On Patient Autonomy

Recently, I was involved in a discussion on an e mail list serve and decided to takes some of my comments on patient autonomy and blog about them. This arose following a debate about whether the term "patient" engendered a sense of passivity and, therefore, whether the term should be dropped in favor of something else, like "client" or something similar.

Having participated in the preparation and dissemination of the white paper on e patients, I don't see the need for 'factions' or disagreements in the service of advancing Participatory Medicine. As Alan Greene aptly stated, "This is a big tent, with room for all". I want all of my patients to be as autonomous as possible. In my view, their autonomy is independent of the doctor/patient relationship that I have with them. They make the choice to enter into, or to activate or deactivate the relationship with me. They may ignore my input, seek a second opinion, or fire me and seek the care of another physician at any time. They truly are in control, in that sense. The only thing I have control over and am responsible for is trying to provide the best advice or consultation that I can.

They use the internet for education about their health issues and, increasingly, to join patient communities for problem solving, support, information and research. Some even seek the input or advice of professionals they have never met through online services like eDocAmerica. Sometimes, they may find that information they get on the internet or from other patients demonstrates that what they received from me was in error. So much the better, if they can use networking to improve the quality of the information at their disposal, we will have a healthier, more efficient health system.

The less they "need me" the better I like it but I continue to hope, in their best interest, that they are exerting their autonomy by making good choices and achieving optimum outcomes. Just like I don't expect to achieve an optimum outcome with a complicated home repair without a consultant such as an electrician, or to be able to fix my car without a mechanic, or achieve a legal victory without a lawyer, most patients won't achieve optimum medical or health outcomes without a medical consultant. And, has also been pointed out, some outcomes absolutely require a physician (e.g. surgery, intensive care, chemotherapy, radiation, etc).

And, do these consultants ever make errors, be they of commission or omission, you bet! That is why the partnership is important. As good or as meticulous as a doctor might be, he is inevitably going to miss things that the patient and their caregivers are in the best position to recognize and correct. They may also be, by virtue of networking and patient communities such as ACOR and others, privy to information that is more current or more relevant than what they may receive by their own physicians. We, as physicians should not worry about, or be threatened by this, but should embrace it as the best chance for the patient to achieve optimum outcomes.

Fitness, Part 2

This is another "eDoc Academy" video on non aerobic fitness. I hope you enjoy it.

More on Fibromyalgia

I'm calling these Youtube videos "edoc Academy". This is the third in an ongoing series of topics from my practice. This one on Fibromyalgia.

Fitness

Take a look at this cam recording video that I did on getting started with a fitness program:

Introduction to Participatory Medicine

This is a video called "Introduction to Participatory Medicine" which I recorded today on You Tube. Take a look if you get a chance and feel free to share your ideas and reactions.

Thanks.

Sugar May Be Raising Your Blood Pressure

Most of us know that salt raises blood pressure in many people. When I learned that in medical school almost 40 years ago, I have not touched a salt shaker since. I enjoy having a low normal blood pressure. A new study published in the Journal of the American Society of Nephrology (July, 2010) suggests that sugar, especially the fructose that comes from corn syrup, may also raise blood pressure.

A study team from the University of Colorado in Denver looked at sugar intake among thousands of Americans in a major national nutrition survey between 2003 and 2006. Those who consumed more added sugars such as the fructose in soft drinks had significantly higher blood pressures than those who did not and ate more natural foods such as fresh fruit.

Fructose from corn syrup is a major cause of the obesity epidemic and may also be contributing to the most common chronic disease of adults, high blood pressure.

I have a bold suggestion to make that if followed will improve your health and that of our nation:

Eliminate all soft drinks and fruit drinks from your diet and the rest of your family. Whether with sugar or "sugar free", they adversely affect your health. Drink water instead. If you want caffeine or some other flavor, drink tea (not sweet tea) or a modest amount of coffee, both natural substances. Use a slice of lemon in your water or tea if you prefer to alter the flavor. Get your fruit natually from an orange, apple, bannana or berries, not from juice.

The elimination of soft drinks and fruit drinks would transform the American diet and help us be healthy again. And don't worry about the soda companies. A growing part of their business is bottled water today. We need to move them in the right direction too.

Food Rules to Live By

Michael Pollan has become one our most important writers about human nutrition. His book, The Omnivore's Dilemma (2006), spelled out why the almost 8 billion humans on this planet had better balance what we eat, for our own health and the health of the planet.

