Exercise and Heart Disease
One of the best books to appear in the 1970s was The Complete Book of Running by James Fixx. Fixx was probably the man most responsible for the rise to popularity of running, or jogging. Fixx found himself, in his mid-thirties, with a heart problem, weighing nearly 16 stones (100 kg) and breathless after trying to run 50 meters.
He decided to take up running, and by the time he wrote his book, ten years later, in 1978, he had lost 4 stone (25 kg) in weight, had run the equivalent of once around the Equator, had competed in marathons all around the world, and was running 10 miles (16 km) every day.
By 1984, his book was recommended reading for all people keen to help their general health, and particularly their hearts. That changed overnight when Fixx died, while running, from a heart attack in his late 50s. Exercise is fine and fun, but it should be tempered by the realization that it is not everything, and that there are times when you need to seek other help.
The problem with James was that he believed that he could 'run through' his heart trouble. He became so engrossed in his running schedule that he did not seek help for his increasing angina problems. He had, in fact, severe atheroma, probably a hangover from his overweight days, and maybe complicated by the fact that his father had died, in his 30s, from coronary heart disease. This sort of history suggests that the Fixx family may have inherited a - tendency to very high blood fat levels. Nowhere in his book does he mention his own blood cholesterol or fat levels.
Perhaps if he had slowed down a little, and asked for medical advice, he could still be alive today. There are plenty of effective ways to lower cholesterol and to treat angina now, which might have helped prevent that final attack.
It still could be argued that James Fixx was a success story. After all, his exercise allowed him around 20 years of extra life before his heart disease eventually killed him. But the suspicion is still there, that if only he had not been quite so obsessional, he could have lived longer.
So what is the place of exercise if you wish to avoid heart disease, or already have it and do not want to end up like Mr Fixx? For a start, the news is all good. Exercise is good for you, even when your heart has been badly affected by previous attacks.
This will surprise many older people who can remember heart victims being asked to rest most of the day, for weeks and months at a stretch. When I qualified in medicine, in 1962, there was a strict routine for all victims of heart attacks. They were kept lying almost flat in bed for between six and twelve weeks.
The idea was that if you 'rested' the heart until the scar of the heart attack healed, the eventual scar would be stronger and smaller, and the eventual recovery would be better. However, the heart attack patient from then on was expected to lead a fairly quiet life.
Perhaps this advice to rest was really a hangover from the Victorian age, when it was fashionable to take to one's bed at the onset of any illness, and to stay there, no matter what, until one was fully 'convalesced'. From the mid-nineteenth century until the 1960s, 'convalescent homes' and 'rest homes' were places where people could relax and laze until they were better from whatever acute illness they were thought to have.
You did not have to be ill to take to your bed. Florence Nightingale and Charles Darwin were two noted Victorians who spent most of their adult lives languishing in bed, suffering from 'neurasthenia', or 'nervous exhaustion'. Such examples made the 'cardiac cripple' almost fashionable. People who had any sort of heart disease were told that they were 'delicate' and must not overexert themselves. Once you had had a heart attack, all sorts of activity were forbidden, including walking upstairs, running or even lovemaking.
All this advice was given on the basis of no facts at all! Because some eminent physicians theorized that rest was good, it was accepted as good. We know different now. We know that the way to strengthen an organ is to use it, not to rest it.
The proof of that is simple. Think of the last time you were ill enough to be forced to stay in bed, say with influenza. After only a few days in bed, how did you feel on the first day up? Weak, shaky, and surprisingly lacking in energy? That was not the aftermath of the virus Infection, but the effect of prolonged rest on your leg and back muscles.
When muscles are not used for more than a day or two, they quickly begin to waste: they lose their stores of energy. The change is only temporary, and they quickly build up their strength again once activity is resumed. However, the longer you rest, the weaker the muscles are, the longer they take to recover, and the more you wish to rest. That starts a vicious circle that can be difficult to break.
The heart is no different from any other muscle in this respect. It needs to be stimulated to keep strong. Working at resting pace all the time will make it difficult for it to step up a gear when it is needed.
Today, therefore, the aim is to keep people with heart trouble as active as their condition will allow. They are asked to exercise on 'treadmills' (really just moving pavement machines used as standard clinic tests) to determine their capabilities. Even if your heart is failing, there is always something you can do to make life more active, and to improve the efficiency of your circulation.
What is true of those who already have heart disease is even more true for the population at large. We human beings developed as hunter-gatherers. We were built to walk for miles, day after day, looking for food. If we sit, inert, for most of the day, we become unfit. Unless, of course, we make sure that we set time aside for exercise. The only argument is about how much exercise we need to keep fit, without going overboard about it, like the late James Fixx.
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