If you have been diagnosed with coronary artery disease (CAD), you might be having a countless number of questions lingering in your mind.
What shall I do?
Is it safe to exercise with CAD?
Can I continue my activities like before?
Can exercising really help me get better?
Will exercise cause me angina?
How to prevent coronary artery disease complications?
Can the food I eat affect my coronaries?
In order to get your questions answered, you need to know more about coronary arteries and coronary artery disease prevention.
Meet The Coronaries
Because the heart is the most hard-working organ in your body, it deserves to have its own blood supply with freshly oxygenated blood.
This is where the coronary arteries come into play.
The coronary arteries are tiny vessels that form a network around the heart, making sure oxygen is thoroughly delivered to every working cell within your heart muscle.
Those arteries are:
1. Left Main Coronary Artery (LMCA):
This artery supplies the left side of the heart and it is divided into:
- The left anterior descending artery (LAD) and
- The left circumflex artery (LCX).
2. Right Coronary Artery (RCA):
This artery delivers oxygen-rich blood to the right side of the heart. It is divided into:
- The posterior descending artery and
- The right marginal artery
Although these arteries are small in size, they are of huge importance as they are responsible for delivering the oxygen and nutrients that your heart needs to work. [1]
Narrowing or blockage of coronary arteries therefore cause coronary artery disease symptoms including chest pain, chest tightness and shortness of breath.
Coronaries Disease: what it’s all about
Coronary heart disease (CHD) occurs by means of several mechanisms:
- Narrowing of the arteries by accumulation of fatty deposits and platelets on the inner wall of the arteries due to atherosclerosis
- Blockage by a thrombus which causes heart attack and may be life-threatening.
Risk factors for coronary diseases include:
- High, uncontrolled blood pressure
- high blood cholesterol levels
- Smoking
- Diabetes mellitus
- Being obese
- Sedentary lifestyles
- Unhealthy diets
- Emotional stress
- Family history [1]
Diagnosed with CAD…? Don’t freak out!
Today’s improvement in medical care offers you a number of treatment options once diagnosed with coronary artery disease.
Your treatment options may include one or more of the following:
- Medications
- Surgery (e.g. CABG, PCI…etc.)
- Diet modification
- Exercise
- Lifestyle modifications
- Weight reduction
- Reversing risk factors (if possible) [7]
Once diagnosed, your cardiologist will set you the best plan of treatment that you need to fully understand and follow.
Be A Part of Your Treatment
It is important to understand that you have an effective role in the success of your treatment plan.
Whether you undergo a surgery or you are required to follow a specific lifestyle with medications, a huge part of the treatment plan inevitably depends on your cooperation.
For example, you will need to:
- Quit poor habits like smoking and drinking
- Quit unhealthy and fast foods
- Lose extra weight
- Make healthier food decisions
- Get rid of emotional stress
- Stay motivated to exercise regularly [7]
Change the Way You Eat
A healthy diet is one important step towards a better health after being diagnosed with CHD.
However, simply quitting fast foods and unhealthy fats are not the only thing you need to do.
Instead, you need to follow a more customized diet plan that helps you:
- Reduce your weight
- Improve your health
- Reduce your blood pressure
- Regulate your minerals (e.g. Sodium, calcium, potassium, magnesium… etc.)
It is always better to seek professional health when it comes to changing your diet for CHD.
Because some of the nutritional advice that you might have heard (although they might be 100% sound).
But they might not be the right advice for your case.
For example, we all know that calcium helps us build strong bones and we are told that it is necessary for our health.
Although this is a fact, too much calcium from food or supplements can make your CHD worse. [4]
So, your nutrition specialist will ask you to regulate your calcium intake, and will also recommend you eat specific foods, or take specific supplements rich in:
- Vitamin C
- Vitamin B
- Antioxidants
- Selenium [6], [5]
Exercising safely: Is it possible?
I know what you are thinking.
Can I exercise with CHD?
Is it even safe?
If you have CHD, I do understand that you think of exercising as a risky thing that could lead to occurrence – or reoccurrence – of angina.
Well, let’s have a closer look on why angina happens in the first place:
Normally, when you work out, your body’s need for oxygen increases.
