• 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.

Interview clips

Related stories

Lifespan vs. health span
Get cozy: How to exercise at home
Cold, cold, go away: How to stay active in chilly weather
Walk this way
A shin-termission: Navigating lower leg pain
‘It shouldn’t be a barrier to play'
Keeping backs healthy in school

It’s been two decades since the first-ever glucagon-like peptide-1 (GLP-1) medication was approved by the U.S. Food & Drug Administration (FDA).

For years, GLP-1s have been used to help those with diabetes. More recently, GLP-1 producers have begun marketing drugs like Ozempic®, Wegovy® (both semaglutide), Zepbound® or Mounjaro® (tirzepatide) for weight loss. Now heart health experts believe these medications can provide a robust benefit to heart health.

This comes as the American College of Cardiology® (ACC) released its five top trends in cardiovascular medicine in 2025, including “Anti-Obesity Drugs: Cardiovascular Benefit Beyond Weight Loss.”

The ACC reports that semaglutide and tirzepatide both “demonstrate remarkable cardiovascular benefits that extend beyond weight management.” Clinical trials show these medications can reduce the risk of major adverse cardiovascular events by up to 20% in patients with obesity and preexisting cardiovascular conditions.

Christopher Sparrow, MD, is an Advanced heart failure cardiologist with OSF HealthCare. He says he’s seen some remarkable benefits in many of his patients.

"The biggest thing I've seen in my practice is that patients who are obese can take these medications and have dramatic reductions in their weight, while doing it in a healthy fashion with a tolerable treatment," Dr. Sparrow says. "When these patients lose weight, they feel better, their blood pressure gets better, their cholesterol gets better, and their diabetes gets better if they have it. If they don't have it, their risk of getting diabetes goes down. Plus, their quality of life improves."

Dr. Sparrow is also the medical director of both the heart transplant program and adult heart unit at OSF HealthCare Saint Francis Medical Center, a Level 1 Trauma Center in Peoria, Illinois. He describes how GLP-1 drugs promote heart health.

"These medications target GLP-1 receptors. These receptors are primarily in the gastrointestinal system, but they're also in the brain and small amounts in the heart. We're learning more and more that these drugs can have direct impacts on the heart," Dr. Sparrow says. "Particularly in small blood vessels that are prone to effects of inflammation and disease in patients with obesity."

GLP-1s are also referred to as incretin analogues. Incretins are substances that promote insulin release to lower blood sugars. They act in the brain to increase the feeling of satiety (not being hungry anymore), which stops overeating and excessive drinking. Dr. Sparrow says the health benefits are both in how the medications are formulated, and because patients are losing weight. 

“Recent evidence has shown that in the obese population with heart failure, these drugs improve quality of life and improve the ability for these patients to function. That can mean being able to walk further distances," Dr. Sparrow says. "They lower systemic inflammation levels and reduce the risk of worsening heart failure events. For us, this is a brand-new tool in our toolbox to benefit the quality of life in these patients."

While GLP-1s are being seen as the heart’s newest best friend, on the flip side, obesity is one of its worst enemies.

"It (obesity) promotes higher blood pressure, diabetes, abnormal lipids and we know it increases inflammation in the body, which has adverse effects throughout the body," Dr. Sparrow says. "Simply by reducing obesity, we think we're making a huge impact on future cardiovascular risk."

Dr. Sparrow says doctors have known for a long time that patients with diabetes who use these forms of medications have a reduced risk of heart attack, stroke and death from cardiovascular causes like congestive heart failure. Now, that's expanding to patients who are obese or those with heart failure. 

Semaglutide and tirzepatide have been shown to have a better weight loss benefit compared to their GLP-1 predecessors, Dr. Sparrow says. Adding that these drugs can reduce cholesterol levels, improve hemoglobin A1C (a marker of diabetes), as well as lower blood pressure and markers of inflammation to a greater extent.

This treatment option can be used as primary and secondary prevention. That means people can take one of these drugs before anything like heart attack or stroke happens (primary), or after heart attack and stroke that could prevent another from happening (secondary). 

Patients with a body mass index (BMI) over 30, diabetes and/or cardiovascular disease are all patients that could benefit from this treatment, Dr. Sparrow says.

The struggle with getting these drugs to all the patients who want them comes down to two factors. 

1: Pharmacies can't stock enough to keep up with demand

2: Many insurance companies aren't covering these medications for weight loss

When it comes to obesity, Medicare recently announced it would cover these drugs for obese patients who have cardiovascular disease. It’s estimated this could impact roughly 3.4 million Americans.

Dr. Sparrow says it’s not surprising that over time researchers are finding health benefits for these drugs when it was previously meant for another purpose. He says it’s the natural order of scientific discovery that comes from a deeper understanding of these medications obtained through years of research and study. 

Video Interview Clips

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.

Video Interview Clips

Related stories

‘A Major Problem’

The heavy lift: women and exercise

Keeping score

Sudden cardiac arrest and women

GLP-1s: The heart's newest best friend?

Diabetes and heart health: Listen, act, prevent

Hello darkness, my old friend

 Researchers used data from a National Health and Nutrition Examination Survey, combined with 2020 U.S. Census counts for years 2025-2060 to make these projections. Using these two data points, researchers estimated the rates of cardiovascular risk factors and rates of cardiovascular disease. They estimate that by the year 2060, compared with the year 2025, coronary heart disease will increase by 31%, heart failure by 33%, heart attacks will go up by 30%, and stroke by more than 34%.

