Most gyms assault their members with a cacophony of distractions – thumping music, blaring televisions, and grunting patrons. We are careful to maintain a clean and distraction-free facility. There is no music and there are no mirrors or televisions. The temperature is kept at 68 degrees. The sessions are one-on-one with a focus on privacy. Instructors are dressed professionally at all times and closely monitor and record every aspect of their client's performance.
One of the rotator cuff strengthening exercises proposed by Kuhn is scaption performed with the thumb down or up. Clinically, this exercise is called the empty-can (thumb-down) or full-can (thumb-up) exercise. When prescribing this strengthening exercise, one should consider the effect that upper extremity position has on the tissues located in the subacromial space. Yanai et al4 showed that impingement forces on the rotator cuff tendons under the coracoacromial ligament were greater with the empty-can exercise than with the full-can exercise. Therefore, the full-can exercise is more appropriate for this patient population.
Pilates is great for individuals of all fitness levels. People who are just beginning a fitness program will find it’s a great way to ease into more intense methods of exercise. It’s also beneficial for pregnant and postpartum women and people wishing to strengthen their muscles after an injury. A physician’s approval should be sought before beginning any exercise program.
Circuit training tips for beginners: my advice here depends on how physically demanding the circuit is. If you’re just getting into working out and you want to circuit train, start with some less challenging exercises as part of your circuit and consider decreasing the time from a minute for each circuit to 30 seconds (or whatever you’re comfortable and able to finish the circuit with). The same advice applies here as in some of the other sections above: it’s good to build a baseline level of strength and aerobic fitness before circuit training, but it also depends on your level of fitness when you start.

The lateral raise (or shoulder fly) is performed while standing or seated, with hands hanging down holding weights, by lifting them out to the sides until just below the level of the shoulders. A slight variation in the lifts can hit the deltoids even harder, while moving upwards, just turn the hands slightly downwards, keeping the last finger higher than the thumb. This is an isolation exercise for the deltoids. Also works the forearms and traps.
So what's so special about tendon problems and eccentric exercise? It seems that eccentric exercise seems to be helpful to injured tendons. Why? Researchers still do not know why this type of exercise is special. Still, if you have a tendon injury, like Achilees tendonitis, your physical therapist may have you perform eccentric exercises to help treat your condition.
My Free Yoga is pretty much exactly as it sounds -- it offers free yoga classes for you to enjoy! It is a little different than other yoga options on this list in that it is really a hub for yoga instructors to post their free yoga class videos. The video library is huge and you can search for classes that focus on your specific problem areas. For example, there is a category for those suffering from hip issues and another for those experiencing back pain.
The Internet may be your favorite way to waste time, but it also offers a wealth of resources for home and/or traveling exercisers. Not all content is created equal on the World Wide Web but, if you know where to look, you can find almost everything you need to know about exercise: How to set up a home gym, create your own exercise program, and learn the basics of cardio, strength training and how to get in shape with exercise.

Alicia Marie, celebrity trainer, says you can change your core with plank twist corkscrews. “Hold in low plank position, keeping your core muscles tight and your forearms flat,” she says. “Slowly rotate your hips to one side, being sure not to drop them to the floor, then rotate your hips back to center. With your core muscles still engaged, rotate to the opposite side. Alternate back and forth slowly, completing five reps on each side for a total of four sets.”

Do you have any health or physical limitations to consider? If you have back problems, knee issues, arthritis, high blood pressure, asthma, or any kind of health or physical limitations, you need to consider these when looking at the array of exercise videos on the market. There are some that will push you to the very edges of your limits and others that can accommodate a necessity for lower impact and a slower pace yet are still effective. Ignoring health problems or physical limitations is very dangerous. Asking your doctor for any restrictions before shopping is a plus as well.