He published a small book in 2009 (Penguin Books) called Food Rules: An Eater's Manual. His rules are around 7 words in 3 brief statements: Eat Food, Not Too Much, Mostly Plants. How simple and wise is that!

These three statements make up the three parts of this small book, with lots of practical "rules". Here are some of the best:

Don't eat anything your great-grandmother would not recognize as food
Avoid food products containing ingredients that no ordinary human would keep in the pantry
Avoid foods that are pretending to be something they are not (like imitation butter)
Shop the peripheries of the supermarket and stay out of the middle
Treat meat as a flavoring or special occasion food
Eat animals that have themselves eaten well
Don't overlook the oily little fishes
The whiter the bread, the sooner you'll be dead
Be the kind of person who takes supplements - then skip the supplements
Eat more like the French, or the Japanese, or the Italians, or the Greeks
Have a glass of wine with dinner
Stop eating before you are full
Eat when you are hungry, not when you are bored
Eat slowly
Spend as much time enjoying the meal as it took to prepare it
Buy smaller plates and glasses
Serve a proper portion and don't go back for seconds
Breakfast like a king, lunch like a prince, dinner like a pauper

and the last one:
Break the rules once in awhile

So, enjoy a healthy diet and eat right!

Getting and Staying Healthy: Getting Enough Sleep

Our busy lifestyles often aren't conducive to getting the recommended amount of sleep at night. According to the National Sleep Foundation, adults need between seven and nine hours of sleep every night. Dr. Kenneth Berg from the Mayo clinic states that persons who get less than seven hours of sleep per night have a higher mortality than those who have adequate sleeping habits. Inadequate sleep has been linked to increased risk of motor vehicle accidents; an increase in body mass index – a greater likelihood of obesity due to an increased appetite caused by sleep deprivation; increased risk of diabetes and heart problems; increased risk for psychiatric conditions including depression and substance abuse; and decreased ability to pay attention, react to signals or remember new information.

So, if you are currently getting less than 7 good hours of sleep at night, consider making a change to try to increase that to a minimum of 7 or 8 hours. Here are some other suggestions for you to consider to improve your quality or quantity of sleep:

1. Establish regular sleep and wake schedules.
2. Have regular, relaxing bedtime routines such as taking a hot bath or playing quiet music.
3. Create a dark, quiet, comfortable and cool environment.
4. Make sure you have a comfortable mattress and pillow.
5. Avoid watching TV, using a computer or reading in bed.
6. Avoid eating 2-3 hours before your regular bedtime.
7. Exercise regularly during the day, but avoid exercise at least a few hours before bedtime.
8. Avoid caffeine and alcohol products close to bedtime.

Let me know if you have comments or additional suggestions...

Getting and Staying Healthy: Getting Enough Sleep

Continuing this series on getting and staying healthy, another one of the basics, other than obtaining and maintaining normal weight and getting enough exercise is getting adequate sleep at night. Our busy life styles often don't lend themselves to the 7 or 8 hours of sleep usually recommended to maintain health.

Exercise Part V: Exercise and Weight Loss

I am often consulted about diets and weight loss. I witness a blinding array of dietary approaches to weight loss and, alas, have discovered that most simply don't work! Yes, that's right, diets if they work at all, tend to be short term solutions at best. People can usually rally their will to restrict their intake and lose for awhile but, inevitably, without a more basice lifestyle change, the pounds slowly creep back over weeks or months.

So, if you are overweight (over 63% of American's are obese or overweight), and want to shed pounds what is the answer? It's actually very simple. The basic concept is "calories in-- calories out". One merely needs to slightly reduce the number of calories consumed per day and burn additional calories over what has been your past pattern, such that a "deficit" is created between the number of calories consumed and the number of calories burned.

If this idea seems rediculously simple, it is but, apart from bariatric surgery, or the rare case of a life-changing epiphany, a simple commitment to combining exercise with moderate caloric restriction is the secret to losing and maintaining weight.

Let me provide an example of how this might work in practice: Let's say, you are 10 to 15 pounds heavier than you want to be and have been having trouble losing it. How should you approach it? First, decide a couple of items typically consumed in a day that you can manage to leave aside that would amount to between 250 and 500 calories. Let's say you decide to give up one soft drink, or one Starbucks flavored coffee or Latte plus the bag of chips that you usually have for lunch; or that you give up the piece of pie or cake that you have with dinner. That's it. It's just that simple. Otherwise, just continue with the diet that you are accustomed to.

