Wednesday, April 30, 2008

Exercise - magic bullet ?

Personal Health

You Name It, and Exercise Helps It

Published: April 29, 2008

Randi considers the Y.M.C.A. her lifeline, especially the pool. Randi weighs more than 300 pounds and has borderline diabetes, but she controls her blood sugar and keeps her bright outlook on life by swimming every day for about 45 minutes.

Randi overcame any self-consciousness about her weight for the sake of her health, and those who swim with her and share the open locker room are proud of her. If only the millions of others beset with chronic health problems recognized the inestimable value to their physical and emotional well-being of regular physical exercise.

“The single thing that comes close to a magic bullet, in terms of its strong and universal benefits, is exercise,” Frank Hu, epidemiologist at the Harvard School of Public Health, said in the Harvard Magazine.

I have written often about the protective roles of exercise. It can lower the risk of heart attack, stroke, hypertension, diabetes, obesity, depression, dementia, osteoporosis, gallstones, diverticulitis, falls, erectile dysfunction, peripheral vascular disease and 12 kinds of cancer.

But what if you already have one of these conditions? Or an ailment like rheumatoid arthritis, multiple sclerosis, Parkinson’s disease, congestive heart failure or osteoarthritis? How can you exercise if you’re always tired or in pain or have trouble breathing? Can exercise really help?

You bet it can. Marilyn Moffat, a professor of physical therapy at New York University and co-author with Carole B. Lewis of “Age-Defying Fitness” (Peachtree, 2006), conducts workshops for physical therapists around the country and abroad, demonstrating how people with chronic health problems can improve their health and quality of life by learning how to exercise safely.

Up and Moving

“The data show that regular moderate exercise increases your ability to battle the effects of disease,” Dr. Moffat said in an interview. “It has a positive effect on both physical and mental well-being. The goal is to do as much physical activity as your body lets you do, and rest when you need to rest.”

In years past, doctors were afraid to let heart patients exercise. When my father had a heart attack in 1968, he was kept sedentary for six weeks. Now, heart attack patients are in bed barely half a day before they are up and moving, Dr. Moffat said.

The core of cardiac rehab is a progressive exercise program to increase the ability of the heart to pump oxygen- and nutrient-rich blood more effectively throughout the body. The outcome is better endurance, greater ability to enjoy life and decreased mortality.

The same goes for patients with congestive heart failure. “Heart failure patients as old as 91 can increase their oxygen consumption significantly,” Dr. Moffat said.

Aerobic exercise lowers blood pressure in people with hypertension, and it improves peripheral circulation in people who develop cramping leg pains when they walk — a condition called intermittent claudication. The treatment for it, in fact, is to walk a little farther each day.

In people who have had transient ischemic attacks, or ministrokes, “gradually increasing exercise improves blood flow to the brain and may diminish the risk of a full-blown stroke,” Dr. Moffat said. And aerobic and strength exercises have been shown to improve endurance, walking speed and the ability to perform tasks of daily living up to six years after a stroke.

As Randi knows, moderate exercise cuts the risk of developing diabetes. And for those with diabetes, exercise improves glucose tolerance — less medication is needed to control blood sugar — and reduces the risk of life-threatening complications.

Perhaps the most immediate benefits are reaped by people with joint and neuromuscular disorders. Without exercise, those at risk of osteoarthritis become crippled by stiff, deteriorated joints. But exercise that increases strength and aerobic capacity can reduce pain, depression and anxiety and improve function, balance and quality of life.

Likewise for people with rheumatoid arthritis. “The less they do, the worse things get,” Dr. Moffat said. “The more their joints move, the better.”

Exercise that builds gradually and protects inflamed joints can diminish pain, fatigue, morning stiffness, depression and anxiety, she said, and improve strength, walking speed and activity.

Exercise is crucial to improving function of total hip or knee replacements. But “most patients with knee replacements don’t get intensive enough activity,” Dr. Moffat said.

