Physical exercise

"Workout" and "Exercise" redirect here. For other uses, see Workout (disambiguation) and Exercise (disambiguation).

A U.S. Marine participates in a triathlon at Catoctin Mountain in 2005

Indian wrestler exercising near Varanasi, 1973

Physical exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, and merely enjoyment. Frequent and regular physical exercise boosts the immune system and helps prevent the "diseases of affluence" such as heart disease, cardiovascular disease, Type 2 diabetes, and obesity. It may also help prevent stress and depression, help to promote or maintain positive self-esteem, improve mental health generally, and can augment an individual's sex appeal or body image, which has been found to be linked with higher levels of self-esteem. Childhood obesity is a growing global concern, and physical exercise may help decrease some of the effects of childhood and adult obesity. Some health care providers call exercise the "miracle" or "wonder" drug—alluding to the wide variety of benefits that it can provide for many individuals.

In the United Kingdom two to four hours of light activity are recommended during working hours. This includes walking and standing.

Classification

Physical exercises are generally grouped into three types, depending on the overall effect they have on the human body:

• Aerobic exercise is any physical activity that uses large muscle groups and causes your body to use more oxygen than it would while resting. The goal of aerobic exercise is to increase cardiovascular endurance. Examples of aerobic exercise include cycling, swimming, brisk walking, skipping rope, rowing, hiking, playing tennis, continuous training, and long slow distance training.
• Anaerobic exercise is also called strength or Resistance training and can firm, strengthen, and tone your muscles, as well as improve bone strength, Balance, and Coordination. Examples of strength moves are pushups, lunges, and bicep curls using dumbbells. Anaerobic exercise also include weight training, functional training, eccentric training, Interval training, sprinting and high-intensity interval training increase short-term muscle strength.
• Flexibility exercises stretch and lengthen your muscles. Activities such as stretching help to improve joint flexibility and keep muscles limber. The goal is to improve the range of motion which can reduce the chance of injury.

Physical exercise can also include training that focuses on accuracy, agility, power, and speed.

Sometimes the terms 'dynamic' and 'static' are used. 'Dynamic' exercises such as steady running, tend to produce a lowering of the diastolic blood pressure during exercise, due to the improved blood flow. Conversely, static exercise (such as weight-lifting) can cause the systolic pressure to rise significantly (during the exercise).

Health effects

Physical exercise is important for maintaining physical fitness and can contribute positively to maintaining a healthy weight, building and maintaining healthy bone density, muscle strength, and joint mobility, promoting physiological well-being, reducing surgical risks, and strengthening the immune system. Through these benefits exercise increases life expectancy.

According to the World Health Organization, lack of physical activity contributes to approximately 17% of heart disease and diabetes, 12% of falls in the elderly, and 10% of breast cancer and colon cancer.

Not everyone benefits equally from exercise. There is tremendous variation in individual response to training; where most people will see a moderate increase in endurance from aerobic exercise, some individuals will as much as double their oxygen uptake, while others can never augment endurance. However, muscle hypertrophy from resistance training is primarily determined by diet and testosterone. This genetic variation in improvement from training is one of the key physiological differences between elite athletes and the larger population. Studies have shown that exercising in middle age leads to better physical ability later in life.

Cardiovascular system

The beneficial effect of exercise on the cardiovascular system is well documented. There is a direct correlation between physical inactivity and cardiovascular mortality, and physical inactivity is an independent risk factor for the development of coronary artery disease. There is a dose-response relation between the amount of exercise performed from approximately 700 to 2000 kcal of energy expenditure per week and all-cause mortality and cardiovascular disease mortality in middle-aged and elderly populations. The greatest potential for reduced mortality is in the sedentary who become moderately active. Most beneficial effects of physical activity on cardiovascular disease mortality can be attained through moderate-intensity activity (40% to 60% of maximal oxygen uptake, depending on age). ... persons who modify their behavior after myocardial infarction to include regular exercise have improved rates of survival. ... Persons who remain sedentary have the highest risk for all-cause and cardiovascular disease mortality.

Immune system

Although there have been hundreds of studies on exercise and the immune system, there is little direct evidence on its connection to illness. Epidemiological evidence suggests that moderate exercise has a beneficial effect on the human immune system; an effect which is modeled in a J curve. Moderate exercise has been associated with a 29% decreased incidence of upper respiratory tract infections (URTI), but studies of marathon runners found that their prolonged high-intensity exercise was associated with an increased risk of infection occurrence. However, another study did not find the effect. Immune cell functions are impaired following acute sessions of prolonged, high-intensity exercise, and some studies have found that athletes are at a higher risk for infections. The immune systems of athletes and nonathletes are generally similar. Athletes may have slightly elevated natural killer cell count and cytolytic action, but these are unlikely to be clinically significant.

