15 April, 2024

Exercise and heart disease

Introduction:
Here is a simple advice I give to my patients:
If you don’t have any heart problems, exercise!
If you have heart problems, definitely exercise!

Benefits of physical exercise:
1. Exercise helps you maintain a healthy weight.
Exercise is not an efficient tool for losing weight, as explained here. Moderate to high-intensity exercise replaces body fat with healthy muscle. More so, exercise strengthens the muscles. As a result, weight loss is very modest, but the resultant weight is healthy with less body fat content.

2. Physical exercise induces the release of brain hormones called ‘endorphins’, which are also known as happy hormones.
Endorphins reduce pain and induce a sense of happiness and well-being.
Physically active kids are less likely to develop depression in their adulthood.
Physically active adults are less likely to develop dementia as they age.
Exercise also helps maintain good digestion, improve sleep quality, and enhance overall well-being.

3. People who stay physically active are less likely to develop Diabetes, Hypertension, reduced blood cholesterol levels, and Heart disease.
Exercise also helps to control sugar levels, and blood pressure in patients with diabetes and hypertension.

4. Aerobic conditioning.
Exercise strengthens the skeletal and heart muscles. It dilates the blood vessels, allowing more blood to pass through the muscles. This is particularly relevant for the heart, where more blood flow reduces the chance of having a heart attack and protects the muscle from significant damage if a heart attack occurs.

5. Exercise reduces systemic inflammation, a condition implicated in many medical disorders, such as heart blockages and cancers.

6. Patients with heart disease benefit immensely from regular physical exercise.
Exercise helps their hearts adjust to the disease much better.
Exercise induces a positive conformational change in a weak heart, making it more efficient and tolerant of new problems.

7. For patients with low HDL, exercise is the only means to increase its levels.
Since HDL levels are genetically determined, medicines have little role in patients with low HDL. All the medicines used to increase HDL have failed to show consistently positive results in maintaining heart health.

Types of physical exercise you can perform:
1. Aerobic (endurance) exercise:
Exercise involving large muscles aimed at increasing the heart rate and breathing. Examples include jogging, bicycling, swimming, dancing, and sports like badminton, basketball, etc. This form of exercise is best for heart and lung health and overall well-being.

2. Muscle-strengthening exercises:
These are your usual resistance exercises, typically performed against your body weight or an external weight. As the name implies, these exercises help promote muscle build-up.

3. Bone-strengthening exercises:
These are specific sets of exercises that push the muscles against the bones. Running, jumping ropes, and a few weight-lifting exercises are examples. Such exercises are particularly important for seniors to help them strengthen their bones.

4. Balance and Flexibility training
Exercises dedicated to the above purposes

Levels of exercise:
Exercise intensity is divided into light, moderate, or high based on the heart rate achieved. Based on an individual’s age and resting heart rate, his/her target heart rate (THR) and heart rate reserve (HRR) can be calculated.
Light-intensity exercise: Maintain a heart rate below 50% of HRR.
Moderate-intensity exercise: Maintain a heart rate between 50 to 70% of HRR.
High-intensity exercise: Maintain a heart rate between 70 to 85% of HRR.

See the chart below.

Exercise duration:
A general recommendation is to engage in:
150 minutes of moderate-intensity exercise per week. This amounts to 30 minutes per day, 5 days a week. A weekly regimen of 75 minutes of high-intensity exercise can also be undertaken. Usually, a combination of the two works the best. An alternate-day regimen of moderate and high-intensity exercise will make you less tired. It is recommended to start slow and gradually increase the intensity and duration over time.
The exercise duration can be doubled for individuals who intend to manage their risk factors, such as obesity, diabetes, and hypertension.

Know when you are overdoing it:
1. If your muscles stay sore even after a few days of exercise regimen, you are either going too fast or too rigorous.
2. Stay within your target heart rate. Not exceeding moderate exercise intensity is recommended for patients with heart disease.

FAQ regarding exercise:
Can exercise help me get rid of the blockages of the heart arteries?
High-intensity exercise, particularly high-impact interval training (HIIT), is associated with a 3 to 5% reduction in blockages. This reduction is likely insignificant to have any major positive outcome. However, exercise stabilizes the blockages, making them less likely to cause heart attacks. More so, by increasing the blood flow into the heart muscles, exercise limits the overall damage caused in case a heart attack occurs in the future. Please note that while HIIT may lead to a minor reduction in overall blockages, HIIT is associated with an increased risk of having heart attacks.

I have a weak heart. Can I do exercise?
Absolutely, yes. Patients with a weak heart benefit immensely from physical exercise. The general recommendation is to participate in aerobic exercise and not exceed moderate intensity. Please discuss this with your cardiologist since patient-specific recommendations vary depending on the individual clinical scenario.

Can a patient exercise after a heart attack?
Yes. Please discuss this with your treating cardiologist since individual patient scenarios are different. Usually, after a brief period of recovery, most patients with uncomplicated heart attacks are recommended to start some form of supervised physical exercise. A formal cardiac rehabilitation program is the best option.

Can exercise ever be bad for the heart?
Yes. There are two common scenarios:
1. An otherwise healthy individual engaging in a very high-intensity exercise regimen without a thorough medical check-up. Research studies have shown that a highly strenuous exercise regimen puts undue stress on the heart and can trigger a heart attack or rhythm disturbances. A long-term moderate-intensity exercise regimen is best suited for maintaining cardiopulmonary health. High-intensity training for athletics can be undertaken but under professional supervision. A simple way to put it is, for exercise and heart health, more is not better.
2. Patients with established heart disease taking up high-intensity exercise without proper medical supervision. Heart patients should start slow, build up gradually, and limit physical activity to max 70% of HRR.

I am sure I didn’t answer all your questions on this topic. Feel free to message me with your queries; I will happily answer them.

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