Preventive Exercise and Physical Activity to Reduce Heart Disease



good afternoon and welcome to today's webinar today is part four of the series that we are producing called reducing your risk of heart disease today's topic is preventative exercise and physical activity the webinar series is sponsored by mended hearts and the American Society for preventive cardiology with an educational grant from Amgen today we are have presentations from dr. Lopez who is the chief medical officer of real-life health a personalized cardiovascular metabolic prevention program CEO of lopez international Medicine Associates a private practice in Jacksonville Florida for over 20 years that focuses on the treatment of lipids cardiovascular disease and diabetes dr. Lopez is also falcone at Lake Erie College of Osteopathic Medicine at the Bradington Florida campus we also have Tiffany hacker Stewart who is a registered nurse Tiffany is was born with the cohort ation of the aorta and a bicuspid aortic valve she became active in advocating for patients after becoming a nurse in 2006 Tiffany works as a nurse case manager at the Phoenix Children's Hospital in Phoenix Arizona and is passionate about her ability to advocate for her patients my name is Andrea Baer I am the director of patient advocacy and program management for mended hearts and Minden little hearts and I am also a mom to a ten year old son with congenital heart disease I will be the moderator for today just to let you all know everyone is in listen-only mode except for the presenters so if you have a question please feel free to enter it into the chat box that is on the right hand side of your screen or raise your hand at the end of both presentations we will do a question and answer time and we would love to be able to share the questions that you have about that to get started mended hearts is the largest peer-to-peer support network in the world the mended hearts mission is to inspire hope and improve the quality of life of heart patients and their families through ongoing peer-to-peer support education and advocacy we have 285 chapters across the country serving over 460 hospitals the American Society for preventive cardiology –zz mission is to promote the prevention of cardiovascular disease advocate for the preservation of cardiovascular health and disseminate high-quality evidence-based information through the education of health care clinicians and their patients with that I am going to turn it over to dr. Lopez who is going to give us some information from the medical professionals point of view dr. Lopez thank you everyone my name is al Lopez I wanted to thank SPC and mended hearts for this opportunity so could I he'll be talking about exercise as a primary and secondary prevention for cardiovascular disease next sliding the sedentary lifestyle is the major one of the major risk factors for cardiovascular disease you I think we've lost you dr. Lopez are you there yep hear me yes now we can thank you let me start pologize so we're not sedentary lifestyle is one of the major risk factors for cardiovascular disease and over 25 percent of the general population to trigger a risk for MI or heart disease is due to inactivity we also know that sedentary lifestyle is important and with risk factor for chronic disease and that's all chronic diseases and we know that cardiovascular disease is pandemic worldwide at this time the World Health Organization estimates about 75% of the premature of cardiovascular disease is preventable and it's improved as we improve the risk factors we can prevent that those diseases and those modifiable risk factors include exercise diet and the recommendation of seven to ten servings of fruits and vegetables a day high fiber low sugar low salt smoking cessation weight reduction to ideal body weight of eighteen point five to twenty four and a half BMI alcohol limitation of warning two drinks for men a day and one for women lipid or cholesterol-lowering therapy anti play that there are beer aspirin glucose control and normalization and the person that has glucose intolerance for high sugars or diabetes with hopefully a fasting below 95 and dr. de Franz would argue below 88 your pressure control and controlling inflammation systemic inflammation so regular exercise and physical activity are important in reversing and reducing symptoms events or death in a number of chronic illnesses diabetes elevated blood sugars obesity lipid or cholesterol disorders high blood pressure aging cancer osteoporosis depression all improved with regular exercise in cardiovascular disease including heart attack stroke arrhythmias or rhythm disturbances peripheral arterial disease in multiple studies in multiple discipline consistently document lower incidence of coronary events and those who are physically active and fit but we went through the last slide so the question is is this new ideas or old ideas if we go back to Joshua and sixth century BC it was an indian physician in India he was credited for writing the first prescription for exercise in fifth century BC a Greek teacher named Maradona kiss a teacher of Hippocrates described exercise for recovery of illnesses and actually Plato criticized herod atticus on how his training practices were unnecessarily prolonging his lifespan and those of others so a quick exercise glossary and mainly because as my daughter heard that she said you know can you explain some of these things beforehand so here we are difficult activities in the body movement produced by skeletal muscles and results of energy expenditure beyond resting above exercise is different in that is planned structured repetitive and purposeful and and it gives you a sense that improvement and maintenance of physical fitness is the objective physical fitness includes multiple disciplines including sorry about that respiratory fitness quantum respiratory fitness physical strength body composition and flexibility dose is the energy of expended physical activity intensity is how hard you do or the rate of energy expenditure and then absolutely intensity this is important the next two is is done and met that's usually the rate of energy expenditure during exercise and a manage is a is a calculated rate that we talk about theta as 3.5 miles of oxygen per kilogram and that energy is expended beyond that that's sitting quietly so if you spend eight minutes and exercise you're using eight times your weight and then brought is intense is the percent of aerobic powered used there's a back ok primary prevention is the prevention of disease without known disease and secondary prevention is prevention of recurrent disease if you have disease you want secondary prevention to that one disease to recur together disease