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Cardiovascular disease (CVD), which includes diseases of the heart and blood vessels, such as stroke, is the leading cause of death in women, claiming nearly 500,000 lives a year. One in 10 women aged 45 to 64 and one in five women age 65 or older has some form of diagnosed heart disease. Despite these facts, many women still believe that heart disease is "for men only."
The good news is that heart disease is largely preventable. So, what can you do to get (and keep) your heart healthy and fit? First of all, be sure to discuss your risks for heart disease with your healthcare professional. Ask how often you should have your blood pressure and blood cholesterol measured. These simple tests can indicate an increased risk for heart disease.
Then: Get moving. "Research shows that cardiovascular fitness helps protect against heart disease. As fitness goes up, the incidence of heart disease goes down," says Judy Wilson, PhD, assistant professor in the Department of Kinesiology at the University of Texas at Arlington.
But don't throw in the towel at this often-repeated message. Working your way to fitness -- and health -- may just be easier than you think.What is cardiovascular fitness?
When a woman can walk briskly, jog, or swim comfortably for a half hour or more, she's achieved cardiovascular fitness: a strong, healthy heart and healthy lungs able to sustain activities that require oxygen. "Put simply, the more oxygen one can utilize, the more 'fit' that person is," Dr. Wilson says.How can cardiovascular fitness be achieved?
The means to cardiovascular fitness is cardiovascular exercise. "Cardiovascular exercise is any activity that involves the large muscles in the body, raises the heart rate, and is continuous and rhythmic," says Nieca Goldberg, MD, chief of Women's Cardiac Care at Lenox Hill Hospital in New York City. This includes walking, biking, jogging, swimming, and even dancing.
Some women avoid aerobic exercise altogether because they fear they'll have to spend hours sweating in a gym to reach their cardiac fitness goals. But cardiovascular exercise can be done in a park, in a pool, or the comfort of your living room.
As a woman swims laps at the community pool or pedals her bike on a nature trail, all sorts of things are happening in her body to help keep cardiovascular disease at bay. "If done regularly, cardiovascular exercise helps improve numerous risk factors for heart disease," Dr. Goldberg says. It improves cholesterol by raising HDL cholesterol (the healthy type of cholesterol) and lowering LDL cholesterol (the unhealthy type of cholesterol). Exercise also lowers blood pressure and maintains weight loss and makes the heart stronger and more efficient so it can deliver more blood to the muscles with each beat.
The benefits of cardiovascular fitness are particularly strong in terms of keeping blood pressure down. The American Society of Hypertension recently reported that an aerobic exercise program may be the single most effective way to control blood pressure.
These benefits start to show up fairly quickly. "If you exercise for three to four weeks regularly, your blood pressure should start to go down," Dr. Goldberg says.
And although still significant, the cholesterol-lowering effects may take a little longer. "Some studies have shown that in order to get a really significant jump in HDL, a middle-aged woman may have to exercise for a year," Dr. Goldberg says.How much cardiovascular exercise is enough?
Any physical activity is better than none, according to the American Heart Association (AHA). Even low-intensity activity -- everything from light to moderate housework, gardening, and climbing stairs -- for 30 minutes a day can help. But, more vigorous activity -- jogging, jumping rope, brisk walking, swimming -- for at least 30 minutes on most and preferably all days of the week are the best for achieving fitness for your heart and lungs.
If you've never exercised before, don't attempt to run for 30 minutes on your first day out. Too much too soon can lead to injury and burnout. After checking with your healthcare professional, start with five minutes of cardiovascular exercise every other day and build up to 30.How intense should the exercise be?
"Your workout shouldn't be painful" to be good for your heart, says Dr. Goldberg. "It should make you feel better," says Dr. Goldberg.
How can you tell if you're exercising enough to get your heart fit?
