Aaron Gutjahr, our resident exercise specialist, invites your questions about fitness and exercise.

About the Exercise Specialist

Our exercise specialist is Aaron Gutjahr from the BJC HealthCare WellAware Center at the Taylor Avenue Building. He has been a personal trainer since 2002 and worked with people of all ages and physical abilities. See our Exercise and Fitness Wellness Tips.

In 2003, Gutjahr earned a bachelor of science degree in kinesiology (minor in mathematics); and he has a master of science degree in education and exercise physiology. He is a certified personal trainer through the American College of Sports Medicine and the American Council on Exercise, and a MADDOG certified spinning instructor. His training philosophy is: resistance training programs are the only way to build lean muscle and increase metabolism; therefore, weight management should focus on building muscle to burn fat. For consistent and sustainable weight loss, resistance training works.

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The BJC Help for Your Health website is intended as a reference and information source only. If you suspect you have a health problem, you should seek immediate care with the appropriate health care professionals. The information in this website is not a substitute for professional care, and must not be used for self-diagnosis or treatment. Do not start, stop or change any health, nutritional or exercise program; or any medications without first consulting your personal physician. BJC HealthCare assumes no liability for the information contained in this website or for its use.

What is a normal heart rate for a 185-pound, 30-year-old woman?
At 30, your estimated max heart rate is 180 beats per minute. Ideally, you should try to achieve 75 percent-95 percenrt of this max during exercise, which equates to a range of 135-171 beats-per-minute. Resting heart rate varies greatly from person to person depending on conditioning, lifestyle, and a number of other factors, but generally should be between 60-90 beats-per-minute.

There's a BoxFlex TreadClimber that supposedly burns 3.5 times more calories than a treadmill. Should I consider replacing my treadmill?
No. Burning 3.5 times the calories requires 3.5 times the work being performed. The equipment doesn't matter, your effort is what makes all the difference.

I weigh 300 pounds and am just starting to exercise. When I do, my heart rate goes to 175. Should I be worried?
Heart rates during exercise is highly individualized -- typically we recommend that an individual exercise at around 75 percent-95 percent of their max heart rate, which can be estimated by subtracting your age from 220. If you're 30 years old, your estimated max heart rate is 190. You may find that you can exercise at a higher percentage while still feeling fine, and that's just how your body works. I do recommend that you consult your primary care doctor and have him or her confirm that you do not have any cardiovascular issues before continuing strenuous exercise.

I am 56, 137 pounds and menopausal. Is it still possible to lose some weight and firm and tone from the waist-down?
Absolutely. The ability to gain lean body mass (needed to "firm qand tone"), lose or gain weight or get stronger, all stay the same as you age and are menopausal. The difference is the relative gains are less, meaning that you can gain muscle and lose fat at the same rate as the rest of us. The best thing you can do is get to the gym often -- physical activity not only reduces the symptoms of menopause, but it also helps to actively balance and regulate the hormones that are fluctuating during menopause. 

I am an active man walking 10,000 steps a day. My doctor recommended I wear weights on my ankles to get a strength training workout. How much weight do I need to wear ?
In my opinion, your doctor is making a very poor recommendation for you. Ankle weights add very little benefit when worn simply for walking, and in the long run, all they do is slow you down. There are better choices for you to make in regards to increasing the strength in your legs. Unless there is an injury that I'm unaware of, a traditional strength training program at a gym or some bodyweight based activities, such as lunges, squats, and plyometrics, are far better choices for you to increase your strength.

I have spinal stenosis and osteoarthritis. Would I be wiser to have physical therapy or work with a 24-Hour Fitness trainer?
I would consult a physical therapist or medical professional prior to starting your exercise program, as a therapist or spine specialist will be able to determine the severity of your condition and give some recommendations. If you choose to not use a physical therapist, I would find a fitness professional who is very experienced, holds at least a bachelors degree in exercise science or physiology, and has a history of working with people with back injuries.

I weigh 158.2 pounds but I want to be at 140 by October 20, 2012, and today is August 20, 2012. Is this realistic?
Eighteen pounds in 60 days is realistic, as it equates to just over 2 pound a week. You need to find a way to "burn off" an additional 1000+ calories per day, either by consuming less food, or by adding in exercise. In order to keep your metabolism fired up, make sure you integrate strength training into your routine. Good luck!

