Month: February 2017

(CNN) — Rick Murphy, a real estate appraiser in Atlanta, had no idea he had a bad heart.

When Murphy turned 50, he decided it was time to get in shape. It wasn’t long before he progressed from running races to an Ironman triathlon.

A fellow triathlete recommended he get checked out by a sports cardiologist, so he went to see Dr. Jonathan Kim at Emory Healthcare in July 2015.

“The next thing you know, Dr. Kim is saying, ‘I think we need to do a heart catheterization on you.’ “

One of the heart’s main arteries was over 95% blocked. Murphy was in the operating room within a few days.

“I was obviously surprised,” said Kim. “He could’ve been that unfortunate terrible story where somebody drops dead.”

“My only symptom was a little extra fatigue,” said Murphy, now 55. “I chalked it up to working too much and not getting enough sleep.”

Murphy wouldn’t be running another Ironman anytime soon, but he was eager to get back to his normal routine. And Kim prescribed just that: more exercise. Though the benefits of exercise are clear for those with an injured heart, Kim said, patients often want to know how best to exercise, how much and how hard.

Increasingly, experts are pushing patients with heart problems harder than what was considered useful — or perhaps even safe — in the past.

Let’s get physical

The idea that exercise can help hearts recover is a relatively modern one.

Until the 1950s, doctors often told cardiac patients to avoid any physical activity at all. In 1952, the recommendation that heart attack patients get out of the hospital bed and into an armchair was seen as controversial. It wasn’t until the late ’50s that exercise guidelines emerged for these patients.

Nowadays, aerobic exercise is seen as a key to recovery, said Kim, who runs an exercise physiology lab.

“One of the tenets of what we do is that exercise is medicine,” he said.

Aerobic exercises like swimming, jogging and cycling raise the heart rate. Over time, the heart becomes more efficient, allowing it to pump more blood with less effort. Exercise can also reverse some of the effects of heart disease, like the narrowing of arteries.

“The goal is to raise and sustain that elevated heart rate in what we call a training heart rate zone,” said Dr. Jonathan Whiteson, medical director for cardiac rehabilitation at NYU Langone Medical Center.

A typical target zone for aerobic exercise might be 70 to 80% of your maximum heart rate, said Whiteson, though many aim higher or lower.

Most people can calculate a ballpark maximum heart rate by subtracting their age from 220, said Whiteson. At 55, Murphy said his heart rate follows that trend to a T, peaking around 165. However, many heart attack survivors fall quite a bit lower, said Whiteson.

Exercise specialists like Whiteson and Kim use a battery of tests and gadgets to find each patient’s new normal — from heartbeat monitors to a mask that measures oxygen use. Once their patients are stable, it’s back to work — though slowly, at first.

“They try to get you up and moving around as soon as possible,” said Murphy.

A comeback workout

In recent years, doctors have continued to push the limits of what they thought cardiac patients could do, opting for high-intensity interval training over more moderate exercise, said Ray Squires, program director of cardiac health and rehabilitation at Mayo Clinic.

During high-intensity interval training, or HIIT, people push themselves for brief intervals — from 30 seconds to a few minutes — followed by a longer periods of lower-intensity exercise.

In 2009, Mayo Clinic began recommending HIIT to people who had been diagnosed with heart attack or heart failure.

“I don’t know if there was anybody else doing it in the United States” at the time, Squires said.

At Mayo, Squires and his team only initiate HIIT once their patients can do 20 minutes of moderate exercise, which may include brisk walking or even mowing the lawn.

High-intensity training has many different “flavors,” Squires said, which can depend on the age of the patient, their fitness level, the nature of their heart problem and other medical conditions, like arthritis, that might make certain exercises more difficult. There is no one way to do HIIT, he said.

Patients are often scared to push their hearts soon after a heart attack, Squires said, but most trust their doctors enough to try. Among the several thousand patients who have gone through Mayo’s 36-week program, “we have never seen a single event during HIIT,” he said.

Patients are more at risk for a physical injury than another heart attack, he added.

In one study, researchers in the Netherlands recorded only two fatal cardiac arrests over 46,000 hours of supervised high-intensity exercise. These cases were so few that they were unable to find a difference between that and moderate exercise; the authors concluded that the benefits of HIIT outweighed the risks.

Some studies suggest that high-intensity exercise might actually be better for cardiac patients than moderate-intensity exercise, nearly doubling their cardiorespiratory fitness according to one analysis.

“HIIT is not new,” said Squires. “It’s been used by athletes probably since the beginning of time.”

The first studies on HIIT in cardiac patients occurred in the late ’70s, but they were largely ignored, said Squires, even though they demonstrated “dramatic improvements” in many of these patients.

But the trend caught on among rehab centers and exercise enthusiasts alike. The American College of Sports Medicine listed HIIT as the No. 3 fitness trend for 2017. Gymgoers are increasingly looking to short, intense workouts as a way to pack the benefits of exercise into a shorter session.

