It is hard to overstate the benefits of a lifelong commitment to exercise and physical fitness. It has long been known that people who get regular exercise remain healthier and stronger than people who do not get regular exercise. Exercise has been linked to decreased rates of heart disease, stroke, cancer, osteoporosis, obesity and diabetes. Specifically, the benefits of exercise for heart patients are well documented. Exercise has been shown to:

• Decrease cholesterol levels and other harmful blood lipids
  
  
• Decrease blood pressure
  
  
• Increase the pumping efficiency of the heart and increase the overall health of the circulatory system
  
  
• Slow and even reverse the progression of “hardening of the arteries,” or atherosclerosis
  
  
• Reduce inflammation throughout the body, which has been linked to coronary artery disease
  
  
• Slow the progression of heart failure
  
  
• Contribute to weight loss and improved insulin sensitivity, both of which are components of the metabolic syndrome, which is associated with dramatically increased risk of heart attack and heart disease
  
  

Even slight amounts of exercise have been linked to improvements in health. Studies have shown that people who exercise once a week, for an hour at a time, have improved heart health. And the benefits increase with greater levels of activity. Based on these results, the Dietary Guidelines for Americans 2006, produced by the U.S. Department of Agriculture, recommend at least 30 minutes of exercise most days of the week to lower the risk of chronic disease. To prevent weight gain, or lose weight, the government recommends at least 60 minutes of exercise most days. These recommendations are in line with guidelines issued by leading medical organizations.

Despite these proven benefits, however, America is still facing a crisis of inactivity. By some estimates, almost 70 percent of adult of Americans are overweight or obese, and more than half of adult Americans do not get enough exercise. This lack of exercise causes an estimated 200,000 deaths every year, including deaths from coronary artery disease, colon cancer and type 2 diabetes. Alarmingly, the lack of exercise is also extending to children, prompting near-epidemic proportions of childhood obesity and a rise in diabetes among children.

Many people, however, find it difficult to initiate and remain committed to an exercise program. This has plagued researchers attempting to study the benefits of exercise because study subjects frequently drop out. One common problem is people beginning their programs exercise too strenuously at first, which results in painful recovery and decreasing motivation. It is important that any exercise program be launched under the guidance of a physician. This will include a pre-exercise screening to make sure the patient is not risking injury.

Once cleared, there are many ways to obtain the necessary exercise. Patients should choose a form of exercise that is enjoyable, fits with their lifestyle and is effective. Popular forms of exercise include yoga, aerobics, lifting weights, bike riding, hiking, walking, swimming and many others. Qualified physical trainers are widely available to help people get started after they have received clearance from their physicians.

A person should never begin an exercise program without a physician's approval.

The link between exercise and a healthy heart is well established. Exercise has clinically been shown to help prevent heart disease, as well as reduce the severity of existing heart disease. Because of its many benefits, exercise is strongly recommended by government health agencies and medical authorities, including the U.S. Department of Health and Human Services and the American Heart Association.

Beyond its cardiovascular benefits, exercise has also been associated with prevention of cancer, diabetes, obesity, osteoporosis and other health problems that affect people as they age. The right kind of exercise, at the right intensity, can help people retain their strength, balance and flexibility as they age.

Research has shown that people who get regular exercise are less likely to have a heart attack and/or die from heart disease. Conversely, lack of exercise has been linked in some studies to 12 percent of all mortality in the United States, as well a twofold increase in the risk of coronary artery disease (CAD).

Although a physician-approved exercise plan can help at any age, people who are physically active during their young adulthood (18 to 30) appear to have fewer heart disease risk factors during middle age, including obesity and diabetes. Both are intimately associated with a healthy heart. A 15-year study of more than 4,000 men and women demonstrated that the cardiovascular benefits of fitness extend into middle age.

In fact, the effect of not exercising has been compared to the effect of smoking a pack of cigarettes per day.

Exercise has dramatic benefits for the heart and blood vessels, which include:

• Decreasing the heart’s need for oxygen because the heart works more efficiently.
  
  
• Strengthening the heart muscle. The heart pumps fewer times while still meeting the body’s demand for oxygen-rich blood.
  
  
• Reducing the levels of triglycerides and LDL “bad” cholesterol. Both of these types of blood fats have been associated with an increased risk of heart disease.
  
  
• Increasing the level of HDL “good” cholesterol. Moderately high levels of HDL cholesterol have been identified as a protective factor against heart disease.
  
