Preventing the First
Heart
Attack
Healthy people who want to prevent
heart attacks also find support at the Y. Motivated, often, by the
illness or sudden death of a close friend or relative, they sign up
for rigorous stress testing and blood tests to determine the health of
their hearts and arteries and the risk of future trouble. Those who
pass the tests with flying colors are sent on their way, says Bronz.
'Whatever you're doing, we tell them, keep it up!' Those with a medium
to high risk of heart disease - about 10 per cent of the people tested
- are invited to join the program. Like the cardiac patients, they
receive individually designed exercise schedules, advice from the
nutritionist, stress counseling from the social worker and
encouragement from the nurse. |
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"Some come to see me periodically for
counseling on weight loss or to see if their diets are OK. I encourage
a low-fat, high-carbohydrate diet, .lots of whole grains and fresh
fruit and vegetables, less beef and more chicken and fish. They are
really open to change." Barbara Eisenstein, whose years as a coronary
care unit nurse have taught her the need for programs like
Downstate's, is particularly enthusiastic. "Once someone gets into the
physical aspect of the program, it becomes a way of life,' she says.
"It gives him or her a wholly different outlook, and it's all to the
good." That, in effect, is the fundamental idea of the Downstate
program - to start both patients and non-patients on the path to a
healthier, more vigorous lifestyle. "All we try to do is form a
lifetime habit of exercise," says Charles Bronz. "We encourage people
to be on their own." More than a few of his patients have, in fact,
become "enthusiastic exercise addicts", Dr Stein says. But what about
risks? Everyone has heard tales of stress tests interrupted by
fatalities, and of apparently healthy middle-aged men found dead on
the side of the running track.
One study that Dr Stein likes to cite shows the likelihood of death or
serious complications in the course of a stress test to be 1 in
200,000. In a good, modem centre, he speculates, the risk may be even
less. "We do very careful screening before exercise testing, we always
have a doctor and a nurse trained in ECG and cardiopulmonary
resuscitation, and there's always a full set of
cardiac-arrest
equipment. With better monitoring devices, we can pick up early
warning signs of when to stop a test." Exercise itself, Dr Stein
grants, does involve some increased risk for a heart patient. "We
minimize it by bringing your heart rate higher, when we test you on
the treadmill, than it will be when you train. And overall, we lower
the daily risk of the individual by putting him in a training program.
If you exercise enough to train, in other words, then running for the
bus on a windy day will involve less physical stress than it would
otherwise."
"In the years since the program
began," he adds, "we've found out that people's hearts and bodies are
much sturdier after a heart attack than we had thought. We're
comfortable prescribing more exercise than we used to - we seem to do
it safely." Similarly, he says, "much of the anxiety about running for
healthy people is - exaggerated. For a vigorous, active person under
40, without symptoms or significant risk factors (such as overweight
or smoking), a stress test may be an unnecessary precaution. If you're
in your late 40s, though, a stress test would be appropriate every
three or four years." And the 'competitive nut' who pushes himself the
extra two miles, or who ignores the heat of summer, may be moving into
a high risk zone, Dr Stein adds. "And if you feel an irregularity in
your heartbeat or you start to have chest pains you've never had
before, be prudent and see your doctor." |