Blood Pressure

Favorite stretches for open heart surgery patients

If you just had your chest recently surgically opened, the last thing you want to think about is stretching, but after time it becomes very important. You may not physically remember the pain of surgery but your body does. It gradually rounds the shoulders forward, the head is carried slightly more forward, and these changes make the subtle curve in the low back gradually flatten. Many patients when they first attend cardiac rehabilitation complain of pain and spasm to their upper back and shoulders. When I worked in physical therapy I would have many patients present several years after open heart surgery with low back pain. Many had the characteristic posture I described above.

Here are a few suggestion to help you in the healing process.

Be very aware of your posture – if you are sore, think about what posture you are in. Are you seated with your shoulders slumped and head forward? If so adding a lumbar support to your chair will help to straighten your back posture. Another suggestion is to get up and move more frequently.

Stretches for open heart surgery recovery.

Neck –  Sternocleidomastoid stretch.

To Stretch the Neck’s Sternocleidomastoid muscle

1. Chin to chest

2. Keeping chin down bring ear to shoulder

3. Shift head so you are looking at your armpit.  Tuck your chin in to further the stretch.

4. Gently place hand on head to give additional stretch and be aware of shoulder, try not to let shoulder rise while stretching.

This stretch is also good to do while lying in bed, or sitting in chair and grasping chair

• Repeat to opposite side.
• Do not apply over pressure.
• Do not experience any pain.

 These are other good stretches for the chest

A suggestion for upper back discomfort is to begin with gentle chest stretching and shoulder stretching. It is very important you avoid pain.  It is safer to wait until  6 weeks in recovery before initiating this.

• Do not take any stretch to pain.
• Do not bounce stretches.

There are three different postures to get the different muscle groups of the chest.

• One leg is forward simply to maintain the curve of the low back.
• Hold the stretch 10 to 15 seconds, repeat 1-2 times.
• It is ok to do this stretch a few times per day.

 

Upper back stretching

Great for relieving pain in shoulder-blade region

The muscles act very similar to pulleys.  If one side shortens the other side lengthens. If the muscles of the chest are short the muscles of the upper back are stretched. Prolonged stretch leads to muscle spasm, and this makes many people feel like they have knots in their upper back. There is a great stretch for this.

• Reach down grasp opposite knee with hand (left hand grasp right knee).
• Relax your head pull up gently, hold 10-15 seconds.
• Repeat with opposite hand/knee.
• Repeat one to two times.

Diabetics Weight Loss and Heart Health

Misleading

This report is somewhat misleading. I get concerned when reading negative sounding reports involving exercise and health. I have several thoughts on this report. One is that the study is too short. Heart disease doesn’t just disappear, once it is active in aggressive disease form it can continue to be problematic for quite some time. 1-4 years is a pretty short period of time to expect change. How long does it take the development of diabetes to display physiologic changes. The inflammatory response of diabetes irritates the arteries making heart disease more prevalent. It may take a decade of maintaining these lifestyle changes before the pay off of less cardiovascular issues shows in the statistics.

To say there was no benefit discounts all the good lifestyle adherence of  nutrition and physical activity did for the patient. It initially  focused on weight loss only, I do look forward to seeing the further analysis. Benefits go well beyond the heart. Weight loss through lifestyle changes caused the hemoglobin A1c levels  to decrease, thus decreasing the likelihood of progression of diabetes such as if unchecked increases the need for insulin or other pharmacological agents. These pharmacological agents as with any drug have good and bad components to health. One could extrapolate and assume if the patients maintained this lifestyle they would have less diabetes complications, such as non healing wounds, chronic renal disease, peripheral artery disease etc., as well as less needs for medications to control the disease. Blood pressure improvement was probably noted as well.   Ah but it is stopped because of futility, the study’s data and safety monitoring board recommended the trial be stopped.

The lifestyle modifications arm of this study showed improved Hemoglobin A1c levels. If the study looks at  keeping the HgbA1c lower rather than simply weight loss, over a period of 10-20 years I bet one would note a decrease in the incidence of heart attack, stroke, angina, re hospitalizations for cardiovascular issues.  Mentally the patients were happier, if you work in healthcare….that means alot!!!

I would still push hard for any and all with diabetes to adopt a healthy lifestyle of good nutrition and exercise, and not just for those who need weight loss. I hope the final research will address these issues and not just focus on a negative. I can just hear patients thinking well I don’t need to worry about weight loss through activity as that won’t help my heart, lets just see what medication I can take to improve my glucose control.   Nutrition and exercise are crucial and should be the front line of treatment for heart disease and not just limited to weight loss.

