About Medicine: Exercise, sleep are important for a healthy heart

Anthony Navone, MD
Marcus Daly Cardiology Services
A service of Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840
(406) 375-4665

Exercise and Sleep are Important for a Healthy Heart
Exercise has a number of effects that benefit the heart and circulation. These benefits include improving cholesterol and fat levels, reducing inflammation in the arteries, helping weight with loss, and helping to keep blood vessels flexible and open.

A sedentary lifestyle is one of the major cardiac risk factors (along with high blood pressure, abnormal values for blood lipids, smoking, diabetes, family history of heart disease, and obesity) for developing cardiovascular disease. The evidence from many scientific studies shows that reducing these risk factors decreases the chance of having a heart attack or experiencing another cardiac event, such as a stroke, and reduces the possibility of needing a coronary revascularization procedure (bypass surgery or coronary angioplasty). People who maintain an active lifestyle have a 45% lower risk of developing heart disease than do sedentary people.

Benefits of Regular Exercise on Cardiovascular Risk Factors
  • Increase in exercise tolerance
  • Reduction in body weight
  • Reduction in blood pressure
  • Reduction in bad (LDL and total) cholesterol
  • Increase in good (HDL) cholesterol
  • Increase in insulin sensitivity
There are a number of benefits of exercise; 2 examples are improvements in muscular function and strength and improvement in the body's ability to take in and use oxygen. As one's ability to transport and use oxygen improves, regular daily activities can be performed with less fatigue. This is particularly important for people 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, resulting in 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.

Experts have been attempting to define how much exercise is needed to produce heart benefits. Beneficial changes in cholesterol and lipid levels, including lower LDL ("bad"cholesterol) levels, occur even when people performed low amounts of moderate- or high-intensity exercise, such as walking or jogging 12 miles a week.

However, more intense exercise is required to significantly change cholesterol levels, notably increasing HDL ("good" cholesterol). An example of this kind of intense program would be jogging about 20 miles a week. Benefits occur even with very modest weight loss, suggesting that overweight people who have trouble losing pounds can still achieve considerable heart benefits by exercising.

Like all muscles, the heart becomes stronger as a result of exercise, so it can pump more blood through the body with every beat and continue working at maximum level, if needed, with less strain. The resting heart rate of those who exercise is also slower, because less effort is needed to pump blood.

Johns Hopkins research has shown that when combined with strength training, weekly exercise on a bike or treadmill or a brisk walk may cut levels of fat in the liver by up to 40 percent in people with diabetes. A fatty liver can speed heart disease. Exercise also reduces inflammation, a process that can lead to cell damage.

American Heart Association recommendations for regular exercise are as follows:

For Overall Cardiovascular Health:
  • At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150 minutes
  • At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity
  • Moderate- to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.
For Lowering Blood Pressure and Cholesterol:
  • An average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week.

How can you fit more exercise into your day, or become more physically active if you haven't been before? Begin with small starts like these, and build up from there.
  • Park your car at the far end of a parking lot, so you have farther to walk to a building's entrance.
  • Choose the stairs rather than the elevator.
  • Spend part of your lunch break walking.
  • On bad-weather days, try walking indoors at a local school gym.
  • Wake up a bit earlier and exercise before you do anything else.
  • Use a wearable fitness tracker to count your steps. Try increasing your daily steps by 500 each week with the goal of reaching 10,000 steps per day, a level that can produce many health benefits.

Sleep and Heart Disease

Sleep is essential for a healthy heart. People who don't sleep enough are at higher risk for cardiovascular disease-regardless of age, weight, smoking and exercise habits. One study that examined data from 3,000 adults over the age of 45 found that those who slept fewer than six hours per night were about twice as likely to have a stroke or heart attack as people who slept six to eight hours per night.

(OSA) is a chronic disease that afflicts nearly 30 million men and women in the U.S., and most remain untreated. Sleep apnea involves the repeated collapse of the upper airway during sleep.

It puts an enormous strain on the heart by repeatedly causing oxygen levels to drop and blood pressure to surge as you sleep.

OSA puts significant strain on the heart and may increase the risk of heart failure, elevated blood pressure, atrial fibrillation (A-fib), resistant hypertension, Type 2 diabetes, and stroke.

Facts about OSA and Heart Disease:

  • Severe, untreated sleep apnea more than doubles your risk of dying from heart disease.
  • Middle-aged men with severe sleep apnea are 58% more likely to develop heart failure.
  • Between 30% and 40% of people with high blood pressure have sleep apnea.
  • The risk for atrial fibrillation is 2 to 4 times higher in people who have sleep apnea.
  • Up to 85% of people with treatment-resistant hypertension have sleep apnea.
  • People with severe, untreated sleep apnea are 2 times more likely to have a stroke.

Watch out for these common warning signs for sleep apnea:

  • snoring
  • silent breathing pauses
  • gasping or choking
  • daytime sleepiness or fatigue

Talk to your doctor if you feel that you may have OSA. Your doctor may refer you to a board certified sleep medicine physician at a sleep center that is accredited by the American Academy of sleep medicine like the one at Marcus Daly Memorial Hospital. If your doctor determines that you have sleep apnea, then the final step is to begin treatment. The most common treatment for obstructive sleep apnea his continuous positive airway pressure therapy, also known as CPAP. Effective treatment of sleep apnea is good for your sleep and your heart. In improves her overall health and lowers her risk of heart problems.

Questions and or comments regarding this week's health column please contact, Anthony Navone, MD at Marcus Daly Cardiology Center, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!



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