The Science Behind Coffee and Why it's Actually Good for Your Health

The Science Behind Coffee and Why it's Actually Good for Your Health

http://rdd.me/cohhrx2u

Great article. 

Cautions:

1. If you are prone to palpitations or arrhythmias, consult with a physician before drinking caffeine

2. Please read the last paragraph of this article. 

Mediterranean Style Diet

Want to read more about the landmark trial showing the benefits of the Mediterranean-Style Diet, check out these articles: 

http://nej.md/VypTpf

http://onforb.es/15JjoEa

http://nyti.ms/ZDLAIj

http://usat.ly/XwcHC1

http://nbcnews.to/X6eD4I

http://on.wsj.com/X9Pvs7

The Mediterranean-Style Diet Works

A very important study was published this week in the New England Journal of Medicine. In one of the largest trials to date, the Mediterranean-Style Diet (either supplemented with extra-virgin olive oil/EVOO or handfuls of nuts) was compared with a low-fat diet. Over 7000 patients were studied. All patients had no established heart disease but were at high risk for heart disease (diabetes, high cholesterol, obesity ...).

The researchers found a 30% reduction in the risk of major cardiovascular events.

Mediterranean meant lots of fruit, fish, chicken, beans, tomato sauce, salads, and wine and little baked goods and pastries.

I have been advocating my patients eat a Mediterranean style diet for years. Now I have strong evidence that this way of eating can be as beneficial as some of the medicines we use reduce risk.

How 'Crunch Time' Between School And Sleep Shapes Kids' Health : Shots - Health News : NPR

http://www.npr.org/blogs/health/2013/02/22/172717996/how-crunch-time-between-school-and-sleep-shapes-kids-health?ft=1&f=1128&sc=tw

How 'Crunch Time' Between School And Sleep Shapes Kids' Health

Image courtesy of The Bishop family (left), The Benavides family (top right), NPR (center) and The Jacobs family (bottom right)

It's an important question for American families and the nation as a whole: Why do so many kids weigh too much?

There are recent hints the epidemic may be abating slightly. Still, one in every three American kids is overweight or obese.

To understand why, NPR conducted a poll with the Robert Wood Johnson Foundation and the Harvard School of Public Health. It focuses on what happens in American households during the hours between school and bedtime.

This is crunch time for most families — when crucial everyday decisions get made about food and exercise.

Our poll used a unique design to get at what is actually happening in the life of a "target child" in each household. We supplemented their responses with more than 800 that came in when we asked parents, through NPR's Facebook page, to describe their own "crunch times."

The most striking finding is that U.S. parents "get it."

When we asked a parent or other principal caregiver in our poll how important it is that their child eats and exercises in a way to maintain a healthy weight, more than 9 in 10 said it was important — and most said it was "very important."

But all too often, there's a disconnect. Despite good intentions, it's not happening.

" More than 9 in 10 parents said it was important that their child eats and exercises in a way to maintain a healthy weight.

More than half of children ate or drank something during the "crunch time" window that can lead to unhealthy weight gain, as perceived by their parents. And more than a quarter of children did not get enough exercise, their parents say.

"It's hard enough to get dinner on the while trying to help them with homework," says Paige Pavlik of Raleigh, N.C. "Once we do everything, there is absolutely no time to go outside and take a walk or get any exercise. It's simply come in, eat, sit down, do homework, go to bed."

The relentlessness of it makes her emotional. Pavlik starts to cry as she talked about her family's daily crunch time. "It's really hard," she says. "This isn't how I thought family life was going to be."

Nearly half the parents in our poll say it's difficult to make sure their child eats healthy.

Lori Bishop of Lexington, Ky., says she tries to excel as a parent and as a full-time laboratory manager. But she ends up feeling mediocre at both.

Both she and her husband have stressful jobs, she says, and often feel exhausted at the end of the workday. "But you gotta go right to work in the kitchen," Bishop says. "And while I would love to prepare a well-balanced meal each evening ... it doesn't happen."

She says dinner at the Bishops' house is often pre-packaged meals — "things that are frozen that you can heat up like frozen pizza, frozen chicken nuggets."

In three-quarters of the households polled, most of the family ate dinner together the previous evening. And of those, most said the "target" child's dinner was prepared at home with fresh ingredients.