Weight Loss No Help for Diabetic Heart

By Chris Kaiser, Cardiology Editor, MedPage Today

Published: October 19, 2012

Losing weight — an average of 5% of total body weight — `and keeping it off for 4 years didn’t reduce the number of heart attacks or strokes in persons with diabetes.

That result prompted the National Heart, Lung, and Blood Institute to pull the plug on its massive Look AHEAD (Action for Health in Diabetes) study.

The study enrolled 5,145 people with type 2 diabetes and a BMI greater than 25, randomizing half to a lifestyle intervention and half to a general program of diabetes support and education.

Although those in the intervention group kept off 5% of their initial body weight at 4 years, there was no difference between them and the standard care group in the rate of myocardial infarction, stroke, hospitalizations for angina, and cardiovascular death — the primary outcome.

Essentially, there was no harm from the intervention, but there was no benefit either, according to a statement from the NIH.

Because of the finding of futility, the study’s data and safety monitoring board recommended the trial be stopped.

Mary Evans, MD, director of special projects in nutrition, obesity, and digestive diseases at the National Institute of Diabetes and Digestive and Kidney Diseases, told MedPage Today that people who “volunteer for a weight-loss intervention study involving reductions in calorie intake and increased physical activity may be healthier than the general population with type 2 diabetes.”

She said that participants had to pass a treadmill test to assure it was safe for them to exercise. They also received annual feedback about their risk factors, including HbA1c, blood pressure, and cholesterol levels.

After the first year, Look AHEAD participants in the lifestyle intervention arm had lost 10% of their initial body weight, but as time went on, they gained some of it back. The standard care group lost about 1% of its initial body weight at both 1 and 4 years.

Despite no reduction in cardiovascular events in those in the intense intervention arm, they did experience other health benefits. Patients in this group saw improvements in sleep apnea and mobility, as well as quality of life. In addition, their diabetes medications were reduced.

In addition, at 1 and 4 years, both diabetes control (glucose, HbA1c) and most cardiovascular disease risk factors (blood pressure, HDL cholesterol, triglycerides) were more favorable in the lifestyle intervention than in the control group with the exception of LDL cholesterol, which was not different between groups at year 1, Evans shared.

At year 4, those in the intensive lifestyle intervention group continued to have more favorable diabetes control and CVD risk factor reduction, with the exception of LDL-C in which there were slightly greater reductions in the standard care group. Participants in the lifestyle intervention group maintained greater improvements in fitness at both years 1 and 4, Evans said.

To be enrolled, patients had to have their blood pressure under at least moderate control (160/100 mmHg), HbA1c levels ≤11%, and fasting triglycerides concentration less than 600 mg/dL. The trial included those with and without a history of cardiovascular disease.

“Cardiovascular event rates in diabetic individuals with heart disease are expected to be approximately twice those of diabetic individuals without a history of heart disease,” according to the study protocol.

The ages of participants ranged from 45 to 76, and 60% were women.

“Data from the end of the study are currently being analyzed to better understand the relationship between changes in fitness, weight, diabetes control, cardiovascular disease risk factor control, and outcomes in the Look AHEAD study,” Evans said.

Researchers also are exploring differences in subgroups, such as minorities (about 37% of the total population) and those with a history of cardiovascular disease.

America’s Nutrition Evolution

Exercise Make it a habit

To make a lifestyle change takes time. Research tells us to make something a habit  it can take as little as one month – or twenty-eight days, to as long as sixty-six days. When it comes to exercise I firmly believe it often takes as long as six months. There are too many barriers that can divert the progress and then you are starting over again.

Wouldn’t that be nice!

Life throws constant curve balls at us and often the first thing to go is our physical activity or exercise.

It’s motivational to think of  this picture as your habit, but reality for many is it isn’t. Life throws all kinds of curveball at us. If you have stumbled on your road to a physically active lifestyle, getting started again and sticking with it gets back sometimes faster, sometimes slower but at least you are back to working to make it a habit or back to maintenance again. When we look at the stages of change model you see it takes doing the action for greater than six months to get to where it is maintenance. I would consider maintenance to be a habit. If you have ever embarked on changing a sedentary lifestyle to a physically active lifestyle you probably hit many stumbling blocks. A stumbling block could be access, weather, family support, time constraints, injuries, illness…etc.

Start today to build that habit.

Can you stay physically active for six continuous month?

Heart Disease