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10 things you must know about Cardiac Rehab

  1. What is cardiac rehab?

Cardiac rehabilitation or cardiac rehab is nothing but a medically supervised program to help individuals with heart diseases get back to normal health and routine activities as early and safely as possible. A cardiac rehab program is an exercise cum education program individualised to the medical, psychological and social needs of the participants.

  1. Why is it gaining importance?

Several research studies from the recent past have demonstrated that individuals who undergo cardiac rehab have better immediate and long-term outcomes as compared to those who do not receive cardiac rehab. The benefits of cardiac rehab are improvement in risk factor control, positive changes in health-related behaviour, increased physical ability to do things, better psychological wellbeing and disease coping skills, and a reduction in symptoms, repeat hospitalisations and complications. The American Heart Association, the European Society of Cardiology and the British Cardiovascular Society recommend that all eligible individuals should be referred for cardiac rehabilitation.

 

Benefits of cardiac rehabilitation
BENEFITS OF CARDIAC REHABILITATION

 

3. Who is eligible for cardiac rehab?

Individuals with one or more of the following conditions are eligible for cardiac rehab: coronary heart disease (blocks in the blood vessels supplying the heart), angina (chest pain on exertion), angioplasty (stenting), bypass surgery (coronary artery bypass graft or CABG), heart failure, heart valve surgery, heart transplantation and device implantation.

  1. How is cardiac rehab provided?

Cardiac rehab centres may be housed within a hospital or they may be located in the community as outpatient units. The program is typically provided by a multidisciplinary team of healthcare professionals, which includes a physician, a physiotherapist, a nutritionist and a counselling psychologist.

There are typically 4 phases and 4 components in a cardiac rehab program:

Phase 1 – guidance and counselling during hospitalisation (the rehab team will meet the affected individual and his/her family and provide clarification about the health condition)

Phase 2 – monitoring and support during the recovery period (which might be just a few days for a stent procedure and about 6 weeks for bypass surgery)

Phase 3 – supervised exercise cum education sessions (participants will attend two or three sessions a week for 6-12 weeks)

Phase 4 – maintenance and follow-up (upon completion of the program, participants will continue to adhere to the lifestyle changes at home and visit the rehab centre periodically)

  1. When should one enrol in a cardiac rehab program?

Enrolment in a cardiac rehab program is best done immediately after a heart disease is diagnosed (such as myocardial infarction or heart attack) or after an intervention or surgery (such as stent placement or bypass surgery). Having said this, not everybody would have easy access to a cardiac rehab facility. Nevertheless, participating in a cardiac rehab program any time after a cardiac event or procedure will lead to better outcomes than not doing so.

  1. Are there any side effects or hazards of cardiac rehab?

Cardiac rehab is generally safe, especially when safety guidelines are adhered to and participants are grouped according to their risk. There is a very small risk of adverse effects such as rhythm problems or injuries but the benefits far outweigh the risks. The rehab team will explain about the warning signals to look for when exercising and ensure that rehab participants exercise safely during the sessions as well as at home.

  1. How are the benefits of cardiac rehab assessed?

Some of the assessment tools used pre-program and at end-of-program are questionnaires to assess health-related behaviour, psychosocial wellbeing and nature and frequency of symptoms, anthropometry (weight, body mass index, waist hip ratio etc.), blood pressure, blood biochemistry (blood sugar, cholesterol levels), functional capacity (ability to exercise) and ejection fraction (an echocardiographic assessment of heart function).

  1. What happens after a cardiac rehab program?

Upon completion of a cardiac rehab program, individuals will be put on a maintenance program whereby periodic visits to the rehab centre will pave the way for better long-term adherence and adequate clinical monitoring.

  1. Is cardiac rehab an alternative to medications, stenting or bypass surgery?

Cardiac rehab is not a replacement for medications, stenting or surgery. It is a more holistic approach to treatment addressing the root cause of disease rather than just the symptoms and signs.

