QHey, Ben!  I am SO EXCITED that you are doing this blog!  I think you can help so many of us who are clueless and trying to figure things out, all the while making things worse.

What would you suggest for those of us who have been (shamefully!) too sedentary for too long and desire to get back to a pain-free, in shape lifestyle?  Where do we start?  Arthritis and excess weight make much exercise seem daunting.  I am deathly afraid of injury because I need to care for my family. Here is what I’ve been doing lately:

1. Tracking everything I eat on MyFitnessPal app
2. Reducing gluten (it swells my joints)
3. Walking 1.5 miles in the morning at a 3 mph pace, including one hill; 20 minutes of deep stretching; 30 sit-ups; and 3 sets of bicep curls and triceps extensions.

I need to do more!!  I need to lose 80 lbs., but I can’t yet do the heavy cardio stuff because I don’t want to get hurt.  I’m 45 years old this year.  I hurt when I move.  Please help me get started with something that will lead to fitness if I stick to it!  Thanks, Ben.

-Erin

A.  Thanks, Erin!  This is a wonderful question because there are many of us who feel exactly the same way you do.  There are many points to ponder about this question, but let’s first acknowledge the positive.  You are aware of your need to address this issue.  It is not too late–45 years is not old (especially when you consider you are likely to live into your 90s).  You are already taking action!

Where we are now in our physical lives is the sum total of choices we have made, and a few random events all sprinkled with the genetics we inherited.  We need to accept ourselves for where we are presently and acknowledge that our fitness and our health is not a destination, but a journey.  Each person’s journey is different.  We need to be realistic with our goals and give ourselves time to undo what we have done to ourselves for years. Let’s get started!

• Put away the scale. Health is not a number, it’s a feeling. How do you feel? Are you feeling more energetic? Experiencing less pain? Motivated to continue your new lifestyle? If so, you’re on the right track. Never weigh yourself more than once per week.
• Aim for 1-2 pounds loss per week.
• Walk daily after dinner. Your walking program is good, but it would be better if you could walk after meals. I would consider after dinner walks. It has a greater benefit on your metabolism and can reduce the risk of diabetes. If you can only walk in the morning, I would suggest walking before your morning meal.

Alexis and I out on an evening stroll/bike ride.

• Perform High Intensity Interval Training. Apart from your walking program, perform your cardio in short bursts ranging from 30-60 seconds at a time followed by a one to two minute recovery. The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high. You should be breathing heavy. If you are overweight or have arthritis, this may be performed while using a stationary bicycle or in the pool. You can also walk uphill at a quick pace, then stop and rest. This is performed in intervals. Review high intensity training (HIT) or high intensity interval training (HIIT). This type of training will produce the best results for weight loss and fitness. HIIT is a superior way to increase cardiovascular fitness; improve hormonal regulation; increase insulin sensitivity; and burn more calories and fat in a shorter amount of time. The biggest drawback is that it is not easy.
• Don’t fear heavy weights. The key to increasing your metabolism is lifting weights. This is critical for muscle development and proper hormonal regulation. You must lift heavy things and concentrate on the large muscle groups. For example, start with chair squats or weighted squats. Women in particular tend to fear lifting weights for fear of bulking up. (Don’t worry–you won’t.) If you are a novice, seek reputable advice by consulting a trainer or a physical therapist. Look for the following credentials: NSCA certifications; CSCS certifications; physical therapists with strength training backgrounds; or better yet, get a personal recommendation. There are many qualified trainers, but be careful of many novices. If their recommendations don’t make sense to you, then they probably wouldn’t to me either. You don’t need fancy, just consistency.
• Test for food sensitivities. Food sensitivities can affect your pain, your energy level, and your hormonal regulation. Request a food sensitivity blood test run from a functional medicine practitioner. http://www.functionalmedicine.org/ If you don’t get your hormones on board with this plan, you will not be successful. A functional medicine doctor can help you work toward health. 
• Do not diet.
• Do not eat anything that comes in a package. Most of our food should be from low sugar fruits and vegetables, and protein and healthy fats (primarily from plant sources such as avocados and coconut or olive oil). Any animal fat should be from organic and grass-fed animals.
• Move more! New research suggests that it is not just about the amount of time spent exercising, it is also about the time spent not moving. The longer you sit, the higher your risk of death. In a recent study, those sitting more than eleven hours a day have a 40% higher risk of death. Move more, more frequently! http://www.medicaldaily.com/sitting-more-11-hours-day-raises-premature-death-risk-40-240006
• Start slow, but be consistent. Work to progress regularly, and don’t do this alone! Find a group, a friend, or a trainer, but don’t give up!

Healthy living is something to strive for.  To be healthy, we need to address all aspects of our bodies.  We need to work on cardiovascular health, which is best done by HIT followed by regular movement and activity; weight training; good sleep of seven to nine hours on average; plenty of water intake; and healthy eating.  Remember our physical bodies are only part of the equation.  Let’s not forget the social, psychological, and the spiritual aspects that must also be in balance.

Injury is always a concern when we start something new, but it is a risk that we must take.  We either risk orthopaedic injury from an active lifestyle or we can guarantee an unhealthy life full of heart disease, cancer, depression, and diabetes.  However, we must be smart about our activities and slowly taper to a level that is appropriate for each of us.  As a physical therapist, I see just as much arthritis and debility in people who didn’t move much in life as those who over-did.  Our bodies must move to be healthy.  Lack of movement and activity doesn’t prevent orthopaedic breakdown.

This question hit at the heart of what I hope to address on The Physical Therapy Advisor blog.  This answer is by no means all-encompassing.  I will continue to address these topics.  Thank you, Erin, so much for this question!

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.