— 95 —
regularly, begin with a 10- to 15-minute walk three times a
week. As you become more fit, you can increase the number of
sessions until you’re doing something every day. Gradually,
lengthen each walking session and quicken your pace. Before
long, you will have reached your goal—walking briskly for at
least 30 minutes daily to reduce the risk of disease or walking
60 minutes per day if you’re also trying to manage your weight.
(See “A Sample Walking Program” on page 98.)
Making Opportunities
Getting regular physical activity can be easy—especially if you take
advantage of everyday opportunities to move around. For example:
■ Use stairs—both up and down—instead of elevators. Start
with one flight of stairs and gradually build up to more.
■ Park a few blocks from the office or store and walk the rest of
the way. If you take public transportation, get off a stop or
two early and walk a few blocks.
■ Instead of eating that rich dessert or extra snack, take a brisk
stroll around the neighborhood.
■ Do housework or yard work at a more vigorous pace.
■ When you travel, walk around the airport, train, bus, or
subway station rather than sitting and waiting.
■ Keep moving while you watch TV. Lift hand weights, do some
gentle yoga stretches, or pedal an exercise bike.
■ Spend less time watching TV and using the computer.
■ Take a movement break in the middle of the day. Get up and
stretch, walk around, and give your muscles and mind a
chance to relax.
— 96 —
Safe Moves
Some people should get medical advice before starting regular
physical activity. Check with your doctor if you:
■ Are over 50 years old and are not used to moderately
energetic activity.
■ Currently have heart trouble or have had a heart attack.
■ Have a parent or sibling who developed heart disease at
an early age.
■ Have a chronic health problem, such as high blood pressure,
diabetes, osteoporosis, or obesity.
■ Tend to easily lose your balance or become dizzy.
■ Feel extremely breathless after mild exertion.
■ Are on any type of medication.
Once you get started, keep these guidelines in mind:
Go slow. Before each activity session, allow a 5-minute period
of stretching and slow movement to give your muscles a chance
to limber up and get ready for more exercise. At the end of the
warmup period, gradually increase your pace. Toward the end
of your activity, take another 5 minutes to cool down with a
slower, less energetic pace.
Listen to your body. A certain amount of stiffness is normal
at first. But if you hurt a joint or pull a muscle, stop the activity
for several days to avoid more serious injury. Rest and over-the-
counter painkillers properly taken can heal most minor muscle and
joint problems.
Check the weather report. Dress appropriately for hot,
humid days and for cold days. In all weather, drink lots of
water before, during, and after physical activity.
— 97 —
Pay attention to warning signals. Although physical
activity can strengthen your heart, some types of activity may
worsen existing heart problems. Warning signals include sudden
dizziness, cold sweat, paleness, fainting, or pain or pressure in
your upper body just after doing a physical activity. If you
notice any of these signs, call your doctor right away.
Use caution. If you’re concerned about the safety of your
surroundings, pair up with a buddy for outdoor activities.
Walk, bike, or jog during daylight hours.
Keep at it. Unless you have to stop your activity for a health
reason, stick with it. If you feel like giving up because you think
you’re not going as fast or as far as you should, set smaller
short-term goals for yourself. If you find yourself becoming
bored, try doing an activity with a friend. Or switch to another
activity. The tremendous health benefits of regular, moderate-
intensity physical activity are well worth the effort.
No Excuses!
We all have reasons to stay inactive. But with a little thought
and planning, you can overcome most obstacles to physical
activity. For example:
“I don’t have time to exercise.” Physical activity does take
time, but remember that you can reduce your risk of disease by
getting only 30 minutes of moderate-intensity activity on most days
of the week. Plus, you can save time by doubling up on some
activities. For example, you can ride an exercise bike or use hand
weights while watching TV. Or, you can transform some of your
everyday chores—like washing your car or walking the dog—into
heart healthy activities by doing them more briskly than usual.
“I don’t like to exercise.” You may have bad memories of
doing situps or running around the track in high school, forcing
yourself through every sweating, panting moment. Now we
— 98 —
know that you can get plenty of gain without pain. Activities you
already do, such as gardening or walking, can improve your
health. Just do more of the activities you like. Try to get friends
or family members involved so that you can support each other.
