While the benefits of exercise are indisputable, how much of it is good for maintaining your heart health has always been a topic of debate. The subject was recently thrust back into the spotlight following some cases of heart-related issues among young sportspersons.
In the Euro 2020 football tournament (held in June 2021), Denmark’s Christian Eriksen, 30, collapsed on the ground during a match, suffering a cardiac arrest. His captain Eric Dier immediately provided cardiopulmonary resuscitation (CPR) and prevented him from swallowing his tongue. Eriksen responded as the medical team rushed in and revived him completely.
After recovering in the hospital, Eriksen was fitted with an implantable cardioverter-defibrillator. About six months later, Eriksen began his physical activities and training. In January 2022, he signed for the English Premier League side Brentford and successfully played the whole season.
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Being a professional footballer, a typical matchday appearance would require Eriksen to undergo tremendous aerobic exertion, besides the usual knocks and tumbles. The fact that he could get back to active football, that too with a defibrillator implant, provides hope for many with heart conditions who would want to start an exercise regimen.
Why exercise is important for heart health?
In their review paper Exercise and the heart: the good, the bad and the ugly, Sharma, Merghani and Mont say that individuals who regularly exercise have a good cardiovascular risk profile (age, sex, hypertension, smoking and diabetes are major risk factors for cardiovascular disease) for coronary artery disease and reduce their risk of heart attack (myocardial infarction) by 50 per cent. Researchers say that exercise promotes longevity of life, reduces the risk of malignancies, delays the onset of dementia, and is considered an antidepressant. However, these benefits are only credited to moderate exercise whereas sportsmen perform way beyond the recommended levels of physical activity.
“For heart patients, performing light exercises under medical advice for about two to three hours a week is essential not only for better recovery but also for the heart to function better,” says Faisal Hussain, an instructor at a popular gym in Bengaluru. “We always ensure that people who come here for exercises provide their medical history. If they have heart issues. We deal with them after ascertaining their problem, treatment and the medication they are under.”
Hussain says that people are asked to perform light exercises so that their cholesterol level improves, and their cardiovascular system makes good progress over a period. “They are given a little more strenuous exercises after their condition improves and the doctor advises them accordingly,” he says.
Cardiac conditioning is key to maintain a healthy heart, says Dr Naveen Chandra, consultant, interventional cardiology, Manipal Hospitals, Bengaluru. “Direct benefits are that it reduces the risk factors of any heart disease like diabetes, hypertension or high cholesterol,” says Dr Chandra. “Also, exercising helps in controlling sugar, maintaining weight and maintaining blood pressure. Secondly, exercise helps in improving cardiac conditioning such as cardiovascular fitness and stress handling as well.”
Dr Chandra says that moderate intensity exercises are more than sufficient to maintain good cardiovascular health. “Only 30 minutes of moderate exercise, cycling, jogging, walking and swimming per day and at least five days a week is enough to maintain good heart health,” he says. “Children also need to follow such a programmed schedule of moderate exercise to prevent obesity and hypertension-like situations.”
Regular exercises help maintain the internal intimal layer of the arteries, ensuring the cardiovascular system is in good shape.
“Exercise releases endorphins, which are good for our mental health,” says Dr Abhijith Kulkarni, consultant cardiologist, at Apollo Hospitals, Bengaluru. “It keeps the cardiovascular system significantly intact. Sedentary life is the cause of most non-communicable diseases including cancer, cardiovascular disease, stroke and many others. Exercise [keeps] the cardiovascular system in an orderly fashion, ensures that the metabolism of cholesterol and related things is properly done, and also maintains the internal intimal layer of all these arteries in the normal contraction-relaxation.”
The benefits are manifold, starting from the molecular level.
“Exercising releases multiple micro-molecules which help in proper regulation of blood flow and prevention of blockages and ensures that the skeleto-muscular system is properly aligned,” says Dr Kulkarni. “Hence exercise is extremely important not just for cardiovascular diseases, but also to prevent other diseases like cancer which are linked to obesity and fatty liver and liver-related cirrhosis.”
How exercise improves heart health?
An active lifestyle with moderate workouts and regular stretching exercises trigger chemical and physical changes in the body that enhance cardiovascular health.
“Endurance can be developed with exercises like aerobics,” says Dr Lal Daga, senior interventional cardiologist, Apollo Hospitals, Ahmedabad. “Strengthening can be achieved through resistance exercises which help develop muscle mass. Such exercises not only develop stronger muscles but also burn fat. Exercising regularly helps develop better elasticity of blood vessels, thereby reducing chances of stiffness. This further reduces the chances of developing plaques, leading to fewer chancers of cardiovascular or cerebrovascular events.”
