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[PATIENT ADVISER]

[EXERCISE IS MEDICINE]

Exercise for Mild Coronary Artery Disease

Michael H. Cox, PhD

Series Editor: Nicholas A. DiNubile, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 12 - DECEMBER 97


Early warnings can be potent motivators. If your doctor has told you that you are at risk for the type of heart disease known as coronary artery disease (CAD) or that you have mild CAD, that's your call to action. Your doctor's exercise recommendation is something you can do that may help head off worsening symptoms or a heart attack.

Why Exercise?

The science behind your doctor's recommendation is that exercise can help reverse or limit the build-up of plaque (fatty deposits) in the arteries and improve the heart's oxygen supply. Among its many other important benefits, exercise raises the amount of good cholesterol (high-density lipoproteins) in the bloodstream, reduces the risk of developing adult-onset diabetes, modestly lowers blood pressure, and aids weight loss.

The aspect of exercise that may really motivate you, though, is that it makes you feel better. It reduces fatigue and improves your mood. The mental boost you'll get from sticking to your exercise program may even help you feel more like making other lifestyle changes such as giving up smoking or losing weight.

A Comfortable Routine

When doctors prescribe exercise for patients who have CAD or are at risk, they aren't talking about working out until you're out of breath and your muscles are sore. Researchers have shown that aerobic exercise at a moderate intensity provides the benefits you need to improve your heart health. An example of a moderate aerobic activity is 30 minutes of brisk walking each day. Other activities that can be done at a moderate intensity include swimming, biking, and working out on an exercise machine such as a treadmill, stair climbing machine, rowing machine, or stationary cycle.

If you've recently learned you are at risk for CAD or have mild CAD, your physician will help you set up a realistic plan to work up to a moderate level of exercise. If you've never exercised before, start with a few minutes a day—such as a 10-minute walk over your lunch hour—and gradually increase the time until you reach 30 minutes a day.

If setting aside 30 minutes a day to exercise sounds overwhelming, you can get similar heart benefits if you break the time up into three 10-minute activities. For example, you could park your car a little farther from work and walk to the door, walk the dog, vacuum the house, or do a home repair project.

How Can I Play It Safe?

Most patients who have mild CAD can exercise safely, but a very small minority may have problems during vigorous activity. High-tech tests don't always flag the people who will have problems, so—in addition to having the tests that your doctor recommends before you begin—your best bet is to be aware of the warning signs that say, "Stop exercising and call your doctor." These signs include:

  • Abnormal heart rhythm. Irregular heart beats, called arrhythmias, feel like extra heart beats or skipped beats. You may also feel dizzy.
  • Chest pain. Pain or pressure in the center of your chest during or after exercise is a signal that your heart isn't getting enough oxygen. The pain may radiate across your chest or down the left arm. Pain or pressure in your back, throat, or stomach may also be a warning sign.
  • Dizziness. Dizziness during or just after exercise may be a symptom of a serious circulation problem.
  • Fatigue. Unusual tiredness during or after exercise can be a heart-related symptom.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Cox is a corporate vice president for the Crozer-Keystone Health System in Media, Pennsylvania. He is also an adjunct professor in the School of Allied Health at West Chester University in West Chester, Pennsylvania. Dr DiNubile is an orthopedic surgeon in private practice in Havertown, Pennsylvania, director of sports medicine and wellness at the Crozer-Keystone Healthplex in Springfield, Pennsylvania, and a member of the editorial board of The Physician and Sportsmedicine.


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