What prevents heart disease “better than any drug”?


by Carolyn Thomas    @HeartSisters

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 exercise calendar). 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 sparkly 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(1) 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(2) 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(3) 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.


(1) T Miller et al. “Exercise and its role in the prevention and rehabilitation of cardiovascular disease”. Annals of Behavioral Medicine 1997 3: 220-229.
(2) Sattelmair J, et al “Dose response between physical activity and risk of coronary heart disease. A meta-analysis” – Circulation 2011; DOI: 10.1161
(3) 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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8 thoughts on “What prevents heart disease “better than any drug”?

  1. What do you think of a cardiologist who ‘prescribes’ a 5 way CABG, but neglects post-op cardiac rehab? – Not suggesting or insisting on it, and later when his patient has an opportunity to join (a different) hospital’s research into the most effective form of exercise… gives them the advice to reject the candidate?

    Yes, I thought so.

    So 18 months later, with declining physical condition but with a new and ‘Interested’ Cardiologist… I’ve started Cardiac Rehab. A month later and I’m aware of improvements.
    So, from my Real Life experience, only 50% of cardiologists are worthwhile.

    We’ve all expressed the appropriate opinion of the other 50%!

    Liked by 1 person

    1. Well, I’m thinking you already know my opinion of that first cardiologist…, as I wrote here. As cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic, once told me:

      “If your cardiologist refers you to cardiac rehab, GO! And if you ask if you need it, and they say NO, find a new cardiologist!”

      And as Oregon cardiologist Dr. James Beckerman warns his colleagues:

      “It is bad medicine to withhold lifesaving treatments from your patients!”

      I’m puzzled by this reluctance of some cardiologists to refer their patients to what is considered worldwide a Class 1 treatment protocol (meaning all evidence supports this as a must-do practice). In some studies, only 20% of all eligible heart patients are referred by their cardiologists to a supervised rehab program. That’s actually far worse than your 50% comparison! There are many practical reasons that heart patients might not show up for rehab (no evening or weekend classes, costs, transportation issues, etc) but a doctor’s failure to refer you should NEVER be one of those reasons. And since we know that physician endorsement is the #1 factor in successfully signing up for and completing a full rehab program, the buck pretty well stops with the doc.

      I’m so glad you managed to find another physician and are already, in just one month, seeing benefits! Keep up the good work!


  2. Hi – I’m 16 years old and I have been suffering these symptoms for a while but they stopped for a few weeks and are now back for the past 3 days, I’ve felt odd and not myself. At times I’ve felt dizzy for a couple hours and a chest pain that sometimes changes position on different days but I frequently panic and think I’m going to die or that something is wrong with me. I saw my doctor and he didn’t really say much but I do think there is something wrong with me?


    1. Hello Josh – I’m not a physician so of course cannot comment on your specific case. But I can tell you in general it would be highly unusual for a person your age to be having a cardiac event. It is common, however, for people experiencing panic attacks to feel chest pain that is not at all related to the heart. In fact, studies have shown that over 40% of all people diagnosed with a panic disorder have gone to Emergency because of chest pain they mistakenly believed was a heart attack. If your doctor suggests your symptoms might be caused by anxiety or panic, ask your doc for some suggestions in managing that. Meanwhile, here are some options that might help.


  3. I have the luxury of time, now that I’m retired. I just DO IT! – go for a strenuous walk every morning right after coffee and before anything else comes up to dissuade me. It takes less than an hour and possibly ensures that I’ll be able to keep doing all the other things I like to do with the rest of the day.

    The hardest part of any exercise is the first two steps out the door.


    1. Hi Joan – you are SO RIGHT! Those first two steps are the biggies. Everything after that is easy… 🙂 Keep up the good work.


  4. Hi Carolyn and thanks for this reminder. I like that doctor’s advice ‘you only need to exercise on the days you plan to EAT!’ but some days its easier to make everything else in life more important than scheduling in that physical exercise. In summer though we like to get our exercise in by kayaking or swimming in the lake which is not exercise to us, it’s summer FUN. Even gardening can be quite the workout. Little things like always taking stairs instead of the elevator can help too.


    1. Very good points, Skippie. Exercise doesn’t have to be in the gym. Watching kids running around at play in the park is a good lesson for the rest of us.


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