The blanket of white may be attractive from the inside, but eventually the snow must be moved.  Heavy snowfall is not an invitation to suddenly start a strenuous exercise program.

An estimated 1,200 people in the United States die each year of coronary artery disease during and after major snowfalls.

Moving heavy snow can also place additional stress and strain on backs and joints.

Shoveling can be made even more physically strenuous by cold air, which makes it harder to work and breathe. "People need to recognize that snow shoveling is a strenuous cardiovascular workout and they need to be cautious," said David Dierks, D.O., Genesis emergency department physician.

To prevent injury while clearing show, Dr. Dierks suggests the following tips:

Warm up first -- Be sure your muscles are warm before you start shoveling. Warm up a little by walking, doing a few squats or walking stairs a few times. Cold, tight muscles are more likely to sprain or strain than warm, relaxed muscles.

Warmed up your muscles? Then stretch -- "Once your muscles are warmed up, you'll want to stretch your quadriceps, hamstrings and the muscles in your calves and lower back,'' Dr. Dierks said.

To stretch your quadriceps (the muscle in the front of the thigh), stand on one foot, holding onto something stable and bend the other leg behind you. Bring your heel toward your butt with your hand. Repeat with the other leg.

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