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Exercise and Heart Disease
Eric P. Durak, MSc

Perhaps the first area of sports medicine to show the benefits of exercise conditioning was in heart disease. From the Framingham study in the 1970's and 80's to the Harvard Alumni report, to Nathan Pritikin and his reports on low fat diets and exercise, to the more recent work of Dr. Dean Ornish, the first reports, and some of the most applicable, relate to the use of exercise in the prevention and treatment of heart disease. This was true almost fifty years ago when cardiologist Dr. Paul Dudley stated that "almost any kind of exercise plays a role in maintaining health in coronary patients".

In the past fifty years medicine has created many types of procedures for correcting malfunctioning hearts. The echocardiograph, persantine thallium (nuclear medicine scan), bypass surgery, angioplasty, etc. all have made an impact on survival percentages for heart disease patients. However, the downside to this technology is that many heart patients may have cardiac abnormalities within months of their surgeries if lifestyle changes are not adopted as part of their recovery process.

Nutrition, quitting smoking, and stress reduction all play a role in therapy. However, one of the most significant changes that can be performed through the recovery process is physical exercise. Why? Exercise reduces the tar and nicotine from the former smoker's lungs more efficiently. It speeds up the healing process from cardiac surgery. After months of chronic exercise, patients can actually change their cardiac dynamics (how the heart performs) regularly. The heart rate can decrease (meaning the heart pumps more blood efficiently), the stroke volume increases (the heart pumps more blood with each contraction), and the coronary arteries become more efficient at getting oxygen to the heart muscle itself.

Many cardiac patients have trouble with insurance reimbursement for their rehab process. Therefore, they need to understand how to perform exercise at home, and create a self-paced program that will improve their cardiovascular abilities, and their muscle strength and tone. With only 5-10 visits to the hospital these days, it is important that they take the information they have learned in rehab, and perform regular exercise at home 3-5 days per week.

A phase I home based program is to continue to walk on a regular basis. This would incorporate a 10-20 minute walk around the block, monitoring the heart rate by hand, or with a digital heart rate monitor.

Moving to phase II, the use of dumb bells and elastic tubing for strength exercises will help improve muscle tone. It is important to remember that consistency, rather than an intricate program may have the most impact. Medical recommendations state that regular aerobic conditioning, plus low level resistance exercise is best for stable post cardiac patients. Avoiding high intensity exercise and supervision are called for in the early stages.

What constitutes a good program? As mentioned, it is important to monitor your progress and exercise response during and after exercise. Blood pressure measures if recommended, heart rate monitoring, proper shoes, and good exercise equipment are all part of a heart recovery program with exercise.

Here is a sample:

PHASE I

Exercise                                   Intensity                                     Comments

Walking or group                     Light                                          Monitor Heart Rate &

Exercise class                                                                            Perceived Exertion

Strength Training                     Light                                          Work  individual major                                                                                                      muscles in weight                                                                                                      training program

Stretches stretching products                                                 Performed for 3-5 min.                                                                                                      post  exercise

PHASE II

exercise cycles     steps

Exercise                                 Intensity                                     Comments

Group Step class,                  Light to Moderate                    Monitor HR & Biking                                                                                                     perceived exertion

Strength Training                   Light                                          Work individual major muscles                                                                                                    in weight training program Stretches                                                                                  General plus specific stretches                                                                                                    for shoulders



References
Durak, EP. Getting with the Program: The New HHS Cardiac Rehab Guidelines. Physical Therapy & Occupational Therapy Today Magazine. Pg. 8-10, June 3, 1996.

Haskell, WL. Mechanisms by which physical activity may enhance the clinical status of cardiac patients. In. ML Pollock, and Schmide (ed). Heart Disease and Rehabilitation, Wiley and Sons, New York, pp 276-96, 1985.

Ornish, D, Brown, SE, Scherwitz, LW. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 336:129-33, 1992.

Roberts, SO. Exercise and coronary artery disease. In: Clinical Exercise Specialist Manual. pp. 55-71, American Council on Exercise, San Diego, CA 1999.

My name is Eric Durak, and for the past 15 years I have been training, writing, and lecturing on exercise programs for persons with special needs. I am now producing articles with bodytrends.com to help people understand how to use exercise to improve their lifestyles. The bodytrends.com newsletter enables us to inform you about information on the benefits of exercise training for persons with specific medical conditions. We have known for many years that exercise is beneficial for conditions such as diabetes and heart disease, but we are finding out that regular exercise may improve the prognosis for almost every diagnosed disease! A pretty powerful tool. With that in mind, it's our intent to make sure that you understand something about exercise as it relates to your condition - that you can talk about your exercise plans with your doctor, and that you select and USE the most appropriate exercise products to fit your needs. If you have any questions, please let us know. And by all means, . . . read on.