SOMETHING IS ALWAYS BETTER THAN NOTHING!

Introduction:

One of the questions that comes up all the time in patients I see in my clinic, relates to exercise and specifically what types of exercise they should be doing, how much exercise they should be doing and is it safe to exercise at all? I know that people struggle to access relevant content and guidelines relating to this issue. There are clinical guidelines produced which outlines and advises about the duration and type of exercise, although these are written in a language that is difficult for lay people to understand (using terminology such as METS and MET per hour in order to grade exercise capacity).

The aim of this initial newsletter is to break down some of the jargon around exercise and give a brief overview as to the type of exercise that is safe and recommended from a cardiac perspective. This has relevance to people that have suffered a heart attack or angina or people who are wanting to prevent heart attacks and strokes.

The Power Of Movement

In individuals that have suffered a heart attack or stroke, we know from historical evidence that cardiac rehabilitation reduces a risk of further cardiac events. Cardiac rehabilitation has it’s origins back in the 1980’s where seminal work and research from the USA demonstrated that not only was it safe to get individuals who have suffered heart attacks moving, it was also beneficial for them in terms of the long term follow up.

Prior to this, we used to treat people who’d had heart attacks with bed  for up to six weeks. When we fast forward 30 years we now that movement has a significant benefit in those who are wanting to prevent heart attacks and those who have already suffered heart attacks. Having a sedentary lifestyle is a significant risk factor for developing heart attacks and strokes.

So how much exercise is it safe for individuals to do? In terms of general advice, I would always recommend discussing this with your GP or doctor but as a general principle, what I tend to tell my patients is that something is always better than nothing. One of the key metrics of movement and exercise that has evolved over the last 10 years is the daily step count. This has come forward due to the development of technology such as iPhones and wearable tech that allows us to easily record our daily step count.  There are common misconceptions around the number of daily steps we should aim for. A very common one that I hear a lot in the clinic, is the number 10,000 steps a day is something that we should be aiming for, but what is the evidence behind this? There has been a recent publication in the European Journal of Prevention Cardiology which analyses the amount of exercise required to reduce cardiac events. This type of study was called a meta analysis and it involves looking at over 17 previously done studies which included nearly 900 participants over a follow up of 7 years. The researchers found that there was a sharp decline in risk of heart attacks and strokes over the first 5,000 steps per day with diminishing returns over the next 15,000 steps. The optimal number of steps per day was calculated at 3,867 and beyond this there was thought to be diminishing returns in terms of protection from heart attacks and strokes.

This is really interesting as it goes slightly against the concept that more is always better when it comes to step counts. Whilst it is true to say that even in the results of this study that there was more benefit at those at the higher end of the step count up towards 20,000, there was diminishing returns and the curve flattened out in terms of outcome. This effect was also found in both males and females and in older and younger adults.

The take home message from this study is that exercise significantly improves your risk profile and reduces the risk of you having a heart attack in the future. There is diminishing returns at the higher levels of step counts, but my advice following publication of this study is that something is always better than doing nothing.