The Power of Exercise: A Heart Attack Survivor's Experience
Survived and Thriving
Learning how to strengthen the heart after a heart attack is essential; regular exercise after a heart attack is critical to cardiac health. For those on the journey of recovery, the path to regaining strength and confidence in your heart's capabilities can be daunting. Drawing from my personal battles with three heart attacks, this guide offers insights on exercise planning.
I advocate for a balanced approach that includes both strength and endurance training, as each can significantly improve heart health and overall functionality. Let's explore together!
A Common Story, but like you, a Unique Journey
After enduring three widow-maker heart attacks within a mere 15 days, a scenario with a survival rate of 1:1000, I faced a diagnosis of progressive heart failure. Several of the seven cardiologists I had at the time advised me to get an implanted defibrillator to avert sudden death. At the age of 50, with a devoted wife and two young daughters, I was resolute in defying the odds. I knew that accepting that diagnosis was an eventual death sentence. I had to believe I could get better or there was no point. I had to have faith that there was a way.
It's imperative to acknowledge that fitness levels before a heart attack can vary widely, and generally, the fitter you are beforehand, the quicker and smoother the recovery. Some may be grappling with obesity, smoking, or diabetes. These factors introduce additional complexity and hurdles in the recovery journey. Therefore, it's vital to customize your recovery and rehabilitation with lifestyle changes that address your unique health concerns, rather than a generic cookie-cutter approach. The last, in my experience, all to common in cardiology circles.
Challenging the Expectations
Heart attack patients often face generic exercise limitations and are prescribed a standard set of medications, but in my experience, treatment should avoid a one-size-fits-all mentality. When I started rehab and noticed no one shared my profile, yet we were all following some version of the same regimen, I grew even more skeptical of the system. I wasn't dealing with obesity, nor did I smoke or suffer from diabetes. Being fit prior to my heart attacks, I possessed a mindset determined to recover. Frankly, my views on traditional cardiac rehab, especially for those similar to me, are largely critical. The system seems inundated with individuals who have relinquished control over their health, passively awaiting instructions.
Educating yourself about cardiac rehabilitation and pushing for a personalized plan that features cardiac rehab exercises tailored to your individual needs is crucial.
When considering exercise after a heart attack, common thoughts turn to activities like walking, swimming, running, and cycling. However, the benefits of weightlifting after a heart attack, a frequently overlooked component of cardiac rehabilitation, are substantial. Integrating weightlifting into your exercise routine can offer significant advantages for your heart's health.
Strength
A 2019 study confirms that post-heart attack strength training can maintain cardiac function as effectively as endurance training. This finding is vital for heart attack survivors and individuals with cardiovascular disease when selecting the most beneficial exercise after a heart attack to incorporate into their recovery and rehabilitation plan.
Crafting Your Recover Regimen
In the aftermath of a heart attack, your workout routine may incorporate a diverse array of exercises. Drawing from my own journey, I've discovered that incorporating kettlebells, body weight exercises, and resistance bands into my regimen has been particularly advantageous. When it comes to kettlebells, I'm partial to the more deliberate tempo that Brett Jones advocates in Iron Cardio and the Hybrid Conditioning program from BreakingMuscle.com. These methods are excellent exercises for rehab because they incorporate short bouts of exercise of 5-15 seconds duration followed by passive recovery for 55-45 seconds for an escalating number of rounds. These short duration demands on the heart give a strong signal to heal and improve function without overwhelming the heart with long, steady-pace, demands without rest. Longer bouts can lead to too little oxygen for too long to an already injured heart.
Later in your recovery, Keith Weber's kettlebell instructional videos might be a beneficial addition to your exercise program. He covers how to scale them up or down as needed, and he can be found on IG under KettlebellKeith. The quality of the videos an dKeith’s inspirational personality truly shine and I am sure you’ll love them as much as I do.
For endurance training, I'm fond of using assault bikes, bouncing on trampolines, skipping, and engaging in bag work. The key with long form, slower paded cardio is the Mafetone Method or 180-your age as a maximum heart rate.
The key takeaway is - to find something you enjoy! There is an incredible amount of benefit to your mental state in doing things you enjoy while getting a workout for your heart. There must be few things worse than doing something you dislike for its purported benefits when every second grates on you. In fact, I'd bet that reduces the benefit of the "thing" you are doing. Remember, the goal isn't to train like are preparing for the Special Forces but to rebuild your strength and endurance for your loved ones.
If you're like me, you might find it challenging to regain trust in your heart after experiencing a heart attack. Before my cardiac event, the thought of my heart failing had never crossed my mind, but post-heart attack, that fear lingered with me daily.
I’ll write about rebuilding faith in my heart in a future blog.
A study by the European Society of Cardiology has highlighted that engaging in regular physical activity, particularly exercise after a heart attack, can significantly reduce mortality risk. The research examined over 14,000 individuals and revealed that those who participated in moderate to high-intensity physical activities post-heart attack experienced lower mortality rates.
