Doctors: Most people don't need to see a physician to start basic exercise

Walking your dog is a great way to start moving around again
Many sedentary people who'd like to start exercising face a little-discussed barrier. It's the common, intimidating phrase, "Consult your doctor before beginning this or any other exercise program."

The implication is that exercise is so dangerous it requires a physician's approval. This leaves many sofa spuds thinking it's safer to stay curled up on the couch.

But that's the wrong message, say an increasing number of health professionals. In our sedentary society, where an epidemic of inactivity is responsible for an estimated 250,000 deaths per year, the new message is that most people don't need a doctor's approval to start exercising at a low to moderate level.

Two basic factors determine whether or not you need a physician's approval to exercise, notes Dallas epidemiologist Steven Blair, who served as senior scientific editor for the 1996 U.S. Surgeon General's "Report on Physical Activity and Health": the intensity of the exercise you plan to do, and your health status .

Intensity of exercise

If you're considering a program of vigorous-intensity exercise, it's generally advisable to consult a physician first ? especially if you've been sedentary and are age 40 or over.

"But you don't need to consult a doctor to go out and take a walk," Blair notes.

What's your health status?

Your health status also affects whether or not you should check in with your doctor. If you answer "yes" to any of these questions, it's advisable to discuss your exercise plans with a physician:

  • Do you have a chronic illness or medical condition, such as high blood pressure or diabetes?

  • Do you have risk factors for heart disease, such as smoking or family history of heart problems?

  • Do you have undiagnosed symptoms, such as dizziness, chest pain or red swollen knees?

  • Are you taking prescription medication?

  • Do you have any bone or joint problems?

  • Have you had surgery within the last year or a previous injury still affecting you?

    Getting started

    Exercise is much safer than inactivity in terms of health and well-being, notes Blair and other experts, who say that rather than seeking permission to exercise, people should have to get permission to be sedentary because inactivity is the more dangerous state.

    Stress tests

    But while active people have a lower overall risk of health problems than do sedentary ones, it's important to be aware that physical exertion also can cause serious cardiovascular events. These typically occur as a result of relative overexertion in people with uncontrolled heart conditions.

    That's why the American Heart Association advises a stress test for middle-aged and older people who have not been physically active and plan to begin a vigorous exercise program.

    Who should get them?

    "To be on the safe side, we recommend that people over 40 and those with risk factors for cardiovascular disease get at least one stress test if they want to do vigorous exercise," says AHA spokesman Gerald Fletcher, a cardiologist and professor of medicine at the Mayo Clinic Medical School in Jacksonville, Fla.

    Risk factors indicating the need for a stress test, he says, include cigarette smoking, diabetes, obesity and family history of cardiovascular disease, particularly if a family member died young of a heart condition.

    But for non-vigorous activities ? such as walking, pool aerobics and doubles tennis ? no physician's approval is necessary, he says.

    "People can start exercising at a low to moderate intensity on their own without medical screening," notes Fletcher, who defines non-vigorous as "an activity you can do while carrying on a conversation."

    When is it not safe to exercise?

    There are a few grave medical conditions that might make exercise unsafe, such as severe aortic stenosis or a serious terminal or untreatable disease. But for most chronic conditions ? like heart disease and arthritis ? exercise is a well-recognized and effective therapy. So if you're not getting regular physical activity, you're missing an important part of your medical treatment.

    Keeping it safe

    To ensure the safety of your exercise, be sure to:

  • Start exercising slowly and progress gradually. Avoid the "terrible too's" ? doing too much, too soon, which can lead to injury.

  • Always warm up with five to 10 minutes of easy movement followed by gentle stretching to prepare your body for activ[ity.

  • Cool down. Never stop vigorous activity suddenly because it can put a strain on the heart. Gradually slow your pace with five to 10 minutes of light activity similar to your warm-up.

    Carol Krucoff is an award-winning medical writer and health columnist, and the founding editor of the Health Section of The Washington Post, where her nationally syndicated column, "Bodyworks," is featured.

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