Exercise and movement are the physical expression of the whole person. They reflect patterns of energy expenditure that are intertwined with a person’s bodymindspirit. Exercise plays an integral role not only in disease prevention but also in health promotion and well-being. Physical activity can release endorphins resulting in a sense of well-being and can elevate mood and promote a positive outlook.¹ The benefits of exercise on well-being have been repeatedly documented for more than two decades. A metaanalysis of 11 studies of exercise for depression concludes that clinicians should integrate exercise as an intervention into their practice because of its high efficacy.² Recent research confirms that moderate exercise improves immunity and protects against upper-respiratory illness, the most prevalent infectious disease worldwide. It also lowers the risk of chronic disease by exerting anti-inflammatory influences that prevent diabetes, cardiovascular disease, arthritis, osteoporosis, chronic obstructive pulmonary disease, several types of cancer, and premature mortality.³ Exercise and movement positively affect both physical and mental health and are effective interventions to promote wellness and prevent illness.

A new paradigm of fitness is emerging. Its orientation is broader and it focuses more on enjoyment, engagement, and adherence. Table 14-1 depicts the old and new fitness paradigms.

The primary purpose of exercise is to produce fitness. The following are the four basic components of fitness:

Flexibility, strength, endurance, and balance refer not only to the physical body but to the whole person and bodymindspirit. Movement practices from Eastern traditions have embraced this understanding for several thousand years and in this sense the paradigm is not new. However, adaptations of these traditions have developed as the practices came to the West. There are many styles of yoga that range from meditative and restorative to athletic and achievementoriented practice. Research is currently under way to evaluate the particular benefits of various types of yoga. In general, styles with pacing of movements and postures that are slow, flowing, meditative, and mindful may be more conducive to relaxation and positive parasympathetic response while promoting endurance, balance, strength, and flexibility.⁴

Movement practices promote health, wellness, and disease prevention. Modalities from Eastern traditions such as yoga, tai chi, and qi gong have become increasingly available and help cultivate mindfulness in movement. These practices employ rhythmic patterns and sequences of movement and/or holding postures or poses along with mindful breathing. They help enhance present moment awareness of what is happening in one’s interior environment of sensations, thoughts, emotions, feelings, and energy flow, as well as awareness in the exterior environment. A greater sense of connection with oneself can be cultivated as well as a sense of being part of a greater unity and flow of life.

A comparison review of 81 scientific and nursing journal articles found that yoga was as effective or better than other forms of exercise in improving various health metrics such as glucose regulation, reduction of depression, pain, and fatigue, improved balance and flexibility, and stress reduction.⁴ Movement that involves slow rhythmic patterns, breathwork, and holding postures may regulate the body’s hormonal response to stress and improve health outcomes in ways equal to or better than exercise in populations with and without disease.⁴ However, aerobic exercise and movement that is more physically active such as dancing are more effective in improving cardiorespiratory fitness. A routine that integrates aerobic exercise, strength training, and mindful movement practices can provide variety and enjoyment that leads to sustained behavior change over time.

In 2008, the U.S. Department of Health and Human Services (DHHS) released the Physical Activity Guidelines for Americans (PAG) that serve as the first ever national guidelines for exercise and movement.⁵ Table 14-2 illustrates weekly recommendations of aerobic activity and muscle strengthening activity according to age group.

In addition to these guidelines, research supports a new trend in cardiovascular fitness called peak interval training (PIT). PIT has been shown to be a highly effective and efficient means to achieve aerobic fitness. By intermittently taking the body up to peak heart rate and respiratory rate for short bursts of 1-3 minutes, and then allowing an interval of reduced effort, true aerobic metabolism is achieved. Typically, one will go through eight cycles of brief peak effort followed by several minutes of reduced effort. In this way, one can experience a complete and productive aerobic workout in 20 minutes. The cyclic intensity of PIT has been shown to improve aerobic ability and quality of life in people with heart failure after myocardial infarctions.⁶ In the absence of contraindications, PIT is a recommended method for all populations to achieve maximum health benefits in a minimal amount of time.

Fewer than 20% of adult Americans meet the U.S. Physical Activity Guidelines for both aerobic and muscle-strengthening activities.⁷ Individual barriers to physical activity may vary but often include “lack of time.” The benefits of exercise are cumulative, and just 10 minutes of sustained vigorous activity can be beneficial and count cumulatively toward the weekly guideline totals.

The nurse can use motivational interviewing techniques to assess the person’s phase of readiness and level of intrinsic motivation (see Chapter 10). It is important to understand the common factors that enhance adherence for many people, as well as learn the unique motivations of each individual. Multiple studies show that exercise adherence in adults is greatly enhanced by the following: enjoyment derived from using a variety of activities; ability to selfselect the level, intensity, and type of exercise; and establishing a regular routine.⁸ The holistic nurse can empower the person to explore types and levels of activity that are uniquely appealing to him or her and find creative ways to implement them. This individualized approach will increase likelihood of engagement and adherence over time.

A person’s cultural background includes his or her beliefs, practices, values, and preferences.

The meaning and purpose of exercise may be culturally and economically influenced. The preference to play a team sport, for example, may come from the desire for community and connection with others and/or may be a result of limited access to health facilities.⁹ Conversely, an individual working out in a health club may be purposefully working toward health maintenance and has the financial means to do so. When working with clients, the holistic nurse discusses relevant cultural and economic factors that may affect choice of activities. Where economic disparities exist, the nurse finds creative ways to meet clients’ needs. Community centers and churches may offer free programs for those who are motivated to exercise in groups. Public television and basic cable channels frequently offer yoga and cardiovascular workout shows for those who are motivated to exercise individually or who may otherwise need to work out at home. Libraries frequently offer free DVD rentals including those for health and fitness. Highquality exercise and movement classes can be easily found online as well as support groups and blogs that foster community and virtual connections with others. As with any exercise class, online classes (such as YouTube videos) should be evaluated for quality of instruction and safety of movements.