Post COVID Syndrome and ways to Overcome it

While you may be aware of the symptoms of COVID-19 by now, it is equally important to know that around 20% of those who recover from the acute phase of the infection may continue to have health issues in the weeks and months that follow, this is known as post-COVID syndrome. With a high rate of recovery in India, several individuals are struggling to cope with the aftermath of the infection. There is strong scientific evidence to show that a medically supervised rehabilitation program helps in the complete recovery from this post-COVID syndrome.

Individuals affected with COVID-19 may be left with physical and mental impairments such as:

  • Impaired lung functions
  • Severe muscle weakness
  • Joint stiffness
  • Fatigue
  • Limited mobility and ability to do daily tasks
  • Delirium and other cognitive impairments
  • Difficulty in swallowing and communicating
  • Mental health disorders and psychosocial support needs

It has been found that not only does the presence of diabetes pose a threat when it comes to recovery from COVID-19, but non-diabetic persons may also develop diabetes as a complication of the COVID-19 infection. Both the direct effect of the virus on sugar metabolism as well as the indirect effect of steroid medications on blood sugar levels have been implicated in this. The impact of the coronavirus on the heart has also been recognised. Acute inflammation of the cardiac cells known as myocarditis, blocks in the coronary arteries leading to heart attack and abnormal heart beat known as arrhythmias are some established cardiac complications of the COVID-19 illness.

Post COVID rehabilitation is the need of the hour to improve the overall wellbeing of individuals by  improving their lung function, functional capacity and exercise tolerance, by enabling early return to work and daily routine and by enhancing psychosocial wellbeing.

The main focus areas in post COVID rehab as outlined by the World Health Organization, European Respiratory Society and American Respiratory Society are:

  1. Improve lung functions
  2. Decrease fatigue at rest
  3. Improve mobility and joint functions
  4. Prevent further muscle weakness
  5. Provide customised exercise training
  6. Provide appropriate dietary advice
  7. Provide adequate psychological counselling
Benefits of Post COVID rehabilitation

Individuals recovering from COVID-19 are advised to focus on some self management techniques as follows:

  • Improving lung functions and breathlessness

Breathing exercises such as diaphragmatic breathing exercise and thoracic expansion exercise will help to improve lung expansion and avoid further deterioration. Forced expiratory technique such as coughing and huffing will improve the bronchial hygiene and also assist in expectorating the mucus. Breathing exercises are proven to decrease the severity of breathlessness and paves the way for being more active.

  • Improving fatigue and exercise intolerance

Fatigue and exercise intolerance are the most common symptoms of post-COVID syndrome and can be managed by appropriate exercise training. Exercise capacity testing is a must to identify the level of functioning and to administer appropriate exercise training. A combination of aerobic exercises, resistance exercises that improves muscle strength and endurance and breathing and flexibility exercises is a must for rapid recovery. Activity pacing and energy conservation techniques should be advised such that it avoids the onset of fatigue and also aids exercise performance.

  • Improving psychological health and mental wellbeing

Survivors of COVID-19 face several psychosocial challenges such as stigma in the living community, at work, at social gatherings and public places. This in turn can result in insomnia, isolation, anxiety, depression and other psychological disorders. It is important that the rehab program provides counselling, reassurance, coping skills, and emotional support to overcome this stressful period.

  • Improving dietary intake

A healthy balanced diet is key to full recovery from any illness. Consumption of fruits & vegetables, protein rich foods and whole grain products with appropriate vitamins and minerals and staying away from unhealthy foods like fast food, packaged food, fatty food and artificially sweetened dishes will aid in the speedy recovery from the coronavirus.

We at Cardiac Wellness Institute are providing Post COVID Rehabilitation through a completely online service. You may contact us at +919902155772 for further information.

Bypass Surgery versus Angioplasty

If you have been faced with the question “bypass or angioplasty”, either for a loved one or for yourself, you are not alone. This is the commonest dilemma people encounter when diagnosed with a myocardial infarction or heart attack. Both are revascularisation techniques, that is, methods to allow blood flow to the heart muscle when there are one or more critical blocks in the blood vessels supplying the heart. However, there are significant differences between the two treatment modalities.

Important facts

While the healthcare team caring for you at the time of the heart attack usually decides on the best management modality based on your medical parameters, it is important for you as the receiver of the treatment to have a clear understanding of what a bypass means, what an angioplasty means, and what to expect in the long term.

To begin with, coronary artery bypass graft or CABG is an open-heart surgery wherein the blocked coronary blood vessels are circumvented or bypassed using healthy vessels from other parts of your body such as your legs or chest area. This alternate route or bypass then supplies the much-needed blood to the heart muscle. Minimally invasive cardiac surgery or MICS is a newer treatment modality in which instead of opening up the chest to access the heart the surgeon performs the bypass surgery through small key-holes in the chest wall using thoracoscopy device. The recovery time is lesser for MICS approach than the conventional approach but only certain patients are eligible for this type of surgery.

Angioplasty, on the other hand, is a non-surgical procedure in which the coronaries are accessed via the peripheral arteries, that is, arteries in our hands and legs. The access points are either the groin or the wrist. A stent is a thin device that is inserted into the artery in our groin or wrist that goes all the way to the heart and to the blocked part of the coronary artery and stays there to allow blood to flow through it. This is an interventional procedure and not a surgery, therefore there are very few complications and the recovery is faster but again it is not suitable for all patients.

Of late, hybrid coronary revascularization is also being performed where minimally invasive coronary bypass surgery and angioplasty with stenting are performed in the same patient when multiple blocks are present.

The major criteria taken into consideration when choosing the revascularisation procedure are:

  • Number of blocks
  • Severity of blocks
  • Location of blocks
  • Known diabetic or not
  • Other comorbidities like kidney failure, chronic lung disease etc.

Better outcomes

The team of doctors treating you will make the decision about what is the best management for you after considering all the relevant factors. Coronary revascularization is a life-saving procedure and whether bypass or angioplasty is chosen, it is important to adhere to the medications prescribed and to follow a cardiac rehabilitation program for better outcomes. Modifying the risk factors, attending the follow-ups regularly and leading a heart-healthy lifestyle are the best ways to prevent occurrence of complications and repeated hospitalizations.

Pandemic restrictions

Due to the ongoing pandemic, there is a doubt in people’s mind about whether it is safe to see the doctor and to get investigated or if should be postponed.

IF YOU THINK IT IS AN EMERGENCY DO NOT DELAY SEEKING MEDICAL HELP.

Tele-consultation is a safe alternative for non-emergency medical conditions but if you suspect a heart attack, stroke or other medical and surgical emergencies, you should report to the casualty at the earliest, taking all COVID-19 precautions.

Eat right to keep that stroke away

Worldwide, 15 million people suffer a stroke each year of which one‐third die and one‐third are left permanently disabled. As a dietician focusing on the prevention and rehabilitation of lifestyle diseases, let me break down some important facts about stroke and it’s prevention.

What is stroke?
Stroke is a medical emergency that occurs due to obstruction of blood flow to the brain. Without proper blood flow, the brain cells fail to work and may even die and this causes serious symptoms such as inability to talk, walk and see and often death. Symptoms of stroke include the following sudden changes – numbness or weakness of the face, arm, or leg, usually on one side of the body, confusion, difficulty speaking or understanding, visual disturbances, dizziness and/or loss of balance.

What are the types of stroke?
There are two main types of stroke namely ischemic stroke and hemorrhagic stroke. An ischemic stroke occurs when a blood clot interrupts the blood flow to the brain. The blood clot is often due to atherosclerosis – a buildup of fatty deposits on the inner lining of a blood vessel. An ischemic stroke can be embolic, meaning the blood clot travels from another part of your body to your brain. A hemorrhagic stroke results as a blood vessel in your brain ruptures or breaks, spilling blood into the surrounding tissues.
It is important to note that stroke is a risk factor for heart disease and people who have had a heart attack have twice the risk of occurrence of stroke.

What are the risk factors for stroke?
Stroke and heart attack are the two major non-communicable (non-infectious) diseases or cardiovascular diseases threatening the world today and have many commonalities. Both are vascular events that involve the blood vessels and the arteries in particular. Both conditions can lead to death in a matter of seconds to minutes. And both diseases are caused by the same lifestyle and metabolic risk factors listed below:


• High blood pressure
• Abnormal cholesterol
• Diabetes
• Unhealthy diet
• Sedentary lifestyle
• Obesity
• Smoking
• Excessive alcohol intake
• Severe mental stress
• Family history
• Atrial fibrillation (abnormal heart rhythm)

How to eat healthy to prevent stroke? A recent study conducted in nine European countries with a total of 4,18,329 participants has concluded that adequate daily consumption of fruits, vegetables, dietary fibre and dairy products reduces the risk of stroke and that too much red or processed meat consumption increases the risk of stroke. This study also shows that too much sodium (salt) in diet is associated with a higher risk of stroke, while improving potassium intake through fruits and vegetables is protective against stroke.

