Exercise: The new vital sign

Physical Activity as a Vital Sign

Becoming more physically active may be the most beneficial thing you can do to improve your health.  The least fit get the most benefit from starting an exercise program and building more physical activity into  their lives. This information is adapted from the Preventative Cardiovascular Nurses Association (www.PCNA.Net) and meant to provide guidance, tools and confidence needed to get started with a safe and effective exercise program.

Steps you can take to become more physically active:

Make exercise a vital sign.

Discuss with your healthcare provider your exercise status  at your next  office visit

  • Do you exercise?
  • If so, what type?, how long?, how hard?, and how often?

Many health systems have added this question to their electronic medical record to ensure a place to conveniently record.  Documenting physical activity at every visit allows you to track your progress over time.If  your answer is no you don’t exercise, do you understand the benefits of exercise?

You can help prevent heart attack and stroke by:

  • lowering blood pressure, or chance of getting high blood pressure
  • improving cholesterol
  • lowering  blood sugar and my chance for getting diabetes
  • burning calories to maintain or lose weight
  • reduce stress, depression or anxiety
  • improving my heart and lung function

Exercise can improve your:

  • ability to play sports
  • muscle strength
  • flexibility and range of motion of joints
  • balance
  • energy level
  • sleep

Exercise can lower your  risk for:

  • some kinds of cancers (colon, breast and lung)
  • osteoporosis (thinning of bones)

The best exercise is the one you will do!
• Start slowly and increase activity over time.
• You may feel sore and more tired when you first start.
• Something is better than nothing.

Be encouraged to move more throughout the day even if you don’t feel ready to start an exercise program.
“Move More, Sit Less!” suggestions to for increasing daily activity.

  • Park farther away from any store or place you go—or get off the bus or out of the taxi a few blocks
  • before you get to where you are going.
  • Avoid the drive-through. Park your car and walk into the grocery store, drugstore, bank, or restaurant.
  • When you are stopped in traffic or at a stop light, tighten, then relax your stomach, arm or leg muscles.
  • Lift your grocery or shopping bags like weights.
  • Take the stairs! Climb up a flight or two whenever you can.
  • Walk around or march in place while you talk to someone on your mobile phone.
  • Clean your house, wash your car, or rake leaves. Maybe start gardening!
  • Try doing some exercises when doing chores where you don’t normally move. Examples include
  • small squats when ironing or folding clothes and calf raises while brushing your teeth.
  • Do some quick exercises during the break of your favorite TV show. Try some push ups,
  • sit ups, or do some light weight training.
  • Instead of watching TV or a movie—go window shopping, walking at a zoo or visit a museum.

Getting Started

If you  are considering starting an exercise program, are you healthy enough to exercise independently? If you have no cardiovascular symptoms and are low risk, get an exercise prescription from your health care practitioner and advice on starting an exercise program.

If you have heart disease or other health concerns, talk with your nurse or doctor before starting an exercise program. They may take a health history, perform a physical exam or request a monitored stress test. This information will be used to make sure exercise is safe for you and to develop an exercise prescription.

Exercise Prescription

There are four parts to an exercise prescription. These four things are sometimes known as F.I.T.T.
F: Frequency (Number of Times Per Week You Exercise)

  •  Try to exercise or be physically active on most, and ideally all, days of the week.
  •  If every day is not possible, work to get in at least 3 days a week. Try to spread out the days you are active (every other day is better than three days in a row).
  • Remember—something is better than nothing.

I: Intensity (How Hard You Exercise)
You may need to work with your nurse or doctor to figure out the best way to measure your exercise
intensity. A few ways are:

  •  Target Heart Rate (THR, or pulse)
  • The “Talk Test”
  •  Rated Perceived Exertion (RPE)

More about these 3 ways to measure the intensity of the exercise you do:
You can  count your heart rate (or pulse) and give you a target heart rate to reach during exercise. Your pulse is the number of times your heart beats in one minute. Pulse rates vary from person to person. Your pulse is lower when you are sitting still and gets faster when you exercise. Knowing how to take your pulse can help you evaluate your exercise program.

Remember some medications or conditions can limit how high your heart rate can go. Be sure to  discuss this  with your healthcare provider.  If taking your pulse is difficult, there are other ways to figure out if you are working as hard as you need to.

