Exercise

Exercise is an important component of any preventative medicine program (approximately 40% of the lifestyle changes). You are what you eat, and what you do with it, therefore you must “start from within”.

There are many reasons why people do not exercise. Some do not have the time, Some do not have the energy, some feel they are not healthy enough to exercise, and some just simply do not want to exercise.

Bluntly, you can not afford to not make the time. The benefits of exercise include stress relief and increased energy expenditure, making it easier to diet and keep that weight off. No successful sustained weight loss program has ever been devised by man which did not include maintenance exercise.

Exercise is one of the best stress relievers you can practice. Stress is a killer, and is unavoidable in today’s world. It takes a surprisingly small amount of relaxation to overcome the stresses of today’s life. It increases the amount of energy available to the working tissues of the body and increases the amount of fatty tissue burned during a 24-hour time even while at rest.

To review briefly the role of health and exercise, let us go back about 200 years. Dr. William Heberden, who gave the first description of angina , wrote in “Commentaries on the history of Disease and Cures” in 1802, that “I have nothing more to add for the treatment of angina, but did know one patient who set himself the task of sawing wood for an hour and one half early in the day and was nearly cured.” Dr. Heberden lived to be well into his 90s.

A practice begun by John Hilton, chief of surgery at Guys Hospital in London, espoused that after major surgery a patient should rest until all the pain has abated so that the body would “heal itself”. This philosophy soon entered the field of cardiology. Heart attack victims were put to bed and assigned to the invalid category. This became popular until 1951 when Dr. Sam Levine in Boston, Massachusetts espoused the philosophy of getting patients up early, leading to fewer complications. To support his recommendation, Dr. Levine suggested that muscle wasting and increasing body fat were a product of long bed rest, with bone softening, the loss of joint mobility and the loss of bone calcium and its many subsequent side effects. Then you enjoy maintaining that the benefits of early mobilization (exercise) resulted in increased cardiac output and stroke volume, increasing total blood volume, decreased resting heart rate, decreased hypertension, increased oxygen capacity, better wound healing, less postural hypotension and strangest of all, an increase in the exercise capacity by 20 to 30%. Perhaps the best result of this philosophy was the opening of the first cardiac rehab center in Montréal Canada. After careful evaluation of patients recovering from myocardial infarction, they were begun on a progressive exercise program initially starting with walking, then jogging, and later running. All patients were exercised to the point of symptoms. Eight patients wished to demonstrate the effect of cardiac rehabilitation by participating in competition. In 1960, after a thorough metabolic evaluation, all eight were cleared for competition. All eight entered, and finished the Boston Marathon.

To be sure, one should have a thorough history, physical and evaluation of disease related systems, including an evaluation of reserves. Everyone can do some exercise, even if only stretching exercises or walking.

As to the specifics of exercise, this should be determined by the examining physician and an exercise physiologist or personal trainer. Exercise should consist of two phases, anaerobic strengthening exercises, and aerobic cardiovascular exercise. Aerobic exercise is any activity involving large muscle groups, done for an extended period of time. Aerobic exercise can be done for weight loss but also provides cardiovascular benefits. Examples of aerobic exercise include walking, biking, jogging, swimming, aerobics classes and cross-country skiing. Anaerobic exercise usually refers to resistance training. Anaerobic exercise is done primarily to increase muscle mass. Weight training is a form of anaerobic exercise. The anaerobic phase of exercise is devoted to maintaining muscle strength and balance to prevent falls. In our later years fractures from falls are infinitely more devastating than one would expect. Approximately one third of patients who survive corrective hip surgery require nursing home care for the remainder of their life. Approximately 50% of patients without appropriate treatment of osteoporosis (thinning of the bones) will experience a fracture during their lifetime.

An article approximately 10 to 15 years ago in the New England Journal of medicine, suggested that for every three years of regular cardiovascular exercise (30 minutes of aerobic exercise three times a week) one would probably gain approximately 1 year of lifespan.