Git along little dogies.

--From an Old West folk song

Carole, a college professor in her sixties, came to her initial consultation colorfully dressed but quite downhearted--literally and figuratively. Her heart had begun to fail seven years before, requiring increasingly stronger drugs to keep it under control. Then she was diagnosed with Type II (non-insulin-dependent) diabetes, which required another medication for blood sugar control. To top that off, she was 95 pounds overweight. She handed me a list of the 12 medications that she was taking: two heart drugs, three diuretics, and an assortment of other medicines.

An intelligent woman, she was perplexed. "Dr. Smith, the doctors I see at the HMO don't seem to have any overall plan to get rid of this. They just keep giving me more medicines, and every time I go back they tell me I have to stay on these for the rest of my life. I don't want to take all these drugs. I want to get well, get off of the drugs, and get on with my life."

Her previous doctors had diagnosed Carole with cardiomyopathy (a heart muscle disorder), high blood pressure, diabetes, edema (fluid accumulation), kidney failure, and hypothyroidism. But the one condition they missed--the one that had gone unaddressed and would surely kill her--was couch potato-ism. Her activity level was virtually nil, and her excess weight reflected this. She was consuming far more calories (mostly from junk foods) than she was burning off, thus accumulating the extra weight that was putting an excessive burden on her heart and slowly robbing her of her health.

We could address the heart problems and diabetes naturally with a combination of nutritional supplements, acupuncture, and other natural therapies. What Carole desperately needed, however, was an exercise program. Without one, she would never truly get better.

Though she was curable, Carole had been given the impression that she was terminally ill. Her doctors prescribed increasingly stronger medications with the admonition that she'd have to take them until she died. Predictably, this robbed Carole of any hope and gave her the feeling that she was indeed dying. One by one, the specialists had instituted appropriate mainstream treatments for the various diseased organs--the failing heart and kidneys, the diabetic pancreas and liver--but none had looked at the larger picture of her overall lifestyle. Carole's inactivity was killing her, plain and simple. An exercise program would be her only cure.

I explained to Carole how exercise would affect each of her health problems and why it would work when even the best drugs had failed. She agreed to gradually increase her level of activity, following a program that we would develop together.

She stuck with it, and the results were nothing short of miraculous. As expected, progress was slow. Success was measured in terms of small accomplishments rather than meeting perhaps unrealistic goals. After six months, Carole was able to get rid of half of her medications. After a year, she was 25 pounds lighter, she was off almost all of her medications, and she felt like she was getting her life back. Her heart was healing. Her blood sugar was returning to normal. She was right on track for getting back to her ideal weight in three or four more years. We'd come this far together, and we both knew she'd make it.

A Natural Elixir

Why did this approach work when the best pharmacological treatments held little hope for a normal life for Carole? Because her exercise program did things drugs cannot do. It healed her heart, lowered her blood pressure, and brought her cardiovascular system back from the edge of collapse. It was controlling her diabetes by correcting her body's insulin response. It strengthened her immune system and restored her endocrine (hormone) system. And the exercise-induced release of growth hormone, endorphins, enzymes, cytokines, and other healing chemicals helped her feel so much better that she found it easy to stay on the program.

The health benefits of exercise are legion. It is just as important to your Anti-Aging Program as to Carole's treatment program. The human body is designed to be active, and things just don't work right if it isn't. With regular exercise, the body produces an array of age-retarding chemicals. Production of antioxidants, anti-aging hormones (especially age-reversing growth hormone), immune factors, and other age-retarding biochemicals is enhanced. Renewal is promoted. Regular exercise will lower your blood pressure and heart rate and slow down age-related bone deterioration while strengthening the arterial, neuromuscular, endocrine, and immune systems. A program of regular workouts, as described in the following pages, dramatically reduces your risk of death from degenerative diseases. The same Renewal enhancement that literally saved Carole's life can prolong yours, too.

Inactivity Is to Die For

Question: What's twice as likely to kill you as a high cholesterol level?

Answer: A sedentary lifestyle.

Inactivity is a luxury that those who would like to live longer (not to mention look and feel better) just plain can't afford. As a result of several decades of research examining lifestyles, certain risk factors have been identified as associated with increased probability of death from heart disease. These risk factors include high cholesterol, high blood pressure, obesity, diabetes, smoking, and sedentary lifestyle.

In a huge, federally funded study of more than 55,000 people, researchers at the Centers for Disease Control and Prevention examined risk factors with respect to exercise. They found that couch potatoes are more likely to die from heart disease because of their inactivity than because of any other risk factor, including high cholesterol. An inactive lifestyle was defined as one that does not include at least 20 minutes of vigorous physical activity three times a week. Amazingly, a vegetative behavior pattern was twice as likely to shorten life span as its closest competitor, elevated cholesterol.

