Atherosclerosis is a costly and fatal disease. Although there is no known cure, new evidence suggests that intensive lowering of serum total cholesterol or LDL cholesterol may retard the progression of coronary artery disease. The box at left contains the NCEP cholesterol guidelines authored in 1993 by a panel of physicians and lipid experts.

Reducing cholesterol through exercise, particularly LDL cholesterol, can be quite labor intensive. When individuals accumulate a sufficient weekly volume of exercise they can lower both total cholesterol and LDL-cholesterol and increase HDL-cholesterol (the “good” cholesterol). Exercise itself does not “burn off” cholesterol like it can with fat tissue. However, when exercise is of sufficient volume, for example, an adequate weekly frequency and duration, it can significantly reduce triglycerides and stimulate several metabolic enzyme systems in the muscles and liver to convert some of the cholesterol to a more favorable form, such as HDL-cholesterol.

For many people with cholesterol disorders the first choice of therapy is dietary modification. If LDL cholesterol (the “bad” cholesterol) is high enough, dietary therapy is often supplemented with cholesterol-lowering drug therapy. Exercise is of tremendous benefit when used in combination with either of these two forms of therapy. For those who maintain a frequent and sufficient level of exercise, it is possible that their physician will reduce their cholesterol-lowering medication and in some cases stop it altogether.

Here are guidelines that outline a systematic approach for favorably altering cholesterol levels with regular exercise:

• If you do have a less-than-desirable cholesterol level, or your doctor has told you have a cholesterol disorder, have your physician establish your cardiovascular health status before engaging in a vigorous exercise program. This may mean that your physician will elect to perform a graded exercise test with an ECG (treadmill stress test) on you first.
• Choose dynamic forms of exercise such as aerobics, recreational, and/or utilitarian activities that tend to last at least 20 to 30 minutes and are performed at moderate intensities. Moderate exercise intensities would be an approximate effort of four to seven, on a scale of one to ten with ten being near maximal exercise.
• In general, for exercise to significantly lower cholesterol levels, a relatively high volume of exercise is recommended (e.g. 1,200 to 1,500 kcal or more per week). In 12 to 16 weeks this volume of exercise can reduce total cholesterol by 10­20 percent. Fifteen hundred calories expended during exercise is equivalent to about six hours per week for the average unfit person performing moderate intensity walking, swimming, walk-jogging or cycling. This volume of weekly exercise is approximately the same volume of physical activity required to lose weight. As a result, fat weight loss tends to be associated with reductions in cholesterol levels, especially fat lost around the waist and abdomen.