Want to do something that will help every other aspect of a healthy lifestyle? Get yourself physically fit. There is no substitute! Physical exercise provides health benefits that cannot be obtained in any other way. It is central to almost all other aspects of a healthy lifestyle. And you really don't need to suffer to do the sorts of activities we're looking for. The greatest benefit to health is obtained by changing from a "sedentary" lifestyle (more or less a "couch potato") to doing 30 minutes of activity a day, such as walking, bicycling, climbing steps, or working in the garden (not just riding a lawnmower, though).  AND . . . you don't have to do it all at once!

·        Want to lose some weight? Exercise is one of the most important aspects of maintaining weight.

·        Need to stop smoking?  Exercise makes it a lot easier, and increases the chances of success.

·        Your blood pressure, cholesterol or glucose levels are elevated? Exercise helps control every one of these processes, perhaps to the point that medications can be decreased or eliminated (under your physician's supervision).

·        Even if you don't have any of these health problems, exercise clearly will help your health. The simple act of regular exercise can be shown to prolong your life.

·        Let's not forget about feeling good! Just about all of us have been on an exercise program at one time or another, and can attest that our bodies feel better, and we feel better about ourselves.

·        And while we concentrate on heart problems here at HeartPoint, exercise helps with so many other health issues: Arthritis, osteoporosis, breast cancer, colon cancer. . . .

Just as achieving a healthy weight doesn't mean you need to look like a mode, achieving a healthy level of physical fitness is not a matter of doing all of the things you see athletes to on TV or in fitness magazines.  This tends to be discouraging and make it harder to achieve a much more satisfying goal:  a healthy fitness program.  You don't need to be an "athlete" to have a healthy level of activity.  And it's not just for the young -- exercise benefits the elderly more than their younger counterparts.  The program just needs to be tailored to the appropriate fitness levels.  The fitness programs we'll talk about here are those designed to help with your health . . . and there's a way for almost everyone to accomplish a health-promoting exercise program that doesn't ask too much of a busy lifestyle. You don't need expensive equipment, you don't need a personal trainer or to join a health club (although we certainly would be glad if these things helped you continue along a path of health!). You simply need to do 20-30 minutes of moderate activity on most days of the week. This may be as simple as walking at a brisk pace.

Go out and start making a healthier and more enjoyable life . . . and exercise for health!


Some common sense reminders.
What are the benefits?

Think about this . . . exercise is as important as high cholesterol or high blood pressure.

Before you start . . . let's get warmed up.

How much exercise should I do?
What sorts of exercise should I do?
What about weights and body building?
What are the risks?
Do I need to talk to my doctor before starting?

What is "aerobic fitness" as opposed to "cardiovascular fitness"?

I travel a lot what should I do?

I just had a heart attack or bypass surgery. What should I do?

How do I tell when I am doing too much?
What about when it's hot?

What about when it's cold?

How do I take my pulse?

But I have a lot of joint problems, and they get worse when I exercise. What should I do?
I get very short of breath or have other symptoms when I exercise. What should I do?

I'm afraid my blood pressure will get too high when I exercise.

I'm pretty old. I don't need to exercise anymore, right?
What about health clubs and personal trainers?
What is a good program to start with?
I want to take it to a higher level.  What should I do?
How come exercise does so much good for the arteries?
How many calories will I burn?
Some other resources and links.
Keep an exercise diary.
The Big Points.
HeartPoint's Exercise Planner.

Some common sense reminders.

We will say more about these issues below, but remember that you should

 What are the benefits?

We won't spend a lot of time here. Almost everyone has heard these facts before. But as a quick reminder more motivating yourself, don't forget the amazing number of things that activity does for you:

Can you imagine if there were a pill or surgical procedure that could do all of these things? People would be lined up around the block! Do some exercise!

Think about this . . . exercise is as important as high cholesterol or high blood pressure.

One of my favorite studies is of a group of men in Hawaii.  This was not a very selected group, just men who were retired and who did not smoke.  The men who did little or no activity had an increased mortality rate twice that of men who walked 2 or more miles daily.  40% of the non-exercisers died over 12 years as compared to 20% in the exercise group. (NEJM 1998;338:94).

