Exercising with heart disease

Start slow and add a little more over time. Make it feel  as if when finished feel like you could have done more easily. Begin exercising at this intensity for several sessions before making large increases in your intensity or effort required to be physically active. . Remember the whole goal is to adapt, and by doing so the body is changing how it responds. In the early recovery stage  the exercise prescription is very light. Do you know What exercise prescription is best for you?

Since exercise should be part of your everyday routine in order to make it a lifelong habit  injury avoidance is important to be aware of overuse signs and symptoms, to rest those muscles when needed.  Occasionally cardiovascular disease patients develop Peripheral Artery Disease and symptoms can present similarly to overuse. Pain should signal the body to be aware that something is going on.  Take some time to evaluate that pain, what happens with it, does it always come on at a certain time or point of the exercise or activity? How long does it take to go away? Can it be avoided while being active by another means for instance switching from walking to biking?  Make sure you communicate these findings with your healthcare practitioner as they could be signals of other health conditions related to heart disease and it’s recovery.

Some exercise and activity is better than none, so start slowly. Even a warmup is better than no exercise session here is why  warming up before strenuous activity helps your heart.

Don’t expect results overnight, but do take small steps each day. Move that blood around, push it through the muscles. Make the muscles use the oxygen in the blood  more efficiently. Exercise helps the the heart recover and stay strong.

You might not notice any big changes—especially in your weight—for a few weeks or even months. It is still good for your heart health! It is not all about weight loss. Forget the scale for a while. In fact many who initially start to exercise following hospitalization are  Sedentary at the start and will gain a couple of pounds. It is their muscles getting pumped up, holding and utilizing more blood flow. Generally the focus on how you feel.

 When not to exercise is if you are presenting with Signs and symptoms of heart problems. Exercise should be avoided if  if you are presenting with congestive heart failure, or are presently sick. When returning to exercise following illness 

Symptoms to be alert for include these.

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Exercise is Medicine for your Diabetes

If you have type 2 diabetes, regular physical activity is essential for controlling your blood glucose and managing your weight. Exercise also improves how well your body responds to insulin, which may reduce the need for medication because your muscle and fat will do a better job of taking glucose out of the blood.

Furthermore, exercise may help protect you against heart disease, which often accompanies type 2
diabetes, by reducing body fat, blood pressure and improving your cholesterol levels. It will help you better understand your diet and exercise if you closely monitor your blood glucose levels to  understand how you respond to different types of activities.

If the benefits of exercise could be put into a pill would you take it?

If so why would you take it? Most likely because you know that pill is extremely helpful.  It would make your muscles stronger, including your heart muscle thus decreasing risk of death from heart disease. It would lower your bad cholesterol, triglycerides, blood pressure and blood sugar, and increase the good cholesterol. It would improve your memory. It would slow osteoporosis. It would make you less likely to have falls. It would improve your mood and lessen symptoms of depression.

Exercise is Medicine!

Exercise does all this and more, however it is extremely difficult to get people to follow exercise advice or adhere to an exercise program? Why? Because taking a pill is so much easier, and maybe because the cost of medicine is covered by insurance. So many take such care to take medications, vitamins, eat healthier, but still find it difficult to adhere to medical advice to exercise. It could be do to the information out there seems conflicting, or too complicated.

Exercise the Diabetes Drug

You take your diabetes medications every day correct? Most people also have concerns about the side effects and the cost of their medication. Yet exercise is one of the best medications out their with minimal side effects. Just like most diabetes drugs it has to be taken regularly to get the benefits, and there is a specific dosage.

Frequency of use: 6-7 days per week.

  • This regulates the body, you need  a certain amount of energy to do this from your body and its energy sources (food and insulin). The more regular you exercise the less wild blood sugar swings.

Intensity:

  •  To a level that feels fairly light to somewhat hard, but not hard. Bring your heart rate up above your resting heart rate, break a light sweat, breath a little harder – yet be able to carry on a conversation

Time or Duration:

  • 30 minutes or more per day. It can be broken up or done all at once.

