Eric Lemkin, Author at MedFitNetwork

Exercise and Cardiovascular Disease

Eric Lemkin/20 May 2022/ All MFN blog/

Regular exercise has a favorable effect on many of the established risk factors for cardiovascular disease. For example, exercise promotes weight reduction and can help reduce blood pressure. Exercise can reduce “bad” cholesterol levels in the blood (the low-density lipoprotein [LDL] level), as well as total cholesterol, and can raise the “good” cholesterol (the high-density lipoprotein level [HDL]). In diabetic patients, regular activity favorably affects the body’s ability to use insulin to control glucose levels in the blood. Although the effect of an exercise program on any single risk factor may generally be small, the effect of continued, moderate exercise on overall cardiovascular risk, when combined with other lifestyle modifications (such as proper nutrition, smoking cessation, and medication use), can be dramatic.

Benefits of Regular Exercise

Increase in aerobic capacity
Decrease in blood pressure at rest
Decrease in blood pressure while exercising
Reduction in weight and body fat
Reduction in total cholesterol
Reduction in LDL (bad) cholesterol
Increase in HDL (good) cholesterol
Increased insulin sensitivity (lower blood glucose)
Improved self-esteem

Physiological Effects of Exercise

There are a number of physiological benefits of exercise. Regular aerobic exercise causes improvements in muscular function and strength and improvement in the body’s ability to take in and use oxygen (maximal oxygen consumption or aerobic capacity). As one’s ability to transport and use oxygen improves, regular daily activities can be performed with less fatigue. This is particularly important for patients with cardiovascular disease, whose exercise capacity is typically lower than that of healthy individuals. There is also evidence that exercise training improves the capacity of the blood vessels to dilate in response to exercise or hormones, consistent with better vascular wall function and an improved ability to provide oxygen to the muscles during exercise. Studies measuring muscular strength and flexibility before and after exercise programs suggest that there are improvements in bone health and ability to perform daily activities, as well as a lower likelihood of developing back pain and of disability, particularly in older age groups.

Patients with newly diagnosed heart disease who participate in an exercise program report an earlier return to work and improvements in other measures of quality of life, such as more self-confidence, lower stress, and less anxiety. Importantly, by combining controlled studies, researchers have found that for heart attack patients who participated in a formal exercise program, the death rate is reduced by 20% to 25%. This is strong evidence in support of physical activity for patients with heart disease.

How Much Exercise is Enough?

Unfortunately, most Americans do not meet the minimum recommended guidelines for daily exercise. In 1996, the release of the Surgeon General’s Report on Physical Activity and Health provided a springboard for the largest government effort to date to promote physical activity among Americans. This redefined exercise as a key component to health promotion and disease prevention, and on the basis of this report, the Federal government mounted a multi-year educational campaign. The Surgeon General’s Report, a joint CDC/ACSM consensus statement, and a National Institutes of Health report agreed that the benefits mentioned above will generally occur by engaging in at least 30 minutes of modest activity on most, if not all, days of the week. Modest activity is defined as any activity that is similar in intensity to brisk walking at a rate of about 3 to 4 miles per hour.

These activities can include any other form of occupational or recreational activity that is dynamic in nature and of similar intensity, such as cycling, yard work, and swimming. This amount of exercise equates to approximately five to seven 30-minute sessions per week at an intensity equivalent to 3 to 6 METs (multiples of the resting metabolic rate*), or approximately 600 to 1200 calories expended per week.

How Can a Personal Trainer Help?

If you have cardiovascular disease or are at risk for developing disease, you may be apprehensive at starting an exercise program. You may have questions such as:

Is exercise safe for me?
How long should I exercise?
How frequently should I exercise?
Do I stretch before or after exercise?
Can I do strength training and lift weights?
How do I know if I’m exercising at the right intensity?
What if I develop symptoms such as dizziness, light-headedness, or nausea?

A personal trainer or exercise professional can answer all of these questions for you and establish a well-rounded exercise program that is safe and effective.