Other studies have shown (JAMA 1989;262:2395 and NEJM 1988;319:1379 among many others) that exercise may be more important than the things many people worry about (like high blood pressure and high cholesterol), and for which billions of dollars are spent in this country trying to control.  Men in the Aerobics Center Longitudinal Study who were at high risk because of their high blood pressure or high cholesterol but were also physically fit had lower death rates than those who would otherwise be considered low risk but were not physically fit.  For example, highly fit men with blood pressures greater than 140 had a death rate of 24 per 10,000 patient-years (the number of patients observed multiplied by the number of years they were observed), while those whose blood pressure was less than 120 but were not physically fit had death rates of 60 per 10,000 patient-years.  Those who did not have high blood pressure or high cholesterol but were not physically fit were 2.5 times more likely to die than those who had higher risk blood pressure or cholesterol but were physically fit.

Before you start . . . let's get warmed up. And don't forget to cool down.

You should "warm up" and "cool down" for about 5 minutes before and after your exercise. If the exercise is walking or jogging, walk slowly as a warm up. Stretching is an excellent way to warm up and cool down.

How much exercise should I do?

This is really a key question. And the two most correct answers are:
1. In general, the more the better.
2. But some is way better than none!

Just like everything else, it depends on what you're looking for:

The key here is to DO SOME EXERCISE REGULARLY. If you can't do 30 minutes today, do 10 minutes of walking. Continue to work this most healthy of pursuits into your life.

Check out our Planner to help come up with the best program for you.

What sorts of exercise should I do?

Design and follow a program you enjoy. That will help keeping you do it, and actually will help you achieve all of the benefits of exercise.

There are many enjoyable activities to participate in. Most experts recommend the simple act of walking. Virtually everyone knows how to do it, it is readily available, it is "portable", it is inexpensive, and it works. You can do it alone, with a friend or with a group. It generally has a low risk of injury.

Jogging certainly is an acceptable form of exercise. Interestingly though, you burn just as many calories walking a mile as you do jogging a mile. You could obviously jog further in the same amount of time and therefore burn more calories and obtain a greater degree of fitness. Jogging generally extracts a little greater price in terms of aches and pains in your bones and joints than walking does.

Some people find that working out with a friend or an entire group is more fun than isolated activities. It can indeed be more enjoyable. It can help encourage regular participation. You and a friend at home or at work can do a walking program together. There are a host of activities at health clubs from aerobic dance, to swimming, to water aerobics . . . the list is virtually endless. These groups are often supervised as well.

Some people enjoy competitive sports such as handball or racquetball or tennis. Others enjoy weight lifting. Do you like to ski? How about mowing the lawn?

Check out our Planner to help come up with the best program for you.

What about weights and body building?   

Walking and jogging have been the traditional means recommended as exercise for “fitness”.  These activities are “aerobic”, increasing the body’s use of oxygen, and appear to be the best way to improve cardiovascular health.  Weights and body building, which are more focused on increasing the strength of the muscles, have not been felt to be as important, and in some cases felt to be dangerous.  The straining associated with weight lifting can increase the risk of myocardial infarction.  Long term and fairly intense weight training can cause thickening of the heart muscle, which increases the need for blood flow through the coronary arteries which may be a problem in those with blockages in those vessels.


However, thinking about this has recently changed to some degree.  Heavy weight training is still not a recommended prescription for people with heart disease (and the use of steroids, creatine, and other such substances are to be avoided!).  The use of appropriate “resistance training” is now encouraged.  A recent American Heart Association Advisory Text Box: Aerobic exercises such as walking remain the cornerstone of exercise programs designed for a healthy heart, primarily because of: 
·	Improvement in the body’s ability to uptake and use oxygen, and 
·	Better control of other risk factors (cholesterol, blood pressure, diabetes, etc.)

Resistance training such as light-to-moderate weight lifting appears to be safe for most people, and offers the following advantages:
·	Assists in weight control
·	Decreases the amount of increased demand for oxygen during daily activities.
·	Develops more muscle mass for greater strength and endurance.
·	Prevents falls and helps with independence in the elderly.
·	Is often helpful for osteoporosis, low back pain, and prevention of injuries.

