DALLAS -- In Russian it's called "aerobica," in French it's "oxygen a` la carte," and in Brazil, it's known as "Doing the Cooper."
"I warned my pubisher that the word 'aerobics' wouldn't translate," says former Air Force flight surgeon Kenneth Cooper, who coined the term in his 1968 best-seller, "Aerobics."
"But look what happened," he says. "Aerobics is universally known."
Yet more than two decades after Cooper helped launch a worldwide fitness revolution, his name is more likely to elicit a puzzled look than a nod of recognition in the U.S. Although autograph seekers mob him on his travels from Tokyo to Rome, many Americans think actress and video workout queen Jane Fonda invented aerobic exercise.
"None of that matters," says the 60-year-old physician, whose missionary zeal helped create a multimillion-dollar fitness complex on a sprawling 32-acre tract in affluent North Dallas. "I'm just gratified that, finally, people are realizing the dangers of sedentary living and acknowledging the benefits of exercise."
"Because the statistics," he continues earnestly, "are just too impressive to ignore. More and more people are understanding that a person dies not so much of a particular disease as of his entire life. It's not so much that we die, as we kill ourselves."
Aerobic exercises are activities, such as running and walking, that use oxygen for prolonged periods. Today, they are well-known to re- duce the risk of cardiovascular disease and other ailments. Although Cooper still speaks about aerobics with evangelical fervor, his views have mellowed. He no longer believes that exercise must be rigorous and intense to be beneficial; he now espouses the virtues of moderate exercise.
The medical establishment has changed as well. The treadmill stress test is now considered one of the best non-invasive ways to detect heart disease -- a sharp contrast to doctors' concern that such testing was hazardous back in the '60s when Cooper first endorsed its use. Cooper's belief in the value of preventive medicine has become widely accepted as well; some insurance companies are start- ing to pay for preventive medical procedures.
"I used to be considered a radical," Cooper says with a chuckle. "Now, I'm the conservative." Between Fact and Fad
Much of the research documenting the health benefits of exercise has come from Cooper's $12 million, state-of-the-art Aerobics Center, originally opened in a cramped three-room office in 1970. The center is devoted to both the practice of, and research about, preventive medicine and aerobic exercise -- which Cooper developed in the 1960s as a conditioning program for U.S. astronauts. Aerobics replaced the then-popular Royal Canadian Air Force exercises and inspired the book that helped propel Cooper to international fame.
Tall and lean, with the deeply-lined face of a man who fought the medical establishment for much of his life, Cooper recalls how the popularity of "Aerobics" helped give him the courage to leave the military after 13 years, with "no income, no retirement pay, no place to live, a pregnant wife and a 5-year-old daughter."
"People told me I was crazy to walk away from a nice military retirement in seven years, just as I was about to be promoted to full colonel. But my dream was to start a preventive medicine center and continue my research on aerobic exercise. I felt confident that exercise could help people improve their health, and I believed it was more effective to prevent disease than to treat it."
Cooper immediately faced suspicion and hostility from many area physicians who considered his use of the treadmill stress test dangerous. "Back when I was in medical school, we were taught that people should never exercise vigorously or it would precipitate a heart attack," says Cooper, who graduated from the University of Oklahoma School of Medicine. "That's why I knew I needed to study exercise to bridge the gap between faddism and scientific fact."
The newest studies show that activity need not be intense to have significant impact. Some of the most respected studies delineating the health benefits of light-to-moderate activity have come from Cooper's nonprofit Institute for Aerobics Research.
"We have found that the greatest boost to health comes to formerly sedentary people who start moving, even at a low intensity," says Steven N. Blair, an epidemiologist at the Institute, whose study published two years ago in the Journal of the American Medical Association showed that inactivity puts people at risk for all causes of death.
Considered the largest repository of exercise and fitness statistics in the world, the Institute for Aerobics Research is the research arm of the Aerobics Center. Cooper's complex also includes the Cooper Clinic, which has seen more than 53,000 patients; the Aerobics Activity Center, one of the nation's largest gyms with 2,300 members and an in-residence wellness program, which attracts adherents from all over the world.
Visitors may not see Cooper at the center, since he spends 60 percent of his time on the road, giving up to 100 presentations annually around the world, for a fee of $10,000 per day. In addition, he has written 10 books which have sold more than 20 million copies and have been translated into 41 languages and Braille.
When he's in Dallas, he moves fast. "I challenge anyone to keep up with me," says Cooper, who walks and talks at breakneck speed, spouting rapid-fire statistics. "My days last 12 to 14 hours. I'm the first one here in the morning and the last one to leave at night." A Day in the Life
Cooper's day typically begins at 5:45 a.m. with a 10-minute calisthenic routine performed on his bathroom floor. He arrives at the center at 6:30 and walks briskly past the glass case that displays the battered running shoes he wore in the 1962 Boston Marathon. Cooper stops at the cafeteria, downs a bowl of oatmeal and then heads to his office for a half hour of Bible study; since childhood he has been a devout Baptist.
