Let’s Get Physical… Exercise and ACHD

DR AMANDA BARLOW, MDCARDIOLOGIST PACH

Lack of activity destroys the good condition of every human being, while movement and methodical exercise

save it and preserve itPlato

Benefits of Exercise

Boosts mental wellness

Improves physical wellness

Enhances immune system

Reduces risk of developing coronary artery disease (weight, blood pressure, cholesterol)

Longer life: for each hour of regular exercise, two hours of additional life expectancy is gained

Advice

Be as active as you can be

Conditioning of your arms and legs is as important as the severity of your heart disease in determining your physical abilities

Walking is the best exercise

Outline

Activity and exercise recommendationsWhat should you do?Factors affecting participation

What can you do?Effects of exercise on the heartDemands of sporting activities on the heartDetermine an appropriate activity level

What should you avoidLimitations to participation

What is the recommended amount of physical activity for Canadians?

A. 60 minutes daily of moderate/vigorous activity

B. 30 minutes daily X 7 days per weekC. 50 minutes daily X 5 days per weekD. Don’t knowE. It depends…

What should you do?

Public Health Agency of Canada

Children and Youth: 60 minutes daily

Include vigorous intensity activities at least 3 days per week

Adults: 150 minutes weekly

Moderate to vigorousModerate: brisk walking, biking,

swimmingVigorous: aerobics, jogging,

basketball

www.csep.ca/guidelines

I meet the following recommendations for physical activity:

A. NeverB. SeldomC. SometimesD. OftenE. always

Activity Levels in Heart Patients are Reduced Compared to Peers

McCrindle et al. Arch Dis Child 2000; 92:509-14

Congenital Heart Adults Have Impaired Exercise Capacity

Fig 3. Maximal oxygen uptake for a variety of congenital heart diseases [8].

Erik Thaulow, Per Morten Fredriksen

Exercise and training in adults with congenital heart disease

International Journal of Cardiology, Volume 97, Supplement 1, 2004, 35–38

Impaired Exercise Capacity Across all Forms of Heart Disease

Which is the most important factor affecting activity levels in young cardiac patients?

A. Severity of heart conditionB. Parental overprotectionC. Social stigma/school factorsD. Belief in one’s ability to participateE. Medical advice to not participate

Which is the most important factor affecting activity levels in young cardiac patients?

A. Severity of heart conditionB. Parental overprotectionC. Social stigma/school factorsD. Belief in one’s ability to participateE. Medical advice to not participate

Young Heart Patients Limit Themselves

Swan and Hillis, Heart 2000;83:685-687

99 adult congenital heart patients

Age 25 (11-51)

Asked about current activity along a scale, compared to what would be medically recommended

55 % had no activity limitations, but only 5% did not restrict themselves.

Barriers to ExerciseNumber of subjects (%)Symptoms: 32 (32.3)Lack of interest in exercise: 24 (24.2)Health fears: 16 (16.1)Lack of time: 15 (15.2)Medical advice: 7 (7.1)Parental fears: 2 (2.0)Other: 3 (3.0)

Swan and Hillis, Heart 2000: 83, 685 - 687

What Should You Do?

Prescription: Children and Youth: 60 minutes

dailyAdults: 150 minutes weekly

Walking is the best exercise!

Walking is the Best Exercise

Its Easy

Simple and safe to start

Costs nothing

Lowest dropout rate of any type of exercise

It Works

Studies show that for every hour of walking, life expectancy may increase by two hours.

Walking for as few as 30 minutes a day provides heart health benefits

Single most effective exercise for heart patients

Try an exercise app or a fitbit

Walk with a friend or get a dog

What Can You Do?

Can I join boot camp?

Can I climb mountains, ski, go mountain biking?

Can I do SCUBA diving?

Can I be on a competitive wrestling team?

Can I snow board?

Answer: It depends.

Exercise Puts Demands on the Cardiovascular System

Dynamic Exercise

Eg. Running, swimming

Large muscle mass movement

Builds endurance

Requires heart rate, blood pressure, cardiac output

Static Exercise

Eg. Weight-lifting

Large intramuscular forces

Builds strength

Increases blood pressure

Exercise is a Stress on the Heart

Dynamic exercise may not be tolerated if:

Obstruction (aortic valve, left ventricle, pulmonary arteries)

Heart can’t meet the demand of exercise fainting (or worse)

Static exercise related increase in blood pressure may stretch blood vessels or strain valves

Aneurysm

Important leakage

What Can you Do? General Principles

Walking program is good for everyone

If you have symptoms from your heart condition:No competitive sporting activityYou and your cardiologist should

consider RX

Discuss exercise and sporting participation with your cardiologist regularly

Cardiologist’s Perspective

What is the nature of the heart condition?

Does the patient have any symptoms?

Echocardiogram: structure/function of the heart

Exercise stress test to intensity equal to level of activity

Consideration of the static and dynamic demands of exercise/sport

Matching Activity to the Patient

Patient Factors:

Heart Condition

Level of participation

Recreational

competitive

Exercise/Sport:

Training regimen

Demands

Dynamic

static

Classification of Sports

What Should you Avoid?Competitive Sports

Not recommended if: SymptomsModerate or severe obstruction in

the heart Severe leaking of a heart valveAneurysm (enlargement) of the

aorta or high risk of developing aneurysm

Taking ‘blood thinners’

What Should you Avoid?

Contact Sports and Sports with Fall Risk(football, hockey, soccer, skiing, water skiing)

Not recommended if:Recovering from open-heart surgeryMechanical valveAneurysm (enlargement) of the aorta or

high risk of developing aneurysm (Marfan)Taking blood thinners

Resistance training

What Should you Avoid?Weight Lifting

Not recommended if:

Aneurysm (enlargement) of the aorta or high risk of developing aneurysm (Marfan)

Severe valve leak

Repetitive light weights better than straining against heavy loads

How much weight can you lift: depends on strength.

Whatever weight can be done comfortably, without bearing down (12 – 15 reps easily)

Remember pushups, sit ups and planks are considered resistance exercises and may NOT be allowed

Summary

What you should do: a modest amount of moderate to strenuous activity

Most patients are not doing enough

Physical activity levels and exercise capacity are reduced in heart patients

Family, health care providers need to foster self- efficacy in heart patients

What you can do:

Get an exercise prescription

Discuss exercise and sporting participation with your cardiologist regularly to understand what is safe for you

Remember to stretch regularly

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 4: Congenital Heart Disease •George F. Van Hare MD, FACC• Michael J. Ackerman MD, PhD, FACC• Juli-anne K. Evangelista DNP, APRN, CPNP-AC, FACC•,Richard J. Kovacs MD, FAHA, FACC• Robert J. Myerburg MD, FACC• Keri M. Shafer MD• Carole A. Warnes MD, FACC• Reginald L. Washington MD, FAHAJACC (Journal of the American College of Cardiology), 2015-12-01, Volume 66, Issue 21, Pages 2372-2384, Copyright © 2015 American Heart Association, Inc. and the American College of Cardiology Foundation

http://www.ironheartfoundation.org/

Working to transform, empower and positively impact the lives of those affected by heart disease