Would Tabata be suitable for a 61-year-old female?
After looking into Tabata, I don't see any issue with you trying this form of training, although I'm hoping you are looking into traditional exercise programs as well. Tabata is a form of high intensity interval training (HIIT), alternating short rest periods with high intensity body weight or resistance training -- by no means what I would prescribe for most 61 year-olds. Give it a try and see if it works for you. Best of luck!

I need to lose about 50-70 pounds. I don't know how to get rid of my belly bulge.
Weight loss is still all about calories in versus calories out. Spend a few days tracking your calories and examining your diet choices. There's no way to spot reduce fat. When you lose a pound of fat you don't get to choose where it comes from. Start strength training with high intensity cardiovascular exercise to get your metabolism (lean body weight) back where it should be and hopefully that will stimulate the weight loss you are looking for. Good luck!

I am a 30-year-old female. Is it normal to have a heart rate of 168-169 during exercise?
Your estimated max heart rate is 190 bpm (220 minus your age). A heart rate of 168-169 is about 88 percent of your maximum. Yes, it's perfectly normal and healthy to raise your heart rate to 170 bpm during exercise.

I weigh 360 pounds. If I work out on my elliptical twice a day -- an hour each time -- how much weight will I lose in two weeks?
It's really about calories in vs. calories out. Depending on how hard you are working, you burn 8-12 calories per minute on the elliptical. If you don't change your diet you would lose 5 pounds every 2 weeks. Dropping calories from your diet, can boost your weight loss.

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Aaron Gutjahr, MSed, ACE, exercise physiologist and personal training coordinator with the BJC WellAware Center, and Titleist Performance Institute Certified for Golf Fitness, shares flexibility exercises to improve your golf game.

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BJC WellAware Center manager Jeremy Koerber shares tips on how to prevent heat illness while exercising in high temperatures.



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Aaron Gutjahr, MSed, ACE, exercise physiologist and personal training coordinator with the BJC WellAware Center, and Titleist Performance Institute Certified for Golf Fitness, shows you why balance is important to your golf swing.

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BJC WellAware Center's Aaron Gutjahr shows you how to easily correct a bad golfing posture to improve your swing.
Gutjahr is Titleist Performance Institute Certified for Golf Fitness.
 

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I have spinal stenosis and can't walk very far. What exercises can I do to get my heart rate up?
Try an upright bike, recumbent bike or elliptical machine for cardio. These will take some impact away and allow for a longer exercise session. Also you can increase the resistance and get your heart rate up a little quicker and to levels you may not have been able to attain while walking.

I'm a 44 year-old woman with heel spurs. My doctor says no more walking; get a bike. Which is best for me, an upright or recumbent?
Your doctor is probably recommending that you switch to low- or zero-impact activity as opposed to walking. Your choice of bike is whichever one you feel most comfortable on and fits your budget.

I go to spin class or on a 5-mile run at least three times a week, but I'm gaining weight. I haven't changed my diet and feel healthier, but don't know why I am gaining weight.
Your body has become accustomed to your amount and mode of activity. Not changing your diet also can be the problem. Eating 100 calories of fruit will affect your body the same way 100 calories of processed cheese will -- if you don't burn it off, it will convert to fat and be stored. Check your diet. Begin a strength training regimen to preserve lean muscle mass and boost metabolism. Continue running and spinning to maintain your cardiovascular health.

If I am 25 and weigh 300 pounds. What should my target heart rate be?
Your age-related maximum heart rate is 195. Try to get your heart rate between 75-95 percent of this maximum during exercise, 146-185 beats per minute. If you are exercising but can still have a conversation with someone, you are not exercising at 75 percent of your capacity, and should try working a little harder.

Can a dancing video game help me shed weight?
If you really like dancing game and it gets you moving, then it's definitely helping you shed some pounds. Dancing has gotten you moving, and that means you will likely see some level of weight loss and improvement in fitness. Next, start a structured exercise program and examine your nutrition to further your weight loss.

I have a c4/5 instability in my neck. Will weight training put additional stress on my neck?
This is not cause enough for you to stop lifting weights, but you need to take special care to not worsen your condition. Spine specialists will sometimes prescribe certain exercises to help alleviate pain and strengthen the ligaments, tendons and muscles in your neck for stability. Talk with your doctor or physical therapist to get recommendations.

