HEALTH MATTERS: For most people, exercise is safe and beneficialQ. I’m a healthy 50-year-old who has decided to start exercising. How do I best monitor my status so I don’t overdo it?
Q. I’m a healthy 50-year-old who has decided to start exercising. How do I best monitor my status so I don’t overdo it?
A. While exercise is usually recommended for most of us, it is important to be sure you really are well enough for exercise. Before starting an exercise program, I recommend that middle-aged or older people first discuss their exercise plans with their health care providers. In some cases, a stress test is performed first if there is a concern about individuals at higher risk. But for most people, exercise is safe and beneficial.
The key to any successful exercise program is to start slowly and gradually increase the level of exercise. We usually recommend at least 150 minutes a week of moderate exercise, or at least 75 minutes a week of vigorous exercise. Once you are actively exercising, 30 minutes a day of moderate to vigorous exercise for five days a week is a good program.
A nice way to monitor how you’re doing is to use a heart rate monitor. Your resting heart rate should be between 60 and 75 beats a minute or so, although younger and more conditioned athletes often have rates less than 60. You can roughly estimate your maximum heart rate by subtracting your age from 220. So for you it would be 170. But most training occurs at submaximal heart rates, so we usually aim for somewhere between 50 and 85 percent of the maximum value.
When you first start exercising, I’d recommend keeping your rate at from 50 or 60 percent of maximum (85 to 102 beats a minute for you), and then gradually (over a few months) work up to a maximum exercise rate of 85 percent (145 beats a minute for you). Good luck with your exercise program. And remember to warm up before and stretch after you exercise.
Q. I recently had a successful elective surgery performed. I was surprised because the surgeon did not order any preoperative blood tests, an electrocardiogram, or a chest X-ray. I thought that these are all part of the standard workup and preparation before surgery. Am I mistaken?
A. You are quite correct to suggest that this type of testing used to be standard before surgery, but not any longer. Why? Because the tests cost money and usually are normal in otherwise healthy, low-risk patients. Now that’s not to say I wouldn’t order clotting studies preoperatively for someone who has had bleeding problems in the past, for example, or a potassium level for someone on diuretics (which can deplete potassium from the body and lower the level).
However for most people, the benefit of tests in this setting is too low to justify their cost. In medicine, we are increasingly focused on high-value testing, where value means the net benefit (benefit in excess of possible harm) of the test or procedure is large enough to counterbalance and outweigh the cost. Another example of generally low-value testing is performing routine exercise stress testing for coronary artery disease in asymptomatic, low-risk individuals. I am glad everything went well with your surgery.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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