Much attention concerning the treatment of high cholesterol in our present society tends to focus on the taking of medicine and the avoidance of poison. When I refer to medicine, I don't just mean prescription drugs like statins or fibric acids, but rather I am referring to any substance that we take in order to treat an illness. Therefore, the foods we choose to eat such as fruits, vegetables, fiber, unsaturated fats, and fish, for example, would also count as medicines. On the flip side, we also spend a tremendous amount of thought and effort on avoiding the ingestion of poisons in our daily lives such as trans fat and animal based fats. In short, we seem to be quite orally fixated when it comes to treating high cholesterol in that we are obsessed over what to put or not put into our mouths. The pharmaceutical industry also seems to share this oral fixation in that they continue to spend billions of dollars to develop cholesterol lowering pills that we can pop and then forget about till the next morning.
Unfortunately, lost amongst this smorgasbord of pills, capsules, bran muffins, and vegetable oil spreads resides a therapy that has been proven to improve cholesterol ever since the beginning of humankind. It's free, can be administered virtually anywhere, and not only has been shown to improve cholesterol but also reduce the risk of a heart attack, cancer, diabetes, high blood pressure, gallstones, depression, loss of mental ability, and overall death. That primordial therapy is called exercise.
It has been estimated that 12% of all deaths in our country may be related to physical inactivity. Numerous population studies have shown that those people who exercise on a regular basis have a lower incidence of developing heart disease as well as a better chance of surviving a heart attack when compared to sedentary people. Furthermore, a cardiac rehabilitation exercise program for those who have survived a heart attack may lower the risk of death by 25%. Some studies even suggest that exercise alone can reverse the development of atherosclerosis.
When I mention improved cholesterol, we often think that means lowering of total cholesterol, LDL, and triglycerides and increasing HDL. However, exercise may not necessarily cause that dramatic of a change in your standard cholesterol blood test. I know some people who after months of intense and regular exercise feel much healthier yet are disheartened when they see that their most recent blood test shows minimal to no change in their total cholesterol and LDL levels and only minor increases in HDL. Does this mean that exercise can only minimally improve cholesterol? If you only look at the numbers of the standard cholesterol test, you may easily get that impression and become discouraged. However, rest assure, exercise is helping you in more ways than one.
The standard cholesterol profile test typically measures global HDL, total cholesterol, and calculates LDL. However, there are several subtypes or sizes of LDL and HDL. In short, smaller LDL and another type of LDL called very low density LDL (VLDL) are bad in that they promote more heart disease development. Smaller HDL also does not seem to be as helpful as larger ones. So with regards to these lipoproteins, bigger is better. Even though exercise may not change the LDL reading on a standard blood test, it can markedly change the different subtypes of LDL by increasing overall LDL and HDL size and lowering the amount of VLDL. All of these are positive effects in preventing heart disease which may not be reflected at all when measured on a standard cholesterol blood test.
The positive effects of exercise on heart disease are many. They include loss of body fat, lowering of blood pressure, reducing overall body inflammation, and improved cholesterol. The actual mechanism by which exercise directly affects cholesterol is incompletely understood. Besides weight maintenance and weight loss, exercise can stimulate or inhibit certain liver enzymes that regulate the size and composition of LDL and HDL particles as well manage fat stores. There is also evidence that not all people respond the same to exercise and that your genetic make-up may govern what type of benefit you may gain. Women may also not get as much of a rise in HDL when compared to men.
One common question is how often and how vigorous should I exercise? A study performed in 2002 examined this question when it compared the effects of different levels and amounts of exercise on cholesterol profiles in overweight, sedentary men and women. The people were randomized to 3 types of exercise programs: high intensity and high amount (i.e. jogging 20miles/week at a moderate pace), high intensity and low amount (i.e. jogging 12 miles/wk at a moderate pace), and finally moderate intensity and low amount (i.e. walking 12miles/wk). The most important result was that all the groups showed benefit with regards to cholesterol but a graded response was noted. The amount of exercise had more of an impact on cholesterol rather than the intensity, and the greater the amount of exercise, the more positive the impact on cholesterol. High intensity exercise seems more important in building cardiovascular conditioning.
The current recommendation from the American Heart Association for healthy heart living is to perform moderate to vigorous physical aerobic activity for at least 30min on most, if not all, days of the week. Brisk walking, aerobics, jogging, cycling, swimming, and sports that involve continuous running such as soccer or basketball all fall into this category. Weightlifting is not considered a sufficiently aerobic activity, although it is important in maintaining muscle mass. Even less vigorous and aerobic activities such as gardening, walking, and dancing do provide some long-term benefit. In general, any exercise is better than none. The greater amount of exercise per week, the greater the benefit one may gain not only in cholesterol levels, but overall mental and physical health.
Published On: October 03, 2008