"Those who think they have not time for bodily exercise
will sooner or later have to find time for illness."
Edward Stanley, Earl of Derby
(from Conduct of Life, address to Liverpool College, 20 December, 1873)


   We are seeking perfect health--a fit, active, vigorous body with a highly efficient cardiovascular system, keen faculties, strong sex drive, disease-free, resistant to effects of heat and cold, stress, germs and viruses, with good digestion, elimination and stamina, and which will stay in that condition for a hundred years or so.

   Some people, despite a sedentary lifestyle, have lived healthy, long and productive lives, having maintained the integrity of their bodies' tissues and vital organs by prudent eating and other sensible lifestyle habits. Others too have lived long, healthy and productive lives despite poor dietary habits, the integrity of their bodies having been maintained pretty well by a lifetime of regular physical activity. The longest lived people studied in the world are usually found to be those whose way of life has provided them with simple food, regular outdoor exercise, and freedom from stress.

   While it is now common knowledge that physical exercise cannot prevent artery disease, and indeed may even precipitate a heart attack in those with blocked arteries, there is no doubt that regular exercise, by improving the circulation of the heart and the rest of the body, and by improving the general metabolism, particularly the metabolism of blood fats, will enhance health and provide strong protection against all disease.

   The desired standard of physical fitness is brought about by what is called the "Training Effect" and the body is said to be "in condition". While some people's day-to-day activity maintains this standard, most will need to deliberately increase their physical activity in order to achieve it.

Types of exercise and exercise programs

   There are different ways in which a person can exercise, which are given specific names.

  1. Isometrics is when muscles are contracted without producing movement; this does not require much oxygen. Muscle can be developed this way as in body-building, and when used by bedridden patients, wasting of muscles can be prevented. Isometrics do not achieve the training effect.
  2. Isotonics contract muscles and produce movement, such as calisthenics or weightlifting. The oxygen requirements are low and training effect is negligible.
  3. Anaerobics produce movement but are either not vigorous enough or too brief in duration, and not much oxygen is processed. Walking short distances or sprinting for brief periods are forms of anaerobics. Training effect is negligible.
  4. Aerobics are a form of continuous exercise which demands oxygen but not to the extent of forcing the participant to stop. He can go on and on with the lungs supplying all the oxygen needed. This is known as "endurance" exercise and this is what we need to produce the "training effect" in our bodies. This is what we want.

   The type and level of activity you should undertake depends on your physical condition at the outset. There are a number of books on the subject and as with books on diet, they vary considerably in their advice. The reason that they vary is because the authors have different conceptions of what fitness is. Here is one definition:

   "Fitness is a condition of the body (and mind) which enables it to perform its assignments efficiently without undue strain or fatigue, with adequate reserves."

   What are the assignments? What do we want? Some people think fitness is having a lean body. A lot of nutrition-minded people think that way. Others consider a well-proportioned muscular body as fitness. Reasonable diet and isometric exercise for a few minutes a day can achieve this. To others a further requirement is a certain degree of agility and skill. Isotonics will produce this. A further requirement again may be sprinting or jumping ability--anaerobics.

   We are getting closer, but read again the opening paragraphs of this chapter. That is what we desire, and the surest way of achieving such a high level of fitness is a program Of regular fairly extended exercise--aerobic or endurance exercise.

   In 1958 the Canadian Air Force produced the famous 5BX exercise program. It is based mainly on calisthenics which when performed together with stationary running in an eleven-minute time limit will improve the fitness of a sedentary person to a reasonable standard. Done property it becomes aerobic exercise and three times per week is claimed to be sufficient.

   My brother, at age 42, said 5BX was wonderful as it enabled him to surf three hours straight, several times a week. I pointed out to him his surfing activity was aerobics and in itself produced his high fitness level. He dropped 5BX and surfs and walks instead, still fit at 70.

   A recent bestseller, Total Fitness in 30 Minutes a Week (1975) by Professor L. Morehouse, Professor of Exercise Physiology and Founding Director of the Human Performance Laboratory, University of California, claims that three 10-minute sessions per week of not very vigorous exercise will achieve fitness. The opening page says:

   "Our thanks to those men and women who voluntarily exercised to exhaustion in physiology laboratories to establish that a desirable level of fitness can be achieved without strain or sweat."

