Live Well Ohio: March 2015

Heart of the Matter
Cleveland Clinic cardiologist Dr. Maan Fares shares his insight into how a sedentary lifestyle affects cardiovascular health.  

Cardiovascular disease is by far the leading cause of death in the United States. According to statistics from the Cleveland Clinic, coronary artery disease causes about 1 million heart attacks each year, and more than 220,000 people who suffer them die before ever reaching the hospital. One major risk factor is a lifestyle that lacks exercise and movement. “Exercise becomes the leisurely thing that we do perhaps only on the weekend,” says Dr. Maan Fares, a cardiologist at the Cleveland Clinic. “That is where we are missing the boat as a society. There has to be time for exercise on a daily basis.” We recently talked to Dr. Fares about the affects of a sedentary lifestyle on heart health.

How does too much sitting affect the heart, and how does exercise improve that?
The heart is like any other muscle. If you exercise the heart, the heart muscle becomes stronger and more efficient. I always give the example of athletes. They generally have a lower heart rate because their hearts are more efficient due to exercises and training. Their bodies are a little bit thinner and leaner, so they don’t have the excessive body mass that needs blood supply.

How much does making small changes in daily activities, say taking the stairs instead of the elevator, really impact heart health?
Every little bit helps and will eventually lead to a change in lifestyle. If you climb stairs, first you start by climbing one flight. Then you go to the second floor and third floor. First it tells you about your level of fitness: Do you get short of breath at the end of climbing one flight of stairs? That reminds you that perhaps, Ok, I am 34 years old and I should start concentrating more on my health because at work today I couldn’t even climb one flight of stairs. If you start to climb those stairs each time that you are at work, it becomes your norm and it adds up. It is better than relying on [a] half-an-hour [workout] on the weekend. You go to work far more often than you have weekends. It is the things that you do every day in life.

What tests and screenings related to heart health should people have done, and when?
It is never too early to check your body mass index and your vital signs: What is my heart rate? What is my blood pressure? Everybody should meet with their primary care physician or their family doctor and make sure that they have those basics under control. About age 20 or sometimes sooner, we start to advocate for having a baseline lipid analysis — in other words cholesterol and triglycerides. It is very important because it will give us a baseline as to what one’s risks are as they go forward in life. A family history of diabetes is extremely important. If somebody is age 45, we like to have a blood glucose level as a baseline and every three years going forward. Meeting [with your primary care physician] also [leads to] going over other aspects of a good lifestyle, and changes in diet and exercise can start to be implemented. 

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In Motion
Health and fitness professionals share simple strategies for moving more.

Most of us spend about 90 percent of our days indoors, and a lot of that time is spent facing a computer screen or watching television. Even those who spend evenings curled up with a book could be hurting their health. “Sitting is the new smoking,” explains Dr. Matt Roth, medical director of ProMedica Wildwood Athletic Club in Toledo. “The beneficial effects of exercise are dose-dependent. If you’re doing nothing now, doing something is better.” We asked health and fitness experts throughout Ohio to share their ideas for working more movement into each day.  

Walk at Work:“Our jobs are becoming more stationary,” says Roth. “More time spent on the computer is contributing to a degree of inactivity. Instead of sending emails all the time, if it is [to] somebody inter-office, then write something out and hand-deliver it or go talk to the person.” Roth also suggests switching up the staff meeting by ditching the conference room and taking your team for a walk.

Energize Errands: Running errands sounds like an active task, but a lot of that time is spent sitting in the car while traveling from stop to stop. Make up for it once you’ve reached your destination. “Park further away from the grocery store,” says Deanna Shuler, supervisor of the Wellness Center for the Memorial Health System in Marietta. “Take the stairs instead of the elevator.” Shuler also finds that an extra lap around the grocery store or mall is a simple way to fit in extra exercise.

Set Rules: Jaclyn Madill, club manager at Mercy-Health Western Hills HealthPlex in Cincinnati, suggests working more movement into your evening routine. “If you recognize that you are maybe watching too much TV, then one compromise is at every commercial break you get up and get mobile,” says Madill. “If you think the main cause of being sedentary is reading, set yourself a goal of page increments. For example, on every fifth page you have to set down the book and get mobile for a few minutes.”

