Cardiovascular ConditionsWorkshop Personal Training

Vleminckstraat, 10 – 2000 Antwerpen (B) – www.functionaltraining.be

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Cardiovasc

ular

Disease

46%

Other

Causes

28%

Cancer

26%

Incidence of Cardiovascular Disease (CVD) on mortality in Belgium

0

2000

4000

6000

8000

10000

12000

14000

Coronary

Heart

Disease

Stroke Other CVD Respiratory

Disease

Stomach

Cancer

Colo-rectal

Cancer

Lung Cancer Other

Cancer

Injuries and

Poisoning

All Other

Causes

Men Women

Source : European Council of Health, 2000

Risk Factors for Cardiovascular Disease

Major Risks Factors:

High Blood Pressure (Hypertension)

High Blood Cholesterol

Diabetes

Overweight and Obesity

Smoking

Physical Inactivity

Gender (Male)

Heredity

Age (+ 55)

Contributing Risk Factors:

Stress

Alcohol

Sex Hormones

Birth Control PillPractice: Fill in the Framingham questionnary for CV risks (end of syllabus)

Risk Factors - Europe

Risk Integration: Smoking, Cholesterol, Age, Sex, Blood Pressure

CHOLESTEROL RISK VALUES

Total cholesterol > 200 mg/dL

HDL < 35 mg/dL

LDL >130 mg/dL

Total cholesterol/HDL < 5.0

Endogenouscholesterol (liver)

Animal (eggs, all types of meat, dairy products)

Saturated Fats(butter-based products, red meat, baking oil)

Chronic Heart Failure

Chronic heart failure (CHF) affects approximately 1% of people aged 50-59 years, and this high prevalence increases

dramatically with age.CHF is a common reason for hospital admission and general practitioner consultation in

the elderly. Common causes are:

1. ischaemic heart disease,

2. hypertension

3. dilated cardiomyopathy.

THE FAILURE OF THE HEART TO ACT AS A PUMP !!!

Management is directed at prevention, retarding disease progression, relief of symptoms and prolonging survival.Non-pharmacological approaches include exercise and risk-factor modification

FARMACOLOGICAL APPROACH:

Angiotensin-converting enzyme (ACE) inhibitors

+

β-Blockers

+

Diuretics

Ischaemic Heart Disease

MIOCARDIAL INFARCTION:

Tissue necrosis for lack of oxygen

1) Blockage of one or more arteries delivering blood to the heart muscle

2) Sudden spasm of a coronary vessel, causing tissue necrosis

CARDIAC ARREST:

Sudden stop of the contractility

of the myocardium caused by irregular neuro-electrical transmission

1) unregulated beating in the atria (atrialfibrillation)

2) unregulated beating in the ventricles (ventricular fibrillation)

ANGINA PECTORIS:

Painful sensation in the chest

normally during strenuous exercise. It can be a useful emergency signal that the blood

supply to the myocardium is not adequate

HYPERTENSION and CHF

HYPERTENSION: > 140/90 mmHg

RISK OF CHF: + 2-3 TIMES

Increased peripheral resistance;

1. What is peripheral resistance?

2. Which kind of exercise can promote heart hypertrophy?

3. Which kind of exercise can increase the vascolarisation of the heart?

•Increased work from the heart muscle

(myocardium);

•Excessive development of the muscular walls

of the heart (hypertrophy);

ACUTE EFFECTS OF EXERCISE ON HYPERTENSION

AEROBIC EXERCISE

1. Aerobic exercise generally brings Stage 1 hypertension inside normal values for the 4-10 hours following the exercise.

2. Reductions in SBP et DBP average 15 et 4 mm Hg, starting from a pre exercise value of 147/94 mm Hg.

3. It has been demonstrated that Hypotension Post Exercise lasts up to 22 h after an exercise session

4. Reductions in BP have been observed after an exercise duration as low as 3 min at an intensity as low as 40% of VO2max

ISOTONIC EXERCISE

• Moderate evidence exists that

isotonic training has little effects on BP in the 24 hours following exercise

ISOMETRIC EXERCISE

1. At present, there is no evidence that can suggest recommendations for beneficial isometric training in BP management

• Overdoing things. Know your limits and try to avoid angina, shortness of breath or extreme fatigue.

• Activities immediately after your meals. Wait at least 60 min after meals

before exercising or doing strenuous activities.

• Burst Activities. Activities that are vigorous in nature and cause a sudden

increase in heart rate are better tolerated with a warm-up.

• Very hot or cold environments. When your heart has to work harder either to

warm or cool the body, exercise/activity may need to be decreased or avoided.

• Lifting heavy objects or weights. This type of straining exercise may produce

angina or dizziness, and can cause increases in blood pressure.

• Saunas and hot tubs (Avoid for at least 4 weeks after your heart attack).

Heart Stressors

Referred Cardiac Pain

Reduction of maximal oxygen

consumption (VO2 max)

Reduction of exercise capacity

Reduction of maximal cardiac output

Reduction of maximal systolic volume

Reduction of max HR

EFFCTS OF CARDIOVASCULAR DISEASE ON EXERCISE

Reduction of the sensibility

to insulin

OR

Insufficient production of insulin

Reduction of the synthesis of

intramuscolar glycogen

Diabetes caused by genetic transmission, pharmacological treatments, or other diseases

Every degree of intolerance to glucose with a first manifestation during pregnancy

Different degrees of insulin resistance and relative insulin deficiency

Deficiencies in the insulin action can be either genetics or acquired as a consequence, for example, of obesity.