If you haven’t strength trained regularly, muscle loss may now reach critical levels, interfering with balance, gait, and other daily activities. But if you take up strength training, those changes are reversible: A number of studies including adults in their 70s have found that progressive strength training two or three times per week can lead to such improvements as increased muscle mass, more ease with everyday activities like climbing stairs and carrying groceries, and reduced joint pain.

Typical balance exercises include standing on one foot or walking heel to toe, with your eyes open or closed. The physical therapist may also have you focus on joint flexibility, walking on uneven surfaces, and strengthening leg muscles with exercises such as squats and leg lifts. Get the proper training before attempting any of these exercises at home.

There are two other studies that have measured prolactin in relation to overtraining. Lehmann et al23 showed that an increase in training volume, rather than intensity, led to more symptoms associated with overtraining. They also observed a close-to-significant exercise-induced decrease in plasma prolactin in the increased intensity group but no change because of increased volume. Budgett et al24 observed a more marked plasma prolactin response to a neuroendocrine challenge in athletes with unexplained underperformance syndrome. They also observed a higher resting plasma prolactin in unexplained underperformance syndrome athletes than healthy controls. These authors also state that prolactin could prove useful in monitoring the individual response to training and recovery.

Now that you understand the vast amount of categories available to you, you can start narrowing the field of choices down by looking at the specifics of exercise videos and deciding which ones will be something you will not only enjoy but continue to use long term. If you are starting out as a beginner to exercise, then you should expect to upgrade your exercise videos as your fitness levels increase. You don’t have to stay with a beginner video when your fitness level advances to intermediate or advanced. Below are some factors to look at when looking at individual videos.
Lie on your back with the knees bent and feet hip-width apart. Place arms at your side and lift up the spine and hips. Only the head, feet, arms, and shoulders should be on the ground. Then lift one leg upwards, keeping the core tight. Slowly bring the leg back down, then lift back up. Try to do 10 reps per leg, then bring the knee in place and spine back on the floor.

Training to Failure. During most lifts with a moderately heavy weight, the set is completed before failure is reached. Muscles feels taxed, the sweating has begun, a few more sets are rocked, and we move on to the next exercise. This is a great way to get stronger, but is taking a set to failure an even better way? Yes and no Muscle Activation strategies during strength training with heavy loading vs. repetitions to failure. Sundstrup, E., et al. 1 National Research Center for the Working Environment, Copenhagen, Denmark 2, Institute of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark 3Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Copenhagen, Denmark. Journal of Strength and Conditioning Research. 2012 Jul;26(7):1897-903.. While training to failure — lifting until the body can't do a single more rep — recruits more muscle and triggers the body to release more strength-building hormones, it’s most effective if a very high percentage of a one rep max can be performed The application of training to failure in periodized multiple-set resistance exercise programs. Willardson, J.M. Physical Education Department, Eastern Illinois University, Charleston, Illinois 61920, USA. Journal of Strength and Conditioning Research; 2007 May;21(2):628-31. The mechanisms of muscle hypertrophy and their application to resistance training. Schoenfeld BJ. Global Fitness Services, Scarsdale, New York, USA. Journal of Strength and Conditioning Research; 2010 Oct;24(10):2857-72.. Also, sets to failure increase the opportunity for overtraining and injury, so it’s best to use this technique only occasionally and with a spotter.

