It doesn’t come in a pill bottle, nor is it supported by multi-million dollar marketing campaigns. It’s affordable, and often even completely free. It has few if any harmful side effects. It’s appropriate for both young and old alike. And just like the fistful of cardiac medications I now take every day since my own heart attack, I keep careful track of it (as evidenced by the stickers on my calendar at left). It is exercise. And it helps to prevent heart disease “better than any drug”, says Mario Mitkov of the University of California at Davis.
“Simply put, exercise trains the heart and skeletal muscles to operate more effectively at any given workload, even in patients with heart failure.”
Mayo Clinic cardiologists, in fact, recommend physical exercise as one of the five most powerful drug-free ways to address heart disease risk factors:
“Getting regular daily exercise can reduce your risk of heart disease. And when you combine physical activity with other lifestyle measures, such as maintaining a healthy weight, the payoff is even greater.
“Physical activity helps you control your weight and can reduce your chances of developing other conditions that may put a strain on your heart, such as high blood pressure, high cholesterol and diabetes. It also reduces stress, which can also be a factor in heart disease.
“Try getting at least 30 to 60 minutes of moderately intense physical activity most days of the week. However, even shorter amounts of exercise offer heart benefits, so if you can’t meet those guidelines, don’t give up. You can even break up your workout time into 10-minute sessions. You don’t have to exercise strenuously to achieve benefits, but you can see bigger benefits by increasing the intensity, duration and frequency of your workouts.”
Keeping track of my own exercise on that little bathroom calendar by rewarding myself with a colourful sticker after each workout may sound corny – particularly to the tech savvy self-trackers of the Quantified Self movement - but it helps me to monitor how much physical activity I’m actually getting. My goal is to exercise every day – as cardiologist Dr. John Mandrola likes to recommend:
“You only have to exercise on the days you plan to eat!”
And there’s just no escaping the graphic evidence of those little calendar stickers.
Research from the Cooper Institute for Aerobics Research in Dallas, Texas has found that it is actually better for our hearts to be fit than to be thin. Unfit, lean people in their study* had a higher risk of death from cardiovascular disease than those who were fit and obese.
Regular exercise has also been found to reduce age-related changes in our cardiovascular function. Maximum oxygen uptake decreases as we age, but less so in physically active individuals. Left ventricular heart function (which is known to decline with age) also improves with exercise. And regular exercise helps keep arteries elastic, even in older people, which in turn may enhance blood flow and normal blood pressure. Sedentary people have a 35% greater risk of developing high blood pressure (hypertension) than athletes do.
In Harvard School of Public Health research** recently published in the heart journal Circulation, pooled analysis of relative risk by sex showed that women derived even greater benefit from physical activity. The analysis showed a 22% reduction in heart disease risk among men and a 33% reduction among women.
Losing weight can also affect an embarrassing problem shared by many women as they age: urinary incontinence. In a randomized trial funded by the National Institutes of Health recently, moderate weight loss in a group of overweight women who undertook a six-month diet and exercise program cut the frequency of urinary incontinence episodes by nearly a half, according to a study undertaken by University of California at San Francisco researchers.
Dr. Rainer Hambrecht of Bremen, Germany saw similarly impressive results in his 2004 study*** published in the journal Circulation:
- Nearly 90% of heart patients who rode bikes regularly were free of heart problems one year after they started their exercise regimen.
- Among patients who had an angioplasty instead, only 70% were problem-free after a year.
Five years later, Dr. Hambrecht presented findings from his follow-up research to the 2009 European Congress of Cardiology meetings in Barcelona, confirming his earlier results that regular exercise training is superior to angioplasty at preventing subsequent cardiovascular events. He said at the time:
“It’s difficult to convince people to exercise instead of having an angioplasty, but it works.”
In an interview with Heartwire, Dr. Hambrecht acknowledged that there are multiple forces working against a scenario in which regular exercise is prescribed instead of stenting.
“For one, patients are not motivated to take responsibility for improving their own cardiovascular health – even if it means better event-free survival.
“For another, encouraging exercising is financially less appealing for hospitals. That was my feeling – that hospitals were reluctant to participate in this study, because they derive revenue from revascularization procedures in their cath labs.”
Dr. Hambrecht also believes his research supports the call for cardiologists to take time between the diagnostic angiogram and the revascularization procedure to discuss lifestyle improvement options with the patient, rather than stenting every patient.
Meanwhile, Mario Mitkov has studied the effects of regular exercise on those you’d expect would be least able to exercise – people diagnosed with heart failure. Heart failure (previously known as congestive heart failure) remains a life-threatening condition, with a one-year mortality averaging 45%. But the surprising benefits of exercise on these people include:
” Exercise-trained heart failure patients fatigue at higher workloads compared to sedentary heart failure patients. Not only can exercise lessen the severity of symptoms of heart failure, it can be more effectively and safely used as a primary preventative measure for heart disease.
“In fact, there has been no single medication that provides the wide array of benefits that cardiovascular exercise does.”
In addition, the longterm effects of exercise have proven to strengthen cardiac muscle causing an increase in the ejection fraction of the heart. Exercise reduces the occurrence of deadly arrhythmias in patients with heart failure, too. And through exercise training, heart failure patients can actually experience a decrease in the severity of shortness of breath because their respiratory muscles and heart work together more effectively.
In fact all of these physiological changes can result in an increased functional capacity that directly correlates to the quality of life that even a patient with heart failure experiences.
* T Miller et al. “Exercise and its role in the prevention and rehabilitation of cardiovascular disease”. Annals of Behavioral Medicine 1997 3: 220-229.
** Sattelmair J, et al “Dose response between physical activity and risk of coronary heart disease. A meta-analysis” – Circulation 2011; DOI: 10.1161
*** Hambrecht R, Walther C, Möbius-Winkler S, et al. “Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial” – Circulation 2004; 109:1371-1378
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