission of American HeartAssociation,Inc.) X kg X min-' for the male and 35-40 ml X kg X min-' for the female. We see a with training. In fact, compared with Vol at a 2I -year interval (Table I). difference in the highest known values, the beginning of the study, the sedentary There was a decrease in both sexes, arra and we see a difference in the average subjects were about 33 percent higher the rate of decrease was very nearly the values. However, I still think the trait on max Vol after the training. This is a same in both, whether one compares on car. be viewed as a continuum, and I general respon.e to exercise in males max Vol in liters X min-' or ml X kg X have tried to represent this in terms of verified by many other studies. If one is min'. Both males and females at age normal distributions for aerobic power inactive or very sedentary, he will de- 42-46 were at about 80 percent of their based on the means and standard devia- crease in aerobic capacity, whereas if ma.: Vol values exhibited 21 years tions (SD) for Swedish young adult one trains, and the training program earlier at age 22-25. physical education students presented observes the proper mix of intensity, Similar results have been obtained by in Astrand's classic 1949 work (Astrand frequency, and duration, Vol max will others. The studies cited above are 1952) (Figure 5). Mean values for aerobic increase. merely good examples of the pattern of power were 58 and 48 ml X kg X min-' Similar data on females are limited, responses seen when males and females for males and females respectively.I but many have become available over of similar fitness status are directly think we canreasonably viewhis data the past few years. One study by Burke compared. The responses to exercise as samples from a normal population (1977) (Figure 3) compared college-age and training appear to be very similar. and use the SD to roughly picture the male and female responses to an 8-week Differences do seem to be operating in way the separate male and female dis- training program. There was also a regard to the degree of response between tributions would look when plotted out control group. In both cases, the subjects v.... r sedentary. Both males and females improved during the 8 weeks at ap- proximately the same rate. The major apparent sex differenceisthat the females were about 20 percent lower 55 than the males on max Vol atti.!, VO2 Max beginning of the stud!, and this relative (0004) difference was maintained throughout. 45 ft nother recent .study compared the effect., of bed rest in both males and ...... females. Although tit., females exhibited NAM( CONT1101 ....''.....". a to _sr.."' a 40 percent lower max 302 before bed ...... "11/111/ AI IXPIIIIIMIP !Al rest, both groups decreased 9-10 percent 30 on the rrAsurement as a result of the 4:51 period of bed rest, which was slightly I I shorter han in the study of Saltinet al. S Weeks (1968) (Convertinoet al.1977). Male-female aerobic-power changes have been compared longitudinally from Figure 3. Changes in aerobic power during 8 weeks of training in young adult males and the aging perspective by measuring max females. (From Burke 1977).

51 56 distributions. Again, considerable over- Table 1 lapping of distributions is noted as in Maximum Oxygen Consumption in Male and Female Physical Educaticn Studepts after a 21-year Interval Figure 5. Viewing the overlapping of distributions in this way, it appears that 1 X min-1 ml X kg X min' the average female compares almost male female male female directly with the untrained male in terms of aerobic power. The questions 1949 4.09 2 83 58 5 47.3 1970 3.28 2.20 45 3 38.4 that become of most interest then are (I) what physiological and anatomical Source: I. Astrand, P.O. Astrand, I. Hallbkk, andA.Kilbom Reduction in maximal differences explain the different relative oxygen uptake with age. Journal of Applied Physiology 35649-654, 1973 positions of males and females on the continuum, and(2) what arethe implica- tions for aerobic exercise prescription?

Anatomical.1ndPhysiological Averages Differences Young adult male 45-50ml Young adult female 35-40 ml Heart Size

Table 2 presents data from a large study of heart size in the Soviet Union. It shows that the female heart is about 85 high percent as large as that of the male when comparisons are made on absolute volume. There have been some argu- ments that if one corrects for body size, 15 ml/kg 95 ml/kg this difference disappears. Not so. When Lung disease Good genetic stock the heartsize is expressed as .al X kg-', Sedentary habits Participation in ml X m2, or as a weight measure in gm X Old age endurance sports kg-1,the female heartisstill 80-90 Circulatory disease Excellent nutrition Poor nutrition percent as large as that of the male (Astrand et a/., 1964; Grande and Taylor 1965). Figure 4. The continuum for maximum oxygen uptake. Values are in ml X kg X min"' The maximum stroke volume is pos- itively related to theheart size (Figure 7,.In the young adult, the SV of the male is about one-third larger than in the female (Astrand and Rodahl 1977). In Younger persons, there doesn't appear to b.- 1 difference, or perhaps as large a difference. However, there really aren't enough data available on maximum SV in young females to be certain. If SV isn't smaller in young females compared with young males, it could mean there is 38 42 46 5r 54 5R 8 62 66 70 also not a significant difference in heart X9 o' size at those ages. MAX c/02 "i kg-I Blood Hemovohin

re 5. Overlapping male and female distn3ut.ons for max Vol when ± 3 standard After about 11-12 years of age, there dc-tions are considered. (Based on data presented in Astrand 1952.) is z difference in the hemoglobin concen- tration of the blc,od in males (15 gm X 100 ml blood') ccinpared with females 3 SD from the respective means. have presented the max ',:)2/ age relation- (12.5-13 gm X 100 ml blood') (Altman What we then see is that the mean male ship (Figure 6). The more.solid lines and Dittmer 1971). Since each gram of value is included within the distribution represent the mean max Vol. Up to hemoglobin (Hb) will carry about 1.34 for females, and the mean for females about age 10, there is essentially no ml 02, this means a reduced oxygen- within the range of the distribution for difference in the male and female values. carrying capacity for her blood. Figure males. There would be considerable After that age, males continue to in- 8 shows the classical oxyhemoglobin overlap between the two distributions. crease while females tend to level off, dissociation curve usually found in Further support for this concept and then both sexes decrease as they physiology and exercise physiology text- comes from material in AsIr.,nd and continue to age up through the range of books. These curves are a rem-esentation Kodahl's textbook on work physiology age shown in Figure 6. The lighter lines of A A-Vo2. Note that in most textbooks (Astrand and Rodahl 1977) where they represent ± 2 SD for each of the the curve pl esented is based on male

52 57 proximately the same in males and females (Astrand and Rodahl 1977) (Figure 10), the net effect of reduced hemoglobin is a narrower A A -Vo2 leading to a reduction of max Vol according to the relationship in Equa- tion :. Because of the lower max A A -Vo2 the female's inaximum performance in aerobic exercise is likely to suffer. If A A-Vo2 ln Equation Iis reduced for a given Vol, Q must be increased. It has been shown that at a Vol = 1.5 liters, the male can transport sufficient oxygen at

10 20 30 40 50 60 a cardiac output of 12 liters X min' while 13.5 liters are required in the Years female (Astrand and Rodahl 1977). Thus reduced A A-Vo2 has a tremen- Figure 6. Mean valuesfor maximal oxygen uptake measured during exerciseon treadmill or dous impact on the efficiency of using bicycle ergometer in 350 female and male subjects four to sixty-five years of age. (From whatever cardiac output is available Astrand and Rodahl 1977. Reprinted by permission of McGraw-Hill Book Co ) within a given individual.

PercentageBodyFat

Anotherfactor that has already been Table 2 mentioned by Dorothy Harris is the Heart Volumes of Athletes and Nonathletes* body-fat differential between males and females. In a typical young adult male, Males Females fat comprises 12-15 percent of the total body composition. Similar values for Athletes 860 725 the young adult female are 20-28 percent Nonathletes 670 580 (Katch and McArdle 1977). As in the *Measurement in milliliters case of max Vol, this difference becomes Adapted from data presented by K. A. Abramyan and R. A. Dzhuganyan. Athlete apparent at about age 10 and continues heart measurements Theory and Prac!ice of Physical Culturo 12.27-29, 1969. throughout the remainder of the life span (Figure I I). In my opinion, extra body fat is a handicap, regardless of the claims by the normal female oxyhemoglobin some persons that it provides a metabolic dissociation curve (Hb = 12.5) is com- reserve for greater endurance. These pared with thz. curve for a normal male clairr are not supported by research. It (Hb = 15) and one typically found in 150 also adds excess baggage to the body, anemia alb = 10). Since the venous 02 and one has to expend extra energy to content during maximal exercise is ap- transport that excess baggage as the

pi, mom um. ma is qua+

tatIvel % WO WOO

00 WS y = 16 + 0 13r 1.1) 0-0INI

I t t 1 1 800 1.000 e Heart volume. ml

Figure 7. Relationship between heart volume and maximal stroke volume of the heart. (From A strand et al. 1964. Courtesy of the American Physiological Society.)

WW A SO 00WO .0 WO 30.10 RI.Iwo 00 values( I 5gmHb X I00 ml blood') The female's blood does not reach 19-20 vol. Figure 8. The oxvhemoglobin dissociation curve, showing the relationship of bloodoxygen percent for 02 shown in these curves as it transport. The full curve applies to the arterial blood of healthy man at rest. The small section passes through the pulmonary capil- to its right applies to venous blood Point a represents normal values for arterial blood, and laries. This is shown in Figure 9 where point v, for venous blood. 53 58 body moves from one place to another.

It is very similar to taking an extra 14711t4LOSINCItel % I weight, trying it on the body where the 2040 NORMAL Nb fat is located, and taking it along with 111.34 you. Recent research has shown that even though the catcliopuln.onary re- 11132 sponse at any given Vol is not increased 14 2 by obesity, the oxygen required for any 12.24 given workload is increased (Davieset 1020 a/. 19751. It

1 do not mean to imply that the t 2 average female is obese compared to 405 known or inferred health standards. 204 That is certainly not the case, and there is evidence that a significant proportion 0 10 20 30 40 5060 70 80 1040 110120 130140 of her fat is necessary for normal sexual POI tam Nil and childbearing functions (Frisch and McArthur 1974). However, there is a Figure 9. The oxyhemoglobin curve for normal male. normal female, arm n anemia relative obesity when she is compared with the average male. This decreases her functional aerobic capacity since maA Vol is divided by tots' body weight to arrive at the functional measure of max Vol in ml X kg X Excess body 0- Ar ler 41 Capactly fat reduces the size of this quantity. One ON Artertal Cortent of the things I tell my own students is 0 V= Muted venous that they can increase their max V°, in ml X kg X min-' without exercising. All they have to do is lose a few pounds of 1 extra fat. 12 a DO, chit

Muscular Strength 0

For an equal body size the female has 5 to 10 percent less mus -le mass relative to total body w: ght than the male (Behnke and Wilmore 1974). Therefore, 4 the size of the musculature involved in a 04)1144 ocoela Mrs mm given exercise is less. For example, a female running, or otherwise using her legs in exercise, has a smaller muscle Figure 10. Oxygen binding capacity and measured oxygen content of arterial blood, mass on those legs. She has k -s total calculated oxygen content of mixed venous blood at rest and during work up to maximum in strength in them than the male. males and females20 to 30 years of age. During maximal work, the arterial saturation is about 92 percent as compared with 9710 98 percent at rest. and the venous oxygen content is very If the contractile force that must be low and similar for women and men. (From Astrand and Rodahl 1977 Reprinted by exerted by a muscle is above about 20 permission from McGraw Hill 1.^9ok Co ) percent of its maximum possible force, thereis going to be atleast some interference with blood flow. The greater the degree of necessary contractile force in comparison to that maximum pos- that the weaker individuals were having I'mplications For Aerobic Exercise sible force, the greater the cutdown of to use anaerobic metabolism to .. greater Prescription blood flow, and the more the person is extent, even though they were all work- going to have to resort to anaerobic ing at the same relative intensity. The metabolism in order to sustain the weaker men were forced more into Intensity of Exercise exercise (Lind and McNicol 1966; Whipp anaerobic metabolism not so much and Phillips 1970). because they couldn't handle the exercise Intensity of exercise has been shown This problem is well illustrated by aerobically, but rr ore because th., didn't to be one of the important c: iteria in Figure 12. The upper two curves show have the strength to effectively overcome exercise prescription, and the American lactate accumulation in a I5- minute the resistance of pushing the bicycle College of Sports Medicine (ASCM) bicycle ergometer ride two low- pedals around. The female is at the recently issued a position statement strength males working at 80 percent same disadvantage as the weaker males recommending the minimum threshold max Vol. The lower curve is from a in Figure 12. Her lower strength levels for aerobic conditioning as 60 percent strong male also working at 80 percent will force her ioto anaerobic metabolism of maximum heart rate reserve [60% max Vol. Lactate accumulation is much at a lower resistance than the male who (max H R Resting 1-11) + Resting H less in the stronger male, an indication is stronger. or 50 percent of max Vo, (AGSM 1978). 54 59 that in the male. An example is easily obtained from the physical education students used in the construction of the 40 Classic Astrand Rhyming nomogram .it/ii----*/ for estimation of max Vol from sub- It--a---"V maximal work (Astrand and Rhyming fa-l 1954). At oxygen uptakes that were 50 0 aMI' i 3 at 4 and 70 percent of max, the males had mean heart rates of 128 and 154 respec- tively. The corresponding pulse rates 20 for the female subjects were 113 and 168 a difference of 10-14 beats X min'. These differences certainly indicate that 10 males more research on the female is needed w females in exercise prescription to determine if IrglelAgers". the guidelines currently used with males are equally applicable to females. 1 1 . I 1 10 20 30 40 50 AGE IN YEARS Anaerobic vs. Aerobic Exercise

Because the female has lower strength, Figure 11. Average percentages of fat in the body as a function of age and sex (From G. L Rarick, H. J. Montoye and V Seefeldt: Growth, development, and body composition. In H any prescribed aerobic exercise based J. Montoye (Ed.). AnIntroduction to measurement in physical education.Indianapolis: Phi on the ACSM guidelines will likely be Epsilon Kappa Fraternity', 1970.) more anaerobic in the female because of the greater occlusion of blood flow. This is another area requiring further research to provide a basis for any adjustments that might be necessary in

801 the exercise prescription for female mg:100 ml c.--C rate/ Vol relationship (Figure 13). There- participants. 70 fore, the Vol associated with a given ...... er"-....:---- o heart rate in the female is different from E60 ...... :"..... --:L 7 ...... 5..- 50 Strength and Injury Prevention r/4 L 0 e. C , a 40 /1. ...-"------.. A significant problem in most aerobic . ii t conditioning programs is keeping the 2 30.--,f , . end of extras. ? d exercise intensity at a level i hat will not t2. 20 160 predispose the participant to orthopedic 41 100 I I injuries. Because of her lower strength, 2 4 6i 8mill10 12 14 16 18 20 160 I think the female runs a greater risk of Time min these injuries at any given intensity of exercise when compared with the male. 140 Figure 12. The course of lactate accumula- Stronger muscles help to stabilize the tion during 15 minutes of exercise at 80 j3ints better during movement and also percent of maximal aerobic power. Data are ta140 during various activities requiring fixa- 1 for one muscular (L 8) end two othe7 tion of body sements. Stronger liga- subjects. ;From C. Kay and R. J. Shepherd, 120 ments and tendons are usually also On muscle strength and the threshold of associated with stronger muscles. This anaerobic work.European Journal of Ap- 120 is something that needs to be carefully plied Physiology.27:311-328, 1%9.) considered when prescribing exercise for the female.

