Joy in Running

Joy in Running

HEART HEALTH

Joy in Running

For adults, running offers unmatched health benefits. How can we recapture the joy in running later in life?

Almost 45 years ago, Thaddeus Kostrubala, MD, a psychiatrist, wrote his bestselling book, “The Joy of Running.” Dr. Kostrubala was one of the first medical professionals in the mid-1970s to investigate the benefits of long-distance running, specifically its effect on a person’s mental and physical health. He began running in San Diego in his early 40s after realizing that his weight, family history, and a lifestyle of limited exercise put him at high risk for a heart attack. After finishing his 3-mile run, at a slow pace, Dr. Kostrubala noted that he was joyful. As he continued running, he identified that reaching a cardiovascular rate of 75-80 percent around the 45-minute point in a distance run three times a week, brought the most health benefits. For almost 45 years, Dr. Kostrubala was called “The Running Doctor” or “The Running Psychiatrist” until his passing on September 4, 2020.

One point that Dr. Kostrubala made in one of his final interviews with Runner’s World was that walking, jogging, and running are activities that date back to the earliest humans, who relied on their feet to travel, some 4-million years ago. That thought came to mind as I watched my nephews chase each other around the backyard during a family cookout this past summer. They were laughing, loudly, as their little legs carried them around the yard. When we were younger, running was fun. There was such freedom found in our youth as we ran as fast as possible. When did we lose that joy? Is it possible to recapture it later in life?

Joy in running became personal as I entered my mid-30s for similar reasons as Dr. Kostrubala. I have a family history of diabetes and stroke. After an annual visit with my doctor, along with some changes to my diet, I needed to find a daily form of exercise that could help manage my “bad” cholesterol numbers. I started by jogging around my neighborhood on Saturday or Sunday mornings. Those jogs gradually led to slow runs where distance and my speed increased. After a year, I entered my first 5K. After that event, I was hooked! I reached out to Charles Woodruff, a former collegiate runner at the University of Connecticut, who has been coaching runners of all abilities since 1994. Woodruff also owns the Fleet Feet running stores in Malta and Albany. He joined me on a recent episode of HeartTalk, presented by Capital Cardiology Associates, as we discussed the recent spike in those who have rediscovered the joy in running.

Starting over

Just as every run has a beginning, so does every runner. The image of a marathon or long-distance runner may come to mind, but if you have a routine of going out three to four times or log a few miles every week, you are a runner. As Coach Woodruff outlined, the most important component in any running routine is rest. “We don’t rest enough; we become a slave to miles or how much we are doing. We need to realize that our bodies are capable of adapting to just about anything. Running is a very progressive sport. You want to approach it gradually.” Start easy is the best advice he offers. “If a friend got you into running, you might not be where they are, and you shouldn’t be trying to keep up with them. Running is a very individual sport.” If your last distance run was the mile in high school, your body needs at least 12 weeks to adjust. The best beginner plan starts with 30 minutes walks that build up to 30 minutes of running.

Once you start your running plan, be ready for changes. I didn’t fully embrace an athlete’s mindset until this year when I began training to run my first 10K. My “weekly” runs became more structured. Instead of getting a run or two during the week and one on the weekend, I formed a plan that increased in time/distance runs with set rest and active rest days. I learned early on how important rest is, especially the days following a five-mile run! Coach Woodruff noted that aches are normal initially — as long as they don’t develop into pain that lasts for more than a day or two. I also realized that proper running gear, hydrating after a run, getting enough protein in my diet, and quality sleep at night are the building blocks necessary for success.

Coach Woodruff’s advice

“When we form our training groups, one of the things we emphasize all of the time is that in a group, you are part of a community. Even when running with other people, you need to be doing this for yourself. You are going to be successful when you take the gifts and talents that you already have and maximize them. Don’t worry about being fast or being the slowest person in the group. If you are taking what you have and working hard to make it better – that’s where you will find success.”

WHAT TO WEAR

“The five things you need to have hanging in your closest for winter running: a good base layer, briefs that are not cotton, hat and gloves, element jacket, shoes, and socks. Come in and talk with us at Fleet Feet and we will be happy to point you in the right direction for gear.”