CAG is coronary artery disease PVD is peripheral vascular disease vo2 max is the rate of expenditure during exercise and then relative expenditure is a percentage of aerobic power during exercise and that shows expressed as a maximal heart rate or a maximum oxygen consumption so now we've got through the doldrums let's talk about exercise so exercise has many pathological pathways that it helps us one we know that it increases pair of reflex sensitivity it know that it also increases endothelium which is an inner lining of the arteries function it actually decreases inflammation markedly during this and it does this by increase nitric ice-t– nitric oxide production it decreases insulin resistance decreases of B city decreases blood pressure increases renal adrenal function so kidneys actually optimize which also helps the blood pressure and insulin resistance it increases your blood body mass and your blood plasma volume and it decreases heart rate so you've optimized your engine it works more efficiently increase this heart mass to a certain size and then improve heart function and then it increases sympathetic tone which usually tightens the artery and increases vagal tone next slide so the main benefit exercises by increasing this nitric oxide or Eno's we increase in inflammatory the small stress in the arterial wall it also allows on the right vascular remodeling which means that the vasculature actually improves and improves its elasticity it launches the conduit of those arteries so you get not a small or part of the wall you have a more dilated Army wall that's stronger increase autonomic balance and decreases data a genetic receptivity which decreases Part B and then you increase this preconditioning which is very cool which means that even if you have heart disease if you start the very low workload you start getting what's called Fried's conditioning which allows you by doing small workload to actually benefit and valuate the arteries and you can norm or function this is done by increased nitric oxide and the risk of carnage is the increases calcium in the mitochondria kind of pretends the whole issue of exercise reduces the risk of heart disease by 42 percent of people and even with mom exercise you can get a 20% reduction just by walking with people that are very active and we'll talk about this later in the talk can have up to a forty two percent reduction in advance next by this slide is really interesting and it seems very complex but let's start with moderate and the blue dots even if you do only 20 minutes of daily physical activity 15 minutes you get a 14% reduction in death from cardiovascular disease I think it's all cause death it's not just karna masta sees that includes from diabetes that including cancer that's overall death if you do about 35 minutes you get a 20% reduction up to about 90 minutes daily you get a 35 40 % reduction in cardiovascular mortality now that changes if you move to a more intense exercise regimen and you can get a much higher benefit of about 45% reduction at about 50 minutes of exercise daily now that isn't the recommendation to example accommodations as we go forth even just walking 15 minutes a day reduce your risk of all-cause death by 15% that's impressive we don't have to run marathons next slide this is a fascinating study and I put in a couple of studies so you see that I'm just not pulling the rabbit out of my hat this was done on almost 6,000 hasting throughout agreement and until the 2000s we were mainly looking at white men we didn't really look at women we didn't look at my other populous and we didn't certainly look at people with severe disease but the average age in this population was 52 and what we found that the highest risk patients were those who are smokers and diabetics and those who had no exercise know that exercise was the strongest independent risk factor of all cause death in a study which was very impressive if you look at the top box and it's small and I apologize FRN Framingham risk score and it's a scoring that that most medical providers will use to assess your risk and I personally find that this is an undervalued risk because it doesn't take in women very well but if you look at the ten-year all-cause our ten-year coronary artery disease risk in both of these if you see that in the timing years that the high risk you have the worst outcome you have long term not a surprise but independent of that they looked at go back with slime Andrea and the analysis of time and years if you exercise just under 8 Mets you had a better survivability you actually had a prolonged wife versus those that did not exercise and for each men that you exercise you had a 12% reduction in death pretty impressive so if you exercise it close to six minutes you have almost a 70% reduction in cardiovascular disease that's impressive things confirmed the protective role of higher exercise even in the presence of his anguished coronary risk factors as in the above slide and then it talks about Mets those if you used five to eight Mets you double the rest of deaths compared to those that did over eight meds that if you only did under five minutes you're definitely high exercisers so the bottom line this slide is better tread no time greater exercise capacity less cardiovascular death less overall death less cardiovascular disease simple so blue is your endpoint right so you know a lot of knidos cut a lot of studies were done until recently and the combined on using strength training resistance training and aerobic exercises but this was done out of three different studies and resisting training along with aerobic exercise had a better end effect on on cholesterol profile spot of mine and have healthy visuals individuals that just did aerobic activity a lot more that was the act but even if you did training one to three times a week less than 15 minutes weekly independent of doing aerobic activity every single day this is combined resistance weight training with aerobic exercise you still reduce your total risk of cardiovascular disease and cardiovascular disease if you did it over four times you Rick didn't have any better benefit and the exercise and look that was not true strength training like you see in linemen and football these were people that had that did kind of ten repetitions eight to ten repetitions three sets using seven big muscle groups and this this bonham study was done at people people with known peripheral arterial disease or had diseased leg and had severe disease that they couldn't walk so they tried strength training and even they had improvement next slide this is a quick slide that shows that if it's kind of look at the green that's the benefit if you look at the very center whoa you