Nearly 2,400 Americans die of cardiovascular disease daily, with an average of one death occurring every 37 seconds. In 2018, roughly one out of every 10 Americans over the age of 20 had some type of cardiovascular disease (coronary heart disease, heart failure, and/or stroke), and one out of every seven deaths in the United States was due to coronary heart disease alone.
It’s been said: “If all the benefits of exercise could be placed in a single pill, it would be the most widely prescribed medication in the world.” Scientific evidence continues to mount supporting the numerous medicinal benefits of exercise. In fact, there’s hardly a disease that I can think of that exercise won’t help in one way or another, be it prevention, treatment, or even cure in some instances.
Breathing patterns determine the physiologic response in the cardiovascular and autonomic nervous system (ANS). Specifically, the physiologic and biochemical response is driven by the length, depth & pace of our breathing and whether we’re mouth breathing or nasal breathing.
Here are some things to look for when working with a client with Atrial Fibrillation (A-fib).
What types of medications are they on? Calcium Channel Blockers, blood thinners (Coumadin)? These may have an effect on the intensity and type of exercise performed. You know that people who have A-fib are at increased risk for strokes, and may have hypertension and get dizzy more often. The medications – while they may help with some factors – may preclude a well-designed exercise program just because they may not tolerate some types of exercise.
What are the exercise goals? Are they wanting to tone up? Lose some weight? Get stronger? Train for a tennis match or 5K? This would help in structuring the program. The type / intensity / duration are all dependent on what the client wants. If they are just coming off surgery or a new prescription – this is important to build the foundation (which you know).
Does the doctor have any contraindications for exercise? Usually, it’s not to “overdo”, which means building up a program. I read a good article by Dr. Bill Sekula on a program for A-fib. It’s essentially a “step down, time up” program, where patients go from a few minutes of exercise a few times per day – to building up to an hour of exercise one time per day. However, I am going to recommend more of an ITP (interval training program) that concentrates on moderate strength programs (using the 40-50% rule similar to cancer patients), so they don’t use the Valsalva maneuver while lifting, but still use a progressive resistance approach.
Monitoring with a HR monitor, and having good hydration status are both important. Of course, you probably have them using the smart water bottle. Because of the heart dynamics and possible Coumadin Rx, the hydration is important. I assume you do a HR variability test with your client. This may be a very important test to do, as over time it may be instrumental in reducing A-fib occurrences.
I like the article by Dr. John Mandrola on the amount of exercise. He states that A-fib is completely controllable through specific lifestyle changes. He states that low inflammation exercise (high intensity endurance / triathlon, etc.) training needs to be modified, as do other lifestyle issues. I really like the discussion on inflammation, which may be one of the biggest issues in cardiac care of late. He talks about the “J curve” of exercise and that the more intense actually increases the odds ratio (OR) for sudden cardiac events and other abnormalities related to A-fib.
I think he is on to something, and you should look into some other lifestyle aspects such as meditation and heartbeat regulation through mindful breathing and relaxation. I know that excess stress, lack of sleep and poor diet have effects on the electrical system, including SA node and conductivity. Regular relaxation may do a LOT to improve the normal sinus rhythm and reduce resting HR to a more manageable level.
Dr. Mandrola also recommends regular monitoring of BP, keeping the use of warm exercise clothing due to peripheral circulation issues, and not overheating.
I like the issue of ITP and progression. I also am more of a fan of modified strength training for most clinical conditions. I think it would work for AF because if you think of the strength of contraction during exercise (even moderate) – it will have a strong steady beat during exercise (in most cases).
Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.
Most of us accept stress as a necessary evil that is a part of the American lifestyle. But living under stress day in and day out can lead to heart disease. According to the American Psychological Association, prolonged stress can contribute to high blood pressure and circulatory problems, and if stress makes you angry and irritable, you are more likely to have heart disease or even a heart attack.
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.
- 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.
