Aerobic Training Program Design

4/8/2016
Readings:
Aerobic Training Program

Design
NSCA text: Chapter 16

pp 389 406
Course web site:
Physical Activity
Guidelines For Americans
2008 - Fact Sheet
Aerobic Training Program Design
Synonyms for Aerobic Training
Aerobic training/exercise
Endurance training/exercise
Cardiovascular training/exercise
Cardiorespiratory training/exercise
General Training Principles
Specificity of Exercise
Aerobic capacity = VO2 (dot over V omitted)

[ml O2/kg/min]
You must stress the cardiorespiratory system to

produce adaptations in aerobic capacity
Resistance training is not a effective stimulus to
produce significant increases in aerobic capacity
There is some transfer of capacity from one
aerobic exercise mode to another, but it is not
100%
Swimming peak aerobic capacity in a trained swimmer

will not be produced if swimmer runs, due to different
muscle use pattern
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Program Design Variables

1.
2.
3.
4.
5.
6.
Mode of exercise
Mode
Intensity
Duration
Frequency
Progression
Variation
More commonly known as: F.I.T.T.

Frequency
Intensity
Type
Time
2.
3.
4.
5.
6.
Terms, Abbreviations, Basic

Formulae
Mode
Intensity
Duration
Frequency
Progression
Variation
Training goal (I want to run a 5KM race vs, I

want to lose weight)
Enjoyment preference (I hate to swim, I find
machines boring, I like the social aspect of
group exercising)
Equipment available, weather
Client physical characteristics (e.g., obese, knee
injuries, etc.)

1.
Variety of modes discussed in

Cardiovascular Activity Techniques unit
Select mode based on:
Resting Heart Rate = RHR

Maximum Heart Rate = MHR
Age-predicted maximal heart rate = APMHR

= 220-age (most common formula)
Heart Rate Reserve = HRR = APMHR-RHR
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Intensity of Exercise
Increasing aerobic work
Resting HR
VO2 Max
Maximum HR
Aerobic exercise intensity

is between MHR & RHR
Resting VO2
We use Heart
Rate as an
easy to
measure
indicator of
aerobic work
the body is
doing.
We dont have
to measure VO2
while a person
exercises
MHR
True maximum method:
Graded exercise test
(increasing intensity) to point
where HR no longer increases
Have physician clearance &/or presence
Not typically done outside of training athletes
10
MHR
Use Age-predicted maximal
heart rate (APMHR) equation:
Training Zone Target Heart

Rate Range (THRR)
determined using:
APMHR = 220-age
1) Percent of APMHR
OR
2) Karvonen Formula
Error 10-15 beats/min

Client must not be using medication that
affects HR
takes into account clients resting HR
Obese clients use: APMRH = 200-(0.5 x age)

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Training Zone by % APMHR

APMHR
85% APMHR
Training zone = 70%-85% APMHR

(55%-65% APMHR for very low capacity clients)
70% APMHR
Target HR upper limit = APMHR(.85)

Target HR lower limit = APMHR(.70)
Resting HR
APMHR

relationship to %VO2 max
85% APMHR = 75% V02 max
70% APMHR = 55% VO2 max
Resting HR
13
So, a person training at 70% APMHR, is training

at approximately 55% of VO2 max
14
APMHR
85% APMHR
EXAMPLE:
30 yr-old client
APMHR = 220-age = 220-30 = 190 beats/min
Target HR upper limit = APMHR(.85)=190(.85) =162
70% APMHR Target HR lower limit = APMHR(.70)=190(.70)=133
65% APMHR
Low Capacity
Client
55% APMHR
THRR (Target Heart Rate Range) = 133 to 162 beats /

min
= 22 to 27 beats / 10 sec
Resting HR
15
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Training Zone by Karvonen (HRR) formula

85% HRR
50% HRR
Heart Rate Reserve
APMHR
Resting HR
17
HRR (Heart Rate Reserve) = APMHR-RHR
Training zone = 50%-85% HRR

Target HR upper limit = HRR(.85)+RHR
Target HR lower limit = HRR(.50)+RHR
Measure RHR in bed after waking up in the
morning, or after laying quietly for 15 minutes
18
Resting HR
Target HR upper limit = HRR(.85)+RHR