Because muscles work harder and they require more oxygen to produce the energy they need.
And your heart is not an exception.
As we exercise, myocardial oxygen consumption (the oxygen needed by the heart) increases.
Which reflexively triggers the coronaries to dilate and deliver more oxygen.
When your coronaries are narrow or blocked, they fail to deliver sufficient oxygenated blood to the heart.
As a result, cardiac ischemia (lack of blood supply) or cardiac hypoxia (lack of oxygen) take place.
This is then felt as anginal pain.
THE QUESTION IS: Does this mean you need to avoid exercising?
The answer is “NO”.
Because exercising is vital in your condition, you cannot completely avoid physical activity.
Instead, exercising with CHD will be completely different from exercising you are used to. In other words, it needs to be:
- Aerobic
- Supervised
- Closely monitored
- Of limited, submaximal intensity.
Before you learn how to exercise safely, you need to know why exercising is vital for your coronaries, even with CHD.
How Exercising Helps?
Exercising under supervision has been found effective not only in prevention of coronary heart diseases, but also in prevention of worsening and possible complications of CHD after they have taken place.
This occurs due to the effects exercising has on your different body systems.
1.Thinner Blood
According to a recent study, aerobic exercises of moderate intensity 3 times a week were effective in reducing blood viscosity. This means:
- Less risk for thrombus formation (clots).
- Less risk for more arterial narrowing.
- Decreased LDLs
- Decreased cholesterol levels [2]
When your blood is of optimum viscosity, it flows smoothly into your vessels.
Thus, it reduces risk for platelets aggregation on the inside of your vessel walls and prevents more narrowing.
2. Wider, Stronger Vessels
Although exercising raises your blood pressure on spot, it helps reduce your blood pressure on the long run.
This is because exercising improves both function and structure of your arteries, including the coronaries. Here is how:
- Exercising causes vasodilatation (widening of vessels) by stimulating the endothelium (inner lining of your vessels) to secrete substances such as prostaglandins and nitric oxide (NO) which are known to be anti-atherogenic.
- Exercising regularly Improves the structure of your vessel walls, reduce risk for plaques build-up and calcification. [3],[4]
3. Better Oxygenation
Regular exercise causes cardiovascular and respiratory adaptations that help your body function better during exercise and even at rest.
For example, aerobic exercises increase your cells’ ability to extract oxygen from the blood.
This means cells become less at risk for hypoxia (lack of oxygen).
This also includes your heart muscle. With the help of aerobic exercises, you can:
- Improve your VO2 max (the maximum amount of oxygen you can use)
- Raise your anaerobic threshold (the point where your body fails to use oxygen for energy)
- Improve tissue oxygenation [3],[4]
Now, here is how you can make sure your exercise is not putting you at risk…
Exercise: From Safe to Safer
Reading about the benefits that exercise brings to your heart health must have got you excited to start working out right away.
But, because safety comes first, you need to discuss with your personal trainer trained in cardiac rehabilitation the best way to monitor your exercise and make sure you are exercising within the safe zone.
According to your condition, your personal trainer trained in cardiac rehab will use one of the following (or more) to determine your safe zone:
1. Stress test
Stress test or exercise stress test is a test that records your heart work during physical activity (e.g. walking or cycling).
With the help of this test, your cardiologist can follow your case up, diagnose your problem or judge your need for surgery.
On the other hand, your cardiac rehab educated personal trainer can determine your fitness level and set the safe zone in which you can exercise without putting load on your heart. [8], [9]
2. Target heart rate
Based on some equations, your personal trainer will use your heart rate to find out the safe zone.
As a result, he will ask you to exercise while maintaining your heart rate within a specific range which forms a specific percentage out of your maximum heart rate. [9]
3. Maximum blood pressure
Your personal trainer with long term expertise in cardiac rehabilitation may also use your blood pressure to make sure you are within a safe exercise zone.
This is why he might ask you to avoid exercises that raise your blood pressure above a specific number
If this is the case, he will also encourage you to:
- Regulate your breathing during exercise,
- Avoid holding your breath
- Avoid heavy lifting
4. VO2 max and Anaerobic Threshold
VO2 max is the maximum amount of oxygen you consume before your body fails to use oxygen for energy.