Choose Active Interests: “Choosing activities that you enjoy will make it easier to stick to a program, and the variety will help you avoid being bored or burnt out,” says Stephanie Rossman, health fitness specialist and personal trainer at University Hospitals’ Avon Health Center. “Light gardening can be a great exercise for beginners,” offers Rossman. She also suggests joining an adult sports league — anything from bowling to kickball. “If you are just starting out, you can volunteer as a substitute or start in a beginner league.”

Start With 10 Minutes: Laura Leach, clinical exercise physiologist at the McConnell Heart Health Center in Columbus, finds that many of her clients have a hard time imagining where to fit exercise into their days. “Just start off with 10 minutes a day,” she says. “Maybe it is at the end of your lunch break. Maybe it’s 10 minutes in the morning before your kids wake up. Maybe it’s 10 minutes at the end of your workday. … Just 10 minutes a day can make a difference.” 

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Small Steps, Big Changes
A visit to the doctor set Christine Tyler on a path to losing more than 100 pounds and rethinking her relationship with exercise and food.

Christine Tyler knew a lifestyle change was vital when she began experiencing heart palpitations in 2003. “I really was overweight all of my life — up and up again until I hit the wall with palpitations,” says the now-54-year-old Tyler.

When medication prescribed by her primary care physician didn’t help, Tyler was referred to Dr. Simon Jung, a cardiologist with TriHealth in Cincinnati.

“He asked me about what I had eaten recently and, of course, I was eating all the wrong things,” says Tyler, who weighed nearly 300 pounds at the time. “I was pretty much a couch potato.”

Jung diagnosed Tyler with hypertension and made some dietary suggestions, including a lower sodium intake, but he also made a simple-but-life-changing suggestion. “He told me to just start by walking.” Tyler’s quiet block measures half a mile, so she saw it as a practical and manageable place to begin.

“That was a struggle at first,” she says. “And then, of course, every day I tried to walk a little farther and a little farther.”

Within six months, Tyler’s heart palpitations subsided, her blood pressure dropped and she lost 40 pounds, giving her the courage to begin 30-minute women’s circuit workouts at a Curves location. “I did that for several years and [my weight] would go up and down,” she says. “I needed to give it a push.”

In 2008, she joined her neighbor as a guest at the TriHealth Fitness & Health Pavilion.

“That was a big jump for me, from the comfort of just women working out at a set routine to going to where there were athletes,” says Tyler. But getting to know the personal trainers at the facility helped settle her insecurities. “It is important to have a personal relationship with the trainers. … They know what they are talking about.”

Tyler hit her weight loss goal in 2009. Down nearly 125 pounds from her starting weight, the milestone was a cause for celebration. “I bought myself a diamond bracelet,” she says. “That was my big goal, and that was my big significant statement that yes I did it, here it is.”

Six years later, Tyler still visits the TriHealth Fitness & Health Pavilion daily, and she does much more than just walk. Between fitness classes and readying for 5K and 10K runs, staying active has become an integral part of her lifestyle. Tyler says consistent tracking and journaling have been vital to her ongoing success.

“I am addicted to my pedometer,” she says. “It is 10,000 steps a day or I don’t go to bed.”

She’s also changed the way she looks as food. “It’s knowing that you eat food to fuel your body and not as an activity,” says Tyler, who keeps a daily food log. “I find that it helps me because I think ... Are you hungry? Or do you think you just want to eat?”

Tyler says she still allows herself the occasional indulgence, but when she does, she savors each splurge. “If I’m going to have some French fries I’m going to sit down and make that an event,” she says. “I am not going to just eat them in the car.”

The 12-year journey has not been without setbacks. Last year, osteoarthritis in Tyler’s knees slowed her down. A month of physical therapy coupled with a gradual comeback at her workout regimen has Tyler back on track, and she has a small but powerful motivator that keeps her going.

“I carry my Nook [e-reader] with me when I go to work out, and inside the pocket … I carry a ‘before picture,’ ” she says. “It motivates me to try to keep it up and to get back into my routine.”