Q: I don't have time to include a cool-down, is it necessary?

Short answer, yes. Progressive cool downs are a hugely important part of a cardiac rehabilitation exercise class. It helps to activate the parasympathetic system and to slowly reduce the amount of circulating catecholamines (Adrenaline and noradrenaline) in your system. This will encourage a redistribution of blood to your vital organs from your well worked skeletal muscles. It is important to keep your lower body moving at this stage of a class as it acts as a pump helping to push blood back up from your lower body. A good 10 minute cool down helps to prevent: -feelings of dizziness -hypo-tension -onset of any irregularities in your heart rate. [1]. This period of a class is also a very good opportunity to take some minutes to relax. Be conscious that as we get older our heart rates take slightly longer to return to a resting state too. It is not a bad idea to continue movement in your feet and lower legs for a small duration post session especially if you are still feeling warm or breathing heavier than normal at rest. Finally, acknowledge that you have just completed a challenging work out, feel good. Reference: 1. British Association for Cardiovascular Prevention and Rehabilitation (BACPR) (2016) Exercise Programming and Prescription, Fourth Edition, London

Question 1

What type of exercise equipment is required for a good home-workout?

Accepted Answer

A good exercise session can be achieved at home without any equipment but a few simple things can really enhance a circuit and make it more fun and enjoyable. Without big investment, try adding things like...
-Chairs
-Cans & bottles as weights
-Balls, tennis balls etc...
-Stairs

Some additional kit at a small expense: 
-Dumbbells
-Resistance bands
   - Looped
   -Standard
   -Exercise bands 
-Medicine balls
-Bosu balls
-Balancing boards/cushions
(*See links on website for reliable kit)

Some more expensive (but worthwhile) investments that may interest some:
-Static bike
-X-trainer
-Rower

Remember, the aim of our exercise classes is to attain 30+ minutes of moderate exertion, these are by nature large rhythmic movements that encourage the heart rate up towards safe and effective levels and for the most part are full-body movements.

You can absolutely manage an effective session without a large investment and if you visit the exercise tab on the site there are some examples of 50-60 minute circuits that do just this!

ATBGO

Question 2

What should I consider before each exercise class?

Accepted Answer

- Is the room well ventilated? Is it cool?
- Temperatures should be between 18-23 degrees... this is not always possible so consider reducing difficulty / water breaks. 
- Clear a space either side of you (no clutter)
- Have you taken all your medications in the past 24hrs?
- Have you got your Inhalers (reliever sprays/GTNs nearby if prescribed?
-Is there a telephone nearby or to hand, or is there someone with you?
- Are you well? Have you had diarrhoea , had a temperature or have you been sick in the past 24hrs? Skip a moderate-strenuous exercise bout until you feel better.
- Are you taking anti-biotics (abx)? If it is for a current infection i.e. UTI or lung infection (oral medications) refrain from exercise until you finish your course. In the mean-time keep sedentary time under control just don't strain yourself.
-Ointments, topical creams / long term small dose abx potentially ok to exercise, mention to instructor.
-If you are diabetic (taking medication aside from Metformin, such as insulin or gliclazide?), if so, have you checked you Blood Glucose (BG)? When exercising you should have some sugar to hand, a biscuit or a sweet drink in case you feel your blood glucose is dropping and you are experiencing a hypo. If you feel your Blood Glucose is not stable this should be raised to your GP and your exercise instructor should know.
-If you have by chance taken your Blood Pressure (BP) before a class (maybe because you have been poorly of late) you should not exercise if it shows either 180+ / 100+ (Systolic(top number) / Diastolic(bottom number)) as well as a Heart Rate >100bpm. Let your GP or your exercise instructor know.

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Question 3

What should I expect in my first class?

Accepted Answer

If you have attended and completed an 8 week program provided by the NHS, you will recognise this as something very similar. Self pacing is key. In your first session you should work well within your ability and get comfortable in a new environment.
​
For those who have been referred by a GP I understand that the first class may bring with it some anxiety, that is completely understandable. Rest assured everyone is very friendly and we're all here to work within our limits. Please remember that everyone who attends Phase IV Cardiac Rehabilitation classes have experienced similar heart related set backs too.

