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Avoiding the e word

September 10th, 2014


Avoiding the e word

Rigorous, sustained and regular physical activity is at the heart of a good heart-recovery regime, but it doesn’t have to be unpleasant or exhausting

There are so many myths about exercise and heart disease, so many misunderstandings. Anyone who has heart disease is automatically regarded as being in a weakened state of health and it is assumed that his or her life could be in danger.

Heart disease is certainly a very scary prospect for many people. Patients of mine with high blood pressure are always asking me whether they have it and that is a hard question to answer because high blood pressure can often lead to heart disease. Also, the medicines used to treat high blood pressure can sometimes be the same as those prescribed for heart disease.

Dr Nithi Mahanonda is a consultant cardiologist and interventionist at the Perfect Heart Institute,

Actually, heart diseases are not as scary as everyone thinks. Medical advances in recent decades allow doctors to treat most heart problems efficiently. A far bigger problem is how patients take care of their health afterwards. Exercise and diet are a big part of that scenario.

Staying healthy means staying strong. When a person who previously suffered from heart disease becomes weak, his or her heart also weakens and the chances of heart disease recurring increases. Heart disease cannot be cured “permanently” like some conditions. If you have heart disease (especially myocardial infarction or a narrowed artery), you will become weaker and your risk of being afflicted by the same disease again is higher than someone who has never had that disease.

To minimise the risk, you have to stay strong; which is not that hard to achieve. Doctors can prescribe extremely effective drugs that have been proven to reduce the risk of heart disease recurring, but, at the end of the day, the patient still has to exercise regularly. This is something the doctor can’t help you with.

Exercising correctly can reduce the chance of heart disease by 30% and it is a far better solution than any of the powerful drugs available these days. Surprisingly, most patients would readily choose medicine over exercise. When the doctor says “exercise”, the patient tends to think of playing sports, excessive sweating and exhaustion. In fact, exercise for the sake of your heart doesn’t have to be that extreme.

Actually, it could even be termed “doing activities” so that people aren’t intimidated by the sound of the “e” word. Anything that gets your heart pumping harder and continuously for 20 to 30 minutes, four or five days a week is good enough. It could be anything from window-shopping (without stopping to make a purchase!), gardening or sweeping floors to washing the car, vacuuming or dancing. The activity just has to be rigorous, last for 20 to 30 minutes without pause and be carried out four or five times a week.

Very few heart diseases require one to cease physical exercise altogether. No matter how serious your heart disease is, you can do some exercise as long as you start slowly and work your way up. An experienced doctor can work out an exercise programme for patients based on their condition. The goal is to strengthen the patient’s heart, but after the exercise programme ends it is up to the patient whether or not to maintain this strength.

A good heart-recovery programme is designed to match a patient’s physical condition and the right diet will also be recommended at the same time. By “right” I mean right for that particular patient, because what’s good for one patient might be dangerous for another. The person’s weight also has to be watched and risky behaviour, such as smoking, has to be avoided.

One patient of mine is about 70 years old. She first came to see me because she had been feeling weak for the best part of a year. Earlier she had undergone bypass surgery to remedy a narrowed artery. She had a heart failure after that operation. Since she had a history of high cholesterol levels, her doctor recommended that she avoid fatty and salty foods.

She was quite savvy when it came to food and nutrition. She had done some research and found that meats are high in cholesterol. She had also read that salt can cause heart failure, due to water retention, and that it is found in many foods, not just those that taste salty. So she only ate vegetables and steamed fish. Her food was either boiled, steamed or occasionally microwaved.

She kept strictly to that diet and within the space of a year her weight gradually dropped from 50kg to 45, 43, 40 and finally to 37 kg. By that stage she was more or less confined to a wheelchair. That was when she first came to see me. After giving her physical examination, I found that she was malnourished and her muscles were weak. I told her that she had to increase her food intake and do physical therapy to boost her muscle strength. After a month or so, she got strongerc and was able to walk unaided for periods of 20 to 30 minutes. Her weight was back up to 47kg, which was proportionate to her height. Now she understands that “watching” her nutritional intake doesn’t mean avoiding most foods.

The Buddhist injunction to follow the “middle path” in all endeavours also holds true when it comes to people with heart disease looking after their health.

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.



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