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The Exercise Myth

Even though I smelled bad enough to knock a buzzard off a gut pile, the people in the medical tent of the 2013 Victoria Marathon were kind and caring. One paramedic even let me use his cell to make a long-distance call to my wife, who was watching via Internet feed and had no doubt seen me collapse at the finish line of my Boston Marathon qualifying race.

I felt like I might die. Although I’d trained for all I was worth, with a few miles left to go I hit the wall like a near-sighted kitten chasing a laser pointer.

Cue Simpsons-Comic-Book-Store-Guy voice: Worst. Pain. Ever!

I collapsed two feet before the finish line and crawled the last several inches. But I made my time! I qualified with a scant 29 seconds to spare, and then spent the next 90 minutes in the medical tent hooked up to IV fluids and oxygen. Also, there was barf. Twice.

Exercise sucks.

At least, it sure did suck for me that day. I was in pain for two weeks after that race. I don’t want to ever experience that kind of emotional and physical trauma again. I decided on that day that I would never again race a marathon for time, and that 3:24:31 would stand up as my marathon personal best. Forever.

That hell I described is what the majority of the population thinks about regular exercise. They hate it, and they don’t want to do it. I am an internationally syndicated fitness columnist with columns read by a whole lot of people, and make my living writing about diet, exercise and weight loss. For years I’ve extolled the virtues of exercise as a way to control your eating behaviors and sculpt your physique into something that looks great and performs amazing feats.

And I have been wrong.

For a lot of you, I’ve been wrong. I’ve inspired many, and converted them into people who run, swim, cycle, compete, lift weights, do fitness classes, ski, hike, Pilate, practice martial arts … Through my various columns, my first book, my consulting practice and my blog I have taught many, many thousands how to change their lives by becoming regular exercisers.

And many more than that I have failed to help.

Failing To See the Light
It is not a personal failing in any person to fail to see the light with exercise, because that kind of light just isn’t visible for some. Actually, it doesn’t work for most. If you don’t want to exercise, then you qualify as “most.” You’re in the vast majority, and it’s nothing to be ashamed of, because exercise isn’t exactly natural. It’s asking you to do something very unusual. It’s asking you to be someone you’re not. It’s asking you to expend energy and to embrace discomfort for a nebulous long-term goal that doesn’t actually accomplish anything in the near term other than shortness of breath and smelly laundry. Also, it costs money.

I’m not turning my back on exercise. I personally love it and will continue to do so (and I’ll keep writing about it too), but in learning to love it I realized how hard it was – how unnatural it was – to dedicate so many hours a week to running and cycling and the lifting of heavy things for no reason other than to put them back down and then lift them up again.

Imagine you’re a visitor from an alien race and, without knowing anything about humans, you use the scanning technology on your interstellar spacecraft to look inside a health club you see people lifting weights, doing Spin classes, sweating on elliptical trainers, and taking the stair-climber to nowhere. You’d fold your tentacles across your thorax, scratch your eye stalk and say, What the hell are those bipedal creatures up to? What is the point of all this?

For most people, they’ll never understand the point of exercise, and listening to someone talk about triathlon training is like trying to understand Klingon. We know it’s good for us, deep down, but that’s not enough to force us to do it on a regular basis. For many, exercise is time-consuming, expensive, awkward, painful, sweaty, boring, stupid … and all for changes just to the body. It doesn’t actually accomplish anything else. When I go for a run, it’s not to get anywhere except back home. When I lift weights, it’s not like I’m building a brick wall or helping a friend move.

For so many people, exercise lacks purpose. The fact that it changes their bodies is not enough.

The Mother of Invention
Exercise is a new invention. When machines took over most of our work for us we had to come up with other ways to get our bodies to move, and so a small portion of the population began engaging in structured physical activities the only point of which was to get the blood flowing, the muscles working, the lungs straining.

Screw that, most people say.

Fewer than 25% of the population exercises enough to obtain even minimal health benefits,1 and that only 5% of the population exercises with enough regularity and intensity to actually have any kind of impact on weight loss.2

I repeat: only 5% of the population exercises enough to affect weight loss. This figure speaks volumes.

This is the structured exercise most people think of when it comes to losing weight: running, Zumba, Pilates, swimming, weightlifting, cross-country skiing, elliptical machines, martial arts, treadmills, personal trainers and gym memberships … Many will try, spending lots of money, and most will fail.

