Let's Get Physical...Exercise and ACHD by Dr Amanda Barlow

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    13-Apr-2017

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<ul><li><p>Lets Get Physical Exercise and ACHD </p><p>DR AMANDA BARLOW, MDCARDIOLOGIST PACH</p></li><li><p>Lack of activity destroys the good condition of every human being, while movement and methodical exercise </p><p>save it and preserve itPlato</p></li><li><p>Benefits of Exercise</p><p> Boosts mental wellness</p><p> Improves physical wellness</p><p> Enhances immune system</p><p> Reduces risk of developing coronary artery disease (weight, blood pressure, cholesterol)</p><p> Longer life: for each hour of regular exercise, two hours of additional life expectancy is gained</p></li><li><p>Advice</p><p> Be as active as you can be</p><p>Conditioning of your arms and legs is as important as the severity of your heart disease in determining your physical abilities</p><p> Walking is the best exercise</p></li><li><p>Outline</p><p>Activity and exercise recommendationsWhat should you do?Factors affecting participation</p><p>What can you do?Effects of exercise on the heartDemands of sporting activities on the heartDetermine an appropriate activity level</p><p>What should you avoidLimitations to participation</p></li><li><p>What is the recommended amount of physical activity for Canadians?</p><p>A. 60 minutes daily of moderate/vigorous activity</p><p>B. 30 minutes daily X 7 days per weekC. 50 minutes daily X 5 days per weekD. Dont knowE. It depends</p></li><li><p>What should you do?</p><p>Public Health Agency of Canada</p><p>Children and Youth: 60 minutes daily</p><p>Include vigorous intensity activities at least 3 days per week</p><p>Adults: 150 minutes weekly</p><p>Moderate to vigorousModerate: brisk walking, biking, </p><p>swimmingVigorous: aerobics, jogging, </p><p>basketball</p><p>www.csep.ca/guidelines</p></li><li><p>I meet the following recommendations for physical activity:</p><p>A. NeverB. SeldomC. SometimesD. OftenE. always</p></li><li><p>Activity Levels in Heart Patients are Reduced Compared to Peers</p><p>McCrindle et al. Arch Dis Child 2000; 92:509-14 </p></li><li><p>Congenital Heart Adults Have Impaired Exercise Capacity</p></li><li><p>Fig 3. Maximal oxygen uptake for a variety of congenital heart diseases [8].</p><p>Erik Thaulow, Per Morten Fredriksen</p><p>Exercise and training in adults with congenital heart disease</p><p>International Journal of Cardiology, Volume 97, Supplement 1, 2004, 3538</p><p>Impaired Exercise Capacity Across all Forms of Heart Disease</p></li><li><p>Which is the most important factor affecting activity levels in young cardiac patients?</p><p>A. Severity of heart conditionB. Parental overprotectionC. Social stigma/school factorsD. Belief in ones ability to participateE. Medical advice to not participate</p></li><li><p>Which is the most important factor affecting activity levels in young cardiac patients?</p><p>A. Severity of heart conditionB. Parental overprotectionC. Social stigma/school factorsD. Belief in ones ability to participateE. Medical advice to not participate</p></li><li><p>Young Heart Patients Limit Themselves</p><p> Swan and Hillis, Heart 2000;83:685-687 </p><p> 99 adult congenital heart patients</p><p> Age 25 (11-51)</p><p> Asked about current activity along a scale, compared to what would be medically recommended</p><p> 55 % had no activity limitations, but only 5% did not restrict themselves.</p></li><li><p>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) </p><p>Swan and Hillis, Heart 2000: 83, 685 - 687</p></li><li><p>What Should You Do?</p><p> Prescription: Children and Youth: 60 minutes </p><p>dailyAdults: 150 minutes weekly</p><p> Walking is the best exercise!</p></li><li><p>Walking is the Best Exercise</p><p>Its Easy</p><p>Simple and safe to start</p><p>Costs nothing</p><p>Lowest dropout rate of any type of exercise</p><p>It Works</p><p>Studies show that for every hour of walking, life expectancy may increase by two hours.</p><p>Walking for as few as 30 minutes a day provides heart health benefits</p><p>Single most effective exercise for heart patients</p></li><li><p>Try an exercise app or a fitbit</p></li><li><p>Walk with a friend or get a dog</p></li><li><p>What Can You Do?</p><p> Can I join boot camp?</p><p> Can I climb mountains, ski, go mountain biking?</p><p> Can I do SCUBA diving?</p><p> Can I be on a competitive wrestling team?</p><p> Can I snow board?</p><p>Answer: It depends.</p></li><li><p>Exercise Puts Demands on the Cardiovascular System</p><p>Dynamic Exercise</p><p>Eg. Running, swimming</p><p>Large muscle mass movement</p><p>Builds endurance</p><p>Requires heart rate, blood pressure, cardiac output</p><p>Static Exercise</p><p>Eg. Weight-lifting</p><p>Large intramuscular forces</p><p>Builds strength</p><p>Increases blood pressure</p></li><li><p>Exercise is a Stress on the Heart</p><p>Dynamic exercise may not be tolerated if:</p><p>Obstruction (aortic valve, left ventricle, pulmonary arteries)</p><p>Heart cant meet the demand of exercise fainting (or worse)</p><p>Static exercise related increase in blood pressure may stretch blood vessels or strain valves</p><p>Aneurysm</p><p>Important leakage</p></li><li><p>What Can you Do? General Principles</p><p> Walking program is good for everyone</p><p> If you have symptoms from your heart condition:No competitive sporting activityYou and your cardiologist should </p><p>consider RX</p><p> Discuss exercise and sporting participation with your cardiologist regularly</p></li><li><p>Cardiologists Perspective</p><p> What is the nature of the heart condition?