What physical activity should you choose to look after your heart? We checked it out with our cardiologist. We asked him what kind of physical activity he does on a daily basis and why.
What does a cardiologist’s physical activity look like?
Based on epidemiological data showing that 2/3 of men in Polish society are obese or overweight, my physical activity habits may seem useful to relatively few people.
I have always been a slim person, for most of my life perhaps even too. Contrary to popular belief, a BMI around the middle of the normal range, in a middle-aged person, does not necessarily mean an advantage when faced with a ‘silver tsunami’.
In people over 60, the most important factor is the so-called fat free mass (FFM fat mass), i.e. simply the body weight remaining after subtracting body fat – mainly muscle, bone and internal organ weight.
With the right physical activity, it is bone and muscle mass that can be influenced, which is key to maintaining independence for the rest of one’s days, thanks to the guarantee of free movement.
In addition, people with low FFM endure surgery, heavy drug treatment, injuries, infections, etc. much less well.
I would particularly like to recommend this passage to 40-50 year-old ladies, whom I meet quite often in my practice. After coping with parental responsibilities, they decide to “take a selfie”.
As part of this strong resolution, they switch to a vegan diet and start training for a marathon. If they are slim people, this approach, to the best of my knowledge, is a nightmare mistake.
How do I take care of my FFM?
Certainly not by preparing for and competing in a marathon.
The popularity of this form of physical activity among middle-aged people invariably remains a curiosity to me. Why, out of hundreds of sports, this one is so popular.
A discipline requiring hours of training, limiting time for family and social relationships and work activities, and offering the development of only one (general endurance) of the 11 fitness elements, most often with a detraction from the other 10.
No „no pain, no gain”
The only effective way to maintain the quantity and quality of muscle and bone is through resistance training. This form of training has only in recent years gained full recognition in the medical community, interestingly most so in people with obesity and metabolic diseases.
In my case, resistance training, despite slightly different indications, involves the same thing. In practice, it is 2-3 workouts a week carried out at home.
Going to the gym, which is a dedicated place for this form of training, means dedicating with commuting min. 3×2 hours per week. If realised at home, this is no more than 3 times for 20-30 minutes each.
There remains, of course, the question of buying equipment and clearing space at home. After years of finagling and cluttering up one room, it turned out that all the equipment needed, fitting into a small bag, could be had for around £100. These are, of course, resistance bands, optimally of the power band and mini-band type.
They can be used for all exercises, with the load adjusted to be able to perform 10-12 repetitions for younger people and 12-15 for older people. It is not advisable to aim for total muscle overload, as is typical in bodybuilding.
The “no pain, no gain” principle does not apply to training for health. Overcoming one’s own limitations in order to break records is a challenge for professional athletes. For everyone else, this approach can only result in injury and elimination from exercise for several weeks.
If not a marathon, what about fitness training?
“Fitness” is in sports medicine terminology, and from 2020, i.e. the date of publication of the cardiology guidelines on sports activity, also popular in cardiology – the pulmonary and cardiac component. Its very universal measure is the so-called maximal oxygen consumption – mVO2.
This parameter, which for decades was only available in exercise physiology laboratories, can now be estimated with sufficient precision by means of popular sports watches or even a simple watch with a second hand.
Like the previously mentioned FFM – mVO2 is a very important medical parameter. It is the most important single known prognostic parameter, i.e. a value that determines the probability of a healthy life.
Contrary to popular opinion, long-distance running is not at all the best way to develop the pulmonary-heart component. Among running disciplines, 400- and 800-metre runners have the relatively highest mVO2 values.
When I was in high school, I trained competitively in athletics, with the 400 m being my crowning discipline. In my ‘SWOT analysis’, I allowed myself to consider my cardio-pulmonary component to be quite good. However, this may not mean giving up endurance training altogether.
MVO2 inexorably deteriorates with age. Maintaining this parameter at a satisfactory level up to advanced age is possible with physical activity performed at an appropriately high heart rate.
It should be borne in mind that intensive training with a high heart rate may increase the risk of adverse cardiovascular events (i.e. heart attacks and strokes).
So how do you get the benefit of increased mVO2 without the risk?
The solution is HIIT (high-intensity interval training). These are short pulses of high-intensity exercise (30 sec to 2 min), optimally with a resistance component, causing an increase in mVO2 much more than moderate-intensity aerobic training (e.g. long-distance running).
It is worth adding that, as with resistance training carried out at home, this means that it can be significantly shortened, thus again saving time.
What can HIIT look like in practice?
Like resistance training, HIIT can be done at home. It is advisable to start with simple exercises with long intervals and, in the following weeks, introduce increasingly complex exercises with progressively shorter intervals.
In my case, the proximity of a popular running path in Wrocław means that sometimes, when the weather is nice, I perform HIIT by running there. It’s 5-6 tempos of 300-400m each, with walking breaks. The whole workout can be completed in 30-40 minutes.
In case of bad weather conditions or an unfavourable smog message (which unfortunately happens quite often), I perform my HIIT from home.
What about traditional sports activities – cycling, skiing, etc.?
