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Exercise
Exercise
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Cycling is a popular form of exercise.
Weight training

Exercise or working out is physical activity that enhances or maintains fitness and overall health.[1][2] It is performed for various reasons, including weight loss or maintenance, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic skills, improve health,[3] or simply for enjoyment. Many people choose to exercise outdoors where they can congregate in groups, socialize, and improve well-being as well as mental health.[4][5]

In terms of health benefits, usually, 150 minutes (2 hours and 30 minutes) of moderate-intensity exercise per week is recommended for reducing the risk of health problems.[6][7][8] At the same time, even doing a small amount of exercise is healthier than doing none. Only doing an hour and a quarter (11 minutes/day) of exercise could reduce the risk of early death, cardiovascular disease, stroke, and cancer.[9][10]

Classification

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Physical exercises are generally grouped into three types, depending on the overall effect they have on the human body:[11]

Physical exercise can also include training that focuses on accuracy, agility, power, and speed.[15]

Types of exercise can also be classified as dynamic or static. '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, albeit transiently, during the performance of the exercise.[16]

Health effects

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Exercise affects many organs.

Physical exercise is important for maintaining physical fitness and can contribute to maintaining a healthy weight, regulating the digestive system, building and maintaining healthy bone density, muscle strength, and joint mobility, promoting physiological well-being, reducing surgical risks, and strengthening the immune system. Some studies indicate that exercise may increase life expectancy and the overall quality of life.[17] People who participate in moderate to high levels of physical exercise have a lower mortality rate compared to individuals who by comparison are not physically active.[18] Moderate levels of exercise have been correlated with preventing aging by reducing inflammatory potential.[19] The majority of the benefits from exercise are achieved with around 3500 metabolic equivalent (MET) minutes per week, with diminishing returns at higher levels of activity.[20] For example, climbing stairs 10 minutes, vacuuming 15 minutes, gardening 20 minutes, running 20 minutes, and walking or bicycling for transportation 25 minutes on a daily basis would together achieve about 3000 MET minutes a week.[20] A lack of physical activity causes approximately 6% of the burden of disease from coronary heart disease, 7% of type 2 diabetes, 10% of breast cancer, and 10% of colon cancer worldwide.[21] Overall, physical inactivity causes 9% of premature mortality worldwide.[21]

The American-British writer Bill Bryson wrote: "If someone invented a pill that could do for us all that a moderate amount of exercise achieves, it would instantly become the most successful drug in history."[22]

Fitness

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Most people can increase fitness by increasing physical activity levels.[23] Increases in muscle size from resistance training are primarily determined by diet and testosterone.[24] This genetic variation in improvement from training is one of the key physiological differences between elite athletes and the larger population.[25][26] There is evidence that exercising in middle age may lead to better physical ability later in life.[27]

Early motor skills and development is also related to physical activity and performance later in life. Children who are more proficient with motor skills early on are more inclined to be physically active, and thus tend to perform well in sports and have better fitness levels. Early motor proficiency has a positive correlation to childhood physical activity and fitness levels, while less proficiency in motor skills results in a more sedentary lifestyle.[28]

The type and intensity of physical activity performed may have an effect on a person's fitness level. There is some weak evidence that high-intensity interval training may improve a person's VO2 max slightly more than lower intensity endurance training.[29] However, unscientific fitness methods could lead to sports injuries.[citation needed]

Cardiovascular system

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Central (cardiovascular) and peripheral (skeletal muscle) adaptations to exercise training

The beneficial effect of exercise on the cardiovascular system is well documented. There is a direct correlation between physical inactivity and cardiovascular disease, and physical inactivity is an independent risk factor for the development of coronary artery disease. Low levels of physical exercise increase the risk of cardiovascular diseases mortality.[30][31]

Children who participate in physical exercise experience greater loss of body fat and increased cardiovascular fitness.[32] Studies have shown that academic stress in youth increases the risk of cardiovascular disease in later years; however, these risks can be greatly decreased with regular physical exercise.[33]

There is a dose-response relationship between the amount of exercise performed from approximately 700–2000 kcal of energy expenditure per week and all-cause mortality and cardiovascular disease mortality in middle-aged and elderly men. The greatest potential for reduced mortality is seen in sedentary individuals who become moderately active.

Studies have shown that since heart disease is the leading cause of death in women, regular exercise in aging women leads to healthier cardiovascular profiles.

The most beneficial effects of physical activity on cardiovascular disease mortality can be attained through moderate-intensity activity (40–60% of maximal oxygen uptake, depending on age). After a myocardial infarction, survivors who changed their lifestyle to include regular exercise had higher survival rates. Sedentary people are most at risk for mortality from cardiovascular and all other causes.[34] According to the American Heart Association, exercise reduces the risk of cardiovascular diseases, including heart attack and stroke.[31]

Some have suggested that increases in physical exercise might decrease healthcare costs, increase the rate of job attendance, as well as increase the amount of effort women put into their jobs.[35]

Immune system

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Although there have been hundreds of studies on physical exercise and the immune system, there is little direct evidence on its connection to illness.[36] 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.[36] 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. Studies have shown that strenuous stress for long durations, such as training for a marathon, can suppress the immune system by decreasing the concentration of lymphocytes.[37] The immune systems of athletes and nonathletes are generally similar. Athletes may have a slightly elevated natural killer cell count and cytolytic action, but these are unlikely to be clinically significant.[36]

Vitamin C supplementation has been associated with a lower incidence of upper respiratory tract infections in marathon runners.[36]

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.[38] The depression in the immune system following acute bouts of exercise may be one of the mechanisms for this anti-inflammatory effect.[36]

Cancer

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A systematic review evaluated 45 studies that examined the relationship between physical activity and cancer survival rates. According to the review, "[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. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers."[39] Evidence suggests that exercise may positively affect the quality of life in cancer survivors, including factors such as anxiety, self-esteem and emotional well-being.[40] For people with cancer undergoing active treatment, exercise may also have positive effects on health-related quality of life, such as fatigue and physical functioning.[41] This is likely to be more pronounced with higher intensity exercise.[41]

Exercise may contribute to a reduction of cancer-related fatigue in survivors of breast cancer.[42] Although there is only limited scientific evidence on the subject, people with cancer cachexia are encouraged to engage in physical exercise.[43] Due to various factors, some individuals with cancer cachexia have a limited capacity for physical exercise.[44][45] Compliance with prescribed exercise is low in individuals with cachexia and clinical trials of exercise in this population often have high drop-out rates.[44][45]

There is low-quality evidence for an effect of aerobic physical exercises on anxiety and serious adverse events in adults with hematological malignancies.[46] Aerobic physical exercise may result in little to no difference in the mortality, quality of life, or physical functioning.[46] These exercises may result in a slight reduction in depression and reduction in fatigue.[46]

Neurobiological

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A woman engaging in aerobic exercise (jogging)

The neurobiological effects of physical exercise involve possible interrelated effects on brain structure, brain function, and cognition.[47][48][49][50] Research in humans has demonstrated that consistent aerobic exercise (e.g., 30 minutes every day) may induce improvements in certain cognitive functions, neuroplasticity and behavioral plasticity; some of these long-term effects may include increased neuron growth, increased neurological activity (e.g., c-Fos and BDNF signaling), improved stress coping, enhanced cognitive control of behavior, improved declarative, spatial, and working memory, and structural and functional improvements in brain structures and pathways associated with cognitive control and memory.[51][52][53] The effects of exercise on cognition may affect academic performance in children and college students, improve adult productivity, preserve cognitive function in old age, prevent or treat certain neurological disorders, and improve overall quality of life.[54][55][56][57]

