accepting or voicing the truth that despite our bestefforts, death may ultimately prevail. I suspect that manypatients hope that we, as physicians, will tell them whenfurther efforts are most likely futile.

While most physicians can recognize when a patient isgoing to lose the battle, we are not good at guessingwhen he/she is going to die. One of the few quibbles Ihave with current hospice rules is having to certify that mypatient has six months to live, before he/she can beenrolled in hospice. It is my hope that this requirementwill ultimately be waived, since many patients cannot beso neatly categorized. My first patient who enrolled inhospice ended up living for over a year, with a relativelygood quality of life until the very end, and I receivedregular letters asking if we should continue to have thepatient enrolled in hospice! I later found out that this wasnot so unusual, and that paradoxically many patients whoenroll in hospice care end up living longer than expected.

Myths regarding hospiceContrary to popular beliefs and fears, hospice care doesnot mean cessation of care. Instead, the focus and priorityof hospice care is on the quality of life, and not theprolongation of life. Hospice tries to help patients havethe fullest possible life without pain, while maintainingmental alertness for as long as possible so that the patienthas the opportunity to reflect on life, put affairs in order,say goodbye to friends, and spend time with loved ones –without being a burden to the family in the process. Theopportunity to have closure is also immensely beneficialto families, and it has been shown that caregivers ofpatients who die in hospice are less likely to experience amajor depression in the subsequent six months.

Focus on relationshipsThe relationship between patients and their families iscentral to this conversation. Patients are often willing to

Lown Forum 2 0 1 1 N U M B E R 3TH

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LOWN CARDIOVASCULAR RESEARCH FOUNDATION

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DE 5 Development in action

6 How can I stick to a weight-loss routine?

Lown Scholars: Solutions 7500 miles away

7 NewsBeat8 Exercising as you grow older

Although sometimes difficult tounderstand or talk about, end-of-life care should be discussed withfamily when the time comes.

At the Lown Center, we meet four timesa year to review the lives and care of allof our patients who have passed away.

This past February, while preparing for our quarterlymortality conference, I discovered that about 20% of thesepatients had died while under the care of hospice. Since Iwas unaware of the existence of a “death-panel” at ourcenter, it seemed reasonable to spend time exploring end-of-life care in this issue of the Forum.

Once upon a time, most of us were born in our homes,and died in our homes. Times have changed, and perhapsdue to the progress of modern medicine, we are nowalmost always born in a hospital and die in one too. Yet inall my years of practicing clinical medicine, I have notencountered a patient who would prefer to die in ahospital, let alone in an intensive care unit. As a society,why are we so ill equipped at dealing with one of theabsolute certainties in life? I believe how we choose to dieis the final frontier of “personalized medicine”.

When it comes to end-of-life decisions, having a choice isof paramount importance for each individual. Since weare all going to die at some point, I suspect people wouldprefer to have a choice regarding end-of-life care and thetrade-offs we are willing to make at the end.

The physicians’ roleWhy, then, are clinicians hesitant to initiate thisconversation? Many case reports in medical literaturehave shown patients who have had unexpectedresponses to therapy, and outlived their projected demisefor many years. Thus, any discussion about dying is usuallyfraught with peril for the clinician, lest it be interpreted asreluctance to fight or prematurely giving up on a patient.When faced with a dying patient, it is natural forphysicians to offer hope, and we usually have trouble

2 President’s message

Meet the Lown staff: Pádraig Carolan

3 ProCor: Louise Lown Heart Hero Award

4 Mahler’s Ninth (con’t.)

Patient profile: A family conversation

continued on page 4

Mahler’s Ninth

Fred Mamuya, MD, PhD

A family conversationEdith Davis, who was 91 and suffering from congestiveheart failure, did not want to spend her last days in ahospital. Her family reflects on their experience withhospice and the importance of discussing end-of-lifecare. (Patient profile, page 4)

PRESIDENT’S MESSAgE

Less is moreVikas Saini, MD

Less is more. Architect Mies van derRohe coined the phrase in 1959, referringto a simpler aesthetic that serves abuilding’s purpose more effectively thanan elaborate design.

What does “less is more” mean forhealth care and the Lown Foundation?

Surgery and other risky invasive procedures are the lastresort, and less invasive treatments – dietary, exercise,medication – often do more for the patient. This approachhas always been our hallmark, and it’s been theFoundation’s role to advance that model of care.

