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EXERCISE AND CARDIOVASCULAR
DISEASE
Pamela O’Mara PT, MS, CWSNovember 27, 2012
CHRISTUS St. Catherine Sports Medicine
About Me…
Education
Background
Squirrel ??
Health Appraisal with Physical Activity
Cardiovascular Disease Risk Factors
Hypertension Diabetes SMOKING Stress Elevated lipids Stress
Family history Age Gender Race Obesity Sedentary lifestyle
Modifiable Cardiovascular Disease Risk Factors
DO NOT SMOKE Vasoconstriction, increase BP, increase HR, 1:5 deaths
GET ACTIVE Stress reduction, increase oxygenation, increase HDL, decrease
BP, reduced insulin needs, reduced platelet aggregation EAT RIGHT
Heart healthy diet low in fat, cholesterol, salt; focus on lean protein, fruits/veggies, grains
AVOID OBESITY Decrease risk of HTN, high cholesterol, and diabetes, reduced
body fat
Modifiable Cardiovascular Disease Risk Factors
AVOID STRESS Cortisol is a hormone released in response to stress. It
functions to increase blood sugar, suppress the immune system, and decrease bone formation.
SLEEP Adequate sleep is necessary for health, fitness, and stress
reduction REGULAR MEDICAL CHECK-UPS
See your physician to monitor your risk factors
Modifiable Cardiovascular Disease Risk FactorsCommon Symptoms of Stress
Increased use of alcohol or drugs
Increased smokingMuscle tensionHeart palpitationsFear / panicDiarrhea or
constipationCold or sweaty hands/feet
Nausea or stomach painShallow or rapid breathingNot sleeping or sleeping
too muchNeed to urinatePacingHeadachesGrinding teeth
Is it surprising that stress is a risk factor for obesity, cardiac arrhythmia, diabetes, depression, hypertension, etc.
Modifiable Cardiovascular Disease Risk FactorsStress Control Techniques
EXERCISE OR ANY PHYSICAL ACTIVITY !!!GET PLENTY OF SLEEP !!! (but not too much)Eat regular, well balanced mealsTake time every day to do something you enjoyListen to your body. Stop and rest when you feel tiredAvoid stimulants if possible. Smoking, caffeine, alcoholTake a mini vacation in your mind
Relax and do mental imagery of a favorite place or eventPractice slow deep breathingListen to slow, calming music or soundsDo stretching exercises daily to relieve that muscle tensionIntimate relationshipsIf you feel depressed, fearful, or hopeless for an extended period of time,
talk to your doctor.
Modifiable Cardiovascular Disease Risk FactorsRelaxation Session – Close Your Eyes
Face – Squinch up your face. Clench your teeth. Purse your lips. Push tongue to the roof of your mouth. Lift eyebrows with your eyes still closed. Hold. Release.
Shoulders – Hunch up your shoulders to your ears. Pinch shoulder blades together. Hold. Release.
Chest – Tense your chest by taking a deep breath and hold for 5 sec. Back – Arch your back. Hold. Release.Abdomen – Tense your stomach muscles by bearing down.Thigh/Buttocks – Tense up thighs/buttocks by pressing feet into the floor
and pinching buttocks together.Toes – Curl your toes up. Hold. Release.Hands – Clench your fists. Feel the tension. Release.RECOGNIZE THE DIFFERENCE IN TENSION AND RELAXION.
Evidence of Inverse Relationship Between Physical Activity and Health
All cause mortality YES Coronary heart disease YES Cardiovascular disease YES Hypertension YES Stroke YES Obesity YES Osteoporosis/Osteoporotic Fx YES Type 2 Diabetes YES Colon cancer YES Breast cancer YES Gallbladder disease YES Anxiety / Depression YES Independent living (Geriatric) YES AND…….drum roll please…….
Evidence of Inverse Relationship Between Physical Activity and Health
CARDIOVASCULAR AND OVERALL ALL CAUSE MORTALITY ARE
REDUCED IN POST HEART ATTACK PATIENTS WHO PARTICIPATE IN REGULAR PHYSICAL ACTIVITY
Exercise Prescription with Cardiac Disease
Health Related Components of Physical Activity
Cardiovascular Endurance Ability to supply oxygen during sustained activity
Body Composition Relative amounts of muscle, fat, bone, etc.
Muscular Strength Ability of muscle to exert force
Muscular Endurance Ability of a muscle to continue to perform without fatigue
Flexibility Range of motion available at the joint
Skill Related Components of Physical Activity
Agility Ability to move with speed and accuracy
Coordination Ability to move the body parts smoothly and accurately
Balance Maintaining equilibrium while stationary or moving
Power Ability or rate one can perform work
Reaction Time Time elapsed between stimulation and reaction
Speed Ability to perform a movement within a period of time
MODIFIED BORG RATE OF PERCEIVED EXERTION SCALE LEVEL DESCRIPTION
0 NOTHING
0.5 EXTREMELY EASY
1 VERY EASY
2 EASY
3 MODERATE
4 SOMEWHAT HARD
5 HARD
MODIFIED BORG RATE OF PERCEIVED EXERTION SCALE LEVEL DESCRIPTION
5 HARD
6
7 VERY HARD
8
9 VERY VERY HARD
10 MAXIMALLY DIFFICULT
Target Heart Rate AHA Recommendation
Pacing yourself is paramount when beginning a new exercise program
Target heart rates allow you to monitor your fitness progression over time.
