Snowstorms and Heart Disease

If you are a heart patient you might be concerned about how the cold weather affects your heart.  The body constricts blood flow to the skin to conserve heat, which also raises blood pressure. Many experience angina when active in cold weather.

Advice for how to manage angina related to cold includes:

• Do a warm up indoors to dilate the blood vessels and get heart rate slightly elevated before outdoor exertion
• Create a zone of warmer air to breath by using a scarf, mask or parka
• Avoid large meals and alcohol before exerting outdoors. Blood flow gets diverted and doesn’t go to the heart or exercising muscles instead it works to digest the food.
• Discuss using nitroglycerine before activity with your healthcare practitioner. Using the nitro to dilate the vessels prior to cold air exposure is a method used by some.

Snow Shoveling for Heart Patients

• Warm up, do some light exertion to dilate the blood vessels and get the heart rate slightly elevated before really “digging out”

• Dress appropriately in layers, when you feel warm take layers off. Preventing overheating from being overdressed is as  important as dressing for the cold. Your heart  works harder to cool your body down. Sweating excessively will lead to being cold later.

• Do not eat a large meal or smoke prior to shoveling, these divert the blood flow away from the heart and exercising muscles.

• Push the snow don’t lift if  you can.

• Exhale on Exertion.  Breath out when pushing or lifting, don’t hold your breath!!!! Holding breath increases blood pressure even further than the cold and exercise already has.

• Switch sides keep alternating the shovel in left and right hand. The constant twist to one side produces muscle injury and can be hard to distinguish between muscles and heart. Muscle pain can be reproduced with touch or movement, whereas heart pain cannot be reproduced by touch.

• Take breaks, listen to your body don’t over do it. The body constricts blood flow to the skin to conserve heat, which also raises blood pressure.

• Stay fit enough to shovel snow. If you don’t exercise regularly you are not strong enough to shovel wet heavy snow. The cardiovascular demands are even more due to excessive cold temperatures. Train for snow shoveling by performing aerobic exercise and resistance training.

• If you have symptoms STOP

Dealing with Raynauds in the cold weather

Raynaud’s occurs when the fingers and/or toes come into contact with cold. Beta blockers medications actually can aggravate Raynaud’s by leading to increased blood vessel spasm. This class of drugs, used to treat high blood pressure and heart disease, includes metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and propranolol (Inderal, Innopran XL). It is important to cover your feet and hands before they get cold with warm gloves and socks. Make sure they are not too tight allow for circulation. Prevent the symptoms by creating a barrier between your skin and the cold. Even if you are only going out for a short while keep your fingers covered and wear warm foot protection. Frostbite occurs much quicker in persons with Raynaud’s.

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Atrial Fibrillation is more common in Winter

The likelihood of being admitted to hospital or dying with atrial fibrillation, a life-threatening chaotic heartbeat common among the elderly, increases dramatically during winter months. Atrial Fibrillation is common in persons with heart disease. Be alert for symptoms of irregular heart rhythm, increased shortness of breath, increased fatigue. Additional factors contributing to the winter connection to atrial fibrillation  may include drinking too much alcohol which leads to high blood pressure, heart failure, and possibly even stroke due to the  atrial fibrillation.

http://www.hearthealthywomen.org/am-i-at-risk/am-i-at-risk/hfother2.html

http://www.nhlbi.nih.gov/health/health-topics/topics/raynaud/

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.

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.

 

 

Exercise the key to a happier healthier you

Do you do it?

Most of the push today is for obesity prevention and control, but for heart patients it is essential for growth of collateral vessels so the body forms its own natural bypass around blockages. This is crucial for anyone with peripheral artery disease PAD. In fact the goal is 60 minutes for PAD patients. My last post was on depression, again the use of exercise lifts the spirits, exercise releases endorphins, which are the feel good chemicals that circulate in the body. We can talk about it all day the why you should exercise, but the bigger question do you do it? Can you stick with it? What barriers must you overcome to be able to adopt exercise as part of you day? If exercise benefits came in a pill form most would never question it and take the pill regularly without regard to side effects. Start your program, keep a log of the frequency you are able to do. It doesn’t have to be high intensity or hard, it just has to happen. Do it regularly for a few months, then try to build the intensity a little if you can.

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Winter Exercise for Heart Patients

Winter is upon us. It is cold, blustery, snowy, rainy, grey outside. This makes it very hard to be motivated to go outdoors and walk. Keep in mind it is very important to go outdoors and get approximately 10 minutes of natural light every day. This gives you Vitamin D. It is beneficial in preventing seasonal effective disorder. Interestingly seasonal effective disorder peaks in February. So there is a cumulative effect of getting natural light. Depression sets in and then people stop exercising entirely. I would always hear my heart patients say they will begin their home exercise when the weather improves. Uhg….your health should not be dependent upon the weather!

