Tag: exercise

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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.

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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!!

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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.

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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.

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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!

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What is Home-Based Cardiac Rehabilitation?

Before explaining about home-based cardiac rehabilitation, let me recall a few important things about cardiac rehabilitation. Cardiac rehabilitation is a medically supervised program for individuals with chest pain, heart attack, heart failure etc. and for those who have undergone any cardiac procedures or surgeries. It is a proven risk-reduction therapy and includes education, exercise training, nutritional guidance and psycho-social counselling. Fewer complications, freedom from repeated hospitalization, ability to do more things and improved health related quality of life are some of the key benefits of cardiac rehabilitation.

Conventional cardiac rehabilitation consists of 4 phases namely:

Phase 1 – Counselling and expert advice during the period of hospitalisation with heart ailments

Phase 2 – Recovery phase lasting a few days to a few weeks after hospitalisation, surgery or any other procedure

Phase 3 – Supervised exercise cum education phase lasting 3-6 months

Phase 4 – Maintenance phase for regular follow-up and guidance after the intensive supervised rehab program

Currently, cardiac rehab programs are offered by a team of healthcare professionals based in multi-speciality hospitals or in dedicated rehab centres like ours. Please go through our earlier blog post about cardiac rehabilitation for more on this topic (http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/10-things-you-must-know-about-cardiac-rehab-2/) .

How did Home-Based Cardiac Rehabilitation come about?

“Home Based” cardiac rehabilitation has been in vogue for a while now in developed countries. As the distance from the rehab facility and the logistics of commute back and forth are the main bottlenecks preventing maximum utilization of cardiac rehab services, home-based cardiac rehab became popular. It typically replaces phase 3 of the conventional cardiac rehabilitation program. Instead of attending 2-3 rehab sessions per week at the cardiac rehab centre, the individuals exercise in and around their home as advised by the rehab team. They also get dietary and psychosocial counselling through phone and/or video calls.

The rehab team at Cardiac Wellness Institute has been providing conventional as well as home-based cardiac rehabilitation for the past 5 years. Please read on for some Patient Stories:

Gentleman based in Singapore: Ram (name changed), a 45 year old gentleman from Tamil Nadu working in Singapore, suffered a heart attack and underwent a stent procedure. He and his wife were in a state of denial and disbelief that he had suffered a heart attack at such a young age. They had a daughter in kindergarten and were worried for her future. Moreover, there was a strong family history of young sudden deaths due to cardiac cause on Ram’s side and the recent demise of his brother had come as a major shock to them.

Ram enrolled in a home-based cardiac rehab program with us as he felt that the cardiac rehab program in Singapore was inadequate in addressing his dietary concerns (pertaining to South Indian diet) and his psychosocial problems (working in a foreign country, lack of support of extended family etc.). Once our rehab team had reviewed all his reports and was convinced that he was clinically stable and ready for home-based rehab, we went all out to provide him the moral support, exercise training, evidence based guidance on what to eat and what to avoid, and stress management advice, all through phone calls, video demonstrations and sharing of study material through internet. Ram successfully completed his 3-month rehab program and has been on a maintenance program for the past 6 months.

We have faced some challenges like for instance when Ram and his wife would get anxious and call us to check about a new-onset pain in the left shoulder during stressful situations or a bout of gastrointestinal symptoms with some food changes. We had to explain to them that long-distance rehab programs are not conducive for emergency health advice as we cannot see and examine the individual.

Gentleman from closer to home: Rathnam (name changed) is a 68 year old gentleman from Namakkal, Tamil Nadu, India, running his own business. He suffered a heart attack recently and was treated with a stent procedure. His risk factors were diabetes, hypertension and obesity in addition to sedentary lifestyle, lack of balanced diet and work-related stress. He and his wife were able to come in person for the initial evaluation and initiation of cardiac rehab program (3 day stay in Chennai near our rehab centre) following which they have had weekly communication with the rehab team on a home-based program. In the past 3 months, Rathnam has had days when work-related travel would come in the way of exercise but he keeps a log of his physical activities and his dietary intake and reports to us systematically. He is scheduled for a repeat in-person evaluation to quantify his progress and to discuss the next steps.

