The two articles below are from American College of Sports Medicine and are position stands. Both of these articles are helpful for the heart patient to understand in the care and prevention of heart conditions. A couple of things to point out to the rehabilitating heart patient would be, the expected drop in blood pressure from exercise is 5-7 mmHg, but can remain lower for quite some time afterwards. This is why you must be alert for dizziness, lightheadedness, fainting, especially after getting up from lying or seated positions.
The article mentions controlled hypertension.Understand you blood pressure as there are levels of hypertension mild moderate and severe. Exercise is not recommended when blood pressure is elevated in the severe ranges. Most should focus their effort in keeping the intensity mild to moderate. This is harder than you think keeping exercise light to moderate, be patient.
The second article, yes there are risks involved with exercise and they can be life threatening. What can you do to lower the risk? The intensity of exercise is important to understand. Learn about MET levels and exercise intensity here after you finish reading the article.
Hypertension (HTN), one of the most common medical disorders, is associated with an increased incidence of all-cause and cardiovascular disease (CVD) mortality. Lifestyle modifications are advocated for the prevention, treatment, and control of HTN, with exercise being an integral component. Exercise programs that primarily involve endurance activity prevent the development of HTN and lower blood pressure (BP) in adults with normal BP and those with HTN. The BP lowering effects of exercise are most pronounced in people with HTN who engage in endurance exercise with BP decreasing approximately 5-7 mm Hg after an isolated exercise session (acute) or following exercise training (chronic). Moreover, BP is reduced for up to 22 h after an endurance exercise bout (e.g., postexercise hypotension), with the greatest decreases among those with the highest baseline BP.
The proposed mechanisms for the BP lowering effects of exercise include neurohumoral, vascular, and structural adaptations. Decreases in catecholamines and total peripheral resistance, improved insulin sensitivity, and alterations in vasodilators and vasoconstrictors are some of the postulated explanations for the antihypertensive effects of exercise. Emerging data suggest genetic links to the BP reductions associated with acute and chronic endurance exercise. Nonetheless, definitive conclusions regarding the mechanisms for the BP reductions following endurance exercise cannot be made at this time.
Individuals with controlled HTN and no CVD or renal complications may participate in an exercise program or competitive athletics, but should be evaluated, treated, and monitored closely. Preliminary peak or symptom-limited exercise testing may be warranted, especially for men over 45 and women over 55 yr planning a vigorous exercise program (i.e., ≥ 60% V̇O2R, oxygen uptake reserve). In the interim, while formal evaluation and management are taking place, it is reasonable for the majority of patients to begin moderate intensity exercise training (40-<60% V̇O2R) such as walking. When pharmacologic therapy is indicated in physically active people it should, ideally: a) lower BP at rest and during exertion; b) decrease total peripheral resistance; and, c) not adversely affect exercise capacity. For these reasons, angiotensin converting enzyme (ACE) inhibitors (or angiotensin II receptor blockers in case of ACE inhibitor intolerance) and calcium channel blockers are currently the drugs of choice for recreational exercisers and athletes who have HTN.
Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of HTN. The optimal training frequency, intensity, time, and type (FITT) need to be better defined to optimize the BP lowering capacities of exercise, particularly in children, women, older adults, and certain ethnic groups. Based upon the current evidence, the following exercise prescription is recommended for those with high BP:
Frequency: on most, preferably all, days of the week
Intensity: moderate-intensity (40-<60% of V̇O2R)
Time: ≥ 30 min of continuous or accumulated physical activity per day
Type: primarily endurance physical activity supplemented by resistance exercise
Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No strategies have been adequately studied to evaluate their ability to reduce exercise-related acute cardiovascular events. Maintaining physical fitness through regular physical activity may help to reduce events because a disproportionate number of events occur in least physically active subjects performing unaccustomed physical activity. Other strategies, such as screening patients before participation in exercise, excluding high-risk patients from certain activities, promptly evaluating possible prodromal symptoms, training fitness personnel for emergencies, and encouraging patients to avoid high-risk activities, appear prudent but have not been systematically evaluated.
