Past Heart Health Tip of the Month

Tips For Starting Or Restarting A Resistance Training Program:

By Christine Ford B.A. Soc, B.A. Kin, C.K.,
Cardiac Rehabilitation Supervisor, Resistance Training Assistant,
Cardiac Rehab and Secondary Prevention Program

What do you picture when you think of resistance training? For some people it may conjure up images of well-toned “gym rats” wearing weight belts, grunting as they attempt a complicated movement with an impossibly heavy weight. For other people the image may be a group of people in a nursing home doing a seated program with exercise bands. Both accurately represent resistance training however, these images represent the two different ends of the spectrum and demonstrate that there is a resistance program to suit everyone’s fitness requirements. This month, we discuss the benefits of resistance training and how to carry out a safe and effective, yet simple, resistance training program. So whether you are new to resistance training or just looking for a refresher after a hiatus from resistance training, please read on.

Resistance Training (RT populations ), also referred to as strength training or weight training, is an important component of any well-rounded exercise program. Research has shown that resistance training is safe for people living with coronary artery disease, diabetes and stroke. The American College of Sports Medicine (A.C.S.M.), one of the leading authorities on the prescription of exercise for special populations, makes specific recommendations on how to perform resistance training safely. We will discuss resistance training guidelines specifically for those living with, or at risk for, coronary artery disease, diabetes and stroke.

Benefits of R.T.:

• Slows the age-related loss of muscle mass and strength
• Makes ability to perform activities of daily living/work easier
• Prolongs independent living
• Prevents or slows progression of osteoporosis
• Enhances self-image and confidence
• Stabilizes joints and prevents injuries
• Improves blood sugar control
   

Components of a RT program:

Frequency: two to three times per week with at least one day of rest between sessions

Intensity: two to three sets of 10-15 repetitions.
Rate of perceived exertion “fairly light” to “somewhat hard”

Time: In each exercise session aim for 8-10 exercises which target all major muscle groups. Programs may be adjusted to account for limitations of the individual performing the exercises or for those with specific strength-related goals in mind. Time to complete each session will vary depending on the number of exercises, sets and repetitions in the program.

Type: The type of equipment used will depend on the equipment available. You may use dumbbells, gym equipment, bands, stability balls or your own body weight.
 

Safety:

• Warm up before performing RT by doing a slow walk and stretches
• Perform exercises using proper technique. Ask for assistance if unsure of proper technique.
• Avoid holding your breath while lifting weights (if you have to hold your breath to lift a weight, it’s too heavy)
• Do not exceed a rating of perceived exertion of “somewhat hard”.
• Take 30-second rests between exercises to allow heart rate and blood pressure to return to resting values.
• Cool down and stretch after each session to prevent injuries.
• Take at least one day of rest between RT sessions to allow your muscles to recover.
   

Speak to your doctor if you have…

• Recently had laser eye surgery
• An un-repaired inguinal (groin area) hernia
• High pressures in your eye (glaucoma)
• Eye complications related to diabetes
• Any other conditions which you feel may affect your ability to perform resistance training safely
   

Check with your doctor before starting a new resistance training program to ensure it is safe for you.

Please refer to the Patient Education Webcasts for more information and video demonstrations on resistance training.

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References:

King, Major, L, PhD et al. The Hemodynamic Effects of Isotonic Exercise Using Hand-held Weights in Patients with Heart Failure. The Journal of Heart Lung Transplantation: December 2000.

Willey, Karen A, RN, Fiatarone Singh, Dr. Maria, Battling Insulin Resistance in Elderly Obese People with Type 2 Diabetes: Bring On The Heavy Weights. Diabetes Care: May 2003.

Dunstan, David, W, PhD et al. High Intensity Resistance Training Improves Glycemic Control in Older
Patients With Type 2 Diabetes. Diabetes Care: October 2002.

McCartney, Neil. Role of Resistance Training in Heart Disease. Medicine & Science in Sports & Exercise: October 1998.

A.C.S.M.’s Guidelines for Exercise Testing and Prescription 8th edition, 2010.

A.C.S.M.’s Guidelines for Exercise Testing and Prescription 8th edition, 2010.

A.C.S.M.’s Guidelines for Exercise Testing and Prescription 8th edition, 2010.

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10 simple steps to a healthy summer salad

By Katie Chapman, Project Leader, Heart Health for Life Program
Toronto Rehab’s Cardiac Rehabilitation & Secondary Prevention Program

1. Choose dark green leafs as your base, for example baby spinach leaves, endive, or mixed leaves. Iceberg lettuce has little nutrients.
    
2. Try to have a rainbow of colors on your plate so that you benefit from a range of nutrients. For example beetroot, red and green peppers, mushrooms, cucumbers, radishes, tomatoes, broccoli, cabbage, cauliflower, and onions.
    