Type:

  • Aerobic – meaning continuous movement that requires oxygen – walking, biking, hiking, spinning, swimming, rowing, elliptical, recumbent equipment, steppers, tia chi, yoga, karate, pilates, belly dancing, dance classes, circuit training, cross country skiing, snow shoeing, kayaking, rollerblading, ice skating….you get the idea.
  • Resistance training – it doesn’t have to be heavy body building weight training, but working with your body as resistance, dumbbells, resistive bands, weight machines, free weights all help to maintain and build muscle. Try doing some sort of resistive training 2-3 days per week.

Side effects:

While there are many benefits to exercise for people with diabetes, it should be noted that there are several potential risks as well, including a worsening of eye complications in people with conditions such as proliferative retinopathy when doing specific exercises (such as weight lifting- with heavy weights that create a large amount of strain), hypoglycemia (low blood glucose), and hyperglycemia (high blood glucose).

Building the Routine

Most people take there medications at a certain time every day, brush their teeth at a certain time, go to appointments because they are scheduled at a certain time. Exercise needs to be scheduled and worked into the daily routine. What works for you? First thing in the morning? Most studies show people who exercise first thing in the morning are more likely to stick with the routine for the long haul. Can you develop a routine –  a walk after dinner, hitting the gym on the drive home from work, fifteen minutes at lunch and fifteen after work? Keeping a log helps, and be accountable to someone with the log, make sure you bring it to your doctors appointments and discuss.

Can you stick with if for the long-term?

It takes six months of exercise to establish a habit.

In medicine we talk about the stages of change

Where are you in the stages of change when it comes to exercise?

http://exerciseismedicine.org/documents/EIMPSA_03.pdf   

Protect your kidneys

It isn’t easy to be a heart patient, there are so many medication and lifestyle consideration to prevent further injury or illness.

Common heart medication interact with our foods and other medications.  NSAIDS increase heart problems, Coumadin requires watching vitamin K, Grapefruit interacts with many heart medications, some diabetes medications increase heart risks, some heart medications increase risk for diabetes. Now we have a another  to be concerned about. Here is a new advisory the combination of NSAIDS and hypertensive drugs. This is challenging as we encourage patients to exercise and often there are side effects of sore muscles and joints. Based on this the recommendation for sore muscles and joints should be to use  ice and stretch…avoid the Motrin, Advil, Ibuprofin, Moabic, etc. The other challenge is to get the orthopedic physician and the cardiologist to work together to prescribe the safest medication regiment for you. Most importantly do not stop your anti-hypertensive medications without first consulting your physician, sudden withdrawal can be very problematic.

side effects and contraindications: antihypertensives

Adding a non-steroidal anti-inflammatory drug (NSAID) to dual antihypert ensive therapy (a diuretic plus either an ACE inhibitor or an angiotensin receptor blocker) is associated with an increase in risk for kidney injury, according to a large new retrospective study published inBMJ.

Adding a non-steroidal anti-inflammatory drug (NSAID) to dual antihypertensive therapy (a diuretic plus either an ACE inhibitor or an angiotensin receptor blocker) is associated with an increase in risk for kidney injury, according to a large new retrospective study published in BMJ.

Analyzing data from nearly half a million people taking antihypertensive drugs, researchers found 2,215 cases of acute kidney injury after a mean followup of 5.9 years. People on dual therapy were not at increased risk for acute kidney injury. However, when NSAID use was added to dual therapy, there was a modest but significant increase in risk (rate ratio 1.31, CI 1.12- 1.53). The increase in risk was highest in the first month of treatment.

The authors concluded that “increased vigilance may be warranted when” NSAIDs are used with dual antihypertensive therapy, especially in the early treatment period.

In an accompanying editorial, Dorothea Nitsch and Laurie A Tomlinson write that the safety of dual therapy still remains to be demonstrated and that the study likely “underestimates the true burden of drug associated acute kidney injury” in patients taking antihypertensive therapy and NSAIDs. Physicians should inform patients taking antihypertensive therapy about the possible risks of NSAID use and should ”be vigilant for signs of drug associated acute kidney injury in all patients.”

Here is the BMJ press release:

Triple mix of blood pressure drugs and painkillers linked to kidney problems

Absolute risk still low, but doctors and patients should be vigilant

Research: Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study

Editorial: Safety of co-prescribing NSAIDs with multiple antihypertensive agents

Patients who take a triple combination of blood pressure drugs and common painkillers are at an increased risk of serious kidney problems, especially at the start of treatment, finds a study published on bmj.com today.