But about a third of children who eat at home with their families are like Lori Bishop's kids — they end up relying on pre-packaged, frozen or take-out food.

And nearly half of those in our poll say it's difficult for families to eat together on a daily basis.

Adam Jacobs' family in Mesa, Ariz., is a case in point. He and his wife have long commutes to work. "My wife and I don't even get to talk about our days," he says. "If I have something to tell her, I literally put it on my smart phone to remind me."

Their two boys, who are 14 and 10, usually have after-school activities. On one recent evening, Jacobs tried to rustle up dinner for himself and his older son.

"I was at home at 7:30 and it was ready by 8:30," he says. "And by that time, my wife and younger boy weren't even home yet and my older son had already eaten ... so it wound up just being another solo deal."

It's not just time that's in short supply. Among the parents we talked to who say it's difficult to prepare fresh foods, money was also a factor.

Araceli Flores and her two young children live in the farm belt of central California, surrounded by fields of broccoli, cauliflower, asparagus and fruit orchards. But she says it's too expensive to buy fresh foods.

"I can buy a box of macaroni and cheese for a dollar," Flores says. "A bunch of bananas – like a good maybe week-and-a-half's worth of bananas — will cost me over a dollar. Strawberries are four dollars. Apples, a bag of apples, is going to cost me five dollars — way more pricier to buy vegetables and fruits than it is to buy boxed food."

And it's not just time and money that get in the way of doing the right thing. Parents say there are other barriers — such as their physical surroundings, school lunch policies, and their family's culture.

Vanessa Benavides is a single mom in Miami who's Cuban-American. She comes from a family with nutrition-related health issues.

"Most of my family is overweight," she says. "Most of my family has high blood pressure. My father's diabetic."

On weekends, Benavides fills up her grocery cart with fresh fruits and vegetables. She intends to cook healthy meals, she says. But at the end of a long day when she picks up 7-year-old Emily at her mom's house, it's often easier to eat the dinner that her mother has made.

" "Once we do everything, there is absolutely no time to go outside and take a walk or get any exercise. It's simply come in, eat, sit down, do homework, go to bed."

- Paige Pavlik

"It's a lot of Cuban meals," Benavides says. "You know, it's just a lot of rice-meat combinations that are often fried or greasy."

And then Benavides' mom and dad keep urging Emily to eat more. "They want to fatten her up," she says.

That bothers Benavides, because she was once a skinny kid like Emily. But now she struggles with her weight.

"They were always trying to tell me to eat more and eat more and eat more," she says. "You know, a nice chunky kid is [considered] healthy in our culture."

Parents often say schools are undermining the messages many parents are trying to give their children. In school cafeterias across the country, kids are still eating dense, high-fat and over-processed food for lunch.

Assonta Wagner, one of our Facebook respondents, lives with her husband and four children in Alamogordo, N.M. Her kids typically take their lunch to school. But sometimes she allows them to eat school lunches. And when they do, she cringes.

"One of their favorite meals was this mashed potato bowl," Wagner says. "It was mashed potatoes, little fried chicken pieces and corn. And then they covered it in gravy."

She's a stay-at-home mom who's super-conscientious about making healthy food at home — lots of fruits, vegetables and lean meats, no pre-packaged foods, no instant meals, no soda. So what's offered at school is particularly upsetting to her.

And it's not just the lunches. At Halloween, Thanksgiving and other holidays, they get bags of candy — even her overweight son — as a reward for doing a good job.

And when all those calories add up over the years, parents say the very environment they live in makes it hard to reverse the problem. Some parents say it's too hard — or too expensive — to get their children to a safe place to exercise.

That's one reason one poll respondent, Vivian Carter-Smith, is so worried about her 17-year-old grandson.

"He's a good boy," she says. "He's overweight. He's short ... and I know he weighs 350 pounds easy."

She says her grandson doesn't get any exercise. He stopped going to the "Y" when other boys teased him about his weight. And Carter-Smith says there isn't a place near his Cincinnati home where her grandson and his younger brother can even get outside and walk. And in fact, they don't want to.

"The way the streets are," she says, "with these kids with no parents and no rules and regulations and upbringing skills — they are scared."

