Keep moderate, regular exercise going

The preventive benefits of regular, moderate intensity exercise are well known. We know that it reduces obesity, insulin resistance, diabetes, blood pressure, LDL cholesterol and triglycerides and improves HDL cholesterol, overall fitness and psychological well-being. Regular moderate exercise cuts the risk of heart attacks by half. However, that it also facilitates early diagnosis and treatment of several maladies, is less known.
A recent experience of the following cases exemplifies this and provides useful lessons.
My 60-year-old friend, a doctor himself, has a habit of walking daily for 30 minutes every morning. One day while walking, he felt discomfort in his upper abdomen. He thought it was a gastric problem and continued walking. But the ‘gas’ did not go away and started spreading upwards to his chest as some form of tightness. He stopped, came home and took some antacids. Although he was alright through the day, he felt something was amiss and consulted me.

After listening to his story, I advised him medication (including aspirin and statins) followed by coronary angiography. And what did it show? It showed a 99 per cent narrowing of a major artery, which had caused the symptoms during his walk. These symptoms resulted because the supply of blood through the narrowed coronary artery fell short of the increased demand made by the heart muscle while walking. This was a demand-supply imbalance. If my friend did not have the habit of ­walking, this demand-supply imbalance would not have been triggered, and he would have known about it only when the blood vessel would have occluded or closed totally, causing a massive heart attack resulting in sudden death. Of course, on finding the 99 per cent narrowing, we opened it with a balloon and fitted a stent, thus preventing a heart attack and permanent damage to his heart.
The moral of the story is that it was due to the habit of walking regularly, that our friend could catch the early warning symptoms. Hence a lesser known but a very important benefit of regular moderate intensity exercise like walking, swimming, aerobics, cycling, etc is that coronary disease may be identified early and before any of its devastating consequences occur.
To quote actor James Cagney: “I try to dance at least once a day because I don’t want to take my heart by surprise!”
An active patient and an astute physician can “abort” a heart attack! Yet another exercise bonus!
Take the case of Parker, a 75-year-old diabetic. He is always on the go. Wherever possible, whenever possible, he avoids a vehicle or an elevator and walks and climbs stairs, besides doing his regular 30-minute walk every morning.
But one evening his long standing diabetes played spoil sport. He started getting chest pain and hence went to his family physician. The doctor took his ECG, diagnosed a heart attack (technically termed ST elevation myocardial infarction) and packed him off to the hospital.
But before sending him, he did a wise thing. He gave him a soluble aspirin to chew and four tablets of clopidogrel (another blood thinner like aspirin) to swallow.
By the time Parker reached the hospital, his pain had subsided completely and the ECG reverted to normal. This was because of the dissolution of the clot or thrombus which was occluding a coronary artery. Usually this requires the intravenous injection of a clot buster (fibrinolytic drug) or emergency balloon angioplasty to dissolve or remove the clot and open the artery. But in Parker’s case it happened without any of these usual remedies. It is very likely this was due to regular physical activity by the patient plus the timely diagnosis with an ECG and administration of the blood thinners by the family doctor.
An angiogram done the next day confirmed our premise; the artery, though narrowed, was not blocked and no major damage had occurred to the heart due to the early treatment.
Regular, moderate intensity ­physical activity is known to stimulate body’s own “fibrinolytic” system — that is, the body’s ability to spontaneously dissolve unwanted clots. It also causes reduced clumping of platelets — the cells involved in clotting — on exercise.
Intense exercise, specially unaccustomed, on the contrary, can increase clotting tendency and may cause a heart attack. That is why the stress on regular, moderate intensity exercise.
Although due to diabetes, Parker had fat deposits and a threatened heart attack due to clot formation, the latter “melted” because of his own vigorous fibrinolytic potential related to regular exercise which made the blood thinners more effective. Hence his heart muscle did not suffer much damage. The bomb was diffused before it could explode!
Thus, regular and moderate physical activity not only prevents heart disease but also helps early diagnosis and aids treatment.
Didn’t someone say, God helps those who help themselves?

(The writer is a cardiologist from RC Bombay Airport –
D 3140.  Email: drakshaykmehta@gmail.com)