Two runners suffered heart attacks and died at the Tata Mumbai Marathon last Sunday. One of them was a man from Kolkata in his forties. He’d led an active life and had run several races, including marathons, and trained regularly. The incidence of heart attacks among seemingly healthy and active people in their thirties, forties and fifties has been rising in India in the last few years. My classmate from boarding school, a 43-year-old who used to cycle and run, died of a sudden heart attack while undergoing some other unrelated tests in a hospital last year.
Heart diseases have long been the biggest cause of death and disease globally. A study published in the Lancet Global Health journal in September 2018 found that cardiovascular diseases contributed 28.1% of the total deaths in India in 2016 up from 15.2% in 1990. That number has only gone up as India is grappling with a serious threat of a diabetes epidemic at the moment. However, nowadays, due to the added stresses of modern life and other risk factors, including a surfeit of ultra processed foods in our diet, rising burden of diabetes, air pollution and obesity are leading to more and more cases of cardiovascular diseases among younger populations in India, and globally too.
It is best, even for active and fit people, to start undergoing regular medical tests once they hit their forties, says Sandeep Sachdev, co-founder and nutritionist at Easy Human, a fitness centre in Mumbai.
“I run races regularly and even work out. There have been news of deaths in international races such as the London Marathon as well in recent times. People often pin the blame on exercise and endurance sports. This is purely fear mongering. Chances are, exercise and running probably delayed the heart attack. Had they not turned to an active life, the adverse event would have come to pass much earlier. Race organisers must create greater awareness about the need to monitor health parameters regularly especially after you enter your forties. Even better if you start doing so in your thirties especially if you have any family history of heart disease, blood pressure and cholesterol problems. Don’t blame exercise and running,” says Sachdev.
Such medical events are serious and certainly life-changing. It is common among people who survive cardiovascular events and those who undergo major heart surgeries and procedures to be a bit more careful about what they do, how much they exert themselves and what they eat. While it is prudent to be mindful of what you eat and drink and monitor your key health parameters while you are healthy, it is even more important after a major medical event, say doctors and nutritionists.
Many people are scared to exercise or play sports post-surgery, but it is highly possible to return to full fitness and lead a highly active life even after such an event. Since we often hold up celebrities as our north star, just look at former Miss Universe and actor Sushmita Sen or Manchester United’s Danish footballer Christian Eriksen, just 31 as of date. Eriksen suffered a heart attack while playing at the UEFA Euro tournament in front of thousands of spectators. A few months after surgery to fit a device to correct his arrhythmia, he went back to training and is back playing at the highest level. Sen suffered a heart attack in March last year and underwent an angioplasty for a 95% blockage of an artery.
Exercise is part of post-op rehab plan
The majority of us are not professional athletes or actors who need to stay in shape as per the demands of their role, and might take longer to regain confidence to return to playing sport or training at full intensity. It remains, however, that exercise is one of the best and most important parts of post-cardiovascular events or surgery.
“Exercise has a very good impact on recovery and can speed up one’s return to work. After a heart attack, when someone is discharged and sent home, they spend their time resting because of the surgery. After a while, the rest causes secondary weakness known as de-conditioning syndrome. It causes our core muscles to weaken, and strength and stamina come down. Hence, if you don’t exercise, it could lead to delay in recovery,” says Dr. Abhishek Srivastava, director, Centre for Rehabilitation Medicine, Kokilaben Dhirubhai Ambani Hospital, Mumbai.
Exercise is not only included in all post-bypass surgery plans but it is also advised soon as one is diagnosed with a heart problem and surgery or a procedure to put stents has been planned, said Dr. Naresh Kumar Goyal, director and head of the department of cardiology at Fortis Hospital, Shalimar Bagh, New Delhi. “Regular exercise has been shown to improve outcomes following all sorts of cardiac surgeries, including valve replacement, device implantation, and even heart transplantation,” Goyal adds.
Not only does exercise help you in recovery and regain your health quicker after a surgery, but it is also very helpful in preventing future events, said Dr. Nagendra Singh Chouhan, senior director of interventional cardiology at the Heart Institute, Medanta Hospital, Gurugram.
Restarting active life
One must consult their doctor and heart specialist before beginning any exercise routine because a full cardiac rehabilitation programme must include supervised exercise sessions, nutritional counselling and psychological therapy. It should be noted that the recovery time varies according to the type of surgery, complications, and the patient’s overall health before surgery. Any surgical procedure, including a bypass surgery, might take 6 to 12 weeks, and occasionally more time, while one could resume activities two weeks after stenting.
Anyone who is hospitalised for a cardiac disease, a heart attack, stent insertion or heart surgery receives specific instructions from the doctor or team of doctors while at the hospital. The doctors also inform them on home care, which is the first phase of a cardiac rehab programme.
“When the patient finishes phase 1 of recovery — two weeks after the stent procedure and four weeks after heart or bypass surgery — they have to undergo a thorough check-up at the hospital. After this they could start an exercise programme with ECG monitoring in the hospital for an hour, three days a week for four weeks. This is known as Phase 2 cardiac rehab and follows the American Heart Association recommendations, which are followed across the world. However, if a patient’s heart function is poor and the heart is not pumping well then the patient has to undergo cardiopulmonary exercise testing. Doctors give further instructions on the basis of this test’s results,” adds Srivastava.
The best exercise to turn to after a heart attack or surgery, both doctors and fitness coaches agree, is walking. We do not recommend patients to start lifting heavy weights or weight training from the very first day; they have to first build up their endurance with aerobic training, and then gradually, start strength training under supervision, says Srivastava.
With time, all patients are advised to include endurance training and aerobic exercises on a treadmill or out in the open, strength training with weights and balance exercises. One thing all heart patients must bear in mind is that they must consult their doctor and get a clearance before starting any exercise routine, keep track of their heart rate, blood pressure, and heart rhythm.
Shrenik Avlani is a writer and editor and the co-author of The Shivfit Way, a book on functional fitness.