Exercise and heart disease Guide for patients
Experts believe that the scheduled exercise and under medical control improves the physical and psychological status of the patients with heart disease. Discover all the benefits that you can bring.
The cardiac pathology in any of its four basic forms (coronary, valvular, myocardial or congenital) is capable of altering the exchange of oxygen (O2) and carbon dioxide (CO2 during physical activity).
The treatment of various cardiac conditions has varied substantially in recent years, from the imposition of absolute and prolonged rest in diseases such as myocardial infarction, the prescription of physical exercise early and progressive intensity, although controlled medically.
In the case of children, it is necessary to make a full assessment of the cardiovascular situation, in order to have the information of the patient's condition.
The participation of children with congenital or acquired heart disease in sports activities, due to the difficulties in quantifying myocardial effort during exercise is difficult to regulate. It depends on the type of recreational activity and the type of heart disease.
This medical examination is essential in those persons practicing a sport and physical activity (school children, elderly, disabled) and participants of other sport activities not included in land sports and competitive national and international sport.
Basic cardiac recognition consists of assessment of personal and family pathological history and made sport, a physical examination, a stress tests and 12-lead resting electrocardiogram. This recognition, which is performed before starting a physical activity program, should have as a goal the attainment of the following objectives:
· Discover any disease, injury or cardiac pathology, which may particularly constitute a vital risk for the athlete.
· Determine which pathological situations can be a medical contraindication absolute, temporary or permanent, for the practice of physical activity.
· Avoid individuals who may be at risk to participate in certain dangerous sports.
· Find out the tolerance of the individual to the efforts to be undertaken and their degree of adaptation to the same.
· Establish a relationship between the physician and the patient who can advise the patient on health issues.
· Comply with legal requirements and safety for organized sports programs.
If you suspect that there is an underlying cardiac pathology complementary studies may be done to confirm the diagnosis. In the sport of competition (both domestically and internationally) should be a registration of ECG and Doppler echocardiography stress test.
Evaluation should be based on the characteristics of the patient and the anomaly that suffers in the type of practiced sport, its degree of intensity, the level of competition and the involvement of the athlete.
In general, when there is a known heart disease should be a detailed medical history, an evaluation of the symptoms and a physical examination that includes a 12-lead resting ECG. It is highly recommended to include a stress test in cardiac recognition Protocol.
Doppler echocardiography is of obliged fulfillment in congenital heart diseases.
Tests are: ambulatory electrocardiographic monitoring, the isotopic study radionuclide ventricular angiography / catheterization, coronary angiography, the electrophysiological study, and other less common such as endomyocardial biopsy.
When the patients are children, it is necessary to make a full assessment of their cardiovascular status, in order to have all the information possible from the State of the child, and that includes:
· Medical history (a family history of sudden death at early age or heart disease). Look for symptoms that make suspect disease cardiology, such as shortness of breath, chest pain, syncope or near syncope.
· Complete physical exam, which should include a good cardiac auscultation, take blood pressure and palpation of femoral pulses (under the inguinal fold, i.e. in the groin).
· Electrocardiogram.
It is important to treat each case individually and assess, in each patient, the ability to limit their physical activity to the practice of recreational activities or, conversely, extend it to training and competition, but establishing a protocol for monitoring that ensures the safety of the patient.
To establish the various recommendations it is useful to classify athletes according to:
· Your load (low, medium or high) static or dynamic.
· And recreational activities of competition practice, dividing them into two groups: little intense and severe.
· Differentiate heart disease suffering from: severe to severe, moderate, mild and benign.
In general, in children with benign heart restriction of physical activity or sport competition, always attending to each clinical history and under the decision of the specialist is not required.
In children with mild heart disease , leisure-time activities are allowed and can perform sports competition, low or moderately intense, bearing in mind that you have to let them rest and if they show signs of tiredness. Intense competition will be allowed only if, after a medical test effort at maximum intensity, not shown that there is a risk to the heart.
Children with moderate heart disease can run risks if they perform strenuous exercise, for which only must allow recreational activities little or moderately intense if shown, after a stress test, that there is no risk to your health. Therefore, recommended sports with a low static load and low or average load dynamics. The intense competitive sport and the intense recreational activity are prohibited.