Regular physical activity is widely advocated by the medical community in part because substantial epidemiological, clinical, and basic science evidence suggests that physical activity and exercise training delay the development of atherosclerosis and reduce the incidence of coronary heart disease (CHD) events (1-4). Nevertheless, vigorous physical activity can also acutely and transiently increase the risk of acute myocardial infarction (AMI) and sudden cardiac death (SCD) in susceptible individuals (5-7). This scientific statement presents the cardiovascular complications of vigorous exercise, their pathophysiological substrate, and their incidence in specific patient groups and evaluates strategies directed at reducing these complications. The goal is to provide healthcare professionals with the information they need to advise patients more accurately about the benefits and risks of physical activity.
Most studies of exercise-related cardiovascular events have examined events associated with sports participation in young subjects and with vigorous exercise in adults. Vigorous exercise is usually defined as an absolute exercise work rate of at least 6 metabolic equivalents (METs), which is historically assumed to equal an oxygen uptake (V˙O2) of 21 mL·kg-1·min-1. Six METs approximates the energy requirements of activities such as jogging. Six METs is an arbitrary threshold and does not account for the fact that the myocardial oxygen demands of any physical activity are more closely related to the V˙O2requirements relative to maximal exercise capacity than to the absolute work rate per se. Consequently, exercise work rates < 6 METs may still place considerable stress on the cardiovascular systems of unfit and older individuals.
Working cardiac rehabilitation, one wants to take time off around Saint Patrick’s day and Easter. Often patients come in with weight up 10 lbs in one to three days, short of breath, swollen, and having elevated blood pressure. When asked, they report celebrating Saint Patrick’s day with sauerkraut and sausage, corned beef and cabbage, with lots of bread on the side, then celebrated Easter early with a ham dinner with gravy.
Caregivers take note, well-intentioned friends and family may have prepared meal or stocked freezers full of sodium laden foods thinking they are helping out during a medical crisis. Be alert to sodium and it’s effect on heart health. Programs such as Meals on wheels also has a tendency to have very salty meals.
If you find weight up, swollen feet/ankles/belly/face, shortness of breath and elevated blood pressure consider the dietary sources of sodium.
Sodium causes fluid retention, weight goes up, and is often treated with increased diuretics (Lasix, Aldactone, Demedex, Bumex, Zaroxolyn etc.). The body can become resistant to diuretics however, so adding more and more diuretics can be dangerous. These throw off the electrolytes and disrupt the sodium potassium balance of the body, which can set in motion additional heart problems including arrhythmia’s - irregular heart beats that could be deadly. Other side effects of diuretics include:
Bought raw or in a can, corned beef brisket is very salty. One 3 ounce serving of cured corned beef has 964 mg of sodium, 40 percent of your daily value of sodium. In addition to sodium, corned beef is generally made from the fattier brisket areas, so the fat and cholesterol levels tend to be on the high side when compared to some of the more commonly available beef cuts. 1 cup of Cooked Sauerkraut has about 900 mg of sodium. Ham isn’t better - 4 oz. of ham can have between 1000 and 3000 milligrams of sodium.
Sodium, Salt, Na, MSG, natural flavors, natural spices, Sodium Nitrate,
If your diet is going be high in sodium, eat more potassium-rich foods. Potassium helps to lessen the dangerous effects of sodium. Foods high in potassium include bananas, potatoes, squash, spinach, raisins, cantaloupe, beans and lentils.
Rinsing foods such as sauerkraut, or canned beans or veggies in a colander can remove up to 40%. Read labels and aim for foods with 300 milligrams or less of sodium per serving.
Learn your sodium intake,read food labels. Do the math. How much are you getting on a daily basis?
medwireNews: Restricting salt intake reverses vascular endothelial dysfunction in people with moderately increased blood pressure (BP), shows a randomized study published in the Journal of the American College of Cardiology. To read more on this go to link at the bottom of this page.
The job of the kidneys is to filter the excess sodium into the urine so that the body can get rid of it. Many with heart disease and diabetes kidneys cannot handle all the extra work. The kidneys become less efficient at filtering the blood stream. This causes excess sodium to enter the bloodstream. Sodium attracts water to it and effect known as being osmotic. Water follows the sodium and is drawn into the bloodstream. Excessive salt keeps the circulatory volume higher than it should be, creating and increased pressure in the blood stream and pressing on the blood vessel walls. The stress of the pressure on the walls creates thickening and narrowing of the vessel, leaving less space for the fluid in the blood vessels and raising resistance. The body then requires higher pressure to move blood to the organs. The heart has to pump against this high pressure system.
