Aerobic Exercise

Aerobic Exercise: Overview

Aerobic exercise is any activity that uses large muscle groups, can be maintained continuously, and is rhythmic in nature.  It is a type of exercise that overloads the heart and lungs and causes them to work harder than at rest.  The benefits of aerobic exercise can be yours today if you simply get up and get moving – life is motion!

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We should all try to get at least 30 minutes of exercise per day.  A lot of things count as physical activity – try walking, jogging, bicycling, swimming, dancing... whatever you enjoy.  In general, the more activity, the better.

Why it is Recommended

Specific benefits of aerobic exercise include:

  • Increased ability to handle stress; a better attitude; emotional lift
  • Increased aerobic threshold and oxygen pickup in the lungs; easier to do more exercise
  • Increased fat burning enzymes; fat deposits are encouraged to release fatty acids
  • Increased glycogen storage; reduced conversion of sugar to fat; reduced incidence of hypoglycemia
  • Increased hemoglobin levels; decreased blood triglycerides; improved high density blood cholesterol levels
  • Increased muscle mass; improved bone calcium levels and strength
  • Increased stroke volume of heart; decreased blood pressure; decreased load on the heart; decreased resting pulse rate
  • Improved handling of excess heat and resistance to cold
  • More calories and fat burned (even while at rest!); decreased body fat; better hunger control
  • Decreased insulin requirement; decreased muscle dependence on sugar
  • Lower chance of senility – increased oxygen delivery to brain

With all of these benefits, and more activities than ever to choose from, everyone should find one or more things that keep their heart rate elevated for a continuous time period and get moving to a healthier life.


On September 5, 2002, the U.S. government released new activity guidelines which double the amount of exercise that adults should get in order to stay healthy.  Previous American Heart Association guidelines recommended 30 minutes of exercise at least three days a week.  The newer guidelines advised that daily exercise was best but "at least six days is recommended." [Circulation: Journal of the American Heart Association]

The recommendation is part of a massive, authoritative study produced by the National Academies' Institute of Medicine which also doubled the amount of recommended daily exercise from the 1996 U.S. Surgeon General recommendation of 30 minutes a day of moderately strenuous exercise up to 60 minutes a day.

NOTE: All changes in one's exercise program should be done gradually and with the permission of a licensed medical professional.

Aerobic Exercise can help with the following:


Myasthenia Gravis

Available literature indicates that patients with myasthenia gravis may benefit from both a strengthening as well as an aerobic/cardiovascular fitness program.  Patients should be taught a home exercise program that is individualized for their limitations and tolerance.  Physical training is safe for patients with mild myasthenia gravis and does produce some improvement in overall muscle strength.

Walking for short periods at a slow pace is a good way to start a walking program.  Increase the exercise time slowly until you build up to 30 minutes of continuous walking.  If you are comfortable with this, then your speed can slowly be increased.  Before beginning any exercise program, please check with your doctor for advice on whether this is appropriate for you, and what form of exercise is preferred.



A carefully graded, progressive, aerobic exercise program (30 minutes 3 times per week) is a necessity.  Walking is a good exercise with which to start.  Since angina is known to be exacerbated by physical exertion following a meal, give your body at least one and a half hours after a meal before exercising.

Phlebitis / Thrombophlebitis

It is important to get regular moderate exercise.  Walking is the best, and swimming may also be helpful.  Regular exercise increases the body's ability to dissolve clots.

Wherever you may be, do not sit for more than an hour at a time without getting up and walking around.  Better yet, every hour exercise the legs for 2 minutes, as if you are riding a bike (lifting the legs) while breathing deeply.  Do not squat (sit back on your heels), except momentarily.  If you have to travel a distance while seated (airplane, car, etc.), stop and walk around every so often.  Do not let the circulation become sluggish.


Regular aerobic exercise lowers fibrinogen levels – a risk factor for atherosclerosis of equal or greater predictive value than cholesterol.  Additionally, exercise improves the production of nitric oxide within the blood vessel wall, which should limit the progression of atherosclerosis.  Exercise improves the fitness of the heart as well as circulation.

Mitral Valve Prolapse

Some patients are told to take it easy, but a recent study found that moderate exercise can benefit individuals with this condition.  Amongst women who exercised, the symptoms that saw the most improvement were chest pain, fatigue, dizziness and mood swings.  Over-exertion can often increase the symptoms of mitral valve prolapse, so increase exercise levels gradually.