Water exercises are particularly helpful for people with multiple sclerosis, who must avoid overheating. And for those with Parkinson’s, resistance training and aerobic exercise can increase their ability to function independently and improve their balance, stride length, walking speed and mood.

Resistance training, along with aerobic exercise, is especially helpful for people with chronic obstructive pulmonary disease; it helps counter the loss of muscle mass and strength from lack of oxygen.

In the February/March issue of ACE Certified News, Natalie Digate Muth, a registered dietitian and personal trainer, emphasized the value of a good workout for people suffering from depression. Mastering a new skill increases their sense of worth, social contact improves mood, and the endorphins released during exercise improve well-being.

“Exercise is an important adjunct to pharmacological therapy, and it does not matter how severe the depression — exercise works equally well for people with moderate or severe depression,” wrote Ms. Muth, who is pursuing a medical degree at the University of North Carolina, Chapel Hill.

Feel-Good Hormones

Healthy people may have difficulty appreciating the burdens faced by those with chronic ailments, Dr. Nancey Trevanian Tsai noted in the same issue of ACE Certified News. “Oftentimes, disease-ridden statements — like ‘I’m a diabetic’ — become barricades that keep clients from seeing themselves getting better,” she said, and many feel “enslaved by their diseases and treatments.”

But the feel-good hormones released through exercise can help sustain activity.

“With regular exercise, the body seeks to continue staying active,” wrote Dr. Tsai, an assistant professor of neurosciences at the Medical University of South Carolina in Charleston. She recommended an exercise program tailored to the person’s current abilities, daily needs, medication schedule, side effects and response to treatment.

She urged trainers who work with people with chronic ailments to start slowly with easily achievable goals, build gradually on each accomplishment and focus on functional gains. Over time, a sense of accomplishment, better sleep, less pain and enhanced satisfaction with life can become further reasons to pursue physical activity.

“Even if exercise is tough to schedule,” Dr. Moffat said, “you feel so much better, it’s crazy not to do it.”



What's On My Other Blogs today: (click blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Wednesday, April 23, 2008

HIGH blood pressure

Personal Health

Hypertension: In Retreat, but Hardly Vanquished

Published: April 22, 2008

As with cholesterol levels, the concept of a normal blood pressure has fallen strikingly as doctors learn what it takes to preserve good health. Decades ago, for example, my brother, Jeff, who had high blood pressure that hovered between 160/80 and 170/90, would have been considered normal.

Lacking good treatments for hypertension, no doctor was concerned when, at age 57, President Franklin D. Roosevelt’s blood pressure was 170/90. And so the president’s blood pressure rose inexorably over the next six years, and on April 12, 1945, at age 63 and with a pressure of 200/110, he died of a brain hemorrhage caused by severe hypertension.

But in 2000, when Jeff was 54, his cardiologist knew better. Now with excellent treatments, most often used in combination, an elevated pressure can be lowered to normal in most people. His doctor said that, with our family’s medical history of three coronaries on our father’s side occurring at ages 56 and 58, something should be done to protect Jeff’s health.

Jeff’s treatment “evolved” until he was taking a daily three-pill cocktail — Diovan HCT, a combination of a diuretic and angiotensin II receptor blocker; Norvasc, a calcium channel blocker; and Toprol XL, a beta blocker. He also works out on a treadmill several times a week, runs up and down stairs at home and at work all day, and eats a mostly heart-healthy diet, including five to 10 servings of fruits and vegetables a day, whole grain breads, nonfat milk and no added salt.

With his blood pressure now at 106/66, the low end of normal, my brother has thus far escaped a premature coronary death.

Hypertension, once known as the “silent killer,” is now not so silent. Through campaigns urging doctors to check patients’ pressure at every visit, most cases have been detected. Although treatment has been prescribed for nearly all people known to have blood pressures consistently above 140/90, now called the high end of normal, up to half of patients still have elevated pressures.