Endurance performance (i.e. exercise duration > 1 min) is extensively studied in exercise physiology using cycling and/or running exercise (e.g. [1–4]). Despite being close to real competition events by involving the whole-body, the use of cycling and/or running exercise presents some important limitations to understand the role of the central nervous system (CNS) in the regulation of muscle fatigue and endurance performance. Indeed, as whole-body exercise involves greater systemic responses than isolated exercise [5], it is difficult to interpret some specific experimental manipulations aiming to understand CNS processes regulating muscle fatigue and endurance performance (e.g. manipulation of III-IV muscle afferents [6, 7]). Furthermore, due to the need to transfer the participant from the treadmill/bicycle to the ergometer, the true extent of muscle fatigue at exhaustion is underestimated [8], leading to inconclusive results on how peripheral (i.e. fatigue produced by changes at or distal to the neuromuscular junction [9]) and central (i.e. decrease in maximal voluntary activation level [9]) components of muscle fatigue might interact between each other’s (for review see [2, 9]). Therefore, due to the aforementioned limitations, the development of a new exercise model is required to better investigate the CNS processes regulating endurance performance.
The good-morning is a weight training exercise in which a barbell, two dumbbells, or no weight at all is held on the shoulders, behind the head. The person bends forward and bows at the hips and recovers to upright. The good-morning is so called because the movement resembles bowing to greet someone. It involves the hamstrings but is primarily used to strengthen the lower back; the degree of knee bend used will change the focus – nearly straight-legged involving the hamstrings most.

