10 | Exercise
WHY BOTHER?
Most people get little vigorous exercise either at work or during their leisure time. We travel by car, bus or train, and at the end of the day we flop down in front of the TV. There is now a lot of evidence that regular exercise of low or moderate intensity, done on a regular basis (daily if possible, four to five times a week otherwise), can reduce the risk of getting heart disease. Activities that benefit the heart include walking, climbing stairs, gardening, housework such as making the beds or vacuuming the stairs (and not just wafting a feather duster), dancing or using home or gym exercise equipment. Increasing your exercise to be more vigorous helps further improve your heart and lungs – brisk walking, cycling, swimming, skipping or running (jogging) are examples of easy exercise that can become part of your everyday lifestyle.
Throughout this book the importance of exercise for the heart has been stressed. It really does help to be fit. If you find it a struggle to exercise on your own, get the whole family to join in and be supportive. Otherwise, try the following ideas.
•Join a sports or leisure club.
•Do any exercise that you enjoy.
•Try a new sport such as golf.
•Clean your car yourself, not in a car wash.
•Get working in the garden if you have one – 30 minutes in
the fresh air digging or weeding is excellent exercise.
•Go swimming with a friend or relative.
•Get the bicycle out of storage; have it serviced if necessary,
and buy the right safety kit; try it out on a quiet road at first
if you don’t feel confident.
•If you have an exercise bicycle, stop hanging clothes on it
and start using it.
•Don’t give up – every little helps.
•Keep working at it.
•Always be positive.
Remember that exercise should be enjoyed, not endured. You should be able to find some form of exercise that you really enjoy.
Why will exercise do me good?
There are many reasons why exercise is so good for everyone:
•It will help you lose and maintain your optimal weight.
•It increases your ‘good’ cholesterol (HDL).
•It helps smokers stop smoking.
•It lowers blood pressure and thus helps prevent heart disease.
Physically fit people are usually psychologically fit also. Fit people feel better, live longer and have less heart disease and diabetes. They also sleep better and handle stress better.
What types of exercise are good for the heart? I have been doing weight lifting for years – is it of any help to my heart?
Activities that involve movement (walking, cycling, swimming)
are known as dynamic or aerobic exercise and these are the ones that benefit the heart. Aerobic means that the body uses oxygen to deliver the energy that you need for the activity that you are performing. Aerobic exercise for at least 30 minutes four or five times a week will strengthen your heart and help to reduce your chance of developing coronary artery disease.
Weight lifting is a form of static exercise, also known as isometric or akinetic exercise. This does not help the heart and can put on unnatural strain on it by raising your blood pressure. Other examples of static exercise are pushing a car that won’t start, lifting heavy bags without help, moving furniture on your own – you know that with a big effort you can do it, but if you wait for help there will less strain on your heart.
Building up your muscles without dynamic exercise may make the outside of your chest look good but it will not help the heart inside. Those ill-advised people who take steroids can actually damage their heart because steroids sometimes weaken the heart muscle so that it becomes flabby. Anabolic steroids can cause the blood to clot more easily and a heart attack becomes more likely.
I’ve read about exercise and there is often a mention of METs – what are they?
A MET is short for ‘metabolic equivalent’. This is a measure of the
work the body does when exercising – the more you work at exercise, the more METs you use. Sitting watching the TV equals 1 MET, walking will use up to 5 METs depending on how brisk it is, and running will use even more (see Table 10.1). When we exercise we achieve our personal limit depending on how fit we are, and this is known as our ‘functional capacity’. As our fitness improves, so does our functional capacity.
If I’m fit why should I quit smoking as well?
No risk factor works on its own. Getting fit goes along with losing weight, not smoking, avoiding fatty foods and moderating alcohol. If you smoke you are three times more likely to get coronary artery disease. Smoking is a bigger cause of heart disease than lack of exercise. So if you are super fit but smoke 10–20 cigarettes a day, the smoking will win the argument and you will lose out – being fit does not allow you to smoke.
I am now 51 and made a resolution on my 50th birthday to take exercise regularly. I found that my good intentions fell away after 3 months when I was ill for a week with flu. What do you suggest might help now?
First of all it is important not to exercise when you are ill, so you did the right thing when you had flu. Start again with a practice walk for about a mile, going slowly, then try and reduce the time that this length takes. Keep a record. If you walk on a footpath by a roadway, you can measure the distance using a car; if you walk in the countryside, select a path where the distance is shown.
