Physical Activity and Cardiovascular Disease

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Definition (cited from WHO)

Cardiovascular diseases are a group of disorders of the heart and blood vessels and include:

• coronary heart disease: disease of the blood vessels supplying the heart muscle;

• cerebrovascular disease: disease of the blood vessels supplying the brain;

• peripheral arterial disease: disease of blood vessels supplying the arms and legs;

• rheumatic heart disease: damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;

• congenital heart disease: malformations of heart structure existing at birth;

• deep vein thrombosis and pulmonary embolism: blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason is a build-up of fatty deposits on the inner walls of the blood vessels. Strokes can be caused by bleeding from a blood vessel in the brain or by blood clots.

Physical Activity Effects on Cardiovascular Diseases

The benefits of exercise with 1000kcal per week in secondary prevention decreases the all cause mortality around 20-30%  Physical activity improves systolic blood pressure, angina symptoms and exercise tolerance in patients without revascularization . For patients with revascularization physical activity improves quality of lives and exercise tolerance, as well as 29% of cardiac events and around 20% lower re-admission rates.
https://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_488240.pdf

Symptoms of Cardiovascular Events (cited from)

Chest discomfort (pressure, squeezing, fullness, pain) Discomfort in one or both arms, back, jaw or stomach Shortness of breath Cold sweat, nausea, lightheadness

Womens Signs:

Women are more likely to experience unusual fatigue, sleep disturbances, weakness, shortness of breath, nausea/vomiting and back or jaw pain

Ressource: 

The American Heart Association designed a `Healthy Heart Quiz` are you able to recognize a Heart Attack? www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Can-You-Recognize-a-Heart-Attack_UCM_303318_Article.jsp

Prodromal Symptoms:

A 10 mmgHg decrease of systolic blood pressure was associated with a higher risk for fatal and non-fatal cardiovascular events

Increased longterm variability in systolic blood pressure was associated with a higher risk for cardiovascular events, mortality and disease

Exercise Prescription (cited from)

Patients with coronary heart disease should perform everyday physical activity as well as supervised exercise lessions. The ACSM prescription based on traditional prescriptions, but they are adapted to the special issue of affected person due to physiological differences to healthy persons.

Mode: Large muscle groups, continuous exercises (e.g. walking, swimming, group aerobics) fosters cardiovascular endurance. Upper extremities exercises like arm ergometers may useful for people with musculoskeletal problems in their lower extremities. Resistance Exercises should be provided in a circuit training approach. 10-12 exercises using 10-12 repetitions of resistances that can be performed comfortably. Cross-training is possible, too.

Frequency: Three nonconsecutive days per week, as a minimum. With increased frequency of exercise, the risk of musculoskeletal injuries increases.

Duration: 10 min. warm-up and cool-down phases, including stretching and flexibility exercises. 20-40 min. cardiovascular exercise continuously or interval training. Interval training may be useful for persons with peripheral vascular disease and intermittent claudication.

Intensity: Exercise in supervised programs in moderate intensity 40-85% VO2 max. or 40-85% maximal heart rate reserve (max. heart rate- resting heart rate) X 40-85% + resting heart rate. Or 55-90% of maximal heart rate. Ratings of perceived exertion (RPE) is appropriate to monitor exercise intensity. The intensity should be moderate.

Progression: Initial slow, progression through longer exercise duration and intensity.

Monitoring: Patient observation and measuring heart rate and rhythm. Blood pressure measuring when clinically indicated, that depends on the patients risks for exercise complications. Patients who exercise without supervision should perform lower exercise intensities.

Contraindications for Exercises

The exercise intensity should be below a level that provokes myocardial ischemia, significant arrhythmias or symptoms of exercise intolerance. Higher risk patients should exercise in lower levels. Absolute Contraindications of Exercise (cited from Motivate 2 Move)

• Uncontrolled or poorly controlled asthma.

• Cancer or blood disorders: when treatment or disease cause leucocytes below 0.5 x10/L, haemoglobin below 60g/L or platelets below 20 x 10/L

• COPD: Patients are required to be stable before training and oxygen saturation levels should be above 88-90%.

• Diabetes: If blood glucose is >13 mmol or <5.5 mmol/l then it should be corrected first. Patients with diabetic peripheral or autonomic neuropathy or foot ulcers should avoid weight bearing exercise. Any diabetic with acute illness or infection.

• Heart disease: acute myocardial infarction or unstable angina until stable for at least 5 days, dyspnoea at rest, pericarditis, myocarditis, endocarditis, symptomatic aortic stenosis, cardiomyopathy, unstable or acute heart failure, uncontrolled tachycardia.

• Hypertension: resting blood pressures of a systolic >180 or diastolic >100 or higher should receive medication before regular physical activity with particular restrictions on heavy weights strength conditioning, which can create particularly high pressures.

• Osteoporosis: avoid activities with a high risk of falling • Fever: should be settled to avoid a risk of developing myocarditis

• Unexplained dizzy spells

• Acute pulmonary embolus or pulmonary infarction. Excessive or unexplained breathlessness on exertion

• Any acute severe illness

Risk of Exercises

Risk of Exercise for patients with coronary heart disease: acute myocardial infarcation, cardiac arrest and sudden death.

Incidence in supervised cardiac rehabilitation programs are: 1 myocardial infarcation per 294,000 patient hours, 1 cardiac arrest per 112, 000 patient hours, 1 death per 784,000 patient hours. Over 80% of persons who reported cardiac arrest symptoms while exercising have been successfully resuscitated with prompt defibrillation .

Exercises and Medications

Exercise response to cardiac medications (Heart online) - Slide http://www.heartonline.org.au/media/DRL/Exercise_response_to_cardiac_medications.pdf How do beta blocker affect exercise? (American Heart Association) – Homepage http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/How-do-beta-blocker-drugs-affect-exercise_UCM_450771_Article.jsp

Resources

CVD News and Research Updates (The Heart and Stroke Foundation South Africa)

http://www.heartfoundation.co.za/sites/default/files/articles/CVD%20news%20and%20research%20updates%20-%2002.06.16.pdf

Exercise Testing

https://www.youtube.com/watch?v=A2z0l9B6aGE Measuring Physical activity Intensity https://www.cdc.gov/physicalactivity/basics/measuring/ http://www.who.int/dietphysicalactivity/physical_activity_intensity/en/

References

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