by Carolyn Thomas ♥ @HeartSisters
If you are one of those misguided sods who still believe in the exercise axiom: “No pain, no gain” – you can stop reading right now. The rest of you – rejoice! According to the National Heart, Lung, and Blood Institute, taking a long daily walk may be a better way to improve heart health, lose weight and feel better compared to shorter periods of more strenuous exercise.
A randomized controlled clinical trial funded by the NHLBI compared two exercise programs for heart attack survivors:
- 1. Standard cardiac rehab exercise: 25-40 minutes of exercise three times per week at approximately 65-75% peak aerobic capacity. This included 25 minutes of treadmill walking and 8 minutes on 2 to 3 ergometers: cycle, rowing, or arm.
- 2. High-calorie expenditure exercise: longer duration but lower intensity, more frequent exercise (45-60 minute sessions, but at just 50-60% peak aerobic capacity, 5-7 times per week).
Walking, rather than weight-supported exercises (such as cycling or rowing), was preferred to maximize calorie expenditure, which was targeted at 3,000-3,500 calories per week. The protocol was essentially to “walk often and walk far.” All heart patients studied were considered overweight before starting the program. Each subject also received 16 hours of group dietary counseling, and were given a target goal of consuming 500 calories per day less than their predicted maintenance calories.
What did their results show?
The high-calorie expenditure (walking) exercise program participants had double the weight loss compared to those in the standard program (8.2 kg vs. 3.7 kg). They also had a greater reduction in waist circumference and in fat mass.
The high-calorie expenditure program participants had a greater improvement in their overall cardiometabolic risk profile, including a greater decrease in insulin resistance and a greater reduction in the total-to-HDL cholesterol ratio (13% vs. 3%).
The high-calorie expenditure exercise participants burned 615 calories per day from lower-intensity exercise for 45-60 minutes, as compared to just 169 calories per day for the standard program that emphasized less frequent and higher intensity exercise over 25-40 minutes.
Dr. Thomas Allison at Mayo Clinic made this observation about the study’s results:
“The results are sufficiently worthwhile that serious consideration should be given to incorporating this research into standard clinical practice in cardiac rehabilitation.”
Read more about this cardiac rehab study.
NOTE FROM CAROLYN: I wrote more about the importance of cardiac rehabilitation – and moving your body every day – in my book, “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press). You can ask for this book at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press. Use their code HTWN to save 30% off the list price when you order.
See also:
Heart Disease is a Sitting Disease
Learning To Live With Heart Disease: The Fourth Stage of Heart Attack Recovery
Women-Only Cardiac Rehab Curbs Depression After Heart Attack
Why Aren’t Women Heart Attack Survivors Showing Up For Cardiac Rehab
Why Your Heart Needs Work – Not Rest! – After a Heart Attack
Returning to Exercise (and Training) After Heart Surgery (THE best and most comprehensive overview on this topic I’ve seen yet, written by cardiologist/triathlete Dr. Larry Creswell; especially useful for heart patients who have been regular exercisers before their cardiac event and are wondering how to safely resume their daily routine).
Heart Sisters 
I’d love to walk more. It was my favorite exercise.
However, the medication causes my legs to feel like lead after 15 minutes, and they won’t change it.
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Hello Linda – it can be quite a shock to go from your “favourite exercise” to having legs that feel like lead.
I had a similar experience as a former distance runner and walker-turned-heart patient. In the early months after my heart attack and subsequent coronary microvascular disease diagnosis, I complained to my pain specialist one day that I was feeling so discouraged because I could not longer reach my former 10,000 steps/day walking goal – it seemed that I just ran out of gas less than halfway through. His suggestion was to cut that goal in half, and see how that goes. I found that I was able to do 4500 steps, so started with that as my temporary goal. As I got used to the fistful of meds I was now taking each day, I was slowly able to build up my endurance. Sometimes I’d break up those walks with much shorter walks three times a day. All of it depended on listening to my body and setting realistic target goals..
I may not ever reach that former 10,000 step/day goal, but at least I’m outdoors, enjoying my walks and moving my muscles.
Take care, stay safe. . . ♥
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Does this apply to those of us with Congestive Heart Failure?
My EF is 28%. I walk some, but not as much as recommended here! Please advise!!
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Hi Virginia – only your doctor can recommend what’s best for you. My understanding is that patients diagnosed with functional Class 4 heart failure should NOT exercise except under direct medical supervision. Class 4 means an inability to carry on any physical activity without discomfort, and heart failure symptoms are present even at rest.
But experts do recommend this advice for all other heart failure patients: “At minimum, exercise by walking a total of 30 minutes a day (include rest intervals as needed), 5 to 6 days a week.” These Cleveland Clinic Heart Failure Exercise/Activity Guidelines may be helpful.
Cheers,
C.
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“…The high-calorie expenditure program participants had a greater improvement in their overall cardiometabolic risk profile…”
This is interesting data that balances recent news that high-risk patients should be doing intense sweat-producing exercise to improve their heart health. Realistically, which exercise do you think a previously sedentary person is most likely to start and continue successfully?!?!? Thanks very much for this, Carolyn.
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After a severe “widowmaker” heart attack, walking often and far probably saved my life. However, walking outdoors in winter can be rather treacherous — so I set up a computer above a treadmill and walked and surfed for hours a day. (You can now buy treadmill work stations, but setting one up is easy). Even walking now as I type this….
Another great article, Carolyn,…
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Thanks, Steve – I liked your Latin proverb: “Solvitur Ambulando” = ”It is solved by walking.” (Note: This does not mean “Solved by Ambulance”)
cheers,
C.
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The other good thing about this walk often advice is that it is so do-able no matter what size, shape or age you are. No need for special equipment or expensive gym memberships – just a good pair of shoes. Rain or shine! Great advice for both heart patients and the rest of us. Thanks for yet another interesting article. love your site.
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