In healthy adults, aerobic exercise has been shown to induce transient effects on cognition after a single exercise session and persistent effects on cognition following consistent exercise over the course of several months.[47][53][58] People who regularly perform an aerobic exercise (e.g., running, jogging, brisk walking, swimming, and cycling) have greater scores on neuropsychological function and performance tests that measure certain cognitive functions, such as attentional control, inhibitory control, cognitive flexibility, working memory updating and capacity, declarative memory, spatial memory, and information processing speed.[51][53][58][59][60]

Aerobic exercise has both short and long term effects on mood and emotional states by promoting positive affect, inhibiting negative affect, and decreasing the biological response to acute psychological stress.[58] Aerobic exercise may affect both self-esteem and overall well-being (including sleep patterns) with consistent, long term participation.[61] Regular aerobic exercise may improve symptoms associated with central nervous system disorders and may be used as adjunct therapy for these disorders. There is some evidence of exercise treatment efficacy for major depressive disorder and attention deficit hyperactivity disorder.[55][62][63][64] The American Academy of Neurology's clinical practice guideline for mild cognitive impairment indicates that clinicians should recommend regular exercise (two times per week) to individuals who have been diagnosed with these conditions.[65]

Some preclinical evidence and emerging clinical evidence supports the use of exercise as an adjunct therapy for the treatment and prevention of drug addictions.[66][67][68][69]

Reviews of clinical evidence also support the use of exercise as an adjunct therapy for certain neurodegenerative disorders, particularly Alzheimer's disease and Parkinson's disease.[70][71] Regular exercise may be associated with a lower risk of developing neurodegenerative disorders.[72]

Depression

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Numerous systematic reviews and meta-analyses have indicated that exercise has a marked and persistent antidepressant effect in humans,[73][62][74][63][75] an effect believed to be mediated through enhanced BDNF signaling in the brain.[63] Several systematic reviews have analyzed the potential for physical exercise in the treatment of depressive disorders. The 2013 Cochrane Collaboration review on physical exercise for depression noted that, based upon limited evidence, it is more effective than a control intervention and comparable to psychological or antidepressant drug therapies.[75] Three subsequent 2014 systematic reviews that included the Cochrane review in their analysis concluded with similar findings: one indicated that physical exercise is effective as an adjunct treatment (i.e., treatments that are used together) with antidepressant medication;[63] the other two indicated that physical exercise has marked antidepressant effects and recommended the inclusion of physical activity as an adjunct treatment for mild–moderate depression and mental illness in general.[62][74] A 2016 meta-analysis concluded that physical exercise improves overall quality of life in individuals with depression relative to controls. One systematic review noted that yoga may be effective in alleviating symptoms of prenatal depression.[76] Another review asserted that evidence from clinical trials supports the efficacy of physical exercise as a treatment for depression over a 2–4 month period.[51] These benefits have also been noted in old age, with a review conducted in 2019 finding that exercise is an effective treatment for clinically diagnosed depression in older adults.[77]

A 2024 systematic review and network meta-analysis of 218 randomized controlled trials involving over 14,000 participants found that various forms of exercise, including walking or jogging, yoga, resistance training, and mixed aerobic activities, were associated with reductions in depressive symptoms. The review observed that the effects of exercise were comparable to those of psychotherapy and pharmacotherapy, with more intensive exercise yielding greater benefits. Resistance training was identified as particularly effective for younger individuals, while yoga appeared to be more beneficial for older adults. While confidence in the findings was limited by methodological concerns in the included studies, the review noted that exercise produced significant improvements in symptoms across a wide range of participants and treatment contexts.[73]

Continuous aerobic exercise can induce a transient state of 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),[78] β-endorphin (an endogenous opioid),[79] and phenethylamine (a trace amine and amphetamine analog).[80][81][82]

Concussion

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Supervised aerobic exercise without a risk of re-injury (falling, getting hit on the head) is prescribed as treatment for acute concussion.[83] Some exercise interventions may also prevent sport-related concussion.[84]

Sleep

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Preliminary evidence from a 2012 review indicated that physical training for up to four months may increase sleep quality in adults over 40 years of age.[85] A 2010 review suggested that exercise generally improved sleep for most people, and may help with insomnia, but there is insufficient evidence to draw detailed conclusions about the relationship between exercise and sleep.[86] A 2018 systematic review and meta-analysis suggested that exercise can improve sleep quality in people with insomnia.[87]

Libido

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One 2013 study found that exercising improved sexual arousal problems related to antidepressant use.[88]

Respiratory system

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People who participate in physical exercise experience increased cardiovascular fitness.[medical citation needed] There is some level of concern about additional exposure to air pollution when exercising outdoors, especially near traffic.[89]

Mechanism of effects

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Skeletal muscle

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Resistance training and subsequent consumption of a protein-rich meal promotes muscle hypertrophy and gains in muscle strength by stimulating myofibrillar muscle protein synthesis (MPS) and inhibiting muscle protein breakdown (MPB).[90][91] The stimulation of muscle protein synthesis by resistance training occurs via phosphorylation of the mechanistic target of rapamycin (mTOR) and subsequent activation of mTORC1, which leads to protein biosynthesis in cellular ribosomes via phosphorylation of mTORC1's immediate targets (the p70S6 kinase and the translation repressor protein 4EBP1).[90][92] The suppression of muscle protein breakdown following food consumption occurs primarily via increases in plasma insulin.[90][93][94] Similarly, increased muscle protein synthesis (via activation of mTORC1) and suppressed muscle protein breakdown (via insulin-independent mechanisms) has also been shown to occur following ingestion of β-hydroxy β-methylbutyric acid.[90][93][94][95]

Aerobic exercise induces mitochondrial biogenesis and an increased capacity for oxidative phosphorylation in the mitochondria of skeletal muscle, which is one mechanism by which aerobic exercise enhances submaximal endurance performance.[96][90][97] These effects occur via an exercise-induced increase in the intracellular AMP:ATP ratio, thereby triggering the activation of AMP-activated protein kinase (AMPK) which subsequently phosphorylates peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α), the master regulator of mitochondrial biogenesis.[90][97][98]

Signaling cascade diagram
Diagram of the molecular signaling cascades that are involved in myofibrillar muscle protein synthesis and mitochondrial biogenesis in response to physical exercise and specific amino acids or their derivatives (primarily L-leucine and HMB).[90] Many amino acids derived from food protein promote the activation of mTORC1 and increase protein synthesis by signaling through Rag GTPases.[90][99]
Abbreviations and representations
 • PLD: phospholipase D
 • PA: phosphatidic acid
 • mTOR: mechanistic target of rapamycin
 • AMP: adenosine monophosphate
 • ATP: adenosine triphosphate
 • AMPK: AMP-activated protein kinase
 • PGC-1α: peroxisome proliferator-activated receptor gamma coactivator-1α
 • S6K1: p70S6 kinase
 • 4EBP1: eukaryotic translation initiation factor 4E-binding protein 1
 • eIF4E: eukaryotic translation initiation factor 4E
 • RPS6: ribosomal protein S6
 • eEF2: eukaryotic elongation factor 2
 • RE: resistance exercise; EE: endurance exercise
 • Myo: myofibrillar; Mito: mitochondrial
 • AA: amino acids
 • HMB: β-hydroxy β-methylbutyric acid
 • ↑ represents activation
 • Τ represents inhibition
Graph of muscle protein synthesis vs time
Resistance training stimulates muscle protein synthesis (MPS) for a period of up to 48 hours following exercise (shown by dotted line).[91] Ingestion of a protein-rich meal at any point during this period will augment the exercise-induced increase in muscle protein synthesis (shown by solid lines).[91]

Other peripheral organs

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Summary of long-term adaptations to regular aerobic and anaerobic exercise. Aerobic exercise can cause several central cardiovascular adaptations, including an increase in stroke volume (SV)[100] and maximal aerobic capacity (VO2 max),[100][101] as well as a decrease in resting heart rate (RHR).[102][103][104] Long-term adaptations to resistance training, the most common form of anaerobic exercise, include muscular hypertrophy,[105][106] an increase in the physiological cross-sectional area (PCSA) of muscle(s), and an increase in neural drive,[107][108] both of which lead to increased muscular strength.[109] Neural adaptations begin more quickly and plateau prior to the hypertrophic response.[110][111]

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.[112] Exercise reduces levels of cortisol, which causes many health problems, both physical and mental.[113] Endurance exercise before meals lowers blood glucose more than the same exercise after meals.[114] 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.[115] 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.