While people recognize the heart-protective effects of exercise, there's a common belief that more exercise is invariably better. Nonetheless, observational studies present evidence that the optimal health benefits exercise are reached at just 35 minutes of intense exercise per day or two hours of moderately intense exercise. Beyond this threshold, heart attack risks may increase, and your exercise may be causing more harm than good.
Intense exercise can exert a strain on the heart, leading to increased blood pressure and the release of troponins, which signal heart muscle damage. Moreover, such strenuous activity amplifies the production of free radicals, potentially causing cellular damage. Studies have shown that professional athletes face a heightened risk of atrial fibrillation, a precursor to strokes. Excessive intense exercise may also contribute to coronary artery calcification and elevate the risk of heart attacks.
To sum up, while a certain level of exercise is beneficial for heart health, going overboard with intense exercise can have detrimental effects on cardiovascular well-being. It's crucial to listen to your body, some days will naturally be more challenging or easier than others. Err on the side of caution, go slow but steady and your fitness will invariably improve.
The Mechanisms Behind Exercise-Induced Improvements
Engaging in exercise post-heart attack not only enhances exercise tolerance but also leads to several beneficial physiological changes. One such change is the increased nitric oxide production, which significantly improves circulation by dilating blood vessels. Additionally, exercise promotes the development of collateral blood vessels in the heart, ensuring blood flow is maintained even when the main blood vessel is seriously blocked.
There is a substantial body of evidence indicating that, with sufficient time and the right stimulus, the body can create a 'natural bypass' by building collateral blood vessels around blockages. This process is an alternative to surgical bypasses or the insertion of stents, and the appropriate amount and type of exercise play a crucial role in this recovery.
Exercise - A Natural Bypass?
How does natural revascularization work? Consider highways and increasing traffic volume: when more capacity is needed, highways are expanded. Similarly, when blood flow increases in coronary arteries, the endothelial cells lining these vessels detect the need and begin the process of transforming capillaries into fully functional collateral vessels. Exercise, such as running, bicycling, swimming, and resistance training, boosts blood flow and promotes the conversion from capillaries into collaterals. This natural revascularization is a process that everyone's body is capable of with the correct exercise regimen and enough time. Beyond interventional, surgical, and medical treatments for coronary artery disease, this collateral adaptation is a natural process that happens automatically with the right stimulus.
Key Points
As a pump, the heart muscle critically relies on the coronary arteries for an adequate blood supply.
The narrowing of the coronary arteries by deposits, known as plaques, can deprive the heart muscle of oxygen and nutrients, leading to chest pain, or angina.
A myocardial infarction, commonly known as a heart attack, occurs when a diseased coronary artery becomes completely obstructed. Consequently, the segment of the heart muscle that is normally nourished by this artery may suffer damage or die.
Following a myocardial infarction, there's a possibility that a certain mass of heart muscle may be irreversibly lost. The infarct size plays a crucial role in determining the quality of life and life expectancy, which can be significantly reduced.
Revascularization is associated with an improved blood supply to the heart, leading to fewer heart attacks, enhanced quality of life, and increased survival rates.
Questioning Medical Protocols
When it comes to medical protocols and treatment standards, I think it's important to consider how they are established and not leave your life blindly in the hands of others. These protocols often rely on terms like 'preponderance of the evidence' or 'medical consensus'. However, history has shown that medical science constantly evolves and proves itself wrong. These so-called 'gold standards' offer safety and expediency to the physician, and deviating from them presents significant liability risks if not properly justified.
In the past, practices like leeching and frontal lobotomies were considered the pinnacle of medical science, the gold standard of their day, but they have since been abandoned. My frustration lies with certain medications, particularly statins, and the overuse of stress tests, which I believe are not always justified by current medical understanding.
If you'd like to know more about my perspective on this topic, you can read my blog on statins, which is available on my website - here.
Personal Anecdote - for what it’s worth
Stress tests and Angioplasties
My personal experience with stress tests has not been positive. That doesn't mean that I am entirely against their use. However, I do believe the risks associated with stress tests, much like those with statins or the risk of death during angioplasty or an angiogram, are not as widely reported as they should be.
If you’ve read this far you know a stress test induced my 2nd heart attack. Given my research and personal experience, I have strong opinions about stress tests. I contend that their value is limited following an exercise-induced heart attack, particularly when unstable plaque or significant plaque build-up is present, and the patient shows symptoms during physical exertion. The critical question remains: what are we trying to discover at the risk of provoking another heart attack that inflicts further damage on the heart muscle?
Another concern I have pertains to how the standard stress test, known as the Bruce protocol, is administered. This approach divides the test into successive 3-minute stages, each requiring the patient to walk at an increased pace and on a steeper incline.
The rationale behind stress tests that escalate the speed and incline on a treadmill is questionable to me. Having undergone six tests within three years, including three stress echo-cardiograms, I wonder why both speed and incline are increased if the objective is to elevate the heart rate. A moderate pace at a steep incline is manageable for me, but running at such an incline is not, leading to an early termination of the test. A steady pace with a gradual incline increase seems more sensible for heart rate elevation. This strict adherence to protocols reveals a lack of critical thinking in health care.
