Sunday, January 29, 2006

Why is exercise so important for diabetics and pre-diabetics?

Thirty-five percent of all Americans will develop diabetes, which can cause heart attacks, strokes, blindness, deafness, impotence, amputations, kidney failure and sudden death. Three studies show why virtually all diabetics should exercise. The first study shows that exercising before a meal markedly reduces the rise in blood sugar that usually peaks 20 minutes after you eat (Lipids in Health & Disease, October 2005). The second shows that exercise lowers HBA1C in diabetics (Journal of Obesity, October 2002), while the third shows that exercise lowers high blood pressure (Medicine & Science in Sports & Exercise, August 2005)

When you eat, your blood sugar level rises. In diabetics, most of the damage is done within 20 minutes after you eat because that’s the time that blood sugar levels are at their highest. The higher blood sugar rises, the more sugar sticks on cells. Once sugar is stuck on a cell, it can never get off. It is eventually converted to a poison called sorbitol that destroys the cell. This cell destruction causes all of the horrible side effects of diabetes.

Doctors measure the amount of sugar stuck on cells with a blood test called HBA1C. The first goal in treating diabetes is to use drugs and diet to get HBA1C below 6. Since blood sugar levels are highest 20 minutes after you eat, you should do everything possible to prevent the high rise in blood sugar that follows meals. The only places that your body can store sugar are in your muscles and your liver. After you eat, sugar goes from your intestines into your bloodstream. Then if your muscles are empty from exercise, the sugar can pass into your muscles. However, if your muscles are full because you do not exercise, the sugar has no place to go and blood sugar rises to very high levels to stick to cells and destroy your body.

Exercise is also vital for diabetics because it helps to control blood pressure. Eighty percent of diabetics die of heart disease, and anything that increases risk for heart attacks puts diabetics in danger. High blood pressure is a major risk for heart attacks and strokes. Since exercise lowers high blood pressure, it helps to prevent heart attacks and thus to keep diabetics alive.

More on diagnosis and treatment of diabetes

Thursday, January 26, 2006

Will exercising at night keep me from sleeping?

Many fitness instructors give bad advice when they tell you not to exercise within three hours before going to sleep. Several studies show that exercising vigorously before going to bed does not interfere with sleep. One study from the University of California at San Diego showed that three hours of vigorous pedaling at 70 percent of maximum oxygen uptake in very bright lights did not stop fit men from falling or staying asleep.

The old argument was that vigorous exercise causes your body to produce large amounts of its own stimulants, adrenalin and nor adrenalin, that make your heart beat rapidly, raise body temperature and prevent you from feeling tired. Newer studies show that doesn't happen. We also know that exercise helps to prevent disease, prolong life and make you feel good. So it is better to exercise whenever it’s convenient for you, even if it's just before you go to bed.

Tuesday, January 24, 2006

How important is the slope-adjustment feature on a treadmill?

Good treadmills have a lever that raises the front end to simulate running up hills, because running on level ground does not do much to strengthen your upper leg muscles. Running strengthens primarily your lower leg muscles. You stress your upper leg muscles significantly only when you run up hills. Each one percent increase in the elevation angle on your treadmill requires four percent more energy.

Serious runners train by running intervals. They run a short distance very fast, rest and then run very fast again. A typical workout could be to run four half-mile repeats, averaging two minutes each, with a slow one-eighth mile jog between each run. If you run a half mile on level ground in three minutes, you will run three minutes and eight seconds on a one percent incline, or eight seconds slower. Runners can expect slower times when they run up hills, but they will strengthen their upper legs.

Monday, January 23, 2006

How is a shoulder injury treated?

The rotator cuff muscles hold the head of the long bone of your upper arm tightly in the socket of your shoulder. Sports that require moving the arm over the head repeatedly can cause tearing and swelling of the tendons of these muscles. Baseball pitchers, swimmers, weight lifters and tennis players often suffer this injury. Chronic irritation can cause pain, swelling and tearing of the rotator cuff. If you continue to exercise in spite of the pain, you will tear the tendons from their attachments.

Initially, pain occurs only when you hold your arm over your head and bring it down or forward forcibly. Later, it will hurt when the arm is moved forward for any reason, such as to shake hands. Usually, it hurts when you push things away and does not hurt when you pull objects toward you. A torn rotator cuff will cause tenderness over the tendons, especially when the elbow is raised above the shoulder. It will hurt when you pull your arm across your chest, and you will have difficulty raising your elbow over your shoulder. An arthrogram is often not sensitive enough to diagnose a partial tear of the rotator cuff but can show a complete tear.