I was diagnosed with moderate spinal stenosis with herniated and compressed discs in my lower back. I have been taking spinning classes for many years. Can I continue?
Yes, if you're not experiencing additional pain. To ensure your back remains healthy, do additional exercises to strengthen the supportive and postural muscles in your neck and back.

I have extreme pain that came on suddenly in my left knee. Three years ago I had arthroscopic surgery on it. I exercise on the elliptical machine and am wondering if this is causing the pain. Because my right foot was surgically repaired many years ago and not stable or strong, my left leg and foot have had to absorb all the bending, walking and lifting. I treat the pain with lots of ibuprofen. Can I continue to work on the elliptical machine or will that make it worse? Can bone spurs grow in a knee?
You need rehabilitation to stop the pain. What you're doing now is mostly correct. Ibuprofen or naproxen-sodium are typically good for stopping joint-related inflammation. Ice works to relieve inflammation, and heat should be used when there is little to no pain to restore blood flow and loosen up the joint. Your knee is such a complex bundle of ligaments, tendons, bursae and other material, you should consult with a physician.

Elliptical machines are considered a zero impact form of cardiovascular activity, but they still require you to support your body weight in an upright position. A recumbent or upright bike may be a better choice, as it remains zero impact on the joints, and allows you to sit -- which takes the weight-bearing forces off your knee. With either machine, make sure that your hips, knees and ankles are in proper alignment. Improper placement of your feet, over-pronation, or improper angles of your hips, knees or ankles can cause additional knee problems. Have someone experienced in gait analysis watch you walk or pedal an elliptical to see if you're moving correctly.

I am currently on a medically supervised weight loss fast. I know there will be loose skin, but is there a way to minimize this? Also, what is the best exercise for building muscle and speeding up the weight loss. I am a 32-year-old female.
If you're losing your weight through diet alone, without the help of cardiovascular and strength training, you will most definitely have loose skin. When an individual loses weight through diet alone, over 1/3 of weight lost comes from loss of lean muscle tissue, with the rest being fat loss. This means that weight comes off quickly, but at a huge cost. You will become weaker, have little to no muscle tone, and your metabolism will slow down drastically. There's no "best exercise" for building muscle. Don't leave any muscle group behind -- have a fitness professional develop a whole body exercise program that you can do 2-3 times each week with a focus on working the largest muscle groups as much as possible. Add some efficient cardiovascular exercise, and you'll have the best chance of avoiding unnecessary muscle loss.

I am a 41-year-old, 185-pound woman. I was on the elliptical for 60 minutes and did 9,122 strides. How many calories did I burn?
Calories burned during exercise is related to the intensity and duration of exercise, and your body weight. If your elliptical workout was difficult (you couldn't have held a conversation while you exercised), you were probably burning 8-10 calories per minute, and burned 450-600 calories in your hour on the elliptical. If you were reading a book, watching TV or able to sing or talk during your hour, you probably burned 300-400.

I do not take diabetes medications. I generally take my sugar level readings the same time each day (after exercise). The readings vary between 120 and 180. Is this acceptable?
Yes, those are acceptable readings. Ideally, blood glucose readings wouldn't be over 180 mg/dl. Take readings prior to exercise, too. Do not exercise if blood glucose is 250 mg/dl or higher, and call your doctor if this happens two or more times in a row.

AFAA, ACE and ACSM recommend exercise a minimum of how many times a week for children under 5?
AFAA, ACE and ACSM share a view on youth exercise -- focus on activity vs. structured exercise programs. At 5, children have developed enough fine motor skills and cognitive ability to perform sport-oriented tasks and movements, but that doesn't mean an exercise program needs to be developed so 5-year-olds will excel. Exercise should focus on further developing motor skills and balance, and social activities with family and other children. Emphasize the role of non-competitive, fun activities, and stick to the basics in regard to sports. Recommendations are that children 4-5 get at least one hour of activity each day, but an additional hour won't hurt!

I weigh 100 pounds. The machine I use is set up for a 185-pound person, and it says 720 calories are burned in 45 minutes. But I want to know how many calories I burn.
Cardiovascular equipment at the gym typically grossly overestimates the number of calories that are burned during a workout. Your weight does have a significant impact on your calories burned, but you must also consider the intensity of the exercise.

The mode of exercise also has a significant impact on the number of calories burned -- treadmill, elliptical, stair-stepper, bike.