   That sounds pretty good, but what is a desirable level? Professor Morehouse says we need a certain amount of muscle strength and endurance in order to live well and carry out our daily activities effectively and without fatigue. A good definition?

   Yes, but is it good enough?

   The standard of physical fitness described by Professor Morehouse in his book as being desirable may be high compared to the average level among the population, but is not up to the standard we are seeking.

   The proof of any pudding is in the eating. The only proof in the world in the field of longevity is to be seen by the study of those centenarians around the world still enjoying happy and vigorous life. There are many of them and most follow a lifestyle containing two common denominators:

  1. Simple wholesome food habits.
  2. A lifetime of regular exercise, whether at work or at play.

   "Fitness is a desirable state for anyone who wants to lead a zestful and productive life and realize his full potential." So says Lt. General R. L. Bohannon (USAF ret.) in the introduction to Kenneth Coopers' Aerobics, first published in 1968 with many reprints since.

   Aerobics (the word means sustaining life by the burning of oxygen) describes the relationship of endurance exercise with fitness and freedom from disease. In that book Cooper coined the term "Training Effect".

   Copper, while in the US Air Force, was the first to scientifically evaluate the effects of aerobic exercise on over 15,000 people. Leaving the Air Force he established a clinic and research center at Dallas, where he has since evaluated and instructed many thousands more.

   The physical training must be regular (at least four times a week), sustained and reasonably vigorous. We must burn oxygen with our effort, requiring the lungs and heart to maintain a high output. The heart deepens its stroke and increases its rate, blood and lymph circulation is boosted. Long vigorous walks, jogging, cycling, swimming or other such endurance exercise, preferably daily, are best. It should be carefully graduated initially because not only may the heart overload, but creaking knees and ankles must be strengthened as well.

   It is the extended processing of oxygen for muscular energy and the rate of oxygen consumption which produce the training effect.

   Major (later Colonel) Cooper devised a point system based on evaluating oxygen consumption with different forms of exercise related to time. It is all in the book. Thirty points a week are required to maintain a good standard and those points can be picked up in any number of combinations of different exercises. For instance, 1 mile walked or run in under 14.5 minutes gets 2 points, in under 12 minutes gets 3 points, in under 10 minutes, 4 points and so on. By comparison, swimming 500 yards in under 12.5 minutes gets 4 points. A popular workout for joggers is to run 1.5 miles in 12 minutes or less for 7.5 points. Four times a week give 30 points in 48 minutes total running time. Incidentally, 1.5 miles in 12 minutes is the pass rate in the Air Force test.

   Less is demanded of women (1.35 miles) and less with age. After 50 a man passes with 1.25 miles and a woman with 1.05 miles in 12 minutes. There are lots of men over 50 who can make 1.75 miles, the excellent rating for young men. When you get into shape you will find at 12 minutes you are just warming up.

   Nathan Pritikin called his exercise system "roving". Roving is essentially aerobic or endurance exercise but it is not done on a strictly calculated basis. You walk or run as you feel, starting perhaps with a couple of blocks, and with improved condition, extend to 6-10 miles. Many patients at the Longevity Center who at first could walk only a few yards, have improved over a four week period to accomplish 10 miles a day. It is never too late to start.

   The 10 fundamentals of roving are.

  1. Distance is important, time is not.
  2. Select a distance to suit yourself.
  3. Rove that distance four or five times a week.
  4. Start slowly to warm up.
  5. Increase your distance only when you are ready.
  6. Use the heart recovery test as a gauge to slow down or speed up.
  7. Give yourself variety.
  8. Don't strain or compete against people or time.
  9. Always enjoy your roving.
  10. The program is for everyone, young, old, male or female.

   Thus, the roving program is not very demanding, it is strictly on the safe side having been designed around people in pretty poor condition.

Heart recovery rate

   After exercise the heart rate gradually slows down to its normal rate. The quicker it returns to its resting rate, the better is the fitness level. If the rate remains elevated too long it indicates the exercise has been too strenuous. You can check your heart recovery quite simply.

   At the completion of the exercise--

  1. Sit and rest for one minute.
  2. Take pulse rate. Count for 30 seconds and double that count.
  3. If more than 130 the exercise was too strenuous.

   A count of 100 indicates a good level of fitness.