Central nervous system

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The effects of physical exercise on the central nervous system may be mediated in part by specific neurotrophic factor hormones released into the blood by muscles, including BDNF, IGF-1, and VEGF.[116][117][118]

Public health measures

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Community-wide and school campaigns are often used in an attempt to increase a population's level of physical activity. Studies to determine the effectiveness of these types of programs need to be interpreted cautiously as the results vary.[23] There is some evidence that certain types of exercise programmes for older adults, such as those involving gait, balance, co-ordination and functional tasks, can improve balance.[119] Following progressive resistance training, older adults also respond with improved physical function.[120] Brief interventions promoting physical activity may be cost-effective, however this evidence is weak and there are variations between studies.[121]

Environmental approaches appear promising: signs that encourage the use of stairs, as well as community campaigns, may increase exercise levels.[122] 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. Such pedestrian zones are part of an effort to combat chronic diseases and to maintain a healthy BMI.[123]

Parents can promote physical activity by modelling healthy levels of physical activity or by encouraging physical activity.[124] According to the Centers for Disease Control and Prevention in the United States, children and adolescents should do 60 minutes or more of physical activity each day.[125] Implementing physical exercise in the school system and ensuring an environment in which children can reduce barriers to maintain a healthy lifestyle is essential.

The European Commission's Directorate-General for Education and Culture (DG EAC) has dedicated programs and funds for Health Enhancing Physical Activity (HEPA) projects[126] within its Horizon 2020 and Erasmus+ program, as research showed that too many Europeans are not physically active enough. Financing is available for increased collaboration between players active in this field across the EU and around the world, the promotion of HEPA in the EU and its partner countries, and the European Sports Week. The DG EAC regularly publishes a Eurobarometer on sport and physical activity.

[edit]

Worldwide there has been a large shift toward less physically demanding work.[127] This has been accompanied by increasing use of mechanized transportation, a greater prevalence of labor-saving technology in the home, and fewer active recreational pursuits.[127] Personal lifestyle changes, however, can correct the lack of physical exercise.[medical citation needed]

Research published in 2015 suggests that incorporating mindfulness into physical exercise interventions increases exercise adherence and self-efficacy, and also has positive effects both psychologically and physiologically.[128]

Social and cultural variation

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Exercising looks different in every country, as do the motivations behind exercising.[4] In some countries, people exercise primarily indoors (such as at home or health clubs), while in others, people primarily exercise outdoors. People may exercise for personal enjoyment, health and well-being, social interactions, competition or training, etc. These differences could potentially be attributed to a variety of reasons including geographic location and social tendencies.

In Colombia, for example, citizens value and celebrate the outdoor environments of their country. In many instances, they use outdoor activities as social gatherings to enjoy nature and their communities. In Bogotá, Colombia, a 70-mile stretch of road known as the Ciclovía is shut down each Sunday for bicyclists, runners, rollerbladers, skateboarders and other exercisers to work out and enjoy their surroundings.[132]

Similarly to Colombia, citizens of Cambodia tend to exercise socially outside. In this country, public gyms have become quite popular. People will congregate at these outdoor gyms not only to use the public facilities, but also to organize aerobics and dance sessions, which are open to the public.[133]

Sweden has also begun developing outdoor gyms, called utegym. These gyms are free to the public and are often placed in beautiful, picturesque environments. People will swim in rivers, use boats, and run through forests to stay healthy and enjoy the natural world around them. This works particularly well in Sweden due to its geographical location.[134]

Exercise in some areas of China, particularly among those who are retired, seems to be socially grounded. In the mornings, square dances are held in public parks; these gatherings may include Latin dancing, ballroom dancing, tango, or even the jitterbug. Dancing in public allows people to interact with those with whom they would not normally interact, allowing for both health and social benefits.[135]

These sociocultural variations in physical exercise show how people in different geographic locations and social climates have varying motivations and methods of exercising. Physical exercise can improve health and well-being, as well as enhance community ties and appreciation of natural beauty.[4]

Adherence

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Adhering or staying consistent with an exercise program can be challenging for many people.[136] Studies have identified many different factors. Some factors include why a person is exercising (e.g, health, social), what types of exercises or how the exercise program is structured, whether or not professionals are involved in the program, education related to exercise and health, monitoring and progress made in exercise program, goals setting, and involved a person is in choosing the exercise program and setting goals.[137]

Nutrition and recovery

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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, to aid the body with the recovery process following strenuous exercise.[138]

Active recovery is recommended after participating in physical exercise because it removes lactate from the blood more quickly than inactive recovery. Removing lactate from circulation allows for an easy decline in body temperature, which can also benefit the immune system, as an individual may be vulnerable to minor illnesses if the body temperature drops too abruptly after physical exercise.[139] Exercise physiologists recommend the "4-Rs framework":[140]

Rehydration
Replacing any fluid and electrolyte deficits
Refuel
Consuming carbohydrates to replenish muscle and liver glycogen
Repair
Consuming high-quality protein sources with additional supplementation of creatine monohydrate
Rest
Getting long and high-quality sleep after exercise, additionally improved by consuming casein proteins, antioxidant-rich fruits, and high-glycemic-index meals

Exercise has an effect on appetite, but whether it increases or decreases appetite varies from individual to individual, and is affected by the intensity and duration of the exercise.[141]

Excessive exercise

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Overtraining occurs when a person exceeds their body's ability to recover from strenuous exercise.[142] Overtraining can be described as a point at which a person may have a decrease in performance or plateau as a result of failure to perform at a certain level or training-load consistently; a load which exceeds their recovery capacity.[143] People who are overtrained cease making progress, and can even begin to lose strength and fitness. Overtraining is also known as chronic fatigue, burnout, and overstress in athletes.[144][145]

It is suggested that there are different forms of overtraining. Firstly, "monotonous program overtraining" suggests that repetition of the same movement, such as certain weight lifting and baseball batting, can cause performance plateau due to an adaption of the central nervous system, which results from a lack of stimulation.[143] A second example of overtraining is described as "chronic overwork-type," wherein the subject may be training with too high intensity or high volume and not allowing sufficient recovery time for the body.[143]

Up to 10% of elite endurance athletes and 10% of American college swimmers are affected by overtraining syndrome (i.e., unexplained underperformance for approximately 2 weeks, even after having adequate resting time).[146]

History

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Roper's gymnasium, Philadelphia, US, c. 1831

The benefits of exercise have been known since antiquity. Dating back to 65 BCE, it was Marcus Cicero, Roman politician and lawyer, who stated: "It is exercise alone that supports the spirits, and keeps the mind in vigor."[147] Exercise was also seen to be valued later in history during the Early Middle Ages as a means of survival by the Germanic peoples of Northern Europe.[148]

More recently, exercise was regarded as a beneficial force in the 19th century. In 1858, Archibald MacLaren opened a gymnasium at the University of Oxford and instituted a training regimen for Major Frederick Hammersley and 12 non-commissioned officers.[149] This regimen was assimilated into the training of the British Army, which formed the Army Gymnastic Staff in 1860 and made sport an important part of military life.[150][151][152] Several mass exercise movements were started in the early twentieth century as well. 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.[153]

