H E A L T H W A T C H 5 P E C I A L A D V E R T I S I N G S U P P L E M E N T

H E A R T H E A L T H HealthWatch
HEART-HEALTHY
YOU S H OU L D KN OW A BOU T
E XE R C IS E
H
ealthwise, one of the best
things to happen to a local
cardiology patient was los-
ing his car. Inconvenient
though it was, the man began biking to
work. When Dr. Simon C. Jung saw him
a year later, he'd lost 50 pounds and dra-
matically reduced his heart-risk profile.
"I couldn't believe it. I didn't recog-
nize him," recalls Dr. Jung, director of
the Cardiac Catheterization Laborato-
ry at Bethesda North Hospital, part of
the TriHealth Heart Institute. "I always
tell all my patients when I talk about
reducing your risk for heart attack and
strokes that you've got to move. Activ-
ity, activity, activity. It doesn't have to
be anything very organized. It doesn't
have to be what we typically think of
that happens in a gym with an instruc-
tor. It's just physically moving that's
absolutely vital."
We've known for more than a half-
century that exercise is good for us.
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H E A R T H E A L T H
W H I L E T H E C ON C E P T OF "N O
P A I N , N O G A I N " A P P L I E S T O S OM E
FOR M S OF E XE R C I S E , P U S H I N G
YOU R H E A R T I S N OT A G OOD
S T R A T E G Y. "A G OOD BR I S K W A L K
3 OR 4 M I L E S FOR A YOU N G P E R S ON
A N D U P T O 2 M I L E S FOR A N
E L D E R L Y P E R S ON I S FA N T A S T I C . "
It has been shown to boost the immune
system, prevent forms of cancer, improve
bone strength and more. But as the medi-
cal community continues to explore its
benefits to our heart health, the case for
exercise gets overwhelmingly strong.
This list of five essential facts reflects
some of the newest thinking about exer-
cise and heart health. If this doesn't mo-
tivate you to get moving, we don't know
what will.
1 . MODERATE EXERCISE
IS GOOD ENOUGH.
While the concept of "no pain, no gain"
applies to some forms of exercise. Dr.
Jung notes that pushing your heart is not
a good strategy.
"A good, brisk walk3 or 4 miles
for a young person and up to 2 miles for
an elderly personis fantastic," he says.
The key is to bring your heart rate up
to between 60 and 80 percent of your
maximum heart rate, explains Jaclyn
Madill, director of Fitness and Aquatics
at the Mercy Health Anderson Health-
Plex. To calculate your maximum heart
rate, subtract your age from 220. If
you're new to exercise or have been inac-
tive recently, err on the lower end during
your workout.
Madill says you can also measure your
perceived level of intensity on a scale of 1
to 10, "with 10 being 'I absolutely cannot
continue' and 1 being 'Yeah, I might be
working out right now.' You want to be
up in the 6 to 7 range."
As a good rule of thumb, you should
log at least 150 minutes of moderate-in-
tensity exercise per week, or 75 minutes
of vigorous activity when you're ready
for it.
If you're uncertain at all about
whether you're exercising moderately or
vigorously, take advantage of the myriad
of beginning fitness programs offered at
gyms and hospital-based facilities all
over the tristate area.
"What we have been counseling our
patients and the community to avoid is
suddenly embarking on a vigorous exer-
cise routine," notes Richard C. Becker,
MD, FAHA, chief of the Division of
Cardiovascular Health and Disease at
the University of Cincinnati College of
Medicine, and the director of the Heart,
Lung and Vascular Institute for UC
Health. "There is a graded and adaptive
response to physical conditioning that is
very important for the heart, lungs and
circulatory system."
Madill adds: "Engage the service of one
of the experts to tailor a program that's
right for you, that you'll enjoy, and that
will motivate you to keep coming back."
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2 . LOTS OF ACTIVITfES
COUNT AS EXERCISE.
Walking, swimming and biking are all
excellent, low-impact ways to bring your
heart rate up. But guess what.' So are
vacuuming, yardwork and chasing the
kids around the amusement park.
While it was once thought that onh
gym-like activities met the exercise goals,
the newest guidelines from the American
Heart Association published in October
2013 identify four acceptable domains ot
exercise:
OCCUPATIONALwork-related tasks, such
as manual labor, walking and lifting
objects
DOMESTIChousework, yardwork, child
care and other home-centered tasks
TRANSPORTATION/UTILITARIANphysi-
cal activity for the purpose of going
somewhere, such as walking and biking
LEISURErecreational activity, such as
participating in sports and hobbies
"The importance of this position from
the American Heart Association is that
each of these activities count, and they
are often well within our reach on a daily
basis," Dr. Becker says. In the past, when
the message was that you must use your
free time to work out, people could not
find ways to include it in their day. The
four domains now give us a great deal of
flexibility in meeting our exercise goals.
