By DR. VICTOR S. SIERPINA
Standing in the salad line for lunch at the Scripps Natural Supplements Conference in San Diego last week, a gentleman behind me said, “Greetings from a fellow Texan.” He extended a friendly handshake and said, “I’m Ken Cooper.” My mouth dropped as I looked at his name badge, “THE Ken Cooper from the Cooper Clinic in Dallas?”
His green eyes twinkled as I told him I had been reading his books and following his work in preventive cardiology since my college days. I had changed my exercise program from the Royal Canadian Air Force program to Cooper aerobics and have long admired his activist approach to cardiac health.
Dr. Cooper was enthused about a recent position statement by the American Heart Association published in the prestigious journal Circulation that advised: “non-exercise estimated Cardiorespiratory Fitness should not be viewed as a replacement for objective assessment of CRF.” This means actually testing like stress tests yield better information.
Fitness can be a better indicator of someone’s risk for heart disease and early death than such standard risk factors as smoking, obesity and high blood pressure. Even small increases in activity and fitness can reduce risk of premature death or disability from heart disease, cancer, diabetes, Alzheimer’s disease, as well as substantially reduce health care costs.
His lifelong message has been that good health is rooted in exercise. He exemplifies his message and though he is in his mid-80s, he looks at least 20 years younger and has an extremely sharp mind and memory.
Dr. Cooper encourages us to follow the American Heart Association recommendation to include more rigorous aerobic testing during physical exams. Such a measurement is highly predictive of longevity. With proper monitoring and using standard protocols, the risk of stress tests is very low. His clinics have performed 225,000 stress tests without a single fatality and have identified many silent heart problems.
His long practice experience has taught him that “the heart is very good at hiding its problems.” Even fit people may need a stress test for silent heart disease, Cooper emphasized. His friend, Jim Fixx, a long-distance marathon runner died at age 52 while jogging. Autopsy showed highly advanced coronary obstruction in multiple vessels. This was despite the fact that Fixx was running without chest pain or shortness of breath at least 40 miles a week including having finished several marathons.
Summarizing the AHA’s recommendations for measurement for cardiorespiratory fitness:
1. All adults should have CRF estimated each year using a non-exercise algorithm during their annual health care examination.
2. Ideally, all adults should have CRF estimated using a maximal test, if feasible using cardiopulmonary exercise testing on a regular basis similar to other preventive services. The specific age of first assessment and schedule for follow-up are yet to be established.
3. Adults with chronic disease should have CRF measured with a peak or symptom-limited CPX on a regular basis.
Be sure to discuss with your physician your risk for heart disease and appropriate screening tests. Above all, keep moving. Motion is lotion and exercise is medicine.
Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.