Exercising for a Healthier Heart -- Kenneth Cooper, MD -- 02/19/03

Last Editorial Review: 10/23/2003

WebMD Live Events Transcript

There are as many cardiovascular exercises as there are hearts, it seems. Is there a perfect exercise? How much exercise do you need to prevent heart disease, and what kind of workouts work for those already suffering from heart problems? We discussed these issues with the father of aerobic exercise, Kenneth Cooper, MD.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live, Dr. Cooper. You are known as the "father of aerobic exercise." How does aerobic exercise help heart health?

Cooper: Exercise can be used in three general ways. It can be used as rest and relaxation, muscle building and figure contouring, and as cardiovascular pulmonary conditioning. All three have merit, but only one has the potential of prolonging life, and that is cardiovascular pulmonary conditioning. Studies clearly show that if you just walk briskly and cover two miles in 30 minutes, three times per week, it has the potential of reducing deaths from heart attack or stroke by 58% percent. Now that's too fast for most; slow it down, walk two miles in 40 minutes, five times per week and you get the same benefit.

But exercise is only a part of a total wellness program, and if you want to reduce risk of death by heart attack you're going to have to reduce cholesterol, stop smoking, control your body weight, and exercise. Those are the keys to good heart health.

Member: We know exercise is an important part of life, but what do you say to patients that say they can't exercise because of health problems?

Cooper: If there is the will to exercise, there is usually a way. Even though you may not be able to walk, to run, other activities can be used effectively, such as swimming, cycling, and now there are many new exercise machines that can be used effectively to improve heart health to the extent that it's rare that I can't find something a person can do to exercise if they want to.

Member: I have three valves with trace, mild, mod regurgitation and take 5mg Lisinopril daily. I would like to start an exercise program and need to know who or where I could get info on this. I used to do weights and the treadmill for about two hours a day before an accident.

Cooper: If you have mild, three-valve disease and you're taking medication to control blood pressure, before you engage in any vigorous activity, you should see your doctor. It might be necessary for you to be involved in a supervised cardiac rehabilitation program, depending on the magnitude of your heart valve program and the severity of your high blood pressure.

But, I have many patients with mild to moderate heart valve disease who are taking Lisinopril and other heart medications and have still been able to exercise very effectively and safely. But since I don't know the magnitude of your medical problems, I can't give you a specific recommendation, except I cannot suggest weight training with your medical problems. I suggest only aerobic-type exercises such as walking, biking, and swimming.

Member: What is the least amount of exercise that will help your heart and lose weight? I don't have much time in my schedule with work and home, but I do want to do something.

Cooper: We have been trying to exercise the question of how little exercise is necessary to get cardiovascular benefits. If you know the aerobic point system that I developed 35 years ago, it's still very valid. That is, 15 points a week are the least number of points that you can earn and get heart benefits. An example is two miles of walking in less than 40 minutes, 5 days a week. Or you can walk three miles in 45 minutes, twice a week. Or two 45-minute aerobic dance classes per week will give you at least 15 points per week.

There are many other ways to get at least 15 points per week and they are described my book, which is available in most bookstores and at our web site, cooperwellness.com. The book I recommend of the 18 I've published is The Aerobics Program for Total Well-being, and there are 41 exercises in that book for which we award aerobic points. All you have to do is use one or more of those exercised and get 15 aerobic points per week. That has been shown to reduce death from all causes: heart attacks, strokes, diabetes, and cancer by some 58%.

But you cannot expect to lose weight rapidly strictly with exercise. You're going to have to reduce the calories if you expect to lose weight. But by combining with even a minimal exercise program, the weight that you lose, you will tend to keep it off.

Member: When a heart patient cannot achieve target heart rate due to medications, is the exercise still beneficial to the heart?

