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I. ULUSLARARASI FİZİKSEL AKTİVİTE, BESLENME VE SAĞLIK KONGRESİ 1 st INTERNATIONAL PHYSICAL ACTIVITY, NUTRITION AND HEALTH CONGRESS Exercise in Cardiovascular Diseases Assoc. Prof. PT. Zuhal KUNDURACILAR Zonguldak Karaelmas University, Health School Department of Physiotherapy and Rehabilitation,Zonguldak, Turkey Epidemiological, clinical and laboratory studies have provided definitive evidence that regular physical exercise is able to decrease the morbidity and mortality due to cardiovascular diseases(CVD) and improve all modifiable cardiovascular risk factors , physical fitness and quality of life. A sedentary life style causes a significant increase in cardiovascular morbidity and mortality has now been demonstrated. Sedentary lifestyle is estimated that eliminating this risk factor may decrease CVDs by 15-39%,stroke by 33% ,colon cancer by 22-33% and bone fractures secondary to osteoporosis by18%. Aerobic exercise is a therapeutic lifestyle approach that is advised for improving lipid and lipoprotein levels for all individuals, including those with coronary vascular diseases. The mechanisms through which these modifications occur can be ascribed to the endocrine-metabolic configuration determined by aerobic physical exercise: reduced insulinamia ,increased somatotrope(GH),cortisol and catecholamine; increased lipoprotein lipase activity, leading to increased lipolysis; increased activity of the lecithin-cholestrol-acetyltransferase(LCAT) enzyme and reduced activity of hepatic triglyceride lipase (HTGL).Regular exercise training improves endothelial dysfunction. In addition to improved endothelial function, exercise training has benefical effects on hemodynamic parameters in chronic heart failure. After 6 months of regular aerobic training program , there is a small but significant improvement of left ventricular ejection fraction accompanied by a reduction in left ventricular end-diastolic diameter. When undertaken by cardiopathic subjects, physical activity must be exclusively recreational or therapeutic. It can never be competitive. It has been been shown that to improve cardiovascular adaptability to effort, the intensity of physical exercise must be 60- 75%VO2max. The basic requirement of such programmes is that workloads should be such that effort is always below 40-50 % of the maximal voluntary contraction(MVC) and heart rate increases to less than 70% of the maximum. Exercise intensity in patients with chronic ischaemic heart disease can be determined according to the indications given in the list below. Endurance dynamic training ; Absence of ischaemia and pump dysfunction: 70-85% of maximum heart rate. Pump dysfunctin: 50-70 % of maximum heart rate. Resistance strength training; Absence of ischaemia and pump dysfunction: interval or circuit training based on the patient’s capacity, not exceeding 70-85 % of maximum heart rate. High level effort ischaemia: no extra load; Pump dysfunction; training without or with lightweights,50-70%of maximum heart rate. Very elderly patients: training with or without extra load. Subjects with mild stenosis who are in sinus rhythm and have normal pulmonary arterial pressure at rest can practice any form of physical activity ;those with moderate stenosis who are in sinus rhythm or atrial fibrillation can undertake low intensity or moderate intensity physical activity. Subjects with associated dilation of the ascending aorta ( >45mm) may be allowed to undertake only low intensity physical activity ,especially in the presence of a bicuspid aortic valve, Physicians are called upon to authorize and indeed encourange, physical and sporting activities even in children and adolescents with congenital heart disease. The current quidelines on sports eligibility provide a brief list of congenital heart diseases for which on the grounds of severity and 23 – 26 KASIM 2011 WOW KREMLİN PALACE, ANTALYA, TÜRKİYE 23 – 26 NOVEMBER 2011 WOW KREMLIN PALACE, ANTALYA, TURKEY 62
I. ULUSLARARASI FİZİKSEL AKTİVİTE, BESLENME VE SAĞLIK KONGRESİ 1 st INTERNATIONAL PHYSICAL ACTIVITY, NUTRITION AND HEALTH CONGRESS complexity, competitive sport is contraindicated. Exercise training programs should contain specific core components that purpose to optimize cardiovascular risk reduction, foster healthy behaviors ,reduce disability and promote an active lifestyle for patients with cardiovascular disease. 23 – 26 KASIM 2011 WOW KREMLİN PALACE, ANTALYA, TÜRKİYE 23 – 26 NOVEMBER 2011 WOW KREMLIN PALACE, ANTALYA, TURKEY 63
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