We also have solid scientific evidence to show that healthy eating habits and a balanced diet reduce the risk of hypertension, diabetes, obesity, and heart diseases.

There are some major food items that need to be considered while planning a healthy diet:

Red meat – meat is a major source of saturated fat, which could contribute to atherosclerosis and thus higher risk of stroke


Whole grains – whole grain products such as cereals and millets are rich in dietary fibre, and help in  reducing the chances of stroke and it’s severity


Fruits and vegetables – fruits and vegetables are rich in anti-oxidants, which reduces free radicals in our body. They provide various micronutrients including potassium and folate. Potassium helps to reduce blood pressure while higher folate intakes may lower plasma homocysteine concentrations, and thereby reduce stroke risk. Fruits and vegetables are also a major source of dietary nitrates which have blood pressure lowering and blood vessel protective properties. Eating at least 5 cups of fruits and vegetables every day is the best thing we can do to keep stroke at bay


Dairy products – Dairy based foods, particularly low fat milk and low fat milk products like cheese, yogurt and paneer are rich sources of calcium, along with potassium, which can help to control blood pressure while keeping cholesterol within normal limits


There is a link between blood cholesterol levels and stroke. Saturated fat (unhealthy fat) found predominantly in animal organs (brain, liver, kidneys) and red meat (beef, veal, pork) are unhealthy and should be avoided while the healthy unsaturated fat found in fish, chicken and turkey breast can be included in our diet. Egg has a combination of proteins, fats and minerals and can be consumed in moderation. 

Minimize the use of highly processed, preserved or packaged and frozen products as they are high in calorie and contain a lot of unhealthy saturated fat

It is important to read the labels of the products and to choose the ones that contain 0% transfat, low fat and no added sugar

What else should we do to prevent stroke?
1. High blood pressure is one of the biggest contributors to the risk of stroke in both men and women. Monitoring and maintaining optimal blood pressure (120/80 mmHg) helps to reduce the incidence of stroke. Also reducing salt intake to 1-2 grams (about a teaspoon) a day is a proven way to keep blood pressure under control and prevent heart attack and stroke.
2. Obesity as well as it’s complications are linked to stroke. Try to maintain a healthy normal weight to prevent occurrence of stroke
3. Regular exercise is extremely important to keep all the risk factors mentioned above under control. In fact, exercising everyday for about 30 minutes has the maximum benefits on all our organs and systems.
4. Elevated blood sugar levels damage the blood vessels over time that might result in clots, more likely to form inside them. Keeping your blood sugar under control through a healthy lifestyle and medications (if necessary) will help prevent stroke, heart disease, kidney failure and several other ailments.
5. Quit smoking and alcohol consumption that are direct risk factors of stroke and heart diseases
6. Atrial fibrillation is a form of irregular heartbeat that causes clots to form in the heart. Those clots can then travel to the brain by dislodging, resulting in an embolic stroke. If you have atrial fibrillation, get appropriate treatment at the earliest.


Too many people ignore the signs of stroke because they are unaware or unable to relate the symptoms to a serious underlying medical emergency. Now that you are aware what stroke is and how it can be prevented, you should become an ambassador of stroke prevention in your community.

If you choose a well-balanced healthy diet, placing emphasis on natural, whole, and unprocessed foods, and if you exercise regularly and keep all your risk factors under control, you can protect yourself from stroke, heart attack and other chronic ailments like dementia, cancer and lung disease.
 


Exercise can break the Work From Home monotony

Work From Home has become the new norm since the start of the COVID-19 pandemic. There are several pros and cons to this way of working but the most noticeable negative aspect is the blurring of boundaries between our professional life and personal life and the associated lack of adequate time for ourselves.

We tend to sit for long hours in front of our gadgets taking calls and attending meetings. We fail to pay attention to our physical activity requirements on a day-to-day basis. We neglect the warning signs like aches and sores until they become a real issue. We even ignore the fact that we are gaining weight and getting out of shape. We need to take remedial action now to ensure that Work From Home doesn’t pose a threat to our heart health and to our overall well-being. This post will focus on some exercises that can easily be done while working from home!

  • Perform active movements or stretching of both upper and lower limbs at least for 5 to 10 minutes every hour
  • Avoid prolonged sitting for more than 2-3 hours at a stretch by getting up from that place, taking a brisk walk or climbing 2 to 3 flights of stairs for 10 minutes

The illustrated exercises are a combination of active movements and stretches focusing on the major joints. They are:

  • The Chin tucks and Head movements will help prevent neck pain which is often a result of prolonged sitting with the head in a particular position – 10 to 15 repetitions each
  • The stretches focus on relieving tension in the major joints of the upper limbs, chest and back and to avoid muscle cramps and stiffness – hold each stretch for 20 to 30 seconds
  • The lower limb exercises namely alternate leg lifts and ankle movements will help avoid stiffness, improve blood circulation, and especially to keep the calf muscles active as they are the peripheral heart in our body – 10 to 15 repetitions each

Pay attention to your work posture

Maintain correct posture while working on your devices to avoid back pain and other musculoskeletal injuries. Keeping a straight back and neck with your device at a proper height is important. As this may be a challenge at home as you may be working on your dining tables or sofas, try to sit straight and prop a pillow on your lap if you need to.

Performing the above exercises helps in:

  • Preventing joint pains and muscle soreness
  • Improving your mood
  • Increasing your working ability
  • Preventing chronic health issues

The current lifestyle change of working from home has given us an opportunity to get work done in spite of the ongoing pandemic. But we have to realize that it’s a double-edged sword that needs to be handled tactfully. A healthy home-cooked balanced diet, adequate exercise in between work commitments and sufficient sleep and relaxation are easier to achieve now than they were ever before but it’s completely in our hands whether we make use of them or ignore them until our health deteriorates. Let us take a pledge to keep ourselves healthy and spread positivity to others too!!

Strategies to checkmate COVID19

Globally, more than 1 crore (10 million) people have been diagnosed with COVID-19 disease caused by the novel coronavirus over the past 6 months and over 5 lakh (0.5 million) people have been reported dead, as of 1 July 2020.

The good news is that the recovery rate from COVID19 is higher in India than in many other countries. However, the overcrowding and lack of discipline amongst the people is leading to a fast spread of the virus in big cities like Mumbai, Chennai and Delhi and in smaller towns as well.

While each and every one of us is susceptible to get infected and should take adequate precautions, individuals with a previous diagnosis of heart disease and other chronic ailments like diabetes, hypertension, kidney disease and cancer should be extra alert and safe as they could become very sick if they contract the virus. In fact, we now know that not only the lungs are attacked by the virus, but the heart, liver and almost all our organs are susceptible to damage, leading to multi-organ failure and death in critically ill patients.

With some antiviral therapies emerging and vaccine discovery underway, the only way to ensure freedom from COVID19 is preventing the infection. Imagine a game of chess in which you have moved your pieces so well that your opponent is in CHECKMATE! In the fight against this pandemic, our opponent is the coronavirus and if we make the right moves we can CHECKMATE this deadly bug. If we all follow the steps for CHECK and those with chronic ailments also follow the steps in MATE as shown below, there is a good chance we can checkmate and eliminate COVID19 in the near future.

If you or your loved ones are worried or anxious about your health condition and would like to get specific advice, you should contact your healthcare provider at once. It is safer to be extra cautious than to regret being careless during these testing times.

Stay home, stay safe, stay healthy! And to mark National Doctor’s Day today, what can be more rewarding for a physician than spreading awareness and educating people about their health!

How to eat healthy during lockdown

With the ongoing pandemic and the enforced lockdown, many of us are increasingly concerned about maintaining healthy eating habits. And those of us under treatment for diabetes, hypertension, heart disease, kidney problems and other chronic conditions are likely to be more anxious about staying safe and healthy during these uncertain times. As a dietician, I can reassure you that eating a healthy diet is the most important thing to keep all our parameters under control while staying home. Taking care of our heart health begins with getting the concept of healthy nutrition right!

Ideal nutrition not only has an effect on our physical health but it also affects our mental health. We need to figure out how to eat in order to keep our immunity intact, how to manage healthy meals with limited ingredients on hand, how to cook when some of us may not be very experienced cooks and also how to be disciplined about our diet and health goals.

Purchasing and storing fresh fruits and vegetables can be challenging during lockdown. But whenever available, it is important to include adequate fruits and vegetables in your daily diet.

