LESSON 1

Introduction to Healthy Living

INTRODUCTION Welcome to Lesson 1! In this lesson an overview of key principles of health, wellness, and fitness will be presented. One important concept to remember is that you are in charge of your own good health. Anyone can have optimal health to the extent it is possible for each individual, given their own limitations. As you complete this lesson, make sure you review each Mastery Check and Quiz question along with the lesson material that relates to each question. If you read and study carefully, you will be prepared for the first exam. LESSON OUTCOMES 1 2 3 Define and contrast health, wellness, and physical fitness. Describe the relationship between lifestyle, quality of life, and risk of chronic disease. Discuss various strategies to boost your motivation to live a healthful lifestyle.

KEY TERMS Body composition: The percentage of the total body weight that is fat mass and lean body mass. Compression of morbidity: Reducing the number of dysfunctional years that come at the end of a lifespan and are typically due to chronic disease. Cardiovascular endurance: The ability to sustain medium-to high-intensity cardiovascular exercise (such as distance running, cycling, and swimming) for long periods of time; also called cardiovascular fitness. Diseases of choice: Chronic diseases that are in part caused by the lifestyle choices a person makes. Exercise: A type of physical activity that improves or maintains the various components of physical fitness. Flexibility: The ability to move the body freely through a normal range of motion. Health: Health is optimal well-being that contributes to quality of life. It is more than just freedom from illness and disease. Muscle endurance: The ability to contract a muscle over and over without becoming fatigued. Muscle strength: The ability of a muscle or group of muscles to produce a maximal force during a single contraction. Motor skills: The ability to move with skill during sports or recreational activities. Overload: To exercise more or harder than normal. Physical activity: Any activity such as walking, climbing stairs, or doing chores that causes the muscles to contract and use energy. Physical fitness: A set of six components (cardiovascular endurance, muscle strength, muscle endurance, flexibility, body composition, motor skills) that relate to a person's ability to be physically active, perform exercise, or participate in sports. Wellness: A type of total fitness for the whole personincluding social, physical, mental, spiritual, and emotional well-being.

DISCUSSION MATERIAL If you were asked to consider what you value most in life and you identified "good health" as a concern, you would not be so different from most people. In surveys conducted in the United States, Canada, and other Western nations, as many as 99% of people identified health as an important concern and no one felt that good health was unimportant. Wellness is considered to be the positive component of optimal health while disease, illness, and debilitating conditions are what detract from optimal health. It is important to realize that even if a person has disease, illness, or debilitating conditions they can still have optimal health and a high level of wellness. Wellness refers to how a person feels about their life and their ability to function in society. A recent story on the radio described a woman who had been diagnosed with ALS (Lou Gehrig's Disease). As she considered her diagnosis and realized that it was a terminal disease, she stated, "I believe that I always have a choice. No matter what I'm doing. No matter what is happening to me. I always have a choice." This person has optimal health, if you consider that health is more than the absence of disease and illness, because she has a strong sense of well-being. As she concluded her story she said, "I can choose to see ALS as nothing more than a death sentence, or I can see it as an invitationan opportunity to learn who I truly am" (Royce, 2006). Objective 1: Define and contrast health, wellness, and physical fitness.

Wellness
In 1948 the World Health Organization (WHO) defined health as ". . . a state of complete physical, mental, and social well-being, and not merely the absence of disease." This definition suggests that health is more than not having a disease and includes how a person feels and functions physically, mentally, and socially. Many experts also believe that health includes the extent to which a person can achieve optimal health given any individual hereditary and personal abilities. In other words, health is more of the perceived ability of an individual to perform to an acceptable level within society. There are at least five dimensions of health that are counted as dimensions of wellness. These include: 1 2 3 4 5 Emotional/mental Intellectual Physical Social Spiritual

It is important to know that if, for example, a person has emotional health they also have emotional wellness because emotional wellness is the positive component of emotional health. By definition wellness emphasizes individual responsibility for how a person manages his or her own good health. Wellness is a concept that is based on behaviors that contribute to increased quality of life and reduction of risk for premature diseases, especially chronic diseases. While the dimensions of health and wellness may appear to be separate or distinct categories, in reality these components are integrated and the total contribution of each is such that the sum of the parts is greater than the whole. Consider the illustrations in Figure 1-1. In the illustration on the left, the complicated integration of wellness components can be seen. In the illustration on the right the relationship of physical wellness to the other components is seen as it overlaps and has impact on all the other dimensions of wellness.