He starts seeing patients at 7:30 a.m. One recent morning he strode into an examining room, hand outstretched to greet Congressman Matthew J. Rinaldo (R-N.J.). Rinaldo first visited Cooper's Clinic with former Health and Human Services Secretary Margaret Heckler while both were in Dallas to attend the 1984 Republican National Convention.
"There's no comparable facility in the country," says Rinaldo, 59, who is accompanied by several friends, including Rep. Norman Lent (R-N.Y.) for a week-long stay at the residential program. "It's a great way to get rejuvenated and help maintain your health."
It's also an expensive way. Rinaldo and others pay $3,000 for a week-long stay -- $1,000 of which is typically reimbursable by insurance. The hallmark of Cooper's residential program is the extensive medical examination. Those who attend also receive individualized nutrition and fitness counseling plus extensive education on improving lifestyle to boost health.
Unlike Rinaldo, most patients are examined by one of the clinic's eight other physicians. Cooper usually sees just former patients and the most famous. Photos and testimonial letters from past patients -- among them President George Bush, whose last visit to the clinic was in 1980; Secretary of State James Baker, who saw Cooper in 1987; former Dallas quarterback Roger Staubach; financier T. Boone Pickens, and "Dallas" TV stars Larry Hagman and Linda Gray adorn the walls.
Cooper finishes seeing patients about 2:30, grabs lunch, then spends the rest of the day on administrative work, meetings, writing and giving lectures to participants in the residential program.
"Since 1968 . . . we've seen a 48 percent decline in deaths from coronary heart disease," Cooper told a recent, rapt audience of two dozen people, who had paid up to $500 per day for a 4, 7 or 13-day in-residence program. "Roughly two thirds of that comes from lifestyle changes Americans are doing for themselves."
These include quitting cigarettes, monitoring blood pressure, watching cholesterol, managing stress and exercising. But of all these factors, says Cooper, exercise is key since regular aerobic activity can help people achieve these behavioral and physiological changes.
So many "needless deaths" could be prevented, he says, if people would stop being sedentary. Exercise can also retard aging, continues Cooper, who is convinced that most physical declines considered inevitable with age are "actually adaptive processes . . . that occur because most people get sedentary as they get older."
Cooper saves his own exercise -- a two to three-mile run around the knee-friendly, rubberized trail that winds through the complex -- for right before dinner.
"It's a great way to dissipate the stress of the day," he says. If time doesn't permit a run, he takes his dog on a brisk, two-mile walk before bed. Rethinking Marathons
Cooper's acceptance of a kinder, gentler form of exercise illustrates a metamorphosis in his thinking since his marathon-running days of the 1960s.
"I used to think, the more the better, you can't run a good thing into the ground," recalls Cooper, who used to run 60 miles per week. "Now I know that you can."
Most of the 24,344 miles Cooper has run since he started keeping records in 1960 were accrued in the early days. He has cut back to a 15-mile-per-week maximum as a result of his research into the injury potential of excessive running and his own experience with exercise-induced problems.
"I kept breaking down," says Cooper, who stopped running marathons in 1969. "My knees were the big problem, as was chronic Achilles tendonitis."
Running more than 12 to 15 miles per week "will greatly increase the incidence of joint and bone injuries and other ailments," Cooper contends. People who run more than three miles five times a week are running, he says, "for something other than fitness."
The second major change in Cooper's thinking is that exercise is no panacea for bad health habits. "I used to think exercise could overcome many if not all of the deleterious effects of diet," he says. "Now I know there's more to it than just exercise."
Proper diet, eschewing cigarettes, avoiding obesity, controlling hypertension and achieving emotional equilibrium are all, he says now, critical to total well-being. Of all these lifestyle ills, Cooper regards stress as his personal nemesis. "I try to balance out the stress by scheduling time for vacation four weeks a year, and no travel during December," Cooper says. "And my exercise and Bible study helps." A Conversion Experience
Cooper's fitness crusade started with a frightening personal experience. A track star in high school and college, Cooper grew overweight and out-of-shape in medical school. At age 28, while water-skiing, he suffered "some type of cardiac arrhythmia" that left him "in nauseous agony" for 30 minutes. "In a very real sense, the serious physical problem I faced triggered a conversion experience," he writes in "The Aerobics Program for Total Well-Being," published in 1982.
Galvanized, Cooper began examining the connection between heart disease and inactivity, obesity and poor eating habits. He earned a master's degree from the Harvard School of Public Health and worked in Harvard's exercise physiology laboratory, where he met several marathon runners, and resumed running.
While he never achieved his boyhood dream of competing in the Olympics, he has become a medical missionary, just as he'd hoped as a teenager. "At age 18, at an evangelistic crusade we had in Southern Oklahoma, I felt the call to be a medical missionary," he says. "Yet I never felt the calling to go into the seminary." Instead, he preaches the gospel of aerobics. Giving Fitness Credibility
Cooper's supporters, as well as his critics, say he has made an important contribution to the field of public health.
