1. Exercise aerobically for 30-60 minutes every day.
2. Do not smoke or use tobacco products.
3. Limit alcohol intake to: two drinks per day for males and one drink per day for females.
4. Try to control stress through regular exercise, yoga, counseling, Tai Chi or meditation.
5. Maintain a body mass index (BMI) of below 25.
6. Always report rectal bleeding.
7. Wear a helmet when biking, snow skiing or skateboarding.
8. Never drink and drive.
9. Always wear a seatbelt.
10. Start getting screened for colon cancer starting at age 50 or earlier if you have risk factors for colon cancer.
11. Have a flu shot every October particularly if you are over 50 years of age or for infants 6-23 months of age.
12. Females should have a mammogram every year starting at age 40 or earlier if they have specific risk factors for breast cancer.
13. Have a pneumonia shot (Pneumovax) starting at age 50.
14. Become knowledgeable about sexually transmitted diseases.
15. Eat fish several times per week. Cold water fish such as Salmon and tuna are best.
16. Try to get at least 30 grams of fiber every day. One half cup of Fiber One Cereal contains 14 grams of fiber.
17. Avoid excessive amounts of sun and use sunscreen. Any moles that change should be evaluated. New moles appearing after age 40 should be evaluated.
18. Report any vaginal bleeding that occurs after menopause.
19. Eat plenty of fruits and vegetables. Taking vitamins is not a substitute for eating fruits and vegetables.
20. Avoid excessive use of NSAID's (ibuprofen, Aleve, Motrin and others)
21. Consider taking a baby aspirin with food everyday if you are at high risk for heart disease.
22. Consider taking a vitamin with minerals everyday.
23. Eat red meat in moderation.
24. Women should perform breast self-examination once each month. Report any breast lumps.
25. Try to get 1200-1500 mg of calcium/day either through diet and/or calcium tablets.
26. Discuss getting a PSA (prostate specific antigen) with your physician at age 50.
27. Get a Tetanus-diphtheria shot every 10 years.
28. Take folic acid 0.4 mg several months before you decide to get pregnant. Taking a multivitamin daily satisfies this recommendation. This prevents a congenital brain disorder called neural tube defects.
In this column I will be discussing exercise. The forms of exercise that I am referring to are those that exercise the heart muscle or cardiovascular system. These would be swimming, jogging, walking, running, biking, aerobics, handball and racquet ball. I would like to provide you with some evidence suggesting that exercise can make you live longer and be happier at the same time. It sounds too good to be true, but consider the following facts. As most of you know, heart disease is the leading cause of death in the United States today. In 1979, over 700,000 people died of heart disease. At the start of the exercise boom in 1968, there were about 100,000 people jogging regularly. In 1978, the number of joggers increased to a remarkable 27,000,000. That is an increase of 100,000 joggers to 27,000,000 joggers in just ten years. Presently, about 22% of adults in the United States are exercising for 30 minutes or more per day. Many physicians felt that there would be a corresponding increase in the cardiovascular deaths associated with the exercise boom. They felt that the strain on the heart when jogging might precipitate a heart attack. Well, let's look at what actually happened. In that ten-year period, the number of deaths from heart attacks decreased by one-fourth. The number of strokes decreased by over one-third. It is my opinion and the opinion of many other physicians that exercise contributed to this tremendous improvement. Certainly other factors were involved such as a decrease in the number of people smoking and better control of high blood pressure. But exercise has been proven to alter most of the risk factors for heart disease. I would like to discuss the risk factors for heart disease and how exercise can affect them. The major risk factors are:
(1) Relatives dying of heart disease before the age of 55 years.
(2) High blood pressure.
(3) Smoking, which is very important.
(4) Elevated cholesterol.
Exercise certainly cannot change your family history, but it definitely will lower your blood pressure. I know of a person in Tallahassee who was on three different medications for his blood pressure before he started running. Now he runs regularly and is on no medication. Exercise is also associated with a lower incidence of smoking. When people start exercising, they seem to be able to give up smoking. This is because of a decrease in the nicotine withdrawal symptoms with regular exercise.
Let's now consider abnormalities of blood fats which is very important as a risk factor and I think is extremely interesting. The main fat in the blood that you have heard about is cholesterol. For years it is known that people who have a high cholesterol tend to die of heart attacks at an early age. This is because the cholesterol tends to form plaques in the blood vessels and can obstruct the flow of blood. When blood cannot get to the tissue it will die. When the plaque builds up to the point where it cuts off the blood supply to the heart, it is called a heart attack, and when it obstructs the flow of blood to the brain it is called a stroke. The cholesterol can be separated into several different components. The most important is high density lipoprotein or just HDL for short. Studies have proven that the higher the percent of the HDL component, the less chance a person has of having a heart attack. The HDL tends to act like a scouring pad by removing the plaque as it forms. Not only does exercise lower the total amount of cholesterol, but it substantially increases the HDL cholesterol. Exercise also reduces the amount of triglycerides which is another fat in the blood. High triglycerides are also considered a risk factor, so you want that to be low.
