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

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  • Lets 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. Dont 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, 3538

    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 ones 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 ones 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 cant 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

  • Cardiologists 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

    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

  • http://www.ironheartfoundation.org/

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

    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 mos