Cooper: The medication that heart patients take that lowers their heart rate is a called a beta-blocker. That lowers the resting heart rate eight to 10 beats per minute and the exercise heart rate by 10 to 12 beats per minute. To get predicted maximum heart rate, use 220 minus the age, and that gives you your predicted maximum heart rate. You work at 65%-80% of that predicted maximum heart rate for 20 minutes four times a week, or 30 minutes three times a week. Whatever your target heart rate is, based on the formula I gave you, you subtract 10 to 12 beats per minute because you are on medication and you'll get the same benefit that you would get if you were not taking the medication that slows your heart rate. So the answer is yes, you can get benefit even though your heart rate is slower than someone's who is not taking meds.

Member: I am a 50-year-old female who a month and a half ago had quadruple bypass surgery. I was wondering how long after surgery I should begin a diet and when I can begin to exercise?

Cooper: When you have surgery such as bypass surgery, within six weeks (which is now) you should be able to start into a progressive walking program. If you had had more serious heart surgery, such as valve replacement, you would not be able to start back so rapidly. I've had my patients, following bypass surgery, walking briskly and even jogging slowly as soon as two weeks after bypass surgery. But that was under very close monitoring and the patient was exercising with a heart-rate monitor.

Since I anticipate that that is not practical in your case, I would suggest that after consulting with your physician and after you get permission to start a walking program, start very slowly walking for a certain time, not for speed or distance. For a detailed exercise program following bypass surgery, you can again go to our website, cooperwellness.com, and order my book Aerobics Program for Total Well-Being and look in the back of the book for a specific 12-week program used by bypass patients who get back into an exercise program.

If it is not possible to follow the book exactly, I would say to start by walking comfortably for 10 minutes, five days a week for the first week. The second week, 15 minutes. The third week, 20 minutes; the fourth week, 25; and the fifth for 30 minutes. Then you can work on walking faster and trying to cover a mile and half in 30 minutes, three to four times a week. That should be a very safe program for you, if your physician concurs. That pretty summarizes the cardiac bypass surgery exercise program mentioned in my book.

Member: My husband has had one heart attack and needs to exercise. However, he also has severe asthma and exercising tends to trigger asthma attacks. Help!

Cooper: Again, with the combination of severe asthma and heart disease, it makes it more difficult to exercise to the point that you can get benefit. But remember what former Surgeon General Satcher recommended in 1996, that collectively, we should all try to get 30 minutes of some type of activity most days of the week. If you're not having any angina, or chest pain, with exercise even though you've had a heart attack and your major problem is asthma or obstructed lung disease, I have found that I have many patients who use Ventilin ventilizer immediately before exercise and can exercise without triggering an attack of asthma. But with a history of both heart attack and severe asthma, exercise is extremely important if you want to live a long, healthy life.

Member: What do you think of pilates exercise?

Cooper: Pilates is more in the category of rest and relaxation and muscle-building rather than cardiovascular pulmonary conditioning. I have many patients using pilates for stretching, strengthening, and for an overall sense of well-being and they have really benefited from it, even to the extent that we offer pilates to the members of our fitness center, the Cooper Fitness Center, and the programs are very popular. So I would say yes, it is a program that I recommend unless you have a history of some major muscular-skeletal problem such as sever arthritis or some type of medical problem that might result in chronic fatigue.

The best way to determine whether you will benefit from pilates is to go through a class. If you get great benefits, continue. If it causes major soreness of muscles, joint pain, or other problems, don't participate in a pilates program.

Member: Can exercise benefit or only strain my atrial aneurysm? It's pretty thin.

Cooper: With an atrial aneurysm that is thin I would be concerned with any exercise that causes your blood pressure to increase. I would not do any exercise without first having a stress echocardiogram. Then the cardiologist can look at that atrium and see how much it dilates with exercise. Based upon the results of the stress echocardiogram, you may be able to get involved in a low intensity heart rate program and still get benefits.

