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[EXERCISE ADVISER]

Heart Health for a Lifetime: Sound Exercise Choices

Barry A. Franklin, PhD with James R. Wappes

THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 11 - NOVEMBER 97


Craving the couch over exercise is bad for your heart. According to the American Heart Association, inactive people have a much higher risk of a heart attack or other heart problems than those who are physically active.

How do you lower your risk of heart disease? Well—get off the couch! A lifetime of good exercise habits will do wonders for your heart, but you can start at any age. This article will help you begin. Remember, too, that eating a low-fat diet and avoiding high-risk behaviors like smoking are also crucial.

Increasing Activity

There are two keys to adding activity to your life: (1) Start slowly and progress gradually. (2) Think of exercise as something you do all day.

With this focus, start retooling your lifestyle. But instead of radically changing your schedule to fit in exercise, get creative with your current routine. If watching TV or reading the newspaper is part of your day, you can ride a stationary bicycle while you're doing it—adding 30 to 40 minutes of exercise a day. Activate your body as much as possible with household chores and by walking or biking on short errands.

Other activity-increasing tips include parking a mile from work and walking briskly from there (which will add 10 miles of walking each week!), parking your car at the farthest end of a mall parking lot, having only one phone in your home, golfing without a cart, switching to a manual lawn mower, taking the stairs instead of the elevator, and walking the dog more often.

To add even more activity, try taking up gardening or going for short walks. If you walk each day, increase the distance. If you run a few days a week, try running five days, or add in-line skating, swimming, or another workout to the "off" days.

Upping Aerobic Output

Once you've overhauled your everyday life, focus on getting more aerobic exercise, which fights heart disease like no other type. Aerobic exercise means using large muscle groups (like in your legs) in a continuous, rhythmic fashion for prolonged periods. In doing so, your heart rate typically increases to 70% to 85% of its maximum. (Remember that although vigorous aerobic exercise is best for boosting heart fitness, your overall health will improve when you exercise at less strenuous levels.)

Medical clearance. Because aerobic exercise stresses your heart, get clearance from a doctor before you start your program if you are very inactive, quite overweight, or middle-aged or elderly. Medical clearance is also important if you have several other risk factors for heart disease, like smoking, high cholesterol, high blood pressure, diabetes, or a family history of heart disease.

Some people worry about having a heart attack while exercising. Your risk is a bit higher during a workout than while resting. But inactive people are at a greater overall risk of heart problems than are regular exercises. In addition, you can minimize the risk by listening to your body and stopping when you feel pain or pressure anywhere from the neck to the navel, dizziness, an abnormal heart rhythm, or nausea.

Warm-up and cool-down. Before beginning any aerobic activity, you need to warm up. Prepare your muscles and raise your heart rate gradually by doing calisthenics and stretching for 5 to 15 minutes followed by several minutes of light aerobic activity like walking. After your workout, cool down by walking and stretching for at least 5 minutes.

Frequency and duration. You may have been told to do aerobic exercise for 20 to 30 minutes three times a week (60 to 90 minutes a week). But this is a minimum goal; aim for it at first, but, if possible, gradually increase to a total of 3 to 4 hours weekly (only 1/2 hour a day).

Intensity. Work out at a level that feels fairly light to somewhat hard. You may sweat and breathe hard, but should not gasp for breath.

If you know how to take your pulse, count it for 10 seconds and multiply by six to get your heart rate in beats per minute. To estimate your exercise heart rate, subtract your age from 220. Then multiply this figure by .70 (70%) and .85 (85%) to get your target range during exercise.

Individualized Workouts

Aerobic activity has little value if it's not done regularly (see "Sticking With It" below). To keep your program going, you need to choose an activity you enjoy. Better yet, pick several and alternate among them.

Walking. In terms of availability, cost, skill required, and enjoyment, it's hard to beat walking. Walking is an especially good exercise for those who have been inactive. Start with good walking shoes and whatever you can do at a pace that makes you pleasantly tired. Work up to 20 to 30 minutes a day, then go beyond that.

Running or jogging. By picking up the pace, you can burn more calories and get a better workout in less time. But because running or jogging involves more pounding on the legs, it also causes more injuries. To ensure safety, buy good running shoes, warm up, run on forgiving, smooth surfaces like a track or asphalt, and stop if you feel pain.

Biking. Bicycling does not involve the pounding of running, but accidents can happen. It, too, provides an excellent aerobic workout, and the risk of serious injury can be reduced greatly if you wear a helmet. Adjust the seat so your knees are slightly bent when the pedals are closest to the ground.

Swimming. Water exercises are the gentlest aerobic activities because the water buoys your body and cushions the joints. Swimming also works muscles throughout the body. It provides a superb workout for people who have arthritis or other muscle or bone problems. If you can't swim, you can simply jog in shallow water or don a life preserver and "jog" in deep water.

Swimming, though, is not as accessible as land exercises. In addition, you need to work harder than you would on land to raise your heart rate to the same level.

Aerobic dance. Aerobic dance classes offer built-in camaraderie and structure—two great incentives for sticking with your program. This activity works all the major muscle groups, and you may find the variety of moves fun. Proper footwear and lower-impact aerobics decrease the risk of injury.

Additional exercises. Other good aerobic options include in-line skating, rowing, cross-country skiing, and ice skating. Vigorous singles racquetball or squash and full-court basketball, though not purely aerobic, can contribute to heart health.

Exercise machines. Stationary bikes, cross-country ski machines, stair-climbing machines, treadmills, and rowing machines can all provide a good aerobic workout. They offer convenience and low injury rates, and many allow you to read, watch TV, or listen to music while getting your heart pumping.


Sticking With It

In combination with a healthy diet and other sound choices, regular exercise is an important safeguard against heart disease. But regular is the key. Here are some tips for making workouts stick:

  • Choose activities you enjoy, and include a variety.
  • Work out with a friend or three.
  • Keep a log of your progress.
  • Set realistic goals. Try to improve gradually over weeks.
  • Schedule periodic fitness testing. Having your doctor show you your reduced body fat, increased fitness, and lower
  • cholesterol can be a great motivator.
  • Establish a schedule. Early morning works for some, while others do better with a noontime or late afternoon workout.
  • Treat your exercise session as an unbreakable appointment!

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Franklin is the director of the Cardiac Rehabilitation Program and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Michigan. He is also a professor of physiology at Wayne State University School of Medicine in Detroit and an editorial board member of The Physician and Sportsmedicine. James Wappes is a senior editor with The Physician and Sportsmedicine.


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