Emotional

Emotional

Intellectual

Social

Intellectual

Social

Physical

Spiritual

Physical

Spiritual

Figure 1-1
Wellness involves the body, mind, and spirit and is the ability to do the very best you can, despite any weaknesses or limitations you may have. Wellness means being positive and trying your hardest. Wellness involves living a healthy lifestyle. Each part of wellness can help anyone excel at whatever they would like to do.

Physical Wellness
Physical wellness includes physical fitness and is a major part of physical wellness, but there's more. Eating a good diet, taking care of your teeth, getting enough sleep, and avoiding addicting drugs (alcohol, tobacco) are also part of physical wellness. Optimal physical wellness leads to optimal physical health. The American College of Sports Medicine (ACSM) suggests that physical fitness is "a set of attributes that people have or achieve that relates to the ability to perform physical activity" (2006). "Physical fitness is the ability of the body systems to work together and do the most physical activity with the least amount of effort" (Corbin, Corbin, Welk, and Welk, in press). Exercise is typically identified as a type of physical activity that is more structured in terms of the type of activity, the time of the activity, and the intensity of the activity. Taken together, a physically fit body allows you to enjoy life to the fullest, because you have the ability to do any type of physical activity and exercise you enjoy. Fitness experts know that physical fitness is made up of several parts. If you carefully study Table 1-1 you can see how each part of physical fitness influences your ability to move. Table 1-1: The Components of Physical Fitness Type of Physical Fitness Cardiovascular Endurance Muscle Strength Muscle Endurance Flexibility Components The ability to sustain medium- to high-intensity exercise (such as running, cycling, and swimming) for long periods of time. This component of fitness is probably the most important in terms of overall health. The ability of a muscle or group of muscles to produce a maximal force during a single contraction using proper form and technique. The ability to contract your muscles over and over without becoming fatigued. The ability to move a joint freely through a normal and full range of motion. The percentage of total body weight that is fat and lean. (The lean weight includes anything that isnt fat, such as muscles, organs, bone, and water.) An appropriate body composition is very important to overall health and is nearly as important as cardiovascular fitness. The ability to move with skill in exercise and sports activities such as tennis, soccer, golf, and basketball.

Body Composition

Motor Skills

Social Wellness
Social wellness relates to a person's ability to interact with and have positive, meaningful relationships with others. In such relationships all involved are better because of the relationship.

Emotional/Mental Wellness
Emotional or mental wellness is characterized by a generally happy mood or attitude. This is accomplished by a person's ability to handle daily stress and deal with these stresses in a positive and constructive way.

Spiritual Wellness
From a larger perspective spiritual wellness often involves a belief in a force greater than the individual. Spiritual wellness relates to a person's ability to commit to and live by certain standards and values. Achieving spiritual wellness can be very fulfilling and have a great impact on other components of wellness.

Intellectual Wellness
Intellectual wellness is directly impacted by a person's willingness and ability to continue learning throughout his or her lifetime. By being informed, a person can take charge of his or her own good health and make choices that improve quality of life and daily functioning.

