Joe Montana, Marion, June 2007
Joe Montana's New Life With Hypertension
By Marion Webb
Since his retirement in 1995, Joe Montana's life has changed quite a bit. He starts a typical day with exercise, runs his business of scanning investment opportunities in properties or land, then drives to his sons' high school to "observe" football before retiring to his Napa Valley home with his wife, Jennifer.
In 2002, Montana was diagnosed with high blood pressure. One year later, he signed a multi-year contract with the Swiss pharmaceutical giant Novartis, to back a hypertension awareness campaign that includes promoting its blood pressure medicine Lotrel.
The campaign recently brought Montana and his cardiologist, Dr. James M. Rippe, to San Diego where he agreed to a one-on-one meeting with the managing editor of the American Council on Exercise at the Manchester Grand Hyatt. Montana talked freely about his heart-healthy lifestyle, exercise and eating habits, and campaign goals.
Known for never showing stress on the field, the quarterback says he was shocked to learn about his medical condition and the associated risks.
"I thought I was going to go to the doctor for a physical exam and get out of there (in no time)," Montana recalls. "I was shocked to learn that my blood pressure was 140 over 90 mm Hg (below 120 over 80 mm Hg is considered normal).
Hypertension or high blood pressure (i.e., blood pressure is consistently 140/90 m Hg or higher) is a serious disease that can cause damage to the blood vessels and significantly increase the risk of damage to the heart, brain and kidneys as well as stroke.
Like many of the estimated more than 60 million Americans affected by hypertension, Montana didn't have any symptoms. Doctors often refer to it as the "silent killer," because the only way to tell if a person has high blood pressure is to have their blood pressure checked. Rippe finds that people tend to underestimate the risk of blood pressure problems.
"The reality is, there is a 20 percent chance in your 20s that you have high blood pressure, a 30 percent chance in your 30s, and a 40 percent chance in your 40s," Rippe says.
The good news is that the disease can be managed with medications, a healthy diet and regular exercise. For many affected individuals adopting these changes represent a radical lifestyle change, and Montana was no exception.
After Retirement
"When I first retired I virtually stopped working out, but was eating as if I was still working out," Montana recalls. His routine NFL days consisted of a "high-caloric, eat what your heart desires" type of diet.
"I was probably eating the typical American diet. I liked all the things that were bad for you, red meat, burgers and fries and all that good stuff," he says.
Since his diagnosis, Montana cut back on total daily calories consumed and eats in moderation, which coincided with retiring the salt shaker to curb his sodium intake. He won't totally deprive himself of the foods he craves.
"I haven't had a hamburger in a while, but I approach (everything food-related) on the moderation side more than anything," Montana says. "If you eat well most of the time, it's OK to occasionally reward yourself. It works better for me than telling myself I can't have something ever again."
Horse-Cutting
Montana also resumed a regular exercise routine-though it is a Super Bowl thrill away from the adrenaline rushes of his record performances. Making the transition from being center stage to the sidelines was tough.
"Early on it was hard, but now it's easy," he says. "I just wish I wasn't limited by my knee. I would play basketball every day if I was physically able. I love that type of sport for conditioning. Leaving the game was hard, because you are so used to being on a schedule. The game is so different, you can't replace it. As a basketball player you can go and play a pick-up game, but you can't find enough football players who can walk, let alone run. There is no way to get the excitement of the game back."
He did however, find one consolation activity: Horse-cutting. Jonathon Hayes (an old football buddy from Kansas City) introduced Montana to the cattle ranch competition. It requires riders to use their technical skills and speed to separate a cow from the herd. These days, Montana's investment business (Montana Property Group) and other obligations leave little time for horse play.
But when it comes to exercise, there is no substitute.
Value of Heart-Healthy Exercise
"I do cardio almost every day for 45 minutes to an hour using the stationary bike, elliptical trainer, treadmill or Stairmaster and I lift three days a week for 30 minutes," Montana says. "Sometimes I work out early in the morning or sometimes I won't exercise (at home) until everybody goes to sleep," he says.