The link between physical health and exercise (or lack of it) was further established in 1949 and reported in 1953 by a team led by Jerry Morris.[154][155] 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.[155]

Other animals

[edit]

Animals like chimpanzees, orangutans, gorillas and bonobos, which are closely related to humans, without ill effect engage in considerably less physical activity than is required for human health, raising the question of how this is biochemically possible.[156]

Studies of animals indicate that physical activity may be more adaptable than changes in food intake to regulate energy balance.[157]

Mice having access to activity wheels engaged in voluntary exercise and increased their propensity to run as adults.[158] Artificial selection of mice exhibited significant heritability in voluntary exercise levels,[159] with "high-runner" breeds having enhanced aerobic capacity,[160] hippocampal neurogenesis,[161] and skeletal muscle morphology.[162]

The effects of exercise training appear to be heterogeneous across non-mammalian species. As examples, exercise training of salmon showed minor improvements of endurance,[163] and a forced swimming regimen of yellowtail amberjack and rainbow trout accelerated their growth rates and altered muscle morphology favorable for sustained swimming.[164][165] Crocodiles, alligators, and ducks showed elevated aerobic capacity following exercise training.[166][167][168] No effect of endurance training was found in most studies of lizards,[166][169] although one study did report a training effect.[170] In lizards, sprint training had no effect on maximal exercise capacity,[170] and muscular damage from over-training occurred following weeks of forced treadmill exercise.[169]

See also

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References

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia
from Grokipedia
Exercise is a subset of physical activity defined as planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness, such as cardiovascular endurance, muscular strength, flexibility, and balance. Unlike general physical activity, which encompasses any bodily movement produced by skeletal muscles that requires energy expenditure—including daily tasks like walking or housework—exercise is intentional and often follows specific programs or routines to achieve health goals. Common types include aerobic exercises (e.g., running or swimming) that enhance cardiovascular health, muscle-strengthening activities (e.g., weightlifting), flexibility exercises (e.g., stretching or yoga), and balance training (e.g., tai chi), all of which can be adapted for different ages, abilities, and settings. Regular participation in exercise yields substantial health benefits, reducing the risk of chronic conditions such as , , certain cancers, and while improving by alleviating symptoms of anxiety and depression. It also supports cognitive function, enhances quality, strengthens bones and muscles, and contributes to better and overall . These advantages are supported by extensive evidence showing that even modest increases in exercise can lower mortality rates and delay age-related decline. Global health authorities, including the (WHO), recommend that adults engage in at least 150–300 minutes of moderate-intensity aerobic or 75–150 minutes of vigorous-intensity activity per week, or an equivalent combination, alongside muscle-strengthening activities on two or more days. For children and adolescents, guidelines emphasize at least of moderate-to-vigorous activity daily, incorporating varied types to foster lifelong habits. These evidence-based standards underscore exercise's role in strategies to combat sedentary lifestyles and promote well-being across populations.

Definition and Classification

Definition

Exercise is defined as a subset of that consists of planned, structured, and repetitive bodily movement, with the objective of improving or maintaining one or more components of , such as cardiovascular endurance, muscular strength, flexibility, or . This distinguishes it from general , which encompasses any bodily movement produced by skeletal muscles that results in energy expenditure, including everyday tasks like walking or chores. The term "exercise" originates from the Latin verb exercere, meaning "to keep busy," "to drive on," or "to train," derived from ex- ("from" or "away") and arcere ("to keep away" or "enclose"), implying the removal from rest or idleness to engage in purposeful activity. By the mid-14th century, it entered English via exercice, initially referring to both physical and mental training before emphasizing bodily exertion in modern usage. Key elements of exercise include its intentional nature—for purposes such as enhancing , athletic performance, or rehabilitation—and parameters like intensity, duration, and frequency, as outlined in guidelines from the (ACSM). For instance, ACSM recommends at least 150 minutes of moderate-intensity per week for adults to achieve health benefits, alongside resistance training two or more days weekly. Unlike obligatory labor, such as manual work performed for livelihood, or unstructured play, exercise is voluntary and goal-oriented, focusing on systematic progression toward specific fitness outcomes rather than incidental or compulsory movement. This purposeful structure allows for measurable improvements in physical capabilities, setting it apart from spontaneous activities.

Types of Exercise

Exercise is commonly classified into major categories based on the primary physiological targets and energy systems involved, as outlined by authoritative bodies such as the (ACSM) and the (WHO). The ACSM framework identifies four key domains: cardiorespiratory (aerobic), resistance, flexibility, and neuromotor exercise. Similarly, the WHO emphasizes aerobic activities, muscle-strengthening (resistance) exercises, balance training, and flexibility for comprehensive physical activity recommendations across age groups. These classifications guide the selection of activities to achieve balanced fitness, with each type serving distinct purposes in enhancing overall physical capability. Aerobic exercise, also known as cardiorespiratory training, involves sustained, rhythmic activities that primarily utilize oxygen to produce energy and improve endurance. Common examples include jogging at moderate intensity, cycling, swimming, and brisk walking, which elevate heart rate and breathing for extended periods, typically 30 minutes or more per session. These activities enhance the body's ability to transport and use oxygen efficiently during prolonged efforts. Anaerobic exercise encompasses high-intensity, short-duration efforts that rely on energy sources without significant oxygen involvement, building power and speed. Examples include sprinting, , and , where bursts of maximal effort last seconds to minutes. Such exercises, often integrated into resistance training, target fast-twitch muscle fibers to increase strength and explosive performance. Flexibility exercises focus on improving the in joints and muscles through controlled movements. Routines such as static holds, dynamic stretches, or poses elongate muscle-tendon units, held for 10-30 seconds per stretch, targeting major muscle groups. These activities, recommended at least twice weekly, promote better posture and reduce injury risk during other exercises. Balance and coordination exercises, categorized as neuromotor training in the ACSM framework, enhance proprioception, agility, and stability through activities that challenge motor control. Examples include tai chi, yoga, or stability ball training, performed for 20-30 minutes per session to improve gait and reaction time, particularly beneficial for older adults. These exercises support functional fitness for daily movements. Each type contributes uniquely to health outcomes like reduced disease risk, as explored further in dedicated sections.