But she knows that a lack of exercise combined with an unhealthy diet can lead to disaster. After all, her grandson's father died last year of a heart attack – at the age of 38.

This story is the first of eight parts in the series On The Run: How Families Struggle To Eat Well And Exercise. The series is based on a poll from NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

Statin-Exercise Combo Lowers Mortality Risk

http://www.medpagetoday.com/PrimaryCare/GeneralPrimaryCare/36134

Statin therapy and physical fitness amounted to a one-two punch for lowering mortality risk in a large cohort of middle-age and older patients with dyslipidemia followed for 10 years.

Patients who took statins and were physically fit had as much as a 70% reduction in the risk of dying during the follow-up period as compared with the least physically fit patients who were taking statins, according to Peter Kokkinos, PhD, of George Washington University in Washington, and colleagues.

Physical fitness also had an independent effect on mortality risk among patients who were not taking statins, reducing the likelihood of death during follow-up by as much as 47%, they reported online in The Lancet.

"Statin treatment and increased fitness are independently associated with low mortality among dyslipidemic individuals," the authors wrote. "The combination of statin treatment and increased fitness resulted in substantially lower mortality risk than either alone, reinforcing the importance of physical activity for individuals with dyslipidemia."

Expert and consensus panels on lipid management have endorsed statin therapy and lifestyle changes, including increased physical activity, to reduce cardiovascular risk. The benefits of statins have been demonstrated in multiple large clinical trials, and evidence from large epidemiologic studies has shown robust inverse associations between physical fitness and mortality risk in healthy individuals and those with cardiovascular disease.

Studies to date have provided limited information about the combined effects of statins and physical fitness on mortality risk or other clinical events. No study has evaluated the potential of increased fitness to lower mortality risk in dyslipidemic patients who cannot take statins, the authors noted.

To evaluate the combined effects of fitness and statin therapy on mortality risk, Kokkinos and colleagues identified dyslipidemic patients who had exercise tolerance tests at two Veterans Affairs medical centers during 1986 to 2011. Investigators rated each patient's fitness on the basis of metabolic equivalents (METs).

The primary endpoint was all-cause mortality, adjusted for age, body mass index (BMI), ethnicity, sex, and history of cardiovascular disease, drug therapy, and risk factors.

The search of medical records identified 10,043 patients, who had a mean age of 59, mean BMI of about 29 kg/m², and peak MET of 7.4. The cohort comprised 5,046 statin users and 4,997 who were not taking statins.

Statin users tended to be older and had lower exercise capacity, higher BMI, and higher rates of cardiovascular disease, risk factors, and use of cardiovascular drugs.

The lipid profile for statin users at baseline and after a median treatment period of 70 months was:

• Total cholesterol: 238 mg/dL and 172 mg/dL
• High-density lipoprotein (HDL): 47 mg/dL for both time points
• Low-density lipoprotein (LDL) 164 mg/dL and 101 mg/dL
• Triglycerides: 142 mg/dL and 134 mg/dL

In the nonstatin group, the lipid profile at baseline and at last follow-up with lipid assessment (median 51 months) was:

• Total cholesterol 234 mg/dL and 199 mg/dL
• HDL: 47 mg/dL for both time points
• LDL: 156 mg/dL and 140 mg/dL
• Triglycerides: 134 mg/dL and 134 mg/dL

During median follow-up of 10 years, 2,318 patients died. The statin group had an overall mortality of 18.5% compared with 27.7% among patients not taking statins (P<0.0001).

Mortality decreased with increasing physical fitness in both groups. In the statin group, the most-fit patients (>9 METs) had 70% lower mortality risk compared with the least-fit (≤5 METs) patients (P<0.0001). In the nonstatin group, the least-fit subgroup had a 35% increase in the mortality hazard (P<0.0001), whereas the most-fit members of the group had a 47% reduction in the hazard ratio (P<0.0001).

For the entire cohort, each 1 MET increase in exercise capacity was associated with a 12% reduction in the mortality hazard (17% in the statin group, 11% in the nonstatin group).

The study had some limitations, most notably the male veteran patient population, making it difficult to generalize the results to women. Also, the authors did not have data for cardiovascular interventions or cardiovascular mortality. Finally, there was no data on adverse effects of statins especially if the treatment interfered with exercise capacity.

