Getting Started with Exercise
Exercise is one of the most well-supported, evidence-based interventions in musculoskeletal medicine. Whether you are managing spine pain, recovering from an injury, or simply trying to stay ahead of the damage that accumulates from a sedentary lifestyle, movement is medicine — and the dose matters.
When I recommend exercise to my patients, the goal is always to exercise to your toleranceand progressively work toward meeting the minimum thresholds that the evidence supports. This guide lays those out plainly, with practical entry points for people who are not already in a gym routine.
The Minimum Weekly Exercise Guidelines
These targets are set by the American College of Sports Medicine (ACSM) and represent the minimum associated with meaningful health benefit — reduced pain, improved function, lower cardiovascular risk, and better musculoskeletal resilience.
Cardio Goal: 150 minutes / week of moderate-intensity exercise
Strength Goal: 2 full-body resistance training sessions / week
If you cannot hit these numbers right away, that is completely fine. Start where you are. Any movement is better than none, and consistent moderate effort beats sporadic intensity every time.
Part 1: Cardiovascular Exercise
Moderate intensity means you are working hard enough that holding a conversation is possible, but singing would not be. On a 1–10 effort scale, you are around a 4–6. Your heart rate is roughly 50–70% of your maximum (a rough estimate: 220 minus your age).
The 150 minutes does not have to be done in one block. Breaking it into 10-minute chunks throughout the day is equally effective — the evidence is clear on this.
Walking
The most accessible starting point for most patients. Brisk walking — where you are slightly breathless but can still speak in full sentences — counts as moderate intensity. Start with 10–15 minutes and build from there. Flat terrain first; add hills as you tolerate.
Stationary or Regular Cycling
Low joint impact, making it an excellent option for knee, hip, and lumbar conditions. Most gyms have stationary bikes, and entry-level upright models are affordable for home use.
Swimming / Water Walking
Water buoyancy offloads the joints substantially. If standing or walking causes significant pain, pool-based activity is often the best starting point. Water walking does not require swimming ability.
Elliptical Trainer
Low-impact and weight-bearing, mimicking the walking and running pattern without the ground reaction forces. Available at most gyms.
Recumbent Bike
Seated cycling with back support — well tolerated in lumbar and hip conditions, and widely available for home purchase across a range of price points.
Part 2: Full-Body Resistance Training
Resistance training means working your muscles against a load — your own bodyweight, a resistance band, or dumbbells. Two sessions per week targeting all major muscle groups is the minimum. Each session takes about 30–45 minutes at an easy pace.
The routine below is intentionally simple and equipment-optional. If any exercise causes significant pain beyond mild muscle fatigue, skip it and bring it up at your next visit.
Key Principles Before You Start
Warm up 5 minutes with light walking or gentle movement
Move through a controlled range of motion — slow and steady beats fast and sloppy
Rest 60–90 seconds between sets
Mild soreness 24–48 hours after a session is normal; sharp pain during exercise is not
Progress by adding reps or light resistance once a movement feels easy for 2 weeks in a row
Equipment needed: None for the bodyweight version. A set of resistance bands ($10–20) and a pair of light dumbbells (5–15 lbs) expands your options significantly. Both are available at any large retailer.
LOWER BODY EXERCISES:
Sit-to-Stand (Chair Squat) - Rise from a chair without using your hands. Too easy: pause 2 sec at the bottom.
Standing Hip Hinge - Hinge at hips, slight knee bend, back flat. The foundation of the deadlift pattern. Add light dumbbells when ready.
Calf Raises - Hold a chair or wall for balance. Progress to single-leg when both legs feel easy.
UPPER BODY EXERCISES:
Wall Push Up (or Pushup) - Hands on wall at shoulder height. Move feet further back to increase difficulty.
Resistance Band Row - Anchor band to a door handle. Pull elbows back and squeeze shoulder blades at end range.
Overhead Press - Light dumbbells or resistance band. Press straight overhead, lower with control.
Bicep Curl - Dumbbells or band. Elbows stay at sides throughout.
CORE EXERCISES:
Dead Bug - Lie on your back, arms pointed up. Slowly lower the opposite arm and leg while keeping your lower back pressed flat to the floor.
Bird Dog - On hands and knees. Extend the opposite arm and leg, hold 2 seconds. Keep your spine stable — no rotating.
Glute Bridge - Lie on back, feet flat on the floor. Drive hips up and squeeze glutes at the top.
Modified Plank (Knees Down) - Forearms and knees down, body in a straight line from knees to head. Build hold time gradually.
Practical Tips for Getting Started
If you have not exercised in a long time, start with one resistance session per week and build from there
Breaking cardio into 10-minute chunks throughout the day is equally effective as a single longer session
Consistency over intensity — a modest routine done regularly outperforms an aggressive one done sporadically
Hydrate before, during, and after exercise
Tracking sessions — even on a paper log — builds the habit and shows you the progress you might otherwise not notice
Bring any new or worsening pain to your physician before continuing
Download the PDF here with suggested exercises!