  • The “Talk Test” is simple. If you can talk while exercising, the intensity of your activity is considered tobe safe and appropriate for improving your health. If you are exercising so hard that you cannot easily talk to the person next to you, this means you are exercising pretty hard. Ask your healthcare provider  if this is safe for you.
  • You can also measure how hard you are working using the Rated Perceived Exertion (RPE) Scale

T Time: (How long you do the exercise) 

How long you should exercise—usually measured in minutes per day. While a minimum of 30 minutes of endurance exercise daily is recommended for most adults, it may take some time to increase to that level if you haven’t been exercising for a while. You may be advised to start with 5 minutes a day and add a few minutes each day as time goes on.
T Type: (What kind of exercise you do)
Walking, jogging, bicycling and swimming are examples of exercise that use large muscles and cause your body to use more oxygen than it would while resting. These types of activities are called endurance and they help the heart.

Strength exercises help to increase strength and muscle tone. They may also help with balanceand fall prevention. Examples of strength exercises are pushups, sit ups, and using weight lifting machines or free weights.

Flexibility exercises stretch and lengthen your muscles to help prevent soreness and injury Start slow and add a little more over time.

Tricks of the Trade

1. Some is better than none, so start slowly.

Don’t expect results overnight, but do take small steps each day. You might not notice any big changes— especially in your  weight—for a few weeks or even months. It is still good for your heart health!

2 .  Get a partner or join a class

Be active with a friend or a group to make it more fun! You are less likely to cancel an exercise date with a friend than one with yourself!

3.  Change your routine around

  • You will be less likely to get bored or injured if you change your activities.
  • Walk one day; bike the next.
  • Mix in fun sports like golf or tennis to stay active and keep exercise fun.
  • Learn to dance or garden.
  • Even chores like mowing the lawn and cleaning your house can keep you moving.

4.  Make exercise fun

  • Plan your walking route to see new sights—change up the neighborhoods you walk through.
  • Take awalk through the zoo or park.
  • Listen to music oran audiobook to help pass the time.
  • Exercise on a treadmill or stationary bike while reading or watching TV.

5.  Write it down

  • Keep an activity journal or diary.
  • Write down what you did, how long you did it, and how you felt. This helps to track your progress. Keeping a journal can also be a good way to set future goals.
  • Write down where you want to be next week, month or year.

6.  Try something new

It may be that jogging is not for you. Try a swimming program instead or sign up for a yoga class or tennis lesson. Find things you enjoy.

7.  Make exercise a habit

  • Choose a regular time for exercise each day.
  • Sign a contract with yourself to exercise.
  • Put exercise “appointments” on your calendarand keep them!
  • Change into workout clothes before you leave work.

8.  Make exercise a priority

  • You have to believe that exercise is important enough to make it happen.
  • Pay attention to your mood, how your body feels, and your stress levelAFTER you are active.
  • Think about your reasons for becoming active.

9.  Come up with solutions to reasons you may not want to be active

  • If you don’t like to sweat—set up a fan or split it up into three 10-minute walks.
  • If you feel too tired, try to be active earlier in the day.
  • Write down your solutions.

10.  Every little bit counts

  • Take a walk on your lunch break or a longer path back to your desk.
  • Walk your dog twice a day.
  • Take the stairs instead of the elevator.
  • Split your activity up into two 15-minute sessions

These are the 4 kinds of exercise that you can pick from:

  •  Endurance
  •  Strength
  •  Balance
  •  Flexibility

Endurance: activities that increase your breathing and heart rate (pulse)

Endurance activities  keep you healthy and more fit, help you do the things you need to do every day  improve the health of your heart and lungs delay or prevent diseases such as diabetes, colon and breast cancers, and heart disease.
Examples of endurance activities:

  •  fast walking
  •  dancing
  •  biking
  •  playing tennis
  • yard work
  •  jogging
  •  climbing stairs or hills
  •  swimming
  •  playing basketball

Strength:activities that increase your muscle strength Strength exercises help you stay independent in your daily activities like                                 climbing stairs and carrying things. Strength exercises include lifting weights and using a resistance band.

Balance: activities that make you more stable. These help improve your balance and prevent falls. Balance exercises include standing on one foot,heel-to-toe walk, and tai chi.
Flexibility: activities that keep your body flexible. These give you more freedom of movement for everyday activity. Flexibility exercises include shoulder and upper arm stretches, calf stretches, and yoga.


You have many choices

When you travel…

• Stay at a hotel that has an exercise room.
• Ask locals or the front desk of the hotel where you can walk or run safely.
• Walk to dinner instead of taking a taxi.
• Do your sightseeing on a bike or on foot.
Do some stretching, yoga or use a strength band in your room.

