With age comes physical limitations. But it’s important to stay active, says John Rinker, MD, an internal medicine physician who specializes in geriatrics at OSF HealthCare. When you keep moving, it helps reduce the risk of things like diabetes, high blood pressure, heart disease, obesity, cancer and neurocognitive diseases like Alzheimer's.

In other words, Dr. Rinker says, it’s not fun to live long if you’re not well. Your lifespan versus your health span, as he puts it.

“It really, really pays to maintain exercise and be in good physical shape as you age. It reaps huge dividends on how long you live,” Dr. Rinker stresses.

Guidelines

Each person should have a tailored plan as advised by a health care provider. But regardless of your age, the American Heart Association (AHA) generally recommends 150 minutes of moderate physical activity or 70 minutes of vigorous physical activity each week, spread out over several days. A brisk walk would qualify as moderate intensity (also called zone two training), while running, swimming or riding a bike would be vigorous. Vigorous exercise is associated with a term called VO2 max, referring to maximum use of oxygen. In layman’s terms, you’re breathing hard and conditioning the heart.

“Most of that type of [vigorous] training is at a higher interval. You’re going to get breathing really hard for three to five minutes while you sustain a pace that’s rather difficult. Then you’re going to rest and let that heart rate come back down. Then go back to the hard exercise,” Dr. Rinker explains. “That back and forth with the heart rate really helps to train how well your heart can pump blood to muscles. That’s a really good marker of how well conditioned you are.”

The AHA also recommends two days of strength training per week. That could be lifting weights, using resistance bands or calisthenics, where you use your body weight for resistance rather than equipment.

“I really like the strength training piece,” Dr. Rinker says.

“It doesn’t take a lot as you age to tension a muscle enough to maintain muscle mass. We really find that people who are able to maintain muscle more muscle mass as they age are going to do much better with those health span and lifespan issues,” he adds. “So, the goal isn’t to make everyone a huge bodybuilder. The goal is to decrease the rate of decline as we age.”

On the days you do strength training, aim for 30 minutes per day. Dr. Rinker says if you really want to lean into this area of fitness, consider getting a personal trainer.

Limitations

It’s important to work around your ability and not push through pain, Dr. Rinker says. If aging has brought back or leg pain, skip the treadmill and try swimming or a weightlifting session while seated.

“You want to make sure you’re not going to injure something further. That will create a bigger setback or other deficit that are not going to help you in the long run,” Dr. Rinker says.

The bottom line

From VO2 max to zone two to calisthenics, there are a lot of terms to keep straight. If you don’t want to overthink it, just remember to keep moving. Push yourself with some vigorous workouts if you can, but commit to some form of exercise regularly.

“Most of your day-to-day exercise [as an older adult] should be just basic activity,” Dr. Rinker says. “Think of a brisk walk. Walking at a pace for about 30 minutes where you could still hold a conversation with somebody, but it would be difficult to sing a song.

“If I can just get someone to walk every day, I think they’re going to be in good shape,” he adds.

Learn more

Read more about moving your body safely and aging well on the OSF HealthCare website.

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• Backward walking: “It works different muscle groups than forward walking. You’re going to work different parts of your shin. It’s going to help a lot with ankle mobility,” Dr. Rinker says.
  
  Try walking backward for a couple minutes on your walk. Keep safety in mind by avoiding trip hazards. Look for an even, non-crowded surface, like a sidewalk or track. Dr. Rinker doesn’t recommend it on a treadmill.
   
• The number six: There are a few workout variations that incorporate the number six. One encourages you to walk for 60 minutes at either 6 a.m. or 6 p.m. Another suggests a six-minute warmup and six-minute cool down, while others say six refers to getting active six days a week.
  
  “The 6 a.m. or 6 p.m. – what I love about that is it schedules the walking,” Dr. Rinker points out. “For some, the barrier to exercise becomes their life schedule. Things get in the way. You meant to exercise, but you look back on your day and realize you never did. Then a week goes by [with no exercise].”
   