A shortcoming of these recommenda- 100 C--1---- tions is that they are based primarily on 30 40 50 60 7C References research on male subjects. Very little Osman uptake pefctnt of Me mammum P L Altman and D S Dittmer (Eds )1971 research has been conducted on determin- Respiration and circulationBethesda, Md . ing minimum or optimum intensity, Figure 13. Relationship between heart rate Federation of American Societies for Exper- duration, and frequency of conditioning during work (bicycle ergometer) and oxygen imental Biology. exercise in females (ACSM 1978; Pol- uptake expressed in percentage of subjects' Amencan College of Sports Medicine. 1978. maximal aerobic power. Left of ordinate, Position statement on the recommended quan- lock 1973). Even though females respond heart rates of women; right of ordinate, tity and quality of exercise for developing and to aerobic exercise in a manner similar those of men. Thin lines denote one standard maintaining fitness in healthy adults. Sports Medicine Bulletin 13(3).1. to the male response, the anatomical deviation. (From Astrand and Rodah11977. and physiological differences noted P -0 Astrand1952. Experimental studies of Reprinted by permission from McGraw- physical working capacity in relation to sex above do result in a different heart Hill Book Co.) and age Copenhagen. E. Munksgaard. 55 GO P.-0. Astrand and I. Rhyming. 1954. A nomogram responses to exercise after bed rest in men and A R Lind and G W McNicol 1967 Muscular for calculation of aerobic capacity (physical women. Acta Astronautica 4.895-905 factors which determine the cardiovascular fitness) from pulse rate during submaximal C. T. M. Davies, S. Godfrey, M. Light, A J responses to sustained and rhythmic exercise work. Journal of Applied Physiology 7:218- Sargeant, and E. Zeidiford1975. Cardio- Canadian Medical Association Journal 221. pulmonary responses to exerc' in obese girls 96 706-715 P.-0. Astrand, T. E. Cuddy, B. Saltin, and J and young women. Journal of Ap died M I allock The quantification of endurance Stenberg: Cardiac output during submaxirr il Physiology 38 373-376. training programsIn J H Wilmore (Ed ), and maximal work. Journaiof Applied Physiol- R. E FnschandJ." McArt '974 Menstrual Exercise and Sport Sciences Reviews, VolI ogy 19:268-274, 1964. cycles. fatness as. deter...... ,it of minimum New York Academic Press P.-0. Astrand and K. Rodahl. Textbook of work weight for height necessary for their mainte- B Saltin, G Blomquist, J. H Mitchell, R L. physiology. 1977. New York. McGraw-Hill. nance or or . Science 185.949-951. Johnson, Jr., K WP1denthal, and C B Chap- A. R. Belinkeand J. H. Wdmore. 1974. Evaluation F. Grande and H. L. Taylor. 1965 Adaptive man 1968 Response to ....omaximal and changes in the heart, vessels, and patterns of and regulation of body build Englewood maximal exercise after bed rest and training. Cliffs, N.J.: Prentice-HaU. control under chronically high loads In W F Circulation 38 supplement 7 E. J. Burke. 1977. Physiological effects of similar Hamilton (Ed.), Circulation. Washington, D C . training programs in males and females. Re- Amencan Physiological Society B J. Whipp and E. E. Phillips. 1970. Cardio- search Quarterly 48.510-517. F I. Katch and W. D McArdle 1977 Nutrition. pulmonary and metabolic responses to sus- V. A. Convertino, R. W. Stremel, E. M. Bernauer, weight control, and exercise. Boston Houghton tained isometnc exercise Archives of Physical and J. E. Greenleaf. 1977. Carchorespiratory Mifflin Co. Medicine and Rehabilitaton 51.398-402 Implementation of Health Related Physical Fitness

62 How Much ExerciseIs Enough?

Michael L. Pollock, PhD Whether the patieil is yo,Ing or old,events often requires two to three hours fat or thin, fit or flabby, long-term of rigorous training daily. Adults gen- involvement in an exercise program erally are concerned with maintaining can significantly affect health. strength and stamina, avoiding increases Exercise prescriptions should be based on the present level of in body weight and fat, and avoiding fitness as well as the individual's potential health problems that occur with specific goals. a sedentary life-siyle. Women often exer- cise for cosmetic reasons such as weight How much exercise isand figure control. enough? How much exercise Physical fitness can be divided into for what purpose? The an-three major categories: cardi'vascular- swers to these questions arerespiratory fitness, physique, and motor difficult and tentative. function. Table ', liststhe major sub- The various reasons people exercise tocomponents of each category. Although become physically fit depend on age, sex,this tabulation is considered comprehen- and current levels of fitness and health.sive in the way it describes fitness, the For example, needs and goals differ forvarious subcomponents are usually em- elementary school children, athletes, andphasized differently depending on age, middle-aged men and women. Schoolneeds, and goals. children need a broad spectrum of sports Adult fitness programs should be and activities to kindle their interests anddesigned to develop and maintain car- to provide them with a broad educational «Winn, I experience. The activities of most ele- mentary school programs should provideDr. Pollock isdirector, Cardiac Rehabilita- for physical development, but many ex-tion and Center for the Evaluation of Human isting physical education classes do not.Performance in the cardiovascular disease Athletes' programs are geared to com-section of the Der-tment of Medicine at th° petitive situations in which maximumUniversity of Wisconsin-Mount Sinai Medi- skill and phynological and psychologicalcal Center in Milwaukee. He is a member of effort is necessary. To i.repare for suchthe American College of Sports Medicine.

G3 59 Table 1. Physical Fitness Categories elude stretching and conditioning exer- cises to develop and maintain flexibility, Cardiovascular- Motor strength, and endurance of the major Respiratory Physique Function muscle groups. To receive optimal health and fitness Heart ?c'::..;" Body Type": Strength- benefits, participants should start pro- Circulation, Composition* Erdurance grams early in life and continue for a Bone Pulmonary (Lungs) Muscle Flexibility lifetime. Improvement with short-term Working Capacity Fat Power experiments (three to six months) will not affect health-related factors as signif- Posture Agility icantly as long-term involvement. Also, A Balance participants probably will not be able to develop or maintain full physiological potentials unless the training programs Table 2. Recommendations for Exercise Prescription for Healthy Adults' are initiated early in life and/or con- tinued for a long time Frequenci--,i'4:-.,-;. 7'1)0,5 days /week. Strength and muscular endurance are Intensity'" :r to 90% of maximum necessary to maintain proper muscle tone .1140 rate' 4 and to protect against injury and low WO80% of maximum back pain. Flexibility exercises are impor- uptake-t--:Av; '`*`-v tant for similar reasons and should be DuratiOn 6'86minutes practiced often. Reduced flexibility can (continuous) lead to poor posture, fatigue, and injury. Mode (activity)"; Run, jog, walk, bicycle, swim. An endurance activity such as jogging or endurance sport activities P.-"! itittthr.,:".41N; can reduce the flexibility of the extensor Initial level of fitness- High = higher work load muscles of the hip, leg, and ankle. Thus, k Low = lower work load avoiding proper stretching exercises for 'These factors can be applied to athletes as well as diseased per- these areas could lead to low back, sons The prescription will differ in that the athlete will require more hamstring, or calf muscle problems. fr'quent and exhausting bouts of work, and the diseased person a m_ re conservative regimen with more interval work The program prescribed for an adult depends on needs, goals, physical and diovascular-respiratory fitness,flexibili-health status, available time, equipment, ty, and muscular strength and enduranceand facilities. this information is avail- that is consistent with personal exerciseable through medical history records, goals and work requirements. These pro-physical fitness and medical evaluations, grams should include endurance activitiesand personal interviews. After a thorough such as running, fast walking, bicycling,evaluation, an exercise prescription is swimming, skating, etc, which can bemade. sustained for a 15-r i60-minute period. The exercise period should start with aExercise Prescription 10- to 15-minute warm-up and muscle Exercise prescription is based on fre- conditioning period, and end with a 5- toquency, intensity, duration, mode of ac- 10-minute cool-down. The length of thetivity, and initial level of fitness. Table 2 endurance period usually is dependent onlists guidelines for exercise prescription the intensity of effort. The endurancefor average adult men and women. These program is designed to burn a minimumrecommendations are based on several of approximately 300 calories perfactors: workout. Thus, if done often enough, it 1. The participants are adults who are will trim body weight and fat and im-not participating in athletic competition. prove or maintain cardiovascular- 2. The participants are engaged in a respiratory fitness. The warm-up andgeneral physical fitness program to muscle conditioning period should in-develop and/or maintain cardiovascular-

so 6 4 respiratory fitness, body composition,strenuous exercise. Because maximumA specific loci of muscular strength and endurance, andoxygen uptake generally summarizesaerobic capacity for flexibility. what is happening in the oxygen trans-optimal health has 3. The participants are generallyport system (including cellular utiliza-not been determined. healthy and free from severe disease suchtion) during maximum or exhaustive ex- as coronary heart disease, pulmonaryercise and can be measured easily, it has disease (emphysema), or neuromuscularbeen used as the measure most represen- problems (muscular dystrophy, multipletative of cardiovascular-respiratory fit- sclerosis, etc). ness. A larger person generally has more The recommendations for exercisemuscle mass, and thus the capability of prescription shown in table 2 emphasizeusing more oxygen. To more easily com- the endurance phase of a training pro-pare persons of different sizes, aerobic gram and focus on preventive health andcapacity is expressed in milliliters of ox- cardiovascular-respiratory fitness. Fx-ygen per kilogram of body weight per ibility and muscular strength and en-minute (ml/kg/min). durance activities are important aspects Figure 1shows a champion distance of a well-rounded comprehensive pro-runner taking a treadmill test to deter- gram, but the detailed rationale for onlymine maximum oxygen uptake. Figure 2 the cardiovascular-respiratory cc-npo-shows a comparison of maximum oxygen nent will be described. The quantificationuptake values of young and middle-aged is based on years of scientific investiga-men of various fitness levels. The figure tion to find the optimal training prescrip-clearly shows the difference in aerobic tion for adults. These recommendationscapacity as related to status of fitness are the best estimates ava;lable at thisand age. Values for women are approx- time, but more investigation is necessaryimately 10% to 20% lower. before the final plan can be adopted. Is there a level of aerobic capacity Much of the evidence used to establis'inecessary to attain and maintain an op- the recommendations in table 2 was bas-timal level of health and cardiovascular- ed on a series of 20-week training experi-respiratory fitness? It is difficult to set a ments conducted on healthy (but seden-standard for optimal fitness because a tary) adult men. In these experiments,specific level of aerobic capacity for op- many physiological variables were eval- uated, but for the purpose of this article, the justification of the recommendations will be based on the values for maximum oxygen uptake (which repre':ents changes in cardiovascular-respiratory fitness), and body weight and fat (which rep- resents changes in body composition). Good cardiovascular-respiratoty function depends on efficient respiration (lungs) and cardiovascular (heart and blood vessels) systems. Other important factors include the quality of the blood (red ..2 blood cell count, blood volume, etc) and specific cellular components to help the body utilize oxygen during exercise. The ability to utilize oxygen at max-Figure 1. The maximum oxygen uptake test is being administered to premier distance runner. Steve Prefontaire imum is the best representation of theseAt the time of this test, Prefontaine held ten American factors. Maximum oxygen uptake (aero- distance running records. His maximum oxygen uptake was 84 4 ml/kg/min, one of the highest values ever recorded for a bic capacity) 4s the largest amount of ox-runner. Breathing valve channels all expired air into a seises ygen that can be utilized under the mostof bags, which were late: analyzed for 02 and CO2 content

65 61 timal health has riot been determined. Acoxygen uptake varies apprommatel shown in figure 2, sedentary middle-agedwhen one is in or out of training. This males chara.-...teristicallyfall below 40can be further reduced with age; thus, mlikg/min of oxygen uptake. This valuethe optimal level of improvement gen- drops to 30 by age 50 or 60. Many ex-erally found in training programs ap- perts feel that a person should maintainproximately 15% to 25%. or develop his aerobic capacity to above Figure 3 shows a person being mea- 40 ml/kg/min. Until more evidence issured for body fat by two methods, and available, the minimal threshold standardfigure 4 shows body fat values of various for optimal fitness seems to be oxygengroups of men. The body fat of women uptake between 38 to 45 ml of oxygenaverages 5% to 10% higher than men. A per kg per minute for men 20 to 60 yearsshown infigure 4, trained persons of of age. various ages are less fat than their seden- The maximum oxygen uptake value istary counterparts. The optimal level of partially controlled by heredity; that is, afat is not known exactly, but most ex- person of Olympic caliber who has aperts agree that men should stay below maximum oxygen uptake over 70 or 8016% to 19% and women below 23% to ml/kg/min is born with this char-25%. acteristic. This does not mean that the champion athlete does not have to trainQuantifying Results of Endurance hard to further develop this potential.Training Programs For example, when Jim Ryun (at the time Cardiovascular-respiratory fitness im- world record holder in the mile run) stop-proves as a result of many factors. In ped training for approximately 18general, the degree of improvement months, his maximum oxygen uptakedepends on the total work or energy cost dropped from 81 to 65 ml/kg/min (20%)of the exercise program. Energy cost can as a result of his reduced fitness and in-be measured by the number of calories creased body weight. Even though he wasexpended. Improvement in aerobic out of shape, he continued to have a highcapacity and body composition depends maximum oxygen uptake. Maximumon the frequency, intensity, and duration 2 80 4 70[

18-28 18-24 18-28 18-28 40.5040-50 40-50 40-5018-28 18-28 18-24 18-28 Age Sedentaryj Endurance Punners Sedentary Athletes Sprinters Endurance Runnet a

Figure 2. Comparison of maximum oxygen Figure 4. Percent body fat values of uptake of young and middle-aged men selected groups of me of various fitness levels

620 6 \

Figure Sa. BOdy fat Menu/nation by the Figure 3b. &fly fat determination by the underwater wt vling technique skin fold fat technique (This method correlates well with the underwater weighing technique.) of the exorcise program. Improvement isproves in direct relation to the frequency also related to the initial status of healthof training; that is, 8%, 13%, and 17 %, and fitness, the mode of exercise (walk-for one, three, and five days pc: week, ing, running, cycling, skating, etc), therespectively. Another investigation we regularity of exercise, and age. conducted comparing two and four days per week of training showed similar Frequency results. The two day per week program To answer the question "How manyshowed a significant improvement in days per week are necessary to developaerobic capacity tilat was approximately fitness?" we designed an experiment toequal to that found in the three day per train men at either one, three, or fiveweek program. days per week. Intensity of training was One might ask, "Why recommend a standardized at 85% to 90% of max-minimum of three days per week, rather imum, with the men pa icipating for 30than two, if a person can get approx- minutes each exercise session. Figure 5imately the same amount of improve- shows that maximum oxygen uptake im-ment?" First, the two-day studies were continued 6 er 4--Duration-o4--Frequency 10 54 4 55 IIIBefore training 52 ElAfter training 50 5 48 C 46 Q 44 le 42 40

30 min 'Standard error of the mean 15 min

Figure b. Effects of different training Figure S. Effects of frequency and frequencies on maximum oxygen uptake duration of training on incidence of injury

63 67 The injur) rateof a high-intensity nature, which may notand shou;d not be extrapolated to other increasedbe suitable or enjoyable for adults. Thesituations. For tile present. lumeer, it dramatically whensecond reason is that no body weight orgives enough information to recommend joggers trainedfat loss occurred in the tw )-day program,a day's rest between workouts and to more than threebutit did inhe three day per weekrecommend keeping the duration of en- days per week. studies. Three subsequent investigationsdurance effort to less than 30 minutes for in which men trained two days per weekbeginning joggers. More frequent and (up to 4 miles per workout) alsu showedlonger workouts may be tolerated as one no changes in body weight or fat. Thus,gets in better shape. it appears that the minimum of three It is not known at this time whether a days per week is necessary to developfive, six, or seven day per week program cardiovascular-respiratory fitness and towill elicit a more significant effect on show significant changes in body weightother health-related variables such as and fat. high-density lipoproteins.If future re- How about training more than fivesearch shcws this to be the case, modifi- days per week? Certainly, training morecations to these recommendations must than five days per week is possible, butbe considered. our experience finds it unrealistic. Most Closely related to frequency of training adults cannot fit more than three or fouristhe regularity with which one par- days a week into their busy schedules. Inticipates and the subsequent effect on addition, the amount of improvement incardiovascular-respiratory fitness.If exercising more than five days per weektraining is not continued, the improve- is minimal and probably not worth thement gained or maintained in a program ad:Led effort unless competition is involv-diminishes rapidly. Significart reductions ed. Most importantly, the injury ratein fitness have been found after only two related to the foot, ankle, and knee jointsweeks of detraining. In one study, par- increased dramatically when joggersticipants trained at equal eight-week trained more than three days per week. periods of activity, nonactivity, and ac- Figure 6 illustrates a study we con-tivity,with subsequent significant im- ducted on young adult men who trainedprovement, decrement, and improvement one, three, or five days per week. Th.;found in aerobic capacity. Also, studies rate of injuries for the five day per weekin which subjects are put to bed for ex- group was three times that of the threetended periods have shown decrements in day per week group. A participant with aaerobic capacity and related cardio- jogging-related injury had to stop train-vascular parameters. ing for at least one week. The injury rate To determine the effects of different also increased significantly when thelevels of detraining, we reevaluated 22 duration of training increased from 30 tomiddle-aged men after a 12-week detrain- 45 minutes per workout (3 1/2 to 5 1/2ing period. Participants originally trained miles).It appears that the body needsby running 8 miles per week for 20 sufficient rest between workouts, andweeks. They were subsequently divided that a day's rest between the days of jog-into three subgroups: Group A continued ging may protect a participant from in-to train 8 or more miles per week, group jury. If one wants to exercise me -e fre-B trained 3 miles per week, and group C quently, logging activities should be in-was inactive. The results showed that terspersed with days of walking, bicy-members of group ^ maintained and/or cling, swimming, and other activities thatimproved theirlevels of fitness, while do not cause the continual "pounding ef-groups B and C regressed significantly. fect" on the legs. A soft jogging surfaceGroup B lost approximately 400Th of its and shock-absorbent shoe insoles alsooriginal improvement and group C lost help. 50010 after just 12 weeks. Another study The injury study (both frequency andshowed a regression to sedentary normal duration) relates to beginning joggersafter eight months of nontraining.