When the weather isn’t the best…

• Walk at the mall.
• Find stairs at your work or apartment building.
• Use a video or TV exercise program.
• Dance to your favorite music.
When you can’t afford a fitness center…
• Use household items for weights such as milk cartons or canned foods.
• Use your own body weight: squats, push-ups or sit ups.
• Join a walking group with friends.
• Find fun activities through a local community center.
When you feel tired…

• Try yoga, light weights or stretching—this will still help your balance,
strength and flexibility.
• Exercise early in the day.
• Start walking—you may start to have more energy with each step.

When it doesn’t seem fun...

• Do an activity while watching TV or a movie, reading a book or a magazine, listening to music, a book or podcasts.
• Consider it “play time” like kids do: play with the dog, play with grandkids.
• Try a new class or activity.
• Find a friend to be active with you.
• Help out a neighbor or friend with moving or housework.

 Get  Assistance if needed

If you need more support in starting an exercise program, consider a referral to a health and fitness professional. Your health systems cardiac rehabilitation or physical therapy programs may be good resources. Become familiar with other local resources. Senior centers and the YMCA may offer chair or water based exercise programs for your patients that have orthopedic or balance problems.
The tool, “It’s Never Too Late!” is a resource for older patients as well as those with health concerns.


Report your results!

At your  follow up  report any exercise-induced symptoms such as shortness of breath, chest pain, excessive fatigue or orthopedic concerns. Discuss your progress with exercise and to update their exercise prescription as needed. This is a good time to problem solve any barriers to exercise and help problem solve ways to stick with the plan.

About PCNA

The Preventive Cardiovascular Nurses Association (PCNA) is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals. The current state of health care demands that nurses and advanced practice nurses play a leading role in identifying and implementing cardiovascular risk reduction strategies. PCNA is committed to the continued education and support of nurses so they may successfully rise to this challenge. We do this by educating and supporting nurses through the development of professional and patient education, leadership, and advocacy.


  • To increase public and political awareness of the critical role nurses play in comprehensive cardiovascular risk reduction.
  • To promote individual and community education in cardiovascular risk reduction and disease management across the lifespan.
  • To provide opportunities for education and professional development for nurses.
  • To advocate for professional certification and development for nurses specializing in cardiovascular disease prevention and management.
  • To disseminate information on innovative, fiscally responsible models of cardiovascular care delivery.
  • To foster productive liaisons with professional organizations sharing similar goals.
  • To support the utilization and dissemination of research and support evidence-based practice in cardiovascular risk reduction and disease management.


Visit the American College of Sports Medicine’s Exercise is Medicine Web Site
for more resources and tips regarding helping your patients become and stay active!
Professional Resources: Assessment and Exercise Prescription

Based on 2008 U.S. Department of Health and Human Services Physical Activity Guidelines for Americans.

Exercise is Medicine for your Diabetes

If you have type 2 diabetes, regular physical activity is essential for controlling your blood glucose and managing your weight. Exercise also improves how well your body responds to insulin, which may reduce the need for medication because your muscle and fat will do a better job of taking glucose out of the blood.

Furthermore, exercise may help protect you against heart disease, which often accompanies type 2
diabetes, by reducing body fat, blood pressure and improving your cholesterol levels. It will help you better understand your diet and exercise if you closely monitor your blood glucose levels to  understand how you respond to different types of activities.

If the benefits of exercise could be put into a pill would you take it?

If so why would you take it? Most likely because you know that pill is extremely helpful.  It would make your muscles stronger, including your heart muscle thus decreasing risk of death from heart disease. It would lower your bad cholesterol, triglycerides, blood pressure and blood sugar, and increase the good cholesterol. It would improve your memory. It would slow osteoporosis. It would make you less likely to have falls. It would improve your mood and lessen symptoms of depression.

Exercise is Medicine!

Exercise does all this and more, however it is extremely difficult to get people to follow exercise advice or adhere to an exercise program? Why? Because taking a pill is so much easier, and maybe because the cost of medicine is covered by insurance. So many take such care to take medications, vitamins, eat healthier, but still find it difficult to adhere to medical advice to exercise. It could be do to the information out there seems conflicting, or too complicated.

Exercise the Diabetes Drug

You take your diabetes medications every day correct? Most people also have concerns about the side effects and the cost of their medication. Yet exercise is one of the best medications out their with minimal side effects. Just like most diabetes drugs it has to be taken regularly to get the benefits, and there is a specific dosage.

