Just recently, the American Heart Association (AHA) has finally suggested that physicians should start measuring fitness, just like they measure other vital signs, such as blood pressure. So, if your own physician doesn’t measure it, then you should do fitness testing on your own.
Over the last 15 years, I have spoken to more than 30,000 physicians across the US and Canada and I have pleaded with doctors to measure fitness levels. My own clinic’s research data has shown that fitness is a more important measure than blood pressure, weight, or cholesterol in predicting death rates, cognitive function, and cardiovascular risk.
This new AHA report notes that a growing body of epidemiological and clinical evidence demonstrates that aerobic (cardio-respiratory) fitness is a potentially stronger predictor of overall death risk than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus. http://circ.ahajournals.org/content/early/2016/11/21/CIR.0000000000000461
The authors recommend that each of us should have our aerobic fitness assessed as part of our routine medical examination and, if our fitness is on the low side, we should be advised and helped to start exercising. The authors also suggest that if your physician does not begin to determine your aerobic fitness in the near future, you should do so yourself, using any of several scientifically validated tools.
If you want to tune up your waist-line, heart, and brain with exercise, I think having a fitness test will give you a big advantage to getting fast results. If you don’t already exercise regularly, talk to your physician to ensure it is safe for you to get started, and anyone with complicated medical problems, such as high cholesterol, high blood pressure, and/or elevated blood sugar levels should speak to their doctor before changing their exercise routine.
In my books, Ten Years Younger and The 30-Day Heart Tune-Up, I have provided my readers with details on how to perform a fitness test. To get you started right now, I would have you determine only one measure of fitness as we do at my clinic: your MET level.
To clarify what I mean by MET level (or METs), this is shorthand for METabolic equivalency level, a measure of how much energy you burn while performing a particular activity. Physicians worldwide now use METs to assess cardiac function, and many exercise machines calculate activity in METs.
- 1 MET is the energy you expend lying quietly in bed
- 2 METs is the energy you expend sitting at a desk, writing, talking on the phone
- 2.5-5 METs is walking at a moderate (not brisk) pace
- 4-6 METs would be an activity like gardening or housework
- 5-10 METs is brisk-to-vigorous walking or cycling
- 10-15 METs is running hard on a treadmill
Most healthy people should be able to “comfortably” work out at a level of 10-12 METs, and in my clinic I have 80+ year olds who can still reach this level of exertion. Some of my more athletic patients reach 15-18 METs.
To measure your MET level, you will need to exercise on a machine that can calculate your MET level for you, as many computerized treadmills and elliptical machines in gyms will do. Ideally, you would perform this type of testing with your physician in her/his office, or with an exercise physiologist in a gym, but most healthy people could do this with a friend to assist them as well. Wear a heart rate monitor to check your heart rate. Start with a 3 minute warm-up, then gradually push yourself, increasing your exertion level every 2-3 minutes, until you start to sweat, huff and puff. When you reach a point where you can’t speak more than one or two short sentences, stop. Don’t push it until you stumble and someone has to catch you. You are done, but before you stop, note your MET level as displayed on the machine, and check your pulse with your heart rate monitor to clarify your maximum heart rate, too. (If you’re working with a physician or exercise professional, they’ll do this for you.) One minute after you stop, walk in place for a minute, and recheck your heart rate to see how much it decreased in one minute.
Your MET level is an excellent measure of your aerobic fitness, and over time as you get fitter, every time you increase your maximum MET capacity by 1 point, you decrease your risk for a heart attack and stroke by 12.5%; increase your fitness by 2 METs, and you just decreased your risk for cardiovascular risk by a whopping 25%.
Your 1 minute heart rate drop (also called heart rate recovery) is also a terrific measure of how well your heart recovers after a work-out. At maximum exertion, your heart might race as high as 180 beats per minute. When you stop, the faster your heart rate drops the quicker you recover from stressing your heart. In published studies using treadmill testing at the Cleveland Clinic on thousands of patients, poor heart rate recovery was the strongest predictor of future heart attacks and sudden death. Normally, your heart rate should drop after 60 seconds by at least 25 beat (some of my really fit patients have a 40-60 point drop at one minute). If your heart rate drops less than 20 beats at one minute, that is concerning. If it drops less than 12 beats, I call that alarming. However, if you happen to take medications that slow your heart rate, then likely these markers will not be reliable, so check with your own doctor. Unless you have medical skills, you would likely need a heart rate monitor to measure your heart rate accurately while you exercise; the ones that come with a chest strap work the best. If your heart rate recovery is less than 20 beats after 1 minute, I’d suggest speaking to your doctor before trying to change your exercise routine.
Many people skip fitness testing and use the gym tables to identify a recommended heart rate target. These tables basically assume your maximum heart rate is 220 minus your age. As an example, if you are 50, 220- 50 = 170 as an estimated maximum heart rate. Then they give you are heart rate target that is 60-80% of that maximum heart rate. The problem is that for one third of people that heart rate will be too hard, and for another third it will be too easy, so this heart rate estimate only works well for about one third of people.
For details on how to measure you aerobic fitness, strength, and endurance, and how to optimize your exercise routine using the results, please see those chapters in either of my books, Ten Years Younger or The 30-Day Heart Tune-Up.
For the New Year, if you want to become trim, fit, mentally sharper, improve your romantic life, and prevent heart disease, all in less time, then a fitness test is a very worthwhile investment to ensure that you work at a level that gives you the maximum benefit from the time and energy you spend.
I wish you the best of health!
Steven Masley, MD, FAHA, FACN, FAAFP, CNS
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