  
• Lowering blood pressure. High blood pressure (hypertension) puts an added strain on the cardiovascular system and is a major risk factor for both heart attack and stroke.
  
  
• Stimulating the natural process of angiogenesis, by which the body creates tiny new blood vessels to bypass clogged or diseased blood vessels.
  
  
• Helping to keep the blood vessels clear of blood clots and the buildup of plaque.
  
  
• Reversing the process of “hardening of the arteries” (atherosclerosis).
  
  
• Exercise may benefit patients with chronic heart failure as well. Recent studies indicate that proper amounts of exercise help heart failure patients live longer and reduce the number of times they must visit the hospital. However, heart failure patients are urged to follow their physician’s recommendations regarding exercise.
  
  
• Reducing inflammation throughout the body by lowering the production of pro-inflammatory chemicals in the blood. Inflammation has been linked to atherosclerosis.

In addition to its many direct cardiovascular benefits, exercise also offers indirect benefits by helping to control two conditions that put strain on the heart: diabetes and obesity.

There are many ways to obtain exercise, including walking, jogging, lifting weights, aerobics, swimming, yoga and many others. Studies have shown that cardiovascular benefits begin to accrue rapidly, even when people begin with just one exercise session a week. Many physicians recommend that patients get between 30 and 60 minutes of exercise, four to six times a week. It is important, that patients do not begin an exercise program on their own. Exercise programs should be initiated under the care of a physician.

In addition to numerous cardiovascular benefits, exercise also helps people maintain their flexibility, strength and endurance as they get older. Studies have revealed that exercise may reduce the risk of:

• Breast cancer
• Chronic lower back pain
• Colon cancer
• Constipation
• General fatigue or low sex drive
• Hemorrhoids
• Osteoporosis (literally “porous bone”)

Exercise also strengthens the lungs, which may reduce the risk of respiratory conditions.

Exercise also offers a number of important emotional benefits. First, exercise is an excellent component of stress management. Taking a walk after dinner can be as helpful (and healthful) to the mind as it is to the digestive system. Walking with a partner can also be a great way to open a conversation and tends to make the walk seem less time-consuming. Consider walking with one of your children or as a family to improve communication and teach healthy habits that will last a lifetime, particularly because obesity in children is on the rise.

Exercise is also well known for its ability to reduce depression. It can increase a heart patient’s confidence and independence, especially after a frightening event such as a heart attack or being rushed into the hospital for emergency bypass surgery. Exercise is a good tool for feeling both physically and emotionally stronger after going through a period of fear and vulnerability.

Many physicians recommend exercise to heart patients and to people in general to reduce the risk of cardiovascular disease and other disorders. There are many types of exercise that can promote heart health, including: walking, aerobic exercise, yoga, Tai Chi, weight lifting and resistance training, kick-boxing, swimming, and others. The basic rule of thumb for all of these activities is to start slowly and work up to a comfortable level of heart-healthy exercise.

It is important to get a physician’s approval before starting an exercise program and to follow the physician’s recommendations or precautions on the types and level of exercise. Some people with heart disease, such as heart attack patients, have strict limits on the kind and amount of activity they can do.

Popular exercises and tips for their use include:

• Walking. The AARP, an advocacy organization for people over the age of 50, endorses walking as an aerobic activity fit for all. People of any age and in virtually any physical condition can engage in some sort of walking program. Experts suggest beginning by walking three times a week at a comfortable distance and speed. For some people, this may be a mile, and for others it is to the mailbox.
  
  The goal is to increase activity without causing muscle cramping or injury. Over time, people can gradually increase their walking speed, distance and number of walking sessions a week.
  
  People are urged to choose carefully where they are going to walk. The risk of injury is reduced when walking on flat, even ground with little or no traffic, such as in a mall. There is also less risk of being involved in a crime when walking in public, well-lit areas. 
  
  For people who choose to carry weights while walking, the following guidelines are offered:
  
  
• • Carry equal weights in each hand or around each wrist.
    
    
  • Do not strap weights to the ankles or lower legs, because of increased risk of a knee injury.
    
    
  • Do not swing the arms too far while walking; keep the swing natural to reduce the risk of a back injury.

Some people choose to walk with a dog, which tends to make the walk more enjoyable for the pet and the owner. However, all pet owners need to take the dog’s comfort into consideration when heading out on particularly hot or especially cold day. Finally, neither humans nor animals should dash off on a fast walk right after eating a heavy meal.