I think we're losing you again dr. Lopez what you took to get heavier better advil kind dysregulation you know you get easier increase faster disease there's increase endothelial dysfunction or arterial wall its function diabetes but if you exercise you get you get reduction of quite a vast disease and obesity and there's an improvement of all of those and the dotted line is the reduction the inner heart study is a very highly quoted article that I use a lot and this was done in 52 countries 15,000 patient 14,000 controls for about 30,000 patients total and they looked at all cause of death cardiovascular death across the world the most common things for smoking hypertension diabetes was that excuse me waist-to-hip ratio dietary patterns how you eat physical activity how much alcohol you consume with Duncan you you we are having a lot of technical difficulties today aren't we are we back on we are back on now are you there even look at ldl-cholesterol they looked at April be lipids which is a bunch of factors of LDL VLDL Iowa glycerides and they looked at psychosocial factors depression and high anxiety increased risk death next slide and what's fascinating if you look at this and just tap it again and you look at fruits and veggies on the left is better improvements they showed better odds of not having cardiovascular disease on the right not so much odds and if you look exercise fruits and vegetables and alcohol had the most improvement cause the most problems with heart disease if you didn't exercise you didn't eat all of those fruits and vegetables and you consumed lots of alcohol next you you there we go I put it easily I put a few slides in here and these are the top in the last five six years studies that are showed how exercise improves and we found that running at slow speeds defined less than six miles in less than 50 minutes even twice a week was associated with significant benefit there was usually occurred the more exercise the better you had cardiovascular outcomes with higher intensity but if you do too much intensity exercise like back-to-back marathons those people actually didn't do as well and we see this in high elite athletes that are extreme athletes they don't live any longer than the average person they actually do worse that the person who does moderate to vigorous exercise position size twice a week and moderate exercise the other days actually live longer than those same athletes non-smoking was very important and there was a 73 percent reduction in attributable to just healthy lifestyle which is exercising eating next slide there is a suggestion in the Atkinson study in Sweden that if he did match your size you had 80 percent higher risk of having heart disease so it was very preventable in 80% of the cases and then women again in the Armstrong study this is different the doctor Galante study which I showed you earlier if they did strenuous exercise they actually did worse if they did it more than three times a week but if they did it twice a week they did very well with moderate exercise in between and then duration but not intensity and the last study showed that it should better improvement so high high high intensity every day is not the best for you next slide we talked about the use of study in inter heart and I talked about that two slides prior and then the galati study was the women's based study on exercise next next slide the only reason I show this is that even with one episode again preconditioning once you even or walk once a week you precondition your heart and those people feel better and again I showed you earlier that if you work 15 minutes every day you have a 15% 14% reduction of all cause death and cardiovascular death when you add to that and you do it several days preconditioning gets better so let me give you the human example I don't exercise for two years I get on the treadmill and I can barely do level one I can grade it up and I can't last 10 minutes I'm cleaning the floor with my tongue dragging I'm just sucking wind but if I do it for a week and I do it a couple of times my exercise my preconditioning gets much better as you improve that two weeks now you start getting functional adaptation I get better and better at it and your heart accommodates to that your body accommodates you get domination you you and you get started getting stuck behind a patient that your body actually adapts to it better and you get that dilatation of your Trudeau wall and your heart becomes stronger in itself next slide so what do we recommend so to prevent the first heart attack we recommend 30 minutes of moderate activity 5 days a week or vigorous exercise for 20 minutes three times a week the preference is a combination of moderate five days vigorous two days a week and when I made moderate the minimum is about 10 to 15 thousand steps a day and that's a good quick step it doesn't have to be a fast walking step but it is not a leisurely stuff that you're worsening the above is in combination for daily activity the things you do every day around the house cooking cleaning walking your watering plants and you can even do it as 10 minute bouts throughout the day you don't have to do all those 30 minutes at once and then twice a week we do recommend major muscle groups to be used to doing some muscular strength exercise maybe a bench press maybe arm curls maybe leg press maybe body squat next next slide it's eating over the minimum amount of that exercise discuss multiple not like the Society of Cardiology recommends about 300 minutes early we recommend here in the States or 150 minutes weekly a vigorous exercise and then versus above a hundred minutes a day of moderate activity doesn't really associate to be better but actually shows worsening of cardiovascular function and death and it may not do well long term so we start with individuals or individuals with multiple risk factors and then work your way up and it's good to go to have an exercise prescription with your doctor or exercise physiologist or nurse and then reducing excessive sitting to less than three hours it is important and excessive television watching of less than three hours a day our other recommendation for weight loss and just cardiovascular fitness if you have a sedentary job is every 3060 minutes move for three just get up and move around because there is an inverse notice ratio in other words the more you exercise the less death you have the less cardiovascular death you have the less risk of cardiovascular disease you have next slide and this is just the original slide to show us limit that inactivity to throwing two or three times a week do some stretch ups and push ups try some reach exercises do some own weight lifting I think the other five to six