  1. How to get further information about cardiac rehab?

The following links give useful and reliable information:

http://www.nhlbi.nih.gov/health/health-topics/topics/rehab

https://www.bhf.org.uk/heart-matters-magazine/wellbeing/cardiac-rehab

You could visit our website www.cardiacwellnessinstitute.com or contact us for any clarifications or additional information about cardiac rehabilitation in India.

 

Author:

Dr. Priya Chockalingam, MBBS, MRCPCH, PhD Cardiology cardiacwellnessinstitute@gmail.com, Phone: +91 9940408828, +9144 43192828

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Physical activity improves quality of life as you age

Physical activity (PA) is associated with reduced risk for several disorders including coronary heart disease, cancers, diabetes, and stroke. Regular physical activity can relieve tension, anxiety, depression and anger. You may notice a “feel good sensation” immediately following your physical activity, and most people also note an improvement in general wellbeing over time as physical activity becomes a part of their routine. Some of the hormones responsible for these changes are endorphins, growth hormone and serotonin.

According to the AHA (American Heart Association), too much sitting and other sedentary activities can increase your risk of cardiovascular disease. One study showed that adults who watch more than 4 hours of television a day had a 46% increased risk of death from any cause and an 80% increased risk of death from cardiovascular disease.

Becoming more active can help lower your blood pressure and also boost your levels of good cholesterol.

Regular Physical activity can improve the anti aging process by increasing strength, stamina and ability to function well. Recent research showed that people who are physically active and at a healthy weight live about 7 years longer than those who are not active and are obese.

If you want to improve your physical fitness, but you find the idea of exercise overwhelming, it may help you to know exercise and physical activity is not the same thing—yet both are beneficial to your health.

Exercise, however, is a type of physical activity that requires planned, structured, and repetitive bodily movement with the intent of improving or maintaining your physical fitness level. Exercise can be accomplished through activities such as cycling, dancing, walking, swimming, yoga, working out at the gym, or running etc. Regular exercise, depending upon the kind, improves aerobic fitness, muscular strength, and flexibility.

Everyday physical activities such as performing housework, walking at work place, or climbing stairs keep your body moving and still count toward the recommended amount of weekly physical activity.

Regular exercises like brisk walking, cycling and swimming can have the following effects on our body…

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Reduces risk of diabetes

Regular physical activity helps maintain blood sugar levels and lowers the risk of developing non-insulin-dependent diabetes mellitus. If you have a body mass index (BMI) greater than 25 or if you have a family history of diabetes, this benefit of exercise may have special value to you.

Helps maintain weight

Physical activity has been shown to be the single most important factor in successful weight maintenance. Aim for burning about 1000-2000 calories per week from activity.

Reduces risk of premature death

The highest risk of death and disability is found among those who do no regular physical activity.

Reduces risk of heart disease

Physical activity increases the level of high density lipoprotein (HDL) or “good” cholesterol in your blood. HDLs are like cholesterol scavengers – they pick up the “bad” cholesterol in the arteries and transport it to the liver for eventual removal from the body. An increase in your HDL is protective; it can decrease the risk of a heart attack. The other ways by which physical activity protects the heart are controlling blood pressure, maintaining blood glucose, preventing obesity and keeping your stress levels at bay.

Improves health of muscles and bones

Regular aerobic physical activity improves blood flow to your muscles and helps them use energy. Strength training increases muscle size and strength. Physical activities like jogging, walking and strength training strengthen your bones and make them denser, thereby preventing osteoporosis and arthritis.

Improves mental health

Regular physical activity can reduce anxiety and depression and improve mood. It may be a beneficial strategy to lower the risk of Alzheimer’s disease, cognitive impairment and vascular dementia. Exercise may directly benefit brain cells by increasing blood and oxygen flow to the brain.

Reduces risk of high blood pressure

Not only does regular physical activity reduce the risk of developing high blood pressure but it also helps lower blood pressure in people who already have elevated blood pressure.