This doesn’t mean you’re lazy if you don’t succeed at exercise. It just means you’re not interested. It means you’re normal. It means you’re part of the 95%.

The Exercise Myth
Haven’t lots of people lost weight via exercise coupled with dietary changes? Yes, they have. I did, and I have helped many change their bodies using this route.

The myth about exercise is that it is a viable solution for the population at large to achieve lasting weight loss. Whether the reasons are physiological, psychological, practical or financial, most people are at the opposite end of the spectrum from Nike’s tagline. They Just can’t do it. They WON’T do it.

For some, exercise works as an important part of a weight loss program, but for most, they will never be able to make themselves exercise hard enough, long enough, and frequently enough to get a considerable caloric burn and therefore affect weight loss. THIS is the myth that has been perpetuated about exercise.

When it comes to being in shape, I am likely in the top 1% of the population. I can lift heavy, run fast and far, swim for an hour, cycle for several hours, hike all day, ski through moguls, see my abs …

But this is my job.

Being super fit is what I get paid to do, and I still sometimes struggle with motivation. Those people you see on the cover of magazines and in action movies? They got paid to look like that. Sometimes, they get paid a lot.

Even if you haven’t seen the latest X-Men film, there’s a chance you saw what Hugh Jackman looked like with his shirt off. Pretty amazing, right? Well, the amount of exercise and dietary deprivation he went through was extraordinary.

“I do heavy weights in the morning for about an hour, and then I do 45 minutes of higher volume lifting in the afternoon,” Hugh explained to me of his “Wolverine” regimen. “For cardio I dance, I ride my bike, I run …” Jackman also got a lot of expert instruction.

“When lifting I’m always with a trainer because the thing that makes a difference is that last 20% in your training,” Hugh said, “and he very scientifically looks after my food as well, because when I’m going for a ‘shirt off’ shot everything changes the month before, and I’m timed down to the day. There is water dehydration for 36 hours before. It’s quite a scientific process to looking your best.”

Provides a bit of realism about how “easy” it is to look like that, doesn’t it? And it’s not just the paycheck he has for motivation: “But I’ve got to be honest, mate; being in a 3-D film on a 40-foot screen is pretty good motivation for being in shape.”

Yes, Hugh the Australian really called me “mate.” And then he told me about how quickly he loses that physique as soon as filming ends. It’s just not that sustainable unless you go full-on fitness junkie, and not many people want to do that.

But what about the female perspective?

If you’re a Game of Thrones fan, you no doubt know of the evil Queen Cersei, played by Lena Headey. In GoT she’s usually covered neck to toe in billowing gowns, but when she reprised her role in the sequel to 300 the revealing attire meant a punishing fitness regimen.

“It was exhausting,” Lena told me of getting fit for the role of Queen Gorgo in 300: Rise of an Empire. “I was doing about two hours a day.” Eva Green had a key role in the film as well, and she spoke to me of her regimen to play a sword-wielding villain: “You almost want to vomit because you’re not used to that kind of intensity.”

The diet aspect of looking good on film is just as rough.

“I never want to look at chicken and broccoli again,” Callan Mulvey, who played a Greek soldier in the film said. And Rodrigo Santoro, who reprised his role as Xerxes and looking leaner than in the first movie, said, “No ice cream, no chocolate, no pasta; not fun.”

But they looked great for the movie, so, worth it, right? Well, maybe not.

“I think everyone went straight to fat camp when we stopped filming,” Mulvey said. Rodrigo Santoro looked forward to such a day: “I had this vision in my head of a beautiful table full of delicious food and a big bucket of ice cream that I would dive into.” Headey echoed this, saying, “The sad thing is that when it’s over it all goes [insert blowing raspberry sound].”

It should surprise no one that Hollywood is not a reflection of the real world.

You CAN look good. You can feel good. And you can do this without the torturous experiences of training for a shirtless scene in an action movie. Gym membership and/or personal trainers are not always required for being healthy, fit and looking good.

Some people just really don’t want to exercise, but to get them to be fit through some form of regular physical activity it’s important to focus on …

Taking Away the Pain
The traditional exercise model of high-intensity classes, weightlifting programs, and extreme efforts that proclaim to be “insane” all have one thing in common: They hurt.

The human body is naturally averse to pain. You will seek to avoid it.

But it’s more than just avoiding pain, it’s avoiding inconvenience and large financial commitments. What’s more, if you Google “the #1 reason people don’t exercise” you’ll see a lot of pages that comes up with the same answer:

“Lack of time.”

