Transcript Becky - the Helderberg Cardiac Support Group

CLOSE TO YOUR HEART
 By
Becky Blaauw
 Biokineticist
Role
of exercise in modern
cardiology
Benefits
of Physical Activity
Maintaining
a safe level of
activity with Heart Disease
Role of exercise in modern
cardiology
 Help
you return to an active life
 ↑ quality of life
 ↑ exercise intolerance
 ↑ functional capacity
 ↑ symptoms of dyspnea and fatigue
 ↑ your energy level and lifts your spirits
 ↓ your chances of future heart problems
including heart attacks.
BENEFITS OF PHYSICAL ACTIVITY
1. Primary prevention
 Higher
activity /fitness = with lower death
rates from cardiovascular diseases
2. Secondary prevention(after
cardiac event)
Research shows mortality is reduced in post
cardiac event in patients who participate in
cardiac rehab due to multi risk factor
reduction
Uncontrollable Risk Factors
 Age
↑
 Gender: Men > women
 Heredity
 Race: RSA > Indian community then
coloured followed by white and then
Black communities.
Controllable Risk Factors
1. Smoking

Smokers ↑ 2 - 4

Good news is that in the year after you
quite smoking your risk of future problems
drops by 50%. After 15 years your risk is as
low as someone that never smoked.
2. Blood Pressure
 High
Blood Pressure: 130/85 or >.
 Immediate:
After exercise systolic may
decrease for several hours.
 Long
term: At Rest B.P may be reduced
moderately
3. Obesity
 BMI
>25
 waist circumference
•
Male > 100cm
•
Female > 90cm

•
•
Being overweight is bad for your health.
Exercise can decrease and control your
weight
Decrease total fat and intra abdominal
fat
4. Unhealthy Diet
 Diet:
unhealthy diet is going to lead to
obesity
5. Cholesterol
 TOTAL
> 5.18mmol
High Cholesterol: The higher your LDL (Bad
cholesterol) > your risk for heart disease.
The higher your HDL (good cholesterol)
the lower your risk of Coronary Heart
Disease.
 12
weeks of endurance training
increase HDL and decrease Triglyceride
levels
6. Diabetes
Diabetes > 5.5mmol/L (fasting)
 Diabetes: Having diabetes puts you in the
highest heart attack risk category. Prediabetic
Risk of developing heart disease is high.
 Physical
activity can prevent and control
Type 2 diabetes
 Improve glucose tolerance and insulin needs
7. Stress
 Exercise
will also help your manage stress
 Decrease
in anxiety and depression.
 Exercise will enhance feelings of well
being.
BENEFITS OF EXERCISE ON THE
HEART
 Heart

Rate
Resting heart rate  10 – 15 bpm
 Stroke
Volume (average volume of blood ejected per
heart beat)

Stroke Volume 
 Cardiac

Output
Cardiac Output 
OTHER BENEFITS
 Increased
exercise threshold (angina,
heart failure)
 Reduce blood platelet adhesiveness
 Health for muscles, bones and joints
 Independence for older cardiac
patients
 Reduced risk of falls
Little white pill
 There’s
no medication that can give the
same benefits without side affects
Reality
Only one third of those
who have heart attacks
enter a formal rehab
program
WHY ????
 According
 Being
to Cooper et al (1999)
older, less aware of cholesterol
values, less likely to be employed and
not believing their condition is
controllable
 Patients have not been advised by their
doctor
SIX MYTHS ABOUT
CARDIAC
REHABILITATION
Myth 1
I’m not in good enough shape
Myth 2
Exercise is dangerous
The risk of Sudden Death during exercise is
very small the most problems associated to
any exercise program is musculoskeletal
injury.
 It
is important to remember that the cause
of death in these cases is Cardiovascular
Disease NOT EXERCISE.
Myth 3
Rehab is only for cardiac survivors
Prevention is better than cure
MYTH 4
Cardiac rehabilitation is just exercise
 It
is a professionally supervised program to
help people recover from Heart attacks,
Heart surgery and help patients reduce
risk factors.
Myth 5
Cardiac rehab is a “guy thing” usually
for the young
Myth 6
“After 12 weeks I am done”
1.Who needs a Cardiac
Rehab Program
 Anyone
of all ages who have Heart
conditions and high risk factors
 Did you know if you already some form of
heart or blood vessel disease or diabetes,
you have a > 20% chance of having a
heart attack or dying from heart disease
within the next 10 years.
2.How long do people attend
Cardiac Rehab program
 For
the rest of your life
 You may need 6 weeks, 6 months or
longer to manage your condition with
your biokineticist
3. What should you consider
when picking a program






