Physical Activity for the Heart

 

Regular physical activity is crucial in preventing and managing lifestyle-related diseases and heart disease. An ideal physical programme should include both aerobic, resistance and lifestyle-related activities to improve endurance and strength training. Physical activity prescription should be tailored according to age, physical fitness and gradual progression for sedentary adults. 

According to the Ministry of Health, one third of Singaporean deaths in 2011 and 2012 were due to heart-related conditions. 10% of total hospital admissions in these two years were linked to heart disease and 40% of polyclinics’ attendances were due to risk factors of heart disease (e.g. hyperlipidemia, hypertension and diabetes mellitus). These statistics demonstrate the rising healthcare burden of heart disease in Singapore.

The heart is the engine of the human body; it ensures consistent and continuous delivery of oxygen and nutrients to our body tissues. Optimum heart function is essential to ensure health and vitality. This can be optimised through regular and sufficient doses of physical activity.

Today, there is an increasing trend of reduced physical activity due to mechanisation. Living a sedentary lifestyle has been associated with increased risks of chronic diseases, cancers, obesity, accelerated functional deterioration and lower life expectancy. Strong evidence has supported the risk of developing both heart disease and early death from occupations that are less active.

The 2010 National Health Survey demonstrated that 39.1% did not meet physical activity guidelines for healthy living. Therefore, physical inactivity is an avoidable risk factor for heart disease.

Types of Physical Activity

Although increasing activity levels have obvious benefits, getting people to participate can be challenging. There are many barriers – on the personal level through external factors and other environmental factors that affect adherence to regular physical activity. In addition, there is lack of understanding on the types and dosage of physical activity in reaping real health benefits. It is usual to assume that any form of physical activity is considered sufficient for health promotion.

Physical activity is defined as any body movement produced by muscle contractions that result in the burning of calories. In contrast, exercise is a purposeful physical activity programme to ensure gains or maintenance in physical function and fitness (e.g. running, walking, dancing, swimming).

Exercise programmes can be divided into aerobic and resistance physical activities. Aerobic exercises help in improving endurance and fitness, while resistance exercises help in loading and strengthening both bones and muscles strength. In order to maximise benefits from incidental physical activity, a new modality, which is ‘lifestyle physical activity', was formulated to acknowledge the role of these activities. Local guidelines of physical activity have an inclusive model for various types of physical activity to improve adherence to regular physical activity.

Benefits of Physical Activity

Regular exercise can reduce overall risk of developing heart disease by 50%, possibly through reduction of hardening, narrowing and decreasing the risks of acute blood clot formation in the blood vessels of the heart. Franklin and McCullough 2009 (Table 1) suggested that it could be contributed by improved dilation, compliance or a combination of factors on the blood vessels.

Table 1

 

Screening and Readiness for Physical Activity

Before prescribing exercise, it is important to screen for red flags for risks of participation in physical activity. Physical activity readiness questionnaire (PAR-Q) is a readily accessible tool to address risks. Further assessment may be required for any “yes” to the questionnaire as well as supervision of exercise intensity and progression. After assessing risks, physical activity prescription is made through the Frequency, Intensity, Type and Time (FITT) principle.

 

Physical Activity Prescription

Physical activity prescription is based on FITT principle. A sample of a complete simulated physical activity prescription should include both aerobic, resistance and lifestyle-related activities (Table 2). Ideal frequency of physical activity should be at least five times a week at moderate intensity level for aerobic-based activity for 30 minutes. Resistancebased exercises should be done at least two to three times a week in a few sets of 10, for major muscle groups.

Table 2: FITT Principle

 

A sample of a simulated physical activity prescription can be shown in Table 3 below.

Table 3: 3 X 3 Physical Activity Strategies

 

Table 4

 

References 

  • Franklin, BA and Mc Collough PA (2009) Cardiorespiratory fitness: an independent and additive marker of risk stratification and health outcomes. Mayo Clinic proceedings 84(9): 776-779.
  • Green, D.J., O’Driscoll, G., Joyner, M.J., Cable, N.T. (2008) Exercise and cardiovascular risk reduction: time to update the rationale for exercise? Journal of Applied Physiology 105(2): 766-768.
  • Sloan et al (2011) National physical activity guidelines: professional guide. Health Promotion Board 1-26.

Walking is a great form of exercise through everyday physical activity. It is readily accessible, does not require equipment and has low health risks. Walking intensity can be gradually built up, according to the physical capacity of each individual. Walking is beneficial for all ages to increase mobility and strength, while reducing the risks of disability and chronic diseases.

Table 4 provides a set of recommended walking speeds for males and females of different age groups. Walk at a comfortable pace for a few minutes to warm up before progressing to the ideal speed suitable for your age; maintain the speed for 30 minutes before cooling down to a slower speed. For sedentary adults or individuals with joint pains and injuries, it would be preferable to start at a slower pace in short bouts of 10 minutes before progressing to an ideal duration of 30 minutes.


 

Ms Cindy Soh  

Cindy Soh is a Principal Physiotherapist at Tan Tock Seng Hospital, Singapore. She obtained her Bachelor of Physiotherapy degree in Australia and a Masters in Preventive Cardiology in UK. She is also an American College of Sports Medicine Certified Clinical Exercise Specialist.