Can't exercise be dangerous for some people? Very rarely, strenuous activity can precipitate a heart attack. This is most likely to occur in someone with artery disease, or some other heart problem. How do you know if you have artery disease? Unfortunately, there is no good way to know. Exercise stress tests can be helpful, but are expensive and not always accurate, causing alarm and further invasive testing in many healthy people who get false positive readings. Nevertheless, they are recommended for men over 40 and women over 50 who have been inactive and are starting a program of strenuous physical activity. They are also recommended for people with two or more cardiovascular risk factors, such as high cholesterol, high blood pressure and so forth, and for people who have experienced symptoms such as chest pain that might indicate heart disease. To make your workouts as low-risk as possible, use the following guidelines: 1) Ask your doctor if you need a stress test, or whether you should follow any special exercise guidelines. 2) Exercise regularly. Exercise is much safer for people who exercise routinely. 3) Warm up and cool down. A slow but steady building of exercise intensity during a warm up allows the cardiovascular system to adjust to the increasing demands of exercise, and a good cool down helps it adjust back to resting level. 4) A mild to moderate exercise intensity is safer than a more vigorous workout. 5) Listen to your body and heed warning signs of cardiovascular disease, such as chest pain or pressure, abnormal heart rhythms or dizziness. While these symptoms are often caused by something other than heart disease, it is best to be safe and check them out.

Does regular exercise guarantee a healthy heart?

My brother runs more than 40 miles a week, but has occasional chest pain. He attributes it to stress, and says he can't possibly have heart disease since his fitness level is so high. Is this true?

Many people mistakenly believe that regular vigorous exercise will make them immune to heart disease. Physical fitness reduces, but does not eliminate, cardiovascular risk. Heart disease can occur even in people with no risk factors. While stress can be the cause of chest pain, it's important not to rule out heart disease just to be on the safe side.



Barbara A. Brehm, Ed.D., is professor of exercise and sport studies at Smith College, Northampton, Mass.

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