In an accompanying commentary, Pedro Hallal, PhD, from the Federal University of Pelotas in Rio Grande do Sul, Brazil and I-Min Lee, MD, from Harvard Medical School in Boston said that the prescription of physical activity should be placed on a par with drug prescription.

"The cost of becoming physically active is lower than that of buying drugs, and moderate intensity physical activity has fewer side effects" they pointed out. "Unlike statins, physical activity should be part of everyday life."

Heart Healthy Diet

Here's a recent posting from the Mayo Clinic: 8 steps to prevent heart disease. mayocl.in/rlHABA

It sounds a lot like what I tell my patient everyday. I talk a lot about the Mediterranean Style diet. 

Here's what to eat:

- minimal lean red meat

- white meat and fish 

- olive oil, no butter or margarine

- lots of fruits and veggies

- legumes and nuts

- 1-2 glasses of red wine

- whole grains, no white starches

Why does a heart attack occur?

Back in April of 2009, I wrote a blog article titled You're never to old for the "big one"
While it is a few years old, the science and explanation remains sound. Not a week goes by where I do not spend a great deal of time explaining the process of atherosclerosis, the "vulnerable plaque" and myocardial infarction to a patient and his/her family. This discussion frequently happens when I am helping a young heart attack victim but more and more I am having the discussion with patients in the 70's and 80's too.

Therefore, I though it would be helpful to republish this explaination -- I hope it helps:

Here goes:

"This past weekend I took care of a 47 year male in the early stages of a large heart attack. On the outside he appeared to be a healthy and fit guy. However, on the inside, he had a huge clot in his proximal left anterior descending artery -- a lesion we call the "widow maker." Think Tim Russert.

Heart attackes (myocardial infarctions/MI's) come in many different flavors. The ones that we all worry about are the acute ST elevation MI's (think Sanford and Son). This is when a cholesterol plaque ruptures and in the process of thrying to heal the crack in the innner lining of the wall of the artery -- a large clot froms. This clot can end up filling up the enite inside (lumen) of the artery and choke the heart muscle (myocardium). If not treated quickly, permanent damage will occur.
My job is to quickly and safely get in that artery and open it up with a balloon and a stent.

How could this have been prevented? My patient did have a family history of heart disease and high cholesterol.

In my patients, I help assess their risk of "cardiovascular events" with the following:

• cholesterol levels
• highly sensitive CRP (marker of inflammation)
• stress test
• carotid ultrasound
• review of risk factors: smoking history, blood pressure, diabetes
• family history
• physical activity levels
• eating habits
• Calcium Score/Cardiac CT

Please consult with your doctor to evaluate your risk of heart disease."

---

Original Article:  http://www.mayoclinic.com/health/heart-disease-prevention/WO00041

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5 medication-free strategies to help prevent heart disease

You can prevent heart disease by following a heart-healthy lifestyle. Here are five strategies to help you protect your heart.

By Mayo Clinic staff

Heart disease may be a leading cause of death, but that doesn't mean you have to accept it as your fate. Although you lack the power to change some risk factors — such as family history, sex or age — there are some key heart disease prevention steps you can take.

You can avoid heart problems in the future by adopting a healthy lifestyle today. Here are five heart disease prevention tips to get you started.

1. Don't smoke or use tobacco

Smoking or using tobacco is one of the most significant risk factors for developing heart disease. Chemicals in tobacco can damage your heart and blood vessels, leading to narrowing of the arteries (atherosclerosis). Atherosclerosis can ultimately lead to a heart attack. When it comes to heart disease prevention, no amount of smoking is safe. Smokeless tobacco and low-tar and low-nicotine cigarettes also are risky, as is exposure to secondhand smoke.

In addition, the nicotine in cigarette smoke makes your heart work harder by narrowing your blood vessels and increasing your heart rate and blood pressure. Carbon monoxide in cigarette smoke replaces some of the oxygen in your blood. This increases your blood pressure by forcing your heart to work harder to supply enough oxygen. Even so-called "social smoking" — smoking only while at a bar or restaurant with friends — is dangerous and increases the risk of heart disease.