Why have a less is more approach? For one,it’s better for patients. And it saves money.

After years of being a voice in the wilderness, we nowhave many allies who recognize the severity of the issue.Unfortunately, the message still isn’t widespread. So theLown Foundation, partnering with the New AmericaFoundation and the Institute of Medicine, is organizing aconference on avoidable care for spring 2012.

Policymakers, payers, providers, and patients mustrecognize the need to remedy the avoidable careproblem, including overutilization of routine services,defensive medicine, and inappropriate care. In a New YorkTimes editorial, cardiologist Rita Redberg - who is on theorganizing committee for our conference - highlights theproblem of avoidable care with several examples:

Clinical trials have shown that cardiac stents are no moreeffective than drugs or lifestyle changes in preventingheart attacks or death…Some studies have shown thatstents provide short-term relief of chest pain, but up to30% of patients receiving stents have no chest pain tobegin with, and thus derive no more benefit than fromequally effective and less expensive medicines.

A recent study found that one-fifth of all implantablecardiac defibrillators were placed in patients who willnot benefit from them. Medicare pays anyway, at a costof $50,000 to $100,000 per device implantation.

Our conference will be the first in a series of meetingsseeking to catalyze a deep shift in medical culture andeducation necessary for developing a new ethic aroundunnecessary care. generating public support to focusnational attention on the problem requires leadership.Our goal is to contribute to the long-term effort totransform the culture of health care in the US from onewhere patients and providers focus on volume andquantity of services to one centered on value and quality.

2 L O W N F O R U M L

MEET THE LOWN CENTER STAFF

Pádraig CarolanAs the research assistant for the Lown Foundation,Pádraig Carolan is working on two second opinionresearch projects designed to study the Lown Center’smodel of care.

“Sometimes patients come to the Lown Center lookingfor a second opinion regarding coronary bypass graftingor angioplasty,” Pádraig explains. “Starting withpatients who came to the Lown Center in 1992 for asecond opinion, we’re looking to see what their originaladvice was, what advice they received at the LownCenter, and how they subsequently fared.”

“The other second opinion project involves patients whocame to the Lown Center between 2007 and 2011. Byusing our practice management software, we canidentify the second opinion patients and then reviewtheir charts to gather data. We hope to answer some ofthe same questions that we have with the 1992 patientset, but with data that reflect more recent changes inboth surgical procedures and medical management.”

Prior to the second opinion research,Pádraig worked on the Lown Center’sHome Care Pilot Study. “One set ofpatients had regularly scheduled face-to-face conversations with theircardiologist over the internet. Theother set of patients had regularlyscheduled phone calls with theircardiologist. We wanted to see if

there was any benefit when a patient talks to his/herdoctor face-to-face compared to over the telephone.”

Originally from Dublin, Pádraig moved to Massachusettsat the age of eight. He graduated from University ofNotre Dame with a degree in psychology, and hasworked at the Lown Foundation for three and a halfyears. Pádraig lives in Brighton with his wife Carrie, ahistory teacher at BC High School, and in his spare time,he enjoys camping and hiking.

“I feel I am making an important contribution to theadvancement of cardiovascular health,” Pádraig says ofhis work at the Lown Foundation.

Reading the Forum onlineDid you know you can read the Lown Forum online?To read it on our website or to have a copy emailedto you, please visit www.lownfoundation.org oremail info@lownfoundation.org.

L O W N F O R U M 3

PROCOR

Educating children to prevent RHD

Benn grover & Jocelyn Sterling

The Kenyan-Heart National Foundation receivesthe 2011 Louise Lown Heart Hero Award

The Kenyan-Heart National Foundation’s (KHNF)rheumatic heart disease (RHD) prevention programrecently received the globally recognized Louise LownHeart Hero Award from ProCor and the LownFoundation. Through local initiatives and outreachefforts, the KHNF successfully educates thousands ofchildren on RHD prevention.

Virtually unheard of in Europe and the US, RHD is a majorcause of death in the developing world. Althoughcurrent estimates say around 15 million peopleworldwide have RHD (80% are in the developing world),recent research suggests that it is more likely to bebetween 62 million and 78 million people and that 1.4million people die each year because of it. In Kenyaalone, there are over 200,000 new cases of RHD eachyear, and it is the most common cardiovascular diseaseamong children and young people.