"The work of exercise scientists like Dr. Cooper has helped the healthy population learn how to exercise properly without injuring themselves," says Atlanta cardiologist Gerald Fletcher, chairman of the American Heart Association's exercise committee. "There are less deaths now from heart attacks, and that has to do with Americans modifying many lifestyle factors and being involved in wellness."
Cooper's former detractors say they respect him for his open-mindedness and his willingness to alter his views.
"I give him a lot of credit for being one of the pioneers of understanding the role of exercise in our lives," says New York cardiologist Henry Solomon, who debated Cooper on national television after publication of Solomon's 1984 book, "The Exercise Myth." Solomon argued that intense exercise invited a host of physical ailments, while Cooper maintained that sedentary living was more dangerous.
"It's always been my belief that the value of vigorous, excessive activity is minimal, and there are some real dangers," says Solomon, who contends, as Cooper now does, that most health benefits can be derived from less intense exercise. "I admire Dr. Cooper for being able to reassess his position, to come out publicly and say, 'I was wrong,' " Solomon says.
Cooper's main contribution, says New Jersey cardiologist-author George Sheehan, 72, was to "give credibility to fitness. A lot of us were into running and felt it was a marvelous thing for the cardiovascular system. But while we were out there enjoying ourselves, it was Ken Cooper who was doing all the hard work to put fitness on a scientific basis."
"The thing about Ken is he's so thorough, everything he does is so precise," says Sheehan, whose prostate cancer was diagnosed by Cooper four years ago during a visit to the clinic. "Every now and then, I'll go to the mailbox and there'll be a letter of encouragement from Ken."
Cooper says the source of his own encouragement is, in large part, Millie, his wife of 30 years; his daughter Berkley, 25, and his son, Tyler, 19 -- all of whom are runners. Cooper's close-knit family was of particular support to him in the aftermath of the 1984 death of his friend, running guru, Jim Fixx.
Cooper still seems shaken when describing how Fixx died at age 52 while jogging on a country road in Vermont. In 1985, Cooper wrote "Running Without Fear," to deal with the onslaught of panicked calls from runners around the world.
"The press came to Dallas in droves, and they all asked the same question: 'Why did jogging kill Jim Fixx?' " Cooper recalls. "I said, 'Jogging didn't kill Jim Fixx. Heart disease killed Jim Fixx.' "
Cooper coined the term "the Jim Fixx syndrome" to describe the "myth of invulnerability" exercisers such as Fixx believed came from their activity.
"These people think, 'I couldn't have heart disease and run the way I run,' " Cooper says. "But the heart is masterful at hiding its problems . . . This year, 240,000 people will die of heart disease, and their only symptom will be death."
Before Fixx started running at age 36, he was a two-pack-a-day smoker, 60 pounds overweight, under severe stress, with a family history of heart disease, Cooper notes. Fixx's father had a massive heart attack at age 36 and died at 43.
"For reasons known only to him, Jim Fixx would not get a stress test," says Cooper.
If only Fixx had gotten on his treadmill, Cooper sighs, wearing the pained expression of a healer powerless to save someone close to him, "he might still be alive today."
To achieve the "training effect" -- beneficial changes to the cardiovascular and pulmonary systems that come from aerobic exercise --
Cooper recommends picking one of the combinations from the "FIT" formula: frequency, intensity and time.
To achieve moderate fitness, a woman would need to walk 2 miles in less than 30 minutes, at least three days per week or walk 2 miles in 30 to 40 minutes five to six days per week.
A man would need to walk 2 miles in less than 27 minutes at least three days per week, or walk 2 miles in 30 to 40 minutes six to seven days per week.
To achieve high fitness, a woman needs to walk 2 miles in less than 30 minutes, five to six days per week or run 2 miles in 20 to 24 minutes four days per week. A man would need to walk 2 1/2 miles in less than 37 1/2 minutes six to seven days a week or run 2 miles in less than 20 minutes four to five days per week.
Always warm up for 3 to 5 minutes and do slow stretching prior to aerobic activity. After exercise, remember to cool down by continuing to walk or move slowly for at least 5 minutes. Never go directly into a sauna, steamroom or whirlpool immediately after vigorous exercise.
If you are over 40, Cooper recommends a thorough physical exam and a treadmill stress test before beginning any vigorous exercise program. This is particularly critical for people with coronary risk factors such as high blood pressure, elevated total cholesterol, family history of heart disease or those who smoke.
FREQUENCY/WEEK......INTENSITY(heart rate).....TIME or DURATION
4 times.........Slightly above 140/beats/minute.....20 minutes
3 times.........Slightly above 130/beats/minute.....30 minutes
4-5 times.......Slightly above 110 beats/minute.....45 minutes