Cardiovascular Disease & Exercise
Cardiovascular disease (CVD) is a big topic with many doctors and scientists dedicating their lives to helping people with CVD and understanding CVD in more depth. In this article, we’ll look at a basic introduction to CVD and how exercise can assist you to reduce your risk of conditions associated with and related to CVD.
What is cardiovascular disease?
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. CVD is the general term for conditions affecting the heart and/or blood vessels, usually associated with the build-up of fatty deposits inside the arteries known as atherosclerosis increasing your risk of blood clots. It can also be associated with damage to arteries in organs such as the brain, heart, kidneys and eyes. In the UK CVD is one of the main causes of death and disability but it can often be prevented by leading a healthier lifestyle.
There are four main areas of CVD:
Coronary heart disease - occurs when the flow of oxygen-rich blood to the heart muscle is blocked or reduced. This puts an increased strain on the heart and can lead to further complications.
Coronary heart disease can be further broken down into:
Angina - chest pain caused by restricted blood flow to the heart.
Heart attack (non-STEMI & STEMI) - blood flow to the heart muscle is suddenly blocked. (non-STEMI - as non-ST elevated myocardial infarction a STEMI is an ST elevated myocardial infarction).
Heart failure - the heart is unable to pump blood around the body properly.
2. Strokes and TIAs
A stroke is where the blood supply to part of the brain is cut off which can cause brain damage and possibly death. A transient ischemic attack is also known as a TIA or a mini-stroke is similar but the blood flow to the brain is only temporarily disrupted. The main symptoms of stroke or a TIA can be remembered with the word FAST:
Face - the face may have drooped to one side, the person may be unable to smile, or their mouth or eye may have drooped.
Arms - the person may not be able to lift both arms and keep them there because of arm weakness or numbness in one arm.
Speech - their speech may be slurred or garbled, or they may not be able to talk at all.
Time - dial 999 immediately if you see any of these signs.
3. Peripheral arterial disease
This occurs when there is a blockage in the arteries to the limbs, usually the legs. This can cause:
Dull or cramping leg pain, which is worse when walking but gets better with rest.
Hair loss on the legs and feet.
Numbness or weakness in the legs
Persistent ulcers (open sores) on the feet and legs.
4. Aortic disease
This is a group of conditions that affect the aorta, the largest blood vessel in the body, carrying blood from the heart to the rest of the body. One of the most common aortic diseases is an aortic aneurysm, where the aorta becomes weakened and bulges outwards. This usually doesn’t have symptoms but it could be life-threatening.
What can exercise do?
It is widely accepted that physical activity is beneficial for your overall health and cardiac health. In fact, frequent exercise is robustly associated with a decrease in cardiovascular mortality and the risk of developing cardiovascular disease.
There are certain risk factors that predispose you to an increased CVD risk those are; family history, ethnicity background, genre and age, unfortunately, we can’t make ourselves younger. However, there are 5 major modifiable risk factors for CVD that can and will have a big impact on your CVD risk and health risk. Those risk factors are; sedentary lifestyle, high blood pressure, abnormal values for blood lipids, smoking and obesity. If we look at individuals who are regularly physically active compared to those who spend the majority of their time sedentary we see:
Improved body composition (fat mass vs muscle mass)
Improved blood pressure control
Improved plasma lipoprotein profile (good vs bad cholesterol)
Improved insulin sensitivity (blood sugar control)
The benefits of exercise go far beyond the 4 points listed above, however simple exercise such as walking can have a hugely positive effect on your cardiac health, your quality of life, life-span, self-confidence, stress and anxiety.
Regular exercise does not have to be time spent in the gym it includes standing instead of sitting at our desk, walking with friends or/to and from work, cycling, yoga, pilates, really anything that involves movement. It’s not so much the activity that is important but that you like doing it. Over time you’ll find that your effort, strain and fatigue are considerably reduced giving you more energy to spend with your family and friends.
One of the main reasons exercise gives you more energy, is due to our relationship with oxygen. Oxygen is the base of all life, exercise will help our bodies to utilise and transport oxygen better and thus providing us with more energy.
What type of exercise is best?
To be short there isn’t one. The best type of exercise for you and for CVD is one you enjoy. Whether that is walking, swimming, running, cycling, or resistance training. Consistency will gain you better results than one particular type or modality of exercise. Choose an activity that you can do 3 or 4 times a week, that will increases your heart rate and your breathing rate.
There are two main categories that most activities will fall into resistance training or cardiovascular aerobic training. Resistance training will increase the strength of your muscles and bones, making you more resilient to injury and will lead to less effort doing everyday tasks such as walk upstairs etc. Cardiovascular or aerobic exercise is typically continuous exercise at a lower intensity for somewhere between 30 - 60 minutes, this type of exercise will improve the efficiency of your heart and lungs and your ability to use oxygen.
Resistance training increases muscular strength, improves posture, cholesterol, insulin sensitivity and body composition, whilst decreasing blood pressure, joint and muscular pain.
Cardiovascular training will decrease your resting blood pressure, heart rate, improve your cholesterol, insulin sensitivity, and body composition.
How much do I need to do?
This question is still unclear. There is definitely a dose-dependent curve, however, it is unlikely you will reach this, studies show that too much endurance exercise (e.g. ultra runners 26.2 miles +) can lead to a similar risk of CVD as those who are sedentary. So it appears, as with anything and everything, the danger is in the dose and that dose will be different for everyone. What is clear is that physical activity and exercise shows clear improvements in physical health and reductions in mortality with small bouts of daily exercise between 50 - 60 minutes per day.
The current governmental guidelines are:
You should undertake physical activity each day.
You should undertake 2 muscular strength (resistance training) sessions twice per week.
You should complete between 150 minutes of moderate or 75 minutes of vigorous activity per week.
How do you start?
Slowly. Rome wasn’t built in a day. It is useful to know your current physical abilities this will allow you to see the progress you will make over the subsequent weeks and month. You can do this by performing the 4 tests below:
12-minute walk/run test - how far can you go in 12 minutes?
Press-ups - how many press-ups can you do? (3/4 press-ups for women).
Squats - how many squats can you do in 30 seconds?
Balance - how long can you stand on one leg with your eyes closed?
Whatever your results, don’t worry, that’s a base which we will look to improve from. A good place to start is by walking 20 - 30 minutes per day, slowly building this up by an extra 5 or 10 minutes per week. If you struggle to do 30 minutes in one stint break it up throughout the day by doing 5 or 10-minute segments followed by periods of rest. This will help your cardiovascular system adapt to the increased demands. Muscular strengthening exercise is important, and a good compliment to walking, begin with squats, glute bridges, dead bugs and counter-top press, these are bodyweight exercises that can have a big difference, aim for 10 reps across 3 sets twice per week. There are more videos that you can find on my youtube channel, here.
I hope this help to give you a little understanding and direction in using exercise when dealing with CVD. If you would like any help with your health or if you know anyone who does please feel free to get in touch via email at ben.duckett@pandhtherapy.co.uk
“Add life to your years & years to your life”
References
www.NHS.uk/conditions/cardiovascular-disease
Nystoriak MA, Bhatnagar A. Cardiovascular Effects and Benefits of Exercise. Front Cardiovasc Med. 2018;5:135. Published 2018 Sep 28. doi:10.3389/fcvm.2018.00135
www.nhs.uk/live-well/exercise
Myers J. Cardiology patient pages. Exercise and cardiovascular health. Circulation. 2003;107(1):e2-e5. doi:10.1161/01.cir.0000048890.59383.8d