Table 10.1 Activities and their metabolic equivalents
Activity |
METs |
Aerobics |
|
low impact |
5 |
high impact |
7 |
Badminton |
4.5 |
Bowling |
4 |
Cycling |
|
< 10 mph |
4 |
10–12 mph |
6 |
>12 mph |
10 |
DIY (e.g. wallpapering) |
4–5 |
Football |
8 |
Gardening (e.g. digging) |
3–5 |
Golf |
4–5 |
Horse riding (trotting) |
5–7 |
Housework (average) |
2.5 |
scrubbing floors |
5.5 |
Playing the piano |
2.5 |
Office job |
1.5 |
Sex (‘normal’) |
2–3 |
Sex (‘vigorous’) |
3–6 |
Skiing |
|
downhill racing |
8 |
leisure |
6 |
Squash |
12 |
Swimming |
|
fast |
10 |
moderate |
8 |
light |
6 |
butterfly |
11 |
Table tennis |
4 |
Tennis |
8 |
Walking (1 mile in 20 min) |
3 |
If you walk for 1 mile at 2 mph, you will take 30 minutes and use up 2.5 METs, which isn’t much effort but it is an important beginning. At 3 mph it will take you 20 minutes and use 3.5 METs; at 4 mph it will take 15 minutes and use 4.5 METs. When you are walking fast and just out of breath, fitness will be achieved for the over-40s at about 5 METs for men and women – this is equivalent to walking 2 miles in 30 minutes.
I’m over 60 and have never really taken exercise properly, though I live an outdoor life. Am I too old to exercise now?
Age should not be a limitation to anybody starting to take exercise
although it is better to have exercised throughout your life. Exercise will keep you feeling and looking younger longer. If you haven’t exercised before or are starting again after a long gap, just remember to build up gradually. Always check with your doctor first, if you are at all uncertain as to whether a particular form of exercise is suitable for you.
I am going to start an exercise routine. How will I be able to work out how many calories I use up?
This depends on the type of exercise you take and for how long.
•If you walk at 3 miles an hour (about normal walking speed), you will burn up 320 kcal per hour.
•If you walk at 4.5 mph (pretty fast, almost a jog), this goes up to 440 kcal per hour.
•If you cycle at 6 mph, you will burn 240 kcal per hour.
•If you swim 25 yards (a length of most swimming pools) in a minute, you will burn 275 kcal per hour.
The fatter you are, the more you burn, and you burn more if you exercise for longer rather than faster; for example cycling at 12 mph burns 410 kcal per hour not 480.
HOW MUCH?
I have a busy life and am not sure that I can set aside half an hour every day for exercising. Is my effort wasted if I do not take exercise every day?
You must begin slowly – you cannot become an athlete overnight – and increase gradually. The aim is to perform any aerobic exercise for 30–40 minutes four to five times a week. Even relatively modest exercise is good, e.g. gardening, housework and dancing, but it is better if you can develop a walking programme to include both distance and speed as well as enjoyment (see below for a good programme to follow).
Try to exercise at least every other day and more at the weekend (a walk in the country at the weekend will be fun and less polluted than a city walk). Try to make it a regular commitment, such as every lunch hour, especially if your workplace offers showers. Afterwards, have a glass of water. Ask a friend or partner to join in. Keep a record to judge your progress. Dancing can be quite vigorous (such as country dancing), so it is a particularly good form of exercise because you can build up from gentler beginnings. It is also exercise with a good social side to it.
I am put off exercising because, in my exercise class, everyone else seems much fitter than me. Why is this?
Life is like that! At first everyone seems fitter: they may have been working at it longer. They were probably unfit once and so they will be supportive. You are the most important person and you should focus purely on your own programme. Don’t worry about what everybody else is doing. It is not a competition. Don’t be embarrassed, get stuck in.
SAFETY
You mention talking to my doctor before I start exercising. Do I really need a medical check first?
If you have no medical problems, the answer is no – get out and start straight away. If you’ve already had heart trouble or don’t know about your blood pressure, get this checked by your doctor and ask for a cholesterol check while you are there. If you are ‘at risk’ (over 60 years, a smoker, have diabetes or on medication for your heart), it’s best to check with your doctor first.
