This article originally appeared in the August 2004 Harvard Men’s Health Watch and is provided courtesy of Harvard Health Publications.

In the swing: Golf and your health

Golf was enormously popular long before Tiger Woods captured the American imagination, and it will remain popular long after he has joined the pantheon of sports greats. Woods is young, slim, and obviously athletic — traits that are absent in many successful golfers. Perhaps that’s why golf is the most misunderstood of sports. In particular, many people share two beliefs that are off the mark. First, because its pace is leisurely, golf does not promote cardiovascular health; second, because golf is gentlemanly, injuries are rare.

Until recently, doctors have helped perpetuate both myths. But new research is settling the score: Golf can be good for your health. Injuries are common, but you can prevent them if you make golf part of a balanced fitness program.

Golf for health
“A good walk spoiled.” That’s how exercise physiologists described golf in the 1970s and ’80s, when the aerobics revolution was at its peak. At that time doctors thought that exercise wouldn’t help your heart unless you worked hard enough to raise your heart rate to 70%–85% of its maximum and long enough to keep your pulse up for at least 20 minutes at a crack. With the possible exception of the first President Bush, who was famous for dashing down fairways at a breakneck pace (he once completed 18 holes on foot in 1 hour and 24 minutes), golfers don’t do that.

Scientists still believe that aerobic exercise is great for health; the second President Bush is a prime example. But over the past 10 years, researchers have learned that modestly paced exercise is also very beneficial, even if it’s interrupted by periods of inactivity. The point is to do it. Your goal should be to exercise at a moderate pace for at least 30 minutes almost every day. A gym workout may still be best — but simply walking to and from the gym can help, as can mowing your lawn, washing your car, raking leaves, dancing, and many other daily activities.

When it comes to golf, the benefit won’t come from swinging the club, no matter how high your score, but from walking.

The average course is about 6,300 yards. Even without trekking into the rough, a round of golf can count as 4 miles of walking. If you walk 18 holes three to five times a week, you’ll get an optimal amount of endurance exercise for your heart. If you pull your clubs or carry them, you’ll burn more calories per round and benefit even more. But if you play less often or if your climate dictates a lengthy off-season, you’ll have to supplement your golf with ordinary walking or an equivalent exercise to get the best results. And even if you walk for 54–90 holes a week, you should add exercises for flexibility and strength to attain balanced fitness, optimal health, injury protection, and — it’s true — a lower handicap (see Golf injuries below).

Golf injuries
A golf swing involves the whole body — and any part of the body can be injured in the course of play. Rotator cuff tendinitis is the most common shoulder problem. Golfer’s elbow is painful inflammation due to overuse. And the twisting motion that powers the swing can also cause muscle strains and back pain.

How to score
Finland is hardly the golf capital of the world, but scientists there conducted a study that shows golf really can promote fitness and health. The subjects were 110 healthy but sedentary men between the ages of 48 and 64. During the trial, half the men played 18 holes of golf two to three times a week, always walking the course. The other men didn’t play golf, but they continued their normal routines, including gardening and household chores. All the men went through a series of tests before and after the 20-week experiment. In just that short period, the golfers had pulled ahead, losing weight, reducing their girth and abdominal fat, improving their aerobic exercise capacity as measured by treadmill tests, increasing muscular strength as measured by back extension, and boosting their HDL (“good”) cholesterol levels. The golfers also showed a tendency toward reduced blood pressure, but these changes, unlike the others, did not meet tough statistical standards for validity.

Heartening news
Golf may be good for healthy men, but is it also safe for men with ailing hearts? Another European study, this time from Germany, is reassuring. Doctors carefully monitored 20 men with heart disease during and after a round of competitive golf. The physical stress of pulling their clubs over 18 hilly holes and the mental stress of competition boosted the players’ heart rates to an average of 105 beats per minute, which is almost at the aerobic target of 109 for men at age 65. Playing golf was also strenuous enough to boost the players’ blood pressures and adrenaline levels. Even so, competitive golf was easy on the heart: All the men wore heart monitors, and none developed abnormal heart rhythms or cardiac symptoms during the study.

Golf is good for your health and safe for your heart — but if you’re not used to walking, you shouldn’t switch from riding in a cart to walking 18 holes all at once. Instead, get into shape for golf before you use golf to stay in shape. Start walking for health, then walk for nine holes once or twice a week. If you build up slowly, you’ll be able to make the transition from riding to walking without a bogie, at least where your health is concerned.

Rough injuries
Walking is one thing, swinging a club 100 times in a morning (as even Tiger Woods does, counting practice swings), quite another. Golf may look leisurely, even gentle, but it puts a lot of strain on your muscles and tendons. Here is a quick rundown on common golf injuries — and how to prevent them.

