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dr. michael evans

Kevin Van Paassen

Should I see my doctor before I start exercising?

Many people are worried they will have a heart attack or some other health calamity if they suddenly start activity. While I wouldn't recommend running to the point of passing out, I am much more worried about people being sedentary.

To make this point, let's consider patients with actual heart failure. In a trial taking place with heart-failure patients at 82 centres in the United States, Canada and France, researchers examined the differences between people who started a new exercise program and people who didn't.

The findings, published in April in the Journal of the American Medical Association, showed no significant differences between the two groups in serious adverse events such as abnormal heart rhythm, hip fracture or hospitalization related to exercise - suggesting that exercise was well tolerated and safe. Moreover, those who did start activity had an 11 per cent lower risk of all-cause death or hospitalization and a 15 per cent lower risk of cardiovascular-related death or heart-failure hospitalization.

By all means, talk to your doctor about tailoring your program to your unique risk factors, especially if you have some underlying chronic disease. But don't refuse to exercise because you are worried about making your health worse. The odds are much more in favour of improving your health.

Why am I thinking of starting to exercise now?

This seems obvious - "I want to lose weight," "I want to feel stronger," "I want to play hockey with my kids" - but it is actually very important from a change perspective. It's really about managing expectations.

Let's say your motivation is to lose weight. For most people, dietary changes are a strong predictor of early weight loss, but consistent activity is a strong predictor of keeping the weight off. For most, the weight loss will taper off, and the "return on investment" becomes less obvious. So if your motivation is weight loss, be prepared for a changing carrot.

One thing you might want to consider about your reasons for doing exercise is quality of life. Research in people young and old has shown activity makes your quality of life better. My personal experience is that when people make this connection - "I just feel better when I exercise" - their motivation has better sustainability.

When is it too late for me to start exercising?

Never. A study published in last month's Archives of Internal Medicine looked at a cohort of people in Israel in their 70s, then followed them for 18 years. Not surprisingly, those who were active did better.

What was surprising is that those who just started up their activity at this late age delayed their functional loss and improved survival. In fact, the survival benefit was most pronounced in the oldest age group.

If you don't believe me, just ask Fauja Singh, the 98-year-old who did the 5K run two weeks ago at the ScotiaBank Toronto Waterfront Marathon. Mr. Singh started running in his 80s and ran his first marathon at 89. Of course, that doesn't mean you shouldn't start now.

What's my activity style?

There is no right answer, but rather what fits for you. For example, I'm a social athlete. I rarely miss my hockey games or other group sports.

My sister is a creature of habit and likes to run three times a week, rain or shine. My friend Pat is motivated by the expert advice and direction of a professional, so he will engage trainers and a Pilates coach. My brother-in-law is goal-oriented, so he will target a marathon and train accordingly.

The other question is, how are you going to fit it into your day? Can you walk or ride part of the way to work? Take the stairs? Go for a walk at your kid's event? If you can fit it into your daily routine, then exercise is much more likely to happen. Think about your style and what works for you.

Dr. Michael Evans is an associate professor of family and community medicine at the University of Toronto, a staff physician at St. Michael's Hospital and leader of the Health Design Lab at the Li Ka Shing Knowledge Institute.