Exercise Guide for the Patient
 
You  must begin to incorporate some type of physical activity into your everyday life.

You need to start getting used to exercising, as it is by far, the best medicine!
 
There are volumes of medical research, studies and articles published which inform and confirm the medical benefits that results from daily exercise.
 
It is YOU who are responsible for improving your current health status.
It is YOU who has control over your illnesses, diseases, weight, well-being and physical condition.
Many times I see and patients in whom their state of mind rather than their actual physical health seem to have control over the person!
This is not living, it's merely existing. You have almost given up it seems, even before you have decided to try to help yourself!

People, Snap Out of IT!
 
It is YOU who must decide to get up from your chairs, recliners and sofas and start doing something beneficial to improve your health and add quality years to your life.
It is YOUR health. Therefore it is you who are in control of it. Do you want to keep taking as many medicines are currently are? Would like to continue feeling as tired, weak, and as bad as you feel? It IS up to you.
 
It is in YOUR control whether you develop insulin resistance, diabetes or uncontrolled diabetes.
It is in YOUR control whether you want to remain a high risk to suffer a heart attack, stroke, high blood pressure and many other preventable medical conditions.
 
It is You that has to decide to want to help yourself.
And the first step is exercise. 
  
It has been shown that exercise controls, improves and in some cases even prevents and elimiantes the following conditions:
~ High Blood Pressure
~ Insulin Resistance
~ Diabetes
~ Cholesterol
~ Osteoporosis
~ Cardiomyopathy
~ Obesity
~ Heart attacks
~ Angina
~ Strokes
~ Peripheral artery disease (P.A.D.)
just to name the more important ones
 
 
What is Exercise?
1) Mariam Webster defines exercise as:
a. A physical or mental exertion, especially made for the welfare or training to improve health status.
b. An activity that requires physical or mental exertion, especially when performed to develop or maintain physical adaptations.
 
What I want to remind and to mention is that when I ask a patient to exercise, what I mean is that they perform a physical activity with the purpose of elevating and maintaining your heart rate elevated for a period of time. In other words, for it to be a real physical activity, or exercise, you need for the activity to be strenuous.
 
When we perform an activity of some physical effort, especially at the beginning of an exercise program, it is normal that you will become tired. It is normal and expected that you will get short of breath, tired, you feel your heart racing and pounding! You feel horrible!
This is NORMAL.

These sensations are most commonly due to your poor physical condition or physical status. If you and your body is not accustomed to exercising, as you mainly are sedentary, than how can anyone expect to perform an intense physical activity? Its impossible. We need to gradually work our way up, by performing the exercise a little longer duration each day, and/or by adding a little more resistance. As a man who works out several times a week, if I were to challenge some of my patients to a foot race, I would win. If an Olympic sprinter raced me, he/she would woop my butt. Why? The differing levels of physical conditioning.  
 

Now,  if you do not feel tired or get short of breath while doing the exercise, your level of intensity is not what it should be and the activity you are doing is not producing the desired results. In other words, if you do not get tired or winded during your exercise, you are really not exercising!
What I would like all patients to try is moderate intensity exercise. Walking is O.K. in some patients, but if at all possible the level of intensity should be more. I will mention some ahead. 
 
Types of Exercises:
Aerobic and Anaerobic
 
The kind of exercise that raises your heart rate, your pulse is called aerobic exercise.
Aerobic exercise makes your heart have to work faster and stronger, which is beneficial for the heart and cardiovascular system.
Remember that your heart is a muscle.
Like any muscle it needs and benefits from a good workout from time to time, to keep fit and strong.

Let me briefly explain this process of aerobic exercise so you may better understand the concept. Aerobic and comes from the Latin "aero" which literally means air.
Now let’s say that you use a stationary bike or a treadmill to perform exercises. The faster you pedal on the bike or the faster the speed of the belt of the treadmill, the faster the individual muscles of your legs have to work in order to keep up with the accelerated workload.
The leg muscles need to contract and work harder and faster and will need more oxygenated blood to keep up with the increased metabolic activity of the cells in the muscles.
As a result, the heart needs to beat faster, to pump more blood. You eventually also start breathing faster and deeper. The breathing becomes more deep and quicker in order to provide increased amounts of oxygen which for the blood that is pumped to the legs were it is most needed at this time. In addition, breathing faster and harder also functions to remove carbon dioxide, a waste product of the increased metabolism. Since these functions involve and require increase air or oxygen use, an aerobic process.
If you now increase the resistance on the bike or the treadmill, you increase the exercise intensity. As a result, with time, your heart and cardiovascular system starts to become stronger.
It is in these moments when the heart is accelerated, pumping more intensely and faster that the heart is being exercised itself. It is across from your aerobic exercise stimulates your heart to beat faster and work.