Also, of course. It’s just that going skiing is an undertaking, it’s hard to do that several times a week as part of following a systematic physical activity recommendation. Cycling is also generally a seasonal activity.
I prefer not to pursue such incidental activities with too much intensity. This can result in the relative risks outweighing the benefits.
It is not good, after a year of sitting behind a desk, to go skiing in the Alps and pretend to be Alberto Tomba for two weeks.
Both activities, on the other hand, are ideal in the form of family trips, i.e. low-intensity, long-term activities. This is the type of activity that is formally classified as NEAT (non-exercise activity thermogenesis), i.e. spontaneous physical activity. This is the same category as walking to work, climbing the stairs instead of using the lift, etc.
In my case, my favourite seasonal activity is cross-country skiing. This is undoubtedly aided by the possibility of relatively frequent use of the trails in Jakuszyce. An argument in favour is also the fact that the athletes achieving record mVO2 values are precisely the cross-country skiers, including biathletes using only skating technique and, in addition, intervals between shooting.
Relatively frequent visits to Jakuszyce mean that I try to treat year-round training activities as part of my preparation for the season.
Functional training
In addition to the resistance and endurance training mentioned above, a third category – functional training – is important in this preparation.
In cross-country skiing, especially in the skating technique, training for coordination, balance and postural stability is very important (in fitness language, this is known as ‘core’ training).
All the elements mentioned are key to reducing the risk of injury in old age. In this way, in addition to the satisfaction of improving my cross-country technique, I am investing in my health future.
If, in the years to come, I am still able to cover a few hundred metres with a technically correct one-step skate, I will be confident that everything is still OK with my ‘core stability’.
What about motivation?
It may indeed not be easy to stay motivated for years, motivated only by the prospect of doing well into your 80s (or maybe 90s(?)).
For me, that’s completely sufficient, perhaps because I’ve seen enough in my many years of hospital work. Investing in the possibility of an independent and fulfilling life to the end convinces me 100%.
However, it is worth reinforcing this motivation, e.g. by preparing to compete in some competition? For example, in the case of cross-country skiing, to take part in the Piast Race every year.
It’s certainly a good idea, provided we start really well prepared and during the competition itself we are able to “do our thing” regardless of whether 3, 30 or 300 competitors want to overtake us.
The time to break records was in our 20s and 30s, when everyone’s physical capabilities are at their greatest. Competing for the somewhat grotesque-sounding ‘masters junior’ title would certainly not motivate me to put myself at risk of sudden cardiac death. A potential ‘championship title’ would certainly not go down in the history of the sport, a heart attack or stroke in my own medical history – sadly certainly.
This approach may seem unattractive, as there may be nothing to brag about ‘on fey’ and other social media. Short workouts directed at improving one’s own body’s imperfections are a bit like systematic tooth brushing. And even the most outstanding brushing technique can hardly make the news for the “observers”.
However, I highly recommend training yourself to become independent of external opinions about yourself. This is the development of a psychological skill called resilience, crucial for victoriously confronting the inevitable crises of old age.
This by no means means means that I always perform endurance activities at a walking pace. There is a certain optimum heart rate range for each type of activity. For long-term moderate-intensity activity this is usually 60-70% of maximum heart rate, for intense activity such as HIIT around 80-90%.
Determining these ranges is possible based on commonly available formulas, optimally with updates every so often. Of course, I don’t really want to do this.
An alternative is trivially simple and increasingly recommended not only for amateurs but also for off-road athletes. It’s a 10-point RPE (rating perceived exertion) scale, where 1 is the minimum activity bordering on rest and 10 is the maximum exertion imaginable.
In practice, an intensity of “5” means such an exertion at which there is a clear speech impediment associated with accelerated breathing, and “7” – is an activity during which we are unable to say more than 2-3 words between breaths. It is worthwhile to perform prolonged exercise at ‘5’ and short pulses of HIIT training at ‘7-8’.
It is worth ensuring that sometimes even simple walking, e.g. in the “brisk walking” formula, reaches a minimum level of “5”, because then the body “switches” energetically from the predominant use of fats to carbohydrates.
This is crucial for preventing insulin resistance and increasing the chances of survival during health crises, when anaerobic processes play a decisive role.
It is sometimes relatively easier to build and maintain motivation by exercising in a group outside the home. It is certainly a good idea for people without much training experience or knowledge in this area.
Exercising in a group somewhat limits the possibilities to individualise training for each person. Instead, they encourage the exchange of experiences and the maintenance of social relationships. This is certainly important for older people, for whom social isolation can be a threat. For younger people who work with people on a daily basis, spending exercise time alone can be an added advantage.
It is a good motivational idea to periodically compare one’s performance on individual fitness elements with tables, published by sports medicine societies. Confirmation that one’s own achievements place one in the top 10-20% of peers in the world is encouraging and motivating. For me, it is hard to imagine a better realisation of Baron de Coubertin’s idea of true sport than a de facto “race against oneself and one’s weaknesses”.
Author: Dr Sławomir Powierża, cardiologist