Of course, to some extent we tend to
overestimate how much exercise we're
really getting during the course of the
workday. Here's the rule: The activ-
ity counts as a cardio workout as long
as you keep moving and your heart rate
stays in the target zone for 30 minutes,
which can be done all at once or broken
up over the course of the day into three
10-minute segments.
"Every time you stop your feet your
heart rate drops," says Cheri Miller, di-
rector of Wellness at The Christ Hospital
Health Network. But if you're vacuum-
ing your entire house, your heart rate is
up, and you keep moving the whole time,
"absolutely that can be cardiovascular."
3. CONDITIONING THE
BODY HELPS THE HEART.
So, what is it about getting the heart rate
up that's so beneficial to the heart? Cardi-
ologists say the heart muscle itself doesn't
particularly need to work out. Rather, it's
the dramatic improvements to the rest of
the body that are mostly responsible for
improving our heart health.
"Exercise gets your heart, your lungs
and your muscles all utilizing oxygen ef-
ficiently," says Miller, who also has an
MS in Exercise Physiology and worked
in cardiac rehab for more than 20 years.
When the muscles and lungs use oxygen
more efficiently, they reduce the burden
on the heart and improve the body's total
efficiency, even at rest.
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H E A R T H E A L T H
MAKING
IT HAPPEN
S I M P L E STRATEGIES T O IN C R E A S E
YOU R P H YS I C A L A C T I V I T Y
PENCIL IT IN
It doesn't matter whether they're working or re-
tired, nobody thinks they have time to exercise,
says Dr. Gregory Clarke, a cardiologist with Ohio
Heart & C Vascular Center, part of The Christ Hos-
pital Health Network.
"The best thing I can tell people is to schedule
it into your day. It has to be a line item on your
schedule," Dr. Clarke says. "If you have plans to go
to the gym or work out with somebody at a specific
time of day, you're more likely to do it."
KEEP IT FUN WITH TECH TOYS
An assortment of apps, pedometers and other
motion-sensing monitors are available to help you
measure your progress. They not only keep you
organizedfrankly, sometimes the chance to play
with a fun tech gadget is enough to keep you moti-
vated to work out.
DO WHAT YOU LIKE
In a perfect world, it may be ideal to vary your
workout routines to exercise different parts of the
body. In reality, the experts just want you to get
moving. If Zumba is the only thing that excites
you, by all means stick to Zumba.
Take advantage of park trails, REALLY walk
the dog, go site-seeing, explore museums or even
browse art galleries as a way to get off the couch,
notes Dr. Manisha A. Patel of Cardiac, Vascular
and Thoracic Surgeons in Norwood.
"It's much easier to sustain an activity that you
enjoy," says Jaclyn Madill, director of fitness and
aquatics at the Mercy Health Anderson Health-
Plex. "And since the goal is a prolonged, active life-
style, rather than short-lived solutions, finding ac-
tivities that you will love is of utmost importance."
FIND A BUDDY...OR DON'T
Social exercisers will have more success if they
team up with a partner or join a class. For them,
every gym and hospital-based facility offers class-
es, one-on-one personalized training and social
groups to connect with.
If you're not a social exerciser, don't fight it. It's
perfectly fine to go it alone.
Within the heart and circula-
tory system. Dr. Becker notes that
physical activity may protect the
cells from damage and aging. As
blood is pumped and the body con-
sumes oxygen during the course of
exercise, "one can detect a series of
fascinating mechanical events that
'signal' the release of cell protec-
tion factors into the circulation,"
he says. These protection factors
are specialized proteins derived
from endothelial cells that line the
heart and blood vessels. These same
events may also cause reprogram-
ming of geneS'a process known as
epigeneticsthat offers more long-
lasting protection, including for or-
gans other than the heart itself.
Exercise also works directly
on most of the risk factors for
heart disease. As noted by Brian
Calkins, president and head train-
er of Adventure Boot Camp for
Women, exercise:
LOWERS BLOOD PRESSURE
PROMOTES WEIGHT LOSS
BOOSTS HIGH-DENSITY LIPO-
PROTEIN (HDL, or "good") cho-
lesterol and lowers low-density
lipoprotein (LDL, or "bad") cho-
lesterol, resulting in less build-up
of plaque in the arteries
LOWERS BLOOD SUGAR
The perfect workout program
includes three types of exercises:
cardio, strength training and flex-
ibility training. We've covered car-
dio, but the other two also contrib-
ute direct and residual benefits to
our heart health.
