The possibility that exercise can result in overuse injuries, dehydration, and heart problems has been noted above. Consequently, a prudent approach to initiating physical activity or exercise by previously sedentary individuals is recommended. Men over 40 years of age and women over 50 years of age, those with pre-existing conditions, known or suspected risk factors or symptoms of cardiovascular and other chronic diseases (physical inactivity being a known risk factor) should seek medical evaluation as well as clinical exercise testing, clearance, and advice prior to initiating an exercise program (ACSM, 2000). The evaluation should include a stress electrocardiogram and blood pressure evaluation. Ideally, respiratory measurements should be performed to evaluate Vo2max.
For all individuals initiating an exercise program, emphasis should be placed on the biological principle of stimulus followed by response. Hence, easy exercises must be performed regularly before more vigorous activities are conducted. Similarly, exercise participants need to rest and recover from previous activities prior to resuming or increasing training load. Also, as already noted, conditions of chronic soreness or acute pain and insomnia could be symptoms of over-training. Hence, activity progression should be discontinuous with adequate recovery periods to minimize chances of injury and permit physiological adaptations to occur. Those adaptations are elicited during exercise but occur during recovery. Thus, physical activity recommendations for healthful living, whether a minimum of 30 minutes for most days, as recommended in the Surgeon General's report (HHS, 1996), or 60 minutes a day, should not be construed as the starting point for an adult wishing to change from a sedentary lifestyle to a more active form of living. Depending on the individual, as little as 5 to
10 minutes a day may represent an appropriate starting point, undertaken under professional supervision for those with cardiovascular risk or orthopedic problems. Attention also needs to be given to stretching and strengthening activities as part of the physical activity core to healthful living.
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