Summary
Each dimension of wellness overlaps and is related to the other dimensions. For example, good physical wellness improves emotional wellness; likewise, good spiritual wellness improves physical wellness. The whole body is interconnected as one: body, mind, and spirit. In this course, we will mostly focus on physical wellness and, even more specifically, physical fitness. However, keep in mind that each part of wellness is important in every dimension of life. DISCUSSION BOARD Jamie (fitness enthusiast): I've always been a little confused as to what the best way is for me to improve my physical fitness. Can you elaborate on this? Instructor: The best way to improve your physical fitness is to be physically active and exercise regularly. Your body systems improve when they have to work harder than normal. To get in tip-top shape you'll need to do all three types of exercise: cardiovascular (or aerobic) exercise, weight training, and stretching. For example: Cardiovascular exercise is the best for improving cardiovascular fitness and losing extra body fat. We'll discuss cardiovascular exercise in Lesson 3. Weight training is the best for improving muscle strength and endurance and gaining additional body muscle. You will learn more about weight training in Lesson 4. Stretching is the best for improving flexibility. We'll show you how to stretch properly in Lesson 5. Jordan (runner): Since I run a lot I feel like I have excellent cardiovascular fitness. Does this mean I'm any healthier than my friends?

Instructor: Your level of cardiovascular fitness affects your health up to a point, but once you obtain a good-to-excellent fitness level it doesn't improve your health much beyond this. The advantage of having really good cardiovascular fitness is that you can run faster, longer, and perform better. So you probably aren't any healthier than your friends, unless they are really out of shape. Keep in mind that good health is a complex interaction of many things. Your overall risk of disease depends on your age, gender, genetics (your predisposition to disease), cardiovascular fitness, and percent body fat. It also depends on many other lifestyle factors, such as your diet, level of physical activity, sleep habits, the quality of the air you breathe, and whether or not you can steer clear of alcohol, tobacco, and other harmful drugs. Debbie (dancer): My mom says that good looks and being fit go hand in hand. Is she right? Instructor: Well, yes and no. Just because someone looks good doesn't mean that person is physically fit. Sometimes looks are deceiving. What really matters is what's under the skin, inside the body. For example, is the heart healthy? Are the muscles strong? Does the person have the right amount of fat and muscle? Are the joints flexible? Surprisingly, some people might look good on the outside, but be very unfit on the inside. On the opposite end, some people who don't look "perfect" on the outside might have excellent physical fitness on the inside. This type of person may have a bigger body size genetically (large bones and a bigger frame), but do a decent job on every physical fitness test. Consequently, you don't have to look like a super model to have super fitness. Of course, it is possible to look good and also be physically fit. Just remember, everyone is different and outward looks may not indicate a healthy lifestyle.

MASTERY CHECK

Instructions:
Answer the following questions and then check your answers in the Answer Key at the end of this lesson.

1.

John wants to improve his overall physical fitness. Which of the following is NOT a component of physical fitness? a. b. c. d. strength cardiovascular endurance body height motor skills

2.

Julie wants to be as healthy as possible. Which component of physical fitness probably has the biggest influence on her overall health? a. b. c. d. strength flexibility cardiovascular endurance body composition

3.

To live a life of "wellness," Brad should . . . a. b. c. d. do the very best he can, despite any weaknesses he may have. live a healthy lifestyle. try to improve the social, physical, intellectual, spiritual, and emotional areas of his life. all of the above

4.

The best way for Kristi to improve her body composition and lose extra body fat is to . . . a. b. c. do cardiovascular exercise five times a week. lift weight three times a week. stretch all of her major muscle groups everyday.

Objective 2: Describe the relationship between lifestyle, quality of life, and risk of chronic disease. The title of a book first printed in 1987 suggests that lifestyle and the choices we make have a great deal to do with our risk for many of the leading killers in our society. The book is titled, "The American Way of Life Need Not Be Hazardous to Your Health" (Farquhar). The author focuses mainly on heart disease, which is the number one killer of Americans, and how the choices we make regarding our physical activity and diet habits impact our risk of heart disease. In fact, it is currently believed by many experts that the most frequently occurring chronic diseases are diseases of choice. The most recent data on the ten leading causes of death in the United States in 2003 indicate that the top three (heart disease, cancer, and stroke) account for 57% of the total (see Table 1-2). Heart disease, cancer, and stroke are considered diseases of choice because lifestyle significantly impacts risk and individuals have control, for the most part, over how they choose to live. This does not mean everyone who makes healthy choices is immune to these diseases, but it does mean that a person's risk can be reduced dramatically by making healthy choices.
Table 1-2: Deaths and percentages of total deaths for the 10 leading causes of death: United States, 20022003

