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Exercise benefit outweighs the risk

Findings from the Physicians’ Health Study are consistent with much of the research that has focused on the benefits of exercise on our health and well-being, although it clearly underscores the risks of sudden exertion for those who are not well conditioned.

Although the Physicians’ Health Study was originally designed to look specifically at the benefits and risk of aspirin and beta carotene in the prevention of cardiovascular disease and cancer, many secondary studies have analyzed the huge repository of data. The findings of this study underscore both the benefit and the danger of vigorous exercise and make an important point for people who are interested in undertaking an exercise program. Vigorous exercise can increase the short-term risk of sudden death, but it also offers protection from this risk for those who exercise regularly.

This seeming paradox shouldn’t discourage anyone from considering an exercise program because the evidence of its benefits far outweighs its risks.

Look before you leap
Exercise should be approached from a very individualized perspective. It’s not one size fits all. There are cardiovascular and orthopedic issues that need to be considered before you lace up your running shoes.

Here’s what I suggest: It’s a good idea to see your physician before you embark on an exercise program if:

• You’re over 40 and haven’t exercised before
• You’ve been sedentary for many years
• You have risk factors such as hypertension, hypercholesterolemia (high blood levels of cholesterol), a positive family history of premature cardiovascular disease, or if you have cardiac disease.

Your physician might think it makes sense for you to have a stress test, which I personally think is a reasonable strategy. A stress test is monitored exercise on a treadmill or stationary bicycle in a doctor’s office or hospital. It’s helpful in determining safe levels of exercise, especially if you have angina or other symptoms of coronary disease.

Developing an exercise plan
Once you have your physician’s approval, I recommend giving some consideration to putting together a formal graduated program. Keep a notebook and set goals for yourself. Start at a low level and gradually, over time, increase both the intensity and duration of your exercise, whether it’s walking, running, swimming or aerobics.

I emphasize to my patients who are starting to exercise seriously for the first time that this is the beginning of something they should do for the rest of their lives. It’s not something you’ll accomplish in a month or two months.

Starting at a low exertion level is important for the health of your heart and also for the safety of your joints and muscles. There’s nothing more discouraging than finally making a commitment to leave sedentary life behind and then develop a hip problem or knee problem that makes it difficult for you to continue.

It’s also important to learn how to exercise the right way. Stretching is vitally important, but many people begin their sessions with stretching when their muscles are cold and prone to tearing. Start your activity at a low level, warm up gradually, complete your workout and then stretch. Some of my patients either do some reading about exercise or consult with a personal trainer to get them on the right road.

Weight work and cross training spread the stress
As we get older, it’s important not to just do aerobic exercise, which includes activities like running, bicycling and walking. You should also consider some low level weight work, which can help in several ways. It tones your body and makes you look and feel better, and it also increases your lean body tissue and reduces fat. The more muscle you have, the higher your metabolism and the more calories you burn, which makes it easier to keep your weight under control. And there’s more—weight work can help you build bone density—a particularly important benefit for women who may be at risk for osteoporosis.

Cross training is also one way for you to exercise frequently and avoid stress injuries. If you go to a gym, vary your cardiovascular workout by alternating sessions on the treadmill, bicycle and Nordic track. This routine will relieve the stress on any one group of muscles and joints and help you avoid injury.

Exercise for life
How often should you exercise? I recommend working out four days a week to my patients. Three days will be beneficial, but five days is probably optimal. And don’t forget to incorporate movement into your daily life. Skip the elevator and park farther away from the grocery store. It all adds up. Exercising becomes a way of life, and those who get the go-ahead from their physicians will find it helps weight control, relieves stress, increases energy, lowers blood pressure, improves your cholesterol profile and decreases your risk of developing heart disease.

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Dr. Zaret is chief of cardiovascular medicine at Yale-New Haven Hospital, medical director of the Yale-New Haven Heart Center and professor and chair of cardiovascular medicine at the Yale University School of Medicine.