Do I need to talk to my healthcare provider before I start exercising?
You should talk to your healthcare provider before beginning an exercise program if you:
- have heart disease, have had a stroke, or are at high-risk for either
- are middle-aged (45 to 50) or older and currently inactive
- have diabetes or are at high risk for it
- are taking blood pressure medication
- are obese (body mass index [BMI] of 30 or more)
- are pregnant
- have a medical condition or disability that may affect your ability to exercise (e.g., knee problems, arthritis)
Your healthcare provider can help you choose suitable activities. You may be sent for an exercise stress test to determine the amount and type of exercise that is right for you.
What are the risks of exercise?
The main risks of exercise are pulled muscles and sprains. The risk of injury is higher for more vigorous activities, especially competitive sports.53 If you are obese (body mass index of 30 or higher, or about 30 pounds overweight for a woman of average height [5'4”]), you are more prone to injury.
Walking is a low-risk activity even for women age 70 and older.54 And unlike running or jogging, your risk of injury does not increase the more you walk.55 To avoid injury with any type of activity:
- start out slowly and gradually build up to a level that is comfortable for you
- stop if you feel pain
- stretch before and after each workout
- wear appropriate clothing including footwear and safety gear (e.g., a bicycle helmet)
What are the chances of having a heart attack or dying when exercising?
The chances of having a heart attack or dying suddenly during exercise are very low.56, 57 An analysis from the Nurses' Health Study found that the risk of suddenly dying was 1 per 36.5 million hours of moderate-to-vigorous activity.58 The risks are highest for people who are not active on a regular basis and are virtually nonexistent for regular exercisers. To minimize risk, anyone with heart disease or people who do not exercise regularly should begin slowly and progress gradually to meet recommended levels (30 minutes moderate intensity activity most days of the week). Experts discourage people with heart disease from participating in competitive sports that are very demanding.59 Remember, go at your own pace—what is moderate exercise for one person may be vigorous exercise for you, depending on your age and fitness level.
1. United States Public Health Service. Physical Activity and Health. A Report of The Surgeon General. Atlanta, GA: Office of the Surgeon General, National Center for Chronic Disease Prevention and Health Promotoin, President's Council on Physical Fitness and Sports; 1995.
2. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. Feb 1 1995;273(5):402-407.
3. Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. Jun 24 2003;107(24):3109-3116.
4. Lee IM, Rexrode KM, Cook NR, Manson JE, Buring JE. Physical activity and coronary heart disease in women: is "no pain, no gain" passe? JAMA. Mar 21 2001;285(11):1447-1454.
5. Heart Disease and Stroke Statistics: 2006 Update. Dallas, Texas: American Heart Association and the American Stroke Association; 2006.
6. Centers for Disease Control and Prevention. Early Release of Selected Estimated Based on Data From the January-March 2005 National Health Interview Survey. Atlanta, GA: Centers for Disease Control & Prevention; 2004.
7. Kimm SY, Glynn NW, Kriska AM, et al. Decline in physical activity in black girls and white girls during adolescence. N Engl J Med. Sep 5 2002;347(10):709-715.
8. Centers for Disease Control and Prevention. Trends in Leisure-Time Physical Inactivity by Age, Sex, and Race/Ethnicity - United States 1994-2004. Centers for Disease Control & Prevention. October 5, 2005. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5439a5.htm. Accessed August 8, 2006.
9. Bouchard C, Dionne FT, Simoneau JA, Boulay MR. Genetics of aerobic and anaerobic performances. Exerc Sport Sci Rev. 1992;20:27-58.
10. Niebauer J, Hambrecht R, Velich T, et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation. Oct 21 1997;96(8):2534-2541.
11. Hambrecht R, Niebauer J, Marburger C, et al. Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol. Aug 1993;22(2):468-477.
12. Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med. Aug 26 1999;341(9):650-658.
13. Manson JE, Greenland P, LaCroix AZ, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med. Sep 5 2002;347(10):716-725.
14. Trolle-Lagerros Y, Mucci LA, Kumle M, et al. Physical activity as a determinant of mortality in women. Epidemiology. Nov 2005;16(6):780-785.
15. Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med. Jun 12 2000;160(11):1621-1628.
16. Kushi LH, Fee RM, Folsom AR, Mink PJ, Anderson KE, Sellers TA. Physical activity and mortality in postmenopausal women. JAMA. Apr 23-30 1997;277(16):1287-1292.
17. Conroy MB, Cook NR, Manson JE, Buring JE, Lee IM. Past physical activity, current physical activity, and risk of coronary heart disease. Med Sci Sports Exerc. Aug 2005;37(8):1251-1256.
18. Blair SN, Kohl HW, 3rd, Barlow CE, Paffenbarger RS, Jr., Gibbons LW, Macera CA. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA. Apr 12 1995;273(14):1093-1098.
19. Gregg EW, Cauley JA, Stone K, et al. Relationship of changes in physical activity and mortality among older women. JAMA. May 14 2003;289(18):2379-2386.
20. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. May 15 2004;116(10):682-692.
21. Witt BJ, Jacobsen SJ, Weston SA, et al. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol. Sep 1 2004;44(5):988-996.
22. Haskell WL, Alderman EL, Fair JM, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Circulation. Mar 1994;89(3):975-990.
23. Schuler G, Hambrecht R. Regression and non-progression of coronary artery disease with exercise. J Cardiovasc Risk. Apr 1996;3(2):176-182.
24. Wing RR. Physical activity in the treatment of the adulthood overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. Nov 1999;31(11 Suppl):S547-552.
25. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th Edition. Washington, DC: U.S. Government Printing Office; 2005. HHS-ODPHP-2005-01-DGA-A.
26. Ross R, Dagnone D, Jones PJ, et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. Ann Intern Med. Jul 18 2000;133(2):92-103.
27. Ross R, Janssen I, Dawson J, et al. Exercise-induced reduction in obesity and insulin resistance in women: a randomized controlled trial. Obes Res. May 2004;12(5):789-798.
28. Yanovski JA, Yanovski S, Sovik K, al. e. A Prospective Study of Holiday Weight Gain. N Engl J Med. 2000;342:861-867.
29. Williamson DF, Kahn H, Remingtom P, Anda RF. The 10-year incidence of overweight and major wieght gain in US adults. Arch Intern Med. 1990;150:665-672.
30. Schmitz K, Jacobs Jr D, Leon AS, Schreiner PJ, Sternfeld B. Physical activity and body weight: associations over ten years in the CARDIA study. Coronary Artery RIsk Development in Young Adults. Int J Obes Relat Metab Disord. 2000;24:1471-1487.
31. Sternfeld B, Wang H, Quesenberry CP, Jr., et al. Physical activity and changes in weight and waist circumference in midlife women: findings from the Study of Women's Health Across the Nation. Am J Epidemiol. Nov 1 2004;160(9):912-922.
32. Littman AJ, Kristal AR, White E. Effects of physical activity intensity, frequency, and activity type on 10-y weight change in middle-aged men and women. Int J Obes (Lond). May 2005;29(5):524-533.
33. Weinstein AR, Sesso HD, Lee IM, et al. Relationship of physical activity vs body mass index with type 2 diabetes in women. JAMA. Sep 8 2004;292(10):1188-1194.
34. Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study. JAMA. Oct 20 1999;282(15):1433-1439.
35. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. May 3 2001;344(18):1343-1350.
36. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. Feb 7 2002;346(6):393-403.
37. Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. Sep 12 2001;286(10):1218-1227.
38. Hu FB, Stampfer MJ, Solomon C, et al. Physical activity and risk for cardiovascular events in diabetic women. Ann Intern Med. Jan 16 2001;134(2):96-105.
39. Leon AS, Sanchez OA. Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc. Jun 2001;33(6 Suppl):S502-515; discussion S528-509.
40. Kraus WE, Houmard JA, Duscha BD, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med. Nov 7 2002;347(19):1483-1492.
41. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. Apr 2 2002;136(7):493-503.
42. Blair SN, Goodyear NN, Gibbons LW, Cooper KH. Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA. Jul 27 1984;252(4):487-490.
43. Haapanen N, Miilunpalo S, Pasanen M, Oja P, Vuori I. Association between leisure time physical activity and 10-year body mass change among working-aged men and women. Int J Obes Relat Metab Disord. Apr 1997;21(4):288-296.
44. Pereira MA, Folsom AR, McGovern PG, et al. Physical activity and incident hypertension in black and white adults: the Atherosclerosis Risk in Communities Study. Prev Med. Mar 1999;28(3):304-312.
45. Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. Apr 9 2003;289(14):1785-1791.
46. Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. Jan 1993;25(1):71-80.
47. Haight T, Tager I, Sternfeld B, Satariano W, van der Laan M. Effects of body composition and leisure-time physical activity on transitions in physical functioning in the elderly. Am J Epidemiol. Oct 1 2005;162(7):607-617.
48. Williams PT. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. May 2001;33(5):754-761.
49. Gulati M, Pandey DK, Arnsdorf MF, et al. Exercise Capacity and the Risk of Death in Women: The St James Women Take Heart Project. Circulation. September 30, 2003 2003;108(13):1554-1559.
50. Kampert JB, Blair SN, Barlow CE, Kohl HW, 3rd. Physical activity, physical fitness, and all-cause and cancer mortality: a prospective study of men and women. Ann Epidemiol. Sep 1996;6(5):452-457.
51. The President's Council on Physical Fitness & Sports. Exercise and Weight Control. Department of Health & Human Services. Available at: http://www.fitness.gov/exerciseweight.htm. Accessed August 8, 2007.
52. Ades PA, Green NM, Coello CE. Effects of exercise and cardiac rehabilitation on cardiovascular outcomes. Cardiol Clin. Aug 2003;21(3):435-448, viii.
53. Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise Standards for Testing and Training: A Statement for Healthcare Professionals From the American Heart Association. Circulation. October 2, 2001 2001;104(14):1694-1740.
54. Pollock ML, Carroll JF, Graves JE, et al. Injuries and adherence to walk/jog and resistance training programs in the elderly. Med Sci Sports Exerc. Oct 1991;23(10):1194-1200.
55. Hootman JM, Macera CA, Ainsworth BE, Addy CL, Martin M, Blair SN. Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. May 2002;34(5):838-844.
56. Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med. Dec 2 1993;329(23):1677-1683.
57. Willich SN, Lewis M, Lowel H, Arntz HR, Schubert F, Schroder R. Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group. N Engl J Med. Dec 2 1993;329(23):1684-1690.
58. Whang W, Manson JE, Hu FB, et al. Physical exertion, exercise, and sudden cardiac death in women. JAMA. Mar 22 2006;295(12):1399-1403.
59. Thompson PD, Balady GJ, Chaitman BR, Clark LT, Levine BD, Myerburg RJ. Task Force 6: coronary artery disease. J Am Coll Cardiol. Apr 19 2005;45(8):1348-1353.