• Aerobic exercise. Aerobic exercises are those that increase the heart rate for a sustained period of time, as opposed to resistance exercises that rely on short bursts of strength. Aerobic exercises include walking, biking and swimming. Water aerobics are an excellent, low-impact exercise for people who cannot withstand the pounding involved with running or stress associated with biking. Like all forms of exercise, aerobics should be started gradually. People who are interested in aerobics should not sign up for advanced spinning classes or step classes unless they are already fit. Spinning is a form of intense exercise on a stationary bicycle, usually situated in an aerobics studio, and step classes are a form of aerobics that use small platforms.
  
  
• Yoga, Tai Chi and Pilates. Yoga and Tai Chi are Eastern forms of movement that improve strength and flexibility. The U.S. National Institutes of Health (NIH) suggests trying yoga or Tai Chi to reduce the risk of heart disease. Pilates has also become popular for improving core strength and flexibility.
  
  Yoga and Pilates may involve some stretches and positions that are inadvisable for some heart patients or patients with back problems. Therefore, patients are encouraged to speak to their physician before beginning.
  
  Tai Chi is a gentle form of exercise that people in China tend to use well into old age. It may be a good place to start for people who have not been exercising. It is advisable to take classes from instructors who are trained or certified in the specific form of exercise.
  
  
• Weight lifting. Studies have shown that resistance training, with either free weights such as dumb bells or resistance machines, has numerous benefits. Weight training benefits people well into old age by increasing strength and bone health, thus reducing the risk of falling accidents and helping people retain balance and mobility. However, weight training carries risks. Inexperienced people frequently start out "too heavy," which can result in training injuries or in such painful recovery that they may stop exercise altogether. If it's economically feasible, hiring a personal trainer (available through most gyms) for a few sessions can help a person learn to lift weights properly. This will include teaching the weight lifter how to use each machine, the proper motions for maximum benefit, and the right form to reduce the risk of a training injury. Many people also find it helpful to weight train with a partner, who can act as a spotter and a motivator.
  
  
• Kick-boxing. One popular trend in exercise is kick-boxing. For many, it is a high-energy and enjoyable activity. However, people can easily sustain injuries from this form of exercise. The following tips are offered to prevent problems:
  
  
• • Always start with a qualified instructor.
    
    
  • Do not do too much too soon. Throwing oneself completely into complicated kicks and punches in the first kickboxing class, especially without one-to-one supervision, increases the risk of injury.
    
    
  • If uncertain that a move about to be performed is correct, reconsider and check out the move with the instructor.
    
    
  • Consider beginning with other forms of martial arts training (e.g., karate), which progressively build muscle groups before starting kickboxing moves. 
    
    
• Joining a health club. Many health clubs are thriving businesses that might not take the time to ask individual members about their heart or medical history. It is important for all heart patients to ask questions such as:
  
  
• • Will there be a staff member here at all times who has current certification in cardiopulmonary resuscitation (CPR)?
    
    
  • Does the facility have a defibrillator in case of emergency?
    
    
  • Will there be a staff member here at all times who is trained to use the defibrillator?
    
    
  • Where is the closest hospital emergency room, and what transportation services are available for getting there?
    
    
  • Are there specific classes geared toward older individuals who are at higher risk for medical problems?
    
    
  • Do you have personal trainers on staff who can help teach me how to use the equipment? What are their rates?
    
    

Although the benefits of exercise far outweigh the risks, it is important to be in a facility that is prepared for any emergency that might arise.

Before beginning any exercise program, individuals should get a complete physical examination and discuss any fitness plans with a physician. A physician will be able to help formulate a fitness program based on an individual's age and health status or, at the least, recommend a suitable fitness trainer. The physician may also order an exercise stress test, which can help determine a safe level of exercise for individual needs. 

According to the American Heart Association, certain individuals are especially urged to seek medical advice before beginning a program, including those who:

• Have reached or passed middle age.
  
  
• Are significantly overweight or obese.
  
  
• Have a family history of heart disease
  
  
• Want to begin a fairly strenuous exercise program but have been inactive for quite some time.
  
  
• Are taking medication for high blood pressure (hypertension), heart disease or stroke.
  
  
• Have any joint problems (e.g., arthritis), bone problems (e.g., osteoporosis), muscle problems or other conditions (e.g., unstable heart failure) that may be worsened or complicated by exercise.
  
  
• Have noticed new symptoms in the past month (e.g., chest pain).
  