The structure of the classes are designed for our safety whilst allowing us to push ourselves up to an appropriate level. Approach slowly and gauge how you feel, if ever unsure return to a slow march on the spot and join in when you feel comfortable.
​
What are the signs that I am doing too much?
​
-Light headedness and dizzy
-Difficulty breathing
-Any chest pain
[1]
​
I ask that everyone brings with them to class, relevant medications such as GTN sprays/tablets and inhalers for asthma or COPD if they have them. Be assured that your GP or Phase III clinician will have only signed you off to partake in an exercise class if he or she felt you were ready and suitable. Part of my role too is to risk stratify, so if there are any issues we can discuss beforehand. Your safety and comfort is the priority.
​
Please get in touch if you do have any concerns.
​
Reference:
1. The British Heart Foundation (BHF), Heart Matters Magazine, Summer Edition, 2019

Question 4

I want to increase my activity post surgery. Where should I start?

Accepted Answer

Firstly, you do not have to head straight back to your local health club or gym to improve your fitness. After an event and whilst in recovery we can become de-conditioned. It is likely that levels we were managing before will be more challenging now. Be patient with yourself, new medications and procedures may mean it is necessary to slightly alter your approach to activity. Remember the government advice is generally 150 minutes of "moderate" activity a week [1]. Do not feel obliged to reach at least 10-20 minute bouts, any amount will be beneficial [1], especially at the start of your rehabilitation.

Anything from:
-Walking
-Shopping
-Cleaning
-Cooking
-Gardening
[2]
​
All activities tend to have a MET value associated with them, this can be a reference to you if you have just "graduated" from a Phase III program. Check your discharge letter you may see this value described (MET). It can help guide you towards the levels of exertion that may be appropriate for you.
​
Of course if you supplement your week with an hours cardiac rehabilitation class, this will go some way to hitting those guidelines. 
​
Exercise has a dose response effect, generally the more you do (so long as you are not over exerting) the better it is for your health and fitness.[1]
​
References:
1. Department of Health & Social Care, (2019). UK Chief Medical Officers' Physical Activity Guidelines.
​
2. British Heart Foundation Heart Matters, BHF, Summer Addition, 2019

Question 5

Is stretching really all that important?

Accepted Answer

Stretches should be introduced to your weekly regime at least twice but ideally most days.

As we get older we are all susceptible to adaptive shortening of the muscles which leads to a loss in our ranges of motion. This in turn can lead to discomfort and injury.

If you have had a CABG or Valve replacement it is important to stretch out your pectoral muscles (chest). People who have had these procedures are prone to role their shoulders slightly leading to a compromised posture [1].
​
The advice on stretching from the British Association for Cardiovascular Prevention and Rehabilitation (BACPR) is:
- 2-7 days a week
- Hold for 15-30 seconds x 2-4 reps
- Static stretching
​
Always be slightly warmed before statically stretching otherwise you run the risk of pulling a muscle. Don't just save these stretches for an exercise class, they can be done all days. There is a vast array of stretches we can complete, some of which are available on the site. 
​
There is some suggestion that some light stretches before bed time can aide sleeping which is always welcome, maybe a new 5 minute routine before your z's is something to consider?
​
Lastly, try not to hold your breath when holding a stretch - easily done, breath!
​
Reference:
1. British Association for Cardiovascular Prevention and Rehabilitation (BACPR) (2016) Exercise Programming and Prescription, Fourth Edition, London

Question 6

How do these classes differ from a standard fitness class at the gym?

Accepted Answer

I am a fully certified Cardiac Rehabilitation Instructor. Although I work as a fitness instructor too I have specialised in the approach to exercise suitable for people in secondary prevention. That is, anyone who has been diagnosed with Cardiovascular Disease (CVD). There are fundamental differences in the general approach for this demographic which aim to get the biggest gains from an exercise class coupled with the lowest risk.
​
Despite this structure we can keep classes interesting by alternating exercises within the structure. I make a point of including some good static stretches, balance exercises, and resistance training during a class. This way everyone is well on their way to achieving weekly targets in each area.

Any questions or concerns, get in touch and I will be happy to discuss.

Question 7

Do I really need to take this long warming up for exercise?

Accepted Answer

Yes. It's even more important for those in cardiac rehab!

