2018 COACH Manual · exercises done after aerobic exercise are also beneficial. AEROBIC exercises require the body to use oxygen. Your heart pumps oxygen-rich blood to the rest of

COACH Heart Manual

Prepared for the COACH Program Health Care Professional Team. Please do not copy without permission.

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Exercise Guidelines Physical Activity Log

Benefits of Regular Physical Activity

Cardiac Symptoms that may occur during activity

Aerobic Exercise

FITT principle

Rating of Perceived Exertion (RPE)

Talk Test

MET Levels

Components of Exercise Session

Guidelines for Stretching

Guidelines for Resistance Training

Myths about exercise

Heat/Cool Weather

Hydration

Sedentary Behaviour

Goal Setting & Motivation

Community Programs

NOTES:

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Physical Activity Log DATE TYPE OF

ACTIVITY TIME IN MINUTES

INTENSITY RPE (1-10)

COMMENTS

Physical Activity Goal: Strive to progress over time to > 150 min/week

Total Week 1:

_________________

Total Week 2:

_______________

Total Week 3:

_________________

Recommendations based on: ACSM’s Guidelines for Exercise Testing and Prescription, 9th ed. 2014

2018 Canadian Exercise Guidelines, CSEP www.csep.ca

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Benefits of Regular Physical Activity

Improves Cardiovascular Risk Factors Smoking: Once you have adopted the healthful habit of regular exercise, it is more likely that smoking will become less desirable. Replace smoking habits with exercise habits! Elevated Cholesterol Levels: Regular exercise increases HDL (the good cholesterol). Healthy eating and weight loss helps to lower LDL (the bad cholesterol) and triglycerides. High Blood Pressure: Regular exercise has been shown to reduce your blood pressure by up to 5-10 mmHg. The combination of a healthy eating plan, regular exercise and weight loss can help control high blood pressure. Exercise provides a natural reduction in blood pressure for 24 hours after your workout. Diabetes: Regular exercise can help maintain blood sugars in a desirable range in diabetics. For those who take diabetic medications regular exercise usually results in decreased medication requirements. Increased Body Weight: Regular exercise and proper diet can help control weight. (ie. calories in vs calories out). Exercising more than 150 min/week has been shown to help maintain and reduce body weight. Decreasing abdominal fat through weight loss decreases cardiac risk. Stress: Regular exercise along with stress management can help reduce your stress levels. Exercise releases a natural “feel good” hormone called endorphins. Learning stress management techniques (i.e. meditation, deep breathing, and prayer) can help you reduce overall stress levels (see Stress Management section)

Increases Fitness/Endurance Level

Regular physical activity will improve your exercise tolerance. Strength & endurance will be enhanced as your muscles & circulation adapt to become more efficient when working.

When the muscle cell is put to work exercising, it requires oxygen for fuel and it must also rid itself of wastes (carbon dioxide/lactic acid). Over time, with regular aerobic exercise the chemical factors in the muscle cells that enhance this exchange will increase. The end result is that your heart does not have to pump as hard to get the oxygen rich blood to the exercising muscle, which in turn reduces the stress to your cardiac system.

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Another beneficial change that occurs with regular exercise is that the number of blood vessels (capillaries) that supply the muscles increases and overall circulation improves. Less demand is placed on your heart muscle and circulation to perform any given activity. Regular daily and recreational activities become easier to do so that you will be able to do more and feel better doing so.

Other Benefits of Exercise

There are numerous benefits of exercise that relate to many aspects of health. Listed are a few important ones:

• Reduce risk for osteoporosis (bone strength loss) – weight bearing activity can improve bone density levels i.e. walking, dancing, hiking

• Reduce risk for cancer (colon, breast cancer) • Help boost immune function- fight infections better • Psychological benefits – decrease anxiety, low to moderate levels of depression,

increase endorphins, energy, and improve sleep patterns • Improve posture, balance and decreases risk for falls.

• Improve respiratory (lungs) muscle strength & endurance

The bottom line is that participation in regular moderate to vigorous exercise can increase life expectancy and quality of

life!