64 686 The dropout rate in is apparent frum this review thatlevels existfor less-fit persons. Th'y tnigh-intensitytraining effects are both gained and losttrinea college men for ten minutes, five interval trainingquickly .nd regular continued stimula-days per week for five weeks at heart program was twicetionis necessary to maintain properrates of 120, 135, or 150 beats per that of acardiovascular-respiratory fitness. Also.minute. When groupsweresubdivided continuous joggingif persons refrain fror' exercise for anyinto high- and low-fitness levels, the program. period, they must take precautions whenhigh-fitness group showed no improve- resum:ng the program. Because c thement at heart rates of 120 and 135 beats reduced fitnera caused by the layoff,per minute while the unfit group did. these participants should start back slow- Although the minimal intensity thr ly and gradually increase the traininghold conceptconcept is generally well-accepted, load to its original level. it is also well-established that improve- ment in aerobic capacity isd: ,ctly Intensity related to the intensity of training. If the What is the optimal intensity leveltraining session duration is short (five to necessary to improve physical fitness?ten minutes), low-intensity programs may Two classicsti.es serve as practicalshow little (up to 5%) or no improve- guides for determining a minimal thres-ment in aerobic capacity (hardly ap- hold level of intensity necessary for im-precilt), while a high-intensity pro- proving atiobic capacity. Both studiesgram may elicit up to a 15% to 20% in- agree that the minimal threold level forcrease. In general, the adult population eliciting a training response is at a heartdoes not seem to enjoy or tolerate a high- rate equal to 60% of maximum. Theintensity program. Recent studies we stud...s were conducted on younger menconducted at the Aerobics Institute in with training heart rate levels rangingDallas showed that the dropout rate in a from 130 to 150 heats per minute. Forhigh-intensity interval training nrog unfit, middle-aged, and older pe.-sons,was twice that of a continuous jogging the minimal training threshold may be asprogram. The program was conducted low as 100 to 120 beats per minute. Aover a 20-week period, and the workouts study conducted in Canada furtherwere equalized for total energy cost. The .11 Before training substantiates the minimal threshold con-physiologic effects of the training pro- LY" After training cept for eliciting a train:effect andgrams were equal; both groups improved supports the idea that lower thresholdsignificantly in aerobic capaci'y and los

38 66 140 14

36 135 13 130 34 12 32 Ma 125 120 >O 30 MN 115

Control 15 min 30 min 45 min 02 max Resting heart rate3ody weight 6 skin .r Mile walk (ml/kg/minl (beats/min) (lb) (m- (min:sec Standard error of the mean n=16

Figure 7. Effects of different Figure P. Effects of walking on the training durations on maxin.am oxygen physical fitness of middle-aged men uptake (The moderate differences found among groups were not statistically significant.)

65 69 body weight and fat. Another group oftion and intensity are interrelated andCompliance is an men in this experiment trained in intervalthat the total amount of work (energyimportant factor in training and jogging on alternate dayscost) accomplished in a training programa training regimen. ana at the end of the study were askedis the most irnpnrtant factor for fitnessPeople participate which program they preferred. Ninetydevelopment. For example, the energyin programs they percent of this group preferred con-cost of running is generally higher thinenjoy. tinuous jogging training to interval train-walking, yet many men and women ing. Also, more injuries were expriencedwould rather walk than run. Since the in- with the interval training group. How-tensity of walking is less than running, ever, intensity of training usually de-can one expect to get similar training ef- pends on health status, level of fitness,fects by walking if the duration and fre- and duration of training. quency arc increased? Several years ago we conducted a 20-week fast-walking Nration study with men40 to 57years oid. They Improvement in cardiovascular-res-walked for40minutes four days per piratory fitness is directly related to dura-week. The improvement in this program tion of training. Improvement in aerobic(figure 8) was equal to that in 30-minute, capa,:ty has been shown with moderate-three day per week, moderate intensity to high-intensity training lasting only fivejogging programs with men about the to ten minutes daily. However, thesame age. The lower intensity of the shorter duration programs of moderatewalking program(65%to -.L.% of max- intensity show a significantly lower train-imum) was offset by the increased dura- ing effect than programs of 30 to60tion and frequency of training. Thus, the minutes' duration. F.,1re 7 shows theenergy cost of the walkirg program was results from a study we conducted onequal to th:-. of the jogging program. men 20 to35years of age for 20 weeks. To further illustrate this point, when 1 ne intensity was standardized at85%towe compared two jogging programs of 90% of maximum, and the men partici-different intensities (80% vs 90%), the pated three days per week. Improvementresults werz similar when the total energy in max' num oxygen uptake was8.5%,cost was equalized between them. This 16.1%, and 16.8% with15-, 30-,and45- means that participants can slow down minute duration groups, respectively. the pace, run several mintstLonger (tn It is important to reiterate that dura-make up for the lower calorie ex-,en- diture), and achieve approximately the same results. This is why the15-to 60- minute duration range is recommended in table 2. If the minimum of 300 calories is recommended for an exercise program, then15minutes would require a fairly high-intensity effort, while walking may require35to 60 minutes. The concept of the slower pace and longer duration nas important implica- tions for exercise prescription. First, compliance is an important factor in a trailing regimen. People participate in Run Walk Bicycle programs they enjoy. The lower-intensity cffort makes the programs more en- joyaule. Also, the musculoskeletal system Figure g. Effects of different modes can tolerate low-intensity work better of training on maximum oxygen uptake than high-intensity work, which means that a pailicipant can avoid unnecessary continued

707 66 No weight lossinjuries by working at a slower pi, e.treadn.'ll. The bicycle group rode resis- occurred unless theFinally,itis often safer and more rea-tance bicycles, which could be regulated participants walkedsonable to exercise at a low to moderateto get the heart rates up to the required for more than 30intensity. This is particularly importantintensity. 'Thanges in aerobic capacity minutes daily.for persons with reduced health status(figure 9) and body composition showed (suspect of coronary heart disease),similar improvements. Thus,it appears middle-aged persons, and persons whothat a variety of aerobic activities can are overweight. be interchanged for improving aril main- One important point should be madetaining physical fitness. concerning body weight and fat loss in In general, activities with moderate to relation to the exercise prescription. Ahigh energy cost, such as running (jog- study was conducted with obese womenging), walking, swimming, bicycling, who exercised daily for one year orcross-country akiing, and game-type ac- longer with no dietary restrictions. Theytivities, show significant increases in lost weight in direct relation to the timecardiovascular-respiratory fitness and spent walking. However, no weight lossreductions in body weight and fat. In occurred unless the narticipants walkedcontrast, activities that are intermittent for more than 30 minutes daily. It ap-and low in energy cost (below the intensi- pears that a minimal threshold for weightty threshold), such as golf, bowling, and reduction and fat loss by endurancemoderate calisthenics, show no improve- training includes the following: con-ment. tinuous physical activity of 20 to 30 What about weight lifting? vie often, minutes' duration; sufficient intensity ofhear about how tired a person is after a exercise to expend 300 calories per ses-weight-training session. Also, the heart sion; and exercise frequency of at leastrate after a weight- training session seems three days per week. Because total energyto be quite high. Early studies testing the expenditure is closely related to weighteffect of weight training on cardiovas- and fat reduction, increased frequency,cular-respiratory fitness showed no signi- intensity, and duration of training shouldficant improvement. These programs elicit greater reductions. often emOasized neavy weights with long periods of rest between exercises. Mode Several studies have been conducted Many people s-ggest that jogging orrecently to evaluatetheeffect of weight running isbetter than other endurancetraining on aerobic capacity. In these ex- training programs. Is this true?If theperiments, men and women lifted rt oder- total energy cost of the program is theate weights (approximately 50% to 60% most important factor,it seems that itof maximum) 10 to 15 times on 8 to 12 would not matter which mode of trainingexercises using two to three sets (general- a person used as long asit burns thely referred to as circuit weight training). calories. To test this concept, about twoThe programs were as continuous as pos- years ago we c-..-inclucted a study compar-sible with little rest between exercises (15 ing running, walking, and bicycling train-to 30 seconds). The results were consis- ing programs. In this study, frequencytent.:hey showed large increases in (three days per week), intensity (85% tomuscular strength, but little (3% to 5%) 90% of maximum), and duration (30or no change in aerobic capacity (figures minutes) of training were held constant10 and 11). Therefore, weight training for 20 weeks. To get the intensity levelis not recommended for improving high enough with the walking program,cardiovascular-respiratory fitness. the men trained by walking up a hill on a It should be noted that the heart rate/

67 oxygen cost ratio is different for arm andwork loads (intensity) should be moderateFor every decade of leg work. For an equal heart rate, the ox-and the rate of progression slower forage after 30, it ygen cost of arm work is about 68a1a ofolder participants. To louc at thetakes about 40% that of leg work. Thus, the high hearttrainability factor, we studied a group oflonger to progress. rates in some weight-training a( tivitiesmen 49 to 65 years of age and found that may be misleading regarding energy cost.their aerobic capacity insproved 17% after 20 weeks of training. Other work Initial Level of Fitness conducted in gerontolog centers has The initial level of fitness is an impor-supported this conclusion. For every ant consideration in starting an exercisedecade of age after 30, it takes about program. The threshold for improvement40% longer for participants to progress is lower with an unfit indivitud. What isin their training programs. That is, their the trainability of an older puson? Is aadaptation to training is slower. For ex- person ever toe old to get started? Age inample, if one is involved in a walk/jog itself is not a deterrent for participati- , program and the distance run progresses in endurance work. Several studies haveevery two weeks for men 30 to 39 years shown that middle-aged and old athletesof age, the interval for progression may can perform at high levels of work inincrease to every three weeks for par- their sixth, seventh, and eighth dec desticipants 40 to 49 years of age, and every of life. Other reports on athletes who ..-four weeks for participants 50 to 59 years ercise regularly show similar results. Theof age. difference in beginning exercise programs Does physical fitness automatically for older individuals is that their initialdecrease with age? There appears to be a level of fitness is lower, and the quantitydecrement in physical fitness aue to the and quality of work that they canaging process; however, if one stays tolerate is less. This means that the initialphysically active, the slope of declineI.Before training

contiqued EZIAfter training 10 11 1

n =23 n=48 n = 11 r =9 n=7 n=7 n =11 n=11 n=48 n = 23 t_Middle-aged controls 1 I Middle-aged runners I Young weight trainers Young runners Young controls Standard error of the ,-r Jan Figure 10. Effects of running Figure 11. Effects of running (and and circuit weight training moderate calisthenics exercises) and on maximum oxygen uptake circuit weight training on one repetition bench press strength

68 72 may be less. In fact, recent evidence hasthree to five days per week generally shown that over a ten-year period whenshowed significant improvements in middle-aged men continued their train-aerobic capacity and body composition. ing, :hey showed no decrement in aerobicAge was not a deterrent to initiating or capacity and body composition.' Thecontinuing an exercise program, but it is men were 45 years Ild at the beginning ofrecommended that older participants this study and continued to train approx-and/or those with low initial levels of imately 60 minutes three days per week. fitness begin their programs at a low-in- tensity level and progress at a slower Summary rate. Research findings have shown that irn- pa ovement in cardiovascular-respirtor:This information is based on a book entitled fitness and reduction in body weight andHealth and Fitness Through Physical Activity fat is dependent on intensity, duration,by M. L. Pollock, J. Wilmore, and S. M. and frequency of training. Intensity andFox. John Wiley and Sons, Inc, New York. duration of training were found to be in-(In press). terrelated, with the total calories expend- A supplemental reading list is available upon ed during a workout being an importantrequest from THE PHYSICIAN 4ND SPORTS- factor. Although there appears to be a '1EDICINE. minimal threshold level for improving cardiovascular-respnAtory fitness (60%Reference of maximum), programs of 15 to 601. Kasch FW: The effects of exercise on the aging minutes of continuous activity performed process. Phys Sportsmed 4:64-72, June 1976 Teaching Physical FitnessConcepts in Public Schools

Russell R. Pate

Most physical educators would agree that a major aim oe fully as possible. Thus we should ask ourselves why it is that, their profession is to promote physical fitness. How- during all of these years, we have essentially overlooked the ever, in the typical public schoo'Aysical education program, cognitive domain in, physical education. I feel that there are students receive a very restricted exposure to physical fitness. several explanations. First, in general, we have not perceived Commonly the student's experience with physical fitness is ourselves as having any responsibility in the cognitive area. limited to participation in a few fitness activities and under- We have seen ourselves as activity spec alists and have not felt going a physical fitness test. In recent years some programs compelled to "compete" with other school programs for a have adopted curricula through which students are systemat- space in the cognitive domain. Also, many of us may have ically exposed to a broad range of lifetime :fitness activities. doubted our own mastery of physical fitness information and But, tragically, it is only the rarest of physical education therefore have willingly assigned it to the bottom of the programs that ensures that its students develop a thorough curricular prim ity list. Certainly we must recognize that there knowledge and understandingofthe conceptsrelated to has been nJ accountability whatsoever regardinz the cognitive physical fitness. The purpose of this article is to draw attention aspect of physical education. No principals, superintendents, to this deficiency and to suggest how it could be corrected. or cooroinators have been pushing us to teach fitness The recent u?surge of interest in physical fitness among concepts, nor have we been evaluated on our effectiveness as adult:, could be interpreted as a major success for the physical facilitators of cognitive learning. And, finally, professional education profession. Certainly it is true that physical educators preparation programs should be indicted for their narrow and have helped to initiate and promote the current fitness exclusive focus Pn the teaching of motor skills. College movement. However, certain aspects of this movement draw programs lave not taught physical education majors how to attention to a weakness of traditional physical education, i.e., teach concepts or how to incorporate material into the the failure to educate students, in,. cognitive sense, regarding physical education curriculum. physical fitness. Manifestations of this failure abound: the fitness marketplace is filled with bogus exercise gadgets and Curriculum machines; bookstore shelves are crammed with phony weight- loss manuals; and "figure salons" sell costly memberships to If we are to begin dealing with fitness concepts inour persons who are promised that the "pounds will just melt physical education programs, the first step is to decide what away." Even among people who select appropriate forms of we are going to teach. That is, we must construct a curriculum. exercise. a collective lack of knowledge seems apparent. In The outline of a suggested curriculum is presented below. The response, millions of adults have sought fitness information concepts vary somewhat in difficulty of mastery. However, through the print media, and, as a result, publication of most can be introduced at the elementary school level, exercise books has become a growth industry. expanded upon :n the middle school, and dealt with in detail These observations should be of concern to the physical in the secondary school. The outline is not intended to be g--cation profession for they prompt the obvious question: all-encompassing. On the contrary, it lists only the topics this why did not the adult population acquire the fitness knowledge author feels are the most critical. it needs in school? At the suprficial level the answer to this question is equally clear information regarding physical fitness has not been taught by physical educators or anyone else in the public schools. The solution to the problem would Suggested curriculum on physical fitness concepts seem to be straight-forward let us begin to incorporate into I.Defer it j Physical Fitness ozr curricula cognitive material related to fitness. A.Fitness components identify and define Analysis of the Problem each B.Health-related fitness components At this point one is tempted to launch immediately into a C. Motor fiti ess (athletic) components series of specific recommendations. These will come. But, II.Cardiorespiratory Endurance before attacking a problem, it is wise to try to understand itas A.Definitions B.Benefits 1. Cororary heart disease risk Russell 'ate is assistan. professor at the University of South 2.Everyday life/physical working Carolina Columbia, SC. capacity, vigor, use of leisure time 70 74 C.Evaluation Tips for Ttaddng Physical Fitness Concepts 1. Field tests - 12-minute run, mile run 2.Stress testing 1.Teach the concept through activity. Whenever possible D. Methods of Improvement build cognitive material into the activity setting. This can 1. Identification of aerobic activities be done by using role playing, learning centers, and stop jog, swim, cycle actions. There is no substitute for the alert teacher's 2. Frequency, intensity, duration of seizure of the "teachable moment." exercise 2. Keep lecturing to a minimum. Students react negatively 3. Heart rate, monitoring of exercise to the lecture method in physical education. Lecture only intensity when absolutely necessary and only when your students 4.Cooper's.aerobics" system are most likely to be calm and attentive (usually after a III.Body Ccmposition period of vigorous activity). A.Evaluation - skinfolds 3.Use audiovisual aids. Films, slide-tape sets, filmstrips, B. Health factors related to obesity video tapes, and posters are available and can be used C.Caloric balance advantageously in the physical education setting. Check D. Weight loss programs with your local health department, Heart Association, 1. Role of diet and Lung Association. 2. Role of exercise 4. Develop a physical education library. A corner of your 3. Weight loss myths gym, locker room, or office could be set ac;rie for a E.Consumer topics reading area. This library can be stocked with apt.. opriate 1. Fad diets nonfictic, i and fiction materials. Check with your school 2. Spot reduction librarian on materials that may already be available to 3. Long-haul approach vs. rapid loss you. 5. Cooperate with science and health education teachers. IV. Flexibility You may be able to coordinate certain aspects of your A.Health factors low-back pain curriculum with the curriculum of other subject matters. 13. Evaluation Physical education can serve as the lab for certain topic 1. Sit-and-reach areas in biology and health education. 2. Kraus-Weber Battery 6. Require or encourage homework or out-of-class projects. C.Methods of Improvement Who said that classroom teachers have a monopoly on 1. Static stretching techniques term papers, required reading, and book reports? Also, 2. Gymnastic, dance activities how about giving credit to students who design and V. Muscular Strength and Endurance execute a behavior modification project. A.Role in overall fitness.id in athletic 7. Use fitness testing as a cognitive experience. When performance administering a physical fitness test, take the opportunity B. Health benefits of abdominal strength to tell stuoents why they are being tested, what the results low-back pain mean, how the results will be used, and how the strdelits C.Evaluation can improve their performance. 1. Bent knee sit-ups, bar dips, flexed arm 8. Apply fitness concepts properly in your teaching. Be sure hang, pull-ups that the fitness activities you prescribe in class are in 2. One repetition maximum bench press concert with the fitness concepts you want the students to 3. Handgrip master. Thai is, be sure that the students' practical D. Methods of Improvement experiences in class reinforce the proper concepts. 1. Calisthenics 9. Do not overlook the "how tor for popular fitness 2. Resistance training isotonic, isometric, activities. There is something to learn about jogging (and isokinetic other fitness activities) do not assume that everyone knows how to jog, swim, or cycle for fitness. Teaching Methods 10. Plan a long-range, progressive curriculum. If you syste- matically plan for the incorporation of cognitive material The successful implementation of a curriculum depends on into your curriculum, a large amount of information can the creation and mastery of appropriate teaching strategies. In be disseminated using only 3-4 minutes per individual the present context this represents a significant hurdle because class period. physical educators often are unaccustomed to teaching Note: cognitive material. Also, we must recognize that the gym- 3 min. 2 classes 40 weeks 10 years 2,400 min. X X X nasium, as a physical setting, is not particularly well adapted class week year (40 hours) for traditional "classroom teaching techniq ues" (e.g., lecturing, reading, workbooks, etc.). In addition, students come to the physical education class expecting action, not talk. These Conclusions factors suggest that innovative teaching methods must be used. To be sure, specific methods must be created by the To summarize. it seems clear that traditional physical individual teacher to suit his or her pesonality and particular education has ow.. looked the cognitive domain. The result is teaching situation. However, the following tips for teaching that students have graduated from our public schools essen- physical fitness concepts are presented for consideration. It is tially uneducated regarding the concept of physical fitness. hoped that these suggestions will start the reader's creative The solution to this prublem lies in th,, implementation of juices flowing. physical education curricula that recognize the cognitive