Still a Common Problem

Why? Because doctors are not aggressive and creative in treating the problem; because unlike my brother, many patients do not follow doctor’s orders and fail to fill prescriptions or neglect to take medicine daily; and because the rising weight of Americans and the passion for high-salt processed and restaurant-prepared foods have raised the once-normal pressures of many people to levels that experts say should be treated.

A new report from the American Heart Association describes untreated hypertension as now particularly serious among women. Midsection obesity, an important risk factor for hypertension, is found in 79 percent of hypertensive women as against 64 percent of hypertensive men. About a third of hypertensive women have blood pressure controlled at optimal levels, 120/80 or below.

The problem is particularly common among women taking oral contraceptives, whose risk of hypertension is two to three times as high as that of women their age who use some other form of contraception or none at all.

Hypertension is one of the nation’s most common life-threatening diseases, with an overall incidence among adults of nearly 30 percent, a survey of 14,600 people in 2003 and 2004 found. And as many as 66 percent of people 60 and older have elevated pressures that warrant treatment, the survey showed. An increase in blood pressure with age is common only in developed countries, largely a result of a rich and salty diet, overweight and inadequate exercise.

In the United States, the high incidence of hypertension and its inadequate treatment has helped level off a decades-long decline in coronary mortality. In addition to heart attacks, untreated or inadequately treated hypertension can cause strokes, congestive heart failure, kidney failure and diabetes.

According to a report last May in The Journal of Clinical Hypertension, myths persist. Last year, a national online survey of 1,245 adults with high blood pressure found that many people still thought that hypertension meant being tense or anxious and that about 30 percent of people thought that it could be cured by losing weight, Dr. Marvin Moser of the Hypertension Education Foundation in Scarsdale, N.Y., and Dr. Stanley S. Franklin of the University of California, Irvine, reported.

While weight loss and improvements in diet and exercise habits can indeed help people lower an elevated pressure, “most people can’t adjust their lifestyles enough to normalize their blood pressure,” Dr. Moser said in an interview. “Most people need help from medication, notably a diuretic in combination with one or two other drugs. The majority of patients don’t get their pressures to normal without such a combination.”

Doctors have more than 100 drugs to choose from. If one or two do not lower pressure to normal or cause unpleasant side effects, patients should insist on trying others, Dr. Moser said. Side effects of blood pressure medications are no longer the problem they once were, the doctor said. “In doses now used, more than 90 percent of people experience very few side effects.”

Difficulties of Following a Diet

One problem with a drug-free approach is the difficulty many patients have in adopting and sticking with a diet and exercise program that can significantly lower their pressure. Data from the latest national nutrition survey, described in the Feb. 11 issue of The Archives of Internal Medicine, said that a diet called DASH that effectively lowered blood pressure was poorly followed by people with hypertension. This diet is rich in fruits, vegetables and low-fat dairy products, a mix that provides excellent sources of fiber, potassium, magnesium and calcium. The diet is most effective if it is low in salt, with a sodium intake of about 1,500 milligrams a day.

The widely publicized value of the DASH diet was demonstrated in a major government-sponsored study published in 1997. But the new report found that in the years since, instead of improving, the dietary quality of people with hypertension has diminished.

Still, as my brother’s case showed, even with a good diet, regular exercise and a healthy weight, most hypertensive patients need medication to achieve an optimal blood pressure. And that includes the elderly, who generally do not respond as well as younger people to blood pressure drugs.

“Studies have shown that even a modest reduction in blood pressure is beneficial to the elderly, reducing their risk of strokes, heart attacks, heart failure and death,” Dr. Moser said. “And a new study in the very elderly, people 80 and older, showed that treating hypertension also reduces the overall risk of death.”

In all age groups, “physician inertia is a major problem,” he said, adding, “In 30 percent of patients whose blood pressure remains high despite treatment, nothing is done about changing the medication.”

He urged people whose blood pressure is higher than 140/90 to ask their doctors, “Shouldn’t we be doing something else?”



