By Tommy Kirkham,
Cardiovascular disease is among the most lethal conditions in the world, and coronary artery disease (CAD) is the most common type and is the leading cause of death for both men and women in Canada and the United States (Lee et al. 2016)(HealthlinkBC 2015). Following diagnosis and especially after surgery or percutaneous coronary intervention it is important for patients to participate in a cardiac rehabilitation program. Those patients that do undergo an exercise based cardiac rehabilitation program have a significantly lower mortality than those who do not (Mendelson et al. 2016). Furthermore, a novel study has shown that meditation based cardiac recovery is also an excellent way to reduce mortality associated with CAD (Lee et al. 2016).
Exercise has been shown to reduce the risk of cardiac mortality along with a reduction in cholesterol levels, incidence of smoking and systolic blood pressure (Lee et al. 2016). The precise mechanisms responsible for this rehabilitation have yet to be elucidated; however, they likely involve improved functioning of endothelial and platelet cells and a reduction in the inflammatory cascade (Mendelson et al. 2016).
A basic exercise focused cardiac rehabilitation program consists of patients participating in two or three 1-hour sessions a week for 12 consecutive weeks (Lee et al. 2016). Each session is comprised of a 10-minute warm-up like stretching or calisthenics, 40-minutes of treadmill exercise and light weight lifting, and then a cool down of 10 minutes (Lee et al. 2016). The intensity of the workouts must be customized to each individual patient so that they exercise at 70%-85% of their maximal heart rate (Lee et al. 2016).
Psychological stress incurred by CAD patients has been shown to actually decrease the coronary luminal diameter (space within the blood vessel) by 0.20 mm (Lee et al. 2016). A new exciting method for cardiac recovery is based on transcendental meditation and mindfulness-based stress reduction, which is incorporated in order to improve the psychological state of a recovering CAD patient (Lee et al. 2016).
This meditative cardiac recovery consists of mindful eating exercises, breath-work, sitting meditation, walking meditation, yoga and forgiving meditation (Lee et al. 2016). Patients participated in twelve 1-hour sessions made up of a combination of the aforementioned psychological activities (Lee et al. 2016). This particular study was performed to compare exercise-based rehabilitation to meditative-based rehabilitation, and it was shown that meditative rehab was just as important as exercise rehab. Furthermore, the meditative cardiac recovery was shown to significantly decrease CAD patient’s depression much more than exercise would alone (Lee et al. 2016). The best rehabilitation programs must incorporate both exercise and meditation in order to yield the best results.
Future considerations to take into account as pointed out by Aslanger et al are first, medications and cardiac rehabilitation programs must work in cohort with one another to optimize ventriculo-arterial coupling for CAD patients with abnormal left ventricular ejection fraction (LVEF, proportion of blood pumped out of the left ventricle at each beat) (Aslanger et al. 2016). Ventriculo-arterial coupling is the dynamic and coordinated process of contraction and relaxation of the atria and ventricles. Aslanger et al. also point out that patients with normal LVEF have a lower arterial compliance (stiff vessels), which results in exercise limitation and/or impaired cardiac recovery (Aslanger et al. 2016). Pharmacological intervention on low compliance vessels will likely be a target or treatment in the future (Aslanger et al. 2016).
For those patients who have recently been diagnosed with CAD, talk to your healthcare provider in order to start designing an ideal rehabilitation program. This conversation should address the prospect of recruiting a personal trainer and/or meditation instructor like a yoga professional. However, it is important to remember that the exercise and meditation programs must work together, and both these rehabilitation strategies must complement the efforts taken by your cardiologist and family doctor.
References:
- Aslanger E, Assous B, Bihry N, Beauvais F, Logeart D, Cohen-Solal A. Association of baseline cardiac mechanics and exercise capacity in patientswith coronary artery disease. Anatol J Cardiol 16: 000-000. 2016.
- Healthwise Staff. Coronary Artery Disease. http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=hw113087 2015
- Lee J, Song Y, Lindquist R, Yoo Y, Park E, Lim S, Chung Y, Mathiason M. Nontraditional cardiac rehabilitation in Korean patients with coronary artery disease. Rehabilitation Nursing: 1-9. 2016.
- Mendelson M, Lyons O, Yadollahi A, Inami T, Oh P, Bradley T. Effects of exercise training on sleep apnoea in patients with coronary artery disease: a randomized trail. Eur Respir J. 1-9. 2016.