Cardio Exercise Harvard Health

A HARVARD MEDICAL SCHOOL
SPECIAL HEALTH REPORT
Cardio Exercise
7 workouts to boost energy, fight disease, and help you live longer
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CARDIO EXERCISE
SPECI A L HE A LT H REPORT
Medical Editor
Contents
Lauren E. Elson, MD
Physical Medicine and Rehabilitation Instructor, Cardio basics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Harvard Medical School Cardio, aerobics, step, calisthenics—what does it all mean? . . . . . 2
Fitness Consultant The nuts and bolts—what, when, how much? . . . . . . . . . . . . . . . 4
Michele Stanten
Certified Fitness Instructor, American Council
on Exercise Cardio exercise and your heart. . . . . . . . . . . . . . . . . . . . . . . 6
Executive Editor
Anne Underwood Exercise is medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Copy Editor Fighting disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Robin Netherton Adding more life to your years. . . . . . . . . . . . . . . . . . . . . . . . . . 10
Creative Director
Judi Crouse Safety first . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Production/Design Manager Injury prevention guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Susan Dellenbaugh
Tips for people with specific conditions . . . . . . . . . . . . . . . . . . . 12
Photographer
Michael Carroll
Published by Harvard Medical School
Myths about cardio exercise. . . . . . . . . . . . . . . . . . . . . . . . 14
David Roberts, MD
Dean for External Education The workouts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Urmila R. Parlikar
Associate Director, Digital Health Products Terminology used in the workouts . . . . . . . . . . . . . . . . . . . . . . . 16
Posture and alignment: Striking the right pose . . . . . . . . . . . . . . 16
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Dear Reader,
Do you get winded climbing stairs? Have trouble keeping up with your kids or grandkids? Wish
that you had more energy to power through your day? If so, it’s a good indicator that you need to
either start doing some type of cardio exercise or else kick your current routine up a notch. Even if
you can sprint down the block with ease, you’re not off the hook. Whether you’re young, old, male,
female, healthy, ill, pregnant, or disabled, you should be doing some form of regular cardio exer-
cise. It is the cornerstone of any effective fitness program and a key to living a longer, more joyful
life. What’s more, the payoffs are impressive—from lowering your risk of heart disease, stroke,
diabetes, and some types of cancer to helping to improve your sleep and mood.
No matter your level of fitness, there are forms of cardio exercise you can do. Also called aerobic
or endurance exercise, cardio is any activity that gets you breathing a little harder and increases
your heart rate. Low-intensity activities (such as walking your dog or waltzing) count. So do
moderate-intensity activities (brisk walking or Zumba) and high-intensity exercise (running or
kickboxing). There are even exercise options for those who are frail or have limited mobility, such
as hand cranks that are like bicycles you pedal with your arms and anti-gravity treadmills that en-
close your lower body and the treadmill in an airtight bubble to reduce impact as you walk or run.
Some of the options, such as swimming or cycling, require specific equipment or locations. Oth-
ers, like kickboxing or aerobic dance, might best be done in a class, but even for these activities,
there are home options like DVDs, digital downloads, and, of course, the workouts in this report.
And then there are cardio activities like walking or jogging that you can do just about anywhere.
You could even walk around your office building, a hospital, or a mall, so there’s really no excuse!
This Special Health Report will help you find the perfect cardio routine—whether you are just
beginning, need to freshen up a routine, or are ready to take your cardio workouts to the next
level. For beginners or people with conditions that limit their mobility, there are three options to
start with: a Basic Cardio Workout you can do in your living room (page 20), a Beginner Walking
Workout (page 25), and a Pool Workout (page 26). If you’re looking to add some variety to an
existing cardio routine, try our Cardio Dance Workout (page 27) or Kickboxing Workout (page
32). If you’ve been doing cardio exercise and want to challenge yourself, try our Interval Walking
Workout (page 37) or Step Workout (page 38). When you’re ready to move on, a Special Section
(page 47) will help you design your own program. So, turn the page and start your new routine
today. No matter what form of cardio you do, you’ll be healthier.
Sincerely,
Lauren E. Elson, M.D. Michele Stanten

Medical Editor Fitness Consultant
Harvard Health Publishing | Harvard Medical School | 4 Blackfan Circle, 4th Floor | Boston, MA 02115
Cardio basics
M ore than 2,000 years ago, Hippocrates recognized

the value of exercise. He advised people of all ages
to “exercise, not too little and not too much.” But until
(jumping jacks, sit-ups, push-ups, and the like) and
strength training. This trend also spurred interest in
physical education programs in schools and, by 1956,
the late 1960s, no one specifically talked about cardio led President Dwight D. Eisenhower to create the Presi-
exercise, and the idea of setting out to achieve a cer- dent’s Council on Youth Fitness (known today as the
tain amount of it per day was pretty much unheard of. President’s Council on Fitness, Sports, and Nutrition).
To say that times have changed would be an At the same time, the scientific community began doing
understatement. Today, recommendations from the more research on exercise. As its benefits were discov-
U.S. government spell out exactly how much cardio ered and links between fitness and disease prevention
exercise we should be doing every week, as part of a were explored, organizations such as the American
broader fitness program that also includes strength Heart Association and the American Medical Asso-
training and flexibility exercises. There are massive ciation started to educate the public on the dangers of
numbers of gyms, classes, DVDs, and books available being out of shape.
to anyone who wants to try. Equally important, the But the idea of cardio exercise per se didn’t emerge
research backing this crucial form of exercise is now until the late 1960s. In 1968, Kenneth H. Cooper, a
unassailable. doctor in the U.S. Air Force, coined the term “aero-
But what exactly is cardio exercise? Why is it so bics” and published a book by the same name touting
important? What’s the connection between physical
activity and the heart? And how much of this exer-
cise do you need to do? This report will answer these
questions and more—and, importantly, it will get you
started with seven workouts, plus a warm-up and cool-
down. First, however, it may help to cover some basics.
Cardio, aerobics, step, calisthenics—

what does it all mean?
Before the Industrial Revolution, it wasn’t hard to get
all the daily exercise you needed. Most jobs were physi-
cally demanding, and transportation more often than
not involved walking or riding horseback. As industri-
alization took hold, however, Americans’ fitness levels
© gradyreese | Getty Images
started to decline. Following World War I, statistics

showed that one out of every three drafted individu-
als was unfit for combat. The situation grew worse by
World War II, when about half of all draftees were
either rejected or given noncombat positions because There are many types of cardio exercise that can help you stay fit.
they weren’t fit enough. To ensure a military in fight- Starting out with a moderate-intensity workout gives you the most
ing trim, government officials promoted calisthenics benefits with the least chance of injuring yourself.
2 Cardio Exercise w w w.h ealt h .ha r va r d.e du
the benefits of aerobic exercise—that is, exercise such ing in popularity. Here is just a sampling of the many
as jogging or swimming that increases heart rate and alternatives that have emerged over the years.
breathing for a sustained period and improves cardio- Aerobic or cardio dance classes were developed
respiratory health if practiced regularly. Today, we also as a way to encourage more women to do cardio. High-
use the terms cardio or endurance exercise to refer to impact, low-impact, or combination routines were set
the same thing. to a variety of music—everything from disco to coun-
Dr. Cooper developed fitness programs for pilots try—to appeal to a wider audience. Today, Zumba is
and astronauts and conducted the first extensive one of the most popular, but some gyms offer other
research on aerobic exercise on more than 5,000 Air cardio dance options with names like Body Jam or
Force personnel. His research demonstrated that this Cardio Hip-Hop. You can give this type of workout a
form of exercise improved the men’s heart function, try with the Cardio Dance Workout on page 27.
physical endurance, and capacity to use oxygen effi- Step aerobics, in which you step onto and off of
ciently. Based on his findings, Dr. Cooper created a a low platform using a variety of footwork, was started
12-minute fitness test and argued in his book that aer- by fitness instructor Gin Miller in the late 1980s.
obic forms of exercise were the best way for everyone Miller came up with the idea when her physical ther-
to condition the heart and lungs and protect against apy following a leg injury included stepping on and off
cardiovascular disease. a milk crate. Some gyms still offer it, but you can do it
Others took the idea and ran with it—in some in your living room with the Step Workout on page 38.
cases, literally. The running boom of the 1970s was Water aerobics or Aquacise takes traditional
one result, boosted in part by an American winning land-based cardio moves into the pool, where you
the marathon at the 1972 Olympics and the publica- perform them in either waist- or chest-deep water
tion of two popular books on running and jogging. or in deep water while you wear a flotation belt. The
Another result was the creation of multiple dance- buoyancy decreases your body weight, making it eas-
based exercise programs, beginning with Jazzercise in ier to do moves like jumping that might be too hard
1969. The release of Jane Fonda’s first aerobic workout on land for some people. To give it a try, see the Pool
video in 1982 brought cardio exercise into the comfort Workout on page 26.
of everyone’s living room. And the charismatic king Tae Bo, created by martial artist Billy Blanks,
of aerobic dance Richard Simmons brought the trend combined martial arts, boxing, and music to kick off
to the people who needed it most—the sedentary and the kickboxing craze in the ’90s. With a focus on ath-
overweight—with his Sweatin’ to the Oldies workouts leticism and power, these types of workouts, including
starting in 1988. the Kickboxing Workout on page 32, appealed more to
In the ensuing decades, a dizzying variety of car- men than earlier cardio classes had, and they offered
dio choices emerged. While the aerobic dance craze women a fresh approach to cardio.
was growing, both avid exercisers and novices were Spinning, a group exercise class done with sta-
getting their cardio fix on bikes, in pools, or on jog- tionary bikes, brought outdoor, often solo cardio
ging/walking paths or even streets and sidewalks. activities indoors in the mid-1990s. And doing it set
Those interests spurred the migration of cardio to music with a group of people amped up the fun and
equipment like treadmills and stationary bikes from intensity. Some gyms tried group treadmill and row-
hospital-based cardiac rehab programs (see page 7) ing machine classes, but none of these gained a follow-
to gyms and homes, providing indoor alternatives to ing like indoor cycling, which now has facilities, like
popular types of outdoor exercise. As the appeal of SoulCycle, devoted entirely to the activity.
cardio exercise equipment grew, new options were Slide boarding (sliding back and forth on a long
introduced, like stair climbers (in the 1980s) and plastic board) and gliding (standing on discs that
elliptical machines (in the 1990s), offering more vari- enable you to slide on the floor) never caught on as
ety. And classes have run the gamut, rising and fall- popular classes , but the tools are still used by trainers.
ww w. h ealt h . h ar v ar d . e du Cardio Exercise 3

The list goes on, with cardio options for every ing health, but for boosting athletic performance. But
age and fitness level. For example, Zumba Gold and as scientists expanded their studies to include older
SilverSneakers are targeted to older adults, while and less fit individuals and less intense activities like
Stroller Strides and Baby Boot Camp are aimed walking, they discovered that you didn’t have to go
at new moms. Depending on your fitness, you can hard or long to benefit from exercise. Moderate-inten-
choose exercises that are low, moderate, or high in sity walking or low-impact aerobic dance improved
intensity (see Table 1, below). You can also choose health and cardio fitness levels, too. The results have
among no-impact exercises (like swimming and been so impressive that some doctors are now writ-
cycling), low-impact (Zumba and walking), and ing prescriptions for exercise—sometimes as an initial
high-impact (running and jumping). But don’t be therapy instead of medications.
fooled by the impact level—even no- and low-impact As history has shown, no one cardio workout is
activities can be high-intensity if you push yourself. right for everyone. That’s why this report offers many
Swimming, for example, can range from a leisurely options—so you can find the right one for you.
sidestroke to a vigorous butterfly stroke.
Don’t fret if you need to go slow at first. The rev-
elation in recent years has been that all exercise is The nuts and bolts—what, when,
beneficial. Early exercise studies were primarily per- how much?
formed on athletes or on young, fit males and focused When people decide to start an exercise program,
on the benefits of vigorous workouts—not for improv- the first question they usually have is just what type
of activity to try—or if they’re bored with an exist-
ing routine, what to try next. That’s followed closely
Table 1: How hard are you working?
by how much time they need to put in. Following are
INTENSITY IT FEELS… YOU ARE…
answers to some basic questions you might have.
Light Easy • Breathing easily
• Warming up, but not yet What type of cardio should you do?
sweating With so many options, it’s easy to feel overwhelmed.
• Able to talk—or even sing That’s where this report comes in. The four main
an aria, if you have the talent workouts here are designed to suit different needs. If
Light to You’re • Breathing easily you’re a beginner, the Basic Cardio Workout (page 20)
moderate working, but • Sweating lightly will get you started. If you would prefer a dance rou-
not too hard
• Still finding it easy to talk or tine, the Cardio Dance Workout (page 27) may be just
sing the thing. For those looking for a little more challenge,
Moderate You’re • Breathing faster the Step Workout (page 38) and Kickboxing Work-
working • Starting to sweat more out (page 32) offer greater complexity and intensity.
• Able to talk, not able to sing This report also includes a Beginner Walking Work-
out (page 25) a more intense Interval Walking Work-
Moderate You’re really • Huffing and puffing
to high working out (page 37), and a Pool Workout (page 26)—plus a
• Sweating
warm-up (page 18) and cool-down (page 44) that you
• Able to talk in short sen-
should always do with any routine.
tences, but concentrat-
ing more on exercise than Beyond the scope of this report, there are many
conversation more types of cardio exercise and workouts to try, no
High You’re • Breathing hard
matter what your fitness level, interests, schedules, and
working very • Sweating hard
goals may be. You’ll find more information about this
hard, almost later in the report (see the Special Section, “Design-
out of gas • Finding talking difficult
ing your own program,” page 47). Over the long haul,
switching up your cardio routine will help prevent
Table 2: Moderate vs. vigorous activities
boredom and burnout. You’ll also work different mus-
How can you tell whether your workout is moderate (meaning
cles, which can help prevent overuse injuries caused you need to exercise 150 minutes a week to meet recommended
by too much repetitive motion. guidelines) or vigorous (meaning you can get by with 75 minutes)?
Here are some examples to help you judge. (For ways to gauge the
intensity of whatever exercise you may be doing, see “Monitoring
How much cardio should you do? intensity,” page 49.)
The Physical Activity Guidelines issued by the U.S. MODERATE VIGOROUS
Department of Health and Human Services recom-
Walking, level surface, Walking, 4.5 mph or faster,
mend at least 150 minutes per week of moderate- 3–4.5 mph or walking briskly uphill;
intensity physical activity—think of it as 30 minutes, jogging or running
five days a week—for all adults, even the elderly and Bicycling, level terrain, Bicycling, 10 mph or faster,
disabled. However, you don’t have to do all 30 min- 5–9 mph or up hills
utes in a single daily session. You can reach your goal Stationary bike, medium pace Indoor cycling class (Spinning)
by performing chunks of exercise in 10- or 15-minute
Tennis, doubles Tennis, singles
blocks throughout the day. For example, do 10 min-
Badminton Squash
utes before breakfast, 10 minutes during your lunch
break, and another 10 minutes after dinner. Or do 15 Swimming, recreational Swimming, steady laps
minutes in the morning and 15 minutes in the after- Adapted from “General Physical Activities Defined by Level of Intensity,” from the
U.S. Department of Health and Human Services, Public Health Service, and CDC.
noon. If you’re just starting out, gradually build up to
150 minutes a week as outlined in the Beginner Walk-
ing Workout (page 25). intensity level while doing the Basic Cardio Work-
If you’re already exercising and fit, you can cut out. But as you become more fit, it may only feel like
your exercise time in half—to just 75 minutes a a light workout. Note that you can adjust the intensity
week—by doing vigorous exercise instead of moder- level of any exercise by the effort you put into it. Take
ate. Generally, that would amount to 25 minutes, three bigger steps, lift your knees higher, or add hops to up
days a week. Or, you can perform an equivalent com- the intensity. Or do the opposite to lower it. The most
bination of the two intensities, with each minute of important guide is to listen to your body. We’ve cre-
vigorous-intensity activity equivalent to two minutes ated an easy-to-use intensity chart (see Table 1, page 4)
of moderate-intensity activity. (For examples of mod- that combines two methods of measuring intensity—
erate and vigorous activities, see Table 2, above right.) the talk test and perceived exertion (for more detail,
If you’re able to do more, that’s even better. The see “Monitoring Intensity,” page 49).
Physical Activity Guidelines specify that you can
derive more health benefits by boosting your workout When should you do cardio exercise?
time from 150 minutes a week to 300. But the most Despite many claims that it’s best to exercise in the
important thing is that you do something. morning, exercising at any time of the day is beneficial
as far as your health is concerned. So, work out when
How hard should you exercise? you want to and when it best fits into your schedule,
You’ll get the most benefits with the least risk of so that you’ll do it on a regular basis.
injury by working at a moderate intensity, especially The only caveat is that it’s best not to exercise too
when you are just starting out. But moderate inten- close to bedtime. Exercise is stimulating and can make
sity means different things to different people and it harder to fall asleep, so try to avoid working out
will even change for you over time. Intensity depends within two hours of going to bed. If you suffer from
upon a variety of factors such as your age and your fit- insomnia, exercising outdoors in the morning is ideal,
ness level. For example, when you first start exercising, because bright, natural daylight can help set your
you might feel like you’re working out at a moderate body’s circadian rhythms.