Here are some numbers. For you, at 100 pounds, walking on a treadmill (at 3.5 mph) for 45 minutes will burn about 175 calories. Running on a treadmill (at 6 mph) for 45 minutes will burn about 360 calories. On low-impact or no-impact equipment like elliptical machines, you must use resistance to raise your heart rate significantly or the estimates will be way off. If you feel like you wouldn't be able to hold a normal conversation while exercising, then you're probably working hard enough. At that intensity on an upright exercise bike, you would burn about 225 calories (at ~10 mph). Increase your pedal speed to 13 mph and you burn around 320 calories. On an elliptical machine or stair-stepper with enough resistance to reach a moderate to high intensity, you will burn between 300 and 360 calories in 45 minutes.

What is the pulse rate at rest? What is the pulse rate after jumping one minute for 30 people ages 16-30?
A person's pulse rate at rest varies. Fit individuals will typically have a lower resting heart rate than those who are not active, simply because they have better cardiovascular health. Most people have a resting heart rate between 60 and 80 beats per minute. The more you exercise at higher heart rates, the lower your resting heart rate will become, as your heart becomes more efficient.

Pulse (heart rate) after jumping one minute also will vary depending upon each person's fitness level. If you can hold a conversation without much difficulty after jumping rope for one minute, then you are probably not reaching 70 percent of your cardiovascular capacity, which for the 16-30-year-old is 133-142 beats per minute. If you're out of breath and virtually unable to speak after one minute of jumping, then you have probably reached 90-95 percent of your capacity, which for the 16-30-year-old is 171-183 beats per minute.

I take the Boot Camp classes at Missouri Baptist Medical Center two times a week and love it! What else can I do to really tone and increase strength? I walked outside when the weather is nice, but I am in a winter funk! And tips on eating better are always helpful.
I'm happy you're enjoying the Boot Camp! Keep up the hard work! The boot camp style workout is meant to increase your cardiovascular health while promoting gains in muscular endurance. Those two components of fitness go hand-in-hand. To start increasing strength and developing greater amounts of lean muscle (which is what you need to have muscle tone), you must start a traditional weight-lifting program.

I am a 168-pound female. How much exercise do I need weekly?
I would need a lot more information to give you a specific answer. But answer these questions first:

• What are your goals (weight loss, strengthening, competition, overall fitness)
• What do you consider your ideal weight, and how do you want to look at your ideal weight?
• What is your current body composition?

What should my heart rate be when working out? I am a 185-pound 44-year-old man.
The common equation used to find your age-related maximum heart rate is 220-(your age), which for you is 220-44=176. You should try to maintain a heart rate of 75 percent-95 percent of this while exercising, and the higher the better. So for you, make sure you are always getting your heart rate to at least 132 (75 percent), but try to get your heart rate to 168 (95 percent) occasionally.

With any form of tendonitis, taking it easy and icing is best. Before venturing into heavy lifting, make sure you get a go-ahead from your physician. But if you really want to keep strength up, certain exercises can be performed -- just keep some key points in mind. Avoid deep knee bending, squatting, kneeling directly on the knees, stairs or hill-climbing and resisted exercises where the knee is bent in 90 degrees. Some safer exercises are a wall squat with an exercise ball without going parallel to the floor, isometric exercises that use the quadricep muscles, and leg extensions with light weights or elastic tubing (without bending the knee past 90 degrees). Stretching gently before and after activity is always recommended for both the quadricep muscles and the hamstring muscles.

I know you talk a lot about cross-training and how you can't target specific areas. What about the perilous triceps (aka arm flab) that are just so darn difficult? And, related to personal trainers, can you recommend some people? Or provide a list of qualifications? I live in St Charles, so closer to home would be better, but I'm willing to travel for health/fitness's sake. What is a reasonable cost of hiring a personal trainer?
Building up the muscles in your upper arms will tone your arms and "pick up that flab." Do exercises like bicep curls, tricep extensions and various other basic exercises.

And as far as more exercises, that's where your personal trainer comes in. Working with a personal trainer often brings about more results than without. That professional can help with more exercises and motivation to make the most of your workout. When choosing a fitness professional, make sure the individual is certified first and degreed second. There are many certifications out there but some of the more nationally recognized are ACSM, ACE, CSCS and AFAA. Go online and search for any of these certifications. You'll probably get a ZIP code search option, so you can locate a certified professional near you. Once you've selected a certified professional, you must decide if you will have them come to your house for training or if you will travel to them. If you choose to have the trainer come to your home, verify that he or she has liability insurance in case you are injured while under their supervision. Finally cost. Costs vary from state to state and vary if you are having the trainer come to your home or if you travel to a gym to exercise. Rates vary from $20 to $100 in the St. Louis area. The real question is how much is your health worth to you, and how long you can afford to work on being healthier?