It is the degree of intensity that is an important factor in achieving any benefit.
The intensity of the exercise is the one that produces the health benefits. You should always remember that exercise intensity is the same as or equal to, the degree of difficulty of the particular exercise or activity you are performing.
The harder and more intense the training or exercise, the stronger and faster the heart has to work and pump and the more beneficial to your cardiovascular system and overall health.
In addition to exercise intensity, duration or the time you exercise is just as important.
 
To be beneficial, the exercise you choose should be carried out for 15 to 20 minutes and the exercise should be done at least 5 days a week.
So in review, a good activity or exercise that promotes health and wellbeing is one that incorporates duration and a moderate level of intensity.
Activities or aerobic exercises include:
Running, jogging, the use of a treadmill, climbing and descending stairs, swimming, and the use of a stationary bike.
 
 
When we perform a stress test at the doctors office, we calculate the expected heart rate our patients should achieve, to make the test medically valid and have meaning in regards to its findings. 
This number we calculate, represents the range of heart rate our patients need to reach in order for the heart to be stimulated enough for our imaging to be beneficial. This number is calculated by taking the number 220 and subtracting the age of the patient. For a 70 year old patient we  the maximum predicted heart rate they can achieve should be 150 beats per minute (220-70 = 150). Now we estimate 85% of this amount, which in this case is calculated to be 128. So for a stress test to be considered a “good” stress test and be able to obtain information about the heart and coronary arteries, we need to increase the intensity of the stress test so the patients heart rate is maintained between 128-150 beats per minute.

Likewise whatever exercise you choose, should also try to increase the heart rate and maintain it elevated for the duration of the activity.
Taking what we have learned about intensity and duration, one can now start to understand why walking as many believe, is not really an exercise. Walking does not produce a significant elevation of heart rate to result in beneficial long term health benefit.
An acceptable walk, would be a walk that is brisk and vigorous and of at least moderate intensity, which should be continued unabated for at least 15 to 20 minutes.

For folks that are sedentary, and who have not done any physical activity in a long time, it is acceptable to start by walking and gradually work your way up. I am not against walking and some recommendations mention moderate walking as being good. I just want for my patients to understand that if you can do more intense activity, you need to. Exercise IS intensity.
Your daily activities at home, or what you do throughout the day at work, is also not considered exercise.

Exercise should be part of every ones life. We need to try to make time for it. It should be as commonplace as a daily shower. Again all you need is 15 minutes and after a short while, I promise you will start to see a difference, feel different and more importantly you will probably not need as many medications, and anyone who knows me, knows that I don’t like for patients to take so many medications.
 

I will briefly mention the other kind of exercise which is known as anaerobic exercise.
Anaerobic exercise are exercises that are based on resistance or resistance training. Exercises that incorporates weights, are anaerobic exercises.
The effect of these types of exercises is that it causes an increase in the size of the muscle mass.

Weight lifters typically lift heavy weights and as a result their muscles hypertrophy or get big. Ideally everyone should incorporate both types of exercises; aerobic and anaerobic into their workout routine. This is because in addition to tightening up the body core, and also being beneficial to reduce LDL cholesterol and delay osteoporosis, the main benefits of the increase muscle mass produced by anaerobic exercise is, that muscle burns more calories than fat cells a fact which is explained in more detail in another of my articles. (I love to teach!)
 
As previously mentioned aerobic activities include running, jogging, walking on the treadmill at the gym or at home, walking up and down stairs, swimming laps in a pool and my favorite for my patients of all ages, a bike stationary. Remember also that while anaerobic exercise is good for building muscle, aerobic exercises is good to strengthen the heart muscle and cardiovascular system.
Now, I say that a stationary bike is my favorite because most of the patients I see, live in small, confined spaces, perhaps an apartment or a room in a home. Since a stationary bike is smaller and have wheels on one end, it is more compact than a treadmill, and much easier and lighter to move. More importantly, they are more comfortable to use, and of less impact on joints for those people suffering from arthritis, degenerative diseases or who have mobility problems.
 A stationary bike lessens the impact to knees, ligaments and allows the user to be sitting during this exercise. A low impact type of exercise like a stationary bike, is also the type of exercise used for rehabilitation of patients who have undergone orthopedic surgery such as knee or hip replacement or ligament repair surgery. So it is safe and beneficial for patients of all ages.
This type of exercise is also my favorite for those patients who while not wheel chair bound may have limited mobility.  You may walk slowly, need a walker or cane and can get around but with assistance or slowly. I don’t expect you to get on a treadmill or climb stairs, so I would encourage you to try a stationary bike or even a recumbent bike.