Cardio exercise and your heart
A s the name implies,

cardio exercise is cen-
tral to heart health. It
Cardio is short for car-
diovascular, which refers
to your heart and blood
improves your cholesterol vessels (arteries and veins).
profile, keeps arteries flex- Throughout most of the
ible, and reduces unwanted day, your heart typically
clotting, lowering your beats 60 to 100 times per
© adamkaz | Getty Images

risk of heart attacks (see minute. When you start
“Heart disease,” page 8). It to exercise, your heart
also reduces blood pres- beats faster, up to 120 to
sure, lowering your risk for 160 times per minute,
strokes. And it decreases The better your aerobic capacity, the more physical activity you depending upon your age
your risk of dying from can do—like climbing stairs or exercising—before running out and exercise intensity, and
heart disease. of steam. In short, you have more energy and stamina. more blood is pumped
But beyond these dis- with each beat—four to
ease outcomes, there are additional ways it boosts your five times the volume at rest. Your breathing rate also
heart health day in and day out. Most importantly, it increases, from 12 to 15 breaths per minute at rest up
increases your endurance and stamina by improving to 35 to 45 at maximum-effort levels. Together, these
the efficiency of your cardiovascular system. changes push more oxygenated blood through your
Why your resting heart rate is important
D iscussions of cardio exercise

usually focus on increasing your
heart rate during exercise, but your
the course of the study. A heart rate
higher than 90 bpm tripled it.
lightly press the side of your neck,
just below your jawbone.
So how do you bring down your resting • Count the number of beats, starting
resting heart rate—the number of
heart rate? Cardio exercise! The more with zero, for 30 seconds, and double
beats per minute while you’re at
fit you become, the more you can lower it to get your beats per minute.
rest—is also important.
your resting heart rate. And watching • Repeat a few times to ensure an
For one thing, it’s a window into your the number go down may help to keep
accurate reading.
cardiac health. A resting heart rate you motivated to exercise regularly.
between 60 and 100 beats per minute Check your resting heart rate several
For the most accurate measurement,
(bpm) is typical for adults. Being on times a week. If you consistently have
check your heart rate before getting out
the high side of the range may signal a high result, check with your doctor. If
of bed in the morning. If you don’t have
problems such as an increased risk of you have a low number and experience
a heart rate or activity monitor (see
heart disease or even early death. In a dizziness or fatigue, you should also
“High-tech monitors,” page 49), you
Danish study published in the journal check with your doctor. Keep in mind
can simply take your pulse. Here’s how:
Heart, researchers followed nearly that the number can be influenced
3,000 healthy middle-aged men for 16 • Lightly press the tips of the index by many factors, including stress and
years and found that having a resting and middle fingers of one hand just anxiety, circulating hormones, and
heart rate of 81 to 90 bpm doubled the below the base of the thumb on medications such as antidepressants
chance that a man would die during the opposite wrist. Or, if you prefer, and blood pressure drugs.
arteries to your muscles. Veins then whisk
away the waste byproducts, such as carbon Cardiac rehab programs
dioxide and lactic acid, that your muscles
produce during exercise. I
n the 1930s, when a patient survived a heart attack, the doctor
typically recommended six weeks of bed rest. Today, you’re likely
to be rustled out of bed by a nurse or physical therapist a day or
How effectively this system works is
two after a heart attack. And your doctor will probably prescribe
referred to as aerobic capacity (also called more physical activity than you were doing prior to your heart
aerobic endurance, cardiorespiratory endur- attack, along with participation in a cardiac rehabilitation program.
ance, or cardiorespiratory fitness). The bet- Cardiac rehab programs started as medically supervised aerobic exercise
ter your aerobic capacity, the more work programs designed to get you back to your usual activities and to
you can do—like climbing stairs or exercis- help prevent another heart attack and stave off disease progression.
In the beginning, cardiac rehab was only recommended for people in
ing—before running out of steam. The more
the early stages of heart disease, and at one point, it was only offered
you train your cardiorespiratory system, the to men under the age of 65. Today, some of the frailest heart disease
greater your aerobic capacity becomes, and patients, including those with heart failure or those who’ve had a heart
the more energy and stamina you have. But transplant, are encouraged to participate, because of wide-ranging
if you don’t use it, you lose it. It’s important benefits. Research shows that cardiac rehab can reduce mortality risk by
as much as 47% two years after participation in a program.
to maintain cardiac fitness at any age. But as
you grow older, the effects of decondition- Today, programs have expanded beyond exercise to include services
such as smoking cessation and nutritional counseling to help people
ing become much more prominent. modify other risk factors. Many also address quality-of-life issues such
On average, aerobic capacity decreases as depression, anxiety, stress, returning to work, and sexual activity.
about 10% every decade after age 30. For Cardiac rehab teams usually include an exercise physiologist or trainer, a
example, a healthy 25-year-old heart can nurse, a nutritionist, and a psychologist or social worker.
pump two-and-a-half quarts of blood a min- Despite all of the advantages of cardiac rehab, many people who could
ute, but a 65-year-old heart can’t get above benefit don’t participate. There are a variety of reasons for this, including
a lack of referrals by doctors. So, if you or someone you know has heart
one-and-a-half quarts, and an 80-year-old problems, talk to a doctor about cardiac rehab. It may extend your life
heart can pump only about a quart, even if and improve its quality.
it’s disease-free. The result is more fatigue
and breathlessness with modest daily activ-
ity. Aerobic capacity can decline even more rapidly after the three weeks of bed rest 30 years earlier, sug-
than that if you are sedentary. gesting that being sedentary is more detrimental than
A classic study from 1966 illustrates just how aging itself. Even more surprising was that six months
detrimental a sedentary lifestyle can be. Researchers of moderate cardio training (walking, jogging, and
had five healthy 20-year-old men spend three weeks cycling) improved the men’s fitness levels enough to
in bed—no activity—to see the effects on VO2 max, a restore them to their baseline measurements from 30
measure of cardiorespiratory fitness. The result: their years earlier. In short, they basically reversed the effect
aerobic capacity declined to levels of men about twice of aging.
their age. Fortunately, the effect was reversible. After Since then, much more research has supported the
eight weeks of cardio training, the men were fitter idea that boosting activity levels even later in life can
than when they started the study. offset age-related changes in heart function (see “Why
Fast-forward 30 years to when the men were your resting heart rate is important,” page 6) and even
retested. While their VO2 max had significantly assist rehabilitation after a heart attack (see “Cardiac
declined over the years, it still wasn’t as bad as it was rehab programs,” above).

Exercise is medicine
Fighting disease
R esearch on the benefits of cardio exercise has
been steadily accumulating for nearly 70 years.
By 1978, there was enough evidence that Dr. Robert
Exercise affects virtually every tissue in the body, so it
makes sense that it has an impact on a variety of dis-
N. Butler, director of the National Institute on Aging, eases—not only heart disease, though that tops the list.
wrote, “If exercise could be packed into a pill, it would
be the single most widely prescribed and beneficial Heart disease
medicine in the nation.” Since cardio exercise targets the cardiovascular sys-
The first study to hint at the benefits of cardio tem, it’s not surprising that it improves your heart
exercise was published in the early 1950s and looked health. Even something as simple as walking for 2.5
at transportation workers. Researchers in London hours a week—or roughly 21 minutes a day—can cut
compared the rates of heart disease in 31,000 men your risk of heart disease by 30%.
who worked as either drivers or conductors on the Cardio exercise benefits the heart in multiple
city’s buses, trams, and trolleys. The drivers sat for ways. For starters, it improves your cholesterol profile,
more than 90% of their shifts, while the conductors lowering total cholesterol, decreasing “bad” LDL cho-
climbed 500 to 750 steps per working day on aver- lesterol, and increasing “good” HDL cholesterol. That’s
age. The difference between those with sedentary and important because LDL lays down plaque in your
active jobs was striking. When the data were analyzed, arteries, while HDL helps remove it. Cardio exercise
they showed that the drivers had a nearly 50% higher also makes blood vessels more flexible and improves
rate of heart disease. While being active didn’t entirely circulation—all while making your heart stronger so it
protect the conductors, it did delay the onset of heart doesn’t have to work as hard to pump a given amount
disease and reduced their risk of dying from it. of blood. In addition, it brings down high blood pres-
The results may not sound surprising today, but sure, the leading risk factor for strokes. And it inhibits
back then they were revolutionary—and met with the formation of unwanted clots that can cause either
skepticism. The researchers, however, continued a heart attack or stroke. It does this by making plate-
building their case. They studied 110,000 active postal lets less “sticky” and promoting the release of enzymes
workers and sedentary civil servants and concluded that break down clots.
that sedentary workers were up to twice as likely to It’s not surprising, then, that people who exercise
have a heart attack. In addition to showing that move- have fewer heart problems and reduce their risk of
ment could be beneficial, these studies were also the dying from heart disease by 35%. According to a 2013
first to suggest the dangers of too much sitting, which meta-analysis published in the British Medical Journal,
is now being compared to smoking in its detrimental when researchers compared 57 exercise studies and
effects (see “Stand up for your health,” page 9). 248 drug studies, regular exercise was as effective as
Since those early studies, the amount of research drugs in reducing people’s risk of dying from strokes
on the effects of exercise has increased each decade, or cardiovascular disease.
with more and more evidence stacking up in support
of cardio exercise to both protect against and help Diabetes
manage a variety of health conditions, supporting the Exercise also helps stave off type 2 diabetes by priming
notion that your body is at its best when you move. your muscles to use insulin and take up excess glucose
This chapter provides an overview of the benefits. (sugar) from the bloodstream. Your muscles become
more sensitive to insulin the more you exercise, which likely to develop breast cancer than their sedentary
means your body has to produce less insulin (a good peers, according to more than two dozen studies. And
thing!) to signal your muscles to move glucose out both male and female exercisers have a 20% lower risk
of the bloodstream and into cells where it is used for of developing colon cancer compared with non-exer-
energy. The improvements are enough to lower risk of cisers, according to more than three dozen studies.
developing diabetes by 30% to 40%, even for people Being active also appears to decrease the risk of a
who are prediabetic, according to multiple studies. recurrence if you have had cancer already. In addition,
If you have diabetes, regular cardio can help you it can help to mitigate some of the side effects of treat-
better manage your blood sugar levels and protect you ment, such as fatigue.
from some of the complications of the disease, such as
heart disease (the No. 1 cause of death in people with Depression
diabetes), stroke, blindness, kidney disease, and nerve Cardio exercise is a great on-the-spot mood booster.
damage. People with diabetes who do cardio regularly When you get moving, your body releases feel-good
are up to 50% less likely to die from heart disease than brain chemicals like endorphins and serotonin and
those who don’t exercise. reduces levels of stress hormones like cortisol. Exer-
cise may even help prevent or diminish more serious
Cancer depression. In a recent study, Australian researchers
Exercise’s impact on hormones like estrogen and insu- followed the moods and exercise habits of nearly 34,000
lin may contribute to its protective effect against some people for 11 years and discovered that couch potatoes
types of cancer, especially breast and colon cancers. were 44% more likely to experience depression. All it
For example, women who exercise are 30% to 40% less took to reduce the risk was one hour of activity a week
Stand up for your health
S tructured workouts like the ones in

this report are essential for optimal
health. But you should also try to stand
was factored in, the difference was even
starker. The most sedentary women,
who neither moved nor exercised a lot,
cholesterol, HDL, to fall, too. The result
is a higher risk of heart disease.
By contrast, everyday movement not
and move around more during the day, were almost twice as likely to die during
only reduces your risk of major ailments,
especially if you have a desk job. Sitting the study period as those who moved
but also helps you burn more calories.
for hours on end can increase your and exercised the most. The most
Dr. James Levine at the Mayo Clinic
risk of serious ailments such as heart sedentary men were 50% more likely to
coined the term “non-exercise activity
disease, type 2 diabetes, and certain die than their more active counterparts.
thermogenesis,” or NEAT, to refer to the
cancers. By contrast, you can lower Similarly, other studies have concluded
energy you burn through ordinary activ-
your risks of all of these conditions that routine, everyday movement has
ity that you don’t think of as exercise,
simply by standing and moving more— benefits, whether for heart disease,
such as fidgeting, carrying the laundry
even if you already exercise. That’s diabetes, cancer, or weight loss. It’s
upstairs, dancing around the house to
because routine movement during the gotten to the point now where some
your favorite tune, or even standing
day adds on to those benefits. doctors actually advise their patients to
while you talk on the phone. In one
use sitting “in moderation.”
That was the conclusion of a large, study, he measured NEAT in lean and
long-term study of 123,000 middle- Why does prolonged sitting have such obese people, all of whom had similar
aged adults by researchers from the harmful health consequences? One jobs and were forbidden to exercise
American Cancer Society, published in explanation is that it relaxes your during the course of the study. There
the American Journal of Epidemiology. largest muscles. When muscles relax, was one key difference between the two
Women who sat the most had a 34% they take up very little sugar (glucose) groups. The obese people sat more than
greater risk of dying from any cause from the blood, raising your risk of type their lean counterparts, by an average
over the 14 years of the study compared 2 diabetes. In addition, the enzymes that of two-and-a-half hours more per day.
with those who sat the least. For men, break down blood fats (triglycerides) Changing that behavior could result in
the increase was 17%. When exercise plummet, causing levels of the “good” burning up to 350 more calories a day.