SAFETY FIRST

“Make sure you are wearing apparel that has reflective material on your moving parts, like your arms and legs. This helps drivers see you more clearly. Make sure you are running on the left-hand side of the road against traffic. Don’t run with your back to the road.”

How running improves your heart health

For adults, running offers unmatched health benefits. It lowers your risk of heart attack or stroke. A massive study in 2014 on running and heart health showed that it’s good for your bones, blood pressure, and brain. This study covered all forms of running: slow, fast, short, and long. As you run, the exercise causes your heart to increase blood flow, training the heart to pump more efficiently. We often don’t think of the heart as a muscle, but it is. Running increases the myocardium (heart muscle), strengthening the heart’s ability to pump blood (ejection fraction) through your vascular system. I never considered how my heart functions while watching TV on my couch, but I think about it during every run. Every stride is making me stronger in ways I cannot see.

Another point I shared with Coach Woodruff was how, during a run, I have some of my best thoughts. He pointed to science, how during exercise, blood flow improves, sending more oxygen through our vascular system, and bringing fresh energy to our brains. While we are listening to music, focusing on the road ahead, or enjoying the scenery, the neurons in part our brain that processes critical thinking and memory are highly active. Some research has suggested that aerobic exercise improves cognitive function, aiding in boosting our memory. The biological effects of running provide a fresh supply of nutrients to the brain, enhancing the brain function all aid in a more “hyper-alert” mind, a by-product that leads runners to say, “I do my best thinking while running!”

Joy in running

In one of his final interviews with Runner’s World, Dr. Kostrubala opened up on when he found his joy in running. It happened after he completed his first 3 miles at a slow pace. For him, the joy replaced depression, which motivated him to pursue greater distances, eventually finishing marathons. In 2011, he shared that when leukemia hit, his chemotherapy made him weak. His runs downgraded to walks, which he could do for about half an hour until he had to use a wheelchair. For almost sixty years, Dr. Kostrubala advocated that running can save your life — and your soul.

I thought about Dr. Kostrubala’s words during my conversation with Charles Woodruff. I had found my joy in running. This may sound odd, but I was excited to wake up before my alarm at 5:30 on summer mornings to go for a run. Why? Because that time is my time. Every beginning ignited a sense of purpose; every finish brought a feeling of accomplishment. Coach Woodruff is a morning runner; he’s logged thousands of miles before sunrise. “There is something magical in seeing the sun coming up, seeing the animals, this feeling that you own the world. There are no distractions. The world is waking up, and you can hear the sound of your feet. It’s the perfect way to start the day.”

Written by Michael Arce, host of HeartTalk, presented by Capital Cardiology Associates

I thought about Dr. Kostrubala’s words during my conversation with Charles Woodruff. I had found my joy in running. This may sound odd, but I was excited to wake up before my alarm at 5:30 on summer mornings to go for a run. Why? Because that time is my time. Every beginning ignited a sense of purpose; every finish brought a feeling of accomplishment. Coach Woodruff is a morning runner; he’s logged thousands of miles before sunrise. “There is something magical in seeing the sun coming up, seeing the animals, this feeling that you own the world. There are no distractions. The world is waking up, and you can hear the sound of your feet. It’s the perfect way to start the day.”

Written by Michael Arce, host of HeartTalk, presented by Capital Cardiology Associates

Women in Medicine

Women in Medicine

HEART NEWS

Women in Medicine

The issues women in medicine care about

September is the American Medical Association’s (AMA) “Women in Medicine Month.” As the AMA website states, ever since Elizabeth Blackwell earned her medical degree in 1849, women have been making their mark in healthcare. This month, Capital Cardiology Associates is proud to shine the spotlight on our women in medicine. Dr. Donna Phelan sat in on a recent episode of HeartTalk, presented by Capital Cardiology Associates, to discuss the issues women in medicine care about.