Pilates uses your body weight for resistance and focuses on working both small and large groups of muscles. Over time, core strength, flexibility and muscle tone will begin to increase. Maximum results are achieved by working out at least 3 days a week. Pilates is not an aerobic exercise method, so it’s best to combine it with a few days of cardiovascular exercise. Although the movements are small and slow, Pilates provides an intense full-body workout.
Other strength training equipment. This includes weight stacks (plates with cables and pulleys), flexible bands, and flexible rods. Fichera says flexible bands are good for beginners, especially since they come with instructions. But he doesn't recommend them for long-term use; your muscles will likely adapt to the resistance and need more of a challenge.
Negative Sets. Weight training works with and against gravity. The motion towards the bar in a pull-up is called the "concentric movement," while heading back towards the ground is an "eccentric movement," or the negative portion of the movement. Resisting the pull of gravity during the negative porting of the movement taxes the muscles in a different way Myofibrillar disruption following acute concentric and eccentric resistance exercise in stregth-trained men. Gibala, M.J., Interisano, S.A., Tarnopolsky, M.A., et al. Department of Kinesiology (Neurology and Neurological Rehabilitation), McMaster University, Hamilton, ON, Canada. Canadian Journal of Physiology and Pharmocology. 2000 Aug;78(8):656-61.. At the end of a long set, switch to just performing negatives (with a partner's help on the way up) or work towards getting those difficult bodyweight movements (like a pull up or dip) by only performing the negative of the movement. Sounds easy? Just try it!
^ Jump up to: a b Szuhany KL, Bugatti M, Otto MW (October 2014). "A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor". J Psychiatr Res. 60C: 56–64. doi:10.1016/j.jpsychires.2014.10.003. PMC 4314337. PMID 25455510. Consistent evidence indicates that exercise improves cognition and mood, with preliminary evidence suggesting that brain-derived neurotrophic factor (BDNF) may mediate these effects. The aim of the current meta-analysis was to provide an estimate of the strength of the association between exercise and increased BDNF levels in humans across multiple exercise paradigms. We conducted a meta-analysis of 29 studies (N = 1111 participants) examining the effect of exercise on BDNF levels in three exercise paradigms: (1) a single session of exercise, (2) a session of exercise following a program of regular exercise, and (3) resting BDNF levels following a program of regular exercise. Moderators of this effect were also examined. Results demonstrated a moderate effect size for increases in BDNF following a single session of exercise (Hedges' g = 0.46, p < 0.001). Further, regular exercise intensified the effect of a session of exercise on BDNF levels (Hedges' g = 0.59, p = 0.02). Finally, results indicated a small effect of regular exercise on resting BDNF levels (Hedges' g = 0.27, p = 0.005). ... Effect size analysis supports the role of exercise as a strategy for enhancing BDNF activity in humans.
The Alfredson protocol for Achilles' tendinopathy is actually two separate exercises.  To perform the exercises, you must have a small step or curb on which to stand.  Be sure to check in with your doctor or physical therapist to ensure that it is safe for you to exercise and that you are performing the exercises correctly.   Here is how you perform the Alfredson protocol:
Back in mid-century America, you did old-style sit-ups, which were once regarded as the gold standard of iron-gut, military discipline. Maybe they still are, so if your idea of "manly" is messing up your lower back, go for it. But few fitness trainers recommend old-style sit-ups, though there are some re-conceptualized versions of them that might work for you.
In fig 3A–D, absolute hormone concentrations are presented for the NFO and the OTS groups. Visual inspection of the data led to the conclusion that resting concentrations cortisol, ACTH and PRLwere higher for OTS patients comparedwithNFO. However, reactions to exercise tests did not differ between the groups. Resting hormone concentrations were tested with independent t tests. Only for ACTH, the t test gave a value >2 (ie, t8=2.6; p<0.05), meaning that only for ACTH, the difference between the groups was more than twice as large as the SE. Sensitivity of resting cortisol, ACTH and PRL was four out of five (cutoff 175 μg l−1), four out of five (cutoff 40 ng l−1) and two out of five (cutoff 50 IU l−1), respectively (table 2). Sensitivity for detection of NFO was three out of five, four out of five and three out of five respectively for cortisol, ACTH and PRL, respectively (table 2).
A simple example of an eccentric contraction is to hold something in your hand with your elbow bent. Slowly allow your elbow to straighten out while holding the weight.  You can visualize your bicep muscle lengthening as you are holding the weight while you are slowly straightening your elbow.  This is an eccentric contraction or eccentric loading of your bicep muscle.
CrossFit Games: The sport of fitness has arrived (or so claims Reebok, the official sponsor of the CrossFit Games). Each summer the CrossFit Games test participants with a barrage of physical challenges and workouts, ranging from swimming and running to pull-ups and handstand walks (sorry, Kobayashi, hot-dog eating has yet to make an appearance). Participants accrue points over the events, and the male and female winners are crowned World’s Fittest Man & Woman. Sectional and Regional qualifiers narrow the field before the annual Games Weekend.
This is also the point at which exercise becomes more critical. Bone and muscle mass peak at the end of your 20s. Unchecked, sarcopenia, or muscle loss, can claim up to 50 percent of an inactive adult’s muscle tissue by the time he or she reaches 70, according to a 2014 Johns Hopkins University study. Your VO2 max — a measure of how much oxygen your body can process — declines similarly, dropping about 10 percent per decade after around age 30 in healthy sedentary adults of both sexes.
A systematic review evaluated 45 studies that examined the relationship between physical activity and cancer survivorship. According to the review, "[there] was consistent evidence from 27 observational studies that physical activity is associated with reduced all-cause, breast cancer–specific, and colon cancer–specific mortality. There is currently insufficient evidence regarding the association between physical activity and mortality for survivors of other cancers."[29] Although there is only limited scientific evidence on the subject, people with cancer cachexia are encouraged to engage in physical exercise.[30] Due to various factors, some individuals with cancer cachexia have a limited capacity for physical exercise.[31][32] Compliance with prescribed exercise is low in individuals with cachexia and clinical trials of exercise in this population often suffer from high drop-out rates.[31][32]
Anyone who watched Jackie Warner on Bravo's Work Out knows she takes a tough-love approach to fitness. And, clearly, if you've checked out her abs lately, it works. She shares her signature circuit-training workout in this high-energy DVD that gives the option of four different 15-minute workouts or one 40-minute total body circuit, and left me feeling like I just had an up-close-and-personal training session with the exercise guru.

If the phrase "3 to 4 reps at 10/5 cadence" is meaningless to you, this book may be also. If the phrase is familiar to you, you probably will already know most of what is written here. It is only to those for whom the phrase is both meaningful and interesting and to those who, in addition, are tolerant of an awkward writing style, that I would recommend the book. Even then, you might enjoy Ellington Darden more.
Cross-training means mixing in different workouts and training methods rather than focusing on just one type of workout. Not only does this help create a well-balanced fitness plan, but it can help you reach specific goals, too. For example, if you’re getting ready to run a race, you’ll want to cross-train with strength and yoga workouts, which will complement your running and help improve your performance and decrease the chance of injury by building muscle and increasing flexibility. “If you only include one form of training, you may be holding yourself back from the results you deserve,” says Lefkowith.