Stress and anxiety are considered to be important risk factors. Exercise acts like a tranquilizer to reduce stress and anxiety. If you ask people why they run, they will almost invariably say because it makes them feel good. It simply makes you feel better by serving as an outlet for stress and anxiety. Since stress lowers the body's ability to fight off infections, you are less likely to become sick if you can reduce or control stress. An example is a college student who becomes sick before or during final exams. Another example is when going through a divorce. The stress of these situations can impair the immune system. They simply cannot fight off infection as well as someone who is not under stress. A recent study proved that people under stress got viral infections twice as frequently as non-stressed individuals when exposed to four different types of viruses.
Another risk factor for heart attacks is obesity and exercise can certainly promote weight loss. In fact, I think a weight reduction program that does not include exercise is doomed to failure. I see this every day in my office. Although some weight loss may occur initially, it is usually temporary. This is because, to reduce weight permanently, you must make a permanent change in the amount of calories you eat or the amount of calories you use. Because dietary habits are established at such an early age, it seems to be difficult to cut down on the amount of calories we eat. Getting exercise can be a permanent change in almost anyone's life. Each mile you run or walk will burn up about 100 calories no matter how fast you go. This may not sound like much, but over time it is an effective and safe way to lose weight. Let me give you an example. If you run 15 miles per week for a year, you will lose 1500 calories per week. Since there are 3,500 calories in a pound, you will lose over 22 lbs. in one year. Exercise also speeds up your metabolism and tends to promote weight loss. Any form of exercise is good for weight loss. Probably one of the best overall forms of exercise is swimming, because it does not stress the joints as much as running does. Biking is also less stressful to the joints. A stationary bike is a reasonable alternative.
Other risk factors for heart disease are diabetes and inactivity. Running obviously eliminates physical inactivity and, strangely enough, reduces the requirements for insulin in diabetes. Diabetic runners can control their blood sugar better and, in adults with mild diabetes, it is sometimes possible to eliminate the need for medication altogether.
People who exercise regularly are more tranquil and suffer less from stress and anxiety. They are able to concentrate better and sleep more deeply at night. Researchers have demonstrated that the amount of deep sleep you get is proportional to the daytime energy expenditure. The more you exercise, the deeper you sleep. This may be why people who exercise actually have more energy during the day. I see this everyday in my practice. Patients who don't get any exercise will almost always complain of a poor energy level. Regular exercise will almost always increase their energy level. The more energy that you use, the more energy you will have.
It has now been proven that exercise will make you live longer. An
article in the Journal of the American Medical Association has shown
that regular exercise will reduce the risk of heart attacks by 60%
in males and 40% in females. Some individuals at high risk for heart
disease should have a stress test before starting an exercise program.
Some physicians recommend a stress test if you are over 45 years old
or if you are over 35 and have risk factors for heart disease.
1. Lee IM; Hsieh CC; Paffenbarger RS. Exercise intensity and longevity in men. JAMA 1995 Apr 19;273(15) :1179-84.
2. Lissner L, et al. Physical activity levels and changes in relation to longevity. A prospective study of Swedish women. Am J Epidemiol 1996 Jan 1:143(1) :54-62.
3. Sherman SE, et al. Does exercise reduce mortality rates in the elderly? Experience from the Framingham Heart Study. Am Heart J 1994 Nov:128(5) :965-72.
4. Sherman SE, et al. Physical activity and mortality in women in the Framingham Heart Study. Am Heart J 1994 Nov:128(5) :879-84.
5. Paffenbarger RS, et al. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med 1993 Feb 25;328(8) :538-45.
6. Thompson WG. Exercise and health: fact or hype? South Med J 1994 May;87(5) :567-74.
7. Weyerer S, et al. Physical exercise and psychological health. Sports Med 1994 Feb:17(2) :108-16.
8. Pate R, et al. Physical activity and public health. JAMA Feb. 1, 1995 pp. 402- 407.
9. Fiatarone MA, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Eng J Med 1994 Jun 23;330(25) :1769-75.
10. Pahor M, et al. Physical activity and risk of severe gastrointestinal hemorrhage in older persons. JAMA 1994 Aug 24-31:272(8) :595-9.
The information provided above is offered as a community service about health-care issues and is not a substitute for individual consultation. Advice on individual problems should be obtained from your personal physician. This information is based on research by the author and represents his interpretation of the literature.
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Readers may send questions to our email address. This column is for informational purposes only and is not a substitute for professional or medical advice.
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