Cardiovascular Disease – today’s modern society has brought about many positives, but it’s also created the perfect environment for cardiovascular disease (CVD) to increase.  The cardiovascular system has the essential role of supplying the body with oxygen and nutrients to support life.  However, this system is being destroyed by excessive food consumption and inactivity.

There are many different aspects of CVD – in this article I will cover Hypercholesterolemia (high levels of cholesterol in the blood), and Hypertension (high blood pressure).Chris OpOuch heart pic

I’ll give you some stats, look at signs & symptoms, risk factors, pathophysiology, drug treatments, and how exercise & lifestyle changes can (and do!) help.

Hypercholesterolemia – In the UK, roughly 66% – that’s 2 out of 3 people – have a total cholesterol level of 5mmol/L or above. Men, on average, have slightly lower levels than women. Even more depressing is the statistic that the UK population has one of the highest average cholesterol concentrations in the world!

Cholesterol is a fatty material found in the blood, and is essential for the correct functioning of body cells. We get approximately 40% of required cholesterol from our diet, with the balance being produced by body tissue, particularly the liver.

In order for fat to be transported around our body, it needs to be attached to a special type of protein called lipoprotein.  There are two types of lipoprotein: HDL – high-density lipoprotein; and LDL – low-density lipoprotein.  A high level of LDL is a risk factor for CVD, whereas a high level of HDL actually reduces this risk.  The role of HDL is to remove excess cholesterol from our blood and take it to the liver where it is removed from our circulation.

Like several other chronic conditions, hypercholesterolemia is asymptomatic – it has no signs or symptoms.  The only way of knowing that you have it is through a simple blood test.

Lifestyle also plays a big part when it comes to risk factors – and the good news is that there is plenty we can do to reduce our risk: be more active, lose some weight if necessary, stop smoking, limit our alcohol intake, curb our salt intake, and stick to a healthy diet.  See my ‘By the weigh…’ section for hints, tips and recipes on how to do this WITHOUT losing the will to live!

When there is too much cholesterol in our blood, fatty plaques called ‘atheroma’ start building up on the inner lining of our arteries.  This condition is called Atherosclerosis.  As the fatty plaques build up, they obstruct the flow of blood within the arteries, which in turn reduces their ability to constrict and expand.  This then increases the workload of the heart and leads to an increase in blood pressure.

The main drug treatments for hypercholesterolemia are statins. As you will be aware, there has been much debate as to their effectiveness, and whether they should be prescribed as a preventative measure as well as a treatment after diagnosis.  Side effects can include aching legs, sleep disturbances, and stomach problems.  From an exercise perspective, a client may well be experiencing muscle ache and fatigue BEFORE their workout!

However, exercise does benefit specifically by: improving cholesterol management, increasing the ration of HDL to LDL, reducing the risk of CVD, and by helping to manage body weight.

The ACSM (American College of Sports Medicine) guidelines are based around increasing work capacity to burn more calories and reduce adiposity (stored fat), and to build up endurance.

  Aerobic Strength Stretching
Frequency 5 days / week 2 – 3 days / week 2 – 3 days / week
Intensity Moderate – getting somewhat breathless Moderate – something you can lift 8 – 12 times before resting Mild tension – do NOT bounce stretch!
Time 40-60 mins

(can be split into 2 or 3 sessions / day)

2 – 4 sets of 8 – 12 repeats, with a short rest between sets 10 – 30 sec hold for each stretch
Type Using large muscles e.g. thighs – so brisk walking is a great example Using resistance machines in gym, or lifting free weights e.g bottles of water or tin cans etc. Chest, upper back, shoulders, front thigh, rear thigh, calf

 

Hypertension – high blood pressure is when your average (at least 2 measurements taken on at least 2 different visitsOmron BP machine post-diagnosis) readings are between 140 – 159mmHg for systolic (the pumping phase of the heartbeat), and 90 – 99mmHg for diastolic (the relaxing phase).

Again, hypertension is a disease which often has no signs and symptoms – highlighting the importance of having your blood pressure checked regularly.

Risk factors are the same as for hypercholesterolemia, and indeed having this condition is a risk factor for hypertension too.  Age, family history, genetics and ethnicity also play a part – although obviously we don’t have any control over these!

Although not immediately dangerous, long-term untreated hypertension can cause widespread damage to the body.  It directly damages the inner lining of the coronary arteries, making them more prone to the build-up of fatty plaques called atheroma.  The main pumping chamber of the heart (left ventricle) will enlarge and weaken, causing the pumping action to be adversely affected, which in turn will cause fatigue and breathlessness. Your kidneys can also be damaged, causing them to falter in their filtering work.  Finally, the delicate blood vessels in the eyes can be affected and result in a haemorrhage as well as damage to the retina.

There are many different types of prescribed drugs to help reduce hypertension.  Beta-blockers reduce the heart rate and the amount of contraction within the heart.  Diuretics reduce the amount of fluid returned to the heart by increasing urination.  Calcium channel blockers relax the artery walls, and can also reduce heart contractility.  However, they all have possible side-effects too.

From an exercise perspective, the exercise specialist needs to be aware which drugs reduce heart rate (and therefore will produce artificial readings of exertion levels).  Other side effects include muscle cramps, shortness of breath, and hypotension (low blood pressure), particularly when changing position from seated to standing for example.

The benefits of exercise are numerous though: increased blood flow to the muscles, improved capillarisation (use of small blood vessels), increased number and size of mitochondria (‘energy cells’) in the muscles, increased myoglobin – a protein which carries oxygen in the muscles, and lowered blood pressure.  Exercise also helps to reduce the risk of coronary heart disease, and helps to manage body weight.

Exercise guidelines are the same as for hypercholesterolemia (see above table).

 

Please note that I am an Exercise Specialist and NOT a medical doctor.  Before starting on any new activity or exercise, please consult with a qualified medical practitioner.

For further information on this condition, I recommend the following:

The NHS advice for Hypertension

The British Heart Foundation advice for Hypertension

 The British Hypertension Society

Blood Pressure UK website

The British Heart Foundation advice for Hypercholesterolemia

The NHS advice for Hypercholesterolemia