= 120(.85)+70 = 172 beats/min
Target HR lower limit = HRR(.50)+RHR
= 120(.50)+70 = 130 beats/min
THRR (Target Heart Rate Range)=130 to 172 bpm
= 22 to 29 beats / 10 sec
19
APMHR
50% HRR
EXAMPLE:
30 yr-old client, RHR = 70 beats/min
APMHR = 220-age = 220-30 = 190 beats/min
HRR = APMHR-RHR = 190-70 = 120 beats/min
85% HRR
50% HRR
Heart Rate Reserve
85% HRR
Heart Rate Reserve
APMHR
Takes into account clients

resting HR
Trained client
Beginner client
Resting HR
20
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Comparison of Training Zone by %APMHR & Karvonen formula
Training Target Intensity by Talk Test
Heart Rate (beats/min)
180
160
140
Useless range
FOR VERY FIT
of Karvonen
PERSON
120
100
no difference
between formulae
top end
80
60
FOR NOT FIT PERSON

% APMHR formula,
more conservative, so
perhaps better
40
For 20 year-old
20
0
200
180
160
140
120
100
80
60
40
20
0
APMHR
FOR MID RANGE FITNESS
LEVEL, No big difference
Between formulae
50
70
90
Karvonen upper limit

APMHR upper limit
APMHR lower limit
For 30 year-old
30
30
Karvonen lower limit
50
70
90
110
110
200
200
180
160
180
160
140
140
120
100
80
60
40
120
100
80
60
40
20
0
20
For 40 year-old
30
50
70
110
Can not speak comfortably

Comfortable speech is just barely
possible
Breathing rate will increase with intensity of aerobic exercise. You
should exercise at an intensity that is just below the level at which
you can no longer speak comfortably (i.e. When comfortable
speech is just barely possible you are at the correct exercise
intensity) (1,2).
For 50 year-old
0
90
200
30
50
70
90
1. Fahey, T. I. (2009). Fit & Well, Core Concepts and Labs in Physical Fitness and Wellness.
8th edition. McGraw Hill.
2. Persinger, R. F. (2004). Consistency of the talk test for exercise prescription. Medicine &
Science Sports & Exercise , 36 , 1632-1636.
Resting HR
110
Resting HR (beats/min)
Resting HR (beats/min)
21
by Perceived Exertion
Example: For a male, a 68% of VO2 max

training level corresponds to a RPE of 5 (see
also next slide)
For men aerobic
aerobic training
intensity
training intensity
RPE 3.5 - 5
RPE 4 5.5
For women
For men
RPE
% of VO2 max
RPE
% of VO2 max
3.5
58
48
82
68
92
89
Utter AC . Validation of the Adult OMNI Scale of perceived exertion for walking/running exercise. Med Sci Sports Exerc. 2004,
36:1776-80
*A widely used Borg RPE scale also exists, and the Utter 2004 article table 2 also relates that scale to % VO2 max. Dr. Chalmers has
85% APMHR
70% APMHR
WHY?
1.
found that some trainers prefer a 0-10 scale, such as the OMNI scale, to the Borg scale of 6-20.
23
At start of exercise program,

check the training intensity
HR target calculated using
formula with clients
subjective assessment of
intensity (talk test or
perceived exertion)
APMHR
A 10 step OMNI Rating of Perceived

Exertion (RPE*) scale has been used to
gauge exercise intensity, and relate that
perceived intensity to aerobic work intensity
(1). The interpretation of the 0-10 scale is
aided by illustrations.
For women
22
Resting HR
EXAMPLE:
72 yr-old client exercises at APMHR?
42 yr-old client unable to exercise at 70% APMHR
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HR targets can be wrong

70-85% APMHR may be:

Way too hard for one person
Too easy for another person
BUT.
Exertion does not lie
RPE technique to set aerobic exercise intensity in:
Faster, Better, Stronger, Heiden, Testa, Musolf, pg 215-7
25
HR targets can be wrong.
Nothing at all
0.5
1
Very, very weak RPE < 2, ZONE 1= easy

aerobic, for warming up
Very weak
and cooling down
Weak
Moderate
Somewhat strong
Strong
Between strong and very strong
Very strong
Between very strong and very, very strong
Very, very strong
10
Maximal
RPE 2-3, ZONE 2 =