at any intensity. Bump it up to 90 minutes a week (30 Longevity
minutes, three times a week) and exercise provides As little as 15 minutes of activity a day may buy you
improvements similar to an antidepressant, suggested an additional three years. And the more you do, the
one study of people diagnosed with major depression. more you may increase your life span. One way exer-
And when exercise was combined with drug treatment, cise helps is by keeping your cells from aging as rap-
it helped people with tough-to-treat cases. idly. Studies have found that exercise slows the erosion
of telomeres, tiny tips at the ends of chromosomes that
Arthritis serve as markers of a cell’s age. As people get older,
Exercise lubricates joints and strengthens the sur- their telomeres shorten, but research shows that older
rounding muscles to keep joints healthy. Studies have exercisers have longer telomeres than their couch
shown that simply walking five to six miles a week potato peers. And one study of sedentary, overweight
may help protect you from developing osteoarthritis, 68-year-olds suggests that increasing activity even
a degenerative condition that causes joint pain, swell- later in life can lengthen telomeres after six months.
ing, stiffness, and weakness. If you already have osteo-
arthritis, being active may be the last thing that you Sleep
want to do, but over time exercise can actually reduce Sleep is essential for your body to renew and repair
pain and your risk of becoming disabled. itself, but unfortunately most of us aren’t getting
enough. A lack of sleep is more than just an annoy-
Dementia ance. It can impair your mood and performance, lead
The increase in blood flow that occurs when you exer- to accidents, and increase your risk of health problems
cise has a positive effect on your brain, too. Dozens like high blood pressure, obesity, type 2 diabetes, and
of studies have shown that exercise helps prevent the maybe even cancer. But regular cardio exercise can
brain from shrinking as you age and stimulates growth help you fall asleep faster, get more deep sleep, and
of new neurons and connections within the brain to stay asleep during the night so you’ll feel more rested
keep you sharper. and alert when you wake up.
For people who already have cognitive impair-
ment or Alzheimer’s disease, exercise appears to slow Intimacy
the progression of the disease. It may even be powerful Move over, Viagra. In a German study, exercise out-
enough to protect those with a genetic predisposition performed the little blue pill in men with erectile dys-
to Alzheimer’s. In a 2017 study published in the Jour- function. When you exercise, blood flow increases
nal of Alzheimer’s Disease, researchers tracked physical throughout the body, including in the reproductive
activity patterns of 93 people at high risk of develop- organs, which can benefit both men and women. In
ing the disease. They also used PET scans to examine one study, a single 20-minute session on a stationary
glucose metabolism in the brain, which is depressed bike boosted women’s sexual arousal by 169%. Plus,
in people with Alzheimer’s. The people who did a little exercising with your partner may improve your rela-
over an hour a day of moderate activity, such as brisk tionship beyond the bedroom, and you’ll be more
walking, had higher levels of glucose metabolism than likely to stick with your workouts than if you go solo.
those who were less active.
Independence
Exercise keeps your muscles strong, your joints less
Adding more life to your years achy, your body more flexible, and your balance bet-
With all of the disease protection that cardio appears ter. That means you’ll be more mobile as you age and
to offer, it shouldn’t surprise you to find that exercise more likely to remain independent longer. Beyond the
can also help you live longer—and make those extra physical component, there are mental and emotional
years more enjoyable. effects, improving your mood and your confidence.
Safety first
W hen you were younger,

you probably never
thought twice about starting
cardio exercise, but your doc-
tor may suggest additional
precautions. In some cases, he
an exercise program or trying or she may suggest you meet
a challenging new workout. with a physiatrist, physical
You just laced up your sneak- therapist, or certified personal
ers and went. As you age, trainer, each of whom offers a
however, it becomes more specific type of help.
important to consult with Physiatrists are medi-

your doctor to determine if cal doctors who specialize
you need to start more slowly in physical medicine and
or take any precautions, like rehabilitation. They treat
avoiding certain exercises. If you have any major health issues, speak with a doctor people with pain, muscle or
Almost anybody can safely before starting a new exercise program. Physiatrists and bone injuries, or nerve dam-
take up walking, and light-to- physical therapists can help with specific injuries. age that affects movement
moderate exercise is usually or quality of life. This could
fine for healthy adults with no troublesome symp- be from overuse, sports injuries, fractures, strokes,
toms. But it’s wise to talk to a doctor if you have any or spinal cord injuries. Physiatrists can also tell you
questions about your health or plan to start strenuous whether certain types of exercises will be helpful or
workouts, especially if you haven’t been active recently. harmful given your situation.
A helpful resource for gauging your ability is the Physical therapists help restore abilities to people
Get Active Questionnaire, a tool developed by the with health conditions or injuries that affect muscles,
Canadian Society for Exercise Physiology. It can help joints, bones, or nerves. They create exercise plans that
you determine whether you should talk to your doc- are safe for a given individual, and they help each cli-
tor before embarking on, or ramping up, any fitness ent perform the exercises correctly.
program. You can find it at www.health.harvard.edu/ Certified personal trainers work one-on-one or
GAQ. The form covers people of all ages. in small groups with generally healthy clients. They
Definitely talk to a doctor if you have any signifi- design exercise programs, instruct clients on good
cant health issues, particularly an injury or a chronic form to avoid injury, keep clients motivated by offer-
or unstable health condition, such as ing a variety of workouts, and push clients when they
• heart disease, asthma, high blood pressure, osteo- need to take a workout to the next level.
porosis, or diabetes
• musculoskeletal problems such as back, knee, or
shoulder problems Injury prevention guidelines
• balance problems Once you have the go-ahead to exercise, follow these
• recent surgery guidelines to ensure a safe workout:
• a stroke or neurological illness • Take time to warm up and cool down properly
• medication that can make you dizzy or lightheaded. (see “Warm-up,” page 18, and “Cool-down and
These conditions may not preclude you from doing stretches,” page 44).

• Never sacrifice good form and posture for the sake • If you go for weeks or months without exercising,
of more reps or a longer workout (see “Posture and drop back if necessary when you start again by
alignment: Striking the right pose,” page 16). shortening cardio workouts or working at a lower
• Boost your activity level gradually. Unless you intensity.
already exercise frequently and vigorously, plan to • Stay hydrated while exercising, especially when it’s
work your way up to high-intensity activities rather hot or humid. If you’re working out especially hard
than starting with them. and sweating for more than an hour, you may want
• Don’t train too hard or too often. Either can cause to choose a sports drink that replaces fluids plus
overuse injuries like stress fractures, stiff or sore essential electrolytes. Just remember that these
joints and muscles, and inflamed tendons and liga- beverages may have lots of calories, sugar, and
ments. Sports prompting repetitive wear and tear sodium.
on certain parts of your body—such as swimming • Choose clothes and shoes designed for your type
(shoulders), jogging (knees, ankles, and feet), and of exercise. Replace shoes every six to 12 months
tennis (elbows)—are often overuse culprits, too. A depending on how often you work out and how
mix of workouts, sports, and rest is safer. quickly the cushioning wears out.
• Pay attention to your body. Don’t exercise when • In hot, humid weather, watch for signs of overheat-
you’re sick or fatigued from overtraining. Fatigue ing, such as headache, dizziness, nausea, faintness,
may increase your risk of injuries. Note that your cramps, or palpitations. And make it a point to
joints should never hurt as a result of exercise. If exercise during cooler morning or evening hours or
they do, stop the exercise you’re doing. at an air-conditioned gym.
• Take steps to protect your hearing (see “Protect
your ears,” at left).
© nito100 | Getty Images

Protect your ears
B y improving circulation,
regular exercise appears Tips for people with specific
to help reduce hearing loss
over time. In the Nurses’
conditions
Health Study, women who walked two or more hours
If you have heart disease, diabetes, arthritis, or osteo-
a week experienced less hearing loss during a 10-year porosis, it is imperative that you speak with your doc-
follow-up period than their less active co-workers. tor before you start any cardio exercise program. Once
However, you can negate this benefit if the music you’re he or she has signed off on your exercise plans, here
listening to while you exercise is too loud. are some tips that may help you get more out of your
Gyms like the loud, thumping beats of, say, Justin workouts and avoid injury. You should also be aware
Timberlake or Lady Gaga because they get you pumped of the warning signs that could indicate a serious
up. But according to a 2017 study, when researchers
problem (see “Warning signs,” page 13).
measured music volume in 15 indoor cycling classes
at six different locations, they found that the average
noise exposure during a 45-minute class was more If you have heart disease
than eight times higher than the National Institute for • A warm-up is even more vital to prepare your
Occupational Safety and Health’s recommendations for heart for activity. And don’t forget to cool down
an entire eight-hour workday. While the study looked at
afterward.
cycling classes only, the music volume in other types of
cardio classes is also frequently cranked too high. • Don’t push through out-of-the-ordinary fatigue. If
you feel overly tired or have any heart symptoms
If you think the music is too loud in any class, wear
such as irregular heartbeats or skipped beats, stop.
a pair of earplugs. And keep the volume down when
you’re playing your own music as an accompaniment to • Be aware that many drugs given to help treat heart
exercise. disease may affect you when you’re exercising. Beta
blockers, for example, keep heart rate artificially
low; that means your pulse is not a good indica-
tor of how vigorously you are exercising. Vasodila- Warning signs
tors and ACE inhibitors may make you more prone
to dizziness from a drop in blood pressure if your S ee a doctor immediately if you experience any of
these symptoms during or after exercise:
• chest pain, pressure, heaviness, or tightness
post-exercise cool-down is too short. Talk with
• faintness or loss of consciousness
your doctor about the medications you take. If you
• significant or persistent shortness of breath or dizziness.
work with an exercise professional, be sure he or
she understands the potential effects, too. Also, ask your doctor whether any other warning signs
specific to your health history warrant a call.
• When it is cold, warm up indoors to reduce stress
on your heart. Then, when you do go outdoors, Call your doctor for advice if you experience
persistent or intense muscle pain that starts during a
cover your nose and mouth to warm up icy air.
session or right afterward, as this might indicate an
• Consider starting with a cardiac rehab program injury. (This is different from the normal muscle soreness
(see page 7). that starts 12 to 48 hours after a session and gradually
abates.) Also call if muscle soreness persists more than
If you have diabetes one to two weeks after exercising or if the routine
you’ve been doing for a while without discomfort starts
• Talk with your doctor about adjusting your med- to hurt.
ications before starting an exercise program or
increasing the intensity of your workouts. Exercise
uses glucose, so it may affect the dose of medication flares up to reduce inflammation, pain, and fatigue.
you need and maybe even the timing of your doses. When it calms down, you can exercise more. Stay-
• Keep carbohydrates like hard candy or glucose tab- ing active with frequent rest breaks tends to help
lets with you when you exercise in case your blood more than long periods spent in bed.
sugar drops precipitously, a condition called hypo- • Exercise within a comfortable range of motion. If
glycemia. Signs of hypoglycemia include sweating, a particular exercise causes significant pain, stop
trembling, dizziness, hunger, and confusion. doing it! Discuss other options with your trainer or
• Wear a diabetes bracelet or ID tag and carry phone physical therapist.
numbers in case of an emergency while exercising. • Generally, you should avoid working out with
actively inflamed joints, at least until the inflam-
If you have arthritis mation eases. However, you should continue to
• Schedule workouts for times of the day when your exercise joints that are not inflamed. In some cases,
medications are working well, in order to reduce water workouts may be a better choice than land-
inflammation and pain. For example, avoid morn- based exercise.
ing workouts if stiffness is at its worst then.
• Before exercise, apply heat to sore joints or tight If you have osteoporosis
muscles, or take a warm shower or bath. After exer- • Stick to controlled, low-impact activities to avoid
cise, cold packs on the joints may be helpful. jarring moves that may contribute to fractures. If
• If you have rheumatoid arthritis or another form your osteoporosis is severe, your doctor may rec-
of inflammatory arthritis, include some gentle ommend no-impact activities, such as swimming
stretching after you warm up. Inflammation weak- or cycling on a stationary bike.
ens the tendons that tie muscle to bone, making • Avoid activities that require a lot of balancing or
them more susceptible to injury. Remember to pose a high risk of falling, such as step aerobics
use slow movements during your warm-up, and and outdoor cycling. Falls may lead to fractures.
gradually extend your range of motion. • Skip moves that involve aggressive twisting or for-
• If you have rheumatoid arthritis, reduce the amount ward bending of your spine. These could increase
or intensity of your workouts when your condition your risk of compression fractures in your spine.

Myths about cardio exercise
A s scientists have learned more about cardio and

its effects on the body, some beliefs have been
disproved. Here’s a rundown of some common myths
cells use calories (in the form of glucose) for energy.
As you age—and as you lose weight, if you’re doing
it simply by cutting calories—you tend to lose muscle
and the true stories surrounding them. mass, so it can be particularly important to keep up
strength training.
MYTH: Cardio is your ticket to weight loss. This is not to say that you can ignore cardio if
FACT: While cardio may be the king of calorie burn you’re watching your weight. It temporarily boosts
compared with other types of exercise, it’s not a sure- your metabolism, so you burn more calories even after
fire weight-loss strategy. For starters, a good workout you stop exercising. Emerging research is showing
may increase your appetite. If that happens, it’s pos- that it may also have an effect on your weight via hor-
sible to quickly negate even a high-intensity cardio mones or even gut bacteria. But it’s more effective for
session if you indulge in high-calorie foods afterward. maintaining weight loss and preventing weight gain
For example, just one extra slice of pizza will replace than for taking off pounds in the first place.
all the calories you burned walking three miles in an If slimming down is your goal, combine cardio
hour. Even if you pick up the pace and jog for an hour, with other healthy habits like lifting weights, eating
a slice of cheesecake for dessert can undo all of your more fruits and vegetables, watching portion sizes,
efforts at calorie reduction. reducing stress, and getting enough sleep. Another
Paradoxically, strength training may help just as Special Health Report from Harvard Medical School,
much as cardio if you want to control your weight. It Lose Weight and Keep It Off, offers much more detail
doesn’t burn nearly as many calories as cardio while (for ordering information, see “Resources,” page 52).
you are doing it, but the long-term effects of building
more muscle may help slim you down, since muscle MYTH: If you don’t have half an hour
to commit to cardio, it’s not worth it.
FACT: The Physical Activity Guide-
lines, which are based on reams of sci-
entific evidence, clearly state that just 10 minutes of
exercise at a time can deliver benefits. Ten minutes of
moderate-intensity cardio can temporarily boost your
mood and reduce your stress level. Fifteen minutes
can curb a craving you might be feeling for chocolate
cake. Doing it on a regular basis gives more sustained
benefits. One study found that people who did mod-
© shapecharge | Getty Images
erate exercise just 15 minutes a day tended to live an