Much research evidence, not to mention common sense, supports the notion that inactivity shortens life span. When researchers divided rats into two otherwise identical groups and gave one group access to an exercise wheel while depriving the other, they found that the exercised rats lived considerably longer: 19 percent longer for the males, and 11.5 percent for the females. Presumably, these rats had no added incentive to exercise other than the presence of the equipment.

How many of us have, in a moment of pure motivation, purchased that exercise cycle, stairclimber, or treadmill--the one that's now collecting dust and creating seemingly endless guilt? Rodents aside, many of us humans apparently do need motivating factors that go beyond the mere joy of exercise--like fear of flab, or the intellectual knowledge that you will be healthier.

Okay, big deal. So rats who work out live longer, I hear you saying. What about humans? There is no reason to believe that rats are any different than humans . . . when it comes to exercise, that is. But for those humans who prefer human studies, a Finnish study of 7,700 men and women found that those with low levels of physical activity had four times the death rate (that is, they were four times as likely to die in any given year) as those in the high activity group.

Further, a study examining the lifestyles of more than 4,000 healthy men, published in theNew England Journal of Medicine, concluded that "a lower level of physical fitness is associated with a higher risk of death from coronary heart disease and cardiovascular disease in clinically healthy men, independent of conventional coronary risk factors."

A Body in Motion Lasts Longer

The more physically fit you are, the longer you will live, concludes the largest study yet to examine the effects of fitness on life span. More than 13,000 men and women were followed over an 11-year period at the Institute for Aerobics Research in Dallas. Each participant received a fitness score (low, moderate, or high) based on how long he or she could keep walking during a treadmill exercise test. All were followed for several years. To make sure participants were capable of fitness and not likely to die of a preexisting disease, only healthy people were allowed into the study.

The results: The least physically fit people were three times more likely to die (of all causes) during the study period than the most fit. And the least fit were eight times more likely to die of heart or cardiovascular disease than the most fit.

Why does a sedentary lifestyle shorten life span? There are many answers to this question, and I'll get to them later, but we must start with the cardiovascular system. Aging happens faster--much faster--if your body isn't properly fed. We were designed to move, and if we don't, the heart and blood vessels get lazy and weak, and they literally shrink. Their muscular walls atrophy, and the capillary beds get smaller, so each supplies a smaller area. Exercise is like the road crew for your vascular highway system. Activity tells blood vesssels to heal, stay strong, and to be prepared to carry some heavy traffic. If they fall into disrepair, the vessels can't deliver the stuff (nutrients, hormones, enzymes) your cells need to Renew. Literally every organ, tissue, and cell in your body is dependent on the blood vessels. If they are sick, you are sick. Exercise keeps them healthy.

Nowhere is the old adage "use it or lose it" more true than when applied to physical conditioning of the heart and blood vessels. Most of us don't think of blood vessels as muscular, but they are. Our bodies contain thousands of miles of blood vessels, the walls of which contain tiny muscles.

Unused muscles in any part of your body become loose and flabby. If they happen to be in your belly, the result of your sedentary lifestyle is merely poor appearance. When those teensy little muscles in your arteries go without exercise, though, they become flabby and clogged, and you have much more than a cosmetic problem. You have a roadblock to Renewal, because the nutrients can't get to where they are needed, and metabolic debris can't be properly removed.

The bottom line with exercise and life extension is this: A body can be no healthier than its cardiovascular system. It comes down to a simple matter of distributing supplies and removing waste. The supply side is the arterial network, which provides nourishment to all tissues and organs in the form of blood carrying oxygen, amino acids, glucose, vitamins, and a wealth of other healing and nourishing substances needed for cellular renewal. The veins are your waste removal system, which drain away the cellular garbage generated by trillions of cells buzzing with metabolic activity. (The waste goes primarily to the liver and kidneys, which excrete it.)

To understand why couch potatoes tend to have shorter life expectancies, imagine a large city under siege, in which the food supply routes have been cut off by 50 percent. (We're talking about atherosclerosis, weak arterial muscles, a flabby heart, and impaired circulation.) Gradual starvation would ensue. Imagine further that half the garbage removal personnel went on strike. Now we would really have a mess on our hands. Like the city under siege, a body slowly starved and then forced to wallow in its own excrement just can't survive for long.

Below I discuss the three keys to a successful exercise program: aerobics, strength training, and stretching. Each is important, but aerobics stands out because it alone provides critical cardiovascular conditioning. You can--and should--train for strength and stretch for flexibility, but without those aerobic workouts, you won't add much to your life expectancy.