Aerobic base, mild stress,
good for beginners
RPE 3-5, ZONE 3 =

Aerobic capacity zone,
Intensive aerobic/Cardiofitness zone RPE 5-7, ZONE 4 =
Aerobic-anaerobic
transition (required zone
for athletes only)
RPE 8-10, ZONE 5 =
only for elite athletes
26
Heart rate by itself is not a very

meaningful measure. It must be in
context with other measures.
Impossible to base training on heart
rate, too many variables affect it. 99% of
the time RPE is a great window into
stress and adaptation.
An APMHR of 85% or more and peak RPP of

25,000 or more were both ineffective in
identifying patients who put forth a maximal
exercise effort (ie, peak RER, 1.10).
Perceived exertion was a significant
indicator (P=.04) of patient exertion, with a
threshold of 15 (6-20 scale) being an
optimal cut point.
Exertion does not lie
Description
Heiden,
Pinkstaff et al., Quantifying Exertion Level During Exercise Stress Testing

Using Percentage of Age-Predicted Maximal Heart Rate, Rate Pressure
Product, and Perceived Exertion. Mayo Clin Proc. December 2010
85(12):1095-1100; doi:10.4065/mcp.2010.0357
Rating
Faster, Better, Stronger,

Testa, Musolf, pg 215-7
Vern Gambetta Blog
, June 11, 2012

http://www.functionalpathtrainingblog.com/archives.html
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1.
2.
3.
4.
5.
6.
Duration of exercise
2008 Physical Activity Guidelines for Americans. US Dept of
Health & Human Services. www.health.gov. Adults 18-64 yrs
Mode
Intensity
Duration
Frequency
Progression
Variation
Minimum 2 hr 30 min/wk (150 min/wk) moderate

intensity or 1 hr 15 min/wk (75 min/wk) vigorous
intensity (or combination), at least 10 min episodes,
spread throughout week (intensity defn next slide)
E.g. 5x/wk @ 30 min moderate exercise
Aim for additional benefits with 5 hr/wk (300 min/wk)

moderate intensity or 2 hr 30 min/wk vigorous
intensity exercise (or combination)
Durations over 10 min, spread through

week, adding up to target time
29
2008 Physical Activity Guidelines for Americans. US Dept

of Health & Human Services. www.health.gov
Haskell et al., (2007) Physical Activity & Public Health. ACSM

Recommendation Statement. Med Sci Sports Ex. 39:1423-34
30
Minimum of:
30 min moderate intensity, at least 10 min
episodes, 5 days/week (= 150 min/wk)
i.e. 5x/wk @ 30 min moderate exercise
or
20 min vigorous intensity, 3 days/week (= 60

min/wk)
Note the use of a talk test to judge intensity of exercise

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1.
moderate intensity
vigorous intensity
2.
Noticeably
accelerates the heart
rate
e.g., Walking briskly
Rapid breathing and

substantial increase
in heart rate
e.g. Jogging
3.
4.
5.
6.
33
Frequency of exercise
Mode
Intensity
Duration
Frequency
Progression
Variation
34
Frequency of exercise
# training sessions / week

2008 Physical Activity Guidelines for Americans. US Dept of Health &
Human Services. www.health.gov. Adults 18-64 yrs
Exercise spread through week,

adding up to target time

Moderate intensity, 5 days/week

Vigorous intensity, 3 days/week
Note that with aerobic training (unlike resistance) it is common that

once a client is beyond the beginner stage, there is often no rest day
between 2 training days of the same tissues, to allow 4+ workouts/wk
Rest days most likely placed after higher volume (intensity &/or
duration) day
35
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1.
2.
3.
4.
5.
6.
Progression
Mode
Intensity
Duration
Frequency
Progression
Variation
37
1.
2.
3.
4.
5.
6.
E.g. 20 min run increased to 22 min next week
38
Maintain exercise intensity & duration

Frequency can be decreased (no less than
2x/wk)
Typically, frequency, &/or duration are increased first

Later, intensity must also be increased to continue to
stimulate aerobic capacity
General Rule: Limit increases to 10% per week
Maintenance of aerobic fitness
By increase in exercise intensity, frequency,

&/or duration
39
Mode
Intensity
Duration
Frequency
Progression
Variation
40
10
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Variation
LSD (Long Slow Distance)
Cross training: Variety in exercise mode

(across or within sessions)
Modifications in exercise intensity & duration
once base aerobic capacity is developed
LSD (Long Slow Distance) see next slide
Lower intensity and greater duration
Pace/Tempo Training see next slide