I am a 60-year-old male. Five years ago I had the cancerous middle lobe of the right lung removed. I am 6'2" and weigh 185 pounds. I take a Tabata Protocol class Monday-Wednesday-Friday. Boxing class Tuesday-Thursday. During the Tabata I get very winded (out of breath) on certain exercises, like running or doing squat thrusts or jumping over a step with 4 risers. During boxing I also get out of breath in sparring or shadow boxing. My classmates don't have this problem. Is this my age, lung capacity or lack of physical strength? Can it get better?

How long does it take for water exercise to help nerve damage?
Without having all of the information as to how your nerve was damaged and the extent of the damage, this is the best answer that can be given. Nerve damage heals very slowly, approximately 1 mm/day. Many factors go into healing. Along with rest, reducing inflammation of the nerve and proper nutrition, aerobic exercise helps promote healing by increasing blood flow. But you need to choose an aerobic exercise that does not aggravate the nerve. Water exercise is typically safe and will not aggravate the nerve, but do not overdo the exercise. Physical therapy can help reduce nerve pain, and you will be given exercises specific to your injury.

I'm pregnant (2 months) and doing 40 minutes treadmill (3 miles per hour) twice a day. Is this good?
When pregnant, any exercise routine should be cleared by your physician. With a healthy pregnancy, you can continue the exercise you were doing prior to pregnancy, such as walking. Because of burning too many calories and the changes in your ligaments, two times a day on the treadmill would not be recommended. Talk to your physician.

I walk for at least 30 minutes, five days a week. I am 110 pounds overweight. Will this help?
Walking is a highly recommended form of exercise for weight loss. It is low-impact, and the only equipment needed is a good pair of walking shoes. Thirty minutes, five days a week is great. But you should vary your exercise routine to reduce the chance of an overuse injury. Add strength training, flexibility or Swissball exercises for variety and to increase your fitness level. Also, your body gets accustomed to the same exercises, and your results will slow down. Proper nutrition keeps your energy level up and speeds up your weight loss.

Just got a new cross-training machine and want to lose weight . . . how many minutes a day do I need to use it?
How many minutes a day will depend on how fit you are and if you have any injuries. If you are new to exercise, start with ten minutes and listen to your body. Try to increase by a couple minutes each day. If you are new to exercise expect some muscle soreness. After a few days, increase your time by five minutes until you are exercising 30-60 minutes a day. This will ensure that you are burning extra fat and calories. Be careful with doing the same exercises every day, as it can cause overuse injuries.

I have a bad back and tight muscles. I've thrown my back out twice. What exercises can I do, and what's the best program to be on?
Start at your physician's office to get a diagnosis. If your physician feels it's appropriate, physical therapy would be a good idea to direct you in what exercises you can do to avoid further painful episodes. The physical therapist can instruct you on flexibility and strengthening exercises specific to your body and your injuries. After physical therapy, you can take what you have learned and build a program in the gym. Get proper guidance to avoid more back pain.

Is yoga a good exercise for someone with bad knees and no access to a pool? I had a Caesarean section four months ago.
Yoga is a great form of exercise if you keep in mind your limitations with bad knees and weak abdominal muscles from the surgery. Yoga requires a lot of flexibility and strength. There may be some exercises you cannot do. The weakness and pain may both improve after you gain some strength by doing the yoga class. Many times, knee pain can be decreased by strengthening the muscles of the hip and the muscles that surround the knee joint. Definitely start with a beginner yoga class, and have fun.

I have bad knees. Where is a good place to take swimming classes or find a personal trainer?
Swimming is an excellent place to exercise when you have bad knees. The local YMCAs have great exercise classes as well as open swim times. Check out discounts for BJC employees to local YMCAs and other participating gyms. Depending on where you live, BJC also has several gyms with knowledgeable personal trainers.

