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.

 

 

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Cold Weather Posture Causing Angina Like Symptoms?

Cold weather changes our posture causing aches and pains, but how can you tell if it is angina?

Having poor posture when it is cold can contribute to aches and pains in the same areas that people complain of angina discomfort. When the cold weather hits many cardiac rehabilitation patients begin having complaints of discomfort that is felt between the shoulder blades, neck pains and chest discomfort. It is tough to tell the difference for many between angina and muscular skeletal pain.

Let talk about posture

What is your posture when you are cold? Do you pull your shoulders up to your ears, roll your shoulders and neck forward to hide in the warmth of our clothes or chair? Do you cross your arms shortening the chest muscles and hold them in these positions for prolonged periods of time? All of these can cause the muscles to spasm and give sensations of pain. Remember most of the time angina pains follow the same pattern, but as with anything human it can change. So your angina should usually present the same way, if it is in the chest or arms, then expect angina to primarily present this way.

               

This posture held for any prolonged pain will cause upper back discomfort, neck pain, possibly chest and arm discomfort.

So is it angina?

Well lets review  first what angina is.

Angina may feel like pressure, squeezing, or heaviness in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.

Stable Angina

Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (“Pattern” refers to how often the angina occurs, how severe it is, and what factors trigger it.) Stable angina usually presents itself with exercise, after eating large meals, emotional stress, and a cold environment such as exertion in the cold air.

If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.

Stable angina isn’t a heart attack, but it suggests that a heart attack is more likely to happen in the future.

Unstable Angina

Unstable angina doesn’t follow a pattern. It is a change from your usual angina pattern, it  is when angina occurs more often and may be more severe than stable angina. Angina occurring while resting is considered unstable angina, or when it occurs with lighter amounts of workload or effort than usual.  If it takes more nitroglycerin than usual to relieve the discomfort, or nitro doesn’t relieve it at all than that too is considered unstable angina. Rest may not relieve the pain.

Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon.

Skeletal Muscular Symptoms

Can be reproduced by touching the area with symptoms and creating pain. You can’t touch your heart, but you can touch your chest, arms, back and jaw. If you touch it and it hurts that is a sign of muscular skeletal symptoms. Can you move a certain way and cause the discomfort to either show up or go away? This too is less likely to be related to the heart.

Does stretching or improving your posture help the symptoms? Consider adding a small pillow to the low back area of your favorite chair, desk and car  this forces your upper body to maintain better posture. Widening and opening up the chest. If you note you have had very poor posture try the chest stretches below.

Be fluid in your upper body movement

Allow your arms to swing when walking, wiggle those shoulders and neck. Dress warm enough that you can maintain good posture. Wiggle your hips, consciously think about your body. Is it stiff and tight? If so loosen up, relax, stretch, workout.

Be Safe

If you cannot tell the difference and suspect you are having angina, follow your care plan established by your health care practitioner, and if necessary seek medical attention. If the symptoms include shortness of breath, nausea, profuse sweating, lightheaded, dizzy contact your healthcare provider ASAP or call 911. 

Winter effects on your heart

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
  • 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.
  • 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.

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 reproduced with touch or movement, where as heart pain cannot be set of 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 spasmThis 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/