Advantages of Home-Based Rehab

  • Simple, feasible and convenient; avoids the hassle of commute and can be done in home surroundings
  • Sessions are administered through phone or video chat
  • Working individuals have the flexibility of doing the exercise at their convenient time
  • Individuals living in other cities or towns in India or residing abroad can also enroll in a home-based program
  • Participants do not get over dependent on the rehab team or the rehab facility.

Disadvantages of Home-Based Rehab

  • Cannot be administered for individuals with high risk of complications
  • Chance of miscommunication or misinterpretation is higher
  • Lack of a fixed exercise schedule may hamper their adherence to our   guidelines
  • Due to long distance communication, the rehab team is unable to provide any emergency medical advice
  • Participants might not take the home-based program seriously and may not derive maximum benefit

Hence, home based cardiac rehabilitation is an alternative to conventional cardiac rehabilitation and can be offered to most individuals who aim for a complication-free recovery and enhanced health-related quality of life.

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Summer, Fitness & Heart Health

As the summer is here, very few will dare to get under the scorching sun and exercise. People literally sweat doing nothing and exercising outdoors will make you sweat more. Dehydration, heat stroke and even death can occur if exposed to too much heat.

In this post, we would like to share answers to some common questions we get asked during our routine work as a cardiac rehab team:

Is it advisable to exercise during summer? – Yes, you can exercise during summer, but it is advisable to do the exercises either early in the morning or just before or during sunrise (Source of Vitamin D) (or) post sunset in the evening.

What are the common precautions to be taken while exercising in hot weather? –Wear appropriate clothing and footwear; take sips of water or electrolyte mixed beverage for hydration; ensure the temperature is regulated (if indoors) or not more than 36 deg Cel (if outdoors); do adequate warm up and cool down exercises.

Can we exercise indoors during the summer? – Yes, you can exercise indoors. There are many exercises that can be done inside your house without any fancy equipment. Use of body weight and space will be helpful.

How to avoid dehydration or stay hydrated during summer? –Increase your intake of fluids. Instead of drinking plain water, add a pinch of salt and sugar to improve water retention. Use of electrolyte mixed beverages that are available in the market may be helpful for individuals who indulge in athletic activities and sports. Others can stick to water mixed with a pinch of salt and sugar, fruit juice (with pulp and without added sugar) or tender coconut water.

What types of exercises are advisable? –Combination of aerobic exercise and strength training can be done at home. Aerobic exercises should be done at least for 30 minutes on 5 days a week and strength training for 2 days a week. Free exercises using one’s own body weight or simple equipment like dumbbells weight cuffs and resistance bands are the main options for building muscle strength. The major muscle groups for strength training are shoulders, biceps, triceps, forearm, quadriceps, hamstrings and calf muscles.

I have been diagnosed with a heart ailment and am taking medicines. Is it safe to exercise in very hot conditions? –As you are under treatment for a heart problem, it is best to take the advice of your Cardiologist or your Cardiac Rehab Team. In general, people with heart conditions should avoid exercising in extremes of weather as it can add to the workload of the heart. However, if you take the above precautions, your exercise regime will be fruitful.

From the above questions and answers, it is evident that exercise can be done indoors and also it is simple, effective and also cost-effective (sometimes zero cost too).

Some of the indoor exercises are:

  • Push ups or modified push ups
  • Forward lunges – with or without dumbbells
  • Half squats
  • Normal planks
  • Steppers – with or without dumbbells
  • Abdomen sit ups
  • Quick sprints
  • Stair climbing – brisk walk or jog 2 to 3 floors in a single repetition

These can be done while traveling too. Adequate warm-up should be done prior to exercise and slow and relaxed stretching should be done as a cool down to avoid muscle cramps or soreness. Not to forget that overtraining can also affect the body.

Thus it is important to exercise with adequate precautions during the hot summers. If you exercise the right way with proper guidance and techniques, it is easier to achieve the desired goal. And remember exercise can be done anywhere and all it needs is dedication, determination and commitment.