   For "high risk" patients, jogging is not recommended because of the possibility of plaque breaking loose within an artery. This is possible with jarring or exaggerated movement and is thought to have precipitated Bing Crosby's heart attack while playing golf.

   The roving program suggests working up the distance to 6 miles. If you took 1 hour 50 minutes for 6 miles which is very easy walking, you earn 6 aerobic points. So if you did that 5 times a week you would get 30 points and it would take a total of 9 hours.

   The two systems seem to agree, and their results are thoroughly proven. They are based on facts documented years ago by physiologists such as Dr Wilhem Raab in his book The Prevention of Ischemic Heart Disease (Chas. Thomas, Springfield, Illinois, 1966) and by Professor Thomas Cureton, University of Illinois Physical Fitness Research Laboratory, in his book The Physiological Effects of Exercise Programs on Adults (Chas. Thomas, Springfield, Illinois, 1969).

   When the physiological effects of exercise are understood, it can be seen that the main advantage of the training effect is that fat metabolism is more efficient both at rest as well as when exercising.

   Even when not actively exercising, a fit person burns more fat in his body and his basal metabolism is high compared to an unfit person. Such people require less clothing to keep warm even though they have less body fat. Kenneth Cooper, while in the Air Force, conducted an experiment with two groups of men, one group physically trained, the other untrained, to observe their metabolism of fat. All the men consumed 1.5 pints of cream for breakfast, nothing else, and through the day blood tests were made. All the men's blood became infested with fat droplets but the trained men's blood cleared in four hours whereas the blood of the unconditioned men took up to 10 hours to clear.

   On the other hand, vegetarians, without the high levels of fat and cholesterol in their blood do not need to the same extent, the protection of the training effect.

   This then raises the point--what is the ideal amount of exercise?

   Our object is to achieve optimum health through optimum body chemistry. We want our body cells perfectly nourished and cleansed, because it is at that level that health is determined. With healthy nourished cells supplied with lots of oxygen, there can be no disease.

   This ideal condition can only be achieved with a pure, healthy bloodstream. This is the vital factor.

   A low fat, vegetarian diet achieves this pretty well by avoiding toxins and high fat levels to begin with. Aerobic exercise helps to achieve this by burning excess blood fats for fuel.

   Live cells can be kept in glass jars in laboratories in healthy condition providing the fluid medium in which they reside is kept pure and provides the cells with all their nutritional requirements, oxygen, and freedom from toxins. It is feasible then that a diet may be possible allowing perfect body chemistry without much exercise but it is very obvious that the more "improper" a person's living habits may be, the more vital physical exercise becomes.

   Assuming you are a typical American or European having always consumed a Western type diet, your arteries will not be in good condition, so not only do you have to clean your blood, you must clean the linings of your arteries as well. The more carefully graduated endurance exercise you get, in conjunction with a low fat/cholesterol diet, the faster will this be accomplished. In the absence of excess fat in the blood, the fatty atheroma choking the artery walls is gradually reabsorbed and used as fuel.

   It should be remembered too, that the incidence of cancer among athletes is only one-seventh that of the general population.

   So the answer to what is the ideal amount of exercise could vary greatly, depending on a person's overall lifestyle. It will be recalled that some of the centenarians studied by Dr de Lacy Evans had sedentary lives. The author, who spends most of his life reading and writing, maintains a good level of fitness by long hours of outdoor manual work on his steep Mountainside fruit orchard. This is in contrast to the 40 miles a week I used to run, and which for my purposes was probably excessive. The fittest I have ever felt has been on the occasions in my life when I have indulged in extended periods of hard manual outdoor work.

   What we do know is that many people suffer from a lack of exercise and that rarely do people suffer from an excess of it.

   Perhaps hours of "roving" may be the ideal if you have the time and the inclination, but on the other hand the more vigorous Cooper aerobic system works very well for those with less time to spare.

Physiology of exercise

   Energy for muscular exercise is supplied by fat and carbohydrate oxidized in the muscle tissues. Fat is stored throughout the body in convenient places and in body cells as well, whereas carbohydrate is stored in the liver and muscle tissues as glycogen derived from blood sugar (glucose). Fat is a much more compact fuel than glycogen as it contains twice the amount of potential energy as glycogen.

   Thus body fat is the main form of stored energy, and for levels of normal activity it supplies the bulk of the body's muscular energy, together with some carbohydrate. So much energy is contained in fat that even lean people have sufficient for days of activity even when deprived of food.