And this is why most people aren’t exercising. Lifestyle overhaul programs often fail, because they’re an overhaul. Big changes lead to big failure. A strategy of suffering speeds you towards relapse.

For those who really hate exercise, it’s time to change your thinking about the usefulness of traditional exercise as a viable method to lose weight. If you hate exercise, then I won’t ask you to join a gym. I won’t ask you to hire an expensive trainer. I won’t ask you to purchase fancy workout clothes, do high-intensity spinning classes, run a marathon or sign up for CrossFit.

The reason why I won’t ask you to do these things is because you feel that …

Exercise is Inconvenient, Unpleasant and Expensive
And that is why so many people don’t do it. Here is the traditional scenario:

  • Sacrifice sleep to get up early for exercise.
  • Go to a place that you would rather not go, to do an activity you would rather not do.
  • Get changed in a hygienically challenged locker room in front of strangers.
  • Do some class or workout with a trainer and get pushed right to your limit.
  • Covered in sweat, go back to the aforementioned locker room and use a shower that has been used by many dozens of other people since it was last cleaned. Don’t forget the “in front of strangers” part.
  • Get dressed, in front of strangers, while still sweating because you haven’t completely cooled off from your workout.
  • Do your hair and other morning preparation rituals, in front of strangers.
  • Finally start with the rest of your day.

Sounds like fun. Go sign up for that.

Hopefully the sarcasm in the previous two sentences is evident. This is a major reason why most people say, “No, thank you.” Granted, lots of people do think it’s fun. They get into gym culture and embrace these types of fitness rituals, but as we’ve established, they are a minority. I am part of this minority. This article is not targeted at said minority. It’s targeted at the people who looked at those bullet points and said, “Yeah, screw that.”

You have other things you need to be doing. Can you leave the house that early in the morning to work out if you have children? What about making lunches? What about getting them to school? Is exercising after work any better? If you hit the gym then it can delay getting home by as much as two hours. Who makes dinner? Who helps kids with their homework or takes them to their activities? Who does the stuff that keeps a home functioning? Who walks the dog?

And lunch time? Can you cram going to the gym, changing, exercising, showering, changing again, and going back to the office all into an hour? Do you even want to try?

Again, don’t you have better things to do?

Also, don’t you have better things to spend your money on? Gym memberships are expensive, and their personal trainers are good at selling, sometimes convincing you that you need to purchase many, many training sessions at a cost of several thousand dollars per year. Those fancy fitness classes can cost a lot of money too, plus workout clothes, running shoes, and other assorted gear. Even gas and parking fees can add up. Working out is big business – it’s an industry that wants to get as much cash out of your pockets as possible, taking advantage of your desire to lose weight by giving you promises in exchange for a chunk of your paycheck.

But the traditional exercise model goes beyond being inconvenient, unpleasant and expensive. Another reason why most Americans don’t do it is because …

Exercise is Painful
Have you ever seen the movie The Running Man with Arnold Schwarzenegger? There is a scene with Jesse Ventura hosting “Captain Freedom’s Workout” on TV where he says, “Are you ready for pain? Are you ready for suffering?”

Unfortunately, so many workout programs and trainers take that example to heart. They think it’s what people want. The exercise program called “Insanity” is called, well, Insanity. What does that tell you?

It gets worse.

Here is a quote from Greg Glassman, founder of CrossFit, speaking to the New York Times in 2005 about his program:

“It can kill you … I’ve always been completely honest about that … If you find the notion of falling off the rings and breaking your neck so foreign to you, then we don’t want you in our ranks.”3 

But it’s not just CrossFit or some extreme DVD program. Running, one of the most popular forms of exercise in the world, has high injury rates as well, with most being caused by overuse, and with a high re-injury rate.4 There are countless physiotherapists who specialize in treating running injuries. There are professors of biomechanics at universities around the world who focus on research into running injuries. There are running injury clinics …

When I Google “running injuries”, with the quotation marks to make sure it’s a focused search, I get over half a million results. What happens when I Google “walking injuries”? I get only 10,000 results. Walking is safer, easier, can be done many times per day, and most importantly, it usually doesn’t hurt.

And what about debilitating low-back pain? That’s something you’d rather avoid, isn’t it? But it turns out that exercise is a primary cause.

“It’s the active folks who are getting low-back pain,” Stu McGill, a professor of spine biomechanics at the University of Waterloo in Ontario told me. “Couch potatoes never create the initial trauma.”

