|In this issue of HEALTHbeat:
• Learning to walk — A graduate course
• What does an enlarged heart signify?
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|February 17, 2009|
Dear HEALTHbeat subscriber,
Seeing as most of us learned to walk less than two years after being born, you might scoff at the idea that you could afford to brush up on your technique—we should be experts on walking by now, right? But the reality is that over time, people can acquire walking habits and patterns of movement that aren’t efficient or necessarily healthy. This issue of HEALTHbeat describes the correct walking posture and gives tips for maintaining it. Also, Dr. Richard Lee, member of the Harvard Heart Letter editorial board, discusses what an enlarged heart says about health.
Wishing you good health,
|Learning to walk — A graduate course|
Walking comes so naturally to us that it is regularly prescribed without a second thought. For example, the Department of Health and Human Services exercise guidelines published in October 2008 advise all adults, regardless of age and health status, to strive to walk vigorously for a total of at least two and a half hours a week. Yet nowhere do the guidelines suggest how to walk.
Nor would we expect them to. For healthy adults, walking is so automatic that it’s impossible to remember having learned how to do it. Yet it’s likely that as we’ve logged pedestrian miles, many of us have picked up a few bad habits along the way that are making our walks less efficient — and maybe even injurious.
The good news is that decades of research have shown that even patterns established over a lifetime can be reversed.
Ideally, by adulthood a person will walk with head erect, back straight and upright, arms bent, knees extending and flexing, feet striking the ground with the heel and pushing off with the toes. The pelvis should rotate back and forth about 8 degrees and list a little downward on the side that isn’t bearing weight. The knee of the weight-bearing leg should flex as we push off our toes. And while we all bob up and down a little when we walk, the pelvic rotation and list, in combination with the movements of the knee, ankle, and foot, manage to smooth out that vertical movement.
Our upper bodies also get into the act. At moderate speeds, rotation of the trunk and shoulders should be out of phase with the pelvis. As a result, the forward swing of one leg is matched by the forward swing of the arm on the opposite side, a balancing act plainly visible in the exaggerated movements of a marching soldier.
Unfortunately, few of us achieve the ideal gait, and even fewer maintain it. Over time, we may lower our heads and thrust our trunks forward at the waist, so our center of gravity is pitched as if we are always about to tumble forward. Instead of swinging smartly, our arms may dangle listlessly at our sides. The rhythmic heel-to-toe movement may become a slap on the pavement.
7 tips on striding right
It’s possible to correct decades of ingrained walking habits with a little work. In fact, even if you don’t think your gait is ungainly, you might benefit from the following tips:
1. Look ahead. Lift up from the top of your head. Don’t tuck your chin or look at the ground, but train your sights 10 to 20 feet ahead of you. If you need to check the ground to avoid obstacles, lower your eyes, not your head. An erect head reduces the likelihood of neck and shoulder pain.
2. Stretch your spine. Your shoulders should be level and square, neither thrust back nor slumped forward. Tuck your buttocks in. When your body is in alignment, you should be able to draw an imaginary straight line from your ear to your shoulder, hip, knee, and ankle when viewed from the side. Maintaining correct posture while you walk will help you to avoid hip and lower back pain.
3. Bend your arms. Flex your elbows at close to 90-degree angles and let your arms swing at waist level. Your fingers should be curled, but not clenched in a fist. If you’ve gotten into the habit of dangling your arms, it may take some conscious effort to keep them raised.
4. Swivel your hips. A slight pivot at the hip can add power to your stride.
5. Flex your feet. Come down on your heel; lift up off your toes. Assume that the person walking behind you wants to see the sole of your shoe as you walk.
6. Take measured steps. Too long a stride throws you off balance. Concentrate on taking shorter steps, but more of them.7. Share your load. There’s a lot to be said for carrying parcels on one’s head; any load on the back or shoulders is likely to affect posture by thrusting the trunk forward. A backpack, which distributes weight evenly across the shoulders, is the best choice for carrying objects. If you use a shoulder bag, transfer it from one side to the other every few minutes as you walk.
For more information on how to prevent knee and hip injuries, order our Special Health Report, Knees and Hips: A troubleshooting guide to knee and hip pain, at www.health.harvard.edu/KH.
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|Notable from Harvard Medical School|
|** Knees and Hips: A troubleshooting guide to knee and hip pain
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|** Harvard Heart Letter|
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|What does an enlarged heart signify?|
Q: My doctor told me I have an enlarged heart. What is this? What causes it and what does it mean for my health?
A. The term “enlarged heart” refers to a heart that is larger than average for the age and size of its owner. It can mean many things, and not all of them are worrisome.
An enlarged heart is typically spotted on a routine chest x-ray that shows the heart’s shadow to be larger than it should be relative to the size of the person’s chest. The difference between normal and enlarged isn’t necessarily huge. For an average-size person, the left ventricle might measure 2 inches in diameter; 2.5 inches would be abnormally large. Sometimes an electrocardiogram tracing suggests the heart is enlarged. The most accurate methods of determining the size of the heart are the echocardiogram and magnetic resonance imaging. These techniques can measure the size of each heart chamber down to about a millimeter.
If your heart is enlarged, it is important for your doctor to determine which part of the heart is enlarged, by how much it is enlarged, and why it has gotten bigger. If you are an athlete, it is probably because of the exercise you do. Olympic athletes can have so much heart muscle that their hearts appear to be seriously diseased. More often than not, though, an enlarged heart is caused by an underlying cardiac problem. The left ventricle may enlarge from high blood pressure or as a result of a heart attack, while the right ventricle can enlarge from lung disease or a hole inside the heart. A faulty heart valve can cause the heart to enlarge, as can alcohol abuse. Genetic disorders such as hypertrophic cardiomyopathy, which cause abnormal growth of muscle fibers in the heart, also cause the heart to get bigger.
It’s reasonable for you to pin your doctor down and ask exactly what he or she means by an enlarged heart. Keep asking questions until you feel you have the whole story.— Richard Lee, M.D.
Associate Editor, Harvard Heart Letter
This Question and Answer first appeared in the February 2009 Harvard Heart Letter, available at www.health.harvard.edu/heart.
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