RHD is caused by strep throat, which can be easilytreated. It costs around US$1 to treat one case of strepthroat with penicillin; however many people areunaware that they should seek treatment for strepthroat. As a result, untreated strep throat leads torheumatic fever, which leads to RHD – requiring openheart surgery that costs thousands of dollars.

“This was a difficult selection process. All ofthe applicants were very deserving ofrecognition and accolade, but the KHNF’sRHD prevention program epitomizes asuccessful, reproducible project that has hadand will have significant impact,” said Dr.Brian Bilchik, member of the Louise LownHeart Hero Award review team.

By targeting the most vulnerable population – childrenand adolescents – the KHNF aims to prevent RHD beforeit starts. The KHNF educates schoolchildren onrecognizing the symptoms of strep throat and onpracticing simple but key prevention measures such aswashing one’s hands and covering one’s mouth whilesneezing or coughing. To date, the KHNF has educatednearly 11,000 schoolchildren on RHD prevention.

“The program focuses on information about the diseaseand the importance of good hygiene for prevention andthe early diagnosis for treatment. The program is not

only having an impact on the prevention of RHD, but alsoon the spread of other diseases,” said Vibeke Hjortdalfrom Aarhus University Hospital in Denmark.

The KHNF’s Kitchen gardens program encourages schoolsto create fruit and vegetable gardens to help servehealthy foods to schoolchildren – this program hasreached 60-70% of the public schools in Nairobi.Additionally, the KHNF has organized over 150 Kenyan-Heart Clubs, which provide opportunities for children tolearn about heart health and educate their communitiesthrough poems, skits, and dance. The 2010 Heart ClubsDay, which is an annual event that brings together all 150clubs to compete in activities and showcase theirprevention efforts, had 5000 schoolchildren participate.

“The strength of the project is its focus on arelatively unknown preventable disease andthe organization of local civil society aroundthis issue,” said Nicolai Houe, from PACT.

The prevention message does not stop at children. “Ibelieve children are very good advocates. Even thoughthey are the ones at risk, they are not shy and once theyknow something it is very difficult for them to keep quiet.They are great messengers; they have a strong ability toinfluence others, like their parents,” said Elizabethgatumia, Executive Director of the KHNF. In addition tousing schoolchildren as heart health advocates, the KHNFtargets adults with their education programs. In 2011alone, the KHNF has trained around 1000 adults, 500teachers, and 300 faith-based leaders on NCD prevention.

Plans for the futureTheir RHD preventionprogram works. Now thegoal is to expand tocommunities all acrossKenya. “Nairobi has beenour area of operation sofar, but we hope toexpand. People have heard

about our success in different communities, and they areinterested in being trained on RHD and NCD prevention.We know we are making a difference,” said Ms. gatumia.

The annual Louise Lown Heart Hero Award recognizesinnovative, preventive approaches to cardiovascularhealth in developing countries. The award was establishedin 2007 by Dr. Bernard Lown, an internationally-renownedcardiologist and Nobel Peace Prize recipient, to honor hiswife, Louise, and her lifelong commitment to the well-being of others as a social worker, activist, and writer.

For more information about the KHNF or the Louise LownHeart Hero Award, visit www.procor.org.

Teaching children about RHD

(continued from page 1)

Mahler’s Ninth

Fred Mamuya, MD, PhD

undergo therapies they do not want if they think theirloved ones want them to do it. Unfortunately, it is notunusual to have competing desires between patients andtheir families, and this situation can be made worse if thepatient is unable to fully participate in the discussion. Onsuch occasions, family members may disagree onpriorities and goals of care, which could lead to additionalstress. It is common to have family across the country,and occasionally the globe. Fortunately new technologiesthat allow for video-conferencing may be helpful inenabling those necessary conversations among familymembers across long distances.

