Getting fit for purpose?

Br J Cardiol 2008;15:137–8 Leave a comment
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We continue our series in which Consultant Interventionist Dr Michael Norell takes a sideways look at life in the cath lab…and beyond. In this column, he considers how cardiologists can stay in shape.

Having only just survived a near lethal skirmish with Influenza Hominis Gravis (IHG – The Oblique View, passim), I am currently in the process of getting back to a reasonable physical condition. It is a sobering fact that excesses of salt, sugar and fat, combined with the relatively sedentary elements of the modern era, require us to expend calories in order to extend our life expectancy or, failing that, at least squeeze into a suit we bought three years ago.

Choosing your weapon

But which energetic pursuits are available to the jobbing cardiologist? What activities are practically accessible and, more importantly, available on a regular basis in order to compensate for any calorific excesses? You can discount pastimes such as sailing or skiing for a start. While I can envisage nothing more pleasurable, I doubt that bending, kneeling, ducking or attempting to stay vertical when all around you are most certainly not, can be regarded as any form of exercise. Add to that being wet through, frozen and ejecting your breakfast by the same route by which it entered, and I think a case can be made against either hobby (the description could be applied to both) producing weight loss, let alone aspiring to the Olympian vision of svelte.

During one ski holiday I tried ski de fond, that rather awkward looking, cross-country technique, popular in Scandinavia and apparently excellent in terms of promoting all-round fitness. Indeed, only one thing was more difficult to accomplish, and that was using the ski-walker machine I bought on my return from the trip. Involving a complex system of pulleys and flywheels, it requires the victim (sorry, user) to slide each foot forward in turn while pulling with the ipsilateral arm. The resistance to both lower and upper limb actions can be adjusted, and the natural tendency to fall flat on your face is prevented by leaning against a padded support cleverly positioned in front of the pelvis. The pleasure derived from the use of such a contraption is more from avoidance of serious injury to you (or a fascinated household pet standing nearby), or damage to adjacent furniture, than from any weight reduction.

Keeping pace

So then, how about running? (Jogging is the same but allows you to keep up a conversation at the same time.) I have found this to be the most reliable and trusted method of achieving at least half of the ancient ideal of mens sana in corpore sano. This oft used quotation from Decimus Junius Juvenalis (55–127 AD), a Roman poet and satirist, frequently adorns the entrance to the male changing room in health clubs. Loosely translated, it reminds us to shower before entering the steam room.

When living in London I used to run round the outer circle of Regent’s Park (2.75 miles, by the way) at least twice a week and particularly recall the sense of triumph one evening when this was accomplished in under 20 minutes (just!). The Royal College of Physicians, London Zoo and the Mosque are all fondly remembered landmarks. The US Ambassador’s residence would frequently prompt a burst of speed because a friend with whom I ran would tempt fate by muttering something like ‘rocket launcher’ as we jogged past, knowing full well that high frequency surveillance microphones were bound to pick up our conversation.

Sadly, neither homo sapiens nor homo erectus were designed for the incessant pounding of Nike Air soles on pavement; the knees, back and neck eventually lose what cushioning properties they once had (if any). So the search began for a non-impact alternative.

Low-impact options

Swimming was hopeless. Yes, I can swim but not in a steady, sustained and rhythmical manner that can be kept up for longer than a few minutes in order to promote the loss of unwanted poundage. It was always the breathing that let me down. How swimmers manage to allow air and nothing else, to enter one side of their mouth while the other side of their face is submerged, I will never know. Maybe I’ve just got an ultra-sensitive uvula …

I used to play a bit of squash, but because I preferred tennis I was never particularly good at it. I, as well as the ball, would bounce off walls and I remember one occasion when my opponent paused halfway through our game to put on a sweater. Another (if he is reading this, he will know who I’m talking about) would always whack the ball at my rear end if I happened to stray inadvertently between him and the front wall.

Similarly, golf, while involving four hours’ walk (minimum) in the open air, at least for me, failed to supply the necessary ‘fat-burn’. This was no doubt because of its relative infrequency, and ‘downtime’ while looking for lost balls – or lost clubs.

And so to cycling. Here was a pastime that not only promoted fitness but also had functional value. Nothing could beat riding to work on country lanes in East Yorkshire during the summer months. On arrival, the donning of cath lab blues after a shower solved a number of the more practical issues. However, having to schlep home again, after a long day in the lab, admittedly tempered some of my enthusiasm. Nevertheless, while I continue to cycle through the countryside of the Shropshire-Staffordshire border, the logistics of the Wolverhampton ring-road and my lack of cycle-sense in heavy traffic, mean that this remains only a recreational pursuit.

Mine is a hybrid, combining road and mountain-bike capability. However, I quickly found that straying onto canal towpaths or bridleways resulted in repeated punctures and walking a mile and a half with a bike slung over my shoulder was not a habit I wanted to get into. So, as I cannot be bothered to repair such lesions, and wouldn’t know what to do anyway, the occasional foray onto the pavement is as much off-road as I do.

The Gym-bunny look

What about the gym? I guess this requires you to be comfortable exercising ‘in company’, but it is not for everyone. Wearing fashionable kit seems to be important, so the combination of plimsolls, an old pair of pyjama trousers and a T-shirt with ‘Jesus Saves’ on the front and ‘Green Shield Stamps’ on the back, is right out. I cannot help feeling a little self-conscious sitting on an exercise bike in a bank of 20 others, multiplied again by the surrounding walls of mirrors, trying to work out which button controls the resistance, incline or specific exercise ‘profile’.

The rowing machines are undoubtedly impressive in their ability to perk up one’s cardiovascular reserve and can also provide stroke-by-stroke data on the calories expended. Becoming delirious with exhaustion, I approach the two kilometre mark thinking to myself, “so that was last night’s spaghetti, and now this is this morning’s pain au chocolat”.

Next to the weights and the other more complicated engineering designed to work on and strengthen individual muscle groups. For some reason mirrors are essential here, presumably to ensure that the correct – if presumably, underdeveloped – myofibrils are actually getting the desired amount of attention. I have never been particularly bothered about my gemelli being toned (look it up), so am happy to give this particular part of the circuit training a miss.

Mans’ best friend

As I complete this article, my loyal canine companion Nelson, a Weimaraner, looks up at me dolefully and reminds me that his daily three-mile trek through woods and fields is now well overdue. Perhaps that is the answer; a regular combination of a mile or two’s run, a brain numbing 20 minutes on my rowing machine and a daily walk with you know who. Yes, that’s it – jog, slog and dog – it has got to be better than dieting.