Exercise for a Healthy Heart Background education Our purpose… Exercise is a key component to a healthy lifestyle  To aid you on a smoother, more effective road to regaining as active of a lifestyle as possible We are here to help YOU establish a safe and effective exercise program (here in the gym classes and at home throughout the week) – at present and long-term Ensure you are progressing, not only with your exercise program but ALL components of heart healthy living – work with other program disciplines to ensure you are achieving what you want

Cardiac Rehab Overview Education Classes Nursing Assessment Exercise Test (Stress Test) Exercise Therapist Assessment Exercise Classes Overview of the program Finish up the education classes Meet with the nurse Have an exercise (stress) test here at the program Meet with the exercise therapist Start into the exercise classes

Exercise Test (Stress test) Functional Assessment Increases in speed and elevation over time Blood pressure, heart rate, rhythm rate and symptoms monitored throughout test A Functional assessment where you work as hard as you can while being carefully monitored Usually occurs on a treadmill, with increases in elevation and speed every 3 minutes according to specific protocol Blood pressure, heart rate, rhythm rate, symptoms are monitored by being connected to a 12 lead and BP cuff for duration of exercise test Exercise therapist use this information to determine individual safe training heart rate range

One-on-One Assessment Exercise Therapist Assessment 30 minutes session Review exercise test Discuss exercise plan and prescription Exercise history and goals Medical history – muscle or joint concerns Exercise log/gym session overview How to monitor intensity Review of exercise test by going through Cardiac Rehab Exercise Guidelines sheet Discuss Fitness level (stress test) and appropriate activities Discuss exercise history and goals Medical history (musculoskeletal injuries, concerns or barriers to exercise) Review of exercise log: keeping track of resting HR, BP, time, distance, speed and HR on pieces of exercise equipment Talk about how to monitor intensity with exercise using HR range or RPE scale

Exercise Classes 2 x per week 60 minutes per class 4 months Monitoring blood pressure, heart rate and blood sugars (if diabetic) Nurse and exercise therapists discuss attendance, missed classes and program length opportunity to monitor blood pressure, heart rate, blood sugars, symptoms and exercise progression throughout the four month program chance for appropriate resources to be accessed while exercising, utilizing the interdisciplinary team members group exercise session with individualized programs

Why Physical Activity? Working to improve both physical fitness & physiological function Heart pumps blood and oxygen to the body with less effort Improves symptom management Improves circulation Positive mental health and quality of life Less mental stress, depression and anxiety Feeling BETTER!! Physical Fitness = capacity of the heart, blood vessels, lungs and muscles to function at optimum Body’s ability to function efficiently and effectively day to day (work, leisure, ADL) Physiological Function = the heart delivers a certain amount of blood around the body per minute With improved physical fitness, the heart pumps blood and oxygen to the body with less effort which improves symptom management and improves vessel function as well as circulation therefore decreasing blood pressure Improved psychological well being through reduced stress, anxiety and depression

Why Physical Activity? Positive effect on risk factors Blood pressure Cholesterol Blood sugars Weight management Stress, anxiety & depression Smoking cessation Blood Pressure: A stronger heart can pump more blood with less effort therefore decreasing the force on your arteries, lowering blood pressure. Cholesterol: exercise stimulates enzymes to move LDL cholesterol from blood to the liver Blood Sugars: exercise helps to improve insulin sensitivity and glucose tolerance Weight Management: exercise helps to decrease fat mass and increase muscle mass for an overall weight management Stress, anxiety, depression: exercise reduces levels of the body’s stress hormones (adrenaline and cortisol) and stimulates the production of endorphins (natural painkillers and mood elevators). Exercise also helps one gain confidence, have a better body image, as well as building networks and friendships Smoking Cessation: decreases appetite, eases nicotine withdrawal symptoms and distracts thoughts of smoking

Physical Activity Any body movement that increases energy expenditure above resting levels Can be activities of daily living, occupation, leisure and active transportation Most days of the week, preferably daily Minimum: 150 minutes/week of physical activity (1000 kcal/week) >50% of people over age 35 are inactive <5% of people actually meet the daily recommended amounts of physical activity 150 minutes/week is the minimum amount of recommended activity to be accumulated per week just to meet metabolic needs

Exercise Planned Structured Repetitive Improves and maintains overall physical fitness Working to improve and maintain overall physical fitness by exercising at a desired intensity for a specified amount of time (Includes cardiorespiratory fitness, muscular strength and endurance, body composition, flexibility, balance, agility, reaction time and power)

Aerobic Exercise Continuous, rhythmic exercise using large muscle groups 3-5 days of the week 30 – 60 minutes per session of moderate intensity Eg. Walking, running, biking, stair climbing, swimming Canadian guidelines: 3-5 days/week, 30-60 minutes of moderate intensity exercise

Aerobic Exercise Moderate intensity exercise measured by: Target Heart Rate Range Rating of Perceived Exertion (RPE scale) 3. Metabolic Equivalents (MET level) Measured 3 ways, each will be discussed on following slides

Target Heart Rate Range Based on your initial stress test Most desirable intensity to exercise at Safe intensity Monitoring Heart Rate Pulse Check Heart Rate Monitor In order to improve fitness level and ensure exercise is in a safe range, a “target heart rate range” is prescribed goal of the exercise is to increase heart rate to within prescribed heart rate range in order to help improve fitness level & achieve goals, decrease risk of cardiovascular events, decrease risk of injury and increase compliance As fitness level increases, heart rate per given workload decreases therefore you have to increase intensity to get “back into” target heart rate range **If medications have been changed, this could affect target heart rate (specifically beta blockers) Monitoring Heart Rate Pulse Check Each time your heart contracts and pumps blood out, a pulse can be felt in your arteries Wrist – safest and easiest place to take your pulse Place 2 fingers on the inside, thumb side of your wrists over the radial artery Exert gentle pressure to feel the pulse When you check your pulse while exercising, you may need to stop however it is important to keep you feet moving, shifting your weight from foot to foot Heart Rate Monitor Will be discussed on following slide