Chronic hyperglycaemia and high levels of FFA can also contribute to develop resistance to insulin.

Destruction of BETA CELLS by an auto immune process that results in a deficiency in insuline production

OTHER TYPES

PREGNANCY DIABETE

TYPE 2

TYPE 1

Diabetes diagnosis and classification

1) Plasma glucose = 126 mg•dL-1;

2) Diabetes symptoms like an inexplicable weight loss associated with plasmatic glucose > 200 mg•dL-1;

3) Plasmatic glucose >200 mg•dL-1 during the 2 hours following induced hyperglicaemiaprovoked by ingestion of 75g of glucose

Diabetes complications

Cardiovascular disease. The risk of myocardial infarction is 50% higher in diabetic men and 150% in diabetic women.

Recommended moderate intensity physical activity (60-80 %of maximal HR, 50-74 % VO2 max)

Peripheral Neuropathy.

Loss of sensitivity in lower legs and feet. Intervention:

•Activities with support of body

•Appropriate sports shoes even in daily activities.

•Regular examination of the state of feet by diabetic person and her doctor

Renal Failure

Diabetic people should avoid all the activities that could raisze the BP >180-200 mm Hg (ex., Valsalva manœuvre,high intensity resistance exercises or maximal aerobic exercise), because systolic BP augmentation can accelerate the progression of the disease.

Retinopathy

Type 2 diabetic clients should be evaluated to determine the degree of retina damage.

In case of retinopathy, any activity that involves sudden changes in BP should be preferably avoided. Ex: exercise with sudden raising and lowering of the head, exercises with head lower than the body, jumping activities

Limitations of exercise in diabetic subjects

Motivation to be consistent with an exercise routine has been reported being poor

Withdrawal rate from exercise routine is higher in diabetic subjects than in any other group.

Diabetics clients often find aerobic exercise uncomfortable.

Insulin resistant subjects have a majority of Type IIb muscular fibers, low percentage of Type I fibers and low capillary density

The anaerobic threshold is usually reached at a lower percentage of VO2 Max

These abnormalities in fibers composition can affect the tolerance to aerobic activity

Q: Why? How can you intervene?

HYPOGLICAEMIA

In order to minimize the incidence of hypoglycaemia, it is necessary to understand the relation between the exercise period and:

(a) The time when the medications are taken (ex., time of oral medications assumption, time of insulin injection);

(b) The alimentation before and after exercise;

(c) The last evaluation of the glycaemia.

(d) Insulin should be injected at least 1 hour before exercise

Transactional model application to Exercise and Disease

Pre contemplation I am not aware that I present risk factors for CV disease

Risk factors awareness – Personal Experience (Fear)

Contemplation I am aware that I present risk factors for CV disease and I’d like to do something about it, but I don’t know what or how.

Positive image of exercise – Realistic objectives - Safety

Preparation I get information on how I can effectively reduce the risks (PT consultation, fitness membership, a visit to an anti-smoking center…)

Information - Structure –Motivation – Short Term Goals

Action I start implementing a strategy to reduce my risk factors (buying 3 months PT, quitting smoking, reducing fat in the diet...)

Social Support – Results – Long Term Goals

Adherence My lifestyle has changed and the risk factors are sensibly reduced

F.E.A.R.

If you can market a product based on fear and emotion (both of which are highly

correlated with cardiovascular disease), chances are you will sell that product andlots of it!

Famous speaker, Zig Ziglar, states that F-E-A-R is really

False Evidence Appearing Real

An ethical approach:

1. Avoid Denial (the negation of the problem)

2. Inform Correctly over the Risks/Benefits of physical activity

3. Stay within your competences

4. Work as a team (PT, Doctor, Client…)

5. Feel free to turn down a client if you feel uncomfortable

Effects of Aerobic and Strength Training on CVD

"If exercise could be

packaged into a pill, it

would be the single

most widely prescribed

and beneficial

medicine in the

nation."

Robert N. Butler, MD, Former Director, National Institute on Aging

Effects of exercise on diabetes

ACUTE EFFECTS

Increase of the sensitivity to insulin

Lasts between 12 to 24 hours after exercise.

Increased tolerance to glucose

Normally lasts up to 72 h after exercise

The acute effects of exercise on insulin sensitivity and glucose tolerance have been proved to be of short term.

Q: “what is your suggestion to increase the beneficial effects of exercise ?

CHRONIC EFFECTS

1. Exercise facilitates the mobilization of fat tissue from the upper body

2. Abdominal adipose tissue is positively correlated with hyperinsulinemia and negatively with insulin sensitivity.

3. Abdominal fat is a significant source of FFA that can be oxidized in place of glucose, causing hyperglycaemia

Q: In which effective way can exercise reduce the degree of diabetes at long term?

F.I.T. Diary

F = frequency(days per week)

I = intensity(easy, moderate,vigorous) orpercent of heart rate

T = time (amount for each session or day)

Intensity and Duration of a Session

5-10’ warm up

20-40’cardiovascular exercise (continuous or interval)

1. 40-85% of the maximal functional capacity (VO2 max)

2. or 40-85%of the maximal reserve capacity (Karvonen)

3. [(FC max – FC rest) X 40-85%] + (FC rest)

4. or 55-90%of maximal HR.

5. or 4-8 RPE

5-10’cool down

Calculate the differences of working zones for a subject 30 yrs old, HR rest 80 and compare them when different formulas are used.

Discuss.