Overly intense exercise hurts during, and it hurts afterwards. Worst of all, it can create injuries that hurt for a long time.

I’m not disrespecting exercise. I love it, and I know many others who do as well. But the traditional model of “go hard or go home” with structured physical activity has its flaws. And it most definitely is not for everyone, especially when you consider that …

You’re Not Burning As Many Calories As You Think
Have you ever done a spinning class and the instructor told you that you just burned a thousand calories? Sorry, but they were mistaken. You didn’t burn anything near that.

To understand just how ineffective exercise is at burning off fat, we need to do a little math. There are complicated methods of determining your exact metabolic rate, but I’ve found that the quick method gives a very close result to that of the complicated method, and since the whole point is to dispel the myth of structured physical activity as some miracle fat burner, and not to measure every calorie burned along with every calorie consumed, “very close” is plenty good enough.

Here is the really easy way to figure out how many calories you burn each day while not moving.

  • For a woman, take your body weight (in pounds) and multiply it by 9.
  • For a man, take your body weight (yes, also in pounds) and multiple it by 10.

So, for a woman who weighs 160 pounds, she will burn (approximately) 1,440 calories in a 24-hour period if she does absolutely nothing.

Now it’s time for just a little more math, and that’s taking that number of 1,440 calories and dividing it by 24 so you can understand how many calories this woman burns in an hour of sitting still.

That number is 60 calories.

A woman who weighs 160 pounds will burn approximately 60 calories each hour she is on the couch.

What happens when she moves around? Well, that number goes up, but by how much?

It depends on the intensity of the activity. The more intense the activity, the higher the number goes. But it’s still not as high as the instructor led you to believe. For one hour of indoor cycling at a moderately high intensity the rate of caloric burn is going to increase your metabolic rate by a factor of about eight. So, 8 multiplied by 60 calories for a one-hour cycling class equals a total burn of 480 calories. But don’t forget that this woman would have burned 60 calories not doing any physical activity, so the actual extra calories burned falls to 420.

But that’s only if she was going hard for the entire hour. I don’t know if you’ve ever done a spinning class, but they don’t usually work that way. Often there is a slow-paced warm up, and some slow spinning and even easy stretching at the end. The reality is, instead of 420 extra calories, it’s more like 300.

That’s a lot of hard work to burn the equivalent of a single chocolate bar. And not a big chocolate bar either; I’m talking about a regular-sized bar.

All that inconvenience, unpleasantness, pain and even risk of injury just to burn a few hundred extra calories? (Again: not everyone sees this as unpleasant – I’m speaking to those who do.) Is this structured physical activity approach worth all the time and trouble? Some like it, and more power to them, but if you have decided that this route is not for you, then I’m behind you in that decision, because you’ve been mislead about the role exercise plays in fat loss.

And there is even more to consider.

Exercise Means More Time Sitting
As I wrote about in this article, sitting is seriously bad, and even being a regular exerciser won’t make up for the damage done to your health from too much sitting. What’s more, exercise can cause you to sit even more during the rest of the day.

Part of this is psychological. When you do short yet intense structured physical activity sessions, it makes you feel like you don’t need to move for the rest of the day. After all, you exercised, right? You deserve a break.

And maybe you’re so tired from this structured physical activity you physically need a break. A 2012 study of 61 sedentary men published in the American Journal of Physiology found that those who were placed in the “moderate” exercise group lost more weight than the ones in the “high” exercise group.5 The examination of the results determined that the high exercise group was too tired to do much else for the rest of the day, so it led to an increase in sedentary behavior overall. (Granted, if they kept it up the latter group could get in good enough shape so that high levels of exercise didn’t wipe them out, but few people ever achieve such a level of fitness.)

What’s more, the high exercise group was more likely to make poor eating decisions, and that’s because …

Exercise Can Make You Eat
Imagine you are the 160-pound woman described earlier, and you do that spin class, then what?

Chances are, you eat. That’s what. A big part of this is psychological. Part of it is the marketing you’ve been exposed to about the need to “refuel” after an intense workout. And, of course, the gym where you did that spin class probably has plenty of those refueling calories for you to partake in.

So you buy a peanut butter protein smoothie, because you’ve been led to believe that it’s a healthy choice and that your body needs this after your intense workout. And so, you drink down that 500-calorie smoothie. And what the heck, you worked out hard, so throw in a 300-calorie muffin as well. After all, you deserve a treat after doing all that exercise, right?

