EXERCISE AND CARDIOVASCULAR FITNESS R Iqbal, PhD.

Physical activity is a medium for fitness and good health which keeps away a heart specialist from an individual. Exercise not only helps to fight heart disease, but for sedentary people, just adding a little exercise to the daily routine reduces the risk of high blood pressure, osteoporosis, breast and colon cancer, depression, anxiety and stress. The greatest benefit from physical activity is seen in people who formerly did no activity and then start to do activities such as walking, cycling, swimming and yogic exercises.

What are the benefits of physical activity?

Regular physical activity-

• improves the strength of heart which makes the heart to work more efficiently during exercise and at rest. The more activity people do, the greater is their capacity for exercise and the stronger is the heart which keeps away any heart problem. This leads to reducing of high blood pressure, controlling blood cholesterol levels, controlling diabetes by improving the body’s ability to metabolize glucose.
• helps weight reduction by mobilizing excess fat from the body.
• indirectly encourages people to quit smoking for maintaining proper health and fitness.
• improves flexibility and builds muscle.
• decreases total and LDL cholesterol ("bad cholesterol")
• raises HDL cholesterol ("good cholesterol")
• increases energy store in the body
• increases tolerance to anxiety, stress and depression
• controls / prevents the development of diabetes
• decreases risk of orthopedic injury by improving flexibility
• helps building healthy bones, muscles and joints.
• reduces the risk of colon cancer.

How to design a fitness program?

There are many programs which can be followed to improve physical fitness. Most generalized program recommended for fitness group, heart patients as well as sedentary population follows FIT formula:

The FIT Formula:

F = Frequency (number of days per week)

I = Intensity (level of exercise like low, moderate or heavy)

T = Time (duration of exercise per day)

FREQUENCY: 3-5 days per week. Exercise can be extended up to six days in a week but not recommended for all seven days in a week since the body requires proper rest to tolerate exercise stress.

INTENSITY: Intensity should be decided on the basis of target heart rate.

Calculation of Target Heart Rate (THR)

THR = 60% of Maximum heart rate = 0.6 x (220 – age).

(220 – age = Predicted maximum heart rate)

Example: For a person of 40 years old, predicted maximum heart rate is 220 - 40 = 180. The THR = 0.6 x 180 = 108 beats per minute.

Therefore, it is recommended to go for continuous activity (jogging, walking, cycling, stair climbing, rowing, aerobics, and swimming etc) at such a speed that heart will pump at the rate of around 108 beats per min or within the range of 105 to 112 beats per min. To check this- stop for a while after 5 min of exercise and check the pulse for 6 sec and multiply the pulse with 10 to make it beats per min. In case the heart beat is less than 105 beats/min then increase the speed of exercise and recheck the pulse. If heart beat is more than 112 beats /min then slow down and recheck.

Once the patient feels comfortable with this level of exercise, gradually the intensity may be increased by 5% after consultation with a doctor. But the upper limit should not be exceeded more than 80% of the maximum heart rate. However, physical activity should not be overdone, since too much exercise can result in injury.

TIME (Duration): For beginners the exercise should be 5 to 10 min per day but slowly it can be increased to a minimum of 30 min per day and preferably 60 min per day.

What are the modes of exercises?

• jogging, running, brisk walking, stair-climbing, aerobics.
• bicycling, rowing and swimming.
• Recreational games such as football, handball, basketball and tennis etc that include continuous running

What is an Aerobic Exercise

The term "aerobic" indicates ‘atmospheric oxygen’ and includes activities that enable the body to utilize oxygen to produce energy needed to perform the activities. Aerobic exercise consists of continuous rhythmic movements of large group of muscles that can be sustained for a prolonged period of time. These activities increase the heart rate and breathing rate and train the heart, lungs and muscles to utilize oxygen more efficiently. Aerobic exercise conditions the cardiovascular system and is also referred to as endurance exercise because it increases one's energy and capacity to perform work. Aerobic exercise is important to develop and maintain basic fitness. It benefits a heart patient when recovering from a heart attack or surgery because it specifically strengthens the heart.

When a person should consult a doctor about exercise?

In case of the following physical and physiological complaints, it is advised to consult a doctor before going for an exercise program.

• Heart disease.
• Chest pains with activities especially.
• Extreme shortness of breath after activities.
• Very high blood pressure.
• Prone to loose consciousness or get very dizzy.
• Bone or joint pains that could be made worse by activity.
• Insulin-dependent diabetes which is not properly controlled.
• Planning to vigorously exercise after a long period of inactivity

How much exercise is recommended following a heart attack or bypass surgery?

A minimum of 30 minutes low to moderate-intensity aerobic activity (jogging, walking, cycling, stair climbing, rowing, aerobics, and swimming etc) three to five days a week is recommended. Exercise should not be done all the seven days in a week. After a cardiac event, exercise should be started by walking 5 to 10 minutes per day. Once the patient feels comfortable with this level of exercise, gradually the duration may be increased up to five minutes each week. The speed of walking can also be increased slowly.

What can be done to prevent heart problems in the future?

Exercising regularly, making changes in daily schedule like avoiding high caloric diet and avoiding smoking risk of heart disease can be decreased in the future. Regular exercise reduces high blood pressure and cholesterol levels and helps maintaining fitness and health.

What are the symptoms of angina or heart attack?

Severe chest pain or discomfort that lasts for more than a few minutes and is not relieved by rest. The symptoms of a heart attack usually last longer and are more severe. Immediately consult a doctor. Avoid all physical activity.

What are the dos and don’ts of exercising at home?

• Always make your body warm (warm-up) before exercise.
• Follow the target heart rate during exercise.
• Always cool down after the exercise program
• Keep an exercise diary and record your resting and exercise heart rates.
• Do not exercise within two hours after a meal.
• Don’t drink alcohol two hours before an exercising program
• Don’t smoke before an exercising program.
• For any abnormal symptoms, such as irregular heart beats, excessive shortness of breath or lightheadedness stop and rest. If the symptoms do not subside in a few minutes immediately consult a heart specialist.