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LIVING A DYNAMIC, ACTIVE LIFE AFTER HEART ATTACK: THE BENEFITS OF EXERCISE
Physical activity does so many good things for you that if it were bottled the advertising would make it sound just too good to be true. Here’s a list of advantages that puts the situation in a nutshell.
Physical activity decreases:
blood pressure resting heart rate vulnerability to cardiac arrhythmias
abnormal blood clotting
effects of stress on the body
depression
cholesterol levels
triglycerides
high blood sugar levels
glucose intolerance
body fat
Physical activity increases:
blood flow to muscles including the heart
blood vessel size
heart muscle efficiency
oxygen usage efficiency
HDL “good” cholesterol
muscle mass
insulin sensitivity
metabolic rate
Now let’s take a closer look at the role exercise can play in your life. In its report on cardiac rehabilitation and exercise for the US Department of Health and Human Services, the US Public Health Service listed chapter and verse extolling the virtues of physical activity. The authors reviewed the available medical literature and concluded that exercise facilitates the ability of muscle, including the muscle of the heart, to extract oxygen from haemoglobin in blood. Blood flow to the muscle also goes up. The result is that muscle can do greater levels of work with less effort. When the heart muscle needn’t work so hard, the episodes of angina go down.
Your heart will also get more blood pumped to it, as the size of vessels increase and the number of tiny arteries increases. The latter is called collateral circulation, which we mentioned in the last chapter. All this means more oxygen getting to your heart.
But it’s not just a matter of less pain from angina. On a far more positive note, the level of energy you’ll achieve will soar to beyond anything you’ve probably experienced before. It’s amazing how bright and alert you’ll feel. You just won’t tire as easily. It won’t happen overnight. Remember that you’ve got some healing to do first, then some catching up from the incapacitation of prolonged inactivity, but then your progress will take off like a rocket. You’ll see the payoff both at work and at play.
Here’s how bypass surgery made me a better skier.
I’d been skiing since I got out of college, but was never really good at it. In fact, I could never get beyond a low-intermediate classification. Then came the bypass surgery and my cardiac rehab program. The next season I couldn’t believe myself on the slopes. I was in total control, my body responded like it never had before; all those lessons suddenly kicked in. I took tun after run without tiring. What a glorious feeling!
And as much as you’ll enjoy your newfound energy, you’ll love the way exercise improves your sleep. You’ll fall asleep more easily, without tossing and turning and watching the hands move around the clock. And you’ll stay asleep longer through the night. It’s better than any sleeping pill ever invented.
Exercise is a wonderful way to control stress, and it’s one of the best ways to keep tabs on your emotions. Here, too, it’s not just the negative idea of diminishing stress; the positive flip side of the coin is a feeling of well-being that often reaches euphoria. That’s because exercise causes the body to release chemicals into the bloodstream known as beta-endorphins. Those substances are chemically related to morphine, and produce a very blissful, serene feeling that’s hard to match. And it’s both legal and healthful!
Bear in mind that this isn’t just my personal opinion. Researchers at the University of New Mexico found that sedentary people report more perceived stress and have mote stress-related hormones in their bloodstream than a group who did regular exercise. The director of the university’s human performance laboratory, Dr Dennis Lobstein, said that exercise decreases anxiety, hostility and other stress-related disorders.
In another study, scientists at Purdue University in America concluded that depression does not automatically or necessarily increase with advancing age, but instead may be associated with controllable variables including fitness. Even the smallest amount of physical activity has positive impact.
A paper presented at the 1988 meeting of the American College of Sports Medicine (ACSM) reviewed 79 published and unpublished studies and concluded that exercise significantly decreases depression.
They saw benefits both in apparently healthy individuals and in those with medical and psychological problems.
At the 1990 ACSM meeting, Loma Linda University researchers offered the first randomised, controlled long-term study looking at psychological well-being and exercise. Subjects walked 45 minutes, five times a week. Even after just six weeks, exercising patients scored significantly better than their sedentary counterparts in tests measuring well-being. A similar study from the University of Missouri determined that a 12-week exercise program generally slashed depression scores to less than half, sometimes to less than a third, of the pre-exercise levels.