Tips to eat healthy during lockdown

  • We can store dried goods like beans, pulses and grains such as lentils, peas and legumes for longer periods of time. They are nutritious as well as affordable. Include dhal, sprouts or sundal in your everyday cooking
  • Include dried fruits, nuts, rice flakes and puffed rice instead of biscuits, chips and fried foods
  • Limit the intake of highly processed drinks, snacks and ready-to-eat meals
  • Try to avoid high fat, high salt foods like pastries, pre-cooked and packaged foods
  • B vitamins are present in green leafy vegetables, beans, eggs, poultry and fish
  • Eat a good source of protein every day (e.g. fish, meat, eggs, nuts, beans, tofu)
  • Consume 2 servings of dairy every day (e.g. milk, cheese, yoghurt or dairy alternatives such as soya milk)
  • Eat at least five portions of fruits and veggies every day
  • Boredom may lead to mindless snacking on unhealthy foods; so make a daily plan to keep yourself busy and follow it
  • Limit the intake of added sugar in the form of sweet beverages and desserts
  • Include anti bacterial and anti microbial foods to improve immunity level, eg: turmeric, lemon, ginger, garlic, green tea
  • Try to minimize consumption of coffee and tea, especially during this lockdown, as this can help you sleep and focus better
  • As we are spending more time inside than ever before, and many of us do not have access to an outdoor space, vitamin D deficiency is common; sunlight is the best source of vitamin D and the morning and late afternoon hours are ideal for some sun exposure in your garden, terrace etc.; a daily supplement of Vitamin D or fortified foods can be consumed if sun exposure is not possible

Eat a balanced diet

Eating a well balanced diet with plenty of fruits and vegetables, wholegrains, plant (pulses and legumes) and animal proteins (lean meat, fish,poultry, eggs) and healthy fats (nuts and oil seeds) is the best option to getall the essential nutrients for good health and optimal immune function.

Eat plenty of fruits and vegetables

Fruits and vegetables are the most important foods for supplying our dailyrequirement of vitamins, minerals and fiber. We should aim to eat 5 portionsof fruits and vegetables every day. Different colored fruits and vegetables provide phytochemicals and antioxidants, which are essential forgood health.

Stay hydrated

Keeping hydrated is essential for overall health. We can add watery fruitsand vegetables (bottle guard, pumpkin, cucumber, muskmelon, watermelonetc.) to maintain fluid level in the body. Try to consume as whole fruits insteadof fruit juices.

Get enough sleep

Adequate sleep is as important as a healthy diet. Make sure you get the recommended 6-8 hours of good quality sleep every night.

Keep healthy snacks around

Keeping healthy and nutritious snacks nearby will ensure you don’t head straight to the fried, baked and preserved foods.

e.g. Nuts and dried fruits, sprouts or sundal, fruits, vegetable salads, soups, smoothies, butter milk, tender coconut water, seasonal fruits

Practice personal and food hygiene

Good hygiene is important when handling food to prevent the spread of virus. Wash your hands thoroughly with soap and water before preparing food. Wash unpacked products of fruits and vegetables thoroughly under running water.

In conclusion, eating a healthy diet should be a priority at this time. Make sure you shop smartly for the essential ingredients; take adequate preventive measures before stepping out, during shopping and after returning home with the products. Following personal hygiene measures and maintaining social distance remain the best means of avoiding infection. There are lots of different nutrients that are involved with the normal functioning of the immune system. So, we would encourage maintaining a healthy balanced diet in order to support the body’s immune function. In addition to exercising regularly and quitting smoking and drinking, maintaining a healthy diet plays a crucial role in preserving our physical health and emotional wellness.

A positive attitude, adequate nutrition and regular exercise are a great way to offset the anxiety, worries and uncertainties during this quarantine period. If you or your loved ones have any special dietary requirements or disease condition and would like professional advice on how to eat healthy during this pandemic, please feel free to email me on tharani@cardiacwellnessinstitute.com.

Strength training and its impact on heart and lung health

Hello everyone! Hope you are safe and healthy in the midst of the ongoing pandemic. In continuation with our previous blog post that focused on performing aerobic exercises at home (click here to read about fitness at home) we will enlighten you about what is strength training, why it is important and how to go about becoming physically stronger.

You may be familiar with the names Karnam Malleswari and Gurdeep Singh, weightlifting champions in the female and male categories respectively, who have made India proud in the global arena! While competitive bodybuilding and weightlifting are not for everyone, toned up muscles and a sleek core are some things we should all work for.

What is strength training?

Strength training or resistance training is a form of physical activity designed to work our muscles against resistance in order to improve muscle strength, power and endurance. There are multiple ways of doing strength training, such as:

  • Use of free weights such as dumbbells and barbells
  • Use of machines/equipments that consist of adjustable weights
  • Use of resistance bands
  • Use of body weight

Benefits of strength training

  • Improves strength, power and tone of the muscle
  • Improves flexibility and functioning of joints
  • Aids weight loss by increasing calorie expenditure
  • Helps in increasing bone mass and density thereby reducing the risk of osteoporosis (weak bones)
  • Also improves posture, mobility and balance

Impact on heart and lung health

Regular strength training exercises help prevent and control diabetes, hypertension, abnormal cholesterol and obesity, thereby reducing the risk of heart attack, stroke, kidney failure, and liver damage. There is also a direct connection between better muscle strength and improved heart function. That is why cardiac patients are now advised to engage in resistance exercises on a regular basis, so that not only their arms and legs but also their heart muscle will work more effectively and more efficiently.

As medical literature has proven that individuals with chronic lung diseases benefit from a combination of breathing retraining, aerobic exercises and strength training exercises, we teach these exercises to our patients with asthma, bronchitis, and even those who have had heart and lung transplant to improve their breathing efficiency and reverse their muscle wasting.

Body weight exercises

Half Squats
Stand tall with feet apart;
out stretch your hands and slowly squat down halfway. Keep your knees in line with your toes and your back straight.
The Lunge | OrthoVirginia
Lunges
Stand tall with feet apart and extend the left leg forward; slowly go down until your right knee nearly touches the floor and come back up; repeat the same on the other leg in an alternate manner.
4 Effective Leg Toning Exercises | WW USA
Calf Raises
Stand tall with feet minimally apart, raise your heel and balance on your toes for 2 to 3 seconds and slowly come down.
Modified Push Ups
From a face-down position with your hands shoulder width apart and from a half kneeling position, lift your toes up and slowly go down until your chest is 5 cm above the ground and come back.

Tips for body weight training

  • Start at a lower level of 8-12 repetitions (1 set) and try to do 1-2 sets
  • Focus on the quality of the movement throughout the regime
  • Avoid holding your breath while performing these exercises
  • Take breaks of 30-60 seconds in between each set and 2-3 minutes between each exercise

What is core strength?

Additionally, adequate amount of time should also be devoted towards strengthening your core, that is, your abdominal and lower back muscles. Core strength will improve your fitness level, enhance your aerobic performance and prevent low back pain and flabby tummy or potbelly.

Core strength exercises

7 best body weight exercises to train your core at home - YP ...
Abdomen curl ups
Lie flat on the ground with your knee bent as shown; keep your hands by the sides of your head to maintain your neck in neutral position. Slowly come up as you breathe out and go back down as your breathe in, feeling the tightness in your abdomen.
Alternate/Both Leg Raises
Lie supine and keep your hands to the side; now slowly lift your legs high up without bending your knees as you breath out and slowly lower your legs down as you breathe in.
Free Workout: Transform-Wk1W1: Power · WorkoutLabs Fit
Modified Plank
Lie prone on the ground and position your upper limb with elbow support and lower limb on your knees with toes lifted up and maintain this position for a few seconds.
Modified Side Plank
Lie on a side and semi flex your knees and with the elbow support lift your upper body and maintain in that position for a few seconds.

The abdominal exercises can be done for 10-12 repetitions per set for a minimum of 2 sets and the plank hold for 10-15 seconds per round and minimum of 2 rounds.

Tips for core exercises

  • For abdominal exercises, remember to breathe out as you come up and breath in as your go down and avoid breath holding
  • In planks, see to it the position is well maintained and focus on breathing throughout the duration
  • Focus on the quality of the movement and do it at an appropriate pace for a better rhythm

Some of the prerequisites one should have in mind prior to performing strength training are:

  • Perform on a non slippery, safe surface to avoid injuries
  • Adequate warm-up and cool-down should be done for better performance
  • Allow adequate rest of 24-36 hours before performing the next session
  • Beginners may experience muscle soreness; application of ice packs on the localised area will help in relieving pain and discomfort

Performing these exercises at home will not only make you fit and healthy but also provide you with the confidence that exercise is simple and fun and can be done without any fancy equipment!

Exercise your way out of the COVID-19 crisis

Today, all of humanity is doing one of these three things: trying not to contract the infection, fighting the infection actively or coping with the post-infective period having survived the infection. Exercising regularly, eating a healthy diet and keeping up the positive attitude are 3 things that will help all of us irrespective of which phase we are in. Let us support one another and get through this crisis together!

Stay Fit at Home without any Equipment

Exercise is nothing but physical activity done in a structured, planned and repetitive manner. The importance of regular exercise in maintaining health and preventing disease is well known. But many of you might be of the impression that walking is the only exercise that can be done without equipment. While brisk walking is a great way to stay fit and can be done almost universally, there are infinite numbers of other exercises that do not require any equipment and can be performed at home.

In this current situation of being confined to your homes due to the COVID-19 outbreak and the work-from-home demands for many of you, keeping yourself active and exercising regularly should be your main goal. This habit of exercising will not only help avoid a sedentary lifestyle but will also help you be more productive in your work. Go ahead, read on and find out how to perform exercises at home without any equipment.