The treatment is to avoid any motion that hurts and strengthen the uninjured shoulder muscles. Do weight-lifting exercises that bring the weights toward the body and do not hurt, such as upright rows and downward "lat pulls". You may need surgery if the rotator cuff tendons are torn completely, or if the tendons do not heal within one year.

Sunday, January 22, 2006

Are there any new treatments for frequent urination at night?

Yes, a study from Taiwan shows that a simple nasal spray controls nighttime urination in men who were not helped by drugs usually prescribed by physicians today. At night, the brains of most younger people produce a hormone called antidiuretic hormone that shuts down the kidneys. However, as men age, most have to get up at night to urinate. Some men have to do this more than six times a night, which interferes with sleep and makes them very tired during the day. Doctors prescribe muscle relaxants and some patients find that they help. However, a very large percentage of older men go from doctor to doctor and are unable to find a drug that will control their night-time urination. Researchers in Taiwan prescribed a nasal spray containing antidiuretic hormone to older men who urinated more than six times each night and had not been helped by conventional treatments (British Journal of Urology International, December 2005.) More than 85 percent improved in a very short time.

Saturday, January 21, 2006

What’s the latest on preventing Alzheimer’s disease?

A study from Brown University Medical School shows that Alzheimer’s disease may be another form of diabetes, and all the recommendations for avoiding diabetes may also protect your memory (Journal of Alzheimer's Disease, November 2005.) Like the pancreas, the brain produces insulin. Professor Suzanne M. de la Monte showed that brain levels of insulin and insulin receptors fall during the early stages of Alzheimer's and continue to drop progressively as the disease progresses. Other features of Alzheimer's, such as cell death and tangles in the brain, could be caused by abnormalities in insulin functions.

Furthermore, lack of insulin lowers brain levels of the neurotransmitter acetylcholine, which is seen regularly in Alzheimer's disease. This would explain why every factor known to increase risk for heart attacks also increases risk for Alzheimer’s disease. Even though these studies are preliminary, it is a good idea to reduce susceptibility to developing diabetes by markedly reducing your intake of sugar and flour; increasing your intake of fruits, vegetable, whole grains, beans, and nuts; avoiding weight gain and exercising regularly. Read my report one Who is pre-diabetic.

Thursday, January 19, 2006

How can I get rid of cellulite on my thighs?

There is no such thing as cellulite. The fat on a woman's hips and thighs is the same as the fat anywhere else. She has skin on the outside, fat in the middle and muscles and fascia underneath the fat. Tiny bands of fiber called ligaments run from the fascia, through the fat and attach on the skin. When fat is stored on the hips and thighs, it pushes the skin upwards, while the ligaments hold the skin down, causing an orange peel appearance from the little dots where each ligament attaches to the skin.

Getting rid of fat gets rid of the dimpling, but for women who store fat primarily in their hips and thighs (rather than their bellies), this can be very difficult. You can be skinny everywhere else and still have dimpled thighs. Don’t be deceived by creams and other products that promise to get rid of cellulite; they are worthless.

Wednesday, January 18, 2006

I’ve started walking every day, but I’m not losing any weight. What am I doing wrong?

Many people do not lose weight when they exercise because they don't do it vigorously enough. You lose weight by exercising intensely enough to raise your body temperature and make you breathe faster. This causes you to burn extra calories for up to 18 hours after you finish exercising. But vigorous exercise makes your muscles feel sore on the next day. If you try to exercise intensely with sore muscles, you can tear them and not be able to exercise at all. The best way to use exercise for weight loss is to alternate two sports that stress different muscle groups, so you can exercise every day without injury. For example, jog or cycle on Monday, Wednesday and Friday and pull on a rowing machine Tuesday and Thursday.

How to increase your walking speed

Tuesday, January 17, 2006

How can I rehabilitate a knee injury?

Many sports injuries cause a progressive permanent osteoarthritis that will prevent a person from exercising to cause the very diseases that a regular exercise program is supposed to prevent. Sports medicine surgeon James Garrick, writing in the medical journal Lancet (December 2005), explains why. You are supposed to exercise. It makes you stronger, faster, healthier and may even prolong your life. However, every time you exercise, you risk injury and many sports injuries last forever. Depression, heart attacks, strokes, obesity and diabetes are all associated with a sedentary lifestyle. A twisted ankle can change an active person into a sedentary one. A torn anterior cruciate ligament or meniscus of the knee has a greater than 50 percent chance of causing permanent pain within five years, regardless of the treatment.

