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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Depression and Heart Conditions

Depression is common in heart patients. Most studies show 2 out of 3 patients will experience depression. Does depression cause heart disease or does heart disease cause depression? Probably both. We all have ups and downs, however when one finds them overwhelming and debilitating it is time to get help. According to the National Institute for Mental Health the following are the symptoms of depression:

Signs and symptoms include:

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

One of the best things a person who is suffering from depression can do is to get daily exercise. Yet it is one of the hardest things to do when depressed. I would encourage patients to at a minimum schedule themselves 10 minutes per day of exercise. I know it is a very short duration, but it is a starting point. We build from there.  If you are a significant other of someone you suspect is depressed, don’t nag them to exercise, rather help them to engage in it. Offer to go for a walk, or go to the gym together.

For many suffering from depression winter can be especially difficult. The holidays may trigger episodes, a change in healthy eating habits to the holiday party foods, a change in exercise habits due to weather changes, getting out and socializing less due to weather, loss of loved ones,  and seasonal effective disorder can all be a catalyst for symptoms to worsen. If you note this contact your healthcare practitioner, consider counseling, increasing exercise, getting sunlight every day, and/or medications. It is important because if depression isn’t treated often heart disease worsens.

Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy

 

http://www.nimh.nih.gov/health/publications/depression/what-is-depression.shtml

 

 

Heart disease patients who have anxiety have twice the risk of dying from any cause compared to those without anxiety, according to new research in the Journal of the American Heart Association.

Patients with both anxiety and depression have triple the risk of dying, researchers said.

Many studies have linked depression to an increased risk of death in heart disease patients. However, anxiety hasn’t received as much attention. Studies show that depression is about three times more common in heart attack patients. The American Heart Association recommends that heart patients be screened for depression and treated if necessary.

Depressed heart disease patients often also have anxiety, suggesting it may underlie the risk previously attributed solely to depression. It’s now time for anxiety to be considered as important as depression, and for it to be examined carefully.”

In the study, 934 heart disease patients, average age 62, completed a questionnaire measuring their level of anxiety and depression immediately before or after a cardiac catheterization procedure at Duke University Medical Center. Patients had anxiety if they scored 8 or higher on a scale composed of seven common characteristics of anxiety, with each item rated from 0 to 3 (range of possible scores: 0-21). Depression was measured using a similar scale composed of seven symptoms of depression.

Researchers, after accounting for age, congestive heart failure, kidney disease and other factors that affect death risk, found that 90 of the 934 patients experienced anxiety only, 65 experienced depression only and 99 suffered anxiety and depression. Among 133 patients who died during three years of follow-up, 55 had anxiety, depression or both. The majority of deaths (93 of 133) were heart-related.

Researchers measured anxiety and depression during cardiac catheterization because levels better reflected how patients normally handle stressful situations. Anxiety and depression each influence risk of death in unique ways. Anxiety, for example, increases activity of the sympathetic (adrenaline-producing) nervous system that controls blood pressure.

People who worry a lot are more likely to have difficulty sleeping and to develop high blood pressure. The link between depression and mortality is more related to behavioral risk factors. Depression results in lack of adherence to medical advice and treatments, along with behaviors like smoking and being sedentary.

Future studies should test strategies to manage anxiety alone and with depression in heart disease patients.

Anxiety reducing medications combined with stress management could improve outcome for patients with just anxiety, whereas patients with anxiety and depression may need a stronger intervention involving more frequent outpatient monitoring and incentives to improve adherence.

Slowly getting there, comments from our cardiac health innovators? http://bit.ly/100zip5

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.