71 75 domain as coequal with the affective and psychomotor Media Resource Center. This tape shows physical educators components of education. At present, such programs are in the actual practice of teaching physical fitness concepts to being successfully instituted by a smattering of individual students at the elementary, middle, secondary, and college teachers who recognize the importance of cognition in levels. A copy of this tape may be obtained by sending a blank physical education and who are stimulated by the challenge to tape (3/4 in., 60-min. cassette) to the following address. create a unique teaching method. It is hoped that the number of such teachers will increase rapidly enough to ensure that the next generation that passes ir,to adulthood will do so having AAHPERD/ NASPE Media Resource Center been, in a comprehensive sense, physically educated. College of Health and Physical Edu _ation Note: A video tape en fitted "Methods for Teaching Fitness University of South Carolina Concepts" is available through the AAHPERD/ NASPE Columbia, SC 29208

76

72 Teaching Health-Related Fitness in the Secondary Schools

Charles B. Corbin

OM,

n 1977, a Gallup poll indicated that twice as many ment is not important; indeed it is. However, these are not the I American adults were participating in recreational exercise only programs of Importance to studentsin physical as were participating in 1961. Many, if not most, of the education classes. activities in which they participated were aerobic in nature. In addition to teaching sports and other motor skills, a need This should be encouraging news for educators for the data exists for more emphasis on the health-related aspects of suggest that our programs may be effective in promoting these fitness in school programs. As noted earlier it is in activities changes in behavior. H owever, a closer look indicates that our designed to improve health-related fitness and in activities programs may lot be responsible for the shift in activity that do not require great amounts of skill that Americans have natterns of Americans. taken a great Interest. These are the lifetime activities that we It seems that tht most effective efforts to promote health- mustteachabout rather thantalkabout. As evidence, related physical fitness, including cardiovascular fitness, consider the fact that 63 percent of Americans interviewed which is the most direct byproduct of aerobic exercise, have concerning the value of their physical education experience 25 come from outside physical education rather than from years after their formal schooling felt that what they learned in within. While medical doctors and journalists are spear- physical education class was of little value later in life heading the movement with books on the best-seller list and (Brunner 1969). A recent Gallup poll on American education best-selling magazines, many physical educators are content (1978) did not list physical education in the top 10 subjects to continue with their "sports as usual" programs. As George rated for their usefulness in ler life, though extracurricular Sheehan noted, "there is a physical fitness and exercise activities including sports, drama, and band were rated in the bandwagon going on in our country; unfortunately the top group. Apparently the lack of importance associated with parade is passing physical education by." This is not to suggest physical education has resulted in deletion of physical educa- that the purpose of physical education in the secondary school tion classes in some secondary schools across the country as is exclusively physical fitness, but it is to suggest that physical evidenced by the fact the National Association for Sports and education should consider some significant changes if it is to Physical Education felt the need to establish a "Save Physical play a significant role in the future of public education. Education Task Force" to help prevent such erosion. This particular article focuses on teaching the health- The development of the Health Related Physical Fitness related aspects of physical fitness, namely, cardiovascular "fest is a step in the right direction toward improvin" health- fitness, strength, muscular endurance, flexibility, and body related fitness, but testing it is of little value if w, do not fatness. There are several good reasons why these aspects of implement programs designed to teach for it. We must not go fitness should be emphasized. First, they are important back to the old physical training of "PT" programs designed bec:suse those who possess them are lees likely to have to force improvement in fitness. That would do little more hypokinetic diseases than those who do not possess them. than teach students tow to hate physical activity and exercise. This is not true for the skill-related aspects of fitness. Fitness is impor.ant, especially health-related fitness, but A second reason for emphasizing the health-related aspects, sound educational programs must consist of more than as opposed to the skill-related aspects of fitness (agility, exercising ant. achieving fitness. balance, coordination, power, reaction time, and speed), is Some years ago I developed a taxonomy of objectives thatall people,regardless of ability, can benefit from regular (Corbikl 1976; Corbin 1978) that ranked these objectives from programs designed to promote these health-related com- low to high in importance.z..e Table 1). ponents. On the other hand, there is a limit to the amount of improvement possible for many people when it comes to skill-related fitness. The principal value of skill-related fitness Table 1 is improvement in sports and other skills. It may just be that A Taxonomy of Physical Fitness Objectives many persons feel that there is a limit to what can be gained from repeated exposure to programs that focus on skill- 1. Physical fitness vocabulary related fitness. Yet in most schools emphasis is'aced on 2 Exercising skill-related fitness. This is not to suggest that skill Improve- 3 Achieving fitness 4. Patterns of regular exercise 5. Evaluating physical fitness Charles Corbin is professor of physical education and exercise 6. Fitness and exercise problem solving science, Arizona State University, Tempe, AZ

73 77 All of these objectives are important. The point is that when self-evaluation as well as sample exercise program information. lower-order objectives have been met, our job is not done. It These materials present information that can be used for a should be our purpose to helpallpeople achievealllevels of lifetime. objectives including those of the highest order. Self-EvaluationsTo help students better understand their As seen in Table I, exercising and achieving fitness are own fitness needs much time is spent in the self-testing of relatively !ow-order objectives. They are important, but we health-related and skill-related physical fitness. should not sacrifice higher-order objectives in meeting these. 1 Sample Exercise Programs. Manydifferent exercise pro- think specifically of the teacher who runs mass calisthenics, grams are tried out, including such formal programs as and uses physical exercises as punishment. Students may aerobics and the West Point program. informal programs achieve fitness in doing these things but they also may choose such as jogging nd rope jumping, and sports of all types. not to exercise later in life because of these experiences. Experiments.Students do experiments to help them discover Further, as they do exercise, students may learn little about information about fitness and exercise. Examples are ex- whythey are doing what they are doing. They may "get fit" for periments designed to help students learn the correct way to the short term but may learn little that will be used over the exercise and experiments designed to locate personal thresh- long haul. olds of training In recent years colleges and universities have implemented Different Grading.It is important that gradingnotbe based courses called lecture-lab or concepts approaches to physical on low order fitness objectives such as achieving fitness. If education. For convenience, they will be called concepts higher order objectives are the concern, current levels of programs for the remainder of this article. These programs fitness based on personal fitness tests shouldnotbe the basis focus on the higher order physical fitness objectives. Listed for grading. For suggestions on grading refer to the following be!coare thrtbasic purposes claimed for these programs reference (Corbin and Lindsey I 979a). (Corbin and Laurie 19781. Planning a Personal Fitness and Exercise Program.The culminating activity for the cony class is the development Why. One purpose is to help students learn that health- and implementation of an exercise and fitness program that related fitness is important. Learning thewhyof physical can be used for a lifetime. fitness and exercise is necessary as part of theprocess of Different Topics.Some of the topics of the course are quite learning to solve personal exercise and titness problems. different from those normally covered in a physical education What. A second purpose is to help students learnwhattheir class. A sample from one secondary school concepts textbook fitness needs are. Evaluating fitness is a higher-order objective is listed below (Corbin and Lindsey 1979b): and something people must be able to do if they are to become effective problem solvers. Fitness for all How. The third purpose is to help students learnhowto Parts of fitness exercise correctly. There is a correct way to exercise. To learn Threshold of training the value of specific exercises is essential to developing Cardiovascuiar fitness patterns of regular exercise and solving exercise problems. Strength Muscular endurance Concepts programs have been most successful at schools Flexibility such as Kansas State University, Mercer County Community Exercise and fat control College, the University of Toledo, Missouri Western University, Exercise and good health and Oral Roberts University to name but a few. But why wait Skill related fitness until college? Are secondary school students not capabie of Correct way to exercise learning higher order physical education objectives? Indeed Physical activity for a lifetime they are! It is my opinion that thewhat, why,andhowof Fitness through sports physical activity are best taught in our junior and senior high Planning your exercise program schools.* The college programs are remedial and necessary Attitudes about fitness only until secondary schools have slIwn that they are The schoo's that have tried the concepts-type program at effectively helping students me- higher-order objectives. the high school and junior high school levels find there are at Already many junior and senior high schools have imple- least three different organizational structures that seem to mented the concepts approach in their c rriculumF Some work hell (Corbin 1978). Because each school has its own unt.sual features of the programs instituted n the programs at unique needs, the best approach for a given school will vary. theseschools are listed btlow. Many of these features The organizational approaches and suggestions for each are reresent significant departures from normal operating pro- listed below (Corbin. 1978; Corbin and Lindsey I979a). cedures used in physical education. The Unit or modular approcI.This is the approach used Lect or Class Discussions.In this type of cot: se some in most colleges. It seems to be most effective in schools with class periods or part of certain class periods are devoted to students of relatively high achievement orientation. In this lectures, class discussions, films, or slide presentations designed approach a specific period of time is set aside, 6 weeks, 9 to teach the facts about fitness and exercise. weeks, a semester, or a full year, exclusively for a concepts Textbook.A textbook is used to supplement the information unit cmodule. given in class concerning fitness and exercise and to provide The integrated approach.This approach merely integratt.3 the what, why, and how into the regular physical education program. On specific days concepts material in the form of *Actually we must begin to meet these objectives in the elementary schools lectures, discussions, films, slides, self-evaluations, exper- This reference simply means that even the highest order objectives can be met iments, and sample exercise programs are used. On otl ?r days by the students in our secondary schools. material from the more typical skill-oriented r.rogram is 74 7S presented. This program seems to be quite effective for large (1977) taints as having "learned helplessness." These people schools and those which have been more traditional in their feel that exercise, sports, and physical activity are not for orientation prior to introducing the concepts approach. One them. They say, "I'rn no good, physical education is for the highly successful integrated program is that of Topeka West jocks, not for me." The concepts course can help all people High School in Topeka, Kansas. learn that there is some formof exercise for everybody. The mini lecture approach. This is a modified form of the (Incidentally, one good reason fornotgrading on fitness test integrated approach. The ece:...ntial difference is that at no time scores is so as not to discourage those persons who already feel is a full class period used for lecture or discussion. Rather, exercise is not for them.) short segments of several periods are used for mini lectures or short presentations concerning important exercise and fitness The concepts approach to physical education is not a cure topics. This approach seems most effective in sch-ols in which for all of physical education's problems nor is it guaranteed to students are lower in academic orientation than in the typical work in all situations. No program can Ile better than the school. people who teach, organize, and aim inister it. There is, however, evidence that this type of program that focuses on As noted very early in this paper, the concepts approach to the health-related aspects of fitress, can be an effect;vc teaching higher order exercise and fitness objectives is not program for helping American youth learn to exercise and be meant as a substitute for more traditional skill-oriented fit for a lifetime. programs. It is meant to complement and supplement sound programs of lifetime sports. For those persons who implement the program there appear to be several important advantages., References Accountability. In this age of cutbacks in spending, physical Brunner, B C 1969. How will today's physical education classes be remembered m 1989? Journal of Pins:cal Education and &creation education programs in many schools are under attack. 40:42-44 Apparently this is partly because many adults do not feel that Corbin, C. B. 1976 Becoming Physically Educated in the Elementary School. physical education has much value for a lifetime. The Philadelphia. Lea and Febiger. concepts program offers physical educators the opportunity Corbin, C. B. 1978. Changing consumers mean new concepts. Journal of to become accountable for significant higher order objectives. Physical Education and Recreation 49 43. Corbin, C. B and Laune, D 1978. Exercise for a lifetime An educational Indeed, it offers physical educators the chance to lead the effort. The Physician and Sports Medicine 6 50-55 exercise and fitness parade rather than allowing it to pass Corbin, C. B. and Lindsey, R 1979a. Fitness for Life: Physical Education them by. Concerts. Glenview, 1111.. Scott, Foresman. Coeducational Instruction. The concepts approach is and Corbin, C B. and Lindsey, R. 1979b. Fitness for Life. Physical Education Concepts. (Teacher's Edition) Glenview, Ill Scott, Foresman. should be coeducational. In life, people exercise corecrea- Gallup, G H. October 7, 1977. "Forty-Seven Percent of Amencans Say They tionally, and this is as it should be. The well-planned concepts Exercise Daily," Minn :polls Tribune p. 3B. class more than meets the guidelines of equal opportunity Gallup, G. H 1978. The 10th annual Gallup poll of the public's attitude legislation such as Title IX. toward the public schools Phi Delta Kappan 60 33-45 Education for All People. The concepts program can easily Roberts, G. C. 1977. Children in competition Assignment of responsibility for winning and losing Proceedings of the NC PEA MI NA PECW 78 328- be adapted to meet the needs of all kinds of special people 340. including the physically handicapped. Perhaps more im- Wright, J 1978 Concepts in physical education an exciting approach portantly, it can meet the needs of those people whom Roberts Physical Education Newsletter 95 1-4, August