Women who smoke and take birth control pills are at greater risk of having a heart attack or stroke than are those who don't do either. This risk increases with age, especially in women older than 35.

The good news, though, is that when you quit smoking, your risk of heart disease drops dramatically within just one year. And no matter how long or how much you smoked, you'll start reaping rewards as soon as you quit.

2. Exercise for 30 minutes on most days of the week

Getting some regular, daily exercise can reduce your risk of fatal heart disease. And when you combine physical activity with other lifestyle measures, such as maintaining a healthy weight, the payoff is even greater.

Physical activity helps you control your weight and can reduce your chances of developing other conditions that may put a strain on your heart, such as high blood pressure, high cholesterol and diabetes. It also reduces stress, which may be a factor in heart disease.

Try getting at least 30 to 60 minutes of moderately intense physical activity most days of the week. However, even shorter amounts of exercise offer heart benefits, so if you can't meet those guidelines, don't give up. You can even break up your workout time into 10-minute sessions.

And remember that activities such as gardening, housekeeping, taking the stairs and walking the dog all count toward your total. You don't have to exercise strenuously to achieve benefits, but you can see bigger benefits by increasing the intensity, duration and frequency of your workouts.

3. Eat a heart-healthy diet

Eating a special diet called the Dietary Approaches to Stop Hypertension (DASH) eating plan can help protect your heart. Following the DASH diet means eating foods that are low in fat, cholesterol and salt. The diet is rich in fruits, vegetables, whole grains and low-fat dairy products, which can help protect your heart. Beans, other low-fat sources of protein and certain types of fish also can reduce your risk of heart disease.

Limiting certain fats you eat also is important. Of the types of fat — saturated, polyunsaturated, monounsaturated and trans fat — saturated fat and trans fat increase the risk of coronary artery disease by raising blood cholesterol levels.

Major sources of saturated fat include:

• Red meat
• Dairy products
• Coconut and palm oils

Sources of trans fat include:

• Deep-fried fast foods
• Bakery products
• Packaged snack foods
• Margarines
• Crackers

Look at the label for the term "partially hydrogenated" to avoid trans fat.

Heart-healthy eating isn't all about cutting back, though. Most people need to add more fruits and vegetables to their diet — with a goal of five to 10 servings a day. Eating that many fruits and vegetables can not only help prevent heart disease, but also may help prevent cancer.

Omega-3 fatty acids, a type of polyunsaturated fat, may decrease your risk of heart attack, protect against irregular heartbeats and lower blood pressure. Some fish, such as salmon and mackerel, are a good natural source of omega-3s. Omega-3s are present in smaller amounts in flaxseed oil, walnut oil, soybean oil and canola oil, and they can also be found in supplements.

Following a heart-healthy diet also means drinking alcohol only in moderation — no more than two drinks a day for men, and one a day for women. At that moderate level, alcohol can have a protective effect on your heart. More than that becomes a health hazard.

4. Maintain a healthy weight

As you put on weight in adulthood, your weight gain is mostly fat rather than muscle. This excess weight can lead to conditions that increase your chances of heart disease — high blood pressure, high cholesterol and diabetes.

One way to see if your weight is healthy is to calculate your body mass index (BMI), which considers your height and weight in determining whether you have a healthy or unhealthy percentage of body fat. BMI numbers 25 and higher are associated with higher blood fats, higher blood pressure, and an increased risk of heart disease and stroke.

The BMI is a good, but imperfect guide. Muscle weighs more than fat, for instance, and women and men who are very muscular and physically fit can have high BMIs without added health risks. Because of that, waist circumference also is a useful tool to measure how much abdominal fat you have:

• Men are considered overweight if their waist measurement is greater than 40 inches (101.6 centimeters, or cm)
• Women are overweight if their waist measurement is greater than 35 inches (88.9 cm)

Even a small weight loss can be beneficial. Reducing your weight by just 10 percent can decrease your blood pressure, lower your blood cholesterol level and reduce your risk of diabetes.

5. Get regular health screenings

High blood pressure and high cholesterol can damage your heart and blood vessels. But without testing for them, you probably won't know whether you have these conditions. Regular screening can tell you what your numbers are and whether you need to take action.