 

Do you feel better after you exercise? I believe when we go outdoors for a walk, run, bike ride, etc. it is more beneficial than exercising indoors.  I feel the best after outdoor exercise.  Not only does the exercise kick in your metabolism, but the bodies need to warm itself, then cool itself due to the exercise can only help the metabolism to increase. If your body temperature regulation system never gets the opportunity to kick in, it slows down and becomes less effective. Again kind of the principle use it or lose it.

A few winter exercise tips, yes I am sure you have heard them before, but here goes.

• Layer your clothing, start off cool, and when you get warm peel off layers before you overheat. Often winter exercise fatigue is related to being overdressed and the body is working extra hard to cool itself.
• Wear good shoes or boots- maintain traction, keep feet warm and dry
• Drink extra water — winter dry air leads to dehydration occurring more quickly
• Carry your nitro with you, just in case
• Walk with ski poles for extra intensity, better stability and posture

On really nasty weather days, have a back up plan. Indoor exercise that day, do weights, yoga, calisthenics, stretching, or take a drop in class at your local gym. Sign up for the gym or an exercise class for the worst weather months. Get out and walk the mall, hit the pool

If you get angina in the cold weather,  start your exercise by doing a warm up while indoors, do 5 or 10 minutes of activity that brings your heart rate up and dilates your vessels. Then when you go outdoors wear a parka, scarf or keep mouth covered. Maintain good posture. Engage your arms and legs…really think about pumping that blood throughout all your muscles.

I don’t recommend that heart patients use snow shoveling as their exercise.

You should exercise to stay fit enough to perform snow shoveling. That is why many heart attacks occur while shoveling. Many are not fit enough to perform this activity. The energy demands can be equivalent to running a marathon. If you are fit enough to run a marathon, then ok go ahead and shovel. The other thing is you can’t count on enough snow to go out and shovel every day…nice try with that one…doesn’t work.

Facts about cold weather and heart disease

Cold temperatures cause arteries to tighten, restricting blood flow and reducing the oxygen supply to the heart, all of which can set the stage for a heart attack.

In cold weather, there is more oxygen demand by the heart because it is working harder to do the work and maintain body heat.

Research suggests that the early-morning rise in blood pressure, or “a.m. surge,” that occurs in most people may dramatically increase the risk of having a heart attack or stroke. In the winter, people tend to exert themselves or do yard work in the morning because it gets dark earlier.

 

 

Benefits of training both the arms and legs

It might seem pretty logical that it is important to train all the major muscle groups in the body. Many people do not train their whole body. For many assume getting out and walking everyday provides all the exercise they need to stay healthy. However that neglects the upper body and core muscles. The muscles of the upper body will tire rapidly when subjected to moderate to heavy upper body workloads such as shoveling, raking, lifting, and  overhead arm work. That is because there is no carry over from leg work to arm work, training your legs with walking won’t improve your arm endurance. Thus, it is important to train both.

Initially many with heart disease will find it is hard to do exercise that works both. Working both can also be an angina trigger depending on how much heart damage one has. It is something that you have to build up as tolerated.  It is advised to warm up just doing a leg activity for 5-10 minutes at light workloads, then progress to adding the arms into the work. If they tire, become heavy or you feel short of breath, then drop the arms and continue with legs only. Be alert for  the following signs of unstable angina:

• unexpectedly becomes worse than usual at a given level of exertion
• starts with lower levels of exertion
• starts while resting
• continues after stopping exercise or taking nitroglycerin medication

If symptoms don’t resolve then stop exercising. It is recommended to progress arm exercise by performing intermittent arm exercise. For instance if on the Schwinn Bike after warming up, then doing a few minutes at higher workloads, add the arms in for 1-5 minutes, then go back to legs only for up to 5 minutes, then add the arms back in. Building arm endurance as able. It is important to actively use the muscles don’t just let the ride along. Think push or pull!

If you are someone who walks for exercise you can work arms at the same time if you carry light weights and actively pump the arms, walk with ski poles.

If your have back issues or balance issues I recommend walking with ski poles. They help you to stand taller, force you to engage your arms with the walk, and you burn more calories on your walk.