Heart disease is devastating to both our health and our economy. It is the number one cause of death in the country. Cardiovascular disease (CVD) accounted for 32.1 percent of deaths in the United States in 2013 – one out of every three deaths is due to this preventable disease.1 A significant number of research studies have documented that heart disease is easily and almost completely preventable (and reversible) through a diet rich in plant produce and lower in processed foods and animal products.6-9
As the prevalence of CVD escalates, medical costs are rising rapidly. The American Heart Association has projected that by 2030, 40.5 percent of the US population will have some form of cardiovascular disease, and the direct medical costs attributed to cardiovascular diseases will triple compared to 2010 costs.2
Risk factors for heart disease are commonplace for U.S. adults:32.6 percent have hypertension, 13.1 percent have total cholesterol above 240 mg/dl,3 9.3 percent of U.S. adults have diabetes,4 and 68.5 percent of U.S. adults are overweight or obese.5 As a result, it has become considered normal in our society to have atherosclerosis, and to die from cardiovascular disease. If you eat the standard western diet that most people eat in the modern world, you will surely develop heart disease and may die from it.
Fighting heart disease: Superior nutrition versus drugs and surgery
In 2015, I published a scientific article in the American Journal of Lifestyle Medicine demonstrating, with survey data and case histories, the dramatic weight loss and cardiovascular benefits possible with a Nutritarian diet. Respondents who started out obese lost an average of over 50 pounds two years after the switch to a Nutritarian diet. After one year, in those who started out with hypertension, there was a 26 mm Hg average reduction in systolic blood pressure. In respondents who were not taking cholesterol-lowering medication, there was an average 42 mg/dl decrease in LDL cholesterol, and an average decrease in triglycerides of 79.5 mg/dl.10
The surgical interventions commonly used to treat heart disease, such as angioplasty and bypass surgery are futile. The COURAGE trial and additional studies conducted since have documented that patients undergoing those invasive procedures do not live longer or have fewer heart attacks compared to those receiving medical therapy with modest lifestyle changes.11-12 Surgical interventions are not long-term solutions to heart disease; they merely treat a small portion of a blood vessel, while cardiovascular disease continues to progress throughout the vasculature.
Drugs that treat hypertension and elevated cholesterol carry serious risks and do not stop heart disease from progressing. Cholesterol-lowering statin drugs are known to increase the risk of diabetes, impaired muscle function, cataracts, liver dysfunction and kidney injury. 13 Each different class of blood pressure-lowering medications is associated with its own risks and side effects. ACE inhibitors commonly cause a persistent cough; diuretics are linked to increased risk of diabetes; beta blockers are associated with increased likelihood of stroke; calcium channel blockers may increase risk of heart attack and breast cancer; and ARBs are associated with increased risk of lung cancer.14-20
The risk associated with these treatments is unacceptable when there is a safe, effective alternative —smart nutrition and exercise – that can actually reverse heart disease and obliterate the need for risky and even futile medical care. Atherosclerotic plaque can be reversed, and cholesterol lowered without drugs or surgery.
Success stories (two of numerous)
Ronnie weighed over 300 pounds when he wound up needing emergency quadruple bypass surgery. Three years later, he was back for an angioplasty and three stents, but his chest pain returned within one month of the surgery. Working with Dr. Fuhrman in the Ask the Doctor Community, Ronnie lost 140 pounds and went off all medications. He runs and plays sports and has served as an inspiration to family members who have also lost weight and begun to live healthier lives. Read his story.
Julia had three heart attacks within three months. After her fifth angioplasty, she still had constant chest pain. She was on 10 different daily medications, suffered migraines, and, at the age of 60, could not walk even one block. Today, Julia has lost 105 pounds, and now enjoys every day pleasures like exercise, gardening, and playing with her grandchildren. She went from a “cardiac cripple” to a healthy, happy woman. Read her story.
Like Ronnie and Julia, over the last 20 years hundreds of my other patients with advanced heart disease have demonstrated that dramatic reversal of advanced disease can even occur in a relatively short time.
Following the lenient recommendations of the American Heart Association and wearing a red dress pin do not form an effective strategy for protecting you or your loved ones against heart disease. Also, drugs and surgery do not cure heart disease. A health-promoting, nutrient-dense (Nutritarian) diet, that I have designed and advanced over the years (coupled with exercise) is dramatically effective and protective for preventing and reversing high blood pressure, high cholesterol and diabetes — as well as heart disease — because it removes the primary dietary cause of heart disease, while providing the most protective and life-span promoting diet-style. For more information, check out my book, The End of Heart Disease.