“I don’t have the energy to be more active.” Get active
first—with brief periods of moderate-intensity physical activity—
and watch your energy soar. Once you begin regular physical
activity, you will almost certainly feel stronger and more
vigorous. As you progress, daily tasks will seem easier.
“I keep forgetting to exercise.” Leave your sneakers near
the door to remind yourself to walk or bring a change of clothes
to work and head straight for the gym, yoga class, or walking
trail on the way home. Put a note on your calendar to remind
yourself to exercise. While you’re at it, get in the habit of
adding more activity to your daily routine.
Move It and Lose It
Activity _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Calories Burned Per Hour*
Walking, 2 mph _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 240
Walking, 3 mph _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 320
Walking, 4.5 mph _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 440
Bicycling, 6 mph _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 240
Bicycling, 12 mph _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 410
Tennis, singles _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 400
Swimming, 25 yds per minute _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 275
Swimming, 50 yds per minute _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 500
Hiking _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 408
Cross-country skiing _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 700
Jumping rope _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 750
Jogging, 5.5 mph _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 740
Jogging, 7 mph _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 920
* For a healthy, 150-pound woman. A lighter person burns fewer calories; a heavier person burns more.
— 99 —
A S A M P L E WA L K I N G P R O G R A M
Warm Up
Activity
Cool Down
Total Time
Week 1
Walk slowly 5 min.
Walk briskly 5 min.
Walk slowly 5 min.
15 min.
Week 2
Walk slowly 5 min.
Walk briskly 7 min.
Walk slowly 5 min.
17 min.
Week 3
Walk slowly 5 min.
Walk briskly 9 min.
Walk slowly 5 min.
19 min.
Week 4
Walk slowly 5 min.
Walk briskly 11 min.
Walk slowly 5 min.
21 min.
Week 5
Walk slowly 5 min.
Walk briskly 13 min.
Walk slowly 5 min.
23 min.
Week 6
Walk slowly 5 min.
Walk briskly 15 min.
Walk slowly 5 min.
25 min.
Week 7
Walk slowly 5 min.
Walk briskly 18 min.
Walk slowly 5 min.
28 min.
Week 8
Walk slowly 5 min. Walk briskly 20 min.
Walk slowly 5 min.
30 min.
Week 9
Walk slowly 5 min.
Walk briskly 23 min.
Walk slowly 5 min.
33 min.
Week 10
Walk slowly 5 min.
Walk briskly 26 min.
Walk slowly 5 min.
36 min.
Week 11
Walk slowly 5 min.
Walk briskly 28 min.
Walk slowly 5 min.
38 min.
Week 12
Walk slowly 5 min.
Walk briskly 30 min.
Walk slowly 5 min.
40 min.
— 100 —
You Can Stop Smoking
The good news is that quitting smoking immediately reduces your risk
of heart disease, cancer, and other serious disorders, with the benefits
increasing over time. Just 1 year after you stop smoking, your heart
disease risk will drop by more than half. Within several years, it will
approach the heart disease risk of someone who has never smoked.
No matter how long you have been smoking, or how much, quitting
will lessen your chances of developing heart disease.
If you already have heart disease, giving up cigarettes will lower your
risk of a heart attack. Quitting also reduces the risk of a second heart attack in women who have already had one. There is nothing easy
about giving up cigarettes. But with support and a plan of action,
you can do it.
Getting Ready To Quit
■ Get motivated. Take some time to think about all the benefits of being smoke free. Besides the health benefits of quitting, what else
do you have to gain? Loved ones no longer exposed to secondhand
smoke? A better appearance? No more standing outside in the cold
or rain for a smoke? More money to spend on things besides
cigarettes? Write down all of the reasons you want to stop smoking.
■ Choose a quit date. Give yourself enough time to prepare
to stop smoking—but not too much! It’s best to choose a date
about 2 weeks away.
■ Consider a “quit-smoking” aid. Ask your doctor about
using a medication that can help you stay off cigarettes. These
aids include a patch, gum, inhaler, nasal spray, and lozenges.
Some of these medicines are available over the counter.