• Farmer’s walking: This is where you walk with a heavy object in each hand for a defined distance. Think of a farmer carrying seed bags back to the barn. Dr. Rinker says this can help with balance, muscle growth and grip strength – all things proven to increase longevity.
   
• Rucking: This is walking with a weighted vest or backpack. Dr. Rinker says this came into the mainstream after people saw military members walking with all their gear. Like farmer’s walking, rucking burns fat and builds strength, including in your heart, without increasing speed.
  
  Dr. Rinker says it can be as simple as loading up a backpack with books or other household objects. Just start with a small amount, and work your way up.
  
  “It doesn’t take a lot of weight for you to really feel it within the first 10 to 20 minutes. You don’t want to be stuck far out with a heavy backpack,” Dr. Rinker warns.
   
• Japanese walking: This involves alternating between slow and fast walking. Dr. Rinker says to think of it as high intensity training but in a walking format. If you set out for a 30-minute walk, try switching from a brisk pace to a slow pace every three minutes. Dr. Rinker says this can be especially beneficial for people who are not well-conditioned. He says it can strengthen your heart.
  
  “For people who have a fear of exercise, this is a nice way to ease in,” Dr. Rinker says.

The bottom line

Dr. Rinker says any of these exercise variations is OK to try. Just know your limits, and find a routine that works with your body and schedule.

“It can be boring to do the same thing every day,” Dr. Rinker says. “Finding different variations often leads you to feel challenged, wanting to do more and wanting to try new things.”

Why it matters

Are you doubting that walking is for you?

“Walking is a wonderful way to improve cardiovascular fitness, muscular strength, endurance and balance,” Dr. Rinker says. “In general, humans are meant to move. The more we’re moving our bodies, the healthier we’re going to be long term.

“Bed rest is good for no one. We need to be moving,” he adds with a smile. Walking is free and requires no equipment, Dr. Rinker adds.

The American Heart Association recommends adults get 150 minutes of moderate-intensity exercise per week. But Dr. Rinker says if your body can tolerate it, try for more.

Limitations

The ability to walk beyond daily tasks might be limited for some. A young person might have a chronic injury, or an older adult might simply have wear and tear on their body. 

Dr. Rinker stresses that if an exercise makes you hurt badly, stop it and seek guidance from a health care provider. But, there are ways you can still make walking a part of your routine.

“Change the timeframe or pace. Go for shorter distances,” Dr. Rinker suggests. “There are some people who, let’s say, have COPD and have trouble breathing. They feel short of breath, so they stop walking. We actually want them to walk and spend some time with some shortness of breath. They actually improve their exercise tolerance. Their breathing improves over time.”

Another approach: if you’re used to taking a 30 minute walk, break it up into five minute walks throughout the day.

Learn more

Read more about keeping your body in top shape on the OSF HealthCare website.

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The American Heart Association and 10 other leading health organizations say it’s time to start checking cholesterol sooner and treating it more aggressively. New, lower low density lipoprotein LDL cholesterol targets are aimed at preventing heart attacks and strokes before symptoms ever appear.

Jason Trager, DO, a cardiologist with OSF HealthCare, says people at risk of heart disease should start trying to lower their cholesterol as early as age 30 and continue into old age. They should also be getting their cholesterol levels lower than many doctors had previously recommended.

Some large clinical studies found that about 72% of high‑risk patients fail to reach guideline‑recommended LDL cholesterol levels, and many are either undertreated or not on medication at all. Recent guideline updates have significantly lowered cholesterol targets, especially for people with heart disease or multiple risk factors.

New LDL cholesterol goals based on risk level

Under the new recommendations, people who have already experienced a heart attack or have symptomatic coronary artery disease should aim for LDL levels below 55. People with underlying but less severe coronary disease or diabetes are encouraged to keep LDL below 70, while the general population should aim for levels under 100.

Dr. Trager says clinical studies show the benefits of lowering cholesterol levels for everyone.

“Lower is better as far as your bad cholesterol level, and it means that a lot of patients who were not taking cholesterol medicines should now be on cholesterol medicines. But the cost-benefit analysis is definitely there. Fortunately, with these new medications, people are living longer.”