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Move ahead with Heart Failure

Heart failure, a growing medical threat across the globe, not only affects the heart but also the functioning of all the body parts. Individuals with heart failure often face various challenges in their day-to-day life like tiredness and exhaustion, shortness of breath, physical weakness, water logging in the body, frequent infections and mental depression. While it may be very frustrating for the affected person and the caregivers to try to overcome the disease, some simple lifestyle measures actually go a long way in improving the quality of life.

In this post, we would like to share with you the heart-warming story of Mr.S, an 84-year old gentleman, who is currently undergoing cardiac rehabilitation with us.

Mr. S is a retired LIC employee . He has had a medical history of diabetes, hypertension, heart attack, chronic kidney disease and heart failure (ejection fraction 40%). He was taking several medicines to keep his illnesses under control. He lived with his family which included his wife, son, daughter-in-law and grandchildren.

Right after our first interaction with Mr. S, we understood that he had multiple health issues and needed individual attention from the rehab team. His main complaints were breathlessness during physical activity, generalized weakness and inability to lead a normal life. He used a walking stick for support and was unable to climb even a few steps. His ambition was to be able to walk at least a kilometer without any hindrance and difficulties.

After ascertaining that Mr. S’s condition was stable, we started him on a personalized cardiac rehab program comprising of supervised exercise, health education, counseling and dietary advice. He visited our rehab centre two times a week and followed our advice for home exercising on the other days. The exercise sessions were very short to begin with. It consisted of a prolonged warm-up period followed by simple exercises like on-the-spot marching with support, and stepping up and down a step a few times, and some cool-down stretches. He needed frequent rests which we allowed.

Breathing exercises were taught to ensure proper breathing technique to help with his breathing difficulty. Education about his current health problems, red-flag signs to watch out for, exercise and its effects, healthy eating and ways to meet his nutritional requirements, role of medications and their importance and adherence to exercise on a long term basis was an integral part of his program.

The rehab team helped Mr. S set weekly health goals that were small but achievable. In spite of a few inter-current illnesses, Mr. S has made progress and is able to do more. He is now cycling continuously for 15 minutes and working with low-weight dumbbells to improve his strength, after a month of continued efforts.

Sometimes, it does take a longer time to see improvement but close monitoring, baby steps and constant encouragement are the keys to success. Mr. S feels that he still has a long way to go before being able to walk a kilometer but we know for sure that he is much nearer to achieving his goal than he was a month ago.

If you or your loved ones are suffering from heart failure, talk to your Cardiologist about cardiac rehabilitation as it is an approved and mandatory aspect of management in the current era.

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Exercise after Heart transplantation

We all know that exercise has multiple positive effects on our body and helps to improve our physical, mental and social well-being. There is ample evidence to show that exercise helps to decrease all risk factors for heart and blood vessel diseases, thereby preventing major diseases like heart attack and stroke in healthy individuals and also controlling and reversing the disease in previously diagnosed persons.

In recent years, organ transplantation techniques and outcomes have advanced commendably and one of the major solid organs transplanted today is the heart. In an earlier post, we had discussed about organ donation in general and heart transplantation in particular: http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/the-most-precious-gift-ever/

Let us look at some interesting facts about heart transplantation and the need for cardiac rehabilitation post transplantation.

As heart transplantation is a major surgery it does take a few weeks of intensive medical care for a full recovery. The immediate post transplant period is challenging as the anti-rejection medications lower the defense mechanism of the body which in turn increases the chances of serious infections. So, adequate rest, regular intake of medications and proper infection control steps are of high priority during this time.

Comprehensive cardiac rehabilitation which includes supervised exercise, appropriate nutrition, psycho-social counselling and alternative therapies like yoga and meditation plays a major role in the long term survival of the transplant recipient. Overall body weakness, reduced muscle strength due to prolonged illness prior to surgery, low level of exercise capacity, decreased chest wall movements due to surgical site pain, and restrictions in daily activities to prevent infections are some of the practical problems faced by the rehab team when dealing with a post transplant individual.

