Advanced Mediterranean Diet

This treadmill stress test is looking for hidden heart disease

To protect yourself from injury, I suggest that you obtain “medical clearance” from a personal physician before starting an exercise program. A physician is in the best position to determine if your plans are safe for you, thereby avoiding complications such as injury and death.

Nevertheless, most adults can start a moderate-intensity exercise program with little risk. An example of moderate intensity would be walking briskly (3–4 mph or 4.8–6.4 km/h) for 30 minutes daily.

Men over 40 and women over 50 who anticipate a more vigorous program should consult a physician to ensure safety. The physician may well recommend diagnostic blood work, an electrocardiogram (heart electrical tracing), and an exercise stress test (often on a treadmill). The goal is not to generate fees for the doctor, but to find the occasional person for whom exercise will be dangerous, if not fatal. Those who drop dead at the start of a vigorous exercise program often have an undiagnosed heart condition, such as blockages in the arteries that supply the heart muscle. The doctor will also look for other dangerous undiagnosed “silent” conditions, such as leaky heart valves, hereditary heart conditions, aneurysms, extremely high blood pressure, and severe diabetes.

She looks healthy enough, but how can you be sure?

The American Diabetes Association’s Standards of Care state that routine testing of all diabetics for heart artery blockages before an exercise program is not recommended; the doctor should use judgment case-by-case. Many diabetics (and their doctors) are unaware that they already have “silent” coronary artery disease (CAD). CAD is defined by blocked or clogged heart arteries, which reduced the blood flow to the hard-working heart muscle. Your heart pumps 100,000 times a day, every day, for years without rest. CAD raises the odds of fainting, heart attack, or sudden death during strenuous exercise. I recommend a cardiac stress test (or the equivalent) to all diabetics prior to moderate or vigorous exercise programs, particularly if over 40 years old. CAD can thus be diagnosed and treated before complications arise. Ask your personal physician for her opinion.

Regardless of age and diabetes, other folks who may benefit from a medical consultation before starting an exercise program include those with known high blood pressure, high cholesterol, joint problems (e.g., arthritis, degenerated discs), neurologic problems, poor circulation, lung disease, or any other significant chronic medical condition. Also be sure to check with a doctor first if you’ve been experiencing chest pains, palpitations, dizziness, fainting spells, headaches, frequent urination, or any unusual symptoms (particularly during exertion).

Physicians, physiatrists, physical therapists, and exercise physiologists can also be helpful in design of a safe, effective exercise program for those with established chronic medical conditions.

Steve Parker, M.D.