Help that great pump within your body function optimally. HiDoc Pulse catches up with Dr Leslie Tay, a cardiologist whose practice is at Mount Elizabeth Novena Hospital, as he unpacks the importance of exercise, and what it takes to help your heart age better.
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Constantly trying to fix your car engine at your mechanic is not optimal. Neither is relying on your doctor to manage your heart health continuously. Rather than having them get trapped in a cycle of breakdown and repair, Dr Tay equips his patients with the knowledge to maintain heart health — especially for patients who have undergone treatment for critical heart conditions. In his specialty of Interventional Cardiology, Dr Tay treats patients with block heart arteries and opens them up with specialised devices like catheters, balloons, and stents.
Following treatment, preventive cardiology forms a crucial part of his duty of care to his patients. He helps those with no known heart disease from developing any and preventing a first heart attack or stroke. He also works to avert further complications in patients who already have heart diseases. “It is quite common for people to think that they do not need to invest time and effort in maintaining their heart health. They can simply see a doctor should doctor should heart disease arise, but intervention by the doctor is not enough to ensure heart health.”
Heart health involves three crucial steps
What does Dr Tay mean when he advocates good heart health? He explains, “It means that there are no significant blockages or heart diseases which put patients at risk during sporting or everyday activities. If there are serious blockage or heart conditions, then the focus is on treatment. On top of treating their underlying conditions, I also work on preventive measures like diet and lifestyle habits.”
He explains that there are three steps which determine an individual’s heart health:
- Diagnosis and treatment
- Risk factor control (by maintaining healthy blood pressure, cholesterol and sugar levels)
- Lifestyle habits (such as diet and exercise)
Each works independently to maintain heart health and only as well as the other steps. Dr Tay explains, “Treatment certainly works — but only if patients take proactive steps. They need to manage their risk factor of developing heart diseases and eat healthily and exercise. Otherwise, treatment will only be about repairing the damage done to their hearts through neglect of the other two steps and disease may develop elsewhere.”
1. Diagnosis and treatment by the doctor
Dr Tay also has special interests in sports cardiology and sports medicine. These two medical fields have equipped him with the expertise to care for individuals with cardiovascular conditions. He guides patients by identifying which exercises are suitable for their particular heart condition so they can safely engage in sporting activities.
Unable to see him in-person? Fret not. Teleconsultations, the use of telecommunication and information technology to provide clinical healthcare remotely, is a new and accessible channel for patients to virtually consult with Dr Tay. He explains, “Teleconsultations bring a lot of convenience and benefits for patients. If they cannot come down to my clinic, they can still consult with me over their mobile phones and I can assess if their conditions are under control and make recommendations as needed.” Teleconsultations help doctors understand patients’ health status and enable care to be delivered to them. “For example, I am able to provide them with instructions to change their medication dosage if necessary. This helps manage their conditions and also allays any anxiety they may experience about the conditions,” he adds.
Some scenarios which illustrate the usefulness of teleconsultations are:
· Follow-up assessment of conditions such as hypertension: Your doctor can find out if your blood pressure is under control and, if not, make recommendations and changes to the medication to improve it.
· Follow-up assessment of stable cardiac conditions: Your doctor will be able to assess whether the cardiac condition is stable and if the physical review can be postponed to a later date.
· Patients who are overseas and experience symptoms are able to consult with their doctors through teleconsultations.
· Foreign patients who have to manage their condition but are unable to schedule regular medical check-ups in Singapore (due to scheduling conflicts, for example) can consult with their doctors through teleconsultations.
2. Risk factor control
Dr Tay spends much of his time and effort promoting preventive cardiology as part of his patient education efforts. Consider this statistic: 50% of his patients aged 50 and above have medical conditions (such as high blood pressure and cholesterol) that need to be treated due to their unhealthy lifestyles. Quite a number of them have to even be persuaded to seek treatment, let alone manage their health proactively.
How does Dr Tay get around patients’ inertia in caring for their health? He smiles, “When I consult with my patients, I work towards finding consensus with them on what “healthy aging” means to them. That way, they are engaged and called to action. After all, they are the ones most invested in their continued good health.” For Dr Tay, healthy aging means:
- Being able to do what you value (activities, hobbies etc) throughout your life, no matter your age
- Not feeling restricted by any disease or medical conditions — when managed to mitigate their effects, they have little influence on your wellbeing
“Work with your doctor to identify health issues which may affect your quality of life. If there is any treatment required, be disciplined and keep to the program. If there are any side-effects, communicate with your doctor to see if these are linked to the treatment program and if there are any available alternatives,” he urges.
3. Lifestyle habits
What’s the most important recommendation Dr Tay can give to his patients? “Before embarking on an exercise program, go for a heart health screening,” Dr Tay replies without hesitation. This ensures patients’ safety by identifying any pre-existing illnesses or conditions which may be exacerbated by exercise and consequently be harmful to health. Dr Tay also recommends that patients work with their doctors to come up with individualised health goals such as:
- Overall healthy aging (being able to climb a flight of stairs without issue, for instance)
- Weight loss (in order to look and feel better)
- Training for a particular goal (being able to complete a full marathon, for example)
Individualised health goals give patients something to work towards and, even for those who resist physical activity of any kind, help them understand the importance of keeping active for their hearts’ sake. Dr Tay adds, “Patients tend to think that having adequate surveillance when they exercise is a complicated matter but it can be as simple as exercising with a buddy. That way, you not only get to socialise, but you do so in a healthy and safe way.”
With just 6 easy questions, Dr Tay can help his older patients in identifying suitable types of exercise and further tailoring these activities to their existing health conditions:
A. Do you have any pains, tightness or pressure in your chest during physical activity (such as walking, climbing stairs or doing simple household chores)?
B. Do you currently experience dizziness or lightheadedness?
C. Have you ever been told by a medical practitioner that you have high blood pressure?
D. Do you have pain, stiffness or swelling that limits or prevents you from doing what you want or need to do in life?
E. Do you fall, feel unsteady or use an assistive device while standing or walking?
F. Is there any other reason/issue you have not mentioned which makes you concerned about starting an exercise program?
What kinds of exercise then would most benefit people, whether they’re young or at an advanced age? There’s two types, and both need to be done in combination with the other. They are:
A. Resistance training
Benefits include increased metabolism, maintains strength and, more importantly for older people, prevents loss of muscle mass.
Bodyweight exercises (such as pushups) and the use of resistance machines and free weights are some examples of resistance training.
B. Cardiovascular exercises
Benefits include increased metabolism, promotion of blood vessel elasticity ( for good blood flow) and improved blood pressure, sugar control and cholesterol control as well as overall heart health.
Outdoor activities include: Brisk-walking, jogging, cycling, swimming and golfing (make sure to walk through the golf course and not take a buggy!).
Indoor activities (at the gym, for example) include: Working out on the treadmill, elliptical trainer and stationary bicycle (the latter two being easier on the joints).
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