Taking a pill every day to lower LDL cholesterol can reduce a person’s risk of heart attack or stroke by 20 to 30%, according to Dr. Trager, and by even more in people with multiple risk factors. He says the benefits are really significant.

New medications improve outcomes and reduce side effects

Advances in cholesterol‑lowering drugs, including combination therapies and injectable medications, have made cholesterol goals more achievable.

“In the past, we were not able to get to these targets without very high doses of medications. So now with some of these newer medications, we can get that. We can get these goals, and that really helps reduce future risk of heart attack and strokes, especially for somebody who already had an event.”

Newer options can also minimize side effects – an issue that often leads people to stop treatment.

High LDL is frequently described as a “silent risk” because people can live for decades without symptoms while damage accumulates inside their arteries. Dr. Trager says this delayed impact makes it harder to convince people to stay on medications. But he tries to help people understand by using an analogy.

“You’re going to replace that tire on your car or you’re going to wait until the big blow out … well, most people would rather replace the tire instead of getting into that big accident,” he explains. “It’s the same analogy. Where your heart is concerned, being proactive and being your own advocate can really reduce future heart attack and risk.”

Other testing to know your risk

Dr. Trager also points to coronary calcium scoring, a specialized CT scan that measures plaque buildup in the heart’s arteries, as a valuable screening tool. While not always covered by insurance, Dr. Trager says the scan can help doctors identify people who would benefit from more aggressive treatment before symptoms appear.

Dr. Trager also recommends that adults have their lipoprotein(a), or Lp(a), measured at least once in their lifetime. High levels of this cholesterol-related particle, largely determined by genetics, are linked to a higher risk of heart attack and stroke.

Dr. Trager stresses the importance of diet and exercise. But for many high‑risk patients, he points out lifestyle changes alone are no longer enough to meet today’s lower cholesterol targets.

“Somebody’s not going to be able to reach those goals with diet and exercise unfortunately,” Dr. Trager shares. “You can go on a straight vegan-type diet and cut out the red meat. You can get the cholesterol level down, but you’re not going to reach those exact goals.”

Dr. Trager encourages people to talk with their medical providers if they struggle with cholesterol medications, rather than stopping treatment entirely. With multiple drug options now available, he says most people can find a regimen that works. He suggests that commitment to taking cholesterol-lowering medication can make the difference between preventing a heart attack and reacting to one.

As new evidence continues to shape clinical practice, Dr. Trager believes the message is clear: knowing your numbers, staying engaged in your care and treating cholesterol early can save lives.

Dr. Trager practices in Bloomington, Illinois but you can talk to your primary care provider to learn more. Don't have one? Here are options. 

Dr. Jason Trager

Heart-wrenching data to consider for marijuana users was recently released in two separate studies.

In the journal JACC Advances, researchers found that cannabis users under 50 were in grave risk of severe cardiovascular events, even though these participants were relatively healthy individuals.

This is on par with what Michael Grzeskowiak, MD, a cardiologist with OSF HealthCare Cardiovascular Institute, has seen in recent years. Dr. Grzeskowiak says he’s seen more young people having heart attacks.

"They found that those that use marijuana had a six-time increase of heart attack. They had a four-time increased risk of stroke, and in general, they had a three-time increased risk of dying from heart attack, stroke or any cardiovascular disease," Dr. Grzeskowiak says.

To add to the startling news, JAMA Cardiology released findings at the American College of Cardiology’s Annual Scientific Session that chronic marijuana smoking and THC-edible use is associated with endothelial dysfunction. This means the cells in the endothelium, the thin layer of cells inside our blood vessels, don’t work properly. In turn, this can block blood flow to your heart, causing a heart attack.

This meta-analysis took 12 previously published studies that collected data from over 75 million people, with an average age of 41.

Add inflammation from marijuana use to inflammation built up from ultra-processed foods, alcohol and a sedentary lifestyle; it’s a recipe for disaster.

"Inflammation, in general, in our current Western diet affects us a lot. A lot of the things I see in cardiology are due to that and if we fixed a lot of things in our diet and lifestyle, heart disease would go down," Dr. Grzeskowiak says. "Unfortunately, it's been the leading cause of death for 100 years."

