Time after time I come across patients who are suffering from stable coronary artery disease (CAD) who, through no fault of their own, are under the impression that they can’t partake in any form of ‘strenuous’ activity, as it would be detrimental to their health. When I broach the subject of why they are under this impression, I commonly discover that they have have not been informed of the merits or safety of exercise or even worse, have been told not to by a health professional. As a Doctor I feel that these patients have been failed by the system and it is my duty to make sure I rectify the situation and their understanding. Hopefully by writing this article I can ensure that this message I tell people everyday is conveyed to as many people as possible.
The fact of the matter is that exercise is one of the most effective treatments on the market, and that is no lie. I would go as far as to say that it is a ‘wonder drug’. If exercise were a pill, it would receive global applause and its inventors would be in line for a Nobel Prize. But instead, time after time, we continue to shun this miracle treatment in preference for pills and surgical intervention. Don’t get me wrong. I am not saying that these treatments are not important, but am instead emphasizing that exercise can be just as, if not sometimes more beneficial, and when carried out in combination, the effects are amplified.
Stable CAD afflicts millions of people throughout the world. Everyone knows someone who has heart disease, and many people have been affected by its effects on loved ones. The possibility of having a heart attack or dying from the same is always a worry, but is not the only concern. The effect on everyday life can be devastating to individuals who, after given the diagnosis, feel a part of their life has been taken away from them. The truth however is that if treated correctly, this condition doesn’t have to be disabling, and a person can lead a very happy and active life in conjunction with the disease. This is where exercise comes in!
When it comes to CAD, so much emphasis is placed on the commonly known risk factors such as hypertension, smoking and cholesterol. We hammer into our patients the need to bring blood pressure down, cholesterol in check and throw cigarettes in the trash, but often neglect the need to encourage exercise. What we also need to start emphasizing is the fact that exercise is a medicine. It is true that exercise is beneficial in heart disease sufferers, but it should also be noted that INACTIVITY IS HARMFUL. By not doing any exercise, individuals are in fact putting themselves at more risk of suffering.
So if exercise is such a beneficial tool in the treatment of stable CAD, why is it so under-utilized and under-promoted? One of the main answers to this is lack of awareness by health providers. Although research has conclusively shown the positive effects of exercise on outcomes in stable CAD, this information is sometimes not adequately conveyed to those providing the treatment and as a result, the patients. Another reason is, as always, funding. Cardiac rehabilitation programs have been around for some time, but in many instances hospitals fail to offer them to patients, and insurance companies may not be willing to foot the bill. This is a shame as if emphasis was placed on this simple intervention, the result would be less money having to be spent on the consequences of not carrying out regular exercise.
A very important study revealed that in patients with stable CAD, there was no difference in clinical outcomes (death rates, heart attacks, hospitalization) between those who underwent aggressive medical therapy with lifestyle modification and those who underwent aggressive medical therapy and percutaneous coronary intervention (stenting, angioplasty etc). Despite this many stable patients are still directed towards the interventional suite, at significant cost, even though it may be of little, if any, benefit to them. I’ll let you decide the reasons for this, but the important thing is that many of these patients are not offered simple exercise programs.
Exercise is POWERFUL as a treatment for CAD. The effects it has are numerous and include anti-atherosclerotic (reduce plaque formation), anti-thrombotic (reduce clot formation – one of the causes of heart attacks), anti-ischemic (reduces angina) and anti-depressive effects. When carried out in patients with stable IHD, it has in fact been shown to reduce mortality (death), and non-fatal myocardial infarction (heart attacks that don’t result in death).
One of the common reasons behind people with stable IHD not exercising is the fear that it will be doing them harm. Often they feel that exercise will bring on their angina and this will be conferred as feeling they are doing themselves damage or bringing on a heart attack. The fact is that this is not true. If this is you, one of the ways to help overcome this fear is to reduce the amount or intensity of the exercise, even below recommended levels, until confidence increases and you can build up to more. After all, as I have said in previous articles, any exercise is better than no exercise. If you really struggle with the thought of angina preventing you from exercising, your doctor may be able to prescribe you anti-angina medications to help prevent it occurring.
The risk of stable CAD sufferers having a cardiovascular event in the rehabilitation setting has been repeatedly shown to be minimal. There are many effective supervised programs available and it is important to know that they are safe. There are also many telephone and internet based programs for those who may be limited by distance, travel or financial constraints, and these provide the same benefits.
It is also important that you know that resistance exercise is also safe for those suffering from CAD. There is a grave misconception that the stress from lifting weights puts increased strain on the heart and should be avoided. Let me tell you now that this is NOT TRUE. Resistance exercise is safe in those with stable CAD, and should form part of any cardiac exercise program. Not only does it confer several positive muscular effects, but also may reduce cardiac demand during everyday activities.
So in conclusion there is NO DOUBT that exercise is hugely beneficial in those suffering from stable coronary artery disease. Medical education of health professionals is increasing, but don’t let lack of awareness hold you back from improving your health and quality of life. If you suffer from CAD and are not already partaking in a regular exercise program, go and see your doctor and ask them about cardiac exercise programs. Although exercise is safe in stable CAD, I would recommend that you see your Physician rather than just jumping into a program. It is important that your individual circumstance it taken into account and that your disease is deemed as stable before commencing increased activity levels. It is best that you begin exercise as part of a supervised program, and when you feel confident you know what you are doing you can go ahead and form your own exercise regimes. If your Physician seems unsure, you are now armed with the information to educate them. If they refuse to listen, then go and find another doctor, but whatever you do, DON’T TAKE NO FOR AN ANSWER!
Don’t let heart disease stop you living your life to the full. Get out there and exercise!