Before a structured bout of exercise I recommend that you spend 15 - 20 minutes working through a progressive warm up.

This should include:
-mobility activities 
-pulse raising
- static/slow full range moving stretches.
+Movement on all planes of motion, gently testing balance and co-ordination
​
In the warm up we aim to perfuse our working muscles, heart and lungs with blood, warm the skeletal muscles and increase their flexibility.

A good warm up achieves this by:
-Dilation of the blood vessels
-Increasing noradrenaline
-Increase cardiac output and aortic pressure helping perfuse the cardiac muscle. [1].
​
All of these mecahnisms reduce the chances of the onset of angina and ischaemia. [1].
​
A good warm up and cool down are two of the fundamental approaches to cardiac rehabilitation that help to keep the sessions safe and enjoyable. Don't skip them out!

References:
1. British Association for Cardiovascular Prevention and Rehabilitation (BACPR) (2016) Exercise Programming and Prescription, Fourth Edition, London

Question 8

I don't have time to include a cool-down, is it necessary?

Accepted Answer

Short answer, yes. 
​
Progressive cool downs are a hugely important part of a cardiac rehabilitation exercise class.
It helps to activate the parasympathetic system and to slowly reduce the amount of circulating catecholamines (Adrenaline and noradrenaline) in your system. This will encourage a redistribution of blood to your vital organs from your well worked skeletal muscles.
​
It is important to keep your lower body moving at this stage of a class as it acts as a pump helping to push blood back up from your lower body.

A good 10 minute cool down helps to prevent:
-feelings of dizziness
-hypo-tension
-onset of any irregularities in your heart rate.
[1].
​
This period of a class is also a very good opportunity to take some minutes to relax. Be conscious that as we get older our heart rates take slightly longer to return to a resting state too. It is not a bad idea to continue movement in your feet and lower legs for a small duration post session especially if you are still feeling warm or breathing heavier than normal at rest.
​
Finally, acknowledge that you have just completed a challenging work out, feel good. 
​
Reference:
1. British Association for Cardiovascular Prevention and Rehabilitation (BACPR) (2016) Exercise Programming and Prescription, Fourth Edition, London

Question 9

Resistance exercises. What, how, and why?

Accepted Answer

Resistance training is a key part of our classes. We should be targeting at least two bouts per week alongside our 3+cardio workouts a week.
​
These sessions would help to:
- Increase lean muscle, associated with better health.
- Increase bone density
- Improve memory, reaction time, and proprioception.
- Improve the regulation of blood glucose.
- Increase Basal Metabolic Rate. A big win for weight loss.
[1]
​
"The value to older adults of activities which improve strength, balance, and flexibility cannot be overstated." [1]
​
"Older adults should maintain or improve their physical function by undertaking activities aimed at improving or maintaining muscle strength, balance, and flexibility on at least two days a week. These could be combined with sessions involving moderate aerobic activity or could be additional sessions aimed specifically at these components of fitness [1].

Resistance exercises can be completed in a smaller time frame if you are limited for time, just set aside 5 minutes with the intention to complete at least two sets. See the link below to find further advise specifically on resistance training and beyond that, gym training from the ACPICR
​
https://www.acpicr.com/publications/patient-leaflets/(https://www.acpicr.com/publications/patient-leaflets/)
(Click patient leaflets to find the appropriate information sheet for you!)
​
 "Active Recovery" (AR) is slightly different to resistance exercise, mainly due to demand or difficulty. The "resistance" exercises we do in the cardio classes are with very light weights and are of little benefit to our strength - more endurance and mobility. When completing "resistance" training - these same exercises can be repeated, for example a bicep curl but the weight can be increased to a point that you can still lift at least 10 repetitions and you can maintain good form and steady breathing. Always keep feet moving even when just doing a short resistance circuit, same mechanism at work.

Reference:
1. Department of Health and Social Work, (2019). UK Chief Medical Officers' Physical Activity Guidelines.

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Question 10

What's the deal with 150 minutes?