Intense recreational activity should be prohibited in patients with severe heart disease . They can practice low-intensity recreational activities, and moderately intense leisure activities will only be allowed if the stress test (which must be regularly fixed by the doctor), shows no danger. They must not practice sports competition.
The results of physical examinations and tests practiced the athlete should be collected in a medical report, that includes diagnosis and recommendations resulting from the observations made. This report will be delivered to the athlete, if adult, or to their parents or guardian, as the case of a minor.
Rehabilitation or exercise set (always under medical control) programs improve the physical capacity of patients, contribute to their good psychological condition, increase the threshold of presentation of angina and arrhythmias, and collaborate so that social, labour and sexual life develop with normality, reducing the overall mortality in these patients.
Dynamic exercises, based on a frequent repetition of low resistance movements involving large muscle masses, such as walking, running, swimming, rowing or cycling are recommended for these patients.
Systolic blood pressure increases slightly, but diastolic blood pressures and media do not vary significantly with this type of exercises, and an increase of cardiovascular tolerance, allowing to improve the ability of patients to carry out daily activities.
Dynamic exercise increases functional capacity and decreases the consumption of oxygen at any level of submaximal exercise, which implies a lower heart work and causes an elevation of the threshold of angina after a period of training.
Exercise also reduces the concentrations of glucose and insulin receptors to union, and diabetics who perform strenuous exercise have reduced insulin requirements.
Currently it is considered beneficial to patients with acute uncomplicated myocardial infarction to initiate soon controlled physical activity that could even start in the coronary care unit.
Subsequently, to leave the coronary care unit or the hospital, the patient should gradually increase the level of physical activity, performing small tasks at home and light exercises involving muscle groups of the arms, legs and trunk. The most appropriate exercise is walking, progressively increasing distances. When the patient is already able to take short walks, you can think to perform submaximal exercise testing, allowing to evaluate their clinical situation and assess their risk.
After this assessment, and determined once possible treatment you need, the patient suffered a heart attack can begin to increase, gradual and controlled, physical activity that throws you mentioned benefits.
Guidelines of action or recommendations on exercise listed below are primarily aimed at lesions that have a degree of severity, moderate or severe, since the light, asymptomatic, and without hemodynamic repercussion, probably do not require restrictions on the practice of physical activities which are not in competition.
Among this group of disease one of the most common is mitral stenosis, which is a disorder of the heart valve that is characterized by a narrowing or blockage of the opening of the mitral valve, which separates the upper and lower chambers of the left side of the heart. This prevents the valve opens properly. Patients are therefore limited its ability to perform physical activity by the presentation of dyspnea.
Yet it could recommend the practice of physical activity, dynamic type, like walking, running, jogging, biking maintenance, swimming, skiing, golf, always below the threshold of dyspnea, avoiding violent efforts, and under medical control, since it must always assess the circumstances of each patient.
Other frequent pathologies are:
· Aortic stenosis.
· Tricuspid stenosis.
· Valvular insufficiencies.
· Chronic mitral regurgitation.
· Tricuspid insufficiency.
· Chronic aortic insufficiency.
· Multivalvular disease.
· Valvular heart disease operated.
· Patients with valvuloplasty.
· Mitral prolapse.
The main symptom is the dilatation of the left ventricle, with thinning of the walls and the consequent decrease in contractile ability, which conditions a bad ventricular emptying. Clinically it presents itself as breathlessness, initially of effort after resting as well as muscle fatigue.
· Warm-up period: the beginning of the year should always be progressive, both in intensity and in the muscle groups working during heating. The progressive elevation of body temperature decreases the viscosity joint and increases muscle elasticity, reducing resistances.
· Aerobic exercise: exercises that are recommended are the isotonic or dynamic (walking, biking, swimming, running, etc.) but always in a gentle intensity to moderate. The patient must experience a pleasant sensation while performing it, never fatigue. So this phase stimulation appropriate, is required for 30-45 minutes, which can be carried out continuously or at intervals, always depending on each person.
It is advisable to training sessions on alternate days, so the body assimilate the work done.
· Muscle adaptation: dynamic and aerobic exercise is that provides more cardiovascular benefits. An increase of muscular development reduces cardiac risk.