While patients and their family members may be worried about exercise making them more tired, aggravating their pain and even putting them at risk for complications, several research studies have shown that cardiac rehabilitation and exercise in particular not only helps individuals recover faster but also greatly improves their quality of life and long term survival.

Here are some exercise guidelines for heart transplant recipients:

  • Enroll in a cardiac rehab program at the earliest; start exercising 3-5 days/week, at mild to moderate intensity, for 30-40 minutes each day.
  • Aerobic exercises such as brisk walking, stationary cycling, treadmill in comfortable speed and cross trainer can be done. Those who cannot visit the rehab centre on a weekly basis due to distance and other limitations can follow home-based rehab programs as prescribed by their rehab team.
  • Once the surgical wound has healed well, strength training can be initiated with moderate intensity twice per week.
  • Regular follow up with the transplant team and the rehab team is important; any pain, discomfort, giddiness or palpitation during exercise should be reported immediately.
  • All medications should be taken as prescribed and blood levels of specific drugs should be monitored periodically.
  • All dietary advice should be followed closely.
  • Remember to note down your BP and heart rate prior to, during and post exercise for those following a home-rehab program.
  • Try to work out in a healthy environment to avoid infections. Wear face-masks while travelling and avoid crowded places.
  • Adequate warm-up and cool-down should be done to avoid exercise related complications.

In conclusion, exercise is an important aspect of the post transplant cardiac rehab program. If performed properly and with adequate education and supervision, it is the best tool to protect, preserve and promote the functioning of the new heart!

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Exercise & Fittness for Women

Women’s day is around the corner and what can be more helpful than reliable and specific information on women’s fitness. Physical exercise, as you may know, is a planned repetition of bodily movements, done on a regular basis. Now let us look at some exercise principles for women.

The FITT principle is often used to describe an exercise session:

F – Frequency of exercise

I – Intensity of exercise

T – Time or duration of exercise

T – Type of exercise

Frequency refers to the number of times per day or week an exercise is done (eg. 2 times/day, 5 times/week). Intensity refers to the amount of effort that is required to perform the particular activity, which is expressed as a percentage of maximal oxygen consumption or maximal heart rate or in easy terms how breathless we become. Time/duration refers to the total time allotted for the exercise regime. Type of exercise refers to the different components of exercise namely – aerobic, resistance or strength, flexibility, balance etc.

Exercise guidelines for women do not differ much from the recommendations for the general population. Thus, the current global exercise recommendations are as follows:

As per the American Heart Association guidelines, every individual should exercise at least 5 days a week that is a minimum of 150 mins of moderate intensity aerobic exercise per week, or 75 mins of vigorous aerobic exercise per week. In addition to this, they should do strength training exercises twice a week.

 

For women new to exercising 

  • Ideal start to exercise regime would be basic aerobic exercise like brisk walking, cycling, hiking or use of equipment’s such as stationery cycle or cross trainer for 30-45  mins on 3-5 days/week.
  • Adequate warm up of 10-15 mins prior to exercise and cool down of 5-10 mins post exercise is a must.
  • Strength training can be started after 4 weeks of regular aerobic exercise.

For women already exercising (following an exercise regime for more than 3-6 months)

  • Increase the exercise intensity and also try other training such as high intensity interval training, recreational sport activities and regular participation in sports events like marathon, hiking, cycling tour etc.
  • Adequate combination of strength and aerobic training can enhance your overall fitness.

 

 

 

    

Here are some exercise recommendations for some special populations of women:

Diabetes

  • Individuals on anti-diabetic treatment can do aerobic exercise of moderate intensity for 30-60 mins for 5-7 days/week and always keep some healthy snack like a fruit or water with electrolytes for use in case of low sugar levels (hypoglycemia).
  • Resistance training helps you to shed more calories and when combined with aerobic exercise is the best way to lose weight and normalize blood sugar.

Hypertension

  • For hypertensive individuals, aerobic exercise such as swimming, cycling and brisk walking is ideal. Resistance training can be added for better results at a later stage.
  • If your resting BP is above 200/100 mm-Hg do not exercise; consult your physician.
  • Avoid breath holding while exercising.
  • If you have nausea, giddiness or palpitations, stop the exercise session and consult your doctor; a low salt diet high fibre diet can help control BP.

