February 17th. 2024
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February is American Heart Month so in honor of this important event I wanted to talk about ways to optimize your heart health with physical therapy and general health and wellness. Why does this matter? According to the Center for disease control and prevention (CDC) heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. So basically it impacts almost every single person either directly or indirectly. A scary fact is that one person dies from cardiovascular disease every 33 seconds and someone has a heart attack every 40 seconds! Even scarier is that 1 in 5 heart attacks are silent meaning they have a heart attack and the damage is done but are completely unaware of it.
What is cardiovascular disease (CVD)? It includes disorders of the heart and blood vessels such as heart attacks, strokes, pulmonary embolism (PE), and deep vein thrombosis (DVT) to name a few. The biggest risk factors for developing CVD are having high blood pressure, high cholesterol, smoking, diabetes, obesity, unhealthy diet, physical inactivity, and excessive alcohol use. Many of these risk factors are considered modifiable which means that you can control for the most part if you have the risk factor or not. Now some of your risks related to high blood pressure, high cholesterol, and diabetes can be connected to your genetics but even so you can still make a significant impact on your risk of CVD which we will discuss below.
So without further ado let’s dive into the 7 strategies for optimizing your heart health!
Learn your family history
One of the most important pieces of advice I give when talking about anything related to health is to know your family history! So many medical conditions can have a genetic component and knowing this risk can help with early detection or even prevention of developing medical issues. Specific to heart health, it is important to know what your family history is related to CVD and at what age they occurred. If one or both of your parents had premature CVD your risk of developing CVD increases 60-75%. Premature means your father was less than 55 years old and/or your mother was less than 65 years old when they were diagnosed with CVD. Even if your sibling has CVD you have about a 40% increased risk!
My recommendation is to create a family medical history form or chart with what relative had what condition and at what age they were diagnosed. If a family member has passed away, record when they passed and if it was caused by any specific medical conditions. There are apps now that can help you create this and share them with family members which is awesome but a good old spreadsheet will do.
If you do find out that you have a family history of CVD, especially if it was premature, you will want to let your medical providers know. This will help them properly screen you and catch any diseases early. If you do not know your family history for whatever reason, it might be beneficial to do further testing with your medical providers to check for genetic links to certain diseases.
Move more, sit less
Being physically active has endless benefits for every single organ of the body. Most importantly, exercise helps prevent and reverse high blood pressure and type 2 diabetes. It can even lower your blood cholesterol, help with stress management, control weight or aid in weight loss, reduce depression and anxiety, and build strong muscles and bones!
Unfortunately, less than 25% of adults over the age of 18 met the physical activity guidelines in the US. That means well over half of the US population is physically inactive! We already know that being physically inactive is a major risk factor for CVD as well as a plethora of other health conditions and it is 100% modifiable. It does not mean that you have to exercise at a super high intensity every day of the week. Even starting with a small walk 3 times a week can make a huge difference.
So what is the recommended amount of exercise? Many health agencies agree that in order to get substantial health benefits from physical activity, adults should aim t do at least 150-300 minutes a week of moderate-intensity aerobic exercise, 75-150 minutes a week of -intensity aerobic exercise, or a combination of the two. Adults should also do moderate-intensity muscle strengthening exercises involving all major muscle groups at least 2 days a week. The exercise minutes can be broken up into whatever timeframe you want, however, I do recommend trying to do at least 20 minutes at a time in order to get the full cardiovascular benefits. How do you gauge the intensity of your exercise? Let me break it down for you.
If you can talk or sing without issue, you're exercising at a low-intensity.
If you can comfortably talk but not sing, you're exercising at a moderate-intensity.
If you cannot say more than a few words without gasping for air, you're exercising at a vigorous-intensity.
If you are well below that recommendation level you should see a physical therapist. Not only will a PT help you start exercising safely but we will also help screen you for injuries, address any issues that arise, and progress you safely.
Eat heart healthy
This one is a no-brainer when it comes to CVD risk and heart health. It has been well known for many decades that the Standard American Diet (SAD) is just that, sad. Most Americans consume excessive calories, saturated fats, added sugars, and sodium as well as severely under consume nutrient rich whole foods. Simply put, we eat too much fast and highly processed foods and not enough whole plant based foods. And don’t be fooled by marketing strategies that label their foods “heart healthy” when there is no proof (cough… Cheerios…cough). Studies have shown that the SAD/Western dietary patterns lead to excessive production of proinflammatory cytokines with a reduced creation of anti-inflammatory cytokines. Basically, if you eat the typical SAD your body is not only not producing anti-inflammatory agents but is actively creating MORE INFLAMMATION! And if you know anything about inflammation you know it is not something you want in your body.
