Over the next several articles, we will be exploring exercise recommendations for residents in “Special Populations”. These residents have more complex health concerns such as coronary artery disease, diabetes and asthma. Hopefully the previous installment dispelled myths and excuses, but what do you do if you have more severe health concerns? This section will be focusing on persons with high cholesterol, high blood pressure and heart disease.
Coronary artery disease, or CAD, is when there is an imbalance between the oxygen that is available to the heart tissue and the heart’s demand for oxygen. High cholesterol, high blood pressure and heart disease are all contributing factors of CAD. They lead to atherosclerosis (narrowing of the arterial walls) and arteriosclerosis (thickening of the arterial walls). Sadly, CAD can go undiagnosed or be asymptomatic. It usually isn’t until there are emotional or physical stress and the heart’s oxygen demands are not met that a genuine issue, like a heart attack, occurs. According to the CDC, only 18% of the population is free from major risk factors.
Having a risk factor does not guarantee a certain outcome. However, when the risk factors accumulate for a person, the statistical probability of developing some form of CAD increases exponentially. For example, two risk factors result in 3.3 times the risk and three risk factors result in 10 times the risk. The six controllable risk factors are smoking, hypertension, high cholesterol, obesity, diabetes and inactivity. Other factors that cannot be changed are heredity, increased age, sex and ethnicity.
When faced with the uncertainty of how to minimize their risk for CAD many people make drugs their first choice. Often this decision is made because of fear and lack of information and professional direction on how to control these risks. The National Cholesterol Education Program (NCEP), suggests drug prescription for high LDL (low-density lipoprotein “bad cholesterol”) levels only after an exhaustive attempt to use exercise and diet has failed.
When starting an exercise program, an individual with CAD needs to work with their physician and other health care professionals to individualize a safe and effective plan. It is highly recommended that they work with a certified trainer experienced in training those with cardiac concerns. Exercise intensity should range from 40-85 percent of their maximum oxygen consumption or heart rate reserve. To stay within this range, a heart rate monitor should be worn.
Guidelines for Cardiovascular Endurance:
Frequency: 3-5 times per week
Warm-up/Cool-down: important to do 5-10 minutes of each to avoid incidents
Exercise Modes: walking, jogging, hiking, cycling, rowing, aerobic circuit training, and water-based exercises.
Strength training is also a valuable component to the exercise regimen for someone with CAD. The American College of Sports Medicine recommends the following criteria be met before beginning a resistance program.
Six weeks have passed since uncomplicated myocardial infarction or bypass surgery.
Two weeks have passed since angioplasty without occurrence of myocardial infraction.
The person has completed four to six weeks of supervised aerobic/cardiac rehab.
Resting diastolic BP is less than 105.
The person is not compromised by congestive heart failure, unstable symptoms, or arrhythmia.
Guidelines for Resistance Training:
Exercise large muscle groups before smaller ones.
Load-weight should be lifted comfortably 10-12 times. Lifting to failure/exhaustion is not recommended.
Increase load by 5-10 pounds when 12-15 repetitions can be performed. Err on the side of progressing conservatively.
Train with slow, controlled full-range movements.
Exhale before the exertion phase of the lift.
Avoid sustained gripping with the hands, which can evoke excess blood pressure and heart rate response.
Minimize rest periods when appropriate to maximize muscular endurance.
Avoiding straining, holding your breath, or forcing reps (don’t struggle with the load).
Do not exercise to muscle failure, which is the inability to do another repetition.
Stop exercising if warning symptoms appear. That includes dizziness, shortness of breath, irregular heartbeat or arrhythmia or chest discomfort.
Lastly, when pharmacological agents are prescribed properly, they enable cardiac patients to exercise safely, effectively and limit the likelihood that exercise-related cardiovascular symptoms will occur. Many heart patients are prescribed drugs that change exercise heart rate and blood pressure response and can even limit exercise capacity. Generally, you should be knowledgeable about the following cardiovascular drug classes and their effect on basic cardiovascular responses. These drug categories include beta-blockers, alpha-blockers, nitrates, digitalis, calcium channel blockers, diuretics, vasodilators, angiotensin-converting enzyme inhibitors, and antiarrhythmic agents. Work with a physician and pharmacist to understand their effects and how their use affects the workout protocol.
1. American Heart Association 2003
2. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Diseases: 2011 Update