Why exercise?

Exercise may save your life! Physical exercise on a regular basis can help prevent heart attacks and strokes.

Fundamentals:

• Every year in the USA there are 1.25 million heart attacks and 750,000 strokes
• Over 50 million people suffer from arterial hypertension (high blood pressure)
• Over 20 million people are diabetics. Over 50 million have metabolic syndrome.
• 300,000 suffer bone fractures
• Over 65% are overweight
• Over 35% are obese
• Over 110,000 new cases cancer of the colon are diagnosed

Multiple statistical studies prove that regular exercise has beneficial effects:

1) Reduces the incidence of premature cardiovascular death
2) Reduces the onset of diabetes and metabolic syndrome
3) Reduces the onset of arterial hypertension
4) Reduces blood pressure in people that have high blood pressure already (BP higher than 130/85 mmHg)
5) Reduces the incidence of cancer of the colon,  breast and uterus (endometrial cancer)
6) Maintains normal weight (BMI or body mass index of 25-26)
7) Strengthens muscles, joints and bones (prevents osteoporosis or softening of the bones)
8) Reduces bone fractures
9) Reduces the incidence of depression and anxiety
10) Improves immunity (possibly through endorphins)
11) Promotes feeling of well being and enhances optimism

Types of exercise:

Aerobic exercise (aeros= oxygen) consumes oxygen, involves motion of different segments of the body. Examples are walking, jogging, running, biking, dancing, swimming, tennis playing, basketball, skiing. Any of these activities are highly recommended.

Isometric exercise primarily increases the muscular tone by sustained contraction of the agonist versus the antagonist (opposing) muscles. It contributes to firm bodybuilding, but increases blood pressure, and may precipitate serious cardiovascular events (heart attacks, strokes). Examples: weight lifting, Greco-Roman fighting, boxing, some forms of wrestling.

What is the physiological effect of exercise? Why does it help?

Exercise facilitates normal activities. Routine exercise maintains the neuro-osteo-muscular complex in optimal condition (nerves, bones, muscles and joints) preparing your body for unforeseeable events. When an individual trains or exercises regularly, coordination and efficiency of the body are maximized. Any form of physical activity in a trained individual demands less effort and oxygen consumption. For instance, a person who exercises regularly can walk further and faster than a person who leads a sedentary life. The cardio-respiratory system responds to training by becoming more efficient. In the trained individual, the response to exercise shows less rapid pulse and less shortness of breath for any given activity. Those that exercise regularly also have less falls and less back strain.

Exercise burns calories. This leads to loss of excess weight. Walking 15 minutes daily at a normal speed (2 MPH) burns, in an average individual (150 lb), 100 calories. More calories are burned when a heavier person walks. Doing this 7 days a week will produce a loss of 10-15 lbs per year if the diet remains unchanged. The list below shows calorie expenditure per hour in common activities:

• Sleeping = 90 cal.
• Sitting quietly watching TV = 84 cal.
• Sitting at the desk working with a computer, writing or playing cards = 114 cal.
• Walking at a normal speed (2 MPH) = 200 cal.
• Doing light house work = 246 cal.
• Bike riding = 174 cal. with intermittent coasting
• Volleyball playing = 264 cal.
• Bicycling (13 MPH) = 612 cal.
• Horse back riding = 246 cal.
• Swimming = 288 cal.
• Tennis Playing = 312 cal.
• Scrubbing floors = 440 cal.
• Aerobic Dancing = 546 cal.
• Jogging I mile = 654 cal.
• Racquetball playing = 588 cal.
• Cross-country skiing = 690 cal.

(Source: William D. McArdle “Exercise Physiology: Energy, Nutrition and Human Performance” Philadelphia 1986)

Remember: you must burn or reduce your food intake by 3500 calories to loose a pound of body weight. 

