Fitness books, videos and workout equipment almost universally offer a cautionary note to would-be exercisers: "Warning: Always consult a physician before beginning this or any...
Fitness books, videos and workout equipment almost universally offer a cautionary note to would-be exercisers: “Warning: Always consult a physician before beginning this or any exercise program.”
It’s enough to strike fear in the exercise-phobic, hinting that perhaps they’d be safer resting on their couches than doing something so risky that a doctor must sign off on it first.
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At the very least, the warning invites the question: “Must we, really?”
For many people, including those who are young, healthy and already physically active, the answer is “probably not.”
And, doctors say, if the exercise in question is moderate, such as walking or riding a bike, most people can probably start without a doctor’s clearance.
“But there is a broad category of people that it does apply to,” said Dr. Rick Streiffer, chairman of family and community medicine at the Tulane University School of Medicine in New Orleans.
“If the person is over 50, and has major risk factors, such as hypertension, sky-high cholesterol or an existing chronic condition such as heart disease, they might need an assessment before they start exercising,” he said.
The American College of Sports Medicine generally advises men who are older than 45 and women who are older than 55 and who have been inactive to check with their doctors before starting a new exercise program.
Young people at risk
But the same advice can also apply to younger people with certain risk factors, said Dr. Bill Roberts, president of the American College of Sports Medicine, based in Indianapolis.
“If you’re 40 and your father dropped dead at about the same age and you’re a smoker and a drinker, then it’s probably a good idea to see a doctor before exercising,” he said.
For younger people who may be at lower risk for cardiovascular disease that is immediately threatening, other factors, such as weight, physical-activity levels, smoking, high blood pressure, the possibility of diabetes or a family history of heart disease can make a pre-workout checkup advisable, said Streiffer, who practices family medicine.
“A lot of people don’t have a regular doctor,” he said. “So any reason for someone to think about having a general practitioner is a good one.”
At the doctor’s office, the first order of business is usually a series of questions about the person’s health status, said Dr. Charles Brown, of the Louisiana State University Health Sciences Center’s Department of Public Health in New Orleans.
“We would be particularly interested in family history, whether the parents or siblings had cardiovascular disease,” he said.
“We would want to know up front whether the person smoked, what his or her blood pressure is, and we’d determine whether to go further to stress tests or lab studies.”
Brown said that if a person has been sedentary, “that in itself is a risk factor for cardiovascular disease.”
Incorporating health-related physical activity into one’s life need not be complicated, he said.
“It can be as simple as parking two blocks from your office, taking the stairs instead of the elevator or walking to the store,” he said. “It’s just the simple physical activity of living, which we’ve gotten away from.”
Walking, in addition to being a simple, effective way to maintain good health, can also provide clues about whether a person might need to see the doctor before going further in an exercise program, said Dr. Paula Johnson, chief of the Division of Women’s Health at Brigham and Women’s Hospital in Boston.
“If, when walking, you’re experiencing pain, shortness of breath or other difficulties, that’s an indicator that you cannot even think about stepping up your exercise until you’ve seen your physician,” she said.
Johnson, a cardiologist, said it’s always important that you know what your cardiovascular risks are. “If you’re at increased risk,” she said, “you should talk to your physician about whether you need a stress test.”
It’s also important for people to know that diabetes is considered a heart-disease equivalent, because of the threat it poses to the cardiovascular system, she said. “If you have diabetes, you absolutely should talk to your physician before embarking on an exercise program.”
A pregnant woman should always discuss her exercise regimen with her physician, said Dr. Elizabeth Lapeyre, an obstetrician-gynecologist in New Orleans.
In the absence of certain health situations, “she should be encouraged to participate in regular, moderate-intensity physical activity,” Lapeyre said.
The American College of Obstetricians and Gynecologists recommends 30 minutes or more of moderate exercise “on most, if not all, days of the week,” she said.
Some of the conditions that would restrict exercise during pregnancy include an underlying heart disease, bleeding and abdominal pain.
Streiffer said it’s important for people to know that physical activity can benefit everyone, regardless of health status.
“I stress that it’s physical activity,” he said. “To many people, ‘exercise’ has a connotation. It might flash them back to a negative experience they’ve had, or remind them of some degree of clumsiness they’ve experienced.
“I tell people that you don’t have to be in an outfit or in a fitness club to exercise. It can be anything that gets you moving, that gets your heart beating faster, such as walking, vacuuming or walking the dog. All those things count.”