BackRecovering with a run
How two cardiac patients got over their fear and hit the running track after bypass surgery
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If you have a heart problem, it need not mean that you have to stop running. In some cases, running could actually be good for you.
Of course, whether you can run or not depends on the nature, and severity, of the ailment. “Heart attack survivors are encouraged to exercise regularly to improve their cardiac health. But the level of exercise allowed for each patient is highly variable and depends on the person’s age, mobility, state of the heart, lungs and weight, among other factors," says Vijay Chopra, director, cardiology, Medanta—The Medicity, Gurgaon. “The level of exercise permitted for a patient can be estimated reliably using a test called the cardiopulmonary exercise test."
One limiting factor is the state of coronary arteries and the extent of damage suffered by the heart. “In a few patients where the heart attack was not major due to a blockage in a small artery, with no significant residual damage, the other major arteries being normal, these patients may obviously be classified as equivalent to any other person with a normal heart and can do heavier exercises. This may not be true when the residual damage is huge," says Dr Chopra.
For those who do get the go-ahead, it’s essential to follow an appropriate training programme designed by doctors. “It is important to set goals and train accordingly. Patients with heart ailments can gain from running on a regular basis. The benefits include weight loss, improved cardiovascular health, bone health and mood," says Nilesh Gautam, interventional cardiologist and head, cardiac rehabilitation and preventive cardiology, Asian Heart Institute, Mumbai. Among stable patients, a gradual increase in activity is generally allowed from the second or third day after a heart attack. “For running, proper training under supervision, four-six weeks after a cardiac procedure or a heart attack, is usually recommended," says Anjali Zende, cardiac rehabilitation specialist, Asian Heart Institute.
Running is an excellent form of exercise that burns more calories than walking. In order to lose 1 pound (around 0.5kg) of body weight, the body must create a calorie shortfall (i.e., eating less or burning more) of 3,500 calories.
Most runners can easily burn off about 500 calories in less than 1 hour of exercise. Running also “lowers blood pressure and helps arteries maintain their elasticity. While running, the arteries expand and contract approximately three times as much as they do when you are sedentary," says Dr Gautam.
People with a heart problem, however, must give themselves adequate time to train for a marathon. “Patients with heart ailments need four-six months of training even if they are targeting a half marathon," says Dr Gautam. They should step up the exercise/training sessions gradually.
We spoke to two heart patients ahead of the Standard Chartered Mumbai Marathon (SCMM) on 18 January to understand how they got back to the track and what running means to them.
Heart matters
Mumbai-based Mukesh B. Limbachia, 54, who runs a travel agency, suffered a mild attack on 1 January 2011. An angiography detected multiple blockages in arteries and he had bypass surgery, followed by an EECP (enhanced external counterpulsation) programme of 35 sessions. EECP is a simple, non-invasive treatment for complex angina problems and heart failure.
Once he gained strength, Limbachia joined the cardiac rehabilitation centre at the Asian Heart Institute to try and build up his stamina. “Initially, I started with around 25-30 minutes of exercise on alternate days, and then slowly increased it to 90 minutes. All the worries I had about the bypass surgery limiting my activities slowly vanished," he says.
Limbachia happened to hear about the SCMM at the centre and decided to try it out. He took part in the 6km Dream Run in 2013, enjoying the entire process of training at the rehab. Last year, he ran the 21km Half Marathon at the SCMM, completing it in 3 hours, 9 minutes. This year, he is training to improve his strength and stamina, and is aiming for another successful run.
The biggest payback, he says, is that his attitude to life has changed completely. “I am enjoying my second life. I feel healthy, energetic and positive. I have become conscious about my diet and exercise. It really feels like I have grown younger by a few years and it’s an amazing feeling," he says. Family members now tell Limbachia that he looks much younger, is full of energy and is a role model for others. “I never miss my exercise and follow a very careful diet. And that’s how I like it now," he adds.
Limbachia says cardiac surgery should be viewed as a new beginning towards a healthy life. “Remove the fears from your mind and just run," he says.
Change of heart
Sunil Fadia, 46, who manages organic farms in Karjat, Maharashtra, was aware of the history of cardiac problems in his family. He had lost his father, mother, elder brother, uncle and aunt to heart ailments. On 9 May 2009, around 3am, he felt uneasy and started sweating. He rested for a while but then asked his wife to call a cardiologist.
Later, at the Asian Heart Institute, doctors discovered he had five artery blockages. He underwent an angiography procedure and, a month later, had bypass surgery. “My erratic lifestyle—hectic workload, sleeping for barely 3-4 hours every day, love for junk food like pizzas and chocolates and sweets, possibly brought all this about," says Fadia.
While Fadia loved exercise, particularly trekking and running, he was afraid to resume vigorous activity after surgery. But doctors at the Institute helped him deal with this fear. He joined the cardiac rehab centre in August 2009, and started exercising. “It was not an easy decision for someone like me to come down from Karjat to Mumbai regularly but I wanted to get back to running," he says.
In 2010, Fadia took part in the 6km Dream Run at the SCMM, finishing it in 40 minutes. Since 2011, he has been running the half marathon; he clocked 2 hours, 53 minutes in 2011, and shaved off 12 minutes in 2014, finishing the race in 2 hours, 41 minutes. He hopes to do even better this year. “I organize runs once a month in the monsoon and winter season in Karjat as well. This is now a way of life for me," he says.
Over the last few years, his lifestyle has changed completely: He wakes up by 4am and does yoga and meditation till 6am. He then goes for a jog/run (10km) or cycles (around 20km).
His lunch consists of dal, rice and vegetables, all grown on his organic farms; he now avoids junk food completely. The snacks he eats include kurmura or cornflakes. He says his wife Ushma is happy that he is now so careful that she doesn’t need to hide cheese and chocolates from him any more.
“I don’t stop practising and training even after a marathon is over, as most runners do. I just take a break for one day and then get back to my regular runs," says Fadia.
INITIAL CHECKLIST
Before beginning training for a marathon:
u Patients should be symptom-free
u Should have clearance from the treating doctor to take part
u Should be on the regular medication prescribed by their cardiologist.
They should get a pre-participation health check, including ECG and 2D Echo, done
u Fasting sugar, lipid profile, blood pressure, body mass index and weight circumference give an indication of the person’s cardiac risk profile. Any person with more than two risk factors for heart disease should ideally consult his/her doctor before taking part in events like a marathon.
ON THE DAY OF THE RUN
u Warm up before the marathon. Maintain a slower pace in the first 5 minutes of the marathon
u Cooling down properly after the marathon is as essential
u Do not stop the run suddenly, slow down gradually in the last 5 minutes. If you have any chest discomfort, nausea or giddiness, stop exercising. Do not hesitate to stop and seek medical help available on the route.
u Stick to your pace, do not get carried away by others around you
u Keep yourself hydrated adequately before, during and after the event.
—Nilesh Gautam, interventional cardiologist and head, cardiac rehabilitation and preventive cardiology, and Anjali Zende, cardiac rehabilitation specialist, Asian Heart Institute, Mumbai
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