Exercise produces endorphins. Endorphins are natural substances produced by the pituitary gland located at the base of the skull. Dr. Choh Li, from Berkeley University isolated these compounds in the mid 60’s and named them B-lipotropins. They are composed of a chain of amino acids that act on certain receptors in the brain. Dr. Avram Goldstein, from Stanford University, reported the location of these receptors in 1972. Endorphins have the ability to give a sensation of well being, eliminate pain, boost immunity (resistance to infections) and combat depression. Exercise, as well as laughter and meditation induce the production of endorphins. In some individuals it can lead to an “addictive state” such as the case of the “runners high” described by some long distance runners who need to run addictively.

Optimal exercise routine: How much, how long, where and when to exercise?

• The simplest and safest exercise is walking. Strive to walk two miles at a normal to fast pace (2 MPH) for 20 to 30 minutes five days a week. To avoid heat exposure, mosquito bites, try doing it in a mall or enclosed school campus, if available. A treadmill or stationary bike is a good substitute for outdoor walking.
• Any form of aerobic exercise is healthy and should be practiced in appropriate manner for your age and experience. Prior to starting a routine, serious exercise program that results in a fast pulse (150 and over per minute), an individual should have a stress test under medical supervision.
• Over the age of 40, a male or female should have a stress test prior to an exercise program. It is necessary to know baseline values and limitations. Remember Clint Eastwood said “A man ought to know his limitations.”. Exercising abruptly without regular training could prove to be catastrophic.
• An exercise program should be built up gradually over several months. It is helpful to determine the “target heart rate” before beginning to exercise; there are tables with weight and age that predict the appropriate heart rate. As previously mentioned, this is best determined after a stress test. A simple rule: Begin with 220, deduct your age and the target heart rate is 85% of that number. Trying to exceed your target heart rate may be dangerous.
• It is best to exercise early in the day, never following a heavy meal. The period of exercise should have three portions: warm up or acceleration, plateau or peak and deceleration. Gradual slowing down is imperative. Never stop exercise abruptly. A good program will take 45 minutes with 3 portions of equal time.

Are there any dangers posed by exercising?

Yes, too much, too soon. An abrupt increase in physical activity by the untrained individual poses a great danger. At least 60-75% of people over the age of 45, have “arteriosclerotic lesions” or “plaques” in the coronary arteries (heart) or in the cerebral arteries (brain). These lesions are dormant and do not show symptoms for a long time. However, if a strenuous activity is performed, or even a sudden state of anxiety is experienced, the rupture of a lesion (plaque) could take place. This may trigger a heart attack or stroke. It is not unusual to see events like these in the northern part of the country during the winter after the first snowfall. Untrained, sedentary individuals shovel snow for a few hours and end up in intensive care if they survive the initial blow of the event. People with cardiovascular disease should be in a sensible, progressive exercise program, preferably under the guidance of a physician or certified physical trainer.

Common questions:

Q: Why don't people exercise enough?
A: Some common excuses people use:
1) It is easier to do nothing.
2) There's seems to be too little time.
3) It can be physically uncomfortable at first.
4) Some forms of exercise can be boring.
5) You don't have the right equipment.
6) You feel "too tired".

Q: What can you do to combat RESISTANCE to exercise?
A: Find activities to make exercise fun such as:
1) Music, group activities, a walking partner, a team sport, a VHS or DVD program, a club (walking or jogging).
2) Experiment. Through trial and error find out what suits you.
3) Try walking first. It's the easiest and cheapest. Vary your walking route if you get bored.
4) If you like a predictable routine, try walking or doing calisthenics every morning or every evening.
5) If you like beauty and symmetry in your life, try Tai-Chi, Yoga, Pilates, Jazzercise, Aerobics or Dance.
6) If you like competition, try tennis, racquetball, baseball or basketball.
7) If you think you like kickboxing or "iron man" training, try it.
8) Take a free trial day at your local YMCA to experience the treadmill, stationary bike, or other equipment.
9) Try new local programs.