Everyone needs to know that heart disease can be avoided; and those who already have heart disease deserve to know that they can reverse their disease. Conventional medical care does NOT protect against heart disease-related death. Only a Nutritarian diet can offer dramatic lifespan-enhancing benefits against both cardiovascular disease and cancer.
Originally printed on DrFuhrman.com. Reprinted with permission.
Joel Fuhrman, M.D. is a board-certified family physician, six-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient-dense, plant-rich eating style.
- Xu J, Murphy SL, Kochanek KD, et al: Deaths: Final Data for 2013. Natl Vital Stat Rep 2016;64:1-119.
- Heidenreich PA, Trogdon JG, Khavjou OA, et al: Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement From the American Heart Association. Circulation 2011.
- Mozaffarian D, Benjamin EJ, Go AS, et al: Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2016;133:e38-e360.
- American Diabetes Association: Diabetes statistics [http://www.diabetes.org/diabetes-basics/statistics/]
- Ogden CL, Carroll MD, Kit BK, et al: Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311:806-814.
- Ornish D, Brown SE, Scherwitz LW, et al: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129-133.
- Ornish D, Scherwitz LW, Billings JH, et al: Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280:2001-2007.
- Esselstyn CB, Jr.: Updating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiol 1999;84:339-341, A338.
- Esselstyn CB, Jr., Ellis SG, Medendorp SV, et al: A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physician’s practice. J Fam Pract 1995;41:560-568.
- Fuhrman J, Singer M: Improved Cardiovascular Parameter With a Nutrient-Dense, Plant-Rich Diet-Style: A Patient Survey With Illustrative Cases. Am J Lifestyle Med 2015.
- Boden WE, O’Rourke RA, Teo KK, et al: Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503-1516.
- Trikalinos TA, Alsheikh-Ali AA, Tatsioni A, et al: Percutaneous coronary interventions for non-acute coronary artery disease: a quantitative 20-year synopsis and a network meta-analysis. Lancet 2009;373:911-918.
- Hippisley-Cox J, Coupland C: Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ 2010;340:c2197.
- Simon SR, Black HR, Moser M, et al: Cough and ACE inhibitors. Arch Intern Med 1992;152:1698-1700.
- Bangalore S, Messerli FH, Kostis JB, et al: Cardiovascular protection using beta-blockers: a critical review of the evidence. J Am Coll Cardiol 2007;50:563-572.
- Gupta AK, Dahlof B, Dobson J, et al: Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm and the relative influence of antihypertensive medication. Diabetes Care 2008;31:982-988.
- Wassertheil-Smoller S, Psaty B, Greenland P, et al: Association between cardiovascular outcomes and antihypertensive drug treatment in older women. JAMA 2004;292:2849-2859.
- Group PS, Devereaux PJ, Yang H, et al: Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008;371:1839-1847.
- Li CI, Daling JR, Tang MT, et al: Use of Antihypertensive Medications and Breast Cancer Risk Among Women Aged 55 to 74 Years. JAMA Intern Med 2013.
- Sipahi I, Debanne SM, Rowland DY, et al: Angiotensin-receptor blockade and risk of cancer: meta-analysis of randomised controlled trials. Lancet Oncol 2010;11:627-636.
Thanks to popular wisdom, we tend to consider animal protein our dietary MVP – it’s associated with building muscle, and high-animal protein weight loss diets are still popular. In contrast, plant protein from vegetables, legumes, nuts and seeds is considered a “second string” source. But as usual, popular wisdom only gets part of the story right. When it comes to protecting your cardiovascular health, it is the source of your protein that matters most.
Many studies have demonstrated that plant protein is beneficial – and animal protein is harmful – regarding outcomes such as cardiovascular disease, cancer, and death from all causes. But new data, gathered by the Adventist Health Study 2, takes a more nuanced look at exactly which types of plant and animal proteins have the greatest impact on your risk of heart disease. Researchers decided to ask which protein-containing foods in particular contribute to increasing or decreasing cardiovascular risk. It will come as no surprise to Nutritarians that nuts and seeds emerged as the most beneficial source of this vital nutrient.
All protein is not equal
In this new study, researchers focused on the specific sources of the subjects’ protein intake. A total of 81,337 participants were asked about their usual intake of these foods during the previous year, and then they were followed for 6-12 years. Data was analyzed to determine the percentage of total protein that came from these animal and plant sources.