Outside of work, more than 25% of the U.S. population live sedentary lifestyles, according to the Centers for Disease Control & Prevention (CDC). Additionally, roughly half of the American diet is made up of ultra-processed foods.

This comes as 48 states plus Washington, D.C., have legalized marijuana for medicinal use, and 24 states allow cannabis for recreational use, and nearly 200 million people worldwide are regular marijuana users, according to a United Nations report in 2018.

"It's concerning. A lot of people have the perception that marijuana is safe. It's natural and it's being legalized in many states for either recreational or medicinal use," Dr. Grzeskowiak says. "The common perception is that marijuana is better than tobacco and alcohol and is safer. But more studies are coming out that are making us take a pause on that thought and show that maybe there are some risks involved."

With this clear data on the risks that marijuana use brings, it adds another important topic for doctors and patients to discuss. He encourages patients to be upfront and honest about their marijuana usage with their doctors.

For overall heart health, Dr. Grzeskowiak says it's important to make healthier choices in terms of diet, exercise and lifestyle. 

He calls sodas and most juices "liquid sugar," and says if you just cut out one drink a day, in one year you'll lose up to 12 pounds. 

Aside from commitments to 150 minutes of exercise per week (which is recommended by the American Heart Association), focus on the "little things." If you're on the second floor for work, take the stairs more often. 

To learn about the services offered at OSF HealthCare Cardiovascular Institute, or to get in touch with the OSF cardiology team, visit the OSF HealthCare website.

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Hello darkness, my old friend

Icy roads? Gym too far away? Or are you just not a people person? Cozy cardio may be right for you.

What is cozy cardio?

Clare Spires, an exercise physiologist at OSF HealthCare, says cozy cardio, in simple terms, is a way to make exercise comfortable in your home. It’s wise to talk to a health care provider about what workout is right for you. But generally, cozy cardio offers some freedom. For example, you can work up a sweat with an instructional video or app. Or you can just find a routine that works for you.

Equipment

Spires says you don’t have to rush out and buy equipment. But if you like having something to hold or press your feet to, there are options.

Walking pads have become popular. These are miniature treadmills with just the bottom structure. There are no rails and monitor at eye level like a traditional treadmill.

“Some can do inclines,” Spires says. “You can put it under a desk if you’re a remote worker. It’s just another way to get those steps in during the day without leaving your house.”

A small set of weights can be a welcome addition. Skip the 50 or 100-pound weights, Spires says. Two to five pounders are a good start.

“If you’re doing some bigger muscle groups like biceps and quads, you could add more weight,” Spires says. “But typically, those at-home workouts are made that you can lift weights with something like a soup can or a water bottle.”

Keep that water bottle handy for hydration, too. And a mat can help with balance.

Safety

Gyms typically have safety measures and employees watching out for injuries or emergencies. During cozy cardio, you could be alone in an environment that wasn’t meant for exercise. Think of a cluttered living room.

So, Spires says to do a safety check before each workout. Remove trip hazards like cords and rugs.

“If you could use a little extra stability, maybe work out next to a counter that you can hold onto. Avoid something that’s going to move on you quickly,” Spires advises.

Exercise with someone, if possible. Have a phone nearby in case you need to call 9-1-1. Start slow, and work up to your goals.

How much?

The American Heart Association recommends 150 minutes of moderate intensity exercise or 75 minutes of vigorous exercise per week, spread out over several days. For those with that goal in mind, many do 30 minutes of sweat-building for five days per week. Others do 50 minutes per day for three days. Spires says you can have some cardio days and some weightlifting days. She says it’s good to mix it up.

Spires says when defining “moderate intensity,” think about singing a song while working out. If the strain of the workout means you can’t sing without running out of breath, you’re at moderate intensity. “Vigorous” would be an activity above that, like running.

It’s a process, but Spires says the benefits are worth it. Regular exercise means lower blood pressure, cholesterol, chance of diabetes and chance of heart disease. You might also see improved mood and sleep.

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“I pour coffee, help the waitresses and hostesses, bring out food,” Lindsey describes.