Then, with your exercise program that you have committed to (30 to 45 minutes five days a week in the "aerobic zone"), you are burning an extra 300 to 500 calories. At the high end of this scheme, you would have a "1000 calorie deficit" (the 500 fewer calories you take in and the 500 extra calories that you are burning). This would take you towards a faster weight loss and at the low end (250 fewer in and 300 burned) to a 550 calorie deficit. The latter plan would likely result in a one or two pound per week loss and the former a 2 to 4 pound loss.

This is not an exact science and, since everyone is different, daily flexibility and adjustment is required. Therefore a daily or every other day weigh in is essential. If the weight is not trending in the right direction, an adjustment is made, either in cutting out a few more calories from somewhere or increasing the duration or effort level of your exercise. This is the fine tuning that is the ultimate secret to the success of this approach. And this regular adjustment process should continue indefinitely. This daily/every other day weigh in serves to reinforce your program and remind you of your commitment to maintaining fitness and weight control.

So, there you have it. The exotic Smith plan for exercise and weight loss, otherwise known as the "Anti Diet Plan".

Your comments and dissenting opinions are always welcome...

Exercise, Part IV: Injury Prevention, Stretching, Warm Up and Cool Down

Preventing injury is an often-neglected component of an exercise program but, when the basics are incorporated into your daily routine, you will be much less likely to spend time on the sidelines because of pulled muscles and other overuse injuries.

Warming up can be confusing to many who are starting out with an exercise program. But, there is nothing complicated about it. The basic tenets are simply to start slow and stay slow until your body is ready for the stress of the workout. This will allow your cardiovascular system to infuse all of your key muscles, and will get your heart and lungs functioning on "high alert" to endure the stress of the workout. For most people, this process involves exercising at appoximately half speed for about the first five minutes; then, if all seems well, you can move to full speed and complete your exercise session. Failure to properly warm up may result in a high degree of muscular stress on muscles and tendons that are still tight and not adequately vascularized, and render them much more susceptible to injury.

Cooling down is a good idea and is almost as important as warming up. What cool down accomplishes is allowing the body to reduce the heart rate and blood flow while, at the same time, reducing the amount of stress and work that the muscles are doing. During this time, the blood courses through the muscles and begins the work of cleansing toxic breakdown products such as lactic acid that can cause soreness and stiffness. It also provides a few relatively stress free minutes to concentrate on form and technique, which are also important, over the long haul, to staying in balance and avoiding injury.

What about stretching? How often should you do it? How should you do it? And, should you stretch before or after a workout? Stretching is important in maintaining optimum flexibility and preventing injury. Failure to stretch results in progressive shortening of the muscles and tendons to the point that, after years of exercising and not stretching, some people literally cannot completely straighten their legs. For walking, running and biking, the most important stretches are the legs. For tennis, weight lifting, handball and other upper body skills, arms and shoulders are most important. It's not that you shouldn't stretch all of these areas regardless, it's just that, if push comes to shove, it is much more critical for a biker to stretch his hamstrings and quads that it is for him to stretch his shoulders and arms.

Stretching should be done a minimum of 5 or 10 minutes three to four times a week. The preferred technique is "proprioceptive neuromuscular facilitation", which involves alternating contraction and stretching of the muscle in question. I prefer to stretch hamstrings for 30 seconds, then the other side, returning the first one for a total of two stretches on each side. I do this by placing my heel about waist high and leaning over til I feel the stretch, alternating contraction and stretching to increase the amount of muscle lenthening that can be accomplished. I stretch the quads by holding on to my foot behind me, same way, 30 seconds on each side, repeat times one. Most people tend not to like to stretch and, so, they often avoid doing it, resulting in a very tight body that cannot perform optimally and is more prone to injury.

Next time, we'll talk about exercise and weight loss...

Your comments are always welcome.

Exercise, Part III: Motivation and Recommitment

Everyone who has exericised regularly has experienced problems and challenges of remaining motivated and committed to keeping up with your exercise schedule and level of intensity in order to stay at the peak of fitness. Some days, if you exercise in the morning, you just feel too tired to get out the door to do your workout. Other days, you feel emotionally lethargic because you have something on your mind that you just can't get over long enough to get started on your daily workout. Other days, you have a cold, headache or other illness that makes it all but impossible for you to workout.