A robust exercise routine should include a warm-up phase (5-10 minutes), an active aerobic exercise phase (30-45 minutes) and a cool-down phase (5-10 minutes), adding up to a total of at least 40 minutes of exercise. This regime should be followed on at least 5 days weekly.

Warm-up is a pre-exercise phase which involves active movements of all joints right from your head to your toes. A good warm-up prepares you adequately for the exercise phase and also helps avoid injuries to muscles, joints and ligaments. Here are 6 warm-up exercises everyone should do. Each warm-up exercise should be done 10 times.

Aerobic exercises that you might have been doing are walking, running, cycling, swimming etc. Some alternatives that can be done inside your house are:

On spot jogging/marches (10 – 20 minutes)
On spot pogo jumps
Jumping jacks
High knees
Butt kicks
Step up & down

On spot marching or jogging can be done for 10-20 minutes. Each of the other 5 exercises can be done for 15 – 30 times (repetitions) per set for 2-3 sets. For step up & down, you can use your stairs as a platform to climb up an down. Repetition is the number of times you perform a particular exercise and Set is the number of cycles of repetitions one completes. A rest period of 30-60 seconds is advised in between each set.

Cool-down is a post-exercise phase which involves active stretching of the major joints to avoid muscle cramps or soreness after exercising. Each stretch position should be held for about 20-30 seconds and repeated 2-3 times. Remember to be gentle while releasing from the stretched position to avoid muscle catch.

Those who are acquainted with exercising in fitness centres and groups can perform these home exercises easily. However, beginners should take note of the following precautions to avoid injuries and other complications while exercising at home:

  • Start with 5-10 repetitions and take adequate rest in between each set
  • Total exercise time may be 15-20 minutes to begin with and gradually go up to 30-40 minutes within a months’ time
  • Keep a log of your exercise duration and the occurrence of pain, swelling, discomfort etc.
  • If you experience giddiness, chest pain, breathlessness or abnormal heartbeat, please stop the exercise immediately

In conclusion, you do not need modern equipment or machines to exercise but you definitely need the knowledge on how to perform the exercise, need to allot time for exercise and need dedication and determination to stay healthy without an external push.

Cardiac Wellness Institute has initiated the HeartHealth@Home program where we are open for online consultation and also provide home-based heart health programs and fitness and diet guidance for individuals. Please feel free to contact us for further information.

In fact, once you master these basic exercises, you can start incorporating strength training exercises and core strengthening exercises at home. I will guide you on these exercises in my subsequent blog post. Until then, STAY HOME, STAY FIT!

Balanced diet vs Crash diet for heart health

As a dietitian, I am disturbed by the fast pace at which crash diets are gaining popularity! And I strongly believe that people need to be aware of the potential health hazards of these currently trending diets. Nutrition is a basic prerequisite to sustain life. A balanced and nutritious diet is one which provides all the nutrients in required amounts and proper proportions. It can easily be achieved through a blend of four basic food groups namely:

  1. Cereals millets and pulses
  2. Vegetables and fruits
  3. Milk and milk products, eggs, meat and fish
  4. Nuts and oil seeds

The quantity of nutrient requirement varies with age, gender, physiological status and physical activity. A balanced diet should offer around 60-70% of total calories from carbohydrates, 10 – 12 % from proteins and 20 – 25% from healthy fat and should also other provide sufficient dietary fiber, antioxidants (Vitamin A, C, E, Beta – carotene, selenium etc.) which protect the human body from free radical damage.

Crash diets are modified diets undertaken on an urgent short-term basis with an aim of achieving rapid weights loss, improving blood sugar control etc. There are multiple crash diets that have sprung up recently and the most popular ones are low carbohydrate diets (Atkins, Zone diet), high fat diets (Ketogenic diet), low glycemic index diet, high protein diet (Paleo diet) and liquid diet. A crash diet is similar to a crash course wherein one cuts off either the fat and/or the carbohydrate intake and thus the calorie amount is drastically decreased (600 – 800 kcals/day instead of 1500-2000 kcals/day).

Crash diets often appear to be working in the immediate term. The diet sends signals to our body to get into starvation mode, where we will experience rapid onset of weight loss, which is mostly due to decrease in muscle mass and not the fat mass.

It is important to note that crash diets carry both short term and long term health risks. The most common short term risk is nutritional deficiency. Carbohydrates are the body’s main source of energy and restricting them completely can cause hypoglycaemia. Food devoid of carbohydrates is going to be low in fibre as well, leading to constipation and infection in the digestive tract.

Long-term risks of crash diets include damage to the brain, kidney, heart and other vital organs. Some established complications are:

  1. Eating disorder
  2. Metabolic disorder
  3. Anxiety
  4. Depression
  5. Muscle loss
  6. Compromised immunity
  7. Impaired brain function
  8. Weak bones
  9. Poor attention span
  10. Hair loss
  11. Skin problems
  12. Dehydration
  13. Cardiac failure
  14. Renal failure

False claims made by crash diet proponents:

Rapid weight loss – In reality, you won’t lose fat but rather lose muscle, bone and water

Restricting or over – Consuming of foods groups–It is better to avoid diets that severely restrict food groups or allow you to eat unlimited quantities of certain foods

Combining foods – There is no evidence that combining certain foods enhances weight loss; eg; Cinnamon powder drink and other preparations

Exercise not necessary –The truth is without adequate exercise the weight you lose will come right back

Crash diet leads to heart diseases:

Crash diet is harmful for our heart health too. In my experience at Cardiac Wellness Institute, I have cared for individuals who were diagnosed with severe coronary blocks after following high-fat diets for a few months and for others who have had several attempts at crash diets for weight loss and had multiple nutritional deficiencies.

Research has shown that individuals on a very low calorie diet suffered heart failure. Low calorie diet can causes abnormal heart rhythms that can be fatal when body levels of magnesium or potassium dropped in susceptible individuals. Excessive dieting can cause cardiac stress, potentially leading to heart attack. Every individual should consume a nutrient dense diet that includes vitamins, minerals, proteins and whole grains in order to control weight, cholesterol, blood pressure and blood sugar.

I would like to conclude that crash diets are not scientifically backed and are almost always harmful in the long run. Medical research clearly indicates that eating the right kind of food in a balanced fashion helps to prevent many health problems like heart disease and cancers, the two leading causes of death worldwide.

Losing weight is best achieved by following a calorie deficit balanced diet, where calories are lost by burning more calories than is consumed. Choosing whole foods and fibre-rich foods and exercising adequately with a positive mental attitude will help to improve fitness and achieve ideal body weight. Again, losing weight should not be the goal; instead, weight loss should be the side effect of following a healthy lifestyle.

Health Information in Tamil to Prevent Coronavirus

உலகம் முழுவதும் பரவிக்கொண்டிருக்கும் கொரோனாவைரஸின் தாக்கத்தைப்பற்றியும் அதை எப்படி தடுத்துக்கொள்ளலாம் என்பதைப்பற்றியும் சில ஆதாரபூர்வமான உண்மைகளை இங்கே பகிர்ந்துகொள்கிறேன்.

  1. பதட்டம் பயம் பீதி வேண்டாம்

பதட்டம் பயம் பீதி ஆகியவை ஏற்பட்டால் நம் நோய் எதிர்ப்புசக்தி குறைந்து நாமே நோயும் அதைச்சார்ந்த வதந்திகளும் பரவுவதற்கு காரணமாகிவிடுவோம்.

2. தடுப்பு முறைகளை கையாளவேண்டும்

தமிழ்நாட்டு அரசும் மத்திய அரசும் வெளியிடும் அனைத்து தடுப்பு முறைகளையும் நாம் அனைவரும் கையாளவேண்டும். கொரோனாவைரஸ் இருமல் தும்மல் மூலம் பரவுவதால் இந்த அறிகுறிகள் இருப்பவர்களடிமிருந்து தள்ளி இருக்கவேண்டும். சோப்பும் தண்ணீரும் அல்லது சானிடைசர் உபயோகித்து அடிக்கடி கைகளை நன்றாக சுத்தம் செய்யவேண்டும். மேலும் முகத்தை கையால் தேவையின்றி தொடக்கூடாது. நம்மை நாமே வீட்டுக்குள் தனிமைப்படுத்தி வெளியில் செல்வதை தவிர்த்துவிட்டால் நோய் பரவுவதை தடுத்துவிடலாம்.

3. ஏற்கனவே பிறநோய்கள் உள்ளவர்கள் மிகவும் எச்சரிக்கையாக இருக்கவேண்டும்

இதயம், நுரையீரல் மற்றும் சிறுநீரக நோய், சர்க்கரை வியாதி, ரத்தக்கொதிப்பு, கான்செர் போன்ற நோய் உள்ளவர்கள் மேற்கண்ட தடுப்புமுறைகளை தீவிரமாக கடைப்பிடிக்கவேண்டும். உங்கள் மருத்துவரின் ஆலோசனையின்றி எந்த மருந்தையும் நிறுத்தாதீர்கள். காய்ச்சல், இருமல், மூச்சுத்திணறல் ஏற்பட்டால் உடனடியாக மருத்துவமனையை அணுகுங்கள்.