Heart Rate Monitor Device that measures heart rate Wear it during exercise and general activities Water proof Purchased at any fitness store Chest Strap Transmitter Contains 2 elements – chest strap transmitter & wrist (watch) receiver when electrodes come in contact with the skin they monitor electrical voltages in the heart when a heart beat is detected a radio signal is transmitted to the receiver and is used to determine heart rate Can be purchase at any fitness stores, place that sells fitness goods or here at the program (Cardiac Rehab sells a Polar Heart Rate Monitor for $88.00 – cash, cheque or visa) Wrist Receiver - Watch

Rating of Perceived Exertion RPE Scale Rating of Perceived Exertion Perceived exertion is how hard you feel like your body is working based on the physical sensations you feel during physical activity and exercise (increased heart rate, breathing, sweating, and muscle (leg) fatigue). By monitoring how your body feels, it is easier to adjust your intensity of your exercise and activity aim for a rating between 3-5 on the 10-point scale = moderate to hard/strong intensity “rating” the feeling of exertion should reflect how heavy and strenuous the exercise feels to you, combining all sensations and feeling of physical stress, effort and fatigue. It is a TOTAL feeling of exertion, not just shortness of breath or leg pain. Use the scale to choose a number that best describes your level of exertion “Talk Test” – can you walk and talk – carry on a conversation?

Metabolic Equivalent Metabolic equivalent = MET Amount of oxygen used by the body during physical activity The harder your body is working during an activity – the higher the MET required Metabolic Equivalent = physiological measure to express energy cost of physical activities Goal = to improve your MET level Compendium of Physical Activities is a reference guide that assigns intensity units (METS) to physical activities

Resistance Training To increase or maintain strength 2-3 days of the week 12-15 repetitions at a moderate weight Eg. Weight Machines, free weights, rubber tubing, resistance bands Canadian Guidelines recommend 2-3 days of the week for at least 12-15 repetitions at a moderate weight in order to achieve muscular strength and endurance

Flexibility (stretching) To improve range of motion 3-5 days per week 20-60 seconds per stretch All major muscle groups Eg. Stretching, Yoga, Tai Chi Canadian Guidelines recommend 3-5 days of the week, holding each stretch at least 20-60 seconds

Exercise Safety Warm Up Allows the body to get ready for exercise 5 – 10 minutes, easy pace Eg. walk slowly gradually increasing speed, bike no resistance, walking on a spot, stepping side-to-side Warm up Prepares the body for physical work by increasing circulation to the heart and muscles Helps to increase muscle temperature allowing for stronger muscle contractions, greater flexibility and decreases muscle injury

Exercise Safety Cool Down Allows the body to recover from your exercise 5-10 minutes, easy pace After your exercise, continue your activity at a lower level walking on a spot, stepping side-to-side Cool Down Helps to return blood to your heart and decrease heart rate to resting rate Prevents muscle cramps, dizziness, hyperventilation and fainting

Exercise Safety Nitro spray Symptoms Blood Sugar Medications Inform staff of hospital or ER visits Replace fluids – Drink water! Coffee, food, alcohol, smoking Nitro Spray: If it’s been prescribed, you should carry it on you at all times…exercise is not any different! Symptoms: If any symptoms occur whatsoever with exercise, tell us so we can help you out and find a conclusion Blood Sugar: Monitor blood sugar before and after exercise in order to be in a safe range during and after exercise Medications: Take them as prescribed. Do not change up the time of your medication because of exercise, if you change your routine, you’ll forget to take them! Hospital Visits: The more we know, the more we can try to help out Replace fluids: Fluid lost through sweating while exercising needs to be replaced. Before, during or after exercise (at least 2 of those 3 times) you should be replacing fluid by drinking water (1 cup for every 20 minutes of exercise) Coffee, food, alcohol, smoking: all of those things can affect heart rate and blood pressure before exercise

Gym Reminders Heart Rate Monitoring Footwear Water Towel Clothing Glucometer and snack (diabetes) Attendance Gym Cancellations Reminders of what to bring/do for the exercise classes: Heart Rate Monitoring: bring heart rate monitor to class, or know of some way to monitor heart rate for the class Footwear: make sure to wear proper footwear (soft, rubber soles, closed toe and heel) Water: proper hydration with exercise, bring a bottle with you as there is no water cooler or fountain Towel: if you sweat excessively, you may want to have a small towel with you during exercise Clothing: wear loose, comfortable clothing that you can move around in easily Glucometer and snack: bring glucometer to class in order to check blood sugars, healthy snack in case needed Attendance: If a medical issues arises, we can place you on a medical hold however there are no make up classes for missed classes or vacations. If you are returning to work, please discuss with exercise therapist Gym Cancellations: if you know ahead of time that you are going to miss a class, please let us know

Tips for getting started Small changes make BIG differences Start by increasing physical activity Slowly introduce exercise Find an activity you enjoy! Variety is important! Find an exercise partner/family member Set exercise goals/action plan It’s NEVER too late to start!

There are 1440 minutes in every day…Schedule 30 of them for exercise!!

Thank you This presentation has been developed by the Cardiac Rehabilitation staff at the Regional Cardiac Care Centre of St. Mary’s General Hospital, Kitchener, Ontario.