First and foremost is exercise. It has seemed to us that the revival of out-of-door sports is one of the best signs of promise of the preservation of a virile, hardy race. That women, as well as men, indulge in the lighter forms of out-of-door exercise should bring it about that the coming generation will start in life under the most advantageous conditions of bodily resistance.
Among all the forms of exercise, golf probably is the best. It is not too violent for the middle-aged man, yet it gives the young athlete quite enough exercise to tire him. It is played in the open. One is compelled to walk up and down in pleasant company, for golf is essentially a companionable game, while he reaps the full benefit of the invigorating exercise. The blood courses through the muscles and lungs more rapidly; the contraction of the skeletal muscles serves to compress the veins and so to aid the return of blood to the heart: the lungs are rendered hyperemic, deeper and fuller breaths must be taken; oxidation is necessarily more rapid, and effete products, which if not completely oxidized would possibly act as vasoconstrictors, are oxidized to harmless products and eliminated without irritating the excretory organs.
Other forms of out-door exercise that can be recommended are tennis, canoeing, rowing, fishing, horseback riding, swimming, etc. Tennis is the most violent of all the sports mentioned and might readily be overdone. Rowing as practiced by the eights at college is undoubtedly too violent a form of exercise, and may be productive in later life of very grave results. Canoeing is a delightful and invigorating exercise. The muscles of the arms, shoulders, and trunk are especially used, the leg muscles scarcely at all. Nevertheless, the deep breathing that necessarily comes with all chest exercises aerates every portion of the lungs, and is of great benefit to the whole body.
Swimming as an exercise has much to recommend it. In this sport all the muscles take part and at the same time the chest is broadened and deepened.
All these methods of using the muscles to keep oneself in trim, so to speak, are part and parcel of the general hygienic mode of life that is conducive to a healthy old age. Exercise can be overdone, as eating can be overdone. Both are essential and yet both can be the means of hastening an individual to a premature grave.
When the arteriosclerosis has advanced so far that it is easily recognizable, certain forms of exercise should be absolutely prohibited. Such are tennis, rowing and swimming. Horseback riding to be allowed must be strictly supervised. At times this may be an exceedingly violent exercise. As an out-of-door sport, there is nothing that equals golf. The physician, knowing the character of the course, and the length of it, can say to his patient that he may play six, nine, twelve, or eighteen holes, depending on the patient's condition.
For those who are not able to get out, exercise in the room with the windows open must take the place of out-of-door sports. Here the use of chest weights is a most excellent means of keeping up the tone of the muscles. By adjusting the weights, the exercise may be made light, medium, or heavy. Every physician should be familiar with the chest weight exercises. They are not as good as open air exercise but they undoubtedly have been the means of saving years of life to many patients with arterial disease.
There comes a time when all forms of exercise must be prohibited on account of the dyspnea, edema, dizziness, etc. It seems unwise to keep such a patient in bed, even though the edema be considerable. Once on his back in bed he becomes weak, and the danger of edema of the lungs or hypostatic congestion of the bases, with subsequent bronchopneumonia, is very great.
Such patients may be allowed to sit up in a comfortable chair with the legs supported straight out on a stool or other chair. The half reclining position is not easy to assume in bed. Considerable ingenuity must often be exercised by the physician in making the patient comfortable without increasing the symptoms from which the patient suffers following the least amount of exercise. Although such persons can not exercise actively, they should have passive exercise in the form of massage, carefully given, so that no injury is done to the rigid vessels. It is possible to rupture a vessel, the walls of which are encrusted with lime salts, and full of small aneurysmal dilatations. Every patient must be watched carefully and measures instituted for the individual.