I've been on my elliptical 40-50 minutes every day for a month. My diet contains lots of fruits and vegetables, and I drink lots of water (2-3 liters per day). I'm 65 kg/143 pounds and not losing any weight. When should I start losing some weight?
A lot of factors play a role in weight loss. Age and health issues can slow your metabolism. You are doing the correct thing with the elliptical, but cross-training is important to progress your weight loss and fitness. By adding walking, swimming or strength-training exercises, your body will respond more quickly. Check out the USDA Choose my Plate website for more information on a well-balanced diet including protein and carbohydrates.

I know women aren't supposed to "bulk up" but the more cardio I do to lose weight, the larger my legs seem to get. Is it possible to overdo cardio? I do at least 60 minutes of elliptical, walking or boxing every day. Which form of exercise is best for calorie burning as well as slimming?
Some women do have a tendency to "bulk up." The important thing is to get more variety in your routine. The elliptical and boxing may be contributing to the increased muscle bulk in your legs. You could cut back the time spent on the elliptical and boxing and add in some Pilates or swimming. Pilates is a good form of strength training that is more of a muscle lengthener. Swimming would also be a good cardiovascular workout that involves the whole body and is not so demanding on the legs. Make sure that you have a good flexibility routine.

I often eat a lot of fats, especially in the morning. I look like I'm two months pregnant. What could I eat to get my figure back, and how should I eat?
Exercise is an important component of healthy living. Along with proper nutrition, exercise can help you achieve your goal of flattening your stomach and getting back in to shape. The three components of a well-rounded exercise program include cardiovascular (walking, running, biking or aerobics), strength training (free weights or machines), and flexibility or stretching exercises. These should all be included in your routine to achieve optimum results. The cardiovascular exercise helps you lose fat, the strengthening exercises help you tone the muscle under the fat and the flexibility reduces the chance of injury.

I take Metoprolol for high blood pressure. It slows down my heart rate and keeps it from going much past 110-120 beats per minute . . . no matter how hard I exercise. Do you know if this will affect my target heart rate for a fat-burning walk?

From Ask the Exercise Specialist
The purpose of Metoprolol is to keep your heart rate under a certain range. Depending on your age, the 110-120 beats per minute may not be 60-70 percent of maximum target heart rate. You are still getting the benefits of cardiovascular and calorie burning even if you are not in the "fat-burning zone."

From Ask the Pharmacist
I would have your cardiologist speak to your trainer or physical therapist. Metoprolol is designed to keep the blood pressure and heart rate low. I checked on the Mayo Clinic Web site and found this answer.

Beta blockers slow your heart rate, which can prevent the increase in heart rate that typically occurs with exercise. As a result, the usual age-adjusted target heart rate doesn't work for measuring exercise intensity. No matter how vigorously you exercise when taking a beta blocker, you may never achieve your target.

There's no precise method for predicting the effect of beta blockers on your heart rate. An exercise stress test can evaluate your exercise capacity on beta blockers and provide information on which to base an adjusted target heart rate. You can also try lowering your target heart rate by the amount that your resting heart rate has been lowered by the beta blocker. For example, if your resting heart rate has decreased from 70 to 50, then try working at a target heart rate 20 beats per minute lower than what you used to do. Again, this is not a precise method, and sometimes the peak exercise heart rate is affected much more than is the resting heart rate. An exercise stress test is the best way to establish a new target heart rate on beta blockers.

If you haven't had an exercise stress test, you can use the perceived exertion scale, which relies on your own judgment of how hard you're working based on effort, breathlessness and fatigue. The scale ranges from 6 (at rest) to 20 (maximal effort). For most workouts, your best bet is to aim for moderate intensity, or a rating between 12 and 14.

I had a second Caesarean 16 years ago, but still have overhang and really low self-esteem. What can I do?
Walking can help decrease abdominal fat and tighten up abdominal muscles. Abdominal strengthening exercises can also tone the abdominal muscles. Proper nutrition can help reduce abdominal fat. Walking and exercise in general are proven to help with self-esteem. I also recommend that you speak with your physician regarding your low self-esteem.

I have stenosis (a condition where the spinal canal narrows and compresses the spinal cord and nerves) in my back. I have an elliptical trainer, but have pain whenever I use it. What should I do?
Stenosis can be aggravated by standing exercises such as walking or the elliptical trainer. It is important to have strong abdominal (stomach) muscles to support and decrease stress on the spine. Flexibility of the legs including the hamstrings (back of the legs) is an important part of the posture of your pelvis. A physical therapist could guide you on proper strengthening and flexibility exercises to improve function and avoid painful episodes. Try cutting back on the time you spend on the elliptical trainer or break up your time throughout the day. Aerobic exercise is an important component of health and the health of your spine.