   Blood sugar contributes to energy production by the muscles and continually enters the bloodstream from the intestines while there is food being digested. That which is excess to normal blood levels is stored by the liver, and what cannot be stored converts to fat. The primary use of blood glucose is for fueling the cells of the brain and nervous system, which use glucose exclusively, and rely entirely on the level available in the blood. When glucose is not available from the digestion of food, the liver maintains the correct level in the blood by converting glycogen back to glucose and releasing it.

   The ratio of fat and carbohydrate used by the muscles varies with the intensity and duration of the exercise performed.

   The purpose of muscle glycogen stores is--

  1. Glycogen can provide bursts of maximum energy quickly, without using inhaled oxygen (anaerobic exercise). These bursts must be of only brief duration because with insufficient oxygen for complete combustion, lactic acid is formed which prevents further muscle activity. Pain may occur, but the lactic acid quickly clears when the exercise is reduced.
  2. Glycogen, containing some oxygen itself, can provide more aerobic energy for a given amount of inhaled oxygen that can fat. Aerobic exercise at low and medium levels can be sustained mainly by fat but as the exercise intensity increases, the oxygen available becomes limiting, and more glycogen is called upon. With intense sustained exercise, glycogen becomes the major energy source but the effort can be sustained only until the glycogen runs out.

   Thus for our purpose of achieving a clean bloodstream and clean arteries and optimum health, it can be seen that moderate aerobic exercise is ideal because we are concerned with fat metabolism, particularly if not maintaining proper dietary habits.

   Two well-built people can stand side by side, both in apparently good physical condition, and yet one may be dreadfully unfit and the other capable of running a marathon. Somewhere inside their bodies they are very different, and recent findings from several Scandinavian sources explain what this difference is.

   Dr J. P. Clauson and Dr Bengt Saltin took physically untrained subjects and on each one selectively trained different limbs, leaving other limbs untrained. When tested for cardiovascular function, the subjects revealed impressive improvement when the test involved the use of the trained limbs, and little improvement if the test involved use of untrained limbs.

   Thus it was shown that most of the improvement in general metabolic function, i.e. training effect, is specific to those muscles which have been exercised by the training.

   Two other experimenters, Dr P. Anderson and Dr Henriksson, demonstrated that the muscle tissue changes with training. Biopsies taken after eight weeks training showed in the muscle tissue an increased level of enzymes which play a part in the utilization of substrates and the release of energy. At the same time, the content of energy substrates in the muscle cells and the density of the capillaries supplying the muscles with blood had increased.

   Comparison of the responses when testing a subject with one "trained" leg and the other "untrained", demonstrated some of the metabolic consequences of training. At rest or when exercising there is an increase in the amount of fat oxidized by the trained muscles and a corresponding reduction in the amount of carbohydrate oxidized. Thus glycogen is conserved and exercise potential increased. The untrained muscles release lactic acid which indicates incomplete combustion due to insufficient oxygen, and are more prone to discomfort or pain.

   Thus the primary changes in training are improvements in the chemistry of the muscle cells and in the capillarity of the vascular bed--the blood supply--of the muscle. These adaptations ensure that the cells of trained muscles can extract oxygen from the circulating blood more completely--removing say, two-thirds to the available oxygen instead of half. These metabolic improvements also reduce the local concentration of certain intermediary metabolites. It is this concentration which determines the calibre of the blood vessels supplying the muscles and hence the volume of blood they receive. Accordingly, the muscles need and receive a smaller blood flow than before training, and therefore place less demand upon the heart.

   The main aspect which affects a person's muscular endurance for vigorous exercise is the amount of glycogen (carbohydrate) stored in the muscle tissue. This varies not only with training but is greatly dependent on diet. It was described in Chapter 15 how athletes on a high complex carbohydrate diet displayed three times the endurance as athletes on a high protein and fat diet. All champion athletes of the present day require the high natural carbohydrate diet to attain their performance.

   Although fat alone provides energy, when a runner's leg muscles run out of glycogen he can no longer run. Similarly, when a boxer's arms run out of glycogen he may scarcely be able to raise them although his legs are still okay.