Accepted Answer

Maybe you have heard that you should target 150 minutes of moderate activity a week by now.
​
What are the benefits?
"In general, the more time spent being physically active, the greater the health benefits" [1].
​
Physical Inactivity is a modifiable risk factor to CHD. Training favourably alters most of the modifiable risk factors [2].
-Blood pressure is reduced
-Total cholesterol is reduced and a better balance between HDLs and LDLs  (this is further enhanced with weight loss and a reduction in body fat %)
-Glucose metabolism is improved with an increased sensitivity to insulin.
- Reduction in platelet "stickiness"
- Improved Basal Metabolic Rate (BMR) with an increase in lean muscle [2].
--
For those that attend phase III or phase IV classes or have in the past you'll be familiar with the 15:25-35:10 minutes split between warm-up:conditioning phase:cool-down. The conditioning phase makes up part of the 150 minutes per week that is suggested. This approach should be adopted where possible into all modalities of aerobic structured exercise, including:
-Walking
-Jogging
-Cycling
-Rowing
-X-training 
-Swimming (Build up your fitness and confidence before returning to swimming.
etc... So long as all can be achieved at a mostly "moderate", "conversational" pace
​
*Cycling and Swimming - if you are in the first 12 weeks of recovery from a bypass or valve surgery we recommend holding off on a return to these two activities due to potential inferction to the wound and a chance fall if on your outdoor bike which could upset the healing process.
​
If you cannot achieve this level - not to despair. Simply reducing sedentary time or breaking up rest periods with small tasks can go some way to reducing inactivity as a risk factor for you...
​
"Prolonged sitting is harmful even in people who acheive the recommended levels of Moderate to Vigorous Physical Activity (MVPA)" [1]

References:
1. Department of Health and Social Work, (2019). UK Chief Medical Officers' Physical Activity Guidelines.
2. British Association for Cardiovascular Prevention and Rehabilitation (BACPR) (2016) Risk Factors for Coronary Heart Disease, Fourth Edition, London

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Question 11

Sometimes I feel blue and down in the dumps...help!

Accepted Answer

Exercise can have a big positive effect on our mental health. Any amount of exercise can bring benefits to our body and mind. Don't feel like you have to achieve 150 minutes, at least not at first. Something as simple as a nice walk in the fresh air can lift the spirits too. Beyond exercise, mixing and socialising with friends & family also has a great effect on us, we are a social animal after all, even if we sometimes don't feel like it!

If you are feeling a little blue and lost for ideas, there is support so please reach out and don't deal with it alone. But please try that walk or run or any other physical activity for 20-30 minutes when you're feeling that way - It can have a surprising effect.
​
https://www.cpft.nhs.uk/services/pws/psychological-wellbeing-service.htm(https://www.cpft.nhs.uk/services/pws/psychological-wellbeing-service.htm)

Follow this link for more information. If you have any questions or doubts please get in touch and we can discuss further.
​
Below are more links and numbers available for support listed from Heart Matters Magazine, British Heart Foundation.
​
Online community -
healthunlocked.com/bhf
​
Local Heart Support Group -
bhf.org.uk/heartsupport
(0300 330 3300)
​
Finally, a related article.
bhf.org.uk/getsupport
​
Aside from physical activity, something I have found useful is putting my phone/tablet out of reach for a period in the day - we are now inundated with social media and even work emails when we needn't be. Cook, read a book, call a friend, or that walk - all I would suggest are better than scrolling endlessly into the social media abyss...

Question 12

HIIT training. So I can or I can't do it?

Accepted Answer

High Intensity Interval Training (HIIT) training is something that is not really approached in a mixed circuits class for Cardiac Rehabilitation.
​
High Intensity Interval Training has been shown to have some positive effects on the health status of some cardiac individuals [1].

I do not currently run this type of group exercise class for individuals in secondary prevention. In years to come it may be something that is prescribed for particular patients, but until there is more literature and proof that it is safe, my classes will not include this method of training as a standard.
​
However, on a one to one basis it is something to consider and would need to be very individualised structured training. For those people who are frequently active, attend gyms and go to spin classes or belong to bike clubs and cycle hours on end up and down hills it may be more appropriate. Using heart rate zones can be useful to see where your training sits and how you're feeling or "perceiving" the exertions.
​
If this is something that you have a big interest in I suggest that you contact your primary care cardiac rehabilitation or GP before starting and ask your suitability to it. Generally moderate exertion is what health professionals are happy to "sign off" with as it relates to a risk / reward scale, why would some push excessively, potentially increasing the risk for only potentially slightly higher rewards? It comes down to the person, their desires and motivations - the choice is ultimately yours.

