Appendix A

Target Heart Rate (THR) is a common way of judging how hard you should exercise during endurance activities. It tells you how fast the average person should try to make his or her heart beat during endurance sessions. It's not always the best way for older adults to decide how hard to exercise, though, because many have long-standing medical conditions or take medications that change their heart rate. We recommend using the Borg scale shown in Chapter 4 instead. However, some older exercisers who are in basically good health and who like taking a "scientific" approach to their endurance activities may find the THR method useful. Others should check with their doctors first. For those of you who can use THR, the chart below shows an estimate of how fast you should try to make your heart beat, once you have gradually worked your way up to it. "Gradually" is an important word here. Going immediately from an inactive lifestyle to exercising at the rate shown in the chart is not advised. One way to reach your THR gradually is to take your pulse during an endurance-type activity that is already a part of your life (walking, for example.) Do it at the pace you normally do it, and record your heart rate, from session to session (or over several sessions), increase how hard you work, so that your pulse rate gradually gets faster, over time. Eventually, you can try to get your heart rate up to 70 to 85 percent of its maximum ability (the rate shown in the chart). Making it beat faster than this is not advised. Note: The goal is not for your heart rate to be faster all the time - just when you do your endurance activities. In fact, you should find that, as your heart becomes more efficient from endurance exercise, your resting pulse rate is slower than it was before you took up this healthy habit. How to Take Your Pulse To take your pulse, press the tips of your index and middle fingers against the inside of the opposite wrist, just below the mound oat the base of your thumb, and count how many pulsations you feel in a 10-second period. Multiplying this number by 6 will give you your heart rate. (Note: Don't count your pulse for an entire minute. During the minute that you have stopped exercising to take your pulse, your heart will have slowed down, and you won't get an accurate reading. Top of Page DO NOT Use the THR Method If... You take medications that change your heart rate You have a pacemaker for your heart You have an irregular heart rhythm called "atrial fibrillation" You have any other condition that affects your pulse rate. All of these situations can give you inaccurate readings. Many older adults take medications in a class called "beta blockers" for high blood pressure or some heart conditions. Your doctor can tell you if your heart or blood-pressure medicine is a beta blocker, or if you have other conditions or medications that will affect your pulse rate during exercise. Some eye drops used to treat glaucoma also contain beta blockers. Your heart rate is a reflection of how hard your body is working. Beta blockers tend to keep your heart rate slower, so no matter how hard you push yourself, you might never reach the heart rate you are trying for. You might end up exerting yourself too much, as you try in vain to reach a heart rate that your beta blockers won't allow. Being on beta blockers doesn't mean you can't exercise vigorously; it just means you can't rely on your heart rate or on your pulse rate, to judge how hard you are working. Age Desired Range for Heart Rate During Endurance Exercise (beats per minute) 40 50 60 70 80 90 100 126-153 119-145 112-136 105-128 98-119 91-111 84-102

When Marty Billowitz throws off his blankets in the morning, he thinks first about his wife Harriet, but seconds later, he is up and moving, pulling on comfortable clothes and lacing up his walking shoes. Where does this 75-year-old grandfather dash off to at 7:00 every morning? Mr. Billowitz goes to the shopping mall not to get a jump on early-bird bargains, but to join a group of mall-walkers organized by the local hospital. These seniors meet each morning to exercise. Some move at a steady clip through the arteries of the mall, others take a slightly slower pace, but all of the walkers count their laps and keep a daily record of their progress pushing themselves each day to go a little faster, a little farther.

Mr. Billowitz joined the mall-walkers at his wife's insistence. "Harriet was clear that once I'd retired, no matter what, we were going to walk each morning!" That was nearly 7 years ago. Today Mr. Billowitz says, "The walkers have been a lifeline. They keep me moving on days when all I want to do is sit." You see, Mrs. Billowitz died unexpectedly last year. "It was quite a blow. I always thought I'd be the first to go," he says.

Still, during those years he spent walking miles around mall halls, Mr. Billowitz had done more than just improve his cardiovascular strengthhe also had built lasting friendships. It was those friends who brought him back into the walking routine after his wife's death. At first, Mr. Billowitz walked because it was something to do each morning. "But over time, I realized I liked how it felt to be moving. I liked seeing my improvement. Measuring how fast I could walk each morning gave me goals, something to work toward. It also made me feel good to see that I could take care of myself."

Mr. Billowitz believes that the mall-walking habit was a small gift his wife left for him, "I walk and feel stronger every day. That really helps. Some mornings I think of Harriet and silently thank her for insisting that we walk together."