Hypotension (Low Blood Pressure)

Regular exercise to promote blood flow and regulation can improve low blood pressure.

Intermittent Claudication

A systematic review of randomized trials suggests that exercise rehabilitation therapy improves symptoms of intermittent claudication. [Physical Therapy 1998 78: pp.278-88]

Not recommended for

Heavy physical activity can be life-threatening for cardiomyopathy patients.  However, appropriate physician supervised exercise often benefits individuals with cardiomyopathy.



Lack of exercise can lead to constipation, although doctors do not know precisely why.

Environment / Toxicity


Fibrocystic Breast Disease

Regular exercise will improve circulation and help detoxify the body.

Painful Menstruation (Dysmenorrhea)

Regular exercise can help minimize pain and cramping.

Female Infertility

Exercise regularly but moderately.  Maintaining a high level of physical fitness increases the possibility of conception.  For both men and women, the ability to reproduce is dependent on a healthy body.  Stressing your body with intensive exercise can cause a decrease in fertility.



Problems Associated With Lack Of Exercise

Even moderate exercise such as a brisk walk for 30 minutes most days helps control weight, cuts stress, anxiety and depression.


Not recommended for
Low Melatonin Level

Exercising in the evening decreases melatonin levels for up to 3 hours afterwards, at precisely the time of day when they should be rising.  Decrease exercise and/or try to exercise earlier in the day.


Not recommended for
Chronic Fatigue / Fibromyalgia Syndrome

Exercise is often a problem for people with CFS because physical activity can worsen symptoms.  Medical opinion has been divided on whether CFS patients should attempt regular exercise or not – some believe that gentle exercise is helpful, while others caution against any form of aerobic activity at all.  However, a study published in the British Medical Journal found that patient education on CFS and a graded exercise program can greatly improve CFS symptoms in many cases.

Some people with CFS, especially in the weeks or months following onset, are unable to perform the most basic activities, such as showering or walking from one room to another.  In such cases of extreme exhaustion and pain, the person may be confined to their bed.  As time passes, they may feel a little better and attempt regular exercise.  However, aerobic activity can cause a relapse of symptoms that forces the person back to their bed again.  The added problem for CFS sufferers is that a sedentary lifestyle causes a range of other health problems including muscle wastage, loss of bone mass, and increased risk of obesity and cardiovascular disease.

A person with CFS needs a gentle approach to physical activity and should only make tiny increases in the frequency, duration and intensity of their exercise program.  General suggestions include:

  • Aim for no more than three exercise sessions per week.
  • Experiment to find the type of exercise that works best for you.  Choose from a range of gentle activities such as stretching, yoga, Tai Chi, walking and light weight training.
  • Stretching seems to be well tolerated by people with CFS.  You may prefer to perform your stretching program while lying down in bed.
  • Aerobic exercise seems to cause relapses for many people with CFS.  If this is true for you, try non-aerobic forms of exercise like weight training with one-kilogram dumbbells.
  • Learn from past relapses.  For example, if walking for 20 minutes worsened your symptoms, try walking for five minutes and see how that goes.  It may be helpful to keep a diary to keep track of what works and what doesn't.
  • Stop the physical activity well before you feel tired.
  • Remember that your exercise tolerance will differ from one day to the next.
  • Listen to your body – if you don't feel up to exercising on a particular day, don't.
  • Only increase the intensity, time spent or frequency of exercise when you know you can cope with it.  For example, if you can exercise for five minutes without suffering a relapse, try for six minutes.


Herpes Simplex Type I

A healthy immune system may be important in controlling the virus, so proper nutrition, exercise and rest is recommended.

Lab Values

High Levels Of Triglycerides

For many individuals, an exercise period of 45 minutes can produce greater reduction in plasma triglycerides than the shorter periods of exercise sometimes recommended for lowering triglyceride levels.

Laboratory Test Needed



Researchers found that walking for 30 minutes each day quickly improved depressive symptoms faster than antidepressant drugs typically do.  Another study compared exercise with antidepressants among older adults and found that physical activity was the more effective depression-fighter. [British Journal of Sports Medicine April 2001;35: pp.114-7]

Previous studies have suggested that exercise is a potent mood-booster, and some research indicates that for some patients regular activity may be a better depression treatment than psychotherapy or medication.  Exactly why is unclear, but exercise does influence certain mood-related hormones.  And it is also believed to enhance people's sense of control over their lives.

