Ask the Exercise Specialist - BJC Help For Your Health

Amy Smoot, our resident exercise specialist, invites your questions about fitness and exercise.

About the Exercise Specialist

Amy Smoot of Barnes-Jewish West County Hospital was the 2004 Cardinals Health Hall of Fame winner for Barnes-Jewish West County Hospital.

Amy advises others to make one change at a time to keep from feeling overwhelmed. "It seems that healthy choices follow one another. If people are new to exercise, I encourage them to stick with it for one month and see how great they feel. Take one step at a time. Look forward and stay positive."

The BJC Help for Your Health web site 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 web site 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 web site or for its use.

I wear running shoes for walking. They are light and I buy them a size bigger. Is that ok?
The choice to go with the shoe that gave you more room in the toe was smart. You need the room in front of the toes to avoid blisters. Different brands of shoes vary in size. We should go with the fit and not just go by our usual size. Running shoes are also a good choice. They are supportive and usually last a bit longer.

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 for me and my pregnancy?
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. Please check with your physician for further details.

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 having 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 food pyramid 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 have PBC of the liver and don't seem to be able to lose the weight the doctor wants me to . . . my exercise is limited due upcoming knee replacement surgery . . . can you help?
A consultation with a nutritionist who specifically deals with people that have PBC would help with the weight loss. Water exercise is great for people with knee pain because it decreases the amount of weight bearing on your joints. Water exercise provides cardiovascular and strength training without causing pain in the knees. It can help to build up strength, endurance and speed recovery from surgery. Water options include physical therapy in water, walking in the water or an exercise class in the water. Consult with your physician as to when it's appropriate to start.

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 Metaprolol for high blood preasure. It slows down my heart rate and keeps it from going much past 110-120 beats per minute . . . no matter how hard I excercise. Do you know if this will affect my target heart rate for a fat-burning walk? Will the medication change this for me?
From Ask the Exercise Specialist
As you know, the purpose of the Metaprolol 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, consult with 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 Swiss Ball. 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.

Lady Swimming 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.

Weights 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!