Exercise
I have always hated exercise. Now that I have had a heart attack, and presumably should take things easy, my doctor tells me that I need to take more exercise. What exercise should I be doing?

Many people like you who have had a heart attack were not physically fit before their heart attack: perhaps, because of pressures of work, there was little time for sport or leisure activities. Exercise is very good for you, but it does need to be enjoyed rather than seen or felt as a punishment. Dynamic exercise, involving movement, e.g. walking, swimming, cycling, jogging, tennis, dancing and golf, is the most helpful. Isometric exercise, e.g. weight-lifting or press-ups, is not beneficial and should be avoided. Exercise should be undertaken every day but it is not compulsory, so avoid wet, cold and windy weather – consider walking in a new enclosed shopping mall if you have one near you. An exercise bicycle is a way of keeping up exercise when the weather is bad, and boredom can be avoided by putting the bike in front of the TV set.
Walking is very good exercise and it is cheap and safe. There is no need to take up jogging, if you don’t want to – just walk briskly, climb stairs and avoid lifts if you can. Swimming is also good for the heart. At first, always stay in your own depth and do not dive in. Gradually increase to swimming some lengths of the pool as slowly as you like, and then speeding up.
Exercise should be increased gradually as the weeks go by. Some people feel unable to do much at first, and may even be afraid of doing anything at all or going out alone. Going out with relatives or friends helps but joining a rehabilitation programme, if possible, is the best way of regaining confidence and getting the maximum benefit.
During your first 2 weeks at home, do slightly more exercise each day in terms of distance and time. There is no need to be afraid of going up stairs or going for a walk. A useful plan is to cancel the daily paper and walk to the newsagent to collect it. This is exercise with a purpose: you can stop for a chat, and you know how long it takes to walk the distance to the shop, so the time it takes can be reduced as you speed up and get fitter.
It is a good idea to chart your exercise and how you are doing over the weeks following your heart attack. You may be surprised at how much you can already do and how much improvement you are making. Aim to walk briskly for 30–40 minutes at least five times a week and for over an hour if you need to lose weight. You can break this up, for example into two 20-minute walks.
By 6 weeks after your heart attack, you should be back to normal activity, or even better, because most people do not exercise enough normally. There is more information in Chapter 10.

How I should begin my exercises?

It is always important to warm up first. Do some bending and stretching, and then set off at a gradual pace, gently speeding up. At the end of the exercise, allow time to cool down. See Chapter 10 for more information.

You hear horror stories about the dangers of exercise, from slipping a disk to straining muscles, or even dropping dead! Are there any ‘commandments’ that I should be following?

Follow these guidelines.
•    Never exercise until it hurts. If you begin to feel uncomfortable, stop immediately and rest.
•    Don’t be embarrassed to rest – it is your health that matters, not your image.
•    Avoid exercise within 2 hours of a main meal. The output from your heart rises by 20% to cope with digestion, so exercising too soon could make you feel unwell.

• Don’t exercise if you feel under the weather with a cold or flu, or when you feel ‘too tired’.
Warning signs that youare doing too much include:
•    pain in your chest;
•    breathlessness;
•    palpitations (see Chapter 6);
•    faint feelings;or
•    just not feeling ‘right’.

Stop immediately, and next time reduce the amount of exercise you do, stepping up again a week later. If warning signs continue when you are exercising less, go and see your doctor.

I am recuperating from a severe heart attack. How can I tell when I am overdoing things?

It is best to join a local cardiac rehabilitation programme, and most hospitals have these now. If you have not been told about such a programme, ask your doctor if there is one near you – it is most likely to have been overlooked.
Ask your doctor or nurse to show you how to take your pulse (see Figure 10.2 on p. 291). It should be less than 100 beats per minute (bpm) before you start exercising, and not go faster than 200 bpm minus your age: so if you are aged 60, your heart rate should not exceed 140 bpm. If your heart rate (measured at your pulse) is consistently greater than 100 bpm before you start exercising, it is best to get the doctor to check you over to make sure that all is well. At first your heart rate will rise quickly on exercise, but it will rise more slowly as you get fitter. If the rate goes above your maximum target, slow down as this is a sign you are overdoing things : it is very easy to be too keen!