Of all the plant and animal protein sources analyzed, risk of cardiovascular deaths steadily climbed with higher consumption of meat protein, and steadily fell with greater consumption of protein from nuts and seeds.
In the groups with the highest meat intake, risk was about 60 percent higher than in the group with the lowest intake. In the group with the highest intake of nuts and seeds, the cardiovascular risk was about 40 percent lower compared to the group with the lowest intake of nuts and seeds.1
These results are consistent with previous research that has compared nuts to meat as a major calorie source.2 Plus, there have now been numerous studies linking higher nut intake to longevity.3
Why is meat so harmful to the cardiovascular system?
- Meat is high in Advanced Glycation End Products (AGEs), which contribute to vascular damage, especially in people with diabetes.4,5
- Meat is high in heme iron, which has pro-oxidant effects that promote cardiovascular disease.6
- Meat contains pro-inflammatory components such as arachidonic acid,7 saturated fat,8 and carnitine.9
- Meat consumption (and animal protein consumption in general) is associated with weight gain.10,11
- Meat promotes the growth of unfavorable bacteria that lead to the production of TMAO, which inflames the endothelium and promotes atherosclerosis.9
In addition to cardiovascular disease, diets high in animal protein also promote cancer. Animal protein, which has a higher biological value (compared to plant protein) because of its greater essential amino acid content, is absorbed and utilized quickly by the body. This raises IGF-1 to dangerous levels, which promotes the growth of tumors and enhances fat storage.12-15
Why are nut and seeds so protective?
- Nuts and seeds are the optimal protein choice for a cardio-protective diet.
- They are rich in a variety of heart-healthy nutrients: potassium, magnesium, fiber, plant sterols, tocopherols (vitamin E), flavonoids and other polyphenols.16
- They have been shown to reduce total and LDL cholesterol.17
- The fat-binding fibers are not absorbed, carrying fat into the stool and toilet.
- They are highly satiating, promoting a healthy weight.18-20
- Nuts are rich in arginine and glutamic acid, which aid in the production of nitric oxide and are important for maintaining a favorable blood pressure. 21,22
- They promote favorable blood glucose levels in studies on patients with type 2 diabetes.16
- Nut consumption is associated with better vascular (blood vessel) function and reduced oxidative stress.23-25
In addition to their cardiovascular benefits, nuts also facilitate the absorption of vegetable-derived phytochemicals, which increases the anti-oxidant potential and the protective function of immune system cells.24 Calories from nuts and seeds are absorbed very slowly, which means that the body is more likely to use them for energy rather than storage. IGF-1 levels that are too high or too low are detrimental to health, and the major determinant of IGF-1 levels is essential amino acid intake.14,27 A diet rich in plant protein sources (such as seeds, nuts, and beans) provide adequate but not excessive amounts of all of the essential amino acids, enabling the body to modulate (lower) IGF-1 to the most protective levels, without getting too low.28
As protein and fat sources, nuts and seeds are the clear winner over animal products. Nuts and seeds are crucial for cardiovascular health and longevity. Now that’s the kind of wisdom that deserves to be popular.
Quick and delicious ways to put some muscle in your protein
Now that you know why your protein should come from the dirt rather than off the hoof, here are a few easy ways to improve the quality of your diet. And if you have any great tips that work for you, please share them in the comments section!
- Limit animal protein to no more than 2 ounces in a day.
- If you have animal protein, skip a day (at least) between servings.
- Use mushrooms, beans and even crumbled tofu to add a meaty texture to a dish.
- Eat nuts and seeds with leafy greens to aid in the absorption of fat-soluble nutrients from the greens.
- Eat some omega-3-rich chia seeds, ground flaxseeds, and/or walnuts every day.
- Add hemp seeds to a smoothie for a protein (and omega-3) boost.
Joel Fuhrman, M.D. is a board-certified family physician, six-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient dense, plant-rich eating style.
- Tharrey M, Mariotti F, Mashchak A, et al. Patterns of plant and animal protein intake are strongly associated with cardiovascular mortality: the Adventist Health Study-2 cohort. Int J Epidemiol 2018.
- Bernstein AM, Sun Q, Hu FB, et al. Major dietary protein sources and risk of coronary heart disease in women. Circulation 2010, 122:876-883.