Cardiac Symptoms that may occur with exercise

If you have stable angina*or claudication * or dyspnea * occurring during an activity you may find that participating in a regular exercise program can help improve these symptoms. The point at which you usually experience these symptoms may occur at higher levels of activity. In other words, the threshold for angina/claudication is pushed upwards allowing you to perform more activity safely and pain free.

It is always important to exercise below the point at which you experience angina or to stop/slow down activity when angina is present. As stated, over time the level at which this occurs may improve.

Stop & Rest when you experience:

1. Chest pain, pressure,

or discomfort that radiates into arms, neck jaw or back.

2. Shortness of breath. 3. Excessive or unusual

sweating. 4. Dizziness or

lightheadedness. 5. Nausea.

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* Angina is a symptom caused by lack of oxygen to the heart muscle due to lack of circulation or blockages in the coronary arteries. It may present as chest, arm, shoulder, upper or lower back, jaw pain / discomfort/ heaviness or it may feel like nausea, indigestion. It is termed stable when the onset of chest pain occurs consistently at a certain level of exertion and usually subsides with rest or nitroglycerin. Unstable angina is more serious and occurs at rest or when the regular pattern of pain changes. Your doctor should be notified if this occurs.

*Claudication is a symptom caused by lack of oxygen to the calf muscle usually due to poor circulation or artery blockages in the lower legs. When exercising with claudication symptoms it is advisable to exercise at a level where you feel the symptoms (calf soreness is moderately strong) and then stop, rest, stop, and rest and so on. The threshold will then improve over time. Weight bearing activity (i.e. walking) is the best activity to improve these symptoms although all other aerobic activities are good to do.

*Dyspnea (shortness of breath) with exercise may be symptom of chronic lung disease (COPD, emphysema, asthma), congestive heart failure, OR from general deconditioning. Regular exercise will help strengthen the muscles of your arms and legs, as well as the muscles that assist in breathing, ultimately making exercise and daily living easier! Practicing the technique of pursed lip breathing when sitting and resting can also help to increase your ability to breathe when exercising.

Pursed lip breathing exercise:

1. Relax your neck and shoulder muscles. 2. Breathe in for two seconds through your nose, keeping your mouth closed. 3. Breathe out for four seconds through pursed lips. If this is too long for you,

simply breathe out twice as long as you breathe in.

If prescribed nitroglycerin (NTG) and you experience chest pain/angina be sure to:

1. STOP activity and SIT DOWN. 2. If angina is still present, take 1-2 puffs

of NTG. Wait 5 min. 3. If angina is still present, take 1-2 puffs

of NTG. Wait 5 min. 4. If angina is still present, take 1-2 puffs

of NTG. Wait 5 min. 5. If pain is still presents after 3 sprays of

NTG call 911.

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Aerobic Exercise Regular aerobic exercise improves fitness, quality of life and has a favorable influence on other risk factors such as increased blood pressure, poor cholesterol, increased body weight, and diabetes. It is sometimes referred to as ‘cardio’ workout. In addition to providing the most health benefits, aerobic exercise is the most effective way to burn calories and lose fat weight. “Aerobic” activities increase the heart and breathing rate above resting levels and can be continued for at least 10 minutes at a time at a comfortable pace. Exercise sessions should include a warm up, conditioning phase and cool down time. Flexibility or stretching exercises done after aerobic exercise are also beneficial. AEROBIC exercises require the body to use oxygen. Your heart pumps oxygen-rich blood to the rest of your body. Since the heart itself is a muscle, aerobic exercise maintains and even increases your heart’s strength and endurance. Aerobic activities include:

¨ Walking ¨ Jogging (for some people) ¨ Cycling ¨ Swimming/water aerobics ¨ Skating

¨ Cross Country Skiing ¨ Rowing ¨ Aerobics exercise class ¨ Dancing

Other leisure activities are good to keep you active but may not be considered aerobic:

♥ Golf ♥ Bowling♥ Curling ♥ Gardening

The F.I.T.T Principle F Frequency How often do you exercise?

Work towards most days of week (5-7 days / week ), reaching 150 min/week. It is recommended that you exercise regularly to significantly improve your cardiovascular (heart & lungs) system, and reduce your cardiovascular risk.

