Stepping my way to cardiovascular happiness.

The heart specialist recommended exercise as the one single thing that could make a difference to my long term survival. Having been an active person the questions become what sort of exercise and how much to make a valuable difference? 

A doctor to doctor joke goes like this;

 " When you ask a patient how much he/she smokes, double the figure they give you. When you ask a patient how much they drink, triple the figure they give you. When you ask a patient how often they have sex, divide that number by four!"

The point in relation to exercise is you don't want to be delusional about how much exercise you do or don't do. There is no need to kid anyone especially yourself. Furthermore, if you can add facts and figures to any representation you are making to a health professional involved in your care it does two things;
1/ He or she is not making mental calculations as to the validity of what you are saying.
2/ If you are interested in your own health, it makes them feel better about helping you.

Meet the Sports Science SD-PRO 3D pedometer, a beast of a machine when you want to take  measurements and qualify the amount and quality of your exercise. I use it to count the number of steps I take and as I know my stride length, this gives me a good idea of the distance travelled. It will when I get the hang of it also measure the speed at which I walk. 

Two points of digression;
1/ I don't do jogging.I have tried many a time to but it just doesn't fit as an exercise for me. As Winston Churchill once described golf as a great way to ruin a good walk, I think the same about jogging. So I walk and when I do I try to do it with purpose, with vim and vigour, to get the most out of it. When I come to a hill I try to increase my determination and  push myself all the while thinking my thoughts, solving the problems of the world, smelling the breeze, enjoying the wildlife, having a good all round exercise session without it feeling like one.

2/There are two studies I will tell you about shortly but one, the Copenhagen Heart Study defines the states of jogging;

"Light jogging- a slow or average pace, 8km per hour or 5 miles per hour,  three or fewer times per week, less than 2.5 hours total per week. 
Moderate jogging- a slow or average pace, three or fewer times per week, but for 2.5 hours or more per week. 
Strenuous jogging - running at a fast pace, more than 11kph or 7 mph, more than 3 times per week, and 4 hours total per week."

As a good paced walker, I am a moderate jogger by this definition, although generally I walk every day either as part of my exercise or as part of my profession. Even with long legs I could never be strenuous enough to attain 11 kph whilst walking, I will be honest. So if you are not a jogger as I am not, walking is a perfectly valid alternative.

The pedometer is another check on your exercise to ensure you are not fooling yourself and you are getting enough to make a difference to your overall well being and to reduce the chances that you might one day fall down with an "unexpected" heart attack as a result of cardiovascular disease. It always makes me laugh to see or here that. As if people "expect" a heart attack. " Hang on a minute, it's 3 o'clock, I am expecting a heart attack!"

Whilst the slogan of 10,000 steps began as a jingle to sell pedometers, it is recognised by the Surgeon General and the American Heart Organisation as a target for people to get to in order to remain healthy. 10,000 steps equates to approximately 30 minutes of walking per day but when you have a pedometer, you can measure what it means for you.

There does not seem to be a breakdown into how you take your 10,000 steps but I do not count slipper shuffling around the house or the ones required to put the garbage out. The steps that I count are the ones I define as the full monty in order that my stride length and therefore the distance I have travelled is meaningful. Over a four week  period work demanded between 11,000 and 18,000 steps per day. If I added the walking the dogs routine, this added a further 5,000. I was happy I was easily meeting the requirements to perform enough exercise to assist with cardiovascular health.

So why does all this matter?
1/ The heart specialist said it did.
2/ Studies show exercise makes a huge difference to a person's life.
3/Well 1/ and 2/ were so good I don't need a 3/. Thanks you Rik Mayall for that gag.

The conclusions of the Copenhagen Heart Study and also backed up by  a much larger American study looking at over 50,000 exercisers makes interesting reading.

• Joggers who ran 1 to 2.4 hours per week had the lowest risk of mortality, with a significant 71% lower risk of death than sedentary non joggers, the couch potatoes.
• The optimal dose of jogging was two to three times per week. These joggers had a significantly 68% lower risk of death compared with the healthy sedentary group. Even those who ran once per week had a significantly lower risk of death compared with non joggers 
• Slow-paced joggers had a significantly 49% lower risk of death compared with sedentary non joggers. The fastest runners had the same mortality risk as sedentary non joggers.
• More exercise isn't necessarily better in terms of health and longevity. The American study  showed the benefits of running are best accumulated in shorter distances, specifically at less than 20 miles per week. In a later addition to this work it was shown just 5 to 10 minutes of daily running, performed even at very slow speeds, significantly lowered an individual's risk of all-cause and cardiovascular mortality.

I will stick to my walking as it is easy to achieve. I am satisfied I am doing enough to take some responsibility for my own health. I am happy I do not need to become a gym junkie and in fact to become one, may be counter productive. Remember too, walking happens to be  the best exercise to suit me. Exercise comes in many forms, it is the overall duration and intensity that counts. Gardening, vacuuming, cleaning the car, bowling, dancing,swimming and so on are all valid forms of exercise. Just do it but remember to take your pedometer to prove it.

Just a quick note on pedometers. 