Cause of Death All causes Heart disease Cancer Stroke Lower respiratory diseases Accidents Diabetes Alzheimers disease Flu and pneumonia Kidney diseases Infection Source: Heron, 2007

Rank 1 2 3 4 5 6 7 8 9 10

Deaths 2,448,288 685,089 556,902 157,689 126,382 109,277 74,219 65,163 63,457 42,453 34,069

Percentage of total deaths 100.0 28.0 22.7 6.4 5.2 4.5 3.0 2.7 2.6 1.7 1.4

Some of the important factors that increase a person's risk for the leading causes of death are smoking, high blood pressure, high cholesterol, physical inactivity, and obesity. Notice that each of these risk factors is potentially related to choices that a person makes in how they choose to live; in other words, they are modifiable risk factors. Obviously a person has a choice in whether they smoke or not. This does not mean that it would be easy to quit, but it is still a choice. Even blood pressure and cholesterol are affected by choices a person makes. A poor diet and lack of regular physical activity and exercise can have negative consequences on blood pressure and cholesterol. There are other risk factors that may predispose a person to increased risk of chronic disease that are called non-modifiable risk factors. Age, gender, and race are all non-modifiable risk factors. Morbidity and mortality are two important words with which you should become familiar. Simply put, morbidity means disease and mortality means death. By making the right lifestyle choices morbidity is decreased and mortality is postponed. Not only is the lifespan increased by living right in terms of healthy choices, but quality of life is improved because of the reduction of risk for many chronic diseases. The current life expectancy is approximately 78 years; however for many people the last decade of their life will be potentially dysfunctional due to some form of chronic disease, such as stroke or cancer. By choosing to live a healthy lifestyle a person can experience what might be called "compression of morbidity," meaning that an individual can live out a full life expectancy without severe morbidity or disease (see Figure 1-2). Additionally, healthy lifestyle choices, such as exercising regularly and eating a healthy diet, can even increase a person's life span significantly. A number of studies have shown that healthy modifications in diet and exercise habits can increase life expectancy from 1020 years, especially if a person adopts a number of new healthy behaviors.

Compression of Morbidity
Unhealthy Lifestyle Choices Healthy Lifestyle Choices 0 10 20 30
66 12 Healthy Years 77 1 Dysfunctional Years

40

50

60

70

80

Years

Figure 1-2
You should know that the current recommendations are scientifically based and well researched regarding physical activity and diet. For years researchers have studied the optimal amounts and intensities of activity and exercise to determine what is best for good health. The current recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine are that everyone should accumulate 30 minutes or more of moderate to vigorous intensity activity on most, preferably all, days of the week. That may not seem like a very difficult thing to do, but more than half of all Americans do not meet that recommendation. You will learn more about the details of writing an appropriate physical activity and exercise program in a later lesson. There are as many scientific results for dietary recommendations as for physical activity and exercise. For good health you do not need to participate in any kind of extreme diet program. Healthy recommendations for diet include eating healthy foods that are in their natural form and reducing consumption of processed foods. This includes consuming whole grain foods, fruits, vegetables, nuts, and legumes. When you do eat foods containing fats and oils, they should be plant oils like olive, canola, corn, and other vegetable oils. Healthy diet recommendations also typically include reducing consumption of foods containing animal products, simple sugars, and saturated fats. You will also have the opportunity to learn more about the specific details of a properly balanced diet in a later lesson.