Physiological Mechanisms

Muscular and Skeletal Responses

Exercise induces profound adaptations in and tissues, primarily through mechanical loading and metabolic demands that trigger cellular and molecular responses. In , these changes enhance contractile capacity, energy production, and structural integrity, while in , they promote remodeling to withstand increased stress. These musculoskeletal adaptations are distinct from broader systemic effects, such as enhanced oxygen delivery via cardiovascular mechanisms, which support muscle performance during prolonged activity. Skeletal muscle fibers are classified into slow-twitch (Type I) and fast-twitch (Type II) categories based on their heavy chain isoforms, contractile speed, and metabolic properties. Type I fibers, characterized by slower contraction velocities and high oxidative capacity, predominate in postural and endurance-oriented muscles, enabling sustained low-intensity efforts through efficient ATP production via aerobic . In contrast, Type II fibers, including the oxidative-glycolytic Type IIa and glycolytic Type IIx/IIb subtypes, facilitate rapid, powerful contractions but more quickly due to reliance on anaerobic pathways. , such as , promotes a shift toward Type I or Type IIa characteristics by upregulating oxidative enzymes and mitochondrial density, enhancing resistance without altering fiber type proportions substantially in humans. Resistance training, however, primarily induces within existing fiber types rather than wholesale transitions, though chronic overload can increase the proportion of Type IIa fibers for improved power-endurance. Muscle hypertrophy, the increase in muscle fiber cross-sectional area, arises predominantly from resistance training through elevated protein synthesis exceeding degradation. Mechanical tension from heavy loads activates mechanosensors like and , initiating signaling cascades involving , which phosphorylates targets to boost ribosomal biogenesis and myofibrillar protein accretion. Muscle damage from eccentric contractions and metabolic stress from high-repetition sets further contribute by releasing growth factors such as IGF-1 and elevating anabolic hormones like testosterone, though these effects are secondary to tension. Studies demonstrate that loads above 65-70% of , performed to volitional fatigue, yield significant hypertrophy across fiber types, with gains of 5-15% in fiber area after 8-12 weeks in untrained individuals. Aerobic exercise drives in muscle cells, expanding the population to meet heightened energy demands. This process is orchestrated by the transcriptional coactivator PGC-1α, which is upregulated by exercise-induced signals like AMPK activation and calcium transients, subsequently coactivating NRF1/2 and ERRα to transcribe nuclear and mitochondrial genes for components. As a result, mitochondrial volume density can increase by 30-100% in Type I and IIa fibers following 6-12 weeks of , improving ATP yield and reducing lactate accumulation. This adaptation is particularly pronounced in response to , which elevates PGC-1α nuclear abundance more acutely than moderate continuous exercise.00044-1) Bone tissue adapts to exercise via remodeling governed by Wolff's law, which posits that bone architecture and density modify in response to applied mechanical loads, with increased strain stimulating osteoblast activity over osteoclast resorption. Weight-bearing and high-impact activities, such as jumping or running, generate site-specific strain that activates osteocytes as mechanosensors, releasing signals like sclerostin inhibition to promote Wnt/β-catenin signaling and bone formation. This leads to enhanced trabecular and cortical bone mineral density, with studies showing 1-3% annual gains in the lumbar spine and hips from programs involving 50-100 impacts per session, three times weekly. Such adaptations are load-magnitude dependent, with higher strains yielding greater remodeling, though excessive loading risks microdamage without sufficient recovery.

Cardiovascular and Respiratory Adaptations

Regular aerobic exercise training elicits profound adaptations in the cardiovascular system, enhancing the heart's ability to pump blood more effectively to meet the increased oxygen demands of active tissues. , the product of and , increases substantially, with rising due to greater ventricular filling from expanded and improved . These changes are driven by eccentric of the left ventricle, allowing for larger end-diastolic volumes without proportional increases in wall thickness. In response to sustained training, maximal may remain stable or slightly decrease, but submaximal heart rates during exercise drop, reflecting improved efficiency. A key metric of these adaptations is the improvement in maximal oxygen uptake (), which can increase by approximately 15-20% in previously untrained individuals after 8-12 weeks of moderate-intensity aerobic training, primarily through elevated and better oxygen extraction in muscles. Elite endurance athletes often exhibit resting , with heart rates 17-26% lower than sedentary individuals (typically 40-60 beats per minute), resulting from intrinsic sinus node remodeling and reduced funny current activity in pacemaker cells. These cardiovascular enhancements are partly stimulated by the muscular demands for greater blood flow during repeated bouts of activity. Vascular adaptations complement cardiac changes by reducing peripheral resistance and improving oxygen delivery. Endothelial function is enhanced through increased expression of endothelial nitric oxide synthase (eNOS), boosting (NO) bioavailability and promoting , which helps regulate by lowering systolic and diastolic values in response to training. In trained skeletal muscles, density grows via , increasing the number of capillaries per muscle fiber by 20-50% after prolonged exercise, which facilitates better nutrient and oxygen . These structural changes, including expanded arteriolar diameters, further support elevated blood flow without excessive pressure rises. Respiratory adaptations to aerobic training optimize and reduce the , enabling sustained performance at higher intensities. The diaphragm and strengthen, increasing their endurance and efficiency, which allows for greater force generation during inspiration without . expands, often by 10-20% in response to training, permitting larger air volumes per breath at submaximal workloads and thereby lowering the to maintain ventilation. This results in reduced effort during exercise, as the ventilatory equivalent for oxygen (VE/VO2) decreases, reflecting improved pulmonary and coupling between ventilation and .

Neural and Hormonal Pathways

Exercise engages complex neural pathways that facilitate coordination, adaptation, and sustained physical effort. During aerobic activities, the brain releases (BDNF), a key protein that supports by promoting the growth of new neurons and strengthening synaptic connections in regions like the hippocampus. This BDNF elevation occurs acutely in response to exercise intensity and duration, enhancing neural adaptability and potentially improving . These central changes integrate with peripheral muscular responses to optimize movement efficiency, though the primary focus here is on brain-level signaling. Hormonal pathways play a crucial role in mobilizing resources and modulating sensations during exercise. Cortisol, released via activation of the hypothalamic-pituitary-adrenal axis, rises to mobilize energy stores by increasing glucose availability and suppressing non-essential functions under physical stress. Endorphins, opioid-like peptides secreted from the pituitary gland and hypothalamus, act to dampen pain perception and induce a sense of euphoria, helping sustain prolonged activity. Meanwhile, growth hormone surges from the anterior pituitary to stimulate protein synthesis and tissue repair, particularly in response to high-intensity efforts. The orchestrates rapid adjustments to meet exercise demands through a dynamic shift in branch dominance. At the onset of activity, sympathetic activation predominates, elevating , redirecting blood flow to muscles, and heightening alertness via norepinephrine release. This "fight-or-flight" state persists during exertion to support energy expenditure. Post-exercise, parasympathetic reactivation takes over, promoting recovery by slowing and restoring digestive functions through vagal stimulation. This transition ensures efficient resource reallocation after stress. Central fatigue arises from neural mechanisms that limit performance to prevent overexertion, involving key neurotransmitters in the . Elevated serotonin levels in the , particularly during prolonged endurance exercise, contribute to feelings of tiredness by influencing and effort in the and . Conversely, acts as an antagonist, with its release supporting reward and drive, but imbalances favoring serotonin can amplify subjective . These monoamine interactions highlight how the modulates exertion independently of peripheral muscle capacity.

Health Benefits

Physical Health Improvements

Regular physical activity contributes to by increasing energy expenditure and promoting fat loss while enhancing metabolic rate. Moderate-intensity , such as brisk walking or , typically burns 300 to 500 kilocalories per hour depending on body weight and intensity, facilitating a that supports reductions in . For instance, engaging in at least 150 minutes of per week has been associated with clinically significant decreases in waist circumference and overall adiposity in adults. Additionally, resistance training builds lean muscle mass, which elevates by increasing the body's capacity to burn calories even at rest, aiding long-term weight maintenance. Exercise bolsters immune function, particularly through moderate regimens that enhance natural killer (NK) cell activity and lower infection susceptibility. Studies demonstrate that consistent moderate exercise training elevates NK cell cytotoxicity, a key component of innate immunity, leading to improved surveillance against pathogens. This adaptation is linked to a 20-30% reduction in the incidence of upper respiratory tract infections compared to sedentary individuals, as observed in prospective trials involving endurance activities like jogging or swimming over 8-15 weeks. Such benefits arise from exercise-induced shifts in immune cell circulation and anti-inflammatory responses, without the immunosuppressive effects seen in excessive training. Metabolic health improves markedly with regular exercise, primarily via enhanced insulin sensitivity that mitigates the risk of . Aerobic and resistance exercises increase in skeletal muscles, improving insulin action by up to 35% following sessions at moderate intensities, such as 50-65% of VO2 peak. Population-level data indicate that meeting guidelines—150 minutes of moderate exercise weekly—reduces the risk of developing by approximately 30%, as supported by epidemiological analyses and health organization recommendations. This protective effect stems from better glycemic control and reduced visceral fat accumulation, key precursors to . Load-bearing exercises, including and high-impact activities like , are essential for maintaining and preventing . These activities apply mechanical stress to bones, stimulating activity and increasing density (BMD) by 1-3% in postmenopausal women and older adults after 6-12 months of . Clinical trials show that combining weight-bearing with resistance yields greater BMD gains at the spine and compared to non-weight-bearing alternatives, effectively slowing age-related bone loss. Long-term adherence to such routines is associated with a lower risk, as evidenced by cohort studies linking higher lifetime to preserved skeletal integrity.