Interval Training -more after next slide
Brief (3-5 min) high intensity ( lactate threshold) and

longer lower intensity exercise (1:1 1:3 work:rest)
41
Vern Gambetta Blog: Feb 7, 2012

Long slow distance was a term coined to describe running at a
steady pace to develop the aerobic base. Unfortunately as it
evolved the emphasis was on SLOW. This is a huge mistake.
The result was proficiency at running slow for a prolonged
period. This has little carryover to racing, remember the goal of
training is to prepare to race. The emphasis in this method
should be on long steady distance. Select a degree of effort that
allows the runner to run a steady effort for the duration of the
distance with good running mechanics. This type of training
needs to be a means to an end. Unfortunately for many runners
it has become an end to itself.
42
Tempo Training
Interval Training
Intensity is generally between:
http://www.coreperformance.com/knowledge/training/energy-systemdevelopment.htm
High Intensity Interval Training

and
Steady state aerobic work
The New Science of Cardio
January 27, 2009
Overview: Energy System Development (ESD) is the cardiovascular

component of Core Performance training programs. The intensity of the
workouts is broken up into three different heart rate zones.
How It Works Forget everything you currently believe about cardio
work. Forget keeping your heart rate in some fat-burning zone.
Forget plodding along with the vague goal of increasing the
distance you can plod. Instead of training like a plow horse, start training
For more information see the article:

Optimal Tempo Training Concepts for Performance and
Recovery
August 27, 2014 by Derek M. Hansen
http://www.strengthpowerspeed.com/optimal-tempo-training/
like a thoroughbred.
Youll only work at the same effort level for an extended period of time, as you
would with traditional cardio exercise on regeneration or recovery days. But
youre going to take the time you typically spend on cardio and
develop the ability to perform at a more intense level. Youll improve
your energy levels, gaining physical strength and stamina without investing
additional time.
43
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Interval Training The usefulness of interval
Interval Training The science of designing
training for recreational athletes is now being explored
interval training workouts
Effects of high intensity training and continuous endurance training on

aerobic capacity and body composition in recreationally active runners
Journal of Sports Science and Medicine (2012) 11, 483-488
The aim of the study was to examine the effects of two different training programs
(high-intensity-training vs. continuous endurance training) on aerobic power and
body composition in recreationally active men and women and to test whether or
not participants were able to complete a half marathon after the intervention
period. Thirty-four recreational endurance runners were randomly assigned either to a
Weekend-Group (WE, n = 17) or an After-Work-Group (AW, n = 17) for a 12 weekintervention period. WE weekly completed 2 h 30 min of continuous endurance running
composed of 2 sessions on the weekend. In contrast, AW performed 4 30 min sessions
of high intensity training and an additional 30 min endurance run weekly, always after
work.
.
Only the improvements of VO2 peak were significantly greater in AW compared with WE.
Both groups completed a half marathon with no significant differences in performance (p
= 0.63). Short, intensive endurance training sessions of about 30 min are
Buchheit & Laursen, High-Intensity Interval

Training, Solutions to the Programming Puzzle.
Part I. Sports Medicine, 2013, 43:5, 313-338

Part II. Sports Medicine, 2013, 43:10, 927-954
High-Intensity Interval Training (HIIT) can stress

(i.e., train):
Aerobic system (one of the most effects means of

improving cardiorespiratory and metabolic function
Anaerobic system
Neuromuscular and musculoskeletal systems
effective in improving aerobic fitness in recreationally active runners

45
Interval Training The science of designing
Interval Training
The science of designing

interval training workouts. Buchheit & Laursen 2013
interval training workouts. Buchheit & Laursen 2013
46
1: WORK
INTERVAL
INTENSITY
Athlete must spend at least several minutes

per session reaching at least 90% VO2max
3: RELIEF
INTERVAL
INTENSITY
2: WORK
INTERVAL
DURATION
Nine different variables can be manipulated

to allow athlete to spend time above 90%
VO2max, AND to control stress (and training)
of anaerobic and neuromuscular and
musculoskeletal system
5: NUMBER
OF REPS IN
A SERIES
4: RELIEF
INTERVAL
DURATION
6: NUMBER
OF SERIES
8: BETWEEN SERIES
RECOVERY INTENSITY
9: EXERCISE MODALITY
7: BETWEEN SERIES
RECOVERY DURATION
RESTING LEVEL OF WORK
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Interval Training
Interval Training Tabata Training

TABATA et al., Effects of moderate-intensity endurance and high-intensity
intermittent training on anaerobic capacity and VO2max. Medicine & Science in
Sports & Exercise: 1996, 28: 10, 1327-1330 (in moderately trained young men)
An appropriate
pattern of work and
relief cycles
Tabata intervals:
Eight, 20 second all out exercise bouts
(170% VO2max) + 10 sec rest
Total workout duration=4 min!

