In discussing exercise with my patients, I frequently need to clarify that “work” and “exercise” are not the same. Many of my patients have physically demanding jobs. They lift heavy objects, or they walk 4-5 miles a day during a 12-hour shift. They sweat all day in a warehouse that does not have air conditioning. They work on an assembly line doing repetitive tasks such as assembling a motor. But to their surprise, none of these constitute “exercise”. While work expends calories, there is not a requirement of performing a certain amount of work within a certain time period. If you add the element of time, then it becomes exercise. Exercise, specifically aerobic exercise, involves aerobic activity that raises the heart rate to 70% of your maximum heart rate and keeps it there for 20-30 minutes. Aerobic activity is an activity such as walking, running, cycling, swimming, or stepping that sustains a high heart rate for a prolonged period of time. This is contrast to anaerobic activity which involves a short duration of high intensity, such as powerlifting, sprinting, or jumping.
Calculating a maximum heart rate is as easy as subtracting your age from 220. This number is your theoretical maximum heart rate. Your goal, in aerobic exercise, is to keep your heart rate between 70% and 85% of your maximal heart rate. If you are 50 years old, your maximal heart rate is 170. Your target heart rate range during aerobic activity should be 119-144. If your heart climbs above the 85% of maximum, then you are crossing into an anaerobic activity level, which may be desirable for advanced fitness enthusiasts, but not necessarily advantageous for cardiovascular benefit.
My patients who are at risk for coronary artery disease are advised to undergo cardiac stress testing before embarking on a physical exercise program. In a controlled environment, we can study their heart for arrhythmias, blocked arteries and assess their exercise capacity. Then if the test shows that their heart can tolerate exercise, I release them to embark on an exercise program. I always advise a slow deliberate entry into exercise. Begin with a brisk walk, with arms swinging, moving fast enough to require deep breathing. Start with a short duration, say 20 minutes, and pay close attention to how you feel. If you struggle, then stop pushing yourself and take a break. If you can tolerate the 20 minutes of exercise, then slowly increase the duration to 25 minutes, and then to 30 minutes. Increase the frequency of the exercise from three times a week to eventually reach the point where you are walking briskly daily for 45 minutes to an hour. I advise walking because of the low cost of entry – there is no gym membership required and no expensive equipment required, other than a simple pair of athletic shoes.
Any activity that you perform daily for 3 weeks becomes a habit. Initially, you will have a difficult time getting motivated to exercise. You will need to make yourself get up to go and exercise. But once you start, you may actually find that you enjoy it, and after a few days, you look forward to exercising, as a release of pent up stress, and a way to decompress at the end of a long day. It may make you less hungry, and may influence you to eat smaller portions when you do sit down to eat. After three weeks of a daily exercise routine, you will discover that you no longer have to force yourself to exercise, but rather, it is an expected part of your day.
Aerobic activity has several effects on your body that are beneficial by themselves, but have a cumulative benefit when combined with other benefits.
Increasing cardiovascular aerobic capacity
Increasing pulmonary capacity
Promoting weight loss
Reducing blood pressure
Improve mood by releasing endorphins
Increase bone density and decrease risk of fractures
Increase insulin sensitivity, and help reduce blood sugar
Other methods of aerobic activity are available for those who are members of a fitness facility. These may include elliptical trainers, stairclimbers, treadmills, stationary bicycles, and rowing machines. Swimming is an excellent aerobic activity, which has the added benefit of low impact on joints. Those with arthritic joints may find this a more agreeable activity than walking on a treadmill or on a walking track. As you progress in your fitness journey, you may choose to join a gym to keep it interesting, and avoid the boredom of the same activity week after week, month after month.
After four weeks, you will start to see a difference in your weight and the fit of your clothes. This seems to be the strongest motivation to continue and keep making gains. Typically, 8-9 lbs of weight loss is sufficient to see a difference in the contour of your face and chin. After 8 weeks, others will notice a difference in your shape and your appearance. It is important to remember that the goal is not a short term change in weight, but a long term adjustment of your lifestyle – one where your basal metabolic rate drifts higher because you lead a more physically active life, and you automatically make choices that are healthier for your heart. This is a lifelong journey, so don’t rush the process, don’t get frustrated with how long it is taking, and enjoy the ride. You are in it for life
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