Our Services
Worried Well
January 01, 2010
By: Barry W. Ramo, MD Every January, hope springs eternal for my patients at the New Mexico Heart Institute. In January, my practice at the Heart Institute is filled with a number of men and women whom I call the “worried well”. The worry is paroxysmal. It reaches a high level on January 1 and fades as the year progresses. These folks are just beginning the second half of their lives, say around 50, and finally decide that since they can no longer button their pants or dress without the assistance of a respirator, and two flights of stairs equals one elevator, that it is time to work on their health and in my case, work on their hearts and blood vessels. The annual event occurs in January. They are worried but what I find is that they are often looking for an easy way to prevent heart disease. I usually make a contract with them that in three months they will lose 6 pounds and will be exercising regularly. The worry dissipates and by April, they return to their December status. (Some, I should note, do exactly what they should do). So I have taken a different approach the past few years and I focus on one element - exercise. Exercise is the central feature of my healthy heart program. I spend much of my day at the Heart Institute motivating patients to exercise. I believe that it is the single most important thing you can do to help yourself stay mentally and physically healthy. Exercise is the ideal drug as it offers so many benefits with few side effects and low cost. It helps make your numbers right (LDL and HDL cholesterol, inflammatory markers, blood pressure, waistline and blood sugar). It appears to reduce the risk for dementia and it reduces stress, but perhaps its most important role, in my mind, is it motivates you to follow all the other elements needed for a healthy lifestyle. That means not smoking, following a Mediterranean-type diet, not getting angry and taking the medicines that you might need for blood pressure, cholesterol and other medical problems. I like the word self-efficacy to describe the benefits. You want to incorporate three types of exercise into your program: aerobic exercise, resistance training and stretching. The time optimally is 30 minutes of aerobic exercise on most days and around 20 minutes twice a week of resistance training and daily stretching. No one is perfect but I advise my patients to try to incorporate exercise into their daily activities. Take a walk if you cannot run and find resistance exercises that you can do without a gym using your body’s weight. Aerobic exercise is where I ask most people to begin. You have a variety of choices but varying them will keep you interested. I use an iPod and listen to books and podcasts of lectures (some think that is more boring than exercise) or music. Walking is the best way to start because one of the major reasons for failure is that the weekend warrior goes out and hurts his or her back, knee or feet and stops exercising. I like the treadmill rather than running outside because there is no pollution, the temperature is stable and it’s harder to make excuses for not exercising. Also high-impact exercise makes an injury more likely. You might go to the Y for a swim, but cycling, stair climbing and my favorite — the elliptical trainer — are great choices. These exercises burn calories and are self-empowering. How do you stay with it if you are not absolutely delighted with how you will feel and look? I suggest several ways. If you have a friend, exercise with them. Distraction with TV or iPod works for me, but you might look into an area I find very helpful called mindful meditation. I would suggest a book by Jon Kabet-Zinn: Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. If you get sick or injured, don’t give it up but start back slowly. I also find it helpful to think about the blood effortlessly flowing through my heart and body and luxuriating in the feeling that I am accomplishing something good. One final tip: Do not exercise on an injury. If it hurts, do not do it. Pain means you are doing something wrong and the idea of “no pain no gain” is nonsense. Continuing to exercise on an injury can mean chronic and difficult to cure pain.
Stretching is key to avoiding injury and staying flexible. You should do this before aerobic exercise. I do it because being the terrible golfer I am; at least I don’t hurt after I play. You want to try to work the structures around your major joints. Hold each position for 10 to 30 seconds and don’t bounce. Each exercise should be performed several times. Stretching and yoga classes are also a good way to remain flexible. The stretch should not cause pain but only mild discomfort. Check out this Web site womensheart.org/content/Exercise/stretchingexercise.asp
I don’t recommend measuring your heart rate because I find that most people begin to obsess about it. I use a very simple metric: You should be able to carry on a conversation but not sing.
Resistance training can be done with a variety of machines or your own body weight. The latter is a good choice if you don’t have access to equipment. You should try to do this twice a week for 20 minutes and leave two days in between to rest to avoid injuries. The measure used is called rep or repetition, which is a back and forth motion of a resistance exercise like lifting a weight with your arm. Most experts suggest at least one set of 8-12 reps for each muscle group. It is ideal if you can start with a trainer and learn these exercises. That reduces the chance of injury and a good trainer is worth the money. Start light and build up. Many of my weekend warrior patients end up in pain and then cannot do their aerobic exercises because they attack exercise like they do their job at the hedge fund.