Follow-Up On Cool-Downs: What To Do And Why You Really Should

My boss, wbur.org chief John Davidow, tells me I ruined his life with this post on the danger zone after exercise, written in the wake of Kara Kennedy's recent death. Used to be, he'd play his boisterous morning game of basketball, then assume that his body was cooling itself down naturally as he shaved. Now he still shaves right after playing, but as he does, he worries that he'll drop dead from a heart attack with a white beard of cream still on his face.

Now, I'd rather not have "life-ruining" appear on my next performance review. Also, I don't want John to die with a foamy face. And I figure if he's left with concerns, probably so are many others. So I asked Dr. Aaron Baggish of Massachusetts General Hospital for a follow-up conversation to help clear up exactly what constitutes an adequate cool-down and why it's so important. He's an expert on the effects of exercise on the heart and cardiovascular system. (Also himself a competitive runner, and the cardiologist for the Boston Marathon.) His conversation with John, edited and distilled:

John: So are you kidding me? Do I really have to warm up and cool down?

[module align="right" width="half" type="pull-quote"]'Tell them to wait. It's much better they all jog with you than have to wait while they're calling the ambulance.'[/module]

Aaron: I'm not kidding you. The issue is this: That we know, and have known probably for 30 or 35 years, that routine physical exercise reduces your risk of heart trouble. That story is very clear. But it comes at a price: If you’re going to run into trouble, it’s going to be while or after you're exercising. If you’re going to exercise — and you should — you have to know how to do it right: You have to let your body warm up and cool down. Your body doesn’t like sudden changes.

So why do I see studies saying, 'Oh, don’t bother stretching'?

Stretching has to do with your muscles, your joints, ligaments and tendons, and nothing to do with your heart. Some people say it's good; some people say it's bad. I think there's injury-preventing value in stretching, but we're talking about your most important muscle, your heart.

So what’s a warm-up? This would require me getting up five minutes earlier than my usual 5 a.m.. What would I be doing in those valuable five minutes?

So you're the guy who jumps out of bed, drives to the court, meets his buddies, plays, then showers and goes to work. You should know that sports like basketball or tennis, where you repetitively go from standing still to full speed, those are the most likely to precipitate heart problems. The short-burst activity is where many people get into trouble.

So the best way to minimize risk is to warm up before play. A warm-up is going gradually from a sedentary state to getting your heart pumping. It can involve jogging, stationary bike, walking briskly — something that allows your body to incrementally work harder.

How long does that take?

Anywhere from five to ten minutes is sufficient, as opposed to just walking onto the court and starting to play.

[module align="right" width="half" type="pull-quote"]'Honestly, all it takes is one guy to start doing it and people start asking questions and before you know it, everyone starts doing it.'[/module]

Even if there's nine guys ready to play and you hold them up?

Tell them to wait. It's much better they all jog with you than have to wait while they're calling the ambulance.

So say I’ve survived the first half of my workout and I look at the clock and I have to get to work...?

First of all, if you go right into the shower you'll just keep sweating and sweat through your suit. The heart and blood vessels do not like sudden stops. After exercise is a time not so much for heart attacks but for arrhythmias and passing out if you don’t take the time to cool down effectively. Take your warm-up and do it in absolute reverse. That's the best way to keep yourself safe after exercise.

So walk the track?

Whatever you did at the beginning, say, jogged for five minutes around the outside of the basketball court, from a walk to a slow jog to a quicker jog to really working — the cool-down is the exact same thing in reverse. That allows everything to come back to a resting equilibrium. Even if you only have an hour to work out, you have to do a cool-down. This is something that time and again ends up bringing people to my office. What can I do to convince you other than giving you an office slot in a year or two when you come see me?

I think a successful exercise routine is just that, a routine, and to change a routine is a bit of a challenge. You back-time your entire day to shoehorn this in, and this would call for a recalibration that will take time, let me put it that way.

That's a reality and I appreciate that. If you were reminded by someone who thinks about this on a daily basis, that your exercise routine, although good, potentially puts you at risk for a bigger problem, would that sway you?

It's an interesting question. People exercise for all sorts or reasons. I exercise because I'm playing basketball and it's fun and it's social. I don’t think of it as primarily health related — unless one considers that it's mental-health-related because it's fun. So taking it into that health dimension is a little bit of a transition. Not a huge one, obviously. It sounds like I just need to get up a little earlier.

Let me put it this way: Do you drive a car with a seat-belt?

Yes.

Why?

It's a routine, a habit that I've learned over time.

That routine stems from the fact that someone taught you that it makes being in the car safer. Regardless of why you exercise, the take-home is the same: If you're going to be doing it, why not do it in a way that minimizes your risk?

You got me.

(An interjection from the peanut gallery: Can you quantify the risk? How much riskier is it not to warm up or cool down?)

i can’t give you any data that quantifies the cool-down and warm-up effect other than that it’s something that those of us who do it all the time know and see. I can give you stats on how much reduction in risk of heart disease you get from exercising, and quantify the elevation in the risk during exercise. It’s quite striking.  The more you exercise, the more hours per week, the risk of having heart disease drops in a linear fashion. That being said, the more vigorously you exercise, the more likely you are, if you have an event, to have it during or after exercise.

Also, I do tell all my patients: If you're playing basketball and tennis, that's great and it's fun but ideally you would also be doing something else that is more strictly cardiovascular that would prepare your body for it.

(Peanut gallery again: So should John just get all the pick-up players to cool down together?)

Yes, yes. Honestly, all it takes is one guy to start doing it and people start asking questions and before you know it, everyone starts doing it.

Will John change his ways and revolutionize his pick-up basketball gang, perhaps saving lives? Or will they laugh him off the court? Stay tuned...