Editor’s note: On the desktop version of this article, you will see images of our Women In Medicine. You can learn more about each woman by following us on Facebook.

cca white hands logo
Amanda O'Malley
Amanda O'Malley
Amanda O'Malley
Amanda O'Malley
Amanda O'Malley
Amanda O'Malley
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Amanda O'Malley
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP
Sarah Slader-Waldorf, NP

Underrepresented

“Gender inequality does not just affect our patients, but also remains a significant problem within the cardiology profession.” That is the opening statement in an American Heart Association article published in 2019 that examined the women in cardiology. The all-female research team found that while women make up most medical graduates, they are less than 15% of practicing cardiologists and less than 5% of interventional cardiologists. There are a couple of reasons why this finding is alarming. The first deals with perception. Fewer women in cardiology “unfortunately creates an opinion that heart disease is not a disease that affects women; if there aren’t women in the field, it must not affect them. That is incorrect as we know,” stated Dr. Phelan. Heart disease is the number one killer of men and women, responsible for about one in every five female deaths in the United States. “Women are often ill-informed or go undiagnosed for heart disease. Helping women recognize how prominent heart disease is in the female population is important, especially at a young age in making good lifestyle choices,” added Dr. Phelan. Knowing your blood pressure, quitting smoking, limiting alcohol use, managing stress levels, making healthy food choices, maintaining daily activity or exercise, and most importantly, regular visits with your health care provider are all steps to lowering the chance of developing heart disease.

“So much of what we think about preventing cancer applies to reducing the risk of heart disease.”

Donna Phelan, MD, FACC

The reality is that cardiovascular disease is largely the most important women’s health issue, mainly because it can be prevented. The American Heart Association’s “Go Red for Women” campaign has helped raise awareness of heart disease at all stages in life. This is key, as there are two points in life where physical and psychological changes can significantly impact women’s risk of heart disease. The first is pregnancy. “Pre-existing conditions like high blood pressure or other congenital issues need to be recognized as potentially problematic when planning for a family or pregnancy,” adds Dr. Phelan. Weight gain is a discussion women need to have with their healthcare provider. Researchers show that overweight or obese pregnant women are more likely to develop heart disease later in life. There are also health risks to the baby, like gestational diabetes or preterm labor, associated with weight. It’s important for women to have open discussions on their physical health, mental well-being, and family health history with their healthcare provider as they begin family planning. “There are many cardiovascular conditions that can arise during pregnancy that often require a cardiologist’s assistance to get [the mother] successfully through pregnancy. There are also conditions that can make the potential for having more children dangerous to the mother’s health.”

Later in life, menopause, which usually happens in the mid-’50s, can be problematic for some women when there are lower levels of estrogen in their body. Researchers say women are susceptible to coronary artery disease during the menopause transition due to a deficiency in estrogen from the loss of ovarian function. Post-menopausal women often have higher cholesterol levels than men and are at greater risk of developing high blood pressure, even if they had normal levels throughout life. Many women have difficulty managing some or all of these added personal well-being needs. “There are natural changes in a woman’s health as she ages that must be discussed ahead of time to try and minimize the issues that can come about,” advised Dr. Phelan.

Issues women physicians care about

A 2020 Medscape survey of more than 3000 women physicians revealed interesting insight on the issues that absorb them the most. Work-life balance was by far the most important issue for women. 64% of respondents named it as their #1 problem. “Among female physicians and I suspect across most fields that require intense work schedules, I imagine an on-going discussion on how to prioritize work and family and your children all at once,” Dr. Phelan acknowledged. Taking care of aging parents or combining parenthood and work schedules are viewed as the largest challenge for women in the workforce today. Dr. Phelan also noted how this concern has intensified during the COVID pandemic. “It’s a constant struggle, something we face regularly, and there is no real solution.” Single parents or in families where both parents work, adults have used their vacation to spend time with their family, exhausted personal time off hours to attend their children’s school functions, or in the time of COVID, utilized the work-from option to provide homeschooling support or child care this past summer. For female physicians, there is also the reality that even when mom is home, she is still on-call for patient care. “There are endless evenings and weekends when I am calling patients back or looking at their testing results after hours. That’s where that juggling is difficult. I’m at home, working, and my kids are used to it.”

