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Interview with the Expert
Bright Hub: When a person has experienced congestive heart failure (CHF), when is it safe for him or her to begin an exercise regimen? Does the person need to have a doctor’s permission?
PJ Striet: It is safe when his or her physician and/or cardiac rehab professional says it is safe. This is not a decision which should be made by a fitness professional, and furthermore, a fitness professional should consult with a CHF patient's physician prior to the patient starting an exercise regimen. Yes, the physician does need to clear the patient and give them the "ok" to start exercising.
Bright Hub: If you had a client who had CHF, what kind of exercise would you recommend they start with once they have medical clearance? What if they’ve never exercised regularly?
PJ Striet: A mixture of cardiovascular exercise and strength training. Three workouts per week for each, possibly a fourth cardio workout depending on energy level. Strength training is often neglected in this population. It is important the initial intensity and volume of activity is low. However, progression also needs to take place--albeit slowly--in order for positive adaptations to occur.
Bright Hub: With the understanding that CHF patients must get the ok from their own doctors, what types of aerobic exercises are best for CHF patients who have medical clearance?
PJ Striet: Low impact activities are preferred for this population (and really any population). Stationary cycles (I like the Schwinn Airdyne bike), elliptical trainers, rowing machines (assuming they don't cause too great of a heart rate response), and seated stair steppers (like NuStep) are recommended.
Bright Hub: What kind of strength training exercises do you suggest to your CHF clients, in general?
PJ Striet: For strength training activities, I would suggest increasing the training weights by no more than 1-2% every other week on all exercises. 1-2 sets of 8-10 exercises which work all the major muscle structures in a full body workout format is preferred.
Bright Hub: How would you advise a CHF patient to perform aerobic exercises safely?
PJ Striet: For cardiovascular oriented activities, I'd rather see an increase in the duration or volume of activity than the intensity (for this specific population). If the patient was going to start out with three 20 minute cardiovascular workouts per week, I might add a minute or two to each workout, while holding the intensity steady, until they can reach 30 consecutive minutes of activity (this would take place over three or four weeks). At this point, we could increase the intensity just a bit, drop the duration back down slightly, and work our way back up to 30 minutes again.
Bright Hub: How intensely can or should a CHF patient exercise?
PJ Striet: CHF patients need not work to a point of momentary muscular failure, or even close to it. When they end a set of any exercise, they should feel as though they could have completed 3 more repetitions if they absolutely had to. Consistency and frequency of strength training is of more importance to this population than working to a point of extreme intensity. We just want to put a mechanical demand on the muscles which is enough to prevent muscle loss. This objective can be achieved with strength training of a very modest intensity and without increasing the resistance drastically week in and week out.
Bright Hub: How important do you consider diet with weight management in congestive heart failure patients?
PJ Striet: Very important, especially considering high intensity and high volume activity isn't going to be practical with this population. If they are going to be limited in regards to the amount and type of activity they can safely perform, then it logically follows that the amount of energy they are going to burn is going to be lower. If output is lower, then input (via the food they consume) has to be kept in check so they don't gain excess weight.
Bright Hub: What type of diet would you recommend for a CHF patient?
PJ Striet: Ethically and legally, I cannot provide specific diets to individuals with significant acute or chronic health conditions. Neither I nor any other fitness trainer is qualified to do this unless they have been trained and registered as a dietician. Providing general nutrition guidance to a healthy individual simply interested in fat loss is one thing, but I'd be overstepping my bounds and expertise telling people with CHF how to eat. Any trainer who tells you otherwise is flat out wrong.
Bright Hub: How difficult is it for a CHF patient to maintain a healthy weight in your experience?
PJ Striet: It is hard for ANYONE in this country to maintain a healthy weight. The obesity statistics don't lie. For someone who is going to be limited in terms of the amount and intensity of exercise they can perform, like a CHF patient, this becomes even more difficult. Eating a diet appropriate in calories is of paramount importance. You can't "out workout" a poor diet. This is true even for healthy individuals. You can consume an extra 500 calories in a matter of minutes, but it would take a CHF patient with a low level of initial fitness and exercise tolerance about an hour and a half to burn this same 500 calories.
Bright Hub: Can a CHF patient lose weight easily? What special considerations should be made?
PJ Striet: The laws of thermodynamics don't change for people who suffer from CHF, so yes, these people can certainly lose weight--but again, more attention has to given to diet because of physical activity limitations. Also, losing weight isn't "easy" for anyone, regardless or health status. Now, the formula for losing weight is straight forward and simple...but putting the simple principles which dictate weight loss into practice, long term, isn't easy.
Bright Hub: Any other advice on weight management in congestive heart failure patients?
PJ Striet: Remember, it isn't going to be practical or necessarily safe for someone with CHF to exercise with very high intensity, frequency, or volume. So again, these people need to watch the input side of the equation a little bit more than someone with no exercise limitations.
Bright Hub: Final thoughts?
PJ Striet: Just because you have CHF doesn't mean you can't exercise regularly. In fact, a recent study appearing in JAMA supports exercise in CHF patients. But it is important the exercise you do perform is appropriate: it should not be excessive in intensity, frequency or volume. This is where a fitness professional can help, with the manipulation of intensity, volume and frequency of exercise. Just make sure, if you seek the help of fitness pro, the trainer you hire consults with your doctor about your condition.
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About the Expert
PJ Striet is a personal trainer and exercise physiologist based in Cincinnati, Ohio. He serves as the Fitness Correspondent for 700 WLW radio, the largest radio station in the Midwest and has presented on behalf of respected organizations, including the American College of Sports Medicine.
He owns FORCE Fitness and Performance in Cincinnati, where he and leads a team of fitness professionals. FORCE Fitness and Performance offers a private fitness training studio and fitness services. Mr. Striet boasts well-known clients, such as Bob Castellini, owner of the Cincinnati Reds, as well as various local radio and television personalities. Mr. Striet and his staff also hold certifications from nationally recognized fitness organizations, including the American College of Sports Medicine, the National Strength & Conditioning Association and The American Council on Exercise.
Weight Management in Congestive Heart Failure: Interview With Expert, PJ Striet
Learn what the experts have to say about your health and fitness. This series offers informative interviews with health and fitness authorities on subjects that matter to you.