As an avid exerciser since I was 15 years old (before that I watched more TV and drank more pop than anyone should in their entire lifetime), being active is a key part of my life. It’s my morning coffee, gets me outside and meeting people, and it just makes me feel good. However, being diagnosed with heart disease was threatening to end that, or was it?
When I saw my cardiologist for the first time about my palpitations, he told me to stop swimming until we figure things out. He was worried I would suffer a sudden cardiac arrest in the pool and, well, that could be pretty much it. This literally put the fear of death in me. Yet all I could think about was I didn’t want to stop exercising (this coming from someone in the field of heart disease).
I was fortunate that I underwent tests for my symptoms before any damage to my heart had occurred. For many others, a heart attack is their very first symptom, and although heart disease develops over decades, it’s usually triggered by a stressful event, and most likely one of physical exertion. Therefore, one would think that avoiding exercise is a good thing, but it’s the exact opposite.
Historically, people with a heart attack were treated as frail and restricted to hospital bedrest for up to 30-days. This lack of movement resulted in patients becoming even weaker. Many patients died from blood clots, primarily pulmonary embolisms from lying motionless (blood can clot when it is not actively circulating– movement helps keep blood flowing).
It was in the 1980s that the idea of supervised exercise as a therapy for people with heart disease came about. These exercise programs evolved into what we now call cardiac rehabilitation, a comprehensive, medically-supervised risk reduction program for heart disease. However, there was much resistance from the medical field to exercising these patients and it wasn’t until numerous studies were done that things began to change. Two separate studies more than 25 years ago showed that exercise programs reduced risk of premature death (by any cause) by 20% to 25%. So today, participating in a cardiac rehabilitation program is part of standard guidelines for treating people with heart disease whether in Canada, USA or Europe.
While cardiac rehabilitation programs are medically-supervised exercise programs conducted in a hospital, clinic or community centre staffed by health care professionals, not everyone has access to these programs, and almost all of them are time limited, meaning a patient can’t stay in the program forever. That means that many of us will be exercising on our own, or at least without medical supervision. That’s totally fine, as long as you do it within your limits.
The first thing to do is get an exercise stress test, which a doctor can refer you to. This will test your fitness, determine if you have any symptoms with exercise and help give an indication of what level you should exercise at. The test is performed usually on a treadmill and at set time increments (like every three minutes) it increases in speed and grade. The test stops when the person gets too tired to continue or experiences significant symptoms.
When I did my test, the technicians running it wanted me to stop, as I had gone “far” enough. No symptoms had shown up though. I asked to continue on as I felt fine. Shortly after that I started to get my palpitations (a heart rate of 255 for 10 seconds!). While I wasn’t happy to have the palpitations, for the sake of the test, I was glad they did happen. The last thing as a patient, and for health professionals, is to have someone leave a test saying they are fine, when it is possible that they aren’t.
The exercise test will help determine one’s exercise target heart rate (the heart rate at which it is safe, and beneficial, to exercise at). If no symptoms occur, then this is a simple calculation based on a proportion of your maximum heart rate on the test. For people who experience chest pain with exercise or show symptoms on the exercise ECG, the doctor will generate a target heart rate that will ensure it does not illicit these symptoms.
So now you’re all set, right? Well, not quite. The idea of the target heart rate is to provide a range to aim for while exercising but you also need to slowly work up to that heart rate. So a good warm-up of about 10 minutes that gradually progresses you into that target range is ideal. The warm-up is important because our heart, as a muscle, needs time to adapt to the increased work and the arteries in the heart need to open up to allow more blood flow through.
Equally important, after exercising in your target heart rate range for 20 to 40 minutes, is a cool down. This cool down should be active, meaning doing the same or similar activity as your exercise. For example, if you were jogging, then cool down with a moderate walk. It’s important not to just stop. With your body all warm from the exercise and the arteries all open to help with blood flow, just stopping can cause the blood to pool in your legs and that can lead to feeling dizzy or fainting. Walking, or continuing other movement will help keep the blood flowing while your body cools down.
Given the target heart rate, you’ll need to monitor it while exercising. This can be done manually but it’s not easy checking your heart rate while doing things like running, cycling, etc. so getting a heart rate monitor is recommended. Be mindful to monitor your heart rate during all moderate or vigorous activities, not just exercise. I’ve had patients who keep within their target during exercise but have gone above it when doing things like cutting the grass.
It’s also a good idea to have an exercise stress test every year to keep a tab on how you’re progressing. Having heart disease doesn’t mean you can’t be opposite, in fact, it means being active is even more important.
In the next blog I will discuss the dangers of shoveling snow.
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