days so we do something moderate a brisk walk cycle Rose sweat dancing is great exercise skipping rope football badminton basketball tennis and then every day do your usual stuff go up stairs don't take the elevator walk to shopping park a little farther from the grocery store the back of the line wants a few extra steps 200 extra sets etc next line will go into secondary prevention what's the importance of exercise and people known a heart disease or cardiovascular disease and we know that it does increase life expectancy we know exercise tolerance and quality of life as people can do more they improve their cardiovascular lipid profile or cholesterol profile insulin is more active and glucose levels go down and we know there's a slow progression of coronary artery disease or peripheral arterial disease or a function of the ethereal wall which is the arterial wall and then we reduce the resting heart rate all the time is not good for you it shows an increased risk of death next let's fly so in secondary prevention I do recommend it you don't have a stress test to see what year your waited you know what you can do or an exercise kind of a next restrictions yes we're gonna coordinate rehab and they will actually monitor you while your interest to see what you're capable of doing and if you have chest pain then we would know is that really carnet just be nervous must but chest pain and then we can individualize the exercise because it's the it's it's it's different for everybody that has coronary disease or cardiovascular disease we know that in middle-aged men and women there's a 30% reduction of death with aerobic exercise but just starting it three solid months if you do three months you reduce your death rate by 30% that's incredible and then aerobic exercise and low risk individuals is very very effective and it's as effective as putting a stent in their food in your daily activity improving blood flow to the heart to the brain and to the legs and then we speak less offensive angina unless death next slide 30 60 minutes of moderate exercise as brisk walking is really important and that's even walking during breaks of gardening or housework and then trying resistance training twice a week and as I noted in that earlier study that people with known peripheral arterial disease in other words they had pain when they walked who would start doing some weights and they actually showed an improvement of blood flow and less symptoms next slide so what counts as a moderate activity we kind of mentioned this dancing swimming the recreation spark or cycling gardening hiking walking get out there and move and if you don't like the word exercise use the word movement therapy you know just change the words a little bit but what's the ideal exercise program you should warm up you should do some endurance training you should do some flexibility some strength in the resistance and then a cool-down if time constraint you have 30 minutes a day then do the resistance training only two to three days a week the rest should be aerobic exercise and consider if you're in good shape high intensity interval trainings warm-up should be five or ten minutes and then you should have a lot of fun then it cool down after you you shouldn't just stop and sit that's not good for you next flight endurance training we talked about what we could do includes dynamic exercise that lose and you should do it again thirty minutes and then if you're getting technical you want to book you about forty six percent of your maximum intensity is what we call called moderate right and then about like about eighty percent is here is the mod is the more progressive intensity and this would be turned by your age because obviously a ninety or cannot be what a twenty year olds can do at sixty I cannot do what I did it thirty and and it's physical ability even though I kind of impress people at sixty what I can do and then perceived exertion scale is very important especially people in our beta blockers the scale we use goes from ten to twenty and you should be somewhere in the middle you kind of feel like you're really pushing yourself and that's a perceived exertion scale next slide flexibility is important it improves your range of motion his blood flow decreases injuries and especially for lower back and post your thighs it really reduces back pain most of the back pain is not disc disease it's tight hamstrings tight glutes tight lower back muscles next slide and resistance training you know you're going to use a low moderate resistance low amount of weights and it and healthy adults and they should be screened for this and use a trainer if they can and you what you about 810 different exercises and using those big muscle groups and do that about twice a week you want to do about eight to twelve repetitions you don't need that three strength max and you want to in cardiac patients may be a little higher ten to fifteen repetitions and maybe those are older than 60 about ten to fifteen repetitions what's interesting is there was a new publication that came out and give me 40 heart risk for about 90 next slide last thought okay mayo clinic here in Jacksonville he says justic medication for my promises like I repeat an activity elevated cardiovascular risk on with smoking I have my authorization what obesity ipod sugars cardiovascular is preventable with exercise along with other forms of risk reduction and disability and then symptoms actually are reduced partly they would it's a bigger ax sexercise a day so where are you on the health tip thank you I appreciate the opportunity thank you so much dr. Lopez and thank you for working through the technical difficulties we seem to be having today um I would like to now turn the table over to Tiffany Hackett sure who is going to talk about the patient perspective on exercise Tiffany are you there I'm higher Kaname yes all right perfect thank you so much dr. Lopez and Andrea so I was really excited when this topic came up because I'm a patient I'm a nurse and actually before I went to nursing school I got my degree in exercise physiology that's my first bachelor's degree so I did a lot of research for this with exercise I'm I really focused on exercise psychology so I'll definitely talk about that as I go through my site so you can go ahead and go to first sight so really tagging on to everything dr. Lopez said he really highlighted some really important things and and really what I'm going to say I'm just going to maybe give a little different perspective but it exercises so beneficial with helping prevent heart disease before and after a diagnosis and it's just something that I really wish people if we just moved a little more I think just the way our lifestyles have