What's On My Other Blogs today: (click blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Saturday, April 19, 2008

College Costs Plummet !

The (Yes) Low Cost of Higher Ed

Article Tools Sponsored By
Published: April 20, 2008

ON Oct. 2, 2003, board members at the University of Virginia filed into the Upper East Oval Room of the Rotunda, the centerpiece of Thomas Jefferson’s campus design, for one of their regular meetings. As usual, they were joined by the university’s top administrators. Just before the meeting began, a member of U.Va.’s public affairs staff walked over to John T. Casteen III, the university president, to hand him a clipping from that morning’s newspaper.

Skip to next paragraph
Illustration by The New York Times; photograph of Drew Gilpin Faust, president of Harvard, by Tony Rinaldo/Harvard University via Associated Press

Education Life

Go to Special Section »

The clipping described a sweeping new financial-aid program that the University of North Carolina had just announced. North Carolina was going to cover nearly the full cost of any student whose family made less than 150 percent of the poverty level or, for a family of four, about $30,000 in today’s dollars. Students would still have to work 10 to 12 hours a week in a campus job, but they would not have to take out any loans.

At the time, it was one of the most aggressive aid programs at any major university.

The program touched a nerve with Mr. Casteen. The son of a shipyard worker from Portsmouth, in the southeastern corner of the state, he was the first member of his family to attend college. But during his 13 years as president, tuition had risen significantly, as it had at many colleges, and the Virginia campus had become even more dominated by upper-middle-class students. North Carolina’s new policy, which had the potential to lure students away from Virginia, could aggravate the situation.

Before the meeting had ended, Mr. Casteen announced to the room that he wanted the financial-aid staff to come up with a response. He wanted it quickly, he said, and he wanted something bigger than what North Carolina was doing. Four months later, at the board’s next meeting, it approved a plan that was similar but somewhat more generous than North Carolina’s. Making sure everyone had a chance to attend college, Mr. Casteen would say, was “a fundamental obligation of a free culture.”

That same spring, officials at Harvard had been working on their own plan. Three weeks after Virginia’s announcement, Lawrence H. Summers, then Harvard’s president, traveled to Miami to give a speech titled “Higher Education and the American Dream.” In it, he alluded to Jefferson’s views on the importance of educating poor and rich alike, and he decried the paucity of low-income students on college campuses. The punch line came toward the end of the speech, when Mr. Summers raised the bar on North Carolina and Virginia. Harvard would cover nearly the full college cost for any student whose family made less than $40,000.

The financial-aid bidding war at the nation’s top universities was under way.

North Carolina soon expanded its program, to cover 200 percent of the poverty level, or $41,300 today. In 2005, Yale undergraduates occupied the admissions office to demand that their university increase aid, and administrators soon did. The University of Maryland came forward with a plan. So did the Massachusetts Institute of Technology, the University of Pennsylvania and Stanford. In 2006, Harvard raised the bar again, saying parents making less than $60,000 would not have to pay anything toward the cost of their child’s education.

All of these moves focused on low- and middle-income students — an ever-rarer breed at elite universities over the last generation. But in 2007, the bidding war took on a new character: it began to address the concerns of the upper middle class as well. In July, Amherst College announced it would eliminate loans for all students, no matter their income. In December, Harvard — under Congressional pressure, like other wealthy colleges, to spend more of its endowment — introduced a policy under which most families making less than $180,000 a year would receive significant aid. For all but the most affluent 3 or 4 percent of the population, Harvard would be roughly as expensive as many state universities.

Harvard being Harvard, the policy received a huge amount of attention, and set in motion a frenzy that made the previous few years of dueling announcements look leisurely by comparison. Within weeks, Yale went as far as Harvard had, while Bowdoin, Colby, Dartmouth, Haverford, Pomona and others came up with their own — usually less generous — policies.