Requires you to measure your pulse (radial or carotid) periodically as you exercise to ensure you remain within 50-85 % of your maximum heart rate.
This range is called your Target Heart Rate. How do I calculate this ????
Target Heart RateMaximum Heart Rate Men: 220 - Age = Max Heart Rate Women: 226 – Age = Max Heart Rate
Target Heart Rate (50-85%) Maximum Heart Rate x 0.5
50% is best when starting a new exercise program
Maximum Heart Rate x 0.85 Progress, as you can tolerate, to 85% over a
period of at least 6 months.
Target Heart Rate
AgeTarget HR Zone50–85 %
Average MaximumHeart Rate100 %
20 years 100–170 beats per minute 200 beats per minute
25 years 98–166 beats per minute 195 beats per minute
30 years 95–162 beats per minute 190 beats per minute
35 years 93–157 beats per minute 185 beats per minute
40 years 90–153 beats per minute 180 beats per minute
45 years 88–149 beats per minute 175 beats per minute
50 years 85–145 beats per minute 170 beats per minute
55 years 83–140 beats per minute 165 beats per minute
60 years 80–136 beats per minute 160 beats per minute
65 years 78–132 beats per minute 155 beats per minute
70 years 75–128 beats per minute 150 beats per minute
Target Heart Rate
Target Heart RateWhat if I can’t stop to take my pulse during
my exercise program ??Try using a conversational pace to monitor
your efforts during moderate activities.If you can talk and walk at the same time,
you aren’t working too hard.If you can sing and maintain your level of
effort, you’re not working hard enough.If you get out of breath quickly, you’re
probably working too hard, especially if you have to stop to catch your breath.
Components of the Exercise Training Session
Warm up 5-10 minutes, low to moderate intensity, RPE 2-3
Stretching 10 minutes, can be done after warm up or cool down
Conditioning 20-60 minutes, aerobic/resistance/neuromuscular/sport Moderate to vigorous intensity for health/fitness
benefits, RPE 5-6 Cool down
5-10 minutes, low to moderate intensity, RPE 2-3
Cardiovascular Endurance (Aerobic) Exercises
Low Intensity Minimal skill Minimal fitness Walking Leisurely cycling Aquatic aerobics Slow dancing Tai chi ** Yoga ** Gardening Housework
Moderate Intensity Minimal skill Average fitness Jogging/running Pilates ** Aerobic class Spinning Elliptical exercise Stepping exercise Fast dancing
**Neuromuscular exercise
Muscular Fitness (Resistance) ExercisesResistance training should focus on the major muscle groups of the chest, shoulders, back, abdomen, hips, and legs.Average fitness individual
2-4 sets for each muscle group 8-12 repetitions for each set 2-3 minute rest between each set
Deconditioned individual 1-2 sets for each muscle group 10-15 repetitions for each set
To avoid muscle imbalances that could lead to injury, train the opposing muscle groups…..
Low back and abdomen (back extension and abdominal crunches) Biceps and triceps (bicep curls and triceps dips) Quadriceps and hamstrings (leg press and leg curls)
And, perform the exercise with the proper technique. Controlled movement, regular breathing pattern (exhale with exertion)
Muscular Fitness (Resistance) Exercises Types of resistance training equipment
Weight stack Cable pulleys Free weights Elastic bands Grocery bags Lawn mower Toddlers Pets
Flexibility (Stretching) Exercises Improves range of motion, physical function Insufficient data to prove that stretching prevents injury,
but it does warm the muscle group in preparation for the activity for optimal performance.
Stretch should involve the major muscle tendon groups of the body (i.e. neck, shoulders, back, hips and legs)
Stretch should be performed to the limits of discomfort (mild tightness) for 4 or more repetitions per muscle group and held for a minimum of 20 seconds each.
Flexibility (Stretching) Exercises
Flexibility (Stretching) Exercises
Flexibility (Stretching) Exercises
Flexibility (Stretching) Exercises
Flexibility (Stretching) Exercises
Flexibility (Stretching) Exercises
Flexibility (Stretching) Exercises
Environmental Factors of the Exercise Training Session
Hot environments Dehydration Heat illness – disorientation, headache, dizziness, wet and pale skin, muscle
cramps, vomiting Tools: gradual acclimatization, hydrate, cooler hours, loose clothing, caution
with low salt diet Cold environments
Frostbite Numbness (miss angina symptoms)
High Altitude Altitude illness – altered mental status, headache, nausea, fatigue, bronchitis,
coughing spasms Expect a significant decrease in physical performance due to decreased ATM
pressure.
Contraindications for Physical Activity Unstable angina Resting systolic BP >200 and/or Resting diastolic BP > 110 Acute systemic illness or fever Uncontrolled tachycardia > 120 bpm Uncompensated CHF 30 AV block w/o pacemaker Peri or myocarditis Recent embolism ST segment elevation Uncontrolled diabetes Severe orthopedic conditions that would prevent exercise Other acute systemic metabolic conditions (thyroiditis, hypokalemia,
hyperkalemia, hypovolemia) Symptoms of exercise intolance
Contraindications for Physical Activity
STOP ALL EXERCISE AT THE FIRST SIGN OF ANGINA SEVERE FATIGUE SHORTNESS OF BREATH
Favorite Cardiac Websites…www.americanheart.org/ www.healthy-heart-guide.com www.nlm.nih.gov www.webmd.com www.mayoclinic.com
www.womenshealth.gov www.healthcentral.com www.medicinenet.com www.ahealthyme.com www.naturalnews.com
