Some time ago, I wrote an article on the top risk factors for heart disease (almost all risk factors for heart disease apply to other areas of health as well). That article was based on research that was current at that time. Everything in that piece is still relevant. However, some fascinating new research has come out over the past year which now attributes a much higher importance to one risk factor in particular in comparison to all the others, and that is something called low Cardiorespiratory Fitness (CRF). Cardiorespiratory Fitness is the ability of respiratory, circulatory and muscular systems to consume, distribute and utilize oxygen during continuous activity. .

Let’s put this in perspective. If we look at two different cases, we have two males in their upper 40s who both see their physician for standard checkups. A. is a little bit over weight (BMI of 26) and his cholesterol is slightly above 200 and his blood pressure is 124/84. A. is an exerciser who does 30-35 minutes of brisk walking or slow jogging every week. He is also careful to use the stairs insteadof the elevator unless he has heavy packages and tries to walk, whenever possible. B. has cholesterol of 187 and even his ratio of HDL (good cholesterol) to his overall cholesterol is very good. His blood pressure is 118/78 and his weight is normal (MBI of 23.5). But B. has leads a sedentary lifestyle and doesn’t do any formal exercise. He uses elevators, parks as close as possible to his destinations, and sits in his office all day long on the computer and telephone. Who has the higher risk of heart disease and who has the higher risk of all-cause mortality? You might be surprised, but B. is probably in more trouble that A.

As I have stated previously, we have all heard about the risk factors for heart disease and coronary artery disease. There are about 20 together, and we can certainly control most of them (although some are beyond our control). Every hour of every day, we are all aging; we can’t turn back the chronological clock or change our family history. And if we were born with a low birth weight, there isn’t much we can do about that either. We can do something about most risk factors, and not necessarily with drug intervention. Case in point: a smoker can stop smoking. But there are many misconceptions when it comes to risk factors, and often, those things that really matter the most are not necessarily diagnosed through a blood test. Consequently, the underlying issue is that we have don’t always have accurate information as to what those risk factors actually are. CRF is one of the risk factors that we most certainly can do something about at just about any point of our lives. To simplify this, if you have trouble walking up hill or stairs, or even walking a reasonable distance on a flatter surface, you probably have this risk factor.

Unfortunately, when we go for a check up to the doctor, the emphasis is put on other risk factors like high blood pressure, diabetes, high cholesterol or weight. But those are easy to measure through blood tests, a blood pressure cuff, or a scale. Assessing our level of Cardiorespiratory Fitness is a little more difficult to measure accurately outside of the laboratory. Nevertheless, even an informal measure would tell us a lot.

Lee, D., et al investigated several research studies in 2010 that demonstrated beyond a doubt that moderate to high levels of CRF are associated with reduced risk of Cardiovascular disease (CVD). In 2009, Kodama et al. reviewed 33 investigations into this topic. They found that each MET (a unit of measure of energy expenditure) more that a person expends in exercise is worth a 13%-15% reduction in all-cause mortality and for the chance of having a cardiac event. The main finding however is everyone, regardless of age, gender, smoking status and weight (as measured with BMI) has reduced mortality rates from all causes, the more fit they are. One study found that even small, incremental improvements reaped large benefits.

But why is the level of CRF so pronounced as a risk factor? One of the most marked ways is that being fit reduces insulin resistance and allows your cells to use glucose as fuel better, and it prevents diabetes. Also, higher CRF shows a lower risk of all variables in metabolic syndrome (waist circumference, triglycerides, HDL-cholesterol, fasting blood sugar). Also, we know that people who have a higher level of Cardiorespiratory Fitness tend to have lower blood pressure. A study several years ago in Japan showed a direct correlation between lowering of blood pressure and people who walked to work- the longer the walk, the lower the blood pressure.

In order to increase your CVF, you don’t need to join a gym or go to exercise class. It’s free. Begin a walking program (okay, spend money on a good pair of running shoes) and start out slowly—even 3, 10 minute increments is useful at the beginning. But slowly build up your stamina and your distance. Remember, over time, if you can begin brisk walking, power walking or even some jogging, you will definitely reap even more benefit. This is less expensive than all the medications you may have to take if you don’t do this, and it is more beneficial in the long run (pun inteneded!).

The American Heart Association wants to improve the cardiovascular health of all Americans by 20% by the year 2020 while reducing deaths from cardiovascular diseases and stroke by 20%. All the “wonder drugs” that have come out in the last 30 years for cholesterol and blood pressure and diabetes haven’t really made much of a dent in the realm of public health. Could it be that we all just starting taking care of our fitness (and make a few subtle changes in our diets) that it will make a difference? I think so!

Becoming fit and bettering your Cardiorespiratory Fitness is another way to “add hours to your day, days to your year and years to your life.”

Alan Freishtat is an A.C.E. CERTIFIED PERSONAL TRAINER and a LIFESTYLE FITNESS COACH with over 16 years of professional experience. He is the co-director of the Jerusalem-based weight loss and stress reduction center Lose It! along with Linda Holtz M.Sc. and is available for private consultations, assessments and personalized workout programs. Alan also lectures and gives seminars and workshops. He can be reached at 02-651-8502 or 050-555-7175, or by email at [email protected] www.loseit.co.il

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