Summary
By following recommended guidelines and implementing the concepts presented in greater detail in upcoming lessons, you will be able to achieve a higher level of health and wellness and reduce your risk of many common chronic diseases. The opportunity to take charge of your own health by the choices you make can be a very empowering feeling. For many, lifestyle changes are not easy. Lifelong habits related to physical activity and diet can be difficult to alter. Remember, any change for the better, no matter how small, is better than no change at all. DISCUSSION BOARD Josh (college student who feels healthy): My grandfather died from a heart attack when he was only 58 years old and my father just told me that he has high blood pressure. Does this impact my own risk for a heart attack? Instructor: Having a family history of heart disease and risk factors for heart disease such as high blood pressure does increase your own risk for those conditions. However, you should know that genetic predispositions are often not manifest in the form of disease unless certain environmental conditions, including health behaviors, are present. Studies have shown, for example, that a person with high blood pressure who is physically fit is at less risk of dying prematurely from a heart attack than a person with ideal blood pressure who is not physically fit. Furthermore, research has also indicated that some people are sensitive to excess sodium (salt) in their diet, which can lead to increased risk for high blood pressure. How we choose to live, eat, work, and play impacts our risk for chronic disease even if we are genetically predisposed because of family history. Consider the graph in Figure 1-3 to better understand

how a healthy lifestyle can reduce risk or even prevent certain chronic diseases. Evidence from large population-based studies indicate that somewhere between 70% and 90% of some of the most common chronic diseases can be prevented by making healthy lifestyle choices.

100% 82% 80% 60% 40% 20% 0% Stroke* Colon Cancer* Heart Disease* 70% 71%

91%

Type II Diabetes*

*(Stampfer, Hu, Mancon, Rimm, & Willett, 2000; Platz et al., 2000; Hu et al., 2001) Figure 1-3

MASTERY CHECK

Instructions:
Answer the following questions and then check your answers in the Answer Key at the end of this lesson.

1.

Which is the leading cause of death in America? a. b. c. d. accidents stroke heart disease diabetes

2.

Which of the following is NOT a modifiable risk factor for chronic disease? a. b. c. d. smoking physical inactivity obesity age

3.

Reducing the number of dysfunctional years at the end of a life span due to illness or disease is called . . . a. b. c. d. compression of morbidity. risk factor reduction. compression of mortality. disease of choice.

4.

Some chronic diseases are called "diseases of choice" because . . . a. b. c. they are more desirable than other types of disease. the choices we make partly determines our risk for the disease. they are communicable diseases.

5.

A good approach to making healthy changes in your life is to remember that . . . a. b. c. d. if at first you don't succeed, why bother. making certain choices guarantees that I won't get a disease. something is better than nothing. your doctor is in charge of your health.

Objective 3: Discuss various strategies to boost your motivation to live a healthful lifestyle.

The Desire to Change Your Lifestyle

For many, the first step in making a change in their lifestyle is the hardest. There are a number of factors that impact a person's ability or desire to make a change. These factors include: 1 2 3 4 Personal factors Predisposing factors Enabling factors Reinforcing factors

Personal Factors
Personal factors are related to health behaviors and lifestyles but are often considered non-modifiable and include such things as age, gender, and heredity. Personal factors may not directly cause a certain behavior to be exhibited, but it is believed that behaviors can vary according to these factors. For example, women use health care services more than men and younger people are more physically active than older people. There may even be genetic conditions that predispose a person for certain behaviorssuch as likelihood for an alcohol consumption problem that can lead to becoming an alcoholic.

Predisposing Factors
Predisposing factors are connected to self-perception and self-confidence and allow a person to feel confident in their ability to make a change. Often feelings of positive perception and high confidence come from a person's knowledge, beliefs, and attitudes. By taking this class you can improve your knowledge and beliefs, which can lead to positive changes in attitude and ultimately create a desire for change. Some characteristics that are common to those who are predisposed for lifestyle change are people who are able or willing to assess their own health and fitness, set realistic goals, have positive attitudes generally, and are able or willing to try to make a change even if they are not very good at it initially.

Enabling Factors
Enabling factors need to be in place in order for a person to make changes. These factors include selfmanagement skills, access to facilities, and the environment. By making efforts to improve goal-setting skills, self-monitoring skills and self-assessment skills, a person increases the probability that they will make and maintain health changes in their lives. These skills, or the development of these skills, can be the deciding factor in your ability or desire to make a change. Having access to a fitness facility, for example, might make it easier for you to exercise regularly. Having friends or family who participate with you can also increase compliance to an exercise regimen.

