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updated 11/4/2003 7:27:20 PM ET 2003-11-05T00:27:20

Ready to start a fitness plan that’s good for your heart? You may be surprised at how good you can feel. Cleveland Clinic fitness expert Gordon Blackburn joined us to talk about heart-healthy habits and the benefits of a well-rounded fitness program.

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The opinions expressed herein are the guest’s alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD University: “Eating Well: A Start Towards Healthy Living.” Our instructor today is Cleveland Clinic fitness expert Gordon Blackburn, Ph.D., who will talk about the mind and body benefits of a well-rounded fitness program.

Support for this WebMD University course provided by Medical Mutual.

Moderator: Welcome, Dr. Blackburn.

Blackburn: Hello. Glad to be here.

Member question:

By all outward appearances I am a fit person. I play soccer once a week year round, and hike occasionally. My concern is with cardiovascular fitness. Heart disease is rampant in my family. I wish to counteract all that is destiny. How can I?

Blackburn: I think the first thing is to emphasize that exercise is only one risk factor for the development of coronary artery disease, and to reduce risk we need to look at all the risk factors. It’s great to exercise, but in addition to that, you should be having your cholesterol and blood pressure evaluated, if you smoke you should stop, and there are other genetic markers that can be evaluated for the development of coronary artery disease.

The issue with coronary artery disease is that there are several factors that contribute and to focus in on only one or two risk factors is insufficient. Exercise, by itself, can reduce the risk of developing coronary artery disease by approximately 50 percent in a primary setting. Primary setting is an individual who has no known coronary artery disease. So if you only focus in on the exercise you are not optimally reducing the risk that you may develop heart disease, especially with your strong family history.

Moderator: At what age should we start worrying about these genetic markers and get evaluated?

Blackburn: The emphasis on the assessment of genetic markers is influenced by your family history of coronary artery disease. The stronger your family history, the earlier in life we would recommend having the markers assessed. However, at this point in time the genetic markers predominantly identify an increased risk, but we have limited or no technology to alter those. The focus would be on the modifiable risk factors such as blood pressure control, cholesterol levels, lack of activity, and aggressively going after optimization of those risk factors. The presence of a genetic marker assists us in refining risk factor management strategies.

For example, if your cholesterol is elevated as well as Lp(a) is elevated, the goal would be to reduce LDL cholesterol (bad cholesterol), but to assist with the reduction of Lp(a) the use of niacin alone or in combination with a statin agent should be considered.

Member question:

Does cooking with olive oil help reduce cholesterol?

Blackburn: I think you are addressing the issue of the Mediterranean diet or the use of monounsaturated oils. The literature suggests that a diet similar to that found in the Mediterranean region assists in reducing the risk of developing coronary artery disease.

However, we still need to focus on the total amount of fat in the diet. In North America, obesity is a major problem and contributes to the development of coronary artery disease. So while increasing the amount of olive oil has a benefit, that must be done with a look at the overall dietary intake of fat and calories.

Member question: Can exercise and diet overcome genetic heart disease risk factors or are some subset of us always “doomed?”

Blackburn: The development of coronary artery disease is influenced by many factors. The genetic risk factors set our baseline likelihood. In addition, uncontrolled, modifiable risk factors in addition to an elevated genetic risk will lead to earlier development of the coronary artery disease. If the modifiable risk factors are well controlled throughout life, even with an elevated genetic risk, the development of coronary artery disease can be delayed.

Member question: I am currently working out at the Curves fitness centers and they say exercising three times a week for a half hour will improve my health and body. Is it possible in only one and a half hours a week?

Blackburn: Any increase in caloric expenditure through exercise or activity seems to impart some benefit in reducing the risk for developing coronary artery disease. The benefit of exercise can be viewed as a continuum to receive a significant benefit. It appears that the individual should expend approximately 1,000 calories a week in physical activity. The benefit continues to increase up to approximately 2,000 calories expended per week.

You should gain some benefit from the one and a half hours that you participate in activity at this time. To increase the benefit, you, in all likelihood, would need to exercise five days to six days a week. And probably 45 and maybe 60 minutes of exercise per day would be necessary to provide you with optimal risk reduction from exercise.

