MB (Marc Braman, MD, MPH):
Our topic this session is “Exercise and How to Get Moving Safely.” I’m Dr. Marc Braman with the Lifestyle Medicine Foundation and LifestyleFACTS and today with me is Marc Anderson, medical student. Welcome, Marc.

MA (Marc Anderson):
Thank you, Dr. Braman.

So, Marc, what questions or concerns do you think people have about getting started with exercise?

Well, many people and patients I talk to have heard that starting an exercise program can be dangerous for you if you have any health issues. You have to go through extensive testing by a doctor for it to be safe. Some are even worried they might have a heart attack and die if they suddenly started exercising. What are the current recommendations for medical clearance for starting exercise?

Well, the end of 2015, the American College of Sports Medicine came out with some new guidelines and the big points are these:
Number one, exercise is great for most people and we want people to exercise.
Number two, most people can exercise without visiting a doctor first.

The major cause of our killer diseases today are largely due to exercise deficiency. The medical profession has basically been making this worse with all the testing they were doing, making people afraid to exercise. We should be afraid NOT to exercise. The actual risk of exercise-induced heart attack or sudden cardiac death, even in high risk patients, is much lower than originally thought. In fact, in cardiac rehabilitation patients, one medical complication was recorded for every 81,670 hours of moderate to vigorous activity and only one fatality for every 752,000 hours of activity. Other large studies involving healthy subjects shows one heart attack or other major medical event for every 1.5 million to 36 million hours of strenuous activity.

So what you’re saying then is that all that testing wasn’t really necessary after all?

No. We were doing a lot of testing that didn’t really help anything, didn’t help people, and putting up unnecessary barriers to one of the most important parts of a healthy lifestyle that there is. Exercise is generally safe and powerful for health. The relative risk of heart attack and/or sudden cardiac death for someone participating in moderate to vigorous exercise 5-6 times a week is nearly 50x less.

Wow, that’s impressive. So who should get screened prior to initiation of a physical fitness program and how are they evaluated?

Well, everyone should go through the ACSM pre-exercise screening flowchart, we have a link to, but only a very small percentage of the population actually need any sort of medical evaluation before starting a fitness program and those that do often are heart and lung disease patients who may be at higher risk of complications. However, under the new guidelines many more of them will be cleared to exercise.

Well, that’s great to hear, but what are the factors involved in this pre-exercise screening flowchart?

They’re pretty simple. Three basic ingredients:
what your current fitness or activity level is
if you have any signs or symptoms of certain diseases, either now or when you start exercising
and what your desired exercise level is

The take away on this topic is EXERCISE! Start with light to moderate intensity and gradually increase as tolerated to your desired intensity level. If you get signs or symptoms of certain conditions, check with your doctor on how best to continue to exercise.

Exercise – it does almost every body good!

ACSM’s Guidelines for Exercise Testing and Prescription. Pescatello, Linda S., and American College of Sports Medicine. Ninth edition. Wolters Kluwer/Lippincott Williams & Wilkins Health, 2014.

Exercise Preparticipation – Health Screening Recommendations. American College of Sports Medicine. Retrieved January 6, 2017, from http://www.acsm.org/docs/default-source/publications/acsm-101-prescreeninginfographiccolorlegal-2015-12-15-v02.pdf?sfvrsn=2

The risk-benefit paradox of exercise. Darren E.R. Warburton, PhD, Jack Taunton, MD, Shannon S.D. Bredin, PhD, Saul Isserow, MBBCh. BCMJ, Vol. 58, No. 4, May, 2016, page(s) 210-218 — Articles.

Marc Braman, MD, MPH

Dr. Braman is board certified in preventive medicine/public health and occupational/environmental medicine. He is founding member, second President and first Executive Director of American College of Lifestyle Medicine and founder and current president of the Lifestyle Medicine Foundation which created LifestyleFACTS.org. He provides lifestyle medicine care in a wide variety of settings as well as initiating efforts to establish professional standards for the field of lifestyle medicine and planning and conducting national professional conferences in lifestyle medicine.

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