Be aware that many HIIT classes run by gyms or on-line sometimes skip the extended 15 minute warm up, and 10 minute cool down. I would say if you are going to push to this level always try to give yourself some time for these two fundamental parts of a planned workout, I would not compromise here. Always self pace and if you have a GTN spray you should have it with you as a standard when exercising.
​
References:
​
1. British Association for Cardiovascular Prevention and Rehabilitation (BACPR) (2016) Exercise Programming and Prescription, Fourth Edition, London

ATBGO

Question 13

I have had a heart attack (MI). 
Where can I find travel insurance options that specialize in offering travel insurance to those with established Coronary Heart Disease (CHD) or Acute Coronary Syndrome (ACS) in the UK?

Accepted Answer

When it comes to traveling after a heart attack or with established Coronary Heart Disease or Acute Coronary Syndrome, it is important to obtain travel insurance that provides adequate coverage. While some insurance companies may be hesitant to provide coverage, there are options available that specialize in offering travel insurance to those with heart conditions.  One option is to use a comparison website such as Medical Travel Compared or AllClear Travel Insurance. These websites allow you to compare policies from multiple insurance providers, with the option to filter results by medical condition.

Another option is to directly contact insurance providers that specialize in covering pre-existing medical conditions. Some companies that offer travel insurance for those with heart conditions include:

-Staysure Travel Insurance
-Saga Travel Insurance
-Goodtogoinsurance.com
-Freedom Travel Insurance
-Avanti Travel Insurance
InsureandGo

*It is important to disclose all medical conditions and medications to the insurance provider when obtaining a quote, as failure to do so may invalidate the policy. Additionally, it is recommended to speak with your healthcare provider before traveling to ensure that it is safe to do so.

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Question 14

If I have had a heart attack followed with a stent procedure, what is the pathway through rehabilitation over the coming year?

Accepted Answer

The rehabilitation pathway for patients who have had a heart attack followed by a stent procedure typically involves three steps:

Step 1: Inpatient Rehabilitation 
This phase involves rehabilitation during hospitalization following a heart attack and stent procedure. During this phase, patients will undergo various tests and scans to assess their current condition and identify any risk factors. Exercise will be prescribed according to the patient's individual needs and capabilities.

Step 2: Outpatient (Phase III) Rehabilitation 
This phase starts after discharge from the hospital and typically lasts for 6-8 weeks. During this phase, patients attend outpatient rehabilitation sessions where they receive education, counseling, and supervised exercise. The exercise program is designed to improve cardiovascular fitness, strength, and endurance.

Step 3: Long term (Phase IV) Rehabilitation (This is generally a paid for service post-discharge)
This phase is optional and lasts as long as the patient desires. It involves ongoing exercise and support to help you maintain a healthy lifestyle and prevent future heart problems.  Your exercise prescription will be tailored to your individual needs and abilities, and may include aerobic exercise, strength training, and stretching. You will also receive guidance on nutrition, stress management, and other lifestyle factors.  Overall, cardiac rehabilitation is a comprehensive program aimed at improving your physical and emotional well-being after a heart attack and stent procedure. Our team at And The Beat Goes On is here to support you every step of the way.
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Question 15

What are the typical pacemaker codes and what do they stand for?

Accepted Answer

There are three main types of pacemaker codes: single-chamber pacemakers (SC), dual-chamber pacemakers (DC), and biventricular pacemakers (BIV). Each code refers to the type of pacemaker and the number of chambers that it operates in.

Single-chamber pacemakers (SC) are designed to maintain the rhythm of the heart's upper chamber, or atrium. They are indicated for patients who have a normal functioning lower chamber, or ventricle.

Dual-chamber pacemakers (DC) maintain the rhythm of both the upper and lower chambers of the heart. They are used in patients who have a slow or irregular heartbeat in both chambers.

Biventricular pacemakers (BIV) are indicated for patients who have heart failure with a slow or irregular heartbeat in both chambers. These pacemakers work to coordinate the contractions of both ventricles to improve the heart's pumping function.
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Question 16

I am 90 years old – am I too old for exercise / rehabilitation?

