Coming back from a meeting in Athens this week on heart attack and stroke prevention, I was saddened by the news that a highly esteemed trustee of ours in the Makati Business Club—Rizalino “Roy” Navarro—succumbed to an apparent heart attack while exercising in the RCBC corporate gym. His death is a big loss to the business community. His words of wisdom and tempering counsels during MBC meetings will be sorely missed. Our deepest sympathies to the family.
Several months ago, someone also fell victim to a fatal heart attack in our village gym. From time to time, we hear about marathon runners and other athletes collapsing while engaging in their favorite sports and are pronounced dead before they even reach the hospital’s emergency room.
Age-old advice
It seems ironical that people following the age-old advice that exercise is healthy for the heart should be its unwitting victims. Just like anything in this world, anything good also has its down side. Even life-saving medicines also have side-effects and when such medicines are used inappropriately without heeding the precautions, serious adverse consequences may also be experienced.
The same thing holds true for exercise. Moderate-intensity aerobic exercise has been shown to be good for the cardiovascular system and can help control the blood pressure when individuals complete 30 minutes or longer, five or more days a week. It is imperative though that one should get a clearance from one’s doctor before he/she engages in any form of exercise. We used to recommend that males 45 and older, and females 55 and older should get a clearance first, but heart attack victims are getting younger and younger these days so it’s worth the trip to the doctor’s clinic to get a clearance prior to gym exercise at any adult age.
10-year risk
Although one may be completely symptom-free, the doctor can identify those who may be unaware that they are already at risk to develop a heart attack or stroke. The 10-year risk can then be calculated using a risk prediction chart or a computerized risk assessment tool which estimates the cardiovascular risk—developing a heart attack, or dying from it—even for individuals who may look in the pink of health.
These risk-assessment tools take into consideration the following details to estimate the 10-year cardiovascular risk:
Gender (male or female)
Age
Smoking status (this should reflect lifetime exposure and measured in terms of number of packs per year smoked previously and/or currently)
Regular blood pressure reading
Total cholesterol to HDL cholesterol ratio
The following factors will increase the risk further:
Family history of heart attack in a first-degree relative at a relatively young age (This increases the risk by 50 percent, so a 10-year risk of 20 percent becomes 30 percent)
Elevated blood triglyceride levels
Impaired fasting blood sugar (borderline) or increased postprandial (after-eating) levels though not yet frankly diabetic
Women with a premature menopause
Ethnic factors such as Southeast Asians (and that includes Filipinos)
Medical advice
After a thorough assessment which may require that a stress or exercise test be done, the physician can advise the individual if he or she is fit for gym exercise and up to what intensity of exercise can be attained.
The intensity is important especially for hypertensive individuals because as a person exercises, the blood pressure naturally increases to keep up with the increased oxygen and energy needs of the body. Individuals with a resting blood pressure of 160/100 or higher should have his/her BP controlled first before exercising. Same thing if the BP shoots up to more than 200/120 mmHg during aerobic exercise. These levels are too high for comfort and could trigger serious heart and brain complications.
If one is hypertensive, one should also avoid isometric exercise, defined as exercises involving overcoming an immovable force and held in a static position for a defined period of time. This includes holding a weight straight out in front or attempting to lift weights. If isometric exercise is really needed, one should learn breathing techniques to dissipate the generated tension in the cardiovascular system throughout the exercise. A doctor’s clearance and advice for isometric exercises can prevent a trip to the emergency room.
If one is being maintained on medications to control the BP or prevent chest pains, one should take these medicines before exercising. A common mistake is to delay taking the medicines when one has eaten breakfast already after exercise, believing that all medicines should be taken on a full stomach. This can be a fatal misconception. One is at highest risk of developing a heart attack or stroke in the early morning hours because of a sudden surge of adrenaline during this period. Coupled with moderate to high intensity exercise and failing to take one’s BP and heart medications, this may be a risky formula for disaster.
So exercise is a good tool to keep one healthy. But, don’t forget to heed the precautions.