A bike you ride the sidewalk or street I consider in the same category as walking. It’s not the best and I don’t consider these activities to be exercise. In both cases there is not as much effort or intensity which is why I don’t consider it as a good exercise.
When riding a bike down the street for example, there are frequent moments where you can stop peddling altogether and simply coast without expending any energy pushing on the pedals. More importunate is the fact that you can’t really concentrate well and focus on the activity itself as you are on the constant look out for pedestrians and the bloody traffic that seem to head right for you only to veer off at the last minute. Then you have dogs coming from out of nowhere, the curbs, obstacles on the sidewalks and many other distractions that may arise. The level of intensity and duration needed, are just not the same.

Patients with cardiac conditions, stroke, congestive heart failure, post-operative state, angioplasty’s etc, all benefit from an exercise program. Heart patients benefit so much from a regular exercise program that this is basis of the cardiac rehabilitation programs offered by many large hospitals. In reality there is very few legitimate reasons to not exercise!
Patients who have had a severe debilitating stroke, those who are wheelchair bound from some orthopedic or neurologic illness or perhaps some forms of crippling arthritis may be incapable of exercising. The rest of us, the vast majority of us however are just lazy and are quick to come up with many reasons why you can’t exercise.
 

Conditions that are benefited from exercising:
 
Obesity
In the United States and in many developing countries around the world, obesity has become an epidemic. In the last decade we have become fatter than at any previous time in history. Not only are we heavier, more overweight and obese, but we are becoming fatter at an ever younger.

Our lifestyle is the main reason for this. We are less active and consume more calories than we ever have been. Many of us live to eat, instead of eat to live.
  

When we eat, we eat fast food, comfort food, foods with high calories, sugars and fat. Fried foods, sweets, biscuits, bread, butter, soft drinks, etc. and in portions so large, they contain several days worth of calories.

Because of cut backs in schools, physical activity programs have been cut back or completely eliminated. Kids instead of playing stickball, running around outside playing games, our time is going to be spent sitting in front of computers, playing on the internet, or watching television or playing video games.
And one wonders, why we become fat.

It’s simple, but it’s worth reminding. 
We get fat because we consume more calories than needed and / or burn fewer calories than we consume. Every kind of diet out there is basically the same concept. They instruct or provide the right combinations of low caloric, low carbohydrate foods that will make you body feel full so you don’t eat as much.
The diets work by reducing the number of calories ingested. When you eat fewer calories, you eventually stop gaining weight.

(Excess calories are turned into fat by the body and stored for future need. This goes back many millions of years ago, when our forefathers where still cavemen and meats where hard to come by. It would be more common for one of our forefathers to become a nice nutritious meal for one of the many big animals of the day than it would for our forefathers to obtain meat. So our bodies adapted and stored calories in fat cells and omentum. Unfortunately it still hasn’t been that long, only several million years, and we have not yet evolved again to be able to loose our fat stores.)   

Notice any and all diets out there. All of them will also include and inform the user to incorporate daily exercise as part of the diet as  exercise will help speed up weight loss, by burning off excess calories. So if exercise is the underlying common factor of all diets out there my friends, then why not eat sensibly, exercise and stop wasting money on all those diets?

 
Learn to eat and exercise and you can also achieve weight loss.
I can continue to write in detail about obesity but it will have to wait in another reading.  
Other conditions the improve from exercise include:
Diabetes
Cholesterol
Osteoporosis
High blood pressure
Cardiovascular Diseases
and many other medical conditions
To cut down on length, I have decided to write about these topics in other articles.
 
I would just like to conclude by again informing you that there is overwhelming evidence that backs up the benefits of a regular exercise program, irregardless of age.
As I write this, another article came out this week in a medical journal about a study sponsored by the National Heart, Lung and Blood Institute that found that exercise reduced sudden death in patients with congestive failure.

What are you waiting for?

 
 
 
Before any patient starts an exercise program you need to see you doctor and make sure that you have no contra-indications. As I have mentioned most everyone is able to and should exercise, but every individual is different and your doctor knows will be able to assist you.