Engaging in a dialogueEnd-of-life care should be discussed with every patient,and written advance directives should be considered acrucial part of every patient’s medical record. It isimportant to have these discussions with patients whilethey are still capable of being active participants, and hereat the Lown Center, time spent with patients and theirfamilies remains sacrosanct. One conversation is rarelysufficient, and usually multiple conversations spread overtime are required to fully understand the needs, worries,

4 L O W N F O R U M

and fears of patients and their loved ones. Rather thanjust telling a patient about the disease process orsurvival rates, the discussion should be driven by anunderstanding of the entire patient

The most needed skills were not taught in a medicalschool classroom when I was in training. Time spent witha patient, honesty about the finality of a disease process,empathy, and above all conveying that one is not

abandoning the patient are among the most importantelements in conversations regarding end-of-life care.

Recently, I was listening to my son play Mahler’s “NinthSymphony” with a local youth orchestra. Sitting in theaudience, I recalled some of the opening lines from anessay by Lewis Thomas on listening to Mahler’s “Ninth”in the age of weapons of mass destruction.

“There was a time, not long ago, when what I heard,especially in the final movement, was an openacknowledgement of death and at the same time aquiet celebration of the tranquility connected to theprocess. I took this music as a metaphor forreassurance, confirming my own strong hunch that thedying of every living creature, the most natural of allexperiences, has to be a peaceful experience”.

It is my hope this article will initiate conversations thatreassure patients that their end-of life care will be well-planned and personalized.

PATIENT PROFILE

A family conversationEdith Davis, who was 91 and suffering from congestiveheart failure, did not want to spend her last days in ahospital. Her son, Andrew, knew she needed extensiveassistance with her daily life but was unsure what optionswere available. “To be honest, I don’t think hospice evercrossed my mind. It was only after Dr. Mamuya discussedhospice that we realized there was a service other thanthe hospital that could assist us.”

On a routine visit to the Lown Center, Andrew’s wife,gayle, wanted an honest assessment of Edith’s health andpulled Dr. Mamuya aside to ask questions. “Instead ofhaving a private talk with just me in the hallway, Dr.Mamuya waited until after Edith’s checkup to have aconversation with both of us in his office. Dr. Mamuyamade sure to include Edith in the conversation. He askedher opinion and answered her questions, making it afamily discussion.” Everyone in the family agreed hospicewas the best option because Edith’s quality of life wastheir biggest concern.

Her quality of life was hospice’s biggest concern as well.“Hospice helped us in so many ways – emotionally by

taking some of the stress away, as well as in a moredirect way by answering questions and providingservices.” Eventually, hospice also took over Edith’sincreasingly complex medications.

“Hospice also took time to ask us how we were feelingthroughout the process. They still call from time to timeto ask how we are doing,” said Andrew.

“I always thought of hospice as a service used during thelast week of life,” gayle said, “but it ended up being asupport more than anything. It never felt terminal.”

Communication between all members of the family waskey in the smooth transition to hospice for the Davisfamily, and the initial discussion with Dr. Mamuyaallowed for the process to occur quickly and withoutdoubt of its necessity.

The Davis’ realize every situation is different, butultimately, believe hospice is an important servicepeople should consider. “Having the conversation withfamily about end of life care is key,” gayle said.

“Everybody, whether patients, children, or parents, hasto come to grips with reality, and once you do that, yousee hospice as a tremendous resource,” Andrew said.

DEVELOPMENT

Donor ProfileCarol and Norton Foxman have been Dr. Charles Blatt’spatients at the Lown Center for ten years, and donors tothe Lown Foundation for nearly as long. We recently satdown for a conversation with the Foxmans about theirinvolvement with the Foundation.

How did you come to be patients at the Lown Center?

Carol: My mother had heart disease. We knew people inour hometown who came here and said such wonderfulthings. We’re very health-conscious, always looking fornew ways to stay healthy, and we were interested in thepreventive philosophy practiced by the Lown group.

Norton: My father and brother both have atrialfibrillation. We were looking for a practice where thephysicians care about the whole patient.

Tell us about your support

for the Foundation.

Carol: We have supported alot of organizationsinvolved with cancerresearch, including twouniversity chairs. Wewanted to do somethingsimilar for cardiology,

especially because of the prevalence of heart disease.We honor our parents through giving.

Norton: We were extremely impressed by Jack Bogle’stestimonial at the Lown gala in 2008. He spoke somovingly about his experiences with the care hereceived at the Lown Center, as did several others.

What aspects of the Foundation’s work are you

especially interested in?

Norton: I am very interested in your outcomes research.I understand lots of people come to the Lown Center forsecond opinions, and that you have good results thatyou want to document. The planned conference onavoidable care next spring is also of great interest.