If you tear your anterior cruciate ligament of you knee, you must have it repaired as soon as possible. After it is repaired at surgery, you have an almost certain chance of tearing it again if you try to return to a competitive sport. When your heel hits the ground during running, your foot stops moving suddenly, forcing the upper femur bone to slide forward on the lower tibia bone at the knee. The anterior cruciate ligament prevents the femur from sliding too far forward and shearing off the cartilage in your knee. Once you tear your anterior cruciate ligament (ACL), even if it is successfully repaired, you have a weaker ACL that still lets the top femur slide forward on the tibia and shear off cartilage. So running causes you to lose cartilage until you lose it all, bone rubs against bone and you hurt 24 hours a day. The only treatment then is a knee replacement. So anyone who has broken cartilage or ACL in his or he knee should never run again for the rest of his or her life.

On the other hand, strengthening the muscles of your upper leg stabilizes the knee and helps to delay and prevent a knee replacement. Anyone with broken cartilage or a torn anterior cruciate ligament in the knee should try to pedal a bicycle every day. Pedaling is done in a smooth rotary motion without sudden stopping, so it does not cause sudden forward movement of the femur on the tibia and does not shear off additional cartilage from the knee joint. If you pedal against increasing resistance you will strengthen the muscles around the knees and increase their stability so there is less wear on the cartilage.

Related report: Arthroscopic knee surgery is usually worthless.

Sunday, January 15, 2006

Is hydrolyzed soy the same thing as partially hydrogenated soybean oil?

No; "hydrolyzed" means that a chemical compound is split into smaller units in the presence of water; for example, sucrose is split into glucose and fructose. It's a benign process, even though it sounds similar to the "hydrogenation" we warn against. You'll see it primarily referring to additives such as hydrolyzed soy protein, which are harmless and used in such small quantities that they are not a significant factor in your diet.

Hydrogenation is the addition of hydrogen atoms in place of the double bonds between carbon atoms in fat molecules. "Hydrogenated" or "fully hydrogenated" means all the double bonds have been replaced; "partially hydrogenated" means some, but not all have been replaced with added hydrogen atoms. Fully hydrogenated oils are solid at room temperature (like Crisco) while partially hydrogenated ones are softer. Many processed foods and margarines use partially hydrogenated oils. Which is worse? Fully hydrogenated vegetable oils resemble ordinary saturated fats, while partially hydrogenated oils have a chemical structure that is found nowhere in nature, so your body doesn't know what to do with them. I avoid both types.

New US labeling laws requiring listing of trans fats have encouraged manufacturers to remove them from many products. Check the list of ingredients. Zero trans fats on the label does not always mean no trans fats.

Saturday, January 14, 2006

Why do I keep gaining weight every year?

Most people become fatter with aging because they are less active, not because they eat more. Thirty minutes of exercise a day may be enough for heart fitness, but it is not usually enough to lose or maintain weight. Our grandparents doing heavy manual labor were active for 8, 10 or more hours every day. If you have a sedentary job, you need an exercise strategy that includes very vigorous exercise, more time spent in physical activity, or (preferably) both. Researchers from the University of South Carolina showed that the increase in body fat that accompanies aging can be completely prevented with prolonged vigorous exercise (Medicine & Science in Sports & Exercise, August 2005.) The authors studied 60 thousand male runners and found that the more miles they ran, the thinner they remained. Waist circumference increased with age at all running distances, but the increase diminished in the men who ran further.

This tells us that you must increase your physical activity with age to prevent weight gain. Your chances for success will improve if you find an activity you enjoy enough to do it for several hours at a time, such as dancing, fast walking, rowing or cycling. Then make your sport a regular part of your social life, not just an exercise chore.

How to start an exercise program

Friday, January 13, 2006

Are spinning classes a good way to exercise?

Whether you’re out of shape or very fit, spinning classes can help you improve. You ride a stationary bicycle in a group, with a leader who tells you what to do and plays lively music to set the tempo. Many health clubs and gyms offer these classes, and I recommend them to all of my patients. Spinning is relatively safe because it is done with a smooth rotary motion that does not involve the muscle damaging road shock of running.