Biokineticist - the Health Professional Council
of South Africa
Time: is the program offered at a time you
can be there
Place: is the program easy to get to
Services: does the program offer the services
you need
Setting: is it a group or individual program
Cost: can you afford it. Is it covered by your
medical aid
4. How can you find out
about programmes in your
community
 Your
doctor and Helderberg Cardiac
Support group
 www.biokinetics.org
Helderberg Cardiac Support
Group
 Cardiac
support system
 Formal rehabilitation
 Guidance on medication, exercise, diet,
stress control.
 First
of it’s kind in South Africa
Maintaining a safe level of
activity with Heart Disease
 Most
patients are capable of beginning a
supervised exercise program 1 to 2 weeks
of leaving hospital
 It’s best to be under supervision for first 6 12 weeks
 You are capable of doing your own home
program quite successful if you have the
basics right
Essential components of a exercise
prescription are: F I T T
FREQUENCY: According to ACSM 4 – 7 days per week
INTENSITY:

RPE scale: 11 – 13 (40 – 60 %) and 11 – 16 (50 – 75%)
THR = (220-Age) – RHR x (intensity) + RHR
Nb:
Beta blockers subtract 10bmin

Initial cardiac rehab should be 40 – 60% of M.H.R

The American Heart association recommends a Target
Heart Rate of 50 – 75% of Maximal Heart Rate .
TIME: American Heart Association 20 – 60min depending
on your intensity.

i.e.: the higher your intensity the lower your duration
TYPE: 3 components of
exercise for Cardiac Patient
 1.
Warm-Up and stretching
 2.
Workout
 Cardiovascular
exercise
 Resistance/strength exercise
 3.
Cool down and flexibility
1. Warm up (5 – 10min)
How…
 - Slow walking or biking with no/light
resistance
Why…
 Gradually improves blood flow to heart
and exercising muscles
 Increase body temperature
 Helps prevent injuries, muscle soreness
2. Muscular Strength and
endurance (20min)
How…..
Use interval training (fartlec)
 Endurance:
Rowing, step ups, more
cycling, walking, swimming
 Muscle strength: Light weights,
resistance bands
Why…..

Cardio – respiratory endurance: this is the main
focus of physical fitness as this causes the most
physiological changes known to reduce
symptoms and risk factors.

Light resistance training can make our activities
of daily living easier and has been shown to
modify coronary risk factors.
Flexibility and Balance
How……
 Light stretches
Why…..
 Improves range of motion
 Improves co-ordination
 Reduces risk of injury
 Decreases muscle soreness
3. Cool Down (5 – 10min)
How…
 - Easy walking or biking with no resistance,
Why…
 To prevent blood pooling
 Prevents muscle stiffness and soreness
 Return the heart, lungs, and muscle
activity to resting levels
 Cool down will minimize the potential for
Arrhythmic episodes
Special Cardiac Patients
Patients with sternotomy
(bypass patient)
:
resistance exercises at 6 weeks and light
weights (0.5 - 1kg female and 1.5 - 2 kg
males) with limited R.O.M exercises
Pace maker and defibrillator
implantation patients:
 Know
what your upper HR limit is (10%
below the ischemic threshold). Exercise at
10 beats below programmed HR
threshold.
 Initially avoid exercises above shoulder
level.
 Rather use RPE scale for intensity
Cardiac Transplant patient:
 for
several months heart does not respond
normally to sympathetic nervous system
therefore resting heart rate is elevated
and HR response is abnormal.
 Rather use RPE scale.
 Use an extended warm up and cool
down.
Chronic Heart Failure
 Exercise
at a lower intensity
 Use a prolonged warm-up and cool –
down
 Avoid isometric exercises
 Rather use a RPE scale for intensity
 Rather use interval training
Hypertensive Patients:



Do not exercise if BP IS > 200/110mmHg
rather use a bicycle ergometer than arm
ergometer. Smaller muscle mass causes
increases SBP
Normal Response To Systolic Blood Pressure:
Systolic Blood Pressure should go up and
Diastolic Blood Pressure remain the same or
go slightly down. SBP that fails to rise or fall
with exercise could be due to severe
coronary artery disease or Left Ventricle
dysfunction
Artrial Fibrillation Patients
 Should
only do moderate intensity
exercise to ensure left ventricular filling
time
Diabetes patients
 Do
not exercise if blood glucose are
>13mmol/l
 Do
not inject insulin into area into active
muscle (rather abd than thigh)
Final Points To Remember







Ideal temp 18 – 22 degrees and humidity of
65 degrees. Anything hotter you should
decrease your intensity
Water
Move feet
Do not hold your breath.
Use rest stations
Avoid isometric exercises.
Listen to your body. Pain is natures way of
saying something is wrong.
Conclusion
 It’s
NEVER too late to start exercising
 (it’s never too early, either)
 Small changes make BIG differences
 There are 1440 minutes in every
day…Schedule 30 of them for
Exercise and
Get Close To Your Heart!!
THE END
 TEL:
021 8527148
 www.blaauwandpartners.co.za