79 75 The Hope-Kellogg Health Dynamics Program

Richard A. Peterson

Hope College is a modest-size undergraduate liberal arts program combines, in a unique and innovative way, certain college located in Holland, Michigan. Characteristics endeavors of the Physical Education Department, a - that distinguish Heim College are its affiliation with the College's Health Clinic, the Food Service, and the Office of Reformed Church in America and a disproportionate number Student Personnel Services to provide a comprehensive of students of Dutch ethnic background. Hope enjoys program of health and physical education, health care, and superb academic reputation, particularly in the sciences. Its health promotion a"d advocacy. mission is to be influential in the development of the total Early on, in the conceptual stages of program development, person through a liberal arts education within the context of the Christian faith. the challenge of how best to fulfill this mission became apparent. College, viewed as a stage of life, exhibits many Hope recognizes that such a miss on includes not only interesting, but often conflicting, characteristics. It represents providing the finest possible education for the mind and a a time when young adults are learning, questioning, analyz- conducive atmosphere for the development of the spirit but ing, and making many decisions about their futures. Con- also includes the best possible opportunities for the develop- versely it is often a time for indulging adolescent dreams about ment and care of the physical self. Therefore, Hope College the good life within an atmosphere of new freedoms from has always offered abundant opportunities in physical educa- restraint. It tion and athletics. is often unpredictable which way the group psychology will react to new approaches to old subjects. Recent trends in American culture indicate that individual well-being may not be taken for granted. The physical This is particularly true when one of ..he major objectives of the new approach is to affect actual health behaviors. College demands of modern life are so minimal that a crisis of physical students have lived in mainstream American culture for many health would be unavoidable without nonessential physical years; habits, attitudes values, and priorities have largely activities. Many persons believe that such a crisis of physical settled in. Although the recommended life -style is not rad- well-being would have inevitable consequences on mental and ically or dramatically different from the current cultural spiritual health and would decrease society's availability of norm, still conscious, willful effort would be required to adopt human resources. Current programs of health and physical changes, to overcome the inertia of life-style by habit, and education appear to have an obligation to meet this challenge in the most appropriate ways. entrench new patterns of life that are oriented at least obliquely to those most commonly followed. In addition to the decrease of physical demands in modern On the other hand, college represents a period of flux in life, rather dramatic changes have occurred (1) in diet, where personal behavior for many. Persons experiment with life- man seems more intent on eating f- ,r pleasure and social styles that are perceived as chic and attractive according to the conformity than for health, (2) in emotional stresses and "Madison Avenue" motel. Such images, often conflict with tensions. where fast pace and aggressive ambition appear to both their role as serious students and with guidelines for overpower perceived needs for rest and relaxation, and (3) in healthful living patterns. many other areas of life-style, where following lines of least Thus a general pattern emerges that seems to hold more resistance or the wish to comply with cultural convention have often than not within our societyIndividuals learn and reduced health concerns to low priority. Programs concerned entrench a life-style as children, depart from that life-style with the health benefits of physical activity seem remiss if they briefly in young adulthood, and then return gradually to do not address these other interrelated aspects of life-style. roughly the same life-style that was learned while growing up, The Hope-Kellogg Health Dynamics Program represents Hope College's response to this need for innovative ap- with appropriate variations to account for changes in society at large. During this process, little thought is directed towards proaches to health and physical education. Those in charge health and fitness and particularly towards the role of life- are convinced that a strong relationship exists between life- style in these important life qualities. style and health, and they are committed to providing fur the physical health and fitness needs of the individual. The All of this takes place within an atmosphere of a societal preoccupation with matters of healthIt would appear a logical paradox that so much stress is placed on health information in our culture yet only a small proportion of the Richard Peterson is director at Hope College, Holland, MI. The population follows life-styles that really promote health, Hope-Kellogg Health Dynamics Program is funded through a wellness, and fitness. heahh-promotion I disease-prevention grant from the W. K Kellogg One of the first steps that a program must take if it is to be Foundation, Battle Creek, MI effective in influencing behavior patterns is to arouse the 76 60 personal interest of the individual in his or her own health; to ergowler. Heart rate, blood pressure, and energy output develop a conscious curious awareness so that learning, level are monitored throughout. Each student also is hydro- analysis, and decision-making may take place in a receptive statically weighed to determine body composition. Tests of environment. Certainly many educational strategies are recog- pulmonary function, flexibility, strength, and power are also nized as effective in arousing interest. The challenge is to given in order to obtain a fairly comprehensive physiological optimize the effectiveness of these techniques while mini- fitness profile. mizing obstacles to interest arousal as well as minimizing the In'Idition to these laboratory tests, assessments of health- generation of resistive interest. This was our intent when we related behaviors are made. Persons are asked to record began to establish the detailed plans for the accomplishment periodically behaviors such as diet, physical activity, alcohol of our purposes. What follows is a description of the salient and tobacco use, stress perception, rest, and bouts of illness. features of the Health Dynamics Program at Hope College. When the biologic functions and behavior information are added into the previously mentioned personal health profile, a Initial Health Screen composite emerges that includes health history, current health and fitness status, h,alth behaviors, and health knowledge, Prior to arrival on campus, each student completes an attitudes, values, and priorities. The profile is characteristic of extensive questionnaire covering health history, health habits, each person and when dealing with the profiles, an individual self-image, and current health status. Upon arrival, further approach seems most appropriate. information is gathered about health and fitness knowledge, attitudes, values, and priorities. This information is reviewed Advising Components by Health Clinic staff and program personnel for potential problems or concerns. if such problems surface, the program Such a profile, although interesting from a "this is me" provides appropriate attention to the concern. Those who standpoint, is of little value unless made meaningful thrcugh have no apparent problems proceed into the basic freshman some form of follow-up, explanation, and, where appro- year experience. priate, recommendations for change. We do this by meeting In each case, careful note is taken of the information with each student, getting to know him as a person as well as a gathered. Those who have no apparent problems should not profile, and giving him an opportunity to know us. In order to feel that thereis no interest in their situation. Health Improve the program staff/student ratio, upper-division information gathered, regardless of source, is summarized in major students are enlisted to augment our staff. During the several ways so that each student has an expanding personal meeting, we share the meaning of the student's profile with health profile that may be added to and which forms the basis him and explore the areas where change might be helpful. for the development of a personal health action plan. Since no Although a one-on-one component such as this might not be two profiles are alike, no two health action plans could be the possible everywhere, we feel it is one of the major strengths of sa ;ne. In this way individualization is achieved both in the our program. process and the product. Prior to this meeting, each student prepares a document that we label a "personal health action plan." This document Academic Component summarizes the personal health profile by pointing out areas of health strengths and weaknesses and also allows the person One of the components of the freshman experience is to voice feelings about plans for reinforcing strengths and academic in -attire. The basic concepts of the relationships accommodating weaknesses. The preparation of such a among exert;e, die:, fitness, and health are explored. Such document has several advantages. It certainly improves the knowledge may be obtained through lectures, reading, media efficiency of the meeting; more gets done in less time. It also and /or other toots typical of the academic approach. Dis- has tremendous value as a tool to focus on one's physical self. cussion is also encouraged through the use of discussion Additionally, it provides a framework for personal education questions. Discussion is uniquely able to provoke personal to take place about health and fitness concepts. Thus, even if thought involvement. Thus this component is expected to the person hasn't the inner resources to actualize his plan, it both inform and arouse interest. has had value in accomplishing something significant for him. Healtn information has increased in a nearly explosive fashion in recent years. There are probably many reasons for Physical Activity Component this, but it seems likely that the trend towards a more individualistically oriented society is strongly involved. In Each st,Ident participates in physical activities in accord- srch an atmosphere, factual, accurate information is mixed ance with the impl.cations of his individual profile and in %.ith generous proportions of myth, partial truth, conjecture, accordance with the particular goals and objectives he has and opinion in such a way that the individual exploring the expressed to us. The objectives of the physical activity are to milieu is often confused and frustrated. The inter: of the provide activities strenuous enough that a training effect takes P Ith Dynamics academic component is to not only arovide place, are enjoyable enough that the student perceives them as valid overview of information but also to prov de the a positive experience, are in accordance with the principles of individual with the necessary analytic tools so that he may do fitness for health, and are effective in laying the foundation for his own literature resolution. a lifetime of healthful exercise. Such goals certainly require not only selecting the appropriate activities, but also the Assessment Component correct teaching methods, philosophies, and attitudes. These, of course, must be mutually understood beforehand and A variety of assessments that have me-ming for health and adhered to. fitness are conducted during the freshman,;ram. Tes ing is The components described above are effectively handled done in the exercise biology laboratory. Each student is given within the context of college coursework. One of the more a graded exercise tolerance test on a bicycle or treadmill unusual features of the program, however, is what happens in

77 81 the broader campus community. We don't believe thata true assures the student mat his health concerns are important. impact will take p'ace in students' lives unless a conducive Even in physical setting, the integration of these servicesis atmosphere or environment exists; the college must be withus apparent. The Health Clinic, the Physical Therapy/ Training in spirit and in action. Campus personnel not directly Room, and the Exercise Bic!ogy Laboratoryare all situated in involved in the program must provide modeling and vocal the same complex and are interconnected. support, not just to enhance the program but because they One intangible factor that may not be leftto chance is the actually believe in what they are doing. Thus we direct efforts attitude of the campus community. Fostering to the campus at larj, a higher visibility of health and fitness relatedconcerns on a campus - One campus activity that impacts stronglyon health is wid : basis is principally a public relationsand communi- residence hall dining. More than 75 percent of Hope's caaons task. The more students and faculty know about students dine on campus. We feel that this should bea philosophies and intentions of theprogram as well as the healthful experience and, to that end,we have developed actual implementation strategies, themore likely they will be working relationships with the food service and thestudents. to retain a supportive mind set. Such amenitiesas newsletters, The food service provides meals that conformto health fitness testing and consultation, and readyaccess to facilities nutrition guidelines, complete nutrient analysis of allitems go a long way toward entrenching positive feelings about served, and a dietitian consultant toanswer questions and health and about the program. provide basic nutrition information. It also providesfor the special needs of dieters, vegetarians, and others for whomthe basic diet is not appropriate. Student committees are formed Conclusion under theauspices of the Health Dynamics Programto advise the food service. to observe the eating habits of thestudents, We feel strongly that "health dynamics" and to serve as a link between the program and the is an idea whose students. time has come. Medicine is moving towards more err The program provides basic nutrition educationso that Rsis students are a pare of health nutrition guidelines. on preventive approaches; health education is focu- acre energy on the importance of life-style in health; and physical The role of the college's health service in initial screening education is increasing its endeavors in health and fitness has already been mentioned. The integration of theprogram related activities. Health dynamics exists where these disci- with the Health Service goes beyond that, however,to a real plines intersect. Health oynamics means doing something partnership in caring for the health of hope students. Cross- personal, positive, and appropriate about promoting one's referrals are immediate whenever appropriate anda team own health, wellness, and fitness. The program at Hope approach to both preventive and restorative healthcare College is designed to offer a means for such promotion.

32 78 The Aerobics Program at Oral Roberts University

Paul Brynteson

vs, hen a health ano physical educa- When we think of the "ech. ation of teaches that man is the temple of God tion (HPE) program becomes a the body" we think of the health and and that as the temple ..f God we're to part of a college or university curriculum, physical fitness of the body and the take care of our bodies because the it implies that the program has some development of life-style patterns that Spirit God dwells within our bodies reason for being, some purpose, some will enhance the health anu physical (I Corinthians 3:16-17 and 6:19-20). goal, some objectives Too often HPE fitness of the body. The development of Therefore, we are not to abus, our programs nave been nazy iti articulating the body is not an end in and of it lf; bodies. The goal of our HPE program those goals and purposes and when rather itis a means to an end. It is is to educate our students on how to called upon to defend why their program through a healthy and physically fit take care of their bod.es. should be required as part of the univc body that the mindn function at its sky curriculum, educators have ofte peak and the spirit can ha e freedo n to Administration of ORU's Aerobics been unable to do so. The evidence is direct the whole person as to be an Program that in 1968, 87 percent of colleges and cffectiv- functioning member of cur universities required physical education. sr dy. On the basis of the philosophy just In 1972 this had dropped to a 74 percent As an implementation of tha .phil- outlined and our knowledge about health requirement, and by 1977 the require- osoplv the Health, Physical Education, factors related to various diseases, the ment had further dropped to 57 percent and Recreation Department at ORU Health, Physicr: Education, and Recrea of the colleges and universities requiring has the responsibility fn. implementing tion Department, together with the physical education. the physical fitness goals of the univer- Human Performance Laboratory ane I believe a significat.: eaf.on for this sity. Therefore, a requirement in H PE is the Student H "h Set vices, has de- trend has been the lack of direction by totally consistent with the goals of the veloped a heal.and physical fitness health and physical education programs. university. program directed toward controlling At ORU we have made a definite attempt Thesecor,' A.con why ORU has ar those factors we can control. The follow- to clearly describe the purpose of the HPE requirement is for medical and ing charts indicate ;he administrative HPE program and relateitto the health goals. One major health problem structure of the ORU aerobics program overall purpose of the university. in the United States today is cardio- as well as the responsibilities of the vascular disease. Research has identified HPER Department, the Human Per- Philosop.)f Oral Roberts I Jniversity the various factors that are related to formance Laboratory, and the Student thi, disease. Some of these are: Health Services as we t.vo, k together to Oral Roberts University has a required direct the aerob;-s program. (ORU in HPE p..egram for three reasors. Inthe 1. Factors h ?can'tcontrolsuch as sex, 19834 1 nad 4,000 undergraduates and firstplace,itis t,onsistent with the age, and neredity. 800 g- 1uate students. It has 8 schools philosophy of the university. The found- 2. Factors for whichwe need medical Arts and Sciences, Law, Medicine, ing philosophy of ORU is to provide an .ssistance to control suchas hyperten- Dentistry, Nursing, Busi,-ess, Theology, education that seeks to develop the sion, diabetes, and hyperlipidemia. and Education.) whole person with equal emphasis on 3. Factorswe can control suchas smok- Responsibilities -;nd, spirit, and body. The college ing, obes;ty, diet, and physic 11 activity. cAtalog statesthat ORU wants its HPER Dep ^tment.To provide the graduates to be "mentally alert. spiritual- It is because we know that we can Aerobics Instructional and Physical ly alive, and physically fit." ORU seeks control some of the factors'Wing to A ;tivity Program. to develop a West; le in its students this debilitating disease that HPE is Student Health Service.To medically conducive to the development of the required at ORU. We believe that the clear all students for exercise and make whole person. President Oral Roberts, education received will enable our modifications in requirements for per- founder of the university, has said, graduates to better control the factors sons needing adap ations. These may "ORU is a lifestyle in which an education relating to the disease, and thus reduce be temporary or pc rmanent. takes place." its incidence. Human Performance Laboratory.Pro- Thethirdreason for the H PL require- vide support services to the HPER Paul Brynteson is a professor at Oral ment at Oral Roberts University is a Department and the Student Health Roberts University spiritual one. We believe the Bible Se. vices in terms of administering blood