The bench press or dumbbell bench-press is performed while lying face up on a bench, by pushing a weight away from the chest. This is a compound exercise that also involves the triceps and the front deltoids, also recruits the upper and lower back muscles, and traps. The bench press is the king of all upper body exercises and is one of the most popular chest exercises in the world. It is the final exercise in 'The big 3'.
LSR, SBS, HV, NPA, JEI, UW and DS contributed to the conception and design of the study. LSR, SBS, HV and DS were responsible for the collection of the Generation 100 data in cooperation with colleagues at the Cardiac Exercise Research Group at the Norwegian University of Science and Technology, Norway. LSR, SBS and XT provided the data for analysis. LSR undertook the data analysis and drafted the manuscript. All authors provided critical insight and revisions to the manuscript. All authors read and approved the final version of the manuscript submitted for publication.
One of the main reasons I don't do Pilates very often is that, for me, it gets too boring after a while. Enter this DVD. Made up of five 10-minute workouts, it kept me engaged because I was able to change up the routine often, or, if I only had a few minutes available, I could still squeeze in a workout with just one of the programs. I just might be a Pilates convert after all.
Most people instinctively move weights very quickly - they jerk upwards, lower the weight without much control, and tense up and use momentum to "bounce" the weight at both ends of the repetition. The instinct serves a purpose - the speed and bounce at the ends do allow heavier weight to be moved. In competitive weightlifting both explosive speed and momentum are essential.
The simplest way to workout at home is to use your own body. There are a variety of effective body weight exercises that can help you build strength, endurance and burn calories. The downside is that, without added resistance, it's tough to work hard enough to really challenge your body and burn calories. One way around that problem? Circuit training. By going from one exercise to the next, without little or no rest, you keep your heart rate up, burn more calories and get the most out of your exercise time.
Selection bias may limit generalizability to other populations of older adults since the included participants in the Generation 100 study were healthier, more educated and more physically active than nonparticipants [19]. However, our study population was diverse and included both healthy as well as older adults with comorbidities, and both inactive and very active older adults were included. The findings in the present study are based on a very large data material, and represent the most comprehensive data material on exercise patterns among older adults to date.
In healthy adults, aerobic exercise has been shown to induce transient effects on cognition after a single exercise session and persistent effects on cognition following regular exercise over the course of several months.[33][42][45] People who regularly perform aerobic exercise (e.g., running, jogging, brisk walking, swimming, and cycling) have greater scores on neuropsychological function and performance tests that measure certain cognitive functions, such as attentional control, inhibitory control, cognitive flexibility, working memory updating and capacity, declarative memory, spatial memory, and information processing speed.[33][37][39][41][42][45] The transient effects of exercise on cognition include improvements in most executive functions (e.g., attention, working memory, cognitive flexibility, inhibitory control, problem solving, and decision making) and information processing speed for a period of up to 2 hours after exercising.[45]
Jump up ^ Int Panis, L; De Geus, Bas; Vandenbulcke, GréGory; Willems, Hanny; Degraeuwe, Bart; Bleux, Nico; Mishra, Vinit; Thomas, Isabelle; Meeusen, Romain (2010). "Exposure to particulate matter in traffic: A comparison of cyclists and car passengers". Atmospheric Environment. 44 (19): 2263–2270. Bibcode:2010AtmEn..44.2263I. doi:10.1016/j.atmosenv.2010.04.028.