Accepted Answer

Age is not a factor in determining eligibility for cardiac rehabilitation. In fact, cardiac rehabilitation can be beneficial for older adults who have experienced a heart event or have heart disease. A program is tailored to meet the needs of each individual, regardless of age. Before starting cardiac rehabilitation, you will undergo a thorough evaluation by a team of healthcare professionals to determine if it is safe for you to participate. We will work with you to create a personalized exercise plan that is appropriate for your level of fitness and health status. Our program also includes education on heart-healthy lifestyle changes, stress management, and nutrition. Don't let age be a barrier to improving your heart health. 
If you have recently finished a phase III hospital program and wish to continue on your rehabilitation journey please contact us today to learn more about our phase IV cardiac rehabilitation programs and one to one options.

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Question 17

What is the risk reduction of a secondary heart event when adding structured exercise to your lifestyle post heart attack?

Accepted Answer

According to research, adding structured exercise to your lifestyle post heart attack can lower the risk of a secondary heart event by up to 35%.

Exercise can help improve heart function, lower blood pressure, reduce cholesterol levels, and improve overall cardiovascular health. Adding regular exercise to your lifestyle is an important step in reducing your risk of future heart events and improving your overall health and well-being.

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Question 18

How is Heart Failure diagnosed?

Accepted Answer

Heart failure is usually diagnosed through a combination of physical examination, medical history, and diagnostic tests. Some of the common diagnostic tests for heart failure include:

- Echocardiogram: This test uses sound waves to create an image of the heart, which can help doctors assess its size, shape, and function.

- Electrocardiogram (ECG): This test measures the electrical activity of the heart and can help doctors detect any abnormalities.

- Stress test: This test involves exercising on a treadmill or stationary bike while being monitored with an ECG, and can help doctors assess how well the heart is functioning under stress.

- Blood tests: These tests can help doctors assess the levels of certain substances in the blood that can indicate heart failure, such as brain natriuretic peptide (BNP).

If you are experiencing symptoms of heart failure, such as shortness of breath, fatigue, or swelling in the legs, it is important to talk to your doctor as soon as possible. Early diagnosis and treatment can improve your chances of managing the condition and improving your quality of life.

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Question 19

What are the modifiable risk factors associated with coronary heart disease?

Accepted Answer

There are several modifiable risk factors associated with coronary heart disease, including:

1. High blood pressure

2. High cholesterol levels

3. Smoking

4. Physical inactivity

5. Obesity or overweight

6. Diabetes

*Stress (indirect risk factor)

Modifiable means we can do something about it, what on the list above is the low hanging fruit for you?

Hypertensive? 
Exercise, reduce alcohol and salt in diet.

Hypercholesteraemic? Medications, exercise and diet (remove saturated fats and cholesterol where possible).

Smoking? 
"The message is clear, if the choice is between smoking and vaping, choose vaping. If the choice is between vaping and fresh air, choose fresh air" - Dr Jeanelle DeGruchy, Deputy Chief Medical Officer for England.

Physically inactive? 
Try to achieve 150 minutes of "moderate" exertion each week. Any modality, walking, swimming, cycling, jogging circuit classes at home (via internet) or face to face group classes. Work to a level that you can describe as "comfortably uncomfortable" and is a "conversational" pace. Walking normally offers the best and easiest introduction.

Obesity or Overweight?
Discuss diet with a dietician, GP's and/or cardiac rehab programs should be able to direct you to the right service. Increase activity levels. Reduce sedentary time. Choose walking and cycling over car journeys. Can you increase activity during a commute?

Diabetes?
Medications, dietary choices and activity levels all play a key role and services are available to support you. Start out with your GP or rehabilitation service.

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Question 20

What exactly is coronary heart disease?

Accepted Answer

Coronary heart disease, also known as coronary artery disease, is a condition in which plaque builds up in the arteries that supply blood to the heart. This plaque build-up can cause the arteries to narrow and harden, making it difficult for blood to flow to the heart. This can lead to chest pain, shortness of breath, heart attack, and other serious complications. Risk factors for coronary heart disease include smoking, high blood pressure, high cholesterol, diabetes, obesity, and a family history of heart disease. At And The Beat Goes On, our cardiac rehabilitation program is designed to help patients manage their coronary heart disease and improve their heart health through exercise, education and support.