The main conclusion to draw from studies conducted is that the practice of exercise shows a negative correlation with depression – in other words, the more you exercise, the less depressed you feel.  Interestingly, any kind of exercise relieves the symptoms of depression.


Exercise is one of the most important coping mechanisms to combat anxiety and stress.  By discharging negative emotions and stress hormones through physical activity, you can enter a more relaxed state from which to deal with the issues and conflicts that are causing your anxiety.

The benefits of exercise can come from many directions: the decision to take up exercise, the symbolic meaning of the activity, the distraction from worries, mastering your inertia and the effects on self-image, and the biochemical and physiological changes that accompany the activity.

Exercise increases blood flow to the brain, releases hormones, stimulates the nervous system, and increases levels of morphine-like substances found in the body (such as beta-endorphin) that can have a positive effect on mood and pain.  Exercise may trigger a neurophysiological high that produces an antidepressant effect in some, an antianxiety effect in others, and a general sense of "feeling better" in most.

Cluster Headaches

Vigorous physical exertion at the earliest sign of an attack can, in some patients, be remarkably effective in ameliorating or even aborting an attack. [Atkinson, 1977; Ekbom and Lindahl, 1970]

Poor Memory

Exercise will improve oxygen levels within the bloodstream, which will in turn naturally increase oxygen levels in the brain.


Regular exercise can help reduce elevated levels of hormones (such as cortisol) that are associated with chronic stress.


Regular exercise may help increase blood circulation to the head and thus reduce the symptoms of tinnitus if it is caused by poor circulation.


Problems Caused By Being Overweight

Increased physical activity lowers the risk of obesity, favorably influences the distribution of body weight and has a variety of health-related benefits, even in the absence of weight loss.  Exercise is the natural partner to weight loss.  You will discover improvement in balance, energy level, immune function, muscular strength, reflexes, and self-esteem.

Syndrome X / Metabolic Syndrome

Exercise is an important aid in the treatment both of insulin sensitivity and Syndrome X. Exercise not only helps with losing weight but also makes muscle more insulin-sensitive, which in turn improves the sensitivity of the whole body.


Moderate exercise improves glucose metabolism.  Those few individuals who find that strenuous or prolonged exercise causes hypoglycemia should take food at the earliest opportunity.

Edema (Water Retention)

Edema can be caused by a sedentary lifestyle – in other words, long periods of standing or sitting.  If this is the case for you, regular exercise (not necessarily prolonged or strenuous) should help.


Poor Bone Health

Exercise frequently and consistently, with a special focus on weight-bearing exercises such as walking since these strengthen bones.


Research shows that a good treatment for Osteoarthritis is exercise.  It can improve mood and outlook, decrease pain, increase joint flexibility, improve the heart and blood flow, maintain or decrease weight, and promote general well being.  The amount and form of exercise will depend on which joints are involved, how stable the joints are, and whether a joint replacement has already been done.

Osteoporosis - Osteopenia

Physical activity may help reduce fracture risk by enhancing bone strength and improving bone quality.  Exercise strengthens bones.

Poor Musculoskeletal Health

Exercising within your tolerances and limitations will invariably produce musculoskeletal health improvement.

Muscular Dystrophy

Activity is encouraged to the degree tolerated.

Neck / Spine

Low Back Pain

For ACUTE lower back pain, exercise should be avoided during the recovery period. [The New Eng J of Med. Feb. 9, 1995;332(6):35 pp.1-55]

However, in cases of CHRONIC lower back pain, normal activity produces better recovery than bed rest, so you should stay mobile.  The success of using exercise as a treatment of low back pain and rehabilitation is overwhelming.  The tissues of the vertebral column need the stresses of exercise, even under conditions of back pain.  Exercises to strengthen the back and abdominal muscles can be useful, but only after recovery from the acute phase.

Organ Health

Diabetes Type II

Aerobic exercise reduces the risk of diabetes and improves the diabetic condition through several different mechanisms.


If there are no other medical contraindications to exercise, nephrologists usually recommend a moderate-to-vigorous exercise program that stimulates the cardiovascular system, such as walking, swimming or cycling (stationary or otherwise).  Because high-impact exercise can worsen proteinuria and/or hematuria, if applicable, you may be advised to avoid those (unlikely unless your proteinuria is heavy or your hematuria is visible).  You may be advised against heavy contact sports, due to the possibility of an impact that might cause direct injury to a kidney.