A personal trainer will tell you what types of aerobic exercise are most appropriate for you and devise an exercise program tailored towards your needs. This will include guidelines for frequency (how many times per week), intensity (how hard you should exercise), and duration (how long each exercise session should last). A well-designed exercise routine will start with a warm-up that includes dynamic movements designed to raise the heart rate, increase core temperature, mobilize the major joints in the body, and prepare the body for more intense exercise. Warm-up can be followed by either aerobic exercise or weight training. Your trainer can monitor your heart rate and blood pressure during both activities to make sure you are exercising at the proper intensity. If heart rate and blood pressure get too high, your trainer will have you decrease the intensity of exercise or stop. If you develop any symptoms while exercising, your trainer will be right there to advise you and check your vital signs. Weight training is very safe as long as it is performed with proper supervision. Your trainer will recommend the most appropriate exercises for you to do and emphasize proper breathing and technique. Under the guidance of an exercise professional, you can help to improve aerobic capacity, decrease blood pressure and cholesterol, improve good cholesterol, lower blood glucose, improve muscular strength, increase joint range of motion, and lower weight and body fat. All of these will result in a lower risk for developing cardiovascular disease or if you already have disease, it will decrease the chances of subsequent cardiovascular events. Most importantly, working with an exercise professional will extend your lifespan and greatly improve the quality of your life.

Eric Lemkin is a certified personal trainer, strength & conditioning specialist, corrective exercise specialist and founder of Functionally Active Fitness. Lemkin has been a certified personal trainer for 17 years and has helped people ages 8-80 reach their fitness goals through customized personal training – specializing in exercise for the elderly or handicapped.

References

Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009 [PDF-2M]. National vital statistics reports. 2011;60(3).
Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association . Circulation. 2012;125(1):e2–220.
Heron M. Deaths: Leading causes for 2008 [PDF-2.7M]. National vital statistics reports. 2012;60(6).
Heidenriech PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, et al. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933–44.
CDC. Million Hearts™: strategies to reduce the prevalence of leading cardiovascular disease risk factors. United States, 2011. MMWR 2011;60(36):1248–51.

Exercise and Fibromyalgia

Eric Lemkin/22 December 2017/ Conditions/

Fibromyalgia is a debilitating condition that affects roughly 1 to 3% of the general population. The syndrome is characterized by widespread muscle aches and pains, stiffness, fatigue and muscle spasms. Most people with fibromyalgia report difficulty doing everyday activities such as carrying objects, walking and competing ADLs (activities of daily living). Pain, fatigue, helplessness, psychological distress and

difficulty coping with stresses plague many people with the condition. The exact causes of fibromyalgia are not well understood, but it is thought to be a combination of increased sensitivity to pain and environmental and psychological factors. Criteria for diagnosis of Fibromyalgia from the American College of Rheumatology include:

Chronic widespread pain in all four body quadrants
Pain in 11 of 18 tender points
Other symptoms: fatigue, weakness, attention and memory disturbances, heat and cold intolerance, and weight fluctuations.

For unknown reasons, a much larger percentage of women suffer from fibromyalgia than men.

Treatment of Fibromyalgia

Long-term effective treatment includes education, pharmacotherapy, behavioral therapy, and exercise. It is important to educate individuals that fibromyalgia is chronic, but it is not progressive and does not cause permanent damage or inflammation. Active participation is the key to improving their condition.

Can Exercise Help?

One would think that individuals with fibromyalgia shouldn’t exercise. And many people limit physical activity out of fear that it will make their symptoms worse. But in reality, if you have fibromyalgia, you can’t afford to not exercise.

If done correctly, exercise interrupts the downhill spiral of muscular and cardiovascular deconditioning and the resulting loss of function. Deconditioning leads to increased muscle soreness after even minimal amounts of physical activity. Additionally, many individuals have postural imbalances, tight muscles and poor range of motion, all of which place more strain on the body and movement.

A program including consistent aerobic exercise improves function, symptoms and well-being. And strength training improves muscle strength and reduces exercise-related pain and exercise-induced muscle fatigue. Overall, an exercise program can help to alleviate many of the physically and emotionally painful symptoms of fibromyalgia.

Exercising Safely With Fibromyalgia

Prior to increasing physical activity, discuss your plans with your physician. Because postural imbalances and tight, inflexible muscles are common in individuals with fibromyalgia, every activity session should begin and end with mobility (flexibility and range-of-motion) activities. You should also include self-myofascial release or foam rolling to help loosen tight muscles and prepare the body for movement. These exercises should be done slowly, emphasizing quality of movement, and never be painful.