Although the absolute risk for individuals is low, it is still something doctors and patients should be aware of, say the researchers.

Acute kidney injury (also known as kidney failure) is a major public health concern. It occurs in more than 20% of hospital inpatients and is associated with around half of all potentially preventable deaths in hospital. It is often triggered by adverse reactions to drugs, but little is known about the safety of different drug combinations.

So a team of researchers from the Jewish General Hospital and McGill University in Montreal, Canada, set out to assess whether certain combinations of drugs to lower blood pressure (antihypertensive drugs) and non-steroidal anti-inflammatory drugs (NSAIDs) are linked to an increased risk of kidney injury.

These drugs are commonly prescribed together, particularly in elderly people with several long term conditions.

Using the world’s largest computerised database of primary care records (CPRD), they identified 487,372 people who received antihypertensive drugs between 1997 and 2008. Drugs included angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and diuretics, with NSAIDs.

Patients were tracked for nearly six years, during which time 2,215 were diagnosed with acute kidney injury that prompted admission to hospital or dialysis (7 in 10,000 person years).

The results show that patients taking a double therapy combination of either a diuretic or an ACE inhibitors or ARB with an NSAID were at no increased risk of kidney injury. However, a triple therapy combination of a diuretic with an ACE inhibitor or ARB and an NSAID was associated with a 31% higher rate of kidney injury, particularly elevated in the first 30 days of treatment during which it was 82% higher.

These results remained consistent after adjusting for confounding factors and controlling for other potential sources of bias.

The authors conclude that, “although antihypertensive drugs have cardiovascular benefits, vigilance may be warranted when they are used concurrently with NSAIDs.” They add: “In particular, major attention should be paid early in the course of treatment, and a more appropriate choice among the available anti-inflammatory or analgesic drugs could therefore be applied in clinical practice.”

In an accompanying editorial, researchers at the London School of Hygiene and Tropical Medicine say this study “is an important step in the right direction” but “probably underestimates the true burden of drug associated acute kidney injury.”

They suggest that clinicians advise patients of the risks and be vigilant for drug associated acute kidney injury, and say “the jury is still out on whether double drug combinations are indeed safe.”

http://cardiobrief.org/2013/01/10/acute-kidney-injury-associated-with-dual-antihypertensive-therapy-and-nsaids/

Cardiac Surgery Patients: Think Posture!

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.

Pain in the shoulder blade region?

If so begin with gentle chest stretching and shoulder stretching. It is very important you avoid pain. I usually wait until my patients are approximately 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.

   These are other good stretches for the chest

Upper back stretching

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.

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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.

Use a lumbar support in your favorite chair, while driving, or sitting for a prolonged time. You can either purchase one at your local medical supply/pharmacy, or you can simply roll up a small towel and put it in the small of your low back.

 

 

How does your family strength train?

What does your family do to Strength Train?

Many don’t incorporate strength training into their fitness routine. Children may be physical with playing soccer, basketball etc.but may not get strength training. By building muscle strength you improve the metabolism, making you less likely to gain excess weight, strengthens the bones, makes you less prone to injury.

When children are very young working with heavy weights in the past was discouraged. The thought on this is that is could hurt the growth plates of the bones, and stunt growth therefore working with heavy weights was discouraged.Research however has disproved this, and it is now recommended everyone participate in some form of strength training.

Most people think of strength training as working with weights.

In fact, the ideal weight-training program for many children need not involve weights at all. “The body doesn’t know the difference between a weight machine, a medicine ball, an elastic band and your own body weight,”   Tree climbing is a favorite in our home, as is a great arm workout. 

 Plank, lunges, push ups, chair arm dips, yoga poses such as powerful pose, boat pose, are ways of building strength without weights. If you do choose weights, start light get 3,5,7,10 lb. weights. Focus on learning technique and endurance, then gradually increase the load.
 

Don’t confuse strength training with weightlifting, bodybuilding or powerlifting. These activities are largely driven by competition, with participants vying to lift heavier weights or build bigger muscles than those of other athletes. This can put too much strain on young muscles, tendons and areas of cartilage that haven’t yet turned to bone (growth plates) — especially when proper technique is sacrificed in favor of lifting larger amounts of weight.