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Workouts - Cardiac Output

By Paul Stephen Lubicz – The Wellbeing Manager

Awareness and Professionalism

The health and fitness Industry is still in a growth period and like any new industry, boundaries are being broken down and new territory is being entered. As a body we are working hard to increase the level of professionalism and standard of service as we take on the responsibility of a major proactive strategy for the nation’s health and fitness.

The first point of call is the health screen.

In the past, regrettably, you could find fitness/personal trainers that would disregard a client’s health status before commencing with an exercise programme and many trainers are still not insured for liability and indemnity. Thankfully this trend is starting to change. Assessing a potential risk status of a client (cardiac risk) and then referring them on to either a doctor and or dietician is the mark of a true professional and only can increase the perceived value of fitness professionals.

As the health and fitness industry grows, so does the inherent possibility of working with different special population groups. As people now live longer, and older people are aware of the health benefits of maintaining fitness, this increases the chances of working with someone in a risk category.

So do you as a trainer screen every new client thoroughly?

As a client have you completed health questionnaires, and had an assessment of your health history and received health clearances from the doctor and/or physiotherapist (if required).

It is important for the fitness industry to become more aware of the dangers of not screening new clients. With an agenda of professionalism and integrity we can offer the safest and most effective service to the population and genuinely improve the quality of people’s lives.

What are the benefits of exercise for heart health?

There is a large body of evidence that regular exercisers have less cardiovascular disease, lower blood pressure, healthier weight levels and less diabetes. This enables them to enjoy longevity and quality of life.

In reference to a healthy heart some of the benefits include:

• A lower resting heart rate (‘pulse’)
• Improved strength of the heart ‘muscle’, which leads to a larger amount of blood being pumped out with each beat (more efficient).
• Fatty deposits in the blood vessels are cleared out (less restriction)
• Reduced stress levels
• Reduced body weight

These points above lead to an improved efficiency of the heart – it can now work against less resistance, with better blood flow & output.

Breast Cancer versus Heart Disease

Breast cancer in women is one of the most publicised illnesses within the U.K. But, the percent of heart and circulatory disease qualifies it as the UK's biggest killer.

For women in England, breast cancer made up 2% of the in-patient cases in the National health services hospitals in 2001/2002, but the combined total of women suffering from various heart and circulatory diseases amounted to 7%.

In 2001, cardiovascular disease (CVD) caused 40% of deaths in the UK, and killed over 245,000 people. Coronary heart disease (CHD), the main form of CVD, causes over 120,000 deaths a year in the UK: approximately one in four deaths in men and one in six deaths in women. Death rates for CHD have been falling rapidly in the UK since the late 1970s. Despite this, death rates from CHD in the UK are still amongst the highest in the world.

These statistics are a very strong indicator that as a general population we still need to address our lifestyle, exercise and eating habits to help reduce the high amount of people succumbing to CVD

UK Department of Health (2002) Hospital Episode Statistics.

How much and what type of exercise is best?

Fun, Varied and Regular Exercise

Regular varied exercise such as walking, swimming, cycling, etc. has been shown to lower blood pressure significantly (as well as increasing levels of ‘friendly’ HDL cholesterol). It is important to find an activity that you enjoy, because if the fun factor is high then there is a greater chance that you will stick with it.

How many times? How long?

The recommended frequency of exercise is 3-5 times a week, maintaining your exercise intensity for 30-45 minutes duration. Warm up 5-10 minutes before activity, gradually reduce the exercise intensity and cool down for 5-10 minutes and stretch. The minimum recommendation for exercise is a cumulative amount of 30 minutes of moderate intensity exercise, which could be 3 x 10 minutes walks a day.

How do I know what intensity to work at?

When you are exercising aerobically, for example walking, how do you know if you're really doing yourself any good? What level is safe for you and what level is most effective for your specific goal?

If you are in a risk category and have been cleared for exercise, are you working too hard or not hard enough? To truly know how hard we are working we need to look to our hearts rates.

The most convenient way to receive this HR information is to use a heart rate monitor, which comes in a form of a band and monitor which raps around your chest and a watch that you can read your HR off. They are relatively cheap and available from gyms and sports stores.

When using the old fashion way there are a number of 'sites' used to monitor the pulse rate. Two convenient sites to use are the radial pulse at the base of the thumb of either hand, or the carotid pulse at the side of the neck. Accurate pulse-count assessment is crucial when monitoring exercise intensity. By using the first two fingers of one hand and locating the artery, a pulse rate can be easily determined. Immediately after exercise, isolate your pulse and count the number of beats in a 10-second period. To determine the heart rate in beats per minute, multiply the number of beats per 10 seconds by six. For instance, if a 10-second pulse count is 20, then the heart rate would be 120 bpm.

When you exercise, your heart beats faster to meet the demand for more blood and oxygen by the muscles of the body. The more intense the activity, the faster your heart will beat. Therefore, monitoring your heart rate during exercise can be an excellent way to monitor the intensity level of the exercise that you are taking part in.

What heart rate level?

The safest and most effective way to gauge the optimal heart rate training zones for you is to work with your fitness professional and for your doctor and fitness professional to work in conjunction with one another. This is essential if you have a history of cardiac illness or are taking medication that alters the heart rate.

What exercise can you do after a cardiac event?

Trainers can provide survivors of a cardiac event with highly effective and convenient individualised treatment. The role of strength, balance, and cardiovascular function in cardiac event (CE) recovery is vital to help CE survivors achieve the best possible recovery and maximise function. This will also assist them with techniques and movements that compensate for abilities that cannot be regained due to their illness. Mobile trainers can provide an additional benefit by minimising travel time and therefore stress on CE victims.

After discussing exercises with the client’s doctor, they may try:

· Walking

· Bicycling

· Swimming

· Rowing

· Walking on a treadmill

· Stair climbing

· Aerobic dancing

· Cross-country skiing

Rehabilitation work requires much patience, motivation, hard work, and time. It is essential that personal trainers adopt a co-ordinated approach with the client’s physician, to receive direction on programming and to provide information on progress.

If you have had surgery for, or are recovering from a cardiac event, it is vital to get a medical clearance from the physician and ask the doctor what type of protocol that you should be adhering to. If you decide to exercise without regular help from a trainer I strongly recommend that you consult one to create a programme for you and update it every 4 weeks. In addition, It is vital that there is communication between a trainer and the doctor so that there can be a plan on how to progress.

One of the leading bodies and education providers in the world has a publication that I strongly recommend. It is the ACSM Guidelines for Exercise Testing and Prescription. This publication is the gold standard of how to work safely within the realm of cardiovascular conditioning.

Another question that must be answered: is the person now on medication that may affect his/her heart? This changes the method of how to monitor intensity. If the person is on beta-blockers or some other form of heart regulatory prescription, you cannot judge cardio training intensity from the heart rate due to the altering effect of the medication.