Sometimes, when two or three of these days pile one on top of another, you find yourself falling off the wagon and, suddenly, you realize you've missed a week or 10 days and panic starts to set in. What if I lose everything I've worked so hard to gain? Why does it seem like getting back in shape is so much harder and takes so much longer than it takes to lose it?



Here are my "10 commandments" for dealing with this problem:

1. Realize that every fitness enthusiast has this problem and it doesn't mean that you are lazy or that there is something wrong with you.

2. Don't entertain the illusion that daily workouts are "fun" or a "piece of cake" and, therefore, it should never seem easy to just bounce out of bed and do your daily workout. Regard daily workouts as part of your work, not part of your play. That is why it is called WORKING out!

3. Remember that becoming fit requires weeks of work, not days and don't allow yourself to become discouraged when you don't feel fitter or slimmer after a few days, or even a few weeks, of working out.

4. Give yourself permission to take two days "off" per week and position those days strategically (such as days you have early meetings or days when you stay up late the night before, etc).

5. Remember to advance your efforts no more than 10% per week, so that you don't overtrain. Overtraining is one of the best ways to injure yourself or just plain burn yourself out.

6. If possible, band together with one or two others who will help motivate you and hold you accountable to your fitness program.

7. If you're having a bad day or feel rushed, give yourself permission to shorten your exercise session for that day. It is better to work out for 20 minutes than to miss the day altogether.

8. In a similar vein, if you don't feel great or are just having a low energy day, give yourself permission to lower your target heart rate by 10 or even 20%. It is better to get in a light day of exercise than to miss the day entirely.

9. If you start to feel burned out with your exercise because you are doing the same thing every day, change your course or use a different modality. For example, if you are a biker, get on the elliptical or treadmill on occasion for a change of pace. If you are a runner, get on your bike. Cross training is a great antidote to boredom and burnout.

10. If you have trouble getting up and jumping into your exercise clothes, get up early enough to enjoy a cup of coffee and read the paper before you venture out.



Everyone struggles with motivation to do their daily workout. The fitter you are and the longer you've been in the habit of doing it, the lower your risk of becoming discouraged and quitting, but motivation issues never go away completely. Just accept their inevitability and apply one or more of the 10 commandments noted here to help you get back in the game.



Next, we'll talk about injury prevention, including warm up and stretching. Your comments are always welcome.

Exercise, Part II: Getting Started

Perhaps you, like many patients I talk to, would like to begin an exercise program, but the idea seems overwhelming. It can be if you decide to start a program without a sound plan, because it will almost certainly not be something you can sustain for the long run. Patients often have no idea how long to exercise, how much to stress or strain their system, or how long it takes to "get in shape". All of this tends to lead to early errors, injury, or discouragement and giving up on the idea of becoming fit. It is important, and possible, to avoid this trap with the proper approach.

If you haven't been exercising regularly, it is important that you first consult with your doctor about whether it is safe. If you are 45 years of age or older, it is probably a good idea for you to obtain a treadmill exercise stress test. It is also important to have a good idea of your risk factors for cardiac disease, including your cholesterol and blood pressure level. You should also get a reading of your body mass index and set a target for your weight (more on weight loss later).

Assuming you get the green light, I recommend starting with about 15 or 20 minute sessions, three days a week. You should choose an aerobic activity, such as walking, jogging, biking, swimming, or an exercise machine like a treadmill or an elliptical machine. Aerobic activities are important to form the basis of your program because they are sustainable and lead to better cardiovascular fitness. We'll talk about the value of anaerobic activities, especially weight workouts, later.

If possible, either work out on a machine that has a heart rate monitor or else purchase a wireless continuous heart rate monitor. It is very difficult to exercise for fitness efficiently without one and they have become very affordable in recent years. As I noted earlier, it is important to exercise in the "aerobic" zone, which is about 60 to 80% of your maximum heart rate. You can obtain an estimate of your maximum heart rate by subracting your age from 220. For example, if you are 30, your estimated maximum heart rate is 220-30=190. So your exercise target is between 114 and 152. I usually recommend a midrange target of 70% or about 130 for this example.

