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Can people with heart disease exercise safely?

People with long-standing coronary artery disease who wish to take up exercise for the first time should see their doctor first.

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The first recommendations on sports and physical activity in all types of heart disease are launched by the European Society of Cardiology (ESC). The document is published online in European Heart Journal.

“With rising levels of obesity and sedentary lifestyles, promoting physical activity is more crucial now than ever before,” said Professor Antonio Pelliccia, Chairperson of the guidelines Task Force and chief of cardiology, Institute of Sports Medicine and Science, Rome, Italy. “Regular exercise not only prevents heart disease, but also reduces premature death in people with established heart disease.”

“The chance of exercise triggering a cardiac arrest or heart attack is extremely low,” said Professor Sanjay Sharma, Chairperson of the guidelines Task Force and professor of sports cardiology and inherited cardiac diseases, St. George’s, University of London, UK. “People who are completely inactive and those with advanced heart disease should consult their doctor before taking up sports.”

The document covers leisure exercise and competitive sports for people with heart disease and conditions which raise the risk of heart disease such as obesity and diabetes. Advice is also given on exercise during pregnancy, or in special settings such as at high altitude, in deep sea, in polluted areas, and at extreme temperatures. The document states that traffic fumes are unlikely to lessen the benefits of physical activity to heart health.

In common with healthy adults of all ages, people with heart disease should exercise on most days, totalling at least 150 minutes per week of moderate intensity exercise. Moderate intensity means increasing your heart rate and breathing rate but still being able to hold a conversation.

For people who are obese or have high blood pressure or diabetes, the guidelines recommend strength-building exercise (for example, lifting light weights) at least three times a week plus moderate or vigorous aerobic exercise, such as cycling, running, or swimming.

Coronary artery disease is the most common type of heart disease and is caused by build-up of fatty deposits on the inner walls of the arteries. If the arteries become completely blocked this can cause a heart attack. Most people with coronary artery disease can play competitive or amateur sports.

“People with long-standing coronary artery disease who wish to take up exercise for the first time should see their doctor first,” said Professor Pelliccia. “The aim is to tailor the intensity of activity according to the individual risk of causing an acute event such as a heart attack.”

Regular, moderate physical activity is recommended to prevent the most common heart rhythm disorder – called atrial fibrillation. People with atrial fibrillation who are taking anticoagulants to prevent stroke should avoid contact sports due to the risks of bleeding.

People with pacemakers should not be discouraged from playing sports (except collision sports) because of the device. However, they need to tailor their choice according to the underlying disease.

Professor Pelliccia noted that anyone experiencing chest pain for more than 15 minutes should call an ambulance. He added: “If you find that exercise brings on palpitations or unusual shortness of breath or chest discomfort, scale back your activity and make an appointment to see your health professional.”

Professor Sharma said: “Physical activity is good for everyone with heart disease and even small amounts are beneficial. We hope these guidelines will help patients and their health professionals choose the best and most enjoyable activities for them.”

Fitness

Study finds moderate-vigorous physical activity is the most efficient at improving fitness

Dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

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In the largest study performed to date to understand the relationship between habitual physical activity and physical fitness, researchers from Boston University School of Medicine (BUSM) have found that higher amount of time spent performing exercise (moderate-vigorous physical activity) and low-moderate level activity (steps) and less time spent sedentary, translated to greater physical fitness.

“By establishing the relationship between different forms of habitual physical activity and detailed fitness measures, we hope that our study will provide important information that can ultimately be used to improve physical fitness and overall health across the life course,” explained corresponding author Matthew Nayor, MD, MPH, assistant professor of medicine at BUSM.

He and his team studied approximately 2,000 participants from the community-based Framingham Heart Study who underwent comprehensive cardiopulmonary exercise tests (CPET) for the “gold standard” measurement of physical fitness. Physical fitness measurements were associated with physical activity data obtained through accelerometers (device that measures frequency and intensity of human movement) that were worn for one week around the time of CPET and approximately eight years earlier.

They found dedicated exercise (moderate-vigorous physical activity) was the most efficient at improving fitness. Specifically, exercise was three times more efficient than walking alone and more than 14 times more efficient than reducing the time spent sedentary. Additionally, they found that the greater time spent exercising and higher steps/day could partially offset the negative effects of being sedentary in terms of physical fitness.