The extra calories you burned off were 300, and the extra calories you ate totaled 800. That’s a caloric surplus of 500 calories. From a weight loss perspective, would have been better off staying at home on the couch.

But it’s not just psychology. The body can have a physiological response that causes you to eat more, and the research backs this up.

A 1997 study published in Medicine and Science in Sports and Exercise found that, long-term, physical activity was associated with increased caloric intake.6 And a 2008 study of a dozen men and women published in the British Journal of Nutrition determined that, over time, exercise creates an incremental increase in appetite in an effort to compensate for burned calories.7 Another 2008 study, this one of 35 men and women and published in the International Journal of Obesity, showed that some people could be especially prone to compensating for exercise by excess eating.8 And unfortunately for women, a 1996 study published in the European Journal of Clinical Nutrition found that women were much more susceptible to overeating after exercise than men, and that they’re more likely to find that certain foods to taste better post workout, which led to more food cravings.9

And more intense exercise can mean more hunger, as a 2004 study of 13 women published in the American Journal of Clinical Nutrition showed.10

I must note that at the physiological level we’re not usually seeing that people are generating enough extra hunger to more than wipe out the calorie burning of this structured physical activity. Most studies are showing that the compensation effect of increased appetite is not enough to undo all the calories burned. But that’s just the biological response. The psychological response is where things can really go off the rails.

I’ve seen it time and again. People work out, and then they reward themselves for working out with treat food. It’s so common that researchers have found …

Exercise Alone is Not an Effective Weight Loss Tool
So many people go through punishing workout sessions day after day, week after week, thinking that’s all it takes. We’ve been led to believe by popular reality TV shows and infomercials alike that you can just sweat the pounds away.

But the reality is, you can’t outrun your knife, fork and spoon.

Study after study has shown that, by itself, exercise alone fails as a tool for weight loss. The numbers we ran about caloric burn rates earlier should drive home why this is so.

A 2011 review published in the American Journal of Medicine looked at 14 trials covering 1,847 people, and determined that aerobic exercise alone – things like running and cycling and swimming – barely resulted in any weight loss.11

Even more shocking is a 2010 study published in the Journal of the American Medical Association, which looked at 3,554 men and women over a 20 year period, and found out that even among those who engaged in “high physical activity” still gained weight.12 Sure, they didn’t gain as much weight as those who were sedentary, but they still gained weight!

And we also have a 2007 study of 257 women published in the Journal of the American Medical Association found that there was little difference in the amount of weight loss between the group that had exercised several days per week, and those who didn’t exercise at all. The study determined there was a significant compensatory effect of eating extra food to make up for the caloric burn of the exercise.13

It doesn’t have to be this way, and I exposed this in my first book in detail about how, psychologically, people tend to adopt a “reward mentality” with exercise where a hard effort of working out makes many feel as though they’re now entitled to a food reward. I know plenty of runners who run just to earn treats. I’ve taught plenty of people how exercise empowers you towards better eating instead of entitling you to a reward, but I also realize that it involves battling a lot of psychological and marketing pressure where you think you deserve / need extra calories because you exercised.

Where Does This Leave You?
There is another option to assist weight loss for the non-exerciser, and it’s pretty neat.

Actually, make that NEAT. It’s Non-Exercise Activity Thermogenesis, which is burning calories via methods other than traditional sport or exercise. It’s movement with a purpose, like walking instead of driving, using your bike as a mode of transportation, taking the stairs instead of the elevator, getting up and walking to a co-worker’s office to chat instead of picking up the phone, pacing while on the phone instead of sitting, doing housework, shoveling snow, yard work, carpentry, playing with your kids, walking the dog, doing laundry, moving furniture … All those things people stopped doing because of technology.

When you adopt a mindset of looking for every possible excuse to add in extra movement, traditional exercise be damned, you can burn more calories each day without the pain and hassle, and without nearly the risk of developing a reward mentality in regards to “earning” a tasty treat. What’s more, movement begets more movement. Starting slowly, you’ll find over time that you transform from a sitter to a mover, and you’ll rack up some caloric burns while achieving greater fitness.

And in terms of weight loss, if you sit less, spend less times in front of screens, and keep those hands busy you’ll be less inclined to engage in mindless snacking, and more likely to establish a regular meal pattern.

In other words, the NEAT approach to fitness can help you on the food intake side, which is where lasting weight loss really happens.

