No heart breaks here: Exercise, need of the hour

Coronary Heart Disease (CHD) is a condition where there is narrowing or blockade to the arteries that carry blood and oxygen to the heart. India accounts for nearly 60 per cent of the world’s heart patients with a massive predicted economic burden of 54 billion dollars by 2015. By 2020, it is estimated that cardiovascular diseases would account for around 5 million deaths in India.

With changing lifestyle habits ranging from decreased physical activity to fast food burgers leading to obesity and a highly stressful life, there is almost a fourfold increase in the risk of being affected with heart problems. More worrisome is the fact that it affects both the rural and urban population equally.

Heart problems are no longer an ‘old’ man’s disease and even people in their mid thirties come within the realm of it. This has become an epidemic that needs to be thwarted and as the old adage goes, “Prevention is any day better than cure”.

Physical therapists play an important role in preventing and rehabilitating individuals with heart diseases by providing a strategy for proper exercise.

Though walking is an easy and popular way of exercising, it does not address all aspects of heart health. Each person is different and requires individualized exercise programs along with physical activity counselling. The positive effects are obtained only when the exercise intensity is in the “Training zone” to load the heart. As heart is a muscle, it responds by working more efficiently. If this load is too much or too little, the desirable effects will not be achieved. Hence, the “Training zone” for exercising is done only after a complete clinical evaluation by physical therapists and varies from individual to individual.

Even if we exercise at the right intensity, the positive effects obtained may be negated by other issues such as smoking, improper diet, lack of sleep and stress. These risk factors increase our predilection towards the path of acquiring heart problems. They are systematically stratified by physical therapists for each individual where they are categorized as low risk, moderate risk and high risk respectively.

After the process of risk stratification, these contributing factors are addressed on an individual basis.

According to Veena Kiran Nambiar, Physiotherapy Consultant, exercise prescription following risk stratification can be viewed from three perspectives. One is a preventative aspect, where people have not yet developed a heart disease but are at a high risk for developing one. Second is where people have developed heart problems such as Angina, Heart failure, Myocardial infarction with exercises prescribed to enhance the recovery period. Third is following surgical procedures such as Angioplasty, Coronary artery bypass graft (CABG) , post valve surgery with exercise rehabilitation suited to the severity of risk stratification had by a patient.

For example, a post-operative patient who has less complications would be given exercises at a higher intensity when compared to a patient who has many complications. Exercise too can be considered as a form of “medicine” where the ultimate aim in individuals who have undergone surgery is to prevent future occurrences of heart diseases by keeping the heart healthy.

The benefits of cardiac rehabilitation includes improvement in physical and psychosocial outcomes along with risk factor reduction. For individuals affected with heart problems, the occupation and medications he/she is taking too play an important role when prescribing exercises.

Consider a daily wage labourer whose primary job comprises of lifting and transferring sacks of weight. What we would require in these situations are tailor made exercise programs to make them meet the demands of their occupation such as graded lifting of weights and increasing the upper body endurance.

In short, site specific training is essential for improving each patient’s productivity, an aspect that is often missed in the current clinical scenario in India. Further, there are some heart medications that can slow down the pumping of the heart. In these cases, if patients over exert themselves without proper guidance from a physical therapist, then the chances for untoward incidents are high.

Cardiovascular endurance

In physical activity counselling, patients need to be educated about monitoring their vitals such as heart rate, blood pressure etc. while exercising and recognising symptoms of over-exertion (such as severe chest pain / light headedness) example, exercising at a low BP is dangerous and can lead to sudden deaths.

Hence, it is important that patients monitor alarming symptoms during exercise so that they can self manage themselves.

Thus, a combination of a well structured rehabilitation program along with medications is needed to achieve which can cause high abnormal loads on the heart too. For optimum benefits for the heart.

Stability and strengthening

Cardiac rehabilitation programs follow an integrated approach involving multiple team members like Cardiologists, Cardiac surgeons, Physical therapists, Nutritionists, Psychologists and Medical social workers. It must be remembered that participating in cardiac rehabilitation program is a lifelong process.

A change in lifestyle, habits and lifelong commitment to healthy living is required to prevent as well as rehabilitate heart problems occurring in people who are at a risk.

Each patient needs an individualised activity counselling by integrating the various issues that may have a predisposition to affect the heart.

Cardiac rehabilitation programs take into consideration a holistic view of the patient in order to achieve a perfect balance of the mind, body and the soul.