Strength training builds muscle
that helps the heart by using oxy-
gen more efficiently. And, depend-
ing on how vigorously you're work-
ing out, you're likely also to get
your heart rate up. Weight-lifting,
resistance training in the pool,
push-ups and squats are all good
examples of this type of exercise.
The American Heart Association
recommends moderate- to high-
intensity strength training at least
two days per week.
"At Adventure Boot Camp for
Women, we use a special protocol
called 'complexes,' Calkins notes,
"which combines strength train-
ing with cardiovascular benefits,
to achieve optimal heart health in
less time than traditional exercise."
Thirty minutes on a treadmill, for
example, followed by 20 minutes
of strength training.
Because cardio and strength
training both shorten our mus-
cles, following them with flexibil-
ity training is essential to lengthen
those muscles back out. If we don't,
we'll experience diminished flex-
ibility over time. Yoga and stretch-
ing are ideal ways to improve our
flexibility. Yoga also promotes
deep breathing, which improves
our circulation and oxygen con-
sumption, which in turn improves
our heart function.
And, all of these exercises re-
duce stress, that insidious villain
that raises our blood pressure, revs
up the heart and releases hormones
that shut down the brain.
"The fight or flight response is
happening," Miller notes. "Any-
thing you can do to turn that off so
your body can relax is important."
4. SITTING IS THE
NEW SMOKING.
Yeah, that's what they're saying.
Several recent studies have shown
that our sedentary lifestyles may
be as harmful to us as smoking.
An Austrahan study published
in October 2012 in the Brit-
ish Journal of Sports Medicine
found that every hour spent
watching TV shortens our life
spans by 22 minutes. By con-
trast, every cigarette shortens
our life spans by 11 minutes.
A study published in the jour-
nal Diabetologica in November
2012 analyzed the results of 18
different studies with a total of
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800,000 participants. Comparing peo-
ple who spend the most time sitting to
those who spend the least time sitting,
the study found a 147 percent increased
risk for cardiovascular events.
An October 2013 article in Circulation,,
the Journal of the American Heart As-
sociation, referenced a recent report
published in the medical journal Lancet
that "characterized the impact of physi-
cal inactivity as similar to that of smok-
ing in relation to the burden of noncom-
municable diseases worldwide."
Now, no one is claiming that you're
better off lighting up a cigarette than
watching American Idol. But the research
is suggesting that the many hours a day
we spend slumped in front of screens is
more harmful than we may have real-
ized. Researchers say our bodies were
never designed to spend this much time
in a position that restricts blood flow to
the feet and legs and contorts the spine.
But this is the primary parallel: Just
as an otherwise healthy lifestyle doesn't
negate the ill effects of smoking, sitting is
so harmful that even getting your recom-
mended minutes of exercise a week doesn't
make up for it. In other words, your 30
minutes at the gym don't count here. But
fortunately the antidote for this particular
risk factor is easy to accomplish.
"Getting up and moving several times
a day breaks that up and lowers your
risk," Miller says. "If you have a confer-
ence call, get up and walk while you're
on speaker phone. Take the stairs. Take
the farthest route to the copy machine.
Find ways within the day to move more."
5. SOMETIMES YOU
REALLY NEED REST.
Would it surprise you to learn that pa-
tients between the ages of 35 and 50
may actually be at the greatest risk for a
sudden cardiac event?
"Fundamentally it's because they're
way too busy, and their bodies are redlin-
ing," Dr. Jung says. "Just as important as
exercise for this group of young people.
who are burning candles at four different
ends, is rest."
"Redlining" is Dr. Jung's metaphor
comparing our hearts to the engine of a
car. If we don't allow our hearts to come
back down to "idle," we won't have the
energy to devote to quality exercise.
"You don't want to over-exercise a
body that's just extremely fatigued," he
says.
It's difficult to gauge fatigue because
we typically drink another cup of coffee
and go. When we are aware of feeling beat
after a long day we may think the remedy
is to go for a run. Sometimes, Dr. Jung
says, we should be doing just the opposite.
Skip your middle-schooler's early morning
soccer practice one Saturday and sleep in.
Since caffeine masks feelings of ex-
haustion, we often can't tell when we're
redlining. Dr. Jung advises his patients
to check their pulse and blood pressure
regularly as a non-subjective measure of
fatigue. On days when your blood pres-
sure and resting pulse are higher, that's a
day to take it easy.
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