The pedals drive a chain that is attached to a heavy flywheel that spins smoothly as you pedal. The amount of work you do is determined by the resistance on your pedals, not by how fast you spin. You perform a lot of work when you spin slowly against great resistance, and do not do much work when you spin very fast against very little resistance. A brake is attached to the flywheel and you regulate the resistance on the pedals by turning the brake clockwise to increase the resistance, and counter-clockwise to decrease resistance.

Before you start real training, you need to do some background work. Start out by pedaling at a very slow rate with no resistance. Stop when your legs start to feel heavy or hurt. You may be able to go ten minutes on the first day, five on the second, and perhaps not be able to exercise on the third. Persist and eventually every healthy person should be able to work up be able to work up to a full 45-minute class.

Your instructor will have you warm up by spinning without any resistance until you start to break a sweat. Then you will turn up the resistance a little and spin the pedals until your thigh muscles start to burn. Then pedal easily with little or no resistance until you have recovered, usually about a minute or two. You will continue to alternate “into the burn” and “out of the burn” until your leg muscles start to stiffen, which is a signal that you are through for the day.

You need to experiment to learn how high you have to turn up the resistance. If you turn it up too high, you will burn out your muscles and not be able to finish the class. If you don’t turn it up high enough, you will not achieve a high level of fitness, not feel sore the next day, and not gain the benefits of being in a high level of fitness. If you have worked out correctly, your thigh muscles will be sore on the next day. Then you have to pedal easily with little or no resistance for as many days as it takes for your muscles to feel fresh again. For most people, this will be one or two days. Then when your muscles are fresh again, you’re ready for another hard workout.

Thursday, January 12, 2006

What’s the proper way to pedal a bicycle?

You should pedal with the ball of your foot, not your arch. The ankle is the fulcrum for the force you generate with your feet. The ball of your foot is further away from the ankle than your arch so you generate far more force with the ball of your foot.

As you straighten your knee, pedal at a 45 degree angle down and forward for the greatest force. Bicycle shoes have cleats that attach to the pedals to keep the ball of your foot over the pedal, where you generate the most force. Don't wear soft-soled shoes that allow the pedals to press against your feet, which can cause pain. Experienced riders know that you should not bend your foot up when you pedal up because it wastes energy and tires you earlier.

Tuesday, January 10, 2006

Should I be concerned about raising my growth hormone levels?

As you age, blood levels of growth hormone drop. A 1990 study from the University of Wisconsin showed that taking growth hormone enlarges muscles. Since then equal numbers of studies support and refute that growth hormone increases muscles and decreases fat. But over-the-counter growth hormone releasers do not contain ANY growth hormone. The advertised products are amino acids, the building blocks of protein, the same as the protein you get in your food. Eating anything raises your blood level of growth hormone temporarily, and protein raises it a little bit more than fats or carbohydrates. So any food can be sold as a growth hormone releaser without lying, but food sources of protein are a lot less expensive than the pills.

Several studies have shown that vigorous exercise also raises growth hormone levels temporarily. We have no dependable tests for aging. The commonly used tests to measure aging actually measure fitness. At this time, the best recommendation we have for reducing the effects of aging and improving your performance on all medical tests of aging is to start and maintain a regular exercise program.

More on "growth hormone releasers"

Monday, January 09, 2006

Will lifting weights make me musclebound?

In 1937, Dr. Peter Karpovich of Springfield College in Massachusetts published a ground-breaking paper showing that lifting weights helped men improve their coordination. At the time, his paper was ridiculed by most athletes, particularly professional baseball players. They were afraid that lifting weights would cause them to develop such large muscles that they would lose the fine coordination necessary to hit and throw a baseball. Today we know there is no such condition as “muscle bound”. Baseball players all lift weights and they are so much better as athletes that the best baseball players in the world before 1940 probably would not even make today’s professional teams.

Training for strength improves coordination. Your brain is a master switchboard that coordinates your muscles. Lifting weights does not interfere with brain function; it improves coordination in activities that require strength, such as playing sports, working as a carpenter or opening a stuck door. Strength training also makes you faster. Muscles are made up of slow and fast twitch fibers. The slow-twitch, red fibers are used primarily for endurance such as running long distances or performing continuous work. The fast twitch, white fibers are used primarily for strength and speed. The same fast-twitch fibers that are strengthened by weight-lifting are used for speed, so the stronger your muscle is, the faster you can move it. Lifting weights will improve your performance in every sport, since they virtually all require power.