4. வீட்டில் பின்பற்றவேண்டிய ஆரோக்கிய வழிமுறைகள்

நோய் எதிர்ப்புசக்தியைக்கூட்டும் உணவுகள் அதாவது வைடமின் ஏ, சி, இ உள்ள காரட், கீரைகள், பப்பாளி, நெல்லிக்காய், ஆரஞ்சு, பருப்புகள் மற்றும் கொட்டைகள் இவற்றை உணவில் சேர்த்துக்கொள்ளுங்கள். தினமும் அரை மணி நேரத்திலிருந்து ஒரு மணி நேரம் வரை மொட்டைமாடியில் நடத்தல், படி ஏறி இறங்குதல், யோகா, நடனம், மூச்சுப்பயிச்சி போன்ற உடற்பயிச்சிகளை செய்யுங்கள். மனதை அமைதியாக வைத்துக்கொள்ள நீங்கள் விரும்பிய பொழுதுபோக்கு அம்சங்களை வீட்டிலிருந்தபடியே பின்பற்றுங்கள்.

5. வதந்திகளை நம்பாதீர்கள், பரப்பாதீர்கள்

சமூக வலைத்தளங்களில் வெளியாகும் வதந்திகளை நம்பவும் கூடாது, அவற்றை மற்றோருக்கு ஷேர் செய்யவும் கூடாது. உங்களுக்கு கேள்விகளோ சந்தேகங்களோ ஏற்பட்டால் எங்கள் மருத்துவ குழுவை தொலைபேசி அல்லது மின்னஞ்சல் மூலம் தொடர்புகொள்ளலாம்; +91 44 43192828; +91 99404 08828; info@cardiacwellnessinstitute.com

Metabolic Syndrome is a threat to heart health

At our centre, we regularly come across individuals with multiple health problems, particularly those related to heart disease. Very often, they need robust prevention and rehabilitation programs to help improve their physical, physiological and psychosocial wellbeing.

One such condition which we encounter commonly these days is “Metabolic Syndrome”. As the name suggests it is a combination of multiple risk factors of heart disease such as abdominal obesity, high blood pressure, increased blood sugar level and abnormal cholesterol level. This condition is growing in number day by day in India and expected to grow exponentially across the globe. The fact that several risk factors are present in the same individuals puts them at a very high risk of heart attack and stroke.

Based on multiple research findings, the rise in the incidence of obesity and diabetes was found to be the main reason behind the increase in metabolic syndrome. Also, the younger population, that is individuals between 25 and 35 years of age, are most affected suggesting that it is high time the youngsters take note of it!

The criteria for diagnosing Metabolic Syndrome as per the International Diabetes Federation guidelines in 2006 are:

  • Higher waist circumference – more than 102cm for men; more than 88 cm for women & higher BMI
  • Increased blood sugar level – more than 100 mg/dL
  • Abnormal cholesterol levels – increased triglycerides and decreased High-Density Lipoprotein
  • Increased blood pressure – more than 130/85 mmHg
Obesity
Diabetes
Unhealthy Diet

The unhealthy lifestyle choices of our people such as

  • Physical inactivity
  • Unhealthy diet
  • Chronic stress
  • Disturbed sleep pattern
  • Increase in tobacco and alcohol consumption

are the culprits causing this sudden surge in metabolic syndrome.

One important fact to be highlighted here is that all the above risk factors are interrelated which means that the occurrence of any one of the risk factors could pave way for the others as well.

If an individual has been diagnosed with metabolic syndrome, the following management should be initiated at the earliest:

1. Intensive lifestyle modification

An intensive lifestyle modification program is the first and only step in fighting metabolic syndrome, especially in individuals who are young, whose blood pressure, blood sugar and cholesterol levels are borderline elevated and who are free of organ damage. The program typically consists of health education about the condition and its effect on the body, tailor-made exercise training which focuses on controlling blood pressure, lowering blood sugar and cholesterol levels and education about the importance of exercise, along with personalized dietary guidance. Psychosocial counselling to help individuals cope better with their mental stress and emotional problems is also included in the program.

Importance of Exercise Training in Metabolic Syndrome

Exercise training is the cornerstone in the lifestyle program because of its multiple benefits:

Aerobic Training

  • Helps to improve endurance and stamina
  • Results in fat and carbs being used up as calories
  • Lowers blood sugar, normalises cholesterol level and also controls blood pressure
  • Aids in weight loss

If you are wondering how much aerobic exercise is adequate, here is my recommendation:

Frequency Intensity Duration Type
5-7 days/week Mild to moderate Intensity 30-60 minutes/day walking, jogging, cycling, swimming, hiking, treadmill,
EFX

Strength Training

  • Helps to improve muscle strength and power
  • Aids in calorie expenditure and weight loss
  • Increases muscle mass and reduces fat mass
  • Can be done with the help of equipment or use of bodyweight too

Guidelines for strength training:

Frequency Intensity Duration   Type
2-3 days/week Mild to moderate Intensity 20-30 minutes/day Bodyweight (push-ups, pull-ups, squats), dumbbells, barbells,
machine-based

Other types of exercise training such as flexibility training, interval training and circuit training can be incorporated in the exercise program as per the individuals’ needs and health goals.

2. Medications

In individuals with advanced metabolic syndrome, that is high levels of blood sugar, abnormal cholesterol and uncontrolled blood pressure, medications such as anti-diabetic drugs, anti-hypertensive drugs and cholesterol-lowering drugs should be initiated along with the lifestyle intervention.

3. Surgery

Fat-reduction surgery or bariatric surgery is sometimes needed to address severe obesity especially if it does not respond to lifestyle changes and medications.

As metabolic syndrome is on the rise and so is the incidence of heart attack and stroke, we need to adopt a healthy lifestyle that includes regular exercise, balanced diet, well-managed stress and adequate sleep, along with regular medical checks. It is never too early and never too late to make a change that will improve your health and your overall wellbeing.

Sitting is the new smoking

If you are someone who sits for long hours, either for work or for leisure, this is a must read for you. Recent studies have shown that sitting at a desk, in front of a television, on the couch etc. for extended periods of time is associated with increased risk of hypertension, diabetes, obesity, cancer and heart disease.

But why is sitting compared with smoking? We all know that smoking is extremely harmful, to the extent that each cigarette is considered as lethal as a bullet. Is sitting also that sinister? Let’s look at some recent trends to better understand sitting and it’s harmful effects and changes we can adopt to minimize the harm.

Work trends

A majority of the youngsters today are working in environments that require long hours of sitting. Computer professionals, bank employees, public service cadres, teachers, medical professionals, call-centre agents, drivers, the list goes on. Number of hours of sitting ranges from 4-8 hours per day for most of them which adds up to almost 30-40 hours of sitting a week. And in their non-working hours, they choose to sit some more to watch television, surf the Internet and socialize over drinks and dinner.

In fact, the risk of heart attack and stroke is much higher in Indians in their 20s and 30s as compared to the western population where it is still a disease of the older age group. A combination of unhealthy lifestyle choices and genetic predisposition underlies this health hazard and prolonged sitting or physical inactivity or less movement is definitely a contributor.

One of the popular solutions has been standing workstations where you stand and work instead of sitting and working. However, standing for long periods of time also has its disadvantages and can lead to varicose veins, foot pain etc. Hence a combination of sit/stand work environment with adequate movement every 30 minutes is what we should aim for. Walking meetings are a welcome trend for small group meetings, phone discussions and conference calls.

Workstation exercises are a set of exercises that individuals do in their work spots every few hours for a duration of 10-15 minutes to relieve the stress of working and to refresh the body and mind. We, at Cardiac Wellness Institute, take pride in providing tailored workplace health and wellness interventions for organizations.

Fitness focus

You would agree with me in my observation that Indians tend to associate movement, activity, exercise, sports and fitness with their growing-up years and then put a full stop to it. As we enter into adulthood, into work routines and start a family of our own, we become less interested in and less motivated to pursue our passion for sports or active hobbies and blame it on the lack of time.

While it is challenging to juggle responsibilities like kids, work, social demands and personal wants, it is not impossible to be active throughout the day. All seated activities should be limited to short bouts of 30 minutes or so and interspersed with stretches, minor exercises and walking breaks as permitted by the work you are engaged in.

A sustainable way to incorporate fitness in the workplace is to form activity groups or clubs and work together as a unit. Running clubs, bicycling events and swim teams are some examples of likeminded individuals pursuing active hobbies in the workplace and this is a welcome change in organizations these days.

Healthy Ageing

As we age, we need to be more active both physically and mentally to counter the slowing metabolism, weakening of bones, the psychological setback of old-age and the neurodegenerative conditions like dementia and memory loss. Sitting should not be the default posture in our retired days, instead it should be a few minutes of sitting in between household chores, outdoor activities and active hobbies.

