CLOSE TO YOUR HEART  By Becky Blaauw  Biokineticist

 Role of exercise in modern cardiology  Benefits of Physical Activity  Maintaining a safe level of activity with Heart Disease

Role of exercise in modern cardiology  Help you return to an active life  ↑ quality of life  ↑ exercise intolerance  ↑ functional capacity  ↑ symptoms of dyspnea and fatigue  ↑ your energy level and lifts your spirits  ↓ your chances of future heart problems including heart attacks.

BENEFITS OF PHYSICAL ACTIVITY

1. Primary prevention  Higher activity /fitness = with lower death rates from cardiovascular diseases

2. Secondary prevention(after cardiac event) Research shows mortality is reduced in post cardiac event in patients who participate in cardiac rehab due to multi risk factor reduction

Uncontrollable Risk Factors  Age ↑  Gender: Men > women  Heredity  Race: RSA > Indian community then coloured followed by white and then Black communities.

Controllable Risk Factors

1. Smoking  Smokers ↑  Good news is that in the year after you quite smoking your risk of future problems drops by 50%. After 15 years your risk is as low as someone that never smoked.

2. Blood Pressure  High Blood Pressure: 130/85 or >.  Immediate: After exercise systolic may decrease for several hours.  Long term: At Rest B.P may be reduced moderately

3. Obesity  BMI >25  waist circumference Male > 100cm Female > 90cm  Being overweight is bad for your health. Exercise can decrease and control your weight Decrease total fat and intra abdominal fat

4. Unhealthy Diet  Diet: unhealthy diet is going to lead to obesity

 TOTAL > 5.18mmol High Cholesterol: The higher your LDL (Bad cholesterol) > your risk for heart disease. The higher your HDL (good cholesterol) the lower your risk of Coronary Heart Disease.  12 weeks of endurance training increase HDL and decrease Triglyceride levels 5. Cholesterol

6. Diabetes Diabetes > 5.5mmol/L (fasting)  Diabetes: Having diabetes puts you in the highest heart attack risk category. Prediabetic Risk of developing heart disease is high.  Physical activity can prevent and control Type 2 diabetes  Improve glucose tolerance and insulin needs

7. Stress  Exercise will also help your manage stress  Decrease in anxiety and depression.  Exercise will enhance feelings of well being.

BENEFITS OF EXERCISE ON THE HEART  Heart Rate  Resting heart rate  10 – 15 bpm  Stroke Volume (average volume of blood ejected per heart beat)  Stroke Volume   Cardiac Output  Cardiac Output 

OTHER BENEFITS  Increased exercise threshold (angina, heart failure)  Reduce blood platelet adhesiveness  Health for muscles, bones and joints  Independence for older cardiac patients  Reduced risk of falls

Little white pill  There’s no medication that can give the same benefits without side affects

Reality Only one third of those who have heart attacks enter a formal rehab program

WHY ????  According to Cooper et al (1999)  Being older, less aware of cholesterol values, less likely to be employed and not believing their condition is controllable  Patients have not been advised by their doctor

SIX MYTHS ABOUT CARDIAC REHABILITATION

Myth 1 I’m not in good enough shape

Myth 2 Exercise is dangerous

The risk of Sudden Death during exercise is very small the most problems associated to any exercise program is musculoskeletal injury.  It is important to remember that the cause of death in these cases is Cardiovascular Disease NOT EXERCISE.

Myth 3 Rehab is only for cardiac survivors Prevention is better than cure

MYTH 4 Cardiac rehabilitation is just exercise  It is a professionally supervised program to help people recover from Heart attacks, Heart surgery and help patients reduce risk factors.

Myth 5 Cardiac rehab is a “guy thing” usually for the young

Myth 6 “After 12 weeks I am done”

1.Who needs a Cardiac Rehab Program  Anyone of all ages who have Heart conditions and high risk factors  Did you know if you already some form of heart or blood vessel disease or diabetes, you have a > 20% chance of having a heart attack or dying from heart disease within the next 10 years.