Isometric exercise is using muscle strength without moving the extremity (like pushing your hands together forcefully for a time).  These exercises are not recommended for cardiac patients.
(Circulation 2000;101:828) stated:

“Although exercise programs have traditionally emphasized dynamic lower-extremity exercise, research increasingly suggests that complementary resistance training, when appropriately prescribed and supervised, has favorable effects on muscular strength and endurance, cardiovascular function, metabolism, coronary risk factors, and psychosocial well-being.”


Resistance training has been studied and is recommended for those without cardiac disease, and can be safely carried out in those with mild heart disease.  There is not sufficient information available to recommend it for those with moderate-to-severe heart problems.


For those without heart disease:

·        A workout lasting 20-30 minutes should be accomplished at least twice, and preferably three times per week.

·        The workout generally consists of 8-10 exercises.

·        Early sessions should use relatively low weights to allow for adaptation to the increased load, and practice good technique.

·        “Good technique” includes slow controlled movements, full relaxed inspiration and expiration, and avoidance of breath holding.

·        When one is comfortable using a given weight for 12-15 repetitions, then the weight can be increased by 5%.


If you have bone or joint problems, consult with the physician who cares for you before beginning, since repetitive exercises may increase wear and tear on particular areas of the body.  Some physical therapists and personal trainers may be able to help as well.  There is generally a program that can be devised that will help, however.

  Most hospitals have exercise physiologists, nurse clinicians or other rehabilitation and/or exercise specialists who supervise the inpatient phase of rehabilitation, and many have outpatient Cardiac Rehabilitation programs as well.  The decision for a specific patient should be based on their own special situation, and only general comments will be made here.  Inpatients who have recently had a heart attack or bypass usually only complete Range-of-Motion (ROM) exercises.  The ROM exercises for the chest and arms are particularly important  for the person who has undergone bypass or other open chest heart procedures to prevent problems in the recovery period.  Most recommend avoidance of resistance training for at least three months after open heart procedures.  For patients who have recently had a heart attack, resistance training should not begin for several weeks after bypass, and then do so slowly and with supervision.


What are the risks?

There are a few. Much is made of the rare occurrence of sudden death of someone who is exercising. This certainly may occur. People who have or are at significant risk of heart disease do need to check things out with a physician prior to starting an exercise program to minimize this risk. On balance however, exercise clearly lowers the overall risk of death, and rather dramatically reduces the risk of sudden death.

Exercise may also be associated with injuries to bones and joints, and these do need to be tended to when they occur. Accidents occur. "Overuse" and "repetitive strain" refer to injuries that may occur from doing the same motions or activities over and over. On the other hand, doing too many different activities all of the time may not allow one to really adapt and prevent injuries from fewer activities.

Starting slowly, stretching and warming up are important preventative measures. Ignore the popular expression "No pain, no gain". Pay attention to pain, and don't push it until you thoroughly understand what your body is trying to tell you. Prompt attention to problems can lead to solutions that allow you to continue to exercise enjoyably. Many injuries may be helped by practitioners familiar with sports injuries.

Do I need to talk to my doctor before starting?

Certainly, if you've recently had a heart attack or bypass surgery, you will need to know your specific limits (see above).

Many authorities recommend that you be evaluated by a physician before starting an exercise program if you fall into certain groups:

What is "aerobic fitness" as opposed to "cardiovascular fitness"?

There are different types of fitness. Good athletes achieve "aerobic fitness", giving them the ability to sustain significant activities for a long period of time. To achieve this, one needs to exercise at least four time a week for 15-30 minutes, employing an exercise which will raise their heart rates to 60-80% of their age predicted maximum heart rate. If you're interested, a good approximation of your maximum heart rate is 220 minus your age.

"Cardiovascular fitness" is good for the health of your heart and the rest of your body. To do this, exercise 15-30 minutes four times a week without worrying about your heart rate.

I travel a lot. What should I do?

Traveling makes it hard to follow a heart healthy lifestyle in many ways. Diet and sleep are difficult to follow. But exercise programs can definitely be continued. You can walk while you're waiting for a plane, or walk in place in your hotel. Most hotels provide exercise equipment. People who advise on good travel habits note that an exercise program cuts down on jet lag. Keep with it!