   Sometimes an athlete will run out of liver-stored glycogen as well, resulting in an immediate drop in blood sugar and consequent irrational behavior. The blood sugar level can be almost immediately restored by eating some food, but the glycogen stores may take hours and several meals to replenish. Depleted muscle glycogen stores may take from 10 hours to several days to replenish.

   Exhaustion of glycogen stores occurs only when exercise is taken to extreme limits and rarely happens to ordinary people on a reasonable fitness program.

   In summary then, the training effect--:

  1. Increases the capacity of the trained muscles to store glycogen.
  2. Increases the efficiency of fuel combustion.
  3. Increases the capacity of the muscle to utilize fat, thus sparing glycogen and increasing maximum potential.
  4. Increases oxygen available for fuel combustion by way of improved blood supply.

   This information explains a few anomalies. Such as why a swimmer with a high degree of cardiovascular fitness may not indicate that degree of fitness if tested by the 12-minute running test or a treadmill test. It explains why some thin and wiry people are stronger than others with bulging muscles. Also explained is how Cooper's trained men metabolized the heavy cream in four hours. The lower blood pressure of trained individuals results not only by virtue of better circulation and lower blood viscosity but also because less blood flow is required.

   It becomes apparent that for optimum fitness, all muscles should be trained, for instance swimming and running may be better than just one or the other.

   Sometimes physical training causes false symptoms of disease:

  1. Athletes generally have greater numbers of red blood cells in their bodies but because their total blood volume is greater as well, the concentration of red cells in the blood is lower (ie lower than what is considered normal)--Because of this lower concentration they may be mistakenly assessed as anemic.
  2. Sometimes hepatitis is mistakenly diagnosed when blood enzymes levels are elevated following vigorous exercise.
  3. When blood sometimes appears in the urine of athletes after strenuous exercise, kidney disease is suspected. This is not uncommon and usually disappears within two days.
  4. It was described in Chapter 12 that 25% of athletes over 40 display heart irregularities when tested on a stress ECG. Whereas these irregularities are considered sometimes as false symptoms, it is very likely that on the wrong diet, no matter how fit, a person will have some degree of coronary artery blockage. Thus I suggest such irregularities should not be regarded as a false symptom and that proper steps are taken to correct the situation while at the same time extremes of exercise are avoided.

   Overtraining by zealous athletes can be highly stressful and occasionally cause debility and fatigue and they become susceptible to infection. On rarer occasions runners collapse and sometimes die of cardiac fibrillation when attempting strenuous feats of endurance. They are usually men approaching middle age subsequently found to have cardiovascular disease. Such men have the misapprehension that strenuous exercise conveys. Immunity to heart attacks, whereas a correct diet and a much less strenuous exercise program would have achieves their purpose.

General discussion

   Neither 5BX nor Total Fitness in 30 Minutes a Week mention diet and its relationship to heart disease.

   Professor Morehouse includes a chapter titled "Why Cardiologists Exercise", In the first paragraph he says: "cardiologists theorize that a well conditioned heart will have more capillaries to take over if and when there's a stoppage of blood vessel". I would like to point out that this is not a theory. Collateral circulation has been shown over and over again to develop as a result of exercise. It will develop without exercise to some extent to help a blocking artery, but exercise brings about a vast improvement.

   To what extent a person living all his life on a low fat, vegetarian diet needs to exercise for best results I do not know. We do know that the fittest oldest people in the world eat simple food and exercise a lot.

   Whereas, in our civilization, women outlive men on the average by about five years (due probably to the more debilitating lifestyles of our men generally), in Hunza and among the primitive Eskimos, the men (who are more physically active) outlive the women by about five years.

   Getting back to ordinary folk. Regardless of what they have appreciated from the chapter on nutrition, I somehow doubt that many people, unless they have been frightened already, will at once relinquish their favorite foods. That is their business, but it should be registered very clearly that aerobic exercise is the second line of defense against degenerative diseases, and therefore should not be skimped. I think it is a rule of life that you get a reward only commensurate with your effort in the long run.

   Quoting from Aerobics Major Cooper says:

   "This program has been tested to exhaustion, by the most modern means available, both in the field, and in the laboratory. And it has been proven several thousand times over in the only place it really counts--in the human body. There's only one problem remaining. I can give you the program, but I can't do it for you. You have to do the rest. It isn't easy, but it works. Keep this in mind whenever you think about quitting: it's medically sound and it works."