I Intensity How do you feel while you exercise? Moderate intensity / 3-6 on the Rating of Perceived Exertion (RPE) scale (see RPE scale on next page). Monitor symptoms of increased heat rate, increased body temperature, shortness of breath (talk test), and comfort level. The level of exercise should not cause any discomfort, and you should be able to carry out a conversation as you do it.

T Time How long do you exercise? 20 to 60 minutes / session (include warm-up & cool-down). It is acceptable to accumulate minutes throughout the day. (ie. 2-3 sessions, 10 minutes each).

T Type What kind of exercise do you enjoy? *Aerobic in nature → Large muscle group activity → Continuous & rhythmical (non-stop) → Raises your heart rate above rest → Done for minimum of 10-15 minutes e.g. Walking, cycling, swimming, rowing, X- country skiing

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Intensity-‐ How hard to work? Rate of Perceived Exertion (RPE) Borg Scale RPE is a valuable tool to help determine how hard to work when exercising. It relies on how you FEEL when exercising taking into account how comfortable you are, how warm you are getting, and how long you think you can last. It is a safe and effective as relying on taking your own heart rate during exercise and keeping it to a target rate. An effective and comfortable exercise level for most people is about 3 to 6 for overall effort. Working above that level does not increase the benefits of exercise, but it does increase the risk of muscle and joint injuries. Therefore, find a place that is suitable for you! You should be breathing quicker, but still able to exercise and comfortably carry on a conversation.

Talk Test Remember the TALK TEST, while exercising. If you are so short of breath that you would have difficulty talking, then you have pushed yourself too hard. This high exercise intensity may put a strain on your heart, and can make your heart irritable. Slow down or reduce your workload if you experience extreme shortness of breath, especially when accompanied by angina.

0 Nothing at all (resting 1 Very Light 2 Light(stroll)-‐you could sing! 3 Moderate (comfortable) 4 Somewhat Heavy-‐you can talk! 5 Heavy (comfortable but working hard) 6 7 Very Heavy (uncomfortable, Hard work) 8 9 10 Very, very hard (almost maximum)

Always: • Work at your own pace. Don’t compete or make up for lost time. • Wear comfortable clothing and footwear. • Do not hold your breath during ANY exercise, ever. • Don’t put your head down below heart when exercising ie, tie shoe laces, fold forward • Take medications as prescribed. Take morning medications prior to exercise. Bring

your nitro spray (if prescribed) and keep it with you during exercise. • Watch for symptoms of: Dizziness or light-headedness, Nausea, Chest pain/any other

type of pain, Feeling excessively tired after a workout, excessively short of breath and sweating more than usual.

• If you feel ill DO NOT EXERCISE. This will do you little good and is potentially dangerous (i.e. Angina or Flu symptoms – REST is BEST!).

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MET levels (Metabolic Equivalents) One MET is the amount of energy (calories) your body uses each minute while resting quietly. The harder your body works during activity/exercise, the more oxygen is consumed, the higher the MET level. Most people feel comfortable working at 50-70% of their maximum M.E.T. level. Your M.E.T. level can be measured from your fitness assessment and regular exercise sessions. This information is used to help determine your personal exercise program. MET levels for certain common activities can be estimated and can be compared to your MET level to what kind of activities you like to do.

1 M.E.T = Body work at rest

See Met LEVEL guide: https://www.cdc.gov/nccdphp/dnpa/physical/pdf/pa_inten

sity_table_2_1.pdf

ACSM’s Resource Manual for Guideline for Exercise testing and Prescription, 7th

ed., 2013.

Physical Activity MET level Light Intensity Activities <3 Sleeping 0.9 Watching television 1.0 Making bed 2.0 Walking 2 mph, level, slow pace 2.5 Sweeping floors 2.5 Fishing in boat, sitting 2.5 Sexual Activity 2.0-‐5.0 Moderate Intensity Activities 3.0-‐6.0 Weight lifting (light to mod) 3.0 Ballroom Dancing (waltz, slow) 3.0 Biking stationary, 50W, light effort 3.0 Golf using power cart 3.5 Walking 3 mph, level, moderate pace 3.5 Water aerobics class 4.0 Yoga, Hatha (light) 4.0 Gardening (weeding) 4.5 Heavy cleaning (wash windows, mop) 4.5 Golf pulling clubs 5.0 Skiing downhill, light effort 5.0 Mowing Lawn, walking 5.5 Biking stationary, 100-‐150W, mod. Effort 5.5 Walking 3.5 mph, uphill 6.0 Hiking cross country 6.0 Chopping wood 6.0 Snow Shoveling (light) 6.0 Tennis (doubles/singles) 6.0/8.0 Vigorous Intensity Activities >6.0 Jogging 7.0-‐10.0 X-‐country skiing, slow 7.0 Biking 12-‐13 mph 8.0 Snow Shoveling (Heavy) 9.0 Running 6mph 10.0 Squash 12.0