“It's eye opening,” remarks Darrel Gumm, M.D., an OSF HealthCare cardiologist and vice president of the OSF HealthCare cardiovascular service line. “And I think we, in the cardiology community, over the last 50-60 years have been seeing a steady decline in deaths from heart attack because of our rapid response to people who come in with a heart attack. So to now see that even though we're reducing the death rate, the total number is going to keep going up, it's a big deal.”

These numbers, however, vary depending on race and ethnicity. Predicted cardiovascular risk factors and cardiovascular disease are generally expected to rise in racial and ethnic minorities, whereas its prevalence in the white population could decrease.

“These are populations that are underserved. So they're maybe not getting the early screening visits with a physician to be told, you know, ‘Your sugar is too high; your blood pressure, your cholesterol is too high. You're a little bit overweight. We’ve got to work on this.’ So they may not be getting those visits. And instead, they're finding out when it's a full-blown disease, as opposed to very early on when there was really an opportunity to prevent it from becoming a full-blown disease,” says Dr. Gumm.

One possible solution to this disparity, according to Dr. Gumm, involves education and outreach – both by health care providers and communities at large. This could include improving access to quality health care for at-risk individuals, along with educating people on cardiovascular risk factors.

“Education, outreach, and changing habits of people and families really could have a potential huge impact in the future,” he says.

While some risk factors like family history and age cannot be controlled, eating healthily, exercising regularly and quitting smoking can all drastically reduce the risk of heart disease. Dr. Gumm recommends making healthy changes now, starting with learning your numbers.

“If we start prevention today, we then look at how that will have a ripple effect in the future,” explains Dr. Gumm. “So number one is know your numbers. What's your blood pressure? What's your fasting glucose, your fasting blood sugar level? And what is your cholesterol count in your blood? And then step on the scale  - and be honest.  Are you carrying a few pounds too many? So those are really big risk factors. And of course, if you're smoking, we got to quit smoking immediately.”

Because the projection goes nearly four decades into the future, Dr. Gumm also recommends getting the entire family involved. Talk to kids about the importance of eating right, exercising and staying away from tobacco products. Taking these steps now can have a huge impact on our health and the health of future generations.

OSF HealthCare Cardiovascular Institute provides a free online heart health profiler that can help you learn important information about your personal cardiovascular health and risk factors. Go to osfhealthcare.org/heart to learn more.

Interview Clips - Dr. Darrel Gumm

As the old adage goes, an apple a day keeps the doctor away. But the apple may not be alone. A recent study presented at the American College of Cardiology’s Annual Scientific Session indicates two to three cups of coffee could also do the trick.

Researchers compiled ten years of survey data from nearly half a million coffee drinkers, and discovered that drinking coffee – specifically two to three cups a day – is associated with a lower risk of heart disease, heart arrhythmia and also with living longer. This data held true for both people with and without preexisting cardiovascular disease.

“What they found is that for people who drink two to three cups of coffee a day, it either had a neutral effect – meaning it did not cause harm – or 10 to 20% improvement in cardiovascular health: less risk of cardiovascular disease, stroke, heart failure,” explains Dr. Sudhir Mungee, an interventional cardiologist with OSF HealthCare Cardiovascular Institute. 

Dr. Mungee thinks the reason behind these finding lies in the power of the coffee bean. Coffee beans have multiple biologically active compounds, including some that can reduce oxidative stress and inflammation, both of which can play a role in cardiovascular health.

“A decrease in inflammation in the body and cardiovascular disease or stroke or heart failure or heart attacks are all related to a state of inflammation. So if there is a biologically active product in coffee beans that reduces oxidative stress, oxidative injury, or reduces inflammation in your body, it probably will have an impact on positive heart health,” Dr. Mungee says.

No matter the coffee type consumed – instant, regular or decaf – the benefits were seen across the board in study participants.

While this data is good news for coffee drinkers, Dr. Mungee says it isn’t a sole reason to start a java habit. He says anyone who gets anxiety, palpitations or insomnia from coffee shouldn’t start drinking it for the sole reason of decreasing their heart disease risk.

“What the study is saying is that if you're a coffee drinker, and if you drink two to three cups of coffee a day, you don't have to stop. Even if you had a heart problem, because they actually looked at people who didn't have a heart problem, it benefited those, and people who had heart problems didn't worsen if they were to take coffee. So I think it's an important message that - okay, don't start it for the wrong reason, but if you're taking it, feel good about it. It's not going to hurt you.”

On top of the natural coffee bean benefits, Dr. Mungee believes there is another factor in the study’s findings. People who drink a moderate amount of two to three cups of coffee a day might have tendencies to do other things in moderation as well.

“Coffee in moderation means you're also doing other things in moderation,” he says. “Moderation in exercise, moderation in how much you eat. So I think there is a subtle message about that lifestyle - how you're taking care of yourself.”

If you have questions about your habits and how they relate to heart health you should speak with your primary care physician, or take the free heart risk assessment at osfhealthcare.org/heart.

Interview Clips - Dr. Sudhir Mungee, Interventional Cardiologist, OSF HealthCare

B-Roll - Dr. Sudhir Mungee