I’m worried that I might overdo things. Should I take any special precautions before exercising?
These are the guidelines.
•Don’t exercise if you feel unwell, for instance if you’ve had flu or a bad cold. If you have had any recent illness, go back to exercising only when you have recovered and then build up slowly.
•If you get chest pain or breathing trouble while you are exercising, see your doctor.
•Don’t exercise after a heavy meal or a hot bath – wait two to three hours before doing any.
•Avoid caffeine and alcohol for an hour before and after exercise.
Last time I tried jogging, I tore a calf muscle and was off work for 2 weeks. How can I avoid this happening again?
Don’t exercise too hard too quickly and always loosen up first (see the warm-up exercises below) and do some cooling down exercises last: walk slowly for 3–5 minutes, stretch for 2 minutes. Never overdo it. One of the best things to do is to buy the correct shoes for the sport you are choosing (see question later regarding special clothing for exercising).
CHOOSING YOUR EXERCISE
My local recreation centre offers 40 different sports from judo to meditation. What is the best form of exercise to do?
Any aerobic exercise is the best. This is dynamic exercise using
large groups of muscles – for example walking, jogging, cycling and swimming. Non-aerobic exercise builds muscle strength (what is known as isometrics) but does little to help the heart’s fitness and can be harmful, as it can make your blood pressure rise.
I lead a very busy life and just do not have time to exercise. Is there anything I can do?
Your health should always come first. No one on his death bed wished he’d spent more time at the office! However, you can exercise around your commitments.
•Climb the stairs rather than take the lift.
•Park so that you have to walk 200–300 yards to where you are going.
•If you use public transport, get off the bus, train, tram or tube a stop early and walk to or from the station.
•Walk the children to school.
•Take your young children to the park and run about with them.
•Clean you car rather than using the car-wash.
I am in my forties and have always hated competitive sport but enjoy walking. Is there a simple walking programme I could start?
Walking is especially good because it is cheap and generally safe and we all know how to do it. It also doesn’t strain the joints as much as jogging or running. The American Heart Association walking programme (Table 10.2) is useful – but not compulsory – and you can vary the timing to your personal needs. ‘Health Walks’ are being developed by the Countryside Commission and the British Heart Foundation (see Appendix 2 for addresses).
You will need a yardstick to assess your progress. Try to find a distance of about one mile that you can walk; measure the distance by car or by striding out and counting the yards or metres. Alternatively, estimate the distance to the park, round the park or to the shops or station. If it’s the shops, cancel the newspaper delivery and go each day to collect it.
•Gently loosen up by bending and stretching (Figure 10.1). Repeat exercises 1–5 up to six times before you start walking.
•Measure your heart rate by taking your pulse at the wrist or next to your Adam’s apple. Count the number in 15 seconds and multiply by 4 or count the number in 6 seconds and add a 0. You now have the beats per minute (Figure 10.2).
Figure 10.2 Taking your pulse at your wrist (a) and neck (b).
•After walking for 5 minutes take your pulse again and speed up to get it above 110. If you are on a beta-blocker drug, this does not apply as these drugs slow the heart. Try to keep the pulse over 110 and note the time you took to complete your mile; take your pulse again whilst winding down. It should settle within 10 minutes.
Table 10.2 A simple walking programme
Weeks |
Warm-up walking |
Target zone walking* |
Week 1 |
||
Session A |
5 min |
briskly, 5 min |
Session B |
Repeat above pattern |
|
Session C |
Repeat above pattern |
|
Continue with at least three exercise sessions during each week of the programme. |
||
Week 2 |
5 min |
briskly, 7 min |
Week 3 |
5 min |
briskly, 9 min |
Week 4 |
5 min |
briskly, 11 min |
Week 5 |
5 min |
briskly, 13 min |
Week 6 |
5 min |
briskly, 15 min |
Week 7 |
5 min |
briskly, 18 min |
Week 8 |
5 min |
briskly, 20 min |
Week 9 |
5 min |
briskly, 23 min |
Week 10 |
5 min |
briskly, 26 min |
Week 11 |
5 min |
briskly, 28 min |
Week 12 |
5 min |
briskly, 30 min |
Week 13 on: |
||
* Your target zone is shown in Table 10.3.