According to the researchers, while the study was focused on the relationship of physical activity and fitness specifically (rather than any health-related outcomes), fitness has a powerful influence on health and is associated with lower risk of cardiovascular disease, diabetes, cancer and premature death. “Therefore, improved understanding of methods to improve fitness would be expected to have broad implications for improved health,” said Nayor, a cardiologist at Boston Medical Center.

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Fitness

Tips to avoid common running injuries

Injuries are very common among runners. Recent research estimates that 82% of runners will become injured during their running career and up to 90% will experience injury while training for a marathon. Some of the most common include a stress fracture, plantar fasciitis, hamstring tendinitis, ankle sprain, runners’ knee, and Achilles’ tendonitis.

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Whether training for a marathon or preparing for your first community race, being knocked off course with pain can be hard to handle mentally and physically.

Injuries are very common among runners. Recent research estimates that 82% of runners will become injured during their running career and up to 90% will experience injury while training for a marathon. Some of the most common include a stress fracture, plantar fasciitis, hamstring tendinitis, ankle sprain, runners’ knee, and Achilles’ tendonitis.

Injury prevention is critical. Here are some safety tips from Dr. Joshua Blomgren, a 15-time Chicago Marathon team physician and sports medicine physician, Midwest Orthopaedics at Rush:

Don’t over-train

Don’t increase weekly mileage or intensity by more than 10 percent each week. Build up slowly and let a good training schedule determine how much you run.

Invest in good shoes

Go to a specialty running shop to be properly fitted for running shoes and/or orthotics. Replace them every 350-500 miles. Incorrect shoes can affect your gait, leading to injuries in your feet, legs, knees, or hips.

Choose the best running surface

Look for running surfaces that absorb shock. Opt for asphalt over concrete. Find grass or dirt trails, especially for higher mileage. Avoid uneven surfaces and seek paths with slow curves.

Stretch!

Training causes tight muscles, leading to strain and changes in your gait. Commit to a stretching program. Just 5 -10 minutes after each workout can make a big difference.

Strengthen muscles

Runners have tight hip flexors because their quads are overtrained. Strengthen your hamstrings and glutes to reduce chance of injury and abductors, adductors, and core to create stability.

Watch out for heel striking

Heel striking occurs when your feet land in front of you and your heel hits the ground first. This is common among new runners but can lead to injuries such as shin splints, stress fractures, and joint pain. Land mid-sole with your foot directly underneath your body.

Prioritize posture

Good form means staying upright and keeping your shoulders back and relaxed. Work core exercises into your training and do posture checks every so often. Hold your head right above your shoulders and hips.

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Fitness

Postmenopausal women can dance their way to better health

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures.

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Women often struggle with managing their weight and other health risk factors, such as high cholesterol, once they transition through menopause. A new study suggests that dancing may effectively lower cholesterol levels, improve fitness and body composition and in the process, improve self-esteem. Study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

After menopause, women are more likely to experience weight gain, overall/central body adiposity increases, and metabolic disturbances, such as increases in triglycerides and bad cholesterol. Together, these changes ultimately increase cardiovascular risk. Around this same time, women often are less physically active, which translates into reductions in lean mass and an increased risk of falls and fractures. As a result of all these changes, postmenopausal women often suffer from decreased self-image and self-esteem, which are directly related to overall mental health.

Physical activity has been shown to minimize some of the many health problems associated with menopause. The effect of dancing, specifically, has already been investigated with regard to how it improves body composition and functional fitness. Few studies, however, have investigated the effects of dance on body image, self-esteem, and physical fitness together in postmenopausal women.

This new study was designed to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. Although the sample size was small, the study suggested some credible benefits of a three-times-weekly dance regimen in improving not only the lipid profile and functional fitness of postmenopausal women but also self-image and self-esteem.

Dance therapy is seen as an attractive option because it is a pleasant activity with low associated costs and low risk of injury for its practitioners. Additional confirmed benefits of regular dancing include improvement in balance, postural control, gait, strength, and overall physical performance. All of these benefits may contribute to a woman’s ability to maintain an independent, high-quality lifestyle throughout her lifespan.

Study results are published in the article “Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women.”

“This study highlights the feasibility of a simple intervention, such as a dance class three times weekly, for improving not only fitness and metabolic profile but also self-image and self-esteem in postmenopausal women. In addition to these benefits, women also probably enjoyed a sense of camaraderie from the shared experience of learning something new,” says Dr. Stephanie Faubion, NAMS medical director.

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