79 83 Organization of the HPER Department ship of physical activity and fitness to health. Asa result of this understanding Dean, School /4Ed.,catiof. Department, and appreciation, we trust that the of Arts & Sconces .f...4Stun '-ealth Service 1 student will select an app-opriate per- sonal lifestyle necessary to produce Chairman HPER ,S - 4-Intramural Department Department -{ Athletic Departmentl optimal lifelong health and well-being. The emphasis in the first course is on Professions:reparation Human the concept of lifestyle, health, and Program offering a B S Service Program for Performance All Students and Faculty Decree In HPER Laboratory physical fitness, the cardiorespiratory system, and nutrition and body composi- tion. The emphasis in the second course I-Coordinator leache- Coordinator Ed.ication Emphasis Health-Fitness Courses is on the musculoskeletal system, a (80 majors) H Coordinator discussion of concepts related to health Coordt--or Activity Courses fitness such as quackery, smoking, and Aerobics Eniwissis Coordinator a practical experience for all the students (25 mc,ors) Adapted Program H to be certified in cardiopulmonary resus- Coordir oor Community Coordinator Weight- Recrei on Emphasis Reduction Prgrem citation (CPA). (.5 majors) The general goal of the course is that Coordinator Adult Aerobics Program students should be able to answer the following questions: pressures, anthropometric tests (weight, Spring Semester skinfolds, and hydrostatic weighing), Genera! Questions rreshman Health Fitness 11 1. IN 'tat is fitness? and cardiorespiratory fitness tests (tread- sophomore Elective A. tivny 2. How is fitness assessed? mill, bicycle ergometer, or arm crank). Junior Elective Activity Senior Elective Activity 3. How is fitness achieved? Purpose of the HPER Department uraduate Elective Activity Personal Questions Students I. What is my level of fitness? The purpose of the Health, Physical 2. How much fitness do I need? 3. No full-time student is exempt from Education, and Recreation Department 3. How much fitness do I want? participation in the HPER activity is to provide an atmosphere for under- 4. How do I achieve and maintain courses for any reason. A sapient v.anding and appreciating the relation- that Iviel of fitnes-3 ship of physical activity and fitness to with a medical problem will partici- nate in a modified aerobics program. optima; lifelong health and well-being The students will be graded on the It is the student's responsibhay to see so that the individual will select an basis of four criteria in Health-Fitness I. the university physician whc will appropriate personal lifestyle reflective A minimum standard must be achieved of the whole person that Christ intended. prescribe a special exercise program for each cri,erion to pass the course. and to communicate this to his or The service program aims to accomplish The criteria are as follows: (I) knowledge her instructor. this purpose ft- , students and faculty at as measured by tests and assignments ORU. The professional preparation pro- 4. Students who are not fulfilling ORU's equals 60 percent of the grade; (2) physical fitness requirements will be gram aims to prepare professionals who physical activity as measured by aerobics placed on physical probation ol sus- can accomplish this purpose in schools, points equals 20 percent of the grade pension. A student's progress will be churches, YMCA's, recreation centers, (the minimal standard to pass the course evaluated at the end of each year and businesses, industry, and similar settings. is an average of 15 aerobics points for he or she will be placed on probation men per week and 10 for women); (3) or suspension for (I) failing an H PER University ;MIER Requirement cardiorespiratory fitness as measured activity course, (2) fairing to enroll in by the field test equals 10 percent of the a specific activity class or classes as The aerobics component is a part of grade (the minimum standard to pass required by the HPER Department, all health, physical education, and recrea- the 11 -mile run for men and I.25 -mile (3) failing to report to the Human tion-activity courses. The following are run for women is14:00 minutes for Performance Laboratory or the requirements all stud us must follow: under age 30, 14.30 for 30 -39, 15:15 for Student Health service as required persons 40-49, and 16:15 for persons by the HPER Department, 0) failing 1. All fril-time undergraduate and over age 50); (4) body-composition fit- graduate students must enroll in and to make satisfactory progress in ness as measured by percent fat equals pass an HPER activity curse every physical-fitness cr 1 eria as prescribed 10 percent of the grade (minimum by the HPER Department and the semester. Failure to do so may result standard to pass the course is 26 percent in suspension from the university. university physician. fat for men and 36 percent fat for 2. Course sequence: w ,men). Health Fitness I and Health Fitness H Fall Semester Collins The ,tudents are graded on the same Freshmen Health Fitness I criteria for Health Fitness II; however, Sophorr ore Elective Activity The purpose of these courses is to the standards are slightly changed. The Junior Elective Activity provide information in the form of criteria are as follows: (I) knowledge Senior Elective Activity lectures and laboratory experiences that 40 percent of the grade; (2) plvsical Graduate Elective Activity the students can understand and develop activity as measured by aerobics points Students a personal appreciation for the relation- 30 percent of the grade (minimum 80 84 standard to pass the course is 20 aerobics materials over various topics. Most of Field Hockey points per week for men and 15 for the video cassettes are approximately Golf women); (3) cardiorespiratory fitness is 20-30 minutes in length. At the comple- Racquetball/ Handball measured in two ways in the first tion of the tape, the instructor will lead Self-Defense place the field test is administered and the students in a dir:ussion of that tape Socce7 the minimum standard to pass the and introduce Ow laboratory session Track and Field course is 13:30 minutes for those under that is to follow. In most cases the Volleyball age 30, 14:00 for 30-39 age group, 14:45 laboratory session complements the Aerobics for Graduate Students for 40-49 age grout., and 15:45 for age tape. Pickleball 50 and over. In addition, students must Tne second hour of the h- -.its-fitness Badminton meet minimum requirements for the S- course then is a laboratory p .iase where Beginning Swimming mile run. The minimum standards are the students normally go to an exercise Cheerleading 30:00 for men under age 30, 33:00 for area, most of'en the track. It is here that Exercise and Weight Control 30-39, 36:00 for 40-49, and 40:00 for the instructor will lead the students in Gymnastics ages 50 and over. Three minutes are developing a health-fitness lifestyle. Karate added to the standards for women. In During the health-fitness course, fewer Recreational Activities place of the 3-mile run, students may than I percent of the students do not SCUBA Diving elect to swim 1,100 meters or cycle 6 meet the physical fitness standards that Softball miles with the same time standards have been established !ly the university. Trampoline & Tumbling applied as the 3-mile run. (4) Body In most cases, students who have diffi- Water Safety Instruction composition is measured by percent fat culty achieving these standards are those Self-Defense 10 percent of the grade. Minimum who are significantly overweigh!. A Ice-Skating standard to p. ss the course is 24 percent special program is available for students fat for men and 34 percent fat for who cannot achieve the body composi- The basic objective of all elective tion standards. Students enroll in H PE activities is threefold: (!) health fitness, During the first two weeks 'if Health Exercise and Weight Control that meets (2) reel eation skill, and (3) social partici- Fitness I, all new students are medically 5 days per week for I hour of low pation. Students are graded according evaluated to determine their current intensity exercise (walking/ stationary to these main objectives: health status by the Human Perform- cycling).In addition, they receive ance Laborato.y al.d the Student Health counseling in nutrition and behavior Health Fitness 50% Services. We do not require an entrance modification. Rather than requiring As Measured by Aerobic medical examination but rather test our them to meet a specific body composi- Points 3C% students on (I) personal health history, tion standard, they must lose a minimum As Measured by Field Test 20% (2) family health history, (3) resting of 8 pounds and I percent fat per blood pressure, (4) physician's heart- semester. As Measured by percent lung examination and (5) anthropo- fat 0% Recreational Skill 40% metric measurements including skin- Elective Activities Social Participation 10% folds, weight, height, and percent fat. 100% After the student has completed these Students who succes -fully complete tests, the results are fed into a computer the Health Fitness 1 and Health Fitness and a printout summa0zes the results II courses take elective individual or Although the activity course will be of the tests and clears the student for team activities the rest of their time at 50 percent graded on health fitness, the exercise or indicates that the student is Oral Roberts University. Some of the total class will be devoted to developing not cleared for exercise. A student not activities offered include: the recreational skill of the course. The cle; red for exercise will be required to students earn aerobics points on their return to the Stident Health Services Advanced Lifesaving own time and fill out a computer card for further evaluation. This further Archery every time they exercise, turn it in to a evaluation may include a graded exercisz Baseball bo'. and each week the instructor receives ECG treadmill test, blood tests, or Body Condit; 3ning a printout back for the aerobics participa- other tests that the physician deems Cycling tion of all students (see sample printout). appropriate. As a result of t:.e. addition- Fencing The 3-mile field and body composition al tests, if necessary the student will be Flag Football tests are given once during the semester. given a modified activity and physical Intermediate Swimming Therefore, in a I 5-week semester, 14 fitness requirement and this will be Korfl. 11 weeks will be devoted to instruction in communica ed to his or her instructor. Recreational Aquatics the activity and one class period will be Once the student has been completely Skin Diving devoted to health fitness education. The cleared for exercise with or without Tennis Minimum standards as established in modifications, the physical-activity por- Varisty Sports health Fitness 11 must be achieved to tion of the health-fitness course begins. Wrestling pas:.; all activity courses. The basic structure of the health-fitness Snow Skiing course is that the sturi:nts meet once a Long distance running Results of the Aerobics Program week for 2 hours. The first hour of the Backpacking course is in a classroom where a video Basketball The results can be presented in various cassette television tape is shown by the Bowling forms a otl in numerous to .ns, but let instructor which presents cognitive Europea'. Team Sports 85 me present results in terms of attic ides 81 and behaviors, since that is what we're Waal SECURITY ACT NOTE: Social Securitynatbot NUMill DISTANCE DURATION trying to influnce. CODE majimemt Activity Coda, Distance and/or 10 Recently we asked ow current stu- 1010 .010 .040 10 14110 .010 (IA141 4 414 4(= a",::7";,,.7",::: dents the following two questions: c c ci (Ho c ilia99 c to c c.toPo cli c:c o "What contribution did your high school 20 4 20-41 4040 20 4 41 41 41 41 .0 0 9.910 414 204 4:itt, :::),:ri';::10:71bil: physical education program make to- c io 10-0040 io c 30 41 so in 41.4110 4.1 4.14 ismtnecoucily to inc.okagros. 3010 4050 wards your knowledge and attitudes 40 4 41-4 20-4 414 41 41 41 41 41 4.420 4 4 11:11 4 i about physical activity and fitness?" 4 20 41-4 2040 4 20 .0 4 20 4 41 4.4 50 414 41:41 4 i "What contributions did the ORU H PE 20 20 440 2040 4 41041 4 9 4 41.411 9: 41:4 i program make toward your knowledge 4 41 41-4 20-0 41 20 41 2010 41 II 2E4 41 4: 41: 21 and attitudes about physical acl .'ity 10104-41 10-41 20 4 4 4 4 910 4.4 41 9:41: 4 and fitness?" The results are indicated in 4 .0 41-4 440 4 4 4 4 401 40110 41.1010 10:IC:.0 Table I.

4710413 ACTIVITY 477007 rnor 444 fu7IM4 : 4/20/711 We've also just completed the analysis 114 CusrIFF 44144 AERRSICS 11 of a questionnaire sent to alumni of ORJ and two other institutions with 474430,401711 12 very good requircd P.E. programs but 1007 sifollf. Trim mai. aaaaa :4 ,11,111010070 ft-70r* IN nr 01111ITS 7701014 1481411 without the aerobics emphasis. In re- 744400 C017111 11111 1111. 711, 00o07T144 ACCEPTER 4,70 4400, AfTE CP Roiv sponse to the following question, "What Cotlf contribution did your college physical education program make 'toward your &Wotan 'mein 1 111.1 111.3 11.1 110.0 0.0 0.0 13) MP 71101 IV 1 140 14.4 II 7 700.3 0.0 A.. 1710 knowledge and attitudes about physical cOeilnn Mina 4 120.1 110.1 10.1 101.4 n.n o.n 1111 .70707 3030 ',Amon I PA.% 70.3 26.1 124.0 0.0 ,.0 activity and fitness?" the results are 70700011 10001 1 70.' 1,.1 170.1 6110 40 o.0 440 FFFFF M 104 4 44.4 01.1 17.0 101.3 0.0 ..e 43E summarized in Table 2. 0(0.1101 004 1 76.0 77.4 30.3 100 00 0.0 401n 7020/ 0711110 S 01.1 040 14.4 1000 0.7 0.1 771 The above data support the conten- 110100 07014 a 43.0 44.3 1.1 410 n.n 44.4 107 TRATE,. 7 11.4 MA 70.7 241.3 n.n 11.0 147 tion that it's not just a required program vATTANTS 100 17 I 14.4 E4.6 77.0 66.1 0.0 9.0 1434 'avec 3 40.4 41.4 40.1 7311.0 .1.7 0.0 1107 that is important, but the program must Tnnn 3 31.1 'to 00.0 101.4 n.n 00) 447 101049r117 IT n R.1 n.0 110 141.1 4.7 0.1 1111 have a health fitness l hrust to affect CiAlvfn WI:ICJ: Fvengt 704 7 n001 VOTER 404004 R n.n n.0 47.) 40.4 0.0 0.1, Ilan attitudes relating to fitness. The same w 04 070 n 0.0 11.0 71.? 144.3 AO 9.0 3000 survey also revealed that since ORU 70000n10 000710 4 47.4 07.4 44.1 134.1 n.n o.0 211A placed the aerobics emphasi; in the FFFFF S Pm. 611711, 071.0 111.2 00.1A434.) 0.0 10.11 curriculum, the alumni are more active than the alumni of the other two 0000770 nf 77400r4 anninonn in 60007 - 11 4.0470 AAA 741170 Tel 07 ,7007 001474 THI4 04E4 - 3 colleges. 00774 47 "NowaOP 101114111 FFFFF n ay avow. 31.4 00700 37 nnioia7000711 40 innsr 11F7IRT1m4 47.0 On three separate occasions we have given pre- and posttests after one 441I7IAT ,14 FFFFF tampoloc in1MT1 - 4).14 semester Health Fitness I course. The 101014144440 nO LAST nays

Table 1 Comparison of Contributions of ORU Physical Education Program with High Scho-,1 Physical Education Programs (Percent)

Very Significant High Average Low No Contribution Contribution Contribution Contribution Contribution

High School Program 8 10 31 30 16 ORU's Program 53 32 7 1 1

Table 2 Comparison of Contribution of ORU Physical Eaucation Program with other College Physical Education Prog, (;-(cent)

Very Moderately Moderately Significant High Average Low No Clntribution Contribution Contribution Contribution Contribution

ORU 39 35 18 6 2 School A 11 23 38 17 11 School B 16 18 36 19 11

82 86 results from spring 1983 support two program. It has strong support r7om maintain it f '-heir remaining years at previous investigations. (See Table 3.) both administration and students In ORU. All imitations are they continue Summary repeated "in house" studies we observe the lifestyle upon graduation the our students significantly improving in ultimate test of our program. We are now in the 10th year of the fitness, knowledge, and attitude during their first year at ORU and tnat they

Table 3 Pre- andPosttest Changes as a Result of a Health Fitness I Course

Mean Level of Variable Group T1 T2 Duff t Confidence

Body Males 182 17.5 -.7 2.12 05 Fat Females 27 3 26.8 -.5 1.34 NS (%) Total 22.3 21 7 -.6 2 38 05

Weight Males 164 163 -1 1.51 NS (lbs.) Females 141 140 -1 1.24 NS Total 154 153 -1 2.06 .05

Field Males 10.98 10.32 -66 7.11 .01 Test Females 11.64 10.90 74 401 .01 (min.) Ttal 11.27 10.58 -.69 7 24 .01

Knowledge Total 42 7 70.0 +27 3 27.38 01 (%)

87

83 Fitness

Helping Adults to Stay Physically Fit Preventing Relapse following Aerobic Exercise Training

G. Ken Goodrick G. Harley Hartung Don R. Warren Jean A. Hoepfel

As a first step in developing relapse probably worse. Long term adherence to an aerobic p.evention strategies for aerobic The survey results revealed that exercise regimen is a major prob- exercise programs, we surveyed by adherers and nonadherers give quite lemamongexerciseprogram different responses regarding their graduates. It is estimated that over mail 200 graduates of a hospital- sponsored adult fitness program. self-,_ported barriers to exercise. As half of participants in exercise pro- There were 77 respondents. Average shown in Table ) , there were :arge grams become nonadherers within 12 age of these graduates was 43, and differences in the reasons graduates months.'or example, Lee, Owens 70% were female. The survey, con- gave to explain reduced exercise. and Innes2 found that only 50% of ducted between six and 12 months Most nonexercisers attributed their persons graduating from a three- after respondents were graduated relapse to a lack of time, while exer- month training progr im adhered to from the 8-week program, asked cisers were most likely to mention in- aerobic exercise one year later. Two- about current exercise habits, andjury or illness. It is noteworthy that year and three-year follow-up adh- about motivational and environmen- 61% of exercisers claimed to have no ence rates were 30% and 5%, respec- tal barriers to regular exercise. problems in maintaining exercise. tively. Using the aerobic criterion of exer- Among nonexercisers, feelings of There has been some recent work in cising at least three times per week for tiredness or lack of energy was the promoting adherence to exercise at least 20 minutes each time, we second most frequently cited reason while individuals are part "ipating in categorized graduates as either for quitting. The "life stress" category programs. Franklin' discussed ways to adherers or nonadherers to aerobic included changes in job or marital enhancemotivation using such fitness regimens. The categorization status, or a change in residence. These techniques as bulletin boards, news- was definitive since all adherers were findings suggest that relapse preven- letters, group interaction, positive meeting or exceeding the criterion tion treatment strategies should help reinforcement, and games. ()there.° with an average frequency of 9 participants deal with perceived time have used behavioral contracts to times per week, and a duration of 40 pressure, lack of energy, and stress. promote attendance and exercise dur- minutes, while nonadherers were av- Perceptions of time pressure could ing programs. Hall° proposed that be- eraging one exercise period per week be dealt with using elements ^f tirnC. havioral self-management techniques with an average duration of 13 min- management training.° "In this train- could help exercisers resist environ- utes. By this criterion, 40 (53 %) were ing, participants would learn that mental and ,motional barriers to nor.exercisers, and 37 (47%; were aerobics need take up only 5% of exercise. However, most participants considered to be maintaining aerobic their waking hours. This 5% could in- do not continue in an exercise class fitness. We were unable to obtain data clude 3 hours of exercise and 2.5 inde:initel). The techniques which on nonrespondents, but one can as- hours of preparation and clean-up promote attendance and exercise dur- sume their rate of adherence was not each week. Participants would learn ing a training program may have no better than for respondents, and how toassess the useof time using positive effect on long-term adher- ence after a participant leaves a pro- Table 1.Reported Problems which Limited or Prevented Exercise gram to exercise alone. Recently, behavioral psychologists NONEXERCISERS EXERCISERS (n = 37) have developed "relapse prevention" PROBLEM (n = 40) treatment strategies for enhancing Time pressure 56%* 6% long-term adherence to recom- Felt tired, lacked energy 51w 20% mend .:(1 health behaviors.' These Injury or illness (unrelated to exercise) 27% 25% treatment strategies were developed Life stress 24% 3% analyzing the reported thoughts, feel- 17% ings, and life situations associated Weather 8% with relapse. From such analyses, Dislike exercise 17% 0% 0% treatment programs have beende- Need group support 15% signed to help patients recognize and No problems at all 0% 61% overcometypica problems leading to *Percent of those responding relapse. 84 88 diaries, how to schedule and set lapse prevention training cannot be priorities, how to discover the causes expected to achieve long-lasting exer- of exercise procrastination, and to cise habits except among a very small think about what value they place on percentage of participants. It remains being physically fit relative to other to be seen whether longer-term pro- uses of their time. grams with relapse prevention can do Perceptions of lack of energy as a better. The authors hope that this re- barrier to exercise could be minimized port will give others a procedure for by emphasizing that increased physi- development of relapse prevention cal fitness is normally associated with treatment strategies. increased perceptions of energy. To enhance feelings of increased energy ant to avoid perceptions of over- exertion, exercise intensity and dura- References tion should be self-regulated based on ' Morgan W P Invo,ement in vigorous phys- ical activity with special reference to adherence perceived exertion' or perceived Proceedings of the NCPEAM PECW Na- changes in breathing.'° Participants tional Conference 1977 would learn that those with higher 'Lee. C , Owen, N and Innes. J M. Durabil- levels of need to use a lower ity of risk factor change. Evidence, models and percentage of their total L. methods. Presented at Geigy Symposium or. capac- Behavioral Medicine, Melbourne, Australia, ity to do the routine physical tasks of August 1980. life, so that they feel less tired as a 'Franklin, B A Motivating an .1 educating result of regular exercise. In addition, adults to exercise. Journal of Physical Edaca- many people find moderate exercise non and Recreation, 1978, :line, 13-17. 'Epstein, L H., Thompson, J. K., :Ad Wing, to be invigorating even to those who R. R. The effects of contract and lottery proce- feel tired at the start of the exercise dures on attendance and fitness in aerooics period. Those who receive this train- exercise. Behavior Modification, in press. ing should be less likely to stop regular 'Wysocki, T, G., Iwata, B., and lbw.- exercise because of perceptions of dan, M. Behavioral management of exercise Contracting for aerobic pointsJournal of tiredness or lack of energy. Applied Behavior Analysts, 1979, 12, 55-64. Some participants reported that `Hall, D. Changing attitudes by changing be- their exercise stopped due to such life havior Journal of Physical nlucation and Rec- reation, 1978, April 20-21 stress as divorce. cha.iged job, or resi- 'Marlatt, G. A. and Gordon. J R Determin- dence. Relapse prevention for these ants of relapse. Implications for the mainte- problems would consist of emphasiz- nance of behavior change In P 0 Davidson ing the stress-reducing" and antide- and S M Lavidson (E)Behavioral medicineChanging health lifestylesNY: pressant'° potential of regular exer- The exercycle is new; the body on tt not so Brunner /Maze!, 'I' 30. cise. Many nonadherers seem to think new. The condition of the former is excellent, 'Ferner. J. D Successfulne management. of exercise as a burden or stress-pro- and of the latter. If exercisers blame not NY John Wiley and Sons. 1980 ducing activity. Participants trained to enough time" on their lapses fiom fitness, fill °Borg. G A V Perceived exertion A note think of exercise as an enjoyable, in the missing te'evision set in this picture on "history" and methodsMedicine and (doing two things at once saves time') and the Science in Sports, 1973, 5, 90-93 stress-reducing behavior should be misting relapse prevention training in the 1° Greist, J H Eischens, R R, Klein. M H less likely to stop exercising when life original exercise course and Fans. J W. Antidepressant running Psy- stressors arise. chiatric Annals, 1979, 9, 134-140 "Morgan, W P Psychological benefits of Traditional exercise programs have physical activity In F J Nagle and .1. J Mon- emphasized how to exercise and what real and perceived _tiers to exer- toye (Eds )Exercise, health and disease health benefits accrue. To maintain cise, solving pralems on an indi- Springfield. IL. C. C Thomas 1979. exercise habits, there is a need to vidual basis. "Foreyt. J P and Goodrick, G K Weight focus on causes it relaps. Cognitive disordersIn C JGolden. B. Graber, F Since the results reported in this Strider. M A Strider, S F Alcaparras (Eds.). stratek,s using cl, Jactic techniques, study are subjective interpretations of Appliea techniques of behavioral medicine and for example, invo;,re changing partic- each respondent's behavioral history, medical psyc':alogy NY Grune and Stratton, ipants' beliefs about time needed for and since the return rate was low, in press exercise, or the health benefits of "Dishma,-, R A Cc mphance/adherence in others will need to discover the most health-related exerciseHealth Psychology, exercise. Affective strategies using important causes for relapse for their 1982 vol1. 237-267 experiential techniques would em- treat-nr.i.t programs and participant phasize the focus on the antidepres- popul Ations. Factors possibly con- sant and stress-reducing potential of tributory to the relapse process but G. K. Goodrick is a research assistant exercise during guided exercise ses- n at reported by participants would at the Baylor College of Medicine, sions. -wed to be invest;gated. These might Houston, TX; Don R. Warren is a re- Treatment programs should in- include lack of soLial support, incon- search fellow at the University 9f clude a follow-up period of up to a venie ice of exercise facilities, un- Houston; G. Harley Hartung and Jean year'', During this period participants realistic goals, or participant-progr.m A. Hoepfel are associated with the In- would exercise on their own but mismatch.' 3 stitut" for Preventive Medicine, The would meet once a month in groups It is clear that traditional, short- Methodist Hospital, Houston, TX with a trainer/therapist to work on term exer 3e programs without re- 77030. 85 89 LEISURE TODAY Imo'.