This contrasts with expert recommendations that people get 30 minutes of moderate exercise five times a week.

“Some people just don’t have the time,” said Kim. “Some people just want to push themselves harder.”

But the science is still emerging, said Kim. For patients with an injured heart, it can be crucial to discuss their goals and fears with a cardiologist and personalize their exercise plan, he said.

“In the field of sports cardiology, we still have a lot of limitations between what we know and what we don’t know.”

It all ‘works out’ in the end

The benefits of cardiac rehab may be limited less by emerging science, and more by who has access to it.

A study released earlier this month added to findings that women and black patients are less likely to be referred to cardiac rehab than their male and white counterparts. Those with insurance coverage are three times more likely to be referred to cardiac rehab, according to another study.

But despite the high-tech tools and education that people can access in these programs, they aren’t a hard requirement for exercising after a heart problem, said Kim

“The benefits of exercise are as tried and true as anything we know about,” said Kim, “whether you have the technology or not.”

Ironman triathlete Rick Murphy has been following Kim’s orders; with 18 months of rehab under his belt, he has only two more to go.

Murphy has already signed up for a triathlon in May. He said that his experience inspired people close to him to get checked out, as well.

“I had a lot of friends who couldn’t believe that this actually happened to me after what I’ve been doing,” said Murphy. “It rocked a lot of people’s world.”

The Brigance Brigade Foundation, a Maryland-based nonprofit, has teamed up with the National Institutes of Health ALS Research Lab to expand research on the racial and ethnic differences across ALS cases.

Classified as an orphan disease occurring in a small portion of the population and commonly known as Lou Gehrig’s disease, amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord.

Officials at the ALS Association note the three words that describe ALS— amyotrophic,” which refers to muscle and nourishment— when a muscle has no nourishment, it atrophies or wastes

away. Further, “lateral” identifies the area in an individual’s spinal cord where portions of the nerve cells that signal and control the muscles are located. As the area degenerates, it leads to scarring and hardening or “sclerosis,” in the region.

Despite the over-sampling for minority populations with ALS, the percentage of African-American cases reported is not proportionate to the population.

“ALS is not spoken about in the African-American community because there are not a lot of African-Americans who are diagnosed with ALS,” said O.J. Brigance, who spent a decade fighting

the disease and as an activist on behalf of families with ALS.

The National ALS Registry gathered data from October 19, 2010 to December 31, 2011 and found that 12,187 individuals were living with ALS, which is more common among whites, males,

non-Hispanics, and those aged 60 to 69.

The study revealed that white men and women were twice as likely to have ALS than black men and women; and males had a higher rate than females across all races with four in 100,000

ever being diagnosed with ALS.

“In 2007, one of the first symptoms I experienced was a loss of strength in my right arm. I was playing racquetball and noticed I didn’t have the same power in my swing,” Brigance said. “I also started having twitching in my muscles, which I later learned were called fasciculations. I didn’t have any family history of ALS. I am what they call a sporadic case, which accounts for 95percent of cases.

“There are also familial cases of ALS, which account for the remaining five percent of cases,” Brigance said, noting that ALS is a disease that is diagnosed by process of elimination.

Brigance and his wife, Chanda, started the Brigance Brigade foundation in 2008 to help with the expenses not covered by insurance, but are critical to everyday quality of life.

While other organizations raise money for research, Brigance says they didn’t notice any that focused on patient services.

“We were seeing these medical bills roll in and wondered how families pay for this. That was the impetus for us starting the Brigance Brigade,” he said. “I am not saying raising money for research is not important. However, we also need to help those living with ALS right now.”

ALS has been shown to have a genetic basis and finding genes that cause ALS will help scientists learn how to treat it, yet African-Americans don’t often volunteer for genetic research studies, Brigance said.

Without African-American DNA in research studies, it’s unclear how blacks contract ALS, a fact that has the potential to leave the community out of the equation when effective treatments for the diseases are developed, he said.

This also hinders scientists from learning everything about the disease regardless of ethnicity.

The NIH needs comprehensive information about DNA from all backgrounds to know more precisely how the disease works so the foundation and the NIH are seeking to increase in enrollment in research studies.

“I would tell anyone diagnosed that even though they have been diagnosed with ALS, it doesn’t have to be a death sentence. Will there be changes and lifestyle adjustments? Yes, but living lifestyle still possible,” Brigance said.

“I’m not saying living with ALS is easy by any stretch of the imagination. Quite the opposite, it will test every fiber of your being.

“However, I also believe that those who walk this journey with ALS have a certain intestinal fortitude and fight to accomplish whatever they put their minds to. Life has a way of preparing us

for every trial through previous life experiences.”

For more information or to contribute, visit www.brigancebrigade.org/