Vitamin C supplementation has been associated with lower incidence of URTIs in marathon runners.

Biomarkers of inflammation such as C-reactive protein, which are associated with chronic diseases, are reduced in active individuals relative to sedentary individuals, and the positive effects of exercise may be due to its anti-inflammatory effects. In individuals with heart disease, exercise interventions lower blood levels of fibrinogen and C-reactive protein, an important cardiovascular risk marker. The depression in the immune system following acute bouts of exercise may be one of the mechanisms for this anti-inflammatory effect.

Cancer

A systematic review evaluated 45 studies that examined the relationship between physical activity and cancer survivorship. According to the study results "There was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer–specific, and colon cancer–specific mortality".

Epigenetic effects

Physical exercise was correlated with a lower methylation frequency of two tumor suppressor genes, CACNA2D3 and L3MBTL. Hypermethylation of CACNA2D3 is associated with gastric cancer, while hypermethylation of L3MBTL is associated with breast cancer, brain tumors and hematological malignancies. A recent study proposed that "DNA methylation may be a mechanism linking exercise and cancer incidence and could serve as a biomarker for behavioral intervention trials. Studies with larger samples, objectively measured exercise, and more cancer-related markers are needed". According to the study, "Individuals who were more physically fit and who exercised more minutes per week had lower levels of DNA methylation. Those who increased their minutes of physical activity over 12 months experienced decreases in DNA methylation."

Cancer cachexia

Physical exercise is becoming a widely accepted non-pharmacological intervention for the prevention and attenuation of cancer cachexia. "Cachexia is a multiorganic syndrome associated with cancer, characterized by inflammation, body weight loss (at least 5%) and muscle and adipose tissue wasting". The exercise-induced transcription coactivator peroxisome proliferator-activated receptor-γ coactivator 1α (PGC1α) (see PPARGC1A), which suppresses FOXO and NF-κB dependent transcription during atrophy induced by fasting or denervation, may be a key intermediate responsible for the benficial antiatrophic effects of physical exercise on cancer cachexia. The exercise-induced isoform PGC1α4, which can repress myostatin and induce IGF1 and hypertrophy, is a potential drug target for treatment of cancer cachexia. Other factors, such as JUNB and SIRT1, that maintain skeletal muscle mass and promote hypertrophy are also induced with regular physical exercise.

Brain function

Main article: Neurobiological effects of physical exercise

Physical activity has been shown to be neuroprotective in many neurodegenerative and neuromuscular diseases. Evidence suggests that it reduces the risk of developing dementia. The Caerphilly Heart Disease Study followed 2,375 male subjects over 30 years and examined the association between regular physical exercise and dementia. The study found that men who exercised regularly had a 59% reduction in dementia when compared to the men who didn't exercise.

In addition, a 2008 review of cognitive enrichment therapies (strategies to slow or reverse cognitive decline) concluded that "physical activity, and aerobic exercise in particular, enhances older adults' cognitive function".

In mice, exercise improves cognitive functioning via improvement of spatial learning, and enhancement of synaptic plasticity and neurogenesis. In a 2009 study, scientists made two groups of mice swim a water maze, and then in a separate trial subjected them to an unpleasant stimulus to see how quickly they would learn to move away from it. Then, over the next four weeks they allowed one group of mice to run inside their rodent wheels, an activity most mice enjoy, while they forced the other group to work harder on mini-treadmills at a speed and duration controlled by the scientists. They then tested both groups again to track their learning skills and memory. Both groups of mice improved their performances in the water maze from the earlier trial. But only the extra-worked treadmill runners were better in the avoidance task, a skill that, according to neuroscientists, demands a more complicated cognitive response.

The mice who were forced to run on the treadmills showed evidence of molecular changes in several portions of their brains when viewed under a microscope, while the voluntary wheel-runners had changes in only one area. According to an author of the study, "our results support the notion that different forms of exercise induce neuroplasticity changes in different brain regions."

Furthermore, anecdotal evidence suggests that frequent exercise may reverse alcohol-induced brain damage.