What would you say to someone who was considering a

donation to the Lown Foundation?

Norton: Anyone who wants to support heart researchwill be making a good, charitable investment here.

Norton and Carol Foxman

L O W N F O R U M 5

Fundraising in actionOn July 27th, 2011, Lown Foundation friends fromSouthern Massachusetts and Rhode Island gathered atthe elegant Wamsutta Club in New Bedford to learnmore about the Foundation’s current activities. Hostedby Kenneth and gwen Sullivan, the event featured Dr.Blatt highlighting the importance of continuing Dr.Lown’s legacy of patient-centered care. Dr. Saini alsoreminded guests that their support furthersFoundation activities such as outcomes research andour upcoming conference on avoidable care.

New Bedford hosts, Ken and Gwen Sullivan

Dorothy and Alfred Costa, Edward and Jacquellen Sullivan

Iris and Harold Katzman, Elia Giusti

Lown gala

When: Spring 2012Where: Mandarin Oriental HotelWhat: For more information or to get involved withplanning the gala, contact Andi Brown, Director ofDevelopment, at arbrown1@partners.org or 617-732-1318, ext. 3350

6 L O W N F O R U M

QUESTION FROM A PATIENT

I know I need to lose weight, butsometimes it feels like a lost cause.How can I encourage myself to stickto a weight-loss routine?

Shmuel Ravid, MD, MPH

Being overweight is very commonamong patients with heart conditions.Losing weight is extremely beneficial inimproving cardiovascular health such ashypertension, diabetes, and heartfailure. Nevertheless, we struggle to loseweight. So I was pleasantly surprised tosee that my patient RJ recently lost 40

pounds after failing to do so for many years despite myurging. I asked him to describe what was different thistime that inspired his resilient commitment and how hewas able to achieve this tremendous accomplishment.

“My most recent visit to the Lown Center made meunderstand that I was trading years of health for the tasteof pasta, pizza, Chinese food, bread, and the like,” RJexplains. “Every walk I took was an effort, every distancewas the enemy – I was headed upon a course that wouldinjure my heart.”

On that particular visit to my office, I reiterated that intime, burdening his cardiovascular system with excessiveweight load is likely to inflict serious damage to his heartand general well-being. He had to make a change!

“Dr. Ravid’s worried face burned into my mind that day.But he didn’t resort to threats – he spoke with anunderstanding that he could do only so much to stop mycertain fall from the cliff of a life well lived and enjoyed. Ileft the office knowing I was sentenced to a self-imposedtroubled future because I still ate like I was a teenager.”

With this new found determination, RJ started eatingwell and exercising.

“Just a month after adjusting my diet, I could walkwithout the shortness of breath that once terrified me.After two months, the old belts and pants came outfrom the back of the closet. I could fit into my old suitsand dress shirts again. By the third month, the belly flabbecame a past memory. I looked ten years younger. Thediet was simple – unlimited fruits, salmon, plates ofcherry tomatoes, and egg whites.”

“The choice was easy. Thanks to those moments in thedoctor’s office, my life changed and I once again couldbreathe, smell the air, and feel proud of my decision tofollow the best advice a doctor ever gave a patient.”

You can talk the talk, but you need motivation andcommitment to stay the course and reap the fruits ofyour efforts.

Finding solutions 7500 miles away

A Lown Scholar’sperspective on thecardiovascular diseaseepidemic in Tanzania

The Lown Scholars programbrings together health

professionals from developing countries to the HarvardSchool of Public Health to learn cardiovascular diseaseprevention and conduct research relevant to their homecountry. As a Lown Scholar, Dr. Marina Njelekela has aunique perspective on the burden of cardiovasculardisease in her home country, Tanzania, as well as how itcan be prevented.

“Compared to the United States, the infrastructure toaddress cardiovascular disease in Tanzania is not welldeveloped,” explains Dr. Njelekela. “In Tanzania peopleare first diagnosed when they have a stroke – they don’trecognize their risk factors before they have a stroke andso the diagnosis comes too late and they havecomplications that are very difficult to manage.”