Mental and Cognitive Effects

Regular physical exercise has been shown to enhance mood through the release of , often associated with the phenomenon known as "runner's high," which contributes to feelings of and well-being during and after prolonged aerobic activities. This surge acts as a natural and mood elevator, helping to mitigate stress and promote positive emotional states. Additionally, exercise reduces anxiety symptoms by modulating gamma-aminobutyric acid (GABA) levels in the , an inhibitory that dampens overactive neural responses linked to anxious states; studies in animal models demonstrate that both wheel-running and exercise elevate GABA concentrations, correlating with decreased anxiety-like behaviors. Exercise also yields cognitive benefits, particularly in improving memory and executive function among older adults, through structural changes in the brain such as increased hippocampal volume. A randomized controlled trial involving 120 older adults found that one year of aerobic exercise training led to a 2% increase in anterior hippocampal volume, accompanied by improvements in spatial memory performance. These adaptations enhance neurogenesis and synaptic plasticity in the hippocampus, a region critical for learning and memory, thereby supporting better executive functions like planning and attention. In alleviating depression, exercise produces symptom reductions comparable to medications, with meta-analyses reporting moderate to large effect sizes (Hedges' g ≈ -0.62 for walking or ) that translate to approximately 30-40% decreases in depressive symptoms on standardized scales. This efficacy holds across intensities, with vigorous activities showing slightly stronger effects, and positions exercise as a viable standalone or adjunct therapy for non-severe depression. Exercise provides neuroprotection against neurological disorders like by lowering risk through mechanisms such as plaque reduction. Meta-analyses indicate that regular reduces Alzheimer's risk by up to 45%, with higher engagement linked to greater protective effects. In animal models of Alzheimer's, moderate-intensity exercise, such as treadmill running, significantly decreases -beta plaque deposition and in the hippocampus, preserving cognitive function. These benefits involve enhanced clearance of proteins and reduced , potentially delaying disease onset.

Longevity and Disease Prevention

Regular physical activity has been consistently linked to reduced all-cause mortality, with epidemiological studies demonstrating that meeting or exceeding current guidelines of 150 minutes per week of moderate-intensity exercise can lower the overall risk of death by 20-35% compared to inactive individuals. This benefit arises from a dose-response relationship, where even modest increases in activity yield significant gains; for instance, the Prospective Urban Rural Epidemiology (PURE) study, involving over 130,000 participants across 17 countries, found that moderate activity levels (150-749 minutes per week) were associated with a 20% reduction in all-cause mortality (hazard ratio [HR] 0.80, 95% CI 0.74-0.87), while higher volumes approached a 28-35% reduction. These effects are attributed to exercise's multifaceted impacts on metabolic health, inflammation, and cardiovascular function, extending beyond immediate physiological changes to long-term survival advantages. In terms of , regular exercise is associated with a 10-20% decrease in risk for common malignancies such as and colon cancers, primarily through its mechanisms that modulate immune surveillance and regulation. Meta-analyses indicate that physically active individuals experience a 12-21% lower incidence of , with similar protective effects observed for colon cancer (approximately 19% risk reduction), as exercise lowers circulating levels of inflammatory markers like and interleukin-6 while enhancing tumor-suppressing pathways. These reductions are most pronounced in postmenopausal women for and across both genders for colorectal tumors, underscoring exercise's role in disrupting carcinogenic processes like chronic inflammation and . For , engaging in recommended levels of exercise confers about a 30% reduction in heart attack risk, mediated in part by plaque stabilization within arteries that prevents rupture and . Longitudinal data from large cohorts show that adherence to 150 minutes of weekly moderate activity correlates with a 22-31% lower incidence of major cardiovascular events, including , due to improved endothelial function and reduced atherogenic lipid profiles that promote fibrous cap thickening in plaques. This protective effect is evident across diverse populations, with vigorous activity yielding even greater benefits, highlighting exercise as a cornerstone for primary prevention of coronary events. Regarding lifespan extension, habitual exercise promotes telomere lengthening—the protective caps on chromosomes that shorten with age—in regular exercisers, contributing to an addition of 3-7 years of healthy . Systematic reviews confirm that aerobic and resistance training preserve length by upregulating activity, an that counters attrition, with observational data linking 150 minutes of weekly moderate exercise to a 7-year increase in compared to sedentary lifestyles. This maintenance underlies broader anti-aging effects, reducing age-related disease burden and enhancing healthspan rather than merely lifespan.

Risks and Management

Injuries and Overuse

Exercise-related injuries can be broadly categorized into acute and overuse types, each arising from distinct mechanisms but sharing common risk factors and preventive measures. Acute injuries occur suddenly due to a single traumatic event, such as a fall, collision, or awkward movement during . These include , which involve stretching or tearing of ligaments; strains, affecting muscles or tendons; and fractures, where bones break under impact. Common causes encompass improper technique, inadequate , or environmental hazards, leading to immediate pain, swelling, and loss of function. For instance, (ACL) tears, a severe form of sprain, affect approximately 0.25 per 10,000 athlete exposures in noncontact sports like running or soccer, though incidence varies by activity level and population. In runners specifically, overall acute injury rates contribute to an annual incidence of 37-56% for all running-related injuries, with knee being prevalent among them. Overuse syndromes develop gradually from repetitive stress on tissues without sufficient recovery time, leading to , microtrauma, and . , or medial tibial stress syndrome, manifest as pain along the shinbone due to overload on the and surrounding muscles, often seen in runners increasing mileage rapidly. Tendinopathies, such as Achilles or issues, result from cumulative strain on tendons, causing degeneration and reduced elasticity over time. These conditions are exacerbated by high volumes without rest, affecting up to 4.9% of long-distance runners for and 4.8% for Achilles tendinopathy in prospective studies. Overtraining syndrome, a more systemic overuse condition, arises from prolonged imbalance between load and recovery, leading to persistent , performance decline, mood disturbances, and hormonal changes; it affects up to 60% of elite endurance athletes annually and requires monitoring of symptoms like elevated resting for prevention. Key risk factors for both acute and overuse include sudden escalations in or volume, such as large increases in a single training session (e.g., longest run exceeding prior efforts by more than 10%), which heighten more than weekly totals alone, as shown in 2025 on over 5,200 runners. Poor lacking proper support or cushioning can heighten impact forces, while uneven or hard amplifies stress on joints and muscles. Prevention strategies emphasize preparation and gradual progression to minimize harm. Dynamic warm-ups, involving light aerobic activity and sport-specific movements, enhance muscle temperature, joint mobility, and neuromuscular coordination, reducing acute injury risk by up to 30-50% in meta-analyses. Progressive loading, through structured increases in exercise demands with attention to session-specific limits rather than strict weekly rules, allows tissues to adapt and prevents overuse by distributing stress evenly. For initial management of acute injuries, the PEACE & LOVE protocol—Protect from further damage, Elevate for fluid drainage, Avoid anti-inflammatories and ice to allow natural healing, Compress to manage swelling, and Educate on recovery; followed by Load gradually, Optimism mindset, Vascularization via movement, and Exercise—is recommended as of 2025 guidelines, applied in the first days post-injury. Brief incorporation of recovery aids, such as active rest techniques, can support healing without delving into advanced rehabilitation.