  
• Have been ordered by a physician to engage only in medically supervised exercise programs.
  
  
• Exhibit any of the following symptoms: severe shortness of breath, fainting (syncope), or pain in the chest, arm, shoulder or left side of the neck after participating in mild exercise

To make the most of aerobic exercise, it is important for people to exercise within 70 to 80 percent of their maximum heart rate. Exercising within this range is one’s target heart rate (THR). To calculate your target heart rate, use the following formula:

• Maximum heart rate (MHR) = 220 – your age. For example, the MHR of a 50-year-old would be 170 (220 – 50).
  
  
• Your MHR multiplied by 0.7 is the low range of your target heart rate. For example, a 50-year-old should reach or exceed a heart rate of 119 (170 x 0.7).
  
  
• Your MHR multiplied by 0.8 is the high range of your target heart rate. For example, a 50-year-old should not exceed a heart rate of 136 (170 x 0.8).

The THR is the pulse rate at which exercise “counts.” With your physician, you can also identify warm-up exercises appropriate for reaching this target rate. Typically, 30 minutes of exercise at your THR is adequate for cardiovascular benefit. Most experts recommend participating in an aerobic exercise at least three days a week. Other experts believe that shorter workouts (e.g., 10 minutes) every day are also effective. Studies have shown that even walking for a period every day can help lower your risk of medical conditions.

While exercising, people are encouraged to monitor their heart rate regularly to make sure that they are staying within the appropriate range for their age.

Many exercise machines (e.g., treadmills, stationary bicycles) provide a heart monitor to help people remain within their target heart rate. If a computerized monitor is not available, individuals may try using a simple "talk test." During moderate exercise, it should be possible to carry on a normal conversation comfortably.

If people are gasping and unable to talk, they have probably reached or exceeded their optimum aerobic zone. At any time, if exercisers feel chest pain (angina) or shortness of breath, they should stop exercising immediately and consult their healthcare provider.

There are certain strategies that should be undertaken as part of any exercise program in order to be safe. These include:

• Warming up and cooling down. Regardless of the type of exercise performed, it is necessary to prepare for the workout by gradually increasing the heart rate (warming up), exercising at an increased heart rate for a given period of time (working out) and gradually decreasing the heart rate until it nears the resting rate (cooling down). This places less stress on the heart and muscles.
  
  
• Stretching before and after exercise. This is the key to a good exercise program. Before exercise, use lighter weights than normal and jog in place slowly or perform other light but full-movement activities, as the goal is to begin speeding up the heart rate. After exercise, however, the goal is to decrease the heart rate. Slow stretches, which focus on movement of particular muscles or body regions, will allow you to “wind down.” Older people are encouraged to take extra time in warming up and cooling down.
  
  
• Not trying to do too much too fast. Overexerting yourself can lead to injury and a much lower chance that you will continue to exercise in the future. When starting an exercise program, take it easy at the beginning and work up to a level where you feel comfortable. Wear appropriate clothes and shoes. Clothes should be loose-fitting, and shoes should fit  properly. For example, people should not be hiking up a mountain in flat shoes that offer no support. People with diabetes are urged to take especially good care of their feet, wearing clean and supportive shoes and socks and checking their feet after exercise for any sign of redness or injury.
  
  
• Drinking plenty of water. This tip is particularly important for people who are exercising in hot climates or who are taking medications that stress the need for plenty of water. Diabetic individuals should also have a light, sugary snack on hand in case they begin to feel light-headed or notice other symptoms of hypoglycemia.
  
  
• Having proper identification on hand. If you wear a medical identification bracelet or tag, you should always have it on while exercising.  When exercising away from home, it is also a good idea to carry your physician’s address and phone number (as well as your own contact information) in case of emergency.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about exercise and the heart:

1. Do I have a heart condition or other problem that restricts my ability to exercise?
   
   
2. What specific benefits can I expect if I start exercising?
   
   
3. What types of exercise do you recommend for me?
   
   
4. Are there any types of exercise I should not do?
   
   
5. At what level should I start?
   
   
6. How fast and how much should I increase my activity level?
   
   
7. Should I use a heart monitoring device while exercising?
   
   
8. Do I need to follow any particular precautions when exercising?
   
   
9. What are the warning signs of overexertion?
   
   
10. When should I seek medical help if I’ve overexerted myself?
    
    
11. Do I use any medications that might interfere with a regular exercise program?
    
    
12. How quickly will I achieve results from exercising?