Compared to regular walking, ski walking  involves applying force to the poles with each stride. Walking with ski poles uses more of their entire body (with greater intensity) and receive fitness building stimulation not present in normal walking for the chest, lats, triceps, biceps, shoulder, abdominals, spinal and other core muscles. This can produce up to a 46% increase in energy consumption compared to walking without poles. It also has been demonstrated to increase upper body muscle endurance by 38% in just twelve weeks. This extra muscle involvement may lead to enhancements over ordinary walking at equal paces such as:

• increased overall strength and endurance in the core muscles and the entire upper body
• significant increases in heart rate at a given pace
• increasing vascular pathways and oxygen delivery efficiency
• greater ease in climbing hills
• burning more calories than in plain walking
• improved balance and stability with use of the poles
• significant un-weighting of hip, knee and ankle joints
• provides density preserving stress to bones

This is my ski pole dealer.  http://www.skiwalking.com/index.asp

What about walking with weights? 

If you want to walk with weights don’t use more than 1-2 lbs in your hands. Heavier weights tend to stress the neck and spine and are not recommended. Again don’t just hold the weights pump those arms, swing up to breast bone and back to hip. You engage the arms, you burn more calories.

 

Gym Equipment that will improve upper body endurance:

• Stationary Bikes with upper body
• Elliptical
• Recumbent Steppers
• Rowing Machines
• Upper Body Ergometers
• Dumbbells
• Weight Machines
• Kettle Bells                                                                                                                                                                                            

Take Classes that work upper body and core.

By taking fitness classes you mix up the workouts, work different muscle groups, prevents boredom,  keeps it fun, gives you alternate exercise for inclement weather. Personally November and April are the hardest months for me to stay motivated with outdoor exercise, as it is cold, dark and wet….not easy to motivate self. But that is another blog post.

• Pilates
• Yoga
• Tia Chi
• Karate
• Belly Dancing
• Zumba

Fitness as we age

It is important to work on physical fitness life long.

Physical fitness benefits include reduction of heart disease, reduction in Alzheimer’s and most importantly independence.  A recent study showed Finnish men who lost more than 15% of their cardiorespiratory fitness over a 10-year period faced a near doubling of their risk of acute MI over the subsequent decade and more than twice the risk of dying of any cause, a new study shows. But as we age fitness programs change. It isn’t realistic to ask the very elderly to jog, participate in spinning classes, hit the elliptical or rowing machine like those who are younger. The issues with mobility and frailty prevent such activities for most. So what does one do for fitness as they age?

Walking, stationary biking, water aerobics, swimming laps with a kick board, recumbent bike or  recumbent steppers are some of my favorite means of obtaining aerobic exercise. Also programs such as Sit and Be Fit. http://www.sitandbefit.org/   Any is exercise is better than no exercise. If exercise is done in a group or a class you also get the additional benefits of socialization. As we age socialization is vital. The more socially isolated a person becomes the worse the predictors for health. I found over the years many adhered to light continuous aerobic exercise because of the socialization of the classes more than the physical benefits of the exercise. New interns would come aboard and roll their eyes when they noted the workloads of many of the elderly, then I would point out the ages of many of my clients being in upper 80’s to mid 90’s and regularly attending classes 2-3 times per week, aerobically exercising, resistance training, stretching and socializing.

Resistance training is very important as we age as well as I am frequently promoting the following:

Your Strength is your Independence

This is what allows you to live in your own home, to care for yourself, to get up off the floor if you fall, to carry in the groceries.  It is your ability to cope with emergencies, to interact with the grandkids by walking up the bleachers, or across the soccer field, to lift up the two-year old, to get to their musicals across a long parking lot, to walk the hills at the nature center etc.

 

Here are a few simple strengthening exercise that most can perform. Wall squat

Wall Squats

With feet 8-12 inches apart and approximately 6 inches from the wall, slide down the wall a few inches. Hold this position as long as able. Push back up to standing. Repeat as many times as possible. Don’t go down to far, and if you fear not being able to stand all the way back up, keep a chair next to you for assistance. Breath out as you push back  up.

Toe Raises

This exercise is surprisingly hard for many of the elderly to perform. Go up on tip toes and back down as many times as possible. To make harder try on a stair step or try doing on only one leg.

Wall push ups

Just like the old-fashioned push up but do against a wall. Breath out as you are pushing yourself back from the wall. Exhale on Exertion! I say this because many hold their breath which is hard on the heart and blood pressure.

Lateral leg exercises

These are really important for maintaining a good gait when we walk as we get older. Lying on side – do in bed – as easier than getting up from the floor. Lift leg out and back down. Do as many as possible.

Be a mentor, assist to make it happen

As most blog readers tend to be younger, pass this advice on to your elders, work out with them, purchase and arrange for transportation to fitness classes, make a big deal out of wanting them to stay fit and healthy to participate in life with you. We all need encouragement at times. Don’t assume being old means sitting in the recliner all day. Keep those in your live vital through physical activity. And have a great day!