Helps older adults become stronger

The loss of strength and stamina that is often attributed to aging is partly caused by reduced physical activity. Inadequate physical activity leads to a thinning of bones, a weakening of muscles, and a reduction in metabolic rate (the rate at which your body burns calories). This often leads to weight gain. Physical activity improves nearly all systems, especially the cardiovascular system and the ability to perform the routine tasks of daily life.

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Diabetes and connection with heart disease

People with diabetes have an elevated risk of heart disease.
A person with diabetes has a higher risk of developing heart disease, and that too 10 to 15 years earlier than individuals without diabetes.

The risk of heart disease is further increased if you have…
• Family history of heart disease
• Extra weight around the waist
• Abnormal cholesterol levels
• High blood pressure
• Habit of smoking / alcohol consumption
• High levels of stress

Diabetic Heart Disease
Diabetic heart disease includes coronary heart disease (CHD), heart failure, and diabetic cardiomyopathy.

Coronary Heart Disease
In coronary heart disease (CHD), a waxy substance called plaque builds up inside the coronary arteries. These arteries supply heart muscle with oxygen-rich blood. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis. Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. The buildup of plaque may partially or completely block blood flow.
Diabetic atherosclerosis can lead to chest pain or discomfort called angina, irregular heart beat called arrhythmia, a heart attack, or even death.
Heart Failure
Heart failure is a condition in which your heart can’t pump enough blood to meet the body’s needs. The term “heart failure” doesn’t mean that the heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.
If you have heart failure, you may tire easily and have to limit your activities. Diabetes can lead to heart failure by weakening the heart muscle over time.
Diabetic Cardiomyopathy
Chronic diabetes can also lead to diabetic cardiomyopathy where the heart muscle weakens, the heart enlarges and the pumping action of the heart gradually fails.
Heart disease can be prevented in a person with diabetes
The best way to prevent heart disease is to take good control of diabetes.
• Keep blood sugar as normal as possible
• Control blood pressure, with medication if necessary. The target for people with diabetes is under 130/80 mmHg
• Keep cholesterol numbers under control. Low density lipoprotein (LDL or bad cholesterol) should be below 100 mg/dL, High density lipoprotein (HDL or good cholesterol) should be higher than 40 mg/dL in men and higher than 50 mg/dL in women. Triglycerides should be lower than 150 mg/dL
• Lose weight if obese
• Exercise regularly. The American Diabetes Association recommends at least 30 minutes of aerobic exercise five days a week
• Eat a heart-healthy diet. Reduce consumption of high-fat and cholesterol-rich foods such as fried foods, red meat and egg yolk, and eat more high-fiber foods, including whole grains, vegetables, and fruits
• Quit smoking / abstain from alcohol
• Manage your stress better

Diabetes friendly diet

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Making healthy food choices and tracking eating habits help to manage blood glucose level better. If you are diabetic, you should choose foods rich in complex carbohydrates, fiber, proteins, vitamins and minerals, and stay away from unhealthy fats and sweets as much as possible.
• Healthy carbohydrates. During digestion, sugars (simple carbohydrates) and starches (complex carbohydrates) break down into glucose. The latter group is preferred to the former as it does not cause a rapid rise or frequent fluctuations in your blood glucose level. So, focus on the healthy carbohydrates such as whole wheat, oatmeal, brown rice, barley and millets.
• Fiber-rich foods. Dietary fiber includes all parts of plant foods that your body can’t digest or absorb. Fiber can decrease the risk of heart disease and help control blood sugar levels. Foods high in fiber include vegetables, especially green leafy vegetables, fruits and whole grains.
• Good fats. Foods containing monounsaturated and polyunsaturated fats such as nuts (almonds, pistachios and walnuts), vegetable oils (sunflower, rice bran, olive and sesame oils) and fish (if you’re in the habit of eating fish) should be a part of your daily diet. Lean meat (skinless chicken and poultry) has lesser unhealthy fats than red meat (mutton, beef, poultry) and can be had occasionally.