What exercises do you recommend for people who suffer from arthritis?
Warm water exercise classes are highly recommended for people with arthritis. The warm water has therapeutic values for muscles and joints. If warm water is not available, try low-impact exercises. Many community centers, gyms and OASIS offer exercise-specific classes. Exercise increases muscle strength, which can help provide stability for the joints, and can help with range of motion for muscles and joints.

I am a 21-year-old female who has enjoyed exercising since high school. In the past, I may have exercised "wrong" and made my arms bigger and more muscular. I had the mindset of weight rather than repetition. Is there any way to tone my arms to look smaller?
High weights and low repetitions build more muscle bulk. For toning, lower reps and less weight is ideal. The muscles will atrophy if you completely stop the weights.

I am 25 with a 35 BMI. I started walking on a treadmill or around my neighborhood. When I begin, my shins hurt so badly, I have to stop to let the pain subside. After 15-20 minutes, the pain gets better. What should I do?
Shin pain with increased activity is typically diagnosed as shin splints or medial tibial stress syndrome. It comes from an overload on the shinbone and connective tissues that attach your muscles to the bone. Shin splints come from:

• Increasing a walking or running program too quickly
• Improper or worn out footwear
• Flat arches
• Exercising without proper warm up

To decrease shin splint pain:

• Rest and use ice on your shins
• Wear properly fitting shoes
• Warm up prior to walking or running
• Cross train
• Strengthen your hips

If these suggestions do not help, see your physician to rule out stress fractures. Cross-training is an important part of avoiding overuse injuries. Elliptical, bike, strength training and flexibility exercises are a great way to cross-train.

I have been working out for a year and lost 45 pounds, but I have reached a plateau, so I got an elliptical trainer. Can I work out on it twice a day without injury?
I always recommend cross-training. Doing the elliptical twice a day can set you up for an overuse injury. Also, your body will get accustomed to doing the same exercise daily and you will not achieve the desired results. Do the elliptical, then take a walk later in the day. Strength training and core stability are an important component of fitness that can help you break through plateaus. The more muscle mass you have, the more fat and calories you burn at rest.

Is there an exercise I can do to lose bra overhang?
It is not possible to spot reduce areas of concern, but proper nutrition and aerobic exercise can help you lose excess fat. Specific strength training exercises including rowing and lateral pull-downs can help to strengthen muscles under the fat and improve overall posture.

I have 30 pounds to lose. I've started doing the elliptical after work for 45 minutes, but I get bored. How long and how many times a week should I do this to lose 30 pounds in the shortest period? I am eating all the right foods.
Cross-training would help reduce your boredom and increase your fitness level quicker. Doing the elliptical every day may increase your chances of injury. Alternating the elliptical with walking would help you avoid overuse injuries; 45-60 minutes of cardiovascular exercise would increase weight loss. Strength training exercises and core stability will help you to lose inches and increase muscle mass. The increased muscle mass will increase your fat- and calorie-burning capabilities. Slow weight loss, up to two pounds a week, is recommended to keep the weight off.

I lost a lot of weight -- from 250 to 160. I am 5'8" and can't get rid of my belly fat and loose skin. I eat a strict 1,200 calories a day and exercise high-intensity 20 minutes on even days and 40 minutes low-intensity with weight training on odd days -- and 100 crunches daily.
Your excess skin will remain with significant weight loss. Cardiovascular exercise for at least 40 minutes (if possible) within your target heart rate zone is most beneficial for fat loss. Strength training of all the major muscle groups is important. Crunches are great, but you need to add lower abdominal strengthening exercises to your abdominal strengthening program. This includes exercises such as pelvic tilts and pelvic tilts with knee raises. These can be performed on the floor or with a SwissBall. An exercise specialist or a personal trainer can instruct you on specific exercises.

Does it matter if I exercise moderately 20 minutes twice a day rather than 40 minutes once a day?
It is better to exercise 40 minutes at once vs. two 20-minute sessions, if you want to burn fat. If you do not have a 40-minute block of time every day, make time for one as often as you can and when you can't, exercise in two 20-minute sessions . . . rather than not exercising at all. If you're deconditioned and lack the endurance for one 40-minute session, begin with the two 20-minute segments and work up to one 40-minute session.