Member question: I have rheumatoid arthritis and fibromyalgia. I’ve gotten the OK from my doctors to exercise but have been told to do so every other day to give my muscles a chance to recover. So far I’ve been doing great — walking briskly on my treadmill — but I’d like to mix things up a little. Since I live way out in the country and have no easy access to a pool, swimming is not an option.

What kinds of cardiovascular exercise or new equipment could I look at that might meet my limitations but give me some variety? I want to stick with a good fitness plan but sometimes it can be overwhelming to be so limited!

Blackburn: I agree with your physician’s recommendations to perform the exercise every other day. Treadmill walking, however, is a weight-bearing activity and imparts an orthopaedic stress that can be minimized by including or focusing on nonweight-bearing activities such as stationery cycling or outdoor cycling. In addition, the orthopaedic stress can be reduced with activities such as cross-country ski machines or elliptical trainers.

Another piece of equipment found mostly in rehabilitation facilities or clubs that is excellent for patients with arthritis and/or fibromyalgia is a NuStep. This is like a seated stair stepper; however, the individual can control the amount of flexion and extension as well as the resistance. We have had several patients who tolerate this activity well and gain benefit.

Member question: What is the best way to lower cholesterol and triglycerides without medication? What do you think of fish oil?

Blackburn: Without medication, my first recommendation — if you are overweight — would be to reduce weight to an optimal level. The second issue would be to evaluate your diet, reducing the level of fat to at least 30 percent, and ideally less. Of the fats, one-third should come from saturated, one-third polyunsaturated, and one-third monounsaturated.

Exercise without weight loss has minimal effect on reducing LDL (bad cholesterol) levels, but can reduce triglycerides and increase HDL (good cholesterol) levels; however, exercise typically provides an increase of only 8 percent to 12 percent in HDL.

If you smoke, I suggest, for your overall general health, you stop smoking, because smoking also lowers HDL and cessation of smoking will result in an increase in HDL. Increasing fiber content in your diet may also assist in lowering overall cholesterol levels.

Member question: I am 39 and my mother is 72. How do we find an exercise program that is suitable for both of us?

Blackburn: Each activity program needs to be tailored to the individual to ensure they receive optimal benefit. Both you and your 72-year-old mother could go to the same fitness facility at the same time, or you could both exercise on exercise equipment at home at the same time, but the programs would be different.

The recommendation is that to receive benefit, the activity should be of moderate intensity. For a 72-year-old female, moderate intensity may be walking at two and a half miles an hour on a level surface, but for a 39-year-old female, a brisk walk at three and a half to four miles an hour on a low grade could be viewed as moderate.

Moderator: What about weight training? I’ve heard it’s good for seniors, like this 72-year-old mom.

Blackburn: We do encourage a well-rounded activity program, which would include aerobic as well as resistance training. As we age, we all lose muscle mass and strength, but a gallon of milk or a bag of garbage or a hamper full of clothes weighs the same when we’re 20 as it does when we’re 80. If we have lost 20 percent to 35 percent of our strength in that time period, the stress placed on the cardiovascular system increases. So we encourage all of our heart patients to include an appropriate low-resistance, high-repetition, weight-resistance training program.

By low resistance and high repetition, we are looking at weights that can be lifted by the large muscle groups 12 to 15 times to local fatigue. Fatigue is defined by the inability to lift the weight, straining (called the Valsalva maneuver), or using accessory muscles (throwing the weight) to raise it.

The activities should be performed one to two sets for each activity per session on alternate days of the week. A general-body workout addressing the large muscle groups can be accomplished with 8 to 10 different activities. Therefore, a resistance workout can be accomplished in 15 to 25 minutes per session.

Member question: I am a type 1 diabetic, 40 years old. I hate the water, but would an aerobics class in a three-foot indoor pool benefit me twice a week?

Blackburn: If you hate the water, have you looked at other forms of activity? Stationary cycling may be an excellent activity that reduces orthopaedic stress, and cycles are readily available for use in the home or in fitness facilities and can give the same benefit as a water-aerobics class, both from a cardiovascular standpoint and in assisting with your diabetes management.

