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 ↑ 2 - 4

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. DiabetesDiabetes > 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 diabetesImprove 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 controllablePatients have not been advised by their doctor

SIX MYTHS ABOUT CARDIAC

REHABILITATION

Myth 1I’m not in good enough shape

Myth 2Exercise 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

www.biokinetics.org

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 6 - 12 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 10bminInitial 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 (5 – 10min)How…- Slow walking or biking with no/light resistanceWhy…Gradually improves blood flow to heartand exercising musclesIncrease body temperatureHelps prevent injuries, muscle soreness

2. Muscular Strength and endurance (20min)

How…..Use interval training (fartlec)

Endurance: Rowing, step ups, more cycling, walking, swimmingMuscle 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 BalanceHow……Light stretches

Why…..Improves range of motionImproves co-ordinationReduces risk of injuryDecreases muscle soreness

3. Cool Down (5 – 10min)

How…- Easy walking or biking with no resistance,

Why…To prevent blood poolingPrevents muscle stiffness and sorenessReturn the heart, lungs, and muscle activity to resting levelsCool down will minimize the potential for Arrhythmic episodes

Special Cardiac Patients

Patients with sternotomy (bypass patient)

: resistance exercises at 6 weeks and light weights (0.5 - 1kg female and 1.5 - 2 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 forExercise and

Get Close To Your Heart!!

THE END

TEL: 021 8527148 www.blaauwandpartners.co.za