The Role of Exercise in Renewal

At the risk of pushing the limits of redundancy, I'll say it again: Exercise buffs up your circulatory system, so more nutrient-rich blood can access more areas of your body. Your body will have developed that more-powerful heart and those sleek, muscle-bound jumbo vessels to service those large, hungry, churning leg and trunk muscles. But guess what? From brain to big toe, the entire body, literally every cell, is the beneficiary of this abundance. Protection is strengthened, repair is more rapid. Healing is enhanced and accelerated. Let me share some examples.

The brain can send and receive nerve and hormone signals faster. The hypothalamus gland (which regulates hunger, thirst, and sex drive) and the pineal gland (which regulates sleep and waking, stress, and immunity) can send out more accurate signals to the rest of the body, which can respond more promptly and effectively to them. The thyroid and adrenal glands, which regulate metabolic activity levels, can make sure you have enough energy. The digestive organs will digest, absorb, and deliver nutrients better. The liver can process blood with greater efficiency, and the kidneys use the extra flow to clean house better. The hormones of the endocrine system go to their target tissue destinations more rapidly and give more appropriate feedback messages. I could go on and on, but you get the point: Everything works better.

Now let's look at some specific benefits of exercise.

Enhanced antioxidant activity. Since exercise, by raising the level of metabolism, is known to cause increased free radical production, one might reasonably wonder--especially after all the negative comments I've made about free radicals--how this could be desirable. In a scenario similar to that with the blood vessels that rise to the occasion, exercise also teaches your body to expect more radicals. Even when you are not exercising, the added antioxidant protection remains, so you have better overall long-term protection. This is attested to by the following study.

In mice given voluntary wheel training (the rodent equivalent of a treadmill), levels of all three internally produced free radical scavengers (glutathione peroxidase, catalase, and superoxide dismutase) increased, while antioxidant protection (as measured by lower levels of oxidized fats in the blood) improved. These findings show that even though exercise increases free radical production, it simultaneously trains the body to improve its free radical scavenging capacity, ultimately improving antioxidant protection. This added capacity for reduction of free radicals adds another dimension to Renewal, and it provides yet another mechanism to explain the anti-aging and life-extending effects noted for regular exercise in humans.

Beefed-up production of anti-aging chemicals. To me, two of the most interesting effects of exercise are that it encourages our bodies to produce more of certain powerful anti-aging chemicals, among which are human growth hormone (HGH) and L-glutamine.

Growth hormone is a potent anti-aging hormone made by your pituitary gland. Though pricey, it is widely administered by anti-aging physicians as a rejuvenative. You can increase your supply of growth hormone for free simply by working out.

The other substance, L-glutamine, is the most prevalent amino acid in the body. It is manufactured by the muscles, and the more muscles you have, the more of the chemical you make. L-glutamine is necessary for optimum immune functioning, and higher levels are associated with both increased immunity and longer life. Thus a powerful connection exists between the atrophying muscles and weakened immunity of old age. With regular strength-training exercises, you will maintain greater muscle mass, which increases L-glutamine production, improves immune system health, and reverses aging.

Better brainpower. Your ability to think, concentrate, problem solve, process information, and remember depends on healthy brain cells. Flabby, cholesterol-laden, clogged-up arteries can't deliver oxygen and nutrients to brain cells, which weakens them and accounts for the gradual faltering of thinking power that is characteristic of aging. When brain cells starve, they can't generate and carry electrical signals as fast, which slows thoughts and blocks access to memory.

Exercise age-proofs the brain by improving the health of the brain's blood vessels, which, when kept vitalized, are then able to continue to properly nourish the brain itself and efficiently remove carbon dioxide and other waste matter.

Augmenting the brain's rations of oxygen- and nutrient-rich blood improves information-processing capability, memory, concentration, and virtually all other aspects of mental performance.

Though all of the nutrients play a role in brain health and Renewal, the most important ones are the B-complex vitamins (especially B₆, B₁₂, choline, riboflavin, and thiamin) and vitamins C and E; the minerals calcium, magnesium, manganese, potassium, and zinc; and the amino acids carnitine, glutamine, phenylalanine, taurine, tryptophan, and tyrosine. A compromised cerebral blood supply would also impede access to the brain by acetyl-L-carnitine, coenzyme Q₁₀, garlic, ginkgo, ginseng, phosphatidylserine, pregnenolone, and other brain nutrients. Suboptimum supplies of these nutrients encourage the development of senile brain disease, the symptoms of which are subtle and insidious at first, but later gather momentum: forgetfulness, disorientation, and confusion.