Medical students considering a career in specialized medicine understand the significant time investment required to obtain their goal. After completing high school, the path to becoming a board-certified cardiologist includes graduate school, medical school, with an additional two to six years of specialty training after receiving a doctorate. Most young women may be thinking about having a family, and that is a lifestyle that is hard to juggle. This decision either leads to delaying a family’s start, spacing out the birth of children (more than four years apart), or choosing to have one child. It takes a lot of dedicating and motivation to pursue a career in the field of cardiology,” Dr. Phelan commented. An overwhelming majority of women physicians said they have had to make such tradeoffs. A professional choice may include avoiding leadership or supervisory roles in order to maintain a more flexible schedule. According to the American Medical Association, women account for 3% of healthcare CMOs, 6% of department chairs, and 9% of division chiefs. Today, there is a push for more female leaders in healthcare as about one-third of women physicians indicating they are interested in achieving a higher position.

Mentors and support

The rigors of medical school are challenging for every student. As we discussed the different desires and goals between men and women, Dr. Phelan shared the unique connection female students form during their education. “Unfortunately, during medical school and training, you don’t have time for a social life. Your colleagues are the people you spend the most time with,” she shared. We discussed the friendship Dr. Phelan formed with a fellow female student while pursuing their medical degrees at Albany Medical College in the late 1990s. Donna Phelan and Allison DeTommasi were both young women who shared an interest in math, medicine, and science. They also had a passion for taking care of others. These women were part of a change in the dynamic of the healthcare industry; more women are replacing the stereotype of a doctor being a man in a white coat wearing a stethoscope.

More than half of today’s medical students are women, while in 1915, less than 3% of med school graduates were women. In October of 2018, Drs. DeTommasi and Phelan were highlighted during WTEN/Channel 10’s Inspiring Women segment. “The proportion of young women that are going into medicine has escalated tremendously, and I think there is great value in that,” Phelan said. DeTommasi spoke about the young women who approach her, with a similar interest in medicine, seeking her advice. “You really have to love this,” Dr. DeTommasi advised. Both physicians addressed the support system that exists from women in medicine. “An important motivator and support system is having colleagues who have gone or are going through this experience together. We are one big team, looking out for our patients and taking care of our families,” said Dr. Phelan.

Written by Michael Arce, Host of HeartTalk, presented by Capital Cardiology Associates

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Mary Witkowski PA-C
Dr Donna Phelan
Dr Donna Phelan
Heather A. Stahura, MD
Heather A. Stahura, MD
Heather A. Stahura, MD
Karen Canniff
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Maryellen
Catarina Paone, NP
Barbara Hendrick, PA
Barbara Hendrick, PA
Barbara Hendrick, PA
Barbara Hendrick, PA
Barbara Hendrick, PA

How stroke affects your brain

How stroke affects your brain

PATIENT EDUCATION

How stroke effects
your brain

Only a few minutes of lost blood flow can damage the electrical signal receptors in the brain

According to the Centers for Disease Control and Prevention (CDC), every year, more than 795,000 people in the United States have a stroke. Of those cases, about 140,000 Americans are killed by stroke each year — that’s 1 out of every 20 deaths. Many myths make stroke a life-threatening health emergency. One common misbelief is that strokes only happen to older people. “Stroke can affect all segments of life, all ages, even from childhood through adulthood,” says Dr. Alan Boulos. Dr. Boulos is Chair of the Department of Neurosurgery, Director of the Neurovascular Section, and Associate Professor of Neurosurgery and Radiology at Albany Medical Center. He has invested over 20 years researching and studying disorders of the brain and spine including stroke. He joined me recently for a special episode of HeartTalk presented by Capital Cardiology Associates that explored the effect of stroke on the brain.

There was concern from the medical community on the severe drop in visits to the emergency department (ED) in April, due to COVID-19 concerns. Hospitals outside of the pandemic hotspots, like Albany, reported almost a 50% reduction in patients seeking critical care. This was alarming to cardiologists, neurologists, ED physicians, and advance care providers who noted that patients were delaying care for serious conditions like stroke or transient ischemic attacks (TIA), otherwise known as ministrokes. Ministrokes, as they are commonly called, are brief interruptions of blood flow to the brain due to clots. “These are a harbinger of bad things that could come,” Dr. Boulos commented. According to the CDC, over a third of people who experience a ministroke have a major stroke within a year if they do not receive any treatment. In the case of a ministroke, a patient may experience the classic stroke warning signs: weakness on one side of the body, vision problems, and slurred speech. Dr. Boulos explained common ministroke scenarios that could last minutes to hours. “You may suddenly drop your coffee mug because the dexterity is not there in your hand. You may temporarily lose vision or have a gray blur in your eyesight while watching TV or reading. That was an event! It’s a sign of things that could come.”

