WALKING THE BEST EXERCISE FOR HEART PATIENTS

Physical inactivity is harmful for health. Physical activity is beneficial to health for all ages and disabilities. Walking is a natural activity and is health promoting. Walking is cheap, flexible in time, speed and location. Although any form of exercise is better than none, walking for those reasons remains the best form of exercise for heart patients. Anyone can build up a regular routine. It is not necessary to go anywhere first in order to do it. Just go outside and enjoy it. If you live in dense urban area, the find a park or an open space to walk in. Biochemical studies show that your feet pound the ground with 3-4 times your body weight when jogging where as your feet strike the ground with only 1-1.5 times your body weight while walking, making it the safest form of aerobic exercise around. The only thing that the heart patient has to take care of is the heart rate. We recommend a daily walk of atleast 35 minutes at one stretch. This means that you have to walk in the same speed for this period of time. If one achieved will be the persons angina threshold, where the ST segment shows depression.

Now one has to simply reach till 75% of the MHR (maximum heart rate). After this all that one has to do is to maintain the speed for 35 minutes. In the beginning one can always start with slow speed and over a period of time increase. If a TMT is not available then it becomes all the more simple. Keep increasing the speed gradually till you are uncomfortable. Now reduce your speed so that the pulse rate comes 20 beats below the angina threshold.

Walking will help you get back the ideal weight by burning up calories and combined with a good diet program, it will help you stay there.

BENEFITS OF WALKING

·         Walking is perfect massage.

·         It improves both muscle tone and strength. It will tone and strengthen your hips and thighs. It will do the same for your stomach and buttocks.

·         It will help you shed all those flabby areas that you always wanted to get rid of.

·         Walking is a universal stress reliever. It energizes you, helps you relax, makes you feel good about yourself. It helps you beat depression and it will help you sleep better.

·         Walking is the best and the cheapest stress management tool around. It is a positive addiction. The more walking you do, the more you will want to do.

·         Walking can easily become a lifelong habit and it is the easiest form of exercise to keep up for  a lifetime.

·         It makes your body supple and you have reserves of strength and stamina. Suppleness prevents you from getting injured and helps keep you active. Increased strength helps you get around and climb stairs. Stamina keeps you going through the day without getting tired.

·         Walking will build cardiovascular and respiratory fitness.

·         Walking aerobically causes the body to take in more air with less effort, since aerobic exercise increases our normal capacity to process oxygen. This results in an improved cardiovascular and respiratory system. The result is an improvement in the vital efficiency of the lungs and the whole cardiovascular system.

·         The weak becomes stronger. It helps promote growth of new blood vessels in the heart which improves the circulation. (collateral circulation or natural bypass).

                                                                                                       

HOW FAST DO I NEED TO WALK?

The easiest way to begin walking is to walk out of your own front door and do a circuit round the block and back- or around some other convenient route that is known to you. It can be a park also. You will need to gauge the distance covered. You can refer to the milestones or you can use the car/scooter meter to measure the distance between familiar landmarks.

As you build up your walking, you will need to increase the length of your circuit. You may also want to calculate your speed. For a heart patient we recommend 35 minutes of walk daily at a sustained speed. The aim is to keep the heart rate at 75% of the maximum heart rate for angina threshold. Once that speed is reached then you have to sustain it for 30-35 minutes.

HOW TO COUNT YOUR HEART RATE?

Our heart rate and the pulse rate are the same. Whenever the heart beats a pulse is created. This can be felt in the wrist or the elbow. To feel the pulse put your two fingers (index and middle finger) of one hand on the wrist of the other hand. The pulse will be felt little away from the middle towards the thumb side on the wrist. The same can also be felt in the elbow as shown in the sketch diagram. Once you can confidently feels the pulse, take a watch with “seconds” markings and count for one full minute. This gives us the exact heart rate.

Your pulse rate varies throughout the day. It is its lowest whilst sleeping. It rises and keeps varying through the day.

Under normal circumstances, the lower resting pulse rate, the healthier you are. Average pulse rate is 72 beats per minutes. But it can vary anything between 50-90 beats per minute. Regular exercise will steadily lower the resting pulse rate.

The heart is a pump. The less work it has to do throughout your life – the less beats it has to make the longer it will last. When you start walking, frequently stop for 10 seconds and count your pulse. You then multiply this figure with six which will give you your pulse rate per minute. Keep increasing the speed till you reach 75% of the angina threshold.

Every muscle of our body needs energy to contract as explained elsewhere in this issue. Energy is obtained from breakdown of the food (carbohydrates, proteins and fats) that we consume throughout our day. The cells of the body or muscles can utilize oxygen and food (carbohydrates broken into glucose, proteins broken into amino acids and fats broken into fatty acids) in their mitochondria (power house) to produce energy. Whenever the intensity of exercise or activity increases, more energy can be produced by these mini power houses or mitochondria present in the muscle cells. But to achieve this, it needs more food and more oxygen.

Our heart is also equipped to supply more food and oxygen to the contracting muscles by increasing their blood supply. For this the heart increases its beats or heart rate. This increase can be 10-20 beats per minute in light exercise where as it can as much as 100-120 in severe exercises. During these exercises the contraction volume of the heart also increases (this is called Ejection Fraction).

The increment in heart rate pushes up the requirement of blood of the muscles of the heart (cardiac muscles) -  which is supplied by coronary arteries (one on the right – right coronary artery and two on the left called left anterior descending and left circumflex arteries.

Since, heart is supplied with much more blood than it requires (it needs 10-30% of the capacity of 100% supply)- the heart can easily meet the increased need even during severe kind of exercises (running, boxing). Coronary heart patients or angina patients have a problem with these severe exercises because more than 70% of their tubes are blocked by deposition of cholesterol and triglycerides. When they are at rest only about 10% of the supply is required. Little bit of physical activity requires 20% and any form of severe physical activity will require 30% of the tube to remain open. Since these patients have blockages which are already more than 70%, a time comes in their physical activity when the demand for blood i.e. oxygen is not met. This produces a condition called angina and the heart rate at which this occurs is known as the angina threshold. This means that heart patients need to do exercises in such a way that the heart rate does not reach the angina threshold.    

 

Hope you liked this blog!

This blog is written by Dr. Bimal Chhajer (India’s best heart doctor)