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Components of Exercise Session

Warm up: 5-10 minutes of activity at a slow easy pace whereby you gradually increase your intensity to your conditioning phase. The purpose of a warm up is to prepare your body (and your heart) for a more demanding workload. This is an essential component to any exercise program. An appropriate warm up opens blood vessels to increase blood flow to the exercising muscles. It enhances the release of oxygen to the tissues, while increasing body temperature. A warm up also helps reduce injuries because warm and relaxed muscles are less likely to tear during vigorous exercise. A proper warm up may also decrease angina, and dangerous arrhythmias.

Conditioning phase: 20 to 60 minutes of continuous aerobic activity at your training intensity (refer to previous Intensity section-RPE 3-6).

Cool Down: 5 -10 minutes of gradually slowing down to an easy workload. The purposes of a cool down are to safely and gradually allow the heart and lungs system to return to a resting state and alleviate any immediate or delayed muscle soreness. Stopping quickly after exercise causes blood to pool in the legs, which may lead to dizziness due to inadequate blood flow to the brain. Muscles may begin to cramp as they begin to cool and promote post-workout muscle tenderness. To avoid these situations, continue to walk slowly for several minutes after exercising, until your heart rate approaches your pre-exercising level. Skipping the cool down is associated with cardiovascular complications including angina, and arrhythmias. The last part of your cool down should include stretching exercises. You will probably note that stretching is more comfortable during the cool down due to an increase in body temperature. The cool down is therefore, the best time to work on flexibility.

Time in Conditioning Phase (10-40 min)

Warm Up (5-10 min) Cool Down (5-‐10 min)

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Guidelines for Stretching

The F.I.T.T. Principle for Flexibility:

F Frequency Stretching may be done everyday and should be a part of each aerobic workout (Stretch when muscles are warm).

I Intensity Stretch to the level of tightness, NOT pain.

T Time 1-3 sets of 8-10 stretches (all major muscle groups).

T Type Slow, controlled, non-bouncy stretching movement that allow the muscle to relax (held for 30-60 seconds).

3 Basic Walking Stretches

Hamstring Stretch: Come to edge of chair & stretch one leg out straight. Keeping back straight, chest open and bend forward at hip. Feel stretch at back of thigh.

Calf Stretch: Back heel stays down, back leg straight; toes point forward, ease into front leg bending at the knee until you feel the stretch in the back calf.

Quadricep Stretch: Keep knees together with thighs parallel. Push hip forward to stretch front of thigh.

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Guidelines for Resistance Training

The F.I.T.T. Principle for Resistance Training F

Frequency Each major muscle group should be trained 2-3 days per week.

I Intensity Monitor any symptoms and work at an RPE or 3-6. The weight should be easy enough to complete 1 set of 10-12 repetitions with the last few reps becoming difficult but comfortable with proper position maintained. Increase the weight in 2-5 lb. increments once you can do 10-15 repetitions easily. Stay at the new weight for at least 1-2 weeks before progressing.

T Time No specific duration of training has been identified for effectiveness.

T Type Dynamic (moving) exercises should be chosen. Avoid isometric (non-moving) exercises, as these tend to raise blood pressure. Movement should be slow, controlled & steady. The resistance chosen may be with equipment such as hand weights or thera-band tubing or against body resistance (ie. wall push up).

Repetitions 10 to 15 repetitions is effective in improving strength. Sets 2-3 sets are recommended for most adults to improve

strength and power. A single set of resistance exercise can be effective especially among older and novice exercisers.

Patterns Rest intervals of 2-3 minutes between each set of repetitions

are effective. A rest of > 48 hours between sessions for any single muscle group is recommended.