By studying the relationship between cardiovasculardisease and the types of food children eat, Dr. Njelekelafound that it is not just health infrastructure that iscausing problems. “We’re starting to see an increase infast food restaurants, refined rice, vegetable oils – all ofwhich are foreign to the traditional Tanzanian diet…People don’t know what they should eat, how muchphysical activity they should do on a regular basis, or ifthey are at risk or already have a disease.”

However, Dr. Njelekela believes that successfulprevention efforts to reduce cardiovascular disease arewithin reach. “We can tie cardiovascular diseaseprevention with HIV/AIDS and use resources to addressboth. We need integrated clinics – clinics that addressboth HIV/AIDS and cardiovascular disease. Currently,when someone goes to an HIV/AIDS clinic they may notget screened for cardiovascular risk factors. But even ifthey are living because of anti-retroviral treatment, theyshould not be dying from cardiovascular disease.”

Dr. Njelekela remains optimistic. “I think the future willbe brighter, but it will take time. It took seven years forthe Tanzanian government to understand they need astrategy for noncommunicable diseases. But now wehave a focus and funding for prevention.”

Dr. Njelekela & Lown physicians

Thank you for your supportThe Lown Cardiovascular Research Foundation promotes cardiaccare that advocates prevention over costly, invasive treatmentsand restores the relationship between doctor and patient.

Your financial support allows us to continue our work and carryour heart health message to local, national, and global audiences.We greatly appreciate any donation you are able to make.

You can donate online at our website (www.lownfoundation.org)or mail your donation to 21 Longwood Avenue, Brookline, MA02446. Please make checks payable to the Lown CardiovascularResearch Foundation. For more information about supporting theFoundation, please contact Andi Brown, Director of Developmentat arbrown1@partners.org or 617-732-1318 (x3350).

Educational opportunitiesInterested in hosting a lecture on a heart health topic by one ofour physicians at your worksite or community organization? Pleasecontact us at info@lownfoundation.org or 617-732-1318 (x3355).

New patient appointments availableNew patient appointments are currently available. If you wouldlike to make an appointment with one of the Lown groupcardiologists, please call 617-732-1318 and select option 1.

LOWN CARDIOVASCULAR CENTER

N e w s B e a tThe Lown Foundation welcomedtwo ProCor interns during thesummer 2011.

Heidi Chase studied art and socialaction at george Mason Universityand received a Masters in PublicHealth from Boston University. She

has worked as an educator, community artist, and publichealth consultant with programs designed to influencebehavior, initiate conversation, and promote change.

Jocelyn Sterling is a graduate student in the HealthCommunication program at Emerson College. She co-hosts and produces a health-focused program atEmerson’s talk radio station. Jocelyn previously workedas a marketing intern at Horizon West Healthcare inCalifornia. She has a Communication Studies andJournalism degree from the University of Portland.

Dr. Tom Graboys was recently interviewed by Dr. PeterRabins for the spring 2011 issue of the “Johns HopkinsBulletins: Memory Disorders”. To read the interviewplease visit: www.tomgraboys.com.

On June 4, 2011, Dr. Vikas Saini and Dr. Fred Mamuya

spoke at the second annual health expo, VivaFest, inHyannis, MA, on the topics of healthy aging and heartdisease prevention and screening athletes for cardiachealth. The event drew an estimated 1200 people andfeatured speaker workshops, an indoor farmers market,healthy lunch sampling, and yoga and tai’chi sessions.

Dr. Bernard Lown was featured in the Spring/Summer 2011Harvard Public Health Review. To read the article pleasevisit: http://tiny.cc/83v90.

Dr. Vikas Saini addressed the Belmont Council on Agingcommunity on August 4, 2011. The topic of his talk wasSecond Opinions and Overtreatment.

Dr. Sara Russell received the second annual Bernard Lown

Award for Excellence in Teaching at Brigham and

Women’s Hospital. A graduate of Tufts and ColumbiaUniversities, Dr. Russell is the Surgical Director ofCutaneous Oncology and Melanoma at the Dana Farberand is involved in various teaching and mentorshipactivities with third and fourth year medical students.