Sample diet chart for Diabetes

Upon waking up: 1 to 2 glasses of water

Breakfast: Idli (3) / Dosai (2), 1 cup boiled/raw vegetables, Sambar/ vegetable/green leaf chutney

Mid morning: Butter milk / Lime juice (without sugar) – 250ml or Fruits 100gms

Lunch: Boiled rice/Brown rice(1-1½ cups) with dhal sambar, buttermilk and more vegetables and leafy greens

Afternoon: Half cup sundal/sprouts

Pre-dinner (or pre-bedtime): Cut fruits (100gms)

Dinner: One cup of vegetable salad, 2 Chapathis/Rotis with dhal, vegetable gravy

Advised to have 2-3 hours gap between dinner and bedtime.

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Heart disease – what’s all the hue and cry about?

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Have you ever wondered, “Why is there such a hue and cry about heart diseases and more so, why is it much more now than a decade or two ago?”

The disease burden

Diseases of the heart and blood vessels such as heart attack, stroke and hypertension, known as cardiovascular diseases, are not only claiming more and more lives across the globe but are also posing an acute threat to the economic development of our subcontinent. While the statistics can make you dizzy, all you need to know is cardiovascular disease is the Number 1 killer disease amongst men and women today. The rising incidence of health problems like diabetes, high cholesterol and obesity, combined with harmful behaviors like smoking, alcoholism, unhealthy diet, inadequate physical activity and high stress levels are contributing equally if not more to this health crisis.

Cardiovascular diseases are multifactorial in origin, meaning there are several environmental and biological factors causing them. Though you might not be exactly sure what caused you or your loved one(s) to acquire the disease, you can be very sure of one thing: The lifestyle choices you make on a daily basis play a major role in causing as well as controlling the disease. There is therefore an urgent need to spread awareness about the risk factors and empower people with ways and means to better manage their health.

The risk factors can be broadly classified into modifiable (those that can be modified by us) and non-modifiable (those that our beyond our control) factors.

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Modifiable risk factors

  • Hypercholesterolemia (high blood cholesterol levels)
  • Hypertension (high blood pressure)
  • Diabetes (elevated blood sugar levels)
  • Overweight and Obesity
  • Physical inactivity
  • Unhealthy eating habits
  • Smoking
  • Excessive alcohol consumption
  • Psychosocial factors (such as chronic stress, anxiety, depression etc.)

Non-modifiable risk factors

  • Hereditary factors (genetic predisposition that runs in families)
  • Ethnicity (racial factors)
  • Age
  • Sex

I personally believe that the non-modifiable risk factors can also be modified but let’s save that for another day.

 

Healthy Lifestyle Choices

You would be surprised if I told you that your diabetes, hypertension and heart condition could be reversed. A healthy lifestyle characterized by regular physical exercise, balanced nutrition, and positive and healthy mindset is the building block for prevention and reversal of all cardiovascular diseases. While medical and surgical interventions are critical, addressing the risk factors by making the necessary changes to your lifestyle will go a long way in improving quality of life and keeping complications at bay.

 

A cardiac rehabilitation program is something you (and your family) should consider if you have had a heart attack, angioplasty or stent procedure, bypass surgery or other heart surgeries. Keep reading my blog entries for more useful info.

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The heart-healthy exercise plan

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Can you name the most important muscle in your body? No, it’s not your abs, thigh muscle or arms. It’s your heart!

The human heart is an amazing muscle, capable of pumping about five litres of blood throughout the body every minute—that’s approximately 7,200 litres of blood each day! In fact, the average heart beats about 100,000 times each day, too, which is why it’s so important to have a strong and healthy heart.

