If you could put exercise in a pill, it would likely be the most frequently prescribed medication in the world. Unfortunately, many of us find exercise to be a tough pill to swallow. Exercise has been claimed to reduce the risk of many chronic diseases and to enhance the quality and maybe even the quantity of life.

You might think you already got the message, but some new twists have been added to previous exercise recommendations by the American College of Sports Medicine.

Question: What are the key ACSM recommendations for exercise?

Answer: The ACSM recommends that healthy adults regularly engage in four types of exercise: at least 150 minutes per week of cardiorespiratory exercises like jogging and biking; resistance exercise (strength building) two or three times a week; flexibility exercise on at least two or three days a week; and neuromotor exercise on two or three days a week.

Q: Why are all four types of exercise recommended?

A: Each type of exercise provides different aspects of fitness. Together, they lead to overall body fitness associated with reduced risk of chronic disease and optimal function in activities of daily living.

Cardiorespiratory exercise, as the term implies, benefits heart and lung health along with muscle endurance. Resistance exercises like weightlifting not only build strength and muscle mass, but also benefit bone health, blood glucose control and blood pressure. The recommendation to achieve 150 minutes over a week is equivalent to expending about 1,000 calories a week.

Flexibility exercises help to maintain normal ranges of joint flexibility. Since this type of flexibility tends to decrease with aging, flexibility exercise becomes increasingly important during the latter years of life. Basic tasks like tying shoelaces or reaching to the top shelf in the kitchen can become impossible when flexibility is lost.

Neuromotor exercises are those that train skills like balance, coordination, gait and agility. Activities like tai chi, qigong and yoga involve a combination of neuromotor and flexibility exercises. The resulting maintenance of balance and agility helps to reduce the risk of falls and enhance the ability to handle a fall without injury.

Q: How should the recommended 150 minutes of weekly cardiorespiratory exercise be accumulated?

A: The general recommendation is to exercise at least 30 minutes a day on five days a week. However, three 10-minute bouts of exercise appear to provide the same benefit as one 30-minute bout. Conversely, longer bouts of exercise conducted on a few days per week provide similar health benefits. The jury is still out on the "weekend warrior" approach, but there is some evidence that it is beneficial for men unless they have cardiovascular disease risk factors.

Q: Are there risks related to increasing exercise?

A: Yes. Poorly designed exercise programs can increase the risk of heart attacks and muscle and joint injuries. The ACSM recommendations provide guidelines for health and fitness professionals to design exercise programs for individuals. Consequently, the guidelines emphasize the importance of personalized exercise programs that account for an individual’s current level of fitness. For most people, this means gradually increasing physical activities over time to eventually reach the recommended levels of weekly activity.

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Joannie Dobbs, Ph.D., C.N.S., and Alan Titchenal, Ph.D., C.N.S., are nutritionists in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii-Manoa. Dobbs also works with University Health Services.