There are several possibilities for why exercise is beneficial for the brain. Examples are as follows:

• increasing the blood and oxygen flow to the brain;
• increasing growth factors that help neurogenesis. and promote synaptic plasticity — possibly improving short and long term memory;
• increasing chemicals in the brain that help cognition, such as dopamine, glutamate, norepinephrine, and serotonin.

Physical activity is thought to have other beneficial effects related to cognition as it increases levels of nerve growth factors, which support the survival and growth of a number of neuronal cells.

Depression

Further information: Neurobiological effects of physical exercise § Antidepressant effect, and Exercise-induced euphoria

Physical exercise, particularly aerobic exercise, has pronounced long-term antidepressant effects and can produce euphoria in the short-term. Numerous systematic reviews suggest that regular aerobic exercise (at sufficient intensity and duration) has comparable antidepressant efficacy to standard pharmaceutical antidepressants in treating depression. Consequently, current medical evidence supports the use of aerobic exercise as a treatment for depression. The biomolecular basis for exercise-induced antidepressant effects is believed to be a result of increased neurotrophic factor signaling, particularly brain-derived neurotrophic factor. Continuous exercise can produce short-term euphoria, colloquially known as a "runner's high" in distance running or a "rower's high" in crew, through the increased biosynthesis of at least three euphoriant neurochemicals: anandamide (an endocannabinoid), β-endorphin (an endogenous opioid), and phenethylamine (a trace amine and amphetamine analog).

Sleep

A 2010 review of published scientific research suggested that exercise generally improves sleep for most people, and helps sleep disorders such as insomnia. The optimum time to exercise may be 4 to 8 hours before bedtime, though exercise at any time of day is beneficial, with the possible exception of heavy exercise taken shortly before bedtime, which may disturb sleep. There is, in any case, insufficient evidence to draw detailed conclusions about the relationship between exercise and sleep.

According to a 2005 study, exercise is the most recommended alternative to sleeping pills for resolving insomnia. Sleeping pills are more costly than to make time for a daily routine of staying fit, and may have dangerous side effects in the long run. Exercise can be a healthy, safe and inexpensive way to achieve more and better sleep.

Excessive exercise

Too much exercise can be harmful. Without proper rest, the chance of stroke or other circulation problems increases, and muscle tissue may develop slowly. Extremely intense, long-term cardiovascular exercise, as can be seen in athletes who train for multiple marathons, has been associated with scarring of the heart and heart rhythm abnormalities. Specifically, high cardiac output has been shown to cause enlargement of the left and right ventricle volumes, increased ventricle wall thickness, and greater cardiac mass. These changes further result in myocardial cell damage in the lining of the heart, leading to scar tissue and thickened walls. During these processes, the protein Troponin increases in the bloodstream, indicating cardiac muscle cell death and increased stress on the heart itself.

Inappropriate exercise can do more harm than good, with the definition of "inappropriate" varying according to the individual. For many activities, especially running and cycling, there are significant injuries that occur with poorly regimented exercise schedules. Injuries from accidents also remain a major concern, whereas the effects of increased exposure to air pollution seem only a minor concern.

In extreme instances, over-exercising induces serious performance loss. Unaccustomed overexertion of muscles leads to rhabdomyolysis (damage to muscle) most often seen in new army recruits. Another danger is overtraining, in which the intensity or volume of training exceeds the body's capacity to recover between bouts. One sign of Overtraining Syndrome (OTS) is suppressed immune function, with an increased incidence of upper respiratory tract infection (URTI). An increased incidence of URTIs is also associated with high volume/intensity training, as well as with excessive exercise (EE), such as in a marathon.

Stopping excessive exercise suddenly may create a change in mood. Feelings of depression and agitation can occur when withdrawal from the natural endorphins produced by exercise occurs. Exercise should be controlled by each body's inherent limitations. While one set of joints and muscles may have the tolerance to withstand multiple marathons, another body may be damaged by 20 minutes of light jogging. This must be determined for each individual.

Too much exercise may cause a woman to miss her period, a symptom known as amenorrhea. This is a very serious condition which indicates a woman is pushing her body beyond its natural boundaries.