In less than five years, the entire tuition and financial aid system at the nation’s top colleges has been overhauled. Today, it looks a lot like a highly progressive tax code, in which the affluent are bearing an enormous share of the overall tuition burden. No matter how high the published cost — almost $50,000, typically — these top universities have become significantly more affordable for the majority of students.

It may be the first time that has ever happened.

The changes have not been greeted with a chorus of joy, however. At colleges without large endowments, administrators are worried about the pressure they will face. Some have suggested that they may end up reducing aid to low-income students to compete for more affluent students, who typically have higher test scores and thus help an institution’s ranking in U.S. News & World Report. In the past, these colleges were able to woo some students away from the Ivy League with merit scholarships.

Others say the latest round of changes will not solve the larger issue of economic opportunity raised by Mr. Casteen, Mr. Summers and others. “There is a perception that this has gone farther than it really has,” says Sandy Baum, an economist at Skidmore College who oversees the College Board’s annual report on college costs. “The number of students going to these schools is tiny. It’s not going to make a dent in educational opportunity.” Increases in the federal Pell grant, which typically go to students whose families make less than $40,000, would probably accomplish far more on that front.

Over the last decade, the average net cost of attending a four-year public college — including room and board as well as financial aid, and controlling for inflation — has risen to $9,980 a year, from $7,650, according to the College Board. The average net cost at private colleges has risen to $23,000, from $18,050.

Still, other education experts have pointed out that the new aid policies aren’t always as generous as administrators make them out to be. Some colleges, for instance, have committed to covering only tuition, not room and board, which can be substantial.

All of these concerns may well be valid. Yet it’s still worth taking a minute to consider how quickly — and how much — the recent announcements have actually changed the landscape of higher education.

THIS past November, the admissions deans from Harvard, Princeton and Virginia went on a recruiting tour together. They no longer had to spend the month reading applications, because they had abolished their early-admissions programs. So they hit the road instead, speaking at high schools across Virginia and West Virginia.

One night, they held an information session at a Holiday Inn in the Appalachian town of Bluefield, W.Va. They had sent invitations to about two dozen students and had told guidance counselors to spread the word. William Fitzsimmons, Harvard’s admissions dean, had expected about 45 students and parents to show up, based on previous recruiting trips.

Just three years earlier, John Blackburn, Virginia’s dean, had gone on a similar tour in nearby western Virginia and discovered that few students had heard about the university’s new financial-aid plan. “You can’t just raise the U.Va. flag and expect a lot of low-income kids to come out,” Mr. Blackburn had said after one lackluster night in 2004 at a college fair in Big Stone Gap, Va. Many had assumed U.Va. was simply too expensive, even if financial aid would have made it affordable for them. This assumption, officials say, is one reason the student body at elite colleges has become less economically diverse in recent decades.

But something may be changing. At the Bluefield Holiday Inn, 110 people showed up to listen to Mr. Blackburn, Mr. Fitzsimmons and Janet Lavin Rapelye, Princeton’s dean. “We were blown away,” Mr. Fitzsimmons recalls.

The best explanation seems to be that the flurry of high-profile announcements about financial aid has helped overcome years of headlines about rising tuition. As Ms. Baum of the College Board says, “Low- and moderate-income kids now know that it’s fine to apply to Harvard and Dartmouth and money won’t be an issue. And that’s good.”

The number of low-income students at top institutions is still fairly low but is growing. The share of Harvard undergraduates receiving Pell grants rose to 13 percent this year, from 10 percent in 2003-4. At Amherst, over the same span, the number has risen to 18 percent from 15 percent.

The purest case study may be Princeton. It took perhaps the first step down this road in 1998, when it replaced loans with grants for low-income students. It expanded the program to all financial-aid students in 2001. But other colleges didn’t follow suit. And the policy had only a modest effect on the makeup of Princeton’s student body. Between 1998 and 2005, the share of undergraduates with Pell grants rose to 7.7 percent, from 6.9 percent, says Robin Moscato, the director of undergraduate financial aid. But over just the last two years, with other colleges trumpeting their new programs, the share of Princeton undergraduates receiving the Pell has increased to almost 10 percent.