My latest experience with this lack of critical thinking is the cardiology team asking for a stress echo-cardiogram, two days after the anesthesiologist asked me to stop taking my anti-clotting cardio-protective medications. So, even though the surgery will not elevate blood pressure or heart rate, it fact the opposite due to anesthesia, . The cardiologists have decided to pressure test my heart, because... you guessed it, protocol.
My second heart attack was triggered by a stress test conducted just 15 days after the first heart attack. Why? Because the cardiologist recommended it to clear me to return to work - it’s the protocol...
This adherence to protocol without logical justification demonstrates a complete lack of critical thinking.
Angioplasty, Angiogram, should you or shouldn’t you?
Some statistics to consider
According to a study by the American College of Cardiology, the mortality rate for coronary angioplasty procedures is rare. For every 100 procedures, only slightly more than 1 percent of patients die. It’s important to note that the risk of death during angioplasty is higher for older individuals and those with heart disease, several blocked arteries, or chronic kidney disease.
The risks associated with a coronary angiogram, an X-ray test that captures images of blood flow through your coronary arteries using contrast dye, are generally low. According to a study by MyHealth.Alberta.ca, fewer than 1 out of 100 people have a stroke, bleed heavily, or die soon after a coronary angiogram.
I survived three heart attacks, each treated with angioplasty. I was conscious and observed the procedure on the monitor above me while conversing with the surgeon and his team.
The System
In Mexico, where I had my heart attacks, they have a two-tier system. There is the public or free (is there such a thing?) system, and the pay-for-service model that follows the American healthcare model, you pay separately for the operating room, bed space, nursing care, every piece of gauze, all the medical tools, and the specialists and doctors. As you can imagine, this creates numerous incentives for medical care procedures, like a stress test. Reflect on this model if you're considering traveling for medical treatment. Despite this, I received excellent medical care in Mexico at a fraction of the cost compared to the US.
Considering the above, it's not that I am against angioplasties or angiograms, but rather that their risks are not negligible and the risk of avoiding them may be overstated. This is especially true when acknowledging the substantial evidence supporting natural heart revascularization or natural bypass, which can occur over time with the right conditions, even in cases with 80-90% arterial blockages.
The cost of diagnostic testing is a significant factor as it influences when doctors can utilize them to diagnose your condition. In Canada, provincial regulations strictly dictate what doctors can order, including the frequency and circumstances, making cost a primary consideration over the ideal diagnostic approach.
While considering costs is important, we should be cautious of a one-size-fits-all approach. As previously discussed, is the risk of heart attacks induced by stress tests justified by the cost savings, especially when non-invasive medical imaging, such as cIMT, fIMT, or ABI, offer safer alternatives? The risks of angiograms and stress tests are not inconsequential: 1:100 for angiograms and 1:10,000 for stress tests; what is the impact on you and your family if you cannot work? Have we considered the wider cost to the economy when there are 700,000 new heart attacks every year in the USA? How many will take multiple stress tests? And how many of them will suffer another heart attack? These numbers do not include all the stress tests conducted on people before they suffer their first heart attack.
Take Charge of Your Health
Bearing these concerns in mind, I urge readers to engage their doctors in conversations about the benefits and potential consequences of stress tests. Remember, we are the ones who face the direct impact of the medical advice we heed. Engaging in open and informed dialogues with healthcare professionals is crucial to making the best decisions for our health.
The prevailing belief among most physicians is that the heart lacks the regenerative capabilities of organs like the liver or kidneys. Yet, current research is delving into the possibilities of heart regeneration and seeking methods to hasten and initiate this process, with STEM cells, hypoxia, and Shockwave therapy being three promising avenues.
STEM cells hold the promise of morphing into heart muscle cells and contributing to heart tissue regeneration. Hypoxia, the strategy of oxygen deprivation to the heart, may stimulate the regeneration of heart tissue. Shockwave therapy, leveraging the novel use of lithotripsy technology, employs high-frequency focused ultrasonic waves. Intravascular lithotripsy (IVL) is being researched for its ability to shatter arterial calcium deposits, while Cardiac Shockwave Therapy (CSWT) is applied to the heart muscle to encourage revascularization and enhance ventricular remodeling following an acute myocardial infarction.
These research pathways are illuminating the future of heart regeneration and have the potential to transform the practice of cardiology.
The Bottom Line
Exercise plays a pivotal role in recovery and rehabilitation. Ensure you include endurance and strength training, and critically, remember - More is Not Better, Better is Better.
As someone who has survived a heart attack, it's imperative to actively participate in your recovery plan, advocate for your specific needs, and learn about the potential benefits of various exercises post-heart attack. Your path to recovery may be daunting, but with the appropriate strategy and a resilient mindset, you can markedly enhance your heart's health and performance.
My focus, and what I believe should be your focus, is not to simply extend lifespan but rather healthspan – the desire is not merely to add years to life, but to ensure those years are lived with quality and independence, avoiding scenarios where one's later years are spent with diminished autonomy.
Disclaimer: It is important to note that the information provided in this article is not intended as medical advice. It is always recommended to consult with a healthcare professional before making any decisions regarding medication or treatment options.
healthspan
noun: The length of time in one's life where one is in optimal health.
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