A CORPORATE HEALTH AND FITNESS PROGRAM MOTIVATION AND MANAGEMENT B'? COMPUTERS

WILLIAM B. BAUN MICHELE BAUN

Many health experts support the hypothesis that chronic participants. Fec:ck has become a critical challenge in negative lifestyles are the leading cause of illness to- these programs. With computers have come creative ap- day. Ind. 'tries' acute awareness of this predicament has proaches for motivating participants. causes theka to seek strategies to l'elp preserve their most important ..sset, the employee. Approximately 50,000 Design ani Devehpment American companies have developed health and fitness Tenneco's health and fitnesv program uses a computer programs emphasizing the acquisition of self-care skills system to help achieve departmental goals and objectives.' required to attain and maintain optimal health. These pro- Infiividuals, both inside and outside the compan, worked grams generally use a health promotion strategy which together over a year to develop the system which was re- begins with employee awareness and understanding fol- viewed, then revised intc a workable program by a task lowed by instruction and practice in health fitness 'teas. force of computer and health and fitness pergnnel. The Their central theme is expanding the employees' responsi- task force ensured that the program was feasible: to de- bility for total health. critical to the success of the program velop, produce, and maintain and that it would fully sup- is motivating employees to participate, thereby enabling port the health and fitness staff's various needs. Important them to improve and maintain their health. in the initial development were detailed descriptions of the Many exercise professionals would agree that adherence various compuJr functiors: (1) employee membership, (2) to ar. exercise program depends almost entirely on motiva- participant check-in and check-out, (3) fitness and medical tion. Motivation researchers have shown that positive testing, and (4) exercisc logging. feedbat Iindicating achievement and progress through These four main functions provide the framework on exercise participation provides a sense of satisfaction for whicn the interacting program was based. Each function 86 JU was further broken down into specific programmatic needs. is a function of METS (multiples of resting metabolic The employee membership function serves as the central units). Every seven days the program requires the user to axis for other functions. It ensures proper identification of enter body weight which is saved and used for the next participants and alt,.'s storage and retrieval of demo- seven days of caloric calculations. The i9 different ac- graphic and exercise data. tivit ies fall into five general equation categories which re- The participant initiates the check-in and check-out re- claire different input to compute the intensity factor. The cording procedure, using a credit card-like employee badg- categories are (1) walking and running, (2) bench stepping, with an identification number on a magnetic strip. As em- (3) stationary bike riding, (4) weight lifting, and (5) other ployees rnmplete the health and fitness screening process, nit les of exercise requiring entry of a perceived exertion the badge is encoded so that they can be identified as a rating. member of the health and fitness center. When employees Crucial to the success of an exercise lo{ ling system is enter the facility, they run the employee badge through the ease of entry. Many systems used in exercise environments badge reader which then recognizes the individual as a are interactive: the program constantly asks questions. Un- member and records entrance and exit time. This data fortunately, an interacting format takes time, ami in a busy permits analysis by user frequency, duration of visits, and exercise facility this could mean long lines at computer who uses the center. terminals. Tenneco's system was developed with both ease The fitness and medical testing function serves as a re- of entry and economy of time as important criteria. The cord management system. Data collected from initial system allows six activities to be entered upon the exercise screenings and subsequent assessments are entered by logging screen. Before the system saves the data, partici- health and fitness support personnel using department pants can check for errors and change the data or location terminals. Using input screens -_,:milar to the collectioncede. The majority of activities are recorded immediately forms makes entry fairly easi. Upon entry, portions of the raw data are aui...matically transformed into useable infor- mation (such as percent fat and percent lean) or into rating scales ;21 cerl-lys being assigned an avenge score for the abdominal curl-up test). This function serves several pur- poses, the most important being storage of testing data with easy accessibility and analysis. The exercise logging function is unique to the system. It allows the participants to reccrd their activity immediately following exercise through four input terminals con- veniently located within the exercise area. Partici ?ants can log 19 different types of 1.-.-ercise activity, including many which cannot be performed within the downtown facility (see Table 1). Thus, exercise activities performed away from the main center are an important part of participants' e irds. 4 ach activity requires duration, intensity, and body weight to be entered before the computer can calculate -.., caloric expenditure mathematically. The formulas for each iar- of the 19 activities are the result of a technical report by t Mike F !lock, Jack Wilmore, and Tony Jackson,2 commis- sioned by Tenneco specifically for this system. Duration is the length of time the activity was performed while :.ttensity

Table 1 ExerciseActivity Offerings ..11111101.

Nautili, s Weight Lifting Swimming ,logginvIRunning Cycling Miring Rope Jumping Fitness Classes Basketball Racquetball Skating (Roller or Ice) ______..i Handball Soccer / Stationary Bike Cross Country Skiing Tennis Badminton Squash Beqcn Step ilk Golf (Walking) Itillaggialle"-- Activities in ita'ics do not rei,../re an intensity code. Intensity At Tenneco's Health and Fitness Center, members log their activities levels of (L) light exercise, (M) medium exercise, and (H) heavy following exercise and receive immediate feedbackinformation that exercise are necessary for all other activities. is not only useful but is also motivational.

87 91 following exercise; however, participants can change the date and exercise location if they want to record exercise completed either outside the center or on a different day than the present date. The exercise logging code sheet is another logging option. This allows individuals to submit a written record of their exercise for the month which sup- port potsonnel then enter 335 Exercise logging generates immediate caloric feedback 335 to the participant on the computer terminal. Participants S3S receive monthly reports of accumulated exercise data in a 355 written activity report. These data are also critical to the 670 445 staff monthly reports, which monitor the effectiveness of 14* 521 the entire program. Therefore, the exercise logging func- tion, estimated at over 17 million bytes a year, is the bulk of 355

31S data entered, stored, and used within the system. 532 Feedback and Reports 531 355 As indicated above, the system produces feedback to 35, participants and the health and fitness staff. The immediate 354 caloric expenditure feedback received following exercise logging has generally elicited several different participant responses. When individuals begin to see the small number of calories they expend while exercising, they are better able to lin :erstand the importance of combining exercise with good eating habits Others appear to monitor their daily caloric intake and expenditure regularly, altering 113 36177 3$ 21517 112.7 their diet according to the number of exercise calories 41 36051 4 ill! I2.4 expended. Still other participants are more interested in 12 1494 m lea3e than in calories expended. Theseindividuals use thc system purely as an exercise diary or a training record. NSW, 111 915111 204.7, 11111 f he system provides the staff flexibility in counseling and motivating individuals toward healthier lifestyles, allowing Figure 1. Activity Report staff tz; deal with participants at all levels of exercise knowl- edge. I Although the immediate participant feedback is impor- wan tant, each exercising member's monthly activity report is p.obably most beneficial (see Figure 1). It provides a re- cord of each activity entered each month, comparing the present to the prior month and giving an accumulationof calories, mileage, and exercise sessions for the year-to- date. This information serves several important purposes. It is motivational, giving those who have a successful - gram several pages of positive feedback. Manyof individuals place these reports in notebooks each month. Individuals with adherence problems receive a very short report reminding thela of their exercise negligence.Since these reports ate pla-ed on microf:che and maintained on file, the staff can refer to speci`ic reports in subsequent counseling. Other feedback components help the staff to evaluate the Program continuously. Monthly statistics, which gener- ate data concerning various elements of the program, are used to compile a monthly report to senior management to provide a quick profile of the center's activities and adher- ence rates. These monthly statisticscontinuously record the center and its members, allowing for longitudinal analysis of the data base. Although riot a major departmental ob jective, research has become a prime outcome from this elaborate monitoring system.

Motivating the Individual The participant feedback mechanisms are not the only tools used to motivate individual;;. The staff uses several Staff member enters data on a staffcomputer terminal. other techniques independent of the ccputer to per- sonalize program offerings. 08 92 Many individuals are drawn into fitness andremain ac- money and allows staff members to personalize their ap- tive because of their- )mpetitiveness. Each month a listing proach. of the top 75 calorie burners, runners, and walkers is posted The computer system has been under constant examina- to provide these individuals incentive for participation. tion to make it a more effective tool for the exercise profes- Interdepartmental weight loss and mileag_ challenges offer sional. Changes have already made the systemuser special prizes or monetary rewards. Every three months the friendly, as this is the first and only direct contact with a center holds a "Fitness Challenge" award program forcomputer for many of the participants. The staff listens individuals who exercise a specified number of days and closely to suggestions which make the system easier touse. burn an allotted amount of calories basedupon their body Expectations for ta e of the systems in other Tenneco weight. This gives every participant an opportunitj toearn exercise environments are high. Currently, the department t-shirt, gym bag, and other items which identify themas manages two other small satellite exercise facilities, serving an active participant. The process is designed so that as aapproximately 170 employees at each location. A project person exercises, more different items are received, but now underway will link these facilities to the main system, people who meet the m'nimum acceptedexercise require- thus permitting collection and analysis of comparative data. ments (three times a week and approximately 300+ Although not presently on line with the main computer, calories) are also recognized. these satellites use the exercise logging function by submit- Monthly letters are sent to individuals whoare becomingting the exercise record encoding sheets each ms,nth. or who are nonparticipants. The initial no-show letter is Corporate health and fitness programs will continue to sent to an individual who has not exercised fo' three multiply and grow in response to higher medical costs. The months. This letter reviews the new activities and thecom- use of the computer in these programs will expand in re- ing events being held in the center. Following six months of sponse to corporation' need to evalute program effective- nenparticipation, an individual is sent a letter reflecting the ness. Evaluation can only be accomplished through the use department's concern. After nine months of nonparticipa- of a sophisticated computer system. The data bases now tion, the individual's locker is given to another participant being collected and analyzed are providiug justification for and the indivi. ual is warned that membership is lost after health and fitness programs. However, the main reason for 12 months of nonparticipation. The final letter invites the using a computer in a c irporate exercise environment will nonparticipant to review his/her exercise record witha remain its tremendous potential as a motivational tool and fitness professional and to set new goals. Thisprocess de- its ability to create employee awareness of the benefits of pends on the computer system to supply labels for the positivc. lifestyles. different performance groups. Because titiprocess has been tested only 18 months, its effectiveness is hard to References measure. However, it appears to improve management of a ' Baun, W B & Landgreen, M A Tenneco hcalth and fitness. A large (3,600) participant population and to increase faith- corporate program committed to evaluation.Journal of Physical Educa- ful participation. tion, Recreation, and Dance,October, 1983 'Jackson, A S., Pollock M L., and Wilmo re, J HEnergy cost calcula- Letters are sent to nonparticipants, and yearly birthday tions for exercise loggingTechnical Re t Prepared for Temotco Health cards are sent to each member. The card not only extends and Fitness Department, Tenneco Inc., 1ost Office Box 2511, Houston, best wishes for a happy birthday, but also reminds the TX 77001 member that it is time for a fitness retest. It also allows the staff to write short personal comments to individuals. The tremendous sorting power of the system is further illustrated when flyers are sent to certain groups of the member population. Targeting a promotional campaign to William B. Baun is an exercise physiologist in the Tenneco specific age, sex, or activity participation groups has in-Health and Fitness Department, Houston, TX 77001. creased campaign effectiveness. The system ;ayes time and Michele Baun is an exercise consultant in He -ton.

s " 89 93 Corporate fitness and health pro- motion programs have experi- enced an exponential increase during the last decade. The popularity of tii?te. programs comes from the emerging public consciousness of the value of preventive medicine. As pro- fessionals, we need to realize that em- ployee worksite programs are no dif- ferent from any other programs they can either be beneficial or detri- mental. An estimated S5-7 billion is spent on corporate fitness each year, capital outlay forcing decision-makers to look at the cost-effectiveness for all health promotiGa programs. While research has been limited, available data indicates that actual employee behavior change and compliance may or may not occur.' Consequently, the effectiveness of programs must be studied. During the last several years, the 'taff of the Aerobics Center's Insti- tute for Aerobics Research has been developing, delivering, and evaluat- ing employee htness and health pro- motion programs within the private and government sectors. In reviewing these efforts, we have attempted to determine the factors most critical to program accountability, defined as Physical Fitness compliance to changing behavior and achieving goals. Programming Issues for Total Well Being First and foremost, we must address the human elersent the target popu- lation. Secondly, program models and Kenneth H. Cooper Thomas R. Collingwood program elementsespecially educa-

tionneed to be applied systemati- ME cally. Finally, we must obtain organi- zational commitment if a program is viding the "human" element in to get off the ground and succeed. volved with policy designed to programming. operate the program. Top man- 7. Programs are personalized, espe- Human Factors agement provides leadership, cially for sed-ntEry adults, to take From the perspectivef preventive often by first getting them in- idividual preferences and needs medicine we feel the major justifica- volved in their own program. into account. tion for a fitness or wellness program 2. A long term : ,mmitment ;s based 8. Education is associated with ac- is reducing disease risk and containing upon the realization that results tivity in which persons partici- costs. However, when asked why they take time. Faith and the realiza- pate. exercise, participants often answer, tion that an investment in human 9. Motivation is not left to chance, "It makes me feel good." The human resources is necessary over a but is planned systematically. element must never be forgotten. period of time. 10. Both formal (such as a reporting Accountability is the major ;-sue in 3. Programsareconvenient, system) and informal measure- program implementation. Accounta- schedules and facility use are ar- ment and evaluation are em- Nifty means' iilding a program which ranged to be convenient for par- ployed to ensure feedback. facilitates adherence. In reviewing a ticipants. il. Social irriolvement is emphasized variety of employee titness programs 4. A goal orientation directs partici- througn spouse, family, and peer and in validating our own efforts with pants' effort. Reasonable goals programming. pa', ;nts and organizations, several are individualized to maintain 12. Programming is fun, all program success symptoms emerge relative to commitment. elements have a positive empha- the "human factor "participant 5. Programs are safe and progres- sis. compliance to a program. sive to avoid :njury az4 to main- 13. Using skilled role models as lead- 1. Administrative support is present tain enthusiasm. ers makes use of identification and is communicated to partici- 6. Adequate supervision ensures and modelingcritical motiva- pant- Top management are in- safe and effective programs, pro- tional tools. 90 94 Program Models program for the first time acquire success, fitness needs to be the base There are many fitness and wellness internal control and an active (as op- and smiling point. models. Some are narrow in focus posed to passive) orientation towards su.h as hypertension screeaing pro- changing their lifestyle. Program Elements grams, while others a tempt to For example. changes m dietary, Because of diverse program ser- provide a broad service program smoking, and stress control canmore vices provided, a conceptual view of which affects physical, emotional, and readily proceed after one has de- program elements is not always easy. spiritual well being. Successful pro- veloped a fitness base. Longitudinal Some programs emphasize screening grams recognize the importance of and cross-sectional research at the and assessment while others provide specific results that lead to positive Aerobics Center indicates that fitness only a facility or exercise classes. behavior change and their generaliza- level (as measured by treadmill times) tion to other areas. Whether a person is acquiring an is a highly significant predictor of exercise habit or an eating habit, that As an example, the Aerobics Pro- coronary risk and disease.2 In many person must first view where he/she gram for Total Well Being is delivered respects, fitness levet can be viewed as currently is, cefine where he/she to patients a./ employe groups alike an index of total lifestyle, in that the needs to be, and have the means to as a comprehensive approach to life- physically fit person obviously gets move to the goal. style change. We feel that fitness and enough exercise, tends to eatmore To maximize fitness and behavior exercise is the base for expanded be- prudently, and usually doesn't smoke. change gains and to facilitate adher- havior change. People on an exercise Consequently, to controlprogram ence, the Institute for Aerobics Re- search is validating an eight element process. The elements are viewed as generic services for any program. The eight elements include (1) medical screening to ensure safe exer- cise risks, (2) fitness and lifestyle as- sessment. (3) individual goal setting, (4) exercise and nutrition prescrip- tion, (5) supervised group starter ac- tivity programs, (6) educational classes, (7) a stfuctured motivation and reinforcement system, (R) an on- going feedback system. These eight services systematically attempt to focus and control behavior change and represent critical components of any successful program, encompass- ing the 13 success factors mentioned previously. The rationale for these elements becomes apparent when we look at the four most important program evaluation questions: (1) Did we get the program to the right population? (2) Did we change behavior? (3) Did we change behavior over time? and (4) Did we obtain a cost benefit? Tt- e screening and assessment ele- mants aid in targeting individuals who really need a program. The goal set- ting and prescription process focuses on a behavior change plan. The group activity program motivates beginning participants to get involved. Struc- tured education, :einforcement, and feedback sustain compliance to be- havior change over time. If a program does not reach indi- viduals who need health and fitness behavior change or if the health be- havior habits are not altered over time, the cost benefit will not be realized. In designing the program elements it is important to account for these factors.