Progression A gradual progression of greater resistance, and/or more

repetitions per set, and/or increasing frequency is recommended.

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When to start Resistance Training? Patients, who have experienced open-heart surgery (sternum/breast bone opened), have the greatest length of time required for recovery. It takes about 8 weeks for adequate bone healing to achieve adequate sternum stability/healing. Several factors may increase the healing time required for the sternum such as diabetes, obesity, immunosuppressive therapy, advanced age, and osteoporosis, increasing the recovery time to 12 weeks. Because each person differs in muscular strength and other factors that may affect healing, no standard weight limits can be recommended during this early 8 to 12 week period. After an individual appropriate evaluation, range of motion exercises and other activities that involve sternal/chest muscles can be gradually introduced and progressed as long as there is no evidence of an unstable sternum. An unstable sternum may be indicated to you by pain, cracking, or popping. If this occurs please speak to your health care providers. Persons who have experienced percutaneous coronary angiogram (PTCA) with stent placement, should complete 2 weeks of aerobic activity, ie, walking (90-150 minutes per week) prior to starting a resistance training program to establish a safe base of exercise. Persons who have experienced a heart attack, should complete 5 weeks of aerobic activity (90-150 minutes per week) prior to starting a resistance training program. Patients, who have experienced an irregular heart rate or rhythm requiring a pacemaker or implantable cardiac defibrillator (ICD), should wait approximately 3 to 4 weeks to allow the device and incision to heal properly. Rigorous upper extremity activities such as swimming, bowling, lifting weights, elliptical machines, and golfing should be avoided during this period. However, lower extremity activities are allowed.

Safety tips:

• Always breathe during weight/strength training, holding your breath may increase blood pressure suddenly and decrease blood flow returning to the heart.

• Maintain a good posture throughout exercise, balanced athletic stance with slight bend in knees.

• Keep the pace of resistance exercise EVEN on both the effort and return to starting position.

• Keep pace slow so you don’t use momentum to complete movement.

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Strength Exercises (handheld weight 2-10+ lb or Theraband tubing) Note: 10-15 repetitions makes one set. Progress gradually over weeks to 2-3 sets of each exercise. Squat: • Feet shoulder width apart. • Squat slowly as if you were

going to sit on a chair. • Keep your knees aligned

over your ankles. • Do not let your knees pass

over your toes!

Bicep Curl: • Feet shoulder width apart,

belly button pulled in towards your spine.

• Arms at your side, palms facing forward.

• Curl palms toward your shoulder.

• Keep elbows stationary, no chicken wings!

Wall Push-Up: • Stand tall, feet shoulder

width apart. • Stand arm’s length from the

wall. • Palms against wall at

shoulder height. • Bend arms and move

towards the wall slowly. • Straighten arms to push

yourself back up.

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One Arm Row: • Hinge forward at your

waist, keeping your back flat.

• Keep your body stationary as you pull upper arm back.

• Keep elbows in, no chicken wings!

Shoulder Raise: • Stand tall with your feet

shoulder width apart. • Arms at your side, palms

facing in. • Slight bend in your arm. • Raise one arm up to

shoulder height.

Calf Raise: • Stand up tall. Raise up

heels off floor and hold briefly, lower slowly.

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Common Myths About Exercise

• No pain, no gain. Pain is a sign of injury, which can slow your training progress!

• More is always better. Too much intensity or volume can lead to injury! • Sweating is an indication that you are working at the right intensity.

Unless you are training to tolerate a hot climate, you are better off minimizing the heat load on your body (see section on Hot Weather), so that it responds better to the exercise.

• Sweating helps you lose weight. This is only temporary, as the weight lost is mostly water weight. Excessive sweating without replacement of lost fluids can be dangerous to your body!

• Shortness of breath is an indication that you’re getting the maximum benefit from your exercise. Breathlessness, when you have difficulty talking, is a sign that you are working too hard! This can result in excessive fatigue with exercise.

• Doing sit-ups is the best way to lose fat around the mid-section. Unfortunately you cannot “spot” reduce fatty areas! Although abdominal exercises are important for improving low back stability, they do not burn significant amounts of calories to reduce excess fat; aerobic exercise is the best way to burn fat!