become I've seen so many amazing things whether it's my own being a patient or taking care of patients but just some little changes in just moving your body and I think kind of like dr. Lopez says you don't have to call it exercise I'll I'll even say I'm just going to move my body more today and I think that it just sounds more fun I don't know if that's the word or less prescriptive but really physical activity really does contribute to you know earlier cardiovascular disease obesity type 2 diabetes and earlier death and increasing your physical activity can also help with anxiety and depression and I definitely did a lot of that so this slide is perfect so when I did my first undergrad study we really looked at cardiac activity and depression and then we did I did a study with resistance training and anxiety and it was amazing these are lifelong skill by a teenage kids who my one daughter is very high-strung where I worked with patients and just kind of like learning just to move your body like I said I've seen huge changes and again after a cardiac event the risk of depression anxiety goes up significantly so not only can tying in that exercise help with just the emotional part of that event but again that rehab part and getting you back on track Rick slide so kind of as we said dr. Lopez said even low levels activity can help reduce the risk of additional heart events or even prevent heart events the thing of getting some exercise is better than none at all and again if you've been inactive I don't think anyone expects you to go from the couch potato to running a marathon in three months you gotta start slow and try not to feel overwhelmed you know don't want to take on that huge chunk because then you're going to get discouraged and go back to the inactivity next slide so build it into your day and there was that great pyramid I love that example it was a very good visual you know exercise doesn't have to be complicated it doesn't have to be you have to have that you know gym membership or attend the class at the gym or work out with a trainer there are so many options now it can be your daily cleaning you can be what's best for you I like the and I've also patients about so 30 minutes a day is the recommendation but break it up into 10-minute three ten-minute chunks I have to do this a lot of the time especially on the days I'm working at the hospital and my kids so maybe I try and do 10 minutes in the morning ten minutes at some point at the hospital and then another ten minutes at night if that's just going for another walk or now you can do so many different videos you know for YouTube in online or if you're doing those house chores maybe turn on the music and dance while you're doing it or be a little more vigorous in that vacuuming or that dusting same thing stand up when you're talking on the phone my husband paces when he's on the phone which actually in preparing for this I was like that's actually a good thing it does sometimes make me a little crazy but stand up when you're on the phone or if you're on a conference call if you have a job where you can have like maybe a sit-stand desk or I've even seen like when I worked more in an office – Chuy people had the pedals under their dust so it's just getting creative or resistant fans ice always have one on the back of my work chair inside be on a conference call and I'd be doing different resistance band exercises so really it's just tying it into something it doesn't have to be this real structured thing because I think that's discouraging next slide so be consistent I think this is a hard part we get on a great routine like I've been going to the gym and I went for a run today and then I've gotten it in like three to five times in the last few weeks and then life happens you know whether it's you're traveling for work you're traveling for fun you've got that graduation that anniversary that wedding it's just being consistent and not being hard on yourself you know keep it up while you're at work kind of like dr. Lopez talked about and something I perfectly do I park further away or maybe I take the stairs if I need to go up to another floor at the hospital instead of getting on the elevator I just take the stairs up and down I work at a very large facility so I can definitely get a lot of walking in just going to different departments or if I have to go to a different meeting so a lot of people have that or you know walking to your mailbox if it's not in front of your house instead of just stopping on your way home and getting out of your car in doing that or walking the dogs or whether it's walking with children or grandchildren going to the park to play there's just so many things you can really incorporate it into your life and I think that realistic goals again if you set these giant goals or that just aren't realistic or SMART goals which are people like to use you're going to be easily defeated and give up and so I think that's always my thing is you know not every day is going to be perfect but just try and be as consistent as you can next size always consult your physician of course some physicians may recommend how much and what type of exercise is best for you cardiac rehab Cardiff rehabs I think is a fabulous program again it can be safely monitored again if you've had some kind of heart attack or recently have hurt surgery you definitely want to be in cardiac rehab plus it gives you that extra little boost of confidence that you have someone there watching you it's going to be safe and you can build your confidence to being able to go do things on your own and learn a lot of what works for you and what you enjoy is that create rehab they get creative a lot of people are exercise physiologist and they're passionate about what they do and they really learned you know it's individualized what works for me is not going to work for dr. Lopez is not going to work for Andrea again combination of strength training and cardio and then just the you know the gym and being at home you can kind of come up with your own thing it doesn't have to be expensive it can be the resistance bands it can be you know just doing some squats every commercial whatever it may be for you great thank you so much thank you so much Tiffany that was great I want to also thank everybody for being here today and now we are going to go into our question and answer period of the webinar before I start the questions I want to remind everybody that our next webinar in the series is on June 6th and it is controlling risk factors for women and it will be at 12 o'clock as well on the eastern coast we have two ways that you can interact with us and ask questions one is to place the chat write your question into the chat box