Exercise, Help for Angina?

Should you exercise if you have Angina? Will it hurt or help? There are many questions associated with all illnesses and working out. This is a good article on Angina that may answer a few of the questions you have. Original source is unknown.

Angina and Exercise
by Cedrick X. Bryant, Ph.D

Patients with stable angina for whom bypass surgery or angioplasty is not appropriate, and/or those with a high angina threshold (4 METs or greater) are appropriate candidates for exercise programs. However, in patients with angina thresholds of 2 to 3 METs, exercise may not be appropriate. A primary goal of physical conditioning in a patient with angina (severe inflammation of the mouth or throat, or deficient oxygenation of the heart muscles) is to increase the amount of exercise before the onset of any limiting anginal pain.

Each patient must be evaluated for ischemic responses before, during and after an exercise test. An essential element of this evaluation is the patient's description of the anginal episode. This evaluation should include a verbal description of the patient's symptoms (discomfort, pressure, tightness, burning and shortness of breath), location of the symptoms (substernal, jaw, teeth, throat, arm, chest, etc.), the observed actions of the patient (clinched fist, rubbing), the duration and frequency of the episodes, and precipitating and resolving factors (exercise, rest, nitroglycerin).

In evaluating the angina patient, several factors should be considered, including the severity of the disease, masking of symptoms by medications, and abnormal blood pressure responses during exercise. Teaching the patient to grade the angina symptoms during the exercise test may be beneficial in determining the intensity of the discomfort for tests and/or exercise termination. If patients experience greater than mild-to-moderate symptoms during an exercise session, they should be instructed to stop exercising and consult a physician.

Exercise intensity for angina patients should be set safely below the ischemic threshold (10 to 15 bpm). The exercise session should include a prolonged warm-up (at least 10 minutes) with range-of-motion and stretching activities. After the warm-up is the aerobic phase, which should not be at a greater intensity than the warm-up. Patients with angina may benefit from intermittent exercise -- alternating work and rest. This approach may be followed until the patient has sufficient strength and endurance to sustain continuous exercise. All of the major muscle groups of the body, including the upper extremities, should be worked using dynamic repetitive motions. Breathing should be emphasized to minimize the tendency toward breath-holding.

If angina occurs with exercise, the exercise period should be discontinued, or at least significantly decreased in intensity, until the symptoms are resolved. The exercise cool-down period should be gradual and prolonged (at least 10 minutes) to prevent complications from blood pooling in the lower extremities. If angina is experienced with increased intensity during exercise, and is not relieved by either termination of exercise or by the use of three sublingual nitroglycerin (one taken every five minutes), the patient should be transported to the nearest emergency room.

Fortunately, the risk of a serious heart problem such as a heart attack is extremely low in angina patients participating in supervised exercise programs. This may be because angina serves as an effective early warning signal. Although vigorous exercise may precipitate angina, moderate exercise has been found to be good for angina patients. For example, regular aerobic exercise can reduce angina symptoms in many patients. Presumably, this is because exercise performed regularly over time decreases the heart rate and blood pressure, both at rest and during exercise. These effects lower the demand on the heart, which allows patients to exercise at higher intensities before reaching the critical heart rate and blood pressure levels that bring on the symptoms of a heart attack.

Cedric X. Bryant, Ph.D., is the senior vice president of research and development/sports medicine at StairMaster Sports/Medical Products Inc., Kirkland, Wash., and James A. Peterson, Ph.D., is a sports medicine specialist residing in Monterey, Calif. Both Bryant and Peterson are fellows and active members of the American College of Sports Medicine and internationally known authors and speakers on topics relating to fitness and nutrition