How to become very strong

Sunday, January 08, 2006

Will eating oat bran help to prevent a heart attack?

No single food causes heart attacks and no single food prevents them. Cereals containing oats may claim that their soluble fiber lowers cholesterol, but you can also get soluble fiber from most fruits and whole grains. You will raise your cholesterol if you take in more calories than you burn, no matter how much soluble fiber you eat.

You may read that you should eat olive oil because it contains monounsaturated fats that help to prevent heart attacks, but you can also get monounsaturated fats in peanuts, nuts, sunflower seeds and many other seeds. It's your total intake of nutrients that counts. You can't prevent heart attacks just by eating oat bran, olive oil, fish oil or any other specific food. The best research on diet available today shows that if you want to prevent heart attacks and many cancers, you should eat a wide variety of fruits, vegetables, whole grains, beans and other seeds.

Modified DASH diet for total heart health

Saturday, January 07, 2006

Why am I getting recurrent sore throats?

If you have recurrent throat infections with staph or strep bacteria, check your toothbrush, your nose and your mate. One study showed that beta strep, which causes rheumatic fever, was grown from toothbrushes of 30 percent of children who were infected with that germ. Beta strep can persist in unwashed toothbrushes for 15 days and in washed toothbrushes for 3 days. Another bacteria called staph aureus can persist in the noses of people even after they have taken the appropriate antibiotic. Having staph in your nose also prevents simple cuts from healing.

Staph grows so luxuriously in the wet nasal membranes that it is difficult to cure by taking oral antibiotics. You can also be re-infected by a mate who has no symptoms at all. If you suffer recurrent staph or strep infections, get a new toothbrush and ask your doctor to culture your nose. If you have a staph aureus infection, apply an over-the-counter antibiotic ointment such as Bacitracin in your nostrils nightly for several weeks.

Friday, January 06, 2006

Should I stock up on bird flu drugs?

The bird flu virus called H5N1 can kill you. There is no bird flu epidemic in humans, but there could be. You can get bird flu only from birds. Since humans spend more time with humans than they do with birds, humans are at very low risk for bird flu. The concern is that H5N1 could mutate and be spread from human to human. This could cause an epidemic that could kill millions of people throughout the world. At this time the only drugs we have to threat bird flu are Tamiflu and Relenza. On the first sign of chills or coughing during an epidemic, you would be instructed to take one Tamiflu pill twice a day for five days. This shortens the course of the disease by one day, which seems insignificant but could save your life. You could also take the drug prophylactically if you were exposed to people who have the flu. Relenza has to be inhaled , so you would take it only after you became sick.

If you hear that bird flu has mutated and is causing an epidemic among humans, you will want to get Tamiflu pills and have them ready if you need them. At this time it does not make sense to stockpile the drugs as there may never be a bird flu epidemic, the drugs are very expensive, and they have a limited shelf life.

Should you get a flu shot?

Thursday, January 05, 2006

Will potassium supplements treat fatigue in an athlete?

Tiredness and cramps in athletes can have many causes, but lack of potassium in their diets is not one of them. Many years ago, Dave Costill of Ball State University tried to create potassium deficiency in runners. He couldn’t do it because potassium is found in all foods except refined sugar, and his athletes would not stay on a diet that consisted only of hard candy.

The kidneys and sweat glands conserve potassium so well that you don’t lose much. If an athlete develops potassium deficiency, it is usually caused by drugs, such as diuretics or corticosteroids, or by diarrhea or repeated vomiting. Some athletes try to control their weight by making themselves vomit. This is called bulimia, and the person usually denies vomiting. Their physicians can prove that they are vomiting by ordering blood and urine tests. If blood levels of potassium are low and urine levels are high, vomiting is a likely cause. Get a work-up for other causes of chronic tiredness. If none can be found, you may overtraining and should talk to your coach or a personal trainer about changing your workouts.

Wednesday, January 04, 2006

Burning off the extra calories

You know you're supposed to exercise if you want to lose weight, control your weight and stay healthy, but many people stop exercising because they're bored. One of the keys to lifelong fitness is to find an activity or sport that you really love.

Whatever your age, if you want a fun way to exercise, try a Trike! It's comfortable and takes no skill. You have no risk of falling, and you can move as fast or slow as you like.

This great action photo of Diana and Thunder was taken by Steve Korn. View more of his work at

More about Diana's trike (more pictures, too)

Tuesday, January 03, 2006

Will cross-training make me more fit?

