BehindTheMedspeak: Why the hardest part of exercising is getting started

The graphic above, which accompanied Howard Schneider's January 29, 2008 Washington Post Health section weekly column entitled "The Misfits," says it all.*

If for some reason you find it doesn't, read the column, which appears below.

Warm-Up Advice From an Ancient Master

We've all heard Confucius's aphorism about the journey of a thousand miles. What I want to know is: Did he actually ever try taking that first step?

Because, boy, is it a doozy. You're sluggish, struggling for breath, and wondering whether you should grow a goatee and handlebars and take up a life of contemplation. You tell yourself that things will be better a little ways down the road, but it's a hard sell.

Let me see if I can make it easier. I have had more than one workout spoiled by the agony of those first few minutes (starting out too fast, and feeling lousy for the duration), which made me want to understand more about what's happening inside the body during that time. It turns out that all those lectures about warming up — from Coach Blunderbuss in phys ed class to the peppy hecklers at the local gym — have a point, though the usual okay-let's-get-your-body-ready-to-move mantra doesn't quite capture the story.

A lot happens when you move from rest to sustained motion, whether you are starting out on a run, riding a bike or trekking up a hill. Until that start-up process is complete, whatever you're doing is going to feel labored.

At rest, your body devotes its attention to the parts that need it: the brain and other critical organs like the kidney and liver. The muscles pretty much get ignored, shut off from all but a trickle of blood.

As movement increases, capillaries leading to the muscles start to open and carry the blood where it is suddenly demanded. Your heart begins not just beating faster to accommodate, but also increasing — perhaps as much as doubling — the amount of blood it pushes out with each beat. The muscles become a sort of pump to help this happen: The contractions that lead to motion also help push blood back to the heart through the veins.

A slight, perhaps one-degree rise in internal temperature, meanwhile, helps further a series of chemical reactions in which your body cycles through different methods of producing energy.

I won't try to describe the whole process. I can't even spell all the words. But here's the gist:

The substance that allows your muscles to contract is called adenosine triphosphate, or ATP. Your body has several ways to synthesize it using such materials as creatine, lactic acid, glycogen and a bunch of enzymes, all present in the body. A couple of those methods can be tapped quickly to support an increase in activity — when you pop up the stairs from the company lunchroom, for example, or run a sprint.

However, those initial energy sources can keep pace for only the first few minutes. After that, the body turns to its real energy powerhouse: aerobic glycolysis, a process in which glucose (the basic sugar that the body uses for fuel) is broken down with the aid of oxygen to produce ATP. It's a very productive system, by some estimates yielding 30 or more molecules of ATP for each molecule of glucose. That's why it can sustain all those crazy bouts on the elliptical, not to mention a marathon run.

But it takes time to stoke up. In the interim, we suffer.

"[The process] is physiological, but it becomes a psychological issue," said Walt Thompson, a professor of kinesiology and health at Georgia State University in Atlanta. "The first half-mile [of a run] is like, 'I am going to quit.'... But I know exactly where I am going to feel better."

Carla Sottovia, an exercise physiologist and assistant fitness director at the Cooper Fitness Center in Texas, said those first few minutes of exercise amount to a state of oxygen deprivation, with the body struggling to keep up with the suddenly increased demand, then finally reaching a steady, sustainable state.

It's a feeling that can be particularly discouraging for beginners, mistaken as a sign of being out of shape (only partially true) instead of understood as a manageable transition into exercise.

"The first minutes you may be out of breath, you don't feel you have a normal rhythm, you are actually in oxygen deficit," Sottovia said.

The trick, of course, is warming up, giving your body a chance to prime itself before the real work begins.

It doesn't much matter what you do. You can dedicate time and specific exercises to the process — sets of jumping jacks or push-ups, an easy ride on the stationary bike — or you can simply begin your workout at an intensity light enough that the body's energy systems never fall behind.

The pace might seem ridiculously slow. But that first step, and the second, will come a whole lot easier. And as Confucius said: "To learn and to practice what is learned time and again is pleasure, is it not?"

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*The legend for the graphic up top reads, "When the muscles are inactive, as little as 15% of the blood circulating through veins and arteries is used to support them, with the bulk focused on the brain, kidneys, liver and other vital organs. During exercise, the ratio reverses. A network of capillaries opens and blood starts flowing to skeletal muscle. The chart shows the distribution of cardiac output at rest and during exercise."

An idle (literally) thought: It would be advantageous (and quite profitable) if someone could figure out a way to shift the blood flow distribution in a lazy individual like me to exercise mode through some sort of mechanical (or virtual) intervention, instead of my having to rely on (mostly futile) daily attempts to overcome my physical inertia by will power.

The trick is to make it more uncomfortable — both mentally and physically — not to exercise than to get up and moving.

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