Here’s how Chickedantz says to do it: Lay on a flat surface with your knees bent. Place one hand on your upper chest and the other on your belly, just below your rib cage. Breathe in slowly through your nose so that you can feel your stomach move out against your hand. There should be little to no movement in the hand resting on your chest. Open your mouth slightly and slowly exhale completely until you feel your stomach fall and ribcage depress. Pause for two counts and inhale again.

One way repeated ANOVA was used to compare pre-exercise neuromuscular parameters between sessions (S1, S2 and S3). As no pre-exercise (pre) neuromuscular parameters differed between sessions (except EMG RMS RF at 60 deg/s), all pre-exercise parameters (except EMG RMS RF at 60 deg/s) were averaged. Neuromuscular parameters were then analyzed with one-way repeated measures ANOVA (time: pre, exhaustion, P20 and P40). Significant effect of time was explored with planned comparison (pre vs exhaustion, exhaustion vs P20, P20 vs P40) adjusted with Holm-Bonferonni correction. Cohen’s effect size f(V) was also calculated.
A number of medical reviews have indicated that exercise has a marked and persistent antidepressant effect in humans,[37][48][49][52][70][71] an effect believed to be mediated through enhanced BDNF signaling in the brain.[40][52] Several systematic reviews have analyzed the potential for physical exercise in the treatment of depressive disorders. The 2013 Cochrane Collaboration review on physical exercise for depression noted that, based upon limited evidence, it is more effective than a control intervention and comparable to psychological or antidepressant drug therapies.[70] Three subsequent 2014 systematic reviews that included the Cochrane review in their analysis concluded with similar findings: one indicated that physical exercise is effective as an adjunct treatment (i.e., treatments that are used together) with antidepressant medication;[52] the other two indicated that physical exercise has marked antidepressant effects and recommended the inclusion of physical activity as an adjunct treatment for mild–moderate depression and mental illness in general.[48][49] One systematic review noted that yoga may be effective in alleviating symptoms of prenatal depression.[72] Another review asserted that evidence from clinical trials supports the efficacy of physical exercise as a treatment for depression over a 2–4 month period.[37]

This is an extremely high-skill movement, and is one of two Olympic Weightlifting events. HOW TO DO IT: Start with the bar on the ground with your feet hip-width apart. With your hands wide on the bar, keep a big chest as you deadlift the weight off the ground (similar to the beginning of the clean). Pull from the floor with your arms in a locked position. Then, drive your hips and pull the bar as high as possible. As you receive the bar overhead, drop down as quickly as possible and lock your arms into place in a squat position with the bar overhead. MUSCLES USED: Glutes, quads, hamstrings, calves, traps, core, shoulders and back.
All six MMB pioneers expected near magical effects from the regular non-exhausting practice of their exercise regimes. This promised a lifetime of optimal health, beauty, and strength for the body and mind. Further, expected benefits include improved quality and efficacy of daily activities, looking and feeling good, making life itself easier and more pleasurable with a disappearance or reduction of symptoms while improving postures. This leads to increased self-esteem, reduced health costs, and the expectation of a longer and high-quality life. It is interesting to note that all six MMB pioneers enjoyed long and fruitful lives that reflect this philosophical model within real life examples: Checkley died in 1925 at 78; Müller in 1938 at 72; Alexander in 1955 at 86; Randell in 1974 at 99; Pilates in 1967 at 87; and Morris in 1980 at 89.
Stand on right foot with left foot elevated and core tight. Hop 3 times then bend down and quickly walk hands out so you are in a high plank position with left foot still off ground. Do 3 push-ups, never putting left foot down. Walk hands back and stand up to return to starting position. Repeat for half the time on one side only, then switch sides.
Developing research has demonstrated that many of the benefits of exercise are mediated through the role of skeletal muscle as an endocrine organ. That is, contracting muscles release multiple substances known as myokines which promote the growth of new tissue, tissue repair, and multiple anti-inflammatory functions, which in turn reduce the risk of developing various inflammatory diseases.[114] Exercise reduces levels of cortisol, which causes many health problems, both physical and mental.[115] Endurance exercise before meals lowers blood glucose more than the same exercise after meals.[116] There is evidence that vigorous exercise (90–95% of VO2 max) induces a greater degree of physiological cardiac hypertrophy than moderate exercise (40 to 70% of VO2 max), but it is unknown whether this has any effects on overall morbidity and/or mortality.[117] Both aerobic and anaerobic exercise work to increase the mechanical efficiency of the heart by increasing cardiac volume (aerobic exercise), or myocardial thickness (strength training). Ventricular hypertrophy, the thickening of the ventricular walls, is generally beneficial and healthy if it occurs in response to exercise.
Each reliability session took place on a Monday, Wednesday and Friday morning at the same time and within the same week. All subjects were given written instructions to drink 35 ml of water per kilogram of body weight, sleep for at least 7 h, refrain from the consumption of alcohol, and avoid any vigorous exercise the day before each visit. Participants were also instructed to avoid any caffeine and nicotine for at least 3 h before testing. Finally, subjects were instructed to consume a set breakfast (2 slices of toast spread with margarine or butter, 250 ml of orange juice, and a banana) 1 h before all testing sessions. At each visit to the lab, subjects were asked to complete a pre-test checklist to ascertain that they had complied with the instructions given to them, and were asked to report any pain or soreness experienced in their leg (to check for the presence of previous session-induced muscle damage). None of our subjects reported leg muscle pain or soreness at the beginning of each session.