2.How long do people attend Cardiac Rehab program  For the rest of your life  You may need 6 weeks, 6 months or longer to manage your condition with your biokineticist

3. What should you consider when picking a program  Biokineticist - the Health Professional Council of South Africa  Time: is the program offered at a time you can be there  Place: is the program easy to get to  Services: does the program offer the services you need  Setting: is it a group or individual program  Cost: can you afford it. Is it covered by your medical aid

4. How can you find out about programmes in your community  Your doctor and Helderberg Cardiac Support group 

Helderberg Cardiac Support Group  Cardiac support system  Formal rehabilitation  Guidance on medication, exercise, diet, stress control.  First of it’s kind in South Africa

Maintaining a safe level of activity with Heart Disease  Most patients are capable of beginning a supervised exercise program 1 to 2 weeks of leaving hospital  It’s best to be under supervision for first weeks  You are capable of doing your own home program quite successful if you have the basics right

Essential components of a exercise prescription are: F I T T

FREQUENCY : According to ACSM 4 – 7 days per week INTENSITY:  RPE scale: 11 – 13 (40 – 60 %) and 11 – 16 (50 – 75%) THR = (220-Age) – RHR x (intensity) + RHR Nb: Beta blockers subtract 10bmin  Initial cardiac rehab should be 40 – 60% of M.H.R  The American Heart association recommends a Target Heart Rate of 50 – 75% of Maximal Heart Rate. TIME: American Heart Association 20 – 60min depending on your intensity.  i.e.: the higher your intensity the lower your duration

TYPE: 3 components of exercise for Cardiac Patient  1. Warm-Up and stretching  2. Workout  Cardiovascular exercise  Resistance/strength exercise  3. Cool down and flexibility

1. Warm up (5 – 10min) How…  - Slow walking or biking with no/light resistance Why…  Gradually improves blood flow to heart and exercising muscles  Increase body temperature  Helps prevent injuries, muscle soreness

2. Muscular Strength and endurance (20min) How….. Use interval training (fartlec)  Endurance: Rowing, step ups, more cycling, walking, swimming  Muscle strength: Light weights, resistance bands

Why…..  Cardio – respiratory endurance: this is the main focus of physical fitness as this causes the most physiological changes known to reduce symptoms and risk factors.  Light resistance training can make our activities of daily living easier and has been shown to modify coronary risk factors.

Flexibility and Balance How……  Light stretches Why…..  Improves range of motion  Improves co-ordination  Reduces risk of injury  Decreases muscle soreness

3. Cool Down (5 – 10min) How…  - Easy walking or biking with no resistance, Why…  To prevent blood pooling  Prevents muscle stiffness and soreness  Return the heart, lungs, and muscle activity to resting levels  Cool down will minimize the potential for Arrhythmic episodes

Special Cardiac Patients

Patients with sternotomy (bypass patient)  : resistance exercises at 6 weeks and light weights ( kg female and kg males) with limited R.O.M exercises

Pace maker and defibrillator implantation patients:  Know what your upper HR limit is (10% below the ischemic threshold). Exercise at 10 beats below programmed HR threshold.  Initially avoid exercises above shoulder level.  Rather use RPE scale for intensity

Cardiac Transplant patient:  for several months heart does not respond normally to sympathetic nervous system therefore resting heart rate is elevated and HR response is abnormal.  Rather use RPE scale.  Use an extended warm up and cool down.

Chronic Heart Failure  Exercise at a lower intensity  Use a prolonged warm-up and cool – down  Avoid isometric exercises  Rather use a RPE scale for intensity  Rather use interval training

Hypertensive Patients:  Do not exercise if BP IS > 200/110mmHg  rather use a bicycle ergometer than arm ergometer. Smaller muscle mass causes increases SBP  Normal Response To Systolic Blood Pressure: Systolic Blood Pressure should go up and Diastolic Blood Pressure remain the same or go slightly down. SBP that fails to rise or fall with exercise could be due to severe coronary artery disease or Left Ventricle dysfunction

Artrial Fibrillation Patients  Should only do moderate intensity exercise to ensure left ventricular filling time

Diabetes patients  Do not exercise if blood glucose are >13mmol/l  Do not inject insulin into area into active muscle (rather abd than thigh)

Final Points To Remember  Ideal temp 18 – 22 degrees and humidity of 65 degrees. Anything hotter you should decrease your intensity  Water  Move feet  Do not hold your breath.  Use rest stations  Avoid isometric exercises.  Listen to your body. Pain is natures way of saying something is wrong.

Conclusion  It’s NEVER too late to start exercising  (it’s never too early, either)  Small changes make BIG differences  There are 1440 minutes in every day…Schedule 30 of them for Exercise and Get Close To Your Heart!!

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