Exercising For A Healthy Heart

Cardiovascular disease (CVD) is the single largest cause of mortality worldwide, accounting for 18 million deaths per year globally. In the past few years, notable progress has been made in treating CVD and a decline is evident due to early detection strategies, advanced medical treatment, and risk factor reduction. However, the trend towards unhealthy lifestyles persists, hampering medical progress, and calling for more affirmative action to prevent such disease.

The main component of cardiovascular disease is Coronary Artery Disease (CAD).

CAD is a progressive, chronic disease which affects the inner lining of the coronary arteries. There is a build-up of atherosclerotic plaque which narrows the arteries and obstructs normal blood flow.

Atherosclerotic plaque can be either active and unstable, or quiet and stable. Unstable plaques, even mild- to moderate-sized plaques can tear, rupture, swell, or undergo a combination of these processes and can result in a sudden and complete obstruction of a coronary artery, leading to an acute myocardial infarction (heart attack)).

Non-Modifiable & Modifiable Risk Factors for Heart Disease

Non-modifiable risk factors for CVD cannot be changed. These factors include:

  • age
  • gender
  • family history

People who are generally at a higher risk for CVD are male, above the age of 50 years, or have a family history of premature CVD (male before 55 years of age, female before 60 years).

On the other hand, modifiable risk factors for CVD can be changed predominantly through healthy lifestyle modifications. The modifiable risk factors include:

  • obesity (BMI ≥30 or waist circumference >94 cm for men; >80 cm for women)
  • smoking
  • cholesterol levels
  • hypertension (140/90mmHg or higher)
  • diabetes
  • lack of exercise
  • unhealthful diet

Modifiable risk factors are shown to be increasingly prevalent in South Africa, contributing significantly to alarming cardiac risk factor profiles.)

What can be done to reduce your risk?

Exercise and a healthy diet are considered the two most important components of lifestyle modifications that can significantly reduce your risk for CVD.

Following a structured routine of frequent exercise can hold many benefits including:

  • Decreased blood pressure
  • Decreased resting heart rate
  • Lower cholesterol levels
  • Decreased stress and anxiety
  • Weight loss
  • Improved heart and lung function

Exercise has been identified as a central element of cardiovascular disease risk reduction and lifestyle modification. It can bring about improved physical performance, reduced symptoms, and improved quality of life.

In secondary prevention, regular training constitutes an important factor that positively affects the prognosis of illness. Exercise training has been shown to have direct benefits on the heart and coronary vasculature, including myocardial oxygen demand, endothelial function, autonomic tone, coagulation and clotting factors, inflammatory markers, and the development of coronary collateral vessels.

The mechanism for reduced cardiovascular mortality in patients who have received exercise-based cardiac rehabilitation is not clear, but may be due to improved myocardial revascularization, protection against fatal dysrhythmias, improved cardiovascular risk factor profile, improved cardiovascular fitness, or increased patient surveillance.

Recommended Exercise Programming

Mode Goals Intensity / Frequency / Duration

Large muscle activities / whole-body exercises

  • Increase aerobic capacity
  • Decrease blood pressure and heart rate response to exercise
  • Decrease submaximal myocardial (heart) VO2 demand
  • Decrease CAD risk factors
  • Increase activities of daily living
  • RPE* 11-16/20
  • 3 days / week
  • 20-60 min / session (can be accumulated throughout the day)
  • 5-10 min of warm-up and cool-down activities

Resistance training

  • Increase ability to perform leisure and occupational activities and activities of daily living
  • Increase muscle strength and endurance
  • RPE 11-16/20
  • Light-to-medium weight (gradually increase resistance over time)
  • 2-3 days / week
  • 2-4 sets of 12-15 repetitions
  • 8-10 different exercises

Upper and lower body range of motion (ROM)

  • Decrease risk of injury
  • Improve joint ROM and muscle function
  • Static stretches (hold for 20-30 sec)
  • 3-5 days/week

*RPE = rating of perceived exertion (how tiring/hard the exercise feels to you). Scale from 6-20. 7= very, very light; 9= very light; 11= fairly light; 13= somewhat hard; 15=hard; 17= very hard; 19= very, very hard.


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By Kelly Kaulback, Biokineticist, Institute for Sport Research, University of Pretoria

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