Tips for Staying Active:

♥ Exercise with a friend. ♥ Pick activities you enjoy. ♥ If you desire you can buy equipment you enjoy for home or join a fitness center. ♥ Vary your activities to reduce injury, and keep your program more interesting. ♥ Keep your exercise intensity at a comfortable level. ♥ Set aside time for exercise each week (e.g. before work, during lunch hour, before

/after supper). ♥ Set short term, realistic goals and keep a journal of your activities minutes or days

exercised (i.e. check marks on your calendar, use wearable fitness trackers).

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Important Points to Remember When Exercising: Rest Periods - When starting an exercise program be sure to begin slowly and take adequate rest periods as needed. As a general rule for inactive individuals, take equal periods of rest and exercise (i.e. 3 min rest = 3 min exercise). As your exercise tolerance improves the rest periods can be shortened and exercise periods extended. For example, an individual just starting a walking program may start out walking for 5-10 min continuously at a low to moderate pace and repeat this 2 -3X in the day with adequate rest in between. After a week or so, it will be easy to lengthen the session to 15 min twice a day. The next progression in a week may be to lengthen the 15 min to 20-30 min of continuous walking once a day. It is beneficial to progress to the point where you can walk comfortably 30-60 min most days of the week. Eating Meals - Never exercise on a full stomach. Approximately 2 hours should be allowed between a large meal and exercise. A small meal 30 minutes prior to exercise (i.e. 1 whole wheat toast) is acceptable, especially if medications need to be taken. Intake of Fluids - As you exercise your body loses water through evaporation, breathing and sweat. This fluid loss must be replaced in order for the cells to function properly (Do not take alcohol, tobacco, or caffeine before exercising). Recommendations for fluid intake are 6-8 glasses per day. If you are on a fluid restriction follow your specific required intake. Arm Activity - There are several points to keep in mind when doing arm activities such as mowing the lawn, lifting, carpentry work, gardening, vacuuming, housework, etc.

• Do not hold your breath when lifting or moving objects. This causes a

rapid increase in your blood pressure and may cause dizziness. Exhale on effort (as you lift).

• Keep the activity at chest height. Use a stool to avoid arms being overhead. (Overhead activity substantially increases blood pressure and workload).

• Keep the intensity of the activity low. Use less weight and make more trips when carrying/moving items. Keep equipment settings low.

• Pace yourself. Aim for a reasonable amount of work, taking a rest is acceptable. Don’t underestimate your fatigue level as it is an indication of overdoing it.

• Keep your handgrip loose. Gripping a handle or object tightly during exercise may cause your blood pressure to increase, increasing the workload on your heart.

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Hot and Cold Weather In COLD weather:

• An extended warm up and cool down are important during cold temperatures. • Be sure to slow your pace and dress warmly, especially when there is the added

resistance of snow and wind. • Always wear something on your head to prevent heat loss. • If you are troubled by angina pain in cold weather and you cannot avoid going

outdoors, wear a scarf around your mouth and nose. This will warm and moisten the air before it reaches your lungs.

• Remember to consider the effects of wind chill. In HOT weather:

• Your resting heart rate may increase and you may tire more easily. • A longer warm up and cool down are beneficial. • Avoid exercising during the hottest part of the day. • Decrease intensity and/or duration of exercise session or try to exercise in cooler

environments (i.e. shaded, air-conditioned) when the heat is intense. • Remember to drink plenty of water (read hydration section). • People with heart disease need to be especially careful to reduce the heat load on

their bodies: Saunas, hot tubs, and in some cases, overly hot showers are may cause your arteries to dilate, lowering blood pressure and cause dizziness. Precaution is recommended.

When to see your Doctor

• If you get pressure, burning, or discomfort in your chest, shoulders, arms, jaw, throat, or between your shoulder blades that is new for you, and your doctor does not know about it yet.

• If there is an increase or change in your normal pattern of angina (e.g. it comes more often, lasts longer, feels worse, or there is a change in the causes of your angina).

• If you experience unusual shortness of breath or sudden weight gain due to retaining water.