I equate it to trying to blow up one of those kids balloons that is turned into animal shapes. They are really tough to blow air into, your cheeks get really sore – this is the resistance of air, similar to the resistance pressure of blood in the arteries. If you stretch the balloon (relax the arteries) then there is less resistance in blowing up the balloon (filling the artery with blood). Twenty percent of the blood pumped from the heart goes first to the kidneys. High blood pressure within the kidneys cause damage to the heart and to the vascular system in the kidneys. Salt makes you thirsty so limit salty foods, especially if on a fluid restriction.
I once had a patient who lost 45 lbs simply from adhering to low sodium diet. He had a very weak heart with only 10% ejection fraction meaning very limited pumping ability. So a weak heart and sodium in the diet made him retain fluid more than most. He began to measure and count sodium with every meal for a few months and was shocked by how much sodium he consumed even though he thought he ate pretty healthy. By reading labels, doing the math every day and making changes such as eating out less, ordering special, reviewing his medication he lost the fluid and added years to his life, not to mention the improved quality of life with less shortness of breath and fatigue by easing the workload of the heart.
According to the American Heart Association, eating more than the recommended 1500 milligrams a day puts you at direct risk of high blood pressure. Yet in America we consume an average of 3400 milligrams a day; more than twice what we should. While people with hypertension, heart and kidney disease are always advised by doctors to eat less salt, the AHA wants all of us to do this, whether or not our blood pressure is currently in the normal range.
Many patients come through their heart procedures and feel they are cured. Unfortunately for most, heart disease is a chronic progressive disorder of the arteries in which deposits of cholesterol, calcium, and abnormal cells (that is, plaques) build up on the inner lining of the arteries. Heart disease usually progressively deteriorates over time, whether due to normal bodily wear or lifestyle choices such as exercise or eating habits. This is a hard concept to grasp, and it doesn’t mean it is a death sentence either.
When patients struggle with this, I point out doing everything right may be why they survived, as approximately 50% of people do not survive their first heart attack. It is so important for each person to know their body’s signs and symptoms and not ignore them. We don’t really know what makes coronary artery disease aggressive, there seems to be several factors. These factors include inflammation, c- reactive proteins, genetics, lifestyle to name a few.
Some patients will have multiple issues for years requiring frequent interventions and then be fine for many years before having another issue. On average coronary artery bypass grafts 10 years out will be 50% blocked. Some patients will go 20-30 years before needing another intervention, yet others may not even go a week or month before having symptoms. Thirty percent of open heart surgery patients will continue to have angina symptoms after surgery. The drug eluding stents have much lower rates of re-stenosis than the bare metal stents which average 25-30% re-stenosis rates, but in both cases the vessels often continue to develop blockages in other locations in the artery. If the bare metal stents are going to re-stenos the usually do so in the first 3-6 months. It is vital to stay on the platelet inhibitors – Plavix (clopidogrel) as prescribed to prevent complications. Frequently second heart attack occur when patients stop taking their platelet inhibitor medication.
Try to adhere to lifestyle changes that will reduce your long-term risk after another heart attack. These are known risk factor reduction measures and they include achieving and maintaining an optimal weight, beginning a heart-friendly diet, ending tobacco use, achieving excellent control of diabetes and high blood pressure, and adhering to regular exercise. Lifestyle changes are much more challenging to start and adhere to. If it were only as easy taking a pill. Keep your risk factors in the best control possible. Try to get blood pressure, blood sugar, cholesterol numbers to national guidelines. Exercise regularly. Eat a rainbow of color in fresh fruits and vegetables each day. Don’t let stress effect your health, manage your stress as best as possible, consider counseling.
Be on the lookout for new symptoms, for changes in energy patterns, note if you are becoming less active due to fatigue. I believe many can stave off a second heart attack if they are very tuned in to their bodies signals. Keep a diary or log of your symptoms, look or patterns especially increasing fatigue, increasing shortness of breath, increased use of nitroglycerin, episodes of sudden weakness or profuse sweating. If you note a pattern don’t wait, contact your healthcare practitioner to discuss. They key is to prevent any further loss of heart tissue by preventing another heart attack. If you think you may be having another heart attack follow the emergency steps listed below:
Call 911 and describe what symptoms you’re feeling and where you are located.
Chew an aspirin (325 mg) at the first sign of an attack. Aspirin makes blood platelets less likely to stick to each other, assisting blood flow and reducing clots. Chewing the aspirin gets it into your blood stream much faster than if you drink it down with water.