I just had a heart attack or bypass surgery. What should I do?

You should definitely start a program, and it should be according to instructions from your physician. Many hospitals offer "Cardiac Rehabilitation" programs specifically designed for people with these conditions. They are supervised, most often by specially trained nurses, and provide a structured setting to exercise in a safe manner. These programs are also of valuable in providing more information on heart disease and a heart-healthy lifestyle. People with similar heart conditions are also enrolled, providing a great deal of emotional support.

General guidelines that are usually offered in this setting include:

How do I tell when I'm doing too much?

First of all, pay attention to how you feel. If you are having chest pain, or dizziness, or marked fatigue or shortness of breath . . . stop. You should check things out if you develop an irregular pulse or become nauseated. If in doubt about these or other symptoms, go ahead and stop the exercise for now and discuss it with your doctor.

It is also useful to monitor your pulse to give an assessment of how hard you are working. A person's pulse is affected by a variety of factors, most particularly some underlying heart problems, certain medications and a person's age. It is useful to consider a "target heart rate".

What about when it's hot?

You can very definitely have problems from getting overheated. "Heat exhaustion" is characterized by dizziness, headache, nausea and sometimes confusion. "Heat stroke" is more serious yet. It too is accompanied by dizziness, headache and nausea but is notable by two other problems: sweating stops, and body temperature becomes dangerously high.

What about when it's cold?

Blood vessels clamp down in response to cold weather. You are able to do more without the warning sensation of overheating, and in fact you may feel better. But your heart is working harder due to the clamping down of the blood vessels.

You don't have to stop because of the cold weather, though! Again you can certainly move indoors . . . walk on a treadmill or in the mall. Or go to a health club.

How do I take my pulse?

You can take your pulse either at the wrist (the radial artery) or the neck (the carotid pulse). It is important to relax your hand and wait a few seconds to allow the pulse to "come to you".

For the radial pulse, place your second, third and fourth fingers along the wrist on the same side as the thumb and place gentle pressure. Relax the fingers, and give yourself 5-10 seconds to begin to appreciate the pulse. For the carotid, use these same fingers placing them to the side of the larynx (Adam's apple). You may also use your thumb if it is more.

It is generally easiest to take your pulse for 15 seconds and multiply it times four.

But I have a lot of joint problems, and they get worse when I exercise. What should I do?

You should start slowly. See the physician who usually cares for your joint problems, or consider seeing a sports medicine specialist.

Good general rules to follow include:

·        Select "low impact" activities (stationary bike, rowing, swimming, water aerobics).  Activities such as yoga or t'ai chi chi may be very beneficial.

·        Select shoes that minimize impact.

·        Avoid stair climbing, jogging, and running in people who have arthritic conditions involving the hip and / or knee.

·        Include stretching an joint mobility as key exercise components.

·        Use low intensity and low duration initially, increasing gradually.

·        Set "time goals" instead of distance goals.

·        Avoid activities that cause increased joint pain lasting more than an hour or two after exercise.

·        It may help to apply warmth to affected joints before starting.

I get very short of breath or have other symptoms when I exercise. What should I do?

You should definitely check with your doctor before starting an exercise program

I'm afraid my blood pressure will get too high when I exercise.

 Blood pressure normally increases during exercise, often to the range of 200 mm Hg or higher. A moderate rise in blood pressure is to be anticipated, and need not be any cause for alarm. If you have substantial medical problems, you may wish to begin a supervised program, such as are available with local Cardiac Rehabilitation programs.  Exercise lowers blood pressure in the long run.

I'm pretty old. I can't do all of those exercises.

 You may not be able to do all of the exercise you were able to when you were younger, but you can definitely do enough to really benefit your health. It is my personal observation that the more activity a senior is able to do, and the more activity he or she does, the better their longevity. It makes a tremendous impact on their sense of well-being as well.

Repetitive strain injuries may be more common, and care should be taken in designing the program prescribed. Extra care should be taken in choosing exercise clothing and equipment, and injuries should be tended to promptly before aggravating them with more inappropriate exercises. An exercise facility or health club may be more valuable for people in this age group.

