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.

Take a walk on National Walking Day

What is National Walking Day?
The American Heart Association has named the first Wednesday of each April, National Walking Day. This day is dedicated to raising awareness of the importance of physical activity.

Invite your family, friends and coworkers to walk with you towards a healthier life!

Why start walking? It’s easy, it works and it pays!

  • Heart disease is this country’s number one killer but by exercising for as little as 30 minutes each day you can reduce your risk.
  • Studies show that for every hour of walking, life expectancy may increase by two hours.
  • Walking is the single most effective form of exercise to achieve heart health

Check out the American Heart Association’s new Walking Paths app to create, find and track walking paths near you! Available for the Android, iPhone and iPad.

For more information visit www.startwalkingnow.org

Get moving today!

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.



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