And just like you can exercise to build strength in your arm and thigh muscles, you can also train your heart to become stronger, healthier and more efficient at doing its function. The right exercise plan is like strength-training for your heart, which helps it pump more blood with less effort.

The Facts
According to the American Heart Association (AHA),physical inactivity is a major risk factor for developing coronary artery disease (CAD). CAD is caused by deposits of fatty substances, cholesterol, calcium and other substances in the inner lining of the arteries that supply blood to the heart muscle. This build-up makes the arteries narrowed or blocked, and when oxygen-rich blood can’t reach the heart, the result is chest pain or a heart attack. Over time, CAD can weaken the heart muscle and lead to heart failure.

While CAD is the most common type of heart disease and the leading cause of death in the World for both men and women, the good news is that lifestyle changes like exercise can help prevent or treat CAD in most people.

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How to Exercise for a Healthy Heart
Fortunately, it doesn’t take hours in the gym to get the heart-healthy benefits of exercise. As little as 30 minutes of moderate-intensity aerobic exercise, such as walking, most days of the week can substantially reduce your risk of heart disease. Additionally, the habit can help improve your mental well being and manage your weight, blood pressure, blood sugar and cholesterol levels better.

While previous recommendations have focused mainly on cardio (aerobic) conditioning for heart health, new guidelines developed by the American College of Sports Medicine (ACSM) and the AHA also take into account higher levels of intensity and the benefits that strength training offers your heart. These recommendations are for healthy adults under the age of 65 who want to improve heart health, prevent heart disease, and increase overall well-being.

Cardio (aerobic) exercise guidelines: Perform moderately-intense cardio exercise for 30 minutes a day, five days a week. If weight-loss is your goal as well, increase this number up to 60 minutes at a moderate intensity. Moderate intensity is defined by ACSM as a target heart rate range of 55-59% of your maximum heart rate which is roughly the pace where you break a sweat but are still able to carry on a conversation.

Strength training guidelines: Do 8-10 strength-training exercises with 8-12 repetitions of each exercise twice a week.

For more details about exercise plans contact us at www.cardiacwellnessinstitute.com

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Sitting for long hours is best avoided

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People with heart disease who sit for a long time have worse health even if they exercise regularly. Limiting the amount of time we spend on sitting may be as important as the amount we exercise. Sitting, watching television, working at a computer and driving are all sedentary behaviours and we need to take breaks from them.

While regular exercise is key to preventing heart disease, obesity and diabetes, limiting the time we spend not moving during the day has emerged as another important aspect of good health. Long hours of sitting need to be broken up with periodic standing or walking around.

Sitting for long periods of time and not using your muscles will have adverse effects on our body. While a person is sedentary (usually sitting and not active) there is a reduced uptake of glucose and fats, which then affects cholesterol and sugar levels. Breaking up your sedentary time will be beneficial in reducing the risk factors of diabetes and cardiovascular diseases. We have to mobilize our muscles to burn oxygen and tap the fuel sources in our bodies. When sitting, there is no weight bearing or stress on the muscles—they aren’t stimulated and energy doesn’t get burned off.

Negative effects of being sedentary may be overcome by regular cardiovascular exercise and also by pushing your exercise limits. Recent research has shown that every extra hour of television viewing per day is associated with increased waist circumference, greater body mass index, and higher systolic blood pressure and triglycerides.

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Keys to Get Moving

  • Get up and move every 30 minutes
  • Stand up during TV commercials or, even better, do light exercises while watching TV
  • Drink lots of water (if your health condition permits) so it forces you to get up to go to the washroom
  • Take lunch breaks outside instead of in front of your work computer, and avoid gadgets while eating
  • Go to bed instead of sitting in front of the TV and get your daily quota of sleep

Monitor your activity patterns to find out when you are most sedentary and replace that with active hobbies

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Eat your way out of your sticky cholesterol problem

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Cholesterol is a soft, waxy, fat-like substance produced naturally by our liver (endogenous cholesterol) as well as consumed in our diet (exogenous cholesterol). Cholesterol is an integral component of all the cells in our body and in fact essential for the life of the animal kingdom.