Frequency of use: 6-7 days per week.

  • This regulates the body, you need  a certain amount of energy to do this from your body and its energy sources (food and insulin). The more regular you exercise the less wild blood sugar swings.


  •  To a level that feels fairly light to somewhat hard, but not hard. Bring your heart rate up above your resting heart rate, break a light sweat, breath a little harder – yet be able to carry on a conversation

Time or Duration:

  • 30 minutes or more per day. It can be broken up or done all at once.


  • Aerobic – meaning continuous movement that requires oxygen – walking, biking, hiking, spinning, swimming, rowing, elliptical, recumbent equipment, steppers, tia chi, yoga, karate, pilates, belly dancing, dance classes, circuit training, cross country skiing, snow shoeing, kayaking, rollerblading, ice skating….you get the idea.
  • Resistance training – it doesn’t have to be heavy body building weight training, but working with your body as resistance, dumbbells, resistive bands, weight machines, free weights all help to maintain and build muscle. Try doing some sort of resistive training 2-3 days per week.

Side effects:

While there are many benefits to exercise for people with diabetes, it should be noted that there are several potential risks as well, including a worsening of eye complications in people with conditions such as proliferative retinopathy when doing specific exercises (such as weight lifting- with heavy weights that create a large amount of strain), hypoglycemia (low blood glucose), and hyperglycemia (high blood glucose).

Building the Routine

Most people take there medications at a certain time every day, brush their teeth at a certain time, go to appointments because they are scheduled at a certain time. Exercise needs to be scheduled and worked into the daily routine. What works for you? First thing in the morning? Most studies show people who exercise first thing in the morning are more likely to stick with the routine for the long haul. Can you develop a routine –  a walk after dinner, hitting the gym on the drive home from work, fifteen minutes at lunch and fifteen after work? Keeping a log helps, and be accountable to someone with the log, make sure you bring it to your doctors appointments and discuss.

Can you stick with if for the long-term?

It takes six months of exercise to establish a habit.

In medicine we talk about the stages of change

Where are you in the stages of change when it comes to exercise?


Mediterranean Diet: Follow the Pyramid

The recent study on the Mediterranean diet decreasing the risk of heart attack is all over the news and the emphasis seems to be on eating healthy fats and nuts. To me that is important but don’t overlook the vegetables.  The Mediterranean diet is rich in vegetables, legumes, nuts, whole grains which provide good sources of fiber.

While working in cardiac rehabilitation I regularly reviewed patients diets. One very consistent issue was lack of eating enough dietary fiber. Many do not get adequate intake of vegetables, legumes and seeds. It wasn’t uncommon for a significant other to shake their head and report their loved one never eats vegetables, or if they do it is only one or two types, such as corn, and carrots. When discussing intakes of legumes, you would see many look at you with that what is she talking about face. I don’t want heart patients to think of the Mediterranean diet as frying everything in olive oil being ok and skip the biggest part of the diet.  Make sure you follow the balance of the Mediterranean Food Pyramid. 

Note the largest portion of the pyramid is fruits, vegetables,beans,  legumes, seeds, nuts.


How do you get people to eat veggies?

I wish I had a dollar for every time I have heard someone say they don’t like to eat vegetables. Funny how often I would hear this while working in Cardiac Rehabilitation. Coincidence? I don’t think so. A healthy diet includes 5 servings a day of fruit and veggies, many people are ok with the fruit but entirely skip the veggies. Women are instructed to get 4 1/2 cups a day of vegetables for heart health. Children are picky and it can take years to get them to eat a variety of vegetables. Don’t give up!!! Keep trying new vegetables, new textures, new recipes.

Beans, dried beans, chick peas, soy beans, lentils, kidney beans.

All of these foods are chocked full of fiber and protein, and are loaded with nutrition including potassium, iron, magnesium, B vitamins. So how does one incorporate eating more legumes in their diet?

  • Add chickpeas, black beans or kidney beans to salads.
  • Mix lentils into your rice dishes.
  • Throw a handful into soups.
  • When making foods  such as sloppy joes, or tacos make with half the amount of meat and add in  a cup or two of pinto, black, white or navy beans.  
  • Hummus is a great way to incorporate legumes. Use as a dip for vegetables, put on a Wasa or Rye crisp cracker.  
  • Use beans as a base for casseroles.
  • Soups are a great way to add beans and legumes.  