It is important to be patient and persistent, remembering that each day builds on the last and that rest and exercise work together to stregthen the muscles and the cardiovascular system. By starting at 20 to 30 minutes three days a week, you minimize the risk of becoming too sore or fatigued to continue your program. A good rule of thumb is to increase your workouts by about 10% per week. So, if you start with 30 minutes, three times a week the first week, then you should increase one of your workouts by 10 minutes the second week. Then, the next week, increase one of your other workouts by 10 minutes. The next week, increase one of your workouts to 45 minutes and repeat the cycle. When you are up to 45 minutes three times a week, then add a 15 or 20 minute session on another day a week; then increase that session to 45 minutes, until you get to 5 days a week, 45 minutes a session. By the time you have reached this schedule, you will have completed at least 12 or 14 weeks and should have achieved a pretty good level of cardiovascular fitness. Congratulations!

Then, when you have achieved this schedule, which is reasonable to maintain, you can continue to pursue your fitness by maintaining your heart rate targets as you become more fit. As you do this, you will actually work harder and the the "10% rule" will continue more or less automatically by allowing you to "do more work" at the same heart rate as you become more fit. This is called the "training effect".

Next time, we'll talk about issues with motivation and what to do when you "fall off the wagon".

A Series on Getting and Staying Healthy: Exercise, Part I

I was reflecting on an earlier post I wrote after reading the book "Younger Next Year" and decided I'd write a series of blog posts on some of the basic principles of getting and staying healthy. These include eating a good, well balanced diet, avoiding smoking, avoiding excessive alcohol intake, managing your stress levels and exercise.

I'll start with the last item, exercise. I'm going to start by telling you what I do now, then backtrack and talk about aspects of an exercise program in more detail in subsequent posts. I'll include motivation, getting started, how much and what kinds of exercise are needed, staying on track, avoiding injury, hydration, warm up and cool down, stretching, rest days, exercise for weight loss, and exercise and staving off depression.

So, let me start by telling you what I do now. I was doing about 30 minutes a day of aerobics about 4 or 5 days a week, but after reading the book, committed to increasing that to at least 45 minutes a day for 5 days or more a week. Most weeks, I work out six or even seven days. I used to be a runner but, since I had my knee replaced a little over two years ago, I've completely given this up. My favorite exercise is on my road bike, a custom-built titanium beauty that is really fun to ride. I often use a pulse monitor to assure that I stay in the aerobic zone (I'll say more about this later). This is, for me, between 70 and 80 percent of my maximum heart rate which is about 130 beats/minute. At that level of work, I am "working" not just playing or having fun. So, one of the key things I tell people is to consider exercise as enjoyable work, not just play or fun. In order to get the benefits of exercise and stay physically fit, you need to do this "work". So many people stroll along on their walks or bike in an upright, comfortable mode and their heart rates are likely not above 100 beats/min. They will get some benefit from this, but nowhere near the maximum result.

On most days, I go on a ride that combines hills and flat terrain about 10 to 12 miles and that takes me about 50 or 55 minutes. On weekends and on some days when I don't have an early meeting, I enjoy going longer about 1 1/2 to 3 hours. One of my favorite rides takes in the Arkansas river, over the Dam Bridge and along the river trail walking/biking trail. In the mornings, with mist coming off of the river, with gulls flying, deer in the pastures, and energetic fitness enthusiasists around me I learn to rejoice in the moment and recognize for those brief swatches of time that "it doesn't get much better than this!".

When weather doesn't permit outdoor biking, I often hop on my reserve bike that is tethered to an indoor magnetic trainer (called a Kurt Kinetic) that does a great job of simulating the road and allows me to get a very good workout indoors. Again I typically use a pulse monitor and will say more about that in subsequent posts. Indoor bike workouts are typically for 45 minutes in front of ESPN SportsCenter or, sometimes, with a workout video to guide me.

For a change of pace, I get on an indoor elliptical machine. It is a good idea to have at least one or two alternative aerobic activities that allow resting of some of the muscles that get maxed out in the other training modes. I either do a programmed workout that does a good job of pushing me through some fitness improving intervals or I just put the machine on manual mode at about a 10 or 12 level that keeps my pulse at the target rate.

I save the sports section of the paper for cool downs and breakfast with cereal and fruit before showering and going to work. This program has served me well for years and allows me to go to work energized and ready for the day.

Next time I'll talk about how to get started on an exercise program for those who may not be doing it on a regular basis.

Could My Body Fat Lead to Dementia?

One of the great fears we all have is to lose our mental ability as we grow old. No one wants to end their life with dementia (such as Alzheimer's Disease). We all should be highly motivated to do things to avoid this tragic outcome. We already know that regular exercise is good for the mind and may reduce the risk of dementia. Recent evidence shows that the use of statin medications to lower cholesterol may help reduce dementia risk. Now we have evidence that the roll of fat around your waist may be a marker for increased dementia risk.