- Grosso G, Yang J, Marventano S, et al. Nut consumption on all-cause, cardiovascular, and cancer mortality risk: a systematic review and meta-analysis of epidemiologic studies. Am J Clin Nutr 2015, 101:783-793.
- Goldberg T, Cai W, Peppa M, et al. Advanced glycoxidation end products in commonly consumed foods. J Am Diet Assoc 2004, 104:1287-1291.
- Goldin A, Beckman JA, Schmidt AM, Creager MA. Advanced glycation end products: sparking the development of diabetic vascular injury. Circulation 2006, 114:597-605.
- Brewer GJ. Iron and copper toxicity in diseases of aging, particularly atherosclerosis and Alzheimer’s disease. Exp Biol Med 2007, 232:323-335.
- de Lorgeril M, Salen P. New insights into the health effects of dietary saturated and omega-6 and omega-3 polyunsaturated fatty acids. BMC Med 2012, 10:50.
- Kennedy A, Martinez K, Chuang CC, et al. Saturated fatty acid-mediated inflammation and insulin resistance in adipose tissue: mechanisms of action and implications. J Nutr 2009, 139:1-4.
- Koeth RA, Wang Z, Levison BS, et al. Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis. Nat Med 2013.
- Bujnowski D, Xun P, Daviglus ML, et al. Longitudinal Association between Animal and Vegetable Protein Intake and Obesity among Men in the United States: The Chicago Western Electric Study. J Am Diet Assoc 2011, 111:1150-1155 e1151.
- Rosell M, Appleby P, Spencer E, Key T. Weight gain over 5 years in 21,966 meat-eating, fish-eating, vegetarian, and vegan men and women in EPIC-Oxford. Int J Obes (Lond) 2006, 30:1389-1396.
- Key TJ, Appleby PN, Reeves GK, Roddam AW. Insulin-like growth factor 1 (IGF1), IGF binding protein 3 (IGFBP3), and breast cancer risk: pooled individual data analysis of 17 prospective studies. The lancet oncology 2010, 11:530-542.
- Rowlands MA, Gunnell D, Harris R, et al. Circulating insulin-like growth factor peptides and prostate cancer risk: a systematic review and meta-analysis. Int J Cancer 2009, 124:2416-2429.
- Thissen JP, Ketelslegers JM, Underwood LE. Nutritional regulation of the insulin-like growth factors. Endocr Rev 1994, 15:80-101.
- Levine ME, Suarez JA, Brandhorst S, et al. Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population. Cell Metab 2014, 19:407-417.
- Kim Y, Keogh JB, Clifton PM. Benefits of Nut Consumption on Insulin Resistance and Cardiovascular Risk Factors: Multiple Potential Mechanisms of Actions.Nutrients 2017, 9.
- Del Gobbo LC, Falk MC, Feldman R, et al. Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials. Am J Clin Nutr 2015, 102:1347-1356.
- O’Neil CE, Fulgoni VL, 3rd, Nicklas TA. Tree Nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in U.S. Adults: NHANES 2005-2010. Nutr J 2015, 14:64.
- Jackson CL, Hu FB. Long-term associations of nut consumption with body weight and obesity. Am J Clin Nutr 2014, 100 Suppl 1:408S-411S.
- Mattes RD, Dreher ML. Nuts and healthy body weight maintenance mechanisms. Asia Pac J Clin Nutr 2010, 19:137-141.
- Vasdev S, Gill V. The antihypertensive effect of arginine. Int J Angiol 2008, 17:7-22.
- Stamler J, Brown IJ, Daviglus ML, et al. Glutamic acid, the main dietary amino acid, and blood pressure: the INTERMAP Study (International Collaborative Study of Macronutrients, Micronutrients and Blood Pressure). Circulation 2009, 120:221-228.
- Katz DL, Davidhi A, Ma Y, et al. Effects of walnuts on endothelial function in overweight adults with visceral obesity: a randomized, controlled, crossover trial. J Am Coll Nutr 2012, 31:415-423.
- Kris-Etherton PM. Walnuts decrease risk of cardiovascular disease: a summary of efficacy and biologic mechanisms. J Nutr 2014, 144:547S-554S.
- Bullo M, Juanola-Falgarona M, Hernandez-Alonso P, Salas-Salvado J. Nutrition attributes and health effects of pistachio nuts. Br J Nutr 2015, 113 Suppl 2:S79-93.