One group of researchers demonstrated the power of exercise to improve mental vigor in a group of previously sedentary 55- to 70-year-olds who were put on a program of brisk walking. Striking increases in short-term memory, ability to reason, and reaction time were observed in virtually all of the participants.

Those who achieved aerobic fitness showed the most improvement. A host of similar experiments has been done, showing improved brain function with exercise.

Quicker reflexes. The benefits of physical activity go way beyond the brain. Exercise is a general tonic for the entire nervous system. Physically active people have quicker reflexes than sedentary types. And remarkably, aerobic exercise speeds up those delayed reaction times that "normally" occur with aging. Maybe membership in a fitness club should be a prerequisite for driver's license renewal after a certain age?

Improved mood. Ever wonder why you feel so darn good after a workout (and generally, when working out regularly)? Or why you no longer feel like the beach wimp in those Charles Atlas ads (you know, the guy who always got sand kicked in his face)? Or why some people seem addicted to exercise?

It's because a workout tells your cells to synthesize the natural (and legal) opiate beta-endorphin. This biochemical is structurally and pharmacologically similar to morphine: It reduces pain, stimulates feelings of well-being, and supplies a natural high.

Elevated endorphins explain why physical conditioning relieves depression, lowers anxiety levels, and increases self-esteem. Fit people feel (and are) more relaxed and self-assured, have fewer mood swings, less fatigue, and improved sleep patterns. So exercise not only helps you stay young longer, it helps you feel younger. In my medical practice, I often prescribe regular exercise for depression and insomnia. The results are so uniformly successful that I have come to regard exercise as one of the best tranquilizers and antidepressants there is.

Stronger bones. Bones need calcium. Physical inactivity causes osteoporosis, the loss of calcium that makes bones brittle and fracture-prone. An individual confined to bed will lose up to 4 percent of bone mass within a month.

A few years ago, on the evening news, we witnessed the return to earth of a Soviet cosmonaut who had been stranded in space for almost a year because the Soviet Union and its space program had disintegrated while he was away. Although certainly a paragon of physical fitness prior to his departure, through inactivity his musculoskeletal system had so weakened that he was unable to stand unassisted when removed from his capsule.

This was a dramatic demonstration of the necessity of weight-bearing exercise to maintain health.

Like the cosmonaut (though not so dramatically, because we live in a gravitational field), if you lead a sedentary lifestyle, your bones will gradually weaken. Bones respond to regular weight-bearing exercise by taking on more calcium, thus adding strength. In other words, when it comes to bones, you either use them or lose them.

Protection against cancer. Virtually every study examining the link between cancer and exercise has confirmed the notion that exercise helps prevent cancer. No one is sure why, though, which gives us license to theorize. My theory is that in fit people, blood-borne antioxidants and immune cells can better penetrate to areas where cancer might be gaining a foothold, reversing it before it expands to irreversibility.

Exercise specifically reduces colon cancer risk. How? Regular activity and toned abdominal muscles massage your intestines, stimulating the peristaltic action that produces increased frequency and regularity of bowel movements. When the bowels are sluggish, carcinogens in the stool sit around and irritate the intestinal wall, eventually causing cancer there. Exercise in combination with a high-residue vegan diet will be far more effective at preventing all types of cancer than exercise alone, however.

Blood sugar regulation. Exercise helps control diabetes and hypoglycemia in people like Carole by increasing the efficiency of carbohydrate utilization. This improves blood sugar control and decreases insulin requirements by making insulin work more efficiently. In fact, Type II diabetes will always be helped just by exercise.

Weight loss and maintenance. Exercise is essential for healthy weight control. Exercise reduces body fat but also turns up your metabolic thermostat, so you're burning extra calories up to 15 hours or more after you have stopped exercising.

Aerobic Exercise: The Best for Longevity

Based on exercise type, who would you expect to live longest: Arnold Schwarzenegger, Mikhail Baryshnikov, or Carl Lewis?

Though the number of ways to exercise your body approaches infinity, experts generally recognize three aspects of any fitness regimen. The first is strength: how heavy a weight you can lift. (Think of Schwarzenegger here.) The second is flexibility: well-stretched muscles, ligaments, and tendons move smoother and with greater range of motion (Baryshnikov). And third is endurance: the ability to exercise over a long period of time (Lewis).

Although each of the three elements of fitness is important, endurance is clearly the champ in terms of Renewal and a longer life. Aerobics has been proven to lengthen life expectancy, while the other two types, weight training and stretching--though vital components of an exercise program--have not.