What is a stroke?

When we think of blood flow in our body, we often think of our heart as the pump that circulates blood through our vascular system. Dr. Boulos reminds patients on the importance of blood flow to the brain. “The brain is very dependent on oxygen and blood flow, more than any other organ in the body. It takes about one-fifth of our blood flow every time the heartbeats.” Dr. Boulos defines a stroke as a condition that brings a sudden change in someone’s neurological function. The term comes from an old Greek phrase meaning someone has been struck by God. “In most cases, stroke occurs when blood flow to the brain is interrupted or blocked off either by a clot or by plaque, and that results in the brain to stop working,” he added. During a common (ischemic) stroke, patients may have trouble walking, speaking, and understanding, as well as paralysis or numbness of the face, arm, or leg. “Where the brain is affected will determine what symptoms are presented. The less common variety is the opposite,” noted Dr. Boulos. A hemorrhagic stroke is when an artery in the brain leaks blood or breaks open. In these events, the artery in the brain bursts or there is bleeding in the area between the brain and the thin tissues that cover it. “When blood sits outside the brain in the skull, that can be a life-threatening event.”

One of the challenges with stroke is that it can happen at any time to anyone. “When a stroke occurs, it has symptoms that vary from patient to patient. It can be anything from a speech problem to a blind spot developing on the right or left side of your field of vision, causing a car accident.” shared Dr. Boulos. Heart attacks traditionally present with chest pain, pressure, or shortness of breath — only about 30 percent of people will have a headache with an ischemic stroke, so pain isn’t a reliable symptom. This is why stroke is the leading cause of disability in adulthood and is the number five killer in the US. As a neurologist, Dr. Boulos detailed how stroke affects the brain. “Patients often can describe when the symptoms do begin. But there is also part of the brain that controls the recognition of those symptoms, the parietal lobe; it’s related to neglect. If stroke targets that part of the brain, we won’t recognize that our right hand is part of our body. Even if our right hand may not be working, we don’t recognize that it is a problem. As part of the stroke, it may cause symptoms that prevent us from recognizing the problem. That is why our friends, family, co-workers, and the people around us are so important. They can recognize when the victim is not behaving properly. That is a clear sign that person needs medical care!”

Mind figurine

Brain damage and recovery

Scientists at the Brain Research Centre at the University of British Columbia and Vancouver Coastal Health Research Institute found that damage to the brain can happen as soon as three minutes following a stroke. As a neurosurgeon, Dr. Boulos plays an important role after the stroke has occurred. “We often get involved in the hospital to try and manage that patent. To try and reverse the stroke or at least perform procedures that minimize the damage that the event has caused,” he shared. The extent of what we know about brain damage from stroke has evolved greatly over the years. “In the old days we used to think that the brain didn’t have the ability to produce cells, it didn’t recover once it was injured, or at best, it was poorly able to recover. That has largely been wrong.”

Your brain is divided into left and right halves, called “hemispheres.” They specialize in different things. Because of this, a stroke on the left side of your brain can be very different from a stroke on the brain’s right side. Let’s look at some symptoms of a left-brain stroke.

The American Stroke Association states that the effects of a stroke depend on several factors, including the location of the obstruction and how much brain tissue is affected. Stroke on the left side of the brain, for example, will affect the right side of the body and vice versa. One significant difference is that left-brain patients may have a slow, cautious behavioral style and speech/language problems, while right-brain patients may have a quick, inquisitive behavior and vision problems. If the stroke occurs in the brain stem, it can affect both sides of the body, and patients may be unable to speak or move below the neck. “I think it’s about rewiring synapses, the tiny brain switches that relay information from one neuron to another,” said Dr. Boulos. “The brain is a complicated electric organ/system. If the connections can be re-established, if other parts of the brain can take over function, then we can see patients recover their abilities despite their being an area of the brain that was damaged.” What is common for stroke patients are physical challenges, communicating clearly, or changes in their emotions or mood.