It might be important for your rehab specialist to know the exercise intensity at which your body stops utilising oxygen and mark it as the intensity you should not reach during exercise. [9]
So, under special circumstances, your personal trainer may use special devices, equations or both to calculate your VO2 max and make sure you are exercising in a percentage out of it. Which means exercising below your anaerobic threshold.
Conclusion
Coronary artery diseases are now more common than ever. However, with today’s advances in medical care, your cardiologist has too many options to choose how to diagnose coronary artery disease.
You also have plenty of treatment options that can reverse your blockade, decrease your symptoms and prevent further deterioration.
These options may include multifactorial lifestyle modifications, healthy diet, regular exercise (under your cardiologist supervision) with or without surgery.
In addition, there is a connection between coronary artery disease and exercise.
So, If you are referred for cardiac rehab, don’t be afraid to exercise.
Just remember, because every person is different, there is no fixed training plan for CAD.
Exercises for cardiac diseases must be designed carefully on case-by-case basis.
Who is Jazz Alessi?
Jazz Alessi is an elite personal trainer and nutrition specialist with long experience in rehabilitation of special cases including heart disease.
Working directly under your chosen cardiologist instructions and with his large experience in cardiac rehab, he makes sure you are thoroughly evaluated before setting a comprehensive plan that is specifically tailored for your goals.
He also works hand-in-hand with MD cardiologists to make sure you are prescribed a safe, customised exercise plan, and a personalized long-term diet plan that is safe and effective to meet your short and term-long goals.
References
1. Themistocleous, Irene-Chrysovalanto & Stefanakis, Manos & Douda, Helen. (2017). Coronary Heart Disease Part I: Pathophysiology and Risk Factors. The Journal of Physical Activity, Nutrition and Rehabilitation. https://www.researchgate.net/publication/316715456_Coronary_Heart_Disease_Part_I_Pathophysiology_and_Risk_Factors
2. Immanuel, Suzanna & Bororing, S & Dharma, R. (2006). The effect of aerobic exercise on blood and plasma viscosity on cardiac health club participants. Acta medica Indonesiana. 38. 185-8.
http://www.inaactamedica.org/archives/2006/17132880.pdf
3. Daniel J. Green and Kurt J. Smith (2017). Effects of Exercise on Vascular Function, Structure, and Health in Humans
- Effects of Exercise on Vascular Function, Structure, and Health in Humans (semanticscholar.org)
4. Tankeu, AT, Ndip Agbor, V, Noubiap, JJ. Calcium supplementation and cardiovascular risk: A rising concern. J Clin Hypertens. 2017; 19: 640– 646. https://doi.org/10.1111/jch.13010
https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13010
5. Knekt P, Ritz J, Pereira MA, O’Reilly EJ, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, Hallmans G, Liu S, Pietinen P, Spiegelman D, Stevens J, Virtamo J, Willett WC, Rimm EB, Ascherio A. Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts. Am J Clin Nutr. 2004 Dec;80(6):1508-20. doi: 10.1093/ajcn/80.6.1508. PMID: 15585762.
Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts – PubMed (nih.gov)
6. Hughes K, Ong CN. Vitamins, selenium, iron, and coronary heart disease risk in Indians, Malays, and Chinese in Singapore. J Epidemiol Community Health. 1998 Mar;52(3):181-5. doi: 10.1136/jech.52.3.181. PMID: 9616423; PMCID: PMC1756686.
Vitamins, selenium, iron, and coronary heart disease risk in Indians, Malays, and Chinese in Singapore – PubMed (nih.gov)
7. Safri, Z. (2018). Management of coronary artery disease. IOP Conference Series: Earth and Environmental Science. 125. 012125. 10.1088/1755-1315/125/1/012125.
(PDF) Management of coronary artery disease (researchgate.net)
8. What is a stress test? American Heart Association
https://www.heart.org/-/media/files/health-topics/answers-by-heart/what-is-a-stress-test.pdf
9. Kym Joanne Price, Brett Ashley Gordon, Stephen Richard Bird and Amanda Clare Benson (2016). A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus?
A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus? (sagepub.com)