Specifically, cardiovascular endurance, unattainable without aerobics, is the most potent anti-aging weapon in the exercise arsenal. So it is important to make a distinction between long-term aerobic endurance training and non-aerobic exercises.

Now the correct answer to my riddle is obvious. It's Carl Lewis, because his exercise form emphasizes endurance over strength and flexibility. Obviously, there is some overlap among these three. A stronger body, for example, will have greater flexibility and endurance; endurance training increases strength and flexibility.

At the start of any exercise, there is enough oxygen stored in the muscles to supply the temporarily increased demand. This, then, is anaerobic exercise, because it requires no additional oxygen. About three minutes into a workout, when your reserve oxygen supply is exhausted, the aerobic form of exercise kicks in. Forced to consume extra oxygen, you begin to huff and puff to extract more oxygen from the air. Your heart begins beating harder and faster, and your blood vessels dilate to carry more blood. The exercise has now become aerobic.

With aerobic exercise you strengthen several kinds of muscles. Your heart is obviously a muscle, and increasing its work load strengthens it. But what about your lungs? Are they muscles? No, but they are surrounded by muscles that force them open and shut to pump air like a bellows. Aerobic exercise strengthens these respiratory muscles. And finally, there are the muscles in the walls of your blood vessels, which also get larger.

Your blood vessels also do something else that's interesting: They multiply. With regular aerobic exercise, you are conditioning your vascular system to expect extra loads and to improve its efficiency. Like adding new lanes and even new side streets to a freeway system, your body's far-flung network of blood vessels grows, forming a thicker network of supply lines. Through a process called vascularization, new networks of vessels grow into all the muscles in anticipation of the next aerobic workout. Your heart, respiratory muscles, skeletal muscles, and even the muscles in the walls of the blood vessels (which are supplying blood to all those other muscles) get extra supply lines. Your payoff for those workouts is a body that has made great leaps in efficiency of operation.

Aerobic exercise is any activity that involves repetitive muscular movements and that raises heart rate to 75 to 80 percent of its maximum for at least 20 minutes. (I recommend 30 minutes.) Although there are many types of aerobic activity, running, jogging, brisk walking, cycling, aerobic dancing, and swimming are the most popular. Aerobic exercises develop cardiovascular endurance, rather than speed, strength, or flexibility. The common goal of all aerobic exercises is to increase the rate at which oxygen is processed by the body. This is called aerobic capacity. The Big, Bad Wolf has nothing on you: If you're huffing and puffing, you're in the aerobic zone.

Physicians and fitness specialists agree that although stretching for flexibility and weight training for strength have their places, aerobic exercise is the most important type of exercise in any fitness program. Other exercises like stretching, toning, weight training, movement, dance, and yoga will lift your spirits, improve neuromuscular coordination, develop specific muscle groups, develop strength, and/or remove flab from unwanted areas like buttocks and bellies. But these can't impart the powerful life-extending properties offered by aerobics, because they don't require the sustained heart rate elevation necessary to develop collateral vessels. Non-aerobic exercises are important, too, but not as a substitute. Aerobics is the sine qua non for life extension.

The Benefits of Aerobic Activity

A regular, moderate aerobic workout cures depression, improves self-esteem, and elevates mood. It gives you increased energy, stamina, and agility. On a metabolic level, it stabilizes your blood sugar levels, reduces cholesterol, and improves fat metabolism. By strengthening the heart and arteries and reducing blood pressure, aerobic exercise dramatically reduces your chances of succumbing to a heart attack, and so provides added protection against those nasty cardiovascular degenerative diseases that kill three out of every four people. By increasing your overall metabolic rate, aerobics improves biochemical functioning of the body, rendering it more resistant to disease.

Endurance conditioning makes for strong, sturdy bones by halting the loss of bone mass responsible for the osteoporosis that plagues so many older people. It strengthens the entire body, stimulates the immune system, assists in weight control by reducing appetite and burning off extra calories, relieves constipation, reduces stress, cures insomnia, quickens reflexes, and helps you look and feel younger.

All this, and it's free, too--or at least not very expensive. Unless you feel you need designer athletic wear to perform at your very best, that is.

Pump Up Your Heart Muscle

As mentioned above, aerobic exercise strengthens the heart muscle, allowing it to pump more blood per beat and thus to circulate more blood with fewer beats. Because it can do the same work at a slower rate, your heart can rest longer between beats, which allows it more time to replenish its oxygen and nutrient supplies. A rate reduction of only 10 beats per minute--easily attained on a moderate exercise program--adds up to 14,400 fewer beats per day, and 5,256,000 beats per year. So, paradoxical though it may seem, increasing your activity level actually rests your heart. Bottom line: a happy, efficient heart which will keep on ticking a lot longer.

