Our topic today is physical activity in coronary heart disease.
Exercising is a more structured form of physical activity, which is widely accepted but can be easily misinterpreted by the uninformed. Talks about ‘getting that heart rate up,’ ‘great adrenaline rush’ and ‘it’s good workout’ are now all around us but often without attaching words like amount or intensity.
There is actually a fine line between moderation and overdoing which must be drawn by proper advice and taken with a touch of common sense.
For the coronary patient, the basic principle is Listening to Your Body’s Warning Signals. These signals can be brought on by exercising and are as follows.
- increasing chest discomfort
- increasing difficulty with breathing
- sensation of heart fluttering
- feeling faint or dizzy
The diseased heart is like an irreplaceable but reparable tool which needs good care to continue to function. In other words, to keep us going.
The purpose of speed limits on the highways is to reduce accidents.
Question: Is there a purpose in doing things at a pace that would bring the above mentioned warning signals on or make them worse?
The answer is no.
Question: What is the purpose of adopting a pace which is tolerated without getting these warning signals?
The answer is as follows.
- to train your heart and muscles to economize on energy expenditure
- to prevent or reverse weight excess
- to feel more fit
Exercising is not a ‘one fits all’ type recipe in coronary heart disease because the disease has various stages.
The stages are as follows:
a) kept under control by drug therapy.
b) the ‘coronary clock’ wound backward by opening a tightly narrow artery.
c) establishing ‘surgical detours’ to maintain coronary blood flow.
d) all done and limited options remaining.
The only logical common rule which can apply to all of these circumstances is moderation. This means avoiding the appearance of the warning signals mentioned above while engaging in physical activity and keeping active.
It’s helpful for a cardiac patient to have an idea about his average pulse/heart rate before starting and during the peak of exercise. One can count it by simple watches/belts, etc. designed for this purpose.
Once the pulse rate during warning signs is roughly known , one may ‘cruise’ below that range for longer and more safely.
The risk of overdoing and the benefits of keeping active in coronary heart disease is a matter of balance like most things in life and needs professional guidance in some cases. However, simple principles remain valid for the most part including knowing the warning signs and respecting them when they occur. This means stopping or slowing down, depending on the nature and severity, and allowing them to subside. Then, continuing at a lower pace without trying to reach to that point again. Obviously, the rule of ‘one nail drives out another’ doesn’t apply here.
Our next talk will be introducing our vision on cardiac maintenance and the special role of patient and family engagement.
Here are two questions:
What questions make your head turn to your other half during a medical interview?
Load, speed, flow and fuel. What do they correspond to in the body?
Dr. Masis Perk studied medicine at the University of Istanbul, University of Alberta and Dalhousie University. He has been active in community-based and patient education since joining the hospital in Truro as a cardiology consultant in 1998. His column appears regularly in the Truro Daily News.