3. Avoid veggie salads (such as coleslaw, potato salad) or pasta in mayonnaise, marinades, or dressings, as these are high in fat.
    
4. Go for pulses such as soy beans, chickpeas, lima beans, or mixed beans. They are high in fiber, making you feel fuller for longer, and they're an excellent source of protein.
    
5. Choose lean meats and fish, such as grilled chicken breast, roast beef, or steamed salmon, and avoid tuna with heavy mayo. Avoid salty cured meats, such as ham, bacon, or salami. Hard-boiled eggs or tofu are excellent vegetarian alternatives.
    
6. Have a small portion of cheese - Go for a small amount of feta, parmesan or low fat cheddar.
    
7. Add more protein to your salad by sprinkling a small amount of mixed nuts or seeds on top such as sunflower seeds, walnuts, slivered almonds, or hemp seeds. This is a great way to give it more variety, texture, and crunch.
    
8. Choose a lower fat dressing - For a zesty, healthier option try an olive oil and lemon (or lime) juice dressing and add your favourite fresh herbs such as parsley, basil, dill or oregano.
    
9. Try a salad dressing alternative and top your salad with a dollop of cottage cheese, a little natural yogurt, or hummus.
    
10. Choose a whole-grain side for your salad - Avoid white breads. Instead try rye, multi-grain, or whole-wheat. These are higher in fiber and will help you feeling fuller for longer.

To complete your healthy salad bar meal, you could add a fresh fruit salad, such as grapes, strawberries, melon, and apple slices, topped with a little natural yogurt. Avoid fruit salad in syrup. Choose un-sweetened options if possible.

Tips from My Heart Central www.myheartcentral.com

Logos and links referenced on this website are provided as an acknowledgement of sponsorship and do not imply an endorsement of products, services or companies by Toronto Rehab.

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Nutrition Tip of the Month

As the warm weather approaches most of us will look forward to a nice cold drink.  A cold beer may seem very inviting on a hot day, but alcohol can de-hydrate and is high in calories.  Liquid calories quickly add up.  We receive low nutritional value from these beverages, and are left with the huge burden of extra calories.  Extra calories is something most of us can live without because it often leads to weight gain, high triglycerides, high blood pressure, diabetes and high cholesterol.  Being mindful about the food and beverage choices we make, can help us achieve a healthier state.  Are you aware of what you are getting in your cup?    Read the following table carefully:

(Source:  Allan Borushek. The Doctor’s Pocket Calorie, Fat and Carb Counter.  5th Ed.2002)

The next time you go to grab a drink … think about it first.  If the drink contains sugar or cream, you might want to think twice.  Choose sparkling water instead – it has no calories!  Compromise.  If you are thinking of having a second or third drink, settle for one.  Drink it slowly and be sure to enjoy it.  When we take our time to enjoy and focus on the food or drink before us, we are more likely to feel satisfied without having to overindulge.

Written by:  Maria Ricupero, RD, CDE at  the Toronto Rehabilitation Institute, Cardiac Program.

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Shin Spints: Causes, Treatment and Prevention
By Ellen Silaj
Cardiac Rehab Supervisor of Toronto Rehab’s Cardiac Rehabilitation & Secondary Prevention Program

Spring is in the air, nice weather has returned.  Many of us are thinking of starting to walk outside again.  Some will have been walking indoors on a treadmill, on a track, in a shopping mall, or have been using a stationary bicycle.  Others will not have been as active as they hoped over the winter.  It can be more interesting and easier to walk further and/or faster outside but pavement and sidewalk surfaces can be very hard.  These differences often result in lower leg pain or “shin splints”.

What are “shin splints’?
“Shin splints” is a general term for lower leg pain caused by repeated stresses on the tissues of the lower leg.  A variety of conditions can cause these stresses.  For example, repeated stresses can be caused by weight bearing activities such as walking, jogging or standing for long periods of time.  One such common condition is called medial tibial stress syndrome (MTSS).  Pain with MTSS is felt along the lower two thirds of the inner border of the shin bone, is tender to pressure, increases with activity, and decreases with rest.

What happens in MTSS?
MTSS is an overuse injury.  Repeated stresses (too much, too quickly) on the lower leg tissues and shin bone, that are not prepared for repeated stresses, can cause tissue fatigue and eventually tissue failure.  These stressed tissues can become swollen e.g. inflammation of muscle fibres and tendons especially where they join outer bone layers.  Another name for this muscle-to-bone stress reaction is ‘periostitis’. 