Let’s explore some symptoms of a right brain stroke.

Grandparents with baby

It is encouraging that recovery from a stroke event is possible; this involves dedication to rehabilitation and time. While a stroke can leave a patient disabled over a lifetime, there is a good opportunity, especially in the beginning, for rehab and recovery. Part of the problem is that this occurs very slowly, up to two years in some cases. Due to the severity of the stroke, there may not be a dramatic improvement in other patients. “I have patients who have committed to the rehab process who have been able to get better over time. How that happens within the brain is poorly understood. When you look at the image of the brain, you will see areas that are damaged by the stroke. We don’t see much change over time,” mentioned Dr. Boulos. “There is also very hopeful research around stem cells and other infusions that might accelerate the recovery process for patients that have suffered from stroke. This is still very much in the early phase, but I am very optimistic about this work.”

Written by Michael Arce, host of HeartTalk presented by Capital Cardiology Associates.

Photos by David Cassolato, Jake Ryan, and meo from Pexels

Work and Heart Health

Work and Heart Health

HEART HEALTH

Are you working
toward an increased
risk of heart disease?

“Job strain” and
stress can be more
dangerous than
hard work

It is a known fact that some careers and jobs are more hazardous than others. For service-oriented professions like firefighters, police officers, or military/soldiers where intensity levels can fluctuate from 0 to 100 miles per hour in a matter of seconds, there is a known risk of the impact of developing irregular heart rhythms or poor blood flow. Researchers have deeply studied the biological pathway between high-strain jobs and the development of atrial fibrillation, connecting mental stress as the cause of elevated blood pressure, inflammation and hypertension, and abnormal electrical activity in the left atrial of the heart. Science has also shown the role in the release of adrenaline and other hormones inside the body that can trigger arrhythmia, causing generalized inflammation that is associated with atherosclerosis; the process that leads to heart disease and blockages in the arteries.

But what about those with desk jobs? What is their risk?

Miranda VonFricken

Miranda VonFricken is a Life & Career Coach based in the Albany area, she is also a member of the Forbes Coaching Council. She joined us for a recent episode of HeartTalk presented by Capital Cardiology Associates to discuss careers, COVID, and heart health. The phrase “work/life balance” is trendy among job seekers, as it depicts a situation where there are clear work and home-life boundaries. “People are talking more about mental and heart health now more than ever. A lot of people in the community are engaged, and so are employers. The stress that comes with working full-time, at-home, with children requires more flexibility from employers,” VonFricken added. This applies to workers searching for new opportunities due to COVID economic downsizing or those looking to make a career change to meet employment demands.

Stress is the number one contributor to heart health problems in the workplace. Sadly, something as simple as a change in shift work (from day to night) or work hours, over time, can affect your heart rhythm. The Women’s Health Study (WHS) is one of the largest and longest-running observational studies of women’s health in the United States. The study included almost 40,000 female health professionals aged 45 years old and older, who were followed for an average of 10 years. Some of the results showed that our body doesn’t distinguish stress as well as our mind does. For example, an emergency triggers life-saving chemicals and hormones to be released that increases our body’s functioning abilities. We have a boost in speed, strength, or stamina in “fight or flight” situations. That reaction is similar when the stress comes from deadlines, interactions with co-workers, or pressure moments at work. What’s worse, an email or text on vacation can trigger that same stress. The amount of stress we carry in our work-life may vary, but everyone can recall or relate to instances where simply worrying about potential work problems consumed our thoughts. In those stressful moments, the body is still releasing the chemicals and hormones needed to confront or escape those perceived threats.

Harvard researchers involved in the WHS trial were unable to find how job strain gives rise to heart health issues. Scientists examined how stress physically affects the body, triggering inflammation in coronary arteries leading to blood clots that can cause a heart attack or stroke. Mental health experts point to stress as a contributor to bad lifestyle choices. People who are stressed out tend to find it harder to consistently exercise, eat a healthy diet, get regular sleep, and avoid excess drinking or tobacco use. One surprise finding was workers who perceive that they are subjected to high demands but have little control are at increased risk for cardiovascular disease.