“I make sure everybody’s happy,” he adds warmly.

But on October 6, 2023, just steps away from the restaurant, Lindsey would have a life-changing moment. He says one minute, he was in a vehicle with his cousin. The next, he was waking up in the hospital.

In between, a good Samaritan who happened to be across the street saved Lindsey’s life, thanks to skills learned at OSF HealthCare and an alert from a smartphone app that OSF brought to Champaign.

“I’m very grateful,” Lindsey says.

Lindsey’s boss, Original Pancake House owner Eric Faulkner, can fill in the gaps of that day.

He says Lindsey’s cousin Charles picked him up from work. As they were driving away, Lindsey was laughing and joking, but suddenly slumped over and became unresponsive. Charles pulled into a shopping center parking lot and asked someone to call 9-1-1.

That’s where Shannon Walter enters the story.

A program manager at the Champaign Park District, Walter got some of her cardiopulmonary resuscitation (CPR) training at OSF. She was across the street getting lunch when she got an alert on her phone: someone close by needs CPR.

“When I pulled into the parking lot, I could see somebody pulling somebody who was unresponsive out of a vehicle and onto the ground,” Walter says.

That was Lindsey, who was in cardiac arrest, where the heart is not able to pump blood properly.

Walter quickly explained she was CPR-certified, observed Lindsey wasn’t breathing and did chest compressions for around three-and-a-half minutes until first responders arrived.

“I believe that is what saved his life and his brain function,” Faulkner says.

Lindsey agrees.

“She’s an angel,” he says. “It makes me feel really blessed. I’m glad she was there.”

Lindsey and Walter’s twist-of-fate encounter shows the importance of a couple life-saving things you can do in just a few minutes, says Kurt Bloomstrand, MD, medical director for East Central Illinois Emergency Medical Services, an OSF organization that trains first responders and CPR instructors.

One, learn CPR. It’s the missing link between when 9-1-1 is called and when first responders arrive. Dr. Bloomstrand says for cardiac arrest outside a hospital, the chance of survival is around 10%. With bystander CPR and use of an automated external defibrillator (AED), the chance increases fivefold.

Dr. Bloomstrand says good Samaritan laws exist to protect people who give first aid.

“You’re not going to hurt the person. You only have an opportunity to help them,” he says.

If you don’t have time for a CPR class, just remember this: push hard and fast on the center of the chest at 100 to 120 beats per minute. Appropriately, that’s the beat of Stayin’ Alive by the Bee Gees. Or if you prefer a more contemporary beat, think of the chorus of The Man by Taylor Swift.

“It’s important to never be caught in a situation where you don’t know what to do,” Walter says.

Two, download the PulsePoint app, the app Walter used to jump into action. PulsePoint is a nationwide app that OSF brought to the Champaign area. It’s active in nearly 5,000 other communities. Dr. Bloomstrand explains that when a 
9-1-1 call is made for cardiac arrest, the dispatcher sends the information to first responders. If PulsePoint is active in that area, the information – scrubbed of specifics to protect privacy – also automatically goes to the app. The app then sends an alert to PulsePoint users that CPR is needed and if an AED is nearby.

The fine print for the alerts: the emergency must be in a public place, and the bystander must be within one-fourth of a mile. And within the app, you must turn on CPR alerts and let the app track your location always, not just when you are using the app. That’s necessary to know anytime CPR is needed near you.

“This is how you, as a lay person, can be a hero, a lifesaver and help somebody in need,” Dr. Bloomstrand says.

Lindsey, meanwhile, is going through rehabilitation at OSF. He also got a pacemaker, a small device that creates electrical currents to keep the heart beating at a normal rhythm.

“I feel wonderful,” he says, adding that he hopes to be pouring coffee for customers again soon.

If you would like to learn in detail how to perform CPR or use an AED, there are several options, including visiting the American Heart Association website, or calling your local hospital to see what training is available. There are two versions of the PulsePoint app for download to your smartphone. PulsePoint Respond alerts you to cardiac arrest, and PulsePoint AED allows you to catalog AEDs around you.

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