The Difficulties of Starting a Program
Guest: Dr. Peter Carek – Family Medicine
Host: Dr. Linda Austin – Psychiatry
Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Peter Carek who is
Professor of Family Medicine and an expert in the area of sports medicine. Dr. Carek, there are certainly a lot of
recovering couch potatoes who, let’s say, at age 39, 49, middle age, want to
begin an exercise program. How do you
counsel those folks? What’s a good way
to start such a program?
Peter Carek: As long as they don’t have
any major underlying medical conditions and, really, the biggest medical
condition we worry about is underlying cardiac disease. As long as they’ve spoken with their
physician and they want to get going with an exercise program, usually the
easiest thing is some sort of walking program.
Linda Austin: Well, let’s back up for a
moment, one does see at gyms, or whatever, the disclaimer, be sure to talk with your physician first. What should a physician actually screen a
patient for before they start such a program?
Peter Carek: The screening involved in
starting a light to moderate exercise program is a really good basic history
and physical exam. Additional testing
beyond that is really not warranted unless the individual want to start a
really vigorous exercise program, they want to begin, you know, playing
competitive singles tennis, or they want to start running 10K races or
marathons. Short of that, most
individuals, as a physician, you’re able to do a good history, looking for, you
know, risk factors for cardiovascular disease, or any hint of cardiovascular
disease, and a thorough physical exam.
If those are all normal, then the person is ready to go with a moderate
to light exercise program.
Linda Austin: And, I suppose, if you did
find risk factors, you’d do an EKG, or further evaluation.
Peter Carek: You’d have to do further
evaluation to determine where they are in terms of the risk.
Linda Austin: So, then, let’s imagine
all that is clear, what next?
Peter Carek: Usually, with individuals,
I find the easiest thing to counsel on is if there’s something you can walk to
or from 20 minutes a day or every other day that you can integrate into your
regular pattern. For example, can you
park in a different parking lot and then walk to and from work? Could you take time over lunch and walk
around for 20, 30 minutes around a park or something like that? I counsel them to make sure that they get
very soft padded shoe wear, hopefully to reduce risk of injury. And then make sure they’re okay with the
climate. You know, here in South Carolina, if you
start a walking program at noon in August, you’re probably not going to last
very long. So, probably, in that case, they
need to either be walking later in the afternoon or early morning, or find a
nice mall that they can begin with.
they start the walking program, then, if they’re so inclined, they can either
increase their distance, and usually with walking, you want to get them to walk
two to three miles four of five days a week.
And that really is about as much benefit as you can get out of an
exercise program. If they’re doing that,
they’re doing great.
want to get to running, then they way you kind of progress is, as soon as you
get to two to three miles walking every other day, then run a couple hundred
yards, walk a couple hundred yards, run a couple hundred yards, walk a couple
hundred yards. And, progressively,
you’ll begin to run more than you walk.
And then, eventually, you’ll be walking but two to three miles three to
four times a week.
Linda Austin: From a heart and vascular
point of view, is there an advantage of a running or jogging program over
Peter Carek: The biggest advantage which
you’ll see in individuals is, and what I tell my patients is, the biggest
advantage, from a cardiovascular point of view, is going from a couch potato to
a regular walker. That gives you the biggest
increase, or decrease, in cardiovascular risk.
If you go from walking to running, then you may be putting icing on the
cake. You may not be. Studies have shown different things. But the biggest benefit is just going from
being a couch potato to a regular walker.
Linda Austin: How about weight
training? What’s your view of how useful
Peter Carek: I think weight training
just kind of breaks up the monotony of either a walking or running
program. It allows individuals to kind
of bulk up, work on muscles that they haven’t used in awhile, maybe decrease
the effects of their job or work, improve their posture, hopefully decrease
rate of injury, and make them feel better.
But, is it really necessary, in terms of cardiovascular benefit? Not really.
But, hopefully, what they’ll get out of a weight training program is a
moderate reduction in injury risk.
Linda Austin: But no great health
Peter Carek: No great health benefit has
been shown from weight training.
