Being out-of-shape is almost as strong a risk factor for a heart attack as smoking. A study in the Journal of the American Medical Association (December 21, 2005) shows that being out-of-shape markedly increases your risk for being fat, storing most of your fat in your belly, having a high bad LDL cholesterol and high blood pressure, and having low levels of the good HDL cholesterol.

We live in a society in which 91 percent of the population develops high blood pressure, 78 percent have high cholesterol, and 35 percent are diabetic. More than 50 percent of us die of heart attacks and strokes from these risk factors. Doctors no longer think of heart attacks, strokes and diabetes as just being due to our genes. We now consider these diseases to be caused by our behavior. You prevent heart attacks, strokes and diabetes by 1) exercising; 2) reducing your exposure to saturated fats (meat and chicken), partially hydrogenated fats (most prepared foods), and refined carbohydrates (flour and sugar); 3) eating larger amounts of fruits, vegetables, whole grains, beans, seeds and nuts; 4) avoiding overweight; and 5) avoiding smoking.

We have known for many years that any kind of exercise or activity helps prevent heart attacks, but more recent data show that the more vigorous the exercise, the better the protection. First check with your doctor to see if you have a medical condition that could be aggravated by exercising. People who are out-of-shape are the ones most likely to suffer heart attacks when they start an exercise program. With your doctors permission, you are ready to start a training program.

The best sports for preventing heart attacks are those in which you exercise continuously. You could run, dance, cycle or swim. It's important to pick an activity that you enjoy, because more than 85 percent of middle aged Americans who start an exercise program drop out in the first six weeks. Those who are most likely to continue exercising are those who exercise with a partner or in a group, such as with their spouses, with a personal trainer or in a class at a nearby health club.