The necessary stimulus for muscular development should be gradually progressive, at various intervals, few repeats throughout the day.
· Progressive cooling: the completion of the exercise should also be gradual to cooling, with gentle stretching and progressive relaxation exercises.
At the time of exercise, should take into account a number of recommendations regarding the used sports equipment. For example, footwear must be appropriate, reducing burdens in the joints of the lower limbs and reduce discomfort related to the osteoarthritic process. Like loose, lightweight and breathable, clothes to avoid the increase of body temperature by facilitating the evaporation of sweat and make exercise more enjoyable.
Exercise and heart disease
Exercise increases metabolic demands, and the main modifications that originates are increased cardiac output and oxygen consumption, the increase in venous return, the increase in contractility of the myocardium and the decrease in peripheral resistance.The cardiac pathology in any of its four basic forms (coronary, valvular, myocardial or congenital) is capable of altering the exchange of oxygen (O2) and carbon dioxide (CO2 during physical activity).
The treatment of various cardiac conditions has varied substantially in recent years, from the imposition of absolute and prolonged rest in diseases such as myocardial infarction, the prescription of physical exercise early and progressive intensity, although controlled medically.
In the case of children, it is necessary to make a full assessment of the cardiovascular situation, in order to have the information of the patient's condition.
The participation of children with congenital or acquired heart disease in sports activities, due to the difficulties in quantifying myocardial effort during exercise is difficult to regulate. It depends on the type of recreational activity and the type of heart disease.
Medical examinations to detect heart disease
Before starting any exercise, especially if it's training to participate in sports competition, it is advisable to carry out a study of the personal and family history of the individual, as well as a physical examination aimed at detecting possible cardiovascular lesions that can cause sudden death or progression of the disease.This medical examination is essential in those persons practicing a sport and physical activity (school children, elderly, disabled) and participants of other sport activities not included in land sports and competitive national and international sport.
Basic cardiac recognition consists of assessment of personal and family pathological history and made sport, a physical examination, a stress tests and 12-lead resting electrocardiogram. This recognition, which is performed before starting a physical activity program, should have as a goal the attainment of the following objectives:
· Discover any disease, injury or cardiac pathology, which may particularly constitute a vital risk for the athlete.
· Determine which pathological situations can be a medical contraindication absolute, temporary or permanent, for the practice of physical activity.
· Avoid individuals who may be at risk to participate in certain dangerous sports.
· Find out the tolerance of the individual to the efforts to be undertaken and their degree of adaptation to the same.
· Establish a relationship between the physician and the patient who can advise the patient on health issues.
· Comply with legal requirements and safety for organized sports programs.
If you suspect that there is an underlying cardiac pathology complementary studies may be done to confirm the diagnosis. In the sport of competition (both domestically and internationally) should be a registration of ECG and Doppler echocardiography stress test.
Cardiological recognition prior to physical activity
When people affected by cardiovascular diseases practice sports of competition may increase their risk of sudden death, as well as the possibilities of his disease to progress. It is very important, therefore, to assess properly and individually for each patient, and establish a good relationship between the physician and the patient, so that the patient has confidence in the advice they can provide you with the optional.Evaluation should be based on the characteristics of the patient and the anomaly that suffers in the type of practiced sport, its degree of intensity, the level of competition and the involvement of the athlete.
In general, when there is a known heart disease should be a detailed medical history, an evaluation of the symptoms and a physical examination that includes a 12-lead resting ECG. It is highly recommended to include a stress test in cardiac recognition Protocol.
Doppler echocardiography is of obliged fulfillment in congenital heart diseases.
Tests are: ambulatory electrocardiographic monitoring, the isotopic study radionuclide ventricular angiography / catheterization, coronary angiography, the electrophysiological study, and other less common such as endomyocardial biopsy.
When the patients are children, it is necessary to make a full assessment of their cardiovascular status, in order to have all the information possible from the State of the child, and that includes:
· Medical history (a family history of sudden death at early age or heart disease). Look for symptoms that make suspect disease cardiology, such as shortness of breath, chest pain, syncope or near syncope.
· Complete physical exam, which should include a good cardiac auscultation, take blood pressure and palpation of femoral pulses (under the inguinal fold, i.e. in the groin).