The elimination of loans is a crucial part of the changes. From a straight economic perspective, this doesn’t entirely make sense: because people with a bachelor’s degree make so much more on average than people without one, college loans are usually well worth their cost. But these benefits come years later, while the costs come immediately — and intimidate many families.

“A lot of students from smaller towns look at the university and they’re like, ‘No,’ ” says Carla Rojas, a senior at North Carolina whose father is a construction worker near Lincolnton, N.C., and whose mother does alterations there. Many students know there are scholarships, Ms. Rojas says, but they figure, “Oh, I won’t get one.”

Replacing loans with grants changes the calculation. Rather than having to persuade would-be applicants that loans are a good investment, recruiters can say the students will graduate debt-free. If anything, Ms. Rojas adds, she wishes North Carolina were doing more to publicize its policy.

Mr. Summers says the ultimate goal should be to repeat the success of affirmative-action policies. Affirmative action has become so ingrained that black students with a given SAT score are more likely to apply to Harvard than white students with the same score, according to a university analysis. High-achieving poor students, however, are much less likely to apply to elite colleges than their affluent counterparts.

Closing that gap will require more than just money. “Increasing financial aid is terrific,” as Mr. Summers says. “But as important or more important is recruitment and the way students are admitted.”

If admissions officers were to give poor students more credit for what they had overcome, colleges would become considerably more diverse. But they would risk angering alumni, whose children would face tougher competition to be admitted. Recruiting more low-income students would also bring a big price tag, because the newly expansive aid policies would then apply to many more students.

It’s easier for college administrators to be generous with financial aid when their campuses don’t have very many poor students to begin with.

THERE are several arguments for increasing economic diversity at elite colleges. For one thing, it makes the universities more consistent with their self-image as meritocracies. In recent decades, as colleges have become more diverse geographically, racially and religiously — changes they regularly celebrate — they have also become less so economically, according to the Higher Education Research Institute at the University of California, Los Angeles.

At the same time that their campuses were becoming more affluent, the colleges have come to play arguably a larger role in American society.

George H.W. Bush, George W. Bush and Bill Clinton all graduated from elite colleges (Yale, Yale and Georgetown). So did Barack Obama (Columbia) and Hillary Rodham Clinton (Wellesley). The number of United States senators and Supreme Court justices with Ivy League degrees has risen in recent years.

Recent research also suggests that lower-income students benefit more from an elite education than other students do. Two economists, Alan B. Krueger and Stacy Berg Dale, studied the earnings of college graduates and found that for most, the selectivity of their alma maters had little effect on their incomes once other factors, like SAT scores, were taken into account. To use a hypothetical example, a graduate of North Carolina State who scored a 1200 on the SAT makes as much, on average, as a Duke graduate with a 1200. But there was an exception: poor students. Even controlling for test scores, they made more money if they went to elite colleges. They evidently gained something like closer contact with professors, exposure to new kinds of jobs or connections that they couldn’t get elsewhere.

“Low-income children,” says Mr. Krueger, a Princeton professor, “gain the most from going to an elite school.”

Given all this, some have argued that Harvard, Yale and other universities are mistaken in giving financial aid to upper-middle-class students rather than using the money to recruit more low-income students. Awarding a $30,000 scholarship to someone whose parents make $180,000 a year doesn’t exactly reduce economic inequality. But it does have two other benefits.

For one, it gives the new financial aid a more solid base of support among alumni. Anthony W. Marx, the president of Amherst, has been talking about the importance of making the college more economically diverse since his inauguration address in 2003. But he says he received more congratulatory e-mail messages after announcing last summer that Amherst would eliminate loans for all students than after any of his announcements about recruiting poorer students.

Expanding the pool of aid recipients may also make the policies more popular among students. It would be rather counterproductive if the children of midlevel corporate executives, who were paying $50,000 in tuition and fees, ended up resenting the children of police officers, who were paying nothing.