Obesity & Overweight

  • Here the focus should be on exercise and proper diet. Calorie expenditure should be more than calorie intake (refer to calorie blog post).
  • The exercise session should be at-least 60 mins, 5-7 days a week with aerobic and strength training combined.
  • Increase the hours of physical activity per day to avoid weight regain.
  • Keep a positive health goal such as improved fitness or a better balanced diet rather than a negative goal like losing weight.

Dyslipidemia (Abnormal cholesterol level)

  • A combination of aerobic exercise, resistance training and flexibility training along with relaxation techniques like meditation will help improve your cholesterol.
  • A high fiber diet rich in fruits, veggies and whole grains is equally important.
  • Long term use of lipid lowering medications can cause muscle weakness and soreness. Kindly consult physician if so

Osteoporosis (Weak bones)

  • Here the main aim is work on weight bearing activities that enhance bone density and also help in strengthening your bones and muscles.
  • Exercising 5 days/week, 30-60 min per session on weight bearing aerobic activities such as walking, cycling, cross trainer and strength training helps to improve bone density and muscle mass
  • While working on strength training, avoid lifting heavy weights and handle the equipment’s with precautions

Post-menopausal women are at a higher risk of obesity, osteoporosis, heart attack, stroke and some cancers. It is important that they indulge in regular aerobic and strengthening exercises to keep these diseases at bay.

Breast cancer is a common malignancy affecting women of all ages these days. If you have a family history of breast cancer, periodic screening tests like mammogram can help to identify the disease early. Maintaining a healthy lifestyle with regular exercise, balanced diet and a relaxed mindset is the key to preventing many cancers including breast and uterine cancers.

Hope the exercise and lifestyle recommendations are helpful for you and your loved ones in keeping good health!

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Calories – Inside Out

We all know that there is a close link between body weight and heart health. In fact, obesity or excessive body weight in relation to height, is an independent risk factor for cardiovascular disease.

Regular exercise along with a healthy diet can help maintain physical, physiological and mental health. Many of us want to reduce weight; some of us wish to gain weight. An important thing to understand before making any weight management plan is the concept of calorie intake and calorie expenditure.

Calorie intake per day refers to the amount of calories that is being taken in the form of foods or supplements by an individual in a 24-hour period. Calorie expenditure refers to the amount of calories that is being burned out by an individual in the same time period. The overall working of our body relies on these two things, in short, on our body metabolism.

Now let us see what Positive calorie intake and Negative calorie intake are. Positive calorie intake refers to calorie intake being higher than calorie expenditure and negative refers to intake being lesser than expenditure.

Positive calorie intake = calorie intake > calorie expenditure = Weight Gain

Negative calorie intake = calorie intake < calorie expenditure = Weight Loss

In India, an average working individual consumes around 2100 – 2500 kcal in a normal day (weekday) and goes upto 3000 kcal during the weekends (outside food consumption). Our body at a resting state expends around 1200 – 1400 kcal for carrying out our basic functioning. Overall an individual has around 600 to 700 calories being left unused post consumption. This results in calorie overload, leading to weight gain.

Incorporation of physical activity and exercises can help in depleting the additional calories. Moreover, a minimal modification in the calorie intake with the help of a dietitian can help you shift from a positive calorie intake to a negative calorie intake resulting in weight loss.

Use of indoor equipments like treadmill, cycle ergometer, and cross trainer with adequate speed, inclination and resistance, burns around 300 – 400 kcal/hr. Outdoor activities such as jogging, swimming, brisk walking, hiking and cycling burns up-to 400 – 500 kcal/hr. Individuals involved in sports such as badminton, tennis, cricket, basketball, volleyball, football etc expend about 450 – 600 kcal/hr. Other activities like Zumba, Pilates, Yoga and Gymnasium can also help you loose your extra calories and attain an ideal body weight. If you are underweight and are planning to gain weight, it should be a healthy weight gain resulting from the intake of a healthy balanced diet and engaging in appropriate exercises rather than taking nutritional supplements, eating junk food and performing excessive exercises and succumbing to injuries.

