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September 13, 2011
Is sex exercise? And is it hard on the heart?
At some time in his life, nearly every man gets exercised about sex. And as many men get older, they wonder if sex is a good form of exercise or if it’s too strenuous for the heart. These questions may sound like locker room banter, but they are actually quite important — and they now have solid scientific answers.
Treadmill vs. mattress
To evaluate the cardiovascular effects of sexual activity, researchers monitored volunteers while they walked on a treadmill in the lab and during private sexual activity at home. In addition to 13 women, the volunteers included 19 men with an average age of 55. About three-quarters of the men were married, and nearly 70% had some form of cardiovascular disease; 53% were taking beta blockers. Despite their cardiac histories, the men reported exercising about four times a week, and they reported having sexual activity about six times a month on average.
Researchers monitored heart rate and blood pressure during standard treadmill exercise tests and during “usual” sexual activity with a familiar partner at home. All the sex acts concluded with vaginal intercourse and male orgasm.
Disappointingly perhaps, the treadmill proved more strenuous. On an intensity scale of 1 to 5, with 5 being the highest, men evaluated treadmill exercise as 4.6 and sex as 2.7. Sex was even less strenuous for women in terms of heart rate, blood pressure, and perceived intensity of exertion.
Sex as exercise
Men seem to spend more energy thinking and talking about sex than on the act itself. During sexual intercourse, a man’s heart rate rarely gets above 130 beats a minute, and his systolic blood pressure (the higher number, recorded when the heart is pumping blood) nearly always stays under 170. All in all, average sexual activity ranks as mild to moderate in terms of exercise intensity. As for oxygen consumption, it comes in at about 3.5 METS (metabolic equivalents), which is about the same as doing the foxtrot, raking leaves, or playing ping pong. Sex burns about five calories a minute; that’s four more than a man uses watching TV, but it’s about the same as walking the course to play golf. If a man can walk up two or three flights of stairs without difficulty, he should be in shape for sex.
Sex as sex
Raking leaves may increase a man’s oxygen consumption, but it probably won’t get his motor running. Sex, of course, is different, and the excitement and stress might well pump out extra adrenaline. Both mental excitement and physical exercise increase adrenaline levels and can trigger heart attacks and arrhythmias, abnormalities of the heart’s pumping rhythm. Can sex do the same? In theory, it can. But in practice, it’s really very uncommon, at least during conventional sex with a familiar partner.
Careful studies show that fewer than one of every 100 heart attacks is related to sexual activity, and for fatal arrhythmias the rate is just one in 200. Put another way, for a healthy 50-year-old man, the risk of having a heart attack in any given hour is about one in a million; sex doubles the risk, but it’s still just two in a million. For men with heart disease, the risk is 10 times higher — but even for them, the chance of suffering a heart attack during sex is just 20 in a million. Those are pretty good odds.
How about Viagra?
Until recently, human biology has provided unintentional (and perhaps unwanted) protection for men with heart disease. That’s because many of the things that cause heart disease, such as smoking, diabetes, high blood pressure, and abnormal cholesterol levels, also cause erectile dysfunction. The common link is atherosclerosis, which can damage arteries in the penis as well as in the heart.
Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) have changed that. About 70% of men with erectile dysfunction (ED) respond to the ED pills well enough to enable sexual intercourse. Sex may be safe for most men with heart disease, but are ED pills a safe way to have sex?
For men with stable coronary artery disease and well-controlled hypertension, the answer is yes — with one very, very important qualification. Men who are taking nitrate medications in any form cannot use ED pills. This restriction covers all preparations of nitroglycerin, including long-acting nitrates; nitroglycerin sprays, patches, and pastes; and amyl nitrate. Fortunately, other treatments for erectile function are safe for men with heart disease, even if they are using nitrates.
Safe sex
Sex is a normal part of human life. For all men, whether they have heart disease or not, the best way to keep sex safe is to stay in shape by avoiding tobacco, exercising regularly, eating a good diet, staying lean, and avoiding too much (or too little) alcohol. Needless to say, men should not initiate sexual activity if they are not feeling well, and men who experience possible cardiac symptoms during sex should interrupt the sexual activity at once.
With these simple guidelines and precautions, sex is safe for the heart — but it should be safe for the rest of the body, too. Sexually transmitted diseases pose a greater threat than sexually induced heart problems. When it comes to sex, men should use their brains as well as their hearts.
| More information | |||
Get your copy of What to do about High CholesterolWhy do people on cholesterol-lowering drugs still have heart attacks? What role does cholesterol really play? How can you lower your risk of heart disease and stroke? What to Do about High Cholesterol answers these questions and explains why lowering your LDLs (the bad cholesterol) is even more important than previously thought. |
What can I do about bumps on my eyelids?
Q. I’m 70 and in good health. My cholesterol levels are normal. Lately, I’ve started to get little yellow deposits on my eyelids, which I’m told are xanthelasma. What causes these, and how can I get rid of them?
A. Xanthelasma are soft, cholesterol-filled plaques that develop under the skin, usually on or around the eyelids and most often near the nose. They occur mainly in middle-aged and older adults — and in women more often than in men. Xanthelasma are always benign; that is, they’re not cancerous and they don’t spread the way a cancer might. They rarely impair vision. But they can be a sign of hyperlipidemia — elevated blood-fat levels.
About 50% of adults with xanthelasma have some type of hyperlipidemia. The plaques are especially common in people with inherited disorders of low-density lipoprotein (LDL) metabolism. They occur in 75% of older people with familial hypercholesterolemia (very high cholesterol levels) and in 10% of people with high levels of apolipoprotein B — which is not routinely measured in a routine cholesterol test (lipid panel). Xanthelasma are also common in people with primary biliary cirrhosis — an autoimmune condition affecting the bile system and the liver.
Because xanthelasma are associated with hyperlipidemia, which in turn is associated with an increased risk of cardiovascular disease, it’s important for anyone with these plaques to have a fasting lipid panel. Your family history of cardiovascular disease is also important. If your lipid panel is normal but you have a strong family history of coronary artery disease, you might ask your clinician to check levels of other lipoproteins, such as apolipoprotein B, which may be elevated despite a normal lipid panel.
If you have hyperlipidemia, exercise and a diet low in saturated and trans fat are essential; your clinician may also prescribe a medication, such as a statin. Treating any underlying lipid condition may reduce the size of xanthelasma. If you don’t have a strong family history of heart disease, you may be one of the many people with xanthelasma who have no lipid abnormality — in which case xanthelasma is largely a cosmetic problem. But for the sake of overall cardiovascular health, you should still pay attention to exercise and diet.
There are several ways to remove xanthelasma. These include cryotherapy (freezing the lesions with liquid nitrogen), laser ablation, surgical excision, electrodesiccation (destruction of the lesion with an electric needle), and chemical cauterization (application of a topical agent such as trichloroacetic acid to dissolve the plaques).
All of these treatments can cause some degree of scarring, and none of them stops xanthelasma from recurring or prevents new plaques from developing. If you’re interested in any of these treatments, be sure to see a specialist such as a dermatologist or cosmetic surgeon who has experience in treating the condition.
— Celeste Robb-Nicholson, M.D.
Editor in Chief, Harvard Women’s Health Watch