One method is to measure your target heart rate, or the rate at which your heart should be beating in the middle of your exercise routine. To calculate your target heart rate, first find your maximum heart rate by subtracting your age from 220. Then take 70 to 85 percent of the maximum heart rate to get your target heart rate. For example, if you are 40 years old, your target heart rate would be 220-40 = 180, times 0.70 to .85, or 126 to 175.
To measure your heart rate, take your pulse five minutes into your exercise routine. Place your fingers on the radial artery at the center of your wrist and count the beats for ten seconds. Based on your age, the number of beats per ten seconds should be:
At age 20: 23 to 28 beats At age 30: 22 to 27 beats At age 40: 21 to 26 beats At age 50: 20 to 24 beats At age 60: 18 to 23 beatsThe Borg Scale
If you're not a numbers person, the Borg Perceived Exertion Scale, a scale from six to 20 that measures the intensity of a workout, is another option. "Perceived exertion" means how hard you think your body is working during an activity based on the sensations you experience during the activity, such as an increased breathing rate, increased sweating, and muscle fatigue.
Though it's a subjective measurement -- you're the one evaluating it -- experts agree that your perception of physical exertion is actually a good estimate of your heart rate during the activity. Once you become more aware of how your body responds to different activity levels, you can change the intensity by increasing or decreasing your movement.
The Borg Scale is easy to use. Use the number ranges below to describe the intensity of your physical activity based on how your body responds:
6-12: Ranges from no exertion to very light and light exertion. A person exercising at the midpoint of this range of intensity would be moving at what's normal for her -- walking at her regular pace, for example.
13-17: Ranges from somewhat hard, to hard and very hard exertion. A person exercising at the lower end of this range might find the activity hard exertion-wise, but feel comfortable enough to continue. The upper range would be described as "strenuous" exertion.
19-20: Ranges from extremely hard to maximal exertion. A person exercising at this intensity is exercising extremely strenuously -- possibly at intensity stronger than they've ever experienced before.The "Talk Test"
Another good gauge of intensity is the "talk test." You should exercise at a level where you feel as if you're working hard, but still be able to have a conversation," Dr. Goldberg says. As you become more experienced with exercise, you'll gain a better sense of how much you're exerting yourself.
According to the AHA, exercising for 30 to 60 minutes at 50 to 80 percent of your maximum capacity on most days of the week will help you exceed a moderate level of cardiac fitness.
There are many forms of cardiovascular exercise. The best forms for you are ones you will both stick to and enjoy. "It's important for a woman to pick an activity she likes to do, she doesn't feel threatened by, and she finds easy to do because it will become a part of her life," Dr. Goldberg says.
Walking is a great physical activity because it's easy, free, and almost anyone can do it anywhere. And walking is a weight-bearing exercise, which, as Dr. Goldberg points out, is crucial for maintaining bone density and reducing your risk for developing osteoporosis -- a bone weakening disease.
If walking isn't your thing, there are a number of other forms of cardiovascular exercise you can try, including rowing, jogging, aerobics classes, home exercise videos, step classes, Tae Bo, boxing, swimming, biking, and dancing.
For maximum fitness, Dr. Goldberg suggests cross training -- including more than one activity that challenges a different part of your body. Walk a few days a week and mix in other forms of cardiovascular exercise, like biking or swimming, for example. And it's also helpful to include strength training to help maintain muscle mass, as well as use relaxation techniques like yoga or Tai chi.
No matter what form of cardiovascular exercise you choose, regularity is the key. "To maintain cardiovascular fitness, you have to exercise consistently at least five days a week," Dr. Goldberg says. To keep up your exercise schedule, she recommends you exercise with a friend or a group -- to keep you motivated and accountable.
And, don't forget: there are other lifestyle considerations, in addition to physical activity, that are important for keeping your heart healthy. These include not smoking, drinking alcohol in moderation (if you drink), eating a balanced, low-fat diet, and losing weight if you are overweight.Resources
American Heart Association
National Heart, Lung, and Blood Institute