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or heavy gardening, and regular walking (>40 min/day) was associated with a significant reduction in death from all causes includ- ing heart related (89).  In this study, even men who were sedentary and initiated light exercise derived some benefit.  The Centers for Disease Control and Prevention and the American College of Sports Medicine agree that even 30 minutes of moderate exer- cise on most days, if not all, will lead to improved cardio- vascular health (90).  So what does "moderate" mean? Walking at 3 to 4 miles per hour would be a good example.  Of course there are many other enjoy- able forms of exercise and all likely derive similar bene- fits as long as the duration is similar and the energy expended is the same.  In addition to walking, consider swimming, rowing, biking, or cross-country skiing.   Does duration matter?  Up until recently, it was EXERCISE Regular exercise should be a part of life's daily routine. It has been well described to have many positive effects on the risk factors which contribute to CHD.   There are several other benefits to routine exercise, which likely indirectly affect the risk of CHD, such as stress reduction.  Exercise is well known to release endorphins which are the body's own chemicals that can reduce pain and invoke mild euphoria.  Perhaps it is this later benefit which reduces emotional stress, and as a result, lowers blood pressure and there- fore the risk of developing CHD.  For individuals who do not yet have evidence of CHD, clinical research such as The Harvard Alumni Health Study have demon- strated that regular vigorous exercise translates into a lower risk of future CHD events-chest pain, heart attack, heart-related death, and the need for bypass surgery or angioplasty (85). For those who already have CHD, The National Exercise and Heart Disease Project randomized 651 men, 2 to 36 months after a heart attack, to an exercise pro- gram for 3 year (86).  In these individuals, there was a 37% reduction in heart related death and 5% reduction in other cardiac events such as heart attack. A second study examined 303 men after a heart attack and found a 42% reduction in mortality after slightly more than two years (87). The findings in neither study were statistically significant, but they certainly suggest the potential for a strong benefit from a routine exer- cise program.   Marathon running is not required to see a heart healthy benefit from regular exercise.   In a recent study of 772 middle aged men with CHD that were followed for up to 5 years, recreation- al activity of at least 4 hours on the weekend, moderate a_regular exercise * lowers LDL, the "bad cholesterol" * raises HDL, the "good cholesterol" * lowers blood pressure * lowers body fat routine:

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