Your heart loves exercise

20 June 2017

Interview with 

Sanjay Sharma, St George's Hospital of London

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Could exercise be the best therapy for your heart? Sanjay Sharma spoke to Chris Smith about the wonderful benefits of getting out of the house...

Sanjay - People who exercise are less likely to be obese, less likely to have diabetes, they’re more likely to have a good blood pressure and lipid profile. By controlling all of these acquired risk factors for atherosclerosis, people who exercise moderately reduce the risk of an adverse event from a coronary event by about 50% when they hit their fifth and sixth decade. They live around 3 to 7 years longer than people who don’t exercise. They are less likely to get cancer of the prostate, the breast, the uterus and the colon. Less likely to be depressed and less likely to develop dementia.

Therefore, if you were going to bottle exercise into some sort of pharmacological pill, it would be considered as the miracle pill - something that is free of charge, that can be taken at any time, that’s devoid of side effects, that will reduce consultations with the General Practitioner, outpatient clinics, and reduce bed occupancy. Therefore I believe that every physician in this country should be prescribing some sort of exercise to every single patient.

Chris - It’s quite challenging though, when someone says you should take more exercise it’s quite hard to quantify what constitutes therapy for that particular person. Because it’s clear that taking some exercise has got to be better than no exercise, but is a brisk walk as good as going jogging?

Sanjay - A good point. Again, our Chief Medical Officer recommends that we perform 30 minutes of moderate exercise five times a week. Now that’s a brisk walk or a gentle jog at a 15 minute mile pace. Clearly that data bears fruit and that has been shown but there is also data that if you do a little bit less than that that you will do better than someone who does nothing. But the question is what is the actual ideal dose to prevent things like diabetes, and heart attacks, and stroke?

Now some of the studies that have been published, these are large meta analyses involving thousands and thousands of patients, have shown that to get the best benefit you probably have to do five times the current recommended limit. Now clearly, not everybody can do that. We’ve got people who’ve got musculoskeletal problems, problems with their hearts, and their lungs; they're just not capable of doing that sort of exercise. So the good news for those individuals is that some exercise is certainly better than none. But for those individuals who are able and can exercise, I do not think that just 30 minutes five times a week is enough. They should be trying to do a little bit more than that.

Chris - There’s no risk, if a person does take up exercise, they’re not putting themselves at increased risk through exercise? Because there are some people say don’t overdo it, you don’t want to give yourself a heart attack through sudden, unaccustomed, severe exercise.

Sanjay - Another good point. There is one thing being an accustomed exerciser, someone who’s run most of their lives, or jogged most of their lives, or been a very active individual. And there’s another thing where someone has looked in the mirror in their fifth decade and noticed that their belly is bulging over their belt and decides I need to go to the gym, and I am going to start on day 1 and go on the treadmill and run at an 8 minute mile pace. I don’t think that’s a very good idea.

I think in those people, they need to ask themselves three questions. The first question is do I experience chest pain, am I more breathless than my peers when I walk with them? Have I got a family history of premature cardiovascular disease? And do I have obvious risk factors -  am I a smoker, have I got high blood pressure, am I taking tablets for hypercholesterolemia? I think if you’re doing all of that then I would certainly exercise cautiously, gently, to the point that you can hold a conversation but are unable to sing - that would be a good point. I think if you’re going to be trying to do any more than that, I do believe it’s probably worth seeing a specialist to make sure that it’s safe to do so.

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