Transplant recipients: walking for health

Progress in Transplantation, Mar 2005 by Cupples, Sandra A, Cooke, Richard H

"Walking is man's [and woman's!] best medicine." Hippocrates

Hippocrates' comment was made thousands of years ago, yet it is still true today! There are many benefits to walking. Although our culture touts the virtues of running or jogging, walking provides as many benefits-and it's safer! For example, walking helps to burn calories, curb the appetite, lower blood pressure, improve muscle tone, boost energy levels, and lessen anxiety. At the same time, walkers are less prone to injuries than runners or joggers.

Getting Started

The first thing to do is consult with your transplant team or your primary care physician. Tell them you are interested in starting a walking program and ask for their advice regarding any specific limitations that you might have. Ask about your target heart rate. If you find it difficult to take your own pulse, consider buying a heart rate monitor.

Footwear

A well-fitting pair of shoes is the single most important piece of "equipment" you will need. However, there is no one "best" shoe. Because everyone's feet are different, the "best" shoes are the ones that fit you properly, are lightweight and comfortable, and provide good support, flexibility, and cushioning. It is important to take some time in selecting a good shoe. You may want to consult with an athletic shoe fitting expert who can help you select a shoe for your particular weight, stride, and walking speed and distance. Such an expert will analyze your gait, have you try on several styles of shoes and observe how you walk in each of them. It is important to invest in a good pair of walking shoes; they will help prevent injuries and should last for many miles.

Where to Walk

Many transplant recipients enjoy walking outdoors. This is fine, as long as you are not exposed to extreme temperatures. Walking in hot weather puts you at risk for heat sickness. Walking in cold weather can also be dangerous-not only because of the cold temperature but also because of ice or snow. On very cold days or hot, humid days, it is better to walk indoors; for example, at your local, air-conditioned shopping mall. Many malls open early in the morning to accommodate "mall walkers."

Clothing

Wear loose fitting clothes. Avoid rubberized clothing. In cooler weather, dress warmly and wear gloves. Wear layers of clothing that trap the heat. You can remove a layer if you get too warm. Wear a hat. You will lose about 30% of your body heat through your head. In warmer weather, wear light clothing made of wicking, breathable fabrics. If you are walking outdoors on a sunny day, don't forget to protect your skin from the sun's rays by applying sunscreen lotion (sun protection factor [SPF] 15 or higher) and wearing a wide-brimmed hat.

Warming Up

Each time you walk, you should warm up by walking slowly for 10 to 15 minutes. This is particularly important for heart transplant recipients. Because the transplanted heart has no nervous system supply, the only way your heart will "know" that you are exercising is by the release of certain chemicals. It takes time for these chemicals to be released; therefore, heart transplant recipients must be careful to warm up properly.

How to Walk

Good posture is key. As you walk, keep your head up and your spine straight. Keep your arms and shoulders loose. Take long, smooth strides with your arms swinging gently at your sides. Keep your elbows close to your body and bent at a 90-degree angle. Keep your hands loose. Don't clench your fists... this will increase your blood pressure. Take deep, regular breaths. Don't hold your breath. If you are walking with someone, you should be able to carry on a conversation in full sentences.

Weight Loss

If losing weight is one of your goals, let "slow and steady" be your motto. The number of calories you will "burn" by walking depends on your weight and the distance you walk. For example, if you weigh 140 pounds and walk at 2 miles per hour, you will burn about 93 calories per mile. However, if you weigh 200 pounds and walk at 2 miles per hour, you will burn about 133 calories per mile. As you begin your walking program, it is more important to increase distance than to increase speed.

A sensible weight loss goal is 1 to 2 pounds per week. A pound of fat is equal to 3500 calories. In order to lose 1 pound a week, you will need to "spend" 3500 more calories than you eat during the week. You can do this by burning more calories through walking, eating fewer calories, or both. Check with your transplant team dietician for advice about your daily caloric intake. This is particularly important for diabetic patients.

Cooling Down

Just as you warmed up before your walk, you should spend 10 to 15 minutes cooling down. You can do this by walking on a flat surface at a slower speed. Again, this is important for heart transplant recipients. The only way the transplanted heart will "know" that you have stopped exercising is when the special chemicals have gone away. It takes time for these chemicals to dissipate.

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