average of three years longer than their inactive peers.
More recent studies suggest that less than 10 min-
utes—even as little as one minute at a time—is ben-
eficial if you do a high-intensity activity like running.
There are many reasons to do cardio exercise, but weight loss isn’t No more “I don’t have time” excuses—some cardio is
necessarily one of them. It’s better for preventing weight gain. better than none!
MYTH: Low-intensity exercise is the best way to mendations that focused on doing vigorous exercise in
burn fat. order to reap benefits. Based on the research available
FACT: This common misconception comes from sci- at the time, the goal was to improve aerobic capacity,
entific research showing that lower-intensity activi- which is best done through higher-intensity exercise.
ties burn a larger percentage of fat compared with Comments like “golf is the perfect way to ruin a four-
higher-intensity exercise, which burns a larger per- mile walk” from researchers themselves encouraged
centage of carbohydrates. It seems reasonable to then the belief. But as more research was done, scientists
believe that this would cause fat cells to shrink, and found that lower levels of activity could also produce
you’d lose weight. But that has never been proved, results. The results may just be different.
and the math doesn’t add up either. A heart-pumping, sweat-drenching run or Spin
Despite the fact that research disproved this the- class will produce greater improvements in your aero-
ory more than two decades ago, it still persists. In bic capacity than playing golf, but depending upon
one study, researchers had people walk and run for your goals and current fitness level, they may not be
30 minutes each. During the exercise sessions, they the best workouts for you. Vigorous training is more
measured the number of calories burned and whether appropriate if you’re interested in improving sport or
those calories were coming from fat or carbohydrate athletic performance.
stores in the body. While walking burned a higher If you’re simply looking for health benefits and
percentage of calories from fat than carbohydrates, not worried about performance, you can get results
running actually burned more actual fat calories. On with moderate- or even low-intensity activities.
average, 30 minutes of walking burned a total of 240 Climbing the stairs, raking the lawn, and washing the
calories (8 calories per minute), and 96 (41%) of those car all count. In an analysis of 22 studies that included
calories were fat calories. But running burned almost more than 320,000 people, modest amounts of activ-
twice as many calories—450 total (15 calories per ity—as little as one hour of walking or gardening
minute)—and 108 (24%) of those were from fat. So, per week—were linked to lower rates of heart attack,
even though fat accounted for a smaller proportion stroke, and death from all causes. Or take Ping-Pong.
of the calories burned when running, the number of It may seem like a game rather than exercise. But in a
fat calories burned was higher. Based on substantial small 2014 study published in The American Journal
research, the total number of calories your body uses, of Cardiology, researchers measured the cardiovas-
whether they are from fat or carbs, is what determines cular effect of playing Ping-Pong for 10 minutes in
weight loss. So, if you can pick up the intensity, you’ll unfit men with heart disease. While the men rated the
burn more calories. But if high-intensity exercise isn’t activity as “fairly light,” researchers found that it had
right for you, you can still shed pounds with lower- the effect of exercise training.
intensity activities—you’ll just have to work out longer Even if you aspire to pursue more athletic activi-
to burn a similar amount of calories. ties like walking or running a half-marathon or
joining the company softball team, start with moder-
MYTH: You have to break a sweat to make it count. ate-intensity activities and gradually build up to more
FACT: Despite hundreds of studies touting the ben- vigorous workouts. If you are already fit but want to
efits of moderate-intensity exercise like walking and see further improvements, you will likely have to push
others supporting low-intensity activities like golf, the yourself harder and break a sweat.
“no pain, no gain” mentality is still part of our culture. Now that you know what exercise can do for you,
Some of this has been fueled by early exercise recom- it’s time to put this knowledge into action.

The workouts
Terminology used in the workouts

N ow that you understand what cardio exercise is,
the benefits it has to offer, and how to do it safely,
it’s time to get moving!
Following are definitions of the terms that we use in
our exercise instructions.
This chapter begins with a few final pieces of advice Starting position. This describes how to position
to ensure that you are prepared—specifically, termi- your body before starting the exercise.
nology to help you understand the exercise descrip- Movement. Here you’ll find out how to perform
tions, posture and alignment tips for a more effective one complete repetition correctly.
workout, and exercise equipment recommendations. Repetitions (or reps). Each time you complete
Following that, you’ll find our seven workouts. an exercise—from the starting position, through the
For people who are just starting a cardio exercise movement, and back to the starting position—it is
program for the first time or who are out of shape or counted as a rep. If you cannot do all the reps at first,
have limited mobility, the following are good ways to just do what you can, and then gradually increase reps
begin: as you improve.
• The Basic Cardio Workout (page 20) provides sim- Set. One set is a specific number of repetitions.
ple moves you can do in your living room. For example, eight to 10 reps often make a single set.
• The Beginner Walking Workout (page 25) estab- Usually, we suggest doing one to three sets.
lishes a progressive plan that builds up to 30 min- Hold. For stretches, this tells you the number of
utes of walking a day, five days a week. The basic seconds to pause while maintaining a pose or position.
plan can also be applied to other types of activity, Tips and techniques. We offer two or three
such as biking, swimming, or jogging. pointers to help you maintain good form and make
• The Pool Workout (page 26) gives you a low- the greatest gains from the exercise.
impact, joint-friendly workout, since water reduces Make it easier. This gives you an option for mak-
impact on your joints. ing the exercise less strenuous.
For those looking for variety in their cardio work- Make it harder. This gives you an option for mak-
outs, these are good options: ing the exercise more challenging.
• The Cardio Dance Workout (page 27) makes exer-
cising more fun by adding fancy footwork.
• The Kickboxing Workout (page 32) adds power Posture and alignment: Striking the
moves like kicks and punches. right pose
For those looking for greater intensity, these work- Exercise is important, but if you don’t do it right, you
outs can help: run the risk of injuring yourself. Working to achieve
• The Interval Walking Workout (page 37) alter- good form means more gains and fewer injuries.
nates short, fast bursts of activity with more mellow Posture helps more than you might think. In fact,
recovery periods and gets you out of your comfort good posture and alignment help anytime you’re mov-
zone for better results. The outline it sets up can ing. If one foot is always turned slightly inward, for
also be used for other types of cardio activity. example, it impedes the power of your movement
• The Step Workout (page 38) picks up the intensity whether you’re walking, going upstairs, jogging, or
by adding up-and-down movements, so you get fit- playing sports. The exercises in our workouts often
ter faster. call for you to stand up straight. In other words:
• Your chin is parallel to the floor. work. No matter what type of shoe you buy, make sure
• Shoulders are back and down. that it fits right and is comfortable from the moment
• Wrists are firm and straight, not flexed upward or you slip it on. Here are a few tips to help:
downward. • Shop specialty athletic footwear stores. The staff
• Hips are even with each other. will be more knowledgeable and better able to help
• Knees point straight ahead. you get the right pair of shoes.
• Feet point straight ahead. • Shop late in the day. That’s when your feet are at
• Body weight is distributed evenly on both feet. their largest, having expanded somewhat during
In addition, it’s important to maintain a neutral the day, so you’ll be more likely to get the right size.
spine. A neutral spine takes into account the slight • Choose socks first. Then wear them when you try
natural curves of the spine, but it’s not flexed or on shoes. The thickness of socks can affect the fit of
arched. One way to find the neutral position is to tip the shoes.
your pelvis forward as far as is comfortable, then tip it • Make sure you have wiggle room. You should have
backward as far as is comfortable. The spot approxi- at least one finger’s width between your longest toe
mately in the middle should be neutral. If you’re not and the front of your shoe.
used to standing or sitting up straight, it may take a • Walk, run, jump, step, or dance around the store in
while for this to feel natural. them. If you notice any rubbing, discomfort, or sore
Few of us have perfect posture, which is why it’s spots, move on to the next pair.
so important to check your posture before and during Clothing. For most cardio activities, comfortable,
each exercise. Looking in a mirror as you do exercises nonrestrictive clothing is all you need. If you tend to
helps enormously. sweat a lot or will be exercising in warm conditions,
moisture-wicking, synthetic fabrics like polypropyl-
ene or Tencel will keep you cooler, dryer, and more
comfortable. You’ll definitely want a pair of pad-
ded bike shorts if you are cycling indoors or out. For
pool workouts, athletic shorts and tops are an option
if you’re not comfortable in a traditional swimsuit.
© lentus25 | Getty Images
Comfort is the key!

Mat. For floor stretches, a padded, nonslip exer-
cise mat is a good idea. Mats come in a variety of
thicknesses, colors, and designs. They are available
Activity-specific shoes are designed for particular activities, such as online or at most stores that sell exercise equipment.
running. Crosst rainers are good for a variety of activities. Mats range in price from about $10 to $50. A thick
carpet, towel, or blanket can be used instead.
Equipment Aerobic step platform. You’ll need this piece of
For our cardio workouts, equipment needs are mini- equipment if you want to try the Step Workout on
mal except for the right pair of shoes and comfortable, page 38. You can find one online or at most stores
nonrestrictive clothing. Here’s what to look for. that sell exercise equipment. Most steps are adjust-
Shoes. It may seem like a marketing ploy, but able from four to six inches, while some also adjust
activity-specific footwear is designed to meet the needs to eight inches. When selecting a step, consider your
of your feet during a particular activity. For example, body size. If you are tall and have large feet, you’ll
walking and running shoes are designed for forward want more height and surface area than someone who
motion, while cross trainers are better for side-to-side is petite with tiny feet. Also, look for a sturdy prod-
motion and quick changes in direction. For a vari- uct that will support your body weight. Check reviews
ety of workouts (as in this report), a cross trainer can online. Steps range in price from about $25 to $90.

Warm-up
Y ou can do this five-minute warm-up routine

before any type of cardio workout. (You can even
do it in the pool.) It will help your body prepare for
2 Marching with arm sweep
Starting position: Stand up straight with your feet together
and your arms at your sides.
exercise by slowly raising your heart rate, warming Movement: Bend your elbows and swing your arms as you
up your muscles, and lubricating your joints. march, lifting your knees. Bring your knees higher as you warm
up.
• March in place for 50 steps (about 30 seconds).
1 Shoulder roll • March four steps forward, four steps backward. Repeat four
times (about 20 seconds).
• March four steps forward on a right diagonal, four steps
back. Repeat on a left diagonal. Do four times (about 40
seconds).
• March in place as you inhale and sweep your arms out to
the sides and up toward the ceiling. As you exhale, sweep
your arms down to your sides. Do six arm sweeps (about 30
seconds).
Reps: See “Movement,” above
Sets: 1
Tips and techniques:
• Take smaller steps if space is an issue.
• Keep your shoulders down and back, away from your ears.
• Relax your hands; don’t clench your fists.
Make it easier: March slower. Don’t lift your knees as high.

Starting position: Stand up straight with your feet hip-width
apart and your arms at your sides. Make it harder: Lift your knees higher, march faster, and really
pump your arms.
Movement: Roll your shoulders up, back, down, and around.
Keep your elbows bent slightly. Do the recommended number
of reps, and then repeat, rolling in the opposite direction—up,
forward, down, and back up.
Reps: 10 in each direction (about 30 seconds each direction)
Sets: 1
• Look straight ahead.
• Keep your abs tight.
• Keep your spine neutral.
Make it easier: Roll your shoulders slower. Make smaller

circles.
Make it harder: Make bigger circles with your shoulders.
Michele Stanten, the fitness consultant for this report, served as the model for these exercises.
Warm-up
4 Shallow side lunge

Starting position: Stand up straight with your feet spaced
widely, your toes pointing forward, and your hands on your hips.
Movement: Hinge forward at the hips, bend your right knee,
and shift your weight to your right foot. Pause, and then shift
your weight to your left foot, bending your left knee and lung-
ing to the left. That’s one rep. Continue lunging side to side for
the recommended number of reps.
Reps: 6 (about 30 seconds)
Sets: 1
3 Mini supported squat Tips and techniques:
Starting position: Stand up straight with your feet about • Keep your head and chest lifted as you hinge forward.
shoulder-width apart and your arms at your sides. • Don’t stick your hip out to the side as you lunge.
• Keep your knees and toes pointing forward as you lunge.
Movement: Hinge forward at your hips, place your hands on
your thighs, and bend your knees, lowering into a half squat. Make it easier: Slow down. Don’t lunge as deep.
Return to the starting position.
Make it harder: Lower into a deeper lunge.
Reps: 10 (about 30 seconds)
Sets: 1
• Bend at your hips, hinging your torso forward no more than
45°, but keep your head and chest lifted.
• Don’t let your knees extend out in front of your toes as you
bend your knees. You should be able to see your toes if you
glance down.
• Keep your knees and toes pointing forward as you squat.
Make it easier: Slow down. Do fewer reps.

Make it harder: Lower into a deeper squat.
5 Side step with arm swing

Starting position: Stand up straight with Sets: 1
your feet together and your arms at your sides. Tips and techniques:
Movement: Step with your left foot out to the • Look straight ahead.
side as far as is comfortable, and swing your • Keep your abs tight.
arms forward, completing the move by trans- • Keep your shoulders down and
fering your weight to the left foot. Bring your back; don’t let them come up
right foot to the left and tap it next to your left toward your ears.
foot as your arms swing back. Repeat on the
opposite side. Each left-tap-right-tap sequence Make it easier: Take smaller steps.
is one rep. Keep your hands on your hips.
Reps: 20 (about 60 seconds) Make it harder: Take larger steps

and bend your knees more.

Basic Cardio Workout
T his is the perfect routine if you’re just starting to

exercise, if you’re coming back to exercise after a
long break, or if you need a moderate-intensity work-
a 10-minute workout. You can repeat it for a longer
workout. In between exercises and in between sets of
certain exercises, you will march or jog in place (see
out to do on days in between high-intensity workouts. “March in place,” page 21). You can march or jog lon-
Do this series of moves twice through for about ger if you need more of a break.
1 Side lunge and reach Easier Harder

and your hands on your hips.
Movement: Step with your left foot out to the side, slightly
behind you, and bend your right knee into a lunge. At the same
time, twist your torso to the right and reach with your left arm
across your body. Return to the starting position. That’s one rep.
Repeat in the other direction, stepping with your right foot and
lunging to the left while reaching across your body with your
right arm. Continue alternating direction for the recommended
number of reps, then repeat, reaching your arms overhead.
Reps: 8 reaching across and 8 reaching overhead
• Tighten your abs.
Sets: 3, with 8 marches in between sets and before doing the
• Keep your shoulders down and back, away from your ears.
next exercise (see “March in place,” page 21)
Tips and techniques: Make it easier: Instead of lunging, simply tap your foot out to
the side. Or skip the arm movements and just do the lunges.
• Keep your bent knee over your ankle so you can see your toes
if you glance down. Make it harder: Take a bigger step and lunge deeper.
Remember: Always begin with the “Warm-up” (page 18) and finish with the “Cool-down and stretches” (page 44).
March in place
S tand up straight
with your feet
together and your arms
at your sides. Bend your
elbows and swing your
arms as you march,
lifting your knees. Or,
do an easy jog in place.
Each step is a rep. Do at
least 8 reps in between
each exercise in this
workout and where
noted between sets.
2 Knee lift with arm pull-down

Starting position: Stand with your feet hip-width apart and
both arms extended overhead.
Movement: Raise your right knee as you pull both arms down.
Put your right foot down again, while raising your arms. That’s
one rep. Repeat with the left leg. Continue alternating legs for
Reps: 8
next exercise (see “March in place,” above)
• Keep your chest lifted and shoulders back.
• Don’t lean forward or back as you raise you knee.
• Pull your arms down with power.
Make it easier: Swing your arms at your sides as you lift your
knees.
Make it harder: Add a hop as you lift each knee.

