Testing Is Advised Before Starting Any Exercise Program
You are about to embark on a rigid diet and exercise program. You’ve bought your sweats and shoes, sworn off chocolate and beer, and are filled with righteous intentions. By summer you’ll be struttin’ your stuff on the beach with the rest of the beautiful bodies. Such are the things a dieter’s dreams are made of.
Too often, those lofty ideals turn to nightmares as the reality of Spartan living sets in. By the end of the first week, you’re so weak you can hardly move. Your shins feel like metal plates, and there’s a band of steel wrapped around your chest. Your heart has taken to beating wildly each time you tie your Nikes, and your stomach lurches in the presence of cottage cheese. You quickly become convinced that your body belongs on a hospital bed instead of a weight bench, and you expend all the energy you have left just getting to your doctor.
Too bad you didn’t start your program there.
It’s common knowledge that before you begin a diet or exercise regime you should get your doctor’s permission, but many of us ignore that caveat. After all, we feel fine and intend to get even better. Why spend the money on a doctor who’s just going to tell us we need to lose weight?
“If you’re going to drive across country and have a brand-new car, it’s OK, but if that car has 50,000 miles on it, you’ll get it checked out. If it has 100,000 miles on it, you’ll check it out even more. The same thing goes for your body,” said Dr. Steven Van Camp, a cardiologist in private practice and consultant to the American Heart Assn. and San Diego State University’s Adult Fitness Program.
“Not many people will go to a doctor if they think nothing’s wrong, but most people really don’t have ‘nothing’ wrong with them. You need to detect any medical problems that might be made worse by exercise or make exercise dangerous. The only thing that you can do that’s positive in health enhancement (without giving something up) is exercise; it’s the major part, the foundation of health. When you start a program, that’s the time to see a doctor and identify your problems. Then you have a good chance for total health enhancement. When you’re all wound up and ready to go, the last thing you want is a bad experience.”
No Rude Surprises
What you do want is to be able to diet and exercise safely and comfortably, without rude surprises such as sudden chest pains or constant hunger pangs. To achieve your goals you need an overall assessment of your body’s condition, and an idea of how far you can push it without causing damage, medical experts say. You want a fitness evaluation, something beyond the normal annual physical that lets you know exactly where you stand.
Such checkups are required by some intense diet or fitness programs and are recommended by activity-oriented physicians for any adult partaking in vigorous exercise or planning a major weight loss. Programs like Scripps Clinic’s Executive Health Plan, UC San Diego Extension’s Fitness Profile and San Diego State University’s Adult Fitness Program incorporate the essentials aspects of an overall fitness evaluation as well as other tests that, though not necessarily vital, do give a more thorough picture of your condition. Of all the tests available, the following are considered desirable, depending on your age, current activity level and history:
- The health history. This is the backbone of any evaluation, beginning with a record of your and your family’s medical problems, including an assessment of your current life style. A thorough history will point out many of the risk factors that contribute to cardiovascular disease, the No. 1 killer of Americans. Such factors include your age and weight, the incidence of heart problems or diabetes in your immediate family, the number of cigarettes you smoke and amount of alcohol you consume each day, how much you exercise and the stress you’re under. These factors, along with others acquired during a physical exam, will determine what other tests you require.
- The physical exam. Besides ruling out symptoms of disease, the exam offers a good picture of your current health, including a record of your blood pressure. Richard Cotton, an exercise physiologist with Scripps Clinic’s Preventive Medicine Center, suggests that more than one blood pressure reading be used to determine your rate, since factors such as the anxiety of being in a doctor’s office can elevate your pressure.
- Blood tests. Blood samples taken in your doctor’s office or a laboratory can indicate the levels of many properties in your blood, including protein, sodium, sugar and cholesterol. The glucose test, which determines sugar levels, is considered essential because it is an indicator of diabetes, which places a tremendous strain on the cardiovascular system. And the cholesterol test is a must, most fitness experts say.
“We should all know our cholesterol count by the time we are 20. The same goes for blood pressure. You could look and feel good, but either of them could be high,” Van Camp said.
Cotton agrees, saying that although experts still argue over whether cholesterol is directly related to heart disease, the overwhelming evidence, including a recent study by the National Institutes of Health, indicates that there is a direct correlation. Cholesterol is determined by your diet (particularly the amount of saturated fats and cholesterol you consume) and your genes.
“You could be doing just fine, doing all the right things, but if one or both of your parents died at 40 or 50 from heart disease, you’re dealing with bad genes,” Van Camp said.
Knowing the total amount of cholesterol in your blood is helpful; for example, Van Camp said a cholesterol count under 200 is good and one over 300 is bad: “If a guy is over 50 and his cholesterol is 300, he does not pass ‘Go,’ and should go straight to his doctor.” But this overall number is only the beginning.
To get an accurate assessment of your cholesterol count, you need a breakdown of the level into a ratio of high-density lipoproteins (HDL) to low-density lipoproteins (LDL). HDL are associated with lower heart-disease risk, LDL with higher. Therefore, you want the ratio of LDL to HDL to be as low as possible; a ration of 4:1 is considered good, while a ratio of 8:1 means you’d better change your eating habits fast. Regular aerobic exercisers tend to have higher HDL levels and less risk of coronary problems than more sedentary types, and smokers tend to have low HDL levels. The good news is that changes in diet can begin lowering cholesterol levels in as little as a week.