Aerobics improves the blood lipid picture by increasing protective high-density lipoprotein cholesterol levels, while decreasing low-density lipoprotein cholesterol and triglycerides, all of which are associated with decreased risk of hardened arteries and cardiovascular disease. Regular exercise increases your body's efficiency at processing fats, so that rather than sticking around and plastering themselves to the insides of your arteries, they are rapidly eliminated, lowering your risk of vascular disease. Exercise's fat-lowering effect is independent of the amount of fat eaten at any given meal, which, in any event, should be kept at a minimum.

And, as if all that weren't sufficient, aerobics also augments the body's ability to dissolve blood clots in the arteries, further reducing the risk of heart attack and stroke.

Diet Counts, Too

Although prevention is clearly preferable, there is also hope for those whose hearts are already giving them messages that all is not well. A person who has angina or who has had a heart attack can still benefit from aerobic exercise. Experiments in which dye was injected into the coronary arteries revealed that regular exercise can slow down the development of coronary artery disease. Of course, strict supervision is crucial here: For individuals whose cardiac function is already compromised, there is an extremely fine line between too little exercise and too much. The postmyocardial infarction patient must be careful not to overexert his unconditioned heart muscle. This situation requires supervision by a physician trained in exercise physiology.

If you are among those who believe that exercise can compensate for a high-fat diet, excess sugar consumption, alcohol use, or other dietary transgressions, please disabuse yourself of this notion now. As good as it is for you, exercise alone will not protect you from heart disease.

Consider the tragic case of James F. Fixx, author of The Complete Book of Running, one of the most successful books on the subject. The premier running advocate, Fixx practiced what he preached: He ran 80 miles per week for the last 15 years of his life. Fixx's arteries were blocked with atherosclerotic plaque, but so strong was his belief that exercise (and the collateral circulation it generates) would protect him that he ignored expert advice about lowering the fat content of his diet. This recommendation emanated from, among others, Nathan Pritikin, director of the Pritikin Longevity Center in Santa Monica, California.

Fixx figured that the American Heart Association's diet, which limits fat intake to 30 percent of calories and cholesterol to 300 milligrams daily, would protect him. But the seven-year, $115 million, 12,000-person Multiple Risk Factor Intervention Trial (MRFIT) resoundingly demonstrated that there is no difference in total deaths between the American Heart Association's 30 percent diet and the higher-fat standard American diet. Others have shown that for meaningful protection you have to get fat intake down to 10 percent.

Like many runners, Fixx also thought that he could "run through" his coronary blockage, healing it in the process. For this miscalculation, Fixx paid the ultimate price: He died of a massive heart attack while running alone on a country road in Vermont.

In his 1985 book Diet for Runners, Pritikin described a conversation with Fixx: "About six months before his death this year, Jim Fixx phoned me and criticized the chapter 'Run and Die on the American Diet' in The Pritikin Promise. In that chapter, I documented my thesis that running is not protective against heart disease. I said that many runners on the average American diet have died and will continue to drop dead during or shortly after long-distance events or training sessions. Jim thought the chapter was hysterical in tone and would frighten a lot of runners. I told him that was my intention. I hoped it would frighten them into changing their diets. I explained that I think it is better to be hysterical before someone dies than after. Too many men, I told Jim, had already died because they believed that anyone who could run a marathon in under four hours and who was a nonsmoker had absolute immunity from having a heart attack."

Allow me to burst the bubble on a couple of other common misconceptions. First, a normal electrocardiogram (EKG), coupled with a running program, is no protection against a heart attack. Coronary vessels can be significantly clogged, and the EKG--even a stress EKG--can be normal. Another delusion is that a high level of HDL cholesterol can protect you from a heart attack, especially if you work out. It won't, and many are those who've lost their lives by mistakenly adhering to this belief. A high HDL can be achieved through healthy activities like exercise, or unhealthy ones, like drinking. Normal levels are 30 to 60 milligrams per deciliter of blood. Fixx's was an incredible 87 milligrams per deciliter.

Heart disease can be reversed by adhering strictly to the Renewal Anti-Aging Program. The only hope for meaningful long-term prevention or reversal of coronary vessel disease is the Renewal approach: a low-fat vegetarian diet, nutritional supplements, and a program of daily aerobic exercise. In fact, Dean Ornish, M.D., founder and director of the Preventive Medicine Research Institute in Sausalito, California, has demonstrated reversal of coronary artery lesions in patients who adhered to a strict regimen that included exercise, a low-fat, high complex carbohydrate, vegetarian diet, and a stress management program.