In case you are forced to sit for long hours due to mobility issues or joint pain, it is advisable to keep moving the neck, torso, upper limbs and lower limbs at frequent intervals to improve circulation, prevent muscle wasting and strengthen muscles.

In conclusion, smoking has devastating effects on our health and is to be completely and totally avoided. Sitting however is not so dangerous for us but the associated lack of exercise leading to heart attack and other chronic ailments is the bigger health concern facing humanity today. As a strong proponent of mindfulness, I would recommend mindful sitting which simply means being aware of our seated posture and sitting straight, doing some exercises while sitting and grabbing any opportunity to break that long sit.

Sit less, move more and live a healthy life!

Healthy eating resolutions for 2020

A new year often signifies a fresh start for many people. For some, this means starting an exercise routine, losing weight or following a healthier diet. It is important to remember that our diet pattern has the power to reduce the risk of chronic diseases over our lifetime and together with a healthy lifestyle it is extremely important to prevent illness.

Very often, within a few weeks of setting our new year health and wellness resolutions, we realise that they are unsustainable due to multiple reasons like work and family commitments, inability to take time off our busy schedules, failure to prioritise our health etc. and we end up breaking our resolutions. Thus we find ourselves making the same resolutions year after year. To break that cycle, we need to make resolutions that can not only improve health but also be followed in our day to day lives. The secret is to set simple and easy goals that are easy to follow and are also sustainable.

Here are some examples of attainable and sustainable healthy eating resolutions:

Goal No 1: Eat out less often

During peak working days and holidays, people eat out a lot at restaurants or other roadside shops due to work demands and lack of time to cook meals. When you eat out, you have less control over what you are actually eating. Moreover, a kind of addiction develops to the outside food, ultimately leading to consuming extra fat, salt, and sugar on a daily basis. Try to avoid or minimise the consumption of outside foods.

Goal No 2: Reduce your added sugar intake, little by little

Added sugars are sugars added during the making of processed (packaged) food and drinks and the sugar we add to our home-made beverages and dishes. Added sugar should be cut down gradually as it causes serious health issues, including diabetes, obesity, heart disease, high triglyceride levels and low HDL (good) cholesterol levels.

Goal No 3: Add veggies to your breakfast

One health-protective habit is to fill half of every plate or bowl with non-starchy veggies. For most people that is easier to do for lunch and dinner than for breakfast. So try to incorporate one serving (that is 80 grams) of vegetables in your breakfast meal.

Goal No 4: Eat two cups of fruits

Fruits are loaded with antioxidants, vitamins and nutrients. High fibre in fruits helps to regulate body metabolism. It is advisable to consume at least 2 cups of fruits (that is 150 – 200 grams) daily.

Goal No 5: Incorporate more probiotics and prebiotics into your diet

Prebiotics are natural, non-digestible food components that are linked to promoting the growth of beneficial bacteria in your gut. The best choices are bananas, onions, garlic, leeks, asparagus, artichokes, soybeans, and whole-wheat bread. Probiotics are active cultures that help change or repopulate intestinal bacteria to balance gut flora. Consuming probiotics may boost immunity and improve overall gut health and the best sources are yoghurt, kefir, kimchi and sauerkraut. Having a combination of prebiotics and probiotics in our diet can be a very powerful step to improving our overall health.

Simple tips for a healthier diet and lifestyle

  • Drink at least 1.5 litres to 2 litres of water per day
  • Follow mindful eating, that is chew food properly, eat slowly and avoid watching any screen/gadgets while eating
  • Aim to eat five servings of fruits and vegetables every day; add more colour in your meals with plant-based foods
  • Include whole grains instead of refined ones
  • Say no to junk foods, processed and preserved foods which are high in trans fat, preservatives, salt and sugar
  • Read the food labels and choose foods that are low fat, fat-free, no added sugar, zero trans fat and no preservatives
  • Try to include small, healthy meals; do not skip meals especially your breakfast
  • Aim for good quality sleep of around 7-8 hours per day

Setting small, sustainable, realistic goals is really the key to success in making habit changes. Any simple diet change is easier if we take slow and small steps. Resolve to make a few small resolutions this year and then just watch how far you go. If you or your loved ones have been diagnosed with heart disease, we recommend that you consult your dietician or your healthcare team to get guidance on the most relevant diet goals for your health condition.

Healthy diet, adequate exercise, sufficient sleep and well-managed stress levels together help to enhance our health and the quality of life. So go ahead and set some simple and achievable goals for a healthy body and mind. Be in the present, avoid distractions, savour every bite and enjoy every meal!

Pursuing your fitness goals after a cardiac diagnosis

Everyone of us wants to lead a healthy and happy life. We like to be fit and active and avoid being sick or afflicted with disease. There is no doubt that any chronic health problem brings with it physical and mental strain due to the need for multiple drug therapy, surgical treatment and other invasive procedures. In fact, very often our fitness goals and competitive attitude take a back seat when diagnosed with cardiovascular or cardiometabolic diseases like heart attack, hypertension or diabetes.

Everyday, we at Cardiac Wellness Institute meet clients of different fitness levels with a recent cardiac diagnosis, angioplasty or bypass surgery. Some of them are depressed and disheartened that they will be unable to run the marathon they had signed up for or continue their passion for sports like swimming or cycling. It is during their personalised cardiac rehabilitation with our team that they begin to believe in themselves and that they can actually achieve their goals.

Let me share some real-life examples with you.

A 45-year old entrepreneur based in Delhi suffered a massive heart attack and immediately underwent an angioplasty where a stent was placed to restore blood supply to the heart. He was married and had a young child. He was worried and anxious about returning to work, leading a normal life and the impact this disease would have on his future wellbeing. He enrolled in our Home-based Cardiac Rehabilitation program right after his procedure and we initiated him on smoking cessation, dietary modification and graded exercise training. He was counselled about getting back to work gradually, about coping with the stress of a cardiac condition, about resuming normal sexual activities and about the actions and side effects of medications.

He had been a physically fit person aiming to participate in marathons when the heart attack had struck suddenly. After about 20 months of cardiac rehab, he is a very confident man who understands that his medical condition is not a barrier for his dream of participating in marathons. He trains regularly covering all aspects of fitness namely aerobic exercise, overall strength and core fitness. He eats a heart-healthy diet, manages his stress levels well and leads a normal work life and social life. His motto has been “try, try, try until you succeed”.

A 58-year old advocate, social activist, organic farmer and a badminton enthusiast suffered a heart attack for which he underwent bypass surgery. He had a poorly functioning heart as a result of the heart attack and that caused him great anxiety. His dream was very simple – to get back to his active life at the earliest. He enrolled in our Cardiac rehabilitation program after a month of bypass surgery and has been extremely consistent in following our exercise training, dietary advice, education sessions and psychological counselling. He was very glad that his physical stamina, exercise capacity, blood pressure control and cardiac function all showed improvement within 3 months.

After completing his intensive rehab program, he signed up for the monthly maintenance program with us and goes to a fitness centre near his residence regularly. He is back in action with more energy and confidence in his daily routine and says, “I believe in things that help me to do better. Regular exercise, appropriate diet and keeping the mind healthy are among them”.

It is clear from the above stories that cardiac rehabilitation can help individuals with heart problems achieve their fitness goals. Some things to be kept in mind are:

  • An expert rehab team has to assess your fitness level, medical history and presence of signs and symptoms prior to enrolling you in a rehab program and giving you an exercise prescription
  • You have to start with mild to moderate intensity exercise with adequate intervals between each exercise and then increase the intensity gradually
  • If you are passionate about running, cycling, swimming, hiking etc. guidance of a fitness instructor or physiotherapist with adequate knowledge about cardiovascular physiology will help
  • Taking care of your emotional wellbeing through psychosocial counselling is very important to help you overcome your fears and chase your dreams

In conclusion, performing exercises the right way, eating the right type of food, keeping your mindset positive and avoiding tobacco and alcohol are keys to overcoming your cardiac ailments and leading a healthy life. Dreams are meant to come true and goals are meant to be fulfilled irrespective of your health barriers; the right guidance is all you need.

The 9 cardiovascular risk factors we should watch out for

As a Preventive Cardiologist, the question I get asked most often is this:

“I (or someone I know) have no bad habits and have not had any health problems in the past, but ended up with a heart attack. How come doctor?”

My immediate response is that there are 9 risk factors for serious heart and blood vessel disorders like heart attack and stroke. In fact, each of these 9 are independent risk factors which can cause disease by itself and when present in combination poses a very high risk of fatal heart disease.

The 9 cardiovascular risk factors: The Framingham (1) and the INTERHEART (2) studies are both landmark research works that have clearly identified the cardiovascular risk factors in all populations. The image below depicts the 9 risk factors that we should all be aware of and should watch out for.