On August 11, 2011, Dr. Vikas Saini was interviewed byMaryann Napoli, the Associate Director of the Center forMedical Consumers in New York City. Dr. Saini discussedhis opinion of the new cholesterol-lowering drug, Lovaza.The interview can be found on the Center for MedicalConsumer’s website: http://tiny.cc/w48kd

Board of DirectorsNassib ChamounChairman of the Board

Vikas Saini, MDPresident

Bernard Lown, MDChairman Emeritus

Thomas B. graboys, MDPresident Emeritus

Patricia AslanisCharles M. Blatt, MDJoseph Brain, SDJanet Johnson BullardJ. Breckenridge EagleCarole Anne McLeodC. Bruce MetzlerBarbara H. Roberts, MDRonald ShaichRobert F. Weis

Advisory BoardMartha CrowninshieldHerbert EngelhardtEdward FinkelsteinWilliam E. FordRenee gelman, MDBarbara greenbergMilton LownJohn R. MonskyJeffrey I. SussmanDavid L. Weltman

CONTACT US

Lown Cardiovascular ResearchFoundation21 Longwood AvenueBrookline, MA 02446 USA(617) 732-1318info@lownfoundation.orgwww.lownfoundation.orgwww.lowncenter.orgwww.procor.org

Lown Cardiovascular GroupBrian Z. Bilchik, MDCharles M. Blatt, MDWilfred Mamuya, MD, PhDShmuel Ravid, MD, MPHVikas Saini, MD

Lown Forum Editorial StaffAndi BrownJessica gottsegenBenn groverClaudia KenneyJocelyn Sterling

©2011 Lown FoundationPrinted on recycled paper with soy-based ink.

L O W N F O R U M 7

Interns, Heidi and Jocelyn

Exercising as you grow older

Charles M. Blatt, MD

It is not uncommon to find grandparentsurging their grandchildren to break loosefrom their computers or video games.“get outdoors and into the fresh air.Exercise, walk, cycle, jog, swim, throw aball!” Indeed, the importance of regularexercise on both ends of the agespectrum cannot be overstated.

Fortunately, young people have many opportunities toengage in exercise at some point as they go throughschool. Older people may find more impediments in thepath to a routine and satisfying exercise. But as difficult asit may be to find an acceptable routine, it is even moreimportant to find one that is easy to stick with and follow.

As we age, we tend to live more sedentary lives - fewertrips up and down the stairs, fewer dashes out to seefriends, walking instead of running, slower rather thanfaster in almost every realm of activity. This makes it moreimportant to adopt a practical and easy-to-follow routinethat fits your body’s limitations. For example, someonewith a knee or hip problem cannot rely on walking outsideor on a treadmill for exercise. Instead, try using astationary bicycle or doing an aerobic stretching activity ina heated swimming pool. Many health clubs offerdiscounts for older members. Another example is to doarm and leg raising activities while sitting in a chair. Manyof these exercises can be augmented by using one or twopound weights attached to the ankles or wrists. However,before starting an exercise regimen, you should consultwith your doctor to make sure the routine is right for you.

Lown Cardiovascular Research Foundation21 Longwood AvenueBrookline, Massachusetts 02446-5239

Nonprofit Org.US Postage

PAIDBoston, MA

Permit No. 53936

I encourage you to introduce an exercise regimen to yourdaily activities starting modestly and progressively addingmore exercise to your routine. For example, beginningwith 10 minutes before breakfast and again before lunchallows you to initiate a routine in a painless fashionadding minutes to each series over time and eventuallyexercising for a goal of 30 minutes daily.

Older people have plenty of age-appropriate exercisesthat can help them live healthier lives. The key is findingthe exercise routine that fits you and then sticking to it.

Some exercise resources for older people

Significant calories can be burned and substantialmuscle and bone strengthening accomplished withsimple, low cost routines followed daily at home. Hereare a couple of examples:

•Livestrong’s “Exercise tips for senior citizens”encourages people to consult a doctor first, see apersonal trainer, start slowly, get proper shoes, workout with friends, and stretch before exercising. Formore information, visit http://tiny.cc/chwub.

•The National Institute on Aging details four differenttypes of exercise that will provide maximum benefit toyou: endurance, strength, balance, and flexibility. Formore information, visit http://tiny.cc/hvdqg.

•Helpguide’s “Senior Exercise and Fitness Tips”debunks common myths about elderly exercise,explains the whole-body benefits of exercise, and givestips for starting safely, building exercise routines, andfor wheel-chair bound individuals. For moreinformation, visit http://tiny.cc/e0141.

8 L O W N F O R U M