Is it really necessary to know my heart rate?

No, it’s not essential but some people like it as a guide. It is quite in order to judge based on how you feel and whether you are breathing comfortably. The best exercise is a progressive programme with a gradual increase in exercise supervised or guided by a rehabilitation nurse or physiotherapist.

I can honestly say that I have never taken any exercise, but my doctor tells me that I need to do so if I do not want more heart problems. For how long should I exercise?

Only for about 15 minutes at first. Don’t overdo things: gradually increase the time and build more exercise into your day.
•    Can you climb two flights of stairs instead of using a lift?
•    Do you really need the car or the bus for the half mile or kilometre to the shops?
•    Can you park half a mile from the station or get off the bus a stop early, and then walk the rest of the way?

Ideally exercise should be built up to 30–40 minutes a day, five or more times a week.

How will exercise help me?

Exercise helps you in many ways.
•    It improves your breathing and thus the supply of oxygen.
•    It strengthens your heart’s pumping action.
•    As your fitness improves, your general well-being improves, along with greater self-confidence.
•    Any bottled up stress tends to be released, relaxation and sleep will be improved, and overall lethargy and fatigue decreased.
• Exercise also helps you lose weight and improves your cholesterol levels.
Exercise is cheap – all that is needed is the will to do it and a good pair of shoes.

Diet
Should I be doing anything about what I eat?

There are two main things about your eating that can be improved: reducing your weight and lowering your fat intake (cholesterol). Both are important and are usually related, although some thin people can have high cholesterol levels, and some fat people can have normal cholesterol levels. See the section Risks of high cholesterol levelsin Chapter 2, for more information about cholesterol and lipids, and what is involved.
I am absolutely miserable when I go on a slimming diet – it never works anyway. What is so wrong with being fat?

Being overweight throws a strain on your heart and causes your blood pressure to rise. Fat people are less mobile and have more pain in their bones and joints.
Losing weight sensibly (and not ‘going on a diet’) will benefit your heart and help keep your blood pressure normal. If you are overweight, losing weight may also help reduce the fats in your body. There are guidelines for your ideal weight (see Appendix 4). Losing weight is about changing your lifestyle and the amount of food you eat. It is not about becoming obsessed with food or going on crash diets. See Chapter 9 for more information about losing weight.

Would it help if I saw a dietitian?

Yes. Dietitians are extremely good at explaining which foods are best to eat, and they know how to advise different ethnic groups with specific dietary requirements. Ask for an appointment at the hospital or at your doctor’s surgery.

My cholesterol was checked 2 weeks after my heart attack. It had gone right down, but my hospital doctor did not seem as pleased as I was. Why not?

After a heart attack, the cholesterol level will fall and return to your normal level after about 6–8 weeks. If it is tested on the day that you are admitted for the heart attack, this will be accurate too. Cholesterol measurements taken after the first 24 hours and up to 2 months after a heart attack are unreliable, tend to be low and therefore falsely reassuring. Whatever your cholesterol was, you will be placed on a statin (forever!) as the benefits are overwhelming. Your response will be checked to make sure that the dose is correct and that the targets have been reached (see the section Risks of high cholesterol levelsin Chapter 2).

I have read a lot about what I should do, now that I am home after my heart attack, but there seems to be too much to do at once.

It may seem that way at first, but it is important that you change your lifestyle. Don’t get obsessed by the need to change, tackle each point of the diet as suggested in Chapter 9, in a gradual way. Get the whole family into healthy eating – pick up any hints or tips from family and friends, or leaflets from your pharmacist.
Begin with the simple tasks of reducing sugar, switching puddings to fruit, snacking sensibly on fruit and not biscuits, and then gradually switching from saturated to unsaturated fats.

Reference:
1) http://www.PubMed.com
2) Jackson G. Heart Health, 4th edition, Class Publishing, London.