A questionnaire-based survey was conducted this World Heart Day by Cardiac Wellness Institute to study the presence of behavioural risk factors for heart disease among college-going women in Chennai. Of the 554 students aged 15-30 years who responded to this survey, almost 40% reported to be chronically stressed. We have also noted a similar trend of staggeringly high rates of chronic mental stress among young corporate employees. Intensive lifestyle modification supervised by medical professionals has proven effective in changing dietary, exercise, sleep and stress-related risk factors in all age groups including young adults.

Hypertension, Diabetes and Dyslipidemia are the three silent killers which can only be identified by routine health check up. All 3 conditions often co-exist in the same individual but do not cause any symptoms leading to a very high risk of sudden death. Simple tests like blood pressure measurement and blood sugar and lipid level analysis will throw light on your risk profile. Mild variations from normal and early stage of disease can be managed with lifestyle changes alone but more severe abnormalities will require medications in addition to lifestyle changes.

Unhealthy diet, Inadequate exercise, Obesity, Mental stress along with tobacco use and alcohol abuse are the risk factors that are soaring high in our population. Spreading awareness about the ill-effects of these lifestyle choices is the first step in curbing them. The second and most crucial step is providing the right tools to help people modify their risky behaviour. Exercise training, meal planning guidelines, stress management techniques, goal-setting to become fit, and professional help to quit smoking and drinking are some ways we help individuals succeed in making these difficult but salient changes that impact their health in a very positive way.

If you have a family history of cardiovascular disease, that is your parents or siblings have had a heart attack, stroke or other cardiac problems, you need to be even more vigilant about the 9 risk factors and take all steps to lead a heart-healthy lifestyle.

Action Point 1 If you are over 40 years old and have not had a medical check yet, it is time you saw your doctor for a cardiovascular risk assessment. If you have had a doctor check up more than 2 years ago, you need to repeat one now.

Action Point 2 If you are over 20 years old and think you have 1 or more of the above risk factors, you should get a doctor’s opinion and blood examination every 5 years.

Action Point 3 If you have been taking medicines for any of the above risk factors, you need to revisit the problem along with your doctor to understand the response to medications and the need for lifestyle modification to reduce and eventually even stop medicines if all parameters are well controlled.

The truth behind Ketogenic diet

Obesity is a major health issue worldwide and increases the risk of several chronic conditions, including cardiovascular disease, hypertension, diabetes, and cancer. In recent times two types of diets have been for weight loss – Ketogenic diet and Paleo diet. Ketogenic (or keto) diets are characterized by a marked reduction in carbohydrates (usually to <50 g/day) and a relative increase in the proportions of protein and fat. The Ketogenic diet comprises of 70-80% fat, 5-10% carbohydrate and 10-20% protein, while the Paleo diet has 30% protein, 40% fat (from mostly monounsaturated and polyunsaturated fats) and 30% carbohydrates. This varies from a normal diet that comprises of 20-35% fat, 45-65% carbohydrate and 10-35% protein.

How the body handles a ketogenic diet

In our body glucose is the main source of energy for all cells and is obtained by consuming carbohydrates rich foods. The hormone Insulin is responsible for the proper use of glucose as a source of energy by the body. When carbohydrate consumption is low initially glucose in the muscles gets utilized and later stored glucose from the liver is used up for energy. If this scenario continues for 3 to 4 days and once stored glucose is fully depleted, blood levels of insulin hormone decreases and the body begins to use fat as its primary fuel. The liver produces ketone bodies from fat, which are used in the absence of glucose. When ketone bodies accumulate in the blood, this is called ketosis. Healthy individuals naturally experience mild ketosis during fasting and very hard exercise.

What to eat and what to avoid in a Ketogenic diet?

Healthy vegetables and fruits that are rich in natural sugars and carbohydrates are limited in this diet.

Foods included in the keto diet are:

  • Chicken, turkey, beef, pork, lamb,
  • Fish and seafood, especially fatty fish like salmon, sardines, tuna and mackerel
  • Eggs and whole milk
  • Nuts and oil seeds
  • Whole milk cheese, butter, paneer, yogurt
  • Avocados

Foods to be avoided in a keto diet are:

  • Cereals and Grains (e.g. rice, oatmeal)
  • Starchy vegetables, including corn, potatoes, and peas
  • Low-fat dairy products
  • Most fruits, except for lemons, tomatoes and berries
  • Pulses and legumes (Beans, peas, lentils)
  • Sugary (Juice and soda) and alcoholic beverages (wine, beer, and sweetened cocktails)
  • Snack foods, such as potato chips, pretzels, and crackers

Benefits versus Harms

Some immediate benefits of a Ketogenic diet are weight loss, reduced blood glucose level and increase in muscle mass. However, an increase in LDL or bad cholesterol, blocks in the coronary arteries due to excessive fat consumption, renal failure and liver dysfunction due to fat accumulation in the liver have been identified as the harmful effects of this diet.

Prolonged Ketogenic diet causes the following side effects in the body

  1. Constipation
  2. Dehydration and loss of electrolytes
  3. Kidney stones
  4. Hypoglycemia
  5. Bad breath
  6. Nutritional deficiencies
  7. High Cholesterol and an Increased Risk for Heart Disease
  8. Several vitamin and mineral deficiencies, decreased bone mineral density, and gastrointestinal distress
  9. People with kidney disease or a history of disordered eating should avoid the diet, and people with type 1 diabetes may want to avoid it

Ketogenic diet may be associated with some improvements in obesity, type 2 diabetes and HDL cholesterol levels, but these effects are usually short lived. Insulin resistance is also a potential negative effect.

If you’re at risk for heart disease, one overarching factor to consider is that the keto diet is restrictive, and it’s tough to stick to a restrictive diet. People go on keto and in the short term lose a lot of weight, but it’s not sustainable. So when they go off from keto, they regain the weight back. This yo-yoing or up and down effect of body weight is also not healthy in the long run.

In summary, the ketogenic diet is not free of side effects. Eating a well-balanced diet which includes all the food groups, that is moderate carbohydrate with high fiber foods such as fruits, vegetables and whole grains, healthy fats and proteins along with adequate water intake helps to achieve health goals without any complications. One should always talk to their doctor before beginning any new diet and also consult a dietitian to ensure they are getting enough nutrients through diet to keep them healthy and free from disease.

An introduction to HIIT

In spite of the strong medical evidence for the positive role of exercise in preventing and reversing obesity, diabetes, hypertension, dyslipidemia, heart diseases and stroke, not many are able to incorporate regular exercise into their busy lifestyles.

Due to time constraints and workplace issues, interval training might be the answer for the younger generation. Interval training is a type of exercise training, which involves periods of intense exercise and recovery. High Intensity Interval Training (HIIT) is a type of interval training that has been investigated a lot in the recent past and has shown promise both in heart disease prevention as well as in cardiac rehabilitation programs.

HIIT involves short bouts of high intensity exercises, with recovery periods that involve mild intensity exercises. There are different types of HIIT regimes, but the basic algorithm is to have a good warm up, short bouts of the combination of high and low intensity exercises for a time period and cool down.

Sample HIIT regime

5-minute warm up + [(4-minute high intensity exercise& 1-minute low intensity exercise) x 4 times = 20 minutes HIIT] + 5-minute cool down

This is different from Moderate Intensity Continuous Training (MICT) which has been followed for a very long time with well established evidence, in the following ways:

  • HIIT duration is relatively shorter than MICT (20 minutes vs 30 minutes)
  • Calorie expenditure is higher in HIIT than MICT
  • HIIT aids in weight loss and increasing muscle mass at a faster rate than MICT
  • HIIT is applicable for both aerobic training as well as resistance training

However, prior to enrolling in a HIIT program, there are some things to be considered:

  • An individual should be following at-least a mild to moderate intensity exercise regime for 2 months before starting HIIT, so it’s not for those of you who are beginners to exercise
  • It is advisable to have a fitness instructor or a physiotherapist initiate the HIIT and monitor you in the early stages
  • If you are a healthcare professional, remember to assess the physical activity level and exercise capacity of your client prior to initiating HIIT

Every exercise regime has some limitations, some of the disadvantages in HIIT are:

  • It is not advisable for high risk individuals (uncontrolled hypertension, angina, arrhythmias, valve stenosis, pulmonary complications, recent heart attack, exercise intolerance) and senior citizens
  • Chances for injury are higher in HIIT if adequate warm up and cool down aren’t done
  • The recovery period for a HIIT program is comparatively longer than other training, which might affect one’s adherence

With this introduction to HIIT, my aim as a cardiac physiotherapist is to help each and every one of you out there find the exercise regimen that best suits your health, work and lifestyle requirements. The secret to success is being regular with your exercise over continuing periods of time and enjoying every bit of it!

The role of plant-based diet in cardiac care

A healthy vegetarian or plant-based diet is a way of eating that emphasizes on a higher intake of fruits and vegetables, whole grains, pulses and nuts and a lower or zero intakes of animal-based foods (lamb, pork, chicken etc). The important message here is a plant-based diet can also be unhealthy if rich in refined grains (like white rice, white bread and maida products) and deficient in fruits and veggies.