Dr Kulkarni agrees. “When you exercise every day – a good combination of aerobics and weight training — it ensures that there is a blood supply,” he says. “When we exercise, the internal layer of the endothelium [all blood vessels have an internal layer], in response, releases nitric oxide, which is important for proper blood supply regulation at the molecular level. This has anti-inflammatory properties, which ensure that the layer is intact. The breach of the layer is one of the most important reasons for acute heart attacks.”
Conditioning of the vascular system along with that of the heart is key.
“Many of the molecules that we use also promote the release of those molecules, like the macromolecules from outside,” says Dr Kulkarni. “These molecules are used to prevent heart attacks. So that’s why exercise does it naturally for you — maintaining the alignment — and it doesn’t breach the integrity of the internal layer, which is an important aspect. And conditioning of the overall heart and the vascular system is done by exercise.”
Exercises that keep the heart fit
Dr Sanjeev Gera, director, cardiology, Fortis Hospital, Noida says, “Aerobic or endurance exercises like brisk walking, jogging, swimming or cycling are the best for the heart. Intermittent resistance exercises like some weights are also recommended to maintain muscle health but should be done after ruling out blockages in the heart.”
Most experts say 30 minutes is the sweet spot when it comes to the ideal duration for exercises.
“Brisk walk means that you sweat,” says Dr Bikas Majumdar, senior consultant, cardiologist, Apollo Multidisciplinary Hospitals, Kolkata. “At least half an hour of walking every day helps. Similarly, swimming is another form of exercise which has been helpful for heart health. You can also do yoga. Not everyone needs to do weight training to improve heart health.”
Age should be considered too, and the intensity of workouts should be increased in a systematic manner. “While people start ageing, one or the other ailments catch up,” says Dr Naushad Ahmed, a Bengaluru-based cardiologist. “If there are no evident heart issues, people can go for aerobic exercises; if not, they can do anaerobic exercises. A weightlifter computing for the weight of 150kg doesn’t start with 150kg even though his weight is around 60kg. He starts with 10kg and gradually builds up and goes to 150kg over a period. Similarly, exercise must be gradual.”
People with a family history of cardiac history should start exercises after undergoing a cardiac screening.
“Whenever a person is [doing] a high-intensity exercise, the exercise protocol must be more structured,” says Dr Chandra. “It’s better to have a trainer and not to push from the very first day. People who have a family history of cardiac issues or risk factors should get a cardiac screening before [doing] in a high-intensity exercise.”
Exercising with cardiac issues
People who have cardiac issues should get into a workout regimen, or even walking, only if they can perform the physical activity without any stress or difficulty.
“People [with] heart diseases also need some form of exercise, but they need to do it under supervision,” says Dr Majumdar. “Walking for half an hour is good even for those who already have a heart disease, provided they can do it without any difficulty. If a person suffers from any chest discomfort while walking, they should stop at this point. They should take professional advice regarding how much exercise they can do. Even those suffering from heart failure need to do some form of exercise, particularly under supervision like little walking, breathing exercise and, if possible, some swimming. It also helps those who are suffering from heart failure.”
Getting back to workouts after heart attack
People who have received treatment with coronary angioplasty and stenting after a heart attack should go back to an exercise regimen gradually.
“There is a myth that people should not do any exercise after a heart attack,” says Dr Majumdar. “But that is not correct. Patients need to go back to their normal self [through] a graded exercise regimen after receiving the treatment. This is a part of routine cardiac rehabilitation programme, where we start with minimal exercise (only a few minutes of walking) and gradually increase the duration of walking. Graded exercises like climbing stairs gradually [follow]. Often by four to six weeks after heart attack and having primary angioplasty, people can go back to their normal self if they follow a cardiac rehabilitation programme after the heart attack.”
How much exercise is best for heart?
There is always a risk of over-exercising. “Too much exercise is not particularly healthy for the heart,” Dr Majumdar says. “For example, if you are a young athlete, running marathons for a long time or doing very heavyweight lifting for a long time, that sometimes causes thickening of the heart muscle and excessive reduction in the heart rate, which may be problematic. We don’t recommend that everyone should be doing excessive heavy exercise.”
Dr Pradeep Kumar, senior consultant, interventional cardiology, Aster CMI Hospital, Bengaluru, says, “Get tested prior to exercise if you are a high-risk individual or if you plan to do intense activities (like long-distance running). Individuals planning to do intense and prolonged exercises need to get a basic echocardiogram and a stress test if necessary.”
A holistic approach is key to maintaining cardiac health. That means it is not just about exercises — lifestyle and one’s approach are important too.
“I would rather call it ‘awareness’,” says Dr Divya Marina Fernandes, consultant, heart failure specialist and interventional cardiologist, Aster RV Hospital, Bengaluru. “You need to be aware of your heart condition and how much you are allowed to push it to give it the exercise that it needs. You need to be aware of what foods are good for your heart and what is bad and how much you are allowed to cheat when it comes to diet. You need to be aware of your mental health since even that directly impacts your heart.”