Fitness refers to your heart, and the harder you exercise, the more fit you become. But every time you exercise vigorously your muscles are injured, and the harder you exercise, the longer it takes for your muscles to heal. Muscle biopsies done the day after a person exercises vigorously show bleeding into the muscles and disruption of the Z-bands that hold muscle filaments together. You are not supposed to exercise vigorously again until the muscle soreness disappears.

Most competitive athletes set up training programs so they exercise vigorously enough on one day to make their muscles feel sore for the next day or two and then after the soreness disappears, they exercise vigorously again. You can use the same principle in your exercise program to achieve a higher level of fitness. You can exercise vigorously on one day and easy on the next few days or until the soreness disappears, or you can train in two sports. This is called cross-training, and it can make you very fit and help to prevent injuries.

Each sport stresses specific muscle groups. Cycling stresses the upper legs, while rowing stresses your back and upper body. If you cycle and row on the same day, you stress your upper legs and upper body on the same day. To reduce your chances of injuring yourself, you should take the next day off, or at least exercise at a very low intensity. If you cycle on Monday and row on Tuesday, you allow your muscles 48 hours to recover from each sport. Pick two sports that use different muscle groups and do them on alternate days. You can then exercise more intensely in each sport and achieve a higher level of fitness.

More fitness and training tips

Monday, January 02, 2006

What causes runner's knee?

Runners are far more likely to suffer knee pain than cyclists. The most common long term injury in runners is a condition called runner’s knee in which the back of the knee cap rubs against the front bottom of the femur, the long bone of the upper leg. If it hurts to push the kneecap against the bone behind it, you have runner's knee.

The back of the kneecap is shaped like a triangle with the point fitting in a groove in the lower part of the bone behind it. During running, the knee cap is supposed to move up and down and not from side to side. When you run, you land on the outside bottom of your foot and roll inward toward the big toe side of your foot. This is called pronation. It forces your lower leg to twist inward while at the same time, three of the four quad muscles attached to the kneecap pull the kneecap outward, causing it to rub against the bone behind it.

The amount of inner twisting of the lower leg during running is related to how straight your knee is. Bending your knee decreases inner twisting and rubbing of the knee cap against the bone behind it. People with runner’s knee usually can pedal a bicycle with their seats set lower than normal to prevent their knees from straightening completely. Orthotics, custom- fitted inserts in the shoes that restrict pronation, may help. They can also use special exercises that strengthen the vastus medialis muscle above the kneecap that pulls the knee cap inward when they run or pedal.

Sunday, January 01, 2006

Is my New Year's resolution to get in shape worth the effort?

Being out-of-shape is almost as strong a risk factor for a heart attack as smoking. A study in the Journal of the American Medical Association (December 21, 2005) shows that being out-of-shape markedly increases your risk for being fat, storing most of your fat in your belly, having a high bad LDL cholesterol and high blood pressure, and having low levels of the good HDL cholesterol.

We live in a society in which 91 percent of the population develops high blood pressure, 78 percent will have high cholesterol, and 35 percent are diabetic. More than 50 percent of us die of heart attacks and strokes from these risk factors. Doctors no longer think of heart attacks, strokes and diabetes as just being due to our genes. We now consider these diseases to be caused by our behavior. You prevent heart attacks, strokes and diabetes by 1) exercising; 2) reducing your exposure to saturated fats (meat and chicken), partially hydrogenated fats (most prepared foods), and refined carbohydrates (flour and sugar); 3) eating large amounts of fruits, vegetables, whole grains, beans, and nuts; 4) avoiding overweight; and 5) avoiding smoking.

We have known for many years that any kind of exercise or activity helps to prevent heart attacks, but more recent data show that the more vigorous the exercise, the better the protection. First check with your doctor to see if you have a medical condition that could be aggravated by exercising. People who are out-of-shape are the ones most likely to suffer heart attacks when they start an exercise program. With your doctor's permission, you are ready to start a training program. The best sports for preventing heart attacks are those in which you exercise continuously. You could run, dance, cycle or swim. It's important to pick an activity that you enjoy, because more than 85 percent of middle aged people who start an exercise program drop out in the first six weeks. Those who are most likely to continue exercising do it with a partner or in a group. Recruit your spouse or best friend, hire personal trainer or join a class at a nearby health club. Just do it!

How to start an exercise program