Reinforcing Factors
Reinforcing factors lead to maintenance of healthy behaviors and are critical if good behaviors are to persist for a lifetime. Reinforcing factors include family, friends, and even health care professionals. An individual feels more confident in any new behavior with the support of family and peers. Imagine how difficult it would be to want to make a change in eating habits and not be supported by family and friends. Children often find themselves in this very situation as they learn about healthy behaviors in school, such as proper dietary habits, but have no control over what kinds of foods are available in the home.

Summary
It is important to realize that each individual is responsible for his or her own health and wellness. The extent to which a person achieves a high level of health and wellness will be related to their determination to make changes. The ability to make a change for the better comes from knowledge, beliefs, and attitudes. Hopefully your knowledge, beliefs and attitudes will improve in positive ways as a result of this course and facilitate your ability to make changes. Probably the greatest determinant of persistence in healthy behaviors is success. Anyone will find it easier to continue doing something if they are successful, and probability for success can be enhanced by setting realistic goals, having a plan, and measuring and recording your progress. Sometimes people do not see the success they desire because they determine success by comparing themselves to others. Everyone should take an individual approach to improving their health and wellness and realize that personal health is not a competition with others. Each of the lessons in this course is designed to increase your knowledge and provide guidelines for modifying health behaviors. Remember that relapse in a behavior is not uncommon. It is okay to recommit after a relapse. Learn from mistakes and be willing to make changes in future attempts to modify behaviors. Nobody ever went to bed at night and woke up in the morning unhealthy. It takes time to develop unhealthy patterns in our lives, and, consequently, it takes time to change our lives and develop healthy lifestyle habits. DISCUSSION BOARD Anna: Beth and I both just learned about how important it is to be active and exercise regularly, and we are both excited to change our behavior. Beth seems to be doing much better than I am, and she is exercising more consistently than I am. What are some things I can do better? Instructor: One of the most important things you can do is to make sure that you enjoy the activities in which you are participating. If you don't enjoy it, you may be able to keep doing it for awhile because you know that it is good for you, but you will soon begin looking for excuses to not participate. Here are a few tips you might use: Choose moderate-intensity activities you enjoy the most. By doing this you will be more likely to continue in your program. Gradually build up the time spent doing the activity by adding a few minutes every few days or so until you can comfortably perform the minimum recommended time for the activity (30 minutes per day). As the minimum amount becomes easier, gradually increase either the length of time performing an activity, the intensity of the activity, or both. Vary your activities, both for interest and to broaden the range of benefits. Explore new physical activities. Reward and acknowledge your efforts.

I know that you both have positive attitudes about regular exercise and are excited to participate. One of the most important considerations is to not compare yourself to others. Your goals and expected outcomes should be personal and not based on someone else's abilities. As I have talked with Beth I know that her roommates are also excited about exercising, so this probably makes it easier for her to stick with her plan. If you can meet people who will support you in your goals by participating with you, it will make it easier for you also. Something else you might try that can enhance your self-monitoring skills would be to keep a journal of your activity. Record the activities you participate in and the duration of your exercise routines. Write about how you feel while you are exercising and even how you feel after you exercise. This will allow you to chart your progress and reflect on your feelings so you can begin to know what works best for you. Another strategy that works for many people is to try and accumulate appropriate amounts of physical

activity throughout the day. One recommendation is to try and take at least 10,000 steps each day. You might consider getting a pedometer and monitoring your steps throughout the day. If you find that you are short on steps, you could make adjustments in your daily routine to increase the number of steps you take. Here are some other suggestions that you might find useful: Walk, cycle, jog, skate, etc., to work, school, or the store. Park the car farther away rather than closer to your destination. If you use public transportation, get on or off the bus several blocks away. Take the stairs instead of the elevator or escalator. Take time to play with children or pets; try to find time in your day that works best for you. Avoid labor-saving devices; turn off the self-propel option on your lawn mower or vacuum cleaner. Use leg power; take small trips on foot to get your body moving. Exercise while watching TV or reading (for example, use hand weights, stationary bicycle/ treadmill/stair climber, or stretch). Keep a pair of comfortable walking or running shoes in your car and office. You'll be ready for activity wherever you go! Create a Saturday morning walking group with friends, roommates, or neighbors.

