Hedging Against Heart Attack

Many years ago, Barry, age 49, played a long doubleheader, and appeared be getting more and more fatigued as the day proceeded. He had a mild heart attack while driving home, and never played baseball again.

Today, it is common for a player who has suffered a heart attack to return to the game. We asked a cardiac rehabilitation expert, Dr. Stephen Guffanti, to explain what we can do to improve our cardiac batting average.

HB: What exactly is a heart attack?

Dr. G: First, a heart attack occurs when the heart receives insufficient oxygen to allow it to contract. If you can do things to cause lots of oxygen to flow through your body, the heart will never be in the position where it lacks the oxygen the heart needs to contract. Keep in mind that the heart is part of the cardiovascular system. If the heart can be trained to output more oxygen with each beat, then the system will have more oxygen throughout, and some of the additional oxygen would be available to allow the heart to contract on subsequent beats.

HB: What can an MSBL player do to keep his heart in good shape?

Dr. G: The key is to improve cardiac output through a controlled exercise program. This applies to all of us. In the case of someone recovering from a heart attack, we start the patient with a low workload, say walking slowly on a treadmill with no incline.

Over a period of several weeks, we increase the load on the heart by increasing the incline. One of my patients, for example, began with a workload index of only 1.1 the first week. We slowing increased the workload by slowing increasing the incline. By the 11^th and 12^th week, we had the patient working a steep incline, at a workload index of 16.

HB: Are you saying that a relatively simple program of exercise can cause the heart to output 16 times as much oxygen?

Dr. G: Yes. This is because organic systems, by nature=s design, have a great deal of extra capacity. We know that heavy drinkers can kill their livers, but it takes 30 or 40 years to do so. This is because the liver needs only to use ten percent of its capacity to perform its vital function. The brain needs less than ten percent of its capacity to function efficiently, and so forth.

HB: Exactly what does this kind of exercise do for the patient=s heart?

Dr. G: Think of the heart as a sponge that can be trained to absorb more liquid. In this case, the liquid is blood, and the goal is to have the heart output more blood, and therefore more oxygen, with each beat. Under the right conditions, the heart can be trained to relax more so that it can receive more blood with each beat, and therefore output more blood and oxygen with each beat.

The implication is that most of us have the means to increase our cardiac output so significantly that we can make the risk of a heart attack much lower. Like anything else, we need to be willing to work at it.

HB: What can increased cardiac output do for a player during a game?

Dr. G: Beside the issue of minimizing the risk of a heart attack, increased cardiac output will help a player when he runs around the bases. As I understand it, most older players have what it takes to run station to station, and they usually can handle running two bases. But when it comes to running three bases--say by scoring from first on a double to the gap--many tend to run out of breath as they round third. If you increase your cardiac output sufficiently, you won=t have that feeling of running out of gas as you head home. However, it takes consistent dedication to the exercise program I will describe to gain this advantage.

HB: That=s great for those who can come to your center, but what about the rest of us?

Dr. G: First, it is always best to consult with a physician. Even if you are confident you are in good health with no heart problems and no family history of cardiac problems, it still pays to have a physician give you his evaluation. Let=s suppose your physician agrees that you are in good health and that the risk of doing things on your own is low. Believe it or not, the easiest way to improve cardiac output is to walk upstairs.

If you have stairs in your home, and you can ascend the steps without getting out of breath, you can go up and down several times until you feel yourself fatiguing or breathing heavily. Over a period of several weeks, you can slowing increase the number of times you are able to walk up and down the stairs without getting fatigues,@ he explained.

However, you would need to be disciplined about checking your pulse. The trick is to achieve a pulse rate that is in the range of 65% to 85% of your maximum capacity. The working formula for estimating your maximum heart rate is to subtract your age from 220. For example, suppose you are 50. Then your maximum heart rate is 170. When doing steps, you would need to attain a pulse rate in the range of 110 to 145. Climb a set of steps, and hold your right wrist gently to count your pulse beats for one minute. If you are below 110, return to the bottom and do another set of steps. When you get to the top, measure your pulse again. Keep doing this until you are in the desired range. Don=t push yourself beyond the upper limit. If your range is 110 to 145, stop doing the steps when you exceed 125.

The key is to do this at least three or four times a week. After several weeks, you will discover that you will have to do more steps to reach the desired range. Eventually, you will reach a stage where you are in maintenance mood. You will have a well established number of times that you need to do the steps in order to have your heart rate in the 65% to 85% range.

Dr. G: No. Keep the pace slow and deliberate. The goal is to motivate the heart to increase your cardiac output. It is resistance--not speed--that does the trick. Each time you lift yourself to the next step is a resistance-and-workload event. The number of total steps that you ascend is the major factor. Suppose you do 14 steps the first day, and can do 140 steps ten weeks later, but at the same slow pace; those 140 steps will means that you have made a significant gain in your cardiac output. I am assuming, of course, that in each case, you reached the 65% to 85% range.