Next on the list of marvellous things that exercise does for you is weight control. Since obesity is a condition that afflicts millions of Westerners, and one that has a direct impact on the risk of heart disease, this is a mighty important consideration.
First, of course, exercise of all kinds helps burn extra kilojoules. But it’s more than that. Even after you’ve stopped exercising, your body continues to burn kilojoules at a faster rate because your metabolism gets stepped up a notch or two. So you burn more kilojoules for several hours after your workout.
Second, the more you exercise the more you replace fat with lean muscle tissue. Only muscle can burn kilojoules, not fat, so now your body has more ability to use the energy you supply in the form of food.
Now what happens when you feel better, you deal with stress more effectively, you are less depressed, you sleep better, and you’ve lost weight and put on a bit more muscle? You look better! No question about it, this has happened to more than one former heart patient.
If all this isn’t enough, increasing the amount of physical activity you do will also keep you alive a lot longer. Virtually every study of longevity ever performed has agreed on one conclusion: Those who live the longest are those who are most physically active and fit.
Exercise expert Dr Ralph Paffenbarger published the first evidence of the exercise-longevity link in 1986 in the New England Journal of Medicine. He studied the exercise habits of nearly 17,000 Harvard University alumni. Physical activity was reported as walking, stair climbing and sports and was inversely related to total mortality, especially due to cardiovascular disease. Death rates declined steadily as the amount of energy expended on any kind of activity increased from less than 2100 to 14,700 kilojoules per week.
It’s fascinating to note that Dr Paffenbarger’s results were statistically exclusive of hypertension, smoking, family history of death and overweight. Not that those things aren’t important, too, but basically his data indicate that an exercising smoker tends to live longer than a non-exercising smoker. By the age of 80, the amount of additional life attributed to adequate exercise was one year to more than two years.
But do these figures hold up for those who have already had a heart attack or other evidence of heart disease, or is it too late? A study published in the Journal of Cardiopulmonary Rehabilitation found that exercise has a positive influence for everyone.
In that study, a group of older persons was surveyed in 1976 and again in 1984. The results showed a direct relationship between mortality and aerobic exercise. The more active the person, the more likely he or she was to live longer. Of those individuals who had reported having had a heart attack in the 1976 survey, more were alive in 1984 if their energy expenditure was high.
Until 1990, we had to rely on small, isolated studies to prove the benefits of exercise in terms of living a longer, healthier life. The ultimate proof was published in the 3 November 1990 issue of the journal of the American Medical Association. Researchers at the Institute for Aerobic Research in Dallas had studied physical fitness and risk of mortality from all causes, not just heart disease, in 10,224 men and 3120 women. Fitness was actually measured by treadmill testing; in the past, studies often relied on questionnaires. The project ran a full eight years.
After screening out all irrelevant variables, the rate of death was 64.0 per 10,000 person-years in the least fit men to 18.6 in the most fit men. The trend held true for women as well, with mortality rates in the least fit at 39.5 and down to 8.5 in the most fit. Higher levels of physical fitness seem to delay death from all causes, the researchers concluded.
At about the same time, investigators at Rockefeller University in New York looked at why exercise offers protection against heart disease. Their ten-week study linked exercise to reduced serum triglycerides and increased lipoprotein metabolism. The study included six healthy men. During a seven-week exercise period following a three-week baseline determination, the men jogged on a treadmill for an average of 25 kilometres a week. At the project’s completion, triglycerides were down by 16 per cent, and total plasma lipoprotein levels dropped an average of 32 per cent.
How much exercise is enough? Virtually every study to date has shown that you’ll benefit from any amount of aerobic exercise. Whether you walk, jog or cycle, the trick is to get your heart rate up for a minimum of 30 minutes three to five days every week. The Dallas study indicates, though, that a little exercise does the job, and that after a certain level there’s a point of diminishing returns. The equivalent of 25 kilometres a week seems to be the point to shoot for. That would be a 5 kilometre brisk walk or jog five days a week.
We’ll look at specific recommendations for exercise in the coming pages. But first I’d like to dispel a number of myths regarding exercise and to put to rest any concerns you might have about safety.
*75/85/2*