Question 21

Simply put, what is METs and how do I increase my functional capacity?

Accepted Answer

METs (Metabolic Equivalents) is the measure of an individual's functional capacity or how much energy they can expend during physical activity. It is a unit of measurement used in cardiac rehabilitation to gauge a patient's progress as they work towards improving their cardiovascular fitness. To increase your functional capacity, you must gradually increase the intensity and duration of your exercise routine. This can be achieved by participating in a structured cardiac rehabilitation program that includes a variety of aerobic and resistance exercises tailored to your specific needs and abilities. It's essential to work closely with your healthcare team to ensure that you're progressing safely and effectively and to monitor any potential side effects or complications. In addition to exercise, lifestyle modifications such as a heart-healthy diet, stress management, and smoking cessation can also contribute to improving your functional capacity and overall cardiovascular health.

The BHF is a fantastic source of information for best management across the board.

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Question 22

Can I continue with my usual activities and exercises after a heart attack?

Accepted Answer

After a heart attack, it is important to gradually increase your physical activity and exercise level under the guidance of your healthcare provider. While some of your usual daily activities may be safe to continue, others may need to be modified or avoided altogether. Your healthcare provider will work with you to create a personalized plan that takes into account your individual needs and limitations. When you have a heart attack there can be significant damage for some, yet others will experience less trauma, this is relevant when prescribing exercise in your rehabilitation. The key message is that exercise is good and so long as it is approached carefully with a structure and to the right level there will be activities and exercises that are fine.

If you have any questions about what activities are safe for you after a heart attack, please don't hesitate to reach out to us and we will try to advise.

In the meantime take a read of these patient leaflets..

https://www.acpicr.com/publications/patient-leaflets/ (https://www.acpicr.com/publications/patient-leaflets/)

Question 23

What are some potential complications associated with Coronary Artery Disease (CAD)?

Accepted Answer

Coronary Artery Disease (CAD) can cause a range of complications that affect the heart's ability to function normally. Some of the potential complications associated with CAD include:

1. Chest pain or angina: Angina is a common symptom of CAD and is caused by a reduced blood flow to the heart muscle.

2. Heart attack: A heart attack occurs when the blood flow to a part of the heart is blocked, causing damage to the heart muscle.

3. Heart failure: Heart failure occurs when the heart is unable to pump blood effectively, leading to symptoms such as shortness of breath, fatigue, and swelling in the legs and ankles.

4. Arrhythmias: CAD can cause abnormal heart rhythms, such as atrial fibrillation, which can cause the heart to beat too fast or too slow.

5. Sudden cardiac death: In some cases, CAD can lead to sudden cardiac death, which occurs when the heart stops beating suddenly and unexpectedly.

People who have CHD are taught how best to manage their CAD and reduce their risk of complications through personalized cardiac rehab programs that include exercise, nutrition counselling, and stress management techniques. There is more on risk factors within FAQs.

Remember the British Heart Foundation (BHF) is a fantastic resource to gather information on risk factors, medications and conditions.

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Question 24

What are the categories of blood pressure readings? What is hypertensive? What is normal for someone with heart failure and medicated?

Accepted Answer

Blood pressure is the force of blood against the walls of your arteries, and it's measured in millimeters of mercury (mm Hg). The categories of blood pressure readings are as follows:
- Normal: Less than 120/80 mm Hg
- Elevated: Systolic between 120-129 and diastolic less than 80 mm Hg
*Established CHD patients asked to aim for 130/80 and below.
--------------------------------------------------------------------------------------------
- Stage 1 hypertension: Systolic between 130-139 or diastolic between 80-89 mm Hg
- Stage 2 hypertension: Systolic at least 140 or diastolic at least 90 mm Hg
*Get in touch with your doctor if yours is frequently > 140/90

- Hypertensive crisis: Systolic > 180 and/or diastolic over 100 mm Hg. 
*Refrain from mod-strenuous exercise, speak with your doctor. Generally community based cardiac rehab classes would ask you not to exercise at this rate however in a clinical environment (e.g. hospital 220/110 mm /Hg

Hypertensive means having high blood pressure, which is a risk factor for heart disease and stroke. It's important to manage your blood pressure with lifestyle changes and/or medication to prevent complications.