   It works all right, as anyone who has seriously tried it knows. The writer checked his medical records back to 1945 and sure enough with passing years the blood pressure figures showed the "normal" increase. From the commencement of training in 1969 the trend reversed and blood pressure soon fell to 114/70, resting pulse rate 42, same as at age 2 1.

   There are many intent people who mistakenly consider themselves in good shape but are nowhere near it, and confusion arises when occasionally one of them keels over. Sometimes it may be someone jogging or playing squash, Unless a good standard has been attained and a prudent diet followed, such exercise could be dangerous. Playing squash requires a high fitness level, and the amount of squash played by most people is insufficient to achieve or maintain such a level.

   Gadgets, weightlifting, touching toes, social tennis, golf, sailing and gardening may make you look fit on the outside, are beneficial to some extent, as indulged in by most people, but they may not achieve the desired training effect.

   Side benefits of exercise accrue gradually too. Toned up postural muscles prevent back strain and "slipped discs" and many common ailments accepted by most people as normal, just do not happen any more, eg. indigestion, constipation, colds, fatigue etc. and although exercise may take up an average say of 30 minutes a day, fit people have more spare time because they need only six or seven hours' sleep.

   Cooper also described many more dramatic recoveries from disease such as ulcers, glaucoma and emphysema achieved by endurance training--one USAF fighter pilot who was finally reinstated to operational flying status, having been grounded with heart trouble.

   There are many recorded cases of recovery from heart trouble achieved by physical training. The most spectacular, in Australia anyway, must be that of Norman Cutter of Adelaide, who suffered a severe coronary attack at age 47, and who, completely fed up with being a permanent invalid, embarked on his own training program. Some years later he demonstrated his renewed self in a non-stop ascent (by stairs) of the AMP Building in Sydney, and later in a non-stop ascent of the Empire State Building in New York. At the age of 59, he raced a 21-year-old Adelaide football player up the tallest building there (22 floors), beat him by one floor. He says it is a good idea to avoid heart attacks; they are not much fun.


The effect of training on heart and circulation and its importance in 
preventive cardiology

Systolic blood pressure in or, average population as compared with that 
of well-trained sportsmen (5) (Courtesy of Dr D. Steinkopff, Darmstadt, 1956)

Exercise, training and cardiac stroke force

Three series of ball istocardiograms consecutively recorded: (1) from 10 
untrained students aged 18 to 2 1; (2) from 10 NCAA championship finalists 
in middle and long distance races in Austin Texas, 1958; and (3) from 
10 middle-aged ex-athletes who eight and more years ago had performed on a 
level comparable to that of the men whose tracings are shown in (2).

Note: the rapid weak action of the students' hearts compared with the slow powerful action of the athletes'. The heart action of the middle-aged ex-athletes shown here is extremely poor, but nevertheless, by graduated training, good heart condition can be restored to such people (see reference Norman Currer). Do not confuse this ballistocardiogram with electrocardiogram.


Results--one year later

Death rate by degree of exercise and age group during period of 
approximately one year after last survey. For example, in the age group 
60-64, 1 per cent (1/100) of the men in the heavy exercise category died,
whereas 5 per cent of those in the no-exercise group died during the 
follow-up year. (Adapted from Hammond [226])


   In September 1974, the University of NSW Medical Foundation held a seminar on Executive Health. Dr Cooper presented two lectures--clear cut data, not speculation. His data clearly demonstrates the direct beneficial effects of fitness on each of the following factors:

   Depression, hypochondria, absenteeism, obesity, ulcers, pulmonary disease, general susceptibility, arrhythmia, abnormal ECG, work performance, efficiency, body shape, ability to handle stress, vital capacity, condition of heart tissues and blood supply, resting heart rate, maximal heart rate, blood pressure, blood cholesterol and triglycerides, fasting blood sugar, recovery from heart disease.

   For those loafers who derive comfort having read occasional reports of joggers dropping dead, check this one paragraph out of 31 close-typed foolscap pages of his lectures. An evaluation of 13,763 Austrian (not Australian) men (aged 29-30 years) versus 6,712 American men (aged 19-20). The Austrians had over 80% pass in the 1.5 mile in 12-minute test as against the American 39%, and the American subjects were 10 years younger, only 19-20!

