After heart ailments set in, can diet and exercise still help?

By Fathima Riznaz Hafi

We often hear advice about diet, exercise and an overall healthy lifestyle as measures to prevent heart disease. Not heeding the advice evidently poses risks; however, people who practise a healthy lifestyle too stand the possibility of developing the condition due to factors such as genetic disposition. 

Whichever the cause, if a person develops heart complications, survives a heart attack or undergoes surgery, what happens next? Is it too late to change or is it possible to embark on a new health regime to maintain good health? Can food and exercise help a person ‘after’ he has developed heart problems?

Parkway Hospitals Singapore Senior Cardiologist Dr. Chuang Hsuan-Hung tells Daily FT that diet, exercise and an overall healthy lifestyle play a big role in maintaining health even after developing a heart problem; the new diet would be different from that which is recommended for prevention – that is, before the problem struck. “If a person has already developed a heart problem, he is starting at a different vantage point. He may have a problem that already led to a weak heart, or he may have needed surgery, etc., for which there are additional dietary requirements,” he says.

If the person follows an individualised health plan, that covers appropriate diet and exercise to suit his condition, he can continue to live a fulfilling life and not give in to his sickness. 

“Unfortunately, there are two stages. The first stage is post-surgery where their state of alertness or the impetus to maintain health is stronger; they are more motivated; this motivation dies over time because the method that they use to keep healthy in the first three months is not sustainable; the guilt level drops with time – and that is the second stage.”

To keep the momentum going, sustainability is important; therefore Dr. Chuang suggests finding a health plan that is easier for the patient to follow; it should be practical and thereby sustainable. A physician would be able to guide the patient through a tailor-made program to suit his preferences in food and exercise and blend it with what is safe for him; this would have long-lasting results and stand a better chance of success. 

A sustainable diet

“Old habits die hard and when you stop eating something you love, you get frustrated. You will do it for a while and when you reach a breaking point you give up. The practical thing to do is to eat what you like but not too frequently and with slight variations such as steaming meat instead of deep-frying,” he said. 

“If I advise someone to eat vegetable, it must be a type of vegetable that he likes, as long as there is a variety so that he gets all the nutrients he needs – he cannot be selective and just pick one type because then he will be lacking certain nutrients.”

“Weight loss is not a quick program; it should be a lifestyle that you can live with, not a lifestyle that you are forced to live with for a short term and not sustainable in the long term. Many people are focussed on losing weight; it’s not that simple. Most people lose weight immediately after surgery, they cut down on carbohydrates, but they do not focus on building up the muscle; if you have more muscle you have higher metabolic rate to burn off the extra calories. Most of the weight loss may be fluid loss and loss of the actual muscle rather than fat because it’s not easy to lose fat especially around the organs (we call it glycerol fat and not subcutaneous fat); they are very difficult to lose. 

“People just look at the numerical part; they are happy that they are lighter on the weighing scale but are not properly losing weight. They are not properly guided in building up their muscle – they just watch their diet but don’t go to the gym.

“So, they have weight loss but not the healthy type; some go on crash diet – but that’s not sustainable – they will be on perfect weight a few months and then their weaknesses return, and they start binging again and then gain weight again. It is important that they choose a diet that they can stick with.”

Dr. Chuang added that family support helps; he stressed that the family and relatives of the patient should eat the same kind of food as he does, with little adjustments such as quantity of salt – a normal person can take the normal daily requirement of sodium but a person with a weak heart cannot. He will have to reduce his sodium intake. So, there may be minor adjustments but in terms of dietary choices, it’s the same. 

Exercise for the heart

Sustainability applies to exercise the same way that it applies to diet. When the patient is happy with the type of exercise advised, it is more likely that he will stick to it. It cannot be as intense as the exercise of a healthy person because a weaker heart can only endure up to a certain limit. Professional guidance is therefore necessary, through cardiac rehabilitation. 

When asked what the most recommended kind of exercise for the heart is, Dr. Chuang said, “I would say walking. Exercise should not be too intense for them as they are living with an impaired heart function; if you look at sports in general; walking has a very low impact; it’s considered moderate activity. Non-competitive swimming is also good.

“When exercising, there’s frequency, intensity and duration; we always encourage moderate activity for at least about 150 minutes a week. If you divide that by 30, it means five days a week. I think that is something that most people can accept – it’s very safe but people are not consistent with their approach. This is for aerobic training; if you are doing intense training that’s around 45 minutes – around three times a week.

“I have a lot of patients who are athletes. Post procedure, they must have an individualised, tailor-made program. There are some people who don’t know, whether before or after the procedure, how to slow down – they just run a lot without consideration for their heart problem; this is a smaller group – overzealous, overdriven type of characters – you need to tell them to slow down and guide them. 

“But there are a lot more who are afraid to do anything after a heart surgery; we need to encourage them, of course within their safety limit, we guide them on what they can do with their fitness over time; that’s why we have ‘cardiac rehabilitation’.

“When guiding an outdoor salesperson after cardiac surgery, our target would be that in three months’ time he will be an outdoor salesperson again. Therefore, in the training phase he cannot just be walking in that room – he needs to be able to carry his suitcase, go out, meet the client, etc. so we need to look at the aerobic part as well as the strength part of training to build him up in a gradual way and to guide him, with the limitation of his residual heart status. 

Taking medicine is not effective if diet remains unrestricted

High blood pressure can eventually lead to heart failure. When a patient follows a healthy diet and takes his medication as advised, he can maintain a safe blood pressure level. Some people think that since they are taking medication, it is safe to continue eating without restriction. 

To this, Dr. Chuang says, “They should always use the minimum amount of medicine to optimise their status. If they want to eat unhealthily, then the physician will have to use more and more medication. If a person takes steps to improve his lifestyle, by doing more exercise and reducing salt intake, both of which can lower blood pressure, the physicians can then reduce his medication. The less medicine we need to depend on the better.

“When we take blood pressure medication, we don’t take the same dosage throughout our lifetime. The medicine dose should be adjusted to what is the safe upper and lower limit. As we grow old, our systolic and diastolic blood pressure is going to go up, until perhaps about 60-70 and then the lower reading may go down because of the loss of elasticity of the blood vessels; the blood pressure goes up this way as you grow old. So, as you grow old, you are bound to take more medication to put it in the optimal range.

“If people continue to practise unhealthy health habits, thinking that it is safe because they are taking medication, they are wrong. Long-term use of medication has side effects. Do they want that? When the condition is not controlled, it will affect their end organs. If the blood pressure is up, the end organs – the heart, kidneys, brain blood vessels, etc., will undergo change and get worse and worse with time. To prevent them from getting worse, the physicians are forced to prescribe more and more medication. Do they want them to do that? And with that comes more cost. Do they want that?” he said.

Do not resign to fate

Dr. Chuang stresses that being diagnosed with a heart condition or having a genetic disposition, does not mean we have to resign to fate. If we adopt healthy habits, eat sensibly and stay physically active, we will have better control of our lives. People can still live fulfilling lives post-procedure if they follow their doctor’s advice, make use of cardiac rehabilitation and have a more positive outlook.