Regular aerobic exercise training (at least 30 minutes on most days of the week) appears to reduce both systolic and diastolic blood pressure by an average of approximately 10 mm Hg. Even a small amount of physical activity can help diminish the long-term consequences of high blood pressure.
In the campaign booklet entitled "Joe Montana's Family Playbook for Managing High Blood Pressure," the Montanas encourage family play time to set a good example.
They walk as a family and even join sons Nathaniel (17) and Nicholas (15) for a round of hoops. With their college-aged daughters Alexandra (21) and Elizabeth (20) being home for the summer Montana says, "it's really active around the house" now.
He credits Jennifer for having no qualms about turning off the television when their teenage sons get a little too comfortable on the couch and encourages other parents to do the same.
"They (children) have so many devices these days that it keeps the kids in the house and inactive. Even with our boys, as active as they are in sports, they want to run to their video games and my wife just doesn't allow it," Montana says.
His message to parents: "Turn off the TV and make them (children) do something outside. Get out of the house and be active with them. Kids don't need supersized anything. (A lot of children) eat too much food and they're not active on top of it."
Medications
Health experts now estimate that 65 percent of America's adults are overweight; 31 percent are obese. The U.S. obesity rate for children aged 6 to 11 has risen to 18.8 percent; for 12-to 19-year-olds it rose to 17.4 percent in 2003-2004, according to statistics by the Centers for Disease Control of Prevention.
There is a strong correlation between being overweight and obese and the risks for developing chronic diseases, which are often preventable. Montana, who has a family history of hypertension, is able to control his condition with medication, exercise and a healthy diet. But even the best medications have side-effects. Montana says the first hypertension drug he was prescribed caused swelling in his hands and feet.
Fitness Professionals
The lineup of hypertension drugs is quite extensive, including beta blockers, diuretics and calcium channel blockers.
It's important that exercise professionals are aware of the effects of the major classes of antihypertensive medications on individuals' heart rate, blood pressure, and other physiological responses to exercise.
Not only that. Trainers should have their hypertensive clients obtain a physician's medical clearance before starting an exercise program for them.
Blood pressure patients and trainers should know that a reading greater than 160/100 mm Hg requires medication. And it's especially critical for trainers to monitor their hypertensive clients at all times.
According to established guidelines, blood pressure should be checked before exercising to ensure it isn't greater than 200 mm Hg systolic or below 100 mm Hg diastolic, which is a contraindication for exercise. Stop the exercise if the reading exceeds 220/105 mm Hg.
Because hypertension medication may alter the accuracy of the training heart rate during exercise, a good fitness professional will also be aware of any changes in medications. For example, Beta blockers are known to slow heart rate and exercise intensity may need to be monitored with ratings of perceived exertion.
One of the best ways for hypertensive individuals to ensure that their trainers are qualified to provide a safe and effective exercise program is to ask if they are certified by an NCCA-accredited fitness organization and have completed relevant continuing education coursework. ACE-certified Clinical Exercise Specialists have gained special knowledge to be able to train people with different types of health conditions.
Rippe finds that trainers themselves often fail to get a health check.
"They think that exercise is going to prevent them from ever developing a chronic illness," he says. Hypertension, however, is a medical condition that can strike anyone, although the risk rises for people with a family history and African-Americans.
Among the best ways to prevent and treat hypertension is lifestyle management: Weight or fat loss, physical activity, reduced sodium and moderate alcohol consumption and a sound eating plan.
By the end of this year, Montana plans to spread exactly this message to people living in 20 U.S. cities (including Kansas City, Mo. and Austin and San Antonio, Tx.) as part of the Novartis deal.
"When you look at all the people who are affected by high blood pressure, we hope we can make a big dent in that number. We're not looking for cures-we have the means to lower people's risks, we just have to get them to be aware."