Abnormal cholesterol levels in the blood, known as dyslipidemia, is a problem as it raises the risk of diseases like heart attack and stroke. When there is too much cholesterol circulating in the blood, it can create sticky deposits (called plaques) along the artery walls. Plaque can eventually narrow or block the flow of blood to the brain, heart, and other organs. Blood cells that get caught on the plaque form clots, which can break loose and completely block blood flow through an artery, causing heart attack or stroke.

Types of cholesterol

As cholesterol particles cannot travel in blood by themselves, they get transported by means of cholesterol-protein carriers called lipoproteins. The two main types are:

  • Low Density Lipoprotein (LDL) – is also known as ‘bad’ cholesterol because it moves cholesterol from the blood to the cells. In other words, LDL can add to the build-up of plaque in arteries and increase the risk of getting coronary heart disease
  • High Density Lipoprotein (HDL) – also known as ‘good’ cholesterol because it helps protect against coronary heart disease by transporting cholesterol from the blood to the liver (from where the excess cholesterol is disposed off)

Thus it is vital to have sufficient HDL cholesterol and on the other hand low LDL cholesterol to lead a healthy life. Dyslipidemia refers to abnormal blood cholesterol levels (high LDL and/or low HDL).

Causes of dyslipidemia
A diet rich in saturated fats, sedentary lifestyle, chronic stress, smoking, diabetes and hypertension are the major reasons for dyslipidemia.

Healthy eating helps lower cholesterol

Changing some of the foods that you eat by following a healthy, balanced diet that is low in saturated fats and trans-fats can help to regularise your blood cholesterol levels.

It’s important to replace foods that contain unhealthy, saturated and trans-fats with foods that contain polyunsaturated and monounsaturated fats (PUFAs/MUFAs). Oils such as sunflower, soybean, rice bran and safflower oil, oily fish, and some nuts and seeds are high in polyunsaturated fats. Olive oil, canola oil, peanut oil, avocados and some nuts are high in monounsaturated fats.

So, which is the best cooking oil?

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We now know that oils of animal origin (ghee, butter) and partially hydrogenated industrial oils (rich in transfats and present in a wide variety of commercial foods) should be sparingly used or completely avoided if possible.

The vegetable oils listed above are rich in PUFAs/MUFAs and can be used safely in the kitchen. However, deep frying and re-using oils can convert the good fats in these vegetable oils to unhealthy fats, so get rid of that habit.

And to answer the question about which is the best oil, the answer is no one oil is the clear winner. Different vegetable oils have different proportions and types of MUFAs and PUFAs, so using 3-4 different oils on a daily basis is recommended. For instance, including sesame seed oil for breakfast, adding olive oil to your mid-morning salad garnish and cooking your vegetables with rice bran or cannola oil might be an interesting and healthful melange. But watch out, even a teaspoon of oil contains over 100 calories, so you don’t want to go overboard with the amounts you use.

The five food groups you should focus on

The best starting point for a healthy diet is to eat a wide variety of foods from each of the five food groups, in the amounts recommended. This helps maintain a healthy and interesting diet and provides a range of different nutrients to the body. Eating a variety of foods promotes good health and can help reduce the risk of disease.

  • Fruits
  • Vegetables and legumes/beans
  • Lean meats and poultry, fish, eggs, tofu, nuts and seeds
  • Grain (cereal) foods, mostly wholegrain and high fibre varieties
  • Low fat (skimmed) milk, yoghurt, cheese

The five mantras for getting rid of your cholesterol issues

  • Eat a healthy diet, even if you are not overweight
  • Cultivate the habit of regular physical exercise
  • Maintain a healthy weight
  • Keep blood pressure and blood sugar under control
  • Avoid tobacco in any form (cigarette, beedi, snuff) including passive smoking