If your beans are coming out of a can, rinse them first, this will reduce the sodium in them by almost half. Dried beans are very inexpensive, therefore try to get into a habit of one to two times per week soaking and cooking up a batch. A favorite snack may be roasted chickpeas. I like to season them up with olive  oil, cumin and chili peppers, but also use a Tuscon blend seasoning, or garlic and onion powder/salt. Lentils sprout very easily. Try putting a in a jar, cover with water, rinse with new water daily and in three days you will have lentil sprouts to add to your salads.  A side dish this week was roasted chickpeas, brussel sprouts and cauliflower. Roast each, but not until mushy, keep the crunch, then toss in a bowl with seasoning of choice and fresh parsley. Even the kids will eat this dish.

Your Strength Is Your Independence As You Age

Think about how hard activities can  become as you lose muscle. Activities such as getting up and out of a chair without using your arm strength, getting off the floor, walking up and down stairs while carrying objects, carrying in groceries from the store, maintenance of your home, lifting or holding a grandchild. These are concerns patients I have worked with bring to me. Things they would like to do but don’t have the strength to handle. 

My answer is building muscle, which we can do at any age. I have had people with heart disease in their 90’s working with weight machines. I start most with dumbbells or soup cans and build them up to exercises using their own body for resistance, then if able get them to the weight machines. The results are not always noticeable in the physique, but rather in the abilities to do perform activities of daily living. As we age we develop many orthopedic – bone and joint issues which limit ability to do traditional strengthening exercises – such as weight machines. Don’t let that stop you from performing strengthening exercises. There are many ways to work around the barriers. Find an ACSM certified exercise specialist in your community to assist you, or a physical therapist. Work these exercises into a daily routine, not just a quick fix for a particular issue. Stick with these exercises, if you have to stop, so be it but build them back into your routine as soon as possible. Your body will thank you!

The Diabetes and Heart Relationship

How does diabetes increase my risk for heart problems?

Both type 1 and 2 diabetes accelerate the progression of artherosclerosis – hardening of the arteries.  Having type 1 diabetes increases the risk for heart disease 10 fold. Heart attacks account for 60% of deaths in patients with diabetes while strokes account for 25% of deaths. Nearly all patients with type 2 diabetes have developed resistance to their own insulin, their pancreases churns out insulin which is a critical hormone in an effort to move glucose into cells, but it is more than the cells can utilize. High levels of insulin in the blood causes damage to the lining of blood vessels that leads to atherosclerosis. Hardening  of the arteries occurs and  sets the stage for plaques  to build.   Evidence shows that patients with diabetes have an increased level of low-grade inflammation of their arterial lining, a process that initiates the blood vessel changes leading to heart disease. Some of the increased susceptibility to blood vessel damage that people with diabetes have  is due to the long-term effects of inadequate control of blood glucose levels on the tissues or as a result of other cell damage related to diabetes.  A chemical reaction between glucose and proteins  exists in the body  to produce compounds called advanced glycosylation endproducts, or AGEs.  Diabetes increases the amount of glucose in your blood that’s available to be glycosylated, people with the disease tend to have high concentrations of AGEs. These compounds  damage arteries, making them more likely to create blockages, in addition to increasing the risk for a long list of other common diabetes complications.

Know your numbers

In the last 10 years, large-scale research studies around the world have shown that optimal control of LDL cholesterol (the “bad” cholesterol) and blood pressure can prevent adverse cardiovascular outcomes by 30% to 50%. The American Diabetes Association and the American Heart Association recommend an LDL cholesterol goal in all adults with diabetes at less than 100 mg/dl. In people who already have heart disease, a more desirable LDL cholesterol goal should be less than 70 mg/dl, based on evidence from more recent studies.

At least half of patients with diabetes have hypertension – high blood pressure. Chronically elevated blood pressure forces your heart to work too hard, which may cause it to weaken over time. High blood pressure also increases wear and tear on the arteries. The blood pressure goal in all patients with diabetes is less than 130/80. In most patients with diabetes, reaching these targets for blood pressure could require two or more medications. With diabetes, high blood pressure  usually develops if the kidneys become damaged. Kidney disease (nephropathy) is a very serious complication of diabetes. With this condition, the tiny filters in the kidney (called glomeruli) become damaged and leak protein into the urine. Over time this can lead to kidney failure. Urine tests showing microalbuminuria (small amounts of protein in the urine) are important markers for kidney damage. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD), occurs in about 20 – 40% of patients with diabetes.