which is on the right hand side and then I can read that to the panelists or we can also if you raise your hand which is there's a little hand button beside your name if you click that it will alert me that you have your hand raised and you would like to ask a question so that I can unmute you and you can ask your question we already have a bunch of questions in queue so I will just go ahead and get right to it um the first question is for the doctor says I suffer from chronic pain and my spine and shoulders as well as some balance issues which makes exercising difficult and it discourages me from trying I've been through physical therapy series twice but the pain limits what I can do any suggestions would be welcome I'm 75 years old and a son of two athletes and used to be quite active myself oh yes you know this is not uncommon and I would recommend if you have access to a pool this would be a great way to start and you don't have to do the regular stroke you can just even doggy paddle there are fins are called tyr tire fins which keep your lower body elevated so you don't think so much but you can even get into the short end of the pool and even walk through the pool and those can be done there are some physical therapy places that do you have aqua aerobics and some have limited like pools and you can walk through and which allows us to put kind of a wave through it gives you some resistance but pool would be one of the best ways for you to do the other one would be a seated bike or it kind of coming fight do you have any suggestions no I think the pool is a great suggestion I've always definitely recommended that as well just because again or if you're coming off an injury you don't have all that pressure on your joints but you can keep moving and like you said just even walking laughs in the pool I've done that and you're like oh wow this is quite a good workout and it doesn't have all that pressure on you and it actually kind of feels a little good because it does you don't have that gravity in there so it'll help your back probably a little better the other thought is immediately you know several hours later you and afterwards make sure you stretch afterwards consider a mild massage just you know Maude rubdown to get what go back into those the muscleman joints and that would help as well 3 Justin's I love the pool idea yeah so the next question is is it safe for a heart patient to train hard as in for a half marathon again I'd go back to the breast test and get an exercise prescription I have seen patients surgery or heart attack go back into full exercise but I would definitely get assessed first by a cardiologist or a good internist or an exercise physiologist or a team even better and then the increased pain incrementally from there is it possible yes but be safe when you do it attempt great thank you can you Rianne sir the question of what is a met I think that and maybe it needs to be a little more clearly identified Stephanie do you want to do that what do you want me to do I'll let you do that but I definitely felt a reminder of my undergrad studies a weight of energy expenditure during exercise and it's a basement of the calculation of 3.5 milliliters of oxygen per kilogram of body weight per minute so it's it's measured that one man is measured at rest so it's it's a calculation that that exercise physiologist would use or physicians would use in a lab setting and as they're driving the treadmill we know that if we put that up five degrees and go so far and you're you're kind of like moving faster you put your bets higher well look at look at it that way so a five to six men is kind of that moderate activity okay five to eight men you know over eight minutes is your really intense activity and that's kind of a base look at it great thank you I have heard there are heart attacks in cold web more heart attacks and cold weather is it safe to do physical stuff like snow shoveling if you're a heart patient and I think that all depends on your your exercise potential you really think of the action of shoveling it takes multiple muscle groups it takes strength and it takes a robic and can you do it yes probably better with machines but again I went to your dock about that first and and you know get yourself into cardiac we have I have had a heart patients that shovel I did my training affiliate UPenn and it's not uncommon to see that and it's more similar to decondition if not exercise tolerant but you can build yourself up to doing shoveling absolutely you just have to do it at a more moderate or slower pace excellent thank you um would you consider yoga a part of moderate exercise or activity you know if you ask me that forty years ago I would have questioned it so is it how are you ever done put me in the floor I do like yoga and have stretching it has some strength to it that it has core training it is more isometric but you can add some resistance to it as you use your body to raise yourself and it's done very controlled yes it's good exercise and I'll tack on to that too I would completely agree and there's such a variety of yoga or even Pilates as well you kinda I think if you see them you're like I are just stretching it's not that big but I can definitely do a yoga workout and be stretched and sweat and and feel like I had a better workout than had I gotten on the treadmill at the gym so I definitely think and again it's just going what's comfortable for you and what your state is doing men don't think you can't do yoga there are classes of Broga you can do it too excellent so after the after a heart attack do the capillaries around the damaged heart improve with exercise yes that we call that two things that's again that's physiologic revascularisation that's our technical term basically you get the smaller blood vessels come around and dilate again and then you push that vessel that's been damaged to kind of as you exercise you decrease the inflammation in there nitric oxide goes down it goes up and then that the muscle kind of revitalize itself yes it does great so what are some examples of good resistance exercises for people with bad joints you know you can start with simple things as a bad and make that band increases the amount of resistance you have against it the weight pushing against it but you can start with easily you know one two three four pounds I usually tell people start with five percent of their body weight or less and then work their way up but that's shown benefit you can do it in a gym in a controlled setting with weights with body you can do with cans you can do it with you know a a pint bottle and add water or sand to it and add weight to it that way but safe weight I would start with is just bodyweight and maybe a one