- Brown MJ, Ferruzzi MG, Nguyen ML, et al. Carotenoid bioavailability is higher from salads ingested with full-fat than with fat-reduced salad dressings as measured with electrochemical detection. Am J Clin Nutr 2004, 80:396-403.
- Clemmons DR, Seek MM, Underwood LE. Supplemental essential amino acids augment the somatomedin-C/insulin-like growth factor I response to refeeding after fasting. Metabolism 1985, 34:391-395.
- Young VR, Pellett PL. Plant proteins in relation to human protein and amino acid nutrition. Am J Clin Nutr 1994, 59:1203S-1212S
To understand how Pulmonary Hypertension reacts to Mind/Body Medicine, you must understand what is going on biologically. Mind/Body Medicine, such as meditation and exercise, can help to give these clients a better quality of life. As a fitness professional, it is important to know how, when and why you are using certain mind/body modalities.
Pulmonary Hypertension is a very rare disease of the lungs and right side of the heart. Sometimes there is no known cause except a change in the cells that line the pulmonary arteries. There is no cure, so managing the disease is the best most people can do. Some clients may be on multiple medications, which is normal. The changes in the pulmonary cells cause the artery walls to be thick and stiff. Extra tissue may form and the arteries may become tight. Young individuals usually become diagnosed by the age of 36 and women are diagnosed more often then men. Each year, 10 to 15 people per million are diagnosed in the United States. It is important to note that life expectancy is about 3 to 5 years if not diagnosed and treated.
Hypertension, as most people know, is a blood pressure which is 130–139 over 80–89. Individuals with hypertension can usually come off of medications with eating healthy and exercising. There are instances where the client will never stop taking medications, due to genetics. The client can eat healthy and exercise, but the blood pressure does not come down. A primary doctor may try to get the blood pressure under control, but can’t.
In this situation, the individual would be sent to a Cardiologist who specializes in Pulmonary Hypertension. There are four types of Pulmonary Hypertension and they each have their own symptoms and treatment. It is important to obtain a doctor’s clearance before working with this population.
Types of Pulmonary Hypertension
Group 1: Pulmonary Arterial Hypertension
This group is usually classified as having no known cause. It can be genetic or develop from someone having Lupus, Scleroderma or HIV. Symptoms for this classification can be chest pain, dizziness, fatigue, inability to exercise, low blood pressure, chronic cough, shortness of breath, swelling or swollen legs.
Exercise is very important for this group by strengthening the heart and lungs. Clients will initially go to cardiac rehab for four to twelve weeks. When rehab is over, remember to obtain a clearance prior to working with your client. Start your client out by doing their cardiac rehab program. The goal is to strengthen the heart and help the client to build cardiovascular endurance.
Group 2: Pulmonary Hypertension due to left lung disease
The heart does not pump blood or relax effectively. Medications are used for this group to help lung functioning. Blood pressure medicine and diuretics may also be prescribed. The physician may also ask their client to lose weight or use a CPAP if they have sleep apnea.
Group 3: Pulmonary Hypertension due to lung disease
This group of individuals may have COPD, Interstitial Lung Disease, Sleep Apnea, chronic high altitude exposure, and pulmonary fibrosis. Treatment consists of improving lung function, proper sleep breathing and staying away from high altitudes.
Group 4: Chronic Thromboembolic Pulmonary Hypertension
In group four, clients have blood clots in the lung. The blood clot restricts blood flow causing hypertension. It is important to work closely with the client’s physician for this type of hypertension.
Overall, exercise is thought to be good for individuals with Pulmonary Hypertension. There are, however, some guidelines to follow. Clients should never over exercise or become overheated. If you are working with someone who presents with symptoms, do not exercise upper and lower extremities at the same time. Exercise in extreme hot or cold environments should be avoided.
Stress management techniques will not help with bring blood pressure or heart rate down. For these clients, it is important to concentrate on the symptoms. Many individuals with Pulmonary Hypertension develop anxiety, depression and chronic stress. Clients may sit in a chair or lie on the floor for mind/body classes. It depends on what is comfortable for each client. It is important that the client knows to not get discouraged because they are not seeing a drop in blood pressure.
Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.