Getting into the nitty gritty of a well balanced diet is far too big of a topic and outside the scope of this blog. But generally speaking you should aim to eat mostly whole foods (i.e. raw or cooked fruits and vegetables), whole grains, natural proteins (i.e. animal or soy products), and healthy fats. You should also decrease your consumption of sugary beverages such as sodas (even if they are diet) and focus more on drinking water. The general guideline for water intake is roughly half your body weight in ounces of water per day. For example, a 150 pound person should aim to drink 75oz of water a day.
To learn more about a healthy diet please read the Dietary Guidelines for Americans. I also highly recommend seeing a nutritionist, especially if you need a complete overhaul of your diet or are not sure if you are eating the right foods.
Get quality sleep
Getting insufficient or irregular sleep can negatively impact your diet, stress levels, and other lifestyle factors which then in turn can increase your risk of obesity, high blood pressure and diabetes. Part of the reason for this is that when you sleep your body is healing and your nervous system settles. Normally during sleep your parasympathetic system (your rest and digest system) takes over and your body can focus on breaking down nutrients and regenerating cells. If you are sleep deprived, your sympathetic nervous system (your fight or flight response) stays active which naturally raises blood pressure, heart rate and cortisol (stress hormone), and shunts blood from your organs to your muscles. So instead of healing tissues and soaking up nutrients your body is stuck in fear. In simple terms, instead of having a spa day to relax and calm your nerves you are in a fight club.
What is the recommended amount of sleep? Most experts agree that adults should aim for between 7 to 9 hours of sleep a night. Interestingly enough, some research says that frequently getting more than 10 hours of sleep can also increase your risk of CVD so there really is a “sweet spot” to sleep. Now getting an occasional night of less sleep won’t be the end of the world but do your best to get most nights with 7-9 hours. If you are a new parent with babies to take care of this can be very challenging so see if you can get a game plan with your family or support system to allow you to get sleep. A great option if you don’t have a support system is to get a postpartum doula! They can usually come stay with the baby or babies at night to allow you to sleep.
Manage stress
Stress is a normal part of life and cannot be completely eliminated. In some instances it is a good thing and it has an important evolutionary role. If we didn’t experience stress, our ancestors would have all been eaten by the saber tooth tigers and we wouldn’t be here today. It is stress and its reaction on the body that allows the mother to lift the car off of her child and the person walking down the street to ward off an attack. So even though it is labeled as “bad”, stress does play an important role for everyone. However, in today’s day and age we tend to live in a more chronic stress state; instead of stress coming and going and being specific to the circumstance, it is more constant and not in proportion to the events happening. When we are stressed our sympathetic nervous system kicks in (remember from above the fight or flight response) which in turn then releases cortisol and raises blood pressure among other reactions. Research suggests that high levels of cortisol from long-term stress can increase blood pressure, cholesterol, and blood sugar. These things can cause damage to the walls of your arteries and promote a buildup of plaque which can lead to strokes and blockages.
Managing stress can look different from person to person but ultimately comes down to learning strategies that improve your ability to cope with difficult events. There are some short term strategies and long term strategies. If you need to decrease your stress quickly, you can focus on deep breathing, removing yourself from the situation, getting sunlight, or taking a walk or exercising. Long term stress management usually involves more work on your part but ultimately has better success. This includes therapy/counseling, getting quality sleep, eating a healthy diet, limiting alcohol, and/or meditation.
You can look forward to more information coming out in future blogs about specific stress management strategies you can do at home. Subscribe to my blog to get access once it drops!
Maintain regular checkups
We discussed above that having a family history can increase your risks of getting CVD but to having a family history does not mean you won't get it. Remember, there are so many other modifiable risk factors that don't revolve around family history. So no matter what, you should maintain regular checkups and monitor your health. Even if you are feeling well and are not having any issues you should always get your annual physical and do normal tests such as blood work with your primary care doctor every year. This can help catch any issues early and treat medical issues that can lead to CVD down the line.