• Blood pressure. Regular blood pressure screenings start in childhood. Adults should have their blood pressure checked at least every two years. You may need more-frequent checks if your numbers aren't ideal or if you have other risk factors for heart disease. Optimal blood pressure is less than 120/80 millimeters of mercury.
• Cholesterol levels. Adults should have their cholesterol measured at least once every five years starting at age 20. You may need more frequent testing if your numbers aren't optimal or if you have other risk factors for heart disease. Some children may need their blood cholesterol tested if they have a strong family history of heart disease.
• Diabetes screening. Since diabetes is a risk factor for developing heart disease, you may want to consider being screened for diabetes. Talk to your doctor about when you should have a fasting blood sugar test to check for diabetes. Depending on your risk factors, such as being overweight or a family history of diabetes, your doctor may recommend first testing you for diabetes sometime between ages 30 and 45, and then retesting every three to five years.

References

WO00041Jan. 12, 2011

© 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

I'm always looking for ways to motivate myself and my patients to keep moving and exercising frequently. Here is a good article.

 fitness.mercola.com

12 Steps to Make Exercise a Lasting Part of Your Life

“Take care of your body, it’s the only place you have to live.” -- Jim Rohn

Sometimes a new thought or a new idea is all you need to make a lasting change. You can wake up one day and decide to make your entire life change. If you are new to exercise or you dropped it for a while and you want to get back to doing it, the best way to begin is with small steps.

You don’t have to become an athlete overnight to make exercise a part of your lifestyle. It’s actually better if you commit to making small changes in your daily routine instead of reinventing yourself overnight, because you are more likely to stick with it. Small changes in habits can lead to lasting, permanent change. So think baby steps and incorporate exercise into your life with these tips.

1.  Develop a "move more" mindset.

Carving out a specific hour of a day for a workout is great (and we will get to that in a little bit) but first, start each day with the mindset to move more. By reminding your body to get more movement throughout the day, you will be more likely to do it. So sit less and stand more. Take more steps and stairs. Walk to talk with a coworker instead of emailing them.

Stretch in your chair, squat to pick something up, park far away from stores so you will walk more, stand up when you talk on the phone and do some exercises while you watch TV. There are numerous ways you can sneak more movement into your day. Begin each day with a move more mindset and you will find them.

2.  Commit to regular activity.

You may not be the type of person who wants to train for a triathlon and that’s perfectly okay. You don’t have to become a fitness buff to benefit from exercise and movement. Start by committing to getting activity regularly. Schedule exercise like any other appointment on your calendar and treat it as a commitment rather than something you squeeze in if you have time. Even if you can only allot 15 minutes at a time, schedule it.

Take a short walk. Walk at a leisurely pace at first if exercise is new to you. You can build up to a power walk. If that’s not your thing, take a fitness class, swim laps or sign up for dance classes. Whatever exercise you start, build up slowly so you don’t overwhelm yourself and give up. If your body isn’t accustomed to regular exercise, build up slowly day by day so you don’t get too sore and throw in the towel altogether.

3.  Find your favorite exercise.

I know people who commit to a form of exercise and hate it. How long do you think they will keep that up? We aren’t inclined to dive in or stick to things we despise. Out of all the forms of exercise out there, find one you just love. Get really specific. Don’t just say, “yoga” discover what form of yoga is your favorite. If swimming is your thing, do you prefer swimming laps or water aerobics? Or maybe you’d dread a step class but you can’t get enough of Pilates.

A good way to identify what type of exercise is right for you is to first figure out if you like to exercise alone, with a partner or in a group setting. You may have to experiment a little bit before you know. Try different forms of exercise until you find one that energizes you physically and mentally. Find your favorite exercise—one where excuses won’t even enter the equation when it’s time to exercise.

4.  Focus on health and strength and what it means to you, and not on numbers on a scale.

Many people can get easily discouraged and give up when there’s too much emphasis on weight loss. Rather than an exclusive focus on weight loss, focus on the joys of exercise and movement instead. Take pride in your body getting stronger or your new ability to able to exercise longer, even if it’s just in baby steps. Think about the great way your body feels after exercise and the exhilaration you feel. Taking the time to consider what really connects you to exercise on an emotional level, is powerful because you can use those thoughts to motivate you.