•As you get fit, your walking time should shorten and your heart rate become slower and your recovery become quicker. You can then extend up to two miles, gradually increasing your walking speed and then your distance. Do not do too much too quickly.
Cool down walking |
Total time |
more slowly, 5 min |
15 min |
5 min |
17 min |
5 min |
19 min |
5 min |
21 min |
5 min |
23 min |
5 min |
25 min |
5 min |
28 min |
5 min |
30 min |
5 min |
33 min |
5 min |
36 min |
5 min |
38 min |
5 min |
40 min |
A friend of mine was told to judge his exercise by the talking test. What is this?
This is a simple but useful guide to how much exercise you are doing. You should be exercising in such a way that you can talk, but you should be a little breathless. If you can talk easily, you are not exercising briskly enough; if you cannot talk, you need to slow down.
I should like to go walking but I’m afraid to walk alone – I’m always reading in the local paper of women being attacked. Isn’t it rather dangerous to walk on my own?
It is a sad reflection on the world that people, particularly women, should be afraid to go walking. Attacks do occur but are rare. We always need to keep a sense of proportion – only the bad things get reported. If, of 10 000 women walking in the countryside, only one was attacked, 9999 were not, but we would only hear of the one who suffered. Being afraid is understandable, but in the end it ruins your enjoyment of life. If you are worried, why not walk with two or three friends, or join a rambling club? Other precautions could include:
•carry an alarm or a mobile phone;
•do not go out when it’s getting dark – pick the clear daylight hours;
•avoid remote areas and keep to open spaces (such as the paths in the park);
•choose the areas where there are lots of people (such as along a sea front or a popular park).
I’ve tried walking 1 mile a day and I find that I get bored after a month. What else can I do besides walking?
Joining a gym will give you access to a treadmill which will give you a better chance to judge your progress more accurately because of its computerised timing.
Other good exercises include rowing, swimming, cycling, dancing (aerobics) or simply climbing stairs. Variety is the thing!
There is a heart testing machine at my local gym, but frankly I do not understand what the figures mean. What should my maximum heart rate be?
Your maximum heart rate should be 220 minus your age. You should aim to get up to 75% of this. So, if you are aged 50, you should aim for three-quarters of 170, which is 127. When you begin your exercise programme, aim for 50% in the first 6–8 weeks and gradually build up to the 75%. Your target heart rate varies with age (see Table 10.3).
This guide applies to healthy people – those aiming to prevent heart disease. Those with heart disease should follow medical advice and limit activity based on awareness of breathing while still comfortable. Beta-blockers slow the heart rate for example, so using the pulse will not be a good guide. Most people with heart problems can ignore the heart rate and exercise with the aim of progressively increasing performance.
Table 10.3 Target heart rates
Age (years) |
Target heart rate (bpm*) |
20 |
100–150 |
30 |
95–142 |
40 |
90–135 |
50 |
85–127 |
60 |
80–120 |
70 |
75–113 |
* bpm: beats per minute
I’ve got a tracksuit and trainers. Do I need any other special clothing to exercise in?
If you are going to build up a walking programme, you will need good shoes – don’t cut corners in footwear. Walking or jogging shoes are the best, or proper walking boots if you are walking in the countryside. Wear thick socks when you try them on and look for shoes with cushion soles and an arch support. In warm weather, wear cool lightweight cotton and remember to put sunscreen skin cream on to guard against sunburn. In cooler weather, wear two or three layers (a vest, a T-shirt and a sweatshirt, for example) to retain the heat. Loose-fitting tracksuit bottoms are comfortable and inexpensive. Don’t feel you have to go out in the rain – the exercise is to be enjoyed not endured.
Does regular exercise help prevent me from getting a heart attack during sex?
This is another good reason to get fit – physically fit people are sexually fit too and have far less risk of a heart problem during sex. Do you need another excuse?
What is ‘exercise with a purpose’?
Some people need a reason for everything and can’t see the point of just taking exercise – they get bored and lose interest. Exercise with a purpose gives them a reason, for example, walking to the newsagent for the daily paper, walking the dog, cleaning the car, getting off public transport early and walking the rest of the way to work and playing a sport such as tennis. All exercise like this is good for you. Remember alcohol in moderation is good for you, so walking as briskly as possible to and from the wine shop is exercise with a very good purpose!