Some important points to keep in mind with calories…

  1. 3,500 kcal = 0.45 kg of fat
  2. Adequate calorie expenditure = 200 – 400 kcal/day (or) 1000 – 1500 kcal/week
  3. Exercise 3-5 days/week for aerobic training, 2-3 days/week for resistance training and daily 15-20 minutes/day for abs and core training for more calorie expenditure
  4. Healthy weight loss = 1-2 kg/month
  5. Adequate calorie intake for weight loss =1600 – 1800 kcal/day
  6. Spend more time in outdoor activities and sports that you enjoy; it will help relieve your stress and expend those extra calories
  7. Incorporate a combination of workouts (rather than the same routine everyday) for better calorie expenditure
  8. High intensity interval training and resistance training burns calories even after the workout session.

Regular exercise and a good diet are sure to help you reach your health goals. Additionally, having an idea of your calorie intake and expenditure is important to maintain fitness and body weight. This is especially true for those of us who are diabetic, hypertensive, obese and diagnosed with heart problems. Better weight management is a sure-shot strategy to improved health metrics. Eat right, stay fit and always believe that you can!

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The 4 components of exercise to counter high BP

High blood pressure (BP) or hypertension is a major threat to your health and your quality of life. It can lead to life-threatening conditions like heart attack and stroke. The youth in India is more and more affected by this medical hazard. In fact, 1 in 5 young adults in our country is suffering from hypertension, according to a recent press release (1). So it is time to shift our focus to preventive rehabilitation in the younger generation.

Preventive rehabilitation is designed to reduce risk factors and prevent diseases. It is teamwork of physicians, exercise therapists, nutritionists and psychologists. In this blog post, I would like to share some exercise tips for the prevention and cure of hypertension.

Are you aware that exercise can reduce blood pressure? Indeed, regular physical activity not only reduces the stiffness in your blood vessels but also makes your heart more efficient hereby lowering your blood pressure to a desirable level.

Aerobic exercise, strength training and flexibility exercise are the three components of exercise that work hand in hand to bring down your elevated BP to normal levels. And together with breathing exercises, you definitely have the upper hand against high BP!

Aerobic Exercise

Any activity that you do use a large muscle group for a long duration which increases your heart rate and breathing rate is known as aerobic exercise. The best examples are walking, cycling and swimming.

Strength training or Resistance Exercise

I am often faced with the question “Is resistance exercise safe?” The answer is YES. It has long-term health benefits on all muscles including the cardiac muscle and also reduces the overall resistance in the arteries which is the underlying culprit causing high BP(2).

The American heart association recommends 2 days per week of resistance exercise for cardiac and hypertensive patients.

Flexibility Exercise

It improves flexibility and blood flow in the muscles. Regular flexibility exercise improves muscle endurance. Yoga is the best example of this group of exercise. It is not only a mind-body aligning tool but also a great stress buster.

Breathing Exercise

Find a comfortable spot at home or at work and start breathing deeply and slowly in a relaxed way for 10-15 minutes. This is known as deep breathing or regulated breathing or pranayama and it helps to relax your mind and your body. Special breathing techniques need to be learnt from experts and practised the right way for maximum health benefits.

The above-mentioned exercises are ideal for hypertensive patients. In addition to exercise, dietary changes and stress management training for all and BP lowering medication for a few are the best tools to reduce blood pressure. Most importantly, consult your physician before beginning your exercise program. We provide personalised preventive rehabilitation programs for individuals with high blood pressure, diabetes, cholesterol problems, body weight issues and psychosocial problems including chronic stress and addictions. The outcomes of our programs are excellent and our results have been published in international medical journals.

Reference

  1. https://www.escardio.org/The-ESC/Press-Office/Press-releases/One-in-five-young-adults-in-India-has-high-blood-pressure
  2. https://www.ahajournals.org/doi/pdf/10.1161/JAHA.112.004473