A golf swing involves your whole body. It’s not surprising, then, that any part of your body can hurt — or that the muscles you use the most are at greatest risk. Anyone who swings a club can be hurt — just one “fat shot” (striking the ground with the club) can do the trick. But the likelihood of injury is greatest in older players and in people who play the most. That’s why up to 50% of touring pros have sustained an injury severe enough to halt their play for three weeks or more. Overuse is the leading cause of injury in pros and top-flight amateurs, but in duffers poor technique is more often to blame. Here’s a comparison of the injuries that are most common in each group:

Back injuries. If you think that golf is for wimps, consider this: A golf swing puts a higher compressive load on the low back (8 times body weight) than running (3 times) or even rowing (7 times). That’s why a single swing can produce a herniated disc or even a compression fracture of one of the vertebral bodies. Although these injuries are extremely painful and can be quite serious, they are rare. Muscle strains, however, are quite common because of the twisting that is required for a good swing. The “modern” swing, with its inverted-C follow-through, may make for longer drives than the “classic” swing but it also produces more torque — and more injuries (see Golf injuries above).

Elbow problems. Despite their many differences, golf and tennis have one thing in common: the elbow. In both sports, the problem is caused by the inflammation of tendons as they attach to the epicondyle, the knoblike bony prominences of the elbow. In textbook cases, tennis elbow involves the outside knob (lateral epicondylitis), while golfer’s elbow strikes the inner prominence (medial epicondylitis). In fact, however, golfers can develop pain and tenderness on either side. A golfer’s leading elbow (his left if he swings right-handed) is at greatest risk.

Hand and wrist injuries. The head of a club can be traveling at 100 miles per hour when it strikes the ball, and the wrist and hand absorb most of the impact. Add a tight grip and repetitive use and you have a recipe for tendinitis, the most common wrist injury. Other problems may include carpal tunnel syndrome, “trigger finger,” and even fractures of the back of the hamate, a small bone at the base of the wrist. Although they are much less painful, blisters on the hand or fingers can be serious enough to interfere with play. The leading hand tends to be the site of all these woes.

Shoulder ailments. Simple overuse causes most shoulder problems. In particular, the top of the backswing and the end of the follow-through place stress on the four muscles of the rotator cuff; tears are infrequent, but rotator cuff tendinitis is relatively common, especially in competitive golfers.

Lower-body injuries. Golf is relatively easy on the lower body, but if you walk the course to help your heart and metabolism, you will increase the load on the lower half of your body. Carrying your clubs will increase the gain for your circulation but may produce some pain in your lower body. Like other athletes (and couch potatoes, for that matter), golfers can develop strains, sprains, and tendinitis of their knees, ankles, and feet. Blisters and athletes’ foot are less dramatic but can be quite annoying.

Health for golf
Although golfing injuries are surprisingly common, most are relatively mild and respond well to simple treatment. Even better, many can be prevented by following these suggestions.

Get in shape for golf before you count on golf to keep you fit. Walk to build up your cardiovascular endurance (see above) and do exercises for flexibility and strength (see below). Your health will improve, and so will your game.

Stretch. As muscles are used, they get stronger but also tighter and stiffer. Age, too, takes a toll on flexibility. Stretching will help reduce your risk of injury and help you develop a smoother stroke. You’ll reap similar advantages off the links. Stretch at least three times a week, paying particular attention to your back, shoulders, and arms.

Build strong muscles and bones. Men lose muscle mass and bone calcium as they age. Resistance exercise will reverse the trend, especially if it’s accompanied by the right amount of protein, calcium, and vitamin D in your diet. Weight training will help you hit the ball farther and will reduce your risk of osteoporosis (“thin bones”) and fractures on and off the course. A simple program can do the trick if you do it two to three times a week.

Warm up. Cold muscles and ligaments are vulnerable to injury; warming up really will help — and it will also improve your swing. An Australian study of 1,040 golfers reported that nearly half didn’t warm up at all, and most of the others did little more than take a few practice swings. Walking and calisthenics will bring your circulation up to speed and stretching will loosen up your muscles and joints. Spend 10–15 minutes warming up even before you start your practice swings. Join the 3% of golfers who warm up properly; it will suit you to a tee.

Take lessons. Good technique is your best defense against both injuries and high scores.

Use good equipment. Golfers pay lots of attention to their clubs, but many overlook the importance of their shoes, socks, gloves, and clothing.

Spot problems early and treat them aggressively. You can play through minor aches and pains, but remember to ice down aching tissues as soon as you get to the clubhouse. Use the PRICE (protection, rest, ice, compression, and elevation) approach to treat more serious problems, and get help from a trainer, physical therapist, or doctor if you don’t improve promptly.

Don’t neglect the little things. Stay well hydrated, but don’t eat a full meal before a game. Protect yourself from the sun (a wide-brimmed hat, long sleeves if it’s not too hot, a sunscreen with an SPF of 15 or higher, and sunglasses) and from insects (repellants containing DEET).

Enjoy the 19th hole, but don’t undermine your gains with ill-advised food or drink. And remember that golf is only a game; don’t let your competitive juices get out of hand to spoil a lovely morning or sour a friendship. Challenge is one thing, stress another.

It may be only a game, but golf is a great game. It’s a test of skill that can be demanding enough for the competitive athlete. It also provides an opportunity for companionship that men often lack. It can even be good for business (“client golf”). Above all, perhaps, golf can be good for your health as long as you follow the simple guidelines that will keep you shouting “fore” instead of “sore.”