What you can do

❤ Foster mutually supportive relationships with friends, family, and co-workers.
❤ Get regular exercise. It’s good for the heart, reduces anxiety and depression, and improves sleep.
❤ Limit intrusions (such as work-related e-mails) on your life outside of work.
❤ Practice relaxation techniques, such as meditation, deep breathing, progressive relaxation, or visualization.
❤ If you’re feeling overwhelmed, seek help from a mental health professional.

Find a job you love

There is an old saying that some will point to on workplace stress, “find a job you love, and you will never work another day in life.” While most Americans enjoy their job, the fact remains that most people spend about 25% of their adult lives working. We are also putting in more hours on the job than any other industrialized nation. According to an International Labor Organization study, Americans put in the equivalent of an extra 40-hour workweek in 2000 compared to ten years previously. We are also working harder. In a 2001 survey, nearly 40% of workers described their office environment as “most like a real-life survivor program.”

The American Heart Association created Workplace Health Solutions to help employers and employees assess and monitor their heart health. The assessment is grounded in the evidence-informed science of the American Heart Association’s Life’s Simple 7®, the seven most important predictors of heart health. What’s unique about this resource is that the program is an easy 4-minute assessment that allows employees to assess their heart health and take small, simple steps that can result in real improvements.

Find Joy Painting

VonFricken also offered advice on committing to personal and professional goals to eliminate stress from daily life. She recommends creating a vision board, a visual tool that can be words, images, photos, or a combination of all three. These boards are typically poster-sized. “The principle is that as you walk by it, you exchange energy with it. I literally have a conversation with my vision board every day. These are things that I want; my goals are focused on the person who I want to be. ‘I am confident. I am strong. I am absolutely determined to achieve my goals.’ These are my affirmations,” VonFricken explained. And, they are not just for adults looking for accountability or inspiration to reach personal or professional goals. “My (eight-year-old) daughter has one with cookies on it! She wants cookies, wants to learn how to ride a bike and get a laptop. Just seeing these pictures every day gives you the power to make them happen.”

Written by Michael Arce, Host of HeartTalk presented by Capital Cardiology Associates

Photos by Brett Sayles and Bich Tran from Pexels

RX for EX

RX for EX

HEALTHY LIFESTYLES

RX for EX

HOW HEART PATIENTS
CAN SAFELY STAY ACTIVE

Regular activity and exercise are two of the most important things you can do daily for your heart health. But how, and how much? On a recent episode of HeartTalk, presented by Captial Cardiology Associates, Dan Myers shared tips on how heart patients can safely stay active. Myers has over 25 years of experience as a certified personal trainer and exercise physiologist. He began his career as the Director of the Coronary Detection and Intervention Center at the 92nd Street Y on the Upper East Side of Manhattan.

In your experience creating exercise requirements for heart patients, where do you start?

It all begins with a review of a person’s Health History. Most heart patients have had a stress test. Based on the results of that stress test, a target heart rate (THR) is generated. The American College of Sports Medicine (ACSM) recommends 60-90% of the maximum heart rate (MHR) comfortably achieved during the stress test. However, other factors need to be taken into consideration.

ITEMS TO CONSIDER

• The present level of health and fitness
• Orthopedic considerations
• Medications

Individuals who have not exercised regularly need to start slow in the 60-70% range. Whereas someone who has been active, 70-90% is a good THR. It would help if you remembered not only are you going to be overloading your cardiovascular system, your muscles, bones, and connective tissue need to adapt to progressive overload. The biggest mistake is to do too much too soon. Sometimes THR is not appropriate primary due to medications that blunt HR at rest and with exercise. Perceived Exertion is recommended. This number represents your overall feeling of exertion. Not just the way your heart and breathing feel but the way your muscles bones and connective tissue feel. The goal is to be working “somewhat hard” if your overall feeling is comfortable, you are probably not working hard enough. On the other hand, if your overall experience is hard to extremely hard you are overdoing it.

Research shows that if you work extremely hard, you do not get any considerable benefits, and the incidents of a repetitive stress injury increases. If you hurt yourself and you cannot exercise, you have to start all over. So why risk it? Choose an aerobic activity that you like! Try to do it for 30 minutes every day. You should be able to carry on a conversation while you are exercising. If you cannot be overdoing it.