Hemoglobin A1C tests— measure of average blood glucose levels over the preceding two to three months—the goal is less than 7%. Intensive control of blood glucose and keeping glycosylated hemoglobin (HbA1c) levels below 7% can help to prevent complications due to vascular (blood vessel) abnormalities and nerve damage (neuropathy) that can cause major damage to organs, including the eyes, kidneys, and heart.

A healthy eating plan, exercise and medications are the cornerstones of managing diabetes.

Blood sugar regulation through monitoring the diet and exercise  and the relationship to blood sugars levels is what diabetics need to understand to decrease the risk of heart disease. Exercise should be viewed as a medication with the goal of getting the proper dose every day to get the sustained benefits. The more regular one is with exercise the better one can control their blood sugars. Exercise requires close monitoring of blood sugars. They should be measured before, occasionally during and after exercise.

When not to exercise

If your fasting blood glucose is more than 300 mg/dl, no matter what type of diabetes you have, it is in poor control. It may be best to bring your blood glucose level back down or to check with your health care provider before exercising. If you decide to exercise, use caution. Make sure you are negative for ketones and re-check your blood glucose to make sure it is dropping in 10-15 minutes. Drink plenty of water, this can’t be emphasized enough the water helps to “wash out” the ketones from the blood stream.

If you have type 1 diabetes and your blood glucose results are 250 mg/dl before exercise, stop and check for ketones. If you have moderate or large amounts of ketones, do not exercise. Ketones are a sign that your insulin level is too low. Exercise could cause the body to make more ketones.  Ketones add acid to the blood. When too many ketones are produced, they disrupt your body’s chemical balance. This can be  very dangerous. Wait until your tests show negative or trace ketone levels before beginning to exercise.

If your blood sugar is lower than 100 before exercising it is considered too low to safely exercise. Exercise uses the circulating blood sugars to provide sustainable energy for the muscles to function. When the blood sugar drops too low this can be extremely dangerous.  The recommendation is to eat a snack containing carbohydrates and protein 30 minutes before the exercise to sustain prevent the blood glucose levels from crashing. If the exercise is prolonged greater than 30 minutes or symptoms develop such as profuse sweating, shakiness, vision changes, nausea, angina it is best to  stop and check the glucose levels again. Some will require a small amount of carbohydrates during the exercise to sustain the blood sugars above 100. If blood sugars repeatedly drop with exercise a medication adjustment may be required and this should be discussed with your healthcare provider. This is a common issue especially as one becomes more fit. Again many pre-diabetics or type 2 diabetics are able to reduce or stop medication through exercise and diet.


Smoking cessation in old age: Less heart attacks and strokes within five years

It is never too late to stop smoking. Even if you have heart disease, by stopping smoking now you lower you risk for further heart issues. Here is a recent study to support stopping tobacco to help your hearts health.  

Feb. 20, 2013 — Professor Hermann Brenner and colleagues analyzed the data of 8.807 individuals aged between 50 and 74 years using data of Saarland citizens. “We were able to show that the risk of smokers for cardiovascular diseases is more than twice that of non-smokers. However, former smokers are affected at almost the same low rate as people of the same age who never smoked,” says Brenner. “Moreover, smokers are affected at a significantly younger age than individuals who have never smoked or have stopped smoking.”

The study shows that the positive effect of smoking cessation becomes noticeable within a short period of time. “Compared to individuals who continue smoking, the risk of myocardial infarction and stroke is reduced by more than 40 percent already within the first five years after the last cigarette,” says Carolin Gellert, first author of the study. The results suggest that smoking cessation programs, which have concentrated on younger participants up to now, should be expanded to reach out to older people as well.For example, a 60-year-old smoker has the same risk of myocardial infarction as a 79-year-old non-smoker and the same risk of stroke as a 69-year-old non-smoker. Dose and duration of tobacco consumption also have an impact on disease risk. The more cigarettes a smoker consumes per day over a prolonged period of time, the higher his or her risk raises.

Last year, Hermann Brenner and his colleagues had already studied the impact of smoking on the overall mortality of people beyond the age of 60. They had used data from international studies without German participation. In their latest study, they have evaluated data from the so-called ESTHER Study whose participants are from Saarland, a state of Germany. They included those individuals who had not suffered a heart attack or stroke prior to study start and whose health status had been surveyed for up to ten years afterwards. In their evaluation, the scientists also took account of the effects of other factors such as age, gender, alcohol consumption, education and physical exercise as well as blood pressure, diabetes, cholesterol levels, body height and weight.

Smoking cessation in old age: Less heart attacks and strokes within five years.