</p><p> Does the patient have any symptoms?</p><p> Echocardiogram: structure/function of the heart</p><p> Exercise stress test to intensity equal to level of activity</p><p> Consideration of the static and dynamic demands of exercise/sport</p></li><li><p>Matching Activity to the Patient</p><p>Patient Factors:</p><p> Heart Condition</p><p> Level of participation</p><p>Recreational </p><p>competitive</p><p>Exercise/Sport:</p><p> Training regimen</p><p> Demands</p><p>Dynamic</p><p>static</p></li><li><p>Classification of Sports</p></li><li><p>What Should you Avoid?Competitive Sports</p><p>Not recommended if: SymptomsModerate or severe obstruction in </p><p>the heart Severe leaking of a heart valveAneurysm (enlargement) of the </p><p>aorta or high risk of developing aneurysm</p><p> Taking blood thinners</p></li><li><p>What Should you Avoid?</p><p>Contact Sports and Sports with Fall Risk(football, hockey, soccer, skiing, water skiing)</p><p> Not recommended if:Recovering from open-heart surgeryMechanical valveAneurysm (enlargement) of the aorta or </p><p>high risk of developing aneurysm (Marfan)Taking blood thinners</p></li><li><p>Resistance training</p></li><li><p>What Should you Avoid?Weight Lifting</p><p>Not recommended if:</p><p>Aneurysm (enlargement) of the aorta or high risk of developing aneurysm (Marfan)</p><p>Severe valve leak</p><p>Repetitive light weights better than straining against heavy loads</p><p>How much weight can you lift: depends on strength. </p><p>Whatever weight can be done comfortably, without bearing down (12 15 reps easily)</p><p>Remember pushups, sit ups and planks are considered resistance exercises and may NOT be allowed</p></li><li><p>Summary</p><p>What you should do: a modest amount of moderate to strenuous activity</p><p>Most patients are not doing enough</p><p>Physical activity levels and exercise capacity are reduced in heart patients</p><p>Family, health care providers need to foster self- efficacy in heart patients</p><p>What you can do: </p><p>Get an exercise prescription</p><p>Discuss exercise and sporting participation with your cardiologist regularly to understand what is safe for you</p></li><li><p>Remember to stretch regularly</p></li><li><p>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</p><p>https://www-clinicalkey-com.ezproxy.library.ubc.ca/#%21/search/Van%20Hare%20George%20F./%7B%22type%22:%22author%22%7Dhttps://www-clinicalkey-com.ezproxy.library.ubc.ca/#%21/search/Ackerman%20Michael%20J./%7B%22type%22:%22author%22%7Dhttps://www-clinicalkey-com.ezproxy.library.ubc.ca/#%21/search/Evangelista%20Juli-anne%20K./%7B%22type%22:%22author%22%7Dhttps://www-clinicalkey-com.ezproxy.library.ubc.ca/#%21/search/Kovacs%20Richard%20J./%7B%22type%22:%22author%22%7Dhttps://www-clinicalkey-com.ezproxy.library.ubc.ca/#%21/search/Myerburg%20Robert%20J./%7B%22type%22:%22author%22%7Dhttps://www-clinicalkey-com.ezproxy.library.ubc.ca/#%21/search/Shafer%20Keri%20M./%7B%22type%22:%22author%22%7Dhttps://www-clinicalkey-com.ezproxy.library.ubc.ca/#%21/search/Warnes%20Carole%20A./%7B%22type%22:%22author%22%7Dhttps://www-clinicalkey-com.ezproxy.library.ubc.ca/#%21/search/Washington%20Reginald%20L./%7B%22type%22:%22author%22%7D</p></li><li><p>http://www.ironheartfoundation.org/ </p><p>Working to transform, empower and positively impact the lives of those affected by heart disease</p><p>Lets Get Physical Exercise and ACHD Slide Number 2Benefits of Exercise AdviceOutlineWhat is the recommended amount of physical activity for Canadians?What should you do?I meet the following recommendations for physical activity:Activity Levels in Heart Patients are Reduced Compared to PeersCongenital Heart Adults Have Impaired Exercise CapacitySlide Number 11Which is the most important factor affecting activity levels in young cardiac patients?Which is the most important factor affecting activity levels in young cardiac patients?Young Heart Patients Limit ThemselvesBarriers to ExerciseWhat Should You Do?Walking is the Best ExerciseTry an exercise app or a fitbitWalk with a friend or get a dogWhat Can You Do?Exercise Puts Demands on the Cardiovascular SystemExercise is a Stress on the HeartWhat Can you Do? General PrinciplesCardiologists PerspectiveMatching Activity to the PatientClassification of SportsWhat Should you Avoid?What Should you Avoid?Resistance trainingWhat Should you Avoid?SummaryRemember to stretch regularlySlide Number 33http://www.ironheartfoundation.org/Working to transform, empower and positively impact the lives of those affected by heart disease</p></li></ul>