Contraindications and Special Populations

Exercise is contraindicated in certain medical conditions where the risks outweigh potential benefits, particularly those involving acute cardiovascular instability. According to (AHA) guidelines, absolute contraindications to include recent (within 2 days), high-risk , uncontrolled cardiac arrhythmias causing symptoms or hemodynamic compromise, acute or infarction, acute or , and acute . These conditions necessitate medical clearance before any to prevent life-threatening complications such as cardiac events. To assess exercise readiness and identify potential risks, standardized screening tools are recommended prior to initiating programs. The Physical Activity Readiness Questionnaire Plus (PAR-Q+) serves as a widely used self-administered tool to evaluate an individual's suitability for , consisting of questions about , symptoms, and current health status, often followed by ePARmed-X+ for clearance. A positive response indicates the need for medical consultation, helping to stratify low-risk individuals who can proceed while referring higher-risk ones for further evaluation. For special populations, exercise programs require modifications to ensure safety and efficacy. In pregnant women, the American College of Obstetricians and Gynecologists (ACOG) advises avoiding the after the first trimester, as it can compress the and reduce , potentially leading to and decreased fetal . Instead, upright or side-lying activities such as walking or are preferred to maintain maternal and fetal well-being. For older adults, the (ACSM) recommends low-impact aerobic exercises like walking, cycling, or to minimize joint stress while achieving the guideline of at least 150 minutes of moderate-intensity activity per week. These adaptations help counteract age-related declines in balance and muscle strength, reducing fall risks. In children, the (AAP) emphasizes play-based activities to meet the recommendation of 60 minutes of moderate-to-vigorous physical activity daily, fostering motor skills and enjoyment without structured intensity that could lead to overuse. Individuals with chronic conditions also benefit from tailored exercise approaches to manage symptoms and avoid exacerbations. For those with , guidelines from the American Thoracic Society recommend pre-medication with short-acting beta-agonists (e.g., albuterol) 15-30 minutes before exercise to prevent , alongside warm-up periods to reduce airway hyperresponsiveness. This strategy allows safe participation in aerobic activities while monitoring for triggers like cold air or high pollen. In patients with , the American College of (ACR) conditionally recommends as a low-impact option, where supports weight-bearing joints, alleviating pain and improving mobility more effectively than some land-based exercises in reducing symptoms. Such programs typically involve 2-3 sessions per week of water-based or resistance to enhance function without flare-ups.

Supporting Factors

Nutrition for Performance

Proper nutrition plays a critical role in fueling exercise, supporting energy demands, and enhancing recovery to optimize athletic . Athletes require tailored dietary strategies that account for the intensity, duration, and type of activity, with macronutrients providing the sources and building blocks for muscle function. Key components include carbohydrates for replenishment, proteins for tissue repair, and adequate hydration to maintain physiological balance during and after exertion. Carbohydrates are essential for maintaining stores, which serve as the primary fuel for high-intensity and prolonged exercise. For athletes engaging in moderate to high volumes, daily carbohydrate intake recommendations range from 5 to 7 grams per of body weight to support glycogen resynthesis and sustain performance. Higher intakes, up to 7 to 10 grams per , may be necessary for those in intense to prevent depletion and . Proteins contribute to muscle protein synthesis and repair following exercise-induced damage, with recommended daily intakes of 1.2 to 2.0 grams per of body weight for athletes across various to promote recovery and . Hydration is vital to replace fluid losses from sweat and prevent impairments in , cardiovascular function, and capacity. Athletes should aim to consume 1.5 liters of fluid for every of body weight lost during exercise to restore euhydration effectively. balance, particularly sodium and , must also be maintained, as sweat can deplete these minerals, leading to or muscle cramps if not replenished through beverages or foods containing 300 to 600 milligrams of sodium per liter of fluid. Nutrient timing strategies further enhance performance by aligning intake with exercise demands. Consuming carbohydrates 1 to 4 hours before exercise, at doses of 1 to 4 grams per of body weight, provides readily available energy and spares during activity. Post-exercise, a combination of protein (20 to 40 grams) and carbohydrates (0.8 to 1.2 grams per ) within 30 to 60 minutes initiates restoration and muscle repair, capitalizing on heightened metabolic rates. Micronutrients support foundational physiological processes critical for exercise. Iron is indispensable for oxygen transport via and , with athletes—especially females and performers—requiring 8 to 18 milligrams daily to avoid deficiency-related and reduced aerobic capacity. Calcium, at recommended intakes of 1,000 to 1,500 milligrams per day, bolsters bone health and , mitigating risks of stress fractures in sports.

Recovery and Rest

Recovery and rest are essential components of an exercise regimen, allowing the body to repair tissues, replenish stores, and adapt to training stresses, thereby preventing and enhancing long-term performance. Active recovery involves engaging in low-intensity activities, such as walking or light , immediately following intense exercise sessions to promote blood circulation, which facilitates the removal of metabolic byproducts like lactate from muscles. Studies have shown that active recovery can reduce muscle soreness and improve subsequent performance compared to passive alone, as it enhances oxygen delivery and waste clearance without imposing additional strain. Adequate plays a critical role in post-exercise recovery by supporting hormonal processes that regulate muscle repair and growth. During stages, the body releases , which aids in protein synthesis and tissue restoration, while also balancing levels to mitigate . Research recommends 7-9 hours of per night for adults engaging in regular to optimize these recovery mechanisms and reduce accumulation. Various therapies can further assist in recovery by targeting specific physiological responses. Foam rolling, a form of self-myofascial release, applies pressure to muscle to alleviate tightness and improve , with evidence indicating it reduces perceived soreness and enhances flexibility post-workout. , involving exposure to cold temperatures, helps diminish and swelling by constricting blood vessels and slowing metabolic activity in affected areas, leading to faster recovery times in athletes. Periodization in training programs incorporates structured rest phases, such as deload weeks, where exercise volume and intensity are intentionally reduced to allow for supercompensation and prevent burnout. These periods enable the neuromuscular system to recover fully, reducing the risk of syndrome, as supported by longitudinal studies on athletes showing improved strength gains following such cycles. Nutritional strategies, like post-exercise protein intake, can complement these rest techniques by supporting repair processes.

Guidelines and Recommendations

Global health organizations provide evidence-based recommendations for to promote health benefits while minimizing risks, tailored to different populations. The (WHO) outlines that adults aged 18-64 years should engage in at least 150-300 minutes of moderate-intensity aerobic per week, or 75-150 minutes of vigorous-intensity aerobic activity, or an equivalent combination, alongside muscle-strengthening activities involving major muscle groups on at least two days per week. These guidelines emphasize spreading activity throughout the week to achieve sustainable benefits, with additional sedentary behavior limits to further enhance outcomes. WHO sets a global target to reduce physical inactivity by 10% by 2025 and 15% by 2030 through strategies. The (ACSM) complements these with detailed thresholds for exercise prescription, defining moderate intensity as 3-6 metabolic equivalents (METs), such as brisk walking or cycling at a moderate pace. ACSM employs the FITT principle—Frequency (e.g., 5 days per week for ), Intensity (e.g., 40-59% reserve for moderate), Time (e.g., 30-60 minutes per session), and Type (e.g., or resistance)—to guide progression and customization, ensuring programs start conservatively and advance based on individual tolerance. This structured approach helps practitioners design regimens that align with WHO targets while accounting for personal fitness levels. Age-specific adaptations ensure safety and efficacy across life stages. For children and adolescents aged 5-17 years, WHO recommends at least 60 minutes of daily moderate-to-vigorous intensity , primarily aerobic, supplemented by muscle- and bone-strengthening activities at least three days per week. Older adults aged 65 years and above follow similar aerobic and strength guidelines as younger adults but should incorporate multicomponent activities including balance training, with supervision recommended for those with mobility limitations or chronic conditions to prevent falls and ensure proper form. To support adherence, guidelines advocate objective measurement tools like wearable devices, which track metrics such as steps, , and activity duration in real-time. Devices like fitness trackers and smartwatches enable users to monitor progress toward FITT and WHO targets, with studies showing they improve motivation and long-term compliance when integrated into behavioral interventions. Health organizations encourage their use alongside self-reporting for accurate adherence assessment in both clinical and contexts.