Anything Can Be Aerobic (Well, Almost Anything)

Because they're inherently ideal for sustained activity, walking and jogging are the best forms of aerobic exercise. But they're not for everyone. It's important to find an exercise you enjoy, because that's the one you'll be most likely to stick with. The only real requirement is that your exercise be a daily aerobic workout of 30 minutes at your target heart rate. Certain sports, like baseball, bowling, golf, horseshoes, and volleyball, are difficult to turn into an aerobic workout. This is because the nature of these activities is inherently intermittent and therefore the sustained activity level requirement is difficult or impossible to meet. (Can you imagine a horseshoe game in which your heart rate would go over 100 for 30 minutes?)

But any activity, done vigorously enough to satisfy the sustained heart rate requirement, would qualify. Here is a real opportunity to be creative. For example, I have attained and sustained my target rate for 30 minutes, at various times in my aerobics career, by pushing a stroller with a baby in it, jogging in place in front of the television while watching half of 60 Minutes, and even pushing a lawn mower. However, most days I either run three to five miles or swim for 30 minutes.

Aim for the Target

For any exercise activity, heart rate is the best indicator for determining whether the activity is vigorous enough to qualify as aerobic. A generally accepted norm is that your exercise should raise and sustain your heart rate to 70 to 85 percent of your maximum rate for at least 20 minutes.

The formula for determining your maximum and target heart rates is as follows: First, determine maximum rate by subtracting your age from 220. (My age is 55, so my maximum rate is 165.) But you don't want to exercise flat out at 100 percent maximum--that would do damage very quickly. The experts have therefore determined that 70 to 85 percent of maximum is best. So multiply your maximum rate by 0.70 and 0.85 (or use the chart that follows) to determine your target heart rate range. Mine is: 0.70 3 165 = 115 (the low end) and 0.85 3 165 = 140 (the high end).

When I exercise, I stop occasionally to take my pulse rate, and if it's below 115, I pick up the pace a bit. Actually, I aim for the middle of my target range, which is about 130. Because my tendency (and most likely yours as well) is to go slower rather than faster than necessary, reducing my activity level has never been a problem. I've never gone above my maximum rate of 165, and I wouldn't recommend it. Getting in shape takes time and commitment, and pushing your limits won't speed up the process, but it can cause an injury.

Heart rate can be measured by taking the carotid pulse in the neck or the radial pulse at the base of the thumb in the wrist. Take a 20-second reading, then multiply by 3 to get the rate per minute. Don't attempt to take your pulse while you are in motion; stop to do it. If you like new age technology and don't want to stop to take your pulse, you can purchase an electronic pulse rate indicator, which can be worn during exercise and will give continuous readings while you are moving.

Like me, you may discover that, after initial frequent pulse readings, you gradually begin to learn what it feels like to be at (or near) your target rate. Then you won't need to take your pulse as often.

Regardless of the type, or combination of types, of exercise you choose, it is crucial to learn to use your target heart rate as your guide. Because it adjusts automatically to your level of fitness, no matter whether you are just starting out or are already in excellent condition, your pulse rate will always tell you whether you are working out at an aerobic fitness level. As your level of aerobic conditioning improves, your resting pulse rate will become slower at any given activity level.

Achieving a moderate level of fitness would provide most of the life-extending benefits exercise has to offer. An average adult can achieve these by jogging or brisk walking for at least 30 minutes, at target heart rate, three days a week. An optimum jogging or brisk walking level would be three to four miles, five to six days per week. Older people might need a little less; younger a little more.

Strength Training: Muscle In on Longevity

Not long ago, muscle strengthening exercises were generally thought to be important only for narcissistic Incredible Hulk - like Neanderthals. Now, most fitness experts agree that strength training, though not as important as aerobics, is an essential component of any well-balanced complete exercise program. Why? Because though aerobics does add some strength, it mainly develops cardiovascular endurance and burns off calories. Strength training adds . . . well, strength. This does not mean the ability to lift 400 pounds; it has to do with stronger muscles--all over your body.

Strength training induces the development of additional new muscle cells and more resilient tendons, ligaments, and muscles. Added strength improves neuromuscular control, which in turn protects you from injury. Strength training is especially important for the back, since lower-back pain is often caused by weakness of the abdominal and/or back muscles.

By adding pure strength, strength training adds depth to your exercise program. Most of the best aerobic exercises--like jogging, brisk walking, or cycling--work primarily on the lower body, which can become overdeveloped in relation to the upper.

