As we’ve seen, all it takes to achieve a good level of cardiovascular fitness which will protect you against future problems is a solid program of brisk walking, about three to five kilometres five days a week. Whether you want to walk, jog, cycle, swim, dance, do aerobics, or just about any other kind of heart-quickening exercise, 30 to 45 minutes five days each week will do the trick. Add to that aerobic program some resistance exercise and you have a complete fitness program that any doctor would be proud to see. So is there any reason to go any further?
While all exercise helps to raise the levels of the protective HDL cholesterol in the blood, the more you do the higher the HDLs’go up. Studies have shown that distance runners and other endurance athletes have higher HDL counts than average.
A few research projects have attempted to show an additional advantage of high-intensity exercise for cardiac patients. Most notable is the work done by Dr Ali Ehsani at Washington University in St Louis. His patients, in a closely supervised program, have done significantly better than those receiving typical cardiac rehabilitation. Dr Ehsani employs an experimental regimen that raises patients’ heart rates to 80 per cent of age-limited maximum rather than the 40 to 70 per cent levels in traditional rehab programs.
“Patients improve their myocardial work capacity, exercise ejection fraction, and plasma lipid profile,” the cardiologist says. That is to say, their hearts ate capable of mote work and pump more blood, and their cholesterol and triglyceride counts improve. Very importantly, Dr Ehsani reports, they have reduced exercise-induced myocardial ischaemia as measured by ST segment changes on their ECGs and fewer abnormalities in their heart muscle contraction. Moreover, after a year of such intense exercise, hypotension (a drop in blood pressure that suddenly occurs when an individual exerts himself) decreases markedly.
Patients follow a routine that starts off with brisk walking and gradually increases in both duration and intensity. After several months, patients jog for 50 to 60 minutes a day four to six times a week. Dr Ehsani has worked with more than 600 patients thus far, and deaths and complications have been rare.
But is this approach for everyone? The answer is a definite no! Only those patients who have had an uncomplicated heart attack and who have no severe heart muscle damage should be considered. The program is limited to those low-risk patients who don’t have severe disease. And for those who do opt for this kind of all-out effort, close medical supervision is essential. Leaving a cardiac rehabilitation program and immediately setting off to train for a marathon is asking for trouble.
But for those who do fit all the criteria and are willing to make the admittedly tough effort, the achievement can make every minute’s worth of work worthwhile. Those who “make it to the top” experience a tremendous surge in self-esteem. Levels of anxiety and depression plunge. Studies at the University of Alabama have revealed that those who complete a high-intensity exercise program do decidedly better in terms of psychological testing. They flat-out feel better about themselves.
Let’s look at a parallel situation. If you do some walking on a treadmill in the cardiac rehab facility at the hospital and you realise that there’s not much in the world outside that you’d want to do that would surpass that level of exertion, you feel a definite sense of security and assurance. Now imagine what it’s like to be able to exercise at full-tilt for an hour, sweat pouring off your body, lungs expanding to their fullest. After your shower you feel like you can take on the world and win!
Today I have a resting heart rate of about 50 beats per minute, a blood pressure of approximately 120/80, and a cholesterol level that consistently remains in the 3.9 to 4.1 mmol/1 range. Dr Michael Lawlor at the Heart Institute of the Desert put my vital statistics through the computer program they’ve devised to determine the level of a person’s health relative to the expected levels of performance and physiological measurements for a person of a given age. Some people may be only 50 years old, but they have the body of a 70-year-old. Imagine how I felt when Dr Lawlor sent back the computer-generated determination that, at age 47,1 was performing at the level of a 26-year-old man!
Armed with that kind of diagnosis, along with the angiogram that had shown absolutely no arterial obstruction in my heart’s bypass grafts and native arteries, and you can imagine how I felt. All those little twinges, or chest discomfort, or abdominal disturbances, or other feelings that once I might have questioned of being of cardiac origin I now knew were completely benign. I was a 100 per cent healthy man!
Yes, a program of brisk daily walking can keep you heart-healthy. But there’s nothing like high-intensity exercise to make you feel really alive! And I’m not the only guy who feels that way.
Chuck Whitlock, a good friend of mine, had his heart attack and bypass surgery at age 42. His approach to recovery was much like mine, with a determination not to let this disease get him down. Today Chuck skis at breakneck speed down the slopes, scuba dives, plays a mean game of racquetball and works hours that would exhaust a man half his age. To keep up his pace and his health, Chuck never misses his exercise. He belongs to a health club near his home, uses a few pieces of equipment in a spare room of his house when he just can’t get away, and makes certain that he stays in hotels that have fitness equipment. Is the effort worth it to him? Chuck says without any hesitation or doubt that he’s never felt better in his life, and that he’ll never quit the program.
Barbara Else at Cedars-Sinai Hospital tells a wonderful story about the motivation and rationale to go that “extra mile”. After one patient, Leon, had a heart attack, his wife and kids wouldn’t let up. They worried about him all the time, urging him to take it easy and not exert himself. In his late forties, Leon wanted to live his life, not just exist. He knew he was just fine, that his recovery had been complete, but he couldn’t convince his family. So he entered a five-kilometre race along with his sons, just to let them see that he was, indeed, OK, and that they didn’t have to baby him. It worked.
Please understand that I’m not encouraging you to run a triathlon, a marathon, or even a five-kilometre race. Not everyone is physically capable of such exertion, and fewer yet would want to do so. But these men serve as shining examples of just how far one can take the concept of complete cardiac recovery.
Everyone’s motivation for going all-out in terms of recovery and exercise is a bit different. I can only tell you that in my own case, the second bypass hammered home the idea that I was a mortal man with a condition that could kill me, and that if I didn’t do something it would be sooner rather than later. There was a lot of living that I wanted to do, and I wanted to live that life with gusto, without limitations.
I told you about my success in the formal rehab program. If I felt that good in such a short period of time, I thought, what would I feel like if I gave it all I had? The result of my efforts, as I’ve said again and again, is that I feel fantastic. My exercise program has become like a drug for me; I literally need an exercise “fix” to keep feeling the physical and psychological “high” I’ve come to regard as the standard of living. Being just OK isn’t enough for me.
Yes, a far more moderate program is all you need. But if you fit the medical criteria to allow yourself to try for a high-intensity fitness regimen, give it a try. Talk with your doctor about it. If he feels that there’s nothing in your medical picture to keep you from it, go for it! There’s a big difference between living and feeling really alive!
Cardio & Blood/ Cholesterol