However, every attempt should be made to design and stick to an exercise program . . . the older, the better.

 What about health clubs and personal trainers?

If you can afford these luxuries, they may be very worthwhile. They generally offer special equipment, and reputable establishments have some special expertise in these areas. Many feel more motivated to follow a program when they have a financial commitment. Some people find that a scheduled time makes continued participation more likely. Health clubs also offer group exercise programs, which are attractive to many people.

If you find that this offers you some advantage, you should participate. However, don't feel that you "have to" get involved in such a program. You can have a successful fitness program without this.

What's a good program to start with?

Start slowly. By doing this, you'll lower the risk of injury, and be more able to gradually integrate it into your lifestyle.

Pick one or more activities that you can do all year long. There are a lot of activities that you can do that involve exercise, but not all of them really lend themselves to a regular form of exercise. Canoeing is great, but not practical as a 3-4 time per week exercise for most people.

Just like with dieting, set reasonable goals. It is marvelous to watch some of today's athletes. You do not need to be as fit or beautiful as they are . . . aim for a level which will help your health.

If you're just starting out, start out your walking program by "strolling" (20-24 minutes per mile or 2.6-3 miles per hour). Pick it up to a "brisk" walk (about 15 minutes per mile or 4 miles an hour). "Aerobic walking" is pretty quick, around 5 miles per hour. Jogging is going faster than this. Roller skating is similar (wear a helmet and safety guards on knees, elbows and wrists!). Ice skating is likewise suitable. Jumping rope may be enjoyable as well, although it may also be tough on the ankles.

Bicycling is very enjoyable to many people (and my personal favorite). It is relatively easy on the joints, and can be a good means of transportation. It's enjoyable to do with others. On the other hand, it is pretty weather dependent. Wear a helmet! Stationary bicycles avoid these weather problems, but are among the least exciting activities of all. This can be spiced up by reading or watching TV or movies.

Swimming is an ideal exercise . . . as long as you have the facilities. It uses all of the major large muscle groups, achieving a large amount of energy expenditure, without putting much strain on the body. You need access to an indoor pool as well as time to change, swim and change back. It should be encouraged as a part of a fitness program if at all possible. There are programs of water aerobics which are ideal for those who have joint problems or find other forms of exercise too tough on their joints.

Aerobic dancing, or any dancing for that matter, is an enjoyable and sociable form of recreational exercise. Aerobic dancing can put some strain on the joints, although it is generally not severe.

Sports such as basketball, volleyball, tennis, table tennis, racquetball, etc. are good forms of exercise, and many people enjoy the speed, challenge and competition. They are tough on the joints in many cases if done with any intensity. They are classic traps for "weekend warriors" to injure themselves. My own personal view is that most people over the age of 35 may be asking for trouble with competitive activities, particularly if they are the type that take a great deal of pleasure from being able to "suck it up" when they're tired so they can win the match. This invites trouble. Pursue these activities, and they are indeed very enjoyable, but realize that they should not turn into literal "life and death" situations.

By the way, if you golf, you only get to count the time you're walking . . . and realize this should be a brisk walk and not a stroll. Please don't even ask about riding a cart!

I want to take it to a higher level. What should I do?

Let's look at some levels of fitness (these are described in the site "Shape Up America" at ):

How come exercise does so much good for the arteries?

It makes plenty of sense that exercise prevents injuries, promotes strength and weight loss, and cuts down on problems like osteoporosis.  It is not immediately clear why it will help prevent problems related to clogged arteries.  It had been speculated in the past that it helped by promoting weight loss, decreasing cholesterol, and other secondary factors.  However, recent studies have shown whole new ways that exercise cuts down on atherosclerosis and cancers. 