Remember that something is better than nothing and you will most likely stick with a plan if you are successful. Don't overextend on goals; make goals realistic, and allow enough time for change to happen. Finally, enjoy what you are doing. If you don't like what you are doing, you probably won't do it for very long.

MASTERY CHECK

Instructions:
Answer the following questions and then check your answers in the Answer Key at the end of this lesson.

1.

Which is not a factor that can influence a person's ability or desire to make a change? a. b. c. d. predisposing factor personal factor heredity factor reinforcing factor

2.

Which factor is considered to be generally NOT modifiable and might include variables such as age, gender, and heredity? a. b. c. d. enabling factor reinforcing factor personal factor lifestyle factor

3.

Which factor emphasizes the importance of having the support of family, friends, and peers to promote maintenance of healthy behaviors? a. b. c. d. reinforcing factors enabling factors lifestyle factors heredity factors

4.

One thing you could do to enhance compliance with chosen health behaviors would be to . . . a. b. c. d. compare yourself with others so you know how much progress you have made. set extremely difficult goals so that you will work harder at achieving them. choose only one type of activity so that you can focus on it and become really skilled at it. explore new activities to help you determine what you like to do.

5.

Which of the following would be a good tip to help increase amount of physical activity throughout the day? a. b. c. d. walk to work, school, or the store turn off labor-saving devices exercise while watching TV All of the above would be good tips.

REFERENCES Aldana, S. (2005). The Culprit & the Cure, Mapleton, UT: Maple Mountain Press. American College of Sports Medicine. (2006). ACSM's Guidelines for Exercise Testing and Prescription, th 7 ed., Philadelphia, PA: Lippincott Willians and Wilkins. Breslow, L. (1999). From disease prevention to health promotion. JAMA 281:10301033. Chakravarthy, M., and Booth, F. (2003). Hot Topics: Exercise, Philadelphia, PA.: Hanley & Belfus, An Imprint of Elsevier. Corbin C., Corbin, W., Welk, G., and Welk, K. (In press). Concepts of Fitness and Wellness: A th Comprehensive Lifestyle Approach, 7 ed., New York, NY: McGraw-Hill. Farquhar, J. (1987). The Amercian Way of Life Need Not Be Hazardous to Your Health, Reading MA: Addison-Wesley Publishing Company, Inc. Heron MP, Smith BL. Deaths: Leading causes for 2003. National vital statistics reports; vol 55 no 10. Hyattsville, MD: National Center for Health Statistics. 2007. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Soloman CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001 Sep 13;345(11):790-7. Nieman, D. (2007). Exercise Testing and Prescription: A Health-Related Approach, 6 ed., New York, NY: McGraw-Hill. Platz EA, Willett WC, Colditz GA, Rimm EB, Spiegelman D, Giovannucci E. Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men. Cancer Causes Control. 2000 Aug;11(7):579-88. Royce, C. (2006). I Always Have a Choice, December 4, 2006, Morning Edition on National Public Radio. Stampfer MJ, Hu FB, Mancon JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000 Jul 6;343(1):16-22.
th

MASTERY CHECK ANSWER KEY

Lesson 1-1
1 2 3 4 c c d a Body height is not a component of physical fitness. Cardiovascular endurance has the biggest influence on health in most people. Wellness means you do your best, live a healthy lifestyle, and follow a balanced approach. Cardio exercise is the best way to burn extra energy (calories) and lose extra body fat.

Lesson 1-2
1 2 3 4 5 c d a b c Heart disease is the leading cause of death in America. You cannot modify you age as a risk factor for chronic disease. compression of morbidity Nobody chooses to get a certain disease; the choices we make partly determines our risk for the disease. Something is better than nothing.

Lesson 1-3
1 2 3 4 5 c c a d d heredity factor personal factor reinforcing factor explore new activities to help you determine what you like to do All of the above would be good tips.