Others require a prescription. All contain very small amounts
of nicotine, which can help to lessen the urge to smoke. Two
other prescription quitting aids are bupropion sustained release
(Zyban™), a medicine that contains no nicotine but reduces the
craving for cigarettes, and varenicline tartrate (Chantix™),
— 101 —
“ I WA S 3 M O N T H S P R E G N A N T W I T H M Y
S E C O N D C H I L D W H E N I S TA R T E D H AV I N G
A R A C I N G H E A R T B E AT. I E N D E D U P B E I N G
D I A G N O S E D W I T H H Y P E R T R O P H I C
C A R D I O M Y O PAT H Y — T H I C K E R T H A N N O R M A L
HEART WALLS. THE CONDITION IS
GENETIC, BUT I DIDN'T KNOW
O F A N Y O N E E L S E I N M Y
FA M I LY W H O H A D I T. I G E T
REGULAR CHECKUPS AND TAKE
C A R E O F M Y O V E R A L L
HEALTH, AND I TEACH MY KIDS
TO MAINTAIN A HEALTHY
LIFESTYLE. MY DAUGHTERS
HAVE BEEN SCREENED FOR
H E A RT D I S E A S E . ”
—Shannon
— 102 —
which both eases withdrawal symptoms and blocks the effects
of nicotine if you slip and begin smoking again. If you decide
to use one of these medicines, be sure to talk with your doctor
about how to use it properly.
■ Line up support. Many women find that quitting smoking is
easier with the support of others. Tell your family, friends, and
coworkers that you plan to quit and let them know how they
can help you. For example, if someone close to you smokes,
ask him or her not to smoke around you. (It is easier to quit
when people around you aren’t smoking.) You might also find
a support group or Internet chat room helpful. Plan to get in
touch with your “support team” regularly to share your
progress and to get encouragement. If possible, quit with a
friend or family member.
■ Make a fresh start. The day before you quit, get rid of all
cigarettes in your home, your car, or at work. (Keeping a few
cigarettes “just in case I need them” will lower your chances of
success.) Throw away ashtrays, matches, and lighters. Many
women like to quit with a clean, fresh home or car that is
free of cigarette odor. You may want to clean the drapes or
shampoo the carpet of your home or car. After quitting, you’ll
enjoy the new scents as your sense of smell returns.
Breaking the Habit
■ Know what to expect. The first few weeks can be tough.
Most people experience strong urges to smoke as well as
withdrawal symptoms, such as headaches, difficulty sleeping,
trouble concentrating, and feeling cranky or nervous. While
these reactions are not pleasant, it’s important to know that
they are signs that your body is recovering from smoking.
Within a few weeks, most people already feel much better.
— 103 —
■ Know yourself. To quit successfully, you need to know your
personal smoking “triggers.” These are the situations and feelings
that usually bring on the urge to light up. Some common triggers
are drinking coffee, having an alcoholic drink, talking on the
phone, watching someone else smoke, and experiencing stress
or depression. Make a list of your own personal triggers and
avoid as many of them as you can. For those you can’t avoid,
plan now for how you will deal with them.
■ Find new habits. Replace your triggers with new activities
that you don’t associate with smoking. For example, if you have
always had a cigarette with a cup of coffee, switch to tea for a
while. If stress is a trigger for you, try a relaxation exercise such
as deep breathing to calm yourself. (Take a slow, deep breath,
count to five, and release it. Repeat 10 times.)
■ Keep busy. Get involved in activities that require you to use your hands, such as needlework, jigsaw puzzles, or fixup projects around
your house or apartment. When you feel the urge to put something
in your mouth, try some vegetable sticks, apple slices, or sugarless
gum. Some people find it helpful to inhale on a straw or chew on a
toothpick until the urge passes.
■ Keep moving. Walk, garden, bike, or do some yoga
stretches. Physical activity will make you feel better and help
prevent weight gain.
■ Be good to yourself. Get plenty of rest, drink lots of water,
and eat three healthy meals each day. If you are not as
productive or cheerful as usual during the first weeks after
quitting, be gentle with yourself. Give yourself a chance to
adjust to being a nonsmoker. Congratulate yourself for making
a major, positive change in your life.
— 104 —
If You Slip
A slip means that you’ve had a small setback and smoked a cigarette
after your quit date. This is most likely to happen during the first
3 months after quitting. Below are three suggestions to help you get
right back on the nonsmoking track:
■ Don’t be discouraged. Having a cigarette or two doesn’t
mean you can’t quit smoking. A slip happens to many, many
people who successfully quit. Keep thinking of yourself as a
nonsmoker. You are one.