The most important issues facing higher education still have relatively little to do with this small group of colleges. Those issues involve preparing more low- and middle-income children to attend college, lifting the graduation rates at community colleges and at four-year colleges that educate large numbers of these students, and simplifying and expanding federal financial aid.

That said, what happens at the country’s best-known universities still matters, both because of their role in society and because of how they shape the discussion about higher education. Yes, the new policies have flaws, and they are likely to make life more difficult for administrators at other colleges. But just imagine if, five years ago, somebody had said that Harvard, Amherst and their peers would soon be using their endowments to reduce costs to almost nothing for most families making less than $60,000 — and to give large scholarships to families making as much as $180,000. Would anyone have argued that this sounded like a bad idea?

David Leonhardt writes the Economic Scene column for The Times.



What's On My Other Blogs today: (click blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/

Wednesday, April 09, 2008

Your Heart Rate

Personal Best

The Flutter Over Heart Rate

Filip Kwiatkowski for The New York Times

Published: April 10, 2008

I have a confession to make. I get so competitive about heart rates when I am at the gym that my husband will not tell me his.

Readers' Comments

Do you monitor your heart rate when you work out? Why or why not? Share your thoughts.

“How was your workout?” I’ll ask when we get off of Spinning bikes or elliptical cross-trainers. He’ll reply that it was good, he worked at “80 percent.” But 80 percent of what? I want to know what he thinks his maximum is. But he won’t say.

Of course, I know it’s ridiculous to think that a higher maximum heart rate means that I’m a better athlete than my husband. He may have a slower heart rate, but he can beat me in cycling any day. And, after all, the goal in exercise is to get more blood to your muscles. The heart does that by beating faster and by pumping more blood with each beat. If your heart is more powerful, it does not have to beat as fast. “There is no association between maximum heart rate and exercise performance,” said Hirofumi Tanaka, the director of the Cardiovascular Aging Research Laboratory and an exercise physiologist at the University of Texas in Austin.

In fact, Dr. Tanaka said, when people start exercising regularly their maximum heart rate often goes down.

And I know that the whole heart-rate monitoring issue is contentious. Many athletes strap on those slender black bands around the chests. Then they try to keep their rate at some percentage of their maximum, 70 percent, say, or 80 percent, depending on their goals for the workout.

For some activities, like using an elliptical cross-trainer or riding most Spinning bikes at the gym, it can be difficult to gauge your effort without a heart-rate monitor. You can’t figure out speed or distance the way you can if you are swimming in a pool or running or cycling outside. Maybe it’s all that sweating, but it always feels as if you’re working hard even when your heart rate tells you that you could do a lot more.

But experts disagree on whether heart-rate monitoring makes sense.

Exercise physiologists tend to favor it. “You need to keep track of exercise intensity” in order to meet performance goals or to improve, Dr. Tanaka said. He does not rely on standard formulas for finding maximum heart rate, though, because they vary so much from person to person. Instead, he advises that people find their maximum “in a field setting.” He suggests going to a track and gradually increasing your speed until your heart rate stops climbing.

Some coaches, like the one who trains Dr. Richard Friedman, 51, a masters swimmer in New York, set their own heart-rate goals for athletes. And, that, said Dr. Friedman, a psychiatrist at Cornell, is a problem. Even though he is one of the fastest on his team, his coach insists that he should hit a heart rate of 150 when he does, say, repeats of 50 meters freestyle in 60 seconds.

“I can never get my heart rate up to his target no matter how hard or fast I swim,” Dr. Friedman said.

Others, like Kevin Hanson, coach to Brian Sell, who just made the United States Olympic men’s marathon team, advise against monitoring your heart rate.

The classic formula for determining your maximum rate, 220 minus your age, is notoriously inaccurate, he said. And glancing at your heart-rate monitor all the time can hinder your training, he cautioned.