The University of California, Berkeley Wellness Letter (February, 2010) reports on a study published in the journal Neurology that followed 1500 Swedish women for 30 years. Those with more fat around the waist were twice as likely to have dementia by age 70 compared with thinner women. A 2008 study from Kaiser Permanente that included men and women showed similar results.

The fat around the waist is a better marker for internal fat than the fat around the hips. If a woman has a waist of 35 inches or greater, and a man a waist of 40 inches or greater, that is evidence of increased cardiovascular risk and dementia risk. The leaner the better as we get older.

Losing this fat is hard work. It requires an excellent diet and regular physical activity. Medications should be used if needed. A healthy body and mind in the senior years cannot be taken for granted. We may be lucky with good genes, but we all must live a healthy lifestyle in order to earn our good health later in life.

Fibromyalgia--Is it Real?

Every Tuesday, I conduct a diagnostic clinic at the University of Arkansas. This clinic sees patients referred throughout the state with complex or hard to manage medical problems, or patients that the referring physician is not sure who to turn to for advice or answers.

One of the most common problems I see is a patient with diffuse, hard to categorize soft tissue pain. Most of the patients have a diagnosis of "fibromyalgia". The patient that I saw this week told me her physician sent her to our clinic because "he doesn't believe fibromyalgia is real". Physicians often become frustrated with these patients because the pathophysiology of this condition is not well understood, and because effective treatment takes time and patience. The physician cannot rely on brief office visits and prescription refills to adequately address the issues of most fibromyalgia patients.

Fibromyalgia is very real and is a common problem in practice. Any busy primary care physician will attest to the fact that a significant number of patients with this condition visit our office every week. Fibromyalgia is a rheumatic condition whose characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can, and often does, lead to depression and social isolation because patients are so uncomfortable and fatigued. Patients with chronic fibromyalgia are often really miserable and need the help of a competant, sympathetic physician. Patients with fibromyalgia often complain of "total body pain". They almost universally have great difficulty sleeping. Most have tenderness when you press on the muscles of the upper back and shoulders. Females are 10 times more likely to complain of these symptoms than men.

How well do patients respond to treatment? I have yet to find a single patient who responds quickly or dramatically to any treatment. Rather, they tend to gradually improve with effective treatment of sleep and depression and tend to improve with stretching and exercise and, occasionally, with certain medications.

There are no blood tests, biopsy findings or imaging studies that confirm the diagnosis of fibromyalgia. This lack of clarity and specificity has led many to assert that this diagnosis is "not real". But many patients, mostly middle aged women, have chronic, diffuse, muscle and soft tissue pain and they all need help managing this condition.

The best treatment approach for those who suffer from this problem includes drugs, as well as alternative remedies and lifestyle habits that may help decrease pain and improve sleep. Medications include antidepressants to help alleviate the pain, fatigue, depression, and anxiety that comes with the disease. In addition, your doctor may recommend physical therapy, moist heat, regular aerobic exercise, relaxation, and stress reduction to help you self-manage your symptoms. There is no one "pill" that treats or cures fibromyalgia. A multidisciplinary approach that uses both medication and alternative or lifestyle strategies seems to work best. Medications that help in certain patients include Cymbalta, Savella, and Lyrica.

Patients with fibromyalgia badly need a compassionate, patient primary care provider who can see the patient at regular intervals and who will take a multidisciplinary, long-term approach to managing this condition.

Ideal Cardiovascular Health

You too can have ideal cardiovascular health. What is that you may ask? The American Heart Association has come out with a new report that defines it.

Ideal cardiovascular health means you do all of the following:

1. You do not smoke
2. You are not overweight (normal body mass index, or BME less than 25)
3. You get regular physical activity, about 5 hours a week
4. You eat a healthy diet low in saturated fats and simple sugars

You also have the following:

1. Your total cholesterol is normal (generally below 200 or a healthy ratio of total cholesterol and HDL (good) cholesterol)
2. Your blood pressure is aroung 120/80
3. Your fasting blood sugar is less than 100 (better yet 90 or less)

All of these are within reach of most everyone, with or without treatment. Ideal health is a choice and requires a commitment to action. Go for it. There are no justifiable excuses.

Reference: Circulation: January 20, 2010