1. Coronary Heart Disease and Exercise Simon Hunt BSc (Hons) Exercise Physiologist www.Sihunt.co.uk

2. Coronary Heart Disease Complex Disease Initiated by injury/damage to inner lining of the coronary arteries Build up of atherosclerotic (fatty) plaque causing blockage Plaque consists of fat deposits. Made worse by smoking, high cholesterol, inactivity, diabetes, hypertension and genetic factors

3. Physical Activity or Exercise? Physical Activity (PA) Washing the car Cleaning windows Walking the dog Exercise Planned Organised Controlled

4. The Circulation Why Exercise or Increase Activity? To Improve Circulation O² & Nutrition Remove Waste Products

5. The Heart and Circulation Cardio Vascular Exercise Benefits: More heart strength and circulation reduces risk factors Body circulation also improves with Resistance and Interval training

6. Risk Factor Reduction through exercise Blood Pressure LDL (bad cholesterol) HDL (good cholesterol) Insulin Sensitivity Glucose (sugar) Metabolism Body Fat Anxiety and Depression

7. Long term Exercise Adaptations Increased Maximal Oxygen Uptake (VO²) At any given level of Sub Max Exercise: Reduced Heart Rate & Systolic Blood Pressure Therefore reduced work load on the heart. Reduced risk of arrhythmias due to reduced catecholamine (adrenaline) Up to 20% Improvement in Physical Capacity seen in Heart Failure patients!

8. Why do we have a heart? Too move blood around the body, working against gravity Other mechanisms that aid return of blood to heart are: Inhalation – suction Valves in veins Muscles that surround the veins. Therefore Keep breathing Keep moving your feet

9. Exercise Recommendations for a Healthy Heart 30 minutes of Cardio Vascular Exercise 3 – 5 Times a Week 70 - 80% max Heart Rate

10. Frequency, Intensity, Time (F.I.T) Exercise Model o Frequency - 3 - 5 times per week o Intensity - 70 - 80% max heart rate o Time - 30 mins at intensity

11. Types of Exercise Cardio Vascular –Large muscles, rhythmic + continuous, using O². Getting a little breathless e.g. walking briskly, swimming, jogging Interval Training (exercise - rest - exercise) Resistance Work – Light Weights – 1 set of 15 Reps – increase metabolic tissue mass

12. Your Exercise Program 15 Minutes Warming Up inc. stretching 30 Minutes of Cardio Vascular exercise (achieve through interval training if necessary) 5 – 10 Minutes of Resistance (can be used in intervals to start with) 10 Minutes Cool Down

13. Individual Exercise Programs Will Vary Depending on : Previous Fitness Levels Type of Cardiac Incident Area of the heart affected Medications Other problems: – arthritis, old injuries etc

14. General Rules Allow an hour after a meal Have a drink of water handy 1 litre Avoid extremes of temperature 18-22 o C and dress accordingly Feel a little breathless – Not speechless! Gradually Increases (Frequency. Intensity. Time)

15. Do’s and Don’ts Don’t Exercise if you are feeling unwell. Do have GTN spray/tablets with you Do pace yourself. Do heed warning signs too STOP: Pain Breathlessness Dizziness etc

16. Medication & Exercise Medication and Exercise work well together. Never stop taking a medication because you are going to Exercise Beta Blockers & ACE Inhibitors. ACE Inhibitors aid exercise capacity in the long-term. Check with your GP before commencing a new exercise or physical activity regime.

17. Avoid Contraindicated Exercises Static non-moving Exercise Heavy weights Arms above the Head for any length of time Standing still Holding your breath Becoming thirsty

18. Summary Decide on your level of physical activity capacity Warm up and cool down Progress gradually (F.I.T) Aim for 30 mins. Cardio Vascular 3 – 5 times a week Be alert to symptoms - listen too your body Balance Medication and eating times with exercise. Chose an activity you enjoy with friends Avoid contraindicated exercise