- Resting electrocardiogram. “Cardiovascular disease is the only thing that can make exercise dangerous--the only one that will kill people,” Van Camp warned. Therefore, it pays to know what condition your heart is in. The experts aren’t saying that everyone needs an electrocardiogram (EKG), but they do advise that once you hit 35 you should evaluate your risk factors, particularly the top three indicators of potential cardiovascular problems: smoking, cholesterol level and blood pressure.
The other factors to be considered in assessing risks are family history of heart disease, and your age, weight, sex and level of exercise. According to Cotton, if you are between 35 and 40 and have even one risk factor, you should consult your doctor about having a cardiovascular workup.
The resting EKG doesn’t show how your heart works under stress, but does show if there are abnormalities such as enlargement or irregular rhythm. To determine what happens during exercise, you must elevate your heart rate so the heart requires more oxygen, and therefore more blood. To do that, you need an active EKG, or what is commonly called a stress test or graded exercise test.
- Graded exercise test. According to Cotton and Van Camp, people worry about undergoing an active electrocardiogram for many reasons, particularly out of fear that they will have a heart attack during the test or find out that they have problems they don’t want to deal with. Such fears can be dangerous. Van Camp uses the sudden death of running guru Jim Fixx last summer from cardiac arrest as an example of what can happen if you ignore the signs of cardiovascular problems.
“The most disturbing contributing factor in Fixx’s death was his refusal to submit himself to periodic medical evaluations,” Van Camp recently wrote in the journal Physician and Sportsmedicine.
“An exercise stress test (on Fixx) would undoubtedly have been marked abnormal, indicating a need for coronary angiography and possible coronary artery bypass surgery. With the present-day combined mortality rate for angiography and bypass surgery of less than 1%, chances are that he would be alive and running today had he decided on having an exercise stress test.”
The test does require some work on your part, and should be directed by a physician, registered nurse or certified technician, particularly if risk factors are involved.
The patient is hooked to a heart monitor with 2 to 12 leads, or wires, attached to the shoulders, chest and abdomen. These give a view of the heart’s electrical activity from different angles. The patient then either walks on a treadmill or pedals a bicycle through increasing rate and grade changes until he is working as hard as he can and the heart is as close as possible to its maximum physiological rate. According to Cotton, the heart must reach at least 85% of its maximum rate to determine if it is really getting enough blood. The length of the test varies from 6 to 20 minutes, depending on the person’s condition.
The results don’t show why the heart is not getting enough blood, but they do offer guidelines as to what arteries might be blocked. If the test shows the heart to be functioning fine, Cotton suggests that it be repeated every five years. If the test shows problems, consultation with a cardiologist will determine what further tests should be done. Even if there are problems, it is possible and desirable to exercise, following a prescription determined by your physician or an exercise physiologist. Tests held at health clubs to determine your target heart rate are not the same as active EKGs and should not even be attempted if you are unsure about where you stand in terms of risk factors and cardiovascular disease, Cotton said.
- Body composition test. This test is really nothing more than the old “pinch an inch” test for fat. It allows you to see what percentage of body fat you are carrying around and whether you are truly overweight or overly fat. For example, a 220-pound football player may seem overweight, but he may be carrying that weight in muscle rather than fat and be perfectly healthy.
Body composition tests are offered at many health clubs and exercise studios, and are usually performed by using a set of calipers to pinch the skin at a flabby area of the body, such as under the arm. Some centers offer underwater tests as well, which are more accurate but not necessary for the average dieter. As Van Camp says, “If you can pinch an inch you don’t have to be a Nobel laureate to know it needs to change. But the tests are good in that you can remeasure body fat for encouragement.”
- Pulmonary function test. This is optional depending on symptoms such as shortness of breath, but is often included in a total health evaluation. For the test, you simply exhale through a tube for as long as you can; the results show how well your lungs are functioning.
- Muscular/skeletal evaluation. Again, this is not essential but can provide further guidance in setting up an exercise program. As Cotton says, “A basic flexibility test done by a physical therapist is helpful. You won’t die or have a heart attack without it, but it can decrease your risk of injury.”
During the exam, the patient moves through a series of positions that show the condition of the joints and the flexibility of the muscles. In addition, an orthopedic evaluation may be helpful if you have specific problems or symptoms.
There are many ways to go about obtaining a total fitness assessment, depending on the amount of money and time you wish to spend. The easiest ways are to either have all the tests prescribed and evaluated by the same physician or to go through a complete screening in a hospital or university fitness program. Such screenings cost anywhere from $300 to $1,000, and may be covered by insurance. Often, hospitals and health centers hold free public health fairs that include body composition and blood pressure readings. And glucose and cholesterol blood tests, which cost $15 to $45, may be a part of your regular physical checkup. Resting EKGs cost $50 to $75; active EKGs range from $150 to $300 and may be covered by insurance if prescribed because of physical symptoms.
Many of the formal fitness screening programs and some private physicians offer an exercise and/or diet prescription based on the test results. This interpretation of all the accumulated data is particularly helpful if you are planning a major change in your diet or exercise habits and are unsure as to how to start out. The testing also gives you some concrete personal statistics that will change as your physical condition improves.
“People love to know their numbers,” said Howard Hunt, director of UCSD’s physical education department and one of the originators of the school’s Fitness Profile program, offered to the public through UCSD Extension. “The numbers give you a base line, motivation, and a form of encouragement.”
With the results of these tests, and retesting scheduled according to need, you can measure more than pounds and inches as you begin to get in shape--you also get to see the ways that you are improving your total health.