pound Li and then move from there great did you have any suggestions Tiffany yeah no I think the band's I'm a huge fan of and they're easy to travel with or easy to you know shove in a bag keeping a car take in a suitcase and typically when you buy in Amazon's my favorite place to shop they come with multiple resistances in one package and they come like in a little nice container I also toy I reminded me of doing a project when I was getting my undergrad where we did use we have lower socioeconomic groups and we were using the cans of food for resistance training really your own bodyweight it's amazing what you can do with your own body weight as well but but yeah bands using cans of food using actual weight which you can pretty much buy anywhere or again at a gym at a facility those are kind of all really I I'm just a big fan of bands I think just because you can do so much with them in pretty much any location yeah slow and low is the way to go that's how you start well great thank you and the next question is my favorite because it directly applies to me with my struggles at home I'm thinking about prevention do you have any suggestions for getting kids to be more physically active you know the tip do you want to answer this person oh that yeah no I think that's my first so I think it's really you know you lead by example kids really do minik I have two children I have a 16 and 12 year old we spend a lot of time playing at the park when they were a little running around or even when they were little they like to do if I tried to work out at home because it was harder to go somewhere with them they like to do yoga with mom or try and do the workout video with mom doing family walks it doesn't have to be a huge thing fleming in the pool is a family depending on what your weather is and where you live or if you live in a cold climate you know I saw there's whether it's skiing or ice skating or plenty of outdoor activities I'm in Arizona we don't have very much cold activities but as a family we go hiking every Sunday morning that's one of the things we do and we get breakfast in at the bottom of the mountain and then we hike together I really think making it a family thing and leading by example it's really the best way riding bikes but I'm just trying to give all the different things we do with our family and and my kids are really active busy kids they just kind of always stayed that way yeah I agree I think if you set my example don't do it it was an interesting study done probably ten years ago and think question just survey on college students why you going to the gym yeah because you look better you look more you look tighter do you feel better and the most common answer was well my parents exercise so we did it with them and so we continue to do it afterwards and so if you said my example they'll do it great thank you yes the next question is does a stent pose any special problems for exercising no again you know there's a period of time with cardiologists would not want you to do a lot he will tell you to start moving and just walking and then you'll build your tolerance up again but that's a great conversation to have with your cardiologist at the time but no it does not there's no real restrictions eventually it's just starting slow and getting your recommendations from the cardiologist great do you recommend fitbit's or Apple watches etc Tiffany you a nice person yeah I personally I love my Apple watch I'm a very competitive person so sometimes I'm almost like peeing it you know you just have on those days where you didn't quite meet you get all your circle filled or get all your steps in so sometimes it can be negative to me but I really do like it here it gives me an idea of more so with the steps or you can you can kind of set your own goal so my move activity which is where you're more doing a cardiovascular activity is 30 minutes today or 40 minutes whatever you set it for in it I'm a very visual person so seeing those rings move or seeing how many steps I've had and then again is it like mid-afternoon I'm like oh I should probably make sure either if I'm at work that I kind of just find ways to do things at work or when I get home I definitely you know take the dog for a walk or go for a bike ride with the kids because I probably won't be able to get into the gym today so I really like it as it keeps me on track and it's just that good visual reminder and it'll you know kind of clue at you and again it has a stand-up reminder so it wants you to stand up every hour and it will remind you and tell you how many times or how much during the day you have actually been standing up which i think is a really important thing as well so for those who like that visual and reminder or those extra little cues and clues to keep moving or to stand up it's very helpful you know the other point I think you know this tiffany is you know we've seen now with these fitbit's and watches that you can actually even check your rhythm and if you your rate is excessively high and stays up it will alert you to lure your physician that something's going on and I've had that with the young woman who thirty years old and said you know I had this we fast right now sweating diffusely and she looks great and I couldn't figure it out she downloaded her watch I put her on a monitor and she had super ventricular tachycardia at a rate of 160 so she was right she caught it she caught her with her without and I have a friend who is 40 and same thing she has was getting alerts on it and more did a holter monitor and they found same thing she was having long runs of PVCs so it's getting the technology of getting impressive yeah these musicians have to learn to adapt with it and not focused on fortunate yeah that's great I love my Fitbit so I'm just exercising help remove plaque from arteries that's controversial I will call you yet and real life health we've used a mixture of supplements prescription medications exercise eating lifestyle and changing exercise intensity and we've seen reversal of plaque on carnality some of thickness exams your Dean Ornish and and called Esselstyn and at Cleveland Clinic have shown reversal of plaque with 29 but the combination does better how you eat how you move maybe something definite can reverse apply yes excellent all right the next question is if I have heart disease should my children be tested for heart problems before joining a soccer or other sports teams if they're we know that atherosclerosis starts early and it's probably happening earlier now that our kids no longer have active exercise in school but we know that when we looked at Vietnam and we did autopsies on our young men we noted atherosclerosis in their arteries at 17 years old