What can cause MTSS?
Muscles and tendons along the shin bone attach to bones in the foot.  With regular walking, when the front of your foot (forefoot) touches the ground, it also turns inwards slightly (=pronation).  Too much pronation(overpronation) puts extra strain and stress on the muscles of the foot and tissues along the lower leg shin bone.  Abnormal alignments of the lower leg or foot bones can result in overpronation movements.  Overpronation can also be exaggerated with increased foot movements such as quick walking versus slow walking, walking long versus short distances, or jogging versus walking.

How do you treat MTSS? 
If you develop MTSS pain, stop the activity and REST.  To help the tissues to heal, change the intensity of the activity.  For example, slow down your walking speed, go easier, do less and use ice to decrease the swelling and inflammation.  Some patients with MTSS that have overpronation of the forefoot, can be helped by special customized shoe insoles (orthotics).  A doctor or health care professional can identify this biomechanical (movement) problem with a good foot assessment.  They may also prescribe therapy for stretching and strengthening exercises.  Rest and ice should decrease the MTSS pain by 7-10 days.  If you MTSS does not improve, see your doctor or health care professional. 

When the MTSS pain settles, start activities slowly.  Alternating non weight bearing activities like cycling with walking or light jogging can help.  If the MTSS pain does not worsen, gradually return to your previous activity.

What can prevent MTSS?
If you have had lower leg pain/’shin splints’ before or are just recovering from them now:  1. See a doctor or health care professional for a foot assessment.  Orthotics and stretching and strengthening exercises may be the best prevention (and treatment).  2.  Start your weight bearing activity slowly – gradually go further, gradually go faster, gradually go harder.  3.  When you can, walk on softer surfaces.  

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Overcoming Barriers to Becoming More Physically Active

Courtesy of Rene Belliard,
Cardiac Technologist and Lab Coordinator for Toronto Rehab’s Cardiac Rehabilitation & Secondary Prevention Program
Even though there is lots of evidence that being physically active is essential to being healthy, many people still don't make regular physical activity a priority in their lives.
This is usually because there are real or perceived barriers to becoming physically active that we must first identify and then plan ways to overcome them to change our daily routines in order to improve and maintain health.
Here are some of the most common barriers you might be experiencing and some solutions to help you overcome them – do any of these sound familiar?

“I don't have time to be active”
Solution: Take a good look at how you really spend each day for a week – chances are you can find time for a 30-minute physical activity break once each day. Try waking up a half hour earlier to walk your dog, getting off a stop earlier when riding the bus or subway and walking the rest of the way, or climbing the stairs instead of the elevator.

“I've been inactive for so long that starting now won't really help anything”
Solution: You're never too old and it's never too late to become physically active. Evidence shows that many people 90 years and older who have become frail from inactivity have successfully built their strength and independence through simple activities in a short time. Any physical activity you add to your life will help build health benefits. Every little bit counts no matter when you start!
“Physical activity is boring”
Solution: Try a social activity you can do with a friend or family member to make physical activity an enjoyable social outing and keep each other motivated. Try something you enjoyed when you were younger or something you've always wanted to explore that looks interesting, like a new hobby involving physical activity such a gardening, yoga or Tai Chi. For variety, mix up different forms of physical activity such as line dancing or group swimming to keep things more exciting. Think about what types of physical activity appeal to you so you'll have fun doing them.

(Ref. WWW.publichealth.gc.ca)

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Keeping Warm and Motivated in the Cold Months
By Pearl Yang
Exercise Leader
Toronto Rehab’s Cardiac Rehabilitation & Secondary Prevention Program

Do you find it hard to keep up your exercise in the winter?  The cold and February blues can make it hard to stay motivated with your exercise program, but here are some tips to help liven up your heart health this month and get you back on track.

• Find an exercise partner and an activity to do together.  Whether it’s your spouse, a neighbour, a friend or a relative, a lot of people are in need of extra motivation.  Making a “walk” date, or having a gym buddy for a weekly or biweekly exercise session can help motivate your own exercise the rest of the week.  After an invigorating exercise session, have a heart healthy meal together to reward yourselves!

• Try to fit in extra tidbits of exercise throughout your day; take the stairs; park a little further from the store; during a break, walk around the office before sitting down; take an extra 10 minutes in your lunch break to walk around.

• Get some new music to motivate you during your exercise.  New tunes to move to will make your workout seem fresh and more fun. 

• If you work out at a gym, try out a different piece of equipment (with instruction of course) or join a group activity like aquafit, dance or yoga. 

• If you have home equipment, move it around in the room for a new view for a change. 

• Write out your work out schedule – the days you will do aerobic exercise and the days you will do resistance exercise.  From here, map out approximately where it can fit into your schedule.  If you plan and prioritize your exercise, it is less likely to get pushed to the bottom of the list.

