I apologize for being absent the last few weeks. About six weeks ago, I was in the car ready to head out for a nice drive in the Sierras with friends and my dogs. We had a picnic lunch packed and even some wine from a local vineyard. And then, the oleanders at the other side of my front lawn attracted my attention.
"Wait just a minute," I said in some famous last words," I want to check to be sure those oleanders are getting enough water."
Stepping across from the brick path on to a brick flower border in my sandaled shoe, perfectly confident and brimming with flowerly enthusiasm...I was unhappily surprised to note that my right ankle did not keep going forward but instead rolled out to the right at a 90 degree angle, bringing with it sharp pain and causing me to fall onto the lawn in my pretty turquoise capri pants, grass staining them pretty badly.
But grass stains were the least of my worries. From that time on I could not walk on my right ankle, which was eventually put into a cam boot and I into crutches, a knee trolley, a wheelchair, and a walker as I attempted to get around my house and rest as much as possible with my right foot elevated. (Needless to say, the picnic was cancelled.) Six weeks later, here I am, just beginning to walk again.
What does this have to do with my heart? Well, several things. For one, there is always the danger of a blood clot in injuries such as these and patients should be vigilant for those symptoms. But more common is inactivity and attendant weight gain.
Despite the fact that my appetite has diminished (due to my inactivity) the calories I do take in are going straight to my stomach, where they are living happily and building a large mountain. Once I am up and moving around more, I hope this will begin to turn things around.
This is a good time to address the importance of exercise in the care and feeding of a healthy heart, particularly for those of us over the age of 35 (and that's no problem for me!) A recent study shows startling information about exercise and heart failure. It tells us that elderly persons who lead more physically active lives are less likely to show a clinically significant rise in levels of a heart-cell injury biomarker, high-sensitivity troponin T (hsTnT), as measured by a high-sensitivity assay (Elecsys 2010, Roche Diagnostics), over two to three years compared with those who are more sedentary, conclude researchers.
This finding was independent of diabetes, cardiovascular comorbidities, and lung disease as well as initial hsTnT levels. The analysis, presented recently at the European Society of Cardiology (ESC) 2011 Congress, was based on 1786 adults >65 years of age in the US community-based, multicenter, longitudinal Cardiovascular Health Study who were initially free of heart failure and had discernible hsTnT (>3 pg/mL) at baseline and at follow-up two to three years later.
Less leisure-time physical activity and the jump in hsTnT levels (>50% elevation from baseline to follow-up) both predicted greater risk of incident heart failure.
"We suggest that the use of high-sensitivity troponin may be useful as a surrogate measure to assess the potential cardiovascular benefit of an exercise intervention in the elderly," Dr Stephen L Seliger (University of Maryland, Baltimore) said when presenting the data. Less common, he said, was a drop in hsTnT from the first reading to the second. And although he did not have numbers to present, greater physical activity was not associated with a decline in the biomarker. If that finding turns out to be "real" and not by chance, "it would suggest that greater exercise can help an adverse trajectory of heart disease but not necessarily promote a beneficial trajectory." To heartwire, Seliger said "We look at change in troponin as kind of a trajectory of cardiac dysfunction over time. So if you're designing an exercise intervention for the elderly as a way to prevent future morbidity, this marker might be a surrogate measure of how effective the increased exercise is in terms of preventing future events."
So exercise not only helps prevent heart failure but also lowers blood pressure and contributes toward weight loss. In my next blogs, I will address exercise and practical ways to apply it in our own lives. I'll also share my Broken Ankle Chronicles toward walking and exercising again.