3 Side step squat

Starting position: Stand up straight with your feet comfortably
together and your arms at your sides.
Movement: Step out to the side with your right foot, bringing
your hands in front of you. With weight evenly distributed on
both feet, lower into a squat. Stand up, bringing your right foot
back to the starting position and lowering your arms to your
sides. That’s one rep. Do the recommended number of reps to the
right side, then repeat to the left side. Then alternate sides for
Reps: 8 on each side, then 8 alternating sides
Sets: 1, followed by 8 marches before doing the next exercise
(see “March in place,” page 21)
• Keep your head and chest lifted as you hinge forward. Make it easier: Don’t squat so low. Keep your feet closer
• Shift your weight back onto your heels as you squat. together.
• Keep your knees aligned over your feet. You should be able to Make it harder: Take a bigger step out to the side and jump to
see your toes if you glance down. bring your feet together.
4 Hamstring curl
Starting position: Stand up straight with your feet hip-width Make it easier: Go slower and don’t bend your knee as much,
apart and your arms extended overhead. keeping your foot lower. Let your arms swing at your sides, or
skip the arm movements and just do the leg movements.
Movement: Shift your weight onto your right foot and bend
your left knee, curling your leg and bringing your left foot toward Make it harder: Go faster, take wider steps, and add a hop with
your buttocks. At the same time, pull your arms down to about each step.
shoulder height. Then lower your
left foot, as you raise your arms
overhead again. That’s one rep.
Repeat, curling the right leg. Con-
tinue alternating legs for the rec-
ommended number of reps.
Reps: 8
Sets: 3, with 8 marches in
between sets and before doing
the next exercise (see “March in
place,” page 21)
• Look straight ahead.
• Keep your shoulders down and
back, away from your ears.
5 Skater 6 Step-back lunge

Starting position: Stand up straight with your feet hip-width
apart and your arms at your sides.
Movement: Step as far back as possible with your left foot and
bend your right knee into a lunge. As you step back, swing your
arms forward, elbows bent, to help you balance. Return to the
starting position. That’s one rep. Repeat, stepping back with
your right foot. Continue alternating legs for the recommended
number of reps.
Reps: 8
• Keep your chest and head lifted as you lunge.
• As you lunge, your knee should be aligned over your foot so
you can see your toes if you look down.
Make it easier: Don’t lunge so low, or don’t lunge at all; sim-

Starting position: Stand up straight with your feet hip-width ply tap your foot behind you.
apart and your arms at your sides.
Make it harder: After lunging, hop as you bring your feet back
Movement: Step with your right foot as far to the right as pos- together.
sible. Bring your left foot across behind you and swing your
arms to the right as you bend your right knee into a lunge.
That’s one rep. Repeat to the left, stepping and lunging on your
left leg. Continue alternating direction for the recommended
number of reps.
Reps: 8
• Keep your chest and head lifted as you lunge.
• As you lunge, your knee should be aligned over your foot so
you can see your toes if you look down.
Make it easier: Take smaller steps. Don’t lunge so deep, or

don’t lunge at all; simply tap your foot behind you.
Make it harder: Hop side to side, go faster, and lunge lower.

7 Half jack
and your arms at your sides.
Movement: With a little bounce or hop, bring your right foot
out to the side as you raise your arms overhead. Tap your toes
on the floor and then bring your right foot back to the starting
position, lowering your arms. That’s one rep. Repeat to the left,
bouncing or hopping to bring your left foot out to the side, tap-
ping your toes on the floor and raising your arms. Continue alter-
nating sides for the recommended number of reps.
Reps: 8
• Keep your shoulders down and back.
• Stand tall. Don’t bend at the waist or hunch forward as you
jump.
Make it easier: Don’t hop or bounce and instead simply extend

your leg out to the side. Raise your arms to chest height only, or
keep your hands on your hips.
Make it harder: Make the hop bigger or do full jumping jacks,
jumping with both feet out to the sides and then back in
simultaneously.
Beginner Walking Workout
I f you haven’t been exercising, this work-

out is a great way to get started. You’ll
gradually increase the amount of time
Walking for 2.5 hours
a week—that’s just 21
you’re exercising, building up to the recom- minutes per day—can
cut your risk of heart
mended 150 minutes of moderate-inten-
disease by 30%.
sity exercise per week. (To help determine
intensity, see Table 1, page 4.)
Note: You can use this general plan not
© ranplett | Getty Images
just for walking, but also for any other type

of cardio activity, such as jogging, cycling,
swimming, dancing, or using cardio exer-
cise machines.
SESSIONS WARM-UP, TIME WALKING, TIME AND COOL-DOWN TIME

WEEK PER WEEK AND INTENSITY INTENSITY AND INTENSITY DAILY TOTAL WEEKLY TOTAL
1 7 3 minutes light 5 minutes light-moderate 2 minutes light 10 minutes 70 minutes
4 6 3 minutes light 5 minutes light-moderate, 2 minutes light 20 minutes 120 minutes

5 minutes moderate,
5 minutes light-moderate
5 6 3 minutes light 5 minutes light-moderate, 2 minutes light 25 minutes 150 minutes

10 minutes moderate,
5 minutes light-moderate
6 6 5 minutes light to 12 minutes moderate, 5 minutes light 25 minutes 150 minutes

light-moderate 3 minutes light-moderate
7 6 5 minutes light to 15 minutes moderate 5 minutes light- 25 minutes 150 minutes

light-moderate moderate to light
8 5 5 minutes light to 20 minutes moderate 5 minutes light- 30 minutes 150 minutes

light-moderate moderate to light

Pool Workout
I f you have joint pain or mobility issues, exercis-

ing in water may be preferable because the buoy-
ancy reduces pressure on your joints and supports
For a more challenging
workout, you can use
your body weight, while providing resistance for accessories like foam
dumbbells to increase
your muscles to work against. The deeper the water,
resistance.
the greater the challenge. If you’re just starting out,
© FatCamera | Getty Images

perform these moves in waist-deep water. As you
become fitter, you can move to chest-deep water.
Go through the sequence of moves two times
for a 12-minute workout. Continue to repeat the
sequence if you’d like a longer workout.
MOVE TIME
Walk while swinging your arms. 1 minute
March while lifting your knees high and swinging your arms. 1 minute
Jump squats: Jump, spreading your feet apart and bending your knees and hips to lower into a squat. 10 reps (about 30 seconds)
Jump to bring your feet back together (similar to “Side step squat” on page 22). This is one rep.
Walk or march. 30 seconds
Skater: Jump to the right side, crossing your left foot behind you. Then jump to the left side, crossing 10 reps (about 15 seconds)
your right foot behind you (similar to “Skater” on page 23). Each jump is one rep.
Skip like you did when you were a kid. Hop onto one foot as you lift the knee of your opposite leg, and 30 seconds
then switch.
Jump lunges: Jump and scissor your legs, landing with one foot in front of the other. Bend your knees 10 reps (about 15 seconds)
to lower your body. Then jump and scissor your legs again, landing with the opposite leg in front. Each
jump is one rep. (This move is similar to “Step-back lunge” on page 23.)
Jog. 30 seconds
Cardio Dance Workout
I f you like to dance or you’re ready to progress from

the Basic Workout to some fancier footwork, this is
the routine for you. To get into the groove, turn on your
at www.health.harvard.edu/cardio-dance.
This workout takes a little less than eight minutes as
written. Do the sequence twice for a 15-minute work-
favorite music and add some shakes and shimmies for a out. For a longer workout, repeat it as many times as
fun workout. Or, do the routine together with the video you like until you reach your desired length of time.
1 Hip rock
Starting position: Stand up straight with your feet about hip- Reps: 20 in place, 4 moving
width apart and your hands on your hips.
Sets: 3
Movement: Gently swing your hips from side to side (A), keep-
ing your knees bent slightly. Each swing is a rep. Do the recom-
• Keep the movement smooth, not jerky.
mended number of reps.
• Take smaller steps if space is an issue.
Next, continue swinging your hips as you turn slightly to the right
• If you have lower back problems, check with your doctor
take four steps to the right (B). Bend your arms and swing your
before doing this move.
arms toward the right with each step. That completes one rep.
Turn to the left and take four steps to the left as you continue Make it easier: Rock in a smaller range of motion. Take smaller
swinging your hips and arms. Continue alternating direction for steps. Keep your hands on your hips.
the recommended number of reps. That’s one set.
Make it harder: Really shake it. Take bigger steps.
A B

2 Mambo
and your hands on your hips.
Movement: Step forward with your right foot and push your
right hip forward. Then shift your weight onto your left foot and
step back with your right foot. Make small circles with your
hands as you step forward and back. That’s one rep. Do the rec-
ommended number of reps with your right foot, then take three
steps in place to switch legs, and repeat, stepping with your left
foot forward and back. That’s one set.
Reps: 8 on each side
Sets: 3
• Get comfortable with the footwork and then add the arms.
• Once you get into the groove, add a little shoulder movement
as you circle your hands.
• If you have lower back problems, skip the hip movement.
Make it easier: Take smaller steps. Keep your hands on your

hips.
Make it harder: Take bigger steps and add more hip movement.
3 Step-touch side lunge

Starting position: Stand up straight with your feet
together and your hands on your hips.
Movement: Step forward with your left foot and bend
your left knee slightly as you tap your right foot out to
the side and raise your right arm toward the ceiling. Then
step forward with your right foot and bend your right
knee as you tap your left foot out and reach up with your
left arm. Take four steps forward and then four steps
back. That’s one rep.
Reps: 4
Sets: 1
• Keep your shoulders and hips facing forward.
• Point your toes as you step out to the side.
• If you need support as you lunge, place your hand on
your bent thigh as you reach up with the opposite arm.
Make it easier: Don’t lunge; instead, keep both legs
straight and simply step-touch.
Make it harder: Bend your knee into a deeper lunge.
4 V-step
Starting position: Stand up straight with your feet together Tips and techniques:
and your arms down. • To switch legs, tap your foot at the end of a rep and then step
Movement: Step forward with your right foot on a right diago- forward with the same foot.
nal, raising your right arm up. Then step forward with your left • Add some hip movement by pushing your hips forward as you
foot on a left diagonal, raising your left arm up. Step back to step forward.
center with your right foot, bringing your right arm back down, • Tighten your abs.
and then do the same with your left foot and arm. That’s one rep.
Make it easier: Keep your arms down or don’t use them at all.
Continue the out-out-in-in motion for the recommended number
Take smaller steps.
of reps. Repeat, leading with the left foot.
Make it harder: Take bigger steps. Hop as you bring your feet
Reps: 8 starting on the right and 8 starting on the left
back together.
Sets: 1

5 Kick ball change

Starting position: Stand up straight with
your feet together and your hands on your
hips.
Movement: Kick forward with your right foot.
Place your right foot behind you, shifting your
weight back onto your right foot and then
forward onto the left foot before you kick for-
ward with your right foot again. Let your arms
swing back and forth naturally. Each kick is
one rep. Do the recommended number of reps,
then repeat, kicking forward with the left foot.
Reps: 8 with each leg
Sets: 2
Tips and techniques: Make it easier: Keep your kick lower or simply tap your foot on
• To kick, lift your knee and then extend your lower leg. the floor in front of you.
• March in place three steps to switch legs.
Make it harder: Kick higher and step back farther.
• Add a little shoulder shimmy.
6 Grapevine
Starting position:
Stand up straight
with your feet
together and your
arms at your sides.
Movement: Step
with your right foot
out to the side.
Cross your left foot
behind your right
leg as you cross
your forearms in
front of your belly.
Step with your right
foot out to the side
again, opening your arms out to the sides. Then bring • Keep your shoulders and hips facing forward as you move
your left foot next to your right one to return to the starting from side to side.
position. That’s one rep. Repeat to the left, stepping with your • It’s all right to look at your feet when you are learning the
left foot out to the side. Continue alternating direction for the move, but after that, keep your head up.
recommended number of reps.
Make it easier: Take smaller steps. Swing your arms down at
Reps: 8
your sides.
Sets: 1
Make it harder: Take larger steps and add hops as you step.
Tips and techniques: Reach your arms up overhead.
• Get comfortable with the footwork and then add the arms.
7 Charleston
Starting position: Stand up straight with your feet together the recommended number of reps, then repeat, stepping forward
and your arms bent in front of you. with the right foot and kicking with the left leg.
Movement: Step forward with your left foot and kick forward Reps: 8 with each leg
with your right leg. Place your right foot down just behind you
Sets: 1
and then step back with your left foot and sink into a small
lunge, front knee bent slightly, back leg straight. On each of Tips and techniques:
these four counts, swing your arms from one side of your body to • Stand tall and keep your head up; don’t look at your feet.
the other in an arc, with palms facing forward. That’s one rep. Do • Tighten your abs.
• Don’t collapse for-
ward as you lunge
back. Keep your chest
lifted.
Make it easier: Take
smaller steps. Kick
lower. Step back with-
out lunging.
Make it harder: Take
bigger steps, kick
higher, and lunge lower.
8 Twist
Starting position: Stand up straight with your feet close right, bringing your heels down, as you swing your arms to the
together and your arms at your sides. left at chest height. Then rotate your lower body to the left as
your arms go to the right. Each twist to the side is a rep. Con-
Movement: Bend your knees slightly, lift your heels off the floor,
tinue alternating direction for the recommended number of reps.
pivot on the balls of your feet, and rotate your lower body to the
Reps: 20
Sets: 1
• Keep the movement smooth, not jerky.
• If you have lower back problems, check with your doctor
before doing this move.
Make it easier: Go slower. Don’t bend your knees as much.
Keep your arms low.
Make it harder: Bend your knees as you twist and see how low
you can go. Raise your arms over your head as you twist.

Kickboxing Workout
T his routine offers a greater challenge as your upper

body performs more powerful arm movements.
It’s also a perfect option if you want to progress from
Here are some general tips and techniques that
apply to all of the exercises in this workout. Keep them
in mind throughout.
the Basic Workout but don’t like a lot of complicated • Don’t clench your fists.
footwork. While the footwork may be simpler than in • On punches, don’t hyperextend your arm. Keep
some of the other routines, the shuffling adds more a slight bend in your elbow when your arm is
impact and the kicks require greater muscle contrac- extended.
tions for an overall higher-intensity workout. • On kicks, don’t hyperextend your leg. Keep a slight
Do the sequence twice for a 15-minute workout. bend in your knee when your leg is extended.
For a longer workout, repeat as many times as you like Additional move-specific tips and techniques are
until you reach your desired length of time. noted with each exercise.
1 Shuffle
Starting position: Stand up straight with your feet about hip-
width apart. Bend your arms so your hands are in front of your
chest like a boxer. Make fists with your hands.
Movement: Bounce from side to side, shifting your weight from
one foot to the other. Each shift is a rep.
Reps: 24
Sets: 1
• Keep your knees bent slightly.
• Keep your hips and shoulders facing forward.
Make it easier: Keep your feet closer together and just shift
your weight.
Make it harder: Spread your feet farther apart. Bend lower
into a squat position. Hop a bit off the floor as you shift from
side to side.
Kickboxing Workout
2 Jab
Starting position: Stand up straight with your right foot in
front of your left one. Bend your arms so your hands are in front
of your chest like a boxer. Make fists with your hands.
Movement: Bring your right hip forward as you extend your
right arm. Rotate your right arm as you punch so your palm is
facing the floor when your arm is extended. Then quickly bend
your arm, pulling your fist back to the starting position. That’s
one rep. Do the recommended number of reps, and then shuffle
for eight reps. Repeat on the left side, followed by eight shuffles.
That’s one set.
Reps: 8 with each arm, shuffling after finishing on each side
Sets: 3
• Keep your arm in line with your shoulder.
• Tighten your abs. Make it easier: Punch slower.
• The heel of your back foot may come off the floor as you shift Make it harder: Pick up the pace, punching as quickly as
your weight forward. possible.
3 Cross punch
Starting position: Stand up straight with your left foot in front
of your right one. Bend your arms so your hands are in front of
your chest like a boxer. Make fists with your hands.
Movement: Turn your right hip, knee, and foot inward, lifting
your right heel off the floor as you punch forward with your
right arm. Rotate your right arm as you punch so your palm is
facing the floor when your arm is extended. Then quickly bend
your arm, pulling your fist back to the starting position. That’s
one rep. Do the recommended number of reps, and then shuffle
for eight reps. Repeat with the right foot in front, punching with
the left arm, followed by eight shuffles. That’s one set.
Sets: 3
• Power the action from your hips and core.
• Don’t bend at your waist as you punch.
Make it easier: Punch slower.