Conclusion
If you exercise and you like it, then please don’t stop. I have no intention of stopping, because I enjoy it and I think it’s awesome. This article is for those who don’t think it’s awesome and who never will think that way. It’s explaining that there is another way; a way to achieve movement with a purpose where you can lose weight and get fit on your own terms, but making movement more about accomplishing tangible goals like a cleaner house, nicer yard, fancier garden, using less gas, paying less for parking, relying less on technology and hiring of labor to do your work and adopting a DIY approach to every kind of labor you can make yourself do. Even those who do exercise can benefit a great deal from adopting this mindset.

My grandma was lean and fit her entire life, and she never once exercised. She didn’t sit much either, because she grew up in a culture where you kept your body busy. And after decades of trying the exercise route to lose weight, my mom finally lost over 60 pounds by embracing NEAT, because it much better suited her personality.

It’s old school fitness, and it works. So if you’ve tried exercise and failed, try this instead.

 

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James S. Fell is an internationally syndicated fitness columnist for the Chicago Tribune and author of Lose it Right: A Brutally Honest 3-Stage Program to Help You Get Fit and Lose Weight Without Losing Your Mind, published by Random House Canada. He also interviews celebrities about their fitness stories for the Los Angeles Times, and is head fitness columnist for AskMen.com.

 

REFERENCES

  1. Cynthia Ogden et al., “Prevalence of Overweight and Obesity in the United States, 1999-2004,” Journal of the American Medical Association, 295 (13), April 5, 2006, p. 1553; Curt Lox et al., The Psychology of Exercise: Integrating Theory and Practice, (Scottsdale: Holcomb Hathaway, 2006): p. 27.
  2. RP Troiano et al., “Physical Activity in the United States Measured by Accelerometer,” Medicine and Science in Sports and Exercise, 40, 1, (January 2008): 181-8.
  3. Stephanie Cooperman, “Getting Fit, Even if it Kills You,” New York Times, December 22, 2005: http://www.nytimes.com/2005/12/22/fashion/thursdaystyles/22Fitness.html?pagewanted=all&_r=0 Accessed February 23, 2015.
  4. van Mechelen, “Running Injuries. A review of the epidemiological liturature,” Sports Medicine, 14, 5, (November 1992): 320-35; L. Ristolainen et al., “Training-related risk factors in the etiology of overuse injuries in endurance sports,” The Journal of Sports Medicine and Physical Fitness, 54, 1, (February 2014): 78-87.
  5. Rosenkindle et al.,” Body Fat Loss and Compensatory Mechanisms in Response to Different Doses of Aerobic Exercise—a Randomized Controlled Trial in Overweight Sedentary Males,” American Journal of Physiology, Regulatory, Integrative and Comparative Physiology 303, no. 6 (September 2012): R571–79.
  6. NA King et al., “Effects of exercise on appetite control: implications for energy balance,” Medicine and Science in Sports and Exercise, 29, 8, (1997): 1076-89.
  7. S Whybrow et al., “The effect of an incremental increase in exercise on appetite, eating behaviour and energy balance in lean men and women feeding ad libitum,” British Journal of Nutrition, 100, 5, (November 2008): 1109-15.
  8. NA King et al., “Individual variability following 12 weeks of supervised exercise: identification and characterization of compensation for exercise-induced weight loss,” International Journal of Obesity, 32, 1, (January 2008): 177-84.
  9. NA King et al., “Effects of short-term exercise on appetite responses in unrestrained females,” European Journal of Clinical Nutrition, 50,10, (1996): 663-67.
  10. Marjorie Pomerleau et al., “Effect of Exercise Intensity on Food Intake and Appetite in Women,” American Society for Clinical Nutrition, 80, 5, (November 2004): 1230-1236.
  11. A Thorogood et al., “Isolated aerobic exercise and weight loss: a systematic review and meta-analysis of randomized controlled trials,” The American Journal of Medicine, 124, 8, (August 2011): 747-55.
  12. Arlene Hankison et al., “Maintaining a High Physical Activity Level Over 20 Years and Weight Gain,” The Journal of the American Medical Association, 304, 23, (December 2010): 2306-10.
  13. Timothy Church et al., “Effects of Different Doses of Physical Activity on Cardiorespiratory Fitness Among Sedentary, Overweight or Obese Postmenopausal Women With Elevated Blood Pressure,” 297, 19, (May 2007): 2081-91.
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