With everything else in place – your hips lifted, your neck long and straight – the ball-and-socket joint of the shoulder should be liberated and your arms should shuffle themselves quite freely and intuitively into the right movement pattern. Except that it’s not quite that simple: if you want to use them as agents of acceleration, and you do, you have to use more deliberation. Move your arms across to the centre of your body and then quite far back.

If it’s too difficult to walk for 30 minutes at one time, do regular small bouts (10 minutes) three times per day and gradually build up to longer sessions. However, if your goal is to lose weight, you will need to do physical activity for longer than 30 minutes each day. You can still achieve this by starting with smaller bouts of activity throughout the day and increasing these as your fitness improves.


Aerobic exercise is indicated for patients who lack the ability to sustain activity for a desired period of time because of decreased cardiovascular efficiency. Oftentimes, these patients have complaints of fatigue with a given level of exercise. Aerobic exercise increases the body’s capacity to absorb, deliver, and utilize oxygen. However, there are some limitations to being able to use aerobic conditioning for older adults. Joint pain and/or muscle weakness may preclude a patient from being able to perform the multiple contractions needed to provide a cardiovascular stimulus. In those cases, strengthening exercises may be needed prior to attempting aerobic exercise. For example, when an individual who is not on β-blockers walks 200 m on the 6MWT, but the heart rate only increases 10 beats per minute (bpm), the assumption can be made that the individual was not able to exert enough effort to increase heart rate and that a lack of muscle strength may exist.30 
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