which means it's probably developing pre-puberty or at puberty so the question is do they need to be screened probably not because they have wide open highways of vasculature but if they're more mature in their 20s or 30s should they yes and in fact today we're seeing younger adults have more cardiovascular events and heart attacks because they are inactive but again you know if you didn't soccer start walking it on the block with them walk or you John they ride their bikes get them ready for that exercise but as a young young and you know child probably not unless you have some really old heart disease or a congenital abnormality or the docket that I hear remember that's that's probably the exception to the rule great thank you and I have one last question if anybody else has any questions please feel free to send them in I will check for hands that are raised but um somebody wants to know if either of the speakers use a standing desk I'm reading so much I don't so moving in and out of patient rooms I don't I'm recovering from verses and so I'm finally moving again and I feel great that I'm moving better but I make it a point to try to move all the time even if it's just a wall or in a pool pen talk I mean I ask my doggy paddle can I go back to the previous question should children be screened and I think both you and Riaan if and he should put some input you know the children should be screened by the pediatrician and a free physical because that's important because you find certain things or children don't feel well when they exercise those are important tags could you guys talk a little bit about kind of ugly needles and how it affected your guys lives yeah absolutely so um I just turned 42 weeks ago so there was no ultrasound my dad was military I was born overseas so I was diagnosed post-delivery but I know now being involved in the congenital heart world and in having being a mom of two children who thank goodness don't have congenital heart disease but my children were watched a lot more closely um also there is my one daughter does have a murmur and so she's had multiple work ups I thought something that was very interesting I learned probably last summer was that even though she had had a workup when she was first born and within that first year they still felt that both my kids needed a workup again last summer to be officially cleared of not having congenital heart disease so you may kind of they may not trigger those initial things like it's so important to do that once two-day fall off with the pediatricians office because you may catch a non diagnosed CH D or anomaly but really having a pediatrician who's checking the blood pressure when they go in not just you know I think a lot of times I get Smith oh they're kids they don't have high blood pressure doctor who thoroughly looking at them and if anything does come up to do those EKGs because I think kids are so tricky you hear about these sudden deaths on the soccer field and they had an arrhythmia the whole time or they had some kind of undiagnosed congenital heart disease I I do know here in Arizona if your child is going to participate in sports or organizations who will go do those screening AKG EKGs for free it's actually a mom who lost a child in college athletics and she has a cardiologist read those so I think there seems like that is a thorough sport physical versus you just go they do your height and weight can you touch your toes looks good I think a true sports physical as important for kids yeah and and I'm glad you mentioned that because after I thought about I wanted to come back as my answer wasn't totally fair every kitchen should have a pre sports physical and it should be done by a pediatrician or because in whatever family practice like someone you know or a nurse practitioner or a PA someone that that really can examine them and understands proper way to do a good sports physical and yes they should always have it so I spent my my original implement thank you and I agree I think that if there's any history and the family of congenital heart disease arrhythmia disorders or anything like that I think that children should be screened you know before joining the sports teams but I don't believe that that has a lot unless it's a genetic and it's hereditary it may not have a lot of reliance on the parents heart disease but I think that you're right Tiffany it needs to be a thorough sports physical and not just you know my son gets one for Boy Scouts every year and he goes in not my son with congenital heart disease but the other one and he'll go in and they basically just sign the paper so you know I do think that a good workup is always good and we have great pediatricians though that follow our kids and my daughter had a murmur and we followed that but I think it depends upon the family and depends upon your you know history and the family tree but it can't ever hurt for sure um the last question I was going to unraised her I was going to unmute her but it looks like she typed the question in it says just wondered how to treat a fast 160 plus heart rate found on an eye watch so I guess it would be is that a concerning problem how do you what would you do if you found that okay is that with exercise or that at rest um I don't know can i I'm going to unmute the person who asked the question P Johnson you are unmuted would you like to have asked that question to that question are you they are either either it's happening you know heart rates that high I think is beyond the filtration you probably should get a good exam and an EKG and probably just an echo but it would be important to get screened for that operating system after exercise or high-intensity not app dependent but as you exercise and you get adapted right you get that an adaptive reaction to it after a while at rest that's not normal you should really have that chip great thank you well I believe that we have answered all of our questions today and we are a little bit over time but thank you all for your patience through all of our little technical difficulties today I think the conversation was great and I would like to take this time to thank our sponsor Amgen cardiovascular for providing us this educational grant to bring these webinars to you and I would also like to thank dr. Lopez and Tiffany Stewart for joining us today lots of really great information that is I think going to be very useful to a lot of people so thank you all and have a great day thank you so much fun thank you thank you thank you

1 Comment

  1. Excellent, very helpful video. Tips for following a physical exercise program (under doctor supervision) extremely helpful and specific. Thank you !

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