91 95 Importance of Education fitness or wellness program. Reduc- ment). In viewing the sources of var- Education, a critical component of tion of health care claims, insurance iance for success or failure in the ef- programming, deserves special atten- premiums, and absenteeism are all fort, we can interpret them as: 50% tion. Some health education is a major valid justifications for a program. leadership, 40% program (including element in most fitness and wellness However, other factors can motivate facility), and 10% organization. programs, yet it has not always been organizational commitment. The concept of a skilled role model effective. We have found that educa- A recent Institute for Aerobics Re- with a valid systematic program in a tion can be effective if (1) it focuses search survey 'nand that the public supportive organizational environ- upon health and fitness maintenance relations benefit of an employee pro- ment must emphasize the leadership. skills rather than just concepts, (2) if gram was the major reason several Having a company gym but without a the participant practices skills inte- large corporations started their pro- structured program and competent grated with exercise and activity, not grams. It was also found that the indi- leadership will not accomplish the only lectures, and (3) it is delivered by vidual commitment of top managers goals an organization is striving for. effective and credible leaders. to personal fitness was also a major Health promotion is about -eople The Institute for Aerobics Re- driving force. changing behavior. Most participants search has been delivering a com- Our erlerience has shown that sev- will not go through what must be done prehensive fitness program to a large eral indn dual reasons may account to change behavior unless there is a public school teacher population. for an organization's getting involved. skilled leader who practices what Data analysis indicated a "chain ef- It is important to be flexible and to get he/she teaches. Leadership allows all fect" in which educational gains dem- input defining a fitness/wellness pro- the other things to happen. gram in an organizations' frame of onstrated a predictive validity for References other gair s.3 Increased fitness knowl- reference. Starting with a pilot pro- gram for top management can aid in ' Fielding, J , Effectiveness of employee edge was associated with positive health improvement program, Journal of Oc- changes in attitude and self-esteem, obtaining the personal commitment cupatioi.al MedicineVol. '4, 11, 1982, pp. stress management, and an approxi- that is so important. 907-916. mate reduction of absenteeism of The concept of providing a larger =Cooper, K. H., Pollock, N,., Martin, R., pilot program also has merit. Deiiver- White, S., Linnerud, A. & Jackson, A ; Physical 35% over the school year. fitness levels vs selected coronary riskfactors: Supported by school tax revenues ing such a program asks an organiza- Journal of the AMA, Vol. 236(2) 1976, 166- the program has been delivered to tion to "buy" proven, not an un- 169. over 4,000 public school tcachers.1 he proven process. The pilot implemen- 'Blair, S. N , Collingwood, T., Re;rnolds, R., Smith, M , Hagen, D , & Sterling, C.; Health eight previously mentioned elements tation becomes the marketing vehicle, reinforcing the importance of provid- promotion for educators Importance In health are applied systematically with an behaviors, satisfaction, and general wt II being. educational focus. The participants ing an effective am.; accountable pro. American Journal of Public Health, 1943. then practice the exercise and nutri- gram. tion prescription they have learned. Conclusions Obtaining Organizational Kenneth H. Cooper is director of The Commitment The bottom line for a program Aerobics Center, Dallas, TX 75230. should be accountability in terms of Thomas R. Collingwood is director for Or the surface, cost benefit is the the human benefit (increased health, Continuing Education and Consulta- major selling point for corporate or self-esteem) leading to a cost benefit tion, Institute for Aerobics Research, government investment in a employee (reduced absenteeism cost contain- Dallas, TX 75230.

96 92 Incorporation of Aerobic Exercise into Health Maintenance Programs of Business and Industry

Dennis Colacino

he beginning and the organization of a corporate cepted, and supported by a group of people. This can be any Tfitness program differs slightly from the beginning and type of group, but the people within any particular group will organization of a university program or private commercial establish certain behaviors which will have a profound effect fitness program. Existing corporate fitness programs tend to on the way we liv our lives. be those of large multinational companies reflecting a major For example, the style of hair, the width of a lapel, or where segment of the Fortune 500. Exxon, Pepsico, Texaco, Boeing, we sit at dinner. These norms are not particularly bad or very Xerox, Prudential, Chase Manhattan, and Ford are a few of important to us, but the norms that I wish to focus upon today these companies. Their programs vary in objectives and size. are the negative cultural norms. Some of these norms can be a Basically they fall into two categories, medical or recreational; matter of life or death. For example, drinking while driving, or a combination of the two types. Within this structure, eating a 2,000 calorie business lunch every day, the need to eligibility for entrance into a program is based either on take a vacation, and the workload and stress build-up at the position grade/salary status (mainly executive programs) or, office. How common are these pervasive negative norms, such a program open to all employees. Many companies delineate as alcohol, drugs, obesity, motor accidents, safety, stress, this structure further into separate fitness programs: executive smoking, nutrition, and inactivity, all of which are spawned and employee. These fitness programs can be operated as by our society? The research of Robert A Ilen, Morristown, company and in-house fitness programs where the facilities New Jersey, searches for the answers. When employees were for exercise and changing are located within the company's asked whether these above - mentioned negative norms existed physical plant or as an "out-of-house" program in which the in their environment, 75 percent of the negative norms were facility is located in a YMCA or private health club. The latter checked by the respondents as existing. If there is a high type of progra /1 usually "contracts" with the company rather instance of negative norms in our culture, what are the than the individual. In-house programs are either totally perceived differences in our present health culture? In other supported by the company or a nominal fee is charged from words, if you ask someone, what is the company doing about the participant's monthly check. The out-of-house program health norms and what should they be doing, the results usually charges a flat corporate membership fee with slightly would indicate a large norm gap of approximately 40 percent. reduced rates when bought in multiples. Furthermore, when asked what is the perceived company How have programs come into existence, and why the support for good health habits, 80 percent of the respondents sudden growth? It would be nice if all programs were initiated noted very poor or not enough support for a cultural change. because of health reasons but this, in most instances, is not the Therefore it is on this framework that present fitness programs case. Some other reasons ire: as a status symbol, or simply should be based to help participants cope with pervasive that the architect in designing a new building decided to put in negative norms and the means to reach self-achievement life- an exercise facilty, or a major competitor has one and style changes. therefore we'd better have one. Whatever the initial reason, be it a status symbol or a program on an experimental pilot basis, How to implement a fitness program in most cases, after the program has developed the initial underlying philosophy no longer prevails. The now prevailing I think itis germane to understand the hierarchy of a conviction is based on strong physiological data, medical corporate setting. The model presented represents this format. benefits, and supportive psychological feelings. At this poin., I would like to emphasize the dire need for good research on Chief Executive Officer (CEO) corporate fitness programs: program participation, fitness President improvement, life-style modification, and cost effectiveness of Senior Vice- president(s) the various fitness programs. Probably the common justifi- Vice-president(s) cation given for fitness programs is that physical fitness General Manager(s) programs will increase work productivity and reduce absen- Manager(s) of Department(s) teeism. This is a worthy goal, but it is my belief that a fitness (Personnel and Corporate Service) program should go beyond that justification and try to change Medical Division cultural norms. Norms are those behaviors expected, ac- Corporate Fitness Program

In moE stances, the corporate fitness program is under the Dennis Colacino is employed with Pepsico, Inc. auspices of the Vice-president of Personnel or Corporate 93 9 Services in which the medical department is housed. It is Participants should receive a specific training program within this department that most fitness programs operate. coordinated to meet corporate policy, and in conjunction with But regardless of the exact chain of command, the schema is a the company's medical policy and the individual's best long, complex, hierarchical system usually resulting in a slow, interest. tedious pathway by which to implement change. Having a There should be a method for tracking compliance /ad- highly ranked proponent of fitness can hasten the process. herence of participation. Research from Canada indicates the Purposes and Beliefs most important form of motivation for adherence to a fitness program was the "retest." When combined with some form of Listed below are some of the major purposes and beliefs educational feedback, the adherence rate was markedly that I believe should exist in corporate fitnes3 programs: strengthened. Surprisingly, T-shirts ranked below retesting and educational feedback as a motivational technique for A company sponsored fitness program should be con- coir 'fiance/ adherence to a fitness program. ducted as an adjunct to the company's medical program. There must be an establishment of strict safety rules in Consideration should be given to programs of physical regards to use of equipment and strict enforcement of training, rehabilitation, and self-achieving life-style. "exercise" training policies. °hysical fitness programs should be conducted on One should observe and comply with federal regulations, company time if at all possible, or within a flex-time work such as OSHA (Occupational Safety and Health Act) con- schedule. cerning exposed chains or moving belts and electrical safety Participants should not be placed in competition with codes. one another in terms of efforts expended, goals obtained, or Dress codes should be established. Within most cor- strength increased. It is more of a life-style change rather than porations there is a logo, which can represent a feeling of peaking to run the New York or Boston Marathon. Running a belonging. marathon may be a carry-over resultant goal of a program, Research and evaluation should be conducted to determine but it is not the primary aim of a corporate fitness program. the effect of the program and if stated objectives have been All programs should be supportive, educational, and met motivational, with an established feedback system to help each individual understand the exercise regime, stress-testing results, and behavioral modification techniques. Medical Provisions Administration All candidates should obtain medical clearance for Each agency (government, university, or private) once physical activity. having established a set of purposes and objectives can Medical emergency procedures should be estabiished. implement them into a functional operating program. The Emergency buttons should be placed in the appropriate underlying code of operation is based on the allocated space, locations within the exercise area and locker room. The stress time commitment, cash outlay, and, unique to fitness pro- testing room, as well as the exercise area, should have a grams, legal ramifications. When these are resolved, then defibrillator, oxygen, and drug cart available. The staff should operational procedures proceed on a day-to-day schedule. be CPR trained. An operational plan should be devised and These include: procedures practiced. Results of the participant's progress in the corporate Definite hours of operation for the facilit' should be fitness program should be sent to the medical staff on a established. If you do not establish strong guidelines, parti- periodic schedule and also to the participant's own private cipants will abuse the hours. physician, upon request.

94 98 1==1.-11111 Prevention of Orthopedic Injuries Related to Aerobic (Jogging) Exercise

David Cundiff

n 1977, a Gallup poll asked Americans Many joggers and LSD runners cause localized foot, leg, knee, or hip I whether they participated in daily, jeopardize their well-being by failing to stress. Examples of improper support- nonwork-oriented physical activity de- recognize the basic mechanical causes phase mechanics are: femoral antever- signed to keep them physically fit and if of jogging injuries. The normal me- sion with external tibial rotation, and they did, whether that daily activity chanics of distance running can be flatfeet or forward varus (extreme included jogging. In 1961, when the summarized by the term "heel-toe."The pronation). Correction for faulty weight same questions were asked, only 24 support phase of the typical jogging gait distribution and reduction of excessive percent of the sample replied affirmative- is divided into the following support rotational stress on the knee and hip ly. In 1977 a surprising 47 percent gave a phase mechanics: can be done in two ways. Sh)e control positive reply with almost no difference adequate heel width prevents hyper- existing in the numbers of males (50 I. Heel strike pronation and snugly tied shoes will percent) and females (45 percent). supination control heel movement at heel strike. Twenty-four percent of those who Impact bearing Orthotic control a soft insert can be worked out daily were joggers, which 2. Mid-stance used to support mild foot plant derange- was a projected 11 percent of all Amer- pronation ment or a rigid orthosis with rear foot icans and 74 percent of those joggers stress dissipation or forefoot post provides the best control covered at least I mile a day. 3. Toe off of severe pronation or supination weak- The jogger or long-slow distance supination Impact nesses. An attempt should be made to run ner (LSD) who covers 30 miles/ week lever lifting have a foot plant so that the big toe Is plans each foot more than I million inside the knee. times a year. Fear of jogging injuries is This typical gait will lead to the shoe- becoming a major obstacle i n convinci ng wear patterns depicted in Figure 1. Muscle Imbalance and Lack of lay persons to start exercise programs The proper approach to the preven- Flexibility and causes a high dropout rate in some tion and /or management of jogging programs. These stress-induced injuries injuries must include attention to the The posture of our sedentary lives are signaled by the onset of localized following considerations: determine leads to shortening of certain muscle pain. In a study of the incidence of whether there are structural foot and groups such as the hamstrings. Muscle running injuries in 456 long-distance leg weaknesses, muscle Imbalances, or tightening and shortening in the resting runners, the following pet zentages were lack of flexibilitand the overuse state is a common response to running reported: syndrome. stress and leads to muscle imbalance. Any abp-rmal foot plant or excessive Running overstrengthens the antigral.ity Calf 9% leg rotation in the support phase may muscles (psoas, hamstring, and calf), Hamstring 9% Achilles 18% Heel 14% Arch 15% Hip 11% Knee 35% Shin 19% Ankle 23% Forefoot 22%

Eighty-three percent of the runners claimed one or more of these injuries Normal Wear Abnormal Wear (rightfoot) (right foot) (caused by excessive pronation) David Cundiff is a professor at University of Figure 1. Normal and abnormal shoe wear Southern Mississippi, Hattiesburg, MS.

95 99 resulting in increased tension and work in the opposing muscle group (quadri- ceps, abdominal, and anterior tibialis). Corrective exercises involve stretching the strong, tight group as demonstrated in Figures 2-4.

Figure 4. Stretchingcalf muscles.

Correctiveexercisesinvolve strength- Overuse Syndrome ening the weak, overworked muscle groups as illustrated in Figures5-8. Whenbiomechanical weaknesses are

Figure 2.Stretching iliopsoasand quadricep muscles.

Figure 5. Strengthening abdominal muscles

Figure 3. Stretching hamstring muscles. Figure 6. Strengthening quadricep muscles.

96 100 overuse syndrome, the body warning symptoms should be heeded by I) resting until localized pain subsides, and 2) modifying training routine.

Summary

1. Tly: prevention and /or successful management of jogging injuries de- pends on the analysis of the static and dynamic aspects of the jogger's gait. 2. Treatment of the basic undtilying muscle imbalance or structural weak- ness will improve or preven, most problems. 3. Shoe modifications can balance the foot and control rotational stress at the knee and hip. The even distribu- tion of force in the mid-stance phase reduces foot strain. 4. Surgery or local injection should be used with caution. Response to brief Figure 7. Strengthening anterior tibialis Figure 8. Strengthening erector spinae rest and anti-inflammatory medica- muscles. muscles. tion should be monitored and train- ing patterns and / or shoe style should be altered. present and one adds the excess stress of compared to 3- and I-day groups. The 5. No medical treatment can produce hard workouts, insufficient recovery leg soreness was chronic throughout the instant healing. p:riods and/ or improper approaches to 20-week program for 6 of 13 persons in 6. An ounce of prevention is the key. training, a breakdown can be manifested the 5-day group. The 5-day group pro- through localized pain and general duced the greatest improvements in Reference fatigue. Getman, Pollock, et al. (1977) cardiovascular function and body com- found that leg- muscle soreness and shin position but they did not recommend a Gettman, L , Pollock, M, et al 1977 Physio- splints were mere prevalent in joggers program of 5-day-per-week for begin- logical responses of men to I. 3. and 5-day per who trained in a 5 day-per-week group week training programThe Research Quarterk ning joggers. To avoid the effects of 47 (4) 638-646

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