· Electrocardiogram.
It is important to treat each case individually and assess, in each patient, the ability to limit their physical activity to the practice of recreational activities or, conversely, extend it to training and competition, but establishing a protocol for monitoring that ensures the safety of the patient.
To establish the various recommendations it is useful to classify athletes according to:
· Your load (low, medium or high) static or dynamic.
· And recreational activities of competition practice, dividing them into two groups: little intense and severe.
· Differentiate heart disease suffering from: severe to severe, moderate, mild and benign.
In general, in children with benign heart restriction of physical activity or sport competition, always attending to each clinical history and under the decision of the specialist is not required.
In children with mild heart disease , leisure-time activities are allowed and can perform sports competition, low or moderately intense, bearing in mind that you have to let them rest and if they show signs of tiredness. Intense competition will be allowed only if, after a medical test effort at maximum intensity, not shown that there is a risk to the heart.
Children with moderate heart disease can run risks if they perform strenuous exercise, for which only must allow recreational activities little or moderately intense if shown, after a stress test, that there is no risk to your health. Therefore, recommended sports with a low static load and low or average load dynamics. The intense competitive sport and the intense recreational activity are prohibited.
Intense recreational activity should be prohibited in patients with severe heart disease . They can practice low-intensity recreational activities, and moderately intense leisure activities will only be allowed if the stress test (which must be regularly fixed by the doctor), shows no danger. They must not practice sports competition.
The results of physical examinations and tests practiced the athlete should be collected in a medical report, that includes diagnosis and recommendations resulting from the observations made. This report will be delivered to the athlete, if adult, or to their parents or guardian, as the case of a minor.
Recommended exercise for acute and chronic coronary disease
Sedentary lifestyle is a factor that increases the risk of coronary artery disease (EC), although that does not mean the exercise to avoid the appearance of it. However, there are studies which guarantee that the exercise is able to improve cardiorespiratory function in different situations, both in healthy individuals and in coronary patients. It has also been proven that there is an inverse relationship between physical activity, cardiovascular and coronary heart disease, and that the risk of a cardiovascular pathology is 1.9 times higher than in sedentary people compared to those physically active.Rehabilitation or exercise set (always under medical control) programs improve the physical capacity of patients, contribute to their good psychological condition, increase the threshold of presentation of angina and arrhythmias, and collaborate so that social, labour and sexual life develop with normality, reducing the overall mortality in these patients.
Exercises recommended for coronary heart disease
The exercises can be classified as isometric (static) or isotonic (dynamic), and each year has a different effect on the body. Isometric exercise promotes muscle development and causes a significant elevation of blood pressure. In a patient heart this can be poorly tolerated, so practice this sport should be restricted and be under control.Dynamic exercises, based on a frequent repetition of low resistance movements involving large muscle masses, such as walking, running, swimming, rowing or cycling are recommended for these patients.
Systolic blood pressure increases slightly, but diastolic blood pressures and media do not vary significantly with this type of exercises, and an increase of cardiovascular tolerance, allowing to improve the ability of patients to carry out daily activities.
Dynamic exercise increases functional capacity and decreases the consumption of oxygen at any level of submaximal exercise, which implies a lower heart work and causes an elevation of the threshold of angina after a period of training.
Other benefits of exercise for coronary artery disease
Intense exercise alters the lipid profile, representing an improvement of cardiovascular risk. Therefore the change of lifestyle, with an increase in physical activity, supposed to adopt a measure that reduces total cholesterol (and particularly LDL cholesterol) and triglycerides and increase HDL cholesterol.Exercise also reduces the concentrations of glucose and insulin receptors to union, and diabetics who perform strenuous exercise have reduced insulin requirements.
Currently it is considered beneficial to patients with acute uncomplicated myocardial infarction to initiate soon controlled physical activity that could even start in the coronary care unit.
Subsequently, to leave the coronary care unit or the hospital, the patient should gradually increase the level of physical activity, performing small tasks at home and light exercises involving muscle groups of the arms, legs and trunk. The most appropriate exercise is walking, progressively increasing distances. When the patient is already able to take short walks, you can think to perform submaximal exercise testing, allowing to evaluate their clinical situation and assess their risk.