Make it harder: Pick up the pace, punching as quickly as
possible.

Kickboxing Workout
4 Hook 5 Uppercut
Starting position: Stand up straight with your left foot slightly
in front of your right one. Bend your arms so your hands are in
front of your chest like a boxer. Make fists with your hands.
Movement: Lift your right heel off the floor and pivot on your
right foot as you turn your right knee and hip inward. At the
same time, raise your right elbow so your forearm is parallel to
the floor. Return to the starting position. That’s one rep. Do the
recommended number of reps, and then shuffle for eight reps.
Repeat with the right foot in front, raising the left elbow, fol-
lowed by eight shuffles. That’s one set.
Sets: 3
• Keep your arm bent about 90° and your hands up.
• Keep your shoulder down, not pulled up toward your ear.
Make it easier: Move more slowly and with less force. Starting position: Stand up straight with your feet wide. Bend
your arms so your hands are up like a boxer. Make fists with
Make it harder: Pick up the pace, moving as quickly as pos-
your hands.
sible and with as much force as possible.
Movement: Dip your right arm down and then quickly punch
up, making a U-shaped movement in front of your left arm
and pivoting on your right foot. Then repeat with your left arm,
coming up in front of your right arm and pivoting on your left
foot. That’s one rep.
Reps: 8
Sets: 3, with 8 shuffles in between sets
• Don’t punch higher than your nose.
• Keep your shoulders down.
• Imagine you are punching an opponent under the chin.
Make it easier: Punch slower.

Make it harder: Pick up the pace, punching as quickly as
possible.
Kickboxing Workout
6 Bob and weave

Starting position: Stand up straight with your feet wider than Movement: Squat down and move your upper body in a U pat-
shoulder-width apart. Bend your arms so your hands are up like tern to the right. Imagine you are ducking under something and
a boxer. Make fists with your hands. then coming up on the other side. As you come up on the other
side, stand back up. Squat
again and duck to the left.
That’s one rep.
Reps: 4
Sets: 3, with 8 shuffles in
between sets
• Keep your knees behind
your toes when you squat.
• Don’t lean forward more
than 45° when you squat.
Make it easier: Don’t squat
so low.
Make it harder: Bend your
knees more to squat lower.
7 Front kick
Starting position: Stand up straight with your feet about hip-
width apart. Bend your arms so your hands are up like a boxer.
Make fists with your hands.
Movement: Step forward with your right foot. Raise your left
knee in front of you, and then extend your leg, kicking straight
ahead with your foot flexed. Bend your knee, lower your leg,
and step back to the starting position. That’s one rep. Repeat,
stepping forward with the left foot and kicking with the right
leg. Continue alternating legs for the recommended number of
reps.
Reps: 8
• You can lean backward slightly as you kick.
• Tighten your abs and power the move from your hips.
• Imagine you’re kicking in a door.
Make it easier: Kick lower.

Make it harder: Kick higher.

Kickboxing Workout
8 Side kick
Starting position: Stand up straight with your feet about hip- of your left foot. Lean your upper body to the right, raise your
width apart. Bend your arms so your hands are up like a boxer. left knee out to the side, and then extend your leg, kicking to the
Make fists with your hands. side with your foot flexed. Bend your knee, lower your leg, and
step back to the starting position. That’s one rep. Do the recom-
Movement: Step forward with your right foot, placing it in front
mended number of reps, and then shuffle for
eight reps. Repeat with the right leg, followed
by eight shuffles. That’s one set.
Reps: 8 on each side, shuffling after finishing on
each side
Sets: 1
• Your knee and toes should be pointing for-
ward as you kick.
• Tighten your abs and power the move from
your glutes.
• Keep your upper body relaxed.
Make it easier: Kick lower. You can hold on to

the back of a chair for balance if needed.
Make it harder: Kick higher. Add a punch with
the same-side arm.
9 Rear kick
Starting position: Stand up straight with your feet about hip- Make it easier: Kick lower. You can hold on to the back of a
width apart. Bend your arms so your hands are up like a boxer. chair for balance if needed.
Make fists with your hands.
Make it harder: Kick higher.
Movement: Step forward with your right foot, lift your
left knee forward, and then thrust your left leg back,
kicking behind you with your foot flexed. Bring your
left foot back to the starting position. That’s one rep.
Repeat, stepping with your left foot and thrusting back
with your right leg. Continue alternating legs for the
Reps: 8
• Tighten your abs throughout the move, and tighten
your glutes as you kick.
• Don’t lean forward more than 45°.
• Don’t rotate your hip up toward the ceiling as you
kick. Keep both hips facing the floor.
Interval Walking Workout
I nterval workouts alternate

short bursts of higher-inten-
sity activity, like jogging or
light-moderate to light inten-
sity). If you’d like to exer-
cise longer, simply repeat the
very fast walking, with longer intervals more times. Do only
recovery segments of lower- two or three interval workouts
intensity activity. Because per week, on nonconsecutive
© andresr | Getty Images
they incorporate more vig- days. Because they are higher-

orous activity, you can get intensity, your body needs
similar benefits in a shorter time to recover. You can do
period of time. If you’ve com- moderate- or low-intensity
pleted the Beginner Walking Because interval workouts incorporate short bursts of activity on alternate days (see
Workout (see page 25) or are high-intensity activity, you get greater health benefits in Table 1, page 4).
already exercising, this rou- a shorter period of time. Note: You can use this
tine is a perfect next step. interval plan not just for
Begin each workout with a five-minute warm- walking, but also for any other type of cardio activity,
up (moving from light to light-moderate intensity) such as jogging, cycling, swimming, dancing, or using
and end with a five-minute cool-down (moving from cardio exercise machines.
WEEK INTERVAL SEQUENCE, TIME AND INTENSITY NUMBER OF TOTAL WORKOUT TIME (INCLUDING
REPETITIONS WARM-UP AND COOL-DOWN)
1 5 minutes moderate, followed by 30 seconds moderate-high 2 21 minutes
2 3 minutes moderate, followed by 30 seconds moderate-high 3 20.5 minutes
3 2 minutes 30 seconds moderate, followed by 30 seconds 3 19 minutes

moderate-high
4 2 minutes moderate, followed by 30 seconds moderate-high 4 20 minutes
5 1 minute 30 seconds moderate, followed by 30 seconds 5 20 minutes

moderate-high
6 1 minute moderate, followed by 30 seconds moderate-high 7 20.5 minutes

Step Workout
A dding a vertical element to your workout kicks up

your calorie burn and tones your legs and glutes.
Because of this, it is considered a higher-intensity
that apply to all of the exercises in this workout.
• Make sure your entire foot is always on the step, so
you don’t fall off the step or strain a muscle. Don’t
workout, so it’s best to build a base of cardio fitness let your toes or heels hang off.
before trying this routine. This workout is not recom- • It’s okay to look down so you don’t trip as you are
mended for anyone with balance issues. learning new moves. Once you master a move,
The workout takes 10 to 15 minutes. If you’d like however, keep your head up to avoid neck strain.
a longer session, simply repeat the sequence of moves • Don’t lean forward. This puts excessive pressure on
for your desired duration. Some of the footwork may your lower back. Stand up straight.
be confusing at first. If you need someone to follow— • As you place your foot on the step, make sure your
or just want the motivation of an instructor doing it knee is over your foot to minimize pressure on your
with you—perform this workout together with the knee joint.
video at www.health.harvard.edu/step-workout. Additional move-specific tips and techniques are
Following are some general tips and techniques noted with each exercise.
1 Basic step
Starting position: Stand up straight facing the step with your • Tap your foot to switch sides.
feet together. • Don’t lean forward.
Movement: Step up onto the step with your right foot and then Make it easier: Do it on the floor without a step.
your left foot. Let your arms swing naturally as you step. Step
down with your right foot and then with your left foot. That’s Make it harder: Use a higher step.
one rep. Do the recommended number of reps, and then repeat,
leading with the left
foot. Then alternate
the leading foot each
time for the recom-
mended number of
reps.
Reps: 8 on each side,
then 8 alternating
sides
Sets: 1
• Keep your toes
and knees pointing
forward.
Step Workout
2 V-step
Starting position: Stand
up straight facing the step
with your feet together.
Movement: Step up as
you did in the “Basic step”
(page 38), but place your
right foot toward the right
side of the step and your
left one toward the left
side, so your feet are wide
apart. As you step up with
the right, raise your right
arm overhead. As you step with the left, raise your left arm over- Sets: 1
head. Step down with your right foot and then your left foot, Tips and techniques:
lowering your arms with each step and bringing your feet back • Let your toes turn out slightly.
together. This completes one rep. Do the recommended number
• Tap your foot to switch sides.
of reps, and then repeat, leading with the left foot. Then alternate
the leading foot each time for the recommended number of reps. Make it easier: Do it on the floor without a step.
Reps: 8 on each side, then 8 alternating sides Make it harder: Use a higher step.
3 Kick
Starting position: Stand up straight facing the step with your • When alternating legs, march in place for two steps to switch
feet together. feet in between kicks.
Movement: Step up with your right foot and kick forward with Make it easier: Do it on the floor without a step. Kick lower.
your left leg. Step back down with your left foot and then with
Make it harder: Use a higher step. Add a hop as you kick. Kick
your right foot. That’s one rep. Do the recommended number
higher.
of reps, and then repeat,
stepping up with your left
foot and kicking with your
right leg. Then alternate
the leading leg each time
for the recommended
number of reps.
Reps: 8 on each side, then
8 alternating sides
Sets: 1
• Tap your foot as you
step down in between
kicks.

Step Workout
4 Knee lift
Starting position: Stand up
straight facing the step with your
feet together.
Movement: Step up with your
right foot and lift your left knee up
in front of you to hip height. Step
back down with your left foot and
then with your right foot. That’s
one rep. Do the recommended
number of reps, and then repeat,
stepping up with your left foot and
lifting your right knee. Then alter-
nate the leading foot each time for
Reps: 8 on each side, then 8 alter- • When alternating legs, march in place for two steps to switch
nating sides feet in between reps.
Sets: 1 Make it easier: Do it on the floor without a step. Don’t lift your
Tips and techniques: knee as high.
• Keep your knees pointing straight ahead as you lift them. Make it harder: Use a higher step. Add a hop as you lift your
• Tap your foot as you step down in between kicks. knee.
5 Back leg extension

Starting position: Stand up straight facing the step with your • When alternating legs, march in place for two steps to switch
feet together. feet in between reps.
Movement: Step up with your right foot and lift your left leg up Make it easier: Do it on the floor without a step. Don’t lift your
behind you. Step back down with your left foot and then with leg as high.
your right foot. That’s one rep. Do the recommended number of
Make it harder: Use a higher step. Add a hop as you lift your
reps, and then repeat, stepping up with your left foot and lifting
leg. Lift your leg higher.
your right leg. Then alternate the leading foot each time for the
Reps: 8 on each side, then 8
alternating sides
Sets: 1
• Lift your leg straight back
so your knee and toes point
to the floor, not out to the
side.
• Don’t overarch your back as
you lift your leg.
• Tap your foot as you step
down in between leg lifts.
Step Workout
6 Turn step
Starting position: Stand
up straight with your feet
together and your right side
toward the step, at the right
end of the step.
Movement: Step up with
your right foot onto the right
end of the step with your
foot pointing forward. Then
step up with your left foot
onto the left side of the step
so your feet are apart. As Tips and techniques:
you step with your right foot off of the step, turn your body so
• Keep your abs tight and stand tall.
your left side is toward the step, at the left end of the step. Step
• Your head should follow the movement of your body, looking
off with your left foot and bring it next to your right foot. Repeat,
stepping up with your left foot. This completes one rep. in the direction you are moving.
Reps: 8 Make it easier: Do it on the floor without a step.
Sets: 1 Make it harder: Use a higher step.
7 Knee repeater
Starting position: Stand up straight facing the step with your Sets: 2
feet together.
Movement: Step up with your right foot and lift your left knee • Keep your weight on the foot that is on the step.
up in front of you to hip height. Keeping your right foot on the • Lean forward slightly to maintain your balance.
step, bring your left foot down to tap the floor behind you, then
immediately bring it back up into another knee lift. Each knee lift Make it easier: Do it on the floor without a step. Don’t lift your
is a rep. Do the recommended number of reps, then repeat, lift- knee as high.
ing your right knee. This completes one set. Make it harder: Use a higher step. Lift your knee higher.

Step Workout
8 Side leg lift

Starting position:
Stand up straight with
your feet together and
the step on your right
side.
Movement: Step up
with your right foot and
lift your left leg out to
the side. Lower your left
foot to the floor, and
then step off with your
right foot. That’s one
• Point or flex your foot as you lift your leg to work different
rep. Do the recommended number of reps, and then switch sides
muscles.
and repeat, lifting your right leg. This completes one set.
• Keep your abs tight.
Make it easier: Do it on the floor without a step. Don’t lift your
Sets: 2 leg as high.
Tips and techniques: Make it harder: Use a higher step. Add a hop. Lift your leg
• Don’t lean to the side as you lift your leg. higher.
9 Off the side

Starting position: Stand up straight with your feet together at Sets: 2
the end of the step, facing it.
Movement: Step up with your right foot and then with your left • Keep your abs tight and stand tall.
foot. Step down off the right side of the step with your right foot • Don’t lean to the side as you step off the step.
and then with your left foot, being careful not to place weight
on your left foot. That way, you’ll be ready to step back up onto Make it easier: Do it on the floor without a step.
the step with your left foot, step up with the right, step down Make it harder: Use a higher step.
backward off the step with
your left foot, then down
with the right. Again, avoid
placing weight on the right
foot, so that your right
foot will be free to start
the sequence again. This
completes one rep. Do the
recommended number of
reps, and then repeat, lead-
ing with the left foot and
stepping off the left side
of the step. This completes
one set.
Step Workout
10 Over the top

Starting position: Stand up straight with your feet together Tips and techniques:
and your right side toward the step. • Master the footwork first and then add the arms.
Movement: Step up onto the step with your right foot and then • Keep your abs tight and stand tall.
with your left foot, keeping your toes pointing in the direction • Don’t bend at your waist as you step.
you are facing. Step down off the other side of the step with
Make it easier: Do it on the floor without a step.
your right foot and then with your left foot. Circle your arms
around and down in front of you as you step. Come back over Make it harder: Use a higher step. Add a hop.
the step, starting
with your left
foot and then
your right foot,
onto the step
and then off
it, circling your
arms. This com-
pletes one rep.
Reps: 8
Sets: 1
11 Straddle
Starting position: Stand up straight with your feet together on Tips and techniques:
top of the step, facing the short end of the step. • Keep your abs tight and stand tall.
Movement: Step with your right foot to your right, off the step. • Don’t bend at your waist as you step.
Then step with your left foot to the left, off the other side of the Make it easier: Do it on the floor without a step.
step, so you are straddling the step. Step back up with your right
foot, and then with your Make it harder: Use a higher step. Hop back onto the step.
left foot. That’s one rep. Do
the recommended number
of reps, and then repeat,
starting with your left foot.
Then alternate the leading
foot, tapping on the last
step of each rep to switch
feet, for the recommended
number of reps.
Reps: 8 on each side, then
8 alternating sides
Sets: 1