For someone with heart failure (HFrEF) who is medicated, a normal blood pressure reading may be lower than the standard normal range. Your healthcare provider will determine your target blood pressure based on your individual needs and condition. It's important to follow your medication regimen and monitor your blood pressure regularly to prevent complications and optimize your cardiac rehabilitation.

Question 25

What are some stress management techniques that could help me and what resources on the web could I use that are safe and certified?

Accepted Answer

Stress management is an important aspect of cardiac rehabilitation and can greatly improve your overall wellbeing. Here are some techniques that could help you manage stress:

1. Deep breathing exercises
2. Meditation or mindfulness practices
3. Yoga or tai chi
4. Regular exercise
5. Getting enough sleep
6. Social support

When looking for resources on the web, it is important to ensure that they are safe and certified. Here are some trusted websites that offer stress management resources:

1. National Center for Complementary and Integrative Health (NCCIH)
2. American Heart Association
3. Mayo Clinic
4. Centers for Disease Control and Prevention (CDC)
5. NHS
6. The British Heart Foundation (BHF)
7. The British Lung Foundation

Remember to always consult with your healthcare provider before trying any new stress management techniques.

ATBGO

Question 26

Can I still have a normal sex life after a Coronary Artery Disease diagnoses?

Accepted Answer

Yes.

Of course there are some considerations.

1. Medications - some medications that will likely be lifelong can impact your mojo and this is something to discuss with your GP who will likely consider your options. Generally small medication changes can make a big difference here.
2. Your event / procedure (if you had one). For valve surgery and bypasses a sternotomy is required, this is quite an invasive surgery that takes time to heal. 12 weeks is generally recommended before a great deal of exertion is applied to the area as there would have been some upset muscles and nerves from the procedure not to mention a rather large bone. This applies also to outdoor cycling and returning to the pool - let the area settle before you get back to your romancing.
3. How long you have been inactive & current level of fitness. Believe it or not, sex does have its physical demands on us. Cardiac rehabilitation programs calculate your fitness in an initial appointments (assessment). They manage this by completing some observations and if deemed appropriate, after a thorough discussion, a sub-maximal functional capacity test will be prompted. We relay the results of this test to patients using METs (VO2/3.5) . Depending on your fitness level sex may just currently be too demanding for what we'd advise. That said a discrete discussion with your GP / health provider should help you understand if it is currently appropriate or not. 
4. Finally. A stable condition. This should be approached like any exercise bout you intend to do. If you are feeling symptomatic, unwell or have recently been sick or carrying an infection / taking anti-biotics it would be wise to not put further strain on your system - certainly not in the early weeks post event/procedure.

A link to a METs compendium has been included below to help understand the demands of certain activities.

https://cdn-links.lww.com/permalink/mss/a/mss_43_8_2011_06_13_ainsworth_202093_sdc1.pdf (https://cdn-links.lww.com/permalink/mss/a/mss_43_8_2011_06_13_ainsworth_202093_sdc1.pdf)

(Tip: hold Ctrl+F for a search bar to appear. Type your activity here).

*If you have had an exercise assessment you should be able to locate your MET capacity in the summary.

Any doubts ask your GP on this one. Don't be shy, they've heard and seen it all before.

ATBGO

Question 27

What exercise programs are available at And The Beat Goes On (ATBGO)?

Accepted Answer

At And The Beat Goes On (ATBGO), we offer a variety of exercise programs tailored for cardiac rehabilitation:

- Virtual Classes (via Zoom): Suitable for all, especially those in the cardiac community.

- Face-to-Face Classes: Held in the community.

- One-to-One Personal Training: Customized sessions.

- Sub-Maximal Assessments: Recommended annually to track fitness and key health metrics.

Resources include free and paid recordings available on our website: [ATBGO ExerciseLibrary]
https://www.andthebeatgoeson.co.uk/exercise-library

Question 28

Should I always use my walking stick or aid, or should I try to use it less to improve my balance?

Accepted Answer

It's best to consult with your healthcare provider or physical therapist for personalized advice. Generally, use your walking stick or aid for support and stability as needed. Incorporate exercises that improve your balance and strength. Gradually reduce reliance on the aid as you regain strength, but always prioritize safety to avoid falls. Your healthcare team can guide you through this process.