What is an exercise physiologist’s role when working with a cardiologist, nurse, dietician, or primary care provider?

When an individual comes to Capital Cardiology, it is usually because they are symptomatic. Chest pain, shortness of breath, palpitations, syncope. Some are referred to a cardiologist because they have an abnormal EKG, high blood pressure, high cholesterol, all major coronary risk factors. Based on their symptoms, our cardiologist then starts an investigation. The results of this thorough examination are used to make a plan to correct the underlying problem that caused the patient to seek medical attention. The program may require the patient to have intervention such as catheterization, a stent or bypass surgery.

All this information is used by the exercise physiologist to design a safe and valid exercise prescription. The cardiologist decides when it is safe to begin to exercise. Once they have been given the green light, that’s when I take over. Again, it is all about looking at the individual’s health history, the results of any testing they have had. This information along the patient’s goals form the basis of an exercise prescription.

What are some ways to walk for at least 10 minutes per day?

Aerobic exercise requires rhythm contraction of large muscle groups sustained over a length of time. Many heart patients have claudication, cramping of the leg muscles. For those individuals, we recommend walking as far as they can tolerate, stop, sit down and rest, and, when recovered, do it again. Slowly build up to a goal of 30 minutes a day.

How much water should a heart patient drink daily?

The rule of thumb for everyone is to drink eight, 8 ounces of water, daily. For every caffeinated beverage you consume, add two more glasses of water. It is estimated that 60% of our population walk around dehydrated. This can lead to all kinds of health issues. People do not realize that during the night, as we sleep, we lose water through our respiration. One of the best things you can do, first thing in the morning is to drink two glasses of water. Think of it like this: water is a celebration of life. Every time you drink a glass of water, you are celebrating your life. One sign to see if you are drinking enough water: your urine should be the color of lemonade by midday. If it is darker than that you are most likely dehydrated.

What other forms of cardio activity exist outside of running or walking?

There is a principle in aerobic exercise called Specificity of Training. Every time you perform aerobic exercise doesn’t matter what kind of aerobic exercise, there is a central training effect. You are either maintaining or improving your heart, lungs, and circulatory system to deliver oxygen and nutrients to the working muscles. The ability to take the oxygen and nutrients out of the bloodstream is specific to the muscles that are used to perform that form of aerobic exercise. That is why Cross Training is advised. The more variety of aerobic exercise performed, the healthier your entire body gets. This also cuts down on the incidence of repetitive stress injuries. Something else to keep in mind when performing aerobic exercise.

Most cardiac rehab programs focus on 5-6 weeks of building up to a 45-minute walk at least five days a week. Walking, jogging, cross country skiing are all considered weight-bearing exercises because they are performed standing up on your feet. Cycling, rowing is done in the seated position and therefore are non-weight bearing examples of aerobic exercise. This an important consideration, especially for the female population because it helps offset the onset and progression of osteoporosis.

The importance of stretching

There are two categories of stretches, active and passive. Active stretches may be static, dynamic, or ballistic. Passive stretches are normally performed as static or dynamic (as in Proprioceptive Neuromuscular Facilitation).

Types of stretching

• Active Stretch: This happens when the person stretching supplies the force of the stretch.
• Passive Stretch: This occurs when a partner or device provides the force for the stretch.
• Static Stretch: A constant stretch in which the end position is held for 30 seconds. It includes passive relaxation and concurrent elongation of the muscle. It is easy to learn and effective. It does not elicit the stretch reflex of the stretched tissue, and the likelihood of injury is less than if ballistic stretching is used. It helps to relieve muscle soreness and is relaxing when correct methods are used. The sitting toe touch is an example of a static stretch.

STAGES OF STATIC STRETCHING

1. Get into the starting position of the stretching exercise. Try to stay relaxed during the whole stretch and breath slowly in and out through your nose.
2. Move the body or body segment into the stretching movement (easy stretch) until a mild stretching of the muscle is felt.
3. From the easy stretch position, slowly increase the intensity of the stretch for 10 to 15 seconds. Do not bounce while stretching!
4. Do not stretch so far that pain is felt in the muscle or joint. If this happens slowly, decrease the intensity of the stretch.