Mechanism of effects

Developing research has demonstrated that many of the benefits of exercise are mediated through the role of skeletal muscle as an endocrine organ. That is, contracting muscles release multiple substances known as myokines which promote the growth of new tissue, tissue repair, and multiple anti-inflammatory functions, which in turn reduce the risk of developing various inflammatory diseases. Exercise reduces levels of cortisol, which causes many health problems, both physical and mental. Endurance exercise before meals lowers blood glucose more than the same exercise after meals. There is evidence that vigorous exercise (90–95% of VO₂ Max) induces a greater degree of physiological cardiac hypertrophy than moderate exercise (40 to 70% of VO₂ Max), but it is unknown whether this has any effects on overall morbidity and/or mortality. Both aerobic and anaerobic exercise work to increase the mechanical efficiency of the heart by increasing cardiac volume (aerobic exercise), or myocardial thickness (strength training). Ventricular hypertrophy, the thickening of the ventricular walls, is generally beneficial and healthy if it occurs in response to exercise.

Public health measures

Exercise in space: Astronaut Daniel Tani, Expedition 16 flight engineer, works out at the Unity node of the International Space Station using the short bar of the Interim Resistive Exercise Device (IRED) to perform pull-ups to increase his upper body strength while in a microgravity environment

Multiple component community-wide campaigns are frequently used in an attempt to increase a population's level of physical activity. A 2015 Cochrane review, however, did not find evidence supporting a benefit. The quality of the underlying evidence was also poor.

Environmental approaches appear promising: Signs that encourage the use of stairs, as well as community campaigns, may increase exercise levels. The city of Bogotá, Colombia, for example, blocks off 113 kilometers (70 mi) of roads on Sundays and holidays to make it easier for its citizens to get exercise. These pedestrian zones are part of an effort to combat chronic diseases, including obesity.

To identify which public health strategies are effective, a Cochrane overview of reviews is in preparation.

Exercise trends

Main article: Exercise trends

Worldwide there has been a large shift towards less physically demanding work. This has been accompanied by increasing use of mechanized transportation, a greater prevalence of labor saving technology in the home, and less active recreational pursuits. Personal lifestyle changes however can correct the lack of physical exercise.

Research in 2015 indicates integrating mindfulness to physical exercise interventions increases exercise adherence, self-efficacy and also has positive effects both psychologically and physiologically.

Nutrition and recovery

Proper nutrition is as important to health as exercise. When exercising, it becomes even more important to have a good diet to ensure that the body has the correct ratio of macronutrients while providing ample micronutrients, in order to aid the body with the recovery process following strenuous exercise.

History

The benefits of exercise have been known since antiquity. Marcus Cicero, around 65 BCE, stated: "It is exercise alone that supports the spirits, and keeps the mind in vigor."

Several mass exercise movements were started in the early twentieth century to realise the benefits of exercise. The first and most significant of these in the UK was the Women's League of Health and Beauty founded in 1930 by Mary Bagot Stack that had 166,000 members in 1937.

However, the link between physical health and exercise (or lack of it) was only discovered in 1949 and reported in 1953 by a team led by Jerry Morris. Dr. Morris noted that men of similar social class and occupation (bus conductors versus bus drivers) had markedly different rates of heart attacks, depending on the level of exercise they got: bus drivers had a sedentary occupation and a higher incidence of heart disease, while bus conductors were forced to move continually and had a lower incidence of heart disease. This link had not previously been noted and was later confirmed by other researchers.

Other animals

Physical exercise has been shown to benefit a wide range of other mammals, as well as salmon, juvenile crocodiles, and at least one species of bird.

However, several studies have shown that lizards display no benefit from exercise, leading them to be termed "metabolically inflexible".

A number of studies of both rodents and humans have demonstrated that individual differences in both ability and propensity for exercise (i.e., voluntary exercise) have some genetic basis.

See also

Main article: Outline of exercise

• Active living
• Behavioural change theories
• Exercise hypertension
• Exercise-induced nausea
• Exercise intensity
• Exercise intolerance
• Exercise-induced anaphylaxis
• Exercise-induced asthma
• Kinesiology
• Metabolic equivalent
• Supercompensation
• Physical fitness
• Street workout

Further reading

• Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett Jr DR, Tudor-Locke C, Greer JL, Vezina J, Whitt-Glover MC, Leon AS. The Compendium of Physical Activities Tracking Guide. Healthy Lifestyles Research Center, College of Nursing & Health Innovation, Arizona State University. Retrieved [date] from the World Wide Web. https://sites.google.com/site/compendiumofphysicalactivities/

External links

• Media related to at Wikimedia Commons
• MedLinePlus's Topic on Exercise and Physical Fitness
• Science Daily's reference on Physical Exercise
• Guidance on the promotion and creation of physical environments that support increased levels of physical activity.