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Hydration Water is a required nutrient. The human body is about 60% water in adult males and 55% in adult females. If you do not have heart failure, be sure to drink at least 6-8 glasses per day or enough to so that your urine is clear or pale-colored. You may be on a fluid restriction in which case follow doctors orders. You may need to drink more water when exercising and/or in hot environments because of loss of fluid through sweating and breathing harder. Drinking water is important because it:

• Digests food and dissolves nutrients. • Carries waste products away and determines urine production. • Sends electrical messages between cells which is important for muscle

contractions, vision and brain function. • Acts as a coolant for working muscles as it maintains body temperature. • Lubricates joints. • Maintains normal circulation.

Note: Heart failure patients may need to be on fluid restrictions, for guidelines see PURPLE section.

Volume Fluid Loss If you get dehydrated, your blood volume decreases. This causes a decrease in blood pressure and your heart has to work harder to pump blood through the body. Because blood flow decreases, there is less oxygen circulating through the system and energy level drops! If your urine is very dark you may be getting dehydrated. Make sure and follow the recommendations for fluid intake as noted above.

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Sedentary behavior; the new risk factor? Along with a sedentary lifestyle, sedentary behavior could also be considered a risk factor for cardiovascular disease and is associated with significant health risks, cancer development, morbidity and mortality. Sedentary behavior is best described as expending 1.0-1.5 METs on a given task (for example, prolonged [2+ hours] sitting periods, driving, desk work, screen time, prolonged recline position).

Active couch potato: This term refers to people that may get their recommended aerobic physical activity but still spend most of their day sitting, usually because they have sedentary jobs. Evidence suggests that sitting for prolonged periods is an independent risk factor on many health outcomes. In other words, being sedentary for most of the day, regardless of how much aerobic activity a person accumulates throughout the day can still be considered a risk factor for heart disease and obesity. The key is to remain active throughout the day not just in spurts. Sedentary behaviors and physical inactivity are closely related to decreased HDL (good cholesterol) in men, high blood pressure in women, and in both sexes, increased waist circumference. SIT LESS and MOVE MORE!

• Get up and walk around during prolonged sitting periods (5-10 minutes of

standing/ walking about every hour). Set reminders on your phone to get up and move around.

• Consider using a sit/stand desk which allows you to work sitting or standing. • Reduce screen time (at home and within occupations). • Take the stairs whenever possible. • Stand or walk while you are on the phone. • Increase the number of times you walk the dog. • Park your car further from where you are headed to; consider walking or using

public transportation. • Ban using drive-thrus. • Reserve aisle seats in airplane so you can get up and walk often without

disturbing others.

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What are some consequences of sedentary behavior?

• The muscles that hold up your skeleton become weaker. Your back rounds forward, muscles become “tight” and shorten; making physical activity more uncomfortable rather than an enjoyable time.

• The body produces less HDL (good cholesterol), less use of blood sugars. • Foods are used to fuel our bodies. If we do not use the fuel we eat when active,

then it will be stored as excess weight. • Bone reabsorption occurs as a faster rate, causing bone mineral content to

decrease leading to higher risk of osteoporosis, bone breaks, and other skeletal injuries.

• Increase in resting blood pressure. Good things about reducing sedentary behaviors:

• Even the smallest movements can stimulate muscles to increase the use of blood sugars within the body (and can help manage diabetes much better).

• Moderate to vigorous physical activity encourages healthy bone growth/maintenance.

• Better blood pressure control. We are all at risk! Be the change and start your own movement!

References

1. ACSM’s Guidelines for exercise testing and prescription, 9th ed., 2014. 2. Lu, B., Ph, D. R., Sands-lincoln, M., Going, S. B., Garcia, L., Allison, M. A., …

California, S. D. (2013). Relationship of Sedentary Behavior and Physical Activity to Incident Cardiovascular Disease Results From the Women ’ s Health Initiative, 61(23).

3. Owen, N., Healy, G. N., Matthews, C. E., & Dunstan, D. W. (2010). Too much sitting: the population health science of sedentary behavior. Exercise and sport sciences reviews, 38(3), 105–13.

4. UHN, An education workbook for people living and thriving with CVD. Toronto Rehabilitation Institute, 2014.

Documents

2018 COACH Manual · exercises done after aerobic exercise are also beneficial. AEROBIC exercises require the body to use oxygen. Your heart pumps oxygen-rich blood to the rest of