Push the snow, dress in layers, and warm up first are sensible rules for shoveling snow. Here are some guidelines you may not know:

•  Avoid caffeine or nicotine before shoveling, especially if you have a history of or are at high risk for a heart attack. These stimulants may increase your heart rate and cause your blood vessels to constrict, which places extra stress on the heart. If you have a heart condition, respiratory issues, or back problems, check with your doctor before doing any shoveling.

•  Drink plenty of water to avoid dehydration.

•  Try to shovel fresh snow, before it becomes packed or refrozen. It may be helpful to shovel a few times during a snowfall rather than waiting until the storm ends when the snow is deeper and heavier.

•  Switch hands periodically and alternate the side to which you are throwing snow to more evenly distribute the work load and repetitive muscle use.

•  Use a sturdy snow shovel that has open ends to allow you to easily toss the snow off to the side.

•  Pace yourself. Be sure to take frequent breaks to rest and avoid overexertion. Exhaustion can make you more susceptible to injury, hypothermia, and frostbite.

Most important:

If you begin to experience any pain in your chest, arm or neck, shortness of breath or profuse sweating, stop shoveling immediately and seek emergency medical attention.

[Source: Kessler Institute]