Q: What should I think about before I do my trial and error search for appropriate exercise?
A: The following should help you with your search:
1) Identify the form of exercise that is least taxing for you.
2) Identify the exercise routine that you believe will be fun.
3) Decide if you prefer to work out alone or in a group atmosphere.
4) Remember doing something is better than doing nothing.
5) Remember to start slowly with 5 minutes a day and gradually work up to 30 to 45 minutes a day.
6) Always warm up and cool down.
7) If you are over age forty or prone to cardio-vascular disease, a stress test is required before beginning a new exercise program.

Q: I am walking to loose calories as well as to keep myself in shape. How do I know the distance I am walking?
A: A city block is about 1/10 of a mile. The average person walks about two miles per hour. If you prefer accuracy, you can use a pedometer to accurately measure the distance you walk.

Q: Is it true that you should not stop exercising abruptly?
A: Yes, definitely. Stopping quickly puts an unnecessary strain on your whole body because it has geared up and will not be able to disperse chemicals gradually through a cool down process. For example, if you stop exercise abruptly, too much adrenalin may remain in the blood stream causing other negative effects.

Q: Is stretching as good as aerobic exercise?
A: It is best to do all three types of exercise: aerobic, strengthening, and stretching. It is important to do stretching exercises to maintain flexibility as well as strengthening exercises in addition to aerobic exercises such as walking, biking, dancing, or jogging.

Q: Is it true that some people die suddenly from exercise?
A: Yes. In some young people there is a condition called hypertrophic cardiomyopathy or IHSS (idiopathic hypertrophic sub-valvular aortic stenosis) that restricts blood flow from the heart. They can die suddenly from strenuous effort. This is a genetic disorder and may affect as many as 1 in 500 individuals, mostly males. A simple echocardiogram can make the diagnosis. Another condition is due to electrical abnormalities in the right ventricle of the heart, which may produce fatal arrhythmias, such as “The Brugada Syndrome”. In other individuals with arteriosclerosis a heart event can be precipitated by excessive effort if they have not undergone previous physical training and conditioning. Physical training on a regular basis can help prevent unnecessary heart events.

Q: Besides diet, exercise and conventional medications does Alternative Medicine have any role in the management of cardiovascular diseases?
A: Yes. Alternative medicine such as Acupuncture, Meditation & Yoga and the vast field of Herbology (study of herbs). can sometimes compliment traditional medicine.

Acupuncture has been practiced by the Chinese for thousands of years and has gained gradual respect in Western Medicine. Dr. Longhurst & Associates from the University of California, Irvine are conducting serious studies for the evaluation of acupuncture. The insertion of a needle in the hand above the palmar crease called "Neiguan" reduces blood pressure, angina and arrhythmias episodes. The mechanism of action is thought to occur through the release of peptides (endorphins-like) by the brain. Patients with angina have been able to do more exercise with this technique. Because of the effects on the autonomic nervous system, possible applications of acupuncture for patients with heart failure is being investigated by Dr. Holly Middlekauff at the UCLA School of Medicine.

Meditation & Yoga: Dr. Herbert Benson of Harvard, founder of the MBMI (Mind/Body/Medical Institute) focused on teaching patients to induce "the relaxation response" to counteract the fight-or-flight response which accounts for elevation of the blood pressure, heart rate, metabolism and respiratory rate. Any disorder worsened by stress benefits from meditation and yoga exercise. Combating depression with yoga and meditation reduced the mortality in patients undergoing bypass surgery to 1/2 - 1/3 of the control groups (800 patients from Duke University, reported in Lancet in August 2003). 

Herbology: Herbs have been used since the beginning of time. The best example is the use of digitalis for heart failure which was used for many years before Dr. William Withering. The use of digitalis was integrated into acceptable medicine In Scotland, 1775. Withering learned about the use of foxglove or digitalis purpurea from a gypsy. At present there are thousand of herbs being used and misused with, as expected, equivocal results. The following website from the Sloan-Kettering Cancer Institute is the most reliable source of information in the field: About Herbs, Botanicals & Other Products.

Revised July 19th 2007