@exerciseworks guest blog series on physical activity and cardiovascular health: Part 2

Heart disease is the leading cause of death for both men and women.

Reduction of heart disease risk in patients is significantly linked to modifiable factors (such as tobacco use, poor diet, physical inactivity, obesity, alcohol use) or factors that can be changed to reduce the risk of further ill health and heart disease (such as appropriate blood pressure control, lipid management and the availability of essential medicines and technologies to treat cardiovascular disease). More than half of the deaths worldwide (due to heart disease) are in men.

Physical inactivity is a major contributor to all types of cardiovascular disease risk- yet regular physical activity can help maintain a healthy weight, lower cholesterol and blood pressure, and help reduce the risks associated with an inactive lifestyle. Children who are inactive are also at risk of developing heart disease and stroke risks earlier in life. A simple solution, you would think, such as helping each of your patients to exercise more, would and should work!

Providing physical activity advice and support to every patient, is an essential part in the prevention and treatment of all aspects of heart disease and stroke health care.  The World Health Organisation is clear on the physical activity message:

Every adult needs to enjoy physical activity for at least 150 mins a week:

• Adults aged 19–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
• Aerobic activity should be performed in bouts of at least 10 minutes duration.
• For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.
• Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

An exercise prescription can include walking, hiking, swimming, dancing, running, jogging, sports and gym activities, or physical activities in leisure time also help to promote heart health!

Every child and teenager needs to enjoy active play and opportunities to exercise:

• Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
• Amounts of physical activity greater than 60 minutes provide additional health benefits.
• Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone*, at least 3 times per week.
• *For this age group, bone-loading activities can be performed as part of playing games, running, turning or jumping.

The exercise ‘prescription’ for children and young adults should emphasise active play, fun, inclusivity and less sitting.

Health professionals are skilled at supporting patients to make the right choices for their best health outcomes. There is no better preventative medicine that you can prescribe than to help encourage and support your patients to exercise daily!

The clinical benefits of regular physical activity on cardiovascular risk factors for patients have been well reviewed but you can summarise for patients as:

• able to exercise more: regular exercise increases exercise tolerance and stamina
• reducing body weight: a loss of just 5 to 10 percent of weight can lower your patient’s risk of coronary heart disease. Regular exercise advice together with a healthy eating programme can help your patients achieve this. Many people may need more than 150 minutes/week of moderate intensity activity a week to stay at a stable weight, as well as to lose weight or keep off weight they have lost. (U.S. Dept. of Health and Human Services. 2008 Physical Activity Guidelines for Americans, 2008)
• a lowering in blood pressure: the average reduction in blood pressure ranges from 7.4mm to 5.8mm Hg in hypertensive study patients
• reduction in ‘bad’ (LDL and total) cholesterol
• increase in good (HDL) cholesterol
• increase in insulin sensitivity: both aerobic and resistance training improve insulin action, blood glucose control, and fat oxidation and storage in muscle. This means that the risks of developing metabolic disorders and type 2 diabetes are significantly reduced with regular physical activity

And finally, as I’m a British Association Cardiac Pulmonary Rehabilitation exercise instructor….

Cardiac or stroke rehabilitation programmes (cardiac rehab) reduce the risks of a further cardiac event by stabilizing, slowing or even reversing the progression of cardiovascular disease. In the USA, only 14-35% of heart attack survivors and only 31% of coronary artery bypass surgery participate in a cardiac rehab programme. In the UK, the average attendance rate post cardiac event is 43%.

Please support, advise, engage, signpost, enable, encourage, prescribe, refer and educate patients as to the benefits of attending their local cardiac rehabilitation programme- it is life-saving medicine after a cardiac event and continuing as a lifelong prescription. Every patient should be able to access cardiac rehabilitation programmes locally, and bespoke to their cultural needs.

In summary: heart healthy exercise prescriptions are critical care medicine at their finest. Let’s start prescribing exercise and fun, physical activities and monitoring our patients at risk of heart disease, every consult they attend, and at every opportunity in their health care pathway!

And remember….. refills and repeat prescriptions of this life saving prescription are on a weekly basis of 150 minutes/week, but review as a ‘vital sign’, every consult!

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Ann Gates BPharm(Hons) MRPharmS

Founder of Exercise Works! in celebration of World Heart Month February.

Member of the WHF Champion Advocates Programme – Emerging Leaders Programme.

Info graphics courtesy of the World Heart Federation Champion Advocates Programme.