If you choose to do water aerobics the intensity of the activity should be moderate in nature. Many water aerobic classes are of a group nature and the instructor sets the class pace. If this is true for you, the intensity may be too low or too high and should be tailored to your specific needs and abilities. A good water-aerobics instructor can provide you with modifications to the activity to assist in focusing the intensity to your needs.

Member question: I have been on a free, trial membership at Curves for women and I have enjoyed it, but my question is, is this the correct program or should I go to the fitness center where there are weights and the other stuff?

Blackburn: If you enjoy going to Curves, that is a key component of any program. Several forms of activity can give you benefit, but to maintain the benefit, it is essential the activity be performed regularly and for the long haul. If you enjoy the atmosphere at Curves then you should be able to receive benefit by continuing the program.

If you are looking for something more or different in your program and that is a motivating factor for you, then you would probably gain by going to another facility or an individual program.

Member question: What are your views on yoga for fitness? How about the Pilates workout?

Blackburn: Yoga is a beneficial form of exercise, especially assisting with flexibility and potentially strength and relaxation, depending on the form of yoga employed. From a cardiovascular standpoint, the benefits derived from other forms of exercise, such as walking or cycling, offer greater cardiovascular benefit and more efficient caloric expenditure.

Pilates is an excellent form of resistance training that also assists in improving flexibility. One drawback of Pilates can be access to the equipment, especially if you are looking at performing this in the home.

Member question: I am a personal trainer and am always getting asked by my clients on my views of the Atkins diet. Though I try to deter clients from such an extreme and restrictive diet I often find it difficult to argue against when I see clients not only lose body fat but increase energy levels and good cholesterol levels whilst lowering bad cholesterol levels. How can I counter this argument?

Blackburn: When it comes to dietary modification, our goal should be to assist clients or patients in establishing long-term healthy habits. There is no doubt that patients who follow the Atkins diet lose weight. This is a result of a reduction in caloric intake.

InsertArt(2051367)As weight is reduced, cholesterol levels will improve, however, long-term adherence to Atkins diet is extremely rare and if patients do not develop a long-term strategy to dietary modification, they will frequently resume previous dietary habits which will result in weight gain and increases in cholesterol.

So our strategy is to work with patients focusing not on the upcoming swimsuit season or social event, but a five-, 10-, or 25-year plan.

Member question: According to the South Beach diet you do not have to exercise to lose weight. Is this acceptable, because all other information desires more output in calories than intake of calories.

Blackburn: Weight loss occurs any time fewer calories are consumed than expended. So weight loss can be achieved through caloric reduction via diet, or it could be achieved exclusively through long-term activity. However, a realistic program that can be adhered to long-term incorporates modest reductions in caloric intake and modest increases in caloric expenditure.

It is much easier and satisfying to reduce caloric intake by five to 800 calories a day and increase caloric expenditure by 300 calories a day than it is to reduce overall caloric intake by 1100 calories and still have the energy to do activities necessary throughout the day.

Member question: I have repeatedly told my doctor that I am concerned about my weight (I am morbidly obese, 37-year-old female, 5’3” and 250 pounds) to no avail. He does not take my concern seriously and has not been willing to schedule a visit solely for reviewing weight-loss options. I think, because I am otherwise healthy and only see him for well visits, that he does not see my obesity as a major health concern. However, there is a history (some siblings, both parents, and both paternal grandparents) of heart disease in my family. What can you suggest to help me prompt my doctor?

Blackburn: If you are dissatisfied with your current weight and view it as a health issue, it is both a personal and health issue. I think your overall health and personal satisfaction would improve though weight loss and regular activity. I would encourage you to discuss this again with your personal physician and if you feel he or she is not receptive, you may want to consider discussing this with another health-care professional.

Moderator: Our thanks to Gordon Blackburn, Ph.D., for being our instructor today, and thank you class for joining us! For more information, please be sure to sign up for the entire WebMD University course. It’s free and easy. And check out all of the nutrition, exercise, and heart health information on WebMD.

WebMD content is provided to MSNBC by the editorial staff of WebMD. The MSNBC editorial staff does not participate in the creation of WebMD content and is not responsible for WebMD content. Remember that editorial content is never a substitute for a visit to a health care professional.

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