Multiple studies have shown that eating more plant-based healthy foods reduces the risk of incidence and severity of cardiac disorders and protects the heart mainly because they contain zero dietary cholesterol, low saturated fat and more fibre. However, overconsumption of vegetable oils (more than 5 teaspoons per day), seeds and nuts and refined sugars can lead to abnormal blood cholesterol and triglyceride levels.

On the other hand, red meats and organ meats are rich in saturated fat and cholesterol so should be avoided or kept to a minimum. Fish, especially oily fish, are rich in healthy fats and can be included in your diet provided they are not deep-fried.

There are different types of plant-based diets such as the Mediterranean diet, the vegan diet, the DASH diet (Dietary Approaches to Stop Hypertension) and the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay). These diets emphasize on certain foods that are associated with heart disease eg. Whole grains, fruits and vegetables, nuts, seeds, oils, legumes, and beans and a minimal amount of low-fat dairy and non-vegetarian products (fish, egg, lean meat, chicken).

Health benefits of plant-based diet:

  • Plant-based fruits and vegetables are loaded with vitamins and minerals
  • Fruits and vegetables consist of antioxidants, which helps to control cell damage and the inflammation in arteries
  • Proteins from non-vegetarian foods consist of increased saturated fat whereas from plant sources (nuts, pulses, legumes) has only a minimal amount of saturated fat
  • A plant-based diet is also beneficial for individuals with high blood pressure and high cholesterol as it offers all the essential nutrients such as carbohydrates, protein, fats, vitamins and minerals for optimal health, and are higher in phytonutrients (Carotenoids, ‎Flavonoids).
  • Healthy and balanced plant-based plate are essential to control many disorders like diabetes, hypertension, obesity, heart disease and cancers.

Remember, a plant-based diet is not always healthy, particularly as

  • Deep-fried and preserved foods
  • Excessive saturated fat, sugar and salt from any source
  • Plant-based fast foods and snacks like veggie burgers, pizza and fries and chips.

If you have been eating non-vegetarian food regularly and a plant-based diet is difficult to follow for you, then begin small. A moderate change in your diet, such as lowering your meat intake by one to two servings per day and replacing it with legumes or nuts as your protein source, can have a lasting positive impact on your health.

Thus a vegetarian diet is healthy, nutritionally adequate and may provide health benefits for the prevention and treatment of certain diseases. Like any diet, a vegetarian diet should be part of an overall healthy lifestyle, which includes adequate exercise and excludes smoking and drinking excess alcohol. It is not necessary to go full vegetarian or vegan to get the best heart health benefits. The focus should be on eating the right foods, avoiding the wrong kind and moderating the intake of healthier animal products (egg, country chicken and fish). As a purely vegetarian diet is low in iron, vitamin D, B12and calcium, the inclusion of 1-2 servings of animal sources or plant-based foods fortified with these essential nutrients helps to overcome these deficiencies.

The chest pain checklist

The aim of this blog post is to provide you, our dear reader, some important facts and points about chest pain and thereby empower you to take the right decision when you or your loved one encounters it.

Chest pain is probably the most feared of all pains, mainly due to its association with heart problems. In fact, it is the second most common reason for presenting to the hospital emergency department across the globe (injury being the leading cause). Here are 5 common causes of chest pain and some tips to differentiate one from the other:

  1. Gastric acidity or heartburn
  2. Heart attack or angina
  3. Lung related causes
  4. Musculoskeletal problems
  5. Neurological pain

Gastric acidity or heartburn

Gastric acidity is also referred to as heartburn because it causes a burning sensation in the middle portion of the chest, typically behind the chest bone. The rising up of gastric juices from the stomach to the tube connecting the mouth and stomach (esophagus) and irritation of the inner lining of the tube is the cause for this burning sensation.

A few indicators of heartburn are:

  • Timing of the pain – the pain might occur before a meal if you often have untimely meals or skip meals
  • Association with food types – heavy meals or food with excessive oil and spice might trigger the discomfort
  • Response to antacids – if the pain or burning sensation subsides with over-the-counter liquids or tablets for acidity, it is likely a heartburn

Heart attack or angina

Chest pain due to cardiac causes can be very severe and sinister. It is important to know that the following causes may lead to cardiac related chest pain:

  • Sudden unbearable pain in the chest or upper part of the body due to a complete block of the blood vessel supplying the heart (myocardial infarction or heart attack)
  • A gradually building up chest pain which worsens during exercise or emotional bursts and gets relieved with rest or relaxation is called angina and is due to poor blood supply to the heart
  • A stabbing or piercing pain of the chest may be due to a tear of the major blood vessel leaving the heart or disease of the covering of the heart

Note: As heartburn and heart attack pain can mimic each other, it is best to see a doctor and get an electrocardiogram or ECG test at the earliest. Also, a healthy lifestyle which includes a balanced healthy diet in a timely manner, regular exercise and stress relieving techniques such as yoga, meditation and deep breathing, is extremely effective in keeping both heart related and gastric acidity related problems at bay.

Lung related causes

A few conditions like infection of the lungs, inflammation of the covering layer of the lungs, block in the artery supplying blood to the lungs and high blood pressure in the blood vessels carrying blood to the lungs can cause chest pain. The clues here are pain that worsens with deep breathing or coughing and at times associated with shortness of breath. As some of the causes are potentially lethal, it is imperative to consult a physician if the pain is severe or associated with difficulty breathing.

Musculoskeletal problems

Injuries to the muscles in the chest region or the ribs and the surrounding cartilages can cause chest pain. Pain on pressing a particular spot, also called tenderness, is an indicator of an underlying soft tissue or bony problem. The pain usually gets better with application of cold or hot fomentation or with anti-inflammatory drugs if it is soft tissue related.

Neurological pain

Any radiating pain in the neck, upper chest, upper back and arm can be due to nerve compression. The severity of pain may be more with upper body and arm movements and may be associated with other symptoms like tingling sensation, numbness etc.

Panic attack is another well-known cause of chest pain. You might not have any of the problems mentioned above but may experience a severe chest pain together with intense fear, rapid heartbeat, rapid breathing, profuse sweating, nausea and dizziness.

Shingles or herpes zoster infection of the chest region can cause a severe chest pain along with a band of blisters from the back to the front of the chest.

While chest pain may be due a variety of causes, cardiac and certain lung causes may be life threatening and should be addressed immediately without any time delay. So, here is the checklist for someone experiencing chest pain:

  • Is this a new-onset pain?
  • Is the pain severe or unbearable?
  • Is the pain radiating (spreading from one point to other areas)?
  • Is the pain associated with exercise or emotions?
  • Is the pain associated with meals, cough, deep breathing etc?
  • Is the pain getting better with over-the-counter drugs?
  • Is the pain lasting for days to weeks?
  • Is the pain getting better with local application of muscle relaxants or cold/hot fomentation?

While this post may come in handy when someone you know has chest pain, we strongly recommend consulting your physician to rule out serious medical conditions.

Are Fitness Apps and Devices safe for everyone?

The world today is more digital than it has ever been before! Smart phones and the associated apps have become an integral part of our work lives, family lives and social lives. People often use fitness apps for exercising these days. Let us take a look at some of the benefits and harms of this trend.

Fitness apps help us exercise better in the following ways:

  • Provide multiple exercise options and range of exercises for individuals who exercise on a regular basis (abdominal exercises, core strengthening, etc)
  • Provide reminders to help us stick to our exercise routine
  • Monitor key parameters like heart rate, steps per day and calorie intake and calorie expenditure and helps keep track of these numbers over time.
  • Help us work on different aspects such as aerobic exercises, strength training, interval training, circuit training and on particular areas like core muscles, upper limbs etc. if necessary

Even though fitness apps and devices help us exercise ourselves without the need for someone to supervise us, there are a few things that we should be aware of before starting to use one of these.

  • Anyone new to exercise should have a medical evaluation for underlying conditions like diabetes, hypertension and obesity as the fitness app or device will not scan for these conditions
  • When beginners indulge in strength training or vigorous intensity exercises without assessing their muscle strength and endurance, it may lead to injury of muscles, ligaments and joints if not done the right way.
  • App-based dietary advice to lose weight or burn more calories are not individualised and safe; hence they can cause excess fatigue, dehydration, fluid imbalance, giddiness and loss of conscious
  • Even though apps may provide illustrations or short videos on how an exercise is to be done, it is always advisable to have a fitness trainer or a physiotherapist to correct you in the early stages

Special advice for heart patients:

While all the benefits and limitations discussed above apply to cardiac patients also, it is important to note that fitness apps, devices and even physical trainers in most commercial gyms are unable to provide a personalized exercise prescription that is effective and safe for your medical condition. They are not trained to assess your heart rate, blood pressure and other symptoms like sweating, breathlessness and chest pain during exercise and this might lead to complications like abnormal heart beat, very high or very low blood pressure, sudden collapse etc. It is mandatory to consult your cardiologist or your cardiac rehab team to understand how to exercise safely and follow their guidance. Initiating the exercise regime under medical supervision and then gradually using relevant apps and devices as an adjunct is advisable.