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January 10, 2022

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Heart disease in women – by Clare Hozack

Heart disease causes 3x the number of deaths in women as does breast cancer. In Australia 90% of women have one risk factor for heart disease, and 50% have two or more. 1 in 4 women will die of heart disease.

“Heart disease” refers to several types of problems that affect the heart. The most common type of heart disease is coronary artery disease (CAD). Heart disease is also called cardiovascular disease, which is disease of the blood vessels.

Symptoms of a heart attack

These can vary between men and women, and women are more likely to have “non-typical” symptoms such as heartburn. Heart Attack symptoms in women are more subtle compared to those in men, and could include:

Uncomfortable pressure, squeezing, fullness or pain in the center of the chest.
It can last for more than a few minutes, or go away and come back
Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath with or without chest discomfort.
Other signs such as breaking out in a cold sweat, nausea or lightheadedness.

Emotional stress can play a big role in triggering heart attack symptoms in women. It has also been noted that women tend to have the symptoms often when resting or even while sleeping.

heart attack symptoms

Managing risk of heart disease

There are many behavioural, lifesetyle and physiological aspects you can modify to control your risk. These include:

Hip to Waist ratio
smoking
eating habits
physical activity
alcohol
stress: long-term psychological, emotional, or physical stress raises your risk of heart disease. If you have heart disease, long-term stress also makes you more likely to have a heart attack. Stress includes emotionally upsetting events, especially involving anger, and can be a trigger for heart attack. Stress also may indirectly raise your risk of heart disease if it makes you more likely to smoke, eat unhealthy foods, or less likely to exercise.
blood pressure
high cholesterol; and triglycerides
diabetes
metabolic syndrome: this is the name for a group of risk factors that happen together and are related to your metabolism. Metabolism is the process your body uses to convert food into energy. Having metabolic syndrome doubles your risk of heart disease. Metabolic syndrome is more common in women than men.If you have metabolic syndrome, you can take steps to control your risk factors. You have metabolic syndrome if you have any three of these five risk factors:
– Waist measurement of more than 35 inches
– Triglyceride level greater than 150 mg/dL (milligrams per deciliter)
– HDL cholesterol less than 50 mg/dL
– Blood pressure of 130/85 mmHg (millimeters of mercury) or higher
– Blood glucose greater than 110 mg/dL after fasting for at least eight hours
excessive blood clotting
lupus and rheumatoid arthritis
depression
sleep apnea
c-reative protein: C-reactive protein (CRP) is made by the body and released into the blood in response to swelling. Swelling (or inflammation) is how your body reacts to heal infections or cuts. Swelling can also happen over time in response to high stress levels or poor eating habits. Swelling for infections or cuts will raise your CRP levels for a short time, but swelling that continues for a long time may mean your arteries are damaged, which puts you at risk for heart disease.

Risk factors you can’t control

age
menopause (increases risk significantly)
family history
race and ethnicity
pregnancy history

The most common risks affecting women are high cholesterol, being overweight, and physical inactivity.

Prevention and treatment

Anyone with multiple risk factors or any symptoms should be referred to their GP for a heart health assessment. While you may not be able to completely eliminate your risk for heart disease, you can take steps to reduce it.

If you are a personal trainer working with a client at risk, these are supportive actions you could take:

Check blood pressure regularly. If it’s high, work with their doctor to lower it. This may include medication and lifestyle changes.
Support quitting smoking: This can be difficult, but a doctor can help create a smoking cessation plan that’s right for them.
If they have risk factors for diabetes, such as family history, get their blood sugar tested.
If they have diabetes, work with them to blood sugar under control.
Help them maintain a healthy weight that works for their body.
Eat a healthy diet that’s high in whole grains, fruits and vegetables, and lean meats.
Limit your alcohol intake to no more than one drink per day.
Manage stress levels – this includes exercise as punishment, excessively hard, or exercise they don’t enjoy.
Get their cholesterol checked and take steps to lower high cholesterol if you need to.
If they have sleep apnea, or believe you do, seek treatment.
Exercise regularly (moderate intensity is best “bang for buck”).
If they’ve had a heart attack, talk to your doctor about daily low-dose aspirin. This isn’t recommended for women who haven’t had a heart attack or stroke, as it can increase bleeding.

Exercise prescription

Once someone has been diagnosed with heart disease their doctor will generally treat the disease with medication and determine if they are clinically stable enough for exercise. Regular exercise can be a very effective secondary treatment and prevention for hert disease and doesn’t introduce adverse side effects. Exercise can help prevent further narrowing and hardening of the blood vessels which supply the heart, may prevent blood from clotting and reduce the stress on the heart during everyday activities – all of which are beneficial.

