Is there any physical activity that is good for everyone, why "packing" in the gym is inappropriate for the heart, when the heart rate monitor may … lie and whether a patient with a pacemaker should be afraid of sports - answers Dr. hab. med. Ewa Jędrzejczyk-Patej from the Heart Rhythm Section of the Polish Society of Cardiology.
"Walking, Nordic walking, swimming or cycling, practiced for pleasure and at moderate intensity, support the effects of cardiac therapy, improve the patient's well-being, prolong life - the benefits cannot be overestimated."
According to the recommendations of the World He alth Organization, regular physical activity is the most important basis of a he althy lifestyle. Is there any activity that is especially good for the heart?
dr hab. med. Ewa Jędrzejczyk-Patej : Physical effort is the basis of the new he alth pyramid developed by WHO (World He alth Organization). In the past, it was said that for optimal he alth, moderate-intensity exercise at least three times a week, lasting a minimum of thirty minutes, with a heart rate of around 130 beats per minute, is optimal. There was a rule: 3 x 30 x 130. Today, in order to maintain good he alth, it is recommended to exercise moderately five times a week. It is worth being active, but it is also good to know what is good for the heart - not every physical activity will be suitable for everyone.
What does the heart like?
E.J.-P .: The heart likes dynamic exercise, cardio training - such as, for example, Nordic walking, running and swimming. From the heart's point of view, static and isometric efforts, such as weightlifting or colloquial "packing" at the gym, are inadvisable. Such training does not improve the body's efficiency and physical condition - it only increases muscle mass and in some cases may lead to cardiac hypertrophy, arterial hypertension or aggravation of arrhythmia episodes. As cardiologists for such efforts, we say: no.
The gym is recommended if we decide to exercise dynamically, using a treadmill, stationary bike or stepper. You should also remember that the effort must be adjusted to the general condition of the body.
A warm-up is a good solution?
E.J.-P .: Warming up is necessary to keep warmmuscles and keep joints moving. It is good if the training includes the phases of: warm-up, proper training and relaxation, with stretching and relaxation. Only when practicing sports regularly, it is worth systematically increasing the intensity of training - a huge, intense "spurt" in the case of beginners may cause serious injuries and overload of the body - it is not worth risking, because rehabilitation can be long and tiring.
What kind of activity can be recommended to seniors?
E.J.-P .: Walking, ideally at an average pace, and Nordic walking, i.e. walking with poles, engaging most of the muscle groups are universal forms of physical activity. You should also try cycling, swimming or dancing - as long as your fitness allows it.
Universal recommendations of the World He alth Organization say that you should take 10,000 steps a day - on the one hand it is not a small amount, but on the other hand, when we spread the activity throughout the day, it is a feasible value. It is worth being active during everyday activities - it is worth to go one stop on foot, take a walk to the store instead of going to it by car and park right next to the entrance, go up the stairs instead of taking the elevator - these are small but very important habits that will help in the long run build better performance and condition.
Are outdoor gyms, built near housing estates, a good and safe solution for the heart?
E.J.-P .: As long as the air quality allows it, dynamic exercise in outdoor gyms is highly recommended. If the concentration of particulate matter exceeds the recommended limits, you should rather avoid outdoor exertion, so as not to inhale pollutants that can harm the whole body. However, if the air quality is good, it is worth going for exercises - devices such as a walker, cross trainer or a romper are especially good, which improve efficiency and help build a better condition of the body.
Will modern technologies and heart rate monitoring applications be helpful during training?
E.J.-P .: Such solutions can be helpful, but you have to remember that these technologies are constantly evolving and are not always 100 percent perfect. They are more and more precise, but can still sometimes give unbelievable results - not even because the measurement is inaccurate but, for example, does not take into account the individual characteristics of the owner.
For example, in patients with arrhythmias such as atrial fibrillation, pulse monitoring devices do not always accurately detect the pulse wave and the indications they give,they do not always correspond to the actual values. Also in patients with a large number of ventricular extrasystoles, the measurements may be distorted. In a he althy person, the chance of incorrect measurements is relatively small and the modern devices and applications available on the market are more and more accurate and reliable.
Patients with heart disease and diagnosed arrhythmias often fear whether sport is for them at all. Are there any activities that I can take despite my illness?
E.J.-P .: It can be stated that, in general, recreational sport is even recommended for patients with cardiovascular diseases, only with the exception of the decompensation stage. The aforementioned walks, Nordic walking, swimming or cycling, practiced for pleasure and at moderate intensity, support the effects of cardiac therapy, improve the patient's well-being, prolong life - the benefits cannot be overestimated.
Performance sports are different - we are much more careful here. Groups of cardiological diseases, such as, for example, arrhythmogenic right ventricular cardiomyopathy or hypertrophic cardiomyopathy, are cases in which competitive sports are contraindicated due to the fact that it may worsen the course of the disease and aggravate arrhythmias.
In the case of atrial fibrillation, if we do not have adequate heart rate control, sport should be treated very carefully and with more intense activity wait until the heart rate is well stabilized.
Should patients with implanted cardiac devices, such as a pacemaker or cardioverter defibrillator, avoid vigorous physical activity?
E.J.-P .: If a patient has a pacemaker, he is not in danger of having a discharge, for example during sports, when the heart rate is rising, because pacemakers do not have such an option. In the case of a cardioverter defibrillator (ICD), the risk of unnecessary discharge during intense training is theoretically existent, but today we have detailed knowledge of how to optimally program the ICD so that the patient does not experience inadequate shocks.
Such inadequate interventions of the device are caused not by the ventricular arrhythmia, but by the rapid heart rate, i.e. the so-called sinus tachycardia in the course of physical exertion that a given patient performs during physical training. Cardiac implantable devices are becoming more and more perfect. They have different algorithms to tell if it is a life-threatening arrhythmia or common exercise-induced sinus tachycardia. Before training, it is always worth asking your attending physician what heart ratethe device starts to recognize arrhythmia and from what heart rate it will respond. Then modern heart rate monitors can help, because if a patient sees that their heart rate is dangerously high, which an implanted device may already recognize as an abnormality, it may interrupt or slow down the training pace.
We sometimes recommend our patients to exercise stress tests to see what maximum heart rate values the patient can achieve during vigorous physical exertion. Such research helps in programming a given implantable device.
I would advise all patients with implantable devices not to be afraid of physical exertion, but before training, consult their doctors regarding the recommendations. One patient has a device implanted for heart failure, another for cardiomyopathy, for example - patients' reactions to exercise may be different, so the sports recommendations should be treated very individually.