Cool-down and stretches
A fter a workout, cooling down for five to 10 min-

utes through a sequence of slow movements helps
prevent muscle cramps and dizziness while slow-
heart rate and breathing are slowing down.
For the stretches:

ing breathing and a fast-beating heart. Finish with After you’ve cooled down, continue with the stretches
stretches to prevent muscles from tightening up. This below, which include calming yoga moves. Flow from
will help enhance your flexibility. one movement to another without rests in between.
You’ll achieve best results by holding stretches for 10
For the cool-down: to 30 seconds and doing these exercises at least two or
Try repeating the “Side step with arm swing” (page 19) three times a week. The longer you can hold a stretch,
and “Shallow side lunge” (page 19) from the warm- the better for flexibility.
up. Do these at an easy intensity. Then walk around Equipment: Mat, towels, or carpet for comfort
or gently march in place until you notice that your during floor exercises (see “Equipment,” page 17).
1 Calf stretch 2 Soleus stretch

Primarily stretches the Primarily stretches the soleus (deeper calf muscle) and Achilles
calf, Achilles tendon, and tendon
ankle
Starting position: Hold the back of a chair or press your
Starting position: Stand hands against a wall, arms extended at shoulder height.
up straight. Hold the
Movement: Extend your right leg behind you about half of the
back of a chair or press
distance as for the “Calf stretch” and press the heel into the
your hands against a
floor. Allow your left knee to bend as you do so, while keep-
wall, arms extended at
ing the heel grounded on the floor. Now bend your right knee
shoulder height.
as much as possible, pressing into your heel until you feel a
Movement: Extend your stretch low in your calf. Hold. Return to the starting position.
right leg straight back Finish all reps, then repeat with your other leg.
and press the heel into
Reps: 2–4
the floor. Allow your left
knee to bend as you do so, while keeping that heel grounded Hold: 10–30 seconds
on the floor. Feel the stretch up the back of your lower right
leg. Hold. Return to the starting position, then repeat with your
• Maintain neutral pos-
left leg. This is one rep.
ture with your shoulders
Reps: 2–4 down and back. Don’t
Hold: 10–30 seconds bend at your waist.
• Keep your front knee
Tips and techniques: directly over your ankle.
• Hold a full-body lean from the ankle as you stretch. • Step closer to the chair
• Step closer to the chair or wall if you find yourself bending at or wall if you are hav-
the waist and leaning forward. ing trouble maintaining
• Keep your front knee over your ankle. good form.
3 Standing quadriceps stretch 5 Chest stretch

Primarily stretches the front of the thigh Primarily stretches the chest and shoulders
Starting position: Stand up straight, Starting position: Stand up straight with
feet together, holding the back of a your arms at your sides.
chair with both hands.
Movement: Bring your hands behind your
Movement: Bend your right knee and back and lace your fingers. Palms should
reach back with your right hand to be facing up. Roll your shoulders back and
grasp your foot, lifting it toward your down. Then, gently lift your hands up and
right buttock. Feel the stretch in the away from you as far as comfortably pos-
front of your thigh. Hold. Slowly lower sible. Hold. Return to the starting position.
your foot to the floor. Switch position to
Reps: 2–4
repeat with your left leg. This is one rep.
Hold: 10–30 seconds
Reps: 2–4
• Keep your shoulders down and back, away from your ears, as
Tips and techniques: you stretch.
• Try to keep both knees together, with the bent knee pointing • Look straight ahead, keeping your chin level with the floor.
toward the floor. • Don’t lean forward.
• Keep your pelvis neutral; don’t arch your back.
• If you have trouble grasping your foot, place a stretch strap
around it to assist with the stretch. 6 Kneeling hip flexor stretch
Primarily stretches the front of the hip and thigh
4 Standing hamstring stretch Starting position: Kneel with your hands at your sides.
Primarily stretches the back of the thigh Movement: Put your left leg in front of you with the knee
bent at a 90-degree angle and foot flat on the floor. Place your
Starting position: Stand up straight with your arms at your sides.
hands on your left thigh for support. Lean forward, pressing
Movement: Extend your left leg straight in front of you, heel into the hip of your right leg while keeping the top of your right
grounded on the floor and toes pointing to the ceiling. Place foot on the floor. Feel the stretch in the front of your right thigh
your hands on your right thigh for support and hinge forward and hip. Hold. Return to the starting position, then repeat with
from the hip, keeping your spine neutral. Bend your right knee your right leg forward. This is one rep.
and sit back until you feel a stretch up the back of your left
Reps: 2
thigh. Hold. Return to the starting position. Repeat with the
other leg. This is one rep. Hold: 10–30 seconds
Reps: 2–4 Tips and techniques:
• Keep your front knee
over your ankle, not jut-
Tips and techniques: ting out past your toes.
• Stretch to the point of mild tension, • Keep your head and
not pain. You should not feel any pres- spine neutral, your shoul-
sure behind the knee or at your back. ders down and back, and
• Keep your shoulders down and back, your abdominal muscles
away from your ears, as you stretch. tightened.
• As you hinge forward, keep your chest • Keep your pelvis tilted forward (tailbone tucked under),
lifted and imagine your chin reaching rather than letting it tip back (tailbone lifted).
toward your foot.

7 Seated torso twist 8 Pretzel stretch

Primarily stretches the back and neck Primarily stretches the buttocks, hip, and outer thigh
Starting position: Sit up straight on the floor with your legs Starting position: Lie on your back with your left knee bent
extended in front of you. Bend your right leg and place your and your foot on the floor. Rest your right ankle on your left
right foot on the floor by the outside of your left knee. thigh, just above your left knee. Your right knee should point
out to the side, toward the wall. Grasp the back of your left
Movement: Slowly rotate your head and torso to the right
thigh with both hands.
side, placing your right hand on the floor behind you for sup-
port and your left hand on the outside of your right knee to Movement: Slowly lift your left foot off the floor until you feel
help you stretch farther. Feel the stretch in your back and neck. the stretch in your right hip and buttock. Hold. Return to the
Hold. Slowly return to the starting position. Repeat to the starting position. Repeat with your right knee bent and your
opposite side. This is one rep. left ankle resting on your right thigh, just above your right
knee. This is one rep.
Reps: 2–4
Reps: 2–4
• Flex the foot of your extended leg. Tips and techniques:
• Use the hand on the floor behind you to help you sit up • Keep your shoulders
straight. down and back, relax-
• Each time you ing them against the
floor.
rotate, choose a spot
to focus on while • Keep your head on the floor and your neck relaxed.
holding. This spot • If it’s too hard to grasp your thigh with both hands, put a
should move notice- strap or small towel around the back of the thigh and hold
ably as your range both ends.
of motion improves.
9 Child’s pose with diagonal reach

Primarily stretches the back, shoulders, arms, and sides Tips and techniques:
• Rest your forehead on the mat
Starting position: Position yourself on all fours, knees hip-
width apart, big toes touching, and head and neck in neutral when holding this stretch.
alignment. • Lower your buttocks only as far
as feels comfortable. If neces-
Movement: This is a three-part stretch. Slowly drop your but- sary, place a pillow or towel
tocks back toward your heels as you extend your hands in front between your thighs and calves
of you and rest your forehead on the mat. Feel the stretch down to limit the stretch.
your arms, shoulders, and back. Hold. Then walk your hands
• W
hile holding, take full
diagonally out to the right and place your left hand on top of
breaths by inhaling gently
your right hand. Feel the stretch down the left side of your body
through your nose and length-
and your back. Hold. Then walk your hands diagonally out to the
ening the outbreath as you
left and place your right hand on top of your left hand. Feel the
exhale through your nose.
stretch down the right side of your body and your back. Hold.
Return to the starting position. That’s one rep.
Reps: 2–4
Hold: 10–30 seconds in each stretching position
SPECIAL SECTION
Designing your
own program
T
he workouts in this report lay a good foundation for
a cardio program. However, once you have mastered
these workouts, you may want to try others, too. For
some people, selecting one activity and sticking with it may
work. Others may need to alternate between activities to avoid
boredom and stay challenged. Maybe you already have a good
idea of what you want to try next. Or perhaps you need some
suggestions. Whether you want to work out on your own or
join a class, you will find ideas in this chapter.
© kali9 | Getty Images
What should you do? fun. Over time, you may also feel
As you know by now, there is a more accountable to a group work-
broad range of cardio workouts, out as you get to know people in When selecting what type of cardio exercise
and no single approach is right for the class; you start to look forward to do, an important consideration is enjoy-
everyone. That’s why it’s important to seeing them, and they miss you ment. If you don’t enjoy it, you won’t do it.
to consider these questions when when you’re not there. Because
creating a cardio exercise plan. classes and instructors vary, it’s ply be alone with your thoughts.
What do you like to do? When important to go and watch a class Again, there are plenty of options,
selecting what type of cardio exer- before you try it to make sure it’s a from in-home workouts to walk-
cise to do, an important consider- good fit for you. For suggestions on ing, jogging, or swimming. Using
ation should be enjoyment. If you some popular types of classes, see cardio equipment like a treadmill,
don’t enjoy it, you won’t keep it up. “Working out with a group,” page 48. elliptical machine, or stationary
And consistency is the key! That’s Others may prefer solo work- bike at a gym may work for some.
how you get results. outs. Instead of socializing while What are your goals? You can
Do you prefer to work out exercising, solitary pursuits give get general health benefits and
alone or in a group? Group work- you a chance to escape and get probably some weight loss from
outs are great way to boost the some much needed “me” time. any cardio routine. If you’re looking
fun factor of exercise. Invite some You can listen to music or pod- to improve performance, higher-
friends to join you for even more casts while you exercise, or sim- intensity workouts, such as high-
www.health.har vard.edu Cardio Exercise 47

SPECIAL SECTION | Designing your own program
intensity interval training (HIIT) have to drive to a path, which may longer than the high-intensity
or boot camp will be your ticket. mean investing in a bike rack. If interval. These types of classes may
To build stronger bones, stick to there’s a path near your office, you use only cardio moves (like run-
weight-bearing workouts in which could ride right after work. ning in place or jumping jacks) for
you are on your feet like walk- How will you round out your a straight-up cardio workout, or
ing or jogging, instead of activities program? Cardio exercise is the they may include moves like push-
like cycling or swimming, in which foundation of an exercise program, ups, kettlebell swings, mountain
your body weight is supported. but other components are impor- climbers, or burpees that involve
What’s convenient for you? tant, too (“see “Beyond cardio: A both cardio and strength training.
Swimming may sound like a great complete fitness plan,” below). Tip: Because this is a very vigorous
activity, but if the closest pool is workout, it is not recommended for
30 minutes out of your way, you’re Working out with a group beginners, and you should check
probably less likely to do it regu- If you like group exercise, see what with your doctor before trying it.
larly. Look for options that are near your gym or Y has to offer. Here Kickboxing and other classes
to locations that you frequent, like are some options to consider. inspired by boxing and martial
your home, office, grocery store, or HIIT (high-intensity interval arts, such as krav maga (an Israeli
kids’ school. If you don’t have to go training) refers to an approach in martial art), offer a high-energy
out of your way to get to an exer- which you repeatedly push your- cardio workout that enhances bal-
cise facility, you’ll be more likely to self to maximum intensity for short ance as you punch, kick, and lunge.
go there. If you’re interested in an periods of time (usually less than Some classes even teach you self-
exercise class, choose one at a time a minute) alternating with brief defense. Compared with other
with the fewest possible conflicts recovery periods. One form, called cardio classes, these types of work-
that could prevent you from going. Tabata, follows a 40-second/20- outs involve more upper-body
Thinking about riding your bike? second pattern, while other HIIT work, so don’t be surprised if you
Consider whether you can ride classes use a variety of intervals, notice your arms are more toned.
from your home or whether you’ll often with a recovery period that’s The footwork is also more basic, so
it’s a good choice for anyone who
doesn’t like choreographed work-
Beyond cardio: A complete fitness plan outs. Tip: When you punch, don’t
fully extend your arms. Keep a
In addition to aerobic exercise, the Physical Activity Guidelines for Americans
slight bend in your elbow to avoid
from the U.S. Department of Health and Human Services encourage adults to
perform strengthening exercises for all major muscle groups (legs, hips, back, hyperextending and possibly injur-
chest, abdomen, shoulders, and arms) two or more times a week, with at least ing the joint.
48 hours in between to allow muscles to recover. Rebounding provides a high-
The guidelines also recommend balance training for older adults at risk for falls. energy, joint-friendly workout
While the guidelines don’t include recommendations for flexibility training, the in which you perform familiar
American College of Sports Medicine recommends stretching at least twice a aerobic moves and jumps on a
week or after any workout. mini trampoline. You’ll feel like a
By adding these other components to your fitness routine, you’ll become kid again as you bounce around
stronger, steadier, and more flexible, making cardio exercise feel even easier.
without your knees or back ach-
If you need guidance or suggestions for any of these, Harvard has additional
Special Health Reports that address these (see “Resources,” page 52). ing. You’ll also train your core as
you work to remain stable. This is
48 Cardio Exercise www.health.har vard.edu
Designing your own program | SPECIAL SECTION
not a good choice if you have any

High-tech monitors
© PeopleImages | Getty Images
balance issues. Tip: Focus on low,

controlled jumps for a better work-
out and less risk of injury. Don’t
aim to jump high.
N ot too long ago, athletes who
were looking to fine-tune their
workouts were the primary users of
Spinning is a group cardio heart rate monitors. As prices came
workout on stationary bikes that down and new technologies were
developed, though, more people started using devices instead of their fingertips
is set to motivating music. The
to track their heart rate during exercise. Along with the traditional chest strap
instructor will guide you through monitors that transmit data to a wrist receiver, there are wrist-only devices,
high-speed intervals reminiscent smartphone apps, and handgrip sensors on cardio exercise machines. Many
of the Tour de France and out-of- of the wrist-only devices today are activity monitors that also track steps and
your-seat, high-resistance bouts sometimes much more. They measure your pulse by using optical sensors that
detect light bouncing back from blood flow beneath the skin.
that mimic steep hill climbs. In
between, you’ll pedal slower to To determine which devices were most accurate, researchers compared a chest
strap monitor and four popular fitness trackers and found the chest version to
recover. While the intensity can be accurate 99% of the time, according to a 2016 study in JAMA Cardiology.
be high, this is a no-impact, joint- The fitness trackers, which are much easier to use, were 83% to 91% accurate.
friendly workout. It’s also a great For healthy recreational exercise, this might be fine. However, if you have heart
option if you shy away from tra- problems and need to monitor your intensity more closely, or if you’re an athlete
in training, you’ll be better served with a chest-style monitor. Definitely skip
ditional group classes because you
the handgrip monitors on exercise equipment. They have been found to be
don’t feel coordinated enough to notoriously inaccurate. The accuracy of smartphone apps is yet to be determined.
follow the footwork. Tip: Make sure
your bike is adjusted to fit you. A
poor fit could lead to knee, back, you don’t even realize you’re work- through a variety of exercises. You
or neck pain. Ask the instructor for ing out. Tip: Focus on mastering can find boot camps offered both
help if you’re new to this. the footwork before you try doing indoors and out, as well as specialty
Zumba pours on the cardio the arm movements. And just have boot camps, such as women-only
through sensual dance moves like fun. You don’t have to be doing the or sport-specific ones. Many classes
salsa, meringue, and cumbia set to moves perfectly. Keep moving, and use body-weight exercises requir-
infectious Latin and international you’ll get a good workout. ing no equipment, while others
beats. If you love to dance, this may Finally, another popular type employ a variety of gear. Since boot
be the perfect workout for you. of class combines cardio and camps tend to skew toward more
While it is low-impact, the routines strength training: experienced exercisers, let the
are choreographed, so if you feel Boot camp workouts include instructor know if you are a begin-
completely uncoordinated, proceed strength exercises like push-ups ner so he or she can offer modifi-
with caution. If you find an instruc- and cardio power moves like jumps cations. Tip: Bring plenty of water,
tor who encourages students to for vigorous total-body workouts because you’re going to sweat!
improvise and you’re comfortable reminiscent of Army basic training.
doing your own thing, go for it While some boot camp instructors Monitoring intensity
no matter how uncoordinated you seem to be channeling drill ser- If you ever took an aerobics class
feel. The classes are designed to be geants (“Drop and give me 50!”), back in the ’80s or ’90s, you might
like a dance party, so you may find most offer encouragement rather remember being instructed to mea-
that you’re having so much fun, than intimidation as they lead you sure your heart rate and then com-