Dry skin

Exercise increases blood flow and thus the supply of oxygen and nutrients to your skin.


Leg Cramps At Night

Exercise, such as riding an exercise bicycle for a few minutes before bedtime, can help prevent cramps from developing during the night, especially if a person does not get a lot of exercise during the day.

Tumors, Malignant

Prostate Cancer

A 14-year study by a team from the Harvard School of Public Health found that men over 65 who worked out vigorously for at least three hours a week had an almost 70% lower risk of advanced and fatal cases of prostate cancer.  The 47,620 men involved in the study were followed from 1986 to 2000.

A preliminary study reported at the AACR-Prostate Cancer Foundation Conference in 2014 found that men who reported walking at a brisk pace had more regularly-shaped vessels in their tumor, which has been associated with having a better prognosis.

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Aerobic Exercise can help prevent the following:


Alzheimer's Disease

Stay physically active.  Patients with Alzheimer's disease have been found to have had lower levels of physical activity earlier in life.  Those who exercised regularly throughout life were less likely to contract the disease than those who were inactive.  Doctors caution that exercise does not guarantee immunity.


Coronary Disease / Heart Attack

A sedentary lifestyle of physical inactivity is almost as great a risk factor for heart disease as smoking because of diminished circulation and weight gain.

Research has shown that even moderate exercise can substantially reduce the incidence of coronary events.  Aerobic exercise reduces cardiac risk by lowering LDL- and raising HDL-cholesterol levels, and by reducing blood pressure, body fat, blood sugar, mental stress, and blood clotting.  Exercise also improves the heart's pumping ability, greatly enhancing the body's functional capacity and stamina.

It is never too late to start.  Healthy people who begin exercising after age 45 can reduce their death rate by 23%, and even patients who have already had heart attacks can use medically-supervised aerobic exercise to reduce their risk of another heart attack by up to 25%.

Hypertension (High Blood Pressure)

One study of 6,000 healthy adults found a 52% increased risk for hypertension in sedentary individuals compared to those who were fit, while another study found a 35% increase.

Varicose Veins

Regular aerobic exercise provides benefits for the circulatory system.


Diverticular Disease

In one of the few studies that have been done, the most active men had a 37% lower risk of symptomatic diverticular disease than the least active men.  Most of the protection against diverticulitis was due to vigorous activities such as jogging and running, rather than moderate activities like walking. [Gut 36: p.276, 1995]

Gastric/Peptic/Duodenal Ulcers

Active men had one-half to one-third the risk of developing a duodenal ulcer over 20 years compared with their sedentary counterparts.  Men who walked or ran at least 10 miles per week were 62% less likely than inactive subjects to develop an ulcer.  Men who walked or ran less than 10 miles each week had about half the ulcer risk of those with no regular exercise.

Not recommended for
Heartburn / GERD / Acid Reflux

Heartburn is more frequent when exercising within 2 hours of eating.


Organ Health

Gallbladder Disease

Studies have shown that the more physically active one is, the lower one's risk of gallstone formation.  One study indicated that men who performed endurance-type exercise (such as jogging and running, racquet sports, and brisk walking) for thirty minutes five times per week reduced their risk for gallbladder disease by up to 34%.  The benefit depended more on the intensity of activity than the type of exercise.  Some researchers guess that in addition to controlling weight, exercise helps normalize blood sugar levels and insulin levels, which, if abnormal, may contribute to gallstones.

Tumors, Malignant

Colon Cancer

Try to get at least 30 minutes of physical activity every day.

Breast Cancer

Exercising at least four hours per week for 12 years can reduce a woman's risk of breast cancer in half, according to a study of breast cancer patients performed at the University of Southern California.  The study revealed that exercise is especially important during the adolescent and child-bearing years.  In addition, the 12 years of exercise do not need to be performed consecutively.  This study complements one performed at the Alberta Cancer Board in Alberta, Canada, which showed that exercising throughout life can cut a woman's risk of breast cancer by 20%.

Ovarian Cancer

Researchers studied more than 2,100 women and found that those who exercised for more than 6 hours per week were 27% less likely to develop ovarian cancer than women who exercised less than 1 hour each week.  High activity levels were found to protect women of all ages. [Obstetrics and Gynecology 96: pp.609-14, October 2000]

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