For the young the prescription is clear, and it was unanimous: keep on exercising steadily all through life, avoid overeating, don't smoke, and try to keep out of stress situations of the type that are only frustrating and cannot end in the satisfaction of a challenge met and something accomplished. This last sounds like the advice, "Don't worry!" but actually it is not quite so fatuous. Several of the authorities in Burlington reported that the healthy, well-exercised man is not only more apt to be outwardly placid but that his inward (and involuntary) system is capable of reacting to stress much more equably than can the man with the loafer's heart.
For those who have subjected their hearts to long years of underexercise neglect, the prescription was also unanimous: get back into training by a graduated program of exercise. Walking is not bad; it simply is not enough. The University of Illinois' Dr. Thomas K. Cureton laid down the maxim that for an exercise program to do the aging male any good it must make him burn from 300 to 500 calories a day. Dr. Cureton scoffed at catchphrases such as "A few seconds a day of isometrics keeps unfitness away." (Isometric contraction got short shrift in Burlington, perhaps partly because its effects are concerned primarily with the voluntary muscles, and it does not provide a complete metabolic cycle even for these.) The days when men recovering from heart attacks were condemned to such utter inactivity that they soon died of inanition are gone, but most doctors have remained cautious indeed about how much exercise they prescribe, and how soon. Dr. Herman K. Hellerstein of Western Reserve used to be as cautious and skeptical as any. Now he is an ardent advocate of the testing of more radical rehabilitation methods. What converted Dr. Hellerstein was the discovery that one of his patients was also enrolled in a "continuous movement" program, following the Cureton doctrine, at Cleveland's Central YMCA. and was suffering no ill effects. Dr. Hellerstein was so impressed by what he saw at the Y that he started a reconditioning program of his own at a Cleveland Jewish community center. Recovered patients who still have 50% to 75% of their coronary artery flow shut off can be restored to near-normal function, he has found. One man who had a massive heart attack is now swimming a quarter of a mile a day.
Dr. Hellerstein feels that the physical educator should derive as much satisfaction from getting a handicapped heart patient to perform at near-normal levels as he would from training a normal subject to perform at championship levels. "This, for the subnormal, is the same as being an Olympic champion," he declared. "The idea that athletic facilities are only for competitive sports and winning trophies should be modified. The use of these facilities should be extended for the general improvement of health, for the also-rans as well as the star performers."
The unquestioned star of the Burlington show was Dr. Cureton, Dr. Physical Fitness himself. At 63, he has gained weight amidships but shows few other signs of aging. First he set forth his dogma: "The greatest need is to train the heart and breathing mechanisms by rhythmical endurance exercises done progressively longer and harder until the desired level of stamina is reached. The best type, short of advocating the overthrow of American recreations, is more walking of the strenuous hiking or racing-walk type. Also the loafer's jog for distance, and the interval training procedure carried out for half an hour to an hour each day, progressing from low to middle to high gear."
Then Dr. Cureton demonstrated what he meant. He began, on his "warmup principle," with deep breathing to get more blood flowing. He walked, then did walking calisthenics, pumping and windmilling and swinging his arms, all the time breathing loudly, as he wants an exerciser's breathing to be heard. Next he began jogging. He did loose kicks and shakes, and walking with stretching, and the heel-toe racing walk. Dr. Cureton was still warming up with the "old man's marathon pace" and had been going 17 minutes before the first drop of sweat appeared. Then, amazingly, he went on with running sidesteps, two-step kicks, knee-to-chest hops and through a whole calisthenic repertoire for a solid hour. Dr. Cureton left every spectator exhausted by his virtuosity.
For the average man, this would be no more possible than it is for the average woman to dance The Dying Swan with the ripples of a Plisetskaya. And every man has to be pretty much his own doctor (until he gets sick). He must prescribe his own exercises, with running, swimming, jog-trotting and bicycling most likely to be effective. Even doctors do not know enough about the interactions of exercise and the heart to be able to give sound advice, and most of them set bad examples themselves. Physical education teachers, too, need to know more about the workings of the heart.
The most hopeful note from the Vermont conference was that at last some of the old jealousies are breaking down. Physicians and physiologists, sports medicine specialists and physiotherapists, rehabilitation experts and psychologists, biochemists and nutritionists, are getting together to seek ways to check the plague of premature heart disease that has been sweeping the Western world for half a century.