The Fit Can Survive
There is no denying it:
exercise is good for you. Whether you have never put on a pair of
running shoes to go for a walk, or they are hiding in the back of
your closet, if you have heart disease, put them on and get moving
- a lot! Recent research shows that exercise is more important than
But if it's clear today, it hasn't always
been so. As early as 1768 English physician William Heberden noted
the benefits of exercise in the treatment of heart disease when
his patient reported relief of angina symptoms after sawing wood
daily for 30 minutes. But the message was not fully understood.
Over the 100 years that followed, doctors commonly ordered complete
bed rest for patients recovering from a heart attack. This inactive
approach didn't get good results and in the 1950's, prompted Dr.
Terry Kavanagh, physician and exercise scientist, to start supervised
exercise rehabilitation for most heart patients. In 1968 he opened
the Toronto Rehabilitation Centre where structured, individualized
exercise prescription and heart health education were the main components
of his specialized cardiac program. Graduates of Dr. Kavanagh's
program reported tremendous improvements in their physical and emotional
well being. Today, we've finally got it - the medical profession
supports that exercise of moderate intensity is recommended for
most heart patients.
How Do We Know Exercise Works?
The results of numerous studies can't be
wrong. An overwhelming amount of scientific research concludes that
exercise improves your health. Researchers have devised the "dose-response
curve"(see Graph 1) to illustrate how this relationship works
(Adapted from Sesso, H. et al. 2000). With more exercise (the dose),
the amount of health benefits increase (the response). In simple
terms, getting the maximum benefit from your exercise is related
to the amount you do. The plateau of the curve shows that the health
benefits don't continue to increase beyond a certain amount of exercise.
It's somewhat like taking medication. Taking more medication than
your doctor has prescribed is not better and in most cases, will
The scientific news keeps getting better.
According to a recent study published in the New England Journal
of Medicine, people who get plenty of exercise live longer, even
people with heart disease (Myers, J et al. 2002). In this study,
6,213 men were divided into two groups, those with and without a
history of heart disease. These two groups were subdivided into
one of three fitness categories (low, medium and high fitness) based
on how much uphill walking they completed during an exercise stress
test. The comparisons between fitness categories are shown in Graph
2 (the group without heart disease) and in Graph 3 (the group with
heart disease). In both graphs, men in the high fitness group survived
longer compared to men in the medium and low fitness groups. Not
only that - men in the high fitness group had a lower risk of dying
even in the presence of high blood pressure, diabetes and excess
body weight. The authors concluded that it was the differences in
fitness that prolonged the participant's lives, despite having other
Why do we exercise?
The changes that occur in the body with regular
exercise go a long way to improve the efficiency of the heart and
lungs and working muscles. Habitual activity lowers resting heart
rate, increases the amount of blood the heart can eject with each
beat and increases the use of oxygen by working muscles. Collectively,
these improvements reduce the workload of the heart. Habitual activity
also lowers blood pressure, increases good HDL cholesterol and helps
regulate blood sugar. Activities of daily living become easier to
perform and leisure activities such as gardening will feel like
a breeze (see gardening article in this issue).
So we know that exercise works but
what are we doing with this knowledge? Are you getting sufficient
exercise? The American College of Sports Medicine, a leading authority
in the area of exercise science, recommends that adults include
a 30 minute brisk walk on most, if not all, days of the week to
improve their health. Following this recommendation is a good place
to start if you have not had your exercising shoes on for a while.
If you are new to the cardiac rehab program, 30 minutes of walking
5 times per week may be your starting prescription. But according
to the dose response curve described early in this article that's
just the beginning! For maximum benefit, exercise needs to be of
longer duration, performed more frequently and with more effort.
With this in mind, your Exercise Therapist systematically and safely
changes your exercise frequency, duration and intensity at regular
intervals throughout your attendance at the cardiac rehabilitation
program. If your exercise routine has become less than habitual
or has been interrupted by other priorities, it is time to get moving
again. It is long-term compliance to your exercise program that
provides greater health benefits and the required time for improvement.
Participating in our upcoming "Walk With Heart"
walkathon on September 27, 2003 in support of cardiac rehab services
may be just the opportunity you are looking for to re-establish
your walking routine. Regular exercise helps you live a longer life!
1: Dose-Response Curve (Adapted from Sesso, H. et al. 2000)
2: Survival rates for normal subjects according to peak fitness
level. (Myers, J. et al. 2002)
3: Survival rates of subjects with cardiovascular disease according
to peak fitness level. (Myers, J. et al. 2002)
CCRF would like to thank the Rouge Valley Health System - Cardiac Rehabilitation Services for their contribution to the website.
The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advise. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.
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