■ Learn from experience. What was the trigger that made
you light up? Were you driving home from work, having a glass
of wine at a party, or feeling angry with your boss? Think back
on the day’s events until you remember what the
trigger was.
■ Take charge. Write a list of things
you’ll do the next time you face that
trigger situation and other tempting
situations as well. Keep the list and
add to it whenever necessary.
Even years after quitting, certain
places, people or events can
trigger a strong urge to smoke.
So stay aware, plan ahead,
and know that you can
quit—for good.
— 105 —
fiveAIDS FOR QUITTING
As you prepare to quit smoking, consider using a medication that can
help you stay off cigarettes. Some of these medications contain very
small amounts of nicotine, which can help to lessen the urge to smoke.
They include nicotine gum (available over the counter), the nicotine patch (available over the counter and by prescription), a nicotine inhaler
(by prescription only), and a nicotine nasal spray (by prescription only).
Another quitting aid is bupropion sustained release (Zyban™), a
medicine that contains no nicotine but reduces the craving for cigarettes.
Varenicline tartrate (Chantix™) eases withdrawl symptoms and blocks
the effects of nicotine if you slip and start smoking again. Both are
available only by prescription. While all of these medications can help
people to stop smoking, they are not safe for everyone. Talk with your
doctor about whether you should try any of these aids.
A W E I G H T Y concern
Many women fear that if they stop smoking, they will gain unwanted
weight. But most exsmokers gain less than 10 pounds. Weight gain
may be partly due to changes in the way the body uses calories after
smoking stops. Some people also may gain weight because they
substitute high-calorie food for cigarettes. Choosing lower calorie
foods and getting more physical activity can reduce the amount of
weight you gain.
If you do put on some weight, you can work on losing it after you have
become comfortable as a nonsmoker. Meanwhile, concentrate on
becoming smoke free—your heart health depends on it.
— 106 —
FOR WOMEN who HAVE HEART DISEASE
I f you have heart disease, it is extremely important
to control it. Eating well, engaging in regular
physical activity, and maintaining a healthy weight will
help to lessen the severity of your condition. If you smoke, you’ll
need to quit. And if you have diabetes, you will need to manage it
carefully.
You also may need certain tests, medications, or special procedures.
This section explains each of these and how they can help to protect
your heart health.
Screening Tests
In most cases, you will need some tests to find out for sure if you
have heart disease and how severe it is. If your doctor doesn’t
mention tests, be sure to ask whether they could be helpful. Most
screening tests are done outside the body and are painless. After
taking a careful medical history and doing a physical examination,
your doctor may give you one or more of the following tests:
■ Electrocardiogram (ECG or EKG) makes a graph of the
heart’s electrical activity as it beats. This test can show
abnormal heartbeats, heart muscle damage, blood flow
problems in the coronary arteries, and heart enlargement.
■ Stress test (or treadmill test or exercise ECG) records the
heart’s electrical activity during exercise, usually on a treadmill
or exercise bike. The test can detect whether the heart is getting
enough blood and oxygen. If you are unable to exercise due
to arthritis or another health condition, a stress test can be done
without exercise. Instead, you will be given a medicine that
increases blood flow to the heart muscle and makes the heart
beat faster, mimicking the changes that occur when you exercise. This
test is usually followed by a nuclear scan or echocardiography to
see whether there are any problems with the blood flow to the heart.
— 107 —
■ Nuclear scan shows the working of the heart muscle as
blood flows through the heart. A small amount of radioactive
material is injected into a vein, usually in the arm, and a
camera records how much is taken up by the heart muscle.
■ Echocardiography changes sound waves into pictures that
show the heart’s size, shape, and movement. The sound
waves are also used to see how much blood is pumped out by
the heart when it contracts.
■ Cardiac catheterization is a medical procedure used to
diagnose and treat certain heart conditions. A long, thin,
flexible tube called a catheter is put into a blood vessel in the
arm or upper thigh (groin) and threaded up into the heart.
Through the catheter, the doctor can perform diagnostic tests and
treatments on the heart. The diagnostic tests include the following:
• Coronary angiography (or angiogram or arteriography)
shows an x ray of blood flow problems and blockages in
the coronary arteries. A dye is injected into the catheter,
allowing the heart and blood vessels to be filmed as the
heart pumps. The picture is called an angiogram or
arteriogram.
• Ventriculogram is sometimes a part of the x-ray dye test