There are many different kinds of exercise, but the most important type for reversing heart disease is aerobic exercise. Lifting weights, isometrics, golf, tennis and even handball or racquetball, for all the sweat they produce, are not aerobic. Aerobic exercises requires repeated regular movement of major muscle groups to bring the heart beat up to a pre-determined amount and keep it there continually for a specific period of time.

With aerobic exercise, different people can do much different levels of work and still be getting the same aerobic benefit. An overweight, out of shape person walking at 3.5 miles an hour may have a heart rate of 125 or more, but a thinner, more fit person may have to run at 6 miles an hour or faster to get to that same level. Age is also an important factor in determining what heart rate is best to provide maximum benefit without causing problems.

As you exercise, you'll need to gradually do more work to keep your heart rate at the level you want. That means since your heart is better able to meet the demand that the exercise requires; it's working more efficiently. What used to be a real effort becomes easier to achieve. To gain the same benefits you'll gradually have to walk a little faster, or climb a slightly steeper hill, or maybe bike in a higher gear. As you become more fit, you'll find that your resting pulse will lower. Mine went from 72 beats per minute to 51 in just six months. Instead of having to work to push blood through the arteries 72 times every minute, it now has to do that only 51 times a minute. If I were resting all the time, that's over 30,000 muscle contractions a day it no longer has to make. When I'm active, it is saving my heart even more energy. Persons who are very much out of shape may start out with a resting pulse rate as high as 90 or more, but as exercise brings about better cardiovascular fitness, this will soon lower. If your resting pulse is above 85, you should consult your physician before starting any exercises. Some heart conditions can be made worse by going beyond a reasonable target heart rate. It is always best to start slowly and gradually build up to no more than 70% of MHR. You should check with your physician if you plan to go higher than 70% of your maximum heart rate (MHR).

To determine your maximum heart rate subtract your age from 220. If you're in reasonably good health and not already exercising, start near to 45% of your MHR. In the past it was believed that all 40 minutes had to be at one time, but two 20 minute sessions, or even three 15 minute sessions will give you the aerobic workout you need. (Caution: Some calcium and beta blocker medications artificially lower heart rate; persons on blockers should not use this formula and should consult their physician for a target heart rate.)

At the same time that the heart muscles are becoming better able to do their job, the arteries that feed them are becoming better able to supply blood to those muscles. In combination with proper diet, these clogged arteries can actually open up. If you've ever had a muscle cramp, you remember the pain your body uses to signal you to change your demand on that muscle group. Most often the cramp is due to an insufficient supply of blood to that muscle, usually because it was overtaxed or not ordinarily used in that particular way. As you build up your muscles, the blood vessels that supply them with fuel become better able to meet the increased demand. Your heart is muscle and it can be strengthened in the same manner as other muscles.

In the Spring of 2002, a study published in the New England Journal of Medicine suggested that exercise capacity may be a key to longevity; that peak exercise capacity, as measured by a treadmill test, may be a better predictor of long life than an evaluation of health risk factors. In the study, researchers looked at 6,200 men whose doctors had referred them for treadmill testing, typically used to check for heart disease. Some of the men studied had heart disease and some didn't. The researchers found that the men with the highest exercise capacity were much less likely to die during the 10-year follow up period than men with the lowest exercise capacity. This was true even after other risk factors for death were taken into consideration, including the presence of heart disease. Their findings reaffirm the importance of physical fitness for health and long life.

The Example of Lee
Let's take Lee, for example. At age 40, Lee's MHR would be 180 (220 minus 40 =180). Forty minutes a day between 45% to 70% of MHR is all that is needed to give Lee's heart and lungs the exercise they need. Using the example above of an MHR of 180, Lee would start with a heart rate of 81. (180 times .45 = 81). Lee should try to keep the heart rate at 81 beats per minute for as much of the time as possible while walking or exercising. Instead of counting out a whole minute, It's easier to divide by six and count the pulse for 1o seconds. (81 divided by six = 13.5). Counting ten second's pulse, there should be 13 or 14 beats. As exercise becomes easier, Lee would gradually move the target percentage up, first to 50% (15 beats in 10 seconds, or 90 beats a minute) and then, in small steps, all the way up to 21 beats in 10 seconds, or 125 beats a minute, to 70% of the MHR.

Walking is one of the best exercises for your heart. If you've recently had surgery or have angina, you may want to start slowly with a brief stroll and gradually increase to a brisk 45 minute walk. It helps to have a watch which will let you count the time you've taken to walk a particular route. If it's a short walk, you can do it several times a day, trying to shave a few seconds off your previous best time. Don't overdo it by trying too hard; you have a lifetime to get your heart in shape.

You can count the steps per minute to see how fast you are walking. Once you have a route to walk, measure the distance. When you know the time and distance, you'll be able to calculate your speed in miles per hour. Here's a rough guide to the number of steps per minute for various walking speeds and the number of calories you might burn while walking on a level surface on a 70 degree day:

per minuteper hourper minute*per hour*
*Actual calories per minute burned depends on body weight, height and other factors.
These numbers are for a 120 pound person. Heavier persons burn more calories.