   Compare Austria and USA in this statistic--death from heart attacks in different countries, young men per 100,000 population. Japan 18.5, Austria 36.2, Australia 66.3, USA 90.6--young men.

   On the brighter side, rehabilitation: 25 heart attack patients of Dr J. Scaff, cardiologist, Honolulu, competed in the Rimner Pacific Marathon, 15 December, 1974. A marathon is 26 miles. In 1973 and 1974 there were 13 people, ex-heart-attack patients, who finished in the famous Boston Marathon. Ever since then recovered heart patients have become commonplace as marathon competitors.

   For someone embarking on a fitness program they would be well advised to start with walking. Do not undertake a program beyond your actual standard and never force yourself to extremes, as this is where the only danger lies. Many elderly Longevity Center patients comfortably manage 10 miles a day by the end of the four-week session at the Pritikin Center, usually split up into two or three separate walks.

   It is a good idea to have a proper check-up first to note all the figures, basal pulse rate, blood pressure, weight, cholesterol, triglycerides, blood chemistry etc, and then observe the improvements as you progress.

   Elaborate "gear" is unnecessary. Those flash tracksuits are only to keep you warm while you are loafing. Sweating is not the object, it is just a byproduct, and is only a temporary loss of water while the body is trying to cool itself. Overheating can be dangerous, resulting in fainting, even sudden death. To lose fat you must burn it as fuel by activity.

   If running, at the completion of each session walk for about five minutes as most of the blood will have been circulating in the lower part of the body, and walking will keep assisting its return upwards until circulation is rearranged. Running on grass or firm sand, barefooted, is less strain on feet and ankles and shins. They are painful enough at first.

Note well

   Having read of the wonderful benefits of endurance exercise you can see it would be easy to accept aerobics as a "cure all". By improving oxygen transport, it benefits all functions and the improvements are rapidly felt; they are measurable and impressive--BUT--

   Remember heart attacks may occur during strenuous exercise and it is important to ensure adequate circulation by first lowering the blood viscosity. This can only be accomplished after several days on a very lowfat, low-cholesterol, low-sugar diet. And remember too that unless such a diet is permanently adopted, atherosclerosis will not reverse but will continue to increase relentlessly.

   In case any misconceptions still remain, remember:

  1. Protein is a poor energy source. Natural carbohydrate is the best energy source. Protein metabolism requires copious amounts of water and water lost in flushing the kidneys can lead to dehydration. It is unnecessary to consume animal protein to provide the body with protein.
  2. The body gets all the salt it requires from natural food. It should not be added to food, and salt tablets are unnecessary and harmful even with exercise and perspiration. Excess salt, by virtue of the urination it induces, can cause dehydration. Endurance athletes avoid it.
  3. Dietary fat is unnecessary and harmful when derived from animal sources. The best source of body fat is natural carbohydrate foods: vegetables, cereals and fruit. Concentrated vegetable fat such as margarine and oils is not desirable.
  4. Sugar and sweets are harmful. The best source of blood sugar is the high natural carbohydrate diet.
  5. It is perfectly safe to drink moderate amounts of water while exercising to replace that lost by perspiration.

   The faculties of keen eyesight, good hearing, clear thinking, efficient body functions and so on, can only be gained with completely clear blood vessels. And until runners ensure the freedom of their arteries, the occasions where, now and again, some of them are stricken with fibrillation, will continue. The "carte blanche" for superbly fit people to eat and drink as they please, and which made me smug for years, never existed. Remember too, that if exercise is discontinued, the training effect will be lost in a few weeks.

   This recent statement by Dr Dintenfas correlates perfectly. "Studies of athletes, normal individuals and patients with cardiac and renal diseases show a progression from a low blood viscosity with a high flow velocity among athletes, to an elevated viscosity and low flow velocity among patients. Furthermore, my colleagues and I have found time and again an elevation of blood viscosity among apparently healthy individuals who later developed symptoms of heart disease and cancer."

   In a nutshell, that means physically fit people have free-flowing blood, and with free-flowing blood they are strongly insured against degenerative diseases.

By chase our fathers earned their food,
Toil strung their hearts and purified their blood,
But we their sons, a pampered race of men,
Are dwindled down to three-score years and ten,
Better to hunt in fields for health unbought,
Than fee the doctor for a nauseous draught,
The wise for cure on exercise depend,
God never made his work for man to mend.
                    John Dryden, 1680