Biomarkers of inflammation such as C-reactive protein, which are associated with chronic diseases, are reduced in active individuals relative to sedentary individuals, and the positive effects of exercise may be due to its anti-inflammatory effects. In individuals with heart disease, exercise interventions lower blood levels of fibrinogen and C-reactive protein, an important cardiovascular risk marker.[28] The depression in the immune system following acute bouts of exercise may be one of the mechanisms for this anti-inflammatory effect.[27]
Warm up. This is the act of preparing your body for the stress of exercise. The body can be warmed up with light intensity aerobic movements like walking slowly. These movements increase blood flow, which in turn heats up muscles and joints. "Think of it as a lube job for the body," Bryant explains. At the end of your warm-up, it's a good idea to do a little light stretching.
Sweden has also begun developing outdoor gyms, called utegym. These gyms are free to the public and are often placed in beautiful, picturesque environments. People will swim in rivers, use boats, and run through forests to stay healthy and enjoy the natural world around them. This is especially possible in Sweden due to its geographical location.[139]

The severity of angina and the effects of therapeutic interventions in patients with coronary artery disease have been assessed by determining changes in both exercise performance and the triple product (TP) of heart rate, systolic pressure, and ejection time occurring at angina. However, the validity of conclusions based on such changes is uncertain since the effects of different exercise protocols on these variables have not been determined. Twelve patients with angina were studied during upright bicycle exercise; repeated bouts of exercise using a standard protocol of 20-w increments every three minutes produced no consistent changes in TP at angina. When exercise began 20 to 60 w above the work load of the standard protocol that produced angina, exercise capacity was reduced (average 1'40'' vs. 4'40'', P < 0.001), and triple product at angina exceeded control anginal values (average 4,840 vs. 4,150, P < 0.001). In the control studies nitroglycerin (TNG) and carotid sinus nerve stimulation (CSNS) enabled patients to exercise to a higher level, although the triple product at angina was unaltered. However, at the higher work load TNG and CSNS exerted only minimal effects on exercise capacity, indicating that if the work load is excessive, a reduction in myocardial oxygen consumption produced by a therapeutic intervention may be comparatively minor so that a potentially salutary effect would be masked. We conclude that work loads causing angina in less than three minutes cannot reliably be used for studying the effects of therapy. However, if progressive work loads are chosen which cause angina in the control studies in three to six minutes, exercise capacity and triple product at angina provide important information about the efficacy and mechanism of action of a therapeutic intervention.