Once you are able to perform these basic exercises comfortably, add strength training two to three times a week using light weights. The emphasis is not on quantity, but rather on the ‘quality’ of muscle movement. If you use too much weight, try too many sets or repetitions, you can cause muscular microtrauma, which leads to muscle soreness and can potentially worsen your symptoms.

Aerobic exercise should also be on your exercise plan. Warm water provides an optimal medium for beginning your exercise program. Many communities have facilities that offer warm-water exercise sessions for people with arthritis and these classes are ideal starting points for those with fibromyalgia as well. Walking is also an excellent activity. Other types of exercises, such as cycling, stairstepping and using other popular machines found in fitness facilities, may increase symptoms if you don’t maintain correct posture. Aerobic activities should be undertaken at a moderate intensity a minimum of three times per week. Start with just a few minutes and gradually increase duration to build up to 20 to 40 minutes of activity each day.

The key to exercise success for individuals with fibromyalgia is consistency. When you experience flare-ups, back off or take a day off. Resume your physical-activity program as soon as you feel better.

With appropriate mobility exercises, strength training and aerobic conditioning, you can expect to see improvement in your functional status overall.

How can an exercise professional help someone with Fibromyalgia?

If you have fibromyalgia and are considering starting an exercise program, you may have questions such as:

What type of exercise should I be doing? Aerobics? Weight training? Both?
How intensely should I be working?
What if I feel pain or discomfort during exercise?
Where should my heart rate be?
What time of day should I exercise?
Should I change my nutritional habits at all?

A certified personal trainer or other exercise professional can help to answer all these questions and develop an exercise program that is tailored towards your needs and abilities. Your trainer will do an initial evaluation on you to find out your baseline measures in terms of aerobic capacity, strength, flexibility, bodyfat, and circumference measurements. An evaluation may also look at your posture and how you perform basic movement patterns. Based upon this information, your trainer can determine what muscles may be tight and need to be stretched or foam rolled. The evaluation process will also indicate what muscles are weak and need to be strengthened through resistance training to help improve mobility and improve quality of life. An exercise professional can also formulate a target heart rate zone for you to train in while you perform aerobic exercise.

If you develop any symptoms during exercise, your trainer should recognize the situation and alter the activity accordingly. Individuals with fibromyalgia often have flare-ups of intense pain. Communication between you and your trainer can help to pin point certain exercises or movements that may cause these flare-ups and be avoided or decrease the intensity. Sometimes rest is the best remedy for pain flare-ups. Your trainer will develop a strength training routine customized towards your needs and abilities and shows you ways to modify exercises or movements that may be too intense or demanding, especially at first. The goal of the client-trainer relationship is to create an exercise program that is effective, challenging, yet comfortable and ultimately leads to a better quality of life.

References

1. Wolfe, F.H., K. Ross, J. Anderson, et al. Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms. Journal of Rheumatology 22:151–156, 1995.

2. Buchwald, D., P. Umali, J. Umali, et al. Chronic fatigue and the chronic fatigue syndrome: prevalence in a Pacific Northwest health care system. Annals of Internal Medicine 123:81–88, 1995.

3. Skinner, J.S. Chronic fatigue syndrome: Matching exercise to symptom fluctuations. The Physician and Sportsmedicine 32:28–32, 2004.

4. Tuck, I., and D. Wallace. Chronic fatigue syndrome: A woman’s dilemma. Health Care of Women International 21:457–466, 2000.

5. Clauw, D.J., and L.J. Crofford. Chronic widespread pain and fibromyalgia: What we know, and what we need to know. Best Practices in Research and Clinical Rheumatology 17:685–701, 2003.

6. Norregaard J., P.M. Bulow, J.J. Lykkegaard, et al. Muscle strength, working capacity and effort in patients with fibromyalgia. Scandinavian Journal of Rehabilitation Medicine 29:97–102, 1997.

7. Simms R.W., S.H. Roy, M. Hrovat, et al. Lack of association between fibromyalgia syndrome and abnormalities in muscle energy metabolism. Arthritis and Rheumatism 37:794–800, 1994.