Another way to keep your speed is to listen to a tape that has a steady number of beats per second. A company called SportsMusic has a series of tapes at different exercise levels for walking, biking, treadmills and other machines, with tapes and CDs ranging from dixieland to pop, showtunes to classical. Here's how to get in touch with them:

PO Box 769689
Roswell, GA 30076

To get the best workout from walking, pump your arms (for increased cardiovascular effect), breathe deeply and use good posture, with your shoulders slightly back and your bottom tucked in. Walk on even surfaces, but do some stepping up and down on curbs and add some hills to vary your workout. Walking has the least possibility of injury of any of the popular exercises.

The aerobic benefit from other exercises compared to walking at 3 miles per hour is shown below. For example, each mile of swimming is roughly the equivalent of 3 miles of walking.

Biking 1 mile = walking ½ - 1½ miles.
Running 1 mile = walking 1½ - 3 miles.
Rollerblading 1 mile = walking ½ - 1 mile.
Swimming 1 mile = walking 3 miles.
Hiking 1 mile up 5% grade = walking 2 miles.
Exerstriding 1 mile = walking 1½ miles.
Golfing 9 holes = walking ½ - 1 mile.

An excellent alternative to the usual exercise workout is Tai Chi Chuan. A series of stretching and balancing poses, smoothly blended into one continuous and graceful movement, Tai Chi is one of Asia's most popular exercise forms. It is gentle enough that some people have been able to continue to practicing it daily for over 90 years. While it is technically possible to learn Tai Chi from a book, the best way is to take a class. Some park and recreation districts and adult education services offer Tai Chi lessons.

Hatha yoga is another exercise form that is gaining much popularity. This form of yoga is a series of poses, called asanas, which help a person relax, stretch and tone muscle groups, and gain better balance. Iyengar is a style of Hatha yoga a bit more physically demanding than some other forms, and allows a number of aids, such as belts and blocks, to make it easier for beginners to work into the more difficult poses. While Hatha Yoga has often been confused with eastern religious practice, it does not need to conflict with any belief system or religion. Taken simply as an exercise form, it provides little aerobic benefits but adds many stretching and toning benefits to traditional aerobic exercise. Depending on the style and instructor, Yoga can be very stress reducing and rejuvinating.

Many books and magazines give different guidelines to the amount and type of exercise that is best. Usually no single exercise will fully meet your body's needs, although some. like swimming, come close. The American College of Sports Medicine recommends that healthy people work out, at a minimum, from three to five times a week, exercising at least fifteen minutes to an hour without resting at from 60% to 90% of the maximum age-adjusted heart rate. People with higher heart disease risk would start at a lower percentage of maximum heart rate and as their condition reverses, gradually increase their heart rate. It isn't usually necessary to go beyond 70% of your maximum heart rate to reverse heart disease.

Warming up and stretching are important parts of any workout to prepare the muscles for the extra demand and help prevent injuries. To get the most benefit from a workout, a cooling-down period is also recommended. Following a brisk walk, aerobic dancing, biking or any other high heart-rate activity, it is important to go a while at a slower pace, gradually getting to the resting point.

Many injuries occur from the lack of proper equipment. Walking and running shoes don't last as long as the tread designs on their bottom. The cushioning in the shoe absorbs most of the shock as the foot comes down to the surface, but the material has limited durability. A few months of use is a long time for running shoes, and in six months walking shoes usually no longer give the protection that is needed. In aerobics the floor surface can also be a source of injury. If the floor is hard, bring a piece of padded carpet or a mat to work on. When bicycling, wear a helmet with a label showing ANSI and Snell approval. A proper helmet is a cheap insurance policy. Why work for a healthy heart if you don't protect against head injuries? Any good bike shop will help you adjust the height of the saddle and position of the handlebars to give the best workout. Proper adjustments are important to avoid strains and injuries.

If you are between 30 and 69 the following guide will help you evaluate your aerobic fitness level. Measure an exact mile course on level ground and see how long it takes you to cover it, walking as fast as you can. Heart risk individuals note: if you feel discomfort or pain, slow down and try again later.

If you find yourself in the Poor or Fair category, your cardiovascular activity related heart disease risk factor is at a critical level. At a minimum, try to attain the High Average level.

Fitness Level: Time Walking One Mile (ages 30-69)
Men min:secFitness LevelWomen min:sec
Less than 10:12
10:13 - 11:42
11:43 - 13:13
13:14 - 14:44
14:45 - 16:23
16:25 & more
High Average
Low Average
  Less than 11:40
11:41 - 13:08
13:09 - 14:36
14:37 - 16:04
16:05 - 17:31
17:42 & more

Persons who exercise strenuously for periods longer than an hour every day and who sweat heavily can create special body demands. In a prolonged workout many vitamins and minerals are lost in perspiration. These are replaced by eating vitamin and mineral rich foods. Competing athletes and persons who work out long and hard, especially in hot and humid conditions, may benefit from additional intake of Vitamins B2, C, E, Iron, Calcium and Zinc, but large doses are not needed. Supplements are not usually needed by persons following the recommendations given in this web site and the Healthy Heart Handbook.

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©1994, 1996, 2002
Dr. Neal Pinckney
Healing Heart Foundation