• If it’s hard to get started, you’re feeling tired and considering whether or not to exercise, make 10 minutes your goal. Just 10 minutes!  After you’ve walked for 10 minutes, reassess how you feel and then decide whether you’ll do another 10 or stop.  You may find that even the small bout of exercise is enough to energize you to want to do more.

• Split up your exercise if you’re not able to do one long bout – do 20 minutes in the morning and then 20 minutes at lunch or after work.  Some exercise is always better than no exercise at all. 

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Heart Health Tip of the Month

By Katie Chapman, Heart Health for Life Project Leader, Toronto Rehab’s Cardiac Rehabilitation & Secondary Prevention Program

Release Your Inner Yogi!
During the cold winter months, you need a little extra motivation to stick to your exercise routine.  This month, nourish your body with good karma and positive energy through yoga. 

Yoga, which means “yolk” or “union,” is the practice of connecting the body, mind and spirit through physical exercise (asana), meditation, and breathing techniques (pranayama).

Yoga offers many benefits to your health and well-being physically and emotionally.  Here are just a few:

• Decreased blood pressure
• Increased cardiovascular fitness
• Increased strength, flexibility and joint range of motion
• Increased metabolism and digestion
• Improved posture, dexterity and reaction time
• Sleep improvements
• Increased immunity
• Weight maintenance
• Decreased anxiety and depression
• Self acceptance and mood increase
• Hostility, anger and stress relief
• Pain Relief:  Studies show that asanas (postures), meditation or a combination of the two, reduce pain for people with conditions such as cancer, multiple sclerosis, auto-immune diseases and hypertension as well as arthritis, back and neck pain, carpal tunnel syndrome, fibromyalgia, eczema, irritable bowel syndrome and other chronic conditions. Some practitioners report that even emotional pain can be eased through the practice of yoga.

Resources:
Visit www.gtayoga.com to find a studio and class level that suits you best!
www.abc-of-yoga.com
www.dailycupofyoga.wordpress.com

Book Recommendation:
Eat, Pray, Love By: Elizabeth Gilbert: A wonderful story of a woman’s journey to Italy, India and Indonesia that will inspire you to accomplish your dreams, take care of your heart and find the beauty and love in everything.

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C-Reactive Protein and Cardiovascular Disease
Written by: J.D. Kato, DC, MSc, ACSM-RCEP, CSEP-CEP

Those who have been on our program know the traditional risk factors for cardiovascular disease (CVD). These are factors such as elevated blood pressure, LDL cholesterol, diabetes, etc. However, another emerging risk factor you may not have heard about is C-reactive protein (CRP). Research into CRP has been going on for decades but recently an interesting study, called Jupiter (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), was published. This study investigated the effects of Crestor®, a statin medication also known as rosuvastatin. Statins are well known for lowering LDL cholesterol, but they are also known to lower CRP. The subjects of this study did not have any history of CVD or high levels of LDL cholesterol, but did have higher levels of CRP. The results of the study showed that those who took rosuvastatin reduced their LDL cholesterol by 50% and CRP levels by 37%. Associated with these changes were reductions in heart attacks by 54%, strokes by 48%, and death by 20%. The authors report that, after an average of about 2 years, the side effects seen with rosuvastatin were the same as with those taking placebo.

So what is CRP you ask? CRP is a protein made by the liver which circulates in the blood. Its function is still not fully known, however CRP can be used as a measurement of inflammation in the body. The test is called ‘high sensitivity CRP’ (hs-CRP) and is a simple blood test just like cholesterol. Levels of CRP usually range from less than 1mg/L to 10mg/L or more. As hs-CRP is a non-specific indicator of inflammation, a high test result can be due to any injury, infection or inflammatory condition (such as arthritis) in the body. Generally speaking though, 3mg/L is considered a high value and although it does not cause any symptoms it may be a marker of risk for CVD. This is because atherosclerosis that causes CVD is an inflammatory process. If there is no reason to attribute the inflammation to another cause then it may be due to low-level inflammation in the walls of the arteries leading to atherosclerosis. In the Jupiter study the investigators focused on reducing inflammation rather than cholesterol.

So, are there other ways to lower CRP? Yes, there are numerous studies that show lifestyle modification can lower elevated CRP. Many studies have found positive results with weight loss, reduction in waist circumference, increased fibre intake and low-fat eating habits. Research also shows that regular aerobic exercise and physical activity can also reduce elevated CRP.

The results of the Jupiter study were impressive because of the dramatic reduction in CVD in adults who would generally be considered healthy. And even though we do not fully understand the nature of CRP in the body and how it works, it may be a helpful tool to improve our prevention and treatment of CVD in certain populations. As we learn more about risk factors and how to affect them we will be able to make healthier lifestyle choices and optimise medical management.

Current Tip of the Month