However, if you are going months or even years between doctor visits you won't necessarily know how your blood pressure and heart rate is doing (risk factors for CVD). For this reason I recommend everyone get a home blood pressure cuff to track their blood pressure on their own. They are relatively inexpensive and easy to find online or in drug stores. If you have an HSA or FSA you can use these accounts to purchase one. Once you have a unit, you want to get into the habit of checking it regularly. If you have risk factors for CVD I recommend using it daily or several times a week. If you don’t have risk factors and are otherwise healthy I recommend checking your blood pressure every other week. In either case, you want to make sure to take your blood pressure at the same time of day each time, usually in the morning before activity, and write down your numbers to show your provider (or put it in a health app on your phone). When you take your pressure make sure to follow the instructions on the machine closely. If you take a measurement that is high (see chart below), wait an hour and retake it. Don’t get worried or freaked out if your reading is elevated. Remember that one high reading does not mean that you have an issue as stress, hydration, activity level, lack of sleep, etc can cause changes in readings. However, if you get a very high reading much higher than 130/90 AND you have symptoms of shortness of breath, vision changes, difficulty breathing or speaking, chest/arm pain, confusion, dizziness, etc call 911 IMMEDIATELY.
Normal BP: 120/80
Elevated BP: 120-129/80-89
High BP: 130+/90+
I strongly recommend also having an excellent physical therapist that you can see annually as well. By seeing a PT each year, we can track how your musculoskeletal health is changing over time, monitor your vitals, and make changes to your fitness routine to promote health and wellness. Even better if your physical therapist is also a pelvic health PT because we can check your pelvic floor strength and coordination as well as bowel and bladder health. You see a dentist at least once a year to check your teeth so why not see a PT once a year to check your muscles and joints?
Take your medications as prescribed
Last piece of advice is to always take your medications as prescribed by your doctor. Your medications for high blood pressure, high cholesterol, and the like are extremely important to take regularly because it is helping decrease your risk of having a stroke, heart attack, PE or DVT. And just because you are taking medications to control your blood pressure or cholesterol does not mean that the disease process is gone or not a problem. It is both funny and shocking to me when I am talking to a patient and ask if they have any medical conditions and they say “no” but when I ask what medications they are taking they have a laundry list of medications related to CVD risks. PSA: YOU STILL HAVE A MEDICAL CONDITION EVEN IF IT IS CONTROLLED WITH MEDICATION! You are still at high risk and need to take actions to better control your modifiable risk factors. The most wonderful thing is that you could potentially remove those risk factors and reverse the medical conditions by making strategic lifestyle changes. I have seen many people be able to reverse their diabetes or high blood pressure and come off of those medications by improving their diet and physical activity.
Here are a few more tips I have related to medications that I feel I cannot leave out because I see these issues so often:
If you are taking medication and it does not seem to be working or is having negative side effects please discuss this with your medical providers. DO NOT stop taking medications without getting clearance and guidance from your doctor as stopping some medications cold turkey can be very dangerous.
Timing of medication ingestion is vital so try to take your medications at the same time each day. Using a reminder on your phone or a health app can be very helpful to stay on track and show if you missed a dose.
Remember that all drugs have interactions with other drugs; some interactions are not a problem, some are very serious. This even goes for over the counter medications and supplements such as vitamins and tylenol. Always check for drug interactions prior to taking something new. Many health apps can check for drug interactions for you or you can ask your pharmacist.
Ok I have one more thing I have to say about supplements. Supplements (i.e. vitamins, minerals, protein powders, health drinks, etc) are NOT regulated by the Food and Drug Administration (FDA). This means that there is literally no one overseeing these manufacturers to confirm that what they say is in the supplement is actually in the supplement. So if a bottle says there is 100mg or 100% daily value of an ingredient it may be correct or it may be not present at all or there can be 3x that amount. This is very scary to me and honestly can be extremely dangerous. Again, just because something is labeled as “natural” and “healthy” does not mean it is. I personally only use supplements that have a stamp from USP which is an independent agency that tests for purity and accuracy.
Whew! That was a lot of information! I tried to keep it as brief as possible but this topic is so important I wanted to make sure this blog had all the information you needed to make the best decisions. As always, like, subscribe and leave a comment below to tell me what you think and if you have any other advice to share.
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