Granted, most of the people she's helped have had a heart attack or other cardiovascular crisis that has helped jolt them into action. But Hazekamp, an exercise specialist at the University of Michigan Health System's Preventive Cardiology program, says that we can all benefit from the same advice she gives her patients - and by doing so, we might keep ourselves from needing rehabilitation help from someone like her. If even heart failure patients can exercise, so can we.

One of the biggest misconceptions Hazekamp encounters in her work is the idea that just because someone is a little -- or a lot -- overweight, they can't be physically fit. Nonsense, she says. And since obesity is reaching epidemic proportions in this country, bringing with it elevated risks of heart disease, diabetes and more, that idea may actually be dangerous.

"It's definitely possible to be overweight and fit, although it depends on the level of fitness that you're talking about," she says. "Even if someone is overweight, they can achieve multiple benefits by starting an exercise program. They can reduce their blood pressure, improve their overall stress management, bring down their overall cholesterol levels, achieve a better energy level, reduce body fat, and improve body composition. And if they're diabetic, they can improve their glucose control and their insulin sensitivity."

In both the short term and the long run, Hazekamp explains, people who get off their duffs and start moving are doing themselves a favor, even if the extra pounds don't vanish immediately. And you don't have to train for a marathon -- activity can start with walking a few extra steps.

Meanwhile, she says, those who think they have to lose the pounds before they ever lace up their sneakers may indeed get some heart benefit. But not only will they find it harder to lose or maintain their weight, they'll miss out on the other benefits of physical activity in the meantime.

Hazekamp's work in the U-M's cardiac rehabilitation clinic, and her master's degree in exercise physiology, don't mean she tries to turn human slugs into elite athletes overnight. Instead, she works with patients to find ways they can include a gradually increasing amount of physical activity into their everyday lives. And, she sees increased fitness as one of several key lifestyle changes that can lead to overall wellness - diet and stress are also important.

U-M physicians have studied exercise in patients with failing hearts and irregular heartbeats. But the same advice could work for all of us, she says, especially those of us who don't already have an exercise routine or a good level of fitness.

"There are many opportunities during your regular daily activities to just take more steps," she explains. "For example, taking the stairs rather than the elevator, parking further away in a parking lot or on the upper level of a parking structure so that you use the stairs."

In fact, she points out, you may think you're saving time by driving around a parking lot to find the spot that's closest to the door, but you probably could get inside faster, and sneak in a little activity besides, by parking in the first spot you find and walking to the door.

As this kind of activity becomes more routine for you, you can then add in a little bit of more formal exercise, with 15 to 20 minutes of continuous activity that gets your heart pumping a little faster and makes you breathe a little harder without being short of breath.

Whether it's gardening, walking briskly, bicycling, swimming, taking an exercise class that suits your style or making a trip to the gym, Hazekamp says the important thing is to find something you like to do - not trying to force yourself into something you think you have to do. Often, she notes, overweight people feel self-conscious going to a gym full of skinny people, so instead they should find an environment where they feel comfortable being active.

If you can build up a total of 30 minutes of some sort of activity during most days, you'll fit right in with the recommendations of the U.S. Surgeon General, whose 1996 report on sedentary people said that even this kind of informal exercise can help non-active bodies in many ways.

But to get a real preventive effect on your heart and cardiovascular system, and reduce the chance that you'll wind up like one of Hazekamp's patients, you need to aim for 30 minutes of continuous activity three to four times a week. Again, the key is to build up to that level gradually, so you don't get discouraged and quit. Adding five minutes a week is a good goal.

Of course, if you are obese or very overweight, Hazekamp advises, you should check with your physician before starting a more vigorous kind of exercise routine, just to make sure your weight isn't causing problems that could be worsened by working out.

So now that you know what you need to do, how do you get going? Hazekamp knows how difficult that initial effort can be. "It's really hard for a lot of people to get motivated to exercise, and I often tell people it's the first five minutes that's the hardest time because that's when you have to change your clothes and get moving," she says.

"There are some keys to success, such as having an exercise partner who can meet you so you have accountability, and choosing music that you enjoy to exercise to," she continues. "It's also important to start at a level that doesn't feel uncomfortable for you, because when you're getting started, comfort is really the key to maintaining and improving your activity."

Once you start, you may be surprised at how quickly you notice a boost to your energy, a drop in your stress, and other perks. This can help keep you going as you adjust to the new routine.

The bottom line, Hazekamp urges, is that it's never too late to start on the road to fitness, but the important thing is just to start.

Facts about overweight, health and exercise:

· By some definitions, more than half of Americans are considered overweight or obese. About 23 percent are obese under the definition used by the Centers for Disease Control & Prevention (body mass index greater than 30 kg/m2).

· Michigan's population is the fourth heaviest in the nation, with more than a third of residents fitting the state's definition of overweight (BMI greater than 27 kg/m2).

· According to the Surgeon General, more than 60 percent of U.S. adults do not engage in the recommended amount of activity, and about 25 percent of U.S. adults are not active at all.

· Lack of physical activity or exercise can help lead to heart and other cardiovascular problems, diabetes, joint problems, overweight and obesity.

· Physical activity does not need to be strenuous to produce health benefits; men and women of all ages benefit from a moderate amount of daily physical activity. The same moderate amount of activity can be obtained in longer sessions of moderately intense activities (such as 30 minutes of brisk walking) as in shorter sessions of more strenuous activities (such as 15-20 minutes of jogging).

· In a recent state survey, nearly four in 10 Michigan adults had been advised by a doctor to exercise more. Almost six in 10 respondents reported trying to exercise more.

· About 57 percent of Michigan senior citizens are classified as sedentary. - By Kara Gavin

Related websites:

U-M Health System, Health Topics A to Z: Fitness topics directory

Michigan Fitness Foundation

Surgeon General's Report on Physical Activity and Health

American Heart Association: Physical Activity in Your Daily Life

American Heart Association: One of a kind personalized health management program

American Diabetes Association: Exercise

[Contact: Kara Gavin, Valerie Gliem ]

11-May-2001