Work time = 2 min 40 sec (does not
meet requirement in Buchheit & Laursen
2013 of several min at high work level)
5 days/week, 6 weeks
WILL
produce a
progressive increase
in fatigue and RPE
Steady state aerobic training:

60 min at 70% VO2max
5 days/week, 6 weeks
over the duration of

the session
49
Interval Training and fat loss
Tabata results:
VO2max increased by 7 ml*kg-1*min-1
Anaerobic capacity increased
significantly
Steady state aerobic training results:

VO2max increased by 5 ml*kg-1*min-1
No change in anaerobic capacity
50

CHALMERS 5-MINUTE
DISCUSSION OF FAT REDUCTION
51
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High-Intensity Intermittent Exercise and Fat

Loss, Journal of Obesity, Article ID 868305, 2011. doi:10.1155/2011/868305
Stephen H. Boutcher,
The effect of regular aerobic

exercise on body fat is negligible;
however, other forms of exercise
may have a greater impact on
body composition. For example,
emerging research examining
high-intensity intermittent
exercise (HIIE) indicates that it
may be more effective at
reducing subcutaneous and
abdominal body fat than other
types of exercise.
53

CHALMERS 5-MINUTE
DISCUSSION OF FAT REDUCTION
CONCLUSION
Wilson, et al., Concurrent Training: A Meta-Analysis Examining

Interference of Aerobic and Resistance Exercises, Journal of Strength &
Conditioning Research: 2012, 26:8, 22932307, doi: 10.1519/JSC.0b013e31823a3e2d
54
Exercise Dose (intensity, duration & freq)
Is it proven to be effective?
DO INTERVAL TRAINING TO LOSE FAT

(or develop your photo editing skills to make it look like you lost fat)
55
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4/8/2016
Michael Lauer, Editorial:
And What About Exercise? Fitness and

Risk of Death in Low-Risk Adults, J Am Heart Assoc. 2012;
1:e003228, published online June 27, 2012, doi:10.1161/JAHA.112.003228
Current US guidelines recommend that most adults seek to engage in at least

moderate-level exercise for 150 minutes a week (eg, 30 minutes a day for 5
days a week). Barlow and colleagues argue that their data support widespread
prescription of higher doses of exercise even among low-risk adults. To date,
though, there are no large-scale randomized trials supporting exercise
recommendations. One small trial of sedentary obese women found that as little as
72 minutes of exercise per week could lead to potentially meaningful improvements
in physical fitness. A large-scale observational study of >400 000 adults suggested
that even as little as 15 minutes of exercise per day predicted a 14% reduction in risk
of death. Some of us worry that that people might misinterpret public
health recommendations to mean that anything less than 150 minutes

of exercise per week is of no value and therefore not worth pursuing at
all. To add to the confusion, we now are aware of data suggesting that some adults
might be harmed by exercise. It is critically important to avoid oversimplifications that
overlook nuanced quantitative and qualitative issues:
57
Increase Your Chances of Living Longer

.
2. You don't have to do high amounts of activity or vigorous-intensity
activity to reduce your risk of premature death. You can put yourself
at lower risk of dying early by doing at least 150 minutes a week
of moderate-intensity aerobic activity. (Chalmers emphasis added)
Source: http://www.cdc.gov/physicalactivity/everyone/health/