There is plenty of evidence that not only do cholesterol levels fall, but that  "good" HDL levels rise with exercise.  Likewise, there is abundant evidence that there is a decreased tendency toward blood clotting.  Studies have shown a decrease in the inflammatory activities of some of the white blood cells in the blood which have been shown to be instrumental in promoting the progression of blockages in arteries (JAMA 1999;281:1722).  Aerobic exercise has proven to decrease the conversion of "bad" LDL cholesterol to the "really, really bad" oxidized LDL (Arterioscler Thromb Vasc Biol 1998;18:1181).  It has also been shown to improve the ability of the coronary arteries to dilate in response to stress, a basic function of healthy arteries lost in those with atherosclerosis (NEJM 2000;342:454).  These are fairly complex concepts, but the point is clear:  Exercise has fundamental health promoting activities that cannot be duplicated by any other mechanism.  Most people would feel cheated if they weren't given the chance to take a lifesaving medicine . . . they should not miss the opportunity to do this for their health.

How many calories will I burn?

To be honest, exercise alone is not a great way to lose weight -- you have to cut down on the number of calories taken in as well.  Nevertheless, it may be interesting to see how different activities stack up in this area.  Here are some estimates of the number of calories burned by a 150 pound person (heavier people will burn somewhat more, lighter people somewhat less):

Walking 2 mph

Walking 3 mph

Walking 4.5 mph

240 cals

320 cals

440 cals

Bicycling 6 mph

Bicycling 12 mph

240 cals

410 cals

Jogging 5.5 mph

Jogging 7 mph

740 cals

920 cals

Running in place

Running 10 mph

650 cals

1280 cals

Swimming 25 yards/min

Swimming 50 yards/min

275 cals

500 cals

Jumping rope

750 cals

Tennis (singles)

400 cals

Cross-country skiing

700 cals

Mowing the lawn

500 cals

Shoveling snow

550 cals

Passionate sex

450 cals


Other links and resources

American Heart Association
7252 Greenville Ave.
Dallas, TX 75231

YMCA of the USA
101 N Wacker Drive
Chicago, IL 60606

Nat'l Org of Mall Walkers
PO Box 256
Hermann, MO 65041

Am Council on Exercise
5820 Oberlin Drive
San Diego, CA 92121

YWCA of the USA
350 5th Ave, Suite 301
New York, NY 10118

Am Running & Fitness Assoc.
4405 East-West Hwy, #405
Bethesda, MD 20814


Keep an exercise diary.

It's not a requirement, but it can be a help to plot your progress, particularly if you've recently had a heart attack or bypass. Take a look at Heartpoint's exercise diary.

The Big Points.

 A healthy lifestyle definitely includes being physically fit. Activity and exercise provide unique additions to a healthy lifestyle. Regardless of anything else, modest amounts of exercise will clearly help you live longer -- a "sedentary" lifestyle is an independent "risk factor" for developing blocked arteries or experiencing sudden death. It helps decrease the risk of other diseases including certain cancers, and clearly leads to improved psychological well-being. Additionally, exercise will help with lowering the risk from other health problems such as high blood pressure, diabetes, high cholesterol and being overweight. There is probably not another single thing that you can do that will benefit your health more.

Fortunately, you do not have to do enormous amounts of activity to realize great benefits for your health. We are not talking major workouts, just increasing the amount of activity you do during the day to a total of 15-30 minutes daily. You can get some of this by parking a long way from the front door of the store where you're going shopping, or maybe getting off the elevator one floor early and taking the stairs. The rest of the work does not need to involve a great deal of trouble or money -- walking at a brisk pace will do just fine.

People who are not fit, are older, or who have problems with their heart should check with their physician before beginning. Common sense ideas such as warming up, starting slow and gradually increasing the level of activity, and doing some simple things to avoid injury are certainly good ideas.

Remember, there are no substitutes! You don't have to be an athlete! Set some reasonable goals. Commit and stick with this miraculous health-promoting activity.

©COPY;1997 HeartPoint    Updated May 1,2000.

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This site presents material for your information, education and entertainment. We can assume no liability for inaccuracies, errors, or omissions. Above all, material on this site should not take the place of the care you receive from a personal physician. It is simply designed to help in the understanding of the heart and heart disease, and not as a diagnostic or therapeutic aid. You should seek prompt medical care for any specific health issues. Please feel free to browse the site and download material for personal and non-commercial use. You may not however distribute, modify, transmit or reuse any of these materials for public or commercial use. You should assume that all contents of the site are copyrighted. ©COPY;1997 HeartPoint