This is a recent revelation for yours truly. Until about two years ago, I thought I was doing everything I needed to do by getting out there and running my little heart out three or four times a week--aerobically, of course. Oh, I did some occasional upper-body stuff, but I never really got systematic about it. Then, in the course of researching this chapter, I learned that people like me who just jog have grossly underdeveloped upper body musculature, and this is not good. Strength training with hand weights can balance things out. So I got myself some hand weights: one-pound ones to do arm exercises with while I am running, and five-pound ones to do other stationary upper-body exercises with. I also do pushups and pullups, and crunches (those modified partial situps) to strengthen my midsection. What can I say? I've developed some muscles I didn't know I had.

It's beyond the scope of this book to provide specific strength-training exercises. Trainers at health and fitness clubs can help, and your local bookstore has many excellent books on fitness that can help you design your personal program.

Stretching: Maintain Range of Motion

Flexibility diminishes with age. Muscle fibers shorten. Connective tissue loses elasticity. Stretching slows these changes, integrates the other aspects of a conditioning program, and improves the flexibility of muscles, tendons, ligaments, and joint tissues and protects them from injury. Ballet, tai chi, and yoga all increase flexibility. But just doing stretching exercises will suffice.

Variety Is the Spice of Fitness

Let's talk about cross-training. From the previous sections, it must be becoming clear that no one exercise does it all. We need to seek variety in our workouts. Cross-training is any fitness program that systematically incorporates a variety of activities to promote balanced fitness. Instead of just running or just swimming or just bicycling or just aerobics classes or just anything, cross-training is participating in several different exercise activities.

Your muscles have memory. They learn. Just like driving a car or adding up long lists of numbers, you'll become very efficient at doing anything you do repeatedly. Whether it is jogging or calypso dancing, if you do the same old thing over and over again, your muscles will get very good at it, and it will no longer feel like exercise.

When you think about it, the possibilities are endless.

Just Do It

As much as I dislike plugging a huge corporation, you have to admit this is a great slogan. It sums up in three words the resistance many of us have to exercising. Lack of time is the "reason" we all use to procrastinate about exercise. Is it reassuring to know that even elite world-class athletes use this excuse? In this modern era, it is easy to let the pressures of work, family, and all those other commitments push exercise time right out of the picture. Don't. Because you'll live longer, and you'll end up with even more time.

With two kids, a busy medical practice, teaching, writing, and keeping up with new research, I admit it's an ongoing struggle to find time to exercise. My search for a few free minutes sometimes leads me to look like a moron, like when I do leg stretches and jumping jacks while my gas tank is filling up. I take work breaks and shoot baskets. At home, I have a Health Rider and a treadmill. I make up activity games with my kids--or we just chase each other around the house. This is not exactly easy for a grown man to admit, but I've even jumped on my daughter's pogo stick.

But Don't Overdo It

Start out slowly and increase your activity level gradually. The importance of this cannot be overemphasized. Although it is never too late to start, one can't make up for a lifetime of inactivity in one month. It takes time. I've seen many a patient who scorned his body's need to adjust gradually to the stress of exercise and paid the price by sustaining an injury. Then often comes the illogical conclusion that "Exercise is not for me."

Moderate activity is best. Some zealots operate on the assumption that if a little is good, a lot must be better. Unfortunately, this is not true. Sustained overexercising can cause damage at a rate faster than the body's ability to heal. This will wear you out prematurely. Not only is there no upside to excessive training but by generating more free radicals than the body is prepared to scavenge, overtraining actually weakens the immune system and increases susceptibility to degenerative disease. Consistency is far more important than intensity.

The early warning signs of overexercise are first fatigue, then pain. If either occurs, the message is clear: Slow down. Another advantage to using target heart rate as a guide to activity level is that it will help protect against overexercise injury. A newly reformed couch potato, when initiating an aerobics program, will require very little activity to achieve target rate. But as he gradually becomes more fit, it takes more and more vigorous workouts to achieve the same rate.

And finally, be sure to exercise as far from traffic and pollution as you can. You don't want to undo exercise's health benefits by exposure to carbon monoxide, ozone, oxides of sulfur and nitrogen, particulate matter, and hundreds of other toxic chemicals. Increased depth and rate of breathing during aerobic exercise magnifies the detrimental effects of polluted air. I am always amazed to see joggers running along heavily traveled city streets, where exhaust fumes are concentrated and air quality is poor. They could just as easily be in the cleaner air of the side streets nearby. Be sure to exercise in a location as far away from traffic as you can get.

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Now that you're familiar with all of the components of the Renewal Anti-Aging Program, your next step is to incorporate them into your lifestyle. Chapter 38 will show you how.