Duck-chul Lee, et al., Leisure-Time Running Reduces All-Cause
J Am Coll Cardiol. 2014;64(5):472-481. doi:10.1016/j.jacc.2014.04.058.
VERSUS..
58
and Cardiovascular Mortality Risk,
Mortality Risk reduced by <51

min/wk, < 6 miles/wk, 1-2x/wk
(not by <6mph)
Can you do less than 150 min/week and

still get benefits??
Risk has similar level up to 120175 min/wk, 13-19 miles/wk,

5x/wk.
Risk INCREASES (still less than
sedentary) for 176 min/wk, 20
miles/wk, 6x/wk.
59
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Arem H et al., Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response
relationship. JAMA Intern Med. 2015 Jun 1;175(6):959-67. doi:10.1001/jamainternmed.2015.0533.
At LESS than 1x daily

recommended PA level, risk
decreases 20%

Lavie CJ, et al. Effects of Running on Chronic Diseases and Cardiovascular and All-Cause
Mortality. Mayo Clin Proc. 2015 Nov;90(11):1541-52. doi:10.1016/j.mayocp.2015.08.001
Follow-up to previous Duck-chul Lee, et al study,

combined with other studies concludes
Most (31%) benefit of risk

reduction occurs at 1-2x
recommended PA level (150
min/wk moderate PA)
Maximal (39%) benefit of risk

reduction occurs at 3-5x
recommended PA level
No significant elevated risk with
> 10x PA level
LTPA = Leisure Time Physical Activity

61
62

Lavie CJ, et al. Effects of Running on Chronic Diseases and Cardiovascular and All-Cause
Mortality. Mayo Clin Proc. 2015 Nov;90(11):1541-52. doi:10.1016/j.mayocp.2015.08.001
Chalmers CONCLUSIONS:
WALKING VERSUS RUNNING?? Is longer duration + lower intensity the same FOR
HEALTH as shorter duration higher intensity?
Less than current PA recommendations reduces risk of

all-cause mortality (and so IS useful).
Current PA recommendations may reduce risk of
all-cause mortality further.
Very high levels of PA may, or may
not, increase risk compared to
moderate exerciser.
63
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and Health Outcomes
Patel et al., Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults. Am J Epidemiol.
2010 Aug 15;172(4):419-29.Epub 2010 Jul 22.
Owen et al., Too Much Sitting: The Population Health Science of Sedentary Behavior, Exercise & Sport Sciences
Reviews: July 2010 - Volume 38 - Issue 3 - pp 105-113, doi: 10.1097/JES.0b013e3181e373a2
Hamilton et al., Too little exercise and too much sitting: Inactivity physiology and the need for new recommendations on
sedentary behavior Current Cardiovascular Risk Reports, Volume 2, Number 4, 292-298, doi: 10.1007/s12170-0080054-8
Owen et al., Too much sitting: a novel and important predictor of chronic disease risk? Br J Sports Med 2009;43:81-83
doi:10.1136/bjsm.2008.055269
Genevieve N. Healy et al., Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 200306. Eur Heart
J. first published online January 11, 2011 doi:10.1093/eurheartj/ehq451
Hidde P. et al. Sitting Time and All-Cause Mortality Risk in 222 497 Australian Adults. Arch Intern Med.
2012;172(6):494-500. doi:10.1001/archinternmed.2011.2174
Do the standard exercise

recommendations really work for
our sedentary population?
Exercise Dose (intensity, duration & freq) and Health

Outcomes
Do the standard exercise recommendations
really work for our sedentary population?
FINDINGS
Time spent sitting was independently associated with total

mortality, regardless of physical activity level. This means:
Even when adults meet physical activity guidelines,

sitting for prolonged periods can compromise
metabolic health and increase mortality.
65

and Health Outcomes
Reduction of too much sitting, or too few breaks from sitting,

should be included in physical activity and health guidelines.
Excess sitting should be considered a health hazard
Reduction in overall sedentary time is desirable.
Breaking up sedentary time, even without a reduction, is
beneficial.
66

and Health Outcomes
Do the standard exercise recommendations

really work for our sedentary population?
Similar FINDINGS in another study
Stamatakis E, et al., Screen-based entertainment time, all-cause mortality, and cardiovascular events
population-based study with ongoing mortality and hospital events follow-up. J Am Coll Cardiol. 2011
Jan 18;57(3):292-9.
Spending more than four hours a day sitting more than

doubles your risk of dying from or being hospitalized for heart
disease, even for those who exercise more than two hours (!)
per day.
Perhaps due to other unhealthy lifestyle factors associated with the

sitting, or due to elevated inflammation resulting from the sitting (blood
levels of C- reactive protein were elevated in the prolonged sitters).
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