The leading cause of death in the United States for individuals age 1-44, according to the Centers for Disease Control, is unintentional injury or accident. For those age 45-64, it is cancer. Once age 65 or older, though, it is heart disease. In fact, with cardiovascular issues being the third leading cause of death among those age 35-44 and second for those age 45-64, it is the overall leader for all ages.

Consequently, a fortune is spent preventing, diagnosing and treating the disease. The cardiac stress test or graded exercise test, according to WebMD, is commonly performed to “determine your risk of having heart disease.”

It typically costs upwards of $1,000, not to mention the cost of taking time off to have the test, nor the cost of subsequent procedures and medications if the results of the test are suspicious.

There has to be a better way.

The best way is to take better care of oneself so that a stress test is not deemed necessary.

A study published online in February by the Journal of the American Medical Association’s Open Network revealed a simple measure and goal for middle-aged men: more than 40 push-ups. Yes, the good old-fashioned push-up which requires little room and no equipment. It strengthens the pectoralis, triceps, anterior deltoid and serratus anterior muscles

Firefighters from 10 Indiana fire departments, 1,104 in all, were evaluated periodically by researchers from Harvard between 2000 and 2007 via stress testing and determination of push-up capacity. Only 75 completed 0-10 push-ups; 200 reached 11-20; 389 ranged between 21 and 30; 285 achieved 31-40; and 155 topped 40 push-ups in 60 seconds or less. The health of those firefighters was then followed until the end of 2010.

Ultimately, push-up capacity was slightly better at predicting the likelihood of a cardiovascular event than stress testing.

Those unable to perform more than 10 push-ups were significantly more likely to end up with a heart issue than those who were able to perform more than 10. However, those “able to complete more than 40 push-ups had a 96% reduction in (cardiac) incidents compared with those completing fewer than 10 push-ups.” Only one of 37 cardiac events occurred among those who topped 40 push-ups. The other 36 were spread out fairly evenly among the other four groups.

Granted, the 40-plus push-up crowd members were the youngest and had the lowest body mass index (BMI). Nonetheless, push-up capacity was found to be an indicator of heart health, independent of age or BMI. It also was linked to the lowest blood pressure, the best cholesterol levels, the lowest blood sugar and the best aerobic capacity.

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The push-up is a simple exercise that requires no costly health club membership nor expensive equipment and time for testing. Thus, the Harvard researchers advised that push-up capacity should be part of a comprehensive wellness evaluation.

Further, they concluded, “Cardiovascular disease risk factor reduction should be recommended, including lifestyle measures for those with low push-up capacity, especially those capable of 10 or fewer.”

Sleep a simple strategy to counter concussion

Apparently, what is good for the bone is good for the brain.

For years, it has been well-established that adequate sleep hastens recovery from concussion.

Last month, researchers at the University of Arizona published a study online in the journal Sleep Medicine that linked insomnia and daytime sleepiness to concussion.

They looked at 190 NCAA Division I athletes and not surprisingly found that sport played was the greatest risk factor for concussion. However, independent of sport, they also found that insomnia tripled one’s risk of concussion and daytime sleepiness doubled it.

The researchers theorized that sleepiness and insomnia-associated fatigue impair coordination and judgment. They also contribute to inattention while playing. Any one of those factors would in turn make one more vulnerable to a concussion-inducing fall or collision.

“Clinicians and athletes,” they concluded, “should be cognizant of this relationship and take proactive measures — including assessing and treating sleep-disordered breathing, limiting insomnia risk factors, improving sleep hygiene, and developing daytime sleepiness management strategies — to reduce sports-related concussion risk and support overall athletic performance.”

John Doherty is a licensed physical therapist and athletic trainer. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATCPT.