Motivation is the key to success

This week's post is a guest post, from Holly Barry, who has written a great piece for us all about motivation, especially when sticking to those New Years goals.
 

MOTIVATION IS THE KEY TO SUCCESS

New Year always grants us with new resolutions which primarily focus on shifting that winter weight. But, a healthy lifestyle offers so much more than weight loss. By feeling rejuvenated, you will feel more inclined to persevere with the gym or exercise you have chosen, and stick to eating those colourful foods which will be sure to boost your general health, mental health, appearance and self-esteem. Here are some reasons to adopt healthy habits to help get you motivated for making small, healthy changes.

1: Eat better = feel better

Adopting some simple lifestyle changes in terms of what we eat and how much exercise we take can have a really positive impact on our overall health and wellbeing. Our diet and activity levels can affect muscle strength, coordination, stamina and concentration levels, and even simple changes can have a dramatic effect.

Cutting down on sugary snacks and foods that are high in processed fats is a simple way to improve your diet. Going cold turkey is unlikely to be successful over the longer term, so instead, try to replace sweet treats with nuts and fruit, and try to adopt an 80/20 approach to what you eat. If 80% of your food intake is healthy, there’s room in the remaining 20% for the occasional sweet treat or indulgence.

It pays to approach exercise in a gentle way too, gradually building up the length of time you spend exercising and the intensity of the exercise itself. That way, you build your strength up and stay motivated.

2: Looking after your heart health

Making a resolution to lose weight and eat more healthily will have an impact on your overall health, particularly your heart. Maintaining an optimum body weight and taking regular exercise can both help reduce the risks of developing cardiovascular disease.

The British Heart Foundation and the NHS recommend that adults try to achieve 150 active minutes a week, which is less than 25 minutes a day. For time to count as ‘active’, your activity needs to warm you up and make you feel a little out of breath. You don’t have to sign up for a gym membership though, as simple things like brisk walking, dancing or exercising at home can all count towards that target of 150 minutes of activity.

As winter is the busiest time for the NHS, with resources stretched to the limit, there’s even more of an incentive at this time of the year to get fit and stay healthy.

3: Healthier Skin

Our skin is perhaps the most visible sign of Christmas over-indulgence and harsh winter weather. If you want your skin to look fresh and healthy, you need to pay attention to the foods you eat, as healthy eating can provide long-lasting benefits. All that processed food you ate over Christmas means that your skin has been starved of the minerals and nutrients it really needs. Crash diets won’t help restore your skin’s vitality, as they rarely offer a balanced intake of nutrients. Instead, concentrate on eating your five-a-day, making sure you get plenty of food that is rich in vitamins and minerals, such as spinach, sweet potatoes, blueberries and tomatoes.

Healthy skin also needs plenty of moisture, as without it, skin will quickly look dry, pale and taut. Ensure you drink lots of fresh water, and try to avoid sugary, fizzy drinks and alcohol. Keeping a bottle of mineral water with you at all times is a great way to stay hydrated throughout the day.

Healthy eating and regular exercise play such a vital role in keeping us in shape, both mentally and physically. We literally are what we eat, and bad habits can have an effect on our entire bodies inside and out. Trying to eat well and exercise regularly is more than just a New Year’s resolution - it’s a lifestyle change that we should all strive for, and one that will repay us every day for the rest of our lives.

4: Shiny Hair

We all know only too well how much damage the winter months can do to our skin, but we often forget about our hair at this time of year. Hair can suffer just as much during the winter - whether from lack of nutrition caused by poor diets over the festive season, or from cold, wet weather and the effects of constant central heating.

There are plenty of things you can do though, to boost your hair’s health. Healthy eating can play a vital role in helping you achieve great-looking hair, with some foods providing essential nutrients and minerals to really strengthen your hair and make it shine. By identifying which foods can boost hair health, you can easily incorporate them into your healthy eating regime, for visible and long-lasting benefits.

Just how important is diet and exercise to improve your heart?

Good morning and Happy Wednesday! I hope you've had a great week so far. We've had a busy week here at Clinical Exercise - lots of new enquiries, lots of fab chat over on our Healthy Hearties Facebook group, a HUGE batch cooking session on Monday (fish pie, fish chowder and fish cakes - yes a lot of fish this week!) and an old client has returned from overseas and is getting restarted on his exercise programme.

This week I'm talking all about Heart Health - obviously I'm always talking about heart health but I wanted to really focus on what you can do to ensure you are reducing your risk of having future heart problems.  This is particularly relevant if you have a history of heart problems in the family or if you are recovering from a heart event or currently have a heart condition.

There are so many do's and don'ts to look after your heart - below are the top 5 things you should be doing to ensure your heart is in tip top condition.

Also, this week I have a simple exercise that you can do any time of day to tone up the back of your arms - easy!

Looking after your heart

Cardiovascular disease (heart disease) is the world’s biggest killer, causing over 17 million deaths a year and many of these deaths are preventable through lifestyle changes.

Most people know someone or have themselves been directly affected by heart disease and a lot of times it is avoidable by changing lifestyle habits. If you've had heart problems in the past it's never to late to make improvements to improve your health for the future.

Simple changes in diet by reducing your salt intake and eliminating processed foods from your diet and trying to get a couple of hours of exercise a day can make a huge difference.
 
A healthy diet reduces the risk of coronary heart disease and prevents weight gain which puts pressure on your heart, the introduction of a healthy diet also helps to prevent further worsening of existing heart disease and it’s not too late to start eating healthily.
 
To help prevent heart disease here are five ways to change your lifestyle and take better care of your heart.

1. Follow the Mediterranean diet

A 2013 study showed the Mediterranean diet reduces the risk of coronary heart disease by 30% and prevents weight gain which puts pressure on your heart, the diet also helps to prevent further worsening of existing heart disease and it’s NEVER too late to start eating healthily. Recent attention has been drawn to the benefits of the Mediterranean diet by cardiologist Aseem Malhotra who has recently filmed the ‘Cereal Killers Movie’ about his quest to find out the secret to a long life in the Mediterranean. Check it out here.

2.  Reduce salt
 
Too much salt can cause high blood pressure, which increases the risk of developing coronary heart disease. Reduce your consumption of crisps, take aways, packaged snack foods and processed sauces. As a cardiac nurse this is one of the biggest misconceptions people have – they think if they don’t add salt to their food then their diet is low in salt.  However salt is hidden in so many things you wouldn’t even think – cans of tuna, ham, tomato paste and roasted peanuts.  Always check the label – if a serving size contains more than 10% of your daily recommended intake, avoid or reduce the amount you have.

3.  Say no to processed foods
 
There are lots of hidden saturated fats, sugars and salts in processed food, fast food and ready meals.  Even foods that may appear ‘healthy’ traditional meals such as lasagne are usually made with cheap ingredients and are laden with salt. I would strongly advise people to check the content of the ingredients of any food they buy and start cooking from scratch together – it’s more fun too!

4.  Quit smoking
 
Smokers are twice as likely as non-smokers to have heart disease with all the health issues it causes it is the most important thing you can do for your heart. Try a nicotine replacement to reduce your cravings – electronic cigarettes, patches, gum or lozenges are a great help when you’re quitting.

5.  Exercise more

The heart is the most important muscle and just a small amount of exercise will keep it functioning properly. Exercising for as little as ten minutes a day can make a huge difference. If you haven’t exercised for some time start out with gentle walking and build up – we should be aiming for a minimum of 30 minutes of exercise 5 days per week.

Aim to improve in one of the above areas each week and you’ll soon be on your way to a healthy heart.

Let me know if you have any specific questions at all!

Exercise of the week - Tricep Dips

1.  Sit up straight on the long edge of a stable, heavy chair or a bench. Your legs should be slightly extended, with your feet flat on the floor.
2. Place your hands on both sides of the bench just outside your thighs. Your palms should be down, fingertips pointing towards the floor.
3. Without moving your legs, bring your bottom forward off the bench.
4. Steadily lower yourself. Beginners: Bend your elbows 1-2 inches and push yourself back up. Advanced: When your elbows form 90˚ angles, push yourself back up to starting position.
5. Repeat up to 10 reps, rest and then repeat up to 2-3 times.

Some people find that this exercise is too much on their wrist joints. If so, you may need to change the exercise to triceps kickbacks, which we will cover in the next couple of weeks.

Do let me know if you have any questions at all!

Exercising safely with a heart condition

I can't believe it's the end of January already. How did the first month go for you? Did you have a look at setting some goals (not NY resolutions, but long term goals for the whole year)? Even if it feels like your goals are so far away from where you are right now, you'll be surprised how much you will achieve over the course of a year.

Some ideas for goals are:

• Double the distance that I can currently walk in 3 months eg if you can walk 5000 steps per day without feeling too tired, aim to be doing 10000 in 3 months time.
• Go down 1-2 belt notches in 2 months time.
• Do my 15 minute exercise routine at home every day.
• Stop using technology in bed so that my sleep improves.
• Eat more vegetables with every meal.
• Say no to sugary desserts 9 times out of 10 (you're allowed some treats every now and then!).

What are your goals?

Don't forget to join my Health Hearties Facebook group here - we now have over 160 members who give helpful tips and advice about all things heart related including exercise, medications, diet and more. Come join us!

Heart tip of the week

There is almost no disease that exercise doesn't benefit from regular exercise. As such, if you've had a heart attack, have heart failure, an arrhythmia or other heart disease, doesn't mean that you can't do regular exercise (even if you don't feel like it right now!). In fact, with regular exercise (greater than 150 minutes a week), you can improve your recovery, improve heart function and even get off of some of the medications you're on.

Cardiovascular benefits of exercise include:

• Strengthening your heart and cardiovascular system
• Improving your circulation and helping your body use oxygen better
• Improving heart failure symptoms
• Lowering blood pressure
• Improving cholesterol levels

Make sure that you get the "OK" and some guidelines from your doctor before you start.

Important things to know about exercising with a heart condition

• Avoid isometric exercises such as pushups and sit-ups. Isometric exercises involve straining muscles against other muscles or an immovable object and often causes you to hold your breath, which increases your blood pressure.
• Avoid exercises that involve pushing heavy weights above your heard eg shoulder press. This causes an increase in thoracic pressure and can increase your blood pressure.

• Don't exercise outdoors when it is extremely cold, hot or humid without checking with your doctor first. High humidity may cause you to tire more quickly and become dehydrated. Extreme temperatures can interfere with circulation, make breathing difficult and cause chest pain. Better choices are indoor activities such as a circuit or using a treadmill.

• Make sure you stay hydrated. It is important to drink water even before you feel thirsty, aiming for around 500ml per hour of exercise. But, be careful not to drink too much water if you have heart failure - check with your doctor if you should be limiting the amount you drink.

• If your exercise program has been interrupted for more than a few days (for example, due to illness, holiday or bad weather), make sure you ease back into the routine. Start with a reduced level of activity, and gradually increase it until you are back where you started.

Precautions

• Do not exercise if you are not feeling well or were very recently ill. You should wait a few days after all symptoms disappear before restarting the exercise program. If uncertain, check with your doctor first.
• Don't exercise if you have very high blood pressure - it needs to be under control/treated first.
• Don't exercise if you have unstable angina or are waiting for test results or treatment.
• Reduce the intensity of the exercise, slow down or stop and rest if you become overly fatigued or short of breath. Discuss the symptoms with your doctor if they have become worse than previously.
• If you have persistent shortness of breath, rest and call your doctor. The doctor may make changes in medications, diet or fluid restrictions.
• Slow down or stop the exercise if you develop a rapid or irregular heartbeat. Check your pulse after you have rested for 15 minutes. If it remains above 120 beats per minute at rest, call your doctor. If you have an arrhythmia, it is safe to exercise however aim to work at an intensity just below where you start to feel breathless.
• If you experience pain, don't ignore it. If you have chest pain or pain anywhere else in the body, slow down and then stop the exercise. If you have a GTN spray, use it and wait 5 mins. If the pain subsides, you can resume the exercise if you feel able. If the chest pain continues, take up to 3 doses of GTN spray and if chest pain persists call an ambulance.

Exercises to include

• Walking - build it up gradually. Get a step counter/activity tracker to keep track of how much you are doing so that you can see an improvement. Aim to add around 10% extra each week. E.g if you currently can do 2500 steps per day, aim for 2750 per day next week. Here is an easy step counter you can use, or use the free app on your iphone, or if you want something more high tech, the new Fitbit looks good: check it out here.
• Create an indoor circuit. Aim to do each exercise for 30 seconds. To make things easier, start by doing the exercises seated. To make them harder, add in hand weights (use food cans to begin with and then you could buy a set of small weights, these ones are good). Choose from:
  • Marching on the spot
  • Heel raises
  • Sit to stand or squat
  • Bicep curl
  • Arm raises out to the side
  • High knees
  • Wall press up
  • Tricep kickbacks
• See if there is a phase 4 cardiac rehab class in your area that you can join in. Search for one here: http://phase-4.cardiac-rehabilitation.net/

Let me know if you have any questions at all!

Running with a heart condition

Good morning and happy Wednesday! I can't believe we are more than half way through November already. Oh and apparently there are only 5 Mondays until Christmas. Who's counting! There are a few problems with this:

A) I haven't bought any presents yet
B) I have no idea what to buy
C) When I did attempt to go shopping the other day I wandered aimlessly not having any inspiration at all.

There must be something to be said about last minute shopping panic mode - it forces you to get your act together! Anyway I'm off tonight for a special 20% off sale at a big department store nearby - let's hope there's hardly anyone there and I don't end up simply buying things for myself.....Fat chance of either happening?!

I digress. This week I want to talk all about running. As you may know, I love running. Having done a few marathons, a lot of trots down the river and back and a few ParkRuns(check it out if you haven't heard of it - BRILLIANT free run every Saturday morning all around the world!).

Running when you have a heart condition can be scary, overwhelming and something that you may think can never happen again. However this isn't the case. If you have been given the ok from your consultant to exercise again, there is no reason that you can't safely build up your fitness (both body and heart) to be able to jog/run again. So you may not be the fastest anymore (who needs to be) but if it's what you enjoy, then let's try to get back out there!

The below also applies if you haven't exercised for a while and would like to ease back into running.

By the way, don't forget to join my brand new group - Healthy Hearties! It has tips/advice/feedback from others who have a heart or health condition. We've almost got 100 members already in just 2 weeks! 

Below I've put the key things to focus on when getting back into running with a heart condition. Remember to always check with your doctor to find out what level of exercise is safe for you.

The following tips are relevant to anyone who would like to improve their running, for those who do and don't have a heart condition. After all, training smarter can definitely help us all!

The below focuses on an aerobic workout. This means that you body is able to use oxygen as it's fuel source. This allows enough oxygen to get to your muscles without reducing the oxygen available to the heart (our main priority).

If you feel out of breath, have any sensation of pain or feel uncomfortable, please slow down, rest and either try another time or see your doctor for more advice.

1.  Always perform a warm up - this applies to walking as an exercise as well as running. To do a proper warm up:

• Allow at least 10-15 minutes at the beginning of your workout.

• Start out at a slow walking pace - slower than your normal walking speed (or start by marching on the spot).

• After about 5 minutes, bring the speed up to your normal (comfortable) walking speed.

• After 10 minutes, begin to walk at a faster pace, slighter faster than before.

• After 15 minutes, walk at a faster speed and swing your arms in exaggerated movements by your sides.  You are now ready to begin the jogging section (or stick with the faster walking speed until you feel ready to add some jogging in).

2.  Watch your intensity. You can do this in a few ways:

• Do the talk test - at the beginning of your warm up you should be able to talk in full sentences.

• By the end of your warm up, you should still be able to have a conversation and be able to say 7-8 words at a time without pausing for breath.

• For the jogging component you should be able to say at least 5-6 words without pausing for breath (we are focusing on aerobic exercise so will not be pushing it any harder than this). If you are alone try singing to make sure you aren't working too hard!

• Get a heart rate monitor. These can act as a great tool to monitor the intensity of your workout. Your individual heart rate is based on your age, medications and genetics so I can't give you the exact heart rate to target. As a rough guide, your heart rate at the end of your warm up, when you are feeling like you are working fairly hard but can still say at least 5-6 words, is about 60% (6/10 effort) of your maximum heart rate zone. Ideally you wouldn't go above 70% (7/10 effort) when you are working aerobically as this starts to reduce the oxygen available. Here is the one that I use with all of my one to one clients: Polar FT7 or Polar FT4. If you want one that does the distance travelled it will need to have a GPS and thus becomes more expensive. Here is a Garmin one that is highly rated.

3.   Build up the jogging gradually. If you haven't run for a while, you will need to start with a walk/jog/walk method. Here's how:

• Complete your 15 minute warm up.

• When you feel ready, start your first jog. It doesn't matter how fast it is, just pick the feet up and move a bit quicker than your walk. It is better to start out slow than to sprint and run out of energy. You are aiming to work at about 6-7/10 (10 being an all out sprint).

• Aim for 20-30 seconds of jogging.

• Slow back down to a walk and recover until you feel ready to jog again. This may take a few minutes, so take as long as you need.

• Repeat. For your first few jogs, you may want to stick with 2 or 3 jogging sets. Build it up gradually over the weeks.

• Eventually, you will feel more comfortable to increase the amount of time jogging and reduce the amount of time walking in between. There is no rush to do this, only when you feel ready.

• Your goal is to complete slightly more each week, unless you are feeling unwell, tired etc. In which case it is better to complete the exercise walking and get some rest, coming back out when you feel better.

• For some their goal may be to be able to jog for 5 minutes without stopping. Others may want to build up to running 5km, 10km etc. It is all dependent on your personal goals and how able your heart is to cope with the increased demands. For some their fitness will increase very gradually, other may see an improvement quite quickly.

4.  Stay close to home. This means that if you get tired you are never too far away. Also, tell someone what your plans are and what route you plan to go.

5.  Always cool down. Take at least 10-15 minutes to reverse the warm up - start by walking briskly at the end of your jogging, gradually slowing the pace until you are walking very slowly by the time you finish. This is a crucial step that is often overlooked. It is essential to ensure that blood in the muscles is returned to the circulation, waste products created from the muscles are moved into the lymph to be cleared and to return the heart rate towards its resting rate gradually, helping to prevent arrhythmias. 

6.  Stretch!!!  Often forgotten, never should be. Stretching helps to release the muscle fibres that have tightened whilst you were exercising. This helps to reduce muscle soreness and prevent injury the next time you exercise.

Don't exercise if you:

1. Feel unwell

2. Have a fever

3. Have very high blood pressure - it needs to be under control/treated first

4. Have unstable angina

5. Are waiting for test results or treatment

All of the above is based on an average. Please do get in touch if you'd like more information specific to you. Don't forget to ask your doctor for clearance before starting any new exercise programme.

Kind regards,

Angela Hartley

Cardiac Specialist Nurse, Exercise Coach

Please note that the information provided is a guide only and does not take into account your individual circumstances. Please seek advice from a medical professional before commencing any exercise programme or new diet.

Tea on the green...

Good morning and Happy Wednesday!

I hope you are having a great week so far. Did you watch the US Presidential Debate? What did you think? Staying up until 3am watching it was certainly different to my usual choice of television (Grey's Anatomy, Home and Away, Location Location Location). Yes guilty of watching rubbish so thought I'd try to understand more about the Presidential race. I still don't understand it! Seems to have become a media race to see who has more 'pizazz' more than anything. Let me know if you predict Trump to win and what you predict will happen if he does! To use some of Trump's fabulous words - I'm not trying to be Bragalicious but I'm getting really busy! Do speak to me if you'd like some extra support with your exercise or nutrition. I'd love to help you in a Bigly way. Isn't he just great for entertainment value?!

This week's I am talking all about green tea and it's benefits. I've also put in a great exercise for your arms and of course the Heart Fact of the Week.

Have a fab week and keep sending me your ideas please!
 

Food of the week

Green tea

This week's 'Food of the Week' is actually a drink – Green Tea.

All types of tea come from the camellia sinensis plant.  The differences stem from the way the leaves are dried and processed.  The key active ingredients in green tea leaves are called flavonoids; they belong to the catechin family, which is a powerful antioxidant.     

In some tests, catechins were found to be more powerful than vitamins C and E in halting oxidative damage to cells and appear to have other disease-fighting properties.  

Additional benefits include:

1. May bring down your heart disease and cancer risk: Green tea’s powerful antioxidants have been found to reduce some types of lung cancer, prostate cancer, skin cancer, stroke and heart attack risks. To add an extra boost, squeeze in a lemon — the vitamin C helps your body absorb more of the antioxidants.
2. Lower your cholesterol and blood pressure: Three cups a day has been shown to help bring down blood pressure and cholesterol when used in combination with a healthy diet.
3. Help you lose weight faster. Drink a cup before your workout and you might boost your fat burn. Studies suggest that the caffeine frees fatty acids so you can burn fat more easily. The tea’s antioxidants might also work together with the caffeine to help you burn more calories.
4. Prevent arthritis. Imbibing green tea daily might help keep your joints healthy, preliminary research suggests.
5. Keep allergies at bay. Japanese researchers found that the compound EGCG (the same one that might fight hepatitis C) found in green tea may help stop your body from reacting to allergens like pollen, pet dander and dust.

6. Less caffeine than coffee:  One cup of green tea contains around 25mg of caffeine compared to 100-150mg per cup of coffee.

In all of the studies on green tea, the tea-drinking group were consuming 3-5 cups per day.  This may be difficult to achieve, so start with one cup per day and work up to replacing a few teas or coffees with green tea throughout the week.  If you aren't sure about the taste, try adding a squeeze of lemon.

A note about medications:
 

Blood Thinning Medications (Including Aspirin) -- People who take warfarin, a blood thinning medication, should not drink green tea. Since green tea contains vitamin K, it can make warfarin less effective. Meanwhile, you should not mix green tea and aspirin because they both prevent platelets from clotting. Using the two together may increase your risk of bleeding.
https://nccih.nih.gov/health/greentea
 

Exercise of the Week

Seated Row

The seated row is one of the most effective exercises for targeting your back muscles.  Because this exercise is a compound exercise, involving more than one joint, it also activates several other muscles as well.  The main muscles you will activate include your erector spinae in your lower back, your middle and lower trapezius in your upper back, your rhomboids and latissimus dorsi in your middle back and your teres major in your outer back. You will also strengthen your shoulder muscles, your biceps and your chest.

How to perform:

1. Sit on a chair or bench with your knees bent and feet flat on the ground.  Use either a resistance band around a pole (or have someone hold the middle of the band for you) or a cable machine if you have access to a gym.
2. Keep your back straight and hold one handle in each hand with your palms facing each other and thumbs wrapped around the handles. Your armsshould be straight and your shoulders pulled back and down.
3. Engage your core and abdominal muscles. Keep the spine as tall and straight as possible.
4. Pull the handles towards you, bending at the elbows until the handles reach your sides. Keep your elbows close to your body. Do not lean back from the hips, arch your back or shrug your shoulders during your pull.
5. Squeeze the shoulder blades together at the end of the movement.
6. Slowly straighten your elbows to return to starting position. Do not allow your torso to round or your shoulders to shift forward.
7. Repeat 10-12 times and perform 3 sets.

et me know if you have any questions at all.

Have a great week!

Week 2 with Mike!

His heart approves!

Welcome to our Week 2 update all about Mike, who has started his new exercise regime and has a new bounce in his step after just one week. That's what more confidence can do for you and I'm so happy that he's feeling much more positive this week.

If you missed week 1 and want to know more about why Mike has started training with me (he has AF) and what the Week 1 assessment looked like, click HERE to read all about it.

Last week's homework for Mike was pretty straightforward, all he had to do was wear a step counter every day for a week and then I would take a look at what his 'everyday' activity levels looked like. This is the step counter I always recommend as it's cheap, the battery lasts for ages and it stores 7 days worth of steps.

The steps that Mike had done over the last week really varied. On sunday when it rained all day, he did 2000 steps, however on Tuesday which was a beautiful day, he hit 11,000! The average over the entire week was 7000, which is a great start and means that Mike is actually much more active than he thought. Mike's target to hit over the coming weeks is a daily average of 10,000. It is different for every person, however I believe that 10,000 is a realistic target based on what he's already doing.

For this week's session, we didn't need to do any big assessments or lots of talking - although there is always lots of questions from me throughout! We did a quick blood pressure and heart rate check and I looked at Mike's AliveCor readings for the last week. AliveCor is a fabulous little machine that you stick to your iphone and it can tell you what your heart rhythm is doing and whether you are in AF. They are a nifty little device and I alway recommend people with rhythm problems, particularly AF, to get one. You can buy them cheaply here.

Unfortunately the AliveCor showed that Mike has still been having regular bouts of AF. He could tell when he was in AF as he felt more tired and had less motivation to do things. This is one of the common complaints of AF - as the heart has to work harder to pump blood around the body, and the heart rate is higher than normal, it makes you feel more tired, like you've been running a marathon all day!For Mike his AF spontaneously came and went. We looked at some common triggers (alcohol, caffeine, stress) however he couldn't say one particular thing set it off.

Mike was in AF during our session. This means that he can still exercise, however the most important thing is we keep an eye out for his energy levels, his breathing and his blood pressure. It is safe to exercise when in AF and in fact, just walking around doing your every day activity is exercise, so don't lose hope that you can do more!

We started out slowly, getting warmed up for 10 minutes before moving on to some great exercises for the lower body. The legs have the biggest muscles in the body, so by building leg muscle, it helps to burn more body fat, supports the whole body, gives you more energy when out walking and makes the body feel stronger and improves your posture.

During the session, if Mike became uncomfortable with his breathing, we slowed things down without stopping. This meant that he could catch his breath, feel more comfortable and then increase again. We aimed to build up to working at an intensity of 6 out of 10, with 10 being the maximum effort he could imagine. A 6 should feel like you are working but comfortable. 

I always encourage people to leave some 'fuel in the tank' and so we never aim to finish a session exhausted. It's important that they can get on with their day and complete their normal every day activities without feeling wiped out.

This week's homework is to replicate the session we did once over the next week, as well as aiming to walk an average of 7500 steps every day. I've reminded Mike that if he feels tired, he should always choose rest over pushing himself and can always do something the following day. 

Next week: we aim to build up to 35 minutes of exercise and will add in some upper body exercises that he can do without any equipment at home.

Making exercise realistic is all part of the fun, there's no point having fancy equipment if you hate using it!

Mike's journey - week 1

Meet Mike - he's your typical British gentleman, opening doors for ladies, offering cups of tea on arrival and generally an all round nice guy. Only thing is - his confidence has been shaken. Badly. He retired two years ago from running a successful dental practice and was enjoying the new freedom that not having to work brings - games of golf every Wednesday, laps of the pool each morning and visiting old friends in new countries.

Until April this year Mike felt great - everything was going to plan and he had a deposit down for a month long cruise Russia and Japan booked. He didn't look in bad shape for his age (70) and his wife was busy planning their social calendar for the summer.

In late April, however, after a two day dental conference in London (just keeping in touch with old colleagues and on top of new trends), Mike returned home to his house in Surrey and was gripped with a strange sensation when he walked through the front door. At first he thought he was having a heart attack, as something was not right with his heart. Being in the medical profession he has all manor of gadgets in the house and so took his blood pressure and pulse. His blood pressure was pretty good - 130/80, nothing to get worried about. However his pulse was unreadable on the machine. His wife took it manually and found it was very difficult to count. In fact, it was going so fast and wasn't regular at all so she couldn't count it quick enough. 

Mike could feel the thumping of his heart rate in his chest and knew that it was most likely he was in an irregular heart rhythm. A trip to the GP (lucky they could squeeze him in that afternoon) and an ECG showed that Mike was in Atrial Fibrillation. Often called AF, it is the most common heart arrhythmia in the UK, with up to 1 million people in the UK who are affected.

You can read more about what AF is, what the symptoms are and how it can be treated here.

Atrial fibrillation isn't usually life-threatening, but it can be uncomfortable and often requires treatment.  Treatment may involve: 

• medication to prevent a stroke (people with atrial fibrillation are more at risk of having a stroke)
• medication to control the heart rate or rhythm
• cardioversion – where the heart is given a controlled electric shock to restore normal rhythm
• catheter ablation – where the area inside the heart that's causing the abnormal heart rhythm is destroyed using radiofrequency energy

Mike was given blood thinners to prevents stroke, a beta blocker to reduce his heart rate and amioderone to control the rhythm. After a few days Mike felt a lot better and started to return to his normal activities. However he never felt confident enough to return to exercise.

After a few months of the AF coming back every few days, Mike decided to have the AF treated with ablation, a procedure that requires a one night hospital stay and two weeks recovery. The procedure was a success and Mike was told he was safe to return to his normal life, including exercise.

That is where I came in. After the ablation, Mike wasn't sure where to start. He had the motivation to exercise, but was missing the confidence and knowledge of how, when and for how long to exercise.

This week was a fact finding session - we did a lot of talking, goal setting and really getting to the nitty gritty of what Mike would like to achieve. He had a lot of questions about the ablation, medications and what exercise would be realistic to return to. 

We now have a plan in place - I'm very much looking forward to helping Mike get up and going. He already has his homework for this week (wear a step counter every day to see how much incidental activity he is doing) and our first session will involve a little bit of cardio and a little bit of weights. Within 6 weeks Mike will feel so much more confident about exercising himself and within 12 weeks he will feel a new man. 

I look forward to keeping you posted on how Mike gets on!

Read all about Week 2 HERE!

p.s this isn't a picture of Mike. Although he does have great teeth!

What are my top 5 HEART HEALTH TIPS?

Good morning and Happy Thursday! I hope you've had a great week so far. We've had a busy week here at Clinical Exercise - lots of new enquiries, a HUGE batch cooking session on Monday (fish pie, fish chowder and fish cakes - yes a lot of fish this week!) and an old client has returned from overseas and is getting restarted on his exercise programme.

This week I'm talking all about Heart Health - obviously I'm always talking about heart health but I wanted to really focus on what you can do to ensure you are reducing your risk of having future heart problems.

There are so many do's and don'ts to look after your heart - below are the top 5 things you should be doing to ensure your heart is in tip top condition.

Also, a simple exercise that you can do any time of day to tone up the back of your arms - easy!

Looking after your heart
(It's the only one you've got!)

Cardiovascular disease (heart disease) is the world’s biggest killer, causing over 17 million deaths a year and many of these deaths are preventable through lifestyle changes.

Most people know someone or have themselves been directly affected by heart disease and a lot of times it is avoidable by changing lifestyle habits. If you've had heart problems in the past it's never to late to make improvements to improve your health for the future.

Simple changes in diet by reducing your salt intake and eliminating processed foods from your diet and trying to get a couple of hours of exercise a day can make a huge difference.
 
A healthy diet reduces the risk of coronary heart disease and prevents weight gain which puts pressure on your heart, the introduction of a healthy diet also helps to prevent further worsening of existing heart disease and it’s not too late to start eating healthily.
 
To help prevent heart disease here are five ways to change your lifestyle and take better care of your heart.

 
1. Follow the Mediterranean diet
 
A 2013 study showed the Mediterranean diet reduces the risk of coronary heart disease by 30% and prevents weight gain which puts pressure on your heart, the diet also helps to prevent further worsening of existing heart disease and it’s NEVER too late to start eating healthily. Recent attention has been drawn to the benefits of the Mediterranean diet by cardiologist Aseem Malhotra who has recently filmed the ‘Cereal Killers Movie’ about his quest to find out the secret to a long life in the Mediterranean. Check it out here.

2. Reduce salt
 
Too much salt can cause high blood pressure, which increases the risk of developing coronary heart disease. Reduce your consumption of crisps, take aways, packaged snack foods and processed sauces. As a cardiac nurse this is one of the biggest misconceptions people have – they think if they don’t add salt to their food then their diet is low in salt.  However salt is hidden in so many things you wouldn’t even think – cans of tuna, ham, tomato paste and roasted peanuts.  Always check the label – if a serving size contains more than 10% of your daily recommended intake, avoid or reduce the amount you have.

3. Say no to processed foods
 
There are lots of hidden saturated fats, sugars and salts in processed food, fast food and ready meals.  Even foods that may appear ‘healthy’ traditional meals such as lasagne are usually made with cheap ingredients and are laden with salt. I would strongly advise people to check the content of the ingredients of any food they buy and start cooking from scratch together – it’s more fun too!

4. Quit smoking

 
Smokers are twice as likely as non-smokers to have heart disease with all the health issues it causes it is the most important thing you can do for your heart. Try a nicotine replacement to reduce your cravings – electronic cigarettes, patches, gum or lozenges are a great help when you’re quitting.

5. Exercise more
The heart is the most important muscle and just a small amount of exercise will keep it functioning properly. Exercising for as little as ten minutes a day can make a huge difference. If you haven’t exercised for some time start out with gentle walking and build up – we should be aiming for a minimum of 30 minutes of exercise 5 days per week.

Aim to improve in one of the above areas each week and you’ll soon be on your way to a healthy heart.

Let me know if you have any specific questions at all!
 

Exercise of the week - Tricep Dips

1.  Sit up straight on the long edge of a stable, heavy chair or a bench. Your legs should be slightly extended, with your feet flat on the floor.
2. Place your hands on both sides of the bench just outside your thighs. Your palms should be down, fingertips pointing towards the floor.
3. Without moving your legs, bring your bottom forward off the bench.
4. Steadily lower yourself. Beginners: Bend your elbows 1-2 inches and push yourself back up. Advanced: When your elbows form 90˚ angles, push yourself back up to starting position.
5. Repeat up to 10 reps, rest and then repeat up to 2-3 times.

Some people find that this exercise is too much on their wrist joints. If so, you may need to change the exercise to overhead triceps extensions, which we will cover in the next couple of weeks.

Do let me know if you have any questions at all!

It's getting hot - coping with the heat when you have a heart condition

Wow! It's hot in here. It's hot on the train, it's hot inside, it's hot outside... It seems like we've been waiting for this moment for MONTHS and now... it's TOO HOT!

Just joking, I know it will only last a few days so I shouldn't complain.

Here's an article from the front of the Aussie news making fun of our 'hottest day': http://www.news.com.au/technology/environment/its-summer-in-the-uk-and-brits-cannot-handle-the-heat/news-story/38fb25e1559d07714347c0ca8ef25c27

This week is all about keeping your cool in the hot weather. This is especially important if you have any health condition, especially high blood pressure, angina or heart failure.

Let me know how the heat affects you and if you have any specific questions about your exercise regime when it's hot.
 

Keeping your cool during summer

When the weather is hot you sweat to cool down, but this means that you lose more fluid than usual from your body. This can drop your blood pressure and make your heart beat faster. This is not a problem for most people as long as they drink plenty of fluids, like water or other sugar-free drinks to keep from getting dehydrated.

However, if you have a heart or health condition, extreme heat may place an extra burden on your heart and circulation, so it’s particularly important to stay cool and look after yourself. 

What can you do to keep cool?

• Keep hydrated by drinking plenty of water or other sugar-free drinks (Though if you've been told to restrict your fluid intake for medical reasons you should speak to your GP)  
• Avoid drinking too many alcoholic or caffeinated drinks.  Caffeine-based and alcoholic drinks can cause you to lose more fluid from your body.
• Eat cold foods, particularly salads and fruit with a high water content.
• Make sure your home is cool when you're staying indoors. Close curtains during the day to keep the heat out and then open when the sun sets to let cool air in. Use a fan with a wet cloth draped over to cool the room down.
• Wear light, loose-fitting cotton clothes.
• Stay out of the heat in the hottest part of the day between 11am and 3pm.
• If you have to go out in the heat, walk in the shade, apply sunscreen and wear a hat
• Avoid extreme physical exertion. Perform any exercise sessions at the coolest part of the day or in an air conditioned room.

HEART FACT OF THE WEEK

Hot weather and heart conditions

Angina

If you have coronary heart disease, you may find you start to experience angina or your angina worsens during hot weather, because hot weather increases the workload on your heart and the demand for oxygen, especially when you are more active. 

Heart failure

It’s particularly important to stay cool if you have heart failure - where your heart doesn't pump as well as it should. If you’ve been told to restrict your fluid intake, speak to your GP about other ways to keep cool during summer.  If you take water tablets and start to feel dizzy or light headed let your doctor know. Your dose can then be reduced or stopped for a little while, if needed, until you feel better.

Heat stroke

Losing too much body fluid can increase your internal body temperature, which could be life-threatening if left untreated. 

Symptoms of heat stroke include sweating, cold clammy skin, dizziness, fainting, muscle cramps, heat rash, oedema (swelling) in the ankles, shallow or fast breathing, nausea and vomiting. 

If you suspect that you or someone else has heat stroke, get medical attention immediately.

Who is most at risk?

Elderly people and very young children have more difficulty in regulating their temperature and so can be more at risk from extreme temperatures. In hot weather, check on your friends and relatives regularly to make sure they are cool and comfortable.

Let me know if you have any questions at all!

Stay cool and have a great week!

Sunshine, strawberries and do's and don'ts of exercise

Good afternoon and Happy Wednesday! What a weekend - I hope you had a good one and enjoyed watching Murray win Wimbledon again! What a great match and a great pick me up for the country.

Speaking of Wimbledon, this week's food of the week is the strawberry. We are now in strawberry season, which means that summer feeling is finally here.  As the season goes on, the strawberries get better and sweeter.  Check out http://www.eattheseasons.co.uk to see what other fruit and vegetables are in season at the moment.

Strawberries have been eaten since Roman times, when they were also used medicinally to help with digestive ailments, discoloured teeth and skin irritations. Strawberries are considered to be one of the healthiest fruits. They are packed with antioxidants, can help to lower blood pressure and protect your heart. Packed with essential vitamins and minerals, they are also sodium, cholesterol and fat free.  There is around 54 calories in 1 cup of strawberries which is 1/3 the amount of calories in a banana.
 
There are several health benefits to strawberries:
 
Can help to boost short term memory:  The anthocyanins in strawberries can help to boost short-term memory
Lower your risk of cardiovascular disease : Flavonoids which are responsible for the colour and flavour of strawberries have been found to help reduce damage to the lining of the arteries.
Promotes bone health : Strawberries contain potassium, vitamin K, and magnesium which are important for bone health.
Anti-aging properties: Strawberries contain biotin, which helps to build strong hair and nails. They also contains the antioxidant ellagic acid, which protects the elastic fibers in our skin to prevent sagging.
Good for weight loss: The compound nitrate found in strawberries which promotes blood flow and oxygen in the body helps with weight loss.
Promotes eye health:  Eating three or more servings of fruit like strawberries may lower the risk of macular degeneration.  

Enjoy them with some natural yoghurt rather than cream to make it healthier.

NEW!!!
HEART FACT OF THE WEEK

Exercise and your heart - do's and don'ts
When you have any type of heart condition - whether it be high blood pressure, high cholesterol, a previous heart attack or stroke, an arrhythmia or any other type of heart problem, you may have been told that you should exercise more to help improve your heart's fitness. However do you know which exercises are good and which ones you should avoid? I've summarised the 'Do's' and 'Don'ts' below. Please ask me for further information if you aren't sure about something.

Do's - What exercises are good for my heart?

• Walking - yes you've heard it before but walking is one of the best activities you can do - it helps to build up your fitness gradually and studies have shown that walking can help to heart attack, stroke and cancer (read more here). Aim to build up gradually - buy a step counter (this one is great), make a note of how many steps you do on a normal day (around the house, at work etc) and add 10% each week.
• Resistance exercise - building stronger muscles helps the heart to work more efficiently. Resistance exercise also helps to reduce bodyfat, strengthen the bones, improve blood sugar levels and increase your metabolism. Exercises to include are:
  • Squats - pretend like you are sitting back into a chair, lower yourself down keeping your bottom back. Push through the heels to return to standing. Repeat x 10.
  • Wall press. Stand 30cm from the wall. Place your hands against the wall, a few inches lower than your shoulders, a few inches wider than your armpits. Bend your elbows out to the side until your nose is a few inches from the wall. Press into the palms of your hands to straight the elbows. Repeat up to 10 times.
  • Other aerobic activity that you enjoy - choose swimming, cycling or dancing (or anything that you enjoy). The key is to always warm upwith 5-10 minutes of walking/marching on the spot to ensure you don't start any activity with cold muscles.

Don'ts - What exercises should I avoid?

• Any activity that feels too hard, makes you uncomfortable, gives you pain or is not enjoyable. The key to any exercise is that you should always be able to hold a conversation, without feeling like you are too breathless. If you feel like you can't catch your breath, slow down, rest and restart slower.
• Any exercise that makes you hold your breath - exercises like the plank or holding one position for a prolonged period. Holding your breath puts your blood pressure up very quickly.
• Using weights that are too heavy for you. You should be able to complete at least 10-15 reps. If you are struggling to push the weight then you are more likely to have poor technique and hold your breath (see last point).
• Moving from lying to standing very quickly - exercises like burpees, down/ups, press ups then jumping up etc. By moving from lying to standing very quickly your blood pressure has to make a rapid change to cope with the increased demands. It then increases rapidly and can make you feel dizzy/unwell. 

Do ask if you have any specific exercise you are worried about.

Have a great week!