I want to turn my fat into muscle without gaining weight. I compete in a sport that requires agility and fast reactions. What workout plan would help?
Muscle and fat are two different types of tissues, so you can't turn fat into muscle. Proper nutrition -- along with aerobic exercise and a low-weight/high-repetition strength-training program -- will decrease fat and increase muscle. The strength gained with lifting weights will help with stability of the muscle and joints for injury prevention. Agility is the ability to change the body's direction efficiently. This requires balance, coordination, speed, reflexes and strength. Agility training may involve using agility ladders on the ground with the participant hopping or using high steps through the rungs with forward, backward and lateral movements. Plyometric exercise uses explosive movements to develop muscular power and the ability to generate a large amount of force quickly. An example of a plyometric exercise would be to jump on and off a platform. There are many physical therapy facilities that offer sport-specific agility training and plyometrics for the fast reactions. It's important to meet with a physical therapist or a certified personal trainer with years of experience to ensure you are performing these exercises safely and accurately.

What is the best way to break a plateau? I walk three times a week for 30 minutes. I have lost 70 pounds, but have now weighed the same for two months. Low back problems keep me from running. I am a 41-year-old female. I am currently eating about 1,500 calories per day, and I weigh 168.
Vary your workout. If you have access to a gym, add an elliptical, bike . . . or try some strength-training machines. Try exercise videos. Invest in free weights to increase your muscle mass. The more muscle you have, the more calories you burn. Also, consider gradually increasing your walking time. Between 40 and 50 minutes of aerobic exercise daily (or most days) is recommended. See a personal trainer if you can.

What are good exercises that really target my abdomen? I had a C-section three years ago, and am still having trouble getting my muscles back in shape. Walking is a little hard to do due to a knee injury, and a swimming pool is not available right now.
Proper nutrition, aerobic exercise and strengthening exercises will all play a role in getting your abdomen in shape. A low-fat diet and aerobic exercise will help to decrease fat around the abdomen. If you cannot walk for exercise because of a knee injury, try a bike or elliptical machine. The SwissBall -- an exercise ball -- is a great way to strengthen your abdomen or core muscles. Exercises can be done sitting on the ball, lying on the ball or with your legs over the ball. SwissBalls can be purchased at most sporting good stores and usually come with an instruction sheet. A basic lower abdominal strengthening exercise that can be performed in sitting or lying down would be pulling the abdominal muscles in and up towards the rib cage and holding for a count of five (do not hold your breath). To progress, you would add alternating knee lifts while keeping your abdominals tight. A visit with an exercise specialist or personal trainer would be very beneficial to instruct you on the SwissBall or on other abdominal strengthening exercises to ensure that you are performing the exercises properly to avoid injury.

I'm walking on a treadmill 30 minutes at 2.2 miles per hour. Is this a good pace to start burning fat? My goal is to lose about 1-2 pounds a week, with a total loss goal of 70 pounds. I'm 44 and weigh 230 pounds.
If you are a beginning exerciser, walk at a comfortable pace where you feel safe and where your endurance will allow. Gradually increase your speed and time on the treadmill, as you can tolerate, up to 40-60 minutes. If possible, cross-training would be great . . . elliptical, strength training or exercise tapes.


What would be some good exercises for someone with very little time, and damage and arthritis in one knee? I have a 20-month-old daughter I would like to work into my routine.
Water exercise is great for arthritis in the knees. Walking and doing resistive exercises in the water can help build strength and stability of the muscles surrounding the knee. If you don't have a pool available, try some exercise videos for home. Make sure that the video is not outdated. Listen to your body. The rule with knee pain is to not work through pain. It is important to exercise the leg muscles and hip muscles to give your knee stability.

I have started to work out on weights. I want to tone up, but still maintain my girl shape. How can I properly work out on my home gym and not become musclebound?
It is difficult for most women to build muscle bulk. I recommend 3 sets of 12 repetitions at a moderate weight. If you are prone to building muscle, you can do 3 sets of 15 at a lower weight. The muscle should feel somewhat fatigued upon completion. It's important to work your large muscles before you work your smaller muscles. You do not want to fatigue the smaller ones first, as they also assist when working the large muscles. For example: on the chest press, you are working the pectoralis, triceps and deltoids. Muscle balance also is important -- make sure that you are hitting all of the major muscle groups. And don't forget your flexibility exercises!