Remember in general if you want to get an aerobic training effect, I think of the concept of FIT (frequency, intensity, and time) of exercise. For example, if you exercise four times a week with an average heart rate 140 for 20 minutes, that gives you aerobic training effect. Or three times a week with a heart rate of 130 for 30 minutes gives you the same benefit. Or five times a week with a heart rate 110 for 40 minutes will give you the same benefit. So if someone with an atrial aneurysm is allowed to exercise, it would have to be at the lower intensity heart rate but only after you've had a stress echocardiogram to determine the magnitude of the atrial aneurysm during exercise.

Member: Is it more beneficial to maintain your target heart rate for a sustained period of time or is interval training going to give your heart a better work out?

Cooper: Depending upon what you want from your program, your activities should be long and slow or short and fast. If you're training for competition and trying to increase your speed at running a certain distance you're going to have to combine aerobic conditioning that is long and slow with interval training, short and fast. But if you're not interested in competition and just in cardio health, I always recommend a long, slow activity, as compared to short and fast.

Member: What is better for your heart, 30 minutes on a treadmill or four hours walking a golf course?

Cooper: To give you an idea, if you wanted to walk 18 holes of golf, not ride a cart, to get aerobic benefit, I will give you three aerobic points for walking 18 holes, and that's in my book. That means if you want to get at least 15 points a week playing golf, you've got to play 18 holes five days a week. You might consider the professional golf circuit then. But that's the only way you can get cardiovascular benefit by playing golf. And if you ride a cart, only the cart gets a benefit.

Member: How do we stick with lifestyle changes such as diet and exercise when our spouse doesn't really understand the significance of such drastic changes? He says go ahead but leave me out. It's like having to cook two dinners each night! And is it best to ease into lifestyle changes or just go for it all at once?

Cooper: We've developed a formula at our Cooper Clinic in Dallas that we have found to be very successful in helping people change their lifestyles. The first step is a comprehensive evaluation, which includes determining your blood lipids (cholesterol), your ideal body weight, by such things as underwater weighing, and determining your level of fitness by the results of your treadmill stress test. Then your performance is compared with others your age and sex.

Number two, it has to be motivating and educational experience. And that's why our physicians spend an hour and a half with each patient at the clinic. And number three is the implementation program that we give our patients that must be safe, effective, and realistic. For example, if someone is overweight, smoking, drinking too much, and totally inactive, if I tell them to lose weight, stop smoking, quit drinking, start exercising all at the same time, I will never see them again. I overwhelm them.

So I would tell a person like your husband, if you have all those problems that would definitely shorten your life, let's correct them one at a time. Forget about your body weight, the smoking, and the drinking, and just start a very light exercise program, because the best way in the long-term to lose weight, quit smoking, and control your alcohol is to start an exercise program.

And finally, the fourth part of the program is a re-evaluation because with the first evaluation we give them goals, which might be weight goal, cholesterol goal, exercise goal. And by having them re-evaluated, that's the best way to keep them motivated for changing their lifestyle. That's the procedure we use at our clinic in Dallas. If you want more info about the Cooper Clinic, a program that has been highly successful, please visit cooperwellness.com, or call us at 972-239-7223.

Member: What about the theory of one minute of full-out effort followed by two minutes below your target heart rate for a 45-minute workout?

Cooper: That type of exercise is dangerous because, remember, the most common first symptom of severe heart disease is sudden death. Forty percent of the people that die of heart attacks, their first and only symptom is death. If you want to put yourself at the possibility of having a fatal outcome from your exercise, use one of those programs that require you to exercise at maximum performance for short periods of time, even though they're intervals. They are dangerous, particularly for the man or woman over 40.

Moderator: We are almost out of time. Before we wrap up for today, do you have any final comments for us, Dr. Cooper?

Cooper: Remember this when you go to our web site that we feel that 21st century medicine consists or proper nutrition, proper supplementation, and proper exercise and early indications are, if you follow these programs, average life expectancy is 80 to 85 years.

Moderator: Thanks for joining us, members, and thanks to Kenneth Cooper, MD, for being our guest.

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