Most likely what motivates you runs much deeper than getting skinnier or being a specific set of three numbers on a scale. Identify what it is for you. Maybe you want to have more energy for your children or grandchildren or you want to be in more control of your health—whatever is your core motivation—connect to it.

5.  Add strength training to your weekly routine.

Exercise isn’t just cardio alone. Strength training is critically important to retain muscle as you age, have a strong body and an effective metabolism. Even if you focus on just one muscle group a day and do three different exercises with three sets of 15 each for that muscle group you will benefit. You can divide strength training up throughout the week. Try two days a week to start and work up to three. Strength training will change how you feel, help you conquer your workouts with all that new muscle you are developing, and it’s the secret to a revved up metabolism.

6.  Put yourself first.

Stressful situations can take your focus away from properly caring for yourself. If you neglect yourself for the sake of external problems, you will be creating more problems than you are solving. Make sure you consider what you need and do something—however small—for yourself each day. Even if you only have 15 minutes, just commit to 15 minutes. It all goes back to the oxygen philosophy you hear about on planes flight attendants advice: “Put your own oxygen mask on before assisting others.” Put the mask on you first and then your children. You aren’t able to effectively take care of anyone else if you don’t take care of yourself first. Keep that in mind.

7.  Exercise with a group.

Exercise doesn’t have to be a solo sport. Make it an outing with friends and family. When you join up with others to exercise, not only do you get the immediate benefits of exercise, you also get time spent with friends—a double deposit into your well-being. When you discover physical activities and forms of exercise you love, you develop a sense of camaraderie and community with others. Accountability works.

8.  Think of how exercise boosts your sense of well-being.

You probably know exercise can help you live longer and go a long way to disease prevention, but what you might find more rewarding is to think about all the immediate benefits exercise provides to your well-being. While the long-term benefits are numerous, let’s face it, many of us aren’t motivated by what we can prevent decades down the road. Think short-term instead. All of us can use exercise today to get more energy, alleviate stress, increase productivity, improve our outlook, sleep better and feel happier—today! Think about what you stand to gain if you work out today. Maybe it’s a sunnier disposition or the satisfaction in knowing you pushed your body. Just give it some thought or better yet, make a list.

9.  Look to the future

Don’t get caught up in guilt or regret because you haven’t worked out or don’t beat yourself up if it has been a while. Guilt and regret only make you feel badly, they don’t get you where you are headed. With a simple decision in your mind, you can let go of what you did or didn’t do and just start again. Look forward. If you are feeling badly about yourself, you are less likely to make positive change. Start over with a clear plan of what you will commit to doing each day for your health.

10.  Avoid stop and start and stop again syndrome

One great way to kill your confidence is to constantly start and stop your exercise routine. It’s common for people to get psyched up and dive in to working out and then drop it altogether when the craziness of life intervenes. But if you start and stop all the time, you are setting yourself up for a never-ending cycle, where you won’t see any progress. Don’t tackle the world in a day. Think baby steps. Think of what you can do and schedule today even if it’s small increments of time that you eventually build upon. Commit to what you can achieve, at least at first.

11.  Remind yourself daily of your why.

It’s easy to get off track if you aren’t reminding yourself of why working out and eating healthy is important to you. This goes back to your core motivation that we addressed earlier. If you make it automatic to wake up and remind yourself of why exercise is important to you, you will be more likely to keep your commitments to yourself. You also will be putting exercise front and center on your day instead of treating it as an afterthought that you skip at day’s end. Wake up thinking of what exercise you will do today and it becomes a priority.

12.  Stretch post workouts.

An effective exercise regimen involves cardio, strength training and stretching. Stretching after exercise can help relax and balance tension caused by the workout itself. Post-workout, when your body is warm is the ideal time to stretch. The risk of muscle injury is much lower, and you will save yourself from tight, sore muscles the following day. Plus, the calm, relaxing feeling of a good stretch is a great way to end a workout.

Try some of these steps to make exercise a part of your life. Remember, a great way to avoid skipping workouts is to ask yourself how you will feel afterward. You can feel proud of your dedication and gain the exhilaration of accomplishment, or you can be disappointed and defeated that you skipped, again.