1/ The cheap ones are in accurate The model I purchased uses 3D motion sensor technology which really just means it is accurate and does not count bumps and shuffles as steps. It also means that where and how you place it on your body to count your steps does not matter.I did my own accuracy tests when I first tried it out.

2/ I found the reviews on the internet quite confusing and contradictory. I bowed to the knowledge of a helpful shop assistant in the end.

3/ I did not receive any financial incentive to promote the pedometer I mention here. I wish I did so I could get another to replace the one I lost. The next one I buy and I will buy the same one again, I will add my own safety chain. I obviously bumped against something and it was gone. An expensive lesson that is shared with you.

The follow up to my procedure is upon me. I sit and wonder what this visit will bring to my life. My previous appointment saved my life! However I am also cognisant of the fact,  the issue with my heart, a significant narrowing in one of the main arteries feeding the muscles in my heart, was discovered on a whim. The whim was to have some imaging tests on my heart, " as there was nothing to lose," given my family history, as the testing I had been subjected to indicated I was otherwise a fine physical specimen!

So here I am.

Before I get to see the specialist, I have to have more testing so he has all the information as to how I am doing post op. They are a repeat of the ones I had during my initial examination so they are familiar to me but no less daunting.

Daunting is probably a little melodramatic but unless you have had a stress test, bear with me. A stress test is not how a person copes with life. Hey there are prison cells, drink cabinets, divorce courts, methadone treatment clinics, truancy rate data and the like that can show you that one. A stress test is simply being wired up whilst you exercise. The exercise is walking on a treadmill at a designated rate which increases incrementally in both pace and incline over time. The wires inform the person sitting at a computer screen how your heart is performing.

Sounds easy!  If you are used to doing some exercise and watching TV from dawn to dusk is not listed as one of your main interests in life it should be...but it isn't. Maybe it is just me but walking on a treadmill is not natural. You have to hang on for a start which means you can't move your arms, your stance is not right, there is no air moving past you, the noise is irritating, and someone is not only watching you the whole time but talking to you. You are trying to do your best but these distractions do not make it easy.

The wiring up is intimidating and a trifle embarrassing. A very young attractive woman who seems to be about half my height and a third of my age clips things all over my near naked body. Yes fifty shades of  wanting to say " I was once young too you know and I looked great back then not like this weathered drooping soggy old biscuit. Once I could have once written a book adding several new chapters. "Sixty shades of Grey" not fifty,but I digress.

The worst part of this wiring up is when she has to place a wire around my waist and her arms can hardly reach around the circumference with her nose pressed very nearly in my navel. I am glad they are not taking photos as it would be hard to explain this to my wife.

The test starts and it is straight forward enough.

"Okay we are going to increase the speed and increase the incline okay?"

"Fine" and it is but the breathing rate increases. Later the question is again asked,  and  again... and again. I wish I had never started to share my experiences with them about life in the country. I make a note that next time I will ask the questions and listen to their replies.Walking and talking at a leisurely pace is fine but not under exertion. After about eleven minutes we stop. I am breathing a little, sweating a lot and thinking if I could just walk outside on a track say, it would be a walk in the park. Eleven minutes walking to me is just not an issue under normal circumstances but  this is their test under their conditions and it is harder than you think.

Stress ECG-eleven minutes. My pedometer tells me that equates to 1100 steps. My morning walk with the dog is around 5000 steps.

Now I am instructed to lie on my side whilst I continue to sweat and heave. A probe is passed over my chest to look at how my heart is working; an ultrasound.

By the time I am sitting across from the heart specialist I have regained my composure, almost. He checks the results and tells me good news.

"Your heart is performing well. There is no indication of any clots and closing of the stent that we  placed, it all looks good."

"So how long before the other arteries might need some work and what is the rate of restenosis of my stent?"

" We get you in every year to re do what we have done today and that will give us a pretty good idea of how your heart is going. I reckon we have probably bought you another 10 to 15 years before we have to worry."

I want to say that I felt fine before my procedure, I still feel fine, my tests we all good before and now but I still had an underlying problem that was only shown by imaging. I let it pass. Nothing worse than a precious patient.

He continues, " The other narrowings could close quickly or it could take years. There is nothing mathematical in how this all works but if we keep an eye on you regularly..."

"What about my blood results what more could I do to improve these? I have pretty much eliminated salt from my diet, I don't eat processed foods generally, I average around 16,000 steps a day at work, I have reduced my intake of saturated fat, I don't smoke..."

"Exercise is good"

"Can I over exercise?"

He ruminates for a time and says "Not generally and overall more is better."

I ask, " I have been on cholesterol lowering drugs and blood pressure reducing medication for two decades now. Have I just been wasting my money?"

His reply is measured, "If you hadn't been on the drugs this might have happened in your early fifties.
There are many unknowns. We know a lot and we know some things with great certainty but there are many factors and each person is different"

Any doctor who doesn't pretend to know everything has got my vote. I put other questions back in the box and decide to do more investigation of my own. Next time my questions will be more researched and specific.

Living with uncertainty. Isn't that what life is all about?

So I will do my own investigations;

• into exercise, what is good and how much is good.
• into diet.
• into salt intake
• into what else matters
• into what else does not matter

I will learn to cope with uncertainty.