SPECIAL SECTION | Designing your own program
pare your number to the numbers Perceived exertion Since these tests are expensive and
on a brightly colored chart with To monitor intensity this way, not necessary for many people,
target heart rate zones. Monitor- you need to pay attention to signs formulas have been developed to
ing your intensity when you exer- from your body, such as how hard estimate your MHR. The easiest
cise ensures that you get a safe and you are breathing, how fast your one to use is 220 – age = MHR. So,
effective workout. While counting heart is beating, and how fatigued for someone age 50, the MHR is
heartbeats is still a valid method, your muscles feel. Then you com- 170 bpm, but a 70-year-old has an
there are easier ways to assess how pare that to a numerical chart. MHR of 150 bpm.
hard you are exercising. You should For instance, the Borg Rating of Based on MHR, moderate
select a method that works best for Perceived Exertion, also called intensity is defined as 50% to 70%
you; it’s a personal choice. No mat- the Borg scale, goes from 6 to 20, of MHR, and vigorous intensity
ter which one you choose, the most with 6 being no exertion at all and is 70% to 85%. Widely available
important thing is that you do it 20 being maximum exertion. This heart rate monitors (see “High-
regularly. scale relates to your heart rate. Mul- tech monitors,” page 49) figure out
tiply the exertion number by 10 to these target ranges for you, but you
Talk test get the equivalent heart rate. So, 6 can still calculate them on your
This is the simplest way to gauge would equate to 60 average beats own if you’d like. Specifically:
intensity. If you can carry on a per minute if you are resting. On • To calculate your moderate-
conversation while you are exer- this scale, moderate intensity is intensity zone, you would mul-
cising, your effort is moderate. If between 12 and 14, somewhat hard. tiply MHR by 0.5 and by 0.7. For
you can sing, then you’re at a low Other perceived exertion a 50-year-old, the range is 85 to
intensity. As it becomes more diffi- charts use a 0-to-10 or 1-to-10 119 bpm. For a 70-year-old, it is
cult to speak, your intensity level is scale. Moderate intensity on these 75 to 105 bpm.
increasing. Never push yourself to scales is around 3 to 5, and high • To calculate your high-inten-
the point where you cannot speak. intensity is 6 to 8. sity zone, you would multiply
MHR by 0.7 and by 0.85. For a
Target heart rate 50-year-old, the range is 119 to
Target heart rate 145 bpm. For a 70-year-old, it is
zones are based 105 to 128 bpm.
on your maximum Now all you have to do is measure
heart rate (MHR) your heart rate (for instructions,
in beats per min- see “Why your resting heart rate
ute (bpm), which is important,” page 6) while you’re
is the upper limit exercising to see if you are working
of what your car- at the right intensity. (Certain med-
diovascular system ications, particularly ones for blood

can handle during pressure, may affect your heart
physical activity. rate and prevent you from getting
The most accurate an accurate assessment from this
Spinning is a popular cardio option at gyms across the country. method of deter- method. If you take medication,
The instructor will guide you through high-speed intervals and mining MHR is an check with your doctor to see if any
high-resistance climbs alternating with slower recovery periods. exercise stress test. of your drugs have this effect.)
50 Cardio Exercise www.health.har vard.edu
Designing your own program | SPECIAL SECTION
Staying motivated style. Any upbeat tunes can add

Exercise shouldn’t be something Tip: Make hard exercise energy to your steps and keep you
you do only when you want to feel easier motivated. Start with songs that
drop those 10 extra pounds or have a slower beat to warm up,
prepare for a charity 10K. To be
successful, it should be as much I f you want to pick up the
intensity of your workouts,
you can make vigorous exercise
then choose higher-energy ones
for the middle of your workout,
a part of your routine as eating, more enjoyable by starting hard and finish with a slower, relaxing
sleeping, and taking your morn- and ending easy. In a 2016 tune. You can even alternate fast
ing shower. Here are some tips to study, researchers had 46 people and slow selections for a musical
help keep you from slacking off pedal on recumbent bikes for 15 interval workout. Just remember to
minutes. Half of the group started
when you’re crunched for time or at a low intensity and then kicked
keep the volume low, and if you are
preoccupied with other things. it into high gear at the end. The outside, use only one earbud, so
Have a backup plan. You can other half did the reverse, pushing you stay alert to your surroundings
improve your chances of exercis- hard at the beginning and then and safe.
gradually bringing the intensity
ing regularly by coming up with Don’t be too hard on your-
down. Surprisingly, the people in
alternate workout options ahead the hard-to-easy group enjoyed self. Next time you miss a work-
of time. If you have a plan B, then their workout more. Even a week out or are thinking of skipping
when you sleep in and miss your later, they had more positive one, don’t scold yourself for miss-
morning step workout, you’ll recollections of their workout ing a session, but pretend you’re
than the easy-to-hard group.
know that you’re going to walk Many experts believe that you’ll encouraging a friend to stick with
during lunch instead. Or, maybe be more likely to keep exercising the program. Use that same sup-
you know that dinner with friends if you enjoy it. portive language to help yourself.
will prevent you from taking your Avoid “I can’t” thoughts or other
Zumba class, so instead you sneak put-downs. Instead, practice posi-
in a 15-minute walk in the morn- the grocery store, but take a walk tive statements such as “I can do
ing and another before you meet before you start shopping. Over this!” “Look how well I did yester-
your friends. Keeping a pair of time you’ll associate exercising day (or last week)!” “I am getting
sneakers in your car gives you the with these activities, so they will stronger.” Any time you notice
option to squeeze in a walk when- remind you to work out. toxic thoughts creeping in, think—
ever you have a little extra time. Get a little rhythm. Music or say aloud—“Stop!”
Create a cue. Many daily makes workouts more fun, so And if you do slip, know that
habits happen because something you’ll be more likely to stick with you’re not alone. Backsliding hap-
signals you to do them, like brush- them. It’s also been shown to pens to everyone from time to
ing your teeth in the morning inspire you once you start moving. time. The important thing is that
and before bed. You can tie your Exercisers who listen to music tend you catch yourself and get back
workouts to regularly scheduled to go longer and harder. Remem- into a routine as soon as possible,
activities, such as getting up in the ber the theme song from Rocky? rather than letting one or two
morning or lunchtime. You could Or Chariots of Fire? Or maybe missed workouts lead to weeks of
also use tasks such as grocery Garth Brooks, Elton John, or Flor- little to no activity. Shake it off, lace
shopping. For example, drive to ence and the Machine is more your up your shoes, and get moving!

Resources
Organizations Rockville, MD 20852
240-276-9567
American Academy of Physical Medicine and
www.fitness.gov
Rehabilitation
www.presidentschallenge.org
9700 W. Bryn Mawr Ave., Suite 200
Rosemont, IL 60018 The President’s Council on Sports, Fitness & Nutrition offers
847-737-6000 simple tips for healthy eating, weight loss, and an active lifestyle.
www.aapmr.org The President’s Challenge website hosts activity logs and fitness
calculators and two levels of fitness challenges.
This is the professional organization for physiatrists—medical
doctors trained in physical medicine and rehabilitation. A referral
service on the website locates physiatrists by state. Harvard Special Health Reports
American College of Sports Medicine You can find additional exercise plans in these Special Health
401 W. Michigan St. Reports from Harvard Medical School. To order, call 877-649-9457
Indianapolis, IN 46202 (toll-free) or to go www.health.harvard.edu.
317-637-9200
Better Balance: Simple exercises to improve stability and
www.acsm.org
prevent falls
ACSM is a nonprofit association that educates and certifies fitness (Harvard Medical School, 2017)
professionals, such as personal trainers, and offers information to
the public on various types of exercise. A referral service on the This report includes both beginner and advanced balance
website locates ACSM-certified personal trainers. workouts, plus information on health problems affecting balance.
American Council on Exercise Core Exercises: 5 workouts to tighten your abs,

4851 Paramount Drive strengthen your back, and improve your balance
San Diego, CA 92123 (Harvard Medical School, 2016)
888-825-3636 (toll-free) Strong core muscles underlie almost everything you do, from
www.acefitness.org walking to playing sports. That’s because your core—which
ACE is a nonprofit organization that promotes fitness and offers includes back, side, pelvic, and buttock muscles—forms a sturdy
educational materials for consumers and professionals. The ACE central link between your upper and lower body. These workouts
website has a referral service to help locate ACE-certified personal use a variety of approaches to help build core strength.
trainers and a free video library of exercises.
Strength and Power Training for All Ages: 4 complete
American Heart Association workouts to tone up, slim down, and get fit
7272 Greenville Ave. (Harvard Medical School, 2017)
Dallas, TX 75231
You don’t have to hoist barbells to do strength training. This
800-242-8721 (toll-free heart disease information)
report includes workouts using hand weights, resistance bands,
888-478-7653 (toll-free stroke information)
medicine balls, and kettlebells. Easier and harder options are
www.heart.org
provided.
The AHA website provides educational materials on all aspects of
heart disease and stroke. The organization also offers educational Stretching: 35 stretches to improve flexibility and
services and materials. reduce pain
(Harvard Medical School, 2017)
National Institute on Aging
Building 31, Room 5C27 Stretching can help prevent or relieve stiffness, improve sports
31 Center Drive, MSC 2292 performance, and, in older adults, make daily activities easier. This
Bethesda, MD 20892 report includes seated, standing, and floor stretches.
800-222-2225 (toll-free) Walking for Health: Why this simple form of activity could
www.nia.nih.gov be your best health insurance
www.nia.nih.gov/Go4Life (Harvard Medical School, 2015)
Among other publications, the National Institute on Aging offers
This report includes five different walking workouts, information
a free, easy-to-follow booklet and companion video packed
on proper technique, tips on finding the right shoes and socks,
with aging-friendly exercises called Exercise & Physical Activity.
safety pointers, and more.
The NIA’s Go4Life website hosts an exercise campaign aimed at
enhancing endurance, strength, balance, and flexibility for people Workout Workbook: 9 complete workouts to help you get
ages 50 and older, including those recovering from injuries or fit and healthy
living with chronic illnesses. (Harvard Medical School, 2016)
The President’s Council on Sports, Fitness & Nutrition Core, strength, stability ball, power challenge, travel, and other
1101 Wootton Parkway, Suite 560 workouts help you bump up activity and enhance fitness.
Glossary
aerobic activity: An activity or exercise that increases heart rate neutral posture: Positioning your body with chin parallel to the
and breathing through repetitive use of large muscles, such as floor; shoulders, hips, and knees at an even height; and knees and
walking, running, or biking. Also known as cardio or endurance feet pointing straight ahead, whether standing or seated.
exercise, aerobic activity conditions the heart, lungs, circulatory
system, and muscles. neutral spine: The placement of the back so that it is straight
except for the slight natural curves of the spine.
cardiorespiratory: relating to your heart and lungs.
perceived exertion: a method of measuring the intensity of
cardiovascular: relating to your heart and blood vessels (arteries activity by paying attention to signs from your body, such as how
and veins). hard you are breathing, how fast your heart is beating, and how
fatigued your muscles feel.
extend: Straighten out a joint (for example, extending your arms
means straightening your elbows). physical activity: Any movement that prompts muscle contrac-
flex: Bend a joint (for example, flexing your knee means bending tions and a rise in metabolism. Under this umbrella is an endless
your knee). list of activities like rising from a chair, crossing the room, tossing a
Frisbee, running a marathon, or vacuuming a floor.
intensity: How hard you are working during exercise, taking into
account your heart rate, perceived exertion, or cues like breathing, physical fitness: A state of being physically sound and healthy;
talking, and sweating. having the ability to perform physical activity well.
joint: A junction in the body where bones are linked together. range of motion: The extent of movement in a joint and thus
flexibility. This is measured in the degrees of a circle.
ligament: Tough, fibrous bands of connective tissue that bind
bone to bone, or bone to cartilage, at a joint, allowing a safe range repetition: A single, complete performance of an exercise. Also
of movement. called a rep.
maximum heart rate (MHR): measured in beats per minute tendon: A flexible cord of strong connective tissue that tethers
(bpm), the upper limit of what your cardiovascular system can muscle to bone.
handle during physical activity.
VO2 max: The body’s maximum capacity for oxygen consumption
neutral alignment: Keeping your body in a straight line from during peak exertion. Also known as aerobic power, maximal
head to toe except for the slight natural curves of the spine. oxygen consumption, or cardiorespiratory endurance capacity.

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What are some of the benefits of cardio exercise?

What are some of the benefits of cardio exercise?

What are some guidelines for safety during cardio exercise?

What are some guidelines for safety during cardio exercise?

A HARVARD MEDICAL SCHOOL

SPECIAL HEALTH REPORT

Here’s what you CAN do Here’s what you CAN’T do

For more information

Lauren E. Elson, M.D. Michele Stanten

M ore than 2,000 years ago, Hippocrates recognized

Cardio, aerobics, step, calisthenics—

started to decline. Following World War I, statistics

2 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 3

4 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 5

A s the name implies,

© adamkaz | Getty Images

Why your resting heart rate is important

D iscussions of cardio exercise

6 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 7

8 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

Stand up for your health

S tructured workouts like the ones in

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 9

10 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

W hen you were younger,

important to consult with Physiatrists are medi-

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 11

© nito100 | Getty Images

12 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 13

A s scientists have learned more about cardio and

erate exercise just 15 minutes a day tended to live an

14 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 15

Terminology used in the workouts

16 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

Comfort is the key!

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 17

Y ou can do this five-minute warm-up routine

Make it easier: March slower. Don’t lift your knees as high.

Make it easier: Roll your shoulders slower. Make smaller

Make it harder: Make bigger circles with your shoulders.

18 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

4 Shallow side lunge

Make it easier: Slow down. Do fewer reps.

5 Side step with arm swing

Reps: 20 (about 60 seconds) Make it harder: Take larger steps

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 19

T his is the perfect routine if you’re just starting to

1 Side lunge and reach Easier Harder

20 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

2 Knee lift with arm pull-down

ww w. h ealt h . h ar v ar d . e du Cardio Exercise 21

3 Side step squat

22 Cardio Exercise  w w w.h ealt h .ha r va r d.e du

5 Skater 6 Step-back lunge

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