The Secret of Tiny Bypass Routes in Your Heart's Blood Vessels
Let me share a fascinating explanation from a cardiovascular specialist at Kangbuk Samsung Hospital. When you look at actual photographs of hearts removed during surgery, you can see countless tiny branches within the blood vessels. These small vessels are called "collateral circulation," and they work just like detour routes when a highway gets blocked.
What's truly remarkable is the stark difference between hearts of people who exercise regularly and those who don't. Hearts of people who exercise consistently have far more of these tiny vessels developed. Every time you exercise, blood flows through your vessels, naturally cleaning the vessel walls and creating new pathways for blood flow.
This difference shows up dramatically in clinical practice too. When two patients in their early 50s come in with acute myocardial infarction, the one who never exercised struggles between life and death, while the one who exercised regularly recovers relatively smoothly. The reason is simple: even when major vessels get blocked, the well-developed bypass routes they've built up continue supplying blood to the heart.
Canada's Revolutionary 1970s Experiment
There's a historic event that completely changed how we think about exercise for heart patients. In the early 1970s, a Canadian cardiologist named Dr. Kavanagh conducted an experiment that was unthinkable at the time. Back then, having heart attack patients exercise was absolutely unimaginable.
But Dr. Kavanagh recruited 8 patients who had suffered acute myocardial infarction and started training with them. They began with 100-meter runs and gradually increased the distance, eventually participating in the Boston Marathon. The results were astounding: 7 out of 8 patients completed the race, and the one who didn't finish stopped due to a foot injury, not heart problems.
This experiment shocked the medical world. It proved that even patients with acute myocardial infarction—the ultimate heart condition—could achieve better fitness than average people with proper exercise prescriptions. Since then, prescribing exercise for heart patients has become standard treatment.
Medications vs. Exercise: A Surprising Comparison
The first question most patients ask when they come to the hospital is "What medication should I take?" or "Can I take aspirin?" Of course, medication is important. Aspirin can prevent about 1 heart attack for every 500 people who take it daily, and cholesterol medications reduce heart attacks and death rates by about 10-15%.
But what about exercise? This is where truly surprising facts emerge. Exercise reduces 10-year mortality rates by 25-30%. It decreases not only overall death rates but also cardiovascular disease mortality by the same amount.
What's even more amazing is its effect on cancer. It not only reduces the incidence of specific cancers like breast and prostate cancer, but even when cancer has already developed, it decreases cancer-related mortality by 25-30%. At this level, exercise should be considered as essential as our daily meals.
Moderate-Intensity Exercise: How to Judge It
The World Health Organization and various medical associations recommend moderate-intensity exercise 3-5 times per week. But this concept of "moderate intensity" can be confusing.
Here's the easiest way to judge:
- Low intensity: Light walking where you don't sweat or get out of breath
-High intensity: Like running fast for 30 minutes where you sweat profusely and breathe heavily
-Moderate intensity: Between these two, where you break a light sweat after 30 minutes of exercise
There's also a practical test. When two people exercise together and have a conversation, if you answer "What did you do today?" with "Today... I went... to work" while catching your breath between words, that's about right.
The simplest criterion is if after 30 minutes of exercise, you feel "Ah, I actually exercised." If you walk along the Han River for 2 hours but it just feels like a stroll, that's not exercise. But if you walk for 10 minutes and your legs feel tight and you're out of breath, that's exercise.
The Second Heart: Calf Exercise Methods
Your calves are nicknamed "the second heart." When your calf muscles are strong, they can provide significant help even when heart function declines. There's an exercise you can easily do on the subway or in the office.
Simply lift your heels while sitting in a chair. Feel your calf muscles contract and hold for 2-3 seconds before lowering. As you repeat this, you'll feel your calves getting tight and slightly out of breath. This level provides sufficient exercise benefits.
Warning Signs to Stop Exercise Immediately
Just because exercise is good doesn't mean you should do it unconditionally. You should avoid exercise in these situations:
Pre-exercise checklist:
- When you're sick or feeling under the weather
- When you have a fever or poor condition
- When your blood pressure is 40-50mmHg higher or lower than usual
- When your pulse is too fast or slow
Symptoms requiring immediate exercise cessation:
- Sudden chest pain
- Severe dizziness
- Severe shortness of breath you've never experienced before
- Weakness in one arm
- Decreased consciousness
If these symptoms appear, don't hesitate—go to the emergency room immediately. Exercise is treatment, prevention, and also the best diagnostic tool for checking your health status.
A New Definition of Exercise: Any Intentional Movement
Many people think of exercise as something grand and difficult. But let's reconsider the definition of exercise. When an ICU patient regains consciousness and intentionally moves their fingers, that's exercise. When babies do "peek-a-boo" gestures, that's exercise.
Even wiggling your ankles while sitting on the couch watching TV is exercise. In other words, if you intentionally move any part of your body with purpose, that's exercise.
In hospitals, we actually start exercise therapy the moment a heart attack patient moves from the ICU to a regular room. Even patients who came in with cardiac arrest receive exercise therapy while still in the ICU. Heart surgery patients also begin exercise therapy immediately after surgery if there are no issues with the surgical site.
Conclusion: Exercise Is Not Optional, It's Essential
As a cardiologist, I want to emphasize that exercise is no longer optional. It should become as essential a daily routine as the medications heart patients take every day.
Many people worry, "What if I collapse while exercising when I'm already short of breath and having chest pain?" But in reality, I see far more patients who visit the emergency room every few months because they don't exercise, whose blood vessels and heart conditions worsen to the point where they need heart transplants.
There's almost no condition that prevents exercise. As long as your body condition allows it, anyone can do it—the intensity may vary, but it's possible. The important thing isn't doing perfect exercise, but developing the habit of intentionally moving your body a little bit every day.
For heart health, exercise is no longer a prescription you can postpone. Start today with something as simple as lifting your heels while sitting in a chair. That small movement will create new pathways of life for your heart.
Source: Based on lectures by cardiovascular specialists at Kangbuk Samsung Hospital.
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