Linda Austin: What about the notion that
since muscle may use more energy, that you can have, let’s say, you can burn up
calories more quickly if you have higher muscle mass, is there any truth to
Peter Carek: Really, when you begin a
strength training program, in most individuals, what you see is an increase in
the amount of weight you’re able to lift within the initial four to six weeks
of the program. What that comes from is
your body gets trained to lift the weights.
You’re really not adding any muscle mass. Muscle mass added on, during a weight
training program, really occurs after four to six months. It takes pretty intense training, so most
people really don’t get that kind of benefit from weight training. What they usually get is more coordinated
with their muscular activity, such that they can lift more weights. So it really doesn’t help burn the
calories. You’d have to put on a whole
lot of muscle mass to burn that many more calories.
Linda Austin: That’s very
interesting. I’m just thinking of
everybody I see at the gym, including myself, and wondering what we’re doing
Peter Carek: It makes you feel better
though, doesn’t it?
Linda Austin: I don’t know. There are other things that also make me feel
Peter Carek: Right. But what I think happens too, with the weight
training, is it helps when you’re walking, because when you’re walking, you’re
using certain muscles, and some of those muscles haven’t been used in a long
time. And some people use, you know,
there are agonist and antagonist muscles, just one side of that spectrum of
muscles. And what weight training does
is it makes you use the other side too, so you keep that balance between
agonist and antagonist muscles.
Linda Austin: Interesting. But it is still a fairly modest benefit?
Peter Carek: Modest benefit, right.
Linda Austin: So, it sounds incredibly
simple, then, that if you just walk briskly 20 to 30 minutes a day four of five
times a week, you’re doing most of what you need to be doing?
Carek: Right. The actual walking part is very simple. The starting to get walking part is the most
difficult part that I see patients do.
And how do you get them motivated, and how do you get them out walking,
is really the big obstacle that we come across.
Linda Austin: Why do you think that’s so
difficult? I mean, it’s not an
unpleasant activity. In fact, I am a
daily walker. I find it one of the most
pleasant parts of my day, to get up when the sun is rising and take a walk with
the dog. Why do you think people have
such difficulty with it?
Peter Carek: I think people, they get
into their lives and they get scheduled, and they get used to their routine of
daily living. If they haven’t always had
some part of their life kind of chiseled away for exercise, they’re not used to
it. And when you have to make a big
change, such as incorporating 30, 45 minutes of some new activity into an
already busy schedule, it can be difficult.
Linda Austin: So it’s just a scheduling
issue as much as anything?
Peter Carek: I think so. Scheduling issue, and then the support.
Linda Austin: And lifestyle?
Peter Carek: Lifestyle. The factors that can help you become a more
regular exerciser, one, make sure your significant other, or your spouse,
exercises. That home support is really
significant in making sure that you’re consistent with your exercise
program. Do it at a time and in an
environment that you’re comfortable with.
You know, a lot of people like to go walk on the beach. They’re used to that environment. They like that environment. And then they’re able to exercise, listen to
music, or watch TV as you’re walking on your treadmill. That way, you know, if you’re normally
watching the morning news, you can add this activity to it too and not really
disrupt your schedule.
Linda Austin: Are there any tips for
injury prevention, or is that unnecessary when you begin a walking program?
Linda Austin: I think the biggest thing
you can do for injury prevention, with a walking or running program, is the
first ten to fifteen minutes, do either mild calisthenics or a mild walk before
you go out on your long walk, basically just to warm up, warm your muscles up
in a controlled environment, and then begin your program.
Linda Austin: How about the right
shoes? Does that help prevent injury?
Peter Carek: I think, in terms of lower
extremity injuries, the right shoes and the right surface is extremely
important. So, what you want to make
sure you do is, have very good fitting shoes that have a very soft sole and you
walk on fairly soft surfaces. So,
probably the best surface to walk on would be grass or dirt. If that’s not available, then asphalt. Cement or hard-packed sand tends to be the
hardest surface to walk on. And that may
be a little bit more wear and tear on your bones and joints.
Linda Austin: Dr. Carek, thanks so much
for talking with us.
Peter Carek: Thank you.
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