General exercise guidelines

The general exercise recommendations for people with heart disease are 30-60 mins per day 3-5 days per week of both aerobic and resistance training.Once clearence from their doctor has been obtained, these guidelines can help you to optimize their training as well as their health and safety:

Include at least a five-minute warm-up and five-minute cool-down in every exercise session to reduce the likelihood of oxygen deprivation to the heart in response to a sudden physical effort or abrupt cessation of exercise.
Engage in moderate-intensity physical activity such as brisk walking for at least 30 minutes on most, preferably all, days of the week.
Monitor your exercise intensity closely. Make sure to stay within your individual heart-rate zone (usually determined from a treadmill test under the supervision of a physician). 60-80% is generally advised.
Be cautious about engaging in vigorous physical activity. If you plan to begin a vigorous program, discuss it thoroughly with your physician. Also be sure to complete an exercise stress test first.
Avoid strenuous activity in extreme environmental conditions. Vigorous exercise in the cold (such as snow shovelling) is associated with heart attack. Hot conditions require a dramatic increase in the heart’s workload. High altitude increases demands on the heart, particularly for individuals who are not acclimatised. In these situations, it is best to take it slow and increase incrementally.
Inform your trainer and physician if you have any abnormal signs or symptoms before, during or after exercise. These include chest pain, extreme fatigue, indigestion or heartburn, excessive breathlessness, ear or neck pain, upper respiratory tract infection, dizziness or racing heart and severe headache.
If prescribed, always carry your nitroglycerin with you, especially during exercise.
Never exercise to the point of chest pain or angina. If you develop chest pain during exercise
Make sure the facility where you exercise is well-equipped in case of an emergency. Ask the managers if the facility has an emergency response plan and an automated external defibrillator (AED) (with staff trained on how to use it) on the premises.

It is never too late to start an exercise program or increase physical activity. In fact, combined with a healthy diet, it’s the best choice you can make for your heart health.

Weight training for heart health

To reduce heart attack risk, cardio (aerobic) exercise is most often promoted as an easily available exercise of choice for improving heart health. However, lifting weights for less than an hour a week can also reduce your risk for a heart attack or stroke by 40 to 70 percent, as well as increase your functional strength, bone density, and balance. If this is you, start lifting weights 2-3 times a week for 20-60 minutes, and build up to a heavy intensity (about 80% of what you can lift once, or 8-12 repetitions) over time. Three great exercises include:

Lunges
Shoulder press
Upright row

A program from a qualified personal trainer is ideal. Progress to super-setting with the Power Plate by adding:

3D Lunges
3D Shoulder press
3D Upright row

If you already have heart disease, strength training with patients with cardiac disease has been, until recently, avoided due to the haemodynamic response observed during isometric (static) exercise – where blood pressure increases up to 2.5 times normal. However weight lifting, or strength training generally, is not an isometric exercise. Isometric is a stationary contraction (like a wall sit or plank), and weight lifting works more like a blood pump; there there’s a period of constriction (during the contraction), and a period of release (which effectively “sucks” the blood in to the tissues).

So, recommendations for people who have heart disease include:

Only perform strength training if you are asymptomatic or only mildly symptomatic;
Begin strength training after an initiation of aerobic training only;
Start with single limb activities;
Set weight at a maximum intensity no greater than 60% of 1 repetition maximum – this is about 15-20 repetitions;
Train at their own pace, progress at your own pace, and take a break when you need it;
Your first few sessions should be medically supervised;
You need to check in periodically for reassessment;
Record your heart rate and response to exercise;
Perform strength training once a week, for no more than 1hr

Cardio and strength training exericse can also be supplemented with Whole Body Vibration, which has a positive effect on arterial stiffness in middle-aged and older adults. Reducing arterial stsiffness and decresing blood viscosity means that the blood flows more easily through the veins and arteries.

Using Whole Body Vibration as a stand-alone prevention and heart disease management tool

Power Plate can be used as a progression tool for heart disease patients re-entering exercise. Power Plate training also offers cardio, strength, and balance training all at once.

Recently, whole body vibration has emerged as a useful method for improving overall health, with improvements in body composition, muscular strength and heart health being common. Whole body vibration training is also particularly effective for elderly and deconditioned people who cannot participate in traditional exercise” – PPNZ https://powerplate.co.nz/effect-of-vibration-training-on-heart-health-part-1/

Because you can train strength, balance, and cardio fitness at the same time, this tool is very effective in both heart disease management and prevention. Also, if you’re elderly or balance-challenged, you can hold on, and you can also use the plate to manage other health issues that contribute to heart disease risk such as obesity and diabetes.

Sample exercises using whole body vibration

Stepping side to side, holding on – cardio
Step ups (weights on one side, holding on other side – strength and balance
Single leg asterix (balance)
Sitting legs wide (circulation and recovery)

Whole body vibration increases circulation

Research also shows that the long-term benefits to the cardiovascular system show whole body vibration can improve circulation also, making it a very relevant method of cardiovascular therapy.

The immediate effects to circulation, of lying with arms or legs on a Power Plate machine, are self-evident. There are local increases in blood flow to the skin in the arms and legs immediately after a passive “massage” session – where no voluntary muscle contractions are performed. An increase in blood flow has also been seen straight after doing 10 minutes of static or dynamic squatting exercises. – PP NZ https://powerplate.co.nz/effect-of-power-plate-training-on-heart-health-part-2/

Build each element to 3 exercises (eg. 3 things that get yo puffed, 3 things that give you a muscle burn, 3 things that make you wobbly, and 3 things that feel good for massage), then build up to 3 sessions per week, for a minimum of 15 minutes (use the Power Plate app for work out ideas: https://powerplate.com.au/)

Whole Body Vibration will not only improve muscle mass and physical fitness, but it is an awesome rehab tool for stroke victims, increasing bone density, and reducing risk of future attacks.