Adherence and Cultural Influences

Adherence to exercise programs remains a significant challenge, with approximately 50% of individuals who initiate a structured exercise regimen dropping out within the first six months. This high attrition rate is often attributed to a combination of motivational deficits and limited access to resources. Key barriers to sustained include socioeconomic factors, such as the financial costs associated with memberships or , which disproportionately affect lower-income populations. Time constraints, including demanding work schedules and family responsibilities, further impede participation, as individuals struggle to allocate consistent periods for exercise. Psychologically, low —defined as an individual's belief in their ability to perform and persist in physical activities—exacerbates these issues, leading to reduced initiation and maintenance of routines, particularly among older adults. Cultural influences shape exercise preferences and participation patterns globally, with notable differences between collectivist and individualistic societies. In collectivist cultures, such as those in many Asian and Latin American countries, group-oriented activities like or team sports are favored due to an emphasis on social harmony and communal engagement, which enhances motivation through shared experiences. Conversely, individualistic societies, prevalent in Western nations like the and parts of , tend to prioritize solitary pursuits such as running or solo , aligning with values of personal achievement and . These preferences influence overall adherence, as activities matching cultural norms are more likely to be sustained. Recent trends post-2020 have highlighted the growing popularity of high-intensity interval training (HIIT) and app-based tracking, driven by the COVID-19 pandemic's shift toward home-based and digital fitness solutions. HIIT gained traction for its efficiency in delivering cardiovascular and strength benefits in short sessions, appealing to time-constrained individuals, and remains a top trend (ranked #6 by ACSM in 2025) with emphasis on functional and low-impact variants. Fitness apps saw a 46% global increase in downloads during 2020, with sustained growth in usage for personalized tracking and virtual coaching, particularly in regions like India where adoption rose by 156%; cumulative downloads exceeded 1.7 billion by 2023, incorporating AI features. Wearable technology, including fitness trackers, ranked as the #1 global fitness trend for 2025 per ACSM, supporting ongoing adherence through real-time monitoring.

Historical and Comparative Perspectives

Historical Evolution

The concept of exercise as a structured practice for health and physical development traces its roots to ancient civilizations, where it was integrated into daily life and medical philosophy. In ancient Greece, gymnastics emerged as a foundational element of education and wellness, emphasizing balanced physical training to cultivate strength, agility, and endurance among youth. Hippocrates, often regarded as the father of Western medicine, advocated for moderation in exercise within his humoral theory, stating that "all parts of the body which have a function, if used in moderation and exercised in labors to which each is accustomed, become thereby healthy, well developed and age but little, and are free from trouble." He prescribed moderate physical activity in works like Regimen II to warm, thin, and purge bodily humors, preventing disease through harmonious bodily function. Concurrently, in ancient China around 2100 BCE, practices akin to qigong—combining breath control, gentle movements, and mental focus—originated as Dao Yin exercises to cultivate vital energy (qi) and promote longevity, with roots in shamanistic rituals and early medical texts. By the , exercise evolved from philosophical ideals to institutionalized programs, particularly in educational and community settings . The rise of in schools began in the mid-1800s, influenced by European models like German gymnastics; the first public school system to implement mandatory was in , , in 1855, followed by widespread adoption in cities like and New York by the late 1850s. This movement aimed to counter urbanization's sedentary effects on youth health, promoting , apparatus work, and outdoor activities as essential for moral and physical development. Paralleling this, the Young Men's Christian Association (YMCA), founded in in 1844 and expanding to the U.S. in 1851, pioneered community-based fitness programs. By the 1880s, American YMCAs emphasized for holistic youth development, introducing gyms, swimming pools, and structured classes—such as those developed by Robert J. Roberts, who coined "bodybuilding"—to build character alongside physical vigor. The marked a shift toward scientific and aerobic-focused exercise, driven by and national initiatives. In 1968, Dr. Kenneth H. Cooper's seminal book popularized , introducing point systems to measure through activities like running and , based on his studies with the U.S. ; the work sold millions and shifted public emphasis from strength to sustained aerobic capacity for heart health. This aligned with a broader fitness boom spurred by President John F. Kennedy's reinvigoration of the President's Council on Youth Fitness in 1961—originally established by Eisenhower in 1956—which promoted school programs, awards, and media campaigns to combat perceived national fitness declines amid concerns. In the , exercise paradigms transitioned to evidence-based strategies, culminating in the Surgeon General's report Physical Activity and Health, the first federal document to comprehensively review linking regular moderate activity—such as 30 minutes daily—to reduced risks of chronic diseases like coronary heart disease, , and certain cancers. Issued by the Centers for Disease Control and Prevention under Surgeon General Audrey F. Manley, the report synthesized epidemiological data to recommend as a of preventive , influencing global guidelines and marking exercise's integration into mainstream healthcare .

Exercise in Non-Human Animals

Exercise in non-human animals encompasses a range of instinctual and trained physical activities that parallel human , providing insights into evolutionary adaptations for locomotion and across . These behaviors, from migratory flights to patterns, have shaped physiological responses such as enhanced oxygen utilization and muscle efficiency, often studied to understand genetic and environmental influences on . Instinctual exercise is exemplified by long-distance bird migrations, where species like the undertake annual round-trip journeys averaging 70,000 to 90,000 kilometers, the longest of any animal, to exploit seasonal resources in polar regions. These flights demand exceptional , with migrants sustaining metabolic rates 10 to 15 times their resting levels—equivalent to twice the maximal aerobic capacity—through physiological adaptations including elevated fat stores, optimized mitochondrial function, and efficient oxygen transport via . Such migrations not only serve ecological purposes but also build aerobic capacity, as young terns develop flight muscles and cardiovascular systems during their inaugural journeys, enhancing survival for subsequent cycles. In domesticated animals, training elicits physiological improvements akin to those in humans, particularly in performance breeds like racehorses. Studies on ponies and horses demonstrate that structured aerobic training increases maximal oxygen uptake (VO₂ max) by 10% to 25% over weeks to months, driven by expansions in , density in muscles, and , mirroring human adaptations for endurance sports. For instance, untrained ponies exhibit VO₂ max values around 83-97 ml/kg/min, rising to 92-108 ml/kg/min post-training, while can reach over 140 ml/kg/min, which correlates with enhanced race performance and reduced fatigue. These gains underscore the conserved mechanisms of exercise-induced plasticity across mammals. Physical activity tied to has played a pivotal evolutionary role in driving locomotor adaptations in non-human animals, including early where demands for efficient resource gathering favored shifts toward upright posture. In ancestral , load-carrying during selected for changes in , such as elongated hindlimbs and a narrower , precursors to that improved energy economy over long distances compared to quadrupedal locomotion. This selective pressure, evident in fossils like , highlights how sustained physical exertion in heterogeneous environments promoted skeletal and muscular modifications for endurance, influencing divergence in lineages. Rodent wheel-running models have been instrumental in elucidating genetic underpinnings of exercise responses, revealing heritable variations in voluntary activity and physiological outcomes. Selective breeding experiments across inbred strains show that high-runner lines increase wheel-running distance by up to 2-3 fold compared to low-runners, linked to polymorphisms in genes like those regulating signaling and mitochondrial function, which enhance and aerobic capacity. These studies demonstrate adaptive responses such as hippocampal and improved insulin sensitivity following chronic running, providing a framework for understanding how modulates exercise benefits in mammals.

References

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