After this assessment, and determined once possible treatment you need, the patient suffered a heart attack can begin to increase, gradual and controlled, physical activity that throws you mentioned benefits.
Exercises recommended for cardiac valvular diseases
It valvular pathology has a high prevalence, but despite being so common and that in most cases symptoms have as a factor triggering and limiting the effort, there are few jobs in which to consider the response and limitation of these patients to exercise.Guidelines of action or recommendations on exercise listed below are primarily aimed at lesions that have a degree of severity, moderate or severe, since the light, asymptomatic, and without hemodynamic repercussion, probably do not require restrictions on the practice of physical activities which are not in competition.
Among this group of disease one of the most common is mitral stenosis, which is a disorder of the heart valve that is characterized by a narrowing or blockage of the opening of the mitral valve, which separates the upper and lower chambers of the left side of the heart. This prevents the valve opens properly. Patients are therefore limited its ability to perform physical activity by the presentation of dyspnea.
Yet it could recommend the practice of physical activity, dynamic type, like walking, running, jogging, biking maintenance, swimming, skiing, golf, always below the threshold of dyspnea, avoiding violent efforts, and under medical control, since it must always assess the circumstances of each patient.
Other frequent pathologies are:
· Aortic stenosis.
· Tricuspid stenosis.
· Valvular insufficiencies.
· Chronic mitral regurgitation.
· Tricuspid insufficiency.
· Chronic aortic insufficiency.
· Multivalvular disease.
· Valvular heart disease operated.
· Patients with valvuloplasty.
· Mitral prolapse.
Exercises recommended for myocardial diseases and inflammatory
Depending on the type of myocardial disease and inflammatory that suffer, these are recommendations to keep in mind if you want to practice exercise:Dilated cardiomyopathy
It is the most frequent cardiac muscle involvement and its origin is different.The main symptom is the dilatation of the left ventricle, with thinning of the walls and the consequent decrease in contractile ability, which conditions a bad ventricular emptying. Clinically it presents itself as breathlessness, initially of effort after resting as well as muscle fatigue.
Hypertrophic cardiomyopathy
It is a primary disease of the heart muscle that causes an increase in the thickness of the walls, mainly of the left ventricle, without expansion of the cavity. The importance of this disease lies in that is the biggest cause of sudden death in athletes young, including people without a history of any type of symptoms.Pericarditis
During an acute pericarditis of any etiology is recommended rest, free practice any type of sport until not proves clinically or by ultrasound and ECG, complete cure.Control of physical exercise in patients with heart disease
Recommendations to make exercise safe and healthy for a patient with heart disease include changes in diet and supplementation of antioxidants or immunomodulatory, proper sports equipment and a program of proper physical exercise, with an initial phase of heating, followed by muscle adaptation and dynamic, ending with a progressive cooling aerobic exercise.· Warm-up period: the beginning of the year should always be progressive, both in intensity and in the muscle groups working during heating. The progressive elevation of body temperature decreases the viscosity joint and increases muscle elasticity, reducing resistances.
· Aerobic exercise: exercises that are recommended are the isotonic or dynamic (walking, biking, swimming, running, etc.) but always in a gentle intensity to moderate. The patient must experience a pleasant sensation while performing it, never fatigue. So this phase stimulation appropriate, is required for 30-45 minutes, which can be carried out continuously or at intervals, always depending on each person.
It is advisable to training sessions on alternate days, so the body assimilate the work done.
· Muscle adaptation: dynamic and aerobic exercise is that provides more cardiovascular benefits. An increase of muscular development reduces cardiac risk.
The necessary stimulus for muscular development should be gradually progressive, at various intervals, few repeats throughout the day.
· Progressive cooling: the completion of the exercise should also be gradual to cooling, with gentle stretching and progressive relaxation exercises.
At the time of exercise, should take into account a number of recommendations regarding the used sports equipment. For example, footwear must be appropriate, reducing burdens in the joints of the lower limbs and reduce discomfort related to the osteoarthritic process. Like loose, lightweight and breathable, clothes to avoid the increase of body temperature by facilitating the evaporation of sweat and make exercise more enjoyable.
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