“It ends up playing mind games with you,” Mr. Hanson said. “Let’s say you are out for a 10-mile run and you don’t feel tired. Then you look at your heart rate,” and it is so high you decide you must have overdone it. Suddenly, he said, you feel tired and slow down.

Everyone’s maximum heart rate declines, slowly and steadily, with the passing years. So if your heart rate is higher than expected, doesn’t that mean you are exercising like a younger person?

It depends. On the one hand are athletes like Lance Armstrong, known for having an unusually high maximum heart rate. And that, said Edward F. Coyle, an exercise physiologist who has studied Mr. Armstrong, was to his advantage because his heart also was extremely efficient. A high maximum heart rate, helps, “all other things being equal,” Dr. Coyle said. The problem, he noted, is that there are so many other factors in performance that rarely are all other things equal.

So if Dr. Friedman could get his heart rate to 150, wouldn’t he be faster?

Not necessarily. And the story of Rebecca Soni, a swimmer at the University of Southern California, helps explain why. Ms. Soni, who has the second fastest time for an American woman in the 200-meter breast stroke, had an irregular heart beat. At times when she exercised her heart would beat up to an astonishing 400 times a minute.

Instead of making her swim faster, though, her fast-beating heart made her go limp. In 2006, in order to continue competing, she underwent a procedure to destroy heart tissue that was causing her heart to beat so fast.

This suggests two things. First, a faster heart isn’t necessarily better. And, second, hearts can beat much faster than they ever actually beat when most of us exercise. Something slows our hearts down, probably for the good of our performance or survival.

A heart beating at its maximum possible rate may be inefficient, Dr. Tanaka explained. As the heart beats more quickly, there comes a point when there is too little time between beats for it to fill with blood. “For exercise capacity, heart rate is not the issue,” said William Haskell, an exercise physiologist at Stanford University. “The heart has got to be an efficient pump.”

It turns out that the heart rate is controlled by three factors. First is the heart’s own intrinsic rate, how fast it would beat if you cut all its nerves and removed it from the body. The heart’s own internal pacemaker would make it beat roughly 40 to 60 beats per second more slowly than its maximum rate. And, Dr. Tanaka said, the heart’s intrinsic rate declines with age parallel to the maximum heart rate’s decline with age. No one knows why.

The other factors controlling heart rate are the sympathetic nerves, which speed it up, and those that slow it down, the parasympathetic nerves.

When you start to exercise, said Patrick O’Connor, an exercise physiologist at the University of Georgia, the first thing that happens is that the parasympathetic nerves become less active. That makes your heart beat faster. As the intensity of your effort increases, the sympathetic nerves come into play, speeding the heart still more.

But there are complications. Anxiety, for example.

“We had people on treadmills who were getting ready to start,” Dr. O’Connor said. “Their heart rates were 160 or 170.” They weren’t exercising, just nervous, he explained. And when they started to run on the treadmill, their heart rates went down.

There’s a lesson here, of course, for runners who use heart-rate monitors during a race. Be careful about interpreting those numbers.

Then there are the differences among sports. Swimmers, for example, have lower heart rates when they swim than runners when they run. The reason, Dr. O’Connor explained, is that during running, your heart has to push blood against gravity to bring it to your head. During swimming, your heart does not have to exert that extra force.

Maybe Dr. Friedman should tell his coach.

As for my husband, he knows that my fixation on whose heart rate is higher is ridiculous. Still, I wish I knew what he thinks his maximum is and how he knows it.



What's On My Other Blogs today: (click blog name to go there) = / 1.3rd Eye Blog / 2. Favorites Blog/ 3. Vita Excolatur (Living Well ...) Blog/ 4. Humor Me Blog/ 5. News and Current Events Blog/ 6. Consider This ... Blog/ 7. Consumer Warnings Blog/ 8. New Orleans Pentimento Blog/ 9. We Constant Gardeners Blog/ 10. Chaillot Family Blog/